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Re: Dr. Who Performed Joan's Throat Surgery is Out

To me, this all seems so simple. Joan likely died from a pulmonary embolism that chose to appear at a very bad time. The clot was likely formed during one of her many flights back and forth across the country. As far as firing doctors (or doctors stepping down) at the clinic she was in, this is easy to understand as well. People naturally want to blame someone or something when the death of a loved one occurs (and to Joan's fans, she was very beloved, regardless of true family ties). The clinic has to minimize their risk of a lawsuit and the damage to the clinic reputation from all the negatively trending media attention. In organizations of any kind, someone is always going to be made the scapegoat when the S hits the fan. Sometimes several someones. It is just human nature, unfortunately. This clinic probably did nothing wrong, biopsy or no biopsy, too much plastic surgery or not, whichever doctor touched her. Joan was elderly, and she flew a LOT. To have even minor surgery without waiting several weeks since the last plane flight, especially with her age in play, was just not a good idea. I hope that if an autopsy was performed, that the medical examiner was smart enough to look for a PE and/or signs of deep vein thrombosis. If the ME was not clever, they would not think to look for that specifically. Melissa deserves to understand why her mom is gone so suddenly. As a disclaimer, this is, just as everyone else's comments are, all speculation on my part. I have no inside knowledge of the situation at all. I do, however, find it odd that absolutely no mention has been made by the media of what is a glaringly obvious possible cause of Joan's sudden demise.
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Re: Dr. Who Performed Joan's Throat Surgery is Out

On 9/12/2014 ThinkOutsideTheBox said: To me, this all seems so simple. Joan likely died from a pulmonary embolism that chose to appear at a very bad time. The clot was likely formed during one of her many flights back and forth across the country. This clinic probably did nothing wrong, biopsy or no biopsy, too much plastic surgery or not, whichever doctor touched her. I hope that if an autopsy was performed, that the medical examiner was smart enough to look for a PE and/or signs of deep vein thrombosis. As a disclaimer, I have no inside knowledge of the situation at all. I do, however, find it odd that absolutely no mention has been made by the media of what is a glaringly obvious possible cause of Joan's sudden demise.

Kidding, right? The reason there was no mention of an embolism is because THERE WASN'T ANY. There WAS an autopsy. No competent Medical Examiner does NOT look for pulmonary embolism. Pulmonary embolism killed my father-in-law. He just keeled over while walking one day at work. Our ME didn't have any trouble finding cause of death. PE.

Joan's heart and lungs were examined. If there were an embolism, it would have been found.

Second, clearly you've read nothing posted on this thread and others.

Joan experienced laryngospasm, among other things. Probably occurred when the scope went down her throat a third time. Her airway then became blocked, then heart stopped due to lack of air - and the rest is history.

There are comments from anesthesiologists on this board and on various professional boards - all saying the same thing. Joan's issue is clearly one of being in the wrong place at the wrong time for a woman of her age and even minor/common heart issues. She should have been in hospital.

Most anesthesiologists I've read ALL say they KNOW when a laryngospasm will occur shortly BEFORE it happens. My belief is there was no competent anesthesiologist present at this procedure. Dr. Cohen actually wrote a paper stating he didn't believe they were necessary in GI procedures. His is a GI clinic.

In short, given her age and heart issues - however minor - Joan should have been in hospital. Better monitoring - and staff REALLY experienced in dealing with CRISIS situations on a daily basis might have saved. Actually, would have saved her seems to be the medical consensus from the what I've read.

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Re: Dr. Who Performed Joan's Throat Surgery is Out

On 9/12/2014 champagnepoodle said:
On 9/12/2014 Arley said:

I first want to say I liked Joan Rivers but as someone who has had many endoscopies (due to a transplant) you have to SIGN many release forms before they touch you. If Joan were uncomfortable with the clinic she had the money to have it performed at a hospital. I had no choice due to my insurance. The reason the healthcare costs what it does is because right away people want to sue. She lived 81 wonderful years. 78 is the average life span. Who knows if she was walking on the street she could have had a heart attack. I am not cold its reality. Look at the obituaries at how many people drop dead. An 18 year old kid here in NJ was playing football and dropped. that is sad!!! Fact -- she signed the papers. NO doctor will do the procedure without a signature!!!

Arley

True! You said it better than I ever could have, Arley

I'd sure like to know what you have against this lady to wish her line gone and seemingly have no problem wither her being gone as well. Ever hear of respect for the dead? May you know the same "kindness and consideration" you show here at a time in your life when you really need it. If you can't say anything comforting due to your dislike of her and her line then why open your mouth to comment?

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Re: Dr. Who Performed Joan's Throat Surgery is Out

On 9/12/2014 blossompie said:
On 9/12/2014 ical said:

This is my take on it, and I am basing this on what I read in various reports, but I like to use my words because you cannot take large excerpts from publications due to copyright laws which I follow.

It appears that Dr. Cohen (let's call him the "stomach" doctor) is no longer at Mt. Sinai, is no longer at either of the two clinics he runs for "stomach" related issues. Calls were made to all, no longer there.

There was another doctor who looked at Joan's voice box BEFORE Cohen (stomach guy) took the endoscope and looked for acid reflux issues due to digestion (stomach guy does this). BEFORE he did it, he allowed another doctor (female it appears) to look at her voice box and then AFTER he also allowed her to look.

If you want links, search for them, but it appears Cohen has had problems before (in other posts I gave links).

Cohen rattled the medical community in 2012 (I'm going by memory, but search for exact year, I think it was 2012). Why did he rattle them? Because he proposed that NO ANESTHESIOLOGIST should be required for endoscopic procedures.

Also, Joan was only 81, just turned 81--vibrant, jump in her step, full of life. Menopause does cause thumping strange feeling in hearts of women (well of course), due to hormonal changes. Joan called her heart thumping lady related problems--and she did so at a time of those presumed changes (hormonal). So her thumping heart should not be something to just assume, "well, she had a "bad heart" and she was due to die" (as I have read).

Being 81 means if she had lived to 93, she'd have 12 years!

Why 93? Well a doctor who was having problems went to see the stomach guy (allegedly this is a lawsuit which was filed so I have to say allegedly)--anyway, this 93 year old man had stomach issues, saw the stomach guy and guess what? When he woke up a procedure was done to the 93-year-old guy without (without!) consent.

Nobody knows how long Joan would have lived she could have lived to 115 or she could have died at 82 but what we do know is she was healthy when she arrived at the clinic and left out of there on life support. Nobody has a right to perform nothing on nobody unless they have consent. Doctors tend to think they are God and they aren't.

The reason I gave the year 93 vs 81 was to show a living example of a lawsuit that exists for not only the same doctor, but to also give a "living example" to those who say, "well, 81 was a long enough life"--a true situation that, even at 93, one can pursue legal action for a procedure done for which there was no consent (by patient).

In other words, if something wrong was done in Joan's situation, if they (Joan's representative(s)), (or some medical regulatory board), or both, choose legal action, they should.

They should because what happened to Joan may not have been known, perhaps, IF she did not have the fame (which gives voice) to the problem. Would an average Jane or Joe have noticed or known or had the "team" to check out why? Has this happened to Jane or Joe and this is just the way it has been? No one, truly, no one can say with 100% certainty that what happened to Joan may not have happened to someone else and it was swept under as "natural causes" or "problem with age" or "anesthesia reaction" or "it was their time" (whatever that means!).

Joan had the reputation for saying it, saying it loudly, saying it to be heard.

Joan, if she had lived, what would she have said about what happened?

A public, tear it apart, out-in-the-open lawsuit will pull the covers off those in the medical community who think they are the owners of the bodies for whom they "care".

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Re: Dr. Who Performed Joan's Throat Surgery is Out

Thanks for that info, ical. It's unbelievable that a doctor would do something without consent, but you do cite a lawsuit. When something unexpected comes up during an operation, they can call next of kin to discuss additional necessary procedures and get consent. I had a routine screening procedure with only a nurse anesthetist present. The conscious sedation did not prevent me from being awake during part of the procedure and feeling pain. After this, I don't know what to think of that.

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Re: Dr. Who Performed Joan's Throat Surgery is Out

On 9/13/2014 ical said:
On 9/12/2014 blossompie said:
On 9/12/2014 ical said:

This is my take on it, and I am basing this on what I read in various reports, but I like to use my words because you cannot take large excerpts from publications due to copyright laws which I follow.

It appears that Dr. Cohen (let's call him the "stomach" doctor) is no longer at Mt. Sinai, is no longer at either of the two clinics he runs for "stomach" related issues. Calls were made to all, no longer there.

There was another doctor who looked at Joan's voice box BEFORE Cohen (stomach guy) took the endoscope and looked for acid reflux issues due to digestion (stomach guy does this). BEFORE he did it, he allowed another doctor (female it appears) to look at her voice box and then AFTER he also allowed her to look.

If you want links, search for them, but it appears Cohen has had problems before (in other posts I gave links).

Cohen rattled the medical community in 2012 (I'm going by memory, but search for exact year, I think it was 2012). Why did he rattle them? Because he proposed that NO ANESTHESIOLOGIST should be required for endoscopic procedures.

Also, Joan was only 81, just turned 81--vibrant, jump in her step, full of life. Menopause does cause thumping strange feeling in hearts of women (well of course), due to hormonal changes. Joan called her heart thumping lady related problems--and she did so at a time of those presumed changes (hormonal). So her thumping heart should not be something to just assume, "well, she had a "bad heart" and she was due to die" (as I have read).

Being 81 means if she had lived to 93, she'd have 12 years!

Why 93? Well a doctor who was having problems went to see the stomach guy (allegedly this is a lawsuit which was filed so I have to say allegedly)--anyway, this 93 year old man had stomach issues, saw the stomach guy and guess what? When he woke up a procedure was done to the 93-year-old guy without (without!) consent.

Nobody knows how long Joan would have lived she could have lived to 115 or she could have died at 82 but what we do know is she was healthy when she arrived at the clinic and left out of there on life support. Nobody has a right to perform nothing on nobody unless they have consent. Doctors tend to think they are God and they aren't.

The reason I gave the year 93 vs 81 was to show a living example of a lawsuit that exists for not only the same doctor, but to also give a "living example" to those who say, "well, 81 was a long enough life"--a true situation that, even at 93, one can pursue legal action for a procedure done for which there was no consent (by patient).

In other words, if something wrong was done in Joan's situation, if they (Joan's representative(s)), (or some medical regulatory board), or both, choose legal action, they should.

They should because what happened to Joan may not have been known, perhaps, IF she did not have the fame (which gives voice) to the problem. Would an average Jane or Joe have noticed or known or had the "team" to check out why? Has this happened to Jane or Joe and this is just the way it has been? No one, truly, no one can say with 100% certainty that what happened to Joan may not have happened to someone else and it was swept under as "natural causes" or "problem with age" or "anesthesia reaction" or "it was their time" (whatever that means!).

Joan had the reputation for saying it, saying it loudly, saying it to be heard.

Joan, if she had lived, what would she have said about what happened?

A public, tear it apart, out-in-the-open lawsuit will pull the covers off those in the medical community who think they are the owners of the bodies for whom they "care".

I agree with what you said. I just find this tragic on so many levels and I listened to Howard yesterday and I also believe it wasn't Joan's time
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Re: Dr. Who Performed Joan's Throat Surgery is Out

On 9/12/2014 Isabella4ever said:

Kidding, right? The reason there was no mention of an embolism is because THERE WASN'T ANY. There WAS an autopsy. No competent Medical Examiner does NOT look for pulmonary embolism. Pulmonary embolism killed my father-in-law. He just keeled over while walking one day at work. Our ME didn't have any trouble finding cause of death. PE.

Joan's heart and lungs were examined. If there were an embolism, it would have been found.

Second, clearly you've read nothing posted on this thread and others.

Joan experienced laryngospasm, among other things. Probably occurred when the scope went down her throat a third time. Her airway then became blocked, then heart stopped due to lack of air - and the rest is history.

There are comments from anesthesiologists on this board and on various professional boards - all saying the same thing. Joan's issue is clearly one of being in the wrong place at the wrong time for a woman of her age and even minor/common heart issues. She should have been in hospital.

Most anesthesiologists I've read ALL say they KNOW when a laryngospasm will occur shortly BEFORE it happens. My belief is there was no competent anesthesiologist present at this procedure. Dr. Cohen actually wrote a paper stating he didn't believe they were necessary in GI procedures. His is a GI clinic.

In short, given her age and heart issues - however minor - Joan should have been in hospital. Better monitoring - and staff REALLY experienced in dealing with CRISIS situations on a daily basis might have saved. Actually, would have saved her seems to be the medical consensus from the what I've read.

Sticking to the facts here, no one knows if Joan experienced a laryngospasm or not. That information has not been released one way or another. It is something that those in the medical field are considering since it might offer a plausible explanation based on the loose facts of what is known about Joan. And it is one of several other plausible explanations of what might have happened.

Fact is there are no anesthesiologists on this (OVC discussion board) that has stated anything along the lines of taking a stand about what happened to Joan. The only thing that has been discussed here are technical questions with experienced health care individuals about laryngospasm in general. No one here knows what happened to Joan.

You characterize Dr. Cohen as being some type of physician that went out on a limb that "wrote a paper stating he didn't believe they were necessary in GI procedures". When in fact, Dr. Cohen and a group of other colleagues actually conducted a study looking at trends of anesthesiology and GI endoscopic procedures across the United States. It is the results of that study that he published the paper along with other colleagues. Please note that to conduct a study like this one means there are many other gastroenterologists out there not using anesthesiologists routinely for the use of propofol in use for various GI endoscopic procedures. Otherwise they would not be able to conduct a retrospective study that compared the 2 groups of procedures using anesthesiologists and procedures not using anesthesiologists.

In fact, requiring the use of anesthesiologists while using propofol has been a focus of study in this country. There are multiple studies in the area that have nothing to do with Dr. Cohen.

Here is just one study conducted by others investigating the administration of propofol by non-anesthesiologists:

Pambianco DJ, Whitten CJ, Moerman A, Struys MM, Martin JF. (2011). Computer assisted personalized sedation for upper endoscopy and colonoscopy: A comparative, multicenter randomized study. Gastrointestinal Endoscopy, 73(4), 765-772.

This study involved a computerized method of delivering propofol monitored by registered nurses.

A search of the medical literature will reveal many articles and studies being conducted in this area. To date, there is no specific consensus among physicians which is one reason as to why there is research being conducted in this area.

I don't have a stance on the issue, but to somewhat portray Dr. Cohen as some lone cowboy out there that is negligent due to views on this subject would just not be accurate. He is one of many that has researched the topic.

But above all, we don't know exactly what type of sedation Joan did receive or that she had a laryngospasm. It might or might not turn out that way, but we won't know until the official report is released.


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Re: Dr. Who Performed Joan's Throat Surgery is Out

Not sure if Larry Cohen was actually the MD who did the endoscopy for Joan. He was the Medical Director and it is reported he stepped down. I got the impression that it was her personal MD who actually did the biopsy which caused the throat swelling that lead to the respiratory distress. Dr. Cohen was my doctor many years ago and he was excellent.

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Re: Dr. Who Performed Joan's Throat Surgery is Out

On 9/13/2014 ical said:
On 9/12/2014 blossompie said:Nobody knows how long Joan would have lived she could have lived to 115 or she could have died at 82 but what we do know is she was healthy when she arrived at the clinic and left out of there on life support. Nobody has a right to perform nothing on nobody unless they have consent. Doctors tend to think they are God and they aren't.

The reason I gave the year 93 vs 81 was to show a living example of a lawsuit that exists for not only the same doctor, but to also give a "living example" to those who say, "well, 81 was a long enough life"--a true situation that, even at 93, one can pursue legal action for a procedure done for which there was no consent (by patient).

In other words, if something wrong was done in Joan's situation, if they (Joan's representative(s)), (or some medical regulatory board), or both, choose legal action, they should.

They should because what happened to Joan may not have been known, perhaps, IF she did not have the fame (which gives voice) to the problem. Would an average Jane or Joe have noticed or known or had the "team" to check out why? Has this happened to Jane or Joe and this is just the way it has been? No one, truly, no one can say with 100% certainty that what happened to Joan may not have happened to someone else and it was swept under as "natural causes" or "problem with age" or "anesthesia reaction" or "it was their time" (whatever that means!).

Joan had the reputation for saying it, saying it loudly, saying it to be heard.

Joan, if she had lived, what would she have said about what happened?

A public, tear it apart, out-in-the-open lawsuit will pull the covers off those in the medical community who think they are the owners of the bodies for whom they "care".

One important detail about that lawsuit involving Dr. Cohen is that the jury ruled in Dr. Cohen's favor and against the plaintiff.

And the that case along with Joan's case really can't be compared.


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Re: Dr. Who Performed Joan's Throat Surgery is Out

On 9/13/2014 pitdakota said:
On 9/13/2014 ical said:
On 9/12/2014 blossompie said:Nobody knows how long Joan would have lived she could have lived to 115 or she could have died at 82 but what we do know is she was healthy when she arrived at the clinic and left out of there on life support. Nobody has a right to perform nothing on nobody unless they have consent. Doctors tend to think they are God and they aren't.

The reason I gave the year 93 vs 81 was to show a living example of a lawsuit that exists for not only the same doctor, but to also give a "living example" to those who say, "well, 81 was a long enough life"--a true situation that, even at 93, one can pursue legal action for a procedure done for which there was no consent (by patient).

In other words, if something wrong was done in Joan's situation, if they (Joan's representative(s)), (or some medical regulatory board), or both, choose legal action, they should.

They should because what happened to Joan may not have been known, perhaps, IF she did not have the fame (which gives voice) to the problem. Would an average Jane or Joe have noticed or known or had the "team" to check out why? Has this happened to Jane or Joe and this is just the way it has been? No one, truly, no one can say with 100% certainty that what happened to Joan may not have happened to someone else and it was swept under as "natural causes" or "problem with age" or "anesthesia reaction" or "it was their time" (whatever that means!).

Joan had the reputation for saying it, saying it loudly, saying it to be heard.

Joan, if she had lived, what would she have said about what happened?

A public, tear it apart, out-in-the-open lawsuit will pull the covers off those in the medical community who think they are the owners of the bodies for whom they "care".

One important detail about that lawsuit involving Dr. Cohen is that the jury ruled in Dr. Cohen's favor and against the plaintiff.

And the that case along with Joan's case really can't be compared.

Then you understand that a lawsuit cannot even get to a trial with jury if it is found to be "frivolous".

A 93-year-old guy vs a powerful stomach doctor...

Edited to add:

I forgot to mention, the 93-year-old who sued due to having a procedure done without his consent, was, himself, a doctor. He never lost his job, but was concerned the unapproved procedure could have jeopardized his life (allegedly).