Well-known comic Joan Rivers died last week.  Ms. Rivers was reportedly undergoing an endoscopic procedure to repair her vocal cords.  She was having the procedure in an outpatient setting – meaning it occurred outside of a hospital.

Little has been reported on how Rivers was treated or what the problems were.  It is well known that when a patient is under general anesthesia, possible complications can occur. One such complication is aspiration (that’s why patients are instructed to eat and drink nothing after midnight before the day of the procedure); another is a severe laryngospasm (vocal cords suddenly seize up or close when taking in a breath, blocking the flow of air into the lung); or over-sedation from the anesthetic.

It has also been suggested that Rivers may have suffered a heart attack.  The combined impact of general anesthesia and a procedure can cause enough stress on the heart to trigger a heart attack.

In any event, something went terribly wrong requiring the facility to call 911.  In Rivers’s case, the responding New York City Fire Department Emergency Medical Services team reported that upon their arrival, Ms. Rivers was found to be unconscious and had suffered cardiac arrest.  She was transferred by EMS to Mount Sinai Hospital where she later died.

The procedure Ms. Rivers was supposedly undergoing is considered low-risk and the 81-year-old Rivers did not seem frail.  Assessing a surgical candidate’s appropriateness for general anesthesia is part of good medical practice.  Rivers’s autopsy did not determine the cause of her death.  The New York State Health Department is reviewing the case and its investigation could take weeks or even months.

We don’t know if medical negligence or the fact that the procedure was being done in an outpatient setting contributed to Rivers’s death.

But the case puts into stark focus the growing use of outpatient office-based settings for medical procedures previously only done in licensed hospital and ambulatory surgical centers.  It raises questions about the adequacy of the current oversight of office-based surgery by the New York State Department of Health.

Under New York State law, these facilities are required to report “adverse events” – incidents in which a patient is harmed during the course of care.  According to the most recent data released by the Department of Health between 2010 and 2013, of 2,200 adverse events reported by just under 1,000 accredited office-based surgical practices in the state, 257 of those events resulted in death.  In other words, in 12% of the reportable adverse events a patient died.

That information prompted the Cuomo Administration to propose in its budget this past winter new measures (recommended by the state Public Health and Health Planning Council) to strengthen the reporting requirements and oversight of office-based surgical centers.  Specifically, the plan was to boost oversight of the use of anesthesia in office-based surgical centers.  Yet lawmakers rejected that proposal and thus no new protections were put in place.

Whether the Cuomo plan would have had any impact on Rivers’s care is, of course, impossible to know at this time.

But what is clear is that even so-called low-risk procedures performed in outpatient centers, involving more than minimal sedation, can lead to serious problems.  And it is also clear that enhanced oversight is needed.

Not just in office-based settings, but in hospitals as well.  Experts estimated that between 200,000 and 400,000 hospital patients are killed each year due to medical mistakes.  That’s about 32 to 65 New Yorkers each day!

Clearly, American health care needs to be safer.  Let’s hope that the attention being paid to the death of Joan Rivers leads to measures to protect all patients.

That’s all for now.  I’ll be keeping an eye on the Capitol and will talk to you again next week.