FILED IN 14th COURT OF APPEALS HOUSTON. TEXAS JUN 30 2015 CHRISTOPHER A. PRINE I CLERK •DIGADIL1TIEG INTERNATIONAL

June27,2015 THE CLERK ^^^M^^m^ TT.E11 TH Courtof 14™ r- . _£ Appeals a ^ _ „„I„ L I *7 t *}- Houston, Texas Dear Clerk of Court, 14th Court of Appeals, RE: ERIC NDUBUEZE UFOM v. WEST WYNDE HEALTH SERVICES CASE # 14-14-00438-cv

JUSTICE DELAYED IS CONSTITUTIONALLY JUSTICE DENIED This letter is to officially notify this honorable court of appeals that, On Friday, May 1, 2015, at 6:03:43pm O'clock, I timely mailed my postpaid, properly addressed, Emergency Motion to this honorable Court through the United States Postal Service Certify Mail # 70130600000009190471, automated 24 hours, after Hours, posting machine services before 12:00 midnight of that last day of filling of filling Motion for En Banc Rehearing Please see the annexed Exhibit 1, copy of the USPS postage transaction # 106, receipt #480378-9550 and Certify mail# 70130600000009190471, which are proves beyond reasonable doubt that the Appellant's motion was timely filed on a weekend of Friday, May 1, 2015.

It is sad and unconstitutional that this honorable Appellate Court, whose duty is to be a gatekeeper, has failed to correctly file my timely motion, as « P.O. BOX 710455 HOUSTON, TEXAS 77271 PH: (832) 758-0612 E-Mail: [email protected] / EQUAL RIGHTS FOR PERSONS WITH DISABILITIES INTERNATIONAL

having been filed on the date of May 1, 2015, which it was timely mailed, but incorrectly or wrongfully filed my timely motion as having been mailed on the date of May 5, 2015, which was the date this Court actually received my mailed timely motion and not the date it was mailed. It is discrimination, disparate treatment, denial of meaningful access to court of Appeals, selective enforcement of Appellate Court's rules and regulations, denial of activities, programs and services, in violations of Title II of the Americans with Disabilities Act of 1990 (ADA), which provides: "[N]o qualified individual with a disability shall, by reason of such disability, be excluded from participation or denied the benefits of the services, programs or activities of a public entity," 42 U. S. C. §12132 and ADA 12203 that Prohibits Against Retaliation or Coercion (Section 503), Title V, [No person shall discriminate against any individual because such individual has opposed any act or practice made unlawful by this chapter or because such individual made a charge, testified, assisted, or participated in any manner in a investigation, proceeding, or hearing under this chapter] and [It shall be unlawful to coerce, intimidate, threaten, or interfere with any individual in CD

the exercise or enjoyment of, or on account of his or her having exercised or « P.O. BOX 710455 HOUSTON, TEXAS 77271 PH: (832) 758-0612 E-Mail: [email protected] Q

EQUAL RIGHTS FOR PERSONS WITH DISABILITIES INTERNATIONAL

enjoyed, or on account of his or her having aided or encouraged any other individual in the exercise or enjoyment of, any right granted or protected by this chapter].

Therefore, pursuant to the Texas Rules of Civil Procedure 316 (Tex.R.Civ.P., 21a (METHOD OF SERVICE) (lb) (WHEN COMPLETED: (1) Services by mail or Commercial Delivery Service Shall be complete upon deposit of the document postpaid and properly addressed, in the mail or with commercial delivery service), I humbly and respectfully request from this honorable court to go back and retrieve the Appellant's original envelop used in mailing this motion that is under the custody of the Court, and verify the date on the postpaid USPS stamp on the mailing envelop and thereafter, correct the incorrect date of filling on the court's docket. Also, please properly and correctly stamp on my timely motion, the date of May 1, 2015, as mandated by the Texas Rules of Civil Procedure 316 (Tex.R.Civ.P., 21a (METHOD OF SERVICE) (lb) (WHEN COMPLETED: (1) Services by mail or Commercial Delivery Service Shall be complete upon deposit of the document postpaid and properly addressed, in the mail or with CO commercial delivery service). « P.O. BOX 710455 HOUSTON, TEXAS 77271 PH: (832) 758-0612 E-Mail: [email protected]

EQUAL RIGHTS FOR PERSONS WITH DISABILITIES INTERNATIONAL

Also, the attached please find copies of my June 26, 2015, United States Postal Service, Certify Mail # 70110470000080139256, used in timely mailing my Pro Se Motion for En Banc reconsideration of the Court's unconstitutional decision of, "NO ACTION TAKEN," on June 11, 2015, on the Appellant's timely filed Emergency Pro Se Motion for En Banc Rehearing on, Friday, May 1, 2015, at 6:03:43pm O'clock, through the United States Postal Service Certify Mail # 70130600000009190471; pursuant to the Texas Rules of Civil Procedure 316 (Tex.R.Civ.P., 21a (METHOD OF SERVICE) (lb) (WHEN COMPLETED: (1) Services by mail or Commercial Delivery Service Shall be complete upon deposit of the document postpaid and properly addressed, in the mail or with commercial delivery service;); Tex.R.App.P. 19.2; Tex.R.App.P. 19.3; Tex.R.App.P. 19.4; Discriminations, Retaliations, Disparate Treatments, Selective Enforcement of the State of Texas and United States Constitution, District Clerk of Court's filling Rules and Regulations, due process of law, faire procedure, and equal protections constitutional rights safeguards, as well as to be free from continued cruel and unusual punishments, pursuant to, Affordable Care Act, Americans with Disability Act (ADA); Title II of the « P.O. BOX 710455 HOUSTON, TEXAS 77271 PH: (832) 758-0612 E-Mail: [email protected] EQUAL RIGHTS FOR PERSONS WITH DISABILITIES INTERNATIONAL

Americans with Disabilities Act of 1990 (ADA), which provides: "[N]o qualified individual with a disability shall, by reason of such disability, be excluded from participation or denied the benefits of the services, programs or activities of a public entity," 42 U. S. C. §12132 and ADA 12203 that Prohibits Against Retaliation or Coercion (Section 503), Title V, [No person shall discriminate against any individual because such individual has opposed any act or practice made unlawful by this chapter or because such individual made a charge, testified, assisted, or participated in any manner in a investigation, proceeding, or hearing under this chapter] and [It shall be unlawful to coerce, intimidate, threaten, or interfere with any individual in the exercise or enjoyment of, or on account of his or her having exercised or enjoyed, or on account of his or her having aided or encouraged any other individual in the exercise or enjoyment of, any right granted or protected by this chapter], U.S. Supreme Court's Trilogy of cases, governing the admissibility of scientific evidence in, Daubert v. Marrel Dow Pharmaceuticals, Inc 509 U.S. 579 (1993), General Electric v. Joiner, 522 U.S. 136 (1997); Kumho Tire Co. v. Carmichael, 526 v. 137 (1999).

LO QJ

Thanks £ P.O. BOX 710455 HOUSTON, TEXAS 77271 PH: (832) 758-0612 E-Mail: e [email protected] EQUAL RIGHTS FOR PERSONS WITH DISABILITIES INTERNATIONAL

Respectfully Submitted

Eric Ndubueze Ufom, Pro Se CERTIFICATE OF SERVICE I certify that on June 27, 2015, a true and correct copy of this Pro Se Motion was mailed tgthe_ Court through the USPS certify mail # f. $T 0*3*^\^~ ' t? 5 O and was served to the Plaintiffs ttorney through e-mail and District Clerk's Attorney through USPS mail.

Please note that this valid, debatable and verifiable Motion was further services to the following interest groups Department of Justice, Civil Rights Division Texas State Supreme Court's Justices Texas State Bar Association Texas State Center for Judiciary Texas State Bar Association's Multiple Continuing Legal Education Office Texas State Senate Texas State House of Assembly Ilru Southwest ADA Center Houston, Texas and the Southeast ADA Center ADA National Network National Alliance on Mental Illness Texas State National Alliance on Mental Illness Brain Injury Association &Disability Rights Te: Eric Ndubueze Ufom, Pro Se 2410 South Kirkwood Drive #260 Houston, Texas 77077 \Q 0>

P.O. BOX 710455 HOUSTON, TEXAS 77271 PH: (832) 758-0612 E-Mail: [email protected] U.S. Postal Service™ debora'sue schatz r- CERTIFIED MAIL™ RECEIPT 2909 r06erdale rd houston, tx 7.7042-9998 a I 05/01A2015 06:03:43 PM

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NO. 14-14-00438-CV TH ERIC NDUBUEZE UFOM AND § IN THE 14 COURT OF EQUAL RIGHTS FOR § APPEALS PERSONS ITH DISABILITIES § INTERNATIONAL, INC § § V. § District Court # 2011-70277 § 113 Judicial District Court WEST WYNDE HEALTH § SERVICES, INC, MRS. § GLADYS IBIK AND MR. JOHN § IBIK § § HOUSTON, TEXAS

EXHIBIT cJ J 3 - 0 T8 NSN 7540-00-«34-4i22 PROGRESS-NOTES 1EDICAL RECORD UFOM, KK1L' #20973-018 -TCDI^abMUlNiNUlE JULY 24,1998 1500 FMC ROCHESTER PAGE 4 .INITIAL IMPRESSION: Schizoaffective Disorder Depressed Type AXIS I: Dementia Mild Secondary To Multiple Head Injuries Alcohol Dependance in Remission, Controlled Setting AXISH: No Diagnosis CVI AXIS ID: Post Polio Syndrome Numerous Musculoskeletal Complaints Blindness of Left Eye EVALUATION PLAN: Dr. Olness has already placed the patient on Zyprexa. He is also.taking 5S1?2l be housed on the inpatient 1/1 unit. He will have regular interacts with the i Si-

UFOM, ERIC #20973-018 ADMISSION NOTE JULY 24,1998 1500 FMC ROCHESTER PAGES nursiS staff case manager, correctional staff, counselors, and his psychiatrist. He will undergo SlShysical exaLation and screening lab work. Iwill review collateral information Imd Jk Dr. Ilvedson to address Mr. Ufom's general medical condition. - •>* <V 2± S Date ArthfigS. Tenenbaum, M.D.

StafiS&ychiatrist dd: 07/24/98 dt: 07/27/98/skd

\ NT'S lUfcNUHCAMUN iHjr tyoea or wnnert tames gm: »sm—<ast. wst. /n«w>.; gm rw,*; r*i*; ncinaieit m/. r»««M " V .

PROGRESS NOTES Medical Record UF0H, ERIC HOffBffEZE ..-.)->;. &&ji:Jr:-t& STANOARO FORM 509(WV.J-9M _,«,«,, Patented oy GSA/iCMfl. RRMR (41cm 2Q1-3W2-1 ?n<m-niH Northwest Community Service Center 3737 Dacoma Houston, Texas 77092 (713) 970-7000Ext.8400 Fax: (713) 970-7002 MENTAL HEALTH • MENTAL RETARDATION AUTHORITY OF HARRIS COUNTY Adult Mental Health Services

August 28, 2002

To Metro:

Eric Ufom has been aclient at the Northwest Community Service Center since 6/10/02 Mr. Ufom has been diagnosed with Bipolar disorder, which is amental illness. Mr. Ufom is disabled, and will be unable to work for the next 6months.

Ifyou have any questions, please contact Xavier O'Neil at (713) 970-8400.

Sincerely,

Attending Physician ££«•§£ •,1. MedrattSn Mlfcttahcelfifc .. . ^Aialit^Namet^iJi^y Xtpnxv^ -^ AmR^ ^^'MlL Date: }H^t-0 ^ Patient: Address:'"^2Sli *i. v':" ' Phone #: Unit Number: . ^ yg'd-cb- ^ 1 % Ri *•$!&*' i srfgj #" ; Rationale?* ^^^PQ*^»^i^ r NR U jkL 4. •* .< RefiDx^i:_NR _^£ MIX--f , v; -& vvwkjj^s^yvjvrfr- MJ>_ Dispense as Written Product Selection Permitted ^_ si£ PfcysieiMl.D.*: ^ DEA #: Print Physician's List Name "i |. '•: •*& AA4-tX^.

Medication Maintenance Patient Name: <$** c lLi£)'L^ MHMRA#: 3^*2-^ Date: llJorfoi- Unit name: c&fl&v--- Start Time: 0^2-2- Stop Time:- Duration: Stage: Weeks in this Stage: Primary Current DX: (Check One) ( ) MDD-NP ( ) BPD-M \jrf BPD-D ( ) scz ( ) MDD-P * ( ) BPD-MX ' ( ) SCZ-A (BP) ( ) SCZ-A(D) ( ) Other (specify) Medications taken as Prescribed? L> Yes/Mostly ( ) No/Inadequate Most Recent Drug Levels: Medication Name Date Drawn Serum Level WNL

Are serum levels needed? [] Yes LgfNo {ifyes, specify in progress note) Clinical Rating Scales Pos.SX: Neg SX: IDS=-SR: Altaian: Other:

Patient Global Self Report (0-10) Q=No symptoms S=Moderate 10=Extrernc Symptom Severity: g> Side Effects: -^ Physician Ratings (0-10) 0=No symptoms S-Modcratc 1(NExireme Core Symptoms: Mania Depression Positive SX Negative SX Other Symptoms: Irritability Labile Mood Insomnia Agitation Anxiety Appetite Energy Interest Level Other (specify): Overall Side Effect Severity: p (Q-1Q) Overall Functioning: _g__ (0-10) n=r,»win-Hi«h Patient/Family Education: Done at this visit? • Yes [] No Between last visit and this visit? [] Yes [] No • Medication Response: [] Full tfPartial QMinimal [] None [] SX Worsening (Measures Decrease of SX: Full= 75-100% Partial- -50-75% Minimal = 25-50% None=0-25%) Reason for medication Change (include Dose changes): [] Critical Decision Point Indicates Change Necessary [] Patient Preference [] Insufficient Improvement [] Intolerable Side Effects [] Symptoms Worsening [] Diagnosis Change [] Other: Rationale for Medication Choices: ~ ~~ Antidepressant: \XP$E Profile QPattern ofAssociated SX [] Past Response [] Other Antipsychotic: •JJ'SE Profile QPattern ofAssociated SX [] Past Response [] Other Mood Stabilizer>{fSE Profile QPattern ofAssociated SX QPast Response [] Other Augmentation: [] SE Profile [] Pattern of Associated SX [] Past Response [] Other Patient Name: MHMRA #: __ Date:.

Progress Note: (Q Check here ifnote was dictated. Date ofDictation: Interval History:

Response to Target Symptoms: tTImproved fj Unchanged: Side Effects to Medication: isB^one ^fOther: aL^u l^cQ<jX>U . LOir • G/C^lZ* Social/family Functioning: c JUs> - / i ^ _¥. V^caa^^uJC ")^ / o -U^ . ~ Occupational Functioning: ^ouv>ei>L>c/> Substance Abuse: . vuCvw Lab Results:

Mental Status Examination:j General Appearance: )r€\^\ Motor Activity: ° rfa~) Mood & Affect: /L&r?cU luJ' Speech: ' ftS) jlru^ - Thought Process: CT fo Thought Content: ^U^c <-My> Suicide/Homicide ideations: aaQ.i^vj Sensorium & Cognition: 4^tU/ A c (/" • Insight &Judgement: ^kviA • _, _______ Assessment: r) No change in Axis I-V ( ) Change inAxis I-V- seediagnosis form

Plan: G ir uu^Lcl^.

LCCU^ p e-? .V^l p UJ^^' V_S &,Q

( ) New medications started. All risks, side effects, and precautions discussed with the patient. ( ) Informed consent signed by patient/ legal authorized representative. ( ) Plan ofcare reviewed with the patient/ legal authorized representative, face to face. Continue medication monitoring for target symptoms, side effects, vital signs and necessary labs. ( ) Revised Treatment plan with the patient/ legal authorized representative, face to face. See updated plan. ( ) Plan ofCare Oversight reviewed with the patient/ legal authorized representative. See POCO. ( ) AIMS completed ( ) Lab Orders \Jry) Return to Clinic: ID weeks Physician Name: ^^f^^^Signature: /f/^\ Northwest QmnmnitySemce Cotter 2S-£te7mi Medication Maintenance /^*X (713)9708400 .

K^/atientName: J?A^c " .U^gi^ mhuqii.

MHMRAf: *2>2-'X2 9 Date: ilfoSTfu^ Patient: Address: Phone #: Unit Number: o73^T~ R _, ^3 2A I Rationale ,M\,^ * XLjg_ M^j »t> i'o;^,,. I MP Q_qU^_^ 2 nrQ ^ b.

3. refill* NR • ?^.-i / 4. RefiUx nrQ _Mi>. J^vo^-^^i^ M.D.

Dispense as Written Product Selection Permitted Physician I.D. #: DEA #: Print Physician's Last Name Location: » Start Time: Total Time: terval 'hite History:

Response to Target Symptoms: U Improved LI Unchanged:

Side Effects to Medication: —None Ql Other.

Social/Family Functioning:

Occupational Functioning: Substance Abuse: 1. General Appearance: 2. Motor Activity: 3. Mood & Affect: 4. Speech: X" 5. Thought Process: X 6. Thought Content: 7. Suicidal/Homicidal Ideation: 8. Sensorium & Cognition: 9. Insight & Judgment: Assessment/Plan:

REC-AMR039c (10/97) Keep Yellow Copy in Recoid Send Pink Copyto OSS-Research and Evaluation Signature: NO. 14-14-00438-CV TH ERIC NDUBUEZE UFOM AND § IN THE 14 COURT OF EQUAL RIGHTS FOR § APPEALS PERSONS ITH DISABILITIES § INTERNATIONAL, INC

V. District Court # 2011-70277 § 113 Judicial District Court WEST WYNDE HEALTH § SERVICES, INC, MRS. § GLADYS IBIK AND MR. JOHN § IBIK § § HOUSTON, TEXAS

EXHIBIT

' A 7l4CUTGEllM- -ky6 ItifJS WeillComeii Medical College Associates Hilary A. Beaver, M.D.

March 21, 2013 Amy G.Coburn, M.D.

Allison A. Dublin, M.D.

Kenneth J._ Hyde, ' MD . .

J*mGS E'Ke* MD* Andrew G.Lee, M.D.

Houston Eye Associates _ . ._ _ ... .. _ J Rahul T. Pandit M.D.

2855 Gramercy Street Sushma s Yalamanchili, M.D.

Houston, TX 77025 6560 Fannin, Suite 450 Houston,Texas 77030 Re: Eric Ufom Tel 713-441-8843 DOB: 11/22/1958 Fax 713-793-1636 www.methodisteyeassociates.org Dear Kenneth:

Thank you for referring Eric Ufom to the Neuro-Ophthalmology Service at The Methodist Hospital today. This patient is a 54-year-old Nigerian male with a past medical history of motor vehicle accident in 1986 and 1989 who had subsequent loss of vision in the left eye since that motor vehicle accident in 1989. He has been followed by Dr. Hydefor the past six years. He developed hypotony in the right eye with intraocular pressures between 7 to 8 for the past three years.

He also states that he had a-foreign body in the right eye as well as the left eye since the motor vehicle accident.

He had an MR! per the patient at Methodist but is unsure why he had the MRI. He states that at that time, he had difficulty breathing.

He denies any giant cell arteritis symptoms such as headaches, jaw claudication, fever, scalp tenderness, anorexia, or malaise. He does state that occasionally he has blurred vision inthe right eye but is not having it at this time.

On review of systems, he denies any constitutional, neurologic, ears, nose, and throat, cardiovascular, pulmonary, gastrointestinal, genitourinary, musculoskeletal, skin, psychiatric, or infectious disease symptoms at this time. The chief reason he is here is he wants to see if there could be any improvement of vision in his left eye.

His past medical history is significant for a motor vehicle accident, ruptured globe, and polio.

His past surgical history consists of multiplefacial/maxillary reconstructive surgeries, cataract extraction in the left eye, and right hip surgery for a congenital deformity.

He is not currently taking any medications.

He has no known drug allergies.

His family history is significant for livercirrhosis in his father and diabetes mellitus.

ERIC UFOM PACE 2 03/21/13 He is a non-profit organizer manager, married, and has one child. He denies any history ofsmoking, alcohol, or illicit drug use.

On exam today, his visual acuity bestcorrected is 20/20 in the right eyeand count fingers in the left eye. Color plates are 14 out of 14 inthe righteye and zero out of 14 inthe left eye. Pupils are 4 mm in the dark and 2mm in the light in the lefteye. He has an irregular pupil in the right eye and irregular pupil inthe lefteye. His ocular motility shows a left45-diopter prism of exotropia in the lefteye. On slit-lamp exam, his lids, lashes,and adnexae are within normal limits. Theconjunctiva shows no injection. The cornea shows a corneal/scleral laceration andpterygium in the right eye andcorneal sclera! laceration in the left eye. He hasan inferior temporal scar in the righteyeandat 5 o'clock in the left eye an inferior oldscaranda superior limbal scar. The anterior chamber at this time is deep and quiet. The iris isround and intactin the right eyeandshows an irregular posttraumatic deformity in the lefteye. The lens isclearin the right eyeand aphakic in the lefteye. The anterior vitreous is within normal limits.

On dilated funduscopic exam, his cup-to-disc ratio is 0.10 in the righteye and 0.15 in the lefteye.

There is no evidence of disc edema or pallor. The macula shows normal reflexes. The vessels show a norma! 2:3 arteriole-to-venule ratio inthe right eye and the left eye shows attenuation. The periphery isnormal, fiat, no holes or tears were detected in the right eye, andthe lefteyeshows an inferior hyperpigmented scar.

AHumphrey 24-2 visual field shows an enlarged blind spot in the righteye with nonspecific defects with a mean deviation of -4.49 and in the lefteyewith a stimulus five shows enlarged blind spotwith out of 13fixation loses.

Insummary, this patient is a 54-year-old Nigerian male with a past medical history of motor vehicle accident in 1986 and 1989 with multiple reconstructive surgeries who presents with loss of vision in the left eye, right eye hypotonia, and a history of ruptured globe repair.

His left eye most likely had a presumed traumatic optic neuropathy. However, there is no edema or pallor at thistime. Healso has an inferiorchorioretinal scar and color dyschromatopsia. Ihave explainedto the patient that most likely he will not recover vision in the left eye.

He hasright hypotony and will be followed byhis primary ophthalmologist. His visual acuity in the right eyeis 20/20. There is no color dyschromatopsia, disc edema, or pallor in the right eye. Ihave recommended the patient wear polycarbonate lenses secondary to being a monocular patient. He has multiple ocular deformities secondary to trauma and will continue to follow up with Dr. Hyde Thank you very much for giving me the opportunity to participate in Mr. Ufom's care. Should you have any questions orconcerns regarding my recommendations, orhave any other patients needing neuro-ophthalmology evaluation, please do not hesitate to contact me. Warmest regards, Post-Polio Fatigue How It Can Change Your Mind n ~ • ''• * \jf Mavis J. Mameson, MD .. • ' v/' •• -,.y u \ '•^".. .V- "-^ ' ;,'s•"" •+?*' •-' •' -- _"*.****yf'.: '•'• February 1995 .' .;"._ "'-V. .-. ' •'_ '•;.*.,•• ,- *'•' .-.'• .• : : -';-'"'':^--. ;'.

One of the most frustrating late effects of pblio for mewas the awareness that I could hot , '•"' • concentrate and a feeling that I wasn't thinking clearly any more. For many of us who have.; s .• •• compensated for our physical limitations through intellectual pursuits this is aterrifying feeling.

Is it not bad enough thatourbodies are giving out? Mustwe undergo the indignity of losing our minds as well? Studies showthat in spite ofmarked impairments ofattention,* polio survivors are within thehigh normal or superior range on measures ofhigher-level cognitive processes and. IQ. [1] They also show that if we allow ourselves to become fatigued we'do lose our ability to focus < ourattention and to rapidly process complex information (requiring 23 to 67 percent more time to complete tasks requiring sustained attention and vigilance than did polio survivors withno. fatigue or mild fatigue). [2] *""_-"' • ? .,' Polio survivors experience two kinds of fatigue. One is physical tiredness and decreased endurance. Theother and often moredistressing kind is "brain fatigue". Brain fatigue describes ". problems with attention, alertness and thinking. Between 70% and96% of polio survivors . /; '. , reporting fatigue complained of problems withconcentration (96%), memory (85%), attention (82%), word finding (80%), staying awake, and thinking clearly (70%). [3] Tests indicate that an impairment of selective attention (related to damage as a result ofpolio) results in feelings of. fatigue and cognitive problems. [2] ... -•• ' The poliovirus damages the anterior horn cells ofthe spinal cord butthat is not all it damages. It also damages partsof the brain stem. Findings indicate that poliovirus consistently and often severely damaged the brain areas known as the ReticularActivating System." [4],[5] These areas are responsible for activating the part ofthe brain involved in maintaining voluntary attention, memory, spontaneous interest, initiative and the capacityfor effort and work, and for preventing feelings of fatigue. This is the area thatkeeps us awake and allows us to focus ourattention. [5] Polio survivors report that they are most disabled by the visceral symptoms of fatigue. These are feelings ofexhaustion, passivity and an aversion to continued effort that generate an avoidance of both mental and physical activity. [5] Dr RL Bruno suggests the existence of a Fatigue " Generator inthe brain. [5] His findings suggest that there isa close relationship between impaired attention and fatigue. There would be survival value in abrain mechanism that promotes rest when attention and information processing ability are impaired. An area of the brain (the BasafGanglia) may generate mental and physical fatigue. When the Reticular t'; ..

Activating System is damaged, the Fatigue Generator takes over and produces p^roblems wdtri - - focusing attention and with physically moving without significant conscious effort, Damage. ^ . caused by the poliovirus chronically reduces the firing ofthe nerve cells in the Reticular .' ; - Activating System. Rest orsleep would increase the firing ofthe brain activatmgsy'stem nerves;; restore activation and once again allow motor behavior. [5] [Ed: An article by Dr Bruno detailing his work in this area was obtained from theInternet and reprinted inPPN Newsletter Issue 24, June 1995.] .... * . •' .,,« .- The damage would explain why polio survivors have ho difficulty cpricentrating after the:: _•; •*?;£ original infection but why are we developing problems thirty or forty years later. One theory isV that the age-related loss ofnerve cells combined with ah already abnormally small number of !J :nerve cells as aresult ofthe original poliovirus infection may impair the brain's activating system -enough to produce impaired attention and fatigue as polio survivors reach mid-life.[4]^ :\%£f> The first step in treating the disorders ofconcentration, memory, attention, word finding; staying '- awakeV and thinking clearly istodeal with the fatigue. Energy conservation, work simplification and the proper provision ofrest periods throughout the day are the treatments ofchoice in ^ dealing with post-polio fatigue. [6] Stress management is also critical in the: treatment^ofposty.-*. polio fatigue. [7] Dr Bruno et al are currently studying the use ofamedication (a post-synaptic dopamine receptor agonist currently used in the treatment ofParkinson's Disease) in the ;. -^.. treatment ofpost-polio patients who do hot respond to conservative treatments. [1] Theyxaution that there is a real danger that treatment with medications will allow Polio survivors toresume - their hyperactive Type Alifestyles and further stress poliovirus-damaged, "metabolically • vulnerable" neurons in the brain stem and anterior horn. [7] As with any treatment strategy we must try to find the most effective treatment that will do the least long term damage while helping us to deal with our current problems. Certainly reducing physical and emotional stresses in our lives and getting adequate rest make sense for everyone, ^ even polio survivors. The good news is ifyou can get rested, you will find your ability to'-" '/f • concentrate, pay attention, remember words and stay awake will improve. You may even find .' that you can enjoy reading and thinking again! ";*'*. • ' -\ References .,Y ...

V .1. 'Bruno RL, Sapolsky R, Zimmerman JR, and Frick, NM. The Pathophysiology ofPost-"* •i Polio Fatigue: ARolefor the Basal Ganglia in the Generation ofFatigue. Annals ofthe' . New York Academy of Science, (1994) in press/ •'• m; .' , . •'£"+**'}''*; 2. Bruno RL,'Galski T, DeLuca J. The Neuropsychology ofPost-Polio Fatigue. Arcri Phys'.

Med Rehabil Vol 74, Oct. 1993.

3. Bruno RL It's All in your Brain: The cause and 'treatment ofPost-Polio Fatigue;Lecture at Healthy Partnerships Conference Oct. 22,1994, Toronto, Ont. Canada. "• 4. Bruno RL, Frick NM, Cohen J. Polioencephalitis, Stress, and the Etiology ofPost-polio - - Sequelae. Orthopedics. 1991; 14:1269-1276. --*•:-..*!- -. - --...-^.

5. Bruno RL, Frick NM, Lewis T, and Creahge SJ. The Physiology ofPost-Polio Fatigue: A ModelforPost-Viral Fatigue Syndromes and a Brain Fatigue Generator. The CFIDS '" Chronicle Fall 1994.. _; '... . • .;.. W-jy ;^>!'• * :' . '?.--J;/ : -J. .' .' 6*. Young GR. Occupational Therapy and the Post polio Syndrome. The American Journal of Occupational Therapy. 1989;"43:97-103.

7. Bruno RL, FrickNM. The Psychology ofPolio as Prelude toPost-Polio Sequelae; Behavior Modification and Psychotherapy. Orthopedics. 1991; 14:1185-1193. t •

'>»;• , '--•<•

'*:.- NO. 14-14-00438-CV

ERIC NDUBUEZE UFOM AND § IN THE 14™ COURT OF EQUAL RIGHTS FOR § APPEALS PERSONS ITH DISABILITIES § INTERNATIONAL, INC § § V. § District Court # 2011-70277 § 113 Judicial District Court WEST WYNDE HEALTH SERVICES, INC, MRS. § GLADYS IBIK AND MR. JOHN § IBIK § § HOUSTON, TEXAS

EXHIBIT xmuyxuy via VSl-FAX Page 2 af 3 3mai?»}5

JgRIVEROAKS ^ W ^ IMAGING AND DIAGNOSTIC

PATIENT NAME ACCOUNTNO UFOM, ERJC 2754180 j - ;cL';j AT THE REQUEST OF DATE OF BIRTH AflE/SEX •DATE CF SERVICE KENNETH J. HYDE MD 11/22/58 mm 2855 GRAMERCY STREET HOUSTON, TX 77025

CT Assessment ofthe Orbits Clinical History: Remote trauma with patient having multiple fiactures. This is a preoperative assessment.

Technique: CT assessment ofthe orbits was conducted without contrast acquiring imaging both axially and coronally with both soft tissue windows and bone windows obtained.

No prior exams currently available.

Findings: Patient is status post feirly well healed fracture ofthe left zygomatic arch with associated hyperostosis and exuberant callus formation. There is a fracture seen involving the left orbital floor with distraction seen ofapproximately 8 to9 mm and inferior displacement ofthe more medial aspect ofthe left orbital floor into the maxillary sinus. Inferior herniation oforbital fet through the defect is seen with the left inferior rectus muscle abutting through the defect but without findings suggestive of entrapment ofthe extraocular muscles.

Deformity ofthe left maxillary sinus is seen with multiple fractures appearing old involving boththe anteriorand lateral walls. The left frontal sinus is hypoplastic. Fracture is also seen involving the lateral wall ofthe right maxillary sinus with mild buckling. Soft tissue density propagating into the left maxillary sinus felt to be on the basis oforbital floor fracture on the left noted. Do not see an air-fluid level.

Both lamina papyracea are intact. Fractures appearing minimally displaced but appearing old involving the lateral wail ofthe left bony orbit is seen.

Fractures arealso seen through theanterior table of both frontal sinuses sparing the posterior table and noted inferiorly without associated frontal sinusitis.

There are benign dystrophic calcifications seen superiorly and anteriorly in the left orbit felt to be likely on the basis ofremote trauma. Both globes are 7520 FM 1960W» HOUSTON, TEXAS 77070 (281) 955-3330 * FAX: (281) 955-3673 09/12/05 IQ:1H PH COT River Daks Imaging via VSI-FAX Page 3

Page #2 RE: UFOM, ERIC 2754180 September 12, 2005

intact. No appreciable proptosis is seen or deformity ofthe orbitswhich are normal in size.

Assessment of the skull base is unremarkable. Normal aeration of mastoid air cells is noted. Hypoplasiaof the sphenoid sinuses is noted. Do not see any acute sinusitis in this patient.

There is deviation of the nasal septum to the left accompanied by bony spurring Accompanying polypoid changes noted in the right sideofthe nasal cavity.

Impression: Fracture ofthe left orbital floor is seen with inferior displacement of the more medial aspectofthe orbital floor into the maxillary sinuses and herniationof orbital fat through the defect. The left inferiorrectus muscle does abut the ostium ofthis fracture without however entrapmentof the extraocular muscles seen.

Deformity ofthe left maxillary sinuses noted due to multiple old fractures seen involvingboth the anterior andlateral wallswith hypoplasia ofthe left maxillary sinus noted and deformity especially laterally noted.

The globes appear intact.

Benigndystrophic calcifications likely due to prior trauma seensuperiorly involving the extraconal portion anteriorlyin the leftorbit.

Multiple other fractures noted involvingthe frontal sinuses and right maxillary sinus but sparing the skull base as discussed above.

Thank you for referring your patient to us, / ©Sja-v^ Deborah Ancona-Schultz, M.D.

DD: 09/12/05 DT: 09/12/05

7520 FM 1960 W» HOUSTON, TEXAS 77070 • (281) 955-3630 FAX: (281) 955-3673 NO. 14-14-00438-CV

ERIC NDUBUEZE UFOM AND § IN THE 14th COURT OF EQUAL RIGHTS FOR § APPEALS PERSONS ITH DISABILITIES § INTERNATIONAL, INC § V. § District Court # 2011-70277 § 113 Judicial District Court WEST WYNDE HEALTH SERVICES, INC, MRS. § GLADYS IBIK AND MR. JOHN § IBIK § § HOUSTON, TEXAS

EXHIBIT Ufom, Eric, PSG, Page 1

FORT BEND SLEEP LAB PSG 14031 Southwest Freeway #605 Sugar Land, Tx 77478 Ph: 1-866-757-2687 Fax: 1-888-757-2680

Recording identification Patient name Ufom Acq 559 First name Eric Type Adult Sex M Started 6/27/2012 at 9:14:44 PM Birth date 11/22/1958 Stopped 6/28/2012 at 5:41:44 AM Patient age 53 years Duration 8:27:00 (507.0 min) INDICATIONS: Rule Out OSA REFERRING PHYSICIAN: Anjum Alam, M.D.

m^'-^m Times [Default values] Recording start 9:14:44 PM Light off (LO) 10:02:44 PM [Recording start] Sleep onset (SO) 18.0 Min [1 pageN1,N2, N3, or REM] Last sleep page (LSP) 5:09:14 AM Light on (LON) 5:09:44 AM [Recording end] - Recording end 5:41:44 AM Latency to Stage REM 193.5 (minutes) Sleep Efficiency 63.8% Durations Recording duration 507.0 min Recording start -> end TIB 427.0 min Light off -> Light on TST 272.5 min REM + NREM + MVT (during SPT) WK during sleep 136.5 min SPT - TST NREM duration 231.5 min N1 + N2 + N3 (during TIB) SWS duration 29.5 min N3 (during TIB) Movement 0.0 min MVT (during TIB) Steep stages distribution Episodes duration TST (#) (min) (%) WK (SPT) 21 136.5 WK (TIB) 22 153.5 —

REM 7 42.0 15.4 N1 14 8.5 2.8 N2 20 193.5 , 71.0 N3 3 29.5 10.8 MVT 0 0.0 0.0 Ufom, Eric, PSG, Page 2

RESRIFfoTORYiEVEfrTSB Respiratory events summary (Sleep period time) CA OA MA Sum Ap HYP A + H RERA Resp.

Events Events Settings (sec.) 10.0 10.0 10.0 10.0 10.0 Number 0 9 0 9 14 23 21 44 Max (sec.) 0.0 24.0 0.0 24.0 61.0 61.0 38.0 61.0 Mean (sec.) 0.0 17.8 0.0 17.8 38.0 30.1 27.6 28.9 Tot duration (min) 0.0 2.7 0.0 2.7 8.9 11.5 9.7 21.2 SPT (409.0 min) % of SPT 0.0 0.7 0.0 0.7 . 2.2 2.8 2.4 5.2 Index (#/h SPT) 0.0 1.3 0.0 1.3 2.1 3.4 3.1 6.5

Respiratory events summary (Total sleep time) CA OA MA Sum HYP A+H RERA Resp.

Ap Events Events Settings (sec.) 10.0 10.0 10.0 10.0 10.0 Number' 0 9 0 9 14 23 21 44 Max (sec.) 0.0 24.0 0.0 24.0 61.0 61.0 38.0 61.0 Mean1 (sec.) 0.0 17.8 0.0 17.8 38.0 30.1 27.6 28.9 Tot duration (min) 0.0 2.7 0.0 2.7 8.9 11.5 9.7 21.2 TST (272.5 min) % of TST 0.0 1.0 0.0 1.0 3.3 4.2 3.5 7.8 Index (#/h TST) 0.0 2.0 0.0 2.0 3.1 5.1 4.6 9.7

Respiratory Event Index Summary (Total sleep time) REM #/h (REM) NREM #/h (NREM) TST #/h (sleep) AHI 8.6 4.4 5.1 RDI 15.7 8.6 9.7 Position Position Periods Duration Sleep REM SWS CA OA MA HYP Index Oesat Leg (#of) (min) (%) (%) (%) (#) (#) (#) <Wh) (#) (#) Mvts (#) L 10 144.0 61.1 0.0 5.6 0 4 0 2 4.1 4 0 P S 15 179.7 58.1 13.3 0.0 0 5 0 11 l_ 14.4 22 0 R 4 85.3 93.9 21.2 25.2 0 0 0 1 0.7 1 45 Up Arousal Total number of WK or MVT episodes 21 Arousal index 14.1/h(sleep) % of pages with arousal during sleep 9.9% Number of arousals associated with leg movements 0 Number of arousals NOT associated with ieg movements 64

Total With resp. event With resp. event & Leg Mvt Spontaneous number desat arousal arousal u arousal REM 8 1 1 0 6 u arousal NREM 26 4 7 0 15 u arousal MVT 0 0 0 0 0 n arousal WK 9 0 1 0 8 H arousal TOT 43 5 9 0 29 arousal >15sec 21 16 5 0 0 Ufom, Eric, PSG, Page 3 —

t ECG Table WK REM NREM : N1 N2 N3 MVT Duration (min) 153.5 42.0 231.5 8.5 193.5 29.5 0.0 Mean HR (BPM) 70.5 74.1 70.5 69.2 70.1 74.1 Median (BPM) 69.000 74.000 70.000 69.000 70.000 76.000 LHR min (BPM) HHR max (BPM) ECG fail (min) 0.0 0.0 0.0 0.0 0.0 0.0 0.0

Oximetry distribution, all durations are in minutes Wa ke REM Non-REiy! Total | Sp02 % Dur % TIB Dur %TIB Dur %TIB Dur % TIB <50 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 I <60 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 I <70 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 <75 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 <80 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 <85 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 <90 0.0 0.0 0.0 0.0 0.3 0.1 0.3 0.1 <95 6.3 1.5 5.7 1.3 61.4 14.4 73.4 17.2 Base Line Sp02 96% Longest continuous duration spent below 0%: 0.0 minutes Lowest Sp02 (>= 2 seconds): 88% # Episodes (>= 5.0 minutes) Sp02 < 88 %: 0 Longest duration Sp02 <88 % (>= 5.0 minutes): 0.0 minutes Respiratory event 02 min levels Mean of the resp. event SpQ2 min levels 93% Mean of the resp. event Sp02 min levels with desat 93% Minimum of the resp. event Sp02 min levels 88%

Count Index Leg movements 45 9.9 Leg movements meeting PLM criteria 45 9.9 Leg movements NOT meeting PLM criteria Leg movements with respiratory events with arousal 0 0.0 Leg movements with respiratory events without arousal 0 0.0 Leg movements with arousal(without respiratory event) 0 0.0 Lev mvts without arousal and without respiratory event 45 9.9 Total number of PLM episodes 2 Mean duration of PLM episodes 589.8 sec Total time with PLM 19.7 min (7.2% of sleep) PLM index (#/h) 0.4 Ufom, Eric, PSG, Page 4

BODY POSITION SUMMARY 1

Body Position Trend

m r\sj j? [Wuruir31 s V 20 . CA.sec 20 OA.sec 20 MA,sec 20 "HYPO.sec 30 "RERA.seq 0 lifl 20 Desal.sec 0 I I 30 LegMvt.sec

100 ~MIC,sec 30 arousal.sec

w ZSiage R J N1 N2 L I N3 T 10:02:44 PM 11 PM 12AM 1AM 2 AM 3 AM 4 AM 5 AM Ufom, Eric, PSG, Page 5

Night Hypnogram HR.BPM

Jl—I—fr—iAM~Ll^».« i...J,..u ^J-J—d—iJ^iiAJ**...*. d~-~ —i^Av^ "A— , [•Lm^^L^jv^, u ,—,—J—in—ij—'—i Sp02.% .«^«"-.»^^<VV|^J^--W--^~-.~Sf^>^MAs^^-*^V-^v-^^*s- T W _Slaflfi.

R _J N1 1 N2 N3 T 20 CA.sec 20 OA.sec 20 MA, sec 20 "HYPO.seJ 0 !

20 TPAP,CmH20

20 . EPAP,cmH20

10:02:44 PM 11 PM 12 AM 1AM 2 AM 3AM 4 AM 5AM Ufom, Eric, PSG, Page 6

Epworth Sleepiness Scale Score: 15 HT: 67" WT: 185 BMI: 29 Neck: 15" RR: 14 BPM Patient History: Mr. Ufom is a 53 year old male with a history of leg cramps, polio, and snoring.

Medications: '0' or 'none' TECHNICAL SUMMARY: Obstructive events along with arousals and mild to moderate snoring were noted by the night technician.

Patient indicated he has difficulty falling asleep. His sleep is restless or disturbed and he experiences frequent or prolonged awakenings. He has nasal obstruction or sinus problems. His weight has increased over the past year He has awakened feeling as if he is choking or gasping for breath. Others have witnessed him stop breathing while asleep.

He experiences repetitive leg or arm movements while asleep. He has leg or arm discomfort which goes away with movement. He experiences sudden jerky body movements at sleep onset. His sleepiness affects his performance at work. He gets approximately 4 to 6 hours of sleep each night and takes 7,120 to 180 minute naps per week.

Patient information was obtained from a sleep history questionnaire.

ECG: NSR.

IMPRESSION: 1) Mild Obstructive Sleep Apnea syndrome.

RECOMMENDATIONS: 1) Return to the sleep laboratory for CPAP titration.

2) Caution with CNS depressants that can exacerbate obstructive events.

3) Caution with driving and operating potentially dangerous machinery until the condition is adequately treated.

Weight loss to the ideal range.

Mauricio Reinoso, MD Diplomate, American Board of Sleep Medicine and Diplomate, Sleep Medicine, ABIM 281-980-1330 6-29-12 /C&/r-o //^Z.Z ^

.& Orlando Ear, Nose &ThroatAssociates, PA. *<&.

Michael M. Bibliowkz* D.O. • Dale C Harrington, D.O, MaWnK.ffibon,M.CDvCCC-Audteto& Ear, Nose& Throat Head &Neck Surety, facial Plastic Su^er* E.NX Allergy. Hearing Aids Hovember 5, 1996

Man L. Moctqv, D.O.

2721 West State Road 434 • ' Longwood. FL 32779 PEt -ERIC-UFOM

.bear Alan* Ihad the pleasure of seeing Eric Ufom in the office on November 5, 1906. Thank you very much for allowing me to participate in his care.. Sric is a very Interesting 37 year old- male with multiple problems, The problem he <x>°**>*> visit me for is difficulty with sleeping, states he waxes up short of breath with his heart racing and shaking all over which sounds to me as though he is having. episodes of apnea, then waking up to breathe. Ke lives alone so he does not know wiethar be is snoring but I would tend to guess that"he is. He. does fall asleep- •dx^fhg the day occasionally but is not Very* tired overall. In addition-to.-this, •in" 1986. he was in a severe car accident in .Africa and had multiple facial fractures that were repaired and. since that time, he cannot .open his mouth very wide and. again. I believe this may be contributing to- the sleep- apnea also. He also has a hearing loss since that accident. He. also states that while driving when he passes a car, he feels a little-wobbly and then, it goes away quickly, and this only occurs when he is driving. He also states that when this occurs, his hearing seems to drop a little bit.

PAST lffiDICAL HISTORY i Otherwise negative.

CURREMT HTOICATIDIB* Kasal spray.

PHYSICAL EmtBKTTOKi HKAOi Kormocephalic'. EARSt 'Left ear - .The tympanic membrane reveals a stenotic meatus and 1H.appears to be.intact but because.of the stenotic meatus, it is difficult to see veil. Right ear - Clear. With good motion. HOSEi Reveals a deviated.nasal septum to the left. -HQUIHi Reveals no lesions or nasses but he is only able to open his jaw a small amount; His. throat does-reveal redundancy of the uvula. MOBf Reveals a previous. left tripod fracture with repair and irregularities can be palpated through: the skin..and there is a visible irregularity. Also, his left eye tends, to be Bore lateral and he does state that he has chronic double vision since this accident.

He has a negative head shake maneuver. Romberg, and Fukuda" tests' are stabl«.

Hallpike test is unremarkable and there is no spontaneous"or induced nystagmus.

ERIC IffCM. • Sovember 5. 1996 Page 2

„; .^-k5&F.tr.2S«si«srt^- mPRBSSIOHSt

2'• ^^U^.!^LaCs: Conductive secondary hearing loss.- secon to trauma.

3. History of multiracial^ trauma.

FLA3> .,, „ *..^.:-.e- evaluate the reasons r- - ot all we will obtain a sleep study ~ -—-•- - .. • 1. ^hiVdificulty with- sleeping. amoral *»e to further 2.

3.

W.you very «u=h-for dig*,>« ^lA* UbU care.

DCHidw "U.v

'ORIDA HOSPITAL, MEDICAL CENTER MI97670H 1XXRXDA HOSPITAL - ORLANDO

) iTE OF BIRTH: January 22, 1958 \rE: 38 years STORY: Mr. Eric ufom is seen in the clinical sleep study center at Florida a «pital/Orlando through the courtesy of Dr. Dale C. Harrington. The pitlent's primary physician is Dr. George A. Pyxe. There is a question of u>per airway obstructed breathing syndrome with multiple awakening occurring slddenly with the patient rinding himself unable to breathe. This evidently h is occurred five times per week over the past month. The patient relates t iat he ierks awake with a sensation that he is unable to breathe through his t iroat. He describes tremulousness and the episode is somewhat frightening t> him. The patient characteristically leaps up out of bed, runs to the bithroom, and pours water over his face and/or head. He is uncertain as to u lether this has any beneficial effect, but his throat obstruction seems to c Lear. The patient has felt somewhat sleepy within the recent past as well afid feels he is not sleeping as well. He reports, that he is afraid to go to sleep. Mr. Ufom experienced a major automobile accident in 1986. I do not nrve details but evidently multiple fractures in terms of face, forehead, crbit. sinuses, and nose were experienced, and the patient underwent xaconstructive surgery. He reports that he did not experience any significant brain injury. Subsequently, it is my impression the patient has experienced difficulty breathing through his nose. The patient further zeports that subsequent to his accident he experienced several episodes of *hat, in essence, is sleep paralysis, during which time he awakens and feels that he is unable to move for 3 to 5 minutes. This sensation seemed to jesolva but has again recurred over the past month or so. The patient does rot describe debilitating daytime sleepiness. He reports a history of loliomyelitis at age 5 years. Evidently, right lower extremity motoric junction was impaired. The patient underwent some form of surgery at a later date and feels that his legs function normally at the present time.

HYSICAL EXAMINATION: Blood pressure,--rigEi'arm, sitting is 92/60. The atlent is a pleasant 38-year-old" gentleman who exhibits"reconstructive acial features and left exotropia and a postoperative left pupil. The atient is somewhat difficult to clearly obtain a history from with tangential responses. The right optic nerve head appears flat. Neck iability is fairly well-maintained. The patient is unable to fully open his iiouth. The posterior airway space is relatively tight. Tongue is midline. ]Etusr7 SLEEP MEDICINE CONSULTATION MORRIS T. BIRD MD J: 11/22/9$ 11/23/96 15:10 PAGE: ** REPRINTED *** UFOM, ERIC N 12/04/98 10.35 MRI t 1487102 e /T JP sKcrwta-OMKO-oo -7o rtooxax MOSPXTAX.

4SFI 0 OX 10U7 ««•*<••' •'•"»»'•••• V0« Ot*K*¥ • \J- §a§a?

I X>RIDA HOSPITAL MEDICAL CENTER MI97670H i ARXDA HOSPITAL - ORLANDO

NaME: ERIC N. UFOM DATE OP STUDY: DECEMBER 8, 1996 SrUDY PERFORMED: POLYSOMNOGRAM ISGT-96-817 1ISTORY AND INDICATIONS FOR THE STUDY: Please see previous. It is of Jnterest that the patient has found that vigorous physical exercise during t le daytime has correlated with a diminished number of frightening nocturnal «rousals. The patient is apparently pursuing physical exercise due to what £• terms a low sperm count. He is taxing testosterone in thae regard. ..

SICAL EXAMINATIONi Please see previous. iBCHNIGAL SUMMARY: Total recording time is 420 minutes. The tracing is initiated at 2225 hours and ended at 0525 hours. No technical difficulty is «ftcountered. Monitoring is as per standard protocol.

IESCRIPTTON: The patient is studied 86% back positional and 14* right-side iositioned. Head of bed is flat with 2 pillows utilized. Initial waking Itate oxyhemoglobin saturation is 98*. Latency to stage I sleep is prolonged st 87 minutes. Rapid eye movement (REM) sleep latency is 68 minutes. A 1otal of 3 REM periods are evident. Once sleep is entered, occasional cantral and/or transitional apneic events are noted, especially early in the recording associated with intermittent arousals. Occasional airflow fluctuation and/or hypopneic events are further observed. REM sleep is i ssociated with partial eye-open position and side-to-side head movement. No t ignifleant or sustained upper airway obstruction is identified. Snoring is iery light. Periodic limb movements of sleep are absent. Electrocardiogram iEKG) remains stable throughout.

INTERPRETATION: J 420-MINUTB NOCTURNAL SLEZP POLYSOMHOGRAM EXHIBITING THE FOLLOWING: PROLONGED SLEEP LATENCY WITH INTERMITTENT AROUSALS AND AWAKENINGS HIKOR FLUCTUATING AIRFLOW AND/OR HYPOPNEIC EVENTS. :.

RAPID EYE MOVEMENT SLEEP ASSOCIATED WITH PARTIAL EYE OPENING AND INTERMITTENT SIDS-TO-SIDB HEAD MOVEMENT.

I tusr24 POLYSOMNOGRAM REPORT MORRIS T. BIRD MD 12/09/96 12/09/96 14:01 PAGE: 1 4** REPRINTED *** UFOM, ERIC N MAX s 1487103 _,, ++s*9 -Ax-22-*,*. *»/«-*^ 0-0070 XXOItTDA HOSPXYAX. ACCTS 4 724S9S ORLANDO, FLORIDA JOB z OX 5713 ftJNfJpENTJAL AND PRIVILEGED INFORMATION FOR PROFESSIONAL USE ONLY I ANY REDISCLOSURE IS FORBIDDEN BY STATE STATUTE. <3Tfe-

AjORIDk HOSPITAL MEDICAL CENTER MI97670H E JORIDA HOSPITAL - ORLANDO

SAME: ERIC N. UFOM DATE OF STUDY: DECEMBER 8, 1996 i TODY PERFORMED: POLYSOMNOGRAM JSGT-96-817 1TSTORY AND INDICATIONS FOR THE STUDY: Please see previous. It is of I IfTORXJ^" i™£"*^«en1. nas found that vigorous physical exercise during tJlte5e^™ le daytime has cor^eia?edwithTdiminished hascorrela|^ *^*e* pur3uingnumbe^f frightening physical exercise due nocturnal to what Je°te^a £v s^rTcountt^ris'l^ing £eltosterone in this regard.

SICAL EXAMINATIONx Please see previous.

IZZ-^ cmnony. Total recording time is 420 minutes. The tracing is ~ JggZS. ef^I'hoursan^dedIt 0525 hours Ho technical difficulty 1* jfcountered. Monitoring is as per standard protocol. rPdpsiwios: The patient is studied 86% back positional and 14* right-side 1^f^^S Head of bed is flat with 2 pillows utilized. Initial waking Irate o^»4?obins-turalion is 98*. Latency to stage I sleep is prolonged !?« StesT Rapid eye movement (REM) sleep latency is 68 minutes. A ~+l\ S 3 REM periods ire evident. Once sleep is entered, occasional fcra! «d^r Slnst^ional apneic events are noted, especially early in the JKordinTassoclated with intermittent arousals. °ccaBi°na£^l"0* 1<s S^w^pSrSat^-^rptsftlon^^^ ?^i?^t or sS^tained upper airway obstruction is identified. Snoring is » iS SK Periootc !LoPmovementsYof sleep are absent. Electrocardiogram <£KG) remains stable throughout.

INTERPRETATION: I 420-MINUTE NOCTURNAL SLEEP POLYSOMNOGRAM EXHIBITING THE FOLLOWING: 2.

PROLONGED SLEEP LATENCY WITH INTERMITTENT AROUSALS AND AWAKENINGS.

MTKOH FLUCTUATING AIRFLOW AND/OR HYPOPNEIC EVENTS.

2 .

ESS OT^OVE^T^LEEP ASSOCIATED WITH PARTIAL EYE OPENING AND INTERMITTENT SIDE-TO-SIDE HEAD MOVEMENT.

J^usr^r"^™ POLYSOMNOGRAM REPORT MORRIS T. BIRD MD I: 12/09/96 12/09/96 14:01 PAGE. 1 ** REPRINTED *** ™*[ «^Ja I >-x.,5?^»U25»fio-ol70 n-ORJOA HOSPITAL ACCTS 472*696 ORLANDO, FLORIDA JOS : 01 5713 Cft«yipENTlAL AND PRIVILEGED INFORMATION FOR PROFESSIONAL USE ONLY. ' ANY REDISCLOSDRE IS FORBIDDEN BY STATE STATUTE. ^w»' >•

F iORIDA HOSPITAL MEDICAL CENTER HI97670H F JORIDA HOSPITAL - ORLANDO ,..^ ^r-"..

Nsee is grossly deviated. Limited cardiorespiratory and neurologic isessments are noncontributory.

I fPRESSIOH: jA RECURRENT, FRIGHTENING DYSPNEIC AROUSALS, RULE OUT UPPER AIRWAY OBSTRUCTION.

AUTOMOBILE ACCIDENT IN 1986 WITH MULTIPLE FACIAL FRACTURES AND FACIAL RECONSTRUCTION.

3|. CHROMIC NASAL CONGESTION.

4. RECURRENT SLEEP PARALYSIS OF UNCERTAIN SIGNIFICANCE.

DISCUSSION.

Mr. Ufom is experiencing a series of recurrent, frightening nocturnal spneic arousals. He experienced a major facial and head injury, evidently th multiple fractures requiring reconstruction with chronic nasal ngestion, limited mouth opening, and now recurrent arousals as above, per airway obstruction is suspect. Will plan nocturnal polysomnography in this regard- Of further interest is a history of intermittent sleep paralysis which is of uncertain significance and may not need further investigation, other than reassurance. inanX you for allowing us to share in Mr. Ufom's continuing care.

SIGNED COPY ON FILE IN THE NEURODIAGNOSTIC LAB copy to: NEURODIAGNOSTIC LAB (AH) DALE C. HARRINGTON, DO (JO) GEORGE A. PYKE, MD (MI)

] tusr7 SLEEP MEDICINE CONSULTATION MORRIS T. BIRD MD :_ 11/22/96 : 11/23/96 15:10 PAGE: ** REPRINTED *** UFOM, ERIC N : 12/04/98 10.33 MRI : 1487102 55^52RJV **5M?.K!»5'5P'fc:fr •rSSXi.^.a* .-...< !Sopy MI97670H FWRIDA HOSPITAL HE3ICAL CENTER F jORIDA HOSPITAL*"-: ORLANDO

ERIC-N. UFOM^ DATE: DECEMBER 8, 1996 >Y PERFORMED: POLYSOMNOGRAM/ADDENDUM SLEEP LABORATORY DATA*, FIRST NIGHT SLEEP STUDY » 5UROLOGIST: MORRIS f- BIRD, MD F I 96-817 SLEEP STAGE INFORMATION: >tal recording time: 419.0 minutes 305.0 minutes latal sleep time; 7?.8% I Sleep efficiency: 85.5 minutes S ieep latency: 69.5 minutes I latency: 27.1% rcent awake: 6.0% 20.5% Stage I: 37.5% Stage II: 8.8% Stage III/Vis IBSPIRATORY EVENT INFORMATION: Jpnea/hypopnea index 1.2 events per hour 27.0 seconds longest event: 91% lowest oxyhemoglobin saturation: IERIODIC LIMB MOVEMENTS IN SLEEP EVENT INFORMATION: Itriodic limb movement index: 0.0

£IGNBD COPY ON FILE IN THE NEURODIAGNOSTIC LAB COPY TO: NEURODIAGNOSTICS LAB (AH) DALE C. HARRINGTON, DO (JO) GEORGE A. PYKE, MD (MI) POLYSOMNOGRAM REPORT MORRIS T. BIRD MD Vtusr41 12/11/96 12/11/96 16:59 UFOM, ERIC N 4** REPRINTED *** MRI : 1487102 12/04/98 10.32 ACCT: 4724696 d/T/P:MJM8-GNN0-D070 FLORIDA HOSPITAL ORLANDO, FLORIDA JOB : 01 6439 ^^W.-W.v^-^ xj^oK»53fi^JS? J&°/#Wi££t STATvTB,