My Thoughts on Joan Rivers
When I heard the news that Joan Rivers was rushed from a clinic to Mount Sinai Hospital after surgery complications, I knew it wasn’t a good situation. With Joan being 81, complications and recovery are much more difficult.
I was really surprised on many levels that someone of Joan’s financial status would end up in a clinic for any procedure at her age, let alone a “surgery”. At her advanced age, she was considered a high risk patient for complications on many fronts and to do an out-patient procedure away from full hospital support staff raised my eyebrows immediately. I remember watching many experts over the years on TV caution people to get knocked out in a doctor’s office because the level of care could put you at risk.
Ironically, the American Society of Anesthesiologists wrote a paper on Safe Anesthesia in the Office-Based Surgical Setting on September 1, 2014…just days after Joan entered the hospital. They write, “Despite the numerous advantages of performing procedures outside the hospital, the office environment can introduce significant concerns over patient safety and well-being.”
So why would Joan go there? All of this made me wonder what was going on…
According to ABC news, Joan performed a comedy routine for an hour the night before she went into cardiac/respiratory arrest, and according to one attendee, there were “no signs that Rivers had any health issues whatsoever.” She even joked about her demise that night.
Furthermore, we never got clear news as to exactly what Joan Rivers was going in to have done. Was it an endoscopy? After all she was at an endoscopy clinic according to reports. Some news agencies reported “throat surgery”–others reported “vocal cord surgery”. What was Joan going in for when these complications arose? It seems hard to find out, and if the family chose to keep it private, its certainly their right to do so.
So I am left to look at what has been reported. Joan seemed in great health the night before her “surgery”. She ended up at an endoscopy clinic, and endoscopic procedures are not typically considered “surgery”–so she had something else done. There are endoscopic surgeries where they insert a small camera and its considered surgery. Maybe she had that done?
Most people are not aware that outpatient clinics are not required to meet the same standard of care of a hospital or ambulatory surgical center. According to the Anesthesia Patient Safety Foundation (APSF):
[As of 2009]…only 23 U.S. states have some regulation for office-based surgery. In addition, a vast majority of offices lack accreditation by one of the major accrediting agencies (AAAHC, AAAASF, JCAHO). Whether such procedures are performed with or without an anesthesia care team provider, current issues include patient and procedure selection, perioperative management, complications, and recovery. Non-patient related issues include proceduralists performing outside their scope of practice, substandard facilities, and lack of qualified office personnel.
So I went to Yorkville Endoscopy to see what they say. They don’t mention the word “surgery” anywhere on their website services page.
Hmmm….
Furthermore, on the front page of their website, there is something interesting. It says, “Yorkville Endoscopy is an Ambulatory Surgical Center, approved by the Department of Health and accredited by……to perform ambulatory procedures to diagnose and evaluate conditions of the upper and lower digestive system.”
Who are they accredited by? It seems to be missing.
MISSING.
See for yourself…
That has me wondering: Did Joan want something done that wasn’t recommended by quality care doctors and so she sought out a clinic that might be willing to do it? We all know Joan had a love of cosmetic surgery…
If so, it could have cost her her life. She could possibly still be with us today had she been at a high quality care facility that was able to properly act when things went south. My heart aches for her surviving family.
So I share this with you in hopes of promoting information that could save you or a loved one’s life. While you may want to go to a clinic down the street for a procedure and it might be cheaper, if you don’t do your homework, it could cost you precious time if things go wrong, and quite possibly it could cost you your life. That’s not to say that you can’t go to a clinic for a procedure, but understand the risks, if you do. Make an educated decision if they are worth it for you.
Maybe Joan did do that and still decided the risk was worth the benefit, though I am not sure she would still say that today, if she was with us.
I hope that is not the case with Joan Rivers…but things aren’t looking good from what we’ve seen so far.
I feel deep sympathy for Joan River’s family and I hope they find peace in all her lovely memories.
Thanks for posting this information. I was totally unaware that the requirements for clinics are any different from other types of medical facilities. That was shocking to me. The report that was quoted – saying substandard care in outpatient clinics can have serious results – simply confirmed that understanding.
Obviously I’ll be very careful with my selection of facilities for medical care. Normally I’ve gone to full hospitals (in the very few times I’ve need to get any medical treatment) and I’ll be careful to do that in the future.
The other oddity is that the facility that treated Joan Rivers does not list who they are accredited by. I checked the web site myself and it still said the same thing – it was missing!
One other note – Joan Rivers always sounded to me like someone who did not take good care of her voice – I’ve known people with similar sounding voices who were heavy smokers. A quick search showed that Melissa (her daughter) was mad at her mom (Joan) for smoking pot – on TV – her own reality show. I would not be surprised if there was something amiss with her vocal chords given the way she treated them. I don’t know if that’s why she went in to this clinic, but it’s a real possibility.
Thanks again for another very good post!
According to another website, she was having botox injected into her vocal chords to help with her raspy voice. If that’s the case, possibly the botox paralyzed her throat muscles constricting her airway.
Thanks for posting this. I guess I don’t know as much about endoscopy as I thought. I agree that there is something disturbing and hinky about this. On a positive note, that photo of her is lovely. She may not have been everyone’s cuppa, but she was a pioneer of sorts for female comics, paving the way, etc and I have to give her that.
I was never a fan of Ms. Rivers, but you make a good point. She did more than most to help her fellow female comedians.
I was never a fan of Ms. Rivers, but you make a good point. She did more than most to help her fellow female comedians.
Wow, I was not expecting a post on this. I knew that there were risks associated with ANY anesthesia, and that the older you are, the higher the risk. I had thought that Joan just got unlucky, and didn’t realize the possibility that there could have been malpractice.
I am saddened at her death. She always made me laugh, and she had a lot of guts and wouldn’t back down. She paved the way for a lot of female comedians.
I felt sad to hear on your site about the death of Joan Rivers. Here is a list of some of her humorous lines http://www.brainyquote.com/quotes/authors/j/joan_rivers.html
good investigation Eyes. Imagine the accreditation being a blank!
Useful information all around. It make sense that a clinic would have less care but I’d never thought about it before and I’m guessing many clinics would prefer people didn’t know the negatives. A hospital is a clinic’s back up plan if an emergency happens.
This typo on the website looks like someone hastily edited it after Joan’s death and I don’t know why…it shows fear, panic, worry…and that is alarming! You would think when the website went live it would have been polished, but I could be wrong.
exactly what I assumed: hastily edited
exactly what I assumed: hastily edited
Yes. Whatever the outcome, good investigating Eyes
Yes. Whatever the outcome, good investigating Eyes
Here is a link on the story that I found interesting: http://www.foxnews.com/health/2014/09/05/joan-rivers-death-puts-spotlight-on-outpatient-clinics/
And here is one that says Yorkville Endo was accredited…and the organization that accredited them is re-thinking that decision! http://www.nbcnewyork.com/news/local/NY-Health-Officials-Investigate-Clinic-Joan-Rivers-Surgery-273953451.html
Updates from TMZ – they say they had all the equipment as a hospital would…http://www.tmz.com/2014/09/06/joan-rivers-yorkville-endoscopy-clinic-anesthesia-health-department/
CNN — “Elective procedure” and if simple procedure, not assisted breathing…http://www.cnn.com/2014/09/05/health/joan-rivers-death/
Now that you’ve got me thinking about this… When I had my surgery in my doctors offices it was described to me like this: “We do this type of surgery outside of the hospital now. Everyone does this type of procedure in the clinic setting.” At the time I didn’t realize it, but I was obviously being put into the mindset that I did not have a choice of where we would do the procedure. I feel that the overall direction of these types of “small” surgeries has been out of the hospital and into the smaller clinic settings. Maybe now people will start to change their minds about that or at least give it some thought?
When doctors work in the hospital they pay high costs for hospital services, operating theaters, equipment, etc., and I can’t help but wonder if their profit margin is higher in the private setting… don’t know, but I wonder… In the major surgery I had last year, the hospital took $39K and the doctor only got like $6K. I was floored!! If the doctor doesn’t have to pay for the hospital, he can take in much more…or so I would think… And yes, they won’t want you to go elsewhere…its all about profit these days! It’s up the consumer to be educated always…
I had an outpatient procedure last year at “surgery center.” To his credit, or possibly due to a law in my state, my physician disclosed the fact that he held a partial ownership in the outpatient canter. In my case, I am sure this affected the profit margin for the doctor.
I had an outpatient procedure last year at “surgery center.” To his credit, or possibly due to a law in my state, my physician disclosed the fact that he held a partial ownership in the outpatient canter. In my case, I am sure this affected the profit margin for the doctor.