5 unanswered questions about Austin’s prostate cancer treatment

Defense Secretary Lloyd Austin is facing mounting pressure to resign — or at least explain himself — as Republicans accuse the Pentagon chief of dereliction of duty for failing to disclose a hospital visit last week. 

While the Pentagon released a statement from Austin’s doctors Tuesday saying that he underwent surgery before Christmas after being diagnosed with prostate cancer, answering one major question, it’s still unclear why President Biden and other key officials were left in the dark for days. 

The cancer was detected during a routine screening in early December, and Austin underwent surgery to treat it on Dec. 22. But then he returned to the hospital on Jan. 1 with nausea and severe pain, which doctors found was caused by a urinary tract infection, and was admitted to the intensive care unit. 

Even Deputy Defense Secretary Kathleen Hicks was not aware of the hospitalization until Jan. 4, the same day Biden was informed. The press and public were made aware the next day.

Biden only learned of Austin’s cancer diagnosis Tuesday, in a call from Austin hours before the Pentagon informed the public, according to the White House.

Peter Feaver, a civil-military relations scholar and a professor of political science and public policy at Duke University, said the situation has spiraled into a political scandal with serious questions. 

“This is a bit of a bigger political mess than national security mess, but there's serious national security questions, and he's going to have to answer them,” he said. 

Here are five unanswered questions as the Pentagon seeks to contain the fallout.

Were any rules broken? 

Austin oversees one of the largest organizations in the world, including more than a million active-duty troops spread across the globe. 

He is also an integral link in the nuclear chain of command, acting in an advisory role. 

His secretive hospitalization, which comes as the U.S. is aiding in two wars and fighting off Iranian-backed militia group attacks in the Middle East, sparked questions of whether any laws were broken or policies violated. 

Feaver said that since the chain of command was not broken throughout Austin’s hospitalization, given he delegated his authorities to his second in command, it appears no laws were broken. 

However, administrative policies requiring the president to know when his cabinet secretaries are out of commission may have been violated. 

“What was not maintained was the situational awareness of the president and senior team as to who would be on the other end of the line if they felt the need to call,” Feaver said. 

“It almost certainly violated protocols and standard procedures that the White House sets up to maintain situational awareness of not just the secretary of defense but all cabinet officers.” 

Will anyone be punished? 

For now, the Biden administration is standing by Austin as it reviews the situation, and the Pentagon is withholding details about who knew what as it conducts its own review. 

The Pentagon has promised to release the results of its 30-day review into whether rules or protocols were broken in the handling of Austin’s hospital stay. 

“This review is going to help us get to ground truth in a holistic way, so that we can learn from it, importantly, but also ensure that we're doing better next time,” said Pentagon press secretary Maj. Gen. Pat Ryder. 

The White House on Tuesday ordered a review of protocols to determine how cabinet officials delegate authority. And it directed agencies to notify the Office of Cabinet Affairs and the White House chief of staff when a cabinet secretary delegates their duties. 

Some Republican lawmakers, however, faulted Austin for dereliction of duty and are calling for him to be removed. 

Rep. Mike Rogers (R-Ala.), chair of the House Armed Services Committee, announced an inquiry Tuesday into Austin’s failure to disclose his hospitalization. He specifically called out Austin’s chief of staff, Kelly Magsamen, in a letter, saying she waited two days to inform the White House after learning of his hospitalization on Jan. 2. 

“As you must be aware, this lack of transparency is inexcusable and could have resulted in calamity,” Rogers wrote. 

Mark Esper, a former secretary of defense under former President Trump, said the incident is a “big communications failure,” explaining high-ranking Pentagon employees have to be in constant communication about where they are at all times.

“Why weren't procedures followed? Was it incompetence ... or were they told not to? “ Esper told CNN. “That is the key question right now that really needs to be discovered.” 

White House national security council spokesperson John Kirby said Tuesday the president maintains confidence in the secretary.  

Why was there a delay in notifying Biden, Congress and the public? 

Ryder, the press secretary, said there was a delay because Magsamen was out sick at the time of Austin’s hospitalization and the office was sparse during the holidays. 

Ryder said the Pentagon review would shine a light on some outstanding questions, like why the second-in-command under Austin’s chief of staff or other staff members did not immediately notify officials. 

The Pentagon Press Association, a group that represents journalists covering the Defense Department, has complained about the delayed notification to the press, which it says was a breach of the rules for cabinet secretaries.  

And Congress, which was not notified until shortly before the press statement came out, has called for hearings into the issue. 

Was Austin going to tell Biden about his diagnosis? 

It’s unclear when exactly Austin first learned that he had prostate cancer, but Tuesday’s statement from doctors said the screening occurred in early December. 

Austin underwent “minimally invasive surgical procedure called a prostatectomy to treat and cure prostate cancer” on Dec. 22 at Walter Reed Army Medical Center in Washington, D.C. 

And yet Biden only learned of the cancer diagnosis on Tuesday morning, according to the White House. 

“Nobody at the White House knew that secretary Austin had prostate cancer until this morning,” said White House national security spokesperson John Kirby on Tuesday, adding it was “not good” to keep the diagnosis from Biden for so long.

“We’re all gonna learn a whole heck of a lot of lessons from this past week,” Kirby said. 

Ryder said Austin would have eventually informed Biden of the diagnosis, even if there had been no political scandal over the hospitalization. 

Who chose the word ‘elective’ in the initial statement? 

Another key question is why the initial statement on Jan. 5 identified Austin as undergoing an “elective” procedure when describing cancer surgery. 

It's unclear if a required cancer treatment would technically fall under an elective medical procedure, as opposed to a medical emergency. However, reporters at the Pentagon Tuesday said the word choice was misleading. 

When asked who chose the word “elective” in the initial statement, Ryder said he was not a medical professional and deferred to the doctors at Walter Reed.

Tuesday’s statement said Austin “never lost consciousness and never underwent general anesthesia” during the eight days he has been hospitalized.

On Jan. 5, Austin was well enough to resume his full duties. He remains at Walter Reed but is out of the intensive care unit and is recovering. Austin was conscious at the time of his admittance and remained so throughout his stay, according to the Pentagon.