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                     Office of the Press Secretary
                       (West Palm Beach, Florida)
For Immediate Release                                     March 14, 1997     
                          PRESS CONFERENCE BY
                             DR. JOEL COHEN
                          St. Mary's Hospital
                        West Palm Beach, Florida                         

6:19 A.M. EST

MS. GLYNN: As we reported earlier today, early this morning the President fell. He slipped coming down some steps at Greg Norman's residence and actually popped his knee. He twisted his knee and he tore a tendon in his upper right thigh. He said it was an audible pop and it was kind of a strange situation. He did not fall down.

It appears that he has torn a tendon in his knee. And I've got Dr. Connie Mariano here, who is going to help him. She's his personal physician. Dr. Joel Cohen, who is an orthopedic surgeon here at St. Mary's, can answer some more of your technical questions.

The President will be returning to Washington early this morning. He's cancelled his events for today. He is going to have surgery at Bethesda Naval Hospital and will probably stay over the weekend.

Q Will he go to the summit this week, Mary Ellen?

MS. GLYNN: I think it's premature, but he would love to go. The President, I should say, is up and alert and joking around and resting comfortably. He was sorry that he's going to miss the school construction event here in Florida and very sorry he's going to miss getting golf tips from Greg Norman.

Q Is it possible he won't go to the summit?

MS. GLYNN: I would not speculate on that at this point in time. I think it's way too early to say.

Q Mary Ellen, tore a tendon in the knee or the thigh.

DR. MARIANO: Let me clarify a couple of things that she had mentioned. About a little after 1:00 a.m. this morning the President was walking out of the Norman residence talking with Greg Norman, and he had gone down the steps and had caught his heel on one of the steps. And he remembers his right leg, his right knee buckling out. He heard a very loud pop and felt some pain in his right leg -- at which point our duty physician at the time, Dr. Bill Lang, examined him and determined that he should be brought here to the hospital for evaluation.

We brought him here by ambulance. Upon arrival he had X rays of his right knee performed. They were felt to be normal. We consulted Dr. Joel Cohen, who is the orthopedic surgeon here, and he examined him as well, determined that it was wise to obtain an MRI of his right knee area, and from the MRI obtained today, found that he has a tear of the quadriceps tendon, the tendon from the upper thigh that connects to the kneecap.

And the plan today is to bring him back to Washington, consult with the physicians at Bethesda Naval Hospital where most likely he will undergo surgery today and if all goes well, anticipate being discharged this weekend.

Q What do you call that tendon?

DR. MARIANO: Quadriceps tendon.

Q Is the President able to walk?

DR. MARIANO: He has to have -- he has a splint, actually a posterior splint on him and he needs crutches right now.

Q Could you just summarize in terms of the average person who is hearing this now --

DR. MARIANO: Dr. Cohen, do you want to --

Q -- and, you know, how serious it is -- if you could also come to the mike -- how serious is this, and in terms of -- how basically serious is this for the future or for him walking around, et cetera.

DR. COHEN: His injury he should fully recover from. It's not an uncommon injury. The repair is pretty straightforward and he's going to have to go through some rehabilitation. But the expectation would be return to full activities.

Q What sort of rehabilitation?

DR. COHEN: After you have the surgery, you're held still for a while and your muscles weaken, so you need to strengthen them back up. So he'll have to go through some physical therapy and strengthen it.

Q Could you give us a time line -- how long would the therapy be, how long before he's in A-1 condition?

DR. COHEN: You know, everybody's different, but usually you immobilize them for a few weeks after the surgery and start the physical therapy, and the recovery can be as quick as six weeks or as long as three months.

Q What do you mean "immobilize"?

DR. COHEN: In a brace.

Q I don't quite understand. So he will be wearing a brace for some period of time?

DR. COHEN: After the surgery, correct.

Q Could you elaborate on that again?

DR. COHEN: Well, you need to protect the repair. They're going to sew the tendon back to his kneecap and in order to protect it we use lightweight braces to hold your leg still so you don't move it before we want you to.

Q Will he be on crutches the whole time he's on a brace?

DR. COHEN: A fair amount of that time just to protect the repair.

Q So he'll be on crutches for weeks to come, possibly?

DR. COHEN: Possibly.

Q Doctor, this was caused by just taking a wrong step?

DR. COHEN: Yes, it's a deceleration injury. He was coming down some stairs; when you step down, that's when your quadriceps function, and he stumbled and his quadriceps contracted very hard and it literally pulled the tendon off the bone.

Q Is that painful?

DR. COHEN: Very painful.

Q Is he in pain now?

DR. COHEN: They gave him some non-narcotic pain medicine and he seemed to get a lot of relief.

Q What's the name of the medicine?

DR. MARIANO: Toradol.

Q And it does what?

DR. COHEN: It's an anti-inflammatory that has pain relief with it.

MS. GLYNN: I should add, too, he's, as I say, joking and laughing and he seems like he's in a pretty good humor. He had asked for a deck of cards so that he could play hearts.

Q Who is he playing with?

MS. GLYNN: He's playing hearts with Bruce Lindsey.

Q He will have to have a general anesthetic, will he not, at Bethesda for the operation?

DR. COHEN: No, sir. Generally, these days, we do that surgery under regional anesthesia or an epidural block, where his leg will go to sleep, but he himself is wide awake.

Q So he will have all of his faculties and so forth?

DR. COHEN: Absolutely.

Q Two questions. First of all, I remember that he had some troubles with a knee in the past -- it was reported in some of the past medical --

DR. COHEN: He gave a history of 17-plus years ago having a skiing injury where he had some ligamenta strain that he had no surgery and recovered fully from it.

Q Same knee, Doctor?

DR. COHEN: Correct.

Q Do you know where the tear --

Q Wait, do you think it might have been related?

DR. COHEN: In no way.

Q And, secondly, this is kind of a delicate question, but had the President had anything to drink tonight --

DR. MARIANO: No. We had just arrived from Miami on the helicopter and he was visiting with them and was going into the guest quarters when that happened.

Q Are you able to say how big a tear it is in the tendon?

DR. COHEN: I mean, it's greater than 50 percent. That's about the characterization from the radiologist.

Q Can you show us on your leg where we're talking about?

DR. COHEN: It's the tendon that attaches right above your kneecap.

Q And it goes from where to where? I don't understand.

DR. COHEN: It's called the quadriceps. They're four muscles in your upper thigh -- quad, four muscles, that come together, form a tendon that envelops your kneecap and gives you the ability to straighten your leg out. And so it tears off the top of his kneecap.

Q Mary Ellen, given the fact that he'll probably just get a local anesthesia or an epidural, is there any reason why the Vice President might be called on to --

MS. GLYNN: I don't know of any plans to do that at this time.

DR. MARIANO: You're thinking the 25th. He's in full control of his faculties. He'll be alert. Should they decide to do the epidural, he's awake during the procedure. I would not --

Q Is it considered a major operation?

DR. COHEN: No. I mean, it's not a minor operation, but it's not a major operation. It's technically not that difficult to do. You literally drill some holes in your kneecap, put some suture through the tendon an reattach it.

Q That sounds pretty major.

DR. COHEN: Well, again, compared to having a knee replacement or something, it doesn't -- it's not that major.

Q Mary Ellen, who was the first person to come to his assistance? Do you know what --

MS. GLYNN: I believe it was Greg Norman. That's what the President told me.

DR. MARIANO: He helped him up -- held on to him.

MS. GLYNN: Grabbed him.

Q And then he went straight to an ambulance or he went back to the residence for a while?

DR. MARIANO: No, the Secret Service called. We have a duty physician on the compound, Dr. William Lang, who is a family physician.

Q Can you spell that?

DR. MARIANO: Lang. And he responded right away and examined him and determined that he needed to be brought here.

Q That's a military doctor or --

DR. MARIANO: Yes. He's our Army physician.

Q Other than just stumbling on the stairs, do we have any further reasons as to why he stumbled? Did he lose his balance --

DR. MARIANO: The steps were of an unusual nature. He says they were sort of irregularly shaped, and he caught his heel onto one of the --

Q Were these outside?

DR. MARIANO: Coming out of the house.

Q He was leaving the Norman residence when that happened?


Q Doctor, this is not -- I take it this is not like a microscopic or what they call -- you're going to have to cut into the knee?

DR. COHEN: Yes. You can't do it orthroscopically.

Q How common is this that just a missed step would result in an injury like this? Is this rare?

DR. COHEN: No. I mean, it's pure biomechanics. That is, if you're stepping down and you slip and that quadriceps retracts, then something's going to give. And in this case, it was that tendon.

Q But it's not unusual for somebody simply walking to have something this --

DR. COHEN: Well, it wasn't walking, it was coming down the stairs. That's where the forces were involved.

Q Right. I want to get a sense of how unusual is it for -- when coming down the stairs for something like that to happen.

DR. COHEN: You know, I would say in our practice we see a few every year.

Q Can you explain that once again? When he's stepping down the steps, what is his muscle doing and how do the muscles leave the kneecap?

DR. COHEN: Okay. When you step down your quadriceps is contracting. That's what controls your deceleration. And so if you were to stumble at that point, those muscles which are now pulling very hard can have forces applied to them that are abnormal. And as a result there was a pull in the opposite direction and something had to give, and in this case, the tendon right up here gave way.

Q And the pull is because he's falling and the knee is going down and --

DR. COHEN: It goes because he's stepping down. That's the initial -- the force -- and there's a tremendous, three times your body weight is transmitted across your knee as you step down, so tremendous force. And then with a little stumble it's just -- given enough circumstances, something gave.

Q And how big of an area is it that you're going to have to sew back in, or how big of an area is it that the muscle has pulled away from?

DR. COHEN: Well, you can feel your own kneecap. I mean, the area is probably the width there of your kneecap.

Q What was the President doing outside at that point?

DR. MARIANO: He was saying goodnight.

MS. GLYNN: He was going back to his own residence. He is staying with the Normans, in a different cottage. And so he was leaving Greg Norman's house, where he had been up chatting and talking to him and thanking him for his hospitality.

Q What time?

DR. MARIANO: A little bit after 1:00 a.m.

Q Is he going straight from here to the hospital?

MS. GLYNN: He's going to go straight from here to the airport, and from Andrews Airport, Andrews Air Force Base to Bethesda Naval Hospital.

Q And, Doctor, could you just summarize one more time --

Q Maybe you can explain how you literally fix this? I understand that you drill-hole the kneecap and then run sutures from the kneecap through the tendon?

DR. COHEN: Correct.

Q But the tendon is only a 50 percent tear, so are you, in effect -- you're not repairing the tendon, you're actually building a new tendon, in effect?

DR. COHEN: No, you're pulling the torn part down to the kneecap where it attached.

Q Will the suture be running through the tendon or --

DR. COHEN: Sure.

Q -- from the tendon to the kneecap?

DR. COHEN: Right.

Q And on the rehabilitation, again, you suspect he will be on crutches for how long?

DR. COHEN: Again, there's a variation. But, initially in the beginning period for a few weeks they're going to keep him on crutches to protect it.

Q Could you be more specific than the next few weeks?

DR. COHEN: Everyone is different. I would say two to three weeks.

Q Two to three weeks on crutches? And when does he begin rehabilitation and what does that entail -- is that weight lifting, is that running?

DR. COHEN: Initially you have him evaluated by a registered physical therapist who will start him on range of motion and then progress him to strengthening.

Q When does that start, the rehabilitation?

DR. COHEN: Again, the variation, I would say in the three to six-week period.

Q Doctor, could you just one more time take what you've said and summarize it for the average person who might be watching, just now tuning in -- just overall how serious it is. Just summarize it one more time.

DR. COHEN: Well, the seriousness, again, it's a torn tendon that needs to be repaired. It's technically not that difficult to repair it. It requires some immobilization after you have it repaired, and then some rehabilitation after that.

Q Doctor, what's it like to work on the President?

DR. COHEN: He was very nice, very cooperative.

Q Have you worked on people this important before?

DR. COHEN: I mean, they're all patients.

MS. GLYNN: All right. Thanks, everyone. We'll let the doctors go back, they have work to do and they've been up for a while.

Q Have you all consulted with each other before coming down --

Q Has the Vice President been informed?

MS. GLYNN: The Vice President has been informed. The Chief of Staff has been informed. The First Lady has been informed. At this point in time, there's no plans for her to change her trip -- at this point in time.

THE PRESS: Thank you.

END 6:33 A.M. EST