York outpatient medical center. Tonight we have there will be plenty to talk about in a moment. A source tells cnn investigators are learning this. An unauthorized procedure, a biopsy on rivers vocal chords was begun on the comedienne while she was sedated chl. Sources say there was no consent form signed by rivers. Knowing what is going to happen to you is crucial. The morning began where she was having a scheduled procedure by the clinics doctor, dr. Lawrence cohen, inserting a tiny camera down her throat looking for possible digestive issues, when staffers say cohen saw something. While rivers was still under anesthesia, sources say that the doctor examined her vocal chords and began a biopsy. And in addition to the fact the procedure was unauthorized, our sources say the doctor was not certified to operate there. Even though youre a licensed physician you need to have the checks and balances to get you the approval to practice in a particular place. Reporter and there is more, a source said that the biopsy had never before been completed at the clinic. The whole story says that the biopsy was started. Our sources say as the operation got under way, her vocal chords began to swell, cutting off her oxygen, putting her into cardiac arrest. Doctor, if the brain is deprived of oxygen, what is the effect . The effect on the brain is damage to the nerve cells, which can cause coma, becoming paralyzed. But in the elderly you have less reserve and less of a window to correct it. Reporter when rivers heart stops beating seconds count. It is 9 40 a. M. The clinic calls 911. The call gets the highest code. Five minutes later, new york fire rescue arrives, cpr is under way, a defibrillator is under way. Fire and rescue takes over, 9 47. A mt. Sinai team arrives and joins the effort. A minute later, a second fire rescue unit arrives. By 9 50 a. M. 10 Emergency Personnel are on the scene. A week later, joan rivers is dead. As new yorks medical examiner and the state Health Department continue to investigate the clinic announcing a shakeup in a statement saying dr. Cohen is not currently performing procedures, nor is he currently serving as medical director. At this time, a source says neither dr. Cohen nor the emt is being accused of wrongdoing. Citing federal privacy laws the clinic declines comment on whether rivers personal doctor was there and performed a biopsy. And now anderson, this headshaking news, while rivers was under anesthesia, rivers personal doctor was taking a selfie, not the kind of thing you may expect from a doctor. Taking a selfie with joan rivers . While she was in the room under anesthesia. So wait a minute, the personal doctor was taking a photo with rivers in the background . In this case, the doctor, in this case, a female was taking a picture in the background, that is according to staffers. With me now is arthur kaplan, the director of the division of ethics in washington, and legal analyst jeffrey toobin. First of all, taking a selfie during an operation like this . I have never heard of it. So you can take pictures of their patients, but you need their permission. You should not be doing it inside the clinical setting because even with consent youre going to try to please your doctor, how many people are going to go no, i dont think so, but you go ahead and operate on me. To do it without consent, without permission, absolute violation of privacy. What do you make of this idea of doing a procedure that has not been preauthorized that the patient has not said yes, okay, if you find something go ahead and biopsy it . Anderson, this is really not an uncommon situation where a person says im going to go ahead and look around and if i see something, maybe well just continue, ill biopsy it or do whatever were going to do you should have consent that goes in that manner. You should consent, to investigate and then do something. You want to consent it all the way through. It is a little odd if that did not happen here why it didnt happen here. That there was not an actual written form . Yeah, to say, i sign up, you have my permission, examine me and if we find something, then dont do anything. Wake me up, well talk about what you need to do. A biopsy, a growth, whatever you need to fine. That is fine, too. Jeff, what do you make of this . How much trouble could the clinic, the doctors be in . Well, certainly all of this is good reason for the rivers family to hire a malpractice lawyer. But i have to say i think it is important that we not try to qui convict the doctors based on what weve seen. As arthur said, it is not uncommon when one procedure is done that the doctors decide to do something while they are inside. That does not seem like an outrageous thing. And the precise wording of the subsequent form, i dont know what the wording was. And it is possible this doctor should not have been there. But this does appear to have been a real doctor who was doing something seemingly reasonable under the circumstances. So it seems like this was not handled in the best way, but whether joan rivers was killed by medical malpractice that seems like a long, long stretch from what has been proved so far. And jeff, the selfie . The selfie is just a terrible thing. And certainly if this thing ever went to a courtroom you can be sure the defense would not want that in front of the jury. It is embarrassing, stupid, unprofessional. I find it hard to believe. I mean, i know it comes from staffers who were there. But if this were her personal doctor i am sure the doctor had plenty of opportunity to get a picture with herself and john rivers, i dont know why she would get one people behave weirdly around celebrities. It doesnt seem out of the question to me. Whether it compromised her care besides being unprofessional, that is a separate question. The idea the doctor was not cleared to perform this in that particular setting, doesnt mean this doctor is not able to perform this properly. And jeff is right, you know, we dont know exactly what the credential ling status was, but what you make this deviation, and say it is true youre not supposed to be licensed here, but come in, help out, well do something additional that was not on the subsequeconsent form. When you get a death and all of this is used against you in a malpractice situation and it all starts to stack up. A bad outcome, you look up and say didnt do this, didnt do that, wrong place, that is troubling. Jeff, there is allegations by authorities. Youre saying also a possibility of a civil lawsuit by the family. Oh, i would say that is the biggest possibility of all the possibilities that are out there. Of course, we dont know what joan rivers condition was, she was an 81yearold woman. As we all know she had had a lot of plastic surgery. I dont know what exactly her health was in those circumstances. I mean, unfortunately, 81yearold people, people at any age sometimes go into cardiac arrest and die. And it is not necessarily a doctors fault. But certainly there does seem to be the basis for further investigation here. And anybody of that age doing something as an outpatient procedure that has to be extra complications and concerns. Absolutely, just by being 81, we all looked at her, and said she had a lot of plastic surgery, when youre 81, you have a problem, that is due to age, you dont have enough reserves. The risk is much higher when youre an older person. The other thing we have going on is does the facility have other equipment . Were seeing other personnel come in, who was on staff. I am sure that will come up as a question, too. Why do we need the outsiders . And the defibrillator, and somebody to run it . One thing that strikes me about this. Celebrity changes so much. The fact that she was a celebrity might have meant that they brought in different doctors. You know, when you start changing rules for celebrities it starts to hurt the celebrities, too. All right, a quick reminder, make sure you set your dvr and watch us. Coming up next, the breaking news, accused of killing a state trooper, this man is, and camouflage, makeup, they have not yet found this man, the latest on the manhunt going on right now. I make a lot of purchases for my business. And i get a lot in return with ink plus from chase. Like 50,000 bonus points when i spent 5,000 in the first 3 months after i opened my account. And i earn 5 times the rewards on internet, phone services and at Office Supply stores. With ink plus i can choose how to redeem my points. Travel, gift cards, even cash back. And my rewards points wont expire. 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Police say he killed brian dixon. A private ceremony was held for him today. Also a flagraising ceremony held for dixon today. Also they say he badly injured alex douglas, were told douglas came out of surgery on monday and is said to be doing much, much better. This shooting happened not far from where we are, he lived about an hour away, and when police got to his house they say his father said two firearms were missing from his house. An ak47 and a rifle. And in terms of what was found in the suspects bedroom, a book titled sniper training. And employment. Today, the press conference gave a little more insight into what the motive may have been. This fellow is extremely dangerous. We have no idea where he is in this community. He has been described as a survivalist who has a lot of training in that particular area. He has made statements about wanting to kill Law Enforcement officers and also to commit massive acts of murder. What his reasons are, we dont know. But he has very strong feelings about Law Enforcement and he seems to be very angry with a lot of things that go on in our society. His father also telling police that his son was well trained and grew up with guns. At one point when he was in high school he was a member of the rifle club. And when asked about his sons shooting abilities he says when his son shoots he never misses. And i understand they found this guys car about two miles from the pond. Right, two and a half miles from the barracks, and inside the car they were able to find camouflage paint, spent shell casings, and military gear. We should also tell you Police Confirm they are working with the fbi, anderson. And one other point. They also had a message for this suspect. They said we will find you. Jason, do we know the area where the car was found . Is it very residential . Are there woods . Do we know . Very wooded area. In fact if it was lighter here you can see from the area where we are it is densely wooded and would be very easy for somebody with survivalist skills like this man has been described in order to blend in, if you will, and hide. That is why police are so deeply concerned about trying to find him before he hurts somebody else. Yeah, jason, appreciate that. Lets dig deeper, i want to bring in a former lapd psychologist and also our law analyst, tom fuente, and deputy director. Jason, theyre saying this is a wooded area. Where does a manhunt like this begin . Because we all believe the suspect would want to get as far away as possible. But in the past weve seen sometimes they actually stay very close. That is right, anderson, and you will recall two years ago the Christopher Dorner case, the lapd police that was killed. He abandoned his car in the mountainous wooded area in San Bernardino county. And they thought this guy has fled the area. He could be within mexico in a day or two. And turns out when he is located weeks later he is located a few 100 yards in the particular you know, the San Bernardino county sheriffs. The big fear you have in a case like this, is a person is going to need shelter, food, water and transportation, if he plans on getting out of the area. And the best way to do that is to do a home invasion. So the public that has Residential Homes in the area, the cabins or shack, theyre vulnerable to him coming there and coming in their home and taking their vehicle. And the other statement, just that he has general hatred sounds like for everybody. And that makes him as dangerous to the public as he is to the police. Also, chris, i imagine what one says they want to do, killing Law Enforcement and what they actually do is two Different Things. And mass murder, that is the worst possible scenario. That is right, this person may not have just one person in mind but the world at large, his vendetta, he made it clear. I think you have to take it seriously. So exactly what tom was saying, is anybody that comes into contact with him should stay clear of him. Notify the authorities and anybody in that region should be very concerned and very vigilant. And talk mentioned the chris dorner situation. He had a grudge against the lapd but he also ended up shooting Police Officers from riverside. That is right, it ended up getting generalized to other Law Enforcement in general. And we dont know the specifics of if there is a certain Law Enforcement agency, this particular guy has a vendetta against. It doesnt sound like it. It sounds like he has a thirst for blood of any sort. And a lot of anger and animosity that he wants to inflict on the world and prove himself. You know, the fact that he has departed to the woods in that vicinity, anybody needs to be very cautious. And tom, just from a Law Enforcement perspective, having somebody who has experience in the woods. Searching the wooded area is a whole different thing that what police normally do searching a residential area or operating in a residential environment. I mean, do they bring in specialists in the woods . How does that work . Well, normally for that kind of search they would be trying to use helicopters with forwardlooking infrared that would look down and be heatseeking for an animal or person moving around. Unfortunately, with those types of equipment they often find deer and bear and other wild animals running around in the woods. And you know, theyre often used, if a lost child is being searched for or Something Like that, there is a lot of technical equipment that can be in. The police are going to have to go doortodoor. Theyre going to have to keep one other thing in mind. The fbi had a case in 2010 involving the militia in michigan where their intent was to kill one Police Officer and ambush hundreds who attended the Police Funeral parade later. And that is going to happen soon for this diseased officer. Tom fuente, appreciate you being on. As always you can find out more on this story and others on cnn. Com where obviously well follow this throughout the evening. Coming up next, the vikings Adrian Peterson, coming up with major news on a sponsor cutting him. And star treatment, allegations against him, generally one gameexpense, now, minnesotas governor is weighing in. Details ahead. For better acce, cutting edge research, and state of the art facilities. And you pay no taxes for ten years. From biotech in brooklyn, to next gen energy in binghamton, to manufacturing in buffalo. Startupny has new businesses popping up across the state. See how startupny can help your business grow at startup. Ny. Gov suddenly youre a mouthbreather. Well, put on a breathe right strip and instantly open your nose up to 38 more than cold medicines alone. So you can breathe and sleep. Shut your mouth and sleep right. Breathe right. 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