Pueblo County Coroner Resigns
Amid Somber Mortuary Scandal
Custer County Coroner and Deputy Coroner Respond with Colorado Coroners Regional Incident Response Team
Photo courtesy of the Custer County Coroner’s Office
by Sangre de Cristo Sentinel editor
The Pueblo County Coroner, who is trusted to handle loved ones with dignity, has resigned amid shocking revelations. On August 20th inspectors from the Colorado Department of Regulatory Agencies (DORA) arrived at Davis Mortuary in Pueblo to conduct their first routine inspection under new oversight laws. What the inspectors encountered was a strong odor and then a horrifying discovery: 24 bodies in various states of decay, containers of bones, and possible human tissue behind a hidden door concealed with a cardboard display.
When confronted, Pueblo County Coroner Brian Cotter, who co-owns the mortuary with his brother Chris and was on site for the inspection, admitted that some bodies had been awaiting cremation for as long as 15 years. He went further saying some grieving families may have received fake ashes.
The swift response from multiple state agencies and neighboring counties reflects how seriously our community and Colorado regard this breach of trust. The Colorado Coroners Association (CCA) called an emergency meeting to address this crisis. Custer County Coroner Brad Baltzly, who serves as Treasurer for the association
and is one of the four members of the executive board, substantiated that Cotter should be removed from the CCA board and called on to resign. Custer County Deputy Coroner
Nikita Phillips also serves as one of the twelve CCA board members making Custer County the only county in the state with two current CCA board members. The group voted unanimously to remove
Cotter as Secretary of the CCA “due to unethical practices and
harm to the community in which he was sworn to uphold”. The CCA also noted in its August 23 press release that Cotter’s
actions violated the highest ethical standards he swore to uphold.
Baltzly and Phillips were called to the Pueblo scene as part of the State Coroner Assist Teams. CCA has a database of all the coroners and deputies in the state who are available to assist in a disaster to include the equipment they have available. These are the folks that make up “assist teams”. Custer, El Paso, Fremont and Douglas
counties all responded to the call for assistance in Pueblo. All four of those county coroners were present with their deputies to help with the processing and cleanup. Because there was suspicion of wrongdoing by the Pueblo County Coroner, all members of the assist teams were deputized in Pueblo County. The deputization permitted them to help with the still incoming calls that require a Coroner response.
Deputy Coroner Nikita Phillips suited up and on the scene.
Photo courtesy of the Custer County Coroner’s Office
When Baltzly and Phillips arrived at the scene on Friday, they were deputized and then began to work out the logistics of setting up a secure processing area with tents. The secure area became necessary because drones equipped with microphones belonging to the media and others were flying over the area. To protect the scene, the investigation, and impacted families, the assist teams were forced to set up a tunnel of tents from the garage door of the mortuary to the morgue trailer. Friday’s hours were spent just creating a secure area so the agencies could safely and confidentially process the scene. The actual processing would not begin until Saturday morning.
Custer County’s assist team was first in the door on Saturday. The Colorado Bureau of Investigation (CBI) flew a drone in the first room and took pictures of everything from all angles. Baltzly and Phillips then began numbering the bodies starting with those closest to the door. In order to limit the transfer of biohazards the teams set up four stations in the tented and secure area. Baltzly and Phillips worked at the first station. They removed the bodies from the room in the facility and placed them on the station one cot. The body was then moved to station two cot where it was placed in a new body bag. At station three the bodies were inspected and checked for identifying information and then logged. The fourth and final station assist team carried the remains to the morgue trailer for transport. Each team stayed in their station to prevent cross contaminating the scene or any evidence. The Custer County assist team was relieved for a break after the first 16 bodies were processed. A total of 20 bodies were processed on Saturday and an additional four on Sunday. All remains were then transferred to the El Paso County Coroner’s Office for autopsy and identification, which is expected to take months.
Pueblo County Sheriff David Lucero pressed for accountability in this violation of public trust. Other Pueblo County officials highlighted their proud commitment to integrity and service, and the fallout for Cotter was swift. The Colorado Bureau of Investigation (CBI) is leading a full-scale criminal investigation. The 10th Judicial District Attorney’s Office is also involved. As part of the investigation, search warrants were executed at the Cotters’ homes, and the mortuary’s business license was revoked. The Cotter’s have also been served a business eviction notice.
Cotter was hospitalized for a cardiac event in the ensuing days. On August 29th, Cotter’s legal counsel announced he would resign effective September 2, 2025. His resignation was accepted on September 2nd by the Pueblo County Commissioners. Coroners from El Paso and Fremont counties stepped in to ensure coroner operations continue uninterrupted.
This isn’t just about one man or one facility. Colorado has long been known for minimal oversight in its funeral industry. Routine inspections and professional licensing were only recently implemented after prior abuses, including a recent case where nearly 200 bodies were found in poor condition at Return to Nature in neighboring Penrose. Baltzly was also immediately on scene for
the Penrose crisis and spent a full week in 2023 assisting Fremont County agencies with the cleanup. He also worked with the FBI to notify those impacted families. Baltzly said, “Even though we have mutual aid agreements with surrounding counties our service time in Penrose was about neighbors helping neighbors to clean up a crisis and help families in grief.”
This story hits close for Custer County. Qualified professionals are sometimes hard to come by in small towns like ours and those we do have often wear multiple hats. Those of us in rural communities rely heavily on our public servants and trust them to serve honorably.
Many have expressed concerns about not knowing what to do or ask when faced with making final resting plans and arrangements. When it comes to choosing the facility that will care for your loved one, there are some important questions to ask.
● Will my loved one be cared for on-site or transported elsewhere?
● What measures do you take to ensure proper handling and dignity?
● Can we tour the facilities before making a decision?
● How long has your funeral home been in operation?
● Are you family-owned, corporate, or part of a larger chain?
● Can you provide references or testimonials?
● Are you licensed?
● Do you handle permits, death certificates, and Social Security/Veterans Affairs paperwork?
● Can you provide a complete, itemized price list (as required by law)?
● What is included in your basic service fee?
● What additional or hidden fees should I be aware of (transportation, death certificates, embalming, etc.)?
As the criminal investigation into Davis Mortuary progresses, we will hold the grieving families in our thoughts and prayers and continue to report new developments.