Staff Had Concerns: What a Surgeon’s Manslaughter Charge Tells Us About Speaking Up

A Florida surgeon, Thomas Shaknovsky, was indicted on a second-degree manslaughter charge on April 13. The charge followed the death of William Bryan, a 70-year-old Alabama man, during what was supposed to be a laparoscopic splenectomy in August 2024. Instead of removing Bryan's spleen, the surgeon removed his liver. The patient hemorrhaged and died on the operating table.

There's a lot to say about this case. Becker's Hospital Review covered the basics. CBS News, NBC News, and WUSF added more detail from the Florida Department of Health's emergency suspension order and the Walton County Sheriff's Office release. I'd encourage you to read the coverage if you haven't.

But there's one line from the Health Department report I keep coming back to:

“Colleagues in the operating room had concerns that Dr. Shaknovsky did not have the skill level to safely perform this procedure.”

Had concerns.

That's the phrase. Past tense. Before the surgery. Not “raised concerns” or “escalated concerns” or “refused to participate.” Had.

What “Had Concerns” Might Mean

I don't know what happened in that OR, and I'm not going to pretend I do. But that phrase could mean a number of things.

It could mean people said something directly to the surgeon and were overruled or dismissed.

It could mean people said something to each other but not to him.

It could mean people raised it through some other channel (a manager, a peer, a credentialing process) and nothing happened.

It could mean people thought about saying something and decided the personal cost wasn't worth it.

All four are failures. They're different failures, and they point to different root causes, but they're all failures of the same underlying thing: a system where concern about a colleague's competence doesn't reliably become action that stops harm.

The fourth one is the most common in my experience, and the hardest to see from outside.

Speaking Up Isn't the Whole Job

I've written before that psychological safety is not about courage. It's about culture. Telling people they have a “professional obligation to speak up” doesn't do much when the cost of speaking up, in a given room on a given day, is high and the path forward is unclear.

But there's a second piece I think gets less attention, and this case brings it into focus.

Even when people do speak up, the system around them has to be capable of acting on what they say. Speaking up without a reliable path to stop the case, or to escalate without retaliation, or to trigger a real review, is not the same as a culture of safety. It can look like one from the outside. A leader can say, “our people can raise concerns anytime.” And that might even be true. But if the concerns don't lead to changes in what actually happens, employees learn the lesson eventually. Ethan Burris's research calls this futility. Fear keeps people quiet. Futility also keeps them quiet–where it's not dangerous to speak up; it just isn't worth the effort.

“Patient Safety Is Our Top Priority”

The hospital's statement, to Becker's, opened with a familiar line:

“At Ascension, patient safety is our top priority.”

They always say that. Every hospital says that. You'd be hard-pressed to find a hospital that doesn't say that after some incident.

The late Paul O'Neill, former U.S. Treasury Secretary and former CEO of Alcoa, used to ask a simple question when leaders made claims like this:

“How do we know that to be true?”

He wasn't being rhetorical. He meant it. If safety is genuinely your top priority, you should be able to produce the evidence. What are the measures? How often are they reviewed? What happened the last time a team member raised a concern?

Credentialing is what hospitals usually point to, and the statement does that too. Surgeons at their facilities have to meet “rigorous credentialing standards,” including a valid state license.

Credentialing is necessary. It's not sufficient.

Credentialing is a point-in-time check. Culture is what happens in the room when something seems off and a decision has to be made in the next thirty seconds. Credentialing tells you the surgeon was allowed to operate. It doesn't tell you whether the team around him felt able to stop the procedure, or whether they would have been backed up if they tried.

The news reporting describes a chaotic scene. The surgery started as a laparoscopy and switched to open surgery because of a distended colon he hadn't documented. According to CBS News, “operating room staff knew splenectomies were complicated procedures that could quickly deteriorate and were not regularly performed at Ascension.” When the patient started hemorrhaging, colleagues began emergency transfusions while the surgeon continued to dissect, reportedly without asking for essential tools like a clamp or cauterizer. He later said he couldn't properly identify the organ he was removing because of shock and chaos.

Somewhere in that sequence, there were moments where someone could have said “stop.” I don't know if anyone did. I don't know what it would have taken for the case to actually halt.

Who Was Reckless?

I want to be careful here, because a patient died and a family lost someone. Nothing I say is meant to minimize that.

But I want to think out loud about the prosecution, because I think it reveals something about how we assign responsibility in healthcare.

Related post: Should Nurses Be Jailed for Medical Mistakes? Blame, Systems, and Patient Safety

The Florida Surgeon General's emergency suspension order, as reported by Fox News, cited a prior incident from May 2023 in which Shaknovsky removed part of a patient's pancreas instead of the adrenal gland and claimed the adrenal gland had “migrated” to a different part of the body. That patient suffered “long-term, permanent harm.” A $400,000 malpractice settlement followed in 2024.

The Surgeon General's order concluded that Shaknovsky's “repeated egregious surgical errors” combined with his “failure to take responsibility” indicated his “reckless conduct is likely to continue.”

Reckless. That's the word that matters in the Just Culture framework, which distinguishes between human error, at-risk behavior, reckless acts, and intentional harm. Reckless conduct involves conscious disregard of substantial and unjustifiable risk. In the Just Culture model, reckless acts can sometimes warrant punishment, where honest human error does not.

So, applied to the surgeon, the case for prosecution is at least defensible. The pattern, the alleged cover stories, the 2023 incident, the documented concerns from the OR team. These aren't the signature of a one-time error.

But here's the question I keep returning to: if Shaknovsky was reckless, was he the only one?

He didn't credential himself. He didn't schedule his own cases. He didn't decide, after the 2023 incident, that he should keep operating. Others did too. An institution did. A system did.

Just Culture is usually applied to the individual closest to the harm, the surgeon, the nurse, the pharmacist–the person at the so-called “tip of the spear” closest to the errot. That's its blind spot when you look at a case like this. The same framework, honestly applied, has to ask about the people and systems that kept putting this surgeon in front of patients after clear warning signs. What did the peer review process conclude after the 2023 incident? What did the credentialing committee know? What did hospital leaders do with what they knew? If reckless conduct is defined as “conscious disregard of substantial and unjustifiable risk,” those questions have to be asked at more than one level.

I don't have the answers. Ascension's statement notes that Shaknovsky “was never a Sacred Heart Emerald Coast employee and has not practiced at any of our facilities since August 2024.” That's technically true that he was not an employee. It's also the kind of statement that tells you what the institution is positioning itself to say, not what it learned or what it changed.

Meanwhile, one person faces up to 15 years in prison.

I still think the concerns about criminalizing medical error are real. The message most clinicians will hear from a prosecution is not “don't be reckless.” It's “if something goes wrong, you could go to prison.” That message, historically, is what drives mistakes underground. It's what makes people less willing to report errors, less willing to speak up when a colleague seems to be struggling, less willing to participate honestly in a root-cause investigation. Dr. David Mayer's story from his surgical residency, which I wrote about in The Mistakes That Make Us, is a case in point. He feared criminal charges after a wrong-side incision. That fear is part of what kept the mistake from being disclosed to the patient.

Prosecution is what we're left with when earlier interventions failed. Earlier meaning 2023. Earlier meaning credentialing and privileging. Earlier meaning the moments when colleagues in the OR had concerns and the surgical case went forward anyway. By the time it's a criminal matter, the system has already failed, probably multiple times, in ways that aren't being charged with anything.

If the surgeon's conduct was reckless, what do we call the conduct of the system that allowed it?

The Question

If a nurse or a tech or an assistant in your organization had serious concerns about a colleague's competence before a procedure, what would happen?

Not “what would we want to happen.” Not “what does the policy say should happen.” What would actually happen, today, this week, in your building?

Would they raise it? To whom? Would the person they raised it to act on it? Would the person who raised it face any consequences, subtle or otherwise, for having done so?

A patient died in August 2024. A surgeon was charged on April 13, 2026. The colleagues had concerns before any of that happened.

What would it have taken for those concerns to stop the case? How do we protect other patients, such as you or your loved ones?