What happened to Floridalma Roque? She went to Guatemala for plastic surgery and never returned.

Floridalma Roque arrived at the Perfektima clinic in Guatemala City on the morning of June 13 for a scheduled plastic surgery. A day later, Roque, a U.S. citizen, had disappeared without a trace.

Roque's family has been searching for her since then, and the experience has left them feeling lonely and desperate as they try to navigate two criminal justice systems and a stalling criminal investigation.

Roque's daughter Vida Roque, 22, told CBS News that on June 14 she spoke to her stepfather, Jeremias, who was crying and saying her mother never came back home from the clinic. Roque, who lives in New York, had undergone a successful surgery at the Guatemalan clinic a year earlier and returned to get liposuction on her back and arms, her daughter said. 

Her daughter said Roque didn't like to travel on her own and always was accompanied so it would be unusual for her to leave alone after the surgery. Vida called her mother's phone repeatedly but there was no answer. Rosario Sandoval, a relative, had agreed to pick up Roque from the clinic at 10 a.m. the day after the surgery, Vida said. 

Sandoval told Vida that she had driven to the clinic and spoken with the receptionist, who put her in touch with the surgeon. The doctor, Kevin Malouf, told Sandoval that Roque had left the clinic by 7 a.m. in an Uber.

That was the first of many red flags for the children of the 59-year-old caregiver from Queens. 

Changing and conflicting stories

"My mother does not know how to order an Uber, nor does she even have the app," Vida, who lives in Maryland, told CBS News. Her son Jose Lopez, 42, told CBS News he usually spoke to his mother every day, so he said it was strange he had not heard from her.

When Sandoval questioned her taking an Uber, Vida said Malouf told Sandoval that Roque had crossed the street. At first, he said she went on her own. Then he said she had been with a nurse and in a wheelchair. Malouf told Sandoval clinic staff helped her into the car.

His story kept changing, and the family felt he wasn't telling the truth. But they felt there was little they could do. The clinic is very popular, and considered one of Guatemala's most luxurious plastic surgery providers. It's in an upmarket neighborhood with nice stores, and Roque had been to the clinic before. 

"The clinic's responses did not add up," Vida told CBS News. 

The family viewed surveillance video obtained by the Guatemalan police that shows a woman being escorted from the clinic, but the family doesn't believe the woman in the video is their mother. The woman seen in the video is tall, and their mother is a petite woman, the children said. 

Vida contacted police in New York, but says she was told they couldn't do anything about a person missing in another country. 

She then approached the FBI and the U.S. Embassy in Guatemala City and asked for help locating her mother – but again to no avail. The Overseas Citizen Office in D.C. connected Vida to the FBI, she said, and officials said local authorities needed to handle the case and they could only make "strong suggestions."

A State Department spokesperson said, "We are aware of reports of a missing U.S. citizen in Guatemala, and we are monitoring the situation." The spokesperson added they work closely with local authorities as they carry out their search efforts and share information with families "however we can." 

Due to privacy concerns, the spokesperson said, no further comment would be provided.

The FBI national office did not respond to a list of emailed questions.

Miami-based attorney Frank Rubino, an expert in international criminal defense who represented Manuel Noriega before the United States Supreme Court, said the U.S. government needs an invitation from local law enforcement to conduct an investigation on foreign soil. 

Rubino said cases in Central America are particularly challenging, but he said the U.S. government should get involved because "she's a U.S. citizen," and would help if the family wants to see results. The FBI could seek permission from Guatemalan authorities to investigate Roque's disappearance, he said. 

Doctor arrested  

Eventually, the case was investigated by Guatemalan police, who obtained the surveillance video from the clinic, the nation's Public Ministry, which oversees justice matters, said in a statement to CBS News.

Clips from the surveillance video appear to show a patient with a bandaged head leaving the office; the family says they don't recognize the person, and additional surveillance video shows seemingly odd behavior by the doctor and clinic. It shows clinic staff taking out a large garbage container and bags the night of Roque's disappearance. 

Guatemala's Public Ministry, in response to CBS News' questions, said that "on July 28, 2023, the Prosecutor's Office against the Crime of Femicide carried out search, inspection, registration and seizure of evidence in four properties due to a report being filed two weeks earlier by the Roque family."

The police arrested the doctor and some clinic staff, including nurses, an anesthesiologist and an assistant from the clinic. Kevin Malouf, Ligia Silva, Luis Castro and Susana Rojas were arrested, the Public Ministry said. The Public Ministry said that the Prosecutor's Office against the Crime of Femicide presented sufficient investigative means to link the four accused to Roque's disappearance and charge them with kidnapping and obstruction of criminal action.

In a June 19 statement on his Facebook account, Dr. Malouf said after a successful surgery Roque left the clinic at 7:00 a.m. from the lobby in a wheelchair then she got into a vehicle and left.  Malouf said afterward he had no communication with Roque and "learned about her disappearance the same day."  

On October 19, the court issued precautionary measures to the bank accounts related to the doctor, the Public Ministry said, and Malouf is being held in jail. The investigation is ongoing, the Public Ministry confirmed to CBS News.

There has been no sign of Roque since her disappearance. 

Caught between two worlds

Roque's children told CBS News they have received no death certificate from authorities in the U.S. or Guatemala, and they don't have their mother's body. More than six months after Roque went missing, her apartment remains as she left it, and there hasn't been an avenue for the family to have her declared deceased.

If Roque is never found it can take months or years for the family to get a death certificate. Because there is no body the family is in a difficult situation, said Renée Williams, Executive Director of the National Center for Victims of Crime, as if you don't have a body someone could have just disappeared. There are concerns of insurance fraud said Williams and courts want to make sure that "person won't come back." 

In Roque's case prosecutors have not proven a crime has been committed. 

"Declaring someone dead without a body – especially with the extra layer of the crime happening outside of the country – is a complex process," said Williams. 

Crime victims or their families should immediately reach out to a victims' support group, said Williams. Advocates should be able to provide resources to the family and help them navigate the often tricky path to closure.

Roque's children, siblings and husband have traveled to Guatemala to pressure investigators on the case. 

Her son Jose Lopez, said, "it's been very difficult because the doctor is someone with lots of resources and money."

Jonathan Villatoro, the Roques' lawyer in Guatemala advising the family, said the case has been on hold because he and the family want to get a "high impact-judge for the type of crime being tried" assigned to the case. The Public Ministry said the defense asked for a change in judge.

"We're caught in between two worlds," said Vida, as her family waits and hopes for answers.

In:
• Guatemala
• United States Department of State
• New York

Cara Tabachnick

Cara Tabachnick is a news editor and journalist at CBSNews.com. Cara began her career on the crime beat at Newsday. She has written for Marie Claire, The Washington Post and The Wall Street Journal. She reports on justice and human rights issues. Contact her at cara.tabachnick@cbsinteractive.com