Bush to Undergo Medical Procedure, Yield Power

WASHINGTON -- President Bush today is scheduled to undergo what White House physicians called a “routine, preventive” colonoscopy, and while he is under sedation, the powers of the presidency will temporarily transfer to Vice President Dick Cheney.

Bush disclosed the news Friday as he departed the White House, en route by helicopter to the Camp David presidential retreat in Maryland’s Catoctin Mountains, where the procedure would be performed.

The transfer of power is only the second time in U.S. history that the 25th Amendment to the Constitution will have been invoked, providing for the temporary transfer of power to the vice president. The first time was July 13, 1985, when President Reagan underwent colon cancer surgery.

The colonoscopy will be Bush’s third--a precaution because of what Bush’s doctor called “a history of [benign] colon polyps.” The procedure is designed to prevent and detect colon cancer.

The president said he decided to transfer power to Cheney “because we’re at war and I just want to be super--you know, super cautious.”

Referring to the vice president, Bush then quipped: “He’s standing by. He’ll realize he’s not going to be president that long.”

Bush’s colonoscopy is expected to last 30 to 45 minutes, Air Force Col. Richard J. Tubb, the president’s doctor, told reporters Friday at a White House briefing.

Barring complications, Tubb said, the president could even exercise by this afternoon, which Bush, 55, said he intends to do.

Citing general security precautions, administration officials were unusually tight-lipped about most aspects of Bush’s colonoscopy, such as the scheduled time of the procedure and Cheney’s planned whereabouts during the time that he will be acting president.

“I really don’t want to put out a time, and I hope you understand,” Bush told reporters on the South Lawn. As for Cheney, he added, “I’m not sure where he’ll be.”

“Just say Washington,” said Mary Matalin, the vice president’s counselor. She said Cheney often works on Saturdays and planned to do so today. “It will be a routine day,” Matalin added.

Presidential Press Secretary Ari Fleischer said it was “likely” that Cheney would be at the White House for a portion of the day.

During the procedure, Tubb said, Bush will be sedated intravenously with the drug Propofol.

The dosage will be adjusted based on the president’s level of comfort--or discomfort, he said. Thus, it does not necessarily mean that Bush will be unconscious during the procedure.

“The anesthesiologist in this particular case will be able to dial the medication to exactly the right level where the president is comfortable but at the same time relaxed enough that they can get a good exam,” Tubb said.

Propofol is such a fast-acting drug that it can put a patient to sleep within 30 to 60 seconds of administration; once stopped, a patient can awake within two to four minutes, he said.

Some patients spurn anesthesia during a colonoscopy, but Bush concurred with Tubb’s recommendation to undergo sedation.

Colonoscopy involves the insertion of a flexible fiber-optic scope through the rectum to allow doctors to see the lining of the colon on a monitor.

“It is the recommended procedure for somebody who’s had polyps before,” Tubb said.

Bush’s previous colonoscopies were in July 1998 and December 1999. Each time, two small adenomatous polyps were detected and removed, Tubb said.

“The last time we did one of these colonoscopies, they found benign polyps and they recommended that ... they take another look and see if there’s anything in there,” the president explained.

Such polyps, once removed, “present no problem whatsoever, and that’s why I say this is preventive medicine,” Tubb added.

“It’s almost become kind of an art, where you’re looking not only at the fact that you’ve got a polyp there, you’re looking at the size of the polyp, you’re looking at the histological character, the microscopic characteristics of the polyp, the family history of the patient, the number of the polyps,” the physician said.

Colonoscopies have become so routine that the medical facilities at Camp David are more than adequate to accommodate today’s procedure, he said. But the physician declined to go into details about the facilities at the well-guarded compound.

“At Camp David, we can provide all the services, including [addressing] any complications at that point,” Tubb said.

He conceded that there are “risks of complications” from colonoscopies but added: “The complications that theoretically could arise generally are not ones that are immediate and life-threatening. In fact, more often than not, they’re ones that manifest themselves over hours or even days.”

The transfer of power will be made shortly before the procedure.

Bush will sign a written declaration voluntarily transferring the powers of his office to Cheney. The document then is to be faxed to House Speaker J. Dennis Hastert (R-Ill.) and Senate President Pro Tem Sen. Robert C. Byrd (D-W.Va.).

The men were briefed on the procedure by the White House Friday afternoon. White House Counsel Alberto R. Gonzales said that, as a matter of courtesy, the White House also will call Hastert and Byrd this morning.

When the colonoscopy is completed and Bush is able once more to fully assume the duties and powers of the presidency, he will fax a second declaration to Hastert and Byrd.

In his last physical, on Aug. 4, Bush was found to be in good health, with no sign of hypertension, diabetes, tuberculosis or heart disease--only a mild, high-frequency hearing loss and some sports-related injuries, including lower-back pain caused by weightlifting.

The president, an avid runner as well as a weightlifter, just last week launched a physical fitness campaign to encourage Americans to get more exercise.

Because polyps can be a precursor to colon cancer, physicians recommend colonoscopies for patients who are over 50 years old as a matter of routine screening. But health insurance coverage for such procedures is still far from common. According to Tubb, 4.3 million such procedures were performed in 2000.

Colorectal cancer is the third most common form of cancer, striking an estimated 135,400 Americans last year and killing 56,700.

Women are slightly more likely than men to have colon cancer, while men are slightly more likely to have rectal cancer.

The most important risk factors for colorectal cancer are a family history of the disease, a family history of polyps and inflammatory bowel disease. Other risk factors include smoking, lack of exercise, a high fat/low fiber diet and alcohol consumption.

Polyps are small, balloon-like growths on the interior of the large intestine and are normally precursors of cancer.

But many years are required for a polyp to become cancerous, and early detection and removal of polyps sharply reduces the risk of developing malignancies.

The American Cancer Society and other health organizations now recommend that adults undergo colonoscopy at age 50 and, if no polyps are found, every 10 years after that.

Alternatively, sigmoidoscopy, which is used to study the lower third of the large intestine, is recommended every five years.

Only about a third of Americans older than 50 have ever had a colonoscopy, according to the American Cancer Society.

*

Times staff writer Thomas H. Maugh II in Los Angeles contributed to this report.