One of the last times Yvonne Postlethwait-Allen talked to her younger brother, she told him not to visit for Christmas.

Her brother, Randall Kain, had struggled with heroin addiction since their mother’s death in 2006. He called his sister last Christmas Eve, asking if he could spend the holiday with her at her home in Akron, Ohio.

“I had my grandkids here, and I told him I didn’t think it was a good idea,” Postlethwait-Allen, 51, said. “That really kills me, because that’s one of the last things I told him. I felt horrible after that, I really did.”

Kain died eight months later, on Aug. 31, at 46 — one of three inmates in Ohio's Cuyahoga County jail system to die that week. The county medical examiner’s office listed his cause of death as accidental “acute fentanyl intoxication.”

From June to October, a total of six inmates died, two others from drugs, and three by suicide.

The deaths are being investigated by the U.S. Marshals Service and have prompted calls to rehabilitate what critics call an overcrowded and understaffed system.

After the sixth death, one of the judges who rotate through the county’s felony court, Michael Nelson, started sending defendants elsewhere.

“I then said that I’m not sending anybody else to this hellhole of a jail, unless it’s a violent felony,” Nelson said.

In May, the former nursing supervisor for the Cuyahoga County jail sent a letter to the county council alleging that inmates with diabetes and HIV were not receiving proper medication, and criticized jail director Ken Mills.

Mills resigned Nov. 14, after a group of county judges also complained about the jail’s medical care.

Cuyahoga County Jail in Cleveland, Ohio. From June to October 2018, a total of six inmates have died in Ohio jails. Google

Daniel Leffler, chief of staff for the Ohio Patrolmen’s Benevolent Association, alleged that some cells could be unlocked from the inside and corrections officers were frequently asked to “double-pod,” taking over two sections of a floor at one time.

“I understand sometimes you’re short-staffed, but it was starting to become a regular procedure,” Leffler said.

The Cuyahoga County Jail is authorized to hold 1,765, according to the union, but its average daily population is over 2,200. The jail is operating with a staff of 575; six years ago, that number was 650.

Judge Nelson has called for an overhaul of the jail system, including how bail is determined. He said the county should avoid cash bonds, because defendants who can't afford to pay end up in jail.

“We still haven’t resolved the problem,” Nelson said. “This isn’t about the managers, it’s about the management of the jail.”

Over the years, Randall Kain was locked up in Cuyahoga County three times, all on misdemeanor charges. His last booking was July 23, into the Euclid Jail, where authorities offer special programs for inmates they see as particularly hopeful cases.

“I was relieved when I found out he was in jail because I knew he was eating, that he would go through the detox,” Postlethwait-Allen said. “I was really hoping that being in there would help, because he would tell me he wanted to be better.”

Around 2011, Kain showed up on his sister's doorstep in Akron, skinny and gray. He asked for help, and Postlethwait-Allen took him in. Kain began living with her family and got a job rehabbing houses in Cleveland.

Randall Kain in a family photo. Courtesy of Yvonne Postlethwait-Allen

But the unsupervised commute offered too many temptations. He slipped back into heroin, she said.

After finding his needles, Postlethwait-Allen said she called the police. She hoped they could give her younger brother the help she couldn’t.

Now she is left wondering her brother died. She says the county had not contacted her, apart from notifications of toxicology tests being performed.

“I’m just kind of sitting here, waiting for someone to tell me what’s going on,” she said. “I don’t know what to do. I kind of feel like I’m in limbo.”

She says the only information she could get was that her brother had died of a heart attack, but the cause was still under investigation. When told by a reporter that her brother had died of accidental drug intoxication, Postlethwait-Allen became upset.

“I am freaking out right now,” Postlethwait-Allen said. “I’m telling you, I’m so upset I can’t even think straight right now.”

She believes that the county was negligent in her brother's death, and she blames faulty supervision at the jail, inadequate health care and easy access to drugs.

She struggles to sleep, hoping for answers.

“I have his ashes on my dresser," she said. "I talk to him every day."