MEDFORD, Ore. (AP) — A former nurse at a southern Oregon hospital is facing criminal charges that she harmed nearly four dozen patients by stealing fentanyl and replacing it with non-sterile tap water in intravenous drips.

Many of the patients developed serious infections, and 16 of them died, but authorities said they did not pursue murder, manslaughter or criminally negligent homicide charges because investigators could not establish that the infections caused those deaths. The patients were already vulnerable and being treated in the hospital’s intensive care unit, the Medford Police Department noted.

Dani Marie Schofield, 36, a former nurse at Asante Rogue Regional Medical Center in Medford, was arrested last week and instead charged with 44 counts of second-degree assault. She pleaded not guilty on Friday and was being held on $4 million bail, The Oregonian/OregonLive reported.

“After review of hospital records, patient records and pathology reports, MPD consulted with multiple medical experts, who each agreed that questionable deaths associated with this case could not be directly attributed to the infections,” the police department said in a news release.

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The investigation began late last year after hospital officials noticed a troubling spike in central line infections from July 2022 through July 2023 and told police they believed an employee had been diverting fentanyl, leading to “adverse” outcomes for patients.

Fentanyl is a powerful synthetic opioid that has helped fuel the nation’s overdose epidemic, but it is also used in legitimate medical settings to relieve severe pain. Drug theft from hospitals is a longstanding problem.

Schofield voluntarily agreed to refrain from practicing as a nurse and to suspend her nursing license pending the outcome of the criminal case, Clark R. Horner, Schofield’s civil attorney, said in response to a pending civil suit filed in February against Schofield and the hospital.

The lawsuit was filed by the estate of Horace Wilson, who died at the Asante Rogue Medical Center. He had sought care at the hospital on Jan. 27, 2022, after falling from a ladder. He suffered bleeding from his spleen and had it removed.

But doctors then noted “unexplained high fevers, very high white blood cell counts, and a precipitous decline,” the complaint said. Tests confirmed an infection of treatment-resistant bacteria, Staphylococcus epidermidis. Wilson died weeks later.

In response to the lawsuit, Schofield denied she was negligent or caused injury to Wilson.

David deVilleneuve, an Oregon attorney, said he has been in touch with about four dozen former patients or their representatives who are exploring whether to sue over their treatment by Schofield. Only 15 of them appeared on the list of victims authorities named in the indictment. He said he expects to file his first lawsuits within about three weeks.

DeVilleneuve said he was surprised that prosecutors did not charge Schofield with manslaughter. But he noted that proving she caused the deaths would be more difficult in a criminal case, where the standard is beyond a reasonable doubt, than in a civil one, where it is a preponderance of the evidence.

“Their burden of proof is higher than mine,” he said.

Asante last December contacted Medford police regarding a former employee “that they believe was involved in the theft of fentanyl prescribed to patients resulting in some adverse patient outcomes,” the complaint said.

That month, hospital representatives “began contacting patients and their relatives telling them a nurse had replaced fentanyl with tap water causing bacterial infections,” it said.

Schofield for each charge faces a mandatory minimum of five years and 10 months in prison with a potential maximum sentence of 10 years.

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