The Wyoming County Board of Education voted Monday to rescind a previous decision that would have ended an agreement between the school system and Tug River Health Association, a nonprofit health clinic in Southern West Virginia.
The partnership allowed Tug River — which operates three nonprofit clinics in Wyoming and McDowell counties — to run a mobile clinic that provided vaccinations and other health services to school children through Wyoming County Schools.
Earlier this month, the BOE voted to stop the partnership after local physicians said their practices were losing business to the clinic, according to reporting in the Beckley Register-Herald.
At a special meeting Monday, however, board members apologized for that move. They said that, after learning more about the needs in the area and services provided by Tug River, they had made a mistake. They voted unanimously to reinstate the memorandum of understanding, or MOU, behind the partnership.
“Whether fair [or] not fair to businesses, this was not our decision to make. Our obligation is to children. I steered us down this path, and it was the wrong path to go down,” said school board member Mike Davis. “I feel like a coach who made a boneheaded decision and lost the game.”
“I’m a business guy, and that’s the route I took, and I was out of my lane ... my lane should always be — and it will from now on — be what’s best for kids,” said board member Richard Walker. “I’m not here to be a business guy. I was elected to do what’s best for the kids in the county, and I failed to do that last time we were here. I apologize.”
Board of Education president Michael Prichard said the initial intention to end the agreement between Tug River and the school system came after private physicians said the mobile clinic was impacting their practices and taking patients.
At the board’s Aug. 31 meeting, three doctors from Family Healthcare Associates, which operates three clinics in Wyoming County, spoke to the board about the effect Tug River was having on their businesses. The doctors, according to the Register-Herald, told board members they were willing to compete for business, but wanted a level playing field: through the MOU, Tug River can use the school’s facilities and resources to contact parents and see children; the private practice cannot.
Family Healthcare Associates operates six total offices in Southern West Virginia. According to the West Virginia Secretary of State’s business database, Dr. Samuel Muscari Sr. is the company’s president as of 2020. His son, Dr. Samuel Muscari Jr., is listed as the secretary.
Samuel Muscari Sr. is also a Wyoming County Commissioner, and Samuel Muscari Jr. is the county health officer. Per state code, county commissioners are responsible for allocating funds to school boards annually.
The Muscaris did not return requests for comment by press time Tuesday.
Prichard said that despite the Muscaris’ connections to local agencies and the health practice, there was no political pressure to end the agreement.
“No. There was no pressure whatsoever. We made the vote based on the information we had at the time, and what we were hearing,” Prichard said. “As you saw, that wasn’t right. We needed more information. We got that, and we corrected the decision to do what’s best for school kids.”
Wyoming County Schools Superintendent Dierdre Cline affirmed Prichard’s response.
“Not from my standpoint, and I can’t imagine [the school board’s] either,” Cline said.
Tug River, per the MOU between the agencies, is responsible for making a mobile health unit available on a recurring basis at Wyoming County schools “determined to be in need” by the county BOE. Tug River covers all costs associated with operating the mobile health unit and its services, according to the MOU.
The BOE is responsible for collaborating with Tug River to determine schools and students in need of the services, as well as scheduling times for visits and the distribution and collection of proper consent forms for treatments, per the MOU.
The initial agreement was signed several months ago, before the COVID-19 pandemic began impacting communities in West Virginia. Since its initial implementation, Tug River has been focused on providing immunizations and wellness checks to children in Wyoming County to prepare for school reopenings.
Dr. Joanna Bailey, chief medical officer of Tug River’s Catterson Health Center, in Pineville, said Tug River is a way for anyone to access health care without worrying about insurance or income.
Bailey said the MOU was drawn up with broad language so if there were a need to expand the services, they could be included under the agreement’s main purposes: ensuring access to “high quality health care” and addressing “unmet health care needs” for all Wyoming County students.
Currently, Bailey said, there is only one mobile unit used by the nonprofit in both McDowell and Wyoming counties, and it stops in the latter just once a week.
“We’re excited to move forward with you all,” Bailey said. “If things go well and we want to expand here — reach more kids — that’s something we’re more than open to, and would be willing to work together on moving forward.”
Like much of Southern West Virginia, Wyoming County struggles with a dearth of health care resources and a surfeit of need.
The county is one of the least healthy in the state, with a majority of adults classified as living in fair to poor health, per the state Department of Health and Human Resources. The population is aging, and poverty — often linked to poor health, and vice versa — pervades.
According to the West Virginia Rural Health Association, there are just 15 physicians, physician assistants and nurse practitioners based in Wyoming County, which was home to about 20,300 residents in 2019, per the census.
Of those residents, more than 8% report not having health insurance.
There is no after-hours health care available in the county, as Family Healthcare Associates and the Tug River clinics close at 4:30 p.m. daily. In 1988, the Wyoming General Hospital, in Mullens, shut its doors, and since, residents have been without any 24/7 service.
Ambulance responses to some more isolated areas can take up to 45 minutes, and hospitals — depending on where a person lives — could be just as far away.
All of this is crucial in emergencies, but rural public health experts believe that strengthening preventive care and wellness services — like those offered by Tug River at no cost — can help communities as a whole become healthier.
Bailey said that was exactly what Tug River was interested in: providing care for students who could otherwise not access it, or afford it. The mobile clinic, she said, is a way to meet people where they were with even a basic level of care — Wyoming County, per the state Department of Transportation, is one of 19 counties in West Virginia without any type of public transit.
In McDowell County, the health association has successfully started two school-based clinics for students, where care providers help and connect with several student patients daily, Bailey said. They offer mental health services, an under-practiced specialty in the area, and can help connect families to more specialty care when it’s needed without the stressors that come with visiting a new doctor.
Walker, with the Wyoming County BOE, said that over the last week, he’d spent much time researching rural health statistics and needs. What he learned, he said, affirmed that there was no downside for the school to continue its partnership with Tug River.
“At the end of the day, the welfare of children must be put first — even above education, even above business,” Walker said. “After learning what I have in the last week, well, this is a slam dunk as far as what’s best for the kids, to me.”
Through its partnership, Tug River is authorized to use the school system’s robo-call system and sometimes social media presence to alert families of upcoming wellness events. Prichard said it was never the school board’s intent to give the nonprofit a step up from the private practices, but that there was no agreement in place to allow the private practices from using the school’s resources for their services.
“If they want those resources, they need to be out here,” Prichard said. “We don’t want to box anyone out — in our eyes, the more services the better for our people, and if they want to do the same thing, we’ll allow that, but we need to talk about it.”