Carrasco, who also received an undisclosed fine, is currently with Triple-A Columbus, putting the Tribe in the same position as on Opening Day. Calling him up from the Minor Leagues is now more complicated, given the need to have him serve the suspension upon promotion.
"We obviously worked pretty hard to try to have his prior suspension not be an issue," Indians general manager Chris Antonetti said Friday. "Obviously, when he returns at the Major League level, we'll have to deal with it again."
The Indians began this season with Carrasco on their active roster so he could serve a prior suspension -- leftover from an incident in July 2011. The original plan was to have the right-hander head to Triple-A upon completion of that punishment, but an injury to lefty Scott Kazmir, Cleveland's fifth starter, forced the Indians to hand the ball to Carrasco on Tuesday.
In a forgettable performance -- Carrasco's first start after a 19-month comeback from Tommy John surgery on his right elbow -- he allowed seven runs in just 3 2/3 innings. With two out in the fourth inning, after surrending a two-run home run to Robinson Cano that put the Tribe in a 7-0 hole, Carrasco threw high and inside to Youkilis, hitting him on the back of the left shoulder.
Home-plate umpire Jordan Baker immediately ejected Carrasco from the ballgame.
"I know it doesn't look good," Carrasco said afterward. "I really want to say sorry. I don't want to hit anybody."
Carrasco insisted that he slipped on the mound while throwing the pitch, and Antonetti said he could only take the pitcher at his word. Following Tuesday's game, Carrasco waited outside Indians manager Terry Francona's office to apologize and explain what happened. The pitcher also spoke with Antonetti following the incident.
Antonetti said he was not angry with Carrasco.
"No," said the general manager. "Carlos is very adamant that it was not intentional. He's been consistent with that from the time it happened to after the game with Terry. Individually, he was the same with me as well. Ultimately, he'll have the opportunity to have others hear his case and hear how remorseful he is."
The situation was nearly identical to the one faced by Carrasco in his second-to-last outing of his injury-marred 2011 campaign.
Against the Royals on July 29 two seasons ago, Carrasco gave up a grand slam to the Royals' Melky Cabrera in the fourth inning to put the Tribe in a 7-0 deficit. Carrasco threw his next pitch in the area of Billy Butler's head and was promptly ejected from the game. Carrasco received a six-game suspension (reduced to five games shortly before this season) from MLB. Because of his arm injury, Carrasco did not serve his suspension until this year.
Cleveland navigated around that previous suspension by opening the season with Carrasco on the active roster, but not as part of the planned rotation. Now, the Indians might be forced to wait until September, when rosters expand to 40 players, to promote Carrasco again. Calling him up from Triple-A before Sept. 1 would create a more convoluted situation.
"In September, it would be the easiest time for us to resolve it," Antonetti said. "But I wouldn't say this precludes us from calling him up before then. It would just make it, again, more challenging."
Antonetti said the most important thing right now is to get Carrasco back to a point where the Indians feel he is a reliable option for the big league staff. Carrasco opened the 2011 campaign in the starting rotation but went 8-9 with a 4.62 ERA in 21 starts before he sustained his elbow injury.
In Tuesday's loss, Carrasco touched 95-97 mph with his fastball and showed spurts of his potential. All seven runs that he allowed came with two outs.
"Despite the results of the outing, we saw that he was healthy, and his fastball had great life to it," Antonetti said. "At times, he demonstrated quality secondary stuff. So we think he's close, and our focus is on helping him get back to being a Major League option for us."