all right our final case for today is turner against department of corrections the primary issue that is here on his and the basis for the district court's decision was that the court decided that the we had in showing the purchase personal participation of the defendants in the care of the  plaintiff in order to establish liability on on their behalf and and just really this was a patient who needed to get referred from cook county jail for a rope for actually knows he obtained at the jail he had to the surgery not cook county hospital or not cook county jail so therefore the doctors and the staff could kind of gel their no responsibility for what happened what do you think they should have done since this record seems pretty clear that it's a little surprised about this but it's the medical and they did several times they far as i can tell they did several times and he did get scheduled and then roughly three times for surgery it's a little unclear but roughly three times for surgery he got scheduled in the surgery gets canceled but if they were monitoring his care as they have a duty to do because he's an inmate at the cook county jail if he doesn't get the surgery and goes back to the gel without getting the surgery they have the operation then to do one of several options they had either call call  the hospital talk to the scheduler which they have the option of doing talk to the surgeon which they have the option of doing or just send them over to the plastics clinic the specialty clinic over there for print so you can get pre op clearance and then go through the process and they just didn't do that enough they they did it a couple of times but then they didn't do it on many time so he got scheduled for surgery it looks like he got scheduled for pre op once in december then it went over to he didn't get skipped he didn't wasn't scheduled for surgery until late february and when that surgery if every twenty six when that certainly got canceled he gets sent back to cook county jail and then again the last time with march st he got scheduled and then that did happen so there was several times and  a lot of delay ensued in between those times so the plaintiff in this case he filed roughly twenty five health service request forms and or grievances in connection with requesting medical services for his care or or just grieving the fact that he was in pain and he needed care and then it got to the point where the criminal court judge it was seeing as a criminal case give gave to orders other related to getting him care and in the course of getting that's who orders they would go to channel that they went through and there was no follow up so let me ask you about the state court judge's participation because it i got the impression reading this sequence that he wasn't entirely forthcoming with state court judge about t carry was getting at least at the jail granted he doesn't get the surgery rhinoplasty surgery until actually after he's out of the jail but but the it sounds like the state court judge was getting the he was just sitting there all by himself nobody was doing anything well i think that the he i don't think he was the most articulate individual in the world for example he said there's a boat for tooting through my eye and he's standing in front of the judge obviously there was  told that his the bone was misplaced near his eye and that's you know that's what he says but so what he said he said a couple things that weren't precisely accurate on the other hand he did clearly say look i'm told of course to get the surgery i'm not getting the surgery and so that the court the judge did exactly i think what the judge should have done he says look give the surgery if you need surgery because of course the judge can't say you need surgery so these court orders would happen they would they would go through this process of th navarro who's going to deal with court orders and they would go to this doctor monella who's in charge of continuing to continue any of care she was the policy maker and then and then the primary care physicians might take a look at it but then there'd be no follow up to see that he such swelling after the original injury that you really need to wait about six months before you should attempt reconstructive surgery sure and that opinion was never expressed in a medical record it was st made up positions after the fact and this is by the same doctor six month time period so i think we can and then both experts even the defense expert said he was a candidate for surgery beginning in january which would have been less than four months post the incident so i don't believe that well that's at the very least that's a credibility issue because of the inconsistency in what he did versus the medical records self the other thing that i want to each of these doctors that saw him the primary care physicians they have they have the obligation to to deal with them plaintiff's care is under the department of corrections they're responsible for sprigs care the doctors represent the department of corrections so what about the administrators usually in cases like this administrators are entitled to rely on what the medical people are so they are entitled to rely on what the medical people are doing but that medical people weren't doing enough and you know they have to if he gets referred they refer him one time over and they send them right back then they've got to do they've got to make sure he gets sent back over again not just like let's fall through the cracks because this would fall through the cracks until either the with a judge a court order or he makes some more health service requests or grievances tell me about you hospital and storage or hospital delay delay delay didn't get it the defense was exactly identical to the defense here with the people of the county jail don't do surgeries so she dealt with that in the context of the liability because it was a pro se inmate that did the case medical need the and she noted that the responsibility for securing medical care for the prisoners rests with the county jail so merely referring them out to somewhere else does not insulate or excuse or conduct so in connection with in that case in connection with which to get your particular question is two points one is in that in that case there was multiple multiple continuous complaints and grievances a request by the inmates just like here and she said that's enough to create the possibility to fact question whether there's a widespread custom because what happened the nd point about that which wasn't at issue in this case that case but is in this case is one of the defendants dr monella here is a policy maker and dr monella was personally involved with trying to oversee care except that she never did the follow up but she was personally involved and she didn't make it happen and she was her job county called her about the need for surgery in fact this is the nd time he's not getting involved and at standard the virals direction dr bell and dr friedman again research the record the medical record for mr turner realize he's been scheduled multiple times for surgery so much apparently i can't read their mind but that's what it i agree with you that's probably as a result you're could decide that a reasonable juror could decide that exactly and whether or not that would meet the requirement of objective reasonable or not would be something a jury could decide which a chronic bureaucratic mentality of enough enough good enough or good enough for county work that's what a jury would be able to sign up for a jury should decide actually in the face so i see my time's up so with that  let me give you a just a square opportunity to answer that you do get the reverse their sense of this record that basically the county took to the people took to position this is good enough for county work and he's not getting the surgery will pass in the paper around good enough believed next you really do get that impression here and nobody really every opinion against the individual named defendants in cook county and so we're talking about what a physician did whether they were objective a reasonable how can a jury determine that a physician acted reasonable or not reasonable without expert testimony and their own expert said that he did not find that the cook county deviated from the standard of care well there's a couple of misrepresentation of the records that mr fox made that i'd like to clear up he said that dr sherbet only a deposition said he what he tumor th two thousand and fifteen and his own expert said that surgery it was appropriate to not do the surgery because after you get hit in the nose as hard as mr turner did the swelling has to come down  january th and the time it was it was it was appropriate and they should have waited till the middle of january two thousand and sixteen to form the surgery and of course it doesn't happen until november there's still a long you know he had been in northwestern the past have been other hospitals he chose to go back to cook county and that's where he got his procedure so to say that cook county did nothing in this case and didn't prior to surgery that's an accurate and mr turner willfully came back to  of the district court appropriately found that there is no evidence that any of these individuals defendants acted on reasonable i think it's important to know this is not like taking off from all this except a plastic and turban it reduction whether the surgeries indicated and when it should be performed but it's repeatedly identified as indicated and it's repeatedly scheduled and then it drops off and that is due to the the special the clinic their own expert says that he does not have any standard of care they're not defendants in this case but even if they were their own expert said that their care he can't say it's a deviation from each and every time mr attorney says hey i need this surgery done each and every time you look at the record the sermon health services positions and administrators get him over to the specialty clinic at structure and that's all they could do there's testimony by dr karp that says that if there was a call placed by someone to say we need  a search right away he would take that in kind but that they can't schedule the surgery the plainest expert dr mcmahon said that if such a situation occurred he's at northwestern and if someone called him and said hey there's this guy who has an elective surgery you've got d else claim i think it's important to know that there are has no extrinsic exit it's of the policies affecting any other individuals in order to prevail in one l you need to show that it's a widespread practice affecting a large number of people and this case all he's done is argued that he individually was getting kicked from the cook county stroger hospital specialty clinic call and there's no evidence to suggest that any other individual get done and those elective surgeries whether they're people that are detained or whether they're people that are free in public world those surgeries get and i think it's important to know to determine whether that's of ject really reasonable they have their own e m t who was hired by them who did not make that conclusion in order to prevail a trial plan if they have to and this case i think judge would you properly started there whenever this issue was brought to any edible individually named defendants attention they promptly and quickly made sure that mr turner was seen all right thank you very much to reagan you've used up your time mr fox will give you one last minute just a couple of points and with regard to the expert testimony our expert dr mcmahon testified that would have been programmed to give him the surgery any time beginning in january th as there are as did their expert he could not testify who is responsible for failing to do that because he's not in the cook county jail that's not his expertise so that's why he didn't do that the nd point is with regard to getting the surgery finally after he was released he did go back to stronger and i'm his own in less than a month he was able to get the surgery he went in there i think it was november th and by november th on his own he was able to get the surgery certainly suggest if you want to do it they can make it happen i can then finally with regard to issues is there was a policy maker that's what was admitted by the defense doctored up monella and she as a policy maker she speaks for the county so her failure to get it done she is the continuity of care policymaker her failure to get a darn speaks for the county and