Brazos County officials propose new jail medical divisions and staffing to bring care in-house

Brazos County leaders presented a plan Aug. 13 to reorganize and expand jail medical services, creating a new jail correctional medicine division and a juvenile correctional medicine division and asking Commissioners Court to approve additional staffing and budget authority.

County presenter Miss Payne said the proposal would move existing positions out of the current external-contract model and place medical staff under the county's health clinic to better control costs and staffing. "This new division will, instead of 19 positions, we'll be bringing 22 positions," Payne said during the budget workshop.

The proposal, as described to the court, would remove 19 positions from the existing contracted clinic (a decrease the presenter described as about $1.3 million), create two separate county divisions for adult and juvenile correctional medicine, and add positions including a nurse manager, registered nurses, licensed vocational nurses (LVNs), medical assistants and a medical clerk. Payne described pay ranges for new positions (examples given in the workshop: nurse manager at a per-pay of $4,230; RNs at about $40.08 per hour; LVNs to a $33.66 top hourly rate; medical assistants and clerk at $28.85 per hour) and said several positions would be initially listed as unfunded to control near-term costs.

Sheriff's office and county health officials said the move aims to reduce reliance on an out-of-state contractor currently used by the jail for medical coverage, and to allow the county to manage scheduling, rotations and the clinic's electronic medical records in-house. A county official noted that the state of Texas requires the county to provide constitutionally adequate medical care for people in custody, and that the county has substantial costs and legal exposure if care is insufficient.

Officials acknowledged recruitment challenges for nursing staff, citing nationwide shortages, competition from travel nursing, and post-COVID workforce shifts. The presenters said the county would hire within ranges rather than at top steps to save costs, keep several positions unfunded initially, and use a $20,000 "correctional rotation" bucket to pay temporary or rotating nurses as needed.

Juvenile services staff will move one existing juvenile nurse into the new juvenile correctional medicine division and align pay ranges with the adult division to allow rotation between sites. Payne told the court that the juvenile move reduces the juvenile budget (she cited a decrease of about $115,000) while the county-wide reorganization produces a net increase to next year's personnel budget described in the workshop as roughly $601,000 on top of the county's existing baseline for those services.

Nurse practitioner Julie Anderson and other clinic staff were referenced repeatedly as providing much of the current coverage; commissioners stressed the county should not depend long-term on a single employee to provide excessive overtime. Chief and county leadership urged the court to weigh in-house control and potential long-term savings against the risk that the county may still need to contract externally if staffing goals cannot be met.

No formal vote or final budget decision was taken during the workshop; officials asked the court to prioritize the request when preparing the proposed budget for consideration.

County officials said they will track staff time between adult and juvenile divisions so costs can be separated in future budgets and asked the court to consider the staffing requests as part of the proposed budget process ahead of final budget decisions.

A 5-minute break was taken at the end of the presentation before the court moved to the next item.