An investigation by the federal government has found many violations at the outpatient clinic that treated Joan Rivers before her death. The clinic must address the problems by January or it could lose any funds from the Centers for Medicare and Medicaid Services.
Rivers went to the clinic, Yorkville Endoscopy in Manhattan, in August for what was supposed to be a routine procedure to examine her throat due to a hoarse voice. Her own ear, nose & throat doctor, who was not credentialed at the clinic, performed part of the procedure.
During the procedure, Rivers’ vital signs had deteriorated for 15 minutes before she went into cardiac arrest. She was taken to a hospital where she died some days later, ultimately her death was caused by brain damage from lack of oxygen.
During the procedure, her own EMT attempted to perform a laryngoscopy to look at the voice box. That procedure was stopped short, after which the clinic’s medical director performed an upper endoscopy where a small camera is inserted to get a look at the digestive system.
Investigators found the anesthesiologist tried to alter the medical records regarding the strength of anesthetic delivered. It also appeared that Ms. Rivers’ body weight was not written down, which is necessary to determine the proper dosage of anesthesia.
There were conflicting reports about when attempts were first made to revive Ms. Rivers after her blood pressure and pulse were dropping. But it appears doctors took longer than they should have to notice and take action on her deteriorating condition.
The medical director involved is no longer with the facility. The clinic says it is Fully cooperating with the investigation.
What do patients need to know about outpatient clinics?
The American Association of Nurse Anesthetists’ (AANA) website discussed the findings in the Rivers’ case. It noted the CMS report cited several anesthesia-related errors, including “failure to record Rivers’ weight before giving her the powerful anesthetic drug, Propofol, and failure to accurately record the amount of Propofol administered. These and other provider errors during the critical moments right after River’s vocal cords seized (known as laryngospasm) have raised questions with the public about the safety of anesthesia care in outpatient facilities.”
The AANA wrote that even after this incident, people should not be afraid to undergo procedures such as endoscopies or colonoscopies in outpatient facilities. They note that accredited outpatient facilities are known to be very safe “if the procedure being performed is appropriate for the setting, qualified and credentialed healthcare professionals provide the patient care, and the facility is properly prepared to address emergency situations.”