Joan Rivers: New details about her death

New details about what went on inside Joan Rivers' operating room

Courtesy of Associated Press.

(CNN) – The death of legendary comedienne Joan Rivers saddened and shocked many. The 81-year-old entertainer was undergoing a scheduled endoscopy when she went into cardiac arrest, according to a CNN source. Rivers died a week later. CNN’s Susan Candiotti reports there may be more to the story.

A source tells CNN investigators are learning this: an unauthorized procedure, a biopsy on Rivers’ vocal chords, was begun on the comedienne while she was sedated. Staffers told authorities they found no signed consent form from rivers. If so, ethicist Dr. Arthur Caplan says, that’s a red flag.

“Knowing exactly what’s going to happen to you is crucial to any care interaction.”

The morning began like this. Our source says Rivers was undergoing a scheduled endoscopy by the clinic’s gastroenterologist, Dr. Lawrence Cohen, inserting a tiny camera down her throat, looking for possible digestive issues, when staffers say Cohen saw something.

While Rivers was still under anesthesia, staffers told authorities Rivers’ personal Ear, Nose, and Throat specialist examined Rivers’ vocal chords and began a biopsy. And in addition to the fact the procedure was unauthorized, our source says the ENT doctor was not certified to operate there.

“Even though you are a licensed physician, you still should have, if you will, the checks and balances to get your approval to practice in a particular place.”

And there’s more. In a statement, the clinic flatly says a biopsy of the vocal chords “has never been performed” at the clinic.

While technically true, it doesn’t appear to be the whole story. The ENT doctor may not have completed the biopsy but our source says, it was started.

Our source says as the unauthorized biopsy got underway, Rivers’ vocal chords began to swell, cutting off her oxygen, putting her into cardiac arrest.

“Doctor, if there was oxygen deprivation to the brain, what particular impact would that have if someone is elderly, in this case, 81 years old?”

“The effect of having no oxygen on the brain is damage to the nerve cells, which can precipitate as coma, paralysis, but in the elderly you have less reserve. You have less of a window to correct it.”

When rivers heart stops beating, seconds count.

It’s 9:40 am. The clinic calls 911. The call gets the highest code.

5 minutes later, NY fire rescue arrives. CPR is underway. A defibrillator is attached; a breathing tube inserted.  Fire rescue takes over CPR.

9:47: A Mount Sinai ambulance team arrives and joins the efforts. A minute later, a second fire rescue unit arrives.

By 9:50 am, 10 emergency personnel are on the scene.

One week later, Joan Rivers is dead.

As New York’s medical examiner, and the state’s health department continue to investigate, the clinic announcing a shake up: in a statement, saying Dr. Cohen “is not currently performing procedures… nor is he currently serving as medical director.”

At this time, a source says neither Dr. Cohen, nor the ENT is being accused of wrongdoing.

Citing federal privacy laws, the clinic declines comment on whether Rivers’ personal doctor was there and performed a biopsy.

And now, this head-shaking news: while Rivers was under anesthesia, staffers tell investigators that Rivers’ personal doctor doing the biopsy was taking a selfie.

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