Meyers v. Miles

Filing 52

MEMORANDUM OPINION. Signed by Chief United States District Judge Glen E. Conrad on 6/29/2017. (tvt)

rl RKSOF C U,. STCOU
-F ' FIE S DI . W

A R fi-zJ ,A
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JKE
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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

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

'
%

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
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t nt nade e
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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
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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
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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
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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
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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
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nt , ahe ha e de i ntbi tcs ha d
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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
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ye s o
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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
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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
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ce s y
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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