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Patient Dies After Doctor Allegedly Removes Wrong Organ During Surgery · Murder Files Unsealed

• 0:00
  Speaker 1: Every single day across the United States, roughly eleven people
• 0:04
  go into a hospital for routine procedure.
• 0:07
  Speaker 2: Right, just completely routine stuff.
• 0:09
  Speaker 1: Yeah, routine, and the surgeon cuts open the wrong body part,
• 0:12
  or they perform the wrong surgery entirely, or they leave
• 0:15
  a surgical tool left completely inside.
• 0:17
  Speaker 2: Of them, like a sponge or a clamp.
• 0:19
  Speaker 1: Exactly eleven times a day, and the medical community actually
• 0:24
  calls these never.
• 0:25
  Speaker 2: Events because they should never happen.
• 0:28
  Speaker 1: Right, because they are so catastrophic, so completely egregious, that
• 0:32
  if basic standard safety protocols are followed, they should literally
• 0:36
  never happen.
• 0:37
  Speaker 2: Yeah, I mean, the name says it all.
• 0:39
  Speaker 1: It really does. But you know, in August of twenty
• 0:41
  twenty four, one of these never events didn't just end
• 0:44
  in a terrible tragedy, it actually ended in an unprecedented
• 0:48
  criminal indictment for manslaughter.
• 0:50
  Speaker 2: Which is just that's earth shattering for the medical world.
• 0:52
  I Mean, we put an immense, almost you know, sacred
• 0:55
  amount of trust in the healthcare system, we really do.
• 0:58
  When you put on that drafty hospital gain and you
• 1:00
  lie down on a surgical table, you are basically surrendering
• 1:03
  total control.
• 1:04
  Speaker 1: Of your body.
• 1:05
  Speaker 2: Yeah, you're unconscious, completely vulnerable. You're trusting a team of
• 1:09
  professionals and the protocols that are supposedly designed to protect you.
• 1:14
  So what we are exploring today is the terrifying reality
• 1:18
  of what actually happens when every single one of those
• 1:21
  protective layers just entirely disintegrates.
• 1:24
  Speaker 1: Okay, let's unpack this. Today's deep dive is an exhaustive
• 1:28
  exploration into the death of seventy year old William Bryan Billbrien.
• 1:34
  We're pulling apart the literal anatomy of a medical catastrophe. Here.
• 1:39
  We'll look at the shocking chaos that unfolded inside an
• 1:41
  operating room at Ascension Sacred Heart Emerald Coast Hospital down
• 1:45
  in Florida.
• 1:45
  Speaker 2: And the trail of institutional blind spots right, the system
• 1:49
  failures that allowed a surgeon with a documented history of
• 1:52
  devastating errors just to keep his scalpel.
• 1:55
  Speaker 1: Exactly and of course the criminal indictment of doctor Thomas
• 1:58
  Chiknoski that literally just came down days ago on April thirteenth,
• 2:01
  twenty twenty six.
• 2:02
  Speaker 2: The intention here is to really deconstruct the mechanics of
• 2:05
  systemic failure. We're going to look under the hood of
• 2:07
  medical credentialing and the psychology of high stress surgical environments.
• 2:12
  It's so complex it is, and the invisible, often super
• 2:16
  toxic hierarchy that just sort of governs an operating.
• 2:20
  Speaker 1: Room because it's not a democracy in there.
• 2:22
  Speaker 2: No, not at all. But by understanding exactly how the
• 2:25
  safeguards failed, Bill Brian, you the listener, can be infinitely
• 2:29
  better equipped to protect.
• 2:31
  Speaker 1: Yourself right to advocate for your own care the next
• 2:33
  time you have to navigate the medical system, because I mean,
• 2:36
  you never know when you'll be the one in that gown.
• 2:38
  Exactly so, And to understand the sheer scale of this failure,
• 2:42
  we have to start with the timeline and the man
• 2:45
  at the center.
• 2:45
  Speaker 2: Of it, right, So set the scene for us, Okay.
• 2:47
  Speaker 1: So it's August twenty one, twenty twenty four. Bill Brian
• 2:50
  is a seventy year old retiree from Muscle Shoals, Alabama, Okay,
• 2:54
  and he and his wife Beverly, who, by the way,
• 2:57
  is actually a registered nurse herself.
• 2:58
  Speaker 2: Oh wow, Okay, that's an important detail.
• 3:01
  Speaker 1: Very important. So they're on a quick getaway in Miramar Beach, Florida,
• 3:04
  just a relaxing vacation. But suddenly Bill gets this severe,
• 3:09
  really sharp stomach pain.
• 3:10
  Speaker 2: Not what you want on vacation.
• 3:12
  Speaker 1: Yeah, absolutely not. So they go to the local hospital,
• 3:15
  Ascension Sacred Heart, and they're probably feeling, you know, completely
• 3:20
  out of their element because it's not their.
• 3:21
  Speaker 2: Home hospital, right, they don't know the staff there. And
• 3:25
  the initial evaluation in the emergency department it reveals an
• 3:29
  enlarged spleen. Okay, and the scams show some possible bleeding
• 3:34
  into the peritonial cavity, which exactly that's the space within
• 3:38
  your abdomen that contains your intestines, your stomach.
• 3:42
  Speaker 1: Your liver, got it.
• 3:44
  Speaker 2: But crucially, and we need to stress this, there was
• 3:47
  no active massive hemorrhage at that exact moment. It wasn't
• 3:51
  an immediate life or death bleeding out scenario right then.
• 3:54
  Speaker 1: Okay, so it was serious, but not like kind them
• 3:57
  open this very secondary dies.
• 4:00
  Speaker 2: The proposed medical solution from the surgical team was a laparoscopic.
• 4:04
  Speaker 1: Splenectomy, so taking out the spleen.
• 4:06
  Speaker 2: Yeah, and in standard elective or semi elective settings, this
• 4:10
  is a really well established procedure. It has relatively manageable risks.
• 4:14
  Speaker 1: But Bill was reluctant, right, I mean, who wants to
• 4:16
  have a major organ removed while they're sitting in a
• 4:18
  vacation talent. He actually wanted to drive back to Alabama.
• 4:21
  He had doctors there, he knew, guys he trusted.
• 4:24
  Speaker 2: Which is a completely natural instinct. Doctor Schichnovsky, who was
• 4:28
  the general surgeon covering cases at the hospital that day,
• 4:30
  he heavily advised against leaving.
• 4:32
  Speaker 1: He pushed back, he did.
• 4:34
  Speaker 2: He reportedly warned Bill and Beverly that delaying the surgery,
• 4:39
  you know, attempting that drive back to Alabama, could literally
• 4:42
  be fatal if the spleen ruptured entirely.
• 4:45
  Speaker 1: On the road. Wow. So he really laid it out
• 4:48
  like a ticking time bomb.
• 4:50
  Speaker 2: Yeah, he frainged it as a very higher risk situation,
• 4:53
  and faced with that stark warning from a medical authority,
• 4:56
  Bill relented. He signed the consent forms.
• 4:58
  Speaker 1: And that's where things go get catastrophically wrong. So they
• 5:01
  go into the operating room for this laparoscopic splenectomy. Right now,
• 5:05
  For those of those who don't spend our days in
• 5:07
  surgical theaters, laparoscopic means this isn't an open surgery, right, Yes,
• 5:11
  slicing you wide open from chest to belly button.
• 5:14
  Speaker 2: No, it's a minimally invasive technique and understanding how it
• 5:17
  works is just it's vital to understanding how the subsequent
• 5:20
  error could even theoretically happen.
• 5:22
  Speaker 1: Break it down for us.
• 5:24
  Speaker 2: So, in a laparoscopic procedure, the surgeon makes a series
• 5:27
  of very small incisions, usually only about.
• 5:30
  Speaker 1: Half an inch long, just tiny little cuts.
• 5:32
  Speaker 2: Yeah, tiny, And through these little ports they insert these
• 5:35
  hollow tubes called trocars. And then, and this is wild,
• 5:39
  they actually pump carbon dioxide gas into the abdomen.
• 5:43
  Speaker 1: Would they inflate the belly?
• 5:44
  Speaker 2: They do, like a balloon. This insufflation creates a physical
• 5:49
  working space. It pushes the abdominal wall up and away
• 5:53
  from the internal organs, so they have room to move.
• 5:55
  Speaker 1: That makes sense.
• 5:56
  Speaker 2: Then a laparoscope, which is essentially a long, thin raw
• 6:00
  with a high definition camera and a light on the end,
• 6:03
  is inserted through one of those ports, okay, and the
• 6:05
  surgeon inserts specialized elongated instruments like graspers, scissors, cauterizing tools
• 6:11
  through the other ports.
• 6:12
  Speaker 1: So they're working with these long sticks.
• 6:13
  Speaker 2: Basically exactly, and the entire surgical team watches the procedure
• 6:17
  on large video monitors that are mounted up in the
• 6:20
  operating room.
• 6:21
  Speaker 1: So the surgeon isn't looking down at their hands all
• 6:24
  They're looking up at a KEYV screen manipulating these long instruments.
• 6:29
  It's almost like playing a very high stakes video game.
• 6:31
  Speaker 2: That's a super common analogy, actually, and it highlights a
• 6:35
  really critical limitation of laparoscopy, which is the loss of
• 6:40
  direct tactile feedback.
• 6:42
  Speaker 1: What do you mean by tactile feedback?
• 6:44
  Speaker 2: Well, when you open a patient up the old fashioned way,
• 6:47
  a surgeon can physically feel the texture of an organ
• 6:50
  with their bare, well gloved.
• 6:51
  Speaker 1: Hands, right. They can feel how squishy or heart it
• 6:53
  is exactly.
• 6:54
  Speaker 2: They can feel the pulse of an artery. But in laparoscopy,
• 6:58
  you are relying almost entirely on two dimensional screen to
• 7:01
  navigate this three dimensional, highly complex, messy anatomical space.
• 7:06
  Speaker 1: And let's talk about that anatomical space, because this is
• 7:09
  where the story just entirely defies belief. Yeah, big are
• 7:12
  going in to remove the spleen. What exactly is a
• 7:15
  spleen and where does it live in the body?
• 7:17
  Speaker 2: Okay, so the spleen is an organ that sits in
• 7:19
  the upper left quadrant of the ebbmen tucked right up
• 7:21
  under the rib cage.
• 7:22
  Speaker 1: Just above the stomach, upper left. Got it.
• 7:24
  Speaker 2: It's part of your lymphatic and immune systems. It filters blood,
• 7:28
  recycles old red blood cells, things like that, and visually
• 7:32
  it is relatively small, like how small, Usually about the
• 7:35
  size of an avocado or maybe a small fist. It
• 7:37
  has a very spongy texture and a deep purple or
• 7:41
  kind of purplish red color.
• 7:42
  Speaker 1: Okay, so upper left side size of an avocado, scushy
• 7:45
  and purple. Right, But doctor Sheiknowski doesn't remove the spleen.
• 7:49
  He removes the liver. Yes, How does the liver compare
• 7:52
  to the spleen?
• 7:53
  Speaker 2: It's night and day. The liver is the largest solid
• 7:57
  internal organ in the human body, the largest, and it
• 8:00
  sits in the upper right quadrant of the abdomen.
• 8:03
  Speaker 1: Wait, so the complete opposite side.
• 8:04
  Speaker 2: Complete opposite side from the spleen. It spans across the
• 8:07
  right side and extends slightly past the midline of your body.
• 8:11
  It's shaped almost like a football or a wedge. And
• 8:14
  in an adult male like Bill Bryan, it can weigh
• 8:17
  over three pounds three.
• 8:18
  Speaker 1: Pounds compared to an avocado.
• 8:21
  Speaker 2: Exactly, and it has a very firm, meaty texture. It's
• 8:24
  a reddish brown color, not purple. Furthermore, it is the
• 8:28
  metabolic powerhouse of the body, meaning its vascular supply is
• 8:32
  just enormous.
• 8:33
  Speaker 1: There's lots of blood, so much blood.
• 8:34
  Speaker 2: It is connected to the hepatoc artery, the portal vein,
• 8:37
  and the inferior venicava. These are massive, massive blood vessels.
• 8:42
  Speaker 1: I just I have to stop you because looking at
• 8:43
  the medical descriptions in the sources, it's not like confusing
• 8:48
  a left kidney for a right kidney where they look
• 8:51
  the same.
• 8:51
  Speaker 2: No, not at all.
• 8:52
  Speaker 1: It's not confusing two identical screws. We're talking in avocado
• 8:55
  on the left versus a three pound football on the right.
• 8:59
  You literally do not have to have a decade of
• 9:01
  medical schooling to know the difference there. How on earth
• 9:04
  does a trained, licensed professional surgeon open up a human
• 9:08
  being and completely forget basic anatomy.
• 9:11
  Speaker 2: What's fascinating here is and terrifying really is this intersection
• 9:15
  of cognitive psychology and high stress environments.
• 9:18
  Speaker 1: Okay, psychology, how did that explain it?
• 9:20
  Speaker 2: We have to look at how the human brain processes
• 9:23
  visual information when it is under extreme cognitive load. There
• 9:28
  is a well documented phenomenon in aviation in the military
• 9:32
  and in surgery it's known as confirmation bias compounded by
• 9:36
  tunnel vision.
• 9:37
  Speaker 1: Meaning he saw exactly what he wanted.
• 9:39
  Speaker 2: To see, much more severe than just wanting to see it.
• 9:42
  When a surgeon begins a procedure, their brain has already
• 9:45
  basically written a script. The script is I am here
• 9:49
  to find and remove a bleeding spleen, Right, that's the goal.
• 9:52
  Once that mental model is fully locked in, the brain
• 9:56
  actively starts to filter out conflicting information. Wow, so it
• 10:00
  encounters unexpected bleeding or if the camera angle gets disoriented,
• 10:03
  which by the way, is very easy to do when
• 10:05
  you're maneuvering a tiny camera inside a dark, gas filled cavity,
• 10:09
  you can lose your bearings easily. If that happens, the
• 10:11
  brain starts to panic, and to resolve that panic, it
• 10:14
  subconsciously forces the visual evidence on the screen to fit
• 10:17
  the pre existing narrative.
• 10:18
  Speaker 1: So even though the camera is pointing at the largest
• 10:20
  organ in the body, the liver, the brain just overrides
• 10:24
  the eyes and says, Nope, that's the spleen. Keep cutting exactly.
• 10:28
  Speaker 2: It is a profound cognitive failure called inattentional blindness.
• 10:32
  Speaker 1: Wait, is that like that famous experiment Yes.
• 10:35
  Speaker 2: Think of the psychology experiment where people are asked to
• 10:37
  watch a video and count how many times a basketball
• 10:40
  has passed between.
• 10:40
  Speaker 1: Players and the gorilla walks through.
• 10:42
  Speaker 2: Yes, a person in a gorilla suit walks right through
• 10:45
  the middle of the game, and half the people completely
• 10:48
  fail to notice it because they are so hyper focused
• 10:51
  on counting the passes.
• 10:52
  Speaker 1: That is wild.
• 10:53
  Speaker 2: Under intense stress, your field of view physically narrows. If
• 10:57
  the surgeon was struggling with the instruments or dealing with
• 11:00
  obscured anatomy because the organs were enlarged or there was
• 11:03
  blood pooling, he.
• 11:04
  Speaker 1: Just lashes onto whatever he sees.
• 11:06
  Speaker 2: He latches onto the first solid mass he could mobilize,
• 11:09
  and his brain simply labeled its spleen.
• 11:12
  Speaker 1: But the biological reality of that cognitive error is immediate,
• 11:17
  and it's devastating because, as you mentioned, the liver isn't
• 11:20
  just big, It is connected to massive blood vessels.
• 11:25
  Speaker 2: Huge vessels the hepatic vascular system processes roughly a quarter
• 11:30
  of your total cardiac output every single minute.
• 11:33
  Speaker 1: A quarter of your blood every minute.
• 11:34
  Speaker 2: Yes, So when the surgeon began discepting and severing the
• 11:38
  attachments and the blood vessels of what he firmly thought
• 11:40
  was the spleen, he was actually severing the major hepatoic vasculago.
• 11:44
  Speaker 1: Oh my god.
• 11:45
  Speaker 2: The result was catastrophic, immediate massive hemorrhage.
• 11:49
  Speaker 1: And Bill Brian went into cardiac arrest right there on
• 11:51
  the surgical table. He did. He essentially bled to death
• 11:54
  internally in a matter of moments. There was nothing they
• 11:56
  could do.
• 11:57
  Speaker 2: It was far too much blood loss, too fast. And
• 12:00
  this is where the tragedy pivots from a catastrophic medical
• 12:03
  error into something just far more disturbing. Because the error
• 12:07
  itself is one thing, right, the physical removal of the
• 12:09
  wrong organ is absolutely horrifying, But what happened in the
• 12:13
  aftermath as the patient lay dying is what ultimately led
• 12:17
  to a criminal indictment.
• 12:18
  Speaker 1: Yeah, so let's get into the operating room cover up,
• 12:21
  because according to the emergency suspension order that was filed
• 12:23
  later by the state, Yeah, and a Walden County Sheriff's
• 12:25
  Office investigation, amidst this complete.
• 12:28
  Speaker 2: Chaos, Yeah, total chaos.
• 12:30
  Speaker 1: The patient is coding, alarms are blaring everywhere. The organ
• 12:34
  is finally completely excised, cut out, and it's placed on
• 12:38
  the instrument table in the.
• 12:39
  Speaker 2: Operating room, right under the bright lights.
• 12:41
  Speaker 1: And the staff in the room, the scrub nurses, the
• 12:43
  circulating nurses, the surgical text. They look at it and
• 12:48
  they immediately recognize it. I knew. They know unequivocally that
• 12:52
  this giant, three pound reddish brown mass sitting on the
• 12:56
  sterile table is a liver.
• 12:58
  Speaker 2: They absolutely knew. The sheer size and anatomical structure make
• 13:03
  it undeniable. Once it is actually out of the body
• 13:05
  and sitting there, you can't miss it.
• 13:07
  Speaker 1: And reports indicate that the spleen, the actual organ they
• 13:10
  went in to remove, was still completely intact inside Bill
• 13:14
  Bryan's body.
• 13:15
  Speaker 2: And it never even been touched yet.
• 13:17
  Speaker 1: Prosecutors alleged that doctor Chiknowski looks at this massive liver
• 13:20
  on the table and actively attempts to persuade his colleagues otherwise.
• 13:24
  Speaker 2: He tries to convince them.
• 13:26
  Speaker 1: He insists that it is an enlarged spleen, and then
• 13:30
  he directs the staff to physically label the specimen as
• 13:33
  a spleen, to send it down to the pathology lab.
• 13:36
  Speaker 2: And the staff, I mean they comply with that directive.
• 13:41
  Speaker 1: Wrote it down. They actually wrote spleen on it, even
• 13:44
  though witnesses later described to investigators that they felt quote
• 13:47
  sick to their stomach because they knew exactly what had
• 13:50
  just happened.
• 13:51
  Speaker 2: The psychological weight of that moment is just staggering. Bill
• 13:54
  Bryan cannot be resuscitated. He is pronounced dead.
• 13:58
  Speaker 1: It's awful.
• 13:59
  Speaker 2: And initially his wife, Beverly, who again is a highly
• 14:03
  trained nurse herself, she knows medicine, she is given a
• 14:06
  completely fabricated narrative by the hospital. She has told that
• 14:10
  her husband died from massive blood loss related to complications
• 14:13
  of a ruptured spleen.
• 14:14
  Speaker 1: They lied to a grieving widow, widow who also happened
• 14:17
  to be a medical professional. The truth was completely hidden
• 14:20
  from her in the immediate aftermass.
• 14:22
  Speaker 2: It was entirely obscured.
• 14:23
  Speaker 1: It only emerged post mortem, after the autopsy confirmed a
• 14:27
  perfectly intact spleen and a missing liver, and after Beverly
• 14:31
  actually had to obtain the medical records and higher legal
• 14:34
  counsel just to get the truth.
• 14:36
  Speaker 2: The compounding trauma for the Brian family here is unimaginable.
• 14:40
  They didn't just lose a husband and a father, so
• 14:42
  suddenly they were actively deceived about how he died.
• 14:46
  Speaker 1: But I have to push back on the dynamics of
• 14:47
  that operating room for a second. Okay, fatigue and cognitive overload,
• 14:51
  tunnel vision, all that stuff. It might explain how the
• 14:55
  surgeon made the initial cut.
• 14:57
  Speaker 2: The inattentional blindness.
• 14:58
  Speaker 1: Yeah, but it absolutely does not explain why a room
• 15:02
  full of trained professionals watch amand bleed out, watched a
• 15:06
  three pound liver get dropped on a table and still
• 15:09
  picked up a literal pen and wrote the word spleen
• 15:11
  on the specimen cup.
• 15:12
  Speaker 2: It's baffling. At what point this following orders crossed the
• 15:16
  line from shock into actual complicity.
• 15:18
  Speaker 1: It is arguably the most unsettling question of this entire case.
• 15:22
  To really understand it, we have to look at the invisible,
• 15:24
  ironclad hierarchy that governs a surgical theater.
• 15:27
  Speaker 2: Power dynamics exactly. An operating room is not a collaborative democracy.
• 15:33
  It isn't a bunch of peers sitting around a table brainstorming.
• 15:36
  Far from it historically, and still in a lot of
• 15:39
  institutions today, it operates with a strict military style chain
• 15:44
  of command. The attending surgeon is universally recognized as the
• 15:48
  captain of the ship.
• 15:49
  Speaker 1: Meaning their word is absolute.
• 15:51
  Speaker 2: Law, total authority from the very first day of their training.
• 15:56
  Nurses and surgical technologists are basically conditioned tonticipate the surgeon's needs,
• 16:01
  to facilitate their workflow, and above all, to defer to
• 16:04
  their expertise, never questioned the captain. Exactly so, when a
• 16:08
  catastrophe is unfolding, when blood pressure is crashing, the monitors
• 16:12
  are screaming, there's blood everywhere, and the environment is just
• 16:15
  highly emotionally charged. That power structure can completely paralyze highly
• 16:20
  trained professionals.
• 16:22
  Speaker 1: It sounds so much like the Stanley Milgrim obedience experiment.
• 16:24
  Speaker 2: Oh, the shock experiment.
• 16:26
  Speaker 1: Where people just kept administering what they truly thought were
• 16:29
  lethal electrical shocks to another person just because a guy
• 16:32
  in a white lab coat with a clipboard told them to.
• 16:34
  Speaker 2: It's the exact same psychological mechanism at play. If the surgeon,
• 16:39
  who is the ultimate authority figure in that room, is
• 16:42
  forcefully insisting on a reality like this is a severely
• 16:45
  enlarged spleen label it, the staff experiences intense cognitive dissonance.
• 16:51
  Speaker 1: Their eyes are telling them one thing, but.
• 16:53
  Speaker 2: The absolute authority figure is demanding another. But you know,
• 16:58
  it goes beyond just psychological obedien There is a very real,
• 17:02
  very grounded fear of professional retaliation in these hospitals, like
• 17:05
  losing their jobs oh easily. If a circulating nurse directly
• 17:10
  contradicts the lead surgeon in the middle of a crisis,
• 17:13
  or refuses a direct order to label a specimen, they
• 17:16
  risk being screamed at in front of their peers, thrown
• 17:18
  out of the room entirely, or having their career quietly
• 17:21
  torpedoed by a powerful physician complaining to hospital administration later.
• 17:26
  Speaker 1: They are terrified for their livelihoods. They have mortgages to pay.
• 17:29
  Speaker 2: Precisely, they are in a state of profound shock, They're
• 17:32
  navigating an unprecedented trauma, and the person with the most
• 17:35
  power in the room is dictating the narrative. The instinct
• 17:39
  to just comply under that kind of intense pressure is overwhelming.
• 17:42
  It is a deeply ingrained cultural flaw that modern medicine
• 17:47
  has been desperately trying to dismantle for decades. But as
• 17:51
  this case shows so clearly, that hierarchy is still lethal.
• 17:55
  Speaker 1: Which begs the question, why was this specific surgeon, doctor Chiknovsky,
• 18:01
  given such unquestioned authority in that room to begin with?
• 18:04
  Speaker 2: Well, that's the other massive failure here, because if you.
• 18:07
  Speaker 1: Look at the investigation, this catastrophic error didn't happen in
• 18:10
  a vacuum. It wasn't just a lightning strikeout of nowhere.
• 18:13
  There was a glaring trail of red flags at the
• 18:15
  institutional system, seemingly ignored entirely.
• 18:18
  Speaker 2: Yeah, when STET investigators and journalists started really digging into
• 18:22
  doctor Sheiknovsky's background after this, they uncovered a documented, terrifying
• 18:26
  history of alleged wrong site surgeries and severe complications.
• 18:30
  Speaker 1: The record show that in May of twenty twenty three,
• 18:32
  which is more than a year before Bill Bryan's death,
• 18:35
  doctor Schiknovsky was operating at this exact same hospital, Ascension
• 18:38
  Sacred Heart, same place, and he was scheduled to perform
• 18:42
  a procedure to remove a patient's left adrenal gland. But
• 18:46
  according to a malpractice closed claim report, he completely missed
• 18:51
  the adrenal gland. He instead removed a portion of the
• 18:54
  patient's pancreas.
• 18:55
  Speaker 2: And just to give some anatomical context here, the adrenal
• 18:58
  glands sit right on top of the kidneys. The pancreas
• 19:01
  is an entirely different organ nestled in the curve of
• 19:04
  the duodenum completely behind the stomach.
• 19:06
  Speaker 1: Suinating close well.
• 19:08
  Speaker 2: They are both located in the retroperitoneal space, which is
• 19:11
  the area behind the abdominal cavity, but they serve wildly
• 19:15
  different functions and have totally different structures. Removing healthy pancreatic
• 19:19
  tissue instead of an adrenal gland is a massive anatomical deviation.
• 19:24
  It's not a tiny.
• 19:25
  Speaker 1: Slit, and it caused severe harm to that patient. The
• 19:28
  reports state that this error led to an abscess, a
• 19:31
  severe infection, and prolonged injuries.
• 19:33
  Speaker 2: For them, and it wasn't an isolated incident either. No
• 19:36
  Filings from the Alabama Board of Medical Examiners, who later
• 19:39
  sought to revoke his license in that state, detailed another
• 19:42
  horrific incident in July of twenty twenty three.
• 19:45
  Speaker 1: Just a couple months later.
• 19:47
  Speaker 2: During what was supposed to be a standard procedure, he
• 19:50
  allegedly removed a section of a patient's intestine, causing a
• 19:53
  massive gastrointestinal perforation.
• 19:56
  Speaker 1: So within a few months, he cuts out a piece
• 19:58
  of a pancreas instead of an adrenal gland, and then
• 20:02
  perforates a patient's bowel by accidentally removing part of their intestine. Yeah,
• 20:06
  and it gets even worse. The sources indicate that by
• 20:09
  late twenty twenty three, the hospital's own peer review committee
• 20:12
  began heavily scrutinizing him.
• 20:14
  Speaker 2: They saw the pattern they.
• 20:15
  Speaker 1: Cited a quote pattern of questionable decision making. They raised
• 20:20
  serious concerns about his case volume, his sloppy documentation, and
• 20:24
  his inability to recognize difficult or complex cases before operating.
• 20:29
  Speaker 2: Which is a huge red flag for a surgeon.
• 20:31
  Speaker 1: He even took a month long leave as absence around
• 20:33
  that time, and staff reportedly described his demeanor in the
• 20:37
  OAR as cavalier.
• 20:39
  Speaker 2: To compound all of those institutional warnings, reports explicitly noted that,
• 20:43
  prior to operating on Bill Bryan, doctor Chiknovsky hadn't performed
• 20:47
  a single splenectomy at that specific hospital in over three years.
• 20:50
  Speaker 1: Okay, here's where my mind just completely stops working.
• 20:53
  Speaker 2: I know.
• 20:53
  Speaker 1: It feels like letting someone keep their commercial driver's license
• 20:56
  after they've drunkenly crashed a semi truck through two different
• 20:59
  storefroms simply because they managed to pay off the store
• 21:02
  owners quietly.
• 21:03
  Speaker 2: That's an alarmingly accurate analogy.
• 21:06
  Speaker 1: How is he still allowed in an operating room. Because
• 21:09
  that May twenty twenty three pancreas case. It was settled
• 21:13
  pre suit. No formal lawsuit was ever filed in public court.
• 21:18
  It was just swept under the rug with a financial settlement.
• 21:21
  Where is the institutional oversight?
• 21:25
  Speaker 2: If we connect this to the bigger picture to understand
• 21:28
  how a surgeon with that kind of track record is
• 21:30
  allowed to touch another patient, we have to explore the
• 21:33
  incredibly complex, opaque and often broken system of medical credentialing.
• 21:37
  Speaker 1: It seems completely broken.
• 21:39
  Speaker 2: And legal liability in the United States. There are massive
• 21:42
  competing tensions at play behind the scenes of every single hospital.
• 21:46
  Speaker 1: So walk me through the mechanics of a presuit settlement.
• 21:49
  How does an error that severe just vanish from the
• 21:52
  public eye.
• 21:53
  Speaker 2: Okay, so, when a catastrophic error happens, like removing a
• 21:57
  piece of the pancreas by mistake, the hospital's disk management
• 22:00
  team and their malpractice insurance carriers, they immediately.
• 22:04
  Speaker 1: Step in like crisis management.
• 22:06
  Speaker 2: Exactly if the error is indefensible, which wrong site surgeries
• 22:09
  almost always are. You can't really defend cutting out the
• 22:13
  wrong organ. Their primary goal is damage control, minimize is
• 22:17
  the fallout. They approach the injured patient or their family
• 22:20
  and offer a substantial financial settlement before a formal lawsuit
• 22:24
  is ever filed in the court system.
• 22:26
  Speaker 1: Because once a lawsuit is filed, it becomes public record.
• 22:30
  Anyone can look it up.
• 22:31
  Speaker 2: Exactly. By settling presuit, they require the patient to sign
• 22:34
  a strict non disclosure agreement an NDA, and the details
• 22:38
  of the error are legally buried forever.
• 22:40
  Speaker 1: Wow.
• 22:41
  Speaker 2: Now in theory. The National Practitioner Data Bank the NPDB
• 22:45
  was created by Congress back in nineteen eighty six specifically
• 22:48
  to prevent this exec thing.
• 22:50
  Speaker 1: Right, there's supposed to be a list.
• 22:51
  Speaker 2: It is a federal repository meant to track bad doctors,
• 22:54
  so they can't just move from hospital to hospital or
• 22:56
  you know, state to state, leaving a trail of bodies
• 22:59
  behind them.
• 23:00
  Speaker 1: So why didn't the data bank flag him if he
• 23:02
  had these massive errors? Why wasn't he on the list?
• 23:05
  Speaker 2: Because the system is just riddled with loopholes. One major
• 23:09
  loophole is called the corporate shield.
• 23:11
  Speaker 1: The corporate shield.
• 23:12
  Speaker 2: Yeah, if the hospital or a corporate entity settles the
• 23:16
  claim without explicitly naming the individual doctor in the final
• 23:19
  settlement paperwork, it often doesn't trigger a mandatory report to
• 23:23
  the NPDB.
• 23:24
  Speaker 1: You're kidding, So they just pay it out from the
• 23:26
  corporate bucket and the doctor's name stays claim exactly.
• 23:29
  Speaker 2: Furthermore, state medical boards operate in absolute silos. They don't
• 23:33
  talk to each other. Well, they are historically underfunded, they're understaffed,
• 23:38
  and they rely heavily on voluntary reporting from the hospitals themselves.
• 23:42
  Speaker 1: But wait, the hospital's own peer review committee flagged him.
• 23:45
  We just talked about that. They knew he was a risk.
• 23:48
  Why didn't the hospital just fire him and revoke his
• 23:50
  surgical privileges?
• 23:51
  Speaker 2: Because revoking a physician's privileges is one of the most
• 23:54
  legally perilous actions a hospital administration can possibly.
• 23:58
  Speaker 1: Take, more perilous than letting him kill someone.
• 24:00
  Speaker 2: Financially, Yes, sometimes, if a hospital terminates a doctor's privileges,
• 24:06
  that action absolutely must be reported to the national databases.
• 24:10
  Speaker 1: Which effectively ends that doctor's career instantly.
• 24:13
  Speaker 2: And because the stakes are so high, doctors will fight
• 24:16
  back with everything they have. They will launch massive, multi
• 24:20
  million dollar lawsuits against the hospital for wrongful termination, for defamation,
• 24:25
  for anti competitive practices.
• 24:27
  Speaker 1: So the hospital administrators are actually more terrified of the
• 24:31
  doctor's lawyers than they are of the doctor's surgical skills.
• 24:34
  Speaker 2: In many cases, yes, unless the hospital has an ironclad,
• 24:38
  exhaustively documented, completely bulletproof case of gross negligence over a
• 24:42
  long period of time, their legal department will often advise
• 24:46
  against termination.
• 24:47
  Speaker 1: That's insane.
• 24:48
  Speaker 2: Instead, they try to manage the physician. They require proctering,
• 24:51
  meaning another doctor watches them, or they suggest a leave
• 24:55
  of absence, which remember Shcheknosky actually took, Or they limit
• 24:58
  the types of surgeries the doctors is allowed to perform.
• 25:01
  They try to find a middle ground to avoid a
• 25:03
  massive lawsuit.
• 25:04
  Speaker 1: But the middle ground leads the patient completely exposed. It does.
• 25:08
  His licenses were only suspended after Bill Bryan died on
• 25:11
  the table. Yeah, Florida issued an emergency suspension in September
• 25:15
  twenty twenty four. Alabama fully revoked his license shortly after,
• 25:19
  and New York, where he also held privileges, suspended him.
• 25:22
  Speaker 2: Yeah.
• 25:22
  Speaker 1: But it literally took a man bleeding to death from
• 25:24
  a severed hepatic artery for the system to finally say, Okay,
• 25:29
  maybe he shouldn't be operated.
• 25:30
  Speaker 2: It highlights a completely reactive system rather than a proactive one.
• 25:35
  The entire system relies on the assumption that doctors are
• 25:38
  universally competent until they prove otherwise in a spectacular, undeniable fashion.
• 25:44
  Speaker 1: He is deeply terrifying. And you know, it's so easy
• 25:47
  and maybe even comforting to look at this and view
• 25:50
  it as just the story of one uniquely reckless cavalier
• 25:53
  doctor to.
• 25:53
  Speaker 2: Brush it off as a single bad apple, right, But.
• 25:56
  Speaker 1: The data reveals a reality that is much much harder
• 25:59
  to say. Stomach. This isn't just one guy. This is
• 26:02
  a systemic rot.
• 26:03
  Speaker 2: It really is a never event? Is the umbrella term
• 26:06
  for exactly these types of catastrophic failure.
• 26:08
  Speaker 1: What's to find that? Again?
• 26:09
  Speaker 2: It includes wrong site surgery, wrong procedure, surgery operating on
• 26:13
  the entirely wrong patient, and retained foreign objects, which is
• 26:16
  when a surgeon sows a patient up with a sponge
• 26:19
  or a clamp or a scalpel still inside their body.
• 26:21
  Speaker 1: Cabints sales left in there.
• 26:23
  Speaker 2: Yeah, and the Joint Commission, which is the major accrediting
• 26:27
  body for US hospitals, officially categorizes these as sentinel events
• 26:31
  when they result in death or severe physical or psychological injury.
• 26:36
  Speaker 1: And the statistics in the research are absolutely staggering. I
• 26:39
  was looking at this landmark twenty thirteen analysis that look
• 26:42
  deeply into the National Practitioner Databank claims over a twenty
• 26:46
  year period from nineteen ninety to twenty ten.
• 26:48
  Speaker 2: Okay, what did they find.
• 26:49
  Speaker 1: During that window? There were nine thousand, seven hundred and
• 26:52
  forty four paid malpractice settlements and judgments, specifically for.
• 26:57
  Speaker 2: Never events nearly ten thousand yes that.
• 27:00
  Speaker 1: Total one point three billion dollars in payouts, and based
• 27:03
  on that data, researchers estimate that roughly four thousand and
• 27:06
  eighty two of these claims occur annually in the United
• 27:09
  States alone.
• 27:10
  Speaker 2: Let's put that number into perspective for a second. Four
• 27:12
  thousand times a year.
• 27:13
  Speaker 1: It's hard to wrap your head around.
• 27:15
  Speaker 2: That equates to more than seventy eight times a week,
• 27:18
  or about eleven times every single day, eleven times today,
• 27:21
  eleven times today, someone in the United States will experience
• 27:25
  an error so fundamental that basic safety protocols say it
• 27:29
  should be literally impossible, and.
• 27:31
  Speaker 1: The human toll is devastating. That same study found that
• 27:35
  mortality like actual death occurred in six point six percent
• 27:39
  of those cases, and permanent life altering injury occurred in
• 27:44
  almost thirty three percent of them.
• 27:46
  Speaker 2: A third of the patients permanently injured, and it isn't
• 27:48
  getting better.
• 27:49
  Speaker 1: The Joint Commission reported that wrong site surgery accounted for
• 27:52
  six percent of all the sentinel events they reviewed in
• 27:55
  twenty twenty two. Wow. The Pennsylvania Patient Safety Authority, which
• 27:59
  is one of the more or robust state level reporting bodies,
• 28:02
  they documented six hundred and sixty four wrong site surgeries
• 28:05
  across their facilities alone between twenty fifteen and twenty.
• 28:08
  Speaker 2: Twenty four, just in Pennsylvania.
• 28:09
  Speaker 1: That is an average of more than one wrong site
• 28:11
  surgery a week, just in that one state.
• 28:13
  Speaker 2: And we really must emphasize that every single one of
• 28:16
  these numbers is a massive.
• 28:17
  Speaker 1: Undercount because of the NDAs, right.
• 28:20
  Speaker 2: Because the reporting systems are largely voluntary for near misses,
• 28:23
  and because hospitals frequently use those pre suit NDAs we
• 28:27
  discussed to settle quietly, the true scope of the problem
• 28:30
  is likely much much larger.
• 28:32
  Speaker 1: So we have the pre op checklists, right, we have
• 28:35
  the imaging reviews, we have the nurses confirming the patient's.
• 28:38
  Speaker 2: Identity with so many protocols.
• 28:40
  Speaker 1: If we know exactly what these errors are and they
• 28:42
  cost billions of dollars, how is it mathematically possible that
• 28:46
  the system still fails over four one thousand times a year.
• 28:50
  Speaker 2: Safety engineers and medical researchers explain this using what's called
• 28:53
  the Swiss cheese model of systemic failure.
• 28:56
  Speaker 1: Cheese.
• 28:56
  Speaker 2: Yeah, it was originally developed by a guy named James
• 28:59
  Reason back in nineteen ninety. Imagine several slices of Swiss
• 29:03
  cheese stacked up right next to each other.
• 29:05
  Speaker 1: Okay, I'm picturing it.
• 29:06
  Speaker 2: Each slice represents a different defensive layer in the hospital.
• 29:10
  So the first slice is the preop check where the
• 29:12
  nurse asks your name and your date of birth, the basics.
• 29:15
  The second slice is the surgeon physically taking a marker
• 29:18
  and signing their initials on the body part they are
• 29:21
  supposed to operate on. The third slice is the radiology review.
• 29:25
  The fourth slice is the surgical timeout just before they
• 29:28
  make the incision.
• 29:29
  Speaker 1: Okay, so you have all these multiple layers of.
• 29:31
  Speaker 2: Defense exactly, But every slice of swift cheese has holes
• 29:34
  in it. Naturally, these holes represent latent conditions and active
• 29:39
  human errors. So a hole might be a nurse getting
• 29:42
  distracted by a blaring monitor, or an electronic health record
• 29:46
  glitches and pulls up an old scan instead of the
• 29:48
  new one, or a surgeon is just completely exhausted from
• 29:52
  working a fourteen hour shift. Okay, Usually, if a mistake
• 29:55
  slips through a hole in the first slice, it is
• 29:58
  caught by the solid cheese of second slice, like the
• 30:01
  nurse catches the air before the patient even enters.
• 30:04
  Speaker 1: The room, so the mistake stops there right.
• 30:06
  Speaker 2: An never event only occurs when the holes in every
• 30:09
  single slice of cheese perfectly align, allowing the error to
• 30:13
  shoot straight through the entire defensive stack and actually reach
• 30:16
  the patient.
• 30:16
  Speaker 1: But why are there so many holes lining up? I mean,
• 30:18
  why is the cheese so holy to begin with?
• 30:20
  Speaker 2: Because the modern environment of high volume corporate medicine is
• 30:24
  actively stretching the cheese and making the holes bigger. How so,
• 30:28
  surgeon fatigue is a massive chronic factor. Chiknovsky, for instance,
• 30:33
  was covering surgical cases across multiple different facilities. When a
• 30:37
  surgeon is sleep deprived, their cognitive function just plummets, like
• 30:41
  driving tired exactly. They suffer from the exact same cognitive
• 30:46
  impairments as someone who is legally intoxicated. They start taking
• 30:50
  mental shortcuts, and.
• 30:51
  Speaker 1: There's the pressure for efficiency too.
• 30:53
  Speaker 2: Immense pressure. Operating rooms are the primary revenue generators for hospitals.
• 30:58
  Speaker 1: They make the money they.
• 30:59
  Speaker 2: Do, so there is a constant, relentless push from administration
• 31:03
  to turn over the rooms quickly, get the next patient in,
• 31:06
  do the surgery, get them out, clean the room, do
• 31:09
  it again.
• 31:09
  Speaker 1: Assembly line medicine, yes.
• 31:11
  Speaker 2: But safety protocols inherently require friction. A proper timeout where
• 31:16
  every single person in the room stops moving, puts down
• 31:19
  their instruments, confirms the patient's identity, the exact procedure, the site,
• 31:23
  and the imaging. That takes a few minutes.
• 31:25
  Speaker 1: It slows things down, it.
• 31:26
  Speaker 2: Does, and in a rushed, high pressure environment, that timeout
• 31:31
  often devolves into a perfunctory fast mumble while people are
• 31:35
  still actively organizing instruments and ignoring it.
• 31:38
  Speaker 1: So the mechanics fail, the paperwork gets rushed, the electronic
• 31:42
  records hide crucial data. Yeah, but that brings us right
• 31:46
  back to the biggest hole in the Swiss cheese, because
• 31:49
  the hole isn't mechanical, really, it is deeply cultural. The
• 31:52
  human element, the final layer of defense is the actual
• 31:55
  human beings standing in the room, and the research on
• 31:59
  the culture of science balance in the operating room is appalling.
• 32:02
  Speaker 2: It really is a heavily sighted. Study in the Certical
• 32:04
  Literature revealed that up to seventy percent of operating room
• 32:07
  staff have witnessed errors or severe safety violations during a procedure,
• 32:12
  but they remained entirely silent.
• 32:14
  Speaker 1: Entirely silent, yes.
• 32:15
  Speaker 2: Due to the fear of retaliation.
• 32:17
  Speaker 1: Seventy percent. That means in seven out of ten surgeries
• 32:20
  where a mistake is happening, a nurse or a text
• 32:22
  sees it, knows it is wrong and decides that keeping
• 32:25
  their mouth shut is safer than speaking up.
• 32:28
  Speaker 2: It's a survival instinct for their careers.
• 32:30
  Speaker 1: It immediately makes me think of the aviation industry in
• 32:33
  the nineteen seventies.
• 32:34
  Speaker 2: Oh, it is the most perfect parallel we have. Throughout
• 32:37
  the sixties and seventies, commercial airplanes were literally crashing into
• 32:42
  mountains or running completely out of fuel and dropping out
• 32:45
  of the sky.
• 32:46
  Speaker 1: And not because the engines failed.
• 32:47
  Speaker 2: Now, the planes were fine mechanically. They crashed because of
• 32:51
  cockpit hierarchy.
• 32:52
  Speaker 1: There is that famous case United Airlines Flight one seventy
• 32:56
  three back in nineteen seventy.
• 32:57
  Speaker 2: Eight, right the Portland crash.
• 32:59
  Speaker 1: Yeah, they were approaching Portland and the captain got completely
• 33:03
  obsessed with a malfunctioning landing gear light, just a little
• 33:07
  indicator light, pummel vision again exactly. He just circled and
• 33:10
  circled the airport trying to figure it out. The flight
• 33:13
  engineer and the first officer knew the fuel gauges were
• 33:15
  dropping to zero. They knew they were going to crash.
• 33:18
  Speaker 2: They saw the reality.
• 33:19
  Speaker 1: But the captain was an intimidating authoritarian figure, so instead
• 33:22
  of forcefully taking control of the plane or demanding they
• 33:25
  land immediately, the junior officers just offered polite, passive hints
• 33:30
  until the engines flamed out and the plane crashed into
• 33:33
  a suburban neighborhood.
• 33:34
  Speaker 2: And that tragedy, along with several others like it at
• 33:37
  the time, forced the aviation industry to have a massive,
• 33:41
  very painful reckoning.
• 33:42
  Speaker 1: They had to change.
• 33:43
  Speaker 2: They realized that having technical skill was entirely useless if
• 33:46
  the team dynamics were leefal. So they completely revolutionized their
• 33:49
  safety culture by developing something called Crew Resource management or CRM.
• 33:54
  Speaker 1: How does CRM actually work in practice? Like? How did
• 33:57
  they fix it?
• 33:58
  Speaker 2: CRM fundamentally dismantled the unquestioned godlike authority of the captain.
• 34:03
  It mandated a culture where a junior flight attendant or
• 34:06
  a young co pilot is not just legally permitted, but
• 34:09
  professionally mandated to voice a safety concern directly to a
• 34:13
  senior captain.
• 34:14
  Speaker 1: So they have to speak up, they have.
• 34:16
  Speaker 2: To, and more importantly, the captain is mandated to acknowledge
• 34:19
  and formally evaluate that concern. They implemented standardized communication protocols.
• 34:24
  They basically removed the ego from the cockpit.
• 34:27
  Speaker 1: So why hasn't medicine been able to do the exact
• 34:29
  same thing. I mean, we've known about CRM for decades.
• 34:31
  Why is the medical hierarchy so much harder to break?
• 34:34
  Speaker 2: Because a hospital operates onto fundamentally different financial and social
• 34:38
  structures than an airline. How So, think about it. A
• 34:42
  pilot is a salaried employee of the airline. If they
• 34:46
  crash the plane, they die right along with the passengers.
• 34:49
  Speaker 1: Right their life is on the line too.
• 34:51
  Speaker 2: In a hospital, the surgeon is often not just an employee.
• 34:55
  They are an independent contractor or they're a partner in
• 34:58
  a massive medical group that it brings in tens of
• 35:01
  millions of dollars of revenue for the hospital every year.
• 35:04
  Speaker 1: Well, they bring the money in.
• 35:06
  Speaker 2: Exactly their status is elevated way above the rest of
• 35:09
  the staff. Furthermore, if a surgeon makes a catastrophic mistake,
• 35:13
  the surgeon doesn't die, the patient does.
• 35:16
  Speaker 1: That is a chilling distinction. So how do you fix it.
• 35:19
  You can't just put up a poster in the breakroom
• 35:21
  that says teamwork makes the dream work and expect the
• 35:24
  hierarchy to vanish.
• 35:25
  Speaker 2: No, posters don't work. You have to build what organizational
• 35:28
  psychologists call psychological safety.
• 35:30
  Speaker 1: Psychological safety, this is an.
• 35:32
  Speaker 2: Environment where a circulating nurse feels entirely empowered and crucially
• 35:38
  knows they are legally, financially and professionally protected by the
• 35:42
  hospital administration to physically step up to the table and
• 35:45
  say stop, I believe we're about to cut into.
• 35:48
  Speaker 1: The wrong organ, and no, they won't get fired for it. Right.
• 35:51
  Speaker 2: Building that requires structural upheaval. It requires hospital leadership to
• 35:56
  unequivocally back the junior nurse over the star surgeon when
• 35:59
  a safety halt is called.
• 36:01
  Speaker 1: Which is hard when the scar surgeon brings in the millions,
• 36:03
  very hard.
• 36:04
  Speaker 2: It also requires mandated strict rest periods for surgeons so
• 36:08
  they aren't operating impaired by sleep deprivation, and it requires
• 36:12
  truly independent, rigorous proctering for any surgeon returning from a
• 36:16
  leave of absence like Shechnovsky did.
• 36:18
  Speaker 1: But when that culture completely collapses, right when every single
• 36:22
  layer of the Swiss cheese fails and a patient dies
• 36:24
  a completely preventable death, the legal system eventually steps in
• 36:28
  to fill the void. Usually, yes, and right now, this
• 36:31
  specific case with doctor Sheknovsky is testing the very boundaries
• 36:34
  of how the legal system handles medical errors.
• 36:37
  Speaker 2: It's pushing into uncharted territory.
• 36:39
  Speaker 1: Let's look at the breaking news of the April thirteenth,
• 36:42
  twenty twenty six indictment.
• 36:43
  Speaker 2: Yes, a Walton County grand jury reviewed the evidence surrounding
• 36:47
  the death of Bill Bryan, and they handed down an
• 36:50
  indictment against doctor Sheiknovsky for second degree manslaughter.
• 36:54
  Speaker 1: This is an incredibly rare earthquake level legal development I'm
• 36:58
  heard of.
• 36:58
  Speaker 2: Really.
• 36:59
  Speaker 1: Normally, medical errors, even fatal, horrifying ones, are handled entirely
• 37:04
  in civil court as medical malpractice.
• 37:07
  Speaker 2: Right, it's about money, not prison.
• 37:09
  Speaker 1: The family hires a lawyer, they sue the doctor in
• 37:11
  the hospital, the malpractice insurance companies battle it out, a
• 37:15
  financial settlement is reached, and maybe the state Medical board
• 37:18
  restricts the doctor's license. But criminal prosecution actually putting handcuffs
• 37:23
  on a physician for actions taken during a surgery that
• 37:26
  is exceptionally uncommon in the United States.
• 37:28
  Speaker 2: Because it requires crossing a massive legal threshold. In civil malpractice,
• 37:33
  the standard is essentially negligence. Right, did the doctor fail
• 37:37
  to meet the standard of care that a reasonable physician
• 37:40
  would have provided a mistake?
• 37:41
  Speaker 1: Basically yes, But for.
• 37:44
  Speaker 2: A manslaughter charge, the prosecution has to prove something called
• 37:48
  culpable negligence.
• 37:49
  Speaker 1: What does that mean? Legally?
• 37:51
  Speaker 2: Culpable negligence it requires proving a specific state of mind.
• 37:56
  It means the conduct was so recklessly devoid of care,
• 37:59
  so grustly negligent, that it demonstrates a conscious, wilful disregard
• 38:04
  for human life.
• 38:05
  Speaker 1: Wow.
• 38:05
  Speaker 2: The Walton County Sheriff, Michael Adjinson, he actually stated that
• 38:09
  investigators simply followed the facts without fear or favor, which
• 38:13
  led directly to the arrest in Miramar Beach.
• 38:16
  Speaker 1: And it is important to note that the Brian family
• 38:18
  is simultaneously pursuing those civil wrongful death and malpractice.
• 38:22
  Speaker 2: Suits too, right, they're doing both.
• 38:24
  Speaker 1: But the criminal charge it has completely split the medical
• 38:27
  and legal communities.
• 38:29
  Speaker 2: It is intensely controversial right now. On one side, you
• 38:32
  have the detractors, medical associations, hospital lobbying groups, and a
• 38:36
  lot of practicing doctors are warning that criminally charging physicians
• 38:39
  sets a terrifying precedent and creates a massive chilling effect.
• 38:43
  They're scared, very They argue that if doctors believe they
• 38:47
  could literally go to state prison for making a mistake
• 38:50
  in the OER, the entire landscape of medicine will change
• 38:53
  for the worse.
• 38:54
  Speaker 1: Their argument is rooted in the reality of medical complexity. Right.
• 38:57
  Speaker 2: Yes, they warn that it will drive of extreme defensive medicine.
• 39:02
  Speaker 1: What does that look like?
• 39:03
  Speaker 2: It means doctors will start ordering thousands of dollars of
• 39:06
  unnecessary CT scans, MRIs and extra blood work for every
• 39:11
  minor procedure, just to create a massive paper trail protecting
• 39:16
  them from potential prosecution down the.
• 39:18
  Speaker 1: Line, driving up costs for everyone.
• 39:20
  Speaker 2: Exactly, and even more critically, they argue, it will completely
• 39:23
  destroy the voluntary error reporting systems we talked about.
• 39:26
  Speaker 1: Right because if admitting a near miss or a mistake
• 39:30
  means you might get a grand jury indictment, no one
• 39:32
  will ever admit anything ever.
• 39:34
  Speaker 2: Again, everything goes underground.
• 39:36
  Speaker 1: We will lose the ability to analyze errors and improve
• 39:39
  the system. I have to play Devil's advocate here for
• 39:41
  a second.
• 39:41
  Speaker 2: Go for it.
• 39:42
  Speaker 1: If you are a world class surgeon and you know
• 39:45
  you could face manslaughter charges if a high risk, super
• 39:49
  complicated surgery goes wrong, aren't you just going to refuse
• 39:53
  to operate on the sickest patients.
• 39:55
  Speaker 2: It's a huge riss.
• 39:56
  Speaker 1: Are we solving one problem by creating a much worse
• 39:59
  reality where people who desperately need complex care simply can't
• 40:04
  find a doctor willing to take the legal risk to
• 40:06
  cut them open.
• 40:07
  Speaker 2: This raises an important question, and it is the exact
• 40:10
  tension at the heart of this legal crossroads. Where is
• 40:15
  the definitive line between a tragic, honest human error and
• 40:18
  reckless criminal disregard it's blurry it is. However, proponents of
• 40:23
  the indictment, including a lot of patient safety advocates, argue
• 40:26
  that this specific case with Strechnowsky didn't just cross the line,
• 40:29
  it leaped over it.
• 40:30
  Speaker 1: Because it wasn't just a slip of the scalpel during
• 40:32
  a chaotic emergency exactly.
• 40:34
  Speaker 2: We are not talking about a micromillimeter error while dissecting
• 40:38
  a delicate tumor wrapped around a spinal cord. We are
• 40:40
  talking about opening an abdomen, ignoring massive visual and anatomical cues,
• 40:46
  removing the largest internal organ instead of a small emphatic one,
• 40:50
  and ignoring a documented history of prior wrong site errors.
• 40:53
  It's egregious, but the defining element, the action that likely
• 40:57
  pushed prosecutors to seek a criminal indictment, occurred post removal.
• 41:01
  Speaker 1: The cover up.
• 41:02
  Speaker 2: The alleged actions in the aftermath are what demonstrate intent.
• 41:05
  If you make a horrific mistake, realize it, try your
• 41:08
  best to save the patient, and then immediately confess the
• 41:12
  error to the family and the authorities, that is malpractice.
• 41:15
  Speaker 1: You are own up to it.
• 41:16
  Speaker 2: Yes, but prosecutors are likely arguing that looking at a
• 41:20
  massive vascular liver sitting on a table, insisting to a
• 41:24
  horrified staff that it is a spleen, and then directing
• 41:26
  them to legally mislabel a pathological specimen shows a clear
• 41:30
  intent to deceive.
• 41:31
  Speaker 1: It changes the trime.
• 41:33
  Speaker 2: It transforms an act of gross incompetence into an act
• 41:36
  of criminal recklessness designed to obscure the truth.
• 41:39
  Speaker 1: While the courts, a judge, and a jury will eventually
• 41:42
  decide whether doctor Schachnovsky's actions actually warned a prison sentence.
• 41:46
  The most pressing issue for you, the listener navigating the
• 41:50
  healthcare system today, is how the medical field is actively
• 41:53
  working to prevent this from ever happening to you?
• 41:56
  Speaker 2: Right? What happens when you are the one lying on
• 41:59
  that table.
• 42:00
  Speaker 1: So what's being done well?
• 42:02
  Speaker 2: The good news is that the field of patient safety
• 42:04
  is not totally stagnant. There are tangible, robust solutions being
• 42:08
  developed and deployed globally right now. At the baseline level,
• 42:12
  we have the WHO Surgical Safety Checklist and the Joint
• 42:15
  Commission's Universal Protocol.
• 42:17
  Speaker 1: These are the protocols that mandate the explicit site marking
• 42:20
  r YES, where the surgeon literally comes into the pre
• 42:23
  oupholding area with a permanent sharpie marker and writes yes
• 42:27
  and their initials directly on the skin of the surgical
• 42:30
  site while the patient is fully awake and participating. Yes.
• 42:34
  Speaker 2: That's a cornerstone of the Universal Protocol. It also requires
• 42:38
  rigorous team briefings before the patient even enters the room
• 42:41
  and that official time out before the incision that we
• 42:43
  talked about earlier, but as.
• 42:45
  Speaker 1: We discussed with the Swiss cheese model. Human driven paperwork
• 42:49
  is fallible. People rush, They.
• 42:51
  Speaker 2: Absolutely do, which is why the frontier of patient safety
• 42:54
  is moving heavily toward technological interventions that remove human cognitive
• 42:58
  bias from the equation entirely.
• 43:00
  Speaker 1: Let's talk about that tech, because relying on a tired
• 43:04
  surgeon to read a paper checklist clearly isn't enough anymore.
• 43:08
  What is actually happening in the oars of the future.
• 43:10
  Speaker 2: Okay, so hospitals are heavily investing in barcode standing for
• 43:14
  every single surgical instrument, sponge and clamp.
• 43:17
  Speaker 1: Like at a grow fery store, exactly like that.
• 43:20
  Speaker 2: Before an incision is closed, a computer must verify that
• 43:23
  every single barcode that was scanned into the sterile surgical
• 43:26
  field has been scanned back out.
• 43:28
  Speaker 1: Oh that's smart.
• 43:29
  Speaker 2: If the computer says a sponge is missing, the patient
• 43:32
  is not closed up until it is found. Period.
• 43:34
  Speaker 1: That definitely prevents the retained foreign objects. But what about
• 43:38
  wrong site surgeries? How does tech fix that?
• 43:40
  Speaker 2: There are incredible cutting edge developments happening right now in
• 43:44
  augmented reality or AR.
• 43:46
  Speaker 1: Overlays like AR glasses.
• 43:48
  Speaker 2: Yes, a surgeon wears a specialized headset that takes the
• 43:51
  patient's specific preoperative CT scans or MRIs and projects them
• 43:57
  directly onto the patient's body in real time.
• 44:00
  Speaker 1: WHOA.
• 44:01
  Speaker 2: It effectively gives the surgeon X ray vision before they
• 44:04
  even pick up a scalpel. They can see exactly where
• 44:07
  the liver, the spleen, and the major blood vessels are
• 44:09
  located beneath the skin, tailored perfectly to that specific patient's
• 44:13
  unique anatomy.
• 44:14
  Speaker 1: That is wild, It's like a GPS for the body.
• 44:17
  But what about the cognitive overload during a laparoscopic procedure
• 44:21
  like what happened here with the video screens?
• 44:23
  Speaker 2: That is where artificial intelligence is making the biggest leaps.
• 44:26
  AI computer vision systems are currently being trained on millions
• 44:29
  of hours of surgical video footage. Okay, these AI systems
• 44:33
  can be integrated directly into the laparoscopic camera feed in
• 44:36
  the operating room. As the camera moves around the abdomen,
• 44:39
  the AI analyzes the tissue textures, the shapes, and the
• 44:42
  vascular structures frame by frame in real time.
• 44:44
  Speaker 1: Let's watch the surgery with them exactly.
• 44:47
  Speaker 2: So if the operative plan says splenectomy and the AI
• 44:50
  algorithm detects that the surgeon's instruments are hovering over the
• 44:53
  distinct cellular texture of hepatic tissue the liver. It instantly
• 44:58
  triggers an auditory and visual alarm in the operating room.
• 45:02
  Speaker 1: It stops them.
• 45:02
  Speaker 2: It acts as an unbiased, unemotional, tireless second pair of
• 45:07
  eyes that is entirely immune to the surgeon's confirmation bias.
• 45:11
  Speaker 1: A digital copilot that isn't afraid to yell at the captain.
• 45:14
  Speaker 2: I love that It's exactly what's needed.
• 45:16
  Speaker 1: There's also a major push for policy changes right, like
• 45:19
  requiring dual surgeon sign us on complex cases, or mandating
• 45:24
  that a second attending physician must be scrubbed in for
• 45:26
  any high risk procedure, just to distribute the cognitive load.
• 45:30
  Speaker 2: Distributing the pressure is key, and we really have to
• 45:32
  highlight Beverly Bryant's role in all of this.
• 45:34
  Speaker 1: Bill's wife.
• 45:35
  Speaker 2: Yes, she is occupying an incredibly difficult, painful space right now.
• 45:40
  She is a grieving widow who watched her husband die
• 45:42
  a horrific, preventable death. But she is also an experienced
• 45:46
  nurse who understands exactly how the system is supposed to work.
• 45:49
  Speaker 1: She knows where it broke.
• 45:50
  Speaker 2: She does, and she, along with her legal team at
• 45:53
  Zarzar Law are refusing to let this be quietly settled
• 45:57
  under an NDA and swept away, running her profound personal
• 46:01
  tragedy into a highly public catalyst for institutional reform.
• 46:06
  Speaker 1: So what does this all mean for you?
• 46:07
  Speaker 2: That's the real question.
• 46:09
  Speaker 1: We've covered macro solutions, computer vision, AI, hospital credentialing policies,
• 46:13
  and grand jury indictments, but let's translate that into microactions
• 46:17
  for the reality of being a patient today.
• 46:19
  Speaker 2: Because you have to protect yourself.
• 46:21
  Speaker 1: Remember Bill Bryan was reluctant to have the surgery away
• 46:24
  from his home doctors he felt rushed. That instinct was
• 46:28
  tragically prescient. If you are ever in a hospital bed
• 46:32
  facing a procedure, you have to become your own loudest,
• 46:35
  most uncompromising advocate.
• 46:37
  Speaker 2: You really do. The entire system is designed by humans,
• 46:40
  and humans are fundamentally fallible. Your active participation in your
• 46:44
  own care is the final thickest layer of defense in
• 46:47
  that Swiss Cheese model.
• 46:48
  Speaker 1: Ask questions until you are completely satisfied, and do not
• 46:51
  let a physicians and patients intimidate you into silence. Physically
• 46:55
  confirm the site markings with your doctor before they administer
• 46:58
  the anesthesia. Actually look at the marker on your skip.
• 47:02
  Speaker 2: Make them say it out loud to you.
• 47:03
  Speaker 1: Demand to hear a clear, comprehensive time out procedure if
• 47:08
  you are awake in the room, and most importantly, never
• 47:12
  ever be afraid to demand a second opinion or to
• 47:15
  simply say no and walk out if something feels rushed, dismissive,
• 47:19
  or wrong. You hold the ultimate authority over your own body.
• 47:23
  Speaker 2: Medicine is a practice, not a perfection. To rebuild the
• 47:26
  trust that has been so violently shattered by cases like this,
• 47:30
  the system must prioritize relentless transparency over financial expediency. But
• 47:35
  until that structural shift happens completely, vigilance is your best protection.
• 47:39
  Speaker 1: We've covered an immense amount of ground today. We trace
• 47:42
  the unimaginable anatomical error that cost a man is life.
• 47:45
  We did we break down the cognitive failures, the terrifying
• 47:48
  cover up driven by an unchecked operating room hierarchy, the
• 47:51
  systemic loopholes that allowed a surgeon with the history of
• 47:53
  catastrophic mistakes to keep operating, and the resulting unprecedented manslaughter
• 47:58
  indictment that could permanently re shape medical law in America.
• 48:01
  Speaker 2: It is an undeniably dark case to examine. But staring
• 48:05
  directly at these systemic failures is the only way the
• 48:08
  medical feel and we as patients, can close the gaps
• 48:11
  in safety.
• 48:13
  Speaker 1: And building on that urgent need for radical transparency, Let's
• 48:16
  leave you with one final provocative idea to mull over
• 48:20
  as you go about your day. Okay, what if the
• 48:22
  future of informed consent requires a complete legislative rewrite. Imagine
• 48:27
  a world where before you are allowed to sign a
• 48:30
  surgical consent form, the hospital is legally mandated to hand
• 48:34
  you a simple, one page graded report card.
• 48:37
  Speaker 2: Like a school grade.
• 48:38
  Speaker 1: Yeah, a public document showing your specific surgeon's exact complication rates,
• 48:43
  their complete history of malpractice settlements, devoid of any NDA's
• 48:46
  and any past never events. If you have the fundamental
• 48:50
  right to know your doctor's history, just as easily as
• 48:52
  you can see a restaurant's health inspection grade taped to
• 48:54
  their front window, would Bill Bryan still be alive today?
• 48:57
  Speaker 2: It is a profound, paradigm shifting question, and it is
• 49:01
  exactly the conversation the medical establishment needs to be forced
• 49:03
  to have.
• 49:04
  Speaker 1: Thank you for joining us on this deep dive, Stay curious,
• 49:08
  stay empowered, and always ask the hard questions when your
• 49:11
  health is on the line.