SPRINGFIELD, IL – The Illinois Department of Public Health has fined Walnut Ridge Rehabilitation and Healthcare Center $10,000 (Statement of Violation) for failure to properly administer physician-ordered medications to two residents. The 251-bed skilled care facility is located at 555 W. Carpenter St. in Springfield.

Responding to complaints, Department investigators learned a resident, who was admitted to the facility for hospice care, mistakenly received 20 times the prescribed dose of pain medication. The resident's physician was not notified until almost 24 hours after the error and just hours before the resident died.

Department surveyors noted that the medication label clearly identified the proper dosage – 0.25 cc – and a dropper was included to assist with measuring small doses.

In another incident, facility nurses failed to follow physician's orders to decrease a resident's blood thinner medication. According to facility records, the resident received a higher dose of the medication for 23 days before the mistake was discovered.

A Department-ordered plan of correction required the facility to review its policies and procedures for administering physician-ordered medications and to ensure a resident's doctor is immediately notified when a medication error occurs.

Walnut Ridge has requested a hearing on the Department's action. No hearing date has been set.