Joan Rivers' death has been under federal investigation, and numerous violations and irregularities have surfaced in how the Fashion Police star was treated during the events that led to her cardiac arrest at a clinic and eventual passing.

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According to a report issued Monday by investigators for the Federal Centers for Medicare and Medicaid Services, the Yorkville Endoscopy clinic in Manhattan failed to notice Rivers' deteriorating vital signs for at least 15 minutes before she went into cardiac arrest and suffered brain damage due to lack of oxygen, The New York Times reported.

Other reported violations are: The clinic's anesthesiologist marked down the wrong amount of anesthetic used on Rivers on the medical record, the clinic's medical director Dr. Lawrence Cohen took photos of an unconscious Rivers on the operating table while the comedian's personal doctor Gwen Korovin was working on her, and Rivers' body weight was never recorded to administer the proper amount of sedation.

Jeffrey B. Bloom and Ben Rubinowitz, lawyers for Rivers' daughter, Melissa, said in a statement on Monday she's "outraged by the misconduct and mismanagement now shown to have occurred before, during and after the procedure," according to The Times.

"Moving forward, [Melissa] will direct her efforts towards ensuring that what happened to her mother will not occur again with any other patient."

The report states that Rivers' blood pressure and pulse decreased quickly and drastically while she was undergoing a routine throat procedure at Yorkville Endoscopy on August 28 between 9:12AM and 9:26AM, yet cardiopulmonary resuscitation reportedly didn't begin until 9:28AM at the earliest.

"The physicians in charge of the care of the patient failed to identify deteriorating vital signs and provide timely intervention during the procedure," read the report.

The unidentified anesthesiologist also claimed his or her initial entry of 300 milligrams of Propofol on the medical record was a mistake made by accidentally double-clicking the automated entry system, so he or she later changed it to 120 milligrams -- which the doctor insists was the actual amount used on Rivers. According to The Times, Propofol has a small window between sedation and respiratory arrest.

In addition, investigators report that Dr. Cohen had taken cell phone pictures of Rivers with Dr. Korovin, an ear, nose and throat specialist, while the comedian was unconscious from anesthesia in the operating room. Dr. Cohen allegedly informed witnesses at the time Rivers would appreciate the photos in the recovery room although the former reality TV star never made it that far.

As for the photographs, the report says, "There was no documentation of prior consent by [Rivers] authorizing her photographs to be obtained by the facility's staff members during the procedure."

Dr. Korovin, who allegedly attempted a laryngoscopy to look at Rivers' voice box, reportedly lacked the proper credentials to perform any type of operation at Yorkville Endoscopy. She also reportedly didn't have Rivers' prior consent to execute any type of operation at that location.

According to The Times, the report also states Dr. Korovin checked out Rivers' throat before Cohen but the procedure "was aborted because the E.N.T. surgeon stated she could not see very well what she was trying to view."

Dr. Cohen then reportedly performed an upper endoscopy, which utilizes a tiny camera, to figure out why Rivers -- who had a history of chronic acid reflux -- experienced hoarseness. When Dr. Cohen completed his procedure at 9:28AM, according to a clinic technician quoted in the report, Dr. Korovin "went in again with a laryngoscope and was there for a minute or two."

After Rivers went into cardiac arrest, she was rushed to Mount Sinai hospital, where she died one week later after Melissa took her off life support.

Shortly after news surfaced of Rivers' September 4 death at the age of 81, Dr. Cohen was fired from Yorkville Endoscopy.

The clinic faces termination of Medicare and Medicaid funding unless it corrects the deficiencies by January 7 and passes a surprise inspection, The Times reported.

A lawyer for Dr. Korovin allegedly declined comment when contacted about the new findings Monday night.
About The Author: Elizabeth Kwiatkowski

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