ME results in Joan Rivers

  1. According to Huffingtonpost:

    The New York City Medical Examiner has finally revealed that lack of oxygen to Joan Rivers' brain caused her death over a month ago.

    According to the medical examiner's report, her death was officially caused by "anoxic encephalopathy due to hypoxic arrest during laryngoscopy and upper gastrointestinal endoscopy with propofol sedation for evaluation of voice changes and gastroesophageal reflux disease."

    I had wondered if the endoscopy center was using propofol, I have admitted several anoxic brain injuries from some area endoscopy centers that used propofol. How many more people must die or have significant brain injury before people wise up that NAPS is not safe. I am not an anesthesia provider, nor do I pretend to be, if you need anesthetics in a procedure get an anesthesia provider.
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  2. 13 Comments

  3. by   wtbcrna
    No one knows at this point who was providing the anesthesia, but the thought is it was probably an anesthesiologist since the clinic was known not to hire CRNAs.
  4. by   Nurseboy1
    Now that I did not know, I assumed that the sedation was provided by a nurse in the clinic. I guess that makes it a bit more shocking to me, if the anesthesiologist missed the patient going deeper.
  5. by   NRSKarenRN
    Joan Rivers Gastroenterologist Lawrence B. Cohen, MD was a supporter of nonanesthesiologist-administered propofol for GI endoscopy

    "Lawrence B. Cohen, MD, AGAF, performs endoscopy in an office setting in Manhattan and administers propofol himself (endoscopist-administered sedation [EAS]. " ... see his article: The Extra Cost of Monitored Anesthesia Care
    There is no evidence that the presence of an anesthesia provider improves the quality of an endoscopic examination. Although some anesthesiologists believe intuitively that the presence of an anesthesia provider improves the safety of endoscopic sedation in average-risk patients when compared with endoscopist-directed sedation, there is no scientific evidence to support that assumption. An evidence-based assessment indicated unequivocally that the rates of sedation-related complications were comparable for endoscopist-directed sedation (both standard opioid/benzodiazepine sedation and endoscopist-directed propofol) and for MAC.6,7
    Wondering if he still feels the same way now. It will come out in NY DOH event review who directed and administered Joan's propofol.


    Position Statement: Nonanesthesiologist Administration of Propofol

    Propofol for endoscopic sedation: a protocol for safe and

    The Propofol Controversy - Medscape
    Last edit by NRSKarenRN on Oct 17, '14
  6. by   wtbcrna
    All I can say is the ASA has been really quiet on this issue, which usually means that it was probably one of their own that did the anesthesia. This is still all just conjecture.
  7. by   jwk
    Quote from wtbcrna
    All I can say is the ASA has been really quiet on this issue, which usually means that it was probably one of their own that did the anesthesia. This is still all just conjecture.
    Nobody seems to be talking - I know you're hoping it's an anesthesiologist. Honestly, the other names have come out, so if there was an anesthesiologist there (or a CRNA), you would think that name would have surfaced by now. Considering Cohen thinks anesthesia personnel are superfluous in GI cases, at this point it makes far more sense to guess that they weren't even there.
  8. by   wtbcrna
    Quote from jwk
    Nobody seems to be talking - I know you're hoping it's an anesthesiologist. Honestly, the other names have come out, so if there was an anesthesiologist there (or a CRNA), you would think that name would have surfaced by now. Considering Cohen thinks anesthesia personnel are superfluous in GI cases, at this point it makes far more sense to guess that they weren't even there.
    I disagree. That GI clinic was known to have only MDAs working there, and the ASA has no problem pointing fingers when it is a CRNA involved in a malpractice case. The AANA actually refuses to do the same when MDAs are involved in malpractice cases... Joan Rivers was also quoted to say she would never have a CRNA working on her, so the two most likely cases were either an MDA or an RN doing the sedation.
  9. by   subee
    Quote from jwk
    Nobody seems to be talking - I know you're hoping it's an anesthesiologist. Honestly, the other names have come out, so if there was an anesthesiologist there (or a CRNA), you would think that name would have surfaced by now. Considering Cohen thinks anesthesia personnel are superfluous in GI cases, at this point it makes far more sense to guess that they weren't even there.
    The Yorkville Endoscopy Center released a press statement in which they admitted to using only anesthesiolgists. The also state that they do not do general anesthesia. Kind of hard to do a vocal cord bx. without it.....at the least, I would NOT want to be doing that case.
  10. by   jwk
    Quote from subee
    The Yorkville Endoscopy Center released a press statement in which they admitted to using only anesthesiolgists. The also state that they do not do general anesthesia. Kind of hard to do a vocal cord bx. without it.....at the least, I would NOT want to be doing that case.
    But they have yet to release a statement saying that an anesthesiologist was present for the Joan Rivers case, and they certainly don't say they use an anesthesiologist for EVERY case.

    I thought they had changed their story about the vocal cord bx - regardless, tickling the cords with an endoscope is pretty easy to do. I frequently have to ask some of our GI docs NOT to go back down and suction of that little bit of snot they see down near the vocal cords as they're withdrawing their scope.
  11. by   wtbcrna
    Quote from jwk
    But they have yet to release a statement saying that an anesthesiologist was present for the Joan Rivers case, and they certainly don't say they use an anesthesiologist for EVERY case.

    I thought they had changed their story about the vocal cord bx - regardless, tickling the cords with an endoscope is pretty easy to do. I frequently have to ask some of our GI docs NOT to go back down and suction of that little bit of snot they see down near the vocal cords as they're withdrawing their scope.
    That is true, and as I have said it is all just conjecture at this point.

    We do know that it had to be either an MDA or an RN doing her sedation.

    IMHO I would still guess an MDA just from past statements by the ASA when CRNAs or RNs make sedation errors, and when MDAs make a mistake the ASA is quiet all of sudden.
  12. by   wtbcrna
    Feds slam clinic where Joan Rivers went into cardiac arrest - NY Daily News This could be a mistake, but it looks like from the report that it was an Anesthesiologist that did Joan River's case.

    It is sad mistake either way.
  13. by   NRSKarenRN
    Entire CMS report is viewable at Feds slam clinic where Joan Rivers went into cardiac arrest - NY Daily News link.

    Page 6 notes anesthesiologist documented ENT performed 2 nasolaryngoscopies pre and post esophagogastroduodenoscopy procedure.

    Page 10-13 lists vital signs and anesthesia notes, 2 code records, dose of propofol inconsistently recorded, first dose of Epi and atropine given 9:38A 10 min after 9:28A arrest, anesthesia record updated at 2:36PM ....

    Many lessons to learn from this case.
    Last edit by NRSKarenRN on Nov 11, '14
  14. by   Silky00001
    It was in fact an MDA doing the Anesthesia. No CRNA ANYWHERE!

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