UF faculty member with checkered past faces state scrutiny
By Jeff Schweers
December 2, 2013
Harold E. Smith, a 61-year-old assistant professor in the College of Medicine’s Department of Psychiatry, is accused of prescribing an excessive and inappropriate amount of oxycodone to a patient that ultimately led to her death, according to the state Department of Health.
The department has asked the Board of Medicine to consider appropriate disciplinary action on Friday when it meets in Orlando. Such action could include but is not limited to permanent revocation or suspension of Smith’s license, restriction of practice, placement on probation, imposition of an administrative fine and a refund of fees billed or collected.
Smith, who over the course of his 30-year psychiatric career has specialized in chemical dependency, addiction medicine and treatment, also is being sued for wrongful death in Orange County by the patient’s husband and her estate. A court hearing has been scheduled for Jan. 7.
Given the chance to answer questions about the two cases and his professional history when reached Monday by The Sun by phone, Smith declined to comment.
Smith was hired in July as an assistant professor and addiction medicine psychiatrist practicing at the UF Health Florida Recovery Center, according to a statement released by UF Health. His salary is $170,000 annually.
“He has been successfully doing the job he was hired to do. We have no current concerns about his ability to practice medicine,” the statement said.
UF Health officials refused to answer whether a background check was performed on Smith or if they knew before hiring him of his history and current pending disciplinary action.
Some have questioned how UF could have hired Smith in light of his medical history, which has included the revocation of his license in three states, disciplinary actions in Florida for the documented use of cocaine and crack cocaine, and more potential disciplinary action pending.
“How he got the job at UF I have no idea,” said Mac McLeod, the St. Augustine medical malpractice lawyer representing Robert C. Tomlinson and his wife’s estate. “The history is staggering. I just have to believe at this point that UF didn’t know his history. And if it did, you have to scratch your head.”
Joel Voss, an investigator with the Citizens Commission on Human Rights, said he is concerned that Smith is teaching medical students and has hospital privileges at UF Health Shands Hospital, the state’s premier teaching hospital.
“This guy has been in and out of rehab and relapsed on crack cocaine so many times he has no business being within 500 yards of a college campus,” Voss said.
The administrative complaint filed June 24 by Florida Surgeon General and Secretary of Health John H. Armstrong alleges that Alice R. Tomlinson, 51, died in December 2010 while under Smith’s care at Central Florida Behavioral Hospital in Orlando.
She was voluntarily admitted Dec. 11, 2010, complaining about frequent and severe panic attacks and chronic pain, crying for hours and having thoughts of cutting her wrists. She had a history of mental illness for which she’d been hospitalized several times before, the complaint said, and she already was taking clonazepam, a sedative used for treating anxiety disorders.
Standard practice would be to consult with a specialist in internal medicine or pain management, neither of which occurred, the complaint said. Smith prescribed Percocet, a combination of oxycodone and acetaminophen, a schedule II narcotic with a high potential for abuse, the complaint said.
Around Dec. 14, the complaint said, he took Tomlinson off the Percocet and gave her OxyContin, an extended release version of oxycodone, a schedule II opioid. Both oxycodone and clonazepam depress the central nervous system and have a magnifying effect when used together.
Around Dec. 16, Smith increased the dose of OxyContin from 20 mg twice a day to three times daily and kept her on the clonazepam, according to the complaint.
Hospital staff began noticing that the patient appeared sedated around Dec. 19, the complaint said. The standard of care is to withhold OxyContin and clonazepam, perform a toxicology report to check the levels of drugs in the patient, and provide respiratory support if needed, the complaint stated.
None of those things occurred. Instead, Smith increased the dosage of OxyContin to 30 mg three times a day, the complaint said.
On Dec. 21, 2010, a psychiatrist noticed Tomlinson was overly sedated and not participating in treatment. Smith decreased Tomlinson’s OxyContin dosage when he should have discontinued it altogether, the complaint said.
Around 5:30 a.m. the next day, a nurse found Tomlinson face down on the floor of her room, the lawsuit said. The nurse led her back to bed but didn’t notice her declining status, the lawsuit said.
Around 8:04 a.m., another nurse found Tomlinson unresponsive in bed with a weak pulse and shallow breathing, the lawsuit stated. Staff did not take emergency action such as resuscitative medication or use a defibrillator, and 15 minutes later, emergency personnel arrived and pronounced Tomlinson dead, the lawsuit said.
The Orange County Medical Examiner said Tomlinson died of cardiopulmonary arrest brought on by oxycontin intoxication, McLeod said.
“He essentially didn’t see this lady and applied the oxycodone that ultimately killed her,” McLeod said.
The lawsuit claims Smith and the hospital were medically negligent and thus responsible for Tomlinson’s death. The hospital also was sued for being negligent in hiring Smith in the first place without checking his background.
The hospital already has reached a confidential settlement with Tomlinson’s husband, McLeod said.
“It’s bizarre to me how (Smith) ended up as a medical officer at a psychiatric hospital in Orlando,” McLeod said.
McLeod said he has asked for a copy of Smith’s application, to see what he included or excluded to get hired by UF. Smith’s attorneys have refused, and the judge in the case denied Mcleod’s request.
While he was prescribing medication for Tomlinson, Smith was under investigation by the DEA. It launched an investigation in 2009, officials said, after having reason to believe Smith had lied on his application for DEA registration for a certificate to prescribe schedule II narcotics such as oxycodone.
A show-cause order was issued April 17, 2009, proposing revocation of his DEA Certificate of Registration and denial of any pending applications to renew or modify the registration “on the grounds that Respondent had materially falsified various applications for his DEA registration and had committed acts which render his registration inconsistent with the public interest.”
A six-page order in 2011 revoking his DEA certificate described a lengthy history of documented substance and alcohol abuse going back to 1982 when he entered treatment for “alcohol and controlled substance abuse.”
The DEA report said Smith tested positive for cocaine in 1990, and entered a treatment center in Georgia. The report documents his “relapse” on crack cocaine in 2006, which led to treatment and suspension of his medical license. He was reinstated in June 2007.
It also documents his prescribing hydrocodone to family members in 1999 and 2000, for which he paid a $5,000 fine.
The DEA said that in 2002, 2005 and 2008, Smith had submitted applications for renewal of his DEA registration without disclosing the various sanctions imposed on him by Georgia and Florida, as well as the previous surrenders of his DEA registration.
“Only one of these material falsifications is necessary to support the revocation of Respondent’s registration; that there are three such instances manifests a shocking level of dishonesty on his part,” DEA Administrator Michele M. Leonhart wrote in her revocation order of Aug. 17, 2011.
“I seriously question whether the university could have seen that Department of Justice order and hired him,” McLeod said. “I’ve never seen anything like it, and I’ve been doing medical malpractice for over 25 years.”
McLeod said he has no idea what kind of settlement offer is in the works at the Department of Health. He said the DOH has invited him to attend the Friday hearing in Orlando.
Voss also expressed shock that Smith was allowed to work in Florida after looking into his lengthy history of abuse and disciplinary actions. CCHR investigates and exposes “psychiatric violations of human rights,” Voss said.
Smith’s resume shows a career in addiction therapy and chemical dependency since 1983, when he was assistant medical director and group therapist of the adult chemical dependency program at Peninsula Hospital in Louisville, Tenn.
He then ran the adolescent chemical dependency program at the Ridgeview Institute in Smyrna, Ga., ultimately becoming director of the program from 1987 to 1990, when he ran into trouble with the state medical board because of his own drug problems.
In 1991, Smith started a psychiatric residency at the University of Tennessee-Memphis, becoming an assistant professor from 1995-97 before going to work for private health companies in 1998 and 1999.
Smith got his license to practice medicine in Florida in January 1999 after leaving Tennessee.
Not only was Smith’s DEA certification suspended several times and ultimately revoked with no chance for renewal, Smith has had his license to practice medicine revoked in Arkansas, Tennessee and Virginia, according to information he provided the Florida Department of Health.
“He can’t work at (Central Florida Behavioral Hospital) because he can’t prescribe the drugs they want prescribed, so he goes off to the academic world and becomes an assistant professor,” Voss said.
Voss said his concern is several fold — that UF either didn’t look into Smith’s background or that it overlooked his background, and now UF has a faculty member with an ethically challenged and medically negligent history teaching medical students.
“This is not a guy who got a DUI 10 years ago, got his act together and is now practicing safe medicine,” Voss continued. “This guy is a perfect storm. He has a huge drug history, he lied on his application and if he had told the truth, this woman would still be alive.”