There’s a pharmacy at the White House — or, at least, there’s a sign that says “Pharmacy,” even though officials insist it’s not. Whatever you call it, the office has received enough internal complaints to warrant a government watchdog investigation.
And his conclusions were hardly encouraging:
- A former pharmacy staffer told investigators a doctor once asked if the staffer could ‘hook up’ someone with a controlled substance ‘as a parting gift for leaving the White House’ .
- The office distributed controlled medications like Ambien and Provigil without verifying the patient’s identity.
- It allowed people to collect over-the-counter medications from open trash cans.
- And more than $640,000 of taxpayer money was wasted in just three years, although that number is unclear because many of the records were poorly maintained and even handwritten.
THE investigation, released this month, was conducted by the Department of Defense’s independent Office of Inspector General; The White House Pharmacy is managed by the White House Military Office and its associated medical unit. The investigation was prompted by complaints received by the Ministry of Defense in 2018 about an unnamed senior military doctor who had engaged in “inappropriate medical practices”. It only covers the office’s activity 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, director of the White House Medical Unit from 2010 to 2014 and physician to the president from 2013 to 2018. He withdrew his name from the post of Secretary of Veterans Affairs of former President Trump over allegations about his lax prescribing practices. and a hostile work environment within the White House medical unit, some of which was confirmed by a separate inspector general in 2021. investigation.
Already, a Defense Department agency that coordinates health care for the military has agreed to establish monitoring, pharmaceutical and eligibility policies for the White House medical unit and pharmacy. But pharmacists and other experts nevertheless expressed serious concerns about these findings.
“If it was a traditional pharmacy, it certainly would have been cited by the state board of pharmacies,” said Douglas Hoey, CEO of the National Community Pharmacists Association, “and there are probably even an outside chance that it is closed. by their state board of pharmacy, if it was a pharmacy operating outside the cocoon of the White House,” he said.
Much of the report, based on interviews with dozens of officials who worked in the office between 2009 and 2018, focused on prescription drug management. The practice did not write prescriptions with the full extent 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. paper dated March 2014 – to leave some, authorized personnel collect controlled prescriptions without the patient’s ID.
White House medical staff also routinely requested brand-name drugs like Ambien and Provigil instead of generics because “their patients prefer to use the brand-name drugs,” a practice that contradicted military policy. These two drugs alone cost the government $144,520 over the period 2017 to 2019, while the generics would have cost $2,064, according to the report.
The investigation also focused on improper record-keeping practices. The White House Pharmacy did not maintain 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 pharmacy were handwritten, illegible, crossed out and filled with errors, the report said.
The inspector general’s investigation suggested that the office, combined with the Washington, D.C. area’s largest military health care complex, wasted more than 640,000 taxpayer dollars from 2017 to 2019, but did not could provide a concrete figure due to poor and obfuscated record keeping. practical, he said.
Former medical providers in the White House Medical Unit told investigators that ineligible White House staffers received prescriptions for controlled substances and free specialized care, including surgeries, at facilities military. Even though the office was only supposed to cover the care of 60 registered patients, the office instituted its own policy that effectively allowed any of the 6,000 people working in or around the White House to seek services. health. All this was inappropriately charged to the Ministry of Defense.
Officials also offered pseudonyms to executive branch figures for “enhanced confidentiality.” They would remove the patient’s real name from the electronic medical record and use other demographic data and identifiers. Walter Reed ultimately had to waive nearly $500,000 in outpatient care costs for top government officials from 2017 to 2019, in part because they were unable to bill patients receiving the treatment.
Staff and former employees also described a toxic culture in which they could not refuse direction from senior leaders.
“(There) were several concerns about ‘we’re not doing the mission the right way,'” said an anonymous staff member interviewed as part of the investigation. “Are things being done?” Yeah. Is this always done appropriately or legally? No, but will they achieve the final result desired by the bosses? Yeah.”
The investigation identified a lack of oversight as a major factor in violations committed by the White House medical unit. Officials with the military health system were unable to identify which organization was responsible for overseeing the office, although it is governed by Navy rules, according to the medical unit. But the Navy told investigators it was not responsible; the Defense Health Agency, which coordinates care on behalf of the various branches of the military, and the Walter Reed National Military Medical Center were. Walter Reed told investigators that it supplied the White House pharmacy, but that Walter Reed was not responsible. The Defense Health Agency admitted to investigators that the White House medical unit actually had “no clear line of oversight.”
The report also notes that a draft of the investigation languished in the White House military office from May 2020 to July 2023.
Gregory Demske, a partner at Goodwin Procter who previously served as chief counsel to the Department of Health and Human Services’ inspector general, called the delay “troubling” and “highly unusual.” It should only take a few months to make technical corrections and accept recommendations for policy changes, he said, and the delay “unfortunately makes the report less timely.”
A spokesperson for the Defense Department’s OIG referred questions to the White House about why the report was delayed. The White House had no comment.
White House medical unit officials, defending these practices to the OIG, stressed that the unit “does not operate a true pharmacy,” telling investigators that “the unit does not handle a large enough volume of pharmaceutical products to be considered a pharmacy or to require a full-time pharmacist.
Investigators disagreed; although they failed to find a military definition of a pharmacy requiring a pharmacist, they concluded that “although the White House Medical Unit may perform a smaller number of pharmacy tasks, these tasks involve the complete universe of pharmaceutical operations”.
Hoey said he was not surprised to read that there was no pharmacist in charge at the White House. “It seemed like an avoidable phenomenon if they had just brought in pharmacists who could have given them a two- to three-month makeover,” he said. “A qualified pharmacist would say, ‘OK, we need to document this. These aren’t Pez candies that we hand 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 higher, not lower.
“We’re all trying to find the right balance between proper regulation to prevent mishaps and protect patient safety, and pharmacy is now so tightly controlled that people are getting into trouble or losing their licenses for much less than that,” he said. she declared. “It’s somewhat of a puzzle that the highest level of government conducts its business in a way that would never be acceptable anywhere else.”
Correction: An earlier version of this article incorrectly stated the amount of taxpayer money the office wasted. It also incorrectly described how the money was misspent.
