4 Investigates: Dangerous diversion

The New Mexico Board of Nursing is leveling charges against a nurse anesthetist accused of taking hospital drugs meant for patients at Alta Vista Regional Hospital in Las Vegas. 

The allegations began in 2019 when colleagues of Caleb Zarzour reported their suspicions to hospital administrators, and then to the state when they felt Alta Vista and its parent company, Quorum Health, weren’t taking the matter seriously. 

Zarzour, who faces a disciplinary hearing next month, refused to sign a settlement with the state and denied the allegations through attorney Ryan Harrigan, who called the case “very weak” and said “there’s scant evidence that any diversion ever took place.” 

In a medical setting, providers taking drugs intended for patients is known as diversion. While rare, it’s a serious allegation — especially considering the drugs in this case are fentanyl and propofol.

“In the medical field, almost always when there’s diversion, it’s the practitioner, the provider that is using them,” said Dr. Michael Lopez, an internal medicine specialist who’s been practicing in Las Vegas, New Mexico for 42 years. He’s served on both the credentialing and medical executive committees at Alta Vista.

4 Investigates reviewed more than 400 pages of documents about the case involving Zarzour, who worked at the hospital until he made the decision to leave in 2022. It began four years ago, when colleagues flagged him for refusing to come in when on call, missing the first case of the day, disappearing after sedating patients and ordering the same amount of fentanyl for each case while never reporting any medication as unused.

The hospital’s internal investigation showed drugs left unattended after procedures and an empty vial of fentanyl found in the operating room’s laundry hamper. One vial of fentanyl returned to the hospital pharmacy failed a test to verify the substance inside was in fact fentanyl. 

The U.S. Drug Enforcement Administration verified the failure but couldn’t pinpoint how the drug had been replaced or who had done it. The inquiry led in part to Alta Vista Regional Hospital signing a memorandum of agreement with the DEA that ordered the hospital to tighten its drug-handling protocols. 

A spokeswoman for the hospital told 4 Investigates, “Drug Enforcement Administration and multiple internal audits have already shown no evidence of drug diversion.” 

“I guess the worst nightmare for a pharmacist is diversion,” said former Alta Vista pharmacist Christella Lovato. A Northern New Mexico native whom friends call Annie, Lovato quit her job because of concerns over the investigation and the hospital’s procedures for dispensing drugs. 

“There were controlled substances that were left out. There were times that they supposedly administered (drugs) but never did,” she said. “But there was no way (to track them). So we didn’t know where syringes of fentanyl were.”

“It wasn’t safe for our patients,” said Dr. Teddi Swidinsky, a general surgeon who likewise quit over the matter. 

In fact, as more colleagues raised red flags about their suspicions, the hospital’s entire medical executive committee quit over the lack of action.

“We’re supposed to have the power to be responsible for the medical quality of what happens at the hospital, and we weren’t,” Dr. Swidinsky said.

“That’s what was frustrating. We couldn’t move forward because the administration was holding us back,” explained Dr. Nancy Wright, who worried about patient safety and liability as head of the medical executive committee. “If an action happens and a patient is harmed, it’s going to be my fault. I can’t be a part of this. I have to leave it. Being on MEC is voluntary and I said, ‘Find someone else to do this. I’m not going to go along with this anymore.’”

After a 2019 report of possible diversion, the hospital tested several employees who had access to the drugs in question. Zarzour’s first drug test was too diluted to be used, the hospital’s internal report says. He was out of state, so the hospital attempted a hair follicle test. A Board of Nursing investigator said Zarzour showed up with a shaved head and the report says hair he provided didn’t have sufficient weight to test. In February 2020, the report says he disclosed to the hospital staff that his drug test would show evidence of marijuana and cocaine. 

He continued to work at the hospital for two more years. 

Harrigan, the attorney, told 4 Investigates many coworkers thought Zarzour was “a stellar CRNA” and would testify to that. He said it would be inappropriate to address the drug test allegations before next month’s hearing, adding “Caleb always complied with what the hospital asked.”