Medical Inattention: The Surgeon Who Disorganized His Patient

Adapted from the writings of Dayan Yitzhak Grossman

May 7, 2026

Ars Technica reports on an egregious case of medical malpractice:

A Florida grand jury has indicted surgeon Thomas Shaknovsky on charges of second-degree manslaughter for the 2024 death of a patient whose surgical procedure was horrifyingly botched.

That patient was 70-year-old William Bryan of Alabama, who was scheduled in August to have his spleen removed in a minimally invasive (laparoscopic) procedure. But instead, Shaknovsky opened Bryan’s abdominal cavity, severed his largest vein with a surgical stapling device—which led to his death—and cut his healthy liver from his body as he bled out, according to an investigation by the state health department. Bryan’s spleen was left untouched…

Investigators found that the case began just a few days before Bryan’s death. At the time, he and his wife were visiting Florida from their home state of Alabama. Bryan developed pain in his upper left abdomen and went to the emergency department of a hospital in Miramar Beach, where Shaknovsky was the on-call general surgeon. Imaging suggested Bryan’s spleen might be enlarged, and there was blood in the membrane that lines the abdominal cavity, though there was no active hemorrhage…

Shaknovsky quickly abandoned the plan for a laparoscopic procedure when he realized, after starting, that Bryan had a distended colon that hindered his view.

Shaknovsky switched to an invasive surgery, opening Bryan’s abdominal cavity. O.R. staff told health department investigators that Bryan’s colon “burst out” when Shaknovsky cut open the cavity, and they had to rush in to move the colon out of the way and suction blood. Shaknovsky then found the blood vessel he wanted to cut and noted to staff that he could feel it pulsing under his fingers. “That’s scary,” he reportedly said to the staff member assisting him.

Shaknovsky then grabbed a surgical stapler, situated it around the vessel, and fired. Bryan immediately began severely hemorrhaging and went into cardiac arrest. Staff reported that a significant amount of blood started pouring out, and they began the emergency blood transfusion protocol, then called a code, and began CPR. Shaknovsky, meanwhile, kept working in the abdomen, which was filled with a pool of blood. Despite not being able to see what he was doing, he did not ask staff for a clamp or cauterizer. Instead, Shaknovsky blindly fired another staple into Bryan’s abdomen and kept working. After a while, the staff was unable to resuscitate Bryan, and he was pronounced dead…

The liver Shaknovsky removed was over 2,100 grams, measuring about 23 by 19 by 11 centimeters. An enlarged spleen is at most 500 grams and only up to 20 cm long, the health department noted. Moreover, livers and spleens are anatomically distinct and have different colors and consistencies. The liver is on the right side of the abdomen, while the spleen is on the left, the side Bryan had said was painful…

An autopsy revealed that Bryan’s spleen was intact, his liver was missing, and his inferior vena cava was severed. The inferior vena cava is the largest vein in the body and brings deoxygenated blood from the lower body back to the heart through the liver.

Amid investigating the ghastly circumstances of Bryan’s death, investigators also noted that it wasn’t the first time that Shaknovsky had removed the wrong organ. In 2023, he wrongly removed a portion of a patient’s pancreas when he intended to remove the adrenal gland. He reported afterward that the adrenal gland had “migrated”…[1]

The case of a physician who inadvertently kills his patient in the course of treating him is addressed in the Tosefta:

A professional physician (rofei uman) who treated a patient with the authorization of bais din and killed him is exiled to the ir miklat (city of refuge).[2]

The Tosefta also makes three separate statements about the civil liability of a physician who injures a patient while treating him:

A professional physician who treated a patient with the authorization of bais din and injured him is exempt from liability. If he wounded him more than was appropriate, he is liable.[3]

A professional physician who treated a patient with the authorization of bais din and injured him is exempt under the laws of man (bedinei adam), and his judgment is given over to Heaven.[4]

A professional physician who treated a patient with the authorization of bais din and injured him: If he did it inadvertently (beshogeig), he is exempt from liability, but if he did it deliberately, he is liable, for the betterment of the world (mipnei tikun ha’olam).[5]

In all four of these passages, the Tosefta is silent on the question of negligence; we can contemplate at least three possibilities:

The Tosefta is asserting a rule of strict liability—i.e., the stated consequences apply to a physician whose treatment results in injury regardless of whether he was negligent or not. This would seem quite logical with respect to civil liability for injury, at least with regard to nezek (long-term loss of a person’s economic value), due to the principle that adam muad le’olam (a human being is always considered forewarned against inflicting damage).[6] But with regard to galus (exile) as a consequence of manslaughter, this is a problem, because someone who is not at all at fault (oness) is not exiled.[7]
The Tosefta is asserting a presumption of liability—i.e., a physician whose treatment results in injury or death is presumed to have been negligent; this presumption may or may not be rebuttable.
The Tosefta is referring only to cases where the physician’s negligence has been established (despite the Tosefta leaving this condition unstated).

Surprisingly, this crucial point was not addressed, to the best of this author’s knowledge, until the Aruch Hashulchan (published 5644-53/1884-93):

But if [the doctor] treated him with permission (of bais din and the government) and he erred and injured him, he is exempt from liability bedinei adam. But he is liable bedinei shamayim (under the laws of Heaven) if it was due to his negligence (hisrashlus) and he did not examine him properly. For if he did examine properly, he has committed no sin, for it is a mitzvah to heal, and the wise one said, “The error of the doctor is the intent of the Creator.”[8] But if the patient dies from his treatment and the doctor knows that he erred (shagag), he is exiled if it may be (kesheyeish makom lislos) that he caused this by negligence or by not examining properly. But absent that, it appears to me that he is not liable to exile…[9]

The Aruch Hashulchan clearly understands the Tosefta according to either the second or the third approach above.

R’ Shlomo Zalman Auerbach is cited as having at least tentatively articulated a view similar to that of the Aruch Hashulchan:

It is also possible that that which the physician is exiled if he kills his patient is not at all talking about where the error was one of judgment, but where the physician intended to give the correct medication but erred and gave a different one, or where he extended his hand to take a good scalpel to operate with and mistakenly took a dirty one; in such cases, he is rightly exiled.

R’ Shlomo Zalman proceeds to explain why the principle of adam muad le’olam does not apply if the doctor erred in judgment.[10]

The Tzitz Eliezer (R’ Eliezer Yehudah Waldenberg) articulates a similar distinction to that of the Aruch Hashulchan and R’ Shlomo Zalman:

It appears logical to say that if a physician inadvertently injected the patient with the wrong substance, and that causes death or injury, he is liable according to all. The same applies if he inadvertently gave him the wrong medication. For only when he erred and thought that this particular injection or medication would be therapeutic is there room to say that he is an oness, for all he can do is to follow what his eyes see. For there is no treatment that does not entail some element of danger, and what heals this person kills that one…Whereas in the aforementioned cases, where he switched the injection or the medication, it turns out that even according to his understanding, he was not engaged at all in the mitzvah of healing; rather, in his hastiness he exchanged the elixir of life for poison. If so, it is logical that in all such cases we say that adam muad le’olam, because it is the way of physicians to carefully consider the administration of medication, and his error (shigegaso) is therefore considered as deliberate (zadon) according to all.[11]

We close by noting that R’ Yitzchak Zilberstein and R’ Tzvi Shpitz discuss similar cases of surgeons who were supposed to remove their patients’ right kidneys but carelessly removed their left ones instead. In both cases it turned out that the inadvertently removed left kidneys were actually cancerous, so the surgeries were entirely necessary and appropriate. They both maintain that the surgeons are not liable for malpractice and are even entitled to fees for their services, though they conclude, for different reasons, that they are not entitled to the full agreed-upon fee.[12]

[1]Beth Mole. Florida surgeon charged with killing man after removing liver instead of spleen. Ars Technica.

Cf. Florida doctor faces manslaughter charge for allegedly removing wrong organ during surgery. Associated Press.

[2]Tosefta Makos (hashmatah minus’cha’os kisvei yad) 5:2.

[3]Ibid. Bava Kama 9:3. For discussion of this passage, particularly the concluding phrase, see Shu”t Tashbeitz cheilek 3 siman 82 and Shu”t Sheivet Halevi cheilek 4 siman 151.

[4]Ibid. 6:6.

[5]Ibid. Gittin 3:13.

[6]See Mishnah Bava Kama 2:6 and Gemara there 26a-b. (We previously touched upon this principle in Well Meaning: Is a Property Owner Liable for an Animal’s Injury? Oct. 30, 2025.)

[7]See, e.g., Rambam Hilchos Rotzeiach 6:7,14,15.

[8]I do not know which “wise one” the Aruch Hashulchan is citing.

[9]Aruch Hashulchan Y.D. 336:2.

[10]Nishmas Avraham (Seconded Expanded Edition) Volume 2 (Y.D.) p. 437 os 9.

[11]Shu”t Tzitz Eliezer cheilek 5 Ramas Rachel perek 23 os 2. This position of the Tzitz Eliezer is endorsed in Shu”t Minchas Yitzchak cheilek 3 siman 105 os 7 (the second).