WASHINGTON — The secrecy surrounding Defense Secretary Lloyd Austin's hospitalizations due to prostate cancer surgery^[1] set off a political firestorm,^[2] launched multiple reviews^[3] and triggered calls for his ouster.

To some, the uproar may be puzzling or even offensive. An individual's right to privacy, particularly about medical issues, is sacred. And most people have that right to privacy. But not all.

As a member of President Joe Biden's Cabinet, a key national security adviser and a guardian of the use and maintenance of the country's nuclear arsenal, Austin gives up some personal privacy. He must be ready to act on a moment's notice if the U.S. is attacked and must be able to make an array of immediate, critical decisions on the deployment of troops or the use of America's military might anywhere in the world.

Although he transferred key decision-making authorities to Deputy Defense Secretary Kathleen Hicks during the surgery and early part of his current hospital stay, he did not tell her why. He also did not tell Biden, other U.S. government leaders, and his senior staff about his surgery, his diagnosis — or that he was rushed by ambulance to the hospital — until days later.

Here's a look at what happened and why it set off an outcry and launched a government-wide demand to fix such lapses.

The cancer

Austin, 70, was diagnosed with prostate cancer in early December after a routine screening.

He was admitted to Walter Reed National Military Medical Center on Dec. 22 and underwent a surgical procedure called a prostatectomy. It is a common procedure to remove all or part of the prostate gland and is often used to treat prostate cancer^[4], He went home the following day.

On Jan. 1, he felt nauseous and was having severe abdominal, hip and leg pain, due to what turned out to be a urinary tract infection related to the surgery. His doctors, who released a detailed medical statement on Tuesday, said he was under anesthesia during the initial surgery, and when he went to intensive care on Jan. 2 the infection had triggered an intestinal backup and his stomach had to be drained with a tube in his nose.

The doctors said his cancer was detected early, and his prognosis is excellent.

Transfer of authority

Based on routine protocols, Austin transferred decision-making authorities to his deputy. That process is not unusual and happens anytime Austin does not have access to secure, classified communications.

For example, last month he flew out to a U.S. Navy aircraft carrier, and he transferred authorities to Hicks during that flight, took them back once he was on the ship, which has full communications capabilities, and then did a similar swap on the flight back to land.

It's not uncommon for Austin to not give Hicks a reason for the transfer, which is handled by email. And such transfers happen regularly across the Defense Department and other agencies, including by military service leaders, service chiefs and combatant commanders.

The department has said Hicks is taking on some of Austin's day-to-day duties as he recovers.

The secrecy

The secrecy surrounding the surgery and his current hospital stay has been extensive and shocking to senior leaders in government and the Pentagon. And it's raised questions about his candor with staff and the Biden White House.

Pentagon officials disclosed last Friday that Austin was hospitalized, but gave no details. They later acknowledged that a few of his senior staff were told Jan. 2, but they did not tell the White House until Jan. 4. And they did not disclose his cancer diagnosis when it was first made a month ago, the Dec. 22 surgery or details about the latest complications until Jan. 9.

A glaring omission appears to be during his phone call on Saturday with Biden. The White House says it was a very brief call for Biden to share well wishes with Austin, who was still hospitalized.

But questions remain — did the president not ask Austin why he was in the hospital? Or did he ask, and not get a full answer? No one will say.

Asked repeatedly about the delays in public notification about the secretary's condition, Pentagon press secretary Maj. Gen. Pat Ryder said discussions about prostate cancer screening and treatment are often deeply personal and private.

Why would Austin have less privacy?

Government transparency is a vital, long-held tenet of democracy. On Biden's first day in office, the White House pledged to bring back truth and transparency and rebuild trust with the American people.

Austin's failure to disclose his hospitalization and the fact that he'd delegated decision-making to his deputy for days before telling the president, is counter to normal practice. The president and other Cabinet members routinely make public when they are incapacitated or have serious health issues. Doctors for the president —- the current one and those who served before him — have routinely done press conferences on medical check-ups.

Austin is just below the president in the chain of command for the military, including oversight of U.S. nuclear bombs. He's sixth in the line of succession if something happens to the commander-in-chief.

And his hospitalization comes as the U.S. juggles war and diplomacy in Israel and Ukraine, and as American ships in the Red Sea shoot down missiles and drones fired by Iranian-backed Houthis in Yemen, and militias repeatedly attack bases where U.S. troops are stationed in Iraq and Syria.

The attacks have forced the Biden administration to threaten retaliation against the Houthis and to strike back in Iraq and Syria multiple times, requiring sensitive, top-level discussions and decisions by Austin and other key military leaders.

Does it matter?

It comes down to trust.

The multiple omissions, if not lies, have eroded the credibility of the Pentagon at a critical time, with both the public and the Biden White House. And, the lack of disclosure has — for no reason — given the administration a black eye, and provided fodder for Biden opponents, who are calling for Austin's resignation.

It also shines a bright light on the apparent lack of detailed procedures that should be followed if a key leader is suddenly rushed to an ambulance and incapacitated.

Pentagon leaders incessantly describe the department as a “planning organization.” The five-sided building is famously known for its obsession with chain of command, endless processes for troops down to the lowest private, and war plans for any and all contingencies around the world.

It's unclear if staff violated any procedures, or if those rules aren't detailed enough or well known.

Opportunity missed

Austin's silence also was a critical opportunity missed. He failed as a mentor.

Austin could have seized his prostate check and early discovery of the cancer as a teaching moment, for his many male troops and workers across the department, and, even more importantly, for the African American population.

Prostate cancer is the most common cancer among American men. It affects 1 in every 8 men — and 1 in every 6 African American men — during their lifetime.

Specifically, it's been a problem for some of Austin's own troops. The Pentagon and Veterans Affairs Department are involved in multiple studies to address cancer rates — including prostate cancer — among service members, such as those deployed to war, aviators and aircrew, and those operating the nation's nuclear missiles.

When TV personality Al Roker was diagnosed with prostate cancer in 2020, he went public and urged others at risk — particularly Black men — to ensure they see a doctor and get checkups to stop a cancer that is very treatable if detected early.

“The problem for African American men is any number of reasons from genetics to access to healthcare, and so we want to make it available and let people know they got to get checked,” Roker said.

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Associated Press writer Tara Copp contributed to this report.