Plastic Surgery by a Non-Plastic Surgeon?

Reprinted from The Arizona Republic:



Liposuction deaths: Phoenix area doctor convicted of murder, manslaughter


by Michael Kiefer - Jul. 15, 2011 10:28 PM
The Arizona Republic


An Anthem physician who had three patients die during plastic-surgery procedures in his clinic was found guilty of murder and manslaughter Friday in Maricopa County Superior Court.


Dr. Peter Normann was pronounced guilty of second-degree murder in the deaths of Ralph Gonzalez, 33, of Scottsdale, and Leslie Ann Ray, 53, of California, and of manslaughter for the death of Alicia Santizo Blanco, 41, of Gilbert.


Throughout the trial, which began June 10, Normann's attorneys, John Johnsonand Vikki Liles, maintained that the deaths were accidental, the result of known risks of plastic surgery, and claimed that if Normann, 50, were found guilty, it would mean that all doctors would be liable for procedures gone wrong.




Autopsy findings had listed the deaths as accidental.


But in her closing arguments earlier this week, Deputy County Attorney Jeannette Gallagher said the "combination of incompetence and arrogance in trying to cover up his (Normann's) incompetence led to their deaths."


Gallagher claimed that two of the deaths constituted second-degree murder because of Normann's "extreme indifference to human life," and the third death was manslaughter because of Normann's "conscious disregard of substantial and unjustified risk of death."


After a day and a half of deliberation, the jury came back supporting Gallagher's side of the story.


Normann's friends and family were surprised at the verdict.


"He is not the monster he's been painted to be," said his friend Cindy Jones. "He's a pure, sweet man."


Liles said she and Johnson plan to file a motion for a new trial, claiming that Gallagher had committed perjury in insisting that Normann did not have inventory of a drug that could have saved the lives of one or more of the patients.


Normann had been an emergency-room physician, certified as an internist, and had never done a residency in plastic surgery or anesthesiology.


Gallagher maintained he had undergone six days of training in liposuction and had done some "hands-on training" in liposuction and breast augmentation. He had never done training in fat augmentation, Gallagher said.


Furthermore, she said, his operating room lacked proper oxygen and monitoring equipment, and he worked without anesthesiologists or nurses, relying on a massage therapist and a former restaurant worker with little or no training as medical technicians.


The massage therapist, who assisted in surgery, has already pleaded guilty to eight counts of unlawful practice of medicine and was sentenced last year to five years in prison.


Gonzalez stopped breathing during liposuction in December 2006, due to what Gallagher called a lethal dose of lidocaine, which is used in the procedure. Then, she claimed, Normann mistakenly inserted a breathing tube into Gonzalez's esophagus instead of his trachea, depriving him of oxygen.


When paramedics arrived, they noted that Gonzalez's belly was distended because of the oxygen being pumped into his stomach instead of into his lungs, and they maintained that they tussled with Normann, who insisted on riding in the ambulance and refused to let the EMTs reinsert the tube correctly.


David Duarte, one of the paramedics, told The Republic after the verdict, "He physically was holding onto it, from the get-go."


Duarte threatened to break Normann's arm and then tricked him into letting go of the tube so he could pull it out. Normann insisted on reinserting another.


Duarte said he filed complaints against Normann with the hospital and the state medical board.


Santizo died in April 2007 during multiple procedures, including repositioning a badly placed breast implant, liposuction and an attempt to inject fat into her buttocks to enhance its shape.


During the fat augmentation, Gallagher said, Normann injected the fat directly into a vein, which carried it to her lungs and killed her.


As had occurred during Normann's attempts to resuscitate Gonzalez, Normann was unable to properly insert a breathing tube.


Duarte, coincidentally, was in the hospital when Santizo was brought in, and he filed another complaint.


After the second death, Normann agreed to a voluntary suspension of his medical license and he hired a homeopathic physician, Gary Page, to do liposuction. Gallagher maintained that as a homeopath, Page was not qualified or licensed to perform such procedures.


Ray had traveled from her home in Blythe, Calif., for the surgery in July 2007, which Page performed with no assistance, serving as surgeon, anesthesiologist and monitor.


After the surgery, Page left the clinic, and Ray was left in a recovery room, where later that night, Normann discovered her in respiratory distress because of a reaction to the combination of drugs she had been given. Normann was again unable to insert a breathing tube when she stopped breathing.


Page was charged with manslaughter in Ray's death, but on Friday, he pleaded guilty to the lesser felony charge of endangerment.


Normann will be sentenced Aug. 19 by Judge Paul McMurdie.

Over the past few years, several things have become clear to me about this significant patient safety issue:

1. There are some people who will always knowingly and willingly put themselves at risk if doing so will allow them to save a few dollars... These patients probably cannot be helped.
2. Some physicians are inherently more ethical and moral than others... in other words, and as I have stated many times in the past, the days when it was safe to assume that all doctors were honest professionals with high levels of moral character and integrity are unfortunately over
3. Doctors with questionable ethics, morals, and training are capable of amazing acts of deceit (if not fraud) in order to attract patients and convince them to have surgery.
• The eye doctor here in Orlando who advertises heavily as an expert in liposuction even gives procedures long established in the legitimate plastic surgery community cute, trendy sounding names ("Naturalfill") to make it seem to patients that he is the only one knowledgeable in the technique, and that he has somehow captured magic in a bottle. This violates the code of ethics of the American Society of Plastic Surgeons- but because he is an eye doctor and not a plastic surgeon, he does not have to comply with this important ethical code.
• The same eye doctor advertises himself as "Board Certified", without saying in what or by whom. I believe this is actually a violation of Florida law- but again, no one will do anything about it until and unless there are complaints.
4. The tragic truth (at least so far) has been that when patients are injured or deformed as a result of surgery performed on them by an ER doctor, Eye Doctor (or anyone else without plastic surgery residency training) they almost never complain to the appropriate authorities.
5. Many Central Florida women don't realize that this problem is prevalent in their backyard. In Orlando alone, there are ER doctors, a urologist, and the eye doctor I describe (!) all claiming to be liposuction experts.

These last 2 facts are what I hope to contribute to changing.

I have found that for patients who have experienced the trauma of misplacing trust for their safety and happiness in someone other than a Board Certified Plastic Surgeon, the only thing that they believe could make their situation worse is to have to talk about how they ended up making the poor decisions that lead to their terrible outcome.

I've seen it over and over again in patients who come to see me for correction of problems resulting from surgery performed by local ER doctors and especially the local eye doctor... They want to have their problems corrected, but usually cringe at the notion of having to re-hash the experience as they would have to do if they complained to the authorities with the power to stop these untrained practitioners from practicing plastic surgery. I believe they behave very much like victims of sexual abuse...

Because there is a perceived stigma associated with being "duped" into compromising your safety and appearance, most of these patients won't complain...

But here's the problem... Unless and until patients injured and disfigured complain to authorities, the only way to stop untrained non-plastic surgeons from harming (or indeed killing) more patients is to wait for someone to die- this is the only circumstance that would require the state to investigate without a complaint. 

So unless someone dies, without people affected complaining, these doctors can go on performing procedures they are ill-trained to perform on unsuspecting patients- injuring more of them over time.

Please don't let yourself or someone you love be the victim of doctors practicing outside their training. And if you are, please contact the Florida Board of Medicine.