A Manhattan clinic treating Joan Rivers in August did not notice that her vital signs were deteriorating for about 15 minutes before she went into cardiac arrest, leading to her death several days later, a federal investigation has found.
Released on Monday, the investigation said that Ms. Rivers's blood pressure and pulse decreased precipitously while she was on the operating table on Aug. 28 between 9:12 and 9:26 a.m., yet cardiopulmonary resuscitation began at 9:28 a.m. at the earliest.
'The physician in charge of the care of the patient failed to identify deteriorating vital signs and provide timely intervention during the procedure,' said the report made by investigators for the federal Centers for Medicare and Medicaid Services.
The investigation found that the anesthesiologist at the clinic, Yorkville Endoscopy, later changed the medical record to reduce the amount of Propofol, a strong anesthetic whose misuse can be fatal, that Ms. Rivers received. The stated dose was reduced to 120 milligrams from 300 milligrams.
Investigators also reported that Dr. Lawrence Cohen, then medical director of the clinic, took cellphone pictures of Ms. Rivers and her ear, nose and throat doctor, Gwen Korovin, while Ms. Rivers was lying on the operating table unconscious from anesthesia. Dr. Cohen told the others in the room that Ms. Rivers might want to see the pictures in the recovery room.
However, the comedian, who was 81, never recovered from what was supposed to be a routine procedure to examine her throat. Instead, she went into cardiac arrest and was rushed to Mount Sinai Medical Center, where she was put on life support. She died on Sept. 4 of brain damage brought on by lack of oxygen, according to the medical examiner.
Lawyers for Ms. Rivers's daughter, Melissa, said in a statement on Monday that she was '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,' the statement said.
