AUSTIN (KXAN) – It took nearly 27 years, but Caitlin Duvall finally had it all figured out. After traveling the world, studying the culinary trade at one of France’s premier schools, Duvall had found her career target: healthcare administration.

Duvall was headed off to Texas State University for her master’s degree. “She was very proud, very excited of her accomplishments, had a big party planned,” Duvall’s mother, Laura Duvall, told KXAN. “The doors were just opening for that kid.”

Duvall’s family had a huge 27th birthday party planned for her, but, first, she had a few finishing touches she wanted to take care of.

Duvall and her mother scoured the internet, looking for the right plastic surgeon to do what Laura Duvall called “minor body sculpting.” The pair settled on Dr. Lawrence Broder, an Austin-area cosmetic surgeon who owns and operates five Beleza Medspa’s across Central Texas.

In July 2017, Duvall went into Broder’s Cedar Park surgery center to have fat removed from her abdomen and then used to reshape one of her breasts. “She’s young, healthy, 26 years old, picture of health. So, why not,” said her mother. “She wants to do it, it’s her money. It was her birthday gift and her graduation gift she said to herself.”

She was in and out of the surgery room in a few hours. Duvall and her mother were sent home that afternoon with a prescription and instructions from the doctor’s office on how to care for the wounds.

Duvall never made it to her 27th birthday party. She died four days after the surgery, just one week shy of her birthday.

An autopsy report that took four months to complete provided the family some answers as to how she died. The medical examiner wrote in the report that Duvall died “as a result of complications of a cosmetic surgical procedure.” The doctor determined Duvall “developed a toxic shock like-syndrome for which she was hospitalized. Despite aggressive therapy, she died 4 days after the procedure.”

The autopsy report does not indicate how the infection happened or where it could have come from.

“You think, why is she gone? If she is dead, why? And, there’s no good answer,” Laura Duvall said.

At the time of Duvall’s procedure, Broder was under investigation by the Texas Medical Board (TMB) for a separate case from 2016. The Duvalls were not aware of the investigation until KXAN notified them.

The Board’s findings claim Broder committed multiple violations of the Texas Medical Practice Act. The TMB report was published on its website one month after Duvall’s death. It was a case the TMB spent 17 months investigating, but the public had no way to know an investigation was underway.

Around March of 2016, a doctor who was fired by Broder filed a complaint with the TMB accusing him of violating multiple sections of the state’s Medical Practice Act. The complaint, among other allegations, centered on a liposuction procedure Broder performed in January 2016 on a woman the TMB complaint detailed as “Patient One.” The woman’s identity is protected in the state’s investigation documentation.

“It was not a normal case,” said former Beleza Medspa aesthetician Ryan Harlan, who was helping in the operating room during the liposuction according to the Medical Board’s report. Investigators determined Broder failed to “maintain an adequate medical record,” didn’t “safeguard against potential complications,” and used workers “not qualified” in the operating room.

Harlan said she was one of the employees who did not have the qualifications to assist during the procedure.

The patient told investigators it felt like surgical instruments were “rubbing against her bones” during the procedure.

“She was definitely in pain, in my opinion, was in more pain than any other patient that I’ve seen,” Harlan told KXAN investigator Jody Barr. “She lost consciousness. She turned blue, was unresponsive. The patient is awake during the whole procedure, so nobody should be losing consciousness.”

For the pain, Broder gave the patient multiple Ativan-commonly known as Lorazepam pills-and an “unspecified amount of hydrocodone,” according to the report.

“More medication. That was his response, just give her some more medication,” Harlan recalled.

The investigation shows Broder terminated the procedure and gave the woman more medication “to revive her.”

That patient survived. Harlan said she quit the day after that liposuction.

Along with the January 2016 liposuction allegations, the TMB also accused Broder of intimidating a witness in the investigation, intimidating the doctor who filed the original tip against him, deceptive advertising and failing to properly treat a nurse he accidentally stuck with a used needle during a surgery in May 2015.

KXAN asked Broder for an interview, but he had his attorney decline. Broder also would not answer questions when KXAN’s reporter approached him in person at his office. Broder’s attorney did provide a copy of his answer to the medical board’s complaint.

Broder, through his attorney, denied all allegations against him relating to the complaint, responding, “The Board’s complaint contains numerous misstatements, assuming facts not in evidence, erroneous conclusions, and taking as truth the comments of former employees and business partners of Respondent [Broder] who were terminated and actively involved in civil lawsuits against Respondent [Broder].”

Earlier this month, Broder’s attorney told KXAN his client filed with the State Office of Administrative Hearings (SOAH) to have two of the allegations in the TMB’s published complaint against him dismissed. In the SOAH motion, Broder’s attorney asserted, “the board lacks evidence to demonstrate a violation of the Medical Practice Act” and asked the judge to dismiss allegations Broder used deceptive advertising and failed to properly treat his nurse following a 2015 needle stick.

KXAN has confirmed through sources the TMB is now investigating a second complaint against Broder. When KXAN asked for a comment regarding the new complaint, Broder’s attorney responded, “Due to patient confidentiality, regulations and laws – doctor Broder is unable to comment at this time.”

Meanwhile, under Texas law, Broder is permitted to continue to practice.

KXAN analyzed five years of Texas Medical Board complaints and agency budget records to figure out how long other doctor misconduct investigations take to become public. It’s not a quick process.

State law provides protection for doctors when complaints are filed, only publishing a complaint once the TMB investigates and finds a claim of doctor misconduct has merit. This prevents a doctor’s reputation from being tarnished by baseless accusations.

TMB records show that since 2010, the agency has received more than 51,000 complaints against doctors, physician assistants, and acupuncturists. Only a quarter of those turned into a formal investigation. Meanwhile, doctors under a formal investigation can continue treating patients and performing surgeries without monitoring or oversight by the State, and leaving the public in the dark.

• Place a complaint with the Texas Medical Board

TMB records show it takes an average of 296.5 days from the time the agency receives the original complaint to investigate it, negotiate a settlement with the doctor, then close the case.

If the TMB is unable to negotiate a settlement with the doctor, the case then goes before the State Office of Administrative Hearings for a review and determination, which can extend the process up to another year.

“If we find that this person cannot keep on practicing-for whatever reason-and we find that as part of our investigation, we’re going to act on it immediately,” TMB President Dr. Sherif Zaafran told KXAN.

“Remember, there’s two things we’re balancing out here: there’s the protection of our public, but also we’ve got to make sure we’re going through due process with our licensees,” Zaafran said.

But, procedural hurdles in gathering evidence and doctor records can drag these investigations out, Zaafran explained. “It’s not a perfect process, but that’s what we’re kind of limited to be able to do.”

Zaafran said the average length of investigation takes his agency between 180 and 195 days. When a doctor disputes the TMB findings the length of time to resolve the case takes significantly longer.

Just last year, Texas lawmakers completed a two-year top-to-bottom review of the Texas Medical Board. The legislature’s Sunset Review Commission was trying to ultimately determine whether the TMB should continue to exist. It’s a process all state agencies go through every decade.

The Commission’s report shows a list of six items listed as “Issues” the Commission was looking to correct within the TMB, none of which appear to have dealt with investigation timelines.

Rep. Cindy Burkett, R-Sunnyvale, was tasked with authoring and filing the TMB’s Sunset Review legislation by the end of the 2017 legislative session.

Burkett would not agree to an interview with us after multiple attempts, so KXAN questioned Burkett’s Chief of Staff, John McCord, at the Texas State Capitol.

When asked if the lawmaker was aware of the TMB’s investigation timeline, McCord responded, “I think that the state has a great review of state agencies, but like I said, I think someone who is on Sunset is the most appropriate to address those issues.”

KXAN also approached Rep. Tom Oliverson, R-Houston, who is a practicing anesthesiologist, and holds a seat on the Public Health Committee with Burkett. When we presented Oliverson the results of our TMB investigation analysis, the doctor was surprised to learn the average time it takes the TMB to close a doctor misconduct case is 296 days.

“If it really, truly is that long, that does seem kind of long to me and that’s something, maybe, we should look into,” said Oliverson.

Oliverson thinks doctors deserve a fair shake during investigations, but said the public needs to be protected, as well. “Maybe it is optimal, I don’t know. But, it’s certainly a question worth asking and it’s worth investigating,” Oliverson said.

Oliverson said he plans to bring the TMB timelines before his committee to find out whether those times can be reduced. As of this report, Oliverson has not detailed a timeline for that to happen.

Caitlin Duvall’s family hopes those efforts get answers for Texans.

“We know that nothing we do here that’s going to bring Caitlin back,” Tim McBride, Duvall’s step-father said. “The only reason we do this is for other people. That’s why we’re talking to you. If it helps somebody else, then it’s been worth it.”

“She was wanting to get into Austin politics, I guess this is her attempt,” Laura Duvall said.

The Texas Medical Board will undergo another review by the legislature in 2019, something that wasn’t supposed to ordinarily happen again until 2029. Legislation authored by Rep. Burkett to continue the agency for the next 10 years did not pass in the 2017 session. In the special session that followed, lawmakers did pass a bill continuing operation of the Medical Board for the next two years.