A Texas anesthesiologist who has a history of disciplinary actions against him injected nerve-blocking and bronchodilation drugs into patient IV bags at a North Texas surgical center, resulting in at least one death and multiple cardiac emergencies, according to federal authorities.
Raynaldo Rivera Ortiz Jr., 59, was arrested Wednesday in Plano on federal criminal charges related to the incidents.
“The safety of the nation’s pharmaceutical supply is critically important,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, in a Thursday news release. “The Department will vigorously prosecute this case consistent with the evidence gathered by our law enforcement partners.”
In the death case, anesthesiologist Melanie Kaspar wasn’t feeling well one day in June and used an IV she got from a hospital at home in an attempt to feel better. She later died. The bag was compromised, according to authorities. WFAA-TV identified the victim, while federal documents called her M.K.
An autopsy report that was completed on or around Aug. 24 concluded that Kaspar died of an accident involving bupivacaine toxicity, and bupivacaine was found in her bloodstream. Bupivacaine is not a drug of abuse, but is rather a common “nerve block” agent used in regional anesthesia procedure.
Ortiz is accused of tampering with an IV at Baylor Scott & White Surgicare North Dallas, according to WFAA. Federal court documents identified the hospital as Facility 1 located in Dallas.
Ortiz is charged with tampering with a consumer product and with intentionally adulterating drugs.
If convicted, he faces a maximum penalty of life in prison.
Ortiz will make his initial appearance before U.S. Magistrate Judge Renee Toliver in Dallas on Friday.
“Our complaint alleges this defendant surreptitiously injected heart-stopping drugs into patient IV bags, decimating the Hippocratic oath,” said U.S. Attorney Chad E. Meacham for the Northern District of Texas. “A single incident of seemingly intentional patient harm would be disconcerting; multiple incidents are truly disturbing. At this point, however, we believe that the problem is limited to one individual, who is currently behind bars. We will work tirelessly to hold him accountable. In the meantime, it is safe to undergo anesthesia in Dallas.”
Two months after Kaspar’s death, an 18-year-old male patient, identified in court documents as J.A., experienced a cardiac emergency during a scheduled surgery. The teen was intubated and transferred to a local ICU.
Chemical analysis of the fluid from a saline bag used during his surgery revealed the presence of epinephrine (a stimulant that could have caused the patient’s symptoms), bupicavaine, and lidocaine, according to court documents.
According to the federal complaint, surgical center personnel concluded that the incidents involving Kaspar and J.A. suggested a pattern of intentional adulteration of IV bags used at the surgical center.
They identified about 10 additional unexpected cardiac emergencies that occurred during otherwise unremarkable surgeries between May and August 2022, which the complaint alleges to be an exceptionally high rate of complications over such a short period of time.
In each of those cases — which investigators believe occurred on or around May 26 and 27; June 27; July 7, 15 and 18; and Aug. 1, 4, 9 and 19 — medical personnel were able to stabilize the patient only through use of emergency measures.
Most of the incidents occurred during longer surgeries that used more than one IV bag, including one or more bags retrieved mid-surgery from a stainless steel bag warmer.
The complaint alleges that none of the cardiac incidents occurred during Dr. Ortiz’s surgeries, and that they began just two days after Dr. Ortiz was notified of a disciplinary inquiry stemming from an incident during which he allegedly “deviated from the standard of care” during an anesthesia procedure when a patient experienced a medical emergency.
The complaint alleges that all of the incidents occurred around the time Dr. Ortiz performed services at the facility, and no incidents occurred while Dr. Ortiz was on vacation.
The complaint further alleges that Dr. Ortiz had expressed concern to other physicians over disciplinary action at the facility, and complained the center was trying to “crucify” him.
Surveillance video from the center’s operating room hallway showed Dr. Ortiz placing IV bags into a stainless-steel bag warmer shortly before other doctors’ patients experienced cardiac emergencies.
The video also captured Dr. Ortiz walking quickly from an operating room to the bag warmer, placing a single IV bag inside, visually scanning the empty hallway, and quickly walking away.
Just over an hour later, according to the complaint, a 56-year-old woman suffered a cardiac emergency during a scheduled cosmetic surgery after a bag from the warmer was used during her procedure.
The complaint alleges that in another instance, agents observed Dr. Ortiz exit his 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 scheduled cosmetic surgery after a bag from the warmer was used during her procedure.