did hear it is where the cumulative standard conduct of works for its employee might in a jury's estimation montu corporate deliberate indifference and it's worth stressing at the outset that this would be an entirely detail the arguments that i made in the briefs but something has occurred to me since that i think needs to be addressed and that's the relationship of emotions for summary judgment of the motion to dismiss and i think it's fair to wonder whether somebody judgments on the would you need to prove that any particular individual employee of wexford had acted with deliberate indifference to our client i don't believe so it's a question of corporate or deliberate indifference institutional exxon because one of its truck drivers ran over somebody on the street and there was a tort suit against exxon is it possible to prove that exxon is liable without proving that the truck driver is want or not but he's auto worker on the line who didn't title didn't tighten the pull that caused your car to go out of control and injure or kill you know you know that there is an individual on the line who made a mistake in the manufacturing process by analogy  talk about manufacturer design do you don't see how that's going to get anywhere that direct liability depends on someone's intent if you can prove say  corporations is what happens when you cannot prove direct corporate liability under the memmott you have to show some individual either you know we've got quite a few cases that say we don't have to consider whether more now on permits liability of the city because unless one particular city employee is liable there is no possibility of city life we show that over and over i wouldn't that be equally true of a corporation let me let me see if i can help i think the supreme court's decisions in on and voting in religious practices suggested that private what do i understand your answer to be we can't i cannot define her intent that's correct but i can i can i can tell you that she added that mr gaston didn't get the medical care that courts depends an awful lot on financial incentives westwards grief tells us that they do not pay for care of outside of hospitals and doctors which would seem to undermine the financial incentive clear and in the market they don't hire and they don't supervise them because their takes more money and then when people have complications you recall that mr gaston's write me went out and he stood in the doorway and dr carter said well we have to wait for you to do that funny she once said it's hard to limit the amount of medical care that they they send off short look at they're just you're not getting my question though dr tremelo i don't know what the the private corporations is that you've got financial incentives for those private corporations that you don't have with municipal governments correct so what is the record show here about those financial incentives well the judgment as applied to mr month delay for knee surgery doctors testified in his deposition that that's not unusual to lie for not for surgery for normal civilian patient s i didn't see or were not in the that that the care that the plaintiff received during those fifteen months was quote probably within the standard of care and your response well he gaston is that he injured he twisted his knee in may of two thousand and nine and tori is cartilage at that point there's nothing but surgery from that day forward to fix the  i think it at some point it's important to to to look back at what the intent of the congress was when they passed one thousand nine hundred three in the mid nineteenth century and that was obviously provide a remedy  r people whose constitutional rights were violated in federal court the argument that i have made and i think it's backed up by the academic consensus that the president  this case on the presumption that mono was wrongly decided we have to assume that's right well we are in the constitutional words and inferior court i think if you recognize though that it is in firm less weight watch be impacting the results that are given and you can look at the parade of horribles and the amicus brief i think at some point that that does come to be a consideration that the court ought to may i acknowledge the court cannot reverse monella what the supreme court has not clear that there was a decision but the case was remanded against press for trial based on the conduct of the employee who was not an independent i agree it's not an explicit holding but i believe that's what  back permits because they know that surgery in these instances isn't always successful so non operative management according to act to dr schnell the independent treating orthopedic surgeon can be reasonable when he was asked well do you think told we can perform surgery on this like me but there's no guarantee that that's going to eliminate the pain that you have from your arthritis that's in the preoperative no dated june two thousand and eleven they're telling him at that time we can do the surgery but there's no yes given the nature of an m r i i don't quite understand that approach i think the medical judgment there was we're not going to be able to do anything with regard to the right knee until this left me in other words we're not going to perform surgery on that ri words or legal issues that may or may not need to be decided in this case you rely heavily on the claim that you do not that works for does not pay for outside care what does the record tell us about what we know and they're not in this record right o outside special ops having if the contract limited them in some manner then we would have a policy and practice claim against the expert on the issue of like serious liability corporation either had to subject the individual to a definition of rights or cause another to deprive an individual of his rights in the supreme court said in a more now that language tells us the congress did not intend