Let me begin by stating the obvious: Practicing medicine while intoxicated is never permissible. Countless colleagues have lost their jobs and their licenses after succumbing to addiction.
But things get ever so slightly less clear-cut in a certain medical sector: Traveling doctors who are “on call” (meaning they must be available for care but may not be necessarily working clinically unless called upon) 24 hours per day have a slightly different standard. This set of caregivers, which includes the physician to the president of the United States, are not actually expected to maintain a 0.00% blood alcohol level throughout what can be a long deployment. After all, if the leader of the free world can have a drink while being responsible for the nuclear football, certainly a doctor can have one while being responsible for its quarterback.
The current physician to the president, Dr. Ronny L. Jackson, is embroiled in a potential scandal after a story surfaced Tuesday that he is facing claims that he “drank too much on the job,” as the New York Times originally put it. (The post has since been updated, and this original phrasing has been eliminated.) The phrasing begs the question of how much, exactly, is too much for a doctor to drink on the job.
What are the standards for this set of physicians? It comes from the strange industry of traveling doctors. Like Air Force One, many chartered luxury vacations come with an amenity: round-the-clock immediate access to a concierge physician. Some of my colleagues serve as concierge physicians for these outfits, where, in exchange for being on call every minute of the trip, they get to temporarily sample the lifestyle of the truly rich and famous. (Many such trips routinely cost $50,000 per passenger, or more.) As such, the doctors sightsee, eat, and yes, drink with their fellow travelers. The pilots follow the Federal Aviation Administration’s rule of an eight-hour gap from “bottle to throttle.” But for concierge docs, who can be called upon at any time, there is a basic rule: One drink with dinner is fine.
On cruises, another situation that has doctors potentially working at any time, ship doctors are often expected to dine with guests. At a weekly “captain’s table,” the ship doctor can actually be expected to buy wine for the table and partake in moderation. Moreover, the officers’ mess hall usually includes a bar, according to Phil Brewer, an emergency physician who has long worked with several well-known commercial cruise lines. While this means that even the ship’s chief engineer is permitted to drink, close tabs are kept (pun intended.) “Because everything is electronic, the ship keeps an eye on what you’re buying with your crew card,” says Brewer.
The question is figuring out when the traveling doctor has crossed the line and needs to be relieved of duty because of impaired cognitive or motor skills. “I’ve had several instances when the doctor had too much to drink and they have had to be removed,” says Thomas Burke, an emergency physician who is a medical director for a company that organizes private jet expeditions for luxury brands and universities. When this becomes necessary, these physicians can almost expect to lose the gig, if not their licenses.
The problems seem to mount when crews are engaged on longer contracts. Many cruise lines hire doctors for short-term contracts specifically to avoid the stresses that weeks or months on the job might bring, which may provide more reason for a doctor to opt for that second, or third, glass of wine. An extended naval deployment, or a longer vacations package, might cause a doctor to grow more irritated or lax.
In Jackson’s case, the allegations he is facing are not all public. CNN has reported that four sources confirmed that one incident centered around Jackson, presumably intoxicated, banging on the hotel-room door of a female employee while serving as presidential physician under then-President Barack Obama. The Times reported on an incident in which staff found Jackson “passed out in his hotel room after a night of drinking” and noted that instead of waking him, they took the medical supplies they needed and left. [Update: April 25, 2018: The Times further reported on Wednesday that Jackson faces allegations that he “wrecked a government vehicle” after becoming intoxicated, and also that he mishandled drug prescriptions.] It’s unclear if any of his drinking caused him to be removed during actual medical procedures or whether they just occurred at times when he might have been called upon to help the president.
“The issue is when no one says anything,” says Brewer. “To me, the story I want to see is: If they found [Jackson] passed out drunk, why was he not relieved of his duty? The real issue is the silence of those who are aware but don’t say anything.”
Disclaimer: The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women’s Hospital.