Cheney's Internist Protected Under Privacy Agreement

Wolfe has long advocated stricter oversight of impaired doctors and has been particularly critical of the D.C. medical licensing board, which ranks among the nation's lowest in terms of the percentage of doctors disciplined each year.

Full disclosure of a doctor's impairment record is but one of several issues raised by the revelations. Another is the apparent ease with which the doctor was able to keep obtaining strictly controlled drugs known for their addictive potential. The New Yorker, citing divorce records and other documents, said that Malakoff wrote several prescriptions to himself using other doctors' names and DEA numbers.

According to the New Yorker, the papers also document his purchase of tens of thousands of dollars' worth of controlled substances over the Internet, including a nasal spray version of Stadol, a powerful pain killer whose addictive powers have prompted some lawyers to advertise for patients seeking to sue the drug's maker.

Also at issue is whether drug tests administered as a routine part of the Medical Society program failed to pick up Malakoff's alleged ongoing drug use. Some people involved in drug treatment programs have managed to manipulate drug test results, using any number of kits available on the Internet. It remained unclear yesterday whether Malakoff was still taking drug tests or why the Medical Society had concluded that his treatment was a failure.

That determination forced Malakoff to choose between agreeing to stop seeing patients or having his case referred to the licensing board.

Almost as soon as Bush selected Cheney to be his vice presidential running mate July 25, 2000, questions arose about Cheney's medical history, which included three heart attacks in the 1970s and 1980s, heart surgery, high cholesterol and gout. Malakoff, who had been Cheney's primary care physician since 1995, spoke up to assuage those concerns.

"At this time, Mr. Cheney is in excellent health," Malakoff said then. "I monitor him closely for his known medical problems. He is up to the task of the most sensitive public office."

By that time, Malakoff was already in treatment for drug addiction.

Malakoff saw Cheney on Nov. 29, 2000, for a routine medical follow-up after his treatment for what doctors called a "minor heart attack" -- his fourth -- seven days earlier. "We told Mr. Cheney he can resume his usual schedule and stressed the importance of good exercise and nutrition," Malakoff announced that day.

Williams, the George Washington provost, said yesterday that he, too, was a patient of Malakoff's and had not noticed evidence of impairment during his visits in recent years. "Was he taking just enough to take the edge off?" Williams asked. "Did he take it every day? I still do not even know what he was taking."

Williams said that some types of doctors, notably anesthesiologists, of which he is one, are especially at risk of becoming addicted to prescription drugs, while internal medicine, which Malakoff practiced, is "not considered a high-risk specialty."

Staff writer Cheryl W. Thompson and researcher Meg Smith contributed to this report.