Interestingly, the analysis put together by the New York Post does not come from Melissa Rivers' lawyers whom she hired to determine if there was a valid basis to proceed forward with a medical malpractice and wrongful death lawsuit against the endoscopy center and the doctors who were involved in Joan's care.
Instead, the article describes how they pieced together a timeline from interviews, emergency medical technician records and a federal report to reach these conclusions.
According to this analysis, it indicates that the gastroenterologist performing the endoscopy procedure together with Joan's ear nose and throat doctor continued to perform the procedure for 14 minutes as Joan's pulse and blood pressure dropped.
According to medical records reviewed, Joan's lips and mouth were blue. A paramedic who reviewed the medical records for the New York Post indicated that the doctors should have stopped the procedure and began resuscitation efforts immediately and performed an emergency tracheotomy in light of an obstruction.
A tracheotomy is an emergency surgical procedure to literally poke a hole into Joan's airway to allow her lungs to get air. You would only perform a tracheotomy if the airway was blocked and there was no air going into or out of her airway.
According to these same medical records...15 minutes into the procedure Joan Rivers went into shock with a significant drop in her blood pressure and a decreased pulse. Her blood pressure continued to drop and according to the paramedic who reviewed these records, that should have told the doctors that she was in shock.
There's a notation in the records indicating that the anesthesiologist gave propofol. According to the Post article, “That doesn't make any sense. You're sedating someone who's going into shock.”
Propofol is an anesthetic used during many endoscopy and colonoscopy procedures. It is a short acting anesthetic that puts the patient to sleep immediately and allows them to wake up feeling refreshed and have no memory of the events that took place.
Presumably, it would have been given at the beginning of Joan's procedure. The article implies that when the doctors recognized her blood pressure had dropped significantly as well as her pulse, that the anesthesiologist somehow gave another dose, known as a bolus, of propofol.
The paramedic who was interpreting these records correctly points out that would make no sense whatsoever. You certainly would not want to sedate someone further who is in shock and suffering cardiac and respiratory problems.
It is likely that if Melissa Rivers ultimately brings a wrongful death lawsuit, the defense attorney representing the anesthesiologist will argue that the notation about when Joan Rivers was administered propofol was simply a ministerial record-keeping error. They likely would argue that there is no reason for an anesthesiologist to give a patient propofol if they are coding or in shock.
The article further states that the records reflect that at 9:30 AM when Joan Rivers had no pulse did the doctors start CPR and give epinephrine and atropine, but 911 was not called for another 10 minutes.
“According to the EMT records, the doctors even stopped administering CPR as they waited for the ambulance to arrive.”
That comment, if true, sounds absolutely horrific and what we would clearly argue would be a violation from the basic standards of medical care.
If a patient has coded, is in respiratory or cardiac arrest, has cyanosis of the mouth and lips, has been given epinephrine and atropine, you would continue resuscitative efforts for as long as possible. Certainly you would continue those efforts up until the time that paramedics arrive to take over and rush the patient to the hospital.
Unfortunately, if you have been following the details of what occurred during this tragedy, you will notice a pattern of multiple errors, medical mistakes and what appears to be violations from the basic standards of medical care just based on the information provided in the news media.
Violations include allowing Joan's personal ear nose and throat doctor to participate in a procedure at the endoscopy facility when she was never credentialed or had privileges to perform any procedure at that ambulatory surgery facility. News reports also reflect that there was no informed consent for any procedure performed by her ear nose and throat doctor.
Remarkably, there is always an anesthesiologist in the room during the course of this procedure in order to monitor the patient's vital signs. If he notices and recognizes that the patient's vital signs are deteriorating, he has an obligation to speak up and to let the doctors performing the procedure know there is a significant problem.
The anesthesiologist has the ability, capability and obligation to stop the procedure if the patient's vital signs deteriorate significantly. Even if the gastroenterologist and ear nose and throat doctor did not wish to abandon the procedure, the anesthesiologist can simply terminate the procedure by indicating that the patient's condition is deteriorating and she is now coding and needs immediate resuscitative measures.
The published news reports also fail to indicate why a tracheotomy was not done if in fact her airway was obstructed.
There were indications, according to the published news items, that because a polyp was removed in the vocal cord area, that caused Joan's vocal chords and the surrounding tissues to go into spasm and swell. This is known as laryngospasm. If true, the next question to be asked is why the patient was not intubated before the procedure as the doctor should have anticipated the swelling and the likelihood of the swelling cutting off of her airway.
The records that were apparently reviewed by the New York Post and a paramedic do not discuss any of these specific issues nor why the two doctors performing the endoscopy and laryngoscopy waited so long in which to address her deteriorating blood pressure and pulse as well as why they delayed their resuscitative measures.