Joan Rivers died of low blood oxygen during a procedure to evaluate voice changes and reflux, the New York City Office of Chief Medical Examiner has ruled, according to The Associated Press. The comedian and actress died at age 81 at Mount Sinai Hospital a week after the operation, a laryngoscopy and an upper gastrointestinal endoscopy which took place on August 28th at New York’s Yorkville Endoscopy clinic. The official cause of death was “anoxic encephalopathy due to hypoxic arrest” – brain damage caused by a lack of oxygen.
“The classification of a death as a therapeutic complication means that the death resulted from a predictable complication of medical therapy,” Fox News reports that the Office of Chief Medical Examiner said. This ruling distinguishes it from more common classifications like homicide, suicide and natural causes, according to AP.
The state Health Department is also investigating Rivers’ death.
“We continue to be saddened by our tragic loss and grateful for the enormous outpouring of love and support from around the world,” the comedian’s daughter, Melissa Rivers, said in a statement. AP reports that she had no comment on the Medical Examiner’s ruling.
The medical director of Yorkville Endoscopy, Dr. Lawrence Cohen, parted ways with the clinic shortly after Rivers’ death, according to Fox. The initial report has not revealed who performed the operation, though CNN reports that sources told them Rivers had had an appointment with her personal throat doctor, Dr. Gwen Korovin, for the laryngoscopy.
That operation involves inserting a device to view a person’s vocal folds. CNN claims that Cohen performed the endoscopy to diagnose why she was experiencing a sore throat and that Korovin performed a second laryngoscopy after that. Korovin, who is not certified by Yorkville Endoscopy, as required by law, has denied “performing an unauthorized procedure.”
In her lifetime, Rivers was known as an acid-tongued commentator, comedian and actress. She lent her distinctive voice to movies like Spaceballs and Shrek 2 and coined the phrase, “Who are you wearing?” during the many fashion-oriented red carpet interviews she conducted at awards shows. At the time of her death, she was working as the host of Fashion Police.