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. 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 defensive for days as the election year opens and have given ammunition to Biden political opponents who question whether his Democratic administration is living up to its pledges of competency.

The Pentagon disclosed Tuesday afternoon, after days of silence on Austin’s medical diagnosis, that the secretary has prostate cancer. Austin, 70, was admitted to Walter Reed National Military Medical Center on Dec. 22 and underwent surgery to treat the disease, but developed a urinary tract infection a week later and was admitted into intensive care. He remained hospitalized Wednesday.

Austin was diagnosed with prostate cancer during a routine screening in early December, but the White House insisted that no one there, including Biden, knew about the diagnosis until Tuesday.

“I think we all recognize — and I think the Pentagon has been very, very honest with themselves — about the challenge to credibility by what has transpired here, and by how hard it was for them to be fully transparent with the American people,” John Kirby, spokesman for the National Security Council, said Tuesday. “We all recognize that this didn’t unfold the way it should have — on so many levels.”

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.

Other top figures, though, have opted to remain cagey about their health, including Senate Minority Leader Mitch McConnell after recent incidents in which he froze up, and the late Supreme Court Justice Ruth Bader Ginsburg, who delayed revealing the recurrence of pancreatic cancer or the seriousness of her condition before her death weeks ahead of the 2020 presidential election.

Disclosures to the public about a Cabinet official’s absence have varied between federal agencies. For instance, the Justice Department in 2022 announced that Attorney General Merrick Garland would undergo surgery to remove enlarged prostate tissue a week in advance of his procedure.

Transportation Secretary Pete Buttigieg cleared his parental leave with the White House after he and his husband adopted twins in 2021, but the leave was not disclosed publicly until he had returned to work.

Multiple current and former officials said White Houses generally aim to keep closer tabs on the whereabouts of the secretaries of state and defense due to their prominent positions in the line of presidential succession, and particularly in the case of the Pentagon.

Cedric Leighton, a retired U.S. Air Force colonel, noted that the chain of command for the U.S. military runs from the president through his defense secretary to the combatant commanders, who then execute orders that could include command and control of any potential use of nuclear weapons.

He said it was “imperative” that the president, top administration and military officials, select members of Congress and even key allied counterparts be notified of even a temporary absence.

“It’s highly unusual for any Cabinet secretary not to notify the president, the White House chief of staff, or the NSC of any absence, especially a medical one,” he added.

White House chief of staff Jeff Zients, in a Tuesday memo to Cabinet secretaries, directed them to report back by Friday on any existing procedures for delegating authority in the event of incapacitation or loss of communication. He also is requiring agencies to provide notice if an agency expects a circumstance in which a Cabinet head can’t perform his or her duties.

The White House also reiterated this week that it is committed to releasing medical information about Biden promptly.

Biden last underwent a physical in February 2023, when his doctor declared him to be “healthy, vigorous” and “fit.” A skin lesion removed from his chest was later found to be a basal cell carcinoma, among the most common and easily treated forms of cancer.

Biden transferred power to Vice President Kamala Harris for one hour and 25 minutes in 2021 when he was under anesthesia during a routine colonoscopy. The White House provided advance notice that he was undergoing the procedure, but waited until Biden awoke before saying precisely when he was unconscious.

The president last year began using a continuous positive airway pressure, or CPAP, machine at night to help with sleep apnea. His use of the machine was only disclosed to the public after journalists spotted telltale indents on his face from the CPAP mask.

Biden’s sleep apnea diagnosis was first revealed in medical reports in 2008, but it did not appear in medical write-ups of the physical he took when he ran for the White House in 2020, or of the two physicals he underwent since taking office in 2021.

The Austin incident has sparked bipartisan criticism from lawmakers who have numerous questions about how his condition could have been kept secret from the White House, Capitol Hill and the public.

Mississippi Sen. Roger Wicker, the top Republican on the Senate Armed Services Committee, said Tuesday that Austin’s lack of disclosure to key lawmakers about his condition and transferring of duties to Deputy Defense Secretary Kathleen Hicks was a “clear violation of the law.” Congress was not told until Friday afternoon of Austin’s hospitalization, the Pentagon has said, a day after Biden and national security adviser Jake Sullivan were informed.

Wicker’s aides said a federal law governing vacancies requires Congress to be informed immediately if a Senate-confirmed official dies, resigns or is otherwise unable to carry out the duties of the office. A March 1999 opinion from the Justice Department’s Office of Legal Counsel said the requirement could apply to sickness in such circumstances.

Sen. Richard Blumenthal, D-Conn., said he was not satisfied with the Pentagon’s explanations so far and called for the Senate Armed Services Committee to look into the matter, potentially with a hearing.

“He owes Congress and the American people additional facts to ensure us that he can continue to serve,” Blumenthal said.

In the House, Armed Services Committee Chairman Mike Rogers on Tuesday sent letters to Austin, Hicks and Kelly Magsamen, Austin’s chief of staff, demanding a detailed accounting of what transpired regarding notification and operational impacts during the secretary’s hospitalization.

“Someone has to resign or be fired,” said Sen. Tom Cotton, R-Ark., an Army veteran. “Maybe there are more facts to come out that will shed light on who exactly is responsible besides the secretary, but to show such a breakdown in communication and poor judgment in such a simple matter really raises questions about judgment in much bigger matters.”

(AP)