Health Resources CityEtCoumy Delentloll Faculties

Development Service Dklahnmn State Departmental Health
1000 NE 10- street
Oklahoma State ottielinma CIty.uK 73117
Department of Hen Ith 'lelenhona (405) 271-39 12
Fax (405) 271-53i74

Email mammal

DETENTION ACILITY INCIDENT REPORT

Per the Department shall he notitied no later than the next working day it any mite following incidents
occur: (A) Extensive damage to detention property; Serious Injury to stali or inmate defined as life threatening or
vequlring itansier in outside medical Escape; (D) serious suiclde attempt, defined as lite threatening Dr requiring
translerto outside medical lacllity; and (E) Death

The completed form may be submitted via email at sedt@henith.ok.gov (click susmn' at bottom at farm); or tax at
(405) 171-5304.

 

 

 

 

 

 

 

 

 

 

 

 

    

 

 

 

 

CHECK TYPE OF INCIDENT
Extenslve Damage to Facility Property serious Suicide Attempt [valtielmake maenlM/bnuking)
Serious Inlury to Staff I: Death by Suicide 
Serious inlury to Inmate 
:1 Emit -,
1. City or County Detention/mills
. NameofFacility ncludeAreaCode)
City Of Tulsa Municipal Jai|
Address
suo Civic Cenler, 3rd Fioor Jail
City I 7 WW stat
Tulsa Oklahoma 74103
2. pensom COMPLETING REPORT: 7 7 7 .
First Name Last Name Title
Dorsey Dennis Jail Administrator

 

 

 

 

cludeArea Code) E-Mail
ddarsey@cityottuiea.oig

 

   

 

 

 

 

 

 

 

a 4. TIME OF 
01/05/2020 8:00 am
5. Have you contacted any other Agencv (OSBI, etc)? VES I No

 

 

 

 

Gf'yogiTloN (Le. Cell Number, Room Name, Floor, Area, etc.)

Cell #320

 

 

 

Oklahoma State Department oi Health ODH No. REV 12/2u19
Detention Program Page a of 2

7. INVOLVED IN INCIDENT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First Name Last Name DOB Date Received in Facility
00022020
8. STAFF INVOLVED IN INCIDENT:

First Name Last Name First Name Last Name
Christa Kaler Moises Izquierdo
Megan Leslie Dennis Dorsey

 

 

 

 

9. LIST WITNESSES li.e. Inmates, Contractor, Other, etc.)

 

 

 

 

 

 

First Name Last Name Staff, inmate, Other
Sarah Whitworth Staff
Christopher Staff

 

 

 

Jackson

 

 

 

 

 

10. DESCRIPTION OF INCIDENT (Be Specific and detailed}

 

On Januaii 2, 2020 at approximately 1850 Hrs. Tulsa Police booked a BIF identi?ed as?

on numerious misd. warrants. 
At approximately 0830 on January 6, 2020 inmate-was found to he unresponsive when requested by
Detention staff to repare for her court appearance. Detention Of?cer Kaler and lzquierdo entered cell 320 and stated it
appeared that was not breathing. At that point Kaler requested Jail Control to notify EMSA and Tulsa Fire
Department via 91 t. Kaler then proceeded to retrieve the AED while Detention Of?cers Izquierdo and Jackson began
CPR. At approximately 0840 Hrs. EMSA and Tulsa Fire Department arrived and took over life saving measures.
Emergency Responders departed the jail with the victim at a roximately 0900. At appromately 1030 Hrs. I recieved
information from Tulsa Police Of?cer- Jason Edwards that arrived at OSU Medical Center in Tulsa at 0909 Hrs.
and was pronounced dead at 0929 Hrs. 

A review of Jail Observation Logs showes that inmate

-was last seen sleeping on the cell bunk at 0822 Hrs.
Jackson further advised that while obseving

he could see her breathing and slight movement.

At 0900 instructed all Detention Staff on duty at the time of the incident to write detailed statments regarding their
actions and involvment. -

 

 

   

 

 

Oklahoma State Department of Health
Detention Program

ODH No. REV 12/2019

Page 2 of 2