Document:

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                                                                   EXHIBIT 10.19

                               FIRST AMENDMENT TO
              SECURITIES PURCHASE AGREEMENT AND SECURITY AGREEMENT

     This First Amendment to Securities Purchase Agreement and Security
Agreement (this "Amendment") is dated as of the ___ day of August, 2001 and is
                 ----------
by and among DVI, INC., a Delaware corporation (the "Company"), DVI FINANCIAL
                                                     --------
SERVICES INC., a Delaware corporation ("Financial"), and DEEPHAVEN/JE MATTHEW I,
                                        ----------
LLC, a Minnesota limited liability company ("Buyer").
                                             ------

                              W I T N E S S E T H:

     WHEREAS, the Company and Buyer are parties to that certain Securities
Purchase Agreement, dated as of June 29, 2001 (the same, as it may be amended,
restated, modified or supplemented and in effect from time to time, the

"Purchase Agreement") pursuant to which it purchased a $12,000,000 9.5% Asset-
--------------------
Backed Exchangeable Term Note (the "Note") from the Company; and
                                    -----

     WHEREAS, in connection with the Purchase Agreement and as security for the
Note, Financial and Buyer entered into that certain Security Agreement, dated as
of June 29, 2001 (the same, as it may be amended, restated, modified or
supplemented and in effect from time to time, the "Security Agreement") pursuant
                                                   -------------------
to which Financial granted Buyer a security interest in certain of its assets as
described therein; and

     WHEREAS, the Company and Financial have requested that Buyer amend the
Purchase  Agreement and the Security Agreement in certain respects (including,
but not limited to reducing the required Collateral Value (as defined in the
Security Agreement)), as more fully set forth herein, and Buyer is agreeable to
such request, upon such terms and conditions set forth herein (including, but
not limited to the issuance and delivery of the August 2001 Warrant (as
hereinafter defined));

     NOW, THEREFORE, the parties hereto hereby agree as follows:

     1.  Definitions.  Capitalized terms used in this Amendment and not
         -----------
otherwise defined herein are used with the meanings given such terms in the
Purchase Agreement.

     2.  Amendment of the Security Agreement.
         -----------------------------------

         (a)   Section 5(a) of the Security Agreement is hereby amended and
     restated as follows:

               "Section 5. Maintenance of Collateral. (a) The Grantor shall at
                           -------------------------
         all times maintain a Collateral Value equal to not less than 225% of
         the Outstanding Secured Note, plus, after the occurrence and during
         the continuance of a Cash Collateral Event, the Cash Collateral
         Reserve."
<PAGE>

         (b)   The definition of "Contract Schedule" set forth in Section 20 of
     the Security Agreement is hereby amended by deleting subsection (x)
     regarding the discounted principal balance of the Contract.

     3.  Amendment of the Purchase Agreement.
         -----------------------------------

         (a)   The terms "Amendment", "Primary Registration Statement" and
     "Resale Registration Statement" shall be deleted from the glossary of the
     Purchase Agreement.

         (b)   Section 4.2 of the Purchase Agreement is hereby amended and
     restated as follows:

         "Section 4.2   Registration Statement.

            (a) The Company shall, as soon as practicable, but in no event later
         than 60 days after the date of issuance of the Note (the "Issuance
         Date") file with the SEC a registration statement ("Registration
         Statement") for resale to Buyer of Exchange Shares and the Warrant
         Shares in an amount equal to 19.99% of the outstanding share of Common
         Stock or such lesser amount equal to the maximum number of Exchange
         Shares and Warrant Shares which the Company is permitted to register
         under the rules, regulations and interpretations of the SEC as in
         effect from time to time. The Company shall use its best efforts to
         have the Registration Statement declared effective by the SEC as soon
         as practicable. The Company shall use its best efforts to file post-
         effective amendments and amended or supplemented prospectuses to or
         with the Registration Statement from time to time so that the latest
         available prospectus will continue to meet the requirements of Section
         10 of the 1933 Act until the earlier of (i) the date as of which all of
         the Exchange Shares and Warrant Shares that may be issued may be sold
         without restriction pursuant to Rule 144(k) promulgated under the 1933
         Act (or successor thereto) or (ii) the date on which (A) all the
         Exchange Shares and Warrant Shares that may be issued are sold and (B)
         none of the Note or any Warrants are outstanding.

            (b) The Company shall permit Buyer or its assigns to review and
         comment upon the Registration Statement and all other amendments and
         supplements to the Registration Statement or at least seven days prior
         to their filing with the SEC."

     4.  August 2001 Warrant.  In consideration of Buyer amending the Security
         -------------------
Agreement as aforesaid, the Company shall issue a Warrant to Buyer identical to
Exhibit A attached hereto (the "August 2001 Warrant").  The August 2001 Warrant
                                --------------------
shall be deemed to be a Warrant under the Purchase Agreement and all shares of
Common Stock purchased pursuant to the August 2001 Warrant shall be deemed to be
Warrant Shares under the Purchase Agreement.

     5.  Conditions.  This Amendment shall become effective on the date on
         ----------
which the following conditions precedent have been satisfied or waived in
writing:

         (a)   The Company, Financial and Buyer shall have each executed and
     delivered this Amendment to each other; and

                                       2
<PAGE>

         (b)   Buyer receives the August 2001 Warrant from the Company.

         (c)   Buyer receives certified resolutions of the board of directors of
     the Company and Financial authorizing the issuance and delivery of this
     Amendment and the August 2001 Warrant.

     6.  Representations and Warranties.  To induce Buyer to enter into this
         ------------------------------
Amendment, the Company and Financial hereby represent and warrant to Buyer that:

         (a)   Since June 29, 2001, there has been no development or event,
     which has had or could reasonably be expected to have a material adverse
     effect on the business, properties, assets, operations, results of
     operation, or financial condition of the Company and its Subsidiaries,
     taken as a whole.

         (b)   The Company and Financial each have the corporate power and
     authority, and the legal right, to make and deliver this Amendment, and
     with respect to the Company, the August 2001 Warrant, and to perform all of
     their respective obligations under the Security Agreement and the Purchase
     Agreement, as amended by this Amendment, and each have taken all necessary
     corporate action to authorize the execution and delivery of this Amendment,
     and with respect to the Company, the August 2001 Warrant, and the
     performance of the Security Agreement and the Purchase Agreement, as so
     amended.

         (c)   When executed and delivered, this Amendment and the Security
     Agreement and the Purchase Agreement, as amended by this Amendment, will
     constitute legal, valid and binding obligations of the Company and
     Financial, enforceable against them,  in accordance with their terms,
     except as such enforceability may be limited by general principals of
     equity or applicable bankruptcy, insolvency, reorganization, moratorium,
     liquidation or  similar laws relating to, or affecting generally, the
     enforcement of creditors' rights and remedies.

         (d)   The representations and warranties made by the Company in the
     Purchase Agreement and the representations and warranties made by Financial
     in the Security Agreement are true and correct in all material respects on
     and as of the date hereof, before and after giving effect to the
     effectiveness of this Amendment, as if made on and as of the date hereof,
     other than those that relate to an earlier or specific date.  The Buyer
     Indemnified Parties shall be entitled to all rights to indemnification
     contained in Article VIII of the Purchase Agreement with respect to
     breaches of any representations or warranties made by the Company or
     Financial in this Amendment notwithstanding the fact that such
     representations and warranties will be made after the Closing Date;
     provided, however, nothing contained herein shall require the Company to
     remake any representation or warranty contained in the Purchase Agreement
     after the later of (i) the date of this Amendment or (ii) the date of the
     issuance and delivery of the August 2001 Warrant.

                                       3
<PAGE>

     7.  Reaffirmation and Confirmation of Security Interests.  Financial hereby
         ----------------------------------------------------
confirms to Buyer that Financial has granted to Buyer a security interest in or
lien upon the assets described in the Contract Schedule (as defined in the
Security Agreement) to the Security Agreement, to secure the Secured Obligations
(as defined in the Security Agreement). Financial hereby reaffirms its grant of
such security interest and lien to Buyer for such purpose in all respects.

     8.  Miscellaneous.
         -------------

         (a)   The Company hereby agrees to pay all of Buyer's costs and
     expenses, including, without limitation, attorneys' fees, related to this
     Amendment.

         (b)   This Amendment may be executed in one or more counterparts, each
     of which shall be deemed to be an original, but all of which shall together
     constitute but one and the same document.

         (c)   This Amendment shall be binding upon and inure to the benefit of
     the parties hereto and their respective successors and assigns.

         (d)   Section captions and headings used in this Amendment are for
     convenience only and are not part of and shall not affect the construction
     of this Amendment.

         (e)   From and after the date of execution of this Amendment, any
     reference to the Purchase Agreement or Security Agreement contained in any
     notice, request, certificate or other instrument, document or agreement
     executed concurrently with or after the execution and delivery of this
     Amendment shall be deemed to include this Amendment unless the context
     shall otherwise require.

         (f)   Except as expressly set forth herein, nothing in this Amendment
     is intended to or shall be deemed to have amended the Purchase Agreement or
     the Security Agreement, which are hereby reaffirmed in all respects.
     Notwithstanding anything contained herein, the terms of this Amendment are
     not intended to and do not serve to effect a novation as to the Purchase
     Agreement or the Security Agreement.  The Purchase Agreement and the
     Security Agreement, as amended hereby remain in full force and effect and
     are hereby reaffirmed in all respects.

      [Balance of page intentionally left blank; signature page follows.]

                                       4
<PAGE>

     IN WITNESS WHEREOF, the parties have executed this Amendment as of the date
first set forth above.

                                        DVI, INC.

                                        By: __________________________________
                                        Its:__________________________________

                                        DVI FINANCIAL SERVICES INC.

                                        By: __________________________________
                                        Its:__________________________________

                                        DEEPHAVEN/JE MATTHEW I, LLC

                                        By: ______________________________
                                            John Fern, President

                                        By: ______________________________
                                            Bruce Lieberman, Chief Manager

                                       5<PAGE>

                                                                   EXHIBIT 10.20

                                       1

================================================================================

                                   Amendment
                                       to
                              Amended and Restated
                              Investment Agreement

                                     among

                               MSF HOLDING LTD.,

                         MEDICAL SYSTEMS FINANCE S.A.,

                                  ESTOLUR S.A,

                        HEALTHCARE SYSTEMS FINANCE S.A.,

                            MSF/HSF ARGENTINA S.A.,

                                      and

      NEDERLANDSE FINANCIERINGS-MAATSCHAPPIJ VOOR ONTWIKKELINGSLANDEN N.V.

                              Dated July 19, 2001

================================================================================
<PAGE>

                                  AMENDMENT TO
                              AMENDED AND RESTATED
                              INVESTMENT AGREEMENT

     AGREEMENT, dated July 19, 2001, among MSF HOLDING LTD., a company organized
and existing under the laws of the Commonwealth of the Bahamas ("MSF Holding"),
MEDICAL SYSTEMS FINANCE S.A. ("MSF"), ESTOLUR S.A. ("Estolur"), HEALTHCARE
SYSTEMS FINANCE S.A. ("HSF"), each of them a sociedad anonima, organized and
                                             -------- -------
existing under the laws of Uruguay, and MSF/HSF ARGENTINA S.A., a sociedad
                                                                  --------
anonima organized and existing under the laws of Argentina, formerly known as
-------
Sistemas Financieros S.A. and as MSF Argentina S.A. ("MSF Argentina"), and
NEDERLANDSE FINANCIERINGS-MAATSCHAPPIJ VOOR ONTWIKKELINGSLANDEN N.V., a limited
liability company organized and existing under the laws of The Netherlands
("FMO").

     WHEREAS:

     (A) Pursuant to an Amended and Restated Investment Agreement dated April
27, 1998, as amended and restated as of September 29, 1998 and as further
amended (as amended from time to time, the "Investment Agreement") among the
parties hereto, FMO has made a loan to the Co-Borrowers (as such term and other
terms used herein are defined in Section 1) in the aggregate principal amount of
up to twenty-five million Dollars ($25,000,000).

     (B) FMO and the Co-Borrowers have agreed to amend the Investment Agreement
as provided herein.

     NOW, THEREFORE, the parties agree as follows:

     Section 1.  Definitions.  All capitalized terms used in this Agreement
(including the preamble and recitals) and not otherwise defined herein, unless
the context otherwise requires, have the respective meanings given to such terms
in the Investment Agreement.

     Section 2.  Amendments to the Investment Agreement.

     (a) Section 1.01 of the Investment Agreement is amended by inserting in
such section in alphabetical order the following additional definitions:
<PAGE>

                                       2

          "Contract Repurchase Guarantee Agreement" an agreement among DVI
Financial, Oferil and the Co-Borrowers, in form and substance acceptable to FMO,
(i) obligating Oferil to purchase Defaulted Receivables in an amount in each
fiscal Year at least equal to the difference between two percent (2%) of Net
Financed Assets and the amount of the Lease/Loan Loss Reserve at a price equal
to the amount of such Defaulted Receivables and (ii) providing for the payment
for each Defaulted Receivable purchased by the reduction of the principal amount
of the loans outstanding under the Stand-by Loan Facility Agreement by the
amount of such Defaulted Receivable;

          "Defaulted Receivable" any Lease/Loan Receivable in respect of which
any amount is due and unpaid for one hundred eighty-one (181) days or more;

     (b)  Section 1.02 of the Investment Agreement is amended by inserting in
such section in alphabetical order the following additional definition:

          "Debt to Equity Ratio" the result obtained by dividing Debt by
Shareholders' Equity;

     (c)  Section 3.07(a)(i) of the Investment Agreement is amended to reach as
follows:

          (i) the Co-Borrowers simultaneously pay all accrued interest and
     Maintenance Amount (if any) on the amount of the Loan to be prepaid
     together with (A) a prepayment premium in an amount equal to one and one-
     half percent (1.5%) of the amount of the Loan being prepaid and (B) all
     other amounts then due and payable under this Agreement.

     (d)  Section 7.02(b) of the Investment Agreement is amended to read as
follows:

          (b) cause the Eligible Co-Borrowers to maintain on a consolidated
     basis a diversified vendor portfolio, with no single vendor
<PAGE>

                                       3

     providing more than (i) 50% of the equipment financed pursuant to Eligible
     Leases/Loans in the MSF Portfolio from July 1, 2002 through June 30, 2003,
     and (ii) 40% of such equipment thereafter;

     (e)  Section 7.03(b) of the Investment Agreement is amended to read as
follows:

          (b) maintain, on an aggregate basis, a diversified vendor lease
     portfolio, with no single vendor representing more than (i) fifty percent
     (50%) of the equipment financed pursuant to Eligible Leases/Loans in the
     MSF Portfolio from July 1, 2002 through June 30, 2003, and (ii) forty
     percent (40%) of such equipment thereafter;

     (f)  Section 7.02(c) of the Investment Agreement is amended to read as
follows:

          (c) maintain a Lease/Loan Loss Reserve of at least (i) one percent
     (1%) of Net Financed Assets during Fiscal Year 1999, (ii) one and one-half
     percent (1.5%) of Net Financed Assets during Fiscal Year 2000, and (iii)
     two percent (2%) of Net Financed Assets in Fiscal Year 2001 and thereafter;
     provided, that in Fiscal Year 2001 and thereafter, MSF Holding may maintain
     a Lease/Loan Loss Reserve of at least one-half percent (0.5%) of Net
     Financed Assets if (A) the Contract Repurchase Guarantee Agreement is in
     full force and effect, (B) in each such Fiscal Year, Oferil has purchased
     from the Eligible Co-Borrowers pursuant to the Contract Repurchase
     Guarantee Agreement an amount of Defaulted Receivables at least equal to
     the difference between two percent (2%) of Net Financed Assets and the
     amount of the Lease/Loan Loss Reserve, each Defaulted Receivable so
     purchased has been paid for by the reduction of the principal amount of the
     loans outstanding under the Stand-by Loan Facility Agreement by the amount
     of such Defaulted Receivable, and DVI Financial has delivered to the Co-
     Borrowers evidence of the satisfaction of the loans so canceled, (C) the
     amount of loans outstanding under the Stand-by Loan Facility Agreement
     after giving effect to any repurchase of and payment for Defaulted
     Receivables is at least equal to the difference between two percent (2%) of
     Net Financed Assets and the amount of the Lease/Loan Loss Reserve, and (D)
     and all loans outstanding under the Stand-by Loan Facility Agreement are
     subordinated on terms acceptable to FMO to all amounts payable under this
     Agreement;

     (g)  Section 7.03(c) of the Investment Agreement is amended to read as
follows:

<PAGE>

                                       4

          (c) maintain, on an aggregate basis, a Lease/Loan Loss Reserve of at
     least (i) one percent (1%) of Net Financed Assets during Fiscal Year 1999,
     (ii) one and one half percent (1.5%) of Net Financed Assets during Fiscal
     Year 2000, and (iii) two percent (2.0%) of Net Financed Assets in Fiscal
     Year 2001 and thereafter; provided, that in Fiscal Year 2001 and
     thereafter, the Eligible Co-Borrowers may maintain on an aggregate basis a
     Lease/Loan/Loss Reserve of at least one-half percent (0.5%) of Net Financed
     Assets if (A) the Contract Repurchase Guarantee Agreement is in full force
     and effect, (B) in each Fiscal Year, Oferil has repurchased from the
     Eligible Co-Borrowers pursuant to the Contract Repurchase Guarantee
     Agreement an amount of Defaulted Receivables at least equal to the
     difference between two percent (2%) of Net Financed Assets and the amount
     of the Lease/Loan Loss Reserve, each Defaulted Receivable so purchased has
     been paid for by the reduction of the principal amount of the loans
     outstanding under the Stand-by Loan Facility Agreement by the amount of
     such Defaulted Receivable, and DVI Financial has delivered to the Co-
     Borrowers evidence of the satisfaction of the loans so canceled, (C) the
     amount of loans outstanding under the Stand-by Loan Facility Agreement
     after giving effect to any repurchase of and payment for Defaulted
     Receivables is at least equal to the difference between two percent (2%) of
     Net Financed Assets and the amount of the Lease/Loan Loss Reserve, and (D)
     all loans outstanding under the Stand-by Loan Facility Agreement are
     subordinated on terms acceptable to FMO to all amounts payable under this
     Agreement; and

     (h)  Section 7.04(a) of the Investment Agreement is amended to read as
follows:

          Section 7.04.  Negative Covenants.  Unless FMO otherwise agrees, each
     of the Co-Borrowers shall not:

     (a)  incur, assume or permit to exist any indebtedness except:

          (i)    the Loan;

          (ii)   the IFC Loan;

          (iii)  that part of Short-term Debt which is Indebtedness for Money
                 Borrowed incurred from commercial and/or investment banks in
                 the ordinary course of business, not exceeding at any one time
                 outstanding the equivalent of
<PAGE>

                                       5

                 twenty percent (20%) of the sum of (A) the aggregate principal
                 amount of Eligible Leases/Loans in the MSF Portfolio plus (B)
                 the value of the Cash Collateral pledged to FMO and IFC under
                 the Trustee Account and Security Agreement and in which FMO and
                 IFC have perfected and registered first priority security
                 interests;

          (iv)   other loans contemplated in the Financial Plan; and

          (v)    additional Debt which would not result in the Debt to Equity
                 Ratio exceeding 8:1; provided, that, at the time of incurring
                 such Debt, and after giving effect to the incurrence of such
                 Debt, no Event of Default or Potential Event of Default has
                 occurred and is continuing and that such additional Debt is not
                 secured by any assets comprising the FMO/IFC Security;

     Section 3.  Miscellaneous.

     (a)  Each of the Co-Borrowers agrees to deliver to FMO such opinions of
counsel as it may reasonably request with respect to this Agreement.

     (b)  All references in the Investment Agreement to "this Agreement",
"herein", "hereof", "hereunder", "hereto" or expressions of like meaning shall
be references to the Investment Agreement, as amended by this Agreement.

     (c)  Except as amended hereby, the Investment Agreement shall remain in
full force and effect.

     (d)  Each of the Co-Borrowers hereby restates, as if set forth herein at
length, and confirms, as of the date hereof, the representations and warranties
made by it in Article V of the Investment Agreement.

     (e)  The Co-Borrowers shall pay to FMO or as FMO may direct the reasonable
fees and expenses of  FMO's counsel in New York, the Bahamas, Uruguay,
Argentina, Mexico and elsewhere incurred in connection with (i) the preparation
and/or review, execution and, where appropriate, translation and registration of
this Agreement, and any other documents related to this Agreement; and (ii) the
giving of any legal opinions required by FMO in connection herewith.
<PAGE>

                                       6

     (f) This Agreement is governed by, and shall be construed in accordance
with, the laws of the State of New York, United States of America.

     (g) This Agreement may be executed in several counterparts, each of which
shall be considered an original, but all of which together shall constitute one
and the same agreement.

         IN WITNESS WHEREOF, the parties to this Amendment have caused this
Agreement to be duly executed as of the date first above written.

                              MSF HOLDING LTD.

                              By: _____________________________________
                                  Name:
                                  Authorized Representative

                              MEDICAL SYSTEMS FINANCE S.A.

                              By: _____________________________________
                                  Name:
                                  Authorized Representative

                              ESTOLUR S.A.

                              By: _____________________________________
                                  Name:
                                  Authorized Representative

<PAGE>

                                       7

                              HEALTHCARE SYSTEMS FINANCE S.A.

                              By: _____________________________________
                                  Name:
                                  Authorized Representative

                              MSF/HSF ARGENTINA S.A.

                              By: _____________________________________
                                  Name:
                                  Authorized Representative

                              NEDERLANDSE FINANCIERINGS-MAATSCHAPPIJ
                              VOOR ONTWIKKELINGSLANDEN N.V.

                              By: _____________________________________
                                  Name:
                                  Authorized Representative

                              By: _____________________________________
                                  Name:
                                  Authorized Representative

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