Logistical challenges, lack of adequate space and difficulty in recruiting as well as retaining qualified employees are some of the issues faced by the Honolulu-based Veterans Administration Pacific Islands Health Care System (VAPIHCS), which provides medical and mental health care across the Hawaiian Islands, Guam, American Samoa, and Saipan, according to a Sept. 22 Healthcare Inspection report by the Veterans Administration’s Office of inspector general.

“In addition to the logistical challenges of coordinating care spanning multiple islands and thousands of miles, leadership and staff consistently reported difficulty in recruiting and retaining qualified employees due to the cost of living, distance, and isolation of island life,” according to the 28-page report following a review of summarized supplementary data in support of a Combined Assessment Program review completed in August 2015 and to respond to letters sent by Hawai’i’s US Sen. Mazie K. Hirono, who expressed concerns about access to care, travel benefits, cultural diversity, homeless services, and mental health care.

Further, VAPIHCS staff reported the lack of adequate space at almost all locations to manage the volume of patients seeking care, the report says.

“We found that VAPIHCS has many of the same administrative and clinician availability issues found across the VA system for non-VA care,” it says. “At VAPIHCS, these challenges are compounded by a shortage of VA-based providers and enrolled non-VA providers, the complexity of island logistics, and the diversity of the population served. VAPIHCS was in the process of hiring and embedding additional non-VA care staff at the community based outpatient clinics to enhance the timeliness and management of non-VA care.”

“To address these challenges,” the report says, “VAPIHCS is in the process of hiring and embedding additional non-VA care staff at the community based outpatient clinics to enhance the timeliness and management of non-VA care.”

VA-OIG also found among other things, that the VAPIHCS:

•     Offers a comprehensive array of programs and services across the islands for homeless veterans. The report says there were no reported homeless veterans in American Samoa.

•     Offers a variety of general and specialty mental health services across the islands that, despite staffing challenges, met mental health access metrics.

•     Has improved staffing in the Suicide Prevention Program in the past year to address past deficiencies and expand its outreach efforts.

On the specific issue pertaining to American Samoa’s community based outpatient clinic (CBOC), which was opened in 2008, the report says it provides patient care and mental health services and uses tele-health for many other services.

It says the CBOC is not equipped to provide emergency services and refers patients to the LBJ Medical Center in Pago Pago for urgent and emergent care.” Leadership informed us that the local community is trying to build a new hospital. In addition, travel can be difficult, as flights available to and from American Samoa and Oahu are limited,” the report, says.

Additionally, VAPIHCS leaders reported that renovations that would expand mental health, physical therapy, and laboratory services at the American Samoa CBOC were scheduled for FY 2016; however, as of August 2016, VAPIHCS leaders continue to work with VA Contracting Services to resolve construction and contracting issues.

VAPIHCS is part of Veterans Integrated Service Network (VISN) 21 and serves a veteran population of about 50,000. The period of review was from February 2014 through March 2016. Selected aspects of the review in August 2016 were updated, and a site visit the week of August 24, 2015 was conducted. Details of the report online: www.va.gov/oig