Under the Trump administration, the White House Medical Unit -- a joint Defense Department team that provides medical care for the president, vice president and family members and also manages health services for certain high-level officials -- sent ineligible staff members to military hospitals for specialty care and surgeries, the DoD inspector general has found.
The medical unit also dispensed hundreds of free prescriptions, including controlled substances, to people in the White House, the DoD inspector general said in a report released Jan. 8.
The federal watchdog determined that the unit, comprised of military medical personnel and DoD civilians and led by an officer with a paygrade of O-6, had received little to no oversight from the Defense Health Agency or the military services for years despite having its own pharmacy and referring White House staff for care at Walter Reed National Military Medical Center in Maryland, Fort Belvoir Community Hospital in Virginia, and elsewhere.
According to the report, from 2017 through 2020, the Defense Department "funded and resourced care for an average of 6 to 20" non-DoD beneficiary patients per week at no cost to them -- medical appointments and services that then were unavailable to active-duty military personnel, their family members or retirees.
The DoD IG launched the investigation in May 2018 after receiving complaints that the White House Medical Unit's senior military medical officer, who is not named, engaged in improper medical practices, and that the pharmaceutical practices at the White House and referrals for ineligible patients to DoD facilities were questionable.
The watchdog subsequently launched a review of the Defense Department's Washington, D.C., area executive medicine facilities, which provide concierge-level medical care for flag and general officers, but also to VIPs such as the president and, on occasion, members of Congress and Cabinet members.
In addition for being responsible for care for the president and family, the White House Military Unit is charged with overseeing the acute medical needs of those who work on the White House grounds.
The review found that the White House Medical Unit's pharmacy, which operates outside the military health system, maintained practices that could have led to prescription errors and patient harm.
According to the report, unit staff kept poor prescription records, including those for controlled substances like opioids and sleep medications, and distributed medications like Ambien in unmarked pill bottles with no instructions or recordkeeping.
Staff members also routinely prescribed brand-name medications instead of trying a generic alternative first, a practice known as step therapy that is required under the military's health program, Tricare, according to the report.
"Without oversight from qualified pharmacy staff, the White House Medical Unit's pharmaceutical management practices may have been subject to prescribing errors and inadequate medication management, increasing the risk to the health and safety of patients treated within the unit," the IG wrote.
Providers told investigators that they had concerns about the practices, including sending non-eligible persons to military treatment facilities, but feared that if they didn't provide referrals to high-ranking administration officials, their careers would be affected.
"We feared mostly, you know, for evaluations, for follow‑on assignments, for credibility as a professional in our own branches and specialties," a staff member told the IG.
As a result of the practice, the Pentagon paid for medical care for those non‑DoD beneficiaries, according to the report.
The investigation also found that across the Washington, D.C., area, more than half of those who utilize the Defense Department's executive medicine services are military retirees or their family members and not on active-duty.
The DoD investigators said that, given the imbalance, the department runs the risk of "expanding resources outside its primary mission" to provide medical care to the active-duty population.
The services' executive medicine programs initially were established to ensure that senior military leaders had quick access to medical care and any treatment they received did not disrupt care and services at regular clinics within the military hospital system.
But that mission has expanded, often to include treating members of Congress and the senior executive service.
Top-level care at Walter Reed has been in the news recently with the hospitalization of Defense Secretary Lloyd Austin, who underwent surgery for prostate cancer in December but returned to the facility on Jan. 1 after developing an infection.
Defense officials did not disclose Austin’s hospitalization until Jan. 5, sparking a backlash from members of Congress and the press over the lack of transparency over the health of a Cabinet member.
As a retired general, Austin has access to the facility’s executive medicine suite, and it is likely that his primary care provider is assigned to Walter Reed's executive medicine staff.
The DoD IG made a number of recommendations to the Defense Health Agency and the military services regarding their executive medicine programs and the White House Medical Unit, which falls under the White House Military Office. Those recommendations included that the DHA develop policies to manage prescriptions at the White House Medical Unit and develop a pharmacy oversight plan; establish controls to determine White House patient eligibility; and improve oversight of executive medicine services.
It also recommended the DHA bill for outpatient medical services that are provided by the DoD to non-military senior officials.
The White House Military Office received a draft of the report in May 2020 for review and held it until July 2023.
In response, DoD Assistant Secretary for Health Dr. Lester Martinez-Lopez said the DoD concurred with all recommendations.