Guest guest Posted December 28, 2002 Report Share Posted December 28, 2002 http://www.boston.com/globe/magazine/2002/1027/coverstory_entire.htm First responder William Frist, who is both a United States senator and a doctor, is President Bush's point man on national medical issues. Next on his resume: Vice president? By Michael Kranish, Globe Staff, 10/27/2002 Boston, 1980 William H. Frist, a rising star of Boston's medical world, is in agony, personally and professionally. Fresh from his years at Harvard Medical School, deep into his surgical training at the city's hospitals, the budding heart surgeon is filled with remorse. He has watched a child die at Massachusetts General Hospital - " died on my service, under my care, while I was in charge. I felt as if I had killed her. " A scion of a prominent Tennessee family, Frist is due to get married in Nashville to his longtime girlfriend. The engagement has been announced, the guests invited to the wedding, the gifts wrapped and sent, and the cream of Tennessee society invited to the grand event. Then Frist meets another woman, Karyn, and his future is changed. " I remembered how it started, at the hospital, " Frist later wrote. " She came to the emergency room with a sprained wrist. Then the telephone call a few days later. Saying I would come that evening to see her. The west-Texas lilt in her voice when she told me to come ahead. The terrible part of Boston she lived in. Columbus Avenue. A one-bedroom walk-up on the second floor. Her white dress. Her sunburnt face. Her big, wide eyes. How she laughed at me, chided me for my cheapness when I first suggested that we walk to Charlestown, then that we hitchhike. Warren Tavern. The dinner. The conversation. The chemistry. The late evening walk along the Charles River. And I remembered the rest of the night, too. " What happened next probably would have been rejected as too improbable even by General Hospital. Two days before the wedding, Frist, still attired in his hospital whites, flew to Nashville and faced what he called " the long, dark tunnel of the wrong future. " He would later explain that he nearly got married to the wrong woman due to the " trauma that medical school was doing to my soul. " Frist walked into the house of his fiancee, where tables were covered with white cloths and gifts were scattered about, and told her that " nothing was right with my life. With me. With me and her. " Later, he wrote that he " had not mentioned Karyn " to his fiancee. And as he returned to Boston, still in his hospital garb, he thought to himself: " I did not miss a minute of work at Mass. General. " Washington, June 2002, the White House It is a sweltering summer day as William Frist, in his eighth year in office as a US senator from Tennessee and now married to Karyn and the father of three children, arrives at the White House to meet with President George W. Bush. It is a day of crowning achievement for Frist, who is to watch Bush sign into law a bill on bioterrorism. The Republican senator wrote much of the bill and used it as the basis for a best-selling book on the subject, When Every Moment Counts: What You Need to Know About Bioterrorism From the Senate's Only Doctor, published this year. For Frist, this is one of those power moments that have become typical for a man who wields enormous influence on an array of medical issues within the Republican Party and thus in the nation. It was Frist who pushed Bush to allow limited research on stem cells, giving Bush cover on one of the toughest issues facing the White House. It was Frist - whose family founded one of the nation's largest health care businesses - who carried water for the president and the medical insurance industry in fighting a version of the Patients' Bill of Rights that would have allowed the biggest possible damages in lawsuits against health care organizations. And it was Frist who responded to discovery of the anthrax letters that went to the Senate by becoming Bush's adviser on the issue and, as the bill-signing demonstrated, also his legislative power broker. In all, the first practicing physician elected to the Senate since 1928 has a status unlike any other senator when it comes to medical issues, making him one of the most powerful men in Washington. For all of these reasons, there has been considerable speculation that the 51-year-old Frist might replace Vice President Dick Cheney on the 2004 ticket, perhaps putting him in position to run for the presidency himself one day. Indeed, Frist was one of the top runner-ups to Cheney in the vice-presidential sweepstakes in 2000. (Cheney, 61, says he is ready to run for vice president again in 2004, but the issue is whether he might be considered too old to run for president in 2008.) More immediate, Frist arguably has the most important political job in the GOP: chairman of the National Republican Senatorial Committee. Frist has raised huge amounts of money - including from the medical and pharmaceutical lobby - and has recruited candidates in an effort to win back GOP control of the Senate. If Republicans retake the Senate in the November 5 elections, Frist's political stock will rise to its highest level yet. It all sounds exactly like the future that Frist envisioned when he transformed his renown as a heart surgeon into a Senate career based on the idea that he could help more people in the political chambers of Washington than in the operating rooms of Nashville. But after leaving the White House ceremony, he gets a dose of reality: As Frist climbs into a minivan, an aide hands him the bad news. It is a copy of the day's editorial from The Washington Post. The headline says it all: " Sen. Frist Backs Down. " The editorial excoriates Frist for vowing initially to fund a $500 million US contribution to an AIDS program to prevent mother-to-child transmission of the disease and then caving in to a White House demand that the amount be reduced to $200 million. " He has taken up this leadership mantle to fight the greatest pandemic of our time, " says Asia Russell, an AIDS activist who cofounded the group Health Gap. " The meaning of leadership is to take risks, but then he buckled under pressure. " The issue underscores the biggest question about Frist: Is he using his extraordinary power as the Republican point man on medicine to advance the cause of patients and the dispossessed, or has he become yet another captive of Washington, a sycophant for industry and the party, quicker to deal and cave than stand on principle? It is not just AIDS; Frist has wound up at odds with the American Medical Association over the Patients' Bill of Rights, and at odds with antiabortion activists over his lack of leadership in banning human tissue cloning. It isn't just an inside-the-Beltway issue. Just days after the Post editorial appeared, a columnist for The Commercial Appeal of Memphis speculated in print about whether Frist was angling for the vice presidency and was too quick to put aside principle when dealing with the president of the United States. " It would be interesting to see Frist stand up to Bush just once, " the columnist wrote. Now, as Frist's van heads up Pennsylvania Avenue to the Capitol, Frist is shaking his head, trying to understand how his successful effort to back AIDS legislation has been turned against him. So he tells a story about Africa. Uganda, January 2002 Frist has visited Africa every year for the past five years but not as a senator. Instead, he travels as a physician, at his own expense, as a medical missionary in the service of the Rev. Franklin Graham, the son of Billy Graham. Frist, a devout Presbyterian, made his first such trip in 1997, because he wanted to see the conditions of the poor and the sick in Africa. " Africa, " he says, " opened my eyes. " The trips are dangerous and difficult. In 1999, Frist, a pilot since the age of 16, flew a Cessna Caravan into southern Sudan territory held by a rebel faction. As Frist landed, 50 gunmen emerged and brandished their AK-47s. The men, it turned out, had come to escort him. Frist usually visits several countries on these trips, often staying in grass huts. The trips are also notable because Frist does something that he rarely does back in the United States: He returns to the operating table, performing all manner of surgery. Frist refers to the trips as something politicians would not do, as if he were not a politician himself. " The politicians can go walk into a house and see someone dying of AIDS, hold their hand for an hour, and leave. I'm in there for eight or nine hours, giving them medicine, putting it in their mouth. " The experience, he says, has been transforming. " Medically, I know we can cure this thing one day. " Last January, on a mission to Uganda, Frist traveled with Bono, the singer from the Irish rock group U2, who has devoted himself to publicizing the plight of AIDS victims in Africa. The trip drew little notice, but it was the precursor to the massively publicized trip last May by Bono and US Treasury Secretary Paul O'Neill. Bono believes Frist is a crucial player in fighting AIDS because of the senator's influence with President Bush. Bono, via e-mail, calls Frist " a unique creature . . . a doctor-turned-politician who chooses to spend his scarce holidays performing surgery in war-torn African countries. I met him in Uganda last January, where we got to see the devastating effects of the AIDS emergency up close. " He is so well placed to do something about this crisis, " Bono continues. He has influence with the president. . . . Polls show that Americans do care about AIDS in Africa, but it's not exactly a slam-dunk vote winner. Putting your neck on the line for the poorest of the poor may not be easy, but I think Senator Frist knows it's the right thing to do. . . . Getting that cash will be the test for him. " As a result of these trips, Frist has become the top Republican on the Senate Foreign Relations Subcommittee on African Affairs and the GOP's de facto leader on AIDS. " It has been a struggle to get the attention of my colleagues and the American people on the issue of the impact that this virus is having on humanity, " Frist says shortly before the appearance of the editorial that excoriated him on the AIDS funding matter. " It is crystal clear it is devastating economies. But politically, it doesn't drive people. Certain constituencies will say it is a big issue, but in, say, rural Tennessee, people would say it is not as important in the big scheme of things as `my pocketbook.' " So from Frist's perspective, he is on the moral high ground: He has been to Africa, worked with people with AIDS, and pushed the president to devote more money to the cause. " This is why I became a senator, " he says. " I could save one life at a time or 500,000. " One week later, Frist again stood in the Rose Garden with Bush, this time for the president's announcement that he would support Frist's original $500 million for AIDS, but that the money would be spread over several years, instead of one year, as originally anticipated. That prompted Senator John F. Kerry of Massachusetts, a possible 2004 Democratic presidential candidate, to issue a stinging press release that said Bush's announcement was a devastating retreat from the AIDS legislation he had cosponsored with Frist. But Senator Frist, who had resisted any impulse to criticize the White House's initial reluctance to increase spending for AIDS, was joyous as he stood in the White House driveway, telling the press corps: " The president's commitment to this issue is, obviously, heartfelt, very, very strong, and so I'm confident that the $500 million will be spent. " But Frist's confidence was premature. Bush wound up killing the bill with that AIDS appropriation, because it was linked to other spending that he didn't support. Earlier this month, Frist issued a statement saying it was all part of the " frustrating " legislative process and vowing to continue to fight for the funding. " It's two steps forward and one step back, " Frist says. This time, there were no Rose Garden accolades. Like any politician, there is only so far that Bill Frist is willing to go to explain himself. He says there is a " Frist wall " beyond which even his closest friends cannot penetrate. But 13 years ago, Frist obliterated that wall. He wrote a book that is as remarkable as it is obscure, titled Transplant: A Heart Surgeon's Account of the Life-and-Death Dramas of the New Medicine. It is taut, well-written, and - to be sure - self-serving. It is long since out of print and sold no more than 15,000 copies. Yet it is remarkable because Frist seems to have held little back in an effort to explain how he was shaped, for better or worse, by his association with Harvard Medical School and the teaching hospitals of Boston for 11 years. He included the story of how he broke off his engagement to his fiancee two days before the wedding, because it helped explain how he responded to such pressure. Throughout the book's 267 pages, there is no more revealing look into the life of William H. Frist, MD, yet even some of his best friends are not aware the book exists. Frist's public image is straight-arrow and religious, a conservative Southern surgeon-senator. All of that is true, but it is only part of the story. There is also the Frist who loved flying so much that he flew solo at age 16 without telling his parents, the Frist who seriously hurt himself in a motorcycle accident at age 15 and survived because he was wearing a helmet. " I guess there is a pattern of living on the edge, " Frist says, explaining that he learned to harness that energy for his later careers. As Frist tells the story, he seemed destined to become a doctor like his father, the legendary Thomas Frist Sr. It was Frist's father and his brother Thomas Frist Jr. who cofounded the Hospital Corporation of America. The struggle of a son to both follow in a father's footsteps and walk an independent path is an age-old dilemma. Being a Frist in Tennessee is something like being a Kennedy in Massachusetts; the gifts are great but the expectations can be overwhelming. Tennesseans had depended for years on Frist's father, first as a doctor and then as a founder of one of the state's major corporations. Frist once compared his conversations with his father to " benign versions of the Godfather and Michael Corleone, " as the two discussed how medical power had shifted from house-call doctors to corporate administrators. He recalls thinking that " I wanted to grow up to be just like Dad " and that, as his father's son, he could never allow himself to fail. It was his " cross to bear. " So Frist decided that he would not work for his father's corporation. Instead, he decided he wanted to become one of the best physicians in the country. Like so many others of like mind, he headed to Boston. Fresh from undergraduate years at Princeton, where he was president of the Princeton Flying Club, Frist arrived in Boston in 1974 to attend Harvard Medical School. Frist's ambition was to perform heart and lung transplants, a field then still in its infancy, and he assumed he would spend his life in Massachusetts. Frist came to Harvard, he wrote, " starry-eyed and amazed " at being part of the " cream of the crop. " But, he continued, " somewhere in the middle of it all, exhausted by years of no sleep and high anxiety, doubting every opinion I ever held, questioning every notion about myself that ever kept me going, I realized that instead of molding doctors, medical school was in the business of stripping human beings of everything but the raw, almost insane, ambition you must have simply to get through. " Frist is an animal lover who said his decision to become a doctor was clinched when he helped heal a friend's dog. But Frist now found himself forced to kill animals during medical research. And his new dilemma was finding enough animals to kill. Soon, he began lying to obtain more animals. He went to the animal shelters around Boston and promised he would care for the cats as pets. Then he killed them during experiments. " It was a heinous and dishonest thing to do, " Frist wrote. " I was going a little crazy. " The craziness continued during Frist's surgical residency, done mainly at Mass. General, which he describes both as the " greatest hospital in the world " and the scene of a series of personal humiliations. There was the time he misdiagnosed a serious illness, prompting the chief resident to roast Frist in front of the staff. Frist talks of being " degraded " and " shamed. " It was training by fear and guilt, Frist says, and he despised it. The worst moment came when he was caring for an 8-year-old girl who had burns over 65 percent of her body. The girl died within hours, leaving Frist to fret that he should have called the senior resident earlier for help. This was when Frist felt as if he had killed a patient. But after 11 years in Boston - four at Harvard Medical School and seven as a surgical resident at the Harvard teaching hospitals - nothing frustrated Frist more than what he perceived as the medical community's reluctance to embrace his dream of heart transplantation. " Boston was one of the least innovative of the major medical centers in the country in the field of transplantation, " Frist says during one of a series of interviews for this article. " My interest in medicine was from the innovative side, being on the cutting edge, walking where people had not walked. " Frist says he was so offended and upset by Boston's conservative stance that he decided " all of a sudden I had to leave Boston. " As he provides this recollection in his Senate office, he still seems visibly upset at the ways his views on transplantation were given short shrift in Boston. (Frist, who notes with relish that heart transplants are now common throughout the world, has maintained his ties to Massachusetts with a house on Nantucket, which he sometimes visits by piloting a private plane.) So Frist left Boston and went to Stanford University in California, where he was mentored by Norman Shumway, the father of American heart transplantation. It is perhaps the moment of highest bravado in Frist's career, a definable instant when he picked up and moved across the country, following his vision of medical innovation. After two more years of training, Frist returned to Nashville, where he eventually performed 200 heart transplants and thousands of other surgeries. Frequently, he would fly in a small plane in the dead of night to pick up a heart somewhere and return to Vanderbilt University's medical center to perform the transplant. But after reaching the pinnacle of his profession, Frist wanted something more, the ability to affect hundreds of thousands of people instead of one patient at a time. He says he had never voted until age 36, and few people were sure whether he even belonged to a political party. Indeed, his first brush with politics came when a Democratic governor appointed him to a Medicaid task force in 1992. Two years later, Frist, a political neophyte, ran as a Republican challenger and beat the popular Democratic incumbent, Senator James Sasser, and then was reelected in 2000. Indeed, it may have been concerns about replacing Frist on the Tennessee ballot that prevented Bush from selecting him as a running mate. It wasn't worth risking the loss of a Republican seat in the Senate. In a chamber filled with lawyers and bankers and political lifers, Frist is an oddity both because he has said he intends to leave the Senate after his second term expires in 2006 and because he continues to carry his medical bag. He has been credited with saving the life of Russell Weston Jr., who in 1998 went on a shooting rampage in the Capitol and killed two police officers. Frist also was called to the floor to help care for Senator Strom Thurmond. Former Senate majority leader Robert Dole says that when he went to the Mayo Clinic for an aneurysm operation, Frist called him just hours before he was about to go under the knife, urging him to try a more innovative form of surgery. Dole took Frist's advice. " He searched all over the country to help me, " Dole says, " even though I was no longer in the Senate. I think he misses being in medicine. " o watch Frist maneuver in the Senate and be pummeled by editorial page writers is to wonder what he would say if he wrote the same sort of revealing book about the nation's greatest deliberative body as he did about his years in medicine. Surely there is much of the same " raw, almost insane ambition " he encountered in medical school. Has he endured the same kind of limiting frustrations that caused him to leave Boston? Has he taken actions under pressure from the White House that leave him just as ashamed as when he acquired cats from animal shelters under false pretenses? To such questions, Frist retreats slightly behind the Frist wall, saying that " I wouldn't have written that book now " if he had known he was going to be a senator. Asked what he could reveal about Senate life if he were to write a book now, Frist says it undoubtedly would focus on " the dichotomy between what I want to be and do and the politics. " As head of the Republican Senatorial Campaign Committee, for example, he has to be one of the most aggressively political people in Washington, and he may be in line to assume a higher leadership position in the Senate, perhaps even majority leader. But with the certainty that he will play a key role in health care legislation ranging from prescription drug coverage to patients' rights to cloning, Frist is uncertain whether focusing so much on politics and leadership will help or hurt his cause. Some Senate leaders are able to use their power to push through legislation, but others spend most of their time keeping party members in line. If Frist is to accomplish more on health legislation, he inevitably will have to work with Senator Edward M. Kennedy, the Massachusetts Democrat. For example, Senator Orrin Hatch, the Utah Republican, has passed numerous health bills with Kennedy. But Frist has been at odds with Kennedy on key measures like the Patients' Bill of Rights, and it might be much tougher to broker a deal if he assumes a leadership position in which politics is paramount. But if Frist were to break with the president and his party on the Patients' Bill of Rights, it might end his chances to be a party leader. " There is this tension between two forces I am engaged in, between raw political power, versus what is probably a little more deeply inside of me, the real quest, the real drive for substantive issues, of really changing things for these few years I am in the United States Senate, " Frist says in one of his most reflective moments. Then Frist wonders aloud whether " you can really pull off the political " and get legislation passed. " I really, really, really don't know, " he says. " I am working so hard right now doing this, " he adds, referring to gaining Republican control of the Senate. The Patients' Bill of Rights, a priority in both parties, deals with the ability of patients to sue health care companies over the denial of service. The theory behind the bill is that an organization that fears a lawsuit will be much more careful about denying claims. But Frist says that if unlimited damages are allowed, medical costs will skyrocket and even fewer people will be able to afford health insurance. The bottom line is that Frist, acting in accord with the White House viewpoint, has not been able to reach a compromise with Kennedy, who is the author of a bill that would allow the largest possible damages. Thus, the legislation is unlikely to be approved by Congress this year. " Bill Frist has a special position on health. When he is with you, we can get a lot done, " Kennedy says. " But we don't always see eye to eye, not on the Patients' Bill of Rights. " From Frist's point of view, of course, it is Kennedy who is unwilling to compromise, but Frist has less room to maneuver, because he must remain in step with Bush's position. Says Frist: " I can't just do something that will blow the top off these lawsuits. " Some of Frist's critics say his position on the Patients' Bill of Rights partly is a result of an obvious conflict of interest. From the time Frist was 18 years old, he says, he purchased stock in the family's Hospital Corporation of America, now known simply as HCA. By the time Frist arrived in the Senate, he owned millions of dollars of company stock and said his investment had done " very well. " Upon entering the Senate, he put the investments in a blind trust. Today, he says he has no idea how much HCA stock he owns. His brother Thomas is a member of the HCA board. " It is as direct a conflict of interest as you ever see in legislation that is moving through Congress, " says Frank Clemente, executive director of Congress Watch, a consumer organization. Frist says the Senate Ethics Committee has found no problem with his stock ownership; the committee declines comment but has not pursued any case again him. Frist says he has addressed the problem by making " full disclosure " - although blind trusts are secret - and by noting he has never held any position with HCA other than stock owner. In December 2000, HCA agreed to pay an $840 million settlement to the federal government as a result of alleged false Medicare claims, but Frist has stressed he has no connection to the matter. By keeping in line with the Bush position on the Patients' Bill of Rights and other health issues, Frist has become the president's key ally on medical matters. Mark McClellan, the White House health care adviser, says Bush puts tremendous stock in Frist's advice on bioterrorism and other medical issues. " The senator's experience with life-and-death decisions provides a unique perspective, " McClellan says. " He makes these issues real and practical, since he has been on the front lines. " Still, Frist suffered a significant defeat when the White House balked at his proposed nominee for commissioner of the Food and Drug Administration, Alastair Wood of Nashville's Vanderbilt University. White House officials worried that Wood was too focused on drug safety issues instead of new drug approvals. As it turns out, Bush earlier this month gave the nod for FDA commissioner to McClellan, with Frist's blessing. Frist's role - or lack of a role - on human cloning has also caused controversy. There are two general areas of cloning: copycat reproduction of humans, which no member of Congress supports, and reproduction of human tissues, which many scientists support for research experimentation for therapeutic uses similar to stem cells. Bush wants to ban all cloning, but some conservative Republicans, including Hatch and Thurmond, want to allow therapeutic tissue cloning in hopes it can be used to cure degenerative diseases such as Parkinson's. When the issue first surfaced in the Senate last year, Frist said any form of cloning " crosses a very dangerous moral and ethical line that shouldn't be crossed, even for the potential of scientific gain. " But Frist never took a leadership role, angering some antiabortion activists who were counting on him. Judie Brown, president of the American Life League, says she is " extremely disappointed in Senator Frist, because he has the scientific credentials to have provided effective discussion on the ongoing debate on human cloning, and yet he has chosen to be politically correct. Frankly, he is a wimp. " Norman Shumway, Frist's mentor at Stanford University, says he believes his longtime friend made a carefully conceived political decision. Frist's opposition to therapeutic cloning is " ridiculous, " Shumway says, and he can't believe that Frist, who left Boston to be on the cutting edge of medicine with heart transplantation, would oppose such a promising avenue of research. But Shumway has a theory about Frist's position, a theory that has been much-discussed in political circles. " Here is what I think is going to happen, " says Shumway. " I think Cheney will probably not run as Bush's vice president [in 2004], and I think it will be Bill Frist. So I think he has to be very careful. I think the Republicans do not want to alienate the far-right component. I think this is what he is being careful about. I'm sure, deep down, he knows full well that therapeutic cloning is essential. He may not be able to come out strongly on it, but sooner or later it will come out. " s Frist concludes a series of interviews for this article, he seems to wonder whether he has succeeded in fully explaining himself. So he ducks into his Senate office and returns with an extraordinary document. It is a copy of a letter that his father wrote just before his 1998 death; there is also a eulogy of his father. The eulogy tells proudly how the senior Frist was once engaged to a woman, but then " engagements were broken and plans were abandoned " when he met another woman whom he would eventually marry. The story neatly parallels what happened to William Frist. In both instances, an event that could be described as cold is instead portrayed as combining romance and courage. The parallels to Frist's medical career and political thought are striking. " I am a conservative, " the senior Frist wrote. " I believe the free enterprise system can do a better job at most things than the government can. People should learn to be self-reliant; when they are self-reliant, they will have self-respect. I believe good people beget good people. " Religion, wrote the senior Frist, " is so very important. " Finally, the senior Frist cautioned that " it is so terribly important in life to stay humble . . . always be confident. But never be cocky. " Frist treasures his father's words as he ponders his own future, whether it be the vice presidency of the United States, Senate leader, or perhaps even a return to the operating room. But first, he vows, he will win the AIDS funding battle and prove wrong the skeptics who say he has backed down. This story, he says, is not over yet. Michael Kranish is a member of the Globe's Washington bureau. He can be reached by e-mail at kranish. This story ran in the Boston Globe Magazine on 10/27/2002. © Copyright 2002 Globe Newspaper Company. (Posted by Margery Glickman) Quote Link to comment Share on other sites More sharing options...
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