Joan Rivers Her Death ... One Year Later


Joan Rivers died a year ago today, and a lot has happened:

1. Melissa Rivers filed a wrongful death lawsuit against Yorkville Endoscopy, the clinic where Rivers went into cardiac arrest during a throat procedure. The case is pending.

2. The feds blocked the clinic from getting Medicare and Medicaid payments.

3. The New State Dept. of Health determined the clinic screwed up by administering an improper amount of propofol to Joan. The Dept. also concluded Yorkville's crash cart was lacking a certain drug that could have helped save Joan's life.

4. Joan's personal doctor, Dr. Gwen Korovin, was also put on the hot seat. The Dept. of Heath said Korovin was in the operating room without authorization, despite her claims she was invited. Melissa's suing her as well.

5. A big deal was made of the fact that someone took a selfie during the ill-fated procedure. Dr. Korovin claims she had no idea another doctor was taking a pic, but Melissa says the photo was taken at Korovin's behest.

6. "Fashion Police" replaced Rivers with Kathy Griffin, but that ended in disaster. Griffin quit and the show went on hiatus, but returned on Monday, August 31. Melissa's now the host.


Melissa Rivers Kathy Griffin 'S*** on My Mother's Legacy'


Melissa Rivers believes Kathy Griffin is self-centered beyond words ... so worried about saving her own ass that she would crap all over the legacy of Joan Rivers.

Rivers was at the 92nd Street Y in NYC where she sat down with Hoda Kotb to talk about her new book. When Hoda zeroed in on "Fashion Police" -- Melissa had trouble harnessing her anger.

Melissa believes Kathy more than disrespected Joan in the way she handled leaving the show, saying she "s*** on her mom's legacy." And she didn't stop there.

Our photogs got Griffin out Tuesday night and asked her about Melissa's comments ... but she wanted no part of it.


'Fashion Police' Staffers Giuliana and Kelly ... Are Ruining Joan Rivers' Legacy


Giuliana Rancic and Kelly Osbourne's battle at "Fashion Police" is tearing down everything Joan Rivers built -- at least that's how show staffers feel ... TMZ has learned.

Sources close to the production tell us producers fear the uproar over the Zendaya joke will cause Giuliana to be more silent on the show -- because she'll be worried about further backlash.

We're told producers are worried the other show hosts will follow suit ... and it will no longer be the sassy show full of sarcastic humor that it used to be. They also wish both women had chilled after the on air apology ... because things would have blown over.

We're told Melissa Rivers is now doing everything in her power behind the scenes to keep her mom's legacy alive.

Stay tuned.

Joan Rivers Oscar 'In Memoriam' Snub Melissa Is VERY Disappointed


Can we talk? Joan Rivers was noticeably snubbed Sunday night by The Academy Awards and Melissa Rivers is not a happy camper about it.

Sources close to Melissa say she feels her mom deserved a place in the 'In Memoriam' portion of the Oscars, but she's not going to focus on the snub.

We're told she'd rather focus on the overwhelming support from her fans, who have rallied behind her mom since her death in September.

But Melissa has a legitimate beef -- seems like the Academy forgot how Joan owned Oscar red carpets for years ... and her hysterical role as Dot Matrix in "Spaceballs!"

Joan Rivers Melissa Sues Clinic Over Mom's Death

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Melissa Rivers has just filed a huge lawsuit against the clinic where Joan Rivers' heart stopped beating ... and Melissa's lawyer says the doctors acted like a bunch of groupies and not medical professionals.

The lawsuit -- obtained by TMZ -- claims gross medical malpractice, alleging during the 20 minutes doctors tried to bring Joan back to life, they didn't think to perform a tracheotomy, which facilitates breathing.

Melissa says, "The level of medical mismanagement, incompetency, disrespect and outrageous behavior is shocking and frankly, almost incomprehensible," adding, "Not only did my mother deserve better, every patient deserves better."

In addition to suing the clinic, Melissa has sued Joan's personal doctor, Gwen Korovin. According to the lawsuit, she should not have been permitted in the room where the procedure was being performed, yet she jumped in and announced, "I'll go first."

The suit claims another doctor took cellphone pics of Rivers before the emergency, while she was under sedation, with Korovin in the photos, saying Joan "will like to see these in the recovery area."

According to the lawsuit, Korovin left the room in the middle of the emergency and the allegation is that she left because she knew she wasn't supposed to be there in the first place and "wanted to avoid getting caught." The suit says Korovin simply abandoned Joan.

And get this. According to the suit, in the middle of the emergency, another doctor took issue with a colleague who wanted to scope the affected area, saying, "Renuka, you're such a curious cat. You always want to know what's going on." The suit says the doctor refused to authorize the scope.

Melissa's lawyer spoke to The NY Daily News, which broke the story, and quotes lawyer Jeffrey Bloom who says, "Had doctors acted as physicians for Joan Rivers instead of groupies, Joan Rivers would have been doing 'Fashion Police' last week."

Yorkville Endoscopy has been under intense scrutiny and they are set to lose their accreditation at the end of the month.

Joan Rivers Clinic No Longer Up to Snuff ... For the Feds, Anyway


Joan Rivers' throat clinic just got a huge slap on the wrist after a federal investigation -- and now a ton of patients will have to get treatment somewhere else.

As we've previously reported ... the Dept. of Health and Human Services found a ton of flaws at Yorkville Endoscopy Center after Joan's death -- and gave the clinic a list of things to improve ... or else.

Well, according to a new DHHS report ... Yorkville still doesn't pass muster in a bunch of areas -- most interestingly ... failing to properly complete and document post-anesthesia evaluations of patients.

TMZ broke the story ... the clinic director Lawrence Cohen is on record saying it's not cost-effective to pay an anesthesiologist for procedures like the one Joan was getting when she died.

As a result, feds are cutting off Medicare reimbursement to Yorkville -- meaning, if you're a Medicare or Medicaid patient ... your benefits will no longer be accepted there as of January 31.

A Yorkville rep tells us they will appeal to have the decision reversed, but in the meantime ... they are still licensed and open for business.

Joan Rivers Surgeon Thinks Anesthesiologists Are a Waste of Money For Throat Procedure


The surgeon who performed the throat procedure on Joan Rivers the day she went into cardiac arrest wrote an article telling his fellow doctors it's not cost-effective to have an anesthesiologist present for procedures like the one that killed Joan.

Dr. Lawrence Cohen -- who was also the Medical Director of the Yorkville Endoscopy Center -- wrote in 2012 ... it was not always COST-EFFECTIVE to have an anesthesiologist on board for outpatient endoscopic procedures.

Dr. Cohen writes, "Although we can all agree that [monitored anesthesia care] is a highly effective and safe method of sedation, the question is whether it is worth the extra cost to our health care system."

Dr. Cohen then answers his question: "The answer is clearly no."

Dr. Cohen crunches the number in his article, saying the average cost for an anesthesiologist is $400 per procedure, but the risk of death is 1 out of 100,000. Cohen therefore concludes it costs $40,000,000 to save one life, adding that cost "far exceeds ... an acceptable level of cost-effectiveness."

There was an anesthesiologist present at the beginning of the procedure, but our sources say it's unclear if she was there when Joan's vital signs plummeted. A scathing report blamed the doctors for being inattentive and not noticing her vital signs were in the danger zone.

Melissa Rivers XMAS Wish I Want My Son to Laugh Again

This will make you cry.

Melissa Rivers had a very simple Christmas wish, which encapsulates the sadness and loss she experienced this year over what seems like the preventable death of her mom, Joan Rivers.

Melissa was leaving Craig's restaurant in West Hollywood when a photog asked the simple question ... she wants 13-year-old Cooper to laugh again.

It was clear from the funeral ... Cooper is taking his grandma's death very hard.

It's one of those simple things people say that tells the whole story.

Joan Rivers Clinic Overhauls Procedures To Avoid Repeat Tragedies


The clinic where Joan Rivers' throat procedure turned deadly ... just filed a plan to make a slew of major changes to avoid getting shut down by the feds.

According to docs obtained by TMZ ... Yorkville Endoscopy is responding to flaws found by the Department of Health and Human services ... by making several upgrades to its procedures.

Among the changes:
- Stricter procedures to credential physicians and observers who are admitted into operating rooms
- The clinic has to perform a full assessment of a patient's weight, allergies, and medical history before administering Propofol
- Supplemental oxygen should be routinely used and immediately available for patients sedated with Propofol
- Anesthesiologists must check vital signs at least every 5 minutes for patients sedated with Propofol
- Unscheduled drills to resuscitate patients using defibrillators/crash carts will be run 4 times a year

Most of the changes relate directly to problems the agency found at the clinic while investigating Joan's death. The Dept. of HHS has signed off on Yorkville's plan.

Yorkville officials had been given a January deadline to get this done ... or the feds could have closed down the clinic.

Joan Rivers Doctors Reportedly Kept Operating As Vital Signs Plummeted

Doctors performing Joan Rivers' fatal procedure were rooting around in her throat with a surgical instrument even as her vital signs deteriorated ... this according to a new report.

And the doctors delayed calling 911 for a critical 10 minutes and instead tried reviving her themselves ... this according to the NY Post.

The Post report says even before Joan went into cardiac arrest ... her pulse and blood pressure were dropping quickly -- a sign she was in the danger zone -- but the doctors continued scoping her larynx and trachea.

Joan's pulse had reportedly sunk to 47 prior to the anethesiologist administering Propofol.

TMZ broke the story ... a federal report showed there were major problems with the amount of Propofol used on Joan.

Dr. Lawrence Cohen from Yorkville Endoscopy and Joan's own ENT, Dr. Gwen Korovin attempted to resuscitate Rivers, but failed during the critical 10 minutes.

Dr. Korovin and Dr. Cohen have not responded to reports detailing alleged errors during the procedure.

Kathy Griffin Replaces Joan Rivers On 'Fashion Police'


Kathy Griffin will be Joan Rivers' replacement on "Fashion Police" ... TMZ has learned.
Sources connected with the show tell TMZ it's a done deal. Kathy will join Melissa Rivers, Kelly Osbourne and Giuliana Rancic. We don't know the fate of George Kotsiopoulos.

We're told the show will no longer be a weekly series. E! will roll it out during awards shows and other occasions as event programming.

One silver lining ... the drapes will now match the carpet for sure.

Joan Rivers Critical Drug Missing During Fatal Procedure


Joan Rivers would be alive today if the clinic where she stopped breathing had a proper crash cart ... sources connected with her family's legal team tell TMZ.

TMZ broke the story ... there were a number of screw ups, including doctor's notes that showed an alarming amount of Propofol in her body. We're told the notes were not accurate and there was nothing in the blood work to suggest Propofol killed Joan.

But the legal team believes the Yorkville Endoscopy Center did not have critical lifesaving equipment on the crash cart ... specifically a drug called Succinylcholine, used to relax a patient's trachea. The legal team believes Joan's vocal chords spasmed and closed shut. The drug would have instantly opened them.

To make matters worse ... the legal team says the doctors were asleep at the wheel, failing to identify "deteriorating vital signs."

Joan Rivers Screw Up Over Propofol During Fatal Surgery


Doctors who performed the procedure that led to Joan Rivers' death screwed up by not following the proper procedure before sedating her with Propofol ... according to a federal report.

The Dept. of Health and Human Services examined the Yorkville Endoscopy Center, where Joan stopped breathing. The Dept. found there's no record that the staff weighed Joan before administering the Propofol ... the point being, the amount of the sedative should be based on size.

The computer at the clinic also shows she was given a huge dosage of Propofol. A staff member told the Dept. she made a mistake inputting the dosage and put in more than twice the actual amount given to Joan.

And according to the report, Joan's personal doctor, Gwen Korovin, came into the operating room without authorization. The Dept. says she announced to the room, "I will go first" ... meaning she would do the first procedure on Joan.

And, according to the report, Joan only consented to an upper endoscopy procedure, but Dr. Korovin did more ... a laryngoscopy.

As for the now-famous selfie pic that Dr. Korovin took in the room ... according to the Dept. the doctor asked the staff to take the picture of her doing the procedure, saying Joan might have wanted it.

And finally ... the Dept. says the doctors didn't notice Joan was literally dying on the table. As her oxygen levels plummeted, they were oblivious.

Melissa Rivers tells TMZ she is "outraged by the misconduct and mismanagement."

Melissa Rivers Lawyered Up and Ready to Sue Over Joan's Death

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Joan Rivers' daughter Melissa has retained a law firm that will file a major lawsuit over her mom's death ... TMZ has confirmed.

We're told the firm -- Gair, Gair, Conason, Steigman, Mackauf, Bloom & Rubinowitz -- will file a medical malpractice and wrongful death lawsuit against the clinic where Joan stopped breathing and the doctors who were involved.

Our sources say Melissa retained the firm Tuesday, but the suit won't be filed for around a month.

We're told letters are going out today to the various people involved in the fatal medical procedure, telling them NOT to destroy records involving Joan's treatment. The lawyers also want phone logs and other documents.

As we reported ... one of the driving forces for Melissa is to figure out how her mom died, but in the end, it's a lawsuit over money.

Joan Rivers Melissa Has 'No Choice' But to Sue


Melissa Rivers will sue the medical center where Joan died and the doctors as well because it's the only way she can find out what really happened to her mom.

Sources connected to the Rivers family tell TMZ ... after the New York Dept. of Health and Human Services came out with its findings that Yorkville Endoscopy LLC was "deficient" in surgical services and medical staff ... Melissa tried to find out the root of the problems and if they caused her mom's death, but she was shut down.

We're told Melissa got advice from her lawyers ... the only way to know precisely what happened is to file a lawsuit, which entitles her to force doctors and facility staff to sit for sworn depositions and answer questions about what happened the day Joan stopped breathing.

Melissa, we're told, is frustrated because it's apparent the facility and the Dept. of Health know exactly what happened, so her only recourse is court.

Joan Rivers Cause of Death May Remain Mystery Because NO AUTOPSY


We may never know exactly what killed Joan Rivers ... because a decision was made NOT to do an autopsy ... TMZ has learned.

Sources connected to the NYC Medical Examiner tell us ... Melissa Rivers was despondent when Joan died and told doctors she did not want an autopsy performed. According to New York law, doctors will honor such a request if there's no evidence of criminality associated with the death.

The Medical Examiner has concluded the cause of death was deprivation of oxygen which caused irreversible brain damage. We're told they determined the "predictable" complication involved the procedure itself and not Propofol.

Here's the problem ... we're told without an autopsy it's impossible to pinpoint the nature of the problem. As one source said, an autopsy might reveal a puncture in the throat or other trauma.

The only way Joan's family might get a definitive answer is if a doctor or nurse owns up to a possible mistake ... and even then it's just someone's word.

So the precise cause of Joan's death may forever stay a mystery.

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