Oh, boy. We have a bit of a doozy here. As you all know this blog is mainly about stupid people doing stupid things. Sometimes, however, it is about smart people doing stupid things (namely me, if I do say so myself). This is one of those times. Except that this time, the smart person gloriously isn't me at all. Have no fear, it is still about a smart person, a surgeon even, having done a very stupid thing.
Indeed this story is about Simon Bramhall, a rather famous British transplant surgeon who gained fame in 2010 by transplanting a liver that was being transported by a plane that crashed. They managed to salvage the organ and he transplanted it successfully. I think we can all agree that that is a Very Good Thing.
But in 2013 Simon did a Very Stupid Thing. He was performing a liver transplant on February 9, when for some inexplicable reason he decided to burn his initials "SB" onto the surface of the organ he was transplanting. Before you start yelling, "Oh come on, he couldn't have done that. It was probably just misinterpreted. What type of egomaniac would do that?" Bramhall would, that's who. The instrument he used was an argon beam coagulator which is designed to effect (yes, 'effect') haemostasis on the surface of a bleeding organ, and yes he branded his initials onto the liver. Keep in mind this was a very superficial injury that he inflicted, one that would be expected to heal very quickly.
If that doesn't sound too bad, have no fear, because it gets worse. He did the exact same thing 7 months later, again branding his initials on a transplanted liver. Again, anyone who understands how livers heal knows that these marks should disappear quickly and completely. Unfortunately, they did not on one of these two patients. Another surgeon re-operating on one of the patients some time later noted "SB" still visible on the surface of the liver, and Dr. Bramhall was busted.
Dr. Bramhall was suspended initially, and he resigned from the hospital the next year. Further, he was arrested and charged with both assault occasioning actual bodily harm (to which he pleaded not guilty), and assault by beating, to which he admitted and was convicted.
Wait wait, assault by beating? How is that possible?
Right, I was as confused as you at first. It seems that the prosecutor didn't know exactly how to charge him, because this past week he stated that there was just no legal precedent for this type of injury. (Seriously, what the hell would you charge him with? Arson? I have no idea. This is one of approximately 2,490 reasons why I'm not a lawyer.) Regardless, the prosecutor did state that Bramhall's admission of guilt indicates that he admits that "what he did was not just ethically wrong but criminally wrong". Sentencing is scheduled for January 2018. I suspect the judge is just as clueless about how to punish him appropriately.
Bramhall was also issued a formal warning earlier this year from the General Medical Counsel which said regarding his behaviour, "It risks bringing the profession into disrepute and it must not be repeated. Whilst 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."
And that is where I vehemently disagree.
In my opinion Bramhall deserves to be struck off the record, to lose his licence to practice. This falls so far outside the bounds of the normal, ethical, responsible behaviour of a physician that something more drastic than a proverbial slap on the wrist is in order. Bad behaviour by surgeons used to be tolerated, and everyone would just look the other way whenever it happened. Harassing nurses, inappropriate comments, throwing instruments, yelling at students, demeaning residents, and other assorted temper tantrums were commonplace in the operating theatre until recently. Nowadays, however, these sorts of outbursts are no longer permissible. Surgeons are now reprimanded and punished for bad behaviour.
But knowingly and purposefully injuring a patient?
I have heard the counterargument that no real harm was done, so it isn't that big a deal. Really? Is that a logical argument? Then by that same logic we should just allow people to drive drunk as long as they don't injure anyone, because no harm is done. Right? Right?
No, not right. Not right at all.
However, not everyone agrees with me. In fact, when he was suspended in 2014 one of his former patients said, "Even if he did put his initials on a transplanted liver, is it really that bad? I wouldn’t have cared if he did it to me. The man saved my life." It's true though, right? The liver heals very quickly, and even if it doesn't heal completely, having a scar on the organ won't affect its function one bit. So it's not a big deal, right?
Wrong. I've written before about the trust that patients put in their doctors, but especially their surgeons. Imagine the amount of faith people must have to allow themselves to be put completely to sleep, completely vulnerable, absolutely at our mercy, and trust that we not only do our best to put them back together but do it with dignity and respect.
Dr. Bramhall violated that dignity. He violated that trust. Not just one, twice.
I don't know if it was a momentary lapse of reason (twice), sociopathy, or simply a massive ego that led Bramhall to do what he did. Yeah, I'll be the first to admit that many surgeons have massive egos (yours truly excluded, of course). But quite frankly, I don't care a whit. I couldn't give a rattus rattus' posterior, because after pondering this since the moment this story broke, I've come to the realisation that there is literally not a single legitimate excuse in the world that would permit a surgeon to brand a patient like this. Not one.