moved to the third case this morning wilson versus adams said a couple of those pieces the first is mr wilson was so confused one points that he had to be pulled off a bus because he couldn't remember his own name his own identification number he was trying to in pain throughout the entire period so i think you can certainly find a liver in deference regardless of what they were doing to look for the source of the pain and the lack of real lack of it to do anything meaningful about addressing the pain joined us or three a period in which he was suffering charges and that's the real serious and you know he's been shipped around to various places and we were spent a lot of months in that one place was is that still hanging out there is at least eligible before the parole board and has been considered and rejected mostly it seems that the theremin i mean just the contacts i mean mr wilson is about i think sixty nine years old at this point so he like he's a not a particularly but you know he's not a a physically strapping individual this point but he seems to have been moved around and seen lots of different people and experts which is what i look at and percy district judge had one opinion from reciting of that and it seems to that when we talk you know it is a deliberate indifference when you're talking about that that's kind of a high standard for somebody who's right doctors i know there was that one gap of three months when dr murphy i guess it was was engaged with lots of other people really two hundred was and twelve two thousand people in this prison one doctor that's that's pretty tough but anyway that that seems to be the only space and time were the time seen a lot of doctors and people that are looking at sure i hate he certainly sees a lot of different doctors and i think you know looking at looking at that treatment you can say w ultimately was taking certain steps to try to identify the root cause of these issues but the whole joining the whole period even while he was seeing these doctors he was stuck on this very limited pain medication and was in your searing pain and i think that's him on the same basic set of medications he didn't try physical therapy didn't try other other medicines that he knew about and could have tried and you know granted that you know some of some of what dr paul is focused on and his it his recommendations may be beyond the scope of what's offered it within the facility so for example you know it may not be possible to acupuncture than the facility but there were reasonable recently available treatment options that adults about feet just didn't think about and didn't bother and just kept him on this very limited set of medications while he was a severe pain and also of you know forgot about him for a hundred days essentially and also and as we mentioned the briefs did a mention didn't follow the recommendation  that he's bothered with and you say that it just it should have been with much heavier pain medication and i don't i don't know what level stuff is now we have an op crisis for people taking too much pain medicine i don't know that had anything to do with this case but still pain medication at different levels of these so it's addictive maybe it's curative i don't know are these preventive murphy is proper for two main reasons first it properly looked at the totality of the care that was provided to mr wilson that's something that this court has told us that we need to first look at when evaluating whether or not i'm an inmate's curing treatment supports a reasonable inference of deliberate indifference and here we have a five year span of continuous treatment from mr wilson on his neck issues he saw five experts his own medical expert and in that five year span and a thousand page medical record only two points were brought up by mr wilson as to where there was some kind of deficiency or recommendation that wasn't followed or a delay in treatment otherwise seen and okinawa just seen and or ear neck and thro all those continuous care and treatment those specialist made recommendations and dr murphy followed collar diagnostic tests trying to find the source of these various issues it wasn't isolated to just pain to professional norms i don't think so your honor referring to dr paul's this is his own hired experts recommendation or i guess conclusion i was he ultimately agreed with conservat  meant this is something that had been done by dr murphy throughout the five year period and no other specialist by the way ever recommended physical therapy or acupuncture or any of these  other suggestions that dr paul said may or may not work he never said that this was something that was it was blatantly inappropriate for dr murphy not to consider these those the record indicating whether those services were readily available in the is the fact that throughout all of the specials that he's seen no one recommended that that course of treatment had they recommended it dr murphy's totality of care that he provided him shows and demonstrates that he followed those recommendations except for the one instance where he was where it was noted by his pulmonologist to perhaps follow up with neurology because of numbness in his fingers and dr murphy considered that  but in exercise of his professional judgment weighed the fact that he had already been seen and examined by dr murphy for this complaint a month and a half earlier that he had already been seen by a specialist dr  wisconsin hospitals and clinics so he did see a provider in that three month period of time dr ferguson monologist your own way and he was addressing what was ultimately found to be his chronic obstructive pulmonary wilson wanted surgery it was deliberately indifferent you claim because he wasn't given the surgery that obviously involved when his own expert didn't support that there is a continued continuity of care here by dr murphy in changing dosages of medications trying different medications giving him the opiates or the or the stronger narcotics when when they when he thought that was necessary there's no evidence of that was blatantly in appropriate by any of the other experts including d he had every opportunity to opine that past treatment given by dr murphy wasn't consistent was inappropriate was so far afield from accepted professional judgment that it actually showed that no judgment was made he didn't say that he said does show is that she did ultimately determine that he didn't require treatment for alzheimer's but there's no decision reached by any medical and medical professional in this case that he actually suffers from dementia  he had some memory issues and we don't dispute that in march of two thousand and twelve he didn't know his six digit inmate number and date of birth when he got back to the health services unit he said he wasn't feeling well and he had chills and he spent the night in the health services unit that isolated incident does not give a reasonable inference that he requires treatment for alzheimer's and i would submit that the fact that dr adams when she first saw him in two thousand and nine  did note that he appeared to have some cognitive deficiencies and i believe actually diagnosed him with some kind of cognitive deficiency that factions that she didn't lately disregard this issue he soft reported at that time that he had been treated for alzheimer's in the community that was never confirmed throughout the course of this litigation there's been no evidence that he was ever diagnosed with alzheimer's by a medical professional and provided treatment she not only used her own professional judgment but she also relied on the assessment from his treating psychiatry us dr thompson who didn't outright dismiss his requests for treatment with alzheimer's she assessed him she they clinically monitored him they brought in a multi disciplinary team from the folks that that interact with mr wilson and ideally basis on his living unit and they saw some discrepancies between the behavior she exhibits every day and the behavior he exhibits when he's being assessed by a clinical staff member to them that flight red flag this that perhaps he's green or at the very least exaggerating his mental and cognitive disability it didn't stop there though they actually did sign him to the wisconsin research center which is a specialized treatment facility for inmates for eight months and he was there and i says this kind of a facility is months right it's a it's a smaller facility your honor it's it's it's purpose is for inmates with some type of michael health issues and for treatment and and specialized environments and staff that are treated to deal with those issues going before the parole board denied that and he was actually revoked for a violent incident with his with his girlfriend so i waited although it's not in the record your honor i would dispute that he's a frail man that poses no danger to the community he's there for citing and what what the staff there found was that first of all they they could not he he would not agree to the neuropsychological testing that would be some objective evidence of dementia  agree to that testing that would have provided some objective evidence for them to go ahead formalize a diagnosis and provide him some treatment if necessary that wasn't agreed to the staff also noted at the resource center that he ate his level of confusion had appeared to decrease that he had minimal distress in the living unit and that he was dimentia free at the time of his discharge the attorney at the time with the disability rights attorneys that he consulted with and he claims in his affidavit that was the reason that he had not agreed to do that was on advice of counsel or because it wasn't a correct or proper form i'd like to address briefly to dr the allegation that dr adams treated him as a nuisance and yelled unbraided him and that that should be provided inference of deliberate and difference that incident happened years after she exercised her professional judgment and determined they could not substantiated diagnosis or dementia or any treatment that could that would result from that kind of diagnosis the decision had already been made and i think that that although that's disputed it has to be taken in mr wilson's favor for purposes of summary judgment i don't think that that leads to a reasonable inference of deliberate indifference two years after when mr wilson is still demanding treatment for something that she and her exercise and fresh judgment in consultation with other mental health professionals didn't believe that he required nine to the state law and negligence claim the district court properly dismissed that because there was no evidence in the record that either dr murphy or dr adams violated a professional standard of care the district court recognized from the gill case that you can't prove a medical malpractise claim without expert testimony where the issue is such that  layperson could conclude from common experience that that these mistakes don't happen unless there's negligence either with his neck issues or with his alzheimers i submit that this is not something a layperson could determine  if by specialists cannot determine how to resolve these neck issues i don't think it's within the purview of the lay person to determine that and whether or not the care that was provided to him was make which and similarly issues of mental health  disorders alzheimer's those issues are not within a lay person's knowledge to either diagnose or to assess whether or not treatment is proper could be effective for those situations so the district court did properly grant summ while providing care if if to use another example if someone had problems with their arms and problems in the legs and you just dealt with the problems in your legs it wouldn't you wouldn't be able to say we did a lot for the legs that we were justified in doing with the arms in the same way  but just to summarize when not disputing that the details of treatment had we not just puting you know what what type of medicine should be given when they can this case is about not receiving treatment