Alaska doctors ration life-saving care as Covid cases clog up

Dr. Jeremy Gitomer at Providence Alaska Medical Center in Anchorage realized last month there weren’t enough dialysis machines to treat the flood of Covid patients suffering from renal damage.

One intubated 70-year old woman, who was also battling kidney failure and on dialysis for six days, wasn’t likely to make it, he recalled.

Gitomer and his medical team decided to terminate her treatment to free up the machine for a 48-year-old man who was also on a ventilator and had a higher chance of recovery if given dialysis. Both patients died in the end, he said, adding that up to 95% of intubated Covid patients on dialysis do not survive in Alaska.

“It’s terrible that I’m living through this because I’ve never seen more people die in my career,” said Gitomer, a nephrologist who works at Anchorage’s three hospitals for the Kidney and Hypertension Clinic of Alaska. “I’ve been doing this 25 years.”

Doctors at Providence have been forced to choose who might live and who will likely die as a crush of Covid patients stretches the hospital’s limited resources to capacity.

Fueled by the highly contagious delta variant, Alaska is in the thick of a surge of cases that devastated the continental U.S. over the summer. To alleviate the burden on the state’s health-care system, Alaskan officials activated “crisis standards of care” on Oct. 2 across 20 hospitals, a measure that gives them some legal protection if they have to choose who will get a bed or ventilator that may save their life while forgoing treatment for others who are less likely to survive.

Anchorage hospitals, where nearly all of the state’s dialysis machines are located, have been forced to reject transfers of patients who have a low chance of survival from other in-state medical centers, Gitomer said. It’s not just putting Covid patients at higher risk. Hospitals are now struggling to treat non-Covid patients with a range of life-threatening conditions, including cancer, accident injuries and organ failure. Patients with brain tumors face extended emergency room delays, prolonging their ability to get an MRI and see a neurosurgeon, doctors say.

Mat-Su Regional Medical Center, located some 40 miles northeast of Anchorage, can’t just transfer renal and heart failure patients to Anchorage like it usually does. The hospital now has to keep some of them overnight and “well enough to make it for outpatient dialysis the next day,” said Dr. Anne Zink, the state’s chief medical officer and an emergency room physician at Mat-Su.

“Instead of one nurse being able to care for four or five…