A New Jersey doctor who has drawn national attention for his unconventional treatment of heroin addicts, including patients in Maryland, has stopped performing the procedure while under investigation in the deaths of six patients.
Dr. Lance L. Gooberman of Merchantville, who has advertised on billboards along the East Coast a detoxification treatment said to be speedy and painless, signed a consent order Wednesday with New Jersey's Board of Medical Examiners that bars him from using the technique in his office until the board conducts a hearing.
The New Jersey attorney general's office filed a complaint this month against Gooberman and his associate that says the treatment, known as Ultra Rapid Opiate Detoxification, contributed to six deaths and sent dozens of patients to the hospital, some with life-threatening conditions.
The complaint accuses Gooberman of "gross and repeated malpractice, negligence and incompetence" and seeks to revoke or suspend his license.
"The only thing ultra about ultra detox was the risk to health of the patients," said Mark Herr, director of the state Division of Consumer Affairs, which oversees the Board of Medical Examiners.
"This is a treatment that is not medically established nor recognized."
Gooberman, who voluntarily ceased offering the treatment early this month and does not admit any wrongdoing in signing the consent order, has performed the procedure on more than 2,300 patients since 1994. None of the deaths involved Maryland residents, his attorney said.
Gooberman, 47, and his attorney say the procedure is safe and that he will resume performing it when he finds a hospital to accommodate him, which the agreement allows with the approval of the medical board.
His attorney, Alma Saravia, said two of the patients who died might have died of subsequent cocaine use.
"Clearly, when [the patients] left the office it was safe to discharge them," Saravia said. "If a patient leaves and chooses on their own to use cocaine -- in our consent form we tell them that using cocaine could jeopardize their life."
The consent order also covers Gooberman's associate, Dr. David Bradway, who lost his medical license in 1980 after he was convicted of manslaughter for his role in a friend's fatal drug overdose and served a 14-month prison term for illegally prescribing drugs. Bradway's medical license was reinstated two years ago.
The rapid detoxification procedure compresses withdrawal from several days into three to five hours by draining the brain of heroin or other opiates while a patient sleeps under general anesthesia.
The cost, $2,900 to $3,600, is substantially less than that of conventional methods, but most insurers don't cover the procedure.
After the patient is detoxified, Gooberman surgically implants a pellet into the patient's abdomen. The pellet contains naltrexone, a drug that blocks the effects of opiates for two months. That method is also controversial and has not been approved by the FDA. Gooberman will continue to administer the pellets to patients who are already detoxified.
According to the complaint:
Six of Gooberman's patients have died since 1995 within three days of the treatment. Since 1994, dozens of patients have been rushed to the hospital shortly after the treatment, shaking, short of breath, vomiting blood or unable to speak.
An unofficial 1996 report by the National Institute on Drug Abuse found the procedure "without ethical, medical, scientific or financial justification as a clinical detoxification treatment."
In other places where the procedure is performed, including England and about a dozen other U.S. states, it is done under the direction of an anesthesiologist, the patient is kept overnight and critical care physicians are immediately available. In Gooberman's practice, patients were given general anesthesia by nurse anesthetists, not by anesthesiologists, and doctors who specialize in critical care were not present.
Under the agreement, Gooberman and Bradway will stop advertising the procedure.
The Sun has reported that Gooberman, who grew up in southern New Jersey, earned a medical degree in Mexico, then trained at a teaching hospital in Camden. He heard about a rapid detoxification program in Vienna, Austria, but it was impractical for use in the United States because it used long-acting drugs that left patients too groggy to go home the same day. The overnight stay produced a cost near $10,000, prohibitive by U.S. standards.
Gooberman tailored the treatment to the American market by using a short-acting anesthetic that enabled him to release patients the same day and cut costs by more than half.
He treated his first patients at a New Jersey hospital that gave him $23 of the $3,200 it collected from each patient, so he brought the method to his private practice.
He built his practice in ways considered unorthodox among traditionalists, through newspaper ads and billboards, including eight in Baltimore; he opened a Web site and appeared on Montel Williams' television show.
The billboards turned out to be an ingenious way of attracting middle-class suburbanites who saw the ads on their way out of drug markets in places such as Camden, Philadelphia, Newark and Baltimore.
Two former heroin addicts who underwent the treatment attended a news conference Thursday at the office of Gooberman's attorney and praised Gooberman and the technique.
"If it wasn't for him, I don't know where I'd be right now," said Stephanie, 20, of Philadelphia, who said she began shooting up when she was 15. She spoke on condition that her last name not be used. "I kept trying and trying to get clean."
Gooberman said this week that he will push forward to bring his procedure to more addicts: "I am concerned for the many patients who desperately need medical help in my absence," he said in a statement.
" I will continue to fight this issue to offer my patients a chance to lead a clean and sober life."