SAN FRANCISCO — Already pilloried for long wait times for medical appointments, the beleaguered Department of Veterans Affairs has fallen short of another commitment: attending to the needs of the rising ranks of female veterans returning from Iraq and Afghanistan, many of them of child-bearing age.
Even the head of the VA’s office of women’s health acknowledges that persistent shortcomings remain in caring for the 390,000 female veterans seen last year at its hospitals and clinics — despite an investment of more than $1.3 billion since 2008, including the training of hundreds of medical professionals in the fundamentals of treating the female body.
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 full-time 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 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 scheduled 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 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 female veterans’ experience of sexual harassment, assault, or rape in a military setting; established working groups about how to build prosthetics for female soldiers; and 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, potentially, 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 giving advice about birth control or treating menopause.
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 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, said 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 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 treatments.
Many female veterans report having to drive hours to get care, while some of them tell of struggling to get the VA to pick up the tab for a private doctor.
Army Sergeant LaQuisha Gallmon of Greenville, S.C., whose daughter was born two months ago, said she had been authorized to see a private physician for prenatal visits and delivery. But because the paperwork hadn’t been fully processed when she went to an outside emergency room for complications in pregnancy, VA has refused to pay the $700 bill, she said.
‘‘I called the VA women’s clinic and they told me everything was approved for me to get outside care,’’ said Gallmon, 32, who served six years in Iraq, Germany, and Fort Gordon, Ga. ‘‘I wound up in the ER for complications, and a week later I received the letter saying they wouldn’t pay for it.’’