the center of disappear is whether controlling president holds that the defendants to correctional officers violated inmates constitutional rights by relying on a deferring to the medical judgments of the nurses who are treating him there is officials like the defendants are titled a qualified immunity so long as none of this court's for the supreme court's precedents squarely governs the facts of the case it seems the mr monkey coalesce sure that existing law placed the defendants both officers but not an slaney were indeed belying on a bona fide medical thing and i know that mr monk people argued otherwise but i believe the basis for that argument and the basis for the court's conclusion on that point the district courts inclusion on that point was that they were relying on the medical judgments of nurses and not doctors and there is no authority and this to my people has cited none holding that only doctors may render the kinds of medical judgments that correctional allegation that that the inmate had told told guards that he didn't like the care that he was really been getting or that he didn't think he was getting adequate care but that wasn't enough what the court might not be receiving adequate care in other words correctional officers don't have to rely upon the medical opinions or the the opinions about the care they're receiving that inmates articulate on the that correctional officers need not defer to inmates judgments about the adequacy of medical care that they are receiving the court is held for example that of your difference in medical opinion between the prisoner and prison medical officials this is just schroeder i also have a question about the record you know i mean did sway me to say that at one point in the record that he wasn't personally aware if the plaintiff has been seen by  medical staff you are the testimony on that point is a little muddled to be sure and it is your court of course some of that testimony in this order what i think is uncontroverted in the record is that talk to medical i mean it would i think is is the key point here that the question really is was twenty relying on medical judgments of nurses and the answer is yes the district court said no because  that sweeney had to talk to the nurses before he interacted with months ago rather than after he interacted with smart people of course is no case law holding anything like that and that sort of rule really wouldn't make much sense inmates tobit shaking was too intense to keep it on one of the also told you may quit acting like a child and get up and houston thinking and seizure the nurse couldn't get a blood pressure reading because the prisoner was shaking so hard she didn't use smelling salts to try to look for reaction but there was none in fact in that space turned blue and yet the officers and the nurse convinced the prisoner was faking left him lying on the floor they did not contact the uncle physician or emergency medical services the seventh circuit  the pinion by chief judge would upheld summary judgment in favor of the officers concluding that they were not deliberately indifferent the court concluded the officers were not responsible for ministry medical care for the prisoner rather they were entitle the jail health of chanel's in that case the nurse as long as they did not ignore the prisoner the court rejected the argument the officers were aware that the nurse was improperly treating the prisoner they were not trained to assess whether inmates genuinely experiencing seizures and so they lack the capacity to judge whether kramer a nurse in that case made an inappropriate diagnosis and i would submit that if the officers and team were not deliberately and different than officer but in an officer swinney cannot possibly have been deliberately indifferent as minimum is not clearly established that they were either and just to emphasize the point to extent that caning places any doubt from the supreme court says that unless the governing case law lets duffing precedents place the constitutional question beyond dispute then the defendant officers are and our kids are entitled to qualified immunity as a matter of law in this case the facts are somewhat similar but much less egregious than the facts and king ask your question about this when when did onshore bennett know about the fact that they were complaining of their pay up there before you talk to the nurses or after you come to the nurses that's a good question you are the district court focused on i actually don't know that there's a finding on that in the record the stamp there is i just unfortunately don't know what it is but i know that the i know for example that the that the  i steven weeks your honour's on behalf of mr monti oh the defendant happily this is a pretty straightforward case in arizona nurses richard nurses are not allowed to diagnose or treat inmates they are allowed to assess they are allowed to take vitals but at the end of the day the decision is for the physician or  a nurse practitioner or somebody higher level than just a registered nurse and in this case it's undisputed that mr monti a contract did botulism after eating some food that he had shared with three other inmates because he contract botulism he started to exhibit signs of botulism between twenty four and seventy two hours after  ingesting the food and botulism is not like a common cold it doesn't just disappear over time here mr monti oh was seen if you look at page  has contracted botulism because what will happen is all of the muscles will slowly but surely start to fail so the eyelids will start to droop the ability to breathe will be diminished the ability to stand will be diminished the ability to talk will be centered it's pretty common that these effects will happen to people who have had some food that is contaminated with the botulism toxin the only way to cure that is to go to the hospital and get the antitoxin now in this case one of the four inmates who contracted botulism was sent to the hospital three of the enemies were held in their cells i represent two of those inmates mr monti a and a mr lopez who were both cell mates at the facility now the second day after the symptoms progressed  under the influence of drugs or alcohol but there was no throat or tongue swelling in his respirations were clear so that is an assessment where they say ok this guy is not looking good but that's all that they can do from that point forward it has to go to a doctor if it doesn't go to a doctor then there is a problem in the system somewhere now what can an inmate do who is locked up twenty three hours a day inside of a cell they have a choice they can either ignore it it just kind of sit back and wait and see if they improve or they can ask for assistance and that is what happened with both of my clients both mr lopez and mr montagu they requested assistance they told both correctional officer bennett and correctional officers officer sweeney that they were not seen by a doctor now the state is arguing hey it doesn't matter they were seen by a nurse that's good enough but even their own citations disagreed with them the citations state in the came case  that so long as the inmates were being seen by a doctor then the correctional officers could rely on it several other cases that they rely on also mention the same thing as long as a medical professional authorized to look at diagnose and treat those are the only individuals who are important here in nurse who cannot diagnose cannot treat cannot order in and meet sent to a hospital does not have the same authority as the medical professional who is hired to make those types of decisions and here is a mid council that's very very i have a question about th legal impression that nurses could be medical professionals on his opinion couldn't the why you know assume further that they were sure the first step is just like a correctional officer does not need to have read every case that has ever been decided on the qualified immunity in order to be held responsible as long as they know  that they have a legal duty and a legal duty is already established at law and in this case it is established in arizona and i believe the entire country  and i know you disagree with the factual premise of support they've been told unequivocal they were taking care of their medical problems and don't need to be concerned we've got it under control you know do they have to go beyond that either factually and legally and my policy is i think my answer to that is yes they must if they see somebody for example if they see somebody inside of a cell that has a compound watched before yes they still have to to make sure the inmate is treated they can't just sit back and rely on it and in this case we have multiple instances where the inmates were collapsed on their floor mr monti it was collapsed on his floor unable to breathe unable to eat unable to do anything that is expected of somebody who is healthy and the nurse says you know what his vitals are good on that's good enough for me if the officer believes that the individual needs to see a doctor and this is botulism it's not something that cures instantly so all that happens is the paralysis and everything gets worse if they see somebody who's in that condition then they have to question the nurse especially given that the nurse is not allowed under arizona law to make any sort of diagnosis there's  what her art is the duty of the officer what she tells so nurses and they say he's not sick or does it go from there but sure and it's actually very simple the first thing that an officer should do is contact his or her supervisor you contact his or her supervisor and say hey i got an issue here with this inmate especially when it's not just one but it's for it's you know one gets taken to the hospital three are stuck in their cells you've got four inmates who come down with something that appears to be something that is preventing them from even being able to walk swallow breathe it cetera if the nurse says it's ok then you go to your supervisor the supervisor then says not fine they have another step that they can go to and that's calling what's called an i c s incident command system i believe this what it stands for and what that is that it immediately cuts everything off it's basically they press a button on their walkie talkie they say you know i need a doctor over here or i need somebody who is able to diagnose it's a relatively simple easy thing instead of leaving somebody in their cell for seven days until they confess to having consumed an illegal beverage in order to get medical treatment does that answer question well that what these officers i guess have a have a command system and after he says there is superior officer they are sick and that superior officer said now they've been taken care of by the measures is he supposed to go i mean that's that is what it is i mean the reason for the i c s system is to allow an override if the individual correctional officer believes that something is not being done properly because correctional officers are legally responsible for both the health and welfare of their inmates so if you have an officer who sees somebody who is unable to get up off the floor or has a compound fracture or whatever the issue is and they first call their commanding officer in the officer says don't worry about it they have a right and the responsibility to say look i'm not going to let that guy bleed out on the floor i'm going to go ahead and call and i c e s so that the medical professionals will actually come here do a full evaluation now i mean it's important to remember that for a week for one week nobody able an authorized under arizona law ever saw any of these inmates except for the one who was immediately taken to the hospital the other three were left to slowly but surely deteriorate over time as the botulism went through their body and there their system you don't lose those symptoms you are a victim of botulism that needs to be treated with some anti toxin that's how you cure it and so if you've got somebody who is showing symptoms on day two and you have a whole bunch of officers saying i didn't see anything even though on day two the medical records show that the individual was incapacitated standard and and you're saying that if the nurses say he's ok and there's supervising officer says ok he must close alarm or he's deliberately endevor whereas these other people have already been deliberately and different it seems and perhaps i'm not unashamed question but but i think that we're on the same page what i'm saying is that the the individual officers have to make their own judgment call to not be deliberately indifferent i mean if you have a an officer and their supervisor both seeing somebody bleed out on the floor in their cell you can't just say well my supervisor said it was ok you know you still have to take that next step and here where you've got people who can't walk who can't breathe who can't eat who can't drink who are vomiting who are exhibiting all kinds of signs of having a an illness that who knows could spread throughout the means of the officers i'm not saying they have to know that it was botulism it could have been some sort of weird flu this is the media there are about two minutes left ok thank you then what you need to do is you need to make sure that the individual is at least analyzed and looked at by somebody authorized under arizona law to do so and that is a license practical nurse a nurse practitioner or a doctor and in this case as as my client was seen by somebody authorized to make a diagnosis he was transported to a hospital because he was dying but nobody would let him see a doctor while he was dying for a week and the reason behind it according to mr swayze testimony was that they wanted a confession so they could back charge the health care costs to my client and so not only does it seem deliberately indifferent but it also appears that there was a motive behind the denial of care and that was to make my clients responsible for the cost of their care oral argument really doesn't change our duty to examine and go whole record to determine whether the district court's conclusion is cool right you are the district court did not find a dispute the staff act on that issue the district court in fact found that mr multifold it testified during discovery that he had no recollection of having interacted with mr swain with officer swain on the day in question august second this is a pair pages twenty versus kramer that is because there is absolutely no authority whatsoever that supports position and a number of things he said are simply contrary to law and he said for instance that under arizona law  a nurse can't diagnose a patient he's never cited the statute on that point and i am aware of none he said that if an officer believes that an inmate needs to see a doctor and he asked the question the nurse i don't know case the sa back he says that an i c s an incident command system exists so the doctors can override the teacher so the correctional officers can override the judgments of nurses i am aware of no case holding back or any fact in the record to that effect he says that an officer passed the the first thing you must do is contact a superior officer again there's absolutely no case that i'm aware of that holds as much i'm sorry  and is not to show as a as a matter of law that our clients that the defendants conduct was constitutional it is mr muncie cause burden to show that the control and precedence squarely governing the facts of this case hold that their conduct was unconstitutional and in the absence of such a controlling precedent then the defendants are entirely qualified immunity as a tastes all by itself disposed of all the legal questions in this case in this case it shows that officers can reasonably rely on the medical judgment of the nurses they don't need to wait for doctors and it shows that there is