HOTEL DETOX: FOR AFFLUENT ADDICTS

Programs For Drying Out In Swank Settings Are Typically Ineffective And
Sometimes Illegal. One Beverly Hills Doctor Defends His High-priced Service.

By almost any measure, the heroin addiction treatment a prominent rock
star underwent earlier this year was unorthodox.

For one thing, it took place not at a licensed clinic but at the
Peninsula Hotel, the five-star center of Hollywood deal-making located
in the heart of Beverly Hills. For another, the patient was spotted
during the course of treatment ordering a Jack Daniels at the hotel
bar.

Although the opiates used for treatment were supposed to be securely
locked in a safe in the hotel room, the patient said he had no trouble
gaining access to them at will.

Finally, the treatment was woefully ineffective.

Within weeks the rock star, who spoke with The Times on condition that
he not be named, was undergoing heroin detoxification again.

As unconventional as the star's weeklong sojourn at the Peninsula
might have been, it was not unique.

So-called "hotel detoxes" at the Peninsula, the Four Seasons and other
Westside luxury hotels have become a lucrative practice for physicians
catering to the entertainment industry's rich and celebrated.

Hotel detox is flourishing even though state medical authorities say
it is illegal in many cases and experts in the field say it is almost
guaranteed to fail. Its availability and popularity highlight one
reason why an enduring drug problem afflicts some of Hollywood's
prominent executives and stars--people with the wherewithal and power
to set the terms of their own treatment, often to their own
disadvantage.

Among them: rock star Kurt Cobain, who underwent at least two
unsuccessful hotel detoxes before succumbing to a long-standing heroin
addiction and committing suicide in 1994, and film producer Don
Simpson, who was detoxed five times at his Bel-Air estate before dying
of an overdose in 1996.

In scores of interviews with chemical dependency experts,
entertainment industry sources and former drug addicts, The Times
found that a small group of physicians has been using Los Angeles'
most luxurious hotels to detox celebrity addicts since the mid-1980s,
when the practice was pioneered by maverick addiction specialist Dr.
Robert P. Freemont.

Over the last few years the white limestone Peninsula Hotel, at
Wilshire and Santa Monica boulevards, has won a reputation as the
cushiest place in town to try to kick a drug habit.

That is largely the work of David A. Kipper, a Beverly Hills internist
whose Lasky Drive office faces the hotel's rear entrance. Kipper, who
treated the anonymous rock star, told The Times that he has conducted
100 such procedures at the hotel in a span of 24 months, weaning
patients from a variety of addictive substances ranging from
prescription painkillers to heroin. (In a follow-up letter he amended
the claim to 40 procedures.) State authorities say that conducting
drug detoxification in an unlicensed facility such as a hotel violates
the state health and safety code.

State law also prohibits the use of an opiate to detox narcotic
addicts--a rule flouted by Kipper, who told The Times he uses the
synthetic opiate buprenorphine to wean his patients from heroin.

"I would bet it's not completely legal," Kipper said in an interview
at his office. "But it's a gray area, and the reality is, it works."
Kipper said he has kept the Peninsula management fully apprised of
what he does. But the hotel's management and owners said Kipper never
told them he was conducting a medical procedure on the property.

After inquiries by The Times, the Peninsula said it had "put a
temporary freeze on all doctor-referred patients until we can better
understand this situation." Kipper's fee, from $10,000 to $19,000 per
week of treatment (not including the hotel rate of up to $800 a night
per room), is exorbitant by the standards of addiction medicine. It is
several times the rate charged by such nationally recognized clinics
as the Betty Ford Center in Rancho Mirage and Arizona's Sierra Tucson
for programs combining detoxification and weeks of rehab therapy.

Kipper said the fees are high in part because his program is
administered by an exceptionally qualified and costly staff--and that
the steep price has some therapeutic value.

"I work in a community where people pay top dollar," he said. "My
detox program is probably the most expensive one in the city." Addicts
under treatment, he added, need to have the consequences of their
behavior brought home to them. "There has to be a price to be paid. I
hate to see that it is financial, yet that is one way to make people
wake up and pay attention." Entertainers Can Be a Challenge to Treat
But other addiction experts criticize Kipper's program for its expense
and setting.

"It's outrageous to charge a patient so much money simply to detox
them--no matter how rich they are," said Dr. Drew Pinsky, medical
director of the chemical dependency program at Las Encinas Hospital in
Pasadena.

"To feed an addict's need for special treatment with such pomp and
circumstance is counter-therapeutic," he said. "From an ethical point
of view, it seems to be taking advantage of people who are desperate
to get better, people who are trying to hide their illness and not
confront the painful reality of their disease." There are no
statistics showing that drug and alcohol addiction afflicts
entertainment figures more than the population at large. But treating
them can present unusual problems. Stars often have the money and
power to fend off therapy or to insist on setting the terms of their
treatment. Their money and prominence may also expose them to greater
temptation than the average person, said some Hollywood veterans.

"Entertainers can get away with anything they want," said Danny
Sugerman, former manager of The Doors rock group and a recovering
addict himself. "And the successful ones have unlimited funds. On the
road the temptations and expectations create more pressure.

That's why relapses are so common." Prominent stars and executives
also commonly surround themselves with teams of "enablers"--friends
and employees inclined to satisfy their whims. This coterie sometimes
includes star-struck medical professionals willing to overprescribe
dangerous and addictive drugs.

Others say the relentless pressure from entertainment corporations to
meet deadlines for production and touring can make it difficult or
impossible to fulfill the six-or nine-month rehabilitation commitment
that experts say is necessary to have a strong chance of staying sober.

"Celebrities want to go through detox and go back to work," said Dae
Medman, executive director of the Sherman Oaks-based Entertainment
Industry Referral and Assistance Center, which works with studios and
unions to help employees overcome chemical dependency. "They're not
provided the opportunity for rehabilitation." The result is a
"quick-fix" mentality that places a high premium on detoxification--a
"drying out" process over several days that cleans drugs out of an
addict's system but fails to address the underlying causes of
addiction as a disease.

Most experts agree that successful rehabilitation depends on an
effective detox and on providing the recovering addict with a secure
environment free from temptation and with sustained psychological support.

"People don't understand that drying out is easy," said Dr. Max A.
Schneider, professor of psychiatry and human behavior at UC Irvine and
past president of the American Society of Addiction Medicine. "The
hard part is not getting wet again." Treatment Pioneer Known as a
Maverick Experts are divided over whether treatment should include a
punitive or humbling element to give addicts an incentive to avoid
further drug use or whether it is more humane for treatment to proceed
in the least painful and most comfortable environment possible.

The humane argument was one rationale behind Freemont's work in hotel
therapy.

Freemont, who ran the chemical dependency unit at Beverly Hills
Medical Center before his death in 1993, sought to develop a painless
and discreet alternative for celebrity patients who refused to enter
conventional drug rehab. He established a reputation in Hollywood as a
maverick addiction specialist offering a way to wean celebrities off
heroin while protecting their anonymity.

By the early 1990s, Freemont had detoxed a string of rock stars at
such hotels as the Beverly Prescott and the Chateau Marmont. Many of
his patients returned as repeat customers after their initial
treatment failed, sources said.

Former Three Dog Night singer Chuck Negron said Freemont's program
failed to help him kick his habit.

"They detoxed me and then sent me out on the road with different
medications that were legal," Negron said. "At one point, I ended up
having a bigger habit on the prescription stuff than when I first
checked in. Freemont had this prescription cocktail, and when you got
excited they would hold you down and give you a shot. And let me tell
you, that shot was better than any dope I ever scored on the street."
In 1993, the Medical Board of California charged Freemont with gross
negligence and unprofessional conduct for allegedly overprescribing
drugs--including buprenorphine--and administering medications without
proper follow-up exams. He died before the board finished its
investigation, and the case was dismissed.

The hotel detox business was then taken up by several Westside
physicians who checked celebrities into such high-end hotels as the
Four Seasons, Nikko, Century Plaza, Miramar Sheraton and Beverly Hills
Hotel, sources said. The hotels were unaware that addicts were being
detoxed on their premises, according to doctors and hotel managers.

The physicians include Michael Horwitz, former head of Cedars-Sinai
Medical Center's chemical dependency unit; Michael Meyers, former
medical director of Brotman Medical Center in Culver City; Milton
Birnbaum, director of addiction medicine at Steps rehabilitation
center in Oxnard; and Stephen Patt, an internist who detoxes addicts
for the Promises treatment center in Malibu.

These doctors said they employed the treatment in their private
practices and only as a last resort to help a patient who adamantly
refused to enter a hospital or licensed rehabilitation center. None of
them charged more than $1,000 per day (including the hotel room) and
none used buprenorphine for detox, sources said.

Some of the doctors have supervised hotel detoxes recently. Birnbaum
and Patt told The Times they found the technique ineffective,
especially when compared with comprehensive detox and rehabilitation
programs at well-supervised clinics.

"It's much safer to detox somebody in a hospital," Birnbaum said. "The
controls in a hotel are not good.

The patient could have a seizure. They could have a heart attack or
have someone bring them drugs. I've had addicts literally get up and leave
the hotel room--despite nurses being in attendance--and go out and cop
heroin in the lobby." Said Patt: "The only thing positive I can say about
hotel detoxes is that sometimes they act as a steppingstone to a later detox
at a licensed inpatient facility." Kipper has embraced the hotel method. The
50-year-old UCLA-trained internist, who took over the practice of the late
Dr. Elsie Giorgi, a well-known physician-to-the-stars, began checking
addiction patents into the Peninsula in 1996. He said about half his
addiction treatments are for heroin; most of the rest are for prescription
drug addictions, with a handful for alcohol.

In the anonymous rock star's case, Kipper prepared a contract
identifying his service as the PENN Project, a term he said
specifically referred to the Peninsula. A copy examined by The Times
covered a 14-day detox for a fee of $38,360, including $18,000 for
Kipper's medical services, $17,360 for 24-hour nursing and $3,000 for
"support staff and administrative." The hotel room was extra. The
treatment ended up being extended for six weeks, covering several
attempts at detox. Kipper billed the patient about $90,000 before it
was over, sources said.

Kipper said the contract covered two weeks during which the star was
on a maintenance program to keep him off heroin. The doctor said the
case was unique, describing the entertainer as "the most recalcitrant
patient we've ever treated." The cost varies from patient to patient,
Kipper said, depending on how many nurses, counselors, therapists and
other professionals he employs to help conduct the detox. Typical
charges run from $10,000 to $14,000 a week, but can go as high as
$19,000, he said. Despite the price, Kipper said his treatment method
is so popular that during one week this year he was detoxing four
addicts in separate rooms around the Peninsula.

Kipper said his program includes round-the-clock nurse supervision as
well as visits from a psychiatrist, a physical therapist and a group
of recovering addicts who are invited to encourage the patient to
enter a rehabilitation program. In some cases, he also brings in a
nutritionist, an acupuncturist and an art therapist to aid a patient's
progress.

Candy Finnigan, a certified drug counselor who works with Kipper, said
his program is unique in the detox field.

"I don't think Dr. Kipper is ripping anybody off," she said. "This
isn't just a spin-dry approach where he's shoving people in there and
then hanging them out to dry. This man is a dedicated professional. I
find not a flaw in his commitment." Some patients have responded well
to his treatment.

One is Karen Rosenthal, a businesswoman whose history of migraines had
left her addicted to a wide range of painkillers.

After rejecting a counselor's suggestion that she check into a
rehabilitation clinic, she turned to Kipper with the request that he
supervise her detoxification during a weeklong stay at the Peninsula
with 24-hour nursing care. She said that the program was a success and
that she has stayed off drugs for the last 18 months.

"Without his intervention, I probably would have died," she
said.

'Not Doing Anything Avant-Garde' The rock star who ordered Jack
Daniels at the hotel bar, however, told The Times he thought Kipper's
program was ineffective and too costly.

He said he relied on Kipper's representation of himself as an expert
in addiction medicine but now questions whether the doctor might have
taken advantage of him, "considering the vulnerable state that I was
in when I entered the program." As a licensed physician, Kipper can
legally conduct conventional detoxification therapy, but some experts
in the field say those with addicts under their care should be
specially trained and certified by the American Society of Addiction
Medicine. The country's leading organization of addiction experts, it
certifies those who pass a test demonstrating familiarity with the
latest clinical developments in the field.

Asked in an interview whether he was certified by the society, Kipper
replied, "I'd have to say no, because I don't know what it is." Kipper
argues that in his treatment program "we are not doing anything
avant-garde." He said he treats narcotic addicts with intravenous
solutions of dextrose and vitamins, followed by detoxification with a
combination of drugs--including buprenorphine, clonidine and depacote.
He said he will not agree to start the treatment unless the patient
agrees in advance to enroll in a rehabilitation program for at least
30 days after treatment.

"Detoxing people is a very separate issue than getting people to stay
sober," Kipper said. "They are really two very different parts of the
puzzle. I focus on the detox part and then, depending on who they are
and what they need, I send them to a variety of places such as Betty
Ford and Sierra Tucson." Kipper, who said he has been practicing
internal medicine in Beverly Hills for more than 25 years, said the
detox program is only one aspect of his medical practice. He said none
of his detox patients has ever experienced a medical emergency at the
hotel.

Shifting Definition of Success in Program Kipper told The Times in an
interview that his program has a 70% success rate, which he defined as
patients having no relapses for a year. In a follow-up letter, he
said, "We consider a detoxification successful only when patients are
admitted and maintained in a treatment facility for one month after
leaving our supervision," a much less rigorous standard.

"Ninety days [of treatment] keeps cropping up as a critical
threshold," said Dr. Norman Hoffmann, an associate professor of public
health at Brown University who has conducted a study of 15,000
alcoholism and drug addiction patients. "Anything less than three
months is essentially useless." Hoffmann said he found implausible
Kipper's claim that 70% of his patients stayed clean for a year.

"Maybe if all his patients are airline pilots, who are highly
regulated, closely scrutinized, and have a hell of a lot to lose," he
said. Among a population of affluent entertainment professionals with
largely unstructured daily lives, "I'd believe that figure as soon as
I'd believe in Santa Claus or the tooth fairy." Hoffmann said 65% of
patients undergoing weekly counseling for six months after detox
remain drug-free for at least a year.

Hotel detox programs raise several concerns for state medical
authorities.

The California Uniform Controlled Substances Act specifically forbids
treatment for narcotic addiction anywhere but in a hospital or a
facility approved by the state Department of Health Services.

"There is a reason we have licensed chemical detoxification programs
in this state," said Marc Gonzalez, a supervising investigator with
the state medical board. "Strict protocols must be followed in a
controlled environment by qualified people who know how to properly
treat potentially life-threatening withdrawal symptoms--and that
doesn't come in a hotel room. Hotel rooms do not fall under the law."
Gonzalez added, "Based on my interpretation of California law, it is
not appropriate to detox someone from heroin or any addictive
prescription drug except in a licensed facility or a physician's
office." Officials said the law also prohibits doctors from detoxing a
patient at a residence, where experts say an addict may be able to
exert even more control over his treatment than at a hotel. The
dangers of home detoxification came to light after the 1996 overdose
death of producer Simpson.

The medical board has since filed an accusation against Westside
psychiatrist Dr. Nomi J. Fredrick for overprescribing drugs to Simpson
and for helping to maintain and operate an "unlicensed chemical
detoxification program" at Simpson's Bel-Air home.

That program ended in 1995 when another physician involved in the
treatment was found dead of a morphine overdose in the producer's pool
house.

Simpson died six months later from an overdose of 21 drugs at the same
residence.

Moreover, state and federal law closely regulates the conditions under
which doctors can administer opiates to narcotic addicts.

Although treating heroin addiction with buprenorphine is an accepted
practice in Europe, it is not legal in the United States, where the
drug can legally be administered to addicts only for pain relief, not
for detoxification, except in clinical trial settings.

In a Sept. 14 letter to The Times, Kipper said that buprenorphine is
used "specifically for heroin detoxification and remains the standard
for therapy for treating acute opiate withdrawal." On Friday, however,
Kipper told The Times that he was careful to record on the patient's
medical chart that he was prescribing the drug for pain relief--the
only legally permissible application.

"You don't write down in the chart that you are giving [buprenorphine]
for detox," Kipper said. "You write down in your charting that you are
using it for pain management. However the semantics are written, it
keeps these guys comfortable and keeps them from drug seeking."
Offering a 'Safe, Not a Sterile, Environment' How well informed the
Peninsula and its staff were of Kipper's activities is unclear.

The hotel's general manager, Ali V. Kasikci, told The Times in an
interview that he had the impression Kipper was checking patients into
the hotel for preoperative comfort and postoperative recuperation--as
many other local physicians do with affluent patients facing surgical
procedures.

"I was shocked and disappointed to learn that physicians in this
community would engage in any alleged unauthorized practice at the
hotel," he wrote in a letter to The Times. "We have asked our
attorneys to look into this matter, and to take whatever legal action
is necessary to prevent any further use of the Peninsula's facilities
or name associated with this practice." He said Kipper has been
instructed not to refer any further patients to the hotel until the
Peninsula can investigate the legality of his program.

Kipper told The Times that security officials at the hotel were
specifically notified of the location of each of his detox patients.
On at least one occasion, he said, he arranged for the bartending
staff to be instructed not to serve liquor to a patient.

A nurse who worked with Kipper's patients said she believed the
activities were well-known to the staff.

"The front desk recognized most of the nurses," she
said.

Kipper said the hotel had even furnished him with a key to its back
door. But Kasikci said Kipper is not authorized to use a hotel key.
"It won't matter if he does have it; the locks will be changed in two
hours," he said Thursday.

Another element of Kipper's program that draws skepticism is allowing
patients to use such hotel amenities as the spa and pool, where they
can come into unregulated contact with other guests. That violates
accepted wisdom in the field that addicts in treatment should remain
in a sequestered environment where they can obtain psychosocial
support from experienced professionals and avoid the temptation to
backslide.

But Kipper insisted that he maintains an appropriate level of security
for his patients. "I want to keep them in a safe, not a sterile,
environment," he said.

Although Kipper has never advertised his treatment program, he said
demand is so great that he turns patients away. "There is a reason why
we are so successful and busy," he said. "It's because we have the
best program out there."

Detox, Hollywood Style Experts in the addiction field say that
successful drug treatment has several key elements and detox programs
conducted in luxury hotels generally don't meet those standards.
Accepted Care Standard / Safety Doctor certified by American Society
of Addiction Medicine and other qualified personnel on site with
access to proper equipment to treat patient in case of a seizure,
heart attack or other medical emergency. Hotel Detox / Safety No
emergency medical equipment on site. Patient is monitored by nurses
around the clock, but doctor must be contacted by pager and rely on
paramedic response in case of emergency.

Accepted Care Standard / Environment Manipulative addicts are
isolated from access to drugs and alcohol. Facility screens out
individuals who might bring drugs to addicts during visits. Hotel
Detox / Environment Addict has access to visitors who can bring in
drugs and is often free to mingle with guests in an environment where
alcohol and other temptations are available.

Accepted Care Standard / Aftercare Rehabilitation program is based on
12-step philosophy requiring interaction with other addicts in
recovery; no patient is given special treatment. Most of the patient's
30-day stay is spent in counseling sessions and group meetings
designed to address the psychological components of addiction
disease.Counseling may continue for months.

Hotel Detox / Aftercare Patient choses whether to continue in
aftercare program to address psychological aspects of the disease.
Special, private treatment in a luxurious atmosphere that can be
easily manipulated by the patient.

Accepted Care Standard / Daily Regimen Patient is placed on a
highly structured daily schedule requiring exercise and specific
housekeeping and other duties. Patient is regularly escorted to AA
meetings in the community.

Hotel Detox / Daily Regimen Individually designed program varies in
structure. Patient has option to quit or leave at any time.

The Cost of Drug Treatment

Dr. David Kipper: $10,000 to $19,000 a week (not including the cost of the
hotel room, which can run up to $800 a day) for detox alone.
Malibu Promises: $24,000 for 30 days, including detox and rehabilitation.
Sierra Tucson (Arizona): $20,000 for 30 days, including detox and
rehabilitation.
Betty Ford (Rancho Mirage): $12,100 for 28 days of recovery, not including
detox.
Steps (Oxnard): $10,000 for 30 days, including detox and rehabilitation.
Impact (Pasadena): $4,500 for 30 days, including detox and rehabilitation.

Checked-by: Patrick Henry