Periodically, officials from the Hawaii-based U.S. Veterans Administration arrive on Guam for a tongue-lashing by vets who have complained for years about inadequate care provided by a bureaucracy located on the other side of the international dateline.
A number one complaint concerned a tiny VA clinic shoehorned into the old Navy Hospital and the constant need for referral to Hawaii for the more serious medical problems encountered by an aging population of vets and the younger cohort of more recent warriors with combat-related disabilities.
When the VA opened an outpatient clinic outside the Navy Hospital gates in 2011, it became immediately apparent that the facility was far too small for the number of veterans living on Guam. Constant turnover of doctors and other personnel discouraged patients and led to cancellation of emergency services and limitations on walk-in visits. To some vets, that old Navy Hospital clinic is looking pretty good in hindsight, since it came with immediate access to the hospital pharmacy. Vets must now order prescriptions and refills from Hawaii, which sometimes takes weeks. And no veteran, young or old, relishes the stress and financial costs associated with a referral to Honolulu, even if the VA covers the basic expenses.
With another VA Town Hall scheduled for Guam in mid-December, the University of Guam’s School of Business and Public Administration held a conference that shed some light on what’s behind these complaints and proposed solutions. Public Administration grad students, government officials dealing with veterans issues and some actual veterans were on hand.
As with many things it’s a matter of numbers, said Rodney A. Cruz, an Iraq War vet and founder of the Iraq, Afghanistan and Persian Gulf Veterans of the Pacific. Those who should know the number of vets on Guam, don’t. Cruz cited counts that are all over the map. The 2010 U.S. Census counted 8,041, while the current VA figure is 9,981. In 2014 the Guam Veterans Affairs Office reported 27,000 vets, yet in 2016, their count was 9,943. Frustrated legislators ordered another veterans registry drive, which so far has signed up 495. “Where did those 27,000 veterans go,?” Cruz asked the conferees. Cruz quoted Eric Shinseki, then Secretary of Veterans Affairs at the 2011 opening of the Guam CBOC clinic: “’This is not right. This is not big enough for Guam.’ And he apologized.”
Guam Veterans Affairs Officer Jose San Agustin said there are some explanations for the reluctance of vets to sign up. “The system let them (Vietnam vets) down from the beginning. They came home and said, ‘I want nothing to do with the service.’” He says many of those with relatively short service times (three to four years) are missing out on potential VA benefits that they earned and the reluctance of military veteran dads to register has carried down to the next generation.
For those who feel that they’re playing second fiddle to U.S. mainland resident veterans, public administration grad student Leilani Giltinag had some pertinent numbers: 2012 spending per veteran in the state of Virginia amounted to $1,275, according to a study, the lowest in U.S. mainland. Spending in West Virginia and Arkansas was the highest, amounting to $7,600 West Virginia and Arkansas. The figure for Guam was $822 per vet.
Giltinag and her colleagues looked into the reality of a medical referral to Hawaii, not exactly a walk in the park for those vets requiring it. While transportation is paid, the cost of hotel rooms and meals are only included until the vet is admitted as an in-patient. There’s no coverage of any expense for escorts. The Fisher House comfort home for vets in Honolulu doesn’t accept advance bookings and in any case is rarely available.
This is likely why vets on Guam have been calling for an inpatient treatment facility for years /aka/ a VA hospital, without success.
Little more than a week after the conference, Jennifer S. Gutowski, Director of the Pacific Islands Health Care System and staffers arrived on Guam for the second VA Town Hall of 2017, clearly well briefed on the litany of complaints she would be hearing. Gutowski had some news to counter this. The VA call center in Honolulu has expanded its hours to better match up with Guam time. A psychologist, social worker and additional physician are being added to the clinic staff, as well as, for the first time, a chaplain.
The town hall at a National Guard auditorium was sparsely attended and strictly time limited. The largely middle-aged audience of veterans and their relatives strained to say nice things about the frontline VA personnel at the clinic, while candidly stating their complaints.
Like many, Robert Deleon Guerrero Benavente blamed the ‘second class,’ non-voting citizenship of Guam residents.
“We don’t have the programs they have back in the continental United States and Hawaii. So sad,” Benavente said. “And I met a lot of veterans out there next to the ocean, on the beach. They’re just hanging around, some of them are hungry, some of them doing nothing at all. They don’t want to deal with the VA and the VA’s not helping them for years and years. Same old thing, promises, promises, promises.”
“I know a lot of people come here to vent and that’s good for them,” said Marie Luarca, daughter of a Vietnam vet, “but we’re here to see what you guys have to offer.” Luarca said the VA helped her father with a successful claim based on his long term injury due to exposure to the defoliant Agent Orange. Vets frequently complaint about VA inaction on such claims.
Navy Vietnam veteran Donald Bruce pulled no punches in describing his go-rounds with the VA in obtaining treatment for chronic heart problems.
“The cardiologist’s office called up and said ‘You have an appointment two months from now.’ Now, I could be dead before I get my medication. So I raise my hand to the VA and say ‘thank you for killing me because you wouldn’t let me have my medication.’”
“Everyone here is a bona fide veteran and they served their country, yet they’re treated like second, third and fourth class citizens,” Bruce said. “We need money allocated to Guam, not to Hawaii. We don’t want to be the red-headed stepchild any more. The Congress needs to act and in particular, we need a veteran’s hospital.”
You’re a U.S. vet living in Palau, the FSM or the Marshalls with medical needs? The VA can’t do much to help
The U.S. military enjoys great success in recruiting throughout Micronesia, but they likely don’t tell the new troops that they will not be treated equally on separation or retirement if they choose to go back to their island homes. Under federal law, residents of non-U.S. entities fall under the Foreign Medical Program, which provides—effectively—insurance coverage for service-connected medical problems for vets who live in foreign places. According to Craig Oswald of the Honolulu VA it’s geared to reimbursing the patient for treatment received elsewhere.
“If you lived in Palau and were trying to get yourself here to Guam, to the nearest VA, you essentially would do that on your own (paying your own transportation). Now, once you get to Guam, the doorstep of the VA, if you’re eligible, you can be treated as if you are anywhere else in the VA system.”
Oswald says the VA recognizes the basic unfairness of the present system, but that any change will have to come from the U.S. Congress.