Volume 49, Number 9

Inside This Issue

Mark Linskey, MD

Mark Linskey, MD

CANS President

President's Message

Well, we are finally making consistent progress and moving forward with in-person meetings despite Covid’s best efforts to the contrary. The Western Neurosurgical Society successfully held their annual in-person meeting in Albuquerque, NM September 10-13, the American Academy of Neurological Surgeons successfully held their annual in-person meeting in Monterey, CA September 22-25, and both the Society of Neurological Surgeons and the Congress of Neurological Surgeons are on track to hold in-person meetings October 13-15 and October 16-20 in Austin, TX. It is now almost a certainty that our in-person Annual Session January 14-16, 2022 will go forward as planned.

This will be a very special CANS Annual Session as it will mark the 50th Anniversary of the largest state neurosurgical society in the United States, and we have a very special program prepared. With each Presidential Message between now and the end of December I will be highlighting some of the special events and special invited speakers that we have arranged. The theme of this Annual Session is the “Challenges of Corporate Employment”. There will be two Special Sessions on Saturday January 15 that will be unique and new topics of interest to all CANS members that, to my knowledge, have never been put together for any other neurosurgery professional meeting presentation. These sessions are Session 5 – Challenges of Corporate Employment, and Session 3 – The Future of Telemedicine in Neurosurgery.

The first of four topics in Session 5 will be “Diminishing Medical Staff Independence”. As members of the hospital medical staff increasingly become employees of the hospital and/or a health affairs conglomerate, leadership within the Medical Executive Committees of these hospitals are no longer independent of hospital control. This can include fusion of the legal representation between hospital counsel, Medical Staff counsel, and even Medical School counsel with developing and emerging legal conflicts of interest. It also allows hospital or health affairs conglomerate leadership access to levers and mechanisms under medical staff bylaws and rules and regulations that used to be only available to medical staff on an independent, and protected physician basis. This can lead to quasi-HR actions taken against individual medical staff members that are unfairly asymmetric, or even selectively targeted. These actions can lack due process or have flawed due process and yet under CA Evidence Code 1157, are protected from legal discovery and subsequent redress in the court system. Examples of these actions include targeted or selected peer review or coding or billing auditing, sham peer review, and referral to the medical staff physician well being committee (or “professionalism”) committee to be placed under very strict 5-year contract for selective scrutiny, among others. The speaker for this initial session 5 topic will be John D. Harwell, Esq. Mr Harwell has over 40 years’ experience in healthcare and healthcare administrative law representing hospitals, individual medical staff members, and governmental healthcare agencies. He is considered to be one of the most expert and respected legal minds in California when it comes to healthcare law. (Harwell head shot

The second of four topics in Session 5 will be “CA Evidence Code 1157 Original Intent/Unintended Consequences”. Code 1157 was originally intended to shield healthcare quality, patient safety and peer review discussions and investigations from legal discovery in order to insure full, open, transparent and honest exploration of these critically important issues related to public health and safety. Unfortunately, over time, and with leverage “creep” and increasing control of hospital and/or health conglomerate leadership over medical staffs and medical executive committees, this code can be used as a “shield” for hostile or unfair actions taken against individual physicians under the pretextual guise of healthcare quality, patient safety and peer review discussions and investigations. Code 1157 is only now just beginning to be challenged in CA courts under very special circumstances. The speaker for this initial session 5 topic will be Ivan Puchalt, Esq. Mr Puchalt is an attorney with Green Broillet and Wheeler, LLC [ ]. He and his firm have extensive experience representing physicians in labor disputes against hospitals and universities including whistleblower retaliation cases. He has extensive knowledge of the difficulties proceeding through pre-trial lawsuits when the truth is being shielded by Code 1157 and he and his firm are actively seeking legal challenges to this code under certain special circumstances. (puchalt)

The first of five topics in Session 3 will be “History, Public Health Emergency Measures & Compliance Issues – Then, Now, and Issues Going Forward”. With the Covid pandemic telehealth went from a somewhat dicey prospect from a compliance and reimbursement aspect. With the emergency measures enacted during the pandemic, issues such as physical examination documentation, state licensing across state lines as well as getting reimbursed for telehealth encounters made great stride forward. The concept has been embraced by both patients and many physicians. However, many questions remain going forward. What is the history of this process? What stumbling blocks might we encounter once the federal emergency measures expire for regulatory compliance, for reimbursement, and for practicing across state lines? The needs and vision for policy proposals to the federal government to try and create a new schema after the federal emergency measures expire seem to be different between primary care and medical specialties championed by the AMA and those that might better serve neurosurgeons. The speaker for this initial session 3 topic will be Valerie M. Dixon, MBA, CHC, CCEP, CPHQ. Mrs Dixon is the Chief Compliance & Privacy Officer for the UC, Irvine Health System where she is responsible for strategic and tactical development, implementation, and maintenance of the UCI Health Compliance & Privacy program for the UCI Medical Center, College of Health Sciences, School of Medicine, and the faculty practice organization in the areas of billing and coding compliance; HIPAA privacy and security; training and education; research compliance; audit, and investigations. She is extremely knowledgeable about all facets of this issue and is very excited about the potential future of telemedicine in healthcare. (Dixon)

A second of five topics in Session 3 will be “AMA Policy Position v Neurosurgery on the Future of Telemedicine”. The speaker for this topic will be Ann Stroink, MD who is one of our senior neurosurgery delegates to the AMA, a member of the AMA Council on Legislation (COL), President-Elect of the AANS, former Chair of the AANS/CNS Washington Committee as well as former Chair of the CSNS. Dr. Stroink brings unmatched knowledge and experience regarding this issue as well as un-matched knowledge and experience as to the workings of the AMA House of Delegates and our own Washington Committee as we each position ourselves, as a profession, to try and influence the federal policy(ies) that will emerge after the emergency pandemic measures have expired. (stroink)

This Annual Session will also be the 50th Anniversary of CANS as an organization and as such we have a very special Saturday pm banquet planned with its own dinner program as outlined below:

6:30         Cocktails
7:00         Dinner                                  Program:

  1. CANS Historical Vignette – Austin Colohan, MD
  2. Formal Presentation of New CANS Members – Joseph Chen, MD
  3. Byron Cone Pevehouse Distinguished Service Award
  4. CANS Lifetime Service Award
  5. 50th Anniversary Thoughts & Observations from a CANS Raconteur– Randy Smith, MD
  6. Randre Grace – Mark Linskey, MD
  7. Avant-Premiere CANS 2022-23 – Javed Siddiqi, MD

As you can see, everyone will get a chance to meet, introduce yourself, and chat with each of our new members and their families in person, there will being interesting and likely humorous reminiscences of our 50 years of existence, we will get a chance to honor two of our very well deserved members with CANS awards, and Dr Javed Siddiqi will have an opportunity to lay out his vision for his presidential term 2022-2023 as the new CANS President and perhaps foreshadow some of his priority initiatives as well as his January 2023 Annual Session. We would ask everyone attending our upcoming CANS meeting to please purchase a banquet ticket so that we can get a proper head count for this special evening event.

As announced in last month’s newsletter the CANS Annual Session will be held the weekend of Martin Luther King’s birthday January 14-16, 2022 in La Jolla, CA. We will be holding our meeting at the Hilton La Jolla Torrey Pines hotel . This venue is only 16.3 miles from the San Diego airport and is easily accessed. It is adjacent to the Torrey Pines State Nature Reserve with beautiful hiking trails and views and is 5 minutes from Torrey Pines State Beach . It is only 7 miles from Sea World and is close to La Jolla village and Birch Aquarium. The hotel overlooks the famous Torrey Pines golf course and all rooms have pacific ocean views. The hotel itself has hosted multiple US Open Championships including the 2021 US Open. It provides exclusive access to daily tee times but also has its own spectacular outdoor pool and pool area as well as tennis courts. This venue promises to be a terrific outing for our members as well as our families. Please be sure to book your rooms in the CANS room block as soon as possible to enjoy the whole 3-day holiday weekend

The more people who sign up and book rooms for both evenings as soon as possible, the better the deal that CANS will enjoy on our venue contract. We really would like to see everyone at the meeting. The support of each of our members is really important and certainly needed at this time.

Registration for our meeting is also now open. I would encourage every CANS member to register for this special and historic meeting in this beautiful location ASAP When you register, it would also be a terrific time to update your CANS membership dues so that they are current

On September 27, 2021 the Department of Health and Human Services (HHS) announced that they are extending 60-day grace period for physicians who received Provider Relief Fund (PPF) payments between April 10 and June 30, 2020 in excess of $10,000 ( PRF recipients are required to report for each “payment received period” in which they received one or more payments exceeding in aggregate. While the official deadline for reporting remains September 30, HHS announced that it will not seek recoupment or initiate enforcement actions for noncompliance until November 30, 2021.

In addition, the Biden administration just announced that it will release the remaining $25 billion of the $185 billion that was deposited into the US Department of HHS Provider Relief Fund to assist physician practices during the Covid-19 pandemic ( Seventeen billion will go to all providers with $8.5 billion earmarked for rural providers

Governor Newsom has renewed most of the Executive Order N-43-20, which aligns CA with the federal emergency rules regarding the release of patient information during good faith provision of telehealth ( The order had been expected to expire September 30, 2021.

In our April newsletter we alerted you to the California Assembly Bill AB 615, [Higher education Employer – employee relations act: procedures relating to employee termination or discipline] introduced February 12, 2021 by Assembly Member Rodriguez. As of the writing of this message, the bill passed in the Senate 09/02/2021 and passed in the Assembly 09/07/2021. It was “enrolled” 09/09/2021 and then corrected 09/13/2021. It would appear that it is now poised to again go to the Governor for review. Last year Governor Newsom vetoed it but for an apparent technicality. What will happen when it reaches the Governor’s desk this time around, remains to be seen. ( We will need to watch this bill closely as it will have potential significant effects on our California neurosurgery residency training programs.

I would once again like to take this opportunity to ask all CANS members to please consider getting involved. We need your thoughts, ideas and input to help plan the best meeting possible January 2022. Suggestions for speakers for the topics outlined in last month’s newsletter message as well as suggestions for possible additional topics are very welcome. We are always in need of concerned, aware, and engaged neurosurgeons. Please do not hesitate to contact me regarding our upcoming meeting, and/or let me know if you would like to get more involved with CANS at Even if you cannot dedicate your own time and effort, please consider financially supporting CANS, the national Neurosurgery Political Action Committee (Neurosurgery PAC) (, and the CMA Political Action Committee (CalPAC – ). Please do whatever you can to support CANS, the NeurosurgeryPAC and the CMA, they are fighting for you.

All the best!

Randall W. Smith, MD

Randall W. Smith, MD

CANS Newsletter Editor

Humble Beginnings Mark Award Recipient

The CANS Awards Committee has nominated U.S. Representative Raul Ruiz to receive the CANS Public Service Award and the BOD has approved. Dr. Ruiz will receive his award in January at the CANS annual meeting.

Raul grew up in the community of Coachella, California, where both of his parents were farmworkers.

Dr. Ruiz achieved his lifelong dream of becoming a physician beginning with public education. After graduating from Coachella Valley High School, Dr. Ruiz graduated magna cum laude from UCLA. He went on to Harvard University, where he earned his Medical Degree, as well as a Masters of Public Policy from the Kennedy School of Government and a Masters of Public Health from the School of Public Health, becoming the first Latino to earn three graduate degrees from Harvard University. He completed his Residency in Emergency Medicine at the University of Pittsburgh and a Fellowship in International Emergency Medicine at Brigham and Women’s Hospital. During his training, Dr. Ruiz served as a consultant to the Ministries of Health of both Serbia and El Salvador.

Dr. Ruiz returned home after completing his medical training and began working as an Emergency Room doctor at Eisenhower Medical Center. Recognizing the physician shortage crisis in the Coachella Valley, Dr. Ruiz started a pre-medical mentorship program for young aspiring doctors, which has grown to include over 100 local students.

The program became part of the University of California, Riverside School of Medicine, where Dr. Ruiz served as a Senior Associate Dean. Through the group Volunteers in Medicine, he helped to open a free clinic to help underserved communities in the Coachella Valley.

In 2010, Dr. Ruiz started the Coachella Valley Healthcare Initiative, which brought together stakeholders from across the region to address the local healthcare crisis. He has also worked internationally in the medical community. In 2010, Dr. Ruiz flew to Haiti immediately following the 2010 earthquake and served as the Medical Director for the J/P Haitian Relief Organization. The U.S. Army’s 82nd Airborne awarded him the Commanders Award for Public Service for his work.

Dr. Ruiz continued his work as an Emergency Room Doctor until he was elected to the U.S. House of Representatives in 2012. He represents California’s 36th District, which includes the entire Coachella Valley, as well as the cities of Banning, Beaumont, Blythe, Hemet and San Jacinto. He resides in Palm Desert, CA.

Dr. Ruiz currently serves on the House Energy and Commerce Committee and the House Veterans’ Affairs Committee. Dr. Ruiz also serves as chair of the Congressional Hispanic Caucus. .

Moustapha Abou-Samra, MD

Moustapha Abou-Samra, MD

Associate Editor

Is it Possible to Agree on…Anything?

Yes, we can agree that with the increased incidence and wide spread of the Delta variant of the Corona Virus, about 2000 Americans are losing their lives every day. We can also agree that these are our family members, friends, neighbors, and fellow citizens. We do not agree, however, on the significance of such a number. Many still feel that this pandemic is a hoax, or that its severity is exaggerated. And many refuse to accept the recommendations of getting vaccinated, wearing a mask when indoors regardless of vaccination status and adopting. physical distancing.

Oh, yes, and we all do agree that we need to move forward and return to some level of normalcy even though the pandemic is not over, but it is becoming clear that we don’t agree on how to do that.

There are states that forbid the requirement of wearing a mask, even in school children who are less than twelve years old and who are not eligible to be vaccinated. And there are labor unions who are fighting against the requirement of wearing masks, even in schools and hospitals.

Even colleges that deal with and must house and educate young adults, do not agree on basic mask requirements. Only 400 colleges throughout the Country have required masks wearing. Predictably, most are in blue states. Why is this a political issue?

And we seem to have a problem getting everyone vaccinated, even in healthcare facilities. In fact, the September 25, NY Times headlines read “New York Hospitals Face Possible Mass Firings as Workers Spurn Vaccines.” And the NY Times reported on September 26 that “New York weighs using the National Guard to replace unvaccinated health care workers.” How did we get to this point?

I discussed anti-vaxxers in a previous essay, so I won’t address this substantial segment of our population here. I will only say that it is becoming clear that most are politically motivated. Again, why is this public health issue politicized?

But now we are facing decisions regarding getting a booster shot and who should get one. Is it a surprise that we can’t even agree on this?

President Biden said last August: “Just remember as a simple rule, eight months after your second shot, get a booster shot.” He went on to say that “his administration planned to deliver booster shots to everyone starting the week of Sept. 20, pending decisions by the F.D.A. and the C.D.C.”

Both the scientific advisory panels of the FDA and CDC, decided to approve a booster shot, but only for some Americans. They specifically excluded those of us who work in high-risk professions. This is contrary to the president’s desire, which he repeated after this decision. To make matters even more confusing, Dr. Rochelle P. Wilensky, the director of the CDC, rejected her advisory panel’s recommendations and added those who work in a high-risk profession to the groups that are eligible for a booster shot. Some are accusing President Biden of influencing the CDC Director’s decision, even though he professes to listening to the Science.

Of course, we are only talking about those of us who received a Pfizer vaccine. Since I received the Moderna vaccine- recent studies suggested that it this the most effective- I’d have to wait for Moderna-specific recommendations; they may be forthcoming in the near future.

But, we don’t even agree on the ethical principal of receiving a booster shot when most of the developing and under-developed world is struggling to vaccinate its peoples.

The mother of a friend who is in her nineties, but who is otherwise healthy and who believes in fairness and justice, decided not to get the booster shot because the actual vaccine is not yet available to millions in the rest of the world. She is to be admired for her principled decision, a decision that aligns with WHO recommendations, as well as those of many scientists. I know that WHO is a dirty word to some of our fellow citizens, but those tend to be the ones who refused to be vaccinated in the first place.

On the contrary, it seems that most people in this country who are fully vaccinated are eager to get the booster shot, or what the British call it “the jab.” Some even started getting them by claiming falsely that they are immune compromised. Is this an appropriate ethical choice? I think not.

What would I do? I plan to wait for clarification regarding the Moderna vaccine, and if old people like me are allowed to get a booster, I plan to get the third shot.

Will we ever agree again, as a Nation, on things that are basic and necessary for the harmonious functioning of our Society?

Being an optimistic neurosurgeon by nature, I am hopeful that we can come to an agreement in the near future!

Tidbit #1 - CSNS In-Person Meet a Stretch

The CSNS leadership has determined that an in-person meeting in Austin on October 16-17 just before the in-person CNS meeting is a worthwhile endeavor involving travel of dozens of delegates to Texas even though the meeting will have no resolutions to consider and there will be no meetings of the quadrants and caucuses. There will be a Zoom option to attend the “Town Hall” meetings and the Sunday luncheon speaker but no way to virtually attend the committee meetings which is the only other activity to occur at the meeting. Austin is nice—but not that nice.

Tidbit #2 - A DC Day for Docs

The Alliance of Specialty Medicine, of which the AANS and CNS are founding members, will be holding another Virtual Capitol Hill Advocacy Day on Wednesday, November 3, 2021

Please mark your calendar and plan to attend the Alliance of Specialty Medicine virtual advocacy day 8:30 a.m. ET – 5:00 p.m. ET. 

The timing of this should be fairly good in terms of raising priority issues to get Congress to act before the end of the year.

You don’t need to set aside the entire day, but can pop in and out of the meeting as your schedule permits.  The goal is to have a dozen or so members of Congress, plus additional speakers, throughout the day. 

Click here to register.  It’s free!

Tidbit #3 -California Ranks Well

U.S. News & World Report came out with its 2022 list of best adult hospitals. The top 15 overall rankings included UCLA (#3), Cedars-Sinai (#6), UCSF (#9) and Stanford (#12). Specifically for neurosurgery, the top 15 included UCSF (#1), UCLA (#8), Cedars-Sinai (#11) and Stanford (#13).

In the overall Children’s’ Hospitals category, the top ten included Children’s in LA (#5) and Stanford’s Lucile Packard hospital (#10). For kiddie neurosurgery, the top 10 included the same two institutions at #9 and #8 respectively.

Within California, U.S. News & World Report felt the top 10 were, in order from 1 to 10:

UCLA, Cedars-Sinai, UCSF, Stanford, USC, UCSD, Scripps La Jolla, UC Davis, Hoag Memorial and John Muir at Walnut Creek.

Newsweek also ranked US hospitals for best neurosurgery care. UCSF and Stanford neurosurgery were in the top 20 with UCSF at #11 and the farm at #15.

Tidbit #4 - Annual Meetings of Big Boys Variable in Access

The recent AANS meeting offered a virtual registration that was less than $400 and allowed viewing of the plenary sessions plus some other offerings. The CNS meeting offered no virtual registration. The currently occurring NASS meeting offered a virtual registration but the $1300 cost for a non-NASS member was ridiculous. We will see the day when virtual attendance will be the norm and at a reasonable price. Not yet though.


Calling all exhibitors! Sign up today to secure your company’s table at our Annual Meeting! Please find information here to do so:  

We appreciate and welcome you all!

Quote of the Month

 When you cruise into your 8th decade on this planet’s road of life, the slow lane looks plenty fast—Ed.


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 16-17, 2021, Austin, TX

NERVES, Virtual Mini-Conference, October 20, 2021, 2:00pm – 4:30pm

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; San Diego, CA

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, June 12-15, 2022, Maui, HI

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

New England Neurosurgical Society: Annual Meeting, 2022, TBA

AANS/CNS Joint Cerebrovascular Section: Annual Meeting, 2022, TBA

AANS/CNS Joint Spine Section: Annual Meeting, February 23-26, 2022, Las Vegas, NV

North American Neuromodulation Society: Annual Meeting, January 13-15, 2022, Orlando, FL

CSNS Meeting, April 28-29, 2022, Philadelphia, PA

AANS: Annual Meeting, April 29-May 2, 2022, Philadelphia, PA

Western Neurosurgical Society: Annual Meeting, September 9-12, 2022, Kona, Hawai’i, HI,


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.


CANS NEWSLETTER – September 2021

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