Shane Gerald McDonald, 21, was ordered held on $500,000 bail. He was arraigned from his bed at Sharp Memorial Hospital.
Authorities said Rodolfo de la Torre, 55, and Teresa Esparza Hernandez, 84, both of Escondido, were killed when a black Audi driven by McDonald slammed into their Honda sedan about 3 a.m. last Saturday south of Mercy Road.
De la Torre was driving south in an I-15 express lane when the Audi, heading north in their lane, hit the Honda head-on, according to the California Highway Patrol. Three other family members in the back seat of the Honda suffered major injuries, the CHP reported.
McDonald faces up to 21 years in prison if convicted, said Deputy District Attorney Geoff Allard.
A readiness conference was scheduled May 27 and a preliminary hearing for June 16.