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Defense Secretary Lloyd Austin says he is 'deeply sorry' for keeping hospitalization for prostate cancer a secret. Here's how we got here.

Facing questions from reporters for the first time since his hospitalization for complications from prostate cancer surgery, Defense Secretary Lloyd Austin admitted Thursday that keeping it a secret was a mistake.

“Let me be crystal clear: We did not handle this right. I did not handle this right,” Austin said at a press conference at the Pentagon. “I should have told the president about my cancer diagnosis, and should also have told my team and the American public. I take full responsibility. I apologize to my teammates and to the American people.”

Austin told reporters that he is recovering well but still has some leg pain and will continue to undergo physical therapy and has been using a golf cart to get around at the Pentagon. He had a noticeable limp as he walked to and from the podium.

Why was Austin hospitalized?

Austin leaves the podium after a news conference at the Pentagon on Thursday.
Austin leaves the podium after a news conference at the Pentagon on Thursday. (Andrew Caballero-Reynolds/AFP via Getty Images)

Austin was diagnosed with prostate cancer in early December and underwent surgery for it on Dec. 22.

At the time, a Pentagon spokesperson said only that Austin had an “elective medical procedure,” was discharged the following day and “continued to work from home.”

But the surgery led to serious intestinal complications. On Jan. 1 — more than a week after his prostatectomy — Austin was rushed by ambulance to the intensive care unit at Walter Reed National Military Medical Center in Maryland with what was later described as “severe abdominal, hip and leg pain.” He underwent tests and was diagnosed with a urinary tract infection.

Austin returned to the Pentagon Monday after “conducting his duties from home since his release from Walter Reed National Military Medical Center on Jan. 15,” according to the Pentagon.

When did the White House find out about Austin’s hospitalization?

Austin speaks during Thursday's press conference.
Austin speaks during Thursday's press conference at the Pentagon. (Andrew Caballero-Reynolds/AFP via Getty Images)

Nobody in the White House — not even President Biden — knew that Austin was at Walter Reed until Jan. 4, when Austin’s chief of staff, Kelly Magsamen, finally told national security adviser Jake Sullivan, who alerted the president. The Pentagon then waited to announce the hospitalization until after 5 p.m. on Jan. 5.

Compounding the mystery, Deputy Secretary of Defense Kathleen Hicks, the person who would stand in for Austin in an emergency, was also in the dark until Jan. 4 — even though the Pentagon said that Austin transferred some authorities to her during his elective procedure on Dec. 22 and then again when he entered the ICU on Jan. 1. Hicks remained in the Caribbean, where she was vacationing, until Jan. 6.

Why did it take so long for Austin’s team to tell anyone?

Defense Secretary Lloyd Austin.
Defense Secretary Lloyd Austin pauses during a press conference at the Pentagon on Thursday. (Alex Wong/Getty Images)

Asked to explain why neither Biden, Hicks nor anyone outside Austin’s inner circle was looped in earlier, Pentagon spokesman Maj. Gen. Pat Ryder said that Magsamen had been “ill with the flu.”

Ryder added that “prostate cancer and the associated procedures are obviously deeply personal.”

Austin said Thursday he was “deeply sorry” for not disclosing it to President Biden but denied creating a “culture of secrecy.”

Austin said the diagnosis was a “gut punch” and that his first instinct was to keep it private.

Why has Austin’s hospitalization caused so much controversy?

Lloyd Austin stands at a microphone in front of an American flag and a plaque that reads: The Pentagon, Washington
Austin at the Pentagon, Thursday. (Andrew Caballero-Reynolds/AFP via Getty Images)

The defense secretary’s duties require him to be available at a moment’s notice to respond to any national security crisis — these days, a very real possibility. U.S. law on “reporting of vacancies” requires executive agencies to report top-level absences and the names of anyone serving in an acting capacity to both houses of Congress; the Pentagon has similar protocols.

And while the Pentagon says Austin “never lost consciousness and never underwent general anesthesia” while in the ICU for a urinary tract infection, he “was under general anesthesia during [the initial prostatectomy] procedure” — a procedure he didn’t even tell the White House about.

“This is no minor lapse,” Slate’s Fred Kaplan recently explained. “U.S. military forces are on high alert in the Middle East. ... If Biden wanted any of those forces to take offensive action, his orders to the regional combatant commander would go through the secretary of defense.”

Are medical issues in the Cabinet usually handled this way?

President Biden holds a Cabinet meeting at the White House.
President Biden, flanked by Secretary of State Antony Blinken (left) and Defense Secretary Lloyd Austin (right), holds a Cabinet meeting at the White House on Oct. 2, 2023. (Kevin Dietsch/Getty Images)

No. When Secretary of State Colin Powell had prostate surgery on Dec. 15, 2003, the State Department issued a statement the same morning telling the public that Powell was at Walter Reed; that he would remain there for several days before returning home; and that he would be on a reduced schedule while recovering.

Likewise, the Pentagon immediately announced that Defense Secretary Donald Rumsfeld had undergone rotator cuff surgery in 2006 — and did the same two years later when his successor, Robert Gates, fell and broke his arm.