A 27-year-old mental patient from St. Elizabeths Hospital died last month from an over-whelming infection he received from massive bedsores, a condition that is both preventable and curable in its early stages, according to medical authorities in the area.
James A. Pinkney Jr., a diagnosed epileptic who had lived in local mental facilities for 24 of his 27 years, was transferred from St. Elizabeths to Georgetown University Hospital Feb. 14 after his bedsore condition had be come critical.
At Georgetown, doctors tried to save his life by amputating his right leg in an attempt to seal his wounds and stem the infection.
"He was just above a vegetative existence when we saw him," said Dr. John W. Little, a plastic surgeon at Georgetown. "He had a couple of particularly gruesome sores, some dead bone and tissues and problems with bleeding from his sores.
"The only solution was high amputations, an extremely difficult procedure," Little said. "I felt sorry for the nurses who had to care for him. He was such a big man, with big bones and such nasty wounds. It was enough to make even medical people sick."
"His case in an outrage," said a nurse at Georgetown who is familiar with Pinkney's case. "His bedsores were so massive and interconnected when he came here that you could put a catheter (tube) through one side of him and easily out the other.
"I would say he's the victim of bad nursing care [at St. Elizabeths]," said the nurse, who asked not to be Identified. "I'm not saying there are bad nurses at St. Elizabeths. But no nurse could be proud of the care he received."
Little, the plastic surgeon who attended Pinkley, said, "Apparently he had received no treatment for bedsores before he came to us. Early on, the [bedsores] can be treated and will heal. These things are reversible in the beginning by proper care."
Medical authorities say that bedsores, more appropriately called pressure sores, develop when blood circulation is cut off from a portion of the body for an hour or more. In bedridden patients, bedsores can be prevented or at least minimized by turning the patient every couple of hours.
Some medical authorities, including Little and D.C. Medical Examiner James Luke, say death from infection resulting from bedsores is unusual.
However, Dr. Sanford Roman, medical director of D.C. General Hospital, said death from infectious bedsores is fairly common among elderly patients who have other ailments that contribute to the deterioation of their condition. Little said, "Usually, a person does not die from bedsores. But because of the deterioration of his condition (Pinkney's)-and other medical problems-I don't think he would have lived more than a year or two," regardless of the bedsores.
For most of his life, Pinkney led a kind of nomadic existence.His condition was diagnosed as epilepsy at age 3 after he suffered a convulsion for 41 hours, his father said. Soon after, he was transferred from the family home in Southeast Washington to a children's convalescent home in the city, later to Forest Haven, the city's home for the mentally retarded, and then to St. Elizabeths at age 13.
His parents said they lost track of him for awhile and knew little of his medical history.
"His mother just couldn't stand to see him the way he was," James Pinkney Sr. said. "We didn't understand much about his condition and we didn't visit him too much because his mother would break down every time she saw him."
"He was a happy child who learned to sing 'Your Cheating Heart,' my favorite song, long before he could walk," said his mother Sophia. "I think about it all the time and what really happened to him, I don't know. I'd like to know where things went wrong."
"Whenever he had to be moved, (the facility) would write us a letter," Pinkney said. "But they never wrote us anything about the development of his condition, and they (St. Elizabeths) didn't even let us know about his transfer from St. Elizabeths to Georgetown. I didn't find out until a doctor from Georgetown called me asking permission to do surgery on him."
A spokesman for St. Elizabeths Hospital declined to say how long Pinkney had been bedridden in the hospital's psychiatric ward before he was transferred to St. Elizabeths medical and surgical department. The spokesman also declined to say whether Pinkney had been treated for bedsores in the psychiatric ward. However, the spokesman said the hospital staff had taken appropriate action to care for Pinkney.
By the time Little saw the Pinkneys only child at Georgetown, he had curled into a near fetal position, the result of the progressively worsening deterioration of his central nervous system and brain functions. His hands were curled downward from his wrists and were useless. Huge calcium deposits had built up above his eyebrows from injuries he suffered during massive epileptic seizures that plagued him most of his life, medical authorities said.
"In that condition, he was the most difficult person I could think of to prevent bedsores," Little said. "Because he was drawn up in a near fetal position, he could only lie on the right side or left side.
"If we had seen him earlier, we could have worked to release the joints so that he could turn, and perhaps the massive sores could have been prevented," Little said.
Pinkney's death on April 9 occurred during a time in which St. Elizabeths Hospital had been struggling to regain the accreditation it lost in 1975. At that time, the Joint Commission for the Accreditation of Hospitals cited numerous deficiencies in the quality of care provided at St. Elizabeths.
Last year, after St. Elizabeths failed twice to regain its accreditation, Health, Education and Welfare Secretary Joseph Califano announced that $52.2 million would be spent to improve facilities there. Califano also announced last year that Georgetown University Hospital had signed a contract to take over responsibility for the physical health care of patients at St. Elizabeths.
But for some reason that St. Elizabeths spokesmen would not explain, Pinkney was not transferred to Georgetown until his condition was critical.
Harold Thomas, a spokesman for St. Elizabeths, said Pinkney's death was considered "normal."
Thomas said Pinkney was transferred from his psychiatric ward Jan. 2, 1979, to the medical and surgical service at St. Elizabeths.
"The transfer was made to provide more specialized treatment for a medical condition," Thomas said. "The treating physicians are of the opinion that Mr. Pinkney's case was handled aggressively and appropriately, but the patient did not respond favorably to the course of treatment and a surgical consultation was requested."
On Feb. 14, Thomas said, Pinkney was transferred to Georgetown Hospital for further treatment.
According to a hospital spokesman, Pinkney was originally scheduled to have both legs amputated. But after the right leg was amputated March 15, he became comatose.
Little said he had hoped to stem the infection by plastic surgery, removing the dead tissue and bone and using flaps of skin and muscle to cover the area.
"But when he arrived here (at Georgetown Hospital) he had a lot of dead tissue," Little said. "Maybe tissue destruction occurred rapidly, but there was no medical report that dealt with the time of the sores (when they sent Pinkney to Georgetown) and it has been hard to get information from St. Elizabeths."
Pinkney's parents told a reporter they have also been unable to get information from St. Elizabeths to account for the severity of the bedsores.
"No, I don't think he was treated properly," his father said. "When I asked his psychiatrist, Dr. (C. Jack) Winfrey, if the sores could have been prevented, he said, 'yes.'"
"But Winfrey wouldn't volunteer any information, he just sat there with a woman who took notes in shorthand, and he said he could only answer specific questions that I asked," Pinkney said. "He wouldn't volunteer anything. That really made me bitter."
Winfrey initially agreed to talk to a reporter about the case. But after checking with his superiors he declined to do so, saying they had told him an interview would be inappropriate. CAPTION: Picture, Sophia and James A. Pinkney Sr., parents of the dead man, say they were told little of their son's condition by the various institutions that housed him. By Fred Sweets-The Washington Post