Shortly after Joan Rivers passed away on September 4, 2014, I wrote a blog that mused over how and why, the comedienne might have died. Now we have to no longer make up stories, and couch our theories. It is true, all of it.
In an online article (ETonline) published on November 11, 2014 and entitled: “Melissa Rivers ‘Outraged;’ Death Investigation Finds Multiple Failings in Joan Rivers’ Medical Procedure,” we learn that:
“In a further investigation into the death of the comedienne, the Department of Health released Monday that errors made at Yorkville Endoscopy included failure to keep proper medication records and snapping photos while Joan was unconscious.
There was conflicting information in Rivers’ medical records in regards to the amount of Propofol, a sedation drug, she was given during the procedure. Investigators also got conflicting stories as to the time resuscitation began.
Another shocking find was that a surgeon who was not a member of the medical staff was granted permission to administer the two nose and throat scoping surgeries. It’s also noted that a staff member snapped photos of Rivers while she was unconscious and without her consent.”
There are several important points we need to discuss from an ethical point of view.
The first problem is that the procedure was so haphazardly conducted, that not only was there no accurate record of the amount of sedative that Ms. Rivers received, and not only did no one apparently see her vitals deteriorate, there was no agreement as to when the resuscitation efforts even began.
Ethically this is troubling to me because it indicates the clinic may have gotten very used to “just filling in the blanks” after these procedures were done, rather than closely monitoring and recording each patient individually.
Second, it appears from the report that an unauthorized surgeon not covered by the clinic’s policy was given permission to work on the patient. Whether this surgeon was Ms. Rivers’ private surgeon or not is irrelevant; the surgeon was not authorized to work in that setting. That means there was a bending of the rules and rather an arrogance in play.
If the surgeon wanted to do such a procedure, why was this not done in a facility where the surgeon had authorization to work on the patient? It also leads us to wonder in how many hospitals and clinics and in how many situations are there people we did not authorize to work on us, working on us? Could it be that people in the clinic “gave up their power” to this outsider? Could they have felt resentment toward this surgeon and let the patient’s vitals go in a terribly wrong direction because they figured the “big shot surgeon” was usurping their space?
Third, though Ms. Rivers was a funny person, I am fairly certain she would not have wished the staff to be clowning around and taking her picture rather than keeping track of her medical condition. I find that to be extremely unethical.
What does it mean for us?
For me, as an ethical speaker and consultant, I am constantly amazed that from the smallest clinics to major hospitals that in most cases there is no on-going, serious training in ethics. When there is training it is typically someone on staff who has given the same droning lecture a hundred times over.
When they do give the lectures, staff is disinterested, bored or excused. They “mail in” their attendance in much the same way that the healthcare “professionals” at the endoscopy clinic could not agree on their records – because the records probably didn’t exist during the procedure. It was played loose, it was played like a comedy act and it was played with a sense of entitlement.
I lecture and consult on ethics; I am not an anesthesiologist or a physician skilled in the ways of endoscopy. However, I will take a stance and say that what caused Ms. Rivers death was not so much poor medicine but lousy ethics.
If the clinic played it so loose with Joan Rivers, how would they have played it with you and me? Here’s another chilling question: how many patients die each year not because of bad medicine but because of non-existent ethics?
I am sure there exist no statistics on that one.
I pray that from this tragic case, the medical community starts to ask itself some tough questions. I hope that continuous ethics training is put on the agendas of all medical facilities.