Monday 10 November 2014

Errors cited in Joan Rivers' death





  • Rivers, 81, died a week after an appointment at Yorkville Endoscopy clinic

  • A federal agency says the clinic failed to identify deteriorating vital signs

  • It also failed to record Rivers' weight prior to sedating her, the agency reports

  • The clinic says it has been cooperative, already taken steps to correct the situation




(CNN) -- The Manhattan clinic that treated comedian Joan Rivers before her death made a number of serious mistakes, including failing to identify deteriorating vital signs, and providing timely intervention, according to a report released Monday.


The report, issued by the Centers for Medicare & Medicaid Services (CMS), a federal agency, did not mention Rivers by name, but referred an 81-year-old female, or Patient #1.


The description of that patient and the procedures she underwent match what's known about Rivers, including her age and the date of her appointment. CMS declined to say whether the patient referenced in the report is Rivers.





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The famed 81-year-old entertainer died September 4, a week after an appointment at Manhattan's Yorkville Endoscopy clinic.









Comedian Joan Rivers died Thursday, September 4, a week after suffering cardiac arrest during a medical procedure, her daughter said. She was 81. Click through the gallery to look back at her career.Comedian Joan Rivers died Thursday, September 4, a week after suffering cardiac arrest during a medical procedure, her daughter said. She was 81. Click through the gallery to look back at her career.



Rivers' big break came in an appearance on Johnny Carson's "Tonight Show" in 1965. It was the beginning of a relationship that would include dozens of appearances as guest and guest host.Rivers' big break came in an appearance on Johnny Carson's "Tonight Show" in 1965. It was the beginning of a relationship that would include dozens of appearances as guest and guest host.



Rivers followed her Carson breakthrough with appearances on talk and variety shows. Ed Sullivan had her as a guest in 1966.Rivers followed her Carson breakthrough with appearances on talk and variety shows. Ed Sullivan had her as a guest in 1966.



Rivers hit a peak in the 1980s, headlining in Las Vegas and becoming a regular guest host on the "Tonight Show."Rivers hit a peak in the 1980s, headlining in Las Vegas and becoming a regular guest host on the "Tonight Show."



Rivers is famed for her quick wit, which she often uses against herself.Rivers is famed for her quick wit, which she often uses against herself.



Rivers later hosted talk shows of her own. Here, she chats with Dolly Parton.Rivers later hosted talk shows of her own. Here, she chats with Dolly Parton.



She starred on the daytime "Joan Rivers Show," for which she won a Daytime Emmy, for five seasons, from 1989-1994. Here, she poses with her dog, Spike.She starred on the daytime "Joan Rivers Show," for which she won a Daytime Emmy, for five seasons, from 1989-1994. Here, she poses with her dog, Spike.



Rivers wanted to be an actress when she was young, and she fulfilled that goal after her success as a comedian -- though sometimes playing herself, as she did on "Nip/Tuck," with Julian McMahon, left, and Dylan Walsh.Rivers wanted to be an actress when she was young, and she fulfilled that goal after her success as a comedian -- though sometimes playing herself, as she did on "Nip/Tuck," with Julian McMahon, left, and Dylan Walsh.



Rivers and her daughter, Melissa, have been regulars on awards show red carpets, critiquing celebrity fashion with lines both generous and cutting.Rivers and her daughter, Melissa, have been regulars on awards show red carpets, critiquing celebrity fashion with lines both generous and cutting.



Rivers talks with Tim McGraw and his wife, Faith Hill, at the Grammys in 2005.Rivers talks with Tim McGraw and his wife, Faith Hill, at the Grammys in 2005.



Rivers with Tina O'Brien at the British Academy Television Awards in 2007.Rivers with Tina O'Brien at the British Academy Television Awards in 2007.



Rivers was a star among comedians, admired for her longevity and wit. She attended the Mark Twain Prize ceremony in 2008. The honor that year went to the late George Carlin.Rivers was a star among comedians, admired for her longevity and wit. She attended the Mark Twain Prize ceremony in 2008. The honor that year went to the late George Carlin.



Kathy Griffin is one of many comedians who can cite Rivers as an influence. Like Rivers, Griffin is known for mocking celebrities at various events. Here, she and Rivers share a stage during a Rivers roast in 2009.Kathy Griffin is one of many comedians who can cite Rivers as an influence. Like Rivers, Griffin is known for mocking celebrities at various events. Here, she and Rivers share a stage during a Rivers roast in 2009.



Rivers proved herself to be quite the savvy businessperson by winning a season of Donald Trump's "Celebrity Apprentice." Trump and his wife, Melania, join Rivers at the season finale in 2009.Rivers proved herself to be quite the savvy businessperson by winning a season of Donald Trump's "Celebrity Apprentice." Trump and his wife, Melania, join Rivers at the season finale in 2009.



Katie Finneran and Rivers attend the Broadway opening after-party of "Promises, Promises" at the Plaza Hotel in New York in 2010.Katie Finneran and Rivers attend the Broadway opening after-party of "Promises, Promises" at the Plaza Hotel in New York in 2010.



Rivers, a fashion lover, attends the LensCrafters' reveal of Sunglass Fashion Crimes in 2011.Rivers, a fashion lover, attends the LensCrafters' reveal of Sunglass Fashion Crimes in 2011.



In February 2013, she attended the Dennis Basso Fall 2013 fashion show. Alongside her, from left, are Martha Stewart, Star Jones and Kelly Bensimon.In February 2013, she attended the Dennis Basso Fall 2013 fashion show. Alongside her, from left, are Martha Stewart, Star Jones and Kelly Bensimon.



After a falling-out with Johnny Carson, Rivers didn't return to the "Tonight Show" until earlier this year, when Jimmy Fallon took over as host. She was a guest on Fallon's show on February 17.After a falling-out with Johnny Carson, Rivers didn't return to the "Tonight Show" until earlier this year, when Jimmy Fallon took over as host. She was a guest on Fallon's show on February 17.



Rivers officiates the wedding of William "Jed" Ryan, left, and Joseph Aiello at the Plaza Athenee on August 15 in New York.Rivers officiates the wedding of William "Jed" Ryan, left, and Joseph Aiello at the Plaza Athenee on August 15 in New York.




Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years

Joan Rivers through the years






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Joan Rivers through the yearsJoan Rivers through the years



Among the major errors CMS found the clinic committed are:


-- Failing to identify deteriorating vital signs and provide timely intervention;


-- Failing to record Rivers' weight, prior to the administration of medication for sedation;


-- Failing to consistently document the dose of Propofol, a sedative, administered;


-- Failing to get Rivers' informed consent for each procedure performed;


-- Failing to ensure that she was cared for only by physicians granted privilege in accordance with the clinic's bylaws;


-- And finally, failing to abide by its own cell phone policy (the report found that a photograph was taken of a surgeon and Rivers while she was under sedation).


Yorkville Endoscopy released a statement in response to the report, saying it has been cooperative and already taken steps to correct the situation.


"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.


"In addition, the physicians involved in the direct care and treatment referenced in the report no longer practice or provide services at Yorkville," it said.


Joan Rivers: In her own words


Rivers' appointment at the clinic was on August 28. Paramedics rushed Rivers from the clinic to New York's Mount Sinai Hospital a mile away, where she was kept on life support until she died a week later.


Her daughter, Melissa, "is terribly disappointed to learn of the multiple failings on the part of medical personnel and the clinic as evidenced by the CMS report," according to a statement from her attorneys.


"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," it read.


The New York medical examiner ruled last month that Rivers died of "therapeutic complications" during a procedure to evaluate her "voice changes" and stomach reflux.


Photos: Groundbreaking women in American comedy


CNN's Carolyn Sung contributed to this report.



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