According to an Associated Press review of VA internal documents, inspector general reports and interviews:
—Nationwide, nearly one in four VA hospitals does not have a fulltime gynecologist on staff. And about 140 of the 920 community-based clinics serving veterans in rural areas do not have a designated women's health provider, despite the goal that every clinic would have one.
—When community-based clinics refer veterans to a nearby university or other private medical facility to be screened for breast cancer, more than half the time their mammogram results are not provided to patients within two weeks, as required under VA policy.
—Female veterans have been placed on the VA's Electronic Wait List at a higher rate than male veterans. All new patients who cannot be schedule for an appointment in 90 days or less are placed on that wait list.
—And according to a VA presentation last year, female veterans of child-bearing age were far more likely to be given medications that can cause birth defects than were women being treated through a private HMO.
"Are there problems? Yes," said Dr. Patricia Hayes, the VA's chief consultant for women's health in an AP interview. "The good news for our health care system is that as the number of women increases dramatically, we are going to continue to be able to adjust to these circumstances quickly."
The 5.3 million male veterans who used the VA system in fiscal year 2013 far outnumbered female patients, but the number of women receiving care at VA has more than doubled since 2000. The tens of thousands of predominantly young, female veterans returning home has dramatically changed the VA's patient load, and the system has yet to fully catch up. Also, as the total veteran population continues to decrease, the female veteran population has been increasing year after year, according to a 2013 VA report.
All enrolled veterans can use what the VA describes as its "comprehensive medical benefits package," though certain benefits may vary by individual and ailment, just like for medical care outside the VA system. The VA typically covers all female-specific medical needs, aside from abortions and in-vitro fertilization.
The strategic initiatives, which sprang from recommendations issued six years ago to enhance women's health system-wide, have kick started research about women veterans' experience of sexual harassment, assault or rape in a military setting; established working groups about how to build prosthetics for female soldiers; and even led to installation of women's restrooms at the more than 1,000 VA facilities.
Yet enduring problems with the delivery of care for women veterans are surfacing now amid the growing criticism of the VA's handling of patient care nationwide and allegations of misconduct, lengthy wait times and potential unnecessary deaths.
Used to treating the men who served in Vietnam, Korea or World War II, many of the VA's practitioners until a few years ago were unaccustomed to treating menopause or giving advice about birth control.
The study on distribution of prescription medication that could cause birth defects is illustrative of the lagging awareness; one of every two women veterans has received medication from a VA pharmacy that could cause birth defects, compared to one in every six women who received drugs care through a private health care system, said the study's author, Eleanor Bimla Schwarz, a senior medical expert on reproductive health with VA.
Schwarz, who also directs women's health research at the University of Pittsburgh, pointed out that while she does not believe any of the veterans surveyed were pregnant at the time, it is critical to keep in mind that many new female veterans are of child-bearing age, a higher percentage are on medication than in the general population and the majority of these women are not on contraception.
Hayes said the VA seeks to place a trained, designated women's provider in every facility and expects to install a "one-stop" health care model that allows women to go to one provider for a range of services, including annual physicals, mental health services, gynecological care and mammograms. Until that happens, however, some VA clinics have limited gender-specific health treatments available for women.
Army Sgt. Ashley Morris, who worked as an operating room technician for six months in 2008-2009 at a military hospital in Baghdad's Green Zone that treated soldiers hit by suicide bombs or wounded in firefights, said that promised transformation is badly needed. She returned having flashbacks and suffering from post-traumatic stress disorder, and spent a month hospitalized in a psychiatric facility in Pueblo, Colorado.
Now back home in Albertville, Alabama, she said she was ordered in March by a physician at the nearby community-based VA clinic to get a mammogram, given her mother's medical history. But Morris said she had to wait so long to get an outside appointment that she never made it to the doctor, in part, she said, because the VA would not reimburse her for the gas mileage to get to the private screening center 65 miles away in Birmingham.