White House Physician Provides Update on Bush's Condition
FREDRICKA WHITFIELD, CNN ANCHOR: We want to, as promised, take our viewers now to the White House, where Ari Fleischer is updating us on the president's condition.</s>ARI FLEISCHER, WHITE HOUSE SPOKESMAN: ... any abnormalities were found. At 7:09 a.m., Article 25 of the Constitution was invoked, temporarily transferring the power of the presidency to Vice President Dick Cheney. At that time, anesthesia was administered to the president. The procedure was concluded at 7:29 a.m., and the president awoke at 7:31 a.m. The power of the presidency was returned to President Bush at 9:24 this morning. The president said he feels great, and he has already resumed his normal routine at Camp David. In fact, he is working out in the gym as we speak. And with that, I'd like to turn it over to Dr. Tubb, who can describe the procedures and take any of your questions.</s>DR. RICHARD TUBB, WHITE HOUSE PHYSICIAN: Good afternoon. As Ari said, the president continues to be in outstanding health. The procedure this morning was a routine surveillance colonoscopy. As we announced yesterday, the president has a history of polyps on previous examinations that led to our recommendation that he receive a colonoscopy some time this year. At 7:09 the anesthetic was begun, and the procedure followed within 30 to 60 second as the president went to sleep. The procedure lasted for 20 minutes and was completely uncomplicated. No polyps were found, no abnormalities were found. The president woke up within 30 to 60 seconds after discontinuation of the anesthesia. He was in good spirits. He was asking questions; made a couple phone calls. He was monitored in the recovery room for approximately 30 minutes following the anesthesia, as would be standard operating protocol. We then disconnected the monitors, and he moved to a more comfortable room. I performed a comprehensive examination of the president at approximately 8:30. The president left after that point to go say hello to Mrs. Bush and to his brother Marvin, and went from there on to breakfast. I think, with that, I'd like to answer your questions.</s>QUESTION: Doctor, I know it's an extraordinary time, it's war time, with troops being overseas and on high alert; this is the July 4th weekend. Do you think that it was necessary that the president transfer his power during this procedure? And do you think that it's an indication, perhaps, that if there are other minor procedures that this might happen again, this might be something that they go ahead and follow, in light of these extraordinary times that we're in today?</s>TUBB: I think, as Judge Gonzales pointed out yesterday, the decision to implement the 25th Amendment rests solely with the president under Section 3 of Article 25 of the Constitution. It is his decision. I applaud him for making that decision. I think the judge can certainly speak better than I can as to the legal issues involved. But medically, the president would be at least momentarily unable to answer issues that arose. Judge, do you want to speak any more to that?</s>AL GONZALES, WHITE HOUSE COUNSEL: As Dr. Tubb says, it is solely within the president's discretion as to when to invoke Section 3 of the 25th Amendment. I don't think that you can glean from this that every time there will be a minor or even a more serious procedure, that the president is going to invoke Section 3. What he's going to do is look at all of the circumstances, the totality of the circumstances, in making a decision of whether or not he believes it's in the best interests, the national security interests, of this country to make this kind of decision. In this particular case, he looked at all of the circumstances -- the length of the procedure, the relationship with the vice president, things going on domestically and internationally -- and made the decision that it was the right thing to do for this country. And I think the American people should be reassured that we have a process in place so that when the president is unable to discharge his powers and duties, that the presidency is not disabled. We do have a mechanism in place to ensure that the presidency continues to function on behalf of the American people.</s>QUESTION: Can you clear up something as to whether or not Ronald Reagan in 1985 did invoke the 25th Amendment? There are many who say he did this informally. He turned over power to Vice President Bush informally, informing Congress after his operation for colon cancer, and that, in fact, Ronald Reagan did not want to invoke the 25th Amendment. Other scholars say, no, he actually did invoke it, kind of. What do you think?</s>GONZALES: I don't know whether or not President Reagan intended to invoke Section 3 of the 25th Amendment. There will be debate about that. I know, as I look at it, I think one can certainly make the argument that it was invoked. The authority of the vice president to assume power exists only through Section 3 of the 25th Amendment. But I don't want to get into the debate about whether or not it was actually invoked.</s>QUESTION: The vice president was notified then, wasn't he, in 1985? The vice president was notified?</s>GONZALES: The vice president was notified, as I understand it, that's right.</s>QUESTION: The president did not actually go through the procedures that you folks outlined yesterday. There was no fax, for example, to Capitol Hill to congressional leaders beforehand. Do you feel that this president, Bush, is the first president to invoke the 25th Amendment?</s>GONZALES: In my judgment, as I said yesterday, I believe that this is the second time that Section 3 of the 25th Amendment has been invoked.</s>QUESTION: The second time.</s>GONZALES: Yes.</s>QUESTION: What did Vice President Cheney do during the procedure? And did you go through the faxed letter as you explained yesterday? Could you walk us through that, how that happened?</s>GONZALES: Yes, when the president arrived this morning, I sat down with him, and he signed the letters, making the decision to transfer power. I immediately left and went to another building in order to fax the letters to the speaker and the president pro tempore. In the interim, Andy Card made calls to both the speaker and the president pro tempore. Once we got confirmation of the transmittal of the letters, I sent also a copy then to the vice president's office, and we made a call to the vice president's office to make sure that he understood that he was now acting as president. And then went back to where the procedure was occurring, stayed with the president until about 9:20, when he signed the letters ending the transfer of powers and went back to the cabin, and transmitted the letters to the speaker and the president pro tempore at 9:24.</s>QUESTION: Judge, can I ask you, what time was the vice president informed that power had been transferred?</s>GONZALES: I believe that he was informed just minutes after the faxes were transmitted to the speaker and the president pro tempore, just momentarily, just minutes.</s>QUESTION: That was before the anesthesia was administered?</s>GONZALES: I believe so, but again, I was not present in the room as the procedure was ongoing.</s>QUESTION: Let me just ask as a follow-up, the procedure was fairly short, 20 minutes, and he was awake within 22 minutes. But the vice president was in control for about two hours and 15 minutes. Why that longer period of time?</s>GONZALES: I think out of abundance of caution. We wanted to reassure everyone that the president was not going to be making a decision, a hasty decision to rush back in and to assume authority and power based upon the recommendation of the doctor. He had numerous conversations with medical experts around the nation about what would be a reasonable period of time to wait to ensure that the president no longer suffered any affects from the sedative. And again, a precautionary move to make sure that the president was able to discharge his powers and duties as president.</s>FLEISCHER: Dr. Tubb can address that as well.</s>QUESTION: What was his level of consciousness?</s>TUBB: The president, shortly after the initiation of the anesthetic, which, as we discussed yesterday, was an anesthetic called Propofol, quickly went to sleep within 30 to 60 seconds. Standard dosages of the medication were administered by two anesthesiologists. And the president was heavily sedated for the initial part of the examination. As we got to the midpoint of the examination, again, through standard operating procedures, the anesthetic was lightened to the point that it was discontinued minutes before the actual procedure actually was discontinued, accounting for the president's wakefulness within one to two minutes following. The follow-up to your question, the judge answered, is a question we had addressed with a number of experts, both experts in the practice of daily clinical medicine, meaning those experts that we see day in and day out that are doing this for a living, and the recognized national experts in this particular type of sedation. We've also taken a look at the research that is out there, the science behind the medication, the clinical experience of those we consulted, and came up with the recommendation that was followed. That, underscored by an examination by me earlier, led me to believe this was exactly the right time. And there is no question in my mind that he took back the powers at the correct moment.</s>QUESTION: Doctor, would you mind giving us a summary again of what you found, why you thought this was important and what you would recommend for the future?</s>TUBB: Let me start with why I felt this was important. His last colonoscopy was performed in December of 1999. At that point, they found two polyps, both very small. And in the medical literature they would describe them as "simple polyps." The threshold for that description is less than one centimeter. Both of these polyps were less than one centimeter. But they had occurred approximately 18 months prior to an exam that also showed polyps. His doctor at the time of both exams made the recommendation that a surveillance should be redone again at two to three years from December 1999. That is what led us to today. Now, with a completely normal exam showing absolutely no polyps, no recurrence of the previous polyps and no mucosal abnormalities -- that means no abnormalities in the lining of the colon -- our recommendation is that he does not need to repeat this for another five years. Now, I should underscore what I did yesterday in saying that the general public -- that is, anybody 50 and over -- should get this exam and then repeat it in 10 years unless there's any abnormalities noted.</s>QUESTION: Question for Ari, and then a question for Judge Gonzales. Ari, because it's war time right now, was there any consideration given, on a national security basis, to not disclosing that this had taken place perhaps until after it was all over? And for the judge, you mentioned that is the president's sole decision whether to invoke the 25th Amendment. However -- and I'm not suggesting this would be the case with the current occupant of the office -- if, for example, dementia was the reason for the incapacity, would the White House make that decision or would the president? How could the president, if he were considered to have dementia, make that determination for himself?</s>FLEISCHER: OK, one, as you know, the president, about three weeks ago, made the decision that the procedure would be this weekend. There was never any serious discussion about withholding the information until after the procedure. The decision was made right up front that this is information the American people deserve to have, should know. Our system is a strong system that is strong because we have disclosure. And so the decision was made early on that it would be disclosed in the manner that it was done.</s>GONZALES: Well, you're talking about a hypothetical situation which doesn't exist here, and would invoke other parts of the 25th Amendment. The only part of the 25th Amendment that is an issue here is Section 3.</s>QUESTION: Ari, can you tell us how the vice president spent his morning?</s>FLEISCHER: Yes, let me tell you how the vice president spent his morning, then I'll fill you in also on what the president did following the procedure, and then we'll take one or two more and we'll bring this to a conclusion. The vice president was at his desk this morning. He had his usual intelligence briefings. The vice president, as you know, has the same briefing the president has each morning. He had his here in the White House this morning. Then he had a series of meetings with his staff to discuss a variety of issues, as he will do on occasion on weekends. So he spent his morning here at the White House. He left the White House approximately 10 or 15 minutes ago.</s>QUESTION: Ari?</s>FLEISCHER: Let me fill you in on the president's day. I indicated I was going to do that.</s>QUESTION: People will ask, Ari, was there anything he did that was directly reflective of the fact that he was, at that point, acting president of the United States?</s>FLEISCHER: No, I really can't say there was. The vice president...</s>QUESTION: (OFF-MIKE)</s>FLEISCHER: I'd have to ask his staff if they address him as Mr. Acting President. I don't think they did. It's a mouthful. The president this morning, let me tell you what he did. Following the procedure, the president went back to his cabin at Camp David, where he greeted his family, and then he proceeded to hit a ball with Barney and Spot.</s>FLEISCHER: Then he had breakfast. He enjoyed some waffles this morning at about 9 o'clock. And then he went for a 4.5-mile walk with Mrs. Bush, with Andy Card and Andy Card's wife, along with his brother Marvin. They walked around the grounds of Camp David. The president, as I indicated, is at the gym as we speak. He's having a light workout. And then he'll spend the rest of the afternoon enjoying himself with his family.</s>QUESTION: May I ask Dr. Tubb a question? Do you mind elaborating on how you knew the president is in good spirits? And is the president an inquisitive patient, or does he let you drive?</s>TUBB: The president is the president...</s>QUESTION: How did -- you characterized him as in good spirits. Do you mind elaborating about that?</s>TUBB: He would be joking about the exam and about wanting to get back to a normal diet and normal activity, I think as any patient would.</s>QUESTION: Could you elaborate please, on the 8:30 exam that you all conducted? I mean, was that in lieu of an annual physical or...</s>TUBB: No, absolutely not. It was an exam specifically targeted towards the exam we just completed. He will still have his routine annual physical. I think I mentioned yesterday, that as one of the reasons we did this exam today, was that this was an important part of the exam, but one that could not reasonably be conducted at the same time as annual physical, not in a patient-friendly fashion, anyway.</s>QUESTION: Can you address -- is the president at higher risk for colon cancer or any abnormalities because his brother has had colitis? Is there at all any kind of correlation?</s>TUBB: Absolutely not.</s>QUESTION: A couple of general health questions. Has the president lost weight since August, fall last year? And has he had an recurrence of that fainting episode?</s>TUBB: In answer to your first question, quite honestly I've not had occasion to weigh him. There's been absolutely no reason to ask the president to come in to weigh him. I can tell you that he has been working very, very hard in his fitness program, and I think the results show.</s>QUESTION: And what about the fainting episode?</s>TUBB: Absolutely no indication whatsoever.</s>QUESTION: Ari, two questions. Did you invoke the 25th Amendment, forgetting 1985, because of the experience in 1981, when there was great confusion after President Reagan was shot and it was unclear who was in charge? You will remember, secretary of state being quoted as saying "I'm in charge." And one other question, if I might. Is the Post story accurate today, that the president is considering new penalties for corporate fraud and malfeasance?</s>FLEISCHER: On the second part, I'm not going to speculate about anything that may or may not be in a future presidential speech. On the first part, the president answered that himself when he addressed the press in the country (ph) yesterday. And the president indicated that we are at war time, and he wanted to be, I think his words were, "super cautious." And so the decision was made by the president to invoke the 25th Amendment. OK. Last question. Yes, sir?</s>QUESTION: Did the president watch the procedure on a video monitor? And a second part, how did you judge that he was able to become president again?</s>TUBB: In answer to your first question, no, the president did not watch the procedure. He was asleep for the majority of the length of time of the procedure. The answer to your second question is kind of a repeat of what we mentioned earlier, that we took a look at the body of literature, the chemical characteristics of the medication, the physiological characteristics of the medication in a patient, the clinical experience of a number of anesthesiologists, the recommendations of nationally known anesthesiologists experienced in this particular medication, and the observations of this particular patient, the president, during the examination. I mentioned yesterday that one of the beauties of this particular medication is you can give exactly what the patient needs, no more, no less. And...</s>GONZALES: Let me emphasize one thing in response to your question. We did not make the determination when the president was able to discharge his responsibilities. The president makes that determination. What he does is he confers with his doctor, he confers with advisers. We give him our assessment or our observations about his alertness, you know, his behavior, his speech. But ultimately, it's the president of the United States who makes the determination that he is, in fact, able to discharge his obligations as president.</s>QUESTION: The doctor said that immediately following the procedure he made some phone calls. Who did he call?</s>GONZALES: He called the vice president and Mrs. Bush.</s>QUESTION: Did he joke with the vice president and say, "You're not president anymore," or anything like that?</s>FLEISCHER: No, I think it was a pretty straightforward, boring conversation. The last thing I want to say is, though, the president does urge all Americans to listen to their doctors, to get preventive check-ups, to have health screenings. The advances in medicine are marvelous, the president thinks, and they can help lead to healthier, better lives and save lives. So the president hopes that as a result of any publicity about anything involving his personal health, Americans will take it to heart and go out and have the screenings and have the preventive medicine that they should take. And I'd like to thank you all for coming in on a Saturday, and we will see you on Monday. Thank you.</s>WHITFIELD: All right. Fairly remarkable. You've been listening to the White House doctor there, Dr. Richard Tubb, as well as Ari Fleischer, the spokesperson and the legal counsel Al Gonzales all saying that after that procedure, a 20-minute procedure of a colonoscopy involving the president, he felt so good that he was able to have a plate of waffles and then go for a four-and-a-half mile walk shortly thereafter. He has restored his power of the presidency, and now all sort of back to normal. But a lot of questions about the regularity, though, of the colonoscopy. He is not going to need another one for five years. Our medical correspondent, Elizabeth Cohen, was here with me and listening in on this. And this really is encouragement, isn't it, that after a medical routine procedure such as a colonoscopy, you can resume normalcy fairly immediately.</s>ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Exactly. I think sometimes people, Fredricka, think that colonoscopy will ruin your entire day, and it doesn't have to. The procedure is that the patient lies on the table, a small flexible tube goes in to check out the colon. And the patient is sedated, like President Bush was asleep. But then once the procedure is over, in his case in about 20 minutes, it sounds like it only took him an hour or two to sort of get out of the grogginess, and then you can eat waffles or whatever you want. If you feel up to it, you can take a walk. Because the sedative he was given sounds particularly a quick one. Acts quickly, and then when you stop gibing it to the patient, it ends quickly.</s>WHITFIELD: Although in many other cases, a lot of patients, I guess, are able to watch the colonoscopy in their groggy state, but they're somewhat aware of their surroundings, but they made it very clearly that he was pretty much knocked out.</s>COHEN: Right. And everybody's different. I mean, the sedatives works -- different sedatives work differently on different people, so that some people are asleep like he was. I was talking to a friend this morning who said, "oh, I watched the whole thing on the monitor. I watched my colon. I saw the whole thing happen." And she was sedated so she was relaxed and happy. But everybody's different.</s>WHITFIELD: We want to bring in Dr. Stanley Benjamin. He's the head of gastroenterology at Georgetown University, and hopefully you were able to listen in on the doctors and the spokesperson for the White House as well. Fairly remarkable, is it, that after a procedure such as this you can resume to normalcy, but the prognosis was so good for President Bush that he won't have to get another colonoscopy for another five years. How unusual is that?</s>DR. STANLEY BENJAMIN, GEORGETOWN UNIVERSITY: That's actually standard of care. Everything that has happened in Mr. Bush's case has been standard of care for every American. He gets a screening test, he has some polyps found. The first test is often done a year or two after that. And then three years, then five years, and he'll go at five to seven-year intervals. This is for colon cancer prevention. We're not looking for cancer, we're looking to prevent it. Standard of care, he's had it.</s>WHITFIELD: Well, what is interesting about President Bush is he last had a colonoscopy in December of 1999. This amount of time has elapsed, a couple of years before he's gotten another one, and that's because they found benign polyps the first go-round, the first two times, actually, and this time it's all clear. And that's why he won't have to see another doctor for a colonoscopy for another five years?</s>BENJAMIN: That's absolutely correct. Remember the focus here, these little polyps, 20 percent of them can turn into cancers. The majority do not. But if you remove those polyps, you prevent the focus that will allow a cancer to develop. This is about preventing cancer, and it works for President Bush; it works for all Americans if they get the test.</s>WHITFIELD: Now, these polyps that develop, fairly normal, and they're very slow growing, as I understand. But that underscores the need for getting regular colonoscopies for all men and women over the age of 50. But are there certain candidates who need to start much earlier in the process?</s>BENJAMIN: Absolutely. This has to be gauged on your family history and personal history. Family history, some folks have cancers in the colon by the time they're in their teens. Some people have it in their 20s. The majority of people, however, are much older than 50. So you need to know about your family history, and most importantly symptoms need to be evaluated, in particular bleeding is something that should never be attributed to hemorrhoids, because God gave us all a set until after diseases have been excluded.</s>WHITFIELD: Now, besides hereditary conditions, are there other things that perhaps may help promote the growth of polyps, such as stress in your life, or certain environmental exposures?</s>BENJAMIN: Well, I think there is no data that would support stress, but clearly something happens in particular the aging of the population. There is something about the diet that we eat, so there are other clearly other factors other than heredity that contribute to a substantial risk for colon cancer.</s>WHITFIELD: All right. Dr. Stanley Benjamin, head of the gastroenterology department at Georgetown University, thank you very much for joining us.</s>BENJAMIN: You're welcome.