Hawaii’s veterans are receiving health care more promptly than in the past, but the U. S. Department of Veterans Affairs continues to struggle to hire and retain enough medical staff to meet the burgeoning need for services, according to a recent government report.

First the good news: The VA increased staffing by 24 percent at community-based health centers in the Pacific region, including Hawaii, according to the report. About three-quarters of new patients obtained an appointment with a doctor within 30 days.

The agency also significantly expanded the services it offers to veterans who are homeless.

But there are also shortfalls. The agency failed to establish a planned 7,500-square-foot community services center on the Windward side of Oahu, according to the report. Three veterans committed suicide in 2014 and 2015, reflecting a need for improved suicide-prevention efforts. And there appear to be significant delays for patients seeking treatment outside of VA facilities.

Logistical issues, meanwhile, remain a thorny problem for Hawaii. Veterans on neighbor islands frequently have to travel to Oahu to obtain necessary treatment and then wait for reimbursement of the cost.

“There’s room for improvement but the VA in Hawaii is doing a really good job.” — Korean War veteran Fred Ruge

The national office that determines whether veterans are eligible for services is located in Atlanta, in a time zone six hours away, causing delays and miscommunication, and employees there have sometimes provided “incorrect or unclear eligibility guidance,” VA employees told the inspectors.

These conclusions emerged in a report recently released by the VA’s Office of Inspector General that reviewed conditions in Hawaii, American Samoa, Guam and Saipan. About 127,000 veterans live in Hawaii and elsewhere the Pacific Basin.

While the OIG investigation was underway, Wayne Pfeffer, the widely criticized head of the VA’s Pacific Islands Health Care System, abruptly stepped down from his post, citing personal reasons. Pfeffer was replaced by an acting director, Tonia Bagby, a clinical psychologist.

The report by the OIG, an independent investigatory arm at the agency, was prepared at the request of U.S. Sen. Mazie Hirono of Hawaii, who serves on the Senate Armed Forces Committee.

Hirono has closely followed progress at Veterans Affairs, particularly since a national scandal erupted in 2014 over reports that veterans had died while waiting months and even years for essential medical care. News reports and congressional inquiries revealed widespread deception by Veterans Affairs officials who masked the poor treatment veterans were receiving and awarded themselves bonuses.

Conditions for Hawaii’s veterans were among the worst in the nation. The Veterans Affairs office eventually acknowledged that some of Hawaii’s veterans were being required to wait an average of 185 days to see primary care physicians.

In August 2014, Hirono conducted a field hearing to examine conditions in Hawaii and pledged to continue to work on behalf of veterans. Hirono’s staff circulated the OIG report in a press release.

“We’ve made important progress to reduce wait time, close resource gaps and improve services in the years since the Senate Veterans Affairs Committee field hearing,” Hirono said in an emailed statement to Civil Beat. “But it’s clear that this will be an ongoing fight.”

The VA’s defenders say that the agency had been cash-strapped for decades because the need for services grew steadily as a result of ongoing armed conflicts around the globe, in which veterans suffered expensive, long-term disabilities.

In 2014, amid vocal demonstrations of outrage in the nation’s capital and demands that top VA officials should be fired, Congress passed overhaul legislation that provided some $15 billion in additional funding for the agency, including provisions that allow veterans to obtain medical service outside the VA, in a program called “Veteran’s Choice.”

But controversy has continued to plague the agency. Only a handful of top agency officials were removed from their jobs, and many veterans across the country continue to wait more than a month for routine medical care.

In interviews last week, some Hawaii veterans who have criticized the VA in the past told Civil Beat that they believe that things have gotten better in the past two years.

“There’s room for improvement but the VA in Hawaii is doing a really good job,” said Fred Ruge, an 86-year-old veteran of the Korean War who lives on Maui. He has a good overview of the situation because he is a volunteer giving help to other veterans. He works with 100 to 150 veterans each year.

“I can say that the wait times have gotten significantly better,” said Elisa Smithers, who served combat tours in Iraq and Kuwait, causing her to suffer back injuries, a concussion and battle-related trauma. “I have heard chatter from my peers that their experiences have improved as well.”

Both Ruge and Smithers said they believed that the improvements had come partly as a result of what they called Hirono’s efforts on behalf of the state’s veterans.

“It’s a fantastic job Senator Hirono is doing,” Ruge said.

Several veterans said they believed the agency hires too many people from the mainland who don’t adapt to the culture of the islands and the high cost of living, and soon leave. They said it would be better to recruit local people for the jobs.

Other vets said they had heard that there were problems on some of the outer islands, particularly in rural areas where there are few doctors.

The death of Roy Hill, a Vietnam veteran, drew public attention last month. Before he died, Hill, who lived in Kalapana on the Big Island, said doctors at the VA health center in Hilo failed to perform medical tests that would have allowed him to get treatment in a timely manner. He believed his lungs had been injured by exposure to Agent Orange in the jungles of Vietnam.

VA officials have said he received good care.

U.S. Rep. Tulsi Gabbard said she visited with Hill and his wife before his death and that the story they told troubled her.

“Roy’s last wish was to share his story with me and so many others in the hopes that it could lead to improved health care for all veterans,” Gabbard said in a statement.

She said veterans face ongoing problems in receiving adequate health care.