Health ConditionsIn the News

What Did Joan Rivers Die From?

As more details emerge about Joan Rivers’ death, one thing is clear: It could have been prevented. When it comes to elective surgery, even famous people – who have access to the best – aren’t immune to complications.

So what did she die of, exactly, and how can you make sure it doesn’t happen to you?

Cause of death

The 81-year-old comedian known for her no-holds-barred, caustic humor most recently skewered celebrities on E!’s Fashion Police. She died September 4, 2014 of cerebral hypoxia, or lack of oxygen to the brain. It’s also being called a therapeutic complication, a predictable complication of medical therapy. But the story is more complicated.

Rivers went to Manhattan’s Yorkville Endoscopy clinic for a minor, elective procedure to help diagnose her hoarse voice and sore throat. Investigators from the federal centers for Medicare and Medicaid Services found that she consented to an upper endoscopy, including a possible biopsy, possible removal of polyps, and possible dilation of the esophagus. She consented to monitored anesthesia and the risks were explained.

Unfortunately, the report says that the clinic made multiple serious errors, which led to Rivers’ death. They include:

  • Not recording her weight, which affected the amount of anesthesia received
  • Her personal Ear, Nose and Throat physician (ENT) performing procedures on her without the proper credentials for the facility
  • Her personal ENT attempting more than once to perform a laryngoscopy – to which Rivers had not consented
  • Physicians failing to identify deteriorating vital signs and intervene in a timely manner

Prevention

One lesson we can learn from this tragedy is to think – more than twice – before going through any non-essential surgery, says Dr. Marc Leavey, primary care specialist at Mercy Medical Center. In his career, he has seen people want unnecessary surgery, cosmetic or otherwise. After fighting to have it, they end up with untoward complications from disability to death. “Surgery is surgery, whether ‘major’ or ‘minor,’ and should not be entered into lightly,” he says.

The Physician-Patient Alliance for Health and Safety — a national organization working with hospitals across the country to provide tools and information to prevent unnecessary injuries and deaths – has four ways in which patients can learn from Rivers’ experience.

  • Know the risks and potential preventative measures, as even ‘minor’ procedures can have major risks and ‘hidden’ harm
  • Know that equipment and resources at outpatient clinics may differ from those at hospitals. Just because you’re at an outpatient type of clinic doesn’t mean you should take it any less seriously. “Ask about code cart [contains specialized medications and equipment for emergency use] availability, emergency drugs to manage your condition and any adverse effects, and trained clinicians available and knowledgeable about handling potential life threatening emergencies,” PPAHS recommends
  • Make sure you fully understand your procedure. It can’t hurt to bring a friend or family member to physician consultations to be extra ears
  • Make sure you’re electronically monitored. “If you are to receive sedation, opioids or anesthesia, electronic monitoring with both pulse oximetry [which measures the oxygen level in the blood] and capnography [monitoring of carbon dioxide] is critical,” says PPAHS

Washington State has a program called Strong for Surgery, which helps pre-surgical patients prepare for their procedures with checklists that address diet, blood sugar (important for non-diabetics too), medications, and smoking. There are many steps patients can take to reduce chances of complications and improve recovery.

Rivers was known for her love of plastic surgery, famously saying, “I’ve had so much plastic surgery, when I die they will donate my body to Tupperware.” While her demise may have been caused by a different elective surgery, can’t you just picture Rivers unleashing her most vicious diatribe on how it happened?

 

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Lisa A. Goldstein

Lisa A. Goldstein

Lisa A. Goldstein is a freelance journalist with a Master’s in Journalism from UC Berkeley. She has two kids, a love of books and sweets, and wishes her metabolism is what it used to be.

2 Comments

  1. William
    February 26, 2015 at 8:09 am — Reply

    Speaking as an anesthesiologist, Rivers died because of one issue – her vital signs were not properly monitored. Any of the alleged problems seem to be ones that are very easily dealt with in a proper surgical/anesthesia setting with skilled/experienced practitioners. Sedation can be a tricky business, and sedation plus airway surgery even more risky. Not unlike the Michael Jackson debacle.

  2. September 5, 2016 at 2:26 pm — Reply

    […] Reports WomensHealth: […]

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