Joan Rivers, Selfies, and HIPAA

Tuesday, July 21, 2015



Court papers have reported supported the contention that Dr. Lawrence Cohen shot a “selfie” while Joan Rivers was lying unconscious on an operating table at Yorkville Endoscopy in Manhattan while undergoing outpatient surgery. The anesthesiologist for the procedure, Dr. Renuka Bankulla, reportedly entered a statement into the medical record that Dr. Cohen took a photograph of Joan Rivers while she was unconscious.  As odd - but completely plausible - cases such this one become more frequently spotlighted, it will certainly test the established classifications of what can be considered a HIPAA  violation.  Who would’ve ever guessed that selfie’s would be in the same conversation as medical records and HIPAA compliance?  The scope of what is considered HIPAA will continue to evolve with new boundaries being identified and established along the way.

Malpractice Suit

Nearly a year later, the malpractice suit filed in January, 2015 against Dr. Gwen Korovin, Ms. Rivers’ private doctor; the clinic; Dr. Bankulla; and Dr. Cohen cited a number of errors in the case that resulted in the death of Ms. Rivers  a week after the August 28, 2014 procedure. The lawsuit also says the doctors were inadequately trained to handle an emergency like the one they encountered when Rivers had a laryngospasm, a spasm of the vocal cords that rendered her unable to take in enough oxygen to support life.

When Dr. Bankulla looked for Dr. Korovin to open an airway for Rivers by performing an emergency cricothyrotomy, Dr. Korovin had already reportedly fled the clinic. The suit alleges allowing Dr. Korovin into the operating room where he was not credentialed to perform procedures at the facility.

Federal Agency Finds Violations

The Centers for Medicare and Medicare Services issued a report of errors related to a case with patient demographics similar to Rivers, including:

  • Failing to ensure that she was cared for only by physicians granted privilege in accordance with the clinic's bylaws.
  • Failing to get Rivers' informed consent for each procedure performed.
  • Failing to abide by its own cell phone policy.
  • Failing to identify deteriorating vital signs and provide timely intervention.

The clinic was notified they would lose their Medicare Health Benefits Agreement January 31, 2015. However, the clinic was later granted an extension to correct their deficiencies and they have apparently, managed to comply.
Proving, perhaps, that social media is NOT infallible regarding ratings of restaurants, movies, and medical providers; Yorkville Endoscopy is currently rocking a 4.5 star rating on Yelp despite the Rivers fiasco.

Follow The Rules

It seems clear Yorkville Endoscopy has significant liability in the Joan Rivers malpractice case. The lack of oversight of their personnel, regardless of the policies and procedures technically in place, appear to have conspired to result in the death of a patient.
The “selfie” isn’t the most egregious error in this case, yet it’s the one that gets much of the attention. Perhaps it should because it’s easy to understand as an abuse of the surgery process and the rights of a patient. Yorkville, based on the CMS findings, has a cell phone policy in place that should have prevented the snapping of a “selfie” in the operating room. Yet, the enforcement of that policy was lacking

Discipline in the workplace is often a slippery slope. The least volatile rule violation, having a cell phone in the operating room, is probably also the one most often violated at that outpatient center. The problem is that many of us make little progress from our behavior as seven year old children, if we can “get away” with one small violation, we’re likely to ignore the next rule if it suits us to do so.

Examine Your Practice

It’s not a stretch to assume that cell phone policies, in particular, are ignored in a significant percentage of medical practices in the US. The advent of Health Insurance Portability and Accountability Act (HIPAA) regulations have at least forced most practices to develop regulations for processes and technology related to the privacy of their patients.

The development of decent rules for HIPAA compliance is only one step. Without adequate enforcement of those policies, practices and individuals leave themselves wide open to significant ethical and monetary liabilities.

MedTunnel is a free HIPAA compliant messaging service - which allows you to send messages, documents and images containing protected health information (PHI) – just like email and text messaging.  It allows providers and patients to communicate and exchange PHI using their computers and mobile devices. Visit us at www.medtunnel.com

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