LAKE WACCAMAW, NC - Federal inspectors discovered that Premier Living and Rehab Center failed to obtain critical pain medications from the pharmacy, resulting in multiple residents missing scheduled doses and one requiring two emergency room visits within 24 hours.
Gabapentin Crisis Leads to Emergency Transfers
The most severe case involved a resident prescribed gabapentin 800 milligrams four times daily for nerve pain management. Between May 8 and May 13, 2024, this individual missed 21 consecutive doses because the facility had not obtained the medication from their pharmacy supplier.
The resident experienced escalating symptoms including constant pain rated at 10 out of 10 - the highest level on the pain scale - along with leg numbness and muscle spasms. After missing 14 doses, staff transferred the resident to the emergency department at 2:00 AM on May 12th for treatment of acute pain. Emergency physicians administered gabapentin and returned the resident to the facility the same day.
Despite the emergency intervention, the facility still had not obtained the medication. The resident missed three additional doses on May 12th, leading to worsening muscle spasms that evening. Staff had to transport the resident back to the emergency department for a second time within 24 hours. Again, hospital staff treated the acute pain with gabapentin before discharge back to the facility, where the resident missed four more doses before the medication finally became available.
Multiple Residents Affected by Medication Failures
The investigation revealed this was not an isolated incident. A second resident prescribed gabapentin 800 mg twice daily for nerve pain missed 14 doses between May 10 and May 17, 2024. The prolonged medication gap resulted in documented symptoms including sleep disruption, increased anxiety, irritability, nausea, and inability to complete normal daily activities due to leg pain.
A third resident's opioid medication - Oxycodone/Acetaminophen 10/325 mg - was also not obtained from the pharmacy, though the inspection report notes "multiple missed doses" without specifying the exact number.
Medical Implications of Gabapentin Interruption
Gabapentin works by calming overactive nerve signals that cause neuropathic pain. When patients taking high doses suddenly stop, the nervous system becomes hyperexcitable. This explains why the first resident experienced such severe muscle spasms requiring emergency treatment - the abrupt withdrawal after missing 14+ doses created a rebound effect where nerve activity surged beyond baseline levels.
The medication requires consistent blood levels to maintain effectiveness. Missing even a few doses can trigger breakthrough pain, but missing 21 doses over five days essentially resets the nervous system to an untreated state. For patients with chronic nerve pain, this represents more than discomfort - it constitutes a medical crisis requiring emergency intervention.
Standard pharmacy protocols require facilities to maintain at least a 72-hour emergency supply of all scheduled medications. Automated ordering systems should trigger refills when supplies drop below seven days. The fact that gabapentin remained unavailable for five to seven days across multiple residents indicates systemic failure in the facility's medication procurement process.
Regulatory Violations and Immediate Jeopardy
Federal surveyors cited Premier Living and Rehab Center under regulation F755, which requires facilities to ensure prescribed medications are available and administered as ordered. The violation received an "Immediate Jeopardy" designation - the most serious level indicating resident health or safety was in imminent danger.
The pattern affected "some" residents according to the inspection report, suggesting the medication procurement failures extended beyond the three documented cases. When facilities cannot maintain basic medication supplies, residents face risks including uncontrolled pain, preventable hospitalizations, and potential permanent harm from untreated conditions.
The inspection occurred on July 2, 2024, as part of a complaint investigation. The findings suggest residents or family members reported the medication failures to state authorities, triggering the federal review. Facilities receiving immediate jeopardy citations must submit correction plans and undergo follow-up inspections to verify compliance.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Premier Living and Rehab Center from 2024-07-02 including all violations, facility responses, and corrective action plans.
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