mr harper in september two thousand and fourteen and by way of background that was nearly two years after he filed his complaint in this matter it was after he made four requests to be appointed counsel it was after he had been the pros and it was after the the standard reviews of the noble standard every view now when we're talking about medical and difference they're essentially two factors it's got to be an object if we serious medical condition and has the evidence that the defendants subjectively were aware of this couple things st there was a discharge summary that i know the court has seen this part of the record evidence here is a discharge summary and mr harper underwent nine surgeries in six weeks nine surgeries in a mr parker pleaded multiple times and put him in the nursing staff on notice that the time he was receiving was not sufficient to alleviate his pain you're not you're not telling us no the prisoner is entitled to pain medication as he requests under the constitution no bill what i have got to be room for medical judgement about the treatment correct what i am saying though is that where there is evidence that a doctor's continued course of treat been ineffective as proven by the complaints the continuous complaints of the plaintiff here mr harper that the jury should be entitled to determine whether or not that as if it's evidence of medical indifference and i think that's something that the and here there is evidence that he pleaded multiple times i need payment as a medication i'm in pain i think i'm dying here he was given pain medication he just didn't like the one he got like it  think presents might have very good reasons for not wanting to prescribe narcotics yes i'm sure there are i can tell you that nine days ago this court heard an appeal where prisoners who were prescribed and allowed to use narcotics hid them sold them to another prisoner the other prisoner in present took an overdose and died from a narcotic overdose prisons don't want to do that and one way to do it is not to use narcotics unless it's just desperately necessary in the other case one of the arguments by the way is that it violated the th amendment to let those prisoners use narcotics rather than some other pain relief s or your if you put these two cases together you've got the presence coming and going that violate the constitution whether they do d or whether they don't and that can't be right can it i think as applied to this case that like it in should have been prescribed to my client i think that there's sufficient evidence here that he has continued his pleas of health his continuous piece of the he was suffering in pain well one thing we know is that it's not possible to diagnose whether there's pain continuous please can easily be faked and that's what was going on in the other case that i just mentioned the people who were demanding and getting our products were faking they got narcotics which they sold for money and somebody thought it was a result you know if we had some easy way to determine whether somebody is overstating the degree of pain then we could solve this problem but we don't get that play and i think that if it was just pain supplemental things that he couldn't tolerate right certain types of drinks and other than there was evidence of him receiving certain kinds of protein drinks and that kind of thing correct but he made it clear to them that you know there are certain kinds of foods he could tolerate certain kinds of foods you cannot tolerate in the foods that he could not could tolerate he was not given and he was sorry about deliberate indifference or not negligence and i think they're when they're attempting to provide him with the things that they think will work maybe they were negligent and should have righted something else just because he wants aids rather than what they were giving him doesn't make it delivering a different but i think the difference is that his request for eggs wasn't just because he liked eggs it was because it was the one thing that could keep it that he could keep the food down and in the pet he's holding or it says evidence that the patient repeatedly complained of him during pain or here i would substitute enduring pain with hunger and no modifications in care and there were no sufficient modifications for him to recuperate i think as evidenced by twenty seven dollars pounds or two month period that is significant and that is something that i think a jury should be entitled here as to whether or not he was given sufficient medical care the other thing that i will mention is the kidney ultrasound now and when she wasn't discharged from st john's hospital the doctors his treating physicians recommended that he undergo a renal ultrasound every three months on his kidney and you might have seen in the records there was a declaration from my client where he says at one point he asked dr santos for a nother ultrasound and doctor said to screen no at him and before before you know is not and he's in evidence at this at this time about whether or not he said any such complications from it he's got undergone some tests but i would argue that it ultra sound was that it would be more comprehensive a more thorough test than the blood test that he's been given but when you take all three of these in totality the evidence of the pain of the pain medicine the evidence of the food the evidence of the ultrasound evidence of people laughing at him when he presented himself to the facility people instructing him was classic bag was removed he was provided with an extraordinary amount of attention all of this is undisputed in the record we provided the court with typed transcriptions of all the nursing notes as well as dr santos's notes to make sure it's clear as you know from  sanders examined mr harper during that eighty seven period is eighty seven day period and thirty one different occasions the nurses assessed him some three hundred and fifty occasions he was constantly provided with attention by the medical at the prison and there's no basis to suggest that he was ever ignored or disregarded or anything like that the record simply does not support that with regard to the pain management your honor you know i think the best thing for me to sue is just quote from this court that whether in hell pain associated with medical treatment should be mitigated is projectors decide free from judicial interference and then of course comes from this course decision snipes hearses the toa and that's what we have here there's new allegation  mr harper was denied pain medication none at all by dr santos as the record reflects a tried with just his pain medications as he went along he changed those orders nine different times mr harper's complaint in this court wasn't given vikki did and i don't believe that alone is entitled to a constitutional protection with regard to his diet runners again it's important to know that when he was discharged from the hospital he was discharged and a regular diet with oral fluid intake once he got back to the prison that was no longer of an option for him because he was vomiting and he was nauseous so what they did the prison was they it's a pride of him an i v to ensure he had proper fluids so they couldn't of vol fluids up and then dr centers again adjusted his diet as he went along he gave in surety of protein drinks as time went along and the record confirms this mr harper's feel he got better he was able eat more solid foods if something would come up then you would investigate further but the blood and urine tests are able to be done and site in the facility and they probably have very good assessment of how the the patient's kidneys are doing there's nothing here the plaintiff testified as you may recall from reviewing the materials in this case that nurse dean was one of the nurses who were initially of if able to respond promptly to his abdominal complaint the records in this case still show that nurse  her shift ended on december and december rd at seven am mr perper didn't present to the infirmary until eight thirty am when distinguished nursing was already gone she go longer work there between that seven am point in time and when he was transferred the hospital so she wasn't even there to have done anything to this to her view which he she never was there you're you're indicated never there when he was being treated well i can say back yes yes i'm sorry multiple times again that's reflected in the records there was you know my best read of your honor's is that there was a personality issue between mr parker and your steen one reason or another i don't know but but the bottom line was one occasion did occur it's not sufficient to to find a deliberate indifference and certainly it caused no longstanding or permanent injury to mr mr harper it was an inconvenience at best and finally was held but again i don't know if that's really an issue of constitutional proportions either runners in the end i believe but both nurse dean and dr santos provided constitutionally adequate health health care to mr a mr harper i believe i might have used all my time up already so ten minutes goes by pretty quickly because you think you've got extra time you've got extra time and thank you very much i don't have anything further unless you have anything further for me i just think the court again i was appointed counsel and i think th