Home >  News >  September, 2014

Source: Spontaneous Biopsy Caused Joan Rivers to Stop Breathing

Doc who performed it said to be part of her entourage.

Published: September 10, 2014

An unplanned biopsy conducted at Manhattan's Yorkville Endoscopy caused comedienne Joan Rivers' vocal cords to seize, cutting off her air supply and leading to cardiac arrest and ultimately her death, according to a New York Daily News story, which cites an anonymous "medical source who was briefed on the case."

The clinic is disputing the report, however, says the paper, insisting that " 'a biopsy of the vocal cords' has never been done at their facility."

The initial report claims that an unnamed physician, a self-identified ENT specialist who was part of the entourage that arrived at the clinic with Ms. Rivers on Aug. 28, intervened after the clinic's physician noticed something on Ms. Rivers' vocal cords. "He asked (to do the biopsy) and they let him," says the source. "A huge no-no."

Yorkville also refuted the paper's assertion that Ms. Rivers was under general anesthesia during the procedure. "General anesthesia has never been administered at Yorkville Endoscopy," it said in a statement. "The type of sedation used at Yorkville Endoscopy is monitored anesthesia care. Our anesthesiologists utilize light to moderate sedation."

Ms. Rivers died on Sept. 4, a week after being put into a medically induced coma.

"If laryngospasm were the precipitating event," says Corona del Mar, Calif., anesthesiologist Barry Friedberg, MD, "IV lidocaine 1 mg per pound STAT could have broken the episode and spared her life. Lidocaine is more often found than the usual muscle relaxants like succinycholine or rocuronium."

Meanwhile, a New York Times story offers further details regarding what took place on the day of the procedure:

  • Rescue personnel arrived at the clinic in waves, starting 5 minutes and 38 seconds after a 911 call was made, including trained medical responders, paramedics from Mount Sinai Hospital and EMTs. Ultimately, 10 emergency medical workers were on the scene.
  • By the time the first rescue personnel arrived, a defibrillator had been hooked up to Ms. Rivers, a breathing tube had been placed in her windpipe and she was being given medications and CPR.
  • The circumstances surrounding Ms. Rivers' death are being investigated by the State Health Department and the New York City medical examiner. "We would love to set the record straight from all the misinformation that's out there," Daniel J. Adler, MD, PC, a colleague of Ms. Rivers' personal physician, Lawrence B. Cohen, MD, tells the Times. "Unfortunately, our lips are sealed."

It isn't known, says the Times, whether an anesthesia provider was present, but the story notes that Dr. Cohen was among 3 authors of a 2007 article that appeared in the American Journal of Gastroenterology, arguing that under the right circumstances, gastroenterologists should feel free to perform endoscopic procedures without having an anesthesiologist present. "Growing evidence suggests that with the appropriate patient selection, equipment, staffing, and training, gastroenterologists can safely and effectively administer propofol during endoscopy," the authors write.

The Times also notes that the tragedy has "drawn attention to" outpatient surgery centers. Yorkville, it says, "is run by an outside management company which is led by a former salesman, a former investment banker and a gynecologist. Its website lists 10 centers in the New York area, and says they take advantage of 'favorable reimbursement market trends.'"

"A biopsy like that should only be done in a hospital setting," adds the Daily News, quoting its source. "If she had been in a hospital when it happened, she might have been OK."

Jim Burger


Also in the News...

Inmate Claims He Was Needlessly Handcuffed and Shackled During and After Emergency Appendectomy
Editorial: Orthopedists Should Hand in Their Football Sideline Passes
Johnson & Johnson Hit With $57M Judgment in Pelvic Mesh Suit
Feds: Sightpath Lured Eye Surgeons With Luxury Trips for Nearly a Decade
Anatomy of a Scam: Materials Manager and His Accomplice Allegedly Bilked Facility Into Buying Supplies It Never Received
Jury Clears GI Doc of Negligence in Colon Cancer Suit
Study: Long-Term Opioid Use Rarely Starts With Surgery

New to Outpatient Surgery Magazine?
Sign-up to continue reading this article.
Register Now
Have an account? Please log in:
Email Address:
  Remember my login on this computer

advertiser banner

Other Articles That May Interest You

News & Notes

Penis Enhancement Surgery Turns Fatal

Researchers believe the patient died from a pulmonary fat embolism during what's generally considered to be a simple and safe procedure.

Furious at Administrators, Surgeon Allegedly Threatened to Get Assault Rifle

Police say they heard him say it was "the only way to get anything done."