More transparency for deaths on law enforcement's watch

The Victoria County Jail.

Officials hope privatizing part of the Victoria County Jail will better address the needs of inmates with mental illnesses.

"There are a lot of patients or a lot of inmates that I see that probably the main reason they are in that facility is they have an underlying mental illness," said Dr. John McNeill, who is the jail's medical director.

Monday, Victoria County commissioners court agreed to enter into a contract with the University of Texas Medical Branch to provide medical services.

It will cost $1,070,171 a year.

On a short-term basis, the contract will not save the county money, but is expected to if it becomes a long-term program.

It's estimated UTMB will cut the sheriff's office's off-site medical expenses by 35 percent. Because of that, the sheriff's office anticipates spending $4,893.52 more than it would have without UTMB. If the off-site medical expenses are not reduced, it will be a $137,988.52 increase from 2016.

One of the most important things UTMB brings to the county is a board-certified psychiatrist, who will be available by tele-video conferencing software 24/7. The psychiatrist will have better expertise on what cost-effective medication to prescribe, McNeill said.

The Gulf Bend Center, one of the state's 39 mental health authorities, has a psychiatrist available to the jail through tele-video, too, but McNeill and Sheriff T. Michael O'Connor described Gulf Bend as being overwhelmed.

"Yes, you can make a phone call, but as we've found out, they are more available during the weekdays than after 5 on weekends," O'Connor said.

Later, he added, "We're not going to discontinue that relationship just because UTMB is coming in. If anything, we've talked to Gulf Bend, and we think this is an enhancement due to the significant responsibilities they have incurred."

McNeill, who O'Connor called the jail's "saving grace," has agreed to stay on as the jail's medical director. The nurses who work in the jail can apply to work for UTMB. Both O'Connor and McNeill strongly recommended UTMB hire the nurses currently there.

Stephen Smock, associate vice president for UTMB Correctional Managed Care Outpatient Services, indicated they likely would be hired "if we can make a salary arrangement."

UTMB has provided the Texas Department of Criminal Justice medical service for 24 years.

Smock said during that time, UTMB saved the state billions of dollars. It spent $11 per inmate per day. UTMB also installed the first electronic medical records system in a correctional environment.

"Which certainly helps with continuity of care," Smock said.

The contract becomes effective after County Judge Ben Zeller signs it Jan. 3. Once the contract is signed, UTMB is expected to take over medical services at the jail in early February.

Zeller said during a commissioners court meeting Monday that several tweaks recommended by the county's lawyer need to be made before he signs the contract.

Commissioner Kevin Janak wanted more caps in the contract to keep costs down.

For example, the contract calls for Victoria County to reimburse UTMB for pharmaceutical costs more than $125,560.

The county's lawyer recommended a cap on how much the county will reimburse above $125,560.

"Right now, we have the sheriff, his staff and Dr. McNeill doing whatever they can for the taxpayers of this county. We are more or less handing you this responsibility. ... What incentive is there for you to keep the cost down?" Janak asked.

O'Connor said he would continue to answer to the taxpayers.

Smock said it was a reasonable contract and similar to contracts they have with other counties.

Overall, O'Connor said UTMB will free up jail administrators and other personnel, who are currently inputting medical records, dispensing medicine and transporting inmates to doctor appointments.

This will enable them "to put more emphasis on who we are and what we are, and that's a jail," O'Connor said.

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