Even for “tinsel town” standards, the passing of larger than life, workaholic comic, Joan Rivers left no one with a final off color joke, (as she undoubtedly would have preferred.) Rather, those who know her best and her fans spanning six decades are left with nothing but shock, disbelief and horror.
Why is this topic intriguing to me? Well, I also spent years “under the knife,” largely for surgeries on my vocal cords for a medical condition known as juvenile papilloma of the larynx. In addition, I was a clinical speech –language pathologist, and a voice therapy patient. I am a product of the traditional medical system that says, “Do no harm.”
However, whether you loved or hated Joan, for her oft-times caustic, “in your face” attitude, superficial cosmetic persona, trying desperately to look ever younger and appeal to the masses as a respected actress as well, this was a terrible “perfect storm” in the making! My respect and knowledge of the true person called Joan increased after watching the PBS American Masters film, “Joan Rivers, A Piece of Work.” It speaks of her evolution as an entertainer…but much more than that, it illustrates her humanity, her fierce drive, insecurities and the considerable good she did for many others- doling out checks to others quietly, holding an annual Thanksgiving dinner for singles she knew (I really like that!).
She felt she had to keep working, she had responsibilities and truly was a “Master of re-invention” –or at least tried to be so! There was the darkest chapter in her life too… the suicide of her life partner, husband Edgar, who was not the best manager or producer. Joan “was the real brains” and still supported him. You should watch the entire film on your local PBS channel: (This link contains vignettes.)
This case remains shrouded in mystery and involves medical negligence (visit another source), questionable management practices, “doctors acting like star struck teenagers” lies, half-truths, journalistic Hollywood sensationalism and failures on so many levels it is impossible to fathom! Hopefully the final truths will be revealed during the course of a civil suit brought by her daughter Melissa. Yes, she is a grieving daughter and a product of stardom herself. However, her motives appear to be sincere in that by bringing this suit, she is also watching out for “the greater good of humanity” such that this ill-equipped day-surgery facility will never operate in the manner it once did!
In later years…with the exception of Donald Trump’s reality show, “Celebrity Apprentice”, which Joan won a couple of seasons ago, as a Master strategist (and a cameo this season); public memories are in large part “fluffy”. You remember the endless nasty analyses of stars’ appearances- clothing/makeup choices on the red carpet, and a very successful QVC jewelry line. Oh yes…and wherever she could find a stand up gig – even in Podunk USA, she did it – to the extent of groveling! She didn’t care. (Does anyone remember her radio show on WOR in New York? That’s when I really enjoyed her!)
Let us not sink to the level in the rag reporting of TMZ as reliable. However, the most detail has been offered by the respected New York Times as well as the New York Daily News used as primary references here.
A Synopsis of Events:
- The night before she went into cardiac arrest, Ms. Rivers performed at a cabaret in Manhattan’s theater district. Then she joined an old friend and collaborator, Jay Redack, for a few bites of salmon and her usual glass of white wine with ice at an Upper East Side bistro. She told him she was “going in for a little procedure” the next morning.
- Joan enters Yorkville Endoscopy on East 93rd Street on August 28th and “something goes wrong”
- The clinic had performed 18,000 procedures since it opened in February 2013. The State of New York had no record of complaints against the facility. Such facilities all over the country are for profit “outpatient surgery centers, which have been licensed by the state to replace hospital operating rooms for minor procedures.”
- Joan complaining of a hoarse voice, a sore throat and strained vocal cords which could have been caused by for acid reflux, which could have affected her voice, BUT “the procedure” was never clear prior to “the intervention”
- In addition to the endoscopy, performed by the clinic’s medical director, Dr. Lawrence B. Cohen, Dr. Korovin performed the laryngoscopy on Ms. Rivers, even though she was not authorized to practice at the clinic. (Dr. Cohen has since resigned as the clinic’s medical director.)
- Contradicting reports are that either the Medical Director, Dr. Cohen or her “Visiting” ENT physician Dr. Korovin had used a smart phone to snap a selfie while Ms. Rivers was under anesthesia, telling someone in the room that Ms. Rivers “will think this is funny.”
Official Cause of Death-
- The medical examiner said the cause of Ms. Rivers’ death, on Sept. 4, was brain damage caused by low blood oxygen, known as anoxic encephalopathy due to “hypoxic arrest.” She stopped breathing during a laryngoscopy (i.e. -an examination of her voice box and vocal cords), and an endoscopy, (i.e. looking at her upper digestive system and is performed under anesthesia, the report said.) The report did not cite medical error as a cause of death, but left open the possibility of malpractice.
- The procedures were performed under sedation with Propofol, according to the medical examiner. Propofol, which was implicated in Michael Jackson’s death, is an anesthetic known for having a small margin of error between sedation and respiratory arrest.
- Comments by other physicians reviewing her autopsy – “This woman had brain death before the medics arrived,” When Ms. Rivers stopped breathing, either the anesthesiologist, the ear, nose and throat specialist in the room, Dr. Gwen Korovin, should have been capable of putting in a breathing tube or doing an emergency tracheotomy to allow her to breathe.” “But she said the death was probably a result of more than one factor. “It’s not easy to kill a patient,” she said. “It takes several errors.” (Dr. Jamie Koufman, an ear, nose and throat specialist in New York City)
- The report also said that Ms. Rivers’ body weight was never recorded, as is required to determine the proper dose of anesthesia. Dr. Korovin went first and tried to perform a laryngoscopy, to look at Ms. Rivers’ voice box. But the procedure “was aborted because the E.N.T. surgeon stated she could not see very well what she was trying to view.”
- Reportedly, Dr. Cohen then took his turn, performing an upper endoscopy, a procedure in which a tiny camera is used to look at the digestive system. When he finished at 9:28 a.m., according to a clinic technician quoted in the report, Dr. Korovin “went in again with a laryngoscope and was there for a minute or two.”
More Conflicting Information –
- Regarding when attempts to revive her were made, the initial record said attempts began at 9:30 a.m., with drugs given at 9:38 a.m. A second record said that ventilation, chest compression and drugs were all given at 9:28 a.m.
- The New York Daily News offered additional details-(But used the wrong spelling of “chords” as in musical versus the correct medical spelling “cords” throughout! Geez!)
- The physicians also did an unauthorized biopsy on her vocal cords that resulted in an examination of her vocal cords and windpipe that resulted in a laryngospasm, (i.e. the vocal cords suddenly seize up or close when taking in a breath, blocking the flow of air into the lungs. Her throat seized up and deprived her brain of oxygen. She also couldn’t expel carbon dioxide from her lungs and the result was a heart attack and irreversible brain damage, the lawsuit alleged.
- During the procedures, doctors ignored the concerns of the acting anesthesiologist, who urged caution after noticing “incredible edema/swelling, in Rivers’ throat.
More Outrageous Physician Comments and Behavior (as reported in the Civil Suit)
“Anesthesiologist Renuka Bankulla suggested taking an internal picture to gauge how bad the swelling was.” “You’re being paranoid … You’re such a curious cat. You always need to see everything,” the lead doctor, Lawrence B. Cohen, told her, before proceeding over her objections.” WHAT????
- During the Critical Minutes: Rivers’ oxygen levels and heart rate sank, a probable airway obstruction. When the team realized the seriousness of the problem it was too late, they called a Code Blue, but never administered a muscle relaxant that might have unlocked the laryngospasm in Rivers’ throat.
- Cohen did frantic chest compressions; Bankulla tried but failed to intubate Rivers, and two other anesthesiologists, Koniuta and Scarola, rushed in to help with the hand pump to push air into her lungs. They worked for 17 minutes before Bankulla called for a tracheotomy kit, but it was never used.
Where’s the Doctor and “Who’s on First?
- When Bankulla looked for Korovin, who could have done the emergency tracheotomy, she was nowhere to be found. Rivers’ doctor had left the room, the suit said. This is disputed by her ENT physician. However reported she was not authorized to be there as a treating physician. This was a violation of state law.
- Melissa’s attorneys are livid that her ENT physician reportedly “could not be found” in the small room at the crucial time…and they seemingly acted like amateurs, with no one stepping up to the plate to do a tracheotomy which may have saved her life.
- By the time EMS got Joan to Mt. Sinai Hospital, she had already suffered irreversible brain damage, the suit said.
Melissa Rivers Comments in the Aftermath –
- Melissa filed the lawsuit in Manhattan Supreme Court, naming five doctors and the clinic as defendants because of her “unwavering belief” that no family should ever have to go through what “my mother, Cooper and I have been through. “The level of medical mismanagement, incompetency, disrespect and outrageous behavior is shocking and frankly almost incomprehensible. “Not only did my mother deserve better, every patient deserves better,” she said.
- A Federal Investigation was initiated: The investigation found numerous violations and irregularities during Ms. Rivers’ treatment. The clinic faces termination of Medicare and Medicaid funding unless it corrects the deficiencies by January 7 and passes a surprise inspection.
- Update: As reported by pagesix.com on January 12th the Yorkville Endoscopy lost its Federal accreditation beginning Jan. 31, “will no longer be eligible to receive federal funds for services provided to Medicare and Medicaid beneficiaries,” according to a notice from the Department of Health and Human Services. BUT…The loss of federal accreditation doesn’t necessarily mean the clinic will close. Doctors there can still treat patients with private insurance. Regulators couldn’t say how much federal money Yorkville Endoscopy stands to lose. In addition they were given another 30 days to “get their act together” for one final inspection to occur around March 2nd. (‘Reminds me of plea bargaining with a murderer!)
And Finally a Phenomenon Plaguing the Very Wealthy of the World –
- “V.I.P. Syndrome,” occurred according to Dr. Barron H. Lerner, an internist at NYU Langone Medical Center, in which famous or influential patients get special treatment, which surprisingly often, it is not for the best!
- Other physicians have written that…. “V.I.P. patients as demanding and manipulative and to resent them for it, which can diminish the quality of their care. For hospital administrators, on the other hand, he said, “The V.I.P. is more than just a patient. He is also an object to be bartered for future favors.”
- In the words of physician and author David Bernstein, MD’s recent Blog-