5--Health—the Issue that Just Wouldn’t Go Away
It’s ironic, indeed, that Bob Casey would be haunted by his health throughout his two terms as Governor. He was a stellar high school athlete in his teens, skilled enough to make the Holy Cross basketball team in college in the early ‘50s when “The Cross” (with the likes of Tommy Heinsohn and Togo Palazzi) was very competitive on the national scene. He also was, I’m told, more than a pretty fair baseball player. If he had serious problems with his health prior to his inauguration in January, 1987, it was a fact known to very few people. But once he became Governor, he was bedeviled with a variety of ailments that would trouble him throughout his tenure.
The first was quadruple heart bypass surgery his first year in office. He recovered nicely, however, and missed but a few weeks from his desk. The most striking aspect of that event was the weight loss he experienced after his surgery. Most people didn’t consider him heavy or overweight when he took his first oath of office in 1987. But his much thinner frame following the bypass surgery was a rather dramatic contrast when set along side the girth he carried in his inaugural pictures. This was the only visible side effect to the bypass surgery. When he returned to the Capitol, he went back full steam.
The surgery, however, set the stage for persistent rumors about the state of his health. It was no accident the rumors seemed to intensify every time the Governor faced a political crisis. I can’t remember how many times during the ’91 budget fight that I had to deny rumors he was going to resign for health reasons…
(Through the years) those of us who worked with him on a daily basis realized he didn’t look as healthy as he might have. But we also saw him every day working long, long hours at being Governor. He never missed a beat. The fact is that he wore many of us out with the stamina and endurance he applied to being chief executive. There would be many an evening when he convened members of his staff around his desk in the Governor’s Office discussing an item of state business after normal working hours had passed. Most times, the sessions would end when Mrs. Casey would call on the private line to tell him to get back to the residence and let the rest of us go home. Thank heavens for Mrs. Casey. It was always a delight to be in her presence. But we never appreciated her more than when she made one of those calls, or else we would have been there much longer than we were.
Amyloidosis. Until I went to work for Governor Robert P. Casey, I had never heard of the word, much less the disease. But it was an affliction which took the life of Pittsburgh Mayor Richard Caliguiri much earlier than his time on this earth should have been. It also claimed the life of Erie’s legendary Mayor, Lou Tullio, a short time later. Both were good friends, personally and politically, of Bob Casey.
So it was curiously coincidental that Governor Casey should become the third member of this Amyloid trifecta. In November of 1990, after his re-election, heading into his second-term inaugural, three years removed from quadruple bypass surgery, the Governor was diagnosed with a form of this genetic disease for which there was no known cure. Given its long-term prognosis, Amyloidosis made the Governor’s by-pass surgery look like a walk in the park. His condition was detected in tests taken during a routine physical examination at the Hershey Medical Center...
The details of Gov. Casey’s dual heart and liver transplant in 1993 have been chronicled innumerable times. There was no better account, and with no more authority than by the Governor himself in his book, “Fighting for Life.”
The book was perfectly titled. Throughout his public career, Casey waged one fight for life after another: First, there was the fight for his political life in the face of three rather convincing defeats for the gubernatorial nomination of his party; second, the fight for his very own life challenged, initially, by a quadruple heart bypass, and then, more ominously, a life-threatening affliction requiring a combination heart/liver transplant that had been rarely performed anywhere in the world; and, finally, of course, his eloquent, courageous and steadfast fight for the right to life for the unborn child. It is worth reading and I’m not about to repeat the details of any of those sagas here.
I was called down to Jim Brown’s office one June day in 1993 and told to be at the Governor’s Residence that evening. The Governor had a major medical announcement to make the next day, and he was meeting with his team of doctors that night. The details of how Gov. Casey first came into contact with Dr. (Thomas) Starzel (head of the Pitt Medical Center Transplantation Unit) are long a matter of public record: A Starzel book on transplantation was given to the Governor by former State Treasurer Catherine Baker Knoll; ultimately, he called Dr. Starzel to acknowledge receipt of the book and thank him; a question from Casey to Starzel inquiring whether there was anything that could be done to counter the amyloidosis; a break in their conversation for Starzel to research the issue; a call back a short time later from Starzel saying a liver transplant might work if Gov. Casey could withstand the rigors of the surgery; a clandestine meeting in Pittsburgh; and a mutual decision for the Governor to undergo testing to determine whether he might qualify for a liver transplant.
That’s what the Governor was going to announce the next day, a Friday: That he was headed to the Pittsburgh University Medical Center the next morning (Saturday) to undergo two days of testing for a possible transplant. The Governor expected to return to Harrisburg Monday, hopefully with a favorable prognosis.
We left for Pittsburgh early Saturday morning on the state plane. Mrs. Casey accompanied her husband, of course. Jack Tighe and I were the staff aides on the trip. Jack, a Pitt grad, was a gubernatorial appointment to the University of Pittsburgh Board of Trustees. He was handling the logistics with Pitt Med center officials. I was along to work on press arrangements and handle their inquiries throughout the weekend.
AP photographer Paul Vathis met us at the state terminal to photograph the Governor’s departure. I remember the Governor took Mrs. Casey arm to steady himself as he climbed the two or three steps to enter the cabin. He paused at the cabin door, turned and flashed a confident “V-for- Victory” sign before entering. With those formalities out of the way, the plane taxied to the runway and we were off.
Sometime Friday afternoon, I received a telephone call from Dennis Roddy, political writer for the Pittsburgh Post-Gazette. He asked if there were any way he could get a one-on-one interview with the Governor before he entered the hospital. I knew the Governor liked Dennis. I also was convinced Dennis liked the Governor. I suspect their shared Irish heritage…there’s that kinship, again…played no small part in their connection. I also expected Dennis’ piece would be fair. Most important, since Pittsburgh was where the Governor was going for testing, why not exclusive quotes in the Sunday Pittsburgh Post-Gazette where the action was taking place. I raised the prospect with the Governor. He agreed. The only question was how could we get Roddy and the Governor together without the rest of the awaiting media becoming aware. We concluded the best possibility would be to slip Dennis in the Governor’s auto at the Pittsburgh airport. He could conduct the interview with Gov. and Mrs. Casey on the way to the hospital. The only condition was that Dennis had to be dropped off a couple of blocks before the Governor’s limousine reached the hospital entrance, where we knew the media would be assembled en masse.
The plan worked. Dennis had exclusive quotes from both Casey’s, (many of) which the rest of the media picked up the next day. The Governor and Mrs. Casey talked with the press for about 10 minutes before going into Admissions. A press center had been set up by the Medical Center staff at a nearby auditorium. We pledged to give the media ample notice once there was some definitive information to impart. Little did I know how soon that would be.
Jack and I met with the Pitt medical staff over lunch in a conference room off the Pitt Medical Center’s presidential suite of offices. Included in the group was Dr. William Follansbee, the lead cardiologist on the test team. The results of the first tests were not very good, he informed us over soup and sandwiches. He said he doubted whether the Governor could leave the hospital without jeopardizing his health…We all immediately grasped the full implication of what we had just heard. This was no longer just a question of transplant testing. The situation now had transformed into a very case of life and death for the Governor.
The press was aware in general of the testing the governor was to undergo. But the very possibility that the Governor was not going to leave the hospital was something no one had even speculated about publicly. Before the liver transplant question could be addressed, the condition of the Governor’s heart suddenly had vaulted into the primary health consideration…We needed to have a public discussion of the criticality of the heart tests almost immediately to brace the public for what we feared might be even worse news to come the next day. Dr. Follansbee was quite willing and prepared to participate. We scheduled the briefing for mid-afternoon.
The session went as well as could have been expected. Dr. Follansbee did a magnificent job in laying out…almost in laymen terms…the reasons for testing the heart first, and the implications those results would have on the Governor’s potential as a candidate for the liver transplant. He did so without shading the truth; nor did he minimize the significance of the test results. What he didn’t do was engage in any speculation, or theorize as to what the initial results might be suggesting. And appropriately so. If the tests had been conclusive, we all would have had to deal with that set of facts at the Fallonsbee briefing. At that point, however, the results were only partial and suggestive. From the very beginning, we were committed to a course of full disclosure…but only disclosure of information dictated by the facts. We weren’t there yet, and we weren’t about to engage in an exercise of hypothetical “what if’s?”. The Fallonsbee briefing that Saturday afternoon was consistent with our policy of full disclosure: It established the stakes of the heart test results without triggering any premature speculation about immediate dangers to the Governor’s life. There the matter rested for the overnight reports, and appropriately so.
Our worst fears were confirmed the next morning. Jack must have alerted Jim Brown overnight, because Jim and Deputy General Counsel Dick Speigelman flew in on a commercial flight first thing Sunday morning. We all soon learned the tests on the Governor’s heart confirmed that his life was at high risk if he left the hospital. Amyloid deposits had formed around his heart muscles and had virtually shut off blood circulation to the rest of his body. A seizure could come without warning and could be fatal. The recommendation of the doctors was that he remain in Pitt Medical Center for safekeeping. A liver transplant was still a possibility; but only if he received a heart transplant first.
We made preparations for the announcement from the medical team. We also made preparations to set up temporary offices in vacant Medical Center space so the Governor could continue to administer to the duties and decisions of his office, even though he was in a hospital room under intense medical watch. The doctors explained the medical situation to the press. The Governor’s capacity to function was not impaired at the moment, they said; but the condition of his heart brought on by the amyloid build-up was too severe to permit him to move too far from the medical center. He would be placed on a list for a heart/liver transplant; meanwhile, he would be monitored from the hospital.
I know I anticipated the Governor would be on the telephone the next day conducting matters of state. He just wasn’t the kind to pull back, hospital confinement or not. I expected to be fielding calls all day about what he did, with whom he talked, what he decided, and why? Meanwhile, we had other decisions to make about the availability of the doctors and what they might say while everything medical was on hold pending the availability of a donor heart and donor liver. As fate would have it, we never had to confront those issues.
The telephone rang in my room about 10 PM. It was Jack Tighe. “Showtime,” he said. “They think they have a donor. Let’s go.”
Jack had been called by the Medical Center staff. A potential donor had been identified. The Governor was at the top of the waiting list for a donor heart and a donor liver. Tentatively, the surgery was set for 6 A.M. the next morning. Working with the director of the Medical Center Public Information Staff, it was decided there would be no advance announcement of the surgery. Rather we would release a press statement first thing Monday morning that the Governor had been taken to surgery after transferring the powers of his office to Lieutenant Governor Singel. Medical briefings would occur throughout the day as developments warranted.
Sometime about mid-morning, Dr. John Armitage, the heart transplant surgeon, and his team of assistants appeared along with Dr. Starzel to announce the Governor’s heart had been replaced. Dr. Fung, the liver specialist, was at work replacing the Governor’s liver as Dr. Armitage spoke. It would be hours before the tedious liver surgery would be complete. But the first hurdle was crossed.
The rest of the day was one of watching and waiting. It was about 8:30 P.M. that night when the doctors appeared to announce the liver transplant was completed; the governor, with his new heart, had endured the delicate procedure; he was taken to recovery where he would remain under very close monitoring for a few days. There were the to-be-anticipated questions about the nature and length of recovery and when, if ever, the Governor could be expected to resume the powers of his office. The only definitive answer the doctors could give was that they expected the Governor should be fully able to serve once his recovery was completed. But no one could predict how long that would take. The two headlines for the day: Gov Casey survived a rare heart/liver transplant; doctors say he would be fit to return to office. Considering the physical and emotional ordeal that Casey and his family had been through the last 48 hours, those story lines were very welcome, indeed.
Jack and I went back to our hotel for a good night’s sleep. We had to man the temporary offices early the next morning and brace ourselves for the questions that were certain to come. The process we had worked out with the medical staff was for the doctors to conduct at least two detailed briefings each day for the rest of the week, even if there was nothing new about the recovery to report. Often there was not. I remember one early briefing Dr. Fung reported the Governor had sipped on an ice popsicle for nourishment. The press wanted to know the flavor. (I think it was grape.)
We had a number of issues to deal with over the next couple of days. Prime among them was whether the Governor received preferential treatment in securing a donor heart and liver so quickly. The organ transplantation unit in Pittsburgh, which fortunately was headed by a Bishop, (Episcopal, I believe) vehemently denied he had. And no one was able to produce evidence otherwise. Because there was none. Governor Casey was the only person in the United States needing both a heart and liver transplant the night a donor was located, and as such, was at the top of the transplantation list for the dual surgery. Those rules, I understand, have since changed. But they were the rules that were followed in the Governor’s case. That was a stipulation of his from the very first meeting he had privately with the doctors in Pittsburgh. No special treatment, whatsoever, was to be given. And none was!
The second question was whether the Governor’s surgery was covered by health insurance? It was…though I suspect it might have been a very close, close call on the insurer’s part. A heart transplant was clearly a covered procedure. So, too, a liver transplant. But a dual heart/liver transplant? Those were so rare you could count them on one hand. A case clearly could have been made that this was an experimental procedure. Medically necessary, absolutely. Experimental? Perhaps, because they had been done so infrequently before. And the recipients had relatively short life spans afterward. There may have been only one living survivor in the world at the time. But the call was made that health insurance would pay—and would’ve paid no matter who the patient might have been. That, for all intents, settled that discussion. I did learn much later on that the operation was not the most expensive claim paid by the Commonwealth health insurance plan. A bone marrow transplant several years earlier held that distinction.
The Governor’s recuperation was slow but steady…The word from the medical staff was almost without fail generally encouraging on the recovery. We kept the media sufficiently informed, and the news was favorable enough to keep the coverage fair and unalarming. That was a big asset in those first weeks as the doctors reported daily on the Governor’s condition. We never attempted in anyway to spin the condition in a certain direction. Truth is we really never had to.
I had no direct contact with the Governor, or with his family for that matter, in the immediate days following the surgery. One situation required attention, however. The identity of the Governor’s organ donor became public knowledge. The Pittsburgh Post-Gazette cleverly matched the Sunday obituaries to the Governor’s transplant surgery and concluded correctly that the Governor had received the heart and liver of a young Black man from Monessen named Michael Lucas.
Michael Lucas literally had been beaten to death on the doorstep of his home in, it later developed, a drug case. The Pittsburgh organ transplant organization had no option in the ensuing press clamor but to schedule a press conference with the donor’s family for mid-week. The purpose was to reaffirm the integrity of the organ transplant system in southwestern Pennsylvania, and to establish once again that no rules were skirted or preferential treatment given in the decision to assign the victim’s organs to the Governor.
Like the medical reports, that, too, was the truth. No rules were bent; no preferential treatment was given. Not in this case. I came to learn subsequently that if the victim’s lungs had not been damaged so brutally in the beating, Michael Lucas’ organs would have gone elsewhere. I was told by the doctors and the organ donor staff that there was someone ahead of the governor on the transplant list in need of a lung and a liver. If the victim’s lungs were suitable for transplantation, they would have gone to the other person, along with the liver the Governor so desperately needed.
Normally, there is no immediate contact between a donor family and a recipient family. But given the extraordinary visibility of this case, it became clear.…that the Casey’s needed to express their gratitude to the Lucas family before that press conference…Mrs. Casey…agreed…Instinctively, she and her children wanted the victim’s family to know how much they appreciated their generosity in donating the organs. The only reason they refrained from doing so was because of the transplantation protocols between families.
(A) note (from the Caseys) was passed on to the donor family prior to their press conference… We treated the note as confidential. The Lucas family could make it public if they chose. The Casey family would not. We regarded it as a private correspondence between one wife and mother to another. That also was the right thing to do for the right reason, in my judgment.