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Joan Rivers, Melissa Rivers

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Joan Rivers' untimely death has brought Yorkville Endoscopy Center into a harsh spotlight.

The federal Centers for Medicare & Medicaid Services has issued a report detailing multiple failings on the part of the Manhattan clinic where Rivers suffered cardiac arrest while undergoing an endoscopy on Aug. 28. She died at the age of 81 on Sept. 4 after being removed from life support.

Among the findings: Doctors did not record Rivers' body weight as part of the pre-assessment to determine the amount of the sedative Propofol to administer; they "failed to identify deteriorating vital signs and provide timely intervention"; Rivers was found to have no pulse at 9:30 a.m. after resuscitation was initiated at 9:28 a.m. but she was not fully resuscitated until 10 a.m.; and overall there was conflicting information as to when CPR was first administered.

"Our client, Melissa Rivers, is terribly disappointed to learn of the multiple failings on the part of medical personnel and the clinic as evidenced by the CMS report," Melissa's attorneys Jeffrey B. Bloom and Ben Rubinowitz said in a statement released Monday.

"As any of us would be, Ms. Rivers is outraged by the misconduct and mismanagement now shown to have occurred before, during and after the procedure. Moving forward, Ms. Rivers will direct her efforts towards ensuring that what happened to her mother will not occur again with any other patient."

Melissa is said to be planning to file a miltimillion-dollar wrongful death lawsuit against Yorkville Endoscopy and the doctors who treated her mother there.

Rivers' death, in official terms, was caused by anoxic encephalopathy due to hypoxic arrest during laryngoscopy and upper gastrointestinal endoscopy with propofol sedation for evaluation of voice changes and gastroesophageal reflux disease, with the medical examiner finding that there was therapeutic complication.

Joan Rivers, Flowers

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Also according to the CMS report, the ear-nose-and-throat doctor who performed the procedures—Joan's personal physician, Gwen Korovin— was not a member of the Yorkville staff nor had privileges to practice at the facility.

During the laryngoscopy, the second of the two procedures performed, another doctor took a picture of Korovin and Joan with a camera phone, at the ENT's request, the report further states. Moreover, the CMS findings also include that Joan had only consented to the upper endoscopy before being sedated and the ENT continued on with the laryngoscopy after complications had apparently developed.

In a statement responding to the CMS report, Yorkville Endoscopy Center said:

"From the outset of the August 28th incident described in the CMS Report, Yorkville has been fully cooperative and collaborative with all regulatory and accreditation agencies. In response to the statement of deficiencies, Yorkville immediately submitted and implemented a plan of correction that addressed all issues raised. The regulatory agencies are currently reviewing the corrective plan of action and have been in regular contact with Yorkville. In addition, the physicians involved in the direct care and treatment referenced in the report no longer practice or provide services at Yorkville. Yorkville will continue its commitment to complying with all standards and accreditation requirements.

"Yorkville has been and remains open and active and is fully accredited by an independent review organization. The staff and providers are focused on providing the highest quality and most advanced care possible to its patients."

—Reporting by James Chairman and Lindsay Good