What are the red flags for Robert Lee Trestman, PhD, MD?

AHA Dossiers Power Map About

Robert Lee Trestman, PhD, MD

Former AHA leadership · Trustee; leaves board Dec. 31, 2026

Senior Vice President and Chair, Department of Psychiatry and Behavioral Medicine | Carilion Clinic

Last verified November 4, 2026

7 Red Flags

Affiliations

•Senior Vice President and Chair of the Department of Psychiatry and Behavioral Medicine at Carilion Clinic in Roanoke, Va., since April 2017, and Carilion's Institutional Research Officer.
•Professor and Chair of Psychiatry at the Virginia Tech Carilion School of Medicine.
•AHA Board of Trustees member whose term ends Dec. 31, 2026; he was not among the trustees elected or re-elected for terms beginning Jan. 1, 2027.
•Chaired the AHA Behavioral Health Services Council in 2021.
•Chair of the American Psychiatric Association's Council on Healthcare Systems and Financing since 2020 and the APA's liaison to the American Hospital Association.
•Previously Executive Director of Correctional Managed Health Care at the University of Connecticut Health Center, which ran medical, mental health, pharmacy and dental care for all Connecticut Department of Correction inmates.
•Chaired the APA Workgroup on Correctional Psychiatry from 2013 to 2019 and is senior editor of the Oxford Textbook of Correctional Psychiatry.

Financial / Compensation

•Trestman does not appear among the officers, directors or highest-paid employees listed on the FY2024 or FY2025 Form 990s of Carilion Clinic, Carilion Medical Center or Carilion Services Inc., so his personal compensation is not publicly reported.
•Carilion Medical Center, the system's main hospital entity, reported FY2025 (year ended Sept. 30, 2025) revenue of $2.32 billion, expenses of $2.16 billion and net income of $164.3 million, up from net income of $64.8 million on $1.98 billion of revenue in FY2024.
•Carilion Medical Center's net assets grew to $1.27 billion at the end of FY2025, from $1.02 billion a year earlier.
•CEO Steven Arner, who succeeded Nancy Howell Agee in 2024, received $1,715,344 in reportable pay plus $489,922 in other compensation in FY2025, paid through Carilion Services Inc.
•Agee received $3,830,705 in reportable pay in her final full year as CEO (FY2024), and $2,565,963 more in FY2025 as "CEO Emeritus."
•At least seven Carilion Medical Center physicians and department chairs received more than $1 million in reportable pay in FY2025; the highest, Eric Marvin, MD, received $1,730,753.
•Carilion opened its $500 million Crystal Spring Tower at Roanoke Memorial in 2025 and had raised more than $105.6 million by October 2025 for the Carilion Taubman Cancer Center, which is planned to open in 2028.
•Carilion operates through several tax-exempt entities, including Carilion Clinic (EIN 54-1190771), Carilion Medical Center (EIN 54-0506332) and Carilion Services Inc. (EIN 54-1190879), so executive pay is spread across multiple Form 990 filings.

Lobbying and Political

•No federal Lobbying Disclosure Act filings for Carilion Clinic were found after the second quarter of 2022; before that, Baker Donelson lobbied for Carilion for $5,000 a quarter in 2021.
•In Virginia, Carilion registered five lobbyists for the May 2026 to April 2027 period: in-house Vice President Mark S. Lawrence (registered Oct. 27, 2026) and four lobbyists from Seven Hills Strategy Group (registered July 8, 2026).
•Lawrence's registered issues run from hospitals, Medicaid, the state budget and medical malpractice to AI, insurance, economic development, transportation, taxation and broadband.
•Carilion operates under Virginia's Certificate of Public Need regime, which shields incumbents from new entrants. The state COPN division approved Carilion's own inpatient rehabilitation hospital project in August 2025.
•As APA liaison to the AHA and chair of the APA council on payment and financing, Trestman sits where hospital-industry and specialty-society positions on behavioral health reimbursement meet.

Revolving Door

•Trestman's prior career was in state government health care: he ran Connecticut's correctional health system through UConn Health Center, a state institution.
•He served as an expert medical consultant to the Western Virginia Division U.S. District Drug Court.
•No federal advisory committee appointments or government roles since 2017 were found.

Home System Record

•Carilion is the dominant health system in western Virginia, with about 15,000 employees, seven hospitals, more than 250 practices and more than 1 million patients a year in Virginia and West Virginia.
•In May 2026, Carilion announced a joint venture with for-profit Select Medical to build a $112 million, 50-bed freestanding rehabilitation hospital in Roanoke. Select Medical will be majority owner and manager, and the hospital is expected to open in 2028.
•Carilion received state approval in 2025 to start a kidney transplant program.
•From 2003 to mid-2008, Carilion obtained roughly 33,000 court judgments against patients in Roanoke's small claims court, about 40% of that court's caseload, according to the Wall Street Journal's April 2008 investigation.
•Moody's rated Carilion A1 in 2019, citing its leading market position across a broad service area.
•No 2025 or 2026 layoffs, strikes, closures or credit downgrades at Carilion were found in public reporting.

Litigation and Scrutiny

•In 2009, the FTC won a consent order forcing Carilion to divest an outpatient surgery center and an imaging center it had bought in 2008 from independent competitors in Roanoke. The FTC said the acquisitions eliminated low-cost competition.
•Carilion Medical Center, Carilion Services and Carilion Clinic paid $403,960.75 under a Jan. 12, 2018 settlement with HHS-OIG over billing established outpatients with higher-paying new-patient visit codes.
•The Justice Department's 1989 antitrust suit to block a Carilion hospital merger (United States v. Carilion Health System) failed in federal court, allowing the consolidation.
•No new False Claims Act, antitrust, state attorney general or patient-debt actions against Carilion in 2025 or 2026 were found.

Red Flags

Carilion's main hospital entity earned $164.3 million in FY2025, a 7.1% margin on $2.32 billion of revenue. It pays no income or property tax and is protected from competitors by Virginia's COPN law.

Carilion paid its outgoing CEO $3.83 million in FY2024 and another $2.57 million in FY2025 as "CEO Emeritus," while also paying the new CEO about $2.2 million, in a lower-income region of western Virginia.

Carilion's history of near-monopoly consolidation includes a federal antitrust challenge in 1989 and an FTC-forced divestiture in 2009 of competitors it had absorbed.

Carilion uses the state's Certificate of Public Need gatekeeping for its own expansions, including a 2025 rehab hospital approval, while lobbying in Richmond on COPN and dozens of other issues.

Carilion used aggressive patient collections at industrial scale (about 33,000 judgments from 2003 to 2008) and retreated only after national press exposure.

Carilion's 2018 OIG settlement for upcoding outpatient visits shows a billing-compliance lapse at a system that markets itself as a community charity.

Trestman's AHA seat went to a department chair rather than a system executive. It gave Carilion, a system with documented market-power and collections problems, a vote on AHA governance until the end of 2026.

Pattern Summary

Trestman is a credentialed academic psychiatrist whose AHA seat served the association's behavioral-health agenda more than any operating role. The seat also gave Carilion, western Virginia's dominant and COPN-protected system, a voice in AHA governance. Carilion's FY2025 numbers ($164 million in net income and multimillion-dollar dual CEO payouts) undercut the hardship narrative the AHA sells in Washington. His term ends Dec. 31, 2026, and he was not re-elected.

Robert Lee Trestman, PhD, MD

Red Flags

Sources and Citations