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Outside autopsy finds Ingram-Lopez died of 'suffocation' while detained by Tucson police

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Outside autopsy finds Ingram-Lopez died of 'suffocation' while detained by Tucson police

Independent review released by man's family challenges conclusions of gov't investigation

  • Carlos Adrian Ingram-Lopez and his daughter.
    courtesy of the Ingram-Lopez familyCarlos Adrian Ingram-Lopez and his daughter.
  • People light a candle for Ingram-Lopez during a vigil at the El Tiradito shrine in downtown Tucson's Barrio Viejo on June 25.
    Paul Ingram/TucsonSentinel.comPeople light a candle for Ingram-Lopez during a vigil at the El Tiradito shrine in downtown Tucson's Barrio Viejo on June 25.
  • Members of Ingram-Lopez's family during a vigil for the 27-year-old man on June 25.
    Paul Ingram/TucsonSentinel.comMembers of Ingram-Lopez's family during a vigil for the 27-year-old man on June 25.

An autopsy done on the behalf of the family of Carlos "Adrian" Ingram-Lopez said that the 27-year-old man died from "suffocation" when he was pinned down by three Tucson police officers during an incident in April.

In the report, a pathologist examined Ingram-Lopez and said that his death is "consistent with an asphyxia event ('suffocation')." The finding differs from the Pima County Medical Examiner's report, which said that the cause of death was "sudden cardiac arrest in the setting of acute cocaine intoxication and physical restraint."

The independent pathologist, a former chief medical examiner for both Maricopa and Yavapai counties, discounted cocaine as a cause of death, saying that "its effects are not sufficient to explain the death."

Ingram-Lopez died on April 21, as first revealed by, after his grandmother called 911 from the family home. Naked and yelling, he was chased through the house by arriving officers, who charged in yelling "Get on the fucking ground." Ingram-Lopez told officers he was sorry and then bolted into the garage, where he laid down and was double-handcuffed by police face down on the garage floor. 

Ingram-Lopez repeatedly asked the officers for water, called for his grandmother in Spanish, and told them "oh shit, I can't breathe." Officers repeatedly told him to "relax" and placed blankets over him, as well as a "spit sock" over his head. About 12 minutes after he was handcuffed on the ground face down, Ingram-Lopez went still and stopped breathing.

Document: Ingram-Lopez outside autopsy report

The three officers involved in the incident — Samuel Routledge, Ryan Starbuck and Jonathan Jackson — resigned before they could be fired as the Tucson Police Department planned. An internal investigation released to said that that three officers "showed complete disregard" for their training, "but most importantly an apparent indifference or inability to recognize an individual in medical distress and take the appropriate action."

The family-commissioned report provided late Monday night to said that Ingram-Lopez's death was "most consistent with asphyxia due to compromised airway which is best explained by a facedown position restricting his breathing."

Ingram-Lopez's death became national news after Tucson police officials released body cam footage during a press conference on June 24, more than two months after the incident occurred, showing a partial view often obscured by darkness of the enclosed garage and the officers' movement. 

The announcement of Ingram-Lopez's death came during a summer of unrest, marked by fury over the death of George Floyd, who died on May 25 after a Minneapolis police officer pressed his knee into the 46-year-old's neck for more than eight minutes as he pleaded for his life. After Floyd's death, early demonstrations marked by vandalism gave way to dozens of peaceful demonstrations, including several in Tucson over the next several weeks. During these protests, marchers often yelled at police officers to quit their jobs, and demanded city leaders "defund" police, moving that funding to social service programs.

June 24: Details revealed about Ingram-Lopez death in police custody; TPD chief offers to resign

Tucson police and city officials did not reveal the incident until after it was exclusively first reported by Internal city sources criticized the delay in releasing information to the public, including one who called the delay an attempt at a "white-wash." 

During a press conference on June 24, Tucson Police Chief Chris Magnus said that the "involved officers did not live up to our department’s high standards." 

As Magnus put it, Ingram-Lopez went into "cardiac arrest" after he was in a "prone position for about 12 minutes." Police officers attempted to revive him, using both CPR and Narcan—a drug used to prevent overdoses from opioids. The county medical examiner found that the cause of death was "sudden cardiac arrest in the setting of acute cocaine intoxication and physical restraint."

Independent autopsy says death caused by 'suffocation'

However, a second autopsy completed by Dr. Philip Keen on April 24 on behalf of Iris Lizarraga, Ingram-Lopez's mother, said that his death "is consistent with an asphyxia event ('suffocation')."

"The family insisted on the second autopsy because they wanted to get to the truth of what happened to Adrian," an attorney representing the family told

Keen — who was the chief medical examiner for Maricopa County from 1992 to 2006, as well as holding that position for Yavapai County from 1975 to 2009 — also dismissed cocaine as a cause of the man's death, writing in his report dated July 17 that there "is a contribution of the influence of the stimulant drug presence, but the death is not due to the drug," he wrote. 

"If the stimulant drug was a dominant factor there should have been some evidence of signs of respiratory distress prior to the encounter," Keen wrote. "The reports indicate the man was mobile and active prior to the terminal event." 

"His death is most consistent with asphyxia due to compromised airway which is best explained by a facedown position restricting his breathing," he wrote. "While there were only small abrasions of his left back and flank he was in a facedown position with his wrists cuffed and this would potentially further compromise his breathing." 

While Ingram-Lopez had used cocaine before the April incident, and he was under the influence of the drug that night, Keen wrote that "the cocaine is a stimulant drug and its effects are not sufficient to explain the death."

'Violent and unconstitutional use of force'

On Monday night, Eduardo Coronado, the family's attorney, said that family members decided to release their own autopsy to push against the official description of Ingram-Lopez's death, he said. "The family insisted on the second autopsy because they wanted to get to the truth of what happened to Adrian, and that’s what this second autopsy accomplished," he said. 

"The family never wanted to put this out there, but we felt like we had to," he told 

"Tucson police officials released the first autopsy, and there’s a narrative that has been put out there that the police officers did nothing wrong, that they didn’t use any force," he said. "Well, I completely disagree with that. Three men, three officers, put 600 pounds of force on Adrian’s back while he’s handcuffed and face down."

"There’s a spit sock on his head, and blankets on him, and they only thing Adrian gets to see is darkness? That’s excessive force. It was a violent and unconstitutional use of force," Coronado said.

Magnus said in June that while officers had failed to follow their training there was "no indication of malicious intent," adding that "nor did any of the officers employ strikes, use choke-holds, or place a knee on Mr. Ingram-Lopez's neck."

However, Coronado rejected this. "They said there was no force, but for the love of god, there was 600 pounds of force from three men on top of him, pressing him down." 

"I don’t even know how to state how disappointing and alarming it is, to me, that one of the officers had 14 years of EMT experience," Coronado argued. "The bottom line is that they were indifferent to Adrian. They were indifferent to his needs."

That now-former TPD officer, Ryan Starbuck, still holds an EMT license, according to Arizona Department of Health Services records.

Coronado said that Ingram-Lopez posed no threat to the officers. “Remember, he’s naked, he’s a completely naked man, and he doesn’t have a weapon. And, he’s not hiding one. Instead, he tells the officers that he’s sorry, he says this five times, and he’s giving himself up and he has nowhere to go.”

Coronado argued that the amount of cocaine in Ingram-Lopez’s body was "minuscule" and that while the 27-year-old man had an enlarged heart because he was “a big man" at 230 pounds, those two factors didn’t kill him, rather it was the actions of the police officers.

“I’m not trying to say that Adrian didn’t have cocaine in his body, and that his heart wasn’t enlarged, but that if you really look at the autopsy, it really means nothing. Adrian could have lived for 50 years and never had a problem," Coronado said.

"Those three officers were part of the judicial system, I get it, but they’re one part—they became the jury and the judge, and the sentence was the most severe sentence there is—that’s what Adrian got from these officers, the death sentence," Coronado said. "And for what? Adrian snorted cocaine, and he died for it."

Coronado said that the family is still considering whether to launch a lawsuit, but that the man’s mother is calling for charges against the three officers.

"We’re inching closer, we’re looking at everything we have. We have to digest and consider this," Coronado said.

Details released during June press conference

During a press conference on June 24, Tucson Police Chief Chris Magnus offered to resign, telling reporters and Mayor Regina Romero that as a demonstration of his "willingness to take accountability" he would leave his position as the Tucson police chief. Romero's jaw dropped as he announced he was putting his resignation on the table. Other city staffers were equally surprised.

However, neither Mike Ortega, the city manager, nor the City Council accepted the chief's resignation. And, Coronado told in June that the family wanted Magnus to stay on. 

Councilman Steve Kozachik said the manager "exercised his authority" and rejected the move. "I, along with 4 of my colleagues, support that decision," he said.

Romero said she was surprised by the resignation offer.

"I did not know he was going to offer his resignation. I cannot impose my thoughts on what his decision has been," she said during the Wednesday press conference. "Chief Magnus has been ... a great police chief for the city of Tucson," she said, saying she would "think about what he's presented to the public" in offering to leave his position.

During the press conference, Romero called for several police reforms, including "immediate notification" of fatal police incidents. "People are mad, people are disappointed, people are outraged — and rightfully so," she said.

The case has been referred to the Pima County Attorney's Office for potential prosecution of the officers, Magnus said. The chief also said he has asked the FBI to review the case.

Second death released

Tucson police also recently released information on the death of another man in custody, in March, with the information finally made public weeks after asked for an accounting of all such deaths, and more than a week after the City Council mandated "immediate" public notifications.

Damien Alvarado, 29, died after a struggle with TPD officers and two witnesses to a hit-and-run crash that Alvarado was involved in on March 22. TPD first provided information about the case to reporters on July 8. 

After the struggle with officers, in which TPD said he pulled a magazine of bullets from an officer's belt, he was hobbled with restraints called "TARP," with his hand and legs bound together behind his back.

"I can't breathe," Alvarado said several times as he was restrained on the ground — for a period on his side in the "recovery position."

The cause of death determined by the Pima County Medical Examiner was "sudden cardiac arrest due to acute methamphetamine intoxication, restraint, and dilated cardiomyopathy," officials said. 

Alvarado was pronounced dead at Banner University Medical Center at 6:30 p.m., about one hour and 15 minutes after the crash.

TPD did not immediately release full information about the case, including copies of all of the bodycam video and the department's internal administrative investigation. The press release from the department said that the internal probe, finished July 7, "determined that the officers’ use of force, including their restraint techniques, was appropriate and within policy. There were also determinations that certain officers’ comments violated policy."

TPD did not explain what those comments by officers were, but the video released by the department includes multiple obscene statements by officers as they struggled with Alvarado on the ground. A department spokesman said that the internal investigation report could not be released yet, until the officers involved are given the opportunity to appeal their discipline. A copy of the autopsy report was provided by the Medical Examiner on Thursday morning.

Police did release a compilation of body-cam video from the incident, and a copy of the initial police report and follow-up investigation.

TPD's criminal probe of the incident had been wrapped up at the start of June, with Alvarado's family told no charges would be filed against the officers involved. However, on June 25 — the day after TPD provided reporters with some details about the April in-custody death of Ingram-Lopez — word came down from police headquarters that the case should be sent to county prosecutors for review.’s Dylan Smith contributed to this report.

This original news reporting was partly supported by the Brechner Center for Freedom of Information at the University of Florida, which awarded Sentinel Editor Dylan Smith a Brechner Reporting Fellowship to pursue in-depth journalism about government secrecy.

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