Under the deal with the medical system, UMMS paid Pugh $500,000 for copies of the books while she served on its board. UMMS paid $100,000 in each of five transactions in 2012, 2013, 2015, 2017 and 2018 to purchase 20,000 copies of her self-published books at $5 per book. Pugh was among nine members of the 30-person UMMS board that had contracts or other business deals with the medical system. Pugh and two other board members have resigned. Several others were placed on leave.