examined mr redmond and noted that the action would add as a source of continuous infection unless the top was amputated got to while he also noted that mr redmond was medically cleared for surgery that every day and that mr redmond agreed to the indication of a record that that your client had an additional health problems that prevented an immediate surgery or mine in my thinking or something that doesn't exist so your honour's right at the i know the record is complicat frequency little confusing so i would love to clarify that for you so on april th when this thread was st admitted to the hospital there was nothing preventing the surgery from going forward that day dr white uncleared mr redmond for surgery and this is the answer to the kidney condition so your out of the kidney condition is what person prevented the actual leg amputation after they had already performed the toe at the teacher so but by then the damage had been done by the time the kidney condition had  obvious there's no need for the verify medical evidence and i think it's clear that when a total goes from simply having a blister on it to the quite where it's falling off and doctors saw miss redmond repeatedly during that timeframe it would have been apparent to a  person that some kind of intervention was necessary and what i think is also important to know on this record is that defendants never scheduled this amputation the only reason that if you take occurred was because mr redmond ended up in the emergency room stone what the defendants could see something needed to be done here independence just ignored it ignored an acute and escalated situation well you keep talking in the you know across the board defendants for the whole period alert of miss redmond's condition and it took mr redmond literally threatening to go on a hunger strike before dr kaczynski saw him again and by that point miss redwood ended up in the emergency room three days later and that's when the  think at minimum dr kaczynski if you know the need to expedite it could have sent mr rehman back to the hospital but he didn't even do that so i don't think and i think this is one of the major problems in this case that the that it's kind of point the finger at recommended the medication change but that doctor with nurse hatters consultation approved giving misread minimises dillon which is a general and a biopic that most of us in this room have taken our guess in this virtual have taken at some point is that of the specialized antibiotic that the experts at the hospital recognize was needed to treat this infection and so while i don't think the causation is necessarily it's clear to see how you get from it to be as this course hadn't shaab causation as a factual question and less it's clearly not the case that this had any effect such that you can rule causation as a matter of long that's exactly the type of question that has to go to jerry but other i mean that that's quite a stretch isn't it i meet your honor i think these types of claims are difficult and i am not obviously in a place to fully hypothesize about what kind of evidence to be presented at trial but i do think there is i do think that it's within the jurors realm of decision making capabilities to say that if a condition worsens and if a medication that was designed to treat that condition was not provided it and i think why the images are important here is because again the words on the paper are a pocket and have doctors describing his toe as disintegrated and teary and you have dr describing th question as expanded you have doctors describing this toas putrid smell and so all of their words make it obvious but if you look at it it is clear that something should have been done sooner and that nobody attempted to do anything sooner and i think that is exactly what deliberate indifference i think it's looking at a condition knowing that something needs to be done but then doing nothing but the argument is there's we get we are reviewing a summary judgment on a summary judgment record and you're telling us that things that mr redmond did not present to the district court you can throw at us and get us to reverse on the district court on the basis of those of that evidence your honor that's not i don't care whether record that we do not owe our your honor no at this point i'm talking about the hospital records that the defendants themselves submitted in the district court and i know there voluminous but a look at those records paints the picture now  was saying is that the two pictures in the brief were not in the summer doesn't record what i'm saying is all of the hospital records outside of the pictures that we cite to what our proof are in the summary judgment record and clearly lay out this the deliverance and difference in this case  yes your honor i'm thank you can you hear me yes thank you lorraine wallace from the i want a partner from the iowa attorney general's office i represent the five prints and the argument is right now the doctor could exist and nurse half a nurse practitioner hackers are my clients as well as warden johnson from fort dodge prison warden mckinney from i m c and deputy warden or from i am c c so my five fine and those are my five clients as it is my clearly by the briefing warden johnson warden mckinney and deputy warden or although they are the mr redmond took an appeal from against them and they are you know the apple leads in this case there is no argument against them and thus i'm asking the court to uphold the lower court obvious because there was no delay in treatment and and he while it isn't obvious it is not obvious when it is proper to do an chose the course of treatment which is proper under all the medical standards and which doctor called since he agreed with in this treatment plan they put a cast on the fo honor i'd like to end my time now my argument well i can tell counsel now i need i need to cover come back to the treatment and put this in summary judgment terms your brief remind heavily or even more to the point of the said i don't need something affirmative but the summary judgment stage because their records they don't have any affirmative evidence of delayed not being detrimental and their records  evidence to the counter how do you respond to that i response that by two things number one the delay issue was never before the lower court this is a new argument time now to mr po no genuine dispute of material fact to support the parable elven redmond's claim that dr wiley was deliberately indifferent to his medical needs on appeal redmon argues that dr wiley was deliberately different required to amputate redmon conflates these two distinct questions without any medical evidence to support his argument to let the decision of when to impute tape mr redmond's th who is a complex medical decision that simply i not within the knowledge of lay persons and requires a medical judgment about and seeing the risks and benefits of infection amputation professor harrar on the court has mentioned many times how the records make reference to the fact that the th needs to be the reason why i don't amputate that toe early in the early in may and april is because he still has an infection surrounding that diabetic foot all sir skin surrounding tissue if on april th through th in the medical record and in the sarin in the joint appendix they are medical records that demonstrate that mr redmond was admitted to the hospital for treatment of eventually amputate the toe what that means is we need to wait for that infection to heal and the reason why wait a minute wait a minute what they have needs to home to a physician out and no one at any point in time says this toad needs to be amputated right now instead what you see in the records repeatedly is attempts to treat his undermine infections around the amputate without treated you cannot tell the difference between healthy bible tissue and unhealthy bible to ship so that is why instead of i april and may you treat with it a bartok's in the total contact cast in an attempt to resolve the infection that's occurring around the toe so that when you amputate it is more amenable to a i think the closest you can get and we didn't get to that stage obviously there were no depositions taken at the district court stage there was no expert evidence forwarded by plaintiffs so we never got to the point where in essence we would you know defense would be submitting its medical experts the closest that we were able to get is in the district court area dr wiley provided an affidavit that indicates from his own medical judgment and it's been sounding to me my qualified immunity was prematurely granted i don't i don't believe it that's where the district court ultimately decided the case the way that i read the district that mr reddon submitted no medical evidence that dr wiley's treatment caused redmond any harm let alone unnecessary and