Iowa Nurse Pleads Guilty to Diverting Fentanyl at Waterloo Hospital

An Iowa nurse who diverted fentanyl at a Waterloo hospital pled guilty today in federal court in Cedar Rapids.  Luis Ramirez-Cajas, age 42, from Cedar Rapids, was convicted of one count of acquiring a controlled substance by misrepresentation, fraud, deception, and subterfuge.

At the plea hearing and in a plea agreement, Ramirez-Cajas admitted that the State of Iowa granted him a nursing license in 2012.  In August 2022, before Ramirez-Cajas began working at a Waterloo hospital, Ramirez-Cajas and the Iowa Board of Nursing’s Iowa Nurse Assistance Program (“INAP”) entered into an agreement under which Ramirez-Cajas promised to abstain from drugs and alcohol and to refrain from working with narcotics.  Ramirez-Cajas previously had admitted to diverting and using narcotics in the emergency room of an Iowa City hospital in late 2021 and early 2022.  The Iowa City hospital was an affiliate of the Waterloo hospital and in the same hospital network.  Ramirez-Cajas knowingly violated his agreement with INAP by accepting employment at the Waterloo hospital.

In September and October 2022, while working at the Waterloo hospital, Ramirez-Cajas diverted fentanyl, hydromorphone, and morphine to his own use.  All these drugs are controlled substances.  Ramirez-Cajas diverted the drugs mostly through purported wasting—falsely documenting in the Waterloo hospital’s records, for example, that he had wasted a full vial because a patient purportedly had refused the drug after Ramirez-Cajas pulled it.  Instead of wasting the controlled substances, Ramirez-Cajas diverted them for personal use.

Sentencing before United States District Court Judge C.J. Williams will be set after a presentence report is prepared.  Ramirez-Cajas remains free on bond pending sentencing.  Ramirez-Cajas faces a possible maximum sentence of four years’ imprisonment, a $250,000 fine, and one year of supervised release following any imprisonment.

In December 2022, Ramirez-Cajas surrendered his nursing license to the Iowa Board of Nursing with leave to apply for reinstatement within one year.  As part of his plea agreement, Ramirez-Cajas agreed to forfeit his nursing license to the United States.

The case is being prosecuted by Assistant United States Attorney Timothy L. Vavricek and was investigated by the Iowa Medicaid Fraud Control Unit and the Drug Enforcement Administration, Diversion Control Division. 

Court file information at https://ecf.iand.uscourts.gov/cgi-bin/login.pl. 

The case file number is 23-CR-2049.

Follow us on Twitter @USAO_NDIA.