OREGON DEPARTMENT OF CORRECTIONS
Unusual Incident Report

Referred to State Police:

(giVes

DNo

SmtePoliceC~e#: ~1~12~2~4~84~1~

Referred to,SIU:

DVes

06-19-11

Time:

3:00-4:00

__________________________________ Medical Attention Required: Wes

DNo

~No

Use of Force

Staff Assault
Inmate Assault

Type of Force Used:

Escape

Contraband

Inmate Death

Apparent Natural Causes

Property

Medical Emergency

Emergency

SelfhUury

Attempted Suicide

EmployeeN0 lunteer/
Contractor/Citizen

Blood and/or Bodily Fluid

Other:

(OR)

J. Campau, Thomas, W.

6298340

12-29-2013

J.

2.

2.

3.

3.

4.

4.

5.

5.

Page 1 of3

Date:

CD 115 (08/05)

3. Incident: Describe Incident in detail: (Times, dates, locations, weapons involved, sequence of events, inmates/staffinvolved, etc. For escapes only:
include a: detailed description ofthe inrnate(s); height, weight, color of hairIeyes, clothing last worn, and other significant info.
On 06-19-2011 at 1330 Captain Bellman briefed me on an incident that involved Inmate Campau. The incident is as follows. On 06-19-11 at I 1251nrnate Campau who was housed in the
infirmary, had cut his left wrist and reported that he had swallowed a razor blade. Captain Bellman prepared the inmate for transport to Salem Memorial Hospital. As the transport was about to
take place. Dr. Vargo (through Ted Randall Health Services Manager) ordered the inmate kept in the infirmary and placed on a suicide watch, At 1535 Officer Kohler radioed me to call the
infirmary. Officer Kohler told me that Inmate Campau was hitting his head on the radiator in his side room. I responded to the Infirmary Side Room #6 and told Inmae Campau to quit hitting his
head or I would place him in a restraint chair to negate his self destructive behavior. Inmate Campau said OK. I ordered lnamtc Campau several times to put his smock on so I could restrain him
and have his injuries checked by medical. During this time Inmate Campau was staggering around his cell asking for help. Eventually he sat on his toilet andcontinued to ask for help. At this
point I told him to forget the smock and come to the cuff port to be restrained. He complied at 1545 by standing up and covering his genitals and placing his hands through the cuff porl After 1
restrained him and the door opened he fell into the wheel chair and appeared to go unconsious. R.N. Tarvis Toman assessed Inmate Campau and told me to call 911. I ordered Officer Kohler to
call911. R.N.'s Travis Toman, Monika Korsncs and Sandra Hendricks began emergency medical treatment on Inmate Campau on the floor outside of Side Room #6. Inmate Campau was
transported to the sally port outside of Master Control where he was turned over to E.M.T.s. Ryan Schenk. Broady Neson, Eric Creech and Paul Telfer at 1555. At 1615 the E.M.T.s called
Doctor Kirkpatrick who told them to pronounce him deceased. I declared the Infinnary Side Room #6 and the Sally Port a crime scene and placed Officer Triede in charge of securing and
monitoring Side Room #6. I placed Officer Sickendick in cbarge of securing and monitoring the Sally Port. All necessary internal and external notifications were made. Medical Examiner
Darrell Britton arrived at 1717. State Police Detective Dave Steele arrived at 1730. District Attorney Nicole Theobald arrived at 1845. Detective Steele and M.E. Britton investigated Infirmary
Side Room #6 and released it as a crime scene at 1821. Mike Trissell of Alternative Burial removed the body of Inmate Campau at~.6l...o.;J I

4. Specific Information: (Personal injury, property darnaae, notification of kin).
was not able to contact nex.1. ofkin at the time of this writing. Will attempt contact in the morning.

Inmate Deceased. Chaplain Raths

Misconduct Report Issued? DYes

~No

I.R. Ridderbusch

O.D.

06-19-11

1621

2.M. Yoder

Assit.
Supt

06-19-11

1624

7.I. Black

Carom.

06-19-11

1646

3.I. Premo

Supt.

06-19-11

1624

8.Darrell Britton

M.E.

06-19-11

1642

9.Ted Randall

B.S.

06-19-11

1628

06-19-11

1630

10.Kelly Raths

Chaplain

06-19-11

1650

06-19-11

1638

4.B. Hoefel

S.M. Dodson

Page 2 on

Assit.
Director
Institution
s
Assistant
to the

CD 115 (08/05)

6. Report Completed By:
Randy Holcomb
Print Full Name

Lieutenant
Title

Signature

06·19-1 I
Date

Page 3 of3

OSP
Functional Unit

CD 115 (08/05)

OPSSOlI
HOLCOMBR
Offender ..
Location ..
Age
Sex
Height
Weight

Status. Discharge
Cell.
DOC cycles. 03-01-02
DNA Collected

6298340 CAMPAU, THOMAS WILLIAM

56
Male
6'

300lbs

DOB
3/02/1955
Race WHITE
Hair BROWN
Eyes BROWN

Caseload 00106 VACANT; CALL
Supervision
Court Case
Cnty ORS Abbrev
C101933CR/01 WASH RETL THEFT
C101933CR/02 WASH THEFT I
C101933CR/03 WASH THEFT I
C101933CR/04 WASH THEFT I
C101933CR/05 WASH THEFT I
F3=Exit
F11=Menu bar

22:00:39
6/19/11

Corrections Information Systems
Offender Public Information

F4=Prompt
F12=Cancel

Discharged date .. '" .. 06/19/2011

373-1666 OR 1665

*DESIGNATOR*

Yrs-Mos-Days Term Date & Code
000-006-000
000-013-000
000-013-000
000-013-000
000-009-000
More ...
F5=Refresh
F6=PTA Caseload
F9=Retrieve
F17=All offenses
CIs
BF
CF
CF
CF
CF

Type
LC
PARO
PARO
PARa
PARO

Begin Date
12/21/2010
12/22/2010
12/22/2010
12/22/2010
12/22/2010

C>.R.EG-C>J'V STATE PEJ'VITEJ'VTIAR..Y

TO: Lt. R Holcomb

CI!)Y;[) t3~
DATE:Sunday, .Tune 19, loli
FROM: Cpt D Burch

SUBJECT: Death ofInmate 6298340 CAMPAU, THOMAS WILLIAM housed in IN-6

I cpt D Burch was assigned as the Master Control Sergeant on Sunday, June 19, 2011. At
approximately, 1550 hrs I received a phone call requesting an ambulance for 6298340
CAMPAU, THOMAS WILLIAM who was non responsive. I called the orc Lt R Holcomb to
confirm the need for an ambulance.l called the ambulauce at 1554 hrs and it arrived at 1556 hrs.
The ambulance alTived and began helping inmate Campau in the R&D area. Inmate Campau
passed away at approximately 1615.

STATE OF OREGON
DEPARTMENT OF CORRECTIONS
OREGON STATE PENITENTIARY

DATE:

6/19/11

TO:

Superintendant J Premo
Oregon State Penitentiary

FROM:

C/O K Darby

SUBJECT:

Campau, Thomas S1O# 6298340

INTEROFFICE MEMO

'XJ:JoAo/

At approximately 4:00 pm I was called to report to the control floor. I met staff at
the Commissary Gate for a hospital escort. I followed medical staff to master control
to take inmate Campau, Thomas SID# 6298340 to the hospital ER. I drew keys to
stage a pace car. I waited outside the sally port to follow the ambulance to Salem
Memorial Hospital. At approximately 4:20pm I was informed to park the car that the
transport was cancelled. Inmate Campau was declared deceased. End of report.

STATE OF OREGON INTEROFFICE MEMO
DEPARTMENT OF CORRECTIONS
OREGON STATE PENITENTIARY

DATE: June 19, 2011
TO: Mr. Premo J.
FROM: CIO W. Sickelldick t/"v"...:--t. /l~....:­
SUBJECT: Inmate Campau, Thomas # 6298340
On 19June2011, at approximately 1553, Inmate campau came across
floor on 'it gurn~y lYitli nursing ~taff performing CPR. sgt.
ph1l1PP1 ass1gned me 1n ass1st1ng transport1ng Inmate campau to Salem
Hospital. upon arriving at R&D, Salem EMT's continued CPR and at 1615
pronounced Inmate campau deceased. LT. Holcomb then assigned me to
start a crime Scene Log and stay with Inmate campaus body. personal
that arrived at the cr1me scene were the EMT'S, Marion County Medical
Examiner, State police Detective and the DA. Once the State police
released the body, LT. Holcomb instructed me to stay with Inmate
campau until the Funeral Home arrived and took control of the body.
At approximately 2000, the Funeral Home arrived and took control of
Inmate campau's body and exited the facility. End of report.
th~ ~ontrol

STATE OF OREGON
DEPARTMENT OF CORRECTIONS
OREGON STATE PENITENTIARY

To: Whom it May ~)?\]cern

INTEROFFICE MEMO

Date: June 20, 2011

wdffL

From: C/O W. Kohler
Subject: Inmate Campau, Thomas Sid #6298340
On June 19, 2011, at approximately 12:00 p.m., Inmate (lIM) Campau, Thomas Sid #6298340 was
placed in Close Suicide Obscrvation, DSU status due to a previous incident. At approximately 3:30 p.m.
while doiug my checks, I was informed by Nurse Toman that 11M Campau was banging his head on tile
mdiator trying to hurt himself more. I told Nurse Toman to watch him while I call the third shift OIC,
Lt. Holcomb. I explained the situation to Lt. Holcomb and stated he be coming up. Lt. Holcomb was
tallcing to JIM Campau and ordered him to put his smock ou so the nurse could check him out medically.
Inmate Campau was very uncoopcmtivc and would not put on his smock. Lt. Holcomb then told JflVI
Campau to the door so he could put restraints on. Once the restraints were put on, we put JIM Campau
in a wheelchair. Once JIM Campau was in the chair he slumped over and he wasn't moving. Nursc
Toman checked fOl' a pulse and stated he did not have a pulse. Nurse Toman started CPR and I called
Master Control to call 911. Inmate Capau was put on a stretcher and was being escorted to the awaiting
ambulance by medical staff.

STATE OF OREGON
DEPARTMENT OF CORRECTIONS
OREGON STATE PENITENTIARY

INTEROFFICE MEMO

Date: June 19, 2011

To Lt. R. Holcomb OIC III

From: C/O Officer Treide

Subject: Inmate Campau, Thomas

thl)i" 6298340

On the above date at approximately 3:45pm I responded to
infirmary room 6. Inmate Campau, T. sid 6298340 was in
wheelchair outside of the room and unresponsive. Nurse Toman,
nurse Hendricks and nurse Korsnes were all working on him.
Also present was C/O Kohler and Lt. Holcomb. Inmate Campau was
moved from the wheelchair and RN Toman started CPR. RN
Hendricks applied the AED and RN Korsenes assisted.
At approximately 4pm the inmate was transferred to master
Control as 911 had been called. At 4:05pm I put up a crime
tape and at 4:15 secured door 6. The area stayed secured until
released by the State Police and medical examiner.

Respectfully Submitted by

Corrections Officer L. Treide

Oregon State Penitentiary
Memo Regarding Man Down in the Infinnary
To: mc LT. R. Holcomb
From: Travis Toman (Institutional RN)
u,
June, 19 2011

I received report from day shift nurses about inmate Campau, Thomas (SID:
6298340) who was placed on a suicide close observation. At approximately 1430, I
checked on inmate Campau who was alert and responsive and in no apparent distress. He
agreed to allow me to come in and evaluate him. I bad informed Officer Kohler who
could get additional staff to open the door. At approximately 1530, imnate Campau began
hitting his head against the radiator in the room. Infumary officer Kohler called the OlC
to come np and assist placing inmate Campau in a wheelchair that way medical could
evaluate his condition. At approximately 1545, inmate Campau was in the wheelchair and
became unresponsive. I was called to the cell where he was unresponsive and had no
pulse. I began CPR and 911 was called. Nurse Monika and Sandy responded with AED
and man down cart. At approximately 1600 inmate Campau was transported to master
control where Salem EMS and Fire took over care.

O R E G O N ST.A.TE PENDTENTUA.RV

HEALTH

S~R.VOOCES

M~MORANDUM

TO:

OIC

FROM:

Monika Korsnes, RN

DATE:

6/19/2011

SUBJECT:

Man down 11M Campau SIO# 6298340
This afternoon at approximately 1550 I was in the med room
when an orderly informed me that the man down bag was
needed in the infirmary, I took the equipment into the infirmary
where Nurse Toman was performing chest compressions on
11M Carnpau on the ground, Nurse Hendricks and I got the
ambu bag and I assisted Nurse Toman with CPR while Nurse
Hendricks applied the AEO, A stretcher was brought, the 11M
was lifted onto it and we brought him to the hallway behind R&D
where EMS met us and took over care,

STATE OF OREGON
DEPARTMENT OF CORRECTIONS
OREGON STATE PENITENTIARY

DATE:

June 19, 2011

TO:

To Whom It May Concern
Oregon State Penitentiary

FROM:

Sandra Hendricks, RN
Oregon State Penitentiary

SUBJECT:

Campau, Thomas
Sld#6298340

INTEROFFICE MEMO

At approximately 1550 I was called as one of the responders to the infirmary ward. Lying
on the floor on his back, was inmate Campau. Nurse Travis Toman, RN was giving patient chest
compressions. Nurse Monika Korsenes, RN brought the man down bag and was giving air via
ambu bag. I connected the defibrillator and prepared for shock. No shock indicated and patient
was transported to R&D, where emergency team was waiting. CPR was continued during
transportation via gurney to R&D. Dr. Vargo and Ted Randall, Nurse manager was called.

. /I

~C-~"'-~

t;;

~ Sandra Hendrie s, RN

cc:

File

.-/

~/------""--~
/

I:\Q'~pmJ;{B_~Hay1W~~{~J~2'~';'*"';;igiI~,'{iqi'D~'j~~~;s;~'f't.,3~'l,~,;;{~')tJ:;t=;[''i.'2~~~~~6tJc~'i-'c!'\'0

From:
Sent:
To:

Cc:
Subject:

Raths Kelly A
Sunday, June 19, 2011 7:50 PM
Dodson Michelle 0; Buchholz Marshall; Randall Ted R
Holbrook Phillip E; Torres Richard A; Holcomb Randy W
6298340 Campau, Thomas William

As of this writing I have not been able to contact Mr. Campau's mother Dorothy his emergency
contact to inform her of his death late this afternoon. I did speak with a Myra Gilchrist from the
visiting list who informed me that Dorothy and Dolores Lorati (on Campau's visiting list) are
neighbors and close friends. I did not inform Myra of Campau's passing. I have left my personal
cell phone number on both Dorothy and Dolores' voicemails so Dorothy can call me this evening.
I will leave a voicemall on Chaplain Holbrook's work phone this evening informing him if I've
talked to anyone. Holbrook can follow up tomorrow (Monday) as needed.
Thanks
Kelly

osp Health Services
Umlsuail Indolent Nursing Form

For Security Report
"

Date:
. Inmate:

Time:

CCt YY) PCt,V)

'Th())V) CIS

SID #:

/5'15

roz q 83Lf6

The inmate named above was seen by a nurse for examination of possible
.. Medical Issues/( Mental Health Issues 0
Post Altercation 0:
In the Clinic

'(es,)&

No 0

"Tv.,$ ''L1 rr'r/V1(d y

In General Population

Yes 0

No 0

(2.66I'V\

In Special Housing

Yes 0

No 0

Injuries Noted

Yes):(

NoD

Medical Treatment Indicated

Yesli('

No 0

Significant Medical Treatment

Yes)4:

No 0

Requiring Infirmary Core

Yes~

No 0

Requiring Hospitalization

Yes/(

No 0

The following was found:

This form needs to be filled out immediately after an evaluation of an inmate and
provided to the Officer-in-Charge (orC) when Incidents arise, e,g" post altercation, use
of force, death, PREA, medical emergency,

p:osp Fonnsjlnmate

..Jd.- C;

Oregon State Penitentiary

Innrmary Side-Room Check In Log

.SID:/i29:Y3 YcJ
(Circle) Room#: 50(6)

Time
IQO()

<:J.?>e""<IHo7

eve"y . IS-

12../ :)
/2-30

Initials
U?-

Com'rrlents
SVIC.Icl..e.

I

/215'

Pl/'1,

./

fU/

./'

t4V

/

td/'

~

£,VV

13:;'0

../".

t4V
&VV'

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/

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/ '-iao

./

{/II!/

./
/

~

1:300

.,..-

J3/5

Ie/I')
l-/30

/'fii"
1.1(Jo
/Sl:;......
J

..-n

-

r.

Comments

Time

Initials

j/d-/

~

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/'

ut.-/

~.

/~.

",..--

~

,.

,

..

I
. --- .

. _,....

.

..

.'+. --+ .

.........L.._..........

Forward the completed log to Group Lrvmg
The OfficercIn-Charge on each shift is responsible for reviewing the check log during rounds.

. ...

Oregon Department of Corrections
H*Crime Scene Contamination Log***

C)~
\ :['" .;

Crime Scene Security Officer:
Location:

':=I'NS=- G

G

c.X <:......-

Crime:

(

'Ii oC,

Daterrime Log Started: _ _ _ _ _ _--;-

De",:\:~

Co, '1'1\ 'Q<i q \,Th OV\lI ~<;:

s, c\

Victim:

CO 9. '\ "'<b 'S1.:\ 0

,,,*** NOTICE: ALL PERSONS ENTERING CRIME SCENE MUST READ AND SIGN ***,"
Admitting officer will fill out all spaces except the signature of entering person.

Only persons authorized by an Oregon State Police supervisor, 01' detective in charge, shall be
permitted 10 enter Ihe crime scene. Those persons may be required to give hail', jibeI', 01' other
types a/samples.

.",c.•. . "ii ·.• .·.• Tif'fi.·; 1+;;.;;,.;··.··
.•. T .•··• •.••.·•.•. · •. •. • . . .<•. . • •.• .•. •.•.
......F..: ...........
. . ·. ·• •· • · •.·/:.·.·.• TI~nl~.·.·.} • ·. . l·i

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•.• ~.~;on~orlCIIF~ ..·.• ·.• • •. • · ·
••••••••••••••

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.0.,.1/ ell .-it
DI/II((£

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4

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; ; 2///Pu
I

CD 1201 D (1/96)

MARION COUNTY MEDICAL EXAMINER
STATE OF OREGON

MEDICAL EXAMINER DIVISION
DEPARTMENT OF STATE POLlCE
COUNTY:

!r1 04'/~

BY DEPUTY:

0,

[3,ifte>r.,

PLEASE PRINT
Decedent:

1hdyOoS

/JIII,;"tY'>

Marital Status:
Address:

M

S

W

D

20(')5 $T;..i-<:J... Sf. S ..
Street·

5(,

ClftnPAIl
Last

Middle

First

City

"d'.

Age

jij//".i'!:w,.

County

2

td
Se.
o~
State

cA'
state

Died - Found

/tb It; .' ,:: :AM~

I notified: Dr. - Gunson~ewm0Nelson Young Other_ _ _ _ _ __
Reason for transfer to MultilOmah County Morgue:

AI.!, fo/Js<>
F/

.

Next of Kin: _ _ _ _ _ _ _ _ _ _ _ _ _Phone: _ _ _ _ __
Funeral Director:_-,-~--:-----_---------Agency Delivering Rem<lins: .....Aq.wIt!7'M,;].,J!f'.!l"'!..i1..!J'

~

K<:.:;·

_ _ _ _ _ _ _ _ __

When remains can be released, contact: _ _ _ _ _ _ _ _ _ __
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Phone:_ _ _ __

Crime Scene Log
Name

Time In

CTZEECJ-I,,

TeLFl5e,

PALIC

IbiS

Iii;
,

\/"'1$

t ~Zb

ILui':'

I/"Gb

1l,,1.5

\ ("2D

11,,15

I("GO

)1,,1.5

11.o2,D

1["1 S

1(,,20

1[,,15

1t.z.o

S

11,,2..0

\ {.,I

i

StEeLe

I

Dfhll D

Time Out

\111

) fe '3

1(1'1

I~O "\

nJ'1

\ &'Cl "\

\&,Ol"

If$'Od'

1b''Z.q

/q//

Inq

\ ~2_"\

'., .\.

CONFIRMED:

OREGON CORRECTIONS DIVISION
OREGON STATE PENITENTIARY
AUTHORIZA TlON FOR RELEASE
TO:

Communications Center

RE:

Campau, Thomas #6298340

DECEASED

,. 'c·

The above named inmate(s) will be released on -'6'-----'--19'----...!-1-'--1_ _ _ __
Purpose:
Discharge

Transferred

Parole

Detainer

Court

Other

DIED

Will be transported by Alternative Burial and Cremation of Oregon.

Identified by

~//
SUperintendent or De5fgnee

cc: Master Control
InsU. Security Mgr.
Receiving and Discharge
OS? No. 74 (Revised 5-81)

IZ:8 d bl Nnr 1I0Z
CD 7281' (2185)

\'
I

()

~

il .l\
I

L~

:: t.J
L

v

Department of Corrections

Oregon state Penitentiary
Inmate Death Notification Sheet
Date:

~-

ICf ~ I I

Inmate Name:

Time!-0.'/0

Ole:

Ca&tA,fU-'..l-- / 1Junv,.'i <;,

Use Offender Information Screen I
1. Assign staff, Name:
initiate a Crime Scene
2. Preserve all Evidence.

U (-/()r~b

SidUca;:<1?r-5'7i2

Print Public Information Screen.

Contam~nat1on

to secure the scene and

Log.

3. Hitness list (Do not intervie\.T)
Time
Paged:

Name of person
contacted:

'/=C.

0.0.

1?,'~d'"
'I,
<ri,Au.",sc,jL

Time
Contacted:

Conunents:

\ Co~\

Asst. Supt. Security
Yoder

1(0 &L(

14.

superintendent:
J. Premo

I (a;LL-l

Asst. Dir. Inst1tut10ns

WZlA. ~\Y .5LAff'.

Pru"'-O

Superintendent ",111 determine
if additional-notifications
beyond the institution need to
be made.
To be notified before the State
Police are notified.

B. Belleque - Apr, Aug, Dec

M. Gower - Feb Jun Oct
Ill. H<>efel
Jan Hay Se '7
ti. Blacketter
Mar, JUL,
Nov

/(030

Unusual Incident Briefing
No
Summary Requested; Yes

-

-

Notify for attempted suicide

P. I.O.
lHchelle Dodson

IG'3o-

state Police

\ G3 \
DOC. Comm. l-1anager:

513tcuJ::..

110 3b

IloLl to

t

(t~

""

Medical Examiner:

!G3 c

Case U

II ~aLl 'S't1 \

After hours call home first
Unusual Incident Briefing
Summary Requested: Yes No-

CTS Manager
Brian \'lalker

Suicide

Health Services:
T. Randall

Notify for ~nmate med~cal
transport after normal business
hours

t~~~

Chaplain/Next of Kin:

Ih!30

Funeral Home Duty Call Calendar
Alternative Burial and cremation of Oregon, Sherwood, Or. 503-925-B6B5

Person Contacted:

Completed

~a,~~~/

By:~/d
~4\h~~
,
"

Time:

/ffl-fl