Byahatti Final Order

NEWARK – Attorney General Gurbir S. Grewal, the Office of the New Jersey Coordinator for Addiction Responses and Enforcement Strategies (“NJ CARES”), and the Division of Consumer Affairs (“the Division”) announced today that the State Board of Medical Examiners (“the Board”) permanently revoked the license of an anesthesiologist who allegedly traveled once a week from her Rhode Island home to her office in Somerset County to indiscriminately prescribe large amounts of addictive opioids and other controlled dangerous substances (“CDS”) to patients.

Pramila Byahatti, who ran the Park Avenue Pain Management practice in Warren, saw approximately 45 patients during a 6.5 hour period each week, prescribing them high dosages of fentanyl, oxycodone, and other opioids without conducting required medical or psychological examinations, properly monitoring their intake of CDS, and screening them for substance abuse issues, according to a Complaint filed by the State on May 13, 2020.

Byahatti has been out of practice since July under a Board-ordered temporary suspension.

In a Final Consent Order filed on October 13, 2020, Byahatti agreed to the permanent revocation of her license as well as the payment of $50,000 in costs and penalties to resolve the allegations against her.

“The COVID-19 emergency has created particular hardship for the very same residents who are most vulnerable to addiction, making our efforts to combat the opioid epidemic more important than ever,” said Attorney General Grewal. “We will take action against any licensee who tries to profit off of their patients’ health by recklessly prescribing opioid pain medications, putting them at risk of addiction, overdose, and death.”

The State alleges that in treating the patients – all males between the ages of 26 and 67 – Byahatti failed to implement coherent treatment plans, adequately document her actions, appropriately examine patients, or take any steps to preclude drug diversion or abuse.

CDC guidelines advise prescribers to use caution when prescribing opioids at any dosage and to start with the lowest effective dosage; to carefully reassess the risks and benefits when considering increasing a patient’s dosage to 50 or more MME per day; and to avoid increasing dosage to 90 or more MME per day, or to carefully justify a decision to bring dosage to that level.

The opioid medications Byahatti indiscriminately prescribed resulted in daily MMEs of 202 – more than four times the CDC’s 50 MME threshold and more than double the upper limit of 90 MME.

For three patients, Byahatti wrote prescriptions that resulted in daily MMEs of 510 – more than 10 times the 50 MME threshold and more than five times the upper limit of 90 MME.

Byahatti also regularly co-prescribed opioids with Xanax, Ambien or other drugs that, when combined with opioids, can result in coma and death.

Since January, the Board has revoked the licenses of six other physicians in connection with their prescription of large doses of opioids without a legitimate purpose. They are:

• Barry S. Sloan, a physician practicing in Wayne, NJ, and Manhattan, whose license was revoked on March 20, 2020, for indiscriminately prescribing CDS to patients, including a New York patient who died of a fentanyl overdose in 2014.In October 2019, Sloan was convicted of manslaughter, criminal distribution of CDS, and related drug charges in New York. A month later, he was convicted of criminal prescription drug distribution in New Jersey. Sloan has been out of practice since July 2018 under a temporary suspension of his license pending the outcome of his case.
• Najum U. Kazmi, a Vineland neurosurgeon whose license was revoked on April 23, 2020, for allegedly prescribing high doses of CDS to his patients for years without even rudimentary safeguards in place to guard against diversion and misuse. Kazmi routinely prescribed excessive dosages of Oxycodone that resulted in dangerously high morphine levels, often in combination with benzodiazepine, putting patients at increased risk of overdose. Kazmi has been prohibited from prescribing controlled substances since July 2019 under a temporary suspension of his N.J. CDS Registration pending the outcome of his case.In January 2020, Kazmi agreed to cease and desist from all practice pending the resolution of his case.
• Craig D. Gialanella, a Belleville internist whose license was revoked on July 29, 2020, as a result of his conviction in a multi-million dollar drug distribution ring. Gialanella was arrested in 2017 as part of “Operation Oxy Highway,” an investigation targeting corrupt healthcare professionals and “pill mills.”  As an alleged supplier to the ring, Gialanella was accused of distributing tens of thousands of oxycodone and Xanax pills. In February 2019, Gialanella pleaded guilty to one count of possession with intent to distribute CDS. Sloan has been out of practice since July 2017 under a temporary suspension of his license pending the outcome of his case.
• Chang Kang, an anesthesiologist in Englewood, whose license was revoked on October 9, 2020. A review of 10 patient files and pharmacy records revealed that Kang indiscriminately prescribed Oxycodone and Alprazolam for pain management over an extended period of time. In a hearing before a committee of the Board, Kang said that he maintained his patients on the CDS regimen they had when they came to him and had little success in weaning them from doses that prior treating doctors had prescribed.
• Jerome Goodman, a psychiatrist in Saddle River, whose license was revoked on October 13, 2020. Goodman agreed to retire his license, to be deemed a permanent revocation, to resolve allegations he was engaged in the indiscriminate prescribing of CDS without sufficient medical knowledge.

“There is no place in the medicine for doctors who abuse their prescribing privileges for financial gain,” said Paul R. Rodríguez, Acting Director of the Division of Consumer Affairs. “Doctors who indiscriminately prescribe addictive pain medications in violation of their professional obligations and state law are contributing to the opioid epidemic we are all fighting to bring under control. By revoking the licenses of these physicians, the Board has removed a significant public threat and sent a message that such conduct will not be tolerated among our medical professionals.”

Also this year, allegations of indiscriminate prescribing led to long-term suspensions for two additional doctors.They are:

• Martin Fried, a pediatric gastroenterologist in Ocean Township who was suspended from practice for five years for prescribing CDS to two patients without a legitimate medical purpose. Fried and the two patients were arrested outside a Toms River pharmacy in July 2018.In June 2019, Fried pleaded guilty to one count of possession with intent to distribute 630 milligrams of Oxycodone. Fried has been out of practice since September 2018 under an indefinite suspension of his license.
• James V. Agresti, an internist with several offices in Morris and Essex counties, whose license was suspended for two years for allegedly prescribing large quantities of opioids and other CDS for prolonged periods of time without medical justification, often in dangerously high MME levels that exposed patients to the risk of overdose.

“The majority of physicians in New Jersey recognize the critical role they play in the fight to end New Jersey’s opioid epidemic and understand the importance of complying with the safeguards in place to prevent the diversion and misuse of addictive opioids,” said Sharon M. Joyce, Director of NJ CARES. “We will not allow their efforts to be undone by a few irresponsible individuals who put profit over patient safety by indiscriminately prescribing controlled substances that can lead to overdose and death.”

The Division of Consumer Affairs’ Enforcement Bureau conducted these investigations. The cases were handled by Deputy Attorneys General (“DAG”) from the Professional Boards Prosecution Section in the Division of Law. DAG Michelle Mikelberg represented the State in the Byahatti and Fried matters; DAG Joan D. Gelber represented the State in the                          and Agresti matter; DAG Kate Calendar represented the State in the Sloan and Kazmi matters; DAG Michael Antenucci represented the State in the Gialanella matter; DAG Kathy Stroh Mendoza represented the State in the Kang Matter; and DAG Bindi Merchant represented the State in the Goodman matter.

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The mission of the Division of Consumer Affairs, within the Department of Law and Public Safety, is to protect the public from fraud, deceit, misrepresentation and professional misconduct in the sale of goods and services in New Jersey through education, advocacy, regulation and enforcement. The Division pursues its mission through its 51 professional and occupational boards that oversee 720,000 licensees in the state, its Regulated Business section that oversees 60,000 NJ registered businesses, as well as its Office of Consumer Protection, Bureau of Securities, Charities Registration section, Office of Weights and Measures, and Legalized Games of Chance section.

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