A Public Death: Will Rivers’ death be the exception to the patient safety rule?

Every time someone famous dies after a medical error, my hopes rise that we will see a meaningful response that will improve patient safety conditions.

In some instances, such as the Michael Jackson case, one doctor is held accountable but no broader improvements are made. In other cases, as with Andy Rooney’s death, nothing seems to happen.

Joan Rivers' death during a surgery has, in an incredibly quick time frame, led to some significant consequences for those involved.

Because things are moving so fast, I put together a timeline of significant events so far.

Aug. 28, 2014 – Joan Rivers goes to the Yorkville Endoscopy clinic in New York City to have her vocal cords, her esophagus, and her stomach examined for signs of acid reflux. Dr. Lawrence B. Cohen, a gastroenterologist, and Dr. Gwen Korovin, an ear, nose and throat specialist who had been Rivers’ physician for years, are both present. The outpatient procedures typically result in the patient going home shortly after. Instead, Rivers goes into cardiac arrest during the procedure and is taken to Mount Sinai Hospital.

Sept. 4, 2014 – Rivers dies at Mount Sinai Hospital in New York City. The State Health Department begins investigating her death soon after.

Sept. 12, 2014 – Cohen steps down as medical director for Yorkville Endoscopy and stops doing procedures there, according to Anemona Hartocollis at The New York Times.

Oct. 6, 2014 – The Centers for Medicare and Medicaid Services (CMS) identifies a range of problems at Yorkville Endoscopy, including: failing to make sure that Rivers had provided informed consent for all of the procedures performed on her, allowing a doctor with no privileges at the clinic to perform procedures on Rivers, and failing to notice when her blood oxygen dropped below normal.

Oct. 16, 2014 - The New York City Office of Chief Medical Examiner determines that Rivers died as a result of complications of low blood oxygen during the procedure, calling it a “predictable complication of medical therapy,” according to Miranda Leitsinger at NBC News. The medical examiner says, specifically, that Rivers died from “anoxic encephalopathy due to hypoxic arrest during laryngoscopy and upper gastrointestinal endoscopy with Propofol sedation.” You may remember propofol from the role it played in Michael Jackson’s death.

Dec. 9, 2014 – The American Association for Accreditation of Ambulatory Surgery Facilities strips Yorkville Endoscopy of its accreditation, according to Jim Burger at Outpatient Surgery.

Dec. 16, 2014 – Yorkville Endoscopy files a plan of correction with the Centers for Medicare and Medicaid Services, promising to fix problems identified by the agency.

Jan. 4, 2015 – Dr. Renuka Reddy Bankulla is named as the anesthesiologist who administered Propofol to Rivers during her ill-fated procedure, according to a story by Susan Edelman in The New York Post.

Jan. 9, 2015 – CMS tells Yorkville Endoscopy that it will no longer receive Medicare or Medicaid funds.

Jan. 16, 2015 – CMS changes course and gives Yorkville a second chance. The agency tells the clinic that it has until March 2 to present a plan of correction that shows how it will fix the problems CMS identified.

I’ll keep watching for developments in Rivers’ case and post updates. The swift action is certainly out of the ordinary, but it remains to be seen if Rivers’ death will lead to changes that will protect future patients.

Photo by David Shankbone via Flickr.