Prosecutors say he should not have even attempted the operation.
The doctor has been charged with manslaughter.
Prosecutors say he did what's called "Smart Liposuction" surgery on a woman even though he knew she had a heart transplant that increased her chances of serious complications.
The former liposuction doctor Oleg Davie said nothing in court Thursday, but his defense attorney had plenty to tell the judge, stressing that what happened to 51-year-old Isel Pineda is tragic but not a crime.
"The fact that she had a transplant or not was not the determining factor of her death," said James DiPietro, Davie's defense attorney.
Well that's neither what prosecutors say nor the family of Pineda, who went in for the procedure called "Smart-Lipo" last May.
They say she wanted it after seeing Dr. Davie's internet ad touting a discount and that Isel was no candidate for Lipo, so she paid dearly.
"Shortly after the procedure was performed, Ms. Pineda collapsed in Dr. Davie's office, her heart stopped, and she died," Kings County District Attorney Charles Hynes said.
"I couldn't believe it, I didn't understand it, I thought it was all a bad dream," said Marni Pineda, the victim's brother.
Isel's brother tells Eyewitness News she had a heart transplant back in 2004.
Prosecutors say the medical records prove that the doctor knew and covered it up.
The original form shows her condition and all the medications that go along with it, and a form shows how Dr. Davie allegedly altered it after her death, leaving all of it blank.
"The documents I suppose you could describe appropriately as the smoking gun," Hynes said.
The New York State Health Department also took issue with the doctor as far back as 2011, when he was placed on a 3-year probation after other complaints.
Meanwhile, the doctor's attorney insists that Isel Pineda was a candidate for "Smart-Lipo" because there's no general anesthesia.
As for the alleged cover-up, they had an explanation.
"Sometimes when people are being accused falsely, sometimes panic sets in, and that might have happened here," DiPietro said.
Isel's friends and family are just hoping a manslaughter charge brings justice although it won't bring back a woman who seemed to value her life, so much.
"In charge, enjoyed life even before the heart transplant, and when she was given a second chance, thank God, she even appreciated it even more," Marni Pineda said.