As the picture becomes clearer and clearer it may be that Joan Rivers was the victim of practices that led to or contributed to her death.
What we know: Rivers went to New York City's Upper East Side Yorkville Endoscopy Center for an outpatient endoscopic procedure to evaluate her vocal cords-- not even a surgical procedure-- they were just supposed to be looking.
"Certainly, they suspect the anesthesia was the issue, based on conversations between the staff and city medics," a source close to the investigation told Radar.
Staff at the Yorkville Endoscopy Clinic told NYC officials that Rivers stopped breathing just as they were putting her under anesthesia for a routine throat endoscopy procedure, a source said.
I asked Cyril_Wecht, M.D., former president of both the American Academy of Forensic Science and the American College of Legal Medicine, and currently head of the board of trustees of the American Board of Legal Medicine, the former coroner of Pittsburgh who has done over 14,000 autopsies, about Rivers' death, based on the understanding that she had been administered Propofol (on of the drugs administered to Michael Jackson, when he died) or some other anesthetic. He replied,
"i don't think anybody should undergo general anesthesia or be given propofol in a doctor's office-- that's my opinion-- but it's being done thousands of times a day. It is not illegal or unethical or malpractice. I would never allow any member of my family to undergo a procedure in which propofol is being used other than in a hospital with the drug administered by an anesthesiologist or nurse anesthetist, because an untoward reaction, like a cardiac arrhythmia or a heart attack can occur. When that happens you have to have the full armamentarium that only a hospital provides."
We don't know for certain whether the anesthesia given to Joan Rivers was Propofol or some other anesthetic. I'm not sure it matters. There are questions that are, as yet, unanswered. Some of those questions have been raised at a studentdoctor.net forum, which I paraphrase:
- Who was in the procedure room with Rivers?
- Was there an anesthesiologist or certified, registered nurse anesthetist (CRNA) present, administering the anesthesia or was the gastroenterologist or an untrained or uncertified assistant administering the anesthesia?
- If there was an anesthesiologist involved, was he/she in the room or supervising from outside the room?
- was the facility or the gastroenterologist (GI doctor) administering the procedure profiting from the anesthesiology billing?
- IN WHAT ORDER did things happen? Did she suffer a cardiac event, and respiratory arrest as a result? Or did she stop breathing after too much propofol (ala Michael Jackson) and suffer a cardiac event when this went unnoticed? (verbatim question from the student doctor.net discussion thread.)
- Did the anesthesia management company have an anesthesia contract. Were illegal anesthesia kickbacks being provided to the GI doctors?
"According to a Yorkville Endoscopy spokesperson, the clinic "as a federally and state licensed facility, has the same level of life-saving and resuscitation devices (such as state-of-the-art cardiac defibrillators, airway management equipment, etc.) found in any hospital emergency room or hospital-based operating room."
The purpose of this article is to raise questions and to get future patients considering procedures that require sedation or anesthesia to ask questions.
Who will be in the room? I'd want an anesthesiologist in the room.