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GAO report points to lack of doctors for VA care in territories

For American Samoa — lack of adequate Internet service & air travel service

Pago Pago, AMERICAN SAMOA — While most military veterans in the US Pacific islands received timely primary and mental heath care, the US Government Accountability Office (GAO) found that some delays and weaknesses in the referral process to community providers such as inconsistent guidance of staff roles and responsibility, according to a GAO study publicly released last Thursday.

Results of the study were send to Congressional committees with oversight on Veterans Affairs — in both the US Senate and US House — who requested the report, as well as to Congresswoman Aumua Amata and Guam Congresswoman Madeleine Z. Bordallo.

The study was requested through a US House report, which accompanied the Military Construction, Veterans Affairs, and Related Agencies Appropriations Bill 2017, and included a provision for GAO to review the scheduling, staffing, outreach, and access management practices at VA Pacific Islands Health Care System (VAPIHCS) that provides health care services to approximately 50,000 veterans that reside in the Pacific Islands of Hawai’i, American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands.


“The study provides further proof of the challenges that veterans in the Pacific Islands face,” Amata said last Friday responding to Samoa News request for comments. And she hopes that the new Secretary of the Veterans Affairs — when confirmed by the US Senate — takes action on the GAO recommendations.

According to the Congresswoman, she along with her US Pacific Islands colleagues in the US House — US Reps. Madeleine Bordallo of Guam, Gregorio K. Sablan of the Northern Mariana Islands, Tulsi Gabbard of Hawai’i and Colleen Hanabusa of Hawai’I — “will continue to fight to ensure that our veterans can receive the care that they are owed.”

“The Pacific Islands continue to need special care and attention due to the vast distances between ourselves and the United States mainland,” said Amata, who noted that she had spoken with US House Veterans Committee Chairman Roe and “he has assured me that his staff will be following up on the issues raised by the GAO.”

She explained that the Veterans Committee would “investigative staff into the field to hear from Pacific veterans first hand and then holding a hearing to further explore opportunities for improving Pacific Veteran healthcare.”

In a public statement released last Thursday, Bordallo said, “Our veterans deserve better. Some progress has been made to improve health care services for veterans who live on Guam and the other Pacific territories, but this report underscores that more needs to be done.”

“This report is also helpful as I continue advocating in Congress for better care and services for veterans who sacrificed much for our island and nation,” Bordallo said.


In it’s 67-page report, GAO, the investigative arm of the US Congress, also provided a summary of its findings, along with specific details. It also noted that GAO didn’t travel to American Samoa the island of Maui, Hawai’i for the study, but spoke with clinic staff from these locations via teleconference while in Honolulu.

For the sample of veterans’ medical records that GAO reviewed, GAO said it found that most veterans received primary and mental health care from the Department of Veterans Affairs’ VAPIHCS within timeliness goals set by VA’s Veterans Health Administration (VHA).

However, GAO also found that some of these veterans experienced delays related to the processing of their enrollment applications, contacting them to schedule appointments, and completing comprehensive mental health evaluations.

For the sample of veterans’ medical records that were reviewed, GAO said VAPIHCS referred nearly all specialty care to non-VA providers within VHA’s timeliness goal, but the time taken to provide care was variable and sometimes lengthy.

Specifically, VAPIHCS sent specialty care referrals to the Veterans Choice Program (Choice Program) — for veterans that GAO reviewed, the number of days to receive care from the Choice Program was, on average, 75 days.

GAO also found that VAPIHCS faces challenges recruiting and retaining physicians. As of last October 17 of approximately 100 VAPIHCS physician positions were vacant, as were several other types of health care providers.

Some of the challenges VAPIHCS faced are unique to the Pacific Islands, such as the availability of only one local medical school from which to recruit, along with travel burdens and a high cost of living that may discourage physicians from relocating there.

According to GAO, the University of Hawaii’s John A. Burns School of Medicine is the only local medical school across Hawai’i, Guam, and American Samoa from which VAPIHCS recruits physicians.

American Samoa, Guam, and Hawai’i all include counties, facilities, or populations designated as Health Professional Shortage Areas, which indicate health care provider shortages in primary, dental, or mental health care. And these designations indicate a limited number of local physicians for VAPIHCS to target in the event of a vacancy.

Finding physicians that are willing to relocate to such remote locations is difficult, according to VAPIHCS officials, said GAO, adding that both American Samoa and Guam are thousands of miles from the U.S. mainland, and travel to and from these islands requires significant time and money.

For example, American Samoa only has two direct commercial flights a week and Guam has only a daily direct commercial flight to Honolulu.

GAO also notes that residents face a high cost of living, limited community resources, and trade-offs associated with island living. “While other regions of the country face similar challenges, they may be more pronounced living on an island where alternatives are limited,” the report said.

For example, the cost of living in Hawai’i is higher than the nationwide average. VAPIHCS officials also said that physician candidates have raised concerns about the quality of the public school system in some areas of the islands, which could add a potential expense of sending their children to private schools and thus deter them from accepting employment.

Other concerns include, for example, the lack of a veterinarian in American Samoa. According to an official, VAPIHCS lost a candidate who had agreed to relocate to the island until learning of the lack of veterinary services.

“Technical issues due to locations”, is another challenge for recruiting physicians. For example, one physician in American Samoa told GAO that it can take almost 1.5 hours to access the web-based program VHA offers for voice-activated dictation of medical notes, and thus, instead, he often uses services offline, although doing so means he has to enter his notes into VA’s medical record at a later time, according to GAO.

Samoa News will report this week on other issues specified in the GAO study as well as its recommendations.