NOTICE: NOT FOR OFFICIAL PUBLICATION.

UNDER ARIZONA RULE OF THE SUPREME COURT 111(c), THIS DECISION IS NOT PRECEDENTIAL

AND MAY BE CITED ONLY AS AUTHORIZED BY RULE.

IN THE

ARIZONA COURT OF APPEALS

DIVISION ONE

STATE OF ARIZONA, Appellee,

v.

PETER NORMANN, Appellant.

No. 1 CA-CR 17-0416

Appeal from the Superior Court in Maricopa County

No. CR2009-006785-001

The Honorable Sherry K. Stephens, Judge

AFFIRMED

COUNSEL

Arizona Attorney General's Office, Phoenix

By Michael O'Toole

Counsel for Appellee

Law Offices of Stephen L. Duncan, PLC, Scottsdale

By Stephen L. Duncan

Counsel for Appellant

FILED 9-20-2018
STATE v. NORMANN

Decision of the Court

2

MEMORANDUM DECISION

Presiding Judge Diane M. Johnsen delivered the decision of the Court, in 

which Judge Maria Elena Cruz and Judge Randall M. Howe joined.

J O H N S E N, Judge:

¶1 Peter Normann appeals his conviction of second-degree 

murder, a Class 1 felony. For the following reasons, we affirm.

FACTS AND PROCEDURAL BACKGROUND

¶2 Normann, a licensed physician, opened his own medical 

clinic in 2005.

1 Three patients died after suffering complications with

cosmetic surgeries performed at Normann's clinic between 2016 and 2007.

See State v. Normann, 1 CA-CR 11-0696, 2013 WL 4859655, at *1, ¶¶ 2-4 (Ariz. 

App. Sept. 12, 2013) (mem. decision).

¶3 In 2009, the State charged Normann with two counts of 

second-degree murder, each a Class 1 felony, and one count of 

manslaughter, a Class 2 felony. Counts 1 and 3 alleged Normann

committed second-degree murder when, under circumstances "manifesting 

extreme indifference to human life," he recklessly engaged in conduct that

created a grave risk of death and thereby caused the death of R.G. on 

December 12, 2006, and L.R. on or between July 3 and July 4, 2007. Count 

2 alleged Normann committed manslaughter when he recklessly caused the 

death of A.S. on April 25, 2007.

¶4 The superior court denied Normann's motion to sever the 

three charges. At trial, the State presented evidence that Normann

recklessly caused each of the three deaths. See Normann, 1 CA-CR 11-0696, 

2013 WL 4859655, at *1, ¶ 5. The jury found Normann guilty as charged,

and the court sentenced him to a total of 25 years' imprisonment.

¶5 On appeal, Normann argued the superior court erred in 

denying his motion to sever. Id. at *1, ¶ 1. We held the court erred in 

denying the motion to sever because there was no valid basis for the cross-

 

1 We view the facts in the light most favorable to sustaining the 

verdict. State v. Payne, 233 Ariz. 484, 509, ¶ 93 (2013).
STATE v. NORMANN

Decision of the Court

3

admissibility of evidence on all three charges. Id. at *6, ¶ 23. We further 

held the error was not harmless and vacated Normann's convictions and 

sentences. Id. at *6, ¶ 25.

¶6 On remand, the State elected to try the three charges 

separately and proceeded to trial first solely on Count 3 involving the third 

victim, L.R. The State gave notice before trial, however, that it would offer 

evidence of Normann's role in the deaths of R.G. and A.S., the first two 

victims, to establish Normann's mental state in causing the death of L.R., 

the final victim, under Rule 404(b) of the Arizona Rules of Evidence. Over

Normann's objection, the superior court issued a detailed minute entry 

analyzing each of the six categories of acts the State intended to offer, and 

ruled it would allow evidence that, with respect to R.G. and A.S., Normann 

failed to: (1) properly administer medications and/or anesthesia, (2) 

properly monitor and intubate the victims, (3) properly equip and staff his 

clinic and (4) promptly contact 9-1-1.

¶7 At trial thereafter, witnesses testified that L.R. went to 

Normann's clinic for a liposuction procedure on July 3, 2007. Dr. Gary Page, 

licensed only in homeopathic medicine, performed the procedure and 

Normann assumed responsibility for L.R.'s post-operative recovery. 

Normann left L.R. alone in a procedure room without suitable hydration or 

monitoring and, when he returned, L.R. was no longer breathing. 

Normann then improperly intubated L.R., perforating her esophagus and

forcing air into her chest and abdominal cavity. Normann delayed

contacting 9-1-1 and, when paramedics arrived, did not inform them of the 

failed intubation. Medical experts testified that L.R. died of respiratory 

arrest caused by a complication with anesthesia and "free air" in the chest 

and abdominal cavities likely resulting from the perforation of her

esophagus.

¶8 Pursuant to the superior court's pretrial ruling under Rule 

404(b), witnesses testified that R.G. and A.S. went to Normann's clinic for 

cosmetic surgery in December 2006 and April 2007, respectively. During 

R.G.'s liposuction procedure, Normann administered local anesthesia and 

R.G. went into respiratory and cardiac shock. Normann improperly 

intubated R.G., forcing air into his abdomen. Normann delayed contacting

9-1-1 and physically prevented paramedics from providing care to R.G. 

When Normann attempted to intubate R.G. a second time, "blood started 

pooling out" of R.G.'s mouth. Medical experts testified that R.G. died of 

"drug intoxication with inappropriate intubation following [respiratory] 

arrest."
STATE v. NORMANN

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¶9 With respect to A.S., witnesses testified her heart stopped 

after surgery, but Normann failed to properly intubate her, delayed 

contacting 9-1-1 and did not inform paramedics of the procedure he had 

performed. Medical experts testified that A.S. died of a pulmonary fat 

embolization caused by the procedure. As with the other two incidents, 

paramedics who responded testified that Normann's clinic was not 

properly equipped for operative or post-operative procedures.

¶10 The Arizona Medical Board ("Board") began investigating the 

first two deaths in May 2007. Board representatives testified that 

Normann's clinic was not properly equipped, medications were not stored 

properly, equipment maintenance records were absent and clinic staff had 

little to no medical training. Pending conclusion of the Board's 

investigation, Normann agreed that he would not perform or supervise

medical procedures in his clinic. This agreement was in effect at the time 

of L.R.'s death. The Board investigated L.R.'s death, made findings similar 

to those it had made in connection with the two previous patient deaths

and referred the case to law enforcement.

¶11 The superior court provided a limiting instruction, directing 

the jury that it could consider evidence concerning the other two deaths 

only to establish Normann's intent, knowledge or absence of mistake in 

connection with L.R.'s death. The jury found Normann guilty; later,

Normann pled guilty to the other two charges and agreed that the second 

offense constituted a repetitive offense for sentencing purposes. The court 

imposed concurrent sentences, the longest of which was 14 years'

imprisonment.

¶12 We have jurisdiction of Normann's timely appeal pursuant to 

Article 6, Section 9, of the Arizona Constitution, and Arizona Revised 

Statutes ("A.R.S.") sections 12-120.21(A)(1) (2018), 13-4031 (2018), and 

-4033(A)(1) (2018).2

DISCUSSION

¶13 Normann argues the superior court erred under Arizona Rule 

of Evidence 403 in allowing the State to present other-acts evidence under 

Rule 404(b). Normann argues admission of the other-acts evidence 

prevented him from receiving a fair trial. We review the admission of 

 

2 Absent material revision after the date of an alleged offense, we cite 

the current version of a statute or rule.
STATE v. NORMANN

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other-acts evidence for an abuse of discretion. State v. VanWinkle, 230 Ariz. 

387, 392, ¶ 18 (2012).

¶14 Evidence of other acts generally is inadmissible to prove a 

person acted in conformance with a character trait. Ariz. R. Evid. 404(b); 

State v. Roscoe, 145 Ariz. 212, 216 (1984). However, other-acts evidence may 

be admissible to prove intent, knowledge, or absence of mistake or accident, 

if the evidence is relevant and the risk of prejudice does not substantially 

outweigh the evidence's probative value. Ariz. R. Evid. 404(b); Ariz. R. 

Evid. 403; State v. Goudeau, 239 Ariz. 421, 444, ¶ 58 (2016). Evidence is 

unfairly prejudicial if it "has an undue tendency to suggest decision on an 

improper basis, such as emotion, sympathy or horror." State v. Mott, 187 

Ariz. 536, 545 (1997). If requested, the superior court also must provide an 

appropriate limiting instruction. Ariz. R. Evid. 105; State v. Lee, 189 Ariz. 

590, 600 (1997).

¶15 To convict Normann of the charged offense, the State had to 

prove, among other things, that he was aware of and consciously 

disregarded a substantial and unjustifiable risk and his conduct created a 

grave risk of death to L.R. See A.R.S. §§ 13-105(10)(c) (2018), -1104(A)(3) 

(2018). As to use of evidence concerning any two of the deaths to prove 

Normann's guilt in a third, we noted in the first appeal that: 

the probative value of the evidence of the three offenses 

would flow solely in one direction – from the earlier to the later. 

For example, while the circumstances of the death of the first 

patient in December 2006 would inform Normann as he 

treated the second and third patients in subsequent months, 

the circumstances of the deaths of the second and third 

patients could not have informed Normann as he treated the 

first.

Normann, 1 CA-CR 11-0696, 2013 WL 4859655, at *3, ¶ 14 (emphasis added). 

We reasoned that "the knowledge Normann gained by his alleged failure in 

[the earlier] case might be relevant to actions he took with respect to a later 

patient who required emergency care." Id. at *4, ¶ 17.

¶16 The State's approach in the retrial on remand was consistent 

with this reasoning: It properly presented other-acts evidence related to 

R.G. and A.S. to establish that Normann knew of the risks involved in 

performing or supervising procedures at his clinic and consciously 

disregarded them. See State v. Buot, 232 Ariz. 432, 433, ¶ 6 (App. 2013) (prior 

threats admissible to establish intent or absence of accident in second-
STATE v. NORMANN

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degree murder prosecution); State v. Woody, 173 Ariz. 561, 563 (App. 1992) 

(prior conviction admissible to establish reckless mental state); State v. 

Smith, 130 Ariz. 74, 76 (App. 1981) (prior abuse admissible to establish

reckless mental state). The superior court properly found the other-acts 

evidence was admissible for a proper purpose under Rule 404(b).

¶17 Without citing any specific evidence, Normann broadly 

argues evidence of the first two deaths was inadmissible under Rule 403. A 

superior court's balancing of the prejudice and probative value of evidence 

under Rule 403 is a matter within the sound discretion of the court. State v. 

Taylor, 169 Ariz. 121, 126 (1991). Here, the three deaths all occurred within 

a seven-month period at the same location under similar circumstances, 

and the first two triggered an investigation by the Board that remained 

pending at the time of the third death. Although the other-act evidence was 

tragic, the record does not show that use of the evidence suggested a verdict 

on an improper basis or prevented Normann from receiving a fair trial.

Although Normann broadly argues the evidence was unfairly cumulative,

the superior court ruled before trial that he could object to specific evidence 

on that ground, and he cites no occasion on which he made such objection. 

The other-acts evidence was relevant to the issue of Normann's mental 

state, its probative value was not substantially outweighed by unfair 

prejudice, and the superior court provided an appropriate limiting 

instruction.

3

 

3 Without supporting citations or argument, Normann argues 

admission of the evidence violated his rights to "due process, an impartial 

jury, [and] equal protection." We will not address an issue for which a party 

provides no supporting argument or legal authorities. See State v. Carver, 

160 Ariz. 167, 175 (1989).
STATE v. NORMANN

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CONCLUSION

¶18 For the foregoing reasons, we affirm the conviction and the 

resulting sentence.