SAN FRANCISCO — Already pilloried for long wait times for medical appointments, the beleaguered Department of Veterans Affairs has fallen short of another commitment: to attend to the needs of the rising ranks of female veterans returning from Iraq and Afghanistan, many of them of child-bearing age.
Even the head of the VA's office of women's health acknowledges that persistent shortcomings remain in caring for the 390,000 female vets seen last year at its hospitals and clinics — despite an investment of more than $1.3 billion since 2008, including the training of hundreds of medical professionals in the fundamentals of treating the female body.
According to an Associated Press review of VA internal documents, inspector general reports and interviews:
• Nationwide, nearly one in four VA hospitals does not have a full-time gynecologist on staff. And about 140 of the 920 community-based clinics serving veterans in rural areas do not have a designated women's health provider, despite the goal that every clinic would have one.
• When community-based clinics refer veterans to a nearby university or other private medical facility to be screened for breast cancer, more than half the time their mammogram results are not provided to patients within two weeks, as required under VA policy.
• And according to a VA presentation last year, female veterans of child-bearing age were far more likely to be given medications that can cause birth defects than were women being treated through a private HMO.
"Are there problems? Yes," said Dr. Patricia Hayes, the VA's chief consultant for women's health in an AP interview. "The good news for our health care system is that as the number of women increases dramatically, we are going to continue to be able to adjust to these circumstances quickly."
The 5.3 million male veterans who used the VA system in fiscal year 2013 far outnumbered female patients, but the number of women receiving care at the VA has more than doubled since 2000. The tens of thousands of predominantly young, female veterans returning home have dramatically changed the VA's patient load, and the system has yet to fully catch up. Also, as the total veteran population continues to decrease, the female veteran population has been increasing year after year, according to a 2013 VA report.
All enrolled veterans can use what the VA describes as its "comprehensive medical benefits package," though certain benefits may vary by individual and ailment, just like for medical care outside the VA system. The VA typically covers all female-specific medical needs, aside from abortions and in-vitro fertilization.
Many female veterans report having to drive hours to get to a facility that offers specialized gender-specific care, while some of them tell of struggling to get the VA to pick up the tab for them to see a nearby private doctor.
Army Sgt. LaQuisha Gallmon of Greenville, S.C., whose daughter was born two months ago, said she had been authorized to see a private physician of her choice for prenatal visits and delivery. But because the paperwork hadn't been fully processed when she went to an outside emergency room for complications in her sixth month of pregnancy, the VA has not paid a $700 bill, she said.
"I called the VA women's clinic and they told me everything was approved for me to get outside care and I should be getting the packet in the mail," said Gallmon, 32, who served six years in Iraq, Germany and Fort Gordon, Ga. "Right after that, I wound up in the ER for complications, and a week later I received the letter saying they wouldn't pay for it."