Peterson Rehab: Pain Medication Delays for Dying Resident - WV
That is what federal inspectors documented after a complaint investigation at Peterson Rehabilitation and Healthcare, a 137-bed facility on Homestead Avenue in Wheeling. The inspection, completed October 8, 2025, found the facility failed to provide timely pain medication to a resident on hospice care who was dying.
The resident, identified in inspection records only as Resident 46, had a terminal prognosis. His diagnoses included a fracture of the first lumbar vertebra, compression fractures at T11 and T12, right hip pain, muscle spasms, and diabetes. His physician had ordered morphine sulfate, 0.25 milliliters by mouth, available every hour as needed for pain or shortness of breath. His care plan noted he was at risk for pain related to his end-of-life condition and encouraged him to ask for medication before the pain became too intense.
He was asking. The medication wasn't coming.
During an interview with inspectors on October 7, Resident 46 said that at times he had to wait a long period of time for staff to bring his pain medication. His granddaughter told inspectors by phone that she had been visiting him on July 26, 2025, when he told her he was hurting. She asked staff for his pain medication at approximately 2:30 in the afternoon. More than an hour passed. She called her mother. The two of them stayed on the phone together for another couple of hours before a nurse finally administered the morphine.
His daughter told inspectors the same pattern: her father was often in pain, and she didn't feel the facility was giving him his medications when he needed them. On August 26, 2025, her own daughter called her to report that Resident 46 was in pain and had asked for medication. The daughter said it took at least another hour before anyone gave it to him.
The medical record confirmed the August 26 delay. Inspectors reviewed the Treatment Administration Record and found the morphine was documented as administered at 6:19 in the evening. The record review was conducted alongside the family interviews, and the timeline matched what the granddaughter and daughter had described.
The Director of Nursing, interviewed the morning of October 8, acknowledged that the pain medication had not been given to Resident 46 in a timely manner on August 26.
That acknowledgment is notable for what it does not resolve. The inspection covers a complaint, not a routine survey, which means someone filed a report with the state before inspectors ever arrived. The family had been raising concerns. The daughter told inspectors she didn't feel the facility was giving her father his medications when he needed them, a statement that suggests this was not a one-time lapse she was describing but a pattern she had come to expect.
A man at the end of his life, with fractures in his spine and a physician's order allowing him morphine every hour as needed, waited in pain while his granddaughter stood in his room making phone calls. The facility's own care plan had anticipated exactly this risk and directed staff to respond before the pain became too intense.
The inspection cited the deficiency at a level of minimal harm, the lowest severity designation in the federal rating system. The family's account of a dying man spending hours in unrelieved pain before anyone brought his medication is what the inspection record contains.
Resident 46's daughter told inspectors her father was often in pain. She used the word often.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Peterson Rehabilitation and Healthcare from 2025-10-08 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 23, 2026 · Our methodology
PETERSON REHABILITATION AND HEALTHCARE in WHEELING, WV was cited for violations during a health inspection on October 8, 2025.
The inspection, completed October 8, 2025, found the facility failed to provide timely pain medication to a resident on hospice care who was dying.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.