A chart in yesterday's Health section listing ages and life expectancies of presidents was based on information compiled by the Metropolitan Life Insurance Co. and should have carried a credit. In addition, because of an editing error, President Reagan's age at his first inauguration was listed incorrectly. He was 69. (Published 2/10/ 88)

When the Reagan White House listed its top 55 officials for the 1981 Congressional Directory, it placed the president's physician at No. 54 -- between the chief usher and the curator of White House artifacts.

President Reagan has changed doctors three times during his seven years in office but, according to a recent report by the University of Virginia's Commission on Presidential Disability, the prestige of the White House physician has remained shockingly low. In the current Congressional Directory, the White House Physician is ranked No. 55 out of 79 positions.

Whether or not Ronald Reagan's physician has clout within the White House may seem a minor issue.

But for a man who on Feb. 6 celebrated his 77th birthday, who is the oldest man to hold the presidency, who has had colon cancer develop undetected, who has undergone three major operations and who was shot while in office, few issues can be as important as the quality of his medical care.

Despite the potentially important role White House physicians can play in determining whether a president is capable of continuing in office, only rarely have presidential physicians moved to the center of Washington's political stage.

"They're the lowest guy on the totem pole," said Dr. Kenneth R. Crispell, a professor of medicine at Virginia and one of the consultants to the Commission on Presidential Disability.

"It's a crummy job," said Dr. Edward B. MacMahon, a Northern Virginia orthopedic surgeon and coauthor of the recent book "Medical Cover-Ups in the White House," which details a number of accounts of poor medical care given presidents from Andrew Jackson to Reagan.

Both MacMahon and the Virginia panel, which was convened to discuss the problems of a medically disabled president, agree that the central player in any scenario involving the president's health should be the White House physician.

But the president's doctor typically is not accorded enough respect within the White House to take charge in a medical crisis such as an assassination attempt or major illness, the panel said. "The commission has been shocked at the low rank and, sometimes, the low esteem accorded to the physician -- and not just in the current administration," it said.

MacMahon, a clinical assistant professor at Georgetown University, has raised medical questions as well, saying Reagan's medical care has "ranged from top flight to questionable." Administration spokesmen declined to comment or provide an interview with the current White House physician.

The quality of care is not the only issue at stake. How much should the public know about the health of a president is also a major question. Sometimes the White House was "a model of candor," but other times it appeared White House doctors "were muzzled," MacMahon said in his book, coauthored with Washington writer Leonard Curry.

Their solution: Senate confirmation of the White House physician. MacMahon said such a step would boost the office's prestige and give Congress "one sure source of direct information about the president's health."

The University of Virginia panel, one of a number convened by the school's White Burkett Miller Center of Public Affairs to deal with presidential issues, rejected the notion that White House doctors be subject to congressional approval. The commission said that a president must have a close, personal relationship with his physician and the selection of that person should not be subject to "approval by any other body, medical or otherwise."

Yet the closed selection process raises concerns about presidential fitness. Who is to decide whether a president is medically able to do the job? The question strikes at the heart of the role of the White House physician. As MacMahon put it: "The whole issue is: Whom does the White House physician serve? The president or the public?"

Crispell called it a "Catch 22": the doctor owes his position -- and his power -- to a man he must to be willing to declare incapable of exercising presidential power.

Dr. William Lukash, the former Navy doctor who held the White House job under four presidents, told the Virginia panel any White House physician must accept "a dual loyalty . . . He or she must consider that he or she, and all those physicians who assist from time to time, are responsible not only for the care of the chief executive but also for the 'care of the country.' " Reagan's Care: Lingering Doubts

Public debate over presidential fitness may be just beginning on the campaign trail. The Virginia commission timed release of its report for the start of the presidential primaries in hopes of getting the next president to begin considering the question before he takes office.

MacMahon's book and one that Crispell will publish in May called "Hidden Illnesses in the White House," as well as lingering questions about the quality of medical care given Reagan, seem likely to keep the question alive.

In an interview, Lukash, who served presidents Johnson, Nixon, Ford and Carter, spoke of growing concern among some doctors about "cronyism" in the selection the White House physician. This, he said, might lead to Congress' establishing "some guidelines" for who can fill the position.

The cronyism charge is not a new one, but it resurfaced with the appointments of Reagan's first two doctors. Dr. Daniel Ruge, who served from 1981 to 1985, was a Veterans Administration neurosurgeon who had worked for Dr. Loyal Davis, Mrs. Reagan's stepfather. Dr. T. Burton Smith, in the White House from 1985 to 1986, was a semi-retired urologist who had cared for the president in California. Both appointments interrupted a tradition of having military physicians, typically surgeons or internists, care for the president.

A number of doctors, including Lukash, maintain that the White House is no place for a medical specialist or a civilian. To begin with, the position pays a civilian doctor $72,300 a year, hardly enough to lure most experienced physicians out of private practice.

Military doctors are paid according to their rank and experience in the service. For them, working in the White House is a prestige assignment, one that allows most to continue practicing at one of the area's military hospitals.

The demands of the job also require a physician who is a generalist, Lukash said.

"This is a position for a seasoned physician, someone who can deal with medical problems that can develop any time and anywhere and an internist is most qualified," said Lukash, now practicing in La Jolla, Calif.

Crispell described the ideal White House doctor as someone with an ability to quickly diagnose an illness, such as an emergency room specialist, and assign specialists with the appropriate skills to work on the president. "His great forte should be his judgment," said Crispell. "Knowing when the president is ill and when to call in the specialists."

The University of Virginia panel and MacMahon's book raise critical questions about the role -- or lack of it -- the White House physician played when Reagan was shot March 30, 1981, and during his cancer operation July 13, 1985.

To the dismay of the panel, it found that Ruge, former head of the VA's renowned spinal injury program, was not consulted by senior White House staffers about whether Reagan was capable of performing his duties when he was hospitalized after the shooting.

The doctor should have a good working relationship with the vice president, the panel said. But George Bush "didn't know who Ruge was," said Crispell.

Ruge left the White House seven months before Reagan's cancer operation, but he did not escape criticism over his attitude toward annual physical examinations or the failure to see that the president underwent tests which might have detected his colon cancer at an earlier stage.

At the time, Reagan had gone 2 1/2 years without a complete physical because Ruge, the president said in 1984, "doesn't happen to be a believer in those . . . he doesn't think they're that essential."

Reagan underwent surgery for the cancer at Bethesda Naval Hospital July 13, 1985. Smith, who served as the liaison between the medical team that conducted the operation and the White House, was criticized indirectly by the Virginia panel's report for failing to keep senior White House officials apprised of Reagan's medical condition. "Prior to the cancer surgery, the White House staff received inadequate medical information or chose to ignore the information it did receive," the commission said.

The cancer operation may have marked a turning point for the Reagans and their health care in Washington. In late 1986, Smith suddenly resigned and returned to California "to attend to pending family business," and Nancy Reagan, described by White House aides as distressed over the intimate details given the press after the cancer operation, ordered new rules for the president's doctors.

The rules went into effect when Reagan underwent his third major operation, prostate surgery, in January 1987. Nancy Reagan told the doctors she didn't want them talking to the press and called on a friend of her late father's to help assemble the team of surgeons from the Mayo Clinic in Rochester, N.Y. They conducted the operation with their own equipment at Bethesda.

Since then, all disclosures about the president's and Mrs. Reagan's health have come through White House press spokesmen and details have been limited by comparison.

Shortly before the operation, Reagan had abandoned his practice of having a civilian doctor and named an Army surgeon, Dr. John E. Hutton Jr., as his physician. Details of how the 56-year-old Hutton, described by the White House as a "noted nautical photographer" as well as an experienced vascular surgeon, was picked are limited.

Some White House insiders say that one of the most influential medical advisers to the Reagans remains Dr. Richard Davis of Philadelphia, a neurosurgeon and Nancy Reagan's stepbrother. However Hutton was selected, he has managed to avoid the attention -- and criticism -- given his two civilian predecessors. He had worked with both, serving since 1984 as one of the three military doctors who are called assistant White House physicians. The lack of criticism may reflect the respect Hutton earned working in hospital emergency rooms, a position that some doctors say should have given him training in how to quickly diagnose any presidential ailment.

During Hutton's tenure, Reagan has also had several small skin cancers removed from his nose and, citing his doctor's advice, the president regularly wears a protective skin cream when he attends even brief outdoor ceremonies at the White House.

In addition to caring for the president and first lady, Hutton officially heads what is call the White House Medical Unit. It is part of the larger White House military office and includes a staff, based in the Old Executive Office Building, that typically includes three assistant physicians, assigned from the military services, and several nurses and enlisted health care workers also drawn from the military.

While their primary mission is to offer around-the-clock medical care for the president and his family, the staff also provides emergency health care for the 1,500 employees in the White House compound, a task that MacMahon said consists mostly of "dispensing aspirin and the like to members of the White House staff."

Hutton also has a tiny office in the White House basement, which his predecessor Smith noted was squeezed alongside those of the florist and decorator.

History of Controversy

Concern over the president's health is hardly a new topic in Washington. According to MacMahon's book, controversy over the role of the physician is almost as old as the position itself. The administration of William McKinley was the first to employ a full-time White House physician.

Military doctors often had waited on previous presidents in addition to their other assignments, a practice that provoked a protest from the Medical Association of the District of Columbia during Andrew Johnson's administration. The doctors apparently were troubled that moonlighting military doctors might be taking patients away from them.

James Polk was apparently the first president to invoke his power as commander-in-chief to use a military physician as his doctor, and the office, like most branches of the federal bureaucracy, seems to have grown since then, according to MacMahon's book.

Part of the office's problem, medical historians say, is that the White House physician often has played a role that has been only part medical. Sometimes as important has been their role as confidante and adviser to many chief executives. The results have not been all positive.

Rear Admiral Cary T. Grayson, Woodrow Wilson's physician and closest friend, helped orchestrate what MacMahon calls "the most celebrated cover-up of presidential disability in the history of the Republic." The doctor aided the efforts of Wilson's wife to hide the severe strokes that left Wilson an invalid in the final year of his presidency.

Army Maj. Robert M. O'Reilly, another White House physician, undertook an equally serious and secretive mission, arranging surgery on a tumor in Grover Cleveland's mouth that the doctors wrongly feared was cancerous. The operation, conducted on a yacht in Buzzards Bay, N.Y., almost killed the president.

Those incidents stand out as exceptions. Most of the work of White House physicians is routine, if not dull. Ruge, who declined to be interviewed for this story, told the University of Virginia panel: "Despite its glamorous name, the office of the White House physician is somewhat blue-collar."

A major concern of the University of Virginia panel was the minor roles Reagan's first two doctors played when he was hospitalized. "It is now obvious that the presidential physician can, and must, play an increased role," the panel said.

Just how to redefine the job is not clear. As the the panel conceded: "It is far easier to say that the physician's job should be upgraded than to suggest how to do it." The panel urged the next president to draft written guidelines spelling out the role the physician should play in determining when he is medically disabled and should invoke the 25th Amendment. That amendment allows the president to pass power temporarily to the vice president.

The panel recommended that the president invoke the amendment whenever he goes under a general anesthesia, something Reagan's staff did not consider after the 1981 shooting.

During his cancer operation, he did delegate power to Bush but specifically said he was not basing the delegation on the amendment, a step that the panel said was the result of incorrect advice from his staff. The Virginia commission said that the president's advisers were wrong in their assumption that the 25th Amendment did not apply to such a situation.

Moreover, they differed with White House officials, who said use of the amendment during Reagan's operation would have set a bad precedent. The panel said it would have set a healthy precedent, by assuring the public that the White House has in place an orderly, routine procedure for passing power to the vice president during such circumstances.

The groups arguing for a more influential physician acknowlege their proposal could thrust the physician directly into some of the most sensitive debates at the White House, put him at odds with the president's own staff and give him a direct and continuing relationship with the vice president.

Whatever the changes the next president makes, the office seemingly can only gain prestige. In the current ranking of the Congressional Directory, Hutton stands far behind the director of the Television Office, nipping at the heels of the director of correspondence, and just ahead of the national security assistant for Asian affairs.


1-Year of 1st inaugural

2-Age at 1st inaugural

3-Age at death

4-*Life expectancy after 1st inaugural Years lived after 1st inaugural Parents' ages at death


6-Above expected

7-Below expectedParents' ages at death




GEORGE WASHINGTON-----1789--57--67--17.1--10.6-- -- -- -- -- ---6.5--49--81

JOHN ADAMS------------1797--61--90--14.4--29.3--15.0-- -- -- -- -- --70--98

THOMAS JEFFERSON------1801--57--83--16.4--25.3---8.9-- -- -- -- -- --49--56

JAMES MADISON---------1809--57--85--16.3--27.3--11.0-- -- -- -- -- --77--98

JAMES MONROE----------1817--58--73--15.6--14.3-- -- -- -- -- ---1.3--22--?-

JOHN Q. ADAMS---------1825--57--80--16.3--23.0---6.7-- -- -- -- -- --90--73

ANDREW JACKSON--------1829--61--78--13.5--16.3---2.7-- -- -- -- -- --?---?-

MARTIN VAN BUREN------1837--54--79--17.2--25.4---8.2-- -- -- -- -- --80--70

WILLIAM HARRISON-----1841--68--68---9.4----.1-- -- -- -- -- ---9.3--65--62

JOHN TYLER------------1841--51--71--19.2--20.8---1.6-- -- -- -- -- --65--36

JAMES POLK------------1845--49--53--21.5---4.3-- -- -- -- -- --17.2--55--75

ZACHARY TAYLOR-------1849--64--65--12.8---1.3-- -- -- -- -- --11.5--84--61

MILLARD FILLMORE------1850--50--74--20.7--23.7---2.9-- -- -- -- -- --91--51

FRANKLIN PIERCE-------1853--48--64--22.0--16.6-- -- -- -- -- ---5.4--81--70

JAMES BUCHANAN--------1857--65--77--11.9--11.3-- -- -- -- -- ---0.6--60--66

ABRAHAM LINCOL-------1861--52--56--19.8---4.1-- -- -- -- -- --15.6--73--34

ANDREW JOHNSON--------1865--56--66--17.2--10.3-- -- -- -- -- ---6.9--33--72

ULYSSES S. GRANT------1869--46--63--22.8--16.4-- -- -- -- -- ---6.4--79--84

RUTHERFORD B. HAYES---1877--54--70--18.0--15.9-- -- -- -- -- ---2.1--35--74

JAMES GARFIELD-------1881--49--49--21.2---0.5-- -- -- -- -- --20.7--33--86

CHESTER ARTHUR--------1881--50--56--20.1---5.2-- -- -- -- -- --15.0--78--66

GROVER CLEVELAND------1885--47--71--22.1--23.3---1.2-- -- -- -- -- --49--76

BENJAMIN HARRISON-----1889--55--67--17.2--12.0-- -- -- -- -- ---5.2--73--40

WILLIAM McKINLEY-----1897--54--58--18.2---4.5-- -- -- -- -- --13.6--85--88

THEODORE ROOSEVELT----1901--42--60--26.1--17.3-- -- -- -- -- ---8.8--46--49

WILLIAM TAFT----------1909--51--72--20.2--21.0---0.8-- -- -- -- -- --80--80

WOODROW WILSON--------1913--56--67--17.1--10.9-- -- -- -- -- ---6.2--84--66

WARREN HARDING-------1921--55--57--18.0---2.4-- -- -- -- -- --15.6--80--61

CALVIN COOLIDGE-------1923--51--60--21.3---9.4-- -- -- -- -- --11.9--80--39

HERBERT HOOVER--------1929--54--90--18.9--35.6--16.7-- -- -- -- -- --34--34

FRANKLIN ROOSEVELT---1933--51--63--21.7--12.1-- -- -- -- -- ---9.6--72--86

HARRY S. TRUMAN-------1945--60--88--15.0--27.7--12.7-- -- -- -- -- --78--82

DWIGHT EISENHOWER-----1953--62--78--14.4--16.2---1.7-- -- -- -- -- --79--84

JOHN KENNEDY---------1961--43--46--28.4---2.8-- -- -- -- -- --25.6--81--AL

LYNDON JOHNSON--------1963--55--64--19.2---9.2-- -- -- -- -- --10.1--60--77

RICHARD NIXON---------1969--56-- -- -- --18.7-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --78--82

GERALD FORD-----------1974--61-- -- -- --15.3-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --59--75

JIMMY CARTER----------1977--52-- -- -- ---1.4-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --59--AL

RONALD REAGAN---------1981--65-- -- -- --12.9-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --?---?-

*Based on contemporaneous experience among white males in the general population of the United States born in the same years as the presidents.

Died during office.