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What we know about Defense Secretary Lloyd Austin’s hospitalization

By Haley Britzky, Natasha Bertrand and Oren Liebermann, CNN

(CNN) — A statement from Walter Reed National Military Medical Center on Tuesday revealed after days of uncertainty that US Defense Secretary Lloyd Austin had been treated at the hospital in December for prostate cancer and later readmitted due to complications.

The revelation came days after the Pentagon announced that Austin had been in the hospital since New Year’s Day – a surprise announcement late Friday that shocked both the Pentagon press corps and the national security establishment.

CNN’s reporting, the statement provided by doctors at Walter Reed and further disclosures from the Pentagon have shed some light on the circumstances around the secretary’s hospitalization — and why it took so long for senior officials to be informed.

The timeline

On December 22, Austin “underwent a minimally invasive surgical procedure called a prostatectomy to treat and cure prostate cancer” that been discovered in “early December,” according to a Tuesday statement from Dr. John Maddox, trauma medical director, and Dr. Gregory Chesnut, Center for Prostate Disease Research of the Murtha Cancer Center Director, at Walter Reed National Military Medical Center.

Austin “was under general anesthesia during this procedure” and he “recovered uneventfully from his surgery and returned home the next morning,” according to the statement. The doctors said that Austin’s “prostate cancer was detected early, and his prognosis is excellent.”

It was previously unclear whether Austin had been under anesthesia during the procedure or what he was being treated for. Pentagon spokesman Maj. Gen. Pat Ryder said over the weekend that Austin went into the hospital for an elective procedure on December 22 when he was on leave, went home the following day and “continued to work from home through the holidays.” The secretary, Ryder said, began experiencing “severe pain” and was transported from his home to Walter Reed by an ambulance on January 1, where he was admitted to the intensive care unit.

According to the doctors’ statement, Austin was readmitted to the hospital on January 1 with complications from the procedure, “including nausea with severe abdominal, hip and leg pain,” and was found to have a urinary tract infection.

The next day, according to the statement, “the decision was made to transfer him to the ICU for close monitoring and a higher level of care. Further evaluation revealed abdominal fluid collections impairing the function of his small intestines.” A tube was placed through Austin’s nose to drain his stomach, and the abdominal fluid collections were drained by non-surgical drain placement.

On January 2, according to Ryder, Austin delegated some authorities to Deputy Secretary of Defense Kathleen Hicks “on the basis of medical advice.” The same day, Austin’s chief of staff Kelly Magsamen, senior military assistant Lt. Gen. Ronald Clark, and Chairman of the Joint Chiefs of Staff Gen. CQ Brown were notified of Austin’s hospitalization.

On January 4, Magsamen informed Hicks and national security adviser Jake Sullivan of Austin’s hospitalization. The same day, Magsamen and Hicks began drafting a public statement and congressional notifications.

It took roughly a day to release those notifications and a statement, Ryder said, because they were working to ensure they “had the facts, to make sure it was coordinated.” Ultimately, the statement was released at roughly 5 p.m. ET on Friday, and Austin was not among those who signed off on it. Congress was notified shortly before.

Austin’s condition

According to the Walter Reed doctors, Austin “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,” they said. “During this stay, Secretary Austin never lost consciousness and never underwent general anesthesia,” they said in the Tuesday statement.

Austin has resumed his duties.

White House was not informed

Ryder, in response to a question from CNN on Monday, said the Pentagon did not inform the White House that Austin was having the procedure.

The Pentagon spokesman was also unable to say at that time whether Austin had been unconscious at any time between his arrival at Walter Reed on January 1 and his delegation of authorities to Hicks. But he emphasized that at “no time was national security in jeopardy,” and that as he understood it, Austin was “capable of executing his duties as the Secretary of Defense.”

Among those who knew of Austin’s trip to the hospital were his personal security detail, who accompanied him to the hospital, and a junior military aid who met with him at Walter Reed on January 2.

“[T]here was positive contact in terms of the Secretary’s location at all times,” Ryder said.

For days, other Pentagon officials and senior members of the Biden administration — including President Joe Biden — did not know that the defense secretary was in the hospital. The president did not learn of Austin’s prostate cancer diagnosis under Tuesday morning.

Among those in the dark about the hospitalization was Hicks, to whom Austin transferred some of his authorities on January 2.

Ryder said Monday that January 1 was not the first time Hicks had taken over some of Austin’s duties due to him being in the hospital; she was also not told after he transferred some authorities to her during his elective procedure on December 22. The White House was not told about that procedure, either.

No notification was made to Hicks, Biden, the National Security Council, or the military service secretaries until days later.

The cause for delay in notification following the January 1 hospitalization, Ryder said, was that Magsamen was “ill with the flu.” It remains unclear why Magsamen did not delegate the responsibility to notify the White House or Congress, or why others in Austin’s immediate circle who knew of his condition did not send the notification. It also remains unclear why no one informed the White House of Austin’s surgery on December 22.

“So I will say upfront … the secretary has taken responsibility in terms of the overall transparency concerns,” Ryder said. “And again, you know, I work every day with Chief Magsamen, and you’re not going to meet anybody that works harder than her. And she was ill with the flu. And so, not standing up here to make excuses other than the explanation for why there was a delay and the fact that we know we can do better.”

In terms of Magsamen’s failure to notify the proper officials, Ryder said one thing under review is essentially taking “the human out of the loop” to ensure a more consistent process.

Asked whether Austin was out of the loop – since the secretary had been in the hospital for days before Biden or the national security adviser knew and it appeared to go unnoticed – Ryder said that Austin “works incredibly hard every single day to make sure this nation is safe.”

“He had a complication due to a surgery, went into the hospital to get it taken care of, and he remains very, very focused on making sure that the department has what it needs and what it needs to do to defend the country,” he said. “So you know, again, not making excuses here, but having worked with him for a very long time, and having observed him up close, he’s not out of the loop. He is incredibly engaged. You will never meet a more dedicated public servant.”

30-day review of Pentagon’s processes and procedures

In a memo Monday, Magsamen directed a 30-day review of the Pentagon’s processes and procedures for notifying senior national security leaders and the White House when the secretary needs to transfer his authorities to the deputy secretary of defense.

The memo, which appears to be the first public memo from Magsamen, reflects the Pentagon’s understanding that the notification process surrounding Austin’s hospitalization was lacking.

Magsamen has directed the department’s director of administration and management, together with the Defense Department’s general counsel, “to immediately lead a review to identify the relevant facts and circumstances during this period and evaluate the processes and procedures through which the Deputy Secretary of Defense was notified” that she would be given Austin’s responsibilities.

“The purpose of such review is to better understand the facts surrounding these events and to recommend appropriate processes going forward. This review will help to ensure (1) clarity and transparency when a determination has been made that certain authorities have been transferred, and (2) that proper and timely notification has been made to the President and White House and, as appropriate, the United States Congress and the American public,” the memo states.

The memo makes no mention of Austin’s earlier hospitalization on December 22 for the elective medical procedure. The review, the memo states, should include a timeline of events from January 1, 2024 – not the earlier medical procedure that precipitated Austin’s subsequent admission to the hospital.

While the review is ongoing, Magsamen mandated that any time a transfer of authority occurs from Austin to Hicks, the Pentagon will ensure relevant parties are notified by email, including the general counsel, the chairman and vice chairman of the Joint Chiefs of Staff, the combatant commanders, the service secretaries, the Service Chiefs of Staff, the White House Situation Room, and the senior staff of the secretary and deputy secretary of defense. The email will also include the reason the transfer of authorities is necessary, Magsamen wrote.

Biden standing by Austin

Despite the mounting questions about why Austin and his staff failed to notify the White House, Congress, and the National Security Council, officials have insisted that Biden is standing by Austin.

National Security Council spokesman John Kirby said Monday that there are “no plans or anything other than for Secretary Austin to stay in the job and continue in the leadership that he’s been demonstrating.”

In a press gaggle on Monday from the Pentagon, Ryder said Austin has not offered to resign, nor has his chief of staff or anyone else who was in a position to notify the president of Austin’s condition. He remains in the hospital, though he is no longer in intensive care, Ryder said.

Asked why the Pentagon did not inform the White House about Austin’s initial procedure at Walter Reed on December 22, Ryder said he did not know, but that the Pentagon is now reviewing their notification procedures and “considering the impact” of statutory reporting requirements.

“[B]ottom line is we know we can do better, and we will do better,” Ryder said.

Political reaction

As the Pentagon attempts to mitigate the fallout of the news with the White House standing behind Austin, lawmakers are demanding accountability and more answers.

House Armed Services Chairman Mike Rogers on Tuesday said his panel had launched a formal inquiry into the secretary’s hospitalization and had sent letters to Austin, Hicks and Magsamen requesting information and documents related to it, the circumstances surrounding it, and why Pentagon officials did not communicate his condition to the White House, Congress or the public.

“My colleagues and I have grave concerns about the handling of your absence and hospitalization. It is unacceptable that neither the Department of Defense (“Department”), the White House, nor the Congress were accurately informed of your position or capacity. With wars in Ukraine and Israel, the idea that the White House and even your own Deputy did not understand the nature of your condition is patently unacceptable,” Rogers wrote in his letter to Austin.

On Monday, Senate Armed Services Chairman Jack Reed wished Austin “a speedy and complete recovery,” but added in a statement that he was concerned “that vital chain of command and notification procedures were not followed.”

“He is taking responsibility for the situation, but this was a serious incident and there needs to be transparency and accountability from the Department,” Reed said. “This lack of disclosure must never happen again.”

The ranking member of the Senate Armed Services Committee, Republican Sen. Roger Wicker, also wished Austin a speedy recovery over the weekend but lambasted the Pentagon for “deliberately” withholding Austin’s medical condition “for days.”

“That is unacceptable,” he said. “We are learning more every hour about the Department’s shocking defiance of the law.”

Republican Sen. Joni Ernst of Iowa told reporters, “It’s absolutely unacceptable, when we’ve got Houthis attacking Americans and carrier ships, when we have the Israeli/Gaza war going on, what we have in Ukraine going on, and we have a secretary of defense that’s just absent.”

Sen. Joe Manchin said that Austin’s actions “were very disturbing,” and that he supports some sort of hearing – public or private – to examine what happened. “Congress needs answers,” the West Virginia Democrat said.

While most senators have expressed shock, Democratic Sen. Elizabeth Warren of Massachusetts said she didn’t see a need for any further investigation into this situation. “Some Republicans want to play politics 24/7,” she said, adding that she has no interest in what caused his hospitalization.

“I hope that the Secretary recovers fully and speedily and is back at work at 100%, as soon as possible. He has taken full responsibility for this. And I’m quite certain it will never happen again,” she said.

On Tuesday, Wicker expressed further concerns following the announcement Austin has prostate cancer.

“I am glad Secretary Austin’s prognosis is good and he is expected to make a full recovery, but the underlying questions remain. The Secretary’s condition is severe. The failure to notify Congress of his inability to perform his duties was a clear violation of the law,” he said. “It remains unclear who decided to ignore federal law but there must be accountability. An internal review – ordered by the same Chief of Staff who played a part in this crisis – is woefully inadequate.”

Austin said in a statement on Saturday that he takes full responsibility for his decisions about disclosure and commits “to doing better.”

This story has been updated with additional developments.

CNN’s Piper Hudspeth Blackburn Kevin Liptak, Manu Raju, Haley Talbot, Morgan Rimmer and Melanie Zanona contributed to this report.

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