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Phillip J. Wetzel901 N. AdamsSpokane, Washingto n 9920 |Telephone: (509) 326-3 502

LINITED STATES DISTRICT COURTEASTERN DISTRICT OF WASHINGTON

LINITED STATES OF AMERICA, )Plaintiff

) NO. CR-0s-0180-LRS

IVS SE,NTENCIN G MEMO RAN D UM

DIXIE ELLEN RANDOCK.Defendant.

A. INTRODUCTION

The overarching sentencing directive is that courts must impose a sentence that is

"sufficient but not greater than necessary to accomplish the goals of sentencing"

Kimbrough v. United States. S22 U.S. _, 128 S.Ct. 558,570 (2007).

The court is to consider the nature of the offense, the history and characteristics of

the defendant, the kinds of sentences available, the need to avoid unwarranted disparities

among similar defendants, and the need to provide restitution to any victims.

For fraud cases, based upon policy reasons, the Sentencing Commission did not

follow data on past practices in setting fraud guidelines. See Kimbrough at 522 U .5.

at_, 128 S.Ct. at 567 . Consequently the Guideline ranges for fraud are a less reliable

appraisal of a fair sentence. Therefore, it is not an abuse of discretion for the court to

DEFENDANT'S SENTENCING MEMORANDUM - I

PHTLLTP J . WETZET-Attorney & Counselor at Law

9Ol N. AdamsSpokane, WA 99201

(509) 126-3502

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conclude that a fraud guideline is greater than necessary. (See Joint Sentencing

Memorandum)

The parties have agreed that this should not be a guidelines case. If the court

follows the agreement, the only issue is whether Mrs. Randock will be allowed to serve

her sentence on home confinement. The sentence suggested by counsel is three years

home confinement, three years supervised release and the forfeiture of approximately one

rnillion dollars in assets.

B. THE PURPOSE OF SENTENCING

The purposes of sentencing are set out at l8 U.S.C 3553(a)(2).

l. Seriousness of the Offense. Promoting Respect for the Law. and Just Punishment

The government and Mrs. Randock have agreed that a sentence of 36 months is

appropriate and that it complies with the purposes of sentencing. Mrs. Randock has

forfeited $486,000 in cash, a vehicle valued at approximately $25,000, and land for

which the Randocks have received offers of $500,000. The total forfeiture, then, is

approximately $1,000,000. Mrs. Randock has been on pre-trial supervision for nearly

three years. The par-ties agree that she will be on supervised release for three years. Her

total time of court-imposed restriction will be nine years.

Mrs. Randock has lost her real estate broker's license.

Mrs. Randock would serve three years home confinement. lt bears repeating that

she would be inside the walls of her home for three years, bound by an electronic fence

court sets the ground rules. Usually, a defendant is confined except for work,

PHrLLrp J. WETZELAttorney & Counselor al Law

901 N. AdamsSnokane, WA 99201

(509) 126-3502

DEFENDANT'S SENTENCING MEMORANDUM - 2

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treatment, church, and obtaining groceries. As Ms. Randock works out of her home, her

confinement would be nearlv constant.

This forfeiture and a sentence of three years home confinement is sufficient, but

not greater than necessary to reflect the seriousness ofthe offense and promote respect

for the law.

2. Deterrence

The primary mischief this prosecution aims to deter is the operation of diploma mills.

But prosecutions of diploma mills are rare. Congress has conducted hearings on diploma

mills, but no legislation has been implemented. Deterrence can be achieved if Congress

were to pass legislation which regulates this activity. The severe forfeiture, coupled with

a sentence of three years of confinement, with no opportunity for recreation, travel,

visiting, or entertainment of any kind will provide a stern warning to any who

contemplate this type of offense. But this prosecution and sentence will not provide

deterrence, no matter what sentence the court imposes, as long as the laws on diplorna

mills are in flux.

3. Protection of the Public from this Defendant

lf one were to hypothesize a defendant who would be the least likely to recidivate, he

would look for someone like Dixie Randock. ln "Measurins Recidivism. The Criminal

History Computation Of The Federal Sentencing Guidelines"

http://www.ussc.gov/publicat/Recidivism_general) the commission analyzed recidivism

Psr lLrp J. WETzELAttorney & Counselor at Law

901 N. AdamsSpokane, WA 99201

(509) 326-3502

DEFENDANT'S SENTENCING MEMORANDUM - 3

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based upon different factors. Mrs. Randock's factors were consistently predictions of the

lowest likelihood of recidivism.

l. p 22 0 Criminal History Points, 6.30/o recidivism based on re-conviction.

2. p I I Women recidivate less than men.73Yo were re-convicted.

3. p 12 Persons over age 50 have the lowest rate.9.5o/o

4. p 12 Whites recidivate less than other races; 160/o

5. p 12 Persons who were employed recidivate less than the unemployed;

190

6. p 12 Persons with some college recidivate less than all others except

those who have college degrees; 18%

7. p 12 Married persons recidivate less than those who are single or

divorced; l3%

8. p l3 Those who do not use drugs recidivate less than those who do;

l70A

9 p l3 Those sentenced for fraud recidivate the least of all categories

summarized. 16.9o/o

10. p.l3 Defendants sentenced to probation with confinement alternatives

recidivate at 16.7o/o, while those who go to prison recidivate at

25 .60

Thus, based on USSC data, a sentence of home confinement is sufficient to carry out the

purpose of protection of the public.

DEFENDANT'S SENTENCING MEMORANDI-]M - 4

PHILLTP J. WrrzelAttorney & Counselor at Law

901 N. AdamsSpokane, WA 99201

(509) 326-3502

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4. Providing the Defendant With Training, Medical Care and Correctional

Treatment

Mrs. Randock hopes to return her real estate school to its former success. She

hopes that income earned from this school will be enough for her to continue to support

her mother, her husband and granddaughter. She hopes that the income will be enough to

employ her daughter, Heidi. While Dixie is healthy, her husband's health is fragile and

medical reports submitted reveal that it is so unpredictable and life threatening that

constant vigilance is required. She is not in need of drug or alcohol treatment, education

or training. A sentence of home confinement is sufficientto realize the goal of providing

her with these necessil ies.

C. RESTITUTION FOR ANY VICTIMS

The parties agree with the PSR that restitution is not an issue.

D. KINDS OF SENTENCES AVAILABLE

Mrs. Randock concurs with the PSR that probation, with a condition of home

confinement is available.

E. THE NEED TO AVOID UNWARRANTED SENTENCING DISPARITY

The focus of this prosecution has been the perceived mischief of diploma mills.

But prosecution of those involved in diploma mills has been rare. Many of these cases are

handled civilly, (see www.post-gazette.comlpgl07225lS09036-84.stm). Mr. Ronald

PHrLLrp J. WETZELAttorney & Counselor at Law

901 N. Adams

Spokane, wA 99201

(509) 326-3502

DEFENDANT'S SENTENCING MEMORANDLM - 5

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Pellar, upon conviction of nine counts of mail fraud, was sentenced to eight months jailin

federal court. (see Attachment l)

There simply are not many diploma mill prosecutions.

D. NATURE OF THE OFFENSE

Professor Frank Bowman has noted that while federal fraud guidelines do not

consider a defendant's state of mind, such distinctions are critically important to calculate

punishrnents that actually fit the defendants' culpability. See 20 Federal Sentencing

Reporter No.3 at 156.

Dixie Randock has accepted responsibility for her offense. In hindsight, she sees

clearly that her activities were illegal and fraudulent. But it did not start out that way.

There were clear attempts to fully explain to customers exactly what was being offered.

Customers were required to acknowledge disclaimers such as this from 2002'.

I declare that all information given in this application and documentationis true and accurate to the best of my knowledge. I understand that I amnot enrolling in a school of any type. I have read all of the information atthis site and have satisfied myself as to requirements and limitations of myown needs as well as the program and process. I am seeking documentsfor personal career and/or recognition enhancement of expertise I havedeveloped from life experience. I have provided documentation of mystatements to Saint Regis University. I acknowledge that there was nocharge for the evaluation of my information, and that I am paying thisamount for acceptance, customization, printing, preparation, shipping andthird party record archive verification service. Verification includesdisbursement of the contents of my records. I understand that verificationwill not include any representation of accreditation or include informationpertaining to matters other than my own record. I acknowledge that mycredentials are to be used for lawful purposes only, and any other use byholder shall not impute liability upon vendor. I agree to have my recordsstored in a permanent database for archive verification by anyone to whomI grant authority. I also understand that I retain control of my records andmay change or withdraw my records by notifying the archive verificationcenter. I agree to all terms:

Ptul l rp J. WETZELAttorney & Counselor al Las

901 N, Adams

Stokane, wA 99201

(509) 326-3502

DEFENDANT'S SENTENCING MEMORANDUM . 6

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This material was contained on the defendant's website:

How do I represent the way I received my degree?

There are literally thousands of schools that offer distance educationdegree programs. It is no longer a requirement that a person attend classesat any special location in order to obtain a degree.Our Sponsor Universities are licensed and registered to issue degrees fordistance learning and portfolio assessment. This is a legal degree. Youmay include it on your resume, business card, letterhead, passport, website, job application, or any other official document you fill out.

Like all documents, you must use your degree in a legal manner. Thedeliberate misrepresentation of how your degree was earned could causeconfusion or potential problems. For this reason we. as well as mostinstitutions. recommend that their graduates be truthful regarding themethod by which they earned their degree.

Earning a degree by an independent evaluation process is a tremendoussource of pride. The methods by which you acquired your knowledgerepresents years of your work, experience and accomplishments and areno less valuable than the more traditional method of sitting in a classroom.ln any case, we protect your right to privacy.

Emphasis Added

Will I receive a transcript with my degree?

Yes. you will receive transcripts for each degree. showing representativecourses that correspond to your experience as compared to a traditionalclassroom setting. The transcripts show a traditional curriculum of coursesthat are the equivalent of the ski l ls you have acquired as though youattended. There is no mention of "equivalency". The dates and gradespoint average will appear.

You may request additional copies of your transcripts and other records atany time (small fee may be required). An enormous amount of researchand labor is required for each individualtranscript. Transcripts arecarefully compiled to match the candidate's qualifications and education.

Emphasis Added

PurLlrp J. WETZET.Attorney & Counselor at Las

901 N. AdamsSpokanq, WA 99201

(509) 326-3502

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DEFENDANT'S SENTENCING MEMORANDUM . 7

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Mrs. Randock acknowledges and is remorseful for misrepresenting the credentials

and names of herself and her employees. But it is clear that for most customers, this was

not material and the customers received what they had bargained for.

THE HISTORY AND CIIARACTERISTICS OF TIIE DEFENDANT

l. Mrs. Randock's Contribution to the CommunityDixie Randock has demonstrated a commitment to help her family, her friends,

her ernployees, and her community. Dixie was the oldest of two children of a mother and

father who struggled with poverty, alcohol problems, who divorced when Dixie was only

12 years old. Dixie became the mother figure of her younger brother and was solely

responsible for all home duties and responsibilities. From the age of 12 to 14, she would

come home from school every day to make her father dinner and clean house when he'd

return from working at Kaiser Aluminum before going to work at their business, the My

Tavern on Sprague Avenue, downtown Spokane.

Her mother worked days at the tavern and would routinely remain there after work with

Dixie's lather until very late hours, leaving Dixie in charge of her brother and the home.

Her mother and father divorced on friendly terms when Dixie was 14. Her mother and

brother moved from the family home to a rental in the Hillyard area. Dixie dropped out of

high school at age 16 and went to work to help support the family. She married at 17 and

had twins at 19, divorced and remarried at age 2l and had her third child. Her husband

was abusive, physically violent and beat her during their 10 year marriage. The children

often called police, but they were not able to help her get out of the situation and the

PurLLrp J. WrrzelAttorney & Counselor at Las

901 N. AdamsSpokane, wA 99201

(509) 326-3502

DEFENDANT'S SENTENCING MEMORANDUM - 8

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marriage dissolved in 1980. She later married Steve Randock, and they have been very

happily married for more Ihan 23 years.

Mrs. Randock has maintained a close relationship with her parents and childhood friends.

For many years she has supported her mother, youngest daughter and 2 grandchildren.

She has provided employment for her oldest daughter, numerous friends and relatives and

her step-mother.

For many years Dixie has offered a program to all victims of domestic violence. It

consists of a free 60 clock hour Pre-License course to help the individual start a new

career in real estate and become independent.

Mrs. Randock has offered military veterans a free 60 clock hour Pre-license course. She

takes no money lrom any military veteran who requests this.

These programs have been posted at her online real estate school www.aplusnow.com

website for many years and many have benefited.

She has contributed to the Spokane community, providing employment for a large

number of people over many years, training, mentoring and employing hundreds of

individuals to become productive professional real estate agents and brokers, anc

teaching hundreds of agents pre-licensing and continuing education courses. Since 1994,

she worked 60 to 80 hour weeks for her real estate brokerage and real estate school. She

has written more than 50 college level courses and programmed them into interactive CD

PHILLIP J . WETZELAtrorney & Counselor at Lau

901 N, AdamsSpokane, WA 99201

(509) 326-3502

DEFENDANT'S SENTENCING MEMORANDUM - 9

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ROM and online courses all approved by the Washington Department of Real Estate. She

spent the past three years writing 51 state license exam preps which are also offered

online.

2. Mrs. Randock is the Key Employee lor Real Estate School

Although the real estate school employs an instructor, John Lenertz, Mrs. Randock is the

only person who knows how to make any changes to the content, keeping it up to date

and state-approved, and more importantly is the only person who knows how to handle

the proprietary technical side of the operations of the CD ROM and online courses.

The courses are programmed to be interactive and are "time-sensitive" as required by

state laws which mandate that all students take the prescribed clock hours. These courses

are programmed to track all hours spent in the course, deliver the content in modules,

deliver reinforcement exams as well as a student evaluations and final exam; and then

delivers the results and scores to the instructor, administrator and student. As with all

technical programs, problems arise that only the programmer can fix.

Unfortunately, there is no mandated format for distance courses, so each author creates

his own method for course delivery. Mrs. Randock is the only person who can keep the

school in operation as no one else knows how to do this.

Without her being available to take care of the online operations, the school would be

closed within a few weeks.

Psrr-r - rp J. WETzELAttorney & Counselor al Law

901 N. Adams

Spokane, wA 99201

(509) 326-1502

DEFENDANT'S SENTENCING MEMORANDUM - IO

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The real estate school is dependent on Mrs. Randock, and in turn many people are

dependent on the income generated from the real estate school.

Her Mother is dependent on income from the real estate school which for many years has

supplemented her $520 social security.

The only other source of income in the Randock household is Mr. Randock's social

security, which is $971.

It is not a business that can be taken over by someone new, and cannot simply close and

reopen later. Numerous State laws govern its operations, storage and retrieval of student

records, and reporting. Only Mrs. Randock has the knowledge to maintain the proprietary

technical processes. The cost to start over would also be prohibitive to regain

certiflcations and approvals.

Closure would also negatively affect hundreds of past and current students

3. Letters of Support

Several members of the community have provided letters in support of Mrs. Randock and

they have been delivered to Ms. Challinor:

l. Joy Lynn Wirsch, teacher

2. Lloyd Torgerson, businessman

3. Kirk Downing, former employee, contractor

PurLLrp J. WETZELAttorney & Counselor at Law

901 N. AdamsSpokane, WA 99201

(509) 326-3502

DEFENDANT'S SENTENCING MEMORANDUM . I I

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4. John Lenertz, real estate broker and competitor

5. Edith Lenertz. personal friend

6. Mike Jefferv. former business associate

7. Leanah Jeffery, friend

8. Janelle Randock, daughter in-law

9. Larry Randock, son

10. Steven Randock. Jr.. son

I l. Don Hertz- Associate- student

12. Arlene Pedersen. mother

13. Jendi Lewis, granddaughter

l4 Britney Lewis, granddaughter

15. Jay Torgerson, friend

16. Robert Jorgensen, bank manager

17. Sharon Torgerson, teacher

These letters are valuable to the court. They contain glowing opinions of Mrs.

Randock. But more importantly, they report hard facts which reveal the characteristics of

Mrs. Randock. She is smart. She is extremely hardworking. She is loved by her family

She has loved and sacrificed for her family She has a reputation of honesty in the real

estate community. She has been respected and successful in the real estate business. She

is a highly competent caregiver to her husband. She established a successful real estate

school. She has struggled though extremely difificult times, even as a young person. She

shoulders great responsibility for the financial, physical and emotion welfare of her

Purr- l rp J. WETZELAttorney & Counselor at Law

901 N. Adams

Spokane, wA 99201

(509) 126-1502

DEFENDANT'S SENTENCING MEMORANDUM - 12

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mother, daughter, husband and granddaughter. She and her husband have been devastated

by this prosecution and have accepted responsibility for their actions.

4. Mr. Randock's Fragility Can be Best Managed With the Assistance of Mrs.

Randock.

Steve Randock, husband of Dixie Randock, has serious health problems that require

imrnediate and specialized treatment if he were to suffer another stroke or heart attack.

His doctor has stated that the stress of imprisonment could kill Mr. Randock and he needs

to have a care giver in his presence to make certain that someone can identifr his

symptoms and get medical attention quickly if he is unable to communicate, as he was

during the beginning of his last stroke. It was Dixie Randock who diagnosed stroke

sylxptoms and rushed him to the hospital in time to be given treatment to prevent death

and disability.

It is Mrs. Randock's fear that her husband will not be able to endure the stress if she were

to be incarcerated and senarated from him.

The records of Dr Jeff White, M.D., regarding Mr. Randock's health will show the

potentially fatal effect of stress on his health if he is incarcerated or left on his own, and

the affect of stress if his wife were to be incarcerated.

PurLrrp J. WElzrrAttorney & Counselor at Law

901 N. AdamsSpokane, WA 99201

(509) 326-3502

DEFENDANT'S SENTENCING MEMORANDUM - 13

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Dr. White is concerned that if Mr. Randock is incarcerated, his life would be in grave

danger, and suggests that serving his sentence under home monitoring with a 24-hour

caregiver in attendance would be much preferred.

Medical records will support that his wife Dixie would be the best caregiver in that

situation as she knows him the best, and is intimately familiar with his past symptoms

when he had his heart attack and cerebrovascular accident and that traditional

incarceration would therefore increase his risk for untimely death or increased morbidity

due to another vascular event. Mrs. Randock has received training in the emergency care

necessary for Mr. Randock's well-being.

CONCLUSION

Mrs. Randock has performed flawlessly on pretrial release. She has been totally

cornpliant. The court can be confident that a sentence of home confinement can be

irnplemented without problems.

This case has been the subject of a lot of hype and histrionics. But there are hard

realities. No one was hurt. No one lost a lot of money. There is no restitution. Only a

handful of people complained.

Mrs. Randock committed mail fraud. But this case has been cast as a monumental

battle in the quixotic war of a few against diploma mills. The diploma mill war should be

fought in Congress, not here. Mrs. Randock began her activities at a time when there was

little regulation and no laws against the type of on-line schools she intended.

PHrLLrp J. WETZELAttorn€y & Counselor at La$

901 N. AdamsSpokane, WA 99201

(509) 326-3502

DEFENDANT'S SENTENCING MEMORANDLIM - 14

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She overstepped the line and the court should impose a sentence that is sufficient,

but not more than necessary to meet the goals of sentencing considering the entire

context.

The forfeitures, three years of home confinement and three years of supervised

release are sufficient

Respectfully submitted this 6'n day of June, 2008

s/ Phillip.J. IletzelPhillip J. WetzelwsBA# 9499Attorney for the Defendant901 N. AdamsSpokane, Washington 99201Telephone: (509) 326-3502Fax: (509) 326-3525Email : plw etzel@mt! ce!1

CERTIFICATE OF SERVICE

I hereby certifu that on June 61h, 2008, I electronically filed the foregoing with the

Clerk of the Court using the CM/ECF System which will send notification of such filing

to the lollowinq:

Mr. George JacobsAssistant United States AttorneyPost Office Box 1494Spokane, WA 99210-1494

s/ Phillip J. WetzelPhillip J. WetzelwsBA# 9499

PsrLlrp J. WErzr lAttorney & Counselor at Law

901 N. AdamsSpokane, wA 99201

(509) 326-1502

DEFENDANT'S SENTENCING MEMORANDUM - 15

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Attorney for the Defendant901 N. AdamsSpokane, Washington 99201Telephone. (509) 326-3502Fax. (509) 326-3525Email. pjwetzel@msn. com

Purr- l rp J. WETZELAttorney & Counselor at Law

9Ol N. Adams

Spokane, WA 99201

(509) 326-3502

2 8

DEFENDANT'S SENTENCING MEMORANDLIM - 16

Diploma faker loses his freedom - and his yacht http ://www. cbc. calworld/story I 200 4 I 0 4/06/diploma_fraud040406. htrnl

Diploma faker loses his freedom - and hisyachtLast Updated: Tuesday, April 6,2004 | 10:23 AM ET9B--c-.N"e..ws.An elderly man in California who made up a university, then raked in millions selling diplomas from ithas been sentenced to eight months in jail

Ronald Pellar, 75, will also have to forleit his luxury yacht, worth $1.5 million US, because the courtruled he bought it with the proceeds of crime.

Pellar invented "Columbia State University" in Louisiana, no relation to the very real ColumbiaUniversity in New York.

He then rnarketed bachelor's, master's and doctorate degrees that could be acquired by correspondencein as l i t t le as one month for between $1,500 and $3,000 US.

U.S. District Judge Alicemarie Stotler sentenced Pellar on Monday on nine counts of mail fraud.

Assistant U.S. attorney Donald Gaffney said most of the people who bought the diplomas weren'treally victims of Pellar's crime because they wanted the degrees to mislead employers into thinking theywere better educated.

Pellar will also have to pay about $45,000 US in restitution.

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To:

Please let me know i f th is is what vou need: Dix ie Randock Doctor 's recordsA P lus (ma in@aplusnow.com)

Ft i 6 /06 /08 11 :26 AI4phil l ip wetzel (pjwetzel@msn.com); Randy Haj (randy haj@yahoo.com)

Subjective: Dixie E Randock is a 58 year old female who presents today forevaluation of left arm pain present on & off for about the past one year, andassessment of thyro id g land.

She repor ts that her mother th inks she is swol len in the anter ior neck, whichcould ind icate thyro id problems. She has not iced some decreased energy,in ter rupted s leep, and weight loss due to poor appet i te but admi ts that th is isqui te l ike ly due to her current l i fe s i tuat ion, which involves d i f f icu l t ies involv ingthe Federa l Government , and the poss ib i l i ty o f incarcerat ion. This is par t icu lar lyd is t ress ing for her , because i t could leave her separated f rom her husband, whohas had myocard ia l in farc t ion, and more recent ly a s t roke whi le at home. Hissymptoms were rather atyp ica l , and d i f f icu l t to recognize. Another s imi lar eventwi thout someone in t imate ly fami l iar wi th h is s i tuat ion in at tendance could bevery dangerous and even fata l to h im, i f h is symptoms were not qu ick lyrecognized and t reated. The thought of not be ing avai lab le to her husband insuch as s i tuat ion is ext remely d is t ress ing for her .

The left arm pain has been something that has progressed persistently over thepast year / and she fee ls is due to hours spent work ing at a computer . Shenot ices pain most s ign i f icant ly over the dorsal aspect o f the four th and f i f th d ig i tsextending up to the la tera l e lbow and occasional ly in to the prox imal arm. Thereis not much swel l ing or weakness noted, symptoms do tend to come and go, andbe re lated to the in tens i ty of her act iv i ty . Reposi t ion ing help symptomssomewhat , but not ent i re ly . She denies past h is tory of neck or shoulderinj u r ies/a rth r i t is.

Socia l / fami ly hx update: As above

Objective:GEN: WD,WN, NAD, A&Ox3, appropriate affect, provides a good history, shelooks to have lost weight s ince I saw her last , but is not over ly pa le inappearanceHEENT: PERRL, EOMI, a t raumat ic , Crania l nerves WNL on genera l inspect ion,Ears: Normal eardrums, Pharynx: Dent i t ion in good repai r , no hyperemiaNECK: Fai r ly fu l l range of mot ion, no adenopathy, bru i ts , or thyro id enlargementCHEST: CTAHEART: Regular ra te and rhythmEXTREMITIES; Wi thout t remor, cool ing, muscle fasc icu lat ion or asymmetry. Theleft upper extremity shows good muscle development good distal sensation intactradia l pu lse normal re f lexes. Shoulder is wi thout s t i f fness or compromised rangeof motion on the left side.

729.5D Arm Pain (pr imary encounter d iagnosis)Comment : Presentat ion is most consis tent wi th rad ia l nerve i r r i ta t ion most l ike lyprox imal to the e lbow, and shoulder reg ion.Plan: X-RAY C-SPINE COMPLETE (COLUMBIA), X-RAYSHoULDER 3VrEW (COLUMBTA)Wi l l get x- rays to ru le out preexis tent ar thr i t is that may be contr ibut ing to th is ,

A t t 1 , . - " ^ r 2 e t g 6/6/200811:31 AM

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and get her to physical therapy to see if we can decrease soft t issue traction onthose nerve roots

783.21Q Weight LossComment : Thyro id exam is unremarkable, weight loss most l ike ly due to s t ress,but wi l l want to ru le out poss ib le metabol ic causePIan: COMP. METABOLIC PANEL, CBC W PLT + DIFF(PAML), TSH, TOTAL CKant ic ipat ing normal lab resul ts , but wi l l le t her know the s ign i f icant f ind ingsreturn. I spoke wi th her br ie f ly about the normal and expected fee l ings of anger ,sadness, hopelessness, e tc . . She admi ts to hav ing considered su ic ide, but hasnot considered how, nor enter ta ined any speci f ic p lan. She agrees to contactmysel f or conf ide in her husband in such thoughts do occur .I d id share wi th her that f rom a medica l s tandpoint , I would s t rongly suppor t asolut ion to her current d i f f icu l t ies that would keep her in prox imi ty to herhusband because of h is medica l issues, and a lso keep h im in prox imi ty to themost prompt medica l a t tent ion avai lab le anywhere.

Sincere ly ,

Jef f Whi te ,MD

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