By Holly Nguyen, PharmD Candidate c/o 2024

The White House Medical Unit employs a small confidential team of healthcare professionals, led by the Physician to the President, to be responsible for the health of the President, the Vice President, their families, the White House staff, and visitors such as national and international diplomats.^1,2 Doctors, nurses, physician assistants, medics, and administrators work onsite at the White House in Washington, D.C., where routine physical examinations, urgent care, and emergency services are performed.² Members of the White House Medical Unit may also travel with the President to tend to his or his visitors’ health needs abroad. Because of this, an operating room is incorporated into the President’s plane, Air Force One, with an emergency medicine physician permanently posted onboard.^2,3

In 2018, the Inspector General of the U.S. Department of Defense launched an official investigation into the White House Medical Unit to address complaints of improper pharmaceutical practices and the eligibility of care for patients treated at executive medical facilities in the National Capital Region.⁴ In January 2024, the Inspector General of the U.S. Department of Defense released the investigation results to the public, and it garnered attention specifically for its operations under the Trump administration from 2017 to 2021. Without proper credentials to establish itself as a pharmacy and the absence of pharmacists to oversee its functions, the White House Medical Unit pharmacy operations sector bypassed the TRICARE policy in the Code of Federal Regulations with the internal privileges of its senior leaders.⁴ One notable example was using Department of Defense funds to obtain brand-name medications over generic equivalents.⁴ Unauthorized medications, including prescription drugs and controlled substances, were dispensed to ineligible White House Staff (i.e., retired military officers and their families), and from 2017 to 2020, an average of 6 to 20 non-Department of Defense beneficiary patients per week skipped billing for their medications and medical services.^4,5 Medical care and surgeries were also provided at no cost, and the pharmacy inadequately managed their medications with unmarked bottles, no instructions, and poor recordkeeping.^4,5 Although healthcare providers were aware of the unethical nature of the pharmacy operations sector, they did not intervene due to the fear of losing their current positions or receiving poor evaluations for future job references.⁵

The Inspector General of the U.S. Department of Defense proposes the reparation of the pharmacy operations sector of the White House Medical Unit with three main recommendations. First, the Director of the Defense Health Agency will be enlisted to develop federally binding policies and procedures for controlled and noncontrolled medications with the White House Medical Director.⁴ Second, the Director of the Defense Health Agency will also establish billing and cost recovery controls for the outpatient medical services provided to non-military senior officials, on par with the Code of Federal Regulations.⁴ Lastly, oversight plans for pharmaceutical practices, patient eligibility, and the eligibility of the White House Medical Unit to implement its services will be created with the Assistant Secretary of Defense (Health Affairs), the Defense Health Agency Director, and the Service Surgeons General.⁴ The Inspector General of the U.S. Department of Defense strives to create a system that will avert any future risks regarding non-executive patients’ health and the haphazard distribution of controlled substances. Over the next several years, hopes to restore the credibility of executive medical care, as well as senior management and healthcare providers working with the federal healthcare system, remain.

Sources:

1. Mishori R. When The Patient Is The President. Parade. Published August 16, 2009. Accessed January 31, 2024. https://parade.com/47565/drranitmishori/16-when-the-patient-is-the-president/.
2. White House doctors: The president’s shadow. CNN. Published September 24, 2004. Accessed January 31, 2024. https://www.cnn.com/2004/HEALTH/09/23/wh.doctors/.
3. Air Force One. White House. Accessed January 31, 2024. https://www.whitehouse.gov/about-the-white-house/the-grounds/air-force-one/.
4. Evaluation of the DoD Internal Controls Related to Patient Eligibility and Pharmaceutical Management Within the National Capital Region Executive Medicine Services. Department of Defense. Published January 8, 2024. Accessed January 31, 2024. https://media.defense.gov/2024/Jan/09/2003373440/-1/-1/1/DODIG-2024-044_REDACTED%20SECURE.PDF.
5. Kime P. Free Surgeries and Prescriptions: White House Staff Got Access to Military Health Care Despite Being Ineligible. Published January 16, 2024. Accessed January 31, 2024. https://www.military.com/daily-news/2024/01/16/ineligible-white-house-staffers-got-free-care-military-hospitals-free-prescription-drugs-watchdog.html.