Chiarino v. United States Of America
Filing
63
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)
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
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
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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
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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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