BOONVILLE, IN - A state inspection at Transcendent Healthcare of Boonville revealed the facility failed to provide a resident with physician-prescribed hemorrhoid medication for multiple weeks despite repeated requests, according to a complaint investigation completed in May 2025.
Missing Medication Leaves Resident Without Pain Relief
The investigation, conducted on May 21, 2025, found that a resident diagnosed with anxiety, irritable bowel syndrome, and hypertension had been requesting his prescribed hemorrhoid cream "multiple times" without receiving the medication. The resident, identified as Resident C in the report, told inspectors during an interview that while he typically received his ordered medications, "he had not been receiving a routine hemorrhoid cream and had asked for multiple times."
The prescribed medication was a specialized compound cream containing Baclofen, Diltiazem, and Amitriptyline, ordered by the resident's physician on March 20, 2025. The topical treatment was specifically prescribed to be applied twice daily to reduce inflammation and pain related to a rectal fissure - a painful tear in the lining of the anal canal.
When state inspectors investigated the complaint, nursing staff were unable to locate the medication anywhere in the facility. The Assistant Director of Nursing initially believed the cream should be stored in the treatment cart but discovered it was missing after conducting a search. The Director of Nursing later confirmed she could not find any pharmacy delivery receipt proving the medication had ever been delivered to the facility.
Medical Significance of Delayed Treatment
Hemorrhoid and rectal fissure treatments serve critical functions in patient comfort and healing. The prescribed compound cream contained three active ingredients designed to work together: Baclofen acts as a muscle relaxant to reduce anal sphincter spasm, Diltiazem helps improve blood flow to promote healing, and Amitriptyline provides pain relief and reduces nerve sensitivity.
Without proper treatment, rectal fissures can become chronic conditions causing severe pain during bowel movements, leading to constipation as patients avoid defecation. This creates a cycle where hard stools further irritate the fissure, preventing healing and potentially requiring surgical intervention.
For residents with irritable bowel syndrome, like Resident C, untreated rectal conditions can significantly worsen existing gastrointestinal symptoms and overall quality of life. The combination of chronic pain and digestive issues can also impact mental health, particularly concerning for someone already diagnosed with anxiety.
Facility Policy Violations
The nursing home's own medication policy requires that prescription refills be reordered from the pharmacy at least three days before the last dose is administered to ensure continuous availability. The facility policy, provided to inspectors, specifically states that "drugs and biologicals that are required to be refilled must be reordered from the issuing pharmacy not less than three (3) days prior to the last dosage being administered to ensure that refills are readily available."
This policy violation indicates potential systemic issues with medication management protocols. Proper pharmaceutical services in long-term care facilities require established procedures for tracking medication supplies, coordinating with pharmacies, and ensuring timely delivery of prescribed treatments.
Federal regulations mandate that nursing homes provide adequate pharmaceutical services to meet each resident's needs. This includes employing or obtaining services from licensed pharmacists and maintaining proper medication management systems to prevent treatment gaps.
Broader Implications for Patient Care
The failure to provide prescribed medication represents a fundamental breakdown in the medication management system that could affect multiple residents. When facilities cannot track whether medications have been delivered or maintain adequate supplies of prescribed treatments, residents face unnecessary health risks and discomfort.
Effective pain management is particularly crucial in long-term care settings where residents may have limited ability to advocate for themselves or seek alternative care. The resident's repeated requests for the missing medication suggest he experienced ongoing discomfort that could have been prevented with proper pharmaceutical services.
The violation occurred despite the facility having established policies designed to prevent such medication gaps, indicating potential issues with policy implementation or staff training on medication management procedures.
Regulatory Response
The state inspection classified this violation under federal tag F0755, which addresses pharmaceutical services requirements. The violation was categorized as causing "minimal harm or potential for actual harm" affecting "few" residents, though the prolonged nature of the medication absence suggests the potential for more significant impact.
The investigation was conducted in response to a formal complaint filed with state regulators, demonstrating the importance of external oversight in identifying care quality issues that might otherwise go unaddressed.
This incident highlights the critical role of proper medication management systems in ensuring residents receive prescribed treatments without interruption, particularly for conditions requiring ongoing therapeutic intervention.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Transcendent Healthcare of Boonville from 2025-05-21 including all violations, facility responses, and corrective action plans.
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