Surgeon Thomas Shaknovsky Charged With Manslaughter: What Actually Happened

This story was all over the news yesterday, and it is absolutely wild. Surgeon Thomas Shaknovsky has now been formally charged with manslaughter following the death of a patient. Some of you may remember when this was first reported on last year — and honestly, I didn't believe it. It's not something I would have ever guessed could actually happen.

Unfortunately, it happened.

Mr. William Bryan was visiting Florida when he developed left-sided abdominal pain and went to the emergency room. On admission, he was found to have an enlarged spleen and his blood count was dropping. The concern was that he might be bleeding from the enlarged spleen.

The imaging done in the ER showed the enlarged spleen — but it did not show any blood or fluid in the abdomen. If a patient had dropped their hematocrit as significantly as was reported, you would expect to see blood or fluid on imaging. That detail alone should have prompted a pause.

The surgeon, Dr. Shaknovsky, recommended a laparoscopic splenectomy. Mr. Bryan did not want the surgery. He wanted to leave and go back home to his own physician's hospital — a place where he was comfortable. By all accounts, he felt bullied into consenting, and ultimately went to the operating room.

What unfolded next is hard to believe:

1. The laparoscopic splenectomy began as planned.
2. The surgeon couldn't see clearly — reportedly because the colon and bowel were distended.
3. He opened the abdomen to convert to an open procedure.
4. During what he thought was dissection of the splenic vessels, bleeding started.
5. To stop the bleeding, he continued cutting.
6. By the end of the procedure, he had inadvertently removed Mr. Bryan's entire liver — not the spleen.

Mr. Bryan did not survive.

When this story was first reported, I initially thought there was no way this could actually happen. Here's why:

The spleen and the liver are in different places, are attached to completely different blood vessels, and look nothing alike. Any medical student — let alone a boarded surgeon — can distinguish between them.

If you've ever rotated on a liver transplant service, you've seen a liver removed — because an orthotopic liver transplant requires removing the old liver before placing the new one in its exact position. It is a slow, technically demanding operation. It is not something you could do in a couple of seconds by accident.

The fact that this surgeon somehow dissected out and removed an entire liver — while believing he was doing a splenectomy — is beyond incompetence. It's criminal. And now, appropriately, he is being charged as such.

Reports also note that Dr. Shaknovsky had a prior malpractice lawsuit in which part of the pancreas was removed instead of an adrenal gland.

Here's where surgeons tend to pump the brakes: pancreatic injury during a left adrenalectomy is actually a known potential complication because of the proximity of the pancreatic tail to the left adrenal gland. So when that first came out, many of us thought, "okay, this might be a plaintiff's lawyer framing." But combined with what happened to Mr. Bryan, the pattern tells a different story.

There are now several cases working through the legal system across the United States where physicians are being charged with actual crimes — not just sued civilly — for care that crosses the line from incompetence into criminal negligence. It will be fascinating, and important, to see how these cases play out.

The hardest question is how someone who did this could make it through surgical training and into active practice at all. Board certification, residency, fellowship — there are many checkpoints. And yet, here we are.

The takeaways for patients are uncomfortable but important:

• Trust your instincts. If a surgeon is pressuring you into a surgery you don't want, that alone is a warning sign.
• Second opinions are always fair game — especially for any non-emergent operation.
• You have the right to go to a surgeon and hospital where you're comfortable, even if that means traveling.

My heart goes out to Mr. Bryan's family. This should never have happened. No patient should die because they were bullied into an operation they didn't want, performed by a surgeon who could not tell a spleen from a liver. I hope accountability here — including criminal accountability — ultimately protects future patients from something like this happening again.