If the President Can’t Lead : Politics: Reagan, Wilson and others were incapacitated in office. A physician/author says steps must be taken to protect the country.

Unless the President drools in public or announces on television that he is Alexander the Great, no one is going to act to interfere with (his) exercise of authority. --George Reedy, press secretary to President Lyndon Johnson

Item: For 10 days after the 1981 assassination attempt, Ronald Reagan was drugged, dazed and physically incapable of leading the nation. Yet his doctor made no move to have him relieved of power.

Item: President Bush’s doctor continues to give the President Halcion “as needed” even though the drug has been linked to bizarre behavior, including paranoia and hallucinations.

Item: When Woodrow Wilson suffered a debilitating stroke in 1919, his wife and his physician covered up the President’s incompetence for a year and half, running the government from his darkened bedroom.

History has shown that when the patient is the President, his physician’s job is as political as it is medical. And that, says Dr. Herbert L. Abrams, is no way to run a country.

In his recent book “The President Has Been Shot,” Abrams, who holds dual appointments at Stanford’s Medical School and its Center for International Security and Arms Control, examines what happens when the President is--even temporarily--out of commission.

Tracing the history of presidential doctoring, Abrams concludes that the time has come to change the way the nation identifies and deals with incapacitated leaders. The time has come for a second opinion.

On the afternoon of March 30, 1981, nearly 20 doctors, nurses and Secret Service agents crowded around a wounded Ronald Reagan in the emergency room of George Washington University Hospital. As the trauma team cut off Reagan’s $1,000 suit, his physician, Daniel Ruge, retreated quietly to the foot of the bed, where, at least symbolically, he remained for the rest of the crisis.

“There was probably no one who knew less about what was going on than Ronald Reagan and I,” Ruge recalls today. “We were isolated from the rest of the world.”

They weren’t the only ones, according to Abrams’ view of events surrounding the Reagan shooting. After five years of interviews and research, Abrams concludes that the world was deceived and the Constitution subverted by a combination of “ignorance, caution, concern and guile.”

The 25th Amendment to the Constitution includes provisions for temporarily transferring the President’s powers when the President is “incapacitated.” The Reagan shooting was the first test of the 1967 amendment and, says Abrams, “a most miserable failure.”

When Reagan was shot, Ruge had a copy of the amendment in his pocket in his capacity as presidential physician. But, Ruge says today, “It never entered my mind to use it.”

“The fact that we didn’t invoke (the amendment) was a mistake . . . (but) I was very optimistic everything was going to turn out all right,” says Ruge, now retired in Denver.

Although such optimism was reflected in official hospital statements, Abrams says painting rosy pictures of the President’s health was “wrong.”

“In the four hours following the shooting, (Reagan) was short of breath, in great pain, losing blood from his chest wound,” writes Abrams. “(He) had a collapsed lung and blood in the pleural cavity. He remained on a respirator for 12 hours . . . and required morphine for his pain.”

Yet, Reagan was described by the hospital as “obviously able to function (as President).” Indeed, the morning after surgery to remove the bullet from his chest, a disoriented and bewildered Reagan penned his wobbly signature on an important farm bill.

History has shown that protective doctors, loyal to the President as patient and friend, have failed to acknowledge the nation’s greater needs:

* Perhaps the most dramatic example is that of Cary Grayson, physician to Woodrow Wilson. In 1919, Wilson suffered a massive stroke and was completely incapacitated.

“For months,” writes Abrams, “he lay in a darkened room, completely isolated from the public and his Cabinet, while the reins of government fell into the hands of Grayson and Mrs. Wilson.”

The cover-up orchestrated by Wilson’s doctor and wife to keep Wilson in office put the nation as well as the President at potential risk.

* Years later, Franklin D. Roosevelt’s doctor engaged in similar deception when he encouraged a dying man to seek a fourth term and issued upbeat reports on his health.

* Throughout his presidency, John F. Kennedy secretly suffered Addison’s disease--a hormone deficiency disorder caused by damaged adrenal glands--as well as often debilitating back pain. His physician’s reluctance to make his condition public might have protected his presidential image but possibly risked his personal health, Abrams says.

Although such subterfuge is not good for the patient or for the country, says Abrams, a President should be able to trust his doctor.

“A well-prepared, scrupulous White House physician should be able to trigger the consideration of disability. . . ,” writes Abrams, “but his very willingness to breach confidentiality might encourage the President to avoid seeking treatment for a condition or to seek it elsewhere.

“Kennedy’s need for the lift provided by injections from Dr. Max (Dr. Feelgood) Jacobson, which apparently contained amphetamine, illustrated how a President could easily obtain secret, and possibly dangerous, treatment by circumventing the official physician,” writes Abrams.

Bush’s official physician, Dr. Burton Lee III, believes that treating the President just like any other patient is the only answer to such conflicts.

“When mistakes are made,” says Lee, “it’s when you treat a VIP differently, when you make exceptions and do things you normally wouldn’t do, when you hack around to try to avoid the press. . . .”

Besides, adds Ruge, “Almost nothing can be (hidden) today.” With publication of the Abrams book and others, medical details of Reagan’s condition unknown even to his personal physician have been publicly scrutinized.

Because the President’s body is not his own--nor is it his physician’s--Abrams wants an independent commission to take charge of presidential health.

“As it stands, it’s up to the President himself to initiate the process that would temporarily transfer his powers,” says Abrams. “And there are many situations that makes this difficult, if not impossible.”

When Reagan was shot, for example, he was probably in no shape to invoke the 25th Amendment. It did not occur to his physician, focused on the prospect of his patient’s recovery, to bring up the subject.

Abrams is calling for panel of experts that would respond to medical crises and oversee periodic exams of the President to guarantee no disabling conditions escape notice.

Bush’s doctor, for one, is opposed: “I think any time you impanel commissions for diagnosing people, it’s a terrible, terrible idea,” Lee says.

And if Bush should become incapacitated while in office? “ I will be the one to advise the chief of staff (to invoke the 25th Amendment),” says Lee, “and I will be the one to say when he should resume power.”

Says Ruge, who served as Reagan’s physician for one term: “It is not necessary to have a panel that is going to tell the physician to the President how to take care of the President. There is no value in that.”

Organized medicine has not taken a position on the idea. But the notion of bringing a group of outsiders into the privileged doctor-patient relationship would seem to be at odds with the American Medical Assn.’s 1992 Code of Medical Ethics.

That code forbids physicians from revealing confidential communications or information without the express consent of any patient, even the President, “unless required to do so by law.”

But if a President has Alzheimer’s disease, AIDS or, say, cancer, does the national interest override his right to privacy?

Although the AMA does not single out high-ranking patients, another professional group did so some years ago when it ruled that the need for confidentiality is absolute. Yet, the Group for the Advancement of Psychiatry added, psychiatrists must “nevertheless accept responsibility to the community and national welfare. . . .”

“Unfortunately, nothing concerning the President is separable from responsibility to the nation,” says Abrams.

“Any physician to the President has to live with that conflict . . . (from) trying to fit medical treatment into the President’s busy schedule (to) seeking to have him relieved of office for the protection of the national interest.”