Former anesthetist at Floyd County Medical Center pleads guilty to stealing, tampering with drugs

By Bob Steenson, bsteenson@charlescitypress.com

A certified registered nurse anesthetist previously working under independent contract with the Floyd County Medical Center has pleaded guilty to stealing drugs from the hospital and using them himself, and to actions that resulted in injury or reduced care to some patients.

Christopher Scott West, age 44, of Charles City, had been charged in March in U.S. District Court with tampering with a consumer product; possession of a firearm by a drug user; and acquiring and attempting to acquire a controlled substance by misrepresentation, fraud, deception and subterfuge.

In one instance, during a laparoscopic surgery, West administered three different forms of anesthesia to the patient, later admitting that he had done so because it would mean he would have narcotics left over for his own use.

The patient suffered complications from the surgery that required additional time in the hospital, multiple bladder catheterizations and resulted in ongoing problems, according to the guilty plea document.

In other cases, during labor some women reported that the spinal anesthetic they had received from West was not preventing pain during C-section procedures and they had to be given a general anesthetic.

In one case, a woman was “crying out in pain” during her C-section procedure and was converted to general anesthesia. Her husband was removed from the operating room and the baby was delivered “with a low APGAR score.”

The hospital had been investigating discrepancies and concerns about West’s actions for a couple of weeks before a Sept. 7, 2018, incident that precipitated law enforcement involvement, according to a 24-page guilty plea agreement filed in federal court in Cedar Rapids last Thursday.

Federal court Judge Mark A. Roberts held a hearing Thursday morning where he accepted the plea and found West guilty.

See the full guilty plea document here: Christopher West guilty plea agreement 190801

The plea agreement, which was initialed by West on each paragraph, then signed by him and his attorneys, lays out in great detail West’s actions and their consequences.

West pleaded guilty to tampering with a consumer product, with a maximum penalty of not more than 10 years imprisonment without the possibility of parole and a fine of not more than $250,000.

He also pleaded guilty to acquiring and attempting to acquire a controlled substance by misrepresentation, fraud, deception and subterfuge, with a maximum penalty of not more than four years in prison without the possibility of parole and a fine of not more than $250,000.

After sentencing, the government will move to dismiss any remaining charges and will not file additional charges unless West violates the terms of the agreement or evidence of additional crimes is discovered.

According to the court document, the issue came to a head when West was discovered on Sept. 7, 2018, slumped on the floor of a public restroom at the Floyd County Medical Center with “a glazed look on his face,” with “very slurred speech” and “very uncoordinated in his movements.”

West had earlier that day provided anesthesia to two patients in surgeries, and hospital staff and law enforcement officials identified items including one depleted syringe of propofol and one full syringe of propofol among West’s items in the restroom.

West admitted to the medical center administrator that he had injected himself with propofol because of personal stress and because it acts and wears off quickly.

The medical center notified law enforcement officials and West’s contract was terminated that day, administrator Rod Nordeng said later in March after West had been charged.

“The actions of Mr. West as an independent contractor do not represent the compassionate and professional physicians, employees and volunteers of FCMC who are committed to caring for patients,” Nordeng said in a statement at that time.

Officers of the Charles City Police Department interviewed West the day he was discovered in the rest room and he admitted he took the propofol from an earlier surgery that day, and that he had been diverting medication including narcotics for his own use for the last six months, using the drugs at his home outside Charles City.

West had worked for the medical center periodically on a fill-in basis in 2016 and 2017 while under contract with another organization. Then, in July 2017, he began working at the medical center under contract to provide anesthesia services through his own corporation.

According to the plea agreement, from February through Sept. 7, 2018, West used his position as a certified registered nurse anesthetist to gain access to the opioid narcotics fentanyl and sufentanil at the Floyd County Medical Center.

The document says West would use his privileges to access hospital Omnicells — locked storage devices that dispense medications including controlled substances such as pain medications, to authorized people who have access either through a fingerprint or a code.

He would obtain vials of fentanyl and sufentanil, remove the contents and replace it with saline, then attempt to cover his actions by gluing the vials shut and attempting to cover tamper indicators and returning the vials to secure storage.

The document says that West would try to avoid having the tampered vials be used on patients by later saying the tampered vials had accidentally become broken and having them accounted for as waste.

The hospital began receiving reports from staff about suspicions regarding West’s actions in the weeks leading up to his arrest. One nurse became concerned because West kept asking her to report as waste controlled substances that he said he had dropped.

A check with Omnicell records showed West claimed to have dropped 27 ampules of sufentanil in eight months. A check showed the previous certified registered nurse anesthetist had only reported five vials in 14 months as having been dropped or contaminated.

Further investigation by the county hospital showed West accessing the Omnicells on weekends or after hours when there were no surgeries taking place. West would also log into an Omnicell to get headphones for patients, including at times where there were no patients to wear the headphones, or would log into the Omnicell with no action reported, creating a “null” report.

The arrangement of the Omnicell allowed West access to his anesthesia box when he logged in to retrieve headphones, the report said. He could remove ampules of fentanyl and sufentanil from his box and later return the ampules after replacing their medication with saline.

“The unusual accesses in the surgery Omnicell began in July 2017. The unusual accesses in the birth center Omnicell began with consistency in June 2018,” the court document states.

West would occasionally order a different pain medication for a patient if he knew tampered fentanyl was in the Omnicell, the document says. In one case he ordered that a patient continue to be administered a different medication, even after a nurse told him that medication was not working and asked if fentanyl could be given.

After the rest room incident, hospital and law enforcement officials examined drugs in the hospital Omnicells and found that at that time 43 vials of fentanyl and sufentanil had physical evidence of product tampering. Testing by the U.S. Food and Drug Administration national laboratory showed they all contained saline solution.

Under the plea agreement, West agrees to pay full restitution to the Floyd County Medical Center and all victims of his actions, including any damages that the court determines the laparoscopic surgery patient is entitled to.

West also said he understands that the imposition or payment of restitution in the criminal case will not restrict or preclude the filing of any civil suits or administrative actions.

West’s nursing licenses were suspended by the Iowa Board of Nursing when he was charged and a judge will decide whether they should be forfeited.

West is free pending sentencing, which has not yet been scheduled.