State of Texas: 'We did it right,' Lt. Gov. Patrick defends Paxton trial process

AUSTIN (Nexstar) - The man who put the gag order in place for the impeachment trial against Attorney General Ken Paxton is speaking freely now that the gag order is over. Lt. Gov. Dan Patrick is defending the Texas Senate's process as "unbiased" while slamming the House's initial decision to impeach in late May.

In a one-on-one interview with Nexstar, Patrick responded to claims that Republican senators' decision to acquit their former colleague was influenced by politics and money. An editorial in the Wall Street Journal said "the fix was in from the start."

"Anyone that criticizes that process, well, that's on them because we did it right," Patrick told Nexstar in a one-on-one interview. He said presiding over the trial was "the most interesting and most challenging thing I've ever done."

Senators voted to find Paxton not guilty on every charge, mostly on a 14-16 vote. Patrick said after hearing the evidence he did not expect Paxton to be convicted, but he wasn't sure of acquittal.

"I didn't think they would convict on many charges, but I thought maybe one or two possibly so I had to be prepared for that."

Only two Republicans — North Texas’ Kelly Hancock and Jacksonville’s Robert Nichols — voted to convict Paxton on any of the charges. All other Republicans voted to find Paxton not guilty on every charge and Democrats voted guilty on almost all articles of impeachment. Paxton was immediately reinstated as attorney general following the verdict, after months of suspension once the House impeached him in late May.

Dick DeGuerin, one of the prosecutors who worked on behalf of the House impeachment managers, spoke with Nexstar after the verdict. The longtime defense attorney condemned outside conservative groups which he said tried to influence the outcome throughout the trial.

After the House impeached Paxton, Republican members were quickly met with opposition from Paxton supporters and early primary challenges.

"They were being threatened with money for primary opponents...if a grand jury were threatened like that, it would be a crime," DeGuerin said. "I thought the senators would have enough courage to fight what they know would be retribution by those right-wing militant wealthy donors."

Before the trial began, Defend Texas Liberty — a conservative political action committee led by former state Rep. Jonathan Stickland — gave $3 million to Patrick. The PAC sent text messages to GOP voters, urging them to call their senators to stop the impeachment trial before it began.

In his interview with Nexstar, Patrick said he is already beginning to fundraise for his 2026 campaign for reelection since Texas lawmakers are prohibited from taking campaign donations during the legislative session.

"No one who gets a campaign donation, that that impacts how they vote on something, you know, there is a certain level of integrity," he said. "Something else that didn't impact [senators], on all the noise on the outside."

Patrick noted he has also accepted campaign donations from Texans for Lawsuit Reform — which further-right conservatives have criticized for pushing impeachment against Paxton, although the group says those accusations are false — which the lieutenant governor also acknowledged in Nexstar's interview.

"I don't think they had anything to do with the impeachment, but I want to be clear, a some of their members felt like there should be a trial," said Patrick about Texans for Lawsuit Reform.

After the Senate voted to acquit Paxton on 16 articles of impeachment and tossed out the remaining four related to his ongoing securities fraud indictment, Patrick gave a blistering speech from the dais, slamming Speaker Dade Phelan and the House for what he believes was a rushed process.

Phelan fired back in response via a statement, calling into question Patrick's ability to manage the trial in an impartial manner.

"I find it deeply concerning that after weeks of claiming he would preside over this trial in an impartial and honest manner, Lt. Governor Patrick would conclude by confessing his bias and placing his contempt for the people’s House on full display," Phelan said. "To be clear, Patrick attacked the House for standing up against corruption. His tirade disrespects the Constitutional impeachment process afforded to us by the founders of this great state."

Patrick continued to blast the House to Nexstar, saying its members "totally ignored" impeachment precedent.

"When the speaker says that, then he questions my integrity. There is no bias. I ran a fair trial. There was no bias with the members, no matter what outside pressure they were getting," Patrick said. "They voted how they believe, and I respect those who voted for conviction, Republican or Democrat and those who did. And he's just very defensive right now because he knows his process is now in the spotlight, and it's an embarrassment."

Turmoil between the top leaders is not anything new. The top Republicans have acknowledged publicly that their relationship is fractured, most notably when the House and Senate couldn't strike a deal on property tax reform, which led to a months-long standoff and two special sessions. But Patrick said he is not concerned about the tension affecting the expected upcoming special session on education issues.

"Tensions between the speaker...myself don't matter. There were tensions between this speaker the session, and we passed the largest tax property tax cut in history, and many other really significant bills. Politics is tough," he said.

Earlier in August, a House interim committee suggested a tapered-down version of an education savings account — one of Governor Greg Abbott's policy priorities that would allow parents to use public dollars to send their children to private school. Patrick said the Senate won't accept a "watered down version," and called out rural House Republicans who have been opposed to a voucher system.

"It's time the Republicans in the House quit blocking this bill," he said. "The Governor and the Speaker have to come to an agreement."

Whistleblowers urge Abbott to ‘take action’ over Medicaid errors

Whistleblowers within the Texas Health and Human Services Commission sent an urgent message to Abbott, pleading for him to "take action now" to potentially save lives.

Their letter says mistakes and a lack of preparation led to hundreds of thousands of Texans losing Medicaid coverage - or waiting months for food assistance.

The anonymous Texas Health and Human Services employees sent the letter to the governor on Tuesday — marking their third outcry about issues with the agency’s systems, staffing and leadership which, they say, contributed to tens of thousands of people erroneously losing Medicaid coverage earlier this year.

"Regrettably, it appears that the full extent of these challenges may not have been adequately conveyed by our leadership, hence our decision to provide you with this comprehensive overview," the whistleblowers stated in the letter to the governor.

KXAN reached out to the governor's office for comment and is waiting to hear back.

U.S. Representative Lloyd Doggett, D-Texas, published the letter on Wednesday, as he and other lawmakers continue their calls on federal regulators to intervene.

In a letter signed by the entire Texas Democratic delegation, lawmakers asked the Centers for Medicare and Medicaid to pause terminations of people's coverage until it can complete an audit of the Texas system.

"Texas was removing people from the rolls through no fault of the individuals, but only because of incompetence at the agency," Doggett said in an interview with Nexstar.

"Texas is not doing what needs to be done. And neither is the Biden administration, they have a responsibility to enforce this Medicare law," Doggett added.

The whistleblowers also provided an update on the length of time it takes the agency to process applications for food assistance applications -- noting it surpassed 100 days and saying the "situation has continued to deteriorate" since their last outcry.

"This means that once someone applies for food assistance, it just sits in our system for over three months before anyone even looks at it," the letter reads.

It goes on to address the governor directly, saying, "The health and well-being of innocent Texans hang in the balance, and it is crucial that you take decisive, corrective actions."

Texas is not the only state with this problem. Data from KFF, which researches health policy, shows more than 7 million people across the country have lost coverage. Texas has the most, with more than 888,000 losing coverage. Florida is next with more than 700,000, and in Arkansas, nearly 374,000 people have been disenrolled.

Concerns grow over Texas patient safety law delay

Concerns are growing after the Texas Medical Board said it will take two years to fully implement a new state healthcare law meant to protect patients. Three weeks after the law went into effect, it's creating confusion, not confidence, among some patient advocates.

"I think it could be done quicker," said Dr. Robert Oshel, a former federal employee who is retired from the U.S. Dept. of Health and Human Services, where he worked for the National Practitioner Data Bank, or NPDB, as associate director of research and disputes. "It's certainly a concern for patient safety."

The state law — House Bill 1998, which passed the legislature with overwhelming bipartisan support and went into effect on Sept. 1 — was sparked by KXAN's "Still Practicing" investigations. It requires stricter scrutiny over Texas doctors and increased transparency when they're disciplined. Due to the "funding mechanism" in the law, the TMB previously said it won't be fully implemented for another two years.

“Based on the statute and funding mechanism, the Board is not concerned it will take two years to have physician and physician assistant licensees enrolled in NPDB CQ,” Texas Medical Board (TMB) spokesman Jarrett Schneider previously said, referring to a National Practitioner Data Bank 'Continuous Query,' which is a round-the-clock physician monitoring program. “The timeline is what is feasible under the method to fund the program using licensing fees. The board is eager to have the new NPDB CQ up and running as we believe it will be of great benefit to our licensure and enforcement programs.”

Still, the drawn-out timeline to fully implement the program has some patient advocates worried.

"I think it’s disappointing that it’s going to take them two years to do it," said Oshel, who worked at the NPDB for 15 years before retiring in 2008. "I can understand that they couldn’t be ready to go on day one as soon as the law is passed because you have to hire staff, you have to have procedures in place. But, two years is a long time to fully implement it."

"My understanding was the intent was to have it take effect as quickly as possible," Oshel said. "That doesn't mean day one but it doesn't mean two years later, either."

He called the two-year delay to fully implement the law "excessive."

"As your reporting found, there were a lot of physicians in Texas that come from states that had taken action against them," Oshel said. "And that’s something people in Texas ought to know about on an individual physician basis, not have to wait two years to find out."

The NPDB is a confidential federal database containing doctor discipline records from across the country. Under the new state law, Texas joins 22 other states enrolling all physicians in the nationwide, 24/7 monitoring program with the NPDB called a "Continuous Query."

"A Continuous Query is important because, as the name implies, it’s continuous," Oshel said. "New information comes into the data bank, it goes out immediately" as an alert to state medical boards who enroll.

If any Texas doctor is disciplined by another state medical board, has their hospital privileges suspended for more than 30 days, is found liable for medical malpractice or is convicted of a healthcare-related crime, the NPDB will immediately alert the Texas Medical Board.

That type of monitoring is important in order to make informed healthcare decisions, according to federal health officials.

"The ultimate mission of the NPDB is to improve health care quality, protect the public, and reduce health care fraud and abuse in the U.S.," said Health Resources and Services Administration spokesperson Martin Kramer. HRSA is under the umbrella of U.S. Health and Human Services, which operates the data bank. "Querying the NPDB for information on health care practitioners, entities, providers or suppliers allows organizations to make informed licensing, credentialing and hiring decisions. Entities who enroll their practitioners in Continuous Query receive notification within 24 hours of a new report obtained by the NPDB, 24 hours a day, 365 days a year."

Under the new law, "any new information" that "is found" during the query must be added to the physician's public profile "not later than the 10th working date."

Oshel, who is familiar with Texas' new landmark, bipartisan patient safety law and the inner workings of the data bank, has concerns.

Under federal law, any information that state medical boards receive from the data bank must be kept confidential, Oshel points out. The Texas Medical Board will have to confirm disciplinary records another way before making them public, which state law requires. One way to confirm that information is when physicians self-disclose any out-of-state actions or criminal records within 30 days. The board required that in a rule change last year following KXAN's investigations.

"TMB will continue verifying information regarding out-of-state actions as part of the process and will handle NPDB information as required by law," Schneider said.

Under the new state law, the Continuous Query monitoring program is funded through an $11 fee each physician, or physician assistant, will pay — either when they apply for a new Texas medical license, or when they renew their license every two years.

It will be the fall of 2025 before everyone is enrolled, Schneider previously said.

"During that two years, you’re going to have some physicians enrolled, other physicians not enrolled," Oshel said. "So, the public looking up information on the board’s website isn’t going to know whether it’s complete, or it’s partial, or what they’re dealing with. So, it’s going to be confusing."

In the meantime, the TMB will continue to rely on alerts from the nonprofit Federation of State Medical Boards, Schneider previously said. The problem with that is FSMB only collects disciplinary records from state medical boards, Oshel said. It does not track medical malpractice payouts, hospital suspensions and criminal actions related to healthcare.

"It's a far cry from what it could be if they had the full information from the data bank," said Oshel.

Oshel questions why money to fund the mandate can't be "advanced" so the TMB can implement the new law quicker and the patients can "get all the information they need as soon as possible."

It's been done in other states. The Medical Board of California, or MBC, said it borrowed two loans totaling $18 million since 2022 to fund its "general operations ... until a fee increase can be secured," MBC spokesperson Emmalee Ross said.

The money was borrowed from a regulatory authority within the California Department of Consumer Affairs and must be repaid, with interest, within two years of being issued, Ross said.

"TMB has no comment regarding the CMB’s funding/Dr. Oshel’s statements," Schneider said. "The TMB is funded for the NPDB CQ (Continuous Query) program as provided in House Bill 1998."

Separate from hiring five new employees, the TMB clarified it will cost $610,895 over two years, not per year like the agency previously said, to fund the Continuous Query subscriptions. Schneider said it is working with the NPDB to implement and test things like electronically enrolling all physicians in the 24/7 monitoring, instead of manually entering each name.

Oshel said making the switch would save time, labor and tax dollars.

"It will work, but it would be more labor intensive than just simply working with the data bank to enroll everybody at once," Oshel said. "That’s got to be more accurate and cheaper to do it en masse than it is for somebody manually to have to keyboard information in every time there’s a licensure renewal."

"TMB has met multiple times with NPDB for program implementation," Schneider said. "TMB is working with NPDB to implement more efficiencies. Until fully implemented and tested in coordination with NPDB to ensure proper information exchange, TMB will be using manual entries."

State Rep. Julie Johnson, D-Farmers Branch, introduced HB 1998 this past legislative session in direct response to KXAN's "Still Practicing" investigations, which began in early 2022. At the time, Johnson pledged to "do something about it."

In a statement, Johnson said with "patient safety on the line," the TMB "must get the implementation of these provisions right on the first try." She said her office will be in contact with the TMB to ensure it has the resources needed to implement her law in a "timely and effective manner."

"My top priority with this piece of legislation has been and will continue to be protecting the safety of patients in Texas," Johnson said. "HB 1998 was the culmination of over a year of hard work and input from many stakeholders, and when patient safety is on the line, we must get the implementation of these provisions right on the first try."

Johnson is now running for Congress to represent the Dallas area.

KXAN reached out to Johnson's Congressional primary opponents for their thoughts on Texas' doctor reporting system. Zachariah Manning suggested it should require doctors to "submit an affidavit under penalty of perjury" to help bridge the two-year delay in the law's implementation by the TMB.

"By including an algorithmic provision in the application process or supplement thereof, doctors would have been compelled to promptly comply with the new requirements, ensuring that the intended impact of the legislation is realized and enacted into law," Manning told KXAN. "It would have provided a clear and enforceable deadline, holding doctors accountable while safeguarding the integrity of the healthcare system."

"Sounds like this is an important issue for the state of Texas, and I'd like to hope that the state agencies involved can make improvements happen on a faster schedule," primary opponent Jan McDowell said.

At this time, it is unclear which state legislator could possibly work to update the law in the next regular session in 2025. Johnson will not be returning to the State Capitol, and her Senate co-sponsor, Republican Bob Hall — whose term is not up until 2027 — has not yet responded to our questions.

New law takes away some Texas Veterinary Board authority, temporarily

Stepping off the elevator at the George HW Bush State Office Building, it’s apparent the staff on this floor recently moved into the newly-built building. While some of the surrounding offices and desks remain undecorated or even empty, Brittany Sharkey’s corner office feels settled: art on the walls, books on shelves and pictures in frames on her desk.

It’s an image of the urgent progress the new executive director said she is hoping to make at the Texas Board of Veterinary Medical Examiners, or TBVME.

The state agency is responsible for overseeing and regulating animal doctors — and it is an agency which, according to lawmakers, has struggled for more than six years.

By 2022, a KXAN investigation found dozens of disciplinary records still missing from a website that was supposed to enable the public to search for information about the agency’s licensees —raising new questions about its internal operations and transparency.

A new law now calls on the agency to give up some of its control, at least temporarily. During the legislative session in spring 2023, lawmakers voted to “attach” the TBVME to another state agency, the Texas Department of Licensing and Regulation, or TDLR, for the next four years.

The governor signed the bill into law in June.

The partnership, which has been described as “rare” and even a “first-of-its-kind,” officially went into effect Sept. 1, and leadership at both agencies told KXAN the work has already begun.

“My goal is really to make the vet board the best small agency in the state of Texas,” Sharkey said. “I know that we've got some work to do, but I think we've really got the tools in place to get it done.”

Sharkey said she began meeting with Mike Arismendez, executive director at TDLR, long before the law went into effect. He told KXAN his agency is focused on consumer protection.

“We want to make sure that all of those that are in Texas — that Texans — have the opportunity to know that anyone that comes into a space that's licensed by us is protected,” Arismendez said.

He explained TDLR already operates a database with licensing information for its nearly 900,000 licensees across 37 different professions and industries. Its public website and search tool also track any penalties or violations by these licensees. He believes it’s one of the main reasons lawmakers elected his agency to help.  

“The citizens need to have access to that, and that's one of the things that we will make you confident that they will have access to,” he said.

He said TDLR will also begin to “triage” the agency’s records on complaints, investigations and inspections.

Sen. Nathan Johnson, D-Dallas, who authored the bill creating the attachment, said he believes this kind of record-keeping and data management should be the initial focus.

“One of the problems we have right now is that we can't really tell — they're not able to collect the information that they need,” he said. “I personally am a big advocate for government transparency. You have a problem, though, if the agency itself can't find its own records.”

Johnson sits on the Sunset Advisory Commission, which is responsible for reviewing the performance of state agencies and which has raised concerns about TBVME in three different reports over the last six years. KXAN’s Avery Travis asked Johnson what makes this attachment different than steps lawmakers took in the past.

“This bill was very specific, and it was assigning administrative and management responsibilities to another entity — that is not a common occurrence. It took away some authority from a previously independent agency, so that's quite significant,” he said. “While respecting their expertise, administratively, they weren't getting the job done.”

Under the law, TBVME’s board members will act as an advisory committee to TDLR on most matters — aside from issues dealing with medical scope of practice, over which TBVME will retain control.

After two years, TDLR will provide a list of recommendations to lawmakers. Johnson said he hopes to see progress, specifically on record-keeping and management, by then.

Another Sunset lawmaker, Rep. Justin Holland, R-Rockwall, authored the House version of the bill creating the attachment. He said lawmakers’ goal has always been getting TBVME back to being an autonomous agency.

“As Texas grows,” he explained, “this is going to be pretty important. I mean, just about everybody's got a pet in their house, or in, you know, the agriculture industry.”

He acknowledged the attachment faced some pushback during the legislative session, primarily from industry experts over concerns about how to handle issues that require medical expertise. The final version of the bill ultimately allowed TBVME’s board, of which six members are practicing veterinarians, to retain control over those types of decisions.

As for how the two agencies will navigate the attachment, Holland remained generally upbeat and positive, but added, “I do expect, you know, to see a little bit of push and pull. Anytime you come in and you have a new process, there's going to be some kinks to work out."

Sharkey and Arismendez, on the other hand, told KXAN they had not encountered any barriers or “kinks” in working with the other agency yet.

Sharkey does foresee one big, upcoming hurdle: the implementation of a new software system to track licensee information. She explained the agency currently uses one database to track license information while keeping information on any disciplinary action in separate Excel spreadsheets — accounting for some of the problems outlined in KXAN’s 2022 investigation.

“You're going to have to combine two systems, and that's always going to pose some challenges,” she noted.

Still, Sharkey believes her team made “great strides” in uploading disciplinary documents and righting problems with the public website, prior to the attachment officially going into effect.

She provided KXAN with numbers showing the number of compliance inspections the agency completed of its licensees dropped to less than 100 in fiscal years 2021 and 2022, down from roughly 900 each year prior. While the pandemic likely contributed to the slowdown, legislative reports noted that record-keeping and management issues at the agency also “undermined” its enforcement efforts and prevented it from meeting “basic expectations.”

According to the data provided by Sharkey, however, the agency has already completed more than 700 of those compliance inspections, so far in fiscal year 2023.

The data provided also show, in fiscal years 2021 and 2022, the TBVME board executed and signed close to half the number of disciplinary orders for licensees as it had in previous years. So far this fiscal year, though, the board has already signed 101 of those orders.

Sharkey credits her small staff of 18 people for this progress but also noted that the legislature approved a budget for some additional employees: six additional investigators, a staff veterinarian and an additional staff attorney to help them “deal” with the caseload.  

“There's a new game in town, and we are transparent, accountable and making sure that we're doing everything we need to be doing,” she said. “You're not going to get stonewalled … it's not going to be a challenge to get documents and ask us for things. We're going to be able to respond to those requests in a way that the previous administration just wasn't.”

Sharkey was appointed in September 2022, after former leadership stepped down amid the legislative criticism and KXAN’s investigation. She had, however, served at the agency previously as its general counsel.

When asked how Texans can trust she would shepherd this agency in a different direction, Sharkey emphasized she left the agency after problems began to arise.

“I saw that we were not meeting our mission to the Texans — to Texans. I felt like I could not continue in this role. So, I left the agency and then was really honored when I — the opportunity opened up, I applied and the board interviewed me and chose me for this role,” Sharkey said, “I take this very seriously; I'm a pet owner. I could not have more skin in the game if I tried, and I want Texans to know that we are really committed to making sure that their veterinary care is the best they can possibly receive."