I Read the DoD Inspector General's Report on the Trump White House Medical Unit So You Don't Have to

It will be interesting to see how widely the story of the Trump White House's pill mill spreads in mainstream media, and if it does at all, how it is played. 

So far, there's this tweet from NBC News that describes it as "before the Biden administration" rather than "during the Trump administration," which is an interesting choice:

That's interesting as in the Minnesota sense of the word.

I woke up to news about this story today, mostly on Twitter. (Here's one doctor's thread, and one from an EMT.) Good old Dr. Ronny Jackson was handing out Ambien and Provigil in extremely large amounts, plus morphine, fentanyl, versed, and ketamine. 

It began because of whistleblowers, and led to a Inspector General's investigation and report. 

The White House Medical Unit does not have a pharmacist on staff. It has always prescribed drugs, yes, but not in these quantities, which is why an investigation was requested.

Provigil (generic name Modafinil), I learned today, is somewhat similar to Aderall — a stimulant used to improve focus and performance. It's prescribed for people with narcolepsy, but people in the comments said that they used it as a student or programmer to stay awake for 48 hours. It's not an amphetamine. It's also prescribed off-label for ADHD and bipolar disorder. Commenters speculated that the Provigil/Ambien combo would be used for people dealing with jet lag from overseas trips. But the quantity of pills is extremely high: thousands per month. 

The fentanyl, versed, and ketamine (all highly regulated drugs) would be reasonable to stock and replace periodically as emergency supplies in the event the White House doctors have to do surgery. Again, the quantities are too high to justify that type of use/replacement. To the question, Can someone explain what some of these drugs are taken for if it's not recreational?, one commenter put it this way:

There isn’t. This isn’t the proper use of Ketamine for anything therapeutic and there’s no other reason for so much use of the benzos and opiate other than abuse. Pure, plain and simple. They were doing speedballs in the White House.

It's a relatively minor point, but the medical unit also bought name-brand medications for all of this for no good reason, so everything cost a lot more than it needed to. How much more? 174 times more for Ambien and 55 times for Provigil, according to the report (page 18). Why? Because "their patients prefer using brand name drugs."

In the detail about how controlled substances were prescribed (pages 15 and 16), it's clear that DEA requirements were not met. Each patient and provider's name and info is supposed to be recorded, and it was not. Ambien and Provigil — which are controlled substances — were given without even verifying the patient's identity, Ziplock bags to take on trips.

And then there's how many people had access, not just to the drugs, but medical care generally. In the usual dense bureaucratese of the federal government, the report says that staffers in the medical unit were not allowed to follow established policy. They were required to treat ineligible White House staffers (including surgery), and the Department of Defense therefore paid for an average 6 to 20 patients per week without reimbursement. Multiple medical staffers quit over this. (Summarized from page ii of the report.)

The medical unit is supposed to serve only the president (and family), vice president (and family), cabinet, visiting dignitaries, and "senior staff," which is loosely defined. Senior staff are supposed to reimburse the Department of Defense for their care unless that is specifically waived (page 33).

Instead of that limited number of people, and reimbursement from the senior staff, someone in the Trump White House made up a policy called "health care by proxy" (described on pages 32–33 of the report), which dictated that anyone working in proximity to the people who had access to the medical unit also could use its services for free. Which is not how things work in the Military Health System. On page 37, the report says, 

We questioned White House Medical Unit officials about the unit’s health care by proxy practices. White House Medical Unit officials could not explain how their health care by proxy practices were in accordance with the statute and Navy guidance.

Not surprisingly, people feared for their careers if they didn't comply with the directives to follow orders. They would be given bad assignments or have their future credibility questioned.

Interviews with medical unit staff also revealed that fake accounts were created to get treatment for ineligible White House staffers at other military facilities. It doesn't go into this as far because the aliases used mean they're untraceable. But it appears the rot goes beyond the White House, and to places like Walter Reed hospital.

So again, I wonder how much this report will receive coverage. It's a lot more important than the baggie of cocaine found in an antechamber at the White House (remember that? Fox News thought that was a big story!). Somehow I don't think Fox News will even mention this report.

In the big picture, it's just one more reason to not put the former guy back in the White House. But in the meantime, the media could at least say which administration was in charge when it happened.