January 2021 Issue

Volume 49, Number 1

Inside This Issue

Mark Linskey, MD

Mark Linskey, MD

CANS President

President's Message

Well, we have finally left 2020 behind us. Here’s hoping that 2021 will be a much better year for everyone! January 2021 has certainly been an eventful month for the California Association of Neurological Surgeons (CANS).

On Saturday, January 16, we held the winter CANS Board meeting. Even without CSNS resolutions to consider the meeting was an event and information-filled 7.5 hours reflecting the large amount of work and effort that has gone into the committee charges this year for our standing-, and ad hoc-committee chairs. It has been a pleasure to see how everyone has rolled up their sleeves and are contributing. It has been a great honor to have worked with such dedicated and talented colleagues during the last twelve months,

On Sunday, January 17, on our 48th Anniversary as a society, we held our first ever CANS virtual “Special Session” via the Zoom platform. This was a 5.5 hour conference that had ~100 MD-physician registrants in addition to registered invited speakers and corporate sponsors. Our Executive Secretary, Emily Schile, did a terrific job of organizing and running the logistics of this first time event. Her hard work and efforts are greatly appreciated. We are also very grateful to our three Platinum Level corporate sponsors (BK Medical, Depuy, and Stryker, as well as our three Gold Level Sponsors for this meeting (Globus, Medtronic, and NuVasive). Without their help and support, this special session would not have been possible.

The meeting itself included an excellent round table discussion on the impact of Covid-19 on neurosurgical practice in California. We had neurosurgeons representing private practice, Kaiser practice, academic practice as well as subspecialty representatives to discuss the special impact on trauma neurosurgery, spine neurosurgery, and cranial neurosurgery. Effects discussed included impact of staff, payroll and over-head, loss of income, shift of cases to ambulatory centers, loss of capital equipment budgets, impact on academic research productivity as well as the negative effects of elective case spectrum restriction on senior resident and fellow training experiences. Everything is being affected.

It also included excellent State and Federal healthcare policy and political shift updates as the result of the recent election from Mr Janus Norman from the CA Medical Association as well as from Katie Oricco of our own Neurosurgery Washington Office. Things are clearly going to be different this year and it is hard to predict all that well come down the pike in advance. At the state level the trial lawyers have collected the necessary signatures to run a ballot measure that, if passed, would decimate MICRA. It not only raises the cap on no economic damages but broadens liability and essentially pays lawyers up front on settlements and awards. They didn’t run the measure on the last election because of the pandemic and “hero” status of healthcare workers in general. It will be very expensive to defeat as the lawyers are well funded. Despite reassembling the coalition to fight the measure, there will also certainly be a large “financial ask” of all doctors and associations to raise capital. We can’t lose this fight. Moreover MICRA is the model legislation for tort reform in the US. Consequently there are a lot of out of state stakeholders who are weighing in. At the federal level our Washington Office is continuing to try and get the recent increase in E&M coding reimbursement applied to the E&M visits currently bundled into our 90-day global CPT reimbursement codes (they were not increased). At the same time they predict another attack on the 90-day global which failed on its last attempt. If successful, Ms Oricco predicts an ~$50,000 hit annual per neurosurgeon in the U.S. Finally, the person nominated for Secretary of HHS under the Biden administration is our own CA State Attorney General Javier Becerra. A lawyer and a career politician, who has no medical experience or training and who has never managed a medical bureaucracy. He has been a strong proponent of a single party payer system in the U.S., coming out strongly and publically in support of Bernie Sanders’ “Medicare for All” plan during the primary. He also has a history of targeting faith-based third party payers in CA with legal actions for their objections to covering certain provisions enfolded in Obamacare. It remains to be seen how surgeons, and especially subspecialty surgeons like us, will fair under this sort of leadership at HHS over the next four years.

All eleven neurosurgery residency training programs in California were very well represented with impressive and innovative abstracts which were very well received. Awards were given for the best Socio-Economic abstract, the best Clinical abstract and the best Basic Science abstract. Finally, after a very appropriate introduction by our first CANS Historian, Dr Don Prolo, the CANS Lifetime Exceptional Service Award to Dr Phil Lippee, was graciously accepted posthumously by his wife Gail Lippe, with many of the other members of the Lippe family also in attendance.

According to the CANS bylaws change approved last fall, in the absence of a formal CANS Annual Session, the CANS Officers and Directors are continued for an additional year 2021-22. Whether or not we will be able to safely have an in-person Annual Session over Martin Luther King weekend Saturday and Sunday January 13-14, 2022 remains to be seen. In the meantime please reserve your calendar now for these important dates. In the meantime your Officers and Board are committed to continuing to work hard on your behalf and strengthen and advance the structure and mission of our society.

I would like to once again remind all CANS members of their Annual Dues commitment. Many of us use the CANS Annual Session registration opportunity as the time where we pay our outstanding and/or 2021 CANS dues to allow us to register. This year we will not be having a formal CANS Annual Session, and will also miss the opportunity this year to for significant income for our operational budget from our Annual Session. 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, and Happy New Year!

Randall Smith, MD

Randall Smith, MD


CANS Board Meeting and Special Session—A Pair of Winners

A lot of folks spent a lot of time January 17th and 18th at their computers or notebooks or cell phones playing a role in our neurosurgical democracy known as CANS. The Board meeting on the 17th was long and at points tiresome but a near 100% attendance by Board members at the Zoom event belied the importance of the business of the Association. Board meetings used to be shorter, but our current President has resolutely assigned each officer and committee chair a task commensurate with the position they hold, and he will not tolerate one of the past common occurrences of an officer or committee chair having “no report”. In the past, one could have simply showed up at the meeting, read the comments created by the executive secretary and gone home. No more.

With the above as preamble, what follows are the highlights of that 7.5-hour meeting.

President Linskey is in full planning mode for a physical CANS annual meeting in January 2022 in southern California. He noted the passage of by-laws changes that allow for continuance of all current officers, directors and consultants and committee chair and members until that meeting.

Secretary and Membership chair Joseph Chen noted his membership drive, encouraged by Dr. Linskey, has taken initial steps toward the goal of increasing active membership by 10%. He presented 10 new members for certification and all were voted into membership: Robert M. Young, Pomona; Parkam Yashar, Los Angeles; Mark Kreiger, Los Angeles Children’s; Yaser Badr. Glendale; Martin Mortazavi, Thousand Oaks; Charles Liu, USC; Patrick Hsieh, USC; Gordon Tang, Berkeley; Laura Prolo, Stanford; Patrick Pezeshian, Kaiser Redwood; Daniel Dilorenzo, Loma Linda. That brings active members to 165.

Treasurer and Finance Committee chairwoman Ciara Harraher presented some options including putting reserves in stock/bond investments vs. the current vehicle which is CD’s yielding practically nothing; holding the spring and autumn BOD meetings virtually saving about 12K a year in travel/venue/food expenses and exploring finding a corporate sponsor for the new website.

John Ratliff, immediate past-president and Nominations Committee chair, recommended CANS submit the following for CNS elected positions: Praveen Mummaneni for President-elect; Nader Pouratian for CNS vice-president, Alexander Khalessi for Secretary and Esther Kim, Anthony Digiorgio and Anand Veeravagu for Members-at-Large. The BOD approved.

Farbod Asgarzadie, vice-president and Long Range Planning Committee chair, presented a slew of ideas to make CANS more successful the simplest of which was to consider increasing the number of resident consultants since with virtual BOD meetings, the cost would be minimal while broadening our inclusion of potential future CANS active members.

Kevin Chao, CANS Website Committee chair, demonstrated the new Website with its array of interactions not available in our previous site. He strongly encouraged all CANS members to pay their dues via the site and update their member profile.

The Virtual Scientific Session on the 18th was attended by 96 CANS members. Dr. Linskey noted commercial support by NuVasive, Medtronic, Globus Medical, Stryker, BK Medical and DePuy which was further acknowledged during the program by recorded company presentations during break times.

The session on COVID-19 impact on the practice of neurosurgery (private practice/academic practice/Kaiser) presented a pretty uniform picture on practice disruption with elective procedures very limited by lack of OR staff (many of whom were assigned to ER and ICU duties) or to severe limits on ICU beds for post-op care.

The session on Legislation discussed pending issues in California and the country and made note of the success of the Surgical Coalition that included the AANS, CNS and the Washington committee in getting the rollback on the planned Medicare cuts to the 2021 conversion factor for surgery.

The eleven resident presentations were very interesting and made by trainees at Cedars-Sinai, Los Angeles (Robin Babadjouni); Desert Regional Medical Center, Palm Springs (Stephen Albano); Loma Linda University (Taylor Wilson); Riverside University Health System (James Berry); Stanford University (Parastou Fatemi); University of California, Davis (Catherine Peterson); University of California, Irvine (Jordan Xu); University of California, Los Angeles (Bayard Wilson); University of California, San Diego (Dan Cleary); University of California, San Francisco (Ethan Winkler) and the University of Southern California (Justin Lee). The $200 awards for best papers went to Dan Cleary for his presentation entitled The financial costs of building and running a spine surgery simulator for resident training as best socioeconomic paper; Bayard Wilson for Studying Brain reorganization following transcutaneous cervical spinal cord stimulation in patients with chronic spinal cord injury as best clinical paper and Ethan Winkler for Endoluminal biopsy for molecular classification of human arteriovenous malformations as best basic science paper.

The 2021 CANS Lifetime Exceptional Service Award was presented posthumously to Philipp M. Lippe. The award was accepted and graciously acknowledged by Gail Lippe, Phil’s wife. Dr. Don Prolo marked the occasion by presenting an excellent eulogy reproduced below.

Finally, the three rapid fire 2 minute presentations were packed with info and well presented by residents from Stanford (Michael Zhang), UCD (Catherine Peterson) and UCSF (Andrew Chan).

In Memoriam


Donald J. Prolo, MD FACS, FAANS

The California Association of Neurological Surgeons is generally regarded as the largest, most powerful, most innovative state neurosurgical society. The one contemporary physician most responsible for this reputation is Doctor Philipp M Lippe. The story of his lifetime, his accomplishments and leadership in multiple organizations of medicine in the United States parallels the record of CANS now at near half-century in its record of leadership in American Neurosurgery.

It is an honor to have been asked to eulogize the life of Doctor Philipp Maria Lippe, an individual of immortal consequence, for the leadership he provided CANS and our profession over his lifetime. The total scope of his demanding view of his duties to his profession and to CANS makes him the inevitable recipient of the CANS LIFETIME EXCEPTIONAL SERVICE AWARD.      

Every life is a journey. This journey is especially salient when Phil’s life far exceeded his personal physician’s projection of an early demise after major heart surgery in 1993 at age 64. This proved not to be a major inflection point downward in the arc of his career, but a momentary pause before continued major contributions to his profession. It has been truly remarkable, nay providential for his fellow neurosurgeons in CANS, that his leadership, enormous influence and assumption of continued duties for his profession have lasted another 27 years of riveted attention to the nonsurgical aspects of neurosurgery and the broader sphere of contributions toward functions of organizational medicine. Over these past nearly three decades physicians from many other specialties with whom Phil has interrelated and influenced could attest to the plenitude of these contributions.

Phil’s earliest memories in 1938 at age 9 were terrors of the Holocaust, Kristallnacht and of the inhumanities occurring about him in Nazi-occupied Austria. Then followed his parents’ and his treacherous flight across Europe and the oceans to Chicago. He adapted well and excelled academically in his new country, eventually graduating Magna Cum Laude from Loyola University in Evanston, IL in 1950 and from University of Illinois College of Medicine in Chicago in 1954, first in his class. His training to become a neurosurgeon followed between 1959-1962 under the tutelage of Professor Eric Oldberg, a student of Harvey Cushing, at the Neuropsychiatric Institute, Research & Education Hospitals, University of Illinois. Phil thereafter invariably followed the most arduous, demanding paths, requiring rigorous, intense application of his innate natural capacities.

After his relocation to San Jose, CA age 34 in 1963 he began a very active neurosurgical practice that continued over the subsequent 30 years until he underwent cardiac surgery in 1993. Simultaneously, since the beginning of his professional career, he was very active in medical organizations, usually ascending to leadership positions. These began as official roles within his local Santa Clara County Medical Association, California and American Medical Associations. They early evolved also into specialty organizations, including CANS. With his unique administrative talents and intellect his activities invariably metamorphosed into leadership roles, including presidency of multiple medical organizations. He was among the original members of CANS formed in 1973, becoming President in 1978.

In his earlier years as a practicing neurosurgeon, Phil adeptly provided the full spectrum of neurosurgical care, but subspecialized in pain medicine. He was sensitive to the toll of human misery derivative of the effects of human pain, becoming a partisan physician in search of its relief. He was certified by the American Board of Neurological Surgery in 1965. Simultaneous with the earlier years of his operative career he also stimulated others nationally to define the borders of pain medicine. This led to the acceptance of Pain Medicine as a medical specialty and his major role nationally in the creation of the American Board of Pain Medicine and the American Academy of Pain Medicine of which he was founding President in 1992, and subsequently Executive Director. His reputation as Father of Pain Medicine followed his role as originator of the nomenclature of terms for this medical specialty he named alguitry, and for which he defined types of pain: “good” pain (eudynia) and “bad” or neuropathic pain (maldynia). He instigated the national “Decade of Pain” 2001-2010, signed into law by President Clinton. Locally he initiated and directed a pain center at O’Connor Hospital in San Jose, California in the 1990’s.

Over his phenomenal career Philipp Lippe has had active membership and leadership roles in an amazing total of 23 medical organizations! These include 7 major medical associations and societies, 6 pain medicine associations and societies, 4 neurosurgery associations and societies, 3 surgery associations and societies and 1 each of associations of physician executives, neurology, and neuroimaging.

One personal note relates to Phil’s capacities as a teacher. He taught me the historic art and practice of “Resolutions” medical organizations used to set policy, legislate or induce change in advocacy, policies, rules of order, governance or whatever cause one promotes.   Members could string together a series of “Whereases” followed by “Therefore Be It Resolved” to advocate for positions one might sponsor to set policy in an organization and pursue its implementation. Up until the early 1990’s the AANS and CNS were ruled dogmatically by anointed “father figure” officers without input from the ranks of neurosurgeons in the trenches. These earliest generation neurosurgeons allowed a Council of State Neurosurgical Societies (CSNS) to ruminate twice a year at the time of Scientific Sessions for both the AANS and CNS.   As an apprentice to Phil, he turned me loose on the Resolution process, which greatly upset the AANS hierarchy enough that there was an effort to evict me from membership in what became the Joint Council of State Neurosurgical Societies (JCSNS). Doctor Julian T. Hoff, Past AANS President, appointed Phil to a committee Hoff chaired to investigate my disruptive behavior and dedication to the Resolution process, which was anathema to the stodgy ruling class of neurosurgeons.   Because of Phil I escaped censure and excommunication.

Philipp Lippe has served 47 years since the origin of CANS in December 1973 until November 2020, as the longest active member of or consultant to the CANS Board of Directors. Every thrust at the integrity of CANS Policies would be countered by the influence of Phil. He never shunned a duty for CANS. He has accepted active or consultive membership on the CANS Board throughout its history since 1973. He was CANS representative on the California State Industrial Medical Council until its elimination in 2002. He represented CANS on the Noridian MediCare Review Council for California and represented CANS in issues before commercial health insurance carriers. He served the CANS Board and all CANS presidents with his bylaw expertise and for all matters of governance, even after physical infirmities restricted him to locomotion by wheelchair.

With his towering intellect more durable in time than his physical capacities to lead the neurosurgical charge, he could continue the battle only because of the devoted, loving, logistical services provided by his blessed wife and enabler, Gail Lippe. She is responsible for continuing Phil’s participation in services to CANS until the very end of his life.

Philipp M. Lippe, MD is a truly uncommon man, having left an indelible mark on Medicine and the soul of the California Association of Neurological Surgeons. From Vienna to Chicago to California his lifetime legacy of service to patients and multiple organizations, his creativity, his accomplishments and professionalism qualify him as a paragon to emulate in every physician’s pursuit of Hippocratic idealism. He is the very appropriate recipient of the CANS Lifetime Exceptional Service Award.

Philippe M.Lippe, MD

Deborah Henry, MD

Deborah Henry, MD

Associate Editor

Brain Waves

In my first year of medical school, I signed up for an elective in medical hypnosis. I had always been intrigued by those shows where a hypnotist could convince people to do cartwheels when they’ve never done one before. As hypnosis can be used to help those with addictions and breaking bad habits, I thought this was a great way to invest in my curiosity and maybe lose some wayward behaviors. The classroom held about 40 students. The hypnotist selected 4 to come to the front of the room. (How do they know who to select?). With his lilting voice, he succeeded in getting them to raise their arms off of the chair. He tried the same technique with the entire audience. Despite my wiliness to have him hypnotize me, my arm sat firmly on the armrest. What makes one person easily hypnotizable and another not?

I set about researching this question. After the insurrection at our capitol on January 6, I also wondered if there was some correlation between those who are more easily hypnotized and those who are easily radicalized. After all, many of those at the capitol were highly educated people such as firefighters, teachers, lawyers, and perhaps a doctor or two. Before I knew it, I had fallen deep down a rabbit hole and was over my head in research. One of the more common similarities between hypnosis and radicalization is the controversial DMN or the default mode network. This is not a pathway that I learned in neuroanatomy. Luckily, I found a great site called that put it in simple terms for me. Basically, the DMN is the part of the awake brain that is active when the brain isn’t active. In other words, it’s where in the brain you are thinking when you have nothing to think about.

The idea that the brain was constantly active sprung forth in 1929 when Hans Berger (who invented the EEG) noticed that the brain always had electrical activity even at rest. Cerebral blood flow studies in the 1970’s showed David Ingvar and others that portions of the frontal lobe were the most active at rest. PET scans in the 1990’s indicated that attentive areas of the brain became less active at rest. As fMRI became commonplace in this century, the published work on DMN grew to the thousands. Though there appears to be no formal definition, the DMN is that area of the brain that shows low activity with attention and high activity when “daydreaming.” The most consistent areas of the brain associated with the DMN are the medial prefrontal cortex, posterior cingulate cortex, and the angular gyrus and inferior parietal lobe. It is suggested in fMRI research that those who have lower DMN activity are more easily hypnotized. In other words, it’s likely my daydreaming ability that kept me from raising my arm in the hypnosis class.

An article in NeuroImage, which also used fMRI, discovered that those like me, who are not easily hypnotized, recruit attentional networks easily and have a better detection and implementation of conflict whereas those who are highly hypnotizable tend to recruit the inferior frontal gyrus in attention activities and that this gyrus is more associated with the DMN resulting in higher attention flexibility. How I interpret this is that likely most neurosurgeons are in the low hypnotizable category as we tend to have high attention to detail. I know I can block out the world when I am operating or writing-like now.

How about radicalization? A study out of Barcelona looked at fMRI data of those willing to fight and die for sacred values and found increased activity in the left inferior frontal gyrus. This article also suggested that social exclusion plays a large role in radicalization. Further down the rabbit hole I went to see if I could find a correlation between those easily hypnotized and those easily radicalized, but all I found was the bottom of the hole. However, if we look at the NeuroImage report and compare it to the Barcelona study, could we draw a connection in that those who are on the lower hypnotizable scale with better conflict detection might be less able to be radicalized? Well, it’s a stretch.

One of my dad’s favorite sayings as I grew up was “mind over matter.” He had me believing as a child that if I could concentrate hard enough, I could move a penny across a desk. There is a tiny part of me that still wants to believe this. Perhaps all that work trying to move a penny taught me to be highly attentive when I wanted to be. (I can be amazingly low attentive and into my DMN during a PowerPoint presentation). All in all, the brain is amazing in its infinite connections. Just another reason to become a neurosurgeon.

If you would like to head down this rabbit hole, here is another interesting article from Stanford on ability to be hypnotized.

Moustapha Abou-Samra, MD

Moustapha Abou-Samra, MD

Associate Editor

The Hill We Must Climb

On January 20, 2021, my eyes were glued to the TV screen. I was looking forward to witnessing a uniquely American tradition: the peaceful transfer of power from one president and his administration to another president and his new administration. There was some concern, however, that this traditionally upbeat ceremony might be disrupted by violence, given the events of January 6.

Thankfully, a peaceful transfer took place, and there was no violence. But for safety and pandemic reasons, and by design, it was a sparsely attended affair and one that was guarded by thousands of National Guard members. The number of deployed troops, about twenty five thousand, reminded me of Syria, the country of my birth where peaceful transfer of power never happens.

For the first time in more than 150 years, the outgoing President chose not to attend. But we experienced a first: the swearing-in of Kamala D. Harris as the first female Vice President, whose parents were immigrants of a mixed Black and South-Asian ancestry. Being an immigrant and a father of five daughters, I was proud to witness that.

Frankly, I was not surprised that a peaceful transfer of power took place. I have always had faith in the American Democracy. I always thought that my adopted Country is different from all others. It is a country where The Constitution is respected and where Democratic principles are strictly upheld. It is a Country where the rule of law applies equally to everyone. I refused to accept that a mob who stormed the Temple of our Democracy would be able to change the course of American History. But let us face the fact that we are a People divided and polarized …

I was, however, rather surprised by a young person who reminded me of the reasons I chose to come to the USA and become an American Citizen. Freedom. Optimism. Courage. Grace. Can-Do attitude. Youth. Future … and an Ideal Country where everything is possible. This individual stepped-up to the podium in a bright yellow coat, a beautiful red headband, and a mile-wide smile. (I made a mental note to buy six red headbands, one for each of my granddaughters.) She was self-assured. Her presence was like a ray of sunshine.

Amanda Gorman, the 22-year-old, National Youth Poet Laureate, was amazing. And I loved her poem “The Hill we Climb.” I enjoyed watching her impeccable delivery and her hand gestures. She reminded me of Arturo Toscanini, the genius and yes, exacting orchestra conductor. I thought of Robert Frost at the age of 86 when he recited his poem “The Gift Outright” at the inauguration of our first Catholic President John F. Kennedy in 1963. She did not seem to be intimidated by the solemn occasion or by the circumstances. She did not avoid tackling what happened on January 6. She faced it. Her youth and grace were a major advantage.

Yes, Amanda Gorman reminded me of the America I dreamed about as I grew up in Syria.

“Where a skinny Black girl descended from slaves and raised by a single mother can dream of becoming president only to find herself reciting for one.”

During his inauguration, Kennedy said “Ask not what your country can do for you, ask what you can do for your country. Gorman told us what we need to do for our country:

“We will not march back to what was but move to what shall be”


“If we merge mercy with might,

and might with right,

then love becomes our legacy

and change our children’s birthright”


“let us leave behind a country better than the one we were left with.”

I was surprised and amazed to learn that Amanda Gorman, much like Joseph R. Biden Jr, our new President, suffered from a speech impediment that plagued her even when she was a college student. Perhaps this is the reason she made this observation:

“That even as we grieved, we grew

That even as we hurt, we hoped

That even as we tired, we tried”


“We will not march back to what was

but move to what shall be”

With wisdom uncommon for someone her age, she explained that we have a hill to climb

“if only we dare”

“because being American is more than a pride we inherit,

it’s the past we step into

and how we repair it“

She told us that

“the Dawn is ours”

and that

“The new dawn blooms as we free it

For there is always light,

if only we’re brave enough to see it

If only we’re brave enough to be it”

Yes, “The Hill we Climb” together will lead us to …

“rebuild, reconcile and recover”

We can do it. We must do it!

Ian Ross, MD

Guest Contributor

Op-Ed: A doctor’s view: Healthcare workers who refuse COVID-19 shots are selfish

(First published in the Los Angeles Times on 1/19/2021)

I’m where no neurosurgeon wants to be before performing an emergency surgery— outside the operating room in the hallway. Usually, I’d be inside, quietly watching, making sure everyone is doing their part, so that things go as smoothly as possible. But this patient’s coronavirus test, administered during routine pre-operative work, came back positive.

Why am I waiting outside? The most dangerous moment is during intubation, when a breathing tube is inserted into the windpipe so anesthetic gases can be administered and breathing supported during the operation. Inevitably, saliva and other respiratory tract secretions— where the virus hangs out — are aerosolized and circulate in the room.

I am wearing full gear, including a medical-grade N95 mask. I’ve even had my first COVID-19 vaccine shot. The anesthesiologists do everything they can to lower aerosolization of the virus at the time of intubation. But being inside the OR at that moment means taking a chance, that not only I could get sick, but that I could spread it to others, including colleagues outside the OR and my patients. The end of the procedure will mirror the beginning: everyone who doesn’t have to be there will leave while the tube is being removed.

The OR staff is kept to a minimum, and everyone in the room has volunteered to work there. Some have signed up because they have already had the virus. One doctor survived COVID two months ago; his sister died from the virus last spring. A scrub nurse has also battled the virus.

During these surgeries, the team always struggles to hear one other — the extra-thick masks and face shields mute sound. At one point, we all mention we’ll receive the second round of the vaccine the next day. Well, all except one.

One team member says he doesn’t want to get the shot, at least not yet. The anesthesiologist is flabbergasted. My immediate impulse is to tell the naysayer to get out of the OR and never come back.  Instead, I quickly compose myself and ask, “Why on earth not?” Silence. Then I hear an “I just want to wait and see.” 

And I thought our greatest risk would come from the patient, anesthetized on the table.

I wish I could say this anti-vaccine stance among medical staff is unusual, but I have talked to nurses and even an emergency department doc who don’t plan to get a COVID-19 shot.

As many as half of the front-line workers in Los Angeles County have refused to take the vaccine. In my hospital, many of those who say they don’t trust it are under 40 and have not been personally touched by COVID. They may fear the vaccine was developed too quickly to be safe or worry it could leave them infertile.

By the time it was approved, the Pfizer-BioNTech vaccine had been given to about 20,000 volunteers without serious incident. Now millions have received it. Other than a very small number of allergic reactions, which can be scary but are easily treated, zero serious side-effects have been documented. Some side-effects may eventually show up from this or other COVID-19 vaccines. But that is part of the everyday practice of medicine. People react to anesthesia, some are allergic to antibiotics, others have issues with blood pressure and cholesterol medications. I could go on.

Those of us in medicine spend our careers administering treatments that are statistically far more dangerous and less proven than this vaccine. Even the surgery I perform this day comes with a risk it won’t work; it could worsen the patient’s condition. But the alternative to surgery in this case is permanent disability.

COVID can mean death, maybe not for you, but for someone you come in contact with and inadvertently infect. And if you work in healthcare, you may end up passing the virus to your sick patient, who is more vulnerable to the disease. Yet some people who have chosen to care for the sick want to wait to make sure the vaccine is safe before they get it?

These people who don’t trust “the man” and think they can beat the virus on their own are selfish. Getting vaccinated against COVID-19 is a civic duty, a little like paying taxes – a far more painful activity. If a few people don’t pay their taxes, society will still run smoothly. But if too many opt out, things fall apart.

Making the choice to get vaccinated against coronavirus shouldn’t be only about what you want to do, especially if you work in medicine. If you don’t trust medical research, and the recommendations that come from the highest level of medical oversight and study, then what are you doing in medicine? And why do you stay?

To protect my medical team and my patients, as well as my family and myself, I just got my second COVID-19 shot.

~Ian Ross, MD
CANS member

Randall Smith, MD

Randall Smith, MD


UCLA Tops U.S. News Rankings in Calfornia

U.S. News & World Report recently released its 2020-21 rankings for the top hospitals in the U.S.  In California, they chose UCLA as the best.

Whoops-a boo-boo by the Editor

The Covid-relief package finally signed by President Trump very late last month did prevent the lump of coal referred to by this writer in the December issue of the CANS newsletter. I should have known this and reported it rather than the article I did include. My apologies.

Further, I didn’t think the Surgical Care Coalition stood any chance of being successful. Good thing we have wiser folk running the neurosurgical show.

On December 27, President Trump signed the law that includes nearly $900 billion for coronavirus relief.  The COVID-19 plan will be attached to a $1.4 trillion Fiscal Year 2021 spending package to fund the federal government through the end of the fiscal year.  The measure incorporates several priorities of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS).  Specifically, the legislation: 

  • Prevents steep Medicare cutsby earmarking $3 billion to help offset the budget- neutrality adjustment and by delaying for three years the new G2211 add-on code for certain complex office visits (so no decrease in Medicare payments to neurosurgeons);
  • Extends the moratorium on the 2% Medicare payment sequesterfor an additional three months through March 2021, allocating $3 billion for this purpose;
  • Provides funding for 1,000 additional Medicare-funded graduate medical education(GME) residency positions;
  • Bans surprise medical billingand incorporates a process for resolving payment disputes for out-of-network care;
  • Includes $284 billion for the Paycheck Protection Program(PPP) and extends the PPP through March 31, 2021; and

·       Funds the National Institutes of Health, Centers for Disease Control and Prevention, Food and Drug Administration and other health-related agencies.

Thought for the Month

A recent study has found that women who carry a little extra weight live longer than the men who mention it.


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.



Newsletter January 2021 Issue Volume 49, Number 1 Inside This Issue President’s Message Well, we have finally left 2020 behind us. Here’s hoping that 2021 will be a much better year for everyone! January 2021 has certainly been an eventful month for the California Association of Neurological Surgeons (CANS). On Saturday, January 16, we held

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Newsletter December 2020 Issue Volume 48, Number 11 Inside This Issue President’s Message Thanksgiving has always been my favorite holiday. It is uniquely American, instituted by Abraham Lincoln. It belongs to, and is celebrated by, all Americans regardless of religion, race, or creed. It is a non-commercial holiday without the pressure for gifts or great

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