It's been one year since Wayne Pfeffer abruptly retired from his post as director of the Veterans Affairs Pacific Islands Healthcare System in Honolulu.
Since his departure, five senior Veterans Affairs executive directors from the mainland have been filling in, rotating as interim directors for Hawaii. The fill-in directors come in for a month, leave the state, and then return.
"These individuals who have been directing are well-experienced in their own right in different healthcare systems, and they have brought value to us," said Craig Oswald, executive assistant to the director.
He insists the local VA hasn't missed a beat, but Congresswoman Tulsi Gabbard calls the lack of a permanent director a problem.
"The mission of the VA is to take care of our veterans, and to do so they need accountability and leadership they can depend on," she said.
Gabbard recently introduced legislation that urges the VA to move more quickly to fill vacancies at medical centers that are operating without a permanent director.
Oswald says Hawaii has been actively recruiting and is getting closer to making a permanent hire.
"We really appreciate Rep. Gabbard's advocacy for veterans," he said. "There is an individual, a name that has been put forward, that is undergoing the vetting process in our headquarters to potentially be named as our new permanent director."
A final decision, though, is up to the recently confirmed Secretary of Veterans Affairs, David Shulkin. Oswald says the process could still take six months or longer.
In the meantime, the interim arrangement will continue.
More than 50,000 veterans in Hawaii get their medical care through the VA. In 2014, Hawaii vets waited an average of 145 days for care, the longest in the country, to see a primary care physician.
Oswald says that with interim directors providing guidance, the wait time has dropped dramatically, to about 10 days.
"My appointments were just one after the other, so I thought the VA was actually pretty good," said Larry Gonzalez. "If it was slow, it was slow on my part in getting the appointments set up."
Gonzalez retired from the U.S. Navy in January.
"We've added specialist physicians and support staff. We've enhanced and increased the amount of telemedicine that we're doing, and we've also increased the on-island visits," Oswald said.
Despite the improvements in delivering care to vets, Gabbard believes the VA needs to develop and implement a plan to hire qualified directors.
Besides Hawaii there are about 20 other centers lacking a permanent leader.