CLEVELAND, Ohio — For nearly a month, medical officials at the Cuyahoga County Jail pleaded with County Executive Armond Budish’s administration to make changes aimed, in part, at decreasing suicides at the jail.

The calls for reform went unanswered, according to emails obtained by cleveland.com.

Two days after Christmas, 27-year-old inmate Brenden Kiekisz hanged himself in his cell.

Within 17 hours, as Kiekisz lay on life-support, the county implemented the changes that would help ensure inmates, like Kiekisz, receive a state-mandated medical screening that provides critical information to jail staff about their mental health and medical needs.

The revelation about Kiekisz’s death — the eighth Cuyahoga County inmate to die in 2018 and now under review by federal investigators — are contained in emails exchanged in December between top county and MetroHealth officials. The county released the emails more than two months after several requests by cleveland.com.

MetroHealth sought to curb the rising number of suicides and attempted suicides at the jail, largely attributed to crowded pods, squalid conditions and an understaffed and overworked jail staff. Half of the eight inmate deaths in 2018 came by suicide, including Kiekisz. The number of attempted suicides tripled to 69 in a three-year span.

When Kiekisz arrived at the jail, he told a corrections officer that he tried to take his own life two days earlier, according to records obtained by cleveland.com.

He never received a medical screening, according to the emails.

And neither did 28 percent of inmates booked into the jail in the four days ahead of Kiekisz’s arrival, the emails said.

MetroHealth Director of Correctional Medicine Dr. Thomas Tallman reiterated in an email to jail officials on Dec. 27 the need to make the changes. The message came less than an hour after Kiekisz was found in his cell.

“Please, please please…” Tallman wrote. “My patience is gone…”

The conversations happened in the weeks when county officials said they were working to make swift changes in response to the Nov. 21 release of a U.S. Marshals Service report that detailed “inhumane” jail conditions.

Every official who participated in the email chain — in Budish’s administration and at MetroHealth, which at the time oversaw a portion of jail health care — did not respond to questions from cleveland.com. Cuyahoga County spokeswoman Mary Louise Madigan said the county would not comment because of lawsuits filed over jail conditions. MetroHealth spokeswoman Tina Shaerban Arundel also declined comment.

Among the unanswered questions is why the county failed to act on MetroHealth’s urgent recommendations until after Kiekisz’s hanging.

On Tuesday, MetroHealth Chief of Staff Jane Platten reported to County Council that all inmates are receiving intake screenings now that MetroHealth is taking over as the jail’s sole medical authority.

Platten had been emailing the county since Dec. 3, asking jail officials to “immediately” implement changes. She asked again on Dec. 17, according to the emails.

One change was ensuring that all inmates get their health screening within four hours of their arrival, according to the emails.

To streamline that process, Tallman asked jail administrators to move nurses who perform the medical screenings to the jail’s entry way, known as the sally port.

Medical screenings used to take place in the sally port, but then-jail Director Ken Mills moved them to one of the jail’s upper floors in May, Platten said in an email.

Having medical personnel located somewhere other than the sally port meant inmates were being dispersed throughout the jail complex without medical officials knowing whether they were booked, let alone given the chance to screen them, Platten’s emails said.

“Moving to the sally port should cure this issue,” Platten’s emails said.

Budish asked his staff Dec. 25 if the changes had been made.

Then-Chief of Staff Earl Leiken, Public Safety and Justice Chief Brandy Carney, Sheriff Cliff Pinkney and interim jail director George Taylor didn’t email him back, the emails show. The county will not say if anyone acted on Budish’s inquiry or otherwise responded to him.

The county’s failure to screen some incoming inmates in accordance with Ohio law was a problem Budish and his administration knew about for months.

In June, the Ohio Department of Rehabilitation and Correction found that the county had failed to screen six out of the 30 inmates sampled. The agency asked to be notified when Cuyahoga County to corrected the problem. No response was sent.

The U.S marshals in November found that some inmates still weren’t being screened.

Even when inmates were screened, officers were being forced to conduct the screenings despite not being properly trained as medical officials, according to a grievance filed by corrections officers in November.

The county denied the grievance.

Another change suggested by Platten involved a new policy that would require the jail to turn away people brought to the jail that met certain medical criteria, including people who had attempted suicide in the previous seven days.

That, too, was implemented within a day of Kiekisz’s hanging.

In the months since, a federal grand jury subpoenaed the records of Kiekisz’s death, a sign that federal investigators have ramped up their investigation into conditions at the jail. The Ohio Attorney General’s Office is also leading a probe into jail conditions that has so far included indictments of the former jail director and five current and former corrections officers.

Below is an accounting of the emails and how the county responded:

Dec. 3

Platten sends the first email to Carney, Pinkney and Taylor about the changes. She asks for them to be “implemented immediately.” No one replied, Platten said in a later email.

Dec. 17

Platten follows up with Budish and jail administrators to see if the changes were made. She cites an incident where an inmate who needs immediate attention did not receive their medical screening. She again asks jail officials to move intake screenings to the sally port and for an update on the proposed changes. No one replied, according to her later email.

Dec. 25

Budish forwards Platten’s latest email to Carney, Pinkney, Taylor and Leiken, and asks if the changes were made. No one returns Budish message.

Kiekisz is booked into jail on an accusation that he violated the terms of his probation stemming from a 2016 heroin and fentanyl possession case

Dec. 27

Morning — A judge finds Kiekisz didn’t violate probation, orders him released from the jail and back into treatment.

10:56 p.m. — Kiekisz, who was returned to the jail to await transfer to a treatment facility, is found hanging in his cell. He is taken to MetroHealth and put on life-support.

11:39 p.m. — Tallman emails Pinkney, Taylor, Platten, and then-warden Eric Ivey. He cites the hanging and again asks for intake screenings to be moved back to the sally port.

“We just had another code green and my nurses tell me the likelihood of survival is low,” Tallman’s email said. “If that is true, then, well you do the math.”

Tallman relays that Kiekisz didn’t receive a screening when he was booked into jail. He asks for a full investigation into the case and wants to know who was working on Christmas and what events contributed to Kiekisz not being screened.

“My patience is gone and we need our nurses down in the sally port intake area 24 seven, beginning immediately,” Tallman said.

Dec. 28

10:12 a.m. — Platten emails Carney, Taylor, Pinkney and copies Budish, Leiken and County Council members. The email says MetroHealth officials were never made aware of Kiekisz’s booking, and he was not given a medical screening.

She again questions officials about her “repeated requests” for the changes, and asks for an immediate response.

“We have gotten no response to our emails and requests and there has been no change at the jail to accommodate medical staff having immediate notice and access to incoming inmates for purposes of medical screenings,” Platten’s email said.

10:15 a.m. — Budish emails Leiken, Carney, Taylor and Pinkney: “I thought all changes were made. What’s the problem? This can’t continue!”

11:11 a.m. — Leiken emails Budish: “I also understood all of these issues had been and were continuing to be addressed at the jail.”

1:39 p.m. —Dr. Julia Bruner, MetroHealth’s physician executive for ambulatory operations, sends Ivey an outline of how some of the changes will be put into practice. She says she reviewed the changes with Ivey and Pinkney earlier that day.

2:18 p.m. — Ivey asks that changes get added to jail policy and asks for the unions representing jail staff to be notified.

3:34 p.m. — Pinkney replies to the group but addresses the message to Tallman. Pinkney says the changes Platten recommended on Dec. 3 would be put into effect immediately. He says he had ordered the changes to be made weeks ago but had to wait for a property machine for an unrelated part of the booking process. (Cuyahoga County refused to answer questions about the property machine, its purpose and why they had to wait for it to implement changes)

Pinkney says that Tallman has authority over medical decision in his role as medical director.

6:37 p.m. — Platten emails Pinkney and points out that she had emailed jail administrators about the changes three times and got no response. Platten addressed Pinkney’s claim that he ordered the changes weeks prior but says “execution of those orders though had not been fully realized.”

She also notes that Pinkney was able to implement the changes within hours after the hanging.

“It is clear that the lines of communication on these matters have broken down,” Platten wrote.

Platten also mentions that 28 percent of inmates failed to receive screenings from Dec. 25 to Dec. 28.

Dec. 30

Kiekisz dies in what is later ruled a suicide.