They came from different areas of the country – eight women, most of them young mothers, all seeking changes in their lives by undergoing cosmetic procedures.

One was a 29-year-old college student who wanted to open a halfway house for drug addicts. Another was a 40-year-old medical clerk who dreamed of competing in bodybuilding contests. And one was a 25-year-old former nursing student who planned to start a home health care business.

Their lives would end after surgeries in two related clinics in South Florida, raising questions about a plastic surgery business that promised to perform procedures at the highest medical standards.

A heart of gold: Heather Meadows

Show caption Hide caption The death of Heather Meadows, a 29-year-old mother of two from West Virginia, in 2016 prompted a state investigation that led to malpractice charges against... The death of Heather Meadows, a 29-year-old mother of two from West Virginia, in 2016 prompted a state investigation that led to malpractice charges against her surgeon by the Florida health department. James McAdoo, who denied any wrongdoing, will appear before the state board of osteopathic medicine. Submitted

For the parents of Heather Meadows, 29, a single mother, the questions lingered well after her death.

Though an autopsy showed she died of a fat embolism after cosmetic surgery in 2016, her mother said she was highly suspicious of the medical explanation.

"In your heart, you know it's not right," said Tammy Meadows.

For months, the family pressed for answers about her death, hiring a Miami lawyer and filing a complaint with the Florida Department of Health.

The doctor who performed the Brazilian butt lift on Meadows sent a report to the state two weeks after she died, saying "there are no issues to improve on" and the staff at the Miami-area clinic founded by Dr. Ismael Labrador acted appropriately during the emergency.

"No correction action taken," Dr. James McAdoo wrote.

But a state health department investigation two years later turned up troubling evidence that put the blame squarely on the surgeon for what were critical breakdowns in the operating room.

Investigators said the physician failed to perform an exam on the West Virginia woman before her surgery and then finished the procedure in just 55 minutes, less than half the time it takes to do the operation, records and medical experts said.

But the most serious mistake took place during the surgery when McAdoo injected her body fat into a deep vein in her buttocks – an area where doctors are warned to avoid – allowing the fat to enter her bloodstream, records and interviews show. An autopsy later showed the fat traveled into her heart and lungs, killing her.

The Florida board of osteopathic medicine will decide whether disciplinary action will be taken. Through his attorney, McAdoo, 49, denied any wrongdoing.

INVESTIGATION: This business helped make Miami a plastic surgery destination. Eight women died.

Tammy Meadows, who is raising her two grandchildren, 8 and 2, said the state inquiry helped shed light on questions that haunted her about errors they may have been committed during surgery.

"I don't know how they can lay down and sleep at night," said Meadows, 55, of West Virginia, who is suing the clinic on behalf of her daughter's estate. "When she died, a part of everyone else died, too."

Meadows said her daughter, who worked full-time while enrolled at Bluefield State College, was on the verge of doing something about the opioid crisis that had devastated their small community in southern West Virginia.

After years of working at a local employment agency, she found that people in drug recovery struggled to get jobs because of prior drug arrests, so they often returned to the same life as before. Her goal: open a halfway house to help them find work and shelter.

She had not worked out the details, but those who knew her said she had talked about it for years. "It was so hard for them to get jobs," said her mother. "She was determined. She was the kind of person when she put her mind to do something, she would do it. One part of her was hardcore, and she could make you know how she felt in a heartbeat. But deep down inside, she had a heart of gold."

Her new start: Maribel Hernandez

Maribel Hernandez, a 51-year-old mother of five and Walmart clerk from Naples, FL, was the first of eight women to die at a Miami area plastic surgery business since 2013. Submitted

Maribel Hernandez traded her long, modest dresses for blue jeans.

At 51, she was no longer a stay-at-home mom, her five children long grown. She was working as a stock clerk at a Walmart store outside Naples, Florida, and was leaving home more often, heading to the beach or dancing with friends.

Divorced, she was paying more attention to herself, family members said.

She wanted a cosmetic surgery that would reshape her body after five pregnancies: a Brazilian butt lift.

After she booked the procedure, Hernandez was so excited that she told her family she wanted to rent a boat to celebrate with them her 52nd birthday and her new body.

Still, her oldest son thought she would back out.

“I didn’t think she was going to go ahead with it because she was so chicken,” said Kermit Hernandez.

Weeks before the operation in 2013, she had a change of heart and tried to cancel it, said her son, Octavio Hernandez. But the clinic wouldn’t give her a refund and she didn’t want to lose about $3,000. She went ahead.

It was still dark when Hernandez left her apartment on the morning of the surgery, telling her son Octavio that she would be back later that day. Her boyfriend drove her more than 100 miles across the state.

Family members said Hernandez wouldn’t have questioned the credentials of the doctors, but instead trusted they knew what they were doing, they said.

Soon after the procedure, however, her blood pressure dropped and she struggled to breathe. The clinic staff called an ambulance, which rushed her to Kendall Regional Medical Center. She was later pronounced dead.

Anthony Hasan, the doctor who performed the procedure, was not board certified in plastic surgery. He did not respond to repeated interview requests.

Ismael Labrador, clinic founder, defended Hasan in an email, saying, “He is an excellent and very meticulous surgeon who achieves consistent and excellent results.”

However, medical experts who reviewed her autopsy showed that her body fat was injected into the very area that doctors are supposed to avoid: the deep, gluteal muscles.

The examination showed that veins in that area were torn, where medical experts say the fat had entered her bloodstream, traveling to Hernandez’s lungs and shutting down her vital organs.

OPINION: I'm a plastic surgeon who won't perform Brazilian Butt Lifts. They're deadly.

Seven other women would die at the facilities overseen by Labrador in the ensuing years, three from the same cause.

Kermit Hernandez said he grew frustrated after learning of the other fatalities. “I just can’t believe they are still doing it,” he said.

She needed a hospital: Tola Warren-St. Clair

Show caption Hide caption Tola Warren-St. Clair, 43, was a mother and school physiologist from New York who died the day after her tummy tuck surgery at the Miami... Tola Warren-St. Clair, 43, was a mother and school physiologist from New York who died the day after her tummy tuck surgery at the Miami clinic in 2014. She had visited the clinic the next day for severe pain, but was released and found dead in her bed about four hours later. Submitted

Tola Warren-St. Clair didn’t expect the wrenching pain. Lying in bed in the rental apartment in South Florida where she was recovering from her surgery, the Yonkers, New York, woman knew something was wrong.

“In the middle of the night, she felt like she couldn’t tolerate it anymore,” said Clayton Webster, a friend who accompanied the 43-year-old school physiologist to Miami for cosmetic surgery in 2014. “And she said, ‘We have to go to the emergency room.’”

Warren-St.Clair wondered if she should dial 911. Instead she called an emergency number provided by the clinic and was told to return to the facility, Webster said.

They both arrived in the morning.

It's unclear whether a doctor saw her when she returned. According to a report filed by her surgeon, Jonathan Fisher, a nurse examined her. “They took her in. They put her in the back. I’m assuming at that point they had everything under control,” Webster recalled.

At about 5 p.m., she was told she could go home, but she needed help to walk to her vehicle, according to Webster.

Not quite four hours later, she was found dead in her bed.

An autopsy by the Broward County medical examiner’s office in Florida showed she died from a combination of drugs prescribed for the surgery, coronary artery disease, and pulmonary fat embolism. Neither Fisher or Labrador, the clinic founder, responded to interview requests.

Miami plastic surgeon Dr. Bernabe Vazquez said the patient should have been examined by her doctor, especially when she complained after her surgery that she was in severe pain. If the doctor can't determine what causes the pain, the patient should be sent to a hospital.

Dr. Arthur Perry, an adjunct associate medical professor at Columbia University, said the clinic had a responsibility to find help immediately when she called. "If the physician was not available, then she should have been sent immediately to the ER," he said. "Postoperative complications are not diagnosed and treated by nurses."

Ultimately, she stood a better chance of being properly diagnosed in an emergency room rather than a cosmetic clinic, he said.

TIPS: Before scheduling a cosmetic surgery procedure, make sure you follow these 14 steps.

Family torn apart: Jasmine Smith

Show caption Hide caption Jasmine Smith, 30, a payroll clerk at Costco in Union, NJ, died of blood clots and other complications five days after her cosmetic surgery at... Jasmine Smith, 30, a payroll clerk at Costco in Union, NJ, died of blood clots and other complications five days after her cosmetic surgery at a clinic in Hialeah, FL, in 2017. "This has torn my family apart," said her older sister, Eva Smith. Submitted

For Eva Smith, the image is etched in memory: her sister, Jasmine, 30, collapsed in her arms as she struggled to breathe while an ambulance sped to the home.

Her cosmetic surgery in 2017 was supposed to bring some discomfort, but nothing like the searing pain that ripped through her chest. Within minutes she was dead.

An autopsy later showed she died from blood clots a few days after the operation, her surgery a contributing cause. But there are no records to show the Labrador clinic told the Florida health department that regulates the facilities.

The lack of reporting to the health department eliminated any chance the state would investigate or medical researchers could study her death.

"Unless someone calls the media, how are we going to know?" said Dr. Adam Rubinstein, a former board member of the American Society of Aesthetic Plastic Surgeons, part of a task force studying cosmetic surgery deaths in Miami-Dade County.

The death was among two that were not reported by doctors or medical staff at the Labrador clinics, a requirement under law. In both cases, the women died of blood clots several days after their procedures, autopsy records show. Labrador did not respond to interview requests about the cases.

Eva Smith said she's still trying to explain her sister’s death to her two young children, who were close to their aunt. "This has torn my family apart," said Smith, of Somerset, New Jersey. She said her sister, a Costco payroll clerk who put herself through community college, helped raise her nephews.

"She was their second mother," Smith said. "She was the cool auntie who took them to the mall, football practices, ice cream. This has been devastating."

Dr. Daniel Calva, who performed the Brazilian butt lift, did not respond to interview requests by phone and certified letters.

Smith said she is angry that her sister’s death was not reported to the state, which could have resolved questions about the surgery.

One doctor who reviewed the clinic records and autopsy said the doctor should have waited longer before operating, because Smith was taking an injectable contraceptive that can cause blood clots.

Dr. Arthur Perry said he would have waited four months from her last injection to avoid any complications.

On the other hand, clinic records show that another cause of the clots may have been because Smith flew back to New Jersey too soon after her procedure – against the orders of her doctor. Flying too soon after an operation can trigger blood clots, medical experts say.

An autopsy in New Jersey shows the contraceptive is cited as a contributing cause of her death, but not the plane flight.

Those questions have never been resolved. “It’s like her life never mattered,” Smith said.

This unreported death: Elizabeth Morales

Show caption Hide caption Elizabeth Morales, 41, a mother of two from Hialeah, FL, dreamed of someday competing in bodybuilding contests. But just five days after her cosmetic surgery... Elizabeth Morales, 41, a mother of two from Hialeah, FL, dreamed of someday competing in bodybuilding contests. But just five days after her cosmetic surgery at a Miami clinic, she died of complications from the procedure. Submitted photo

After raising her children alone, Elizabeth Morales found her passion: the gym.

At 41, the single mother began a daily ritual of weights, stretching, and calisthenics. After more than a year, she shed 80 pounds, a breakthrough for someone who had once weighed 250 pounds. Her goal: to compete in bodybuilding contests.

"She was ready for the next chapter in her life," said June Martinez, her sister.

To tighten her skin after the weight loss, she decided to have a tummy tuck and breast lift at Labrador’s clinic in March 2015.

But five days after the operation, she collapsed in her home in Hialeah and was rushed to the hospital, where she was pronounced dead. The cause: blood clots and complications from the surgery, an autopsy showed.

Her death stunned her two children, Alex, and daughter, Estefania, who were living with her in a two-bedroom apartment, Martinez said.

"They were left abandoned," said Martinez, who took them into her home.

Martinez, who had just lost her own son three months earlier to cancer, did not press the clinic for answers on what went wrong. “I was a zombie. I didn’t know what to do,” she said.

What's not clear is why the state did not investigate. All deaths tied to surgery centers are supposed to be reported to the health department.

Brad Dalton, an agency spokesman, said officials could not find any such report from the clinic or the doctor, McAdoo.

Dalton said the health department ultimately decides whether clinics violate the reporting requirement but would not comment on whether the state would investigate.

USA TODAY discovered Morales' death after requesting autopsy records from the Miami-Dade medical examiner's office on cases tied to cosmetic surgery procedures.

Neither the clinic or McAdoo responded to interview requests. One year after Morales died, another patient would not survive her surgery by McAdoo.

In that case, McAdoo reported the death of Heather Meadows to the state, which later launched an investigation and determined he committed malpractice. McAdoo has denied any wrongdoing in the case, which will be decided later this year by the state medical board.

Rescuers blocked: Maria Christian

Maria Christian, 32, suffered complications during her plastic surgery and later died. Submitted

Maria Valeria Christian was dying. More than an hour into her surgery, her heart slowed. The nurse in charge of the anesthesia gave her a drug to increase her rate, but it didn't help and she went into cardiac arrest.

The surgery team tried to revive the 32-year-old woman while a staff member called 911.

But when the paramedics arrived – a crew trained for precisely this event – they were blocked from the front entrance by the clinic staff and told to go around the building to a rear door, according to a lawsuit and fire-rescue report.

By the time they gained access, five minutes had passed, a critical lapse at a time she was undergoing cardiac arrest, said medical experts who reviewed the records.

“In all my years, I’ve never heard of anything like that,” said Dr. Arthur Perry, an adjunct associate medical professor at Columbia University. "That's an enormous breach of protocol."

Perry and two other doctors who reviewed the records said it’s unlikely Christian could have been saved during her tummy tuck procedure in 2016, but barring the rescue workers for that period time lessened the possibility that she could have been revived.

"In that kind of situation, every second counts," said Dr. Adam Rubinstein, chief of plastic surgery at Jackson North Medical Center in Miami.

Christian was rushed to the hospital, where she was declared dead. An autopsy found she died from micro blood clots and complications of the surgery. Dr. Camille Chavez, the doctor who performed the tummy tuck, did not return phone calls.

Just days before her operation, Maria Christian gathered her family on a Sunday in her apartment in Doral, Florida, to celebrate her youngest son’s second birthday with cake and a shrimp ceviche, one of her favorite recipes, said her sister, Maria Carolina Flor. It was the last time Flor would see her alive.

“She left in the best moment of her life,” Flor said.

A stay-at-home mom with two children, Christian planned to resume the journalism studies that she started in her native Ecuador once her youngest son became older. In the meantime, she wanted to study cosmetology and hoped to create her own makeup line, Flor said.

She had undergone a butt lift at Vanity Cosmetic Surgery months earlier and decided to return for the tummy tuck, her sister said.

Her death prompted the family to file a malpractice claim against the doctor, the nurse and the clinic. The case is still pending.

A month after her death, Flor received an email from the clinic because she was on the mailing list. The facility would no longer be known as Vanity Cosmetic Surgery. The email announced the new name: Eres Plastic Surgery.

She didn't know: Kizzy London

Show caption Hide caption Kizzy London, a 40-year-old mother of two and medical clerk from Louisiana, died in 2017 after cosmetic surgery at a Miami facility where at least... Kizzy London, a 40-year-old mother of two and medical clerk from Louisiana, died in 2017 after cosmetic surgery at a Miami facility where at least four other women died after undergoing procedures. The Florida health department later said the 75-year-old surgeon who performed the operation was not adequately trained to do the procedure. Submitted

The call for Edward Graves came shortly after 4 p.m. He needed to come to the Miami cosmetic surgery clinic immediately.

There was a complication during the operation on his fiancee, Kizzy London. She had slipped into cardiac arrest and was rushed to the hospital, but the clinic said she was going to be all right, he said.

"I said, 'Are you sure?' They said: 'Yes. She's going to be fine."'

Shortly after arriving at the hospital, however, Graves said he was told by the emergency room doctor that her condition was far worse than what was conveyed by the clinic. She was already dead.

"He said to me, "What did they tell you?"

Graves said the Miami clinic's call that day in December 2017 was the beginning in a series of discoveries about the facility that have left him perplexed and angry.

He said he learned other women had died during procedures at the same facility, but the name of the business had been changed after the deaths. And neither he nor his fiancee made the connection.

Then he found out the surgeon who carried out the Brazilian butt lift on his fiancee was not adequately trained in the procedure and botched it, according to a state malpractice complaint filed against him in August.

State health department agents also said the doctor, Arnaldo Valls, made a critical error during another surgery six months earlier on a patient who was hospitalized after he punctured her small intestine, according to state records. Valls, 75, denied that he injured the patient and is contesting the administrative charges in both cases.

Graves said he was upset when he learned about the doctor's credentials and the facility. "I didn't know any of this stuff," said the Louisiana native, 49. "How are they allowed to let this go on?"

The discoveries made it even more difficult for Graves because he and London, who were parents of two children, had plans to be married. In the weeks leading up to the surgery, he said, he tried to talk her out of the procedure.

"She was a pretty black woman," he said. "But I couldn't drive it into her head that she didn't need that."

He said that after turning 40 and giving birth to two children, she wanted to improve her appearance. The butt lift was a popular procedure because it enlarged the buttocks and made her look thinner. "She told me she didn't like her stomach," he said.

London, a medical clerk at the Baton Rouge Clinic, was a popular figure among a wide circle of friends and relatives in their hometown of Baton Rouge, Graves said. "She was the type of person when you first met her, you liked her."

He said that for months, he was unable to unpack her suitcase from the trip to Florida or clear her clothes from their closet. "It’s just the way she left it. I haven’t even touched it," he said.

Last surgery of the day: Ranika Hall

Show caption Hide caption Ranika Hall, a 25-year-old mother and former nursing student from Missouri, wanted to someday open her own home healthcare business. She died after undergoing a... Ranika Hall, a 25-year-old mother and former nursing student from Missouri, wanted to someday open her own home healthcare business. She died after undergoing a Brazilian butt lift operation in a Hialeah, FL clinic in 2017 when her surgeon injected her own body fat so deep in a muscle, it tore veins and allowed the fat to enter her bloodstream, autopsy records and experts said. Submitted

Ranika Hall’s surgery was the last procedure of the day for Dr. Daniel Calva, his ninth or 10th case since early morning.

It was already dark outside the Hialeah clinic when he had a few minutes left to finish Hall’s Brazilian butt lift in March 2017. But the ventilator triggered an alert and soon her heart rate plummeted. Calva knew what it meant.

“It’s the first thing I worried about,” he would later tell police in a statement. “I was like, ‘Oh, my God, this’s got to be a fat embolism.’”

He was right. He had injected fat too deep.

The autopsy showed loose globules of fat deep in Hall’s buttocks – an area known as a danger zone because of the risk of tearing large veins and causing the fat to enter her bloodstream. An autopsy showed deposits had invaded her lungs, causing a fat embolism.

Of the eight women who died after surgeries in clinics operated by Labrador since 2013, Hall was the youngest at 25.

A member of a close-knit family in Kansas City, Missouri, she had attended nursing school and wanted to start her own home health agency, her obituary said. Her daughter just weeks away from her second birthday.

Calva told police he had done many similar procedures, but three weeks later, he lost another: Jasmine Smith, who died of blood clots.

After the deaths of Hall and Smith, Calva stopped performing Brazilian butt lifts. He later said in an Instagram post that it was too risky.

“This is a very dangerous procedure. Ethically and morally I had to stop doing it,” he wrote in July. “The high rate of patients dying is unacceptable.”

A few weeks after Hall and Smith died, the clinic operators shut down the Hialeah facility where both operations took place.