A physician testified Wednesday that a woman who died in custody at the Las Colinas jail in Santee exhibited clear signs of alcohol and drug withdrawal — including seizures and other symptoms — which warranted a higher level of medical care than she received.
The testimony came in the ongoing preliminary hearing for a doctor and nurse accused of negligence resulting in the Nov. 11, 2019, death of 24-year-old Elisa Serna.
Dr. Friederike Von Lintig, 58, and nurse Danalee Pascua, 38, are charged with involuntary manslaughter and face up to four years in state prison if convicted.
Von Lintig was the physician on duty the day Serna died. Pascua witnessed Serna fall inside a medical observation unit cell on the date of her death and prosecutors allege she left Serna lying on the floor of the cell for the next hour.
Dr. Shaun Carstairs, an emergency physician at Scripps Chula Vista and Rady Children's Hospital, testified Wednesday that Serna's self-reported history of alcohol and benzodiazepene use should have put jail medical staff on the lookout for withdrawal symptoms.
At the request of the San Diego County District Attorney's Office, Carstairs reviewed medical records, autopsy reports and video footage from inside the jail.
The doctor said that throughout her custodial stay, Serna exhibited signs of confusion and "multiple episodes where she appeared to be suffering generalized seizure activity," which he said were signs of withdrawal. He testified that withdrawal from alcohol and/or benzodiazepenes is potentially life-threatening, but treatable.
Along with withdrawal symptoms, Carstairs said that after falling in her cell, Serna was left on the floor in a position that likely obstructed her airway.
Video played in court earlier this week showed Serna stand at her cell door, then fall, strike her head against a wall and collapse to the ground. After the fall, Serna lay on the floor with her head slumped forward and propped up against the wall while the rest of her body was prone.
Pascua and a deputy entered the cell, but later left without moving Serna from that position. She was pronounced dead a short time later.
Carstairs said he believed airway obstruction was "the proximate cause of death," but multiple seizures also played a role.
Medical staff were alerted to Serna's cell multiple times on Nov. 11, including one instance in which Von Lintig responded and examined her.
Von Lintig measured Serna's oxygen saturation level, which shows how much oxygen is in a person's bloodstream. Serna's oxygen saturation rate was measured at 87%, which Carstairs described as "quite abnormal" and she should have been closely monitored afterward, he said.
According to testimony during the preliminary hearing, Von Lintig might have believed Serna was faking her seizures.
Carstairs testified that given Serna's history, she was at a high risk of suffering from withdrawal symptoms, including the seizures. Even if Serna had been pretending to have seizures, the oxygen saturation rate that was measured could not have been faked, he said.
"In the end, it doesn't matter whether someone thinks a person is faking their symptoms or genuinely having seizure activity. I think that as a treating provider, one needs to assume the worst until they are able to prove otherwise," Carstairs testified.
Serna's death is also the subject of a federal wrongful death lawsuit filed against the county by her family, which alleges jail medical staff failed to provide proper care despite knowing her substance abuse history.
Von Lintig, Pascua and several others are also named as defendants in the ongoing lawsuit.
