WASHINGTON — Chief Justice John Roberts checked himself out of a Maine hospital on Tuesday following a medical emergency that illuminates anew the potential fragility of the Supreme Court.
One day after suffering a still-unexplained seizure, Roberts returned to his summer vacation home on remote Hupper Island and told President Bush that there was no cause for alarm.
"It was a brief conversation, but one where the chief justice reassured the president that, in fact, he was doing fine," White House spokesman Tony Snow said.
But with four of the court's nine justices over the age of 70, and with the 52-year-old Roberts' health vulnerabilities now more fully exposed, judicial infirmity becomes the elephant in the room. It's the political topic that's both hard to avoid and touchy to handle.
"I think it brings into sharp relief just how precarious the balance of power is on the court right now," Nan Aron, executive director of the liberal Alliance for Justice, said in an interview.
One justice, 74-year-old Ruth Bader Ginsburg, survived a bout with colorectal cancer in 1999.
In the two years that Roberts has been chief justice, many of the most controversial rulings have been 5-4 decisions, with Justice Anthony Kennedy providing a swing vote between two consistent groups of four, one tilting liberal, the other conservative.
Aron said she's certain that the White House has a list of potential Supreme Court nominees, even though so far "all reports are the justices remain energized, with absolutely no signs of fatigue among them."
Roberts' release late Tuesday morning from the Penobscot Bay Medical Center didn't resolve all questions about his health and potential future treatments. These include, for instance, whether doctors will prescribe drugs to prevent a recurrence of what a Supreme Court statement described as Roberts' "benign idiopathic seizure."
The phrase means that doctors don't know what caused Roberts to collapse on a dock. Roberts fell during his seizure Monday afternoon, suffering what the court called "minor scrapes." He was taken by boat to an ambulance on the mainland, where he was transported to the hospital.
Fourteen years ago, Roberts suffered a similar seizure, which led him to give up driving for several months. He wasn't asked about it during his 2005 Senate confirmation hearing, where he assured senators in a written statement that his health was "excellent," but Snow said Tuesday that White House officials were aware of the earlier episode.
"It was something that people did take a look at," Snow said. "It obviously was not something that was seen as an issue of overwhelming concern."
Seizures can be caused by anything from a tumor or brain infection to low blood sugar or a metabolic imbalance. Seizures typically last between two and five minutes and often leave the patient sore, fatigued, confused and sometimes incontinent, according to the Merck medical manual.
Doctors will usually examine a seizure patient with tools that include CAT scans and magnetic resonance imaging, or MRI. They also will want to know whether there have been other episodes that Roberts hasn't owned up to publicly.
"The most important thing for him is to be honest about whether he has had other seizure episodes," said Tony Coelho, a former California congressman who chaired the Epilepsy Foundation. "You have to question the individual very aggressively about whether they have had other episodes."
Coelho was diagnosed with epilepsy while growing up in California's San Joaquin Valley. Prior to his resignation from Congress in 1989, he introduced the first version of the Americans with Disabilities Act.
Physicians can prescribe various medications for seizure disorders, although they must also try to avoid potential side effects.
"It's not just a matter of taking a single pill," Coelho said. "It's like trying to find a needle in a haystack."