Volume 49, Number 3

Inside This Issue

Picture of Mark Linskey, MD

Mark Linskey, MD

CANS President

President's Message

Since the end of February, a lot has happened regarding healthcare on the national/federal front. From
the standpoint of good news, on March 25 the US Senate voted to delay Medicare payment cuts for the
rest of 2021. This was a big win for hospitals and providers as these cuts were originally scheduled to start
April 1, 2021, in the absence of Congressional action. These cuts would have been a significant “hit”, for
neurosurgeons, other physicians and healthcare providers as well as hospitals. This moratorium provides an
important “stay of execution” for us, but it remains to be seen if they will yet be implemented come fiscal
year 2022. At least it gives our Washington Office and other allied healthcare lobbyists critically needed
additional time in order to try and influence eliminating the cuts all together.
From the standpoint of uncertainty and concern, on March 18 the US Senate confirmed former California
(CA) Attorney General Xavier Becerra as President Joe Biden’s Secretary of Health and Human Services
(HHS). Xavier Becerra is not a physician nor a PhD in Public Health or Healthcare Policy. He does not even
have a masters degree in public health, healthcare policy or health administration. He is, in fact, a lawyer
and a career politician, with no medical experience or training whatsoever. He has certainly never
managed a medical bureaucracy. Furthermore, as CA Attorney General, he was a strong proponent of a
single party payer system in the U.S., coming out strongly and publicly in support of Bernie Sanders’
“Medicare for All” plan during the presidential primary. He also has a history of targeting faith-based thirdparty 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. It was also somewhat troubling and
disconcerting to see that his appointment was actively supported by the American Medical Association
On March 11, the Mayor of Anaheim, CA along with business and union officials renewed the push on the
CA Governor’s Office to reopen the Anaheim Convention Center and to release information on when CA
hotels can resume indoor meetings. On the same day a spokeswoman for the Governor’s Office stated –
“As you know, we have yet to provide guidance for larger social events, due to the increased risk
of indoor disease transmission at large gatherings where it can be harder to enforce consistent
masking, particularly during meals, and physical distancing,” …”That said, conditions are
improving, as we learn more about COVID-19 and how it spreads, more people are vaccinated,
Californians continue to adhere to safety protocols, and business continue to take substantial
measures to keep their employees, customers, and guests safe,” the statement added. “As such,
we expect to release new guidance for events such as conventions in the coming weeks.”–events-and-conventions–in-coming-weeks- However, as of March 29, 2021, we
are still waiting for the Governor’s Office to release their Meeting and Convention Re-Opening
Guidelines . These guidelines will have a very
important impact on how the California Association of Neurological Surgeons (CANS) approaches
potential venues for potentially negotiating an in-person CANS annual session, tentatively
planned for Saturday – Sunday January 15-16, 2022, and as a result the CANS 2022 Annual
Meeting Committee has held back soliciting bids so far this year.
As of the writing of this message, all professional medical meetings for April and May have either
been cancelled, re-scheduled for later dates, or are proceeding “virtually”. From a neurosurgery
standpoint, the American Association of Neurological Surgeons (AANS) has moved their 2021
California Association of Neurological Surgeons Volume 49 Number 3 March 2021
meeting to a “Covid-open” state – Orlando, FL August 21-25, while the Congress of Neurological
Surgeons (CNS) and the Society of Neurological Surgeons (SNS) are meeting in another “Covidopen” state – Austin, TX, October 16-20 and October, 14-16 (rescheduled from May 2021),
In the State of CA, the website for the University of CA (UC) San Francisco (UCSF) 2021 Spine
Symposium June 4-5 is still accepting registration for an in-person meeting . However, as of the end of February 2021, the Chancellor at UC Irvine
(UCI) has cancelled the in person UCI “Spine by the Sea” symposium in June as well as the Fall UCI
Multidisciplinary, in-person, Neuroscience Symposium”. Both UCI events are now being re-engineered as
“virtual events”.
Even if Governor Newsom’s office comes forward with formal Meeting and Convention Re-Opening
Guidelines, this will not necessarily address the separate issue of relevant, applicable, institutional
pandemic-related travel restrictions. For example, the UC currently has a formal travel restriction
in place only allowing approval and/or re-imbursement for essential travel for all faculty, residents
and fellows. There has been no indication from the UC Office of the President (UCOP) so far, as
to if, and/or when, this travel restriction will be lifted. The University of CA includes neurosurgery
faculty at six CA medical schools as well as residents and fellows at 5 of the 11 current M.D. (n=9)
and D.O. (n=2) neurosurgery training programs in the state. The UC “essential travel” definition
specifically excludes travel to professional meetings, even if this is for continuing medical
education (CME) purposes, and even if the employee in question is presenting at the meeting. It
affects out-of-state meeting travel to meetings like the AANS, CNS and SNS as well as meetings
within the state of CA. To attend these meetings as things currently stand, UC faculty, residents
and fellows would have to take personal vacation days and fund all expenses on “their own
dime”, as well as keep their travel plans confidential with respect to the UC. As a result, things
currently remain “murky” for trying to predict the feasibility of having our in-person CANS Annual
tentatively planned for Saturday – Sunday January 15-16, 2022, though we remain hopeful. Please
stay tuned…
While the AANS has moved their meeting from April to August 2021, the Council of State Neurosurgical
Societies (CSNS) is still moving forward with their Spring CSNS meeting as a virtual meeting April 23-24, 2021.
For this meeting, the CANS Board has unanimously (without any abstaining vote) endorsed submission of a
resolution from CANS entitled: “Improving diversity, equity and inclusion within the Congress of
Neurological Surgeons (CNS) leadership”. We look forward to vigorous discussion of this resolution and the
important issues it addresses at the upcoming CSNS meeting. The CANS Board will be meeting either
Saturday April 10 or Saturday April 17 to formally review all upcoming CSNS resolutions in preparation for
CSNS Reference Committee testimony from our CANS CSNS Delegates April 23. As of March 29, 29021, the
CSNS has yet to post the final list of, and description for all the resolutions accepted to be considered at
their upcoming meeting. Our CANS Newsletter Editor, Dr Randy Smith will no doubt present all CSNS
resolutions, CANS’ position on each of them, as well as their eventual outcome in the April CANS newsletter.
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 Session 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
California Association of Neurological Surgeons Volume 49 Number 3 March 2021
3 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

Editor in chief

Last Minute Reprieve!

Randall W. Smith, MD – Editor
AMA president Susan R. Bailey, M.D., wrote in The Hill (3/22) that “there remains a fastapproaching threat to private physician practices that jeopardizes patient care at a moment
when it is needed most.” She explained that the American Rescue Plan Act of 2021 “fails to
address an imminent threat to the financial viability of physician practices: the April 1 expiration
of the existing moratorium on the 2 percent Medicare sequester,” and “even worse, the
package triggers a second and even more severe threat on Jan. 1, 2022: an additional 4
percent Medicare sequester that would devastate independent practices that already have
suffered tremendously during COVID-19.” Dr. Bailey argued, “Enacting the provisions of H.R. 1868
will allow physicians and others in the health care [field] to focus on bringing the pandemic to a
close and eliminate the financial uncertainty tied to reduced Medicare reimbursement.” She
concluded, “Physicians need all the support and assistance we can provide in the fight against
COVID-19, and H.R. 1868 is a vital step in this direction.”
The Senate on Thursday 3/26 passed H.R. 1868, a bill that will prevent the 2% Medicare sequester
cuts that hospitals and physicians opposed. The bill passed with an amendment added by
Senators Jeanne Shaheen, D-New Hampshire, and Susan Collins, R-Maine, to delay the Medicare
payment cuts through December 31 and ensure that the cost of the delay is paid for. The bill as
amended received overwhelming support in a 90-2 vote.
The bill now awaits action by the House of Representatives who plan to take it up after returning
from Easter break. It is anticipated that Medicare will not act on payments submitted for care
delivered on and after April 1st until the House has a chance to act and the President to sign
1868 once he receives it.

Picture of Deborah C. Henry, MD

Deborah C. Henry, MD

Associate Editor

Brain Waves

Did you get a gift from your hospital on Tuesday? Or perhaps a card or note from a
patient? Happy Doctor’s Day!
In 1933, the first unofficial Doctor’s Day in the US was observed in Winder, Georgia when
Dr. Charles Almond’s wife Eudora wished to thank doctors for their work. She rallied the
town to send cards to physicians and place flowers on the graves of deceased doctors.
Typically, the red carnation serves as the Doctor’s Day flower. March 30 was chosen as
the national day to recognize the contributions of physicians, for it was the initial time
anesthesia was used for surgery. In 1842, Crawford B. Long, M.D. administered ether
anesthesia to a patient undergoing removal of a tumor of the neck (perhaps it should be
National Patient’s Day too). On September 17, 1990, a joint resolution was presented to
Congress asking that March 30, 1991 be designated as National Doctor’s Day. Senator
Joe Biden reported the resolution to the Senate on September 27 where it passed
without amendment. Likewise, it passed without objection on October 16 in the House.
On October 30, 1990, George H. W. Bush signed the resolution that became Public Law
Formal appreciation of doctors occurs on different days world-wide. It falls on October
18 in Brazil. This is the Roman Catholic feast day of St. Luke, the physician and gospel
writer. Allegedly, St. Luke was a slave who was trained in medicine to serve as a resident
The word doctor comes from the Latin docere, meaning to teach. Starting in the 14th
century, doctor referred to theologians who were allowed to speak on behalf of the
Roman Catholic Church, teaching its dogma. By the time of the Renaissance, the term
doctor began to be used to recognize accomplished academicians and medical
practitioners as well.
The word doctor denoting a surgeon is not universal. In my 6 months at Queens Square
Hospital in 1990, the nurses were addressed as Sisters and the attending doctors, known
as Consultants, were called Mr. or Mrs., Ms., or Miss. Eighteenth century medical doctors
in the UK were physicians who had earned their medical degree abroad or purchased
them for about 20 pounds. Surgeons, on the other hand, had no formal training, and thus
were called Mr. When the Royal College of Surgeons of London was founded in 1800,
many surgeons took the exams for membership and therefore put MRCS (Member of the
Royal College of Surgeons) after their name. As the number of hospitals grew in the 17th
California Association of Neurological Surgeons Volume 49 Number 3 March 2021
century and through the prominence of surgeons such as John Hunter, the admiration of
surgeons grew, and many felt then that the training of a surgeon was far superior to that
of a physician (medical doctor). By the 18th century, it was a badge of honor to be
called Mr. rather that Dr., thus illustrating the higher caliper education of surgeons.
On December 11, 2020, Joseph Epstein wrote a controversial editorial published in the
Wall Street Journal where he asked community college teacher Dr. Jill Biden to drop the
Dr. in front of her name for having earned it writing a dissertation rather than delivering a
baby (his words paraphrased). Obviously, Mr. Epstein (who holds an honorary doctorate
from an unnamed university) did not do his research on the root of the word doctor
meaning teacher. Though doctor now means more than its origin as a teacher, it still
reflects those who have excelled in a field of study. But to our patients, the word doctor
will always mean healer. To the one million plus physicians in the US, happiest of doctor

Picture of Moustapha Abou-Samra, MD

Moustapha Abou-Samra, MD

Associate Editor

A Different Sort of Celebrities

My wife Joanie and I are jokingly considered celebrities by some of our friends and acquaintances. They’d
call or email to ask if I was branching out into something other than neurosurgery. And invariably they
remark that Joanie was the better looking, the more natural and the one who is better suited for a career
in commercials.
Some of you may have seen us and wondered …
A few months after we lost 557 to the Thomas Fire in December 2017, and while we were still having high
hopes in our first insurance adjustor, I wrote a letter to his manager, complimenting him. Shortly after, a PR
representative from AAA called and asked if we’d be willing to do a testimonial for “our” insurance
company. Why not, we thought: we’ve had the same insurance company for all the homes and cars we
owned since we were married in 1973. AAA also provided us with our umbrella policy. Generally, we were
happy. And now that we lost our home and since we had a provision called GRC-guaranteed
replacement coast, we were repeatedly told: “you are so lucky and have no idea how good your
coverage is; we are here for you.” Doing a testimonial might encourage AAA to treat us even better, we

Being the trusting kinds, we believed. We agreed to do the testimonial. It turned out to be a commercial
that started airing mid 2018 and it continues until now.
We showed up early on the designated morning. Joanie was dressed stylishly as usual. Me? I had my
neurosurgery uniform: button down blue shirt, navy blue blazer, slacks, and of course one of my cheerful
new bow ties.
We were welcomed to one of the movie-set lots in the West San Fernando Valley and ushered to the
clothing and make-up trailer. The staff fussed over Joanie’s attire; they didn’t find anything wrong with it.
Mine didn’t pass the muster. The bow tie, my button-down shirt and navy-blue blazer was not the look they
were looking for. I was given an open collared tight-fitting shirt and an ill-fitting jacket. Oh well. We were
interviewed by a jolly and experienced “TV personality” who put us at ease. The session ended with us
smiling, holding up and proudly displaying our insurance cards.
By the end of 2018, we received a notice that our homeowners’ insurance was up for renewal. We noticed
that the premium was the same as before the fire, even though we no longer had a home on our now
empty and sad lot. When we enquired, we were told that AAA does not sell liability coverage without
homeowners’ coverage and that our options were two: continue to pay the full premium or cancel our
policy. We, absolutely, did not want to cancel. We were concerned, much like many of our neighbors that
finding insurance coverage might be difficult, since Ventura was devastated by the wildfires.
We continued to pay our annual premium until December 2020, a total of three years. And while still trying
to cope with the pandemic and as we were getting closer to breaking ground for our future home- after
many delays, many due to insurance requirements- we received a notice from AAA. We were informed
that since our home is in a fire hazard area, our homeowners’ policy would not be renewed. If you want to
know the truth, however, I will simply say that some of our neighbors who have the same coverage by the
same company did not lose their insurance coverage … yet.
And the commercial is still airing as far away as the Great State of Texas!
How can AAA justify such an act, such mistreatment?
We found out that we had no recourse; insurance companies may decide not to renew one’s coverage
without giving a reason. The only thing they can’t do is cancel a policy mid-cycle. We felt misled. They
should have told us early on that they planned to cancel our coverage. And for sure, they should have
reimbursed us for three years of premiums, we thought.
We are now expecting to lose our umbrella policy in April. We started scrambling to find proper coverage;
it would be more expensive.
We do think that AAA should at least stop using our likeness in their commercials …
Sadly, our celebrity status did not help us with the insurance company, nor did it help us start another
career. !

Picture of Joseph Chen, MD

Joseph Chen, MD

CANS Secretary
Chair, Membership Committee

Guest Editorial

The ringing in of the New Year in 2021 was met with much anticipation for a new beginning after the horrible events of 2020. A hoped for reset and fresh start, however, has been met with continuing confusion, a potential new cold war and social divisions –
along with continued mixed messages and results regarding the pandemic itself.
COVID has been an accelerant for long brewing changes in American culture, pushed by the “never let a crisis go to waste”
mentality of social, business and political leaders.
Some of these changes have been technologically driven necessity, such as the widespread adoption of telemedicine. Some have
reflected pre-existing trends caused by structural economic issues such as widening wealth inequality, further consolidation of
large corporations and erosions of small businesses.
Within the realm of medicine, these forces, oftentimes in the name of the public interest, will continue to try to push us further
from the classic professional ideal to a level more akin to skilled laborers, accountable not to our patients nor to the science of
neurosurgery, but rather to sundry business people, non neurosurgeon medical workers and political advocates.
There has never been a more critical time for us as neurosurgeons to stay unified in the face of these forces for the sake of our
Organizations such as the AANS, CANS and the Washington Committee are your advocates to ensure that your voices are heard
on a level similar to the competing voices of lawyers, public health “experts”, insurers, hospitals, and other professional
CANS comprises a diverse group of neurosurgeons with various political persuasions, practice venues and identities. Opinions
in these pages therefore may reflect certain personal viewpoints and concerns of the individual writers, but do not necessarily
represent the official views of CANS.
The membership of CANS is, however, united in our advocacy for the professional practice of neurosurgery on behalf of our
patients. CANS also stands for the advancement and promulgation of medical knowledge and science as it pertains to
neurosurgery. We are not affiliated with a particular political party, but will support those who will support our overarching
goals as a professional organization.
Most of our CANS membership has been recruited through word of mouth by trusted and respected colleagues. I would like to
ask all of our membership to personally appeal to their neurosurgical colleagues to join CANS. Growing CANS will
strengthen our advocacy and will help protect our profession in these challenging times.
Lastly, speaking on behalf of the CANS executive committee, I would like to take the opportunity to thank all of you for your
work during the last year where you have put yourself at risk countless times to care for your patients. I look forward to seeing
you at our next meeting if not sooner.
Joseph Chen
CANS Secretary
Chair, Membership Committee

Picture of Ciara Harraher, MD

Ciara Harraher, MD

Contributing editor

CMA Corner

The CMA Council on Legislation met via zoom on March 11, 2021. We reviewed over 200
bills put forward by The House of Assembly and Senate and discussed our position
(Support, Oppose, Watch and Support/Oppose unless amended). We also had a CMA
policy review mainly regarding pending legislation on a single-payer system. Here are
the highlights of this meeting
CMA Policy Review:
Single-Payer/Healthcare for all:
What is Necessary?:
CMA HOD 212a-06 policy requires that all of the following criteria, at a minimum, are in
place to support a single payer health care delivery system:
(1) Physicians must be provided a means to ensure payment of their usual
and customary charges as defined by the Gould criteria
(2) a scientific, apolitical body must make benefit/coverage decisions
(3) Pluralistic delivery system options must be retained (e.g., pre-paid group
practices, fee-for-service)
(4) There must be a mechanism for addressing fraud
(5) Patients must be allowed to “buy up” – to purchase additional coverage
outside “single” plan
(6) There must be a mechanism to address capital investment and
infrastructure building
(7) Medically appropriate co-payments on a sliding scale must be
incorporated to discourage excessive utilization
(8) Physicians must be permitted to collectively negotiate.
AB 1400 (Kalra): Guaranteed Healthcare for All: OPPOSE unless amended:
This would create the California Guaranteed Health Care for All program, or CalCare, to
provide comprehensive universal single-payer health care coverage and a health care
cost control system for the benefit of all residents of the state. The bill, among other things,
would provide that CalCare cover a wide range of medical benefits and other services
and would incorporate the health care benefits and standards of other existing federal
and state provisions, including the federal Children’s Health Insurance Program, MediCal, ancillary health care or social services covered by regional centers for persons with
developmental disabilities, Knox-Keene, and the federal Medicare program. The bill
California Association of Neurological Surgeons Volume 49 Number 3 March 2021
would require the CALCare board to seek all necessary waivers, approvals, and
agreements to allow various existing federal health care payments to be paid to
CalCare, which would then assume responsibility for all benefits and services previously
paid for with those funds.
AB 1400 fails to include the minimum provisions required by CMA policy.
CMA Sponsored Bills:
1. AB 32 (Aguiar-Curry) Telehealth: Requires the State Department of Health Care Services
(DHCS) to extend the telehealth flexibilities implemented during the COVID-19 pandemic.
Expands reimbursement parity for telehealth services to Medi-Cal providers. Specifies that
telehealth parity extends to audio-only or telephone-based telehealth visits.
2. AB 80 (Burke): Coronavirus Aid, Relief, and Economic Security Act: Federal Consolidated
Appropriations Act, 2021: Brings partial conformity between the California tax code and
the federal law as to the deductibility of business expenses for those entities that took out
a federally-offered Paycheck Protection Program (PPP) loan that was forgiven, or is
assumed to be forgiven by the Internal Revenue Service (IRS).
3. AB 454 (Rodriguez) Health care provider emergency payments: This bill would authorize
the Director of the Department of Managed Health Care or the Insurance Commissioner
to require a health care service plan or health insurer to provide specified payments and
support to a provider during and at least 60 days after the end of any declared state of
emergency to preserve the viability of the providers in their network while going through
4. AB 457 (Santiago) Telehealth Patient Bill of Rights: The intent of this bill is to ensure
integration of care and preservation of the doctor-patient relationship. Prohibiting patient
steering to or incentivization of direct-to-consumer telehealth and ensuring patient
notification of their right to have an appointment with their own provider via telehealth,
protects patients’ rights to telehealth care with a physician backed with infrastructure
should the patient’s needs extend past the telehealth visit, and that meets the Knox-Keene
requirements as per time and distance standards.
5. AB 864 (Low) Controlled Substances- CURES Database: This bill states the intent of the
Legislature to move CURES from DOJ to CDPH.
6. SB 242 (Newman) Healthcare Providers Reimbursements: SB 242 requires health care
service plans and insurers, including Medi-Cal, to reimburse health care providers for costs
related to the procurement of critical safety supplies, such as personal protective
equipment (PPE), necessary infection control materials, and testing supplies, to ensure
availability and better protect California’s health care workers while preventing the
spread of COVID-19 and allowing medical practices to remain open to treat patients.
7. SB 250 (Pan) Healthcare Coverage: SB 250 would reform the prior authorization process by
working within the current structure of utilization management and allowing physicians a
two-year “deemed approved” status, in which they do not have to submit a prior authorization for any services or prescription drugs, if those physicians are utilizing services
that meet certain criteria. At the end of the two-year period, the health plan may
conduct an audit of the physician’s utilization over the previous two years to determine if
the physician still meets the specified utilization criteria in the bill. The second burden SB
250 addresses is the collection of patient cost-sharing in hospital settings. The bill would
require insurers and plans to collect the patient cost-sharing amounts directly from the
patient and reimburse hospital-based physicians their full contracted rate.
8. SB 371 (Caballero) Health Information Technology: Establishes a framework to support
health care data exchange in California. It accomplishes this by reestablishing data
exchange leadership within the California Health and Human Services Agency, providing
bidirectional access to public health data, and leveraging enhanced federal financial
participation (FFP).
9. SB 428 (Hurtado) Healthcare Coverage: adverse childhood experiences: This bill would
require a health care service plan contract or health insurance policy issued, amended,
or renewed on or after January 1, 2022, to provide coverage for adverse childhood
experiences screenings. Currently, California only provides the trauma screening benefit
for Medi-Cal beneficiaries.
10. SB 510 (Pan)Healthcare Coverage: COVID-19 cost-sharing: SB 510 will allow patients to
receive COVID-19 testing, as long as the test has been approved by the FDA, and
vaccination with no patient cost-sharing or utilization management requirements by plans.
SB 510 also applies these provisions to declared future health emergencies related to a
Assembly Bills: Extracted 11 for discussion: highlights
• Supported Medication Assisted Treatment Program
• Improving WCP networks
• Using AI to streamline prior authorization
Senate Bills: highlights
• SB 379 would prohibit UCs from contracting with facilities governed by ethical and religious
directives – CMA oppose as it would reduce access to care
• SB 221: impose time limits on access to mental health services – 10 days- could be
unrealistic and hard to uphold – CMA watch

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 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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