More than $800,000 that had been allocated to a Southwest Virginia free clinic — then abruptly pulled from the state budget following concerns about executive compensation at the nonprofit — had been earmarked to fund a free summer health care expo.
Hundreds of thousands of dollars in state money had flowed to the Health Wagon for the expo since at least 2018, even during two years when the event was canceled due to the COVID-19 pandemic.
Legislators cut the funding from the state budget earlier this month after Cardinal News reported that the Health Wagon’s leadership had been receiving outsized compensation packages.
Del. Terry Kilgore, R-Scott County, said Tuesday that legislators had decided to pause state funding until concerns surrounding compensation could be resolved.
The Health Wagon’s top executive, Teresa Tyson, was compensated more than $520,000 in 2022, according to tax documents, a sum that nearly doubled over two years and is two to three times higher than the salaries of comparable executives in much wealthier regions of Virginia.
Her compensation increased by 53% from 2021 to 2022, according to the most recent tax documents available. This increase was on top of a 27% increase from 2020, when her compensation package totaled $267,564.
Health Wagon’s clinical director, Paula Hill-Collins, saw a 39% increase to her compensation in 2022, when she was paid $308,725.
“Those salaries are way outside of the norm,” Kilgore said.
Before deciding to pull state funding, legislative staff reviewed the organization’s financial information and found that the Health Wagon had substantial reserves that would allow it to continue operating until the question of state support can be revisited when the General Assembly reconvenes in January, Kilgore said.
The state funds would have been used to support Move Mountains Medical Mission, an annual health expo that is held in Wise every summer, according to Linda Scarborough, a public information officer with the Virginia Department of Health, which oversees the budget allocation.
Neither Tyson nor Hill-Collins responded to questions about whether the health expo would be affected by the lack of state funding. Steve Smith, the chairman of the Health Wagon’s board of directors, did not respond to requests for comment.
However, the organization recently announced on Facebook that the expo will continue this July.
In previous years, the expo offered free health screenings and services to uninsured and underinsured residents, including dental exams and emergency extractions, nutrition education, ultrasounds and chest X-rays, according to an informational poster that was distributed last year. The Health Wagon’s service area is among the poorest and most medically underserved regions of the state.
At least some legislators were unaware of the intended use of the funds.
“I’m not exactly sure what it was for,” Kilgore said Tuesday, adding that the appropriation had been automatically added to the budget for several years.
State funds continued to be delivered to the Health Wagon even when the expo was canceled due to the COVID-19 pandemic.
More than $402,000 was appropriated for the expo in 2020 and 2021, according to the state budget. However, a 2020 media release distributed by the Health Wagon announced that the expo was canceled that year due to the pandemic. In 2023, a report by the Bristol Herald Courier announced the return of the expo after two years of cancellations and a smaller event in 2022.
The Virginia Department of Health did not respond to questions regarding oversight of the Health Wagon’s programming in time for publication.
The state budget from 2020 and 2021 specified that the Health Wagon was required to use the funds for the summer outreach program.
Sen. Todd Pillion, R-Washington County and one of the budget negotiators this year, did not respond to requests for an interview.
The Health Wagon first received a dedicated line item in the state budget in 2006, totaling $50,000, when Tyson became the executive director. State funding for the Health Wagon fluctuated between about $76,000 and $202,000 in the adopted budgets from 2010 to 2016.
During the 2018 regular session, at least $302,712 was designated from the general fund to the Health Wagon for the initial year of the budget. This was the first year the budget language specified that the funds should be used for the summer outreach program. An additional $302,712 was allocated for the subsequent year. Adjustments were made during the 2019 General Assembly, increasing state funding to at least $402,712 annually.
This appropriation remained consistent through 2023 and was included in an earlier version of the 2024 state budget before legislators removed it earlier this month.
The free health expo was first held in Wise in 1999 in partnership with Remote Area Medical at the invitation of Sister Bernie Kenny, who founded the Health Wagon. RAM partners with communities across the country to bring free health care services to the uninsured and underinsured in remote areas, according to Jeff Eastman, CEO of RAM.
In 2019, RAM decided to pull out of Wise, aiming to serve communities with greater needs.
“It was a strategic decision on RAM’s part,” Eastman said. “There are a significant amount of services in that area … we try to serve people who are hours and hours away from health care.”
Leadership at the Health Wagon then formed the Move Mountains Medical Mission in order to continue the annual health expo, which draws thousands of patients every year.
Kilgore expects that legislators will take a closer look into the finances at the Health Wagon in the months before the 2025 General Assembly.
“I think most people agree that the Health Wagon serves a lot of needs in that area, but there appears to be a need for some investigation, some examination of what is going on with the money,” Kilgore said. “No one’s saying that if we get those questions answered that we wouldn’t be at the table again as a state to make sure services are delivered.”
A first step, Kilgore said, would be to reform the board of directors at the Health Wagon.