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14 December 2017, 15:25 | Updated: 14 December 2017, 15:26
A surgeon has admitted burning his initials on to the livers of two unconscious patients during transplant operations.
Simon Bramhall, 53, admitted two counts of assault by beating at Birmingham Crown Court but pleaded not guilty to alternative charges of assault occasioning actual bodily harm.
In a statement, the Crown Prosecution Service (CPS) said Bramhall wrote his initials on the livers of the two patients without their consent and for no clinical reason while working as a liver transplant surgeon at the Queen Elizabeth Hospital.
The CPS said he used a medical instrument called an argon beam coagulator - which seals bleeding blood vessels by directing a beam of electricity on to the area - to "burn" his initials on to their livers.
After Bramhall's pleas were entered, prosecutor Tony Badenoch QC said the Crown accepted the medic's not guilty pleas in a case which was "without legal precedent in criminal law".
Judge Paul Farrer allowed Bramhall to stand in front of the dock, in the well of the court, as the surgeon pleaded guilty to assaulting a patient whose name is protected by a court order during an operation in August 2013.
He also entered a guilty plea relating to an operation performed on an unknown patient in February of the same year.
Addressing the court after the pleas, Mr Badenoch said: "This has been 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."
The barrister added that Bramhall was employed as a consultant surgeon in Birmingham at the time of the transplant operations and that both patients had been under anaesthetic.
"The pleas of guilty now entered represent an acceptance that that which he did was not just ethically wrong but criminally wrong," Mr Badenoch told the court.
"They reflect the fact that Dr Bramhall's initialling 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."
Describing the offences as an abuse of position, Mr Badenoch said they had been carried out with a disregard for the feelings of unconscious patients.
The prosecutor said of the assaults: "It was an intentional application of unlawful force to a patient whilst anaesthetised.
"His acts in marking the livers of those patients were deliberate and conscious acts.
"Suffice to say, for current purposes, these pleas meet the broad public interest.
"It will be for others to decide whether and to what extent his fitness to practise is impaired."
The offence of assault by beating was brought against Bramhall to reflect the act of marking the liver and there is no suggestion that he was responsible for physically "beating" either patient.
Elizabeth Reid, from the CPS, said: "Simon Bramhall was a respected surgeon who assaulted two of his patients while they were undergoing surgery.
"His acts in marking the livers of those patients, in a wholly unnecessary way, were deliberate and conscious acts on his part."
Bramhall was a consultant liver surgeon at the Queen Elizabeth Hospital between 2002 and 2014 and, according to his website, he dealt with liver, biliary and pancreatic surgical matters.
As well as surgical duties, his website also said he had been involved in tutoring and examining medical students, supervising postgraduate students in higher degrees, management and research.
West Midlands Police Detective Constable Paul Read, from Force CID, said: “This was a totally unnecessary action by a renowned surgeon who had conducted over 350 liver transplants since becoming a consultant on the liver unit in 2002.
“He cannot offer any explanation for his actions. The court heard that his actions were an arrogant disregard for the dignity and feelings of the unconscious patient… and that it was an abuse of position and patient trust to use the coagulator in the way he did.
“Although he did not lose his job, he resigned as he felt is position had become untenable.
“The patient, although fully recovered, felt violated by the surgeon’s actions and I hope his admission of guilt goes some way to assist her recovery.”
Bramhall, from Brooklands Lane in Redditch, will be sentenced at Birmingham Crown Court on 12 January.