inaction was objective great unreasonable this changes the standard that was applied to mccann in a district court therefore we asked the court to reverse the particular case the standard has changed under the fourteenth amendment due process clause the true pretrial detainees are entitled to more protection it is found in a due process because you cannot which did not hold the jail employees responsible when they were alive recently on medical professionals and in this case that is not the facts the facts are completely different the sheriff in this case sheriff vital never seven which they needed can was a very special and he had second and third degree burns on forty percent of his body he was released from a burn unit after twenty one days of care because his medicare insurance ran county because when he was released the warrant was affected in ogle county but hospital was located in one of bagel or winnebago sheriff picked up mccann from the hospital brought him to win a bagel and immediately drove him to we did not want to have any risk or have any responsibility for him so we drove him immediately that's the condition that was mccann mccann was an and i think the court also has to take into consideration the factors that the medical care that was provided here  was not at all adequate you had an lpn cannot make any decisions who must follow only instructions from an m d or an r n there was no r and r on duty and there was a medical doctor only present two hours a week or four hours every two weeks in this case that medical doctor did not seem a candidate in the seventh day of his incarceration the sheriff had already made the decision to mccann and that decision was made on a telephone call strike that and a meeting with the state's attorney at a board county board meeting that night april twentieth two thousand and ten the day that the pm was transferred the whole county correct there was never a discussion about medical needs there was never a discussion about whether or not there was a decision as to his medical condition to keep that we could keep him here sheriff i don't make that decision himself if you look at  let me ask you there obviously are a lot of reasons to second just some of those decisions and square but what concerns me is on keeping mckeon in the jail or not in the jail is the causation issue the defendant's raised saying look the problem was the doctors missed her and prescribing too much methadone that's wh guards deputy white a normal individual no medical training no substantial education had explained that mccann's condition had changed that he was unstable he was wobbly and he was falling asleep at the time  professional to check your vital signs it's the first thing that he would do especially when she ran out of remember for ten days the time the twenty or thirty right in the medical experts say that these signs of a methadone overdose you're not high a level of narcotics he no longer with breathing and nursed mongan had stayed alive didn't see him struggling to breathe well you won't because he's going to pass away very slowly very in that three hours had he been given appropriate medical analogy standard where we start with was there a constitutional violation and then go to was the law clearly established at the time i could just skip to part two and i think i'd be done in a minute cindy mind and who was the license practical nurse who delivered daily consistent medical care to mr mccann who  daily to the doctor about his care who saw that he was sent to the hospital many times during the course of her ten days ten days he was there there's no question that she followed the direction that she was given by the doctor and the hospital's on every answer as a license practical nurse she has a limited options and limited capabilities  thirtieth of the morning where he was having problems she attended to him she put gave him his medication she treated his drank so that he had were great because he had swallowed problems she put low she changed his bandages she put lotion on tended to him and she had every day she was in a position where she could tell if there was some distress going on if something would alarm her to the point that she should get up take his vitals but but she didn't stop there she called that didn't meet that standard doesn't meet what what is the application of the of the objective reasonable standard to that type of conduct we don't have any guidance yet on that but you have spread two things about that your miranda decision you've said that it can't be based on negligence this is not medical malpractise even under due process and objective and reasonableness we're not talking about medical malpractise under supreme court precedent there has to be a higher level of mens rea it has to be at least reckless at least reckless and maybe not maybe that standard might not even meet the standard because we don't have that yet knowingly take on reasonable measures following the doctor's directions not the plaintiff says that she knowingly administered methadone to mecan without any knowledge of the drugs reactions side effects standard that requires a nurse to act that way a licensed practical nurse so this cannot be objectively reasonable conduct by her what go to the clearly established law part the if the low standard wasn't clearly established until you came down with miranda after the supreme court changed the standard regarding the entire what conduct was clearly established as let's just say improper by a jail nurse back then there was case after case the state of cold case  other cases from this cork which said that a nurse unless it's obviously you know the doctors prescribing arsenic or something i'm nurse is allowed and is is not indifferent by following a doctor's orders so in terms of a factual a course of action that's what was in place at the time that was not clearly established that that was improper and the legal  the non medical defendant here when you current relying upon the medical decisions and judgments made by the medical staff number three qualified immunity both on the merits question and the clearly established arrest warrant for him credibly asserted around that discussion but according to the record but right what what if anything what does what does the record show regarding the decision on april twent conditions and getting some direction from the sheriff or the sheriff wanted to talk to the state's attorney and once that you're found out there was an arrest warrant which mr mccann was remanded to his custody what resulted from that was the decision to detain him at the judgment to be brought to bear upon whether the facility has the capacity and resources to appropriately care for him absolutely and i think that was done here your honor because the nurse the nurse came in off it she was off duty at the time she came in  deal center through his conversations with the nurse yes yes and under the contract that the county had with with the doctor it was the doctor's decision to advise the sheriff medical judgment and based on my medical judgment there was no need to transfer this in me out plus you have the testimony from dr paul of titus and dr cume who were the discharging doctors at the hospital and they said that you know this me and wounds were he enough where he could be treated on an outpatient basis whether at his house by his family or in the jail by correctional officers in the other circumstance he didn't need any other you know any type of in patient care th clearly otherwise the most important fact is the kid was out of hospital for three weeks and then he was released from the hospital and the doctor's testimony was he could even go home and have someone to hold care for  to arrive there on the twentieth he was a classic human cases with the nurse and i think right away from that communications he determined that yes we can care for him based on his conversations with the nurse i'm he did this at them on the twenty seventh the doctor visited him so there was  everything was going on this treatment seemed to be going according to plan and then the unfortunate methadone overdose which was the cause of his death which player it makes to i think right away there that defeats a potential liability for any other kind of so there's his decision to keep the can incarcerated at all ronnie correctional center was based on his statement that a discussion with the state's attorney we believe we owe it to the community that we are going to keep this man representing mccann in the criminal case and asked him if he could do something nobody wanted to go against the sheriff they were all concerned about their job and the public defender states that in his deposition provide an opinion as to treatment doesn't have the ability to to provide a plan of care order to can only enforce the plan of care as instructed by an hour and then an extremely important in this case that we keep saying that there's a medical judgment here and this is why we distinguish it from the miranda case and say that these particular jail employees have responsibility they close their eyes and they did whatever the she really i believe that was his testimony in his deposition but there's no record to substantiate that there's nothing in the medical records that yes i believe we can appropriately care for this individual that's something that comes up after explained himself that he had never spoken with a medical doctor and edition we have a medical doctor who has a contract with the county provide medical services he receives a reasonable sum of money for his services he does not want to rock the it wasn't six months it was ten days and he died because there was not a medical staff in the miranda case there was a reasonable medical staff there were many doctors there were many nurses they were she's the one who carefully man she's over her head she comes in our days off and she watched this man die because she refused to go against the sheriff's statement that no seventh's observation and treatment for him she called one nursing facility only they said we don't have any nurses we never tried to get any additional care afterward that action is unreasonable