AUSTIN (KXAN) — Gov. Greg Abbott tapped top-dollar donors to sit on the Texas Medical Board. He also appointed members — tasked with representing the consumer — who come from telecom, business, real estate and energy sectors, with no obvious patient advocacy or medical experience, a KXAN investigation revealed.

The TMB’s mission is to “protect and enhance the public’s health, safety and welfare” but some advocates worry that comes with a political price tag.

“The question isn’t: ‘Is this someone who donated a bunch of money to a political campaign? Is this someone who checks a political box?,’” said Ware Wendell, the executive director of the non-partisan organization Texas Watch, which advocates for patient safety. “The question should be: ‘Is this someone who’s going to make sure that patients are protected?’”

‘Take politics out of patient safety’

KXAN wanted to see how money and politics intersect with patient safety in Texas. Digging through campaign finance records, we found several board members, appointed by the governor, who have collectively donated hundreds of thousands of dollars to Abbott’s campaign, according to records dating back to 2014.

By law, the 19-member medical board is in charge of licensing and regulating physicians in Texas. All are appointed by the governor to serve six-year terms. A dozen of the TMB board members — more than half — are doctors. Less than half, seven, are considered “public members.” These are members who, by design, have no medical background and help balance the board by defending the interests of patients and consumers. Advocates like this approach and have pushed for more outside representation on medical boards across the country.

The TMB’s website doesn’t specifically identify which of its members are “public,” like other states do. KXAN found some members, meant to represent the average patient and consumer, who don’t have an obvious track record of patient advocacy work but do have a history of donating to Abbott since 2014:

  • Arun Agarwal, CEO of Nextt, a large textile company, gave the governor $196,758.
  • Michael Cokinos, president of Cokinos Energy Corporation in Houston, donated $32,500 to Abbott’s re-election.

KXAN searched campaign records for every board member. In addition to Agarwal and Cokinos, we found five doctors gave the governor between $7,425 and $85,000, according to campaign finance records. The highest amount came from Dr. Sherif Zaafran, the board’s president.

KXAN analyzed every state medical board in the country. In nearly every state, board members are governor-appointed. Texas is tied for second with the most number of public members on its board. Despite that, Wendell, and others, worry that appointing donors allows for the potential to politicize these positions.

“We need to take politics out of patient safety,” he said.

INTERACTIVE: State Medical Boards

ClickTap on a state to see how Texas compares


Alabama

Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia

Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia West Virginia Wisconsin Wyoming District of Columbia

District of Columbia

×

TEXAS

State medical board:
Texas Medical Board

Physician or medical background: 12

Public board members: 7

Governor appointed? Yes

Total members: 19

×

ALABAMA

State medical board #1:
Alabama Board of Medical Examiners (determine if applicants are qualified for licensure, investigates complaints, brings formal charges)

Physician or medical background: 16

Public board members: 0

Governor appointed? No. Members come from Medical Association of the State of Alabama’s Board of Censors (elected by licensees)

Total members: 16


State medical board #2:
Alabama Medical Licensure Commission (issues licenses for physicians, tribunal for imposing discipline)

Physician or medical background: 7

Public board members: 1

Governor appointed? Yes and No (Governor appoints 4 members, including public member; Lt. Gov. and Speaker of the House of Representatives each appoint 2 members)

Total members: 8

×

ALASKA

State medical board:
Alaska State Medical Board

Physician or medical background: 6

Public board members: 2

Governor appointed? Yes

Total members: 8

×

ARIZONA

State medical board:
Arizona Medical Board

Physician or medical background: 8

Public board members: 4 (1 public member is a licensed nurse)

Governor appointed? Yes

Total members: 12

×

ARKANSAS

State medical board:
Arkansas State Medical Board

Physician or medical background: 12

Public board members: 2

Governor appointed? Yes

Total members: 14

×

CALIFORNIA

State medical board:
Medical Board of California

Physician or medical background: 8

Public board members: 7

Governor appointed? Yes and No: Most appointed by governor; 1 public member appointed by Speaker of Assembly; 1 public member appointed by Senate Rules Committee

Total members: 15

×

COLORADO

State medical board:
Colorado Medical Board

Physician or medical background: 12

Public board members: 4

Governor appointed? Yes

Total members: 16

×

CONNECTICUT

State medical board:
Connecticut Medical Examining Board

Physician or medical background: 14

Public board members: 7

Governor appointed? Yes

Total members: 21

×

DELAWARE

State medical board:
Board of Medical Licensure and Discipline

Physician or medical background: 10

Public board members: 5

Governor appointed? Yes

Total members: 16 (includes 1 director of Division of Public Health)

×

FLORIDA

State medical board:
Florida Board of Medicine

Physician or medical background: 12

Public board members: 3

Governor appointed? Yes

Total members: 15

×

GEORGIA

State medical board:
Georgia Composite Medical Board

Physician or medical background: 14

Public board members: 2

Governor appointed? Yes

Total members: 16 (15 voting members + 1 physician assistant ex-officio member)

×

HAWAII

State medical board:
Hawaii Medical Board

Physician or medical background: 9

Public board members: 2

Governor appointed? Yes

Total members: 11

×

IDAHO

State medical board:
Idaho Board of Medicine

Physician or medical background: 8

Public board members: 3

Governor appointed? Yes

Total members: 11 (includes 1 director of Idaho State Police)

×

ILLINOIS

State medical board:
State Medical Licensing Board

Physician or medical background: 7

Public board members: 0

Governor appointed? Yes

Total members: 7

×

INDIANA

State medical board:
Medical Licensing Board of Indiana

Physician or medical background: 6

Public board members: 1

Governor appointed? Yes

Total members: 7

×

IOWA

State medical board:
Iowa Board of Medicine

Physician or medical background: 7

Public board members: 3

Governor appointed? Yes

Total members: 10

×

KANSAS

State medical board:
Kansas Board of Healing Arts

Physician or medical background: 12

Public board members: 3

Governor appointed? Yes

Total members: 15

×

KENTUCKY

State medical board:
Kentucky Board of Medical Licensure

Physician or medical background: 8

Public board members: 3

Governor appointed? Yes

Total members: 15 (including 4 de facto members: 3 deans of medical/osteopathic schools; 1 Commissioner of Public Health)

×

LOUISIANA

State medical board:
Louisiana State Board of Medical Examiners

Physician or medical background: 9

Public board members: 1

Governor appointed? Yes

Total members: 10

×

MAINE

State medical board:
State of Maine Board of Licensure in Medicine

Physician or medical background: 8

Public board members: 3

Governor appointed? Yes

Total members: 11

×

MARYLAND

State medical board:
Maryland Board of Physicians

Physician or medical background: 16

Public board members: 6 (includes 1 “knowledgeable in risk management or quality assurance matters”)

Governor appointed? Yes

Total members: 22

×

MASSACHUSETTS

State medical board:
State medical board: Massachusetts Board of Registration in Medicine

Physician or medical background: 5

Public board members: 2

Governor appointed? Yes

Total members: 7

×

MICHIGAN

State medical board:
Michigan Board of Medicine

Physician or medical background: 12

Public board members: 7

Governor appointed? Yes

Total members: 19

×

MINNESOTA

State medical board:
Minessota Board of Medical Practice

Physician or medical background: 11

Public board members: 5

Governor appointed? Yes

Total members: 16

×

MISSISSIPPI

State medical board:
Mississippi State Board of Medical Licensure

Physician or medical background: 9

Public board members: 3 non-voting

Governor appointed? Yes and No: The governor appoints all but non-voting consumer members, who are nominated by the board’s president.

Total members: 12

×

MISSOURI

State medical board:
Missouri State Board of Registration for the Healing Arts

Physician or medical background: 8

Public board members: 1

Governor appointed? Yes

Total members: 9

×

MONTANA

State medical board:
Montana Board of Medical Examiners

Physician or medical background: 11 (includes 1 nutritionist, 1 acupuncturist)

Public board members: 2

Governor appointed? Yes

Total members: 13

×

NEBRASKA

State medical board:
Nebraska State Board of Medical Examiners

Physician or medical background: 6

Public board members: 2

Governor appointed? No: Nebraska State Board of Health appoints.

Total members: 8

×

NEVADA

State medical board:
Nevada Board of Medical Examiners

Physician or medical background: 6

Public board members: 3

Governor appointed? Yes

Total members: 9

×

NEW HAMPSHIRE

State medical board:
New Hampshire Board of Medicine

Physician or medical background: 7

Public board members: 3

Governor appointed? Yes

Total members: 11 (includes 1 Commissioner of Health and Human Services or designee)

×

NEW JERSEY

State medical board:
New Jersey State Board of Medical Examiners

Physician or medical background: 16

Public board members: 3

Governor appointed? Yes

Total members: 21 (includes 1 Commissioner of Health or designee; 1 executive department designee)

×

NEW MEXICO

State medical board:
New Mexico Medical Board

Physician or medical background: 9

Public board members: 2

Governor appointed? Yes

Total members: 11

×

NEW YORK

State medical board:
New York Medical Board

Physician or medical background: 20

Public board members: 2 minimum

Governor appointed? No: Appointed by Board of Regents

Total members: 24

×

NORTH CAROLINA

State medical board:
North Carolina Medical Board

Physician or medical background: 10

Public board members: 3

Governor appointed? Yes and No: 11 appointed by governor; 2 appointed by General Assembly

Total members: 13

×

NORTH DAKOTA

State medical board:
North Dakota Board of Medicine

Physician or medical background: 11

Public board members: 2

Governor appointed? Yes

Total members: 13

×

OHIO

State medical board:
State Medical Board of Ohio

Physician or medical background: 9

Public board members: 3

Governor appointed? Yes

Total members: 12

×

OKLAHOMA

State medical board:
Oklahoma State Board of Medical Licensure and Supervision

Physician or medical background: 7

Public board members: 4

Governor appointed? Yes

Total members: 11

×

OREGON

State medical board:
Oregon Medical Board

Physician or medical background: 11

Public board members: 3

Governor appointed? Yes

Total members: 14

×

PENNSYLVANIA

State medical board:
State Board of Medicine

Physician or medical background: 8

Public board members: 2

Governor appointed? Yes

Total members: Total members: 12 (includes 1 Secretary of Health Designee; 1 Commissioner of the Bureau of Professional and Occupational Affairs)

×

RHODE ISLAND

State medical board:
Board of Medical Licensure and Discipline

Physician or medical background: 7

Public board members: 6

Governor appointed? Yes

Total members: 13

×

SOUTH CAROLINA

State medical board:
Board of Medical Examiners

Physician or medical background: 10

Public board members: 3

Governor appointed? Yes and No: Governor appoints 3 public members, 1 physician; Board nominates remainder, but governor can reject

Total members: 13

×

SOUTH DAKOTA

State medical board:
South Carolina Board of Medical Examiners

Physician or medical background: 7

Public board members: 2 (1 can be non-physician health care professional)

Governor appointed? Yes

Total members: 9

×

TENNESSEE

State medical board:
Tennesee Board of Medical Examiners

Physician or medical background: 9

Public board members: 3

Governor appointed? Yes

Total members: 12

×

UTAH

State medical board:
Utah Physicians and Surgeons Licensing Board

Physician or medical background: 9

Public board members: 2

Governor appointed? Yes

Total members: 11

×

VERMONT

State medical board:
Vermont Board of Medical Practice

Physician or medical background: 11

Public board members: 6

Governor appointed? Yes

Total members: 17

×

VIRGINIA

State medical board:
Virginia Board of Medicine

Physician or medical background: 14

Public board members: 4

Governor appointed? Yes

Total members: 18

×

WASHINGTON

State medical board:
Washington Medical Commission

Physician or medical background: 15

Public board members: 6

Governor appointed? Yes

Total members: 21

×

WEST VIRGINIA

State medical board:
West Virgnia Board of Medicine

Physician or medical background: 13

Public board members: 3

Governor appointed? Yes

Total members: 16

×

WISCONSIN

State medical board:
State of Wisconsin Medical Examining Board

Physician or medical background: 10

Public board members: 3

Governor appointed? Yes

Total members: 13

×

WYOMING

State medical board:
Wyoming Board of Medicine

Physician or medical background: 6

Public board members: 2

Governor appointed? Yes

Total members: 8

×

District of Columbia

State medical board:
DC Board of Medicine

Physician or medical background: 10

Public board members: 4

Governor appointed? N/A: Appointed by mayor

Total members: 15 (includes 1 director of Department of Health or designee)

KXAN put together a map showing the make up of every state medical board in the U.S.

That is especially true in Texas, Wendell said, after a series of KXAN investigations revealed the TMB is not following the law by keeping dozens of out-of-state disciplinary records secret and allowing some physicians the board deemed “a threat to public welfare” to keep practicing, with restrictions.

A TMB spokesperson declined an on camera interview but in a statement defended the way physicians are disciplined and said the agency “does not have appointment authority” when it comes to who gets to sit on the medical board.

“The TMB does not control the selection/appointment of Board members,” TMB spokesperson Jarrett Schneider wrote in a statement. “Requirements of individual board members are set out in state law as you noted. The Governor has appointment authority with the Texas Senate giving confirmation.”


			Photos of the Gov. Abbott and the TMB on top of campaign finance records (KXAN Photo/Josh Hinkle)

Photos of the Gov. Abbott and the TMB on top of campaign finance records (KXAN Photo/Josh Hinkle)

TMB Insider: ‘It is very political’

At least one current TMB employee believes the governor should appoint public members with backgrounds in patient advocacy and safety work. KXAN agreed to conceal this person’s identity because they are not authorized to speak to reporters and could be fired for doing so.

“I’m not shocked that these people who are appointed are big donors,” the employee said. “I don’t think it should be that way. It is very political.”

This insider believes the current system allows “bad doctors” to keep practicing, which they say is “sad.”

“I think there are some board members that would rather protect the physicians because they are physicians themselves,” the TMB employee said. “I think they could do a lot more to protect the public.”

“We do not have a comment regarding remarks from an unnamed individual,” Schneider said.

Longtime Austin patient advocate, Lisa McGiffert, with the Patient Safety Action Network, said she isn’t surprised by what KXAN uncovered.

“Typically in Texas,” she said, standing in front of the Capitol, “donors get appointed to these important boards. I’ve seen that for 30 years.”

Like Wendell, McGiffert is also pushing for legislation in response to what KXAN uncovered. In 2017, she added her name to a letter sent to Abbott, which was signed by more than a dozen consumer advocates. The letter asked for more public members to be appointed to the medical board. The letter was sent to all 50 states.

“Your state Medical Examining Board is an essential organization protecting citizens from unprofessional and incompetent doctors,” the letter said, according to an email of it, which was forwarded to KXAN. “Public members (sometimes referred to as citizen or consumer members) play a critical role on Medical Examining Boards. Because they should be free of financial and other professional ties to the health care professions, their experience can ground a medical examining board and provide insight and common sense to deliberations.”

The coalition recommended appointing public members with a “demonstrated interest in health care safety” and “a track record of consumer and/or patient interest advocacy.”

McGiffert said she never heard back.

The governor’s office did not respond to multiple requests for comment.

“Your reporting has uncovered ways that the Texas Medical Board has not always taken the public’s interest — in actions against doctors who were harming patients, and in some cases, repeatedly harming patients,” McGiffert said. “I think people, absolutely, who are patient advocates, should be considered [for board-appointment].”


			Patient advocates Ware Wendell and Lisa McGiffert discuss legislative ideas in front of the Capitol (KXAN Photo/Matt Grant)

Patient advocates Ware Wendell and Lisa McGiffert discuss legislative ideas in front of the Capitol (KXAN Photo/Matt Grant)

‘This remedial plan is non-disciplinary’

McGiffert and Wendell are both concerned about what KXAN uncovered, including possible conflicts of interest. Last year, TMB board member and physician Dr. Satish Nayak — who donated $38,920 to the governor — entered into a “remedial plan,” according to the TMB’s public records. The board determined he “failed to keep adequate medical records for multiple patients.”

Under the Texas Administrative Code, that constitutes “grounds for potential removal” from the board by the governor. Two of Nayak’s fellow board members offered him the opportunity to take an eight-hour class as part of the remediation plan. Towards the bottom of the board’s order against Nayak, written in all caps and bold letters, the board wrote: “THIS REMEDIAL PLAN IS NON-DISCIPLINARY.” The governor did not respond to requests asking if he is aware of this or made attempts to remove Nayak.

According to the TAC, a board member who is the “subject of a non-disciplinary or disciplinary action, including but not limited to any remedial plan, board order, or administrative penalty, regardless of the nature of the violation(s)” can face “potential removal.”

The American Medical Association writes doctors have an “ethical obligation” to manage records appropriately, which serve “important patient interests for present health care and future needs, as well as insurance, employment, and other purposes.”

The TMB’s spokesperson deferred to the governor.

“TMB does not have appointment nor removal authority of Board Members,” Schneider wrote in a statement. “The TMB does not control the selection/appointment of Board Members… The Governor has appointment authority with the Texas Senate giving confirmation.”

Records detailing Nayak’s initial complaint are not on the TMB’s website for the public to view. The TMB says complaint records are confidential. The action was also not posted in the TMB’s quarterly bulletin, even though actions taken against other physicians were, for similar offenses.

“Remedial plans are ‘non-disciplinary’ actions by statute and are not included with disciplinary orders in publications such as the TMB bulletin,” Schneider said. “However, they are public documents and are posted to the online profiles as required by law. Remedial Plans were created by state law enacted in 2011. All physicians receive the same treatment regarding the posting of Remedial Plans.”

Schneider would only say “each case will have its own set of facts that must be evaluated regardless of sharing similar allegations.” He denies Nayak received any preferential treatment.

“The enforcement process is the same whether the individual is a Board member or not,” Schneider said. “The entire process, including who hears the case, follows all statutes and rules just like every other physician. TMB has no authority to create a separate process for TMB-licensed Board Members with alleged violations.”

These type of standard-of-care violations are reviewed by expert doctors, not affiliated with the TMB, Schneider said, who are from outside the area where the complaint was made.

KXAN reached out to Nayak along with other TMB board members identified in this report for comment but did not hear back.

“Your reporting has uncovered real problems in our state, a clear and present danger for patients,” said Wendell. “If the Texas Medical Board is really about protecting patients, we need people on the Texas Medical Board who have a demonstrated history of protecting patients. It makes sense.”

Graphic Artist Rachel GaleDirector of Investigations & Innovation Josh Hinkle, Investigative Producer Dalton Huey, Photojournalist Chris Nelson, Digital Special Projects Developer Robert Sims and Digital Director Kate Winkle contributed to this report.



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