A group of Miami plastic surgery clinics called Jolie Plastic Surgery lost eight patients in a spate of unprecedented casualties over the past six years, an investigation by USA Today found. Together, the facilities account for about 1 of every 5 plastic surgery deaths in the state of Florida, according to the report. The doctor in charge of the clinics, Ismael Labrador, has remained despite numerous preventable deaths. Labrador’s business is just one of more than a dozen high-volume plastic surgery clinics that have transformed Florida into a national destination for discounted cosmetic procedures. At Labrador’s clinic, unqualified doctors operate on as many as eight patients a day, the investigation found. Many of the fatalities were not the result of unavoidable surgical complications, but of serious mistakes, the report says. Four women died after their doctors mistakenly injected fat deep in their muscles during a popular surgery known as the Brazilian butt lift, records and interviews show. The procedure tore their veins, pooling blood in their hearts and lungs, and killing them in minutes, USA Today reports.

The Florida Department of Health has investigated at least a half-dozen deaths at Labrador’s clinics, charging at least two doctors with malpractice. Labrador has argued that doctors are responsible for patient deaths, not clinic owners. But disciplining the doctors hasn’t stopped patients from dying. The health department has the power to impose emergency suspensions on facilities that pose a public threat, but has not yet taken such action.