EL CAJON —
On Friday, more than four years after a 24-year-old woman died on the floor of a jail medical isolation cell, jurors in El Cajon Superior Court heard opening statements in the criminal trial of the jail nurse and a doctor who had treated the woman earlier in the day.
Nurse Danalee Pascua and Dr. Friederike Von Lintig are charged with involuntary manslaughter in the death of Elisa Serna, who died Nov. 11, 2019, days after she’d been booked into the jail. Each faces up to four years in prison if convicted. They have pleaded not guilty.
The case is a rare instance of medical providers being charged in connection with an inmate death.
Friday’s presentation to the jury offered a peek at some of the defense’s case. Attorneys for both defendants told the panel their clients had incomplete information, and the doctor was not responsible for treating Serna until the day she died at Las Colinas Detention Facility in Santee.
A deputy medical examiner with the county testified Friday that Serna died from complications of polysubstance abuse with a contributing factor of early intrauterine pregnancy.
Undated photo of Elisa Serna
The trial may provide a look inside how the jails provide medical care for people in custody. San Diego County jails have faced heavy scrutiny for their high rate of deaths. A report from the California State Auditor, prompted in part by a 2019 investigation published by the Union-Tribune, found 185 people died in local jails between 2006 and 2020.
Two years ago, 20 people died in San Diego County jails. Last year, the number dropped to 13. Sheriff Kelly Martinez has said the department is taking steps to address concerns, including reforms to medical services.
Serna died in November 2019. The District Attorney’s Office brought charges against Pascua in the fall of 2021, and against Von Lintig a year later.
During opening statements, Deputy District Attorney Samira Seidu told jurors: “You will see the last hours of Elisa Serna’s life. You will hear about the treatment — or lack thereof.”
Serna was pregnant and suffering from withdrawal of alcohol and narcotics, the prosecutor said. During booking into jail, Serna reported she had used heroin within two hours of her arrest, but she was not started on the jail’s withdrawal protocol. “She went through the next three days nauseous, vomiting and dizzy,” Seidu said.
Serna was initially in the general population but four days later was moved to a cell in the medical unit for observation.
Serna had two seizures in the hours before she died, one in a wheelchair and one in her cell. The prosecutor alleged that after the second seizure, a colleague went to get Von Lintig, but the doctor did not go see Serna. Von Lintig should have sent Serna to a hospital, Seidu told jurors.
The jury saw a video, taken from inside Serna’s cell, as Serna went to the cell door to slip her arm through a flap so Pascua, the nurse, could check her vital signs — pulse, oxygen levels and the like. But at the door, Serna fell, her head striking the wall before she slid down it.
The footage shows Pascua and a jail deputy enter. Pascua tried get the woman’s vital signs. They soon left with Serna still slumped against the wall of her cell.
Danalee Pascua, left, 36, appears for her arraignment with her lawyer Alicia Freeze and pleads not guilty to involuntary manslaughter at the El Cajon Courthouse on Nov. 19, 2021.
(Eduardo Contreras/The San Diego Union-Tribune)
When Pascua returned an hour later, Serna was dead. According to the prosecutor, rigor mortis was already setting in.
Defense attorney Dana Grimes said Serna had been under the care of physicians other than her client.
“Dr. Von Lintig had her one day,” Grimes said. “You will hear about the care — or lack thereof — that others provided.”
When Von Lintig encountered Serna earlier in the day, the woman appeared to be “clinically improving” and there was already a plan in place to return her to the general inmate population, Grimes said.
The attorney said the doctor was operating on limited information and that Von Lintig never personally witnessed Serna having a seizure. The attorney also alleged that other medical providers had started “wholly insufficient withdrawal protocols” for Serna.
The doctor was told there was a high suspicion that Serna was faking her seizures. Grimes said the doctor was presented with “a complicated picture” of what was going on with Serna.
Von Lintig’s shift ended a few hours before Serna collapsed in her cell and died. The doctor left work that day “not understanding the gravity of the situation because it was never communicated to her,” Grimes said.
“With all of the information she had at the time, and not 20/20 hindsight and hours of video,” Grimes said the jury should come back with a verdict of not guilty at the end of the case.
Attorney Alicia Freeze, who represents Pascua, said her client followed standard nursing procedures. “This is a classic case of hindsight is 20/20,” she said.
Freeze said no one had relayed to Pascua that Serna had been having seizures, and also said that Serna had not been left in a position that would be life-threatening.
“Ms. Serna’s death was not caused by nurse Pascua in the four minutes she saw her,” Freeze said.
Paloma Serna, left, speaks to the media about the death of her daughter, Elisa Serna, as Yusef Miller, executive director of the North County Equity and Justice Coalition, holds a sign during a rally and vigil outside the El Cajon Courthouse on March 27, 2023.
(Kristian Carreon/For The San Diego Union-Tribune)
A trial brief filed by the prosecution states that several of the witnesses expected to testify during the trial were also responsible for Serna’s care, but their testimony won’t open them up to criminal liability. According to the brief, “The most serious applicable charge in regard to Ms. Serna’s death is involuntary manslaughter … a crime for which the statute of limitations has expired.”
Aside from the criminal case, Von Lintig and Pascua’s licenses were suspended last year. In addition, the state medical board filed an accusation late last year against the doctor who had been treating Serna in the days before her death. That action is pending.
Serna’s family is also suing the county and others in a civil case in federal court, alleging several causes of action including wrongful death. Trial had been scheduled for February, but that date has been vacated and no new date has been scheduled. The parties have their next hearing slated for March.
City News Service contributed to this report.