Frist Treads a Delicate Path in Citing Medical Background

As Senate Majority Leader Bill Frist pushed Congress to intervene in the Terri Schiavo case, he drew attention to a part of his resume many expect him to spotlight as he prepares for a likely 2008 presidential bid: the fact that he is a physician.

Polls find that physicians rank among the most trusted professions, and most political experts think Frist’s medical background will be an asset for him as a presidential candidate, separating him from the welter of lawyers and career politicians in Congress.

But critics say the Republican senator from Tennessee may have overplayed his hand by offering a medical opinion in the Schiavo case.

In a speech last week on the Senate floor, Frist said that “speaking more as a physician than as a U.S. senator,” he believed there was “insufficient information to conclude that Terri Schiavo is in a persistent vegetative state.”

Frist -- who as a surgeon performed more than 150 heart and lung transplants -- said his conclusion was based on a review of footage of the brain-damaged Florida woman whose parents are seeking to reconnect her feeding tube. He said he also consulted court documents and spoke to a neurologist who examined Schiavo two years ago.

Frist’s comments raised eyebrows in the medical community.

Although there are no official rules against the practice, ethicists said, it is generally considered unprofessional for a doctor to make or question a diagnosis on the basis of incomplete information.

“In general, physicians would consider it unprofessional for doctors to take clinical stands on issues without adequate clinical data,” said Dr. Neil Wenger, head of the ethics committee at UCLA Medical Center.

William J. Winslade, a bioethicist and law professor at the Institute for the Medical Humanities at the University of Texas Medical Branch at Galveston, was more direct. Frist “has no business making a diagnosis from a video,” he said.

In his comments on the Senate floor, Frist said that based on the videotape of Schiavo and court records, she “does respond” to outside stimuli. “That footage, to me, depicted something very different than persistent vegetative state.”

A Frist spokeswoman said Monday that the majority leader was not offering a diagnosis of Schiavo. “What he’s saying is, it seems like there is a lot of gray area about whether she is in a persistent vegetative state,” said Amy Call.

Michael Williams, chair of the ethics committee of the American Academy of Neurology, was among those taking exception to Frist’s comments.

“For Dr. Frist to make a statement like that -- it’s like me making an off-the-cuff statement about a heart transplant patient,” said Williams, a neurologist at Johns Hopkins Medical Institutions in Baltimore.

In the Senate, Frist is hardly shy about his medical credentials.

The front door to his Capitol Hill office has “William H. Frist, M.D.” on the nameplate. He signs ordinary correspondence “Bill Frist, M.D.” He keeps a doctor’s bag in his office, and put it to real use in 1998 -- saving the life of a man who had been shot after allegedly storming the Capitol building and killing two Capitol police officers. Frist became a familiar face on television delivering public briefings after anthrax attacks on the Capitol in 2001. And he has cited his background in promoting legislation to fight bioterrorism, establish a prescription drug benefit under Medicare and limit payouts in medical malpractice cases.

Some analysts saw political dividends for Frist in his high-profile efforts to bring the federal courts into the fight over whether Schiavo’s feeding tube should be reconnected.

David Carney, who served as White House political director for President George H.W. Bush, said Frist generally has been linked more to the fiscal conservative wing of the GOP than its social conservative wing.

“With social conservatives, this certainly helps,” Carney said of Frist’s involvement in the Schiavo case.

Carney, a political consultant based in New Hampshire, noted that Frist has been making trips to the state, home of the nation’s first presidential primary. Frist has visited the state twice this month, including attending a Republican Party dinner Saturday in the midst of the controversy over the Schiavo case.

Some Democrats resent Frist’s use of his medical background in debates. He projects the attitude that “he’s a doctor, and he knows best,” said an aide to a senior Democratic senator, who asked not to be named.

Frist, 53, was elected to the Senate in 1994, becoming the first practicing doctor in the chamber since the late 1930s. Although he has been noncommittal about presidential aspirations, he has said he does not intend to seek reelection in 2006, sparking speculation that he would then focus on seeking his party’s nomination.

In a 2003 speech at Princeton University, Frist said some people found it confusing that “William H. Frist, majority leader, M.D., can be merged together.” He added: “But at the end of the day, it allows me to address things with a perspective that’s just different.”

That could prove especially beneficial in a presidential run, political analysts say.

“When you can say you saved probably hundreds of lives in your career before you got to Congress, that’s not something the average run-of-the-mill elected official can say,” said Michael Franc, a former GOP congressional aide who works at the Heritage Foundation, a conservative think tank. Carney, the political consultant, said, “In the primary, there will be one doctor and a bunch of politicians. Dr. Frist can go make house calls.”

John J. Pitney Jr., a former GOP strategist who is now a professor of government at Claremont McKenna College, noted that there was a potential downside to Frist’s background: His family founded a hospital company, HCA Inc.

“While people like doctors, they dislike corporate medicine,” Pitney said.

And ultimately, voters will be more interested in Frist’s politics than his medical practice, said Keith Appell, a public relations consultant who worked on Republican Steve Forbes’ presidential campaign.

“Folks ... will only care if you’re a doctor if you’re on the right side of the issues they care about,” Appell said.