President Donald Trump required personnel at Walter Reed National Military Medical Center to sign non-disclosure agreements last year before they could be involved with treating him, according to four people familiar with the process.
During a surprise trip to Walter Reed on Nov. 16, 2019, Trump mandated signed NDAs from both physicians and nonmedical staff, most of whom are active-duty military service members, these people said. At least two doctors at Walter Reed who refused to sign NDAs were subsequently not permitted to have any involvement in the president's care, two of the people said.
The reason for his trip last year remains shrouded in mystery.
The four people familiar with the process did not know whether, during the president's most recent visit over the weekend, he had the same requirement for Walter Reed staff members who had not previously been involved in his care.
Anyone providing medical services to the president — or any other American — is automatically prohibited by federal law from disclosing the patient's personal health information without consent. The existing legal protection for all patients under the Health Insurance Portability and Accountability Act, or HIPAA, raises the question of why Trump would insist that staff members at Walter Reed sign NDAs.
"Any physician caring for the President is bound by patient physician confidentiality guaranteed under HIPAA, and I'm not going to comment on internal procedures beyond that," White House Deputy Press Secretary Judd Deere said in a statement.
In addition, all personnel assigned to the White House Medical Unit, which treats the president and the vice president day to day, are required to have special "Yankee White" security clearance. To obtain the clearance, they must be U.S. citizens and undergo extensive background checks.
Transparency about Trump's health has been a heightened concern since the White House announced last week that he had tested positive for the coronavirus, and the president has seemed to tightly restrict the information his doctors are authorized to share with the public. Dr. Sean Conley, the president's physician, has refused to answer key questions, such as when Trump last tested negative for the virus and whether the illness has caused him to develop pneumonia.
Multiple times in recent days, Conley, a Navy officer, has refused to disclose information about Trump's health by citing HIPAA.
"We've done routine standard imaging. I'm just not at liberty to discuss," Conley told reporters Monday when asked whether the president had any pneumonia or inflammation in his lungs.
Conley's written updates on Trump's health have included the note "I release the following information with the permission of President Donald J. Trump."
Walter Reed spokesperson Norris Agnew referred NBC News to the White House for comment.
Trump has routinely required that employees at his company, the Trump Organization, sign non-disclosure agreements. He continued the practice when he ran for president and even with some White House officials after he took office.
Arthur Caplan, the director of medical ethics at NYU Grossman School of Medicine, said some celebrities and wealthy businesspeople ask their physicians to sign NDAs, even though it is not necessary to protect their privacy.
"Ethically and legally you can ask for an NDA, but you don't need one," Caplan said. "Doctors can't share information with anyone except anyone caring for the patient or anyone billing the patient. And ultimately it's up to the patient whether or not the doctor can share information.
"It's more redundant than unethical. The presumption is privacy first," and doctors who violate privacy rules without just cause face severe consequences, he said.
Since his coronavirus diagnosis became public Oct. 1, Trump has sought to project an image of strength, with carefully choreographed public appearances, and he could see any information about his health to the contrary as undermining that narrative.
Trump spent three nights at Walter Reed after the White House announced that he had tested positive. He was discharged Monday and returned to the White House.
After Trump's unscheduled trip to Walter Reed last year, the White House said he was there to complete parts of his annual physical exam, which is usually done in one visit after the new year.
"Anticipating a very busy 2020, the president is taking advantage of a free weekend here in Washington, D.C., to begin portions of his routine annual physical exam at Walter Reed," Stephanie Grisham, the White House press secretary at the time, said in a statement.
Trump's two previous physical exams as president had been announced in advance, and the medical staff at Walter Reed was widely notified to expect a high-level visit. Neither of those steps were taken ahead of Trump's visit last year.