Web Posted: 02/03/2006 12:00 AM CST

Elizabeth Allen
Express-News Staff Writer

Bexar County's festering jail population problem just got worse.

A new state rule has cut the number of hospitals that can take mentally incompetent defendants now sitting in county jails, and taken San Antonio State Hospital off the list.

That likely will add to the number of inmates the most difficult and expensive kind in Bexar jail. And it surely will add significant transportation costs, because the county will have to take such "forensic inmates" out of town and in most cases across the state.

Bexar County has about 20 male inmates in its acute mental health and suicide watch units, and about 280 more in the "stable" mental health units, said Dr. Cesar Garcia, a jail psychiatrist. He estimated the jail holds about 150 mentally ill female inmates between the acute care and stable units.

Many of them are people Garcia, who had been with the county since 1985, has seen again and again.

Some often are lucid. Others can't function at all.

"This young man is probably the sickest man you will ever see," Garcia said, motioning to a wide-eyed prisoner with a slack half-grin, staring out the large window of his cell. "The man just exudes mental illness."

A little later, the man began to scream.

They come from all kinds of backgrounds, but by the time they get to jail they're almost all poor and alone. In jail, they can wait up to six months to get competency hearings.

If found incompetent, they'd usually wait another 10 days to be sent to a state hospital. If they were violent, they would go to Vernon State Hospital. If not, they'd usually go to San Antonio State Hospital or sometimes Kerrville.

But now the San Antonio hospital is out of the mix. The county will have to take such inmates to Kerrville if beds are available. If not, they'll have to go as far as El Paso, Vernon, Rusk or Big Spring.

That means shelling out up to $1,000 per overnight trip with two deputies, said Deputy Chief Dennis McKnight.

Bexar County deputies took forensic patients to San Antonio State Hospital 190 times last year, McKnight said.

"If we do 190 next year" to the four more distant hospitals, "that's $190,000 that's getting dumped on the taxpayers all of a sudden," he said.

State officials said they hope the new rule, which went into effect Wednesday, will speed getting inmates to hospitals, where they're treated until deemed well enough to stand trial.

"The hope is that it will not increase the waiting period," said Doug McBride, spokesman for the Texas Department of State Health Services.

It might be more efficient than the current system, he said, since the new way creates a central clearinghouse where patients get assigned hospitals on a first-come, first-served basis. Also, he said, the state has increased the number of forensic patient beds from 432 to 642, concentrated in the five hospitals.

But at the end of November, there already were almost 740 in the overcrowded state system.

Counties didn't get any encouragement from the state Thursday at a Texas Commission on Jail Standards hearing in Austin.

Bexar County representatives who attended the meeting said a state health official said his agency would address the overcrowding problem by not taking new forensic patients for a while. The official could not be reached for comment.

County officials aren't optimistic.

"I think it's going to contribute to the jail overcrowding problem," said Magistrate Andrew Carruthers, who oversees competency hearings. "We see somebody daily who comes before us who is incompetent."

If the patients caught in the current revolving-door system of state mental health care go to a new hospital each time, they'll be strangers, making treatment harder, said Dr. John Sparks, medical director of detention health care services

And their commitment begins on the day of the judge's ruling so if it does take longer to get them to treatment, it's that much less time they have to get better before their next hearing before Carruthers. New hearings mean more costly trips, McKnight noted, although he hopes the county can buy video conferencing to cut that cost.

To Garcia, it's just part of a decades-long erosion of state care for the mentally ill that leaves them no home but jail.

"A lot of these chronic schizophrenics, they were living at the state hospital with room and board, smoking cigarettes. They never got into trouble," he said.