For Martha’s Vineyard veterans the past year has been one of frustration as they have been forced to travel off-Island for treatment, and often left to pay the bill.

After administrators discovered more than a year and a half ago that the contract between the Veterans Administration and the Martha’s Vineyard Hospital had expired, Island veterans, some more than 90 years of age, have had to navigate a maze of bureaucracy and endure day-long trips to Providence, R.I., for basic treatment.

“I was in Providence a couple weeks ago,” said former U.S. Marine and Viet Nam veteran Woody Williams of Vineyard Haven. “You’ve got these old vets with all kinds of different conditions waiting in the hallways up there. It’s overbooked, it’s overcrowded, it’s just really pitiful.”

Although no one could provide exact dates, for about a decade the Vineyard hospital had contracted with the VA to treat the Island’s population of over 300 veterans. Five years ago that contract ran out. Even then nobody noticed until Vineyard veterans began opening their mail just over a year ago.

“We started getting collection agencies coming after us,” said Mr. Williams. “We’re not even supposed to see any of these bills. Now we’re forced to drive all the way to Providence to see our primary care doctor. What the hell sense does that make?”

At a recent meeting of Island selectmen with state Sen. Dan Wolf, county commissioner and Tisbury selectman Tristan Israel pressed Mr. Wolf on the issue.

“I’m asking here that you do what you can,” he said. “Since the contract expired there’s been real hardship on a lot of the Island veterans, especially the elderly ones. There are World War II veterans that have to travel off-Island to get the services they need. The hospital says they want to set up an agreement, the VA says they want to set up an agreement, but the thing seems to go on and on.”

Mr. Wolf said it was the first he had heard of the problem. “We haven’t heard anything about this in our office. Now that it’s flagged, the first call is going to be to John Kerry or Scott Brown to make sure that we’re getting adequate pressure,” Mr. Wolf said.

To Mr. Williams such pressure on Washington has seen little effect.

“I sent letters to all of them and we got absolutely no help,” he said.

Mr. Israel concurred. “I’ll throw both parties under the bus,” he said at the meeting with Mr. Wolf. “We’ve written letters to Brown and Kerry and we didn’t get responses from either.”

Martha’s Vineyard Hospital president and chief executive officer Tim Walsh said this week that negotiations between the VA and Partners HealthCare, the parent company that owns the hospital, were promising, but he was uncomfortable speculating about when the contracts may be completed.

“It’s a very slow process,” Mr. Walsh said. “We’re trying the best we can because we certainly want to serve the veterans. It’s so inconvenient for them to have to go off-Island.”

In the short-term, he said the hospital will provide primary care to veterans.

“Any vets that need primary care should come in,” Mr. Walsh said. “We’re open to it and they can still see their primary care doctors and we’ll figure out the billing part afterwards.”

He said when the contracts lapsed the veterans were billed in error.

“They never should have been billed for treatment,” Mr. Walsh said. “If they did, it was a problem on our side because we’ve committed to not do that. We can deal with the VA, they’re trying to help, it’s just not something they do a lot of where they contract with an outside provider, they prefer to use their own facilities.”

For Mr. Williams, who has what is known as a fee-basis card that allows him to see his longtime primary care doctor on the Vineyard, he is still subject to the impenetrable VA bureaucracy.

“If I need X-rays, blood work or anything like that my doctor has to send what’s called a consult request to Hyannis,” he said. “The Hyannis VA then sends it to Providence to get approved. Once the doctor in Providence approves it, it has to be signed up there by the fee-basis guy. Then it’s sent back to me and the doctor. This takes several weeks, sometimes several months.”

According to Dukes County veterans’ agent Jo Ann Murphy, sometimes veterans do not have the luxury of time to clear their medical procedures.

“I had one veteran who didn’t have insurance who got really, really sick and he had to go to the hospital right away,” she said. “All of a sudden he started getting billed for all the treatment he got. We’re still fighting the VA on that one.”

When he has been forced to seek treatment off-Island, Mr. Williams says the typical trip to Providence is an all-day affair, requiring veterans to leave on early ferries and return at night. For veterans who do not meet service-related disability requirements the travel expenses to and from Providence, from the $165 round-trip ferry fare to gas, comes out of their own pocket. And once at the VA hospital, Mr. Williams said, service can be frustrating.

“The Providence VA is terrible,” he said. “The treatment is really bad, it doesn’t matter what department. It’s like that movie Born on the Fourth of July. It’s really a trip going up there.”

Ms. Murphy said when veterans see private physicians they are often ill-equipped to follow VA procedures. As a result billing can often become a muddle, sometimes ending up in the laps of the veterans themselves.

“Private physicians not in the VA system oftentimes don’t get how it works,” she said. “They don’t know how to fill out the forms and which ones to fill out. A lot of times it just doesn’t happen.”

Dukes county manager Russell Smith said the entire situation can and will be resolved once the VA renews its partnership with the hospital. To that end Mr. Smith has been in close contact with the Providence VA office to facilitate contracts for radiology, lab work and primary care. He said Island veterans, who numbered some 357 in 2007 [privacy laws enacted since then make collecting accurate data difficult], are not asking for much.

“It’s often perceived that we’re looking for full service here on the Island and we’re not. We’re looking for primary care,” Mr. Smith said.

But like Mr. Walsh, Mr. Smith said he could not speculate when the contracts would be completed.

“When the VA in Providence gets done with it, it all has to be blessed by Washington, so that should give you some idea of the time frame we’re looking at,” he said.

Meanwhile, Mr. Williams is trying to sell his house in Vineyard Haven so he can move to South Carolina to be closer to the top-flight Beaufort naval hospital. Before he leaves, though, he wants to make sure that his fellow Vineyard veterans are properly cared for. After more than a year of fighting to bring treatment back to the Island Mr. Williams has difficulty hiding his frustration.

“Veterans helping veterans is the only way we’re going to get this fixed because the VA doesn’t care about us,” he said.