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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Although George says he was absolutely convinced that Spiva had fabricated the results, he realized that proving his accusation would be difficult since she denied the charges—it would be Dr. Spiva’s word against the technician’s. He also saw that his evidence was not sufficient to ask her to leave the program or to withhold her certificate of performance. After debating how to proceed, George told her that he would inform only two other people on the faculty, physicians she was doing collaborative experiments with. Beyond that he would not pursue the matter. He added that if he was ever contacted for a recommendation, he would not tell of the incident, but he would decline to recommend her for a position, which would be seen as a very negative sign.
One of the doctors George spoke to was Richard Pope, who is now in the department of medicine at Northwestern University Medical School. Pope already had doubts about Spiva’s veracity. Concerned about the flawless results of her experiments, he too had coded the samples she was working on and found that her data reflected not what was really being measured but what Spiva had assumed was being measured. Pope had ended the experiments. “The reason we couldn’t do anything against her was that we had no proof that would stand up in a legal setting. It was her word against ours,” Pope says. “And even if we showed her data, she always had excuses why it wasn’t the case. She’s pretty smart and quick on her feet. What could we have done?”
After their confrontation, George and Spiva had little interaction. He began to hear stories that he was trying to destroy her career and was pushing her off the project in order that she not get credit. He says that he reran the experiment she had done for him, using the technique she had developed. “The experiment did work out, although not quite as she said it did,” he recalls.
Because of staffing changes taking place in the division of hematology, there was no opportunity for an appointment for Dr. Spiva. George says he would have prevented her appointment in any case. Spiva says her plans for an academic career went awry because of circumstances beyond her control, both in and out of the hematology division. “It was a giant upheaval. It was at the same time that the feds were cutting back and grants were disappearing. So I left at the same time as a lot of friends who had been on a similar track,” she says.
When asked about the accusations in the letters of Uhr and George, she says, “I know about those letters. They’re not true.” On her lawyer’s advice, she declines to discuss the accusations further.
Vampires and Werewolves
With no prospects at the medical center, Spiva decided to go into private practice in 1980. By that time her personal life had also taken a new direction. Toward the end of her fellowship in San Antonio she met Fred Cecere, a tall, burly, outgoing Army doctor from Massachusetts. He was at the medical center in San Antonio to get extra training. For Cecere it was love at first sight. “He says he remembers meeting me and he made this giant decision,” Spiva says.
Spiva had a rule never to date other doctors, but she and Cecere became friendly, and he started spending more time in the laboratory. Soon he got an apartment in the building she was living in. They were married in 1981. “There wasn’t anything else to do,” she says. “He was going to stay forever. When he said he wouldn’t squawk about me not changing my name, it was a good deal.” They eventually bought a large home in the gentrified King William section of town and spent their spare time restoring it.
Through a family friend, Spiva was put in touch with Dr. O. Roger Hollan, a founder of San Antonio Medical Associates (SAMA), a small, prestigious private group of internal medicine specialists that was formed in the fifties. SAMA’s downtown offices are in the same art deco high rise as the Nix Medical Center, long considered the city’s society hospital.
After Spiva’s initial contact with the group, Dr. Karl Hempel, a rheumatologist with SAMA, contacted Dr. George for a recommendation. George did not tell him about the episode with the experiments, but as he had warned Spiva, he did not give her a recommendation. He recalls telling Hempel that the hematology faculty had been concerned about Spiva’s credibility during her clinical year of training. In sworn testimony before the Board of Medical Examiners, Hempel (who, like all his SAMA colleagues, declined to be interviewed) said, “We called and got recommendations from the hematology department there and did hire her.”
In June 1980 Deborah Spiva went to work at SAMA, specializing in hematology and immunology. The Nix was her primary place of practice, but she also applied for and received privileges—the right to admit and treat patients—at several other San Antonio hospitals, including Humana Hospital Metropolitan, Baptist Memorial, and Santa Rosa Medical Center.
In the beginning, her association with SAMA seemed to be a good one. Her parents’ social contacts were beneficial in helping to establish her practice, and she found that being a female doctor had its advantages. “A lot of patients wanted a woman doctor, particularly women patients with breast cancer or ovarian cancer,” she says.
Her days started and ended with hospital rounds at the Nix, where she saw about fifteen patients; the rest of the day she would see the same number of patients in her office. Along with her heavy patient load, she did independent research and published papers.
When Spiva describes her approach to medicine, one word she often uses is “aggressive.” She says she assiduously followed medical literature to give the most-current treatments. She also took an aggressive approach to diagnosis. While patients with undiagnosable, nagging symptoms might be described by other doctors as the “worried well,” Spiva was determined to find the cause of their distress. In doing so, she concluded that many of her patients had terrible, rare illnesses that required powerful medication and extensive hospital treatments. She also concluded that San Antonio was an extraordinary breeding ground for an exceedingly rare hereditary disorder known as porphyria. It is a condition so unusual that most doctors in this country never see a single case, but Spiva eventually diagnosed and treated about thirty victims.
In porphyria the body produces excessive porphyrins, a component of hemoglobin, which imparts the red color to blood. The disease is diagnosed through specific tests of blood, urine, and feces. Porphyria can affect the brain, most of the organs, and the skin—victims are susceptible to acute sunburn with minimal exposure. Because of this phenomenon and the sometime occurrence of mental disorders, it has been hypothesized that the supposed vampires and werewolves of days gone by may actually have been porphyria sufferers. There is no cure, but drugs alleviate some symptoms.
One of the people who Spiva discovered had the disease was Hazel Topoleski. Topoleski, now 40, is a supervisor in the Harlandale Independent School District. Until she saw Spiva, no doctor could tell her what was wrong. An ophthalmologist sent her to a neurologist, who put her on medication for vertigo, but Topoleski still did not feel well. In 1983 her gynecologist, unable to come up with a diagnosis, sent her to Dr. Spiva. According to court documents, on that first visit Dr. Spiva said she thought she knew what was wrong with Topoleski. “I thought she was just wonderful,” Topoleski recalls. “Very sharp and caring. I felt maybe I was lucky this time. I felt I don’t care what it is, just as long as I know.”
Two weeks later Topoleski went in to discuss test results. Finally, after years of seeing doctors, she had an answer: Topoleski had a type of porphyria. “Dr. Spiva said it was the disease of vampires and werewolves. She used those words. That was a real shock,” Topoleski says.
Spiva believed that porphyria resulted in another condition: hyperviscosity, or thickening of the blood. To keep both conditions under control, Spiva had her porphyria patients undergo regular pheresis treatments. During pheresis blood is withdrawn from a patient. In some cases a portion of the blood—the platelets, for example—is removed, and the remainder is transfused back into the patient. In other cases donor blood is transfused. Pheresis is an invasive procedure, performed in the intensive care unit at the Nix. As with all blood transfusions, patients run the risk of contracting hepatitis or having an allergic reaction to the blood products.
According to court records, Spiva told Topoleski that pheresis was the only treatment available for her condition. On September 2 Topoleski began her weekly treatments at the Nix. Spiva was there to greet her. Then a plastic valve was inserted into a vein in Topoleski’s arm, and the three-hour procedure to control her disease began. Topoleski was one of many of Dr. Spiva’s patients to undergo pheresis.
A Problem with the Records
By 1984 Deborah Spiva looked to all the world like a success. In four years she had developed a thriving practice with a prestigious group. She received many referrals from other doctors and was generous in her referrals to them. Such referrals make for both goodwill and good fees. Because of the nature of the illnesses of many of her patients and the complicated treatments she prescribed—such as pheresis—Spiva generated large medical bills, which generated large payments to the Nix and to SAMA. And as other doctors even now attest, Spiva had a way with patients; most of them loved her.
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