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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Shortly after Villarreal’s death, Dr. Spiva was suspended from the Santa Rosa Medical Center. Boldt called to give her the news, a call he did not relish making. “She was very likable, very personable. I felt bad,” he says. “I don’t like to see that happen to any doctor, it’s one of the most crushing things that can happen to a doctor.” He recalls Spiva’s reaction. “She was surprised. She was disappointed. She really didn’t think it would come to that.”
The Board Acts
Dr. Whitecar had helped get Spiva out of Humana, but he was still concerned about her actions and alarmed at the continuing body count that followed her from hospital to hospital. He had heard about the deaths at Baptist—that made him furious. He and others had spoken to an investigator from the State Board of Medical Examiners more than a year before, yet he knew that nothing had been done since then.
While driving to work early one morning in December 1985 he heard on the radio news that Dr. John Bagwell, a cancer specialist from Dallas, had been appointed to the board. Whitecar had met Bagwell several years before. Whitecar pulled into a 7-Eleven and phoned Bagwell to tell him about Dr. Deborah Spiva. He said it was a matter the board had to deal with immediately.
On January 16, 1986, an emergency executive committee session of the Board of Medical Examiners was called. The subject: Deborah Anne Spiva, M.D. That day four board members heard testimony from Dr. Hempel, Dr. Cohen, and Dr. Whitecar about their former colleague. Their comments were blunt. The recounted her involvement in several deaths and made it clear that they thought she was a danger to the public.
After hearing the testimony, the board members ordered that a full hearing on the case be scheduled as soon as possible. They also, fourteen months after being told by Hempel that her actions should be investigated, temporarily suspended the license of Dr. Spiva.
On January 20 her office was closed and her license confiscated by Raymond Juarez of the board, and she was informed that a hearing would be scheduled. And soon much of San Antonio knew about Dr. Deborah Spiva. Jerry Urban, a reporter for the San Antonio Express-News, obtained a transcript of the January meeting. Urban wrote a story about the hearing; he also passed a copy to the district attorney’s office. It was the first notice the office had had about her activities. An investigation was started into the deaths of Juan Garcia and of another hemophiliac, Richard Collins, who died after she treated him at the Nix, but the DA’s office decided it did not have sufficient cause to press charges. Ben Sifuentes, Jr., an assistant district attorney in the special crimes section, says the office is now looking into the case of Johnny Elkins.
The publicity from the January hearing resulted in a lot of calls to San Antonio personal injury lawyers. None of the sixteen suits filed so far has yet come to trial. On January 31, 1986, however, a settlement for an undisclosed amount was reached in the suit filed in October 1985 by Hazel Topoleski, one of Dr. Spiva’s porphyria patients. It turned out Topoleski never had porphyria but instead suffered from a form of migraine.
The defense mounted by Spiva resulted in a legal bonanza of its own. By early 1986 she was employing five law firms to handle her problems. One of her first actions was to bring a slander suit against Hempel, Cohen, and Whitecar for their January testimony. Those remarks were found by the court to be immune from prosecution. The slander suit was then amended to include remarks made outside the board room and expanded to include Buckwold; Joseph Dean McCracken, Spiva’s successor at SAMA; and Victorio Rodriguez, a physician at Santa Rosa. Included in the slander action were comments made by Whitecar, Hempel, and McCracken to Fred Cecere’s superiors at Fort Sam Houston regarding allegedly fabricated data in papers published by the couple.
If 1986 was turning out to be a bad year for Deborah Spiva, it was also a miserable year for the Board of Medical Examiners. The board was under fire from the Legislature and the press for its disciplinary procedures. Almost all of the disciplinary actions it took against doctors were kept secret; members of the public had no way of checking if their doctor had been reprimanded by the board. And chances were if a complaint had been filed against a physician, the physician had not been disciplined anyway; the backlog was so great that some cases lingered in the files for six years. Late last year the board began making available to the public a record of its disciplinary actions. And legislation to reform the board’s procedures further is scheduled for hearings this session. It includes proposals that would strengthen requirements for physicians to report questionable practices by their colleagues, and provide legal protection for physicians who speak out.
The case the board has prepared against Spiva turned out to raise as many questions as one of her patient charts. In June Travis County district judge Paul R. Davis found, in response to pleadings filed by Spiva’s lawyer Michael Sharp, that the charges against her were so vague—in one charge no patients were named—as to violate Spiva’s right of due process. On June 4 Judge Paul Davis restored Dr. Deborah Spiva’s license to practice medicine.
Austin lawyer and former assistant attorney general Paul Gavia was brought in by the board to handle the prosecution of the Spiva case. He started retracing the steps investigator Raymond Juarez had walked more than a year before, interviewing doctors in San Antonio. He rewrote the original charges, and on June 23, 1986, after months of delays, a Board of Medical Examiners hearing began concerning whether Deborah Spiva should be licensed to practice medicine in Texas. It ended July 11. Her husband was the main witness to testify on her behalf. As a parade of former colleagues testified that she was not competent, Spiva sat hunched over a legal pad, taking copious notes, rarely looking at her accusers, her face a kaleidoscope of tics and pained expressions.
“Some people, after they testified, would come up to me and tell me they still had a lot of affection for me,” she says. “They take you off at the knees and then say they have a lot of affection.”
Austin attorney Carla Cox was hired by the board to preside at the hearing. In October she issued her conclusion: Dr. Spiva’s license should be revoked. On December 3 the full board of medical examiners met to make a final decision on the recommendation. Spiva did not appear. The meeting took a little over an hour. After presentations by both sides, the board unanimously adopted Cox’s recommendation. It also found that Dr. Spiva was an imminent danger to the public health and safety and made the order effective immediately. Deborah Spiva became one of only 27 out of 42,784 doctors licensed by the state to be so disciplined last year.
An Uncertain Future
No one thinks Deborah Spiva was motivated by money, although while she was in practice the treatments she prescribed ran up enormous medical charges. When colleagues speculate on what went wrong, some say she has some sort of impairment that leaves her unable to distinguish between a lie and the truth. Others say that she was driven to discover diseases no one else could diagnose and that she would alter reality to fit this need. Some say her need for approval is so overwhelming that her pursuit of it became pathological. But mostly these men of science, so comfortable with the precise, esoteric vocabulary of medicine, use layman’s terms when describing Deborah Spiva. They say she’s crazy.
Spiva is all too familiar with the things that have been said about her, the talk that she is crazy. “That’s a good throwaway, that’s easy for people to buy, then they can live with themselves,” she says. “But there’s nothing in any of those records you could hang a psychiatric diagnosis on. How could I have been a solid citizen all these years, then December 20 [the day of her suspension from Humana Hospital Metropolitan], I’m crazy?”
When asked if she’s ever considered seeing a psychiatrist, she shakes her head. “Up to now, my life wasn’t that exciting.”
Spiva says her plans are uncertain. Fred Cecere is now at the U.S. Army Command and General Staff College at Fort Leavenworth, Kansas. She and her husband have talked about having children, but she adds with a smile that first they would like to live in the same city. It is hard, though, for her to make any plans with so much legal action pending. Last October she dropped her slander suit against her former colleagues, but she could refile it at any time. And there are all those malpractice trials to come. Her malpractice policy offers between $1 million and $3 million of coverage—and if she begins to lose her malpractice cases, she could quickly become personally liable for the rest. It is a more or less existential predicament—Spiva says she’s broke.
She is also fighting in the courts to get her license back. In February Judge Paul Davis, who restored it once before, did so again, pending Spiva’s appeal. He did, however, include the unusual stipulation that she not be allowed to treat patients. Judge Davis is scheduled to hear Spiva’s appeal in May.
Texas may end up with legislative reforms imposing stringent requirements on doctors to report the substandard care of their colleagues. But all the reforms in the world won’t work if physicians won’t see that there is a problem in the first place, if they allow questionable behavior to be talked away.
Even if Deborah Spiva does get her license back, she says the publicity has made it impossible for her to practice medicine again; she says she could never get malpractice insurance. That realization has been difficult for her. “Of course it’s painful. There’s no way it’s not,” she says. “What I’ll end up doing I really don’t know. I don’t know what doors have been closed. To have defined yourself as something and not be able to do that any longer is obviously painful. Especially when you did some good.”
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