For years, the University of California San Diego (UCSD) hospital system allowed one of its anesthesiologists to sedate patients knowing that he had a long-standing addiction to fentanyl and other drugs, that he had been in treatment for addiction, and that he routinely withdrew far more anesthetics from the pharmacy than his peers, according to court documents.
What UCSD leadership failed to realize is that Bradley Glenn Hay, MD, had been stealing and injecting himself with anesthesia drugs intended for patients for a very long time, court documents show.
As he acknowledged in a 4.5-hour in November, Hay, 44, had been slipping fentanyl and other controlled substances from UCSD pharmacy dispensing machines sporadically since his first year of anesthesiology residency in 2003, as frequently as five to eight times a day.
Often, he administered anesthesia to his patients while he was under the influence of those drugs himself, sometimes , he acknowledged, and according to federal and state lawsuits now filed.
And he was never stopped.
That is, not until Jan. 27, 2017.
That's when he administered anesthesia to orthopedic surgery patient Randy Dalo and led him to the surgical recovery room. Hay then went into a stall in the nearby bathroom and injected himself with the sedative that was to be used for Dalo's surgery, as he later admitted he did routinely.
This time, however, the drug was sufentanil, five to 10 times stronger than fentanyl. He made a mistake, he said.
Moments later, Hay was found by a nurse: "unconscious, face-down on the patient/staff bathroom floor, covered in vomit, with his pants down around his ankles," according to a .
'The Gig's Up'
"Well I'm caught," he recalled saying when he woke up to a handful of medical staff standing over him. "I'm ... the gig's up."
The state medical board filed an accusation against Hay that October, and in April 2018, ordered him to surrender his license.
Now, UCSD, its department of anesthesiology chair Gerard Manecke Jr., MD, orthopedic surgeon Richard Todd Allen, MD, and nurse anesthetist Tammy Nodler face two lawsuits filed in state and federal courts.
UCSD declined to comment on pending litigation. Attorney Barton Hegeler, who is representing Hay in these two lawsuits, declined comment except to say that "Dr. Hay has accepted responsibility for his actions and is extremely remorseful for his conduct."
The , filed in November 2018 in San Diego Superior Court by Dalo and his wife Karen, alleges that Hay and anesthesiology nurse Tammy Nodler "failed to provide the adequate amount of anesthesia to Randy Dalo, resulting in harm to him," and that they falsified the medical record, overstating how much anesthesia Dalo had received.
The Dalos' complaint alleges that after his surgery, Randy recalled seeing fuzzy people and a bright light during surgery, and that he felt paralyzed and tried to scream, suggesting that not only did Dalo receive insufficient anesthesia to keep him asleep during surgery, but that he had a form of horrifying surgical awareness, said his attorney, Eugene Iredale.
"When he woke up from his surgery, he was in excruciating pain," said Julia Yoo, Iredale's co-counsel. "He had recurring nightmares, day after day after day."
The Dalos said that the impacts from getting insufficient anesthesia caused Randy to suffer "depression, anxiety, emotional and mental distress, past, present and future pain and suffering, loss of consortium and economic loss related to past and future medical expenses."
Widespread Surgical Awareness?
That raised the issue detailed in the filed in U.S. District Court for California's Southern District on Jan. 24, 2020, on behalf of Cynthia Lopez and her late husband, Robert Lopez, who had surgery to insert a dialysis access graft on the same day as Dalo. (He died later from unrelated causes.)
The complaint maintains that Hay stole anesthetics from Lopez for Hay's own use, but that UCSD officials did not inform Lopez or his wife -- or any other patients who had been under Hay's care -- that Hay and may have been under the influence during their procedures.
That violates California law that to the state and must inform patients of that adverse event, according to the federal complaint. Defendants and supervisory officials at UCSD "had a duty to inform patients of the following: (1) that Hay had performed anesthesia during patients' surgeries in order to use the patients' identities to steal Fentanyl that was intended for the patients' use; (2) that Hay had falsified patients' medical records to conceal his misappropriation of controlled substances; and (3) that Hay had been under the influence of drugs at the time he performed anesthesia during patients' surgeries."
Also looming is the horrifying possibility, Iredale said, that some or even many of Hay's patients experienced surgical awareness; they may have been given just enough sedation to keep them quiet, preventing them from speaking or crying out, but not enough to keep them from feeling excruciating pain, seeing and hearing and smelling everything that was going on around them.
800 patients since April 2016
Iredale shared with 鶹ý UCSD documents obtained during discovery that revealed that from April 2016 through late January 2017 -- the period when Hay overdosed in the UCSD bathroom and when Hay was "addicted to fentanyl, but also Dilaudid and morphine" -- he cared for some 800 patients, "whose dates of care and patient numbers are recorded as an exhibit."
Iredale emphasized that in his deposition, Hay cooperated completely and was honest and sincerely remorseful.
"Dr. Hay's testimony was some of the most truthful, and wrenchingly accurate testimony one would ever expect to hear," Iredale said.
Hay explained in great deal how he escaped capture, often by ordering more drugs than he would need for the patient's sedation, so some would need to be "wasted," or disposed of into a sink or receptacle before witnesses, according to the hospital's drug disposal policy. But he frequently substituted saline and kept the excess drug -- if he hadn't already injected himself with it.
In his deposition, he acknowledged that he switched saline for drugs some 800 times in 2016 and 2017, and that about 50 times his colleagues witnessed him wasting a drug that wasn't really the drug, or wasn't all of the drug, without raising any questions.
He added that he often administered anesthesia to multiple patients simultaneously, going from room to room as their cases progressed, which gave him access to even more sedation drugs.
Lawyers: UCSD Needs to Tell Hay's Patients
"The greater fault lies not with Dr. Hay, whose failings were individual and the result of all-too-human weakness," Iredale said. "The fault resides with the institutional lack of enforcement of procedures designed to prevent this from happening. The fault resides with his superiors who failed to understand that addiction is a life-long problem which requires monitoring."
Iredale added that it's "inevitable" that many patients under Hay's care while they underwent surgery had inadequate anesthesia to the point where they may have had surgical awareness, felt pain, or had other mental repercussions.
"Given the constant thefts, the undisputed evidence that five to eight times a day Hay was shooting up in the hospital's bathroom, given that he had a serious addiction ... the only issue is how many patients have suffered without understanding that the cause was not a physical malady or surgical pain attendant to the procedure itself, but was the result of their being mistreated," Iredale said.
Iredale had especially harsh words for anesthesiology department chief Manecke, who hired Hay as an attending in 2008 after his residency.
"He knew that anesthesiologists, as a matter of their occupation, have a much because they have a lot of accessibility," Iredale said. "And he knew that Dr. Hay had previously been found under the influence, and had previously been required to check himself into Betty Ford [the well-known rehab clinic in Rancho Mirage, California] to get clean."
"Knowing all those things, he did not counsel him on a regular basis, he did not arrange to check him, he did not adequately communicate with the pharmacy regarding audits," Iredale said. And he and UCSD didn't notify any of Hay's patients after his January 2017 overdose.
Attorney Timothy Blood, who is representing Cynthia Lopez in the federal suit against Hay, UCSD, and other defendants, said that it's "critical for patients to simply be notified that this happened to them, because there may be other consequences from this and they need to understand, like waking up from surgery in absolutely crippling pain, or psychological complications. They should know there was a reason for it and what that reason was. For their peace of mind."
Tampering with surgical anesthetics has been a growing concern in the last 10 years, especially with high profile cases like that involving David Kwiatkowski, a cath lab tech who stole fentanyl and other drugs set out for patients in a small New Hampshire hospital, then used those drugs himself replacing the contents with saline. Kwiatkowski is serving a 39-year sentence in federal prison.