Agency Information PA Number: PA16263CJ Report Date: 6/22/2016 9:02 AM Status: Submitted Agency/Facility Information Department ID: 869 Department Type: SHERIFF Agency Name: Travis County Sheriff's Office Agency Number: TX2270000 Agency Phone: 5128549770 Agency Address: P. O. Box 1748 Agency City: Austin Agency County: Travis Agency State: TX Agency Zip: 78767 Director Information Director Salutation: Sheriff Director First Name: Greg Director Middle Name: Hamilton Director Last Name: Reporter Name: Inocencio Flores Reporter Email: inocencio.flores@traviscountytx.gov Location / Custody Information OLD Custodial Death Report :: Page 1 of 6
Where did the event causing the death occur? Street Address: 500 W. 10th St City: Austin County: Travis What type of custody/facility was the Decedent in at the time of death: County Jail Type of Custody: Specific type of custody/facility: Jail - single cell Specific Type of Custody/Facility: Custody Type Facility: What was the time and date of the deceased's entry into the law enforcement facility where the death occurred (mm/dd/yyyy hh:mm AM/PM): Entry Date Time: Entry Date Time N/A: Where did the death occur? Death Location: At medical facility Death Location Elsewhere: Decedent Information Identity of Deceased OLD Custodial Death Report :: Page 2 of 6
First Name: Justin Middle Name: Daniel Last Name: Dominguez Suffix: Date of Birth: 5/22/1992 Sex: Male Ethnicity: Hispanic Date/Time of Death (mm/dd/yyyy hh:mm AM/PM): Death Date and Time: 6/11/2016 10:56 AM Date/Time of Custody (arrest, incarceration) (mm/dd/yyyy hh:mm AM/PM): 6/10/2016 7:05 PM Date/Time of Custody or Incident: Manner / Cause of Death Has a medical examiner or coroner conducted an evaluation to determine a cause of death? Yes, results are available Medical Examinor/Coroner Evalution?: What was the manner of death? (select only one) Alcohol/Drug Intoxication Manner of Death: Manner of Death Description: OLD Custodial Death Report :: Page 3 of 6
Death Reason: t applicable Medical Cause of Death: Medical Cause of Death: Cocaine and Methadone Toxicity Had the decedent been receiving treatment for the medical condition that caused the death after admission to your jail's jurisdiction? t Applicable Medical Treatment: If death was an accident, homicide or suicide, who caused the death? Who caused the death?: t applicable; cause of death was suicide, intoxication or illness/natural causes Death Causer Other: If a weapon caused the death, what type of weapon caused the death? (mark all that apply) t Applicable Type of Death Weapon: Was the cause of death the result of a pre-existing medical condition or did the decedent develop the condition after admission? Pre existing medical condition?: t Applicable; cause of death was accidental injury, intoxication, suicide or homicide If death was an accident, homicide or suicide, what was the means of death? Means of Death: t applicable; cause of death was intoxication or illness/natural causes OLD Custodial Death Report :: Page 4 of 6
General Information What were the most serious offense(s) with which the deceased was (or would have been) charged with at the time of death? Assault B/I F V Misdemeanor A Offense 1: Offense 2: Offense 3: Filed Were the Charges:: What were the types of charges or reason for contact? Type of Offense: Injuries of Decedent Injured By: Injured by NA At any time during the incident and/or entry into the law enforcement facility, did the decedent: Appear intoxicated (alcohol or drugs): Exhibit any medical problems?: Exhibit any mental health problems?: At any time during the incident and/or entry into the law enforcement facility, did the decedent: OLD Custodial Death Report :: Page 5 of 6
Threaten the officer(s) involved: Resist being handcuffed or arrested?: Try to escape/flee from custody: Grab, hit or fight with the officer(s): Other Behavior: Specify Other Behavior: Use weapon threaten/assault officer(s): 0 Was the deceased under restraint in the time leading up to the death or the events causing the death? Under Restraint: Summary of Incident Summary of How the Death Occurred: (max. 30,000 characters) Summary: Inmate was booked into jail on 06-10-16 at 8:00 PM. Inmate did not complain or claim any medical conditions or problems at the time of booking. He was placed in a one person cell at approximately 11:23 PM on 06-10-16. The post officer did not receive a response from the inmate while serving lunch at approximately 10:14 AM. Corrections officers, jail nursing staff and paramedics performed CPR on the imate for several minutes. Inmate was transported by EMS to a medical facility. A death pronouncement was given by a doctor at the medical facility at 10:56 AM on 06-11-16. OLD Custodial Death Report :: Page 6 of 6