VA NY Harbor Healthcare System
Doctor's foresight prevents shortage amid pandemic
NEW YORK — With the COVID-19 pandemic raging through the city and country, everyone understood the need for ventilators. But a different deadly complication created another problem: patients experiencing kidney failure were straining dialysis resources.
Fortunately, Dr. David S. Goldfarb, chief of nephrology at VA New York Harbor Healthcare System, predicted this problem and received the support he needed to ramp up equipment and personnel. The renowned nephrologist had the foresight to solve the problem before it existed, and as a result, every patient who needed it received life-saving kidney replacement therapy.
“We had to be creative – innovative – to make sure we were doing everything we could to treat patients with kidney failure,” Goldfarb said, adding that VA, the hospital, nurses and volunteers all helped make it possible. It was a tremendous team effort with evolving challenges.
In mid-April, as many ICU patients began to lose kidney function, media began breaking the story about this overlooked problem, citing doctors around New York City stating patients had a dire need for dialysis. Goldfarb himself was cited in a New York Times article that fully explained the gravity of the situation, saying nothing like this had ever been seen in terms of patients facing acute renal failure.
Goldfarb correctly estimated that about 30 percent of ICU patients would suffer some form of kidney failure, and as it turned out, hospitals were indeed running out of the supplies and nurses they needed to provide this emergency procedure. At New York Harbor, Goldfarb (with the cooperation of hospital leadership) had already procured cutting edge dialysis machines, fluids, and had nurses in place to help.
“In talks with Dr. Goldfarb and his colleague Dr. Marie-Alex Michel at our Brooklyn campus we realized we had a significant challenge to deal with,” said Dr. Patrick Malloy, executive chief of staff at Harbor. “We made an emergency procurement for cutting edge dialysis machines and I believe we were the first VA medical center to use them. We understood there was a local and national shortage of fluids for the machines, so we quickly worked with our logistics department and supply chain to get them.”
Malloy went on to explain that without Goldfarb’s foresight, the hospital would’ve had a much tougher time meeting these patients’ significant acute care needs. With the scale and sometimes mystery of emerging COVID-related care problems, Malloy worked exhaustively to ensure his doctors had what they needed to treat patients.
Notably, the patients here weren’t just veterans. Less than a month before the media broke the story of dialysis shortages in mid-April, VA Secretary Robert Wilkie had announced the department was invoking its “Fourth Mission,” meaning VA medical centers were opening 1,500 beds to civilian, humanitarian patients in need. With 50 of those beds (35 acute, 15 ICU) here at New York Harbor, many of patients who received dialysis here were civilian New Yorkers in need, sent here from city and private hospitals.
“Although things have slowed down and the peak has passed, we are obviously concerned that a second wave in the coming year could lead to a similar set of overwhelming concerns,” Goldfarb said.
The difference, Goldfarb concluded, is that hard-earned experience and an in-depth understanding of the problem have enabled him and his team to be ready for that challenge … should it arrive.