When you're an artist, it's considered customary to sign your work. When you're a surgeon, it's considered bizarre and illegal. Renowned British surgeon Simon Bramhall, who branded his initials on the livers of at least two transplant patients in 2013, pleaded guilty to assault Wednesday, the BBC reports. The liver, spleen, and pancreas surgeon used an argon beam—normally used to stop livers from bleeding or to sketch out areas to be operated on—to brand "SB" on the patients' organs. Such marks usually disappear on their own, but Bramhall's handiwork was discovered when a colleague operated on a patient whose liver had failed to heal normally, the Guardian reports. Bramhall was suspended from Birmingham's Queen Elizabeth Hospital and resigned after a disciplinary hearing in 2014.
At Wednesday's hearing, prosecutor Tony Badenoch said the "highly complex and unusual case" was "without legal precedent in criminal law." He added that the branding of initials required "some skill and concentration"—and was carried out in the presence of colleagues. The prosecutor said the guilty plea shows Bramhall accepts what he did to unconscious patients "was not just ethically wrong but criminally wrong." Bramhall will be sentenced next month. NPR notes that while the case was apparently without precedent in Britain, there have been similar incidents in the US, including a 2010 case in which a California gynecologist was sued for branding a patient's name on a uterus he had removed.