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An anesthesiologist is under arrest, facing criminal charges related to alleged tampering with patient IV bags at Baylor Scott & White Surgicare, a North Dallas, Texas, surgical center. Raynaldo Rivera Ortiz Jr, MD, 59, is accused of injecting nerve-blocking and bronchodilating drugs into patient IV bags, resulting in at least one death and multiple cardiac emergencies.

Dr Raynaldo Ortiz

In June, an anesthesiologist identified by Dallas ABC affiliate WFAA as Melanie Kaspar, dosage leflunomide MD, a colleague of Ortiz’s at the outpatient center, was ill and treated herself for dehydration using an IV bag of saline she had taken home from work. She died immediately after injecting the contents of the bag. According to the autopsy report, she died from a lethal dose of bupivacaine, a nerve-blocking agent often used during the administration of anesthesia. According to WFAA, Kaspar’s death was initially ruled accidental, but the Dallas County Medical Examiner has since reopened the case. 

Then in August, an 18-year-old male patient, identified in court documents as J.A., experienced a cardiac emergency during a scheduled surgery at the clinic. The teen, who according to local press coverage was undergoing nose surgery after a dirt bike accident, was transferred to a local ICU. A chemical analysis of the fluid from the saline bag that was used during his surgery found epinephrine (a stimulant that could have caused his symptoms), bupivacaine, and lidocaine.

According to court documents, an investigation by the surgical center identified about 10 additional unexpected cardiac emergencies that occurred during what should have been unremarkable surgeries, an exceptionally high rate of complications, suggesting a pattern of intentional adulteration of IV bags. These surgeries were performed between May and August.

In addition, the complaint alleges that none of the cardiac incidents occurred during Ortiz’s surgeries; however, all of the incidents occurred around the time Ortiz performed services at the facility, and no incidents occurred while he was on vacation. The incidents began 2 days after Ortiz had been notified that he was the subject of a disciplinary inquiry stemming from an incident in which he allegedly “deviated from the standard of care” during an anesthesia procedure when a patient experienced a medical emergency, according to federal officials.

The complaint also alleges that Ortiz had a history of disciplinary actions against him, including at the facility, and he complained that the center was trying to “crucify” him.

Surveillance video from the hallway of the center’s operating room shows Ortiz placing IV bags in the stainless-steel bag warmer shortly before other doctors’ patients experienced cardiac emergencies, according to the complaint. In the description of one instance captured on video, Ortiz was observed 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, Ortiz was observed exiting his operating room carrying an IV bag concealed in what appeared to be a paper folder, swapping the bag with another bag from the warmer, and walking away. Roughly 30 minutes 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. 

“Our complaint alleges this defendant surreptitiously injected heart-stopping drugs into patient IV bags, decimating the Hippocratic Oath,” said Chad E. Meacham, US Attorney 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.”

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 US Magistrate Judge Renee Toliver in Dallas today.

On September 9, the Texas Medical Board suspended Ortiz’s license in connection with this investigation, noting that the panel found “an imminent peril to the public health, safety, or welfare” and that Ortiz’s “continuation in the practice of medicine poses a continuing threat to public welfare.”

“It is astounding, stunning [for the victims] to think that anyone did this intentionally,” said Bruce W. Steckler, an attorney for some of the victims, in an interview with WFAA.

Baylor Scott & White Health, which operates the surgical center, said in a statement that the North Dallas facility will remained closed as the investigation continues.

“We actively assisted authorities in their investigation and will continue to do so. We also remain focused on communicating with patients,” the health system said.

Avery Hurt is a Birmingham, Alabama-based freelance science writer who writes often about the science and practice of medicine.

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