Secretary of Defense Lloyd Austin testifies at a Senate Appropriations Committee hearing on Capitol Hill October 31, 2023 in Washington, DC.
Washington CNN  — 

President Joe Biden on Friday said Defense Secretary Lloyd Austin had a lapse in judgement by not notifying him of his hospitalization, but White House officials made a point in emphasizing Austin remains heavily involved in military decision making.

Touring an Allentown, Pennsylvania-area coffee shop, Biden was asked by reporters whether Austin’s delay in informing him about his treatment for prostate cancer showed a lapse in judgment.

“Yes,” Biden responded. But asked if he still maintains confidence in Austin, the president said: “I do.”

Still, White House officials said Austin had been heavily involved in the US airstrikes on Houthi targets in Yemen as he approaches his second week in the hospital.

Austin’s role in the US airstrikes was “seamless,” National Security Council spokesman John Kirby told reporters Friday, though he was working from Walter Reed National Military Medical Center.

“His participation was no different than it would be on any other given day, except that he was briefing the president on options and engaged in the discussions from the hospital,” Kirby said during a news briefing aboard Air Force One.

Kirby said Austin “was fully engaged as he would be in any other event.”

The defense secretary has been “very much in command of all issues,” a senior administration official who has spoken with Austin multiple times told CNN, coordinating the strikes while facing sharp questions about the initial lack of transparency related to his health.

Defense officials told CNN that Austin, who is hospitalized with complications from the treatment of prostate cancer, has access to everything he needs to fulfill his duties. Austin monitored Thursday’s strikes real-time from the hospital “with a full suite of secure communications,” an official said.

The US and UK-led strikes in Yemen on Thursday come as Austin and Biden deal with criticism over transparency, the strength of Biden’s command over his Cabinet officials and the efficiency of the process for transferring military power and decision-making after the belated announcement of Austin’s prostate cancer diagnosis.

Austin has now been hospitalized for more than 11 days due to complications from the treatment.

The fallout from that hospitalization – and the delays in reporting it to the public, the president and senior national security officials – has seen the initiation of three separate reviews from the White House, the Pentagon and the Pentagon’s inspector general to examine the notification process and whether policies need to be changed, not to mention increasing scrutiny from Capitol Hill.

“This was an unusually prolonged hospitalization,” said Dr. Oliver Sartor, chief of the Genitourinary Cancer Disease Group at the Mayo Clinic, who is not treating Austin. “At this point, I am a little bit uncertain as to what is happening, but it would seem as though whatever complication that he has experienced is actually rather severe, because otherwise the hospitalization would not have lasted this long.”

According to different statements from the Pentagon, Walter Reed National Military Medical Center officials and the White House, medical providers identified the cancer during a screening in “early December.” Officials haven’t given a precise date.

Austin underwent what the Pentagon described as an “elective medical procedure” on December 22. He was discharged from Walter Reed and went home December 23.

On New Year’s Day he participated in a call with Biden and other administration officials. On that same day – it’s not clear whether it was before or after Austin participated in the call – he was taken back to Walter Reed after experiencing “severe pain.”

He was transferred to the hospital’s intensive care unit the next day. That same day, top defense officials, including the chairman of the Joint Chiefs of Staff, Austin’s military adviser and Austin’s own chief of staff, learned he was hospitalized, and Austin delegated some of his authority to his deputy.

It took another two days for Biden to learn about Austin’s hospitalization on January 4. A day later, the Pentagon released the first public statement revealing Austin’s hospitalization.

Austin on Saturday released his first public statement since being hospitalized, in which he conceded he “could have done a better job ensuring the public was appropriately informed.”

Austin was transferred from the ICU on Monday. At that point, the public had not been told exactly why he was in the hospital – and neither had the president, despite the two men speaking over the weekend.

Biden was made aware about Austin’s cancer diagnosis on Tuesday morning, and the rest of the world learned about it later that afternoon.

Working from the hospital amid military strikes

Austin remains hospitalized in good condition and has resumed his full duties, Pentagon spokesman Maj. Gen. Pat Ryder said.

“The secretary gave the order to Central Command to initiate those strikes,” Ryder said Friday on “CNN This Morning,” adding that afterwards, Austin monitored the strikes, conducting phone calls with Biden’s national security adviser Jake Sullivan and other top military officials for an initial assessment.

“He’s been actively engaged throughout,” Ryder said.

Another senior administration official said that following a barrage of Houthi attacks in the Red Sea on Tuesday, Biden convened his national security team to discuss possible military options – and that it was at the end of that meeting that Biden specifically ordered Austin carry out the airstrikes.

Senior White House officials pushed the Pentagon to release a statement on Austin’s hospitalization after learning of his status last week, two administration officials told CNN earlier this week. White House chief of staff Jeff Zients and Sullivan called Austin’s chief of staff, Kelly Magsamen, last Thursday urging the department to release a public disclosure statement as soon as possible, the officials said.

The Pentagon said that department officials began drafting the public statement as “a logical next step,” seemingly pushing back on reports that the White House pressed defense officials to release a statement. Politico was the first to report on the White House’s push for a statement.

Questions remain over Austin’s hospitalization

Several important questions remain, including why Biden apparently didn’t learn about Austin’s cancer for about a month after the diagnosis was made – despite the president and Austin speaking last weekend after news of his hospitalization broke – and why members of Austin’s own inner circle didn’t learn about the complications for a day after he was hospitalized. The intensely private defense secretary has since allowed more of his health details to be released.

In public statements, Austin’s doctors have reported that he was readmitted to the hospital on New Year’s Day with complications that followed a recent surgery to treat prostate cancer. Those complications included a urinary tract infection and fluid buildup in his abdomen that impaired the function of his small intestines. He also reportedly had severe pain in his abdomen, hips and legs.

“To me, it was a bit vague exactly what the complication was,” Sartor said.

“Fluid is a pretty nebulous term because there are so many bodily fluids out there,” Sartor said, noting that in that part of the body it might have been urine, blood, or even fluid from the bowel.

Other experts said that because Austin is a high-ranking official, his doctors may be exercising an abundance of caution and that might explain Austin’s extended hospital stay.

“Taking care of big-name people who get into trouble, you start getting very, very cautious,” said Dr. Otis Brawley, an oncologist at Johns Hopkins Kimmel Cancer Center.

“It’s possible that it if were me and I had the problems he had on January 1, that I’d already be at home,” said Brawley, who is not treating Austin. “Taking care of senators, Supreme Court justices, you get very, very cautious.”

Members of Congress want accountability

Calls for accountability over the lack of transparency have been steadily rolling in from members of Congress.

“This doesn’t need to happen again,” Sen. Roger Wicker, the top Republican on the Senate Armed Services Committee, said on Thursday. “We’re thankful that nothing so serious occurred during this incapacity of the secretary that national security suffered, but it is a learning experience, I hope, for the administration, for the secretary, and an opportunity for us to make sure this never happens again.”

Other legislators said the US was lucky there was no major national security emergency while Austin was undergoing treatment and before notification of his hospitalization had been made.

“We’re talking about command here, and this is serious,” Sen. Deb Fischer, a Nebraska Republican, said Thursday, warning that the breach in protocol damaged the US’ ability to project strength on the world stage. “Look at what’s going on in the world – this is so serious that you have somebody out of pocket, the president doesn’t even know that the secretary of defense is out of pocket.”

One Democrat went as far as to call on Austin to resign. Rep. Chris Deluzio of Pennsylvania said he “lost trust in Secretary Lloyd Austin’s leadership of the Defense Department due to the lack of transparency.”

But Austin’s job appears to not be in any danger. 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.”

But Kirby later also tersely acknowledged significant shortcomings in Austin’s failure to notify the public, members of Congress and the president about his condition.

“It is not optimal for a situation like this to go as long as it did without the commander in chief knowing about it,” he said on Tuesday.