Joan Rivers Update - According to a report released on Monday, state health investigators revealed the Manhattan clinic where Joan Rivers suffered a cardiac arrest during a medical procedure failed to follow standard protocols while treating her. Rivers died on Sept. 4, a week after she stopped breathing at the Yorkville Endoscopy Centre.

Based on the latest update about Joan Rivers' death, the Department of Health mentioned multiple mistakes, including failing to detect the comedian's deteriorating vital signs during the procedure. According to BBC News, the New York medical examiner's office ruled Rivers died of brain damage due to lack of oxygen during the procedure examining the back of her vocal cords and throat.

During the medical procedure, Joan Rivers had been sedated with the anesthetic Propofol, but the report said there were inconsistencies recorded in its dosage. It also added there was no record that staff at the clinic weighed Rivers before administering the drug. Fox News reported Joan Rivers' death was classified as a "therapeutic complication," which means it was a known risk.

As said on the latest Joan Rivers' update, a patient usually sign a waiver before surgery to confirm they understand the risks. However, the report said there were no records of medical consent signed by Rivers for all the procedures performed.

Investigators also mentioned the clinic violated its mobile phone policy when a personnel took photos of the 81-year-old entertainer without her consent and while she was under anesthesia.   

As a result of the state investigation, the federal Department of Health and Human Services has given Yorkville Endoscopy Centre until Jan. 7 to correct their deficiencies to avoid losing Medicare accreditation.

In response to the report, CNN said Yorkville clinic released a statement saying it has been cooperative and already taken steps to correct the situation.

"In response to the statement of deficiencies, Yorkville immediately submitted and implemented a plan of correction that addressed all issues raised," the clinic stated. "The regulatory agencies are currently reviewing the corrective plan of action and have been in regular contact with Yorkville. In addition, the physicians involved in the direct care and treatment referenced in the report no longer practice or provide services at Yorkville."

As per the latest Joan Rivers' update, the comedian's daughter, Melissa Rivers said she was "outraged by the misconduct and mismanagement" that occurred. And she wanted to ensure it does not happen again to other patients. Melissa's legal team are investigating the circumstances surrounding her mother's death.

"[Melissa Rivers] is terribly disappointed to learn of the multiple failings on the part of medical personnel and the clinic as evidenced by the CMS report," as stated by Melissa Rivers' lawyers. "As any of us would be, Ms. Rivers is outraged by the misconduct and mismanagement now shown to have occurred before, during and after the procedure."

In line with the latest Joan Rivers' update, the esteemed comedian's official cause of death is anoxic encephalopathy due to hypoxic arrest during laryngoscopy and upper gastrointestinal endoscopy with Propofol sedation.

In 2009, Propofol hit the headlines after the death of superstar Michael Jackson, when it was revealed he had overdosed on the powerful sedative.

According to the recent Joan Rivers' update, Melissa's legal team needs to obtain her mother's medical records before filing a case in Manhattan Supreme Court. In The Daily Mail report, 46-year-old Melissa Rivers will file a multimillion-dollar medical malpractice and wrongful death lawsuit against Yorkville and is working with elite firm Gair, Gair, Conason, Steigman, Mackauf, Bloom and Rubinowitz.