Joan Rivers' Malpractice Settlement 8 figures

[BLADEMDA]

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TV is reporting that Joan Rivers' daughter got $10-$15 million from all the parties involved. The lawyers got 1/3 of course but this was a huge settlement.

How did the parties come up with say $10 million? Let's assume all the Physicians involved settled for $1 million each.

1. Anesthesiologist- $1 million
2. ENT- $1 million
3. Gi- $1 million
4. GI center- $5 million?

I can see maybe $8 million here but where does the other $2 million come from?

 

[BLADEMDA]

Settlement Reached in Joan Rivers Malpractice Case

http://www.nytimes.com/2016/05/13/n...hed-in-joan-rivers-malpractice-case.html?_r=0

 

[BLADEMDA]

As for the money, our sources would not be specific, but one source insinuated it is in the 8 figures


JOAN RIVERSMALPRACTICE SUIT SETTLED FOR MILLIONS

 

[BLADEMDA]

by Jeremy Gerard

May 13, 2016 5:11am

• 1
  

Melissa Rivers and other members of comedian Joan Rivers‘ family have settled a malpractice suit against Yorkville Endoscopy and the doctors treating her, following her death in 2014. Lawyers for the family Thursday wouldn’t specify the amount of the settlement, other than to call it “substantial.” They added that the doctors had accepted responsibility for Rivers’ death during a typically routine throat procedure.



Related
Joan Rivers Wins Spoken-Word Grammy Five Months After Death



The doctors agreed not to contest the suit’s findings. “The parties agreed to settle this case to avoid protracted litigation,” a spokesman for Yorkville Endoscopy said. “We remain committed to providing quality, compassionate health care services.”

Rivers’ daughter, Melissa, filed the lawsuit in NY State Supreme Court in Manhattan against the clinic, a for-profit outpatient surgery center where her mother, who was 81 at the time, was being treated. The suit also named Dr. Gwen Korovin, an ear, nose and throat specialist; Dr. Renuka Bankulla, the main anesthesiologist, and two other anesthesiologists; and Dr. Lawrence Cohen, who subsequently stepped down as the clinic’s medical director.

 

[BLADEMDA]

TV is reporting that Joan Rivers' daughter got $10-$15 million from all the parties involved. The lawyers got 1/3 of course but this was a huge settlement.

How did the parties come up with say $12 million? Let's assume all the Physicians involved settled for $1 million each.

1. Anesthesiologist- $1 million
2. ENT- $1 million
3. Gi- $1 million
4. GI center- $5 million?

I can see maybe $8 million here but where does the other $4 million come from?

Okay, It seems they sued TWO OTHER ANESTHESIOLOGISTS as well for this case. So, I see how they reached $10 million. Imagine you are helping a colleague out and being forced to settle a case for $1 million in damages due to his/her error.

1. Anesthesioologist number 1 $1 million
2. Anesthesiologist number 2 $1 million
3. Anesthesiologist number 3 $1 million
4. ENT doc- $1 million
5. GI doc- $1 million
6. Gi center- $5 million

$10 million. Maybe the same insurance company covered all three anesthesiologists so only the main person (Dr. Renuka Bankulla) actually got stuck with the $3 million settlement.

The settlement came very quickly by legal standards ... it never even reached the deposition stage.

 

[BLADEMDA]

As for the money, our sources would not be specific, but one source insinuated it is in the 8 figures


JOAN RIVERSMALPRACTICE SUIT SETTLED FOR MILLIONS

The amount of the settlement is confidential, although details from the federal Centers for Medicare and Medicaid Services’ investigation are available as to the clinic’s many errors: the clinic did not have properly recorded medication records, the doctors did take selfies, Yorkville hadn’t received informed consent for each procedure doctors performed on Rivers, and the staff hadn’t recorded the comedian’s weight before sedating her.

Both parties agreed to settle in order to avoid a drawn-out litigation.

 

[BLADEMDA]

Guess how much money Melissa Rivers would have gotten if the same thing happened in Florida: $0.00 Florida has strict laws on the books regarding malpractice lawsuits if an elderly person dies in a hospital, ASC or GI center. Melissa Rivers would not likely have any grounds to initiate the lawsuit. Typically, only young adults or the affected spouse of the supposed "wrongful death" has any legal standing to initiate a lawsuit in my State.

 

[BLADEMDA]

Melissa Rivers 'inherits $75m in cash and $35m New York co-op' from late mother Joan

http://www.dailymail.co.uk/tvshowbi...cash-35m-New-York-condo-late-mother-Joan.html

Now, you can add in $7 million in cash from a settlement due to a wrongful death claim against Yorkville endocopy center and the doctors there.

 

[IlDestriero]

It's nice that she sued 2 other anesthesiologists as well. Probably 2 that came to try to aid the primary one when the **** hit the fan. Nothing says thanks like suing the code team.
Maybe she should donate $3000 back for some of the new dantroline so they can stock succs and not kill the next one. I'm sure none of the folks there intubated anyone in a decade.
That dantroline looks cheap as chips now I bet.


--
Il Destriero

 

[Chloroform4Life]

"The main anesthesiologist, Dr. Bankulla, concerned that she would be blamed in the death, wrote out five pages of notes on the day of the procedure detailing what she saw and heard. Lawyers for the Rivers family said they were greatly aided in their case by Dr. Bankulla’s notes"

Do you guys try document details of what happen after an adverse event? Seems like it may have backfired.

 

[IlDestriero]

If something "unexpected" happens, I write a detailed note. I don't want to leave that to some attorney to spin years later.
This situation was very unusual and likely had a lot to discuss while still fresh, I'm sure this note actually saved her ass from being hung out to dry and spread the pain around to all of the responsible people and the center.


--
Il Destriero

 

[Ezekiel2517]

"The main anesthesiologist, Dr. Bankulla, concerned that she would be blamed in the death, wrote out five pages of notes on the day of the procedure detailing what she saw and heard. Lawyers for the Rivers family said they were greatly aided in their case by Dr. Bankulla’s notes"

Do you guys try document details of what happen after an adverse event? Seems like it may have backfired.

Good documentation can most definitely save your ass. But if you're stupid to begin with or lack attention to detail, the documentation will likely reflect that and a sharp attorney can find something in it to use against you.

 

[aneftp]

"The main anesthesiologist, Dr. Bankulla, concerned that she would be blamed in the death, wrote out five pages of notes on the day of the procedure detailing what she saw and heard. Lawyers for the Rivers family said they were greatly aided in their case by Dr. Bankulla’s notes"

Do you guys try document details of what happen after an adverse event? Seems like it may have backfired.

I am just shocked no one from the ASA or even AANA failed to discuss no sux at the facility. Maybe the GI anesthesia cash cow? No one wants to harm the hand that feeds them?

I haven't worked at a true GI center in years. But a couple of the ones I used cover didn't have sux. They would buy roc for me to use in an emegency. Just so they could avoid buying MH cart.

 

[deleted171991]

"The main anesthesiologist, Dr. Bankulla, concerned that she would be blamed in the death, wrote out five pages of notes on the day of the procedure detailing what she saw and heard. Lawyers for the Rivers family said they were greatly aided in their case by Dr. Bankulla’s notes"

Do you guys try document details of what happen after an adverse event? Seems like it may have backfired.

We don't know how much she had to pay. 😉

 

[deleted171991]

I am just shocked no one from the ASA or even AANA failed to discuss no sux at the facility. Maybe the GI anesthesia cash cow? No one wants to harm the hand that feeds them?

I haven't worked at a true GI center in years. But a couple of the ones I used cover didn't have sux. They would buy roc for me to use in an emegency. Just so they could avoid buying MH cart.

What stops us from carrying our own sux, for emergencies?

 

[Chloroform4Life]

What stops us from carrying our own sux, for emergencies?

Would we have to carry our own dantrolene too?

 

[Doctor4Life1769]

Would we have to carry our own dantrolene too?

If you carry your own sux and give it, and the pt experiences MH.. You better as hell have it on ya or your ass is even more grass!

 

[urge]

"The main anesthesiologist, Dr. Bankulla, concerned that she would be blamed in the death, wrote out five pages of notes on the day of the procedure detailing what she saw and heard. Lawyers for the Rivers family said they were greatly aided in their case by Dr. Bankulla’s notes"

Do you guys try document details of what happen after an adverse event? Seems like it may have backfired.

That's what I was taught in med school.

Didn't you guys get taught the same?

 

[urge]

TV is reporting that Joan Rivers' daughter got $10-$15 million from all the parties involved. The lawyers got 1/3 of course but this was a huge settlement.

How did the parties come up with say $10 million? Let's assume all the Physicians involved settled for $1 million each.

1. Anesthesiologist- $1 million
2. ENT- $1 million
3. Gi- $1 million
4. GI center- $5 million?

I can see maybe $8 million here but where does the other $2 million come from?

In my eyes the GI and the ENT were the ones who did the deed.

The anesthesiologist was unable to reverse what they did, partly because the GI center did not provide the right tools.

I would make it

Anesthesiologist 0.5 million
GI 5 million
ENT 5 million
GI Center 5 million

 

[IlDestriero]

In my eyes the GI and the ENT were the ones who did the deed.

The anesthesiologist was unable to reverse what they did, partly because the GI center did not provide the right tools.

I would make it

Anesthesiologist 0.5 million
GI 5 million
ENT 5 million
GI Center 5 million

They should have burned the ENT at the stake if she really left during the crisis as was written. She (at one point anyway) was fully trained to do a tracheostomy and could have saved her life easily. Joan was about 90# and had a neck you could have hit with a dart from across the room. Of course the anesthesiologist should have tried as well. I wonder if they hesitated to escalate because she was famous? Or denial?
I have a knife on my keys. I'd send someone to the locker room and use my dirty pocketknife before I let my patient die in front of me. One more reason to keep it sharp.
I'd love to know who the other 2 anesthesiologists were. One is probably the medical director that approved no Succs & dantroline, roc, emergency airway box/cart, etc.



--
Il Destriero

 

[pgg]

If you carry your own sux and give it, and the pt experiences MH.. You better as hell have it on ya or your ass is even more grass!

There's more than dantrolene on a MH cart. You going to wheel one of those around too?

 

[Chloroform4Life]

They should have burned the ENT at the stake if she really left during the crisis as was written. She (at one point anyway) was fully trained to do a tracheostomy and could have saved her life easily. Joan was about 90# and had a neck you could have hit with a dart from across the room. Of course the anesthesiologist should have tried as well. I wonder if they hesitated to escalate because she was famous? Or denial?
I have a knife on my keys. I'd send someone to the locker room and use my dirty pocketknife before I let my patient die in front of me. One more reason to keep it sharp.
I'd love to know who the other 2 anesthesiologists were. One is probably the medical director that approved no Succs & dantroline, roc, emergency airway box/cart, etc.



--
Il Destriero

They may not have a scalpel available in the GI suite

I carry one of these in my inside front pocket to ward off bad joojoo

 

[Doctor4Life1769]

There's more than dantrolene on a MH cart. You going to wheel one of those around too?

So you're just gonna carry around unapproved sux and start giving it when you have airway emergencies? What happens if you get a bad outcome like MH?

 

[deleted171991]

If you carry your own sux and give it, and the pt experiences MH.. You better as hell have it on ya or your ass is even more grass!

If the patient goes into unbreakable laryngospasm, and I don't have any roc around, like in this case, you bet I will give sux.

 

[deleted171991]

So you're just gonna carry around unapproved sux and start giving it when you have airway emergencies? What happens if you get a bad outcome like MH?

What's the likelihood of that (versus anoxic brain injury in the absence of sux)?

Let me answer that for you: about 1 in 100,000.

 

[Doctor4Life1769]

What's the likelihood of that (versus anoxic brain injury in the absence of sux)?

Let me answer that for you: about 1 in 100,000.

I agree.
But, I'm sure you've heard of the perfect storm.
I don't even know what the policy is regarding ASCs and unapproved meds, that's another entirely different legal issue potentially.

 

[mapa1001]

Most GI facilities I have worked at do not keep succinylcholine because of the expense of maintaining a MH cart. Using your own sux in such a facility would be an instant payout in any case you used it with a bad outcome whether or nor MH occurred...the lawyers would paint you as a rogue physician working outside the constraints of the facility, using unapproved medications in the facility etc.
I would suspect that this whole case was a cluster$&*#. Even with no Sux, they could have given her an induction dose of propofol (which very likely would break spasm in a 81 year old) and intubated.

 

[Doctor4Life1769]

If the patient goes into unbreakable laryngospasm, and I don't have any roc around, like in this case, you bet I will give sux.

Why wouldn't you have roc around? No Pyxis? Why would you perform anesthesia in a center without a muscle relaxant in house?

 

[Doctor4Life1769]

Most GI facilities I have worked at do not keep succinylcholine because of the expense of maintaining a MH cart. Using your own sux in such a facility would be an instant payout in any case you used it with a bad outcome whether or nor MH occurred...the lawyers would paint you as a rogue physician working outside the constraints of the facility, using unapproved medications in the facility etc.
I would suspect that this whole case was a cluster$&*#. Even with no Sux, they could have given her an induction dose of propofol and intubated.

Exactly

 

[pgg]

So you're just gonna carry around unapproved sux and start giving it when you have airway emergencies? What happens if you get a bad outcome like MH?

You mistake me. I wouldn't work somewhere that didn't have basic emergency supplies and equipment in the first place.

 

[mapa1001]

That's what I was taught in med school.

Didn't you guys get taught the same?

It seems as if this anesthesiologist burned herself with her narrative, there is no medical circumstance where I can imagine a 5 page narrative being necessary. Unnecessary information/opinions inserted into a medical record are nothing but fodder for lawyers.

A simple note delineating the events (without commentary such as her voicing concern and being called paranoid etc.) would have served her better. If she had stuck to what what she tried to do with the tools at hand (ie. "I attempted to intubate the patient but could not for reason xxx, no anectine available) rather than what others did not do (ENT not available for slash cricothyrotomy) I think she and her colleagues would have been better off.

 

[narcusprince]

Honestly why not get the Sux and give it. If you have to intubate the patient then you very well may be going down the algorithm of sending her to a higher echelon of care. You can manage MH for 15-20 minutes while someone calls another hospital and gets dantrolene into the facility or she is packaged and sent out of the facility. Hypoxia kills, MH can be managed, honestly Mrs Rivers was no stranger to anesthesia....... I would argue that using Succ in her case would be low risk for MH catastrophe. What do I know I am a MDA.

 

[mapa1001]

There is no question that Sux would be good choice. However to use sux in a facility you have to have a MH cart. Regardless of the true risk of using sux in a case such as this; the liability is huge. There is no way you can argue that you did the right thing in a litigation situation if you used medications that were not approved for use in a given facility.

 

[Doctor4Life1769]

You mistake me. I wouldn't work somewhere that didn't have basic emergency supplies and equipment in the first place.

I didn't think you would.
We are talking hypotheticals here and that was my reply to your question.

 

[pgg]

I didn't think you would.
We are talking hypotheticals here and that was my reply to your question.

Gotcha

To be honest, I'm not entirely sure what I'd do if I had a mobile office-anesthesia type job where I took all my own gear. I guess I'd take succ (and a knife, among other e-things) with me as an emergency drug, but not a MH cart. I don't think I'd ever take such a job though, in part because of my low risk tolerance.

I can't imagine working at a fixed location that couldn't be bothered to have basic emergency supplies.

 

[Doctor4Life1769]

Gotcha

To be honest, I'm not entirely sure what I'd do if I had a mobile office-anesthesia type job where I took all my own gear. I guess I'd take succ (and a knife, among other e-things) with me as an emergency drug, but not a MH cart. I don't think I'd ever take such a job though, in part because of my low risk tolerance.

I can't imagine working at a fixed location that couldn't be bothered to have basic emergency supplies.

Absolutely agree.
I wouldn't take such job, especially if succ or similar muscle relaxants weren't considered "formulary" and in-house. I'd want access to a difficult airway cart and MH cart. There better be pressors too.

 

[BLADEMDA]

I would have used sux in the Joan rivers' case and she wouldn't have died. I'd rather deal with using the sux (approved or not by the facility) then let a patient die. Yes, I'd keep a bottle with me at all times in one of these facilities.

Sux by itself vs sux with inhalational anesthetic has lower incidence of triggering MH. In addition, how often have you seen MH in 80 year old patients?

I think the concept of not having sux available for life and death situations in these Gi centers is wrong. I agree that sux should not be routinely used in centers without an MH cart but as an emergency drug it should be available to all anesthesia providers.

 

[BLADEMDA]

Short Communication
Journal of Anesthesia

November 2008, Volume 22, Issue 4, pp 464-466

First online: 15 November 2008

Malignant hyperthermia developing during esophageal resection in an 82-year-old man

• Norihito Nakamura
• , Tomomi Ueda
• , Reiri Ishikawa
• , Yosuke Tasaka
• , Kiyoshi Fukuuchi
• , Nobukazu Sato

Get Access
Abstract
Malignant hyperthermia (MH) is a rare but fatal complication that develops under general anesthesia. Reports on MH in patients over the age of 80 years are unusual. We experienced a case of MH in an 82-year-old patient during esophageal resection. Anesthesia was induced with propofol and succinylcholine, and maintained with sevoflurane. Neither masseter spasm nor rigidity of the limbs was seen during induction. Body temperature (BT) at induction was 36.0°C. Three hours after incision, the level of end-tidal CO2 was elevated to 55 mmHg. We assumed that the rise in end-tidal CO2 had occurred due to secretions in the airway. However, the BT, which had risen at 3 h after incision, continued to rise, and about 60 min later, the BT exceeded 39.0°C. A rise of more than 0.5°C in less than 15 min was seen, and MH was suspected. With dantrolene administration, the BT decreased from 40.9°C at maximum to 37.7°C. With continuous infusion of dantrolene when the patient was transferred to the intensive care unit (ICU), BT remained within the normal range. The next day re-operation was performed, without further complications or recurrence of MH during the postoperative period. Because it is necessary to initiate treatment in the early stage of MH, as soon as possible, although MH prevalence is low in the elderly, it is important to suspect MH when hypercapnia and/or hyperthermia are seen.

Key words
Malignant hyperthermia Elderly Esophageal resection OnsAuthors

• Norihito Nakamura (1)
• Tomomi Ueda (1)
• Reiri Ishikawa (1)
• Yosuke Tasaka (1)
• Kiyoshi Fukuuchi (1)
• Nobukazu Sato (2)

Author Affiliations

• 1. Department of Anesthesiology, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan
• 2. Deparment of Anesthesiology, Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan

 

[Doctor4Life1769]

I would have used sux in the Joan rivers' case and she wouldn't have died. I'd rather deal with using the sux (approved or not by the facility) then let a patient die. Yes, I'd keep a bottle with me at all times in one of these facilities.

Sux by itself vs sux with inhalational anesthetic has lower incidence of triggering MH. In addition, how often have you seen MH in 80 year old patients?

I think the concept of not having sux available for life and death situations in these Gi centers is wrong. I agree that sux should not be routinely used in centers without an MH cart but as an emergency drug it should be available to all anesthesia providers.

Nobody is saying it shouldn't be avail or be used, but if policy dictates against it.... I wouldn't work there

 

[BLADEMDA]

Anesthesiology. 2011 Jan;114(1):84-90. doi: 10.1097/ALN.0b013e318200197d.
Prevalence of malignant hyperthermia and relationship with anesthetics in Japan: data from the diagnosis procedure combination database.
Sumitani M1, Uchida K, Yasunaga H, Horiguchi H, Kusakabe Y, Matsuda S, Yamada Y.
Author information

Erratum in

• Anesthesiology. 2011 May;114(5):1257.

Abstract
BACKGROUND:
Malignant hyperthermia (MH) is a rare but life-threatening disease that occurs during general anesthesia. The actual prevalence of MH remains unclear, and the association between MH and various anesthetic drugs remains controversial because of a lack of universal reporting.

METHODS:
Using the Japanese Diagnosis Procedure Combination database, we collected data of inpatients who had general anesthesia between July and December 2006-2008. Patients' age, gender, diagnoses, procedures, and the use of drugs during anesthesia, including volatile agents, muscle relaxants, and propofol, were investigated. Univariate comparisons were made to examine the relationship of each anesthetic drug or demographic factor with the occurrence of MH.

RESULTS:
Of 1,238,171 surgical patients undergoing general anesthesia, we identified 17 MH patients. Only one in-hospital death was identified. Men were significantly more likely to contract MH(odds ratio: 3.49; 95% CI 1.14 -10.7; P=0.029). No MH patient was found among 19,871 suxamethonium users. The prevalence of MH was relatively high in users of sevoflurane and rocuronium compared with nonusers but was not statistically significant [corrected]..

CONCLUSIONS:
No single drug was significantly associated with the occurrence of MH. Data should be continuously compiled, and further analyses with larger numbers of cases are necessary to identify possible causative agents.

PMID:

21169796

[PubMed - indexed for MEDLINE]

 

[urge]

It seems as if this anesthesiologist burned herself with her narrative, there is no medical circumstance where I can imagine a 5 page narrative being necessary. Unnecessary information/opinions inserted into a medical record are nothing but fodder for lawyers.

A simple note delineating the events (without commentary such as her voicing concern and being called paranoid etc.) would have served her better. If she had stuck to what what she tried to do with the tools at hand (ie. "I attempted to intubate the patient but could not for reason xxx, no anectine available) rather than what others did not do (ENT not available for slash cricothyrotomy) I think she and her colleagues would have been better off.

Have you read the notes?

I don't agree with you. Without said notes this would have been all blamed on the anesthesiologist.

The GI and ENT would have claimed she was stable when they left and decompensated later, etc.

 

[urge]

What stops us from carrying our own sux, for emergencies?

All of you who claim to have some bootlegged sux with you, where the heck do you think you are going to get sux from if you have been working for years at a facility that does not have sux?

Plus, in case you work at two facilities, do you want to explain why you go around stealing drugs from another employer?

 

[caligas]

K.I.S.S.

http://emcrit.org/wp-content/uploads/2014/08/EMA-Scalpel-FInger-Bougie.pdf

 

[pgg]

All of you who claim to have some bootlegged sux with you, where the heck do you think you are going to get sux from if you have been working for years at a facility that does not have sux?

Plus, in case you work at two facilities, do you want to explain why you go around stealing drugs from another employer?

I've got a medical license and a DEA number, I can buy any drug I want from a distributor. Don't you? Can't you?

I'm not saying this is a great set of circumstances, just that there are options besides theft. 🙂

 

[urge]

I've got a medical license and a DEA number, I can buy any drug I want from a distributor. Don't you? Can't you?

I know so many people who buy their own emergency drugs because their employer doesn't, right.

 

[pgg]

I know so many people who buy their own emergency drugs because their employer doesn't, right.

🙂

I don't know anybody who does either, and I wouldn't take this job.

But again, you said the only option was theft, and that's not true.

 

[BLADEMDA]

All of you who claim to have some bootlegged sux with you, where the heck do you think you are going to get sux from if you have been working for years at a facility that does not have sux?

Plus, in case you work at two facilities, do you want to explain why you go around stealing drugs from another employer?

Simply ask someone like me to get you a bottle. No theft necessary on your part. Perhaps, we could trade three ampules of propofol for one vial if sux? My point is that using sux is a whole lot safer and faster than cutting the neck which was entirely unnecessary if the proper drugs and equipment are available.

 

[BLADEMDA]

I know so many people who buy their own emergency drugs because their employer doesn't, right.

I know someone who works at offices on the side and purchases his/her own drugs.

 

[jwk]

There is no question that Sux would be good choice. However to use sux in a facility you have to have a MH cart. Regardless of the true risk of using sux in a case such as this; the liability is huge. There is no way you can argue that you did the right thing in a litigation situation if you used medications that were not approved for use in a given facility.

We work at several different GI centers. No sux and MH cart? We won't go there. I mean really - some of these places do dozens of endoscopies a day, many thousands of procedures a year, which means many millions of dollars at a single center. To say they can't afford a basic supply of dantrolene (somewhere in the neighborhood of $3000 and good for a couple years) is absurd. If people are stupid enough to ***** themselves out to these places without reasonable supplies, they deserve what happens to them when things hit the fan.

 

[narcusprince]

We are in the developed world. Why not buy the sux, have an agreement with a hospital that once used if mh occurs you can have dantrolene brought to facility or medevac. Her death was a facility driven death versus individual provider malpractice. Shame on the medical director of the facility.