San Antonio Report
by Iris Dimmick
August 20, 2023

A sense of optimism was in the air earlier this month as Bexar County officials approved a pay increase for deputies who work in and outside the jail.

They estimated that the jail had about 250 vacancies as of August, causing the county to spend millions on overtime annually and leading to low morale among staff.

“It’s a step in the right direction,” Ronald Tooke, president of the Sheriff’s Deputy Association of Bexar County, told the San Antonio Report. Just over one week after jailers received the “fair market” pay bump, he said deputies who had retired are thinking about coming back.

With that change made, Bexar County leadership is aiming to start tackling other problems at the jail — chief among them being the increased number of inmates experiencing mental health issues who are awaiting placement in a psychiatric hospital. This population, while small, has an outsized impact on the overall conditions at and safety of the jail.

Before the coronavirus pandemic, there were typically fewer than 100 people waiting for hospital beds where they can receive mental health and competency restoration care in order to stand trial, according to county officials. But that population has more than doubled — often tripled — over the last three years as COVID created a bottleneck in the jail, delaying cases and causing staffing shortages at state hospitals.

The jail, which has a capacity of 5,200, housed 4,154 people as of Aug. 13 — 230 of whom have been found incompetent for trial.

Prior to the pandemic, an inmate at the Bexar County Adult Detention Center who has been found incompetent might wait weeks or months to transfer to a hospital. Currently, the average wait is 287 days, or more than nine months.

The length of stay under these conditions varies. As of Aug.13, one inmate had been waiting 934 days, more than two and a half years, since being found incompetent to stand trial. Another had been waiting two days.

These inmates typically require their own cell and 24-hour supervision, costing about $250 per day per person, officials estimate. Assuming the number of such inmates remains at about 230 for one year — though it spiked higher than 300 earlier this year — that additional burden would cost Bexar County nearly $21 million per year. Overtime expenses just for staffing in recent years have ranged from $2 million to $3.7 million.

Statewide figures show some light at the end of the tunnel, as the state and Bexar County have taken steps to reduce the lag time between when an inmate is deemed incompetent and when they are transferred to a hospital to receive the care they need.

Previously, the union’s concerns about the jail were “like an afterthought,” Tooke said. It’s still too early in new Bexar County Judge Peter Sakai’s tenure to tell if these efforts will translate into a less crowded, safer jail, but there’s some reason for optimism.

“Not all criminal defendants at the county jail have to be incarcerated,” Sakai said. “We should be able to divert them to [hospital] beds, we should be able to divert them to electronic monitoring or intense pre-trial services that will keep our community safe.”

The new pay for deputies and policy adjustments won’t fix all the issues within the jail, Tooke said, but it’s a start.

“It’s like your car,” he said. “If you don’t change the oil and do what’s required on it, it’s gonna leave you on the side of the road one of these days. … And I think that’s been the way the jail has been for the last 15 years.”

‘Constantly full’

No one entity or elected body has complete control over the jail or the flow of its population.

While the Bexar County Sheriff’s Office runs the day-to-day operations of the jail, the commissioners court oversees its budget.

To begin with, the San Antonio Police Department and sheriff’s deputies both make arrests. Then the county District Attorney’s Office prosecutes, with power to dismiss cases, take plea deals or offer other competency restoration services, which prepare defendants to stand trial. But judges, who are also elected officials, have the ultimate say.

Meanwhile, the state oversees most hospitals that house inmates who have been found incompetent.

“It takes many players to make the cogs of the criminal justice system work,” District Attorney Joe Gonzales said. “We’re all working together to try and reduce the numbers as much as we can, but we have competing interests. While we may want to move a case along as swiftly as possible and want to bring justice to the victim of a crime, the accused has a right to [their] day in court.”

Inmates who have been found incompetent to stand trial are often the most vulnerable and also the most dangerous population, Sheriff Javier Salazar said earlier this year.

“They’re not getting any better … they’re getting worse day by day,” Salazar said. “They’re assaulting deputies, assaulting each other and harming themselves.”

This subgroup of the jail population waiting for secured and supervised hospital beds, often called forensic beds, has been arrested but not convicted of a crime because a judge has found they either don’t understand the charge against them or cannot assist in their own defense because of a mental health issue.

While they wait, jailers do not have the authority to force inmates to take medication that psychiatric hospitals have.

“Our mental health unit is constantly full,” said Capt. Lance Spangler, vice president of the union who is a supervisor at the jail. Once inmates are ruled incompetent by a judge, “we sit and wait. It’s dead time. … That’s five or six officers that could be working somewhere else.”

If those inmates could more quickly be placed in a treatment facility, and if pay changes are successful in attracting and retaining deputies, Spangler said the county could eliminate forced overtime. That could also make working at the jail more attractive to job-seekers who desire some level of flexibility in their schedules.

“They’re showing up to work and planning to go home for their anniversary dinner [or] take their daughter to volleyball practice,” Commissioner Grant Moody (Pct. 3) said. With forced overtime, “at the end of their shift, they’re just told: ‘You can’t go home, we don’t have anybody to just sit there and man that watch.'”

Seeking help from the state

Moody said conversations like that led him to travel to Austin with other Bexar County officials, including Sakai, to press lawmakers for solutions to the lack of hospital beds. State Sen. Bob Hall, a Republican from North Texas, filed a bill seeking financial compensation for counties if they have to house an incompetent inmate for more than 45 days — as is the case for delayed transfer of inmates to prison. That bill ultimately failed.

In Austin, they tried to push for funding to build an additional state hospital. “We did get $15 million of that,” Moody said. “However, that money was dedicated at the statewide level, so it doesn’t provide us any more control over those beds.”

Sakai said he has charged a subcommittee of county staff, including Bexar County Office of Criminal Justice Director Norma Greenfield-Laborde, to develop strategies to reduce the population of people waiting for hospital beds.

The county has jail diversion programs and other inpatient and outpatient facilities where it can send some inmates, but the severe cases are largely left in the jail, Greenfield-Laborde said.

“Regardless of what they’re there for, the fact of the matter is, they’re not being helped,” she said. “I think we’re very fortunate to have diversion programs, because if not, we would be in a worse situation.”

Balancing interests

A vast majority of the Bexar County jail’s inmates has been charged with violent felonies, according to numbers provided Greenfield-Laborde’s office.

That’s largely by design, Gonzales said.

If all the jail beds are occupied by people accused of low-level nonviolent crimes, there wouldn’t be room for those accused of more serious violent crimes, he said.

“Being concerned with jail overcrowding or the jail population is not traditionally one of those responsibilities that a prosecutor thinks of,” Gonzales said. “I take a different approach.”

For those awaiting hospital beds, the DA’s office has some power to release those inmates if they have been in jail for as long or longer than they would have been incarcerated for the crime they’re accused of.

There are also competency restoration programs outside of the jail and hospitals, which can be paired with probation tools like ankle monitors, said Christian Hendrickson, chief of litigation and first assistant to the district attorney.

“The question that you have to deal with, and this is case-by-case, is: ‘Can this person do outpatient restoration or do they have to be inpatient?'” he said. “A lot of that is going to be [determined by] how dangerous they are.”

But without enough state beds available, the underlying issue remains, he said.

“We’ve seen a big fall-off in the number of beds available with the state for competency restoration, and just mental health beds, generally,” Hendrickson said. “That just makes the problem substantially more difficult.”

Shortening the wait for beds

In October 2021, the Texas Health and Human Services Commission launched a statewide campaign called “Eliminate the Wait” to shorten the wait for forensic beds. The commission partnered with the Texas Police Chiefs Association, the Sheriffs Association of Texas and the Texas Council of Community Centers to provide a toolkit of strategies for mental health and criminal justice stakeholders.

In January, Health and Human Services had 850 state-owned and operated mental health beds out of service due to staffing issues, according to the agency. It increased starting salaries in February for registered nurses, psychiatric nurses and food service workers to close that gap.

Bexar County recently launched a pilot program that hired seven clinical and medical staff who will provide medication management, group and individual therapy sessions and perform competency evaluations inside the jail. Previously, there was no program within the jail dedicated to restoring legal competency. 

The Jail Based Competency Restoration program was announced in April but only started last month, so its impact on the incompetent population has yet to be seen.

The state is also building a new, 300-bed San Antonio State Hospital in the South Side that will replace the old one next year. The state plans to partner with Bexar County to find the best use for the old facility. The county also has plans to renovate and expand its mental health facility on Applewhite Road.

But adding to the number of beds means little if the hospitals are understaffed, an issue that the February salary increase is starting to address, according to Texas Health and Human Services.

Since December, more than 350 beds in state-owned and operated hospitals have come online, Tiffany Young, an HHS press officer, stated in an email. Of the 2,354 funded beds, there are 1,806 beds online and 548 beds offline, meaning they don’t have the staff to monitor them, statewide.

More than 900 full-time staff vacancies have been filled statewide, including 120 positions at the current San Antonio State Hospital, Young said.

As a result of these changes, the average wait time for inpatient services across the state has decreased by 85 days from a high of 310 days in April to 225 days in July, Young said.

The cost of progress

The Texas Code of Criminal Procedure says individuals deemed incompetent must be transferred to a treatment facility “within a reasonable amount of time and without undue delay.”

Bexar County has not joined Dallas County in its lawsuit against the state on those grounds, despite Salazar’s request.

While he agrees with the principle, “I always want to be fruitful and effective with the use of taxpayer money for lawyers and lawsuits,” Sakai said, and he doesn’t believe such a lawsuit will be successful.

If their other efforts to eliminate the wait are unsuccessful, then he’ll consider legal action, Sakai said.

In either case, the state should shoulder a large portion of the financial burden in the quest to find a solution, he clarified: “I am not relieving the state of his obligation to take care of the inmates.”

The county will need the state’s help to make meaningful changes on this issue, Moody said.

“Making this into a legal fight with the state is not productive, in terms of where we want to go,” he said. “We need to keep our eye on the ball and focus on trying to work with the state rather than fight the state.”

During a recent tour of the Bexar County jail, State Sen. José Menéndez said he was struck by how much mental health issues strain the inmates, jailers and the taxpayers.

“One: It’s wrong — it’s inhumane. And two: It’s also unbelievably fiscally irresponsible to the taxpayer,” said Menéndez, who is supportive of Dallas County’s lawsuit. “It’s one of those situations where doing the right thing would save people money. … What we’re doing currently in the state is unconstitutional when you look at cruel and inhumane punishment.”

Menéndez is still in talks with commissioners about other possible pilot programs they could implement, but was too early to share specific details, he said.

Any state-owned property that is used for behavioral health should be considered for expansion he added, to build more beds with “some of the billions of dollars that are being wasted on the border.”

Beyond the mental health issues inside the jail, the union has a long list of other physical and policy improvements that could be made, including quicker response to maintenance issues, better food offerings and reliable transport vehicles.

The condition of the jail does not yet require a formal intervention, Sakai said, like when the San Antonio community hit a boiling point on domestic violence four years ago. At the time, Sakai (then a district court judge) issued a special order to establish the Collaborative Commission on Domestic Violence.

“That is a strategy that I might be using with criminal justice — to create a task force,” he said, but for now, the subcommittee has been tasked with that work.

During the next legislative session, Sakai said he will be lobbying the state to help fund a regional hospital to serve Bexar and rural county inmates.

By joining forces with those counties, he added, “I think that the likelihood of success is very good.”