Commissioners Approve a New Intake Facility Designed to Identify Medical Emergencies, Mental Health Crises and Withdrawal Symptoms Before People Enter the Jail
Bexar County commissioners have unanimously approved a plan to move comprehensive medical screenings closer to the beginning of the jail intake process, responding to years of deaths, medical emergencies and concerns about delayed treatment inside the Bexar County Adult Detention Center.
The Bexar County Enhanced Medical Screening and Early Intervention Initiative will place University Health professionals inside a new modular medical screening facility at the Justice Intake and Assessment Annex. The facility will be installed within the vehicle sallyport, allowing medical staff to examine people shortly after they arrive and are searched.
Commissioners authorized a $250,000 budget transfer for the facility and related improvements.
The change is intended to reduce the hours people may currently spend completing fingerprints, photographs, questionnaires and other booking requirements before receiving a more detailed medical evaluation.
Once implemented, the new facility will allow licensed medical professionals to conduct up to 10 screenings at the same time and provide a dedicated area where people can be observed while remaining close to medical care.
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“We will be providing better quality of service so we can address the needs of the people that are coming into our jail system,” County Judge Peter Sakai said according to local reports.
Many Deaths Occurred During the First Week
The decision comes amid increased scrutiny of health care and conditions inside the jail, where at least 92 people have died in custody since 2020.
County officials reviewing jail deaths found that 44% occurred within the first seven days of custody, a period when people may be experiencing untreated illnesses, withdrawal symptoms or complications from chronic medical conditions.
About 50,000 people were booked through the county’s intake system in 2025. County data shows 34% of the jail population has a diagnosed mental health condition, 24% receives medication for cardiac conditions and 15% receives medication related to diabetes.
More than half of the jail population receives some form of prescription medication.
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“The jail does not create these conditions,” county officials wrote in their presentation to commissioners. “It receives them — often at the point of crisis.”
People entering the jail may have high blood pressure, diabetes, heart conditions, mental illness or substance-use disorders that are not immediately visible. Earlier screenings are intended to identify those conditions before they worsen into emergencies.
University Health will coordinate the expanded screenings and determine whether someone can safely continue through the booking process, needs additional observation or should be transported for hospital treatment.
The county also expects the changes to reduce avoidable hospital transports and prevent medical deterioration after a person enters the general jail population.
Plan Addresses One Demand From Reform Advocates
Community groups had already been pressing county leaders to strengthen intake procedures and provide earlier medical intervention.
The proposal, developed by ACT 4 SA, All of Us or None Texas and the Texas Jail Project, called for prompt screenings for medical emergencies, suicide risk, mental illness, alcohol and drug withdrawal, chronic conditions and necessary medications.
Advocates also called for stronger diversion programs, continued medical treatment after intake, better communication with families and independent reviews of deaths.
The newly approved screening plan directly addresses part of the safer-intake recommendation, but it does not resolve the larger concerns surrounding overcrowding, staffing, accountability and the number of people with serious behavioral health needs being held in jail.
Ananda Tomas, executive director of ACT 4 SA, told commissioners that medical care and diversion decisions must begin before a person reaches the jail.
“A real continuum of care begins at the point of arrest,” Tomas said.
She also emphasized that many people who die in county jails are awaiting trial and remain legally innocent.
Larger Jail Problems Remain Unresolved
The changes come as Bexar County continues confronting jail deaths, overcrowding and the rising cost of housing inmates elsewhere.
The Adult Detention Center frequently operates near capacity, leading Bexar County to pay other counties to house hundreds of people. Staffing shortages have also contributed to millions of dollars in overtime expenses.
Commissioners continued discussing behavioral health treatment, jail diversion programs, mental health bed capacity and the possible reuse of buildings at the San Antonio State Hospital.
County leaders also revisited “double magistration,” the system under which people arrested by San Antonio police are processed at a city facility before being transferred into the county system, where portions of the process may be repeated.
County officials said the duplication creates delays and operational problems. Nearly 29,000 of the approximately 50,000 people booked through the county intake facility last year came from the San Antonio Police Department.
The city’s cooperation will therefore be necessary to fully streamline intake and ensure people receive medical evaluations as early as possible.
