Police arrested Dr. Raynaldo Rivera Ortiz Jr. on Wednesday, nearly 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 IV fluids killed 55-year-old colleague Melanie Kaspar, who used an IV bag to hydrate herself and died almost immediately afterward. Lab results later determined that 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 faced a disciplinary investigation after a patient under his care stopped breathing during a routine procedure. The 59-year-old anesthesiologist at Baylor Scott & White Surgery North Dallas is expected to make his first court appearance Friday morning. He is charged with tampering with a consumer product causing death and/or serious bodily injury and other charges. A special agent’s affidavit with the FDA’s Office of Criminal Investigation says “there appears to be a possible correlation between Ortiz being reviewed for medical errors and the adverse events affecting other anesthesiologist patients” at the surgery center. According to the filing, the surgery center began investigating Ortiz after a May 19 incident involving a patient identified only as “GA.” The unit said Ortiz “departed 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 Garland Medical Center, the filing says.) Co-workers at the Dallas facility told authorities that “Ortiz was aware of the investigation into the May 2022 incident and expressed his displeasure about it,” allegedly telling a colleague that the center was trying to “crucify” him, according to the affidavit. That doctor was “personally familiar with Ortiz” and indicated that losing his job at the surgery center “would be financially “devastating” for him, the filing adds. The May investigation, however, was not the only disciplinary action Ortiz 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 that Ortiz had a “history of violence against women.” In August, the board reprimanded Ortiz for failing to “meet the standard of care for a patient” at North Garland Surgery Center in November 2020. A board order indicates a patient required CPR and emergency transport after Ortiz administered anesthesia . As a result, the new criminal affidavit says, Ortiz waived his privileges at the Garland facility. The filing says Ortiz performed “a significant portion” of his work at the Dallas surgery center and was making much of his income there as of mid-2022. Two months after Kaspar’s death, an 18-year-old male patient referred to as “JA” visited the operating room for “a scheduled ENT surgery,” during which “his heart began to beat uncontrollably and his blood pressure soared to about 200 /150,” the affidavit states. JA was taken to an emergency room and intubated during his four-day hospital stay. Authorities obtained two IV bags used during JA’s surgery and two bags staff had taken from the facility’s “warmer” and discovered some had small holes. Testing revealed that the fluid in the bag attached to JA’s hand contained epinephrine, or the hormone adrenaline, as well as bupivacaine and lidocaine. Facility staff “found that the incidents involving JA and [Kaspar] were likely not isolated and likely were part of a pattern of intentional adulteration of IV bags used for procedures,” the affidavit states. The filing states that staff “determined that there were approximately ten other suspicious incidents since late May 2022 where patients experienced unexpected cardiovascular complications during otherwise unremarkable surgeries.” Medical staff said the heart attacks appeared to occur during longer surgeries when patients needed another IV bag from the “warmer,” a stainless steel device that looks like a refrigerator and raises the temperature of the bags being prepared for use in surgery. None of the cardiac emergencies occurred while Ortiz was the anesthesiologist, the staff added. Staff at the surgery told investigators that superiors informed Ortiz of the investigation into the May 19 incident around May 24. The first heart attacks in the model occurred about two days later. The affidavit states that Ortiz “appeared at another meeting regarding the May 19 incident on or about Wednesday, June 22, 2022, and there was a suspected cardiovascular event the following week on or about Monday, June 27, 2022.” “Other cardiovascular events involving suspected ruptured IV bags occurred on or about 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 reactions occurred. But the heart attacks increased 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 these drugs are controlled substances.) Meanwhile, authorities reviewed surveillance footage from August 2 onwards, as the digital camera system automatically deletes footage after a certain period of time. The video reportedly showed that at 11:35 A.M. on August 4, Ortiz came out of surgery with an IV in his arm and went through the warmer. The affidavit says Ortiz “then turned and quickly placed the IV bag on the warmer” and “looked both ways” down the hall before quickly walking away. “A short time later,” the affidavit states, “Ortiz opened the heater and looked inside, then quickly turned the heater off.” About half an hour later, a nurse grabbed an IV bag from the heater for cosmetic surgery on a 56-year-old female patient referred to as “TY.” Surveillance video revealed that no one had access to the heater between Ortiz and the nurse. At 12:50 p.m., TY “developed severe hypertension and cardiac arrhythmias” and was taken to the emergency room. The video also captured Ortiz placing a bag in the warmer on Aug. 9 around 10:19 a.m., shortly before a 78-year-old male patient identified as “JE” underwent wrist surgery. “Medical records reflect that JE’s blood pressure increased at 11:02 am. or around 11:02 a.m.,” the affidavit states. “Emergency measures were implemented and JE was taken to an emergency unit.” Investigators documented a similar episode on Aug. 19, when a 54-year-old female patient known as “KP” had a medical emergency just over 20 minutes after Ortiz was caught on camera exchanging an IV bag from the heater. A nurse told investigators of an “unusual” episode that month during a surgery where Ortiz was the anesthesiologist. “The nurse stated that she took an IV bag from the warmer to use during the procedure, but that Ortiz adamantly refused to use the bag and physically relinquished the bag,” 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 it was unusual for Ortiz to engage in this practice, as doctors [the facility] they usually didn’t get their own IV bags.” In a statement announcing Ortiz’s charges, U.S. Attorney for the Northern District of Texas Chad Meacham said the doctor “secretly injected heart-stopping drugs into patients’ IV bags, decimating the Hippocratic Oath.” “A single incident of apparently intentional patient injury would be concerning. many incidents are really disturbing.”
