Malpractice Lawsuit Regarding Joan Rivers’ Death Settles

Melissa Rivers has settled her wrongful death claim against the doctors who were responsible for her mother’s death. Although the terms of the medical malpractice settlement are confidential, one source described the settlement amount as “an eight-figure sum.”

Ms. Rivers filed the lawsuit against Yorkville Endoscopy, an outpatient surgery center in Manhattan, as well as the gastroenterologist who served as the center’s medical director, its anesthesiologists, and an ear nose and throat (ENT) surgeon. She said that the doctors “accepted responsibility for their actions quickly and without equivocation.”

While the settlement ends the legal controversy involving Joan Rivers’ death, Melissa Rivers hopes to wage a broader battle against outpatient surgical centers that may not provide the same patient safeguards as hospital operating rooms.

Malpractice During Joan Rivers’ Treatment

Joan Rivers visited Yorkville Endoscopy in August 2014 for treatment of a hoarse voice and sore throat. The lawsuit alleged that the doctors were overwhelmed by Joan Rivers’ celebrity status. Perhaps the strongest evidence in support of that allegation is an unauthorized selfie that an anesthesiologist took as he was standing next to Ms. Rivers while she was on the operating table.

Doctors performed a laryngoscopy (an examination of the voice box and vocal cords) and an endoscopy (an examination of the upper digestive system that is performed under anesthesia). The laryngoscopy was performed without Ms. Rivers’ recorded consent by the ENT surgeon, who did not have medical privileges at the surgery center.

Perhaps because he was eager to have his center perform surgery on a celebrity, the center’s medical director disregarded an anesthesiologist’s warning that Rivers’ vocal cords were dangerously swollen. That concern was dismissed as “paranoid” and the surgery proceeded. The unauthorized laryngoscopy apparently triggered a laryngospasm, causing Ms. Rivers’ vocal cords to close and preventing her from breathing.

The clinic did not have a “crash cart” available. Crash carts are usually equipped with a drug that could have relaxed Ms. Rivers’ muscles so that a breathing tube could be inserted. The surgeon who performed the endoscopy was trained to open a hole in Ms. Rivers’ throat by performing an emergency cricothyrotomy, but she had already left the clinic.

The remaining personnel called 911. Unfortunately, by the time help arrived, Ms. Rivers had gone into cardiac arrest. She did not regain consciousness and was removed from life support seven days later. Brain damage caused by oxygen deprivation was determined to be the cause of death.

A federal investigation determined that the doctors failed to notice Ms. Rivers’ deteriorating condition, failed to maintain appropriate records concerning the anesthesia she received, failed to obtain Ms. Rivers’ consent for every procedure they performed, and allowed surgery to be performed by someone who had not been granted surgical privileges in the center.

While Ms. Rivers’ celebrity status may have contributed to the acts of malpractice, the medical negligence might never have come to light if Ms. Rivers had not been a celebrity patient. When New York’s medical examiner certified a cause of death, no mention of medical negligence was made. The federal investigation was likely motivated by the publicity surrounding Ms. Rivers’ high-profile death.

Safety Concerns

Ms. Rivers’ death raised nationwide concerns about the safety of outpatient surgical centers (sometimes known as “ambulatory patient surgery centers”). While the procedures performed in the centers are classified as minor, any surgical procedure carries a risk. Emergency teams are available to make a rapid response when hospital surgery goes wrong, but patients in an outpatient center may need to await transfer to a hospital. As in Ms. Rivers’ case, that delay can be fatal.

Hospitals are equipped to handle a variety of crises, while the staff at outpatient centers is usually focused on a narrow set of health issues. They may not have the training and experience needed to respond to allergic reactions, heart failure, or a respiratory problem like the one that caused Joan River’s death.

About half of all patients treated at outpatient surgical centers are age 60 or older. Geriatricians caution that outpatient surgical centers can be a particularly risky choice for elderly patients who are “more likely to have multiple health conditions that can affect how their body responds to even minor surgical procedures.” Elderly patients experience more physical stress during surgery and deteriorate more quickly if an emergency arises.

Unlike hospitals, most outpatient surgical centers are owned by doctors. While they are subject to state licensing requirements, well-publicized harms like the death of Joan Rivers may spur a demand for more intensive regulation of outpatient facilities. At the very least, Ms. River’s death and the subsequent malpractice settlement should raise public awareness of the enhanced risks associated with outpatient surgical procedures that are performed on elderly patients.

(Photo Credit: “Joan Rivers at Musto’s 25th Anniversary” by David Shankbone is licensed under CC BY-SA 2.0.)