The head of Veterans Affairs in Hawaii said Friday he will not resign after U.S. Rep. Tulsi Gabbard called for him to be fired, claiming he has been “dishonest” with Hawaii’s congressional delegation and is incapable of handling the needs of the island’s 127,600 veterans.

Wayne Pfeffer, director of the VA Pacific Islands Health Care System, said he apologized to congressional staffers for any misunderstanding about how long veterans wait for health care.

In her Friday letter to Acting Secretary of Veterans Affairs Sloan Gibson, Gabbard wrote that Pfeffer “should be fired due to his dishonesty, lack of integrity, incompetence and his flagrant lack of transparency when dealing with those to whom he is ultimately accountable to — the American people and veterans who defend freedom when faced with certain peril.”

The Hawaii Democrat referred to statements made by Pfeffer in a June 5 briefing with congressional staff members at the federal building in Honolulu. Under persistent questioning, Pfeffer told Hawaii staff members that the current wait time in Hawaii for new patients at the VA was about 30 days. At the same meeting, Gabbard said, a member of Pfeffer’s staff from the VA’s enrollment department confirmed that the wait time for new patients was between 30-50 days.

That was just four days before a scathing audit by the VA revealed that new patients in Honolulu actually had the worst wait times in the entire system, 145 days.

In her three-page letter to Gibson, Gabbard said that four days after the congressional briefing, Pfeffer denied ever discussing wait times during the June meeting with members of her staff and other congressional staff members. 

“This blatant display of dishonesty undermines the nature of public service, additionally, it reflects an arrogant disregard for our veterans, and being held accountable to the American people,” she wrote.

“In this urgent crisis, there should be zero tolerance for lies or misrepresentation about the dire situation our veterans are facing in Hawaii,” she added.

Gibson’s office in Washington, D.C.  said it has received the letter from Gabbard and will provide an official response.

Gabbard, a captain in the Hawaii Army National Guard who served two combat tours in Iraq, said she had “serious concerns about the handling of information on wait times in Hawaii, and the dishonest statements made to me and my office by local VA Pacific Islands Health Care System leadership.”

Adding that she has “zero confidence” that Pfeffer, who was named head of the VA in Hawaii eight months ago, “understands the severity of this problem, nor is he taking urgent action to address this crisis by expediting access to non-VA care for wait-listed veterans. He has been dishonest with me and the public, and has not been forthright or transparent with information.”

She called for a “thorough review of the cause for the excessive 145-day wait times.”

Pfeffer told the Associated Press Friday that he knew before the audit was released that veterans sometimes waited 100 days or more for their first appointment. 

“I didn’t know it would say 145 days on the report. It varies every day,” Pfeffer said in an interview. “I knew it was in that range, but I wasn’t sure what date the report was going to use.” 

Pfeffer said he told Congressional staffers that the wait was about 50 days, but he was referring to the wait time for veterans once the VA called them back to set an appointment.

“I tried to explain what I could, maybe I wasn’t clear enough, but I certainly wasn’t trying to deceive her,” Pfeffer said. “I knew the information was coming out on Monday, so it wouldn’t have made any sense to mislead her.”

Gabbard told Gibson that some of the reasons that she has “zero confidence” in Pfeffer’s abilities to continue is because Pfeffer seems unaware of former VA Secretary Eric Shinseki’s directive last month to ensure long-waiting veterans were getting immediate access to care. Shinseki, 71, was driven from office by a growing scandal over the agency’s health care system. The Kauai-born retired Army general resigned May 30.

Although Pfeffer’s office told Gabbard that the electronic wait list for veterans already enrolled in the VA system was reduced from 1,800 in May to 677 as of June 9, Gabbard said she has doubts whether the VA here can drop it to zero as officials have told her staff on June 9.

Gabbard said she is still waiting for a response from Pfeffer the number of newly enrolled veterans waiting for care or the longest wait time a new enrollee has experienced.

At least one member of Hawaii’s four-party delegation doesn’t support Gabbard’s call for Pfeffer’s ouster.

U.S. Sen. Mazie Hirono said in a statement that she believes there are procedures within the VA to review Pfeffer’s performance so that appropriate disciplinary action can be taken.

Hirono also wants to wait for the outcome of an independent investigation of VA’s wait times that she has requested.

“We need to get to the bottom of what has gone wrong and put forward productive solutions to fix problems at the VA that have existed for years. Our veterans are counting on us,” she said.

Hirono also referred to legislation passed by the House, which she co-sponsored, which she believes “strengthens these procedures to enable the VA to deal with these personnel matters more quickly. I expect that the VA is reviewing the performance of it’s managers to hold them accountable.” 

On Monday, Hirono wrote a letter to Richard J. Griffin, the VA’s acting inspector general, to verify a 14-day wait time that VA Pacific Islands Health Care System provided Hirono’s office for more than “91 percent of established patients requesting primary, specialty and mental health care appoints.”

“Additionally,” Hirono wrote, “the response did not address my request for information on the time it takes for newly registered patients to be established and seen by a VA Primary Care provider.”

Responding to information supplied by veterans in islands, Hawaii’s other senator, Democrat Brian Schatz on June 4 also sent a letter to Griffin, asking him to look into “second-hand” information from VA doctors and nurses that staffers at the Spark M. Matsunaga VA Medical Center were asked  “to wipe their computers clean regarding patient wait times.”

Schatz said Hawaii VA staffers were reportedly ordered to “cook the books” regarding patients’ appointments.

“I request that you investigate these allegations as part of your nationwide review of misconduct at VA hospitals,” Schatz wrote to Griffin. “We owe it to the 117,000 veterans living in Hawaii, many of whom are rural veterans on the neighbor islands who are already struggling to access routine care.”

In response to Schatz’s letter, Pfeffer wrote Thursday in an email to the Honolulu Star-Advertiser: “It has been continually emphasized that our employees continue to document our veteran needs in an appropriate and timely manner. I am not aware that anyone has violated those principles. It is our desire to ensure our veterans are seen commensurate with their healthcare needs. Our lengthy wait times though regrettable show we are recording wait times in our health care system. We continue to seek ways to reduce wait times locally, while providing quality health care to each veteran.”

Regarding calls for Pfeffer’s firing, U.S. Rep. Colleen Hanabusa said the priority now should not be on pointing fingers but on addressing problems at the VA and getting veterans the services they’re entitled to. Yet, she said unspecified “immediate action” would be called for if “disturbing” allegations about manipulating records are true. 

The congresswoman said in a statement she called for a report on the VA’s Hawaii operations in April but hasn’t yet received a response. 

Pfeffer began his VA career at the Bronx, N.Y. VA Medical Center, where he started as chief of fiscal service. He has served in various capacities at 11 medical centers. Before coming to Hawaii Pfeffer was the director of the VA Medical Center in Louisville, Ky., from July 2005 until September 2013.

The VA in Hawaii provides outpatient medical and mental health care through a clinic at Tripler Army Medical Center on Oahu and through five community based outpatient clinics on the Neighbor Islands including: Hilo and Kona on the Big Island, Maui, Kauai, and Guam. Traveling clinicians also provide care on Lanai and American Samoa. Its website said is services 127,600 veterans.

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The Associated Press contributed to this report.