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There are two continuing controversies of major import over the decision to admit the former shah that still require exploration. The first revolves around the true state of the shah’s health in October 1979 and what exactly the president was told about the shah’s condition. On this point, there are not only significant differences among the accounts of the principals, but also the key participant, former President Jimmy Carter, has contradicted his own earlier account of the event. And a second important figure, the State Department’s senior physician at the time, has yet to present any public account, thus depriving scholars of a defining perspective.

The second unresolved controversy lies within attempts to determine precisely why the president made the ultimate decision that he did. Here, again, there are significant contradictions. Most intriguing is an apparent — and perhaps decisive — reliance by Carter and his senior advisors on a positive security assessment supposedly contained in a cable from Tehran, but which is in fact completely absent from the content of this consequential document. Until all of the materials which pertain to this event — cables, White House phone logs, sensitive memoranda — are released to the public and thoroughly scrutinized, a definitive understanding of the decision permitting the shah to enter the United States will remain elusive.

Early fall of 1979 found the shah in Mexico suffering from an undiagnosed abdominal ailment. It was Friday, 28 September, when Undersecretary of State David Newsom was advised by two associates of David Rockefeller — Robert Armao, a public relations consultant and former Nelson Rockefeller employee now in the employ of the shah and his twin sister at the suggestion of Rockefeller, and Joseph Reed — that "the shah was seriously ill," possibly with malaria, and might require medical attention in the United States on a temporary basis. This news arrived just after Chargé Laingen had departed Washington, where he had been for routine consultations. During his discussions, Laingen advised State officials strongly that the shah not be permitted into the United States until the relationship was more stable and the risk to the embassy staff reduced. Laingen, now back in Tehran, was queried by State about possible Iranian reaction to a visit by the shah to America. The response from Tehran asserted that there remained an "atmosphere of hostility towards the shah," the reaction of the Iranians could be even "worse than would have been the case a few months ago," and that "with the power of the mullahs growing, admission of the shah, even on humanitarian grounds, might provoke a severe disturbance."

President Carter has related that he first received word of the shah's distress in a note from Secretary Vance the evening of Monday, 1 October, or approximately thirty-six hours, give or take, after Newsom learned of it; the president was also informed that David Rockefeller's "personal physician" was on his way to Mexico to examine the shah. Vance's note opined that if the shah's illness was determined to be sufficiently serious, there might come a request for his admission to the United States for medical treatment. In point of fact the physician, Dr. Benjamin H. Kean, chief of tropical medicine at New York Hospital (a long-time close friend of the banker's but not necessarily his personal physician) had already flown to Cuernavaca the day prior. Kean was chosen in part at least because of the shah's Mexican medical advisor believed that the shah might have contracted malaria. Dr. Kean found that the shah did not have malaria but was suffering from jaundice, the origin of which was unknown. The physician returned to New York either the same day or the next morning.

Unable to make a firm diagnosis, Kean suspected that shah might have some form of cancer, and sent word back to Rockefeller's staff that the best option would be for the shah to be treated at an American hospital where a full range of diagnostic tests could be performed and appropriate treatment provided. Very shortly after his return, Kean was informed by Armao that the shah's condition had worsened. Armao also disclosed — a bit belatedly, no doubt — that the shah had a history of cancer, the airing of a secret that, had it been known several years earlier, would have literally changed the course of history. In 1974 the shah had been diagnosed with mild form of lymphoma (cancer of the lymph glands) by French doctors, but, regarding the illness as a state secret, the shah informed no one, not even his twin sister, Ashraf. The French doctors continued to treat him, first in Iran and then later in Mexico. The physicians did not betray their patient's confidence, even to their own government. In later years, former director of central intelligence and ambassador to Iran during the Nixon administration, Richard M. Helms, made numerous inquiries among his former contacts in French intelligence, friends who served at the very highest levels, and, without exception, they confirmed to Helms that French intelligence had never learned of the shah’s condition.

On Thursday, 18 October, Dr. Kean returned to Cuernavaca, where he was given more information on the shah’s lymphoma by Dr. Georges Flandrin, one of the shah’s French physicians. Flandrin saw no need for treatment in New York City and decided to withdraw from the case. Kean discussed with the shah at least nine countries, including Mexico, which had the facilities to diagnose and treat him. None was acceptable to the former monarch. There followed consultations between State’s chief medical officer, Dr. Eban H. Dustin, and Dr. Kean, details of which neither State nor the participants have ever made public. However, according to a New York Times investigation in 1981, Kean told Dustin (in a telephonic exchange, apparently, for there is no written record that Kean and Dustin actually met) merely that it was "preferable" for the shah to be treated at an American hospital, that Mexican hospitals were adequately equipped to administer the same diagnostic tests, and that the tests needed to be done only "within a few weeks." (Armao told Newsom, however, that the shah refused to be treated by Mexicans.)

It is probable that Dustin was also told of the cancer at this time, at least in general terms. Kean invited the State physician to fly to Cuernavaca to examine the shah, but Dustin declined. The Times investigation found no proof that a second medical opinion to Kean's was sought, but another researcher has written that something akin to a second opinion was received by Dustin from an unnamed specialist through a "telephonic consultation." (Vance has written that Dustin did go to Cuernavaca and conducted an examination of the shah, but this seems to be erroneous). Thus, Kean was the only American physician to have personally examined the shah before he arrived in New York.

Dustin next reported the substance of his discussions with Kean, whatever they were, in a memo to Secretary Vance. Despite other remaining questions, however, it is readily apparent that the shah was ultimately admitted into the United States on the basis of a limited examination by a doctor who had been engaged by one of the shah's strongest advocates. It is likewise obvious that, somewhere in the information channel, accurate information on the true state of the shah's condition and the adequacy of Mexican facilities became, accidentally or otherwise, distorted in a manner that ultimately appeared to leave the president no choice give his consent.

Serious discrepancies in the accounts of the principals appear just at the time Dr. Dustin's memo was on its way to, or just arriving at, Secretary Vance’s office, discrepancies in critical dates and over the actual state of the shah’s medical condition. According to White House senior advisor Hamilton Jordan, the State Department was told on Tuesday the 16th that the shah had suffered from cancer for a decade and was now in "critical condition." The former president has written that his next word of the shah's health (following the vague 1 October report) arrived on the 17th, informing him that the shah was seriously ill with an undiagnosed malady that might be cancer, and that the next day he read a memo from Secretary Vance confirming the news of the cancer. In contrast, Vance has written that he learned on the 18th that the shah's health was deteriorating, that the shah's ailment could be neither "diagnosed nor treated" in Mexico, and that "cancer could not be ruled out" – and that it was "two days later," on 20 October, that he was first informed of the lymphoma. Three journalists who separately looked into the event have claimed that Reed told Newsom of the cancer on either the 16th or the 18th; a fourth journalist, the medical correspondent for the Times during that period, wrote that Kean flew again to Cuernavaca on the 18th, returned to New York on the 19th, and told Dustin that the shah was suffering either from gallstones or cancer of the pancreas. Thus, there is no definitive time-line for this critical stage, nor is there any concurrence on what the White House was being told about the shah’s condition.

Regardless of the correct date that the president and others learned of the cancer, Vance's note to the president had suggested that if the shah were to be allowed into the United States for medical treatment, the Iranians should be told it was for humanitarian purposes only and to "leave open the question of future residence." Carter scribbled an "OK" in the margin. At this point Vance's undersecretary broke ranks: David Newsom's position all along was that the United States should only assist in locating "alternate havens" for the shah and under no circumstances admit him to the United States; while others changed their positions, Newsom remained adamant to the end.

On 19 October Carter presided over his usual Friday morning "foreign policy" breakfast with his principal advisors; the shah's admission was predominant on the agenda – thus Vance must have known of the shah's cancer prior to the 20th, despite what was written in his memoirs. At the meeting Vance acknowledged that he could not now, in a medical emergency, stand in the way; he switched his vote and agreed with Brzezinski that the shah should be allowed to come to New York for medical treatment. Vice-President Mondale and Secretary of Defense Harold Brown also supported the admission of the shah. Only Carter argued against it.

Two points stand out at this meeting: First, the director of central intelligence was absent, represented instead by the deputy director, Frank Carlucci. As the discussion progressed, no one requested any intelligence assessment of the possible repercussions in Iran from Carlucci and no one asked Carlucci for his own opinion. Apparently, the only information proffered on this subject was Bruce Laingen's cable from July. A frank analysis by the individual closest to and most knowledgeable about the probable Iranian reaction, Laingen's cable nonetheless held no sway. The second key point is that the president now seemingly stood alone. He queried the group as to what actions they would advise if Americans in Iran were taken hostage. There was no response; no one offered a "Plan B."

Vance recommended that they obtain another assessment from Laingen before making the final decision. This seemed a sensible suggestion and was initially agreeable to the president. The president then reversed himself on this suggestion the next day, although it should probably not be too surprising, as he had commented as far back as February that he would be willing to admit the shah if it was a case of medical necessity. Now Carter conceded that the shah was "welcome, as long as the medical treatment is needed,” although such was contradictory to his earlier reluctance borne of concern for the danger it posed to the embassy staff.

The next day, 20 October, the president was in Boston when he received another report on the shah, this time from Warren Christopher (on behalf of the Secretary Vance who had left that morning for Latin America), stating that that shah had "malignant lymphoma" and "severe jaundice. Christopher’s communication was apparently based on the memo penned by Dr. Dustin, which further advised that the shah had been started on chemotherapy six months previously by his French physicians. The shah, asserted Christopher's memo, needed additional diagnostic tests and chemotherapy and added that it was Dr. Kean' s opinion that Mexico lacked any facility capable providing the "highly technical studies" to diagnose the illness. As the Times investigation found that Kean in fact believed that Mexican medical facilities were more than adequate, it is unknown how or why Christopher's note maintained the opposite.

Also on either this day or the next (20 or 21 October), the medical advisor to the American embassy in Mexico City met with Dr. Dustin in Washington. In response to questions from Dustin, the Mexico City physician detailed the diagnostic and treatment equipment available in the Mexican hospitals, facilities that apparently were perfectly satisfactory for the shah's needs; this was later confirmed by the director of Mexico's National Cancer Institute. But Armao concurrently told the New York Times that only New York City had the requisite facilities, an assertion to which Kean reportedly responded, "nonsense." Armao would eventually become so angered at State, and at Dave Newsom in particular over his efforts to "deflect the shah," that Armao arranged for the hospital in New York to admit the shah under Newsom's name, without State's or Newsom's permission, just "out of spite."

In Christopher's 20 October message to the president, though, it was either stated or implied that Dr. Dustin concurred with the diagnosis and the need for immediate treatment in the United States. Christopher, following Vance's lead, recommended to the president that Prime Minister Barzargan be notified and that the shah be granted leave to enter the United States — but only if there were no "strongly negative responses from the Iranian government." Reversing the agreement seemingly made with Vance the day before (and ignoring the same request from Christopher), Carter instead directed Zbigniew Brzezinski to do the needful to bring the shah into United States forthwith. Brzezinski was told merely to "inform our embassy in Tehran that this would occur." Apparently the presidential directive was either wrongly quoted to Vance or else Vance misunderstood, for he later wrote that the president's decision to admit the shah was only "tentative" and that the final decision would be made only after "satisfactory" word was received from the embassy. But this is not what eventuated. At this point Vance was operating on two premises, both erroneous. The secretary thought that Dr. Dustin had traveled to Mexico City and physically examined the shah, and he believed that the decision to admit the shah was contingent upon receipt of an affirmative response from the Iranians regarding protection of the embassy.

A NIACT (Night Action, immediate precedence) cable was sent to Tehran on 20 October (but dated the 21st due to the Department's practice of using Greenwich Mean Time on cable traffic) directing Chargé Bruce Laingen to advise the Iranian government that "the shah was in the process of being admitted to the United States for urgent medical treatment," and to seek the regime's understanding and its assurances of security for the embassy. Henry Precht, State’s director of the Office of Iranian Affairs, was in Tehran visiting the embassy at that time and he was to accompany Laingen to the meeting with Prime Minister Barzargan and Foreign Minister Yazdi. The White House cable made no mention of any "tentative" decision, to admit the shah, nor did it say that a final decision was contingent upon a "satisfactory" assessment. In fact, it requested no security assessment at all.

Why, then, did the president not proceed with Vance and Christopher's recommendation to test the reaction of the Iranians before making the final decision? There was time available to do so, and the secretary of state certainly seems to have thought that it was being (or had been) done. So far, a definitive answer to this mystery is elusive. But it also raises the question, did it really matter? It is at least theoretically possible that a statement from Barzargan along the lines of "I'm sorry but we can not protect your diplomats from the terrible danger you are creating" would have convinced the president not to admit the shah — or, to be precise, would have caused him to reverse the decision already made — but it seems unlikely. Most probably, even with such a clear expression of the threat, the president would still have admitted the shah, but perhaps with one significant difference, the evacuation of the embassy staff prior to the shah's arrival in New York.

Undeniably, the president and his advisors were already well aware of the probable Iranian reaction, so the most reasonable explanation for neither requesting Barzargan to provide security nor for awaiting reassurances, is that it just wasn't worth the additional time. For one thing, the decision to admit the shah was firm. In Brzezinski's mind, it made no sense to "consult" with the Iranian government or to "bring them into the decision making process." As he saw it, the United States was a sovereign nation and no other nation had the right to exercise a veto over any person whom the United States wished to admit, for whatever reason. And, too, underlying the whole idea of keeping Americans in the embassy was the belief, reinforced by the events of the previous February, that the Iranians would protect the embassy, come what may. Still, Vance and Christopher had made a reasonable recommendation, but somewhere along the way, for whatever reason, the president decided an additional security assessment was superfluous.

In Tehran on the Sunday, 21 October, the White House cable, a decidedly "unwelcome" missive, was received by Bruce Laingen over breakfast. It directed Laingen and Precht to inform Barzargan and the PGOI that the shah was being admitted to the United States on "humanitarian grounds" and the U.S. government expected the PGOI to "provide the necessary level of security for Americans in Iran. To both Laingen and Precht, it was clear from the language of the cable that the decision to admit had already been made and that the shah was even then possibly on the way to New York. Laingen was especially dismayed as he recalled the two previous cables in which he had recommended that the shah be admitted only after the institutions of the new provisional Iranian government had stabilized and the appointment of a permanent American ambassador, a step that would serve as a living sign that the U.S. government truly accepted the new Iranian regime.

Absent these two measures, Laingen argued, the risk of capture of the embassy and its personnel was high. Obviously, his warnings had fallen on deaf ears, as neither of these two desiderata had been met. Carter himself had earlier made it known to the shah, through the personal emissary sent to the Bahamas in April of 1979, that he would not be welcome in the United States until the revolutionary regime in Tehran had established a measure of permanence and stability. Now the president was ignoring not only the informed professional opinion of his ambassador, he was ignoring his own judgment as expressed to the shah. Laingen collected Precht and left to see the prime minister.

Because of the eight-hour time difference between Tehran and Washington, the response from Laingen and Precht arrived in Washington following their meeting with Barzargan, Yazdi, and Abbas. Amir Entezam, a senior MFA official, arrived at the White House also on 21 October. Laingen and Precht first laid out the decision of the administration to admit the shah to medical facilities "soonest," quickly following up with assurances that the president still wished "to work together in any way possible to build a new relationship with Iran." The American diplomats "stressed hope and confidence that the PGOI would take whatever steps are necessary to assure the security of our community in Iran."

The Iranian officials’ reaction was "mixed but generally subdued." Barzargan was "quiet but concerned," indicating an "acceptance of the reality." It was the foreign minister, the American – trained Yazdi, who "dominated the discussion with an explanation of the problems this [the shah’s admittance] would create for the US in Iran." Yazdi made four salient points: (a) the shah "should receive treatment anywhere but the United States;" (b) if the United States absolutely had to allow the shah in, then he should not be treated in New York City — "anywhere else would be marginally better" — as New York City was the "center of Rockefeller and Zionist influence;" (c) to prove that the shah’s illness was not a "ruse," the officials "hoped that Iranian doctors would be allowed to confirm the validity of the medical findings;" (d) the PGOI expected the U.S. government to obtain prior assurances from the shah that he would not engage in political activities while in America and that he give no "press interviews to further his political interests." Laingen summed up the meeting by noting that, "throughout the discussions [the Iranians], particularly Yazdi, never accepted the shah’s illness as serious." Missing from the memo was an additional Yazdi comment: The Iranian people would not believe the story about the shah’s illness and would import a far more sinister meaning to the event.

Of critical importance to the decision to admit the shah, also missing from the memo was any response whatsoever, explicit or implicit, from the Iranians to Laingen’s request for protection for American citizens in Iran, including those in the embassy. Simply put, the cable reported absolutely nothing to Washington of Iranian comments with respect to the provision of protection to the embassy. Yet, for some reason, Carter and his senior White House advisors have almost all written that Barzargan had "promised" or "guaranteed" or "assured" or otherwise gave a "positive official response" for protection for the embassy. But there was just nothing anywhere in the cable addressing that point!

How Washington came to find such assurances in the cable is, to say the least, baffling. One possible explanation is that the absence of a clear warning was sufficient for policymakers merely to assume the Iranian government would take appropriate measures. A second possibility, again, is that there was already in the minds of senior officials the belief that, since the Iranians — and Yazdi personally — had intervened back in February to protect the embassy, they and he would obviously do so again. And there is a third possibility: whatever Laingen said simply didn’t matter. Both diplomats realized that the decision to admit the shah had already been made and that, no matter what they reported back, it would not affect the president’s approval. The cable could have relayed nothing but risqué Irish limericks transliterated to an obscure Mongolian dialect and the effect would have no doubt have been the same.

On Monday, 22 October, the shah arrived in New York on Rockefeller’s private Gulfstream jet. His immediate medical problem was gall stones blocking the bile duct and an enlarged spleen. Regarding the lymphoma, a specialist treating him believed that the deposed monarch had a "50-50 chance for long-term survival." And then three days later, also for reasons that yet remain obscure, in another memo to the secretary of state, the Department’s chief medical officer, Dr. Dustin, wrote again that the "treatment and further care" required for the shah could not be carried out in Mexico. But this, to be sure, was not true.

The nature of what, exactly, the president was really told about the shah’s health was called into question less than eighteen months after the shah arrived in New York. In his 1982 memoirs, Carter claims that he was advised that the shah was "seriously ill" or "quite ill with a disease difficult to diagnose" and which "could be cancer." But in an interview given to the New York Times in May of 1981, Carter had a different explanation. The former president related that he had been told by Vance in a phone call (at some unspecified point after receipt of the first note) that "the shah was desperately ill, at the point of death…that New York was the only medical facility that was capable of possibly saving his life and that he was reminded [by Vance] that the Iranian officials had promised to protect our people in Iran." Yet, "at the point of death" is neither the verbiage nor the implication Vance used. Nor did Dr. Kean use these or synonymous terms. So when, how, and why did the president come to the conclusion that the shah was at death’s door? And again, no one in Iran had told the White House anything about any "promise" to protect the embassy staff.

An even more salient issue is whether the shah’s illness was in fact life-threatening. All evidence now indicates that this was not the case. More to the point, there was sufficient information at the time (in the fall of 1979) that the shah was neither in critical condition, nor at "death’s door"; it was further known that there were suitable and appropriate medical facilities in Mexico that could have diagnosed and treated the shah. So where did the train leave the track, and why?

Dr. William J. Daugherty, who specializes in Middle Eastern affairs, teaches political science at Armstrong Atlantic State University, Savannah, Georgia, USA. He is a former Marine officer and Vietnam War veteran who has served with the National Security Council Staff. He is the author of In the Shadow of the Ayatollah: A CIA Hostage in Iran (2001). His Ph.D. is in government, from the Claremont Graduate School in California.

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