PLANO, Texas (KXAN) — A Dallas-based anesthesiologist was arrested on Tuesday on charges related to tampering with IV bags, which caused at least one death and multiple cardiac emergencies.

According to an arrest affidavit, Raynaldo Rivera Ortiz Jr. is an anesthesiologist who provides medical services to patients at a surgical center in Dallas. The U.S. Department of Justice said on or around June 21, a 55-year-old coworker of Ortiz had a medical emergency and died immediately after treating herself for dehydration using an IV bag of saline taken from the surgical center.

An autopsy report revealed that she died from a lethal dose of bupivacaine, a nerve blocking agent often used during the administration of anesthesia.

Two months later, on or around August 24, an 18-year-old had a cardiac emergency during surgery. He 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 a complaint, surgical center personnel concluded that the two incidents suggested a pattern of intentional adulteration of IV bags used at the surgical center.

They also identified around 10 other unexpected cardiac emergencies that happened during surgeries between May and August 2022. The complaint alleges that 10 is an exceptionally high rate of complications over such a short period of time.

Each patient in those cases was stabilized only through the use of emergency measures.

Most of the incidents happened during longer surgeries that used more than one IV bag, including one or more bags retrieved mid-surgery from a stainless steel bag warmer.

According to the complaint, none of the cardiac incidents happened during Ortiz’s surgeries, and they started two days after he was notified of a disciplinary inquiry stemming from another incident, in which he “deviated from the standard of care” during an anesthesia procedure.

The complaint alleges that all of the incidents happened around the time Ortiz performed services at the facility, and no incidents happened while he was on vacation.

The DOJ release also said that a nurse who worked on one of Ortiz’s surgeries at one point refused to use an IV bag that was retrieved from the warmer. The complaint said that surveillance video from the center’s operating room hallway showed Ortiz putting IV bags in the stainless-steel warmer shortly before other doctors’ patients experienced cardiac emergencies.

The affidavit said four IV bags were identified as possibly being compromised. Two of them showed small puncture holes in the plastic packaging that encases the IV bags. Those are believed to have been physically tampered with, as there is no explanation for a sealed IV bag to have holes in the packaging surrounding it.

Other evidence detailed in the affidavit gave probable cause for agents with the Food and Drug Administration’s Office of Criminal Investigations to charge Ortiz for crimes related to tampering with IV bags.

Ortiz faces the following charges:

• Tampering with a Consumer Product and Tampering with a Consumer Product Causing Death and/or Serious Bodily Injury
• Doing of an Act that Results in a Drug being Adulterated while Held for Sale after Shipment of the Drug in Interstate Commerce
• Intentional Adulteration of a Drug having a Reasonable Probability of Causing Serious Adverse Health Consequences
• Adulteration of a Drug by Mixing or Substituting Another Substance

Ortiz also has a history of disciplinary actions against him, according to the complaint and the arrest affidavit.

Ortiz’s history

Ortiz also provides services at other surgical facilities in the area, though a “substantial portion” of his income comes from the Dallas-surgical center, the affidavit says. He’s been a licensed physician in Texas since 1991.

Ortiz already has a disciplinary history with both the Texas Medical Board and medical facilities where he’s been previously employed, according to the affidavit. He was the anesthesiologist for a November 2020 procedure at a surgical facility in Garland, in which the patient suffered complications during anesthesia. In April 2021, Ortiz relinquished his medical staff membership and all clinical privileges at the facility.

On August 19, 2022, Ortiz entered into an agreed order with the Texas Medical Board related to the November 2020 incident. He agreed to several conditions, including submitting to extensive ongoing monitoring by a Board-selected physician at Ortiz’s expense, re-taking a Medical Jurisprudence Exam given by the Texas Medical Board, completing 16 hours of continuing medical education credits, and paying a penalty of $3,000.

There is also a private disciplinary inquiry pending at Ortiz’s main place of work — the medical center in Dallas — in which a patient under his care stopped breathing during a routine procedure.

According to a review commissioned by that facility, Ortiz did not maintain the patient’s airway and did not document critical aspects of the incident. Similar conduct was noted during the November 2020 incident.