What happened to Joan Rivers?



Robert A. Guida, MD; New York City Board Certified Otolaryngologist and Facial Plastic Surgeon
Adam Waldman, MD; New York City Board Certified Anesthesiologist

As more information becomes available, patients and health care professionals are paying close attention to the mysterious death of celebrity icon, Joan Rivers.

Dr. Waldman and I work together in an AAAHC certified office based ambulatory surgery center on Park Avenue, just blocks where Joan Rivers had her surgery. News of the tragic and sad event was disturbing. When operating on patients in an office based setting, patient safety is paramount. We discuss issues all the time when working together – and we have been discussing the Joan Rivers incident quite a bit so as to learn what happened, how to avoid such situations, and to educate our patients. Just yesterday, as I was seeing patients who were preparing for their surgery in our office, several asked, “What happened to Joan Rivers?” This is a legitimate question and concern.

Dr. Waldman and I have important thoughts on this topic and would like to share them with you.

  • Appropriate patient selection is a top priority. Patients with serious medical conditions requiring prolonged monitoring after their procedure should not be done in an office based setting.
  • A certified and credentialed operating room is the law in New York State. Operating rooms or office based ambulatory surgery centers are certified for different levels of anesthesia. Some centers are certified only for IV sedation and others are certified for general anesthesia as well as for sedation.
  • Appropriate drugs and equipment are required if a center is certified for general anesthesia. The equipment and medications are for use on a daily basis, as well as certain medication, which is simply available only in an emergency situation. Being prepared for any event is mandatory.
  • A board Certified anesthesiologist is essential for performing procedure under sedation or general anesthesia in an office based operating room. The anesthesiologist pays 100% attention to the patient’s vital signs and safety so the surgeon can focus 100% on the procedure being performed. Throughout the procedure, there is dialogue and interaction between these doctors, ensuring all is well.
  • A credentialed, board certified physician performing procedures is necessary for any certified ambulatory surgery center. Doctors must be appropriately screened and credentialed before being allowed to operate in any certified facility.
  • Appropriate transfer plan that is rehearsed and discussed is a part of the credentialing process. There must be a written out and well rehearsed plan of action in case of an emergency. This includes everything form functioning fire extinguishers to the ability to transfer a patient to a hospital, if needed.
  • Doctors and staff are required to be certified in ACLS (advanced cardiac life support) and BLS (basic life support. It is a requirement that these certifications are to be renewed on a regular basis.
  • No exceptions – The doctor is not doing the patient a favor by making an exception for them, but actually placing them in a riskier situation, even if they are a famous celebrity.
The point of these comments is to ensure patients that surgery in a properly certified, office based ambulatory surgery facility with appropriately credentialed physicians and staff is extremely safe. Through this horrible tragedy, may we all learn, grow, and become more educated and aware in order to ensure the utmost safety for future patients.

Article by
New York Facial Plastic Surgeon