Joan Rivers 'stopped breathing' in surgery

Another link:

http://www.tmz.com/2014/11/10/joan-rivers-surgery-death-propofol-yorkville/#ixzz3IiWJBjcU

The computer at the clinic also shows she was given a huge dosage of Propofol. A staff member told the Dept. she made a mistake inputting the dosage and put in more than twice the actual amount give to Joan.

And according to the report, Joan's personal doctor, Gwen Korovin, came into the operating room without authorization. The Dept. says she announced to the room, "I will go first" ... meaning she would do the first procedure on Joan.
 
I knew all along it was going to turn out this way. I bet Melissa is PISSED because I am royally pissed and I am not even a Joan Rivers fan.

It sickens me that those to whom Joan Rivers trusted with her life had so much disregard for her well-being. It happens every day. Ther are multitudes in the medical field that are in it for the payday and could care less about those who are so trusting and vulnerable. Just sickening!!! I hope some licenses are revoked.
 
Another link:

http://www.tmz.com/2014/11/10/joan-rivers-surgery-death-propofol-yorkville/#ixzz3IiWJBjcU

The computer at the clinic also shows she was given a huge dosage of Propofol. A staff member told the Dept. she made a mistake inputting the dosage and put in more than twice the actual amount give to Joan.

And according to the report, Joan's personal doctor, Gwen Korovin, came into the operating room without authorization. The Dept. says she announced to the room, "I will go first" ... meaning she would do the first procedure on Joan.

Dr. Korovin has a very high opinion of herself!
 
The bigger issue, as I see it, was "why" couldn't they secure her airway, once it was clear she wasn't breathing? FTLOG, cut a hole in her neck and trach her if necessary-- there was an ENT standing RIGHT there!

Another bigger issue is why the staff was unable to detect deteriorating vital signs. My suspicion is the alarm limits were not properly set and/or the alarms were disabled so as not to trouble the doctor. What other reason could there be for failing to notice she was crashing? The three stooges could have done a better job!
 
At interview with Endoscopy Technician, Staff #5
on 9/3/14 at 2:05 PM, she stated the ENT
surgeon performed a Laryngoscopy for Patient #1
that was aborted because the ENT surgeon
stated she could not see very well what she was
trying to view. She stated that Staff #1 proceeded
with the EGD and when it was completed at 9:28
AM, the ENT surgeon went in again with a
laryngoscope and was there for a minute or two.
She stated the laryngoscope was withdrawn at
9:30 AM. Staff #5 confirmed there was no
separate "Time Out" announced for the initial
Nasolaryngoscopy conducted prior to the EGD
and the second Nasolaryngoscopy after the EGD.

3. The review of the Procedure Notes and
Cardiac Resuscitation Records for Patient #1
revealed the physicians in charge of the care of
the patient failed to identify deteriorating vital
signs and provide timely intervention during the
procedure on 8/28/14. Abnormal vital signs as
well as abnormal values of peripheral capillary
(the smallest of a body's blood vessels located
away from the heart, such as, in the arms, hands,
legs and feet) oxygen saturation (a term referring
to the concentration of oxygen in the blood -
SpO2 - normal levels are considered 95 to 100
percent), and End-tidal carbon dioxide (ETCO2 -
concentration of carbon dioxide in the expired air;
normal value is 35 to 45 millimeters Mercury
(mmHg) were not addressed.

Pre procedure vital signs on 8/28/14 at 8:44.06
AM were as follows:
Blood Pressure (BP) 118/80, Pulse 62 Regular,
Respirations 16, Temperature (Temp.) 97.2
Fahrenheit, SPO2 100%.

Intra-procedure vital signs were as follows:
9:12.49 AM - BP 117/60, Pulse 71, SpO2 92%
9:16.13 AM - BP 92/54, Pulse 56, Respirations
16, SpO2 94%, ETCO2 26
9:21:42 AM - BP 89/44, Pulse 54, Respirations
17, SpO2 97%, ETCO2 19
9:26.36 AM - BP 84/40, Pulse 47, SpO2 92%


The Cardiac Arrest Record indicated that
resuscitation of the patient was initiated two
minutes later at 9:28 AM.
However, at interview with Staff #5, on 9/3/14 at
2:15 AM, she stated that following the EGD scope
withdrawal at 9:28 AM, the ENT doctor proceeded
to do another Nasolaryngoscopy. The Endoscopy
Technician reported, "ENT doctor was in there for
a minute or two before the removal of the
laryngoscope at 9:30 AM. Vital signs recorded at
9:30:04 notes a blood pressure of 85/49, no pulse
recorded, and oxygen saturation was at 92%.
In the addendum by the Anesthesiologist, Staff #2
at 2:36 PM, she notes that the patient maintained
saturation at approximately 90% during
Laryngoscopy. In another note hand written by
Staff #2, she explained that oxygen saturation
was maintained with a combination of jaw thrust
and increase in oxygen flow to 5 Liters/min

There was conflicting information in the medical
record regarding the time resuscitation was
initiated and the overall management of the
patient during the code (situations requiring
cardiopulmonary resuscitation).

There were two code records in the patient's
medical record. One of the record titled Cardiac
Arrest Record indicated the patient went into
cardiac arrested at 9:28 AM and cardiopulmonary
resuscitation was initiated at 9:30 AM. This record
notes that the first set of medications,
Epinephrine 1 milligram (mg) and Atropine 1 mg
were administered at 9:38 AM.

The second code record titled Endoscopy Code
Blue Record noted the patient had a pulse and
was in ventricular tachycardia (V-tach or VT - a
type of rapid heart beat, that starts in the bottom
chambers of the heart, called the ventricles, the
main pumping chambers of the heart) at 9:28 AM.
It was documented that assisted ventilation and
chest compression were initiated at 9:28 AM.
However, there was no indication that the
ventricular tachycardia with presence of pulse
was immediately treated in accordance with
Advanced Cardiac Life Support. Instead, the code
record notes that Epinephrine 1 mg and Atropine
1 mg were administered to the patient at 9:28
AM.

The patient was successfully resuscitated at
10:00 AM and transferred to a hospital at 10:04
AM for further management. The patient expired
at the hospital on 9/4/14 at 1:15 PM.
 
I bet Korovin didn't know that just deleting a photo doesn't remove it from the device. What a fool!
 
Melissa Rivers "Terribly Disappointed" by Report Detailing Mistakes at Endoscopy Center Where Joan Rivers Had Procedures

Natalie Finn, eonline
6 hours ago

Joan Rivers ' untimely death has brought Yorkville Endoscopy Center into a harsh spotlight.

The federal Centers for Medicare & Medicaid Services has issued a report detailing multiple failings on the part of the Manhattan clinic where Rivers suffered cardiac arrest while undergoing an endoscopy on Aug. 28. She died at the age of 81 on Sept. 4 after being removed from life support.

Among the findings: Doctors did not record Rivers' body weight as part of the pre-assessment to determine the amount of the sedative Propofol to administer; they "failed to identify deteriorating vital signs and provide timely intervention"; Rivers was found to have no pulse at 9:30 a.m. after resuscitation was initiated at 9:28 a.m. but she was not fully resuscitated until 10 a.m.; and overall there was conflicting information as to when CPR was first administered...

http://xfinity.comcast.net/articles/entertainment-eonline/20141111/b596741/
 
Trying to compose a post and I just can't get the words right. The doctors involved should be hiding in shame. I would be mortified to be involved in a situation that was so grossly negligent as to cause a person to die. If these doctors are not severely disciplined...!
 
The issue of not weighing her was an omission, for sure-- but professionals have to guesstimate weight every day of the week, especially in emergency situations (and for sure, this was an elective procedure). I'm not as worried about the lack of weight documented-- the anesthesiologist should have been able to guesstimate within 10-15 pounds of her actual weight. She wasn't that big.

I keep reading comments to articles by CRNAs or anesthesiologists saying people are making such a big deal about the omission of the weight when that is actually a minor thing in comparison with the other huge blunders.

Those monitor alarms would have to have been turned off, but even then it's a head scratcher. In my endoscopy center, the CRNAs have to constantly record all the vitals. It's not something you can go back and do later. I just can't imagine how they could not have been aware of a dropping O2 sat.

Just mind boggling.
 
In reading the report, it seems that there were several admissions as to events that day by the doctor who performed the EGD and other staff present that were expressly denied by both Yorkville Endoscopy Center and Joan's ENT in the immediate aftermath of the incident.

So rather than saying "We have no comment at this time," both the center and the MD in question lied numerous times to the press.

This is the kind of thing I don't get. Did they think they'd be able to convince every staff member who witnessed these events to lie under oath about it? Very naive notion if so. I would NEVER risk my license or my personal liberty (perjury is a crime) to save someone else's butt.
 
When does something cross from malpractice to criminal? Because if you ask me, we need to see some manslaughter charges.
 
I keep reading comments to articles by CRNAs or anesthesiologists saying people are making such a big deal about the omission of the weight when that is actually a minor thing in comparison with the other huge blunders.

Those monitor alarms would have to have been turned off, but even then it's a head scratcher. In my endoscopy center, the CRNAs have to constantly record all the vitals. It's not something you can go back and do later. I just can't imagine how they could not have been aware of a dropping O2 sat.

Just mind boggling.

I posted what was recorded above. I figured it must have been some type of a digital recording with alarms silenced which is crap because without one or the other of them, you are screwed.

The other thing that I don't get is WTH the lack of alarms or hand recording were not mentioned in the report.
 
Her death at this time was needless, she was such a vital woman. I'm so sorry for Melissa, Cooper and all her friends and I'm especially sorry that Joan had to linger in that limbo between life and death for a week. I also feel this has crossed the line from negligence into more.
 
With every report that published, I am more and more incredulous. The reported behavior of the OR staff is reprehensible. In the years I spent working PACU and coding patients in the OR, I don't think I have ever seen or heard of such inappropriate and unprofessional behavior.

Our crash carts were stocked and sealed by pharmacy and had a plastic lock on them so one could tell immediately if the crash cart was accessed. I don't remember if Succ (pronounced sucks for short) was routinely stocked on the crash cart. The anesthesia ppl had it at the ready for when they had to intubate someone. I can't imagine the anesthetist or anesthesiologist not having those drugs in their intubation kits.
 
Are we sure they had an anesthesiologist there?

Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam

Lawrence B Cohen, MD, Charles D Hightower, BA, Daniel A Wood, BS, Kenneth M Miller, MD, James Aisenberg, MD
Current affiliations: Department of Medicine (Gastroenterology), The Mount Sinai School of Medicine, New York, New York USA

http://www.giejournal.org/article/S0016-5107(04)00349-9/abstract?cc=y

Background

Propofol provides several benefits over benzodiazepine and narcotic agents as a sedative medication for endoscopic procedures, including faster recovery and improved patient satisfaction. However, its use generally has been limited to anesthesiologists because of the risks associated with deep sedation.


Propofol for endoscopic sedation: a protocol for safe and effective administration by the gastroenterologist

Lawrence B Cohen, MD, Amelia N Dubovsky, BA, James Aisenberg, MD, Kenneth M Miller, MD

Current affiliations: Department of Medicine (Gastroenterology), The Mount Sinai School of Medicine, New York, New York USA

http://www.giejournal.org/article/S0016-5107(03)02010-8/abstract

Lots more here:

http://scholar.google.com/scholar?q=lawrence+cohen,+md+propofol&btnG=&hl=en&as_sdt=0,34


Love to get some feedback about this from the experts here.
 
Didn't the report linked make reference to "Staff member #2, patient's anesthesiologist on 8/28/14"? (page 7 of 22)

I personally have never witnessed propofol administered by anyone other than an anesthesiologist or CRNA; in other words, people specifically trained in the administration of general anesthesia. I have seen endoscopies or colonoscopies performed where RNs used IV sedation, NOT propofol. I've never seen a procedure like this where the GI doctor performing the procedure is also handling the anesthesia or sedation. I don't see how that would actually be physically possible.

K_Z will be the authority on this most likely.
 
Per the released report, the notes say that she was given a large amount of propofol, but the person administering this propofol claims that this was an error and she was actually give a much smaller amount. Somehow I don't find this believable. But if it's true, that suggests poor record keeping on the part of this clinic.
 
I keep reading comments to articles by CRNAs or anesthesiologists saying people are making such a big deal about the omission of the weight when that is actually a minor thing in comparison with the other huge blunders.

Those monitor alarms would have to have been turned off, but even then it's a head scratcher. In my endoscopy center, the CRNAs have to constantly record all the vitals. It's not something you can go back and do later. I just can't imagine how they could not have been aware of a dropping O2 sat.

Just mind boggling.

Weight would have been a part of how much propofol she was supposed to get. The notes say she got a very large amount, although the person administering it claims that was an error and she got a smaller amount. But how did they know how much to even give her since they didn't take her weight?
 

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