The Joan Rivers case and patient safety

I read today a settlement has been reached among the doctors, the medical facility, and the family of Joan Rivers, who died in 2014 during the course of what is usually described as a routine, minor medical procedure. The details of both the settlement and the specific events are confidential, but the Times article does offer some key information we should all think about.

Ms. Rivers had complained of a hoarse voice and a sore throat and was having these symptoms evaluated at an outpatient surgical center in New York City. The procedures she was having — laryngoscopy and endoscopy of the esophagus and stomach — are standard ways of evaluating that problem. Both are generally low risk. But they’re not zero risk — nothing in medicine is.

What apparently happened is Ms. Rivers had her airway close off, laryngospasm, something those of us who sedate and anesthetize people see now and then. There is a standard, step-wise way of dealing with this, and it appears this routine was not followed: appropriate equipment and personnel were not available. So she died from lack of oxygen.

The key point in this tragedy is routines and protocols are key to patient safety, and one always needs to be prepared to deal with the worst case scenario. If you aren’t, statistics will catch up to you eventually and people will be harmed.

From the news story I think in Ms. Rivers’ case there was probably another issue: rich and famous people don’t always get the best care. They can (and do) make special requests to deviate from protocol, and physicians are tempted to allow it. I spent many years working at the Mayo Clinic. Although Mayo cares for many thousands of ordinary folks like you and me, they have a fair number of patients like Ms. Rivers. I’ve had patients in that category. What I saw at Mayo was that everybody, from Saudi royalty to children of billionaires, got treated the same. It’s a patient safety issue we should never forget.


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