1. New Workers’ Comp Fee Schedule
2. President’s Message
3. Report from Executive Secretary
4. Other News

1. Med Mal—What You Can Learn
This writer recently reviewed a book about medical malpractice for another publication that is worth your time and money. The book tries to teach a bit of law dumbed down for docs which makes for pretty heavy reading but the chapters on Legal Duty, Expert Testimony and Informed Consent are most pertinent and informative. What I didn’t know about informed consent was near frightening and makes my tail coverage very important. Reading the chapters on Medical Records and Patients Who Drive will be an eye opener for most of us and have you documenting your records very thoroughly in self defense. The chapter on Cyber-Medicine is a must read if you use this form of patient communication and the chapter on Medical Errors disclosure is very insightful and helpful. Finally, the chapter on malpractice insurance is very good and will send you to your archives to read your policy carefully. The book title is “Medical Malpractice; Understanding the Law, Managing the Risk,” it is written by S. Y. Tan, an M.D./J.D, and is published by World Scientific Publishing Company. It costs $65 and is worth every penny. Amazon carries it.

2. President’s message for November: Transitions in Neurosurgery
I am writing this editorial in my mother’s front room in my hometown of Butte , Montana , while watching the Macy’s Thanksgiving Day parade. A belated Happy Thanksgiving to you all.

As I return home to Montana , I always appreciate why Montana is called the Big Sky state. Buildings and landscape appear to have more of a three-dimensional effect, and trees and rock formations on the mountain ridge to the east stand out individually as do the plethora of stars at night, all due to the elevation and clear environment. Those of us who live in California are not accustomed to this in most areas. But all is not pristine in Montana . Unfortunately, like many states, Montana is not immune to problems in health care delivery. The newspapers here reflect physician and hospital administration conflict of a very serious nature – problems common to California physicians and prominent here in Butte , as often seen throughout our Nation. To the physicians’ disadvantage, there is only one hospital to utilize in Butte , while most of us in California usually have the luxury of multiple hospitals in which to attend.

The situation in Butte is one currently being experienced everywhere: one which splits the physician community into those closely aligned with the hospital system and its administration, and those who would like to practice more independently outside a hospital-controlled group. The hospital administration has responded by attempting to exclude those who do not want to conform to its desires.

It appears that we physicians in California enjoy more protection from such issues, as the hospitals are unable to directly employ physicians, although there are strong forces, including industry, attempting to change this. At the November 28 Commonwealth Club discussion concerning digitalizing medicine and conversion to complete electronic medical records, it was held that medicine currently is a cottage industry that has to be realigned into efficient hospital based groups with medical licensure becoming national rather than state-based and issued by the state. This would allow physicians to be utilized and consulted – no matter where they are located – by digital medicine. The Microsoft official responsible for medical digital planning and organization is a supporter of such medical reorganization.

Industry and its technological advancement, including a planned individually-carried health card which contains all of one’s health history, will certainly help physicians deliver better care to patients; but it should be noted that industry also is not supportive of our current system of medical care delivery. An illustration of this is that General Motors reports that it costs them more per unit produced for medical care for the employees than the steel necessary for car products (although I have not seen this assertion supported by actual financial proof). Industry also desires to make its employees more responsible for their own care by not providing for it directly, but by providing a salary portion with which the employee makes his or her own health care decisions. I fear that many would not use this supplement for health care, producing a larger non-insured group. Health care is certainly in evolution.

Currently in California , hospitals do not directly employ physicians to deliver care, and the CMA strongly supports this. I suspect we will see an attempt to change this, as this is not the case in many states, and I understand that Montana is one of these.

We will drive home soon through the snow, as we had snow the last two days and it is expected to snow the next seven days – a real change compared to where we live in California .

By the way, CANS was instrumental in opposing Proposition 86, the so-called Tobacco Tax, which had as one of its prominent features (as designed by the California Hospital Association), an exemption of the hospitals from anti-trust concerns, to the disadvantage of physicians. CMA attorney Catherine Hanson noted that “since Prop. 86 provides an anti-trust immunity for hospitals but not for physicians, it creates a profound structural imbalance to the detriment of physicians.” (Catherine Hanson, as noted in last month’s editorial).

I hope that we have an outstanding membership registration at our January 12th to 14th meeting in Sacramento . The hotel reservation rate is a real deal, unusually low for the quality of facility and meeting site. The program should be extremely useful and is well balanced. Do not be disappointed by missing it. The banquet will feature the official ragtime piano player of Missouri , whom I have heard several times; he is a real attraction and quite enjoyable. Don’t miss the meeting.

John Bonner, M.D.

3. Report from the Executive Office
Annual Meeting
By now, you should have received the Annual Meeting registration information. Registrations received before December 15 can be discounted $25.00. Complete schedule of events, registration and hotel information can be accessed at the CANS website (

Dr. Bonner has planned a great program featuring Dan Walters, political journalist and author, as the keynote speaker. Mr. Walters has been a journalist for over 40 years and is a well-respected authority on California politics and economic events in California . One of his books has become a widely used college textbook on socioeconomic and political trends in the state. His discussion will be especially timely due to some of the legislative changes at the Capitol. He will provide a behind-the-scenes look at Sacramento lobbyists, their trade and their influence as well as his thoughts on California ’s economic and political future and its affect on the health care system.

Also of note is a workshop on Accounts Receivable. This workshop is available for your practice administrators who can attend free if their neurosurgeon/employer registers for the CANS meeting; the workshop will focus on bottom line improvements for neurosurgery offices.

A session on Electronic Medical Records will feature an overview of how to transition to a computerized system, the financial and human resource cost of such a transition and what to look for when selecting a software vendor. (Some vendors will be exhibiting at the meeting). A panel discussion will follow in which Dr. Michael Robbins and Dr. Kimberly Page (both current CANS Board Members), along with their respective office managers, will participate. Other topics/speakers at the Annual Meeting include:

¨ CMA legislative update by Dustin Corcoran and Senator Joe Dunn, new CEO of CMA

¨ neurosurgical recruitment

¨ how and when to retire

¨ academic roundtable discussion

¨ NERVES (Neurosurgery Executives’ Resource Value & Education Society)

¨ ER Negotiations

¨ Risk Management by NORCAL (attendance will qualify for a loss prevention discount

To date, the following are some of companies that will be exhibiting: DePuy Spine, Kyphon, Medcomsoft, Medsoftware, Medtronic, MGI Pharma, PDL BioPharma, PMT Corporation, Prime Clinical and Synthes.

Pain Management CME
For a last chance to complete the AB487 requirement of 12 pain CME credits, see for UCSD’s on-line program.

Please contact me at with your input on any of the above items.

4. Prop. 86; Pevehouse Award; Comp Complaints; Annual Meeting
Prop 86
The defeat of this proposition, hopefully in some small part due to opposition by some medical organizations including CANS, puts to rest the specter of ED coverage negotiations occurring on a playing field tilted much in favor of the hospitals. If the proposition had only addressed funding smoking cessation endeavors and included a smaller increase in the tobacco tax, this writer feels it would have passed easily. The greed of Rob Reiner and his allies in making the tax increase so large and including a lot of money for other medical issues having nothing to do with smoking allowed opponents to focus on the expansive nature of the payout and the hospitals’ move to restrict fair market negotiations. I am not delighted that it took the tobacco companies deep pockets to defeat the proposition, but I thought their ads focused on the main faults of the prop for which we should probably be thankful.

Pevehouse Award to George Koenig
The Awards committee has recommended and the CANS Board has approved George Koenig as the 2007 recipient of the Pevehouse Award. The Award was created to honor California neurosurgeons who have given unselfishly of their time and effort on behalf of neurosurgery in the state and/or nation and/or world and was named the Pevehouse Award to honor Cone Pevehouse for his crucial endeavors in the 1970s which led to the MICRA legislation which saved California neurosurgeons from annihilation by the plaintiff’s bar and runaway juries. The award has been bestowed on 17 individuals since 1988.

George is a product of a complete undergraduate/med school/internship/residency gestation at Stanford and spent his entire career in private practice in the bay area. He has served as Chairman of the CMA’s PAC and Professional Liability Committee, is a founding member of CANS and was our President in 1993. He has been a CANS delegate to the CMA and an AANS delegate to the AMA as well a state coordinator for the national neurosurgery PAC. Locally, he served as President of his hospital’s medical staff and the San Mateo Medical Society. His official CV does not disclose his age but he can be presumed to qualify for pre-dead as does this writer. He is retired now in the Palm Springs area with his long suffering wife, Beth, and enjoys a little tennis and a good lunch.

A tip of the newsletter hat to a very good neurosurgical soldier.

Utilization Review Fightback
For those of you who have to deal with seemingly endless utilization reviews of proposed treatment of work comp patients now have an avenue to register complaints. The Division of Workers’ Compensation (DWC) now has a complaint form that is available online at Once to the site, do about a 2 page scroll down to find the form. If you open the Word version of the form, you can complete it using your computer and E-mail it in as well as save it on your computer. The DWC says they are committed to enforcing UR rules but need info to spark enforcement. Apparently, treatment cannot be denied solely upon the grounds that it is not blessed by the ACOEM guidelines. Just how to deal with reviewers who selectively quote the literature to support their personal or corporate bias against a particular treatment remains an obstacle requiring a time consuming appeal process. One wonders if a reviewer’s compensation is partly based on how many denials are generated. Where are those investigative reporters when you need them?

Annual Meeting
Elsewhere in this newsletter, you are encouraged to attend the annual meeting in Sacramento in January. I would like to suggest that if you can’t or won’t attend, register for the meeting anyhow. We need the registration income to keep the meeting in the black and I hope the January newsletter will document in detail what transpired and thus make your registration gift worthwhile. It is realized that the January newsletter will arrive whether or not you register but I have it on good authority that the great neurosurgeon in the sky will judge you more favorably if you are part of the solution rather than part of the problem.

That said, a most pleasant holiday wish for you and yours. This time of year reminds us of why we do what we do. If it isn’t for sick folk and your family, you must be miserable.

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.