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Office of the Press Secretary

For Immediate Release September 13, 1996
                           PRESS BRIEFING
                           BY MIKE MCCURRY

The Briefing Room

8:03 P.M. EDT

MR. MCCURRY: Good evening. I think you have all had a chance to look at the material that Dr. Mariano has prepared for my use. Let me do a couple -- just one or two addendums to this because there is some other information that she elected not to put into her own report of the President's physical exam and some of the reports on his medical history.

Remember, back on August 21st I was asked by the Dole-Kemp campaign a couple of questions about the President's blood count results. If you look on page 3 of the document that Dr. Mariano prepared, she says that the complete blood count, normal -- and some of the other things. But she indicates that.

But let me give some specific test results on that because the Dole-Kemp campaign had raised that as an issue, and at that time I provided some specific numbers. I just want to reiterate those for the record. They asked, what is the President's hemoglobin count? The answer is 16.1, which was in the parameter of normal, which is a range of 14 to 18. What is the President's white blood cell count? The answer was 5.8, which is within the realm of normal. Four to 11 is the normal range. What is the President's platelet count? The answer is 250,000, which is in the range of normal -- 150,000 to 450,000 is the normal range for a patient in the President's age bracket. And what is the President's AGT reading, which is a liver function reading? The answer was 42.

Q Was that AGT?

MR. MCCURRY: AGT(SGOT). I have no idea what that stands for. The answer was 42, which was in the normal range of 17 to 49. Those are additional test results that we had made public in the past that are not reflected here. It's reflected in Dr. Mariano's statement that he had a normal blood workup when he did his exam.

Any other questions about some of this material?

Q What about this material was embarrassing -- you talked about "embarrassing" the other day -- that you didn't want to release before.

MR. MCCURRY: Well, I'll just cite one example of the kind of thing that I was talking about. If you look on her summary of medical history, item number three, which is recurrent episodes of voice hoarseness due to a combination of the reflux syndrome the President has, which I reported on May 24th, his allergies, and overuse of his voice, they have actually got pictures of the President's inflamed vocal chords, which are part of his medical records. I don't know what useful purpose it would serve to make available a picture of the President's inflamed vocal chords. We've told you that from time to time he has inflammation in his vocal chords and he is being treated for that as indicated in item number three. And that's the kind of thing that I think, in preserving the dignity of the office, we elect not to provide.

At the same time, we recognize the responsibility to provide the comprehensive type of information here that allows you to evaluate the President's overall health condition and confirm the judgment of his doctors that he is in overall excellent health.

Q On page 2 on the past medical history, which says, no history of hypertension, diabetes, tuberculosis, et cetera, et cetera, et cetera -- now, is that based on Dr. Connie's examination of his past records or is that --

MR. MCCURRY: It is based on the examination -- her examination of his past records, the personal conversations she's had with him that are subject to the normal doctor-patient confidentiality that applies to any human being, and also the indicators from the clinical exams that have been conducted during the time he has been President.

Q Do you all feel like you've caved in to the Dole campaign? Certainly there has been a lot of controversy around this issue, even with Lawrence Altman requesting an interview with Clinton and Mariano.

MR. MCCURRY: Sure, probably. I mean, what we've done is we reported to you on May 24th that the President was in excellent overall health. There has been a concerted effort on the part of the Republican campaign to raise questions about that evaluation by the doctors, physicians. Many of you in this room and your news organizations have posed questions now that we felt had to be answered satisfactorily, and so we have provided this information.

Q And it's still the White House contention that it's not necessary -- or will you release the actual medical records?

MR. MCCURRY: Well, these are medical records. This is part of the President's permanent medical file that is maintained by his doctor. So these are medical records. They are being released to you. You could look at the electronic evaluation of some of these lab and test results. They would have to be explained to you. They would be explained to you in the fashion that Dr. Mariano has done here.

Q Well, you made the example -- you cited the example a moment ago of his inflamed vocal chords. So there are some of his records which you think are not appropriate to be released?

MR. MCCURRY: Any patient's records include those things that they have done for diagnostic purposes, including in this case pictures of those inflamed vocal chords, and I don't see the useful purpose to release those pictures, because we've released to you here the information that describes the physician's evaluation of what that's all about.

Now, be careful on that. We have got one doctor's statement that is still outstanding, which is from Dr. Sen (phonetic) down in Little Rock. He was in surgery all day today, and so he is racing around Little Rock, Arkansas, right now and putting together a statement similar to the ones that we received from the other seven attending physicians --

Q Did he perform that surgery for sinusitis?

MR. MCCURRY: I don't know the answer to that. That procedure was covered in the release of the materials that then Governor Clinton made in 1992.

Q Mike, nobody asked for a picture of the President's vocal chords --

MR. MCCURRY: No, that's not was I --

Q And there's nothing in here that is remotely embarrassing. Why wasn't this released earlier?

MR. MCCURRY: Well, most of the information here in Dr. Mariano's summary is information that was available to me looking at my notes on Mary 24th when I briefed on the President's physical. And I was prepared to go at any great length into any question that anyone had at that time. But I held forth on those subjects and I would have answered in this kind of detail any of the questions if they had been posed at that point.

Q Was this President Clinton's directive personally that you release these? How did he feel about you all giving out this information, considering some organizations are saying that he is setting a dangerous precedent by releasing all these records?

MR. MCCURRY: Well, the President is very conscious of the fact that many in the health care profession are concerned about preserving the fundamental importance of the doctor-patient confidential relationship. At the same time, the President understands that in seeking the office of President of the United States, he has an obligation to inform the public about his health status that goes beyond that of an average American citizen. We would hope that nothing about the release of these records and these test results and this medical history would lead others to assume that this is a requirement that would apply to all Americans. We're aware of the statements that have been made by various organizations that they were expressing concern about that. But we just think that is a unique situation when an individual American citizen seeks the Presidency. There is an obligation to the public to provide the kind of detailed information provided here.

Q But did the President say, oh, let's just release this stuff, let's get this over with?

MR. MCCURRY: I think a number of us who know that the President is in excellent overall health wanted to put an end to any questions that suggested otherwise.

Q But did -- the question is, did the President --

MR. MCCURRY: Of course the President is fully supportive of this. The President -- Dr. Mariano was very appropriately prudent about providing information unless she had the specific release of her patient.

Q When did the President sign off on this?

MR. MCCURRY: The President has for several days said, just tell them what they need to know about my health condition so that we will not have any further questions posed --

Q Mike, did I understand you to say that there is really nothing in this four-page summary that was not provided to you at the time you were prepared to brief on this exam?

MR. MCCURRY: That's -- well, let me amend that. There is information in this report related to the President's medical history. I was prepared to brief on May 24th about the results of his exam. The information here that relates to the examination performed on May 24th I had ample detail about and was prepared to brief on. But we provided additional information here so that you can get a complete record that includes his medical history.

Q Do you consider this a closed case now? Do you think that you have provided all of the relevant information? I mean, can you give some assurance that no relevant information is being withheld and as far as you're concerned this is everything that the public needs to know?

MR. MCCURRY: I personally felt we had already met that test. I think we've taken this additional step in light of the questions that some news organizations have posed, based, no doubt, on some of the prompting that has been raised by Senator Dole's operatives and others who have been attempting to raise questions.

Q Mike, let me take another stab at this question, maybe from the other end. Forgetting about the campaign and Senator Dole for a minute, given the history of Presidents and their health, Presidents have covered up having heart disease, Addison's disease, cancer. These are things that happened. This sentence here, no history of hypertension, diabetes, tuberculosis, cancer -- these things -- don't you think the public has a right to know that?

MR. MCCURRY: I acknowledge the public has a right to know about the President's health status, which is why when then Governor Clinton sought the office in 1992 he released detailed information about his medical history and why we have provided information at the time of his annual physical exam that keeps that information current and updated for the American public.

At the same time -- and by the way, in checking with previous Presidents we have gone much, much farther in providing this type of medical information than have previous Presidents, including the President's two immediate predecessors. But there is a public right to know. There are also important principles about physician-patient confidentiality. Those are addressed, by the way, in a variety of ways.

There is an excellent article in the New England Journal of Medicine, October 5, 1995, edition, by Dr. George Annis (phonetic), which is about the health of the President and Presidential candidates and how you balance those needs with the public's right to know. Dr. Mariano drew that article to my attention, and it's well worth reading because it raises the question, how do you preserve and protect the dignity of the office, the importance of the confidential relationship that must exist between any doctor and the doctor's patient, and balance that against what is a legitimate public interest in the health status of a candidate or President.

Q You were quoted in a report this evening as saying the President did undergo a test for HIV. Can you confirm that?

MR. MCCURRY: That's confirmed in the material we provided in 1990 in connection with an insurance -- reevaluation of insurance coverage for the President. He was tested, and tested negative for HIV in 1990.

Q It was a mandatory test?

MR. MCCURRY: I don't know the terms of the insurance policy, but it was conducted in connection with the renewal of an insurance policy.

Q You said that Dr. Mariano was appropriately prudent in choosing what should or should not be released. Did she actually sit down with -- how did that work, Mike? Did she actually sit down with the President and go over a list, and they say, here's what I'm going to release, and the President said, okay, okay, okay, okay? And did either one of them decide that something shouldn't have been released?

MR. MCCURRY: She is a very competent board-certified physician who attends to the President. And that's a distinction that in her profession carries a great deal of weight. She prepared this material looking at the scope of things that are available publicly about the candidates for President, specifically Mr. Dole, in the desire to provide additional information and more detailed information than has been presented by even Mr. Dole himself, consistent with her obligation to protect the confidentiality of her own relationship with her patient.

She prepared these materials, sought the statements from the attending physicians who supervised the President's physical exam, and then reviewed that material with the President to seek his consent to release it. She was very keen on the fact that -- as she says right at the very top, with President Clinton's consent, I release the following medical information regarding his health. She would not have felt it proper or within the boundaries of her own profession to have released this information unless she had the President's specific consent.

Q And did either one of them delete something from the medical --


Q Okay.

MR. MCCURRY: The President reviewed the material that you have been given and told her it was perfectly fine to release that.

Q Mike, it's a pretty safe bet that the Dole campaign is going to say this is not a complete medical history because it's still a summarized record. It doesn't include actual lab reports, EKG strips, et cetera, et cetera.

MR. MCCURRY: Well, it gives all the results of the lab tests covered in this statement. And in Dr. Mariano's view it is beyond the information that Mr. Dole has provided about his own health status. And I'll leave you to judge that.

Q Just a couple of things. On the second page, just to make sure that I understand, the past medical history, the no history of, and the list of things there -- is it Dr. Mariano's statement that there is no evidence of any of these things currently in the President as well?

MR. MCCURRY: Well, you can see from the statements of each of the physicians who conducted tests that there is ample evidence from their examination currently that there is no evidence of that. And she is not aware of any medical history that suggests otherwise.

Q Okay, just two other things. Do you have a reason for the President's high frequency hearing loss?

MR. MCCURRY: The President and Dr. Mariano both believe that is a combination of many factors. It's not unusual in adult males age 50 to experience some high frequency hearing loss. It is most likely associated, in the doctor's opinion and in the President's opinion, with two factors. One is his experiences as a young boy hunting, the sound of gunshot explosions. And also because he played in a band and listened to loud music.

Q What did you say, Mike?

Q What? (Laughter.)

MR. MCCURRY: I think I got the same problem. (Laughter.)

Q Just one other thing, Mike --

MR. MCCURRY: Yes, and to describe this in lay terms, it means -- it's not infrequent with many people age 50 that high frequency decibel loss or audio-sensory loss comes from -- it means that in crowded rooms you sometimes don't hear conversations that are occurring nearby. As the report indicates, there is no loss of ability to hear speech -- normal speech. It's not indicated that there is any debilitating factor.

Q Okay. One last thing. It was suggested to me earlier today by one of my colleagues who felt that members of the military were required to have HIV tests annually. And the question earlier was whether the President, as Commander-in-Chief, is also required to undergo such testing.

MR. MCCURRY: Not required. The tests suggested are those that are clinically suggested. Dr. Mariano has, in observing her patient, determined those tests that are clinically suggested. We have an HIV negative test in 1990, and in the doctor's opinion there was no clinical reason to retest that indicator.

Q Okay, so he has not undergone such a test since then.

MR. MCCURRY: This is only recent test that he had, and the doctor says that it was not clinically suggested that there should be another test of that factor.

Q On the insurance plan, in that regard, was that a routine thing that other people would also normally --

MR. MCCURRY: I don't know the terms of the policy. I just know it was done in connection with an insurance policy, and I believe it was an insurance policy renewal. But I don't know the terms of the policy.

Q Mike, when you say that you have gone much, much farther than previous Presidents have gone, does that mean that with this release, would it be safe to say that the public knows more about the particulars of this President's health than any previous President.

MR. MCCURRY: Well, there was a question earlier about instances in which some information had not been forthcoming from previous White Houses about the medical condition of Presidents. This White House takes very seriously the obligation to keep the public informed about the health status of the President. We've attempted to do that even when there are routine minor procedures involving the President's health. We attempt to keep informed about that. We did that just last week, as a matter of fact.

But I do believe, based on what I have been told by the doctor based on the doctor's consultations with previous White House physicians, that this is a more extensive release of medical information about the President's health status than has routinely been the case here at the White House.

Q Mike, after all of this has been done, would it be a good idea for the medical community to get together, perhaps recommend some markers to lay down, parameters, that would protect the public's right to know and the dignity of the office?

MR. MCCURRY: Well, the President is currently absorbed with the question of whether he would have the opportunity to serve in that capacity. (Laughter.) But I think there are good questions arising about health information about the President. There is one question in particular that the academic community has looked at carefully, and that's the application of the 25th Amendment. There have been serious academic discussions on that question, involving people ranging from former White House physicians to current people in our medical unit here at the White House to White House Legal Counsel representatives and people who are known specialists in Constitutional law.

Those are good, serious discussions about how do you balance patient confidentiality with the public's right to know, and it may very well be that we could have a group of outside experts examine that type of question so that we take this out of the realm of partisanship and into the realm of what is -- what protects the public's legitimate right to know information about the health status of the President and at the same time preserving the dignity of the office itself.

Q Mike, if I could --

MR. MCCURRY: That's not -- by the way, I won't -- I'll say that's not a question we're dealing with. That was basically getting through this day. I apologize, by the way, I know the hour is very late now to be releasing this information but we obviously made a fairly strenuous effort today to contact each and every one of the physicians who attended to the President's annual physical so that we could make this information available. Some of these statements that you have now received didn't come from the Bethesda Naval Medical Center until quite late this evening.

Q Is some of that urgent?

Q Mike, there's a question. Wait. There's a question here.

Q Let me just -- I just want to go back over one thing with you. When you were asked whether there was anything that either he or the doctor decided not to release, you said she was a very competent board-certified physician. And you also said that she put out material that you all thought was putting out more publicly than Mr. Dole. But that still doesn't answer the question. There are things that you're not releasing publicly?

MR. MCCURRY: No, no. The doctor prepared this report. She intended it to be a thorough report on the President's medical history and an evaluation of his most recent physical examination. The President, nor anyone at the White House, made any changes in that report as she prepared it.

Q But did she specifically delete --

Q Right.

Q You were relying on her expertise to determine what should or should not be released, and you even cited -- she made that comparison to what Bob Dole has released. Did she on her own decide that something should or should not be released?

MR. MCCURRY: She drew up this report and I think gave a very comprehensive report on the tests that the President underwent in May and summarized them. And obviously there are electronic readings and graphs and things like that are a part of the President's volume of files available. And she summarized that so that it would be comprehensible to the American people.

Q Let me just try again. Can you give us an assurance here tonight that nothing of importance was left out of this report?

MR. MCCURRY: I can assure you here tonight that the White House has an obligation to report on the President's medical condition. The President's physician has said he is in excellent overall health. We have provided all the information necessary for anyone to make a fair judgment about the veracity of that statement. Nothing that would indicate a contrary evaluation of the President's health has been withheld from this report.

Q Now that you have released so much detail about his platelet count and everything else, is this the way you're going to do every exam he has?

MR. MCCURRY: Well, that goes back to the previous question, but I think maybe there are -- I again would cite at least the one article, one academic article I've seen. It might be a good case where a panel of experts can evaluate the information that should properly be in the public domain and establish some type of parameters about how this question gets addressed since it has become an issue in this campaign.

That's not for us -- at this time we are satisfying what we think are our obligations to inform the American public, to respond to questions that have come from your news organizations, however motivated those questions arose, and to answer these questions to the satisfaction of the public.

Q You think the motivation was less than professional?

MR. MCCURRY: I think that it's very clear that Republican campaign and Mr. Dole in particular and his operatives have tried to make this an issue. So we are trying to lay to rest that issue by providing the detailed information we have now provided.

Q Did the President himself, Mike, resist doing this? And did he have to be convinced by his staff? How did the --

MR. MCCURRY: To the contrary, he kept saying, we should just give them what they need to say that I'm in good health.

Q Then why -- what was the barrier?

MR. MCCURRY: I thought that's what I had done. I gave you a very detailed briefing May 24th. We have provided you updates. I was frankly surprised that there continued to be questions. But there were questions. You posed them in Fresno. And this was the best course of action for the White House to lay to rest any doubt or questions or mystery, as I heard Mr. Warfeld describe it.

Q Let me shift gears to Iraq. We have seen that 5,000 troops are now being deployed to Kuwait. When did the President make that decision? I assume he did. Was that a product of this morning's meeting?

MR. MCCURRY: There have been a variety of discussions under way, and there is one under way at this very moment. Is that correct, Mr. Johnson?

MR. JOHNSON: That's correct.

MR. MCCURRY: In the Oval Office, at this very moment. Is that correct, Mr. Johnson?

MR. JOHNSON: That's correct, Mr. McCurry.

MR. MCCURRY: Mr. Johnson is going to go get a report on that meeting and make it available to those of you who are interested.

Q Can we expect further deployments? I mean, we've had a whole series of individual actions over the last couple days.

MR. MCCURRY: You should expect that any actions that we take that are prudent to report upon we will report.

Q On this particular action, this was a decision made by the President? And was the President aware that the decision had been implemented?

MR. MCCURRY: My understanding, if I'm not mistaken, is that this was a previously scheduled training exercise that is occurring in Kuwait involving U.S. army units that are taking some of the --

Q They all are.

MR. MCCURRY: -- pre-position supplies that we have in Kuwait and doing an exercise there. Obviously it sends whatever signal is interpreted in Baghdad and elsewhere.

Q So the President did specifically -- had to sit down and sign off on this specifically troop movement?

MR. MCCURRY: Well, this was previously approved, but the President was aware of it.

Q The President was aware of it?

             MR. MCCURRY:  He was aware of it.
             Q    Did he have to sign off on it? 

             MR. MCCURRY:  He's the Commander-in-Chief. 

             Q  Is this the meeting the President was having on Iraq

tonight, is that over or is it still ongoing?

MR. MCCURRY: It's ongoing now. The President's national policy advisers met earlier in the day. They have had some discussion on and off during the day. The President has had one or two updates during the day, but he wanted to have the opportunity to have a lengthier session this evening, and that's what's going on now.

Q And who is in the meeting?

             MR. MCCURRY:  Secretary Christopher, Secretary Perry --
             MR. JOHNSON:  I have not been in the room.  I don't know


MR. MCCURRY: We can double-check, but we believe Secretary Christopher, Perry, DCIA John Deutch, General Shalikashvili, Ambassador Albright. And I reserve the right to amend and adjust that list once we check out the room.

Q Revise and extend.

MR. MCCURRY: All those same people participated in the session this morning.

Q Is Perry in fact going to the Middle East? Is that done?

MR. MCCURRY: If we have anything to say about that, we would probably say it after the meeting that's going on now.

Q On the health records again, can you say why, if the doctor decided to leave something out, why she would have made that decision, because it seems clear that --

MR. MCCURRY: Look, I didn't say the doctor left anything out. I said the doctor provided you a comprehensive report on the President's medical history and the tests performed on him at the time of his examination on May 24th.

Q Comprehensive but not complete necessarily?

MR. MCCURRY: I think this is as complete as it gets. I can't imagine anything that would be more complete than this. We have given you just about every major indicator of health that any doctor would ask of a patient. We have summarized test results and given you statements from everyone from the President's dentist to his allergist -- well, we're waiting for -- no, his allergist to his ENT specialist. I mean, if this don't do it, I can't imagine what else --

Q It doesn't say anything about hypertension, though, Mike?

MR. MCCURRY: There is no indication he has been treated --

Q I was joking.

Q Were you all putting this together before your grilling in Fresno, or was it the issues that were raised in that briefing that triggered this?

MR. MCCURRY: Frankly, no. I mean, we have been looking to lay this issue to rest once and for all, and as I say, most of the information available here I was prepared to brief to on May 24th. I thought I had satisfied everyone's questions then, but apparently that was incorrect. This information was available -- some of this information was available then. And our judgment, based on the questions that were posed to me in Fresno, was that we should go the extra mile and provide additional detail. And this is what we've done.

Q You said that you feel as though the statements are objective and Dr. Mariano's summary, if you will, is objective. But they are statements and they are done under her discretion. And wouldn't the records be objective and quell every other question that would erupt?

MR. MCCURRY: There are significant concerns about -- you know, records are things that doctors look at, and then doctors interpret for patients, and in this case interpret for the public. I have looked at some of the these records. I wouldn't be able to make head or tail of them. And so the best thing to do is to take qualified physicians who know how to explain these things to patients and to the public in this case and have them explain the test results -- provide the test results and explain the test results so that people understand what they mean.

Q What about a second opinion?

MR. MCCURRY: Well, you can look through the list of the people whose statements are covered here. And I would suggest you all check around in the medical community about some of the individuals who have now reported to you on the President's health. You'll find that they are among the most distinguished people in their fields and I can't imagine that there is anyone in the medical community at least that would question the judgment of the physicians who have provided these statements.

Q Let me pose a serious question. Suppose the Dole campaign -- (laughter) -- as opposed to my usual -- but suppose the Dole campaign comes back at you and says, Senator Dole submitted his health records to a third-party physician, namely Dr. Altman, who writes for the New York Times, and subjected them to the scrutiny of an outsider, whereas the President has subjected his records to the scrutiny of his personal physician, who may have some interest --

MR. MCCURRY: Well, you asked about Dr. Altman. Dr. Altman, on the day of the President's physical, we made available Dr. Mariano. He had an extensive interview with Dr. Mariano. And for reasons that the New York Times would have to explain to you and not me, they elected not to write about the results of that interview. But he was in a position to ask detailed questions of the President's physician. We would be happy to have him ask questions of the President if that's what is suggested here.

There have been other news organizations that have suggested that Dr. Altman, who is -- I've never seen competing news organizations so fond of one of their rivals, but if that's --

Q We have Art Ulene. I would be willing to have him. (Laughter.)

MR. MCCURRY: What about the foot guy? Who is the foot guy? Gabe Merkin. Who's got Gabe Merkin?

Q Local radio.

MR. MCCURRY: We would -- that's certainly an interview --

Q As the interested party here, so you're saying that if Altman wants to interview the President on his health, he can? I think that's what he said.

Q That's what I heard, Allison.

Q But would he be able to see the records? Would the White House lay out the records?

MR. MCCURRY: He has already had -- and my understanding is -- a fairly substantive and detailed conversation with Dr. Mariano. And we always consider interview requests from news organizations. But given everyone's fondness for Dr. Altman and their desire to nominate him as the appropriate third-party official adjudicator, maybe we'll give that one a higher priority.

Q If we don't end this, we won't be able to get our cars out of the parking lots.

Q Can we get the foot doctor to interview Dick Morris? Would that be -- (laughter).

MR. MCCURRY: You're a bad boy.

Listen, one other thing. Nobody asked this question but let me volunteer it. The Vice President obviously, consistent with the President's decision on this, will be making available records that are very similar to these. He's going to do much the same thing, provide an overall statement from his physicians.

Q When?

MR. MCCURRY: Tonight.

Q Tonight?

MR. MCCURRY: It will be available very shortly. We're doing much the same thing that the President has done.

Q You mean, shortly, tonight?

END 8:36 P.M. EDT