UF could not maintain

my speech obturator

Dr. Kusiaks photo of my

oral-nasal fistula, 1985

CPCF Journal, unoperated adult

July 1992, Vol. 29 No.4, page 371

Mr. Rodems breached his duty to avoid a limitation on independent professional judgment, violated
Rules 4-1.7, 4-1.9, 4-1.10; McPartland v. ISI Inv. Services, Inc., 890 F.Supp. 1029, M.D.Fla., 1995
Transcript, March 3, 2006, page 6
4
5
6
7
8
9

MR. GILLESPIE: Now, you call here and just

marched into a tirade of insults.
MR. RODEMS: No, actually I haven't insulted
you at all. I've never said anything about you. I
just said that you don't really know the law
because you don't know how to practice law.

Transcript, March 3, 2006, page 7

24 MR. RODEMS: Didn't you at one time purchase a
25 car so that you could get the cash rebate to get
Transcript, March 3, 2006, page 8
1 some dental work done? We're going to get to the
2 discovery, anyhow, so just tell me, did that really
3 happen?
4 MR. GILLESPIE: What?
5 MR. RODEMS: Did you purchase a car so that
6 you could get the cash rebate to get some dental
7 work done?
8 MR. GILLESPIE: Listen, this is why you need
9 to be disqualified.
10 MR. RODEMS: No, I mean, that's -- because I
11 know that? Because I know that to be a fact?
12 MR. GILLESPIE: You know it to be a fact from
13 your previous representation of me.
14 MR. RODEMS: Well, you know, see that's -15 MR. GILLESPIE: If it is -- if it's a fact,
16 anyway.
17 MR. RODEMS: You need to study the rules and
18 regulations of the Florida Bar because when you
19 make -20 MR. GILLESPIE: I think, I think I bought a
21 car so I would have something to drive. I don't
22 know why you buy cars, but that's why I bought it.
Transcript, March 3, 2006, page 9
MR. RODEMS: Okay. Well, I just want to be
20 clear because I understand that in talking with you
21 it's very important to be precise because you don't
22 really have a good command of the language that,
23 you know, lawyers speak.

AMERICAN ONCOLOGIC HOSPITAL

PROGRESS REPORT
Notll prairllss of caslI. complications. chanilll In dlaposls

condition on dlscharill. Instructions to patlllnt

415-13

Rev. ]-8]

CHART COpy

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 ...

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.

ep
s1ak, M.D.
econstructive Surgery
JK:bsm
T--8/1/85
D--7/23/85

ADMINISTRATIVE OFFICE OF THE COURTS

THIRTEENTH JUDICIAL CIRCUIT OF FLORIDA

LEGAL DEPARTMENT

DAVID

A.

GENERAL COUNSEL

ROWLAND

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

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 of your 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

BARKER, RODEMS & COOK

PROFESSIONAL ASSOCIAllON

AlTORNEYS AT LAW

CHRIS A. BARKER
RYAN CHRISTOPHER RODEMS
WILLIAM J. COOK

300 West Platt Street, Suite 150

Tampa, Florida 33606

Telephone 813/4891001
Facsimile 813/4891008

March 27,2001

Neil 1. Gillespie
Apartment C-2
1121 Beach Drive NE
St. Petersburg, Florida 33701-1434

Re:

Vocational Rehabilitation

Dear Neil:
I am enclosing the material you provided to us. We have reviewed them and, unfortunately,
we are not in a position to represent you for any claims you may have. Please understand that our
decision does not mean that your claims lack merit, and another attorney might wish to represent you.
If you wish to consult with another attorney, we recommend that you do so immediately as a statute
oflimitations will apply to any claims you may have. As you know, a statute oflimitations is a legal
deadline for filing a lawsuit. Thank you for the opportunity to review your materials.

William 1. Cook

WJC/mss
Enclosures

Neil J. Gillespie
1121 Beach Drive NE, Apt. C-2
St. Petersburg, Florida 33701-1434

Telephone and Fax: (727) 823-2390

March 22, 2001
William 1. Cook, Attorney at Law
Barker, Rodems & Cook, PA
300 West Platt Street, Suite 150
Tampa, Florida 33606
Dear Bill,
Thank you for agreeing to consider my claim of discrimination/negligence against
the State of Florida and its Vocational Rehabilitation Program. Enclosed please find the
following:
1.
My Second and Third (final) Amended Petitions for Administrative Hearing.
These documents set forth much of my claim.
2.
My Motionfor Summary Final Order. The Administrative Law Judge (Johnston)
failed to rule on my motion. The state's response was to try and expand the issues and
compel another psychiatric exam. Seeing this was going nowhere, I motioned to
withdrawal the request. (See my motion, the order and final order, enclosed).
3.
October 5, 1998 letter from Douglas Ligibel, Fla. DVR. This "addendum" letter
sets forth the state's claim that I was not cooperative as a reason to deny services.
4.

Binder with the Fla. Vocational Rehabilitation web site printed out. (not current)

5.
Photo of me taken June 6, 1994 (at 150 pounds) before afilicted with depression
(current weight 290 pounds).
6.

A brief medical history relevant to VR.

In essence, the state discriminated against me based on disability and refused

services as set forth in the petitions. As a result I became severely depressed. The state is
negligent because its own psychologist (Dr. Justice) warned of my depression risk, a
warning the state ignored. The state also misdiagnosed my condition(s). There may be a
breach ofprivacy relevant to my file. During the time referenced by Mr. Ligibel in his
October 5, 1998 letter (item 3, above) my contact with the state was monitored by a
private lawyer, Mark Kamleiter, who disputes the allegations contained therein.

Ne'.~f:~~
osure~ie""t
en

Ps. Bill, these are mostly original documents, please copy and return if needed. Thanks.

BARKER, RODEMS

& COOK

PROFESSIONAL ASSOCIATION

ATTORNEYS AT LAW

CHRIS A. BARKER
RYAN CHRISTOPHER RODEMS
WILLIAM J. COOK

300 West Platt Street, Suite 150

Tampa, Florida 33606

Telephone 813/489.1001
Facsimile 813/489.1008

May 25,2001

Neil 1. Gillespie
Apartment C-2
1121 Beach Drive NE
St. Petersburg, Florida 33701-1434

Re:

St. Petersburg Junior College

Dear Neil:
I have and thank you for your May 22, 2001 letter with enclosures. We have reviewed the
materials that you provided, and while we do not disagree with your criticisms of the St. Petersburg
Junior College, we are not in the position to pursue litigation. Of course, another attorney may have
a different opinion. If you wish to consult with another attorney, you should do so immediately, as
a statute oflimitations will apply to any claims you may have. As you know, a statute oflimitations
is a legal deadline for filing a lawsuit.
Again, we appreciate the opportunity to review your potential claims.
Sincerely,

WJC/so

2671 EXEC. CENTER

CIRC. W. SUITE 100

INC.

1 ffJ92
TALLAHASSEE, FL 3230 -

FOR

June 25, 1998

(850) 488-9071

(8ffJ) 488-8640 (FAX)

Mr. Neil Gillespie

1121 Beach Drive NE, Apt C-2
st. Petersburg, Fl 33701

A/OICE)

(800) 342-08 23 \ v

(800) 346- 4127

(T DD ONLY)

Dear Mr. Gillespie::

This is in further response to your issue about
services for students with disabilities not being available
at st. Petersburg Junior College- in particular job
placement services.
If you feel this is a discrimination issue you may
contact either the Dept. of Justice Civil Rights Office,
Americans with Disabilities Information Line at (800) 514
0301 or the Fla Commmission on Human Relations at (800)
342-8011.

o
198 WILSHIRE BLVD,

CASSELBERRY, FL 32707
(407) 262-765 c

(407) 262-7661 (FAX)

(800) 408-3074

010ICE OR TDD)

o
bee:

Steve, Ann, Linda

2901 STIRLING ROAD

SUITE 206

FT, LAUDERDALE, FL 33312

(954) 967-1493

(954) 967-1496 (FAX)

(800) 350-Li56t

VOICE TDD OR ESPANOL)

(
-----

rALL~ASSEE. FL 3230 J-5Q92

FOI

June 23, 1998

(850) .::38~7l
(850) J88~ (FAX)

Mr. Neil Gillespie

1121 Beach Drive NE, Apt. C-2
st. Petersburg, FL 33701

(e<XJ) J42.Q82J (VOICE)

1''''

-'1"7 (TOO ONLY)

(800)J~

Dear Mr. Gillespie:

I was asked to review your Second Amended Petition.

.J

198 vVILS;.4Ir<E 5LvO.

I am not your attorney and see no reason for a

detailed review, particularly since the Petition has been CASSc'1SEr'<RV. FLJ2i07

filed.
I believe, while your Petition is too long, that you
have corrected the previous problem of what relief, in
terms of VR services, you are seeking.
you
are
already
aware
that
the
Administrative Law JUdge cannot grant some of the other
relief you are seeking.
Of

course,

I would just advise -you not to rely on any of the

exhibits as being in evidence.. Make sure to ask the Judge
at the hearing to move into evidence any of the documents,
etc. that you want.

(JOn :62;~::O
(AOn:62.i66J (F.J,XJ
(SCO) JCS~OiJ

(VCICE CR TCO)

..-t'ING~C..~c

~1~11I(,,",

SUITE :c~

Leonard T. Helfand
General Counsel

LTH:ljl
bee:

Ann

MARK S. KAMLEITER
A TIORNEY A T LAW
Courthouse Square
600 First Avenue N. - Suit. 206

Office: (813) 824-8989

Fax: (813) 824-6389

St. Petersburg. FL 33701

March 17, 1997

Jura Philpot, Supervisor

Division of Vocational Rehabilitation
525 Mirror Lake Drive N., Rm 145
St. Petersburg, FL 33701

Re: Neil J. Gillespie: Application for Vocational Rehabiliative Services

Dear Ms. Philpot:

Please be advised that I ha\'e been consulted by Mr. Neil J. Gillespie. Mr. Gillespie feels that
he has not been treated correctly by your division and he believes that your office may have
discriminated against him due to the particular nature of his disability.
I have reviewed Mr. Gillespie's file, including correspondence between himself, yourselfand
a Ms. Van Ess. I must be frank when I say that I can understand Mr. Gillespie's frustration and
irritation with the treatment he has received. I am not at this time entirely certain as to why he has
received this type of treatment, but I feel that Mr. Gillespie deserves more direct and courteous

treatment. This being the case I would like to request several things:
1. That Mr. Gillespie's letter Ms. Van Ess, dated January 16, 1997, be disregarded to the
extent that it may be interpreted as withdrawing his prior request for services. Mr. Gillespie
rema~s determined to seek and obtain the vocational rehabiliative services that he has a right
to.

2. Mr. Gillespie expects that the Individualized Written Rehabilitation Program produced by
your office (3/24/94) and which took nine months of effort on Mr. Gillespie's part to get
produced, be implemented. If for any reason your office C8IU1ot or will not implement this
plan, then I expect to be notified of that decision and the reasons therefore.
3. That a correction to Ms. Van Ess's letter dated 1/15197 be made with an appropriate
apology to Mr. G~ll~spie. This letter was clearly offensive, suggesting dishonesty and lack of
cooperation on Mr. Gillespie's part. If Mr. Gillespie's application is examined it is very clear
that Mr. Gillespie info~ed your office ~at his disabilities were related to "Velopharyngeal
incompetence, Personality Disorder (Schizoid)" (overweight & high BP)." This would make
Ms. Van Ess's assertion that Mr. Gillespie had not truthfully indicated his "mental health
issues." Mr Gillespie's Social Security disability letter indicated only the recognition ofhis
disability and not the grounds for the recognition. In any case the fact of Mr. Gillespie's

disability for Social Securit}' purposes is not in question.

4. Because there seems to have been a hostile attitude displayed toward Mr. Gil1espie~ I am
asking your office to correspond with Mr. Gillespie through my office. I will be monitoring
the timeliness, professionalism and the appropriateness ofthe your office's handling of Mr.
Gillespie's file.
5. Apparently there has been some misunderstanding relative to the interplay. between Mr.
Gillespie's "velopharyngeal incompetence" and his personality disorder. It would appear that
this lack of understanding has caused Mr. Gillespie to be forced to l.Uldergo evaluations and
counseling by individuals who are completely unqualified to understand, relate to and to help
Mr. Gillespie (Marbeiter). This treatment has not only not been helpful to Mr. Gillespie and
not advanced his application to the granting of services, but has directly created a high level
offcustration, aggravating his disability. For this reason I am asking that each time Mr.
Gillespie is asked to participate in counseling, guidance, or interviews related to his
application, that I be advised in advance as to the purpose of the session, the name, title and
qualifications of the cOWlselor or interviewer.
Please Wlderstand that my purpose is not to interfere or to create greater conflict than now
exists, but it is my hope that I can serve to improve communications and facilitate Mr. Gillespie
receiving the services which he has a right to and which he needs in order to successfully integrate
productively into the work force_ I am asking that this past history of problems be set aside and that
a fresh, unbiased focus be given to Mr. Gillespie's application. I am asking that we not allow Mr.
Gillespie's disability (personality disorder) cause us to treat him differently or with less respect than
we would give any other candidate for services. If I am able to help in achie,,-ing this, I will feel that
I have contributed something very positive to your \vork.
I thank you in advance for your kind consideration of my requests and I await your
compassionate response.

Sincerely,

Mark S. Kamleiter

Social Security Administration

Retirement, Survivors and Disability Insurance
Notice of Award
Office of Disability and
International Operations
1500 Woodlawn Drive
Baltimore, Maryland 21241-0001
Date: August 23, 1993
Claim Number: 160-52-5117HA
NEIL J GILLESPIE
266 7 AVE NE APT 5
ST PETERSBURG, FL 33701-2651

1 11 11.1 11111 1.1.111.1 11.11 11 11 1

We recently told you that you met the medical requirements to receive Social
Security benefits. Now we are writing to tell you that you meet the other
requirements. Therefore you qualify for monthly disability benefits from Social
Security beginning July 1992.
However, we cannot pay you for July 1992 through July 1993.
The Date You Became Disabled

We found that you became disabled under our rules on January 17, 1992. This is
different from the date given on the application.
Also, you have to be disabled for 5 full calendar months in a row before you can
be entitled to benefits. For these reasons, your first month of entitlement to
benefits is July 1992.
What We Will Pay And When

You will receive $1,185.00 for August 1993 around September 3, 1993.

After that you will receive $1,185.00 each month.

Your Benefits

We raised your monthly benefit amount beginning December 1992 because the
cost of living increased.
Enclosure(s):

Pub 05-10072

Pub 05-10153

See Next Page

. 160-52-5117HA

Page 2 of 3

Other Government Payments Affect Benefits

Besides the money we are sending you now, you may be due some more Social
Security money for July 1992 through July 1993. We must first subtract the
amount of your Supplemental Security Income payments for some or all of these
months from the Social Security money you are due. When we figure the
amount we have to subtract, we will send another letter to show how it was
done. If you are still due some money after the subtraction, we will also send
you a check.
Other Social Security Benefits

The benefit described in this letter is the only one you can receive from Social
Security. If you think that you might qualify for another kind of Social Security
benefit in the future, you will have to file another application.
Do You Disagree With The Decision?

If you think we are wrong, you have the right to appeal. A person who did not
make the first decision will decide your case. We will correct any mistakes. We
will review those parts of the decision which you believe are wrong and will look
at any new facts you have. We may also review those parts which you believe
are correct and may make them unfavorable or less favorable to you.

You have 60 days to ask for an appeal.

The 60 days start the day after you receive this letter.

You must have a good reason if you wait more than 60 days to ask for an
appeal.

Things To Remember For The Future

The doctors and other trained personnel who decided that you are disabled expect
your health to improve. Therefore, we will review your case in July 1994. We
will send you a letter before we start the review. Based on that review, your
benefits will continue if you are still disabled, but will end if no longer disabled.
For you to be considered disabled under our rules, your health problems must
keep you from doing not only your usual work, but also any other kind of
substantial gainful work.
Also, you must meet this requirement at the same time when you have earned
enough credits for work under Social Security. The last date when you will have
earned enough credits is December 1994.
Please read the enclosed pamphlet, "How You Earn Social Security Credits,"
which explains how the credits are earned and how many a person needs to
receive benefits.

Page 3 of 3

160-52-5117HA

Your Responsibilities

The decisions we made on your claim are based on information you gave us. If
this information changes, it could affect your benefits. For this reason, it is
important that you report changes to us right away.
We have enclosed a pamphlet, "When You Get Social Security Disability
Benefits...What You Need To Know." It will tell you what must be reported and
how to report. Please be sure to read the parts of the pamphlet which explain
what to do if you go to work or if your health improves.
If You Want Help With Your Appeal

You can have a friend, lawyer or someone else help you. There are groups that
can help you find a lawyer or give you free legal services if you qualify. There
are also lawyers who do not charge unless you win your appeal. Your local Social
Security office has a list of groups that can help you with your appeal.
If you get someone to help you, you should let us know. If you hire someone, we
must approve the fee before he or she can collect it. And if you hire a lawyer, we
will withhold up to 25 percent of any past due benefits to pay toward the fee.
If You Have Any Questions

If you have any questions, call us toll free at 1-800-772-1213. We can answer
most questions over the phone. You can also write or visit any Social Security
office. The office that serves your area is located at:
DISTRICT OFFICE
898 30TH AVE NORTH
ST PETERSBURG, FL 33704
If you do call or visit an office, please have this letter with you. It will help us
answer your questions.

Cl . ~ ~

//~~q
Louis D. Enoff
Acting Commissioner
of Social Security

PENNSYLVANIA HOS- TTAL

~

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

'',

DEPARTMENT FOR SICK AND INJURED

EIGHTH AND.SPKUCF; STREETS
P.ADELPHIA, PENNSYLVANIA 19107
.
PHONE (215) 829-5643

HARVEY M, ROSEN. M,D, D,M,D,

Head, Se,lion of Plastic Surgery

gtiTie 3H,301.50uth Eighth sr

H, ROBERT CATHCART, President

1?A ~,.;.7~

I etV1

August 12, 1985

Lj-)-?7
',.,

:.",

Joseph Kusiak, M.D.

American Oncologic Hospital
Central " Shelmire Avenues
,.',
~~~l~~elphia, Pennsylvania
19111

RE:

/8&

".
Neil Gille.pie

Dear Joei"" ,
This lllorning your patient, t-lr. Neil Gillespie, was seen in
consultation regarding his secondary cleft lip and palate deformi
ties. 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 pre
senting 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 cross
bite 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 ap
pliance, 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 per
formed 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

Joa.ph Kuaiak, M.D.

Auguat 12, 1985

-2-

Thank you for referring K% G11leQpie.

cuas~9 him with you.

I looK forward to 41a

Sest revarda.
Sincerely youre,

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

1iHa/e~

cel

u:

Rosie Mayro, D.M.D., 1830 Rittenhouse Square, Phila., PA 19103

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

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

\.

~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 ' l s 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
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
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:,,:,:9

M.D~.

PlASTIC SURGERY: Peter Randall, M.D., Don LaRossa, M.D., Linton Whitaker, M. D., Ralph Hamilton, M. D., R:Barrett Noone, M.D.,). Brian Murphy,
, ,:" 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.

l'

,
0'

RE: Neil Gillespie

(2)

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
,: ....

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

MI\~!f~ I~

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

~I!;~)' III J II I ',IX: III f'J III 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.

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 S
PROGRESS.
I

SINCERJ~Y,/,
Ii

MARK

~.

\1

,./'
/';

,/

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.

RITTENHOUSE SQUARE
PHILADELPHIA" PA 19103

1850

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 HIM
AGAIN SHORTLY BEFORE HIS SURGERY WITH HARVEY ROSEN. HIS PERIODONTIUM
IS CURRENTLY HEALTHY ENOUGH TO WITHSTAND THE RIGORS OF ANY
ANTICIPATED TOOTH MOVEMENT.
i

THANK 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.

CC:

HARVEY ROSEN" D.M.D." M.D.

JUL 0,,1986

.._._ ...._,

I ...

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

DEPARTMENT FOR SICK AND INJURED

EIGHTH AND SPRUCE STREETS
....ADELPHIA, PENNSYLVANIA 19106

HARVEY M. ROSEN. M.D. D.M.D

He.d. Section of PI..tic Suraery
Suite 3H. 301 South Eiahth Street

~EPHONE (215) 829-5643

H. ROBERT CATHCART, Pruidenl

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 pal
atal fistula with a significant alveolar defect. In addition, he had
a rather severe cleft nasal deformity with a large amount of velopharyn
geal 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 reduc
tion 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,fficul
ties wi t~ nas';ll br 7athing.. For thi~ reason. no extensi.Y,~.~~9r:kwa~~~ne
to the r~ght ~nfer~or turb~nate, wh~ch is s~.'.~~;J~
".t'IY'hypertrop~~ed,
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) 4712000
, ,,-:t:. I )f~

'1 '

.:;~ .

'. I,,):,

HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA

4TH FLeOR - SILVERSTEIN PAVILION
3400 SPRUCE STREET
PHILADELPHIA, PA. 19104
(215) 662-2000

JONATHAN E. RHOADS, M.D.

CLETUS W. SCHWEGMAN, M.D.
BROOKE ROBERTS, M.D.
PETER RANDALL, M.D.
JULIUS A. MACKIE, M.D.
L. HENRY EDMUNDS, JR., M.D.
LEONARD D. MILLER, M.D.
CLYDE F. BARKER, M.D.
RALPH HAMILTON, M.D.
HENRY D. BERKOWITZ, M.D.
HAZEL I. HOLST, M.D.
LINTON A. WHITAKER, M.D.
ERNEST F. ROSATO, M.D.
LEONARD J. PERLOFF, M.D.
JAMES L. MULLEN, M.D.

June 17, 1987

DON LA ROSSA, M.D.

RICHARD N. EDIE, M.D.

LARRY W. STEPHENSON, M.D.

JOHN L. ROM BEAU, M.D.

GORDON P. BUZBY, M.D.

ALI NAJI, M.D.

W. CLARK HARGROVE, III, M.D.

V. PAUL ADDONIZIO, M.D.

CLIFFORD W. DEVENEY, M.D.

KAREN E. DEVENEY, M.D.

IRA J. FOX, M.D.

JOHN M. DALY, M.D.

MICHAEL H. TOROSIAN, M.D.

scon P. BARTLEn, 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

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, includ
ing the use of dental prosthetics and posterior pharyngeal flap. I also ex
plained to Mr. Gillespie that the prognosis after placing a posterior pharyn
geal 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.,
AUDIOLOGY: Dan F. Konkle, Ph.D.
PEDIATRICS: Patrick Pasquariello, M.D.
SOCIAL WORK: David ). Beele, M.S.W., A.C.S.W.
Lawrence W. C. Tom, M.D.
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.

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 pre certification 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

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

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

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

'The Plastic Surgery Centre

Plutic and Re.:onsl:ruc:tivc Surgery Tel. (305) 325144.
1444 N.W. 14th Avenue

Miami. Florida 33125

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

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.

Tampa, FL 33603-3301

Telephone: 813/231HH09
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 com
municate with us.
Sincerely,

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

MBH/bbd/5-8

BETH INGRAM AND ASSOCIATES, INC.

Speech - Language Pathologists

PAMELA KYNKOR, M.S., C.C.C.

FOR APPOINTMENTS CALL: (813) 653-1149

911 S. Parsons Ave., Suite # K

Brandon, FL 33511

3314 Henderson Blvd.

Tampa, FL 33609

3450 E. Fletcher Ave.

Tampa, FL 33617

SPEECH/VOICE EVALUATION

Neil Gillespie
266 7th Avenue N.E.I5
St. Petersburg, Florida
894-7914

D.O.B. :
C. A. :

Date of Testing:

March 19, 1956

37 years
June 1, 1993

TESTS ADMINISTERED:
Test of Oral Structures and Functions
The Fisher-Logemann Test of Articulation Competence: Word
Sentence Level
Oral Facial Communicative Disorders Clinical Tests- Bzoch

and

Mr. Neil Gillespie, a thirty-seven year old male, was seen for
a Speech and Voice Evaluation on June 1, 1993. He was referred by ,
Robert William, Ed.D., certified rehabilitation counselor for
Vocational Re;habilitation, and Jane Schuerle, Ed.D., coordinator of
the Tampa Bay Craniofacial Team, due to the patient's reported
difficulty with speech and voice in previous employment situations
and history of cleft lip and palate.
HISTORY:
Mr. Gillespie has an extensive medical history beginning with
a diagnosis at birth of unilateral cleft lip, cleft palate and
ruptured eardrum.
He reported that initial cleft surgery was
performed at three Inonths of age and palate surgery at two years of
age. Speech therapy and orthodontic treatment was also completed.
In 1986,
Mr.
Gillespie stated that he began pre-surgical
orthodontic treatment, including peridontal surgeries. Surgery was
also performed that year to close the oral nasal fistula with bone
graft to alveolus of nasal floor (septoplasty). Further surgeries
performed in 1986 included cleft lip revision and rhinoplasty. Mr.
Gillespie reported that he was dissatisfied with the results of
these surgeries due to the subsequent development of a breathing
problem. Additional surgeries were performed in 1990, by Dr.
Millard, Jackson Memorial Hospital, Miami, Florida. These included

Page 2 - Neil Gillespie

cleft rhinoplasty with submucous resection and pharyngeal flap.
On May 5, 1993, Mr. Gillespie consulted with Mutaz Habal, M.D., of
the Tampa Craniofacial ~eam. According to Mr. Gillespie a course
of treatment was suggested requiring several surgeries, following
"confirmation of my condition".
A confirmation procedure was
initially scheduled for June 1, 1993, however, it was canceled.
Reportedly, this surgery was contingent on Mr. Gillespie being
accepted by the Vocational Rehabilitation Services Program. He has
not been involved in speech therapy services since eight years of
age.
Mr. Gillespie was previously employed in business (sales),
where he stated experiencing difficulty due to his speech and voice
problems. He is presently unemployed, however, he wishes to pursue
a college degree in a different field.
ORAL EXAMINATION:
The structure and function of the oral mechanism appeared to
be impaired. Mr. Gillespie was able to imitate isolated movements
of the lips and tongue (i.e., lip pucker and retraction; tongue
elevation, lateralization, depression and protrusion).
Sequenced
functioning revealed the inability to build intraoral pressure
(i.e., inflate a balloon, holding air in cheeks).
ARTICULATION:
The Fisher-Logemann Test of Articulation Competence (Word and
Sentence Version) revealed difficulty with articula~ory precision.
Predominant errors occurred with pressure consonants
(i.e.,
plosives,
fricative,
affricates), with manner and placement
generally normal.
Nasality of nonnasal cognates and distorted
perception of phonemes secondary to resonance imbalance and nasal
air escape. Nasal air escape primarily occurred during production
of voiceless plosives (i.e., 'pi, 'b', etc.) and fricatives (i.e.,
's', If', Ish').
Additionally, glottal articulation for Igl and
Ikl was observed in connected speech. High vowels lui and Iii were
hypernasal. Production of consonant blends were also occasionally
imprecise (i. e. , ' sn I,
I sk "
'pr' etc.) .
Intelligibility of
connected speech was approximately 85% if the context was unknown.
Speech rate appeared slow as a compensatory mechanism to maintain
intelligibility.
VOICE EVALUATION:
Resonance balance was characterized by hypernasality.
Nasal
air emission was also observed. Voice quality was somewhat breathy
with reduced volume and rate I which appeared to be used 9-compensatory mechanism.

Page 3 - Neil Gillespie

HEARING:
A pure tone audiometric screening was deferred due to a
scheduled audiological evaluation with Noreen Frans, M. S., clinical
audiologist, on June 4,' 1993.

SUMMARY:
Mr. Gillespie presented himself as somewhat guarded and
exceptionally concerned about the appropriate course of treatment
to pursue.
He exhibited difficulty with oral motor function and
sequencing, articulation skills and voice quality.
Oral motor
deficits included difficulty building and maintaining intraoral
pressure
and
repetitive
movements
of
the
articulators.
Articulation was characterized by errors with production of
pressure consonants
(i.e.,
plosives,
fricative,
affricates).
Nasality of nonnasal cognates and distorted perception of phonemes
secondary to resonance imbalance and nasal air escape was also
noted.
Nasal air escape primarily occurred during production of
voiceless plosives (i.e., 'p', 'b', etc.) and fricatives (i.e.,
'Sf, 'fe,
Ish').
Additionally, glottal articulation for Igl and
Ikl was observed in connected speech. High vowels lui and Iii were
hypernasal. Production of consonant blends were also occasionally
imprecise.
Intelligibility of connected speech was approximately
85% if the context was unknown.
Speech rate appeared slow as a
compensatory mechanism to maintain intelligibility. Voice quality
was characterized by hypernasality,
nasal air emission and
breathiness.
Reduced volume and rate were also observed, which
appeared to be used a compensatory ,mechanism.
RECOMMENDATIONS:
1.

Consultation with Mutaz Habal ,M.D., and Jane Schuerle,

Ed.D, coordinator of the Tampa Craniofacial Team, to
determine appropriate course to purse.

2.

Speech and voice therapy should be considered in

conjunction with medical management of velopharyngeal
insufficiency.

Pamela Kynkor, M.S., C.C.C.

Speech-Language Pathologist

June 2, 1993
Robert E. Williams, Ed.D.
certified Rehabilitation Counselor
Department of Labor and Employment Security
Divisional of vocational Rehabilitation
11213 B North Nebraska Avenue
Tampa, Florida 33612

Department of Communication Sciences

and Disorders
College of Arts and Sciences
University of South Florida
4202 East Fowler Avenue, BEH 255
Tampa, Florida 33620-8100
(813) 974-2006
FAX (813) 974-2668

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

UNIVERSITY OF SOUTH FlORIOA IS

FORT MYERS

LAKELAND

m AFFIRMATIVE ACTION I EOUAL OPPORTUNITY INSTITUTION

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

V732

> 160525117,02

VOCATIONAL REHABILITATION
ACCEPTANCE INFORMATION
CLIENT ID
160525117
NAME NEIL J
GILLESPIE~
STATUS
lOt"
PLAN DEVELOPMENT
DISTRICT 06
PRIMARY DISABILITY
SECONDARY DISABILITY
SEVERE HANDICAP
CATEGORY OF SELECTION
VOCArrrONAL GOAL
TYPE OF INSTITUTION

1--Q7/30/93

Uf\IIT V33

CASE
02
COUNSELOR 1481

1
1

CLEFT PAL.ATE/HARELIP
NONE
FUNCTIONAL LIMITATION
PRIORITY ONE

99

NOT IN AN

680
999

15' 25

UPDATED 99/99/99

INSTITUTE

SPECIAL ~ROjECT 1
SPECIAL PROJECT 2
SPECIAL PROJECT 3
FEDERAL PROJECT 1
FEDERAL PROJECT 2
FEDERAL PROJECT 3
EFFECT I VE DATE OF I WRP
DATE OF INJURY
UPDATE COMPLETE

01:4

PRESS

<XMIT>

FOR FINANCIAL

INFORMATION

/24

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

To Whom It May Concern:

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 oral

nasal 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.

STATE OF WASHINGTON

DEPARTMENT OF SOCIAL AND HEALTH SERVICES

PO Box 45345 Olympia WA 98504-5345

March 22 1996

Social Security Adnlinistration

3700 Martin Way E #] 08
Olympia WA 98506

To Wholn It May

Concern~

Neil Gillespie., SS# 160-52-5117., is an eligible and current participant oftheDivision of

Vocational Rehabilitation (DVI~). I-Ie has been actively involved ill a Rellabilitation Plall
and is working llard towards his vocatiollal goal. At this time, it appears that it may be
necessary to extend his original plan.
;
Please contact me if you llave allY questions.

Sincerely,

r<UJJ~~ ~V~i
Kathi Wolf
VRC
438-8953
1-800-548-0946

\J

~"

Craniofacial Center
Health Science Center

PO Box 100424
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:
Dental No.:
Medical No.:

Neil Gillespie
18-80-41
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.

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:;~~

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

November 19, 1997

Douglas M. Ligibel, MA, CRC
Vocational Rehabilitation Consultant
Florida Division of Vocational Rehabilitation
Bay Park Executive Center
18840 US Hwy. 19 North, Suite 420
Clearwater, FL 34624-3120

RE: Psychotherapy and Craniofacial Disorders

Dear Doug,
Enclosed you will find a copy of a psychological paper entitled "Psychotherapy for
Persons with Craniofacial Deformities: Can We Treat without Theory?" This paper,
authored by Bennett and Stanton, was published in the Cleft Palate-Craniofacial Journal,
July, 1993, Vol. 30 No.4. This information is provided to facilitate your understanding of
my disability because it is both frustrating and non-productive when Florida DVR
repeatedly refers psychologists who are ignorant of craniofacial disorders and their related
psycho-social implications.
This information is offered in the spirit of cooperation and evidence of my
continued submission to the process. Thank you for your consideration.
Sincerely,

(Q)~V
Neil J. Gillespie
1121 Beach Drive NE, Apt. C-2
St. Petersburg, FL 33701
(813) 823-2390
cc: Mark Kamleiter, Attorney at Law
enclosure

Psychotherapy for Persons with Craniofacial Deformities: Can We Treat

without Theory?
M. ELIZABETH BENNETT, PH.D.
MARY L. STANTON, B.S.
In recent yrs, 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. Suggted directions In p.ychotherapy
r....rch tor clen children are discussed.
KEY WORDS:

clfJfting, emotional dysfunction, psychotherapy

Numerous studies have documented psychosocial prob

lems 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 addi
tion, 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 disor
ders 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 psycho
logical services were available to children receiving treat
ment 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% pro
vided 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 be

cause 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 iden
tified as needing psychological care? At least two factors
may contribute to this, including (I) the relatively low
priority of psychological services in public assistance pro
grams mentioned previously, and (2) the inherent difficul
ties 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 re
sponsible 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 psycho
logical 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 psychother
apy 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

Bennett and Stanton, PSYCHOTHERAPY AND FACIAL DEFORMITIES 407

change?" Although we found numerous studies which de

scribed 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 popula
tions 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, emo
tional problems typically accompany a diagnosis of clefl
Ii p/palate.
For example, Richman ( 1983) reported that cleft adoles
cents did not show significantly more personality or ad
justment problems than did nonnal controls. In addition.
this report noted no significant differences in self-per
ceived academic functioning and social satisfaction in
cleft persons compared with their noncleft peers. Simi
larly, 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 signifi
cant number of cleft patienls report continuing dissatis
faction with appearance, hearing, speech. and teeth. Simi
larly, Kapp-Simon (1985) reported that cleft patients had
poorer self-concepts than normal controls. With regards to
achievement motivation, Peter and Chinsky (1975) re
poned that cleft subjects had significantly lower educa
tional 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 re
ports seem to indicate that clefting has relatively insignifi
cant 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, mean
ingful answers to questions about emotional dysfunction
and clefting cannot be answered without sufficient theo
retical specificity. Even if we accept that there are emo
lional problems which occur more frequently in cleft
children than in normal children. Strupp's second ques
tion, "how change can be brought about" cannot be ad
dressed 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 emo
tional 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 treat
ment of emotional dysfunction in cleft children.
The most popular notion of emotional dysfunction in
cleft children has been that of 'reflected appraisals" or 'lhe
"looking glass selr' (see Shrauger and Schoeneman. 1979,
for a review). From this lheoretical viewpoint, cleft chil
dren are at a developmental disadvantage emotionally be
cause they incorporate a negative societal view of facial
deformity into the self-concept. Researchers into cleft
palate issues have noted support for this concept of emo
tional development in the extensive literature on physical
attractiveness. This large and frequently cited literalure
suggests that 'there are far-reaching social benefits to be
ing physically attractive, and severe negative social conse
quences for those who are physically unattractive (see
Berscheid, 1980; Dian. 1981,1986; Adams, 1984; Patzer, '
1985; Alley and Hildebrandt. 1988 for reviews). To sum
marize, researchers have discovered that physically unat
tractive 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 con
form 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 unattrac
tive 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 chil
dren and adults.
Although intuitively pleasing, such an explanation is
problematic for several reasons. Researchers have re
cently begun to question the benefits of physical attrac
tiveness. Often referred to as the "what is beautiful is
good 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 con
el usions. 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
6

408 Cleft Pal.re-Craniofacial Journal. July 1993, Vol. 30 No.4

tional adjustment. Other investigators have noted in

stances 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 oversimplified interpreta
tions of the ubeauty is good" phenomenon. These authors
have noted that a myriad of factors contribute to impres
sion 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 re
search 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 attractive
ness studies have produced less clear results concerning
the benefits of beauty For example. Reis et al. (1982)
found that moderately attractive college women had more
dates and more same-sex socializing than did very attrac
tive college women.
Another problem with the "reflected appraisals" concept
of emotional development is the implicit equation be
tween 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 con
cerning social development in cleft populations (e.g.,
Katz. 1981). Katz postulates that the experience of a stig
matized individual is marked by societal ambivalence.
That is~ there are strong cultural traditions which dictate
help and sympathy for the handicapped, but such tradi
tions 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 accom
pany 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 cra
niofacial defect has profound con seq Jences for concepts
4

of the development of self-esteem in cleft children. While

the prevailing theory of reflected appraisals clearly pre
dicts 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 en
hancement (Crocker and Major, 1989; Hillman, 1992).
Briefly, Crocker and Major outline an attributionbased
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 peo
ple 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 re
moved 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 nega
tivity, a victim of cultural prejudices against unattractive
persons. Therapy might consist of social skills training to
overcome initial negative reactions from peers and teach
ers. 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 ex
tremely negative reactions in other instances (e.g., peers
avoiding interaction, being chosen last for teams)" therapy
that is focused on coping with inconsistent social experi
ences 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 re
ceive noticeable cosmetic benefits through surgery (i.e.
the stigma becomes less visible) may be less able to pro
teet their self-esteem by using their facial stigma. Thus
psychotherapy aimed at helping patients make other attri
butions for interpersonal events may be useful.
Shortcomings in current concepts of emotional dysfunc
tion in cleft populations leave the clinician with litlle
empirical guidance for psychological treatment. Not only
are we unsure about which treatments are most appropri
ate, 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, em
pathy warmth, skills training) on a case-by-case basis.
Evidence from the limited literature on psychotherapy for
physically handicapping conditions suggests that few em
pirical data are available in Ihose areas either (e.g., Ser
voss, 1983; Hoxter, 1986; lureidini, 1988).
II is not suggested that therapists currently providing
psychological treatments to cleft patients are offering in
effective treatments, or even that a specific theory of psy
chological dysfunction is necessary to help a given cleft
patient or family. Studies of the outcome of psychother
apy 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 pro
grams specifically for cleft patients, especially programs
designed to teach effective coping early in social develop
ment. 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

I. Cleft palate centers and organizations should encour

age and promote cross-fertilization between social scien
tists outside the cleft area and scientists working primarily
in cleft palate. Researchers who focus on other stigmatiz
ing conditions (e.g., obesity) and scientists who develop
and refine theories of stigma (e.g., Katz, 1981; Jones et
al. 1984) are rarely cited in the cleft literature. The infor
mation and insights they have to offer should become
integrated with infonnation specific to eleCting. Some at
tempts have been made to incorporate study of other stig
matizing 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
9

vey studies and impression studies are useful, but the

information they offer is limited. Mental health interven
tions 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 inter
action in an ongoing fashion which have been used in
studies of smoking cessation, weight control. and inti
macy (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. Iden
tification 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 effec
tively with their facial differences.
4. Research concerning the mutability of attitudes to
wards physical deformity will enable therapists and com
munity 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 atti
tudes are changeable. With the advent of popular televi
sion 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 per
sons 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 treat
ment 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 em
pirically demonstrated psychological treatment needs for
cleft patients in conjunction with replicable, specific treat
ment 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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Journal of Pediatric Psychology, Vol. 22, No. 4. 1997. pp. 433-438

Matthew L. Speltz2
University of Washington

Lynn Richman
University of Iowa
Received March 13, 1997; accepted March 17. 1997

The term "craniofacial anomalies" (CFAs) refers to a diverse group of congenital

disorders including complex syndromes marked by multiple sutural fusions
(e.g., Crouzan's, Treacher Collins, and Aperts syndromes), simple craniosynostoses involving single fusions (e.g., sagittal synostosis), hemifacial microsomia, clefts of the lip and/or palate, and isolated "birth marks" on the face and
neck, such as benign vascular nevi (i.e., port-wine stains). Most children with
these disorders experience one or more associated complications including feeding and growth difficulties, oral-dental problems, chronic ear infections, speech
and language impairments, and multiple structural and cosmetic surgeries for
both visible disfigurement and "invisible" dysmorphologies (e.g., cleft palate).
Any or all of these factors may produce significant stress and conflict for the
child and family.
Various psychological risk factors have been identified that may compromise the child's psychological adjustment, such as parental guilt or overprotectiveness, stigmatizing social responses to speech impairment or facial disfigurement, and certain neuropsychological limitations (see Barden, 1990; Richman &
Eliason, 1993, for reviews of this literature). Although the majority of children
with CFA appear to show normal psychosocial development (Speltz, Galbreath,
'This paper was supported in part by National Institute for Child Health and Human Development
Grant R01-HD25987-04. We also thank the National Foundation of Facial Reconstruction for their
support of the Psychology Working Group on Craniofacial Conditions.
2
AI1 correspondence should be sent to Matthew L. Speltz, University of Washington, Box 359300CM)8, Seattle, Washington 98105.
433
0l46-8693/97/O800-O433$l2.5(M) 1997 Plenum Publishing Corporalion

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Editorial: Progress and Limitations in the

Psychological Study of Craniofacial Anomalies1

434

Speltz and Richman

More recently, developmental models have been proposed to examine the

interactions and reciprocal relations among multiple domains of risk and protective factors (e.g., Eder, 1995; Richman & Eliason, 1993; Rubin & Wilkinson,
1995; Speltz, Greenberg, Endriga, & Galbreath, 1994). Most have included child
variables (e.g., craniofacial appearance, speech and feeding problems, temp-

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& Greenberg, 1995), the risk of behavior disorders and learning disabilities in
this population is higher than expected (Broder & Richman, in press; Speltz,
Morton, Goodell, & Clarren, 1993). This suggests that a significant number of
these children would benefit from psychological assessment and treatment. In
fact, patient care standards set forth by the American Cleft Palate-Craniofacial
Association (1993) identified the need for early childhood assessments of developmental status, neuropsychological testing in older children, and various psychological interventions including parent training, presurgery anxiety reduction,
and social skills training for children.
Although some CFAs, such as cleft lip and/or palate, occur relatively frequently (e.g., 1 in 1,000 term newborns), many psychologists are unaware of the
distinctive psychological sequelae of these disorders and the interventions most
likely to reduce the risk of poor outcomes. This may be due, in part, to the
infrequent publication of craniofacial research in psychology journals and in part
to a history of many anecdotal reports and case histories with minimal empirical
data. Existing data have been limited by several methodological problems such
as small and diagnostically heterogeneous samples and nonstandardized measures of psychological functioning. In a review and meta-analysis of research on
children's physical disorders (Lavigne & Faier-Routman, 1992), only two studies
of CFAs met criteria for inclusion.
Another significant problem noted by many researchers in this area has been
the absence of studies designed to test a priori hypotheses (Berry, 1995; Eder,
1995). Many early studies of CFAs opportunistically compared children with and
without CFA on numerous parent questionnaires and self-reports of psychological adjustment with little theoretical justification. Social-psychological theories
of facial attractiveness and attributional processes were first introduced as conceptual frameworks in the late 1970s and 1980s (e.g., Bull & Rumsey, 1988;
Tobiasen, 1984). These models led to important advances in the measurement of
facial disfigurement (e.g., Tobiasen, 1995) and a better understanding of how
dysmorphic appearance may lead to social stigmatization (Langlois, 1995). However, empirical findings have not supported a specific, robust effect of facial
dysmorphology on psychological adjustment. Most studies comparing children
with invisible craniofacial dysmorphologies (e.g., isolated cleft palate) with
those having visible facial disfigurement (e.g., cleft lip and palate) have found
few differences in psychological outcomes (see Speltz et al., 1995, for a review),
suggesting that risk factors other than facial disfigurement may be of equal or
greater importance (e.g., feeding, speech, or hearing problems).

Psychological Study of Craniofacial Anomalies

435

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erament, cognitive status), parent variables (e.g., personality, well-being, responsiveness), family/social context (e.g., social support, marital functioning),
and medical treatment variables (e.g., number, type, and outcome of surgeries).
Neuropsychological formulations of CFAs have also shown increased complexity, as indicated by recent work on the differing frequency and course of reading
disabilities in children with different cleft diagnoses (Richman & Eliason, 1993)
and the cognitive correlates of various craniosynostoses (Kapp-Simon, 1996;
Speltz, Endriga, & Mouradian, 1997). There have been improvements in methodology as well. The long-standing emphasis on single variables and crosssectional designs is being replaced by multimethod assessments (including direct
observations of parents and children) and longitudinal and multivariate analyses
(e.g., Campis, DeMaso, & Twente, 1995; Hoeksma & Koomen, 1991; Speltz,
Endriga, Fisher, & Mason, 1997).
The four articles in this special section of the Journal ofPediatric Psychology demonstrate the progress made in recent years, as well as the considerable
challenges that remain. Endriga and Speltz (1997) observed the face-to-face,
presurgery interactions of mothers and infants with cleft lip and palate, isolated
cleft palate, or normal craniofacial morphology. This study is one of the first to
examine the behavioral contingencies between mothers and infants with clefts
using lag sequential analyses. Endriga and Speltz found that the mothers of
infants with cleft palate were more likely than mothers of infants with cleft
lip/palate to disengage when the infant was attending to the mother's face. This
study is limited by a common problem in the study of clefts: the confounding
of gender and diagnosis due to a population gender difference in the incidence
of cleft disorders (i.e., more males have cleft lip/palate, more females, cleft
palate only) and the difficulty of recruiting subjects of the underrepresented
gender.
The study by Pope and Ward (1997) was designed to test theory-driven
hypotheses about the correlates of social competence in preadolescent children
with CFA, as well as to generate new hypotheses for further research. One of the
most interesting findings to emerge from this studyand one with important
implications for interventionwas the relation between parental characteristics
and preadolescents' social competence: Greater social competence was associated with parents who worried less about their child's friendships and actively
encouraged their child to interact with peers. This suggests that the social inhibition of some adolescents with CFA may be related, in part, to their parent's
anxious communications about the quality of the child's peer relationships. As
noted by Pope and Ward, a necessary follow-up to this research is the replication
of these findings using a larger sample and multimethod assessments of social
functioning.
The Richman and Millard (1997) study represents one of the very few
longitudinal studies in this area, and is remarkable in its inclusion of parental

436

Speltz and Richman

The final study in this series of papers by Demellweek, Humphris, Hare and
Brown (1997) reflects the social-psychological tradition in craniofacial research,
with an important methodological advance. Nearly all studies of the attributional
responses of children or adults to CFAs have used still photographs of children
showing affectively neutral facial poses. However, still photographs cannot provide information about facial movement and communications of affective states,
two important sources of information in the perception of facial attractiveness
(Berry, 1995; Langlois, 1995). Demellweek et al. assessed the responses of
school-age children to "target" children with and without fabricated port-wine
stains (PWS) by using videoclips in which target children smiled and briefly
talked, turning their head from side to side. The results of their study suggest that
peers' judgments of character, physical attractiveness, and the social impact of
PWS are complex and multidimensional, with some effects moderated by gender. Overall, there was little evidence of significant prejudice against children
with PWS. The clinical significance of these findings will depend on the extent
to which ratings of videoclips can be shown to predict observed social behavior.
In conclusion, the studies in this special section have illustrated some important advances in psychological research on children's CFAs including microanalytic coding techniques, hypothesis-driven analyses, prospective longitudinal
designs, and the consideration of multiple risk factors. Perhaps the most glaring
weakness still evident in this research is one that has limited the study of CFAs
for decades: small samples that constrain the power of statistical analyses. Although the CFA samples in these studies are relatively larger than those in many
previous studies, the measurement of multiple risk factors has increased the
requirements for sample size considerably. Because of the relatively low incidence of these disorders, research informed by multifactorial models requires
multicenter investigations, in which the outcomes of children with different
combinations of medical and environmental risks can be studied with adequate

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reports of child status for 8 consecutive years. The findings of this study suggest
that the behavioral adjustment of children with clefts may vary by age and
gender, with females showing increases in both externalizing and internalizing
problems with age. An unexpected finding was that measures of three important
medical risks associated with clefts (i.e., impaired speech and hearing, and
atypical facial appearance) failed to predict behavior problems, after controlling
for gender, age, intelligence, and socioeconomic status. This was a very conservative test in that at least one of the covariatesintelligencehas shown strong
relations to externalizing problems in samples of children without congenital
impairments (e.g., Moffitt & Silva, 1988); and, as the authors note, small samples limited the power of the predictive analyses. Nevertheless, these findings
imply that the long-term prediction of psychological outcomes in children with
clefts require the measurement of non-cleft-related factors, including parent and
family variables.

Psychological Study of Craniofacial Anomalies

437

statistical power. We hope this special section on craniofacial disorders will help
to promote the collaboration necessary to undertake such projects.
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Richman, L. C , & Millard, T. (1997). Cleft lip and palate: Longitudinal behavior and relationships
of cleft conditions to behavior and achievement. Journal of Pediatric Psychology. 22, 487-494.
Rubin, K. H., & Wilkinson, M. (1995). Peer rejection and social isolation in childhood: A conceptually inspired research agenda for children with craniofacial handicaps. In R. A. Eder (Ed.),
Craniofacial anomolies: Psychological perspectives (pp. 158-176). New York: Springer-Verlag.
Speltz, M. L., Endriga, M., Fisher, P., & Mason, C. (1997). Early predictors of attachment in
infants with cleft lip and/or palate. Child Development. 68 (I), 12-25.

438

Speltz and Richman

Speltz, M. L., Endriga, M. C , & Mouradian, W. E. (1997). Pre- and post-surgery mental and
psychomotor development of infants with sagittal synostosis. Cleft Palate-Craniofacial Journal,
34 (5), 1-6.

Downloaded from jpepsy.oxfordjournals.org by guest on September 26, 2010

Speltz, M. L., Galbreath, H., & Greenberg, M. T. (1995). A developmental framework for psychosocial research on young children with craniofacial anomolies. In R. A. Eder (Ed.), Craniofacial anomolies: Psychological perspectives (pp. 258-286). New York: Springer-Verlag.
Speltz, M. L., Greenberg, M. T., Endriga, M., & Galbreath, H. (1994). A developmental approach
to the psychology of craniofacial anomalies. Cleft Palate-Craniofacial Journal, 31, 61-67.
Speltz, M. L., Goodell, E. W., Endriga, M. C , & Clarren, S. K. (1994). Feeding interactions of
infants with unrepaired cleft lip and/or palate. Infant Behavior and Development, 17, 131-140.
Speltz, M. L., Morton, K., Goodell, E. W., & Clarren, S. K. (1993). Psychological functioning of
children with craniofacial anomalies and their mothers: A follow-up from late infancy to school
entry. Cleft Palate-Craniofacial Journal. 30. 482-489.
Tobiasen, J. (1984). Psychosocial correlates of congenital facial clefts: A conceptualization and
model. Cleft Palate Journal, 21. 131-139.
Tobiasen, J. M. (1995). Social psychological model of craniofacial anomolies: Example of cleft lip
and palate. In R. A. Eder (Ed.), Craniofacial anomolies: Psychological perspectives
(pp. 233-257). New York: Springer-Verlag.

VIA V.P.S. No. lZ64589FP290713304

September 30, 2013

Michelle Wilson, Executive Director

Florida Commission on Human Relations
2009 Apalachee Parkway, Suite 100
Tallahassee, FL 32301
RE: 1998 Charge of Discrimination - Florida Division of Vocational Rehabilitation
Records request and request for information update
Dear Ms. Wilson:
Enclosed is a copy of a Charge of Discrimination - Florida Division of Vocational Rehabilitation
filed by me June 2, 1998. The complaint is addressed to "Florida Commission on Human ReI.
and EEOC". What was the final outcome on this complaint? This is a request for the case
records. Also, please update my address, I now live in Ocala Florida.
Recently I became aware that a clinical psychologist who evaluated me when I first became a
client ofDVR was either not licensed by the state of Florida, or used a nickname and failed to
provide his business address in his report. The report itself show professional negligence and
disability discrimination, which I only recently came to fully understand. The Department of
Health is sending me a copy of the licensee's licensure file so I can figure this out. Does this new
information allow me to make another complaint of disability discrimination against DVR?
Thank you in advance for the courtesy of a response.

Telephone: (352) 854-7807

Email: neilgillespie@mfi.net

AGENCY

CHARGE OF DISCRIMINATION

CHARGE NUUBER

FEPA
Th1s form 1s affected by the Pr1vacy Act of 1974; See Pr1vacy Act Statement before
IX)
EEOC
complet1ng th1s form.

FLORIDA COMMISSION ON HUMAN REL.

and EEOC

State or local Agency, ifany

NAUE (Indicate Hr., Hs., Hrs.)

HOUE TE.LEPHONE (Include Area Code)

(81~) 82~-2"1qo

Mr. Neil J. Gillesoie

STREET ADDRESS

CITY. STATE AND ZIP CODE

1121 Beach Drive N.E.

Aoartment C-2

DATE OF BIRTH

St. PetersburQ:

FL "1"1701

0~/1q/56

NAMED IS THE EMPLOYER, LABOR ORGANIZATION, EMPLOYMENT AGENCY APPRENTICESHIP COMMITTEE,

STATE OR LOCAL GOVERNMENT AGENCY WHO DISCRIMINATED AGAINST ME (Ir more than one list beloit.)

NAIIE

NUUBER OF EIIPLOYEES. IIEIIBERS

State Of Florida/Div. Of Voc. Rehab

STREET ADDRESS
NAIIE

STREET ADDRESS

FL

St. Petersburll

~~70"1

COUNTY

10"1

TelEPHONE NUIIBER (Include Area Code)

CITY. STATE AND ZIP CODE

CAUSE OF DISCRIIIINATION BASED ON (Check appropriate box(es))

TELEPHONE (Include Area Code)

CITY. STATE AND ZIP CODE

"1251 "1rd Avenue North

DRACE

Cat D (501 +)

DATE DISCRIIIINATION TOOK PLACE

COLOR
RelIGION
NATIONAL ORIGIN
DSEX
RETALIATION
IX] DISABILITY
OTHER (Spectt;y)
DAGE

COUNTY

EARLIEST

12/04/91
0

THE PARTICULARS ARE

LATEST

CONTINUING ACTION

(Ir additional space is needed, attach extra sheet(s)):

I. Personal Harm:

On December 4 , 1991, I was denied vocational rehabilitation services.

II. Respondent's Reason for Adverse Action:
Douglas Ligibel, Vocational Rehabilitation Consultant, stated: "you are
not eligible for vocational rehabilitation services because your
disability is too severe at this time for rehabilitation services to
result in employment.
III. Discrimination Statement:
I believe that I have been discriminated against on the basis of my
disability, in violation of the Americans with Disabilities Act of 1990
(ADA) .

I want th1s charge f1led w1th both the EEOC and the State or NOTARY (When necessary for State and Local Requ1rements)

local Agency, 1f any. I w1ll adv1se the agenc1es 1f I Change my

address or telephone number and cooperate fully w1th them 1n the I swear or aff1rm that I have read the above Charge and that

1t 1s true to the best of my knowledge, 1nformat10n and bel1ef.

processing of mv charge 1n accordance w1th the1r procedures.
I declare under penalty of perjury that the foreg01ng 1s true
SIGNATURE OF COMPLAINANT
~

.,.."oot.

DatJ

EEOC FORM

:l

(Rev.

06/92)

SUBSCRIBED AND SWORN TO BEFORE ME THIS DATE

(Day, month, and year)

'",,,',g "", 13"..'.=)

CHARGING PARTY COPY

STATE OF

FLORIDA

CASE NAIlE

CITY/COUNTY OF

St.

CASE NUMBER

Petersburg/Pinellas

Gillespie vs State 0

AFFIDAVIT

I, Neil J. Gill e s pie

being first duly sworn upon my oath affirm and hereby say:

(Name)

I have been given assurances by an Agent of the U.S. Equal Employment Opportunity Commission that this
Affidavit will be considered confidential by the United States Government and will not be disclosed as long as
the case remains open unless it becomes necessary for the Government to produce the affidavit in a formal
proceeding. Upon the closing of this case, the Affidavit may be subject to disclosure in accordance with
Agency policy.

I am ~ years of age, my gender is Ma 1 e

and my racial identity is _ _......:.:W~h...io..:t~ei"---;-

(sex)

Iresideat

(race)

1121 Beach Drive N.E. Apartment C-2

(Number/Street)

City of

St.

State of

Pe t e r s burg

, County of

---=-P-=i:.=.n.:.;:e::..:l=l=-a=s

, Zip Code __....3

3 ....7.L0~1~_

--'F'-"L==--

My telephone number is (tncluding

area code) _ _...l(~8::..::1:...3J...J...)~ 8-=2

....3,--~2=-3.L.9LO~_

My statement concerns _----==S~t~a~t~e::........:O~f---=-F-=l:..::o~r'-'i!:.:d~a~/~D,.=i~v:_::.,........:O~f=--.,V~o...:::c;..:.~R~e~h=a..:::b~

which is

(Name of Union/Company/Agency)

located at

3251 3rd Avenue North

(Number/Street)

St. Petersburg

My job classification is ( I f

FL

33703
(Zip)

(State)

(City)
applicable)

....,.,....,:--:-.,--,-

(job tit/e)

My immediate supervisor is ( I f

appl icable)'_.....I...;c:-;----:-

---:"....,-:-:-:;--;--

(Name)

(job tit/e)

I believe that I have been discriminated against on the basis of my

disability, personality disorder and speech disability, in violation of
the Americans with Disabilities Act of 1990 (ADA).
Respondent employs over fifteen (15) employees.
On December 4, 1997, I was denied vocational rehabilitation services by
Douglas Ligibel, Vocational Rehabilitation Consultant.
Mr. Ligibel
stated: "you are not eligible for vocational rehabilitation services
because your disability is too severe at this time for rehabilitation
services to result in employment.
I did appeal the agency's decision.

K !l;f~
(ijitia/s)

E:E:OC Att-A (Utl/89)

'V

Page 1 of _ _

 STATE

_
St. Petersburg/Pinellas

OF _ _--"-F.::L:.>::O~R:.=I:.=D~A~

CITY/COUNTY OF

CASE NAME
CASE NUMBER

G111 e s p 1e v sSt ate 0

_

AFFIDAVIT (cent.)

'2--h,andwritten 0
I have read and had an opportunity to correct this Affidavit consisting of
of
my knowledge and belief.
facts
are
true
and
correct
to
the
best
typed g pages and swear that these

Subscribed and sworn to before me

'~ay of
/IL
this

.:I1z e

( 9 r.~

() ~~. ,1.2 )~)

--.

AfF-B (6/211969)

X ~f/~r---

VIA U.P.S. No. 1Z64589FP298921708

February 11, 2014

Aleisa McKinlay, Director

Division of Vocational Rehabilitation
4070 Esplanade Way
Tallahassee, Florida 32399-7016
Re: Records request
Dear Ms. McKinlay:
The Florida Division of Vocational Rehabilitation (DVR) prepared for me as a client in 1994 an
Individualized Written Rehabilitation Program (IWRP), and a Vocational Screening, done by
Brad L. Meyer, CRC, Senior VR Counselor, 525 Mirror Lake Dr. St. Petersburg, FL 33701.
DVR required and obtained several of psychological evaluations of me in conjunction with
habilitation of a congenital speech disorder. Recently I learned that Mark Justice, Ph.D., a
clinical psychologist who evaluated me in January 1994, was not licensed by the state of Florida,
at least not under the name Mark Justice. Enclosed you will find a redacted cover page of a
Psychological Evaluation of me, Neil Gillespie, by Mark Justice, Ph.D. on referral of Brad
Meyer, DVR Counselor. Also enclosed is my email communication with Angela Barton of the
Florida Department of Health. Ms. Barton emailed me September 24, 2013 at 8:40 AM,
I can not be certain that Marcus T. Justice and Mark Justice are one and the same.
Marcus T. Justice was licensed by the state, but he apparently died, according to a story
October 1, 2004 in the St. Petersburg Times, as discussed in my email with Ms. Barton.
My IWRP was not implemented. I received some VR services out-of-state between 1994 and
1996. In late 1996 I returned to Florida and unsuccessfully sought to implement my Florida
IWRP, copy enclosed. My counselor then was Douglas M. Ligibel, MA, CRC, DVR, Bay Park
Executive Center 18840 US Hwy. 19 North, Suite 420 Clearwater, FL 34624-3120.
It has also come to my attention that vocational rehabilitation is not an appropriate substitute
for habilitation of a congenital speech disorder resulting from a craniofacial disorder, in my
case a unilateral cleft lip and palate. In case you are not familiar with this disorder, enclosed you
will find images thereof of a non-operated adult male and adult female from the CPCJ1.
Habuilitation vs. Rehabilitation
An important difference between rehabilitation and habilitation services and devices is the fact
that habilitation services are provided in order for a person to attain, maintain or prevent
deterioration of a skill or function never learned or acquired due to a disabling condition.
1

Cleft Palate-Craniofacial Journal, July 1992, Vol. 29 No.4, page 371

Aleisa McKinlay, Director

Division of Vocational Rehabilitation

February 11, 2014

Page - 2

Rehabilitation services and devices, on the other hand, are provided to help a person regain,
maintain or prevent deterioration of a skill that has been acquired but then lost or impaired due to
illness, injury, or disabling condition.
Unfortunately persons seeking habilitation of a congenital disorder are often seen as
unreasonable and/or displaying a sense of entitlement to a benefit not provided to the nonafflicted, who do not need habilitation. This is technically correct: Normal folks do not need
habilitation or corrective surgery, and congenitally deformed people want habilitation. Also,
some normal folks believe congenitally deformed people were cursed by G-d and not worthy of
habilitation, or are deviant and thus undeserving of treatment or full inclusion in society.
In 1992 I attended a conference in New York by the National Foundation For Facial
Reconstruction (NFFR), Special Faces: Understanding Facial Disfigurement. Enclosed are
sections from the program, including the part for State Vocational Services. The NFFR is a fine
organization, but did not adequately consider speech disorders related to craniofacial disorders.
My application to Florida DVR followed the NFFR conference and recommendations.
Today I am requesting the following records:
1.
2.
3.
4.

Records showing whether Marcus T. Justice and Mark Justice are one and the same.
The personnel file of Douglas M. Ligibel.
My files from 1993-1994 and 1996 onward; and any other file for Neil Gillespie.
Any recent inquires about me, Neil J. Gillespie or variations of my name.

You may provide the records in PDF by email. I do not need paper copies. Thank you in advance
for the courtesy of a response.
Sincerely,

Neil J. Gillespie
8092 SW 115th Loop
Ocala, Florida 34481
Telephone: 352-854-7807
Email: neilgillespie@mfi.net
Enclosures:
Individualized Written Rehabilitation Program (IWRP) for Neil Gillespie
Vocational Screening for Neil Gillespie, by Brad L. Meyer, CRC, Senior VR Counselor
Email correspondence with Angela Barton of the Florida Department of Health
NFFR program sections
Cleft Palate-Craniofacial Journal, July 1992, Vol. 29 No.4, page 371

VIA Email: davidt@flcourts.org

Thomas A. "Tad" David, General Counsel
Office of the State Courts Administrator
Supreme Court Building
500 South Duval Street
Tallahassee, FL 32399

August 25, 2014

cc: John A. Tomasino, Clerk, Florida
Supreme Court, tomasino@flcourts.org
cc: John F. Harkness, Executive Director
The Florida Bar, jharkness@flabar.org

RE: Florida Commission on Human Relations FCHR, Public Records, Loyalty oaths,
876.05 Public employees; oath; Oath of Office, Article II, Section 5(b), Fla. Const.
Dear Mr. David:
Attached you will find my records request July 16, 2014 to Michelle Wilson, Executive Director,
Florida Commission on Human Relations (FCHR), and Jodi Jones, Regulatory Specialist, in the
Disability Discrimination Complaint of Neil J. Gillespie submitted December 10, 2013 to the
Commission, FCHR No. 201400117. I also requested the current status of my complaint.
I requested records of the loyalty oath, as a recipient of public funds from the state of Florida,
that he/she supports the Constitution of the United States, and Florida, for Ms. Wilson and Ms.
Jones. I requested records of the Oath of Office for the Chairman, Vice-Chairman, and each
Commissioner of the FCHR required by Article II, Section 5(b), Fla. Const.
As of today I do not have a response from Ms. Wilson, Ms. Jones or anyone on behalf of the FCHR.
Mr. David, insofar as complaint FCHR No. 201400117 named employees of the OSCA, the
Office of State Court Administrator may have responsive records. If so, this is a request for those
records, and any other records about complaint FCHR No. 201400117.
Mr. Harkness, insofar as complaint FCHR No. 201400117 named the Executive Director of The
Florida Bar et al., The Bar may have responsive records. If so, this is a request for those records,
and any other records about complaint FCHR No. 201400117.
Mr. Tomasino, insofar as complaint FCHR No. 201400117 rises from my use of the Florida
Courts to petition the Government for a redress of grievances, please advise if Rule 1-14.1(a)
Access To Records might be useful in this instance as an add on to the Rule 1-14.1(a) request
submitted to you. The right to petition the Government for a redress of grievances is protected by
the First Amendment to the U.S. Constitution, and Article I, Section 21, Access to Courts, of the
Florida Constitution. Please note, I still have additional information to submit under Rule 1-14.1.
The Florida legislature recently passed the Florida Unborn Victims of Violence Act, Bodily
injury to an unborn child, CS/HB 59: Offenses Against Unborn Children, found at these links,
https://www.flsenate.gov/Session/Bill/2014/0059
https://www.flsenate.gov/Session/Bill/2014/0162/?Tab=RelatedBills
http://www.flsenate.gov/Session/Bill/2014/0059/BillText/er/PDF

Thomas A. "Tad" David, General Counsel

Office of the State Courts Administrator

August 25, 2014

Page - 2

In my view Florida does not have an adequate program of habilitation for persons born with
physical birth defects. Therefore, I believe a constitutional challenge is needed to amend the
Florida Unborn Victims of Violence Act to include all unborn children. Otherwise a law that
only protects certain unborn children in a few circumstances appears unconstitutional.
Nhu Nguyen, born in Vietnam, believes her birth defect was caused by Agent Orange, described in
Babbling about my birth defect on YouTube. Nhu was born with a cleft lip and palate, a serious
physical birth defect that may affect speech, hearing, breathing, eating, socializing and appearance.
Congenital craniofacial deformity may stigmatize a person; effects of stigma can last a lifetime.

Nhu Nguyen: Babbling about my birth defect

http://youtu.be/g368cugbWZQ

Birth Defect Research for Children (BDRC)

http://youtu.be/-Tmbm9mIJwA

Ten million gallons of Agent Orange were sprayed during the Vietnam War. Eighteen different
birth defects have been service-connected in children of women veterans who served in Vietnam.
Attached you will find evidence of my physical disability, and evidence that Barker, Rodems &
Cook, PA investigated my claim of discrimination/negligence against the State of Florida and its
Vocational Rehabilitation Program (DVR). In turn Florida/DVRs discrimination prevented an
accurate assessment and mandated services under section 504 of the Rehabilitation Act of 1974.
Evidence shows Mr. Rodems later used my confidential client information against me, client
information learned from his firms prior representation of me. Mr. Rodems breached, inter alia,
his duty to avoid a limitation on independent professional judgment, violated Rules 4-1.7, 4-1.9,
4-1.10; and the holding of, inter alia, McPartland v. ISI Inv. Services, Inc., 890 F.Supp. 1029,
M.D.Fla., 1995; and State Farm Mutual Automobile Insurance Co. v K.A.W, 575 So. 2d 630
(Fla. 1991). Unfortunately The Florida Bar failed to protect me, a consumer of legal and court
services, from Mr. Rodems, et al. Article V, Section 15, Attorneys; admission and discipline.
Thank you in advance for the courtesy of a response. Sincerely,

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

Telephone: (352) 854-7807

Email: neilgillespie@mfi.net

attachments

Deputy Secretary-General Jan Eliasson

Executive Office of the Secretary-General
Rule of Law Unit, United Nations Headquarters
First Avenue at 46th Street
New York, NY 10017 Email: rol@unrol.org

May 18, 2014 - by email only

Re: Records Request
For records of contacts made on my behalf,
or that pertain to Neil J. Gillespie

Special Rapporteur Shuaib Chalklen

Disability, United Nations Enable
405 East 42nd Street
New York, New York 10017
Email: enable@un.org
Special Rapporteur Gabriela Knaul
Independence of Judges and Lawyers
Office of the United Nations High
Commissioner for Human Rights
United Nations Office at Geneva
8-14 Avenue de la Paix
1211 Geneva 10 Switzerland
Email: SRindependenceJL@ohchr.org

Dear Deputy Secretary-General Eliasson, Mrs. Knaul,

Mr. Chalklen, and United Nations Associates,
On April 23, 2014 I made a records request of the United Nations. A copy of the records request
is attached. As of today I do not show a response. Please advise when I can expect a response.
President Barack Obama wrote me March 12, 2014 in response to my letter suggesting specific
action by the United Nations under the Rome Statute in lieu of unilateral aggression by the U.S.
against Syria. Our correspondence is attached. President Obama provided me a comprehensive
response, including a link to U.S. foreign policy on Syria on the White House website.
http://www.whitehouse.gov/issues/foreign-policy/syria
Tellingly President Obama did not mention or respond to my suggestions for specific action by
the United Nations under the Rome Statute. Honestly I am surprised President Obama would
respond to an ordinary person like me. But the United Nations did not responded to me, and
President Obama did not mention the U.N. in his letter, so perhaps I misinterpreted the role of
United Nations. If so, I regret any inconvenience to the United Nations. I also regret suggesting
to President Obama specific action by the U.N. under the Rome Statute if that was wrong.
Regarding disability, Ms. Zinnah Begum of Bangladesh was born with a craniofacial disorder.
Fortunately 58 year-old Zinnah finally got life-changing craniofacial surgery on May 24, 2010
through Touching Souls International for freedom of smile,
http://touchingsoulsintl.org/blog/2010/05/24/giving-freedom-of-smile/
A ten (10) page composite for Zinnah Begum accompanies this letter, and includes photos and
URL links, a white paper on The problems of establishing modern cleft lip and palate services
in Bangladesh (The Journal of Surgery, Volume 2, Issue 1, 2004), and a PDF of the World
Health Organization (WHO), Global Health Workforce Alliance for Bangladesh.

Deputy Secretary-General Jan Eliasson

Special Rapporteur Shuaib Chalklen
Special Rapporteur Gabriela Knaul

May 18, 2014

Public Records
Page -2

Ms. Zinnah Begum, Bangladesh. Unfortunately, not all persons are born or created equal.

Social stigma and sadness

Transformation and hope

Article 1 of The Universal Declaration of Human Rights states,

All human beings are born free and equal in dignity and rights. They are endowed with
reason and conscience and should act towards one another in a spirit of brotherhood.
http://www.un.org/en/documents/udhr/
The United States Declaration of Independence proclaims all men are created equal,
We hold these truths to be self-evident, that all men are created equal, that they are
endowed by their Creator with certain unalienable Rights, that among these are Life,
Liberty, and the Pursuit of Happiness. That to secure these rights, Governments are
instituted among Men, deriving their just powers from the consent of the governed.
http://en.wikipedia.org/wiki/All_men_are_created_equal
However it is self-evident that Zinnah Begum was not born or created equal because she needed
craniofacial surgery since the time of her birth to be free and equal in any meaningful way.
It took 58 years for Zinnah to get her face fixed, another fact that also calls into question whether
all men are created equal or All human beings are born free and equal in dignity and rights.
Does the United Nations consider Zinnah Begum disabled? Does the U.N. sponsor or facilitate
craniofacial surgery? I was not able to find this information on the U.N.s website. Thank you.
Sincerely,

Neil J. Gillespie
8092 SW 115th Loop
Ocala, Florida 34481
Enclosures

Telephone: 352-854-7807
Email: neilgillespie@mfi.net
cc: U.N. email service list

Deputy Secretary-General Jan Eliasson

Executive Office of the Secretary-General
Rule of Law Unit, United Nations Headquarters
First Avenue at 46th Street
New York, NY 10017 Email: rol@unrol.org

April 23, 2014 - by email only

Re: Records Request for UN contacts or records
made on my behalf in Petition No. 12-7747
and Petition No. 13-7280, U.S. Supreme Court

Special Rapporteur Shuaib Chalklen

Disability, United Nations Enable
405 East 42nd Street
New York, New York 10017
Email: enable@un.org
Special Rapporteur Gabriela Knaul
Independence of Judges and Lawyers
Office of the United Nations High
Commissioner for Human Rights
United Nations Office at Geneva
8-14 Avenue de la Paix
1211 Geneva 10 Switzerland
Email: SRindependenceJL@ohchr.org

Dear Deputy Secretary-General Eliasson, Mrs. Knaul,

Mr. Chalklen, and United Nations Associates,
Thank each of you and the United Nations for your interest in my legal and disability matters
brought to the U.S. Supreme Court. Unfortunately my petition for rehearing Petition 13-7280
was denied March 10, 2014. The Consumer Financial Protection Bureau (CFPB) notified me
March 10, 2014 that it cannot pursue the Congressional Inquiry of U.S. Senator Marco Rubio,
with a referral to HUD, the U.S. Department of Housing and Urban Affairs, PDF attached.
HUD and CFPB Freedom of Information Act (FOIA)/Privacy Act responses are attached in PDF.
Forwarded below is my March 13, 2014 email to Mr. Ethan Torrey, Legal Counsel, Supreme
Court of the United States, about my March 5th letter to The Honorable John G. Roberts, Jr.,
Chief Justice of the United States, which is attached, along with letters to the Federal Bureau of
Investigation (FBI), and Deputy Secretary-General Jan Eliasson and OPR Counsel Robin
Ashton, U.S. Department of Justice.
As of today I do not have a response from the Chief Justice. So I am requesting records that you
and the United Nations may have about me and my two petitions to the U.S. Supreme Court, so I
can better understand my situation. I trust this email is sufficient for a records request, since I
was not able to find a specific records request procedure for the United Nations online.
Thank you in advance for the courtesy of a response.
Sincerely,

Neil J. Gillespie
8092 SW 115th Loop
Ocala, Florida 34481
Telephone: 352-854-7807
Email: neilgillespie@mfi.net
cc: U.N. email service list

THE WHITE HOUSE

WASHINGTON

~1arch

12, 2014

Mr. Neil J. Gillespie

Ocala, Florida
Dear Neil:
Thank you for writing. Three years into the Syrian conflict, we face a brutal and protracted civil
war, \vhich extremists are exploiting and which poses a threat to stability throughout the region. I am
glad you took the time to sllare your concerns.
The conflict in Syria began as a series of peaceful protests against the repressive regime of Bashar
aI-Assad. He responded with violence and further repressioII. Today, over 130,000 people have been
killed. Millions have been displaced arld are ill d.esperate need.
In response, the United States has stepped up as the largest donor of humanitarian assistance to
those affected by the war. Our aid has helped. ease the pressures this conflict has put on families and on
the region, but international efforts to pro\Tide more assistance have been blocked by regime obstruction
and insecurity. That is why we continue to demand greater humanitarian access to those in need.
Over the past 2 years, we have also worked with friends and allies to help the moderate Syrian
opposition and chart a path to a political resolution. The January 2014 launch of negotiations between the
Syrian government and opposition, mediated by the United Nations, was a critical step on that path.
One thing I have said since the beginning is that I will not pursue an open-ended military
intervention in Syria. Last year, when the Assad regime violated international law by using chemical
weapons in an attack that killed over 1,000 Syrians, I was prepared to respond through narrow and
targeted military action. But when a diplomatic option opened up, we took it-because I believe any
chance to remove the threat of chemical weapons without the use of force is one 'Ne must pursue.
Today, there is potential for progress. Anlerican diplomacy, backed by a willingness to use
military force, has paved the way for a plan to eliminate Syria's chemical weapons for good. Now, Syria
must meet its international obligations to implement that plan, and Russia has a responsibility to ensure
that Syria complies. And in the months ahead, we will contiIlue to work with the international community
to usher in the future the Syrian people deserve-oIle free from dictatorship, terror, and fear.
Thank you, again, for writing. You can stay up to date on the conflict in Syria and my
Administration's response at www. WhiteHouse. gOY/Issues/Foreign-Policy/Syria.
Sincerely,

rOIl'

rer'

it

THE

WHITE

WASHINGTON,

IT

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President Barack Obama

The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500

September 9, 2013

Dear President Obama,

There is an alternative to bombing or attacking Syria. You could propose the United Nations:
1. Evacuate the city of Damascus where Bashar al-Assad lives in the Presidential Palace.
2. Immediately relocate the population to protect the Syrian people from further harm.
3. Blockade Damascus to contain Assad and his supporters until they run out of supplies.
Eventually Assad will surrender or be captured and brought to justice under international law.
The Rome Statute applies because Syrian national systems have totally failed. The Prosecutor of
the International Criminal Court may open an investigation of Assad on referral by the United
Nations Security Counsel, or by a Pre-Trial Chamber. [The United States cannot make a referral
because we have not ratified the Rome Statute]. Then Assad may be prosecuted for international
crimes, and convicted if the evidence proves his guilt beyond a reasonable doubt. This plan may
be a viable alternative to pending unilateral aggression by the United States.
In my view the Slattery Report1 concept should also be considered instead of hostilities, now or
in a similar situation. People would support evacuating a civilian population to de-escalate a
situation like this one with Assad, so that justice may prevail while protecting the Syrian people.
You were given the Nobel Peace Prize in 2009. Give peace a chance first. Syria can always be
attacked later if necessary, and with better moral grounds than you have now. Thank you.
Sincerely,

Neil J. Gillespie
8092 SW 115th Loop
Ocala, Florida 34481
Telephone: (352) 854-7807
Email: neilgillespie@mfi.net
1

The Slattery Report, officially titled The Problem of Alaskan Development, was produced by the United States
Department of the Interior under Secretary Harold L. Ickes in 193940. It was named after Undersecretary of the
Interior Harry A. Slattery. The report, which dealt with Alaskan development through immigration, included a
proposal to move European refugees, especially Jews from Nazi Germany and Austria, to four locations in Alaska,
including Baranof Island and the Mat-Su Valley. Skagway, Petersburg and Seward were the only towns to endorse
the proposal. http://en.wikipedia.org/wiki/Slattery_Report

http://www.abajournal.com/news/article/brain_injury_leads_to_suspension_for_maine_lawyer_i_couldnt_stick_to_tasks/?utm_source=maestro&utm_...

Legal Ethics

Brain injury leads to suspension for Maine lawyer; I couldnt stick to tasks, he
says
Posted Jun 25, 2014 5:45 AM CDT
By Debra Cassens Weiss
A Maine lawyer says he can no longer function effectively as a trial lawyer and he agrees with his indefinite suspension, imposed by
a Maine Supreme Judicial Court justice on May 27.
Newport lawyer Dale Thistle, 66, attributes his problems to a traumatic brain injury caused by a November 2011 car accident,
CentralMaine.com reports. Complaints made to the bar about his handling of cases are serious and meritorious and directly stem
from my brain injury, he told the publication. I even self-reported a misfiling in federal court.
Thistle says his intelligence is intact but his ability to perform executive functions is impaired. He suffers from minor seizures and
small blackouts. I couldnt organize my day-to-day life, he told CentralMaine.com. I couldnt stick to the tasks. Its just the result o
the brain injury.
The Bangor Daily News calls Thistle a well-known lawyer in its earlier coverage of the suspension. He represented a former
Newport official accused of embezzlement, a 14-year-old girl accused of stabbing her aunt 106 times, and class-action clients who
claimed they were illegally strip-searched at the Knox County jail.
Thistle can regain his license if his condition improves, but hes not optimistic. I have no plans at the moment, he told
CentralMaine.com. I dont know what Im going to do."
Copyright 2014 American Bar Association. All rights reserved.

SUPREME JUDICIAL COURT

Docket No. BAR 14-10

STATE OF MAINE

BOARD OF OVERSEERS OF THE BAR

Phn:rdff
ORDER
OF SUSPENSION
M. Bar R. 7.s(e)(2)(B)
(DISABILITY)

DALE F. THISTLE, ESQ.

of Newport, Maine
Me. Bar #7483
Defendant

By filing dated May 27,2014, the Board of Overseers of the Bar (the
Board) petitioned this Court for

al

immediate Order suspending Dale

F Thistle

for disability-related reasons from the practice of iaw in the State of Maine.
Included with the Board's Petition was a Confidentia-l Affrdavit of Bar Counsel.
For good cause shown by the Board., Dale F. Thistle, Esq. appears to be a
disabled attorney; as a result, he has comrnitted apparent vioiations of the
Maine Rules of Professional conduct, thereby serving as a threat to ciients, the

pubiic ard to the administration ofjustice. The court finds

that Attorney
Thistle's actions constitute vioiations of M. R. prof.
Conduct i.3; 1.4(a);
1.

1s(a)(b)(d)(e); and 8.4 (a)(c)(d).

Accordingly, this court oRDERS that

Da-.e F. Thistle be suspended from
t,.e practice of Iaw in Maine pursualt

to M. Bar R. 7.3(e)(2)(B) untii further

Order of this Court.

The Court further ORDERS

that Attorney Michael A. Wiers of Newport,
Maine is appointed as the Receiver
of Attorney Thistle,s practice.
The separate
Order for the Appointment
of Receiver is incorporated
herern by reference.

o"t a,

1/,{,(.rl ?8,.

RECEIVE
JUN 0 6

?nt/
Ellen Go
Maine

Justice
Court

r"""

?01

r""JiJ[""?[i?

http://bangordailynews.com/2014/06/09/news/augusta/newport-lawyer-suspended-from-practice-because-of-disability/print/

Gabor Degre | BDN

Cindy Dunton of Newburgh sits in the courtroom with her attorney Dale Thistle during her sentencing at the Penobscot Judicial
Center in Bangor in this July 2011 file photo.

By Judy Harrison, BDN Staff

Posted June 09, 2014, at 6:46 p.m.

AUGUSTA, Maine A well-known Newport lawyer has been suspended from the practice of law
because of a disability, according to the Maine Board of Overseers of the Bar.
Dale Thistle, 66, was suspended indefinitely on May 27, according to information released Monday
by the board.
The nature of his disability was not disclosed.
Thistles order of suspension, signed by Maine Supreme Judicial Court Justice Ellen Gorman, said
that he appears to be a disabled attorney; as a result, he has committed apparent violations of the
Maine Rules of Professional conduct, thereby serving as a threat to clients, the public and to the
administration of justice.
His practice was placed into a receivership to be overseen by Michael A. Wiers, 65, of Hartland. He
is to deal with Thistles clients and report to the court about the financial shape of the practice,

http://bangordailynews.com/2014/06/09/news/augusta/newport-lawyer-suspended-from-practice-because-of-disability/print/

among other duties.

To be reinstated, Thistle must apply to the state supreme court. The suspension was recommended
by the legal staff at the Board of Overseers.
Thistle has represented many high profile defendants over the years, including Cindy Dunton, 52,
the former deputy clerk and treasurer in Newburgh. She was sentenced July 1, 2011, at the
Penobscot Judicial Center to to five years in prison with all but 20 months suspended for
embezzling nearly $200,000 from the town since 2006.
Dunton, who pleaded guilty in April 2011 to Class B theft by unauthorized taking, also was ordered
to be placed on probation for three years after serving her sentence and to pay about $252,000 in
restitution which is the sum of the money she stole plus attorney and forensic auditor fees.
Dunton was released Oct. 12, 2012, after serving 15 months of her sentence, according to
previously published reports.
Thistle also represented clients in at least half a dozen federal lawsuits alleging illegal strip
searches at county jails.
http://bangordailynews.com/2014/06/09/news/augusta/newport-lawyer-suspendedfrom-practice-because-of-disability/ printed on June 25, 2014

http://www.centralmaine.com/2014/06/20/newport-lawyer-agrees-with-his-suspension-over-disability-concerns/

PRESSHERALD

MAINETODAY

25, 2014
Public Notices WEDNESDAY JUNESUBSCRIBE:
KENNEBEC JOURNAL

MORNING SENTINEL

67 LIGHT RAIN
High: 70 | Low: 63
FIVE DAY FORECAST

HOME

NEWS

SPORTS

OPINION
CARS

NEWS

Posted June 20

BY DOUG HARLOW

COMMUNITY
REAL ESTATE

Updated June 20

STAFF W RITER

dharlow@centralmaine.com

| @Doug_Harlow | 207-612-2367

LIFESTYLE

OBITUARIES

INDEX
INCREASE FONT SIZE

JOBS

http://www.centralmaine.com/2014/06/20/newport-lawyer-agrees-with-his-suspension-over-disability-concerns/

NEWS

Newport lawyer agrees with his suspension over disability concerns

Newport lawyer Dale Thistle that he finally reported himself to the state Board of
Overseers of the Bar.
That report and other complaints about his work led to Thistles indefinite
suspension from practice by the Maine Supreme Judicial Court this month.
Complaints to the bar included Thistles alleged mishandling of a divorce case, real
estate litigation that took too long and on a couple of occasions, misspeaking to the
judge in the courtroom.
ADDIT IONAL IMAGES

SUSPENDED: Dale Thistle explains details of

the car accident he suffered in 2011 that
caused him a brain injury that led to
suspension to practice law. Thistle was
speaking from his home in Skowhegan on
Thursday. Staff photo by David Leaming

OUT OF WORK: Attorney Dale Thistle

speaks about being suspended to practice
law because of a car accident in 2011 at his
home in Skowhegan on Thursday. Staff

photo by David Leaming

In
Ou
ou
you

The June 6 order of suspension, based on a

recommendation by the Board of Overseers, refers to
Thistle, 66, of Skowhegan, as a disabled attorney
whose injury caused him to violate the rules of
professional conduct and as someone who is a
threat to clients, the public and to the administration
of justice.
Thistle said he agrees with the suspension. He said
persistent seizures, mini-blackouts and a lack of
direction paint the real picture of what he can do and
what he can no longer do following damages to the
nerves in his right frontal lobe.
They are right I did not disagree with the action
of the board of overseers, he said in an interview.
The complaints are serious and meritorious and
directly stem from my brain injury. I even
self-reported a misfiling in federal court. I made an
error in filing a document an error I would never
have made previously. I reported on myself, in other
words.
Attorney Gordon Johnson, founder of the Brain
IN NEWS
Injury Law Group inNEXT
Sheboygan,
Wis., said that
Supreme
while damage to the frontal
lobeCourt
can be cellphone
decision
life-changing, there can
be hopewont
notaffect
for Maine much

regeneration of the broken nerves, but from a redirection of the brains activity. The

http://www.centralmaine.com/2014/06/20/newport-lawyer-agrees-with-his-suspension-over-disability-concerns/

NEWS

Newport lawyer agrees with his suspension over disability concerns

In

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Supreme Court cellphone

decision wont affect Maine much

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. no SOh~ f~OdS, IMlally;:When dla~rhea decreas~s, uy-~~~~.~~~r. "',
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4. Avoid strenuous physical exereisefor at least 24 hours after the injury.

Return to the Emergency Room immediately if:

Blend Diet~eggs. meat. fish. poultry. potato. rice.

, 1. The patient becomes confused. vomits. is unsteady or clumsy

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DATE

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~. ~

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;.;:~:::,

'

'3. The patient has a'seizure or convulsion

~rse~~'~~~r f~

4., Headache gets worse.,

Pain is usually mild when the injury occurs. but

a
hours. Swelling also comes on gradually.
" ,", "o~',-;~;~; . " : - \ ' ;

5. The patient complains of double or blurred vision.

... ;;"

.';. -~. ",'

1. Rest is the most important treatment.

o.ur

2. Keep injured arm or leg eleval8d higher than Y,

'heart level to '
prevent swelling and reduce soreneb.,. : .. "': ,~~-' .

o WOUND CARE

3. Coid packsshouhl be appliedfor the first 24-48

1. Keep the wound and bandage dry and clean,

hour~. Use ato~el

between the ice bag and the skin to avoid frostbite.

2. Even with every precaution. any wound can become infected.

4. Warm
packs or soaks may be used after 48 hours,
,
'

3. Return to the Emergency Room at any time if:

6. po not stand on an injured foot or leg until you can do so~ithout pain;
then gradually return to normal activity.
,

a. wound becomes red. swollen or hot

b. wound breaks open. drains or has bad odor
c. sore glands or red streaks develop
d. pain worsens

e dressing becomes blood soaked

o NECK & BACK STRAIN

. 1. .Rest the injured area. avoiding anypainful m<Wemen~.. , ,;,~,

2. Apply heat at least 3 or 4 times a day.

4. Keep injured arm or leg elevated high,il',than your heart level to

Plevent swelling and reduce soreness. /
.

....

.,
;

'~--:~:::.:.;; '<c

~ .. '

.. ".

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-------..;,,;;.--

C
.....

'0
0

the skin to avoid frostbite.

-0 Heat every
.beginning

hours for

minutes until

o Soak in warm water every

o May take aspirin or Tylenol 1 or 2 tablets every 4 hrs. as needed.

..

"C

ou

for

hours for

,
,

~,

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.

minutes

days.

OTHER INSTRUCTIONS

MEDICATIONS/PRESCRIPTIONS
Medication

~
Amount Order,c!

~~

Directions _

Dose

...

>II:

c(

c(--

--

....-

........

~~=

~~

"'::!"C~.,~

\~ ~.....,~

"~

_==~"":";=;:"':"_,,,..S~.~':;;;;:'''''''':::,:....:.,'~-,''="""::::.1+.'2"-( \..~'~ . :-SC"'''-'7

CD

0::

(J

gla"'s of fluid a day until

- 0 Make an appointment with a physician for~. tetanus toxoid booeter in 1

0::
W

o Drink

o Cold packs for first 24-48 hours. Use a towel between the ice bag and

~,<..,-.:-.:".,,-

~ ~~'-'-'- ~~"""''''~.

. . . .__.. . _ -..-....__.. . . .

__=_~~~~~

___=~"=~~~~~~""!!!!""!!~-

IFYOU HAVE ANY FURTHER PROBLEMS CALL YOUR DOCTOR OR CALL THE EMERGENCYROOM.
o Industrial Compensetion Clinic (Enter thru Bobst Entrance)
FOLLOW-UP CARE
o City Compensation Clinic 216 N. Broad St. 6th Fir. (; day)
o Oral Surgery Clinic 326 N. 16th St.
o Your appointment is on
at
_
o William Penn Bldg. 246 N. Broad St.
,0 Call for an appointment to be seen in
days.
o Feinstein Bldg. 216 N. Broad St.
o
Clinic 448_
o Your own doctor - - - - - - - - - - - - - - - - -
Interpretation of X-rays and tests is preliminary only.
o Other

.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.
01t..llt<f:
Q0
LlI-k.J.re.v. hC'
~-

DATE

'

40 0l an.

TIME

W1vsICIAN SIGNATURE

-~The patient may return to work or school.

~"i'he patient may not return to work or school
until
Restrictions:

.0. Signature:

----::;IH'S AUTHORIZATION MUST BE SIGNED BY THE PATIENT, OR BY AN AUTHORIZE&PERSQN,

__ .,': ,.....--'
- - - - , - - - - - - - .. --(ExceP1To~ecgenci8sr
---'--'--::.----'..:..:;.~~~iooEo. ........;;-.....
_I

-:-;Alrthorization for Eme!gencv Department Treatment

_~~-=:

".

.:.~-

__::-l! 1.<.=,
- .]q

.
.
'.
. ' .iI~Pfeseati~mYse4ft~~;agnosis.andtreatrneot.atltbe
Em,fgencv'l)epiirtinenfof Hahnemanfi1'vfelficilIC011ege-ailafiospitarTcOilserit:uislrChcare ;tnCfUarng -diig_--~::.---t--~

--- precedures. surgicid and medical treatment. and blood transfusions, .." physicians.and other health care pe~nne"
::;0 u maV in their professional jiJagemenDJinecemrv..:.--------.-,;-,,_.;'....----~:--'-,-:-::.,:;V.'"; -_....::-~f.'-~,-<~-:+-

.I
;

UD~~~. ~_I

If further treatment is required. or If c:DlIlPlications_arise or if hospitalization is necessary. IDIl.undersigned

0
stands t~ a personal phvslcian 15 !O De selected by or on behalf of the patient within 24 hours.
,l(1l2a3P
.
- -.. . - - - -- -- - ~ 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.
y-\._
/\ \-"\... J'.~

---

._~

---

. :-.AME.AU;HORIZED PERSON(Print)

rliis

' '-;'' . _:.

'at
I.r'

is to

SIGNATURE

AUTHORlZq,1?-~RSON

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..... ' .

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-.;,,------ ... ~--...:=-:"_~

:./

--,

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r,

RELATIGNSHIP TO PATIENT

R~~~~St~~RO~t;S;ONSIB6JU&~tCGAI~~M~,~I,~A~"~,~d::)E
Z~;;e~::>;:~
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__ ...";:;.;;",,,,,;~ _

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is being discharged against the .advi~ of the. attending .. physic:ian and. the

' .J - ' - - - .- _

hospiUl administrator;

-.

---.-

; - .-

_ _ ,9

.-----------------+-

I have" !leen inflStmed of -all risks involved ailcF;'~fe~se: itiif:hospital.

DATE.

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(.......P)

ER RECORD

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IN&~ANCE

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