University of Florida psychiatrist Harold E. Smith facing discipline relative to treatment of patient who died

November 17, 2013

Harold Edward Smith is a psychiatrist who holds or has held licenses in Arkansas, Tennessee, Florida and Georgia over the last 36 years. His positition on the psychiatric department faculty of University of Florida at Gainesville comes after 28 years of state and federal investigations and disciplinary actions, most recently involving the prescriptions drug-related death of a patient under his care at Central Florida Behavioral Hospital (which is owned by Universal Health Services--Google them for more information).

The following is a record, compiled by the Tampa office of Citizens Commission on Human Rights, of investigations and actions taken against Smith in the order in which they occurred going back over 25 years. All the data below was obtained from documents from the various state medical boards in the states he has held medical licenses, the U.S. Drug Enforcement Agency (DEA), Lake County Florida Court, Orange County Florida Court, the University of Florida’s website and Smith’s own curriculum vitae.

(Due to how common this psychiatrist’s name is, a painstaking effort was made to verify all the data.)

May 1977: Graduated from medical school, University of Arkansas.

July 1977: Obtained medical license #C-5235 in Arkansas.

1982: According to a document issued by the U.S. Drug Enforcement Administration in 2009, Smith's documented substance abuse history dates back to 1982, when he "entered treatment for alcohol and controlled substance abuse."

April 1983: Smith “was discharged from an impaired physicians program.”

July 1983: Obtained Tennessee medical license #14953.

November 1984: Obtained Georgia medical license #27319.

Controlled substances are narcotic drugs like Percocet, OxyContin, Hydrocodone & Morphine; psychiatric tranquilizers such as Valium, Xanax and Klonopin; psychiatric amphetamines (stimulants) such as Ritalin, Vyvanse & Adderall, etc. For contrast, a few drugs that require a prescription but which are not controlled substances, are insulin, antibiotics, etc. Controlled substances have a high potential for abuse due to their addictive properties. In order for any doctor to prescribe controlled substances he must be approved by, and registered with, the DEA. Without a DEA registration a doctor cannot prescribe controlled substances. Insulin and antibiotics can be prescribed by a doctor who has a medical license but does not have a DEA registration.

April 1985: Smith entered into an agreed order with the Georgia Board of Medical Examiners (Georgia Board) based on his "chemical dependency," which placed him on probation for four years and imposed various conditions including that he "abstain from the consumption of alcohol or controlled substances," undergo random drug testing, and "relinquish" his controlled substance privileges.

April 1987: Became board certified by the American Society of Addiction Medicine .

1987 – 1990: Authored or co-authored the following papers:

          “Adolescent Inpatient and Outpatient Chemical Dependence Treatment: An Overview”

          “Chemical Abuse and Dependence: An Occupational Hazard for Health Professionals”

          “Chemical Abuse and Dependence: An Occupational Hazard for EMS Personnel”

          “Alternatives in Adolescent Chemical Dependence Treatment”

          “Drugs- A Deadly Game”

          “Parenting A Drug-Free Child”

          “A Physician’s Fifteen Years of Drugs”

June 1990: Physicians at Smith’s place of employment requested that he provide a specimen for drug testing. The specimen tested positive for cocaine. Subsequently, the Georgia Board ordered him to "undergo a 72-hour inpatient mental/ physical examination evaluation" and thereafter, Smith entered "treatment for relapse of chemical dependence."

October 10, 1990: He entered into an agreement with the Georgia Board under which his medical license was suspended and he was ordered (1) Not to practice medicine, (2) not to use his DEA registration, and (3) "to participate in a program for impaired physicians."

1993 – 1995: Smith specialized in child and adolescent psychiatry at the University of Tennessee in Memphis.

January 1999: Obtained Florida medical license #ME77300. He also became certified by the American Board of Psychiatry and Neurology as a specialist in psychiatry.

December 2001: Smith was arrested and jailed in Lake County, Florida for battery. The prosecutor offered him a deal: Pay the fines and take an anger management course and the charges will be dropped. Smith accepted the deal.

April 2002: Smith submitted an application to renew his DEA registration. In section 3 of the application, question 3(d) asked: "Has the applicant ever surrendered or had a state professional license or controlled substance registration revoked, suspended, denied, restricted, or placed on probation? Is any such action pending?" Smith circled "No." The application was approved and Smith was free to prescribe controlled substances.

October 18, 2002: The Florida Department of Health filed an Administrative Complaint against him, alleging that "from on or about July 24, 1999 to on or about August 14, 2000," Smith “wrote hydrocodone prescriptions for J.R.S.,” and that "from on or about January 14, 2000 to on or about June 30, 2000," he wrote hydrocodone prescription for L.L.S., both of whom were alleged to be related to him. The complaint further alleged that Smith "did not keep records of his examinations, diagnoses, treatment or drugs prescribed" for either person.

June 18, 2003: Smith entered into an agreement with the Florida Department of Health in which he neither admitted nor denied the allegations but agreed to pay a fine of $2,000 and to reimburse the Department for its investigation costs of $4,776.58. He was also required to complete a course entitled "Protecting Your Medical Practice, Clinical, Legal and Ethical Issues in Prescribing Abusable Drugs."

The Florida Professional Resource Network (PRN) is a non-profit organization run by the Florida Medical Association. PRN is contracted by the Florida Department of Health to treat impaired healthcare practitioners. The Florida PRN’s website states “The primary mission of PRN is to protect the health, safety and welfare of the public while supporting the integrity of the health care team and other professionals”. PRN’s Medical Director, Assistant Medical Director and Medical Consultant are all psychiatrists.

August 18, 2003: The Florida Board of Medicine rejected the aforementioned consent agreement between Smith and the Department of Health and offered a counter agreement, which the parties accepted. The agreement increased the fine to $5,000, imposed a restriction on his license requiring him to "remain in compliance with any and all terms of" his contract with the Professional Resource Network (PRN), and prohibited him "from writing prescriptions for controlled substances for any family member."

February 28, 2005: Smith submitted another application to renew his DEA registration. Once again, in answering question 3(d), "Has the applicant ever surrendered or had a state professional license or controlled substance registration revoked, suspended, denied, restricted, or placed on probation? Is any such action pending?" Smith again circled "No." The application was again renewed and Smith was free to prescribe controlled substances, as far as the DEA knows.

October 2005: Smith was evaluated by PRN and "diagnosed with cocaine dependence" and "opioid dependence, in apparent relapse." The evaluator found that Smith “was not safe to practice medicine.”

May 2006: The Florida Department of Health filed another Administrative Complaint against Smith. The complaint alleged that on approximately August 9, 2005, he had ceased complying with his PRN contract and that, on August 16, 2005, a PRN monitor had contact with him and recommended, based on his "body language and general demeanor," that he undergo a psychiatric evaluation. PRN then allegedly "requested that Smith submit to a psychiatric evaluation and drug screen." However, Smith failed to appear for his drug screen. The complaint further alleged that three weeks later, Smith contacted PRN and admitted to a relapse on crack cocaine and agreed to be evaluated.

February 2007: The Florida Board indefinitely suspended Smith’s medical license based in part on his admission of having relapsed on crack cocaine and failure to submit to a urine screen while under contract with the Board's impaired physicians' program.

June 2007: The Florida Board reinstated Smith's medical license. It is almost impossible that the Florida Board to would reinstate his license without a favorable report from Smith’s own psychiatrist within the PRN.

January 31, 2008: Smith submitted another application to renew his DEA registration. This time, however, he answered "Yes" to the question: "Has the applicant ever surrendered (for cause) or had a state professional license or controlled substance registration revoked, suspended, denied, restricted, or placed on probation, or is any such action pending?" In the application's block for explaining the "nature of incident" and the "result of incident," Smith wrote "see attached." He attached a copy of the Florida Board of Medicine's June 2007 Order on Reinstatement and a letter to him from a Florida Department of Health Compliance Officer relating the minutes of a September 7, 2007 meeting of the Board's Probation Committee. The letter related that the Committee had lifted the restriction on his prescribing authority. He did not, however, disclose the two Georgia proceedings or the 2003 Florida proceeding and also failed to disclose previous "surrenders" of his DEA registration.

April 2009, the Deputy Assistant Administrator, Office of Diversion Control, Drug Enforcement Administration, initiated an action against Smith “on the grounds that he had materially falsified various applications for his DEA registration and had committed acts which render his registration inconsistent with the public interest.”
By law, his DEA registration remains valid until this case was settled and action to revoke it is approved. At that time he was completely free to prescribe controlled substances.

December 11, 2010: Female patient “A.T.” was admitted to the Central Florida Behavioral Hospital (CFBH) in Orlando (operated by Universal Health Services) with complaints of panic attacks, depression and of being overwhelmed by chronic pain. Smith was her psychiatrist. Department of Health records indicate that from the time she checked in, she continued to complain of pain, appeared depressed and withdrawn and exhibited drug seeking behavior. Smith did not consult with a pain management specialist but prescribed the very addictive narcotic Percocet and the addictive psychiatric sedative Klonopin the day after she checked in.

December 14, 2010: Smith switched A.T.'s Percocet to OxyContin--another highly addictive and powerful narcotic--at the dose of 20 milligrams twice a day and increased her Klonopin dosage by 33 percent. OxyContin “may lead to severe psychological or physical dependence.” Both it and Klonopin are central nervous system depressants which, when used together, can increase the effects of the other.

December 16, 2010: Smith increased A.T.'s OxyContin dosage by 33 percent and left the Klonopin dosage the same.

December 19, 2010: Hospital staff reported that A.T. appeared sedated. “When A.T. began to appear sedated, the standard of care was to withhold the OxyContin and Klonopin, obtain a toxicology report to check the level of drugs in the patient's blood, and then closely observe the patient. Respiratory support should have been provided as needed.” Florida Department of Health records state that Smith  failed to do any of these actions. Instead, the next day, he again increased the OxyContin dosage an additional 33 percent.

December 21, 2010: Another CFBH doctor noted that A.T. was overly sedated. Smith decreased A.T.'s OxyContin and Klonopin dosages by about half but it was too late. The following morning, A.T. died after being found unresponsive.

August 2011: Concluding the investigation which it began in April 2009, the DEA revoked Smith's DEA Certificate of Registration (which imparts the privilege to prescribe controlled substances). The agency also denied his pending application. The order was effective September 29, 2011.

January 18, 2012: Family of deceased patient A.T. filed a medical malpractice lawsuit against Smith and CFBH relative to her death.

About 2013: Smith joined the faculty of and becames an assistant professor at the University of Florida, Department of Psychiatry, in Gainesville.

June 2013: The Florida Department of Health filed their third administrative complaint against Smith, relative to his treatment of A.T.