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The recent settlement of a medical malpractice lawsuit concerning the wrongful death of Joan Rivers raises questions about the safety of ambulatory surgery centers. Unlike hospitals, most outpatient surgery centers are owned by doctors. That gives them an incentive to recommend that their patients have surgery in the center they own rather than the safer environment of a hospital.

Joan Rivers’ Wrongful Death

The malpractice committed during Joan Rivers’ treatment at Yorkville Endoscopy was undoubtedly compounded by her celebrity status. Melissa Rivers contended that doctors made the decision to perform surgery on her mother at the outpatient center rather than a hospital because they wanted the prestige of operating on a celebrity in their own facility. That theory is supported by the fact that one doctor took a selfie next to Ms. Rivers while she was under anesthesia.

Whatever their motivation may have been, the doctors chose not to contest that they made serious errors. Ms. Rivers entered the facility with complaints of a sore throat and hoarse voice. She consented to an endoscopy, a procedure that allows a doctor to examine the patient’s digestive tract using a flexible tube that has a light and a camera. Both before and after that procedure, however, another physician performed a laryngoscopy. A doctor performing that procedure uses an instrument to examine the vocal cords and voice box.

An investigation by the Department of Health and Human Services (DHHS) found no evidence that Ms. Rivers consented to the laryngoscopy. According to the DHHS report, the laryngoscopy was performed by an ear, nose and throat surgeon who had not been granted the privilege to practice medicine at the surgical center.

An anesthesiologist questioned the wisdom of performing the laryngoscopy, noting that Ms. Rivers’ vocal cords were “dangerously swollen.” The gastroenterologist who performed the endoscopy (and who also served as the facility’s medical director) told the anesthesiologist that she was being paranoid.

The laryngoscopy irritated Mr. Rivers’ vocal cords, causing further swelling. That cut off Ms. Rivers’ ability to breathe. According to the DHHS report, the doctors failed to monitor Ms. Rivers’ condition and did not immediately notice that she was in distress. When they realized there was a problem, they called 911.

Hospital “crash carts” are routinely equipped with a drug that relaxes throat muscles to permit the insertion of a breathing tube. The surgical center did not have that drug. None of the doctors who remained in the center were trained to perform a procedure that could have saved Ms. Rivers’ life by opening a hole in her throat. The gastroenterologist had that training but he left the center immediately after the procedure was completed.

By the time paramedics arrived in response to the 911 call, Ms. Rivers had gone into cardiac arrest. Seven days later, she was removed from life support. An autopsy determined that she died from oxygen deprivation to her brain.

Risks of Outpatient Surgery

Outpatient surgery centers are usually licensed to perform minor procedures. For that reason, they tend to be less carefully regulated than hospitals. Surgical malpractice occurs in hospitals as well as outpatient centers, but hospitals are equipped to handle emergencies caused by a surgeon’s mistake. That may not be true when the surgery is performed in an ambulatory surgery center.

The risks of having outpatient surgery are higher for elderly patients. Older patients are more likely to experience complications during surgery, even when the procedures are minor. Yet half of the patients who are treated at ambulatory surgery centers are at least 60 years old. The premature death of Joan Rivers highlights the risks that seniors may be taking by having surgical procedures performed outside of a hospital setting.

Outpatient surgery centers may offer patients the benefit of convenience, lower costs, and less likelihood of developing a hospital-acquired infection than surgery performed in hospitals. At the same time, medical experts are cautioning patients to be wary of ambulatory surgery centers that do not have readily available safety equipment (including a fully equipped crash cart) that is standard in hospitals. Some experts also suggest that older patients should always opt to have surgery in a hospital.

A patient of any age who is the victim of medical malpractice in an ambulatory surgery center has the right to receive compensation. Victims (or surviving family members) should contact a medical malpractice attorney immediately if they suspect that a health complication, disability, or death was caused by negligent treatment in an outpatient surgery center.