The Deadly Doctor
For years Dr. Deborah Spiva made bizarre diagnoses, ordered strange treatments, and prescribed massive doses of powerful drugs. Patients died because of her. And for years no one tried to stop her.
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But what happened to Dr. Deborah Spiva is more than the destruction of a once-promising career. It is a lesson in the ways of the medical profession. For years doctors who felt that she couldn’t be trusted, that she might even be dangerous, were reluctant to take any action against her. Fearing she would retaliate in court if they tried to stop her, they simply made sure she moved on. Finally, though, a few doctors decided that she must be stopped. They turned to the government agency responsible for disciplining physicians, the Texas State Board of Medical Examiners. But for more than a year the board’s investigation of Dr. Spiva lay neglected in a file cabinet, another one of its backlog of cases. Meanwhile, Dr. Deborah Spiva moved from hospital to hospital.
The Ideal Girl
No one worked harder at being the ideal girl than Deborah Anne Spiva. She was born in 1947 in Fredericksburg, a Hill Country town founded in the nineteenth century by German immigrants whose ethic of frugality and conservatism still very much pervades the place.
The Spivas were one of Fredericksburg’s best-known families. Debby’s father, Vern, was a dentist. He was a tall, handsome, easygoing man who was active in community affairs. His wife, LaVerne, universally known as Dippy, was strong-willed and sharp-tongued. She was the more socially ambitious of the two and proud and protective of her family. Debby was the oldest of the Spivas’ three daughters. Diana Dee, “DeDe,” was born in 1948, and Dorothy Jane, “Dotty,” in 1951.
In 1955, when Debby was seven, the first accidental death struck the Spiva family. That year a Fredericksburg doctor, a close friend of the Spiva family, performed a tonsillectomy on three-year-old Dotty. She died shortly after surgery.
Debby says “a reaction to something” caused her sister’s death. “Back then,” she says, “I don’t know that anybody knew that much about immunological phenomena or allergic reactions.” Over the years people have suggested that her sister’s death pushed Debby to become a doctor, pushed her to make up for the loss. “If it had, I would have done pediatrics and surgery,” Spiva responds. “It was such an isolated event. And pediatrics was just not what I wanted to do.”
From her earliest years, Debby Spiva was an achiever. The 1965 edition of the Mesa, her high school yearbook, is punctuated with pictures of Debby. She graduated among the top ten in her class; she was a senior twirler, varsity basketball guard, saxophone player in the band, member of the German club, student council vice president, coeditor of the yearbook, and member of the National Honor Society. Debby was also rewarded for her ability to think on her feet. In 1965 she was on the debate team that came in second at the state championship. In her high school speech class she was selected the Best Girl Extemporaneous Speaker and the Best All-Around Girl Speaker.
There were students in Fredericksburg who were more gifted than Debby, but there were few who were more determined. Several of her classmates recall that she could hardly be described as a natural athlete, but she spent hours shooting baskets and ended up making the varsity team. Her need to succeed could make her abrasive at times. High school science teacher Hubert Nixon told the San Antonio Light, “She was very reluctant to give in, even when she was obviously wrong.” A classmate recalls, “You couldn’t win an argument with Debby.”
In 1965 Debby left Fredericksburg for the University of Texas, where she worked to stand out academically and socially. She was chosen for Orange Jackets, a prestigious UT service organization whose uniform was a badge of social acceptance. She was on the varsity debate squad, was a nominee for outstanding student and for Bluebonnet Belle, and was selected for Phi Beta Kappa. But Debby’s plans were larger than just joining the right college organizations. Unlike so many students—especially female students in that era—Debby had a clear, unwavering vision of her future beyond the campus. She was going to be a doctor. It was an ambition formed before the great social upheaval of women’s liberation and affirmative action and one that set her apart from her peers.
Today Spiva says he can’t remember when she first decided on a medical career. “It just sort of seemed to make sense. Daddy had a clinic at home and I hung around. It was familiar.” Despite the familiarity, her parents did not encourage her. “Daddy had gone to Baylor in the thirties and forties when women in medicine had a tough time, so he discouraged me because of that. Mother was really cool about it.”
In 1969 Debby, who majored in zoology and minored in chemistry, graduated with honors. That fall she enrolled at a new medical school, the UT Health Science Center at San Antonio.
The Protégée
Just as she had in high school and college, Debby rose swiftly to the top of her medical school class. She won a Legislators Merit Scholarship, she served on the school’s admissions committee, she was the editor of the yearbook, and she received an award for academic achievement from the American Medical Women’s Association. “Debby was in the first group of students to go through the full graduating program here. She’s a charming person, so quick and bright and colorful. She was clearly a star,” recalls Dr. James George, a faculty member at the medical school.
George is a hematologist, a specialist in diseases of the blood. He is a tall, slim man with strong features and a warm manner who chooses his words with care. He encouraged Spiva’s interest in academic medicine, arranging a course of study for her that would groom her for a teaching position at the medical center. “We pictured her as our first homegrown faculty person in our hematology division,” he says. “She had the ambition, and she had the ability.”
Students spend their first two years of medical school in classrooms and laboratories. In the third year, however, they get their first clinical experience, accompanying senior faculty members, interns, and residents on teaching rounds. For part of her third-year rotation Spiva was one of four students assigned to Dr. George.
She seemed to thrive on hard work. Teaching rounds began at nine-thirty, but George often arrived at the hospital at seven in the morning and found that his star student had gotten there even earlier. It was also noted, as it would be throughout her career, that Spiva had a way with patients. George recalls several patients saying that Spiva was the first physician who ever seemed to really care about them. Another unusual quality also surfaced in medical school. Hospitals are hierarchical places, and doctors are clearly at the top of that hierarchy. But unlike many physicians, Spiva treated the rest of the staff—the nurses and the technicians—as equals rather than subordinates, earning their admiration.
In the last two years of medical school, students narrow their career choices and plan internships and fellowships accordingly. The fourth year is an all-elective year focused on the student’s area of interest. Spiva was interested in immunology, and because many immunological problems are blood-related, she decided to become a hematologist. “Every time you picked up a journal the field was changing. There was fascinating technology. And I kept finding funny immunological problems,” she says.
Dr. George, by then Spiva’s faculty adviser, was helping to make an academic hematologist out of her. He arranged for her to do her laboratory research on a rare anemia. He hoped the project would result in a publishable paper. His hopes were fully realized.
“She had an incredible talent for making experiments work,” Dr. George says. “I remember sitting at the bench, looking at the results, thinking, ‘This is incredibly beautiful.’” The results were published in 1974 in the American Journal of Medicine, under the names of Dr. Spiva, Dr. George, and Dr. David Sears, then the head of the school’s hematology division. It was the first of Debby’s papers in which the experiments worked out just perfectly.
George then arranged for Spiva to spend two months at the University of Connecticut Health Science Center to do a special study with a friend of his. Following that, in 1973 she went for her internship and residency to Strong Memorial Hospital, the teaching hospital of the University of Rochester in New York, where both George and Sears had trained.
Dr. Tom Anderson, now the head of the hematology and oncology section of the Medical College of Wisconsin, was a chief resident during Spiva’s second year at Strong. He remembers that she was considered vivacious and outgoing. She did an adequate job, and it looked as if she had a reasonable career ahead of her, he recalls.
However, one incident sticks in Dr. Anderson’s mind. During rounds one day, Spiva gave a presentation on a potentially fatal disorder known as disseminated intravascular coagulation, in which the body’s clotting mechanism goes out of control. What struck Anderson was the superficiality of Spiva’s presentation. “It was one of the few times that I saw a significant question from the chairman of medicine of a synopsis and the data,” he says.
Spiva calls Rochester a “great learning experience.” She says that she not only learned a lot clinically but also learned about the human qualities required to be a good doctor. She was particularly influenced by one faculty member, now dead, named Art Bauman. “Art Bauman was a tremendous clinician,” Spiva says. “When one of his patients died, they didn’t die alone. There’s a tendency when someone starts going bad, you feel so bad you step back. He didn’t do it. He was a great role model.”
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