It’s now clear that two public assessments of President Trump’s health since 2015—the only ones we know about—were seriously compromised.
The import of this has been eclipsed by other (more salacious) recent events—Stormy Daniels, etc. But what has transpired raises troubling questions and should prompt a reassessment of how candidates for president and presidents are medically evaluated, and the public’s right to that information.
I’ve written two pieces for THCB on Trump’s physical and mental health. You can find them here and here.
The first assessment of Trump’s health, conducted in 2015 by his personal physician of 35 years, Harold Bornstein, is now under a dark cloud. Bornstein told CNN this month that Trump dictated the contents and language of a one-page letter signed by Bornstein and released publicly by the Trump campaign in the early months of the campaign.
The letter aimed to assuage concerns about Trump’s age and health status. Clinton and Trump were two of the oldest candidates ever to make a presidential bid and neither had shared much information about their health status up to that point; both were under pressure to do so.
“He dictated that whole letter. I didn’t write that letter,” Bornstein told CNN. He had previously admitted (in August 2017) that he had typed the letter in his office in just five minutes while a limo sent by Trump waited outside.
At the time, the four-paragraph letter seemed suspicious, to say the least. It didn’t contain any details of test results or the like. Instead, the letter made unusual and hyperbolic statements about the president’s health such as: “His [Trump’s] physical strength and stamina are extraordinary.” And: “If elected, Mr. Trump, I can state unequivocally, will be the healthiest individual ever elected to the presidency.”
Who does that sound like? But the letter was soon forgotten since no one at the time (the fall of 2015) thought Trump had a chance of being elected.
Bornstein further disavowed the letter this month by characterizing it as “black humor.” Of course, we now know that Bornstein has (a) an ax to grind against the president and (b) standards of behavior and ethics uncharacteristic of most physicians. (He was also clearly complicit in something more than black humor by presenting Trump’s self-assessment as his own as a physician.)
Bornstein’s ax-to-grind derives from: (a) being told bluntly in January 2017 that he was not being considered to be White House physician. Had Trump raised this prospect? We don’t know; and (b) being expelled from the Trump universe in Feb. 2017, a month after Trump took office.
That expulsion—in addition to being fired as Trump’s doctor—included what Bornstein now characterizes as a “raid” on his office to collect all of Trump’s medical records—a raid conducted by Trump’s lawyer and long-time security guy, not anyone from the White House medical office, Bornstein says.
This occurred, says Bornstein, because in January 2017 he told The New York Times that he had prescribed Trump the hair-growing drug Propecia.
The White House says that what occurred was not because of anything Bornstein said or did and was not a “raid” but instead a “business-as-usual” collection and transfer of Trump’s medical records to the White House.
That’s actually not business as usual. Although presidents do shift from being treated by their private sector doctors to White House and military doctors—especially those at the National Naval Medical Center and Army-affiliated Walter Reed National Military Medical Center, both in Bethesda MD—they are not precluded from seeing or seeking advice from their established private sector doctors.
And it’s decidedly not business as usual to take all the original copies of a president’s medical records from whatever doctor or doctors he or she saw before becoming president. More commonly, a request for a copy of such records is made, along with a strong request that a president’s previous records be kept especially secure. Existing law (HIPAA) protects the privacy of medical records, of course.
But, yes, the medical records, or episodes, of previous presidents have leaked out—usually many years after they served. So it could be argued—especially if Bornstein had an EHR on Trump (we don’t know)—that the White House was exercising an abundance of caution given Bornstein’s obvious eccentricity and casual mention of Trump’s hair loss drug to a newspaper.
In any event, Trump was firing Bornstein as his doctor and so had the right to request a copy of his records—but it’s unclear to me whether the White House had the right to rapidly remove all the records from Bornstein’s office without a formal request or medical reason to do so. Who owns a medical record? Technically, they are the possession of the provider.
The second assessment of Trump’s health came in January 2018 from White House physician Ronnie Jackson. That assessment, too, is now in question. Like Bornstein’s letter, Jackson’s now-famous televised briefing on Trump’s health was unusual. Though it contained more detail and actual lab results, Jackson’s language was effusive and hyperbolic. He stated, for example, that Trump’s overall health was “excellent,” that he had “great genes,” and that if the president had a healthier diet he might “live to be 200.”
Jackson also released the results of a cognitive test he gave the president that he said Trump passed with a “perfect score.” The test was later widely criticized by other doctors and experts as being too simple to qualify as a full and meaningful examination of the president’s mental health and cognitive ability.
The test was administered at Trump’s request given widespread speculation in the media at the time (and since) that Trump has some sort of cognitive deficit or is mentally unstable.
Also like Bornstein, recent events suggest that Jackson’s assessment and conclusions may have been compromised by Trump’s offer or hint of an offer of either a future promotion or new job.
Out of the blue, Jackson was nominated in April to head up the Dept. of Veterans Affairs, a job for which that many observers and lawmakers from both parties considered him unqualified.
Jackson withdrew his nomination on April 26 following a barrage of alleged medical ethics violations and unprofessional behavior.
We don’t know what happened between Trump and Jackson. We do know Trump greatly appreciated Jackson’s TV “performance” in the Jan. 2018 briefing. We also know that it’s Trump’s modus operandi to schmooze people by offering them favors or jobs. (Stormy Daniels says it was Trump’s repeated promise of an appearance on his TV show that led her to engage with him.)
Apart from what all this reveals about Trump, Bornstein and Jackson, it prompts a host of policy and ethical questions, some of which are not new and a few of which have been raised over the past decade in the context of new historical evidence that past presidents have kept critical information about their health from the public. (FDR’s polio and JFK’s Addison’s disease and chronic back pain are most often cited.)
Among the questions, with my quick take, are these:
(1) Should presidential candidates be required to release a synopsis of their health status, including an assessment of their mental health? Yes. Period.
(2) Should a candidate be required to undergo a fresh exam after announcing his or her candidacy? And if so, who should conduct it? Yes. A reputable physician in good standing or team of physicians should conduct it. Such a team could include a candidate’s existing personal physician. But the wise choice would be a third party in consult with the candidate’s physician to avoid the appearance of favoritism; many people are good friends with their doctors and this is a high stakes matter.
(3) How detailed should the information released to the public be? As detailed as the candidate feels comfortable with. Professional medical organizations should offer standards. For now, nothing should be mandated.
Notably, Sen. Bob Dole in 1996, at age 73—the oldest candidate ever to run for president—released his full health records under pressure from Bill Clinton’s campaign. That tracked into 2000, 2004 and 2008 with George W. Bush and Sen. John McCain releasing their full records, too. Trump and Clinton broke that trend.
(4) Should a newly elected president be required to release all their medical records? No. But they should be required to undergo a medical exam by a government-sanctioned team of doctors with access to the president’s full medical record. That team, in turn, should be required to release the salient details to Congress and the public. The exam should include a thorough cognitive assessment.
(5) Should a newly elected president be permitted to remove the medical records from the office of the president’s private physician? Congress should order up an assessment of this by federal agencies, selected physician organizations and other stakeholders.
(6) How often should a president’s health—physical and mental—be assessed? Annually, by a government sanctioned team not just the White House physician. The physical exam is now customary. A cognitive assessment is not. Congress should consider whether to mandate both.