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The New York City clinic that treated comedian Joan Rivers made several errors, including not noticing her deteriorating vital signs during surgery, according to a federal investigation.

The U.S. Department of Health and Human Services released its report on Monday.

Rivers, 81, died on Sept. 4, a week after being rushed to Manhattan’s Mount Sinai Hospital after her heart stopped during throat surgery at the Yorkville Endoscopy clinic. Doctors at the hospital put her in an induced coma from which she never awoke.

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According to the report, Rivers’ vital signs were deteriorating for at least 15 minutes before cardiopulmonary resuscitation began, The New York Times reported. The report also said that Dr. Lawrence Cohen, who served as medical director of the clinic, took pictures on his cellphone of an unconscious Rivers on the operating table with her ear, nose and throat doctor. Cohen has since left the clinic.

Rivers was identified as Patient #1 in the report, according to the Times. The comedian and talk show host was at the clinic for a routine procedure to examine her throat.

Rivers’ daughter, Melissa, said in a statement issued by her attorneys that she was “outraged by the misconduct and mismanagement now shown to have occurred before, during and after the procedure.”

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