Primum non nocere, a doctor's sacred duty to first, do no harm. A doctor takes the Hippocratic Oath promising to do all they can to save lives. It is startling to think that any doctor would consider undertaking an operation or treatment, knowing full well they will likely harm the patient. However, on Monday, an unlicensed cosmetic surgery from Yonkers was sentenced to nine months in jail for doing just that.

Elsa Then, 58, was called cold and calculating by prosecutors. She performed plastic surgery on several women even though she was not qualified to perform them. She ran a phony surgical clinic out of her Bronx apartment, preying on naïve Hispanic women.  

On March 16, 2009, Then allegedly improperly injected silicone into the buttocks and thighs of Fiordaliza Pichardo, 43. She allegedly used paper towels, Band-Aids, and industrial strength glue in order to finish her botched operations, as reported by the Daily News.  Pichardo fell ill hours after the operation, receiving an infection from the surgery. Then attempted to cover up what she had done by appearing at the hospital and the victim's removing bandages. However, Pichardo eventually succumbed to her infection.

Some might describe what happened as tragic accident, but it was not that, Judge Martin Marcus said to Then at her sentencing, according to the Daily News. You lulled [the victim] into trusting you and presented yourself as a professional.

One can only speculate the reasons why Then would perform an operation that she was not licensed to conduct. However, it would appear that she was motivated by the almighty dollar.

She seems to be an unscrupulous greedy individual, Dr. Naftali Berrill told International Business Times' Crimes of New York. Dr. Berril is a forensic psychologist and is the Executive Director of the New York Center for Neuropsychology and Forensic Behavioral Science.  He has years of experience dealing with crime and criminals and analyzing their behavior. Dr. Berrill speculated that Then purposely chose strapped-for-cash Hispanic women to perform the surgeries on, who became her go-to targets.

She had built a constituency that can't flex their muscles, says Dr. Berrill. She knows this population is a population that she can exploit. Some of those women, continued Dr. Berrill, maybe are here illegally, maybe don't know the proper channels to receive cosmetic surgery safely.

This isn't a rare case. Berrill said that every so often these cases appear in the New York typically in the ethnic communities. Phony doctors have similar motivations to those of Berrill. They look to prey on the communities and individuals who do not know any other place to turn.  However, Berril said that when it comes to surgery, individuals cannot cut corners and go to the cheap guy or gal or the one who is offering. It is just like buyers beware.

Based on Berrill's previous work and studies, he also speculated that Then might have been extremely egotistic.

These people behave in a antisocial or predatory fashion he said. They are always extremely narcissistic and it is that narcissism that leads them to believe that they will be the exception to the rule and won't get in trouble for their misdeeds. Then was not only breaking the law, Berrill pointed out, she was doing something morally reprehensible. It was possibly her narcissistic views that lead to continue the surgeries and try and cover up the crimes. In fact, Then had allegedly attended Pichardo's wake and told family members she died from smoking too much.  

I am dead-alive with her two children, who are without a mother and who miss her dearly, said Pichardo's mother, Margarita, 63, according to the Daily News.