Biden, flanked by Secretary of State Antony Blinken and Secretary of Defence Lloyd Austin, makes a statement to the news media ahead of a cabinet meeting at the White House in Washington. Image Credit: REUTERS file

WASHINGTON: President Joe Biden’s administration pledged from day one to restore truth and transparency to the federal government — but now it’s facing a maelstrom of criticism and credibility questions after Defense Secretary Lloyd Austin’s hospitalization was kept secret for days, even from the White House.

The controversy has prompted a government-wide review of what protocols are in place to prevent such failures and the Pentagon is scrutinizing its own procedures following the extraordinary lapse, which left even Austin’s top deputies unaware of his condition for days.

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Senior congressional Republicans are investigating whether Austin ignored legal requirements to inform Congress, and Biden administration officials are privately fuming about Austin’s lack of disclosure, believing it to be an unforced error that undercuts the president’s message of restoring competency through his administration.

The prolonged focus on a senior official’s medical secrecy is also shedding an unwelcome spotlight on Biden’s own health, which already was under scrutiny as the oldest president in history seeks another term and faces regular questions and concerns from voters about his age. Combined, the questions over transparency and health have put the White House on the defencive for days as the election year opens and have given ammunition to Biden political opponents who question whether his administration is living up to its pledges of competency.

No policy on handling absences

There is no government-wide policy in the Biden administration on how absences of Cabinet officials should be handled, according to people familiar with the matter, although there is a general expectation that the White House should be made aware of such circumstances. The people spoke on condition of anonymity to discuss government practices.

While there is no statutory requirement for public officials to disclose their medical histories, it has become common practice for presidential and vice presidential candidates and incumbents to do so. Many choose to share more about their health than a private citizen would.

Here’s what has been revealed publicly about Austin’s condition

When was he admitted?

Austin was admitted to Walter Reed National Military Medical Center on December 22 and underwent surgery to treat the cancer. He developed the infection a week later. Biden and other senior administration officials were not told for days about his hospitalization or his cancer.

According to the doctors, the cancer was detected when Austin had a regular screening in early December. They said he “underwent a minimally invasive surgical procedure” and went home the next day. But on Jan. 1 he reported nausea and severe abdominal, hip and leg pain due to the infection.

What was his prognosis?

They said his prostate cancer was detected early, and his prognosis is excellent.

The cancer revelation comes after days of persistent questions about Austin’s hospitalization and the delays in notifying key leaders. And it raises more questions about the transparency and truthfulness of the Defense Department, which for the past four days said he was initially at Walter Reed for an “elective medical procedure,” and not prostate surgery.

Austin sits just below Biden

Austin, who is 70, sits just below Biden at the top of the US military’s chain of command, and his duties require him to be available at a moment’s notice to respond to any national security crisis.

That includes always being ready to enter secure communications with other officials in the event of an incoming nuclear attack, something that would be difficult from an ICU bed.

The Pentagon initially said Austin’s December treatment was for an elective medical procedure. It was not clear how prostate cancer treatment would be considered elective.

Some prominent Republicans, including Donald Trump, called for Austin to be removed from his job.

No plans to resign

But the Pentagon said the retired four-star general had no plans to resign and the White House said Biden was not seeking to remove him. Austin remains at Walter Reed.

The way the Defense Department handled Austin’s hospitalization stands in contrast to how the State Department dealt with then-Secretary of State Colin Powell’s prostate surgery on Dec. 15, 2003.

Image Credit: Reuters

The State Department spokesperson at that time issued a statement in the morning making public that Powell, a retired four-star general and former chairman of the Joint Chiefs of Staff, was in surgery at Walter Reed and would remain there for several days.

It also disclosed Powell would be on a reduced schedule while he recovered from the operation. The department’s spokesperson at the time, Richard Boucher, then offered details on Powell’s surgery in his daily briefing.

Ryder said the Pentagon would do better as the White House acknowledged damage to its credibility.

“I think the Pentagon has been very, very honest with themselves about the, the challenge to credibility by what by what has transpired here and by what and by how hard it was for them to be fully transparent with the American people,” Kirby said.

How did Walter Reed treat Austin’s infection?

On January 2, Austin was moved to the Intensive Care Unit for close monitoring and a higher level of care, the hospital said.

Further evaluation revealed abdominal fluid collections impairing the function of his small intestines. This resulted in the back up of his intestinal contents.

Walter Reed treated this by placing a tube through Austin’s nose to drain his stomach. The abdominal fluid collections were drained separately.

It was unclear if Austin had robotic laparoscopic surgery, which is considered minimally invasive. But in one recent study of 404 men who underwent minimally invasive surgery using robots to help surgeons remove the prostate and lymph nodes, 7.4% of the patients developed symptomatic collections of fluid in the body.

Austin’s infection has cleared but he remains hospitalized. Walter Reed said it anticipates he will make a full recovery but cautions “this can be a slow process.” The Pentagon and Walter Reed are not speculating about a possible discharge date.

How common is prostate cancer?

Prostate cancer is the most common cancer, aside from non-melanoma skin cancer, among American men. Overall, about 1 in 8 US men will be diagnosed with prostate cancer during their lifetime. Most men diagnosed with prostate cancer do not die from it.

The risk of developing prostate cancer varies based on age, ethnicity and other factors. About 6 in 10 prostate cancers are diagnosed after age 65, according to the American Cancer Society.

The risk is higher in African American men and in Caribbean men of African ancestry than in men of other races.

The Pentagon said Jan. 5 that Austin’s procedure was elective, meaning that treatment was chosen by the patient. More than 95 per cent of patients survive prostate cancer for 5 years or more after diagnosis, although those in the later stages of the disease have dimmer survival prospects.