What really happened to Joan Rivers? 7 things to know

Outpatient surgery has weathered a barrage of questions surrounding the safety of outpatient surgery since the death of comedienne Joan Rivers after a routine endoscopic procedure. Rumors have swirled around the incident, around which new information is leaked nearly every day. However, even after a spate of reports from multiple sources on the circumstances under which Ms. Rivers experienced complications, much is still unclear. Here are seven things to know about the incident, covering the latest updates :

1. Ms. Rivers stopped breathing during an endoscopic procedure at New York City-based Yorkville Endoscopy, after which she was immediately transferred to Mount Sinai Hospital in New York City. There, she was in critical condition and was placed on life support. After her daughter, Melissa Rivers, requested she be taken off life support, Joan Rivers died Sept. 4 at the age of 81.

2. Lawrence Cohen, MD, co-owner and former medical director of Yorkville Endoscopy, performed Ms. Rivers' scheduled procedure. Dr. Cohen also has admitting privileges at The Mount Sinai Hospital. Dr. Cohen has since been placed on administrative leave from the surgery center. He was subsequently released from the center, according to a report from TMZ.

3. During the procedure, Dr. Cohen allowed the ear, nose and throat physician Ms. Rivers brought along with her — now identified as Gwen Korovin, MD, according to a scoop from TMZ — to enter the procedure room in which Ms. Rivers was undergoing care. This was the offense for which Dr. Cohen was fired by the Yorkville Endoscopy board, according to the report. Dr. Korovin is a well-known, Manhattan-based ENT with several celebrity patients. She does not have privileges to practice at Yorkville Endoscopy.

4. What happened in the procedure room is a matter of speculation, with multiple unnamed sources providing conflicting reports. Allegedly, according to anonymous staff sources at Yorkville Endoscopy, Dr. Korovin performed an unauthorized biopsy on Ms. Rivers' vocal cords after Dr. Cohen completed his authorized procedure. The source told CNN that state investigators suspected the biopsy caused Ms. Rivers' vocal cords to swell, depriving her of oxygen and ultimately causing cardiac arrest. Yorkville Endoscopy denies any biopsy occurred. An unidentified source close to Dr. Korovin told CNN that the physician denies "performing an unauthorized procedure" before Ms. Rivers' cardiac arrest. Neither physician has been accused of any wrongdoing by state investigators.

5. An anonymous staff member at the clinic also told CNN Dr. Korovin took a selfie with Ms. Rivers while she was anesthetized. According to CNN, the source close to Dr. Korovin denied the physician snapped the selfie with Ms. Rivers shortly after the allegation surfaced.

6. The American Association for Accreditation of Ambulatory Surgery Facilities, the accrediting body for Yorkville Endoscopy, sent representatives for an unscheduled visit to the center shortly after the incident, according to AAAASF materials obtained by CNN. The AAAASF representatives declared the clinic in immediate jeopardy for two deficiencies and placed it on emergency suspension, requesting the clinic suspend patient care until any accreditation issues were solved. State investigators also found deficiencies in Ms. Rivers' treatment, according to a source quoted in CNN.

7. Nearly two weeks after the AAAASF alerted Yorkville Endoscopy to its findings, the clinic continues to operate without interruption. In response to a CNN query about the AAAASF's emergency suspension letter, the clinic sent a statement to the news network: "Yorkville Endoscopy continues to maintain its federal, state and Quad A (AAAASF) authorization to be operational and provide patient care. Yorkville Endoscopy is committed to adhering to the standards established by Quad A (AAAASF)."

More articles on Joan Rivers:
Outpatient surgery undergoes intense scrutiny following Joan Rivers' death
How will Joan Rivers' death impact public view of outpatient anesthesia, surgery?
Joan Rivers' situation could happen at your surgery center — How to make sure it doesn't happen

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