Legal Case Summary

Margaret Littlepaige v. United States


Date Argued: Tue May 14 2013
Case Number: 13-50657
Docket Number: 2598705
Judges:Allyson K. Duncan, G. Steven Agee, Andre M. Davis
Duration: 29 minutes
Court Name: Court of Appeals for the Fourth Circuit

Case Summary

**Case Summary: Margaret Littlepaige v. United States** **Docket Number:** 2598705 **Court:** [Specify Court, e.g., United States District Court] **Date:** [Specify Date] **Overview:** Margaret Littlepaige brought a case against the United States, invoking federal jurisdiction to address grievances stemming from an incident or issue that allegedly caused her harm or financial loss. The specifics of the claim involve [briefly summarize the nature of the claim, e.g., negligence, a violation of rights, etc.]. **Background:** The case originates from [provide background details such as dates, relevant events, or actions taken by the parties involved]. Littlepaige alleges that the actions of the United States [specify the government agency if applicable] resulted in [explain the impact on Littlepaige, i.e., injury, financial loss, denial of rights]. **Legal Arguments:** - **Plaintiff’s Position:** Littlepaige argues that [summarize key points from Littlepaige’s legal arguments, including any statutes or precedents cited]. She seeks [mention specific relief sought, such as damages, injunctions, etc.]. - **Defendant’s Position:** The United States contends that [summarize key defenses raised by the government, including any legal doctrines, immunities, etc.]. They argue that [detail any major counterarguments aimed at dismissing the case or reducing liability]. **Court Findings:** The court [describe any key rulings or findings made by the judge]. This may include determining the applicability of certain federal laws, evaluating evidence presented, or finding in favor of one party based on the legal arguments and evidence. **Conclusion:** Ultimately, the court [summarize the decision, whether it was a ruling in favor of Littlepaige or the United States and any reasoning provided by the judge]. The case highlights important issues regarding [mention any broader legal principles or implications the case may have, such as liability of the federal government, individual rights, etc.]. **Next Steps:** Depending on the court’s ruling, further legal actions may be pursued by either party, including possible appeals or motions for reconsideration. --- **Note:** Please ensure to fill in specific details as necessary for accuracy and completeness, using actual information from the case when available.

Margaret Littlepaige v. United States


Oral Audio Transcript(Beta version)

May I please the court, my name is Peter Sarduk. I am a member of the Wake County North Carolina Bar and admitted before this court. We're here today on behalf of Alfred Little Page and a decorated veteran who, after the facts and question, passed away, so we're representing his state. At the time, he went to the VA Hospital. He was a seven-day-old man who was, as his wife described, has agitated somewhat out of control. Yes, ma'am. Please. No, please. After he was admitted to the hospital in an agitated state, he was taken to the VA Hospital in Durham, North Carolina. He was taken to the ninth floor, which is a psychiatric ward within the hospital. Because of his agitated state, his wife was not allowed to visit him for three days. At the end of that time period, she visited him, found him on the floor, even though he had been put on the recall's precaution while he was treated at the hospital. We are here because this case was dismissed by the trial court for failure to comply with Rule 9J of the North Carolina rule. This is a sole procedure. And if I could just for a second talk about Rule 9J, because I think it's important to understand how it fits into the puzzle in this case. Rule 9J was passed by the General Assembly in the mid-80s because of a series of lawsuits that were filed against medical professionals. The General Assembly wanted to stand with the claims of questionable nature. And in doing so, it would bring relief to the litigation that was presented to the medical professionals, including hospitals, doctors, and some nurses

. They passed Rule 9J, which requires a plan in a civil action to certify to the court that he's had the medical records of the alleged malpractice. Reviewed by a person who is saying education and qualifications as the medical professional in question. That person has to certify that he's willing to testify that the medical care he reviewed reads the standard of care. In other words, that there was a negligent act within those records. We did not cert a Rule 9J certification. We've never, I've never read any secret about that. We don't think it's appropriate. And the reason we don't think it's appropriate is because it was a failure to monitor and observe. We contend that that is the act of negligence. If the court would join with me and a rhetorical question, that as to who you would name in a situation like this, what field of expertise would you ask your expert to have? Because what we have is no medical care being administered. Simply, they can seem to be what you've led in your complaint. Actually, at paragraph 13, I say as a result of the failure to observe and monitor the veterans suffer to hip fracture, bruises, and contusions result of his fall. What about paragraph 17 and 2030? You're on a certain there that it is the due care of the Medical Center. In the due care there, it's not a medical standard, but rather a simple standard of negligence. And we contend that the North Carolina cases that have dealt with this very issue have been circumspecated in the medical negligence claims from simple negligence claims. In the leading case that we asked the court to consider is the the Blan versus Moses come. And the Blan versus Moses come and the court said just because a person has a medical license does not mean that that person must be sued under rule 9 check

. And that there are facts in which that rule does not apply. Part of the problem, I don't mean to call it a problem, but as Judge A.G pointed out in that paragraph, you actually refer to the hospital as the defendant. Yes, Your Honor. I do. Well, the hospital is not the defendant. The United States is the defendant here. Now, if this occurred at a private hospital or public hospital, not the government, if it weren't a government, it weren't a VA hospital or United States facility, you don't deny do you that you could actually bring a professional malpractice case against the hospital. Correct? You could bring it if you had the facts to support it and you had a physician willing to testify under rule 9 standards. Well, but on these facts, you don't mean to suggest to you that you couldn't find an appropriate expert who could come in and say under rule 702, any hospital in the world would not permit this to happen for the following reasons. And this expert would have referred to standards of the American Hospital Association, the organization of healthcare providers. I mean, in other words, my point is, and this is actually a friendly question to you. This could have been brought as a medical malpractice case. That's correct. Okay. Your argument is, that's not how I brought it. That's correct

. And just because it happened in a hospital doesn't make it a medical malpractice case. That's correct. That's correct. And frankly, the district judge, at least some of the language in the district court's order, seems to suggest that the district court thought that because it occurred at a hospital, it had to be a medical malpractice case. That's correct. And you are, even if that's not true. That is correct. Let me ask you this if I may, and then I'll be quiet. If you win here, and this goes back as a quote-unquote simple negligence case, would that have an impact? In other words, would a trial of this case on a theory of simple negligence look any different, apart from the absence of expert testimony, would an actual trial look any differently, with the measure of damages, be any different if it were a medical malpractice case? No, you're not. No difference. You'd have to prove that the hospital personnel failed to keep him from falling out of the bed. That's correct. That's your claim. That's correct. And whatever damages flow from him falling out of the bed, would be the limit of his life, the government's life. Now, would you want to introduce evidence of that? Would you call it restraint protocol or the false policy? False policy. False policy

. I'm going to ask you, not so friendly a cabinet question. What if the government said, all right, we'll treat it as a negligence case, but you can't introduce evidence of the false policy? I think that would be a risk that I would run. You would have to have the right to say no, we're not going out. Because that would be speak medical malpractice. It does. And you're willing to try the case on the basis of simple negligence. Simple negligence, sure. That would be it. I didn't mean to lay a trap for you or anything. Sometimes the pellet concessions can come back and bite counts. I understand. Secondly, the second portion of our argument is that we can tend that the facts are presented here, that specifically, that no one was allowed to visit the patient while he was in the ninth floor education wing. All of the facts, all of the control of the patient during that time was by the VA hospital. And that there is no evidence of direct negligence that those facts as a certain in our complaint and as it can take him taken from reading the complaint by the court, we contain constitute the doctrine of residence of local force, which is an exception from the rule 9J requirements. So we can tend that there are two basis for finding that the trial court error in dismissing the case number one, rule 9J, that's not applied to this case, as it is a simple negligence case. And number two, that it is a rest, if it's a local force case, as pled. And therefore, so you're, you're approved for that would be that the plaintiff was in the care of the defendants, not a proportionality

. He was injured, therefore there was negligence. Well, the residence, the look at the required is that generally speaking, the worst that I've generally speaking, this act would not have occurred absent the negligent submission of some party. And that some party would be an administrator, a clerk or a men tech, not for medical care. Could you give me an example of medical malpractice that didn't involve negligence? No, I think the essential element of medical malpractice is that the case is negligence. If I can stray a little bit from the pleadings, I would like to say that Mr. Lil Page defended his country, received three bronze stars when he was in Korea. He was a simple laborer. He had only his heart of labor as an ability to earn an income. He defended our nation one at the time, it was right. We asked that the court do the same and find that his case fits under simple negligence standards and reverse the finding of the trouble. Thank you. Thank you, Mr. Sardin. Miss Shaw? May it please the court give me more names. My name is Shaluk Shaluk, I'm here on behalf of the United States. For others, as an incident matter, this is a medical malpractice action. The North Carolina Court of Appeals in 2010 spoke directly to this issue

. In the deal, the Fry Regional Medical Center, the North Carolina Court of Appeals held that the decision to evaluate for and implement a false precaution plan involved questions that the clinical judgment and intellectuals just give such that any challenge would be a claim of medical malpractice. So now you have a case based on a session in which there will be no evidence introduced, no discovery related to the false protection plan or whatever it's called. And that like what you're arguing. Well, if you're on looking at the plane at some claim, they will judge. They don't allege any duty that doesn't arise from the duty from the false precaution plan. At that point, if the only duty that they're alleging their complaint is part of the false precaution plan, they can't separate that out. The fault, their, their allegation, their, their... I'm sorry, are you now saying that I'm not sure I'll follow you? Council just conceded that he is willing to try the case without evidence that you undertook a special duty, which is what this falls protection plan. It's a special duty. A medical duty. Council's now saying, look, this could have just been the guy down the street hired to look after somebody's grandfather. And one of the things you know about 78-year-old in this condition is that you don't... You don't run the risk that was run here

. Has nothing to do with medical judgment? You disagree? Yes, you're on a respectfully-ID disagree, because in this case, they have... There's no duty that the hospital owed to the person that walked in to keep them from falling out of the bed. It's not an ordinary duty. This isn't a normal premises liability question where Mr. Little Page was walking down the hall and slipped on a puddle of water. What we're dealing with here is a patient with severe dementia who's agitated and out of control. The doctors were having to evaluate him on a daily basis to determine his... Identify the risk of him falling out of bed, determine what steps they needed to take to keep him from falling out of bed. That's where the duty arises from. Beyond that, there was no duty on behalf of the hospital. So, if somebody hires the lady across the street who doesn't have a regular employment to look after grandma who's agitated and 78-year-old, that person doesn't have a duty to ensure that grandma doesn't fall either fall out of bed or slip and fall once having gotten out of bed. That's not part of what the lady across the street has agreed to take care that doesn't happen to grandma. You're on a just to clarify your question

. So, lady across the street is no medical professional. Just a neighbor watching her and... She's an unemployed executive for a home decode. I just think those facts are so different from the ones before us because he wasn't interested to take care of a lady across the street. He was interested to take care of medical professionals. And what the argument here is that I'm not relying on. The plaintiff is relying on the fact that he was in a hospital. Well, you're on a... That this could have happened anywhere. It was bad. And I don't think..

. And I think the problem with that argument is that that person, while caring for... It's the medical professional that has this duty to prevent them to consider their diseases and prevent them from falling out of bed. But the lady across the street would also have that duty to protect my grandma. I don't think she would have this being duty under... To keep her from falling and breaking her, yeah? Well, I think you're on her... Grandma's conscious, if she was awake, she could have... She could have fallen out of bed without any negligence on the part. Exactly! That's exactly the point. That's exactly the point

. There may not have been any negligence. There may not have been... You may win the case. I would agree with that. And you don't have to face a jury. Right? Yes, Your Honor. Because a private party would have to face a jury on this. But you're going to have a United States District Judge deciding whether there was any negligence. Well, you're on her in this case. I don't think that very specific claims can be separated out from the fact that the duty they're alleging did come out of the hospital. I understand what you're saying, but I don't think that's with a claim that they're complaint-break. Well, they do talk about, in paragraph 13, the failure of monitoring and supervising, specifically what they're referring to is the failure to monitor and supervise the execution of the false precaution point. So while they can attempt to separate out those two duties, I think they're complaint completely pushes the two together. And therefore, we say that they are making a medical malpractice claim. In North Carolina law, has spoken to this issue and has decided to follow the precaution point because of the clinical judgment and skill that it involved. As I understand the facts here, Ms. Little Page actually found him on the floor. Yes, Your Honor, that's correct. If I may speak to that. So Ms. Little Page. I mean, she hadn't, according to the allegation, she hadn't seen him for three days. She shows up, apparently some health professional actually admits her to the room or squirts her to the room. And she finds him on the floor. Yes, Your Honor. And I think that that factual allegation alone does not establish the fact that he fell out of bed. Here, we're dealing with the patient who had seen him on the floor. I'm sorry? How long had he been on the floor? Your Honor, I don't believe that's in the record exactly how long he was on the floor. Because he hasn't been in his discovery. No, Your Honor. There has not this place. This was decided on a mission to dismantle it

. As I understand the facts here, Ms. Little Page actually found him on the floor. Yes, Your Honor, that's correct. If I may speak to that. So Ms. Little Page. I mean, she hadn't, according to the allegation, she hadn't seen him for three days. She shows up, apparently some health professional actually admits her to the room or squirts her to the room. And she finds him on the floor. Yes, Your Honor. And I think that that factual allegation alone does not establish the fact that he fell out of bed. Here, we're dealing with the patient who had seen him on the floor. I'm sorry? How long had he been on the floor? Your Honor, I don't believe that's in the record exactly how long he was on the floor. Because he hasn't been in his discovery. No, Your Honor. There has not this place. This was decided on a mission to dismantle it. Right. And so eventually, if this case goes bad, people are going to find out how long he likely been on the floor. It's possible, Your Honor. But I do think it's the plaintiff's burden. As the plaintiff in this matter, as the person bringing the complaint and trying to make a claim under a breast-ypsilopeter, or maybe... No, I'm not talking about Ray Zipsa. I'm talking about the medical charts going to show when was the last time anybody in the VA Center went in and checked. Oh, Mr. Little Page. Yes, I believe the medical records would show that. Since he wasn't in the VA center. You've seen him. Council hasn't, or maybe he has, but anyway. Well, in the false precaution plan, it dictates things just of that nature. When he needs to be checked on, accompanying him to the bathroom, accompanying him for feeding, putting on certain pairs of shoes, whether or not the side rails need to be up or down, and also constant nurse monitoring, seeing his up and down

. Right. And so eventually, if this case goes bad, people are going to find out how long he likely been on the floor. It's possible, Your Honor. But I do think it's the plaintiff's burden. As the plaintiff in this matter, as the person bringing the complaint and trying to make a claim under a breast-ypsilopeter, or maybe... No, I'm not talking about Ray Zipsa. I'm talking about the medical charts going to show when was the last time anybody in the VA Center went in and checked. Oh, Mr. Little Page. Yes, I believe the medical records would show that. Since he wasn't in the VA center. You've seen him. Council hasn't, or maybe he has, but anyway. Well, in the false precaution plan, it dictates things just of that nature. When he needs to be checked on, accompanying him to the bathroom, accompanying him for feeding, putting on certain pairs of shoes, whether or not the side rails need to be up or down, and also constant nurse monitoring, seeing his up and down. Again, he has severe... He's decorated for your war veteran with severe dementia. He was agitated. He was out of control. And they had to resext medical professionals had to re-assess when a daily basis. If not numerous times during a day, did determine what was necessary to keep him from falling out of bed. Ms. Shaw, I will ask the same question that Mr. Sardar has specifically helped me understand how the false precaution in this case differed from the fall risk screen assessment that was at issue in deal. Your Honor, I think they're one and the same. I think the false precaution plan is something that results from the fall risk screen assessment. So once they make that assessment, they look at the patient, assess his specific diseases that he's coming in with, his disabilities, whatever the situation may be, identify his risk of falling and implement certain measures. That plan, those measures are what part of the false precaution plan. In Mr. Little Cage's case, that involves everything that I was just describing, constant monitoring, being close to a nurse's station, constant re-evaluation to determine whether or not he needs more or less supervision for that specific day

. Again, he has severe... He's decorated for your war veteran with severe dementia. He was agitated. He was out of control. And they had to resext medical professionals had to re-assess when a daily basis. If not numerous times during a day, did determine what was necessary to keep him from falling out of bed. Ms. Shaw, I will ask the same question that Mr. Sardar has specifically helped me understand how the false precaution in this case differed from the fall risk screen assessment that was at issue in deal. Your Honor, I think they're one and the same. I think the false precaution plan is something that results from the fall risk screen assessment. So once they make that assessment, they look at the patient, assess his specific diseases that he's coming in with, his disabilities, whatever the situation may be, identify his risk of falling and implement certain measures. That plan, those measures are what part of the false precaution plan. In Mr. Little Cage's case, that involves everything that I was just describing, constant monitoring, being close to a nurse's station, constant re-evaluation to determine whether or not he needs more or less supervision for that specific day. This patient specifically had a tendency, he was a veteran and he thought his dementia was taking him back to a time when he was so in war. Is this in the record? No, Your Honor, that's not in the record. But based on that is how the nurses were evaluating what types of risks, for example, for a patient who's going to consistently get out of bed and lay down on the floor, hypothetically speaking, they would maybe want to lower the side rails as opposed to keeping him in the record. There are cases about, different cases out there about side rails whether or not they need to be offered down. But if a patient's constantly trying to get out of bed is movable, those side rails may present an obstacle that would be making more likely fall and injure himself. And again, these are all issues that are within the medical judgment of the nurses and the doctors administering this plan. Therefore, that's why we claim that this is a claim the medical malpractice. Well, does it really matter what we think? I mean, we're sitting here to apply North Carolina law. Yes, right. The question isn't so much whether we can make the distinction. It's what North Carolina law tells us about the distinction. Yes, Your Honor, just talking about corrects. So the United States references the court to the North Carolina Court of Appeals in DLV Fire Regional Medical Center. Because I think that's the one case in North Carolina where they really looked at something that was almost identical to the false precaution plan that we're dealing with that issue. And they found that that was something that involved identifying the risk, implementing steps, clinical judgment, intellectual skill, those something that came after the North Carolina Court of Appeals decision in Sturgeon, which didn't address the false precaution plan. The court in DLV Fire specifically said we didn't address it before. We're looking at it now

. This patient specifically had a tendency, he was a veteran and he thought his dementia was taking him back to a time when he was so in war. Is this in the record? No, Your Honor, that's not in the record. But based on that is how the nurses were evaluating what types of risks, for example, for a patient who's going to consistently get out of bed and lay down on the floor, hypothetically speaking, they would maybe want to lower the side rails as opposed to keeping him in the record. There are cases about, different cases out there about side rails whether or not they need to be offered down. But if a patient's constantly trying to get out of bed is movable, those side rails may present an obstacle that would be making more likely fall and injure himself. And again, these are all issues that are within the medical judgment of the nurses and the doctors administering this plan. Therefore, that's why we claim that this is a claim the medical malpractice. Well, does it really matter what we think? I mean, we're sitting here to apply North Carolina law. Yes, right. The question isn't so much whether we can make the distinction. It's what North Carolina law tells us about the distinction. Yes, Your Honor, just talking about corrects. So the United States references the court to the North Carolina Court of Appeals in DLV Fire Regional Medical Center. Because I think that's the one case in North Carolina where they really looked at something that was almost identical to the false precaution plan that we're dealing with that issue. And they found that that was something that involved identifying the risk, implementing steps, clinical judgment, intellectual skill, those something that came after the North Carolina Court of Appeals decision in Sturgeon, which didn't address the false precaution plan. The court in DLV Fire specifically said we didn't address it before. We're looking at it now. It does involve clinical judgment. It does involve the knowledgeable skill retrieving this as a medical malpractice action. And I think that's instructed in government's situation that's before us today. I think the plaintiff then goes on to attempt to capture claim under an exception to North Carolina Civil Procedures Rule 9J and claim that it's a claim of rest ifs a local. Well, I think in this case, Your Honor, they fail to alleged three prongs to reply for rest ifs a local. Under North Carolina law, it's required that they should that in a medical malpractice case to make a claim for rest ifs a that they should have a direct cause, they can't alleged direct evidence of the cause of the injury, that the injury happened while in the exclusive control of the defendant, and that the injury is now the type that would occur at past actions. And I think on these second two prongs is really a strength of worth their argument completely. Is the deal case binding authority in North Carolina? Your Honor, I believe it's a published opinion, but I think it is un-published. And so is it binding authority in North Carolina? Your Honor, I do not believe that it would be binding the already in North Carolina, but it is instructed and it's the only case in North Carolina that's looked at the issue. So I think it's instructed and helpful in this case. As to the claim of Resebsa, the plaintiff has not shown that the patient's injury occurred while in the exclusive control of the defendant, because she has failed to eliminate the possibility that he came into the hospital with his injury. As we've already talked about, this patient was very frail. It's coming in on September 18, had no increase in pain between September 18th and September 21st. He was found laying on the floor. Again, his pain remained constant until September 25th, which is when he was evaluated, for intestinal issues, not for any potential pain or hip-ray, there were no signs of any such injury. At that point, incident to that ex-ray, they found the hip-ray. The plaintiff hasn't eliminated the possibility that he entered the hospital at hip-ray

. It does involve clinical judgment. It does involve the knowledgeable skill retrieving this as a medical malpractice action. And I think that's instructed in government's situation that's before us today. I think the plaintiff then goes on to attempt to capture claim under an exception to North Carolina Civil Procedures Rule 9J and claim that it's a claim of rest ifs a local. Well, I think in this case, Your Honor, they fail to alleged three prongs to reply for rest ifs a local. Under North Carolina law, it's required that they should that in a medical malpractice case to make a claim for rest ifs a that they should have a direct cause, they can't alleged direct evidence of the cause of the injury, that the injury happened while in the exclusive control of the defendant, and that the injury is now the type that would occur at past actions. And I think on these second two prongs is really a strength of worth their argument completely. Is the deal case binding authority in North Carolina? Your Honor, I believe it's a published opinion, but I think it is un-published. And so is it binding authority in North Carolina? Your Honor, I do not believe that it would be binding the already in North Carolina, but it is instructed and it's the only case in North Carolina that's looked at the issue. So I think it's instructed and helpful in this case. As to the claim of Resebsa, the plaintiff has not shown that the patient's injury occurred while in the exclusive control of the defendant, because she has failed to eliminate the possibility that he came into the hospital with his injury. As we've already talked about, this patient was very frail. It's coming in on September 18, had no increase in pain between September 18th and September 21st. He was found laying on the floor. Again, his pain remained constant until September 25th, which is when he was evaluated, for intestinal issues, not for any potential pain or hip-ray, there were no signs of any such injury. At that point, incident to that ex-ray, they found the hip-ray. The plaintiff hasn't eliminated the possibility that he entered the hospital at hip-ray. In fact, that's just as likely as him having sustained that injury while in the care of the hospital. I actually had a question that was triggered by deal that I don't think he addressed. And that is how unpublished opinions are treated varies from circuit to circuit. We have roles that say that they have to be... There is no distinction as to how they are treated after a certain point. I guess it was 2007, I don't remember. But in any case, circuits can each decide whether or not they are binding precedent in that circuit. Does North Carolina have a role about that? I'm not aware of that. I think the case was decided in 2010. And I don't know if that would change your question at all about that. But I'm not aware of that. Thank you. I'm sorry. This occurred to us. You're on

. In fact, that's just as likely as him having sustained that injury while in the care of the hospital. I actually had a question that was triggered by deal that I don't think he addressed. And that is how unpublished opinions are treated varies from circuit to circuit. We have roles that say that they have to be... There is no distinction as to how they are treated after a certain point. I guess it was 2007, I don't remember. But in any case, circuits can each decide whether or not they are binding precedent in that circuit. Does North Carolina have a role about that? I'm not aware of that. I think the case was decided in 2010. And I don't know if that would change your question at all about that. But I'm not aware of that. Thank you. I'm sorry. This occurred to us. You're on. Are there any cases... Has this come up to your knowledge in a federal court claims that case court? Yes, Your Honor. It has come up in a federal court's claim that not in the state of North Carolina. No, I mean North Carolina. In North Carolina. Okay. I think it's right that the United States, the middle district of North Carolina, did deal with the federal court claims that. Judge it is the issue of opinion. This is opinion that's also cited in the district for judges opinion. In that case, the court found that, I believe that case specifically was dealing with recipe a lot more. So it wasn't dealing specifically with the court and your negligence versus the matter. So there are no federal court claims at cases dealing with a public comment. dealing with 9J in North Carolina. Other than this race of episode case that you've.

. Are there any cases... Has this come up to your knowledge in a federal court claims that case court? Yes, Your Honor. It has come up in a federal court's claim that not in the state of North Carolina. No, I mean North Carolina. In North Carolina. Okay. I think it's right that the United States, the middle district of North Carolina, did deal with the federal court claims that. Judge it is the issue of opinion. This is opinion that's also cited in the district for judges opinion. In that case, the court found that, I believe that case specifically was dealing with recipe a lot more. So it wasn't dealing specifically with the court and your negligence versus the matter. So there are no federal court claims at cases dealing with a public comment. dealing with 9J in North Carolina. Other than this race of episode case that you've... There are probably cases dealing with rule 9J on whether or not I'm pro taking a case out where it fails to lie to 9J. But not anything that specifically relevant to the case to the case of hand. Which is there was in a federal district court case in North Carolina that's photo-false precaution plan. And whether or not that would require 9J certification or not. Is that answer a question or not? Unless there are any other questions from the court, the government, the United States respectfully ask that. This court affirmed the judgment of the district court based on existing North Carolina law. Thank you. Mr. Sardin. You're on the right hand, nothing further to add. Okay, I did want to ask the same questions. How would you distinguish the fall precaution in this case from the fall risk screen assessment deal? Because it was a screen in your honor. I think it required actual medical involvement. It wasn't just a direction. Make sure the slats were up. Make sure the wheelchair was properly braced, etc

.. There are probably cases dealing with rule 9J on whether or not I'm pro taking a case out where it fails to lie to 9J. But not anything that specifically relevant to the case to the case of hand. Which is there was in a federal district court case in North Carolina that's photo-false precaution plan. And whether or not that would require 9J certification or not. Is that answer a question or not? Unless there are any other questions from the court, the government, the United States respectfully ask that. This court affirmed the judgment of the district court based on existing North Carolina law. Thank you. Mr. Sardin. You're on the right hand, nothing further to add. Okay, I did want to ask the same questions. How would you distinguish the fall precaution in this case from the fall risk screen assessment deal? Because it was a screen in your honor. I think it required actual medical involvement. It wasn't just a direction. Make sure the slats were up. Make sure the wheelchair was properly braced, etc. The deal case has actual medical involvement in terms of what the nurse is, what the doctors had to do from minute to minute. That's not the case here. So what's, I'm not understanding. What's the distinction between the screening plan and the fall precaution's plan? It did not appear to me picking up on the JG question. It appeared to me that I can go back and look that the precaution involved some of the same analyses and safeguards. I think there are parallels, but I don't think there's the same thing. I think one is just an instruction to the med tech, to the license, practical nurses, etc. It is make sure the rats make sure the wheeljacks are locked, make sure he doesn't fall. That is not the same as the deal case. By the way, there was no hearing below. And you never asked to amend the complaint. I did not. No, do you think you need to? I do not. Thank you. Thank you. Thank you. If there are no further questions, we will come down

. We will take a short break