Staff members at a New York clinic where Joan Rivers went into cardiac arrest photographed her with a cell phone while she was sedated, improperly documented how much of the sedative propofol was used, and "failed to identify deteriorating vital signs and provide timely intervention during the procedure," according to a new report from the U.S. Department of Health and Human Services.
Rivers was 81 when she died at a hospital on Sept. 4 from low blood oxygen just days after going into cardiac arrest at Yorkville Endoscopy during procedures to treat voice changes and acid reflux, officials have said.
After her death, the New York State Health Department launched a routine investigation of the clinic, only to find lapses in four categories necessary for accreditation: governing body and management, surgical services, medical staff and patient rights.
Yorkville Endoscopy said today it has been fully cooperated with regulatory agencies since Rivers' Aug. 28 cardiac arrest and, "in response to the statement of deficiencies, Yorkville immediately submitted and implemented a plan of correction that addressed all issues raised."
"The regulatory agencies are currently reviewing the corrective plan of action and have been in regular contact with Yorkville," the clinic's statement added. "In addition, the physicians involved in the direct care and treatment referenced in the report no longer practice or provide services at Yorkville. Yorkville will continue its commitment to complying with all standards and accreditation requirements."
Nevertheless, Rivers' daughter, Melissa Rivers, has retained attorneys to investigate her mother's death.
"Our client, Melissa Rivers, is terribly disappointed to learn of the multiple failings on the part of medical personnel and the clinic as evidenced by the CMS report," attorneys Jeffrey B. Bloom and Ben Rubinowitz said today in a prepared statement. "As any of us would be, Ms. 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."
The HHS report, based on the work of New York state investigators, found that a clinic staff member “proceeded to take pictures” of Rivers with an unauthorized ear, nose and throat surgeon who was allowed in the room while Rivers was sedated.
The staff member taking the picture allegedly said, “Maybe [Rivers] would like to see this in the recovery area,” according to the report.
The clinic also failed to assure only authorized personnel were in the procedure room when Joan Rivers went in for treatment, the report stated, and failed to “have an effective process in place to assure that only credentialed physicians can perform procedures.”
It failed to ensure informed consent was obtained for all the procedures performed on Rivers, the report said, adding that all of those failures “compromised” Rivers’ safety.
Yorkville Endoscopy will lose its certification Jan. 7 unless it fixes the deficiencies found by state investigators and reported to the Centers of Medicare and Medicaid Services, HHS said.
In addition, it added, an unannounced survey was to be conducted at the site. If the survey finds the corrections have been made, Yorkville Endoscopy will no longer face termination of federal Medicare and Medicaid funding.
"Yorkville has been and remains open and active and is fully accredited by an independent review organization," the clinic said in its statement. "The staff and providers are focused on providing the highest quality and most advanced care possible to its patients.”