Bexar County commissioners approved a series of changes to improve medical care and oversight at the county jail following months of scrutiny over inmate deaths.
The actions, approved unanimously by Commissioners Court, include a $250,000 agreement with University Health to expand clinical screening at the Bexar County Adult Detention Center by funding the construction of a modular medical screening room at the jail intake area. The funding also directs county staff to develop a public-facing dashboard tracking jail deaths, inmate population data, medical referrals and other performance measures.
County officials described the measures as immediate operational improvements while acknowledging the broader effort to address overcrowding, behavioral health and the growing number of medically vulnerable people entering the jail.
“What we’ve done today is basically get some immediate solutions that will help alleviate the jail, but more importantly recognize the needs of the people that are coming into the jail, especially those that are medically fragile or have medical issues,” said County Judge Peter Sakai at the meeting on Tuesday.
Under the initiative, the county will move enhanced clinical screening closer to the beginning of the jail intake process by constructing a modular medical screening facility inside the Justice Intake and Assessment Annex’s vehicle sally port.
Officials say the redesigned intake process will allow University Health clinicians to identify acute medical conditions, behavioral health crises and substance withdrawal symptoms earlier, helping determine whether someone needs immediate treatment before being admitted into the jail.
County officials said the recommendations grew out of a review of jail deaths and the current inmate intake process.
County data shows that 39 of the 91 in-custody deaths since 2020 occurred within the first seven days after booking, with 25% of those deaths labeled as natural causes and 37% died from substance toxicity with combined acute medical issues.
University Health officials said they will also work to create dedicated housing units for detainees experiencing substance withdrawal so nurses can monitor them more closely, administer intravenous fluids when necessary and respond quickly if their conditions deteriorate.
According to the presentation at the public meeting, the health system also plans to assign around-the-clock nursing staff to the units, work toward stationing an emergency medical technician at the jail and standardize medical communication between the city’s Central Magistrate Office and the county jail so that critical health information follows detainees throughout the booking process.
Commissioners also directed county staff to return with recommendations for a public dashboard tracking jail deaths, inmate population trends, medical referrals, hospital transports and other performance measures by Oct. 1.
Diversion, dual magistration and long-term goals
Commissioners at the meeting focused on longer-term efforts to reduce the number of people entering the jail in the first place and shorten the time medically vulnerable detainees remain in custody.
One recurring topic was the city’s long-standing dual-magistration process, in which many people arrested by San Antonio police are first taken to the city’s Central Magistrate Office before being transferred to the county’s Justice Intake and Assessment Annex.
Officials said the process can delay comprehensive medical evaluations by several hours because the county’s more extensive screening does not begin until after detainees arrive at the county facility.
In February, after securing a new training site for the sheriff’s academy at the former Wilshire Elementary School campus, Sheriff Javier Salazar proposed repurposing the department’s Toudouze training facility into a centralized booking, magistrate and diversion center serving both the city and county.
In a letter seeking federal funding for the project, Salazar said the facility would eliminate duplicate booking and magistrate procedures while allowing people experiencing mental health crises to be connected with treatment earlier in the criminal justice process.
“The highest and best use for that facility would be to, with some modifications, turn it into a booking facility,” Salazar told commissioners. “Drop them off there to us at the Toudouze building, they’d be able to get more immediate medical care, medical screening and diversion or deflection away from the jail system if need be.”
Salazar said city officials have toured the Toudouze facility and discussions are ongoing. But on Tuesday, commissioners approved terminating the sheriff’s lease at the former Wilshire Elementary School citing the anticipated cost of remediating the old school campus.
Salazar said the sheriff’s academy will remain at the Toudouze facility until another training site is identified, delaying potential plans to convert the building into a centralized booking center.
“We’re proceeding as if it’s probably going to happen at some point,” he said. “ I just have to find a suitable training facility to move my cadets to.”
The court also previewed diversion initiatives expected to return later this year, including a proposed pilot program designed to keep some people experiencing mental illness or substance use disorders from ever entering the jail.
The proposal, being developed by the joint city-county diversion and deflection committee alongside the Center for Health Care Services, UTHealth Houston School of Public Health and other community partners, would create a 15-bed voluntary residential diversion center for adults arrested on certain low-level, nonviolent misdemeanor charges where untreated mental illness or substance use is believed to be a contributing factor.
Instead of being booked into jail, eligible individuals would undergo an initial behavioral health screening in the field by law enforcement officers before being evaluated by a clinician through STRAC’s MedCom system to determine whether they are appropriate for diversion. If accepted, they would be transported directly to the diversion center rather than the county jail.
Dr. Amber Pastusek, chief medical officer for the Center for Health Care Services, said participants could remain at the facility for up to two weeks while receiving primary medical care, psychiatric treatment, substance use services, counseling and case management. Discharge planning would begin immediately, with aftercare teams continuing to work with participants for about 90 days after they leave the program to help secure housing, benefits and ongoing treatment.
Pastusek said the pilot is modeled after a diversion center she helped establish in Harris County, which initially focused on people arrested primarily for criminal trespassing before expanding to additional low-level misdemeanor offenses as the program matured.
If funding can be secured, officials hope to launch the pilot in late 2026 or early 2027. Pastusek said project partners have already developed a proposed operating budget and are meeting with community stakeholders to secure funding but declined to disclose the estimated cost.
At the same time, UTHealth Houston is conducting a feasibility study using Bexar County jail data to determine how many diversion beds the community ultimately needs. The study is expected to wrap up by the end of the year, with a final report anticipated in January 2027.
