Addiction Treatment Can Be Fatal -- N.J. Investigates Six Patient Deaths At Detox Clinic

Frank Stavola Jr. had family that loved him, a thriving construction business in Monmouth County, N.J., and money enough for big-game hunts, ski trips and saltwater fishing in Cancun.

He also had a heroin addiction he concealed from almost everyone.

Three years ago, determined to get straight before Christmas, Stavola, 43, turned to Lance Gooberman, a South Jersey doctor whose highway billboards promised a swift cure for drug addiction.

Stavola checked into Gooberman's U.S. Detox clinic in Merchantville on the morning of Dec. 23, where he was anesthetized and given a cocktail of drugs to sweep the opiates from his brain. By afternoon, he had returned to his parents' home in Middletown.

Seven hours later, he was dead.

New Jersey officials are now investigating the deaths of six patients who died within 72 hours of leaving Gooberman's outpatient clinic. Their efforts have focused attention on the treatment those patients received, ultra rapid opiate detox, and the secretive world of suburban drug abuse.

The state hasn't revealed the dead patients' names, but The Star-Ledger of Newark has identified several including Stavola and Lisa Ann Flowers of Elizabeth, N.J.

All could afford the cost of treatment, as high as $3,600. And Gooberman's ads promised them confidentiality. Few people knew they took drugs.

Attorney Alma Saravia, who represents Gooberman and his partner, David Bradway, in their fight to save their licenses, defended the procedure and said the doctors are just beginning to examine autopsy information from all six cases in question. Bradway was the attending physician for Flowers.

"I don't think anybody can say with any evidence that the procedure caused the deaths," she said.

In many ways, Stavola was typical of Gooberman and Bradway's clientele, precisely because he didn't fit the stereotype of a street junkie.

Born in Red Bank, N.J., he attended the Christian Brothers Academy in Middletown and Franklin Pierce College in New Hampshire. Eventually, he took his place in the enterprise built by his father and uncles. The family's holdings, including real estate, quarries, contracting and road-supply companies, were recently estimated by the Business Journal of New Jersey to exceed $200 million.

Stavola ran a quarry. Tall and well-built, Stavola came off as a gentleman in a rough, dirty business. He was generous and unassuming, friends said, and unlikely to lose his patience when something went wrong.

Stavola's family, while acknowledging he died after visiting U.S. Detox, would not discuss his death, saying it was too painful.

Monmouth County Prosecutor John Kaye said Stavola contributed to his own death by taking drugs, even as he set out for Gooberman's clinic. After using heroin with a female friend, Stavola left for Gooberman's clinic at 6 a.m., Kaye said.

His detox treatment began at 8:15 a.m and finished by 1:30 p.m. Two hours later, he left. After his discharge, he went to his parents' home to recuperate.

About 9:30 p.m. Stavola collapsed in a bedroom. He died at 10:07 p.m. of a pulmonary cerebral edema due to drug abuse, according to Kaye and to Board of Medical Examiners records. The autopsy found traces of cocaine, morphine and an anesthetic, as well as nordiazepam, the active ingredient in Valium.

Kaye said Stavola took drugs after leaving the clinic. Other practitioners of rapid detox programs say that the likelihood that patients may relapse or even overdose is one of the reasons patients must be watched closely after the treatment.

For many addicts, ultra rapid detox amounts to a last chance. Many patients who had tried going cold turkey or who had given up on methadone clinics turned to Gooberman.

Parents brought him their children. Executives took time off from work to detox. College students visited his clinic during school breaks. Most of Gooberman's patients could pay or had friends or family who could.

In ultra rapid detox, powerful anesthetics render patients unconscious four to six hours. A breathing tube is inserted in the patient's throat. Drugs called opiate antagonists displace opiates clinging to the nerve endings in the brain. Addicts endure in a few hours the harrowing process of withdrawal that can last several days in conventional detox programs, sleeping through the excruciating pain, anxiety and intense craving for the drug.

Gooberman, who says he was once addicted to amphetamines but has been in recovery since 1987, vigorously defended his practice in a recent interview at his attorney's office. Since 1994, he said he's helped about 2,150 patients, many of whom have kicked the habit for good.

"Almost all of my patients have tried and not succeeded at other forms of treatment such as methadone or sedative detoxification," Gooberman said.

State medical officials, however, say Gooberman and Bradway put their patients at risk through substandard care. A complaint filed last month by the New Jersey Board of Medical Examiners contends the doctors lacked proper training to perform such a dangerous procedure.

The complaint also says the doctors failed to take adequate safeguards before and after treatment.

Lisa Ann Flowers was released just minutes after emerging from detox and, according to family members, was carried into a waiting car. Several hours later, her mother, Diane Flowers, got a telephone call. Ambulance workers had taken her 20-year-old daughter to a hospital. She was having difficulty breathing.

Flowers rushed from her home to the hospital, where doctors told her, " `We think Lisa had a heart attack.' I was shocked. Just stonefaced," the mother recalled. Within hours, Lisa Ann Flowers was dead.

The mother soon learned that 18 hours earlier Lisa had undergone ultra rapid opiate detoxification at U.S. Detox. Flowers had no idea her daughter used heroin, or that any doctor could put patients under anesthesia and then let them leave the office a short time later.

The attorney general's complaint says Lisa Flowers began the detox at 8 a.m. and the procedure, performed by Bradway, ended at 11:15 a.m. She was released 15 minutes later.

"You might ask, `How could I not know?' But we were close," Diane Flowers said. "Just before her death, she gave me this book about mothers and daughters. She said she knew I was working hard. She didn't want me to know (about the drugs) because she didn't want to hurt me."

A year before she died, Lisa, a teenage mother, was taking her daughter for ice cream when her car collided with a pickup truck.

The toddler died. Lisa walked away.

Her mother said the death drove Lisa to psychological counseling and, eventually, to drugs.

"He told me that when Lisa heard about this detox, she said, `It's a dream come true. I have to do it.' She had enough sense in her head that she knew drugs were the wrong way, and she sought help," Diane Flowers said.

The Ocean County Prosecutor's Office is investigating and says the autopsy cites "acute myocardial infarction following rapid opiate detoxification" as the cause of death, according to spokesman Greg Sakowicz.

The state complaint before the Board of Medical Examiners faults the clinic for not providing enough care after discharge.

Saravia, Gooberman's lawyer, said clinic policy is that every patient who leaves must be awake, alert and able to walk 300 feet. Caretakers are briefed about the procedure, and any patient experiencing continued withdrawal symptoms can contact the office for additional medical care. Gooberman has admitted people into the hospital if necessary, she said.

Supporters of Gooberman said they kicked drugs because of the procedure. Two of them appeared at a recent news conference to answer the state's charges.

"I don't know where I would be without him," said Stephanie Hunt, 20, a former addict and prostitute from Philadelphia who was referred to Gooberman by a friend.

Gooberman said his interest in the treatment arose from his own struggles with amphetamine addiction. After completing medical school in Mexico, he earned a medical license in New Jersey and began working at Cooper Medical Center in Camden.

In 1995, he began performing ultra rapid detoxes at the Cooper Medical Center but had to stop because there were not always enough beds in the intensive-care unit for his patients.

"Patients who knew that I was doing this were actually coming to me and crying, literally, in my office," he said. "I realized that if I got the equipment and personnel, there was really no real reason why it couldn't be done in the office."

To David Kerr, president of Integrity House, a drug-rehabilitation center in Newark, the whole area of ultra rapid detox puts too much emphasis on the initial detox. His clients come to Integrity House through the criminal justice system.

"Our guys kick heroin cold in jail. The chemical withdrawal is really not a big deal," he said. Detox is just the beginning of a long, complex effort to remain clean, Kerr said.

"No one has the answer in one quick formula."