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State: Joan Rivers' Doctors 'Failed to Identify Deteriorating Vital Signs'

A report reveals shocking new details about Joan Rivers’ death and what happened inside the medical clinic where she went into cardiac arrest.

The clinic where Joan Rivers had a medical procedure during which she suffered brain damage because of lack of oxygen "failed to identify deteriorating vital signs and provide timely intervention," an investigation by the New York Department of Health and Human Services has determined.

Rivers, 81, was undergoing a laryngoscopy and an upper gastrointestinal endoscopy at Yorkville Endoscopy on Aug. 28 when she went into hypoxic arrest, which occurs when the brain lacks oxygen. The legendary comedian had been suffering from chronic reflux disease, according to the health department's report. Rivers was rushed to a hospital where she died Sept. 4 after being removed from life support.

The health department investigation of the Manhattan facility, which opened in 2013, determined that the clinic failed "to ensure that patient care services are provided in a manner that protects the health and safety of all patients." It also found that Yorkville Endoscopy failed to have a process in place to ensure that only authorized personnel were permitted in the procedure room and that only credentialed physicians can perform procedures, and to ensure that consent is obtained for all procedures that will be performed.

According to the investigation, an ear-nose-throat specialist "who was not a member of the medical staff and was not privileged at the facility" performed two different "nasolaryngoscopies," one before the endoscopy and one after it. The ENT surgeon performed the procedure, which examines the nasal passageways and the area between the cavity of the mouth and the throat, in front of the clinic's medical director, an anesthesiologist and a technician. The ENT surgeon was noted in Rivers' medical records as a referring physician, the report states.

A staff member told state investigators that the ENT surgeon was "in there for a minute or two" performing the second nasolaryngoscopy and removed the laryngscope at 9:30 a.m. At that time, the report states, vital signs were recorded at 85/49, and there was no pulse.

The state report notes that there was conflicting information in the medical records about the time resuscitation was initiated. But "the patient was successfully resuscitated at 10 a.m. and transported to a hospital at 10:04."

Rivers' medical records also contain discrepancies regarding the amount of Propofol she was administered for the procedures, the report states.

Rivers' manner of death was determined to be "therapeutic complication." The death resulted from a "predictable complication of medical therapy," the medical examiner’s office said in a statement.

In a statement Monday, Yorkville Endscopy said the clinic remains open and is still fully accredited.

"Yorkville has been fully cooperative and collaborative with all regulatory and accreditation agencies. In response to the statement of deficiencies, Yorkville immediately submitted and implemented a plan of correction that addressed all issues raised. The regulatory agencies are currently reviewing the corrective plan of action and have been in regular contact with Yorkville. In addition, the physicians involved in the direct care and treatment referenced in the report no longer practice or provide services at Yorkville. Yorkville will continue its commitment to complying with all standards and accreditation requirements."

Melissa Rivers hired the New York personal injury law firm of Gair, Gair, Conason, Steigman, Mackauf, Bloom & Rubinowitz last month to investigate the circumstances surrounding her mother's death. On Monday, her lawyers issued a statement on her behalf:

"Our client, Melissa Rivers, is terribly disappointed to learn of the multiple failings on the part of medical personnel and the clinic as evidenced by the CMS report. As any of us would be, Ms. Rivers is outraged by the misconduct and mismanagement now shown to have occurred before, during and after the procedure. Moving forward, Ms. Rivers will direct her efforts towards ensuring that what happened to her mother will not occur again with any other patient."