ST. LOUIS • John Cochran VA Medical Center in St. Louis has again been cited for health and leadership problems after a nurse failed to monitor a patient who died following kidney dialysis.

The nurse did not recognize or report that a man, 58, became unresponsive at some point during a five-hour dialysis treatment in December 2010, according to a report released Monday by the Veterans Affairs Office of Inspector General.

When his condition was discovered by emergency responders, the man was admitted to the intensive care unit and died the next day. An autopsy showed inflammation and bleeding around the heart associated with kidney failure, according to the report.

In the last two years the veterans hospital has also been cited for violating sterilization rules in its dental clinic and operating rooms.

Federal health inspectors visited the hospital in May 2011 after receiving complaints about the dialysis clinic. The allegations involved the patient who died, another patient who may have received inadequate care, favoritism by the nurse manager and improper blood testing procedures.

The investigators concluded that the first patient did not receive adequate care because the man "was well known to the (dialysis) staff and the subject (nurse) presumably should have been able to identify a decline in the patient's mental status."

The investigators did not find evidence of other patients who were treated improperly. They also discounted the allegations of favoritism in the department and improper blood testing.

They did find fault with management, citing "a lack of effective nursing leadership" with "no policy for reporting events to the charge nurse or a physician."

Federal health officials recommended that the hospital clearly define the responsibilities of its nurses and make sure the nurses are competent in those tasks.

The hospital hired additional registered nurses for the unit and has completed the recommendations, according to director RimaAnn Nelson.

It is at least the second time this year the federal agency has reported problems at Cochran. In April, the inspector general's office cited ongoing issues with the hospital's sterilization procedures, two years after problems in the dental clinic were first identified.

In 2010, the hospital notified more than 1,800 veterans that they might have been exposed to HIV, hepatitis or other viruses in the facility's dental clinic after tools were found to be visibly dirty even after going through the sterilization process. Four of the veterans later tested positive for hepatitis, although it was never determined if their exposure occurred at the dental clinic.

More sterilization problems were found in February 2011 when the hospital shut down its operating rooms after rust stains were discovered on surgical equipment.

The operating rooms were cleared to reopen after a month of testing, cleaning and replacing of faulty equipment.

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