Latest / The JEMS Report / When Clinical Red Flags and Custody Collide
Transcript
- Nat Kapustin: Hey everybody, Mike Brown from Gems. Welcome back to the Gems Report Podcast. I'm joined today by one of my good friends, Adam LaChapelle, the recess tailor. He came to me a while back with a with an interesting case that that kind of caught his eye that he's done some research into and was like, Hey, I think this would make a great great podcast episode. just some things that we could discuss. So Adam, for anybody that doesn't know you, why don't you go ahead and introduce yourself and then we'll kinda we'll unpack this a little bit. Hi folks, my name is Adam LaChappelle. I'm a paramedic. I've been in EMS for sixteen years now. That's still my first love, but like any other paramedic, we have a bajillion jobs. My f full time job is is running the recess tailor. Awesome. And you got some great things going on there. We just we just saw a few things at EMS World, right? The the decent airway simulators that that you're carrying now and doing some some really innovative things with bags and tailoring those pun intended towards you know resuscitation architecture, which is also a big passion of yours that I know from from speaking with you. Also saw the the skin that you did for the Hamilton T one ventilator. That was pretty pretty nice. So a lot of great things you're doing. So thanks. thanks for all of that. Yeah. And I I think how it kind of relates to the case that we'll talk today. My drive is to improve EMS and the care that we we provide. And that is a number of different facets. So as things kind of pop up, whether it's designing bags or education, which education has always been you know my passion, you know, we you and I met at Foam Frat. and so, you know, really wanting to to push EMS forward. And so, you know, when this case came up, I I thought it was a good way for us to discuss some of the the legal implications, you know, within the EMS community. Yeah, absolutely. I also wanna just kind of get it out there right from the beginning that this is not meant to you know to speak negatively about any of the EMS providers or any of the the police officers that are that are in this this body cam video that we'll be we'll be linking so that people can take a look at for themselves and you know not to say that these aren't things that have happened to me, situations that I've been in, I'm sure you've been in. So, you know, this is just an opportunity for us to talk about a situation. and perhaps learn some things so it doesn't get repeated in the future. So just to give a little bit of the detail, this is a case out of Monroe County in Tennessee, right? Yes. So this this was initiated as a nine one one call where some people at a business called in, they were concerned about an elderly gentleman that was there that he may be experiencing some sort of medical issue. You you actually went to the depth of a public records request to get the nine one one audio and and the complete body cam footage as well. So you know we'll be releasing that as as a part of that pot part of this podcast as I said so that So that people can take a look at that. But what did they find when they arrived, the law enforcement officers? I think with a little bit of context, it can kind of help guide us into why the response, you know, happened the way it did. I think another thing too is that you mentioned, you know, getting the public records. That was actually a big pain to do. So I first learned about this case from the civil rights lawyer on YouTube. he does some great, you know, analysis there. And his was very focused on, you know, the law enforcement, the the in custody, you know, issues, you know, there. And I think the the glaring part, especially for us, is how EMS, you know, responded, you know, to that. And getting those records, I had to I'm my assistant, she works in Tennessee, so you have to be a Tennessee citizen to get them. And then They string you along for, you know, two months, even though they've given this already to many other people. and it it's just one of those things that's it takes some persistence to get through. And so with that, they actually sent us the nine one calls for everything but the this case beforehand. And the backstory is to is this is Mr. Lester Isbill. he is a retired preacher, I believe, you know, in the community. And over you know, the the last you know six months or two year, forgive me if I get that exact time frame long, since he retired, he has had several cognitive, you know, issues, you know, with it. Sometimes it can just be my neighbors, you know, being annoying, to things, you know, like he was experiencing today at the incident. So he had gone to a some sort of finance place or bank here. he had driven there and then he was starting to drive he wanted to drive away. And the folks called him Diamond One One because they were concerned that he wasn't fit to drive. They could tell he was altered and just didn't want him driving. they didn't allege any crime, you know, had been committed. They were just concerned. And as the body cam starts up, it's like, hey, how you doing? It they're very cordial, you know, at the beginning there. The the one thing that really stood out to me if if you watch it here, is on his turn signal, the key to the car was on a string. So he wouldn't forget his key there. And I'm like, okay. Like that was a big you know, thing for me. They start asking him, you know, some questions. I believe even the police officers, you know, ask him who's the president? It's like George Washington. Like, George Washington is not the president. It may have been the president when you started Mike EMS but come on. It hasn't it hasn't been that it hasn't been that long, all right. Even, you know, during you know that the the encounter, they're like, I think he's having a medical emergency. That is voiced out loud by, I believe, the the police officers, you know, in the body camp. And I I'm it's really kind of unclear of was EMS and police dispatched at the same time, or were they requested, you know, at some point during their interaction, because they arrived, you pretty shortly, you know, afterwards here. Yeah, in the way so as I kinda As I kind of started to watch the the body cam footage, the way that they arrived and some of the communications, I would agree they were probably they were probably dispatched around the same time. But as you as you said, law enforcement made initial initial contact, they're ensuring scene security and really from the very beginning of speaking with him, they're kind of making some indications that that that he's not. alert and oriented. He's not responding appropriately. It's an in fact you know experiencing an altered mental status. so he's at least prior to EMS arrival is not alert oriented. So he's altered mental status. and so I went through the body cam footage and I noted some timestamps where some where some specific things happened that I think are are worthy of talking about a little bit further. And these timestamps are the are the times that are on the body cam footage itself, so not the duration into it. So at twelve thirty, so just twelve thirty in the afternoon, one of the law enforcement officers literally says, I've talked to him before and he's never been like this. I've talked to him several times before. He's never that. So we know that okay, this is a This is not the normal mental status for this person. You know, we know we've got some some history of potentially some issues or struggles with with psychological or mental problems. but this is today is different. And that's something that's that's very notable. It's it's pretty obvious, you know, from the onset, you know, here that that something is of an issue of a medical nature, you know, for it. And and if I look at the call report, it says medic four thirty-four was dispatched to Isbel Road per law enforcement request. It doesn't have much much more information, you know, than that. Yeah, and then as we get a little bit further into the video, at twelve thirty seven fifty five, so just shy of twelve twelve thirty-eight, one of the law enforcement officers is speaking to the patient's daughter and says that he seems disoriented and can't drive. Started acting disoriented and dropping his money and about fail. So we called MS but he's he's not wanting to go to the hospital, but he seems kind of disoriented and he doesn't need to drive. Is there any way somebody can come out here and pick him up or so if they're making determinations that they've got questions about his mental status or his mental faculties to the ability to say that he's not going to be able to drive and stating that they know that he's disoriented based on previous previous dealings with him that's indicating a a patient that needs further further evaluation and I'm sure that's what prompted the the request for EMS. and I think if we kind of dive into okay EMS is there, they start, you know, evaluating them. Some of the the things that we can also kind of glean from that is the set of idols. So if I if I look at the time, the time they say in when I look at the EMS report here, it doesn't look like they're pulling the times from the PSAP because they're all you know the the whole minute here. So they s they said they received the call at 1226. Around at 1228 on scene at 1232 and made patient contact a minute after that. And this looks like an ESO report in SC that the call was closed at 13:32. But the viral signs time, it says they're they're taking at 1324. he was alert, his blood pressure was 218 over 110, pulse of 60, respiratory rate of 24. Rumor Santa eighty nine percent zero for pain and his GCS was fifteen. So one thing and and I'm sure you probably also picked up on this, but as you watch the body camera footage, at thirteen twenty-four he was actually in the back of a police car being transported to the jail. At at that point, he had been placed under arrest. had been handcuffed and it was in the back of a police vehicle when those vital signs were documented. I'm not now again, I'm not saying that there was any conscious effort to to falsify anything, but it's in situations like this where we have to be very careful how we're how we're documenting things. It it's been a little bit since I've seen the body cam, but I believe they actually took the vitals when he was sitting inside his own car. It wasn't in the law enforcement vehicle. Correct. I guess just give a little bit more context to the the rest of the call and kind of why you and I are are talking you know, here. We look the rest out. Blood glucose was one thirty-one here. They tried to talk him to go to the hospital. It says that he became more irritable and no longer wanted to continue to talk. Law enforcement was able to get a number for the daughter, who is apparently the the POA for it. And they called the daughter because they know that, you know, sometimes before that she's been able to talk, you know, him to to going into the hospital, continue to refuse. But I I think when we say that he continued to refuse of it, he clearly doesn't have capacity to To make the decision to go to the hospital or not. Like this guy needs to go to the hospital. I'm not sure of Tennessee's exact laws on ECO or Baker Act or anything else, you know, along you know those lines. But daughter arrives on scene, says he needs to go to the facility, get some psychiatric help a few minutes after nine. They said they refused, obtained a refusal from the patient. Daughter, law enforcement, placed him into custody. If we look at the the video and what I think a lot some people missed on it was he said, I'm gonna go into the back of my trunk and grab my shotgun and they're like, that's disorderly contact, you're you're going to jail. She got mad at me because she can get blood. He's gonna explain school today. I was down as a co-op, so that's sort of chill. That's never what I Really? Down or. He had a gun in there. I got it out there. Do you see that? Yeah. I'm just gonna submit that to evidence for safekeeping only, and then somebody can come get it. Okay. Because it's gonna be a fight. Yeah, he's catching up. You don't want that wet, so I see what I'll be doing. Alright. I see you. Alright, here put your hand behind your. back. Put your hand behind you back. Don't don't be fired. Don't fight. You're under arrest. Put your hand behind you back. Put your hand back. Turn me loose. Put your hand back there. Turn me loose. You can make me fight off. Put your hand back. Put your hand back there. Put your hand back there. Put your hand back there. And once I he got to jail. he fell and he hit his head on the concrete, you know, slab. They then placed him in a restraint chair for several hours. And during that time he continued to spiral downwards and ultimately went to cardiac arrest. For this same agency had to come attempt resuscitation and he ultimately died. There's a lot of other things that happened within the the law enforcement side, and so those folks. are now facing federal civil rights charges. And those f charges were filed, I think, earlier this year in February of 2026. The trial date is set for August 26. In that EMS was was not included in the criminal charges. Civilly, this case has been settled for about a year. I think they settled for just over 1.5 million dollars on both the EMS and and sheriff's, you know, department, you know, side of things here. Yeah, and a couple so a couple other things that are that are notable and I think this is yeah, I'm a I'm I'm an advocate that I feel like body cams in EMS are are are important. Obviously as as you know as many of the The people watching may know I also have a law enforcement background. I was a reserve police officer for twelve years. so and most law enforcement officers today that I talk to would not want to work without their body cameras because they've helped them so much more than than they've ever than they've ever hurt them. But what this also allows us to do is see all of the things and see some of the indicators that this patient doesn't have the capacity and that there is a need to to take every single step that we can to ensure that they're transported for definitive care. if you if you watch the if you watch the video, at twelve fifty-three fifteen the patient actually experiences a syncopal episode in the presence of police and ems. he's not responding to any verbal stimuli. and you can hear one person, I don't know if it's an EMS provider or law enforcement responder that says he goes into these trances. Blaster Esther. and these like the something like a clicking. Let's go get your money and get you checked out, buddy. So that's that would indicate to me that this is not the not the first syncopal episode that he's potentially experienced which which needs further medical investigation. You know, they've checked a blood sugar, but you know, we don't have we don't have you know an ECG or anything you know, checking other p potential issues, looking at altered mental status. at twelve fifty five twenty in the in the recording you can hear the police department explaining the risk of heart attack and stroke to the patient. It's obvious that that he needs further care and assessment. At thirteen one when they get him out of the vehicle you can see that he's very unsteady on his feet when he's standing. You're not driving a seat. No. You listened to me last year. You only gonna have two options in this. One's either gonna be gone with your daughter. You gonna you're either gonna go with your daughter. Now he does have a walking stick with him, so I would assume that some difficulty in ambulating is is fairly likely a normal finding for him. but you can even at so at thirteen two r shortly after that, he he actually is incontinent to urine. While standing. So that's your two options. You're either going You need to go pee, we'll help you inside and we'll let you go pee. That you had a stroke. No, I've had this has been a hurt dog bit me. Lester. Just have a seat. Let me go here and pee. Well you're already paying on yourself. Yeah, I'm called Genesis ho I have a I have a Okay. We wouldn't have made it anyway. You know what I mean? Well have a seat. No, they go in here and pee. It's too late now. We wouldn't have even made it. So many, many indicators that that were that were able to see that there is a There's a significant medical issue that this person is experiencing. And this is that place where we've got to take every single step that that is within our power to ensure that this person is transported and for further evaluation. Yeah, and I think that's part of EMS too of especially having the you're going with them or you're going with us conversation. And I think there is a boldness that we need to have as EMS providers of you're going to the hospital. for for our agency, usually what we ask instead of like, Do you want to go to the hospital? It's which hospital do you want to go to? We're already presupposing, you know, that. And even telling law enforcement like this guy's going to the hospital, he's experiencing a medical emergency here. He does not have capacity. Help him get it to the structure here. Yeah, absolutely. And I know this is a lot of this is gonna vary from state to state. So from an EMS standpoint, I practice in Indiana and you know a law enforcement agency would have the ability to take someone essentially against their against their desires or against their will to to the emergency department for further evaluation if they can if they can show that the person is a danger to themselves or others or gravely disabled, which you know, I I think arguments could be made based upon some of the talking points that we've already discussed and watching the video that that an argument could be made for for either of those but probably more so within the gravely dis disabled category based upon you know an in inability to make appropriate decisions and you know be able to ensure that that person gets the right care that they're entitled to. And from a law enforcement standpoint, I think and an EMS standpoint, I think you'd have to further unpack what the what the individual states how they look at power of attorney and what exact power of attorney the daughter had who arrived on scene. Yeah, and and that's something I haven't been able to obtain is the actual document for it. what we do know is that when the daughter arrives on scene, she is trying to get him to go to the hospital, you know, here. I I don't think law enforcement originally I don't think they in general want to take somebody into custody. That's more paperwork for them. Like go with the go with the EMS. Thank you. See ya. You know, sort of thing. What has been cause I've I've gotten to a situation where, you know, the daughter calls for mom, mom says I'm not going to the hospital, daughter says I'm the POA. I'm like, okay, let me see it. I look at it, it's a financial POA. It says nothing about, you know, medical decision making here. I'm like, I you know, luckily I was able to talk the patient into going, you know, with that. but I I think just also that there's a way to generate momentum to you're going to the hospital, you know, here's the stretcher, you know, have a seat, you know, sort of thing. you know, there, because we we know that they they can't really consent to the transport and the other you know procedures. And that's why we're using implied consent, you know, for that. A couple of the things that I want to highlight, especially from the report here is with the GCS, he's clearly not a 15. At some points, he is definitely less than 14 on it. We we know he's hypertensive. We know he's hypoxic. I'm looking at the report and I'm not entirely sure that there's any history, you know, taken from it. You know, so I don't know, you know, meds or if he has history of COPD or anything else. you know, along those lines. And if they are on scene for, you know, almost an hour here, you have plenty of time to to do other things, you know, within that. But if we look at it, especially if we look at timestamps from what the Peace app, you know, says what time did you say he was in custody? so he was handcuffed and arrested at thirteen nineteen. So he is, for all intents and purposes, a a prisoner An arrestee, whatever phrasing your your state, you know, utilizes. Which means at that point he is under the control of law enforcement. Which basically means if law enforcement says you're going to the hospital, you're going to the hospital. especially, you know, if or you're not going to the hospital, which is probably more likely the case. The refusal was signed at 1321 by the daughter. Which she can't really assign the refusal to it because according to the police, he's in in their custody and he is within their care and control. And so that's that's especially, you know, if you get in this contentious situation of, okay, he's now in in in your custody. You're responsible for him. Here's the refusal. Three copies press real hard, you know, here. Hey, nobody's using paper charts anymore. I I think that's where you can really kind of get, you know, the the law enforcement to understand, like I don't want to do that, you know, here like okay, he can go with you guys, you know, sort of thing. Yeah. I mean it just as we're so as we look at this, we know we've got an undifferentiated hypertension, right? you know, at the with altered mental status. you know, d is the is the hypertension a response to the stressful event that he's experiencing? Don't don't know. he's he's markedly hypertensive again. He was two eighteen, one ten, heart rate of sixty. We know he's got a normal blood sugar. We also know that he's hypoxic. So you know, we've got a you know, a couple different potential sources for his altered mental status that we're unable to explain. you know, so those are those are definitely areas where We as EMS providers have to do all that we can and everything within our power to advocate for these patients. And that's why I wanted that's why I was really interested to have this conversation with you. not to not to be critical of past events, but to help with future events and help people understand when we're seeing these indicators and now, you know, having body cam imagery, we can see a lot of these indicators and allow us the opportunity to do that complete assessment, understand that this person is not able to make their own decisions. They're not you know, they're they're not of of sound mind and that, you know, we need to be their healthcare advocates and truly be explaining to them the the the grave situation that they're potentially in. and I think that at least throughout the the bulk of my career, most people that I really wanted to go to the hospital, and I say most because I not all, I'm not undefeated. most people that I really wanted to go to the hospital, I was able to convince them to make that decision. but we've got to take every step within our power and that's why I was it that's why I wanted to have this conversation. to be able to help everyone in the profession know that we're there to be that advocate and we've got to be vocal about it. If it doesn't feel right, we've got to speak up and make sure that we do everything that we can to advocate for what we believe is the best thing. Yeah. And I I think to kind of get along with that line and kind of think about what are other things that that could have that you can implement in the future here. I I think first just stating knowing that he went into custody here, whether he had probable cause or not, that's really not for us to to judge on it. Do we know that, you know, he's gonna fall down and they're gonna keep him in a chair for several hours? No, you know, here like we we don't know that he is going to to die because of you know the the restraint, the fall, whatever, you know, happened with that. We can say though, is everyone agrees that he was having a medical emergency. He did not receive, you know, that medical care. I I do believe that there was at least some negligence on behalf of the the EMS providers. And we can prevent that negligence in the in the future by first being like, you're going to the hospital. Just plain and simple, a very bold, you know, statement. You want to go to this hospital, you gotta go to this hospital. You know, getting, you know, law enforcement involved of like you most of the time when people don't want to go to the hospital, I'm like, okay, well, I may have to ECO them. I call law enforcement. Usually by the time that they get there and they see the police are here, they're like, go to the hospital. And that's usually, you know, what's helpful. This situation was kind of on that that fringe there. They called the daughter. They tried to get her to convince them. Even in the report, they say Go with her or go with us. I I think it's okay that she he would have gone with her. I still would have preferred, especially since he was hypoxic, to go with us. Hypertensive ultramenta says hypoxic, like he's sick. But if it's the only way he's gonna go to the hospital, like by God, we'll follow behind you. But then, you know, if it is, you know, law enforcement, he needs to go, you know, with us, it's okay, what what kind of led you to that? Do you do you have probable cause for this? Are you wanting to be responsible for you know the medical decision making for him now? Let me talk to your supervisor. Being able to kind of escalate, you know, things appropriately. We don't have to get combative or mean. We can still be really empathetic, but still be bold in in being able to, whether you want to call it stand up or anything else like that, but just advocate really well for your patient of this is a medical emergency. He's going to the hospital. We're gonna take care of him. Yeah, and I think that's where that's where the the biggest opportunity lies. And like I said, that's why I wanted to have this conversation. Some things that I think have helped in the past in my experience is oftentimes having the stretcher there at the you know, at the at the you know, wherever the patient is at, because that sometimes presents itself as one less barrier. They see that the cot's there, it's like, I guess I'm going to the hospital. you know, sometimes that can sometimes that can be helpful. but as you said, kind of maybe talking to a law enforcement supervisor, maybe t trying to talk to another officer who who's also at the scene who may be able to to interject with their partner or, you know, the other the other law enforcement officers that are there and make sure that you've very well vocalized your concerns. You know, hey, this person is hypertensive, they're hypoxic, they're altered mental status. I'm very concerned that there's a serious time critical medical emergency that they're experiencing, that we need to get them to definitive care or they could have a a potential negative outcome. So, you know, I think saying things like that get law enforcement moving in a in a different direction. That's been been my experience when they hear some of those words. They're like, yeah, this is probably something that we need to that that momentum needs to steer us towards the hospital rather than rather than incarceration. Yeah, and I think if you kind of get to the stage of nope, he's going to jail now. Okay. I've got to do an informed you know, refusal here, want to tell you some of the risk of of not going to the hospital. He can have a stroke, which means that he can be permanently disabled, not able to eat or drink, you know, by himself, go to the bathroom. You're expect accepting, you know, responsibility for getting him, you know, appropriate medical treatment. He can also die within your custody. He can fall. there are a numerous number of medical emergencies that can be going on here. And I'm glad you're willing to to sign this to accept you know responsibility, you know, for this and just r being very explicit of what the consequences, you know, would be. Yeah, and not only that, you know, particularly for you know, the agency that I work for, obviously when law enforcement is there, their body cams are always running and I know that. and you know, honestly, I I like that. because that allows me to especially in this case, if I'm informing this person of all the risks that are associated with a refusal, I can be very verbose and you know say all of the things that could potentially happen. And that's all gonna be captured on that body camera. So if there's any question whatsoever as to whether or not I told the patient that you know, I suspected they could be having a stroke, they could be having a heart attack, they could have long term death that's disability related to that, you know, that's all now captured and well documented. Yes, that still needs to find its way into my PCR. but I, you know, maybe I don't have to list every single thing that I told the person could potentially be happening, but they have to be informed. The patient has to be informed, the law enforcement providers have to be informed, and we've got to be good advocates. Yeah, I I think that's that's great for somebody that has capacity. Like you're talking to the person or you're talking to the POA or who whoever. I had one case where the nursing home called us and they're like, Hey, she's unresponsive. here. Get there and well, sure enough, she is unresponsive. She is butt breathing. I'm like, wow, this is accurate today. There's a first time for everything. Yeah. Ner the the nursing supervisor comes in and she's like, What are you guys doing? She's on hospice. I was like, okay, hold on. Hold on, guys. Have we talked to the POA? no, we haven't yet. I was like, okay, let's call the POA. We had just we had just gotten blood pressures assessment, so we hadn't done anything, you know, major, you know, after that. Sure. And so talked to the daughter. She's like, Nope, don't want you guys to transport her. She's fine. You know, just let her be there. I was like Okay, like this is an easier kind of informed. She could die. She's in the hospice, but this also could just be a blood pressure. It could be, you know, other things. So it it is other parts, you know, that we did have to kind of explain, you know, within that. But it is okay. She is the POA. The nursing homes documented it. we have done an informed, you know, refusal for it. With this case, the the patient isn't able to refuse. By himself. When the refusal was done, it was not done by the appropriate person because he was in custody. And so it is, you know, now law enforcement's job to sign that refusal. And so it it it gets into these kind of more niche, you know, incidents of understanding of who can sign the refusal, what is an informed, you know, refusal for this. But I think most of the time in in a lot of things that we've been able to experience is saying just using our words of like, hey, there's a turkey sandwich. You're you hungry? Like, come on. There there are ways to encourage people and still be very frank, be up front, be compassionate. We don't have to be a jerk about any of this. And we can still be bold, still get the patient. the the care that they deserve. Well, hey, we've been at this for coming up on coming up on forty minutes. and I I just I can't tell you enough how much I appreciate you doing the legwork on this and bringing this to me. And I you know I think this has been a great conversation and that's why I just enjoy you know things like this. I was able to kind of go through the the body camera footage that you that you sent me, but I enjoy ha just having this conversation and you know, be able to, you know, hopefully try to impart you know a little bit of a little bit of wisdom possibly and maybe help someone not not experience a similar negative outcome because I I have I have full belief that everyone who responded to this incident did not want to experience a negative outcome. I have full belief that every every person doing this profession every day does not want to experience a negative outcome. So, you know, I want to do everything I can to to try to help help prevent that from happening. So thank you. I appreciate you doing this. And you have any kind of final closing thoughts as we wrap it up? Yeah, I just appreciate you and and everything that you've been able to to help us with. I'm glad that we're able to have a conversation and be able to you know continue try to elevate you know the profession. We're we're all in this, you know, even if it is just a paycheck, we still want people to at the end of the day go home, be healthy, be relieved from whatever ailment, you know, they've called us, you know, to be. And sometimes we get burnt out because of, you know, things we've seen, the frustration of, hey, this isn't going the way it should be. And all of those things, you know, may be true. And we can still show up with empathy. We can still be able to, you know, love our neighbors and love each other and be able to come at the at the end of the day knowing I did everything in my power. I treated people with dignity and respect. And we were able to to show people a lot of compassion and care. And so I really appreciate the opportunity to discuss, you know, how to be able to do that with, you know, this specific incident. And I I pray that everybody in the future is able to apply these principles and be able to advocate for their patience. Absolutely. Couldn't say it better myself. Awesome way to close it out. Thanks, Adam. I really appreciate it. And until next time, thanks for thanks for watching the Gems podcast and we'll see you soon. Thanks, Mike.