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White House officials and others familiar with the situation said the circumstances surrounding Dr. Jackson’s fall from grace and Dr. Pena’s departure dated back many years, to longstanding divisions in the medical unit — which is part of the military — where there are two factions that do not get along.

Dr. Pena — known to patients simply as “Dr. Jen” — submitted her memos about Dr. Jackson last fall to Nick Ayers, Mr. Pence’s chief of staff, who shared them with John F. Kelly, Mr. Trump’s chief of staff, according to a person familiar with the matter who spoke on the condition of anonymity to describe private conversations. Both Mr. Ayers and Mr. Kelly directed Dr. Pena to go through her military chain of command to address the issue, the person said.



CNN, which obtained the memos, reported that Dr. Pena had accused Dr. Jackson of having intervened in a medical matter involving Karen Pence, Mr. Pence’s wife, and possibly violating her medical privacy rights. She also said Dr. Jackson had become irate and aggressive during a confrontation over the situation, and that he had fostered an unprofessional atmosphere in the medical unit.

Dr. Jackson, an Iraq war veteran, has insisted that all the allegations against him were untrue, an assertion backed up by Mr. Trump and numerous White House aides from the current and previous administration.

But some members of the medical unit, which houses a few dozen doctors and nurses, described Dr. Jackson as a bully and a sloppy record-keeper, who drank too much — sometimes becoming intoxicated during overseas trips with the president — and loosely dispensed strong drugs to curry favor with the powerful politicians and political aides he admired. Several of them detailed the alleged misconduct in interviews with the Democratic staff of the Senate Veterans’ Affairs Committee.

Despite Mr. Trump’s strong defense of him, Dr. Jackson has not resumed his job as the top physician in the medical unit since he announced his withdrawal from consideration as secretary of veterans affairs. Sarah Huckabee Sanders, the White House press secretary, said on Tuesday that another doctor, Sean Conley, who had been acting in Dr. Jackson’s role while he prepared for confirmation hearings, would stay in the post instead.

“Dr. Jackson continues to be an active-duty Navy doctor that’s assigned here at the White House,” Ms. Sanders said, “where there are a number of doctors that are part of the White House Medical Unit.”




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