Melissa Rivers, daughter of the late comedian Joan Rivers, filed suit in Manhattan State Supreme Court seeking unspecified damages and claiming that a New York facility failed to competently care for the patient during what was to be a routine endoscopy. Earlier, some reports suggested that the endoscopy might have included an unscheduled and unapproved biopsy. The NYC Medical Examiner (ME) judged that Ms. Rivers’ death was caused by “a therapeutic complication” when she stopped breathing during the endoscopy.

Although the ME’s report does not assign blame, the suit claims that the endoscopy was performed improperly, and that a separate, unauthorized laryngoscopy was performed.

A separate investigation into the incident by the federal Centers for Medicare and Medicaid Services (CMS) resulted in a temporary revocation of the clinic’s accreditation, though it was restored months later. CMS cited the clinic for failing to keep proper medication records, to get informed consent for all procedures performed, and failing to properly record patient weight prior to anesthesia.

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Regardless of the exact details of this case, health care experts have used the occasion to identify actions that hospitals and clinics can take to avoid malpractice suits and improve patient safety. Medication errors are a common cause of malpractice suits, which some suggest are related to staff fatigue or overwork. To remedy this, oversight groups can be assigned to monitor and enforce working hours, pace, and workload. Others recommend the use of third party patient surveys after treatment to help with possible forensic investigations.

Studies have shown that so-called “defensive medicine” does not lead to improved outcomes. Instead, investigators have pointed to the need for improved patient–physician communication. A recent study published in the Annals of Emergency Medicine  showed that the median estimate of whether a cardiac patient might die at home of a heart attack following an emergency room conversation was 80% for patients, and 10% for physicians. As Professor Aaron Carroll of the Indiana University School of Medicine wrote in a New York Times opinion piece presenting these findings, “Learning to be better communicators…is no small task for physicians. But improving those skills might actually make a difference in whether they are sued. Too many doctors would rather see policy changed than change themselves, even if those policy changes have a much lower chance of succeeding.”

Ann Latner, JD, a former criminal defense attorney, is a freelance medical writer in Port Washington, N.Y.