An "arrogant" surgeon who admitted burning his initials on the LIVERS of two transplant patients during surgery has avoided jail.
Simon Bramhall, 53, told a nurse "I do this" when she questioned him after seeing him burn 'SB' into an anaesthetised patient's liver at Birmingham's Queen Elizabeth Hospital in 2013.
His initials were discovered after a donor liver failed following an operation in 2013 by a colleague who then took a picture on a mobile phone.
More than 20 former patients of the transplant surgeon were in Birmingham Crown Court today as he was handed a 12 month community order and 120 hours unpaid work after pleading guilty to assault by beating in the first case of its kind in British criminal history.
Judge Paul Farrer QC told the defendant: "Both of the (transplant) 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."
Opening the facts of the case against Bramhall, prosecutor Tony Badenoch QC said one of the two victims initialled by the world-renowned surgeon had been left feeling "violated" and suffering ongoing psychological harm.
Mr Badenoch told the court that Bramhall used an argon beam machine to "write" his initials on the organs of two anaesthetised patients at the end of transplant operations in February and August 2013.
Acknowledging that Bramhall's actions had not caused either patients' new liver to fail, Mr Badenoch said: "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."
One of the victims, referred to in court as Patient A, received a donor organ in 2013 in a life-saving operation carried out by Bramhall.
But the donor liver failed around a week later - for reasons unconnected to its implantation - and another surgeon spotted Bramhall's initials on the organ.
A photograph of the 4cm-high branding was taken on a mobile phone and Bramhall, who now works for the NHS in Herefordshire, later admitted using the argon beam coagulator to mark Patient A's liver.
Mr 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."
A nurse who saw the initialling queried what had happened and Bramhall was said to have replied: "I do this."
The court heard that Bramhall 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," Mr Badenoch said
Frank Ferguson, head of special crime at the CPS, said Bramhall was a "very respected" surgeon to whom many patients owed their lives.
But asked about the doctor's motive, he said: "I can't speak in terms of why he did that. Clearly he did not anticipate that it would be seen, I would suggest, but there was further surgery and he may not have understood how long it was likely to last.
"There was medical evidence about that that it may have lasted up to a couple of months in the way that a minor burn might do on external skin.
"He accepted what he was doing was arrogant. He said 'this is what I do' to one of his colleagues in one of the operations but beyond that I could not say."
Mr Ferguson said in the case of one of the victims, they had not been identified but Bramhall's actions had been witnessed in the operating theatre.
He said the victim who had been identified in the "unique" case had suffered minor physical injury and psychological harm.
"There was a very profound impact on that person in terms of distress caused by what happened, the psychological impact," Mr Ferguson said.
"There was physical damage, some physical harm to the liver, although that's minor in terms of cell damage but it would be akin to a minor external burn.
"The first point is it's a crime and the second point is the aggravating features are that it was very vulnerable victims, in the sense there is no greater trust than the trust which a patient places in a surgeon when they are having an operation.
"And no greater vulnerability than that of a patient who's under general anaesthetic and the breach of that trust and the abuse of that power were aggravating features that led us to conclude it was the right thing to do to take this case forward."
Birmingham's 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, who came to attention in 2010 when he transplanted a liver saved from a burning aircraft into a patient, was suspended when the branding was discovered by another surgeon.
He was also previously involved in tutoring and examining medical students and supervising postgraduate students in higher degrees, management and research.
In 2010 Kate Jakes - then 18 - told how her life was saved by the donor liver snatched from the wreckage of a burning plane.
Just weeks before Kate – who has never touched alcohol – was told she had the liver of a chronic alcoholic and given 72 hours to live and put on the transplant list.
Suffering acute liver failure Kate was hours from dying when a suitable organ was found in Northern Ireland and put on a plane to Birmingham.
Amazingly the Cessna burst into flames on landing on November 19, but rescuers found the organ still in its ice box and – as police closed roads – it was rushed to Queen Elizabeth Hospital.
Just 45 minutes later surgeons began transplanting the liver into Kate.
Bramhall said at the time: “The box was covered in soot and petrol and foam, but inside the liver was pristine, so I decided to go ahead with the surgery.”
Tragically eight days later the liver died in Kate’s body meaning that once again she had just hours to live.
Dad Mike, 45, a lorry driver, said at the time: “We were told to say goodbye.”
She then went on to have a further two transplants throughout her life, but tragically she passed away at the age of 22 as she waited for a fourth .
She documented her transplant journey on a blog and in turn inspired others to sign up to the donor register.
Her husband Gareth paid tribute to his wife and ‘princess’ earlier, saying: "Kate you have and always will be my princess and the best thing that has ever happened to me.
"I love you to the end of time and back, you're at peace now with grandad, nan and ampie!"
Bramhall denied two other counts of assault occasioning bodily harm - a plea which was accepted by prosecutors.