“Epilepsy and Anonymity in Federal Litigation” – The Eleventh Circuit Clarifies When Medical Conditions Warrant Pseudonym Status

1. Introduction

In Tessa G. v. Secretary of Health and Human Services, No. 24-11764 (11th Cir. 2025), the United States Court of Appeals for the Eleventh Circuit confronted a recurring procedural tension: when may a civil-rights plaintiff litigate under a pseudonym to shield sensitive medical information? The plaintiff, a former attorney with the U.S. Department of Health and Human Services (“HHS”), alleged disability discrimination and retaliation after disclosing her epilepsy. She sought to proceed anonymously, arguing that public linkage of her name to her condition would magnify employment stigma and invade privacy. Both the magistrate judge and the district court denied anonymity. Sitting on the non-argument calendar, an Eleventh Circuit panel (Jordan, Luck, and Kidd, JJ.) affirmed.
The judgment crystallises the threshold for “utmost intimacy” in the Eleventh Circuit: epilepsy, standing alone, lacks the social, moral, or physical dangers that have previously justified pseudonymity (such as HIV status, abortion, sexual orientation, or transgender identity). Consequently, the presumption of openness embodied in Fed. R. Civ. P. 10(a) remains paramount.

2. Summary of the Judgment

• Holding: The district court did not abuse its discretion in denying the plaintiff’s motion to proceed anonymously; epilepsy does not, by itself, constitute information of such “utmost intimacy” that it overcomes Rule 10(a)’s presumption of party identification.
• Standard of Review: Abuse of discretion, because denial of anonymity is a collateral order appealable immediately under Plaintiff B v. Francis.
• Key Factors Considered: Whether the plaintiff challenges governmental action; nature of the information (utmost intimacy); potential for admission of illegal conduct; minor status; risk of physical harm; and unfairness to the defendant.
• Outcome: All factors except the first weighed against anonymity; the existence of social stigma and privacy concerns may be mitigated by sealing or redaction rather than pseudonymity.

3. Detailed Analysis

3.1 Precedents Cited and Their Influence

1. Plaintiff B v. Francis, 631 F.3d 1310 (11th Cir. 2011).
   • Established six-factor framework for anonymity; treated HIV and sexual abuse victims more sympathetically.
   • Court here applied Francis nearly verbatim, stressing that anonymity is “exceptional.”
2. Doe v. Frank, 951 F.2d 320 (11th Cir. 1992).
   • Denied anonymity to a postal worker alleging alcohol-related discrimination.
   • Current panel analogised epilepsy to alcoholism: both implicate medical facts but lack the overwhelming stigma courts find compelling.
3. Southern Methodist Univ. Ass’n of Women Law Students v. Wynne & Jaffe, 599 F.2d 707 (5th Cir. 1979).
   • Older Fifth Circuit case (binding pre-split) providing the original “government activity / utmost intimacy / illegal conduct” trio of factors.
4. Miscellaneous HIV, mental-illness, and gender-identity cases referenced by parties.
   • The plaintiff invoked them to argue analogy; the court distinguished each as involving communicable disease, fatality, or highly personal identity traits.

3.2 Core Legal Reasoning

The Eleventh Circuit reaffirmed that Rule 10(a) creates a “strong presumption of openness.” Departing from that presumption demands a showing that privacy interests substantially outweigh transparency. The panel progressed through the Francis factors:

• Government activity: Yes—suits against HHS. Helpful, but non-dispositive.
• Utmost intimacy: Epilepsy, although medical, does not meet the “highest tier” of intimacy comparable to HIV, abortion, or transgender status. Social science articles citing stigma lack binding force.
• Illegal conduct admission: Not implicated.
• Minor status: Plaintiff is an adult lawyer.
• Risk of physical harm: No specific threat alleged.
• Unfairness to defendant: HHS either already knows her identity or can discover it; but knowledge alone does not tilt balance in plaintiff’s favour.

The court further emphasized that alternative safeguards—sealing targeted exhibits, limited redactions, protective orders—can protect medical privacy without eroding public access to core judicial information (i.e., party names).

3.3 Impact on Future Litigation

• Narrowing of “utmost intimacy”: Litigants with non-communicable, non-fatal disabilities (e.g., epilepsy, diabetes) now face an uphill battle obtaining pseudonym status in the Eleventh Circuit.
• Strategic shift toward protective orders: Plaintiffs will likely shift from anonymity motions to tailored sealing requests under Local Rules and Fed. R. Civ. P. 26(c).
• Guidance for district courts: Provides explicit validation that denial of anonymity is not an abuse of discretion even when plaintiffs produce empirical stigma studies, unless those studies place the condition at a uniquely sensitive societal intersection.
• Inter-Circuit Influence: While unpublished, Eleventh Circuit decisions are persuasive. Circuits with similar doctrines (Fourth, Seventh) may cite it to constrain the expansion of pseudonymity in ADA and Rehabilitation Act suits.
• Government-employment cases: Reinforces transparency where the public has a special interest in monitoring governmental conduct.

4. Complex Concepts Simplified

Collateral Order Doctrine
A narrow category of trial-court orders—like denying anonymity—that are immediately appealable because waiting for a final judgment would defeat the right involved.

Utmost Intimacy
Information so personal (e.g., sexual identity, abortion history) that public disclosure can cause profound personal, professional, or physical harm.

Presumption of Openness
The Constitution and common law favour public access to courts; parties must normally be named so citizens can monitor the judicial process.

Protective Order vs. Anonymity
A protective order seals documents or redacts details; anonymity hides the party’s name entirely. Courts prefer the narrower remedy.

5. Conclusion

Tessa G. v. HHS signals that, within the Eleventh Circuit, most disability discrimination plaintiffs cannot cloak themselves behind pseudonyms merely because their suits involve medical details and potential stigma. The decision fortifies Rule 10(a)’s default rule, clarifies that “utmost intimacy” is reserved for matters approaching the sensitivity of HIV status, reproductive choice, or gender identity, and encourages litigants to rely on conventional confidentiality tools rather than anonymity. Ultimately, the ruling safeguards public confidence in the judiciary’s transparency while still allowing granular privacy protections through sealing and redaction. Practitioners should recalibrate litigation strategy accordingly, carefully documenting any extraordinary threats that might elevate a medical condition to the “utmost intimacy” category.