Among the major errors CMS found the clinic committed are:
-- Failing to identify deteriorating vital signs and provide timely intervention;could this be said of every single person that passed away in a hospital?
-- Failing to record Rivers' weight, prior to the administration of medication for sedation;So they may have weighed her but just failed to write it down somewhere?
-- Failing to consistently document the dose of Propofol, a sedative, administered;consistently document? this says nothing about whether the dose was appropriate
-- Failing to get Rivers' informed consent for each procedure performed;exactly what procedure did they perform that she didn't ask for? why is the term 'informed consent' and not just 'consent'?
-- Failing to ensure that she was cared for only by physicians granted privilege in accordance with the clinic's bylaws;what does this mean? did an orderly stop in to take out the trash? did a nurse not sign in that morning?
-- And finally, failing to abide by its own cell phone policy (the report found that a photograph was taken of a surgeon and Rivers while she was under sedation).Worth a lawsuit in itself but unrelated to her death I would think

All of the above things are routine paperwork errors and would have little bearing on her treatment. That said, the items missing (i.e. signed consent, dose administered) paint a very sloppy picture of the clinic. Situations like this are the exact reason why such a paper trail is created.

So much of the cost of healthcare is not related to health of patient but rather the legal aspect of treatment. The man hours needed to comply are staggering.

Things could get pretty slow around here if we did that to everyone ;)

Dead on IMO.

If their real motivation is not a big ole pile O'money I'll be surprised.

I can understand some of the OP's frustration, I think.

Here's an old woman who has had what most would consider waaaaaaaaaay toooooooo many cosmetic surgeries. Hundreds of them.

Some would say (including me) that she simply rolled the dice one too many times, she put herself in danger too many times and it finally caught up to her. It was inevitable.
Lots of us are sick and tired of the law-suit metality of our culture, always trying to put the blame on someone else and always trying to cash in on that often misplaced blame.
It's BS, it's dishonest, it drives health care costs through the roof, just so some sleazebag parasite can win the lawsuit lottery.

I hope that is not the case this time.

Of course people die in hospitals everyday. Sometimes a mistake leads to a death. Sometimes people just die...as people do outside of the hospital every day. No mistakes, they simply experienced an event that killed them.

As for the weight, if it wasn't documented, it will be presumed to have not been obtained.

Medication documentation receives similar considerations by people reviewing records.

The difference between consent (you're going to have this procedure performed) and informed consent is the later includes an explanation of the plan, risks, reasonable expectations. Signing an informed consent document acknowledges that the communication occurred and the patient understands and is in agreement with those items.

Lastly, documentation in a crisis can fall way down on the priority list. Too many organizations including hospitals routinely operate in crisis mode. That problem can start quietly and is frequently unrecognized by most. The few that do recognize the issue fail in calling it out for lots of reasons but the failure can usually be traced to pride or greed. Occasionally it is something else but usually it is some basic ugliness at the root.

disclaimer: I'm not a lawyer.

Ironically enough, I don't think she was in for plastic surgery. I thought I remember reading it was an endoscopy clinic and she was having her throat looked at.

That is correct. Not cosmetic surgery.

I guess you can say that it's all just "paper work", but these are professionals and this is the nature of their job. There's a reason all of this minutia is documented, and "CYA" is part of it. When I board an aircraft, I assume that those professionals behind the locked door have run through all of their pre-flight checks and protocols and that I'm in safe hands. Why expect any less from someone doing the cutting?

^^^ This.

But some of the OR staff had the time to take selfies with Ms. Rivers while she was dying from a double dose of sedative. So yeah, I might be a bit pissed if I were family.

California and a few other states have a cap on non-economic damages ("Pain and suffering") only which, in California, is limited to $250K. In Ca., there is no limit on economic losses nor punitive damages (penalties assessed for negligence, fraud, reckless behavior.

BTW, that $250K was established in 1975 and is not adjusted for inflation. Prop. 46 in the recent election was designed to raise that limit and add an inflationary adjustment component. Prop. 46 failed to pass.

Rivers died in New York, so the caps do not apply.

Tough crowd here. She was 81, I have active parent, uncles/aunts, and father in law older than that.

Despite the poor paperwork, they were taking selfies, and gave her more than twice the amount of propofol.

All leads to an unprofessional staff and procedure.

I missed the quote and source for "twice the amount of propofol". Where can we read or hear that?

While there is a conventional weight-based dose that can be used as a starting point for induction of general anesthesia, there are a LOT of factors that need to be considered. Is it fair to presume that someone was dedicated to her anesthetic administration and monitoring? After that, concerns such as age, past medical and medication history, current medications, concurrently administered medications, intention of medications (induction of general anesthesia or deep sedation) ... .

Second guessing a bad outcome is relatively easy and I'd imagine those directly involved with the incident have lost a lot of sleep.

Feds slam clinic where Joan Rivers went into cardiac arrest - NY Daily News
There were also mistakes admitted by the anesthesiologist, who told investigators she gave Rivers 120 milligrams of Propofol, but wrote in records that she administered 300 milligrams.

The above article has a copy of the report.

If I'm not mistaken she was having a procedure to inspect her vocal chords to see if they could make her voice less gravelly and irritating (old).
So not cosmetic bit pretty much the same thing. Surgery to alter the way others percieve her.
Vanity.

And I was correct that she had undergone hundreds of cosmetic procedures but I had no idea it was over seven hundred.


Self-confessed surgery addict Joan Rivers celebrates 80th birthday