Reference: Patient A Brenda WXXXXX Date f Birth: 4/15/57 49 year ld white female patient presented n July 20, 2006 with chief cmplaint f stage 4 cancer, initially diagnsed in Octber, 2003 with Cervical Cancer. Histry included Radical Hysterectmy, Bilateral Salping-Ophrectmy and pelvic lymph nde dissectin in August 27, 2003 with 1/14 ndes being psitive. By September f 2003, pt had cmpleted 25 sessins f radiatin therapy. After cmpletin f radiatin therapy, pt had regular check ups every 6 mnths. In April 2004, patient began having right sided pain and saw family physician. Ultra sund and CAT scan revealed metastasis t liver and lung. Referred t MD Andersn and had chemtherapy which included Carbplatin treatment x 2, administered every 4 mnths. Pt cmpleted last treatment June, 2006. July 2006, reevaluated at MD Andersn, and nted t have liver enzymes elevated. Patient was referred t hspice and recmmended pain cntrl. Pt sught us ut due t the fact she was nt willing t give up. Patient was under the care f Dr. Buttar frm July 20, 2006 thrugh August 17, 2006. Despite impending rgan failure as identified by Dr. Buttar, pt and pt s daughter wished t cntinue t fight and nt give up. She was admitted t the hspital n August 17, 2006 and died August 19, 2006. ---------- Each numbered item belw is the NCMB s expert reviewer s cmments n the charts. Each bulleted item is ur respnse, with references t the medical charts shwing the facts. - Dr. Petersn: 1. NCMB Expert s (Dr. Petersn) pinin n Treatment Belw standard f practice/care Patient with Stage 4 metastatic varian cancer, refractry t cnventinal therapy including: Multiple runds f Chemtherapy Multiple runds f Radiatin therapy. Referred t Hspice. Presented with early rgan failure with impending hepatic failure. Sught treatment frm Dr. Buttar. Patient left previus dctrs because they had given up n me. Patient was lking fr a chance. Patient had failed all ther therapies and was NOT willing t simply give up and die! Results clearly BEYOND the standard f care. Patient requested treatment when n ne else was willing t try. Treatment was administered with daughter being fully aware that prgnsis was pr due t: Multiple runds f chemtherapy, refractry t treatment. Multiple runds f radiatin therapy, refractry t treatment. Impending multi-rgan system failure Extended quality f life, albeit nly fr a shrt perid.
We helped the patient t maintain her dignity in allwing her t make her wn chice f cntinuing t fight rather than give up. 2. Dr. Petersn states the patient chart des nt fllw the Prblem Oriented Medical Recrd methd knwn as SOAP. C1a C1b: SOAP frmat is clearly used. C2a C2b: SOAP frmat is clearly used. C4a, C4b: SOAP frmat is clearly used. C6a, C6b: SOAP frmat is clearly used. C7a: SOAP frmat is clearly used. C11a, C11b. SOAP frmat is clearly used. 3. The standard f care wuld have been referral t hspice fr palliatin. C7a: 8/14 Prgress Ntes clearly state that the patient was adamant abut cntinuing treatment. Discussin between Dr. Buttar and daughter n mre than ne ccasin discussing reality f situatin due t impending multi-rgan failure. Daughter requested Dr. Buttar cntinue with treatment and thanked him fr cntinuing t try, despite dire prgnsis, due t multi rgan system failure due t iatrgenic causes secndary t chemtherapy. 4. Dr. Buttar clearly engaged in a fruitless exercise w/ therapy f n benefit in what appears t be nthing but an attempt t extract mney in exchange fr fake hpe. Dr. Petersn has clearly established he is NOT an expert in assessing ur apprach t cancer. Dr. Petersn s canned respnse t each patient shws he was either biased, did nt read the charts, r is incapable f assessing benefit f ur treatment. Patient clearly had benefits, exemplified with better pain management, imprved ambulatin, and increased energy. A1b: N claims f a cure were ever given. Patient signed a cnsent which states: n claim t cure cancer with these therapies has been made t me C7a: 8/14 Prgress Ntes clearly state that the patient was adamant abut cntinuing treatment, even in light f her deterirating cnditin. By definitin, there is NO such thing as false HOPE. HOPE indicates having the pssibility f a desired utcme. By Dr. Petersn s indicated definitin and use f the wrd HOPE, all HOPE wuld be false. 5. N physician cntact dcumented. I1: 7/26 Dr. Buttar perfrmed an IRR treatment n patient. When ever IRR s dne, Dr. Buttar always cnsults with patients and addresses any issues r questins patients have. I2b: 8/3 Dr. Buttar perfrmed an IRR treatment n patient C7a: 8/14 Dr. Buttar had ffice visit with patient and wrte detailed Prgress Ntes I2a: 8/15 Dr. Buttar perfrmed an IRR treatment n patient
In additin, at least 3 separate detailed cnversatins with patient s daughter regarding patients pr prgnsis, cnducted while NP was seeing patient. Mst ther ffice visits were with nurse practitiner but Dr. Buttar was present fr mst f thse visits. Hwever, due t increased rate f ffice visit fr Dr. Buttar, NP wuld see the patient t keep charges lwer and Dr. Buttar wuld cme in and visit with the patient. Ntes were made by NP. - Dr. Mann: 1. N indicatin that Dr. Buttar actually saw r examined the patient. I1: 7/26 Dr. Buttar perfrmed an IRR treatment n patient I2b: 8/3 Dr. Buttar perfrmed an IRR treatment n patient C7a: 8/14 Dr. Buttar had ffice visit with patient and wrte detailed Prgress Ntes I2a: 8/15 Dr. Buttar perfrmed an IRR treatment n patient In additin, at least 3 separate detailed cnversatins with patient s daughter regarding patient s pr prgnsis, cnducted while NP was seeing patient. Mst ther ffice visits were with nurse practitiner but Dr. Buttar was present fr mst f thse visits. Hwever, due t increased rate f ffice visit fr Dr. Buttar, NP wuld see the patient t keep charges lwer and Dr. Buttar wuld cme in and visit with the patient, answer any questins, etc.. Ntes were made by NP. 2. Repetitive labs including serum lipids in particular withut justificatin r explanatin f hw the results were guiding therapy. Ding cmplete panel with lipids was cheaper test than separating test. Patient was nt charged fr serum lipids. Cancer patients as with ther chrnic disease, exhibit lwer serum lipids. Increase in lipid prfile appears t be a gd prgnstic marker fr ur treatment regimen. It is clear Dr. Mann is NOT an expert in the integrative apprach t treating cancer. D1 D16: Requirement fr mnitring renal functin, hepatic functin, electrlytes, and hemglbin cunts in a cancer patient are HIGHLY relevant, especially when they are aggressively being treated fr a stage 4 cancer with multiple IV regiments daily. Labs HIGHLY necessary t mnitr patient safety Labs HIGHLY necessary t assess patient respnse Labs necessary t assist in guiding treatment intensity G1 G11: Cancer panels necessary t establish immune functin, with detailed explanatin in charts prvided G1, G10, G11: explanatin f significance f level f uncntrlled cellular prliferatin mnitring in immuncmprimised pts. Immune functin CD 19, CD 56 cunts Immune functin NKHT3 + Immuncmpetent Natural Killer Cells, NK Cell activity, NK cell activity/cell G3 G4, G11: Lymphcyte Subppulatin prfile CD2, CD4, CD8, CD 3, CD 26
G8, G11: Cell cycle Analysis and dsyregulatin in ncgenesis G6,G7, G11: Apptsis and subsequent suppressin f apptsis in cancer explained in detail 3. Ntes written by NP Jane Garcia cntain sme indicatin f guidance by Dr. Buttar tward the end f the patient s life. C2b: 7/24: Jane Garcia s Prgress Ntes, c-signed by Dr. Buttar I1: 7/26: IRR Treatment perfrmed by Dr. Buttar. When ever IRR s dne, Dr. Buttar always cnsults with patients and addresses any issues r questins patients have. I2b: 8/3: IRR Treatment perfrmed by Dr. Buttar C4b: 8/3: Jane Garcia s Prgress Ntes, c-signed by Dr. Buttar C5: 8/8: RN Penningtn ntes labs were discussed with Dr. Buttar C6b: 8/10: Jane Garcia s Prgress Ntes, c-signed by Dr. Buttar C7a: 8/14 Dr. Buttar s Prgress Ntes fr an examinatin he perfrmed C7b: 8/15/06 Dr. Buttar s nte f cnsult with cnsulting nclgist. C10: 8/15: RN Penningtn ntes patient discussed with Dr. Buttar. Dr. Buttar gives Verbal Order fr treatment. I2a: 8/15: IRR Treatment perfrmed by Dr. Buttar C11b: 8/16: Jane Garcia s Prgress Ntes, c-signed by Dr. Buttar C12: 8/17: Jane Garcia s Prgress Ntes, c-signed by Dr. Buttar 4. Immunlgic studies rdered. Results nt interpreted in the recrd. C11a: 8/16/06 ffice visit, Ca Panel f 7/20/06 discussed and dcumented. Standard plicy in ur ffice fr ffice visits includes: Thrugh review f all lab wrk with the patient. All infrmatin is explained with further details prvided t the patient f any thing the patient des nt fully understand. Cpies f all tests are given t the pt at the cnclusin f any ffice visit where tests were reviewed. 5. Intestinal health screen rdered and btained. N interpretatin. The Cmprehensive Diagnstic Stl Analysis had NOT been cmpleted by the labratry prir t the patient s last ffice visit Therefre, it was nt available fr interpretatin r t review with the patient at the time f the visit. 6. Lymphatic massage rdered. N indicatin it was perfrmed. B7: A Lymphatic Massage was rdered as per reference We d nt perfrm lymphatic massage in ur clinic. Patient had the treatment scheduled by ur ffice with the certified lymphatic massage therapist and given the time and place t g. It was up t the patient t keep their appintment at anther facility. If the prcedure was nt perfrmed, it was due t a patient cmpliance issue. 7. Placed n Nutri-Energetics Infceluticals Prtcl. Jusitificatin and results nt recrded. The Nutri-Energetics System is an advanced bitechnlgy fr the analysis and repair f the human bdy energetic field based n
quantum physics. The system integrates research frm the fields f physics, quantum bilgy, mathematics, acupuncture and Western and Chinese medicine. H3: There are n results recrded f this treatment. Patients generally request this treatment frm us. 8. Philbert Infra Respiratry Reflex Prcedure perfrmed justificatin, and results nt recrded. I1: Prcedure nte with O2 saturatin clearly recrded shwing Pre Treatment and Pst Treatment O2 Sats. Results clearly recrded,, shwing immediate clinical respnse t treatment, assessed with respiratry reserve and O2 saturatins. I2a: Prcedure nte with O2 saturatin clearly recrded shwing Pre Treatment and Pst Treatment O2 Sats. Results clearly recrded,, shwing immediate clinical respnse t treatment, assessed with respiratry reserve and O2 saturatins. I2b: Prcedure nte with O2 saturatin clearly recrded shwing Pre Treatment and Pst Treatment O2 Sats. Results clearly recrded,, shwing immediate clinical respnse t treatment, assessed with respiratry reserve and O2 saturatins. 9. The varius prcedures seem in keeping with alternative and cmplementary care practices and seem safe t the extent knwn. Sme are nt described in terms f methds and intended effects. This is a general statement made based n speculatin. It will be respnded t in a general manner, since there is nthing specific t cunter. In 17 years, Dr. Buttar des NOT have a single frmal patient cmplaint against him. All cmplaints initiating these charges by the NCMB have: NEVER even met Dr. Buttar at any time NEVER had ANY frm f cmmunicatin with Dr. Buttar at any time A clear financially based incentive t cmplaint against Dr. Buttar, which even the NCMB investigatr recgnized and acknwledged during his visit with Dr. Buttar All treatment methds and effects ARE described t the patient in implicit detail. If we did NOT explain methds and intended effects, We wuld have real cmplaints frm real patients, nt family members r ther dctrs. We wuld NOT have patients cming back t us We wuld NOT have patients referring ther patients t us. 10. The medical recrd des nt use SOAP. C1a C1b: SOAP is clearly used. C2a C2b: SOAP is clearly used. C4a C4b: SOAP is clearly used. C6a C6b: SOAP is clearly used. C7a C7b: SOAP is clearly used. C11a C11b: SOAP is clearly used.
11. Early ntes c-signed by Dr. Buttar, later ntes are nt. C2b: 7/24 Jane Garcia s Prgress Ntes, c-signed by Dr. Buttar I1: 7/26 IRR Treatment perfrmed by Dr. Buttar I2b: 8/3 IRR Treatment perfrmed by Dr. Buttar C4b: 8/3 Jane Garcia s Prgress Ntes, c-signed by Dr. Buttar C5: 8/8 RN Penningtn ntes labs were discussed with Dr. Buttar C6b: 8/10 Jane Garcia s Prgress Ntes, c-signed by Dr. Buttar C7a: 8/14 Dr. Buttar s Prgress Ntes fr an examinatin he perfrmed C7b: 8/15 Dr. Buttar ntes patient discussed with Dr. Hlbert, C10: 8/15 RN Penningtn ntes patient discussed with Dr. Buttar. Dr. Buttar gives Verbal Order fr treatment. I2a: 8/15 IRR Treatment perfrmed by Dr. Buttar C11b: 8/16 Jane Garcia s Prgress Ntes, c-signed by Dr. Buttar C12: 8/17 Jane Garcia s Prgress Ntes, c-signed by Dr. Buttar