Nonetheless,
a ruling of death from therapeutic complications typically does not
address “errors of omission, clinical judgment/management or missed
diagnosis,” according to a review in the Journal of Forensic Sciences of
New York City deaths investigated by the medical examiner’s office. Ms.
Rivers, 81, went to a private clinic, Yorkville Endoscopy, on Aug. 28
for what was supposed to be a routine procedure on her throat. She had
been complaining of hoarseness, friends said.
She
stopped breathing and went into cardiac arrest before emergency medical
workers were summoned by a call to 911. She was put on life support and
died seven days later.
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.
“This
woman had brain death before the medics arrived,” Dr. Jamie Koufman, an
ear, nose and throat specialist in New York City, said after reading
the autopsy report.
Dr.
Koufman said that when Ms. Rivers stopped breathing, either the
anesthesiologist, whose identity has not been publicly disclosed, or 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.
Korovin’s lawyer, Michael S. Kelton, said he would not comment until he
had “an opportunity to read and evaluate the complete M.E.’s report.”
In
the past, Mr. Kelton has said Dr. Korovin, who had a long list of
celebrity patients, was “revered” by her patients but could not discuss
Ms. Rivers because of privacy law.
A spokeswoman for the clinic also declined to comment. Dr. Lawrence Cohen, the gastroenterologist who performed the endoscopy,
resigned from his post as medical director of the clinic after it
became known that he allowed Dr. Korovin to practice there, even though
she was not authorized to do so.
The State Health Department is also investigating the death.
In
a statement issued on Thursday, Ms. Rivers’s daughter, Melissa, said:
“We continue to be saddened by our tragic loss and grateful for the
enormous outpouring of love and support from around the world. We have
no further comment at this time.”
http://www.nytimes.com/2014/10/17/nyregion/joan-rivers-died-of-complication-in-treatment-medical-examiner-says.html?_r=0
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