NC Medical Board Dr. Rashid A. Buttar Transcript - Page 4 of 16
MR. KNOX: Exhibit 5.
MS. GODFREY: The Board's Exhibit 5, page 47.
MR. KNOX: May I proceed, ma'am?
PRESIDENT RHYNE: Please do.
Q(By Mr. Knox) Back to this ‑- this was from Kelly to you and ‑- and it was dated Thursday, October the 5th. I was looking over the e-mail I sent to you. I wanted to clarify that I was referring to the Lexapro as been prescribed again for your child. Again, keep her at the 1.5 milligrams, but you may bump it up to 2, if necessary. Do you remember getting that e-mail?
ARight.
QThat was notwithstanding, and you said there was ‑- you unilaterally ‑- they told you to stop cold turkey, but you broke it down in two different times, right?
AWhat do you mean I broke it down into ‑-
QIn other words, you did not stop it cold turkey, but you took her off some amount to start with and then a second time you took her off a certain amount. Is that true?
AShe was weaned, yes.
QYeah. And so ‑- and that's exactly what they had told you at the doctor's office, to reduce it half and then to a fourth. Am I right?
ANot initially.
QOkay.
PRESIDENT RHYNE: Okay. Thank you very much.
WITNESS: Okay.
PRESIDENT RHYNE: I think at this point, we'll go ahead and take a break.
MR. JIMISON: I'm sorry.
PRESIDENT RHYNE: It's now 12:35 and we can resume back 1:30. I don't know if that gives you enough time to really have lunch.
MR. KNOX: Anyway, we can find something to eat.
PRESIDENT RHYNE: Yeah. 1:30 should give you time to get back.
MS. GODFREY: We'll do that.
PRESIDENT RHYNE: Okay.
(12:35 P.M. - 1:39 P.M. LUNCH RECESS)
PRESIDENT RHYNE: Okay. Mr. Jimison, are you ready to proceed.
MR. JIMISON: I call Marie Church to the stand.
WHEREUPON,
MARIE CHURCH,
being first duly sworn,
was examined and testified
as follows:
DIRECT EXAMINATION BY MR. JIMISON:
QGood afternoon, Ms. Church, could you introduce yourself to the Board Members, please?
AI'm Marie Church.
QWould you please use the microphone.
AI'm Marie Church.
QAnd where do you presently live?
ALenoir, North Carolina.
QAnd do you work with Dr. Herman?
AYes.
QAnd how long have you worked for Dr. Herman?
ANine years.
QAnd are you related to Patient A?
AYes, she's my mother.
QAnd at some point was your mother diagnosed with cancer?
AYes.
QAnd when was that?
AThe first time?
QYes, ma'am.
AI can't remember. I think it was 2003.
QAnd how was your mother originally treated ‑- initially treated after she received that diagnosis?
AShe would get a radical hysterectomy and was treated with radiation therapy.
QAnd did that stop the cancer from progressing?
AAt the time, they said it was gone.
QDid it come back?
AYes, it did.
QAnd after it came back, what did your mother do? How did she get care for the cancer after it came back?
AWe had seen a local doctor here and they sent her to an oncologist.
QAnd ‑- and what therapies did that oncologist provide?
AWe considered M.D. Anderson and they really couldn't do anything for her here, so we had ‑- that her ‑- my mother and father went to M.D. Anderson in Texas.
QOkay. And what's your understanding of M.D. Anderson as a cancer center?
MS. GODFREY: Well, if she knows.
QOnly if you know.
AI know they do a lot of experimental things.
QOkay. And ‑- and did the therapies that they tried at M.D. Anderson, did they work?
ANo.
QAnd what did your mother do after that?
AWe had checked into some alternative therapies that could be done.
QAnd specifically what type of alternative therapies?
AThe hydrogen peroxide.
QAnd ‑- and at some point did you ‑- did your mother go see Dr. Buttar?
AYes.
QAnd how did she learn of Dr. Buttar?
AWe had her see the book that had information about the treatments in it and we had called a doctor's office in Canada and they gave us the number of Dr. Buttar.
QAnd this hydrogen peroxide therapy, did you know it under a name of oxygen therapy?
AYes.
MS. GODFREY: Well, object to the leading.
QDo you know hydrogen peroxide under a different name?
AWell, we ‑- it's a type of oxygen therapy, is what it is.
QOkay. And did you go with your mother to Dr. Buttar's office?
AYes.
QDid you go with her the first time she went there?
AYes.
QDid you see Dr. Buttar on that first visit?
ANo.
QWho did you see on that first visit?
AJane, the nurse practitioner.
QWhat's Jane's last name?
AWell, at the time it was different. I don't know what it is now. I don't know what it is now.
QWould it be Ms. Garcia?
AYes.
QWhat did she tell you ‑- tell me about that conversation that you and your mother had with Ms. Garcia on that first visit?
AWe had explained her situation and she looked over the notes and they told me the type of treatment they did. And she told us that they could help her at the time of the visit.
QDid ‑- you said the type of treatments that they did. Were these treatments for cancer?
MS. GODFREY: Well, objection.
QI mean, if you know.
MS. GODFREY: Objection to what ‑-
PRESIDENT RHYNE: Wait. What's your objection?
MS. GODFREY: Well, I don't know the type of treatments who gives.
MR. JIMISON: Dr. Buttar gives.
Q(By Mr. Jimison) Did he say what it was for? Did Ms. Garcia say what the treatments were for?
AThey were for cancer patients.
QAnd she said they could help your mother?
AThey could help, yes.
QWhat ‑- did you go to your ‑- with your mother for her therapies?
AYes.
QDid you go with her every time?
AYes.
QAnd how did your mother get to Dr. Buttar's office for the therapies?
AI drove. We stayed in a hotel at the time.
QYou stayed at a hotel ‑-
AYes.
Q‑- while your mother was getting therapies?
AYes.
QAnd how often would she get therapies?
AEvery day.
QFive ‑-
AExcept for Saturday and Sunday.
QSo she would get therapies Monday through Friday?
AYes.
QAnd ‑- and she received those therapies from Dr. Buttar's office?
AYes.
QAnd how long would she be in Dr. Buttar's office during those days?
AAround ‑- it depended on the day. It was between 8 to 5, or sometimes we would come in at 9.
QSo basically 40 hours a week?
AYes.
QFive days a week. And how many weeks did she ‑- she get therapy from Dr. Buttar?
AIt was ‑- it was around a month.
QOkay. How often did your mother see or did you see Dr. Buttar when she was there to receive her therapies?
AI seen him maybe three to four times.
QDid Dr. Buttar ever examine your mother?
AI think the first time she met him. I didn't go in the room at that time.
QOkay. Despite your mother's going to Dr. Buttar, did her cancer still progress?
AYes.
QDescribe your mother's physical appearance to the caregivers ‑- during this time she was receiving therapy, describe her physical appearance.
ABeginning or ‑-
QAt the beginning and ending.
AAt the beginning of the treatments, she wasn't in real good shape to begin with and she had swelled some in the stomach area. During the treatment time, she did, you know, the first or second week, she went off her pain meds and then she had to go back on them again.
During that time, she kept swelling in her stomach and fluid kept building up and so we had to have that drained off one time.
And more towards the end, she started swelling a lot in her legs, but then it progressed from there and she was unable to walk real good, so I had to put her in a wheelchair at the very end.
QWas she jaundiced?
AYes.
QAnd how ‑- how did her skin look?
AIt was yellow.
QWas that visible to the caregivers there at Dr. Buttar's clinic?
ANot at the beginning, but more towards the end, she did turn jaundice.
QOkay. Describe the IV treatments. How ‑- how long did it take per day for her to get all the IVs that Dr. Buttar was giving her?
AUsually with this, it was mostly about all day unless they done the hyperbaric treatments which she didn't do much.
QAnd why was your mother not able to have the hyperbaric treatments?
AShe was claustrophobic.
QWhat were the IVs, if you know, that were administered to your mother while you were in there in the office with her?
AWhat were they?
QUh-huh (yes).
AI don't know exactly what all of them were. I know one of them was the peroxide, I think, and one of them was for her liver and I'm not sure about the other ones. I think there were some vitamins.
QOnly if you can recall, was one of them ozone?
MS. GODFREY: Well, objection.
QIf you recall.
MR. JIMISON: Only if she recalls.
PRESIDENT RHYNE: Wait a minute. What is your objection?
MS. GODFREY: I'm objecting to the leading, putting words in the witness's mouth.
MR. JIMISON: I'm just asking was one of them an ozone.
MR. KNOX: She said she didn't ‑-
MR. JIMISON: If she knows.
PRESIDENT RHYNE: She said she didn't know.
MR. JIMISON: Okay.
Q(By Mr. Jimison) So hydrogen peroxide, vitamins?
AYes.
QAnd how ‑- how many IVs would he run a day?
AWell, they would change the bags out. It was ‑- I don't know the exact amount, but it was like three or four maybe. It may have been more. I don't know.
QDid your mother get chelation therapy?
AShe was getting the drop treatments, yes.
QAnd when she was getting these treatments five days a week for several weeks, did this ‑- did her physical condition get better or worse from your observations?
AShe never got better as far as the physical condition.
QI know this is difficult, but tell me about the day your mother died.
AShe was unresponsive at the time. She wasn't even conscious. She was at the hospital.
QWhich hospital was she at?
ALake Norman Medical.
QAnd is that a hospital near Dr. Buttar's office?
AYes.
QAnd was she getting treatments from Dr. Buttar's office up to the moment she died?
AI believe that Thursday was her last treatment and I took her to the ER that night.
QWas she scheduled to come in the next day for treatment?
AYes.
QSo she finished her treatments on that Thursday and you took her to the hospital that Thursday night?
AYes.
QWhy did you take her to the hospital?
ABecause she had a lot of pressure on her stomach, the fluid had started building up again. And since they had drained it off the first time, that's what ‑- she thought that what's they could do again, but when we got there, they were unable to.
QAnd did she die ‑- when you took her to the hospital that Thursday night, did she die at the hospital?
ANo, she died on that Saturday, the 19th of August.
QWhere at?
AAt Lake Norman.
QSo she never left the hospital ‑-
ANo.
Q‑- from when you took her?
She was there at Dr. Buttar's office getting treatment on that Thursday. Did ‑- did you ever have a conversation with Dr. Buttar about whether to continue treatment for your mother?
AYes.
QAnd what was that conversation?
AWell, Jane had come to me about she didn't think the treatments were helping.
And then I went and spoke to Dr. Buttar and asked him ‑- you know, talked to him about it and asked him what he thought I should do.
And, you know, he ‑- he said he didn't ‑- you know, he wasn't the type of person to give up and I told him I wanted to do what she wanted to do and she wanted to continue on with the treatments at the time.
QSo your mother wanted to keep on with the treatments at the time ‑-
AYeah, she said we'll discuss it this weekend and I remember we never got to that weekend because that was the weekend she was in the hospital.
QHow much money did you pay ‑- did your parents pay Dr. Buttar for any of the treatments for your mother?
AI'm not sure. I know we paid $12,000 up front, I believe it was, and then I think it was around six. I'm thinking it was three to six a week. I can't remember. It was probably around $30,000, I'm not sure.
QDid you call complaining in this case?
ANo.
QAnd why did you not call and complain?
AI didn't see a need to. I mean, I just ‑-
QAre you aware that a complaint was filed on behalf of your mother?
ANot until just recently.
QDo you know who filed that complaint?
AYes.
QWho was it?
AIt was Dr. Herman.
QWas Dr. Herman your mother's doctor at one point?
AYes.
MR. JIMISON: I have no other questions.
PRESIDENT RHYNE: Do you want to cross-examine, Ms. Godfrey?
MS. GODFREY: I do.
CROSS-EXAMINATION BY MS. GODFREY:
QMs. Church, you're here under subpoena today, correct?
AYes.
QAnd it was your desire not to be involved in these proceedings; isn't that correct?
AYes.
QAnd sometime about a week or so ago Mr. Jimison called you at work, correct?
AYes.
QAnd you work as the receptionist in Dr. Herman's clinic?
ACorrect.
QAnd you've been the receptionist there since 1999?
AYes.
QAnd Mr. ‑- even though you didn't want to talk to Mr. Jimison, you did talk to him, correct?
AYes.
QAnd after that conversation, he issued a subpoena for you to come here to testify today?
AYes.
QAnd that's why you're here, not because you want to be?
ANo, just by subpoena.
QNow, did you accompany your mother to M.D. Anderson?
ANo.
QWhat is ‑- is your understanding when they came back from M.D. Anderson, was there anything else that they could do for her?
AShe had had two treatments at M.D. Anderson and on the last trip they told her that there was nothing else that they could do for her.
QOkay. And ‑- and her ‑- did your father accompany her down there?
AYes.
QAnd they flew back and forth to Texas?
AThree times.
QThree times. And they stayed down at M.D. Anderson for a period of time ‑-
AUh-huh (yes).
Q‑- in, I guess, a hotel or something down there ‑-
AYes.
Q‑- while she was getting chemotherapy treatments at M.D. Anderson ‑-
AYes.
Q‑- is that correct?
And they ‑- they did that in May and June of 2006, shortly after her cancer came back?
AYes, when we found out in April.
QOkay. And after ‑- after she was released from M.D. Anderson, after they told her there was nothing more they could do, that was when your father and mother sought out Dr. Buttar?
ACorrect.
QAnd that was their decision to do?
AYes.
QAnd you say your father had some kind of book that ‑- that you ‑- that he found out about Dr. Buttar through?
AYes.
QOkay. During this time was your mother able to make decisions for herself?
AYes, she was.
QOkay. And when ‑- when you first went to Dr. Buttar, was your father with your mother, father ‑-
AThe first ‑- the first visit, yes.
QOkay. And you were there?
AYes.
QAnd the three of you looked over the paperwork that she ‑- that ‑- that she was to sign?
AWe looked over it, but I couldn't tell you anything it said.
QOkay. I understand. But ‑- but your mother and your father were there ‑-
AYes.
Q‑- and they looked over the paperwork?
AYes.
QAnd she signed it?
AYes.
QNow, when you met with Jane the first time, she explained to you that ‑- that they had a different approach than the conventional treatments for cancer?
AThat's what I recall, as to what I recall, yes.
QOkay. And did she explain to you that their approach was to treat the patient and build up the patient's strength and immune system to help them better battle the cancer on their own?
AYes.
QOkay. And that was what you understood Dr. Buttar's treatment was directed towards; isn't that right?
AThe cancer, yes.
QOkay. It was directed to the cancer, but it was directed towards building the patient's immune system and resources to be able to better fight the cancer themselves?
AYeah, they treated that and metal toxicity as far as the mercury.
QOkay. And was it explained to you that the metal toxicity on your ‑- on Dr. Buttar's approach was something that would ‑- would help the body better able to fight the cancer?
AYes, getting rid of the mercury would help.
QOkay. Now, they never said they would cure the cancer, did they?
ANo.
QAnd they never said that there was a 100 percent chance of success?
ANo.
QAnd when ‑- when your mother was treating with Dr. Buttar, you accompanied her back and forth and your father gave you the money to pay Dr. Buttar's office?
AYes.
QAnd at first your mother showed some improvement, did she not?
AYeah. The first week or so, she went off her pain meds.
QOkay.
AThat was the improvement she showed, but then she had to go back on it.
QOkay. So she had a short period of feeling better?
AYes.
QOkay. And at that ‑- and later on in August, you say you discussed it with Dr. Buttar and Jane that the treatments didn't seem to be helping; isn't that right?
AThey had come to me, I didn't go to them. They had come to me and said they didn't think it was helping her.
QOkay. And at that point your mother was still adamant about continuing on?
AWhen I ‑- I talked to her before I talked to them I said, do you want to just go on home and she said, we'll talk about it this weekend. I'll go ahead and go to it this week and we'll talk about it this weekend, is what she told me.
QOkay. So she wanted to finish out the week, that was her desire?
AYes.
QOkay. Would you say your mother had a strong will to fight that cancer?
AYes.
QAnd a strong will to want to get better?
A(Nods head in affirmative response.)
QOkay. After your mother's death, did you and your father return to Dr. Buttar's clinic to return some medications?
AYes.
QAnd you were given a refund ‑-
AWe did ‑-
Q‑- of about $2500, weren't you?
ACorrect.
QOkay. And you and your dad said good-bye to the staff at that time, did you not?
AWell, I had talked to a couple of the nurses that were there. I cannot recall their names.
QOkay. And you were on good terms with the staff at that time?
AYes.
QOkay. And you never heard anything about a complaint filed against the medical ‑- against Dr. Buttar until about a couple of months ago, did you?
AOn our part, yes.
QOkay.
ANo, I --
QLet me rephrase that question because I think it was confusing, I'm sorry.
When did you first find out that a complaint had been filed against Dr. Buttar?
AFrom Dr. Herman.
QWhen?
AIt was I guess when the Medical Board had requested records.
QOkay. And would that have been in early February of 2008? A couple of months ago?
AI don't know if it's been that long ago, but I had found the records, is the reason I knew.
QOkay. So within the last month or two ‑-
ARecently, yes.
QOkay. And that was after your mother died in August of 2006?
ACorrect.
QSo no one ever talked to you at all about ‑- from the Medical Board ‑-
ANo.
Q‑- between August of 2006 and just this past week or so?
ANo.
QAnd you never knew anything about a complaint?
ANo.
QOkay. And your dad is still alive, right?
ACorrect, yes, he is.
QAnd he's not expressed any desire to be involved in this either?
ANo, he doesn't want to be.
QOh. One other question. Dr. Herman is a family practice doctor, right?
AYes, she is.
QAnd she took care of your mom for a long time?
AYes. She seen her occasionally.
QOkay. And ‑- but during the time that your mom was undergoing cancer treatments both at M.D. Anderson ‑- well, let me ‑- let me back up and break that up.
After your mom's cancer came back, did she ever see Dr. Herman?
AThat was when we found out that she had cancer.
QOkay. But after ‑- after ‑-
ANo.
Q‑- she was diagnosed with the ‑- with the recurrence, did she ever go back to see Dr. Herman?
ANo. After we got the results, no.
QAnd did Dr. Herman ever see your mother while she was being treated by Dr. Buttar?
AI don't believe so, no.
QDid she ever come to your house to visit her or ‑-
ANo.
MS. GODFREY: Okay. That's all I have.
PRESIDENT RHYNE: Mr. Jimison, do you want to redirect?
REDIRECT EXAMINATION BY MR. JIMISON:
QWhen you spoke to me, were you on a conference call to Ms. Carpenter as well? Do you recall that?
AYes.
QDid we tell you you had to speak with us?
AYou said that we had to, but you said you had thought about doing a subpoena and that you know that I didn't want to get involved in it. And after you talked to me, I went ahead and said, yeah, go ahead and do it because I felt like you were going to subpoena me anyway.
MR. JIMISON: That's all.
PRESIDENT RHYNE: Do you want to recross?
MS. GODFREY: No.
PRESIDENT RHYNE: Any Board Members have any questions? I have one question.
EXAMINATION BY THE PANEL MEMBERS:
PRESIDENT RHYNE: You said during this time something about that your mom had some fluid drained off her stomach.
WITNESS: Yes. She had had an ultrasound done and they had drained some fluid after the ultrasound.
PRESIDENT RHYNE: Uh-huh (yes). And ‑- and where was that done? Was that ‑- did Dr. Buttar do that?
WITNESS: Lake Norman.
PRESIDENT RHYNE: So it was done at the hospital?
WITNESS: Yeah, it was. Yeah, they had ordered an ‑- well, he had ordered an ultrasound through another doctor.
PRESIDENT RHYNE: I'm sorry, who had ordered it?
WITNESS: Dr. Buttar has sent us ‑- sent us to another doctor and then they ‑- we had got an ultrasound after that.
PRESIDENT RHYNE: Okay. So it was another doctor you saw?
WITNESS: Yes.
PRESIDENT RHYNE: And ‑- and what kind of doctor was that doctor?
WITNESS: A urologist. I believe that's what he was.
PRESIDENT RHYNE: Okay. Thank you. Thank you very much, Ms. Church, for testifying and we are truly sorry for your loss.
Mr. Jimison?
MR. JIMISON: The Board would now like to call Dr. Herman to the stand.
WHEREUPON,
DENNICE H. HERMAN, M.D.,
being first duly sworn,
was examined and testified
as follows:
DIRECT EXAMINATION BY MR. JIMISON:
QDr. Herman, could you introduce yourself to the Members of the Board, please?
AMy name is Dr. Dennice Herman and I'm a family practitioner in Lenoir, North Carolina.
QAnd how long have you been a family practitioner?
AI've been in Lenoir for 19 years. I did about eight and a half years of emergency medicine and then went back to family medicine about nine and a half years ago.
QAre you presently board certified?
AYes.
QIn what?
AIn family medicine.
QOkay. And did you know Patient A?
AYes.
QAnd how did you know Patient A?
AI know her both professionally and personally. She did see me as a patient on occasions and then I knew her because her daughter is one of our employees in the office and I had met her in social settings as well.
QOkay. And did you ever treat her as a patient?
AYes, I did.
QAt some point, did Patient A get cancer?
AYes.
QAnd how did you understand ‑- how did you learn of that diagnosis?
AI did not actually diagnose her. She had been seeing a GYN physician for some pelvic problems and was somewhat inadvertently diagnosed with cervical cancer. She had actually had some negative PAP smears and then had some bleeding and upon re-examination was diagnosed with cervical cancer.
QAnd did you treat her after that diagnosis of cervical cancer?
AMaybe a couple of times right after her initial treatment for colds and things like that. I did not ‑- I certainly was not involved in her cancer treatment initially.
QAnd Ms. Church, she works for you, correct?
AWell, we both work for the hospital. It's a hospital-owned practice.
QOkay. And are you familiar with the cancer center, M.D. Anderson?
AYes.
QAnd what's your understanding of M.D. Anderson?
AIt is supposed to be one of the premier cancer centers in the country.
QDoes it have the reputation of ‑- what kind of a reputation does it have for cancer?
AIt's supposed to be very progressive and looking on the cutting edge, so to speak, of cancer treatment.
QAnd at some point did you ever become aware that Patient A sought treatment at M.D. Anderson?
AYes. Actually, what happened and I don't have records in front of me, but I did bring her chart. At some time I think it was around April of '06, she had apparently been doing very well after her hysterectomy and radiation treatment. She came to me with a history of right upper quadrant pain and some nausea associated with eating. And my initial impression was, she probably had gallbladder disease and, therefore, I arranged for her to go for the initial ultrasound.
And do you want me to continue with that?
QYes.
QThe ‑- she went to Valdese Hospital for an ultrasound and the radiologist actually called me right after he did the ultrasound and said she doesn't have gallbladder disease, but she had multiple liver metastases and also had some pulmonary or lung metastases as well. And to be honest, I was very shocked at that. He was very certain at that point that it was metastases.
QOkay. And why don't you treat cancer as a family practitioner?
AI'm not trained to treat cancer. I follow my patients along with oncologists and other physicians who are treating them for cancer and treat the other chronic problems that they may have such as diabetes or hypertension, but I have no training in cancer, therefore, I don't treat it.
QWhy is that important for you to only treat those diseases that you have training in?
MS. GODFREY: Well, objection. I think we're getting into an expert witness area.
MR. JIMISON: She's a doctor. I can qualify her, if you would like.
MS. GODFREY: Well, she was not named as an expert witness and I took her deposition, but it was not with the understanding that she was going to be asked for her medical opinions on things. The Board has an expert witness that they did designate already and they did not designate Dr. Herman as an expert witness, but simply as a fact witness.
MR. JIMISON: There ‑- there is no ‑- again, there has been no rule or citation of any rule or statute. An expert witness can give an opinion on an ultimate legal matter like was this within the standard of care. I'm not asking her about whether treatments by Dr. Buttar were within the standard of care for a cancer doctor.
The question was, why is it important for you as a physician to only treat those diseases that you have training in. It's not even ‑- it's not an expert opinion about the quality of care.
PRESIDENT RHYNE: Proceed and answer the question.
AI'm sorry, what was the question?
Q(By Mr. Jimison) Why is it important for you to treat only those diseases that you got trained in?
ABecause the one thing I remember ‑- try to remember most frequently and that is Primum Non Nocere which means first do no harm. And I think that when physicians are ‑- are treating things that they are not well-trained in, they may inadvertently do harm.
If I might just digress, I was reading in the lobby the ‑-
MS. GODFREY: Well ‑-
A‑- the copy of the Forum and one of the first things is your patients build a trusting relationship with you and they respect your advice and your recommendations for treatment and they expect that they will receive appropriate treatments.
QOkay. As a physician, are you familiar with any of the following treatments: hydrogen peroxide ‑-
MS. GODFREY: Well, objection again. She's not an expert witness and she says she doesn't treat cancer patients.
MR. JIMISON: I'm only asking her if she's familiar with these treatments.
PRESIDENT RHYNE: Okay.
MR. KNOX: May I say something?
PRESIDENT RHYNE: Yes.
MR. KNOX: The Rules of Evidence apply and when you don't name an expert even in a medical malpractice case, you cannot subject and alert everybody that you know the truth is the doctor is an expert. It's clear and the statement that he's making is absolutely a erroneous statement. And they never told us that she would be an expert, so we didn't ask her about her opinion. We asked her about the observations that she had learned from somebody else which is hearsay and we would object to.
MR. JIMISON: Again, I mean, I don't want to go back and forth, but it's ‑- you know, this constant back and forth between counsel. I'm trying very hard to avoid it. The ‑- their ‑- the question is, is she familiar with these therapies and I'm not asking her for her opinion. I'm asking her as a doctor, are you familiar with these therapies. An expert witness is designated because they can give an opinion about therapies. I'm only asking if she's familiar, that's all.
MR. KNOX: Well, the proper question is do you know whether or not -- do you know what hydrogen peroxide is, but he puts in a phrase ‑- phase as a family practitioner doctor, so and so, so and so, and that's an absolute erroneous opinion and --
PRESIDENT RHYNE: Mr. Jimison, I would agree that you need to rephrase your question so that they are not leading and ‑- and she was not designated as an expert.
Q(By Mr. Jimison) Are you familiar with hydrogen peroxide therapy?
AI am not.
QAre you familiar with ozone therapy?
ANo.
QAre you familiar with hyperbaric chamber therapy?
AVery little, mainly not related to cancer therapy.
QAnd did you file a complaint with the Board?
AI did.
QAnd why?
AI struggled with this because in my 19 years of medicine, I never filed a complaint against another physician and it was very difficult for me to come to that decision.
But I felt like that my patient and her family were being taken advantage of when they were in a very ‑- very serious situation.
And I was concerned about the therapy that she was receiving and the fact that it was preventing her from being able to spend quality time with her family and, quote, get her affairs in order and deal with life and death and for her family to do the same.
And, therefore ‑- and also the cost that it was incurring to the family who are middle class, not wealthy, and that concerned me as well.
MR. JIMISON: Thank you, Dr. Herman.
PRESIDENT RHYNE: Would you like to cross-examine the witness?
MS. GODFREY: Yes, thank you.
CROSS-EXAMINATION BY MS. GODFREY:
QDr. Herman, when you ‑- the information that you got about what was going on with Patient A, you got that not from Patient A, did you?
ANo.
QYou got that from ‑-
AOh, I'm sorry, excuse me. You'll have to back up. What information are you talking about?
QYou know that was a terrible question.
AIt was.
QLet's all start over.
The information that caused you to file the complaint with the Board ‑-
AOkay.
Q‑- you did not obtain that information directly from Patient A, did you?
ANo.
QOkay. The information that you obtained was from her daughter?
ACorrect.
QAnd from the other employees that are sitting in the back who work in your office?
AYes.
QOkay. And after you got the information, I guess you were concerned?
A(Nods head in affirmative response.)
QIs that ‑- you have to answer verbally, Doctor?
AYes, I was concerned.
QOkay. But you did not go and talk to Patient A or her family about it, did you?
ANo, and I'll tell you why I did not. They ‑- it was just a very tenuous situation. They were having a very difficult time dealing with the fact that Patient A was terminal and I did not want to add to that pain by bringing up this issue at the time.
And Marie was not working at the time. She was going with her mother to these treatment sessions as you've heard, so she was on leave of absence at the time. And as they were gone Monday through Friday every week and so, you know, the weekends were the only time they had at home and I ‑- I just didn't want to impose upon that.
QAnd even after Patient A died, you didn't go to the family and express any concerns to them, did you?
AI had talked with Marie briefly on one occasion and I cannot give you dates or at what point in her treatment that occurred because I do not remember.
But she had come into the office when they were first beginning this treatment and asked me ‑- walked into my office and said, do you know where I can get concentrated hydrogen peroxide. And I had no clue what she was indicating and I said no and she started to tell me about this therapy. And I said, I've never heard of that, Marie, and I don't know what it is.
And then she came by the office again on another occasion and I again expressed to her that I wasn't sure that this was going to be helpful. But I can't give you dates or anything like that.
QWell, and the question I asked is that you never went to Patient A or her husband ‑-
ANo, and I ‑-
Q‑- and ‑- excuse me, can I finish my question?
You never went to Patient A or her husband and said, I have some concerns about the therapy?
ANo.
QOkay. And with regard to Marie, Patient A's daughter, you were only seeing ‑- she was on leave of absence from your office?
AThat's correct.
QAnd so I think you testified when I took your deposition that during the time she was treating ‑- when Patient A was treating with Dr. Buttar, you only saw her maybe two or three times in passing when she would stop by your office for various things ‑-
AThat's right.
Q‑- isn't that right?
You were aware because your office got correspondence from M.D. Anderson that Patient A had failed her treatments at M.D. Anderson?
AThat's correct.
QAnd you were also aware that she did not want to give up hope for trying to do something for her cancer?
AI was aware of that, but most patients are like that.
QOkay. And she never came back to see you ‑-
ANo.
Q‑- as a doctor after she returned from M.D. Anderson?
ANo.
QWhen ‑- when you filed your complaint with the Board, you told the investigator that you did not believe that Patient A's family wanted to become involved; isn't that true?
QThat's true.
QAnd you told them, in fact, that you thought that ‑- that Patient A's family was content with the care they had received from Dr. Buttar?
AAt the time I had no reason to think otherwise and so I didn't offer my opinion on that.
QOkay. And when Mr. Jimison contacted you about being a witness at this hearing, you told him that Marie Church did not want to become involved in this, didn't you?
AI did.
MS. GODFREY: Okay. That's all I have.
PRESIDENT RHYNE: Mr. Jimison, do you want to redirect?
MR. JIMISON: Yes.
REDIRECT EXAMINATION BY MR. JIMISON:
QDoctor ‑- Dr. Herman, would you turn to page 38?
AOf what?
QOf Tab 4 of the big thick notebook.
MS. GODFREY: Page 38.
PRESIDENT RHYNE: Mr. Jimison, there are two big thick ones. Are you referring to ‑-
MR. JIMISON: The Board's which is the particular one with four tabs.
MS. GODFREY: The one ‑- yeah.
PRESIDENT RHYNE: The one with four.
Q(By Mr. Jimison) Are you on Tab 4?
ATab 4, I'm sorry. I didn't hear you say Tab 4. Page 38 under Tab 4?
QRight.
AOkay. We're there.
QAll right. Do you recognize that document? It's already been introduced into evidence.
AYes.
QAll right. And what is that document?
AThis is a record of Patient A's last visit to M.D. Anderson.
QAnd I turn your attention to the first full paragraph, but it looks like the second paragraph of that ‑- of that ‑- of that record.
AYes.
QWhat is being done here?
AEssentially, the physician is telling the patient and the family that there's no other treatment that would be beneficial to her and that she's terminal and they actually recommended hospice.
QOkay. There's a sentence there that says the husband was interested in some type of oxygen therapy.
AYes.
QWould you read that to the Board, please?
AThe husband was interested in some type of oxygen therapy which we do not have available here and I am unaware of any legitimate clinical trials that are being conducted with this approach at this center.
QAnd from your previous testimony we know that M.D. Anderson, in your view, is one of the more progressive and aggressive cancer centers in the country?
MR. KNOX: Objection, it's already been asked about.
PRESIDENT RHYNE: Yes.
MR. JIMISON: Thank you, Dr. Herman.
WITNESS: Thank you.
PRESIDENT RHYNE: Ms. Godfrey, do you want to recross?
MS. GODFREY: No, thank you.
PRESIDENT RHYNE: Are there any Board Members with any questions?
Thank you, Dr. Herman. We appreciate your being here.
MR. JIMISON: At this time, the Board would like to call Dr. John Peterson.
WHEREUPON,
JOHN L. PETERSON, M.D.,
being first duly sworn,
was examined and testified
as follows:
DIRECT EXAMINATION BY MR. JIMISON:
QDr. Peterson, would you introduce yourself to the Members of the Board, please?
ASure. I'm Dr. John Peterson. I am a hematologist and oncologist. Do you want me to fill in the ‑-
QWe'll start. And fortunately I have my index switched here. If you could turn to the thin notebook, Exhibit 15 ‑- no, I'm sorry, Exhibit 7 in the thin notebook.
AYeah, okay.
QSo could you go over your formal medical education and training?
AYeah. I did my undergraduate at the University of Wisconsin in Madison, went to the medical school at the University of Wisconsin in Madison. Did my medical residency at the Medical School of South Carolina in Charleston.
Then I was in my public health service payback for two years to help finance medical school.
And then academic hematology/oncology fellowship at the University of North Carolina for three years. I spent some of my time at time Duke, I spent of the time at the Fred Hutchison Cancer Research Center in Seattle. Following the conclusion of my fellowship at UNC. I did some additional training in transplant at the University of British Columbia in Vancouver.
And after that I went into private practice in Sanford and I've been there ever since. I worked for about 7 years until 1999. I also have clinical faculty position at the University of North Carolina and continue to have a clinic appointment at the ‑- at the Lineberger Cancer Center at UNC.
QSo you are associated with the UNC Cancer Center at the Lineberger Cancer Center?
AI still have clinical appointment, but I do not actively participate in any work there at all now. Since 1999, I've been in full-time private practice in Sanford.
QAnd prior to that, you had a faculty position at UNC?
AYes. And I still have the appointment, but it's really not active.
QAre you board certified in any specialties?
AHematology and oncology.
QAnd how long have you been board certified?
AI don't remember. I'm going to say 1995. Is it in there? It looks like 1995 in oncology and 1994 in hematology.
QAnd do you stay current with your CME?
AYes.
QDescribe some of the things you do to the Board. Describe some of the things that you do to stay current on topics regarding cancer?
AWell, I subscribe to three journal, the Journal of Clinical Oncology and the Journal of Medicine and the Journal of Cancer. And I go to at least one or two medical meetings a year. I typically go to the meeting at Sloan-Kettering every fall. The work I do typically puts on review courses both at the hematology meeting and the oncology meeting every summer and I usually go to those. I sometimes go to breast cancer meetings in San Antonio and they'll be other conferences and other meeting that I attend at various times during the year.
QAnd do you stay current on your CME hours?
AYes.
QOkay. Describe cancer for us. In my opening statement, I mentioned cancer as a single name. Can you describe what is meant by the word cancer?
AYeah. It's unfortunately a vague term. In general what cancer is, is a growth of -- unregulated cell growth. To make it simply and highball the cell program becomes a certain size and it stops growing, but cancer cells are cells that have lost the signal and they just grow and form tumors that get in the blood stream and lymphatic system and migrate through the body and lodge and form more tumors and you just simply lost the mechanisms that normal ‑- normal cells have.
QAre all cancers the same?
ANo. In fact, one of the biggest problems we are having in cancer is that it's getting ‑- it's becoming increasingly -- I guess depressingly clear that finding a treatment for cancer is going to be really a question of finding thousands of treatments for thousands of cancers.
Even a disease like breast cancer, what you'll find is there's really hundreds if not thousands of these cancers. I mean, there was a recent report where they just took one patient's cancer cells and in that tumor they found they could separate cells and they couldn't find any cells that actually had identical genetic mutations. When they got down to that level, what they find is there is no such thing as just breast cancer. You know, we've tried to cut and slice and cut and slice.
I mean, when I first started to study lymphoma there were three kinds of lymphomas, there's over 30 now and under those 30 names, each one of those will have a whole list of molecular mutations that further subdivide them to the point that, you know, it's just a tremendous effort.
And it's made ‑- it's one of the things that made such different cancer disease or diseases so difficult to treat.
MR. JIMISON: At this point, I'd like to tender Dr. Peterson as an expert in the treatment of cancer, oncology and hematology.
PRESIDENT RHYNE: Without objection, accepted.
Q(By Mr. Jimison) Describe ‑- you touched on this, but describe the research that goes on in the battle against cancer. Describe what kind of research goes on today.
AYou want it like drug development research or ‑-
QSure, start with that.
AWell, I guess clinically that's what we see. Of course, in the molecular level there's all kinds of research done at the lab level.
But at the clinical level, you know, they'll find a substance in the lab that looks like it has anti-tumor activity in the cell line. There's a whole screen of these cells lines and now we can kind of standardize for experimental treatment. There's lung cancer cell lines and colon cancer cell lines and breast cancer cell lines and were derived from patients with cancer.
And they can set up a million miles where they can actually get these cancers to grow in rats or mice and then try these various substances that they found in test tubes to see what kind of effect they have on a system such as a rat or a mouse.
And then they get pre-clinical data in the animal studies, they will then move forward with what's called the Phase I study and the patients have a hard time understanding that.
The Phase I study really doesn't necessarily benefit the patient because at that point all you're doing in a Phase I study is trying to see what the appropriate dose in a human is and what the toxicity in a human is.
Now, sometimes the drugs work well in some of those patients on a Phase I trial and will actually get some benefit, but there's no promissory intention of benefit with the Phase I trial. It's just an attempt to go literally from the rat to the human and see are these drugs safe, what's the toxicity, what would be the appropriate dose in a human.
In a Phase I trial they're typically not targeting a typical tumor. You know, a typical or any tumor and list a bunch of their failed standard therapy in which standard therapies are unavailable and with informed consent the patient can consent to go on these trials, but it's made quite clear to them that these are experimental.
After the Phase I, if they get good data, they're safe and they got the appropriate dose and it's all under FDA approval, they can then, after approval, move forward for a Phase II trial.
And throughout all of these trials, these have to go through something called an Institutional Review Board and every single institution would offer it. It's not just ‑- because if UNC wants to do a trial that's offered at Duke, it has to go through the UNC Institution Review Board and it has to be okayed and it's a panel of people. There's lay people, there's oncologists, and surgeons on it and get the data and feel it's ethical, they'll have permission from IRB to do the trial and offer it to patients.
If the Phase I approves, they can go back to the FDA and NIH and get permission to go on to Phase II and then they have to design the trial.
And, again, the Phase II, it's the same IRB that Phase I went through to make sure they are safe and appropriate, the consent form is ethical, the patients have been given a chance to understand what they're signing on to.
At Phase II you start to get some true clinical information where you'll actually know if it's working. Not only have they got the doses down, possibly more patients on it now, and you'll start seeing more side effects and you got more data. And at that point it's usually when you hope to get somebody of which tumors this is most active on.
From there you'll go to a Phase III trial, again through the same regulatory standards. You have to show the data.
And in a Phase III trial is where you're actually now offering treatment benefit potentially. At this point you've got data, it's working in these cancers. This is the approximate response and you're going to compare it then to standard therapy.
At that portion of the trial, the patient can go to the university or even at some private offices and you can get standard therapy for the trial. And the hope is the new drugs or drug or drugs are superior to the old ones. And it would be a randomized trial in which you'll have an opportunity to compare the standard therapy to the new therapy and you'll found out which one is superior.
And after that it goes back to the FDA and they get approval for the regimen.
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