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The NSPA Blog

Star-Struck, Nervous, and Fumbling

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Posted on June 21st, 2016 by Teri Dreher, under Patient Advocacy, Tips & Resources

At NShore Patient Advocates, we are not usually particularly attentive to celebrity news, but a recent article from the New York Times caught our attention.  The article, entitled “Settlement Reached in Joan Rivers Malpractice Case”, brings to light the importance of safety in patient care, and the need for regulatory oversight of outpatient surgical centers.

The NYT article summarized the medical condition and care that ultimately was found to have contributed to 81 year old comedian Joan Rivers’ unexpected death. According to the article, Joan was experiencing a hoarse voice and sore throat, and was scheduled to undergo an Upper Endoscopy and laryngoscopy under anesthesia at a for-profit outpatient facility.  She did indeed go in for the procedure, but complications arose during the procedure that ultimately led to her death. After Joan’s cardiac arrest at the facility, the anesthesiologist on duty wrote a 5 page report , giving details about what went on during her procedure.  What is reported to have been revealed in her report (released in court documents to The Times) is chilling.  The article paints a picture of “star-struck” physicians (one even took a picture of Ms. Rivers during the procedure) who were so “eager to please” (quote from NYT quote) that they violated protocols, and were “nervous and fumbling as the crisis unfolded” (quote from NYT).

Here’s the gist of what happened, according to the NYT article.  The Times reported that the anesthesiologist caring for Ms. Rivers said that she warned the other physicians in the room performing the procedures that Ms. Rivers vocal cords were getting very swollen.  The vocal cords allow us to speak, and they are like a set of rubber bands that open and close the air passageway known as the trachea. The other physicians apparently downplayed the anesthesiologist’s concerns, calling her a “curious cat”, and her concerns “paranoid”, and proceeded with the procedure.

When Ms. Rivers’ vocal cords swelled shut, the Times reported that none of the physicians in attendance took the steps needed to restore her breathing.  The lawsuit argued that the physicians on duty had a couple of options to open her vocal cords:  administering a specific medication to relax the vocal cords or performing a surgical procedure called a tracheotomy to allow air in by bypassing the vocal cords.  As a result of not being able to breathe in oxygen, Ms. Rivers’ heart stopped.  Although her heart was ultimately re-started, Ms. Rivers never woke up after the cardiac arrest and her family had to make the difficult decision to withdraw life support several days later.

Melissa Rivers, Joan’s daughter and the plaintiff in the suit, was quoted in the Times article that by settling the lawsuit, she would be able to “ensure that those culpable for her death have accepted responsibility for their actions quickly and without equivocation.”  She said she and her attorneys will focus efforts at a legislative level so that outpatient centers will be held to the same safety standards as hospitals in New York.

We are truly sorry for the untimely loss of this very talented comedian, Mom, and Grandma.  This tragic story could have happened to any patient.  The fact that it happened to a celebrity causes everyone to take notice.  We sincerely hope that with the notoriety of the Rivers family, their tragedy will inspire new legislation in New York and across the country to improve patient safety at outpatient surgery facilities.

Following a report of any bad outcome, we private, professional healthcare advocates always ask ourselves whether we could’ve made a difference had we been involved.  But, as they say, hindsight is 20/20, so we will never know in the case of Ms. Rivers.

How can a private, professional healthcare advocate help when contemplating a surgery? 

  • If a client comes to us asking for our help before a procedure, here is what our approach might look like:
    • We would research physicians who were tops in their field for the types of procedures needed, and the best places to get these procedures done. The public really has no idea what “good” medical care really looks like, but we do!!  Though we always appreciate a great bedside manner, there is so much more to consider.
    • We would ask questions that patients and their families have no idea to ask.  Here are just a few examples:
      • How many times have you performed this particular procedure?
      • What types of complications have you seen, and how have you handled them?
      • Who will be overseeing the anesthesia?  What type of training do they have?
  • In general, we always recommend elderly patients always be treated at a hospital, just because they are at higher risk for complications. At a hospital, there are more specialists on hand to help out in the case that things don’t go as planned.
  • As far as the day of surgery goes, an advocate may or may not be allowed in the surgical suite.  Many facilities would not welcome the general public in an operating room (but then again think of all the new dads who are present for c-sections!), but perhaps some might welcome a registered nurse or physician (advocate) who understands from their professional training how to not interrupt the sterile field in the room.

 

With over 36 years of clinical experience in Critical Care nursing, home based health care and expertise as a cardiovascular nurse clinician, Teri is well acquainted with the complexities of the modern healthcare system. She has served as a nursing leader, mentor, educator, and consistent patient advocate throughout her career in some of the best hospitals across the country. Her passion to keep the patient at the center of the model of nursing care led her to incorporate NShore Patient Advocates, LLC in 2011, serving clients throughout the northern suburbs of Chicago.

For a no-cost 30 minute initial consultation, please call 847-612-6684 or click here to fill out our online callback request form.