good morning your honor is made please the clerk with the court's permission i would like to reserve three minutes for rebuttal of your orders this is a case in which a young fellow  still a teenager was admitted to the jail in frankfort franklin county kentucky and over the sit period of six days profusely to the point that on the th day he began to have seizures had to be transferred in there and then airlifted to u k hospital because he had renal failure lactic acidosis from such severe dehydration he almost died the reason this happened is two fold run he was the responsibility of two organizations st the jail and the jail staff secondly southern health partners in the medical staff in the jail the jail let's talk about the jail st the jail had a policy a written policy that was supposed to prevent this the jails written policy said that alcohol or drug withdrawal was a medical emergency and that when its officers its deputy jailers observe the signs and symptoms of alcohol  drug withdrawal they needed to at least tell the nurse what they were seeing in this case the evidence demonstrated that that policy the the guards responsible and who were monitoring mr griffith didn't even know that the policy the jailer didn't even know what training those officers had received on in the policy and that to the contrary what the practice runs in the jail w that the deputy jailers would look in and check an inmate and merely two for the purpose of confirming and they said this repeatedly in their depositions one after another that the inmate was living breathing flesh if they weren't then they would tell the nurse as a consequence the judge rochon mr griffith vomit over and over and over again six times in the st three hours he was in jail sixteen times in the st three days but they never told the nurses they didn't fully logged it in observation sheet that's how we know how many times they saw him vomiting but they never told the nurses and the nurses never looked at the observation sheet now brings us to seven health partners so the health partners has a written policy in place that is critical it says it's very specific about how detoxing inmate's condition should be managed and it requires the notification of a provider a doctor or an a p r and at the outset and then their continued involvement in the management of that patient's condition it also ask you there was a detox unit he went into a nationally correct yes or forty eight hours yes and at the end of that period he was not bomb a team at that point was yes he was judge in fact he stayed in the detox unit he came in on a sunday night he stayed in the detox unit until wednesday afternoon on wednesday afternoon the officers observation logs indicated that he was still vomiting while he was in detox while he was indeed talks he was seen on wednesday afternoon by a one of southern health corners  lpn or are in need to double check that but he was still complaining of vomiting and nausea and they knew then your daughter that he was at that point having trouble urinate which created real concerns about dehydration despite that your honor the medical staff said ok take him off the top didn't they give him some medicine for based on the urine reason southern health partners written policy saying look if you've got a patient that's going through detox call a provider from the get go and even their protocol for nausea vomiting says that call a provider is because in our ends can not diagnose or treat patient illness absent the supervision of a provider that he can't provide medical attention so a provider was not called at any point while he was in detox no in fact your honor the there was a there was a practice that an a p r in would visit the jail once a week to spot and the judge and the a p a or in the evidence in this case showed that the a p r in visited the jail rom mr griffith was still in detox ron he was still vomiting after the nurses the o p s in the are in at the jail became concerned about  hydration because he was having trouble urinating and because the e p o or is when she would visit the jail would only see those patients that the origins of the opiates diagnosed as mer attention they didn't put mr griffith on the on the list for her to see them so he was never seen by a p r n or an lpn in fact you're out of the deep the hospital system at the documents if you will that seven health partners provides its employees and in this case it's employees or you know peons in the aryans it's their policies and procedures and then they have protocols that and for example in this case the policy and procedure talks at length about the importance to monitor somebody going through drug withdrawal or alcohol withdrawal of which vomiting can be a symptom the protocols this doesn't talk about detox doesn't talk about those things it says tells the nurses look if an inmate presents its sick call and he's complaining of nausea and vomiting the st thing it tells them to do scala provide what these nurses were doing was they won't call in the provider they were just going down the protocol and that's wrong st of all it's abolishing the policy it's a bottom of the protocol nd it's got them diagnose it they don't need to call a provider because they believe they know what's wrong with this young male and as mr griffiths case made clear they clearly didn't they knew they provided him medication you're on or they knew correct in a in applying objective reasonable notice by virtue of the court's decision in king salie that had everything to do with the presumption of innocence that attends a pretrial detainee and and  the objective and reasonable this test and we're a very fluid situation here because we have the court's decision in kingsley and we have different circuits talking about what objective and reasonable means judge been tate who said he said we didn't have a federal claim number one because mr griffith was it ignored in number two because he was not recklessly  given the the language being used became confused the supreme court in came slowly the district clerk when it remanded the case said don't instruct the jury on medical claim they said now there's reckless there's objective recklessness which is knew or should have known and then there's a subjective recklessness where you have to prove in ted well circuit the nd circuit settlements would apply in this case and i think where he went with that your honor was he went right back into subjective intent with the regular particular circuit that we're dealing here with a case particularly when it comes to southern health partners and its in its personnel where we have proven number one violation of policy number two we've got an expert or a qualified expert who has said they violated the standard of care and the lp ends and they are ends were violating the legal limits on their scope of practice and we have evidence that this wasn't a mistake this was an inadvertent this was an accidental this wasn't a miss phone call this wasn't somebody failing to see a yellow sticky trying to remind them to do something this was what they did this was again your letter let me take that from two perspectives st the jailed and seven health partners in the shed rick case judge strangers opinion in that case said look it's bad enough when the employees don't know the policy when the supervisors don't know the policy you've got a case for failure to train and supervise and in with regard to the jail the the employees obviously did know the policy you got you've got a an argument on a practice that constitutes a policy that constitutes a constitutional violation but the jail or the gender didn't know what trying to use employees received on the m s policy and their expert the are experts in deposition when it comes to an emergency medical service policy when you're talking about life and death issues there's no excuse for not training supervising and knowing that your employees know enforce their policy when it comes to sudden health partners judge you can look at judge branches opinion in chadrick because it goes straight to seven health partners that was a sudden health partners case and that case was reversed sent back on southern health partners for trial of deliberate indifference fader train and supervise because none of the employees followed the policy they are in mishra rowe was the head of the medical services unit at the jail and she didn't know the policies or follow them so it's just a continuous this is this again this is subsequent to shed like trying to say stop this stuff but they keep doing it right  take six miss bray is going to take three days can be a very bored of argument i'm going to make someone try to get some of the half points and i hope that you will pay attention to my briefs in this case more than mom arguments because i'm sure i will not be able loses twenty five of our brief it's show that these deputies were trained on on these policies and procedures polluting the e m s policies and procedures mr belly took mr rogers deposition and that is mr mr belize or mr rogers testimony we gave him place twenty four hour brief when these were these officers given eighty hours of training including going over the policies and procedures which includes the mass policy also they're given sixteen hours at that time annual training in kentucky for jail to jail guards us now call it twenty four hours but this time a believe it was eight hundred and sixteen dollars and that includes going over these policies so it's just an absolute mis characterization of the record that these these officers were trying but then how do you explain that all the officers are saying that they were just a need to keep keep inmates living breathing flash that's better is their interpretation there's no proof that mr indicate in call and tell them the nursing staff this is not a situation where mr griffith was in a detox cell for three days would know by looking at him he was in fact seen by the s h p staff the next day he was in there like six hours after he got in there they started administrating whatever whatever they were doing to him in fact he was seen twice a day during his detox by a nurse for s h p that was that was part parcel of the of the regimen here and also once he went out for detox it's not like he continually had a medical issue for six straight days like mr mr gill mr velshi characterizes three days went by with no problems no medical no medical slips were were were injured in fact the medical slips that mr mr griffin testified he knew how to do fill a medical slip he knew where to get it and he gave it two or three times while i was in detox and even seen every day that day to say to pee what about his contention of vomiting  before he left detox he didn't have a seizure until three days later it was in general population has one seizure he's immediately as he did two is there a policy as to how long prisoners typically kept and d your title to a basic human need both parties are entitled to basic basic human need would a convicted or not convicted there's no difference in that the the fact is there's been a lot been made of this saw mr griffith in the early part of the his stay i do take issue with the number of arguments put forth by mr belzer st of all the issue of detox there is not evidence that mr griffith was detoxing and i think that has been set forth that this is you mr griffith show up in jail and was going through withdrawal he there's no evidence of that he was point in a detox i would see vomiting if you i mean what what did the nurses think when they saw him bob that stomach bug your honor and in fact that mr griffith himself testified that he felt it was nerves he was scared that night when he got he was young kids eighteen years old he calls mom he's crying he's evaluated by mental health that evening and they put him into medical or they put him into observation forty eight hour observation as a moderate risk are nurses see him full time during an observation they also see him on two separate sick calls he puts the night he's immediately seen by mr that she does vital signs she checks his skin she refuses would wear his hydration with him everything looks ok he puts another sleeping on the tent same thing she refuses vital signs refuses hydration review something called skin to her you'll see that in the briefing in some of the medical records she's checking for hydration and she reviews his hydration with him once again what a dead there that are strained to do any kind of analysis of the urine sample they cannot do when else is the sample that was the intent of that was for a nurse practitioner who has a higher level to come see him on her weekly visit and review that you're ok and  acute dehydration to the point he's going to suffer an acute kidney injury this is someone who's fine who's at the canteen who's buying a number of goods what caused the seizure i have no idea i don't know that there's been no gets if you will of potential ingesting of illegal substances such as synthetic marijuana there was comments made in some of the u k in frankfurt original records alluding to that i don't read cause a seizure i don't think anybody can say that any sort of dehydration at the jail causes acute nurses you represent that were involved after he left detox and treating him they were they saw him on the th they did not see him on the th or th he was seen by miss a basic human need which is what medical care is should be no difference between a pretrial detainee and somebody who's convicted i don't think that standard should be different to take this to  your amount of time thank you very much it's important to require that the district court granted summary judgment on the basis of no verifying medical evidence of any harm to mr griffith so regardless of the standard applied my client is entitled to summary judgment on the basis of the fact that there is absolutely nothing that ties any action or inaction of my client to any harm to the planet i believe your opposing counsel made the argument that the nurse didn't review the notes that the prison guard had written about his condition actually your honor if you were read through mr bell's lee's brief you'll see that what he does over and over is he conflates all of the nurses as if we are eleven organization so establish any individual action on behalf of any individual violation on behalf of nurse monday time so there had no reason to review any laws or anything with respect to mr griffith when she arrived at the thousand six hundred inmates at the jail she comes in and have to have a kite you have to have some sort of you has to be brought to you by deputy there has to be some reason why if there is someone who is in a particular type of cell like a detox or suicide watch then there are protocols that say women are supposed to go see them so yes you would necessarily have a kite for that but in the absence of that there is no reason for a nurse monday and even though that mr griffith is there there was no and there was no quite the st thing that she knew about it was the st thirty days that she was she involved in the care she was there only only the morning that she was there for two days that he was inmate the only time she saw him was the day that he said and she sent him out so she saw him for approximately two hours there's a seizure she responds to the cell she brings him to medical she spends forty five minutes to an hour assessing him reevaluating him he  e for want of a better time comes back to himself request to be sent back to the cell she sends him back to the cell after she's done med pass comes back to review his chart at which point there is a nd seizure and she sends him out  there's absolutely nothing that that shows that anything that she did or could have done would have prevented the seizure or would have mitigated any of the damages that that occurred after that where you know he had more than one  there is absolutely no expert evidence that demonstrates that every seizure needs to be sent out and quite frankly lots of inmates have lots of seizures that do not result in  any treatment that needs to be done outside of what ms has monday and did and we had once again mr besley did not pose any of our experts we have correctional health care nurse who says that this was within the standard of care and i would take exception with the characterization of mr mandela and sending him or calling their show as opposed to sending him out as if that is any different from me walking down the hall in my law firm and saying hey i this case what do you think about it these are the things i've done can you think of anything else i should do she's not deferring to michelle rose decision with respect to shipping him out she's just asking are these are the five  eight things i've done in response to this seizure do you think i'm missing anything if i could or our hats there's absolutely no reason to differentiate between pretrial detainees and convicted prisoners with respect to medical needs your honor because it is a basic human right you don't get any more rights to a basic human need because you're  will because they've got a presumption of innocence your honor the reason the deliberate indifference standard so you believe that people that go to prison should get reduced health care from people that are out of prison  people that have been convicted and found guilty of a crime are in taht i mean they're going to be punished there's a recognition of that and th amendment says we recognize some punishment is appropriate but not cruel and unusual punishment so because of that distinction the court has all in farmer and then and still be gamble well we got that reversed a still st and then pharma said you've got to have you've got to prove that the punishment is unreasonable when it comes to a convicted prisoner and so to do that you've got to show deliberate indifference subjective intent but the supreme court in kingsley was very clear that when it comes to a pretrial detainee as to whom no decision has been made as to whether they want punishment or not it has to be an objective unreasonableness standard what's even more interesting is they make that distinction in an excessive force case is an excessive force case under the th amendment you have prove more than deliberate indifference you've got to prove that the conduct was malicious and sadistic because it's oftentimes split nd and an officer is trying to decide what to do when it comes to medical people you just have to show deliberate indifference and that's because they have training they have time to consider their actions their conduct and the consequences now the defendants in these cases continue to conflate lpn or in care with medical care  ot say you know they they took his temperature they did this they did that when i question these peons in orange and deposition i always ask them and they say we cannot diagnose and treat we can do is we can take vital signs we can take objective and subjective complaints and symptoms and we pass that on to somebody who can give medical treatment a diagnosis and a decision as to how the person can be help the defendants to to acknowledge that there's no telling nobody over the course of six days it would determine what was causing this young man to vomit is stunning now there are a lot of factual issues that need to be resolved by a jury the nurses said they didn't have to know how often he was vomiting they could have looked at the observation logs and determined that the jailer said they didn't tell the nurses because in their opinion this profusion of vomiting was no different than what goes on with a lot of the people that come into their jail and detox that's a jury issue what happened in the last three days is a jury issue w honor you raise the issue of the release from general population into general population when there was a vet thought mr griffith needed to be monitored he needed to be put in what's called a dry cell to determine how much fluid he was taking it there was no dry cell of able shrugged her shoulders he wasn't monitored at all our experts say he got a monitor you can't leave it on the back of some terrified eighteen year old kid to t