Pubdate: Sun, 31 Dec 2000
Source: Bergen Record (NJ)
Copyright: 2000 Bergen Record Corp.
Contact:  150 River St., Hackensack, NJ 07601
Fax: (201) 646-4749
Feedback: http://www.bergen.com/cgi-bin/feedback
Website: http://www.bergen.com/
Author: Linda A. Johnson, The Associated Press

DETOX DOCTOR IN TROUBLE WITH STATE

MERCHANTVILLE -- Dr. Lance L. Gooberman knows the long, difficult road
to recovery from drug addiction -- from experience.

A recovering methamphetamine addict who's been drug-free for nearly 14
years, Gooberman for the last seven years has devoted his practice in
addiction medicine to perfecting a procedure called Rapid Opiate
Detoxification. It's designed to eliminate much of the agony of
withdrawal, and to get many addicts terrified of withdrawal into recovery.

The method uses medications to rapidly flush drugs out of addicts'
bodies and ease withdrawal symptoms such as diarrhea, cramps, and
tremors, all while patients are under anesthesia for about four hours
in his office in this working-class Philadelphia suburb. Gooberman
then implants a pellet of medicine in the patient's abdomen that
prevents them from "getting high" if they take opiate drugs during the
crucial first two months of recovery.

Gooberman says his business, U.S. Detox Inc., has successfully
detoxified about 2,350 patients hooked on heroin, morphine, methadone,
and prescription painkillers and guided them into long-term recovery
programs, whose precepts are plastered all over his office.

"I'm just trying to come up with a better way to do detox," Gooberman
says.

But over a four-year span, seven of his patients died within days of
the procedure. Gooberman and his expert witnesses say autopsies showed
the patients had undetected heart problems or took cocaine, triggering
a heart attack.

In a trial beginning Wednesday, state regulators will try to strip the
medical licenses of Gooberman and his former employee, Dr. David
Bradway. Both are charged with gross and repeated malpractice,
negligence, incompetence, and professional misconduct -- and have been
barred from doing the procedure in the meantime.

"Even drug addicts have the right to proper treatment," says Mark
Herr, director of New Jersey's Division of Consumer Affairs, which
oversees the state board regulating physicians. "We just want to make
sure these 'cutting-edge treatments' aren't cutting off life."

Gooberman and his attorney insist the procedure is safe and have lined
up medical experts to testify that Gooberman and Bradway followed
accepted medical standards and that Gooberman's procedure did not
cause any patient's death.

At least a dozen other U.S. physicians, including one in northern New
Jersey, perform variations on the procedure, but in a hospital and
with an overnight stay required. Most learned it from doctors in
Europe, who pioneered the procedure in the late 1980s.

Gooberman and other doctors have been refining it, with some patenting
their particular versions. And a handful of insurance plans have begun
paying for the procedure.

But experts say rapid detoxification severely stresses addicts'
ravaged bodies, and at least a dozen of the thousands of American and
European patients who underwent rapid opiate detoxification in a
hospital also have died.

New Jersey's lawyers are expected to focus on the fact that Gooberman
and Bradway are the only doctors known to perform detoxification as an
outpatient procedure.

"It's not a good procedure if as soon as someone's been able to sit
upright, you toss them out the clinic doors," Herr says.

The state alleges, among other things, that the doctors did not have
sufficiently trained support staff and adequate emergency equipment,
warn patients enough about the method's risks, or properly instruct
the caregiver taking the patient home. The doctors deny all of that.

John Sitzler, the doctors' lawyer, notes their patients' death rate
was just 0.3 percent, lower than for most surgical procedures, and
that outpatient procedures involving anesthesia are commonly performed
in physicians' offices. Meanwhile, heroin kills about 5 percent of
U.S. addicts each year.

Rapid opiate detoxification has been approved by the professional
organization for doctors in their specialty, the American Society for
Addiction Medicine, as long as it's "performed by adequately trained
staff with access to appropriate medical equipment." The society's
executive vice president, James F. Callahan, says patients also should
be monitored for a sufficient time after waking up.

Gooberman, who once advertised his procedure on billboards, estimates
his business has lost $2.7 million in revenues from not being allowed
to do the procedure for the last 18 months. Meanwhile, he has spent
about $400,000 in legal fees.

Gooberman charged $2,900 to $3,600 for his procedure, whereas most
doctors doing it in a hospital charge about $7,000.

Bennett Oppenheim, a psychologist in Fort Lee, once oversaw treatment
at several U.S. rapid detox centers run by a for-profit company called
CITA Biomedical. He now believes the procedure should be done in
community hospitals, not for-profit centers.

"It cannot be an assembly line," says Oppenheim, whose company,
UltraMed International Inc., offers the procedure at Pascack Valley
Hospital in Westwood.

An anesthesiologist performs the procedure, and patients remain there
on monitors overnight. Oppenheim then oversees the patients'
counseling for at least six months. He claims a success rate of 80
percent for about 50 patients treated in the last two years, and plans
to offer it soon in four other hospitals.

The chief medical officer of Oppenheim's company, Dr. Clifford Gevirtz
of Mount Sinai School of Medicine in New York, is expected to testify
against Gooberman. Gevirtz, who has performed the rapid detox
procedure at least 185 times, expects it will eventually gain wide
acceptance.

"If it's done properly, it brings people a humane, safe approach to
detox," Gevirtz says. 
- ---
MAP posted-by: Richard Lake