The medical clinic that serves hundreds of Maui veterans will lose its only full-time physician Oct. 1, and veterans are worried, even though the Veterans Administration says it will expedite hiring a new doctor and will fill the gap with visiting physicians and telemedicine.

"We've been disappointed, because after a part-time doctor left six months ago, they haven't filled that position, and now the full-time physician is leaving," said Rogelio Evangelista, a disabled veteran and president of the Maui County Veterans Council.

The Veterans Administration's Pacific Islands Health Care System says it learned Aug. 15 that the facility's primary care physician, Dr. James Santoro, planned to leave. The system immediately began active recruitment, but has not indicated how soon it might fill the spot.

Bill Staton, a state veterans representative on Maui, said he hasn't been impressed with the agency's recruiting.

"We're six months into the recruiting for a part-time physician who should have been closer to full time. We had a long waiting list to see these doctors before the physician left in March. My concern is that we're going to have a lot of veterans whose needs aren't being met," Staton said.

Evangelista said he has been told there are no qualified applicants for either medical position. He said there is no substitute for a live physician who knows his patients, although Pacific Islands Health Care System director Dr. James Hastings said it will use several systems to fill the gap.

"The VA intends to make maximum use of ongoing technology, especially with telemedicine, and wants to assure the veteran community and their families on Maui that they will continue to receive the high level of care that they have come to expect from the VA," Hastings said. Additionally, sub-specialists from O'ahu and the Mainland will support the resident nurse practitioner at the clinic, and an internal medicine doctor will intermittently make on-site consultations, he said.

U.S. Rep. Ed Case said telemedicine may not be sufficient, and that rural veterans' healthcare needs to be adequately funded to prevent this kind of lapse.

"This is another chapter in a long struggle to maintain rural healthcare and to fight administration reductions in funding for veterans' healthcare," Case said. "This is part of a big picture that needs to be remedied in Washington. When you short-fund veterans' healthcare, this is what you're going to get."

U.S. Sen. Daniel Akaka said he has asked the Veterans Administration to replace Santoro as quickly as possible.

"This clinic not only serves Maui but its neighboring islands as well. I am very concerned about the break in physician service but am hopeful VA will act quickly," he said. Akaka said he worked on legislation that allows the administration to hire physicians at beyond-standard rates of pay.

"I have always stressed that VA must ensure a greater presence in our Islands where there is a lack of VA facilities and staff. As the ranking member on the Veterans Affairs Committee, I will continue to work with VA to see to it that our veterans get the treatment and care they deserve," Akaka said.

Evangelista said Hawai'i remains, with Alaska, one of only two states without a Veterans Administration hospital, and that small clinics on Neighbor Islands are key to the health needs of men and women who have served in the armed forces.

"We have about 10,000 veterans in Maui County, and I'd say about 2,000 of them use the clinic. That's my full-time primary care, and there's a lot of disabled veterans here who use it," he said.

One possible recruiting problem, Evangelista said, is that part-time physicians at the clinics do not accrue seniority toward full-time positions with the Veterans Administration, and that could reduce interest in the positions.

Reach Jan TenBruggencate at jant@honoluluadvertiser.com.