Joan Rivers and Mystery behind the Office of the Chief Medical Examiner

Joan Rivers and Mystery behind the Office of the Chief Medical Examiner

The New York City medical examiner has ruled that the comedian Joan Rivers, 81, died after a “therapeutic complication” during medical procedures to evaluate changes in her voice and determine whether she had acid reflux.[1]  The autopsy report said an investigation by the medical examiner’s office found that the disruption in Ms. Rivers’s breathing was “a predictable complication of medical therapy.”[2]

The autopsy is a post-mortem medical examination for studying the pathologic changes present and determining the cause of death.[3]  Coroners and medical examiners (C/MEs) have a statutory duty to file an autopsy report, as a certified written record of their examinations, when investigating certain types of deaths, such as when a death appears unexplained, violent, unusual or suspicious, or when a body is mysteriously found.[4]

In New York, rules concerning disclosure of autopsy reports heavily depend on who have produced them, whether the reports are generated by medical examiners or by hospitals.  Additionally, there are medical examiners’ reports generated upon hospitals’ requests.  New York City Charter governs C/MEs’ autopsy records in the City while Sections 4210 (2-a) and 4214 of New York Public Health Law set forth rules for hospital-originated autopsies.  In New York City, the Office of the Chief Medical Examiner (OCME) within the Department of Health and Mental Hygiene keeps full and complete autopsy records.[5]  The chief medical examiner must “promptly deliver to the appropriate district attorney copies of all records relating to every death as to which there is, in the judgment of the medical examiner in charge, any indication of criminality. Such records shall not be open to public inspection.”[6]

Further, New York Public Health Law § 4210 (2-a) codifies that if a person dies while under care or treatment at a general hospital, any autopsy report by the coroner or medical examiner for such person shall be made available to the hospital for the purpose of ongoing performance improvement of such hospital.  All such reports in the possession of a hospital shall be deemed confidential records.[7]

Hospital officials may order the performance of an autopsy provided that they first notify the next of kin and no objection is raised.[8]  In cases where a person dies in a hospital and the attending physician is able to certify the cause of death, the autopsy, if one is performed, is done in the hospital and the results are readily accessible to the hospital staff.[9]  The director of a hospital in which a patient has died may order the performance of an autopsy upon the body of such deceased person, after first giving notice of the death to the next of kin of such person.[10]  In the case of an unclaimed body of a deceased person, the medical colleges, schools, institutes and universities have a priority claim to the body, for the purposes of medical, anatomical or surgical science and study.[11]  Additionally, autopsies may be conducted at the request of the next of kin to determine the cause of death.[12] 

In Joan Rivers’ case, either her daughter or the hospital, where she died in September 2014, could have requested the Office of Chief Medical Examiner to perform an autopsy report to determine the cause of her untimely death.   Hopefully Joan’s autopsy report will not only be used as evidence in a potential medical malpractice lawsuit, but it will also deter other physicians from performing similar procedures in ambulatory setting.

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[1] Anemona Hartocollis, Joan Rivers Died From Complication in Treatment, Officials Say, Oct. 16 2014, available at http://www.nytimes.com/2014/10/17/nyregion/joan-rivers-died-of-complication-in-treatment-medical-examiner-says.html?_r=0.

[2] Id.

[3] Marc D. Ginsberg, The Confrontation Clause and Forensic Autopsy Reports-A "Testimonial", 74 La. L. Rev. 117, 171 (2013).

[4] Id.

[5] N.Y. Charter § 557 (g).  

[6] Id.

[7] N.Y. Pub. Health Law § 2805-m (McKinney 2014).

[8] N.Y. Pub. Health Law § 4214 (1) (McKinney 2014).

[9] Cent. Gen. Hosp., Inc. v. Lukash, 140 A.D.2d 113 (2d Dep’t 1988), aff'd, 74 N.Y.2d 619 (1989).

[10] N.Y. Pub. Health Law § 4214 (1).

[11] § 4214 (2).

[12] § 4210 (3).