A US Health Department has issued an emergency licence suspension for an osteopath who removed a patient’s liver instead of his spleen, contributing to his death – described by his wife as “unnecessary and brutal”.
The emergency suspension order from the Florida Health Department details how Thomas Shaknovsky severed William Bryan’s inferior vena cava, the vessel that connects the liver with the heart, “resulting in the bleeding event that precipitated his death”.
It also documents that a year earlier, Shaknovsky had removed a portion of a patient’s pancreas when he was supposed to remove an adrenal gland, reports Medpage Today.
“Dr Shaknovsky’s continued practise of osteopathic medicine constitutes an immediate, serious danger to the health, safety, or welfare of the citizens of the State of Florida,” according to the order.
Interviews with operating room staff by the Health Department painted a starkly different picture from Shaknovsky’s operative report regarding Bryan’s spleen removal surgery.
Shaknovsky said he started a laparoscopic procedure, but switched to an open one due to poor visibility created by a distended colon and blood in the abdomen – although he didn’t document that in his report.
He then discovered a splenic artery aneurysm that ruptured, leading to significant blood loss, but said he went on to remove the spleen, even though it was enlarged and deformed.
However, witnesses in the operating room “consistently and clearly recounted a summary of events markedly more troublesome than Shaknovsky’ s written account of what occurred”.
According to the report, witnesses said that when the patient’s abdomen was opened, “a megacolon burst out of the …cavity, disrupting visibility”.
As the operating room staff “cleared the field by moving the large colon and suctioning blood”, Shaknovsky “identified a blood vessel he intended to cut and noted he could feel it pulsing under his finger”.
He reportedly then said, “that’s scary”, before grabbing the vessel, positioning a surgical stapling device around it, and firing the stapler, the report said.
Immediately afterwards, the patient started to severely haemorrhage and went into cardiac arrest. A code was called and the OR team began performing CPR.
While staff worked the code, Shaknovsky continued his dissection even though the abdomen was full of blood and there was no visibility, the report stated.
Eventually, he removed the liver and identified it as a spleen – even though the operating room staff knew better.
“The team looked at the readily-identifiable liver on the table and were shocked when Dr Shaknovsky told them it was a spleen,” the report noted.
Despite their efforts, Bryan was pronounced dead, and Shaknovsky told staff that cause of death was a ruptured splenic artery aneurysm. He requested that the organ be labelled as spleen and sent to pathology.
“The person responsible for labelling the specimen knew it was not a spleen but did as instructed,” the report stated.
Ultimately, the pathologist confirmed it was an “intact liver”.
During an autopsy, the medical examiner confirmed the spleen was still in place, but that the liver was still missing, and that the inferior vena cava had been severed. There was no evidence of a ruptured splenic artery aneurysm, according to the report.
Yet in his operative report, Shaknovsky described in very specific detail his removal of the spleen, “identifying that he dissected specific structures and ligaments which were never touched”.
“There is no other explanation for this other than Dr Shaknovsky attempting to avoid blame for severing a significant vessel,” the report stated.
The patient’s wife, Beverly Bryan, who said her husband's death “was exceptionally unnecessary and brutal”, has hired a lawyer to bring legal action in the case, but has not yet filed a lawsuit because medical malpractice lawsuits in Florida must first go through a pre-suit process, which can take six to nine months.
Despite the emergency suspension of his license in Florida, Shaknovsky maintains an active license in Alabama, and appears to have not yet been affected by the Florida discipline.
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