OREGON DEPARTMENT OF CORRECTIONS
Unusual Incident Report

Referred to State Police:

IZlYes

DNo

State Police Case #: -=-:10"-'0"'6-'--.79::.;7"'5_ _-'---_ _ _ _ _ _ _ _ _ _ _ _ __
Location'.

Other
"

,
,

211911

Time:

5 :00 - 6:00 a.m_

Medical Attention Required:

Functional UnitlInstitution'
I
"
Type ofIncident - Critical Indicators Involved
Use of Force

<SpecifY>

Inmate Assault

<SpecifY>

Escape

<SpecifY>

Contraband

<SpecifY>

Inmate Death

Unknown

Property

<SpecifY>

Medical Emergency

<SpecifY>

Emergency

<SpecifY>

Selflnjury

<SpecifY>

<SpecifY>

(OR)

Attempted Suicide

<SpecifY>

EmployeeNolunteer/
Contractor/Citizen

Blood and/or Bodily Fluid

<SpecifY>

Other:

1. Inmates Involved: (Attach facesheet(s) for all offenders listed).
,
Projected
,
Name(s)
SIQ#
Release Date

1. Hill, Michael R

'.

12996424

03/30/2011

OSP

<SpecifY>

2. E mployee, VI
o unteer, C ontractor, or C'
itlzen I nvo Ived :
,
Contact
Work
j\[ame(s) "
Location
Information
','

I. N/A

2.

2.

3.

3.

4.

4.

5.

5.

Page 1 of3

DNo

,

"

,'",

IZlYes

<SpecifY>

Staff Assault

Type of Force Used:

°

Date:

CD 115 (08/05)

3. Incident: Describe Incident in detail: (Times, dates, locations, weapons involved, sequence of events, inmates/staff involved, etc. For escapes only:
include a detailed description of the inmate(s); heiaht, weight, color of hairIe yes, clothina last worn, and other significant info.
On 2119/2009 I was assigned to Salem Hospital Watch I" Shift Room B5134 housing solely Inmate Michael Hill SID#12996424. Thoughtout the night
Inmate Hill had a distin~tive breathing pattern that could be heard from several feet away. At approximately 5:05 I noticed his breathing had changed, His
breathing had a distinctive gasping sound that I could no longer hear. I could not tell visually if Inmate Hill was breathing so l immediately notified RN Kellie
Lombardi who had been sitting rigbt outside the door to come in and examine inmate Hill immediately. She entered the room and examined him. She stated
she could not tell ifhis heart had stopped and had to get her stethescope. She returned with RN Cheryl McINtosh, RN Joey Dixon to examine Inmate HilL I
contacted OIC LT James Taylor to advise him ofthe incidents taking place and while on the phone with LT Taylor the nurses pronounced Inmate Hill dead. I
let LT Taylor know this .as-and he contacted the§tat9cl~0Iice. I advised the nurses in the room that this was now declared a crim~ scene and started my log
accordingly letting them know that no one is to enter the room without being written in my log going forward to keep the area stjcured. [ continued the Log
and was relieved by CO J Stephenson at approximately 7:40. The Body was examined and released by Detective Scott Yunker at 8:50AM.

4.
Information:
After nursing staff had pronounced him dead, the nurses
to remove
see
him". I instructed them to back away from the bed and [eave all items alone as this has to be a secured crime scene for the State Police to inspect undisturbed.

Misconduct Issued? DYes
5.

I8lNo

Communicated To'
Name

'Title

Date

Time

"

II .' , .

.

',,'1

"

Title

Name

. Date,
,
'

')fime

I .Amy Pinkley-Wernz

O.D.

2-19·10

0537

6.Medical Examiner

N/A

2-19-10

2.M.Yoder

Ass!.
Supt. Sec.

2-[9-10

0519

7.Ted Randall

Healtll
Services

2-19-10

0655

3.J eff Premo

Supt.

2-19-10

0533

8.Funeral Home Peggy at Salem
Hospital Bed Control

2-19-10

0859

4.Michele Dodsonr

PIa

2-19-10

0529

9.

5.State Police

0525

2-19-[0

.

10.

6. Report Completed By:

o Taro, CO asp
Print Full Name

Page 2 of3

Officer
Title

asp
Functional Unit

CD 115 (08/05)

OPS501I
SHEDDR

Corrections Information Systems
Offender Public Information

8:52:17
2/19/10

Offender .. 12996424 HILL, MICHAEL RAY
Location .. asp
OREGON STATE PENITENTIARY
Age
Sex
Height
Weight

30
Male
5'11"
170lbs

DOB
1/23/1980
Race WHITE
Hair BROWN
Eyes BROWN

Caseload 00109 KAREN FRANKE
Classification 2
Court Case
Cnty ORS Abbrev
230721945/01 LANE POSS METH
200900059/01 LANE ASSA OFFI
200900059/04 LANE POSS METH

status. Inmate (MEDI)
Cell.
DOC cycles. 02-02-02
DNA Collected
Inst admission date ... 12/03/2009
Earliest release date. 03/30/2011

*DESIGNATOR*

503-378-2213
CIs
CF
CF
CF

Type Begin Date
PROB 9/09/2008
I
12/03/2009
I
12/03/2009

Yrs-Mos-Days Term Date & Code
000-018-000
000-024-000
000-000-060
Bottom

F3=Exit
F11=Menu bar

F4=Prompt
F12=Cancel

F5=Refresh
F6=PTA Caseload
F17=All offenses

F9=Retrieve

Oregon Department of Corrections (ODOC)
Offender Information System (OIS) Report
Produced by STEPPK 02/19/201005:19:28 AM

Mission: To promote public safety
by holding offenders accountable
for their actions and reducing the
risk of future criminal behavior

Public Information

~/

T=,. '
i

A Public Records request is REQUIRED for releasing information outside the Public Information box.
Offender Name:
Age;

30

Sex:

Male

OREGON STATE PENITENTIARY

Hill. MICHAEL RAY
DOB:
01/2311980

Height: 5' 11"
Weight: 170

Race:

White

Hair:
Eyes:

Brown
Brown

Caseload:00109 KAREN FRANKE

Location: Cell:

503-378-2213

SID: 12996424

Docket
Number

County of

Conviction

Status: Inmate(MEDI)

Fla9: Detainer

Custody Cycle:
Institution Admission Date

DNA Collected
2·2-2
12103/2009

Earliest Release Date:

0313012011

Classification:

2

Crime

Crime

Class

Sentence
Type

Begin

Sentence

Date

Length

Termination
Date

Termination
Reason

230721945101

LANE

POSSESS METH

CF

Probation

09/0912008

000-018-000

200900059102

LANE

ASSAULT IV

AM

Probation

0212712009

000-036-000

1113012009

CRTR

200900059103

LANE

RESIST ARREST

AM

Probation

0212712009

000-036-000

1113012009

CRTR

200900059105

LANE

RESTRICTED WEAPON{)(CON POSSESS

AM

Probation

0212712009

000-036-000 .

1113012009

CRTR

200900059106

LANE

BURGLARY TOOLS - POSSESSION OF

AM

Probation

0212712009

000-036-000

1113012009

CRTR

200900059101

LANE

ASSAULT PUBLIC SAFETY OFFICER

CF

Inmate

1210312009

000-024-000

200900059104

LANE

POSSESS METH

CF

Inmate

12103/2009

000-000-060

-Visitors
Visitor Name

Visitor Age

ViSitor Type

Relationship

Visitor Status

BANKS. BRYAN JAY

48

Privileged

Step Fth

Approved

FAUGHT. TAMARA SHANNON

29

Privileged

Friend

Approved

Hill. WILMA ANN

52

Privileged

Mother

Approved

Page 1 of 1

.

Offender SID: 12996424 Name: HILL, MICHAEL RAY

Confidenti.llity Notice: This document eontairls information belonging te the Department of COlleciiom:;. Thi~ jnformation may be confidential, fcstridcd, rind/or \ogolly privilegod, and b intended for oppropriate and npprovcd usc undor existing deportment rur~,
regulations, ccnfirlenliaUty and security agreemenl!i.. !f you haw received !his document In error, preosc notify DOC immediately, keep the contenls confidential, ;Jnd promptly dcstroy the info;'J"fi;l\ion and/erdclele Ille document information from your c:ompUier :lystem,

Department of Corrections

Oregon State Penitentiary

Date:;c?

:kIJ j20?()

Inmate Name:

0u

I

Inmate Death Notification Sheet

()<rJO

Time:

OIC:

Mrdae-f

Lt . ..::J. !tt<.-! loy

Sid#

12?'1&t!;t.Y

Use Offender Information Screen, Print Public Ipforrnation Screen.
1. Assign staff, Name:

~ '1),

initiate a Crime Seers

'!lr1-0

Contam1nat~on.Log.

to secure the scene and

2. Preserve all Evidence.

3. Witness list (Do not interview)
Name of person

Time
Paged:

Time
Contaoted:

Conunents:

contacted:

b.r31
f

,

Asst. Supt. Security
M. Yoder
Super!n tendent:
J. Premo

Superintendent will determine
if additional notifications
beyond the institution need to
be made.

Asst. D1r.

To be notified before the State
Police are notified.

Inst1tut~ons

B. Belleque - Jan l May, Sap

. M .. ~ -

Feb, Jun, Oct

"B;'Hoefel - Mar I Jul, Nov

S. Blacketter - Apr l Aug,

08Sl

Unusual Incident Briefing
Summary Requested: Yes __ No__

Dec

Notify for attempted suicide

P. I.O.
Michelle Dodson

State Police
'After hours call horne first
Unusual Incident Briefing
Summary Requested: Yes
No

,.,DOC. Carnm. Manager:

Medical Examiner:

0531-

CTS Manager
Brian Walker

Suicide

Health Services:
T. Randall

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

OiP56

Chaplain/Next of Kin:

Funeral Home Duty Call Calendar
Alternative Burial and Cremation of Oregon, Sherwood, Or. 503-925-8685

Person

Time:

08C]1

Oregon Department of Corrections

*** Crime Scene Contamination Log ***

,~

Crime Scene Security Sfficer:
"

]bIOI

Location:

2Jx11lO

Co:))To(.20

.:::.>{\ \eu\

1100'ijil±al' Crime:

Date/Tlme Log Star,l:ed:
~ J. 1J,\c,Me,1 HdI
,
Lr'lY!gr(!; ,\')fain
Victim:. tv\. ,

\1d,\

A

:S I d it- I N. ~ (p;..fCl'" \

MMM NOTICE: All Persons Entering Crime Scene Must Read and Sign MMM

Admitting officer will fill out all spaces except the signature of entering person.
Only persons authorized by an Oregon State Police supervisor or detective In charge shall be
permitted to enter the crime scene. Those persons may be required to give hair- fiber- or
other types of samples.

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