Joan Rivers’ daughter ‘outraged’ over mistakes that led to comedian’s death


The daughter of Joan Rivers said she was “outraged” on Tuesday after a federal investigation into the death of the comedian after routine surgery found a series of mistakes were made before and during the procedure.

Rivers died at the age of 81 on 4 September, following an endoscopy that her personal ear, nose and throat doctor performed on her at the Yorkville Endoscopy clinic in New York City’s Upper East Side neighborhood.

An investigation by the federal Centers for Medicare and Medicaid (CMS), begun days after the procedure and before Rivers’s death, found the facility failed to respond to the comedian’s waning vital signs, failed to record her weight before sedating her, performed procedures to which she did not consent and allowed a staff member to photograph Rivers while she was anaesthetized. These lapses violated federal regulations and the clinic’s own bylaws.

The report does not refer to Rivers by name, but matches the date she went into the facility, her age and the circumstances surrounding her death.

Responding to the findings of the report on Tuesday, Rivers’s daughter Melissa said she was “outraged” and promised to work to ensure the safety of future patients.

According to the report, Rivers arrived at the facility around 9am with her personal ear, nose and throat doctor. The doctor did not have clinical privileges at the facility, and many staff members, including the vice-president of clinical operations, had never met her.

Rivers’s vital signs began to deteriorate after the procedure started, around 9am on 28 August. During the procedure, over the course of 14 minutes, Rivers’s blood pressure dropped from 117/60 to 84/40 and her blood oxygen saturation level dipped to 92%, 3% below the low end of normal. Less than four minutes later, Rivers had no pulse.

What happened next is unclear. Records conflict about whether physicians attempted to revive her about two minutes later, at 9.28am, or whether it took another 10 minutes to give Rivers doses of drugs meant to treat cardiac arrest, Epinephrine and Atropine.

One report states physicians started chest compressions at 9.28am, and gave Rivers doses of the two drugs at the same time. A second record says Rivers was given those same medications at 9.38am, fully 10 minutes later.

She was not resuscitated until 10am, after which she was transferred to the hospital. She died several days later at Mount Sinai hospital in New York, having never awoken from a coma. The medical examiner said she died from brain damage caused by a lack of oxygen.

Even before the procedure began, staff members failed to record key pieces of information, federal investigators found. A patient’s weight is a key determinant of how much sedative they can receive, but hers was not recorded in an anesthesiology assessment.

After the team went into the surgical room, the anesthesiologist was supposed to perform a “time-out”, a protocol meant to ensure doctors treat the right patient. Instead of the anesthesiologist calling a time-out, as required by the clinic’s bylaws, a technician did.

Investigators found a conflict in how much of the powerful sedative Propofol Rivers received. A record said she received a 300mg dose, but a staff member said she administered a 120mg dose.

Federal investigators also found that physicians failed to obtain “informed consent” from Rivers. The comedian authorized a procedure in which a thin scope with a camera is inserted through the esophagus. A second procedure, in which a scope is inserted through the nose, was also performed, but there was no record indicating Rivers consented to it.

While Rivers’s personal ENT was performing a second laryngoscopy on the comedian, a procedure there is no record of Rivers authorizing, a staff member took a cellphone photo of the celebrity while she was sedated. The staff member allegedly told another staffer in the room that, “Maybe [Rivers] would like to see this in the recovery area.”

Yorkville Endoscopy has until 7 January to correct deficiencies found in the report, or lose Medicare accreditation provided through the Department of Health and Human Services. The clinic has said the physicians who were involved in the procedure no longer practice at the clinic.

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Olivia Wilson
By Olivia Wilson


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