NC Medical Board Dr. Rashid A. Buttar Transcript - Page 14 of 16
We use in ‑- don't use it on a regular basis, we have a treatment protocol for that.
PRESIDENT RHYNE: Even though this lab test for parasites, there's no parasites seen?
WITNESS: Well, that's based on the basis that there are parasites within cancerous tumors, within tumors and there is a Ph.D. ‑-
PRESIDENT RHYNE: Well, wait, whoa, whoa, whoa. Where did you get that from?
WITNESS: There is ‑- I can't recall the Ph.D.'s name. I would have to ask Dr. Buttar to comment on that, if that's okay.
PRESIDENT RHYNE: Okay. So ‑- so in other words, you're using Cipro to treat bacteria in the stool ‑-
WITNESS: The dysbiotic flora, the Cipro, yeah.
PRESIDENT RHYNE: Right. You would expect that's a normal finding of bacteria in the stool. Everybody's stool has bacteria.
WITNESS: Well, yeah, but this is three plus. The imbalance is for commensurable bacteria. The beneficial flora is of course the good bacteria and you want that to be higher. You see she has no bifidobacteria.
PRESIDENT RHYNE: Right, but she has four plus E. coli and three plus bifidocater.
WITNESS: Yeah, and that's good.
PRESIDENT RHYNE: Yeah.
WITNESS: And then if you look the last page under sensitivities, bacteria susceptibilities.
PRESIDENT RHYNE: Right. I see that, but as you know there again it's generally not recommended that you give antibiotics, all you do is deplete the good bacteria out of the stool. Okay.
Let me go on and ask you just two other questions ‑-
WITNESS: Certainly.
PRESIDENT RHYNE: ‑- and I'll be finished. What thing struck me ‑- has struck me today and that it seems like every patient ‑- this goes along with what they said, every patient we have got the challenge test has too much lead and too much mercury.
Isn't it a little strange to you that almost 100 percent of patient ‑- the same patients have the same things to show up in their labs.
WITNESS: They don't have the same levels and they are elevated levels.
PRESIDENT RHYNE: Yeah. Does it make you think that that's what you get if you did that test that everybody will have those elevated levels?
WITNESS: No. It's a specialized test ‑-
PRESIDENT RHYNE: It doesn't strike you as a little strange that a 100 percent of the patients have the same results?
WITNESS: No.
PRESIDENT RHYNE: Okay. And let me just go on then.
Throughout the day also you have said that some people have gotten vaccines and that vaccines are helpful and they stimulate the immune system. And in the e-mails ‑- I think we've heard that and certainly in this e-mail in your book, Patient B is saying he had two vaccines last weekend, one with salmonella and strep ‑- and strep bacteria.
MR. KNOX: That's an e-mail that he sent from Mexico where he was being treated back from this clinic where he was just telling what was happening to him in Mexico.
MS. GODFREY: Because that wasn't ‑- that wasn't ‑-
MR. KNOX: I maybe didn't make it clear.
PRESIDENT RHYNE: No, but Dr. Buttar had testified that he sent him down and he was glad he went to Mexico, that he had agreed with that treatment and had sent him down there.
MR. KNOX: I'm certainly not going to argue with you about what the evidence was, that he felt he had stress and he recommended to go to Mexico because he thought -- he goes to Mexico and one of the treatment they got, he e-mails one of the ‑- Nina back and tells her how he's doing and in that it says vaccines, but I don't think Dr. Buttar would prescribe that.
PRESIDENT RHYNE: Okay. Then ‑- then it's my misunderstanding. I understood Dr. Buttar to say he had actually agreed with the therapies down in Mexico and, in fact, had done some of the same therapies.
DR. BUTTAR: Do you want me to answer that?
PRESIDENT RHYNE: No, that's ‑- that's ‑- that's okay.
MR. KNOX: I'm sorry.
PRESIDENT RHYNE: Well, let's look again since they're talking about vaccines and you're saying something else about vaccines.
MR. KNOX: Okay.
PRESIDENT RHYNE: I'll withdraw that question. I don't have anything else. Thank you.
RECROSS EXAMINATION BY MR. JIMISON:
QI do have a question just based on ‑- I do believe from your direct testimony, Ms. Garcia, that a child had not gotten his vaccines, your step-grandson?
AMy ‑- my grandson.
QDo you advise children about getting ‑- or parents of children not getting vaccines?
AWe made that decision for my grandson.
QI mean, on other patients.
AThat's a ‑- that is a personal decision.
MR. JIMISON: Okay.
FURTHER EXAMINATION BY THE PANEL MEMBERS:
PRESIDENT RHYNE: I have one other question. Have you read the North Carolina Medical Board's policy?
WITNESS: Yes, ma'am.
PRESIDENT RHYNE: Okay. Thank you. That's all I have.
WITNESS: Okay.
MS. GODFREY: Okay. Thank you.
MR. JIMISON: At this ‑- do you want to add anything else.
MS. GODFREY: Yes. As long as we're sure on the record that we have all the exhibits in that we listed, I think we did ‑- I think we clarified that already and I think we said that there were some ‑-
MR. JIMISON: I think we've said that Number 3 and 50 was tendered, but not admitted.
MS. GODFREY: Right. And of the ones on our list, Exhibit 30 and 51 through 54 were not tendered.
MR. JIMISON: Those are just deposition transcripts.
MS. GODFREY: Those are deposition transcripts that were of witnesses that testified.
PRESIDENT RHYNE: Okay. Are we ready for closing arguments? Is there any ‑- any other ‑-
MR. JIMISON: We're ready, however, we have one rebuttal witness ‑-
PRESIDENT RHYNE: Oh, okay.
MR. JIMISON: ‑- and Mr. Mansfield we'll be calling.
PRESIDENT RHYNE: Okay. Proceed.
MR. MANSFIELD: Thank you, Madame President. In rebuttal, we would call Dr. Buttar back to the witness stand, please.
MR. KNOX: Well, I don't want to be a technician, but the truth of the matter is, if you have another lawyer examine and then they go bring in another one who needs to be examiner now is just absolutely contrary to procedure.
MR. JIMISON: He's on the Medical Board staff in the legal department. I don't think there are two lawyers.
MR. KNOX: Well, sure.
MR. MANSFIELD: Madame President, actually I was just glancing through the rule, Mr. Knox mentioned that to me in the hall. I was glancing through the rule and it says that in cross-examining a witness for instance when Mr. Jimison was cross-examining Dr. Buttar earlier we could not take turns. It wouldn't be fair for Marcus to go until he got tired and let me take a look at Dr. Buttar, that's what the rule is about.
Dr. Buttar was testifying as ‑- as a direct testimony witness for his case called by Mr. Knox at that time and we are now calling him as a rebuttal witness and we're not going to take turns questioning.
I have about ten minutes worth of questions, I think at the outside, and I don't believe it's contrary to the rules.
MS. GODFREY: Well, and I will state as far as that goes as a rebuttal witness, the ‑- the testimony needs to be limited to matters that were brought up in our case, not ‑- not new matters. I believe that is the rule.
MR. MANSFIELD: Correct. Madame President, I intend to ask him only about previous testimony in his case.
PRESIDENT RHYNE: Okay. Proceed. You've already been sworn in, Dr. Buttar ‑-
DR. BUTTAR: Yes, ma'am.
PRESIDENT RHYNE: ‑- so you can have a seat.
DR. BUTTAR: Thank you, ma'am.
WHEREUPON,
RASHID ALI BUTTAR, D.O.,
having been previously sworn,
was examined and testified
as follows:
REBUTTAL EXAMINATION BY MR. MANSFIELD:
QDr. Buttar.
AYes, sir.
MR. KNOX: The rules keep changing and I mean -- I'm --
QDr. Buttar, you testified previously today that you were involved in the passage of House Bill 886 at the North Carolina General Assembly, correct?
AYes, sir, I was.
QAnd that was in the year of 2003, correct?
AThat's correct.
QAnd I believe you testified earlier today that you testified to the House Committee on Health; is that right?
AI don't remember saying which committee. I testified I wouldn't even know which committee it was. I was just -- wound up and pointed in the right direction.
QDo you remember whether it was in April of 2003 that you gave the testimony that you recall giving?
AI recall that the day was the same day that my past --I served with the 101st Air Assault Division was moving into Iraq and I remember it was that day. I don't remember what that day was, but I believe that would be around the right time at some time in April.
QThank you. And did you work with any legislators with regard to House Bill 886?
ADid I work with any legislators?
QWell, did you ever have a conversation with any legislator in the General Assembly about House Bill 886?
AOh, I spoke with quite a number of them.
QDid you ‑- other than testifying in a front of a group within a committee setting, did you ever have any other conversations with legislators?
AI don't remember meeting any legislators one on one.
QIf ‑- if I asked you whether you had ever met with Representative Thomas Wright in particular, would you remember him?
AThe name is ‑-
MS. GODFREY: Well, objection.
MR. KNOX: Objection.
A‑- not familiar to me, I have no ‑-
MS. GODFREY: I mean, and ‑- and what's this got to do with what he testified to on ‑- in his ‑- in his original testimony?
MR. MANSFIELD: Madam President, he testified about participating in the process and I just have a few preliminary questions about what he did in the process and then I'll get to the point.
MR. KNOX: How can that be relevant to what's going on it with this today.
PRESIDENT RHYNE: He's the one that brought it up that he testified.
MR. MANSFIELD: He brought it up.
MR. KNOX: I understand, but then you wouldn't let us show that there was retribution as a result of it.
PRESIDENT RHYNE: I beg your pardon.
MR. MANSFIELD: Well, I don't have any questions ‑- well, I'm not ‑- my questions are limited to his testimony about his participation and his personal knowledge of what happened with the legislature.
PRESIDENT RHYNE: Go ahead and proceed. He's the one that brought it up when he testified.
Q(By Mr. Mansfield) Did you ever make any suggestions to anyone involved in the process of House Bill 886 regarding concepts or particular language that you ‑- you thought should be added to the Medical Practice Act?
AMr. Mansfield, all I remember is that you and Mr. Henderson came in and slouched in a chair to show intimidation with 13 members of the Medical Board and the North Carolina Medical Society.
And you had no interest in talking to me after the public ‑- the ‑- the public hearing ‑- excuse me, the press conference and then immediately you all wanted to talk to me.
I was also essentially threatened by the North Carolina Medical Society attorney who told me that, why don't you be a smart boy and not testify because, one, you know you're not going to change the law; and, two, you know it's only going to make it difficult for you to practice medicine in the state of North Carolina.
I also know that two weeks after I testified I was given ‑- I was delivered a registered letter while I was talking to Mr. Henderson on the phone and that the ‑-
MR. MANSFIELD: Madame President, I apologize for interrupting the witness, but my question is whether he made any suggestions to anybody about the concepts or language that should be added to the Medical Practice Act. And this ‑- I apologize ‑- apologize that if this is by way of explanation of his suggestions or concepts ‑-
PRESIDENT RHYNE: Just answer his question.
AI don't ‑- you're asking me a question, ma'am ‑- he's asking me a question that I can only tell him what I remember. I remember having conversations with you sitting at a table with a number of other people.
QOkay.
AI remember that.
QThat's when you made suggestions to me about what ought to change in the Medical Practice Act?
AI remember you asking me that there were certain things that were being proposed that may not be fair because you gave me an example that if a doctor cuts off the wrong leg, it's not fair that he be ‑- he be allowed to practice for another six months without the ability of the Medical Board to intervene and I agreed with that and we changed that language. I remember that.
I cannot specifically remember what you just asked me because I don't remember that, but I do remember having conversations with you one-on-one and among -- with a number of other members of the North Carolina Medical Society and the North Carolina Medical Board.
QOkay. Before you testified to the General Assembly about House Bill 886, did you read it?
AOf course, we read it. We came up with certain language ‑- and when I say we, I'm talking about the members of the North Carolina Integrative Medical Society as well as our lobbyists and there were certain changes that were ‑- that were proposed and that were made and it went back and forth and it's like a Mexican bizarre with people negotiating, but that's ‑-
QOkay. Thank ‑- thank you, that's precisely.
MR. MANSFIELD: Madame President, I'd like to ask the Court Reporter to mark a document as the next numbered exhibit for the Board.
MR. JIMISON: 26.
MR. MANSFIELD: Exhibit 26. Would you ‑-
MS. GODFREY: Can we see a copy of what you're marking, please?
MR. MANSFIELD: Yes.
MR. KNOX: May we just have a chance to look at it?
MR. MANSFIELD: Sure, absolutely.
MR. JIMISON: You can keep that one, Dr. Buttar, and I'll hand it up to the Board Members.
MR. KNOX: Which section are you talking about?
MR. MANSFIELD: Have you had a chance to take a look, Mr. Knox and Ms. Godfrey?
MR. KNOX: Well, can you tell me which section? It's a pretty broad five-page document to review in 30 seconds.
QDr. Buttar ‑-
MS. GODFREY: Excuse me, do you have the section that you want us to review?
MR. MANSFIELD: I have some questions for the witness actually, Madame President, if I might be permitted to ‑-
PRESIDENT RHYNE: Proceed.
MR. MANSFIELD: ‑- whenever you're ready.
MR. KNOX: Again, we're going to object to the record to the relevance of this to about three cases.
PRESIDENT RHYNE: Go ahead.
Q(By Mr. Mansfield) Dr. Buttar, can you identify the document that's been marked and it's marked as Exhibit 26. Can you look at the first page of that and tell me what that is?
AI can only read to you what it says. I don't recognize it, I don't remember ever seeing anything like this, but it says General Assembly of North Carolina, Session 20 ‑- 2003 House Draft, 70244, which was not the bill that we proposed.
QDo you see a short title for this bill?
AI do not. Where would that be?
QDid you testify previously today that you participated in the passage of a bill called Due Process for Physicians?
AYes.
QAnd do you see that phrase on the first page of this document?
AI don't. Where would I ‑- oh, I see a short title, yes, I'm sorry, yes.
QThank you. And ‑- and just to get back to where we were a minute ago, I asked you already whether you read this before you testified at the General Assembly and you said, yes, correct?
AI don't remember reading anything like this. We had a specific component that we had. It was one paragraph that had been submitted and that had been changed, but I don't remember ever seeing this whole thing, no.
QOkay. Well, then let me direct you to some particular language and ask you if you remember that language. It's on page 3 of this document and you'll see that there are line numbers on this down the side.
AYes.
QAnd at line 34 there's some underlying language and I would ask you to read out loud that underlying language beginning at line 34 down to ‑- to the end of the page, please.
AFrom ‑- starting from line 34 you said?
QYes, sir. The standards of ‑-
MS. GODFREY: Well ‑-
MR. KNOX: Objection.
MS. GODFREY: We're going to object to this. I mean, he says he does not remember this particular document and I think it's unfair to have him ‑- to cross-examine him about it if he doesn't remember the document or remember ‑-
WITNESS: I've never seen this document. I just remember one paragraph. It's about integrative medicine.
MR. MANSFIELD: Madame President, I'd like to direct him to some language and ask him if that compares to the paragraph that he was referring to.
PRESIDENT RHYNE: Proceed.
Q(By Mr. Mansfield) So it's for the purpose of some of your attorneys and some of the Board Members, if you could read that language and then ‑- but I can make my question two parts. I'm asking you if this is the language that you were talking about, the paragraph that you were interested in?
AIt's beginning at 34 you said?
QYes, sir. The standards of practice in any specialty, yeah.
AMine says: Such license may appear personally and through counsel, may cross-examine the witness.
What page are we on? A number of the page.
QPage ‑- page 3, and by that I mean the numbered page 3.
AOh, the number of the page, I'm sorry.
QI'm sorry. It's a two-sided copy.
AGotcha.
QSo the lower right-hand corner will say page 3 and at line 34 on the right-hand side there's some underlying language that begins with the standards of practice.
ARight. The standards of practice in any specialty, including complimentary treatments, shall be defined by specialists in that field. Continue?
QPlease.
AThe Board shall not annul, suspend, revoke the license of or deny a license to a ‑- to a person ‑- to ‑- to any person, harass, or initiate an investigation solely because of that person's practice of a therapy that is experimental, nontraditional, or that departs from acceptable and prevailing medical practices unless, by a preponderance of the evidence, the Board can establish that the treatment has a safety risk of harm to the patient greater than the prevailing treatment or that the treatment is generally not effective -- as effective in comparison to the effective rates of other prevailing treatments.
QDr. Buttar, is that language the same or similar to the paragraph you were referring to before?
AYes, Mr. Mansfield, it is.
QOkay. Thank you.
Let me also direct your attention to the preceding page, page 2. In the lower left-hand corner of page 2 at line 28, the underlying language and we can just give everybody a chance to read it. You can read it silently, if you like or you can read it out loud, and I would like to ask you again if this is some of the language in the paragraph that you were referring to that you wished to be added to the Medical Practice Act.
AIf this is the language, it certainly wasn't adhered to in my case this time, was it?
QWell, is that language similar to or the same as the paragraph you were referring to earlier?
AI actually don't remember this being part of it, but I think it's good it's in there.
QOkay. Then let me go back to your testimony to the General Assembly. Is it fair to say that when you testified you were testifying in support of the notions and the language you read on page 3 from line 34 and forward?
MR. KNOX: Object again to the relevance.
PRESIDENT RHYNE: Madame President, it was Dr. Buttar and his counsel who repeatedly said that the ‑- his conduct is to be judged by the standard that's reflected in this language.
WITNESS: Mr. Mansfield, if I may ‑-
MR. MANSFIELD: Sure.
WITNESS: ‑- it also ‑-
MR. KNOX: Objection. I don't want you do that, I'm objecting for the record, just for the record.
PRESIDENT RHYNE: Okay. Okay. Objections noted. Go ahead and proceed.
AIt says that the power of the Board to subpoena is limited to persons with knowledge related to a matter before the Board and yet of these four cases brought against me, three of them were all hearsay and yet it's in the Board and yet it was complaints against me of people that lied and said that they were there when they had never even been there. Three people, so I'm ‑- I'm sorry.
QNo, I'm sorry. I was just going to make sure I understood the language you're talking about. You're talking about the page 2 again at line 28, correct?
AYes, sir.
QOkay. Those most recent comments you made about that language?
AYes, sir.
QThank you. And so when you ‑- my question before was when you ‑- when Mr. Knox objected was when you testified for the General Assembly, isn't it true that you testified in support of the provisions on page 3 again at line 34?
AYes, sir, it is. It was for due process and I believe that was part of the due process.
QCertainly. And after you testified to the General Assembly about this language that you had seen then as previous ‑- we've previously referred to as the paragraph similar or the same as this language, did you continue to follow the progress of House Bill 886 through the summer?
MR. KNOX: Objection to relevance. And I know you can go on, but I want to note this for the record, but go ahead.
AI think I mentioned, Mr. Mansfield, that the ‑- the internal price freedom is constant vigilance and I believe we dropped the ball on that one.
QWell, my question was, did you visit the General Assembly during the summer?
AThat summer?
QYes, sir, 2003 after you testified about the bill.
AI ‑- I came to the Assembly twice, two days in a row both in April, both back to back and I never came to the Assembly again. I came on ‑- the day that I came was I think whatever date you said, that I had to come back the next day because I had ‑- I was supposedly invited, but they didn't hear me and then after my press conference one of the state representatives insisted that I be there and they adjourned at ‑- they stopped everything at 10:00 the following day and they heard my testimony, but I had never been ‑- I've never been back to the Legislature after that.
QYou testified previously that after you testified the bill passed the House.
AYes, sir.
QAnd did you have any occasion to review the bill or language in the bill at any point in time after it passed the House?
MR. KNOX: Objection, relevance.
AI am not certain that we did. Again, as I said, we were a little overwhelmed with the fact that we passed this bill so fast. We had a lobbyist that was looking at this. I know that it was changed when it went on and I think the Senate voted on it sometime in December, but I was not there and I am not aware of what the wording was.
I know the wording has changed since then, like last year or two years ago, but this original I'm not aware of what happened with that. I wasn't directly ‑- I'm the president of the society, but there were other doctors involved with it. There were lobbyists and other administrative people that were involved with it.
So the question you're asking, I'm sorry, but I don't ‑- I can't ‑- I can't give you an exact time because I don't remember.
QI'm sorry, just so I'm clear, are you saying that you never again read a version of the bill after you read whatever you read in preparation for your testimony?
AWe submitted language that we wanted and it was ‑-
MS. GODFREY: Objection.
A‑- there was something that you had ‑- you guys wanted us to consider, I think because you guys knew that we had the ear of the Legislature at that point.
I even had Dr. Kanof call me at home to make sure I got home that night which was very interesting. There was all of a sudden at lot of interest in my well-being and I appreciate that.
And I just remember that the language that we had originally submitted and that the rest of the group that we had discussed with had been negotiated down to a certain amount, but what ‑- what happened with it subsequent to that date, I cannot remember.
I do know it was changed. There were some words that were taken in and out. There were some other doctors that were looking at it closer than I was, doctors that are here in Raleigh that I'm not and that's all I can tell you. But I'm ‑- I did not come up again after April whatever it was.
QOkay.
MR. MANSFIELD: Madame President, I'd like to ask the Court Reporter to mark another document as Exhibit 27. And, Marcus, I'm going to hand you two copies so Mr. Knox and Ms. Godfrey ‑-
PRESIDENT RHYNE: Yeah. Mr. Mansfield, do you have copies for us.
MR. MANSFIELD: And I have copies also for you, Madame President.
PRESIDENT RHYNE: And you said this would be ten minutes.
MR. MANSFIELD: Oh, I'm sorry, this ‑- I'm really almost done.
Q(By Mr. Mansfield) I'll be very quick about this, Dr. Buttar. You're ‑- you're now looking at what's been marked Exhibit Number 27 and I would ask you to take a moment to look at that and tell me whether you have read the contents of this document previously and I'm particularly interested in page ‑- what's numbered page 2, so the back side of the first piece of paper. Have you ever read this ‑- this document or the language in Section 2 or Section 4 on page 2?
MR. KNOX: Object to the relevance.
AThe 90-2.1 where integrative medicine is defined, I'm familiar with that, yes, sir. And what was the next section, I'm sorry?
QSection 4.
AI ‑- I think that sounds familiar, yes.
QOkay. Dr. Buttar, are you aware of whether the language ‑- I'm sorry, I'm jumping back and forth from the documents. I'm now going to ask you a question about Exhibit 26. Are you ‑-
AIs it the first one?
QYes, sir. Do you still have a copy of that?
AYes, sir, I do.
QAnd I'm going to direct your attention back to page 3 again beginning at line 34. Are you aware of whether that language that I had you read out loud a little earlier and that you said was the same or similar to your paragraph, are you aware whether that language was removed from the bill prior to the time it was passed into law?
MR. KNOX: Objection.
MS. GODFREY: Objection. And he says he's not been to the Legislature since April.
MR. MANSFIELD: Madame President, he doesn't have to go to the Legislature to be aware of whether the language was taken out. And he's testified as to continuing activities, monitoring ‑- he remained vigilant and if he ‑- if he's not aware, that's fine, I'm just asking.
AWe were not vigilant, that's what I said. That was our fault.
Could you ‑- I'm not quite sure what you're asking. Are you saying that line 34 on the first document on page 3 ‑-
QYes.
A‑- whether that's been taken out.
QThat language. My question was, that language that you supported in your testimony, are you aware of whether that language was removed from the bill such that by the time it passed into law as you described that that language was no longer in the bill?
MR. KNOX: Objection.
AI was not aware that it had changed out significantly, but obviously it has. I know ‑- as I said before when you asked me, I knew that it had been changed.
MR. MANSFIELD: Madame President, I would like to offer into evidence Exhibits 26 and 27 and I don't have any more questions for Dr. Buttar although there may be some cross-examination.
PRESIDENT RHYNE: Do you want to cross-examine?
MS. GODFREY: Well, we're going to object to these being offered into evidence. I wasn't aware that we were going to be ‑- I think this is what they call legislative history and it's used by ‑- sometimes by courts to ‑- to look at the law as it ‑- as it evolved, but I don't think it's given a lot of weight because the law is what the final law is.
And I don't think that what the House did and what the Senate did and what language went in and out has a lot to do with what we're about today.
And I ‑- and, again, I know of no relevance of this to this proceeding that is under, as I understand it, the law as it was finally enacted. Your Honor, I'm sorry, Dr. Rhyne, it's getting late. But ‑- but again, I'm just not seeing any relevance to ‑- oh, to ‑- to what we're about today which is what happened in Patients A, B, C and D and whether or not if the Board should take any action against Dr. Buttar based on his treatment of those patients.
That's what we're here about today, not about what happened in the Legislature.
MR. MANSFIELD: Madame President, if I may respond if Ms. Godfrey is through.
The standard for admission into evidence first ‑- first is that something must be relevant. It's ‑- this is relevant because I've asked Dr. Buttar about facts related to these documents and the questions I asked were based on his previous testimony in which he made statements including that he was involved in the process, that he testified to the Legislature, that he gave a press conference.
And he testified that to the effect of, and I'm not quoting, but to the effect of that the Medical Board was targeting him and other integrative physicians unfairly and that he was at the Legislature trying to change the Medical Practice Act in order to protect practitioners like himself and including himself.
Also, in his ‑- his case, both in defending against our expert witness and in presenting their own expert witnesses, Dr. Buttar and his counsel repeatedly indicated that this Board must judge his conduct by the standard of an integrative medicine physician. And Dr. Buttar explains why that was so, because he went to the Legislature and worked to change the law.
So I've asked him questions about facts when I ‑- and I would modify my motion to say with regard to Exhibit 26, I would like to move into evidence the portion that ‑- that if you wish to exclude some part of this document, I would move into evidence the portions that Dr. Buttar just testified about with regard to the language that he recognizes that were changes that he himself sought and testified about to the Legislature.
And with that explanation, I would again ask that Exhibits 26 and 27 be admitted into evidence.
MR. KNOX: Again, we again object. Now, he said he's got a whole document and would like for you to decide which part you're going to accept in the last hour. They really have not introduced this until today at the closing. The exhibits should have been handed out earlier when we had the conference when they were exchanged and it's not relevant to this case.
PRESIDENT RHYNE: Can I have the attorneys approach please?
MR. KNOX: Yeah.
(BENCH CONFERENCE)
PRESIDENT RHYNE: I think we need to ‑- we're going to take a ten minute break and we're going to start with closing arguments. In fact, do you want to make it five minutes, Mr. Knox?
MR. KNOX: Whatever you say, you're the ‑- you're the head doctor.
PRESIDENT RHYNE: Okay.
(6:03 P.M. - 6:10 P.M. RECESS)
PRESIDENT RHYNE: Okay. Mr. Knox or Ms. Godfrey, would you like to make a closing statement?
MS. GODFREY: I will.
PRESIDENT RHYNE: Please proceed.
CLOSING STATEMENT BY MS. GODFREY:
I want to tell you a couple of things I'm not going to talk about first of all. I'm not going to try to talk to you about medical ethics. I ‑- I'm a lawyer, I have been trained as a lawyer. I'm not going to try to tell doctors how to interpret the medical ethics.
I'm also not going to give a jury speech. You all aren't a jury. You're the findings of fact that have specialized training in this arena. And while I want to convey to you that Dr. Buttar's case is, I think, very plain here. I'm not going to strive to do anything like that because this is not the proper forum for that.
I do want to talk about this issue that Mr. Mansfield has brought before you and I brought before you about what is the standard of care because I think ‑- I think that's really what we're looking at here, whether or not Dr. Buttar violated the standard of care. And the question is, what is the standard of care?
There's a whole lot of law in that area in the medical malpractice field. And I will tell you having participated in some of those cases, that the standard of care is very specific in the law of North Carolina, in the case law of North Carolina. The standard of care is determined by a practitioners in the same or similar specialty.
And the reason for that in the medical malpractice arena is because it would be grossly unfair to hold a general practitioner or family doctor with a doctor that practices with a broad range of patients and conditions to the same standards as a specialist. And that is what I argue to you the standard of care is in this case.
Now, I want to go back a little bit and talk about history. Marcus ‑- Mr. Jimison handed up to you the George Guess case and that is the only case I know of that has come through to interpret anything about the Medical Practice Act.
For whatever reason, cases since then have not reached the appellate levels necessary to generate published opinions. They may have gone to a Superior Court judge, but Superior Court judge's opinions are not published and are not precedent. The only legal precedent in ‑- in this area is the George Guess case which ended up in the Supreme Court in the year 1990.
And Mr. Jimison has argued to you that this case is ‑- that it stands for the fact that there is only one standard of care by which we judge medical providers and it's the same standard of care no matter what kind of doctor you are.
The facts of the Guess case are that Dr. Guess was a family practitioner that also practiced, I guess, in the late eighties, homeopathic medicine. And the evidence was that he was the only homeopathic practitioner that was licensed by the Medical Board in North Carolina at that time. I don't know if it's true, but that's what the ‑- that's what the case says.
And because Dr. Guess was practicing homeopathic medicine that was not practiced by any other medical practitioners at that time, it was held that he practiced below the standard of care and for that reason his license was taken away.
It went back and forth through the courts and the issue ‑- the burning issue was not, is there more than one standard of care. That wasn't even discussed.
What was discussed is whether or not the Medical Board in order to take Dr. Guess's license had to show harm.
And the Medical Board made a specific finding that there was no harm to Dr. Guess's patients. They took his medical license anyway and in the earlier appeals to the Superior Court and the Court of Appeals, they reversed that decision. They said that we feel like you have to show harm.
And it got up to the Supreme Court and the Supreme Court said, no, the Medical Board can take away a practitioner's license if they find it's below the standard of care whether or not any patient is harmed.
Now, that was a controversial decision and there was a very strong dissent and the dissent was written by Justice Frye. And in that dissent he argued very strenuously for the opposite position. That's what we lawyers do, there's ‑- there's always two sides to every case and even in the Supreme Court of this state, there's two sides to every case.
And Justice Frye said that clearly the public policy of the state was to protect patients. If Dr. Guess was ‑- was the only homeopathic person ‑- practitioner in the state, there was nobody to compare him to any other homeopathic practitioner and so therefore on that basis hold that he was below the standard of care when no showing of patient harm was brought.
And he went on to say that the majority of the evidence of the legitimacy of homeopathy in other states and countries throughout the world as being irrelevant because homeopathy is not a currently accepted ‑- accepted and prevailing system of medical practice in North Carolina.
This raises the legitimate question of how the acceptable and prevailing practice can be improved in North Carolina, if we do not even consider what happens in other states, so Dr. ‑- Justice Frye raised the question.
And there was some change to the Medical Practice Act in 2003 that at least attempted to address and answer this question.
First of all, I want to go through some specific changes that are in the final statute, not in the draft that you have, but in the final statute and which are the law of North Carolina.
As we stated, but I want to emphasize, in 90-1.13 a definition was added recognizing that integrative medicine was a diagnostic or therapeutic treatment that may not be considered a conventionally accepted medical treatment. And a licensed physician in that position ‑- and that a licensed physician in the physician's professional opinion believes maybe a potential benefit to a patient, so long as the treatment posses no greater risk of harm to the patient than other comparable ‑- than the comparable conventional treatments. I'm sorry I'm having trouble reading this.
That was a change in the law that addresses the question of Dr. Guess's case, thirteen years later. And it recognizes that there can be an integrative practice of medicine in North Carolina and you don't have to prove that every other doctor considers these practices, you know, or uses ‑- uses the practices in their practices or considers them, you know, opposites.
What is says is that you can depart from the conventionally accepted ‑- accepted medical treatment and still practice integrative medicine in the state of North Carolina. That's critical here.
Now, we've also looked at the change in 90‑14(a)(6) and 90-14 is the disciplinary authority of the Board and those are the 13 or ‑- no, I'm sorry, 15 things ‑- I guess it's actually 16 because there are to 11(a), things that this ‑- this Board can discipline a physician for.
And Dr. Buttar has been charged under two of these. It's subsection 6 which is unprofessional conduct and subset ‑- subsection 12 which is exploitation of patients. So that is the law that you are considering in this case, whether or not he has violated either one of these provisions.
The definition is unprofessional conduct including, but not limited to, a departure from or failure to conform to the standards of a acceptable and prevailing medical practice or the ethics of the medical profession irrespective of whether or not a patient is injured thereby or committing any act contrary to honesty, justice, good morals, whether the same is committed in the course of the physician's practice or otherwise, and whether or not committed in the state of North Carolina.
That sentence must be read in the context of the entire statute. And when the Legislature added the provision that recognized integrative law ‑- integrative medicine, it specifically defined integrative medicine as a departure from the conventionally accepted medical treatment.
What do you do? How do you ‑- how do you make those two statutes go together? I submit to you, Doctors, that what you have to do is import the law that's well established in the state of North Carolina in the medical malpractice arena that says when a physician is judged, he or she should be judged by people in their own field of practice.
And I have some more evidence that I think the Legislature meant that when they ‑- when they made this change to the law.
If you will look at 90-14.6(b), I believe that was a change that was made at the same time in 2003. This is a section that deals with the evidence admissible at this hearing.
(b) says: Subject to the North Carolina Rules of Civil Procedure and Rules of Evidence in proceedings held pursuant to this article, the individual under investigation may call witnesses including medical practitioners licensed in the United States with training and experience in the same field of practice as the individual under investigation and familiar with the standard of care among members of the same healthcare profession in North Carolina.
The evidence to be considered by the Board that can be presented by these ‑- the practitioner under investigation is members in the same field of practice.
What we have presented to you today or today and yesterday is evidence from an integrative medicine doctor, Dr. Wilson, and an oncologist who also practices integrative medicine. They both testified that Dr. Buttar met the standard of care for a doctor practicing integrative medicine in the state of North Carolina in ‑- in the treatment of these patients.
The question is, is Dr. Buttar held to the standard of an oncologist when he is clearly not an oncologist or is Dr. Buttar held to the standard of care of a doctor practicing integrative medicine?
And I argue very strenuously that the latter should apply based on the language ‑- on the clear language in the statute and the laws of North Carolina as it has defined the standard of care and based on fundamental fairness.
Again, the whole idea of the standard of care is that we do not judge a family practitioner by the standards of a neurosurgeon by diagnosis or treatment or anything else. And you can say they look at different conditions, but so many times doctors who are in more general fields, like you Dr. Rhyne, or an internist or a family practice doctor, see a wide variety of conditions. And should doctors in the more general fields like Dr. Buttar who is an integrative medicine be held to the same standard of care as a specialist. Is that fair? We believe not.
Finally, and I don't want to overlook this, another section was added that I need you to turn back -- and I hope you're following with me on the numbers, it's 90-14 again, subsection (g). That section was also added in 2003. Again, I think a lot in reaction to the Guess case.
And that section says: Prior to taking action against any licensee who practices integrative medicine for providing care not in accordance with the standards of practice with procedures or treatments administered, the Board shall consult with a licensee who practices integrative medicine.
Well, we brought that ‑- those people to you in this hearing. And what they have told you is that Dr. Buttar has met the standard of care.
Now, again, the Legislature has carved out and it's not put integrative medicine doctors in a ‑- in a special category, but again they did. Because I think in reactions to the Guess case saying that there's conventional medicine and then there is alternative medicine and that's clearly recognized here, the right to practice integrative medicine is clearly recognized here. We don't have, you know, Dr. Guess being run out of town because there were no other homeopaths by which to judge him.
The Legislature has mandated that you do recognize this and that ‑- and we say that the law should be interpreted that you judge Dr. Buttar by the standards of a doctor practicing integrative medicine.
Now, we brought you the testimony of Dr. Buttar himself to directly answer the criticism of Dr. Peterson and it's ‑- it's pretty fundamental here. For conventional medicine oncology, no more treatment was available for these patients. They had all been refused treatment as many patients that Dr. Buttar treats.
And if you judge him by the conventional standards, he should turn every patient away. He couldn't practice alternative medicine. But he sees medicine differently from the conventional practice of medicine and sees alternative medicine, I'm sure, differently from the way you practice medicine. He believes in different therapies and different theories of disease.
And, again, no area of science has a monopoly on truth. I mean, if there's any example of that, it's the debate about will the climate change in global warming. You can find just as many good science ‑- scientists on either side of that debate no matter which side you are for. Does that mean, you know, there's ‑- there's one side that should be prevalence over another? We don't know yet.
And that's how science progresses because some people think that things should be done differently. Sometimes they're right, and sometimes they're wrong, but they have the right to disagree with the established belief. That's how science progresses.
And we say that Dr. Buttar has that right and we believe his patients have that right to get alternative treatments. Again, I'm not going to rehash the medical evidence for you because you can see that yourself if you saw the many patients that he has helped and the various patients that believe in his treatment, believe they were helped by him.
You met Dr. Buttar, he's not a snake oil salesman. He's not, as Justice Frye put it, this is not the case of a quack yelling in the public, but a dedicated physician seeking to find new ways to relieve human suffering. That's a quote from the Guess case and I think it's applicable here.
Dr. Buttar is a sincere, passionate individual who sees things I'm sure differently than you do in the practice of medicine. But the question is, are any of his patients harmed by his treatments? Are some of them helped? Well, you've seen evidence of that. You've heard it from him, you've seen it from the patients themselves.
And does he have the right and do his patients have the right to his treatment, his care? Even Dr. Peterson has to admit that in the four patient charts that he reviewed in the two hours that he reviewed them, that he could not see any physical harm to the patients.
The last thing I want to do is urge you to keep your decision here confined to the complaints that were before the Board, Patients A, B, C and D.
We're heard a lot about Patient E, that complaint is not part of these proceedings. Mr. Jimison opened the door with that by saying I want to show a pattern of practice here, but what I really think is that when he decided not to call Patient D, the complaining witness in Patient D ‑- for whatever reason he decided not to call them, that he wanted some other evidence to put before the Board.
But what you have to remember is the charges here have nothing to do with Patient E. We've had no opportunity to investigate any charges for Patient E and more importantly the complaint that's brought before you doesn't include Patient E in this case, that's for another day.
And the question here is, in cases of Patient A, B and C, and to the extent that you want to consider Patient D, who I think really has sort of been abandoned by ‑- by the Board, did Dr. Buttar meet the standards of care for an integrative medicine doctor practicing medicine in the state of North Carolina for the relative periods.
Patient A, B and C were cancer patients who had been turned away by conventional medicine. They were not roped into Dr. Buttar's practice with any kind of advertising, he tried to be honest with them, he told ‑- he never made any promises to them except that he would try to help them. With what he has seen through ‑- treatments that he has seen empirical evidence that this practice and the practice of practitioners in the alternative medicine are successful with some patients.
With regard to Patient A, there was not one family member that was upset with Dr. Buttar. Not one family member. Dr. Herman, the person who did file the complaint, while she may have been very well intentioned, I think she files her complaint based on her interpretation of what was going on through somebody else's mouth.
And what's amazing to me is, she had an employee with a mother who had been her patient, the patient was dying of cancer. She was hearing things that apparently disturbed her about the treatment of this patient and she did not even go to see her and she was home on the weekends. She didn't go to see her, didn't go to see her family, didn't go to see ‑- go to check anything out firsthand.
Patient A wanted to be treated even when Dr. Buttar and his nurse felt that this really wasn't going to help her. Patient A wanted to continue treatment and it was their clinical judgment to honor her wishes. Just like Ripoll said, when we're dying you don't have very many things you can control, but one of the things you can control is whether or not to be treated and how you're treated. Is that wrong?
Again, no complaint from Patient A's family even ‑- you know, they've had two years there to look back and to think about it. Had to subpoena her daughter to be here. The daughter did not want to be involved.
Patient B, the complaint ‑- again, we heard Patient B had a daughter that she loved very much apparently according to the testimony. She was the sole heir of the estate. As we hear it ‑- do we even see Patient B's daughter here complaining? Do we see anybody who is on the scene with Patient B complaining? No. The complaint comes from a nephew in Los Angeles who was not here at all when Patient B was being treated.
Did the Medical Board go out and find any firsthand witnesses that were over here when Patient B was being treated, the fiance we've heard so much about? No. It all comes in through somebody who through time and distance really didn't know, really didn't take time to investigate what was going on with that patient.
And, again, Patient B is a different case. It appears that, you know, she really didn't want to do this treatment after a while and she withdrew from the treatment and that was fine. She was not a compliant patient and the practice released her. Nobody tried to rope her in for more therapy when she wasn't doing what Dr. Buttar said she needed to do.
Finally, Patient C, the complaint was by his wife, but we've heard a lot of testimony about the dynamics of that family situation. It's clear that Patient C's wife was not supportive at all of this treatment while every bit of evidence you have was that Patient C wanted to pursue this treatment and indeed other treatments ‑- other alternative treatments in Mexico.
Patient C, and all of these patients, were intelligent, informed, capable of making their own treatment decisions. And it was his decision to continue on with Dr. Buttar's treatment and then to seek other treatment in an effort to do something to help his ‑- his disease.
Now, finally, you know, a lot has been said about safety and ‑- and efficacy. Again, where that comes into play is if you were to decide that Dr. Buttar practiced below the standard of care, then if you were to decide that his license should be taken, you would have to make a finding that the treatments that he gave were either less ‑- well, let me ‑- let me get the statute and I'll read it to you because I'm not going to try to recall that by memory at 20 minutes till 7.
Under 90-14 ‑- I'm sorry, (6) it says: The Board shall not revoke the license or deny a license to a person solely because that practice ‑- that ‑- or that person's practice of a therapy that is experimental, nontraditional, or that departs from the acceptable and prevailing medical practices unless by competent evidence, the Board can establish that the treatment has a safety risk that is greater than the prevailing treatment or that the treatment is generally not effective.
Okay. And I'm going to go over the issues with you that we say you should decide. They're not very different than Mr. Jimison's issues. But the way this works is, if you make a finding that Dr. Buttar has departed from the standard of practice and you recommend a disciplinary measure, if that disciplinary measure were to be a really -- a patient one, you would have to make a specific finding of one of these things.
Now, I want to ask, rhetorically, suppose Dr. Buttar's position and Dr. Peterson's positions were reversed and Dr. Peterson as an oncologist were brought before you? Suppose you were the alternative medical board and Dr. Peterson who is a conventional practitioner were brought before you for treating patients with chemotherapy and that is different from alternative practices. Would Dr. Peterson's treatment pass this same test?
Would Dr. Peterson's treatments, chemotherapy, conventional therapy for cancer patients pass the test that they are ‑- have the safety risk -- or that they do not have a safety risk greater than the ‑- than the alternative treatment. There's lots of toxic side effects to the risks to chemotherapy -- it is far more risky than anything Dr. Buttar is doing.
What about efficacy? Conventional treatments for cancer were generally effective, there would be no need for alternative treatments. But the fact is, that's one area of medical practice that is just in its infancy. And do we shut off alternative treatments just because they're different? What we're here to do is seek doctors to treat and to help patients and, of course, to do no harm.
Can we say at this stage of development of cancer
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