that was not the case or else it w problem with the appellant's argument is that they consider both lack of informed consent and patient abandonment to be standalone claims that don't require expert testimony that can be tension is incorrect as it pertains to both or either one of those causes of actions each requires a plaintiff to present expert testimony to establish not only the standard of care but also patient so in that regard expert testimony is required for a in this case a a plastic surgeon to provide testimony and opinions regarding what on the need for expert testimony as to who the form consent but sad if i reveal to you all of the evidence there is no triable issue of fact that she was that the doctor failed to give her adequate but and from asian he in fact did give adequate information the ends of the signed consent form was put into the record the drawing was put into the record and that i understood that that actually was the more important point of the ruling can see informed consent climb am i wrong about that and no i would say that you're correct and i would have to confess that your feed froze up a little bit so i didn't hear the st part of your  of your comment that the district court did not rely on the proposition that our expert kester mony is always required under puerto rican law for informed consent that the district court and uring summary judgment and stead looked at all of the evidence and said the cremation were vied it was adequate to support in the form consent and that's what i said to you am i correct in my reading of the district court and you said yes i was correct yes i would agree that you work or act although i think you'd have to also go then to the district court opinion denying the motion for reconsideration where she did go into a little bit more detail as far as why there was a ne  or expert testimony with regards to the informed consent  so we have different standards of review actually for denial of greek consideration and denial of summary judgment correct correct yeah right what is your separate argument as to why the denial of greek consideration was not an abuse of the court's discretion it was not an abus the only new argument which was raised and it was not until that their motion for reconsideration was the one pertaining to the regulation seven thousand six hundred and seventeen dollars which that was not raised in any of the summary judgment briefings motion for reconsideration that in light of the information that was given to the patient she could not make out the claim of negligence based on form consent absent expert testimony saying that what was given was the na i'm a little more puzzled by how to think about the district court's prior ruling before the denial the most and reconsideration which is that even without that an expert witness and a plastic surgeon what is necessary in order to provide the court and of the jury if the case assuming that the case were to go to the jury with the information that a similarly situated  expert evidence to support plaintiffs claim i can i agree with that i do agree with that i think she recognized even though it's not stated she focuses more on just the negligence of the medical not quite let's say the just straight medical malpractise when she focuses more on her opinion but in her in the in that opinion having to do with the reconsideration she does go into a little bit more detail as far as i didn't send which decides the initial one she's already made the decision there's no expert on on the plaintiff side to provide any support for any of these claims that's correct i think she just you know based on her ruling that an expert was required she determined that under any of the  that to make it out an informed consent case you do not need an expert witness why does your response to that my response to that is that actually he doesn't cite any puerto rican and even in his argument now you heard he was relying on canterbury for suspense there's two lines of cases and in all the jurisdictions in the united states regarding in one sense one of use the informed consent from the perspective of the patient so if you have a patient that says if i had known that i could have had this result or just consequences i would not have consented to the procedure of the operation there is another line of cases which say that you did it it expert to prove the the information that was reasonable to be given to the patient and that is from the from the physician's point of view it's not from the patient's point of view and that's the diffuse look if you in and one of the cases that says that you don't need to prove a separate negligent act and what that is referring to is in a case where you could have let's say you have a person who gives a limited scope or limited consent for consented to but there's no medical malpractise in the sense that the that the patient we covered well and actually benefited from the surgery that's where here puerto rico courts recognize that the lack of informed consent could be a stand alone cause of action in a situation is just an example of but in that type of state to ation but it would still require an expert to to let's say provide testimony or provide opinion saying in this context we would have included a sentence saying if during the course of the surgery we see any other problem we'll remove it or this that or the other thing with regards to abandonment patient abandonment it is all that's a  ality of a medical malpractise that is not really well developed in puerto rico law but the case law from other jurisdictions usually requires that it be or that it involves the termination court pointed out that would require expert testimony to know in this case since when we're dealing with a patient who was dissatisfied with the outcome of a surgery you would need an expert to provide  or pin ins as to what was the appropriate post operative treatment and or what were the conditions necessary for a tape for a revision surgery that didn't happen here we also have this the procedure was not medically necessary this is a cosmetic surgery that was that the patient voluntarily submit it to and basically was just as intent with with the outcome of the procedure so in any event the lack of an expert in this case was i guess fatal to all three causes of action and it would be required for testimony would be required to prove both the informed consent and the abandonment  and so we would leave the court to affirm the district court as far as its opinion is concerned if there are any other judges have any further questions i'd be glad to answer i ask my colleagues whether they have any questions i don't know how to thank you very much thank you very much that concludes the arguments for thanks session of the honorable united states court of appeals is not recess until the next session the court god save the united states of america and this honorable