David E. Smith, MD ’64, Resident Alum : Providing care, free of charge and free of judgment

Dr. Smith received his award at the Class of 1964 Medicine Alumni Dinner during Alumni Weekend on April 13, 2019.

In nominating David Smith for Alumnus of the Year, his classmate Bernhard Votteri, MD ’64, said, “Over the past 55 years he has joined the ranks of the audacious, innovative, and compassionate caregivers that serve as role models for current and future UCSF alumni.”

Much of Smith’s reputation comes from his role as founder of the Haight-Ashbury Free Clinic (HAFC), which he opened in 1967, and through which he cared for countless young people struggling with drug addiction, illness, and homelessness.

Starting a free clinic was not his initial career goal; in fact, he expected to go into academic medicine. But when he saw so many young people struggling in his own neighborhood, he decided to use his medical training to help. It was a calling that required someone truly special.

Farming roots

Smith grew up in a farming community in Bakersfield, Calif. He notes that his grandparents fled the Oklahoma Dust Bowl of the 1930s to California’s Central Valley, working overtime to be sure his mother, Dorothy, could get training to become a nurse.

Dorothy died when Smith was a teenager, but he followed in her footsteps by pursuing medicine. He initially studied at Bakersfield Community College, then UC Berkeley, where he majored in zoology. Just as he was beginning medical school at UCSF, his father died.

Thus, he says, college and medical school brought academic challenges, but the personal and cultural challenges were even greater.

“Most of my classmates had intact families. Many of their fathers were doctors, so they understood the system,” he says. “But one reason I love UCSF is because of those incredible classmates. They really helped me, including inviting me to their homes for the holidays. Those days were tough but I also think of them with great fondness.”

Finding home

Smith found mentors among USCF faculty, including Chancellor Philip R. Lee, MD, Emeritus Faculty, who prioritized care for the disadvantaged and was one of the architects of Medicare. Lee later served on HAFC’s board.

Then there was Fred Meyers, MD ’49, professor of pharmacology and experimental therapeutics, who was on the frontier of psychopharmacology, studying the effects of LSD and other psychotropics on the brain. Smith was captivated by Meyers’ work and completed a master’s degree in pharmacology under his mentorship.

Meanwhile, with funds from his father’s estate, Smith bought an apartment building on Frederick Street in Haight-Ashbury. Having a home meant a lot to him after losing his parents, and his apartment became a gathering place for medical school classmates. With a view of Kezar Stadium from the building’s roof, they established the “49ers Ladder Club” to watch football games from up high.

Living there also put him in the epicenter of the counterculture that was gathering in the city. It was an incredible time for young people, but many of them struggled with drug addiction, hunger, and homelessness.

Free to be you and me

HAFC was open 24 hours a day, with an all-volunteer staff, to provide a safe space to get treatment for addiction and illness or even just to come down off a bad high. But Smith notes that the “free” in “free clinic” was not just about providing care at no cost – it was also about providing care with no judgment.

“The free clinic movement’s ideal was not simply to create charity clinics,” he says. “It was a philosophical concept for delivery of healthcare to destigmatize outsider populations of any kind.”

Smith felt like he could understand the outsider: “I think I still carried the ‘Okie’ culture from my grandparents, so I identified with the outsider culture, and had an internal need to seek justice for myself and others.”

HAFC also helped city residents cope with the AIDS crisis in the 1980s, and is still very much needed today, with San Francisco home to thousands who live on the streets, plus a skyrocketing drug problem and epidemic overdose rates.

Now part of a larger organization called HealthRIGHT 360, HAFC still provides those in need with healthcare, as well as meals, job training, counseling, and more.

Still giving back

Today, Smith says, about 4,000 free clinics exist nationwide, and he often speaks at conferences, explaining the ideals behind the original free clinics – which have moved beyond the counterculture and can be found in major cities across the country, often run by churches.

“Whether or not you agree with the philosophy behind free clinics, they have saved millions of lives and millions of dollars,” he says.

It’s especially gratifying for Smith to see free clinics in the Central Valley that tend to the health needs of undocumented farmworkers. He’s also helped his childhood community by establishing a nursing fellowship at the East Bakersfield High School Health Careers Academy, allowing students with farmworker backgrounds to shadow healthcare professionals and get a jumpstart on a medical career.

“My mother motivated me to work hard and make something of myself,” he says. “I’m giving back to these kids, many of them underprivileged, so that they can have opportunities like I had to have a fulfilling career.”

Smith is also proud to serve on the Alumni Association of UCSF (AAUCSF)’s Diversity and Outreach Committee, which aims to help expand diversity among UCSF students and ultimately among the medical workforce.

Smith has retired from the HAFMC, which has evolved into HealthRight 360 (HR360), the largest non-profit addiction program in California, seeing over 25,000 patients per year for a variety of medical and psychiatric problems. HR360 continues to support Smith’s original mission statement for the Haight Ashbury Free Clinic—“Health Care is a Right, Not a Privilege.” He continues his involvement with Health Professional Training as an adjunct Clinical Professor at UCSF, where he finds mentoring and teaching the next generation to be inspiring.

“Working with them is one of the most motivating things in my life,” he says. “UCSF is putting a greater emphasis than ever on serving underserved populations. I meet these young medical students and physicians and I’m confident that they’ll carry that message forward into their careers.”

In addition, each year, the Smith Family Foundation co-sponsors a San Francisco Addiction Summit—a one-day symposium at the UCSF-Mission Bay campus—with the San Francisco Health Department and San Francisco Marin Medical Society. Always on the cutting edge, the 2019 symposium’s theme is “Psychedelic Medicine, Technology and Conscious Recovery.” The information for the June 28, 2019 event can be found on the symposium website: drsmithsymposium.com. All of the conference papers will be published in the Journal of Psychoactive Drugs, which Smith founded in 1967 during the Summer of Love (with the very apt title, Journal of Psychedelic Drugs.)

Clinically, Smith continues to practice addiction medicine, serving as the Medical Director of several addiction treatment programs in Marin, including Muir Wood (an adolescent treatment program), Avery Lane (a woman’s only program) and Center Point (a program similar to HR360).

Right where he belongs

Smith met his partner, Millicent, though HAFC, where she was key to the clinic’s recovery program. “She brought long-term recovery into the neighborhood’s wild world of drugs,” he says. The couple has four children and five grandchildren, and many of them will be present when he receives the Alumnus of the Year award.

“I’m really looking forward to seeing my classmates and getting this big honor in front of family and friends,” he says.

Haight-Ashbury may have changed over the course of 50 years, but if you go there, you’ll likely still see young people who have come to San Francisco; some for a fresh start, and others still struggling with homelessness and drugs – you might just run into Smith, giving tours to UCSF medical students or simply walking in the neighborhood he’s never left.

“This neighborhood has so many diverse and bright people from all over the world in such a little area, plus restaurants and arts and culture – it’s like Florence during the Renaissance,” he says. “I’m where I belong.”