Medical Violence: A Manslaughter Case Highlights Risk to Incarcerated Persons

Well, this is discouraging.

On October 27th, I published a post called "Medical Violence," cataloging some of the abusive care or negligence I witnessed at San Diego jails when I used to staff the jail clinics. That was some years ago. But little more than a week later, a friend notified me about a manslaughter charge against a nurse at Las Colinas Detention Facility, one of the three jails where I worked.

Details of the case

According to a press release from the District Attorney, "Serna fell in the defendant's presence ... The defendant failed to get Serna's vitals, did not move Serna into a recovery position, and left Serna on the ground in the cell. About an hour later, Pascua and deputies returned to Ms. Serna's cell and began futile life-saving measures."

For the non-medical people out there wondering if that's ever an ok thing to do, the answer is no. Never. You don't abandon someone who appears to be having a medical crisis, particularly one in which someone appears unable to care for herself. Not as a medical professional. Not as a layperson.

And not, even, as a deputy. The Los Angeles Times notes that a deputy had accompanied the nurse. Two people left this woman alone after she fell and struck her head. Despite that, a review board found no validity to a complaint about the officer—a decision the board later reversed. The public will probably not learn about any discipline for the officer, but why isn't there a manslaughter charge for him or her, too?

Medical background

Here's some additional medical context: The inmate admitted to heroin and benzodiazepine abuse during intake. That would have earned her treatment with institutional withdrawal protocols. None were ordered. Opioid withdrawal could have been causing her vomiting, which can cause dehydration, and lead to collapse. Benzo withdrawal is dangerous and could have caused a suspected seizure, one theory as to why she fell. Oh, here's an interesting point: In a more enlightened society, perhaps this individual with substance addiction would have been in a treatment center instead of jail, or never arrested, because she would have engaged in treatment offered to her at state-regulated drug dispensaries.

Possible reasoning

Now to speculate... did these two think she was faking? Being dramatic? Was she ... annoying? Complaining? Did her inmate status, substance habits, and behavior cause the two jail employees to experience a failure of basic empathy?

Don't know. Don't care. Doesn't matter. If you don't want to deal with addiction issues and patient complaints, you don't go into nursing, especially at a jail. If you don't want to deal with complaints and difficult people, don't become a Sheriff's Deputy. The job is to care for and detain people who'd rather be free. They're going to be irritable sometimes. They're not all going to give you chocolates and a thank you card. Basic care was their job. One they signed up for and got paid to do.

Treatment of detainees

Perhaps the trial will reveal whether this was about incompetence or indifference. It's possible this had nothing to do with the woman's incarcerated status. Doctors, nurses, and deputies are just people, and some people are bad people; a nurse in Texas was just sentenced to death for killing non-incarcerated patients with air injections. But my suspicion is this is another reminder of the need to speak up for those who have no voice and little agency for themselves, a group that includes detainees. Treating our saints well should be easy. Treating the unfortunate or the downright evil is harder, but still the right thing to do.

“A society should be judged not by how it treats its outstanding citizens but by how it treats its criminals.”―Fyodor Dostoyevsky