By Sarah Ruppenthal

Maui veterans who gathered in protest after dismissal of one of their two physicians receive interim doctor until a full-time replacement is hired. "We weren't going to take no for an answer."

As they prepared to honor their fallen comrades on Memorial Day this year, island veterans were stunned to learn that their trusted physician would no longer provide medical care at the Maui Community Based Outpatient Clinic (CBOC) in Kahului.

News of the physician's departure spread quickly, and within days, groups of veterans joined together to appeal to lawmakers for a formal congressional investigation and expressed their displeasure in a sign-waving demonstration outside of the Kahului clinic on Friday, June 6.

Maui County is home to more than 10,000 veterans, and approximately 3,000 are enrolled in the medical benefits program provided by the Kahului clinic and two outreach clinics located on Moloka‘i and Lana‘i. The U.S. Department of Veterans Affairs (VA) has been under fire since 2006, when an unexpected shift in personnel left the Kahului clinic understaffed and its patients without continuity of care. Island veterans appealed to local, state and federal government officials, testifying that they had been neglected by the VA, spending months struggling with erratic clinic hours, misplaced medical records, inconsistent staffing and extended waiting periods between appointments-some as long as seven weeks.

For nearly nine months, a rotating team of part-time doctors and a staff of dedicated nurses worked tirelessly to care for an increasingly heavy patient load. While they did the best they could in such circumstances, the absence of a full-time physician generated a great deal of frustration.

Then in June 2007, a full-time primary care physician and psychiatrist arrived at the clinic, followed by a second full-time physician in September. But just when island veterans thought the problem had finally been resolved, VA Pacific Islands Health Care System administrators announced in May that one of the primary care physicians had been terminated because of a "failure to fully meet the requirements of employment during her probationary period."

Baffled by the sudden decision, veterans across Maui County began dialing phone numbers and writing letters, demanding answers. But the breaking point came a few weeks later, when a sick veteran arrived at the clinic and was told he could not be seen by a physician; instead, he was handed a scrap of paper with a phone number and instructed to call a nurse on O‘ahu. Desperate to find medical care, the man wound up in the emergency room of Kula Hospital, and the incident triggered outrage across the island. For the first time in island history, Maui's veterans gathered on the grounds of the clinic in a peaceful demonstration, waving handmade signs in protest.

"We are back to square one," said a Ha‘iku veteran who asked to remain anonymous. "It [clinic services] was on the up-and-up... not perfect, but it was on its way there."

In an interview with The Honolulu Advertiser, VA Pacific Islands Health Care System Public Affairs Officer Fred Ballard assured that officials are reviewing applicants for the vacant position. Until then, he said a physician will travel from O‘ahu twice a week to assist the remaining physician at the clinic. In addition, Ballard said the CBOC has hired a nurse practitioner and is expecting a physician's assistant to join the clinic this month, pending a credentialing process.

But according to Vietnam Veterans of Maui County President Mitch Skaggerberg, a part-time physician is not good enough. "We dealt with that for nine months... and it didn't work," he said. "Our greatest concern is continuity of care, and a part-time physician cannot provide it."

Skaggerberg said veterans who were not aware of the doctor's departure arrived for their scheduled appointments to find that she was not there. The terminated physician had a patient load of nearly 800 veterans, leaving each of them to start from scratch with a new practitioner-a costly and time-consuming process.

"This did not have to happen again," said Skaggerberg. "But this time, we didn't stay silent." With the guidance and assistance of Hawai‘i Sen. Daniel Akaka, chairman of the Veterans' Affairs Committee, island veterans banded together to fight for what they wanted most-their health and well-being.

Skaggerberg and several others met with the VA director several weeks after the department announced the physician's dismissal and demanded the immediate placement of a full-time interim physician until a full-time replacement is hired.

"We weren't going to take no for an answer," he said. Just a few days later, a full-time interim physician arrived on the front doorstep of the Kahului clinic. "If we didn't step up for our healthcare," said Skaggerberg, "Who knows what would have happened?" It is possible, said Skaggerberg, "That if we hadn't acted so quickly, it could have been another nine months without a physician."

According to Ballard, the search for quality health practitioners to live and work in a high-cost area such as Maui is an arduous process. In a 2007 interview with the Maui Weekly, Ballard maintained, "Unfortunately, these things don't happen overnight... and we want to do this the right way, for the benefit of our heroes, the men and women of the U.S. military."

But until resident veterans like Skaggerberg are convinced the clinic is doing things the right way, they will be paying close attention.

"Our antennas will be up after this," he said. "And we will be on our guard."

For now, only one thing is certain. The brave men and women who fought for the freedoms upon which this nation is founded-the freedoms that we often taken for granted-deserve the respect, honor and healthcare they have earned.

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