as alleged on numerous occasions during his incarceration mr pratt exhibited obvious signs of delirium tremens and head trauma or brain injury emergent and life threatening conditions as we allege it would have been obvious even to a lay person that mr pratt's emergent and life threatening condition could not be properly or adequately manage in a correctional setting and they required immediate hospitalization yet even after mr pratt began hallucinating profusely sweating continuously bombing showing signs of an acute panic state harming him self sustaining head injury the medical staff at the jail refused to send him to a hospital in violation of armor correctional services own policies and clinical protocols bydel signs were never taken for three days and violation of policy and caesar seizure precaution order mr pratt did not receive transport to an emergency room until he was pulseless and completely non respons by then it was far too late the damage had been done and this tragic result would not have occurred but for deliberate indifference plaintiff has brought constitutional claims that are eminently plausible and should not have been dismissed we allege that mr pratt was a pretrial detainees as such plaintiffs allegations of deliberate indifference to mr pratt serious medical needs rather the th amendment rights of pretrial detainees like mr pratt should be analyzed under an objective standard of liability the stems from the supreme court's two thousand and fifteen decision  kingsley made clear that the subjective standard applied in th amendment cases does not carry over to analogous challenges alleging due process violations treatment and the other is alcohol withdrawal and the defendant's position as i understand it is this was a case of alcohol  was treated properly so my question is is there a difference between the two in your mind is that this because perhaps when the inmate is having d t s and everyone agrees he or she should be taken to the hospital to the emergency room but if it's alcohol withdrawal there are other protocols giving vallium things like that and that's that's ok to do in that circumstance can you can you clear up my mind on  that issue with care yes or i mean obviously i'm not a medical expert but my my understanding is that delirium tremens is along the continuum of on december th two thousand and fifteen where she documents constant nazia frequent dry heaves and bombing severe tremors acute panic state as seen and severe delirium or acute schizophrenia reactions required and intent such as an intent to punish and kingsley is that there's an objective standard for excessive force cases for example here's a any cases by this circuit or the supreme court that apply to a nuclear standard in other words no longer a subjective standard and deliberated different type cases  score involving not outside the context of excessive force where the objective kingsley standard was applied  qualified immunity now there is no qualified immunity defense in this case or search and the underlying by aleisha is were committed by a medical staff that's employed by a private medical provider and the only claim against the sheriff isn't as fishel capacity so there's actually no there is no qualified immunity defense in this case   tremors acute pain and so forth this is assessed and indicated that mr pratt was suffering from delirium tremens have you adequately alleged however that nurse dean protocol that armor used that would have indicated that this was delirium tremens i think it would have been part of her training where she should have she should have known that  well i think he continued he was continuing to suffer and exhibit these symptoms that was an emergent condition he continued to exhibit these symptoms throughout that eight hour period  symptoms that nurse dean observed but he had sustained an injury to his head either self's self sustained or through a seizure or falling and there was a pool of  situation didn't dr mcelroy though and when he and again we're we're we're working off your complaint because we're at the twelve the six situation but  well it's just it's so obviously inadequate and also we we don't concede that we don't concede that mr pratt was provided with the bombarding to just give that man about him and an essentially call of the day is so obviously inadequate that it can right rise to the level of delivery and difference in the case that we cite for that wondering if we went to a pure objective standard how does that not put us in a situation where we're negligence claim could survive well i think that of course the court could adopt a negligence standard but the if you look at the the the other courts that have extended kingsley outside the context of excessive force they've used a  reasonable the th circuit uses a reasonable practitioner standard the nd circuit and are now used as a standard of recklessly failed to act with reasonable care to mitigate a risk that the official knew or should have known of which is actually similar to a deliberate and different standard that was adopted by the th circuit in  s is actually a form of alcohol withdrawal it's just on the far end of the spectrum anyways not only were the health care providers treating the symptoms and complaints related to his alcohol withdrawal they actually recognized he was likely suffering from alcohol withdrawal they then implemented a course of treatment targeting not just the symptoms he was exhibiting but the actual condition he allegedly had as for the alleged deprivation plaintiff complains that more frequent monitoring should have been made but more importantly the real crux of her claim is that the defendants failed to transfer mr pratt to a hospital to get e r level care of course she fails to allege what additional treatment would have been provided in a hospital setting versus the medical unit at the told to county jail according to a complaint while the tulsa county jail the health care providers assessed in multiple assessed him multiple times implemented alcohol withdrawal protocols initiated treatment while monitoring him in the medical unit he was ordered to be given librium a sedative used to treat patients going through alcohol withdrawal as the symptoms worse and more defendants change his medication to value a stronger sedative used to treat patients going through alcohol withdrawal plan it does not allege that the medical providers at the told the county jail were unqualified to treat a patient going through alcohol withdrawal plan it does not even allege the medical unit lacked any particular resources equipment or specialist necessary to treat a patient going through alcohol withdrawal claimed it merely alleges that mr pratt may have been suffering a more severe form of alcohol withdrawal therefore he needed to be at a hospital disagreements about the location of the treatment received so long as the treatment is tailored to the medical need is not a constitutional deprivation disagreements with how assessments are performed when vital signs are taken and what specific medication should be given sound in negligence and not a constitutional deprivation the plaintiff did not allege the defendants ignored mr pratt symptoms or that they refused to treat his alcohol withdrawal she merely claims that untreated alcohol withdrawal the way they should have she alleged that he deserved more and better care those allegations alone are insufficient to state a claim for relief based on the substantive due process clause of the th amendment as such the district court appropriately found that the plaintiff had failed to state a claim upon which relief could be granted heart withdrawal it's just absolutely by the book send the person to an emergency room in the hospital so i'd like to divide after two issues well and i said adequately there was sufficient evidence of t t s are you traveling that i am your honor i think based off the allegations including the diagnosis that the plaintiff allege  was given at st john's medical center which does not include d t s as a medically diagnosed condition that this patient had that extreme form of alcohol withdrawal was not diagnosed  alcohol withdrawals they the symptoms mirror one another and so it's it is a condition contained within a broader condition that was being treated the treatment is the same and they don't allege the treatment is any different other than the setting in which they claim the treatment should have occurred and i think as we've all come to learn recently the setting or the side us of treatment is far less important than the quality as well as the specific treatment you're getting it doesn't matter if you're being treated in a hospital or a medical resources and expertise that the medical unit of the jail is that correct correct where he's alleged that in the medical unit at the tolls the county jail mr pratt was under the care and treatment of nurses licensed mental health professionals as well as a physician he has an alleged that he would have received any further additional treatment had he been transported to a e r care setting where as we all know a care setting may just be seen by a physician's assistant a nurse practitioner a mid level provider let alone a doctor mcelroy which he was actually being treated by in the medical unit the jail and i was listening to your answers the question that came to mind is why why aren't the arguments you're making more appropriate to a summary judgment  context as opposed to where we are right now with a motion to dismiss we we have to take the allegations of the complaint is true try and senses in favor of those allegations and right now we're talking about whether the jail was adequate or but did they really need to go to the hospital anywhere on the spectrum and it just seems to me we're getting into fact questions that would be more appropriate  summary judgment stage can you address about sure and i think i think the district court has rested in its opinion in order when it said the facts taken as true indicate that mr pratt received medical treatment although they challenge the efficacy of it and that's the issue is that the treatment was rendered according to the plaintiffs they just disagree with what it was for the condition but the treatment was the patient was being treated for the condition alleged by the plaintiff throughout and the what level to which that treatment was given is not a question for a constitutional deprivation claim such as this that's a good question for a negligence claim but not for a claim such as this and to allow official capacity liability rises only when there's an underlying constitutional violation as the district court correctly found in this case plaintiff is not sufficiently pled facts which would give rise to the constitutional violation and if i could i'd like to address judge harts your your issue with regard to deal the whether there was a diagnosis of d t s it's plain from the complaint a diagnosis of delirious truman's was never reach with regard to mr pratt paragraph twenty one dollars of plaintiff's complaint and it's on page five of their brief they conclude that the assessment indicated that he was suffering from delay or instruments they don't cite anywhere in the that anybody else concluded that he did they then go on to cite some out of circuit cases that suggest that it's a serious medical need one suggesting that it's a serious medical need that requires me hospitalization but what their own only the only thing that they're doing is taking issue with the conclusions reached by the individuals who were present giving treatment on that day that's a classic not a civil rights case that is just taking issue with the decisions made in light of what they were they were seeing the assessments and and how they treated him and not any knowledge or deliberate indifference to his medical need so  never indifferent to his medical need whether he was or counsel yes this is this is judge mathis and you mention his server at twenty one of the complaint but paragraph twenty two alleges this to any moderately trained medical that that this is a fact this is just merely conclusory language by them to support their case in these type of cases of deliberate indifference you have to have some knowledge and awareness and the the record as reflected in the complaint shows awareness of his condition and treatment at every turn whether it was for an injury to his head or for his alcohol detoxing i thought it was interesting and judge carson asked a question about you know if we were to go for kingsley is this just next negligence i think we have to remind ourselves that even kingsley stated that you know liability for negligently inflict the threshold of constitutional due process and i don't think this case we need to wrestle with that standard at this time because of the timing of this case  in my view a constitutional violation to give rise to official capacity liability and if the standard at the time is deliberate indifference then there can be no constitutional violation  is limited at least according to the the the case itself to excessive force issues if we're going to broaden that and certainly there's ongoing debates and discussions throughout m circuits there just isn't any notice to these individuals and there certainly didn't exist as a constitutional violation at the time and that's why i say i don't think we have to reach kingsley in this case at this time capsule matheson to do ha the obvious signs of d t s that these and this individual these individuals were assessing this isn't a case where somebody wasn't observed wasn't brought into the medical unit observations were made and d conclusions were reached and treatment was given on this this stands apart from a lot of deliberate and different cases where you can show that there is a need that they're aware of this going on treated so i think the district court was if prison officials intentionally deny or delay access to medical care or intentionally interfere with the treatment once prescribed there simply isn't any alleged fact that any medical provider and tinsley denied or delayed access or intentionally interfered with the treatment once prescribed appellant doesn't even address the standard and redmond versus crowther just complains that it's too narrow the court followed existing law and found this case correctly we asked t over forty five seconds at this time ok i'm going to give him thirty seconds things get confused here and time it used up quickly  fifty six and we should be i think we again we've plausibly alleged deliberate indifference and to the extent we should be given the opportunity to conduct discovery and develop the factual