AUSTIN (KXAN) — In a direct response to a series of KXAN investigations, Democratic gubernatorial candidate Beto O’Rourke is pledging, if elected, to increase patient safety statewide by transforming the Texas Medical Board.

“That’s what stands out to me, from what I’ve learned from your reporting, is just this pay-to-play system that we knew existed in Texas,” O’Rourke said during a virtual interview May 13. “I didn’t know how bad it was at the TMB. But, it’s something that we’ve got to change.”

The TMB is the state agency overseeing how doctors are licensed and disciplined. In our months-long series, “Still Practicing,” KXAN discovered the TMB is keeping dozens of out-of-state disciplinary records secret, contrary to state law, and allowing doctors it deemed to be a “threat to public welfare” to keep practicing. Those include more than a half-dozen credibly accused of sexual misconduct with patients and one recently convicted of selling more than a million opioid pills.

Our team also revealed Texas Gov. Greg Abbott appointed top-dollar donors to sit on the medical board — several with real estate, energy and business backgrounds but no obvious patient safety or patient advocacy experience. One board member, Dr. Satish Nayak — who gave the governor $38,920 — is eligible to be removed from the board by Abbott due to being placed on a remedial plan. The board determined he “failed to keep adequate medical records for multiple patients.”

KXAN reached out multiple times to Gov. Greg Abbott to request an interview. A spokesperson did not respond when asked if his office was aware of this and if he looked into removing Nayak from the board. Instead, we received a written statement.

“Governor Abbott expects all medical professional at the Texas Medical Board and across Texas to uphold the highest standards of care and trust Texans deserve, and will accept nothing less,” wrote his spokesperson, Ranae Eze, in a statement.

His office would not say why the governor appointed donors to the TMB and did not respond to O’Rourke’s allegations that he’s giving donors “plum appointments” as part of a “pay-to-play system.”

Board members, including Nayak, did not respond to KXAN’s request for comment.

“I think one of the problems we see with the TMB right now is you have doctors who probably should have been removed who are still practicing,” O’Rourke said. “You even have members of the TMB who have had problems with how they’ve handled patient information and records who probably should have been removed from the TMB who are still there right now in this position.”

O’Rourke — a former presidential hopeful turned Democratic nominee for governor — said he wants more accountability for physicians and board members. He also wants more oversight of the TMB.

“We may not have the oversight and the accountability for our medical providers that we should be able to count on,” O’Rourke said. “For ourselves, and our for our family.”

Transforming the TMB

Following KXAN’s reporting, O’Rourke is proposing to change the make up of the 19-member board so public members with non-medical backgrounds — meant to balance the board by representing patient interests — are “closer to half” of the number of board members who are physicians. It’s a measure praised by patient advocates.

Board members are appointed by the governor and confirmed by the Texas Senate.

A KXAN analysis of every state medical board in the country found Texas has seven public members, more than all but one other state in the country — a fact cited by the governor.

“Tied for first with the most number of public members on our state medical board,” Eze said, “Governor Abbott has worked to appoint members that will help promote his policies to protect the interests and care of Texans.”

While Texas has among the highest number of public members, they still represent less than half the entire board. There are also no requirements that those public members have any patient safety or patient advocacy experience. In fact, we found several of the TMB’s public board members plucked from real estate, energy and business sectors. In a news release announcing the appointment of Arun Agarwal to the TMB — the CEO of a textile company who gave the governor $196,758 — Abbott highlighted his “business interests in textiles, cotton trading and real estate.” At least seven board members collectively, donated nearly $400,000 to Abbott since 2014, according to campaign finance records.

“If I’m governor,” O’Rourke said, “we’re gong to make sure that the Texas Medical Board is comprised of people whose sole focus is in protecting the public health and protecting the public from the rare instances where we have medical providers who abuse the public trust and end up abusing their patients.”

O’Rourke said he would not look to appoint people who donated to his campaign.

“No, I would not look to donors for any appointment,” he said. “What I would look for are the best people who could provide the greatest value to the folks in Texas.”

He pledged to select board members with expertise in patient safety. O’Rourke also said he wants to work with the legislature to do-away with appointing donors for all state boards in order “to ensure that we end the pay-to-pay that has long defined appointments in the state of Texas,” he said.

“The last thing that we’ll want to look at is whether someone has donated to me. People need to be placed in these positions on their merits,” he said. “We have to expect, and then hold the governor accountable, for having the very best people in these positions.”

“Look, at the end of the day,” he added, “our responsibility in our state government is to look out for, and protect, the people of Texas.”

National leader in transparency and discipline?

In a statement, Abbott touted the TMB as a “national leader.”

“Our office continues working with TMB to ensure board members and physicians are held accountable to their patients and to Texas, making our board a national leader in transparency and enforcement of state and discipline laws,” Eze said.

To make the case, his office sent KXAN a 2016 investigation by the Atlanta Journal-Constitution. The report looked at a few focused areas, including medical board transparency when it comes to discipline records being made public for doctors accused of sexual misconduct.

The six-year-old AJC report also highlighted doctors in Texas allowed to keep treating patients despite being credibly accused, in one case, by multiple patients. It found a “difficulty in prosecuting a well-connected doctor and how that can force a medical board into compromise.”

The report did not measure the overall performance of the TMB when it comes to things KXAN found such as: allowing physicians to practice in Texas, despite having their medical licenses revoked in other states; dozens of out-of-state disciplinary records kept secret, contrary to state law; and doctors deemed a “threat to public welfare” to still practice.

A spokesperson for the TMB previously told us it would “welcome the opportunity” to work with any lawmaker to “better serve Texans.”