The operating room should be a place where precision matters most. Yet on an August evening in 2024, Florida surgeon Thomas Shaknovsky turned what should have been a routine laparoscopic spleen removal into a death sentence for 70-year-old William Bryan of Alabama.
A Florida grand jury has now indicted Shaknovsky on charges of second-degree manslaughter. The details of what happened inside that operating room, according to investigations by the Walton County Sheriff’s Office and Florida’s state health department, read less like a medical case and more like a cautionary tale about what happens when competence, attention, and basic anatomical knowledge fail catastrophically.
The Surgery That Should Never Have Happened
Bryan arrived at the emergency department in Miramar Beach complaining of upper left abdominal pain. Imaging suggested his spleen might be enlarged, with blood present in the membrane lining his abdominal cavity. Shaknovsky, the on-call general surgeon, recommended removal.
Here’s where things get murky. According to a lawsuit filed by Bryan’s widow, Bryan initially declined the surgery. He wanted to go home to Alabama and seek treatment at a facility with higher-level care. But Shaknovsky allegedly pressured him over several days until Bryan finally agreed.
The pressure to undergo surgery, combined with what happened next, raises uncomfortable questions about how medical decisions get made in emergency settings, especially for patients far from home and potentially vulnerable.
The Operating Room Nightmare
The surgery was scheduled for 4 pm. Shaknovsky arrived an hour late.
Bryan was brought into the operating room around 5:20 pm when only a skeleton crew was available. Shaknovsky began with the planned minimally invasive laparoscopic approach but quickly abandoned it when he realized Bryan’s distended colon was blocking his view. He switched to open surgery, cutting directly into Bryan’s abdominal cavity.
That’s when things went visibly wrong. Bryan’s colon “burst out” of the cavity, and staff had to rush to move it aside and suction blood. So far, still recoverable territory. But then Shaknovsky located the blood vessel he wanted to cut and announced to staff: “That’s scary.” He’d felt it pulsing under his fingers.
He grabbed a surgical stapler, positioned it around the vessel, and fired.
Bryan’s body immediately began hemorrhaging catastrophically. The inferior vena cava, the largest vein in the human body that carries blood from the lower body back to the heart, had been severed. Bryan went into cardiac arrest. Staff initiated emergency protocols, called a code, and began CPR.
What Shaknovsky did next defies understanding. Unable to see anything in the pool of blood filling Bryan’s abdomen, he didn’t request basic surgical tools like a clamp or cauterizer. Instead, he blindly fired another staple into the cavity and kept working.
They couldn’t save him. Bryan was pronounced dead.
The Unthinkable Discovery
After Bryan’s death, Shaknovsky extracted what he claimed was the patient’s spleen and placed it on a table.
Staff looked at it in shock. One reportedly felt sick to their stomach.
What lay before them wasn’t a spleen. It was a liver. A 2,106-gram liver measuring about 23 by 19 by 11 centimeters. An enlarged spleen maxes out at around 500 grams and roughly 20 centimeters long. The organs aren’t just different in size; they’re anatomically distinct with different colors and textures. A liver is on the right side of the abdomen. A spleen is on the left, the exact side where Bryan had complained of pain.
Shaknovsky insisted the staff label it as a spleen. He returned to the operating room three times that evening trying to convince them it was actually a spleen. It wasn’t. The pathology report described it plainly: “a grossly identifiable 2,106 g liver.”
The autopsy revealed the full scope of the disaster. Bryan’s spleen was still there, completely intact. His liver was gone. His inferior vena cava was severed.
A Pattern of Catastrophic Error
What makes this case even more disturbing is that it wasn’t Shaknovsky’s first major surgical mistake.
In 2023, he’d removed a portion of a patient’s pancreas when he’d intended to remove the adrenal gland. His explanation? The adrenal gland had “migrated.”
That explanation strains credulity. Glands don’t migrate. Surgeons get lost in anatomy, lose track of where they are inside the body, or fail to consult basic reference materials. The pattern suggests something more systematic than a single tragic error.
The Question Nobody Wants to Ask
This case raises an uncomfortable question about healthcare systems and accountability. How does a surgeon make the same category of catastrophic error twice? More pressingly, why was Shaknovsky still operating after the 2023 incident?
State Surgeon General Joseph Ladapo ordered an emergency suspension of Shaknovsky’s license in September 2024, months after Bryan’s death. The action came after the state health department investigation. But the lag between the catastrophic error and the license suspension represents a window during which other patients could have been at risk.
Walton County Sheriff Michael Adkinson released a statement after the indictment: “The Grand Jury has spoken, and our responsibility is to ensure the charges are carried out through the proper legal process. Our thoughts remain with the victim’s family and their unspeakable loss.” Shaknovsky was arrested and released on bond, facing up to 15 years in prison if convicted.
What Bryan’s Family Wants
Bryan’s widow, according to NBC News reporting, told the network: “He would want his death to prevent someone else from being hurt, which is what I think the criminal charges being brought will do. If we had to suffer through this and he had to die, then at least no one else will be hurt by this man now.”
It’s a devastating statement from someone trying to extract meaning from an essentially meaningless tragedy. A man died 800 miles from home after traveling for a procedure he didn’t initially want, at the hands of a surgeon who appears to have made fundamental errors about basic anatomy during a high-pressure moment in an understaffed operating room late in the evening.
The justice system can hold Shaknovsky accountable. It can send him to prison. It can suspend his license permanently. But none of that brings back William Bryan or reverses the trauma inflicted on his widow and family.
What remains is a question that lingers after every preventable medical catastrophe: what systemic failures allowed this to happen in the first place?
