1

CARILLO vs. PEOPLE G.R. No. 86890 (January 21, 1994)

Petitioner Dr. Leandro Carillo, an anesthetist, was convicted by the RTC (affirmed by CA along with Dr. Madrid) of the crime of simple negligence resulting in homicide, for the death of his thirteen-year-old patient Catherine Acosta (operated on for appendectomy). Only Dr. Carillo filed this petition for reversa of the CA decision. In this case, the patient Catherine was ambulatory prior to the operation but was observed to be shivering afterwards and with abnormal heartbeat. She was diagnosed as comatose and later died. The CA held that Catherine suffered from an overdose of, or an adverse reaction to anesthesia, particularly the arbitrary administration of an experimental drug Nubain (a pain killer), without prior weighing. It ruled that this triggered off a heart attack as a post-operative complication, and that this is the immediate cause of Catherine’s death. Petitioner, however, argues that the cause of death was a ruptured appendix, which led to blood poisoing. Issue: W/N Dr. Carillo is guilty of simple negligence resulting in homicide. Ruling: Yes.  Medical evidence presented at the trial was consistent with findings of the CA whch concluded that an overdose of, of adverse reaction to Nubain, an anesthetic and pain-killing drug the appropriate dose of which depends on the body weight or mass of the patient, had triggered off cardiac arrest, which in turn led to lack of oxygen in Catherine’s brain, which then brought about hemorrhaging in the brain. The order sheet did not contain the precaution against the drug; prescription was made in Dr. Carillo’s handwriting but was unsigned, instruction was openended in that some other individuals still had to determine if circumstances existed warranting administration of the drug. Since he entered subsequent prescriptions on the same order sheet, he was in a position to correct eh anomaly but he did not, this is an abdication of his duty to his patient.  While there was no proof to establish whether overdose of Nubain or ruptured appendix could have exclusively caused the death, Court ruled that what is of critical importance is the set of circumstances which the lower courts appreciated as constituting simple negligence of the doctors. - When patient was wheeled out of operating room, showed signs of instability (shivering, irregular breathing, etc), was not brought to a properly-equipped recovery room. Worse, the doctors left her, anf fifteen minutes later she suffered cardiac arrest. - Inadequate care considering the patient’s condition, failed to monitor patient. Once summoned, petitioner could not be readily found, and when he finally appeared was in bad temperand evidently indisposed to attend to the patient, in violation of the canons of

-

-

medical profession that as a physician, he should servce the interest of his patient ‘with the greatest solicitude, giving them always his best talent and skill.’ It requires a physician to ‘attend to his patients faithfully and conscientiously.’ No intensive preoperative preparations, i.e. administration of antibiotics, which s a standard procedure for patients who are, after being diagnosed, suspected of suffering from a perforated appendix and consequent peritonitis. Rupture of appendix happened during the appendectomy procedure, that is, at a time and place where the two accused were in full control of the situation and could determine decisively what needed to be done.This needs to be considered in conjunction with other related circumstances, that she was ambulatory when brought to the operating room, that she left the operating room in serious condition. Both doctors failed to inform the parents of the nature of her illness, and to explain the dramatic deterioration of her condition after surgery. To give atruthful explanation was a duty imposed by the canons of the medical profession.

The gravamen of the offense of simple negligence (Art. 365, RPC) is the failure to exercise the negligence necessitated or called for the situation which was not immediately life-destructive but which culminated, in the present case, in the death of a human being three days later. Such failure is a negative ingredient of the offense which prosecution must prove to establish prima facie basis of guilt of the accused. Thereafter, burden is shifted to accused to disprove or counter the proof of the negative ingredient. This rule is particularly applicable where the negative ingredient of the offense is of such a nature or character as, under the circumstances, to be specially within the knowledge or control of the accused. 50 In the instant case, the Court is bound to observe that the events which occurred during the surgical procedure (including whether or not Nubain had in fact been administered as an anesthesia immediately before or during the surgery) were peculiarly within the knowledge and control of Dr. Carillo and Dr. Madrid. It was, therefore, incumbent upon the two (2) accused to overturn the prima facie case which the prosecution had established, by reciting the measures which they had actually taken to prevent or to counter the obviously serious condition of Catherine Acosta which was evident right after surgery. This they failed or refused to do so. Wherefore, the decision of the CA is affirmed.