court i asked the four to consider in this specific set of circumstances about graham dyer that the extent of his crime if there was any was potentially trespassing and at a middle school a situation where if he had been any normal friend of mine the police would have likely just said leave go home go somewhere else but he was in a crisis the very fact that he was in a crisis was the reason that they took him into custody that he was in a medical and emotional crisis that day it was obvious and in which they were aware and so i think that's important to consider in this case because you're talking about someone being detained for sending that is not really substantial criminal activity right so so on the as i understand it there's a twelve b six on the paramedics and yes or summary judgment on the officers yes from so i'm focusing on the paramedics which was it was dismissed by the judge district judge when the pleadings i'm looking at your i guess a  district judge said these these pleadings don't you know make your case with respect to medical indifference to do they were dismissed on the pleading what i guess what is your what is your key argument on that what why did those pleadings rise to the level make allegation oh we have to accept them as true why the show the deliberate indifference of the of the paramedics who did expect you'll concede the defendant your honor i don't to see that and they when the paramedics arrived they went st to mr carpenter the other the other young man that was there be careful and stay within the confines of paramedics looked at him that they didn't for example if you look at i believe it's paragraph thirty it states that there was no report or certainly that the city could not find any report so the paramedics didn't even bother to record any examination of graham or record any by those who were providing reporter anything else there was absolutely there's no record whatsoever that they even examined him at all and that's in the in the complaint but let me ask you this the so you i assume i take a lot of your argument to rest on the this allegation that he had a head injury right he had it he had had that's what you allege he had a head injury and very police car on the way to the jail yes so how much understand an allegation against the paramedics who who show up you say ok had a head injury at that point they examined him they sent him away with the police officer and then all of this other stuff happened relating to the head injury i'm just trying to figure out you're alleging what the police officers ignored all of the head banging in the car i get that that's what the with respect to police officers that i'm trying to square that with the allegation that well he had he had a head injury the paramedics examined him and then let him go and try to understand how those two work together in terms of a medical difference going it's our contention that the overdose is actually more severe injury including self harm is a highly predictable consequence of a drug overdose or the paramedics be responsible for any self harm that occurred in the police car they because if the paramedics had taken him in unable to transport him to the hospital he would have st of all been put in a gurney and stretched down and he would have been taken to hospital today did he would not be in the back of a place car slamming his head fifty times into the cage in the side of  car so that the the fact of the drug overdose is linked to the highly predictable consequence of harms that occur as a result of a drug overdose plus a drug overdose paramedics going to be deliberating deliberately in different ways at the l at the at the twenty six dollars day job if they don't order him to go to the hospital i have i believe that that's accurate i believe that paramedics should be held to a standard and that would require them if there's a visible drug overdose to transport some of that matter may or may not be be required to do that as a matter of of negligence but we're talking about deliberate indifference to medical yes yes there are there are cases that address paramedics and guess what your best case that would guide a paramedic to do that under these circumstances  the paramedics were called to the home of a gentleman who had fallen and said that he couldn't feel as feet and their response to that was to put him in a chair and try to roll it out put him in his own car they said they were very real potential of a serious and injury that what they did posed that there was a risk of serious harm from that and so so stories are is one of our decision  wouldn't been in the back of a place car and so the we did plead that that the failure to transport in an ambulance strapped in a gurney and mr dyer was the indifference to a serious risk of injury and i believe that the i believe and i believe that we pled that paramedics would be expected to understand serious risk of injury related to a substantial drug overdose so that is with respect to the paramedics and is there any evidence in this case i know we're paramedics tw the six but is there any evidence anywhere that would suggest the reason he died was the self inflicted head injuries yes and i believe that's i'm not sure not that we can pinpoint any specific point in time and that there was the fatal blow to the head but you only have to watch the video of him in the back of a police car and see him slamming his head fifty times  the way to the police station and officers gafford and scott also pulled over and then they all went to do whatever you know to encounter and graham in the back of the place car so kind of gathered around as officer hired her that with an open the door and basically pulled him out onto the ground he never from the moment they put him in the back of the police car he never walked again they pulled him out then they picked him that they carried him into the jail they put him in yes the claim as it currently exists is with respect to officers gafford scott and heidelberg and with respect to those officers and i think that himself they were all aware that he was landing his head in the car and and whether or not they get a pass for calling the paramedics and having the paramedics check in out that which we contend they don't for a number of reasons but even if they did that would end at the time they put him in the back of the place car and transported him to the jail in the never they didn't even not only did they not call the paramedics that were taken t hospital or get him medical help they didn't even tell the jailers that he had been slamming his head inside the police car with respect to the officers qualified immunity what is your best case  cases that would should have informed those officers that failure to seek medical care was delivered was was unconstitutional would it what are your best cases for the well there are i believe that issue of intent and whether or not there's that there's that extra requirement after this if that's true it was after this incident and there are i mean there are a number of cases that we cite that established the right to medical care and in and i don't i did not know that there was going to be any issue about whether or not the right was clearly established and well no i understand ability to do so the district court what did i guess i'd like to hear your response to the specific rationale on which the district court i'm not qualified immunity which is i understand the district courts of well there's confusion of the circuit law with respect to this alleged rd element and so therefore they have to have qualified immunity well so my reading about was that the court said that the judge said she was not going to include the intent that there was an intent to harm but she said that our cause of action was doomed and was the word she used because she said the right was not clearly established because of the confusion around whether or not there was acquirement i don't think that that is the way that that should be analyzed because what we're looking at with whether or not it was clearly established was the right to medical care not whether it was clearly established  there the confusion over whether or not officers had to intend the harm doomed the and that didn't the cause of action and i don't think that's the current focus i think the correct focus is on whether or not there was a right to medical care that was clearly appeal the district court's granting of the twenty six motion for the paramedics on the medical intervention calling and then the district court granting of the summary judgment motion for the officers on the medical turn overdoses been at that but they also that they plead that he had a serious head injury and the paramedics saw the paramedics saw the serious head injury there are no factual allegations were guarding was examined by paul polish and joe baker is the paramedics right and then paragraph forty eight goes on to say at that time graham was in the custody of the police and had sustained a visible and serious head injury so i guess my my question  in the in light of that allegation does not sufficiently plead deliberate indifference to his medical needs given the fact that the paramedics didn't order and take him to the hospital it does not go to the facts as to why the alleged head injury was serious or not given what more did you want than to allege there i'm sorry what more do you want than to allege they could have described the injury if it were less the paramedics did examining as admitted in the bleedings and in the record now plaintiff took issue with the extent of the examination and the results of it but they did examining therefore that brings their claim down to mere negligence which does not support a cause of action under the th amendment the left lane attention and i would suggest to the court and this issue's not been briefed in this case but there is when you have paramedics involved responding to a prisoner in custody and you have a medical inattention claim under the th amendment there's a tension that arises between that and the notion that there is no constitutional right to receive emergent medical care the only reason mr dyer had a constitutional right in question is the fact that he was in custody by the police officers paramedics didn't arrest again that's a tension there arises and it arises from the pleadings against the paramedics that were before the court on the motion dismissed are not sufficient to support the claim to support the elements that the paramedics had subjected knowledge of a serious medical need and disregarded that knowledge disregarded that any of the paramedics examined him they told the officers we can't take him now there's a dispute in the record about whether say we can't again they construe that is being clear but that came up later in the record is the relationship between the paramedics and the county or the police department when they were the county they all work for the city are in summary judgment territory with the the officers now i'm looking at the district judges summary judgment opinion the order at page nineteen of that order and i want to read you something  says she says the video evidence also shows graham repeatedly and forcefully bashing his head against interior surfaces of officer heidelberg police car now in light of that i assume you concede that a a reasonable juror a rational jury could find from this adds that mr dyer was bashing his head against the and interior of a police car and at least officer heidelburg was aware of  dire was in the backseat the car beating his head against the car right couric you are ok i will point out that the record establishes that mr dyers demeanor his actions remained unchanged throughout this i mean are you contesting so as i understand the district judges summary judgment order she found that there is a fact issue as to whether there's a medical indifference claim here that a juror a jury could find that she granting qualified immunity on the nd problem is as is that is that my understanding of the order she said well there's no clearly established law that showed the police officers that they should have done anything to help him out if it the standard step beyond by judge boyle failed that that was not the case she found that there was confusion in the th circuit opinions in the th circuit case law which was compounded by the plaintiff's allegation that kings should have applied an objective standard judge boyle found to the addition of standards in the th circuit case law that the deliberate indifference must be supported by subjective recklessness and an intent to harm person has is bleeding out when they arrest him and he's any tells the police officers i am bleeding out i'm afraid i'm going to die help me in the blood is gushing out from him and the police response to that is to change him to a chair now is that a deliberate indifference clime is it clearly established that the police officer shouldn't do that in a situation like say your honor i think i think if i strap a suspect who's bleeding out to the chair and prevent him from getting medical attention i think that's going to meet all three standard ok so how is this case different at least at least at least from the perfect image of a jury who could find the facts how is this different  taken l s d his behavior was as described in the video the officers call the paramedics to check it paramedics said we're not going to take so the officer taking the job that his demeanor remained unchanged after those paramedics checked it right but i just pointed to summary judgment evidence that showed he was beating his head against the interior of the police car and the officer knew it right that's after the paramedic said ok to take it the officer suspected it going he cannot see it from where he was this referred to was not the behind of bercy do not see that he could have seen it if he had chosen to look at the video instead of drive his vehicle but he had to drive that car you can't see in the back seat with a review clearly are not with that screen indicates back there at what's in the record i'm sorry that's what's in the record the officer say i couldn't see because of the dark and the screen he didn't describe he was a question both there when they got to the sally port gafford was a backup officer scott was transporting the other person who was arrested sort all three of them went to the site did they all three take him out of the car dyer out of the car when they got to the police office how long after they put him in the streets here i think it was an hour or two but subsequently paramedics came again when they did transport in the hospital since he was in custody software's had to go with him and they did and these officers were still on duty they were dispatched to follow the amish to the  summary judgment as to the officers scott heidelberg and gaffer was properly granted because the flag says to each other and again the facts as to those officers must be reviewed individually they were aware that he was banging his head in cough they were not aware and did not see any additional injury resulting in that what is the medical report reflect he died out i'm not enough of the doctor to give you the but the life and again the qualified immunity issue as judge boyle recognized the confusion as to the legal standard prevents the standard from being clearly established and therefore prevents anyone from overcoming the qualified immunity that's not that sounds a little bit like because there's allegedly confusion in our case law there can there's always going to be qualified immunity in a medical indifferen i i could be wrong but i don't have in my file a reply brief by you did you found one you know you're on juana on i didn't think that there was someone in custody bangs their head that it's deliberate indifference if you do not take them directly to medical school i think it would say that if someone banged their head fifty times in the back the place car so hard that it shipped the car from side to side and you could hear it smacking into the car that and when you arrived at the sally port that person laid on the ground and continued to bang his head but was unable to walk that yes it would be deliberate indifference not to take him to the hospital or seek immediate medical care or listen for in the jail and maybe some go also add that the person was in the grip of an autistic psychosis up in the grip of head and that's why he pulled over in the end it officers scott and gaffer both testified that when they saw the car moving around they knew that he was hit in his head and that when he pulled over that that's what they were going to address and so cut from their depositions and the video evidence yes and it's in that it's in our our briefs the with specific references to the record on appeal where  said that emitting his head was what prompted him to pull over record on appeal seven hundred and sixteen he was aware that it was a head injury record on appeal seven hundred and seventeen his intent for pulling over was to try to stop him from  hit his head record on appeal a seven hundred and seventeen and that the other officers acknowledged that that's what they were doing when they pulled over was trying to stop him from hitting his head so hard that bit was obviously going to cause some kind of injury i truly don't know how you could see and hear what landed in the back of that place car and not conclude that he was seen inflicting severe injury upon himself and then getting to the sally port and yet that's in the record that and when they got to the sally port they they pulled him out of the car and officer scott stepped on his head with his that point and that you can see on the video and it's in the record that it that point when they they picked him up and they carried in him he was not he was sort of still making noises but he was not physically moved very thing in the record the reflects how long after he was put in the restraint chair he was been taken to hospital apologizing and i'd think it was a period of a bit of a pox i'm only an hour or so on that day then that someone who was observing on the camera noticed that he was not moving you may call the paramedics came in and then transported on a motion for summary judgment qualified immunity by the officers i haven't looked at the the papers in the district court but was this aspect of it after kingsley but i what i didn't know was that that was going to be used to say that the right to medical care was not clearly established at the time i thought they were completely separate issues one is do you have to show the officers intended to hurt him and the other when is was it clearly established that someone is in time of medical care if there is a known serious risk of harm which i believe was clearly established so what was my opinion that those were separate issues and