OREGON DEPARTMENT OF CORRECTIONS
Unusual Incident Report

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Referred to State Police:

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State Police Case #: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Referred to SIU:

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October 12, 2010

Time:

9:42 AM

Medical Attention Required:

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Functional Unit/lnstitution:

~. Location:
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Date:

:e"o(!IDcident,~i'entidilllid'lditors.tnyolved'

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Oreuon State Penitentiary

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;-:,(_!:(,:_,!t!:!_!:::i:l:!;~:!

Use afForce

Staff Assault

Type of Force Used:

Inmate Assault

Contraband

Escape

Property

Apparent Natural Cause

Inmate Death
Medical Emergency

Emergency

SelfInjury

Attempted Suicide

EmpJoyeeNolunteer/
Contractor/Citizen

Blood andlor Bodily Fluid

Other:

(OR)

1. Inmates Involved: (Attach facesheet(s) for all offenders listed).

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1. Herman, Robert Eugene

17668542

05/07/21

1.

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); heicrht, weicrht, color of hair/eyes, c1othini! last worn, and other si!lJlificant info.
At approximately 0942, while assigned to the infirmary, nurse Kathleen Walker notified me that hospice patient, inmate Herman, Robert 17668542 was
deceased. The OIC, Lt. Redding was notified at approximately 0942. The state police and medical examiner arrived in the infirmary at 0945. At
approxiamtely 1000 Mr. Petty from the funeral home arrived. The state police and medical examiner released the body at approximately 1005. Mr. Petty and
the state police left the infirmary with the body at approximately 1008.

4. Specific Information: (personal iniury, property damage, notification of kin).

Misconductlssued? DYes

5

~No

Communicated To'.

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. ,.Date.:
1me'

'.:Date .'

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: Ime

OD

10112/10

0955

6.state Police

10/12/10

0945

2.M. Yoder

Asst. Sup

10/12110

0950

7.Doc cornm Manager

10112110

0956

3.J. Premo

Supt

10/12f10

0949

8.l'I1E

10112110

0945

4.M. Gower

Asst. Dir

10112/10

0949

9.TRandall

10/12110

0941

5.M. Dodson

PlO

10112110

0956

10.Chaplain

10/12/10

0957

"., ',:.Name"
I.S. Mitchell

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Name

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InfMgr

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6. Report Completed By:
R. Shedd
Print Full Name

~
Signature

Page 2 of2

c/o
Title

OSP
Functional Unit

10/12/2010
Date

CD 115 (08/05)

OPS501I
SHEDDR

corrections Information Systems
Offender Public Information

11:11:05
10/12/10

Offender .. 17668542 HERMAN, ROBERT EUGENE
Location .. OSP
OREGON STATE PENITENTIARY
Age
Sex
Height
Weight

80
Male
6'

165lbs

DOB
8/28/1930
Race WHITE
Hair GREY
Eyes BROWN

Case load 00107 EDSALL, RON
Classification 4
Court Case
Cnty ORS Abbrev
08C51354/03 MARl SEXABI N
08C51354/04 MARl SEXAB1 N
08C51354/05 MARl SEXABI N
08C51354/06 MARl SEXABI N
08C51354/07 MARl SEXABI N
F3=Exit
Fll=Menu bar

F4=Prompt
F12=Cancel

Status. Inmate
Cell. IN-4
DOC cycles. 01-01-03
DNA Collected
lnst admission date ... 01/27/2009
Earliest release date. 05/07/2021

503-378-2319

*DESlGNATOR*

Yrs-Mos-Days Term Date & Code
000-075-000
000-075-000
000-075-000
000-075-000
000-075-000
More ...
F9=Retrieve
F5=Refresh
F6=PTA Caseload
F17=All offenses
CIs
BF
BF
BF
BF
BF

Type Begin Date
I
1/27/2009
I
1/27/2009
I
1/27/2009
I
1/27/2009
I
1/27/2009

INTEROFFICE MEMO
STATE OF OREGON
DEPARTMENT OF CORRECTIONS

Date: October 12, 2010
To: J. Premo, Superinteudaut
From: C/O T. Boughton BPSST#28468
SUbject: Inmate Death, 11M Herman Robert SID# 17668542
On the above date at approximately 9:45AM I was instrllcted by the Officer III Charge, Lt.
Reding, to report to the Infirmary due to an iumate death. When I arrived I assumed duties
as the Crime Scene Officer until the hody was released hy the Medical Examiner at
approximately 10:08AM.

asp Health Services
Unusual Incident Nursing Form
for Security Report

Date:

lIERMAN, ROBERT E.

Time:

Inmate:

17668542
08/28/30

SID #:

DqLJ

I

----------------

The Inmate named above was seen by a nurse for examination of possible injuries:
In the Clinic

Ye~

No D

In General Population

Yes D

No D

In Segregation

Yes D

No D

No Injuries Noted

YesD

No D

Minor Injuries
(No medical treatment indicated)

Yes D

No D

Minor Injuries Requiring Treatment

Yes D

No D

Significant Injures Treated in Clinic

Yes D

No D

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The following was found:

Significant Injuries
~o D
(Requiring Iiospitaliziltion-) D~~,,»e .... \-

Medical Staff Name£ IA.Jo.-I ,l(.e..l<!..

This form needs to be filled out Immediately after an evaluation of an inmate and
provided to the Officer-In-Charge (Ole) when incidents arise, e.g., post altercation, use
of force, death, PREA, medical emergency.

p:osp Forms/Inmate

Depar1lment of Corrections

Oregon State

~enitentiary

Inmate D1eath Nctification. Sheet

10

Date:

~ 112

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Inmate Name'

Time:

#btI /'iJ"..-IrfJ I ,

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LT 6. RiPD)";'C,

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Use Offender Information Scree n, Print public Inior.mation SCIeen.
Assign staff, Name:

1,

initiate a Crime Scans.

2, Preserve all
3, Witness ~i:3t

1",;0 p~aln1n

Evidence.
(Do not inter" ~ew)
Ti e
P"g d:

Nam" of pe:reon
contacted:
0,0,

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Superintendent:
Premo

Superintendent will determine
if additional notifications
beyond the institution need to

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be made.

InStl. tut~ona

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JM 1

tio ~

M. Gower - Feb, Jnn, Qot
US!e'1 ~t).ll Sef!' .
II Bee£e:l;
S
PlasJ~ett:&;C'
hpr, hug, ~

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Comments:

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J,

D~r,

Time
Contacted:

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1\sst. Supt, Security
N, Yode:r

As"t,

tc secure the scene a.nd

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S, A,,,- rr;C1ffr..L
ST"

.. uon .... og.

To be notified before the state
Police a:re notified,

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Unusual Incident Briefing
Summary Requested: Yes
No

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Notify for attempted suicide
p, I .0.

Michelle Dodson

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State Police

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DOC.

Corom. Manager:

ty/d

Medical Examiner:

'<)'17771

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

Suicide

Health Services;

(J'N/

T, ~all

Ohapl~~0.$l.t

of l\in!

Notuy ~or l;mnate m.. o;.c,,~
transport after normal business
hout's

01)7

Funeral Home Duty Call Calendar

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Cas .. 4t Ii}

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CTS Manager
Brian Wa~kBr

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Alternative Burial and C:rematiQn of Oregon, Shel:wood, Or, 503-925-8685
~erson

Time:

Contaoted:

Completed 13y:

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Oregon Department of Corrections
···Crime Scene Contamination Log*""
Crime Scene Security Officer:

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Location:

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Log Started:

Crime.

Victim:

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l-Ie"""",!>

I Rober-T
1:t \7&/::,13542
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 supervisal', 01' detective in charge, shall be
permitted 10 enter the crime scene. Those persons may be required to give hail', fiber, or other
Iypes ofsamples.

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CD 1201 D (1/96)