Health Advisory
GUIDANCE AFTER PAIN MANAGEMENT PHYSICIAN’S LICENSE REVOKED

The Division of Public Health (DPH) is issuing this health advisory to make health care providers aware that the Board of Medical Licensure and Discipline has permanently revoked the medical license of Dr. Nihar B. Gala, effective immediately. The revocation was a result of allegations of unprofessional conduct related to the prescription of opioids to a patient at high risk of addiction.

There may be former patients of Gala who wish to obtain opioids, benzodiazepines, amphetamines or medication-assisted treatment (MAT) for continuing management of their symptoms. Individuals who may be misusing and abusing prescription medications are at a higher risk of drug-seeking behavior, illicit use of prescription medications and illegal substances and for dangerous withdrawal symptoms, including the potential for overdose or death.

Summary

The Board of Medical Licensure and Discipline met on Tuesday, May 7, and voted to revoke Gala’s medical license following a recommendation by an administrative hearing officer. A revocation, by law, is to become effective immediately upon the vote by a board, regardless of when the Order is signed.

Background

According to a complaint filed by a state prosecutor, Gala exchanged opioid prescriptions with a female patient who was struggling with addiction in exchange for sexual favors while working at various “Got-A-Doc” medical centers in Millsboro and Camden prior to 2017. Gala ran a pain management and addiction treatment center — Alpha Care Medical — in Millsboro.

Reccommendations

To help Gala’s patients find appropriate continued pain management care and appropriate medication support, DPH is recommending that:

•  Patients of who were receiving treatment for substance use disorder contact DSAMH’s Mobile Crisis Helpline for Kent and Sussex counties at 1-800-345-6785 to get connected to new treatment services or talk with their insurer.
•  Prescribers should evaluate patients for substance use disorder risk as part of any regular clinical visit, but especially if they will be prescribing any controlled substances in general and opioids in particular. A sample opioid risk assessment tool can be found at Help Is Here: https://www.helpisherede.com/Content/Documents/Opioid-Risk-Tool.pdf
•  Consider tapering to a reduced opioid dosage or tapering and discontinuing opioid therapy under certain circumstances. Abruptly stopping opioid medication is not recommended. Review the Centers for Disease Control and Prevention guidance about tapering at Help Is Here in the Safe Prescribing section: https://www.helpisherede.com/Health-Care-Providers/Safe-Prescribing#intro.
•  If a patient appears to be at risk for substance use disorder, consider alternatives to controlled substances and in the event the use of these medications is unavoidable, monitor their use very closely. To the extent possible, use alternative therapies such as:
  •  Rehabilitative services, physical therapy, exercise and strength training for chronic pain
  •  Cognitive behavior therapy and relaxation techniques for chronic pain and anxiety
  •  Clinically appropriate non-controlled medications including but not limited to:
    •  acetaminophen and/or non-steroidal anti-inflammatory drugs (NSAIDs) for chronic pain
    •  selective serotonin and serotonin and norepinephrine reuptake inhibitors (SSRI and SNRIs) or tricyclic antidepressants (TCAs) for anxiety and chronic pain
    •  atomoxetine (Strattera) and/or guanfacine (Intuniv) for ADHD
•  For further information on substance use disorder for community members and medical providers, visit “Help is Here” at:  www.helpisherede.com. For a list of current locations that offer outpatient, inpatient, detoxification, recovery support, and recovery living, visit www.helpisherede.com/Resource-Guide/Here-for-me.
•  To reduce “doctor-shopping” and to check the patient’s history for controlled substances, query the Prescription Drug Monitoring program at http://dpr.delaware.gov/boards/controlledsubstances/pmp/default.shtml.
•  Medical providers and law enforcement should be especially vigilant about potential patient overdoses or those with drug-seeking behavior, particularly in and around Millsboro where Gala’s practice was located.
•  Patients should be reminded to lock up all medications or put them out of the way of anyone, including children or pets, who might try to consume them, whether by accident or on purpose. Patients can safely dispose of any unused medications at Delaware prescription medication drop boxes. There are 21 permanent drop boxes at this time. For a complete list of locations, visit www.helpisherede.com.

Additional information

•  U.S. Surgeon General resources on opioids for physicians and patients:
  http://turnthetiderx.org/
•  CDC Guidelines for Prescribing Opioids:
  https://www.cdc.gov/drugoverdose/prescribing/guideline.html
•  Opioid risk assessment tool:
  https://www.drugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf
•  Help Is Here
  www.helpisherede.com

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