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Comedienne Joan Rivers died of brain damage from low blood oxygen, the New York medical examiner’s office concluded.
The star died on September 4, aged 81 after being on life support for a week following a cardiac arrest during a routine medical procedure.
Her death was ruled as a “therapeutic complication”, which means it was a known risk of the procedure.
The medical examiner listed the cause of death as anoxic encephalopathy due to hypoxic arrest – a condition caused when brain tissue is deprived of oxygen leading to brain damage.
Rivers had been sedated with propofol during her outpatient procedure examining the back of her throat and vocal cords.
She was admitted to Mount Sinai Hospital after she stopped breathing, where she was put on life support. Hypoxia and cardiac arrest are rare but existent side effects of propofol.
Medical malpractice lawyer Steven Harris told Associated Press that every surgery is like playing Russian roulette.
“I always tell my clients when they come through here, every time you have surgery you’re playing Russian roulette. The more surgery, the more the numbers can catch up with you – and as we know, Ms Rivers had a lot of surgery.”
The medical examiner’s ruling, however, does not prevent Rivers’ family from filing a legal claim against the clinic where the procedure took place.
Rivers’ daughter, Melissa, said she had no comment on the ruling.
“We continue to be saddened by our tragic loss and grateful for the enormous outpouring of love and support from around the world.”