AUSTIN (Nexstar) — Texas legislators have their eyes on topics ranging from transgender and reproductive rights to immigration, property taxes and voting ahead of the 2023 session.

On Monday, the first day to file bills ahead of session, nearly 1,000 bills were filed just before 5 p.m.

The bill filing process gives us the first look into what Texas lawmakers want to pass next year.

Some policymakers are already drafting legislation aimed at legalizing sports betting. Republican former Gov. Rick Perry announced Thursday that he is joining the Texas Sports Betting Alliance as a spokesperson, pushing for the Lone Star State to join the 35 other states that have already legalized mobile sports betting.

“The legalization of mobile sports betting in Texas would mean implementing smart and efficient oversight to preserve the integrity of sporting events, empower Texans to safely participate in mobile sports betting, and fight illegal gambling,” Perry said in a press release. “Given that Texans are already participating in mobile sports betting, legalization would be a win for all involved.”

Both online sports betting and casinos are illegal in Texas — except for three casinos operating legally on Native American territory in the Lone Star State due to federal law. Despite casino-lobbying groups pouring millions of dollars into policymakers’ pockets in recent years, state lawmakers failed to move forward on legalizing either during the 2021 legislative session.

Advocates hope Perry’s endorsement will help further push the needle.

“We have a lot of good momentum going into this session, just based on the work we were doing before Governor Perry even joined our team,” said Cara Gustafson, spokesperson for the Texas Sports Betting Alliance.

Gustafson said Texans are already placing an estimated $8.7 billion in illegal bets through offshore betting websites. If legalized, the alliance estimates Texas would generate upward of $556 million per biennium.

Lt. Gov. Dan Patrick previously said it’s not enough money to consider legalizing online sports betting, but advocates say consumers are being hurt as long as the state isn’t regulating it.

“These offshore betting sites — there’s no safeguards for your private and financial information. You’re putting all of your information out there and at risk of getting stolen.”

Opponents of betting legislation have raised concerns about gambling addictions and the social consequences of gambling. Earlier on the campaign trail, Gov. Greg Abbott expressed openness to at least legalizing casinos, but with limitations.

“We don’t want slot machines at every corner store, we don’t want Texans to be losing money that they need for everyday expenses, and we don’t want any type of crime that could be associated with gaming,” Renae Eze, Abbott’s press secretary, told the Houston Chronicle. “But, if there is a way to create a very professional entertainment option for Texans, Gov. Abbott would take a look at it.”

State Sen. Carol Alvarado, D-Houston, said she feels confident about her legislation making it across the finish line during this legislative session, especially after garnering more bipartisan support. The senator already filed a resolution this week that would allow for casino gambling in Texas. If her constitutional amendment passes and is approved by voters, Alvarado says it will help “foster economic development and job growth,” and establish the Texas Gaming Commission.

Bill filed to create ‘District of Austin’

Mixed in the stack of Texas bills intended to disrupt a historically liberal Austin City Council, House Bill 714 and House Joint Resolution 50 would strip it of its power altogether.

In an act the director of the Donaldson Center for Communication Studies at the University of Texas, El Paso called, “a heavy dose of political theater,” North Texas Rep. Jared Patterson filed a bill, and a joint resolution, that would make Austin a district with state oversight. Think something similar to Washington D.C., Patterson explained.

“This is a statewide issue because decisions that are made in Austin affect folks all around the state,” Patterson said. He pointed to Austin’s voting to become a sanctuary city and defund its police department as examples.

Both candidates for Austin mayor were highly critical of the bill and other Central Texas state lawmakers declined to comment altogether.

Political science expert, Dr. Richard Pineda from the University of Texas El Paso, explained the constitution prevents this type of oversight overhaul from happening.

Austin is a home rule city, along with roughly 350 others in Texas, which gives the city power to govern through its city charter as long as the rules are not in violation of the Texas Constitution or state and federal law.

“Essentially home rule defines municipalities as having their own constitution in most cases. That’s the city charter,” Pineda explained. “The idea that you would upset the balance of a home rule city by trying to turn it into a governable district is I mean, you know, again, I think the best way to describe this is political theater.”

Patterson said even though it’s an “uphill battle,” he thinks getting a Constitutional Amendment passed alongside the bill is possible.

It would require a two-thirds vote from both the House and the Senate and it would go before Texas voters.

In the House, that amounts to no less than 100 members voting yes. Even if every Republican in the House of Representatives did so, they would still need to convince roughly 20 Democrats to join them.

“Your voices are still going to be heard. All we’re talking about is some oversight at the state level. And I think if we could come together in that way — Republicans and Democrats — and come together and work together, then we can have an even greater city as our capitol district for the state of Texas,” Patterson said.

New Texas politics email newsletter launches — how to sign up

KXAN News is bringing you a new way to immerse yourself in the world of Texas politics.

On Saturday, Nov. 19, the news station will launch a weekly email newsletter dedicated to happenings in the Texas legislature, updates on the issues state politicians are tackling and analysis of the current political climate in the state.

The Texas Politics Newsletter will also give you a peek at what’s to come in “State of Texas” — a program that centers on Texas politics airing statewide on Sundays.

To receive the new Texas Politics Newsletter, head over to kxan.com/newsletters.

Type in your email address in the box near the top of the page.

Then, scroll down to “KXAN Texas Politics Newsletter.”

Select the checkmark box on the left side of the newsletter’s description.

Then, at the bottom, click “sign up.” That’s it!

The newsletter will appear in your email inbox every Saturday morning for you to read with your morning coffee.

‘Design overhaul’ aims to fight fraud issues with temporary license tags

Following years of widespread fraud and KXAN investigations, the Texas Department of Motor Vehicles on Thursday announced a “major design overhaul” of its temporary paper tags.

As part of its ongoing crackdown on temporary tag abuse — which ballooned into a $200 million black market and allowed criminals to hide in untraceable “ghost cars” — the TxDMV said after months of working with law enforcement on a redesign, it came up with a “more complex and secure” tag. The agency last redesigned temporary tags in 2018 but that proved ineffective.

The new security features will include a new Texas flag watermark, enhanced dealer descriptions and font sizes along with “numerous pieces of embedded data and text” that will link to law enforcement databases.

For security purposes, the TxDMV did not reveal all the new security features, many of which will only be detectable to law enforcement.

“With the support of our law enforcement partners, the Texas Department of Motor Vehicles is setting a new standard for temporary tag security and design,” said TxDMV Executive Director Daniel Avitia in a statement.

Dealers will begin issuing the new tags on Dec. 9.

Since 2020, the number of temporary tags issued in Texas has dropped, according to data KXAN obtained. It suggests recent fixes are working.

In January 2020, 422,154 tags were issued. That number jumped to 498,204 in January of 2021 and reached a high of 619,866 that April. This past January, it dropped to 375,070.

In September, it was 254,170.

Of the 30 dealer applications denied in the past two years, 27 were from this year. Dealer license revocations are also up. In 2020, 228 dealer licenses were revoked. In 2021, it was 229. In the first nine months of 2022, it’s 256.

The TxDMV credits improvements to measures the agency has taken along with the implementation of House Bill 3927 last fall. The new law allowed the agency to cap the number of tags that licensed Texas dealers can create. It also gave the agency the authority to immediately cut off access to its temporary tag database to any dealer suspected of fraud.

Most recently, following KXAN’s reporting, the TxDMV updated its policy and now requires fingerprint background checks for all dealers issuing tags in Texas.

Central Texas law enforcement deputy David Kohler, who previously testified before state lawmakers about temporary tags, praised the latest changes but still has concerns.

“I’m always optimistic about any positive changes that will help…law enforcement,” Kohler said. “I’m still very cautious of the fact that we’re still dealing with paper and tags that can very easily be manipulated using PDF software. And those tags are being sold illegally.”

Kohler showed KXAN a legitimate temporary tag he says he manipulated using PDF software to show how real and undetectable it looks. That tag had a hashtag in the license plate number and listed the owner as “Mickey Mouse” with an address of the TxDMV headquarters in Austin.

He said when the system generates a tag, it lets people save it as a PDF. He was able to use software to adjust it “to read whatever you want.”

“You still have the vulnerability of a legitimate paper tag being manipulated,” he warned, “and illegally being sold to unsuspecting victims in the state of Texas.”

He also said he recently took a photo of a car near Manor with a fake tag — which they could spot because “60 day permits do not exist.”

When asked if the newly redesigned paper tags are still vulnerable, Kohler didn’t hesitate.

“Everything is vulnerable,” he said.

Some doctor malpractice lawsuits kept quiet, even when patients die

Sitting at a small dining table, Carol Ross, her daughter, Lynda David and granddaughter Lacy leaf through old family photos. With the turn of each page, memories of a loving husband and father emerge along with the picture of a life Ross and David say was stolen.

“That was typical daddy,” David said, pausing over one picture. “Big grin.”

What they miss most, in a word, is “everything.” Today, Roy Ross’ big grin is seen only in old photos and shared memories. In 2009, Carol Ross, now 76, drove her husband to the hospital after he began vomiting blood. He had an esophagus tissue tear — called a Mallory-Weiss tear — which should have been easily treated, according to court records and her own opinion as a former nurse.

Roy Ross never left the hospital alive. He was 63.

In 2011, two years after Ross’s death, the family filed a medical malpractice lawsuit against the hospital and anesthesiologist, alleging providers failed to intubate him, did not protect his airway and delayed CPR when he began choking on his own blood.

Roy Ross suffered severe brain damage and died days later, court records detail.

“I don’t know what they should have done, could have done,” Ross’ widow said. “But they did nothing.”

In 2012, a jury in the family’s medical malpractice lawsuit found the hospital and anesthesiologist responsible for Ross’ death and awarded the family $1.9 million.

“Just total despair,” his widow said. “I mean, he was my everything.”

STILL PRACTICING: KXAN investigates problem physicians

That outcome, our investigation found, is rare.

KXAN analyzed malpractice lawsuits filed in Texas over the last decade. We found 97% were settled out of court or handled by a judge. In those cases — the overwhelming majority — the outcomes can legally be kept secret in the state of Texas. In the other 3% of malpractice cases, it was a jury that made the determination if a physician was at fault, which state law says is the only scenario, under Texas Occupations Code 154.055(b)(16), where a malpractice case must be made public.

Malpractice cases that go to trial, and are decided by a jury, are so rare we had to travel more than 200 miles to East Texas to find the Ross family and another patient, Billy Pierce.

“I’m not like I was,” said Pierce, 70, who lives in Tyler. “Never will be.”

In 2014, Pierce had surgery to remove gallstones in his bile duct. He was placed into a medically induced coma for more than a month, according to a lawsuit he filed.

“Basically put me under,” he said. “And I woke up about 42 days later.”

A jury determined the gastroenterologist failed to properly diagnose and finish his surgery. It’s unclear why Piece wasn’t transferred to another hospital or why he was kept in a coma for so long. His physician, it turns out, was on probation at the time, with hospital privileges suspended for failing to meet basic standards of care that resulted in a patient’s death, according to Texas Medical Board records.

Pierce’s lawsuit claimed “negligent care and treatment” led to his liver transplant and forced retirement as executive vice president of a chemical company. A jury awarded him $43 million.

Because the doctor in Pierce’s case was found at fault for malpractice by a jury, with appeals exhausted, under Texas law the outcome should be public on the medical board’s website. Despite that requirement, we found no record of any lawsuit listed when you search the doctor’s name.

“I’m angry. Very angry,” said Pierce said when KXAN showed him the TMB website which said: “The physician has the following reportable claims. NONE.”

“The system,” Pierce responded, visibly upset, “is set up to protect doctors.”

Ross’ family, including his widow, Carol, were unaware the outcome of their lawsuit was also missing from the TMB website until we showed them.

“You’re kidding me,” she said. “Makes me feel like I’m going to throw up.”

Our investigation identified at least four doctors found liable by a jury for malpractice over the past decade with no record of any judgment on the state’s website. According to court records, that includes a doctor who failed to diagnose and treat the buildup of fluid in a patient’s brain. Another doctor was found to have improperly inserted a breathing tube, which became dislodged, and caused the patient to lose oxygen for more than 30 minutes.

Both of those patients died.

Under Texas law, those malpractice cases should be disclosed on the medical board’s website.

The president of the TMB, Dr. Sherif Zaafran, said patients have a right to transparency.

“I want patients to know as much as possible about their physicians,” Zaafran said.

Still, Zaafran admits the agency can do better. KXAN asked if he thinks there should be more transparency when it comes to patients finding out about malpractice lawsuits, especially when doctors are found to have harmed patients.

“The more transparency [there] is — it’s absolutely better for patients,” Zaafran said.

In response to our previous reporting, this summer the board said it requested $2.5 million from the legislature to address licensing issues.

“Yes, reporting in late 2021 and early 2022 was a factor,” TMB spokesperson Jarrett Schneider said when asked if KXAN’s investigations played a role, “in addition to internal discussions before and after the reporting.”

The agency processes over 50,000 applications each fiscal year that require a background check, Schneider said. The $2.5 million would fund more staff to manage a new physician monitoring section for the agency. For $2.50 per doctor annually, the money would also pay for continuous background checks with the National Practitioner Data Bank — instead of relying on doctors to self-report.

“Right now, medical malpractice lawsuits are self-reported by licensees,” Zaafran said. “And, again, that’s only as good as the information we get from our licensees.”STILL PRACTICING: Doctors come to Texas to escape problem pasts

If approved and signed by the governor, the TMB could begin receiving funding for continuous background checks on Sept. 1, 2023.

TMB records show the physicians involved in the Ross and Pierce cases are both still practicing. The one who treated Pierce was sued again and settled in 2018 following another death. Last year, the TMB ordered him to be accompanied by a medical staff member anytime he sees a patient. The board’s website shows a clean record for the physician in the Ross case.

“I had all the confidence in the world in the medical system,” Ross’ widow said. “Until this happened.”

Listening to her grandmother talk, Lacy David, 27, can’t hold back her tears. Roy Ross was her “best friend,” she said. His death inspired her to attend nursing school where she is expected to graduate next summer.

Her goal: “to be there for families.”

“We were not done right by the system,” she said. “And I still have a lot of faith in it. I really do. It’s just some things need to change. … I want to make things different. … I just want to be the change.”

“And you will be, Lacy,” her grandmother said.

The TMB said it will look at the four malpractice lawsuits KXAN identified.

“The Board will review to determine if any meet the requirements” for public reporting, Schneider said.

‘A long time’ before Congress takes up medical error transparency

Our report looked at transparency — not just in Texas, but across the country — when it comes to medical errors. The exact number of patients who die every year due to medical errors is unknown and debated. One often-cited study from Johns Hopkins, published before the pandemic in The BMJ medical journal, found medical errors to be the third leading cause of death in the US. In 2016, those researchers found more than 250,000 deaths a year were “due to medical error,” surpassing respiratory disease.

Eight members of Congress declined to talk about this issue with us or didn’t respond, including leaders of the Senate’s Health Committee.

The only person who agreed to talk with us is a Texas congressman, and doctor, who opposes any changes.

“I actually fail to see the problem that you’re talking about,” said U.S. Rep. Michael Burgess (R-Texas). “Of course, that is a state issue, not a federal issue.”

The North Texas Republican congressman said the decision to disclose medical errors should be left up to individual states. He also wants the National Practitioner Data Bank — a confidential clearinghouse of doctor discipline records — to stay sealed to patients and the public.

“I don’t know what purpose that would serve [to open the NPDB],” he said. “I think the Texas Medical Board actually does a pretty good job.”

The Data Bank was established by Congress in 1986. Under federal law, it’s only accessible to hospitals and state medical boards. It is not public “by design,” Burgess notes.

While he doesn’t support a federal transparency standard, he does support one thing: capping how much a jury can award victims of medical malpractice.

“I mean, look, if we want to get into a whole argument, should medical liability be a federal issue? Yeah,” he said. “I’d like to see a federal limit on non-economic damages, like we’ve done in Texas.”

Those opposed to opening doctor discipline records to patients say those records may lack context, unfairly damaging a physician’s reputation if made public. They point out doctors can settle lawsuits for business reasons rather than guilt. Lobbyist groups like the American Medical Association blame lawsuits for malpractice insurance rate hikes and have pushed for so-called “tort reform.”

The AMA drafts ready-made model bills where lawmakers can fill in the blanks with their state’s name suggesting reforms like: setting statute of limitations, capping non-economic damages at $250,000 like in Texas, and requiring an affidavit from a board-certified doctor swearing “reasonably prudent” care wasn’t followed even when a patient dies. The AMA suggests calling the bill the “Frivolous Lawsuit Reduction Act.“

“Most doctors do not accept that even in a situation of clear malpractice that they have done anything wrong,” said Joanne Doroshow, executive director of the Center for Justice and Democracy at New York Law School. “They really believe just about every lawsuit is frivolous.”

Doroshow has testified before Congress on this issue before. She believes insurance rate hikes are caused by medical errors — which she says have killed or injured “way too many people.” Increasing transparency would help weed out bad doctors, she argued.

In 2020, citing the Johns Hopkins study, then-Rep. Tulsi Gabbard introduced a bill — the Medical Error Transparency Act — that would have ensured “patient access to data and reports for medical injury due to medical error, negligence, or malpractice.” It had no cosponsors and went nowhere.

“They’re not getting any pressure from any large lobby groups to deal with it,” said Doroshow, who notes this issue comes up cyclically and often when rates are up. “And, so, it’s going to be a long time before Congress even considers doing something again on this.”

For now, Rep. Burgess said the Constitution will likely keep this out of Congress.

“The states are where that jurisdiction currently exists,” he said. “And under the 10th Amendment, that’s likely where it’s going to stay.”

In Texas, after our nearly yearlong series of reports, several state lawmakers have pledged to work on making the system more transparent. In June, the TMB approved a new rule change requiring doctors to self-report criminal convictions, out-of-state disciplinary actions and medical malpractice claims within 30 days. Previously, it was every two years. The following month, the TMB requested $2.5 million to hire more staff and pay for continuous background checks with the National Practitioner Data Bank.

“You could always argue for more transparency,” Burgess said. “And that’s, perhaps, a fair argument. But I know the Texas Medical Board has made changes.”

The Texas Medical Association, which represents tens of thousands of physicians across the state, did not respond to a request for comment.

After getting a Republican perspective, KXAN reached out to other lawmakers, including the ranking member on the Senate Health (HELP) Committee, Sen. Richard Burr (R-North Carolina) and Chair Sen. Patty Murray (D-Washington). We also contacted other Democrats including: Rep. Lloyd Doggett (D-Austin), Rep. Raul Ruiz, M.D. (D-California), Rep. Katie Porter (D-California), Rep. Kathy Castor (D-Florida), Sen. Elizabeth Warren (D-Mass.) and Sen. Ron Wyden (D-Oregon). Our requests for an interview or comment were either not returned or declined.

When it comes to medical malpractice lawsuit transparency, a number of states provide patients more information about their doctors than Texas.

In Texas, when doctors are found liable for medical malpractice, the state medical board doesn’t always disclose that — even though it’s required to by law — a KXAN investigation found.

In Texas, patients and the public can only find out about medical malpractice lawsuits when a jury determines a doctor is liable and appeals are exhausted. That doesn’t happen often. When it does, the Texas Medical Board isn’t always quick to make that information public.

Other states believe patients have a right to know. North Carolina publishes all cases that result in a payment of over $75,000 for a period of seven years. Colorado requires any final judgment, settlement or arbitration awards since Sept. 1, 1990, be made public so patients can “make the best healthcare decisions.”

“Some studies have shown that there is no significant correlation between malpractice history and a healthcare professional’s competence,” a disclaimer on Colorado physician profiles reads. “At the same time, consumers should have access to malpractice information. To make the best healthcare decisions, you should view this information in perspective.”

KXAN is not naming the physicians and hospitals in our reporting in order to focus on problems within the system. We attempted to get comments from all physicians and hospitals involved but either did not hear back or they chose not to comment.