Inside Intel / Who cares for the PM's health?

A few months ago, the Shin Bet security service's VIP unit was looking for a candidate to fill the position of the unit's physician. The physician's primary job is to accompany the prime minister on his travels across the country and abroad, and when necessary, to provide him with emergency care. It is a demanding job that requires the physician to be available 24 hours a day.

The need for a unit physician, his job description and the traits he needs to do the job were crystallized by two tragedies: the assassination of prime minister Yitzhak Rabin and the emergency hospitalization of prime minister Ariel Sharon. Following these events, it was decided that the physician should be an internist and, primarily, an expert in emergency medicine (trauma and immediate care).

For years, pursuant to a signed agreement, Sheba Medical Center had supplied physicians to the VIP protection unit, so this time as well, the unit approached Sheba and asked several physicians employed there to recommend a suitable candidate. Based on these recommendations, negotiations commenced with a female physician in her forties who has experience in emergency medicine. By definition, the job requires a candidate with the highest security clearance, but this woman met all the security requirements. She was therefore informed that she had been chosen for the job, and a personal contract would be signed with her.

Some time later, however, she was told that the decision had been changed, and she would not be hired. She was not told why, even though her professionalism and skills were unquestioned and there were no security reasons for denying her the job.

Nevertheless, it must be stressed that officially, the premier's bureau was not involved in the negotiations in any way: All of the decisions on her candidacy were made by the Shin Bet. The physician refused to comment on the matter and asked that her name not be mentioned.

This story, marginal and gossipy though it may be, raises a broader question: Who is responsible for the prime minister's health? This is an important question that obviously affects the functioning of the person who bears supreme responsibility for the country's fate. The prime minister's health may impair or improve his thinking.

Surprisingly, the Prime Minister's Office formulated internal regulations on this matter only a few months ago. During all the years until then, the prime minister's "personal physician" had no clearly defined role or legal status. For the most part, prime ministers simply used a physician they knew in the past or had met during the course of their job. For example, Prof. Marvin Gottesman of Hadassah Hospital was considered prime minister Menachem Begin's personal physician, while Dr. Shlomo Segev of Sheba served as personal physician to Rabin, Sharon and Ehud Olmert, without this being formalized in any way.

In the absence of any protocol, it was unclear who was responsible for paying the prime minister's physician. Thus Segev, for example, treated three prime ministers on a voluntary basis, without pay - an embarrassing phenomenon by any measure in a modern country subject to the rule of law.

After what happened to Sharon, the Prime Minister's Office decided to establish clear-cut procedures. But in typical bureaucratic fashion, formulating these procedures took almost the entirety of Olmert's term of office. Among other things, the PMO did a comparative study of other countries' practices. The discussions were attended by the attorney general, the director general of the Health Ministry, the director general of the Prime Minister's Office, physicians and a representative of the Inbal insurance company.

A major reason for the delay in signing a contract with Dr. Segev was the question of insurance payments and liability in the event of medical malpractice. At various stages of the talks, the impression was that the state wanted to make Segev himself responsible for the insurance. Segev declined to comment on this matter.

In the end, a compromise was reached and the agreement was drawn up. But then the elections were moved up, so it was decided to postpone signing the contract with Segev, since whoever was elected to the post might prefer another doctor.

This is indeed what happened: Benjamin Netanyahu was elected prime minister and announced that he wished to appoint Dr. Herman Berkowitz, a pediatrician who had cared for Netanyahu's children and is considered a family friend, to the position.

Incidentally, Berkowitz was arrested in the 1990s, during Netanyahu's first term as premier, on suspicion of tax evasion. His attorney, Udi Barzilai, said in a written response, "I hereby confirm that a tax adjustment was made that resolved the disagreement with the tax authorities over the technical charges of ostensibly failing to report income in negligible amounts. A fine was paid by consent and the [tax] assessment was settled as a civil matter."

The legal adviser to the Prime Minister's Office's, attorney Shlomit Barnea-Prego, told Haaretz that under the new rules, the work is split between the VIP protection unit's physician and the prime minister's personal physician. The VIP protection unit is responsible for emergencies. A paramedic must also accompany the premier on all his travels.

Around six months ago, at the request of the president's office, the Shin Bet also assigned a paramedic to Shimon Peres. When the president collapsed several weeks ago during a public event, the paramedic rushed to treat him.

The premier's personal physician covers ordinary days. According to the protocol, the personal physician is the "head of the medical team," and must be an internist. His job is to monitor the prime minister's health. The personal physician must consult and work with the Shin Bet physician; he also has a public committee to advise him.

The procedures also offer guidelines on when and how to give the public a report on the prime minister's health.

According to Barnea-Prego, a contract to employ Dr. Berkowitz is now on the verge of being signed. Asked if there were not a problem with selecting a pediatrician rather than an internist for the job, she explained that "this is a position requiring confidence, and it is the privilege of the prime minister, just like any other citizen, to choose the doctor that he deems acceptable."

The Prime Minister's Office stated in response: "After he assumed the prime minister's job, security officials approached Mr. Netanyahu and asked him who he would like to have as his personal physician. The prime minister immediately responded that he would like to appoint Dr. Herman Berkowitz, his personal physician for many years now, who is an expert and experienced doctor and is familiar with the prime minister's medical history. On August 30, 2009, the ministry's tender committee discussed the contract with Dr. Berkowitz and decided to approve it without a tender, subject to approval by the ministry's [tender] exemptions committee.

"The tender committee deemed it essential for there to be complete trust between the prime minister and his medical team, and found that Dr. Berkowitz is an experienced physician with background and experience in the field, and is appropriate for the job."