NC Medical Board Dr. Rashid A. Buttar Transcript - Page 13 of 16
QAnd you're satisfied that the time that he spent there not only helped him, but also he was happy with it; is that correct?
AYes.
QWere there times that he would be on the phone that you could hear somebody screaming at him?
AYes, there was.
QDo you know who it was?
AYes, sir, I do.
QWho ‑-
AOn several occasions, I don't know how often.
QWho did he say it was?
AMany times he would be very upset and just slam the phone and say something about his wife.
QSo he was under distress with the cancers and marital stress, as far as you knew?
AYes.
MR. KNOX: All right. That's it.
CROSS-EXAMINATION BY MR. JIMISON:
QMs. Wall, do you know Patient C's wife?
ANo, sir, I do not.
QDo you have any idea whether she is a grieving mother or not?
ANo, I do not. I have no knowledge.
QAnd when Patient C passed away he left three children behind?
AI do know that.
QAll right. He left his wife?
ACertainly.
QAnd ‑- and you've never been a visitor to their household?
ANo.
MR. JIMISON: That's all I have.
PRESIDENT RHYNE: Do any Board Members have any questions of this witness? I have one.
EXAMINATION BY THE PANEL MEMBERS:
PRESIDENT RHYNE: You said that you're certified in chelation therapy. What did ‑- what did you do to obtain that certification?
WITNESS: There is an International Society of Chelation Therapy Technicians and I went through their course.
PRESIDENT RHYNE: All right. All right, thank you.
MR. KNOX: Let me ask one question.
REDIRECT EXAMINATION BY MR. KNOX:
QDid you go to the funeral ‑- did a number of some of the employees at the clinic go the funeral.
ANo, I did not. I was out of town.
QI'm sorry, I misread that. Thank you.
MR. KNOX: We have that other video ready and then we'll have one other witness.
PRESIDENT RHYNE: All right.
------------------------------------------------------------
(WHEREUPON, THE VIDEOTAPE DEPOSITION
OF ELLEN HINSHAW TAKEN ON APRIL 20, 2008
WAS PLAYED AND IS HEREBY ATTACHED
IN ITS ENTIRETY AS EXHIBIT 44
------------------------------------------------------------
PRESIDENT RHYNE: We're ready to continue. Ms. Godfrey, do you have another witness?
MS. GODFREY: Yes, we have Jane Garcia. Ms. Garcia, please come be sworn.
WHEREUPON,
JANE GARCIA,
being first duly sworn,
was examined and testified
as follows:
DIRECT EXAMINATION BY MS. GODFREY:
QCould you state your name for the record, please?
AJane Garcia.
QAnd, Ms. Garcia, I'm going to be using the notebook that's to your left there, the big one there. And if you could turn to Exhibit 2 in that notebook, is that the copy of your CV?
AYes, it is.
QOkay. And are you ‑- where are you currently employed?
AOver at Advanced Concepts in Medicine with Dr. Buttar.
QHow long have you worked there?
ASince September of '03.
QAnd what is your training?
AMy training is ‑- from the very beginning?
QFrom ‑- from post-high school, yes.
AOkay. I'm a registered nurse. I attended the first associate degree program at Central Piedmont College at Charlotte Memorial Hospital in 1965 and 1967, so that that makes me an old nurse, so to speak.
And then I went to the University of North Carolina at Greensboro in 1979 and '80 because AGW gave a grant to them for three one-year tracks in occupation -- for occupational nurse practitioners. At that time I worked for Burlington Industries when Burlington Industries was an important factor in textiles in the state of North Carolina. And there were probably like 120 occupational health nurses and I received a degree from this program.
QAnd did you obtain a degree in the nurse practitioner's program?
AYes, I did.
QAnd what is the nature of that degree?
AThe nature of the degree is occupational health. And when I sat for my certification there was no other certifications other than being a certified patient health nurse. For a practitioner, I saw for the national certification for nurse practitioners.
QAnd when did you sit for that certification?
A1981 and 1982 because at that time I transferred to Mississippi with Burlington Industries and it was a requirement in the state of Mississippi to be nationally certified. At that time it wasn't a requirement in North Carolina.
QAnd did you continue to work in the occupational health field?
AI did for a short time and then my former husband was in law school in Michigan and I went to Michigan and I worked with Ingham Otolaryngology.
QAnd how long did you work with the ‑-
AFor about a year. For about a year.
QAnd that was from '82 to '83?
AYes, it is.
QAnd following ‑- following that ‑-
AFollowing that we moved to south Florida for my husband's law practice and I started to work for a medical management company that were emergency physicians. At that time, it was a private group and then it became a public group and then ‑- which was under the name Impotent Medical Management. And then we were sold and it became American Services Group. But during that time, I spent 20 years with that company, both private and public.
QOkay. And during that 20 year period and I guess that's from 1983 ‑-
A'83 ‑-
Q‑- to ‑- to 2002?
AYes.
QWhat positions did you hold with the company ‑- with the medical management company?
AOkay. Initially I worked as a nurse practitioner with a collaborative relationship, was hospital based internists.
At that time, I don't know if you remember there was an HMO in South Carolina which was called Gold Plus and it later became Humana. It was for ‑- I can't recall the first name, but then it became Humana. And at that time, that was a hospital where they referred all there patients from their HMO clinics. And our company had been hired to set up a group of nurse practitioners and hospital based internists to do the hospital folks inside that took care of their patients from the HMO.
QAnd then did you advance through the ‑- through the company until ‑- what was your position in 2000 ‑- in 1998 to 2001?
AI'll do that, but can I also add something there, that I forgot to add the first time?
QI was going to ask you about the ‑- that. I'm sorry.
AThe oncology.
QOkay, I'm sorry.
AYeah. During that time in the hospital, I worked as a ‑- in the hospital and we also worked with oncologists and they wanted to have an oncology nurse practitioner. Of course, I was not trained as an oncology nurse practitioner, but they had worked with me and they said we want to train you. So I went to the University of South Florida and took some courses in oncology and I worked with those oncologists.
QAnd that was 1983 to 1987?
AYeah, '87, yes.
QThen did you advance through the company to ‑-
AYes, I did.
Q‑- okay, of an administrative position?
AYes. I became the manager of physician recruitment for the physicians.
QOkay. Now, during the period starting 1987 through the time that you left the medical management company, how did you maintain your clinical skills?
AWell, we also had the contract with the Broward County Sexual Assault Treatment Center. Prior to that, gynecologists were doing the rape exams and the nurse practitioners -- we got that contract and we started doing the rape exams. And I kept very active in doing rape exams throughout that time.
QAnd ‑- and on estimate, how many hours a week would you work at ‑-
AAt least eight hours. I always did at least eight hours to keep my certification.
And also during this time, I was director of nurses for a military services contract. That's the time there was privatization with the military bases, primarily the Navy, to bring in outside physicians and groups to manage their emergency departments and their ‑- their clinics. And we set up an employee based certification that was required more for physicians and for ‑- well, initial blood work and that sort of thing and I oversaw that.
QAnd that was part of your clinical ‑-
ARight. All of that work came into my office, yes.
QNow, in 2002 or 2003 did you leave south Florida?
AYes, I did.
QAnd where did you move to?
AI moved back here to North Carolina.
QAnd since 2003 where have you been employed?
AI've worked with Dr. Buttar.
QAnd what's been your position with Dr. Buttar?
AI've been a nurse practitioner.
QAnd as a nurse practitioner how did you become familiar with integrative medicine?
AEverything I know about integrative medicine, Dr. Buttar has taught me, except for one thing that I would say I did integrative medicine for myself.
When I became that age of maturity where people thought that you needed to be on hormones when you're going through menopause and that sort of thing, I did not go the traditional route. There was an integrative medicine book that I read and I treated myself at that regard by not doing that type of thing. But everything else that I know of integrative medicine Dr. Buttar has taught me.
QAnd do you have with Dr. Buttar a Collaborative Practice Agreement?
AYes, I do.
QAnd I believe that's our Exhibit 5; is that correct? That was identified in Dr. Buttar's testimony.
AYes, uh-huh (yes).
QAnd do you and Dr. Buttar update that Collaborative Practice Agreement on a yearly basis?
AWell, we review it and update it if it needs to be, yes.
QAnd what is the scope of practice that you have under your agreement with Dr. Buttar?
AWell, my scope of practice is really under the agreement of the North Carolina Board of Nursing and with the Medical Board as ‑- because I am certified as a nurse practitioner.
QOkay.
AHowever, in our practice, we treat heavy metal toxicity and I follow that protocol for adults and children. I do not treat children for private care or well baby checks or anything in that regard. The same as when I worked the otolaryngologist. He had had a family nurse practitioner who did not work out, but because he had not trained that person to look at the ear as a specialist would, but he did train me in that regard and I did see children and adolescence before he did surgery on them and then afterwards.
Because in nurse practitioner training I was taught if you don't know the answer, you don't -- (inaudible) -- and if you work with a physician in a collaborative practice, you can be taught by that physician.
QAnd does your Collaborative Practice Agreement list the types of drugs and devices that you ‑-
AYes.
Q‑- can prescribe?
AYes.
QAnd do you ‑- do you in your practice with Dr. Buttar stay within those limits?
AYes. I do not prescribe controlled drugs. I could get a DEA, but I chose not to, so that is not in my scope of practice.
QDescribe your working relationship with Dr. Buttar.
AOkay. My working relationship with Dr. Buttar is this. When I work with a physician, I have to believe in what they're doing. And when I came to work with him, initially we had a love-hate relationship and that doesn't mean bad that it was a love-hate relationship in that regard.
It was just that when he was in the room seeing a patient and we were on a schedule, you know, I tried to stay on schedule. And one thing that I liked about our practice is I have been an administrator in a medical management company and even set up guidelines that our PAs and nurse practitioners and physicians in other clinics should see so many patients an hour.
In our practice with Dr. Buttar, we schedule at least one hour for a patient visit and that to me is very good because we have the time to sit down and really listen to the patient. I think a lot of times in healthcare we don't listen to patients. We go in with an idea of a cookbook or whatever, they tell us one thing and then we write a prescription and that's what we do.
Sometimes I would get aggravated with him if we have a patient and we're supposed to see another patient in an hour, we might be in there for two hours. And that's what I meant because I'm a pretty rigid person and if I've got an appointment in hour, I make sure I see that.
QDid you and Dr. Buttar work out that problem ‑-
AYes, we did.
Q‑- between you?
AYes, we did.
QAnd as you progressed in his practice, did you begin to see patients on your own ‑-
AYes
Q‑- and not just with Dr. Buttar?
AYes, yes.
QAnd is that the way you practice today?
AYes, yes.
QIn your experience with Dr. Buttar, does he review your charts on a regular basis?
AYes, he does and we have a weekly meeting that we review the patients that I have seen for that week. If I needed him for, you know, a consultation or if I was having a question or needed him with a patient, I could see him any of that time or call him.
But as my understanding as a nurse practitioner, that's why there were nurse practitioner programs that nurse practitioners and PAs are extenders of those physicians and the physician doesn't have to see the patient every time the nurse practitioner does or co-sign the chart every time the nurse practitioner sees a patient other than that first six months when they're working with a new provider.
QAnd in your ‑- in your experience, is there any limit on the types of patients that you see or do you see all patients in the practice?
AI see all patients in the practice.
QAnd is there any patient that you don't intake?
ANo.
QAnd so you've worked both with cancer patients and other patients in ‑-
AYes, yes.
QWell, I'm going to direct your attention to Patient A and ask you to turn to Exhibit 9 in the book. Did you do the intake on Patient A?
AYes, I did.
QAnd just ‑- we've been through the medical records. What I'd like you to do though is tell ‑- tell the Board your recollections of Patient A and what you understood about her situation on this patient when you first met her.
AWell, when the patient came initially she came with her daughter and her husband. And this ‑- this lady was 49 years old and her daughter is in her 20s. And you could tell they were a very close knit family and this was a horrible time for them. And they were a very concerned family and wanted to do whatever they could do and I know that this lady had a strong will to live.
QAnd after you did the intake on ‑- on Patient A, did you consult with Dr. Buttar?
AYes, I did.
QAnd was a treatment plan developed for Patient A?
AYes.
QAnd did that involve some ‑- some testing?
AYes, it did.
QWhat kind of testing did Dr. Buttar order to develop a treatment plan on this patient?
AWell, normally when I see a new patient, we do the initial visit which is the consult to review their history and to ask them of any history or anything that they bring with them.
And then we go to develop a plan. Before we start treatment, there's initial blood work that we do. There is initial testing that we do to look at the GI tract -- (inaudible) -- analysis. We do a physical and we do an EKG.
QAnd as a result of those tests, was a treatment plan determined for this patient?
AYes.
QAnd ‑- and what the treatment plan?
AOkay. We have an established treatment plan which is to help to build up the immune system in cancer patients.
QAnd is that implemented ‑-
AAnd it's a guideline. It doesn't mean that this patient gets this ‑- this much. We have a treatment plan to detoxify the body and to treat the patient.
QAnd is that what was implemented with Patient A?
AYes.
QDid ‑- did you see Patient A on a regular basis?
AYes.
QAnd what did you notice about her problems?
AWell, initially when I saw her, I noted ‑- I think our initial visit, she did have some jaundice, okay. And for the first several weeks, she started feeling better because she had -- and I think it's in my notes that she had reduced her pain medication, but then she did have to increase it later on in her treatment.
But as she progressed and the fact that her jaundice continued and she started developing abdominal pressure and distension which we sent her to the gastroenterologist to evaluate her for any blockage. She ‑- she started going downhill.
QAnd was there ‑- was there a period of time when you and Dr. Buttar were concerned about her continuing treatment?
AYes. I think it was after she had seen Dr. Clements, the gastroenterologist. And as a matter of fact, Dr. Buttar and I spoke with her about it. And I think that's documented in the charts, Dr. Buttar's note on 8/14.
QOkay. That would be page C7?
AYes.
QAnd were you present ‑-
AC7A, yeah.
QWere you present for that meeting as well?
AYes, yes.
QAnd what was discussed, if you recall?
AWell, the results of the consultation with Dr. Clements, that she was not improving and ‑- but the daughter said that her mother did not want to give up hope and wanted to continue.
QAnd what did you and Dr. Buttar do as a result of that request?
AWe needed to do a treatment plan.
QAnd then ‑- and this patient died a few days after that?
AThat was the 14th. I believe it was that following weekend.
QAnd did you continue to monitor her treatment?
AYes.
QAnd ‑- and continue ‑- and did Dr. Buttar continue monitor her treatment?
AYes.
QOkay. With regard to Patient B, that's Exhibit 13, and whose notes are they, the first page, the intake sheet for this patient?
AThey're my notes.
QAnd tell us what you recall about Patient B.
AWell, she came in and I thought she was with her husband, but it was her fiancee because I always document who is in with the visit when we see the patient ‑- when I see the patient.
And she was coming to us I think from Rutherfordton, North Carolina, that area. And she had been treated ‑- yeah, she had surgery for ovarian cancer in August '02 and she was coming to be treated by us April of '04.
QAnd do you happen to know who referred her for treatment?
AHer family physician.
QAnd I believe we've discussed there was some ‑- some better results in her lab work. What did you notice about the patient as she ‑- as she started treatment?
AOkay. She was a slightly quiet lady. When you talked with her and went over the plan as far as what she should do, as far as there's something ‑- some procedures we would like for them to do like the castor oil liver packs, they help detoxify the liver and -- and when I would see her I would always go over what we had recommended, to ask her of her compliance if she was doing that and she did not do that.
Also, based upon one lab test, the comprehensive diagnostic stool analysis would show she had -- (inaudible) -- and it was recommended the sensitivity of the bacteria for her to be treated with Cipro. And I had seen her and then the following office visit, I asked her if she was on it and she said she wasn't, she had not filled the prescription, but it is documented that that ‑- one of our staff was in the room with me that I had given her the prescription. So she was there, but she didn't always follow through with what we asked her to do. She was non-compliant.
QAnd did you discuss that ‑- that problem with Dr. Buttar?
AYes.
QAnd what was the ‑- was there a period of time when you all tried to work with her on the compliance?
AYes.
QOkay.
AAt each visit I would always go over everything that we recommended and stressed the importance of everything.
QDid there come a point when you and Dr. Buttar determined that a change in plan needed to be made with regard to this patient?
AYes, it was. Yes.
QAnd what was that change?
AThat she was discharged from the practice for noncompliance.
QAnd when ‑- when that happened, did you document it in a note?
AI didn't document it in a note. I documented it on the last visit or it really wasn't a visit, this was the day that she was discharged. I think that's ‑- that's the last note, it's C8.
QC8?
AUh-huh (yes).
QOkay. And that note is on what date?
AThat note is on ‑- I don't think I see a date on this, on my copy.
QIt may have been taken off when the ‑- when the thing was redacted, I'm not sure.
AYes, because here is the last ‑- second to the last paragraph of my note, date of the option to see this physician at Lake Norman Regional Medical Center or go back to her family physician by Dr. Theresa Romzick. And she ‑- I had her ‑- I wrote down her office number and she said she wanted to go back to her family physician.
And I called Dr. Romzick and discussed the patient with her and she was to see the doctor as soon as she could get to that office and I sent her latest blood work with her.
QAnd did ‑- did you continue to follow the patient until she as back under the care of Dr. Romzick?
AWell ‑- well, she was to see the physician that day.
QOkay. Oh, so that was the day ‑-
ARight, right. Uh-huh (yes). My note says, patient to see physician as soon as we could get to the ‑- as she could get to the office, so that was that day, but this was in the morning, so she was going directly there.
QAll right. Now, with regard to ‑- now, on Patient C, that's Exhibit 18. Whose notes are in the ‑- on the intake for this patient?
ADr. Buttar's.
QAnd were you involved with this patient's care?
AYes, uh-huh (yes).
QAnd what do you recall about this patient?
AI thought he was a young man. I don't ‑- yeah, I see he was a young man, 43 years old. He had a strong will to live and he was always very compliant. And I do not recall ever seeing anyone come with him to any of his office visits.
QTo your knowledge, did he leave the practice on good terms?
AYes.
QNow, with regard to Patient D, that's the non-cancer patient and I believe her office notes are at Exhibit 23.
AOkay.
QDid anyone besides you see this patient on ‑- as a prescriber of treatment?
ANo.
QAnd what did this patient come to the office with?
AWell, she came here for the ‑- came to our office for evaluation of heavy metal toxicity.
QAnd was that something that she reported to you in the first visit?
AYes.
QDid it appear she had had lab work done elsewhere?
AA previous challenge, is what we call that.
QOkay. But she came to be evaluated for heavy metal toxicity?
AShe ‑- she came to be evaluated for heavy metal toxicity and she had also had a history of constipation.
QOkay. Now, did you ever diagnose this patient with heavy metal constipation?
ANo, there is no such thing.
QAnd did you order a urine metal test that ‑- or I guess we've been calling it a challenge test.
AYes.
QAnd is that ‑- are those notes in ‑- or is that lab work in Exhibit 24?
AYeah. That was only ordered after she had had the physical and had her lab work, EKG and bone mass density because we don't order this until they've had their physical done.
QOkay. And then at the time ‑- once the results came back from the challenge test, what was determined as far as her heavy metal levels?
AWell, if you look at Exhibit 24 and you look at the test results, her levels of lead were 12 micrograms per gram of kilo ‑- of creatinine and her mercury was 5.4. And the reference range for lead is 5 and for mercury it's 4. Nickel was 14, the reference range is 12. And the reference range for tin is 10 and it was 9.8. She did have heavy metal toxicity.
QAnd based on those labs did you initiate some treatment for the ‑-
AYes.
QAnd what treatment did you initiate?
ATo alternate IVs of EDTA specifically for lead and cadmium and DMPS for mercury and the other metals.
QAnd to your knowledge, was this a compliant patient?
AShe was compliant up to ‑- well, I saw her one additional time and let me get to that note.
QThe private sets would be in 23.
AOkay. I saw her initially 12/6 and then I saw her for a follow-up visit and at that visit is when we go over some of the tests like diagnostic and the previous challenge and she had had three IV treatments and at that point she had been compliant.
QAnd then at some point was this patient discharged from the practice?
AYes, she was.
QAnd what was the reason that this patient was discharged from the practice?
AWell, if you look at the progress notes, I saw her on January the 17th of '06 and then a month later she called telling us she was having problems and then further on the note she was upset because she had not seen Dr. Buttar.
And that was the first time I had any knowledge of it because when we saw ‑- when I saw her on the 17th of January, her subjective reports to me was that she had noticed she had more energy and had less constipation, had been taking her supplements as prescribed, had lost two pounds and that was one of her goals, she wanted to lose weight.
And the only thing she had not done is started our GI liver detox program that we had recommended.
QLook if you would at Exhibit 25.
AOkay.
QIs this ‑- and I'll represent to you that this is a letter written by Tasha Claridge to ‑-
AYes.
QWhat is your memory about why Patient D left the practice?
AWell, later on I was told that she had tried to use ‑- she used a credit card to pay the payment and then tried to take the credit card back and that whole issue. I don't really get involved in that, so I don't keep up with those details.
QBut you were aware that she was ‑-
AI was aware, yes.
Q‑- she was discharged from the practice for ‑- for non-payment or for reversing the credit card charge?
AYes.
QJust tell the Board briefly in your own words what your observation is in general of the practice of Dr. Buttar in how he treats patients, how he interacts with patients.
AI have worked with a lot of physicians over my span as a nurse and as a nurse practitioner. Dr. Buttar is very conscientious. He spends time with a patient. He has a tremendous gift. He's an intelligent man. He is a excellent teacher. His lectures are very good and his true gift is seeing patients.
And he has a sense or an ability to look at the physiology of a patient ‑- not of a patient, but of a body and that's how our approach is to treating patients.
When I started working with him, I worked with him for about a month because, you know, when you develop a collaborative relationship with a physician, part of it is to see if the physician wants to work with you, but part of it as a nurse practitioner is to see if you want to work with that physician as well.
And I have a step-grandson who had been diagnosed with autism and I had never seen any treatment for heavy metal toxicity in children with autism. As a result of that, I had my step-grandson come and be treated by Dr. Buttar.
Anyone who has ever gone through that or have any relatives that have had to deal with a child that is not what you thought that child was going to be or have developmental delays particularly after when that child did not have any up to a certain point of time, that's very traumatic for everyone.
And you have to have a lot of trust in an individual to look at treating a child from a non-traditional way when other people have said they might be mentally retarded or they have some severe developmental delays.
We treated my grandson, he has made a lot of progress. He also has treated my daughter just from a preventative perspective and has treated my mother. And as a result, my daughter had her first child and he's three months old today and he has not had any vaccines and he is starting his life being as clean as you possibly can be and not having anything to help compromise his immune system.
MS. GODFREY: That's all.
CROSS-EXAMINATION BY MR. JIMISON:
QThank you for coming, Ms. Garcia. Do you have your CV in front of you?
AYes.
QAnd isn't it true that you have no formal training in oncology as a nurse practitioner?
AIn what regard do you call formal training?
QYou're not an oncologist nurse practitioner?
DR. WALKER: Microphone please.
MR. JIMISON: Oh, I'm sorry.
QYou're not an oncologist nurse practitioner, are you?
ANo. But I worked as an oncology nurse practitioner and I have training in oncology. I've never taken the certification as an oncology nurse practitioner.
QAnd under the rules of the Medical Board and the Nursing Board, a nurse practitioner can only practice within her certification?
AYes.
QAnd your certification is as an adult nurse practitioner, correct?
AYes.
QAnd there's actually a thing called a pediatric nurse practitioner, is there not?
AYes.
QAnd you're not certified as a pediatric nurse practitioner, are you?
ANo, I'm not a pediatric nurse practitioner?
QAnd during the two days you have been here, you heard the mother of Patient D testify?
AYes.
QAnd that patient's mother basically consulted with you over the telephone, correct?
AYes.
QAbout her child that had autism?
AYes.
QAnd you sent her materials, transdermal chelation agents and ‑- and self-testing kit to her initially, correct, your office?
AYes, our office did, yes.
QOkay. At no time did your office ever personally see that child, correct?
AYes, we did.
QPrior to sending those materials?
ANo.
QOkay. At some point, she came down later, like four months later, correct?
AYes.
QSo it would be fair to say that the materials were sent to her to start the treatment of chelation therapy and the self-testing prior to your office personally seeing the child?
AYes, but we take an intake form on any child that we ‑- any phone consult that we do.
QWell, under your view, it's good medical practice to begin treating a child for severe autism without first seeing the child?
AWe did the intake form. The parents fill out a detailed history on the intake form.
QSo it is good medical practice to do that?
AWe're not treating the child for autism, we're not treating autism, we're treating the heavy metal toxicology ‑- toxicity. There happens to be a protocol for children.
QAnd with metal toxicity, it's okay to begin treatment of the child for metal toxicity without seeing the child first?
AWe always like to see the child, but because of the distance, we did not.
QYou could have just refused, could you not, to sent them materials until you saw the child?
AWell, at that time, there's been such a backlog for patients being seen that we did agree to do some phone consults.
QOkay. And sort of instruct the mother on how she could self-treat her child?
AWell, there are detailed instructions that are given.
QWhen Patient A ‑- when Patient A first met ‑- came in the office, she didn't see Dr. Buttar, correct?
APatient A?
QPatient A.
AI saw her initially.
QBut Dr. Buttar was not there, correct?
AA lot of times Dr. Buttar comes in when I'm seeing a patient and he's seeing another patient. We did discuss the plan. I did go over the plan with Dr. Buttar.
QAnd if you could turn to -- in the big notebook.
AOkay.
QIt's the Medical Board's big notebook, I believe.
AThis ‑- this ‑-
QYes.
AOkay.
QTab 4 and page 95.
MS. GODFREY: That's not the Medical Board notebook.
MR. JIMISON: I'm sorry.
MS. GODFREY: I think it's not that notebook.
WITNESS: This one?
MR. JIMISON: No, that's not it.
MS. GODFREY: It's right there behind her.
MR. JIMISON: Oh, it's like on the chair.
MS. GODFREY: Here, I have it.
WITNESS: Okay.
MR. JIMISON: There you go.
Q(By Mr. Jimison) On page 95, that's ‑- is that the initial visit?
AIs there a section or just by pages?
QTab 4 in that. Tab 4 and then you can see the page numbering at the bottom.
AAnd what page did you say?
Q95. And if we can flip over to 96. Okay. This is your note, correct?
AYes, it is.
QOkay. And that last line, you actually note that the husband is this person and the daughter is this person?
AYes, uh-huh (yes).
QOkay. And ‑- and ‑-
AOh, yeah, the last line I wrote their names, so when I communicate with them I can call them by name.
QAnd you did a impression, that's kind of a quarter of the way up and your impression is metastatic cervical cancer, correct?
AYes. And that's metastasized.
QAnd there's a metastasized to liver and heart.
AUh-huh (yes).
QAssessment and plan, patient to let us know if wants to follow with ‑- is that cancer plan?
AYes.
QSo you had a conversation with Patient A and her family?
AYes, I did.
QAnd what did you say in that conversation with her?
AWell, they came to us looking for treatment to help her mother, okay.
QWith her cancer?
ABut that was her underlying issue was cancer, yes. And I explained to her what we do as far as cleaning up her immune system and her body to help make break the cancer itself.
QSo you didn't tell them you treat cancer, you just told them you treated the immune system?
AYes, that's our approach, yes. To detoxify the body and to build up the ‑- enhance the immune system.
QAnd ‑- and your note says, patient to let us know, wants to follow ‑- and this is your handwriting, correct?
AYes, it is.
Q‑- with cancer plan?
APatient to let us know if wants to proceed with cancer plans, correct.
QIt doesn't say immune building plan, does it?
ANo, it doesn't.
QIt doesn't say heavy metal detoxification plan, does it?
AWell, that's part of it.
QIt says cancer plan.
AYes, it is written there.
MR. JIMISON: Thank you, ma'am.
REDIRECT EXAMINATION BY MS. GODFREY:
QJust a little follow-up. Ms. Garcia, with regard to Patient D that Mr. Jimison asked you about, was any ‑- were any medications sent to Patient D's parents prior to doing labs or getting labs?
AOn any patient we don't ‑- I'm sorry, we don't treat any patient prior to doing elementary lab work, standard lab which will be other tests. We don't do anything until we ‑- because our rule in our office is to do no harm.
QSo when ‑-
AAnd how can you treat someone if you don't do anything, do any preliminary testing and we can see where the body's problems are.
QAnd so ‑- I know you don't have the record in front of you, but to your recollection and to your way of practicing, were ‑- were labs done to determine what types of problems or manifests for Patient D?
AWell, the labs were done primarily to look and see what the child's kidney function is because she did not ‑- we would not start anything without knowing the kidney function, that's very important. Also to look at liver function studies and also to look a iron levels.
QAnd once those are determined the ‑- the treatment is sent to the parents, correct?
AYes.
QAnd what kind of treatment is it? What ‑- what's ‑- how is it administered?
ATransdermally. Transdermally is you put it on the skin and rub it in.
QAnd that's the only type of treatment that this patient was administered prior to coming to North Carolina?
AAlso recommended some minerals and vitamins and some -- (inaudible).
QAnd then was ‑- when the patient ‑- when the appointment was made for her to come North Carolina to review all those things, did you ‑- did you have further lab work done?
AYes. The lab work and other tests is done on a regular basis.
QAnd when patients come from out-of-state, is there an effort made to try to ‑- to try to schedule with Dr. Buttar?
AIf they want to see Dr. Buttar, they do. And if they don't, they see me and I try to bring Dr. Buttar in the room. He always tries to come in to see the patient.
MS. GODFREY: That's all I have.
PRESIDENT RHYNE: Do you ‑- did you want to recross, Mr. Jimison?
MR. JIMISON: No, ma'am.
PRESIDENT RHYNE: Okay. Are there any Board questions? Go ahead.
EXAMINATION BY THE PANEL MEMBERS:
DR. McCULLOCH: Thanks for being here, Ms. Garcia.
WITNESS: You're welcome.
DR. McCULLOCH: I'm going to ask you perhaps a few questions that are difficult to answer. I don't think you're a bad person, they're just difficult questions and they may not be that hard. With respect to this transdermal ‑-
WITNESS: COPS.
DR. McCULLOCH: ‑- are you aware of the efficacy of this treatment?
WITNESS: Yeah.
DR. McCULLOCH: It works?
WITNESS: It works.
DR. McCULLOCH: Studies?
WITNESS: I'm not aware of studies, but I see the result we see in patients.
DR. McCULLOCH: Now, did you send that treatment along with the test kit?
WITNESS: That's sent from our office.
DR. McCULLOCH: At the same time?
WITNESS: No.
DR. McCULLOCH: No?
WITNESS: No, it's not ‑- that's not sent until after the tests are done and we look at the tests and everything is okay. That's never sent out until we ‑- we know kidney function, iron levels, that sort of thing.
DR. McCULLOCH: Okay.
WITNESS: Never.
DR. McCULLOCH: But this patient was sent the treatment without having been seen by anybody in your office; is that correct?
WITNESS: Yes.
DR. McCULLOCH: I recall ‑- I'm going to ask you this because you may know, somebody -- I think it might have been done a videotape, I think it was a videotaped deposition -- something about someone being instructed on how to give a vaccination to someone at home. Have you ever done that?
WITNESS: No.
DR. McCULLOCH: I didn't make that up.
MR. KNOX: I'm not sure.
WITNESS: I don't give vaccinations. I wouldn't instruct on that.
DR. McCULLOCH: I need some chelation.
MR. KNOX: You'll have to talk to the doctor afterward.
DR. McCULLOCH: All right. Now ‑-
WITNESS: But there are things we have to do beforehand.
DR. McCULLOCH: Okay. What percentage of patients that come for treatment receive chelation therapy, roughly?
WITNESS: I big portion of them.
DR. McCULLOCH: A 100 percent?
WITNESS: 98 maybe, but a big portion of our patients.
DR. McCULLOCH: So every patient that comes to you ‑- through your door has heavy metal toxicity?
WITNESS: They're evaluated for that.
DR. McCULLOCH: Every patient is treated for it, so everyone must have it?
WITNESS: Well, I can't recall ‑- no, I have seen ‑-
DR. McCULLOCH: Virtually everybody?
WITNESS: A lot of people do, yes.
DR. McCULLOCH: Have you been treated?
WITNESS: Yes, I have.
DR. McCULLOCH: I figured so. Does that seem unusual to you that 100 percent of the patients that come through your door would have a particular condition?
WITNESS: Well, when we look at what we are doing in our environment. What are we doing with toxic waste? What are we doing with pollutants? Where is that going? It goes in our water supply, it goes in foods we eat and what do we do, we ingest that.
DR. McCULLOCH: So it does not seem unusual?
WITNESS: It doesn't. It would have seemed unusual to me six years ago, but not today. I mean, my daughter is 35 years old, we tested her. She had some not severe, but she's young, so she did that from a preventive perspective. I have high levels of lead. I made a joke out it after I got a speeding ticket, so they said you had a lead foot. I said, well, I guess I do. That's just a joke, but, yes.
I mean, if you think about it and what we've done in our environment, what do we do in our environment to make sure we detoxified it or to take care of ourselves? What do we do with processed foods?
DR. McCULLOCH: That's all I have.
DR. WALKER: Ms. Garcia?
WITNESS: Yes, sir.
DR. WALKER: Let me follow-up on one point that Dr. McCulloch raised.
WITNESS: Yes, sir.
DR. WALKER: Do you know what the medical practice laws are in Michigan?
WITNESS: No. I was a nurse practitioner and lived in Michigan at one time.
DR. WALKER: Would you consider prescribing transdermal chelation therapy a form of medical practice?
WITNESS: Yes, it could be. I've don't -- I haven't thought about it.
DR. WALKER: Did ‑- did it occur to you that perhaps it would be wise to check the regulations in the state of Michigan before you started practicing medicine across state lines in a state that ‑- are you currently licensed in Michigan?
WITNESS: No, I'm not, sir.
DR. WALKER: Did that thought of ‑- is that ‑- is that a consideration when you all were taking telephone consults?
WITNESS: It hasn't been.
DR. WALKER: Let me go over a few points of the medical records of the patients that you have helped take care of.
WITNESS: Yes, sir.
DR. WALKER: And I echo Dr. McCulloch's remarks, I don't mean to be argumentative, I'm just trying to sort of establish what's in the record versus what you said. And correct me if I misstate what you have said.
WITNESS: Yes, sir.
DR. WALKER: At one point you said that before your patients receive any treatment they have a history and physical and laboratories; is that correct?
WITNESS: And an office visit for adults, yes sir.
DR. WALKER: Well, and when you said that I was intrigued because when I read the notes on Patient A, Patient A came in, according to your notes, on July 20th and you went through the history and you had your discussions and then you started the patients on multiple supplements or substances. There was no physical exam done on that day according your note.
WITNESS: Well, we start ‑- we give them the supplements, but they don't start them until after they've collected the comprehensive diagnostic stool analysis and we do the physical on them.
DR. WALKER: Okay. Your second note was 7/24/06 and the top of the note was, here for physical slash BMD slash EKG, feels fine, okay.
And then when I read your note, you report on the effects of the supplements, you report labs, but there's no physical exam, though.
WITNESS: May I leaf through here?
DR. WALKER: Sure. You can look in ‑-
WITNESS: At which book? I mean, I have ‑-
DR. WALKER: ‑- in your ‑- Dr. Buttar's book, it's on ‑-
WITNESS: Okay.
MS. GODFREY: I don't think you'll find it in our book. You have to select --
DR. WALKER: Well, actually is this your book?
MS. GODFREY: Yes.
DR. WALKER: It's under Tab 9.
MS. GODFREY: Right, but the physical exam, I don't think is under Tab 9. I'm glad to hand that ‑-
DR. WALKER: Well, are you stating that some of the physical exams were included and some are not?
MS. GODFREY: Well, I put the progress notes and I think the physical exam is in a different section.
DR. WALKER: Well, in reviewing the records, there were ‑- there was one occasion of a physical exam by Dr. Buttar on your form and was very thorough. And then there were notes in your progress notes of physical exams later on, so I was ‑-
WITNESS: His visits --
DR. WALKER: Pardon me?
WITNESS: With all his visits ‑-
DR. WALKER: Correct, right.
WITNESS: ‑- the exam, not as extensive because we did an exam.
DR. WALKER: Right. So I guess is ‑- is what counsel is saying is that y'all gave us incomplete records there.
MS. GODFREY: No. What I'm saying is that I ‑- that Mr. Jimison gave you a complete set of the records. I was trying to not duplicate what he was doing. And indeed in the records and this is D5A there is a physical exam of this patient.
The problem and I apologize to the Board, Mr. Jimison and I, we coordinated ahead of time, but we did not. Of course, he didn't ask me about his exhibits and I didn't ask him about mine.
But in the ‑- in the complete record there is ‑- and I can't find it, I can't locate it for you in Mr. Jimison's, but I can show you a complete record that at B5A in our records, there is a physical exam on 7/24/06 of this patient.
DR. WALKER: Okay. So in other words, it wasn't real clear from what I reviewed.
MS. GODFREY: And I apologize for that, Dr. Walker. That ‑- that is definitely my fault.
MR. JIMISON: If you look to Tab 4 in the Medical Board's, the complete record I believe is page 92.
MS. GODFREY: Is it page 92?
DR. WALKER: You're exactly right and I apologize for bringing up an issue which was apparently not the case because of the record review I did.
WITNESS: That's okay. I knew there was a physical note, so just locating it.
DR. WALKER: Well, I have no other questions.
PRESIDENT RHYNE: I need ‑- and thank you, by the way, for being here, Ms. Garcia.
You said something and I just didn't hear all of it. You said that and it had to do with Patient B and you said the stool showed something and you gave them Cipro.
WITNESS: Dysbiotic flora.
PRESIDENT RHYNE: Can you tell me what dysbiotic flora is?
WITNESS: Dysbiotic is ‑- well, we explain it to patients that it's bad bacteria. It's bacteria that is not good bacteria that can create problems in the gut.
PRESIDENT RHYNE: Can I see that lab test?
WITNESS: Sure.
PRESIDENT RHYNE: Because ‑- go ahead.
WITNESS: And we've got tests that also gives you a sensitivity of what the bacteria is sensitive to and Cipro was for that -- one of those.
PRESIDENT RHYNE: Yeah, I would just like to see that ‑-
WITNESS: Sure.
PRESIDENT RHYNE: ‑- because generally even with, you know, with many infectious diarrheas, you don't even want to treat them with antibiotics, they're self limited. The more antibiotics you give, the more you're giving the antibiotics that --
WITNESS: And at the same time we give them good antibiotics as well.
PRESIDENT RHYNE: ‑- clear the good bacteria out of your gut.
WITNESS: Well, that's one reason sometimes they have dysbiotic flora is they don't have enough good bacteria ‑-
PRESIDENT RHYNE: Right.
WITNESS: ‑- so we treat that as well. Let me find that.
PRESIDENT RHYNE: And ‑- and then the antibiotics tend to make it worse and that is why ‑-
WITNESS: This is B, Patient B we're talking about?
PRESIDENT RHYNE: Yeah. You had testified of Patient B.
WITNESS: Yes, it's B.
PRESIDENT RHYNE: Now, actually, I was looking in your book, I wasn't looking in the Medical Board book, so it may be ‑-
WITNESS: Is this our ‑- this is --
MR. JIMISON: Yeah.
PRESIDENT RHYNE: I'll tell you what, Dr. Walker will look for it while I go ahead.
MR. JIMISON: I guess it's a little confusing.
WITNESS: It's F1 in the resource I'm looking at.
MR. JIMISON: That's your notebook --
WITNESS: Okay.
MS. GODFREY: Right. It's a non-redacted, but she can ‑-
MR. JIMISON: But just to clarify this entire issue, what was decided was the Medical Board book for Patients A through D to be the medical records. Those are in the big thick book.
DR. McCULLOCH: So we have those?
MR. JIMISON: Yeah. And they're actually in alphabetical order unfortunately and not correlated, so Patient ‑- which one are you looking for?
PRESIDENT RHYNE: It's Patient B.
MR. JIMISON: Patient B would be Tab 3.
PRESIDENT RHYNE: Tab 3, okay.
DR. McCULLOCH: I'll look, too.
MS. GODFREY: And the lab work which is in ‑-
PRESIDENT RHYNE: Oh, is that D, Patient ‑-
MS. GODFREY: Patient --
MR. KNOX: D was four.
MR. JIMISON: Yeah, they're in alphabetical order.
MR. KNOX: Patient B was two.
MR. JIMISON: By ‑- by their last name, they're in alphabetical order, so E is five.
PRESIDENT RHYNE: I see something that shows parasites.
WITNESS: It looks like this. Can you see that?
PRESIDENT RHYNE: And what is it -- oh, it says started parasite protocol. What is parasite protocol?
WITNESS: As reference to this or are you asking me another question?
PRESIDENT RHYNE: Yeah. On one of the other things it said started parasite protocol and what is your parasite protocol?
WITNESS: All right. It is a number of things to treat parasites. I can't tell it to you by memory.
Dr. Buttar Truth Quotes
“Whoever undertakes to set himself up as a judge of Truth and Knowledge is shipwrecked by the laughter of the gods.”
—- Albert Einstein
“Truth is generally the best vindication against slander.”
—- Abraham Lincoln
"All truth passes through 3 phases: First, it is ridiculed. Second, it is violently opposed, and Third, it is accepted as self-evident."
—- Arthur Schopenhauer
"There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success than to take the lead in the introduction of a new order of things because the innovator has for enemies all those who have done well under the old conditions and lukewarm defenders in those who may do well under the new."
—- Machiavelli, The Prince