Updated January 9, 2024 at 4:04 PM ET
Defense Secretary Lloyd Austin was treated for prostate cancer, which was identified last month, Walter Reed National Military Medical Center said in a statement, and complications from that procedure led to his hospitalization on New Year's Day. The White House said President Biden was only informed that Austin had prostate cancer Tuesday morning.
White House spokesman John Kirby told reporters that Biden was informed earlier this morning that Austin had prostate cancer by his chief of staff, Jeff Zients. No one at the White House knew that Austin had prostate cancer until this morning, Kirby said.
The Walter Reed statement statement — from Dr. John Maddox, trauma medical director, and Dr. Gregory Chesnut, director of the Center for Prostate Disease Research of the Murtha Cancer Center, at Walter Reed — is the first indication of why Austin was hospitalized on New Year's Day. It still does not answer questions, however, of why everyone, including the news media, was kept in the dark about where he was or his condition.
New rules for Cabinet members
The secrecy surrounding Austin's hospitalization prompted the White House to take a hard look at rules for Cabinet members, according to a memo obtained by NPR.
Zients on Tuesday told Cabinet secretaries in the memo that he was reviewing the rules for how Cabinet members delegate their authority when they are hospitalized, under anesthesia, traveling to places with limited access to communication or are otherwise unable to be reached.
Zients ordered Cabinet members to submit their current protocols in writing for his review by Friday — and also emphasized that they need to keep the White House informed about potential cases where they need to delegate authority.
At the White House briefing, Kirby said Biden retains confidence in Austin, but acknowledged: "It is not optimal for a situation like this to go as long as it did without the commander in chief knowing about it, or the national security adviser knowing about it, or frankly other leaders at the department of defense. That's not the way this is supposed to happen."
Timeline of events
The Walter Reed statement provided a timeline of the events that led to Austin's hospitalization. It said Austin has undergone regular prostate-specific antigen (PSA) surveillance as part of his routinely recommended health screenings. Prostate cancer, the most common cause of cancer among American men, affects 1 in every 8 men — and 1 in every 6 Black men — during their lifetime.
"Changes in his laboratory evaluation in early December 2023 identified prostate cancer which required treatment," the statement said. "On December 22, 2023, after consultation with his medical team, he was admitted to Walter Reed National Military Medical Center and underwent a minimally invasive surgical procedure called a prostatectomy to treat and cure prostate cancer."
A prostatectomy is the surgical removal of the prostate gland. It is sometimes done in a minimally invasive way, using, for instance, a robot to help the surgeon perform the operation more precisely. Despite the Walter Reed statement that Austin "required treatment," the Pentagon has continued to call Austin's procedure "elective."
Austin was under general anesthesia during this procedure, which the White House was not aware of at the time. He recovered from his surgery and returned home the next morning, the statement said, adding: "His prostate cancer was detected early, and his prognosis is excellent."
But on Jan. 1, Austin was admitted to Walter Reed with complications from the Dec. 22 procedure, including nausea with severe abdominal, hip and leg pain. Initial evaluation revealed a urinary tract infection, the statement said.
The following day, Austin was transferred to the intensive care unit, where he was found to have abdominal fluid collections that impaired the function of his small intestines, according to the statement.
"This resulted in the back up of his intestinal contents which was treated by placing a tube through his nose to drain his stomach. The abdominal fluid collections were drained by non-surgical drain placement," the statement said. "He has progressed steadily throughout his stay. His infection has cleared. He continues to make progress and we anticipate a full recovery although this can be a slow process. During this stay, Secretary Austin never lost consciousness and never underwent general anesthesia."
Kirby said Biden didn't learn Austin was in the hospital until late Thursday, Jan. 4, shortly after Jake Sullivan, the national security adviser, and Zients learned about it. The two men spoke Saturday, Kirby said, but haven't spoken since then.
Austin remains in the hospital, though he has returned to his full duties.
Secrecy surrounding the hospitalization
Kathleen Hicks, the deputy secretary of defense, assumed the top role on Tuesday, Jan. 2, a not-unusual transfer of power that sometimes occurs purely for operational reasons. She did not learn of Austin's hospitalization until that Thursday. Hicks was on vacation in Puerto Rico at the time.
When Hicks learned of Austin's hospitalization, she "immediately engaged staff on the drafting of a public statement and congressional outreach. She also began to make contingency plans to return to Washington, D.C., on Friday. However, she was informed that afternoon that the secretary was preparing to resume full communications capability and the associated operational responsibilities on Friday," the official said.
Defense Department officials did not make a public announcement about Austin's hospitalization until last Friday. The secrecy is in contrast to the usual practice among the president and Cabinet members, who will generally provide notice of when they are stepping away from their official duties.
Sen. John Thune, R-S.D., who is on the Republican leadership team in the Senate, said Tuesday he was "sorry" to learn of Austin's diagnosis.
"I'm glad he's getting it addressed. I just wish that he had been more forthcoming about it," he said. "I think in a position like his transparency is essential. And ... we didn't see that. And that raises a lot of concerns and questions in his position — with all the national security interests of the country at risk."
Austin said in a statement released Saturday evening said he knows he could "have done a better job ensuring the public was appropriately informed. I commit to doing better. But this is important to say: this was my medical procedure, and I take full responsibility for my decisions about disclosure."
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