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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After their residency ends, most doctors start looking for their first jobs. Spiva went back to school to pursue her goal of an academic career. She came home to Texas for a two-year fellowship in immunology at the University of Texas Health Science Center at Dallas, the home of Southwestern Medical School. The Dallas program involved no patient care; it was strictly research. Spiva says she was there to learn the basics in a field that was exploding with new discoveries.
Dr. Jonathan Uhr, the chairman of the microbiology department at the Health Science Center, was a co-director of Spiva’s postdoctoral fellowship. Uhr’s experience with Spiva fell into what had become the established pattern—her experiments worked out beautifully. But in a letter written years later to the Texas State Board of Medical Examiners at the request of a board investigator, Dr. Uhr indicated that there was a hitch: others could not get the experiments to work the way she had. And on experiments that required subjective analysis, he wrote, her colleagues simply did not see the same thing under the microscope that Spiva saw. To check her results, Spiva was asked to repeat her experiments using coded samples—that is, she did not know the content of what she was working with.
Uhr wrote that when Spiva worked with the coded samples, even she could not reproduce her own findings. He also wrote that both he and another supervising physician “were very suspicious that Dr. Spiva was incapable of reporting the truth.” He continued, “We could not distinguish whether she had consciously reported false results or whether she had convinced herself that the observations were real.” He also reported, “Her performance during this time was so bizarre that I dictated a note for my files after she had been in the laboratory for 10 months. This is the only note of this type that I have dictated during 25 years of supervising students and fellows in the laboratory. During this period, I have probably trained approximately 100 young scientists.” That note, dictated on April 30, 1976, concluded that Spiva’s findings “represent her unconscious expectation of what the results should be.”
Before Spiva completed her fellowship in Dallas, her family was shaken by another death. Over the Thanksgiving holiday in 1976 her father and two of his friends went on a hunting trip, spending the night in a trailer in West Texas. The three were found dead, asphyxiated by fumes from a small stove they had used as a heater.
People recall that Debby was the strong one in her family. “My father was very much the get-up-and-get-about-your-business person. When things happened to our family before, I just sort of did,” she says. As she looks back on his death now, she brings an almost stoic acceptance. “One thing struck me: if you had to pick how you were going to die, how better than to not know it, to be with your friends doing what you want to do. He didn’t get old and sick.”
So Spiva went on. According to the career plan, she was to complete her training in Dallas and return to San Antonio for yet another postdoctoral fellowship, this time in hematology. For administrative purposes, Spiva was asked to complete a formal application, with recommendation letters from Rochester and Dallas.
A positive letter from Rochester arrived. On September 14, 1977, a letter from Dr. Uhr arrived. It was brief and did not mention his doubts about Deborah Spiva’s work. He described the studies she participated in, then concluded: “Dr. Spiva’s excellent background in clinical medicine together with her training in cellular immunology should enable her to tackle important problems in immunohematology.”
Today Uhr declines to talk about his experience with Spiva. “I wish she’d never been at Southwestern, that we’d never heard of her,” he says. Of the letter he wrote to the Board of Medical Examiners regarding his former student, he says, “I felt it was so important that it was a matter of conscience.”
In his letter to the board, Uhr also wrote that he didn’t have enough evidence to stop Spiva’s career: “Dr. Spiva acknowledged no problem on her part during our interactions with her and showed no evidence of any insight that she had a problem. On our side, we had no definitive evidence that she had committed fraud, only that she was not able to present a true account of her findings.” But for the first time, a doctor who thought that Deborah Spiva could not be trusted simply let her move on.
The Switched Samples
Spiva returned to San Antonio in 1977. Dr. George was surprised that during her fellowship in Dallas no papers had appeared under her name. But Spiva, the champion extemporaneous speaker, had plenty of reasons. “She had many stories about what went wrong, why this, why that. They were all accepted,” he says. Today Spiva says that she was not trying to do publishable research while in Dallas.
Her program in San Antonio was divided into two parts: a clinical year to be followed by two years of laboratory research. She began seeing patients again. George remembers one occasion when he was treating a leukemia patient with chemotherapy. Leukemia is a cancer of the blood cells that are produced in the bone marrow. In chemotherapy, drugs are given in carefully controlled doses to the patient. The desired result is that the drugs will destroy the abnormal cells in the bone marrow and that after chemotherapy the marrow will replace itself with healthy cells, putting the patient into remission.
Dr. George recalls that in preparation for the patient’s chemotherapy, he asked Spiva what the white blood cell count was. She said the patient had 50 per cent normal cells—meaning that chemotherapy could begin. “I checked casually and found the patient had no normal cells and that chemotherapy would have been a disaster,” George remembers. “I said, ‘What happened?’ She said, ‘So-and-so told me.’” Dr. George found that other faculty members had had similar experiences with Spiva. At the end of Spiva’s clinical year George warned Spiva that her credibility was in jeopardy. “I thought I was being real tough on her, that she was an errant youth who needed a little counseling,” he says.
In spite of concerns about her accuracy, Spiva received a satisfactory evaluation for her clinical year and proceeded to become a research fellow in the hematology division—which was going through personnel changes stemming from political turmoil.
From 1978 to 1980 Spiva’s research work was supervised by Dr. David Sears. In December 1979, however, George approached Spiva and asked her to do some hematology experiments with him. She had developed a technique that could quickly and accurately measure selected proteins bound to the surface of circulating blood cells. By then, George says, he felt she was “flaky but legitimate.”
Spiva measured the reactions on the experimental plates and presented the results to George. The experiment had been a success, perfectly proving his hypothesis. He recalls his reaction when he saw the perfect results: “At that moment I thought, ‘This is too good to be true.’ And when you say that, the dam breaks.”
In a letter Dr. George wrote to the Board of Medical Examiners, he described what happened next. To either confirm or put to rest his suspicions about Spiva, George came up with a plan. He told her he wanted to rerun the experiment. As in the first project, all the steps until the last were to be performed by the technician. Without telling Spiva, though, George had the technician switch the control and the experimental samples, mislabeling them so she would not know what had been done. After the experiment was completed, George stopped by the technician’s desk to pick up Spiva’s results. As he wrote the board, without a word the technician handed him the sheet. Instead of showing opposite values, Spiva’s results were identical to those of the first experiment. George was sure that Spiva had fabricated the data.
He knew Spiva was at work in a laboratory on the floor. He remembers dreading the walk down the corridor; he believed that his revelation could lead to the end of the career of the young doctor who had been his protégée. She was working at her bench when George came in.
“Debby, there’s a problem with the experiment,” he recalls telling her.
“It seemed to me to work out perfectly,” she replied.
Then he said, “Debby, the samples were switched, and you have fabricated these data.”
Without a trace of hesitation or emotion, Spiva replied that she knew they had been switched; she said the technician had told her. “Then I recorded the data just as we had done the first time so that the data charts would be consistent,” Spiva said. Instead of Debby Spiva, it was Jim George who was reeling from the confrontation. Next, as he recounted in his letter, he and Spiva conducted a search through the laboratory’s wastebaskets, looking for the tapes from the machines that had printed out the lab data, so that they could reconstruct the experiment. They couldn’t find them. Nor could they find the experimental tubes and plates from which the counts were taken. George says Spiva apologized for having thrown away everything so quickly.
George went back and talked to his technician. She confirmed that she had said nothing to Spiva about switching the samples. That afternoon George went to Sears to discuss what had happened, but Sears was angry that George had set a trap for Spiva.
The next day George had a three-hour discussion with Spiva. He told her he could never trust her again. Then he said that he felt she needed psychiatric help and that he would like to assist her in obtaining it. At that suggestion, George wrote, “she exploded.”
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