Informational Report Review of Availability of Mental Health and Orthopedic Services at the VA Pacific Islands Health Care System

This limited-focus review was performed at the request of Senator Daniel Akaka, Chairman of the Senate Veteran’s Affairs Committee. The objective was to identify challenges impacting the delivery of mental health and orthopedic services at PIHCS. The review focused on the availability of services at the main Ambulatory Care Center in Honolulu and the Maui CBOC to address if PIHCS places restrictions on care. PIHCSs Ambulatory Care Center in Honolulu meets veterans’ mental health needs on Oahu, although ensuring timely access to mental health services on Maui has been a challenge for PIHCS due to reported shortages of VA and community health providers on the island. PIHCS has been proactive in ensuring that services are made available, and MHEI funding has allowed PIHCS to establish additional mental health provider positions and expand telehealth capabilities at CBOCs to improve the availability of services. Because PIHCS is effectively allocating MHEI funding to recruit mental health providers, we made no recommendations. Also, initial orthopedic appointments for PIHCS patients were generally timely, and the average wait time for elective orthopedic surgery procedures has improved significantly. Since FY 2006, PIHCS has hired two orthopedic surgeons and TAMC has dedicated operating time to PIHCS, thereby improving the timeliness of orthopedic surgery care to VA patients. We found no evidence that PIHCS places unnecessary restrictions on access to orthopedic services. Our review indicated that although scheduling delays occasionally occur, PIHCS patients generally received initial orthopedic appointments within 30 days, and we found no indication of unjustified delays of elective orthopedic procedures at TAMC, we made no recommendations.