"That would save a lot of people, a lot of money," said Danny Kanahele, a Veterans Affairs Advisory Council member and one of eight veterans testifying Thursday in the Maui County Council Chambers before the U.S. Senate Committee on Veterans Affairs, chaired by Akaka.

As dozens of veterans listened, their representatives called for a 24-hour healthcare center, an increase in mental healthcare services, a long-term care facility and a home healthcare program.

Representatives of the Department of Veterans Affairs acknowledged ongoing difficulties with delivering services to veterans here and promised improvements, including a new, second physician due here by Sept. 7.

There are also plans to hire a nurse practitioner and a social worker, plus a new team of mental health professionals, including a psychiatrist, a psychologist, a social worker, a clinical nurse specialist and a substance abuse counselor, according to Dr. Michael J. Kussman, undersecretary for health with the U.S. Department of Veterans Affairs.

The hearing on Maui is one of a series to review veterans services in Hawai'i led by Akaka, who also is holding informal sessions with veterans on Moloka'i and Lana'i. A Moloka'i meeting will be held today, while about 40 veterans and family members participated in a meeting held Wednesday on Lana'i that included Akaka and Congresswoman Mazie Hirono.

According to Akaka staffers, a major theme in comments from Lana'i veterans was the difficulty vets had in accessing medical treatment. Lana'i vets must travel off island to be treated.

Akaka and VA officials are working on a partnership with the Lanai Community Hospital and Straub Clinic to provide Lana'i veterans with care on Lana'i, eliminating the need to travel for simple diagnosis and treatment.

At the hearing on Maui, Grant Steward, 28, of Lahaina was the youngest veteran testifying Thursday. He moved to Maui 11 months ago after serving in Operation Iraqi Freedom for a year with the Oregon National Guard in 2004.

"The 24-7 care center would be wonderful," Steward said. "Life doesn't exist only between 8 and 5 p.m., Monday to Friday."

A machine-gunner in the war, Steward suffers from the loss of feeling in his arms and fingers and has experienced post-traumatic stress syndrome from his tour of duty in Iraq. He said he also has a constant ringing in his ears.

Steward said he's been to five different Veterans Affairs centers since his return to the United States and has always found staff, including personnel on Maui, to be courteous and professional.

Like his fellow veterans, Steward offered suggestions for improvement in the VA clinic, such as providing counseling to family members of soldiers experiencing trauma from their war service. He also recommended e-mail appointment reminders and spoke of his frustration over an inability to get dental coverage.

"There's still so much red tape," said Rogelio Evangelista, Maui Veterans Council president.

In response to a question from Akaka, Evangelista said he's noticed marked improvements in VA services on Maui since he last testified before the Senate committee in January 2006 during a hearing at the Cameron Center in Wailuku.

Evangelista said there are still problems with veterans seeking access to acute medical care, especially individuals with disabilities and those experiencing acute mental health problems. In some cases, veterans have been called by collection agencies because of the VA's slow response in covering some of their medical expenses.

Mitch Skaggerberg, president of the Vietnam Veterans of Maui County, expressed gratitude to Akaka for his assistance in helping to get a nine-month vacancy in the Maui clinic's physician position filled.

"Bless you," Skaggerberg told Akaka.

Skaggerberg estimated that as many as 70 percent of Maui's veterans are 60 years old or older and will soon need a long-term care facility. He said the veterans have begun talking about the possibility among themselves of a new facility and would like to get federal funding to support it.

"We think the timing is now," Skaggerberg said.

William Stroud, a Vietnam veteran and former mayoral candidate, said he's found ways to get the medical services he's needed over the last several years by bypassing the Maui clinic and seeking a medical referral from the O'ahu Veterans Affairs office. Stroud said he understands that the office here is overwhelmed with calls.

Stroud proposed Akaka seek federal funding for a new program that would match longtime combat veterans with those recently returning from war to assist them with dealing with post-traumatic stress disorder.

"We must be ready and get ready for the realities of PTSD," Stroud said. "Do not be afraid to try something new."

According to health undersecretary Kussman, the Maui community-based clinic in Wailuku recorded 9,217 clinic visits for fiscal year 2006, a 46 percent increase from fiscal year 2002.

The vacant physician position forced the VA to provide coverage with a combination of contract and VA staff traveling from Honolulu. Kussman's written testimony indicated that waiting times for new patients has been reduced. It now takes no more than 30 days for veterans to get their first primary care appointment.

Kussman also announced plans to begin shortly a new home-based primary care services program for veterans on Maui. The same service is provided to former soldiers on O'ahu, Kaua'i and the Big Island, and provides noninstitutional long-term care "in the least-restrictive setting for veterans."

In addition, because of the significant demand for mental health services (32 percent of the 2006 Maui clinic visits involved mental healthcare), the VA will increase the availability of mental health professionals after receiving nearly $2 million in additional funding in the current biennial budget.

On Moloka'i, the VA office had 148 veterans receiving services in 2006 in a shared space near Molokai General Hospital. The clinic is staffed part time with a VA physician and contract support staff who operate two half-day primary care clinics each week. A psychologist also travels twice a month, and a psychiatrist visits once a month with Moloka'i patients.

On Lana'i, 30 veterans received services from the VA in fiscal year 2006. Kussman said the VA has been sending a primary care physician from Honolulu to Lana'i once a month to provide services. This began in June, with the VA planning to reassess the services in six months.

Akaka closed the Maui hearing after nearly two hours of testimony.

"Without question, it's going to be helpful to all of us," he said.

For more Maui news, visit The Maui News.

VA SESSION ON MOLOKAI TODAY

As part of the Senate Committee on Veterans Affairs review of the quality of services provided by the U.S. Department of Veterans Affairs, Sen. Daniel Akaka will hold a town hall meeting for veterans today on Moloka'i at 2 p.m. at the Kulana 'Oiwi complex.

A Department of Veterans Affairs representative also will be available to meet with veterans on Moloka'i from 9 a.m. to 2 p.m. at the Molokai Vets Center, preceding the Akaka town hall meeting. For more information, call 808-553-8387.