During previous presidential administrations, the White House Medical Unit operated a pharmacy where staff members freely distributed prescription and non-prescription drugs – including controlled substances – without adequate record-keeping and sometimes to people who weren’t legally eligible to get them, according to a report released this month.
The report – from the independent Office of the Inspector General of the US Department of Defense, which oversees the Military Health System and thus the White House Medical Unit – says the clinic also misused taxpayer funds by dispensing brand-name drugs instead of less expensive generics and providing free medical care to staff who weren’t allowed to get it.
The Office of the Inspector General said in a news release that the problems it uncovered in the White House clinic were “severe and systemic.”
The report is based on reviews of records from the White House Medical Unit, including prescriptions, from between 2017 and 2019. In addition, investigators interviewed more than 120 officials, including hospital administrators, military medical providers and pharmacists. The office also reviewed the transcripts of 70 previous interviews with former members of the White House Military Office who served there between 2009 and 2018.
The interviews indicated that medication was often dispensed without any written records. Before “we would get ready for a big overseas trip,” staffers were directed to make “prepacks” that consisted of plastic sandwich bags containing the sleeping drug Ambien as well as the stimulant Provigil, which is meant to help people stay awake. Both are categorized as controlled substances, meaning they require special handling and record-keeping by pharmacies because they carry a risk for dependence and abuse.
These prepacks would often be handed out to senior staff or their assistants without any record of who was ultimately getting them, the testimony said.
The directive to give medication, “including all controlled substances,” to patients’ representatives “without the need to present the patient’s ID card” was also found by investigators on a handwritten note dated March 21, 2014.
In one case, according to the excerpted testimony, a doctor in the medical unit asked a staffer if they could “hook up” someone with some Provigil “as a parting gift for leaving the White House.”
Sloppy records and no oversight, among other problems
The report, published January 8, found that the “White House Medical Unit’s controlled substance records did not accurately reflect the unit’s procurement, inventory, or disposal of controlled substances.”
The report says the practices it documents did not comply with guidance from the government or the Department of Defense. Rather, it says, the problems occurred because officials in the medical unit “did not consider their operations to be a pharmacy,” despite the fact that the medications were kept and dispensed behind a door marked “pharmacy” and that medications were handed out in pill bottles that bore the logo of the White House Medical Unit.
However, there was no pharmacist on staff at the medical unit, although officials said controlled substance audits are performed quarterly, according to the report. Staff members testified that they submitted a request to get a pharmacy technician assigned to the White House, but it still had not been filled during the period of the investigation.
The unit’s lax prescribing practices were allowed to go unchecked because the office lacked oversight, according to the report. None of the senior Military Health System leaders interviewed for the report could identify which division was responsible for the medical office.
Complaints lead to a second inquiry
The investigation was launched after the Defense Department received complaints that a senior military medical officer assigned to the unit had “engaged in improper medical practice,” the report says.
In May 2018, the Office of the Inspector General began a separate inquiry into complaints about Dr. Ronny Jackson, who had previously served as physician to the president and head of the White House Medical Unit.
Several of the complaints alleged improper medical and pharmaceutical practices as well as problems with Jackson’s behavior. They also called into question the eligibility of some patients to be seen at the executive medical facilities in the National Capital Region.
Jackson, who is not named in the new report, was director of the White House Medical Unit from 2010 through 2014 and served as physician to the president for both Barack Obama and Donald Trump.
He stepped back from his role as physician to the president in March 2018, after Trump nominated him to helm the Department of Veterans Affairs. But he withdrew from consideration for that role after the Senate Committee on Veterans’ Affairs interviewed 23 current and former colleges of Jackson’s who alleged that he led a hostile work environment and allowed overprescribing of medications.
He was named chief medical adviser to the president in February 2019.
Asked whether he participated in the activities described in the report or was aware of them, a spokesperson for Jackson – who is now serving in Congress as a representative from Texas – noted in a statement that “Dr. Jackson was not the Director of the White House Medical Unit during the timeframe mentioned in the report (2017-2019). He was Physician to the President and later Chief Medical Advisor. The Chief Medical Advisor is a policy role, not clinical. This healthcare policy role had no association or involvement with the White House Medical Unit’s clinical delivery of care.”
Overspending on drugs and medical care
According to a review of the clinic’s medical records detailed in the report, staffers dispensed brand-name medications instead of less-expensive generics in violation of Defense Department policy. Over the three years from 2017 through 2019, the brand-name drugs Ambien and Provigil cost taxpayers $144,520, but generic versions of those drugs would have cost $2,064, the report found.
The White House Medical Unit cost taxpayers in another way too, the report says: by routinely treating people who weren’t legally eligible for care through the Department of Defense. This was done at the direction of senior leaders of the medical unit, the report says.
According to the Code of Federal Regulations, people who can access care through the Military Health System include the president, the vice president, their spouses and their minor children; members of the Cabinet; officials of the Department of Defense who were appointed by the president and confirmed by the Senate; assistants to the president; the director of the White House Military Office; and former presidents and their spouses, widows and minor children. Anyone needing emergency care can get it through Military Health Services, but they have to pay for their care.
According to the report, the White House Medical Unit has about 60 patients enrolled in its clinic but provided “health care by proxy” to 6,000 White House and other government and employees and contractors, many of whom were ineligible to receive it. These employees were given urgent care including the provision of cold medications, antibiotics or sleep aids, the report says, but this care was not tracked and couldn’t be billed. Records show that the Department of Defense waived nearly $500,000 in care for senior US officials over three years, according to the report.
The report makes recommendations that include:
Developing policies and procedures for the White House Medical Unit to better manage medications, including their procurement, storage, inventory, prescribing, dispensing and disposal
Developing a pharmaceutical oversight plan for the White House Medical Unit
Developing controls for patient eligibility in the Military Health System
Developing a plan to oversee eligibility of patients treated at the White House Medical Unit
Developing a plan to oversee executive medical services, including patient access
Developing controls for billing and cost recovery for care provided to non-military patients
The report says that the Department of Defense’s assistant secretary for health affairs agreed with all the recommendations and that they would be implemented, although it noted those tasks haven’t yet been completed.
The White House did not immediately offer comment to CNN on the report’s findings or any changes made in the medical unit made since the investigation was completed.
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