OREGON DEPARTMENT OF CORRECTIONS
Unusual Incident Report
UIR#:

Referred to State Police:

!8JYes

ONo

State Police Case #: ----'..:10:..:1'-'-9-=-8=-58::..:1'-----_ __ __ _ __ _ _ __ _ _ __ _
Location'

Date:

5/2811 0

Time:

8:00 - 9:00 a.m .

Medical Attention Required:

Functional U nitlInstitution'.
Type of Incident - Critical Indicators Involved

Other

Staff Assault

<Specify>

Inmate Assault

<Specify>

Escape

<Specify>

Contraband

<Specify>

Inmate Death

Apparent Natural Cause

Property

<Specify>

Medical Emergency

<Specify>

Emergency

<Specify>

Selflnjury

<Specify>

<Specify>

(OR)

Use of Force
Type of Force Used:

Attempted Suicide

<Specify>

EmployeeNolunteerl
Contractor/Citizen

Blood andlor Bodily Fluid

<Specify>

Other:

3418480

03-16-20 II

ascI

<Specify>
<Specify>

I.

2.

2.

3.

3.

4.

4.

s.

s.

Page I of2

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2. E mp1oyee, Vo Iun t eer, C on t rae t or, or etiz
I
I ed :
en I DVOV
Work
Contact
Name(s)
Location
Information

1 Inmates Involved ' (Attach facesheet(s) for all offenders listed)
Projected
Name(s)
SID#
Release Date
I. Ankney, Bruce

!8JYes

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); height, weight, color ofhair/~s, clothiJ!glast worn, and other si""ificant info.
On 05-19-20 I 0 Inmate Ankney, Bruce #3418480 was admitted to Salem Memorial Hospital (SMH) for treatment of an ongoing medical condition. On 05-2810 at approximately 8:59AM, Inmate Ankney expired from natural causes under the care SMH. The site and body was secured as a crime scene until it was
processed by the Medical Examiner and then released by the Oregon State Police at 10:30AM. Custody ofInmate Ankney transferred to Alternative Burial
Services at 1:30PM.

4. Specific Information: (Personal injury. property damage. notification of kin),
Notification ofkin was completed by W. Hatfield (PIO).

Misconduct Issued? DYes

IZINo

5. Communicated To'.
Name

Title

Date

Time

Name

1. R. Briones

OD

05-28-10

6.

2. B. Kelly

ISM

05-28-10

7.

3. W. Hatfield

PIO

05-28-10

8.

4. B. Belleque

DOME

05-28-10

9.

5. A. Parker

HIS

05-28-10

10.

Title

Date

Time

6. Report Completed By:
David T. Beal
Print Full Name

Signature

Page 2 of2

a

Lieutenant
Title

OSCI
Functional Unit

05-28-2010
Date

CD 115 (08/05)

Oregon Department of Corrections (ODOC)
Offender Information System (OIS) Report
Produced by BEALD OS/28/2010 09:12:15 AM

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

Public Information
A Public Records request is REQUIRED for releasing information outside the Public Information box .
.:...~

~.J~

!' ~'j

Offender Name:

Age:

60

Sex:

Male

ANKNEY, BRUCE W
08/11/1949
OOB:

Height: 6' 02"
Weight: 228

Race:

White

Hair:
Eyes:

Brown
Blue

Caseload:00300 DAVENPORT, TRISH

SID: 3418480

Docket
Number

10C40662101

Page 1 of 1

County of
Conviction

MARl

OREGON STATE CORRECTIONAL
INSTITUTION
Location: Cell:
Flag: DetaineriNotiiier
Status: Inmate(MEDI)
Custody Cycle:

DNA Collected
5-1-2

Institution Admission Date

03/18/2010

Earliest Release Date:

03/161201 1

Classification:

2

Crime
Class

Crime

IDENTITY THEFT

CF

Sentence
Type
Inmate

Begin
Date
03/1812010

Sentence
Length

Termination
Date

Termination
Reason

000-019-000

Offender SID: 3418480 Name: ANKNEY, BRUCE W

Confidentiality Notice: This document conl3ins If'Iformalion beJonging 10 the Department of Corrections. This infoonation may be confidential, restricted, and/or Jeg:lDy privileged, and is Intended for appropri3te 3nd approved usc under existing department rules,
regul:ltlOf'lS, conftdonti.:llity :lnd security agreements. If you have rece.ved thIS document in error, please notlfy DOC immediately. keep the contents confidential. :lnd promptly destroy the Inform:ltion and/or delete the document information from your computer system.

VIR Check List
This form is to be used to assist you in the reviewing process and to insure complete
UIR documents are submitted.

YES

Use this form to look for and check off documents that may apply.
Face Sheet with Inmate Photo

NO

N /A

X

Use of Force - Preliminary Review Summary (CD 1346)

X

Inmate Assault on Staff- Preliminary Review Summary (CD 1397)

X

Misconduct Report (CD 293D)

X

Supportive Misconduct or Incident Memos (CD 787D)

X

Staff Memos (Witness or participant to incident.)
I.
2.

3.

4.
5.
6.
7.
8.
Employeel Volunteer Report of Incident, Neal' Miss, Injury, Illness (CD 1381)

X

OSCI - UIR Cost itemization Attachmenl (CD liS)

X

Chemical Deployment Form (CD 143S)

X

Body Fluid Spill Report
X

Altercation/lnjury Medical Rep0l1s

X

Photographs

X

Video (2 Copies)

X

Incident Notification Worksheet (Do not attach to VIR packet)

X

REVIEW Pj1.0CESS

Officer of Ihe Day
Institution Security Manager

It

Name:
A
R. Briones h V
B. Kelly { 'f]1!f\

Assistant Superintendent

General Services
Superintendent

G. Kilmer

v

~~

/

Date:
(Q_ / ~ /U

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