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By Brittany Trang Jan. 23, 2024 for STAT
There’s a pharmacy in the White House — or, at least, there’s a sign that says “Pharmacy,” though the people in charge insist it isn’t one. Whatever they call it, the office has had enough internal complaints to warrant a government watchdog investigation.
And its findings were hardly encouraging:
The investigation, published this month, was conducted by the Department of Defense’s independent Office of the Inspector General; the White House pharmacy is run by the White House Military Office and its associated medical unit. The probe was prompted by complaints the Department of Defense received in 2018 about a senior military medical officer, who is not named, engaging in “improper medical practices.” It covers only activity in the office through early 2020 under the Trump administration, but investigators interviewed staffers who also worked there under former President Obama.
The OIG report does not mention Rear Admiral Ronny Jackson, the White House Medical Unit director from 2010 to 2014 and the president’s physician from 2013 through 2018. He removed his name from consideration as former President Trump’s Veterans Affairs secretary amid allegations about his lax prescribing practices and a hostile work environment in the White House Medical Unit, some of which were confirmed in a separate 2021 inspector general investigation.
Already, a Defense Department agency that coordinates health care for the military has agreed to establish oversight and pharmaceutical and eligibility policies for the White House Medical Unit and pharmacy. But pharmacists and other experts still expressed grave concerns about the findings.
“If this had been a traditional pharmacy, they certainly would have been cited by their state board of pharmacy,” said Douglas Hoey, CEO of the National Community Pharmacists Association, “and there’s probably even an outside chance that they’d be shut down by their state board of pharmacy, if this was a pharmacy operating outside of the cocoon of the White House,” he said.
Much of the report, which was based on interviews with dozens of officials who worked in the office between 2009 and 2018, focused on the handling of prescription medicines. The office didn’t write prescriptions with the full scope of information required by law, and in addition to dispensing Ambien and Provigil without verifying patients’ identities, it also had a policy — handwritten on a piece of paper dated March 2014 — to let certain, authorized staff pick up controlled prescriptions without the patient’s ID.
White House medical staff also regularly asked for brand-name medications like Ambien and Provigil instead of the generics because “their patients prefer using the brand name drugs,” a practice that contradicted military policy. Those two drugs alone cost the government $144,520 over the period from 2017 to 2019, whereas the generics would have cost $2,064, according to the report.
The investigation also focused on improper record-keeping practices. The White House’s pharmacy did not keep records of controlled substances in accordance with federal law. For example, records detailing the receipt of fentanyl, ketamine, morphine, and Ambien at the White House’s pharmacy were handwritten, illegible, crossed-out, and error-filled, the report said.
The inspector general’s investigation suggested that the office, combined with the larger D.C. area military health care complex, had wasted more than $640,000 taxpayer dollars from 2017 to 2019, but couldn’t come up with a concrete number because of the poor and obfuscated record keeping practices, it said.
Former White House Medical Unit medical providers told investigators that ineligible White House staff members received controlled substance prescriptions and free specialty care, including surgery, at military facilities. Even though the office was only supposed to cover care for 60 enrolled patients, the office instituted its own policy that effectively let any of the 6,000 people working in or around the White House seek health care services. Those were all inappropriately billed to the Defense Department.
Officials also offered aliases to executive branch VIPs for “enhanced privacy.” They would remove the patient’s actual name from the electronic medical record and use alternate demographic data and identifiers. Walter Reed eventually had to waive almost $500,000 in outpatient care fees for senior government officials from 2017-2019, partially because they were unable to bill patients who got this treatment.
Staff and former staff also described a toxic culture in which they were not able to deny directives from senior leadership.
“[There] were several concerns about ‘we’re not accomplishing the mission the right way,’” said an anonymous staff member who was interviewed in the investigation. “Is stuff getting done? Yeah. Is it being done appropriately or legally all the time? No. But, are they going to get to that end result that the bosses want? Yeah.”
The investigation pinpointed a lack of oversight as a key driver of the White House Medical Unit violations. Military Health System officials were unable to identify which organization was responsible for overseeing the office, though it is governed by the rules of the Navy, according to the medical unit. But the Navy told investigators that it was not in charge; the Defense Health Agency, which coordinates care on behalf of the different branches of the military, and Walter Reed National Military Medical Center were. Walter Reed told investigators that it supplies the White House’s pharmacy, but that Walter Reed was not in charge of it. The Defense Health Agency admitted to investigators that the White House Medical Unit actually has “no clear line of oversight.”
The report also noted that a draft of the investigation languished in the White House Military Office from May 2020 until July 2023.
Gregory Demske, a partner at Goodwin Procter who previously served as chief counsel to the inspector general at the Department of Health and Human Services, called that delay “troubling” and “highly unusual.” It should only take a couple months to work out any technical corrections and agree to recommendations for policy changes, he said, and the delay, “unfortunately, makes the report less timely.”
A Department of Defense OIG spokesperson directed questions about why the report was delayed to the White House. The White House did not comment.
White House Medical Unit officials, defending the practices to the OIG, emphasized that the unit “does not operate a true pharmacy,” telling investigators that “the unit does not handle a large enough volume of pharmaceuticals to qualify as a pharmacy or to require a full time pharmacist.”
Investigators disagreed; while they were unable to find a military definition of a pharmacy requiring a pharmacist, they concluded that “while the White House Medical Unit may be performing a smaller number of pharmaceutical tasks, those tasks entail the full universe of pharmaceutical operations.”
Hoey said he was unsurprised to read that there was no pharmacist in charge at the White House. “It looked like stuff that was preventable if they had just brought in pharmacists who could have given them a two-to-three-month makeover,” he said. “A trained pharmacist would say, ‘OK, we need to document this. This isn’t Pez candy that we’re handing out like we’re a giant Pez dispenser.’”
Gina Moore, president-elect of the American Society for Pharmacy Law, said that at the White House, standards probably should have been more strict, not less. “We all try to find that right balance of appropriately regulating to prevent misadventures and protect patient safety, and pharmacy is so tightly controlled now and people get in trouble or lose their licenses for far less than this,” she said. “It’s sort of head-scratching that you have the highest level of government conducting business in that manner that would never be acceptable anywhere else.”
Head scratching? Not really. Obama became president in 2009. Guess who his Veep was? --TPR