Feds Float Likely Motive of Raynaldo Rivera Oritz, Dallas Doc Accused of Putting Deadly Drugs Into IV Drips

A Texas doctor accused of injecting drugs into IV bags—leading to the death of a colleague and medical emergencies in as many as a dozen patients—may have tampered with them because he was unhappy his surgery center was investigating him, authorities say.

Police arrested Dr. Raynaldo Rivera Ortiz Jr. on Wednesday, almost a week after the Texas Medical Board suspended his license and said his “continued practice of medicine poses a continuing threat to the public welfare.” Investigators say Ortiz’s contamination of his surgery center’s intravenous fluids killed 55-year-old coworker Melanie Kaspar, who used an IV bag to rehydrate herself and died almost immediately afterward; lab results later determined the IV bag contained a lethal dose of the anesthetic bupivacaine.

Now an affidavit in support of the criminal complaint suggests a possible motive for Ortiz’s alleged crimes: In May, he was confronted with a disciplinary inquiry against him after a patient stopped breathing under his care during a routine procedure.

The 59-year-old anesthesiologist at Baylor Scott & White Surgicare North Dallas is expected to make his initial court appearance on Friday morning. He is charged with tampering with a consumer product causing death and/or serious bodily injury and other counts.

The affidavit from a special agent with the FDA’s Office of Criminal Investigations says there “appears to be a likely correlation between Ortiz coming under scrutiny for medical errors and the adverse events affecting other anesthesiologists’ patients” at the surgery center.

According to the filing, the surgery center began investigating Ortiz after a May 19 episode involving a patient identified only as “G.A.” The facility said Ortiz “deviated from the standard of care by failing to maintain the patient’s airway and failing to document critical aspects of the incident.” (A similar incident occurred in November 2020 at a Garland medical center, the filing says.)

Colleagues at the Dallas facility told authorities that “Ortiz was aware of the investigation into the May 2022 incident and expressed his unhappiness with it,” allegedly telling a fellow doctor that the center was trying to “crucify” him, the affidavit alleges. That doctor was “personally familiar with Ortiz” and indicated that Ortiz losing his work at the surgery center “would be financially ‘devastating’” to him, the filing adds.

The May inquiry, however, wasn’t the only disciplinary action Ortiz has faced. As The Daily Beast reported, the state medical board reprimanded the doctor in 2018 for failing to report his conviction for shooting a neighbor’s dog in the chest. In previous disciplinary filings, the board alleged Ortiz had a “history of violence against women.”

In August, the board reprimanded Ortiz for failing “to meet the standard of care for one patient” at North Garland Surgery Center in November 2020. A board order indicates a patient required CPR and emergency transport after Ortiz performed anesthesia.

As a result, the new criminal affidavit says, Ortiz relinquished his privileges at the Garland facility. The filing says that Ortiz performed “a substantial portion” of his work at the Dallas surgery center and made much of his income there as of mid-2022.

Two months after Kaspar died, an 18-year-old male patient referred to as “J.A.” visited the surgery center for “a scheduled ENT surgery,” during which his “heart started beating out of control and his blood pressure spiked to around 200/150,” the affidavit states.

J.A. was transported to an emergency medical facility and intubated during his four-day hospital stay. Authorities obtained two IV bags used during J.A.’s surgery and two bags that staff had obtained from the facility’s “warmer device” and discovered some had small puncture holes. Testing revealed that the fluid in the bag attached to J.A.’s arm contained epinephrine, or the hormone adrenaline, as well as bupivacaine and lidocaine.

The facility’s personnel “identified that the incidents involving J.A. and [Kaspar] were likely not isolated and were likely part of a pattern of intentional adulteration of IV bags used for procedures,” the affidavit says. The filing states that staff “determined that there were approximately ten other suspected incidents since late May 2022 where patients experienced unexpected cardiovascular complications during otherwise unremarkable surgeries.”

Medical staff said the cardiac incidents appeared to happen during longer surgeries, when patients required another IV bag from the “warmer,” a stainless steel device that looks like a refrigerator and increases the temperature of bags in preparation for use in surgery.

None of the cardiac emergencies occurred when Ortiz was the anesthesiologist, staff added.

Surgery personnel told investigators that higher-ups informed Ortiz of the inquiry into the May 19 incident around May 24. The first cardiac incidents in the pattern occurred around two days later. The affidavit states that Ortiz “appeared at another meeting related to the May 19 incident on or around Wednesday, June 22, 2022, and there was a suspected cardiovascular incident the following week on or around Monday, June 27, 2022.”

“Other cardiovascular incidents involving suspected compromised IV bags occurred on or around July 7, 15, and 18; and August 1, 4, 9, and 19,” the filing continues. Ortiz had performed services at the surgery center at times close to those dates.

When Ortiz went on vacation from July 23 to 28, no adverse events occurred. But the cardiac incidents ramped up again once he returned, the affidavit says.

Staff added that Ortiz had access to the facility’s IV bags, as well as epinephrine, lidocaine, and bupivacaine. (None of those drugs are controlled substances.)

Meanwhile, authorities reviewed surveillance footage from Aug. 2 and onward since the digital camera system automatically deletes video after a certain time period.

The footage allegedly showed that at 11:35 a.m. on Aug. 4, Ortiz left an operating room with an IV in hand and walked past the warmer. The affidavit says Ortiz “then turned and quickly placed the IV bag into the warmer” and “looked both directions” in the hallway before quickly walking away. “A short time later,” the filing states, “Ortiz opened the warmer and looked inside, then quickly closed the warmer.”

About a half hour later, a nurse grabbed an IV bag from the warmer for cosmetic surgery on a 56-year-old female patient referred to as “T.Y.” Surveillance video revealed no one accessed the warmer between Ortiz and the nurse. At 12:50 p.m., T.Y. “developed severe hypertension and cardiac arrhythmias” and was transferred to an emergency facility.

Video also captured Ortiz placing a bag in the warmer on Aug. 9 around 10:19 a.m., just before a 78-year-old male patient identified as “J.E.” had wrist surgery. “Medical records reflect that J.E.’s blood pressure spiked at or around 11:02 a.m.,” the affidavit says. “Emergency measures were employed, and J.E. was transferred to an emergency facility.”

Investigators documented a similar episode on Aug. 19, when a 54-year-old female patient known as “K.P.” had a medical emergency a little over 20 minutes after Ortiz was captured on camera swapping out an IV bag from the warmer.

One nurse told investigators of an “unusual” episode that month during a surgery where Ortiz was the anesthesiologist. “The nurse stated that she retrieved an IV bag from the warmer to use during the surgery, but that Ortiz strongly refused to use the bag and physically waived the bag off,” the affidavit states.

“The nurse also stated that, around the same time, Ortiz retrieved his own IV bags for use during his procedures,” the document adds. “The nurse said that it was unusual for Ortiz to engage in this practice, as doctors at [the facility] did not typically obtain their own IV bags.”

In a statement announcing Ortiz’s charges, U.S. Attorney for the Northern District of Texas Chad Meacham said the physician “surreptitiously injected heart-stopping drugs into patient IV bags, decimating the Hippocratic oath.”

“A single incident of seemingly intentional patient harm would be disconcerting; multiple incidents are truly disturbing.”

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