Balancing act key for GOP's Frist

WASHINGTON -- The New Hampshire primary is more than 2½ years away, but the presidential candidacy of Senator Bill Frist of Tennessee, who visited the Granite State twice last month, will probably be defined by a history-making battle unfolding on Capitol Hill, political analysts say.

As a Senate majority leader with open presidential ambitions, Frist needs a smooth-running ship to build a credible legislative legacy.

But as a Republican vying for primary election votes from increasingly restless religious conservatives, the two-term senator and Harvard-trained surgeon needs to demonstrate a steely determination to lead the charge on the religious right's most hallowed issue: control of America's courts.

Now those competing political priorities are about to collide. Late last week, Frist allied himself with religious conservatives who want to change Senate rules and eliminate the filibuster, the Democrats' most effective tool for blocking votes on President Bush's judicial nominees.

The move brought him into open warfare with his Senate colleague, Democratic leader Harry Reid of Nevada, who on Friday accused Frist of exploiting religion, and could retaliate by using Senate rules to shut down virtually all Senate operations.

''Frist has clearly reached a fork in the road," said Scott Reed, strategist to Bob Dole, a former Senate majority leader-turned-presidential candidate. The brewing fracas on Capitol Hill, Reed noted, is ''going to be a real test of his leadership skills."

Frist's future is complicated because of his Senate majority leader post, which requires constant give-and-take with Republican colleagues nursing their own ambitions, as well as a duty to carry out the White House agenda. Former majority leader Howard Baker, Frist's friend and Tennessee colleague, once likened the job to ''taming tigers."

''Being Senate Republican leader isn't about expressing your own views and principles, as a presidential candidate would," said Senator John E. Sununu, Republican of New Hampshire. ''The day-to-day operation is about negotiation with members of your own party, as well as with the opposition party."

The recent track record for Senate party leaders with presidential ambitions is not good. Baker failed in his presidential bid in 1980, followed by Dole in 1996. Lyndon B. Johnson, Senate majority leader in the 1950s, was an unsuccessful candidate for the presidential nomination in 1956 and 1960. He became vice president and stepped into the Oval Office after John F. Kennedy's assassination.

''Our expectations for majority leader are high. There's a lot of attention paid to what you do," said Sarah Binder, associate professor of political science at George Washington University. ''But the rules don't give him a lot of power."

Supporters say Frist is not rattled by the torrent of competing political pressures now pouring down on him. ''Not to be cute, but Bill Frist is accustomed to taking out people's hearts and putting them in other people," said his spokeswoman, Amy Call. ''He is used to having to be perfect and be seamless when he operates. He is used to that kind of pressure -- and if you make a mistake you make it once."

Frist's cool demeanor assures that he is well-liked by fellow senators. But Republicans on Capitol Hill say he lacks his predecessors' political instincts for taming tigers. ''He's a BlackBerry addict," Binder noted, referring to his electronic communications with senators. ''That's not how Lyndon Johnson got it done. It takes face-to-face interaction."

Frist, 53, assumed his leadership post just two years ago, after he emerged as the White House favorite to replace Trent Lott of Mississippi, who was under fire for making nostalgic comments about segregation.

For a conservative but pragmatic Republican such as Frist, the pitched battle over the courts is particularly dicey. ''He gets a lot of pressure from the conservative right to be active on issues which are not popular with other voters," said Binder.

Frist looked as if he almost dropped a ball in this juggling act last month, when he was accused of making a ''video diagnosis" of Terri Schiavo, the incapacitated Florida woman.

For the religious right, Schiavo's plight was a deeply emotional cause that underscored the growing power of judges. Courts consistently rejected her parents' pleas to keep her alive and instead affirmed her husband's request to remove Schiavo's feeding tube and let her die.

Frist, whose career as a heart and lung transplant surgeon routinely brought him into contact with brain-dead donors, read the court transcripts, talked to family members and a neurologist who had examined her two years earlier, watched video footage of her, and then took to the Senate floor to express doubts about whether she was actually in a ''persistent vegetative state," as courts and other doctors had concluded.

Critics immediately accused the senator of making a secondhand diagnosis in a political ploy to appeal to the Republican Party's religious right. And the decision by Congress to intervene to keep Schiavo alive proved deeply unpopular with most Americans.

Frist then distanced himself from hard-core conservatives, including House Republican leader Tom DeLay of Texas, who used Schiavo's death to call for retribution against ''activist" judges. Frist declared support for an ''independent judiciary." And, knowing that some senior Republican senators were opposed to changing the filibuster rule, Frist made overtures toward Democrats suggesting the possibility of compromise. In the process, he drew the ire of many religious right leaders.

Late last week, however, Frist donned boxing gloves, drafting Ed Gillespie, former chairman of the Republican National Committee, to mount a campaign to counter the ''war room" the Senate Democrats are running and the multimillion-dollar advertising campaign their liberal allies have launched. Frist also agreed to participate in a Christian right event next Sunday designed to ramp up grass-roots pressure on senators to confirm Bush's judicial nominees.

News of Frist's starring role in the event, which will feature a video feed to evangelical churches, created such a stir that his press office on Friday distributed an October 2004 newspaper account of then-presidential candidate John F. Kerry's speech at a black Baptist Church and claimed critics were applying a double standard.

Democratic leader Reid called Frist's participation in the event ''beyond the pale. . . . He should rise above all this. God does not take part in partisan politics."

Like another GOP presidential prospect, Massachusetts Governor Mitt Romney, Frist is widely perceived as a social conservative but doesn't precisely fit the mold. Just as Romney has come under attack by some on the right for failing to stop gay marriage from taking root in Massachusetts, Frist has drawn fire from antiabortion activists who say he wasn't enough of a leader against therapeutic human tissue cloning.

Medical associates said Frist was balancing political imperatives with his own instinctive doctor's embrace of cutting-edge medicine. Meanwhile, an antiabortion leader called him ''a wimp."

But ''bold" and ''audacious" are the labels most often applied to Frist by friends and associates. At 16, he piloted a plane solo without telling his parents. At 28, two days before his planned wedding to a longtime girlfriend, he flew home to Nashville and called off the engagement, freeing him to pursue the woman who would become his wife.

Scion of a prominent Tennessee family, Frist studied medicine at Harvard but left Boston frustrated by the lack of medical innovation he saw during a seven-year surgical residency he mostly pursued at Massachusetts General Hospital. (He still co-owns a vacation home on Nantucket.)

He studied heart transplantation at Stanford University. Then he founded and ran Vanderbilt University's transplant center, performing the first successful heart-lung transplant in the South.

When there was a shoot-out in the Capitol in 1998, Frist rushed to the scene with his medical bag, saving the assailant's life. Following the anthrax scare after the attacks of Sept. 11, 2001, he wrote a book on bioterrorism.

Globe staff reporter Rick Klein and correspondent A.B. Stoddard contributed to this report.