Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 530033 (X3) Date Survey Completed 01/02/2018
Name of Provider or Supplier Mountain View Regional Hospital Street Address, City, State 6550 East 2nd Street, Casper, WY
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
A2400 COMPLIANCE WITH 489.24
CFR(s): 489.20(l)

[The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24.


This STANDARD is not met as evidenced by:
Based on interviews with staff, law enforcement, and DFS (Division of Family Services), and review of policies and procedures, police report, and event report, the facility failed to ensure a policy was developed to address a situation in which local law enforcement was called by the facility as an intervention for 1 of 1 confused family member. The findings were Refer to A2406 for details concerning facility failure to perform a Medical Screening Exam for a patient's family member who was in the waiting room and appeared confused. In addition, the facility lacked a policy for notification of law enforcement for this type of situation that did not include an unlawful act.