Can Dr. Conley — a Military Doctor — Say 'No' to the President?

After days of vague and occasionally muddled updates on President Donald Trump’s health, the president’s personal physician, Navy Cmdr. Sean Conley, is facing intense scrutiny as onlookers question whether a uniformed doctor can say no to a patient who happens to be his commander-in-chief.

Conley, 40, stands at the epicenter of the president’s battle with the coronavirus. In particular, he has been criticized for giving a rosy assessment of the president’s health on Saturday, without disclosing that Trump had been placed on supplementary oxygen and a steroid typically reserved for patients with severe COVID-19. On Sunday, House Speaker Nancy Pelosi, D-Calif., told CBS’s “Face the Nation” that she was concerned the information that Trump’s doctors are relaying to the public “has to be approved by the president,” adding, “That’s not very scientific.”

The concerns extend beyond whether Trump is controlling the information that his doctors release to the public about his health — a right awarded to all patients under the HIPAA health-privacy law, albeit a disputed one in the case of the president — to the actual care he is receiving. In May, Conley raised eyebrows when he treated the president with hydroxychloroquine, an anti-malarial drug touted by Trump as a miracle drug, but which some studies showed to pose serious risks for some patients. Conley at the time said that he concluded that “the potential benefit from treatment outweighed the relative risks.” 

Former military physicians and defense officials say that it’s not true that Conley, as a uniformed doctor, can’t say no to the president’s demands. Like any patient being treated by a doctor, Trump has perfect authority to decide what treatment he or she wants or will accept. But also like any other physician, a military doctor would still be at risk of losing his license were he or she to administer a treatment to the president that he knew to be harmful but acceded to provide because he is in uniform and the commander-in-chief ordered it.

Further, these people said, uniformed doctors are ethically bound to give their best medical advice and counsel to their commanders — even if that counsel isn’t likely to be well-received, these people said. In a military setting, this might mean telling a commander that a given patient shouldn’t deploy, or needs to be removed from the cockpit, for example. That responsibility stands even if the commander is the patient, as in Trump’s case. 

But the dynamic of a uniformed officer treating his commander-in-chief still has the potential to warp the traditional doctor-patient relationship in less structural ways, said Dr. Stephen Xenakis, a retired Army brigadier general and psychiatrist. 

“It is tougher for the doctor in uniform,” Xenakis said. “The pressure from the commander in chief to a uniformed physician —  it does have a different character, and is different than another VIP on a doctor, even if he’s a company doc.”

“It forces the doctor to be much more adamant about the ethical principles and, in that sense, risk being straight and truthful to his patient who ends up being the president.” 

In general, so-called “VIP patients” can sometimes get worse care than average patients, Xenakis said, because they tend to “drive their care in a way that backfires for them. The VIP says, well, if you don’t do what I want, I’m going to fire you.”

The president, he noted, is “the ultimate VIP.” 

Part of the debate surrounding Conley’s treatment of the president hinges on the question of how much the public is entitled to know about the health of the president — and whether Conley’s responsibility is to the president or the American people. Some critics argue Conley has violated his oath by providing conflicting accounts of the president’s health. 

“Dear Dr. Conley: You took an oath to the Constitution as a military doctor. Your job is not to spin the American people. It is to tell the truth,” Rep. Ted Lieu, D-Calif., a former military prosecutor in the Air Force, tweeted on Saturday. “A @WhiteHouse pool report contradicts the tenor of what you said publicly. Don’t shred your own credibility. Just tell us the truth.”

Xenakis and other former defense officials have argued that Conley is prohibited from lying to the public about the president’s condition by the Uniform Code of Military Justice. 

During the 2016 campaign, former White House physician Lawrence C. Mohr, who served as physician to the president under Presidents Reagan, George H.W. Bush, and Clinton, told the L.A. Times that “the American people are entitled to know the health status of their president and presidential candidates.” 

But, he said, “the release of any medical information has to be the decision of the candidate and not the doctor.”

Any information that is disclosed, he said, “should be accurate, it should be complete, it should be timely, and it should include whatever medicine is being prescribed, and the physician should offer some prognosis about how long it will take to get well.” 

There is a long history of presidents and their staff obscuring illness and injury. Perhaps most famously, the White House kept the devastating impact of President Woodrow Wilson’s 1919 stroke a secret from the public for the duration of his presidency in 1921. But in recent years, presidents and presidential candidates have been far more forthcoming with their health. 

Conley has repeatedly cited Trump’s privacy in declining to offer some specifics on Trump’s medical condition, including at one point, when he had received his last negative coronavirus test. Asked to address his sunny assessment of Trump’s condition on Saturday — the briefing during which he did not disclose either the administration of oxygen or the steroid — Conley said that he was trying to “reflect the upbeat attitude that the team, the president, over his course of illness, has had.” 

“I didn’t want to give any information that might steer the course of illness in another direction,” Conley said Sunday. “And in doing so, you know, it came off that we were trying to hide something, which wasn’t necessarily true.”