The Cuyahoga County Jail has been calling Cleveland EMS more and more over the last several years to take detainees to the hospital.
Ambulance responses to the jail’s address have grown by more than a third since 2022, according to numbers the city provided to Signal Cleveland. Dispatches to that address have roughly doubled since 2018, the year of a wave of deaths and a damning federal report.
Figures provided by the city and the EMS union show a similar trend: Ambulance runs to the jail have been growing over the last several years — even as the jail population has fluctuated.
The jail’s address, 1215 W. 3rd St., was the No. 1 destination citywide for Cleveland ambulances in 2024, outranking both the men’s and the women’s homeless shelters, according to statistics posted on the union’s website.
Often, those ambulances take people to the emergency department at MetroHealth, the county’s public hospital. Since 2019, MetroHealth staff have offered medical care inside the jail and typically decide when to call EMS. The hospital system’s numbers also show an increase in transports to the emergency room over the last several years, both by ambulance and by the Sheriff’s Department.
Elected leaders and hospital officials say calls might be on the rise for a number of reasons. People held in the jail often have serious medical needs, and, on evenings and weekends, doctors aren’t in the jail to make decisions. Providers also may be more cautious given the history of deaths at the jail, County Council members have suggested.
Rising ambulance runs have elected officials concerned about the county’s costs. EMS union leadership has been worried about the citywide pressure on staff, successfully lobbying this year for funding for more workers.
“The jail is taking up more EMS resources, I think, than it ever has before,” said Tim Sommerfelt, an official with the Cleveland Association of Rescue Employees, the EMS union. “There’s not an infinite amount of EMS resources. If we’re responding to the jail, it means we’re not available somewhere else.”
The union also tracked an additional 180 EMS responses in 2018 to the police headquarters and city jail, which was merging with the county facility at the time. Including those, the increase since 2018 was 75%.
In a statement to Signal Cleveland, a spokesperson for MetroHealth wrote that caregivers evaluate every person who is booked into the jail for medical or mental health issues. The hospital system provides an on-site pharmacy, specialties such as dentistry and obstetrics and access to telemedicine.
The spokesperson, William Dube, wrote in an email that people detained in the county jail are more likely to face serious health problems – a situation that has worsened since the pandemic. He added that regardless of how many people are in the jail, medical needs there can’t be predicted.
“We have seen an increase in the complexity of healthcare needs of the jail population over the last several years,” Dube said.
Tyler Sinclair, a spokesperson for the City of Cleveland, wrote that it was “extremely difficult” to measure whether jail responses were straining EMS resources. Sometimes the calls may stretch EMS capacity and sometimes they may not, he wrote. It all depends on the number of other calls around the city, their location and their severity.
“We are aware of an increase in recent years, but – as with any call for emergency medical services regardless of location – are obligated to respond under state law once certain criteria are conveyed,” he wrote in an email, “and trust that those calls by jail medical staff, who are trained experts in their field, are being made in good faith on behalf of individuals who truly do need care.”
On average, a dispatch to the jail keeps an ambulance busy for 1 hour and 8 minutes, 2024 data reviewed by Signal Cleveland shows. The average EMS response time citywide has been getting longer over the last several years, according to figures gathered by the union.
What medical issues trigger an ambulance?
More than half of the Cleveland EMS runs to the Cuyahoga County jail in 2024 addressed three medical issues: chest pains, pregnancy or signs of sickness – encompassing issues from nausea to an altered mental state. That’s according to city records that detail the reasons for EMS runs to the jail’s address in 2024.
Chest pains in particular have been a recurring reason for emergency care. Dr. Christine Alexander-Rager, CEO of MetroHealth, told Cuyahoga County Council members in a committee meeting last November that it can be difficult for a doctor who is not on-site to assess the severity of the symptom.
Calls to EMS can be categorized on a sliding scale of importance, from the least severe – Alpha – to the most severe – Echo.
Alpha calls involve a minor injury or illness, while Echo calls can require advanced life support due to crises like cardiac arrest, according to explanations by the EMS union.
Dispatchers tagged about three out of every five EMS calls to the jail in 2024 with a middle- or high-severity ranking – issues including miscarriages, abnormal breathing or heart attacks.
The other two in five calls were categorized as Alpha or Bravo-level severity, the lowest levels. Examples include vomiting, trauma or assaults to the head.
“The Bravos mean … we basically just checked your vital signs and said you’re okay and drove you to the hospital,” Sommerfelt said, adding that paramedic-level care is not required for a Bravo call.
After a year of crisis in the jail, the county hires a new medical provider
The year 2018 was a low point for the Cuyahoga County Jail. Eight people detained in the facility died that year. In the years since, at least two dozen more have died.
A 2018 report published by the U.S. Marshals Service that year faulted the jail for inadequate medical care, “inhumane” confinement conditions, nutritionally deficient food and other health and safety problems. In 2019, the county brought in MetroHealth to run the healthcare service at the jail.
Asked about the rise in EMS calls, some County Council members have suggested that, considering the jail’s history, medical staff would rather be safe than sorry.
“These nurses are not going to make the call, ‘Oh you’re OK, I’ll give you an aspirin,’” said Michael Gallagher, chair of the county’s Public Safety and Justice Committee, in an interview. “‘No, you’re going to the hospital, I don’t need a death on my watch.’”
Hospital officials offered other explanations. They told County Council that jail residents are sicker in the years after COVID and need care that’s not available in the jail and may require a hospital visit. Equipment – such as X-ray machines, CT scans or MRIs – are either unavailable in the jail or can only be used at certain times, said Aisha Parnell, director of Nursing for Correctional Medicine at MetroHealth, in a June 2024 council meeting.
There’s also jail staffing to consider. Alexander-Rager told Cuyahoga County council members last year that the majority of hospital transports take place after business hours or on the weekend because of staffing at the jail: During those time periods, there are no advanced providers like physicians, nurse practitioners or physician assistants to see patients. Instead, they are on-call. Nurses are on-site.
“Being the person on-call and getting the call about someone having chest pain – could be a heart attack, could be acid indigestion,” Alexander-Rager told County Council. “But it’s really hard to know the difference when you’re on the phone with a nurse who’s there with the patient in the moment. And so, safety first, you end up asking them to be transported in.”
Transports to the hospital are split roughly half and half between MetroHealth’s day shift – 7 a.m. to 7 p.m. – and night shifts and weekends, according to numbers the hospital provided for 2019 through 2025.
In order to decrease hospital transports, Alexander-Rager told council members last fall that the hospital had hired one doctor to begin working nights in early December. The doctor could provide necessary medical care within the jail instead of moving the patient to the hospital.
But Gallagher said that, since then, the hire has already come and gone – leaving the jail without an overnight doctor once again.
“He just up and quit after a very short period of time with us,” Gallagher said. “So now we’re back to that.”
MetroHealth said in a statement that it is actively interviewing and recruiting for the nighttime doctor.
Ongoing ambulance costs for Cuyahoga County
Transporting jail residents to the hospital costs the county in ambulance bills, in pay for deputies who accompany patients to the hospital and in additional off-site medical expenses.
For instance, the county paid Cleveland almost $99,000 in ambulance bills at the jail in 2019, according to figures the county shared with Signal Cleveland. Midway through 2025, the county has already spent more than $214,000. The amounts may reflect costs from prior years, depending on when the county paid the bills, a county spokesperson said. Cleveland also doubled its ambulance rates in 2022.
Those expenses are in addition to MetroHealth’s current nine-month, $17.2 million contract with the county to provide on-site medical care inside the jail.
At a County Council meeting last November, Council Member Dale Miller said the approach to calling EMS had changed since the jail crisis in 2018. He is now the council president.
“Six or seven years ago, in the bad old days, we were not providing nearly enough medical care to the inmates,” Miller said. “But it now seems that we’ve gone to the other extreme, where people are getting transported to the hospital if there’s even the slightest question whatsoever.”
County deciding on next medical provider at jail — and options in Garfield Heights
The county plans to relocate the jail to Garfield Heights, a smaller city with fewer emergency personnel than Cleveland has. The move also gives officials the chance to reimagine the medical services provided on-site in a new building.
Some of the options up for discussion are a behavioral health center, space for addiction services and an onsite clinic offering primary and urgent care, Jennifer Ciaccia, the county’s press secretary, wrote to Signal Cleveland in an email. Other ideas include medical examination rooms and “dental services, x-rays, lab services, dialysis, physical therapy, and pharmacy services,” she wrote.
In the meantime, the county solicited proposals for a new medical provider at the current jail. It closed the process in mid-January.
The county received six proposals, including one from MetroHealth, Sheriff’s Department contract monitor Julia Gron confirmed to county council members in January. The county’s new provider will be required to have a doctor on site overnight.
Gron told council that the county wants to provide as much quality healthcare as possible within the jail.
