The White House was caught off guard once again on Tuesday when it learned that Defense Secretary Lloyd J. Austin III had been diagnosed with prostate cancer a month ago and had surgery to treat the disease under general anesthesia on Dec. 22 without notifying either President Biden or his staff.
The new revelations exacerbated the frustration in the West Wing, where officials were still dealing with the discovery that Mr. Austin, 70, had been secretly hospitalized last week for complications resulting from a condition that the Pentagon did not disclose even to the White House until Tuesday morning.
While aides to the president said he would not fire Mr. Austin, they acknowledged the breakdown in communications and moved to assert new discipline over the administration. Jeffrey D. Zients, the White House chief of staff, ordered a review of procedures and sent a directive to cabinet secretaries making clear that they are to inform the White House when they are unable to perform their duties.
“Notify the Offices of Cabinet Affairs and White House Chief of Staff in the event of a delegation of authority or potential delegation,” Mr. Zients wrote in the memo, which was obtained by The New York Times. “This notification should occur when agencies anticipate or are preparing for a delegation of authority and again when the delegation occurs.” He added that he wanted any such notification in writing.
John F. Kirby, a White House spokesman, said that Mr. Biden’s “first and foremost concern is the secretary’s health” and that the president still had “full faith and confidence” in Mr. Austin and would keep him until the end of his term.
But Mr. Kirby acknowledged concerns with the secrecy. “It’s not good,” he told reporters at a briefing. “It’s certainly not good, which is why we want to make sure it doesn’t happen again.”
Republicans remained dissatisfied. “The failure to notify Congress of his inability to perform his duties was a clear violation of the law,” said Senator Roger Wicker of Mississippi, the ranking Republican on the Senate Armed Services Committee. “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.”
The president was not told until Thursday that Mr. Austin had been taken by ambulance to Walter Reed National Military Medical Center in Bethesda, Md., three days earlier, and the Pentagon did not make it public until Friday evening. Even then, the Pentagon said only that he was being treated for complications from “an elective medical procedure.” Mr. Austin did not even reveal the specifics of his condition in a telephone call with the president on Saturday, according to White House officials.
The White House only learned Tuesday morning that Mr. Austin had been diagnosed with prostate cancer, at which point Mr. Zients informed Mr. Biden. Mr. Kirby confirmed that the White House likewise did not know at the time about the Dec. 22 surgery that required general anesthesia, which normally would trigger the transfer of a defense secretary’s power to his deputy.
A statement released later Tuesday by Mr. Austin’s doctors at Walter Reed disclosed that he had been diagnosed in “early December” and did not describe the resulting surgery as “elective.” Mr. Austin was brought back to the hospital on Jan. 1 after experiencing nausea with “severe abdominal, hip, and leg pain,” according to the doctors, who determined that he had developed a urinary tract infection. He remains hospitalized and the doctors said they “anticipate a full recovery although this can be a slow process.”
The White House memo to the cabinet reflected the sense of consternation that the nation’s top defense official could be in the intensive care unit for so long without the president or other major national security officials being aware of it. Even Mr. Austin’s deputy secretary, who would be called upon to act in a crisis in his absence, was not told at first that he was in the hospital.
While Mr. Biden has been described as understanding, people close to the White House recounted a deep frustration and bafflement among some on the president’s team. Mr. Austin, a reserved retired general, does not have a particularly intimate relationship with Mr. Biden or his team, but he is well liked and deeply respected, making the situation all the more upsetting to them.
For days, White House officials pressed the Pentagon to disclose more about the medical issues and were flabbergasted that it took so long. The defense secretary’s secrecy has unwittingly provided critics with ammunition to accuse Mr. Biden of not being in full control of his own administration and raised questions about how the 81-year-old president would handle a health crisis of his own.
The Defense Department has initiated its own 30-day review of what happened and how its procedures should be changed if necessary. In a memo, Kelly E. Magsamen, Mr. Austin’s chief of staff, on Monday ordered Jennifer Walsh, the department’s administration and management director, “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 should carry out the functions and duties of the secretary of defense.”
While the review is underway, Ms. Magsamen directed that if the secretary’s power is delegated again, his office should notify the chairman and vice chairman of the Joint Chiefs of Staff, the combatant commanders, service secretaries and chiefs of staff, the Pentagon general counsel, senior aides to the secretary and his deputy and the White House Situation Room.
In his own memo on Tuesday, Mr. Zients told all cabinet departments to send him their current procedures by Friday so that he can evaluate them to determine if they need adjustment. He made clear that power should be transferred “when a cabinet member is traveling to areas with limited or no access to communication, undergoing hospitalization or a medical procedure requiring general anesthesia, or otherwise in a circumstance when he or she may be unreachable.”
Mr. Austin participated in a secure conference call on the morning of New Year’s Day with Mr. Biden, Secretary of State Antony J. Blinken, the national security adviser Jake Sullivan and other officials about operations in the Middle East, according to the White House. At some point later that day, Mr. Austin experienced what a spokesman said was “severe pain” and was taken to Walter Reed.
Four aides to the secretary were informed the next day, according to the Pentagon, but did not promptly pass word to the White House or to key colleagues at the Defense Department. Mr. Sullivan was not informed until Thursday and even then was not told specifically what prompted the secretary’s treatment. He and Mr. Zients informed Mr. Biden, White House officials said. The Pentagon then made the secretary’s hospitalization public on Friday evening in a bare-bones statement.
A key question will be how the delegation of authority to Kathleen Hicks, the deputy defense secretary, was handled. Ms. Hicks, who was on vacation in Puerto Rico at the time, was told on Jan. 2 that the secretary’s power was being transferred to her, but officials have said it was not until Thursday that she was informed that Mr. Austin was actually in the hospital. She offered to return to Washington but was told that was unnecessary because Mr. Austin would be well enough to assume his duties once more from the hospital the next day.
Mr. Austin has acknowledged the lack of transparency. “I recognize I could have done a better job ensuring the public was appropriately informed,” he said in a statement on Saturday. “I commit to doing better.”
Karine Jean-Pierre, the White House press secretary, pointed to that as an acceptance of accountability in explaining why the president has remained supportive of his defense chief. “Secretary Austin was very clear,” she said, “and we appreciate that he had taken responsibility for this.”
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