The investigation into the North Texas doctor accused of compromising IV bags revealed at least 10 more “unexpected cardiac emergencies” between May and August, the U.S. attorney’s office for the Northern District of Texas announced Thursday.
Authorities noted in charging documents that the incidents began on the heels of a separate disciplinary investigation into the doctor, about which he had expressed his displeasure.
Dr. Raynaldo Rivera Ortiz Jr., 59, was taken into custody in Plano on Wednesday, Dallas police said. He faces federal charges of tampering with a consumer product causing death and intentional drug adulteration.
Ortiz was being held in the Dallas County jail Thursday. He did not have an attorney listed in court records.
Ortiz, an anesthesiologist, is part of an ongoing criminal investigation into serious cardiac complications suffered by patients at Baylor Scott & White Surgicare North Dallas and the death of 55-year-old Melanie Kaspar, another anesthesiologist at the facility.
In a statement, the health care system — which paused operations at the North Dallas facility — said it had assisted authorities with the investigation, and will continue to do so.
“There is nothing more important than the safety and well-being of those we serve,” the statement said.
If convicted, Ortiz faces a maximum penalty of life in prison.
“Patients expect that their doctors will use only safe and effective medical products during their surgeries. When illicit tampering occurs, serious harm and even death can result,” Charles Grinstead, special agent in charge of the FDA’s Office of Criminal Investigations, said in a written statement. “Working with our law enforcement partners, we will continue to monitor, investigate and bring to justice those who would risk patients’ health and safety.”
A pattern emerges
On June 21, authorities were called to Kaspar’s home in Lakewood after her husband said she gave herself an IV, then complained of severe pain roughly half an hour later before collapsing, according to a police incident report. Paramedics were unable to revive her.
Although Kaspar was initially thought to have died from a heart attack, the Dallas County medical examiner’s office later determined her cause of death was the toxic effects of bupivacaine, a local anesthetic.
The Texas Medical Board said Kaspar used an IV bag from the facility, where Ortiz was seen on surveillance footage placing IV bags into a warmer outside operating rooms. According to the board, lab tests of IV bags from the warmer showed they had been tampered with and not labeled to reveal they contained bupivacaine.
“Such drugs could and would be fatal when administered unknowingly and intravenously,” the board wrote.
Another compromised IV bag left an 18-year-old on a ventilator following what the board called a “routine surgery.”
On Aug. 24, the patient went in for surgery at the center to repair a deviated septum, but the procedure was halted when his blood pressure spiked so high it caused severe respiratory distress.
The patient was intubated and placed on a ventilator. He was released five days later in good condition, Bruce Steckler, the family’s attorney, said.
An analysis of the fluid from the saline bag used during the teen’s surgery revealed the presence of bupivacaine, epinephrine and lidocaine, other drugs that could have caused the patient’s sudden symptoms.
These two incidents suggested “a pattern of intentional adulteration of IV bags used,” surgical center personnel found, according to the criminal complaint against Ortiz.
10 more emergencies
Surgical center personnel identified 10 additional “unexpected cardiac emergencies” that happened during “otherwise unremarkable surgeries” between May and August, an “exceptionally high rate of complications over a short period of time,” the U.S. attorney’s office said.
A majority of the incidents occurred during longer surgeries using more than one IV bag, including bags retrieved midsurgery from a stainless-steel bag warmer.
The criminal complaint detailed one instance in which Ortiz was seen on video quickly walking from an operating room to the bag warmer, placing a single bag inside, looking both directions down the empty hallway and then quickly walking away. Just over an hour later, according to the document, a 56-year-old woman suffered a cardiac emergency during a cosmetic surgery after a bag from the warmer was used during her procedure.
In another instance, the complaint says, video showed Ortiz leave an operating room carrying an IV bag concealed in what appeared to be a paper folder, swap the bag with another bag from the warmer, and walk away. Roughly half an hour later, a 54-year-old woman suffered a cardiac emergency during a cosmetic surgery after a bag from the warmer was used.
Authorities wrote in the criminal complaint that no other workers were seen placing single IV bags in the warmer.
“Our complaint alleges this defendant surreptitiously injected heart-stopping drugs into patient IV bags, decimating the Hippocratic oath,” U.S. Attorney Chad E. Meacham said in a written statement.
The Texas Medical Board was contacted by federal authorities last Thursday about the criminal investigation. They suspended Ortiz’s medical license Friday after concluding he posed “imminent peril” to public health.
Ortiz was previously disciplined by the state medical board in August regarding a 2020 procedure during which he performed anesthesia and the patient required CPR. The board ordered Ortiz to have another physician monitor his practice, take additional education and pay a $3,000 penalty.
In 2018, he was reprimanded for failing to report his arrest on an animal-cruelty charge.
Days before the incidents began in May, Ortiz learned about another disciplinary investigation over a patient who stopped breathing while under his care during a procedure at Surgicare North Dallas, according the criminal complaint.
According to the U.S. attorney’s office, Ortiz “expressed concern” to other physicians over the disciplinary action and complained the center was trying to “crucify” him. One doctor at the surgery center told authorities that Ortiz losing his work at the facility would be financially devastating.
According to Collin County records, Ortiz accumulated $4.1 million of unpaid taxes to the IRS from 2015 to 2020. The IRS removed a lien on his home after he paid a portion of that amount, but tax liens filed in 2021 and 2022 said he owed more than $570,000.
Property records show that Ortiz’s 7,700-square-foot home in Murphy is appraised at $1.3 million.
Baylor Scott & White said recent patients are being contacted and patients with questions may call 214-818-2794.