Chiarino v. United States Of America, No. 9:2015cv80465 - Document 63 (S.D. Fla. 2016)
Court Description: ORDER AND OPINION. Judgment should be entered in favor of Joseph Chiarino and against the United States of America. Final Judgment will be entered by separate order. Signed by Judge Donald M. Middlebrooks on 5/31/2016. (mc)
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Chiarino v. United States Of America Doc. 63 UNI TED STATES DI STRI COURT CT SO UTH ERN DI STRI O F FLORI CT DA CASE NO:15- vc 80465- I M DDLEBRO OK S J OSEPH CHI NO, ARI Pl i if antf, UM TED STATES OF AM ERI CA, De enda . f nt / O PI I N A N D O R DER N O Thi i an ac i f ne i enc br ss ton or glg e oughtby J e Chirno aga ns t Unie St t of os ph a i i t he t d aes Am e ia. M r Chirno alege t Unied Stt s ofAm e ia i labl unde t Fe r Tors rc . ai l s he t ae rc s i e r he de al t Cl m s Ac f f iur t dignos bldder c nce durng M r Chirno' te menta va i ai t or a l e o a e a a r i . a i s r at t rous Veea sAfar (& ' fcl iso c ni g fom S p e r2 2t r u hAp i 20 3 OnM a tr n fis ç ) a ii e c u n r e tmbe 01 h o g rl 1 . VA' t y 9,201 1hel abenc ti a whih tme d ume a y and t tmoni le denc wer pr e e 6, d h ral t c i oc nt r esi a vi e e es nt d. Ba e on t e denc pr e ed,1m ak t f l ng fndi off c and c l i ofl w. s d he vi e es nt e he olowi i ngs a t onc usons a 1 . FI NGS OF FACT NDI M r Chai o i a v trn o te Uni d Sae Ai Foc wh s r e a a fg trj t . irl s eea f h a t tts r r e o e v d s ih e e e me h n ca dwa h n r byds h r e i 1 7 ( . irn Tetmo y . c a i n s o o a l ic a g d n 9 0. J Ch aio si n ) 2. l Se e be 201 M r Chirno beg n e bii gr s he a ura,bl i hi urne. n pt m r 2, . a i a xhi tng os m t i ood n s i ( ChirnoTetmony'V.ChirnoTesi J. ai si , ai tmony) . O n Se em be 1 201 M r Chi i c a t d t V A,c pl i ng of t he a ura. pt r 2, 2, . arno ont c e he om a ni he m t i ( era Stp. 2) On Se e r1 201 M r Chirnoviie t e r ncyr m a Prtil i at . ptmbe 6, 2, . a i std he me ge oo t t VA c nt r i W es Pam Be c Flrda. The VA pe f m e a CT s a wihout he e e n t l a h, o i r or d cn t c r tofMr Chirno' bldde (l ptmbe Sc n') ( Tesi ontas . ai s a r i e r a '. Yun tmony;P' Ex.1 a se s t Dockets.Justia.com The Septm be Sc n r vea e a bldde di riul e r a e ld a r ve tc um, a out hi on t n pouc ng he bldde . ( n Te tmony;P' Ex.1 a 1 . The Se e rSc n di notr a t a r Yu si s t 22) ptmbe a d eve l he prs n eo a yso e i t eba d r ( nTe tmo y; sEx.1a 1 2) ee c f n t n s n h ld e . Yu si n P' t2 . 4. On Se e r 20,201 t VA pe f m e a ulr s pt mbe 2, he ror d n ta ound of M r Chi i s bldder . arno' a . ( n Te t n ) Th uta o nd dd n t rv a a y son s i t ba d r ( n Yu si y . e l s u i o e e l n t e n he ld e . Yu mo r Te tmony;P.Ex.1a 11 ) TheVA t n sheduld acons t i wih aVA ur ogs, si t 5. he c e ulaton t ol it ( Ex.1a 1 2) P. t2 . On Ocobe l 201 M r Chirno metw ih Dr Di ,a ur ogita t VA hos ial t r 6, 2. . a i t . az ol s t he pt . ( n Te t n ;J Chirn Tetmo ) Dr Diz o d r d a urn lss ts a d a Yu si y . aio si ny . . a r e e mo iay i e t n c ol yt ogy. ( l Tesi ) A c ol i a ts of a pai ts urne by whih a Yt n tmony . yt ogy s et ten ' i c n exa n l mi er ooks a c l t ha s fom t bldde lni i or t c k f t t els hat ve hed i he a r i ng n der o hec or he pr e of bldder c nce . ( Tesi esnce a a r Yun tmony) The evi e doe noti cae t . denc s ndi t he c t lg wa e e pel me ( n Te t n ) yoo y s v r rbr d. Yu si y . mo 6. On Nove mber5,201 Dr Diz pef me acysos py on M r Chirno. ( Ex.1a 2, . a ror d t co . a i P. t 34546 .A cysos opyi apr edur wheet docori e t as lr rc r i o - ) t c s oc e r he t nsrs mal ubbe ame a nt t urtlat vi t i i oft bldde .( Tesi ny) l hi de ci i zoft he elr o ew he nsde he a r Yun tmo . n s s rptol he pr ce e, . azwr e: o dur Dr Di ot Up e e i g t bl r t blddermucos wa nor a . The e wasa on nt rn he adde , he a a s m l r lr di ri um on t l tpose i wal a s onepr s i i t r a ge ve tcul he ef t ror l nd t e sng n he e. Ther we e no m uc a l sons pr s nt The bldde wa s a d e r os l e i ee . a r s c nne c plt l a we di not s e a m o e sones The e we e s om e ey nd d e ny r t . r r ome c c fc i on t s f c oft pr tt glnd a t pr sat waA aliiatons he ur a e he osa e a nd he o t e ' h-abe bl quiee iy. i l, ed t asl ( Ex.1a 3 ( P. t 45) empha i a d) Hi di osswa t M r Chirno ha ss dde . s agn i s hat . a i d ç gn pr ttc hy r a i' CI 4' a a û a s beni osai peplsa' BP1 ' nd s dderdi riul wih (' ) bl ve tc um t a l so .'(#.. tne' / ) 2 On J nua. 8,201 M r Chirno vi ie hi prm a y ca e physcin a t VA,Dr a l y 3, . a i std s i r r i a t he . La e e Gr ns ur nc ee poon,f hi a or s nnua physc .The ne da M r Chirno r pore t Dr l ial xt y . a i e td o . Gre poont hesilha he tli.( Ex.1a 87) e ns hat tl d matra P. t . 8. OnJ nuay9,201 M r Chirnorpore t Dr Dizt thesilha he t i ( a r 3, . ai e td o . a ha tl d maura. Yun Tes i ony;P.Ex.1 a 80) tm t . . 9. On J nuar 22.201 M r Chi i c le Dr az' ofs e t i o m hi t t M r a y 3, . arno a ld .Di s tc o nf r m ha . Ch aio wa e h bt h mau i a d d s i (an wh nu iaig . ( Te tmo y irn s x i ing e tra n y ura p i e rn tn ) Yun si n ; i P Ex.1a 76 . Dr Diz n e M r Chirnotdoe haveafibl p os tcurt a a a t ) . a otd . ai û s ra e r ai ehr nd di ri ul wih sone. W ilsa thi on fna t rde ....I bl e ng doesnots i ve tc um t t l tr m i se i f e di ubsde wiln e t h v c solc p l a d lto rp y' ( Ex 1 a 7 ) Fia trd i a l e d o a e y t s o y n i tis . P . t 6 . n se ie s h ' me cai us t pr ve ble ng duet a enlr pr tt ( vaTe i ) A di ton ed o e nt e di o n aged osae. Ka smony . lt ti yi apr dur usdt bra upsones ( Tesi ny) ihorps s oce e e o e k t . Yun tmo . On Fe u y 6,201 M r Chirno viie Dr Diz an i or e Dr Diz t the ne r br ar 3, . a i st d . a d nf m d . a ha ve r c ve t ïnasei prs rpi ( Ex.a 74, Diznot S te ha d uraa e ei d he s trde e citon. P. t ) a ed:t int s ys i nd . pa hemaura. Ha ng s ti vi ome to e e yi bldde a vey a ous g'e ne r rubl mpt ng a r nd r nxi . I1 ve I r c ie p o c ro d ro 12 .... Hen e sp osa a d Flma ' (d) P osa i a e ev d r s a r e n / 2 e d r c r n o x. 1 .. r c r s ' me cai smia t fnaserde.( vaTe tmony) di ton i lr o i t i Ka si . 11 . On M ar h 8,201 M r Chi i c l t VA compl nig oft si e a gr n pa n. c 3, . arno aled he ai n e tcl nd oi i (. irn Te t n ;P. 1a 686 ) J Chaio si y Ex. t - 9 . mo OnM ach 1 201 M r Chi i we t te ener nc r a t VA. (' Ex.1a r 2, 3, . arno nt o h l ge y oom t he P. t 65) Ie c ane ofKow a . - ompli d t bdomi lpan,pai ul(i whe voi ng a biae a l l na i nf sc) n di nd ltr l gr n pai rditng t t t tce .. oi n a ai o he esils (d ) TheVA pet me a CT s a wih 1 . rbr d cn t c ta tCi r h Sc '.Thepr lmi y rpor-- eae by t r ol s wor ngt onrs Ma c an' ) ei nar e t fr td he adi ogit ki he ni ts f f nd a tglldei d 2. c ce aed l i wih c nta hypode iy gh hit ou n sil- fne 5-m rnult eson t e r l nst 3 a utn telf ba d r q e to ac la s db a d rdie t uu . ( Ex.1a 6 ) s e b tig h et ld e, u sin olp e ld e v ri lm ' P. c ' t 2 ;e alo ( Tetmony . Thene d on M ach 13,201 te da i r ol s,Dr s Yun si ) xt ay, r 3, h ytme adi ogit . He y St n,r e d t M a c Sca and c ng t pr lmi r r por' c uson, nr er eviwe he r h n ha ed he ei na y e ts oncl i wrtng ça s s co so so a no mai i n tie tte .... an se i a lfi : b l u piiu se us b r lt s o d ni d i g y s Ag i e n s e t sd d b a d r dv riuu ' ( Ex.1 a 2 ) Th M ac S a d d n tr v a t ie ld e ie t lm. P. c ' t 95 . e rh c n i o e e l he pr enc ofanybl rson ( es e adde t e. Amma Tesi ) nn tmony . On Mach 1 201 M r Chirno c le t VA con ani ofa r 9, 3, . ai ald he pli ng bdomi pan.( Ex. nal i P. 1a 46- .Hewast dt g t t e ge yr om.(#.. ChirnoTe tmony) t 47) ol o o o he mer nc o / ;J ai . si . 1 4. On M ac 21 201 M r Chi i sw Dr Gre poon.( Ex.1a 41. Dr Gre poon rh , 3, . arno a . e ns P t ) . e ns rf re Mr Chirn t aps c oo it (. irn Tetmo y; Ex. a 4 ) ee rd . ai o o y h lg s. J Ch aio si n P. 1 t 3 . 1 5. OnM ach22,2013,M r Chi i s aps hol s.( Chirno Tesi r . arno aw yc ogit J. ai tmony;P.Ex.1 a 3 . Theps hol s t d Mr Chirno t thi hemau i mi be c usd by srs t 2) yc ogit ol . a i ha s tra ght a e te s i hi l e ( . irn Te t n ) n s i . J Cha io si y . f mo 1 6. On Aprl30, 3,M r Chirno c l t VA r pori f t rpai a he ura. M r i 201 . a i aled he e tng urhe n nd mat i . Chi rno as d t s e Dr Di butwa t d t ta app nt e wih Dr Diz wasnot ai ke o e . az s ol ha n oi m nt t . a a lbl untlAugus 201 ( Chirno Tesi y) The on- alVA nure t d M r vaia e i t 3. J. ai tmon . cl s ol . Chirn t got t emege yr aio o o he r nc oom.(.Chi i Tesi ,P.Ex.1a 30) J arno tmony' t . On M a 8,201 M r Chirno s w a prv e ur ogit Dr Pa rc Hunt r Dr Hunt y 3, . a i a i at ol s , . tik e. . er pef me a c t c on May21 201 ( 'esi ror d ysos opy , 3. Yun I tmony;D.Ex.1I a 3) Durng B t . i t c t c he ysos opy,Dr Hunt rc d nots e t e e ie b a ra t r wa t m uc bl . e oul e h ntr l dde s he e s oo h ood; heor r daf l u c t c unde a shesa.( n Tesi de e olow-p ysos opy r ne t i Yu tmony) . l 8. On May23,201 Dr Huntrperbnne acysos opyunde a t sa.( era Stp.a 3, . e t d t c r neshe i Prtil i t Dr Huntri ntge a m aa s lngon t lf sdewa loft bl r Hewas . e de iid de f nd weli he e t i l he adde . una et s et l tur e orfee(heope ngf t t ladi t aki y)bec us bl o e he ef etr ii t ni or he ube e ng o dne a e 4 a tmo wa c v rng t e h l. (d4 Dr Hu tr c n e td te p oc d r t a u r s o ei h oe l .. . ne o v re h r e u e o ta urt a r eci ofbldde t rns ehrl es ton a r umor(t S TURBT',a be s vi a y te i i ' nd gan ha ng wa h nsde ) o t et mo .(J) Dr Hu tras o s r e t a tet mo h ds r a t t fo ro t f h u r / .. . n e lo b ev d h t h u r a p e d o he l o f he bldd r (d4 A tsuebi ywaspef dt trve e t prs nceofahi gade a e . 1 . is ops ronne ha e ald he e e gh r ur hei c cnoma i M r Chirno' bldde . ( era Stp.a 2- . Thet ot lal ari n . ai s a r Prtil i t 3) umorwas a oxi t y7c i tr.( Te tmony) ppr mael entmees Yun si . On J 28,201 M r Chirno unde we a r di a c t t une 3, . a i r nt a c l ysecomy,a pr edur i whih oc e n c hi bl r wa r moved a a bne adde ' was c e t fom a pori of M r s adde s e nd i obl r' r aed r ton . Chi i sc on.( eralStp. t3,YunTetmo . arno' ol Prti i a ' si ny) 20. Si e ha ng t r ca cyse t nc vi he adi l t c omy,M r Chirno hasha m uli es ge i i l ng a . ai d tpl ur res ncudi s gey t ur r o s l bowe obsr ton a t e he ni rpais (. Chirno mal l tuci nd hre r a e r. 1 ai Tesi tmony) M r Chirno hasha a tona heat pr e ,i l ng i tne e . . ai d ddii l lh oblms ncudi nconi nc and ee tl dysk ton. ( Chirno Tesi rcie fmci J. a i tmony;V.Chirno Tetmony) Si e hi ai si . nc s s ge y on J 28,201 M r Ch a i ha notexpe inc d a r cu r nce ofhi ca e . ur r une 3, . i rno s re e e re s nc r ( era Stp.a 3 . Prtil i t ) 21 On M a 6,201 M r Chi rno a hi wie Vane s Chirno,a tnde an a r e e nt . y 4, . a i nd s f , s a a i te d dve s ve me tngatt VA i W es Pam Be ch. ( Ex.1a 1 . Att a ree ntme tng, ei he n t l a P. t 8) he dves ve ei Dr Al r M . Amman t d t Chirnos t t Dr.St r i r c l i e pr t d t . be t n ol he ai ha e n ncore ty ntr e e he M ac Sc n.( rh a Amma nTetmo ) n si ny . 22. OnAprl9,201 M r Chirnobr i 5, . ai oughtt i tnts ta ns t Unie Stts ( 1. he nsa ui gai t he td ae . DE ) lhel a be h ti be nni M ay 9,201 Se r e rst sis d. The expe t e h d nc ral gi ng 6. ve al xpe t e tte rs ac ha i pe ca e c e i l a we e r fes ngl c ndi wih t Cour. 1 c d m c bl r denta s nd r e r hi y a d t he t omm e nd t hem f t rt tm o or hei es i ny. 5 a. Dr Edwar Yun t tfe on b l ofM r Chi rno. Dr Yun i a boa d c rii d . d esiid ehaf . ai . s r e tfe u ol s fom Calf ni He t sii d t t a t tm e M r Chirno Ert r ogit r ior a. e tfe ha , t he i . ai t s i pr s nt wih hema ura he woul ha s pe e bldderc e . Thi i ba e e e ed t t i, d ve us ctd a anc r s s sd on t he aura whih c n be c e by bl r c nc r Addii nal M r he m t ic a aus adde a e . to ly, . Chirno had muli e rs t c or f bl dde ca er i l ng:a Ove 401 ai tpl ik - t s or a r nc ncudi a ge r ; ma e;hit y ofs oki 2 a d e l sor m ng ; n xpos et c ur o hemi l bas on m iiar s r ce cas ed lt y e vi es i ly asa ai l cem e ha c. He t tfed t ta sanda d wo kup f g os pec al n r br c ni esii ha t r r or r s he trai udes ( a CT s a wih a wiho eonrs;( urne c ol , mau i ncl : a) c n t nd t ut ta t b) i yt ogy' a d ()ac t so .A CT s a wi o tc nr s i h l 'l o s ec ranobe t n c yso c py c n t u o tat s epf t e e ti j cs h u i t bldder s h a sones A CT s an wih c r t me nga doc orus sa n he a , uc s t . c t ontas- ani t e c n rsig d e i e o e t fn oh ro j css c a tmo s Un e aCT o tatn y - s mply d o i d te be t u h s u r. d r s a wih contas,t or lg up. Het sii d t tacy ol i a s par oft cn t r t um s i ht e tfe ha t ogy s lo t he sa d wor p t de e mi whehe t r i c nce i t bl dder tndar ku o t r ne t r he e s a r n he a . b. Dr Y u t tfed t tDr Di s d ha c . n esii ha . az houl ve onduced a CT s n wih contas i t ca t r tn Oc obe 20l Het sii d t tDr Diz wa co r c t or r acyt ogy aswel, t r 2. e tfe ha . a s r e t o de ol l bu t tDr Diz i ope l f ie t f l u whe t cyt ogy wa ne r t ha . a mpr ry a ld o blow p n he ol s ve conduc e Dr Yun t tfe t ,durng t c os py i Novembe 201 whe t d. . esiid hat i he yt co n r 2 n Dr Di s wha he be ived t be a sone i t bl der Dr Diz s d ha . az aw t le o t n he ad , . a houl ve r lz d t i wa no a sone be us t ulr ound a t Se e be Sca eai e hat t s t t ca e he tas nd he ptm r n ha notr ve l d t pr s nce ofa sones3 Thus a cor ng t Dr Yun,Dr d e a e he e e ny t . di o . . , c D i z m i di gnos a t m ori N ove be 201 asa bl dders one. a s a ed u n m r 2 a t 1M r Chirnowasbor onFe uay 11 1 47.(.ChirnoTesi . ai n br r , 9 J ai tmony) . 2M r Chirnoqui s ngi 1 9.( ChirnoTetmony . . ai t moki n 98 J. ai si ) 3 He alo t tted t t a CT s n wihout c r s i exte e y efe tve a i ntf ng t s esii ha ca t onta t s r m l f c i t de iyi he pr e e ofsonesi t bldde . Acc di t Dr Yt i t CT s a di notr vea a sone, es nc t n he a r or ng o . m, f he cn d e l t 6 Dr Yun alo t siid t a t ors gr h r t va i s bas on t i vi l . s e tfe hat um ' owt ae re ed he ndi dua t a ' bi og aswe la t pa intsbi ogy. Howe ,he tsii d t atM r un ors ol y l s he te ' ol ver e tfe h . Chirno' pr es i ofs a i s ogr son ympt wa c itntwih no ltl gr t oms s onsse t nna tmor ow h. d. Acc di t Dr Yun,t t or ng o . he umorexit i N ove sed n mber201 a wa tny. Had 2 nd s i Dr Diz or r d t pr r wor f he ura.he woul have c . a de e he ope kup or mat i d aughtt he t orwh n i wa tny,as St ge lca ert twasc i d t t e di riul um e t si a nc ha onfne o h ve tc um. M r Chi rno woul ha ha t opton t r move i vi ata ur t a r s c i . ai d ve d he i o e t a r ns ehz l e e ton o a d r u Ci fbld e t mor TURBT' p o e u e I tec nc rh dp o r se t Sa el. ' r c d r . f h a e a r g e sd o tg I ) whe e t ca e ha i ded t bl rwa l M r Chirno woul ha ha a r he nc r d nva he adde l, . a i d ve d pa ta c t com y- a pr edu e wher onl pa toft bl dde wa li r moved. ri l ys e t oc r e y r he a r l s e Ha t eVA c dl a aughtt c c i M a ch 201 when i woul ha lkel silbee he an er n r 3, t d ve i y tl n St ge 1 c nce .M r Chi i woul silhave ha apa ta c t t y. Dr Yun a 1 a r . arno d tl d ri l ysecom . t tte t t b f ii t c c t tl or e r i r M r Chi i s c ce es ii d ha y a lng o at h he tm a le , . arno' an r pr es e t St e 11 i whih t onl te t nt opton was a r di l ogr s d o ag 1, n c he y r a me i a ca . esii ha he a c l yse om es td n r cys ed om y, Dr Yun t tfed t tt r di a c tct y r ule i nume ous t complc tons i udi t bowe obsr c i muli e he nis a cure iai ncl ng he l tu ton, tpl r a , nd r nt i on i nce an e ecie dys unc i Dr Yun t tse t att e complc tons nc tne d r tl f ton. . esi d l hes a iai woul lkel notha Oc ured ha M r Chirno ha a TI RBT pr edu e ora d i y ve c r d . ai d J oc r pa ta c t t y. Dr Yu a s t sii d t t at ril ysecom . n lo e tle ha , lhough M r Chirnoha notha . ai s d a r ur nce ofc ce snc hi r dia c tct es ge an r i e s a c l yse omy,he s ill e a l rc tl àc s owe hanc e ofs vi la o ur va s ppos t apate whos ca e wasf und whe i wa St ge Io ed o i nt e nc r o nt s a r t n t e m os lkel wasno sone M or ove ,ac or ng t Dr Yun,t r i no e de ofa he her ti y t . e r c di o . he e s vi nce sone be us not n i M r Chirno' pa int hit y a i fom Dr Di s c t c t ca e hi g n . a i s te sor - sde r . az' ysos opy r por- i c t a sone w a e ri ntfe e t ndi a es t s ve de ii d. 7 He t tfe t t f t st ofc nce ,St ge 1s vi lr t f fve ye si esiid ha , or hi ype a r a ur va a e or i ar s 88 ,St e 1 s r va r t i 63% ,a Stge 1ls vi lr t i 46% . % ag 1 u vi l ae s nd a l ur va ae s e Dr Am man alo t sil d f Pl i if Dr Am ma i a boa d ce tfe . . n s e tte or antf. . nn s r riid r ol s who haswor d a t VA snce 2003. Het tfed t the r viwe adi ogit ke t he i esii ha e e d t M a c Sc i pr par ton f t VA' a er e e ntm e tng. He t tfe he r h an n e a i or he s dv s ve ei esiid t the a ura c b ca e by sones i t e bldder butt t her ,no so s ha m t i an e us d t n h a ha . e tne we e f r ound. Dr Amm am t sii t t Dr St r m is d t t or i M arh . l e tfed ha . e n s e he um n c 201 Dr Ammann t tfed t the i entse t t m or bas on t M ar h 3. . esii ha d i d he u ed he c Sca n. He ts ii d t t he s e tfe ha howe t M ar Sca t t ee or f r ot r d he ch n o hr ou he r di ogit, t d,'wihou a ba kg ound i br ton, a t y al s w a a ol ss d ' t t ny c r col nf ma i nd he 1 a t umor He t tfed t tt swa aca eofa ç ltoutm is. He as t sii t t . esii ha hi s s ta f s' ' lo e tfed ha t e VA mi have s en t t h ght e he umor i Sep e be 201 had t VA pe f m e a n t m r 2, he ror d CT s n wih con r t ca t tas. f Bo h M r .and M r Chirn t tfe The c oni e t rmuli e a t t ,i . t s , a i o esii d. y hr cld hei tpl temp s n tyi t ge a pr pe dignoss a t VA . The t tfe r r ng M r r ng o t o r a i t he y esiid ega di . Chirno' pa n a t i colec i fusr ton durng t s pr es The alo a i s i nd her l tve r tai i hi oc s. y s t tfe r ga di t sg fca r ove y p i M r Chi i u r nta t r esiid e r ng he i nis nt ec r erods . arno nde we fe hi rdial c t c o y a s eque s ge i . The t sil d as t M r s a c yse t m nd ubs nt ur res y e tte o . Chi i s qua iy oflf bef e a al rt cyse t ny. M r Chirno t si d arno' lt ie or nd fe he t c ol . a i e tse t t he wa wo re sari i Se embe 201 t t he ha bl r ca e , ha s r id t tng n pt r 2 ha d adde nc r be e hi da e -n-a sf he had bl rca ert ye b or a ha caus s ught ri lwe at r adde nc he ar ef e nd d t s me s he a ympt s M r Chi rno t tfe t the t d e r om . . a i esiid ha ol ve yone he coul a t d t he VA,i l ng Dr D i ,t athebeleve he h bl rca er ncudi . az h i d ad adde nc . 8 g. Dr Br e Ka a pr ks orofur og a t Uni r iy ofM im i t siq d f r . uc va, ot s ol y t he ve st a , e tfe o t Gove nm e . Dr Kavat sii d t taCT s a a ulr ou ar note he r nt . e tfe ha c n nd tas nd e noug h ofa wor i c es s h as t s a doc or s ul alo c kup n as uc hi; t ho d s onduc a c t c t ysos opy, whi i t gol sa r dignosi t . He a s a e t tt sa r o ch s he d t nda d a tc ool lo gr ed ha he tnda d f ca e f ra wor p on he t i i cl r o ku ma ura n udesa CT s a wih conta t He e Dr Diz cn t rs. r, . a pr ry p f med a c t c ope l eror ysos opy a notd t t M r Chi i ha a fi bl nd e ha . arno d ra e pr t tc ur t a a a si ty l r pr t t ,whih c eaed a pr penst f r oshe i ehr nd lgh l a ge osa e c r t o iy o ble ng. Het si d t tDr Diz di notlkey misa t ori t c t c e di e tse ha . a d i l s um n he ysos opy i No n vembe 201 l M r Chirno ha a t r 2. f . a i d umor i hi bl dde i Nove r n s a r n mbe 201 i woul ha me a t i e s ea t ot rpars oft body. He e,t 2, t d ve t sasz d- pr d o he t he r he t umordi no s e d be d t pr a yond t bl r t i c d notha be n a t he adde , hus t oul ve e umor i n Nove be 201 le t tfed t tt c t c m r 2. I esii ha he ysos opy wa pr ry peror s ope l f med and t tDr Diz wa lkey viwi e ty wha hedes rbe a sone l waslkel ha . a s i l e ng xacl t c i d, t . t i y t t a sone was pr e i t di ri um e n t ha t es nt n he ve tcul ve hough t CT s a wihou he cn t t contas a ulr s r t nd ta ound di notr ve lt pr enc ofa sone:he c uded t s d e a he es e t oncl hi ba e on t i e v ni tme fom t i talt t andt s eque c t c s d he nt r e ng i r he nii ess he ubs nt ysos opy, as wel a t p sbiiy t at i was a t of sone t woul notha be l l s he os i lt h t ype t hat d ve ea r ve l d i a CT s a orulr s e ae n cn ta ound. He t tfed t t he aura wa lkel esii hat he m t i s i y c us d bybeni pr ttchy ml i (û '. Hetsiid t thewoul ha a e gn osai pe asa ç BPH') e tfe ha d ve f l olowed up i t e t f rmont . Dr Ka a s t tfed t the r viwe t n hr e o ou hs . va lo esii ha e e d he M a c Sc a f r h an nd ound no e de ofa tl or vi nce tm . Dr Kava t tfe t he w oul ha done s e t ngs dif r l he w oul . es ii d hat d ve om hi f e enty, d ha or r d a cy ol y,he w oul ha per or ed a CT Sca w ih co r t a ve de e t og d ve f m n t ntas , nd he w oul ha had M r Chi rno r t n e ler t per or a s co cys os y d ve . a i e ur ari o f m e nd t cop 9 a tr t hemat i contnte Howe r Dr Kava t tfed t t none of t e fe he ura i ld. ve , . esii ha hes cha swoul ha m a any dif r nc i i e r mel difcutt c t h bldde nge d ve de fe e e: t s xte y fi l o a c a r ca e a a sage w he e s e f m of c t t y i notne es a y. He t tfe nc r t t r om or ys ec om s c sr es ii d t tpa ta cyse t e do ha a r e i m e ci butt y l a t r s oft ha ril t c omi s ve ol n di ne, he e ve he e t he bldde wal a rs f a hi r e ofr cure e ofc er He alo t tfe t t a r l t i k or gh at e r nc anc . s esii d ha tal ysec om t l aton of t s t he oc i hi umor ne r t ur t r woul ma a pari c t t y , a he e e , d ke t c c l difc t and c ld ha 1 t ki y de tu ton and ot r e hnialy fi ul otl ve ed o dne sr c i he complc tons i l ngbowelc mplc i . ia i , ncudi ol iatons Dr Ka t tfe t t whe M r Chirno wa di . va esii d ha , n . a i s agnos d i M a 201 he woul e n y 3, d ha e rc mme d d M r Chirno r c ie n o du a t c e te a y p ir t v e o n e . ai e ev e a j v n h moh rp ro o ha ng hi r di a cyse t vi s a c l t c omy,w hih woul have gi n M r Chi i e be t r c d ve . arno ven te oddsoffghtng t bldde ca r Howe r Dr.Ka ts iid t tr ar es , i i he a r nce . ve , va e tfe ha eg dl s M r Chirno ha a good pr noss Si e M r Chirno has no ye ha a . ai s og i . nc . ai t t d r c l nc ofc e ,hei doi ex r m e ywel. Het sii d t tt botom lne e tl e anc r me s ng te l l e tfe ha he t i i not ng hewoul ha c ng a s hi d ve ha ed boutt VA docor 'pe f he t s r onna ewoul have nc d m a adif e e. de fer nc Fi l Dr J e Pizolt adocorwho wor satM t Si me c c era naly, . os ph z a o, t k . nai dial ent nd s calz si media o ol and he aol t tte f t Gove nm e . pe i i e n c l nc ogy m t ogy, esis d or he r nt He tsi e t a Mr Chirn s o l h v b e te td wi n o d u a t e tt d h t . aio h ud a e e n ra e i t e ajv n h che he apy p i t ha ng t r ca c t c omy, He a s ts i e t t mot r ror o vi he adi l yse t lo e tt d ha s not ng t e V A doc or c d ha done w oul ha c nge M r Chi rno' hi h t s oul ve d ve ha d . ai s c nc ofs r va bec e M r Chirno ha be n c erf'e a t am os t z e ha es u vi l aus . ai s e anc ' fer l t h e i e ye ssnc hi s ger Het sii d t t afe t e ye r ,t r i gr atrt n a ar i e s ur y. e tfe ha , t r hr e a s he e s e e ha 95 c ncet M r Chi i ha be n c e % ha hat . arno s e ur d. 10 I. l CO NC LU SI N S O F LA W O Attil M r Chirno cl m e t tt VA ha a dut t M r Chirno whe he s ra , . a i ai d ha he d y o . ai n ought me c lte t nt M r Chi i ag dt VA br c dt tdut on mtli eocc i by:( ) dia rame . . arno rue he ea he ha y ltpl asons 1 f ii t or raCT Sc n wih c r twhe M r Chi rno pr s ntd wih he aura i Oc o r a lng o de a t ontas n . ai e e e t m t i n t be 201 ( fii t f l upt ens eac t ogywa a t lype f me a tri wa or r i 2;2) alng o olow o ur yol s cual ror d fe t s deed n Ocobe 201 ( i opel i ntf ngat t r 2; 3) mpr ry de iyi umorasasonedurngt c t c i Nove r t i he ysos opy n mbe 201 ( l tpl l lr t f l u wih a c ol CT Sca wih c r t o a s ond 2; 4) nuli e àiues o olow p t yt ogy, n t ontas, r ec c t c durng t m ont afe t frtc t copy,wher M r Chi rno con i ed t have ysos opy i he hs t r he is ysos e . ai tnu o he uraa pr esi l wores oms a ( midi mat i nd ogr svey s ympt ; nd 5) s agnosng t t i he umori M ac 201 n rh 3. M r Chi i con e t ta o oft s f l esc tt ed a b e ch oft du y ofc r a . arno t nds ha ny ne he e aiur onsiut ra he t a e, nd ca ed M r Chi i ha m by lti hi bl rc e de op fom St e Iorl,t St e 11 us . arno r e tng s adde anc r vel r ag I o ag 1. Asa rs t Mr Chirno s fr d da ge ba e on ( )rdtc lf e ct y and ()beng e ul, . ai ufe e ma s s d a e led ie xpe anc b i t c t ha a r ca c t c omy,whi h r uled i a tona da a i l ng s ver l br ed o ve adi l yse t c es t n ddii l m ges ncudi e a s equ s r res a r duc d qualt oflf - al ofwhi woul n ha occ r d ha he ubs ent u ge i , nd e e iy ie l ch d ot ve ure d be n a et haveaTURBT orpa ta c se omy.M r Chi rno s e $2,000,000 i dama . e bl o ri1 y t ct . a i e ks n ges4 l r pons t Gover e a gue t r wa no br c of t dut ofc e Dr Diz n es e, he nm nt r d he e s ea h he y ar - . a a t ot VA docor and wor sm e t sa r ofca e. The Gover nta s contnded nd he her t s ker t he t nda d r nme lo e t tM r Chi i hasnotesabls d t atany br ac oft dut ofc r c e M r Chirno hi ha . arno t ihe h e h he y a e aus d . a i s 4I i unc e re cty how t sfgur wasc c ae The Com pl ntsa e M r Chi i t s l a xa l hi i e alul td. ai t t s . arno s e s $ 0 0,0 f r émld c le pe s s ic re i t e p s,a me c l e p nss t be e k 2,0 0 0 o l e ia x n e n u rd n h a t nd dia x e e o g i ur e i t f tze;pai a s f i dia lt physc i r e ,difgtr me ,me a nc r d n he u lr n nd uferng, s biiy, ial mpaim nt s le nt nt l an s i onve e guih, nc nince,agg ava i ofa die e orphysca def t a l sofc pa iy f rt r ton s as i l ec , nd os a c t o he e j y n o lf s san d i t ep s a d t b s san d i tef tle' ( mpl a 6 . I h s n o me t f ie u tie n h a t n o e u ti e n h utr. Co . t ) n i ' pr e fndi of f t he lss $336, 25 dola s : or t r as bl coss ofne es a y opos d i ngs ac , it 255. lr ç he e ona e t f c sr m e ca a he t ca e, t a me c tons s pples r quied by hi m e c co to di l nd alh r her py, di ai , u i , e r s dial ndii n r uli fom t oc ure i que tonfom t daeofti t t daeofhi de t ' ( 5 es tng r he c rnce n si r he t ral o he t s ah. DE 4 ' a 9 . He se $ , 00 00 (o p s a ft r p ysc lp i a s fe ig, a ta d ft r t) e ks 165 ,0 .0 t r a t nd uu e h ia an nd u f rn p s n uu e f me tl ng s d s blt, ifg e n a dpata d ft r l so t e j y n o lf . (d.. n a a uih, ia ii d s urme t n s n uu e os f he n o me t f ie' 1 ) y ' Atti ,M r Chirno a ndone hi c am sf f t eme c e ns s ral . a i ba d s l i or uur dial xpe e . prsn ij re . Ac o dng t te Go emne t a y alg d d ly i Mr Cha io' te t n ee t nu is c r i o h v r n , n le e ea n . irn s r ame t woul notha c nge t e r s t r ga dls oft VA' a lged br a h,M r Chirno d ve ha d he nd e ul; e r e s he s le ec . ai wo d ha had a r di a c tct ul ve a c l yse omy. Furher a M r Chirno ha nothad a r cure e of t , s . ai s e r nc c nce ,he ha ha t b tout om epos i e Any e rirc t h ofa t m orwotl notha l d a r s d he es c sbl . a le a c u ld ve ea t a b teroutome. Fi ly,t Gove nme cont o et c na l he r nt endst tany dif r e i t ou c e wa ha fe enc n he t om s c us d by M r Chirno ort prv e docor he us The Gove nm e a gued M r Charno a e . ai he i at ts ed. r nt r . ii wasa s t slge y:t the di notwa t have a c t c a t Nov vere o tr r ha d nt o ysos opy fer embe 201 a t t r 2 nd ha he f ld t s Dr Di afe Fe ua y 2013. The Govemm e alo c e d t a aie o ee . az t r br r l nt s ontnde hat ny r duc i i M r Chirno' s val r t woul be ati a e t hi c c t no have e ton n . a i s uni ae d trbut bl o s hoie o t n o du a tczmo h rpy e a j v n l t ea . e df e Fede al Tor Cli s Ac was desg t' -h r t am t i ned t pr de r dr s f or nar t t o ovi e es or di y ors rc g ie b saelw. So ev UntdStts 3 3F.d 1 2 ,1 3 ( 1h Ci. 0 4 (ntr a e o n z d y tt a ' tn . i ae , 7 3 1 9 1 0 1 t r 2 0 ) i en l ' e q o ai somitd . Ast e alg d tr o c re i Flrd ,Flrd t r 1w a p is 1 . I u tt on te ) h le e o t c u rd n o ia o ia o t a p le . d n Flrd ,çth ee nt o a me ia map a tc a to a e ()ad t b t p y iin,( a o ia dj e lme s f g dc l lr cie ci n r : 1 u y y he h sca 2) b e c o ta d t a d( )c u ain. Sa n e sv Dik n ,1 S 3 43 , 41( a 2 4 .A ra h f h t uy, n 3 a s to ' u d r . c e s 51 o. d 4 4 F1. 01 ) ' pl i ifm us pr ea h oft e eement by apr ponde anc oft e de e,m e ni l or antf t ove c hes l s e r e he vi nc a ng ç e m lke yt n not' I a 442. i l ha .' d t A . D ut and B r ach y e The du y a physc a o s a pai nt i bas d o dhe sa r of pr es i l c r ' t i i n we te s e n û tnda d t of sona a e. ' Saunde s 1 So.3d a 441 lf e sanda d ofpr e sona c e i a l ve of c r s l,a r , 5l t . f' t r -h of s i l ar s e l a e, kil nd tea m e t t i co i r ton ofa 1s r und ng c r um s anc s i r c r t nt ha , n ns de a i 1 ur o i i c t e , s e ogni ed a a e a e a z s cc pt bl nd a oprae by sm ia a r s na ypr de he lh ca epr de s n s t i i t pr det ppr i t i lr nd ea o bl u nt a t r ovi r .l hor, t s o ovi he ca et tar a o bl pr ntphyscin woul pr de. l r ha e s na y ude ia d ovi ' d ' Faiig & or r: CT Awa wih cp r ,i Ot & r2012 ln ? de ? t ra/cl n 7 / &p M r Chirno fr tc e t tt sa r ofpr e sona c er uied t t whe M r . a i is ont nds ha he tnda d of s i l ar eq r ha, n . Chirno pr s nt wih he trai Se e ai e e ed t matli n pt mber201 he be e ua e f bldde c nc rusng 2, val t d or a r a e i ( )aCT s a wi a wih u c nr s,()ac oo y, 3 a dac so c p Hec n e d Dr 1 c n t nd t o t o ta t 2 ytlg ( ) n y t s o y. h o tn s . Diz a t VA b e che t sa d ofca eby f lng t or raCT Sca wih c r t a nd he r a d he t ndar r aii o de n t ontas. Dr Yu Dr Am mann,and Dr Ka ea h t tfe t tt san d of c r i l de . n, . . va c esii d ha he t dar a e nc u s or rng a CT Sc wih contas, Dr Yun t sii d t t a sa r wor de i an t r t . e tfe ha t nda d kup f he t i or ma ura i l d a CT Sc n wih c r t pa tcul l i lgh ofM r Chi rno' hit y and pr nst ncude a t ontas, ri ary n i t . a i s sor ope iy f bldd r c nc r l r e ng t or i a CT Sc n bot wih a wihout c r t Dr or a e a e . n ef ni o derng a h t nd t ontas, . Ammn t tfe i i t wa t ç t r word' pe f m s wor nn esii d, t s he y he i e n wes l ' ror kups f he t i . The or ma ura Gov nme ' own expe t Dr Ka c ede t tt sa r ofc e f c es s ast s er nts r, . va, onc d ha he t nda d ar or as uch hi i ude aCT s an wih and wihoutc r t 1fnd t sa d ofc r r quie a CT s a wih ncl s c t t ontas. i he t ndar ae e rd cn t co r s. The evi nce i caest tn t Dr Di z,nora neele a t VA,o der d a CT nta t de ndi t ha eiher . a nyo s t he r e s a wih c r s i Ocober201 Thus M r Chirno e tbls d t VA br ac t du y of c n t onta t n t 2. , . a i sa ihe he e hed he t Car e. J Faiig t b lw u t e s r tz oo wzsa t al c?#? /# ttri wJ$o d r d , ln oj lo p o n u e z ytlgv z cu l : / t ' e t . r e e y n c? f i Oc obe 2012 n t r Dr Yun a Dr Ka alo agr d t tt sa d ofc e r quie o de i a c ol . nd . va s ee ha he t ndar ar e r d r rng yt ogy and f l ng up t ma s e i wasa t ly co olowi o ke ur t cual nduc e The e d e i c t no one a t t d. vi enc ndi aes t he VA f l olowed up t m a s e t c ol wa c o ke ur he yt ogy s onduc e The f iur t e ur t c ol y t d. a l e o ns e he yt og waspe f r e c tt e abr a h oft sa r ofc r r o m d onsiut d ec he tnda d a e. I o ry ie t n at mo Jjaso ed rn t c ,T'f i No e e 2 2 ppr pe l d n l g u r , t n u ig he z5 lc? n v mb r 01 #i , ' A ry / A he t c r pr de S sa dut t pr vi apr rdi nossmade a t rt c ti ng alh a e ovi r û ha y o o de ope ag i fe as era ni a pa intsmedialc to tloug e mi to a t si '' Per z v Unie St e ,883 F. te ' c ondii n lr h xn na in nd e tng.' e . td ats 1 3 S p 2 1 5 ,1 8 ( . Fl. 01 )( u tn Siv v 5 . o iaBlo Ba k I c, 1S 2 u p. d 2 7 2 6 SD. a 2 2 q oi g la . ' Flrd o d n , n .60 o. d w 1 8 ,1 8 ( 1 .1 9 ). M r Chai o c ne s t t Dr Diz mid a n s d t e tmo i 1 4 1 7 Fa 9 2) . irn , o tnd ha . a s ig o e h u r n Nove be 201 asa sone. Dr Yun t tfed t tDr Di z s d ha known t t orwa m r 2 t . esii ha . a houl ve he um s nota sone,ba e on t pr ousCT s a wihoutc r ta ulr s t sd he evi cn t ontas nd ta ound,whi bot i c t ch h ndi aed no so we epr s nt TheGove n e , ed on Dr Ka st si ony,con e t tDr Diz t nes r e e . r m nt bas . va' e tm t nds ha . a pr pe l di nos d e ty wha wa pr s nt a sonei t bl dde . o ry ag e xacl t s e e - t n he a r He e,M r Chirno hasnote t bls d by a pr ponde a e oft e de t twha Dr r . ai sa ihe e r nc he vi nce ha t . Di zviwe durng t c t c wasa t ly a t a e d i he ysos opy cual umor Ac r ng t Dr Yt ,bl de ca e . co di o . m ad r nc r i m o e lkey t deve o wihi di ri ul He t sii d t tt r was no s o t c us t s r i l o l p t n ve tc a. e tfe ha he e t ne o a e he he t i Dr Yun co l ma ura. . ncuded t tt he t i mus ha bee ca e by t t ha he ma ura t ve n us d he umor whih , c me ntt t orde l pe i Se e r201 l a ton,Dr Yun t sii d t tt s t or a he um ve o d n pt mbe 2. n ddii . e tfe ha hi um a a st ha gr ppe r o ve own fom t di tc a He t r f e bele t twha Dr Di i ntfe r he veriul. he e or ives ha t . az de ii d a asonewa ,i f t t t or s t s n ac, he um . Howe r Dr Ka t sii d t ta so c d c us he aura. He expl ne t ti i ve , . va e tfe ha t ne oul a e m t i ai d ha t s pos i et ewa a sonei t di ri ul a t CT s a i Sep e be a ulr ound smpl sbl her s t n he ve tc a nd he c n n t m r nd tas i y di not i ntf i. Dr Ka t tfe t t he t i c d a s ha bee ca e by BPH. d de iy t . va esiid ha ma ura oul lo ve n us d M or over Dr Ka t tfe t tt t e , . va esiid ha he umor di notne es a iy c d c s rl ome fom t di ri a but r he ve tcul, a he pori of t bl dde . M or ove , he t tfed t t had t t not r ton he a r e r esii hahe umor de ope i vel d n Sep e be 201 perM r Chi i s t or t t tm r 2 . arno' he y- he umorwoul have me a t i d. Thi di no d t sasze s d t oc ur Bas on t t tm ony,Ifnd t tM r Chi i di no esa ih Dr Di m idignos d c . ed he esi i ha . arno d t tbls . az s a e a t o a a sone. The e wa ,t r or no b e c oft dut ofc e durngt c t c i um r s t r s he ef e, r a h he y ar i he ysos opy n Ocobe 2012. t r 4 On igjl u e t .a/ w u wih a c tto$CF Sc n wih c nr s,o f s c d . go n èi r o / /f p t y// . l iy ?a a t o ta t r : e on 1 c /uc py du i g t mont w/c c M i C' ario c i d t h e lcnt/// and ylt q r n he hs /r ' hi n ontnue o av lz zlrt . z #r)rT&$ L/ WOr e S fj X? $ ,# 2 S ympt v om b ' M r Chi rno cai sm uli e b ea hesoft sa r ofc r bas on t VA' ongoi . ai l m tpl r c he t nda d a e ed he s ng f iur t core tispas m it ke . Dr Yun t sii t t VA s d ha f l d up a t r al e o r c t t sa s . e tfed hat he houl ve olowe fe M r Chirno c i d t e bi hema ura. Dr Ka a s agr e t the woul ha f l wed . a i ontnue o xhi t t i . va lo e d ha d ve olo up wih M r Chi i a tr hi he aura di not cea u A c or ngl M r Chi rno ha t . arno fe s m t i d l r p. c di y, . a i s e t bls d ongoi br ac oft sanda d ofca e ba ed on t VA ' f l e t or ra CT s an sa ihe ng e h he t z r s he s aiur o de c wih c r tora c ol durng t m ont ladi up t t e e ge y r t ontas yt ogy i he hs e ng o he m r nc oom vii i M a ch st n r 201 3. M idignosng t t mori M ar 2013. s a i he u n ch Dr Yun a Dr Ka diag ee r r ngwhehe t CT Sc n i M a c 201 r a e . nd . va s r d ega di t r he a n rh 3 eve l d t pr s nc ofat he e e e umor W hie bot a e e t e e ur ogit ,ne t ri a r di ogit The o y . l h r se m d ol ss ihe s a ol s. nl r di ogit t t tf was Dr Amm a a ol s o esiy . nn. Dr Amm a wa une voc t t t CT s n . nn s qui al ha he ca i c t d t pr e e of a a ndi a e he es nc n bnor lt He a s t tûe t tt a m a iy l ol el ' ma iy. lo esi d ha he bnor lt û abs ut y' s ul ha bee pr s ho d ve n e umed t be bl dde ca e untlpr n o he wie b f t rt si Dr o a r nc r i ove t r s y urhe e tng. . Str di noti ntf t a m aiy asa c en d de iy he bnor lt once n,buti t d diag ee wih t pr i i r r nsea s r d t he elm na y r por wihoutf rhe t si t r e ou t pos i lt ofa t or Ac r ngl M r Chirno e t t u t r e tng o ul t he sbiiy um . co di y, . a i esa ihe abr a h oft sanda d ofc ei m idi g i t t tbls d ec he t r ar n s a nosng he umori M a c 201 n rh 3. B . C aus t on ai To esabls c aton,çhe pl i ifmus s w t twhatwa do orf ie t be done t ih aus i ç t antf t ho ha s ne a ld o pr bl woul ha afe e t ou c oba y d ve f ctd he t ome. And t pl i if m us do s wihout a he antf t o t n i per i s bl sac ng of i e e s ' Sant L uc a v feVi N o. 2D 1 5011 201 W L m m s i e t ki nf r nce . ' a i . ne, 4, 6 8 6 8 , t* ( a 2 DCA M a . 2 6 (nena ctto a dq o ai n omitd . 8 3 4 a 4 F1. d r 9, 01 ) i tr l iains n u tto s te ls The r calc t t y and s e adi ysec om ubs quenthar . M r Chirno c e t tt d a i m . a i ont nds ha he ely n di g i c ed hi t ha t r di a c t ct a nos s aus m o ve he a c l yse omy,a t t t r di lc t c omy ca ed nd ha he a ca yse t us ha m ,i udi s ge is f rbowe obsr cton a he is i ontne ,e ecie dys unc i r ncl ng: ur re o l tu i nd m a , nc i nce r tl f ton, ongoi pai a a de e e i qualt oflf I or rt esa ih t c us ton elm e ,he ng n, nd cr as n iy ie. n de o t bls he a a i e nt ha t e t bls t t butf rany oft br a s oft d y ofc r he woul no ha had t d o sa ih ha , o he e che he ut a e, d t ve he r di lcyse t m y. Hef l t mee t sbur n. a ca t c o aied o t hi de M r Chirno' c e wa St e ll i Jme 201 Hi onl opton a t tm e wa a . a i s anc r s ag 1 n t 3. s y i t hat i s r di lcyse t a ca t c omy. M r Chirno pr s nt t aler tve team e optons t t he cai . ai e e ed wo t na i r t nt i ha l ms we ea lbl ha hebee di nos d a a e rirsa ,TURBT and apari c t c omy. r vaia e d n ag e t n a le t ge tal yse t Ast t TURBT,f t tt ha be a vald te t ntopton,M r Chirno woul o he or ha o ve en i r a me i . ai d ha hadt bea di nos a St ge1 The ewa no e de e pr s nt dt t whe t br ac ve o ag ed t a . r s vi nc e e e han he e hes oc ur e - t c nce wa St e Ia o c r d he a r s ag s ppos t St e I. The onl e de e t tt br c ed o ag l y vi nc ha he ea hes o c re wh nt ec n e wa a a e rirsa ewa Dr Diz sd s rp in o teo j c h sw c u r d e h a c r s t n ale tg s . a ' e c ito f h be t e a i t di ri um i Ocober201 a t tme i ofwhe t t n he ve tcul n t 2, nd he i lne n he umor wasr emove i J d n une 201 Ba ed on t sze Dr Yun esi t d t c nc wa St e 1 Howe ,t sc uson i 3. s he i , . tma e he a er s ag . ver hi oncl i s s c ai . l r leson Dr Di z' des rpton,whih Dr Yun sm ula ousy a tcksa beng a pe ul tve t e i . a s ci i c . i t ne l ta s i m idignoss and a fxe tm ei oft t orgr t Dr Yun hi s l t tfed t tt o s a i, i d i lne he um ow h. . m ef esii ha um r gr h c be va i bl M or over Dr Ka t tfed t tt t owt an ra e. e , . va esii ha he umorcoul no ha e se i d t ve xit d n Nove rof201 a i wo d ha me a t i d be or t r di lcyse t mbe 2, s t ul ve t sasze f e he a ca t c omy oc ure Put c r d. 5Asat e hol m a t r lrj c t Go en n ' a g me t h tM r Ch aioc u e a y hr s d te , ee the v r me ts r u n t a . irn a s d n of t ha m . The G ove n e a g he r r m nt r ued M r Chi r no di not s gn ce t i c e doc e s . ai d i r a n ons nt um nt (vd n igad sr t a oi sr r)h ddn t n t flo u wi Dr DizatrF b ay e ie cn eie o v d ujey, e i o wa to olw p t . a fe e nzr, h a he wo d no ha ha addil nd ul t ve d tonalt tng i pr en e wih t opton. Thi i no s esi f es t d t he i s s t uppored t by t evi nc whih i c t s M r Chirno di e yt ng pos i e t ty t g t a pr he de e, c ndia e . ai d ver hi sbl o r o e oper di g i . a noss smpl i i uncla whe t c nce frtde ope a when i pr e s be wee sa . i y, t s e r n he a r s vel d, nd t ogr s ed t n t ges As t a pa ta c t t y sila pos i e te t nt opto f Stge 1 c nc r Dr o ril ysecom - tl sbl r a me i n or a 1 a e - . Ka tsii d t ta pa talcyse t va e tfe ha ri t c omy la s t r toft bldde atrs f r c r nc of e ve he es he a r ik or e ur e e c nc r He a s t sii d t t bas on t l a i of t tz a e. l o e tfe haed he oc ton he lmor nea t ur t r a pa ta r he e eril c t t y woul ha bee tc cal difc tand c d l d t ki ysecom d ve n e hni ly fi ul oul ea o dney desr ton orbowe tuc i l co i to . Dr Ka t tfed t t m os of hi pa int woul ha g mplcai ns . va esii ha t s te s d ve one wih a r di l t a ca cy t t y secom --eve i t ca erwa St e I . M r Chirno di no e t bls t ,gi n t s n f he nc s ag I . ai d t sa ih hat ve he e potntal c e i omplc tons a i e s d rs of r u r nce he woul ha elc e a pa tal ia i nd ncr a e ik ec r e , d ve e t d ri cysecom y ha he bee gi n t o i Fi l M r Chirno di notesa ih t s g i t t d n ve he pton. naly, . a i d tbls he ur eres t toc ure a trt r c cysec o y i udi t bowe obsr ton and he ni s we e ha c r d fe he adial t t m - ncl ng he l tuc i r a- r c us by t r di lcyse t a ed he a ca t c omy. M r Chirno di notesa ih whatsa t c nce wa i when t br c occ r d . ai d tbls tge he a r s n he ea hes ure ort the woul ha ee e a at na i t t r di lc t c o y. Acc di l he di not ha d ve lctd n ler tve o he a ca yse t m or ng y, d e t bls t t t br c sa ih ha he ea hes c us d hi t have a r di a c t t y, or a ha m t t a e m o a c l ysecom ny r ha s e nty oc ur e ubs que l c r d. Sur valr e M r Chirno di notesa ih t a oft VA ' br he ca e M r vi at . . a i d t bls hat ny he s eac s us d . Chi no a de r s d s r va r t M r Chi i ha notha a r c r nc ofca rf am os mi c ea e u vi l ae. . arno s d e ure e nce or l t t e ye r . Dr Pi ol o t si d t - a t spoi - M r Chi i hasha t be tpos i e hr e a s . zz at e tse hat t hi nt . arno d he s sbl outom e f r a bldde ca e di gnoss,r ga dl s oft sag i c d ha bee i ntfed. c o a r nc r a i e r e s he t e t oul ve n de ii The i tals vi r es ba e on t sa oft c nc ,t r f e,do notr pr e s vval nii ur val at sd he tge he a er he e or e es nt ur i r t s a t M r Chi rno. As s h, a da ae s o . ai uc ny mage bas d o t i r s d rs of c nc l e s e n he nc ea e ik a er ç ar s cultvebas d on t pos i lt t tt c nc may r occ i t f ur A m e epos i lt pe a i e he sbiiy ha he a er e ur n he ut e. r sbiiy off ur c us ton i note ut e a a i s nough .... Wr y v N M i M e Ct Lt ,9 So. 111 1 1 ' o . ' ami d r, d. 37 2d 6, 1 8 ( a 3 DCA 2 0 )(fimig s mma yj g n f rt e d fnd n a t d ma e b s d o F1. d 0 6 afr n u r ud me t o h ee a t s o a g s a e n e arno t ihed ha a n agnoss i d ce s d c a c o s vv l. Her M r.Chi i has notesabls t ta dely i di e ra e h n e f ur ia) c us d ar duc d s vvalr t 6 a e e e ur i a e. Pai and s f r ng. M r Chi rno di ho ve ,de n ufe i . ai d, we r monsr t t tt br a oft dut ta e ha he e ch he y ofc r c us d hi pa n a s f i durngt tm et c nce une voc l s d ha be n a e a e m i nd uferng i he i he a r qui aly houl ve e ca ught on M a c 1 201 a whe i wa eve ualy dic r d on M a 23,201 M r r h 2, 3, nd n t s nt l s ove e y 3. . Chi rno r peae y i itd t t VA docor a sa ft the beleve he ha bl rc e . a i e tdl nsse o he t s nd t f ha i d d adde anc r Rahe t n r e veteam e f t ca e ,he wasr f r e t a ps hol s. Ha t br c t r ha ec i r t nt or he nc r eer d o yc ogit d he ea h ofdut notoc ur e he m os lkel woul ha r ceve t r di lcysecomy a a e rir y c r d, ti y d ve e i d he a ca t t t n a le tme He ma t r o e r co rf t pan a s f rng c us d by t de a i . y, he ef r , e ve or he i nd ufe i a e he l y. l a ton,a pli ifma rcove f t t ina dnmag ...asa r ul of ( n ddii antf y e r or he t o l emot es es t j i r s f rofr ure ofca e ' Swai v Cury 5 So.2d 1 ,1 ( a.1tDCA nceaed ea ec rnce nc n' n . r 95 68 73 F1 s 1 9 ) Hee at o g Mr Ch mi o d d n te tbih h p e e ty ha ahih rlk lh o o 9 2 . r, lh u h . i n i o sa ls e r s n l s g e ieio d f r c r nc ,he di s e ure e d how t t bas d on bei di nos a St ge 11 he was f c - a las ha , e ng ag ed t a 1, a ed t e t i taly wih t pos i lt ofa mor negai out nii l- t he sbiiy e tve come asop e t St e lor l. l ot pos d o ag l n her wor :a t tme he wasdi gnos d by prvae physca ,M r Chi rno di no know he wa ds t he i a e i t i ins . a i d t s goi t ha t ss c sulofa ou c ng o ve hi uc es f n t ome. He m a t r f e r cove t e o i y he e or e r he m tonalda mage s off i aworepr acng s ognossf t trtt ye r f l ngt dignoss(hetmei whiht i or he is wo as olowi he a i t i n c he c n e wa mo tlk l t r c r. Ba e o t e p i a d s frng c u e b t d ly i a c r s s iey o e u ) s d n h an n ufei a s d y he ea n dig i ,a wel a t e i a noss s l s he motonalhn m se mi fom hi r duc d pr c e s v va r t i r t m ng r s e e edit d ur i l ae n t t ye r afe t c t c o y,Ia r M r Chi no $500, he wo a s tr he ys e t m wa d . mi 000. 6AsIfnd M r Chirno hasnotesabls d c us to ast s v va r t lne d notaddr s t i ai t ihe a ai n o ur i l ae, e e s he . Go e z n ' ag n t a te fi r t h v n o du a c t te a y b fr t e rd c l v n me ts r ume t h t h al e o a e e a j v nt h moh rp eo e h a ia u c t t m a ha c rbut t ar e s vi lr t ysecomy y ve onti ed o educ d ur va a e. 18 11 1. C O N CLU SI N O The VA br c isdut ofcae t M r Chirno. Alhough t sbr a h wasnots ea hed t y r o . ai t hi e c hown t ha r s t d i a dif e pr o ve e ule n fer nt ognossorte t e ,t de a i di i r am nt he l y n agnossc us M r Chi rno i a ed . a i pai a s f i aswel asemoto ldnma .Ac di y,i i n nd uferng, l ina ges cor ngl t s ORDERED AND ADJ UDGED ta fn lud me ts ul b e tr di fv ro J sp h t i a j g n ho d e ne e n a o f o e h Chi rno a ag ns t Unie Stt sofAme ia. Fi J m e wilbe e e ed by s pa ae a i nd ai t he t d a e rc nal udg nt l nt r e rt or e . dr D AN ORD RE i C a esa sP l ec, r a ti F dyo ONE D E D n hmbr tWet a ah F i ,hs / a f d M ay, 6. 201 LD M . l LEBRO OK S M D UNI TED STA TES D I STRI J D GE CT U Copi st c e o: ouns lofr c d e e or 19
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