Joan Rivers did not consent to medical procedures that caused her death
If it were not so serious, it would be a most bizarre 'comedy' of errors – the tragic sequence of events that led to the death of an American icon – comedian and TV star Joan Rivers. Media headlines have said the clinic that treated her 'made mistakes'. I'd say that was putting it very mildly. A report into Rivers' death has uncovered a litany of errors, starting with no informed consent from her for the procedures she was given, that points to gross misconduct by both the clinic's management and the doctors who treated her. Rivers was known to have a very oddball sense of humour, but I doubt even she would have found anything amusing about this fatal sequence of events. Daughter Melissa has quite rightly declared herself 'outraged', according to reports. Watch this space for a massive civil suit to follow. MS
By Michelle Fay Cortez
The Department of Health and Human Services (HHS) said it planned to terminate the surgical centre's accreditation for patients covered by Medicare and Medicaid on January 7 because the facility was not compliant with the agency's regulations. Yorkville Endoscopy was given 10 calendar days to provide a plan to correct the deficiencies uncovered by the September investigation into Rivers' death, according to a letter dated October 9.
The survey conducted by the New York State Department of Health turned up numerous flaws with the treatment of Rivers, who was identified only as an 81-year-old female who received care on August 28. She underwent two diagnostic procedures by an ear, nose and throat surgeon who was not a member of the medical staff and did not have treatment privileges at the facility.
"Based on the review of medical records, documents, policies and procedures and interviews, it was determined that the facility failed to ensure that patient care services are provided in a manner that protects the health and safety of all patients," according to the HHS report.
"Medical staff members failed to assure that only physicians who have been credentialed and appointed as members of the medical staff of the facility could provide and supervise care of patients."
Officials for Yorkville Endoscopy did not immediately return a voice message or e-mail left after regular business hours. The Los Angeles Times reported on the HHS document earlier yesterday.
Rivers was undergoing a diagnostic procedure to evaluate voice changes and acid reflux when complications occurred. She died from a lack of oxygen to the brain, according to a report from the New York City Medical Examiner. The medical director of the ambulatory surgery centre stepped down following her death, and no longer practices there.
No informed consent
The physician in charge of taking care of Rivers failed to see that her vital signs, oxygen saturation and carbon dioxide concentrations had started to deteriorate and did not promptly intervene, the HHS report said. The medical record did not include informed consent for all the procedures done. Rivers' weight was not noted, and conflicting information was given about the dose she received of propofol, a short acting sedative.
Information in Rivers' medical record yielded inconsistent details about when resuscitation started and how it was managed. One record said she went into cardiac arrest, when the electrical function of the heart stops, at 9:28am, with cardiopulmonary resuscitation starting at 9:30 a.m. The second said she showed signs of an erratic heart rate at 9:28am and immediately received help breathing and chest compressions.
There was no evidence she received advanced cardiac life support, and instead was given injections of epinephrine and atropine. She was resuscitated at 10am, and transferred to another hospital at 10:04am. She died on September 4.
Once the Centres for Medicare and Medicaid Services determines that Yorkville Endoscopy has submitted an acceptable plan to correct its violations, an unannounced survey will be conducted, the agency said. If improvements are sufficient and comply with federal rules, it will no longer face termination from the Medicare and Medicaid programmes, the agency said.
"A statement of deficiencies provides details on the official findings during a facility's survey," CMS said in a statement. "The Centres for Medicare & Medicaid Services does not comment on information contained in a facility's statement of deficiencies." Bloomberg