Hawaii’s VA medical system demands further investigation after an audit found that veterans wait an average 145 days for their first appointment with a primary-care physician, the longest wait in the country.

The Veterans Health Administration did not flag the state for follow-up based on the results of its internal Access Audit, but Hawaii’s long delays, coupled with discrepancies between what local VA officials had stated publicly and what the audit ultimately revealed, raise the bar for transparency and accountability.

The internal audit, conducted May 12-June 3 at VA facilities nationwide amid a growing scandal of gross administrative mismanagement and doctor and nurse shortages that left veterans underserved throughout the country, included data from the VA Pacific Islands Health Care System that was current as of May 15. The audit report, released June 9, said that 14,202 appointments were scheduled in Hawaii, and 97 percent of established patients were scheduled to be seen within 30 days or less.

Where Hawaii fell far short was in providing timely access for new patients:

» 1,068 people were on the Electronic Wait List (EWL), and their average wait to see a primary-care doctor was 145 days — worst in the nation.

» An even larger number — 1,966 people — languished on the New Enrollee Appointment Request (NEAR) List, the tally of veterans who have requested an appointment during the past 10 years but have never been seen by a VA doctor.

Nationwide, auditors interviewed clinical and administrative staff at 731 VA hospitals and clinics and flagged 112 locations for further investigation, because data on patients’ appointment times may have been falsified, office staff may have been instructed to falsify waiting lists, or other problems.

Any instance of suspected willful misconduct is being reported to the VA’s Office of the Inspector General.

No Hawaii facility was flagged for further review. Although reassuring at first glance, this raises many questions about the scope of the audit.

The 145-day wait alone should be a red flag warranting further investigation. While it’s true that Hawaii’s large number of eligible veterans and far-flung service area, which includes American Samoa, Guam and the Northern Mariana Islands, makes scheduling appointments more complicated than in compact, contiguous regions, the interminable delays new patients endure are unconscionable.

Moreover, local VA officials painted a far rosier picture for the press and Hawaii’s Congressional delegation about wait-times throughout the islands after the audit was conducted but before the results were publicly released.

Whether due to ignorance, incompetence or intentional disinformation, this serious breach highlights the need for further investigation of Hawaii’s VA health-care system. Trust is at a low point. Wayne Pfeffer, director of the VA Pacific Islands Health Care system for the past eight months, apologized for "any confusion between myself and our Hawaii delegation related to local health care issues."

The demand for VA care simply outstrips the system’s capacity to provide it in a timely fashion for all eligible patients, he said, getting to the core issue in Hawaii and throughout the nation.

There are not enough doctors and nurses employed by the VA to treat all these patients, no matter how efficient the medical staff.

U.S. Senate and House bills that would make it easier for veterans to seek treatment elsewhere at the VA’s expense offer a welcome short-term solution, although it will tax the private sector, which suffers its own doctor shortage.

The longer-term solution is one that attracts more primary-care doctors to the VA, with better pay, college-loan forgiveness or other financial incentives that do not jeopardize patient safety.

In the meantime, though, we need more information about exactly what’s going on in Hawaii’s VA health-care facilities. The initial internal audit was not enough.