Is your surgery center safe — what happened to Joan rivers?

Published November 17, 2014 by Dr. Mark Mandell-Brown

Written by Ellie Rizzo
November 11, 2014
Becker’s ASC Review

Results of the federal investigation into Joan Rivers’ death following an elective procedure at New York-based Yorkville Endoscopy have been released, and they show the center made several preventable errors to which her death could be attributed.

According to CNN and The New York Times, among the errors CMS found with the clinic’s treatment of Ms. Rivers, who is not identified in the report, include:

• Late identification of deteriorating vitals signs and delayed resuscitation efforts. Ms. Rivers’ vitals signs decreased markedly between 9:12 a.m. and 9:26 a.m. on the day of her procedure, but CPR was only administered starting at 9:28 a.m. at the earliest. Another part of the record says CPR and medication were administered at 9:30 a.m., while another says resuscitation began at 9:30 a.m. with medication administered at 9:28 a.m.
• Failure to record Ms. Rivers’ weight prior to sedation. Whether her weight was in fact taken is unclear, but the fact remains: It was not documented.
• Inconsistent documentation of the dose of Propofol administered to Ms. Rivers. While the unidentified anesthesiologist first recorded the administration of 300 milligrams of the drug, the medical record was later revised to 150 milligrams, which the anesthesiologist said was to correct for an entry error, involving a double click-induced multiplication.
• Failure to obtain Ms. Rivers’ informed consent for all procedures performed. While Ms. Rivers went to the clinic for an endoscopy but also received a laryngoscopy, for which there was no documentation of consent.
• Allowing an unprivileged provider to administer care to Ms. Rivers. Gwen Korovin, MD, Ms. Rivers’ personal ear, nose and throat physician, administered the laryngoscopy to Ms. Rivers. Dr. Korovin is not privileged to practice at Yorkville Endoscopy.
• Not abiding by the clinic’s cell phone policy. Leonard Cohen, MD, the clinic’s former medical director, snapped a photo of Dr. Korovin and Ms. Rivers while Ms. Rivers was unconscious, and told the staff in the room Ms. Rivers might want to see the photo in the recovery room. Neither Ms. Rivers nor the clinic authorized the use of the phone or the photo.

The report also unveiled the progression of events on Aug. 28, the day of Ms. Rivers’ procedure. After Ms. Rivers was sedated, Dr. Korovin began to perform a laryngoscopy but aborted the procedure because she couldn’t see Ms. Rivers’ anatomy well. Afterward, Dr. Cohen performed an upper endoscopy. At 9:28, Dr. Korovin tried to perform the laryngoscopy another time “for a minute or two,” according to a technician quoted in the CMS report.

Yorkville Endoscopy put out a statement around the same time as the report, which was released Monday, saying it has already taken steps to address the deficiencies and has been cooperative with CMS.

Lawyers for Melissa Rivers, Joan Rivers’ daughter, also released a statement Monday, according to the reports. “[Melissa Rivers is] outraged by the misconduct and mismanagement now shown to have occurred before, during and after the procedure….Moving forward, Ms. Rivers will direct her efforts towards ensuring that what happened to her mother will not occur again with any other patient,” it read.