incarcerated at cal state prison los angeles county in nineteen ninety eight lot just revealed that fourteen has suffered from kidney stones one of the most painful medical conditions that a person can experience for t o complaint repeatedly of this pain pain as coming from surgical scars and not kidney stones that on its own may have just been negligence but dr de castro discovered the misdiagnosis and did nothing to make sure of that party or receive the treatment he needed how do you were  was because johnson is the administrator somehow he became the go between between the patient and dr de castro and the attachments reflect that it appears that johnson de castro communicated and the castro sat and looked at the x rays and he that might be negligence you know appears from the record that it was very rare for an inmate to see any any doctor at all let alone a specialist it took two years to get him to see anyone so dr castro realizes he made a back and looked at the x rays he ordered when they came in and he tells dr johnson that they pair asked how are you and i will point out that the x rays indicated that he still had kidney stones there was at least one presence down even attacked in time around that to page twenty one there's a handwritten note patient across the top and it describes the doctor the castrol went back and looked at the x rays and determined that he did have kidney stones but they had passed not if he didn't make sure that if he did it in our view it reading this record they gave the way a doctor should behave if you make a mistake especially with the holder of a patient like mr portillo you need to make sure that he gets treated properly he and that and that standard was just a little too tight in courts expanded to permit deliberate indifference where somebody really just knows that knows there's a problem and looks in the other direction for a so you have a stronger case against him but still if at the point he refers the case to the specialist who's the castro and then the castro makes a mistake and it looks like johnson just relied on the castro why can't a supervising medical officer relying on a specialist in other words why isn't that just in the negligence range realm when johnson was kidney stones actually for years his medical file had indicated kidney stones and he hadn't gotten treatment even for two years leading up to and even i think the pain is extremely important in this case it wasn't something minor he was in excruciating pain for years and so i think when a doctor states find mellowing how risky kidney stones are and knowing what kind of pain he was on her it is deliberate indifference to send him back to her cell and not give him any treatment if you want to save a minute rebuttal yes please thank you very much thank you that would be the example that i referenced and in addition to that there's another reference to it and that would be again the ministry of appeal and that would be equally true when mr patel goes to the i'm sorry this would be depend four days i think that that shows that as long as the kidney stone is not a blockage and i would also refer the course of the x rays there was never any blockage and there was never any serious medical condition but this is not summary judgment this is a complete and he's  them would be negligence you know absolutely no indication from the record that what the doctors did were the appropriate that perhaps that would right then but in this particular case there are the documents themselves show that these doctors didn't do anything wrong but i would say fans of the course question directly if there was a situation where there are treatment with so outside the norm that there could be only one conclusion and that is deliberate indifference i would number of documents of past all the documents i've referred to so far and i would also emphasize again for the court to look very closely at the administrate of appeal because in that you will see that when he came to dr de castro dr johnson and i believe the lower court acted appropriately in determining that that correspon the deliberate indifference standard and secondly don't you think castro may well have known that there were stones in the x rays that he looked at we don't know if he made a second mistake or if he saw that they were there and simply didn't pay any attention to that so it's not they were talking earlier about were there just two mistakes not necessarily in fact he may have overlooked and deliberately the second time and that would strengthen into a case of fifty nine page twenty one that castro concluded