US defense secretary Lloyd Austin was hospitalised for the third time since December as he underwent treatment for a bladder issue following his prostate cancer diagnosis.
Mr Austin, a retired four-star general and the first Black secretary of defence, was put under general anaesthesia on 12 February for a non-surgical procedure to treat the “emergent bladder issue,” his doctors at the Walter Reed National Military Medical Center said in a new statement.
They added that he was set to get back to work on 13 February and that “a prolonged hospital stay is not anticipated”.
In Brussels, he was set to attend a monthly meeting of the Ukraine Defense Contact Group, which includes the more than 50 countries that are sending military aid to Ukraine to help them push back the Russian invasion. Mr Austin was also scheduled to take part in a separate meeting of Nato defence secretaries in the Belgian capital. The secretary instead hosted a virtual session from his home after leaving the hospital.
The 11 February hospital visit was Mr Austin’s third hospitalisation following his prostate cancer diagnosis in December. Pentago press secretary, Major General Pat Ryder, was unable to state on 12 February if the bladder issue was a complication following his 22 December 2023 surgery for prostate cancer.
Maj Gen Ryder added that Mr Austin is no longer receiving treatment for his cancer diagnosis apart from physical therapy to deal with leg pain.
Dr John Maddox and Dr Gregory Chesnut at Walter Reed National Military Medical Center in Bethesda, Maryland just outside Washington DC, said in a statement on 12 February: “The current bladder issue is not expected to change his anticipated full recovery. His cancer prognosis remains excellent.”
This comes after Mr Austin faced widespread criticism in early January when it emerged that the 70-year-old had failed to disclose his cancer diagnosis – and that he was out of action for treatment – to the president and the rest of the administration for several days.
Here’s what we know so far about this latest hospital stay:
February hospitalisation and transferral of duties
The Pentagon announced on 11 February that Mr Austin had been hospitalised for treatment of symptoms indicating a possible “emergent bladder issue”.
Maj Gen Pat Ryder said in a statement that Mr Austin was taken to hospital by his security detail at about 2.20pm on 11 February.
He added that Mr Austin was taken to Walter Reed National Military Medical Center to be seen for symptoms suggesting an “emergent bladder issue”.
“The deputy secretary of defense and the chairman of the Joint Chiefs of Staff have been notified. Additionally, White House and Congressional notifications have occurred,” the statement read.
Initially, Mr Austin retained the duties of his office and he “travelled to the hospital with the unclassified and classified communications systems necessary to perform his duties”.
But, in a follow-up statement, the press secretary said that, “Secretary Austin transferred the functions and duties of the office of the secretary of defense to deputy secretary of defense, Kathleen Hicks. The deputy secretary of defense has assumed the functions and duties”.
The transferral of his duties came after he was moved to a critical care unit in the hospital.
Doctors at the hospital said in yet another statement later on 11 February that “after a series of tests and evaluations, the secretary was admitted into the critical care unit at Walter Reed National Military Medical Center for supportive care and close monitoring”.
“At this time, it is not clear how long Secretary Austin will remain hospitalised. The current bladder issue is not expected to change his anticipated full recovery. His cancer prognosis remains excellent,” they added.
The initial statement regarding Mr Austin’s hospitalisation came within three hours of his arrival at Walter Reed, a clear reaction to avoid the mistakes of the past.
During his previous hospitalisation for prostate cancer in early January, President Joe Biden did not know for three days that his top defence official was out of action.
The defence secretary later admitted that there had been failures in communication about his medical status – both with the public and the rest of the Biden administration. The uproar over the lack of communication prompted the Pentagon to conduct a review of its procedures.
Prostate cancer diagnosis and previous hospital stay
Back in early December, Mr Austin was diagnosed with prostate cancer. He underwent a surgical procedure on 22 December, for which general anaesthesia and staying overnight at Walter Reed were needed.
Following complications from that procedure, Mr Austin was readmitted to the hospital on New Year’s Day with a urinary tract infection.
Mr Austin spent two weeks in the hospital and subsequently worked from home for another two weeks.
During this time, he delegated his authority to Ms Hicks, but the Defense Department didn’t share the hospital stay with the White House, top officials in its own ranks, Congress, or the media for a number of days.
Mr Biden only became aware of Mr Austin’s absence three days after he was hospitalised when national security advisor Jake Sullivan was told just before he was set to take part in an event the defence secretary had also been scheduled to attend.
Ms Hicks was also not made aware of Mr Austin’s status for three days, despite being his deputy – and the person to take on his duties in his absence.
She took on the duties of the secretary temporarily, even as she was on vacation in Puerto Rico.
Pentagon officials were made aware about two hours before an initial public statement was released, and Congress was told about 15 minutes before, according to Politico.
This all came at a time of escalating tensions in the Middle East over Israel’s military actions in Gaza, rising attacks on US military bases in the Middle East by Iran-backed militias, as well as a time when the US Navy was combating strikes by Houthi rebels on international shipping in the Red Sea.
The lack of communication flew in the face of standard practices around reporting medical problems of cabinet secretaries and other top US officials, and prompted significant concerns regarding transparency.
Backlash over lack of communication
Both Democratic and Republican members of Congress slammed the Pentagon for its handling of the situation and called on Mr Austin to step down.
In mid-January, Mr Biden acknowledged that it was a lapse in judgement for Mr Austin not to share his medical status, but the president added that he still has confidence in the secretary.
“Generally, the president has been like, this can’t happen again,” an anonymous White House official told Politico early last month.
“He has been missing for one week, and nobody, including his boss, Crooked Joe Biden, had a clue as to where he was, or might be,” he ranted.
“He has performed poorly, and should have been dismissed long ago, along with ‘General’ Mark Milley, for many reasons, but in particular the catastrophic surrender in Afghanistan, perhaps the most embarrassing moment in the history of our Country!”
The Pentagon Press Association, which represents media outlets covering the department, sent a letter to Maj Gen Ryder and Chris Meagher, the assistant defense secretary for public affairs saying: “The fact that he has been at Walter Reed National Military Medical Center for four days and the Pentagon is only now alerting the public late on a Friday evening is an outrage”.
The letter added: “At a time when there are growing threats to US military service members in the Middle East and the US is playing key national security roles in the wars in Israel and Ukraine, it is particularly critical for the American public to be informed about the health status and decision-making ability of its top defense leader.”
Towards the end of February, Mr Austin is set to appear before the Republican-controlled House Armed Services Committee to address concerns over the matter.
Appearing before the Pentagon press corps on 1 February, Mr Austin said: “We did not handle this right, and I did not handle this right. I should have told the president about my cancer diagnosis. I should have also told my team and the American public.
“And I take full responsibility. I apologise to my teammates and to the American people.”
The Office of the Secretary of Defense has now finished a month-long review of the communication procedures regarding the transfer of responsibilities.
Maj Gen Ryder told the press that Mr Austin is looking at the review, adding that while large parts of it are classified, the Pentagon would attempt to share as much as possible with the public.
Legal experts have said that Mr Austin may have violated a law regarding “reporting of vacancies”, which states that executive agencies have to report any absences of top officials and who is serving in an acting capacity to both the House and the Senate, Reuters reported on 9 January.
“The law is largely procedural and does not spell out any penalties for lapses. Legal experts said that Austin appears to have clearly violated the rule,” the news agency noted. “Austin may have also violated internal US Department of Defense protocols.”
Who will step in if he’s out of action?
Ms Hicks briefly took on duties of the secretary of defence on 11 February – marking the second time she has taken on his duties so far this year.
During the Trump administration, several cabinet secretaries served in an “acting” capacity – without the Senate confirmation which is required for a permanent secretary. Mr Austin, a retired four-star general, was confirmed by a vote of 93-2 on 22 January 2021.
Before Mr Trump came to office, there was little precedent in terms of acting defense secretaries.
“There have only been two acting defense secretaries in the 71 years since the role was created,” Defense One noted in January 2019. “Although there is little debate that the deputy secretary is the most appropriate person to fill in until the Senate can confirm a replacement... there is a fierce debate over what time limits – if any – the administration faces to nominate that person.”
The 1986 law known as the Goldwater-Nichols Act governs how top officials are replaced at the Pentagon. It states that the deputy secretary has full powers of the office whenever the secretary’s position is vacant.
But the law doesn’t set time limits for the deputy’s time at the top, and it states there are no constraints on the authorities of the deputy when they take on the acting secretary role, retired two-star Marine general Arnold Punaro, who helped write the law, told Defense One.
Hosts virtual session on Ukraine aid following hospital release
Mr Austin was released from the hospital to resume his duties from home on 12 February.
In a statement, the Pentagon said: “Following consultation with medical staff, Secretary Austin was released from Walter Reed National Military Medical Center today at approximately 3.30 pm.”
“He is recovering well and resumed his full functions and duties today at 5pm. The deputy secretary of defense, chairman of the Joint Chiefs of Staff, the White House, and Congress have been notified,” the defense department said. “On the advice of his doctors, Secretary Austin will recuperate and perform his duties remotely from home for a period before returning to work at the Pentagon later this week. He has full access to the unclassified and classified communications systems necessary to perform his duties.”
The secretary’s doctors at Walter Reed said that he was admitted on 11 February “with discomfort and concern from a bladder issue related to his December 2023 prostate cancer surgery. His condition indicated a need for close monitoring by the critical care team and supportive care. His diagnostic evaluation identified the cause of his bladder issue and it was corrected with non-surgical procedures” on 12 February.
The physicians added that Mr Austin “remained in good condition throughout and no longer needed critical care monitoring” as of the morning of 13 February.
“He progressed well and was discharged to his home today. He is anticipated to continue his full recovery,” they said. “The bladder issue was not related to his cancer diagnosis and will have no effect on his excellent cancer prognosis.”
Mr Austin, who cancelled a trip to Brussels for meetings with Nato and the Ukraine Defense Contact Group, instead hosted a virtual session from his home on 14 February, pushing for further aid to Ukraine as it fights the Russian invasion.
As the war approaches its two-year mark on 24 February, Kyiv is in urgent need of ammunition and artillery as it faces rationing of its arms even as Russia has completely changed its economic output to a war footing.
The Wilson Center noted in September 2023 that “Russia’s military expenditure has tripled compared to pre-war times. By 2023, the government intends to spend $160bn on military needs, or 40 per cent of its budget. Combined with regional and private war-related expenditures, this figure may surpass 10 per cent of GDP in 2023”.
Speaking to the Ukraine Defense Contact Group, Mr Austin said he was planning on being there in person “but I had to return to the hospital for non-surgical procedures”.
“I’m in good condition, and my cancer prognosis remains excellent,” he added.
Mr Austin said the group was working on filling Ukraine’s most acute short-term needs, such as “its urgent need for more artillery, ammunition, and air defense missiles”.