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Not a good day for her doctor. I'm wondering if her daughter is going to sue.
Imo, for the amount of surgeries Joan Rivers had, she sure was fortunate that nothing went wrong up until now.
Not a good day for YEC or the PCP involved. As to who will take the fall if any remains to be seen.
Once an informed consent is signed that is that, and it is clear violation to deviate from what the patient agreed to unless perhaps under grave circumstances. Unless the consent form spoke to "exploratory" surgery and what could or would happen if anything were found (a biopsy or removal) all involved have some explaining to do.
OTOH from a physician's point of view it could make very good sense to "look at" or biopsy something found once a patient is "opened up" so to speak. The alternative would be to leave things as they were, allow the patient to come out of the procedure *then* explain "something" was found and schedule another procedure to go back in again. Considering how concerned Ms. Rivers was about the changes in her voice along with her age and other factors it may have been seen as the lesser of two evils to simply get a bit of what was found so it could be determined what was going on while she was already "on the table".
Once an informed consent is signed that is that, and it is clear violation to deviate from what the patient agreed to unless perhaps under grave circumstances. Unless the consent form spoke to "exploratory" surgery and what could or would happen if anything were found (a biopsy or removal) all involved have some explaining to do.
OTOH from a physician's point of view it could make very good sense to "look at" or biopsy something found once a patient is "opened up" so to speak. The alternative would be to leave things as they were, allow the patient to come out of the procedure *then* explain "something" was found and schedule another procedure to go back in again.
Considering how concerned Ms. Rivers was about the changes in her voice along with her age and other factors it may have been seen as the lesser of two evils to simply get a bit of what was found so it could be determined what was going on while she was already "on the table".
We've had extensive discussion on lack of hospital for a woman of her age, heart issues, anesthesia, and the very real possibility of laryngospasm, here:
Joan should have been in hospital with a qualified, experienced anesthesiologist present.
Period.
AnesthesiaMD's posts have been and are on-point. Laryngospasm was always a real possibility. An experienced anethesiologist can deal with this in seconds. After reading above article, he posted these today (plus many other earlier informative comments on that thread - well worth reading):
Quote:
Originally Posted by AnesthesiaMD
The first time I saw laryngospasm, back in my residency, it was very scary. After 5 times, it didn't even phase me anymore. In my career I have seen it, and dealt with it many times and I know I can fix it in a matter of seconds. It's all a matter of experience. If this story is true, I can't imagine there was an anesthesiologist involved. If there was, it wasn't a very good one.
Quote:
Originally Posted by AnesthesiaMD
Believe it or not, anesthesiologists have more experience with laryngospasm than ENTs. In most cases, the ENT will stop what he is doing and the anesthesiologist will take over until the laryngospasm is gone.
If, for some reason, I couldn't break the laryngospasm in a few seconds, I can always paralyze the patient with a drug called succinylcholine. Paralyzed vocal chords always open up. Some anesthesiologists use this right off the bat, but I can't even remember the last time I needed it. But at least I always know I have that as a last resort.
Most ENTs don't have a lot of experience giving succinylcholine. At that point you have gone from giving sedation to giving general anesthesia.
Quote:
Originally Posted by AnesthesiaMD
A true tracheostomy would take too long, but he could have put a large needle in the throat and gotten some oxygen in her lungs that way until a more permanent fix could be done. That's another trick we use in a pinch. Again, that shouldn't even be necessary for laryngospasm, but if you don't know how to deal with it any other way, that will work.
Also, there is something called a cricothyrotomy, which can be done pretty quickly. They make kits for this. It is the same concept as the needle, but with a bigger hole to get air in the lungs. I don't know if this endo center would have these kits available.
Never - never - should Joan have had any type of throat biopsy outside of a hospital. If a qualified, experienced anesthesiologist had been present, none of us would be talking today.
Sounds to me like Joan's ENT was a bit too full of himself - and forgot the risks.
I thought the whole thing of looking down ones throat was to "see", not to cut.
To "see", then to plan on what to do.
not "see", "cut", die.
I'm terribly upset over this.
There was nothing wrong with her, it really wasn't her time to leave us.
OTOH from a physician's point of view it could make very good sense to "look at" or biopsy something found once a patient is "opened up" so to speak. The alternative would be to leave things as they were, allow the patient to come out of the procedure *then* explain "something" was found and schedule another procedure to go back in again. Considering how concerned Ms. Rivers was about the changes in her voice along with her age and other factors it may have been seen as the lesser of two evils to simply get a bit of what was found so it could be determined what was going on while she was already "on the table".
No way. Not unless she had consented prior to the procedure to having additional procedures done if deemed necessary. The consent form she signed would outline what she agreed to have done. If Melissa had been there and the doctor talked to her mid-procedure and got consent to perform a biopsy (assuming Joan had made Melissa her power of attorney, which it looks like she had), then they could have done it. But they couldn't just decide after starting the procedure to do a biopsy without informed consent.
No way. Not unless she had consented prior to the procedure to having additional procedures done if deemed necessary. The consent form she signed would outline what she agreed to have done. If Melissa had been there and the doctor talked to her mid-procedure and got consent to perform a biopsy (assuming Joan had made Melissa her power of attorney, which it looks like she had), then they could have done it. But they couldn't just decide after starting the procedure to do a biopsy without informed consent.
True, but then again find it hard to credit that a physician of the caliber that was Mrs. Rivers ENT guy would go out on such a limb without having something or one at his back so to speak. For that matter that the Yorkville practice would simply step aside and let the doctor "dig in" again without something to cover their behinds as well.
As any nursing or medical student learns early in their education the first rule is to CYA for your license, fiscal health not to mention reputation and quite honestly liberty depend upon it.
True, but then again find it hard to credit that a physician of the caliber that was Mrs. Rivers ENT guy would go out on such a limb without having something or one at his back so to speak. For that matter that the Yorkville practice would simply step aside and let the doctor "dig in" again without something to cover their behinds as well.
As any nursing or medical student learns early in their education the first rule is to CYA for your license, fiscal health not to mention reputation and quite honestly liberty depend upon it.
We don't know if that actually happened. The clinic is saying no biopsy was done. We don't know what's true and what is just rumor. I doubt her ENT doctor would have privileges at the GI clinic anyway, so I would say it probably didn't happen and that it's just rumor and speculation. Doctors can't just go wherever they like and start practicing medicine. They have to be on staff at the facility.
I don't know if anything shady was going on in this case. Maybe, but maybe not. If this was a highly respected facility, and I think it was, I would think everything would be above board.
Working in healthcare, most of the healthcare workers I have known, including doctors, are very conscientious. Maybe I've just been involved with quality facilities, but I think for the most part healthcare personnel are doing their best for the patient. The #1 priority is the patient. I hope that was also the case in this situation and that something just happened that was beyond their control.
I'm hesitant to believe the stories in the press about an ENT doctor performing a biopsy, though. First, he wouldn't have privileges there. Second, Yorkville says that didn't happen (and why would they lie - it is going to come out if that did happen, so why would they make a statement saying it didn't happen if it did?). Third, I doubt the ENT doctor or the GI facility would put their reputations on the line.
Working in healthcare, most of the healthcare workers I have known, including doctors, are very conscientious. Maybe I've just been involved with quality facilities, but I think for the most part healthcare personnel are doing their best for the patient. The #1 priority is the patient. I hope that was also the case in this situation and that something just happened that was beyond their control.
Please don't say you have not seen mistakes, BIG mistakes happen. They happen every day, even in good clinics and hospitals.
The patient isn't always #1 in the USA, sorry, don't think so, not to everyone at least. You'd hope it different for a big star like Joan but for the little people?
Also for a biopsy wouldn't you need more than light sedation esp somewhere like vocal cords?? Been wondering bout that
The clinic is saying no biopsy was done. We don't know what's true and what is just rumor.
That statement may be true - as far as it goes. It's possible no biopsy was actually done, but the biopsy may have been attempted, at which point the laryngospasm occurred. And no one there - i.e., no qualified, experienced anesthesiologist was present - had enough experience to bring her out of it before the lack of oxygen caused the heart failure and/or heart attack and resulting brain death.
I think there's some truth to the story that the ENT guy asked to participate - he just may not have been able to complete the procedure. Guys at that level are very arrogant. Wouldn't surprise me at all that the good ole boys club just thought it was OK - without considering the consequences.
That statement may be true - as far as it goes. It's possible no biopsy was actually done, but the biopsy may have been attempted, at which point the laryngospasm occurred. And no one there - i.e., no qualified, experienced anesthesiologist was present - had enough experience to bring her out of it before the lack of oxygen caused the heart failure and/or heart attack and resulting brain death.
I think there's some truth to the story that the ENT guy asked to participate - he just may not have been able to complete the procedure. Guys at that level are very arrogant. Wouldn't surprise me at all that the good ole boys club just thought it was OK - without considering the consequences.
I want to know why Joan's ENT doctor accompanied her. Odd. This may have been one time when star power was very detrimental. If Joan wanted her ENT there and she trusted his judgement then she may very well have given the go ahead nod to him to step in and we now know what resulted
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