The Health of the President, the Health of the Nation

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Connie Mariano, M.D., visited Fordham Law’s Presidential Succession Clinic on April 25 to discuss her nine-year tenure as a White House doctor, and the insights her work afforded her regarding the issue of presidential succession.

Mariano, a retired Navy rear admiral who founded the Center for Executive Medicine after leaving the White House, was a physician to President George H.W. Bush before President Clinton selected her to head the White House Medical Unit in 1994, making her the first woman to serve in the position. President Clinton credits her with transforming the unit during her tenure.

“I think that the things you study in [the Presidential Succession Clinic]are vital, because they really determine what will happen with the future of presidential succession,” said Mariano. “It really is a relevant topic, because as my friends in the Secret Service have always told me, ‘It’s not if the President dies or is assassinated in office, it’s when the President dies or is assassinated in office.’”

The Presidential Succession Clinic, led by Professor John Feerick ’61 and Adjunct Professor John Rogan ’14, investigates the issue of presidential continuity through the lens of the 25th Amendment, a 1967 addition to the Constitution that Feerick himself helped craft. The amendment provides a legal mechanism for designating a head of state in the case of presidential disability or death. The history of the amendment, including Fordham’s unique tie to it, is captured in a new archive launched by Fordham Law’s Maloney Library.

In her presentation, Mariano described the extent and role of the White House Medical Unit, which currently boasts a staff of more than 60. The unit, according to Mariano, cares not only for the president, but also for the first family, the president’s closest advisors, and, on occasion, journalists tasked to cover the White House. White House doctors also perform such duties as designating a hospital in each city the president visits for use in case of an emergency.

In describing her experience caring for presidents, Mariano emphasized the role of the 25th Amendment, which governs succession in cases of presidential incapacity.

“Succession planning is something that’s really on the agenda,” said Mariano. “Every training scenario in which the president is injured or attacked comes up with the question, ‘What about the 25th Amendment?’”

She illustrated her point with an anecdote from the early days of Bill Clinton’s presidency. During a trip to Florida, the president ripped his quadriceps tendon while descending a flight of stairs. The injury required surgery and the president demanded the use of a local, rather than a general, anesthetic, so that he would not have to invoke the 25th Amendment while he was unconscious.

Mariano said that many questions pertinent to presidential succession remain unanswered.

“Al Gore ruptured his Achilles tendon playing basketball a year prior [to President Clinton’s injury],” she said. “He underwent general anesthesia. So the question that would have been then was, ‘Who is the vice president while the vice president is unconscious?’”

As it happens, Dr. Mariano’s question is one that the succession clinic’s students have been working to answer. Their report, which is expected to be published later this year, will include a proposal for declaring the vice president disabled.

In order for its students to gain context concerning the amendment, the clinic has hosted many distinguished guests, including former CIA Director John Brennan, who visited last fall. Mariano added her own thoughts on working in the White House to the clinic’s growing store of wisdom.

“As the physician to the president, you’re one of the few people who can argue with them because you care enough about them,” she said. “And it has nothing to do with your politics. You can be of a different political persuasion, but you’re there all the time. So you get to the point where you have mutual respect and he listens to you.”

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