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reportedly found a polyp when he performed the endoscopy. Reports
say he then let Ms. Rivers's personal otolaryngologist, who was neither
credentialed nor privileged at the ASC, perform a biopsy on her vocal
cords. The throat doctor, identified as Gwen Korvin, MD, was only
authorized to observe Dr. Cohen. It's unclear whether Ms. Rivers had
given Dr. Korvin consent to perform a biopsy.
The airway manipulation during Dr. Korvin's attempted biopsy likely
triggered a laryngospasm, which led to cardiac arrest. Attempts to res-
cue Ms. Rivers failed, which has fueled speculation that there wasn't
an anesthesiologist in the room.
"Sedation for upper GI procedures is extremely tricky," says Louis
G. Stanfield, CRNA, PhD, pain management specialist at the Skiff
Medical Center in Newton, Iowa. "The instrument goes right by the
airway and all it takes is a little blob of mucus or some other irritation
and the vocal cords can snap shut. The longer a laryngospasm per-
sists, the more deleterious it is and the harder it is to break."
While a laryngospasm is not an uncommon response to a vocal cord
biopsy, experts say it shouldn't have proven fatal. "Anesthesiologists
are trained to treat airway issues," says Dr. Shapiro, adding that
reversing or "breaking" a laryngospasm requires practiced airway res-
cue skills.
"Laryngospasm. That is the stuff of nightmares," says Dr. Shapiro.
"The patient is dropping off a cliff and you've got one opportunity to
reach your hand out and connect with their hand and secure the air-
way. Otherwise, they're going down."
It's unclear if an anesthesiologist, who would be trained in sedation
and intubation, was in the room with Ms. Rivers. Yorkville released a
statement saying that "only licensed medical doctors who are board-
certified anesthesiologists administer anesthesia at the clinic. Our
anesthesiologists monitor the patient continuously utilizing state-of-
C O V E R S T O R Y
