For Immediate Release
Office of the Press Secretary
June 29, 2002
Press Briefing by Dr. Richard Tubb
The James S. Brady Briefing Room
12:16 P.M. EDT
MR. FLEISCHER: Good afternoon. I want to make a brief statement and then turn this over to White House Physician Dr. Richard Tubb.
President Bush this morning underwent a colorectal screening procedure at Camp David in which no polyps were found and no evidence of any abnormalities were found.
At 7:09 a.m., Article XXV 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 a.m. 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.
With that, I would like to turn it over to Dr. Tubb, who can describe the procedures and take any of your questions.
DR. TUBB: 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 sometime this year.
At 7:09 a.m., the anesthetic was begun and the procedure followed within 30 to 60 seconds 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 a.m. 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.
Okay. With that, I'd like to answer your questions.
Q Doctor, I know it's extraordinary times, wartime, with troops being overseas and on high alert because of 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?
DR. 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 XXV 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?
JUDGE GONZALES: As Dr. Tubb said, 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 is going to do is look at all the circumstances, the totality of the circumstances, in making a decision 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 the circumstances -- the length of the procedure, the relationship with the Vice President, things going on domestically and internationally -- and made the decision 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.
Q Judge Gonzales, 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?
JUDGE GONZALES: I don't know whether or not President Reagan intended to invoke Section 3 of the 25th Amendment. That will -- 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.
Q The Vice President was notified then, wasn't he? In 1985, the Vice President was notified?
JUDGE GONZALES: The Vice President was notified, as I understand it. That's right.
Q But 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?
JUDGE GONZALES: In my judgment, as I said yesterday, I believe that this is the second time that the 25th -- that Section 3 of the 25th Amendment has been invoked.
Q The second time?
JUDGE GONZALES: Yes.
Q Can I ask you, what did Vice President Cheney do during the procedure? And did you go through the faxed letter, as you explained yesterday? Can you talk -- walk us through that, how that happened?
JUDGE 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 Tem. In the interim, Andy Card made calls to both the Speaker and the President Pro Tem.
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 I went back to where the procedure was occurring. I stayed with the President until about 9:20 a.m., when he signed the letters ending the transfer of powers, and then went back to the cabin and transmitted the letters to the Speaker and to the President Pro Tem at 9:24 a.m.
Q Judge, can I ask you, what time was the Vice President informed that power had been transferred?
JUDGE GONZALES: I believe that he was informed just minutes after the faxes were transmitted to the Speaker and the President Pro Tem. Just momentarily, just minutes.
Q That was before the anesthesia was administered?
JUDGE GONZALES: I believe so. But, again, I was not present in the room as the procedure was ongoing.
Q And let me just ask, though, just to follow up.
JUDGE GONZALES: Sure.
Q Thank you. 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?
JUDGE GONZALES: I think out of an 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 into and 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 effects from the sedative. And, again, a precautionary move to make sure that the President was able to discharge his powers and duties as President.
MR. FLEISCHER: Dr. Tubb can address that, as well.
Q What was his level of consciousness?
DR. 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 that the Judge answered, it was 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 that 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.
Q 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?
DR. 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. In the medical literature, they would describe them as simple polyps.
The threshold for that description is less than one centimeter. Both these polyps were well 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 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.
Q A question for Ari. And then I've got a question for Judge Gonzales.
Ari, because it's wartime 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 it 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? How could the President, if he were considered to have dementia, make that determination on himself?
MR. FLEISCHER: Okay. 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.
JUDGE 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.
Q Ari, can you tell us how the Vice President spent his morning?
MR. FLEISCHER: Yes, let me tell you how the Vice President spent his morning, and then I'll fill you in also on what the President did following the procedure. 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 would 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.
Let me fill you in on the President's day. I indicated I was going to do that.
Q 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?
MR. FLEISCHER: No, I really can't say there was.
Q Was he addressed as "Mr. President"? (Laughter.)
MR. FLEISCHER: I'd have to ask his staff if they addressed 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. And then he had breakfast. He enjoyed some waffles this morning at about 9:00 a.m. And then he went for a four-and-a-half mile walk with Mrs. Bush, with Andy Card and Andy Card's wife, along with his brother, Marvin. They walked around the grounds at Camp David.
The President, as I indicated, is at the gym as we speak. He is having a light workout. And then he'll spend the rest of the afternoon enjoying himself with his family.
Q Dr. Tubb -- 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? (Laughter.)
DR. TUBB: The President is the President. (Laughter.) And he calls the shots. He is an inquisitive patient. He wants to know exactly what's going to transpire and afterwards, what has transpired. I think that's --
Q And Dr. Tubb, you characterized him as in good spirits. Do you mind elaborating about that?
DR. 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.
Q Dr. Tubb, could you elaborate, please, on the 8:30 a.m. exam that you all conducted? I mean, was that in lieu of an annual physical or --
DR. TUBB: No, absolutely not. It was an exam specifically targeted towards the exam we just completed. He would still have his routine annual physical. I think I mentioned yesterday, that was 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 his annual physical, not in a patient-friendly fashion anyway.
Q 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?
DR. TUBB: Absolutely not.
Q Dr. Tubb, a couple of general health questions. Has the President lost weight since August 4, last year? And has he had any recurrence of that fainting episode?
DR. TUBB: In answer to your first question, quite honestly, I have 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.
Q And what about the fainting episode?
DR. TUBB: Absolutely no indication whatsoever.
Q 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 the Secretary of State being at the podium saying, "I'm in charge."
And one other question, if I may, is the Post story accurate today that the President is considering new corporate penalties for corporate fraud and malfeasance?
MR. FLEISCHER: Okay, 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 and the country yesterday. And the President indicated that we are at wartime, and he wanted to be -- I think his words were, super cautious. And so a decision was made by the President to invoke the 25th amendment.
Okay, last question. Yes, sir.
Q 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?
DR. 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 the 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. As 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.
JUDGE 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 advisors; we give him our assessment, 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.
Q The doctor said that immediately following the procedure he made some phone calls. Who did he call?
DR. TUBB: He called the Vice President and Mrs. Bush.
Q Did he joke with the Vice President, say, you're not President anymore, or anything like that? (Laughter.)
MR. FLEISCHER: No, I think it was a pretty straightforward, boring conversation.
The last thing I want to say is, though, that 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 that 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.
I'd like to thank you all for coming in on a Saturday, and we will see you on Monday. Thank you.
END 12:35 P.M. EDT