Timeline emerges in Joan Rivers’ death

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(CNN) — A new timeline emerged in the emergency response to comedian Joan Rivers’ cardiac arrest. She stopped breathing and her heart stopped beating during treatment at Yorkville Endoscopy.

A New York City official with knowledge of the emergency response told CNN that on August 28 at:

9:40 a.m: A 911 call from the Yorkville Clinic reports a patient in cardiac arrest. The incident is given the highest priority code.

9:45 a.m: The New York Fire Department response team arrives at the clinic and finds CPR efforts on Rivers already under way with the defibrillator attached and a breathing tube inserted into her windpipe. The firefighters take over the CPR efforts.

9:47 am: An ambulance from Mount Sinai Hospital arrives at the clinic. The ambulance team joins in the CPR efforts.

9:48 am: A second NYFD unit with Emergency Medical Technicians, along with a supervisor, arrive at the clinic.

9:50 am: A total of 10 rescue workers are on the scene.

Rivers, 81 was rushed to Mount Sinai Hospital, where she died a week later.

Yorkville Endoscopy said in a statement this week that Dr. Lawrence Cohen “is not currently performing procedures … nor is he currently serving as medical director.” The statement did not say that his departure was connected to Rivers’ death and clinic spokeswoman Marcia Horowitz declined to elaborate.

In a statement, the Manhattan clinic said that the cardiac arrest did not happen during her elective procedure, and, responding to reports of a biopsy, said: “A biopsy of the vocal cords has never been performed at Yorkville Endoscopy.”

Many questions have been raised about what treatment was given and what might have gone wrong that led to the comedian’s death. Few answers have been made public because of medical privacy rules, but the New York State Health Department confirmed the agency is investigating.

The clinic statement also seemed to address speculation that her cardiac arrest could have been related to the anesthesia used to sedate Rivers while an endoscope, which is a long, flexible camera, was used to examine her throat.

“General anesthesia has never been administered at Yorkville Endoscopy,” the statement said. “The type of sedation used at Yorkville Endoscopy is monitored anesthesia care. Our anesthesiologists utilize light to moderate sedation.”

Only licensed medical doctors who are board-certified anesthesiologists administer anesthesia at the clinic, the statement said.

“Our anesthesiologists monitor the patient continuously utilizing state-of-the-art monitoring equipment, and remain at the bedside throughout the procedure and into recovery,” it said.

The clinic statement also deflected criticism that Rivers should have been treated in a hospital and not a clinic because of her advanced age.

“Yorkville Endoscopy has strict policies in place for the criteria of who gets treated in this center versus in a hospital,” the statement said. “Every patient is pre-screened by their gastroenterologist, an anesthesiologist and a nurse for appropriateness to be treated at Yorkville Endoscopy. Some patients are also pre-screened by their personal physicians.”

CNN’s Alan Duke and Doug Ganley contributed to this report.

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1 Comment

  • Barry Friedberg MD

    As a board certified anesthesiologist, I find it difficult to believe another board certified anesthesiologist was involved in Rivers’ care. Laryngospasm appears to have been the precipitating factor. Laryngospasm does not have to end the patient’s life.
    Prompt recognition & treatment is needed. Many times jaw thrust & positive pressure breathing is insufficient. Muscle relaxants like succinylcholine or rocuronium are not needed for GI endoscopy, so neither might have been readily available. Lidocaine is commonly found.
    Treating laryngospasm with IV lidocaine STAT, 1 milligram per pound body weight, typically resolves the issue & may well have saved Joan Rivers’ life. Sadly, few of my anesthesia colleagues, much less untrained providers as the case seems here, have this knowledge.