OREGON DEPARTMENT OF CORRECTIONS

Unusual Incident Report

(J5 f20l!

UIR#:

050DOl)i

Referred to State Police:

\ZlYes

DNo

State Police Case #: _-1"'1"'1:..:7:..:1"'06"'8"-,-_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Location:

Date:

5/1\/1\

Time:

<Specify>

Medical Attention Required:

Other

Functioual Unitllustitution:

<Specify>

Inmate Assault

<Specify>

Escape

<Specify>

Contraband

<Specify>

Inmate Death

Apparent Natural Cause

Property

<Specify>

Medical Emergency

<Specify>

Emergency

<Specify>

Self Injury

<Specify>

<Specify>

(OR)

Type of Force Used:

Attempted Suicide

<Specify>

EmployeeN 0 lunteer!
Contractor/Citizen

Blood andlor Bodily Fluid

<Specify>

Other:

DNo

oSP

<Specify>

Staff Assault

,Use of Force

DYes

<Specify>

1. Inmates Involved:

1. Dement, Ellis

6365485

04-12-15

L

2.

2.

3.

3.

4.

4.

5.

5.

Page 1 of2

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 of hair/eyes, clothing last worn, and other significant info.
On May II, 20 1 I Inmate Dement was at Salem Hosptital room ICU 4008 having been admitted on May 10, 20 II. At II :20 a.m., Officer Larry Contreras
called to inform me that inmate Dement had just passed away from apparent natural causes.

4. Specific Information: (Personal iniurv, propertv dama,ae, notification of kin).
Mr. Ted Randall Health Services Manager made the following next of kin notifications: 11 :41 a.m., Michael Dement (brother), Katherine McBride (fiancee').

Misconduct Issued? DYes

(giNo

5.
"'I,

"-i'

I.Mr. Boudrou

OSPOD

5-11·11

1138

6.Mr. B. Walker

CTS

5·11-11

1220

2.Mr. Yoder, M.

Asst Sup

5-11-11

1147

7.Mr. T. Randall

Med Ser

5-11-11

1141

3.Ms. Dodson, M.

PIa

5-11-11

1141

8.Asst. Director Institutions (E-Mail)

5-11·11

1204

4.Brandy, State Police

5-11-11

1134

9.Mr. J. Premo

5-11-11

1225

5.Medical Examiner

5-11-11

1207

10.

Supt.

6. Report Completed By:
T.Brown
Print Full Name

w.z----T7-1Page 2 of2

Captain, orc II

asp

ntle

Functional Unit

May 11,2011
Date

CD 115 (08/05)

OPS501I
BROWNTE

Corrections Information Systems

12: 11: 41
5/11/11

Offender Public Information

Offender .. 6365485 DEMENT, ELLIS GENE
Location .. OSP
OREGON STATE PENITENTIARY
Age
Sex
Height
Weight

63
Male
6'01"
1901bs

DOB
9/04/1947
Race WHITE
Hair BROWN
Eyes BLUE

Case load 00107 EDSALL, RON
Classification 3
Court Case
Cnty ORS Abbrev
CR0900293/02 CLAC RAPE III
CR0900293/06 CLAC SODO III
CR0900293/07 CLAC SODO III
CR0900293/11 CLAC SEXAB2 N
CR0900293/13 CLAC SEXAB2 N
F3=Exit
F11=Menu bar

F4=Prompt
F12=Cancel

Status. Inmate (MEDI)
Cell.
DOC cycles. 02-01-06
DNA Collected
Inst admission date ... 09/17/2009
Earliest release date. 04/12/2015

503-378-2319

Cls
CF
CF
CF
CF
CF

Type Begin Date
9/17/2009
I
I
9/17/2009
I
9/17/2009
9/17/2009
I
9/17/2009
I

*DESIGNATOR*

Yrs-Mos-Days Term Date & Code
000-024-000
000-030-000
000-022-000
000-036-000
000-036-000

F5=Refresh
F6=PTA Caseload
F17=All offenses

More ...
F9=Retrieve

Department of Corrections

Oregon State Penitentiary

_I I
Date,';;-/u ILl
7 7

Inmate Death Notification Sheet

11'2-0

Time:

OIC:

vemeYlt £../(,$

Inmate Name:

Cfl, 15\",0"1

Sid!'

fo3~SfJ0

Use Offender Information Screen, Print Public Information Screen.

Assign staff, Name,

1,

initiate a Crime Scene Contarn~nation Log,
2. Preserve all Evidence.

to secure the scene and

3, l'Iitness list (Do not interviel,j)
Time

paged,

Name of person
contacted:

O,D,

<6oLJ{keqv

1;2'2'6

Asst. Supt. security
14. Yoder

Wi3
(;)Itf

Superintendent:

J. Premo

D~r.

IIlst~tU1:.~ons

• GO~ler -

Feb, Jun I

f /'-11

\~
(ZOL(

B. Belleque - Apr, Aug l Dec
l~

Comments:

{\ 32

'tflCl

Asst.

Time
contacted:

V'C1..
tfr'Y1<HI

Oct

B. Hoefel - Jan, May, Sep
S, Blacketter - Mar, Jul,

fe'

f-'I'1-1'l'1OJ[lo'f','ry lM£ ID(~(" ,'Y!.y,~ "-7

1",$'/¥vc17.

'W

IY/"-~ 1Wf,'A"~1?tn.I$

tc- Cu<fra( OfR"e;e

V'lq

£iN/., (

Superintendent 1'1111 determine
if additional notifications
beyond the ~+~~tution need to
be made. fI 0 I' 'T~C\

To be notified before the state
Police are notified.
Unusual Incident Briefing
Summary Requested: Yes __ No __

Nov

Notify for attempted suicide

P. I.O.
1·1ichelle Dodson
state Police

t \ tt(

'B Ca.

~

II '3L{

i~

DOC. Camm. Manager:

~h"7
}'1edical Examiner:

IISS
I?--I ~

CTS Manager
Brian Nalker
Health Services:

T. Randall

Chaplain/Next of Kin:

I~
Ida. 6'tY\Qi!
\'2'<)(

ld-dD
11'-+ (

ro{ ~l{ ;>ivNJ€ &!(1'tW1-cdI:'(' '7),~ ••

uSeJ. (ll ",.--~,,",n 9i.l.i"'t /f,sfct4l1;; '(
Case H

1/-niOG:Sf

Sq{<t4' Oil'it,,'/-eli

. 1161

After hours call home first
Unusual Incident Briefing
Summary Requested: Yes
No
Ct.ettf\£;~{~

l--e~,"

M,E, w'/{ iW-r t>e

{ 'b

fbor<\

Sbiciae

Notify for

~nmate

med~caL

transport aiter normal business

hours?~ lJo ""'11, ak~"\ <t WMe..

,

I

Funeral Home Duty Call Calendar
Alternative Buria.1 and cremation of Oregon, Sherwood, or.- 503-925-8685

Person

contacted:~·q£n~

\(Ab\;~

n( -

.,

.

Completed By:

{'- .\\Ctv~~C,2,
qV'\\' (7'VY/
'-1'

&,<H' {'J.

'f<o eWlu«Lou

f\e1Yli

Time:

!:J?-'2

O R E G O N STATE PENITENTDA.RV

TO:

OIG

FROM:

Ted Randall, Medical Services Manager

DATE:

05/11/2011

SUBJECT:

Notification of Death, Dement, Ellis G. #6365485

Received notification of Denth ofInmate Dememt, Ellis G. SID # 6365485 approximately 11 :40 am on
this date.
Placed phone call to Michael Dement (son) immediately upon notification.
Fiancee' (Katherine Me Bride) called back at 1 pm and was informed and directed to Supts. Office fol'

further direction.

Department of Corrections

Oregon State Penitentiary

_I I

Date:

Inmate Death Notification Sheet

S/u III

1120
OIC: ('pl. g'f!),JVl
7 ( '

Inmate Name:

Time:

velY\eVlt

S/(iS

Sidlf

b3t.SrsS

Use Offender Information Screen, Print publio Information Screen.
1. Assi~n staff, Name: -=-=-=-n-=-=~~~~~~~-------- to secure the scene and
inltiate a Crime Scene Contam1nat~on Log.
2. Preserve all Evidence.
3. \-Utness list (Do not interview)

Time

Name of person
contacted:
0,0.

Paged:

«70 LlGke«v

{\ 32
/)2'6

'{f)Cl
Asst. supt. Security
Yoder

IH3

Superintendent:
J, Premo
D~r.

Conunents:

fer

/1'11 *'

(fM\1O) [lot-.

/VI $'lv'v

H,

Asst.

Time
Contacted:

(J-I'1-

Instl.tutlons

\~
120'-{
v,e,
,GiYl,,,1

B. Belleque - Apr, Aug, Dec
z..t. Gm'ler - Feb, Jun, oct
B. Hoefel - Jan, May, Sep
S. Blacketter - Marl Jul l
Nov

fir llVtf ,fur~r I\Y/<f.~ ~

c'f'5 -I!?-'Yl';'k /'1hl-/Ff6\..~~..s
e;e V'''( £i.;va, (

U~{

om

Superintendent \'dll determine

if additional notifications

beyond th~;.rr~tutiQn need to
be made,
l
~~C\

n

To be notified before the State
Police are notified.
Unusual Incident Briefing
Summary Requestedt Yes __ No __
Notify for attempted suicide

P,I.O,
l-lichelle Dodson

t \ qf

state Police Bnt~~

)/'3L/
{~

DOC. Comm. Manager:

1I,"a. 6')'Y\Q (\
Medical Examiner:

I/Sb
I)-I (p

CTS Manager
Br ian ~lalker
Health Services:
T. Randall

CbaPlaiA'~+k of Kin:

1'2.1(),(

id-J-O
114-1

'(eJ! ~W rlvJ~..e a!(1'~-e( '»,e~' .
1\ewl'
i>o tVl")u,e.. Ov
&.tl.,.~ t>
i.{S,J (ll ..-'\{..e.,n 9z41-Yl f69Pda./";
Case ft
9z «t~' OtlW<-kll

l/-l71 6G2

I{~

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

Ct--rt~D.,-t;J M.e) w.1f JL<>t--be

,--e . '1&'-

'To 100 "'-

Stdclae

NotHy tor

~nmate

rnecfwal

tran~~rt a~ter normal business

hours

B<' 1)0

';!<lv>,

"lreoJ."I

I

!3YJ

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

1lJ.: Ka[\~
rn(\~-:C;;

Person contacted:Sc

Completed By:

'-1f

Time:

IJ-?-'),

It WM'e.

. Oregon State Penitentiary
Department of Corrections
Date:

May J I, 201l

To:

Cpt. Brown, 2

From:

C/O Contreras

Subject:

Death oflnma e Ellis Gene Dement, SID# 6365485

nd

Sh_~~5-;J ~/
C" ,

V

On Wednesday, May 12, 2011, I was assigned as the hospital watch officer for Inmate
Dement. Inmate Dement was located at Salem Memorial Hospital, Room 4008, in the A
Building.
At 10:38 am, I was notified by the attending nurse, Becky Cool, that Inmate Dement had
only hours left to live. I notified Captain Brown oflnmate Dement's condition.
At 11 :20 am, Inmate Dement expired. Three nurse were in attendance at the time; Becky
Cool, Dorothy VanHess, and Danyelle Ness. Captain Brown was notified of Inmate
Dement's demise. I spoke with Cpl. Panther who inf01111ed me that he had arranged for
Inmate Dement's remains to be picked up by Alternative Burials & Cremation of Oregon.
At 12:42 pm, Oregon State Police detective Sarah Kelly and her assistant Kristina
Manley arrived and assumed control of Inmate Dement. After reviewing and
photographing the body, Detective Kelly called the District Attorney's office and
received clearance for Inmate Dement at 1:10 pm.
At 3 :35 pm, Mr. Mike Tissel from Alternate Burials arrived. I assisted him with loading
Imnate Dement on his gurney and proceeded back to the Oregon State Penitentiary.
End of Report

CONFIRMED:

OREGON CORRECTIONS DIVISION
OREGON STATE PENITENTIARY
AUTHORIZATION FOR RELEASE

TO:

Communications Center

RE:

DElviENT, ELLIS GENE 6365485

The above named inmate(s) will be released on -,5~a"1,...a,,,-1_ _ _ __
at 1310
Purpose:
nj"rh:1rO"P

Parole

Detainer

Court

Other

DIED

Will be transported by ALTERNATIVE BURIAL & CREMATION OF OREGON

Sigruum" of Person Re.:eiviu!! llUmt.:

:cac
~'C

Mil.'l[.'r O1ntrol
hmi.St.."uril\':"lgr.
R~.;ning J.nd [)j>~hlll:C

usp No. 74(lt1!\i!~tl5-81
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