Amended Disability Motion, 12-11213-C, C.A.11

Case: 12-11213 Date Filed: 08/09/2012 Page: 1 of 42 (1 of 43)










































UNITED STATES COURT OF APPEALSFOR THE ELEVENTH CIRCUIT

ELBERT PARR TUTTLE COURT OF APPEALS BUILDING56 Forsyth Street, N.W.Atlanta, Georgia 30303

John LeyClerk of Court

August 07, 2012

For rules and forms visitwww.ca11.uscourts.gov

Sheryl L. LoeschUnited States District Court 207 NW 2ND STOCALA, FL 34475

Appeal Number: 12-11213-C Case Style: Neil Gillespie v. Thirteenth Judicial Circuit, F, et alDistrict Court Docket No: 5:10-cv-00503-WTH-TBS

The enclosed copy of the Clerk's Entry of Dismissal for failure to prosecute in the above referencedappeal is issued as the mandate of this court. See 11th Cir. R. 41-4.

Sincerely,

JOHN LEY, Clerk of Court

Reply to: Walter Pollard, CPhone #: (404) 335-6186

Enclosure(s)

DIS-2 Letter and Entry of Dismissal

Case: 12-11213 Date Filed: 08/07/2012 Page: 1 of 2

http://www.ca11.uscourts.gov/

IN THE UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT

______________

No. 12-11213-C ______________

NEIL J. GILLESPIE,

lllllllllllllllllllllllllllllllllllll lllPlaintiff - Appellant

versus

THIRTEENTH JUDICIAL CIRCUIT, FLORIDA, GONZALO B. CASARES, ADA Coordinator, and Individually, DAVID A. ROWLAND, Court Counsel, and individually, JUDGE CLAUDIA RICKERT ISOM, Circuit Court Judge, and individually, JUDGE JAMES M. BARTON, II, Circuit Court Judge, and individually, et al.,

llllllllllllllllllllllllllllllllllllll llDefendants - Appellees,

BARKER, RODEMS & COOK, P.A. et al.,

llllllllllllllllllllllllllllllllllllll lllDefendants.

__________________________________________

Appeal from the United States District Court for the Middle District of Florida

__________________________________________

ENTRY OF DISMISSAL: Pursuant to the 11th Cir.R.42-1(b), this appeal is DISMISSED for wantof prosecution because the appellant Neil J. Gillespie has failed to pay the filing and docketing feesto the district court within the time fixed by the rules, effective August 07, 2012.

JOHN LEYClerk of Court of the United States Court

of Appeals for the Eleventh Circuit

by: Walter Pollard, C, Deputy Clerk

FOR THE COURT - BY DIRECTION



ELBERT PARR TUTTLE COURT OF APPEALS BUILDING56 Forsyth Street, N.W.Atlanta, Georgia 30303

John LeyClerk of Court

August 09, 2012

For rules and forms visitwww.ca11.uscourts.gov

Neil J. Gillespie8092 SW 115TH LOOPOCALA, FL 34481

Appeal Number: 12-11213-C Case Style: Neil Gillespie v. Thirteenth Judicial Circuit, F, et alDistrict Court Docket No: 5:10-cv-00503-WTH-TBS

I am returning to you unfiled the papers which you have submitted. This case is closed.

Sincerely,


Reply to: Walter Pollard, CPhone #: (404) 335-6186

PRO-3 Letter Returning Papers Unfiled


http://www.ca11.uscourts.gov/

UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT

ELBERT PARR TUTTLE COURT OF APPEALS BUILDING

56 Forsyth Street, N.W.

Atlanta, Georgia 30303

John Ley

Clerk of Court

August 09, 2012

For rules and forms visit

www.ca11.uscourts.gov

Neil J. Gillespie

8092 SW 115TH LOOP

OCALA, FL 34481

Appeal Number: 12-11213-C

Case Style: Neil Gillespie v. Thirteenth Judicial Circuit, F, et al

District Court Docket No: 5:10-cv-00503-WTH-TBS

I am returning to you unfiled the papers which you have submitted. Your appendices to your

motion for accomodation are returned unfiled because these cases are closed.

Sincerely,


Reply to: Walter Pollard/aw, C

Phone #: (404) 335-6186

PRO-3 Letter Returning Papers Unfiled


August 7, 2012

John Ley, Clerk of Court U.S. Court of Appeals for the 11 th Circuit 56 Forsyth St., N.W. Atlanta, Georgia 30303

Appeal Nos. 12-11213-C and 12-11028-B

Dear Mr. Ley:

Please find enclosed for filing Appendixes 1-3 to my to Consolidated Amended Motion For Disability Accommodation, etc. submitted yesterday, August 6, 2012. Also enclosed is a Certificate of Service.

On July 27, 2012, and again on· July 30, 2012, I wrote you that my Consolidated Amended Motion for Disability Accommodation was forthcoming, but it was delayed due to disability and declining health. I am sorry it took until August 6, 2012 to submit. I also regret the delay in providing the enclosed Appendixes 1-3.

I apologize for any inconvenience caused to the Court by my delay.

Thank you for your consideration.

~ / /1 / ?~,?

// . u..~/:-----eil J. G· esp~//' ~

8092 SW Ilsfh Loop -Ocala, Florida 34481

Enclosures

cc: Catherine Barbara Chapman, Esq. Ryan Christopher Rodems, Esq.

-------------

UNITED STATES COURT OF APPEALS FOR THE ELEVENTH CIRCUIT

NEIL J. GILLESPIE, ESTATE OF PENELOPE GILLESPIE,

CASE NO.: 12-11213-C Appellants/Plaintiffs,

vs. CASE NO.: 12-11028-B

THIRTEENTH JUDICAL CIRCUIT, FLORIDA, et al.

Respondents/Defendants. /

Certificate of Service

I HEREBY CERTIFY that a PDF ofAppendixes 1-3 to Consolidated Amended

Motion For Disability Accommodation, etc., was emailed August 7, 2012 to Catherine

Barbara Chapman (For Robert W. Bauer, et al), at [email protected], Guilday,

Tucker, Schwartz & Simpson, P.A., 1983 Centre Pointe Boulevard, Suite 200,

Tallahassee, FL 32308-7823.

Gillespie respectfully requests Ms. Chapman forward a PDF copy to Mr. Rodems

because Gillespie cannot afford due to indigence and/or insolvency to mail a paper copy

to Mr. Rodems. Gillespie cannot have email or telephone contact with Mr. Rodems

because of Mr. Rodems past misconduct toward Gillespie. Gillespie respectfully requests

Ms. Chapman also forward to Mr. Rodems a PDF copy of the Affidavit (Jul-30-12) and

Notice (July-27-12) in support of this motion.

Ryan Christopher Rodems, Esquire (For himself, his law partner, and his firm Barker, Rodems & Cook, PA) Barker, Rodems & Cook, PA 501 E. Kennedy Blvd, suite 790

}

Tampa, Florida 33602


NEIL J. GILLESPIE,ESTATE OF PENELOPE GILLESPIE,

CASE NO.: 12-11213-CAppellants/Plaintiffs,

vs. CASE NO.: 12-11028-B

THIRTEENTH JUDICAL CIRCUIT,FLORIDA, et al.

Respondents/Defendants._______________________________/

APPENDIX - 1

CONSOLIDATED AMENDED MOTION FOR DISABILITY ACCOMMODATION

WAIVER OF CONFIDENTIALITY

MOTION FOR DECLARATORY JUDGMENT - APPOINT GUARDIAN AD LITEM

Exhibit 1 The ADA does not apply to the Federal Judiciary

Exhibit 2 Social and Psychological Implications of Dento-Facial Disfigurement; Macgregor

Exhibit 3 Affidavit of Neil J. Gillespie, panic attack July 12, 2010, Judge Martha Cook

Exhibit 4 Plaintiff's Amended Accommodation Request, ADA, March 5, 2007

Exhibit 5 Medical History of Neil J. Gillespie

Exhibit 6 Exhibits 6.1-6.17, Doctor letters and medical evaluations of Neil J. Gillespie

Exhibit 7 Velopharyngeal inadequacy - Wikipedia

Exhibit 8 Psychosocial Implications of Congenital Craniofacial Disorders; Gillespie

Exhibit 9 Psychotherapy for Persons with Craniofacial Deformities; Bennett-Stanton

Exhibit 10 Deficits in short-term memory in adult survivors of childhood abuse; Bremner

Exhibit 11 Hahnemann University Hospital ER, Aug-20-1988, Gillespie head trauma/TBI

Page - 1

The ADA Does Not Apply to the Federal Judiciary

The ADA does not apply to the federal judiciary, a fact not known to Gillespie

until he was informed April 10, 2012 by Chris Wolpert, Chief Deputy of Operations, U.S.

District Court for the Northern District of California. Mr. Wolpert emailed Gillespie in

response to his query, and wrote in part, "My understanding is that the Americans With

Disabilities Act does not apply to the Federal Judiciary." Mr. Wolpert appears correct.

A review of Title II shows the ADA only applies to a state or local government:

Title 42 - Chapter 126 - Subchapter II - Part A - § 12131As used in this subchapter:(1) Public entityThe term "public entity" means—

(A) any State or local government;(B) any department, agency, special purpose district, or otherinstrumentality of a State or States or local government; and(C) the National Railroad Passenger Corporation, and any commuterauthority (as defined in section 24102 (4) [1] of title 49).

Prior to that time the following judicial officers and court personnel in the U.S. Eleventh

Circuit led Gillespie to believe that the ADA applied to the federal judiciary.

a. On March 16, 2012 Gillespie received a phone call at 1:43 p.m. about the ADA

from Brenda McConnel, a Supervisor in the Eleventh Circuit. Ms. McConnel was

responding to Gillespie’s call about the ADA initially directed to case handler Walter

Pollard. Ms. McConnel advised Gillespie to file a motion and provide supporting

documentation for his ADA accommodation request, but did not inform Gillespie that the

ADA did not apply to the federal judiciary. Gillespie served a motion for accommodation

under the ADA in this Court April 7, 2012. Gillespie also made the following ADA

requests and/or inquiries in the Eleventh Circuit:

1

Page - 2

b. James Leanheart, Court Operations Supervisor, U.S. District Court, M.D. of

Florida, Ocala Division, prior to, and during the litigation.

c. Sheryl L. Loesch, Clerk, U.S. District Court, M.D. of Florida, by letter dated

April 5, 2012. A copy of the letter is attached as Exhibit 8 to Consolidated Notice of Pro

Se Electronic Case Filing Prohibition by District Court, submitted July 27, 2012.

d. The Hon. Anne C. Conway, Chief District Judge, U.S. District Court, M.D. of

Florida, by copy of the letter to District Clerk Loesch . Gillespie also wrote to Chief

Judge Conway March 22, 2012 about the Court’s failure to disqualify Mr. Rodems as

counsel. Gillespie’s March 22nd letter is an exhibit to a Rule 59(e) Motion to Amend the

Judgment in District Court case no. 5:10-cv-503-oc (Doc. 60).

e. Blair Patton, Supervisor, N.D. of Florida, by telephone April 3, 2012.

None of the above judicial officers or court employees informed Gillespie that ADA did

not apply to the federal judiciary. Chief Judge Conway responded by letter April 25,

2012 and wrote “I am in receipt of your correspondence dated March 22, 2012. Since this

case is not assigned to me there is nothing I can do to assist you.” A copy of the letter is

attached. District Clerk Loesch has not responded to Gillespie’s concerns. This conduct

in the Eleventh Circuit is inconsistent with the effective and expeditious administration of

the business of the courts, and conduct prejudicial to the administration of justice.

United States District Court Middle District of Florida

George C. Young Courthouse and Federal Building 401 West Central Boulevard, Suite 6750

Orlando, FL 32801-0675

Anne C. Conway Chief Judge 407-835-4270

April 25, 2012

Mr. Neil J. Gillespie 8092 SW 115th Loop Ocala, FL 34481

Re: Gillespie v. The Thirteenth Judicial Circuit, Florida, et al. Case No. 5:10-cv-503-0c-10TBS

Dear Mr. Gillespie,

I am in receipt of your correspondence dated March 22,2012. Since this case is not assigned to me there is nothing I can do to assist you.

Sil1cerely,

./ .. {l~/1 nne C. Conway U

SOCTAI.. }.:,l) r:':"CEGLC;}ICAL !:·:HICA'l'IC:S OF DENTO-:'lLCIAL DI3i·'IGURSmri'l'*

**Frances C. r'~~-lcV'et;or

One of the t:~inC'3 that has al'flays str'Jck me as ironic is the fact that,

of all the co~cercs wit~in the field of physical disability and rehabilitation,

tte large D::'ouP 0::: D€:::-scns in our society .'lith fncial deviations, Le.,

. s f'i '!'l~~er.:ent is seldo~ included. In this res~ect they

are the mar?inal or fcr~ot~en peonle.

When I ceg~~ my r~3earch on the psycholobical and sociological aspects

of facial c.eformity some twenty years ago, in searching the literature I was

surprised to discover t~at, in all the studies of the psychological aspects

of physical disability ~~U problecs of adjust~ent, etc., there was practically

no ~ention of the face. In 1953 a co~pilation by Parker and others1 of the

social-psychological research on adjust~ents to physical h~~dicap and illness

contained but t~o references on facial deformities, and these were listed in

2the subject index under the rubric "cosr:!etic. 1l A subsequent survey by Wright

in 1960 included five references to studies involving iacial disfigurement.

Even today, by corn~arison with other types of disabilities, attention

given to the facially disfigured is mi~l. In campaigns for the handicapped

*Presented at conference "Psychological and Ecological Implications of

¥~occlusion and Dento-Facial DisfigJreffient and Its Impact on the

Well-Being of the Individual," National Institutes of Health,

Bethesda, Md., November 17, 1969.

*t-Research Scientist, InsUtute of Reconstructive Plestic Surgery,

New York University ~edica1 Center, ~ev York, N.Y.

v,· I . % I

2

-2

,

cither to raise fund8 or to cnccurn::;c their" employT:;cnt, the focus is on

amputees, p,'lr::lplesics, th~ blind, the deaf, those wi th cereb::al 'palzy, and

so on - persons with sorce f\L'1ctional or organic impairment. '1'11e victims

of such disaLilitics ~ay even be seen or interviewed on television, but

never a person with a facial dis[iguYe'T:ent. Even at most national and

international conferences on disability or rehabilitation, facial disfigure

ment as a oatego=y is omitted.

Disability has been defined as any condition which prevents one from

performing the no~al activities of caily living. Yet the insbility of the

facially disfigured to lead nor:I:al lives tends to be over"looked because

they are oster~ibly able-bodied, can work, and can physically accomplish

the basic routines of daily living.

The more I pursued my investigation of patients whose faoes were

marred, repulsive to look at, or ~r-ose ~alfo~tions though less severe

were stimuli for jokes or ridicule, the ~ore paradoxical I fO\L'1d the omis

sion of this large group. As I interviewed and follofted patients in need

of plastic surgery, prosthetic devices, and orthodontic work, it became

abundantly clear that defects of the face can be one .)f the most tragic

handicaps a person can have. It is quite true that u~ess there is some

functional problem, the physical ability of the facially disfigured is not

impaired. His handicap is social and psychological.

It is not within the scope of this paper to go into the social and

psychological significance of the face end its role in human relations.

This has been treated elsewhere. 3 ,4 It is enough to say that the role of

the face in our interactions with others is the crux of the problem for

anyone whose face deviates from the norm. Coupled with our cultural

...3

cmp1":!l.sis on cxternul nt':>~nrance, physical nttrnctiver.css, Hnd conforr:lity,

the problcl~:-; of the facially handic;:lpped lie squarely in the area of mental

health.

One might supcose t::lat the psychic distress caused by disfigurellient is

in direct pro~ortion to its severity. But this is not the cuse. In an

interdisciplinary stud7 of facially disfibJred Fatients cond~cted at New

York Univer.sity College of Z.:edicine (1949-1952), we found that, for those

whose defor~ities evoked ridicule, bordered on caricature, stimulated jokes,

and were so~rces of a~usement, the psychological i~~ect was exceeaingly

great. In fact we found that many patients ....ith such deviations were in

worse psychological shu~e, had more behavioral disoraers, and were more

maladjusted than those ~ith the kinds of deformities that were distressing

to look at or tended to elicit strong emotional reactions such as pity or

revulsion.

This is not to say that our gTossly disfigured patients were well

adjusted. But we did find that they complained less bitterly than the

mildly disfigured and vere more passive -- or perhaps more resigned. Wnile

many variables are involved in determining adjustment to facial deformity,

one important factor seems to be the consistency of responses which can be

expected from others. Our investigation showed that the "grossly disfigured

individual feels that he can almost always count on a negative response

wherever he goes. It may be surprise, pity, curiosity, or repulsion, but

seldom, if ever, is it one of immediate approval. Since he expects a

negative response, he is usually prepared and has developed overt or covert

techniques of coping with situations. On the other hand, there are types

of deformitie5 which are not so i~~ediately conspicuous, such as a missing

-4

ear or a Clalforma tiol'! ...!~ich sU~Ges ts a oS tcreot~r,e. rrhese may be no ticed one

time but not the next. In certain si tua tion~ a particular type 'of deformi ty

rnn;y be lauehed at or evcke an tipa thetic feelir:[,3; ur:der 0 ther concH tions it

may be co~plctely ignored or not even noticed. In general, the responses are

erratic ~~d unpredictable, and individuals w~th such deformities appear to be

held in a hair-trigger and precariol,s position: They are never quite certain

what will happen. They alternate bet~een feelings of relief and tension, and

adjustment to their situation is made difficult. Predictability and con

sistency of res~onse, then, may be one of the ~ost important factors which

permit the grossly deformed to adjust, whereas unpredictability and incon

. t ~ t· ~ fl' f . t ,,3 (pp. 86-87)S1S ency o~ response seem 0 re1n!orce ee 1ngs 0 anx1e y.

Persons with dento-facial defor7~ties seem to fall in this latter

category. The Ferson with buck teeth ("Bugs Bunny syndrome"), for instance,

or a recedi~g chin is less apt to be vie~ed with compassion than as a target

for teasing, nich.-names, or caricature; for, as Aris totle said, "The thing at

which we laugh is a defect or ugliness ~hich is not great enough to cause

suffering or injury. Thus, for exanple, a ridiculous face is an ugly or

misshapen face, but one on which suffering has not mar~ed." Yet for the

victim derisive laughter is one of the most potent and destructive instru

ments men can use, and the shame, anger, and distress it can generate is

immeasurable. These reactions to derisive laughter apnear to be universal.

The Hopi Indians, well aware of its effect, could and did deliberately drive

an offender in the co~~unity to insanity by the simple punisr~ent of laugh

lng at bim.

We do not ~~d will not know, I suppose, how many lives and persor~lities

of those vith noticeable ~alocclusion and dento-facial disfig~rement have

-5

however, haV0 some knO'tdedge of persons who have reported and spd:en of their

particular problems in this connec~ion. ~lrs. Roosevelt, whom I knew well,

reported in her wri tines her feelin[;3 about being what she called an "ugly

duckli::lg." She had a miserably unhappy childhood and young adulthood, and

had to st:~~ITle long and valiantly before she at last succeeded (overtly at

least) in overcodng her feelings of inferiority and shyness. (I have often

wondered whether she would have become the great person she was had she not

had this visible handicap.) During her years as First Lady caricatures of

her we=e legion -- always with larce protruding teeth. Although so late in

her lifeti~e, she finally had relief from this. She was in an automobile

accident ~d lost, as I recall, three or four of her front teeth. Following

dental restoration she told me with \L~abashed delight what a fortunate

accident it had been, because at last she had straight front teeth.

Even in the absence of stereotyping, .there are two other handicapping

aspects associated with dento-facial deformity. In the first place, the

area in and around the mouth is both emotionally charE~d and strongly con

nected with one's self-image. As an instrument of speech and eating, as

well as a mirror of emotions, it also has unique soci.3.1 and psychological

implications and symbolic meaning. Any abnormality in this area. therefore,

is not only highly visible and obtrusive but -- as research has shown

tends to evoke a type of aversion which is both esthetic and sexual.

A second handicapping factor has to do with the degree to which such

defects interfere with the flow of social interaction. The man without an

arm can partially hide its absence in a sleeve; a cripple in a wheelchair

-6

ca:1 attend a di nne r \.. i tr.ou t r;enerati nc uneo:1incss. Eu t the same cannot be

said for tho~e with f&.cial defects. Because in normal interaction the eyes

attend the face, any irreg~larity can be distracting and produce uneasiness

for the afflicted and t~e non-afflicted alike.

As social scientists h~ve pointed out, sFontaneous interaction requires

certain skills and rules on the part of both participants. But spontaneity

is inhibited by the relle of "not noticing." Not to notice dento-facial ')\"S: )

irregularitics is especially difficult, for, as Goffma...'1 points-ou-t, liThe

closer the defect is to the communication eauip~ent upon which the listener

must focus his attention. the smaller the defect needs to be to throw the

listener off balance. These defects tend to shut off the afflicted individual

from the stream of daily contacts, transforning him into a faulty interactant,

either in his eyes or in the eyes of others. 1I5

References

1. Barker, R.G., Wright, B.A., Meyerson, L., and Gorrick, M.R.: Adjustment

to Physical Handi~an and Illness: A Survey of the Social Psychology of

Phvsiaue ar.d Disa~ilitv. Bulletin 55, rev., Social Science Research

Council, New York, 1953.

2. Wright, B.A.: Physical Disability: A PsycholoRical Annroach, Harper and

Eros., New York, 1960.

3. ¥~cgregor, F.C., Abel, T.M., Bryt, A., Lauer, E., and Weissmann, S.:

Facial Defo~ities and Plastic Sur~rr: A Psychosocial SrJdy,

Charles C Tho~as. Springfield, Ill., 1953.

·-7

4. Goffrr:un, E.: 2n(;0Imt"n~: '1.\:0 Sl;.dj ,,:-; in tr.t> S0cioloe:v of In t~r~ction,

Bobbs-~e~rill Co., In1i~~apolis, 1963.

5. Goffman, E.: Alienation from interaction, IIuJT:2.n Relations, X: 52, 1957.

May 12, 2002

Paid Notice: Deaths MACGREGOR, FRANCES COOKE MACGREGOR-Frances Cooke. With apologies for the delay to her friends and colleagues, it is with regret that we advise that Frances Cooke Macgregor, an expert on the psychological effects of facial deformities, died on Christmas Eve (2001) at her retirement home in Carmel, California. She was 95 and died of congestive heart failure. She was a renowned social scientist whose research and writing on the social and psychological significance of facial differences was the first acknowledgement of disfigurement as a disability. Her publications document 40 years of research. Mrs. Macgregor was born in Portland, Oregon, but grew up in San Rafael, California and earned a bachelor's degree in economics from the University of California at Berkeley in 1927. She moved to Massachusetts several years later and in 1933 married the late Gordon Macgregor, an anthropologist for the U.S. Bureau of Indian Affairs. They later divorced. While they were married, the Macgregors visited Indian reservations around the country. A professional photographer at the time, Mrs. Macgregor took pictures that captured daily life on the reservations. Those photographs, published in 1941 in a book entitled, ''Twentieth Century Indians'', helped prompt Congress to devote more money to Indian reservations. Other pictures Mrs. Macgregor took over the course of a year in the small Massachusetts town of Hingham, were also published in 1941 in a book called, ''This Is America'', with text written by her friend, former first lady Eleanor Roosevelt. In the 1940's, Mrs. Macgregor moved to New York City and did graduate work in anthropology at Columbia University under Dr. Margaret Mead. Mrs. Macgregor obtained her master's degree in sociology at the University of Missouri in 1947. Her work on facial disfigurement began during World War II while photographing patients at the Ellis Fischel Cancer State Hospital in Columbia, Missouri. Shortly after the war, she met plastic surgeon Dr. John Marquis Converse, who helped repair the shattered and burned faces of French and English pilots. His specialty coincided with her interest in social and psychological ramifications of facial disfigurement. Dr. Converse accepted her suggestion to conduct an exploratory study of his patients. At that time, the existing literature on physical disabilities was limited almost entirely to functional impairments: the loss of a leg, blindness, deafness and so on, and the problems of physical rehabilitation. As for those whose faces happen to deviate from the norm, there was and is, a special irony with which they must contend. Their problems have their roots in the inextricable relationship of the face to the person and its role in human relations. Moreover, it is a situation made even worse in a society whose frenetic efforts to look young and beautiful makes looking different a social stigma-a stigma that has the potential for social and psychological death. Her work led to the World Health Organization adding facial disfigurement to its list of disabilities. In 1951 The Society for the Rehabilitation of the Facially Disfigured was established. Now known as The National Foundation for Facial Reconstruction, the Foundation helps fund the work of the Institute of Reconstructive Plastic Surgery at New York UniversityMedical Center. Mrs. Macgregor remained in close touch with Dr. Joseph G. McCarthy, who became Director of the Institute following the death of Dr. Converse in 1981. The innovative streak in Macgregor drew the attention of the Russell Sage Foundation where she did a threeyear study at the New York Hospital, Cornell University School of Nursing in order to introduce social science into the education of nurses. She published a textbook, ''Social Science in Nursing; Applications for the Improvement of Patient Care'' (Russell Sage Foundation, New York, 1960). She became a full professor teaching at Cornell University Medical and Nursing School from 1954 to 1968 then rejoined the Institute of Reconstructive Plastic Surgery at NYU Medical Center. In 1991, Macgregor moved from New York City to Carmel, California. She continued her consultancies adding legal clients as well as medical colleagues and patients. Magregor's last research efforts focused on iatrogenic illness. Years before it was frontpage news in the New York Times (Sunday, December 19, 1999), she wanted her philanthropic funds to go to studying medical errors caused by physicians and other health professionals. On the same page as the continuation of The New York Times article of December 19, 1999, ''Breaking Down Medicine's Culture of Silence'', the Institute of Medicine estimated that between 44,000 and 98,000 Americans die each year as a result of medical errors. Macgregor had already contributed to studies by the Institute of Medicine and also the Harvard Medical School in her name through the aegis of The Commonwealth Fund. She has left her estate to The Commonwealth Fund who will administer the Frances Cooke Macgregor Awards for further study of iatrogenic illness. At a private ceremony on January 4, 2002, Frances Cooke Macgregor was buried at the family burial plot beside her father, mother, brother and nephew at the Mt. Tamalpais Cemetery in San Rafael, California.

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IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT IN AND FOR HILLSBOROUGH COUNTY, FLORIDA

GENERAL CIVIL DIVISION

NEIL J. GILLESPIE,

Plaintiff and Counter-Defendant, CASE NO.: 05-CA-7205 vs.

BARKER, RODEMS & COOK, P.A., DIVISION: G a Florida corporation; and WILLIAM J. COOK,

Defendants and Counter-Plaintiffs.

-------------_/

AFFIDAVIT OF NEIL J. GILLESPIE

Neil J. Gillespie, under oath, testifies as follows:

1. My name is Neil J. Gillespie, and I am over eighteen years of age. This

affidavit is given on personal knowledge unless otherwise expressly stated.

2. Circuit Judge Martha J. Cook is presiding over this lawsuit.

3. I made a request for accommodation to the Thirteenth Judicial Circuit

under the Americans With Disabilities Act (ADA) to Gonzalo B. Casares, the (ADA)

Coordinator. On Friday July 9, 2010 Court Counsel David A. Rowland sent me a letter by

email that denied my ADA accommodation request. Mr. Rowland denied my request less

than one business day prior to a hearing I was scheduled to attend.

4. On Monday July 12,2010 I attended a hearing at 10:30 AM before Judge

Cook in this lawsuit. While attending the hearing I suffered a panic attack. I informed

Judge Cook that I was ill and needed medical attention. Judge Cook excused me. This is

exactly what Judge Cook said:

Page 1 of3 3

6 THE COURT: All right. Mr. Gillespie, you're

7 excused. Thank you.

(Transcript, July 12,2010, page 6, beginning at line 6)

5. Deputies of the Hillsborough County Sheriffs Office saw I was in distress

and offered assistance. Tampa Fire Rescue was called. Corporal Gibson was by my side

and walked me to the lobby of courthouse where I waited for the paramedics.

6. Tampa Fire Rescue arrived and I received medical attention at 10:42 AM

by EMT Paramedic Robert Ladue and EMT Paramedic Dale Kelley. Later I obtained a

report of the call, incident number 100035129. The narrative section states "found 54yom

sitting in courthouse" with "tight throat secondary to stress from court appearance". The

impressions section states "abdominal pain/problems". The nature of call at scene section

states "Resp problem". A copy of the report is attached to this affidavit as "Exhibit A."

7. Because the Court denied my ADA accommodation I appeared at the

hearing without one and became ill and was excused by Judge Cook, who continued the

hearing without me, thereby denying me by reason ofmy disability to be excluded from

participation in or be denied the benefits of the services, programs, or activities of a

public entity, or be subjected to discrimination by any such entity in violation of law.

8. I received a document from Judge Cook dated July 29,2010 "Notice Of

Case Management Status and Orders On Outstanding Res Judicata Motions" and "Notice

Of Court-Ordered Hearing On Defendants' For Final Summary Judgment". A certified

copy of the document is attached to this affidavit as "Exhibit B". The document begins

with a false account of my panic attack and medical treatment on July 12,2010. Judge

Cook wrote: "[t]he Plaintiff voluntarily left the hearing prior to its conclusion.. .loudly

Page 2 of3

gasping and shouting he was ill and had to be excused." At footnote 2 Judge Cook wrote:

"Mr. Gillespie refused medical care from emergency personnel when called by bailiffs

and left the courthouse immediately after learning that the conference was completed."

8. Upon information and belief, Judge Martha J. Cook knowingly and

willfully, with malice aforethought, falsified a record in violation of chapter 839, Florida

Statutes, section 839.13(1) if any judge shall falsify any record or any paper filed in any

judicial proceeding in any court of this state, or conceal any issue, or falsify any document

filed in any court or falsify any minutes or any proceedings whatever of or belonging to

any public office within this state the person so offending shall be guilty of a

misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.

FURTHER AFFIANT SAYETH NAUGHT.

Dated this 27th day of September 2010.

STATE OF FLORIDA COUNTY OF MARION

BEFORE ME, the undersigned authority authorized to take oaths and acknowledgments in the State of Florida, appeared NEIL J. GILLESPIE, personally known to me, or provided identification, who, after having first been duly sworn, deposes and says that the above matters contained in this Affidavit are true and correct to the best of his knowledge and belief.

WITNESS my hand and official seal this 27th day of September 2010.

C~~ Notary Public

~~ CECIUA ROSENBERGER State of Floridaf,.: ~ Commission DO 781620 • .; Expires June 6, 2012

80ndId TtIU TIGf FIil........701.

Page 3 of3

Page #1 Incident Number: 100035 129; Incident Date: 7/1212010; Patient: Gillespie. Neil Printed By: MOLINA. LAURA Admin Asst (000) on 712712010 7:49:45 AM

TAMPA FIRE RESCUE (EMSID: 2911; FDID: 03072) 808 Zack St.

Tampa, FL 33602· (813) 274-7005 x

TAMPA FIRE RESCUE Incident Date: 07/12/2010Incident Number: 100035129 Patient 1 of 1 RESCUE 1 shift: B GILLESPIE, NEIL 54 YEAR OLD, MALE

PAST MEDICAL HISTORY: Depression, Diabetic, HypertensionALLERGIES: None ;MEDICATIONS: unknown pt doesnt know names;

ASSESSMENT: 10:42 Patient Conscious. NO External Hemorrhage Noted; Mucous Membrane Normal Central Body Color Normal Extremities Normal WITHIN NORMAL LIMITS (Airway, Breathing Quality, Accessory Muscle use,chest Rise, Radial pulse, Skin Temp, Skin Moisture, skin Turgor, capRefill, Pupil size and Reaction)

ALS Assessment Done to rule out NOC at Dispatch.

SECONDARY ASSESSMENT - INJURY: CHEST - No Injury:. Left breath sounds are clear to auscultation.

Right breath sounds are clear to auscultation. Breath sounds are equal. Heart sounds: Normal.

NARRATIVE: R1 found 54yom sitting in courthouse. pt a&ox3, skin w&d, pt cc tightthroat secondary to stress from court appearance pt states, lungsclear bi-lat, sa02 100%, pt blood sugar 179mg/dl, vitals as shown in flow sheet section, monitor shows sinus rhythm w/ no ectopy noted, ptdenies being in any pn, secondary found no acute findings, advise ptmulto times to be transported to hospital pt refuses transport and states he would rather go to his Dr. pt signed refusal and advise to call back if any issues occur w/ full understanding.

TREATMENT: 10:42 pulse:120 Regular and Rapid Resp:16 Respiratory

Effort:Normal BP:148/96 Rhythm:NSR Sa02:100% (on Room Air)Blood Sugar:179 Ectopy:NO GCS:4 spontaneous; 5 oriented; 6 obeys = 15 Responsiveness:Alert painseverity:O

10:42 Sao2, successful, 1 attempt, LADUE, ROBERT EMT-Paramedic (PMD514678) (unchanged) (100 room air)

10:43 Blood Glucose, KELLEY, DALE EMT-paramedic (PMD49960)(unchanged) (179mg/dl)

10:44 ECG 4 Lead, successful, 1 attempt, ENGINE 1 (unchanged) (nsrw/ no ectopy)

10:48 pulse:110 Not Assessed Resp:16 RespiratoryEffort: Normal BP:153/86 Rhythm:NSR sa02:100% (on Room Air)Ectopy:NO GCS:4 spontaneous; 5 oriented; 6 obeys = 15 Responsiveness:Alert painseverity:O

No Venous Access No Medications Done

IMPRESSION: primary Impression: Other secondary Impression: Unknown Other Impressions: Abdominal pain / problems

INCIDENT INFORMATION: Incident location: 0000800 TWIGGS ST E Tampa, Hillsborough, FL 33602

'EXHIBIT

IJL

Page ##2 Incident Number: 100035129; Incident Dale: 7/12n.O 1O~ Patient: Gillespie, Neil Printed By: MOLINA. LAURA Admin Asst (000) on 7127/20107:49:45 AM

TAMPA FIRE RESCUE (EMSID: 2911; FDID: 03072) 808 Zack St.

Tampa, FL 33602(813) 274-7005 x

Nature of call as dispatched: chest pain Nature of call at scene: Resp Problem (Anatomic Location: Not Known) (organ system: Not Known) (primary symptom: None) (Other symptom: Not Known )(condition code: other)

Disposition: Non-Transport Evaluation only Type of exposure on this run: None

07/12/2010 10:36:35 Call Received

07/12/2010 10:37:24 Dispatched07/12/2010 10:38:50 Depart07/12/2010 10:39:51 Arrive location 07/12/2010 10:40:00 patient Contact 07/12/2010 10:40:00 Assume Patient Care 07/12/2010 10:56:31 Available

Response to scene: Lights and sirens

Lead Crew Member: LADUE, ROBERT EMT-paramedic (PMD514678)Crew Member 2: KELLEY, DALE EMT-paramedic (PMD49960)

ASSISTING: ENGINE 1,

PATIENT: GILLESPIE, NEIL OOB: 03/19/1956 54 YEARS OLD.

white, Male, 285 lbs 8092 sw 11Sth lOOpocala, FL 34481

SSN#: 160-52-5117

BILLING INFORMATION: work Related: NO Next of Kin Name:, () Address: City: State: Z; p: Phone:

SSN:

NFIRS: Exposure #: 000 Incident Type: 321 EMS call, excluding vehicle accident with injury Action Taken: 32 provide basic life support • (BLS)

N None property Use: 599 Business office

RESPONDING UNITS: suppression [Apparatus:l personnel:4]EMS [A~paratus:1 personnel:2]other [Apparatus:O personnel:OJIncludes no mutual aid resources.

Human Factors Involved: N None other Factors Involved: N None Impression: 00 other condition of patient: 2 Remained Same Census Tract:

Page 113 Incident Number: 100035 129; Incident Date: 7/1212010; Patient: Gillespie, Neil Printed By: MOLINA, LAURA Admin ASSl (000) on 7127120107:49:45 AM

TAMPA FIRE RESCUE (EMSID: 2911; FOlD: 03072) 808 Zack 51.

Tampa, FL 33602(813) 274-7005 x

•

SIGNATURES:

signed By: LADUE,Last Modified By:

PM

ROBERT EMT-paramedic (PMD514678)MILLER, LILAH Admin Asst. (000) on 7/23/2010 1:46:04 ..

***** Addendum / Data correction Added (000) on 7/23/2010 1:46:07 PM *****

by: MILLER, LILAH Admin Asst.

(-) : 124(+): Last 1:46:04

125(+): PM

141000 Modified By: MILLER, LILAH Admin Asst. (000) on 7/23/2010

..

-r'~

r-


CIVIL LAW DIVISION

NEIL J. GILLESPIE, Plaintiff, Case No: 05-CA-007205

Division: G and

BARKER, RODEMS & COOK, P.A., A Florida Corporation, and WILLIAM J. COOK,

Defendants.

------------_---.:/

NOTICE OF CASE MANAGEMENT STATUS and ORDERS ON OUTSTANDING RES JUDICATA MOTIONS

THIS CAUSE came before the Court for case management on July 12, 2010. Both parties

appeared for the hearing; however, the Plaintiff voluntarily left the hearing prior to its conclusion, stating

his objection to the case management conference, demanding status of ADA claims already addressed by

the court administration, objecting to the physical presence of opposing counsel, objecting to this Court

presiding in this matter due to his "notice of filing" of a purported lawsuit against the 13th Judicial

Circuit,l and finally loudly gasping and shouting he was ill and had to be excused.2 Prior to the Plaintiff s

voluntary departure, the parties were asked by the Court for a status update on this case and to list for the

Court those petitions and motions presently outstanding. Subsequent to the hearing, the Court reviewed

the 11 volumes, paying specific attention to Court orders that substantively disposed issues. In so doing,

it was clear that certain of Plaintiff's re-filed motions are res judicata - matters that have been

"definitively settled by judicial decision.,,3 Having considered these re-filed motions, the Court hereby

ORDERS AND ADJUDGES:

13thlRegarding the Plaintiffs "noticed" lawsuit against the Judicial Circuit, it is well-established law that the Plaintiff's filing does not present legally sufficient grounds for this Court's disqualification or recusal from this case. See Dowdy v. Sa/fi, 455 So.2d 604 (Fla. 5th DCA 1984), 5-H Corforation v. Padovana, 708 So.2d 244 (Fla. 1997), May v. South Florida Water Management, 866 So.2d 205 (Fla. 4t DCA 2004) and Bay Bank & Trust v. Lewis, 634 So.2d 672 (Fla. 1st DCA 1994). This objection was addressed in the Court's July 27, 2010 denial of disqualification. 2 Mr. Gillespie refused medical care from emergency personnel when called by bailiffs and left the courthouse immediately after learning that the conference was completed. 3 Black's Law Dictionary, 7th Edition.

EXHIBIT

Page 1 of 7 1-8

1. Plaintiff's "Motions to Strike CMC" (6-14-10) were DENIED prior to the July 12, 2010

hearing.

2. Plaintiff's Motion for Rehearing (7-16-08) is DENIED. The judge to whom this rehearing

motion was directed removed himself from the case and the subsequent judge has, in .her

discretion under Rule 2.330, denied reconsideration of the orders of proceeding judges (see order

dated June 22, 2010).

3. Plaintiff's "Amended Motion to Disqualify Counsel" (no date provided in Judge Barton's

order) and "Emergency Motion to Disqualify Defendant's Counsel" (7-9-10) are each

DENIED. The Plaintiff's original attempt to disqualify Defendants' counsel was first denied,

with prejudice, on May 12, 2006. When a Court dismisses a motion "with prejudice" that means

that the motion in question is "finally disposed ... and bars any future action on that claim.,,4

Additionally, pursuant to the doctrine of res judicata, these motions must be denied.

4. Plaintiff's "Motion to Declare Complex Litigation" (5-3-10) "Motion to Disclose Conflict"

(5-5-10). and "Motion to Disclose Ex Parte Communication" (5-5-10) were each addressed and

DENIED in the July 16, 2010 order denying disqualification of Judge Cook, the Plaintiffs

motion for which referenced these matters.

5. Plaintiff's "Motion for Leave to Amend," citing ADA (4-1-10), "Motion for Leave to

Amend" (5-5-10), "Motion to Consider Prior ADA Accommodation," (5-3-10), and "Motion

to Stay Pending ADA" (6-14-10) are each DENIED. Even if ADA applied in the fashion which

the Plaintiff sought to employ it, a stay would be unnecessary as that is the point of the protection

- to allow a "person with a disability who needs an accommodation to access court facilities or

participate in a court proceeding.,,5 Court administration has informed the Plaintiff that the nature

of his ADA requests, thus far, involve "the internal management of pending cases,,6 - in other

4 Black's Law Dictionary, 7th Edition. 5 13th Judicial Circuit Website, accessed July 22, 2010: http://www.fljud 13.org/dotnetnuke/BusinessOperations/CourtFacilitiesSecurity/ADAAccommodations.aspx 6 See July 9, 2010 letter from administration, as copied to all parties.

Page 2 of7

words, Plaintiff s issues are the subject of "case management." Moreover, excepting Count 1,

Plaintiff's breach of contract claim against Defendant law firm, all of the Plaintiff's pleadings and

answers have been disposed and amendment is thereby impossible. See Order Granting Motion

for Sanctions (7-20-07), Order Granting In Part Defendants' Motion for Judgment on

Pleadings (11-28-07), Final Judgment (3-27-08), Order Determining Amount of Sanctions

(3-27-08), Order Granting and Denying in Part Defendant's Motion for Judgment on

Pleadings (7-7-08), Final Judgment as to Defendant Cook (7-7-08), Order Granting

Defendant's Motion for Writ of Garnishment (7-24-08), and the Order from Second District

Court of Appeals (2D08-2224), opinion and mandate. See also Florida Rule of Civil Procedure

1.100(a).7

6. Plaintiff's "Motions for Reconsideration" (6-18-10 and 6-23-10) were duplicative and

DENIED by this Court's discretion on June 23, 2010. Plaintiff's "Motion for

Reconsideration" (6-28-10) filed after entry of that denial is DENIED, as it is duplicative of the

prior two motions, and is disposed by res judicata.

7. Plaintiff's "Motion Dissolve Writ" (5-3-10) is DENIED as lacking legal basis. The Defendants

are entitled to this Writ by a final judgment and a judgment granting motion for sanctions;

moreover, the Second District Court of appeal has affirmed and issued a "mandate," which means

this Court has no option but to enforce the judgment.

8. The Plaintiff's "Motion for Order of Protection," (no date provided in Judge Barton's order)

renewed in his "Motion to Cancel Deposition" (6-16-10) is DENIED. The Plaintiff has

repeatedly been the subject of Motions to Compel by the Defendants during the course of these

proceedings, and has ignored Court orders requiring his participation. The Court will not accept

these or any further attempts by the Plaintiff to avoid the Defendant's right to discovery in this

7 "There shall be a complaint or ... petition, and an answer to it; an answer to a counterclaim ... an answer to a cross claim [if applicable]; a third party complaint [and answer, if applicable] ... no other pleading shall be allowed."

Page 3 of7

case and to bring this matter to a close. Non-compliance with the Court's orders is grounds for

dismissal of the Plaintiff s remaining count with prejudice.

9. Each of the Plaintiff's "Motions to Disqualify" against the undersigned have been DENIED by

separate order of the Court, the most recent of which was entered July 27, 2010.

10. The Court RESERVES JURISDICTION to consider the following motions:

a. Plaintiff's "Motions to Compel Discovery" (12-14-06,2/1/07,4-1-10, and 6-23-10) b. Plaintiff's "Claim for Exemption" (8-14-08 and 5-3-10) c. Plaintiff's "Motion for Contempt" (no date provided in Judge Barton's order) d. Plaintiff's "Motion for Order to Show Cause and Contempt" (no date provided in

Judge Barton's order) e. Plaintiff's Motion for Sanction" (4-28-10) f. Defendant's "Motion for Proceedings Supplementary for Execution" (no date

provided by Defendants) g. Defendant's "Motion for Examination Pursuant to Section 56.29(2)" (no date

provided by Defendants) h. Defendants' "Motion for an Order to Show Cause as to Why Plaintiff Should Not

Be Prohibited from Henceforth Appearing Pro Se," received July 27, 2010.

11. These motions shall not be set for hearing until the Court has first ruled on the Defendant's

outstanding motion for Final Summary Judgment.

12. The Court GRANTS the Defendant's request to set a mandatory hearing upon their outstanding

"Motion for Final Sumnlary Judgment," served upon the Plaintiff January 23, 2007.8 Both the

Defendants and the Plaintiff are ORDERED TO APPEAR on September 28, 2010 at

11:00a.m. The hearing shall be for no more than 30 minutes. The hearing will be held at 800 E.

Twiggs Street, Hearing Room 511, Tampa, Florida, 33602. The Court shall not grant any

continuance, or any motion for reconsideration or rehearing of this order setting hearing.

13. The Court will allow the Plaintiff to appear telephonically, but it is his responsibility to file a

timely written motion no later than September 21, 2010 and for him to provide, at his own

expense, for the services of a notary on his end of the phone, since it may be necessary to swear

8 Pursuant to Fla. R. Civ. Pro. 1.080, the question of whether or not a receiving party facilitates acceptance of papers (i.e. refuses to accept certified mail and/or federal express deliveries) is irrelevant; the question is the "good faith" of the party who is attempting to produce the document, which can be proven up by delivery receipts and/or any other evidence of legitimate attempt at service. In addition, "the certificate [of service] shall be taken as prima facie proof of such service in compliance with these rules." Fla. R. Civ. Pro. 1.080(t).

Page 4 of7

him in for testimony. Should the Plaintiff fail to arrange telephonic appearance, then his in

person appearance is mandatory. Should the Plaintiff voluntarily forfeit his appearance by failing

to attend, call in, or not participate in good faith (including failure to provide the required notary),

then the hearing shall proceed in his absence and the Court may consider sanctions for his non

appearance.

14. At this mandatory hearing the parties must also be prepared to discuss the effect of the "Order

Adjudging Contempt" entered by Judge Barton on July 7, 2008. This order found that the

Plaintiff had ability to comply with the "Final Judgment" entered on March 27, 2008 and that

the Plaintiff violated the terms of that order by failing to complete Form 1.977 Fact Information

Sheet. The Plaintiff was ordered to complete the sheet and to serve a copy to the Defendant no

later than July 11, 2008. If the Plaintiff did not timely submit Form 1.977, as ordered, then

pursuant to the "Order Adjudging Contempt," "the Court shall dismiss" with prejudice, the

Plaintiff's last remaining claim (i.e. Count 1, Plaintiff's breach of contract claim against

Defendant law firm). Because this dismissal sanction may render hearing on the Defendant's

"Motion for Final Summary Judgment" to be moot, the parties are ORDERED to provide

proof to this Court that this prior contempt sanction has been addressed.

15. A separate notice of hearing on the motion for summary judgment accompanies this order. Copies

will be sent to the parties at the address provided to the Clerk of Court.

DONE and ORDERED in Chambers at Tampa, Hillsborough County, Florida, on July m, 2010.

~)~t~ Martha J. Cook CIRCUIT COURT JUDGE

Page 5 of7


CIVIL LAW DIVISION :!: ......, r c::::::')-r" ~

NEIL J. GILLESPIE, Plaintiff,

and

Case No: Division:

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Defendants.

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NOTICE OF COURT-ORDERED HEARING ON DEFENDANTS' MOTION FOR FINAL SUMMARY JUDGMENT

TO: Neil J. Gillespie, pro se (Plaintiff) 8092 SW 115th Loop Ocala, FL 34481

Ryan Christopher Rodems, Esq. (for Defendants) 400 North Ashley Drive, Ste. 2100 Tampa, ~ 33602

YOU ARE NOTIFIED that a hearing on the Defendants' Motion for Final Summary Judgment, filed and served upon the Plaintiff since January 23, 2007, has been ORDERED by the Court (see "Notice of Case Management Status and Orders on Outstanding Res Judicata Motions," entered July 29, 2010).

At this mandatory hearing the parties must be prepared to address the ORDER ADJUDGING CONTEMPT entered by Judge Barton on July 7, 2008, as instructed by this Court's prior order.

Both the Defendants and the Plaintiff are ORDERED TO APPEAR before:

JUDGE: The Honorable Martha J. Cook PLACE: 800 E. Twiggs Street, Hearing Room 511, Tampa,·Florida, 33602. TIME: ll:00a.m. DURATION: 45 minutes DATE: September 28,2010

Should either party fail to attend or to participate in good faith as described in the "Notice of Case Management Status and Orders on Outstanding Res Judicata Motions," then the hearing shall proceed on the merits without that party. All parties will be required to abide by the Rules of Civil Procedure and follow appropriate courtroom decorum.

A copy of this notice has been furnished to the parties on the date of this NOTICE.

Page 6 of7

The parties are further advised that failure to appear or to comport with either the "Notice of Case Management Status and Orders on Outstanding Res Judicata Motions" or this "Notice of Court-Ordered Hearing on Defendants' Motion for Final Summary Judgment" may constitute contempt of court, which could result in the imposition of sanctions, including without limitation fine, incarceration or dismissal of the action with prejudice.

DONE and ORDERED in Chambers at Tampa, Hillsborough County, Florida, on July 29, 2010.

/hLLLU/U. if' ~ Martha J. Cook CIRCUIT COURT JUDGE

Ifyou are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision ofcertain assistance. Please contact the

Administrative Office of the Courts, Attention: ADA Coordinator, 800 E. Twiggs Street, Tampa, FL 33602, Phone: 813-272-6513, Hearing Impaired: 1-800-955-8771, Voice impaired: 1-800-955-8770, e

mail: ADA @fljudI3.org. at least seven (7) days before your scheduled court appearance. Ifyou are hearing or voice impaired, call 711.

Page 7 of7

IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT IN AND FOR IDLLSBOROUGH COUNTY, FLORIDA


NEIL J. GILLESPIE,

Plaintiff, CASE NO.: 05-CA-7205 vs..

BARKER, RODEMS & COOK, P.A., DMSION:C a Florida corporation, WILLIAM 1. COOK,

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Defendants.

------------_/

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n= -0 PLAINTIFF'S AMENDED ACCOMODATION REOUEST:;;£ :x

AMERICANS WITH DISABILITIES ACT (ADA) r-~ ca ..., ~

Plaintiff requests an accommodation under the Americans With DisabilitierAct

(ADA) and states:

1. Plaintiff was detennined totally disabled by Social Security in 1994.

2. Defendants are familiar with Plaintiff's disability from their prior

representation of him. Defendants investigated his eligibility to receive services from the

Florida Department ofVocational Rehabilitation (bVR). DVR detennined that Plaintiff

was too severely disabled to benefit from services. Defendants concurred, and notified

Plaintiffof their decision in a letter to him dated March 27, 2001. (Exhibit A).

Defendants were also infonned of Plaintiff's medication for depression by fax dated

October 6, 2000, Effexor XR 150mg. (Exhibit B).

3. Plaintiff has the following medical conditions which are disabling and

prevent him from effectively participating in court proceedings, including:

a. Depression and related mood disorder. This medical condition prevents

Plaintiff from working, meeting deadlines, and concentrating. The inability to

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4

Gillespie v. Barker, Rodems & Cook, }- .A., case no. 05-CA-7205

concentrate at times affects Plaintiff's ability to hear and comprehend. The

medical treatment for depression includes prescription medication that further

disables Plaintiffs ability to do the work of this lawsuit, and further prevents him

from effectively participating in the proceedings.

b. Post Traumatic Stress Disorder (PTSD), makes Plaintiff susceptible to

stress, such as the ongoing harassment by Defendants' lawyer, Mr. Rodems.

c. Velopharyngeal Incompetence (VPI) is a speech impairment that affects

Plaintiffs ability to communicate.

d. Type 2 diabetes. This was diagnosed in 2006 after Defendants'

representation.

4. Prior to the onset of the most disabling aspects Plaintiff's medical

condition(s), he was a productive member of society, a business owner for 12 years, and a

graduate of both the University ofPennsylvania and The Evergreen State College.

5. On March 3,2006, Ryan Christopher Rodems telephoned Plaintiff at his

home and threatened to use infonnation learned during Defendants prior representation

against him in the instant lawsuit. Mr. Rodems' threats were twofold; to intimidate

Plaintiff into dropping this lawsuit by threatening to disclose confidential client

information, and to inflict emotional distress, to trigger Plaintiff's Post Traumatic Stress

Disorder, and inflict injury upon Plaintiff for Defendants' advantage in this lawsuit.

6. On March 6, 2006, Mr. Rodems made a false verification the Court about

the March 3, 2006 telephone call. Mr. Rodems submitted Defendants' Verified Request

For BailiffAnd For Sanctions, and told the Court under oath that Plaintiff threatened acts

of violence in Judge Nielsen's chambers. It was a stunt that backfired when a tape

recording of the phone call showed that Mr. Rodems lied. Plaintiffnotified the Court

Page - 2 of4

1.70

Gillespie v. Barker, Rodems & Cook, f:A., case no. 05-CA-7205

about Mr. Rodems' perjury in Plaintiffs Motion With Affidavit To Show Cause Why

Ryan Christopher Rodems Should not Be Held In Criminal Contempt Of Court and

incorPorated Memorandum OfLaw submitted January 29,2007.

7. Mr. Rodems' harassing phone call to Plaintiff ofMarch 3, 2006, was a

tort, the Intentional Infliction ofEmotional Distress. Mr. Rodems' tort injured Plaintiff

by aggravating his existing medical condition. From the time of the calion March 3,

2006, Plaintiff suffered worsening depression for which he was treated by his doctors.

a. On May 1, 2006 Plaintiffs doctor prescribed Effexor XR, a serotonin

norepinephrine reuptake inhibitor (SNRl), to the maximum dosage.

b. Plaintiffs worsening depression, and the side affects of the medication;

lessened Plaintiffs already diminished ability to represent himself in this lawsuit.

c. On October 4,2006 Plaintiff began the process of discontinuing his

medication so that he could improve is ability to represent himself in this lawsuit.

d. On or about November 18, 2006, Plaintiff discontinued the use of anti

depression medication, to improve his ability to represent himself in this lawsuit.

8. Mr. Rodems continued to harass Plaintiff during the course of this lawsuit

in the following manner:

·a Mr. Rodems lay-in-wait for Plaintiffoutside Judge Nielsen's chambers

on April 25, 2006, following a hearing, to taunt him and provoke an altercation.

b. Mr. Rodems refused to address Plaintiff as "Mr. Gillespie" but used his

first name, and disrespectful derivatives, against Plaintiffs expressed wishes.

c. Mr. Rodems left insulting, harassing comments on Plaintiffs voice mail

during his ranting message ofDecember 13,2006.

Page - 3 of4

Gillespie v. Barker, Rodems & Cook, r.A., case no. 05-CA-7205

d. Mr. Rodems wrote Plaintiff a five-page diatribe of insults and ad

hominem abusive attacks on December 13, 2006.

9. Plaintiffnotified the Court ofhis inability to obtain counsel in Plaintiff's

Notice ofInability to obtain Counsel submitted February 13, 2007.

10. Plaintiff acknowledges that this ADA accommodation request is unusual,

b:ut so are the circumstances. Defendants in this lawsuit are Plaintiff's fonner lawyers,

who are using Plaintiff's client confidences against him, while contemporaneously

inflicting new injuries upon their former client based on his disability.

WHEREFORE, Plaintiff requests additional time to obtain counsel, a stay in the

proceedings for 90 days. Plaintiff also requests accommodation in the form of additional

time to meet deadlines when needed due to his disability.

RESPECTFULLY SUBMITTED this 5th day of March, ,2007.

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been

furnished via US Mail to Ryan .C. Radems, attorney, Barker, Rodems & Cook, P.A., 400

N Ashley Dr., Suite 2100, Tampa, FL 33602, this 5th day ofMarch, 2007.

Page - 4 of4

172

BARI<ER, RODEMS & COOK PROFESSIONAL ASSOCIATION

ATIORNEYS AT LAW

CHRIS -A. BARKER Te lep hOlle 813/489 .. 1001300 West Platt Street, Suite 150RYAN CHRISTOPHER RODEMS Facsimile 813/489 .. 1008 WILLIAM]. COOK Tampa, Florida 33606

March 27,2001

Neil J. Gillespie Apartlnent C-2 ] 121 Beach Drive NE St. Petersburg, Florida 33701-1434

Re: Vocntiollal Rellabilitntion

Dear Neil:

I am enclosing the material yOll provided to us. We 11ave reviewed tIlem and, llnfortllnately, we are not in a positiol1 to represent you for allY clainls yOll may have. Please understatld tllat our decision does not 111ean tllat your claims lack nlerit, and another attorney might wisll to represent you. If you wisll to consult witll another attorney, we recolnlnend that you do so immediately as a statute of lilllitations will apply to any claims you Inay have. As you know, a statute of linlitations is a legal deadline for filing a lawsllit. Tllanl( you. for the opportunity to review your Inaterials.

Sincerely,

\Villialn J. Cool{

WJC/rnss

Enclosures

1.73

'EXHIBIT'

I:·········

Fax From: Neil J. Gillespie

1121 Beach Drive NE, Apt C-2 St. Petersburg, FL 33701 Phone/Fax: (727) 823-2390

To: William J. Cook, Attorney at Law

Fax: (813) 228-9612

Date: October 6, 2000

Pages: just this page

Re: ACE Check Cashing deposition

o Urgent o Please Reply o For Your Review

• Comments:

RE: Current medications

Effexor XR 150 mg (depression)

Levoxyl 0.075 mg (hormone)

STATE OFFLOFlIOA ) COUNTY OF HiLLSBOROUGH)

THIS IS TOCERTIfV THAT THE FOREGOING IS ATRUE AND CORHfiCT cot'1 Of Tf£ DOCUMENT ON FILE IN MY OFFICE. WITNESS MY ~ ANO Of!FICIAL SEAL THIS 31.v1"" DAYOF ,to T 201 0

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Neil J. Gillespie, medical history (partial) August 6, 20128092 SW 115th Loop CORRECTED Aug-14-2012Ocala, Florida 34481

DOB: March 19, 1956, Philadelphia, PA, Thomas Jefferson Hospital.

Congenital disorder: unilateral cleft lip (L), cleft palate, eustachian tube defect (L), retractedeardrum (L).

Medical Conditions ICD-9-CM Code

Post Traumatic Stress Disorder (PTSD) 309.81with PTSD related panic attack in response tostimuli associated with a serve stressor

Anxiety disorder due to medical condition 293.89Dysthymic disorder (chronic depression) 300.4Depression 296.3

Cleft palate with unilateral cleft lip (L) 749.21Facial disfigurement, scaring 709.2Velopharyngeal Incompetence (VPI) 528.9Voice disorder, hypernasality 784.43

Retracted eardrum (L) 384.28Eustachian tube defect 381.89Hearing loss 389.90

Diabetes (mellitus) NOS, Type 2 diabetes, adult onset 250.00Brain trauma, head injury from a mugging (1988) 310.20

Prosthesis

Speech bulb obturator. In September 2001 my palatopharyngeal musculature had changed whereI could no longer insert the obturator in my mouth.

Omni ADV hearing aid, serial no. 36-95-300004 (no longer functional)

Medical history

1. Craniofacial surgery, age three months, Misericordia Hospital, Philadelphia,Dr. Duncan, 18th & Walnut Streets, Philadelphia.

2. Palate surgery, age two years, Thomas Jefferson Hospital, Philadelphia, Dr. Duncan.

3. Speech therapy, age eight years, Easter Seals Center, Levittown, PA.

5

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4. Orthodontic treatment, 1968-1974, Temple University Dental Clinic, Philadelphia. Fitted witha removable retainer with a prosthetic left lateral incisor.

NOTE: Additional reconstructive surgery was scheduled at Temple University Medical Center,including bone graft and pharyngeal flap procedures, but was canceled due to denial of insurancecoverage based on a “preexisting condition” clause of my private insurance policy. That was in1974 when I was 18-years old and graduating high school. The insurance policy was boughtfrom a local insurance agency, paid for with money earned cutting lawns. After reconstructivesurgery was canceled, my life took another path. I did not follow my contemporaries to college,but worked as a steel mill laborer at the U.S. Steel Fairless Works. Following a layoff a yearlater I worked in the restaurant business, and later in the car business.

Eleven years later in 1985 I was able to reschedule the bone graft surgery. The pharyngeal flapsurgery was delayed until 1990. I also entered the Wharton Evening School in 1985.

Bullying. Like many children afflicted with a congenital craniofacial disorder, I experienceddisability-based bullying, and physical assault. Disability-based bullying caused me severedepression and anxiety from my earliest days. I became an Eagle Scout December 3, 1971. TheBoy Scouts allowed me a modicum of normalcy and chance for success in an otherwisephysically and psychologically abusive school environment.

---------------------------------------------------------------------------------------------------------Adult Treatment Time-line

Beginning at age 29 I continued rehabilitation with better insurance (Blue Cross), and income frommy car business. I estimate that from 1985 forward I spent at least $100,000 out of my pocket fortreatment and rehabilitation of my congenital craniofacial disorders. This list is representative anddoes not include every treatment or provider. There are too many treatments and providers to list,and many records are long gone.

Philadelphia, Pennsylvania

5. July 22, 1985 Consultation with Joseph Kusiak, MD, Plastic and Reconstructive Surgery,American Oncologic Hospital, Central & Shelmire Avenues, Philadelphia, PA 19111.Examination; proposed surgical plan and medical team.

6. 1985-1987 Dr. Sharon Wainright MD, Psychiatrist, 22nd & Walnut Street, Philadelphia. Iwas a private-pay client in ongoing weekly or biweekly visits for general anxiety, and anxietyrelated to medical treatment. After Dr. Wainright left private practice I saw other therapists,including Dr. Harriet Wells, as a private-pay outpatient client at the Institute of the PennsylvaniaHospital in Philadelphia.

The challenge for mental health providers is shown in a paper by Bennett and Stanton:Psychotherapy for Persons with Craniofacial Deformities: Can We Treat without Theory?(Cleft Palate-Craniofacial Journal, July 1993, Vol. 30 No.4)

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7. August 1, 1985 Marilyn A. Cohen, BA, speech pathologist, The Cleft Palate Program,Children’s Hospital of Philadelphia (CHOP), 34th and Civic Center Blvd., Philadelphia, PA19104. Speech evaluation (re-evaluation March 30, 1989).

8. August 12, 1985 Harvey M. Rosen, MD, DMD, Reconstructive Surgery, PennsylvaniaHospital, Philadelphia, PA 19106. Surgery scheduled; bone graft and rhinoplasty.

9. March 10, 1986 Rosario F. Mayro, DMD, DDS, 1830 Rittenhouse Square, Philadelphia, PA19103. Pre-surgical orthodontic alignment. Ongoing treatment. Referral for periodontal surgery.

10. April 22, 1986 Mark B. Snyder, DMD, periodontist, 220 South 16th Street, Suite 900,Philadelphia, PA 19102. Periodontal surgery. Ongoing treatment.

11. August 12, 1986 Reconstructive surgery (bone transplant), Dr. Rosen, PennsylvaniaHospital. Closure of oral-nasal fistula; bone graft to alveolus of nasal floor; septoplasty. Bonegraft donor site, left hip.

12. December 15, 1986 Reconstructive rhinoplasty, Dr. Rosen, Pennsylvania Hospital.Developed breathing obstruction following surgery.

13. July 6, 1987 Peter Randall, MD, Hospital of the University of Pennsylvania, 3400 SpruceSt., Philadelphia, PA 19104. Consultation, obstructed breathing. (no consensus).

14. April 20, 1988 Dennis G. Sanfacon, DMD, 1829 JFK Blvd., Philadelphia, PA 19103.Completed prosthodontic treatment (five unit bridge), stabilized surgical site. Was supposed tolast 20 years; failed Feb-17-2005 (17+ yrs.). Barry Korn, DDS, endodontic treatment.

15. Aug-20-88 Head trauma, street mugging, lost consciousness, taken by police car toHanemann University Hospital ER, see report. Sutures to close laceration to right outer eye,severe head pain. Suffered traumatic brain injury, loss of cognitive and motor functions forseveral weeks, difficulty speaking and forming sentences.

Within several months I thought I recovered from this brain injury, but now that assessmentappears incorrect. This injury diminished my business ability, and I have not held substantialemployment since. Today I do not have a bank account because I cannot manage one. I wentfrom self-sufficiency to total disability in 1994. My inability to manage funds resulted in twobankruptcy proceedings and homelessness. The bankruptcies are:

Chapter 7 bankruptcy, discharged January 7, 1993, case 92-20222, U.S.Bankruptcy Court, Eastern District of Pennsylvania.

Chapter 7 bankruptcy, discharged March 5, 2003, case 02-14021-8B7, U.S.Bankruptcy Court, Middle District of Florida.

I have been indigent and/or insolvent since I first filed bankruptcy December 31, 1991.

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---------------------------------------------------------------------------------------------------------Florida

16. May 26, 1989 Consultation, D. Ralph Millard, Jr., MD, FACS, 1444 NW 14th Avenue,Miami, FL 33125. Surgery scheduled, obstructed breathing and velopharyngeal incompetence.

17. December 14, 1990 Surgery, Dr. Millard, Jackson Memorial Hospital, Miami, FL. Cleftrhinoplasty with submucous resection, pharyngeal flap. Resolved breathing issue somewhat;pharyngeal flap failed a few weeks later.

18. December 19, 1990 Consultation, Felipe Martinez, MD, FACS, 1350 SW 57th Avenue, Suite210, Miami, FL 33144. Developed ear infection following surgery.

19. May 5, 1993 Consultation, Mutas B. Habal, MD, FRCSC, FACS, and Jane Scheuerle,Tampa Bay Craniofacial Center, 801 W. Dr. Martin Luther King, Jr. Blvd., Tampa, FL 33603.Diagnosis: velopharyngeal incompetence. Recommendation: surgery to re-graft alveolus of nasalfloor with bone from skull, and to perform another pharyngeal flap procedure (declined, poorrisk/benefit analysis after consulting with Dr. Wainright).

20. June 1, 1993 Consultation, Pamela Kynkor, MS, CCC, Speech-Language pathologist, BethIngram and Associates, Inc., 3450 E. Fletcher Ave., Tampa, FL 33617, Speech evaluation.

21. June 4, 1993 Consultation, Noreen P. Frans, MS, CCC-A, (dispensing clinical audiologist),Better Hearing Services, 2312 West Waters Avenue, Tampa, FL 33604, (813) 935-3446. Somehearing loss, no recommendation for intervention.

22. August 23, 1993, Social Security determined that I was totally disabled. Social Securityfound that I became disabled under their rules on January 17, 1992. On August 1, 2012 SocialSecurity wrote that there was no need to review my case. However I would like to work if Icould find suitable employment.

---------------------------------------------------------------------------------------------------------Oregon

23. May 26, 1994 Robert W. Blakeley, Ph.D., speech pathologist, Oregon Health SciencesUniversity, CDRC, Portland, OR 97207. Diagnosis: velopharyngeal incompetence.Recommendation: speech obturator (reduction program), then surgical intervention. Peter Lax,DMD, fitted a temporary obturator during twelve appointments from May 26, 1994 throughApril 11, 1995. (good result)---------------------------------------------------------------------------------------------------------Washington

24. January 22, 1995 David R. Zielke, DDS, MS, Suite A-103, Allenmore Medical Center, 19th

& South Union, Tacoma, WA 98405. Endodontic treatment, tooth 18, supports speech obturator.

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25. March 22, 1995 Susan Porter, MA, clinical audiologist, Hearing Healthcare Center, Inc.,3525 Ensign Road NE, Olympia, WA 98506, (360) 491-9733. Hearing evaluation with testresults showing a significant conductive hearing loss in the left ear. DVR.

26. March 26, 1995 Herbert C. Thomas, MD, MS, Pacific Northwest Otolaryngology, 4540Sandpoint Way NE, #320, Seattle, WA 98105, (206) 527-5366 (examiner, Susan A. Wilcox,MACCC-A). Medical evaluation and clearance for a hearing aid. DVR.

27. August 17, 1995 Barry L. Kimmel, MSCCC-A, Hearing Healthcare Center, Inc., 3525Ensign Road NE, Olympia, WA 98506, (360) 491-9733. Provided hearing aid, Omni half shellwith K-amp, left. DVR.

28. November 11, 1995 Eric F. Pinczower, MD, Assistant Professor, Department ofOtolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, WA98195, (206) 548-4022. Velopharyngeal incompetence/pharyngeal flap surgical consultation.

29. November 15, 1995 Jeffrey E. Rubenstein, DMD, MS, Director, Maxillofacial ProstheticClinic, University of Washington Medical Center, D683 Health Sciences Building, Seattle, WA98195, (206) 685-2344. Velopharyngeal incompetence/obturator consultation and maintenance.

30. November 21, 1995 Craig S. Murakami, MD, Assistant Professor, Department ofOtolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, WA98195, (206) 548-4022. Pharyngeal flap surgery consultation.

31. November 21, 1995 Kathryn M. Yorkston, Ph.D., Speech/Language Pathologist, Universityof Washington, Seattle, WA 98195, (206) 543-3134. Velopharyngeal incompetence consultation.

32. December 18, 1995 Jeffrey E. Rubenstein, DMD, MS, obturator reduction procedure.

33. February 28, 1996 Dean Wiese, MD, 410 Black Hills Lane, #C, Olympia, WA 98502.Primary care physician. Consultation for otitis media/serous (recurring ear infection)

34. March 19, 1996 Allen D. Hillel, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, U of Washington Medical Center, Seattle, WA 98195, (206) 548-4022.Speech-hearing clinic, fiber-optic nasendoscope, Dr. Yorkston.

35. March 19, 1996 Jeffrey E. Rubenstein, DMD, MS, obturator reduction procedure.

36. August 22, 1996 Jeffrey E. Rubenstein, DMD, MS, obturator reduction procedure.

37. August 29, 1996 R. Dean Russell, MD FRCS[C], (ear, nose, throat, head and neck) 403Black Hills Lane SW, Suite F, Olympia, WA 98502, (360) 357-6314, 1-800-270-6314.Consultation, ear fluid build-up, ear tube procedure.

---------------------------------------------------------------------------------------------------------Florida

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38. November 12, 1996 William N. Williams, Ph.D., (Speech-Language Pathologist) Directorand Professor, Craniofacial Center, University of Florida Shands, Room D8-30, Dental SciencesBuilding, Gainesville, FL 32610 (352) 846-0801. Consultation, velopharyngeal incompetence,obturator reduction plan, surgical options.

39. November 12, 1996 Glenn E. Turner, DMD, MSD, Associate Professor of Prosthodontics,Director, Maxillofacial Prosthetics, University of Florida Shands, College of Dentistry,Gainesville, FL 32610 (352) 392-4294. Consultation, velopharyngeal incompetence, obturatorreduction plan, surgical options.

40. November 21, 1996 Dr. Nixon, Endodontic Specialists, 3201 SW 34th Ave., Ocala, FL34474. Endodontic treatment, tooth number three. (supports speech prosthesis).

41. November 25, 1996 William N. Williams, Ph.D. Videofluorographic evaluation, Universityof Florida Shands, College of Dentistry, Department of Oral Biology.

42. February 4, 1997 nasendoscopic assessment, Drs. Williams and Turner, Shands.

43. February 4, 1997 M. Brent Seagle, MD, University of Florida Shands Clinic at Park Avenue,1015 NW 56th Terrace, Gainesville, FL 32605, 1-800-749-7424, (352) 395-6810, consultation,velopharyngeal incompetence, surgical options; palatal extension or pharyngeal flap.

44. February 6, 1997 David J. Zaner, DMD, 2825 SE 17th Street, Ocala, FL 34471. Periodontalsurgery (crown lengthening), tooth 18. (supports speech prosthesis).

45. February 27, 1997 Glenn E. Turner, DMD, MSD, Associate Professor of Prosthodontics,Director, Maxillofacial Prosthetics. Completed prosthetic restoration of tooth number three.(supports speech prosthesis).

46. March 25, 1997 Stephen H. Dunn, DDS, 9401 SW SR 200, Suite 101, Ocala, FL 34481,(352) 873-2000. Prosthetic restoration of tooth 18. (supports speech prosthesis).

47. May 9, 1997 Bayfront Medical Center (ER), 701 Sixth Street South, St. Petersburg, FL.Experienced sudden hearing loss (L), accompanied by bleeding in ear & mouth.

48. May 14, 1997 Alan M. Gall, MD (otolaryngologist), 2299 Ninth Avenue N, Suite 3B, St.Petersburg, FL 33713, (813) 321-3344. Follow-up consultation, removed ear tube.

49. May 23, 1997 Dr. Gall, follow-up appointment. Noted improvement. Scheduled hearing testin July to measure hearing loss. (not completed).

50. August 22, 1997 contacted J. Douglas Bremner, MD, Assistant Professor of DiagnosticRadiology & Psychiatry, Yale University School of Medicine; and Dr. Dorothy Lewis,Dissociative Disorders Clinic, New York University Medical Center, following their appearance

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on the ABC Evening News, Health Report, August 18, 1997, the segment Growing up damaged,by John McKenzie, ABC News. I wrote in part to Drs. Bremner and Lewis:

Thank you for your recent appearance on the ABC News Health Report with JohnMcKenzie entitled "Growing up damaged." I am interested in additional informationabout the subject, including diagnostic recommendations.

My interest is personal. Born with a craniofacial disorder affecting both speech andappearance, I was subjected to severe psychological abuse, both familial and societal. Atage 41 I am currently disabled with "mental health issues," but I do not believe anaccurate diagnosis has been made in my case.

Dr. Bremner responded September 12, 1997 with an offer, one that later did not materialize:

Thank you for your interest in our research program on victims of childhood abuse andthe brain. If you or anyone else is interested, you can stay for free in our research unit andobtain financial compensation which more than offsets travel expenses, as well as acomprehensive diagnostic and biological assessment, including brain imaging. You cancall 203 737 5791 for information.

Dr. Lewis responded September 4, 1997 and wrote:

Thank you for your letter of August 22,1997. Unfortunately I do not know of someone inyour area who specializes in the complications of craniofacial disorders. I am sorry Icannot be of more help.

51. December 4, 1997, the Florida Division of Vocational Rehabilitation (DVR) notified me byletter that I am too severely disabled to benefit from vocational rehabilitation:

During our meeting we thoroughly reviewed and discussed your evaluation reports. It hasbeen determined that you are not eligible for vocational rehabilitation services becauseyour disability is too severe at this time for rehabilitation services to result in.employment. This decision was reached 12/4/1997.

Previously DVR on May 29, 1994 prepared for me an Individual Written Rehabilitation Plan(IWRP) after a long evaluation process. The DVR plan had three objectives:

Objective 1: Neil will be able to speak for up to 8 hours without rest or complaint of painand deterioration of vocal quality.

Objective 2: Neil will develop a marketable skill as a general practitioner.

Objective 3: Neil will obtain employment as a general practitioner. (medical doctor, MD)

I also received DVR services in Olympia, Washington, in 1995, one year of education at TheEvergreen State College, and a hearing aid.

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52. March 21, 2001, Mr. Rodems’ law partner, William Cook of Barker, Rodems & Cookreviewed my case with DVR, DLES case no: 98-066-DVR, and wrote me March 21, 2001:

“We have reviewed them [DVR claims] and, unfortunately, we are not in a position torepresent you for any claims you may have. Please understand that our decision does notmean that your claims lack merit, and another attorney might well to represent you.”

Mr. Cook previously represented to me that he would represent me with DVR, as set forth inPlaintiff’s First Amended Complaint, 05-CA-7205, paragraph 43.

53. December 31, 1997 John A. Ferullo, DDS, 1 Progress Plaza, #1340, St. Petersburg, FL33701-4353. (813) 822-8101. Initial visit, pending prosthetic restoration of tooth no. 19.(supports speech prosthesis).

54. February 20, 1998 David D. Whitaker, DMD, 111 2nd Ave. NE, Suite 1102, St. Petersburg,FL 33701, (813) 895-7519. Endodontic treatment, tooth no. 19. (supports speech prosthesis).

55. September 4, 1998 Selina Kassels, Ph.D, Licensed Psychologist (PY0005229), FloridaCenter For Cognitive Therapy, Inc., 2745 State Road 580, Suite 103, Clearwater, FL 33761.Consultation for Post Traumatic Stress Disorder (PTSD), Dysthymic disorder (chronicdepression), Anxiety disorder due to medical condition, etc.

56. 1999-2005, Dr. G. Anthony Figueroa, MD, 1201 5th Ave. N., Suite 300, St. Petersburg, FL33705, telephone: (727) 895-4500. Dr. Figueroa was my primary care, from January 1999through June 2005. Dr. Figueroa offered me a part-time job in his office, on the business side,however the office manager, Julie, refused to cooperate, and the job fell through. Julie was laterreplaced. Dr. Figueroa encouraged me to reestablish contact with my family, which I did, endinga nine year break. Dr. Figueroa treated me for depression at various times with Effexor,Wellbutrin, fluvoxamine, paroxetine, lexapro, and cymbalta. When I was homeless Dr. Figueroagenerously offered to pay a deposit on an apartment for me, but I declined.

August 10, 1999 Spoke with Dr. Figueroa that my obturator causes pain in mouth, and Ifear being unable to wear the appliance in the future, and deterioration of the appliance.

December 18, 2002, low speed car crash, became very tired (possibly pre-diabetic) andnodded-off while driving. This happened while driving as an independent contractordocument courier. The income did not cover expenses. The total loss of my car ended theemployment, and left me homeless, since I was living in my car and motel rooms.

57. September 2001 (temporarily homeless) Unable to wear speech prosthesis. Speculate that thepalatopharyngeal musculature changed to where I could no longer insert the obturator in mymouth, and I could not wear it anymore. I had a marked deterioration in speech.

58. September 6, 2000 through June 30, 2005 Robert S. Pastorius DDS, 3864 Fifth Ave. N.,Saint Petersburg, Florida 33713. Numerous procedures, fillings and extractions. Feb-17-05,

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extracted #11, removed five unit bridge made in Philadelphia (14. April 20, 1988 Dr. Sanfacon)installed flipper. June 30, 2005 Dr. Pastorius felt I was not enthusiastic enough and he washesitant to proceed with further treatment. Referral from Dr. Figueroa.

59. May 15, 2001 Randall T Hedrick, DDS, 4957 38th Avenue N, Suite E, Saint Petersburg, FL33710 tooth 30, endodontics (root canal).

60. September 2002 - February 2005, I was homeless during this period in Tampa, Florida. I leftmy apartment in Brandon Florida over harassment from neighbors, young people who made lifeintolerable, from verbal harassment to leaving dog feces on my doorstep. One time they set offan explosive device at my door and I reported that to the Hillsborough Sheriff.

After leaving the apartment I lived in motels if I could afford a room. Sometimes I slept outsideif the weather was good. Sometimes I lived in my storage unit at Shurgard in Tampa, where myfurniture was stored. I met another homeless man there, James Worley, we became friends, andwe have remained in contact. (James’ step-father killed his mother when James was about 14years old, and he has been adrift since). For a week or so I lived at a Salvation Army shelter inTampa. In February 2004 I bought a 1990 Dodge minivan for $600 and converted it to a livingspace. I lived in the van until I moved to Ocala in February 2005. I still own and drive the van,and may live in it again. The mortgage holder on the family home where I currently live notifiedme that it will soon begin foreclosure.

61. April 4 2002 David M. Pedley, DMD, Oral Surgery, 3810 Fifth Ave. N, St. Petersburg,Florida 33713, remove root (apicoectomy) of tooth no. 12.

62. April 1, 2005, Gregory G. Langston, DMD, MSD, Periodontics & Implant Dentistry 8487Fourth Street North, St. Petersburg, Florida 33702, gingival biopsy, evaluate for dental implants.

63. March 3, 2006 beginning on this date an attorney by the name of Ryan Christopher Rodemshas directed, with malice aforethought, a course of harassing and bulling conduct toward me thathas aggravated my disability, caused substantial emotional distress and serves no legitimatepurpose. On March 3, 2006 Rodems called me at home and started an argument over my motionto disqualify him. Rodems ridiculed my speech, and said you don’t talk like a lawyer. Rodemsthreatened to use his knowledge against me from prior representation that I spent a $2,000 carrebate on dental work. While this expenditure was lawful, Rodems was trying to upset me.

Rodems later made a false affidavit about the call to the court, and accused me of threatening toattack him in Judge Neilsen’s chambers. The matter was investigated by Kirby Rainesburger ofthe Tampa Police Department, who found I did nothing wrong. Mr Rainesburger also saidRodems was not right and not correct for representing to the court as an exact quote languagethat clearly was not an exact quote.

Mr. Rodems has intentionally inflicted severe emotional distress on me which has affected everyaspect of my life and the life of my family. I have sought medical treatment for depression andother injury caused by this severe emotional distress.

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I believe Mr. Rodems has an earlier edition of this medical history document from his law firm’sprior representation of me. Mr. Rodems knew that I considered taking my own life, from his lawfirm’s prior representation of me. Therefore Mr. Rodems knew I was severely impaired.

This is from the transcript of my deposition May 14, 2001 in the Amscot lawsuit when Mr.Rodems’ firm and partner represented me. This transcript is in the court file in Hillsborough Co.,Gillespie v. Barker, Rodems & Cook, case 05-CA-7205, see Exhibit 4, Verified Noticeof Filing Disability Information of Neil J. Gillespie filed May 27, 2011. From the deposition ofNeil Gillespie by John Anthony representing Amscot Corporation:

From pages 31-32

22 Q Have you ever tried to take your own life?23 A No.24 Q Do you recall ever saying that you would consider25 that under oath?

1 A I've considered it. Yes.2 Q When is the most recent time you've made that3 consideration?4 A I think about it from time to time.5 Q Even now with your medication?6 A Pardon?7 Q Even now with your medication?8 A Yes.

Surely Mr. Rodems reviewed this transcript in representing his law firm and law partner.

64. May 16, 2006 to February 26, 2008 consultation with Dr. William N. Williams, Ph.D.,(Speech-Language Pathologist) Director and Professor, Craniofacial Center, University ofFlorida Shands, Gainesville, FL, for velopharyngeal incompetence, my speech prosthesis(obturator) no longer fits, I cannot wear it any longer. Glenn E. Turner, DMD, MSD, Director,Maxillofacial Prosthetics tried to make a new obturator, he failed; then another failed attempt byDr. Fong Wong, BSD, DDS, MSD, Assistant Professor, Department of Prosthodontics.

At the beginning of treatment I was unable to insert my old obturator in my mouth due to a gagreflex. Dr. Turner said this would be a problem in making a new obturator. Dr. Turner said therewas no physical reason for my gag reflex or choking sensation. He said my gag reflex wascaused by a psychological issue. He said this would complicate and delay the construction of anew obturator. After almost two years of effort, neither he nor Dr. Wong were able to make forme an obturator. Dr. Turner offered the name of Dr. Kelly at the Moffitt cancer center in Tampa.Due to the choking issue and travel distance I declined to pursue another speech prosthesis.

65. March 2006 to October 2007, Dr. Michael Rowley MD, West Marion Family Medicine,4600 SW 46th Court, Ocala, Florida 34474, primary care, closed practice to become hospitalist.Treated me for diabetes; depression and PTSD, with Effexor XR, and propranolol,

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August 25, 2007 West Marion Hospital ER, severe back pain following the death of a petat UF College of Veterinary Medicine under awful conditions. (Aug-13-07). Thisincident of pain continued though October 1, 2007. Also treated by Dr. Rowley.

66. September 16, 2009, untimely death of my Mother, proximate cause of this lawsuit. This hascaused me significant emotional distress. Mr. Rodems has ridiculed my reference to this fact,including statements to Colleen Jenkins of the St. Petersburg Times, in a story January 22, 2010,Client-turned-adversary accuses Tampa law firm of conflict in judicial bid. Online at this URL:

http://www.tampabay.com/news/courts/client-turned-adversary-accuses-tampa-law-firm-of-conflict-in-judicial-bid/1067460

67. November 2009, Dr. Karin Huffer, 3236 Mountain Spring Rd. Las Vegas, NV 89146,Americans with Disabilities Act, ADA accommodation advocate and designer.

February 17, 2010, Dr. Huffer prepared my ADA Assessment and Report (ADA Report)for the Thirteenth Judicial Circuit, Florida, submitted February 19, 2010 to Mr. GonzaloB. Casares, ADA Coordinator, in Gillespie v. Barker, Rodems & Cook, 05-CA-7205.

DSM-IV Multiaxial Assessment (Axes I-V)

Axis I: Depression 296/3, Post Traumatic Stress Disorder, 309.81 withchronic and acute symptoms anxiety.

Axis II: N/AAxis III: Velopharyngeal incompetence, Diabetes Type II Adult OnsetAxis IV: LegalAxis V: Global Assessment of Functioning (GAF) prior 85

GAF with stress from legal system 60 in court

Dr. Huffer’s report shows the following: (These are selected passages, see the full report)

Brief History: Mr. Gillespie suffers from Chronic Depression as diagnosed by Cesar R. Gamero,M.D. in Ocala, Florida, 2009. Dr. Gamero also concurs with earlier diagnoses as does KarinHuffer, M.S., M.F.T., of Post Traumatic Stress Disorder and recognizes that Mr. Gillespiesuffers from velopharyngeal incompetence that worsens when he is stressed. This presents abarrier to managing effective communication during litigation. The Social SecurityAdministration found Mr. Gillespie totally disabled in 1994.

Mr. Gillespie has been in need of ADA Accommodations since commencement of his legalactions. The fact that he was not protected by the ADA created an inaccurate perception of himto the Court and clearly demonstrates that Mr. Gillespie did not have equal access to thelitigation proceedings or due process of law. The Americans with Disabilities Act should haveprotected Mr. Gillespie when he was first in litigation. With accommodations, he may well haveavoided the severe trauma he suffers today.

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IV. Interference with Major Life Activities:A. Functional Impairments:

Mr. Gillespie is functionally impaired in the areas listed below. It is important to note that Mr.Gillespie's impairments are largely invisible. He may appear to be functional on a superficiallevel even when he is not. Mr. Gillespie's functioning is the highest when he is in supportive andsafe environments. His functioning deteriorates when he is in non-supportive, unsafe, orintimidating environments or when he is under any perceived time pressure or stress. Hisimpairments are dramatically intensified during litigation.

• Mr. Gillespie cannot sustain concentration due to depression and symptoms of PTSD in theform of flashbacks, emotionally arousing and exhausting intrusive thoughts triggered byreminders of the traumatic events.

• Mr. Gillespie cannot sustain a communication path if interrupted, distracted, or threateningbody language is used toward him. Such circumstances result in cognitive disorganization,dissociation, and an inability to integrate and process information. Mr. Gillespie cannotsustain a progressive chain of communication under stress due to his congenital speechproblem. This communication is critical for litigation.

• Mr. Gillespie cannot open mail or address matters pertaining to his legal case withoutextreme anxiety. This slows him down when he faces deadlines. He cannot manage largeamounts of hard copy documents. He must have the time to scan documents for managementpurposes.

• Mr. Gillespie cannot sleep normally, rest, or recuperate due to Post Trauma Stress symptomsincluding nightmares and startle responses (i.e., he jumps when doorbell rings). He hashyperreactivity/hyperarousal and she can't eat or sleep or digest food normally.

• Mr. Gillespie is easily hyperaroused on a physiological level, especially when feelingoverwhelmed or under any perceived time constraint or threat. Hyperarousal makes itimpossible for him to think clearly and make logical and knowing decisions when underextreme pressure.

• Mr. Gillespie is unable to withstand stress without triggering moments of dissociation. Hemay be unable to consistently remember the words that are spoken in Court and cannotperform verbally to participate in his legal case without assistance and accommodations.

• Mr. Gillespie is vulnerable to neuroanatomical effects that can be devastating, i.e. decreasedhippocampal volume and hyperadrenia. Hyperadrenia influences all of the majorphysiological processes in the human body and has a host of physical, emotional, andpsychological effects. Physical impairments may be induced when stress is protracted andunrelenting.

B. Physiological impairment - Symptoms:

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Often overlooked by judicial personnel are well-established physiological changes experiencedwith PTSD, that seriously impair a person’s ability to function during litigation withoutaccommodations:

Psychophysiological EffectsFlashbacks;Startle responses;Hyper-reactivity/hyper-arousal

Neurohormonal EffectsFear and extreme anxiety; Hyper-vigilance, unable to relax or have peace due to intrusivethoughts/emotions; Stress hormones reduce and down-regulate receptors, causing a feeling ofbeing numb/exhausted and freezing the ability to process information and respond.

Serotonin-dependent Effects, Depression

Memory Impairment, Dissociation; Mr. Gillespie must use energy to fight the natural urge todeny the reality put before him; Traumatic intrusive thoughts threaten to crowd out the issue athand during legal processes; Increased opioid response; a numbing hormone intended to protectthe traumatized from pain must be overcome to deal with the legal issues at hand; It is anexhausting emotional "swim upstream" to stay focused and attentive in the . courtroom, criticaldata is missed, and nuances escape the person with PTSD.

February 19, 2010, I submitted my ADA accommodation request (ADA Request) with aNotice, and the Court’s ADA form in Gillespie v. Barker, Rodems & Cook, 05-CA-7205.

October 28, 2010, Dr. Huffer wrote a letter documenting the abuses in my case.

Dr. Huffer is the author of Overcoming the Devastation of Legal Abuse Syndrome, and a founderof Equal Access Advocates (EAA), and Legal Victim Assistance Advocates (LVAA).

Due to my indigence and/or insolvency, I can no longer afford Dr. Huffer’s services. Dr. Hufferhowever remains a part of my support system.

68. July 12, 2010 I had a panic attack during a hearing before Judge Martha J. Cook at theGeorge E. Edgecomb Courthouse, 800 E. Twiggs Street, Tampa, Florida. Judge Cook refused tofollow the directives of Court Counsel David Rowland on ADA accommodations. Mr. Rowlandwrote to me July 9, 2010 and said the ADA coordinator could not moderate Mr. Rodems’bullying behavior toward me. Coincidentally on July 9, 2010 I submitted an emergency motionto disqualify Mr. Rodems, and handed it to Judge Cook at the start of the hearing on July 12,2010, but she refused to consider the motion and I suffered a panic attack.

I felt a sudden onset of intense panic and terror. My symptoms included choking, palpitations,sweating, shortness of breath, chest pain, nausea, abdominal distress, feelings of unreality,feeling dizzy, unsteady, and feeling lightheaded. I felt an urge to escape danger.

Page - 14

When Deputies of the Hillsborough County Sheriff Office (HCSO) saw I was in distress theyoffered assistance. I believe HCSO Corporal Gibson was present, along with HSCO DeputyHenderson and perhaps others. Tampa Fire Rescue was called. Corporal Gibson stayed by myside and walked with me to the lobby of courthouse while I waited for the paramedics.

Tampa Fire Rescue responded, and an assessment was done at 10:42 a.m. by lead crew memberRobert Ladue, EMT Paramedic (PMD 514678) and crew member 2 Dale Kelley, EMTParamedic (PMD 49960). Later I obtained a report, incident number 100035129, which stated inthe narrative section “found 54yom sitting in courthouse” with “tight throat secondary to stressfrom court appearance” and “advise pt mult. times to be transported to hospital” and “pt refusestransport and states he would rather go to his Dr. pt signed refusal”. The impressions sectionnoted “abdominal pain/problems”. The nature of call at scene section noted “Resp problem”.

After the panic attack I drove home and spoke with Dr. Karin Huffer by telephone at 3:03 p.m.and told her about the panic attack. At 3:36 p.m. I responded to an email for legal representationfrom attorney Pedro Bajo in Tampa. This is what I responded:

Mr. Bajo,Would you consider just evaluating my motion to disqualify Mr. Rodems, with norepresentation? Thank you.Neil Gillespie

69. July 2008 to present, Dr. Cesar R. Gamero, MD, 9401 SW Highway 200. Building 2000,Suite 2004, Ocala, FL 34481. Dr. Gamero is a primary care doctor who treats me for diabetes,anxiety, depression, and all other medical issues. Tried Sertaline for depression and Clonazepamfor anxiety but the side effects were to severe. Also Mirtazapine for depression, and Pristiq. AlsoNuvigil to improve wakefulness and concentration. For diabetes and high blood pressure,lisinopril, metformin hydrochlorothiazide.

Nuvigil works to focus my attention and temporarily overcome depression, but the side affectsare significant and include severe headache, insomnia, sweating, dry mouth, constipation,dizziness, altered sense of being, and mood changes such as increased agitation, irritability andexaggerated sense of well-being. I also found Nuvigil not reliable. Sometimes it worked, butother times it incapacitated me. Nuvigil is also relatively expensive. My last prescription for 1550mg tablets cost about $80. Samples of Nuvigil are available from Cephalon, the manufacturer,and from Dr. Gamero, but the sample size is 150mg. That strength (150mg) incapacitated me andled to extreme headaches. Attempts to cut the 150mg tablet into a smaller size may result in anuneven dose, and reduced effectiveness, according to the pharmacist.

Nuvigil is the replacement for Provigil, which patent has expired. The U.S. military providesProvigil to military pilots on long missions to keep them awake. Provigil has other off-label uses.Generic Provigil is also relatively expensive; Walmart quoted me $588.68 for thirty (30) 100mgtablets on July 18, 2012. This was a $398.78 savings off the $987.46 full price. This cost isprohibitive for me.

Page - 15

Current health issues

I become easily confused and distracted. This is especially true when I leave home. When mylawsuit began in 2005, I had the ability go to the law library and do research for about one hour.Now when I go to the law library I am overwhelmed by the environment and cannot do anything,other than to hand the librarian a list of cases I found in outdated books at home and return laterto pick up the copies.

Short term memory deficit. I am unable to read more than a few words at a time and type thosewords on the computer. This makes legal work very time consuming. I believe short termmemory deficit causes a hearing problem in court.

Lack of concentration. I loose focus often and find it difficult to concentrate. Sometimes Ibecome overwhelmed. At that point I stop and rest, or switch to another task. It takes me a longtime to do things.

Hand-eye coordination deficit. My ability to do ordinary tasks is declining. My mind thinks ofthe task, but my hands and body do not respond like they used to. Many years ago I worked part-time as a banquet server, but I became too slow was unable to continue. I was not able to settables or serve food quick enough, and my stamina declined. Assembling documents in mylawsuit has become difficult. I am only able to do so with computer-assisted technology.

Forgetfulness. I have become very forgetful. This is a problem while cooking food. Whileheating soup on the stove, I soon forget about it, until I smell the food burning. This has resultedin the destruction of pots.

I compensate for forgetfulness by making lists, and leaving items in plain sight in the sameplace, so the location is impressed in my memory. This results in a home that looks verydisorganized to the casual observer.

Diabetes. I become very tired when my blood sugar is too high. My ideal blood sugar level is110. Records show my blood sugar level May 25, 2011 at 8:41 p.m. reached 245. This was aweek before a civil contempt hearing June 1, 2011 before Hillsborough Judge James Arnold.This was a very stressful time. Through a series of ex-parte hearings, Mr. Rodems presentedfalse testimony and obtained June 1, 2011 a warrant for my arrest on a writ of bodily attachment.

Velopharyngeal Incompetence (VPI). I can no longer wear my speech prostheses. The June 2,1993 assessment of Dr. Jane Scheuerle, Tampa Bay Craniofacial Center, explains this issue.

Social life. I live alone in a small two-bedroom retirement home with my pet bunny. My sociallife is limited to an occasional Thursday morning breakfast at a local restaurant with retired menwho live on my street in Oak Run, a retirement community. The Thursday morning breakfast is aweekly event, but attending weekly is too stressful, so I go about once a month.

Page - 16

I also have a telephone relationship with a woman in Miami that began in late 2008. We havenever met in person. She is retired and cares for both her elderly parents who are in their mid-eighties and very ill. Otherwise I stay at home and work on my case.

Hearing deficit. This appears related to short term memory deficit.

Telephone recording. My short-term memory is poor. My ability to accurately take notes isseverely reduced. Even my concentration during a conversation is impaired. So recording a callallows me to listen to the caller a second or third time for a better understanding of the issues.This is in addition to another issue, that opposing counsel once misrepresented the contents of acall to the court. When I was caring for my Mother who had Alzheimer’s and other ailments,recording calls from the doctor allowed me to accurately understand the call and follow thedoctor’s orders. That is how I began recording calls. Sometimes the recording programinadvertently records my screams as I sit at my desk, cursing this lawsuit and legal system.

Website as a coping mechanism. In my ADA accommodation request made February 19, 2010 inHillsborough Co. lawsuit, I described how I would create a website to help find counsel. While Idid not find counsel, I met people with stories of legal injustice, and we support each other.

Combinations of disabilities. A study by the World Health Organisation shows depression ismore damaging to everyday health than chronic diseases such as angina, arthritis, asthma anddiabetes. Researchers found if people are ill with other conditions, depression makes themworse. Somnath Chatterji of the World Health Organisation led the study. The most disablingcombination was diabetes and depression, the researchers said. "If you live for one year withdiabetes and depression together you are living the equivalent of 60 percent of full health,"Chatterji said in a telephone interview. News of this study was reported by Reuters on September7, 2007. The study is reported in the Lancet Medical Journal, Vol. 370 No. 9590 pp 851-858.

On February 19, 2010 I made requests under the Americans with Disabilities Act (ADA),including this one.

ADA Request No.6: Mr. Gillespie requests time to scan thousands of pages ofdocuments in this case to electronic PDF format. This case and underlying causeof action covers a ten year period and the files have become unmanageable andconfusing relative to Gillespie's disability. Mr. Gillespie is not able to concentratewhen handling a large amount of physical files and documents. He is better ableto manage the files and documents when they are organized and viewable on hiscomputer. Mr. Gillespie will bear the cost of converting files and documents to PDF.

• • • • • 415-13

Rev. ]-8]

AMERICAN ONCOLOGIC HOSPITAL

CHART COpy PROGRESS REPORT

Notll prairllss of caslI. complications. chanilll In dlaposls condition on dlscharill. Instructions to patlllnt GILLESPIE, Neil #74123

7/22/85

The patient is a 29 year old white male referred by Dr. Carver who is status post left unilateral 'Class IV lip and palate repair at approximately age two years old. He is unclear about the details of the degree of his defects, the surgical procedures, who performed this, or exactly where it was done. Apparently, after the initial bout of surgeries to repair the lip and hard and soft palate, he had no further surgical intervention. He had no ongoing follow-up for this problem. At approximately age 13 to 14 years old, he underwent orthodontic treatment at Temple University Hospital's Dental School and this ultimately resulted in the placement of a retainer with a prosthetic left lateral incisor. He has worn this since that time. He notices drainage of food into the left nasal floor. His left and

·right nostrils are opened, although the left is somewhat stuffy and occluded.

His main concerns upon presentation are related to the persistent cleft in the left alveolus, the draining fistula, and the possibility of foregoing the need fOD a prosthetic device. In addition, however, it is obvious on confronting the patient that he has a moderate amount of nasal deformity, flattening of the left side in the premaxillary region, and lip distortion, particularly at the vermilion. In addition, the patient has a significantly hypernasal speech pattern with ~bvious velopharyngeal incompetence.

On physical examination beginning externally, the patient has a slightly large nose with a small dorsal hump. The size of the nose is slightly larger than proportional to his face, although not exaggeratedly so. The right alar dome is full. The left alar cartilage is posteriorly and laterally displaced and somewhat hypoplastic compared to the left side. The left alar base is also laterally displaced. The nostril sill is flattened, and there is an obvious fistula between the distal nasal floor and the oral cavity. The left columella, likewise, is somewhat hypoplastic and twisted. The upper lip scar is well healed and appears to be a LeMesurier or Tennison-Randall type repair. The upper lip tubercle is preserved, but the vermilion border is somewhat irregular. Length appears, however, to be satisfactory. There is a-lateral orbicularis bulge of the left upper lip. Internally, there is a wide cleft of the left alveolar ridge at the level of the lateral incisor with a fistula into the nasal floor. This runs posteriorly and nearly to the end of the secondary palate. The soft palate has a linear scar. it is very short, and there is lateral movement but no central movement of note.

continued ...•

6.1

• • • •

GILLESPIE, Neil Page Two . 7/22/85

My impression and recommendation to the patient generated three specific areas of interest. One relates to the scar revision of his upper nose and the relationships of his nasal tip, nose, and secondary deformities in this area. The second area of interest in importance is the alveolar cleft with the naso-oral fistula. The third area is the palate with obvious velopharyngeal incompetence and a foreshort and scarred palate.

My initial recommendations will be that the patient undergo orthodontic evaluation. I will arrange for him to see Dr. Rosario Mayro for evaluation as well as x-rays to assess his occlusal relationships. It also should be noted that he, in general, had a fairly satisfactory occlusal relationship.with some lateral collapse and crossbite on the minor segment on the left and evaluate his adequacy as a candidate for bone graftin~which I think he would qualify. Subsequent to this, I will have him see Dr. Harvey Rosen concerning the actual surgical procedure and also he will be seen by Miss Marilyn Cohen, a speech pathologist with special interest in patients having cleft lip and palate for an evaluation concerning feasibility of posteropharyngeal flap in a patient of this age group. Concerning the external revisions, this can be accomplished concerning the upper lip, possibly at the same time as the fistula closure with orlllcularis redirection, a revision of the nostril sill and the lateral alar base, and also possibly tip rhinoplasty or this can be accomplished at a later date with a formal rhinoplasty in concert with other procedures. In addition, the vermilion border should be repaired. This can be done by Z-plasty technique.

The patient, therefore, will be seen by the consultants and a general plan with timing'for surgery, etc., will be made. We will arrange to make these arrangements and follow-up with the patient. No letter.

M.D. econstructive Surgery

JK:bsm T--8/1/85 D--7/23/85

ep s1ak,

•

PENNSYLVANIA HOS- TTAL ~ ,

The Nl!!,i.\la~~ Hospital I Founded 1751 '',

DEPARTMENT FOR SICK AND INJURED HARVEY M, ROSEN. M,D, D,M,D,EIGHTH AND.SPKUCF; STREETS Head, Se,lion of Plastic Surgery

P.ADELPHIA, PENNSYLVANIA 19107 gtiTie 3H,301.50uth Eighth sr® . PHONE (215) 829-5643 -H, ROBERT CATHCART, President

1?A ~,.;.7~

August 12, 1985 I e·tV1 Lj-)-?7 /8&

',., :.",

Joseph Kusiak, M.D. American Oncologic Hospital Central " Shelmire Avenues ~~~l~~elphia, Pennsylvania

,.', 19111

".

RE: Neil Gille.pie

Dear Joei"" ,

This lllorning your patient, t-lr. Neil Gillespie, was seen in consultation regarding his secondary cleft lip and palate deformities. His major concern at this point in time is the edentulous space in the region of the left lateral incisor which necessitates wearing a removable appliance. This area has never been bone grafted. On physical examination there is the obvious stigmatA of an unilateral left sided cleft lip and palate. Examination of the lip reveals poor aligrunent of the vermilion border. There is lack of muscle continui'ty high in the lip. Nasal examination shows a deviated septum with the body of the septum in the left nasal airway and the caudal end presenting in the right nasal airway. There is a fla~~Q,~lar base. Tho alar sill i~ recessed. There is a slumping of the left alar rim. Tht:: right lower lateral cartilage is hypertrophied compared to the left lower lateral cartilage. Intraoral examination reveals an edentulous space in the region of the left li1teral incisor. There is an obvious oronasal fistula. There i~ a slight posterior crossbite in the lett posterior segment. There is marked velopharyngeal escape.

I exp~a1nwd to Mr. Gillespie that in order for nim to have a iix~d

bridge appliance made 60 thathhe could be rid of his removable appliance, an alveolar bone graft would be necGssary. Whether or not the posterior cro86bite should be corrected prior to this time is up to Dr. Mayro. At the &~e time that the bone graft is performed lip revision could be done as well. At a secondary procedure a posterior pharyngeal flap And naaal reviaion could be performed.

and The Institute. III North 49th Street I Philadelphia, Pennsylvania 19139 I Telephone (215) 471.2000

6.2

.__ _...•......_ .---_..__• ..

~.

.71,':. ' ,

Joa.ph Kuaiak, M.D. -2- Auguat 12, 1985

Thank you for referring K%••G11leQpie. I looK forward to 41acuas~9 him with you.

Sest revarda.

Sincerely youre,

Harvey M. Rosen, M.D., D.M.D.

1iHa/e~ cel Rosie Mayro, D.M.D., 1830 Rittenhouse Square, Phila., PA 19103

Ma. Marilyn Cohen, Facial Reconstruction Center, Children'. Hoapital, Philadelphia, PA 19104

u: 10-,,, ~ .~ J;.1/..~

\.

I

~UUNUtD 11155

THE CHILDREN'S HOSPITAL OF PHILADELPHIA THE CLEFT PALATE PROGRAM

34th and Civic Center Boulevard Philadelphia. Pa 19104

(215) 596-9120

Don LaRossa. M. D., Director

September 12, 1985

Joseph Kusiak, M.D. American Oncologic Hospital Dept. of Plastic Surgery Dept. of Surgery Central and Shelmire Ave. Philadelphia, PA 19111

RE: Neil Gillespie B.D. 3/19/56

Dear Joe:

Thank you for referring Neil Gillespie for a speech evaluation. I had the opportunity of evaluating this gentleman on August 1, 1985.

~e had a history of a unilateral cleft lip and palate repaired some >" ••1me in early childhood. He is presently wearing a dental shell which l'ls obturating to some degree an anterior parallel fistula. He has

had a short course of speech therapy during his early school years.

Mr. Gillespie's speech is characterized by hypernasality with nasal escape. Hi~ hypernasality is accentuated when he removes his palatal appliance but I do not feel that the fistula is the prime cause ~f

the hypernasality or the nasal excape. Occlusion of his naris with the appliance in place greatly improves the overall quality of his speech and generally eliminates the hypernasality. His articulation is well within the normal range.

On direct physical examination, he appears to'have a deep oral pharynx' with a short but mobile soft palate. He has an active gag reflex,with

l'fairly good lateral wall motion. I would suspect that he would do - fairly well with a posterior pharyng~al flap ~ut given his age the .

,prognosis is guarded. I discussed this recommendation with Mr. Gillespie 0'

and also informed him that there is the possibility even with the posterior pharyngeal flap that there may not be an improvement in his speech and that he could possiply require speech therapy following the flap. I do not feel he would benefit from a course of speech therapy at this point in time as this appears to be an anatomic defect.

>.' :

1:,,:,:9PlASTIC SURGERY: Peter Randall, M.D., Don LaRossa, M.D., Linton Whitaker, M. D., Ralph Hamilton, M. D., R:Barrett Noone, M.D.,). Brian Murphy,·M.D~. , ,:" Arthur Brown, M.D. SPEECH PATHOLOGY: Marilyn Cohen, B.A., Marilyn Bernhard, M.A.; DENTIST."" Rosario Mayro, D.M.D., 'Imes Schweipi;

D.D.S.; QTORHINOLARYNGOLOGY: William Potsic, M.D., Steven Handler, M.D., Ralph Wetmore, M.D.; AUDIOLOGY: Richard Winchester, Ph.D.; PEDIATRICS: Patrick Pasquariello, M.D.; SOCIAL WORK: Susan Freimark, A.C.S.W.

6.3

(2) RE: Neil Gillespie

If you would like further confirmation of the problem, I would recommend proceeding with nasal pharyngoscopy rather than lateral static x-rays.

Thank you for allowing m~ to participate in Mr. Gillespie's care. With best regards,

Sincerely yours,

Marilyn A. Cohen Speech Pathologist

MAC/med

cc: Harvey Rosen, M.D.

Rosie Mayro, M. D. t..""

Rosario Felizardo Marro, D.M.D. Practice Limited to Orthodontin

Harch 31, 1986

Dr. Harvey Rosen Pennsylvania ~ospital

Suite 309 700 Spruce Street Philadelphia, PA., 19106

Re: Neil Gillesoie

Dear Harvey:

Mr. Neil Gillespie has began orthodontic treatment in preparation for bone grafting. I anticipate that he will be ready for surgery in the month of August, 1986. ~tr. Gillespie will be in touch with you shor~y

to set up a definite date •

Please do not hesitate to call me if you have any questions. i

Best regards,

Sincerely yours,

,~ Rosario F. r:layro, D.J.·LD. RFi'1:er

cc: Dr. Joseph Kusiak

1830 Rittenhouse Square, I-A, Philadelphia, Pennsylvania 19103 215-735-5211 ,: ....

6.4

-- n"l()(jCV1tic_~ ;kld Oral Dli/g .'S/S

MI\~!f~ I~ '.f.JYI)1 f!, I-)M 1),1\

~I!;~)' III JII I ',IX: III f'J I II ejmll 9.111 i 'J(~,

Pllli 1\11111'1111\, III r'II'~WI V;\NI/\ I')K)')

APRIL 22) 986

ROSARIO F. MAYRO) D.M.D. 1850 RITTENHOUSE SQUARE PHILADELPHIA) PA 19103

RE: NEIL GILLESPIE DEAR ROSIE:

AT YOUR KIND SUGGESTION I EXAMINED YOUR PATTFNT" NEIL GILLESPIE" TODAY TO EVALUATE THE EXTENT OF GINGIVAL RECESSION AND PLAN CORRECTIVE SURGICAL PROCEDURES. THIS THRITY-YEAR OLD MAN IS IN GOOD GENERAL HEALTH. HE IS CURRENTLY UNDERGOING ORTHODONTIC TREATMENT IN YOUR OFFICE AND A MAXILLARY BONE GRAFT IS SCHEDULED LATE NEXT SUMMER WITH DR. ROSEN.

THE PATIENT HAS SEVERE GINr.IVAL RECESSION IN THE LOWER ARCH EXTENDING FROM THE LOWER LEFT· FJ RST PREMOLAR TO THE LOWER RIGifT FIRST PRfMOI_AR. THERE IS ALSO SEVERE CERVICAL EROSION WHICH APPEARS TO BE SECONDARY TO OVERZEALOUS TOOTHBRUSHING. IN THE UPPER ARCH THERE IS RECESSION AND MUCOSAL MARGINAL TISSUE ON THE CANINES AND RIGHT LATERAL INCISOR. THERE IS ALSO A HIGH MAXILLARY FRENUM BETWEEN THE CENTRAL INCISORS. THE PATIENT HAS MINOR COMPLAINTS OF SENSITIVITY WITH EXTREMES OF HOT AND COLD IN AREAS OF RECESSION.

As WE DISCUSSED" I WILL BE PROCEEDING WITH CORRECTIVE MUCOGINGiVAl PROCEDURES IN ORDER TO ST~BILIZE THF. DENTOGINGIVAL JUNCTION AND PREVENT FURTHER RECESSION DURING ORTHODONTIC TREATMENT. IN AR E A 5 WHERE SENSIVITITY IS A PROBLEM OR THERE ARE COSMETIC CONCERNS" THE PROCEDURES WILL BE DESIGNED TO OBTAIN COVERAGE OF EXPOSED ROOT SURFACES.

6.5

DR. ROSARIO MAYRO APRIL 22J 1986 PAGE Two

I SEE NO PROBLEM WITH CONTINUED TOOTH MOVEMENT IN THE UPPER ARCH. I WOULDJ HOWEVERJ DEFE~ ACTIVE ORTHODONTIC TREATMENT IN THE LOWER ARCH UNTIL AFTER I HAVE COMPLETED THE MUCOGINGIVAL SURGERY.

I LOOK FORWARD TO COLLABORATI NG WITH YOU IN THE TREATMENT OF TH IS VERY CHALLENG ING CASE. I WILL KEEP YOU POSTED ON Mi<. GILLESP I E I S PROGRESS.

SINCERJ~Y,/, ,./' Ii \1 ,/

/';

MARK ~. SNYDERJ D.M.D.

MBS:MEB

CC: HARVEY ROSENJ D.M.D.J M.D. " ,:-' 1". t.. L:, •...

PeriodontICS and Ora/Diagnosis

MARK BSNYDER, DMD, PC _. ---_.._._----220-sc5JTH SIXTEENTH STREET SUITE 900

PHII.ADELPI /lA, PLNN5YIVANIA I(JIOY (21':» ':>46 O/?9

JULY 3" 1986

ROSARIO F. MAYRO" D.M.D. 1850 RITTENHOUSE SQUARE PHILADELPHIA" PA 19103

RE: NEIL GILLESPIE DEAR ROSIE:

I AM PLEASED TO REPORT THAT I HAVE COMPLETED PERIODONTAL SURGERY ON YOUR PATIENT NEIL GILLESPIE. A BAND OF KERATINIZED GINGIVAL TISSUE WAS PLACED FROM THE LOWER LEFT SECOND PREMOLAR EXTENDING ACROSS THE ANTERIOR REGION TO THE LOWER RIGHT SECOND PREMOLAR. IN THE UPPER ARCH THE MUCOSAL MARGINS ON THE ANTERIOR TEETH WERE ALSO REPLACED BY KERATINIZED GINGIVA. NEIL TOLERATED THE PROCEDURES ~XTREMELY WELL AND HEALING HAS BEEN UNEVENTFUL. INCIDENTIALLY" THERE HAS ALSO BEEN SIGNIFICANT IMPROVEMENT IN HIS PLAQUE CONTROL.

I HAVE RECOMMENDED THAT NEIL BE SEEN ON AN ONGOING BASIS FOR PERIODONTAL HEALTH MAINTENANCE APPROXIMATELY EVERY FOUR TO SIX WEEKS DURING THE ORTHODONTIC PHASE OF HIS TREATMENT. I WILL EE SEeING HIMAGAIN SHORTLY BEFORE HIS SURGERY WITH HARVEY ROSEN. HIS PERIODONTIUM IS CURRENTLY HEALTHY ENOUGH TO WITHSTAND THE RIGORS OF ANY ANTICIPATED TOOTH MOVEMENT.

iTHANK YOU FOR REFERRING THIS MOST CHALLENGING CASE TO ME FOR TREATMENT. IF I CAN BE OF ANY FURTHER ASS ISTANCE" PLEASE DON 'T HESITATE TO CALL.

JUL 0,,1986

CC: HARVEY ROSEN" D.M.D." M.D.

.._._ ...._,

6.6

I ...·

.~NSYLVANIA HOSPJ~ ~L . N.tion's Fint HOIpit.11 FoundN 1751 /

DEPARTMENT FOR SICK AND INJURED HARVEY M. ROSEN. M.D.• D.M.D He.d. Section of PI..tic Suraery EIGHTH AND SPRUCE STREETS Suite 3H. 301 South Eiahth Street

....ADELPHIA, PENNSYLVANIA 19106 H. ROBERT CATHCART, Pruidenl ~EPHONE (215) 829-5643

May 18, 1987

Pete~ Randall, M.D. University of Pennsylvania Hospital Four Silverstein 3400 Spruce Street Philadelphia, Pennsylvania 19104

RE: Neil Gillespie

Dear Peter:

I have asked Mr. Neil Gillespie to see you in consultation regarding a secondary cleft nasal deformity. Mr. Gillespie had been referred to me by Joseph Kusiak for a bone grafting procedure to his residual alveolar cleft. When first seen by me he had a very large nasal palatal fistula with a significant alveolar defect. In addition, he had a rather severe cleft nasal deformity with a large amount of velopharyngeal insufficiency. A pharyngeal flap was discussed, but he declined this and wanted to concentrate on the bone grafting of his alveolar cleft as well as some secondary nasal surgery. He was operated upon last spring, at which time he underwent bone grafting of his rather

,..-extensive alveolar cleft and, at the same time, repositioning of the nasal septum and nasal' spine in the midline. He did wel~ followinq

~ these procedures, and approximately six months later he underwent a rhinoplasty procedure involving further work on his septum with only minimal resection, reduction of a dorsal nasal hump, and reduction of his left alar flaring. As a Desult of the last mentioned maneuver, he has developed some blockage of the left nasal airway due to excessive buckling of the lower lateral cartilage. It is-significant to note that prior to his ·nasal surgery he denied having anY}di,fficulties wit~ nas';ll br7athing.. For thi~ reason. no extensi.Y,~.~~9r:kwa~~~ne to the r~ght ~nfer~or turb~nate, wh~ch ".t'IY··'hypertrop~~ed,is s~.'.~~;J~and the nasal septum was not more ~~--.e:i¥.el~·'~rese'6ted. .' .

',' '., ~'i'r,:~~;'f:::'·.'" - ..

I would appreciate your thouqhts on his residual problem. If you think further significant improvement can be obtained, and if he is agreeable, please do not hesitate to proceed with any surgery that you think advisable. ..

Thank you in advance for seeinq Mr. Gillespie. Best regards.

Sincerely yours,

Harvey M. Rosen, M.D., D.M.D.

hrnr/eg

.nd The Institute. 111 North 49th Street I Phil.delphi., Pennsylv.ni. 19139 I Telephone (215) 471·2000

, ,,-:t:. I )f~ ''1

. '. I,,):, .:;~ .•

6.7

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA 4TH FLeOR - SILVERSTEIN PAVILION

3400 SPRUCE STREET PHILADELPHIA, PA. 19104

(215) 662-2000JONATHAN E. RHOADS, M.D. DON LAROSSA, M.D. CLETUS W. SCHWEGMAN, M.D. RICHARD N. EDIE, M.D. BROOKE ROBERTS, M.D. LARRY W. STEPHENSON, M.D. PETER RANDALL, M.D. JOHN L. ROM BEAU, M.D. JULIUS A. MACKIE, M.D. GORDON P. BUZBY, M.D. L. HENRY EDMUNDS, JR., M.D. ALI NAJI, M.D. LEONARD D. MILLER, M.D. June 17, 1987 W. CLARK HARGROVE, III, M.D. CLYDE F. BARKER, M.D. V. PAUL ADDONIZIO, M.D. RALPH HAMILTON, M.D. CLIFFORD W. DEVENEY, M.D. HENRY D. BERKOWITZ, M.D. KAREN E. DEVENEY, M.D. HAZEL I. HOLST, M.D. IRA J. FOX, M.D. LINTON A. WHITAKER, M.D. JOHN M. DALY, M.D. ERNEST F. ROSATO, M.D. MICHAEL H. TOROSIAN, M.D. LEONARD J. PERLOFF, M.D. scon P. BARTLEn, M.D. JAMES L. MULLEN, M.D.

Harvey M. Rosen, M.D., D.M.D. Suite 3H 301 S. Eighth Street Phi1ade1phLa, PA ··19106

RE: Neil Gillespie

Dear Harvey:

Thank you so much for your letter concerning Mr. Neil Gillespie. This certainly sounds like an interesting and rather difficult situation. I would be very pleased to see him. I will certainly keep you in touch with any plans, and do appreciate so much information.

Thanks again.

Peter Randall, M.D.

PR:spd

cc: ~oseph Kusiak, M.D. ~Mr. Neil Gillespie

6.8

FOUNDED 1855

THE CHILDREN'S HOSPITAL OF PHILADELPHIA THE CLEFT LIP AND PALATE PROGRAM

34th and Civic Center Boulevard Philadelphia, PA 19104

(215) 596-9120

Don LaRossa, M.D., Director Pam Onyx, Coordinator

March 30, 1989

Don LaRossa, M.D. HUP

RE: Neil Gillespie DOB: 3/19/56

Dear Don:

I had the opportunity of reevaluating Neil Gillespie on March 30, 1989. The speech evaluation is essentially unchanged since his last evaluation in 1985. Mr. Gillespie's speech is characterized by hypernasality with consistent nasal escape. On direct physical examination the palate appears to be short and slightly immobile. Articulation is within the normal range.

I would recommend nasoendoscopy to confirm velopharyngeal incompetence and to evaluate the degree of lateral wall motion. Mr. Gillespie was counseled regarding the options for correction of his hypernasal voice quality, including the use of dental prosthetics and posterior pharyngeal flap. I also explained to Mr. Gillespie that the prognosis after placing a posterior pharyngeal flap are somewhat guarded in an adult and that he may continue to have some persistent hypernasality requiring additional speech therapy. I believe Mr. Gillespie is interested in proceeding with a nasoendoscopy and will be contacting you after he receives notification from your office.

Thank you for the opportunity of participating in this patient's care.

Sincerely yours,' ,/' ,/-' '., /'

- ·_-:;rh ~rC/¥ Marilyn E. Cohen Speech Pathologist

MEC:sam

cc: Mr. Neil Gillespie

PLASTIC SURGERY: Peter Randall, M.D., Don LaRossa, M.D., linton Whitaker, M.D., Ralph Hamilton, M.D., Harvey M. Rosen, M.D., Joseph F. Kusiak, M.D., R. Barrett Noone, M.D., ). Brien Murphy, M.D. SPEECH PATHOLOGY: Marilyn Cohen, B.A., Marilyn Bernhard, M.Ed. DENTISTRY: Rosario F. Mayro, D.M.D., Dennis G. Sanfacon, D.M.D., Barry S. Kayne, D.D.S., Stanley Horwitz, D.D.S., Howard M. Rosenberg, D.D.S. OTORHININOLARYGOLOGY: William Potsic, M.D., Steven Handler, M.D., Ralph Wetmore, M.D., Lawrence W. C. Tom, M.D. AUDIOLOGY: Dan F. Konkle, Ph.D. PEDIATRICS: Patrick Pasquariello, M.D. SOCIAL WORK: David ). Beele, M.S.W., A.C.S.W. GROWTH/ANTHROPOLOGY: Nancy Minugh-Purvis, Ph.D. GENETICS: Elaine H. Zackai, M.D., Donna M. McDonald, M.s. PATIENT EDUCATION: Pamela H. Onyx, B.A. NURSING: Kelly Gould, R.N.

6.9

li. 'Ralph Millard, Jr., M.D., F.A.C.S.

thony Wolfe, M.D., F.A.C.S.

Walter R. Mullin, M.D., F.A.C.S.

December 3, 1990

Mr. Neil J. Gillespie 23 Sweetgum Road Levittown, PA 19056

Dear Mr. Gillespie:

Arrangements have been made for your admission to Jackson Memorial Hospital, East Tower, on Thursday, December 13th, 1990 between the hours of 12:00 and 2:00 p.m., for surgery the following day. Please be prepared to pay the hospital a deposit of $4400 toward payment of your final bill. However, they may accept insurance forms in lieu of payment. Please let us know at once if you prefer to be admitted on the morning of surgery, as we would have to arrange for your lab work to be done prior to the day of surgery.

Also, we've arranged for Dr. Millard and his Resident, Dr. LaTourette, to see you in our office on Wednesday, December 12th at 10:00 a.m. for medical workup.

Please send us your insurance forms with "insured section" completed and signed. This will help expedite the processing of your claim. Be sure to find out and let us know if your insurance company requires precertification for planned surgery. Contact Marisol in our office as soon as possible regarding this matter.

Kindly confirm these arrangements upon receipt of this letter. If we do not hear from you by December 12th, we will assume that you are unable to go ahead at this time and we will find it necessary to remove you from the schedule until we hear from you again.

Enclosed is a list of special instructions which should help answer some of your questions. If we can be of further assistance, please feel free to call upon us.

~urs.

Chris Montoto Secretary to Dr. Millard

6.10

D. Ralph Millard, Jr., M.D., F.A.C.S. 'The Plastic Surgery Centre

Plutic and Re.:onsl:ruc:tivc Surgery • Tel. (305) 325·144·.Anthony Wolfe, .M.D., F.A.C.S.

1444 N.W. 14th Avenue • Miami. Florida 33125Walter R. Mullin, M.D., F.A.C.S.

December 6, 1990

Christy Barcelona Pennsylvania Blue Shield Pre-authorization Request P. O. Box 890041 Camp ~ill, PA 1708900041

Re: Neil Gillespie ID: D5ll5395 Group: 20l63C

TO WHO-I IT HAY· CONCERi'J

The above natmed patient was seen in consultation by D. Ralph Hillard, Jr., M.D. on May 26, 1989 at which time reconstructive. surgery was scheduled.

The patient \Vas born with a tmilateral cleft of the lip and palate including nasal distortion lvith difficulty breat~~g and nasal escape, secondary to tIle cleft. TIle proposed surgical procedure lvill be cleft rhinoplasty lvith submucous resection, possible pharyngeal flap and cleft lip correction, procedure codes: 30520, 40720 and 42226. Dr. Hillard's fee for these procedures lvill be approximately $3,900.00. Dr. ~lillard feels very strongly that this surgery is functional i."1 nature.

We will greatly appreciate receiving pre-authorization for this surgical procedure. We will also appreciate your expeditious attention to this request as Hr. Gillespie's surgery is scheduled for Dece.'nber 14, 1990.

S)7Z:t:~r:L£ Marisol Pardo, Insurance Secretary

~1P/a

6.11

JUN 29 1993

MUTAZ B. HABAL., M.D., F.R.C.S.C., FAC.S. PLASTIC AND RECONSTRUCTNE SURGERY

801 W. Dr. ".rtin L ICing, Jr. BIwI. Telephone: 813/231HH09 Tampa, FL 33603-3301 FacsOnBe: 813/.238-1119

May 5, 1993

RE: NEIL GILLESPIE

To Whom It May Concern:

Neil Gillespie is a pleasant 37 year old white male patient seen 'today for the first time at the Tampa Bay Craniofacial Center. He brings with him today an organized synopsis of the multiple operative procedures that he has undergone, initially in Philadelphia and the last in Miami.

The patient presents with velopharyngeal incompetency and is leaking air both posteriorly and interiorly. The palate is short and does not appear to have much activity. Prior to preparing Mr. Gillespie for a surgical procedure, I would like to do a complete visualization of his problem to see if the pharyngeal flap needs to be removed and enough time allowed for the tethered flap to adjust, or if a complete flap with two small posts on each side is appropriate in order to allow him to communicate and be understood despite his hypernasal speech which at the present time cannot be comprehended.

These operative procedures will be discussed with the patient following the visualization procedure which has been scheduled at st. Joseph's Hospital on 6/1/93 and again in consultation with Dr. Scheuerle. I will see him prior to the procedure on 5/26/93 at 1:45 p.m.

Should you have any questions, please do not hesitate 'to communicate with us.

Sincerely,

/U V£/G.-i~- fr~{t:-L--l Mutaz B. Habal, M.D. (dictated but not read)

MBH/bbd/5-8

6.12

June 2, 1993 Department of Communication Sciences and Disorders

College of Arts and Sciences University of South Florida Robert E. Williams, Ed.D. 4202 East Fowler Avenue, BEH 255

certified Rehabilitation Counselor Tampa, Florida 33620-8100 Department of Labor and Employment Security (813) 974-2006 Divisional of vocational Rehabilitation FAX (813) 974-2668

11213 B North Nebraska Avenue Tampa, Florida 33612

Re.: Neil J. Gillespie

Dear Dr. Willia~s,

Thank you for your letter of inquiry concerning Mr. Neil Gillespie's health and employment status and potential. Each of your five questions concerning Mr. Gillespie's diagnosis and treatment plan is listed and addressed below.

1. What is Mr. Gillespie's disability (ies) and what is the level of severity? -.,.

Mr. Gillespie has sustained the surgical results of mUltiple treatments for a congenital cleft lip and palate. While he is facially intact, he retains several incomplete elements of the sequelae of this congenital dysmorphology. Because of the oro-nasal fistula and velar limits, Mr. Gillespie is utilizing extreme measures to make his speech intelligible. He is applying undue stress to the laryngeal and pharyngeal musculature a control the normal air stream. Because of his extra effort in striving to meet the demands of society, he is at risk for damaging his larynx. Also, the unnatural openings between the nose and mouth invite incidence of infection and irritation to sensitive tissues that were never meant to associate in this way. Exchange of food stuffs and secretions between the two cavities must be stopped to promote complete healing and maximal function.

2. What is Mr. Gillespie's functional level? What physical limitations (e.g., speaking, hearing, communicating, etc.) are imposed by the disabilities?

Because of his present oro-facial-pharyngeal status, Mr. Gillespie is not advised to use his full voice in long-term verbalization. That is, prior to closure of the fistulae, and correction of the palate, he would be ill advised to lecture, or undertake pUblic speaking. He can communicate intelligibly on a one-to-one basis and as such he displays an astute mind with considerable .~

experience with interpersonal communication. This level of communication is possible due to Mr. Gillespie's conscientious and accurate speech articulation. When he attempts to use a stronger (louder) voice, the increased

'<\MPA ST. PETERSBURG SARASOTA FORT MYERS LAKELAND

UNIVERSITY OF SOUTH FlORIOA IS m AFFIRMATIVE ACTION I EOUAL OPPORTUNITY INSTITUTION

6.13

air pressure increases the hypernasal resonance and thereby decreases the effectiveness of his speech. He looses intelligibility and fatigues rapidly.

Because I have no objective data on his hearing status, I can only be suspicious that it is currently within normal range, but also that he has sustained the effects of early, untreated middle ear effusions that usually result in conductive hearing loss during infancy. effort was seen yesterday at the Tampa Bay Craniofacial

Center for assessment of the current status of his congenital orofacial cleft condition. Mr Gillespie is experiencing severe speech expression problems due to inadequate intra-oral and oronasal structures. Although he has had several surgeries in an earnest attempt to resolve this problem, none of the procedures have completed the treatment he requires in order to produce clear verbal communication ..

3. What is the probable future course of the disability (ies)?

If untreated, Mr. Gillespie rjsks irritation and abuse with abrasion to the laryngeal tfssues, continued irritation to the upper airway and mutual irritation and possible infection to the oral and nasal mucosa due to the uncontrolled exchange of cavity contents during every day living activities.

4. Are there any work environments that must be avoided?

If untreated, Mr. Gillespie must work in settings that provide minimal irritants to the nasal, oral and pharyngeal mucosa. He must avoid excessive drying of those tissues and the linings of the larynx. He must not shout, use his speaking voice in excess, or be exposed to excessive or continual loud noise because of both the hearing factor and the need to override the noise with use of a loud voice.

5. will treatment ease, alleviate, or remove the disability (ies)? If so, what treatment is recommended?

Treatments are available to alleviate the current problems and remaining dysmorphologies that underlie the problems cited above. However, the exact mode of treatment requires an objective examination of Mr. Gillespie's intra-oral, oro-nasal, and oro-pharyngeal structures. The approach that has been suggested by the Craniofacial Team at the Tampa Bay Craniofacial Center includes the following steps.

A. - out patient hospitalization for nasendoscopy to determine the present cause of immobility in the soft tissue of the soft palate and to visualize the extent of the nasopharyngeal gap. If the last surgical result has modified over time, it mqy be desirable to surgically

modify the present condition by severing any tethering tissue that is limiting palatal function. Prior or sUbsequent to the hospital experience, a complete aUdiological assessment would be helpful to rule out any middle ear dysmorphologies connected with the congenital problem. .

·B. - Clini9al observation indicates that following this careful, objective examination, Mr. Gillespie will need surgical correction of (a) the anterior oronasal fistula; (b) bone graft to complete the maxillary alveolar arch; and (c) 'secondary palatoplasty to form a pharyngeal flap to reduce the hypernasality. [Please note that the order in which these are listed assure that the separation of cavities, the continuation of the airway and the skeletal support of soft tissue modification will prevent any' future deterioration of these same tissues.] ,. ".,'

, . c.' :.-Following surgeries to correct all ·the current interfering dysmorphologies, Mr. Gillespie will need to

'.' have sixmontlls of speech therapy to 'assure' that he no .'c longer over-activates his larynx and' learns to utilize ;. fully 'th.e're-confiqilred oral and oro";;pharyngeal· ,," :: structures. '"," '

.. ·,;':::;Due to his current physical disability Mr. Gillespie is ':experiencing rejection in job applications •. It is the opinion of the Craniofacial Team that correction of the 'identified sequelae of the congenital dysmorphology, this young may will be able to find employment in any current or emerging job site that requires his type of skills. He is competent in matters of business, and has a keen interest in dealing with people~ He may seek employment in human service areas, personnel management, or counseling whether in business or in some specialized area., of human communication. As a student at the University of South Florida and a promising contributor to our community, this young man needs support to pursue

. appropriate treatment for the remaining dysmorphologies of his mouth, throat and face. ' .

Please let me know if I can be of further assistance . to you in your efforts to provide the needed assistance to

Mr Gillespie.

fLe~:l~y~,~'t.G-<A.,c...'l/t.."', ~/i6 euerle, CCC-SLP Professor co-Director, Tampa Bay Craniofacial Center

m OREGON

I-IEALTI-I SCIENCES UNIVERSIlY CIIII..I) I)EVELOPMENT & REHAUIfJTA'Il0N CENTER

1'.0. Box 57/i~ Portland, Oregon 97207-0574

Services for G1., ildre1l u,itb Special J/eallb Needs l}1lfl..ersity AjJUfated Plugrllll1

June I, 1994


RE: Neil Gillespie

This 38 year old I1lan has a repaired unilateral cleft lip and palate. His primary surgery was done in Pennsylvania and he had SOITIe secondary work including a pharyngeal flap for speech, in Florida.

Since speech treatlnent for serious hypernasality has been unsuccessful up to this point, the patient came to Ine for consultation about a speech plan.

Examination shows objectionable hypernasality with moderate nasal emission of air which markedly weakens all 16 air pressure phonemes. Use of the fiber-optic nasendoscope on May 26th verified that the pharyngeal flap, done three years ago (for speech), has pulled loose.

The treatment plan is to utilize a telnporary speech prosthesis (for circa two years) to markedly obturate all sounds froln entering the nasal cavity. After normal oral resonance is obtained and Inaintained for about four to five ITIonths, an obturator reduction program would begin whereby the throat and palate 111usculature would be "challenged" by slowly making the obturator sl11aller, in stages. At the end of approximately two years, it is expected that oralnasal resonance anti oral air pressure would be close to normal limits and that pharyngeal and· palate 111usculalurc \vould have inlproved considerably. This is expected to nlake the patient's velopharyngeal systenl nluch Inore anlenabie to a surgical procedure to substitute for the speech prosthesis \vithout c0l11promising the patient's nasal airway.

Respectfully sublnitted,

Robert W. Blakeley, Ph.D. Professor of Speech Pathology, Director, Craniofacial Disorders Progralll

blak/b:gille~pi.

6.14

Craniofacial Center PO Box 100424 Health Science Center Gainesville, FL 32610-0424

Telephone: (352) 846-0801 Fax: (352) 846-1539 e-mail: Wiliiams@dentaLufLedu

Clinic Report: Videofluoroscopic assessment of the velopharyngeal port during function for speech

Re: Neil Gillespie Dental No.: 18-80-41 Medical No.: 10-44-032

This forty year old white male was seen on November 25, 1996 for a videofluoroscopic assessment of his velopharyngeal port during function for speech. Mr. Gillespie is currently wearing a speech bulb obturator, and his speech resonance frequently alternates between hyponasality and hypernasality. The purpose oftoday's filming was to determine the size, configuration and placement of the bulb in the nasal pharynx to determine if alteration of these factors can improve his overall resonance quality. The nasal pharyngeal structures were coated with a thin barium sulfate solution to aid in defining soft tissue contrast. Records were obtained in the lateral and frontal (A-P) planes with and without the speech bulb obturator.

Detailed analysis of the film revealed the following conditions:

1. Without the obturator the soft palate is mobile, demonstrating a movement pattern appropriate to the several speech samples Jared produced. Although there is good velar mobility, contact with the posterior pharyngeal wall is not achieved. That is!, a consistent gap of 10 - 12 mm exists between the elevated velum and the posterior pharyngeal wall during speech.

2. The depth of the nasopharynx, as measured along the palatal plane from the posterior nasal spine to the posterior pharyngeal wall is 25 mm. This compares to the norm of 24 mm ± 2 mm/SD revealing Mr. Gillespie's nasopharyngeal depth to be well within normal limits for his age.

3. The configuration of the posterior pharyngeal wall is nearly vertical above and below the palatal plane, a pattern well within normal limits.

4. An A-P view revealed symmetrical mesial movement of the lateral pharyngeal walls approximately 25 - 50% of the distance from rest to midline.

6.15

2

Neil Gillespie Fluoroscopic assessment of VP Function for Speech November 25, 1996

In summary, Mr. Gillespie presents with a speech pattern characterized by near normal resonance but which frequently alternates between hyponasality and hypernasality. He is currently wearing a speech bulb obturator and today's assessment revealed placement and configuration to be near optimal.' Without the obturator, Mr. Gillespie's speech is significantly hypernasal and although the velum elevates appropriately there remains a consistent gap of 10 - 12 mm during speech. In order to further define whether any improvement can be made to the speech bulb obturator or if a secondary surgical technique might be a viable consideration, a nasendoscopic assessment should be conducted.

If I can be of any further assistance in the interpretation of this film please call me at (352)

8:;~~ 1 W. N. Williams, Ph.D. Speech-language Pathologist

cc: Mr. Neil Gillespie 1121 Beach Drive, N.E. Apt. C-2 81. Petersburg, FL 33701-1434

Mr. Glenn Turner P.O. Box 100435 JHMHC

Dr. Brent Seagle P.O.Box 100286 JHMHC

Medical, Dental, Center Records

o ]. Douglas Bremner, M.D.Yale University Departments ofDiagnostic Radiology and Psychiatry School ofMedicine Diagnostic Imaging Yale-New Haven Hospital 20 York Street New Haven, Connecticut 06504

Yale Psychiatric Institute POB 208038, Yale Station New Haven, CT 06520 (203)737-5787 FAX7857855 email, [email protected]

~~~ 8/14/97

Thank you for your interest in our research program on victims of childhood abuse al1d the brain. If you or anyone else is interested, you can stay for free in our research unit and obtain financial compensation which more than offsets travel expenses, as well as a comprehensive diagnostic and biological assessment, including brain imaging. You can call 203 737 5791 for information.

Also look at our web site at http://info.med.yale.edu/psych/org/ypi/traumaltauhome.htm

Thanks again.

~~ ~~mner, M.D. Assistant Professor of Diagnostic Radiology & Psychiatry Yale University School of Medicine; Research Physician, YaieNA PET Center, VA Connecticut Healthcare System; Director, Trauma Assessment Unit, Yale Psychiatric Institute

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6.16

o ABC Evening News, Health Report, August 18, 1997. Peter Jennings introduces,

Growing up damaged - by John McKenzie, ABC News - (JM)

JM - It is a time ofadventure, a time ofdiscovery. It's long been known that what children see, and hear, and feel, can have a powerful impact on their development. But only now are scientists beginning to understand just how powerful

Dr. Dorothy Lewis, New York University: We realize that the consequences actually can affect the brain's anatomy, the structure ofthe brain itself: and then it can affect the way in which the child adapts for the rest ofhis life.

JM - At Yale University scientists are conducting pioneering research on the effects ofchild abuse;

Dr. Douglas Bremner, Yale University: Being physically injured, having broken bones, bruises, trips to the hospital, having objects thrown at them, sexually assaulted by relatives.

JM - Researchers discovered that kind ofabuse produces physical changes in the brain, including one area called the left Hippocampus. Researchers found the abuse results in the Hippocampus actually shrinking, and by as much as 20 percent. For victims the affects can be profound.

Dr. Douglas Bremner, Yale University: They have behavioral problems, they have increased aggression, they can't form lasting relationships, they have trouble keeping jobs, they intrusive memories and night mares that make it almost impossible for them to lead a normal life.

JM - Scientists believe that repeated abuse causes stress in the child, and the production ofstress hormones. Too much ofthese hormones can damage, even kill nerve cells in the brain. And scientists are discovering the abuse need not be physical. Researchers affiliated with Harvard University tested people who had been subjected as children to severe psychological abuse, subjected to repeated screaming, and yelling, and harsh critical language. The results were startling. Guxtaposed brain scan images appear) This is a scan ofa health brain, and this from someone who was verbally abused as a child. Although subtle, you can actually see a difference. Right here in the pathway linking the left and right hemispheres ofthe brain. In the abused, the area is smaller, narrower; that can lead to hyperactivity and impulsive behavior. And the effects appear lasting. Researchers find these brain abnormalities in adults well into their forties and fifties.

Dr. Dorothy Lewis, New York University: And its something that we don't know ifwe can reverse.

JM - Revealing evidence that a child's brain may be much more vulnerable than ever imagined. John McKenzie, ABC News, New Haven, Connecticut. (end).

August 22, 1997

Dr. Douglas Bremner PET Center 950 Campbell Avenue, lISA West Haven, CT 06516

Dear Dr. Bremner,

Thank you for your recent appearance on the ABC News Health Report with John McKenzie entitled "Growing up damaged." I am interested in additional information about the subject, including diagnostic recommendations.

My interest is personal. Born with a craniofacial disorder affecting both speech and appearance, I was subjected to severe psychological abuse, both familial and societal. At age 41 I am currently disabled with "mental health issues," but I do not believe an accurate diagnosis has been made in my case.

Having earned a BA in psychology, my understanding ofbrain development suggested the possibilities reported by the ABC News Health Report. However I have not been able to locate a practitioner knowledgeable about this condition, or willing to perform a bran scan. Your suggestions are appreciated.

Thank you again for your consideration.

Sincerely,

©@[?))1 Neil J. Gillespie 1121 Beach Drive NE, apt. C-2 St. Petersburg, FL 33701

(813) 823-2390

o

September 17, 1997

J. Douglas Bremner, MD Assistant Professor ofDiagnostic Radiology & Psychiatry Yale University School ofMedicine; Research Physician, YaleNA PET Center, VA Connecticut Healthcare System; Director, Trauma Assessment Unit, Yale Psychiatric Institute POB 208038, Yale Station New Haven, CT 06520

Dear Dr. Bremner,

Thank you for your letter and accompanying information about Post Traumatic Stress Disorder (PTSD). Pursuant to your offer ofa comprehensive diagnostic and biological assessment, including brain imaging, I would like to schedule an appointment.

Last Friday I spoke briefly with Susan Insell at the number you provided (203-7375791). Ms. Insell was unable to offer any definitive information. Kindly advise when this appointment could be scheduled.

Thank you again for your consideration and patience.

Sincerely,

©(Q)[?JW Neil J. Gillespie 1121 Beach Drive NE, apt. C-2 St. Petersburg, FL 33701

(813) 823-2390 9- I Z~ fj 7 e z:· l.f",

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NYU Medical Center

550 First Avenue, ~~~I~Y~o~1514 Cable Address: NYUMEDIC

Department of Psychiatry (212) 263

6208

September 4. 1997

Mr. Neil J. Gillespie 1121 Beach Drive NE, Apt. C-2 St. Petersburg, FL 33701

Dear Mr. Gillespie:

Thank you for your letter of August 22,1997. Unfortunately I do not know of someone in your area who specializes in the complications of craniofacial disorders. I am sorry I cannot be of more help.

Sincerely.

Dorothy 0 now Lewis. M.D. Professor

DOL/vh

«

6.17

o ABC Evening News, Health Report, August 18, 1997. Peter Jennings introduces,

Growing up damaged - by John McKenzie, ABC News - (JM)

JM - It is a time ofadventure, a time ofdiscovery. It's long been known that what children see, and hear, and feel, can have a powerful impact on their development. But only now are scientists beginning to understand just how powerful

Dr. Dorothy Lewis, New York University: We realize that the consequences actually can affect the brain's anatomy, the structure ofthe brain itself: and then it can affect the way in which the child adapts for the rest ofhis life.

JM - At Yale University scientists are conducting pioneering research on the effects ofchild abuse;

Dr. Douglas Bremner, Yale University: Being physically injured, having broken bones, bruises, trips to the hospital, having objects thrown at them, sexually assaulted by relatives.

JM - Researchers discovered that kind ofabuse produces physical changes in the brain, including one area called the left Hippocampus. Researchers found the abuse results in the Hippocampus actually shrinking, and by as much as 20 percent. For victims the affects can be profound.

Dr. Douglas Bremner, Yale University: They have behavioral problems, they have increased aggression, they can't form lasting relationships, they have trouble keeping jobs, they intrusive memories and night mares that make it almost impossible for them to lead a normal life.

JM - Scientists believe that repeated abuse causes stress in the child, and the production ofstress hormones. Too much ofthese hormones can damage, even kill nerve cells in the brain. And scientists are discovering the abuse need not be physical. Researchers affiliated with Harvard University tested people who had been subjected as children to severe psychological abuse, subjected to repeated screaming, and yelling, and harsh critical language. The results were startling. Guxtaposed brain scan images appear) This is a scan ofa health brain, and this from someone who was verbally abused as a child. Although subtle, you can actually see a difference. Right here in the pathway linking the left and right hemispheres ofthe brain. In the abused, the area is smaller, narrower; that can lead to hyperactivity and impulsive behavior. And the effects appear lasting. Researchers find these brain abnormalities in adults well into their forties and fifties.

Dr. Dorothy Lewis, New York University: And its something that we don't know ifwe can reverse.

JM - Revealing evidence that a child's brain may be much more vulnerable than ever imagined. John McKenzie, ABC News, New Haven, Connecticut. (end).

August 22, 1997

Dr. Dorothy Lewis Dissociative Disorders Clinic New York University Medical Center 540 1st Avenue New York, NY 10016 (212) 263-6208

Dear Dr. Lewis,

Thank you for your recent appearance on the ABC News Health Report with John McKenzie entitled "Growing up damaged." I am interested in additional information about the subject, including diagnostic recommendations.

My interest is personal. Born with a craniofacial disorder affecting both speech and appearance, I was subjected to severe psychological abuse, both familial and societal. At age 41 I am currently disabled with "mental health issues," but I do not believe an accurate diagnosis has been made in my case.

Having earned a BA in psychology, my understanding ofbrain development suggested the possibilities reported by the ABC News Health Report. However I have not been able to locate a practitioner knowledgeable about this condition, or willing to perform a bran scan. Your suggestions are appreciated.

Thank you again for your consideration.

Sincerely,

©(Q)~W Neil J. Gillespie 1121 Beach Drive NE, apt. C-2 St. Petersburg, FL 33701

(813) 823-2390

Velopharyngeal inadequacyClassification and external resources

ICD-9 528.9 (http://www.icd9data.com/getICD9Code.ashx?icd9=528.9)

eMedicine ent/596 (http://www.emedicine.com/ent/topic596.htm)

MeSH D014681 (http://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?field=uid&term=D014681)

From Wikipedia, the free encyclopedia (Redirected from Velopharyngeal incompetence)

Velopharyngeal inadequacy (VPI) is a malfunction of avelopharyngeal mechanism.

The velopharyngeal mechanism is responsible for directingthe transmission of sound energy and air pressure in both theoral cavity and the nasal cavity. When this mechanism isimpaired in some way, the valve does not fully close, and acondition known as 'velopharyngeal inadequacy' can develop.VPI can either be congenital or acquired later in life.

1 Terminology2 Relationship to cleft palate3 Classification4 Causes5 Treatment6 References7 External links

Different terms can be used to describe this phenomenon in addition to “velopharyngeal inadequacy”. Theseterms and definitions are as follows:

Velopharyngeal insufficiency: The inability of the velopharyngeal sphincter to sufficiently separate thenasal cavity from the oral cavity during speech.

Velopharyngeal incompetency: When the soft palate and the lateral/posterior pharyngeal walls fail toseparate the oral cavity from the nasal cavity during speech.

Although the definitions are similar, the etiologies correlated with each term differ slightly; however, in the fieldof medical professionals these terms are typically used interchangeably. Velopharyngeal inadequacy is thegeneric term most often used to describe the functionality of the velopharyngeal valve.

A cleft palate is one of the most common causes of VPI. Cleft palate is an anatomical abnormality that occurs inutero and is present at birth. This malformation can affect the lip, the lip and palate, or the palate only. A cleftpalate can affect the mobility of the velopharyngeal valve, thereby resulting in VPI.

Velopharyngeal inadequacy - Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Velopharyngeal_incompetence

1 of 3 7/29/2012 8:08 AM

7

The most frequent types of cleft palates are overt, submucous, and occult submucous.

While cleft is the most common cause of VPI, other significant etiologies exist. These other causes are outlinedin the chart below:

VPI flow chart compiled from the following sources: Johns, Rohrich & Awada, 2003 andPeterson-Falzone, Karnell, Hardin-Jones,& Trost-Cardamone, 2005

A common method to treat Velopharyngeal insufficiency is pharyngeal flap surgery, where tissue from the backof the mouth is used to close part of the gap. Other ways of treating velopharyngeal insufficiency is by placing aposterior nasopharyngeal wall implant (commonly cartilage or collagen) or type of soft palate lengtheningprocedure (i.e. VY palatoplasty).

Conley SF, Gosain AK, Marks SM, Larson DL (1997). "Identification and assessment of velopharyngealinadequacy". Am J Otolaryngol 18 (1): 38–46. DOI:10.1016/S0196-0709(97)90047-8 (http://dx.doi.org/10.1016%2FS0196-0709%2897%2990047-8) . PMID 9006676 (//www.ncbi.nlm.nih.gov/pubmed/9006676) .

Johns DF, Rohrich RJ, Awada M (2003). "Velopharyngeal incompetence: a guide for clinical evaluation".Plast. Reconstr. Surg. 112 (7): 1890–7; quiz 1898,1982. DOI:10.1097/01.PRS.0000091245.32905.D5


2 of 3 7/29/2012 8:08 AM

(http://dx.doi.org/10.1097%2F01.PRS.0000091245.32905.D5) . PMID 14663236(//www.ncbi.nlm.nih.gov/pubmed/14663236) .

McWilliams, Betty Jane; Peterson-Falzone, Sally J.; Hardin-Jones, Mary A.; Karnell, Michael P. (2001).Cleft palate speech. St. Louis: Mosby. ISBN 0-8151-3153-4.

Hardin-Jones, Mary A.; Peterson-Falzone, Sally J.; Judith Trost-Cardamone; Karnell, Michael P. (2005).The Clinician's Guide to Treating Cleft Palate Speech. St. Louis: Mosby-Year Book.ISBN 0-323-02526-9.

Willging JP (1999). "Velopharyngeal insufficiency". Int. J. Pediatr. Otorhinolaryngol. 49 Suppl 1:S307–9. DOI:10.1016/S0165-5876(99)00182-2 (http://dx.doi.org/10.1016%2FS0165-5876%2899%2900182-2) . PMID 10577827 (//www.ncbi.nlm.nih.gov/pubmed/10577827) .

Several Examples of Velopharyngeal Inadequacy (http://www.FauquierENT.net/voicenasal.htm)

Retrieved from "http://en.wikipedia.org/w/index.php?title=Velopharyngeal_inadequacy&oldid=496889991"

Categories: Congenital disorders

This page was last modified on 10 June 2012 at 11:56.Text is available under the Creative Commons Attribution-ShareAlike License; additional terms mayapply. See Terms of use for details.Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization.


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The Evergreen State CollegeOlympia, Washington

Psychosocial Implications of Congenital Craniofacial Disorders

Lifespan Developmental PsychologyJerry Shulenbarger, Ph.D, faculty

Winter quarter, 1995

"I just wanna be normal Doctor, give me that old fashioned normality"

--Actress Uma Thurman as Sissy Hankshaw pleadingto Dr. Dreyfus in the film "Even Cowgirls get the Blues"

Submitted by Neil J. Gillespie

8

Dedication

To Dr. Robert W. Blakeley

Professor of Speech Pathology Director, Craniofacial Disorders Program

Oregon Health Sciences University Child Development & Rehabilitation Center

Thank you

Your effort and treatment on my behalf have given me the voice to make this oral presentation

Table of Contents

Page 1 Introduction

Page 2 Birth

Page 6 Freud

Page 7 Hi story

Page 9 Teasing

Page 12 Speech

Page 15 Bibliography

Final Page Reasearch Outline

Introduction

My interest in the subject of the psychosocial

implications of congenital craniofacial anomalies is

personal. I am afflicted with a unilateral cleft lip and

palate. I welcome the opportunity to write and speak on the

subject to promote further public understanding. The

process also provides me with greater self-awareness.

This report will focus on persons with congenital

anomalies as opposed to acquired disfigurement. Acquired

craniofacial disfigurement results from accidents, fires and

illness. The psychosocial implications for each group vary

and I will note them throughout the report.

My presentation will include photographs of persons

with various examples of craniofacial disorders. Unlike

other disabilities, facial disfigurement is to a large

extent visual, and a picture really is worth a thousand

words.

I will begin this paper with the story of a young

mother and the birth of her son. I'll also discuss Freudian

implications, historical background, the subject of teasing

and speech concerns.

In America, about 4 million babies are born each year.

Between the 7th and 8th week of gestation, the nasomedial

process completes the fusing of the philtrum of the lip.

This fails to occur in about 1 of every 700 live births,

resulting in about 5,700 new cleft cases per year.

Page-l

Birth, the beginning of mother-child relationship

I would like to begin this project by considering the

thoughts of a young mother, Rita Brzozowski, and her

reaction to the birth of her son, Adam. Rita's story

appeared in the May/June 1992 issue of AboutFace, a

craniofacial support group newsletter. Rita begins,

"For most people, having their first child is

an exciting event. There are the usual

concerns about what could go wrong, but a

normal, healthy baby is expected. When our

first child, Adam, was born this was not the

case. It started with a discernible hush in

the delivery room. "Just a hare lip",

replied my obstetrician. Not able to see the

baby's face, I tried to recall anything I

knew about this condition ... When I saw him,

my heart sank. This was not the perfect baby

I had envisioned - the one with the rosy

checks, delicate lips and upturned nose.

This baby's face was disfigured ... As I held

my newborn son, all I could see was this

defect ... I felt I was in a dream and held

someone else's child."

Later Rita would say, "My ego had suffered a major

blow. I did not feel pride in showing my baby to others.

Even a trip to the pediatrician was a challenge to my pride

Page-2

and vanity. In the waiting room I would keep Adam's face

hidden over my shoulder."

My information indicates that Rita's experience is not

unusual. Brantley and Clifford (1979b) found that mothers

of children with cleft lip and/or palate reported

significantly greater negative recollections of the

postnatal period than mothers of normal children. Other

reactions have been more negative, including abandonment of

the child. This is particularly true in Russia (Blakeley),

Korea and to a lesser extent, China (Li). All of this

information points to an important fact: The interaction

between mother and child is a critical factor in determining

the psychological adjustment of these children.

A recent study entitled The Role of Maternal Factors in

the Adaptation of Children with Craniofacial Disfigurement

was completed at Harvard Medical School and Children's

Hospital, Boston, MA (Campis, DeMaso, Twente, 1993) and

reported in The Cleft Palate-Craniofacial Journal (January

1995). This study hypothesized that maternal adjustment,

perceptions, and social support would better predict child

adaptation to craniofacial disfigurement than medical

severity. Of the 77 children (ages 6-12) in the study, 33

had cleft lip and/or palate, the other 44 had a more severe

deformity. The study found that maternal adjustment and

maternal perceptions of the mother-child relationship were

more potent predictors of children's emotional adjustment

than either medical severity or maternal social support.

This study also reported that the degree of facial

Page-3

disfigurement had no relationship to child or maternal

perceptions, but that having a comorbid severe medical

condition was related to greater behavior problems in

children. This study cited nine prior studies which

indicated that children with craniofacial disfigurement have

difficulties in psychological adjustment and two studies to

the contrary. The study also cited other conflicting

information in almost every category. The major limitation

of this study was that the evaluation of child adjustment

relied on parent report. Also, with a predominance of upper

SES families in this study, caution is the word regarding

generalization of findings.

Another study I found was done at the University of

Washington School of Medicine in Seattle, entitled

"Psychological Functioning of Children with Craniofacial

Anomalies and Their Mothers: Follow-up from Late Infancy to

School Entry" (Speltz, Morton, Goodell, Clarren, 1992). In

this study, 23 mothers and their 5- to 7-year old children

with craniofacial anomalies (CFA) who were assessed in an

earlier study (Speltz, et al., 1990) were followed. Despite

the small sample size and high rate of control-group

attrition, this study is important because longitudinal

research on the psychological development of CFA children

and adolescents is almost nonexistent. The results of this

study indicated that a (1) a sizable minority (18%) of the

children with CFA had clinically significant behavior

problem scores; (2) individual differences of CFA children

were predicted by observational measures of earlier mother

Page-4

infant interaction; (3) mothers of CFA children with visible

defects reported less favorable social support than mothers

of CFA children without visible defects.

One interesting aspect of this survey was that the

potential predictor variables used were based on

observational measures of mother-infant play and teaching

interactions. These measures are infrequently used in CFA

psychological research despite their widespread application

in other areas of developmental psychology. Also, mothers

of CFA children reported higher levels of emotional distress

and greater marital conflict than controls, as reported on

standardized questionnaires. In the Child Behavior

Checklist (CBCL) portion of this study, girls with CFA had

mean scores above the 85th percentile for their normative

group, but boys with CFA had mean scores very near their

normative average. In addition 18% of the CFA children had

CBCL scores above the 95th percentile, indicating the need

for clinic-referral for psychiatric problems (compare with

non-CFA children at considerably less than 5%). The

researchers suggested that the mother's child-directed

orientation during play with her infant or toddler may

predict maternal behavior problem reports up to 4 years

later; higher levels of child-directed play skill were

associated with lower subsequent CBCL scores.

As we have seen from the foregoing information, there

are early psychological implications for persons with

congenital craniofacial anomalies. Juxtaposed with acquired

disfigurement in later life, these implications are unique.

Page-5

Freudian Considerations

From a Freudian psychosexual developmental perspective,

cleft lip and palate offers some interesting considerations.

These considerations involve the first psychosexual stage,

the Oral Stage.

"According to the theory, from birth to age one, the

mouth, tongue, and gums are the focus of pleasurable

sensations in the baby's body, and feeding is the most

stimulating activity." (Berger, 1994)

Feeding an infant with cleft lip and palate presents a

challenging set of physical circumstances. "Children with a

cleft palate cannot create sufficient negative pressure to

suck milk, which is expressed from the nipple between the

upper and lower gum pads, because of the absence of a

palatal seal" (Berkowitz, 1994). One mother described each

feeding of her cleft palate infant as a "nightmare"

(AboutFace January/February 1993).

In addition to feeding problems, surgery of the lip,

palate and gums of an infant presents an opportunity for

pain and trauma. Presurgical orthopedic alignment

procedures as well as postsurgical concerns are another

source of possible interference with oral stage development.

In addition postsurgical feedings are sometimes especially

difficult.

I feel that the above issues place an afflicted infant

"at risk" for possible oral stage fixation. This is not a

concern with craniofacial disfigurement acquired later in

life.

Page-6

Historical Perspective

Dr. Benjamin M. Spock, in his latest book A Better

World For Our Children, provides a poignant example of the

negative attitudes confronting persons with congenital

deformities. On page 21 of his book, Dr. Spock relates a

story told by his mother and the impact the remarks made on

him. "She taught us that sinful thoughts were as harmful as

deeds, and to touch ourselves "down there" was not just

sinful but might cause birth defects in our children. After

four years of medical school and four residencies, I thought

I had long outgrown such teachings, but I recall when our

first child was born I returned from the hospital's nursery

to my wife's room to exclaim happily, "Mike has ten fingers

and ten toes!"

Attorney Allen Fagin spoke at the 1992 NFFR Conference

on facial disfigurement and noted that until recently a

number of major American cities had "ugly laws" that imposed

fines on "unsightly" people who were seen in public places.

An example was the Chicago municipal code which, until 1974,

fined persons who appeared in public who were "diseased,

maimed, mutilated or in any way deformed, so as to be an

unsightly or disgusting object".

In addition, I found examples dating from Medieval

England. One example dating from the late eleventh or

twelfth century is the first evidence for both cleft lip and

palate in British archaeology. "Despite the inability to

breast-feed, and the possible social stigma, the individual

had survived into adulthood" (CPJ).

Page-7

Another example is found in documentary evidence from

sixteenth century Kent. The document, with an illustration

of the child, is dated 1568. This document is interesting

for two reasons. While descriptive of the facial cleft, the

document clearly repudiates the child's mother for being

unmarried. The headline of the document proclaims "The

forme and shape of a monstrous child", and describes the

cleft lip as "the mouth slitted on the right side, like a

Libardes [lizard's] mouth, terrible to beholde". The

document also proclaims "A warnying to England", describes

the mother, one Marget Mere as, " ... being unmaryed, played

the naughty packe, and was gotten with childe ... " The

document suggest that this deformed child should be a

warning to those indulging in a sinful life, and thus move

them to repentance.

Page-8

"Teasing"

I'd like to begin this section with a brief quote from

the book "Beauty is the Beast, Appearance-Impared Children

in America", by Ann Hill Beuf. "On Monday, March 1, 1988,

an American sixth-grade student walked into his elementary

school classroom and shot himself. He did this because his

classmates had teased him about being overweight". Clearly

the time has come to address the problem of "teasing".

The first step in confronting the issue of "teasing" is

to give this activity a more appropriate name: Verbal

Assault, based on disability or appearance.

In a sense, it is easy to understand why children

verbally assault those who look different. As Dr. McCurdy

states in his book "The Complete Guide to Cosmetic Surgery",

"Young children are extremely perceptive of differences in

appearance, and, as they are relatively uninhibited in their

social interactions, such differences are freely pointed

out" .

Sociologist Macgregor notes that derisive laughter is

also a potent and destructive force. She writes "These

reactions to derisive laughter appear to be universal. The

Hopi Indians, well aware of its effect, could and did

deliberately drive an offender in the community to insanity

by the simple punishment of laughing at him".

Two other groups of unlikely offenders are health care

providers and teachers. "When a child is born with impaired

appearance, many hospital staff members employ the term

F.L.K. ("funny looking kid") to describe the infant to one

another (Beuf). "Use of the "F.L.K." term constitutes an

Page-9

act of objectification. So does any use of language that

refers to the child by his or her disorder such as "the

cleft palate in room 320" (Beuf). "That is, by focusing on

the master-status of "person-with-impai red-appearance " and

thus ignoring the traits possessed by the child as an

individual, the stigmatizer manages to reduce the victim to

the position of a thing rather than a person" (Beuf).

Trivialization was used by some doctors to remind the

children of people who were worse off than they were, with

comments such as, "You're lucky you don't have cancer."

Surely doctors do not set out to wound the feelings of their

young patients, but they have been taught in medical school

to judge the seriousness of a medical problem in terms of

its life-threatening nature.

In a New York Times story on physical disfigurement,

author Jill Krementz said that while many of the disfigured

children she interviewed received support from their peers,

a few were teased mercilessly or even attacked by

schoolmates because of how they look. "The only children

who had a really painful time from their peers were the ones

who had facial disfigurements," Ms. Krementz said, adding

that children who are missing limbs or have other

disabilities are more likely to receive comments on how well

they are doing.

Krementz's observations have been noted by Macgregor

who states;

" ... there are two other handicapping aspects

associated with dento-facial deformity. In the

Page-IO

first place, the area in and around the mouth is

both emotionally charged and strongly connected

with one's self-image. As an instrument of speech

and eating, as well as a mirror of emotions, it

also has unique social and psychological

implications and symbolic meaning. Any

abnormality in this area, therefore, is not only

highly visible and obtrusive but - as research has

shown - tends to evoke a type of aversion which is

both esthetic and sexual.

Teachers are another source of problems for afflicted

children (The Providence Sunday Journal). Examples cited by

Beuf include a teacher ridiculing a student who lost a

contact lense and another who's home-room teacher didn't see

the harm of a student being called "Dumbo ears" because of

protruding ears.

Legislation such as the American's with Disabilities

Act, the Rehabilitation Act of 1973, and the recently passed

Washington State bill # 5474 on Disability Discrimination

should be utilized to prevent the abuses cited in this

section. Parents must be willing to fight for their child,

Beuf emphasized, "and why they don't is sometimes a

mystery" .

Page-II

Speech

Speech is a mirror of the soul; as a man speaks, so is he.

Publilius Syrus, circa 42 B.C.

Speech is a concern that separates cleft palate from

some other craniofacial disorders. The psychological

implications of speech present challenges to the afflicted

individual from infancy through adulthood.

Cleft palate children are at risk for language

development problems. A screening device to address this

issue was the subject of a recent study. The "Parent

Questionnaire for Screening Early Language Development in

Children with Cleft Palate" is the title of the paper.

Thirty subjects, 16 to 30 months of age received the

MacArthur Communicative Development Inventory: Toddler

(CDI:Toddler). A control group was also tested. Both

groups received a speech language screening. Results

indicated that the CDI:Toddler was a valid screener of

language development.

The cleft group demonstrated evidence of delays in

expressive language development. The cleft group had a mean

vocabulary of 177 words, compared with 288 words for the

control group. The cleft group used shorter, less complex

sentences. Intelligibility was poorer in the cleft group.

Within the cleft group, hypernasality ratings of moderate

and severe were associated with expressive language delays.

Page-12

Adult cleft palate populations are also at risk for

impaired speech concerns, when related to employment, as

demonstrated by two studies. "From a psychological

standpoint Neiman and Duncan emphasized the importance of

speech. This study revealed that speech was the single

factor that adversely affected the selection of prestigious

jobs even in the presence of a facial disfigurement. It

would appear that speech should be given top priority."

(Lehman, Jr., MD, 1993)

I spoke with Dr. Lehman about this study, where photos

of persons with both unilateral and bilateral cleft lip and

palate were shown to a personnel manager. Also presented

were tape recorded voices, both normal and hypernasal

speech. The hypernasal speech was much less likely to be

viewed as having the communication skills needed in the

marketplace.

Another study was conducted by Dr. Jane Scheuerle at

the Tampa Bay Craniofacial Center. In this test adult cleft

palate subjects voices were tape recorded, both preoperative

and postoperative. The recorded voices were presented to a

panel of three business persons for evaluation as employees.

The results favored the postoperative voices unanimously.

Adult speech issues were also noted at the First

International Symposium for Long Term Treatment in Cleft Lip

and Palate at the University of Bern, Switzerland. "When an

adult does not speak correctly, those around him notice it

immediately, and speculate whether or not the affected

person is of normal intelligence. For this reason, we feel

Page-13

that correct speech has many important consequences." (J.

Weissen, 1979) "From the beginning our team considered

speech evaluation and speech therapy as most important,

because receptive speech, i.e. that which one hears, is

dependent on the entire environment (i.e. 360 degrees) as

opposed to the operative cosmetic result which is only

visual, i.e. maximal field of 180 degrees." (Weissen

& M. Bettex, 1979)

Goffman's view of craniofacial handicapping conditions

expressed the subject especially well. "The closer the

defect is to the communication equipment upon which the

listener must focus his attention, the smaller the defect

needs to be to throw the listener off balance. These

defects tend to shut off the afflicted individual from the

stream of daily contacts, transforming him into a faulty

interactant, either in his eyes or in the eyes of others".

Sigmund Freud was an individual who suffered acquired

speech impairment. In April, 1923, Freud underwent surgery

for palatal cancer. More operations followed in the fall

and Freud was compelled to wear a prosthesis. He had

trouble speaking and was rarely free of discomfort (Gay).

Page-14

Bibliography

1. Robert W. Blakeley, Ph.D., Professor of Speech

Pathology, Director, Craniofacial Disorders Program,

Oregon Health Sciences University, CDRC, Portland, OR

Personal communication and photographs.

2. The Cleft Palate-Craniofacial Journal (CPJ),

January 1995, Volume 32, number 1, American Cleft

Palate-Craniofacial Association (ACPA). "The Role of

Maternal Factors in the Adaptation of Children with

Craniofacial Disfigurement" by Leslie Campis, Ph.D.,

David Ray DeMaso, M.D., and Allison White Twente, Ph.D.

3. CPJ, January 1995, Volume 32, number 1, ACPA, "Parent

Questionnaire for Screening Early Language Development

in Children with Cleft Palate" 1993, Nancy Scherer, Ph.D

and Linda L. D'Antonio, Ph.D.

4. CPJ, November 1994, Volume 31, Number 6, ACPA, "Medieval

Example of Cleft Lip and Palate from St. Gregory's

Priory, Canterbury", by Trevor Anderson, M.A.

5. CPJ, September 1993, Volume 30, Number 5, ACPA,

"Psychological Functioning of Children with

Craniofacial Anomalies and Their Mothers:

Follow-Up from Late Infancy to School Entry" by

Matthew L. Speltz, Ph.D., Kathi Morton, Ph.D.,

Elizabeth W. Goodell, Ph.D., Sterling K. Clarren, M.D.

Page-IS

6. Dr. Benjamin M. Spock, "A Better World For Our Children"

National Book Network, 1994

7. National Foundation For Facial Reconstruction (NFFR),

Conference Proceedings of 11/18/92, "Special Faces:

Understanding Facial Disfigurement."

8. AboutFace newsletter, May/June 1992, Vol. 6, No.3,

Rita Brzozowski, "A Mother's First Lesson", cover story.

9. Weissen, J., Speech Therapist, Department of Pediatric

Surgery, Inselspital, CH-3010 Berne. Proceedings of the

First International Symposium, Long Term Treatment in

Cleft Lip and Palate, August, 1979, University of Bern,

Switzerland.

10 Jim Lehman, Jr., MD, AboutFace Newsletter, March/April,

1993, "Ask a Professional" column and personal

communication.

11 Ningyi Li, MD, DDS, Professor and Chairman, Department

of Stomatology, Qingdao University Medical College and

Hospital, Qingdao, Shandong, The Peoples Republic of

China. Personal communication.

12 The Complete Guide to Cosmetic Facial Surgery,

John A. McCurdy, Jr., MD FACS, 1981, Frederick Fell

Publishers, Inc.

Page-16

13. Ann Hill Beuf, "Beauty is the Beast; Appearance

Impaired Children in America", 1990, University of

Pennsylvania Press.

14. Kathleen Stassen Berger, liThe Developing Person Through

the Life Span", third edition, 1994, Worth Publishers

15. Samual Berkowitz, DDS, MS, FICD, liThe Cleft Palate

Story", 1994, Quintessence Publishing Co., Inc.

16. The New York Times, Thursday, October I, 1992, "Parent

& Child" by Lawrence Kutner.

17. Frances Cooke Macgregor, M.A., Social and Psychological

Implications of Dento-Facial Disfigurement, 1969

18. The Providence Sunday Journal, October 7, 1990, by

Rosemary Jones of the Allentown Morning Call.

19. Thurston County Works in Progess, November 1994,

Legislative Report Card, Disability bill

20. Cleft Palate and Cleft Lip: A Team Approach to Clinical

Management and Rehabilitation of the Patient. 1979,

W.B. Saunders Company

21. Sigmund Freud, Introductory Lectures on Psycho-Analysis

Page-17

1966, W.W. Norton & Company, Inc., Peter Gay, intra.

22. Dr. Jane Scheuer1e, Co-Director, Tampa Bay Craniofacial

Center, Tampa, Florida, personal communication 1993.

23. Goffman, E., Alienation from interaction, Human

Relations, 1957.

Page-18

Dr. Blakeley is a pioneer in the use of speech obturators to correct velopharyngealincompetence, the hypernasal speech associated with cleft palate.

April, 1994 Multnomah Athletic Club, Portland, Oregonright: Dr. Robert W. Blakeley, Ph.D, Speech Pathologist

left: Neil Gillespie, age 38

My speech obturator made at Oregon Health Sciences University (OHSU)under the direction of Dr. Blakeley.

m OREGON

I-IEALTI-I SCIENCES UNIVERSIlY CIIII..I) I)EVELOPMENT & REHAUIfJTA'Il0N CENTER

1'.0. Box 57/i~ Portland, Oregon 97207-0574

Services for G1., ildre1l u,itb Special J/eallb Needs l}1lfl..ersity AjJUfated Plugrllll1

June I, 1994


RE: Neil Gillespie

This 38 year old I1lan has a repaired unilateral cleft lip and palate. His primary surgery was done in Pennsylvania and he had SOITIe secondary work including a pharyngeal flap for speech, in Florida.

Since speech treatlnent for serious hypernasality has been unsuccessful up to this point, the patient came to Ine for consultation about a speech plan.

Examination shows objectionable hypernasality with moderate nasal emission of air which markedly weakens all 16 air pressure phonemes. Use of the fiber-optic nasendoscope on May 26th verified that the pharyngeal flap, done three years ago (for speech), has pulled loose.

The treatment plan is to utilize a telnporary speech prosthesis (for circa two years) to markedly obturate all sounds froln entering the nasal cavity. After normal oral resonance is obtained and Inaintained for about four to five ITIonths, an obturator reduction program would begin whereby the throat and palate 111usculature would be "challenged" by slowly making the obturator sl11aller, in stages. At the end of approximately two years, it is expected that oralnasal resonance anti oral air pressure would be close to normal limits and that pharyngeal and· palate 111usculalurc \vould have inlproved considerably. This is expected to nlake the patient's velopharyngeal systenl nluch Inore anlenabie to a surgical procedure to substitute for the speech prosthesis \vithout c0l11promising the patient's nasal airway.

Respectfully sublnitted,

Robert W. Blakeley, Ph.D. Professor of Speech Pathology, Director, Craniofacial Disorders Progralll

blak/b:gille~pi.

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I"op anll btt:ral views ot the Slll.:C\:h prostltC~i~; wilh its palatal ponilH1 J tai' piece, obl.urato.' und rCfcntiuo w'ircs.

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The Evergreen State CollegeOlympia, Washington

Freud’s Oral Psychosexual Theoryand Craniofacial Disorders

FREUD AND PHILOSOPHY

Alan Nasser, Ph.D, facultyWinter quarter 1995

Submitted by Neil J. Gillespie

Page - 1

This paper considers Freud's oral psychosexual theory and persons with a

craniofacial disorder. Information is presented in four sections, followed by my

conclusion.

1. Infantile Sexuality

The Freudian oral psychosexual stage begins at birth. "The mouth, tongue, and

gums are the focus of pleasurable sensations in the baby's body, and feeding is the most

stimulating activity" (Berger). Freud notes that the "[M]ost striking feature of this sexual

activity is that the instinct is not directed towards other people, but obtains satisfaction

from the subject's own body. It is auto-erotic..." (Freud, Three Essays). Freud goes on to

say that, "It was the child's first and most vital activity, his sucking at his mother's breast,

or at substitutes for it, that must have familiarized him with this pleasure. The child's lips

in our view, behave like an erotogenic zone, and no doubt stimulation by the warm flow

of milk is the cause of the pleasurable sensation" (Freud, Three Essays). So, Freud

asserts an oral erotogenic zone and suggests that the flow of warm milk causes a

pleasurable sensation in this zone. His theory states that, "The sexual aim of the infantile

instinct consists in obtaining satisfaction by means of an appropriate stimulation of the

erotogenic zone which has been selected in one way or another" (Freud, Three Essays).

2. Craniofacial Disorder

For this paper I use the craniofacial disorder cleft lip and palate. The etiology of

this congenital disorder occurs between the 7th and 8th week of gestation, with a fusion

failure during the nasomedial process (Patten). The resulting disorder presents an oral-

nasal fistula, often with premaxilla protrusion. In layman's terms this means that the

afflicted individual, internally, has a hole in the palate, or roof of the mouth, resulting in

an unnatural opening between the mouth and nose. Externally, the afflicted individual

Page - 2

has a facial deformity, where the openings of mouth and nose are conjoined. Sometimes

the upper gum line protrudes from this opening (premaxilla protrusion). The afflicted

individual almost always experiences feeding problems and surgical trauma.

3. Clinical Observations.

Feeding an infant with a cleft presents a challenging set of circumstances.

Dr. Berkowitz notes that “Children with a cleft palate cannot create sufficient negative

pressure to suck milk, which is expressed from the nipple between the upper and lower

gum pads, because of the absence of a palatal seal” (Berkowitz).

In addition to feeding problems, surgery of the lip, palate, and gums of an infant

causes pain and trauma. Reconstructive procedures may include pre-surgical orthopedic

alignment of the premaxilla (infant wears a facial orthopedic device), arm restraints (to

prevent the baby from removing the device), cleft lip and palate closure, and construction

of a pharyngeal flap (for speech improvement). Post-surgical trauma includes pain,

swelling, sutures, additional feeding problems, and wearing arm restraints.

4. Non-clinical observations

One mother described each feeding of her cleft afflicted infant as a “nightmare”

(AboutFace). Another mother relates the experience with her afflicted baby saying, “Few

individuals would try the challenge of feeding him, risking his choking and vomiting on

every drop” (AboutFace). These experiences are in stark contrast to Freud’s observation

of a normal infant. Freud states, “No one who has seen a baby sinking back satiated from

the breast and falling asleep with flushed cheeks and a blissful smile can escape the

reflection that this picture persists as a prototype of the expression of sexual satisfaction

in later life” (Freud, Three Essays).

Page - 3

Conclusion

Freud states the following about oral stage developmental fixation: “Every

external or internal factor that hinders or postpones the attainment of the normal sexual

aim will evidently lend support to the tendency to linger over the preparatory activities

and to turn them into new sexual aims that can take the place of the normal one.” (Freud,

Three Essays). If so, it follows that the clinical and non-clinical observations cited in this

paper point to the possibility of fixation to the oral psychosexual stage of development.

Examples of behavior indicating oral psychosexual stage fixation include smoking,

drinking, eating disorders, and a proclivity to speaking. Thus I conclude that a cleft lip

and palate puts an afflicted individual “at risk” for oral fixation. Concerning the

legitimacy of the theory, Fisher and Greenberg state in their book Freud Scientifically

Reappraised: Testing the Theories and Therapy, that Freudian oral psychosexual

developmental theory is a valid psychological phenomenon. (Fisher and Greenberg).

Bibliography

1. Kathleen Stassen Berger, The Developing Person Through the Life Span, third

edition, 1994, Worth Publishers.

2. Sigmund Freud, Three Essays on the Theory of Sexuality, Basic books.

3. Samual Berkowitz, DDS, MS, FICD, The Cleft Palate Story, 1994, Quintessence

Publishing Co., Inc.

4. AboutFace, craniofacial support group newsletter, January/February 1993 and

May/June 1992.

5. B.M. Patten, Human Embryology, third edition, 1968, McGraw-Hill Book Company.

6. Seymour Fisher and Roger Greenberg, Freud Scientifically Reappraised: Testing

the Theories and Therapy, first edition, 1996, Wiley-Interscience Publishers.

Psychotherapy for Persons with Craniofacial Deformities: Can We Treat without Theory?

M. ELIZABETH BENNETT, PH.D. MARY L. STANTON, B.S.

In recent y••rs, Incr..slng number. of experts hev. recomm.nded tMt psychological support be avall.ble for cle" children .nd their ,.rent•• Fe. cle" ,...1. c.nt.... howev.r offer comprehensive psychologlCIII ..rvlees. This paper pr.sent. lOme conceptual tactor. which may contribute to the piluclty of psychological treatment. available to cleft children and their famlll... Shortcoming. In current concepts of emotional dy.functlon In cleft chlldr.n are dl.cussed, and the effect. of conceptu81 confusion on options for psychother.py ar. outlined. Sugg••ted directions In p.ychotherapy r....rch tor clen children are discussed.

KEY WORDS: clfJfting, emotional dysfunction, psychotherapy

Numerous studies have documented psychosocial problems associated with cleft lip and palate. Children with clefts have been reported to have lower self-concepts than normals (Broder and Strauss, 1989), lower self-esteem than nonnals, impaired peer relationships, and increased dependency on adults (Pil1emer and Cook, (989). In addition, poor body image (Strauss et aI., 1988) and poor academic performance have been noted in children with clefts (Richman el a1.. 1988). Teachers have also reponed that cleft children more frequently display conduct disorders when compared with their normal peers (Richman. 1976). Information from surveys of the parents of cleft children suggests that cleft children master developmental tasks more slowly and resist separation from parents more strongly (Benson et aI., 1991).

Given this list of psychological problems and familial distress associated with clefting, it is not surprising that numerous authors have suggested that psychological treat.. ment should be available to children with clefts and their families (Heller et al., 1981; Arndt et aI., 1987; Bjomsson and Agustsdottir, 1987; Pertschuk and Whitaker. 1987, 1988; Broder and Strauss, 1989). Such recommendations are so common that cleft palate centers were surveyed (Broder and Richman, (987) to determine what psychological services were available to children receiving treatment at cleft palate centers.

The results of the Broder and Richman survey were discouraging. Few centers reported offering psychological treatment for cleft children. Less than SOli, of centers offered mental health screening interviews, and fewer still offered short tenn therapy (21%). In 1987, only 13% provided long...term psychological support for children with clefts or their families. Although these figures may have

Dr. Bennett and Ms. Slanton are affiliated with the University of Pittsburah. School of Dental Mcdic:inc. Pittsburgh. Pennsylvania.

Submitted November 1992; Accepted January 1993. Reprint requests: M. Elizabeth Bennett. Ph.D., Department of Rehav·

ion1 Science. University of Piltlburgh School of Dental Medicine, Pittsburah. PA IS261.

improved over the past 5 years, this seems unlikely because of the low priority of mental health services in most publicly funded agencies.

How is it that psychological services are so difficult to come by in a population which has consistently been identified as needing psychological care? At least two factors may contribute to this, including (I) the relatively low priority of psychological services in public assistance programs mentioned previously, and (2) the inherent difficulties of providing weekly psychological interventions to center populations which may be diverse economically, geographically. and culturally.

The Problem of Psycbotherapy

While either factor just mentioned may be partially responsible for the generally low level of psychological services available to cleft children and their families, we believe there may be a more obvious and troublesome root to the lack of psychological services. Having determined that psychological services are a necessary adjunct to cleft treatment, few investigators have defined which psychological treatments are suitable for cleft children. We could locate no controlled studies that differentially evaluated the efficacy of psychotherapy for cleft children or their families.

As Strupp (1978) notes in his studies of psychotherapy outcome, it is not enough to demonstrate that psychotherapy is effective in a general sense. Because the major issue of psychotherapy is behavior change, researchers must define what is to be changed and how change can be brought about. In the area of facial deformities, we are largely unable to answer these questions. What does a cleft child (or adult) want to change? What should the aim of psychotherapy be for a cleft child? What are the chief emotional problems of indiv iduals with faci aI deformities?

Emotional Dysfunction in Cleft PersoDs

A review of the literature provides few answers to the first question, "What does a cleft child or adult want to

9

Bennett and Stanton, PSYCHOTHERAPY AND FACIAL DEFORMITIES 407

change?" Although we found numerous studies which described emotional problems in cleft children, many lacked appropriate control groups. Thus. it is impossible to draw firm conclusions from these studies because equivalent, noocleft children drawn from the same sorts of populations may experience emotional problems as well. An examination of those studies which did employ adequate or methodologically appropriate empirical techniques suggest that questions remain regarding what, if any, emotional problems typically accompany a diagnosis of clefl Iip/palate.

For example, Richman ( 1983) reported that cleft adolescents did not show significantly more personality or adjustment problems than did nonnal controls. In addition. this report noted no significant differences in self-perceived academic functioning and social satisfaction in cleft persons compared with their noncleft peers. Similarly, Bjomsson and Agustsdottir (1981) concluded that cleft individuals were relatively well adjusted socially and achieved educational levels similar to those of normal controls. Most imponant, these researchers noted that their cleft subjects did not believe that their cra.niofacial defect had significantly influenced their lives.

In contrast, Heller et aI., (1981) reported that a significant number of cleft patienls report continuing dissatisfaction with appearance, hearing, speech. and teeth. Similarly, Kapp-Simon (1985) reported that cleft patients had poorer self-concepts than normal controls. With regards to achievement motivation, Peter and Chinsky (1975) reponed that cleft subjects had significantly lower educational aspirations when compared with their normal peers. Additionally. McWilliams and Paradise (1973) reported that fewer cleft subjects were married during adulthood when compared to their normal peers.

Clearly, there are inconsistencies in the data regarding emOlionaVsocial dysfunction and clefts. While some reports seem to indicate that clefting has relatively insignificant effects on emotional functioning, other data provide strong evidence to the contrary. Such contradictions have not gone unnoticed in the literature, leading at least one author (Tobiasen, 1984) to suggest that consistent, meaningful answers to questions about emotional dysfunction and clefting cannot be answered without sufficient theo· retical specificity. Even if we accept that there are emolional problems which occur more frequently in cleft children than in normal children. Strupp's second question, "how change can be brought about" cannot be addressed without theory.

How Can Change be Brought About?

This question must be answered in the context of theory; a theory of how dysfunction develops and how it can be changed. Although broad theories of personality may be of use in generating general answers about human emotional dysfunction, they may be considerably less useful in providing specific answers for the facially deformed.

For example, both psychodynamic and social learning theorists would postulate that emotional distress arises in part from repeated, painful, developmental experiences. However, such broad hypotheses tell us little about the nature of those experiences for facially deformed persons. It is understandable that researchers have sought a model more specific to the experiences of cleft palate children to answer questions relevant to the development and treatment of emotional dysfunction in cleft children.

The most popular notion of emotional dysfunction in cleft children has been that of 6'reflected appraisals" or 'lhe "looking glass selr' (see Shrauger and Schoeneman. 1979, for a review). From this lheoretical viewpoint, cleft children are at a developmental disadvantage emotionally because they incorporate a negative societal view of facial deformity into the self-concept. Researchers into cleftpalate issues have noted support for this concept of emotional development in the extensive literature on physical attractiveness. This large and frequently cited literalure suggests that 'there are far-reaching social benefits to being physically attractive, and severe negative social consequences for those who are physically unattractive (see Berscheid, 1980; Dian. 1981,1986; Adams, 1984; Patzer, ' 1985; Alley and Hildebrandt. 1988 for reviews). To summarize, researchers have discovered that physically unattractive people of all ages are perceived less positively by observers of all ages than attractive people. Assuming that faces with deformities are inherently unattractive, some researchers have suggested that negative reactions from observers are partly responsible for the emotional distress noted in cleft children (Tobiasen. 1984).

The appeal of this concept of emotional dysfunction is clear. Not only does the idea of reflected appraisals conform to common sense notions of emotional development (e.g., "children learn what they live"), but in the case of cleft children. the concept is supported by a literature that delineates society's negative views of physically unattractive children. It should not be surprising therefore, that this particular view of dysfunction has been frequently cited in the cleft literature (see Clifford, 1973; Glass and Starr, 1979: Edwards and Watson, 1980; Tobiasen. 1984) as a useful theory of emotional dysfunction in cleft children and adults.

Although intuitively pleasing, such an explanation is problematic for several reasons. Researchers have recently begun to question the benefits of physical attractiveness. Often referred to as the "what is beautiful is good t phenomenon, the benefits of physical attractiveness •

have been noted as some of the most replicable and robust findings in the social science literature. However, a recent meta-analysis of the physical attractiveness literature (Bagly et at, 1991) found major limitations in such conelusions. The results of their meta-analysis suggest that beauty serves as a strong cue for suppositions of social ease. but has little effect on perceptions of intelligence, honesty, virtue, helpfulness. potency, or general emo

408 Cleft Pal.re-Craniofacial Journal. July 1993, Vol. 30 No.4

tional adjustment. Other investigators have noted instances in which beauty may be a handicap, especially in inferences about vanity, and self-centeredness (Cash and Janda, 1984).

Additional doubts concerning the applicability of the physical-attractiveness literature have recently arisen. Several authors, both in the psychological (Zuckerman et aI., 1991) and dental literatures (Pertschuk and Whitaker, 1987) have cautioned against over·simplified interpretations of the ubeauty is good" phenomenon. These authors have noted that a myriad of factors contribute to impression fonnation, including vocal attractiveness. nonverbal gesturing, mannerisms, and social skills. Others have noted that frontal photographs, typically employed in physical attractiveness research, are not representative of real-life interaction. as three-quarter a"d profile views are also captured in day to day interactions (Shaw et ai., 1985). While some research has moved to impression research using video images and field research, these studies are rare (e.g., Reis et at., 1980, used standardized diaries to study naturalistic interactions). Not surprisingly,the results of field-based versus lab-based physical attractiveness studies have produced less clear results concerning the benefits of beauty4 For example. Reis et al. (1982) found that moderately attractive college women had more dates and more same-sex socializing than did very attractive college women.

Another problem with the "reflected appraisals" concept of emotional development is the implicit equation between perceptions of physical unattractiveness and physi· cal deformity. Both Reis and Hodgins (in press) and Pertschuk and Whitaker (1987) caution against applying the literature on physical attractiveness to craniofacial populations. They propose that unattractive individuals, even very unattractive individuals, may have profoundly different social experiences from the facially deformed. Reis and Hodgins cite the social science literature devoted to physical stigmata as an alternate source for theory concerning social development in cleft populations (e.g., Katz. 1981). Katz postulates that the experience of a stigmatized individual is marked by societal ambivalence. That is~ there are strong cultural traditions which dictate help and sympathy for the handicapped, but such traditions coexist with societal avoidance and discomfort with handicapped persons. Reis and Hodgins postulate that the experience of ambivalence (strong positive reactions and strong negative reactions) should be markedly different from that of the generalized ncgativity thought to accompany physical unattractiveness. As additional support for a distinction between the effects of unattractiveness and stigmata, they note the societal distinction between stigma and unattractiveness; there is a Cleft-Palate Craniofacial Association but no association for "homely individuals or parents of homely babies" (p.21).

Finally, the distinction between unat.tractiveness and craniofacial defect has profound conseqJences for concepts

of the development of self-esteem in cleft children. While the prevailing theory of reflected appraisals clearly predicts lower self-esteem in cleft children. recent work sug· gests that members of some stigmatized groups may actually use their stigmatized status for self-esteem enhancement (Crocker and Major, 1989; Hillman, 1992). Briefly, Crocker and Major outline an attribution·based model whereby the stigmatized individual may attribute negative feedback to factors associated with their stigma (e.g., he doesn't like me because I have a scar above my lip) rather than to factors more closely aligned with the self (e.g., he doesn't like me because I'm an unacceptable person). In so doing, these theorists note, stigmatized people can and do protect their self-esteem. This effect has been noted clinically in facially deformed populations, but has not been studied explicitly (see Baker and Smith, 1939; Macgregor, 1979). The applicability of this model to the cleft population warrants further study. While some studies suggest that self-esteem is lower in cleft children (Broder & Strauss, 1989), Brantley & Clifford (1919) found higher self-esteem in cleft teens than in normal teens.

Providing Treatment in the Absence of Theory

At first glance, differing theoretical models concerning emotional development of cleft chi Idren may appear removed from the day to day concerns of the psychologist interested in psychotherapy for cleft patients. A closer examination reveals that different models of emotional development may lead to divergent clinical treatments. For example, if facial deformity can be considered as equivalent to extreme unattractiveness, a clinician might assume that any cleft child is regarded with unifonn negativity, a victim of cultural prejudices against unattractive persons. Therapy might consist of social skills training to overcome initial negative reactions from peers and teachers. In contrast, if facial deformity is conceptualized in line with Katz's (1981) ambivalence model, a therapist would make an entirely different set of assumptions about the cleft patient's social experience. Assuming that the cleft child is met with extremely positive reactions in some instances (e.g.• teachers more likely to provide help, parents inviting the child to birthday parties) but extremely negative reactions in other instances (e.g., peers avoiding interaction, being chosen last for teams)" therapy that is focused on coping with inconsistent social experiences might be most appropriate.

Similarly, a therapist assuming low self-esteem in cleft clients might focus on interventions aimed at enhancing self-esteem. If a therapist accepts Crocker and Major's (1989) attribution-based model, however, a therapy aimed at making accurate and adaptive attributions for social feedback would be warranted. In addition, if a therapist assumes rhat the stigma serves to protect the self-esteem, additional psychotherapeutic support might be necessary

Bennen and Stanton. PSYCHOTHERAPY AND FACIAL DEFORMITIES 409

for patients undergoing surgical interventions aimed at cosmetic improvements. In other words, patients who receive noticeable cosmetic benefits through surgery (i.e.• the stigma becomes less visible) may be less able to proteet their self-esteem by using their facial stigma. Thus psychotherapy aimed at helping patients make other attributions for interpersonal events may be useful.

Shortcomings in current concepts of emotional dysfunction in cleft populations leave the clinician with litlle empirical guidance for psychological treatment. Not only are we unsure about which treatments are most appropriate, we have little data that compare different treatments for cleft clients. In the absence of theory. clinicians follow general principles of psychotherapy (e.g., acceptance, empathy I warmth, skills training) on a case-by-case basis. Evidence from the limited literature on psychotherapy for physically handicapping conditions suggests that few empirical data are available in Ihose areas either (e.g., Servoss, 1983; Hoxter, 1986; lureidini, 1988). II is not suggested that therapists currently providing

psychological treatments to cleft patients are offering ineffective treatments, or even that a specific theory of psychological dysfunction is necessary to help a given cleft patient or family. Studies of the outcome of psychotherapy strongly suggest that on the whole, psychotherapy is effective in reducing emotional distress for a wide range of clients and emotional problems (Garfield and Bergin, 1984). A skilled clinician will also conduct a thorough assessment of a client's social environment regardless of population-based data. However. in order to develop programs specifically for cleft patients, especially programs designed to teach effective coping early in social development. a more specific plan is needed.

How can research contribute to the development of specifie treatments for cleft children who are experiencing emotional dis~s? How can research contribute to the development of primary prevention interventions that might offset the effects of facial defonnity? In the course of our research. we have fonnul ated 'Ihe following suggestions:

I. Cleft palate centers and organizations should encourage and promote cross-fertilization between social scien· tists outside the cleft area and scientists working primarily in cleft palate. Researchers who focus on other stigmatizing conditions (e.g., obesity) and scientists who develop and refine theories of stigma (e.g., Katz, 1981; Jones et al. 9 1984) are rarely cited in the cleft literature. The information and insights they have to offer should become integrated with infonnation specific to eleCting. Some attempts have been made to incorporate study of other stigmatizing conditions (e.g.• Harper and Richman, 1978; Brantley and Clifford, 1979). and further work in this tradition should be encouraged. 2. Longitudinal field studies of cleft children in their social environment should become a funding priority. Sur

vey studies and impression studies are useful, but the information they offer is limited. Mental health interventions for cleft children can only be developed when we understand what makes a cleft child's social environment different from that of a normal child. We cannot expect to treat psychological distress effectively if we cannot define how the distress manifests itself in day to day functioning. There are well-validated means for measuring social interaction in an ongoing fashion which have been used in studies of smoking cessation, weight control. and intimacy (see Reis, 1983. for a review). The application of similar assessment techniques to cleft populations may be feasible. 3. Studies which focus on individual differences and risk factors in cleft populations should be encouraged. As we noted earlier. there are no clear answers regarding the association between clefting and emotional distress. Identification of mediating and moderating factors will enable us to predict which cleft children are at risk for emotional problems. For example, it may be that there are important parental variables which will predict which cleft children will experience emotional problems. Studies of individual differences in cleft children. such as different coping styles, may also be useful in understanding which cleft children will experience emotional dysfunction. If such variables prove to be important. we may be able to learn, and eventually teach how some cleft children cope effectively with their facial differences. 4. Research concerning the mutability of attitudes towards physical deformity will enable therapists and community leaders to launch programs intended to change societal attitudes towards physical stigmata. If we accept the premise that in some fashion, emotional problems associated with elefting stem from negative societal views, a logical research question is whether such attitudes are changeable. With the advent of popular television characters with visible (e.g., obesity) and invisible (e.g., homosexuality) stigmata. we may be able to study the extent to which societal treatment of stigmatized persons can change.

A focus on any of the above areas will bring valuable information to those interested in developing and refining mental health interventions for cleft children and adults. As mental health interventions are developed, controlled studies can be launched, and better matches can be made between clients, 'therapists, and interventions. Although there is much to be learned about the psychological treatment of cleft individuals, we believe that there is much to be gained through the study of psychological problems associated with clefting. When social scientists have empirically demonstrated psychological treatment needs for cleft patients in conjunction with replicable, specific treatment plans, we believe that funding for mental health services will be substantially easier to secure.

410 Clefl Palate-Craniofacial Journal, JUly 1993, Vol. 30 No.4

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PSYCHIATRY

RESEARCH

Psychiatry Research 59 (1995) 97-107

Deficits in short-term memory in adult survivors of childhood abuse

J. Douglas Bremner*a,b,c, Penny Randalla,b,c, Tammy M. Scottc,d, Sandi Capellib,c, Richard Delaneyb,d, Gregory McCarthyb,d,e, Dennis S. Chameya,b,c

·D~partment of Psychiatry. Yale Uni~ersity School of Medicine. West Ha~~n. CT 06516. USA bWest Ha~en VA Medical Center. West Ha~~n. CT06516. USA

CNatiolUl1 Center for Posttraumatic Stress Disorder. West Ha~en VA Medical Center (/51). West Ha~en. CT 06516. USA dDepartment of Psychology. Yale Uni~ersity School of Medicine. West Ha~en. CT 06516. USA

cDepartment of NftUosurgery. Yale Uni~ersity School of Medicine. West Htnen. CT 06516. USA

Received 6 March 1995; revision received 31 July 1995; accepted 8 August 1995

Abstract

Exposure to stress has been associated with alterations in memory function, and we have previously shown deficits in short-term verbal memory in patients with a history of exposure to the stress of combat and 'the diagnosis of posttraumatic stress disorder (PTSD). Few studies of any kind have focused on adult survivors of childhood physical and sexual abuse. The purpose of this study was to investigate short-term memory function in adult survivors of childhood abuse. Adult survivors of severe childhood physical and sexual abuse (n =21), as defined by specific criteria derived from the Early Trauma Inventory (ETI), who were presenting for psychiatric treatment were compared with healthy subjects (n =20) matched for several variables including age, alcohol abuse, and years of education. All subjects were assessed with the Wechsler Memory Scale (WMS) Logical (verbal memory) and Figural (visual memory) components, . the Verbal and Visual Selective Reminding Tests (SRT), and the Wechsler Adult Intelligence Scale-Revised (WAIS-R).

t Adult survivors of childhood abuse had significantly lower scores on the WMS Logical component for immediate and delayed recall in comparison to normal subjects, with no difference in visual memory, as measured by 'the WMS or the SRT, or IQ, as measured by the WAIS-R. Deficits in verbal memory, as measured by the WMS, were associated with the severity of abuse, as measured by a composite score on the ETI. Our findings suggest that childhood physical and sexual abuse is associated with long-term deficits in verbal short-term memory. These findings of specific deficits in verbal (and not visual) memory, with no change in IQ, are similar to the pattern of deficits that we have previously found in patients with combat-related PTSD.

Keywords: Physical abuse; Sexual abuse; Memory; Intelligence; Trauma; Posttraumatic stress disorder; Neuropsychology

• Corresponding author, West Haven VAMC (116a), 950 Campbell Ave., West Haven, cr 06516, USA.

0165-1781195/$09.50 © 1995 Elsevier Science Ireland Ltd. All rights reserved SSDI OI65-1781(95)02800-C

10

98 J.D. Bremner et al. / Psychiatry Research 59 (1995) 97-107

1. Introduction

Childhood physical and sexual abuse is a problem ofenormous magnitude. Rates of sexual abuse have been estimated from community samples to be from 110/0 to 620/0 in women (Russell, 1983; Finkelhor and Hotaling, 1984; Kercher and McShane, 1984; Wyatt, 1985) and from 3% to 39% in men (Finkelhor and Hotaling, 1984; Kercher and McShane, 1984). Childhood abuse has been associated with a range of adverse psychiatric outcomes, including depression (Briere et aI., 1988; Swett et aI., 1990), anxiety (Briere et aI., 1988; Swett et aI., 1990), dissociation (Putnam et aI., 1986; Chu and Dill, 1990; Ross et aI., 1991), posttraumatic stress disorder (PTSD) (Greenwald and Leitenberg, 1990), borderline personality disorder (Herman et aI., 1989; Ogata et aI., 1990), alcohol and substance abuse (Ladwig and Anderson, 1989; Brown and Anderson, 1991), and other psychiatric disorders (Green, 1978; Herman, 1981; Carmen et aI., 1984; Bryer et aI., 1987; Bulik et aI., 1989; Hall et aI., 1989; Palmer et aI., 1990). In spite of this, few studies have examined the long-term consequences of exposure to childhood abuse.

Considerable evidence supports a relationship between stress and alterations in memory (reviewed in Charney et aI., 1993; Bremner et aI., 1995a). Studies in animals suggest that exposure to stress results in deficits in short-term memory (Drugan et aI., 1984). High levels of glucocorticoids released during stress have been shown to cause damage to neurons in the hippocampus (Sapolsky et aI., 1988, 1990; Uno et aI., 1989), a brain structure that plays an important role in learning and memory (Squire and Zola-Morgan, 1991). Neurotransmitters and neuropeptides released during stress also have the potential to result in an overconsolidation of memory traces, which may explain the existence of intrusive memories in patients with PTSD (Pitman, 1989; Pitman et aI., 1993; Bremner et aI., 1995a). Studies of war veterans suggest an association between the extreme stress of combat and alterations in memory function, including the forgetting of names or other pieces of important personal information. Five percent of soldiers in a major campaign in World War II had no memory for events which had just occurred immediately

after they had participated as combatants (Torrie, 1944). Other studies in combat veterans and prisoners of war from World War II and the Vietnam war have documented amnesia and other disturbances of memory (Archibald and Tuddenham, 1965; Thygesen et aI., 1970; Eitinger, 1980; Goldstein et aI., 1987; Bremner et al., 1992, 1993b). Empirical studies of short-term memory have shown deficits in short-term memory, as measured by the Logical component of the Wechsler Memory Scale, in prisoners ofwar in comparison to combat veterans without a history of containment during the Korean war (Sutker et aI., 1988, 1991). We have previously reported deficits in short-term verbal memory, as measured by the Logical component of the Wechsler Memory Scale and the Verbal Selective Reminding Test, with no change in IQ, in Vietnam combat veterans with posttraumatic stress disorder (PTSD) in comparison to control subjects (Bremner' et al., 1993a). We have also found a decrease in volume of the right hippocampus in Vietnam combat veterans with PTSD in comparison to matched control subjects. Deficits in verbal short-term memory, as measured by the Wechsler Memory Scale, were associated with decreased right hippocampal volume in these patients (Bremner et aI., 1995b). Other studies in Vietnam combat veterans have shown deficits in new learning and memory using different neuropsychological tests than the Wechsler Memory Scale (Uddo et al., 1993; Yehuda et aI., 1995). Studies in children have sho~ a relationship between markers of abuse and deficits in the arithmetic subscale of the IQ test (Lewis et aI., 1979).

The purpose of this study was to compare memory function in adult survivors of childhood physical and sexual abuse with that in healthy matched controls. Based on our previous findings in Vietnam combat veterans with PTSD, we hypothesized that adult survivors of abuse would have deficits in verbal (but not visual) memory, with no change in IQ, in comparison to matched controls.

2. Methods

2.1. Subjects The patient group consisted of 21 adult sur

vivors of childhood physical and sexual abuse. Pa

99 J.D. Bremner et al. / Psychiatry Research 59 (/995) 97-/07

tients were recruited from the inpatient and outpatient treatment units of the West Haven VA Medical Center over a 12-month period. A long period of recruitment was necessary to identify patients with a severe history of abuse, based on the criteria outlined below. All new admissions to these units were briefly screened for a history of abuse, and referrals were made for the study, following which a more complete evaluation was performed to determine eligibility. All but one of the patients who were identified in this manner, who met inclusion criteria for the study, and who were eligible for study entry consented to partici

pate. Patients were included if they had a history of severe childhood physical and/or sexual abuse, as determined by the Early Trauma Inventory (ETI), and an Axis I psychiatric disorder on the basis of a semistructured interview, the Schedule for Affective Disorders and SchizophreniaLifetime version (SADS-L; Endicott and Spitzer, 1978). Patients were excluded if they had a history of exposure to combat trauma, a diagnosis of schizophrenia or current alcohol or substance abuse based on the SADS-L, a history of traumatic brain injury or neurological disorder, current use of benzodiazepine medication, or a history of loss of consciousness for > 10 min. Some of the patients were being treated with antidepressant medication at the time of the study.

The comparison group (n =20) comprised physically healthy men and women of nonprofessional occupations who were matched with the patients for age, sex, race, handedness, height, weight, years of education, years of parental education, and years of alcohol abuse. Subjects with a history of traumatic brain injury, meningitis, neurological disorder, current alcohol abuse by DSM-III-R criteria (American Psychiatric Association, 1987), physical illness, psychiatric disorder, or history of loss of consciousness for > 10 min were excluded from the study.

There were no differences between patients and comparison subjects in any of the demographic variables that were measured in this study. Patients were similar to controls in age (patients: mean =39.7, SD =7.1; controls: mean =36.7, SD = 10.0; t =1.1, dj= 39, P =0.28), race (pa

tients: 18/21 [860/0] white, 1/21 [5%] black, 2/21 [100A»] Hispanic; controls: 14/20 [700/0] white, 4/20 [200/0] black, 1/20 [5°A.] Hispanic, 1/20 [5%] other; x2 =3.61, dj =3; P = 0.31), sex (patients: 15/21 [71°A»] males and 6/21 [290/0] females; controls: 16/20 [8oo/0] males and 4/20 [2OU/o] females (x2 =0.41, dj= 1, P = 0.52), handedness (patients: 18/21 [86%] right-handed and 3/21 [14°A»] non-right-handed; controls: 19/20 [95%] righthanded and 1/20 [5%] non-right-handed; x2 = 1.34; dj= 1; P =0.50), years of education (patients: ·mean =13.5, SO = 2.1; controls: mean = 14.0, SO = 3.0; t = 0.59, dj= 39, P = 0.55), and years of alcohol abuse (patients: mean =10.9, SO =9.4; controls: mean =6.6, SO = 10.2; I =1.39, dj= 39, P =0.17).

Patients were evaluated with the SADS-L for comorbid psychiatric diagnoses. SADS-L data were not available (or three patients. All patients in the study met criteria for current PTSD related to their early trauma. Many patients also had diagnoses of affective disorders. Five out of 18 (28°A») patients evaluated with the SADS-L met criteria for current and 16/18 (890/0) for lifetime major depression. In addition, 1/18 (6%) patients met criteria for current and 2/18 (110/0) for lifetime dysthymia, while none met criteria for either current or lifetime bipolar disorder or bipolar disorder not otherwise specified. There were a number of patients with comorbid anxiety disorder diagnoses. Seven out of 18 (390/0) met criteria for current and lifetime panic disorder with agoraphobia, and 2/18 (110/0) for current and 5/18 (28%) for lifetime panic disorder without agoraphobia, 2/18 (110/0) had a history of current and lifetime diagnoses of agoraphobia without a history of panic disorder, 3/18 (170/0) current and 4/18 (22%) lifetime social phobia, 2/18 (110/0) current and 3/18 (17%) lifetime generalized anxiety disorder, 1/25 (4%) current and lifetime simple phobia, and none with current or lifetime obsessive-compulsive disorder. No patients had current or lifetime diagnoses of schizophrenia. Other diagnoses included current bulimia in one patient (60/0) and lifetime bulimia in two patients (110/0), and current anorexia in no patients and lifetime anorexia in one patient (60/0). No patients had current or lifetime psychosis not otherwise

100 J.D. Bremner et ale / Psychiatry Research 59 (/995) 97-/07

specified, somatization disorder, somatic pain disorder, undifferentiated somatization disorder, or hypochondriasis.

Consistent with previous reports, comorbid lifetime diagnoses for alcohol and substance abuse disorders were increased in our group of early trauma patients. Fourteen out of 18 patients (780/0) met criteria for alcohol dependence and 1/18 (60/0) for alcohol abuse, 3/18 (17%) for sedative/hypnoticlanxiolytic dependence and 1/18 (60/0) for abuse, 9/18 (500/0) for cannabis dependence and 2/18 (11°~) for cannabis abuse, 7/18 (390/0) for stimulant dependence and 2/18 (110/0) for stimulant abuse, 5/18 (28%) for opiate dependence and none for opiate abuse, 10/18 (56%) for cocaine dependence and none for cocaine abuse, 1/18 (60/0) for hallucinogenlPCP dependence and 2/18 (110/0) for abuse, and 4/18 (220/0) for polydrug dependence and none for abuse.

2.2. Assessment of childhood abuse Research in the area of childhood abuse has

been limited by the lack ofa comprehensive instrument with demonstrated reliability and validity (Briere and Runtz, 1988). The current study used the Early Trauma Inventory (ETI), which was developed as part of a parallel project for the assessment of childhood physical, sexual, and emotional abuse. The ETI was developed by a multidisciplinary team including one of the authors of the current study (Kriegler et aI., 1993) in collaboration with colleagues from the National Center for PTSD, based on clinical experience, a review of available existing instruments, and a survey of the clinical literature on childhood abuse (Finkelhor, 1979, 1986; Lewis et aI., 1979; Herman, 1981; Herman et aI., 1986; Russell, 1986; Briere and Runtz, 1987; Wyatt, 1885). The ETI assesses the frequency of abuse experiences at different developmental periods/academic epochs (preschool, elementary school/junior high school, and high school), the age of the individual when the abuse began and when it stopped, the perpetrator(s) of the abuse, the emotional impact of the abuse on the individual immediately after the event and across the life span, and the effect of the abuse on social and occupational functioning as assessed with a 7-point dual-valenced (positive

and negative impact) bipolar rating. In cases where individuals reported abuse that occurred from before age 4, and indicated that they believed it had occurred since birth, abuse was scored as having occurred since birth. Immediate and long-term sequelae for the events, such as medical health seeking and change in custody status, are assessed at the conclusion of the interview. Interrater reliability and validity studies of the ETI are currently being performed and will be reported in a future publication. The ETI was administered by a clinical psychiatrist trained in the use of the ETI by one of the authors of the instrument. The Clinical psychiatrist was unaware of the information obtained from neuropsychological testing. Asessments of abuse in this study were based on self-report.

Although considerable variation exists with regard to the definition of childhood abuse (Kinsey et aI., 1953; Finkelhor and Hotaling, 1984; Wyatt, 1985; Briere"and Runtz, 1988), there are no empirical bases to justify the use of specific criteria. One approach is to identify subjects with a history of very severe abuse, for whom there is no question from their report that they have been exposed to childhood abuse. We have developed specific criteria for severe abuse based on the ETI interview to identify subjects with severe abuse. Severe abuse was defined as a history of exposure to physical abuse (being hit with an object, burned, or locked in a closet, or suffering penetrative sexual abuse) that had occurred once a month or ·more for at least a year and that had extremely negative effects on the individual when the event occurred as well as.on current emotional, social, or occupational functioning.

Histories ofabuse were obtained in this study by self-report. It might be argued that patients do not accurately report their abuse. One should consider, however, other methods of validating the history of abuse. Obtaining history from family and friends has its own problems, as these individuals may have been involved in the abuse or be in active denial that abuse could have occurred. Limiting study to individuals for whom there are court records of abuse would represent a biased sample, as our clinical impression is that the majority of abused individuals do not enter the legal system. One might also argue that deficits in

101 J.D. Brmm~r ~t al. / Psychiatry R~search 59 (/995) 97-/07

memory in these patients could result in deficient memory for episodes of abuse. These memory deficits, however, involve short-term new learning (not recall of long-term storage). We hypothesize that memory deficits are the result of abuse exposure; therefore, there would be no reason to expect that memory for the abuse itself would be impaired. It is also our clinical impression that memory traces for these events are often very strong (in circumstances where amnesia does not exist).

Patients in this study, as would be expected from the selection criteria, had experienced high levels of physical and sexual abuse. All of the patients experienced some form of physical and emotional abuse, while 19/21 (900/0) experienced some form of sexual abuse. As can be seen in Table 1, patients endorsed experiencing a wide range of abuse experiences in the different abuse domains (physical, emotional, and sexual abuse). Abuse experiences in the different domains were related to each other; that is, there were significant correlations between severity of physical and emotional abuse (r = 0.50, df = 20, P < 0.05), sexual and emotional abuse (r =0.47, df= 20, P < 0.05), and physical and sexual abuse (r = 0.60, df= 20, P = 0.004). These abuse experiences had a very negative effect on the patients' current lives. For example, 16/21 (760/0) of patients reported that physical abuse had an extremely negative effect on them emotionally, 14/21 (68%) an extremely negative effect on work performance, and 16/21 (760/0) on family life at the current time. Onset of the abuse occurred from infancy for physical abuse in 16/21 (76%) patients, emotional abuse in 16/21 (760/0), and sexual abuse in 3/21 (140/0) (or 6/21 [29%] before the age of 5 years). Fourteen out of 21 (68°AJ) patients reported that the primary perpetrator of their physical abuse was a male primary caretaker (e.g., father), 6/21 (290/0) a female primary caretaker (e.g., mother), and 1/21 (50/0) a female child family member. For emotional abuse, 12/21 (570/0) reported that the primary perpetrator was a male primary caretaker and 9/21 (430/0) a female primary caretaker; for sexual abuse, 3/21 (140/0) reported that the primary perpetrator was a male primary caretaker, 1/21 (50/0) a female primary caretaker, 2/21 (10010) a male known adult family member,

Table I Frequency of exposure to traumatic events as assessed by the early trauma inventory (ETI)

Abuse N Percent (o/u)

Physical abuse Spanked with a hand 19121 91 Slapped in the face 18121 86 Burned with hot water/cigarette 8/21 38 Punched or kicked 16121 76 Hit with objects 20121 95 Choked 15121 71 Pushed or shoved 17121 81 Tied upllocked in closet 9/21 43

SeXIIQI abuse Exposed to inappropriate comments 16121 76

about sexlbody pans Exposed to someone flashing 17121 81 Someone watched you dressing 8121 38 Forced/coerced to watch sexual acts 13121 62 Touched in private pans made 17121 81

you uncomfonable Someone rubbed their genitals

against you 14/21 67 Forcedlcoerced to touch another 14121 67

penon's private pans Had genital sex against your will 5121 24 Had oral sex on someone against

your will 11121 52 Someone performed oral sex on you 8/21 38

against your will Someone had anal sex on you 8121 38

against your will

Emotional abuse Often put down or ridiculed 19/21 91 Often ignored/made to feel you

didn't count 18/21 86 Often told you were no good 18/21 86 Often shouted at or yelled at 21121 100 Most of the time treated in cold or

uncaring way 19121 91 Parents controlled your life 19121 91 Parents fail to undentand your

needs 21121 100 Parents expected you to act older 14121 67

1/21 (50/0) a male child family member, 9/21 (430/0) a known adult male, 3/21 (140/0) a known adult female, and 2/21 (100/0) did not experience sexual abuse.


The ETI was also used to develop an index of severity of abuse exposure so that the relationship between severity of childhood abuse and memory function could be examined. Childhood abuse severity indexes were developed for each of the subscales of the ETI (physical, emotional, and sexual) by multiplying the total number of items endorsed as having occurred times the total number ofyears during which the event occurred, times the frequency with which the event occurred when it was occurring most frequently (based on an integer from 1 to 6, with 6 being the most frequent, definitions available upon request). The three subscales were also summed to give a total abuse severity index.

2.3. Assessment of alcohol abuse The Addiction Severity Index (ASI) interview

was used to assess lifetime alcohol abuse. The ASI evaluates the total number of years of alcohol abuse over the individual's lifetime (i.e., drinking to the point of intoxication, three or more drinks per day, on a regular basis, three or more days in a week) (McClellan et aI., 1985). Early trauma patients with a history of alcohol abuse were matched on a case-by-case basis with controls with a history of alcohol abuse on the basis of the ASI interview.

2.4. Neuropsychological testing of memory and intelligence

All subjects were administered a battery of neuropsychological tests as described below. (1) Four subtests of the Wechsler Adult Intelligence Scale (WAIS-R) were administered, including Arithmetic, Vocabulary, Picture Arrangement, and Block Design, to estimate an intellectual level for each subject. (2) Two subtests of the Wechsler Memory Scale (WMS) were administered according to the Russell revision (Russell, 1975). The subtests include Logical Memory, the free recall of two story narratives, which is felt to represent a test of verbal memory, and Figural Memory, which is felt to represent visual memory, involving the reproduction of designs following a 100s presentation. For both the WMS subtests, immediate and delayed reproduction were tested, and a percent retention score was computed (delayed

recalVimmediate recall x 1(0). (3) The Verbal Selective Reminding Test (VeSRT; Buschke and Fuld, 1974; Hannay and Levin, 1985) is a measure of verbal learning in which a list of 12 words is presented for immediate recall. On subsequent trials, only the words not recalled on the prior trial are presented. The task is complete after two consecutive perfect recall trials or 12 presentations. (4) The Visual Selective Reminding Procedure (ViSRT; Buschke and Fuld, 1974; Hannay and Levin, 1985) is a task modeled on the verbal selective reminding in which 12 designs are presented one at a time for 3 s each, followed by an opportunity for the subject to draw all from memory. Each design that is not accurately reproduced on a given trial is shown again until perfect recall is attained or 12 trials are reached. Five indices of learning and memory are obtained from each of the selective reminding tasks: Total Recall, Longterm Retrieval, Long-term Storage, List Learning (Consistent Long-term Retrieval), and Delayed Recall.

2.5. Data analysis A series of t tests were performed between

patients and controls for each of the subcomponents of the WMS, SRT, and WAIS-R. Twotailed nonpaired tests of significance were used throughout. Pearson's product-moment correlations were performed between scores on neuropsychological testing and abuse severity scores. The Bonferroni correction was applied to adjust for multiple comparisons. Significance was defined as P < 0.05.

3. Results

Adult survivors of abuse had deficits in verbal short-term recall, as measured by decreased scores on the Logical component of the WMS for immediate recall and delayed recall, but not..percent retention. Adult survivors of abuse also had deficits in verbal recall, as measured by the VeSRT (Table 2). After adjustment for multiple comparison with the Bonferroni correction, only the WMS Logical immediate and delayed recall tests differed significantly between patients and controls (P < 0.(03). Adult survivors of abuse did not have


Table 2 Wechsler Memory Scale (WMS) and Selective Reminding Test (SRT) scores in early trauma patients and normal subjects

Early trauma patients (n =21)

Normal subjects (n= 20)

P

Mean SO Mean SO

WMS Logical Memory Immediate recall Delayed recall Retention (%.)

13.6 10.5 75.0

3.3 5.6

24.1

2Q.8 17.8 84.7

6.5 6.1

11.9

3.71 3.98 1.58

0.0007· 0.0003· 0.12

WMS Figural Memory Immediate recall Delayed recall Retention (o/u)

10.2 10.1 96.4

2.9 3.2 6.9

10.9 9.3

82.9

3.4 4.2

20.8

0.66 0.73 2.96

0.51 0.47 0.007

Verbal SRT Recall Long-term storage Long-term retrieval Continuous long-term retrieval Delayed recall

102.6 92.4 83.8 58.7 8.0

19.1 18.5 29.1 32.5 3.5

115.6 111.5 101.5 83.8 10.0

14.4 16.6 21.6 32.4 2.2

2.47 2.64

'2.21 2.48 2.24

0.019 0.013 0.033 0.018 0.03

VisuDl SRT

Recall Long-term storage Long-term retrieval Continuous long-term retrieval Delayed recall

126.3 124.4 121.1 111.5

11.3

16.6 21.4 23.4 30.2

1.0

126.3 125.1 123.9 120.4

11.1

30.7 30.8 30.9 31.5 2.7

0.004 0.08 0.32 0.92 0.44

0.99 0.93 0.75 0.36 0.66

.p < 0.05 after Bonferroni correction for multiple comparisons (df= 39 for all comparisons).

deficits in visual short-term memory as measured by the WMS figural component or the ViSRT. In fact, there appeared to be a tendency (which was not significant after correction for multiple comparisons) for the patients to have higher scores on the WMS visual memory task than did the controls (Table 2).

There were no significant IQ differences between adult survivors of severe childhood physical and sexual abuse and controls. Specifically, there were no differences in WAIS-R scores between PTSD patients (n =21) and controls (n =20) for verbal IQ (patients: mean =101.0, SO =17.5; controls: mean =103.0, SO =17.6; t =0.34, dj= 39, P =0.73), performance IQ (patients: mean =100.5, SO =18.4; controls: mean =107.8, SD =19.5; t =1.21, dj= 39, P =0.23), or full scale IQ (patients: mean =101.0, SO =16.5; controls: mean =106.7, SO =19.1; t =1.01, df= 39,

P = 0.32). Although there were no statistically significant differences, there was a tendency for the abused patients to have slightly lower IQ. The magnitude of difference was not nearly so large as for memory. We elected not to compare memory scores between the two groups with covariation for IQ, because deficits in memory could cause slight decreases in IQ (Le., memory function likely contributes to some of the variance in IQ).

Severity of abuse was related to deficits in verbal short-term memory in the PTSO patient group. Overall severity of abuse, as measured by the summed abuse severity score (sum of physical, sexual, and emotional abuse severity scores, calculated from the ETI as described above), was significantly correlated with deficits in short-term verbal recall, as measured by the WMS Logical immediate recall subcomponent (r =-0.46, df=20, P =0.035). In addition, severity of sexual abuse

104 J.D. Bremner et al. / Psychiatry Research 59 (/995) 97-/07

when considered alone was correlated with deficits in verbal short-term memory, as measured by the WMS Logical immediate recall subcomponent (r =-0.48, df = 20, P = 0.026). Although there were no statistically significant differences in IQ between early trauma patients and comparison subjects, it is of interest to note that there were some relationships between IQ and abuse in this study. Overall severity of abuse, as measured by the summed abuse severity score, was associated with decreased performance IQ (r = -0.45, df= 20, P =0.039) and full-scale IQ (r = -0.44, df =20, P =0.045). Severity of physical abuse was associated with decreased performance IQ (r =-O.SO~ df =20, P =0.022).

4. Discussion

Adult survivors of childhood physical and sexual abuse had deficits in verbal short-term recall, as measured by the WMS Logical component, as well as immediate and delayed recall, with no difference in IQ in comparison to matched control subjects. There were no differences in visual memory between adult survivors of childhood abuse and control subjects. Overall severity of abuse was related to degree ofmemory impairment in the early trauma patients.

Stress at different stages ofdevelopment appears to have similar effects on verbal short-term memory. In our previously reported group of patients with contbat-related PTSD, exposure to trauma in most patients occurred at about the age of 20, while in the current group of survivors of childhood abuse, traumatic exposure often occurred as early as before the age of 5 years. There is a similar pattern of specific deficits in verbal memory, with no significant change in IQ, in both adult survivors of abuse and patients with combatrelated PTSD. The left hippocampus is felt to be involved in verbal memory to a relatively greater degree than the right, while the right hippocampus is involved in visual memory to a greater degree. Thus, left hippocampal dysfunction might explain our findings.

These- findings add to the growing literature in support of a relationship between stress and alterations in memory. A number of preclinical studies suggest that stress is associated with deficits in

memory. For example, animals exposed to the stress of electric footshock develop deficits in short-term memory as manifested by deficits in maze escape behaviors (Drugan et aI., 1984). High levels of glucocorticoids associated with stress result in damage to neurons of the hippocampus (Sapolsky et aI., 1988, 1990; Uno et aI., 1989), a brain structure that plays an important role in learning and memory, with associated deficits in memory (Luine et aI., 1994). Stress also appears to result in overconsolidation of memory, which may be related to neurotransmitters and neuropeptides released during stress that facilitate the laying down of memory traces (Pitman, 1989; Pitman et aI., 1993; Bremner et aI., 1995a).

There was a relationship between overall level of abuse exposure measured with the ETI and deficits in short-term verbal memory in the patients in this study. The relationship suggests that deficits in short-term memory are clinically meaningful and relate to exposure to the stressor of abuse itself instead of to other factors such as psychiatric patient status. In addition, the current findings are a partial validation of the ability of the ETI to measure abuse-related phenomena. Early trauma patients also showed a relationship between IQ and level of trauma exposure, where lower IQ was associated with increased levels of abuse. This relationship between trauma exposure and IQ was not seen in our combat-related PTSD sample. Previous studies in children with a history of severe abuse have found a relationship between the arithmetic subscale of the IQ test and markers of abuse (Lewis et aI., 1979). Trauma at early stages of development may have an effect on IQ that is not seen in patients exposed to traumatic stress at later periods of development. Alternatively, since IQ is remarkably stable throughout the lifetime, and appears to have a heritable component, one might consider that families in which there is lower IQ may be associated with situations of abuse. Therefore, low IQ may be a risk factor, rather than an outcome, for exposure to abuse. Although our patients did not have significantly lower IQ scores than comparison subjects, it can be seen from the data that with a much larger number of subjects, it might be possible to demonstrate lower IQ in the patients in comparison to the normal subjects.

One might argue that our findings of deficits in

105 J.D. BremMr et al./ Psychiatry Research 59 (1995) 97-107

verbal memory in patients with early traumarelated PTSD are attributable to an impairment in concentration. Decreased concentration is a symptom of PTSD. However, emerging findings from other groups using the continuous performance test (CPT) in the evaluation of concentration in PTSD patients have revealed no difference between patients and controls in concentration. In addition, a general concentration impairment would not be expected to result in a specific deficit in verbal memory function, but rather a general effect on both visual and verbal memory.

Findings of deficits in short-term verbal memory have implications for the clinical treatment of individuals with a history of severe childhood abuse. These patients may have difficulties with learning that impair academic performance (P. Saigh, personal communication, February 1, 1995). There is a tendency to direct patients who are disabled by psychiatric disorders toward rehabilitation programs. These programs often involve a return to the university to learn new job skills. Patients with a history of severe abuse may have deficits in new learning and memory that make academic goals difficult to attain. Rehabilitation that involves, for example, training in job skills that do not require a large amount of memorization may be indicated. In addition, early treatment interventions may prevent the long-term impairments in memory function, and hence academic performance, that appear to be associated with exposure to high levels of stress as occurs with childhood abuse (Saigh, 1989). Studies such as the current one that demonstrate long-term impairment in academic performance, which appears to be associated with childhood abuse, underscore the magnitude of childhood abuse as a major public health problem.

Acknowledgments

The authors thank Valinda Ouelette, R.N., for assistance in administration of testing and Beverly Homer for assistance in research administration and data management. This project was supported by a Veterans Administration Research Fellowship in Biological Psychiatry and a Veterans Administration Career Development Award to Dr. Bremner, as well as the National Center for

PTSD Grant. The authors also thank Dudley Blake, Ph.D. (formerly of the VA Medical Center site of the National Center for PTSD in Menlo Park, Calif., and now in Boise, Idaho), and Paula Schnurr, Ph.D. (White River Junction site of the National Center for PTSD), for useful discussions, as well as their contribution and those of other individuals to the Early Trauma Inventory (ETI) project, which involved the collaboration of investigators from the four sites of the National Center for PTSD (White River Junction, Vt.; West Haven, Conn.; Boston, Mass.; Menlo Park, Calif.). We also thank Carolyn Mazure, Ph.D., for expert collaboration in instrument development methodology in the ETI project.

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Return to the Emergency Room immediately if:

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. no SOh~ f~OdS, IMlally;:When dla~rhea decreas~s, uy-~~~~.~~~r. "', Blear Liquids:' Jello. fr.llit IUI.ces (apple. cranberry, ~r.pe);:'broth/soda. (seven-up. glnger-aleh Don t remain on a clear liquid dietfotmorethan 72 hours. Call your doctor if diarrhea persists more thtin:72hours.

Blend Diet~eggs. meat. fish. poultry. potato. rice. n~i;S:·~~;;81:;toast.· • .. ---.:'¥" • ~:~ ~. ~ . •

NOTE: AVOIO-milk and other dairy products. raw fi'uiIa end~. nuts. chocolate, and fatty or fried foods until you a,. better;- . ,~'" '.~">-""'i'w ...;.-\';.,~ o JOINT SPRAINS. SEVERE BRUISES:"- •:.~,;:r;.;:~:::,

Pain is usually mild when the injury occurs. but ~rse~~'~~~ra f~ hours. Swelling also comes on gradually. " ,", "o~',-;~·;~; .":-\'; ,

... ;;" :

1. Rest is the most important treatment. .';. -~. ",'

2. Keep injured arm or leg eleval8d higher than Y,o.ur 'heart level to ' prevent swelling and reduce soreneb.- ,. : .. "': ,~~-' .

3. Coid packsshouhl be applied·for the first 24-48 hour~. Use ato~el between the ice bag and the skin to avoid frostbite.

4. Warm packs or soaks may be used after 48 hours, , '

6. po not stand on an injured foot or leg until you can do so~ithoutpain; then gradually return to normal activity. ,

• o NECK & BACK STRAIN

. 1. .Rest the injured area. avoiding any·painful m<Wemen~.•. , ,;,~, '~--:~:::.:.;; '<c . ~ .. '

2. Apply heat at least 3 or 4 times a day. .... ., ; .. ".

3. For neck strains. try sleeping with a low pillow or no pillow at all.

4. I~crease activities very gradually. "',' i-;.To ~,----------~D""""O""T"'Hf~F""O-l-LO-W-IN-G-_O-N-L-Y-I-F-C-H-E-C-K-E-D-S-Y-r-H-E-O-O..;,C-T-O-R-------..;,,;;.--

- I o Cold packs for first 24-48 hours. Use a towel between the ice bag andC ..... the skin to avoid frostbite. '0 -0 Heat every hours for minutes until _0 .beginning _

0:: o Soak in warm water every hours for minutesW

for days.~ Z o May take aspirin or Tylenol 1 or 2 tablets every 4 hrs. as needed. ~

MEDICATIONS/PRESCRIPTIONS "C.. Medication Amount Order,c!

~ Dose Directions _o

u CD

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o Drink gla"'s of fluid a day until , ~ , ~,

- 0 Make an appointment with a physician for~. tetanus toxoid booeter in 1 month and again in 6 months to complete ybur immunization.

1:1 Do not drink any alcoholic beverages, drive a car, or operate any dangerous machinery while taking the medication given or...-c:ribed for you.

OTHER INSTRUCTIONS

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o Your appointment is on at _ ,0 Call for an appointment to be seen in days. o Clinic 448- _

• Interpretation of X-rays and tests is preliminary only. .You will be contacted if there is any further abnormality

~- '

that needs medical attention. • I understand that I have had emergency treatment only

and that I must arrange for follow-up care as indicated above.

• I understand the instructions above.

01 t..llt<f: Q0 40 l an. LlI-k.J.re.v. hC'

DATE TIME W1vsICIAN SIGNATURE 0

o Industrial Compensetion Clinic (Enter thru Bobst Entrance) o City Compensation Clinic 216 N. Broad St.• 6th Fir. (; day) o Oral Surgery Clinic 326 N. 16th St. o William Penn Bldg. 246 N. Broad St. o Feinstein Bldg. 216 N. Broad St. o Your own doctor ----------------- o Other

-~The patient may return to work or school. ~"i'he patient may not return to work or school

until Restrictions: ,

.0. Signature:· I

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SIGNATURE AUTHORlZ£q,1?-~RSON RELATIGNSHIP TO PATIENT. :-.AME.AU;HORIZED PERSON(Print)

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-:-;Alrthorization for Eme!gencv Department Treatment

----::;IH'S AUTHORIZATION MUST BE SIGNED BY THE PATIENT, OR BY AN AUTHORIZE&PERSQN, __ .,': ,.....--' ----,------- ·..--(ExceP1To~ecgenci8sr ---'--'--::.----'..:..:;.~~~iooEo. ........;;-.....

_~~-=:__::-l! 1.<.=, . . '. .' .iI~Pfeseati~mYse4ft~~;agnosis.and·treatrneot.atltbe - .]q Em,fgencv'l)epiirtinenfof Hahnemanfi1'vfelficilIC011ege-ailafiospitarTcOilserit:uislrChcare;tnCfUarng-diig_--~::.---t--~

If further treatment is required. or If c:DlIlPlications_arise or if hospitalization is necessary. IDIl.undersigned UD~~~. ~_I .. stands t~ a personal phvslcian 15 !O De selected by or on behalf of the patient within 24 hours. ,l(1l2a3P

0' .

--- precedures. surgicid and medical treatment. and blood transfusions, .." physicians.and other health care pe~nne" ::;0 u maV in their professional jiJagemenDJinecemrv..:.--------.-,;-,,_.;'....-- ---~:--'-,-:-::.,:;V.'"; -_....::-~f.'-~,-<~-:+- --,

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. - - - --- .. . - - - -- - -- - - ._~ - --- - ~ ~.

~ THE UNDERSIGNED HAS READ THE ABOVE AUTHORIZATION AND UNDERSTANDS THE SAME AND''-~ -,IA ..... '.

'CERTIFIES THAT NO GUARANTEE OR ASSURANCEliAS BEEN MADE AS TO THE RESULTS THAT' ",', '."J." , I'vtAy BE OBTAINED.

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vs. CASE NO.: 12-11028-B



APPENDIX - 2




Exhibit 12 FDLE, NO Florida criminal history for Neil J. Gillespie

Exhibit 13 HCSO, NO criminal history for Neil J. Gillespie

Exhibit 14 Gillespie certified as Eagle Scout, December 3, 1971

Exhibit 15 University of Pennsylvania, Wharton Evening School, ABA, Dec-23, 1988

Exhibit 16 The Evergreen State College, BA, December 16, 1995

Exhibit 17 Letter from Terry D. Silver, CPA, December 13, 2001, Re: Neil Gillespie

Exhibit 18 News stories of Gillespie’s business, Bucks County Courier Times

Exhibit 19 Mr. Rodems law firm’s representation of Gillespie, DVR

Exhibit 20 Gillespie letter to Mr. Cook, Barker, Rodems & Cook, Re: Hate Speech

Exhibit 21 Letter of Dr. Karin Huffer, Re: Neil Gillespie and the ADA

Exhibit 22 Gillespie’s Nov-11-06 letter to Judge Neilsen, ADA; Mr. Nauman’s response

Step 5 of 5

Your Search Results

Your Search Criteria

FDLE found NO Florida criminal history based on the information provided. No criminal record check was conducted for other states or for the FBI.This record (or statement that there is not a record) is based on a request from a member of the public.This customer used the FDLE internet system to search for the Florida record. FDLE is providing this to respond to the customer's request.

Help understanding these results

First Middle Last Date of Birth Age Race Sex SSN

Name Neil Joseph Gillespie 03191956 W M 160525117

Maiden/ Alias - - - - -

* Name Aliases/Also Known As DOB SSN Sex Race Height Weight Eye Hair

Print Home Email Results to: [email protected] New Search

Page 1 of 1FDLE Criminal History Information on the Internet

9/12/2010https://www2.fdle.state.fl.us/cchinet/CCHCandidates.aspx

12

SANCHEZ. BARBARA

From: LINDSEY, HOWARD Sent: Wednesday, August 31, 2011 1:56 PM To: SANCHEZ, BARBARA Subject: RE: PRR - Neil Gillespie

Ms. Sanchez, I have spent approximately 45 minutes searching diligently to locate any record of arrest or otherwise for Mr. Gillespie. At this time I am unable to find any paper record or video of this individual and my search covered June 20, 2011 thru June 22, 2011. Please let me know if I can be of any other assistance.

Corporal Howard Lindsey #5243 Operations Corporal HCSO DDS (Orient Road) (813)247-8311 [email protected]

-----Original Message----From: SANCHEZ, BARBARA Sent: Wednesday, August 31, 2011 1:03 PM To: LINDSEY, HOWARD Cc: ADLER, EDWINIA Subject: FW: PRR - Neil Gillespie

Good Afternoon Cpl:

Please review the email below and attachments. Please research to assure if there are any records in your areas. Please provide me with the records and completed cost sheet (as soon as possible please) .

Barbara Sanchez, Records Custodian Records Section Hillsborough County Sheriff's Office Post Office Box 3371 Tampa, FL 33601 Office (813) 247-8153 Fax (813) 247-8295 Email: [email protected]

This agency is a public entity and is subject to Chapter 119 of the Florida Statute concerning public records. Email messages are covered under such laws and thus subject to disclosure.

-----Original Message----From: SANCHEZ, BARBARA Sent: Monday, August 29, 2011 9:51 AM To: LIVINGSTON, JAMES P Cc: OLIVER, SARAH; ADLER, EDWINIA Subject: PRR - Neil Gillespie

Good Morning:

Attached is a public records request from Neil Gillespie. Please review the attachment and provide the record from your area. Additionally, please complete the attached cost

1

13

I

sheet and return with the records.

SUSPENSE: 9/2/11

have included additional information regarding previous communications.

Barbara Sanchez, Records custodian Records Section Hillsborough County Sheriff's Office Post Office Box 3371 Tampa, FL 33601 Office (813) 247-8153 Fax (813) 247-8295 Email: [email protected]

This agency is a public entity and is subject to Chapter 119 of the Florida Statute concerning public records. Email messages are covered under such laws and thus subject to disclosure.

-----Original Message----From: [email protected] [mailto:[email protected]] Sent: Monday, August 29, 2011 10:16 AM To: SANCHEZ, BARBARA Subject: Message from KMBT 600

2

NEIL J GILLESPIE

TROOP 124- LEVITTOWN PENNSYLVANIA

HAVING SATISFACTORILY COMPLETED THE REQUIREMENTS

IS HEREBY CERTIFIED AS AN

EAGLE SCOUT BY THE

BOY SCOUTS OF AMERICA

DECEMBER 3 1971DATE

777 (Jl..Lr~

HONORARY PRESIDENT

~~ PRESIDENT

~ CHI Ef SCOUT EXECUTIVE

~~-~~~~1k~ ~:'A!'~~Lo~~~-o/~r~

~.-. /Yj-C;~~+~.~~~~~

~LorAYn/Lodkr~~ qj~

~.-..~~~.u,v,~~~

14

V N' .1 V E R SIT A S PENNSYLVANIENSIS

OMNIBVS HAS LITTERAS LECTVJtIS SAL'/TEM DICIT

,urn. academiis antiquus m.os sit scientiis litterisve '. humanioribus excultos titulo ius-to condecorare

nos igitur auc-tpri-tate Curatorum nobis com.m.issa

NEIL JOSEPH GILLESPIE ob studia a Professoribus approbata. ad gt'adum

ASSOCIATE IN BUSINESS ADMINISTRATION admisimus eique omnia iura honores privilegia. ad hunc

gradum pertinentia. Ubenter con.cessimus Cuius rei testimonio nOtnina nostta die mensis

Decembris XX\\\ Anno Salutis MCMLXXXVll\ et Vniversitatis conditae CCXL1X PhUadelphiae subscnpsimus

HIe GRADVS CONLATVS EST CVM LAVDE

s~ {::::) p R. ~ E

r 5

M ... A..unP1~ ~u11 e. ~ DECANVSSigilli Custos

15

THE EVERGREEN STATE COLLEGE

In recognition of completion

of the course of study approved by the faculty

)Veil joseph (jillespie

is awarded the degree

BACHELOR OF ARTS

with all its honors, privileges and obligations, Conferred at Olympia,

Washington, the Sixteenth day ofDecember,

Nineteen hundred and Ninety-Five.

v 16

YAMPOLSKY, MANDELOFF, SILVER & COMPANY, P.C.

Certified Public Accountants

1420 WALNUT STREET. SUITE 200 TELEPHONE (215)5454800 PHILADELPHIA. PA 19102 FAX (215) 985-1161

December 13, 1991

To whom it may concern:

I have been requested to set forth a history of my relationship with Mr. Neil Gillespie, which is as follows:

1) I have known Neil since 1978 when I became his accountant. At that time, Neil was an automobile sales person.

2) Several years after I began performing Neil's personal income tax work, he began his own used automobile business which was incorporated under the name of Kar Kingdom, Inc. The Company operated from a rental location for approximately two years, at which time Neil purchased a car lot in Langhorne, Pennsylvania to further the growth of the business. Under Neil's,direction, Kar Kingdom, Inc. continued to grow from one year to the next, realizing sales approaching $2,000,000 per year and employing approximately seven individuals.

3) Kar Kingdom, Inc. operated successfully through mid 1988, at which time the lot was sold due to a down turn in the automobile business in Langhorne.

4) During 1989 and 1990, Neil was instrumental in the formation of two Companies, Automotive Specialists, Inc. and Global Business Services, Inc. Neil lent his professional expertise to Automotive Specialists, Inc. while he offered professional business consulting services through his Company, Global Business Services, Inc.

5) Neil maintained his personal residences in Philadelphia ~rom 1984 through 1989, most of this period residing at the John Wanamaker House.

6) While Neil's business interests have suffered due to the ongoing current recession, our office continues to consider Neil as a quality client and a friend.

17

Page 2

Neil Gillespie December 13, 1991

We would be happy to provide any other information required regarding Neil Gillespie if requested.

Sincerely,

Terry D. Silver

TDS/kw/Gillespie

••

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un. Phlo} One-room Edgehlll school near Oxford Valley Mall

. . . built in 1894 and saId 14st month

Spared Middletown businessmen buy Wstoricschoolhouse

By Joe C1allnl Courier Times Stat( Writer

The site of the historic Edgchlll School In Middletown Township will not become I car wash, but a u~cd car lot mil!ht be in its futurC'.

The structure was recently purchas~d by two township business· men atter a car wash firm hacked out of a deal to buy it. And one oflhe ways the two are considering using the properly Is as a used car lot.

Nell Gillespie. owner of Kar Kingdom. aod Daniel Day. a realtor• paid $87,500 for the.tormer school, located at the Intersecllon of Routes I and 213 and next to the Joshua Tree 'restaurant. That is the same amount bid by National Pride at a public aucllon laslyear.

Nallonal Pride, which had hoped to build a car wash on the site, was unable to complete the sale because of high Interest rates and a Ilght loan market. .

Gillespie and Day made settlement on tbe property Jan. 20 but have not decided what to do with it.

"We arc considering sa ving the building and keeping it In the style It's In," Oay.sald.

One-room schoolhouse Although thp. structure was converted to a sjx~Toom house years

ago. ft is one of the last one-room schoolhouses In Lower Bucks County. The sale of the house prompted township officials to see if they could

.save the building. Barbara Russell, chairwoman of the township's Historical Pres

ervallon Commission, had urged township supervisors to do what they could to save the bUilding and the township convinced Nallonal Pride to withdraw a permit to demolish the building while alternallves were considered.

. Before a fin'al decision could be made, however, National Pride decided not to go through with the purchase and the bulldln~ became the property of Day and Gillespie, who were unsuccessful bidders at the public aucllon.

"We bought It as an Investment," Gillespie said. Day said one of the possible uses of the building Is as an office,

but he said he and his partner have not reached a final decision yet. . Used car 101 .

On Jan. 23 Gillespie wrote to Middletown building Inspector E. Max Einenker to say h.e hoped to use the property for the sale of used cars.

Elnenkel responded four days later. however. that the zoning or- . dinance affecting the property "specifically prohibits any use which involves, 8S its matn usc, 8 direct servJce to the general public. II

The two would then need to apply for a zoning variance and Day said he and Gillespie still are considering what use they can make of the building and the property.

Courier Times photo bv Art Gentile!

Neil Gillespie, president of Kar Kingdom in Middletow~ Township, displ.ays the Lo'itdon Roadster. ., i

~ew roadster has'408 imag~ Middletown dealer offers spiffy sports car

' .. !

~ByDave Chandler . Courier Times Business Editor

.::.~Kar Kingdom, a Middletown Township business, has be· come the exclusive area auto· ~mobile dealer for the London

:-fu}adster, an American·made convertible that looks like a

.'British sports car of the 1940s. :::';':,'''A lot of new cars today all ; JOl;)k alike," said Neil J. Gilles· ·;'pie. president of Kar Kingdom, .·which is located at Lincoln ~Highwayand Route 213: ., ;':"':':.;4But no one is going to con,:·rase this car...• he continued. ;' '''It's an original. U

;.':;~:The London Roadster is Kar ::l.I;1pgdom's first line of new ,Cllrs. Gillespie said. Up until ··now. ·the dealership only sold

used cars. The top-of-the-Iine London

Roadster model sells for $16,985, Gillespie explained. "It really is a fun kind of car," he said.

The car is manufactured by London Motors Corp. of Dear· born, Mich.

"The company has been in· .business for 19 years." Gillespic ·said. "Up until now, the 'company sold directly to the public through ads in the Wall

.Street Journal and the New York Times, .' . .,: "But now, they decided to in· crease their market sharc hy establishing dealers." . Gillespie, a Levittown native and a graduate of Bishop Egan

·Hil!h School, said hc found out

about the London Roadster in an advertisement in the W.all Street Journal.

"I called about getting a dealership," he said. "I flew out to Detroit and liked it. It's very similar to the early MGs (a British sports car) of the late 1940s and early 1950s.

".It's a very high-quality car. It's 78-percent hand made. ,," .

The London Roadster has a l.8-liter, 4-cylinder' engine. 'It has rack an~ pinion steering, disc brakes iii the front and drum brakes in the rear, an independent fou'r-wheel s'uspen-' sian, and a non-rust, fiberglllss body on a steel frame. .

A customer interested in buying a London Roadster must know how to drive a car

with manual transmission. . "It's modeled after the line. of real sports cars, and they didn't come with an automatic shiH," Gillespie said. ': . Kar Kingdom was started in 1980. Gillespie said. Its office building is located in the former Edge Hill School building: which was built in 1894 and used as a school until the 1940s.. ,·i

, "I After that. the building was

used as a residence up 'until thl! time Kar Kingdom bought i.t•.~:;

In order to display thc' Lo!!: don Roadster, GlIlespiebui!(.l! showroom adjoining Kar Kin'gdam's office building. The. deal, ership also recently built a ser: vice center to handle' all of its cars. . .. . ;:' ~'.\

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18

IN THE SUPREME COURT OF THESTATE OF FLORIDA

NEIL J. GILLESPIE

Petitioner, Case No.: SC11-1622Lower Tribunal No(s).: 2D10-5197

05-CA-7205vs.

BARKER, RODEMS & COOK, P.A. andWilliam J. Cook,

Respondents.________________________________________/

PETITION FOR WRIT OF MANDAMUS

APPENDIX, VOLUME 14

Respondents’ Representation of Petitioner in Florida Vocational Rehabilitation

Exhibit 1 2001, 03-22-01, Letter, Gillespie to Mr. Cook, Barker, Rodems &

Cook, Florida Vocational Rehabilitation (DVR), DLES CASE NO: 98-066-DVR

Exhibit 2 Second Amended Petition for Administrative Hearing, 06-07-98

Exhibit 3 Third Amended Petition for Administrative Hearing, 07-02-98

Exhibit 4 Petitioner’s Motion for Final Summary Order, 10-02-98

Exhibit 5 Petitioner’s Notice of Withdrawal Of Request for Hearing, 11-09-98

Exhibit 6 Order Dismissing and Closing the File, Final Order, 11-12-98

Exhibit 7 2001, 03-27-01, Mr. Cook, Barker, Rodems & Cook, to Gillespie, re DVR

19

Neil J. Gillespie 1121 Beach Drive NE, Apt. C-2

Saint Petersburg, Florida 33701-1434

Telephone and fax: (727) 823-2390

May 21,2001

William J. Cook, Attorney at Law Barker, Rodems & Cook, PA 300 West Platt Street, Suite 150 Tampa, Florida 33606

Dear Bill,

Thank you for letting me know about the Copernic Internet search tool. This search tool is similar to the ForeFront Direct product with which I was involved.

While using Copernic recently I came across some information illustrating the negative attitudes some people have toward persons born with cleft palate. Given the number of disability questions raised by John Anthony during my recent deposition, I thought you might find this data informative. Enclosed is the printout of the web page.

Sincerely,

Neil J. Gillespie

enclosure

20

Guess What?!! Page 1 of2

Guess What?!!

[ Follow Ups ] [Post Folowup ] [Tel Us Your Cleft Stories ]

Posted byHushG.. RecktIMm on December 12,19100 at 18:59:37:

In Reply to: anyone born with deft pallet and bare lip. ITom the UK? posted by Donna on February 03, 19100 at 05:10:45:

I hate people with hare-lips. I think you all are disgusting and should be killed at birth. God has punsished your parents for their sins.

Follow Ups:

• Re: Guess Wbat'!!J V 10:02:294/11/101 (0) • Re: Guess Wbat1!, You're • jackass, that's what" Frank 23:36:17 12/17/100 (0)

Post a Followup

Name:

I E-Mail:

Subject: IRe: Guess What?1!

Comments:

: :

I hate people with hare-lips. I think you all are disgusting and should be killed at birth. God has punsished your parents for their sins.

~

..:.J

rtiOnal Link URL:

http://www.cleft.net/storieslmessages/971.html 5/7/01

I

Guess What?!! Page 2 of2

Link Title:

Optional Image URL:

Submit FplJow Up I Reset I

[ Follow Ups ] [Post FoUowup ] [Tell Us Your Cleft Stories ]

http://www.cleft.net/storieslmessages/971.html 5/7/01

Gillespie p1 of 2

1

DR. KARIN HUFFER

Licensed Marriage and Family Therapist #NV0082ADAAA Titles II and III Specialist

Counseling and Forensic Psychology3236 Mountain Spring Rd. Las Vegas, NV 89146702-528-9588 www.lvaallc.com

October 28, 2010


I created the first request for reasonable ADA Accommodations for Neil Gillespie. Thedocument was properly and timely filed. As his ADA advocate, it appeared that his rightto accommodations offsetting his functional impairments were in tact and he was beingafforded full and equal access to the Court. Ever since this time, Mr. Gillespie has beensubjected to ongoing denial of his accommodations and exploitation of his disabilities

As the litigation has proceeded, Mr. Gillespie is routinely denied participatory andtestimonial access to the court. He is discriminated against in the most brutal wayspossible. He is ridiculed by the opposition, accused of malingering by the Judge andnow, with no accommodations approved or in place, Mr. Gillespie is threatened witharrest if he does not succumb to a deposition. This is like threatening to arrest aparaplegic if he does not show up at a deposition leaving his wheelchair behind. This isprecedent setting in my experience. I intend to ask for DOJ guidance on this matter.

While my work is as a disinterested third party in terms of the legal particulars of a case,I am charged with assuring that the client has equal access to the court physically,psychologically, and emotionally. Critical to each case is that the disabled litigant is ableto communicate and concentrate on equal footing to present and participate in their casesand protect themselves.

Unfortunately, there are cases that, due to the newness of the ADAAA, lack of training ofjudicial personnel, and entrenched patterns of litigating without being mandated toaccommodate the disabled, that persons with disabilities become underserved and are toooften ignored or summarily dismissed. Power differential becomes an abusive andoppressive issue between a person with disabilities and the opposition and/or courtpersonnel. The litigant with disabilities progressively cannot overcome the stigma andbureaucratic barriers. Decisions are made by medically unqualified personnel causingthem to be reckless in the endangering of the health and well being of the client. Thiscreates a severe justice gap that prevents the ADAAA from being effectively applied. Inour adversarial system, the situation can devolve into a war of attrition. For anunrepresented litigant with a disability to have a team of lawyers as adversaries, thedemand of litigation exceeds the unrepresented, disabled litigantís ability to maintainhealth while pursuing justice in our courts. Neil Gillespieís case is one of those. At thisjuncture the harm to Neil Gillespieís health, economic situation, and generaldiminishment of him in terms of his legal case cannot be overestimated and this bell

21

Gillespie p2 of 2

2

cannot be unrung. He is left with permanent secondary wounds.

Additionally, Neil Gillespie faces risk to his life and health and exhaustion of the abilityto continue to pursue justice with the failure of the ADA Administrative Offices torespond effectively to the request for accommodations per Federal and Florida mandates.It seems that the ADA Administrative offices that I have appealed to ignore his requestsfor reasonable accommodations, including a response in writing. It is against mymedical advice for Neil Gillespie to continue the traditional legal path without properlybeing accommodated. It would be like sending a vulnerable human being into a field ofbullies to sort out a legal problem.

I am accustomed to working nationally with courts of law as a public service. I agreethat our courts must adhere to strict rules. However, they must be flexible when it comesto ADAAA Accommodations preserving the mandates of this federal law Under Title IIof the ADA. While ìpublic entities are not required to create new programs that provideheretofore unprovided services to assist disabled persons.î (Townsend v. Quasim (9th Cir.2003) 328 F.3d 511, 518) they are bound under ADAAA as a ministerial/administrativeduty to approve any reasonable accommodation even in cases merely ìregardedî ashaving a disability with no formal diagnosis.

The United States Department of Justice Technical Assistance Manual adopted byFlorida also provides instructive guidance: "The ADA provides for equality ofopportunity, but does not guarantee equality of results. The foundation of many of thespecific requirements in the Department's regulations is the principle that individualswith disabilities must be provided an equally effective opportunity to participate in orbenefit from a public entity's aids, benefits, and services.î (U.S. Dept. of Justice, Title II,Technical Assistance Manual (1993) ß II-3.3000.) A successful ADA claim does notrequire ìexcruciating details as to how the plaintiff's capabilities have been affected bythe impairment,î even at the summary judgment stage. Gillen v. Fallon Ambulance Serv.,Inc., 283 F.3d. My organization follows these guidelines maintaining a firm, focused andlimited stance for equality of participatory and testimonial access. That is what has beendenied Neil Gillespie.

The record of his ADAAA accommodations requests clearly shows that his well-documented disabilities are now becoming more stress-related and marked by depressionand other serious symptoms that affect what he can do and how he can do it ñ particularlyunder stress. Purposeful exacerbation of his symptoms and the resulting harm is, withouta doubt, a strategy of attrition mixed with incompetence at the ADA Administrative levelof these courts. I am prepared to stand by that statement as an observer for more thantwo years.

Neil J. Gillespie 8092 SW 115th Loop Ocala, Florida 34481

Telephone: (352) 502-8409

Septerrlber 26, 2006

The Honorable Richard A. Nielsen Circuit Court Judge Circuit Civil, Division F 800 E. Twiggs Street, Room 524 Tampa, Florida 33602

RE: Americans with Disabilities Act (ADA) Accommodation Request Gillespie v. Barker, Rodems & Cook, P.A., and William J. Cook Case number: 2005-CA-7205, Division F

Dear Judge Nielsen,

In reply to the telephone message from your judicial assistant Myra Gomez, I am disabled and being treated for depression and anxiety, which limits my ability to participate in court proceedings and meet deadlines. I request that you provide an acconunodation for my disability under the Americans with Disabilities Act (ADA), specifically the appointment of counsel to represent me in this lawsuit and counterclaim.

Thank you.

cc: Ryan Christopher Rodems, Attorney for Defendants

22.1

ADMINISTRATIVE OFFICE OF THE COURTS THIRTEENTH JUDICIAL CIRCUIT OF FLORIDA

LEGAL DEPARTMENT DAVID A. ROWLAND COURT COUNSEL

September 29,2006

Neil 1. Gillespie 8092 SW 115th Loop Ocala, Florida 34481

RE: Gillespie v. Barke.r. Rod~ms & Cook, P.A., and William J. Cook, Case No.: 05-CA007205, Thirteenth Judicial Circuit Court, General Civil Division

Dear Mr. Gillespie:

Judge Richard A. Nielsen forwarded to me your letter dated September 26, 2006, for response.

Please be advised the Thirteenth Judicial Circuit is aware of the provisions of the Americans with Disabilities Act (ADA) and makes every effort to ensure persons with disabilities are given accommodations in order to provide equality of opportunity and full participation before any court of this circuit.

In your letter to Judge Nielsen you indicate that you are being treated for depression and anxiety and are therefore requesting the appointment of counsel to represent you with your pending civil lawsuit as a reasonable accommodation under the ADA. While depression and anxiety are conditions that mayor may not be considered impairments under the ADA, depending on whether these conditions result from a documented physiological or mental disorder, your specific request for the appointment of counsel to represent you in a civil lawsuit is not a reasonable or appropriate accommodation under the ADA.

I can assure you the Thirteenth Judicial Circuit will fully comply with the requirements of the ADA and will provide any appropriate accommodations that may be necessary to allow you equality of opportunity and full participation in your case before Judge Nielsen. However, any further requests for ADA accommodations should be directed to the attention of Gonzalo B. Casares, ADA coordinator for the 13th Judicial Circuit, 800 E. Twiggs St., Tampa, Florida, 33602. Mr. Casares may also be contacted by telephone at 813-272-6513, and selecting option 2.

Sincerely,

X.~~ K. Christopher Nauman Assistant Court Counsel

cc: The Honorable Richard A. Nielsen

419 PIERCE STREET • ROOM 214 E • TAMPA, FLORIDA 33602-4022 • PHONE (813) 272-6843 • FAX (813) 272-5522

22.2




vs. CASE NO.: 12-11028-B



APPENDIX - 3




Exhibit 23 13th Circuit Counsel David Rowland to Gillespie, Re: ADA July 9, 2010

Exhibit 24 Affidavit of Neil J. Gillespie, Re: Judge Cook and Rodems’ disqualification

Exhibit 25 Mr. Rodems’ Motion for Order Determining ADA Disability for Gillespie

Exhibit 26 Order by Hon. Wm. Terrell Hodges, Gillespie established a cause of action inGillespie v. HSBC Bank, Case 5:05-cv-00362-WTH-GRJ Document 32 09/25/06

Neil Gillespie

From: "Rowland, Dave" <[email protected]>To: <[email protected]>Cc: "Casares, Gonzalo" <[email protected]>; <[email protected]>Sent: Friday, July 09, 2010 3:28 PMAttach: Response to Neil Gillespie ADA Request.pdfSubject: Gillespie v. Barker, Rodems & Cook, Case No: 05-CA-007205, Thirteenth Judicial Circuit, General

Civil Division

Page 1 of 1

8/6/2012

Attached is a response to your July 6, 2010 ADA request for accommodation. David A. Rowland General Counsel, Thirteenth Judicial Circuit 800 East Twiggs Street, Suite 603 Tampa, Florida 33602 Telephone: (813) 272-5905 [email protected]

23.1

ADMINISTRATIVE OFFICE O F THE COURTSTHIRTEENTH JUDICIAL CIRCUIT OF FLORIDA

LEGAL DEPARTMENT

D AVID A. ROWLAND GENERAL COUNSEL

July 9, 2010

Neil J. Gillespie8092 SW 115`h LoopOcala, Florida. 34481

Via E-Mail: lleilhillesJ^ie r mli.net

Re: ADA Accommodation RequestGillespie v. Barker, Rodems & Cook, Case No.: 05-CA-007205,Thirteenth Judicial Circuit, General Civil Division

Dear Mr. Gillespie:

This is a response to your July 6, 2010 ADA request for accommodationdirected to Gonzalo Casares, the Thirteenth Judicial Circuit ADA Coordinator.You request the same ADA accommodations previously submitted on February 19,2010. Your February 19, 2010 ADA request was a request for the court to take thefollowing case management actions:

1. Stop Mr. Rodems' behavior directed toward you that is aggravating your

post traumatic stress syndrome.

2. Fulfill case management duties imposed by Florida Rule of Judicial

Administration 2.545 and designate the above-referenced case as complex

litigation under Florida Rule of Civil Procedure 1.201.

3. Offer services, programs , or activities described in Judge Isom 's law review

article - Professionalism and Litigation Ethics, 28 Stetson L. Rev. 323, 324

(1998) - so the court can "intensively" manage the case.

800 EAST Twmos STREET • SurrE 603 • TAMPA. FLORIDA 33602 • PHONE: (873) 273-6843 • WEB: wwwfljudl3.org

Neil J. Gillespie

July 9, 2010

Page 2

4. Enforce Judge Isom's directives imposed on February 5, 2007 which require

both parties to only address each other by surname when communicating

about this case and require parties to communicate in writing instead of

telephone calls.

5. Allow a 180-day stay so you can scan thousands of documents in this case to

PDF and find and hire replacement counsel.

As ADA Coordinator, Mr. Casares can assist in providing necessaryauxiliary aids and services and any necessary facility-related accommodations.But neither Mr. Casares, nor any other court employee, can administratively grant,as an ADA accommodation, requests that relate to the internal management of apending case. All of your case management requests - that opposing counsel'sbehavior be modified, that the court fulfill its duties under Rule 2.545, that theabove-referenced case be designated as complex, that your case be "intensively"managed as suggested by Judge Isom's law review article, that Judge Isom'sprevious directive regarding communication between parties be enforced, that yourcase be stayed - must be submitted by written motion to the presiding judge of thecase. The presiding judge may consider your disability, along with other relevantfactors, in ruling upon your motion.

Sincerely,

cc: The Honorable Martha J. CookRyan C. Rodems, Counsel for DefendantGonzalo Casares, ADA Coordinator for the Thirteenth Judicial Circuit

ADMINISTRATIVE OFFICE OF THE COURTS THIRTEENTH JUDICIAL CIRCUIT OF FLORIDA

LEGAL DEPARTMENT

DAVID A. ROWLAND GENERAL COUNSEL

July 9,2010

Neil 1. Gillespie 8092 SW IIS lh Loop Ocala, Florida 34481

Via E-Mail: neilgillespic(Ct:mli.Jlct

Re: ADA Accommodation Request Gillespie v. Barker, Rodems & Cook, Case No.: 05-CA-007205, Thirteenth Judicial Circuit, General Civil Division

Dear Mr. Gillespie:

This is a response to your July 6, 2010 ADA request for accommodation directed to Gonzalo Casares, the Thirteenth Judicial Circuit ADA Coordinator. You request the same ADA accommodations previously submitted on February 19, 2010. Your February 19,2010 ADA request was a request for the court to take the following case management actions:

1. Stop Mr. Rodems' behavior directed toward you that is aggravating your post traumatic stress syndrome.

2. Fulfill case management duties imposed by Florida Rule of Judicial Administration 2.545 and designate the above-referenced case as complex

litigation under Florida Rule of Civil Procedure 1.201.

3. Offer services, programs, or activities described in Judge Isom's law review

article - Professionalism and Litigation Ethics, 28 Stetson L. Rev. 323, 324

(1998) - so the court can "intensively" manage the case.

800 EAST TWIGGS STREET • SUITE 603 • TAMPA, FLORIDA 33602 • PHONE: (813) 272-6843 • WEB: www.fIjud13.org

23.2

Neil 1. Gillespie July 9,2010 Page 2

4. Enforce Judge Isom's directives imposed on February 5, 2007 which require both parties to only address each other by surname when communicating about this case and require parties to communicate in writing instead of telephone calls.

5. Allow a l80-day stay so you can scan thousands of documents in this case to PDF and find and hire replacement counsel.

As ADA Coordinator, Mr. Casares can assist in providing necessary auxiliary aids and services and any necessary facility-related accommodations. But neither Mr. Casares, nor any other court employee, can administratively grant, as an ADA accommodation, requests that relate to the internal management of a pending case. All ofyour case management requests - that opposing counsel's behavior be modified, that the court fulfill its duties under Rule 2.545, that the above-referenced case be designated as complex, that your case be "intensively" managed as suggested by Judge Isom's law review article, that Judge Isom's previous directive regarding communication between parties be enforced, that your case be stayed - must be submitted by written motion to the presiding judge of the case. The presiding judge may consider your disability, along with other relevant factors, in ruling upon your motion.

Sincerely,

ilfJ~ David A. Rowland

cc: The Honorable Martha J. Cook Ryan C. Rodems, Counsel for Defendant Gonzalo Casares, ADA Coordinator for the Thirteenth Judicial Circuit

- ----~ - ~. - ~.~ . _.. _._.- _-_...

ADMINISTRATIVE OFFICE OF THE COURTS

13TH JUDICIAL CIRCUIT

LEGAL DEPARTMENT

800 EAST TwIGGS ST., SUITE 603 TAMPA, FLORIDA 33602

o12H1621()396

... QI $00.449 VI ~ 07,:1712010 J:

MaHed F=rom 33601 US POSTAGE

Neil J. Gillespie BOQ2 SW 115th Leop Ocala, Florida 34481

:-':::::+4i~ :l :t:::::~:::::· 7 'liff II( lIi,l /Iii I I 1.1I1i/lIlJ!!I,I" 1/11 j III lid Ill/Idi "fd

--------------



NEIL J. GILLESPIE,

Plaintiff and Counter-Defendant, CASE NO.: 05-CA-7205 vs.

BARKER, RODEMS & COOK, P.A., DIVISION: G a Florida corporation; and WILLIAM J~ COOK,

Defendants and Counter-Plaintiffs. /

AFFIDAVIT OF NEIL J. GILLESPIE

Neil J. Gillespie, under oath, testifies as follows:

1. My name is Neil J. Gillespie, and I am over eighteen years of age. This

affidavit is given on personal knowledge unless otherwise expressly stated.

2. Circuit Judge Martha J. Cook is presiding over this lawsuit.

3. I am suing my former lawyers in this lawsuit. On information and belief,

Ryan Christopher Rodems is unlawfully representing Barker, Rodems & Cook, PA and

William J. Cook against me.

4. Plaintiffs Motion To Disqualify Counsel was heard April 25, 2006 by

Judge Nielsen. On May 12, 2006 Judge Nielsen signed Order Denying Plaintiffs Motion

To Disqualify Counsel. The Order holds that "The motion to disqualify is denied with

prejudice, except as to the basis that counsel may be a witness, and on that basis, the

motion is denied without prejudice." A certified copy of the Order is attached to this

affidavit as "Exhibit A". There has been no Order on adjudication as to the basis that

Page 1 of4 24

counsel may be a witness. The question of disqualification on the counterclaim has not

been heard at all.

5. Under Florida law the question is not whether Mr. Rodems may be a

witness but whether he "ought" to be a witness. Proper test for disqualification of counsel

is whether counsel "ought" to appear as a witness.[l] Matter of Doughty, 51 B.R. 36.

Disqualification is required when counsel "ought" to appear as a witness. [3] Florida

Realty Inc. v. General Development Corp., 459 F.Supp. 781. On information and belief

Mr. Rodems ought to be a witness.

6. On July 9, 2010 I filed Emergency Motion to Disqualify Defendants'

Counsel Ryan Christopher Rodems & Barker, Rodems & Cook, PA. The motion properly

raises the issue in paragraph 4. The motion properly considered de novo the question of

disqualification on the counterclaim. The motion also shows misconduct by Mr. Rodems

at the April 25, 2006 hearing sufficient to overturn the Order of May 12, 2006.

7. On July 22, 2010 Judge Cook issued "Order Denying Plaintiffs

Emergency Motion to Disqualify Defendants' Counsel Ryan Christopher Rodems &

Barker, Rodems & Cook, PA". A certified copy of the Order is attached to this affidavit

as "Exhibit B". In her Order, Judge Cook wrote "This is the third time that the Plaintiff

has motioned to disqualify Defendant's counsel, despite having been informed in an order

issued May 12,2006 that this issue had been DENIED WITH PREJUDICE." This

statement by Judge Cook is false. The Order issued May 12, 2006 clearly states that

"[e]xcept as to the basis that counsel may be a witness, and on that basis, the motion is

denied without prejudice."

Page 2 of4

8. Judge Cook also wrote, "The Clerk of Court is ORDERED to never accept

another pleading from the Plaintiff that indicates an attempt to disqualify Defendants'

counsel, as this matter has been DISMISSED WITH PREJUDICE."


willfully, with malice aforethought, falsified a record in violation of chapter 839, Florida

Statlltes, section 839.13(1) if any judge shall falsify any record or any paper filed in any

judicial proceeding in any court of this state, or conceal any issue, or falsify any document

filed in any court the person so offending shall be guilty of a misdemeanor of the first

degree, punishable as provided in s. 775.082 or s. 775.083.


willfully, with malice aforethought, engaged in official misconduct to harm Neil Gillespie

and benefit Ryan Christopher Rodems and his clients, by falsifying an official record or

official document as described in this affidavit, to deny Gillespie due process, in violation

of the Misuse of Public Office statute, chapter 838 Florida Statutes, section 838.022

Official misconduct. (1) It is unlawful for a public servant, with corrupt intent to obtain a

benefit for any person or to cause harm to another, to: (a) Falsify, or cause another person

to falsify, any official record or official document; (3) Any person who violates this

section commits a felony of the third degree, punishable as provided in s. 775.082, s.

775.083, or s. 775.084.


willfully, with malice aforethought, made a false statement in writing with the intent to

mislead a public servant, Pat Frank, Clerk of the Circuit Court, in the performance ofher

official duty, in violation of the perjury statute, chapter 837 Florida Statutes, section

Page 3 of4

837.06 False official statements. Whoever knowingly makes a false statement in writing

with the intent to mislead a public servant in the performance of his or her official duty

shall be guilty of a misdemeanor of the second degree, punishable as provided in s.

775.082 or s. 775.083.

FURTHER AFFIANT SAYETH NAUGHT.

Dated this 27th day of September 2010.

STATE OF FLORIDA COUNTY OF MARION

BEFORE ME, the undersigned authority authorized to take oaths and acknowledgments in the State of Florida, appeared NEIL J. GILLESPIE, personally known to me, or produced identification, who, after having first been duly sworn, deposes and says that the above matters contained in this Affidavit are true and correct to the best of his knowledge and belief.

WITNESS my hand and official seal this 27th day of September 2010.

~~ CECIUA ROSENBERGER Notary Public ,

it1 Commission 00 781620 •• Exptres June 6, 2012 State of Florida

BondId l1w T~ Fain InuInoe....701.

Page 4 of4

Defendants. /-------------

I EXHIBIT

3ft



NEIL J. GILLESPIE,

Plaintiff,

vs. Case No.: 05CA7205 Division: F

BARKER, RODEMS & COOK, P.A., a Florida corporation; and WILLIAM J. COOK,

Motion to Disqualify Counsel, and the proceedings having been read and considered, and counsel

and Mr. Gillespie having been heard, and the Court being otherwise fully advised in the

premises, it is ORDERED:

The motion to disqualify is denied with prejudice, except as to the basis that counsel may

be a witness, aJ.1d on that basis, the motion is denied without prejudice.

DONE and ORDERED in Chambers, this lZ"'Afday of May, 2006.

Richard A. Nielsen Circuit Judge

Copies to:

Neil J. Gillespie, pro se Ryan Christopher Rodems, Esquire


CIVIL LAW DIVISION

NEIL J. GILLESPIE, Plaintiff, Case No: 05-CA-007205

Division: G and


(,;.,)..Defendants.

-----------_-----:/

ORDER DENYING PLAINTIFF'S EMERGENCY MOTION TO DISQUALIFY DEFENDANTS' COUNSEL RYAN CHRISTOPHER RODEMS & BARKER RODEMS & COOK, P.A.

TillS CAUSE came before the Court upon the Plaintiffs motion, filed July 9, 2010. This is the

third time that the Plaintiff has motioned to disqualify Defendant's counsel, despite having been informed

in an order issued May 12, 2006 that this issue had been DENIED WITH PREJUDICE. "With

prejudice" that means that the motion in question is "finally disposed ... and bars any future action on

that claim."1 Moreover, because of the doctrine of res judicata 2 this motion must be DENIED.

The Plaintiff is again noticed (as he has been in two previous Court orders) that repeat filings

attempting to revisit the same issue can be found to rise to the level of a sanctionable offense.3

The Clerk of Court is ORDERED to never accept another pleading from the Plaintiff that

indicates an attempt to disqualify Defendants' counsel, as this matter has been DISMISSED WITH

PREJUDICE.

DONE and ORDERED in Chambers at Tampa, Hillsborough County, Florida, on July ~~ STATE OF FLORJOA )

201~OUNTY OF HILLSBOROUGH) THIS IS TO CERTIFY Tf-'.ATTHE FO~EGOING IS A TRUE

AND CORRECT COpy OF THE DOCUMENT ON FILE IN ~ A ~:'s~'~ WITNOEA·Sy-'S' MF'LXuaND AND••.oFFlCiAL SEAL . ,~ J~C u..A/___O ...""",\\\ . -' .t\.A R 20@. ~~ -- -..

:~~.\J.to~111 / Martha J. Cook f~>-~""~':/~i PAT FRANK~r.~d "CLE' '~OFCjRCUIT CIRCUIT COURT JUDGE III:~~'" .~... ..~>f!

\"" ....

I Black's Law Dictionary, 7 than. D.C.

2 Matters that have been "definitively settl by judicial decision." Black's Law Dictionary, 7th Edition. 3 Lanier v. State ofFlorida, 982 So. 2d 626 (Fla. 2008).

Page 1 of 2

EXHIBIT

Copies Furnished To: Neil J. Gillespie, pro se (Plaintiff) 8092 SW 115th Loop Ocala, FL 34481

Ryan Christopher Rodems, Esq. (for Defendants) 400 North Ashley Drive, Ste. 2100 Tampa, FL 33602

Page 2 of 2

IN THE CIRCUIT COURT OF THE TIDRTEENTH JUDICIAL CIRCUIT IN AND FOR IDLLSBOROUGH COUNTY, FLORIDA


NEIL J. GILLESPIE,

Plaintiff,

vs. Case No.: 05CA7205 Division: C

BARKER, RODEMS & COOK, P.A., a Florida corporation,

Defendant. _____________--:1

DEFENDANT'S MOTION FOR AN ORDER DETERMINING PLAINTIFF'S ENTITLEMENT TO REASONABLE MODIFICATIONS UNDER TITLE II

OF THE AMERICANS WITH DISABILITIES ACT

Defendant Barker, Rodems & Cook, P.A., moves the Court for an Order scheduling an

evidentiary hearing to determine PlaintiffNeil J. Gillespie's entitlement, under the Americans

with Disabilities Act (ADA), to reasonable modifications to the rules or procedures for litigating

this action, and as grounds therefor would state:

1. On December 29,2009, Plaintiff sent a letter to the presiding Judge's Judicial

Assistant complaining that Defendant's counsel had not cleared the hearing date on January 19,

2010 with him. In the December 29, 2009 letter, Plaintiff requested that the Court cancel the

hearing on January 19,2010, and also stated:

Please be advised there are five important outstanding motions that need a hearing ... In the interest of economy please schedule my five motions together with anything Mr. Rodems wishes to set. I will need two hours for my five motions.

(Exhibit "1")(Emphasis added). Subsequently, the Court entered an Order canceling the January

19,2010 hearing and scheduled all pending motions for a one hour hearing on January 26, 2010.

2. At the January 26, 2010 hearing, however, Plaintiffdelivered a letter to Judge

25

Barton in open court, which stated in pertinent part he had disabilities and required

"accommodations." In direct contrast to his prior request that the Court schedule all five ofhis

pending motions for hearing on the same date over a period of two hours, Plaintiff stated:

Some of the accommodations requested are a limit on the number ofmotions considered in a single hearing. This Courts December 30, 2009 Order setting "all pending motion" [sic] is not acceptable. First a determination should be made of the pending motions, then a reasonable schedule must be set to hear them.

(Exhibit "2").

3. At the hearing on January 26, 2010, after hearing the Plaintiffs assertions that he

was disabled, the Court began an inquiry into this matter, but Plaintiff requested additional time

to submit information to the Court. The Court granted the request and did not hear any oftIle

motions. On February 4, 2010, Plaintiff sent a letter to the Court stating "Regarding the ADA

accommodation information requested by the Court at the hearing January 26, 2010, I plan to

submit the information to the Court by Tuesday, February 9, 2010." (Exhibit "3"). On February

9, 2010, he sent another letter to the Court stating "The ADA accommodation information

requested by the Court at the hearing January 26,2010 is taking longer to prepare than originally

planned. I am sorry to report that it is not ready today as promised. It will be a couple more days,

hopefully by Friday, February 12." (Exhibit "4").

4. To bring this issue to resolution, Defendant requests that the Court schedule an

evidentiary hearing on Plaintiffs claim that he requires "accommodations" under Title II of the

ADA.1

1 Under Title II ofthe ADA, "no qualified individual with a disability shall, by reason of such disability, be excluded from participation in or be denied the benefits ofthe services, programs, or activities ofa public entity, or be subjected to discrimination by any such entity." 42 U.S.C. § 12132. "A public entity shall make reasonable modifications in policies, practices,

2

5. To be covered under Title II of the ADA, Plaintiff must have a "disability,"2 and

even then, Plaintiffis entitled to "reasonable modifications3" only if he is a "qualified individual

with a disability." 42 U.S.C. § 12132. Stated in plainer terms, ifPlaintiff is not a "qualified

individual with a disability," then he is not protected by Title II of the ADA.

6. Plaintiff bears the burden of proof (a) that he has a "disability"; and (b) that his

"disability" requires "reasonable modifications." Compare Weinreich v. Los Angeles County

Metropolitan Transp. Authority, 114 F.3d 976, 978 (9th Cir. 1997)("To prove a public program or

service violates Title II of the ADA, a plaintiff must show: (1) he is a "qualified individual with a

disability"; (2) he was either excluded from participation in or denied the benefits of a public

or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program, or activity." 28 C.F.R. § 35.130(7). "Public entity" includes "any State or local government" and "any department, agency, special purpose district, or other instrumentality ofa State or States or local government ...." 42 U.S.C. § 12131(1).

2 Under Title II of the ADA, "[d]isability means, with respect to an individual, a physical or mental impairment that substantially limits one or more of the major life activities of such individual; a record of such an impairment; or being regarded as having such an impairment." 28 C.F.R. § 35.104. "The phrase physical or mental impairment" includes "[a]ny mental or psychological disorder such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities." 28 C.F.R. § 35.104. "The phrase major life activities means functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working." 28 C.F.R. § 35.104. A "qualified individual with a disability" is "an individual with a disability who, with or without reasonable modifications to rules, policies, or practices, the removal ofarchitectural, communication, or transportation barriers, or the provision ofauxiliary aids and services, meets the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by a public entity." 42 U.S.C. § 12131(2).

3 IfPlaintiffhas a "disability," then the "reasonable modifications" he may request are those necessary for him to meet "the essential eligibility requirements for the receipt of services or the participation in programs or activities provided by a public entity." 42 U.S.C. § 12131(2).

3

~ODEMS'ESQUIRE

entity's services, programs or activities, or was otherwise discriminated against by the public

entity; and (3) such exclusion. denial of benefits. or discrimination was by reason ofhis

disability. See 42 U.S.C. § 12132 (emphasis added).").

7. As for the specific factual and legal issues to be resolved at the evidentiary

hearing, Defendants request that the Court schedule an evidentiary hearing to determine:

a. Whether Plaintiffhas a "disability," as defmed by Title II of the ADA;

b. IfPlaintiffhas such a "disability," then what specific "modifications" he is

requesting to the Court's "rules, policies, or practices ... for the receipt of services or the

participation in programs or activities provided by" the Court. 42 U.S.C. § 12131(2); and,

c. whether the requested "modifications would fundamentally alter the nature

of the service, program, or activity." 28 C.F.R. § 35.130(7).

8. Additionally, because Plaintiff is pro se, the Defendants request that the Court

advise Plaintiff that the Florida Evidence Code shall govern the evidentiary hearing.

WHEREFORE, Defendant moves the Court to schedule an evidentiary hearing to

determine PlaintiffNeil J. Gillespie's entitlement to reasonable modifications under the ADA.

RESPECTFULLY SUBMITTED this 12th day ofFebruary, 2010.

Florida Bar No. 947652 Barker, Rodems & Cook, P.A. 400 North Ashley Drive, Suite 2100 Tampa, Florida 33602 Telephone: 813/489-1001 Facsimile: 813/489-1008 Attorneys fur Defundant

4

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by

u.s. Mail to Mr. Neil J. Gillespie, 8092 SW 115th Loop, Ocala, Florida 34481, this 12th day

February, 2010.

5

12-30-2009 03:34 NEIL GILLESPIE PAGE2

Neil .J. Gillespie 8092 SW 1151h Loop Ocala. l<'Iorida 34481

Telephone: (352) 854-7807·

December 29,2009

VIA FAX: (813) 276· 2725

Ms. Linda Greno, Judicial Assistant The Hono~le James M. Barton, II Circuit Court Judge, Thirteenth Judicial Circuit Circuit Court., Division C 800 E. Twiggs Street, Room 512 Tampa. Florida 33602

RE: Gillespie Vo Rarker, Rodems & Cook, P.A., and Willjam J. Cook, case no.: 05·CA·7205, Division C

Dcar Ms. Greno:

This faxed letter is a follow-up to my voice message to you earlier today.

I am requesting the court cancel a hearing set for Tuesday, January 19, 2009, at 4:00 PM set by attorney Ryan Christopher Rodems because Mr. Rodems set the hearing without consulting with me about the date and time of the hearing.

Please be advised there are five important outstanding motions that need a hearing, one dating to 2006: (in a.~cending order, oldest to newest, by date)

1. December 14,2006, Plaintiffs Motion to Compel Defendants' Discovery

2. February 1,2007, Plaintiff's Second Motion to Compel Defendants' Discovery

3. July 16,2008. Plaintiff's Motion for Rehearing. This motion is Mr. Bauer's, and js necessitated beealL'ie Mr. Rodems misrepresented to Judge Barton that there was a signed written fee llbTfeement between plaintiff Neil Gillespie and defendant Barker, Rodems & Cook, PA. For the record, let me state that there is NO signed written fee agreement between myself and Barker, Rodems & Cook. No sueh agreement wa.~ signed, none exists, and Mr. Rodems has not produced one. The lack ofa signed written fee agreement between the parties is also a violation of Bar Rule 4-1.5(f)(2).


Ms. Linda Greno, Judicial Assistant Page- 2 The Honorable James M. Barton, Jl December 29, 2009

4. August 14,2008. Plaintiffs Claim ofExemption and Request for Hearing. This motion was also filed by Mr. Bauer and mu.~t be held to detennine plaintiff's exemptions.

5. December 15,2009, Plaintiff's Motion hold Mr. Rodems in Contempt for violating Judge Rarton'5 ruling of October 1, 2009. Judge Barton ruled that the case was stayed and the parties were prohibited from doing anything ofrecord for 60 days. Nonetheless on October 13, 2009 Mr. Rodems filed ofrecord an amended notice of duces

.tecum during the stay period.

Please advise the undersigned when the above motions can he set for hearing. In the interest of fa.imes~, please cancel Mr. Rodems' improperly scheduled motion set for January 19,2009. In the interest ofeconomy please schedule my five motions together with anything Mr. Rodems wishes to set. 1win need two hours for my five motions.

Thank you fllr your kind consideration.

Sincerely,

enclosure: Plaintiffs Motion for Rehearing, July 16, 2008

•AU calls on my home l\ffice bu."iine~~ telephone extension are recorded for quality o.~urallce Jlurpor.e.'l pUNlUllnt to the business usc exemption or Florida Statllres chapter 934, specifically section 934.02(4)(a)( 1) and the holding of Rc>yal Health Care Servs.• JfIe. \I. Jefferson-Pi/ol Lift Ins. Cf)., 924 fo.2d 215 (11th elr. 1991).

Neil J. Gillespie 8092 SW IISth Loop Ocala, Florida 34481

January 26, 20I0

VIA HAND DELIVERY

The Honomble James M. Barton, II Circuit Court Judge, Thirteenth Judicial Circuit Circuit Court, Division C 800 E. Twiggs Street, Room 512 Tampa, Florida 33602

RE: Gillespie v. Barker, Rodems & Cook, P.A., and William J. Cook, case no.: 05-CA-7205, Division C

Article I, Section 21 of the Florida Constitution claims to provide access to the courts to every person for redress of any injury, but for an ordinary citizen justice is often not administered fairfy and is frequently denied or delayed - Neil Gillespie

Dear Judge Barton:

I apologize for the late timing ofthis letter, but yesterday I became aware ofRule 2.540 Florida Rules ofJudicial Administration, Notices to Persons with Disabilities:

All notices ofcourt proceedings to be held in a public facility, and all process compelling appearance at such proceedings, shall include the following: "Ifyou are a person with a disability who needs any accommodation in order to participate in this proceeding, you are entitled, at no cost to you, to the provision of certain assistance. Please contact [identifY applicable court personnel by name, address, and telephone number] within 2 working days ofyour receipt ofthis [describe notice]; if you are hearing or voice impaired, call 71 I."

Yesterday I tried to clarifY this issue with Court Administrator Mr. Bridenback and left a message for his assistant Tracy at (813) 272-5368, but no one called back. In addition to the Rule 2.540 notice, I have a question about how and where to submit my ADA Assessment and Report. I retained author and health professional Ms. Karin Huffer, MS, MFT as my Americans with Disabilities Act (ADA) Accommodations Designer and Advocate. Some ofthe accommodations requested are a limit on the number ofmotions considered in a single hearing. This Courts December 30, 2009 Order setting "all pending

The Honorable James M. Barton, IT Page-2 January 26,2010

motion" is not acceptable. First a determination should be made ofthe pending motions, then a reasonable schedule must be set to hear them.

The Court's Order setting today's hearing does not comply with Rule 2.540. Because the George E. Edgecomb Courthouse, 800 East Twiggs Street, Tampa is apublic facility, I believe any notice for a hearing there is subject to Rule 2.540. Also, none ofMr. Rodems' notices for hearings in the courthouse have contained a Rule 2.540 disclosures throughout this litigation. In all fairness, neither did any ofmy notices, but I am just an ordinary citizen and pro se litigant. (Note: the Court's web site cites Rule 2.065).

More importantly, while reading Rule 2.540, I noticed Rule 2.545, Case Management. For whatever reason none ofthe judges assigned to this case have iinplemented any case management in over four years. In addition, Rule 1.200 provides for Pretrial Procedure and a Case Management Conference. In the past I asked Court Counsel about this and did not receive a response. One ofmy letters to Court Counsel is enclosed. The problem is so bad in this case that I believe it should have been designated Complex Litigation under Rule 1.201, Fla.R.Civ.P because A "complex action" is one that is likely to involve complicated legal or case management issues and that may require extensivejudicial management to expedite the action, keep costs reasonable, or promote judicial efficiency.

But the conclusive evidence ofofficial wrongdoing in this case is from a law review by The Honorable Claudia Rickert Isom titled Professionalism and Litigation Ethics, 28 STETSON L. REv. 323,324 (1998). In it, Judge Rickert described the issue ofadversarial parties and discovery problems, which she calls "cutting up". This is what Judge Isom wrote: "When this litigious attitude begins to restrict the trial court's ability to effectively bring cases to resolution, the judge must get involved to assist the process." So apparently extreme measures such as $11,550 sanctions are not the next step in the process. It is outrageous that Judge 180m would ignore herown law review in my case that was before her Court on February 5, 2007. Clearly the 13th Judicial Circuit is prejudiced against me as either a pro se litigant or a person with disabilities, or both.

Because of this newly discovered evidence I believe a motion for reliefunder Rule 1.540, Fla.R.Civ.P is appropriate to overturn this Court's Order Determining Amount of Sanctions, and Final Judgment ofMarch 21, 2008. This sanction ofattorney's fees is even more outnlgeous given the fact that plaintiff's motion to compel defendants· discovery has not been heard and is pending since December 14, 2006. How can this Court award $11,550 against me when defendants are guilty ofthe same offense?

I commenced two lawsuits pro se in August 2005 (one being the instant case) because I could not find or afford counsel to represent him. One lawsuit in federal court involved a credit card dispute, Gillespie v. HSBC Bank et ai, case no. 5:05-cv-362-0c-WTH-GRJ, US District Court, Middle District ofFlorida, Ocala Division. The HSBC lawsuit was resolved a year later with a good result for the parties. Plaintiffwas able to work amicably with the counsel for HSBC Bank, Traci H. Rollins and David J. D'Agata, counsel with Squire, Sanders & Dempsey, LLP and the entire case was concluded in 15 months.

The Honorable James M. Barton, n Page-3 January 26,2010

• August 17~ 2005, Complaint filed, Gillespie v HSBC Bank, et al • September 25, 2006, Order establishing a cause ofaction (US District Judge William

Terrell Hodges) • October 23, 2006, Settlement Agreement and Release • November 17, 2006, civil judgment entered dismissing case

Apart from these proceedings I am a law abiding, engaged citizen. I am a former business owner and graduate ofThe Wharton School (Evening Division), University of Pennsylvani~and The Evergreen State College. Since 1994 I have been disabled, a condition that affects me ability to represent himselfwhen confronted by a hostile lawyer like Mr. Rodems who knows ofmy disability from his firm's prior representation. In addition, Mr. Rodems sued plaintifffor libel over a letter about a closed bar complaint. Tobkin v. Jarboe, 710 So.2d 975, recognizes the inequitable balance ofpower that may exist between an attomey who brings a defamation action and the client who must defend against it Attorneys schooled in the law have the ability to pursue litigation through their own means and with minimal expense when compared with their fonner clients.

And there is more newly discovered evidence. Mr. Rodems~ application to the 13th

Circuit JNC lists two other clients who complained to the Florida Bar that he charged an inappropriate fee in a contingency case, Rita Pesci and Roslyn Vazquez. This shows that Mr. Rodems and his law firm utilize a cormpt business model that works as follows:.

A. Usurp the clientts fiduciary interest. B. Procure a signed agreement from the client by any means, including fraud. c. Rely upon the parol evidence rule to enforce the settlement

Because Mr. Rodems failed to provide this infonnation in discovery, it was not available for my defense on March 20, 2008 for the sanction hearing to determine attorneys fees.. And the discovery that Mr. Rodems was actively seeking appointment to the bench on March 20, 2008 was a conflict and explains' his obsession with the status ofjudges both at the hearing and during the course ofthis litigation. The Commentary to Judicial Canon 2A states a judge must expect to be the subject ofconstant public scmtiny. A judge must therefore accept restrictions on the judge's conduct that might be viewed as burdensome by the ordinary citizen and should do so freely and willingly.

In addition to relief from judgment it is time for Plaintiff's FirSt Amended Complaint, which will include a count ofBreach o"fFiduciary Duty~ which· is appropriate given the facts and can be added under Rule 1.190(c), FIa.R.Civ.P and the relation back doctrine. BreachofFiduciary Duty was first argued in this case in 2005, October 7,.2005, see Plaintiff's Rebuttal To Defendants' Motion to Dismiss and Strike.

Mr. Rodems testified at the March 20, 2008 hearing on the attomey's fees that "I am board-certified in civil trial law and I've been practicing law since 1992.." (transcript, page 14, line 23). Mr. Rodems also testified that "rve been trying cases for the last 16 years." (transcript, page 15, line 4). On cross examination, Mr. Bauer asked: "How m~y 57.105

, The Honorable James M. Barton, n Page-4

January 26, 2010

actions have you been involved in?" (transcript, page 15, line 18). Mr. Rodems testified: "I filed I believe two in this case and I may have filed one or two other ones in my career but I couldn't be sure exactly.n (transcript, page 15, line 20).

Since the March 20,2008 hearing, Mr. Rodems has filed two additional section 57.105 motions in this lawsuit. On July 31, 2008, Mr. Rodems submitted his third section 57.105 motion in this lawsuit, because I did not withdrawn my Complaint For Breach ofContract and Fraud. Mr. Rodems submitted his fourth section 57.105 motion in this case; also on July 31, 2008, because I did not withdrawal my motion for rehearing, which was necessitated when Mr. Rodems lied to the Court at the October 31, 2007 hearing about the existence ofa signed contingent fee agreement - there is no signed contract with Barker, Rodems & Cook, PA and Mr. Rodems falsely told the court otherwise.

Furthermore, Mr. Rodems threatened to file another section 5'7.105 motion against Mr. Bauer in April, 2007, and again in May, 2007, regarding appellant's. reinstatement ofhis claims voluntarily dismissed, which the 2DCA upheld in 2D07-4530.

So far in this lawsuit Mr. Rodems has filed four (4) section 57. lOS motions and threatened another - while in the balance ofhis sixteen (16) year career Mr. Rodems testified that he may have filed one or two other ones but he couldn't be sure exactly. It is clear that Mr. Rodems is misusing the section 57.105 motion as a weapon in his "foll Duelear blast approaeh" because he has a conDitt of interest in this la~suit and should have been disqualified as counsel upon apoeUant's motion, Plaintiffs Motio" to Disqlltl.lifv Counsel, submitted February 4, 2006.

As for Judge Nielsen's Order ofMay 12,2006, the Order states· "The motion to disqualifY is denied with prejudice, except as to the basis that counsel may be a witness, and. on that basis, the motion is denied without prejudice." As for Mr. Rodems being a witness, the nature ofthis case is that he is essentially a perpetual witness. The transcripts show that his representation is essentially ongoing testimony about factual matters. Mr. Rodems should be disqualified, it is long overdue.

Finally a letter written by Mr. Rodems surfaced relative to a lawsuit disclosed on his JNC application, Wrest/eReunion. LLC v. Live NatioT4 Television Holdings, Inc.,. United States District Court, Middle District ofFlorida, Case No. 8:07-cv-2093-T-27, trial August 31September 10, 2009. Mr. Rodems lost the case and then wrote a letter attacking the .credibility ofEric BischotI: .a witnesses. The letter is enclosed and may also be found online at: www.declarationofindependents.netldoilpageslcorrente91O.html

Mr. Rodems' letter calls into question his mental well-being. After the jUlY spoke and the case was over Mr. Rodems wrote the following; "It is odd that Eric Bischoff: whose welldocumented incompetence caused the demise ofWCW, should have any comment on the outcome ofthe WrestIeReunion, LLC lawsuit.. The expert report Bischoffsubmitted in this case bordered on illiteracy, and Bischoffwas not even called to testify by Clear ChannellLive Nation because Bischoffperjured himself in a deposition in late-July 2009

The Honorable James M. Barton, n Page - 5 January 26,2010

before running out and refusing to answer any more questions regarding his serious problems with alcohol and sexual deviancy at the Gold Club while the head ofWCW.."

Mr.. Rodems also wrote, '~To even sit in the room and question him. was one ofthe most distasteful ~gs I've ever had to do in 17 years ofpracticing law. In fact, we understand that Bischoffwas afraid to even come to Tampa and testify because he would have to answer questions under oath for a third time about his embarrassing past"

Mr. Rodems continued his attack on the witness writing, "The sad state ofprofessional wrestling today is directly attributable to this snake oil salesman, whose previous career highlights include selling.meat out ofthe back ofa truck, before he filed bankruptcy and had his car repossessed. Today, after running WCW into the ground, Bischoff.peddles schlock like ftGirls Gone Wildtt and reality shows featuring B-listers."

In conclusion, my fonner lawyer, the congenial Robert W. Bauer, complained about Mr. Rodems in open court: " ...Mr~ Rodems has, you know, decided to take a full nuclear blast approach instead ofus trying to work this out in a professional manner. It is my mistake for sitting back and giving him the opportunity to take this full blast attack. (transcript, Aug-14-08 hearing before Judge Crenshaw, p. 16, line 24).

Thank you for your kind consideration.

cc: Mr. David A. Rowland, Court Counsel (letter only) Mr. Mike Bridenback, Court Administrator in the 13th Judicial Circuit (letter only) Mr. Gonzalo B. Casares, ADA Coordinator for the 13th Judicial Circuit (letter only) Mr.. Ryan Christopher Rodems

NEIL GILLESPIE~-0S-201e e5:3e PAGE1

Neil J. Gillespie 8092 SW l1Slh Loop Ocala, Florida 34481

February 4, 2010

VIA FAX: (813) 276- 2725

The Honorable James M. Rarton, II Circuit Court Judge, Thirteenth Judicial Circuit Circuit Court, Division C 800 E. 'l'wiggs Street, Room 512 Tampa, Florida 33602

RE: Gillespie v. Barker, Rodems & Cook, P.A.) and Wi1liam J. Cook, casc no.: 05-CA-7205. Division C

Dear Judge Barton:

Regarding the ADA accommodation infonnation requested by the Court at the hearing January 26,2010,1 plan to submit the information to the Court by Tuesday, February 9, 2010. Thank you.

cc: Mr. Ryan Christopher Rodems

-....;


Neil .J. Gillespie 8092 SW 115th Loop Ocala, Florida 34481

February 9,2010

VIA FAX: (813) 276- 2725

lbe Honorable James M. Barton, IT Circuit Cowt Judge, Thirteenth Judicial Circuit Circuit Court. Division C 800 He Twiggs Street, Room 512 Tampa, Florida 33602

R.E: Gillespie v. Barker, Rodems & Cook, P.A., and William J. Cook, case no.: 05-CA-7205, Division C

Dear Judge Barton:

The ADA accommodation information requested by the Court at the hearing January 26, 20lOis taking longer to prepare tban originally planned. I am sony to report tbat it is not ready today a.q promised. It will be a couple more days, hopefully by Friday, February 12.

"Ibis is still a question about wbere to submit my ADA assessment and report. Enclosed is a copy of my email to Mr. Gonzalo B. Casares, ADA Coordinator for the 13th Judicial Circuit. Some of the confusion stems from the fragmented cowt system. Apparently there is an ADA Coordinator for Hillsborough County, Ms. Sandra Sroka, and an ADA Coordinator tor the Clerk ofthe Circuit Court, Ms. Lynn Ryder. My previous calls to Court Administrator Mr. Bridenback, his assistant Tracy WelJs at (813) 272-5368, have not been returned.

.!bank you for the Court's patience and understanding.

BARKER, RODEMS & COOK PROFESSIONAL ASSOCIATION

ATTORNEYS AT LAW

CHRIS A. BARKER Telephone 813/489-1001400 North Ashley Drive, Suite 2100 RYAN CHRISTOPHER RODEMS Facsimile 813/489-1008WILLIAM ]. COOK Tampa, Florida 33602

February 12,2010

VIA HAND DELIVERY

The Honorable James M. Barton, II Circuit Court Judge Circuit Civil, Division "C" 800 E. Twiggs Street, Room 512 Tampa, Florida 33602

Re: Neil J. Gillespie v. Barker, Rodems & Cook, P.A., a Florida Corporation; and William J. Cook

Case No.: 05-CA-7205; Division "C"

Dear Judge Barton:

As you will recall, a hearing was scheduled on all pending motions on January 26, 2010, and during that hearing Plaintiff claimed he was disabled and entitled to "accommodations" under the Americans with Disabilities Act. He asserted that he would provide certain information to the Court, but has yet to do so.

The motions scheduled for hearing included motions to compel Plaintiff's attendance at a deposition in aid of execution and to compel complete responses to discovery, as my clients obtained a Final Judgment on March 27, 2008 against Plaintiff due to his violation of section 57.105, Florida Statutes and various discovery violations.

Clearly, Plaintiff's claim ofdisability has delayed my clients from moving forward and collecting on the Final Judgment protecting their rights.

Therefore, I have filed "Defendant's Motion for an Order Determining Plaintiffs Entitlement to Reasonable Modifications under Title II of the Americans with Disabilities Act." In it, I have requested that the Court schedule an evidentiary hearing on this matter.

Pursuant to your direction at the hearing on January 26, 2010, I am requesting that this motion be set for an evidentiary hearing as soon as possible.

Thank you for your time and attention to this matter.

Re, ectfullY'uhmiW Christopher Rodems

RCR/so Enclosure cc: Neil 1. Gillespie (wi encl)

1Although the Plaintiff lists the Consumer Credit Protection Act in the first paragraph of hisFirst Amended Complaint, (Doc. 22), he does not allege any claims under the Act, or otherwisemention the Act. Therefore, the Court will not further address the Consumer Credit Protection Actin this Order.

UNITED STATES DISTRICT COURTMIDDLE DISTRICT OF FLORIDA

OCALA DIVISION

NEIL J. GILLESPIE,

Plaintiff,

-vs- Case No. 5:05-cv-362-Oc-10GRJ

HSBC NORTH AMERICA HOLDINGS,INC., a Delaware corporation; HSBC BANKNEVADA,N.A., a National Bank formerlyknown as Household Bank (SB), N.A.;RISK MANAGEMENT ALTERNATIVES,INC., a Delaware corporation,

Defendants.______________________________________

O R D E R

The Plaintiff, proceeding pro se, has filed suit against the Defendants alleging

violations of the Consumer Credit Protection Act, 15 U.S.C. §§ 1640(e) and 1692k,1 the

Truth in Lending Act, 15 U.S.C. § 1601 et seq., the Fair Debt Collection Practices Act, 15

U.S.C. § 1692 et seq., and Florida law, with respect to various charges and fees assessed

against the Plaintiff’s credit card account. (Doc. 22). The case is before the Court for

consideration of Defendants HSBC North America Holdings, Inc.’s and HSBC Bank

Nevada, N.A.’s motions to dismiss, (Docs. 4, 29), to which the Plaintiff has filed a response

Case 5:05-cv-00362-WTH-GRJ Document 32 Filed 09/25/06 Page 1 of 22

26

2

in opposition (Doc. 5). Upon review of the Amended Complaint and the record in this case,

the Court finds that the motions to dismiss are due to be granted in part and denied in part.

Factual Background

The following facts are alleged in the Plaintiff’s First Amended Complaint (Doc. 22)

and are taken as true for the purposes of the motion to dismiss. The Plaintiff, Neil J.

Gillespie, is a resident of Ocala, Florida. On February 27, 2003, Gillespie opened a

MasterCard credit card account, issued by Defendant HSBC Bank Nevada, N.A., f/k/a

Household Bank (SB), N.A. (“HSBC Nevada”). Defendant HSBC North America Holdings,

Inc. (“HSBC North America”) is the parent company of HSBC Nevada.

At the time Gillespie opened the account, HSBC Nevada charged him a $59.00

annual fee. The initial credit line for the credit card was $300.00. Gillespie maintained his

credit card account in good standing and received credit line increases to $400,00, then

$500,00, and again to $600.00 over the next year. In mid-2004, Gillespie decided to close

his credit card account and pay off any remaining balance. By letter dated June 9, 2004,

HSBC Nevada notified Gillespie that his account had been closed. Due to the busy 2004

Hurricane season, Gillespie chose to reinstate his credit card account in order to pay for

hurricane related expenses. A $29.00 reinstatement fee posted to Gillespie’s account on

September 6, 2004.

On or about September 2, 2004, Gillespie requested, by telephone, an increase in

his credit line. In a letter dated September 6, 2004, HSBC Nevada agreed to increase his


2See Amended Complaint, (Doc. 22), ¶ 22.

3

credit limit to $800.00, provided that Gillespie pay in advance a $50.00 “automated credit

line increase” fee. HSBC Nevada told Gillespie that the $50.00 fee would later be credited

back to his account, and that he should make his check for the fee payable to “ACLI.”

Gillespie mailed a $50.00 money order payable to “ACLI” to HSBC Nevada on September

7, 2004.

Gillespie contends that HSBC Nevada never credited the $50.00 “automated credit

line increase” fee back to his account. Instead, HSBC Nevada charged Gillespie’s credit

card account a $50.00 credit line increase finance charge on September 9, 2004, then

reversed the fee the same day. According to Gillespie, these two transactions cancelled

each other out, and did not take into account the $50.00 fee he had already paid and was

promised would be credited to his account. Gillespie contends that HSBC Nevada’s

actions constitute a “slight-of-hand theft.”2

While his account remained open, and throughout the entire dispute process, HSBC

Nevada continued to mail Gillespie monthly account statements, each providing a 24-hour

automated account information telephone number. On September 11, 2004, Gillespie left

Florida in order to avoid Hurricane Ivan, and traveled to Ooltewah, Tennessee. During this

trip, Gillespie used his credit card for various travel-related expenses. He relied upon

HSBC Nevada’s 24-hour automated account information telephone number to ensure that

his credit card balance remained within the credit limit.


3See Doc. 22, exhibit 2.

4

Gillespie contends that the automated account information telephone number

provided him with incorrect balance information, such that he unknowingly exceeded his

credit limit and was penalized with various overlimit fees. His September 20, 2004 credit

card statement showed an overlimit balance of $161.62, the majority of which was

attributable to various bank fees.3 If Gillespie had received accurate information

concerning his account balance, and if he had received a credit on his account for the

$50.00 “automated credit line increase” fee, Gillespie argues that he would not have

exceeded his credit limit.

On November 13, 2004, Gillespie notified HSBC Nevada in writing that he was

closing his account. In his letter, Gillespie agreed to pay all legitimate charges, including

those for purchases, cash advances, cash advance fees, and lawful interest. He objected,

however, to paying any overlimit fees and late fees resulting from the allegedly inaccurate

account balance information provided by HSBC Nevada’s automatic telephone service.

Gillespie also requested an updated account statement within 30 days.

By letter dated November 29, 2004, HSBC stated that Gillespie’s new account

balance was $1,121.27 and demanded immediate payment of $355. Gillespie did not pay

this amount, and returned the letter with various comments to the Chief Operating Officer

of HSBC Bank USA, N.A.


5

On December 6, 2004, HSBC Nevada sent Gillespie a Delinquent Account Notice

demanding payment of his account balance, which had reached $1,150.27. Gillespie

telephoned HSBC Nevada on December 20, 2004 to dispute the balance. HSBC Nevada

again contacted Gillespie by letter dated December 31, 2004. This letter notified Gillespie

that his account had been canceled effective October 7, 2004. However, HSBC Nevada

continued to charge Gillespie the $59.00 annual fee on March 20, 2005, and charged a

$29.00 late fee and $29.00 overlimit fee every month.

On or about December 31, 2004, HSBC Nevada placed Gillespie’s account for

collection with Defendant Risk Management Alternatives, Inc. (“RMA”), a collection agency

with its headquarters in Duluth, Georgia. RMA contacted Gillespie by letter dated January

3, 2005, notifying Gillespie that it was HSBC Nevada’s debt collector on this account, and

demanding payment in the amount of $1,174.74. That same day, Gillespie received a

telephone call from a Roger Harrison at RMA offering to settle the entire dispute for

$900.00. Gillespie immediately agreed to the settlement, and agreed to send an initial

payment of $135.00 by January 25, 2005, with payment of the remaining $765.00 balance

in February 2005.

Gillespie sent the $135.00 payment on January 15, 2005, ten days ahead of

schedule. He spoke with a Holly Reynolds at RMA, who confirmed the terms of the

settlement and provided Gillespie with RMA’s receive code to accept the payment. Despite

this settlement agreement, and Gillespie’s initial payment, RMA continued to call Gillespie

another 21 times throughout the month of January, 2005.


6

On January 24, 2005, RMA called Gillespie and informed him that RMA would no

longer accept the settlement agreement and demanded payment of $1,089.27. RMA

called Gillespie again on January 25, 2005, demanded the same payment, and threatened

to call Gillespie’s family if he did not pay the entire $1,089.27 immediately. RMA also

claimed to have contacted Gillespie’s uncle, which was not true, as Gillespie’s uncle had

passed away a short time before. Gillespie eventually changed his telephone number to

an unpublished number to avoid any further contact with RMA.

On January 20, 2005, HSBC Nevada provided Gillespie with an account statement

listing a payment of $135.00, and demanding a payment of the remaining balance of

$1,089.79. The statement did not mention the settlement with RMA. HSBC Nevada also

charged Gillespie another $29.00 overlimit fee and assessed a $21.05 finance charge.

On January 31, 2005, Gillespie wrote to Martin Glynn, President and Chief Executive

Officer of HSBC Bank USA, one of HSBC Nevada’s parent companies. In the letter,

Gillespie discussed the alleged harassment and threats from RMA, including the fact that

RMA broke its settlement agreement with Gillespie. He also stated that any further

settlement offers must be made in writing. Jory Berdan of Household Bank Credit Card

Services responded to Gillespie by letter dated February 24, 2005, acknowledging RMA’s

breach and offering to settle Gillespie’s account. The terms of the new settlement offer are

not mentioned in the Amended Complaint, although Gillespie states that they were

contradicted by later HSBC Nevada correspondence.


7

To date, it does not appear that Gillespie has made any further payments on his

account. HSBC Nevada has continued to assess late fees, overlimit fees, annual fees and

interest on the credit card account. As of July 20, 2005, the outstanding balance had

reached $1,675.21.

Procedural History

Gillespie initiated this action on August 17, 2005 (Doc. 1). In his original Complaint,

Gillespie alleged three claims against HSBC Nevada: (1) a state law claim for fraud, based

on the alleged “slight-of-hand theft” over Gillespie’s $50.00 “automated credit line increase”

fee; (2) a claim that HSBC Nevada violated various provisions of the Truth in Lending Act,

15 U.S.C. § 1601 et seq. (“TILA”), by failing to disclose in advance the various fees and

finance charges it assessed against Gillespie, and by failing to provide Gillespie with

accurate account balance information; and (3) a state law claim alleging violations of

Florida’s usury laws. Gillespie also asserted a claim against RMA, alleging that RMA’s

collection activities violated the Fair Debt Collections Practices Act, 15 U.S.C. § 1692, et

seq. He seeks as relief compensatory damages, punitive damages, statutory damages,

interest, costs, expenses, and attorneys’ fees.

On October 17, 2005, HSBC North America and HSBC Nevada filed a joint motion

to dismiss all claims against them. (Doc. 4). Gillespie filed a response in opposition on

November 4, 2005 (Doc. 5). Before the Court could consider the motion, Gillespie sought

and obtained leave to file an Amended Complaint (Docs. 8, 12). The Amended Complaint


8

is identical in all respects to the original Complaint, with one exception. Gillespie has

added a common law claim of negligence against HSBC Nevada, apparently based on

HSBC Nevada’s alleged hiring of RMA to act as its debt collector. Neither the original or

the Amended Complaint allege any claims against HSBC North America.

In granting Gillespie leave to file his Amended Complaint, the Court also provided

that HSBC North America’s and HSBC Nevada’s motion to dismiss (Doc. 4) would apply

to the Amended Complaint, and granted leave to file another motion to dismiss focused

solely on the new negligence claim. (Doc. 12). HSBC North America and HSBC Nevada

did so on April 5, 2006. (Doc. 29). Gillespie has never responded to this second motion

to dismiss and the time for responding has elapsed.

On July 7, 2005, approximately six (6) weeks prior to Gillespie filing this suit, RMA

filed a voluntary petition for relief under Chapter 11 of the United States Bankruptcy Code,

11 U.S.C. §§ 101-1330. On September 6, 2005, RMA filed a Notice of Pendency of

Bankruptcy Case and Automatic Stay of Proceedings with this Court. (Doc. 2). As such,

all claims against RMA are stayed pending notice that the automatic stay in the bankruptcy

proceeding has been lifted.

Motion to Dismiss Standard of Review

In passing on a motion to dismiss under Rule 12(b)(6), the Court is mindful that

“[d]ismissal of a claim on the basis of barebones pleadings is a precarious disposition with

a high mortality rate.” Int'l Erectors, Inc. v. Wilhoit Steel Erectors Rental Serv. 400 F.2d


9

465, 471 (5th Cir. 1968). Thus, if a complaint “shows that the Plaintiff is entitled to any

relief that the Court can grant, regardless of whether it asks for the proper relief,” it is

sufficiently plead. Dotschay v. Nat. Mut. Ins. Co., 246 F.2d 221 (5th Cir. 1957). As the

Supreme Court declared in Conley v. Gibson, 355 U.S. 41, 45-46 (1957), a complaint

should not be dismissed for failure to state a claim unless it appears “beyond doubt that the

plaintiff can prove no set of facts in support of his claim that would entitle him to relief.”

See also Cook & Nichol, Inc. v. The Plimsoll Club, 451 F.2d 505 (5th Cir. 1971). The

Federal Rules of Civil Procedure “do not require a claimant to set out in detail the facts

upon which he bases his claim.” Conley, 355 U.S. at 47. Instead, all that is required is that

the claimant set forth a “short and plain statement of the claim” sufficient to give the

defendant “fair notice of what the plaintiff’s claim is and the grounds upon which it rests.”

Id. However, “while notice pleading may not require that the pleader allege a ‘specific fact’

to cover each element of a claim, it is still necessary that a complaint contain either direct

or inferential allegations respecting all the material elements necessary to sustain a

recovery under some viable legal theory.” Roe v. Aware Woman Center for Choice, Inc.,

253 F.3d 678, 683 (11th Cir. 2001) (quotations omitted).

In addition, when considering a motion to dismiss pursuant to Federal Rule of Civil

Procedure 12(b)(6), the Court is limited to a review of the allegations set forth on the face

of the complaint itself, as well as any attached and/or incorporated documents which are

central to the plaintiff’s claim. Brooks v. Blue Cross & Blue Shield of Florida, 116 F.3d

1364, 1369 (11th Cir. 1997). Review of such incorporated documents will not convert a


4See Doc. 22, ¶ 4.

10

motion to dismiss into a motion for summary judgment. Id., see also Harris v. Ivax Corp.,

182 F.3d 799, 802 n. 2 (11th Cir.1999). However, the Court will not consider factual

arguments made in motions or other papers, or other evidence not attached or

incorporated by the face of the complaint itself.

Discussion

I. Claims Against HSBC North America

Defendant HSBC North America seeks to be dismissed from this case because

Gillespie has not alleged any claims against it. It appears from the face of Gillespie’s

Amended Complaint that HSBC North America is a separate and distinct entity from HSBC

Nevada.4 It is also clear from the Amended Complaint that Gillespie has not made any

allegations against HSBC North America other than to aver that it is the parent company

of HSBC Nevada. Thus, it would appear that dismissal of HSBC North America is

appropriate.

Normally, a parent corporation is not liable for the acts of its subsidiaries.

See United States v. Bestfoods, 524 U.S. 51, 61 (1998). Gillespie, however, argues in his

opposition that HSBC North America should remain in this case because it is the “head of

the hydra.” See Doc. 5, p. 3. While not entirely clear, it appears that Gillespie is arguing

that HSBC North America, in its role as parent of HSBC Nevada, either exercised some

sort of control over the actions of HSBC Nevada in this case, or should be held vicariously


5There are three ways in which a parent can be held liable for the acts of its subsidiaries:(1) an alter ego theory to “pierce the corporate veil;” (2) vicarious liability based on general agencyprinciples; or (3) direct liability where the parent directly participated in the wrong complained of.See In re Managed Care Litigation, 298 F. Supp.2d 1259, 1309 (S.D. Fla. 2003). Gillespie hasnot alleged any facts in his Amended Complaint to support any of these theories.

6In his original complaint, Gillespie asks the Court to mail a copy of the complaint to UnitedStates Senator Richard Shelby and John C. Dugan, Comptroller of the Currency. (Doc. 1). In itsfirst motion to dismiss, HSBC Nevada asks the Court to strike this request on the grounds that itis impertinent and scandalous. Gillespie has omitted this request in his Amended Complaint,therefore it is no longer a part of this case, and HSBC Nevada’s request is denied as moot.

11

liable for the actions of HSBC Nevada.5 However, Gillespie has made no such allegations

in his Amended Complaint. Indeed, none of the five claims even mention HSBC North

America. Given the complete absence of any allegations or claims in the Amended

Complaint against HSBC North America, the Court concludes that dismissal without

prejudice of HSBC North America is appropriate.

II. Claims Against HSBC Nevada

A. Fraud Claim

HSBC Nevada seeks dismissal of each of Gillespie’s claims against it.6 The first

claim against HSBC Nevada is a state law claim for fraud. HSBC Nevada asserts that

dismissal is appropriate because Gillespie has failed to state a claim upon which relief can

be granted pursuant to Fed.R.Civ.P. 12(b)(6), and because Gillespie has not alleged his

fraud claim with the sufficient level of particularity required by Fed.R.Civ.P. 9(a).

To allege a claim of common law fraud in Florida, Gillespie must allege: (1) a false

statement concerning a material fact; (2) knowledge by the person making the statement

that the representation is false; (3) the intent by the person making the statement that the


7See Doc. 22, ¶¶ 18.a., 21, and exhibit 2.

8Id., exhibit 2.

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representation will induce another to act on it; and (4) reliance on the representation to the

injury of the other party. Knight v. E.F. Hutton and Co., Inc., 750 F. Supp. 1109, 1114

(M.D. Fla. 1990) (citing Lance v. Wade, 457 So.2d 1008, 1011 (Fla. 1984)). See also

Romo v. Amedex Ins. Co., 930 So.2d 643, 651 (Fla. 3d DCA 2006); Hillcrest Pacific Corp.

v. Yamamura, 727 So. 2d 1053, 1055 (Fla. 4th DCA 1999). HSBC Nevada contends that

Gillespie has not sufficiently alleged either a false statement of a material fact, nor any

injury attributable to his reliance on HSBC Nevada’s statements. The Court disagrees.

Gillespie’s fraud claim centers on the representations made by HSBC Nevada

concerning his $50.00 “automated credit line increase.” Gillespie alleges that HSBC

Nevada told him that if he made that payment in advance, it would be later credited back

to his account and he would receive a credit limit increase. In other words, he would

receive a refund of his $50.00 payment. According to the Amended Complaint, while

Gillespie did receive the credit limit increase,7 he never received a refund of the $50.00.

Instead, HSBC Nevada charged his credit card account an additional $50.00 fee, and

reversed that charge. Simply put, HSBC Nevada double charged Gillespie for the credit

line increase, and only credited him back for one of the charges. The partial copy of

Gillespie’s September 20, 2004 account statement further demonstrates this fact.8 The fact

that HSBC Nevada did not credit Gillespie as it stated it would, thereby resulting in a loss


9The Court seriously questions whether Gillespie will be able to establish that the otheroverlimit fees, late fees, and finance charges are a direct result of this allegedly false statement.However, that is a discussion for another time, and at the very least, Gillespie has sufficientlyalleged damages in the amount of the $50.00 “automated credit line increase fee” which permitthis claim to go forward.

13

of the $50.00 and additional charges to Gillespie’s account, establishes both a false

statement of a material fact and a resulting injury.9

The Court further finds that Gillespie has satisfied the heightened pleading

requirements of Fed.R.Civ.P. 9(b). He has stated with particularity all of the circumstances

constituting the alleged fraud in this case. More specifically, Gillespie has identified the

precise statements he alleges are false or misleading, including the time place and identity

of speaker; how he was mislead by those statements; and what HSBC Nevada obtained

as a consequence of the alleged fraud, i.e., the additional $50.00 as well as other

subsequent charges and fees. Although Gillespie’s fraud claim could have been read as

HSBC Nevada contends - that the $50.00 promised credit was really just a reversal charge

- if a complaint “shows that the Plaintiff is entitled to any relief that the Court can grant,

regardless of whether it asks for the proper relief,” it is sufficiently plead. Dotschay v. Nat.

Mut. Ins. Co., 246 F.2d 221 (5th Cir. 1957). Gillespie’s fraud claim may go forward as

alleged.

B. Truth in Lending Act Claim

Gillespie also alleges that HSBC Nevada violated numerous provisions of the TILA

throughout the existence of his credit card account, including after his account was closed.


10See Doc. 22, ¶¶ 58-59; 15 U.S.C. § 1637(c)(2).

11See Doc. 22, ¶¶ 60-61; 15 U.S.C. §§ 1637(b)(3), (4), (7), and (8).

12See Doc. 22, ¶ 70.

13See Doc. 22, ¶ 62; 15 U.S.C. § 1637(a).

14

For example, Gillespie contends that HSBC Nevada did not comply with the TILA’s

disclosure requirements when it solicited him over the telephone to open his credit card

account in February 2003.10 He also contends that HSBC Nevada violated the TILA’s

disclosure requirements in September 20, 2004 when it did not refund his $50.00

“automated credit line increase” fee, and as a result of not crediting his account for this

amount, did not provide him with the correct account balance, total amount of credits to his

account, the correct finance charge, and did not correctly identify and credit other

charges.11 Gillespie alleges that HSBC Nevada violated these same disclosure

requirements in each subsequent monthly statement.12

Gillespie also challenges HSBC Nevada’s 24-hour automated account information

telephone line, stating that it provided him false and inaccurate account balance

information, and failed to disclose that reliance on such information would result in finance

charges and overlimit fees.13 He also contends that HSBC Nevada failed to identify that

his $135.00 payment on January 15, 2005 was made as part of a settlement agreement,

and failed to include any of the terms and conditions of his February 24, 2005 settlement


14See Doc. 22, ¶¶ 67, 70.

15Id., ¶¶ 63-66

1615 U.S.C. §1666c provides that all payments received from an obligor under an openended consumer credit plan by the creditor shall be posted promptly to the obligor’s account.

17HSBC Nevada also seeks to use the September 20, 2004 account statement to disproveGillespie’s contentions that HSBC Nevada did not disclose it would charge overlimit and late feeson closed or cancelled accounts. However, that statement was created while Gillespie’s creditcard account was open and active. Therefore it does not establish any disclosures with respectto closed or cancelled accounts.

15

agreement in any of his future account statements.14 Finally, Gillespie asserts that HSBC

violated the TILA when it failed to disclose that he would be charged annual fees, overlimit

fees, and late fees on a closed account in violation of 15 U.S.C. §§ 1637(a), (c) and (d).15

Taking the allegations set forth in Gillespie’s Amended Complaint as true, which the

Court must at the motion to dismiss stage, and refraining for passing on the merits, it

appears that the majority of Gillespie’s TILA claims are properly alleged, and provide a

clear and plain statement sufficient to place HSBC Nevada on notice of the allegations

against it. Indeed, HSBC Nevada does not challenge many of Gillespie’s assertions.

Rather, HSBC Nevada limits its challenges to Gillespie’s claims concerning the September

20, 2004 account statement. According to HSBC Nevada, the portion of Gillespie’s

September 20, 2004 account statement which is attached to his Amended Complaint

directly contradicts his allegations that HSBC Nevada did not credit back the $50.00

“automated credit line increase” fee on his September 20, 2004 account statement,16 and

did not disclose the correct amount of credits and charges on that same statement.17


18HSBC Nevada argues that if this claim is not dismissed with prejudice, the Court shouldorder Gillespie to provide a complete copy of his September 20, 2004 account statement. TheCourt will deny this request. The portion of the statement provided with the Amended Complaintsupports all of Gillespie’s allegations such that dismissal is not appropriate. Moreover, if HSBCNevada believes that this is an incomplete document and that other portions of the document arenecessary at this point in the litigation, it could have easily attached them to its own motion todismiss. Gillespie is correct, HSBC Nevada, as the lender in this case, has just as much accessto Gillespie’s account statements as Gillespie does. HSBC Nevada has not demonstrated thatit will suffer any undue hardship by producing the complete account statement, and the Courtdoubts that it could, given that it readily submitted Gillespie’s Cardholder Agreement.

16

Because the Court has already found that, from the face of Gillespie’s Amended

Complaint and incorporated documents, Gillespie has sufficiently alleged that HSBC

Nevada did not credit his account for that $50.00 fee as promised, the Court is satisfied at

this stage in the litigation that Gillespie has also sufficiently alleged that HSBC Nevada

improperly failed to disclose its credit of the $50.00 “automated credit line increase” fee and

did not provide the correct balance, credits and charges on the September 20, 2004

account statement.18 Accordingly, Gillespie’s TILA claim may go forward as alleged.

C. Usury Claim

The third claim HSBC Nevada challenges is Gillespie’s assertion that HSBC Nevada

violated Florida’s usury law, Fla. Stat. § 687.01, et seq. HSBC Nevada contends that this

claim should be dismissed both because Gillespie has not pleaded any of the elements

necessary to establish a claim of usury, and because Florida law does not apply to

Gillespie’s credit card account. The Court agrees.

Under Florida’s usury law, it is considered “usurious and unlawful” to charge a rate

of interest in excess of 18% for any loan, money advance, line of credit, or other obligation


19Doc. 22, ¶ 91.

20Id., exhibit 2.

21The September 20, 2004 statement listed miscellaneous finance charges of $58.26, aswell as the monthly finance charge of $10.72.

22In his opposition papers, Gillespie contends that his March 20, 2003 account statement(continued...)

17

where the principal balance is $500,000 or less. See Fla. Stat. § 687.03(1). A creditor who

willfully violates Florida’s usury law is liable to the borrower for double the amount of

interest collected. See Fla. Stat. § 687.04; Jersey Palm-Gross, Inc. v. Paper, 639 So.2d

664, 667 (Fla. 4th DCA 1994). Although Gillespie cites to the correct Florida statutes, he

does not explain how his credit card account with HSBC Nevada violates this law.

Gillespie alleges that HSBC Nevada charged him a nominal interest rate of 18.9%, an

annual percentage rate of 22.9%, and periodic interest rates as high as 224%.19 Not only

does Gillespie fail to explain how he arrived at these interest rates, but the partial copy of

his account statement which he attached to his Amended Complaint directly contradicts his

allegations.20 That statement lists a finance charge of $10.72 on a balance of $494.85.

Simple math shows that the nominal interest rate charged is well under 18%. Even if

Gillespie is correct that all of his late fees, cash advance fees, and overlimit fees also

constitute interest, the nominal interest rate would still only amount to approximately

13.9%.21 Given the contradictions between Gillespie’s account statement and the

allegations in his Amended Complaint, the Court cannot say that he has properly alleged

a claim of usury.22


22(...continued)demonstrates how he calculated his interest rates. See Doc. 5, p. 6. This is a factual argument,inappropriate for consideration at the motion to dismiss stage. Moreover, Gillespie has notincluded any allegations concerning this statement in his Amended Complaint, nor attached it tohis Amended Complaint, so that the Court cannot consider this statement incorporated into hispleadings. The Court also does not see anywhere on the partial copy of the September 20, 2004statement an annual percentage rate of 0.00%, as Gillespie claims.

23HSBC Nevada has attached a copy of the Cardholder Agreement to its motion to dismiss.See Doc. 4, exhibit A. Gillespie refers to his credit card contract with HSBC Nevada throughouthis Amended Complaint, and many of the issues he references, such as interest charges, theeffect of closing an account, and other fees and charges, are directly related to the CardholderAgreement. It is therefore clear that the Cardholder Agreement has been incorporated into theAmended Complaint, and may be considered by the Court without transforming the motion todismiss into a motion for summary judgment. Brooks v. Blue Cross & Blue Shield of Florida, 116F.3d 1364, 1369 (11th Cir. 1997).

24Doc. 4, exhibit A, p. 4.

18

Even if Gillespie had established that HSBC Nevada exceeded Florida’s 18%

interest rate cap, this claim fails for a more basic reason. Gillespie’s Cardholder

Agreement with HSBC Nevada clearly states that it is governed by Nevada law.23

Specifically, the Agreement states that Gillespie’s credit card account “will be governed by

federal law and the laws of the state of Nevada, whether or not you live in Nevada and

whether or not your Account is used outside Nevada.”24 Under Nevada law, “[p]arties may

agree for the payment of any rate of interest on money due or to become due on any

contract, for the compounding of interest if they choose, and for any other charges or fees,”

so long as the interest rates, fees and other terms are reduced to writing. NV Stat. §

99.050. See also, Mapes v. Palo Alto Town and Country Village, Inc., 584 F. Supp. 508

(D. Nev. 1984). Because Gillespie has not alleged any violations of Nevada law, nor


25Gillespie argues, without any legal support, that because he did not sign the CardholderAgreement, it is void under the statute of frauds. Doc. 5, p. 7. Such a bald conclusory statementcannot save this claim from dismissal. In addition, it is unclear from the Cardholder Agreementwhether a signature is required for the Agreement to be enforceable. It is also unknown whetherGillespie signed any papers consenting to this Cardholder Agreement at the time he opened hiscredit account. These unresolved questions are all factual disputes, which cannot be decided ona motion to dismiss.

26Doc. 22, ¶ 96; Doc. 5, p. 8.

19

alleged that the Cardholder Agreement’s choice of law provision somehow does not apply

to this case, he has failed to state a claim upon which relief can be granted. Gillespie’s

Florida usury claim will be dismissed without prejudice.25

D. Negligence Claim

Gillespie’s final claim against HSBC Nevada is a common law claim for negligence

under Florida law. From the very brief allegations asserted, it appears that Gillespie is

arguing that HSBC Nevada was negligent in hiring RMA to act as its debt collector with

respect to Gillespie’s credit card account, apparently because RMA is now in Chapter 11

bankruptcy and cannot be sued.26 To bring such a claim, Gillespie could pursue either a

negligent hiring theory, or a common law negligence theory. Gillespie’s barebones claim

does not specify the legal theory upon which it is predicated. However, under either theory,

Gillespie has failed to allege a claim upon which relief can be granted.

To allege a prima facie claim of negligent hiring, Gillespie must assert that:

(1) the employer was required to make an appropriateinvestigation of the employee and failed to do so; (2) anappropriate investigation would have revealed the unsuitability ofthe employee for the particular duty to be performed or foremployment in general; and (3) it was unreasonable for the


27The Court seriously doubts Gillespie could establish such a relationship in any event.

20

employer to hire the employee in light of the information he knewor should have known.

Malicki v. Doe, 814 So.2d 347, 362 (Fla. 2002) (citing Garcia v. Duffy, 492 So. 2d 435, 440

(Fla. 2d DCA 1986)). Gillespie’s Amended Complaint does not allege any of these

elements. In fact, he does not even establish or allege that RMA was HSBC Nevada’s

employee.27

To the extent Gillespie is instead proceeding under a simple common law claim of

negligence, this claim also fails. To allege a prima facie case of negligence, Gillespie must

aver that: (1) HSBC Nevada owed a legal duty to Gillespie; (2) HSBC Nevada breached

that duty; (3) the breach legally caused an injury to Gillespie; and (4) damages resulted

from the injury. See Pinchinat v. Graco Children’s Prods., 390 F. Supp.2d 1141 (M.D. Fla.

2005). Again, Gillespie has not alleged any of these elements, and has not responded to

any of HSBC Nevada’s arguments challenging this negligence claim.

Because Gillespie has not alleged any of the elements necessary for either a prima

facie claim for negligent hiring or for common law negligence, his claim must be dismissed.

And while the Court has great doubts Gillespie could ever succeed on such a claim, the

Court will provide him with one more opportunity to properly allege this claim.

E. Punitive Damages and Attorneys’ Fees

HSBC Nevada also requests to have Gillespie’s claim for punitive damages in his

state law fraud claim stricken because it is based on “conclusory allegations in the absence


21

of a reasonable basis in fact to support a claim for fraud.” See Doc. 4, p. 9 (citing Porter

v. Ogden, 241 F.3d 1334, 1340 (11th Cir. 2001). Because the Court has determined that

Gillespie has sufficiently alleged a claim for common law fraud, his request for punitive

damages may also go forward.

Gillespie has also included in his requests for relief under each of his claims a

request for attorneys’ fees and costs. HSBC Nevada has moved to have Gillespie’s

request for attorneys’ fees stricken, arguing that a pro se litigant is not entitled to attorneys’

fees. The Court agrees. See Kay v. Ehrler, 499 U.S. 432 (1991); Ray v. U.S. Dept. Of

Justice, 87 F.3d 1250 (11th Cir. 1996); Celeste v. Sullivan, 988 F.2d 1069 (11th Cir. 1992).

The fact that Gillespie may have some paralegal experience or training is of no relevance.

Accordingly, any requests on behalf of Gillespie for attorneys’ fees shall be stricken, and

Gillespie is instructed not to include any such requests if he chooses to file a second

amended complaint.

Conclusion

Accordingly, upon due consideration, it is hereby ORDERED and ADJUDGED that:

(1) Defendants HSBC North America Holdings Inc.’s, and HSBC Bank Nevada,

N.A.’s motion to dismiss (Doc. 4) is GRANTED IN PART AND DENIED IN PART. All

claims against Defendant HSBC North America Holdings Inc., to the extent any are alleged

in the Plaintiff’s First Amended Complaint (Doc. 22), are DISMISSED WITHOUT

PREJUDICE. Count IV of the Plaintiff’s First Amended Complaint against Defendant


22

HSBC Bank Nevada, N.A. is DISMISSED WITHOUT PREJUDICE. The Plaintiff may not

recover attorneys’ fees while proceeding pro se, and therefore all references to attorneys’

fees are STRICKEN, and the Plaintiff may not assert any claims for attorneys’ fees in any

future pleadings. In all other respects the Motion to Dismiss (Doc. 4) is DENIED.

(2) Defendants HSBC North America Holdings Inc.’s, and HSBC Bank Nevada,

N.A.’s motion to dismiss negligence count (Doc. 29) is GRANTED. Count V of the First

Amended Complaint is DISMISSED WITHOUT PREJUDICE.

(3) All claims against Defendant Risk Management Alternatives, Inc. are hereby

stayed pending notice that the automatic stay under 11 U.S.C. § 362 has been lifted.

(4) The Plaintiff shall have twenty (20) days from the date of this Order to file a

second amended complaint correcting the deficiencies discussed in this Order. Failure to

submit an amended complaint within this time period will result in the dismissal with

prejudice of the above-listed claims.

IT IS SO ORDERED.

DONE and ORDERED at Ocala, Florida this 25th day of September, 2006.

Copies to: Counsel of RecordNeil J. Gillespie, pro se


Amended Disability Motion, 12-11213-C, C.A.11

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