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On August 28, 2014, Joan Rivers was taken to Yorkville Endoscopy clinic in Manhattan for a vocal chord procedure. Her Facebook page shows a picture of her in front of signed photos of Hugh Jackman and Daniel Radcliffe, and her who’s-who list of present and past patients includes Lady Gaga, Pink, Mick Jagger, Liza Minnelli, John Mayer and Luciano Pavarotti.
Yorkville Endoscopy: 5 Fast Facts You Need to KnowYorkville Endoscopy Center is under investigation after complications during Joan Rivers' procedure there led to the comedic legend's hospitalization and eventual death.
The latest report regarding Joan Rivers’ deadly throat procedure is that her personal physician took a selfie before allegedly performing an unplanned biopsy on her vocal cords. A staff member at the Yorkville Endoscopy clinic told CNN on Tuesday that the doctor -- who was not authorized to practice medicine at the private facility -- paused to snap a selfie with the unconscious Joan.NY Daily News first reported the news that the ear, nose and throat specialist, who has yet to be named, performed the biopsy while the comedy great was undergoing what was supposed to be a routine endoscopy. Anna Nicole Smith's daughter Dannielynn Birkhead attended the Kentucky Derby with dad Larry. Lady Gaga, Katy Perry, Selena Gomez and others rocked the Met Gala red carpet in some fierce fashion. News just broke about Prince’s sudden death, and celebrities are already mourning him on social media.
Stars like Emma Roberts, Alessandra Ambrosio and Kylie Jenner hit the Coachella scene over the weekend. Sign up here for exclusive access to all your favorite celebrities and breaking entertainment news! The ear, nose and throat specialist who treated comedian Joan Rivers on August 28 has been identified as Dr. With a physician who is an expert in airway anatomy at her side, and all the technologic advantages of a modern clinic in Manhattan’s upper east side, the 81-year-old Ms. In fairness, the credentialing process at a hospital or ambulatory surgery center (ASC) simply reviews documentation that the physician is qualified to perform procedures, and grants the physician privileges to practice there. Initial autopsy results were inconclusive, according to CNN’s report of a statement from the medical examiner’s office, meaning that no obvious cause of death was clear, and more tests will be done. Since 2009, the state of New York has required accreditation of facilities where “office-based surgery” is performed. It can be hard to tell the difference between an OBS facility and an ambulatory surgery center (ASC), since many of the same procedures may be performed at either. Yorkville Endoscopy has stated that it maintains AAAASF authorization to provide patient care. Complicating the story further, there have been conflicting reports about the emergency resources that were available at Yorkville Endoscopy. The AAAASF publishes a document called the “Medicare Standards and Checklist” for accreditation of ambulatory facilities. Class C:  All the above methods of anesthesia, with the addition of inhalation anesthetics, and the option to use endotracheal intubation or laryngeal mask airways.
There isn’t much public information about what class of anesthesia care Yorkville Endoscopy elected to provide, except for one statement from the facility that it uses only “light to moderate” sedation, not general anesthesia.
The “class” selected by the facility determines what equipment and medications it should stock, and what personnel are required. Any facility that offers propofol for its patients is supposed to have airway resuscitation equipment readily available: laryngoscopes, endotracheal tubes, laryngeal mask airways, and self-inflating bags for positive pressure ventilation.
Any facility that offers propofol for its patients, the AAAASF says, should stock neuromuscular blocking agents. I can vouch for the fact that it isn’t always easy or fun to take care of a famous patient. Every physician knows that sometimes adverse events happen, and they are more likely to happen to older, more fragile patients. Often, patients are advised to stop taking aspirin or blood thinning medications before a procedure, but their absence can increase the risk of a stroke caused by a blood clot in the brain. Presumably, the results of the tests done during her hospitalization have determined if Ms.

The bottom line is that patients should consider risks and benefits carefully before consenting to invasive procedures requiring anesthesia, no matter how minor the procedure might seem. I’m wondering how patients can consider the risks of anesthesia when they go for a procedure and are presented with a complex consent form without a detailed discussion with the doctor and anesthesiologist. When I considered having outpatient surgery at an ambulatory center, due to my complex medical needs, I asked to meet with an anesthesiologist ahead of time. I wonder though even if you meet with the anesthesiologist ahead of time if it would be the same one working on the team when you go in.
I think there needs to be video recording of operations synched with the readouts of vitals so that if something happens it will be known what actually did happen. If I had had the surgery at the hospital, I would have had a good chance of meeting with the anethesiologist who would be doing the surgery. Yes, gastroenterologists do endoscopy procedures but ENT also has endoscopic procedures they do as well.
Patients tend to like cushy, outpatient facilities because they don’t look or smell like hospitals. I must be an unusual patient because I don’t care if the facility smells or looks like a hospital.
If she suffered true laryngospasm, it may not be possible to break it with propofol and positive pressure ventilation alone as true laryngospasm may cause the false cords and soft tissues to close in as well, creating a ball-valve effect which PPV will make worse.
With a large endoscope in the mouth, it can easily happen that breathing will become obstructed even if the dose of anesthesia or sedative medications was completely appropriate.
Gwen Korovin has been named by TMZ as Joan Rivers’ personal doctor, who was working on the legendary comedian when she slipped away. During the scheduled endoscopy to diagnose her hoarse voice, a Daily News report alleges that one of Rivers’ personal doctors noticed a possible tumor and performed an unplanned biopsy. Korovin had no authority to practice medicine at the Yorkville Endoscopy clinic, where Rivers underwent the surgery that led to her eventual death. Korovin graduated from Cornell University undergrad in 1980 and studied medicine in the State University of New York system.
Years before she shot to superstardom, the panicked singer flew to New York for another opinion when two Canadian doctors recommended surgery on her swollen vocal cords. Korovin provides treatment for all ENT problems and has special expertise in voice and throat problems. She subsequently went into cardiac arrest and died a week later without regaining consciousness.A Yorkville Endoscopy spokesperson told "Extra" in a statement, however, that "a biopsy of the vocal cords has never been performed" at the clinic, adding that "general anesthesia has never been administered" there either. Gwen Korovin, a prominent New York physician who is known as a voice doctor to many entertainers and Broadway stars including Hugh Jackman and Julie Andrews. Korovin had not completed usual credentialing procedures at Yorkville Endoscopy, and did not have privileges to do anything but observe on the day Ms. Physicians choose where they want to work, and don’t necessarily maintain privileges at more than one hospital or ASC. Korovin’s case, her attorney’s statement notes that she “maintains privileges at one of the city’s most prestigious hospitals.” Her prominence in Manhattan may have led to an assumption that her credentials at Yorkville Endoscopy were in order, although it is the responsibility of each facility and its medical director to make sure.
Rivers suffered cardiac and respiratory arrest while at Yorkville Endoscopy for evaluation of why her voice was getting raspier. Rivers’ condition deteriorated during or after examination of her vocal cords and endoscopy to evaluate her esophagus and stomach. Rivers didn’t wake up after being resuscitated suggests that heart disease wasn’t the primary cause of her death.
Rivers ever showed signs of consciousness during her week-long hospitalization at Mount Sinai Hospital. Rivers’ caregivers were distracted by all the excitement surrounding her appearance at the clinic, and the entourage that probably accompanied her, they might not have completed all their usual cross-checks of medications and equipment.
Rivers’ cardiac arrest had nothing to do with the physicians and staff who took care of her that day, or what emergency resources they had on hand.

Rivers suffered a stroke or if her condition was more likely the result of hypoxic brain injury. Sibert is an associate professor of anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA.
If so, a little propofol and positive pressure can break laryngospasm, and I would think almost all anesthesiologists would know that. The first thing you look at is the medical record and in a case of this nature, it will be flyspecked on a minute to minute basis, supplemented with interviews with everyone who was present in the operating room and some additional personnel as well. The loss of such comic genius is a tragedy, but then of course, the loss of any life during such a minor procedure is a tragedy. If I had to choose one cause only, it would be VP syndrome, but in a much broader application. During that procedure, the Daily News reported, the legendary comedian’s vocal chords seized, blocking her airway, and she suffered a cardiac arrest. Some early reports indicated that anesthesia may have played a role in her death.Yorkville Endoscopy Medical Director Dr. She was resuscitated and transferred to a nearby hospital, but died a week later after discontinuation of life support. Patients who are resuscitated after cardiac arrest due to an arrhythmia or a heart attack usually wake up afterward.
Free-standing ASCs are governed by the same strict “Article 28? regulations that apply to hospitals and hospital-based ambulatory surgery units. I have no doubt there was no sux at the center, but I’m sure there was propofol and there was definitely an ambu bag.
Also, I am not a doctor, and I don’t play one on tv, so I can only say what my doctors told me and hope real doctors weight in. And if the clinic and the people are not proficient in the techniques and familiar with the equipment that may or may not be at their reach, bad things happen. It seems that even if there were some complications the personnel should have been able to handle those.
Rivers’ gastroenterologist, was the medical director of Yorkville Endoscopy at the time of Ms.
Rivers’ airway was too swollen, an ENT specialist would know how to create a surgical opening in the neck (cricothyrotomy or tracheostomy) to permit emergency ventilation. Imagine if a pilot crashed the plane because a celebrity was on board and wanted to fly at a different altitude?
According to my ENT, I have reflux laryngitis with pretty much the same symptoms that were described above for Joan Rivers.
This is truly hard to understand and any doctor that would allow a patient to dictate against proper and safe procedure should not be practicing (such as the doc who killed Michael Jackson). I hope we will find out what happened in this case and that if there were deviations from the standard of care that this facility will learn from it. But, I didnt want to put my mother through anything and I was given the choice to have an autopsy.
Also, why does ENT performed the endoscopy instead of referring her to a gastroenterologist and having the latter decide which tests are necessary? I know I scared the anesthesia doctor as he would visit me every day i was in the hospital a would ask my mom about me for years.

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