Agency notes clinic errors in Rivers' treatment
ALBANY, N.Y. - A New York City clinic where Joan Rivers suffered a fatal complication during a medical procedure made several errors, including failing to keep proper medication records and snapping cellphone photos of her while she was unconscious, state health investigators said Monday.
Rivers, who was 81, died Sept. 4. New York City's medical examiner found she died of brain damage due to lack of oxygen after she stopped breathing during an endoscopy days earlier.
A report released by the state Department of Health on Monday cited Yorkville Endoscopy for numerous deficiencies related to the Rivers case, although negligence is not alleged. The comedian's death was classified as a therapeutic complication.
As a result of the state investigation, the federal Department of Health and Human Services has given Yorkville Endoscopy until Jan. 7 to correct deficiencies to avoid losing Medicare accreditation.
In a statement to NBC News on Monday, Yorkville said it has submitted a plan to state and federal accreditation agencies addressing all issues raised. It said the physicians referenced in the report no longer provide services there.
The state report said the Manhattan clinic "failed to identify deteriorating vital signs and provide timely intervention" in Rivers' case.
Investigators found conflicting information in Rivers' medical records regarding the amount of the sedation drug Propofol she was administered and about the time resuscitation was initiated. They also faulted the clinic for allowing a surgeon who was not a member of the medical staff to perform two nose and throat scoping procedures.
Investigators also noted that a staff member took cellphone photos of Rivers and a surgeon while she was under anesthesia without her consent and in violation of the facility's cellphone policy.
The survey conducted by the New York State Department of Health turned up numerous flaws with the treatment of Rivers. She underwent two diagnostic procedures by an ear, nose and throat surgeon who wasn't a member of the medical staff and didn't 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."
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 didn't promptly intervene, the HHS report said. The medical record didn't include informed consent for all the procedures done.
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 9:28 a.m., with cardiopulmonary resuscitation starting at 9:30 a.m. The second said she showed signs of an erratic heart rate at 9:28 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 10 a.m. and transferred to another hospital at 10:04 a.m. She died on Sept. 4.