In August, Bexar County commissioners approved a series of changes to improve medical care at the county jail following growing scrutiny over inmate deaths, access to behavioral health treatment and the risks associated with substance withdrawal.
On Tuesday, commissioners received an update on how those initiatives are taking shape, including changes to the jail’s medical screening process, expanded treatment services and new investments in programs intended to keep some people out of jail altogether.
One of the most significant changes begins at the jail’s entrance, where commissioners originally approved $250,000 to construct a modular medical screening facility near the vehicle entrance of the Justice Intake and Assessment Annex.
The proposal followed a review of jail deaths that found 39 of the 91 people who died in custody since 2020 died within seven days of booking, according to county data, highlighting concerns about how quickly medical conditions and substance withdrawal symptoms are identified when someone is jailed.
But rather than constructing a separate facility, University Health, which oversees medical care at the jail, redesigned the existing intake area to bring medical personnel closer to where detainees first arrive.
The health system invested $144,000 of its own funding to double the number of medical screening stations from four to eight, while relocating staff to an area with a direct view of detainees entering from the vehicle sally port.
The new process, implemented Sept. 23, allows nurses to conduct an initial medical assessment shortly after someone arrives, followed by a more comprehensive screening within four to six hours of booking.
Stephanie Stiefer, University Health’s vice president of detention health services, said the changes are particularly important during the first few hours after someone enters the jail, when detainees can experience acute medical conditions, behavioral health crises and substance withdrawal symptoms.
University Health has also recruited 16 additional registered nurses, including eight assigned to intake screening and eight to newly-established detoxification units, although some are still completing onboarding and training.
The dedicated detox units, which began operating in August, serve an average of 110 detainees daily, with an average stay of seven days.
The jail also now has a dedicated ambulance and emergency medical personnel stationed on site, around-the-clock to respond to emergencies and expedite hospital transports.
Sheriff Javier Salazar said Tuesday that the redesigned intake area appears to have eliminated the need for the original modular screening facility.
A county spokesperson confirmed that the $250,000 previously allocated for the project remains available, with a portion now expected to fund additional seating near the jail’s medical screening area.
County officials reported seven in-custody deaths so far this year, with none occurring since the enhanced screening process began on Sept. 23. While it is too early to determine whether the changes have reduced deaths, commissioners highlighted that development during Tuesday’s discussion.
Expanding beyond the jail
While those changes focus on improving medical care for people entering the jail, the county is also expanding efforts to connect people with behavioral health needs to treatment outside of the detention center.
Earlier this month, commissioners approved $3.5 million in agreements supporting behavioral health treatment, transportation and transitional housing for people involved in the criminal justice system.
The investments include an expanded diversion network called Bexar Connects, which connects eligible people entering the county’s Justice Intake and Assessment Annex with community providers.
Under the new program, University Health clinicians conduct mental health assessments, and a magistrate determines whether someone facing eligible low-level, nonviolent charges qualify for diversion. Participation is voluntary.
Those who qualify are connected with UT Health San Antonio, where providers assess their behavioral health needs, existing medical conditions and other circumstances to determine what level of treatment and support they need.
County Public Health Director Andrea Guerrero said the expanded network will also allow officials to follow participants after their release, tracking whether they attend appointments, remain engaged in treatment and receive additional services when needed.
“We’re not just looking at whether someone was diverted and whether or not they were re-arrested,” Guerrero said. “We’re really holding our providers accountable to timeliness and access.”
The expanded network is separate from a proposed 15-bed pre-arrest diversion pilot being developed with the Center for Health Care Services, which would allow police to take some people accused of low-level offenses directly to treatment instead of jail.
A CHCS spokesperson said funding has been secured from Bexar County and the City of San Antonio, while confirmation of University Health’s contribution remains pending.
CHCS is targeting January to begin operations and plans to hold a hiring fair on Nov. 5. A spokesperson for UH referred questions regarding the funding to CHCS.
Remaining reforms and oversight
Beyond the changes to medical care and diversion, the county is also working to increase transparency around jail operations and deaths in custody.
On Tuesday, the county’s Office of Criminal Justice presented a preliminary public dashboard that would provide information on jail populations, in-custody deaths, medical screenings, hospital transports and other measures.
The dashboard was among the initiatives commissioners requested in August following concerns about jail deaths.
Officials said an initial version is ready to be published as a PDF once commissioners approve it, while a fully interactive website can be built in about six months.
Commissioner Justin Rodriguez said the proposal would need to return to the court for approval, potentially in the coming weeks.
The county is also developing plans for an independent administrative audit examining whether the sheriff’s office has complied with requirements for investigating deaths in custody. The proposed scope remains under legal review, with officials hoping to bring it back to commissioners before the end of the year.
But despite the changes inside the jail, commissioners raised concerns about the hours people arrested by San Antonio police can spend at the city’s Central Magistrate Office before receiving more comprehensive medical screening at the county jail.
The issue stems from a process known as double magistration, in which people arrested by San Antonio police are first taken to the city’s magistrate facility at 401 S. Frio St. before being transferred to the county’s Justice Intake and Assessment Annex for additional processing and medical screening.
The process has been a longstanding point of debate between city and county officials, particularly over delays that can leave people waiting hours before receiving more appropriate medical assessments available at the county jail.
Salazar confirmed Tuesday that the process remains unchanged but said he and newly appointed SAPD Chief Jesse Salame have been discussing a potential pilot program to shorten the delay.
“We proposed an idea for what we think the pilot would look like, and they’re chewing on that, so to speak,” Salazar said. “I’m hoping that during this pilot, we can eliminate that hours-long wait at 401 South Frio.”
Salazar previously proposed converting the sheriff’s office’s Toudouze training facility into a centralized booking, magistrate and diversion center serving both the city and county. He said the pilot could serve as proof of concept for city officials to invest in the larger project.
