Understand how we got here — and how to move forward.


December 20, 2017

A renowned surgeon's strange crime: Marking his initials in patients' livers

Daily Briefing

    Simon Bramhall, a formerly renowned surgeon, pled guilty to two counts of assault by beating on Wednesday after he branded his initials into the livers of two of his patients.

    Here's your cheat sheet for understanding health care's legal landscape

    Bramhall was a liver, spleen, and pancreatic surgeon at Queen Elizabeth Hospital in Birmingham, West Midlands, for 12 years. According to the Washington Post's "To Your Health," he gained media attention in 2010 after he saved a patient's life by transplanting the patient's own liver back in the patient's body following the liver's recovery from the site of a private plane crash in Birmingham.

    What happened

    In 2013, using an argon beam coagulator—which, according to the Associated Press, "seals bleeding blood vessels with an electric beam"—Bramhall marked "SB" into the livers of two patients. While such marks would typically be harmless and fade over time, one of patient's livers didn't heal correctly, and doctors discovered the markings during a follow-up operation.

    Bramhall was suspended from his position in December 2013, following the discovery of the markings. However, in 2014, he was briefly reinstated pending an internal investigation. One month after his reinstatement, Bramall tendered his resignation, citing a stress-induced illness.

    At the time, speaking with the press, Bramhall said that carving the initials into the patients' livers had been a mistake, but that he had not been fired over the incident. "I had a disciplinary meeting on 15 May. I was not dismissed," he said. "I made the decision on 16 May I would hand in my notice. It is a bit raw and I have to move on."

    A guilty plea

    According to a Birmingham Crown Court representative, Bramhall was charged in court with assault causing bodily harm. On Wednesday, he pled guilty to the lesser charge of assault by beating.

    Bramhall was granted unconditional bail and will be sentenced on Jan. 12, The Guardian reports. The judge in the case, Paul Farrer, has requested new victim impact statements and a pre-sentencing report, saying the focus should be on "damage that was done to the surface of the liver" and not emotional distress.

    According to Tony Badenoch, the prosecutor in the case, others will determine whether Bramhall's surgical license will be suspended or revoked as a result of the incident. The General Medical Council (GMC) earlier this year issued Bramhall a warning, stating that his behavior fell short of the standards required for a physician. "It risks bringing the profession into disrepute and it must not be repeated," GMC stated. "Whilst this failing in itself is not so serious as to require any restriction on Bramhall's registration, it is necessary in response to issue this formal warning."

    GMC added on Wednesday that it was the organization's practice to assess criminal convictions issued to physicians.

    A case 'without legal precedent in criminal law'

    Badenoch said the incident was a "highly unusual and complex case, both within the expert medical testimony served by both sides and in law. It is factually, so far as we have been able to establish, without legal precedent in criminal law."

    Badenoch added, "The pleas of guilty now entered represent an acceptance that that which he did was not just ethically wrong but criminally wrong. They reflect the fact that … Bramhall's initialing on a patient's liver was not an isolated incident but rather a repeated act on two occasions, requiring some skill and concentration. It was done in the presence of colleagues."

    Similarly, Elizabeth Reid of the Crown Prosecution Service said Bramhall abused the trust his patients placed in him. "It was an intentional application of unlawful force to a patient whilst anaesthetized," she said. "His acts in marking the livers of those patients, in a wholly unnecessary way, were deliberate and conscious acts on his part."

    But Tracy Scriven, a former patient of Bramhall's, said that Bramhall should be immediately reinstated. "Even if he did put his initials on a transplanted liver, is it really that bad?" she said. "I wouldn't have cared if he did it to me. The man saved my life."

    The Washington Post was unable to reach Bramhall for comment (Eltagouri, "To Your Health," Washington Post, 12/14; Domonoske, NPR, 12/13; Perraudin, The Guardian, 12/13; Willingham, CNN, 12/14).

    Here's your cheat sheet for understanding health care's legal landscape


    With MACRA, HIPAA, the ACA, and countless others, the health care landscape has become an alphabet soup of legislation. To help you keep up, we've created a series of cheat sheets for some of the most important—and complicated—legal landmarks.

    Check them out now for everything you need to know about the Affordable Care Act, antitrust laws, fraud and abuse prevention measures, HIPAA, MACRA, and the two-midnight rule.

    Get the Cheat Sheets

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.