— -- Sources familiar with Melissa Rivers' legal situation said she has not decided whether to file a lawsuit against Yorkville Endoscopy, the Manhattan clinic where her late mother, Joan Rivers, went into cardiac arrest, but added that a recent report citing the facility for multiple violations contains plenty of fodder for her attorneys.
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 report from the federal Centers for Medicare & Medicaid Services, obtained by ABC News Monday.
The report by CMS, part of the U.S. Department of Health and Human Services, faulted the clinic’s then-medical director for allowing Rivers’ ear, nose and throat doctor to perform a laryngoscopy even though she “was not a member of the medical staff and was not privileged at the facility.”
Sources told ABC News that the presence of unauthorized personnel raises a question: If it's unclear whether or not Rivers knew who was in the room, how could she have granted her informed consent to have certain procedures done?
Sources added that attorneys could seize on the lack of protocol to question whether the clinic was properly prepared to perform and monitor a laryngoscopy, which requires certain equipment and medicine the clinic may not have stocked.
Lastly, the sources said, Melissa Rivers' attorneys are outraged by the report's finding that a doctor took a cell phone photo of a sedated Rivers. They also are upset medical personnel at the clinic allegedly failed to notice a deterioration in her vital signs.
The CMS report, based on the work of New York state investigators, stated that a doctor "proceeded to take pictures" of Rivers with her personal ear, nose and throat doctor. Investigators quoted the doctor saying, "Maybe [Rivers] would like to see this in the recovery area."
Last month, Melissa Rivers retained attorneys to investigate her mother's death.
"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," attorneys Jeffrey B. Bloom and Ben Rubinowitz said Monday in a prepared statement. "Moving forward, Ms. Rivers will direct her efforts towards ensuring that what happened to her mother will not occur again with any other patient."
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 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, according to the federal report.
In addition, the report 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 Endoscopy said Monday it has 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."