FACTS:

Petitioner Dr. Leandro Carillo, an anesthetist, seeks review of the Decision of the Court of Appeals dated 28 November 1988, which affirmed his conviction by the Regional Trial Court for the crime of simple negligence resulting in homicide, for the death of his thirteen (13) year old patient Catherine Acosta. The information filed against petitioner and his co-accused, the surgeon Dr. Emilio Madrid, alleged that they operated on Catherine Acosta in a reckless, careless, and imprudent manner, which caused her death. The prosecution presented four witnesses, including Catherine's parents and two expert witnesses. After the prosecution rested its case, the defense was granted leave to file a demurrer to the evidence. However, they failed to file it within the reglementary period, and the trial court denied their motion for extension of time. The trial court then promulgated its decision convicting both accused, and the Court of Appeals affirmed the judgment of conviction. Petitioner Dr. Carillo alone filed the present Petition for Review seeking reversal of his conviction. The facts established by the Court of Appeals are that Catherine Acosta complained of abdominal pain and was examined by Dr. Emilio Madrid, who suspected appendicitis. She was brought to the hospital for observation and later underwent an operation performed by Dr. Madrid and assisted by Dr. Carillo. During the operation, Catherine's mother noticed unusual behavior by the nurses, and when she asked to enter the operating room, she was refused. After the operation, Catherine exhibited abnormal symptoms and did not wake up.

The case involves the death of a child named Catherine Acosta, who underwent an appendectomy procedure in a hospital. Witnesses testified that Catherine experienced abnormal symptoms after the surgery, including shivering, abnormal heart rate, difficulty breathing, and pale complexion. The child was administered oxygen, but her condition worsened as she developed convulsions and stiffness. Doctors were called to examine Catherine and diagnosed her with severe infection that spread to her head. Despite efforts to treat her, Catherine remained unconscious and eventually died three days later. The Court of Appeals found that Catherine suffered an overdose or adverse reaction to anesthesia, particularly the arbitrary administration of Nubain without weighing the patient's body mass. The court held the doctors, Dr. Carillo and Dr. Madrid, criminally negligent for failing to meet the required standard of diligence in administering anesthesia and monitoring Catherine's condition after the surgery. Petitioner Dr. Carillo argues that Catherine's death was caused by a ruptured appendix, as indicated in her death certificate and biopsy report, rather than faulty anesthesia. He also disputes that there is no direct evidence showing Nubain was administered to Catherine.

The case involves a petition for review on certiorari filed by Dr. Carillo challenging the decision of the Court of Appeals. The first issue raised is whether the findings of fact of the Court of Appeals are supported and whether petitioner has shown "misapprehension of facts" on the part of the Court of Appeals. The second issue is whether the findings of fact of the Court of Appeals adequately support the conclusion that petitioner, along with another doctor, was guilty of simple negligence resulting in homicide. Petitioner disputes the Court of Appeals' finding that an overdose or allergic reaction to the anaesthetic drug Nubain caused the death of the patient, Catherine Acosta, claiming that the true cause of death was septicemia due to a perforated appendix with peritonitis. The concept of causation, specifically the cause of death, is discussed as a complex and difficult notion.

ISSUES:

1. Whether or not there are questions of fact that need to be resolved in this case.

2. Whether or not the findings of fact of the Court of Appeals support the conclusion that the petitioner was guilty of simple negligence resulting in homicide.

3. Whether the petitioner anaesthesiologist violated the canons of his profession by not attending to his patient with the greatest solicitude.

4. Whether the petitioner anaesthesiologist and Dr. Madrid exhibited a low level of diligence in the prescription of medication for their patient.

5. Whether the rupture of the patient's appendix occurred during the appendectomy procedure and whether the accused were in control of the situation.

6. Whether the accused were guilty of simple negligence.

7. Whether the accused were guilty of simple negligence resulting in homicide.

8. Whether the petitioner was denied due process.

RULING:

1. The Supreme Court held that questions of fact cannot be raised in a petition for review on certiorari, unless there are well-known exceptions. After examining the petitioner's contentions and the record of the case, the Court found that there was no "misapprehension of facts" on the part of the Court of Appeals that would warrant the reversal of its judgment.

2. The Supreme Court affirmed the finding of the Court of Appeals that the petitioner was guilty of simple negligence, which resulted in the death of the patient. The Court held that the petitioner and the other doctor failed to provide adequate care to the patient, considering her vulnerable condition and the inadequate post-operative facilities of the hospital. Both doctors failed to appreciate the serious condition of the patient and did not monitor her closely or provide further medical care. Their conduct constituted simple negligence.

3. Yes, the petitioner anaesthesiologist violated the canons of his profession by not attending to his patient with the greatest solicitude.

4. Yes, the petitioner anaesthesiologist and Dr. Madrid exhibited a low level of diligence in the prescription of medication for their patient.

5. Yes, the rupture of the patient's appendix occurred during the appendectomy procedure and the accused were in control of the situation.

6. The court did not explicitly state the ruling on the issue of whether the accused were guilty of simple negligence.

7. The accused were guilty of simple negligence resulting in homicide. The court considered several factors: the failure of the accused to appreciate the serious condition of the patient and provide close patient care, the low level of care and diligence exhibited by the petitioner, the failure to inform the parents of the patient's true condition, and the failure to prove that they exercised the necessary degree of care and diligence to prevent the patient's decline and eventual death.

8. The petitioner was not denied due process. The court found that his counsel of record represented him with reasonable competence during trial. The petitioner had opportunities to terminate the services of his counsel or seek appointment of counsel de oficio, but he did not exercise them. The constitutional objection was deemed an afterthought.

PRINCIPLES:

• Only questions of law may be raised in a petition for review on certiorari before the Supreme Court.

• The cause of death in human beings can be complex and difficult to determine, with multiple events potentially contributing to the death.

• The identification of the "true cause" or "real cause" of death is not crucial; what is important is the set of circumstances that constituted negligence leading to the death.

• Doctors have a higher standard of professional diligence when dealing with patients in inadequate medical facilities.

• Physicians have a duty to serve the best interests of their patients and should attend to them faithfully and conscientiously.

• Physicians should use their professional skill and care to secure all possible benefits for their patients.

• Violation of the duty to fulfill obligations to a patient is discreditable and inexcusable.

• Physicians should exercise the necessary degree of care and diligence called for by the situation.

• Failure to exercise necessary care and diligence can be considered simple negligence, which is penalized under the Revised Penal Code.

• The chain of circumstances can establish the guilt of the accused.

• Negligence resulting in homicide can be considered a criminal offense.

• Medical professionals have a duty to inform the patients and their families of the nature of the illness and the events surrounding the patient's condition.

• A defendant in a criminal case is entitled to competent representation and a fair opportunity to be heard.

• Afterthought objections may be disregarded by the court.