Meyers v. Miles, No. 7:2016cv00360 - Document 52 (W.D. Va. 2017)

Court Description: MEMORANDUM OPINION. Signed by Chief United States District Judge Glen E. Conrad on 6/29/2017. (tvt)
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rl RKSOF C U,. STCOU -F ' FIE S DI . W A R fi-zJ ,A T OAN 7 V JKE :! t I TH E UM TED STATES DI N STRI COURT CT FOR THE W ESTERN DI STRI OF VI NI CT RGI A R O A N O K E D I SI N W O ANTH ONY M EYERS, J 2g 2 1 UN 27 JUL C. U BY: CASE NO.7: 6CV00360 1 Pl ntff ai i , V. M EM OM NDUM OPI ON M D R .M I LES, By: G l n E.C onr e ad Chi fUni e St e D i t i tJudge e t d at s s r c De e f ndant . Ant hony M e r ,aVig ni i ae pr ee ng pr K ,fld t scvi rght a ton unde ye s r i a nm t oc di o ie hi i l i s c i r 4 U. C.j1 8 a an tDr M ie ,aph sca wh te td hm a a lc l al Th matri 2 S. 9 3 g is . ls y iin o r ae i t o a j i. e te s c re ty b f r t e c u to Dr M ie 'mo in f rs mmayj d me ta d M e es r s o s s u rn l eo e h o r n . ls to o u r u g n n y r' e p n e t r t Fi ng t t M e r 'n e d co pl ntand ot r s he e o. ndi ha ye s m nde m ai he ubmi so pr e no ge ne s i ns es nt nui is ofmaeilfc i ds e s ng a vibl cam unde j 1 t co twilgrnt sues tra a t n iput howi a e li r 983, he ur l a sl r u me t o Dr M ie . l mmayj dg n f r . ls Backaround M e r wa frtic r e ae a t rg o l alfcl y i Du fed Vigni,o M ac yes s is n a c rtd t he e ina ji a it n fil, r i a n rh i 7,201 t e mont be or Dr M iesbe n wo ki t r The c s ofteam e t r a tr 6, hr e hs f e . l ga r ng he e. our e r t nt he e fe p o i e t M e esa t ej i,a r fe td i Dr M ie 'afd vtCW f , ECF No 3 - )a d r v d d o y r t h al s elce n . ls fi a i f' ' . 51 n a tc e me ia r c r s(1 e .' No. 5 2 , su d s u e t h d dc l e o d < d, ECF 3 - ) i n ip td. a M ' M e s r quese a was g a ed a mediale m i ton o Aprl28 201 whe he yer e t d nd r nt c xa na i n i , 6, n Meyers v. Miles Doc. 52 rpo td difc t wih urnai a ea ai andr se apr tt e nain. A nure e re f uly t i ton nd j culton eque td osae xnmi to s . pr ttone ,Kr t lLa ge, dbr e a r c ale m o M e r a not a mid e a ge e of acii r ysa r pe m d e t xn n ye s nd ed l nlr m nt hi pr tt She or r l b wo k,di s osa e. de ed a r agnos hi wih pr t tts a m i r r t nton,a ed m t osa ii nd na y e e i nd pr c i d a a i o i f t n days She not d M e r ' s a e e t t he w a c ac i a es r be n ntbi t c or e . e ye s t t m nt ha s ont tng Dockets.Justia.com ' % lwye be us G one i i e e t d i me i up t t i r quie e s a m e c l sa f' a r ca e l no s ntr se n etng o her e r m nt s di a tf ' ( e . t1 . M d a 3) M e e sn x viie t ej i' me ia t to Ma 1 ,20 6 wh n he c mpli d o y r e t std h als dc l mi n y 6 1 , e o ane f trna y hest nc Dr M o e c li r ia y. . r no onduc e a physc l e m t t r ve e no a td i a xn ha e ald bnonnalte , iis alhough a M e r 'r ques,t docorde e r d c t t ye s e t he t f r e onduc i a ge t le m i ton. Dr M or no tng nia xa na i . e di gnos d M e r wih cuoni pr tttsa pr s rbe ar fl oft an i o i Bacrm f r30 a e ye s t l c osa ii nd e c i d e l he tbi tc ti o days Healopr s rbed Flm a t i o urna i s . s e ci o x o mpr ve i ton ympt s om . Dr M or no s w M e r a n on J 6,201 whe he not si hti ove e i . e a ye s gai une 6, n ed lg mpr m nt n urna y s pt s buta i r as i c tpa i a dirhe Ag n,aphysc le m r veaed i r ym om , n nc e e n onsi ton nd a r a. ai i a xn e l no a bnonnaltes butM e r de e r unde g ng a ge t e m . Dr M or no r fled t pro ii , ye s f red r oi nial xa . e e l he i r pr c i nsf 30m or da .Ac r ng t M e r , . or no di gnos d li wih apr t t es dpto or e ys co di o ye s Dr M e a e lm t osae i e to a ds i i ame tc ul tk fo 6mo t st ay a . ( . mpl2 ECFNo 2 . nfcin n ad te t n o d a e ' m r n h o e r' Am Co . , ' . 0) l ea J y,afe t Ba ti pr s rpton r n o ,M e r wr t a me c lgre nc n dy ul tr he c rm e c i i a ut ye s o e di a iva e, ç ' sa i : AM SUPPOSED TO TAKE BACTRUM FOR AT LEAST 4 M ONTH S. THE ttng 1 FLOW M AX HI LPS W I URI EJ TH NATI UNTI M Y P ON L ROSTATE I BACK TO NORM AL. S 1 jHASBEEN I T( NFECTED AND M ES EI UP FOR A LONG TI E SO ( REATMENT SE D M Tj M AY TAKE LONGER....A P osae itecin i a g rj aig a s mei sp if l' r tt nl jto s g g av tn nd o tme an u . ' ( p.a 2,ECFNo. ) Res , t 48. Dr M ie 'i ta c a twih M e r oc ure on J y 11 201 The doc o not d t t . l s niil ont c t ye s c r d ul , 6. t r e ha M e r w a a glm e t tve a i i t d t he ha a pr t t i e ton a waspl l i t f l a ye s s r l n a i nd ns s e hat d os a e nf c i nd a m ng o ie lws t The docors no esa s r po tM e r 'sa e e st the f l he wa pa ayze be ow a ui. t ' t lo e r ye s tt m nt ha et s rl d l t wait he c d nottrna eco r cl hedi notwa apr tt exa , a d hene de anot r he s, e d he oul li t r e ty, d nt osa e m 1 n 1 M e r de est the r us d t unde go a pr tt e na i o J y 11 201 s e CountrAf.2, ye s ni ha ef e o r osae xami ton n ul , 6, e e f ECF No. a c 42, nd ompli i va i s misonst tDr M ie neve peror d apr t ee na i o hi ans n rous ub s i ha . ls r f me osat xami ton n m. dos ofantbi i s Te tr uls s wed t tM e r 'urne wa ne tve f r i eci a t t e i otc . s es t ho ha ye s i s ga i o nf ton nd ha hi PSA wa nonna . Dr M ies ex ai d t M e r t t a to l a i otc we e no s s l . l pl ne o ye s ha ddiina ntbi is r t i c e b t s r uls az coul a ly be ha mfz.2 I ta , t docor r fle t ndiatd y he e es t ld d cma l r t l ns e d he t e ild he pr c i i n f rFl m r and o de e aurne c t e3 es rpto o o r rd i ulur . Dr M ie s w M e r a n o J y 1 whe t M e r c . ls a ye s gai n ul 8, n he ye s' ompli s we e r pore a ant r e td s f l : olows ( r M ilj Ic mz t h n le tis s ro l ,hes mpo a ere t r igt D). les a olj a d lq h lj eiusy t y tms r rq' nn he u mlq iain wa h l n i y u d n lql o h w t d a n s meIn e t s e e dc to s epig f o o ot t w o o ig o e n ed o e s e il t bllial f esl e 1g ta b llo n i my b t l e mlqbu g i p cai , a sc ly e l i s k o ag o n j ut i k y tt s j t rnngi i eo tb r sc nlq u iaeh rsi ce s i i etihslwe b c ull i nsd u u n a 't rn t u t n ra e nsd h g o r a k fesb us d isd l Ic b t e tsilsa dr c if ce p o ttso l e l r ie n ie . th ewe n e tce n e mm, n e td r sae ny j g lqwo s a dc ntkemo t t c r . et re n a a nhs o u e ( e .a 1 . Thed co e mi e M e esa d fu noa n r lte .Hi u i c lu ewa M d t 0) o tr xn n d y r n o nd b o mai s s rne utr s i a i negai f i e ton. The docor r as tr M e r t t he di no ha a pr t t gan tve or nf c i t e sled ye s ha d t ve osa e i e ton a t ttm e. nf c i t ha i Dr M iesne s w M e r on Augus 1 201 . l xt a ye s t 7, 6.He no e t tM e r wa c t d ha ye s s ompli ng a ni of ce fui 9om hi r cum a a ic be we n hi r t m a t tc e ,as we las l ge lar l d s et nd n t h t e s ec u nd esi l s l ar ea uain . M e esi sse ta h h d l o l d o me ia is e p s il c n e ' a d j c lto s y r n itd h t e a G me dn f d c l su , o sby a c r' n s d ma e ada n i.( f a !9. Ba e o h ss mp o , . ie da n e M e e swih e nd d ig oss Af. t ) s d n i y t ms Dr M ls ig os d y r t po sb ec l i a d o iia l bo ls n r me(ç ' a d p e ci e Be t lt te tt I . sil oi s n /r n tbe we y d o GBS' n r srb d n y o r a he BS t I ) Thedoc o as or r af l up e m i t we ks t r lo de ed olow xa n wo e . 2 Acc di t M e r, Dr. iess i U ai wilnotpay f te t nt you c or ng o yes M l ad, l l or r ame , annottkea i otcsf t t a ntbi i or ha ln , o c n o sean ljoo it. ( Co . . o g y u a n t e eurlgss' Am. mpl3) ' 3 M e r fld a me ca greva aqe hi a nt di l i nce r s ppoi menton J y ll c ul , ompli ngt tt a i otc Dr ani ha he ntbi is . ye s ie M or pr ci s d ha be c i d f f t sx mont . A nure r ponde H s n t docor eno es rbed houl ve en ontnue or our o i hs s es d: You ee he t td y(uy l , 01 1 Hei od rngau i c tr whihy ug v asmpl frti AM i wil h w iyo ha e o a J l 1 2 6 . s rei rne ul e c o a e a e o hs u t ls o f u v b cei i yo ruie . . eBa ti h sb e dic n iu db cu ey u c mpee i (n lted co d e n t a tra n u rn . . Th crm a e n s o tn e e a s o o ltd t a d h o tr o s o wiht ro d ra tboisu ls y u uiec luec me b c po iv . ( s , t3 ECFNo 4 . s o e r e n iit nes o r rn utr o s a k st er Rep.a , c i ' . 8) 3 Att f l up a nt nton Se e r8,Dr M ie not M eye s r por t tt he olow ppoi me pt mbe . l s ed r ' e t ha he cla fui i hi sool ha dec e ed.Thedoct i r as t pr s rpton f Be ylal alo e r l d n s t s d r as or nc e ed he e c i i or nt ld s c tnue t Fl a on i d he om x. Dr M ie e . ls xami d M e r a i on Oc o r 1 201 a t M e r c ne ye s gan t be 0, 6, fer ye s ompl i of aned s li i hi pr t t a ditc t wih urna i Hi physc e we lng n s osa e nd fi uly t i ton. s ial xam wa no m a ,howe r s r l ve . D r M ies pr c d a co s oft a i otc Bac r m i a a t m ptt ale a e s e or al of . l es dbe ur e he ntbi i ti n n te o l vi t om 1 M eye s s pt s a co i r ' ym om nd ntnued t Fl u . he om Me r c ye s nme t s e Dr M ie agan on Oc obe 25. M e r t n i itd t tt t ee o e . ls i t r ye s he nsse ha he hr we k c s ofa i otc t doc orhad or r wa E ntes ' be a e l osa e i e tons e our e ntbi is he t de ed s G l s' c us t tt nf c i poi pr tk mo tst te t' IZ a ! 1 ) Dr M ie o d rd 1b wo k a d a f lo u e a i t a e nh o ra. J t 2. . ls r ee a r n olw p x m n wo ' . we ks Two dayslt r on Oc obe 27,M e r waspl e o s cde wa c l i Nove be 2, e . ae, t r ye s ac d n ui i t h mtl m r 201 6. A ntr e pr cii ne exa i d M e r o Nove be 1 201 She not d hi r pors of ls a tto r m ne ye s n m r 6, 6. e se t ongoi pr e w ih trna i a hi c ng obl ms t li ton nd s ompl i sofpan i hi t tc e a cea fui fom ant i n s esil s nd l r l d r t r ct . A r t exn r ve e a enlr d pr tt ,a t di gnoss wa pr t tts he e um ecal m e ald n a ge osa e nd he a i s osa ii. M e r r c i d apr c i i n f t o a i otc --onet t ke f rt eem ont a onet t ke ye s e e ve es rpto or w ntbi i s o a o br hs nd o a f f l we ks or otr e . M e r fl d hi n e ye s ie s m nded compl nt agans Dr M ie i e ry Novembe 201 4 ai i t . ls n al r 6. Li r ly co t i hi al ga i a s iso ,he cli s t t Dr M e r vi a e hi be a l nsnzng s le tons nd ubm s i ns am ha . ye s olt d s c tt ona rght by: ( ) ds ntnui t a i oi ( fii t snd M e r t a onsimi l i s 1 ico i ng he ntbitc; 2) alng o e ye s o 4 M e r i tals bm isonale d asf l : R J y 11Dr ( ls sae t met'eJii n tg ig yes' nii u s i lge olows On ul . Mi ) ttd o e 'h als o on l t pa f yo keament' Iwa tki medi ton a he dic i d my mediai Physc har Fal e t o y or ur t . s a ng cai nd s ontnue c ton. ial m, iur o po ieme ia te t n ' ( mpl4 ECFNo 1) Thec u'noiidMe esta te ealg t nsddn tsae rvd dc lrame t' Co . , .. o l tfe y r h t h s l ai i o tt t e o s fiin fcsfra ato a ecam u d rj 1 8 a an tted co a d ga tdhi a o potnt t tl a utce t at o n cin bl li n e 9 3 g is h o tr n rne m n p ru i o ie n y amende c d ompli ,whih he di Si e t n,M e r ha as con i ant c d. nc he ye s s lo tnued t s tlte sand exhi t t t o ubmi etr bis hat he co thasc i r d i s ur onsde e n uppor oft cl msr s i t a t he ai aied n he mende c d ompli . ant 4 l eu r l gs' o oh r s e ils;a d () rf sng t da n s o te tM e es t o lm. i llo o it' r te p cait n 3 e u i o ig o e r r a y r ' ç be ' n pr ' ( Co l 34, No. . Me e sa mista Dr Mie h sc n iu dt eFlma t t a Am. mp . - ECF 20) y r d t h t . ls a o tn e h o x ha h s heped wih hi urna i di c tes He c l t s i ton o uli . ompl nst tt doc o û d notdignos orc c ai ha he t r G di a e he k (ilp osae' n rp ae l me to dt a M e e swa o y28y a sod ( eECF No 31) hs r tt 'a d e e t dy nine h t y r s nl e r l. Se . . He pr e s medialr c ds r l c i t tDr M ie e mi d hi i J n 201 f rt s me es nt c e or efe tng ha . ls xn ne m n a 7 o he n pr e sa sildi notpe f m apr t e e m . M e r co e t tbe a e ofDr M ies oblm nd tl d ror osat xn ye s nt nds ha c us . l ' te t n d cso , i û r b e ' re e a dhel s 3 pomd .( Co l 3. Hes e rame t e iins hs G o lm'wo s n d n p o t 5 t s Am. mp . ) e ks mo eayd ma e a dij n tv r le o d rngt a heb d a n s da dte td n tr n g s n nu cie eif r ei h t e ig o e n r ae . D i si scus on A c r s o l g a ts mmayj d me tçfte mo a ts wsta t eei no g n i ou t h ud r n u r u g n G h v n ho h t h r s e une i d s u ea t a ymaeilfc a t mo a ti e tte t j d me ta amatro lm ' Fe . ip t s o n tra a t nd he v n s n i d o u g n s l te f a ' d R. v. 5 () G t maeil y . .gq l d s u e o e fcst tmih a fc t o to Ci P. 6a . 1 o trai . o ny ip ts v r a t ha g t fe t he u c me As t o t e s i t e te g venn 1w wilp o el prcu e t e ty o s mmay j g n ' f h ut md r h o r ig a l r p ry e l d he nr f u r ud me t' An es n v. b rv Lo y I . 4 7 U. 2 2, 48 ( 9 6 . A ds t a o tamae lfc i d ro Li e t bb e nc, 7 S. 4 2 1 8 ) ipue b u tda a t s g n n çft ee i e c i s h ta ar a o bej r c udr tr av r itf rten n vn e uie t h v d n e s uc h t e s na l u y o l et n ed c o h o mo ig i l pa t ' I Fi l i r vi wi t e de e,t c tmus dr w a lr a ona e i e e e i ry.' d. naly, n e e ng he vi nc he our t a l e s bl nf r nc s n f vor of t nonmovi pa t a m a not m a c edi lt de e mi to or we gh t a he ng ry nd y ke r biiy t r nai ns i he e d n e' W il msv. tpls l c, 7 F.d6 2 6 7 (t Ci. 0 4 . vie c . li ' n Sa e e n -3 2 3 6 , 6 4 h r 2 0 ) Se ton 1 pe misa a c i 983 r t n ggde d pa t t fl a cvi a ton agans ape s f a tons ve ry o ie i l c i i t r on or c i t ke unde c orofs a e l w t tvi a e hi c ns iu i ldght . Se Coo rv.She han,735 a n r ol t t a ha ol t d s o tt tona s e pe e F. 1 1 (t Ci.201 . The Ei h Ame nt whih a i t t sae unde t 3d 53, 58 4h r 3) ght ndme , c pples o he tts r he Due Pr es Clus oft Foure nt Am e oc s a e he te h ndme ,gu r nt esfe m fom c ue a unus nt a a e r edo r r l nd ual pl s e .To pr i o a cai of co tt tonaly i qua e medialc r ,pli if mus nihm nt eval n l m nsiu i l nade t c a e antf t e tbls a s or omisons ha mf e sa ih ct si r ul nough t c tt e de i r t i f e e e t s rous o onsiut lbe a e ndif r nc o e i me c l e ds Esel v Gn l, 2 U. 9 1 6( 9 6 . dia n e . tl . mb e 4 9 S. 7, 0 1 7 ) e F rt t e p io e mu ts o ta t e d p i ai n s fee o t e ij r ifitd wa , is, h rs n r s h w h t h e rv to u fr d r h n u y n lce s G b e tv l ,Gu t e ty sro s' Fa me v Brl n 51 U. 8 5 8 4 ( 9 4 (iains l j ciey s fkin l ei u .' r r . ema , 1 S. 2 , 3 1 9 ) ctto o ' omitd) A s rousme c lnee ûsonet thasbe n dignos d by aphysca a ma tng te . ei dia d t i ha e a e iin s ndai team e or o t ti s obvi t te a 1 pe s wo d e iy r cognie t ne es iy r t nt ne ha s o ous ha ven ay r on ul asl e z he c st f ra d co ' atn in' 1 o v.S rve 5 F.d 2 5 2 4 h Ci.2 0 )(i to o te ) o o trs te to - k ' h e , 35 3 2 , 41(t r 0 8 ct in mitd . a Fo pur e oft sopi o t c twilpr um et tM e r 's r pos s hi ni n, he our l es ha ye s ympt spr s nt a s ro om e e ed e i us medialne a t tm eofhi i e a tonswih Dr M iesbe wee J y a Nove be 201 t c ed t he i s ntr c i t . l t n ul nd m r 6, he pe i a is i t slw s t rod t s ue n hi a ui. Toprvai onhi j 1 3 cam agans Dr M ie ,howe r Meyesmus as s w t t e l s 98 li i t . ls ve, r t lo ho ha t doc ora t d wih delber t i fer nc t hi s dous media ne d. Spe fcal hem us he t c e t i ae ndif e e o s e cl e ci ly, t sa e f c s i c tng t tDr M ie kne ofa dir ga de a e e sve rs t hi he lh or t t a t ndi a i ha . l s w nd s e r d n xc s i ik o s at s f t Se Fn me ,511 U. a 8 a ey. e r r S. t 37. The de e ntmus G t be a r off c s fom whih f nda tç h bo wa e a t r c t i e e ecoul be dr wn t ta s t talrs ofs roushn e s s a hemus a s dr w he nf r nc d a ha ubsan i ik e i nn xit, nd t lo a t ile e e. 1 The de e nti notla e i he ûc w t unde l ng f t butbei ve he zf r nc ' d. ' f nda s ibl f Gne he l ryi ac s le d (letu s t l)t a t rs t whih tef csg v rs wa is b tn ilo no e itn , o ab i n omdy h t he ik o c h a t a e ie s n u sa ta r n x se t' r ' i he r po d r as bl t t trs I a 844. t'o esa ih t ta he lh c r pr de ' f es nde e ona y o ha ik. d. t ç- tbls ha l a t a e ovi r s a tons c tt e de i r t i fe e e t a s ro m e ca ne t te t nt mus be s ci onsim lbe ae ndif r nc o e i us di l ed, he r a me t o gr sy i os l ncompe e ,i quat,ore s i ast s k t c ce e ort be i ol a e t t nt nade e xce sve o hoc he ons inc o nt er bl o fmd me tlf in s . M ite v Be r ,8 6F.d 8 ,8 (t Ci.1 9 )(ver ld o o h r t a n a ar e s' l r . o n 9 2 48 51 4h r 9 0 o rue n t e ' i g o byFame) r unds r r. Afe c r f r vi w of t pa te ' s iso ,pa tc a l t undiput m e ca tr a e ul e e he ri s ubm s i ns riul ry he s ed di l r co ds pr vi d,t cour co l e r o de he t ncudes t t M e r c ha ye s annotpr de i r t i fe e e he e. ove lbe a e ndif r nc r The evi nc esa ihes t a no tme di Dr M ie i e M e r 'c to or r f s t de e tbls hat t i d . ls gnor ye s ondii n eue o e xami ,di nos orte thi . W he M e sc m pl i d t Dr M ie a ne ag e, r a m n yer o ane o . l s bouthi s s ympt ,t oms he d co wa r s o sv t t s c mpans i lg to h se mi ain o M e e sa o j cie o t r s e p n ie o ho e o lit, n ih f i xn n to f y r nd b e tv t si Att i fr tmeei i J y 201 Dr M ie di no bele M e r ha a pr t t e tng. her is tng n ul 6, . l s d t ive ye s d osae ifcin a d ma e a me ia j d me tt o d rt e t ie c lu e a d e au t isr s t a d n e to n d dc l u g n o r e h z n u tr n v lae t e ul n r s ltr de opme s r t rt n r or rng a i o i t tha notpr vi l r s ved M eye s ae vel nt , ahe ha e de i ntbi tcs ha d e ousy e ol r' i s . At t Augu t e m ,t doc or bei ve M e s r ce hit r s s ues he s xa he t le d yer ' e nt so y, ympt s a t t om , nd es r ulsm i i c t c ii or1 a di gnos d a te t d hi te t nta c di y. Ata es t ght ndia e olts BS nd a e nd ' a e m r a me c or ngl r f lw u e a i e rySe tmb r Dr M ie a j tdM e e s me iain, a e o t rpo t ol p x m n al pe e , . ls duse y r ' dc to b s d n he e rs o ofhi s s ympt sa t ttme. W he M e r c om t ha i n ye s ompl i a uta s l n pr tt i Ocobe , he aned bo wole os ae n t r t doc ort n pr s rbe a i otc . t he e c i d ntbi is M e r alo c ye s s ompli t t Dr M ies s d ha r f n-d M e r t a s c ait a ns ha . l houl ve e e e ye s o pe i ls. Be us t physca e ms Dr M ie pe f r e on M e r we e nor ala M e r 'ti ca e he i l xa . ls rom d ye s r m nd ye s u ne c lte a d PSA tsswe eas n r l h we e , . ie ma ea G dc l u me tt ta utl s n r et r lo o ma, o v r Dr M ls d ç ia j dg n ha me r fra t as e ils wa no me i d' ( f! 1 ) e erl o p cait s t rt . Af. 5. e ' M e r cla l dia ee wih Dr M ies te t nt de ii . He be ives he s d ye s e ry s gr s t . l ' r a me c sons le houl ha r eve a i otc f s ve a mont a Dr M or no a lge y pr dit d w o d be ve ec i d ntbi i s or e r l hs s . e le dl e c e ul ne s ar or r ce ved e l ton of hi s m pt s by a s c a i t The G lbe a e i f er nc ce s y e i va ua i s y om pe i ls . i i r t ndif e e de sa r i nots tsi d by ...me e diag e me E t e painta docor co e ng tnda d s aite r s r e nt bewe n te nd t l nc mi Gq u sin o me ia j g n 'Ge manv.S e rn 5 F.Ap x 3 2 3 5 (t Ci.2 3 (l e to s f d c l ud me t'' r i h ai , 31 p' 9 , 9 4h r 01 ) ( n u ls d (uoi Ru s lv. hefr 5 F. 31 , 9 (t Ci. 9 $; rg t Coln , u p bihe ) q tng sel S fe, 28 2d 8 31 4h r 1 75 W ih v. lis 7 6F.d8 , 4 ( t Ci.9 5 (n ) 6 2 41 8 9 4h r1 8 ) sme . Att mos,s h dia ee nt r fe tM e s a us to t tDr M ie m idi nos he t uc s gr me s e l c yer ' cc ai n ha . l s s ag ed hi c ton fo J y t ough Se e be a m itke y deaye pr di hi wih s ondii r m ul hr ptm r nd sa nl l d ovi ng m t a i oi or a s caits e l to ofhi c ton. Eg n i dve tntfitr t pr de ntbitcs pe ils' vauain s ondii GAl na re alle o ovi a uae medial ca e' does not a o t de i r t i fe e e a r r d t pr deq t c r' m unt o lbe a e ndif r nc s equie o ove a c tt i lde i ton. Esel,429U. a 1 Thus t rj1 a doco ma notbe onsiutona prvai tle S. t 05. ,mde 983, tr y hedla ef al dl ne i ntdi nosso te t nt d.a 1 (l c maprciedoes l ibl or lege y glge ag i r rame .I t 07 GMedial l a tc notbe comeac tt ona vi ai meeybe a et vitm i aprs n' s ealoJ hns onsimi l olton rl c us he ci s ione l; e s o on v Oun n s 1 F.d 1 4 1 8 6 (t Ci.1 9 )( rni g sl r j g n wheed co . io e , 45 3 6 , 6 - 9 4h r 9 8 g a tn l mmay ud me t r o tr pr de dignoss a te t e , but di not dignos o te t piuia y gl nd t m or t t ovi d a i nd r a m nt d a e r ra t tr a u ha . ul maey bid d te p io e plitf) Fid n n g n n is e o mae ilf c i d s u e t tl l e h rs n r an it. n i g o e uie su f tra a t n ip t i n s howi t Dr M ie kne M e r ha a s rousm e ca ne f rdif r ntte t ntt the ng hat . ls w ye s d e i di l ed o fe e r a me ha waspr de ort the co cousy i no e s h a nee t c tc l ovi d ha ns i l g r d uc d, he our oncudest tDr M ie i ha . ls s e t ldt sl r u g n a amatro lw.Ana p o raeo d rwil e tr dt i d y. ni e o l t mma yj d me t s te f a p r p it r e lbe n ee ls a z The Cl r i die t t s nd co e oft s m e a e k s r ced o e pi s hi mox ndum o ni n a a o pa ng pi o nd cc m nyi o de t pl i ifa t c ms lofr c d f t de e nt r r o antf nd o ot e e or or he f nda . ENTER:Ths JQ d yo Jme 2 1 . i . a ft ,07 Chi U nie St t s D it i tJ ef t d a e s rc udge 8