Health Officials Issue Scathing Report Against Clinic Where Joan Rivers Died

Doctor took pictures of late comedienne when she was under anesthesia.
8:56 | 11/10/14

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Transcript for Health Officials Issue Scathing Report Against Clinic Where Joan Rivers Died
The clinic. Where a late comedian Joan Rivers died. Under scrutiny health official saying that doctors should have been paying closer attention to are vital signs. And prevented her death. Hello everyone I'm damned Cutler in New York it's a scathing report by the Department of Health and Human Services this solves the doctors took pictures of Joan Rivers. When she was under sedation so for more on the report want to bring in ABC's Garrick -- fund store force and air what exactly did this report say. Well this is a report from the department of health and human services and at risk for York Phil endoscopy is its Medicare certification. And it would lose that certification by January 7 and last. There is proof that the clinic has taken corrective steps we just learned from the of the clinic in a statement that they have submitted a corrective plan of action we're waiting to see. If that's going to be approved but there was a lot for them to improve bond because the investigators who conducted. This thorough review after the death of Joan Rivers back in September faulted the clinic for a number of missteps. One. A doctor at that time the chief of of medical services for York they'll endoscopy. Took a cell phone photo held at the cell phone wall Joan Rivers was a dated. Took a picture of her and of an unauthorized surgeon that was allowed in to do to do a procedure on her. Oh without a proper clearance and so that was perhaps a final indignity for Joan Rivers and at the same time while they're taking pictures in the procedure room. The report said that they failed to notice Joan Rivers deteriorating vital signs. Something that Melissa rivers attorney said in a statement that. She is just outraged by and and disappointed the statement said by the multiple failings identified in the report. What do we know of any the exact cause of death. When the exact cause of death was released by the medical Examiner's office she had a lack of Volvo of oxygen in her blood ship brain damage. And this all stemmed from these two procedures. To treat acid reflux that she went into your co endoscopy for. And she went in there under that premise served for for acid reflux she was also having some trouble with her voice and anyone who watched fashion police or knew of her work. In her last months knew that there was a deep grasp and and often she would lose her voice during the show she wanted to get that treated. And her personal. ENT her ear nose and throat. Doctor a woman by the name of Quinn core of an. Ended up coming to the clinic the day she went in for her acid reflux procedure and performed a procedure on her throat this was not authorized before hand. Doctor Cora vin is not supposed to be working at the clinic because she is not part of that clinics team. And yet she was allowed in perform this wall rivers was a dated with Propofol in one of the under other findings was that proper dose of Propofol. Was never properly recorded by the anesthesiologist. So those who do we know that's is that that this is all taking place and the person I was involved with the cellphone pictures that doctor Korb and doing now. No that's doctor Lawrence Cohen who was the medical director of York Phil endoscopy up until recently he has since left the clinical was fired depending on who's interpretation you believe. But the clinic says that nobody involved with the direct care of Joan Rivers is still working. At the clinic which remains open at the moment though is now under threat of losing its Medicare certification. But the report that comes out Buena despite that threat for the clinic really is the fullest picture as to what happened Joan Rivers was in that clinic for all of 45 minutes. Her vital signs before she she it went in for the procedure were all normal. At some point though there was that dramatic drop in her vital signs something doctors the report said failed to notice. Maybe because they were taking a cell phone picture of current doctor Cora and at the time and a later she she died at the hospital. The doctors were able to successfully resuscitate her we know paramedics were called there were there and pretty short order. And and she later died at the hospital what do we know that about the punishment that's going up against this this this center I mean I'm senate that is still open but. What kind of violations are in place. Well it did do they could lose their Medicare certification so if they want federal money. Four for procedures covered by Medicare and Medicaid they're going to have to fix a lot of things and the clinic says it has submitted a corrective plan of action. More broadly though and I think probably more significantly for the clinic is it may face a lawsuit by Melissa rivers she is hired. A a pretty well known and and well established firm personal injury firm here in New York. Of that though those lawyers said they are now investigating the death on her behalf she may yet decide to sue the clinic. Right exert interest you. On the very latest on that report and thank you so for more I wanna go to our medical contributor doctor mark they'll Malick and doctor out the not. One of the drugs in question here is Propofol its course very familiar to a lot of people because the same drug involved in the death of Michael Jackson. There seems to be discrepancy though about the dosage. That's right so the drug is. In question is Propofol. This is an anesthetic that a lot of people are given every day millions of people who are having surgery it is used to sedate people so that. Perform exams can be performed the question here is exactly how much Propofol. Joan Rivers got. They in a report today outlines that she was given 300 milligrams in the beginning. Later on five hours after she coded the staff at center went back and adjusted the medication dose down to. Less than half of that 120 milligrams. Citing that there was a clerical error in electronic medical record and they really didn't give that higher dose so we really are unclear about exactly how much she got. What we do know is that just seven minutes after she was given that powerful anesthetic she was coating it her heart. Had stopped or when into an irregular rhythm. We're also hearing and that her personal physician or air as a throat specialist was in the room during the procedure. Is that common practice. So here's what we see that's consistent in Joan Rivers now unfortunate passing and Michael Jackson's unfortunate passing as that. These people are celebrities they get VIP treatment and with the practice of medicine. Everybody should be treated as a VIP and so bringing in your own doctor to a facility where that doctor is not licensed accredited. Is not within the realm of normal ways of practicing medicine you know that doctor is certainly probably qualify to do all these procedures. But. By that doctor coming in it through the staff off probably this is somebody new in the mix it changes the flow. You with surgery and procedures everything happens in an orderly fashion and adding a new person in the mix on very short notice. Really doesn't bode well for anybody in clearly didn't bode well for Joan Rivers in this case. It seems that Joan Rivers also had a nasal exam has performed that she had not given written consent in fact to have done. Is there any way in fact that a physician if it is a private physician working under her care there. Would have had any kind of a blanket agreement or permission to perform something like that. Well there was probably a verbal agreement again it was probably a Joan Rivers request we don't know the details of that. But what happened was she was most likely. Going to say she was going in for a procedure to look at her reflux problem and while she was at it why not look at the nose and throat. And voice issues that she was having so there was certainly a verbal agreement and she knew that she was gonna have this procedure but again because they went outside of the normal. The proper protocols of documenting. And informed consent was written papers. Those steps were mixed and again if she'd went through the proper protocols. That you know we don't know that that outcome would have been any different but it certainly would have given us a little bit of ease and would not have given many of these citations and violations at this facility. Is speaking of violations clearly an ethical violation by snapping some kind of a photo. Inside of very but doctor's office a medical office but it's also a violation of hit the laws right. So it hit if that. Photograph was shared with anybody certainly right away that would be a violation of people lost so even other people in the facility. Who let's say were in the next room over if you show that picture to those don't those staff members that as a violation of hip. You know having the documentation of a photograph for a non medical reason again there was all this was probably just because of who she was. I'm very very tragic story right ABC's medical contributor to mark though not doctor at the not thank you so much. You can keep up with the story in real time by downloading the ABC news happened star in the story for exclusive updates on the go. For now I'm down Cutler in New York.

This transcript has been automatically generated and may not be 100% accurate.

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