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 just when life should have been most satisfying, things started to unravel. For one thing, according to a letter written by Dr. Hollan to the Board of Medical Examiners, SAMA was unhappy with Dr. Spiva’s record-keeping, a vital part of a medical practice. Doctors communicate with each other about a patient’s care through the chart. Patient charts must accurately reflect diagnoses and treatments so errors are not made by other physicians or nurses. And a doctor’s records are the source of billing information. From testimony at a hearing before the Board of Medical Examiners and from depositions taken in malpractice cases, it has been established that Deborah Spiva’s record-keeping could be described as eccentric. Important information on test results would be missing from patients’ charts, values from lab tests would change inexplicably from entry to entry, unusual therapies were ordered, and contradictory diagnoses would appear.
In his letter Hollan also said that Spiva was also not as active a participant in the practice as the group would have liked; she often failed to attend management meetings. SAMA was also concerned about her research methods—she was publishing papers without having colleagues review her findings first. Members of the group had discussed those problems with Spiva over the years; she usually promised to try to do better. But Dr. Hollan felt he had no reason for serious concern until February 12, 1984. In his letter to the state medical board, he recounts what happened that day: “While making rounds, I heard the nurses discussing the questionable need for transfusing a patient with a normal hemoglobin. I suggested that the blood not be given until the order was clarified, since it involved Dr. Spiva. About the same time I heard a rumor about a patient who was very angry about Dr. Spiva and was threatening to sue her. Then her husband requested a conference on March 9 to discuss Deborah’s problems with the group.”
Then, as Dr. Hollan wrote in his letter, another rumor surfaced—that Spiva was not board certified in hematology. Though she had passed her internal medicine exams in 1976, she twice failed to complete her hematology boards. She said in a deposition that she thinks she had an allergic reaction to the air conditioning in the room in which the exam was given. Today, Spiva says she never told anyone that she had passed her hematology boards, only that she was eligible to take them.
But that wasn’t all. In March two papers with Spiva as principal author came to Hollan’s attention. One, on pheresis, was published in the journal Plasma Therapy Transfusion Technology and listed Dr. Charles Robinson and Dr. James Langley as coauthors. Robinson, the chief pathologist at the Nix, discovered he was her coauthor when Spiva brought him a copy of the paper. “I reckon I was a little dumbfounded,” he says. “But the horse was out of the barn.” The data came from tests he had run on patients of hers, but he says he can’t comment on the accuracy of her paper because he “never had an opportunity to review the data.” Dr. Langley, who was then the medical director at the South Texas Regional Blood Bank, says that he was never informed by Spiva of the paper, even after its publication. The other paper was on pheresis as a treatment for systemic lupus erythematosus; the coauthor of that paper was her husband, Fred Cecere.
The Spiva-Cecere paper raised some troubling questions. According to a detailed memo written by Dr. Hempel, the paper documented the pheresis treatments done at the Nix on nineteen patients with lupus. But the nurse in charge of the Nix intensive care unit, where pheresis was done, said she didn’t know of nineteen such patients. In the paper the patients were identified by number only. Spiva was asked to provide her colleagues with the patients’ names. According to the SAMA memo, she declined to identify five of them. Of the patients she did identify, there were numerous discrepancies between the laboratory data Spiva and Cecere gave in the paper and the laboratory data recorded on the patients’ charts at the Nix. Most disturbing of all to her colleagues was this discovery: three of the patients she identified as being helped by the pheresis treatments were dead at the time she documented their therapy.
On April 10 a meeting of SAMA members was called to discuss the paper with Spiva. By then, another problem had come up. Some physicians had notified that doctors at SAMA of questions regarding one of Spiva’s patients, a middle-aged professional woman whom Dr. Spiva had diagnosed as having porphyria and hyperviscosity. The treatment Spiva had prescribed was her usual one: pheresis. According to minutes dictated by Hempel, the group received a copy of the letter that Dr. Spiva had sent to Guardian Life Insurance about the need for aggressive therapy for this patient. Yet when the patient’s records at the Nix were checked, her colleagues found no evidence of either condition. The lab results were in fact normal, or at least they were normal on the slips printed out in the Nix laboratory. Another set of data, handwritten by Spiva, did not match the hospital’s.
The April 10 meeting did not go well for Spiva. She says it brought to a head the difference in her philosophy of medicine and that of the rest of the group. She contends that often her colleagues, because of fears of malpractice, did not give patients adequate treatment or adequate doses of medication for intractable diseases. As for their concerns about all the rare diseases she saw, she says, “I saw a lot of patients who had been seen by six or seven doctors and were undiagnosed. They had had excellent tests, and the common stuff was ruled out, so all that was left was weird stuff.” She also says her colleagues were sexists. “I don’t know if they were ready for me. None of them had been in school at the time there were aggressive women doctors with opinions. There were some people in the group who didn’t want a woman, who did not want anything avant-garde or academic, and they said so.”
As a result of the meeting, it was mutually decided that Deborah Spiva would leave San Antonio Medical Associates and begin practicing on her own. The split was not entirely amicable. According to a SAMA memo, on April 23, 1984, Hollan requested Spiva’s resignation. Acting on the advice of her lawyer, Spiva refused to sign the letter of resignation. At three-thirty the next afternoon Hollan handed her a letter of termination. Her departure from the group was to be on June 30. To help her establish her own practice, Spiva was allowed to copy her patients’ charts. She says she took 1200 charts with her.
Even after she was gone, the SAMA doctors found themselves continuing to deal with nagging Spiva problems. In his letter to the Board of Medical Examiners, Hollan said that in May he was contacted by a former patient of Spiva’s who complained about his diagnosis. Spiva had told him that he had Von Willebrand’s disease, a rare hereditary blood disorder that resembles, but is generally not as severe as, hemophilia. She had treated him by administering an antihemophiliac blood factor to which he had an allergic reaction. Dr. Hollan checked the laboratory data from the patient’s chart; it was normal. In October, Hollan wrote, he was told of another patient whom Spiva had also diagnosed as having Von Willebrand’s disease. Hollan again checked the charts, again they were normal. Then another paper on treating porphyria with pheresis, cowritten by Spiva, came to his attention. Hollan stated in his letter that he tried to match up the cases described in the paper with charts at the Nix, and again there were major discrepancies.
During our day-long interview in Miami, the one display of emotion Spiva shows is when she describes what happened at SAMA: “We got a divorce. That’s really all I thought it was.” For a moment her eyes tear up, then she quickly regains her composure. “It was a worked-out agreement. It was a case of irreconcilable differences.”
For Spiva it was a chance to begin again. She set up her own downtown office, decorating it with antique furniture and plants. An aquarium was installed in the room where she administered chemotherapy. And her Yorkshire terrier regularly wandered around. “Doctors’ offices always scared the spit out of me—all that funny Naugahyde,” she says. “We had a sort of Fredericksburg office. Being sick is a big enough threat.”
A Bleeding Crisis
In hospitals there is one thing that rivals viruses for persistence and pervasiveness, and that’s gossip. By 1984 a major subject of speculation at the Nix was the activities of Dr. Deborah Spiva, who continued to practice there, even though her association with SAMA had been severed. One of her patients was a young hemophiliac, 31-year-old Juan Jose Garcia. At a Board of Medical Examiners hearing, extensive testimony was given about the case, although the board did not identify Garcia by name. Garcia entered the Nix on April 23, the day Dr. Hollan requested Spiva’s resignation. According to testimony before the Board of Medical Examiners, in general Garcia’s health was good; he had come in for elective surgery to repair damage done to his left wrist during a childhood bleeding episode. Garcia’s surgeon was Dr. John Evans, and his hematological care was handled by Dr. Spiva.
Hemophilia is an inherited disease in which the victim experiences uncontrolled bleeding because of extremely reduced amounts of one of two blood proteins responsible for coagulation; those proteins are known as Factor VIII and Factor IX. Since the late sixties the ability to isolate those clotting factors from the blood of normal donors has greatly increased the chances for hemophiliacs to have near-normal lifespans. Concentrates of these factors can be administered to hemophiliacs to stop bleeding crises.
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