New York clinic that treated Joan Rivers could lose license

NEW YORK -- The Upper East Side clinic where Joan Rivers underwent a procedure right before her death is now in danger of losing its accreditation.

An investigation into Yorkville Endoscopy by the state health department revealed breaches in four required areas, including management, surgical services, medical staff and patient rights.

Specific details were not released.

The Centers for Medicare and Medicaid Services, the federal subsidiary of the Department of Health and Human Services that certifies ambulatory surgery facilities, notified the clinic that "Yorkville Endoscopy LLC no longer meets the requirements for participation as a supplier of services in the Medicare program."

Accreditation will be terminated January 7, 2015, unless the clinic can prove it has corrected the deficiencies, according to the state officials.

Rivers died last month after going into cardiac arrest during a procedure at the facility.

A Yorkville Endoscopy spokesperson released the following statement:

"The Center has been working collaboratively with appropriate government regulatory agencies to ensure complete compliance with all regulations. The Center remains open and will continue to collaborate with all accreditation and government regulatory agencies to ensure quality care."

On Thursday, the New York City Medical Examiner released its report on the investigation into Rivers' cause of death, concluding that the comedy legend died from low blood oxygen during a medical procedure.

The report said the death was caused by "anoxic encephalopathy due to hypoxic arrest during laryngoscopy and upper gastrointestinal endoscopy with propofol sedation for evaluation of voice changes and gastroesophageal reflux disease."

The report said the manner of death is therapeutic complication.

The finding was that Rivers was sedated with propofol before she died of low blood oxygen during a procedure to treat voice changes and acid reflux.

Anoxic encephalopathy means that she did not have sufficient oxygen to her brain tissue for a prolonged period of time, which caused damage to her brain.

The classification of a death as a therapeutic complication means that the death resulted from a predictable complication of medical therapy, the autopsy concluded. The classification is not commonly used; more deaths are certified as homicides, suicides or natural causes.

Rivers' daughter and TV partner Melissa Rivers said they 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," she said in a statement.