washington university meant to practice in illinois his undergraduate degree from washington university as a law school degree is from columbia and he's invited to practice in colorado greg gardner when she does undergraduate degree from calvin college his law school degree is from the university  degree from michigan state university law school degree is from notre dame and she's made it a practice in the state of indiana and she's appeal turns chiefly on one issue which is whether a jury would reasonably infer based on the available record that mr petty's treating physicians at stateville dr carter and dr obasi knew of a substantial risk of harm to mr petty's and disregard of that be made about whether or not this treatment should be provided it also goes to the fact that judge dr carter didn't make a judgment call a medical judgment in deciding to provide this treatment or certainly no evidence of that in the record but there's no argument that can be that's what doctors all testified to the outside physician and that simply wasn't provided here and there was no other means of remoting that sort of immobilization and feeling stability for the ankle distinguishing when a but the physicians here agreed that it healing would be hindered without keeping the angle at one place so who was the outside physician testified that because the angle wasn't to mobilize for that six week period there were two types of harm there was increased pain from the ankles mobility that resulted in the tendon edges that would normally be sort of pressed together pulling apart and prevented from healing because the scar case she would air would be continually disrupted so that's the pain aspect of it and it's also the delayed healing record as things like my ankle is killing me it's hurting me a great deal but he's receiving strong painkillers but he's continually stating in records between january and february that the pain control is insufficient and when he was seen on february fourteenth by dr carter the note  came up with later was one of reflection and we had a similar issue going on with dr obasanjo to all get to a little bit later but who made a similar argument about physical therapy and the fact that mr pett is kind of self exercised extended that wasn't discussed with mr petit that wasn't just together to enable that response but dr carter was talking about that almost immune like response to treat the area you're going to keep disrupting the healing process and as you might imagine that's going to create a lot of take so dr carter did understand this when he was pres circumstantial evidence that can indicate a knowing disregard of character i would hesitate to push that knowing point too far because i think it's clear from the case law that you don't have to show an intent to harm and we've never contended that this was somehow malicious but we have to anymore he had to go around the prison in order to get his meals to go to the shower you know in the sorts of things that happen on a day to day basis in the prison and when he did those things got to do that with his legs just sort of dangling while he was using crutches and you know you can hold your leg in  certainly can see that it's not a mandatory protocol the protocol makes clear that physicians do have medical judgment that they can exercise it was an exercise here but they do have the judgment to exercise but the protocol can provide circumstantial evidence of  appropriate standard of care that's one element that has already been articulated i think in this case there is a line of sufficiency that is easily prospect it has to do with what the physicians themselves knew about the appropriate treatment and i think that that's a helpful touchstone because the record about ab and i appreciate all that and it was a point i was going to make it was that if one considers what dr carter did and it's a clear distinction from all the cases that have been cited including the cases that were cited in the security issues at the facility and the issue i think it comes down to can or should oriented deliberate indifference for a doctor who has ordered a consulate and is told by the security personnel of the facility that is that there are competing inferences that do not permit summary judgment in favor of the defendants we certainly as a judge would noted we would not contend that this is a case where we are entitled to judgment as a matter of law i would turn to the delay point that was discussed a little bit and just to clarify a couple of points in the