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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He found Spiva’s beliefs about porphyria troubling. He had never heard that hyperviscosity, an easily measurable condition, was connected in any way to the disease. Pheresis is used in the treatment of hyperviscosity, but if the porphyria patients didn’t have that, then what was the pheresis for? Whitecar began calling porphyria experts around the country to see whether they concurred with Dr. Spiva’s methods. He did not have to make many calls—a convention of porphyria experts would fill the average living room—and none of them had seen hyperviscosity in their patients, nor did they use pheresis as a treatment for porphyria. “I then presented this data in a meeting,” Whitecar later told the Board of Medical Examiners. “She sat on the Pheresis Committee, and I presented it to her. She told me that I had called the wrong experts.”
By this time, Whitecar was concerned about Spiva. “I wasn’t sure her elevator stopped on every floor,” he says. The pheresis committee then reviewed some charts of Spiva’s porphyria patients. Whitecar told the board, “Except for the age and the sex, those notes were identical, as if they were produced by a word processor. And they all end up with the same three diagnoses; variegate porphyria, and they don’t all have that; hemolytic anemia, that’s another entity not shown to exist in variegate porphyria; and hyperviscosity. So at that point we knew we were in bad trouble.”
Prompted by Dr. Hempel’s complaint, the state Board of Medical Examiners had started an investigation of Dr. Spiva. On December 4 Raymond Juarez, an investigator with the board, visited Whitecar. Since receiving the call from Hempel, Juarez had been making the rounds in San Antonio. For several weeks he talked to about a dozen doctors who had dealt with Spiva, going back to her medical school days. Juarez found a tremendous unanimity of opinion. As Juarez later told the board, “They did feel that…there was some type of mental impairment. They didn’t feel that she was doing this for monetary reasons.”
Juarez asked the doctors to write to the board, summarizing their dealings with Dr. Spiva. Over the next several months nearly all of them did. The letters just sat there. For more than a year after Juarez’s initial interviews, while Spiva continued practicing medicine, the board took no action against her.
During his interview with Juarez, Whitecar told the investigator that the hospital was looking into her practices. Despite his concerns, Whitecar did not have any strong evidence against her. When challenged, Spiva responded with a wall of words.
Then, according to Whitecar’s testimony before the board, Deborah Anne Spiva, M.D., did John Philip Whitecar, M.D., a big favor.
Late in December, Spiva admitted an elderly retired lawyer to Humana. Her tentative diagnosis was leukemia. She ordered a variety of tests: a liver-spleen scan, a CAT scan, and a bone marrow aspiration and biopsy. Frequently, hematologists perform the bone marrow tests themselves, but Spiva asked Humana’s pathology lab to do them. The smears were made, and Dr. Thomas Snider, then the hospital’s chief of pathology, did the analysis. The lab tests were negative for leukemia, and the patient did not have any other significant blood disease. When Snider went to review the patient’s chart, however, he found a baffling note from Spiva. She also had checked the smears that were under the microscope at the pathology lab. Based on what she believed she saw, she wrote that the patient’s OKT8 suppressor cells were increased. She followed up with orders to administer Prednisone, a steroid, and Velban, a powerful antitumor agent.
OKT8 cells are lymphocytes, a component of the blood. What baffled Dr. Snider was that their presence cannot be detected by looking under a microscope; special tests must be done, tests that were not performed at Humana’s laboratory. After looking at the entries on the chart, Snider talked to Whitecar.
Whitecar immediately suspended the drug order, then sent the bone marrow slide to a laboratory at another hospital for independent confirmation of Snider’s finding. That report also came back normal. In his testimony to the board, Whitecar said, “In fact, she did us a favor by not doing the bone marrow herself, because I think, had she done it herself, it could not have come to anyone’s attention that the guy didn’t have what she said he had.”
On December 20, 1984, Whitecar suspended Dr. Spiva from practicing at Humana Metropolitan. This time, however, Spiva was not going to take her patient charts and go off quietly to the next hospital. She was going to fight. She remembers the events of December 20 quite well. “I was practicing, getting consults, chugging along. Guys from the Nix were consulting me,” she says. “And December 20, after lunch, I get a registered letter from Whitecar. That’s the first I knew of anything. That started everything. There was nothing specific in the letter; I didn’t know what he was talking about.”
She and her husband tracked Whitecar down by phone that afternoon and found out. “Basically, he didn’t believe in a particular disease, an immunological problem with suppressor cells, which had been in the literature since 1978,” Spiva says.
According to Spiva, her abilities as an immunologist threatened the self-esteem of many of her colleagues. “The field I was in was so new, a whole large segment of the medical community doesn’t understand and is put off by it.”
Spiva immediately took the first of what would be many court actions. Her lawyer, Jane Macon, a partner at Fulbright and Jaworski, went to district court for the reinstitution of Spiva’s privileges at Humana, saying Spiva’s patients’ lives would be endangered if she was not able to render care. On December 21 a temporary restraining order was granted, lifting her suspension. Humana responded by reinstating her privileges and establishing an ad hoc committee to review Spiva’s fitness to practice at the hospital. It was the beginning of an imbroglio of suits and countersuits that has not yet been resolved.
Spiva portrays the events after December 20 as a sort of vendetta orchestrated by John Whitecar: “I was really a nobody, and I’d obviously irritated people who were somebody. People who were my supporters when it happened turned around and testified against me—that’s understandable because they were young and wanted to get by too.” Whitecar says there is some truth to her accusation that he made sure steps were taken against her. As he told the Board of Medical Examiners, “One morning driving to work, at six o’clock in the morning I said to myself, why am I doing this? And then I realized that I knew there was a serious problem and if I walked away from it, then I would have to leave medicine. Because I didn’t want to prove those people right that say we can’t police our own selves.”
Whitecar’s term as chief of staff expired December 31 (he was succeeded by Dr. Snider). The executive committee asked that Dr. Frederick Buckwold, a specialist in internal medicine and infectious diseases and the newly selected chairman of the hospital’s department of medicine, conduct an investigation of Spiva. From his testimony before the board, Buckwold seemed to welcome the job about as much as an outbreak of salmonella. Buckwold considered himself not only a colleague of Spiva’s but a friend. He was also a recipient of her generosity with referrals. In 1984, he testified that she had sent about thirty patients to him, for billings of around $13,000, the largest block of referral income he had received that year.
Spiva’s lawyers contended to the board that she was being attacked by doctors who were her economic competitors. But Whitecar says just the opposite was true. “Along the way a lot of people gave me grief because of economics,” he says. “She was a big referrer. She sent people for a lot of inappropriate consults. She’d send a non-heart patient to a cardiologist.”
At the hospital a committee of six doctors was formed, and they were given 91 of Dr. Spiva’s charts to review. Before her actions could be considered unacceptable, three doctors had to agree that a chart deviated from accepted medical practice. Buckwold says that he purposely biased the committee in her favor—one of the doctors had even been the best man at her wedding.
The committee reviewed charts for two and a half months. The group concluded that eighteen demonstrated substandard care. On March 11 the ad hoc committee’s findings were presented to the hospital’s medical clinical board at a lengthy meeting. Two unanimous decisions were made. One, that a recommendation to revoke Spiva’s privileges should be sent up the hospital chain of command for final action. And two, that she was an immediate danger to her patients and her privileges to practice at Humana should be suspended for a second time, effective immediately.
These actions did not interfere with her right to treat patients elsewhere, however, as demonstrated by the phone call Buckwold told the board he made that evening to Spiva. “If I remember correctly, I gave her approximately 24 hours to make arrangements for the transfer of any patients she had in the facility to other physicians and/or transfer them to another facility.”
The privilege of practicing medicine is an enormously valuable one. A doctor who doesn’t voluntarily give up that privilege has the system firmly on her side. Spiva went back to court. On March 15 she again got a temporary restraining order lifting her Humana suspension. In the meantime, the hospital continued its laborious administrative procedures against her.
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