WASHINGTON -- Alaska veterans have faced delayed and diminished access to health care at an outpatient clinic in Wasilla, according to the Department of Veterans Affairs independent inspector general.

The clinic didn't have a permanent care provider for much of last year, and patients faced an uphill battle when trying to receive care or adequate follow-up, according to a report released Tuesday. The report concluded that the problems it uncovered "have the potential to compromise patient safety."?

The investigation began in August 2014 at the request of Alaska Sen. Lisa Murkowski. Murkowski cited claims by Dr. Jacqueline Brecht, a former Anchorage VA physician, regarding scheduling and care issues.

Murkowski called it a "scathing report" and said in an interview that she is "just really saddened and disappointed that the worst suspicions that we had not only about the Wasilla (clinic) but (also) the Alaska VA have been confirmed."

The report shows "we were allowing some of our veterans to fall through the cracks in a way that denied them access to potentially life-saving care, and that's really disturbing," Murkowski said.

Claims of mismanagement and long waits to see a doctor followed the nationwide VA scandal that began in Phoenix, Arizona, and resulted in the resignation of VA Secretary Eric Shinseki. In the months after the revelations, an internal audit by the VA found that more than 57,000 veterans had been waiting more than three months for an initial doctor visit.

The investigation found that the Mat-Su community-based outreach clinic, which opened in March 2009, has struggled to keep physicians on staff. For a little more than year, in 2011 and 2012, there were two permanent physicians on staff. But in May 2014, the remaining doctor resigned, "citing an excessive workload," the report said.

"After May 2, 2014, although the clinic remained open, it did not have a permanent provider. Rather, the (clinic) was staffed by contract physicians and a nurse practitioner detailed from Anchorage," the report said. A nurse practitioner joined the staff in October 2014, but the clinic still has no permanent physician. Patients are sent elsewhere instead.

For much of the last several years, patients had to wait more than two weeks for an initial appointment at the Wasilla clinic, according to the inspector general report.

A review of medical records of several elderly patients who died also found evidence of poor care and lack of follow-up for serious medical conditions.

The investigation also found ongoing problems of employee morale at the clinic, including "distrust of management and lack of guidance/support from leadership as well as a communication disconnect amongst and between medical staff throughout the system and clinical leadership," the report said. The report said employees complained of "slowness and dysfunction" in "personnel processes" that directly affected the clinic's ability to become and remain fully staffed.

Internal processes that should have taken days or weeks took months. Patients faced long waits to get an appointment and were treated without seeing a doctor. This all led to turnover, office-wide stress and "a hostile work environment," the report said.

That the facility was short on doctors was not surprising, Murkowski said. But the larger, systemic problems at hand -- particularly follow-up for sick patients -- need to be dealt with, she said.

Murkowski said many of the problems are not unusual issues but stem from the VA doing what is already required of it. She hopes the report will put a spotlight on the issues that could lead "those who were concerned about speaking up" to come forward with new information.

"If there are people within the Alaska VA that are not allowing for changes in the system to come about, we need to figure out how we get them out of the way," she said.

The Mat-Su VA clinic responded to early information it received from investigators with plans for improvements -- some already in place.

"As of April 6, 2015, demand for new patient primary care appointments is being met within 14 days of the preferred date 95 (percent) of the time," the report said. The clinic is seeking approval "for recruitment, relocation, and retention incentives up to 25 (percent) of annual pay, and local authority to approve guaranteed home buyouts for physicians at those sites to attract qualified applicants," the report said.