Bad Doc

[George K]

This is just amazing...

Texas Medical Board suspends doctor connected with 'compromised' IV bag

A Texas Medical Board disciplinary panel has temporarily suspended the license of a Baylor Scott & White doctor connected to its investigation into a 'compromised' IV bag that caused a death and serious heart complications.

The order states that surveillance footage shows Ortiz in the facility, placing single IV bags into a warmer in a hall outside of operating rooms. Shortly after Ortiz deposited a bag, a patient would suffer a serious complication, the order said.
A fellow Baylor Scott & White Surgicare North Dallas anesthesiologist, Melanie Kaspar, took a tampered IV bag home on June 21 to rehydrate while she was feeling ill, the order details. Once inserting the IV into her vein, she almost immediately suffered a serious cardiac event and died...An autopsy report from the Dallas Medical Examiner's office in August 2022 concluded Kaspar's death came from accidental bupivacaine toxicity, the order added. Bupivacaine is an anesthetic used to numb areas of the body and provide pain relief during surgical, medical and dental procedures.
The order also detailed that lab tests run on IV bags from the warmer found visible tiny holes in the plastic wrap around the bags, and that the bags were found to contain bupivacaine, but were not labeled as such.
Additional tests on the remaining contents of an IV bag given to another otherwise healthy patient who had a serious heart event during a routine surgery showed that the IV fluid in their bag had similar drugs that shouldn't have been inside.
"Such drugs could and would be fatal when administered unknowingly and intravenously," the order states.

Wow. Just wow...

There is no reason, none whatsoever, to put bupivicaine (Marcaine) into an IV bag. It is a great local anesthetic, but has a relatively high toxicity if it goes intravenously. It has a high affinity for cardiac tissue, and can cause cardiac arrest which is difficult to reverse because of this affinity.

When I started practice, it was common to use 0.75% bupivicaine for epidurals during c-sections. It was a great drug - reliable, long lasting, and a great sensory and motor block. However, the total dose would end up being about 150 mg. That was dangerously close to toxic dose if it got its way into the circulation.

So, although 0.75% bupivicaine remained on the market, because of the large volume (dose) used for c-sections, it was verboten to use it in that way. We had to use 0.5% or a different drug (I used lidocaine).

I can't understand why this guy put bupivicaine into an IV bag, unless it was some sick "My patient just arrested and I was able to save him/her!" type of thing.

[taiwan_girl]

Since the doctor should have known that, I assume he could be charged with murder or manslaughter?

(Also, how common is it for other doctors to just grab a IV bag and start giving it to themselves?)

[George K]

@taiwan_girl said in Bad Doc:

(Also, how common is it for other doctors to just grab a IV bag and start giving it to themselves?)

Not unusual. Someone very close to me has been known to abscond with a bag or two and administer it in my their bedroom to avoid a trip to the ER with the spouse.

[taiwan_girl]

LOL

[Jolly]

@George-K said in Bad Doc:

@taiwan_girl said in Bad Doc:

(Also, how common is it for other doctors to just grab a IV bag and start giving it to themselves?)

Not unusual. Someone very close to me has been known to abscond with a bag or two and administer it in my their bedroom to avoid a trip to the ER with the spouse.

At least you knew someone giving it to their spouse. I knew someone who used to hang Ringer's on his dog...

[George K]

This guy was a piece of work...

Ortiz was charged with and convicted of shooting his neighbor’s dog in the chest with a pellet gun. And, as the medical board alleged in previous filings, he had a “history of violence against women.”

According to court records in the animal cruelty case, Ortiz’s neighbor Roxanne Bogdan helped his ex-girlfriend move out of his house in December 2014 after police were called there over a domestic dispute. Bogdan would also later testify about this incident at a hearing for the woman’s protective order against Ortiz.

Ortiz was convicted of misdemeanor cruelty to a nonlivestock animal and sentenced to 25 days in jail, two years of community supervision, and a $4,000 fine for shooting the dog. He was also ordered to pay $505 for the dog’s veterinary bill, attend anger management counseling, and refrain from harassing or threatening his girlfriend, their kids, and his neighbors and their children.

The Court of Appeals in Dallas upheld Ortiz’s conviction and its memorandum opinion details some of the animal abuse allegations.

According to the ruling, Bogdan believed that Ortiz blamed her for his split from his former girlfriend. The day before the shooting in April 2015, Ortiz allegedly visited Bogdan’s home and argued with his girlfriend on speakerphone over a child custody arrangement.

The following afternoon, Bogdan was in her bedroom when she heard Ortiz’s “very loud sports car” peel into his driveway. She heard a gunshot and her dog’s yelping moments later. “She then ran into her backyard and saw her dog’s chest covered in blood,” the ruling says.

“Bogdan called a friend who came to take her and her dog to the animal hospital,” the filing continues. “The dog survived.”

The opinion says that Bogdan called 911 on her way to the animal hospital and reported that she believed Ortiz shot her canine. She later testified that Ortiz frequently shot rabbits in his own yard and that they ran into her yard and died.

The daughter of Ortiz's ex, who once lived with her mom and the doctor, also testified that Ortiz told her “hundreds” of times that he wanted to shoot Bogdan’s dogs and that he seemed annoyed by their barking.

“The circumstantial evidence in this case was sufficient to prove appellant was the person who shot Bogdan’s dog,” the court’s January 2018 ruling states, adding that “there was evidence of animosity between” Ortiz and Bogdan after he split from his girlfriend and that he “blamed Bogdan for the breakup.”

Bogdan declined to comment, and Ortiz could not be reached by The Daily Beast.

The incident involving the dog led the state medical board to reprimand Ortiz in October 2018 for “failing to notify all hospitals of his misdemeanor criminal charges” and order him to pay an administrative penalty of $2,000.

[George K]

Wow....

Kaspar’s autopsy revealed a lethal dose of bupivacaine, “a nerve blocking agent that is rarely abused but is often used during the administration of anesthesia,” the DOJ indicated.

The incident involving Kaspar occurred “on or around” June 21, according to the DOJ. On Aug. 24, another incident involving an 18-year-old man identified only as J.A. occurred. That incident was described as a “cardiac emergency during a scheduled surgery.”

“The teen was intubated and transferred to a local ICU,” the DOJ said. “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.”

A subsequent investigation “suggested a pattern of intentional adulteration.” A total of 10 “unexpected cardiac emergencies” had occurred during “otherwise unremarkable surgeries between May and August 2022,” prosecutors indicated — an “exceptionally high rate of complications over such a short period of time.”

(bupivicaine is NEVER administered intravenously)

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.

She stated that ORTIZ was the anesthesiologist for the surgery. 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 nurse stated that she recalled the event as unusual. The nurse also stated that, around the same time, ORTIZ retrieved his own IV bags for use during his procedures. The nurse said that it was unusual for ORTIZ to engage in this practice, as doctors at Facility-1 did not typically obtain their own IV bags.

Surveillance video shows that, on August 4, 2022 at or around 11:35 a.m., ORTIZ exited Operating Room 5 and walked toward the warmer with an IV bag in his hand. No one else is visible in the video from the OR Hall at this time. In the footage, ORTIZ walked slightly past the warmer, then turned and quickly placed the IV bag into the warmer. After he placed the IV bag in the warmer, he looked both directions in the OR Hall and then quickly walked away. A short time later, ORTIZ opened the warmer and looked inside, then quickly closed the warmer.

On August 9, 2022, at or around 10:19 a.m., surveillance video shows ORTIZ exiting Operating Room 5 with an IV bag in his hand. The OR Hall was empty at the time. ORTIZ walked to the warmer and quickly placed the IV bag in the warmer.

J.E., a 78-year-old male, was in Operating Room 4 for a scheduled wrist surgery at or around the time that ORTIZ placed the IV bag in the warmer on August 9. At or around 10:54 a.m., a staff member exited Operating Room 4 and retrieved an IV bag from the warmer. Surveillance video shows that no other staff member accessed the warmer between the time ORTIZ placed the IV bag in the warmer and the time that the staff member obtained the bag at 10:54 a.m. Medical records reflect that J.E.’s blood pressure spiked at or around 11:02 a.m. Emergency measures were employed, and J.E. was transferred to an emergency facility.

“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.”