1. Injured Worker Kills Attorney
2. President’s Message
3. Report from Executive Secretary
4. CANS at the Crossroads

1. The Doc at risk—be careful out there.
The rather disturbing news that a disgruntled injured worker shot and killed his comp attorney in his Santa Cruz office brings to mind that we docs who make determinations about ultimate impairment/disability (which equals money) have some exposure to this kind of risk as well. I well recall being threatened by a non-comp patient many years ago which resulted in some bullet proof office glass and some handgun purchases. The latter were never really needed but it was a time of some anxiety and learning about calibers and hollow-points, subjects a bit foreign to most of us. As we lament the nature of the AMA Guidelines which now have to be used to determine final impairment, it might not be unwise to make sure every patient we rate is made aware that docs no longer have anything more than very minor leeway in determining impairment—it is all a cookbook by the chefs at AMA wherein even maximum pain frosting is limited to 3%. By the way, I can’t quite get my mind around the involved pain section in the AMA Guides so have no compunction about recommending an additional consultation with a “pain specialist” if the parties involved don’t want to accept my 3% pain recommendation based upon clinical impression rather than jumping through the arcane hoops of the Guides pain chapter.

2. President’s message for June: Transitions in Neurosurgery–VI
The Tobacco Tax Act of 2006 will be on the ballot this fall, sponsored by the ER physicians and the Hospital Association. This initiative does raise the tobacco tax, hopefully decreasing tobacco sales and use. Unfortunately, it contains an ER stipend provision that would allow all consultants to receive a stipend for coverage that would be determined by a ‘consultant method’ that most likely would apply to all ER consultants, and most likely would result in a much lower stipend than that negotiated by many of our membership. Neurosurgical stipends, and other specialty stipends such as plastic surgery, thoracic and cardiovascular and orthopedic surgery, should be higher than many other categories of medicine due to the likely severity of the emergency situation; the likelihood of being detained for long periods of time to deliver care, possibly eight to twelve hours; the likelihood of no insurance or other no pay, especially with trauma patients; and the enhanced possibility the consult may interfere with the following day’s surgical or office schedule. Increased malpractice exposure is also a significant factor. And, being fewer in number, neurosurgeons are susceptible to more frequent call and exposure to the above issues. Decreasing the stipends from present negotiated rates will likely cause more neurosurgeons to not provide ER coverage, aggravating an already present ER crisis. This issue was discussed as an agenda item at our last CANS Board Meeting and strong opposition to it was the predominant opinion, or I recall, unanimous. A recent poll of our Board in June in view of the July CMA Board of Trustees meeting also resulted in majority opposition to the initiative.

The CMA Board, I understand, originally did not support this initiative, but later decided to support, but not financially contribute to it. I have contacted Dr. Lewin, CMA CEO, with our concerns, and found that the CMA Board did not sympathize with our concerns, nor as those of other specialties. The CMA was more concerned about possible public image issues and potential reputation damage if it did not support the initiative. This was despite the likelihood of our specialty, as well as others, being penalized by the passage of the initiative. As a specialty organization we prefer not to be in opposition to a CMA stand, but there are times, such as this, when it becomes necessary.

I do not care for tobacco and I do not smoke for numerous obvious reasons, but personally I feel the public is tired of sin taxes and increasing governmental taxation control of activity and personal choice, micromanaging us. There are many other concerns and issues to which such a policy could next extend. CANS exists to represent the needs and concerns of California neurosurgeons, such as this issue, another example of how CANS benefits and represents our profession.

The recently administered house officer hour restrictions have been an interesting topic, one that I intend to discuss in the near future. The new call hour policy appears in some categories, not all, to benefit the house officers, but has put additional stress and work load on the attending physicians. That is another issue I intend to revisit. I also intend to revisit the emergency room crisis in the near future.

Please note Randy’s entry about our special meeting. The organization exists to serve its members, and we would appreciate your input.

John T. Bonner, M.D., CANS President

3. Report from the Executive Office
Dr. Bonner sent out notifications this week that members who are 2 years delinquent will be dropped from CANS. This means that after this month, these former members will no longer receive the newsletter and all other mailings typically sent to the membership. This letter was accompanied by final dues notices that were sent to the 45 Active Members and 25 Seniors who are 2 years delinquent. I apologize if you have received this letter by mistake, thinking that your dues are up to date. Please have your office contact me immediately at and we can work together to correct any discrepancies.

4. CANS—the sound of one hand clapping?
President Bonner has called for a special meeting of the Board of Directors for July 22nd. A single topic is to be discussed—the future of CANS. Since our active dues paying membership is now at 127 (of the estimated 500+ California neurosurgeons) and annual meeting attendance continues to be sparse, the time for a good hard look at things seems appropriate. I don’t envy the voting Board members’ task of dealing with hard questions like “Should we continue to exist?,” “What can and should we do for those who pay their dues that we aren’t doing already?” and “Does the annual meeting accomplish anything really useful?” Now is certainly the time for members to let President Bonner know what they want that they are not getting and how much of what they are getting isn’t useful (for instance, this newsletter). I am sure Jack Bonner would also be receptive to suggestions from those readers of this newsletter who receive it complimentarily even though they have not paid dues. The latter group’s input might be particularly meaningful and helpful if it included the reasons for quitting the organization. Here’s your chance, folks; don’t pass it up. Send your E-mail comments to Ms. Tash at

Randy Smith, M.D., Editor

The newsletter is a mix of fact, rumor and opinion. The facts are hopefully clearly stated. The rest is open to interpretation. The opinion is mine. R.S.

The assistance of Janine Tash and Jack Bonner in the preparation of this newsletter is acknowledged and appreciated.If you do not wish to receive this newsletter in the future, please E-mail or fax Janine Tash (, 916-457-8202) with the word “unsubscribe” in the subject line.