JUNEAU — High workloads and inadequate staffing had a negative effect on access to care at the Department of Veterans Affairs clinic in Wasilla, an inspector general’s review found.

It found that eight of 40 patients assigned to the clinic who died between July 2013 and July 2014 received poor access to care. For six of those eight patients, the delay resulted in poor quality care, the review found. While the inspector general identified 40 patients assigned to the clinic who died during that span, it excluded one from further review in part because there was no documentation that patient had requested to be seen at the clinic.

The review, requested by Sen. Lisa Murkowski, was released Tuesday. It cited staff morale as an area of concern that, if not addressed, could affect access to care and patient safety.

It recommended, among other things, that the VA implement plans to ensure continuity of care for patients during situations including understaffing, as required by policy; have a primary care provider permanently on staff; and assess culture, morale and leadership issues identified in the report and take any appropriate action.

In a response dated April 10 attached to the report, the director of the Alaska VA Healthcare System, Susan Yeager, said she agrees with the recommendations and that the Alaska VA has taken or was in the process of taking steps to resolve the issues.

The Alaska VA has said the recruitment of doctors and nurses is one of the biggest challenges it faces. Yeager, in her written comments, noted “extreme difficulty” in attracting and keeping qualified candidates in “remote care sites” in Wasilla, Fairbanks, Kenai and Juneau and a proposal to sweeten incentives that already include relocation benefits. Wasilla is about 45 miles from Anchorage.

The inspector general report acknowledged a “chronic shortage” of doctors in Alaska and efforts taken by the VA to allow veterans unable to receive timely appointments to access care at non-VA facilities. The Wasilla clinic opened in 2009.

Between June 2013 and February 2015, 509 new VA patients who wanted to begin care at the Wasilla clinic but couldn’t because of a health care provider shortage and 535 established patients who couldn’t get timely appointments received care at the Southcentral Foundation, the report stated. Additionally, between August 2013 and February 2015, about 150 new or established patients who couldn’t get timely appointments received care at other community health centers.

Murkowski, R-Alaska, called the report scathing and a “confirmation of the worst suspicions” — that some veterans with serious health conditions were allowed to fall through the cracks “in a way that denied them possibly life-saving access to care.”

“I think Alaska VA needs to look really, really carefully and critically as to how they are providing care for our veterans, because what has been happening is simply not acceptable,” she said in a phone interview.