The question of interrupting President Reagan's schedule during the 1984 campaign year to perform a more complete examination of his colon -- something many doctors outside the White House say should have been done then -- never came up for discussion, White House officials said yesterday.
In the wake of Reagan's cancer surgery Saturday, there have been suggestions that the White House knew there were medical reasons for a more complete exam but it was deferred for political reasons. The London Observer published a story Sunday claiming that Reagan's doctors knew he needed surgery but put it off for political reasons.
However, numerous sources close to the Reagan campaign and White House insisted yesterday that this was not so. And in fact, there was no way to know that Reagan would need surgery until he had his thorough colon exam last Friday.
"His health never came up [during 1984]," one senior official said. "We assumed he was in the best of shape because of the way he acted."
If there had been any hint that the president ought to have a more complete exam, said another official, Nancy Reagan would have taken her husband "by the ear" to the hospital.
Others close to the White House said that if a decision had been made to postpone a thorough examination until after the election, it would have made no sense to postpone it eight more months until last week. If Reagan had known during the campaign that there was reason to fear he might have cancer, one campaign official said, "he would have been to the hospital" the day after the election.
The first indication of possible colon disease came in May 1984, when a routine medical examination found a small polyp in the president's lower intestine. It was removed and determined to be benign.
Cancer specialists not connected with the Reagan case have said in recent days that the president should have received an immediate examination of his entire colon. Some doctors made that point last year. The 1984 exam involved looking only at the lower third of the colon.
These same specialists have said that an even stronger indication for a complete colon exam came last March, when another routine exam turned up a second benign polyp and, more ominously, evidence of blood hidden in the stool. This stool test suggested that Reagan could be bleeding from a point farther up the colon, a finding that is not definitive but that many cancer specialists say warrants an immediate, complete examination of the colon, either by means of a barium enema or a colonoscopy, the procedure that discovered the tumor Friday.
Instead of insisting on an immediate full colon exam, the president's doctors merely recommended such a procedure when it was convenient. White House officials have said that the press of events in April and May led them to schedule the examination for June, but that the hijacking of Trans World Airlines Flight 847 pushed it off again until last week, nearly four months after it was recommended.
Although cancers of the colon grow more slowly than most other forms, doctors know that any delay increases the risk.
Political questions for the delay aside, attention is now turning to the quality of medical care available to the president.
Although medical experts not connected with the case have argued that the president of the United States ought to receive the most prudent and aggressive medical services possible, White House physicians have tended to say that Reagan should be treated much the same as any other patient.
During Reagan's first term, the White House physician was Dr. Daniel Ruge, a neurosurgeon who began his career as a student of Nancy Reagan's father, Dr. Loyal Davis, also a neurosurgeon. Later Ruge practiced medicine in partnership with Davis, and he apparently knew both the president and Nancy Reagan for many years. When tapped to join the White House staff in 1981, Ruge had not recently been a clinician treating patients. At the age of 63, he was director of the Veterans Administration's spinal-cord injury service.
The new president, who had undergone annual physical exams for decades, suddenly stopped having them. When the first polyp was found, it was during Reagan's first complete exam in 2 1/2 years.
Ruge was well known for practicing what one official called a minimalist style of health care. When asked why the president had not had a physical in a long time, Ruge would tell reporters, "He's healthy. He doesn't need one."
A source close to the Reagan White House called Ruge the kind of doctor who likes to assume the best about a patient's condition -- who rarely "finds anything wrong with anybody." However, the same source called him a "classy doctor" who took care to consult with other doctors before rendering an opinion on the president's treatment.
Ruge could not be reached for comment. His secretary at the Veterans Administration, to which he returned after leaving the White House in January, said he was in and would return a call from The Washington Post. He did not, and repeated attempts to call him were unsuccessful.
Efforts to reach doctors connected with Reagan's case since Ruge's departure were also unavailing. Since the operation, the White House has told the president's current doctors not to discuss the case without White House approval.
In 1984, two months after the first polyp was found, questions were raised about whether Reagan should have a more complete colon exam. At that time, Ruge said benign polyps are "something you don't have to worry about," adding that Reagan was "one of the healthiest people I know."
Doctors outside the White House immediately criticized the decision, saying that prompt removal of polyps was a proven way to prevent them from turning cancerous. Others defended the do-nothing decision, saying that rigorous follow-up was justified only if the growth were an adenoma, a classification of pre-cancerous tumor.
The growth removed last Saturday, a villous adenoma, was found almost five feet farther up the colon than the polyps discovered in 1984. The two were unrelated except that polyps in one place are a tip-off that unseen polyps may be developing elsewhere in the colon, beyond the reach of the examining device.
James Lake, Reagan's 1984 campaign press secretary, also said politics played no role in the decision not to do a more complete exam.
"Reagan's health matters have always been something he dealt with himself -- with his doctors. We'd go to him for the reports," Lake said. Any decision not to further examine the president "was a medical decision," not a political decision, he said.
A second official familiar with all aspects of the 1984 presidential campaign offered a similar view. If anyone made a decision not to look further, it would have been Ruge, this official said.