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.
(Page 8 of 9)
Then, abruptly, on June 26 Spiva short-circuited the process. She resigned. Her letter of resignation explained that she was doing so because of “disagreements with the medical staff over medical application, and academic interpretation.” The hospital administration felt the letter was at odds with reality and rejected her resignation. In response, that same day the hospital’s board of governors wrote to Dr. Spiva, informing her she could no longer practice at Humana Hospital Metropolitan. In less than a year, two San Antonio hospitals had forced her out.
Whitecar says now with some satisfaction, “She didn’t kill anyone at Humana.” But according to lawsuits and testimony from her former colleagues, the same claim cannot be made about the next two hospitals Deborah Spiva went to.
Two Unfortunate Patients
When Dr. Spiva started admitting patients to Baptist Memorial Hospital, Dr. Stephen C. Cohen, then the chief of oncology, warned an administrator that she should be watched. He knew firsthand about the concerns other doctors had had with Spiva. Cohen, a hematologist as well as an oncologist, had been asked earlier to review the charts of some of her porphyria patients while she was practicing at the Nix and was disturbed by what he found.
But because Spiva already had privileges at Baptist, it would be legally difficult to prevent her from practicing there. The easiest way to get her out would be to wait and see whether she did something wrong.
The first week of May, according to a court deposition, Spiva received a call from a medical school classmate, a doctor practicing in Jourdanton. He had a patient who had been diagnosed as having leukemia. The Jourdanton doctor wanted to transfer the young man to someone who was an expert in blood diseases, and he asked Spiva if she would take the case. On May 7 Johnny Van Cleve Elkins, a pump operator in South Texas, arrived at Baptist Hospital.
Johnny Elkins had been born and raised in Freer. He was muscular and good-looking—at 28, he still carried himself like the high school football star he once was. According to her testimony, Spiva ran another blood test on him and confirmed the diagnosis. Elkins had chronic myelogenous leukemia. With treatment, he could be expected to live two to four years. Elkins came from a close family; his parents, two sisters, and two brothers were distraught at the news. But Elkins’ sister Barbara Tenery remembers that Dr. Spiva offered them a great deal of hope. “We were told she was the best doctor in cancers of the blood in the area,” Tenery recalls. “She said he had a curable kind of cancer and he’d be able to go to work in two months.”
To get Elkins’ white blood cell count back down to normal, Spiva started him on a regimen of chemotherapy. The primary agent was the highly potent drug, busulfan, the drug of choice for his form of the disease.
The entry for busulfan in the Physicians’ Desk Reference, the standard reference work on pharmaceutical agents, begins with an italicized warning that the drug can arrest bone marrow function; busulfan should be reduced or stopped at the first such sign. The PDR also warns that the drug’s action is not immediate—it is common for the white blood cell count in a leukemia patient to increase during the first two weeks of administration before falling. If an overdose occurs, the effects on the bone marrow can be deadly.
To induce remission of leukemia, the recommended daily dose is 4 to 8 milligrams, with a preference for the lowest-possible dose. In her deposition, Spiva stated that on May 8 Johnny Elkins received his first daily dose of busulfan ordered by her—12 milligrams. On May 10 she revised her order—to 16 milligrams of busulfan a day. Two days after that she revised her order again. Elkins was then receiving 20 milligrams of busulfan a day, several times the recommended dose.
On May 17 Spiva discharged Elkins from the hospital with orders to continue taking 20 milligrams of busulfan a day at home. In spite of the eventual effect of the doses, Elkins at first responded exactly as the PDR predicted. His white blood cell count rose slightly and then began falling.
On June 11 Elkins was readmitted to Baptist Hospital, sicker than he had ever been. He was experiencing bleeding in his gums and nose, bruising, and hair loss. In her notes on that admission, Dr. Spiva wrote that he had had leukemia for two months—one month longer than it had been diagnosed. More strangely, she wrote that his original white blood cell count was 300,000, which she later revised in his records to 350,000, although it had never been documented as being higher than 170,000. In her deposition Spiva said this was a record-keeping error. But those new entries made it appear that Johnny Elkins was more dangerously ill than he actually was. She ordered some lab work done on his blood, and the results confirmed the warnings about the effects of busulfan. On June 14, she testified during a court proceeding, Elkins’ white blood cell count was below 500, a reading so low that the machine can no longer count the cells accurately.
In one sense, Deborah Spiva did at least part of what she had promised Elkins’ family that she would do. She did wipe out the cancer in his bone marrow. However, she also proved the accuracy of the Physicians’ Desk Reference. The amount of busulfan she administered destroyed not only the cancerous cells in his bone marrow, it destroyed the bone marrow, period, and with it, the body’s ability to fight infection.
On June 19 Spiva again discharged Elkins from the hospital. On June 24 he was back; he had hit his knee on the edge of a door, and an abscess had formed. He went home five days later, and he returned to the hospital on the Fourth of July for fever, chills, and gum bleeding. Elkins’ family was alarmed at his decline. Then a nurse who had recently left Baptist called Elkins’ brother one night and said the family should get another physician. On July 25 Johnny Elkins’ sister phoned Dr. Spiva and told her she was dismissed from her brother’s case.
The family turned Elkins’ care over to Dr. Cohen. When he looked at the chart, he was shocked by the dosages. Nurses who were concerned about Spiva’s methods also brought to his attention the case of another leukemia victim, a 34-year-old man who died from what Cohen found was an inappropriate cycle of chemotherapy.
Cohen brought the cases to the hospital review committee. The committee asked Spiva to come and explain her treatments. She never appeared. So Baptist Memorial Hospital then had its reasons for suspending her privileges to practice there, and did so.
In the meantime Cohen had brought in Buckwold to assist him on Johnny Elkins’ case. They tried to restore his immune system, but Elkins died October 6, 1985.
In her deposition in the malpractice action brought by the Elkins family, Dr. Spiva testified that she believed the cause of Elkins’ death had been the treatment he received under the care of Dr. Cohen and Dr. Buckwold.
After her problems at Baptist began, Spiva started admitting her patients to the Santa Rosa Medical Center. Dr. Derick Boldt, then the medical director of Santa Rosa, like so many others, had heard the rumors about Spiva. He couldn’t help but hear them—stories about misdiagnoses and incorrect treatments came from doctors practicing at his hospital. But Boldt is a man who hates rumors. “I don’t ever want to deal with a doctor on a rumor,” he says. “I insisted they bring me the facts.”
Boldt had a phone conversation with Whitecar about Spiva. Whitecar warned Boldt that she could cause serious problems. Boldt found the conversation insufficiently convincing. Then he turned to the Board of Medical Examiners. “I called and wrote. They just ignored me,” Boldt says. “They didn’t want to give me any information on the phone or anything on paper. That raised my suspicions—do they really have anything on the woman?” he says.
Finally, after months, the proof Dr. Boldt needed was found in the case of 33-year-old Gloria Villarreal. Villarreal, a mother of four, had been a patient of Dr. Spiva’s for several years. Her primary problem, Spiva testified during a deposition in a malpractice case, was systemic lupus erythematosus. Lupus is a chronic disease usually affecting young women. There is no cure, but flare-ups, in which connective tissue in any part of the body can become inflamed and damaged, can often be medicated with drugs. Lupus is considered an autoimmune disorder—one in which the body’s immune system begins attacking itself. For that reason steroids, which suppress the immune system, are often prescribed to control the disease.
Spiva had ordered pheresis for Villarreal when she was practicing at the Nix. By the time Villarreal entered Santa Rosa on December 2, 1985, she was a sick woman, suffering from diabetes and heart trouble, as well as, according to Spiva’s diagnosis, a rare disorder of the blood known as thrombotic thrombocytopenic purpura (TTP). On December 12 Villarreal successfully underwent a heart valve replacement and bypass. Following surgery, Spiva ordered enormous doses of steroids for Villarreal to treat what she considered a flare-up of lupus and TTP. In her deposition Spiva called it a “super-pharmacologic dose,” one used in “a heroic attempt to save a life.” Occasionally large doses, up to a gram, of steroids are prescribed for one to three days for severe flare-ups of lupus or arthritis. Such doses are dangerous, however, if a patient has diabetes, chronic infections, or hypertension. Villarreal had all three. In addition, Spiva ordered not one gram, but two grams of steroids, and not for one to three days, but for twelve days.
Over the course of those twelve days Villarreal began exhibiting common symptoms of steroid overdose: psychosis, kidney failure, persistent infections. Other doctors reviewing Villarreal’s progress wrote many requests in the chart that the steroids be reduced. The morning of December 27 Gloria Villarreal died of massive infection.
My Library
