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 531310 (X3) Date Survey Completed 05/03/2012
Name of Provider or Supplier Powell Valley Hospital Street Address, City, State 777 Avenue H, Powell, 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)
C0323 ADMINISTRATION OF ANESTHESIA
CFR(s): 485.639(c)(1)

The CAH designates the person who is allowed to administer anesthesia to CAH patients in accordance with its approved policies and procedures and with State scope of practice laws. Anesthesia must be administered by only - (i) a qualified anesthesiologist; (ii) a doctor of medicine or osteopathy other than an anesthesiologist, including an osteopathic practitioner recognized under section 1101(a)(7) of the Act; (iii) a doctor of dental surgery or dental medicine; (iv) a doctor of podiatric medicine; (v) a certified registered nurse anesthetist (CRNA), as defined in Sec. 410.69(b) of this chapter; (vi) an anesthesiologist's assistant, as defined in Sec. 410.69(b) of this chapter; or (vii) a supervised trainee in an approved educational program, as described in ยงยง413.85 or 413.86 of this chapter.


This STANDARD is not met as evidenced by:
Based on staff interview, review of credentialing privileges for 4 physicians and 1 physician's assistant, and review of policies and procedures, the facility failed to develop policies and procedures that specified the physicians or physician assistants who could administer anesthesia, thus failing to meet the regulatory criteria for conducting post-anesthesia evaluations. This failure had the potential to affect any surgical patient whose post-anesthesia evaluation was conducted by a physician or physician's assistant. The findings were: During an interview with the interim nurse manager and CRNA #1 on 5/1/12 at 2:35 PM, the CRNA stated outpatients sometimes left the facility before a post-anesthesia evaluation could be performed. He further stated he was aware that a physician could perform the evaluation. However, he did not think there were policies and procedures specifying which physicians could administer anesthesia. Review of the credentialing files for physicians #1, #2, #3, #4, and physician assistant #1 verified they were not credentialed to provide anesthesia. Review of surgical policies and procedures confirmed the lack of those policies.