Add sausage, onions, and pepper to a large skillet over medium heat. Cook for 4-5 minutes then add garlic and continue cooking until fully browned. Drain fat and spoon meat mixture into the slow cooker.
Add tomatoes, pinto beans, tomato paste, and seasonings. Open can of pineapple and drain juices into the slow cooker. Place remaining pineapple in the the fridge, it will be used later in the recipe.
Stir slow cooker contents until fully combined and cook on low for 7-8 hours or high for 5 hours.
In last hour of cooking, stir in pineapple tidbits.
Serve hot with hot sauce, sour cream, cheese, and chips.
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