Future Tense

Trump’s Doctor Is Using HIPAA to Dodge Hard Questions

A man in a white coat at a lectern frowns.
White House physician Sean Conley gives (something of) an update on President Donald Trump’s condition on Monday at Walter Reed Medical Center in Bethesda, Maryland. Saul Loeb/Getty Images

Since President Donald Trump was admitted to Walter Reed hospital on Friday afternoon following his COVID diagnosis, questions have swirled about his health. Reporters, doctors, and public health experts have tried to piece together Trump’s condition from the few, sometimes contradictory bits of information revealed by his medical team.

At daily press conferences, Trump’s physician Sean Conley has repeatedly sowed confusion and evaded questions about Trump’s health. On Saturday, Conley laid out a timeline of Trump’s diagnosis and treatment that contradicted the White House’s story. He also claimed Trump was doing well, though minutes later, an anonymous source said the president’s condition was actually much more worrying than the press conference portrayed. (The source was later revealed to be Mark Meadows, the White House chief of staff.) On Sunday, Conley refused to elaborate on whether X-rays of Trump’s chest revealed lung damage or pneumonia. And on Monday, after Trump tweeted that he was leaving the hospital that evening, Walter Reed pulmonologist Sean Dooley said Trump was doing “very well,” but again, Conley refused to answer questions about the takeaways from Trump’s lung imaging, as well as questions about when Trump last tested negative. “There are HIPAA rules and regulations that restrict me in sharing certain things for his safety and his own health and reasons,” Conley said.

HIPAA, the Health Insurance Portability and Accountability Act does protect patients’ medical information, through a privacy regulation that went into effect in 2001. But in this case, what’s holding Conley back from sharing details about Trump’s condition is not HIPAA, but Trump himself. “People always say, ‘I can’t tell you that because of HIPAA,’ but the truth is, they can, if the patient gives them permission,” says Florida Rep. Donna Shalala, who wrote the privacy recommendations for HIPAA while she served as the U.S. secretary of health and human services. “What [Conley] was really saying was: ‘I don’t have permission from Donald Trump to tell you that.’ ”

Under HIPAA, patients can give providers permission to share certain details about their treatment and health. You may have experienced this yourself if you’ve ever signed paperwork allowing a past physician to share information with a new doctor, and you’ve seen it in practice if you’ve ever seen updates on your favorite athlete’s injuries. You also saw it if you’ve watched any of the Trump medical team’s press conferences; Monday, for instance, they told the public that Trump was to receive new doses of remdesivir and dexamethasone, and gave specific readouts of his blood pressure, temperature, heart rate, and oxyhemoglobin. Those details are considered protected health information under HIPAA, and doctors would’ve needed permission from the president to discuss; revealing those facts without Trump’s blessing would be HIPAA violations.

The most plausible explanation here is that Trump has given his doctors permission to reveal positive details but not negative ones. The man has always been attentive to appearances; after all, on Sunday, he insisted on a joyride to greet fans. So it would be no surprise that he wishes only to release good news. “The president is controlling the information, and it’s hamstrung the doctors,” says Shalala.

But the details are important and have grave implications for the country as a whole. With such carefully cherry-picked information, it’s impossible to know the whole story, and some of the details from his doctors suggest a more severe illness than Trump is willing to reveal; dexamethasone, one of the medications he’s receiving, is typically reserved for COVID-19 patients experiencing severe symptoms. Also concerning are the drug’s side effects, which can include irritability from sleep deprivation, delusions of grandeur, mania, and psychosis. Even as concerns around Trump’s health swirl, there’s little more we’ll learn unless Trump himself is willing to reveal the truth.

Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.