Vice President Mike Pence’s physician privately raised alarms within the White House last fall that President Donald Trump’s doctor may have violated federal privacy protections for a key patient — Pence’s wife, Karen — and intimidated the vice president’s doctor during angry confrontations over the episode.

The previously unreported incident is the first sign that serious concerns about Ronny Jackson’s conduct had reached the highest levels of the White House as far back as September — months before White House aides furiously defended Jackson’s professionalism, insisted he had been thoroughly vetted and argued allegations of misconduct amounted to unsubstantiated rumors.

The episode — detailed in three memos by Pence’s physician — is also the first documentation that has surfaced involving a specific allegation of medical misconduct by Jackson. It adds to a series of significant allegations leveled by unidentified current and former colleagues, including that he casually dispensed prescription drugs.