inferences therefrom in the light least favorable to mr chester that turns this court's standard for evaluating pro se complaints on its head were still the court dismissed the case with prejudice without giving mr just leave to cure any alleged deficiency in his two page and written complaint if this court can merely conceive of facts which if amended into the pleading would be a plausible and timely claim this court should reverse and remand with leave to do just that i want to begin by clearly defining mr chester's injury in this case that has been the source of some confusion both among defendants and by the district court this court augustine explained that the standard for determining when a claim has accru is slightly different in cases where a physician's failure to diagnose or treat has caused the injury in a traditional case the physician inflicts a clearly identifiable injury by some referred of action but in a case like this the injury occurs quote with the development of a preexisting problem into a more serious condition which poses a greater danger to the patient that quote is from august thing that is from augustine applying that standard here the injury mr chester alleges in his complaint was permanent paralysis his hand and arm are now hanging motionless in the sling is permanently and  of motor function even prior to surgery in two thousand and seven a temporary process following brain surgery is a normal and expected consequence indeed his neurosurgeons of the university of san francisco apparently anticipated that he would experience temporary paralysis because they recommended post surgical therapy to address that condition and his treatment plan and finally mr chester alleges that in one thousand nine hundred one he previously experienced a v m following surgery had temporary paralysis and with appropriate therapy regained the use it was right also brain surgery that was also brain surgery and what year was that surgery and according to the report appended to his complaint that was in one thousand nine hundred one the surgery this was the second time he experience his condition and undergone surgery so to be clear the district court here based its ruling entirely on a single sentence in his handwritten complaint stating that dr william the  doctor that he was referred to in january two thousand and nine determined that he was experiencing the onset of heavy priestess which is another word for temporary paralysis but in fact that wasn't new information to mr chester while he was doing was observing that he was mr spriggs the therapist that he saw after transferring out of defendant's care determined that the window for correcting the temporary paralysis had closed quote several months prior to the october two thousand and thirteen report that means according to mr spriggs which must be taken as true on a motion to dismiss he had a five and a half year window between january two thousand and eight when he underwent brain surgery and mid two thousand and thirteen when the window for progression had closed because he didn't receive adequate therapy now that we believe that mr chester alleges a timely complaint in the complaint is written a sorry excuse in a timely claim in the complaints for three reasons first he alleges that his injury did not actually occur until mid two thousand and thirteen and that is the window for progression from temporary to permanent paralysis closed according to kubrick i claim does not accrue until there's actually an injury mr chester could not have filed his claim any earlier than two thousand and thirteen because he was still only experiencing temporary paralysis which if you've been referred to a competent doctor or therapist could have reversed so i can just as claim was timely under the delayed discovery doctrine even if there is a dispute about and third just just claim was timely under the continuing violation doctrine because defendants were persistently indifferent to shuster as ongoing medical needs and that's true in at least two respects first then gauging a pattern of conduct and which they continue ignored or chester's pleas for appropriate a v m treatment and post surgical therapy and second regardless of what chester requested defendants were aware of the fact that he's experiencing deteriorating condition in his right hand and arm and failed to do anything about it but first go ahead to what you just said though about the delay in surgery he certainly knew that the delay in surgery had happened yes right and i did wasn't of his his arm that's correct his claim is primarily against the primary care providers that he had at the prison hospital where he was staying and against the director of medical services at that hospital and if you were given leave him in but what he  complaint he had several things to extend necessary he would clarify that his his injury was only temporary and it was a preexisting condition not necessarily caused by defendants conduct but resulting possibly from  that and number two i think he would add more factual detail explaining the precise timeline i mean admittedly this complaint is not one that we would include as a model in the ninth states good morning and may please the court my cause good for the defendants the district court correctly held that the statute of limitations barred the specific claims plaintiff made against defendants those claims were that defendants denied or delayed plaintiffs treatment which causes harm to become paralyzed as plaintiff wrote the delays included that he was quote was denied being sent to the right doctor for post surgical care for a year i want  just says he had him a priest and he claims he recovered from it another thing so a claim accrues for a patient when they know about a bad medical outcome and who has allegedly caused it as plaintiffs conceded below he sued defendants over quote their treatment of him in two thousand and seven through two thousand and nine so back in two thousand and nine plaintiff knew defendants manage care had delayed treatment and his hand had become paralyzed like in the ninth circuit's look of ski decision plaintiff quote knew he had been injured and by plaintiff and this is very important plaintiff  never did you know it was permanent you know a couple thing when i took from this is that with this type of surgery that he had it seems that there is one of the residual effects is some temporary paralysis a couple of things he addressed a couple things on your honor one is his actual subjective understanding it's not the test sandringham it's an objective test so on that point i do year after he gets a surgery and he goes and sees dr william and all doctor when can do according to plaintiff is give him some stretching exercises for comfort he should have suspected it was permanent now saying all he could do that was all the doctor said he was going to do the i'm stuck with mr chester's words and what he said was all he could do the doctor everybody was i mean that's part of the question when we have a pro se complaint is they say you're stuck with it so you're correct to say it that way but we do try to interpret it liberally i understand you're on but getting getting back to the question about the permanence of the injury a temporary bout of paralysis is an actionable injury and causes a claim to crew and i put this thought experiment in my brief if dr william had given mr chester the correct exercises and cure the process mr chester would have a viable lawsuit saying hey you guys delayed getting me to  william he fixed my problem i've been paralyzed in the mean time that's an actionable injury and the supreme court is clear that it's not appreciation of the full extent of the injury that causes it's to crew if you have an actionable injury at that point you're able to sue in that let me give a classic example so if a person finds out they have cancer and it was caused by someone or wasn't treated properly they don't have to wait to die before their claim accrues they're just the knowledge that that will happen the claim accrues and they can file suit at that poll though if they putting aside the way he couched it in your hypothetical if the surgery was done right and he the then did not do the proper post op here then he wouldn't have had an actionable injury for a year let's call it  paralysis and he in his complaint he does talk about pre op and post op so if he didn't have a viable pre op claim but he did have a viable post op plane you have to distinguish what he knew from from when it happened right just sort of but what i would say is he knew that he wasn't getting the post op care so he in the nose defendant's role in providing getting him to that care when you say he knew he wasn't getting it because there was a delay in getting to dr william correct your honor so in in fact he alleges the reason why these defendants were deliberately indifferent why they knew as his managers there was a problem is he was telling them that he needed to get the care and this kind of leads to the paradox in plaintiff's case deliberate indifference requires the defense to know of a problem and then ignore it i haven't been able to find a lot of delay discovery and deliberate indifference cases because of this paradox either normally it's the plaintiff and the doctors know there's a problem and then the doctors are ignoring it but then that gets rid of delayed discovery because people know there's a problem or and i think this is this case no one knew there was a problem with dr williams treatment plaintiff alleges that he is telling the doctors that he needed to be seen by the right doctor and then he says in his complaint in his opposition that he was seen by dr william and that who at least had experience with a v m so that point there's no allegation that the defense knew there was any problem with dr williams treatment so what is been missing from plaintiff's presentation in their briefs and even here today is what is it that plaintiff later learned about what defendants actually did that he didn't know about back in two thousand and nine the difference being the did the injury i mean i agree that all of the things that happened other than the fact that nothing happened later on happened earlier but if the mindset was it was temporary before it seems to be temporary now and then they tell me i'm never going to get any  better and if dr william that was why i was sort of diggin you on the all he could do if the doctor says this is all i can do you're never going to get any better i would agree that he accrued right then but but but  then there's a problem of that your own if dr william said there's stuff i could do or mr chester had any idea there was something that could be done his claim also he accrues and he can't claim delay discovery because he knows right then there's still a problem and at that point he can file suit he can get injunctive relief he can get sent to the right treatment providers i do these cases we see that a lot of planes will file saying i need to be seen by this nationalist get me to th specialist and by their claim a cruise they can get injunctive relief and they get seen by the right specialist but no one here there's no allegation here that anyone knew there was a problem with dr williams treatment and that's the does what the district court said below about that is mr i and i put it in my opening brief and in my reply there's been no connection made between what defendants allegedly did and the problems with dr william scare and it seems to me that this is what this lawsuit  about is what dr william did he provide the wrong care that may be a complaint against dr william but it's not a deliberate indifference claim against these defendants who what they supposedly did was just delayed getting plaintiff to dr william and turning back to the injury not only is it an objective standard so that means that would a reasonable person suspect that they were permanently injured  so a year after surgery mr chester has seen no improvement another year after that he's still outside the limitations period at that point that's two years after his surgery he apparently is not see any improvement a reasonable person would suspect at that point that the paralysis was permanent what the plaintiff's plaintiff would have us the core belief was that five years after the surgery he was still paralyzed and he somehow still says believe that this was a temporary condition and it wasn't till a physical therapist told him no something could have been done that he learned it was permanent what mr chester the reasonable reading of that report is what mr chester learned was that in fact what he thought was permanent wasn't permanent it could have been fixed so he actually learned his permanent injury was not permanent or could have been it would maybe it was now permanent but here he should have been believing it was permanent he didn't think anything could be done which is why he hadn't done anything trying to get more treatment after dr william at least according to the complaint any conduct that occurs within the limitations period is not suggested you should be given leave to amend the plaintiff's didn't ask for in their opening brief your honor in so i would argue that it's futile because fundamentally this is a lawsuit about what dr william did and we haven't heard anything about what these defendants did that actually would be an actionable deliberate indifference claim so i think the claim would be futile and that would be my argument on thank you thank you briefly touch on the nature of mr chester's allegations here to be clear he alleges the failure to act both before and after surgery that began with delaying the surgery itself following surgery he didn't see anybody who could treat the temporary process he was experiencing either resulting d v m or surgery until a year later when he saw dr william and then you alleges that for a period of four point five years between bring suit against dr william because he felt like dr william wasn't the person he should be referred to he should be referred to somebody skilled in treating a v m injuries but the critical allegation here is that he allege failure to act after two thousand and nine continuing until two thousand and thirteen it defies common sense to suggest that these defendants absolve themselves of any responsibility because in the period of five and a half years they referred him to a specialist wants to treat temporary process i also want to clarify that in two thousand and nine he was not fully paralyzed he was experiencing partial paralysis a declining ability to use his right hand an arm is described as a loss of motor function but he was not fully paralyzed and fact dr william perscribe stretching exercises which would be totally counterintuitive if you were in fact fully paralyzed at that point it was only partial and didn't become permanent until two thousand and thirteen which is when h