A surgeon who burned his initials on to the livers of two patients during transplant surgery has been given a 12-month community order and fined £10,000.

Simon Bramhall, 53, used an argon beam – used to stop livers bleeding during operations and to highlight an area to be worked on – to sign “SB” into his patient’s livers. The marks left by argon do not impair the liver’s function and disappear by themselves.

In December, the liver, spleen and pancreas surgeon admitted two counts of assault by beating. The offences relate to the incidents on 9 February and 21 August 2013. Prosecutors accepted his not guilty pleas to the more serious charges of assault occasioning actual bodily harm.

Bramhall was first suspended from his post as a consultant surgeon at Birmingham’s Queen Elizabeth hospital in 2013 after another surgeon spotted the initials during follow-up surgery on one of his patients. A photograph of the 4cm-high branding was taken on a mobile phone.

Bramhall tendered his resignation the following summer amid an internal disciplinary investigation into his conduct. Speaking to the press at the time, he said marking his initials on to his patients’ livers had been a mistake. He now works for the NHS in Herefordshire.

Opening the facts of the case against Bramhall, Tony Badenoch QC, prosecuting, said one of the surgeon’s victims had been left feeling violated and suffering psychological harm.

“This case is about his practice on two occasions, without the consent of the patient and for no clinical reason whatever, to burn his initials on to the surface of a newly transplanted liver,” said Badenoch.

Badenoch said of the initial transplant operation: “Mr Bramhall had to work exceptionally hard and use all of his skill to complete the operation. At the end of the operation he performed a liver biopsy using the argon beam coagulator, and then used it to burn his initials.”



The court heard that a nurse had asked what the marks were and Bramhall replied: “I do this.” The surgeon later told police he had “flicked his wrist” and made the mark within a few seconds.

“He knew that the action could cause no harm to the patient. He also said that in hindsight this was naive and foolhardy – a misjudged attempt to relieve the tension in theatre,” Badenoch said

The judge, Paul Farrer QC, ordered Bramhall to carry out 120 hours of unpaid work. He told Bramhall: “Both of the operations were long and difficult. I accept that on both occasions you were tired and stressed and I accept that this may have affected your judgment. This was conduct born of professional arrogance of such magnitude that it strayed into criminal behaviour.

“What you did was an abuse of power and a betrayal of trust that these patients had invested in you. I accept that you didn’t intend or foresee anything but the most trivial of harm would be caused.”

The Queen Elizabeth hospital said in a statement: “The trust is clear that Mr Bramhall made a mistake in the context of a complex clinical situation and this has been dealt with via the appropriate authorities, including the trust as his then employer. We can reassure his patients that there was no impact whatsoever on the quality of his clinical outcomes.”

Bramhall was issued with a formal warning by the General Medical Council in February 2017. The body said his conduct had not met the standards required of a doctor.

“While this failing in itself is not so serious as to require any restriction on Mr Bramhall’s registration, it is necessary in response to issue this formal warning,” it said at the time.