Volume 49, Number 4

Inside This Issue

Picture of Mark Linskey, MD

Mark Linskey, MD

CANS President

President's Message

It has been an eventful month since my last CANS newsletter message. On Saturday April 17th CANS held its Spring Board of Directors meeting. We were once again able to demonstrate that virtual Zoom board meetings are efficient and effective while saving our organization a significant amount of money compared with in-person meetings. In addition to taking care of the business of our organization, we were
able to vote on seven resolutions to be considered at the upcoming Council of State Neurosurgical
Societies (CSNS) meeting and organize our eight CANS CSNS delegates under the guidance and leadership of Dr Patrick Wade, our senior CANS CSNS delegate. I wish to personally thank all members of
the CANS Board for their continued hard work and dedication to CANS.
During the CSNS virtual Zoom meeting Friday and Saturday, April 23-24, CANS was very well represented. I am happy to announce that during the Southwest Quadrant meeting California UC Irvine resident Jordan Xu, MD was chosen as one of the three CSNS Resident Fellows for 2021-22. Congratulations to Dr Xu! Our
eight delegates each gave testimony before the CSNS Reference committee on the seven standard, and
one emergency resolution under consideration. Both during Friday’s Reference Committee testimony and
Saturday’s plenary session the CANS Resolution VI – Improving Diversity, Equity and Inclusion within the
Congress of Neurological Surgeons (CNS) Leadership, triggered extensive discussion and debate. I am
happy to report that our resolution asking the CNS to remove the age restriction for their President officer
eligibility, and thus on their upstream Executive Committee choices, passed by a vote of 43-23. We
successfully argued that the age restriction not only represented age discrimination, but that it had a
disproportionate negative impact on the career path and organized neurosurgery service opportunities
available to our female neurosurgery colleagues, as well as depriving the CNS of excellent talented and
deserving individuals who simply fell 1-5 years outside their current goal posts. This was a very important
CANS initiative that will hopefully have a significant and positive impact on one of our two major national
neurosurgery organizations going forward.
During the CSNS Southwest Quadrant meeting it was pointed out that CA bill AB2114 – Higher Education
Employer-Employee Relations Act: procedures relating to employee termination or discipline ) seeking to amend
the existing law to interject union representation into the house officer discipline and/or termination
processes at the University of CA, which had passed the State Assembly and Senate only to be vetoed by
the Governor last September, was re-introduced February 12, 2021 as AB 615
( As many of you
know all University of CA residents are represented by the Service Employee International Union (SEIU). This
union, has worked with Democratic State Assembly member Freddie Rodriguez, to get both AB 2114 and now AB 615 introduced. In the
past, the University of CA came out strongly opposed to AB2114. More importantly the American Board of
Medical Specialties (ABMS) of which the American Board of Neurological Surgeons (ABNS) is a part came
out in writing opposing this bill and notifying of potentially undesirable consequences for our residency
graduates if the bill goes on to pass. They have each now taken the same position opposing newly
submitted AB 615. In essence, if this new bill passes, the ABMS has threatened to not accept as qualified
for board certification any residency graduate from a residency training program where their continued
employment was subject to the oversight or decision reversal by any body or individual external to the
GME Training Program and/or Sponsoring Institution. Clearly this could affect the future ability of residents
graduating from any UC Neurosurgery residency training program from being able to be ABNS-Certified. It
is also clear that the UC and ABMS opposition letters did not stop AB 2114 from being passed by both the Senate and the Assembly last August. If it were not for the Governor’s veto in September, it would now be law. What will now happen with the new AB 615 remains to be seen.

Beginning on March 30, the Governor’s office finally began to relent on the California Covid-19 lockdown.
On March 30, both LA county and Orange County were moved from the red-to-the-orange tier, and on
April 6, San Diego County also transitioned. As of April 27, this is still where we stand without further
transition yet to the yellow tier. Most importantly the State of CA finally allowed industry opening for “Private Venues and Events” on April 14, 2021. The most recent information/restrictions/regulations in place can be found at and (Covid-19 Industry
Guidance: Private Venues and Events). Additional California Hotel & Lodging Association (CHLA)
information/restrictions/regulations currently in place can be found at ( ,
Now that we finally have some guidance of parameters for negotiating our next planned Annual Meeting in January 2022, we can finally move forward with planning and venue negotiation. On April 29th we sent out a survey to our industry vendor partners that have supported our in-person meetings from 2018-2020 (three years) assessing their level of interest in sponsoring and/or exhibiting at a proposed CANS meeting
under Orange, Yellow and Green Tier conditions. This week we will be sending out requests for proposals to
3-4 venues in Orange and San Diego Counties asking them to submit proposals for hosting our proposed
meeting also under Orange, Yellow and Green Tier conditions. We should be touring these venues and
reviewing these proposals in May. Once we have allowed additional time to pass to see how other
Neurosurgery in-person meetings as well as in-state other medical in-person profession meetings, and
before any un-refundable deposits come due, we will also be polling each of our CANS members to assess
your interest in attending the proposed meeting with, or without your families.
I think that everyone at the recent CANS Board meeting expressed their sincere hope that the January
2022 CANS meeting under consideration will be able to be an in-person meeting. We all recognize the
desirability of social interaction and re-connection on a professional and personal level, the need to
network, and the utility and desirability of industry and vendor product and services updates. I truly hope
that with continued improvement in vaccine supply and availability that “herd immunity” in California will
be reached by this summer. It is certainly been a pleasure to finally walk around outdoors this week
without a mask. I hope everyone will please reserve Saturday and Sunday January 15-16, 2022 for our 2022
CANS meeting. Please stay tuned to monthly newsletter messages updating everyone on our course and
progress as we work towards this date for our meeting.
I would like to once again remind all CANS members of their 2021 Annual Dues commitment. Many of us
use the CANS Annual Session registration opportunity as the time where we pay our outstanding CANS
dues to allow us to register. This year we did not be have a 2021 formal CANS Annual Session, and as a
result, many members missed this opportunity this year. We derive a significant income for our operational
budget from our Annual Meeting which did not occur. Thus, this year it is extremely critical that every
member take the time to follow this hyperlink to our CANS website and pay our CANS annual dues I would ask every CANS member to please do this right now as you are reading this in
order to help our organization remain fiscally healthy going forward. This is extremely important, and your
participation and support of our organization is greatly appreciated!
I continue to hope that all of our members continue to remain healthy and safe during this trying time with
Covid-19. CANS has yet to hear of any member who has been sick with Covid-19, but we very much want to know and keep track of any such event(s) to measure and document the direct personal impact of the
pandemic among individual California Neurosurgeons. Anyone who knows of a CANS member, or any California neurosurgeon, for that matter, who has been sick with Covid-19, please contact our executive secretary Emily Schile with the particulars at .

Please stay safe everyone. Please support CANS and the CMA, they are fighting for you. All the best! !

Picture of Randall W. Smith, MD

Randall W. Smith, MD


Last Minute Reprieve - Part 2!

House extends moratorium on 2% Medicare sequester cuts through 2021

In a vote of 384-38, the House on Tuesday April 13th passed a bill that eliminates the 2% cut to Medicare payments until the end of 2021. President Biden signed the bill into law.
on April 15th.

The Centers for Medicare and Medicaid Services had instructed Medicare administrative contractors to
hold all claims with dates of service on or after April 1 until the bill was signed by President Biden. Thus the
claims will now be processed.
And so we wait until December to see what will really happen. In the meantime, enjoy the current fantastic reimbursement rate for Medicare patient services.

Where there is smoke . . .
The publication Health Affairs (Volume 40, No. 4 (2021): 603-612) has reported on medical device company’s payments to physicians are 7 times higher than drug company physician payments. They used federal data freely available.

Turns out neurosurgeons and orthopods got the most money and that about 70% of all docs in those specialties got some payments. The average payments were less than 10K which suggests there were
some docs that got a lot more.
The presumption is that the payments were for legitimate assistance in product creation or evaluation or for attending training programs in device usage.

Hard to imagine this data will not attract some governmental attention since this info might raise the specter of kick-back schemes.

Careful out there!

Picture of Deborah C. Henry, MD

Deborah C. Henry, MD

Associate Editor

Brain Waves

My first job other than babysitting and house-cleaning was at Dairy Queen. At sixteen, I was ready
to earn a real paycheck, one that was typed out with my name. At our introductory work
meeting, the DQ manager’s final words to us was to define the word “assume”. Not waiting for an
answer, she said, “If you assume, you make an “ass” out of “u” and “me”. That phrase has stayed with me,
likely because I had never said the word “ass” but too for its meaning of the mistakes we make when we
In the LA Times, (April 13, 2021, p. A11), Pauline Chen writes on being an Asian-American woman surgeon
and that when in an OR with an unknown male scrub nurse, the white male resident was offered the gown
before her, a breech in the established etiquette of gowning the chief surgeon first. She makes a point
that it is her race that makes people assume she is not the surgeon. She does not even suggest that her
gender may be a factor. As I, a white female, have often been mistaken as not being the primary surgeon,
I would beg to differ that it is her gender rather than her race. After all, I suspect that most registered nurse
first assistants (RNFAs) are female as the percent of female RNs in 2020 was between 88-91% (depending
on the source). Faced with the dilemma of whom to gown first, this scrub nurse went with the gender odds
that the woman was a nurse assistant and the male a surgeon. Indeed, there were many times early in my
career that when asked my profession and when I answered neurosurgeon, what was heard was “nurse.”
Later, I would often say brain surgeon as that was rarely misunderstood and sometimes, I was treated with
a moment of awe and ah. Of course, it is equally challenging for the nurse. One of my students when
asked what his eventual career goal was, answered, “I want to be a male nurse.” I quipped back that he
was halfway there.
As a child, we identify with gender before we identify with race. Young children tend to play with their
same gender without regards to skin color. I knew early on that I was a girl before I realized that my skin
color put me in a special category known as white. We are later taught that skin color divides us into racial
groups. I cannot assume what it feels like to be male or to be a different race. I can only listen from the
experiences of others and learn.
You may know the riddle, which I must admit stumped me long ago when I first heard it.
There once was a father and son who were traveling on the interstate. A car swerved in front of them, and
they crashed into the concrete barricade. The father was killed instantly. The son was transported by
ambulance to the nearest hospital. He had severe abdominal injuries that required emergency surgery.
The surgeon on call came down to the emergency room. On seeing the patient, the surgeon remarked, “I
cannot operate on him. He is my son.”
How can this be?
Of course, the surgeon was the son’s mother. !

Picture of Moustapha Abou-Samra, MD

Moustapha Abou-Samra, MD

Associate Editor

Homelessness Do we have the will to eradicate it?

In a recent trip to Austin, Texas, I was struck by the number of homeless people on the streets. They
were everywhere, at every corner and under every bridge. This reminded me of Los Angeles’ skid
row and the tenderloin in San Francisco. Of course, I haven’t been to either location since before
the pandemic started. Somehow, during the pandemic, the homeless became less visible in Ventura,
where I live. I was hoping that homelessness, somehow decreased during the pandemic … but no such
luck, it was simply wishful thinking.
California has had a serious problem with homelessness for a while, and it seems to be getting worse.
The start of homelessness in California can be traced back to the de-institutionalization of the mentally ill
from State Hospitals. This was under Governor Ronald Reagan when he signed the Lanterman-Petris-Short
Act in 1967, thus ending the practice of institutionalizing patients against their will. This was compounded
by “prison reform” under Governor Jerry Brown; it significantly decreased the prison population but
increased the number of the homeless. Both actions were well intended but also poorly executed.
When California de-institutionalized the patients of State Hospitals, the plan was to care for these patients
in community treatment facilities. However, these were never built. During the following year, the number
of the mentally ill entering the criminal system doubled. This created a vicious cycle. A patient would
commit a low-level crime and land in jail where he or she is stabilized and released, only to decompensate
and do it again. Police preferred taking offenders to jail, with the notion that it is a safer environment for
them. Alternatives were not available.
In 1978, the prison population in California was about 25,000. By 2006, it had grown to over 170,000 and 30
percent of the prison population needed mental health services.
By the end of Governor Brown’s term, the prison population decreased by a third, but the percentage of
prisoners who needed mental health services increased significantly and the number of inmates who are
now deemed incompetent to stand trial increased by 60%. This, clearly, puts a strain on the prisons and
In 2020 the number of homeless in Los Angeles was estimated to be 66,000.
Who are the homeless?
According to the Canadian Homelessness Research Network-CHRN-“Homelessness describes the situation
of an individual or family without stable, permanent, appropriate housing, or the immediate prospect,
means and ability of acquiring it. It is the result of systemic or societal barriers, a lack of affordable and
appropriate housing, the individual/household’s financial, mental, cognitive, behavioral or physical
challenges, and/or racism and discrimination. Most people do not choose to be homeless, and the
experience is generally negative, unpleasant, stressful and distressing.” Indeed, a thoughtful and wellcrafted definition.
So, the homeless is not a uniform group. However, I think they mostly fall into three categories: the mentally
ill, the drug addict, and increasingly, the low-income individual who cannot afford the rising cost of
housing; this is particularly acute in California and other expensive cities like Austin.
There are potentially many ways to tackle and hopefully solve this problem, which is a stain on us as a

‘To Advocate for the Practice of California Neurosurgery
Benefitting our Patients and Profession’
In Austin, Texas, Proposition B is on the ballot. The vote is scheduled for May 1, 2021. {A “yes”
vote supports making it a criminal offense (Class C misdemeanor punishable by a fine) for anyone to sit, lie
down, or camp in public areas and prohibiting solicitation of money or other things of value at specific
hours and locations.} As you can imagine, the city is divided on this issue. But is this a solution for
homelessness? I don’t think it is.
Here in California, there is a significant effort to build more affordable housing units throughout the state;
this should be helpful, but it is a short-term solution.
Drug addiction was recently addressed in a New York Times article. It described the problems in San
Francisco and indicated that the drug epidemic claimed 713 lives in 2020, more than twice as many as
died from the coronavirus in the city. Thomas Wolf, one of the loudest critics of the city’s policies was
quoted as saying: “It’s not enough to just hand out clean needles. We need to take it a step further and
get you off the street.” He went on to say: “What I’m pushing for is an urgency for the city to expand and
promote drug treatment for people.” I agree that drug addicts should be off the streets, but not in jail.
As to mental illness, treatment facilities and supervised environments where patients can receive their
medications are essential. But, to me, a percentage of patients are incapable of functioning on their own.
Such patients need to be committed to modern day State Hospitals where they can be treated with
No matter the cause of homelessness, let us not forget that the homeless are people and they should be
treated as human beings.
A recuring thought that haunts me, is this: was the medical profession responsible for the deinstitutionalization of the mentally ill. I’d have to say: to some degree, yes. Maybe we should have been
more forceful in advocating for the institutional humane treatment of those who were and are not able to
function independently. But this should be the topic of another essay.
We live in an affluent Country. We can afford to eradicate homelessness. The question is: do we have the
will to do it?

Jay Levy, MD

CANS Member

Guest Editorial

One of our own got severe COVID and survived!
Like a lot of us, I suspect, I was hoping that since there are so few neurosurgeons as compared to the
population in general, no neurosurgeon I know would get a real case of COVID-19. CANS President Mark
Linskey has been asking for over a year to have any member of CANS report getting COVID-19 or hearing
of someone who did—with no response.
Well, the second shoe dropped when Jay Levy from Napa let us know about his saga with the virus plus a
bout of Guillain-Barre. Here is his story:
Jay Levy here.
I had Covid, and because it was complicated by a neurological disease I’ll tell the whole long story for the
interest of CANS members.
I’m 86 years old, in good health, and did not retire from neurosurgery until I was 81 years old. I did my last
surgery working as a locum’s in North Dakota and retired in 2017 just before my house and property burned
in the wild fire.
I’m now 86 , and considered myself to be in fine health before any symptoms began.
On September 11 I had my annual influenza vaccination.
Two weeks later I began to notice weakness in my hamstrings and quadriceps on both sides.
The last week in September I had to walk off the golf course in the middle of a round because my legs
were weak and I simply couldn’t hit the ball.
In July 2019 I had a decompressive laminectomy at L3 for spinal stenosis with symptoms that were mostly
weakness of the L4 and L5 innervated leg muscles and little of the usual pain.
For this reason I contacted my surgeon and a lumbar MRI was done the following week with no evidence
of recurrent stenosis.
This was during the Covid epidemic and no one had seen me to examine me.
The second week of October I saw my family practitioner and we decided that I could very well have
Guillain Barre syndrome with symptoms of ascending weakness with minimal sensory loss.
An EMG was scheduled for the next week for 21 October.
At that time I could still ambulate and could climb two flights of stairs but with severe muscle fatigue
On Sunday the 18th I happen to use my pulse oximeter and it read 90 instead of the usual 97.
As usually happens when physicians are trying to treat themselves I thought this was a mechanical failure
and not pertinent.

Monday I was confused and Tuesday I really could not think straight, but with no fever, no pulmonary
symptoms of any sort and on Wednesday the 21st the day my EMG had been scheduled I had to go to
the hospital for confusion and increasing weakness.
When they examined my lungs prior to admission there were abnormal findings and I was taken to the emergency room for a chest x-ray which revealed a Covid type pneumonia.

I saw this x-ray and it looked pretty serious to me.

That is the last thing I remember the five weeks.
Because I had Covid the thought of Guillain Barre was ignored and I was sent home.
By the time I got home, a 15 minute ride, I was unable to walk and it was necessary to get help and carry me into my home in a chair.

An ambulance was called and I was returned to the hospital and placed in ICU.

During five weeks in the acute-care hospital including ICU time, I was intubated for a week and subsequently had a tracheostomy placed.

It’s difficult to say how much Covid symptoms were involved in my treatment but clearly the tracheostomy was required because of ascending paralysis.

I did have the usual prescribed treatment for Guillain Barre.
The first memory I have after seeing my chest x-ray on 21 October was being wheeled into the acute rehabilitation units on the last day of November.

At that time I had marked atrophy of my hand muscles but had recovered reasonable strength in my upper extremities and the tracheostomy had been removed.

At that time, however, I was unable to move my lower extremities.

I was in the hospital rehabilitation for a month, and then skilled nursing rehabilitation for two months
Now, with April Fools Day approaching, over five months after Guillain Barre onset, and over four months after exacerbation by Covid I have had gradual improvement every day and am now able to ambulate short distances with ski poles.

My grip strength is now 91 pounds, up from 51 pounds when I first left the acute hospital and though I
sometimes use a wheelchair or a walker I am totally independent in all of my dressing and bathroom

I intend to recover and go back to the golf course, but will just have to be patient and see how long that takes.

A friend of mine from Arkansas told me he knew I would get well because he described me as being
“tough as woodpecker lips”.
I offer this long story because the rapid exacerbation of my weakness related to the onset of the Covid virus infection might be of interest to neurological surgeons.

Also, my ultimate good recovery, particularly at my age, is encouraging.
Jay Levy

Jay’s long suffering wife Jodi had a miserable 5 months as one might imagine and was unable to visit Jay or even communicate with him during his extensive ICU stay. She was alone at their home for 4 months but like most neurosurgeon’s wives, she toughed it out and kept the home fires burning until her man came

Picture of Ciara harraher, MD

Ciara harraher, MD

CANS Treasurer and CMA liaison

Guest Editorial - Covid Re-Entry

Now that I and most of my friends and family are vaccinated, life is starting to edge slowly toward normality. I am still not quite ready to rip my mask off and head into a crowded shopping mall, but I am starting to get excited about the prospect of getting back to more of the things I enjoy and that includes seeing my colleagues in Neurosurgery. There is a high likelihood that by Fall we will be resuming in-person meetings and with that there will be a shift in what has become my “new” norm. I have still gone into my hospital and clinic regularly throughout the pandemic, but my family has also gotten used
to me at home more. I spend frequent evenings and some weekends in my home office on “zoom” but my children can still come in for a quick kiss, let me do their hair for ballet, or show me their homework. That will all change when I start travelling to meetings again, often more than 10 times per year. Or will it?

I think we have all learned that some things can be accomplished just as well using a virtual format. Do we need to all meet in an airport hotel twice a year for a board meeting that takes a few hours in most cases? Probably not. However, I do think that most scientific meetings are more worthwhile in person and I look forward to getting back to them. When I travel for work, I have a separation between being a mother and being a neurosurgeon. I have time to think about improving my practice, learning new
skills or taking on an interesting project. I get to connect with colleagues, share a drink and a laugh and occasionally commiserate about something that only another neurosurgeon can understand. I also get to sleep in a nice bed with no child or dog crawling on top of me. I may even get to sneak in a hotel workout or watch a movie that isn’t animated. It reminds me of something Ruth Bader Ginsburg was quoted as saying some years ago about juggling motherhood and work: “Each part of my
life gave me respite from the other”. When she was home and her children were there, she was a mother and that alone. That break from work allowed her to go back to it re-energized and more focused.
RBG was also very open about shared parenting duties. She didn’t cook and neither do I. Her husband was a true partner in managing their children, as is my husband. The world, however, and especially the world in COVID, does not always assume
those roles. When schools closed in March, I was definitely the one contacted about homeschooling and expected to be on top of
their daily lesson plans. I felt at times like quoting RBG who had been known to tell her children’s school that “This child has two parents, please alternate calls”. People still assume, and often rightly so, that the mother will take care of everything related
to their children. In truth, many more women have had to drop out of the workforce during Covid and who knows the longerterm career consequences on those of us that stayed but had to take on more responsibilities at home. The pandemic has forced
the boundaries between work and home to become less clear.
So, will I be happy to have some of my time back to grow professionally and indulge my career passions? Yes. Will I still wish
at times I could zoom in my PJS with my son snuggling on my lap? Yes, of course!


Spiridon Koulouris, long time CANS member and surgeon at Kaiser, has died.
He asked for no obituary. Our condolences to his family.

Tidbit 1- 7 CSNS Resolutions up for Debate

Seven CSNS resolutions up for debate The Council of State Neurosurgical Societies will conduct a virtual meeting on April 23-24 at which the
following submitted resolutions will be considered. CANS BOD has voted to submit resolution VI for
consideration. Any CANS member who would like to comment on any of the resolutions should contact
our Secretary Joe Chen at

TITLE: Understanding and Facilitating the Process of Retiring From a Career in Neurosurgery
WHEREAS, a growing number of neurosurgeons are reaching the age of retirement, or are seeking to retire
early; and
WHEREAS, there will likely be increasing societal and legal pressure for neurosurgeons to retire from surgical
and clinical duties in their early senior years; and
WHEREAS, retirement is a major epoch in a neurosurgeon’s life and can be fraught with psychological
destabilization, loss of a sense of financial security, loss of motivation, loss of direction, loss of selfworth, loss
of identity, loss of sense of purpose, and more; and WHEREAS, retired neurosurgeons can be anticipated to
remain highly creative, highly productive, highly motivated, highly invested, and highly contributory,
potentially for decades following their retirement; and
WHEREAS, retired neurosurgeons constitute a relatively “untapped” resource in graduate medical, resident,
medical student, allied health, undergraduate, patient and community education; medical-legal analysis
and advising; research; socioeconomic analysis and advocacy; practice advising; wellness promotion;
ethics analysis and advising; public relations and more; and
WHEREAS, the CSNS has committed by resolution to create a Senior Neurosurgeons Representative Section
within CSNS, “so that Senior Neurosurgeons may continue to contribute to Neurosurgery, our Societies, and
the next generation;” therefore
BE IT RESOLVED, that the CNS commits to studying, through surveys, interviews, analysis of scholarly material
and discussion with experts, the overall impact of retirement on neurosurgeons, the experience of retiring
from neurosurgery, the disengagement pathways chosen by retiring neurosurgeons, and the postneurosurgical career and lifestyle choices made by retired neurosurgeons; and
BE IT FURTHER RESOLVED, that the CSNS generates an index of retired neurosurgeons who wish to advise
and assist newly retiring neurosurgeons; and
BE IT FURTHER RESOLVED, that the CSNS commits to a regular educational program on the process of
retirement from a career in neurosurgery, the maintenance of well-being and resilience after retirement
from a career in neurosurgery, and the potential career, lifestyle options, and activity pathways available
to the retiring neurosurgeon.

TITLE: A Call for Organized Neurosurgery to Divest Itself of any Relationship with Elected Officials Who
Helped Incite the Violent Civil Unrest of January 6, 2021
SUBMITTED BY: Gary Simonds MD MS, Cara Rogers DO, Richard Ellenbogen MD, William Monacci MD,
Stephen Ondra MD
WHEREAS, on January 6, 2021, a violent insurrection took place in the United States Capitol building; and
WHEREAS, said violent civil unrest was at least in part incited by the words and behaviors of various
members of the executive and legislative branches of our federal government; and WHEREAS, the insurrection was at least in part a result of a persistent false messaging to the American public that the 2020 Presidential Election was fraudulent and invalid; and WHEREAS, persistent disingenuous assertions about the
validity of the 2020 presidential election has contributed to public distrust in the electoral process and
democracy as a whole, and has contributed to a dangerous sense disenfranchisement amongst a
considerable percentage of the electorate; and
WHEREAS, various neurosurgical organizations have known ties and affiliations with several politicians who
in one form or another contributed to this cynical false narrative about the 2020 Presidential Election
and/or to the violent civil unrest of January 6, 2021; and
WHEREAS, various neurosurgical organizations have made financial contributions to politicians who in one
form or another contributed to this cynical false narrative about the 2020 Presidential Election and/or to
the violent civil unrest of January 6, 2021; and
WHEREAS, it is unconscionable for our representative neurosurgical organizations to be affiliated with or
support any governmental actor(s) who has or will perpetuate such false narratives about the 2020
Presidential Election, promote rejection of the results of the presidential election, and/or contribute to
violent civil unrest in the name of said false narratives; therefore
BE IT RESOLVED, that the CSNS asks its parent organizations to publicly divest themselves of any official
relationship with, or support of, any elected official who helped incite the insurrection of January 6, 2021,
officially contested the validity of the results of the 2020 Presidential Election, and/or have repeatedly
asserted that the presidential election was fraudulent, and its results illegitimate; and,
BE IT FURTHER RESOLVED, that the CSNS requests that the Neurosurgery PAC ceases any relationship with,
and financial support of, any elected official who has helped incite the insurrection of January 6, 2021,
officially contested validity of the results of the 2020 Presidential Election, and/or have repeatedly asserted
that the presidential election was fraudulent, and its results illegitimate.

TITLE: Establishing Curriculum for the Practice of Neurological Surgery During Residency Training
SUBMITTED BY: Nitin Agarwal, M.D., Robert F. Heary, M.D., John K. Ratliff, M.D., Praveen V. Mummaneni,
M.D., M.B.A.
WHEREAS, the practice of medicine is continuing to evolve with a greater focus on value-based care; and
WHEREAS, trainees may not be exposed to formal training regarding neurosurgical practice either at their
local training program or as part of boot camps; and
WHEREAS, a solid foundation is essential for success as an independent practitioner as identified by prior
resolutions with interest from members to create surveys and fund workshops; therefore
BE IT RESOLVED, that the CSNS work with the parent bodies to establish and distribute a formal curriculum
for trainees geared towards neurosurgical practice management, including billing, coding, and
compliance; and
BE IT FURTHER RESOLVED, that the content from this curriculum be incorporated into the written ABNS
primary examination and further emphasized in the oral examination to highlight the importance of this
knowledge; and
BE IT FURTHER RESOLVED, that in the meantime the CSNS work with the parent bodies to integrate chief
residents and fellows into ongoing practice management and coding courses.
TITLE: Defining Veritable Legal and Fiscal Counseling
SUBMITTED BY: Nitin Agarwal, M.D., Ann R. Stroink, M.D., Catherine A. Mazzola, M.D., Robert F. Heary, M.D.,
on behalf of the Medico-Legal Committee
WHEREAS, many trainees may not be well versed in contract negotiation or wealth management; and
WHEREAS, upon transition from residency and fellowship to the workforce, trainees may seek legal counsel
or financial advice but do not know where to find veritable information or advocates; and
WHEREAS, all healthcare providers should have easy access to a true fiduciary; therefore
BE IT RESOLVED, that the CSNS form a task force to identify veritable sources of legal and fiscal counseling
for trainees and those transitioning jobs; and
BE IT FURTHER RESOLVED, that the CSNS works towards dissemination of these resources both through
training programs but also online within the dedicated education sections of the parent bodies

TITLE: Publication of Patient Generated Outcome Measures
SUBMITTED BY: Mick Perez-Cruet, M.D., M.S., Ann Parr, M.D., Catherine Mazzola, M.D., on behalf of the
Medico-Legal Committee
WHEREAS, Patient generated outcomes and surveys are rapidly becoming standard of care in many
neurosurgical practices and are particularly important in validating spinal procedures; and
WHEREAS, Quality improvement methods to improve health care quality and safety often do not require
Institutional review board (IRB) approval; and
WHEREAS, Data and publications that demonstrate the effectiveness and safety of neurosurgi- cal
treatment is paramount to payers (insurance companies) reimbursement for neurosurgical services; and
WHEREAS, Many neurosurgical practices, both academic and private, do not have ready access to
administrative personnel for internal review board (IRB) peer review publication of patient generated
outcomes focused on quality improvement of patient care and safety, and are uncertain which types of
patient generated data/ surveys need IRB approval; therefore
BE IT RESOLVED, that the CSNS form a task force to identify IRB requirements for neurosurgical practice
publication of patient generated outcomes and surveys; and
BE IT FURTHER RESOLVED, that the CSNS works towards mechanisms that facilitate publication of patient
generated outcomes studies and surveys without administrative demands required by IRB approval.

SUBMITTED BY: The California Association of Neurological Surgeons (CANS)
WHEREAS, in Article III, Executive Committee (Board of Directors), Section 2, Number and Election,
paragraph C, the Congress of Neurological Surgeons (CNS) bylaws states that ….” No person shall be
nominated as a member of the Executive Committee after such person reaches the age of forty-nine (49)
years”, and
WHEREAS, age is considered a protected category against employment discrimination under most Equal
Employment Opportunity Laws with age discrimination illegal for employment and frowned upon for
service organizational inclusion purposes, and WHEREAS, age cut-offs disproportionately negatively impact,
and differentially discriminate against, the professional service careers of women in neurosurgery as they
often delay professional and service itineraries for personal and family reasons, whereas men in
neurosurgery do not usually suffer from similar constraints and/or choice requirements, and
WHEREAS, the CNS has never had a woman neurosurgeon President, and
WHEREAS, none of the eight current CNS officers are woman, and
WHEREAS, only three of the current 12 voting members of the CNS Executive Committee (EC) are woman,
WHEREAS, the historical reason(s) for this age criteria cut off, to create a professional society allowing
access and priority to younger neurosurgeons where those opportunities did not exist elsewhere in
organized neurosurgery, no longer exists, as the American Association of Neurological Surgeons (AANS)
now offers classes of membership as well as leadership potential to neurosurgeons of all ages, and
WHEREAS, even the CNS, themselves, has within the recent past “moved the goal posts” for EC age cutoff
several times using bylaws changes to extend the age cutoff to allow selected members of the CNS EC to
ascend to the Presidency position in the CNS, and
California Association of Neurological Surgeons Volume 49 Number 3 March 2021
WHEREAS, a CNS EC age cut-off is not only no longer necessary, but actually robs the CNS of the potential
executive committee and leadership service of some highly experienced, talented, and servicededicated neurosurgeons who are Active Members of the CNS, but happen to be over age 49; therefore
BE IT RESOLVED that the Council of State Neurosurgical Societies formally petition the Congress of
Neurological Surgeons (CNS) to eliminate their current age restriction for CNS Executive Committee
membership from their bylaws to allow potential CNS leadership position access, and EC service
opportunities to all Active CNS members regardless of age.

TITLE: Maintaining Surgical Cadaveric Training
SUBMITTED BY: Cletus Cheyuo, Redi Rahmani, Kris Kimmell, Bharat Guthikonda WHEREAS, there is an
increasing reliance on imaging and navigation for procedures in neurosurgery eroding knowledge of
anatomy; and
WHEREAS, an increasing number of surgical specialties, including neurosurgery, are experimenting with 3-D
printing and virtual simulators for surgical teaching; and
WHEREAS, these technologies while adaptive, will not be able to, in the foreseeable future, mimic real
tissue qualities and normal anatomic variants of cadaveric specimen or the ability to dissect surrounding
anatomy with alacrity; and
WHEREAS, the continued push for technology-based learning will lead to a decrease in cadaveric learning,
leading to loss of benefits of such learning; therefore
BE IT RESOLVED, that the CSNS conduct a survey to evaluate the number of cadaveric learning
opportunities each program has over a one-year period; and
BE IT FURTHER RESOLVED, that the CSNS encourage the parent bodies to work with the SNS to create a
standardized cadaveric curriculum for neurosurgery programs.

Tidbit 1 - The meeting was virtual—the issues were real

The CANS Board of Directors met via Zoom on Saturday morning the 17th of April.
Noteworthy were the following:
1. Plans for the annual CANS meeting in January 2022 are still fluid but it appears that physical meetings are likely to be allowed. Venues being considered are the Laguna Cliffs Marriott, the
Westin Carlsbad Marriott and the San Diego Hotel Del Coronado. The CNS meeting in October will be a bellwether for physical vs virtual meetings in Texas but we will need to sign a venue contract earlier than that so meetings in California in late summer will be more telling. The travel restrictions on employees of the University of California as well as Stanford and USC will need to be lifted if we want our academic colleagues to attend.
2. The board decided to strongly support Dr. Richard Pan to head the HHS Health and Resources Service Administration which administers various maternal and child health programs as well as trauma and GME issues. Dr. Pan, a practicing pediatrician in Sacrament and member of the California Senate, has received the CANS public service award for his efforts to assure vaccinations for children.
3. The CANS virtual Special Session meeting in January was supported by 6 companies: BK Medical,
DePuy, Globus, Medtronic, NuVasive and Stryker to the tune of $18,000 with basically no overhead
so that plus expected dues for 2021 will leave about a 25K shortfall in covering the costs of running
CANS for 2021, the deficit being covered by about 140K in reserves.
4. The Board voted to create as policy that the recipients of the Resident Awards for papers presented
at the annual meeting shall be determined by the Program Committee and not the Awards
5. The Board congratulated CANS Treasurer Ciara Harraher on her nomination to be President of the
Santa Cruz County Medical Society.
6. Finally, the Board took positions on the seven Resolutions to be debated at the virtual Council of
State Neurosurgical Societies on April 23-24. Those positions are indicated in the article on the CSNS
meeting elsewhere in this newsletter.
California Association of Neurological Surgeons

Tidbit 2 - You as an employer in the #MeToo era—a gift from CAP

Even though the January 1 deadline has passed, you can still stay compliant to avoid the legal risks
associated with sexual harassment in the workplace. All California employers with five or more employees
must provide sexual harassment avoidance training for their staff every two years.
The Cooperative of American Physicians (CAP) is pleased to provide at no cost a two-hour supervisory
course and one-hour non-supervisory course for you and your staff to help your practice meet the state
Sign Up Now
This free and easy program provides:
• Convenient Online, On-Demand Access
• Supervisory and Non-Supervisory Courses
• Certificates of Completion to Demonstrate Compliance
• An Easy-to-Use Interactive Format
Until recently, CAP offered this free course, which can cost hundreds of dollars elsewhere, exclusively to its
physician members. As part of our commitment to helping all physicians succeed in their practices, CAP is
waiving the membership requirement and recommends that your practice train your employees now.

The Observation for the Month

grounding of that cargo ship in the Suez canal was a bellwether for
the last year—stuck in the mud.


Meetings of Interest for the next 12 months:

AANS/CNS Joint Cerebrovascular Section: Annual Meeting, July 26-30, 2021, Colorado Springs, CO

AANS/CNS Joint Spine Section: Annual Meeting, July 28-31,2021, San Diego CA

AANS: Annual Meeting, August 21-25, 2021, Orlando, FL

CSNS Meeting, August 20-21, 2021, Orlando, FL

NERVES Annual Meeting, August 18-20, 2021, Orlando, FL

Western Neurosurgical Society: Annual Meeting, Santa Ana Pueblo, NM, September 10-13, 2021

North American Spine Society: Annual Meeting, September 29-Oct. 2, 2021, Boston, MA

Congress of Neurological Surgeons: Annual Meeting, October 16–20, 2021 Austin, TX
CSNS Meeting, October 15-16, 2021, Austin, TX

International Society for Pediatric Neurosurgery: Annual Meeting, November 14-18, 2021, Singapore

AANS/CNS Joint Pediatric NS Section: Ann. Meeting, December 7-10, 2021, Salt Lake City, UT

Cervical Spine Research Society: Annual Meeting, December 2-4, 2021, Atlanta, GA

CANS, Annual Meeting, January 15-16, 2022; Location TBA

North American Neuromodulation Society: Mid-year Meeting, July 15-17, Orlando, FL

Southern Neurosurgical Society: Annual Meeting, February 17-19, 2022, Hollywood, FL

California Neurology Society: Meeting, November 12-15, 2021, Santa Barbara, CA

AANS/CNS Joint Section on Pain: Annual Meeting, TBA

Neurosurgical Society of America: Annual Meeting, 2022 TBA

Rocky Mountain Neurosurgical Society: Ann. Meet., 2022, TBA

New England Neurosurgical Society: Annual Meeting, 2022, TBA


Looking for a new partner or position?

Any CANS member who is looking for a new associate/partner/PA/NP or who is looking for a position (all California neurosurgery residents are CANS members and get this newsletter) is free to submit a 150 word summary of a position available or of one’s qualifications for a two month posting in this newsletter.  Submit your text to the CANS office by E-mail (

To place a newsletter ad, contact the executive office for complete price list and details.


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