A doctor and nurse accused of negligence in the in- custody death of a woman at the Las Colinas jail in Santee were ordered Monday to stand trial on involuntary manslaughter charges.
Dr. Friederike Von Lintig, 58, and nurse Danalee Pascua, 38, are charged in the death of 24-year-old Elisa Serna on Nov. 11, 2019, five days after Serna was booked into the jail.
The defendants face up to four years in state prison if convicted.
Their prosecutions come as San Diego County continues to face scrutiny for the number of in-custody deaths at its jail facilities. Eight people have died in local custody this year, including two in the last week.
Serna was pronounced dead shortly after she collapsed in her cell in the jail's medical observation unit.
Von Lintig was the physician on duty the day Serna died and Pascua allegedly witnessed the fall.
Following a week of testimony and arguments Monday morning from attorneys, El Cajon Superior Court Judge Selena Epley ruled the case can proceed to trial.
Deputy District Attorney John Dunlap said the defendants were directly responsible for Serna's care, yet failed to prevent her death and furthermore, contributed to her passing. The prosecutor argued Serna, who reported to jail staff that she had a history of drug and alcohol use, was clearly suffering from withdrawal symptoms that warranted a more urgent level of medical care.
Both defendants' attorneys said their clients' actions were being examined with the benefit of hindsight. The attorneys also argued their clients were provided information by other nurses and doctors, who indicated Serna was in relatively good condition and may have been faking certain symptoms such as fainting and falling to the floor.
Evidence presented during the hearing highlighted three instances in which medical staff was alerted to Serna's condition on Nov. 11.
The first time occurred early in the afternoon when Serna was being moved out of the medical observation unit in a wheelchair and her limbs began stiffening, which prosecutors described as "seizure-like activity."
She was taken back into her cell and multiple staff members, including Von Lintig, responded and examined her.
During that examination, Serna's oxygen saturation level, which shows how much oxygen is in a person's bloodstream, was measured at 87%. Dr. Shaun Carstairs, an emergency physician at Scripps Chula Vista and Rady Children's Hospital, testified that figure was "quite abnormal" and should have prompted closer monitoring of Serna's condition.
Von Lintig later told an investigator that she believed it was a "false reading" because Serna appeared awake and alert and was resistant when nurses tried to place an oxygen mask on her, according to testimony.
About two hours later, nurses witnessed Serna lying across the seat of the toilet in her cell. A nurse requested that Von Lintig return to Serna's cell, but she never did.
A few hours later, Serna fell in her cell as Pascua was attempting to check her vital signs.
Video played in court last week showed Serna standing at her cell door, then collapsing.
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. Serna remained there for the next hour as urine can be seen spreading along the ground from beneath her body.
Pascua and other deputies later re-entered the cell and Serna was pronounced dead shortly afterward.
Carstairs testified that Serna's positioning with her head bent forward likely obstructed her airway and he believed that was the "proximate cause" of her death.
Pascua's attorney, Alicia Freeze, highlighted testimony from Serina Rognlien-Hood, the sheriff's department director of nursing, who said the position was not necessarily life-threatening. Freeze also noted the county Medical Examiner's Office finding that Serna died of natural causes related to substance abuse, with a contributing factor of early intrauterine pregnancy.
Dunlap quoted different testimony from Rognlien-Hood, in which she stated that 911 should have been called after Serna fell. He also said Pascua was informed by a deputy that Serna had urinated herself, yet did not respond to the cell for another half hour.
"To leave Elisa in that position was beyond simple negligence, beyond gross negligence. Quite frankly, it was inhumane," the prosecutor said.
One of Von Lintig's attorneys, Dana Grimes, argued Von Lintig was told by others that Serna appeared to be improving. Though the information she received from other medical staff may have turned out to be incorrect, Grimes argued Von Lintig only saw Serna beginning on Nov. 11 and was relying on information others provided her.
Grimes argued another doctor at the jail who examined Serna before Nov. 11 bore more responsibility for not alerting Von Lintig to the seriousness of Serna's condition.
Dunlap said that whatever Von Lintig was told by others, she was aware Serna had been vomiting, was dehydrated, and had the low oxygen saturation rate.
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 listed as defendants in the ongoing lawsuit.
In a statement released after the preliminary hearing, the sheriff's department said it "extends our sympathies to everyone affected by the death of Elisa Serna. No family should have to experience the level of grief felt with the loss of a loved one. The sheriff is grateful for the hard work and integrity of the sheriff's investigative team who presented this case to the District Attorney for criminal filing. We appreciate the high ethical standards displayed during this difficult time by all our staff, many of whom were in court last week, testifying in this case."
