Joan Rivers, the comedian and television personality who died after undergoing a medical procedure in New York, didn’t give permission for all the work done at Yorkville Endoscopy LLC, U.S. regulators said.
The Department of Health and Human Services said it planned to terminate the surgical center’s accreditation for patients covered by Medicare and Medicaid on Jan. 7 because the facility wasn’t compliant with the agency’s regulations. Yorkville Endoscopy was given 10 calendar days to provide a plan to correct the deficiencies uncovered by the September investigation into Rivers’ death, according to a letter dated Oct. 9.
The survey conducted by the New York State Department of Health turned up numerous flaws with the treatment of Rivers, who was identified only as an 81-year-old female who received care on Aug. 28. She underwent two diagnostic procedures by an ear, nose and throat surgeon who wasn’t a member of the medical staff and didn’t have treatment privileges at the facility.
“Based on the review of medical records, documents, policies and procedures and interviews, it was determined that the facility failed to ensure that patient care services are provided in a manner that protects the health and safety of all patients,” according to the HHS report. “Medical staff members failed to assure that only physicians who have been credentialed and appointed as members of the medical staff of the facility could provide and supervise care of patients.”
Officials for Yorkville Endoscopy didn’t immediately return a voice message or e-mail left after regular business hours. The Los Angeles Times reported on the HHS document earlier yesterday.
Rivers was undergoing a diagnostic procedure to evaluate voice changes and acid reflux when complications occurred. She died from a lack of oxygen to the brain, according to a report from the New York City Medical Examiner. The medical director of the ambulatory surgery center stepped down following her death and no longer practices there.
The physician in charge of taking care of Rivers failed to see that her vital signs, oxygen saturation and carbon dioxide concentrations had started to deteriorate and didn’t promptly intervene, the HHS report said. The medical record didn’t include informed consent for all the procedures done. Rivers’ weight wasn’t noted and conflicting information was given about the dose she received of propofol, a short acting sedative.
Information in Rivers’ medical record yielded inconsistent details about when resuscitation started and how it was managed. One record said she went into cardiac arrest, when the electrical function of the heart stops, at 9:28 a.m., with cardiopulmonary resuscitation starting at 9:30 a.m. The second said she showed signs of an erratic heart rate at 9:28 and immediately received help breathing and chest compressions.
There was no evidence she received advanced cardiac life support, and instead was given injections of epinephrine and atropine. She was resuscitated at 10 a.m. and transferred to another hospital at 10:04 a.m. She died on Sept. 4.
Once the Centers for Medicare and Medicaid Services determines that Yorkville Endoscopy has submitted an acceptable plan to correct its violations, an unannounced survey will be conducted, the agency said. If improvements are sufficient and comply with federal rules, it will no longer face termination from the Medicare and Medicaid programs, the agency said.
“A statement of deficiencies provides details on the official findings during a facility’s survey,” CMS said in a statement. “The Centers for Medicare & Medicaid Services does not comment on information contained in a facility’s statement of deficiencies.”
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