Presidents Deserve Medical Standard of Care


Blog Editor

Publish date

February 15, 2019

by Bandy X. Lee

Is Donald Trump capable of protecting the interests of the United States? Is he capable of keeping the country safe without placing it in further danger? Is he capable of discharging the duties of his office? These are not comfortable questions to ask, but they are the most fundamental, and a growing number of mental health professionals and non-professionals are asking them. Just as signs of likely criminal involvement have led to investigations through the Special Prosecutor’s office, signs of likely mental incapacity should lead to a proper examination by mental health experts.

Yet even the scant results of Mr. Trump’s annual exam are concerning. His physician wrote, that Trump is “in very good health… will remain so for the duration of his presidency, and beyond.” Dr. Ronald Klain, who led the U.S. response to the Ebola crisis under Barack Obama, already pointed out: “No doctor can predict someone’s future health”. Also concerning is the statement that “11 different Board certified specialists” were involved. Why so many? All we called for was a functional, capacity evaluation, and since he seems physically capable, a simple mental capacity evaluation. This takes only one specialist, that is, an independent, forensic mental health professional. Perhaps he also needs a cardiologist for his own personal health, but that is his private affair; other than being visibly over healthy body weight, he has not fainted or grasped his chest in pain. He has, however, shown multiple and consistent signs of emotional instability, dangerousness, and cognitive decline.

When I worked as an intern at Bellevue Hospital in New York City, it was necessary to rotate for a couple of months at the neighboring private hospital. The difference of care was stark: at Bellevue, most patients were indigent or homeless and could not pay, but they received the textbook medical standard of care, according to need and in keeping with the best medical research available. At the private hospital, however, wealthy and famous clients were put through numerous unnecessary tests and needless specialists—it seemed whatever their private physicians could think of. These private physicians seldom had time to teach or even to talk to training physicians, despite being on the same team, but one thing was clear: their patients were not receiving textbook medical standard of care. They were receiving the most expensive care, and possibly even harmful care, given the onus of unnecessary tests and possible follow-up on false positives.

The “11 different Board certified specialists” are concerning for this reason. Why would the president need so many specialists unless he were deathly ill with a condition that affected most of his organs? Would having so many specialists doing assessments not cause more harm, through unnecessary testing and false positives, than provide benefit, especially if there were no need to consult? Meanwhile, the independence of any of them has not been ensured.

What needs addressing, rather, is Mr. Trump’s promotion and reappointment of Dr. Ronny Jackson, who declared him “mentally fit to serve” last year despite lacking the training or the independence to do so. Mr. Trump desired to promote him to veterans affairs secretary then but was derailed when allegations of drunken behavior and possible medical malpractice surfaced, for which Dr. Jackson is still under investigation. Many have eagerly awaited Mr. Trump’s annual exam, after the false “mental health exam” that did more to obscure than clarify a year ago. As a reminder, Dr. Jackson, in response to the public’s concerns over the president’s mental stability, performed a sham 10-minute dementia screenon which full-blown Alzheimer patients and hospitalized schizophrenia patients are known to have scored 30 out of 30, such that an Alzheimer’s research consortium discouraged its use in lieu of a full neuropsychiatric evaluation. Besides, fitness for duty is determined not through a personal health exam, but through an independent functional test that has to do with a person’s ability to do a job and not to put others in danger.

Our questions are as follows. Does Mr. Trump have the capacity to command troops to the southern border, as he has done? Does he have the capacity to declare a national emergency, as he has done? Does he have the capacity to shut down the government again, as he might? Does he have the capacity to initiate a war, which he has threatened to do many times, and is presently? Mental health experts are alerting that he shows signs of not possessing the requisite capacity: that is, the capacity to take in necessary facts and advice, to process that information, and to make decisions while weighing different consequences, based on reality, without undue influence from impulsivity or delusional thinking. We are not yet speaking of whether he is a good leader or a politically necessary one: at the medical level, it is much more basic than that. The underlying mental process is what needs testing, and those in power should require proper examination so that suspicions can be confirmed or discarded.

It is an unfortunate omission that our nation does not have fitness for duty exams as a requirement before taking the office of the commander-in-chief, when we do for all military officers and especially for those handling nuclear weapons. We have an opportunity to remedy that omission. That Mr. Trump is running the country, and not his emotional needs, is what the people who depend on him need to know. The people, who are the president’s employers in a democracy, have every right to demand that their elected leader be mentally fit, and the annual exam seems a perfect occasion to refer the president for a reliable test of capacity by independent specialists, as per the proper medical standard of fitness for duty evaluations.

The views reflected in this piece are those of the author alone and not that of her institution.

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