All the president's physicians

Unit works secretly to protect health, anticipate emergencies


WASHINGTON - With earpieces in place, they trail the president and vice president everywhere, lurking in the shadows. But they aren't there to take a bullet for the president.

They're there to take out the bullet. Or start a heart. The 22 doctors, nurses and technicians of the White House Medical Unit work around the clock in partnership with the Secret Service to protect the health of the president and vice president.

On television it would be "ER" meets "The West Wing." But this team is much more secretive.

President Bush and Vice President Dick Cheney's doctors declined to speak directly about the White House medical team, but Knight Ridder interviews with former chief doctors provide a look at this shadowy unit.

All the secrecy is for the president's protection, both as a patient and the nation's leader, said Dr. Daniel J. Ruge, former President Ronald Reagan's top physician. It is important to ensure an enemy does not discover how to exploit a medical vulnerability, he said

The presidential doctors must balance the privacy of their patient and the public's right to know about the health of the country's leaders.

Twenty years ago today, Reagan was shot and wounded in an assassination attempt by John Hinckley Jr. Since then, the medical unit has updated its procedures and training to make it more rigorous and ready to handle complex medical and constitutional issues.

"The Medical Unit is a lot healthier. We've come a long way," said Rear Adm. Connie Mariano, former President Bill Clinton's physician, who headed the unit until January. She made the unit an emergency-oriented team, began all-hours operations and upgraded the care of the vice president.

Cheney, who has had four heart attacks, has a doctor near him 24 hours a day, seven days a week. His official residence, at the Naval Observatory, has been renovated to include a medical suite. Those changes were long overdue to bring the care of the vice president up to the same standard as that of the president, Mariano said.

The director of the unit, Air Force Lt. Col. Richard J. Tubb, oversees the extensive mobile emergency and trauma units assigned to the president and vice president as well as exam rooms in the White House and in the nearby Old Executive Office Building. His team is filled with family medicine, emergency and internal medicine specialists who have additional certification in cardiac life support and trauma and have passed rigorous background checks.

The White House physician also plays a crucial role in the constitutional process of deciding whether the president is fit to govern because this is made mainly on the basis of medical judgment, rather than for political reasons, Mariano said. If the president is incapacitated, the medical unit must report that to a classified group of White House and Cabinet officials.

At the same time, they must earn the president's trust that they will not divulge personal medical history.

"You have to walk a very fine line between respecting their privacy and protecting the American public," Mariano said. All of the medical team members are military officers, sworn to uphold the Constitution.

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