Texas veterans homes overseen by George P. Bush were often the deadliest places to be during COVID-19 pandemic

By Shannon Najmabadi, The Texas Tribune, Jay Root, Houston Chronicle, and Carla Astudillo, The Texas Tribune

"Texas veterans homes overseen by George P. Bush were often the deadliest places to be during COVID-19 pandemic" was first published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs Texans — and engages with them — about public policy, politics, government and statewide issues.

About this story: The Texas Tribune and Houston Chronicle spent months investigating how Texas cared for veterans and their spouses during the coronavirus pandemic at the nine state-run veterans homes. Reporters reviewed hundreds of pages of inspection reports and internal emails, and interviewed more than a dozen experts, resident advocates and families.

Mary Kay Dieterich was encouraged last year when Texas Land Commissioner George P. Bush promised to shake up the management of the El Paso nursing home where her father died of COVID-19.

She knew it wouldn't bring Eugene Forti, a World War II veteran, back to life. But as the top elected official in charge of all nine of the state's nursing homes catering to veterans in Texas, Bush certainly had the power to hold the private management company accountable for what Dieterich saw as a botched response to the pandemic.

Yet, despite telling the for-profit operator of the Ambrosio Guillen Texas State Veterans Home that he was “deeply concerned" about the care it was providing in El Paso, Bush's promised shakeup, delivered to the local news outlet El Paso Matters, never came — even as COVID deaths soared at the facility.

More than a quarter of its infected residents died, nearly double the average 13% death rate across El Paso County's 21 nursing homes.

And it's not the only one.

Nursing homes, which care for people who are already medically vulnerable, were ravaged by the pandemic. But Texas' state-run veterans homes were often the deadliest places to be.

The nine state homes had more than double the death rate among COVID-19-infected residents compared with other nursing homes in the state, according to a Texas Tribune-Houston Chronicle analysis of state data from the pandemic's start until June 2021.


Findings

The Houston Chronicle and The Texas Tribune spent months investigating how Texas cared for veterans and their spouses at the height of the coronavirus pandemic at the nine state-run veterans homes in Amarillo, Big Spring, Bonham, El Paso, Floresville, Houston, McAllen, Temple and Tyler. After reviewing hundreds of pages of inspection reports and internal emails, and interviewing more than a dozen experts, resident advocates and families, the Chronicle and the Tribune found:

  • Texas' state-run veterans homes had more than double the death rate among COVID-19- infected residents compared with other nursing homes in the state.
  • Seven of the homes had a fatality rate of 25% or more — far higher than the statewide average — 11% — among Texas nursing homes.
  • Approximately 23% of the state veterans homes nationwide are overseen by outside management companies, but in Texas all nine of them are, and they account for a quarter of the privately run homes in the United States.
  • Resident advocates say for-profit nursing homes tend to have lower staffing levels and perform worse than nonprofit and government-run facilities. Average staffing levels in Texas nursing homes are among the lowest nationwide. Five of Texas' veterans homes fell beneath the state average.
  • On July 8, one day after the Tribune and the Chronicle shared their analysis with the agency, Land Commissioner George P. Bush decided to end the relationship with the two for-profit operators of the homes and asked his staff to conduct a nationwide search to find replacements.

Three of the state's nine veterans homes — including Ambrosio Guillen in El Paso — had the highest death rate among all nursing homes in their county. Seven had a fatality rate of 25% or more, far higher than the statewide average of 11% across Texas nursing homes.

All told, nearly 570 veterans home residents tested positive for COVID-19 in Texas and nearly a quarter of them, 134, died.

Veterans home residents are typically male and older than people in other nursing homes, and many have chronic conditions that can make them more susceptible to severe infection, Bush's agency and experts said. The homes are often larger facilities, which studies have shown were at greater risk of outbreaks.

But Texas' nine veterans homes are also among about 23% nationwide that are managed by private contractors rather than the state, which residents' advocates and experts said could expose them to cost-cutting by for-profit companies.

After the Tribune-Chronicle findings were shared with Bush's office two weeks ago, he vowed to take action to improve care — by not renewing the operators' contracts and starting over from scratch.

Two for-profit companies manage Texas' nine state homes under the auspices of the Veterans Land Board. The board, which oversees programs for veterans, is headed by Bush and housed within the General Land Office. A representative of Bush's agency is on-site in each home and has sweeping access to attend meetings, hear complaints, “protect the interests of the board" and advocate for residents' rights, according to the homes' contracts.

Three of the homes are run by Texas VSI and accounted for 40% of the fatalities among sick veterans home residents.

The other contractor, Touchstone Communities, oversees the state's other six veterans homes — including one in Floresville where state inspectors found residents were in “immediate jeopardy" and failures that constituted “actual harm," according to regulatory records from May 2020.

After inspectors documented multiple violations, the Frank M. Tejeda Texas State Veterans Home was hit with state and federal fines totaling nearly $300,000 — the largest by far of the veterans homes in Texas, health authorities say. It had the most coronavirus cases and second-highest death toll of the five nursing homes in Wilson County, where Floresville is the county seat. (The home with the highest number of deaths had a dedicated COVID-19 ward that took in patients from other facilities and hospitals, its administrator said).

A second inspection in February of this year uncovered a new infection control violation at Frank Tejeda and resulted in another $30,000 in fines, federal records show.

Floresville Mayor Cecelia Gonzalez-Dippel blamed the Bush-led Veterans Land Board for failing to follow up on complaints and to ensure that residents received proper treatment.

“It makes me angry, you know. Yes, angry at COVID. But also angry at 'how did this happen?'" Gonzalez-Dippel said in a January interview. “I can't go and investigate [the veterans home] myself. I'm leaning on the Land [Board] to do everything they can to take care of all of the residents."

On July 8, one day after the Tribune and the Chronicle shared its analysis with the agency, Bush — now running for Texas attorney general — decided to end his agency's relationship with the for-profit operators of the homes and asked his staff to conduct a nationwide search to find replacements with “a proven track record at infection control procedures," General Land Office spokesperson Rachel Jones said.

“The care our veterans receive is of utmost importance to the Veterans Land Board, and we take every charge levied by family members, residents, and public health authorities seriously," Jones said.

Texas VSI and Touchstone referred questions to Bush's agency.

The land board, citing incomplete federal data, said the homes operated by San Antonio-based Touchstone had a comparable death rate with other skilled nursing facilities nationwide. The Tribune-Chronicle analysis did not use the federal data from the Centers for Medicare & Medicaid Services because it does not include all COVID-19 cases and deaths before late May 2020 — and therefore doesn't capture more than two dozen cases and 14 deaths at state veterans homes captured by state data.

Touchstone has managed every veterans home in the state at some point, Jones said.

Texas VSI is affiliated with South Carolina-based HMR Veterans Services, which manages at least nine veterans facilities across four states. In 2018, inspectors found an HMR-operated veterans home in South Carolina failed to thoroughly investigate claims of abuse and injuries and encouraged employees to be misleading in reports, according to The Greenville News.

The Land Board has previously tried to replace the operators without success, but as COVID-19 infection rates have dropped, the agency is “now able to review practices and procedures … and better prepare all homes for future pandemics," Jones said.

In the meantime, inspectors have continued to find problems. A second Touchstone-operated facility, the Richard A. Anderson Texas State Veterans Home in Houston, was hit with another “immediate jeopardy" finding — a severe deficiency meaning at least one resident is at risk of harm or death — when an 81-year-old veteran was “found outside, unsupervised, crawling on the ground in his undergarments" in May of this year, according to federal records obtained by the Tribune-Chronicle.

After the Tribune-Chronicle sent Bush's agency the federal records, Jones said the agency had already moved to terminate Touchstone's contract to oversee the home, which opened at the end of 2019. Bush told agency staff to do so after the incident happened but before the “immediate jeopardy" finding was issued, she said.

The home received a $69,225 fine, according to federal health officials.

The disproportionate death toll in Texas' veterans homes follows a national trend: According to a report in The Wall Street Journal, the facilities were among the hardest hit during the height of the coronavirus pandemic.

The heavily male and elderly population inside veterans' homes may explain some of the discrepancy, since men are more likely to die from COVID-19 than women. But Texas' nine homes account for about a quarter of the privately run state veterans facilities in the United States, and experts and residents' advocates say for-profit nursing homes tend to have lower staffing levels and perform worse than nonprofit or government-run facilities.

“Studies for decades have documented that not-for-profit and public facilities have more staff, they spend more money on staff, they spend more money on supplies, on food, things like that, and they generally have better care," said Toby Edelman, senior policy attorney with the Center for Medicare Advocacy, a national nonprofit.

Texas' nursing homes overall have some of the lowest nursing hours per resident nationwide, behind all but three U.S. states, and five of Texas' nine veterans homes fall beneath even the state average, according to federal data. At the end of 2020, six of Texas' veterans homes were reporting that residents received less time with a nurse each day than the average across nursing homes nationwide.

The numbers are “cause for serious concern," said Richard Mollot, head of the Long Term Care Community Coalition, an advocacy group based in New York.

It's particularly disheartening to see government officials fail to ensure proper care for a population that gave so much to keep Americans safe, he said.

Veterans homes are “set up to care for people who have sacrificed — or dedicated at least a part of their lives to protecting our country," he said. “We've kind of stepped back, as a country, from protecting them just when they needed it most."

The Texas State Veterans Home is located in Floresville and is administered by the Veterans Land Board. Land Commissioner George P. Bush's General Land Office hires the for-profit contractors who run the facility.

The Frank M. Tejeda Texas State Veterans Home in Floresville is administered by the Veterans Land Board. Land Commissioner George P. Bush's General Land Office hires the for-profit contractor that runs the facility.

Credit: Billy Calzada

“Who's in charge?"

COVID-19 outbreaks in veterans homes nationwide have highlighted what critics describe as a porous regulatory structure, where oversight is fragmented among states and federal agencies — as evidenced by the title of a July 2020 congressional hearing: “Who's in charge?"

The U.S. Department of Veterans Affairs gives states funding to help operate each home and inspects each facility annually. But the nonpartisan U.S. Government Accountability Office criticized those inspections as lax and said the VA did not post information about the quality of the homes on its website. VA officials have now done so and emphasize the homes are “owned, operated and managed" by the states.

More than half of the veterans homes, including all those in Texas, are subject to extra scrutiny from federal health authorities because they receive Medicaid or Medicare payments.

The Centers for Medicare & Medicaid Services is the primary regulator for nursing homes in the U.S., but most of the health agency's inspections were paused during the pandemic. The surveys that did occur were focused on infection control or responding to serious complaints, leaving a gap in oversight, said Charlene Harrington, a professor emeritus of social behavioral sciences in the University of California, San Francisco's nursing school and an expert on nursing homes.

Following federal guidance, nursing homes halted visitation to forestall the spread of the virus. The state ombudsman's office, an independent advocate for nursing home residents' rights, also stopped making in-person visits because of the pandemic.

“I think that nursing homes knew they didn't have the oversight and they could pretty much do what they wanted," Harrington said. “So they took advantage of it. And as a result, I think there were a lot of unnecessary infections and deaths."

A Centers for Medicare & Medicaid Services spokesperson noted that federal authorities increased penalties for noncompliance with infection control, issued regulatory waivers to help nursing homes obtain staff quickly, and provided funding for facilities to buy tablets and other communication devices to help residents better communicate during the pandemic.

But Melissa Jackson, president of the National Association of State Veterans Homes and administrator of Vermont's state-run veterans home, said critics unfairly villainized the homes during a pandemic that the entire country was unprepared for. Administrators scrambled to find protective equipment that was initially in short supply and had to hire contract staff to help when their employees had to quarantine.

The first positive case at her state's veterans home was the “worst day" of her career, she said. She at times felt helpless or went home and cried.

“I still haven't done that sigh of relief. You go into long-term care — in any setting but specifically in the setting when you're caring for America's heroes — and you do everything you can to keep them safe," she said. “Then you have this outside virus and all of the system failures that came down."

Half a dozen experts interviewed by the Tribune-Chronicle said the pandemic laid bare long-standing issues in long-term care including chronic understaffing and high employee turnover.

Nursing homes often have more than one resident in each room, which can make it difficult to separate residents to stem the virus's spread. Many of their employees are front-line workers who receive low wages, sometimes lack paid sick leave and work in multiple facilities — providing hands-on care in close quarters.

“You couple that with a virus that can be asymptomatically spread and that's airborne, and that's going to pose a risk pretty much no matter what nursing homes do," said R. Tamara Konetzka, a health economist at the University of Chicago, who co-authored several studies about nursing homes during the pandemic.

Studies have found that the prevalence of the virus in the surrounding community and the size of the nursing home largely determined how hard facilities were hit: Larger facilities in COVID-19 hot spots were more likely to have infections. Having more staff helped to blunt an outbreak once the virus entered a nursing home, according to one study.

The Frank Tejeda Texas State Veterans Home is located in Floresville. It is administered by the Veterans Land Board. Land Commissioner George P. Bush's General Land Office hires the for-profit contractors who run the facility.

A sign for Floresville, where the Frank M. Tejeda Texas State Veterans Home is located.

Credit: Billy Calzada

Like “pulling teeth"

Inspection records from the state's health commission paint a chaotic picture of life inside several of the state veterans homes as the pandemic took hold.

In the spring of 2020, state inspectors found potentially life-threatening deficiencies at the Frank Tejeda home in Floresville, reporting that the facility — then home to some 140 residents — hadn't put in place recommendations from the U.S. Centers for Disease Control and Prevention to prepare for COVID-19, and failed to prevent transmission of the virus to more than a dozen residents and nine staff members.

Residents with no symptoms were not separated from those who tested positive. Employees cared for both infected and well residents, sometimes while not wearing proper personal protective equipment. Some of the residents' care plans didn't say they were infected or should be isolated.

“I can't believe they have both positive and negative [residents] on the same hall way," one licensed vocational nurse told the state inspectors, according to the report. “We are trying to be careful not to cross contaminate, but it's going to [happen]. Especially with staff coming in and out of the resident rooms."

The director of nursing told the inspectors that residents weren't separated because employees were waiting for coronavirus test results to come back and figured those not yet sick “were already contaminated." Another employee said it was difficult to separate residents because there was not enough staff working overnight to care for both the sick and healthy groups.

Touchstone is disputing the state report in administrative proceedings, and Bush's office said the contractor is asking federal authorities to remove deficiencies they documented in a published report — including alleged failures in infection control and PPE use. The Texas Health and Human Services Commission said it could not discuss the related state case due to the “active litigation."

Workers at the home also said they had to reuse masks and were told they did not need goggles or face shields.

One nurse would take her mask home, spray it with disinfectant and let it air dry. Another employee said she was given a loose-fitting N-95 and wore it while working in each unit, including the one housing infected residents, the inspection report said. Others wore just surgical masks while caring for patients with the coronavirus rather than the recommended N-95.

The Frank Tejeda Texas State Veterans Home in Floresville.

Downtown Floresville.

Credit: Billy Calzada

The findings anger but don't surprise Jeanette Christensen, whose 64-year-old husband has been housed at the Floresville home since 2019. She said getting information from Touchstone during the pandemic was like “pulling teeth."

In one email she sent to Touchstone and the land office in January, she said a message the operator sent notifying families about new cases came across as a “slap in the face" because it included only a link that led to a webpage with no information about the Frank Tejeda home.

“This is NOT transparency in any possible way, shape, or form. In fact, if I may be so bold as to speak truth, it has a tendency to feel more deceiving than clarifying," she wrote to the company.

Before the coronavirus, she said, Touchstone had a “revolving door" of workers at the home and failed to help her husband with daily tasks — like regularly brushing his teeth — and did not consistently change a patch that helps control symptoms of his dementia.

“The corporation is always about the bottom line," she said.

Beyond the Frank Tejeda facility, at least six other Texas veterans homes were cited for health or regulatory failures since the pandemic began, including deficiencies unrelated to the pandemic like poor continence care and unpalatable foods (“pureed sausage — gravy grainy and salty," according to a March 2021 state inspection of the Lamun-Lusk-Sanchez Texas State Veterans Home). Four, including Frank Tejeda, received fines for the lapses; another faces a potential fine.

Jones, the General Land Office spokesperson, said the land board was not made aware of the problems at the Frank Tejeda home until after state inspectors issued their warning to the company, and was not told about any protective equipment shortages by Touchstone. She faulted Touchstone for the “failure" of not ensuring staff wore available protective equipment and said the agency helped obtain COVID-19 test kits for each home.

Jones noted the contractors are in charge of staffing, but she did not respond to questions about why the land board's on-site representative did not alert the agency to problems at Frank Tejeda and other homes.

“It makes me furious"

Local officials and distraught loved ones say Bush's land board and the veterans home operators left them blind to the risks posed by COVID-19 and with little information about what was happening inside the homes as the pandemic took hold.

Cecelia “Cissy

Cecelia “Cissy" Gonzalez-Dipple, the mayor of Floresville, said she was unhappy with the Veteran Land Board's response to complaints about care at the Frank M. Tejeda Texas State Veterans Home.

Credit: Billy Calzada

Floresville's mayor, Gonzalez-Dippel, said the situation there has been “very, very concerning since day one, since the first reported case and the first reported death." She said she was “not impressed" with the land board after it provided her with incorrect information — that residents would receive coronavirus tests in a set time frame, which didn't happen — in the pandemic's early days.

Gonzalez-Dippel said Touchstone Communities never returned her calls.

She learned of new cases at the home through information the Veterans Land Board released to San Antonio media outlets. Family members of residents said they “didn't know how their loved one was doing" or whether they had tested positive for the virus, Gonzalez-Dippel said.

In the spring of 2020, Gonzalez-Dippel alerted state health officials to possible problems in the home after hearing there wasn't enough protective equipment and that it was being improperly stored. She said no one told her that the inspection in May 2020 found that residents were in “immediate jeopardy" — and resulted in fines totaling $281,500.

“It makes me furious," Gonzalez-Dippel said after being told last month of the violations and the fines. “These people deserve so much more than what they got."

Jones said the agency stayed in regular contact with Gonzalez-Dippel throughout the pandemic.

Mary Kay Dieterich, the daughter of the late Eugene Forti, a WW2 veteran who died at the Ambrosio Guillen Texas State Veterans home in El Paso, believes her dad got horrible care once COVID-19 hit, and faults Land Commissioner George P. Bush for claiming he was going to shake up the contracted management of the home after her father's death but failed to do so.

Mary Kay Dieterich, the daughter of Eugene Forti, a World War II veteran who died of COVID-19 at the Ambrosio Guillen Texas State Veterans home in El Paso, believes her dad got poor care after the virus struck the facility.

Credit: Nick Oza for the Houston Chronicle

Information scarce

At Ambrosio Guillen in El Paso, Mary Kay Dieterich said she and her brother Guy Forti could get almost no information about their ailing father despite promises from management that they would be kept in the loop.

“I'd have to really give them a poor, poor grade for communication. And especially during such a stressful time," Dieterich said. “We were getting no information."

Forti was admitted to a nearby medical center last May with chest pains, a fever and a dry cough. He tested positive for the coronavirus and was moved to a COVID-19 wing on the seventh floor of the hospital, where his attending physician called Forti's son and daughter and promised to give daily updates.

Before that, they'd received two text messages — similar to Amber Alerts — saying the facility was locking down to prevent spreading the new coronavirus and that visitors were no longer allowed, even at the windows.

An employee at the veterans home also had declined to tell Forti's son how many cases the facility had.

“Those numbers were protected by law and could not be revealed," Dieterich said her brother Guy was told by phone around the time his father tested positive.

Yet the for-profit contractor was providing regular updates to the General Land Office, many of them obtained this summer by the Tribune and the Chronicle. In one email, sent just weeks after the promised leadership shake-up that never came, a Texas VSI representative told Bush's office that 14 new residents and nine staff members had been diagnosed with COVID-19.

“El Paso test results were horrifying but this was no Halloween trick," the employee wrote. “4 residents are hospitalized. … Current numbers are 44 positive residents and 19 positive staff members."

In later calls with Texas VSI officials, Dieterich said she was told the contractor didn't have the staff or funding to have employees wait to receive negative test results before starting to work.

Jones called the email update by the VSI representative “disrespectful and unprofessional in every sense" and said the state could release medical information only to a resident's “responsible party" — in Forti's case, his son Guy. She also said the homes together sent thousands of mass messages during the pandemic.

Dwight Henry, a 77-year-old resident of the El Paso home, was hospitalized with COVID-19 for 14 days, four in the intensive care unit, around the time his friend Forti was also in the hospital, he said.

He learned of Forti's death while he was there. Two other residents who lived across the hall from him also died, he said.

“We lost a lot of them," he said.

Dieterich said her father had improved in the hospital after receiving a convalescent plasma treatment. But he took a sudden turn for the worse three days after he was returned to the veterans home.

He stopped eating and drinking. He wasn't responding verbally. The next day, he was dead.

Dieterich said in a June 2020 email that her dad was “a war hero, a husband of 68 years to a woman he adored, and a dad that worked his fingers to the bone supporting his family."

She believes her dad's death was “100% preventable" and said she was “extremely disappointed" that Bush did not follow through on his promise to shake up the leadership of the Texas VSI team that oversees the El Paso facility.

“He was demanding these leadership changes and nothing happened. Nothing," Dieterich said. “George P. Bush certainly needs to be held accountable."

Texas Tribune Deputy Data Visuals Editor Chris Essig contributed to this story.

This article originally appeared in The Texas Tribune at https://www.texastribune.org/2021/07/23/texas-coronavirus-veterans-homes-george-p-bush/.

The Texas Tribune is a member-supported, nonpartisan newsroom informing and engaging Texans on state politics and policy. Learn more at texastribune.org.

Texas governor signs into law one of the nation’s strictest abortion measures -- banning procedure as early as six weeks

Gov. Greg Abbott signed into a law Wednesday a measure that would prohibit in Texas abortions as early as six weeks — before some women know they are pregnant — and open the door for almost any private citizen to sue abortion providers and others.

The signing of the bill opens a new frontier in the battle over abortion restrictions as first-of-its-kind legal provisions — intended to make the law harder to block — are poised to be tested in the courts.

Abortion rights advocates have promised to challenge the new law, which they consider one of the most extreme across the country and the strictest in Texas since the landmark Roe v. Wade decision.

The law takes effect in September.

The Legislature "worked together on a bipartisan basis to pass a bill that I'm about to sign that ensures that the life of every unborn child who has a heartbeat will be saved from the ravages of abortion," Abbott said, in a livestream posted on Facebook.

The governor's signature comes just after the U.S. Supreme Court said it would hear a case concerning a Mississippi law that would ban most abortions after 15 weeks, and which could lead to new limits on abortion rights. It is the first major abortion case heard before the court's newly expanded conservative majority, and could have far-reaching effects for Texas, where a pending bill would outlaw nearly all abortions if the Supreme Court overruled Roe v. Wade.

Senate Bill 8 was a top priority for Republican lawmakers, nearly all of whom signed on as an author or sponsor of the measure.

The bill bans abortions after a fetal heartbeat has been detected. It includes cases where the woman was impregnated as a result of rape or incest. There is an exception for medical emergencies.

Similar "heartbeat" bills have been passed by other states and held up by the courts, but Texas' version has a twist.

Instead of having the government enforce the law, the bill turns the reins over to private citizens — who are newly empowered to sue abortion providers or anyone who helps someone get an abortion after a fetal heartbeat has been detected. The person would not have to be connected to someone who had an abortion or to a provider to sue.

Proponents of the new law hope to get around the legal challenges that have tied up abortion restrictions in the courts for years. While abortion providers typically sue the state to stop a restrictive abortion law from taking effect, there's no state official enforcing Senate Bill 8 — so there's no one to sue, the bill's proponents say.

"It's a very unique law and it's a very clever law," said Josh Blackman, a constitutional law professor at South Texas College of Law Houston. "Planned Parenthood can't go to court and sue Attorney General [Ken] Paxton like they usually would because he has no role in enforcing the statute. They have to basically sit and wait to be sued."

Legal experts have been divided on the strategy, and abortion rights advocates have said they plan to fight regardless.

Elisabeth Smith, chief counsel at the Center for Reproductive Rights, which has represented abortion providers who have sued Texas, said it and other abortion rights organizations are "not going to let this six-week ban go unchallenged."

Drucilla Tigner, policy and advocacy strategist of the American Civil Liberties Union of Texas, said the "governor's swipe of a pen can't change the Constitution."

While the law is most extreme abortion ban in the country, "abortion is both legal in Texas and supported by the majority of Texans," Tigner said.

Abortion rights advocates and lawyers say the new law would allow for a cascade of lawsuits against abortion providers, that would sap their time and money even if they ultimately won in court.

Family members, abortion funds, rape crisis counselors and other medical professionals could be open to lawsuits, under the broad language in the bill, according to legal experts and physicians who opposed the measure. People who sued would be awarded at least $10,000, as well as costs for attorney's fees, if they won.

"Every citizen is now a private attorney general," Blackman said. "You can have random people who are against abortion start suing tomorrow."

John Seago, with Texas Right to Life, an anti-abortion organization that supported the bill, said

he doubted there would be an "overwhelming number of cases on day one."

Lawsuits might be filed by anti-abortion activists who learned through talking to the woman that she got an abortion after six weeks.

"There's going to be a lot of different [fact] patterns that could lead to the case," he said. But the bill isn't "throwing out the typical way that the judicial system works — there's still going to be a judge, there's still going to be depositions, there's going to be a high bar" before fees are awarded.

The ultimate goal, he said, is to incentivize abortion providers to comply with the law instead of fighting it in court.

They can "easily avoid all of that," Seago said. "Have a public statement. Put it on their website that they're not scheduling appointments after six weeks."

The bill does not allow rapists to sue but abortion rights advocates say the wording offers flimsy protection as most rapes and sexual assaults aren't reported and don't result in a conviction.

Most abortions in Texas were already prohibited after about 20 weeks. Pill-induced abortions were barred at 10 weeks. The abortion provider must perform a sonogram on the woman 24 hours before the abortion and give them information about medical risks, abortion alternatives and assistance available to those who follow through with their pregnancy.

More than 56,600 abortions were performed on Texas residents in 2019, according to state statistics, most of them in the first trimester.

Proponents of the law celebrated its signing.

"The Legislature and Governor prioritized this historic legislation, and with his signature, approximately 50,000 precious human lives will be saved in Texas next year alone!" said Chelsey Youman, with Human Coalition Action, an anti-abortion organization.

This developing story will be updated.

Bill that would ban abortion at six weeks heads to governor's desk to become Texas law

Legislation that would ban abortions after as early as six weeks and let virtually any private citizen sue abortion providers and others was given final approval by lawmakers Thursday and is headed to Gov. Greg Abbott, who has signaled he will sign it into law.

Senate Bill 8, a Republican priority measure, is similar to "heartbeat bills" passed in other states that have been mostly stopped by the courts. But proponents of the Texas legislation believe it's structured in a way that makes it tougher to block.

The bill was denounced by hundreds of lawmakers and doctors — in letters circulated by opponents of the measure — who said its broad legal language could open the door to harassing or frivolous lawsuits that could have a "chilling effect" on abortion providers.

The bill bans abortions after a fetal heartbeat can be detected without specifying a specific timeframe.

The bill, which would take effect later this year, bans abortions after a fetal heartbeat can be detected without specifying a timeframe. A legislative analysis and the bill's proponents have said that can be as early as six weeks, though state Rep. Donna Howard, D-Austin, in a floor debate cited medical experts who say there is no fully developed heart at that gestational age and that the sound referred to as a heartbeat is actually "electrically induced flickering" of fetal tissue.

The bill would be enforced by private citizens empowered to sue abortion providers and others who help someone get an abortion after six weeks, for example, by driving them to an abortion clinic.

Those private citizens would not need to have a connection to an abortion provider or a person seeking an abortion.

A person who impregnated someone through rape or incest could not sue.

The anti-abortion Texas Right to Life organization, which supported the bill, said the bill lets citizens hold abortion providers "accountable through private lawsuits," a strategy that has not been tried in any other state.

"The Texas Heartbeat Act is the strongest Pro-Life bill passed by the Legislature since Roe v. Wade," said the organization's senior legislative associate Rebecca Parma.

Texas Attorney General Ken Paxton sues Biden administration demanding reinstatement of Keystone XL Pipeline permit

Twenty-one states, led by Texas and Montana, filed a lawsuit Wednesday against the Biden administration for revoking a permit for the long-disputed Keystone XL pipeline.

The complaint, filed in a Texas federal district court by Texas Attorney General Ken Paxton and Montana Attorney General Austin Knudsen, argues the president exceeded his authority when he canceled the pipeline's permit after being sworn in on Jan 20. The decision should rest with Congress, according to the lawsuit.

The project was supposed to move Canadian crude oil to the U.S. — and on to Texas Gulf Coast refineries. But it has been a flashpoint in fights over economic development, fossil fuels and environmentalism.

Biden said in an executive order revoking the permit that letting it remain was inconsistent with his administration's "economic and climate imperatives."

Former President Donald Trump granted a permit in 2019. The Obama administration denied one in 2015.

According to the complaint, the states expect cancellation of the pipeline would lead to a significant loss in tax revenue that would have particularly benefited "poorer rural areas." The project was expected to create high-paying union jobs in several states, the complaint says.

The contract Biden yanked revolves around a proposed part of the pipeline that would stretch from Canada to Nebraska. A portion of the project has already been built through East Texas.

Biden's swift moves to combat global warming brought equally quick criticisms from state officials that Texas oil and gas jobs are in danger. But their comments often ignore that there is a global push in the free market to limit reliance on fossil fuels, and their rhetoric belies the benefits Texas' oil and gas sector could see from Biden's early moves.

"People have a sort of litmus test gut reaction to the cancellation of the Keystone pipeline, but the reality is it's not likely to have an impact on Texas employment," Amy Myers Jaffe, managing director of the Climate Policy Lab at Tufts University in Boston, told The Texas Tribune earlier this year.Mitchell Ferman contributed to this report.

'Pro-Life' Texas lawmaker files bill making abortion punishable by the death penalty

A Texas Republican state lawmaker's bill would outlaw abortion, classify it as homicide, and make having an abortion or performing an abortion subject to the death penalty. The legislation also bans abortion as soon as the egg is fertilized.

State Rep. Bryan Slaton, who is also a minister, drafted the legislation with no exemption for rape or incest, The Texas Tribune reports. Ectopic pregnancies if they seriously threaten the life of the woman “when a reasonable alternative to save the lives of both the mother and the unborn child is unavailable" would be allowed.

“It is time for Texas to protect the natural right to life for the tiniest and most innocent Texans, and this bill does just that," Slaton said. “It's time Republicans make it clear that we actually think abortion is murder. … Unborn children are dying at a faster rate in Texas than COVID patients, but Texas isn't taking the abortion crisis seriously."

The U.S. Supreme Court has ruled abortion is legal up until the point a fetus can survive outside the womb, usually considered 24 to 28 weeks. In Texas abortion is legal until 20 weeks, per the ACLU.

This Texas Republican is pushing to make abortion punishable by death

A Texas lawmaker has filed a bill that would abolish and criminalize abortions, leaving women and physicians who perform the procedure to face criminal charges that could carry the death penalty.

The legislation, filed Tuesday by state Rep. Bryan Slaton, does not include exceptions for rape or incest. It does exempt ectopic pregnancies that seriously threaten the life of the woman "when a reasonable alternative to save the lives of both the mother and the unborn child is unavailable."

"It is time for Texas to protect the natural right to life for the tiniest and most innocent Texans, and this bill does just that," Slaton said. "It's time Republicans make it clear that we actually think Abortion is murder… Unborn children are dying at a faster rate in Texas than COVID patients, but Texas isn't taking the abortion crisis seriously."

Similar measures have in the past been filed by state Rep. Tony Tinderholt, R-Arlington, who received death threats and was placed under the protection of the Texas Department of Public Safety after he introduced the bill in 2017. The legislation did not receive a hearing.

In 2019, a related bill from Tinderholt drew nearly eight hours of public testimony. State Rep. Jeff Leach, R-Plano, faced "security concerns" that year after he said the bill would not move out of the committee he chaired for a vote of the full House. The bill died in the committee.

Under the bill filed Tuesday, women who receive an abortion and physicians who perform the procedure could be charged with assault or homicide, which is punishable by death in Texas, confirmed Shannon Edmonds, a staff attorney with the Texas District and County Attorneys Association. The association does not have a position on the bill.

The bill could require people to give evidence or testify about offenses involving the death of or "bodily injury to an unborn child," and would offer immunity to those who do.

It also instructs the state Attorney General to monitor and to "direct a state agency to enforce those laws, regardless of any contrary federal statute, regulation, treaty, order, or court decision."

The bill bans abortions starting at fertilization; most abortions in Texas are currently prohibited after 20 weeks. The bill's language cites one justice's opinion in a recent Supreme Court case, June Medical Services, L.L.C. v. Russo, that says the Constitution "does not constrain the States ' ability to regulate or even prohibit abortion."

Slaton, a freshman Republican from Royse City, previously tried to stop the House from naming bridges or streets without first voting to abolish abortion. The amendment failed, but was supported by more than 40 lawmakers, about half of the Republicans in the House.

Asked about the bill's language and effect, Slaton said, without further explanation, that he does not think his bill would "put a single person in jail. All my bill does, is say that an unborn child is the same as a born child and should be treated the same by the laws."

Lt. Gov. Dan Patrick has identified two abortion bills that will be priority items during the legislative session that started in January. One would ban nearly all abortions if the Supreme Court overturned the Roe v. Wade decision — that recognized the right to an abortion — or otherwise altered abortion laws. The other has not been filed, but is expected to be a "heartbeat bill" that could bar abortions before many women know they are pregnant.

‘Slap in the face’: Texans who lost loved ones are outraged by GOP's lifting of mask mandate

What confuses Delia Ramos about Gov. Greg Abbott's recent decision to cast off coronavirus restrictions in Texas isn't his order to let more people into restaurants. The Brownsville school counselor knows people are hurting economically.

But with more than 43,000 dead in Texas — including her husband — is wearing a mask in public too much to ask? At the least, it could take pressure off the medical systems and help prevent more people from dying, she said.

"It's not about taking away anybody's job or making anybody else suffer financially because everybody has their families to take care of," said Ramos, who lost her husband Ricardo to the coronavirus last year.

"People can go pick up groceries, people can go into a restaurant and people can shop around the mall in masks," she said.

Abbott's Tuesday declaration that it was time to "open Texas" has been decried by local officials and health experts, who say it's too soon to become lax with coronavirus restrictions, as just 7% of the state's residents have been fully inoculated against the virus. President Joe Biden likened the decision to "Neanderthal thinking," and an official with the U.S. Centers for Disease Control and Prevention said it's not the time to loosen precautions.

But the announcement hit harder with Ramos, and others who have lost spouses, parents or friends to the virus — in some cases, making them wonder if the deaths of their loved ones meant nothing.

It feels like people that think it's "inconvenient to wear a mask" override all the "people that have been lost" to the virus, as well as doctors and nurses working long hours and teachers scared to go to work for fear of being exposed, Ramos, 39, said.

She'll continue to wear her mask "with honor."

"I don't want other children to grow up without a father, the way that mine unfortunately are going to have to grow up without one," she said.

After teasing an announcement for days, Abbott said Tuesday that masks would soon no longer be required statewide, and that businesses could return to full occupancy starting next week.

From a Mexican restaurant in Lubbock, Abbott said the state is in a "completely different position" now that vaccines are available and there is broad awareness of prevention measures. He also said there is more protective equipment, testing and treatments, and he cautioned Texans to exercise personal vigilance.

The governor's spokesperson, Renae Eze, said he "joins all Texans in mourning every single life lost to this virus, and we pray for the families who are suffering from the loss of a loved one."

"As the governor has stressed repeatedly, removing state mandates does not end the need for personal responsibility nor the importance of caring for family members, friends and neighbors," she said in a statement.

Abbott's order — which makes Texas the most populous state without a mask mandate — comes as virus variants that are more contagious have emerged in Texas, with Houston becoming the first city nationwide to record cases of every major variant, according to a recent study.

The announcement also comes before a spring break period that could send people traveling across the state, timing that makes Dr. Jamil Madi, in Harlingen, think "we're shooting ourselves in the foot."

"The virus is still here, it's not like it's faded away," said Madi, chief of critical care medicine and director of the intensive care unit at Valley Baptist Medical Center in Harlingen. "The virus is just dormant and the way it wakes up is by human contact."

Texas has seen infections and deaths from the virus drop, and hospitalizations are at their lowest point since October. But the state ranks nearly last among states for the share of its population that have gotten a shot, and the number of patients hospitalized with the virus is higher now than it was when Abbott first began a phased economic reopening of Texas last spring.

In the hard-hit Rio Grande Valley where Madi works, infections went into a lull in September and early October but have picked back up, he said. There was a wave after the winter holidays when people traveled and gathered with family members to celebrate, and he's seen patients who had the disease and recovered return sicker than ever.

"Every time we decide to let loose, whether it's gatherings or [changes to] mask mandates, we see a definite spike after an event happens," creating a kind of "roller coaster," Madi said.

"We go back to the same cycle again and again and we're tired, we're all tired, to say the least," he said.

More than 43,000 people have died with the virus in Texas during the pandemic, which has devastated swaths of the state's economy and taken a toll on people's mental health.

Ramos, among those who lost a loved one, found out about Abbott's orders on Facebook. The next post in her feed asked for prayers for two school district employees fighting the coronavirus in the ICU, she said.

She was struck by the "harsh difference in those two realities."

In nearby McAllen, Ana Flores watched Abbott's announcement in disbelief on Tuesday. For the 39-year-old, who works at an adult day care, it immediately brought back memories of when Abbott loosened COVID-19 rules in May — weeks before infections surged and devastated the predominantly Hispanic or Latino communities along the U.S.-Mexico border.

She got severely sick with the virus. Her husband of ten years, a truck driver, who was cautious and "knew a little bit about everything," was hospitalized and died at age 45.

"For [those of] us who lost a loved one, for us who survived — because I got pretty sick as well … it's like a slap in the face," Flores said of Abbott's announcement, noting his "happy" tone and the "clapping" people around him.

For Abbott to say "it's time for us to get on with our lives, everything to go back to normal," she said, "normal is not going to happen for us ever again."

She said it felt like Abbott "doesn't care" that counties in the border are "still struggling" even if other parts of Texas are doing better.

Mandy Vair, whose father, a hospice chaplain, died with the virus last summer, saw the order and wondered: Did his death not matter? She and other family members were limiting social activities and wearing masks, but were infected in November and Vair was sick for weeks. Her family still hasn't had a memorial ceremony for her late father because they don't feel it's safe to gather.

She said Abbott's decision made her think, "He got his immunization and maybe all of those that are important to him already got the immunization. So [now] the rest have to kind of fend for themselves until their turn comes up," she said. "We have to be responsible for ourselves — well, haven't we been trying to be responsible for ourselves the whole time?"

Local officials have slammed Abbott's order, saying it's premature and sends the wrong signal to residents who take cues from their leaders about how seriously to take the virus. Some have also expressed worry that front-line workers and communities of color could be left vulnerable to infection if others aren't required to wear masks around them. A CDC website says wearing a mask protects the wearer and those around them, and works "best when everyone wears one."

More than half of the COVID-19 deaths have been Black or Hispanic people, and advocates fear these communities have fallen behind in the vaccination efforts in Texas. In Texas, fatality rates in border areas like El Paso and Hidalgo, where a majority of residents are Hispanic or Latino, were among the highest per capita of big counties statewide.

State Sen. Borris Miles, a Houston Democrat, said on Twitter that Black people have a disproportionate fatality rate and that the governor lifting a statewide mask mandate amounted to "signing the death warrants of communities of color."

"Today he made it clear Black lives don't matter," Miles tweeted.

Rebecca Fischer, an epidemiologist at Texas A&M University, said she was surprised such a "drastic measure was taken at such a critical time" and thinks the state could face "potentially a devastating trajectory" if prevention measures are relaxed.

Now is "not the time to be dropping our masks or throwing them in the trash can. This is the time really to be stepping up our prevention behaviors," said Fischer, an assistant professor with A&M's school of public health.

Public health experts have recently said two masks may be better than wearing just one, given differences in how they are constructed and fit, she said.

Eze, with the governor's office, said Abbott will continue to work with other officials to "speed the vaccination process to protect Texans from COVID, with the immediate priority of vaccinating Texans who are most likely to be hospitalized or lose their life from COVID." She cited a state initiative that deployed the National Guard to help vaccinate homebound seniors.

She said Texas "has the tools and knowledge we need to deal with COVID and keep Texans safe," and that the number of vaccines is "rapidly increasing" each day and more Texans are protected.

Abbott has also said local judges can reimpose some restrictions if COVID-19 hospitalizations exceed 15% of capacity in their region for seven straight days.

But Hidalgo County Judge Richard Cortez said he doesn't want to wait until that point to be able to take action.

He said he was "very concerned" about Abbott's decision, and did not receive advance notice of the order.

Between the vaccinations and people who have contracted the virus, Cortez estimated about a quarter of his residents have some immunity to COVID-19.

"But we still have a long way to go," he said. "[Abbott] said from the very beginning that he was going to let science dictate his actions. Well, science tells us to have physical distance and separation, facial coverings," and to take other precautions.

What was "so special, what was so scientific" about having Texas' Independence Day be the day that the announcement was made, he asked.

In El Paso, city and county leaders urged their residents to practice the unity that helped them weather several recent tragedies, including a mass shooting in 2019 and a flood of coronavirus infections last fall. Just a few months ago, officials had to ask jail inmates to work for $2 an hour moving bodies, because regular staff couldn't keep up with the demand.

County Judge Ricardo Samaniego said COVID-19 patients were still taking up some 14% that of the region's hospital beds, indicating the area isn't ready to reopen.

"The timing is really what the problem is," he said. "If, in fact, it were true that we were ready to open, it'd be exciting for everybody, we'd be celebrating."

Texas Attorney General Ken Paxton sued Samaniego last fall after the county judge imposed tighter restrictions than the state on business openings. Paxton won, and in his victory lap on Twitter referred to Samaniego as a tyrant and El Paso County, the state's sixth largest, as a "rogue subdivision."

Samaniego said he doesn't expect that kind of interference again because he knows he's limited in what he can do moving forward.

"We're not going to do anything that is outside of the legal components and legal elements [of the order]," he said. "We're going to look more at trends and we're going to talk to all the leaders and consult with the county-city task force. We're going to check the science before we check the politics."

El Paso Mayor Oscar Leeser said his plea for El Pasoans to continue wearing masks came not just from his duties as an elected official. Leeser's mother and brother died from the disease less than two months apart in 2020.

"My mother was sick and we didn't realize that my mother had COVID-19. But I said 'Guys, make sure you wear your mask,'" Leeser recalled telling his brother and sisters late last year. His sisters listened but his brother didn't, he said.

"My brother did not wear a mask while he was there and unfortunately got COVID-19 and also lost his life," Leeser said. "I am a living testimonial that it works."

Meanwhile, the executive director of Operation H.O.P.E., an El Paso charity that helps families pay for funerals, said he's not talking to a dozen or more families every day the way he was in late 2020, when the border city was the country's COVID-19 epicenter.

But Angel Gomez, the executive director, said he's not optimistic that won't happen again.

"I just hung up with the seventh [family] today," he said. "We should have just waited a little bit longer, but with this governor it's like we take one step forward and two steps back."

"Give it until the end of April and we're going to start seeing a spike again," he added.

Flores, in McAllen, remembers when Abbott loosened the coronavirus restrictions in May. She and her husband were scared. He traveled all over Texas as a truck driver, and would call her saying he'd gone into a store and saw few people were wearing masks. She remembers seeing a newspaper headline describing South Texas as a "Valley of Death" — an apropos description to her at the time.

"Look what happened the first time around, that's when we got hit really bad especially here in the Valley. … All these people that were sick and dying, my husband included. I just feel like it's too soon again."

She's going to keep wearing a mask. If her husband were alive — if he "wouldn't have been taken from" her — she thinks he would, too.

Julián Aguilar contributed to this report.

Disclosure: Facebook and Valley Baptist Medical Center have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

Don't Sit on the Sidelines of History. Join Raw Story Investigates and Go Ad-Free. Support Honest Journalism.