california-neurology-society

CNS Advocacy Day 2026 Wrap Up

Mon, 04 May 2026 17:35:29 GMT

A reminder of the impact neurologists can have when they speak with a unified voice

The California Neurology Society’s Advocacy Day on Monday, April 13th brought neurologists, trainees, and advocates together at the State Capitol to elevate the voice of neurology in statewide policy discussions. The day was grounded in collaboration and purpose, giving clinicians the opportunity to share firsthand perspectives on patient care, workforce challenges, access barriers, and the realities facing neurology practices across California. By meeting directly with legislators and staff, participants helped ensure that the needs of people living with neurological conditions were clearly understood by those shaping health policy.

The gathering also strengthened the neurology community itself. Advocacy Day created space for colleagues from across the state to connect, exchange insights, and align around shared priorities. Whether discussing reimbursement issues, public health initiatives, or the future of neurological care delivery, the conversations throughout the day reinforced a collective commitment to improving outcomes for patients and supporting the clinicians who care for them.

As everyone came together in Sacramento, the energy was both hopeful and determined. Advocacy Day was not just a series of meetings—it served as a reminder of the impact neurologists can have when they speak with a unified voice. It offered an opportunity to highlight the importance of neurology in California’s healthcare landscape and to help shape policies that will influence care for years to come.

"On Monday, April 20th, Senator Scott Wiener presented my first legislation, SCR 124, on the Senate floor. The resolution passed unanimously! For the California Neurology Society, which sponsored this resolution, this was a significant milestone. SCR 124 recognizes transportation access as a critical determinant of employment and independence for adults with epilepsy, a population that faces unemployment rates way higher than those without the condition, largely due to mandatory driving restrictions and unreliable public transit." - Selim Yilmaz, CNS Legislative Advocate.

We'd like to send a special thank you to all of our Advocacy Day attendants, our LEDGE committee participants, and our membership for helping to make this a reality.

To express your interest in participating in future advocacy days or to get involved with the CNS Legislative Committee, please contact us directly at LEDGE@caneurologysociety.org .

Learn more about CNS policy positions through the button below.

Selim Yilmaz and Senator Scott Wiener

CNS Guest Blog: Understanding Neurogenic Stunned Myocardium

Tue, 24 Mar 2026 16:51:21 GMT

Motor vehicle accident complicated by neurogenic stunned myocardium and neurogenic shock

Acute brain injury and high spinal cord injury can trigger powerful autonomic responses that transiently impair cardiac function—a phenomenon known as neurogenic stunned myocardium that deserves greater clinical awareness.

We welcome this guest blog from Pacific Medical Training:

CNS Guest Blog: Share Your Insights

We invite our members, neuroscientists, and trusted non-commercial partners to contribute to the CNS Guest Blog.

This is a space to share:

• Clinical pearls and practical insights

• Emerging research and new discoveries

• Thoughtful perspectives on neurologic care and brain health

• Innovations that advance our field

Our goal is to foster a collaborative, evidence-informed community that benefits both clinicians and the patients we serve.

Submissions should be educational, non-promotional, and relevant to neurology or neuroscience.

If you’re interested in contributing, we welcome your voice. Email Info@CANeurologySociety.org to submit your blog.

CNS Membership Committee

Abstract

A 25-year-old woman was a restrained driver in a rollover motor vehicle accident (MVA) and suffered a C5-C6 fracture-dislocation with spinal cord injury. She developed neurogenic stunned myocardium and neurogenic shock. Her unopposed parasympathetic nervous system triggered multiple episodes of unstable bradycardia which resulted in multiple cardiac arrests. She was treated with inotropes and vasopressors to keep her mean arterial pressure (MAP) > 85 mmHg for adequate spinal perfusion. Chronotropic medications were used to elevate her heart rate (HR) in order to prevent her unstable bradyarrhythmia from causing a cardiac arrest.

Support the Multiple Sclerosis Registry

Sat, 21 Mar 2026 15:45:06 GMT

The registry aims to provide clinicians with meaningful insights into treatment response, support evidence‑based use of high‑cost therapies, and create a long‑term resource for research

The California Neurology Society is supporting a statewide prospective registry to advance understanding of Multiple Sclerosis (MS) and related autoimmune neurological diseases. Led by Principal Investigator Dr. Johanna Rosenthal , this collaborative effort brings together neurologists from Arrowhead Regional Medical Center, Riverside Community Hospital, and across California.

This registry collects de‑identified laboratory and clinical data —including immunoglobulin subclasses, lymphocyte populations, and flow cytometry results—to evaluate how modern Disease Modifying Therapies (DMTs) affect the immune system.

Participating neurologists submit data from consenting adult patients, with testing performed at standardized intervals before and after treatment.

By freezing and analyzing data quarterly, the registry aims to provide clinicians with meaningful insights into treatment response, support evidence‑based use of high‑cost therapies, and create a long‑term resource for research. The project includes an initial one‑year cohort of 100 patients, with potential for expansion based on findings.

If interested in joining the registry please contact Johanna Rosenthal, MD via text at 714-213-0492 or by email at johanna.rosenthal@cusm.edu .

Spend a Night with Venus and an Eternity with Mercury: The Rise and Fall of Syphilis/Neurosyphilis

Mon, 16 Mar 2026 13:41:31 GMT

Join CNS for a special session during Saturday Night's ticketed dinner

Syphilis has haunted humanity for over five centuries—shaping medicine, neurology, public health, ethics, art, and even war. This Saturday Night Soirée traces the dramatic rise, fall, and resurgence of syphilis and neurosyphilis through the lens of history, culture, and clinical practice.

From Renaissance poetry to penicillin, from moral panic to modern public health, this session will explore how one disease influenced not only the evolution of medical knowledge, but also society’s deepest anxieties about sex, sin, and stigma. Attendees will confront uncomfortable truths about past medical abuses, reconsider the relevance of syphilis today, and leave with a renewed appreciation for why this “old” disease still matters in contemporary neurology and healthcare.

Learning objectives

By the end of this session, participants will be able to:

Trace the evolution of medical understanding and treatment
Describe how concepts of syphilis and neurosyphilis have changed from the 15th century to the present.
Identify key milestones in diagnosis and therapy, including the impact of penicillin and modern neuroimaging.
Analyze social stigma and cultural perceptions
Discuss how syphilis became a symbol of immorality, shame, and “contagious vice.”
Recognize how stigma has affected patients’ willingness to seek care and society’s willingness to confront the disease.
Examine syphilis in public health history
Explain how syphilis shaped early public health policies, venereal disease clinics, and contact tracing.
Relate syphilis control efforts to broader developments in epidemiology and population health.
Connect syphilis to major historical events
Explore the relationship between syphilis and war, including troop movements, brothels, and military medicine.
Consider how epidemics of syphilis intersected with other infectious disease crises.
Evaluate ethical implications of past research and practice
Describe the Tuskegee Syphilis Study and the Guatemalan experiments, and their lasting impact on research ethics.
Reflect on how these abuses inform current principles of informed consent, justice, and respect for persons.
Recognize syphilis in art, literature, and popular culture
Identify representations of syphilis in visual art, literature, and moral tracts (e.g., Le Livre Sans Titre).
Discuss how these works shaped public perception and moral narratives around sexuality and disease.
Relate historical insights to modern clinical practice
Summarize current epidemiology and clinical stages of syphilis and neurosyphilis.
Articulate why syphilis remains relevant to neurologists, nurses, pharmacists, and other health professionals today.

Questions to ponder

Relevance and responsibility
Why should I care about syphilis and neurosyphilis as a health professional—nurse, pharmacist, neurologist/physician—and as a member of the public?
How does this “old” disease challenge our assumptions about what is “historical” versus what is still very much alive?
Origins and naming
Where did syphilis come from, and what are the major theories of its origin?
Why is the disease called “syphilis,” and what is the story behind its name?
Key historical figures and symbols
Who was Girolamo Fracastoro, and in what ways was he ahead of his time?
How are Venus and Mercury connected with syphilis—medically, mythologically, and metaphorically?
How is Le Livre Sans Titre: The Fatal Consequences of Masturbation related to syphilis, morality, and fear?
Medical evolution and war
What were the catalysts for the evolution in the understanding and treatment of syphilis and neurosyphilis?
How is war connected to the spread, recognition, and control of syphilis?
What are the stages of syphilis, and how do they intersect with neurological involvement?
Modern landscape
What are the current statistics on syphilis and neurosyphilis, and what do they reveal about today’s public health challenges?
How has treatment evolved—from mercury and salvarsan to penicillin and beyond?
Ethics and legacy
What was the clandestine Guatemalan Study, and how is it related to the Tuskegee Study?
What medical specialties evolved, at least in part, from the study of syphilis (e.g., dermatology, venereology, neurology, psychiatry, public health)?
How are religion, social morals, and ethics intertwined with the history of syphilis—and what lessons does that hold for us now?

A Guaranteed Night of Entertainment for all!

George Sarka, MD, DrPH, MPH
Neurologist, Public Health and Medical Historian, and Chair, Medical/Neurological Section and Secretary of the CNS

CNS at the Global CTE Summit

Thu, 05 Feb 2026 20:34:34 GMT

Together, we are making California a safer place for every young athlete

In the world of policy change, a public announcement is often the culmination of months of quiet, strategic work. Last Monday, a significant moment for brain health in California, highlighted this very process, and the California Neurology Society was at its core.

At the prestigious Global CTE Summit organized by the Concussion and CTE Foundation , Assemblymember David Tangipa took the stage to announce he will introduce a resolution to encourage Chronic Traumatic Encephalopathy (CTE) education for youth sports coaches statewide. In his address, he credited and thanked the California Neurology Society for our essential advocacy. This recognition was an honor, and more importantly, a testament to the impact of our methodical engagement.

This announcement did not occur in a vacuum. It was the direct result of a proactive CNS initiative. Understanding the critical gap in coach education regarding CTE and traumatic brain injury prevention, we brought the issue directly to Assemblymember Tangipa’s office. We presented the compelling neurological evidence, outlined the tangible risks of unrecognized head trauma, and demonstrated how informed coaches are vital first-line defenders of young athletes' brain health. Persuaded by the argument and the data, the Assemblymember committed to authoring the resolution.

To solidify this commitment and connect him with global leaders in the field, we facilitated his participation in the Global CTE Summit. His announcement on that stage signals California’s growing leadership in addressing this urgent public health issue and marks a concrete victory in our mission to advance neurological care and champion patient rights.

This resolution represents a crucial foundational step. By formally encouraging CTE education, California can empower thousands of youth sports coaches with the knowledge to identify potential concussions, advocate for athlete safety, and foster a culture that prioritizes long-term brain health. It is a proactive measure to protect the neurological future of our children.

Major speaker at the global CTE Summit, Ann Mckee, MD, Neuropathologist, Neurologist, Researcher, DIRECTOR, BU CTE CENTER

Dr McKee defined the Stages of CTE now used globally by neuropathologists.

The work continues. The California Neurology Society will remain actively engaged with Assemblymember Tangipa’s office as the resolution is formally drafted and introduced in the State Assembly. We will leverage our expert membership to inform the educational components and rally support from across the medical and sports communities.

This achievement underscores a powerful truth: when neurologists and patient advocates engage directly with policymakers, we successfully translate medical evidence into life-saving policy. We extend our sincere gratitude to Assemblymember Tangipa for his leadership and partnership. Together, we are making California a safer place for every young athlete.

Selim Yilmaz
CNS Legislative Advocate

United for Access: Leading Medical and Advocacy Groups Rally Behind Epilepsy Transportation Reform

Mon, 27 Oct 2025 12:56:44 GMT

The Epilepsy Transportation Endorsement Form initiative is gaining powerful momentum, with 23 endorsements received to date—including resounding support from some of California’s most respected medical, neurological, and advocacy organizations.

This groundswell of backing underscores the urgent need to modernize transportation policies for people living with epilepsy and related neurological conditions.

A Coalition of Credibility

Among the most notable endorsements is the California Medical Association , which formally adopted the initiative—an extraordinary step that signals broad physician support across the state. This endorsement alone elevates the conversation to a statewide policy priority.

The initiative has also been embraced by Epilepsy California , the statewide grassroots coalition of the Epilepsy Foundation of America, along with two of its regional affiliates: the Epilepsy Foundation of Northern California and the Epilepsy Foundation of San Diego . These organizations represent thousands of individuals and families affected by epilepsy and bring decades of advocacy experience to the table.

Neurological Leadership Speaks Out

Support from the San Francisco Neurological Society, California Neuromedical Services, Inc, and Axon Neurology further amplifies the medical consensus around the need for reform. These groups, composed of practicing neurologists and epilepsy specialists, understand firsthand the barriers outdated transportation policies pose to patient independence and quality of life.

Additionally, the International Autoimmune Encephalitis Society has lent its voice to the cause, recognizing the shared challenges faced by individuals with autoimmune neurological conditions.

Academic Excellence Joins the Effort

Perhaps most compelling is the endorsement from individual neurologists affiliated with world-renowned institutions, including UC Davis Epilepsy, Stanford, and the UCSF Epilepsy Center. Their support reflects both clinical expertise and a deep understanding of the real-world impact of transportation restrictions on patients’ lives.

This growing list of endorsements sends a clear message: the time for change is now. As more stakeholders join this movement, we move closer to a future where transportation policies reflect medical realities, not outdated assumptions.

Stay tuned for updates as we continue to build momentum—and thank you to every organization and individual who has stepped forward to support this vital initiative.

HHS Actions Undermining Vaccine Safety and Efficacy

Mon, 13 Oct 2025 18:11:21 GMT

CNS must voice its deep concern regarding recent actions by the U.S. Department of Health and Human Services under Secretary Robert F. Kennedy Jr.

The California Neurology Society (CNS), dedicated to advancing neurological health through education and advocacy, must voice its deep concern regarding recent actions by the U.S. Department of Health and Human Services under Secretary Robert F. Kennedy Jr., which undermine established vaccine science and pose serious risks to public health. Vaccines are among the greatest achievements of modern medicine, preventing illnesses that can cause permanent neurological harm, such as poliomyelitis, measles encephalitis, and fetal brain abnormalities from congenital infections. Their safety and efficacy reflect decades of rigorous research and oversight by independent experts worldwide.

Recent decisions, however, diverge from this evidence-based foundation. Secretary Kennedy’s dismissal of expert advisory bodies, such as the CDC’s Advisory Committee on Immunization Practices (ACIP), and the cancellation of critical mRNA research funding disrupts the scientific progress that enhances vaccine safety and innovation. These actions risk creating public confusion, delaying critical advancements, and weakening our preparedness for future outbreaks. Furthermore, recent guidance that minimizes the importance of routine vaccinations contradicts overwhelming scientific evidence and risks reducing vaccination rates, leaving communities—particularly immunocompromised and neurologically vulnerable patients—exposed to preventable disease.

Drawing on decades of daily experience caring for patients with neurological illness, we know that these policies will result in preventable morbidity, unnecessary suffering, and premature death. The actions of the Secretary represent a serious threat to public health and to the safety of all Americans. For this reason, we urgently call for a change in decision-making leadership at HHS. We know the President is committed to ensuring the nation's health, and we trust that, upon recognizing the dangers these policies pose, he will view such action as both prudent and imperative.

Accordingly, the CNS strongly affirms the science-based guidance of the California Department of Public Health, which reinforces the critical role of vaccination in safeguarding community health. We urge our members to advocate for their patients by sharing accurate information, countering misinformation, and supporting policies that protect the well-being of all Californians.

California Neurology Society Executive Board,

October 13th, 2025

CNS Legislative Committee MEETING MINUTES - Wednesday, September 24, 2025

Mon, 29 Sep 2025 16:06:08 GMT

Medicare coverage changes, legislative initiatives, and CTE Education

Meeting assets for California Neurology Society LEDGE meeting, Wednesday, September 24, 2025

Quick recap

The meeting began with a discussion about Medicare coverage changes and potential legal challenges to federal policies. The group then reviewed several legislative initiatives, including updates on bills related to AI usage, emergency medication administration, and utilization review decisions. The conversation ended with discussions about CTE education and advocacy efforts, including potential legislation and upcoming conferences where CNS will promote their legislative and scientific initiatives.

Summary .

Medicare Cuts and Shutdown Concerns

Bob and Stella discussed the upcoming Medicare billing cutoff date of October 1st and the potential impact of a government shutdown. They expressed concern about cuts to Medicare and Medicaid, as well as the increased cost of Obamacare, which Stella described as "ridiculous." Bob suggested that a lawyer should be hired to challenge these transgressions against the Constitution, but Stella argued that it should not be about money or individual organizations. They also discussed the firing of a Virginia Attorney General who had delivered an unfavorable report about Trump's actions.

Legislation

Selim provided updates on several bills, including AB489, which prohibits AI from using terms suggesting professional advice, and AB1172, which allows volunteers to administer emergency anti-seizure medication in daycare and elderly care facilities. Both bills have passed the legislature and are on the governor's desk with no opposition. Selim also mentioned AB512, which reduces the timeframe for utilization review decisions.

Assembly Bill 512 Discussion

The group discussed Assembly Bill 512, which reduces the timeframe for utilization review decisions to 3 business days for electronic submissions and 5 business days for non-electronic submissions. Stella suggested amending the bill to include faster turnaround times for appeals on denials, but Selim explained that amendments are not possible since the session is over and the bill is on the governor's desk. The group agreed to support the bill as a small step forward, while acknowledging that the appeals process may still be problematic. Selim also reminded the group about the upcoming deadline for submitting presentation slides for the legislative section of the conference to Dorian by October 14th or 15th.

CTE Education and Advocacy Initiatives

The group discussed several key initiatives related to CTE (Chronic Traumatic Encephalopathy) education and advocacy. Selim reported on progress with Assemblymember Valencia regarding potential legislation, including a possible appearance at a CTE event early next year. The group explored opportunities to incorporate youth sports and prevention aspects into the summit's agenda, with Jeff offering to prepare a presentation on CTE prevention in children. They also discussed an upcoming dementia conference on October 4th, hosted by the San Francisco Neurological Society, where CNS will have a table to promote their legislative efforts and scientific collaboration with UCSF's Memory and Aging Center.

California Neurology Society 2025 Legislative Session Recap: Advancing Neurological Care and Patient Rights

Tue, 16 Sep 2025 15:03:31 GMT

Stay informed on our ongoing advocacy efforts

As the 2025 legislative session concludes, the California Neurology Society (CNS) celebrates a successful year of advocacy, championing policies that protect patients, support neurological research, and uphold the highest standards of care. Through direct engagement with lawmakers, detailed position letters, and a powerful presence at our Capitol Advocacy Day, the collective voice of California’s neurologists played a vital role in shaping outcomes that benefit both physicians and the patients we serve.

ENHANCING PUBLIC SAFETY AND ACCESS TO EMERGENCY CARE

A primary focus of our advocacy has been ensuring that individuals experiencing neurological emergencies receive immediate and effective help. CNS successfully supported AB 369 (Rodriguez) – Emergency Services: Liability, which has been chaptered into law. This critical legislation extends Good Samaritan protections to volunteers who administer emergency anti-seizure rescue medication at the scene of a seizure emergency. By encouraging bystanders to act confidently and promptly, this law helps save lives and prevent brain injury through timely intervention. It removes a significant barrier to care in community settings — a reform CNS strongly endorsed to improve public safety for individuals who experience seizures.

PROMOTING AWARENESS AND UNDERSTANDING OF NEUROLOGICAL DISEASE

Raising public awareness remains a crucial step toward improving outcomes for those living with neurological conditions. This session, CNS proudly endorsed two significant awareness measures. We supported SCR 11 (Cervantes), which has passed and officially proclaims November 2025 as Epilepsy Awareness Month in California, helping reduce stigma and increase understanding for Californians living with this condition. Additionally, CNS endorsed SCR 80 (Niello), which has been adopted and declares the week of September 21–28, 2025, as Frontotemporal Degeneration (FTD) Awareness Week. This resolution brings crucial attention to this often-misdiagnosed terminal neurodegenerative disease that affects people in the prime of life, aligning with our mission to advocate for all patients impacted by neurological disorders.

REDUCING BARRIERS TO CARE AND ADVANCING RESEARCH

Reducing administrative burdens that delay treatment and creating new pathways for research funding were central to our legislative goals this session. A victory was achieved with the passage of AB 512 (Harabedian) – Prior Authorization: Shortened Timelines, which shortens the timeframe for utilization review decisions to three business days for electronic submissions and five business days for non-electronic submissions. In urgent cases, decisions will be required within 24 hours for electronic submissions and 48 hours for non-electronic submissions. This reform will help ensure neurology patients receive timely access to essential medications and treatments. Furthermore, AB 829 (Sharp-Collins), approved by the Governor, establishes the Parkinson’s Disease Research Voluntary Tax Contribution Fund, creating a sustainable public funding stream to support vital research through the California Department of Public Health.

PROTECTING PATIENT SAFETY AND CLINICAL INTEGRITY

CNS remains vigilant in opposing legislation that threatens the quality and safety of neurological care. This session, we successfully opposed SB 44 (Umberg) – Brain-Computer Interfaces: Neural Data. Although the bill aimed to enhance consumer privacy, its overly broad definitions and regulatory approach would have created significant unintended consequences for clinical neuroscience research and the practice of neurology, potentially impeding the use of critical diagnostic and therapeutic technologies. Our advocacy helped ensure this bill did not move forward.

OUR ADVOCACY IN ACTION

Our advocacy efforts helped shape these outcomes. Throughout the session, we authored detailed position letters to legislative committees, mobilized members to communicate with their representatives, and hosted a successful Capitol Advocacy Day where neurologists and patients from across the state met with legislators to share expert perspectives.

The success of this session’s work underscores the power of organized advocacy. As we look ahead, CNS remains committed to building on this momentum, monitoring the implementation of these new laws, and preparing for the opportunities of the next legislative session. We extend our deepest gratitude to every member who contributed their time and expertise. Together, we continue to protect the future of neurology.

To stay informed on our ongoing advocacy efforts, please visit our website at caneurologysociety.org/advocacy.

CNS Legislative Committee MEETING MINUTES - Wednesday, September 10, 2025

Mon, 15 Sep 2025 14:01:26 GMT

CTE, Epilepsy Advocacy, and Legislative Updates

Summary

Vaccines and Epilepsy Advocacy

The group discussed a letter of support for epilepsy transportation legislation, with Selim seeking additional organizational endorsements. Steven shared his experience with historical vaccines and their impact on life expectancy. Jeff proposed focusing on the neurologic aspects of vaccinations, including conditions like measles encephalitis and SSPE, and suggested exploring opportunities to present this information at the upcoming conference.

Epilepsy Transportation Legislation Support Initiative

Selim is leading an initiative to gather support for epilepsy transportation legislation following a CMA resolution. He is collecting endorsements from various organizations, including UCSF and epilepsy foundations, and has scheduled meetings with legislators for November. Jeff expressed interest in joining the legislative visits if his schedule allows. Selim is preparing a folder with research and support letters to present to lawmakers.

CTE and Legislative Updates

Selim provided updates on legislative activities and shared plans that will now take place in February. The group discussed the importance of creating and distributing a survey to gather input from CNS members on legislative priorities, with Jeff and Steven emphasizing the need to move away from decisions being made by a small group. Selim also mentioned ongoing work on research information for CTE education and epilepsy transportation, as well as tracking legislation at both federal and state levels, with Jeff highlighting the significance of amplifying CMA's efforts on prior authorization issues.

CNS Conference Advocacy Planning Meeting

Jeff and Selim discussed coordinating priorities and initiatives, with Jeff offering to connect Selim with more endorsements. They agreed to have a table at the San Francisco Neurological Society's dementia conference on October 4th to promote the upcoming CNS conference and advocacy efforts. Jeff requested that Robin and George be informed about staffing the table, and Selim mentioned that materials for advocacy and legislative efforts would be ready by then.

Opposing AI in Medical Decisions

The group discussed concerns about a new AI-based prior authorization model that will be implemented in several states for specific medical procedures, including neurologic treatments. Jeff expressed strong opposition, arguing that these complex medical decisions should only be made by expert neurologists rather than AI systems, and highlighted that the model could increase administrative burdens and delay patient care. The team agreed to prepare a public statement opposing the implementation, particularly focusing on neurologic conditions that require specialized expertise.

Special Event Spotlight at the CNS Fall Conference: Dr. Chris Nowinski to Deliver Keynote on the Latest Neuroscience Behind CTE

Wed, 03 Sep 2025 13:58:17 GMT

Dr. Nowinski is a former Harvard football player and WWE wrestler turned leading advocate and expert in traumatic brain injury.

Join us for an extraordinary session with Dr. Chris Nowinski, CEO and co-founder of the Concussion Legacy Foundation, as he shares cutting-edge insights on Chronic Traumatic Encephalopathy (CTE) — a preventable, progressive neurodegenerative disease that continues to reshape the landscape of sports, brain health, and public policy.

Dr. Nowinski is a former Harvard football player and WWE wrestler turned leading advocate and expert in traumatic brain injury. He was instrumental in founding the Boston University CTE Center and Brain Bank, now the world’s largest repository and research hub for CTE.

Whether you’re a clinician, researcher, or advocate — you won’t want to miss this conversation on the future of CTE prevention, early detection, and neuroscience breakthroughs.

CME credits available

Full program details coming soon!

A Major Victory for the Parkinson's Community: AB 829 approved by Governor Newsom and chaptered by Secretary of State

Mon, 01 Sep 2025 17:02:22 GMT

The impact of this new funding stream will be profound.

The California Neurology Society is proud to celebrate a significant achievement with the signing of Assembly Bill 829 into law. Our organization was a dedicated supporter of this critical legislation, naming it one of our top three priorities for the year. Through visits to legislative offices and unwavering testimony, CNS advocated to highlight the urgent need for this bill, and we are grateful to see this effort come to fruition for the benefit of patients and families across California.

This new law establishes the Parkinson’s Disease Research Voluntary Tax Contribution Fund on the California state income tax return. This provides a simple and powerful way for Californians to directly support the fight against Parkinson’s disease by voluntarily donating all or part of their tax refund. The funds generated will be continuously appropriated to the State Department of Public Health to support the vital work of the Richard Paul Hemann Parkinson’s Disease Program. This program is essential for maintaining the California Neurodegenerative Disease Registry, which collects the data necessary to advance research, improve treatments, and better understand this devastating disease.

The impact of this new funding stream will be profound. It will amplify research efforts, strengthen the state’s data collection capabilities, and raise public awareness for a disease that affects many Californians and costs the state billions annually. This victory is a testament to the power of collective advocacy, and we share this success with the entire community of patients, caregivers, researchers, and partner organizations who lent their voices to this cause. Together, we have created a new path for progress in the fight against Parkinson’s disease.

Best regards,

Johanna Rosenthal, MD

Chair, CNS Legislative Committee

LEDGE News: Assembly Bill 369 has been signed into law by Governor Newsom

Thu, 28 Aug 2025 16:43:04 GMT

This law makes public spaces and workplaces safer for individuals with epilepsy and supports neurologists by extending protection beyond the clinic.

California Neurology Society is proud to share important news for our community. Assembly Bill 369 (Rodriguez) , now California Civil Code Section 1714.27 has been approved by Governor Newsom and chaptered by Secretary of State.

This new law protects Good Samaritans who, in good faith and without compensation, administer emergency anti-seizure rescue medication during a seizure. As long as their actions are not grossly negligent, they are shielded from civil liability, criminal prosecution, and professional review.

AB 369 works alongside the Seizure Safe Schools Act, ensuring that trained school volunteers remain governed by existing education codes. For the epilepsy community, it removes the fear of legal repercussions and encourages bystanders—whether coworkers, restaurant staff, or community members—to act quickly in an emergency.

This law makes public spaces and workplaces safer for individuals with epilepsy and supports neurologists by extending protection beyond the clinic. Its passage is a victory for patient safety and community empowerment, and CNS is proud to have supported it. We remain committed to advancing policies that improve neurological care for all Californians.

CNS Legislative Committee MEETING MINUTES - Wednesday, August 20, 2025

Mon, 25 Aug 2025 15:21:03 GMT

The group discussed several legislative updates, including AB 350, AB 369, and more

Summ ary

Legislative Updates on Seizure Bills

The group discussed several legislative updates, including AB 350 , which would cover fluoride treatments for under-21s but is currently in the Senate appropriations suspense file due to cost concerns. They also reviewed AB 369, which allows trained volunteers to administer anti-seizure medicines at school, which was approved by the governor. The group expressed confusion about why a similar bill for adult day programs (AB 1172) was not passed, given it addresses the same issue of emergency room visits for seizures. They agreed to investigate further, with Selim planning to meet with legislators after the break.

Volunteer Medication Bill Advocacy

The group discussed a bill that would allow trained volunteers in adult residential facilities to administer anti-seizure medication, similar to existing laws for children in schools. Jeff expressed confusion about it being in the suspense file in the Appropriations Committee, noting that emergency room visits for untreated seizures could be costly for the state. The team agreed to contact a consultant to understand the concerns about liability and costs. They also decided to submit a comment emphasizing the potential cost savings and parallels to existing laws for children, while highlighting that the proposed treatment would follow a doctor's plan similar to what parents currently do at home.

Healthcare Legislation and AI Concerns

The group discussed two legislative issues. First, they addressed concerns about a bill regarding seizure management for elderly patients, where Jeff explained that the issue was about allowing medical staff to administer certain medications rather than requiring emergency room transports, and they decided to draft a comment emphasizing the cost-effectiveness of this approach. Second, they discussed a bill prohibiting AI from misrepresenting itself as a healthcare professional, which was placed in the suspense file due to enforcement costs concerns, and agreed to follow up with other lobbyists to understand the opposition and CMA's progress on resolving the issue.

Legislative Updates and Policy Decisions

The group discussed several legislative updates, including the status of bills related to youth tackle football helmets, Parkinson's disease research, and resolutions. They decided to let the youth tackle football helmet bill "die" as they agreed it likely wouldn't prevent CTE, while maintaining their support through a letter. Jeff offered to provide research on the effectiveness of add-on shells.

Legislative and Organizational Initiatives

The group lastly discussed several legislative and organizational matters, including CTE and AI initiatives. They agreed to gather more information from CMA about AI activities and to post legislative successes on the website. Stella suggested contacting certain stakeholders for a letter of support regarding the epilepsy transportation act.

CNS Legislative Committee MEETING MINUTES - Wednesday, August 6, 2025

Mon, 18 Aug 2025 13:55:19 GMT

Advocacy efforts for epilepsy care, CTE education, and navigating relationships with epilepsy organizations

Quick recap
The meeting focused on advocacy efforts for epilepsy care and CTE education, including discussions about legislation, funding, and partnerships with various organizations. The group reviewed and refined resolutions related to youth tackle football, transportation access, and healthcare legislation, while also planning to collaborate with football foundations and prominent players for broader outreach. They concluded by discussing strategies for navigating relationships with epilepsy organizations and exploring legislative approaches for CTE education and epilepsy transportation access, with plans to restart efforts on mandatory reporting for seizure disorders in 2026.

Summary

Epilepsy Advocacy and Legislation Planning
Selim and Stella discussed their efforts to gain support for a resolution and potential legislation related to epilepsy care in California. Stella shared her conversation with Wendy, CEO of Young Adults With Epilepsy (YAWE), about involving the Epilepsy Alliance in California to strengthen their advocacy. They discussed the need for funding and research to support their cause, with Stella suggesting framing it as funding productive members of society. Selim planned to reach out to Stuart Thompson to align their stance on a specific bill and to seek his guidance on their current initiatives. They also prepared for an upcoming Epilepsy Foundation meeting and gala, with Selim planning to make connections with politicians and organizations.

Youth Football Resolution Discussion
The group reviewed a statement submitted by Dr. Nowinsky in support of a youth tackle football resolution on the CMA Forum, which Stella had already posted. They agreed to meet with Dr. Nowinsky next Thursday, and Selim noted that he would need to be added as a host for future meetings.

CTE Education and Flag Football Campaign
Selim and Stella discussed strategies for promoting CTE education and creating a video to target young audiences about the benefits of flag football over tackle football. They planned to collaborate with Chris's foundation, Concussion Legacy Foundation (CLF), for a national video campaign, focusing on protecting young brains and promoting flag football. Selim also aimed to gather insights from Chris's foundation's efforts in Alabama to address potential challenges in CTE education. Additionally, they considered involving prominent football players like Steve Young in their advocacy efforts, with plans to track down former players in California or leverage their endorsements for a broader reach.

Epilepsy Transportation Advocacy Strategies
The group discussed strategies for advocating for epilepsy transportation access, with Selim reporting outreach from epilepsy foundations in California seeking information about their transportation resolution. Jeff suggested framing the issue by emphasizing that epilepsy affects only about 8% of the population, making it a relatively small financial burden on transportation agencies while offering significant societal benefits. The group agreed to be cautious about promising increased funding to transportation agencies, as this could lead to skepticism when actual numbers don't materialize, and Stella mentioned a previous successful epilepsy transportation program in Tennessee that could provide valuable insights.

Epilepsy Organizations Partnership Strategy
The group discussed navigating relationships with epilepsy organizations, particularly the Epilepsy Foundation of Los Angeles (EFLA) and Epilepsy Alliance (EA). Jeff and Selim agreed to reach out to neurology organizations in Southern California and San Diego, offering collaboration opportunities while remaining clear about CNS's non-profit mission. They decided to ask organizations for either active participation or letters of support, ensuring transparency about their goals and maintaining a focus on patient advocacy.

Support for Employee Prioritization Bill
The group discussed Assembly Bill 393, which requires the Department of Human Resources to prioritize state employees over contractors for certain positions. They agreed to support the bill, with Stella providing contact information for Representative Jimmy Panetta's staff. Robert explained that the bill would prevent corporations from using prior authorization to deny care and overcharge for services. The group also discussed concerns about corporate interests and the potential for misuse of government funds but ultimately supported the bill as beneficial for healthcare and state employees.

Healthcare and Concussion Education Resolution
The group discussed two main topics: healthcare legislation and concussion education. Selim agreed to write a letter about healthcare legislation and share the bill and committee analysis with the team. They reviewed and refined a concussion education resolution, focusing on requiring annual distribution of CTE education materials to guardians of K-6 students participating in contact sports. The resolution was shortened to less than two pages and included provisions for tracking compliance, integrating CTE awareness into health education, and implementing safety measures in youth sports.

Neurology Document Review Discussion
The group reviewed and discussed a document, with Stella offering to submit it on behalf of the California Neurology Society. They debated the inclusion of a "peer review" line, with Jeff suggesting it might be too technical for legislators and recommending "evidence-based" as an alternative. Selim agreed to make this change and send the final document to the group for review. Johanna mentioned she had written another resolution on lifestyle factors contributing to strokes and obesity, which she planned to share with the group.

Advocating for CTE and Epilepsy Legislation
The group discussed pursuing legislation for CTE education and epilepsy transportation access in California. Selim will meet with Senate Committee consultants to develop a bill draft, while Jeff suggested reaching out to Stuart Thompson at CMA for collaboration and support. Johanna offered to provide names of doctors who know their legislators, and Stella emphasized the importance of involving law enforcement in their advocacy efforts. The team agreed to explore both legislative and resolution-based approaches, with Selim planning to gather epilepsy foundation data to identify potential legislative sponsors.

Seizure Reporting Bill Veto Discussion
The group discussed a bill regarding mandatory reporting of patients with seizure disorders to the DMV, which passed the Legislature but was vetoed by the Governor. Jeff explained that only 6 states have mandatory reporting, and voluntary reporting has worked in the other 44 states. The group agreed to start working on this issue again in 2026 when a new governor takes office, and Stella suggested supporting a physician running for governor in a purple district. Selim announced that he had sent the final version of the resolution and bill analysis for AB 393, and the next meeting was scheduled for August 20th.

Read the resolution here .

The California Medical Association (CMA) adopts CNS Resolution on 'Expanding Transportation Access for Working Adults with Epilepsy'

info@caneurologysociety.org (California Neurology Society CNS) — Thu, 24 Jul 2025 14:55:24 GMT

As CMA indicated at the most recent HOD meeting in Sacramento, it has adopted the resolution that CNS put forward on the subject

The California Neurology Society (CNS) is pleased to announce that the California Medical Association (CMA) has approved our joint resolution to expand transportation access for working adults with epilepsy. The resolution, which highlights the critical barriers faced by individuals with epilepsy who cannot drive due to seizure risks, received strong support from CMA’s Board of Trustees, who adopted it with amendments to broaden its impact. The approved resolution now urges state and federal transportation agencies to enhance public and paratransit options for adults with epilepsy and other medical conditions that impair safe driving, particularly in underserved regions. Additionally, CMA will advocate for medical advisory boards to collaborate with the DMV on licensing criteria and work to align local, state, and national efforts to improve mobility for this population. This milestone reflects a significant step forward in addressing employment and equity challenges for Californians with epilepsy, and CNS looks forward to continuing our partnership with CMA, advocacy organizations, and policymakers to implement these vital transportation solutions.

Board Actions on Q3 Council Reports

RECOMMENDATION 4: The Council on Science and Public Health recommends approval with amendment for Resolution 108-25: Expanding Transportation Access for Working Adults with Epilepsy.

RESOLVED: That CMA supports having medical advisory boards working in collaboration with the Department of Motor Vehicles to develop state driver’s licensing criteria for medical conditions; and be it further

RESOLVED: That CMA supports urging state and federal transportation agencies to explore policies that enhance access to public transportation for adults with epilepsy and other medical conditions that impair the ability to drive safely, particularly in regions where driving restrictions pose significant employment barriers; and be it further

RESOLVED: That CMA supports the alignment of local and state-level efforts with national policy initiatives aimed at enhancing access to public, paratransit, and subsidized transportation for adults with epilepsy and other medical conditions that impair the ability to drive safely; and be it further

RESOLVED: That CMA supports leveraging existing programs and funding sources to expedite the implementation of policies that improve transportation access for individuals with epilepsy and other conditions that impair the ability to drive safely.

Board action: Approved Council's recommendation to adopt amended Resolution 108-25.

CNS Legislative Committee MEETING MINUTES - Wednesday, July 16, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Thu, 24 Jul 2025 14:44:06 GMT

Legislative advocacy efforts, including support for various bills and planning for upcoming meetings with legislators

Quick recap
The group discussed legislative advocacy efforts, including support for various bills and planning for upcoming meetings with legislators. They explored creating a legislative advocacy network for neurological disorders and discussed strategies for submitting resolutions to the California Medical Association regarding CTE education and youth sports safety. The conversation ended with discussions about future meeting topics, strategies to attract pharmaceutical company sponsors, and plans for an upcoming meeting in March 2026.

Epilepsy Advocacy Visit Planning
The group discussed planning advocacy visits to state legislators, aiming to schedule them in mid-March to mid-April, potentially aligning with Epilepsy Awareness Day on March 26th. They explored the unique idea of having both doctors and patients participate together in these advocacy efforts, which Jeff noted would be unusual but potentially powerful. Epilepsy suggested creating a form to gather participants from various neurology groups across California's counties, with Zoom meetings to prepare them, while Jeff agreed to share information about upcoming bills through his Council of Legislation role at CMA.

Neurological Disorders Advocacy Network
The group discussed creating a legislative advocacy network for neurological disorders, with Selim proposing a public forum for announcements and Stella suggesting a dedicated patient section on their website. Jeff emphasized the importance of partnering with existing patient advocacy groups rather than creating a new membership and suggested a proactive approach of reaching out to these organizations when relevant legislation arises. The group agreed to compile a list of neurology advocacy organizations through various sources, including neurologist networks and legislative tracking reports, while being mindful of potential conflicts of interest with pharmaceutical companies.

CTE Education Resolution Draft
The group discussed a draft resolution on CTE education and its potential submission to CMA and legislators. They agreed to make the language less prescriptive and avoid mandatory tracking requirements to address concerns about costs and implementation. Selim will revise the document to emphasize voluntary reporting and consider a phased implementation approach. The team also discussed the benefits of submitting a resolution to CMA before approaching legislators, as it could help build support and prevent opposition.

Youth Sports Safety Advocacy Strategy
The group discussed engaging school nurses and coaches to support legislation for youth sports safety. Stella suggested reaching out to the Association of Nurses to gain their support and potentially help implement the initiative. Jeff and Steve emphasized the importance of getting buy-in from coaches and nurses, noting that previous bills faced opposition when non-physicians were involved in emergency situations. Selim agreed to talk to individual coaches, particularly at the elementary level, to gauge their support and gather grassroots backing for the bill.

CMA Resolution Strategy Meeting
The group discussed strategies for submitting a resolution to the CMA (California Medical Association) regarding contact sports and CTE education. Jeff advised simplifying the resolution by focusing on clear "resolves" while keeping detailed background information in the "whereases." Selim agreed to meet with education committee consultants in mid-August to get feedback on the draft resolution, which Stella and Jeff will help edit. The group also discussed the need to prepare a framework for potential legislation, separate from the resolution, to be used when working with legislators. Steve warned that CMA staff may not be supportive, so they should be prepared to respond to any negative analysis of the resolution.

Health Initiatives and Policy Proposals
Johanna proposed several initiatives, including establishing conservatorships for patients with cognitive disabilities, changing insurance regulations for Medicare Advantage plans, and requiring developers to include walking trails in new urban developments. She emphasized the need to address sedentary lifestyles, which contribute to stroke and other health issues. Jeff suggested that these topics might be more appropriate for the California Medical Association or American Medical Association rather than the California Neurological Society, as they affect broader health issues.

Urban Planning Resolution Strategy
The group discussed taking a leadership position on urban planning and walkable cities, with Johanna advocating for developing legislation to incorporate walking trails into city planning. Jeff expressed concerns about the group's effectiveness and suggested writing a resolution for the California Medical Association (CMA) instead, which the others supported. Selim and Stella agreed to work on a separate project, while Johanna committed to drafting the CMA resolution, which Jeff described as a potential major issue that could gain broader support and influence.

Conservatorship Challenges for Brain Injury Patients
Johanna discussed challenges with conservatorship for homeless patients with severe brain injuries, noting that while there are programs for psychiatric patients, similar support is lacking for neurology patients. Jeff suggested investigating the differences between mental health and neurology conservatorship processes, with Johanna planning to consult social workers and the court. They also discussed housing accessibility for disabled patients, particularly those without transportation options, with Jeff recommending integrating this into broader housing policy discussions.

Medical Meeting Planning and Promotion
The group discussed plans for an upcoming meeting on March 26, 2026, and agreed to vet attendees beforehand. They also talked about promoting the meeting to medical professionals, with Jeff offering to reach out to Kaiser Permanente and the University of California, San Francisco. Stella mentioned that epilepsy representatives cannot support the current meeting due to its lack of epilepsy-focused content. The group agreed to consider adding a section on autoimmune diseases related to epilepsy in future meetings. They scheduled their next meeting for August 6.

Pharmaceutical Sponsorship and Topic Strategies
The group discussed future meeting topics and strategies to attract pharmaceutical company sponsors. Jeff suggested focusing on unique topics like autoimmune neurology and epilepsy, which Stella agreed could be addressed in dedicated sections rather than entire meetings. They also considered including a session on hyperbaric oxygen therapy, though Stella expressed skepticism about its effectiveness. The conversation touched on the changing landscape of neurology residency training and the group's niche as a clinically oriented organization.

Why you should attend the California Neurology Society’s NeuroImmunology and Beyond at the DoubleTree by Hilton Berkeley Marina in Berkeley, Ca from November 6 to November 9, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 11 Jul 2025 19:43:28 GMT

Why you should attend the California Neurology Society’s NeuroImmunology and Beyond at the DoubleTree by Hilton Berkeley Marina in Berkeley, Ca from November 6 to November 9, 2025

In the busy world of neurology, neuroimmunology, neurorheumatology and medicine, it is hard to keep up with new advances, new tests, new technology and new treatments related to the above fields. This upcoming conference has a distinguished group of world-class speakers from major universities on a host of great topics from which to learn in a cost-effective manner with the opportunity to earn up to 25.5 CME . Note that most meals are included for registered attendees.

For example, there are many questions that you might have prior to this conference:

How do you approach and treat a patient with suspected autoimmune encephalitis?
When do you consider IgG4-Related Disease and did you know that the FDA just approved a new medication for this disease?
Did you know that there is now an FDA approved medication for Neuromyelitis Optica Spectrum Disorders?
What are Stiff Person Syndrome and other GAD antibody disorders? How do you diagnose it and what is the current treatment?
Did you know that there are now 25 medications used to treat Multiple Sclerosis? How do you select the appropriate one to use? What are MS Mimickers? Note that not all patients with suspected with MS have MS.
How do you approach the pediatric population in regard to pediatric MS, autoimmune epilepsy.
What is new in Myasthenia Gravis and Eaton Lambert Syndrome in regard to tests, diagnosis and treatment?
How do you diagnosis and treat NeuroSarcoidosis and Autoimmune Neuropathies?
Do you know about antibodies to CD 320 and the blood brain barrier and its relationship to vitamin B12 deficiency? What does this evaluation involve and what is the treatment?
Do you know about the History of Multiple Sclerosis, the harbinger of NeuroImmunology? From where did these diseases originate?
Do you know about the History of Autoimmune Pernicious Anemia, “the Forgotten Disease” and that there were 4 different Nobel Prizes awarded to individuals regarding this historically, challenging disease.
What is new in Alzheimer’s Disease, Parkinson’s Disease, CTE, NeuroSLE, NeuroSjogren’s Disease, NeuroVasculitis, NeuroPsoriasis and Spondyloarthropathies, Myositis, Paraneoplastic Autoimmune Neurological Disorders, and CNS Legislative Matters
How do you treat chronic pain in patients with Multiple Sclerosis?
What is CAR-T Therapy in Autoimmune diseases.

If the above questions whet your appetite for knowledge and better patient care, then this symposium is a must for you and your colleagues to attend. We hope to see you then. Register early and let your colleagues know about this unique and intellectually provocative conference.

Sincerely,

George Sarka MD, DrPH, FAAN, FACR and Robyn Young MD, FAAN, FACP; CoChairs for the CNS sponsored NeuroImmunology and Beyond!

CNS Legislative Committee MEETING MINUTES - Wednesday, July 2, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Wed, 09 Jul 2025 16:40:45 GMT

Concussion awareness, CTE prevention, and epilepsy-related issues, with an emphasis on youth sports safety and transportation access for adults with epilepsy

Quick recap

The meeting covered various topics related to the California Neurology Society, including board changes, legislative priorities, and advocacy efforts. Discussions focused on creating educational materials and legislation for concussion awareness, CTE prevention, and epilepsy-related issues, with an emphasis on youth sports safety and transportation access for adults with epilepsy. The group also addressed organizational matters such as developing a code of conduct, planning future meetings, and coordinating with other medical associations to strengthen their advocacy efforts.

Summary

Steve Holtz's Resignation and Code of Conduct

Stella and Selim discussed Steve Holtz's resignation from the CNS Board, expressing sadness and agreeing to organize a celebration for him. They considered hosting the event in person but noted logistical challenges. Stella emphasized the importance of a code of conduct to foster inclusivity and improve the organization's image. Selim shared his experience as a legislative advocate and highlighted the impact of CNS's conduct on his professional interactions.

Transportation Access Resolution Status

Stella presented the status of a resolution on expanding transportation access for adults with epilepsy, highlighting the support received from various medical organizations and districts, with only one opposition and two requests for information. Selim suggested creating a consolidated support letter with logos from endorsing organizations to strengthen their case, and Stella explained that the resolution would undergo lobbyist analysis before adoption by CMA. Stella also mentioned the need for Natalia and Selim to assist in addressing potential critiques from lobbyists during the analysis phase.

Youth Football and CTE Education

Selim presented on youth tackle football and concussion/CTE education, sharing resources about current laws and practices. He discussed concerns about separating CTE education from concussion education in legislation and proposed creating a simple fact sheet for CTE information instead of producing a separate video. Stella suggested targeting schools and directly reaching children with CTE education, as the current focus is on youth sports organizations.

Child Brain Development Awareness Video

The group discussed creating a video to educate children about brain development and concussion risks, with Stella outlining three key messages: the brain continues developing until age 25, concussions and repetitive impacts can cause long-term problems, and school performance affects future life outcomes. Selim presented a template for amending existing concussion legislation in California, which the group agreed could serve as a foundation for their efforts. The team decided to first test their video approach by showing it to local schools before pursuing legislative changes, while also planning to research and connect with stakeholders who supported previous concussion legislation from 2012.

CTE Legislation and Youth Sports

The group discusses how to include Chronic Traumatic Encephalopathy (CTE) in legislation alongside concussion and head injury education for youth sports. They consider targeting not just coaches but also athletes and parents with information sheets. Selim raises concerns about singling out CTE, but Steven assures that CTE's high public profile justifies its specific inclusion. The group also debates whether to focus on public schools, private organizations, or both, and considers contacting the American Academy of Neurology for existing guidelines on the matter.

CTE Position Statement Development

The group discussed the need to create a clear and accessible position statement about chronic traumatic encephalopathy (CTE), emphasizing its development over time through repetitive head trauma. Stella and Steven agreed to focus on explaining how symptoms can emerge years after the initial injury, using layman's terms to avoid technical jargon. Johanna suggested creating a one-page summary for the California Neurology Society's website and linking it to ongoing legislative efforts, such as the helmet bill introduced by Assemblyman Valencia. Stella planned to use a recent article as a reference to draft the summary, while Selim highlighted the importance of translating complex information into legislative text to support advocacy efforts.

Football Fatality and Neck Safety

The group discussed a tragic incident where a high school football player died after being kicked under the chin, which led to a discussion about the importance of documenting such cases with supporting evidence like news reports or witness statements. They agreed to seek out a parent or sibling of the deceased player to provide testimony, with Selim suggesting they could find willing participants through concussion organizations. The conversation touched on the broader issue of neck muscle strength and its role in preventing such injuries, with Stella suggesting that weak neck muscles could contribute to whiplash during head impacts.

Youth Football Concussion Safety Legislation

Selim outlined his plan to prepare legislation for youth tackle football and concussion safety, which includes collecting resources, drafting legislation, and building a coalition of supporting organizations. He emphasized the need for clear goals and information to effectively approach legislators and other stakeholders. Stella suggested working on both national and local levels, while Johanna highlighted the importance of being prepared well in advance of legislative deadlines to avoid delays caused by new legislators.

CTE Education Legislation Planning

The group discussed legislation related to CTE awareness and education, focusing on youth football players and their families. Stella emphasized the importance of starting education early, around age 5 or 6, while Robert suggested framing the legislation as protecting football itself from stigma. The team agreed to target all age groups from early childhood through high school, with Selim tasked to prepare draft legislation by February for a year-and-a-half deadline.

Neurology Advocacy and Legislative Priorities

The group discussed several key issues facing neurologists and patients, with Joanna proposing three major legislative priorities over the next year and a half: one for patients, one for doctors, and potentially a third issue. Stella emphasized the need to support neurologists through advocacy and suggested inviting an AI practice guide to speak at a future meeting. The group also discussed challenges with electronic medical records, particularly for neurologists, and Joanna proposed legislation related to urban planning and public health to reduce the likelihood of neurologic diseases. Steven and Stella agreed that fighting Medicare prior authorizations would be a more effective advocacy strategy than focusing on insurance company spending transparency, as it directly impacts patient care and resonates with legislators.

Legislative Planning and AAN Relations

The group discussed legislative updates and the need to file bills by February 21st, 2027. They agreed to pursue legislation on epilepsy, transportation, and other neurology-related issues. Steven, who was planning to retire, agreed to continue helping the organization’s legislative efforts, particularly with its relationship to the AAN. The group also touched on the need for a code of conduct and Stella's role as liaison to the AAN.

CNS Legislative Committee MEETING MINUTES - Wednesday, June 18, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Wed, 25 Jun 2025 14:59:07 GMT

Reviewing two CMA Resolutions for the upcoming board meeting

Quick recap

The group reviewed and discussed responses to two California Medical Association resolutions, one regarding youth tackle football and another about transportation access, while also addressing comments from other members. They discussed organizational matters including legislative meetings and delegate roles. The conversation ended with discussions about educational content development for concussion awareness, and planning for upcoming board meetings to address various organizational issues.

Summary

CMA Resolution Review Meeting

The group discusses two resolutions submitted to the California Medical Association (CMA) website - one on youth tackle football and another on expanding transportation access. They review comments from other CMA members on these resolutions and debate how to respond. The group also discusses logistics around upcoming legislative meetings and CMA delegate roles. Joanna and Stella navigate the CMA website to view the resolutions and comments, with some technical difficulties. They consider reaching out to provide more information on existing transportation discount programs for people with disabilities.

Neurological Pre-Authorization and Concussion Laws

The group discusses issues with pre-authorization for neurological procedures, with Dr. Prasad sharing his frustrations about the process being time-consuming and burdensome. Selim, the Legislative Advocate for the California Neurology Society, then shifts the conversation to concussion education in youth tackle football. He presents research on concussion education laws across states, highlighting that 43 out of 50 states have such laws for coaches. Selim identifies issues with current concussion education, including a focus on definitions rather than symptoms and a lack of mandates on how the education should be provided or verified.

CTE and Concussion Education Planning

Selim updates the group on his plan to implement CTE education alongside concussion education in legislation, aiming to draft it before September. Jeff suggests making the education less costly by providing online content, possibly created by CNS. The group discusses creating a video lecture to be distributed to schools, with Jeff emphasizing the need to simplify the content for a general audience. They consider involving Ian Mattimo for production and potentially including Chris Nowinski in the video. The group agrees to work on developing a script and creating the video content over the summer to have it ready for Selim's legislative approach in September or October.

Brain Injury Education Content Planning

The group discusses creating educational content about brain injuries in sports, targeting a 4th-grade reading level (around age 10). Jeff suggests developing brief, compelling content from the California Neurology Society, focusing on decisions and next steps. Stella experiments with using ChatGPT to create a poster, but the group acknowledges the need to carefully proofread AI-generated content. They plan to review materials at the next legislative meeting on July 2nd. Selim postpones his legislative updates to the next meeting due to time constraints.

Board Meeting Agenda and Updates

The board agrees to hold a meeting on July 1st to discuss important issues. The agenda will include Jeff's feedback from AAN, a proposal for a code of conduct, and approval of a letter. The meeting aims to address these matters before Jeff's trip to Alaska from July 8th to 15th. Regarding CMA resolutions, Jeff advises responding to comments that require answers, but not to purely positive feedback. The group also plans to discuss prior authorization at their next ledge meeting on July 2nd.

Bill Comment Response Strategy

The group discusses how to respond to comments on their bill, particularly focusing on two responses: one from Samantha Mann who opposes the bill for being too narrow, and another from Quinn Lipman requesting more information. Jeff suggests reaching out to Samantha directly to understand her concerns, while for Quinn, they agree to provide additional background information online. Johanna proposes that team members prepare responses within three days for group review before submission. The team also considers involving Natalia Schuer, the CEO of Norcal Epilepsy Foundation, to help address some of the concerns. They agree to contact the CMA to determine the appropriate protocol for reaching out to commenters.

CNS Legislative Committee MEETING MINUTES - Wednesday, June 4, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Mon, 09 Jun 2025 15:38:57 GMT

Reviewing several legislative updates and bills, and discussions about transportation and infrastructure challenges in California

Quick recap

The group reviewed several legislative updates and bills, including discussions about disability accommodations in schools and concussion education initiatives, while also addressing concerns about youth tackle football and helmet technology. The conversation ended with discussions about transportation and infrastructure challenges in California, including proposals for improving walkability and public transportation, along with plans to meet with representatives from various companies and addressing delegate roles for future meetings.

Summary

Legislative Updates and Bill Review

Selim provided legislative updates, including the death of SB 44 on brain computer interfaces and the status of several other bills. He mentioned that Assembly Member Valencia's office requested a letter of support for AB 708, which is in the Senate Health Committee. The group discussed AB 1100, a bill related to victim compensation, and its potential relevance to epilepsy cases. Jeff expressed uncertainty about the connection between the bill and epilepsy patients, prompting Natalia to clarify that it addresses postictal aggression and seizure-related arrests. The group agreed to further review the bill text and consider its relevance at the next meeting.

Supporting Disability Rights in Education

The group discussed two national cases involving disability accommodations in schools: AJT vs OSSEO Area Schools in Minnesota and Texas v Kennedy, where states are challenging federal disability protections. Steve suggested writing supportive letters to align with the American Academy of Neurology's (AAN) position, which Johanna agreed to draft. Jeff expressed concern about focusing on California neurology issues rather than getting involved in national politics, leading to a decision that Steve would contact AAN to confirm their position before drafting any support letters.

Youth Tackle Football Concussion Bill

The group discussed addressing concerns about youth tackle football and concussion education. Selim shared feedback from Dr. Nowinski, who supported their youth tackle resolution but expressed doubt about passing legislation with Gavin Newsom in office. Instead, they agreed to focus on expanding concussion education to include CTE awareness for coaches, with plans to draft a bill by September/October. Stella and Selim will work on drafting the bill with Chris Nowinski's help, while Jeff suggested positioning it as an expansion of existing concussion education requirements rather than a controversial ban on youth tackle football.

Youth Football Concussion Strategy

The group discussed their strategy for addressing head trauma in youth football, focusing on education rather than legislation after facing resistance. They agreed to develop a mission statement and start presenting their initiative to potential supporters, including NFL players who previously testified. Selim will research current educational requirements around concussions to inform their approach, with the goal of having legislation ready by September 2026.

Helmet Safety and Manufacturing Challenges

The group discussed helmet manufacturers' opposition to bill 708, with Selim explaining he was contacted to submit a letter of support but noted manufacturers' resistance due to potential impact on profits. Steven shared details about advanced helmet technology developed by UCSF professor Bob Knight, which addresses rotational forces and could reduce brain injuries by up to 80%. The group agreed to pursue discussions about rotational force technology with manufacturers, though Stella and others acknowledged manufacturers' primary focus on profit rather than safety. Stella also proposed inviting Dr. Charles Flippen to speak at the next conference about the "physician as citizen" topic, which received positive support from the group.

Urban Health and Transportation Planning

Johanna discussed the impact of hypertension, hyperlipidemia, and diabetes on stroke patients and emphasized the need for urban planning that supports walking and public transportation. She proposed a resolution to reallocate the gas tax to fund traffic enforcement and walking trails, aiming to improve public health. Selim informed Johanna that transit agencies already offer discounted fares for people with disabilities, including those with epilepsy. The group agreed to create a resource page on the California Neurology website for epilepsy patients regarding transportation aids, with Dorian tasked to handle this. Jeff advised Johanna to check existing CMA policies on walking-related resolutions before pursuing new ones.

California Transportation Challenges Discussion

The group discussed transportation and infrastructure challenges in California, with Steven noting that California has the highest gas prices in the country and suggesting that raising the gas tax would be politically unfeasible. Jeff and Johanna agreed that improving walkability and public transportation infrastructure would be difficult due to historical decisions by General Motors that prioritized car usage over public transit. The conversation concluded with a discussion about self-driving cars, where Natalia suggested that Waymo could provide discounted rides for epilepsy patients, leading to a decision to arrange a meeting with Waymo to explore this possibility further.

Delegate Selection and Meeting Coordination

The group discussed meeting with representatives from a company, with Selim offering to meet first before inviting others. They agreed to keep others informed via email, with Selim offering to forward relevant emails. Stella raised concerns about Roger Bertoldi's involvement and lack of attendance, leading to a discussion about finding an alternate delegate for CMA meetings. Jeff offered to take on this role, though Stella agreed to serve as alternate through December due to her current CMA membership. The next legislative meeting was scheduled for the 18th.

CNS Legislative Committee MEETING MINUTES - Wednesday, May 7, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 16 May 2025 14:26:16 GMT

Lobbying Efforts & The Importance of Building Relationships with Legislators

Quick Recap

The team discussed the need for better communication about upcoming meetings and the success of their recent capital visits. They also emphasized the importance of maintaining relationships with legislators and the need for a separate organizing committee to manage the process. The team also discussed various topics, including lobbying efforts, the importance of building relationships with legislators, the need for volunteers to establish contacts in local legislator offices, and the importance of maintaining relationships with legislators.

Next steps

Selim to send out meeting agendas at least 5 days in advance, with a reminder on the day of the meeting.
Selim to update the group on the status of SB 44 after reaching out to Mr. Thompson.
Selim to draft letters of support for AB 350 and AB 489.
Selim to create a list of 10-20 endorsed legislations to send out to members for prioritization.
Jeff to provide Saleem with contact information for CMA staff involved in organizing their legislative advocacy day.
Jeff to look into the status of CNS resolutions submitted to CMA and provide an update.
Joanna to check her email for any updates on the resolutions submitted to CMA last year.
All members to write down ideas for a survey to send to neurologists before the next meeting.
Selim to work with Dorian to post the next meeting agenda a week in advance.
Stella to forward Selim data on fluoride and mental retardation for the support letter on AB 350.

Summary

Improving Communication and Capital Visit Success

In the meeting, Stella, Selim, Steve, Steven, and Joanna discussed the need for better communication about upcoming meetings. They agreed to have a standing meeting on the third Wednesday of every month, with a week's notice and a reminder email on the day of the meeting. They also discussed the success of their recent capital visits, with Stella and Steve receiving positive feedback on their preparation and organization.

UC Davis Faculty Meeting Success

Stella and Steve discussed the successful UC Davis faculty meeting, where they received positive feedback and support from the attendees. They also praised the epilepsy group for their contributions and the professionalism displayed during the meeting. Steven suggested that future meetings should be independent events, with attendees arriving the night before for orientation, and then departing later that day. The team agreed with this idea and expressed their willingness to participate in such events.

Strengthening Lobbying Efforts Through Relationships

The team discussed the effectiveness of their lobbying efforts and the importance of building relationships with legislators. They agreed to focus on three key issues each year and to organize a one-day event annually to meet with legislators. The team also emphasized the need for volunteers to establish contacts in local legislator offices. Stella suggested involving their Uc. Davis partners in the process to train them and build stronger relationships. The team agreed to consistently implement this approach to strengthen their lobbying efforts.

Maintaining Relationships with Legislators

The team discussed the importance of maintaining relationships with legislators and the need for a separate organizing committee to manage the process. They agreed on the need for a regular meeting with legislators, possibly in their districts, to keep the connections fresh. The team also discussed the criteria for selecting attendees, emphasizing the need for commitment to the organization and attendance at future meetings. They agreed to reach out to their UC Davis colleagues to get their contact information and potentially involve them in the lobbying process.

Neurology Advocacy Budget and Accommodation Discussion

Steven proposed a separate entity for neurology advocacy, independent of educational meetings, with a budget to be carved out from existing funds. Stella agreed, suggesting unspent funds return to the program committee. Selim suggested further discussion on the agenda for the next meeting. Steven emphasized the need to identify the number of people to accompany them and their accommodation costs. Stella agreed on the budget and the need for informal training. Jeff suggested a cost-saving approach similar to the CMA's.

Sacramento Training and Legislative Advocacy

Jeff discussed the logistics of a training event in Sacramento, California, emphasizing the importance of neurology-specific issues and the potential for cost savings. He also highlighted the value of maintaining a relationship with the California Medical Association (CMA) for legislative advocacy. Stella and Steve agreed on the need for leadership in negotiating with CMA, particularly regarding neurology-related legislation. Selim was tasked with reaching out to a lobbyist for updates on the current language of a bill. The team agreed to move on to the next item, with the understanding that they could revisit the current topic later.

Fluoride Treatment Coverage Support

The committee discusses supporting a bill requiring health insurance plans to cover fluoride varnish treatments. Jeff emphasizes the importance of being clear and direct in their support, stating that fluoride does not cause mental retardation and that they strongly support public health measures like tooth fluoridation. He advises against using nuanced language or discussing technical details, suggesting instead to focus on the safety and effectiveness of fluoride treatments. Stella mentions data on the benefits of fluoridation in reducing tooth decay, but the group agrees to keep the message simple for political purposes.

Resolutions and AI Discussion

The team discussed various topics, including a letter of support for a group and a resolution related to artificial intelligence. They also discussed the status of resolutions submitted to CMA, with Stella mentioning three resolutions submitted last year, one of which was on gun legislation. The team agreed to check the status of these resolutions.

CMA Resolution Updates and Legislative Day

Jeff and Stella discussed the status of submitted resolutions at CMA. Jeff suggested that Saleem could reach out to CMA directly for updates. Stella asked if there was anyone at CMA Saleem could contact directly, and Jeff agreed to look into it. Jeff also mentioned that he would find out who is involved in setting up Legislative Day so Saleem could contact them. Stella suggested inviting Stuart Thompson, who had expressed interest in being more involved, to a Zoom meeting with doctors. Jeff agreed that this could be a positive development.

CMA Engagement and Collaboration Strategy

Jeff emphasized the importance of increasing engagement with the Canadian Medical Association (CMA) to leverage their expertise and amplify their voice. He clarified that as a component medical society, they already have a level of membership and engagement with the CMA. Stella expressed her desire to work closely with the CMA on neurology issues, while Steve suggested a collaborative approach rather than an adversarial one. The team agreed on the need to focus on overlapping interests and not antagonize each other over non-overlapping areas.

Neurology Community Prioritization and Advocacy

The team discussed the need to focus on the neurology community's priorities, with a particular emphasis on prior authorization. They considered sending out a survey to gather input from neurologists on what they want to focus on. The team also discussed the importance of patient advocacy and the need to understand what patients want from their care. They considered involving other neurology patient groups in future conferences and using their website to gather opinions from members. The team also discussed the need to build up the policy on duty of care and the implications of practicing medicine without a license.

Healthcare System Transparency and Urban Planning

The meeting focused on discussing the issues in the healthcare system, particularly the high costs of medical care and the need for transparency in the use of Medicare tax dollars. The participants agreed that the current system is driven by business interests rather than a duty of care for patients. They discussed the need for a shift in focus towards the physician-patient relationship and the importance of doctors being in charge of healthcare decisions. The group also considered the impact of urban planning on public health and the need for more walkable communities. The conversation ended with plans to create a survey to gather more ideas on these issues.

MAINTENANCE OF CERTIFICATION - Exciting Developments

info@caneurologysociety.org (California Neurology Society CNS) — Mon, 28 Apr 2025 16:36:43 GMT

UnitedHealthcare and HCSC Accept NBPAS Certification

Recent advancements highlight major strides for the National Board of Physicians and Surgeons (NBPAS) in promoting physician choice. UnitedHealthcare and Health Care Service Corporation (HCSC) now accept NBPAS certification as part of their credentialing processes, moving away from reliance on Maintenance of Certification (MOC) programs. UnitedHealthcare recognizes physician competency through clinical practice and ongoing learning, while HCSC’s decision marks a pivotal endorsement.

Additionally, Texas Senate Bill 2207, which seeks to remove hidden MOC requirements and allow NBPAS physicians to advertise as "board certified," has gained momentum, passing unanimously in the Senate and heading to the House. These developments collectively reflect progress in modernizing credentialing standards and empowering physicians.

Read the NBPAS Monthly Dose for April 2025 here:

CNS Legislative Committee MEETING MINUTES - Wednesday, April 24, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 25 Apr 2025 17:14:41 GMT

One week until Conference and Legislative Day

Quick recap

The group discussed preparations for an upcoming State Neural Society leadership roundtable and a meeting with legislators, focusing on key issues such as the Epilepsy Transportation Act and reimbursement rates. They planned the conference agenda, including speaker arrangements and timing, and addressed logistical concerns for the Capitol visit. The team also explored advocacy ideas for epilepsy patients, such as free public transportation passes, and finalized details for their upcoming meetings and events.

Next steps

Selim to email legislators asking about maximum number of visitors preferred for meetings.
Selim to add "Senator" title to Richard Pan's name on the conference agenda.
Dorian to update the conference agenda with Senator Richard Pan's correct title.
Joanna to prepare a 5-minute talk on transportation costs and epilepsy patients for the conference.
Selim to distribute the legislative priorities document on social media and the CNS website.
Selim to confirm with Priscilla about Dr. Richard Pan's presentation title and content.
Joanna to check with YAWE representatives about current free transportation pass policies for disabled individuals.
Selim to create meeting agendas for future meetings.
Selim to inform Dorian about website content to post.
All attendees to review the folder content email sent on April 19th at 8:15 PM.
All attendees to prepare for May 1st Capitol visit, including reviewing talking points and group assignments.

Summary

State Neural Society Leadership Roundtable

The group discusses the upcoming State Neural Society leadership roundtable and a recent email from Grant Naiver about Medicare contractor advisory committees. Stella emphasizes the importance of getting involved in these committees to have a say in reimbursement rates. The group also addresses some communication issues, with Robert and Steve not receiving the email in question. They briefly touch on the upcoming conference agenda, which is scheduled for May 1st, and Selim mentions they are one week away from the event.

Epilepsy Transportation Act Meeting Discussion

Selim announces a meeting at the Citizen Hotel's Grange restaurant from 6 to 8 PM to discuss final meeting groups for May 1st. The group plans to present three issues, with a focus on the Epilepsy Transportation Act, as the first two issues have already passed. Stella suggests including Young Adults with Epilepsy to discuss transportation challenges, while Dr. Rosenthal and Stella will share patient experiences. The team aims to gauge enthusiasm from legislators for potential future legislation without making direct requests.

Logistics for Legislative Meeting Discussion

The group discusses logistics for an upcoming meeting with legislators or their staffers. They agree to have three main issues presented by designated speakers, with other attendees introducing themselves briefly. Stella suggests limiting each issue to 7 minutes, leaving 9 minutes for new participants. There is debate about how to handle potentially larger groups, given space constraints in legislative offices. They decide to confirm attendance numbers with the offices beforehand and prepare a list of attendees' names. The group emphasizes the importance of being concise and allowing everyone to participate appropriately.

Legislator Meeting Preparation and Agenda Review

Selim shares a document containing information about legislators and their offices for upcoming meetings. The document includes committee memberships, relevant bills, and district information. Selim also presents a double-sided handout about the organization, main issues, letters of support, and resolutions. The group discusses the status of resolutions submitted to CMA and agrees to post the meeting information on their website and social media to attract attendees. They also plan to review the May 1st agenda.

Conference Agenda and Speaker Arrangements

The group discusses the upcoming conference agenda, focusing on speaker arrangements and timing. They confirm Stuart Thompson's role in presenting legislation updates and clarify confusion about his identity. The agenda includes talks on California lawmaking, CMA collaboration, and experiences from a DC trip. Stella emphasizes the importance of preparing attendees for the afternoon Capitol visit. The group also discusses the inclusion of Senator Richard Pan, ensuring his title is correctly displayed. Joanna requests to speak briefly about financial aspects of job loss and driving restrictions for epilepsy patients, which Stella suggests incorporating into the panel discussion.

Epilepsy Patients' Hidden Driving Costs

The group discusses the hidden costs of driving and how epilepsy patients who lose their driver's licenses still pay for road infrastructure through taxes and mortgages without benefiting from it. Joanna suggests advocating for free bus and train passes for epilepsy patients as compensation. The conversation touches on the dangers of epilepsy patients driving illegally, with Joanna sharing stories of fatal accidents. The group also finalizes plans for an upcoming meeting to prepare for a Capitol visit, discussing expected attendees and logistics.

CNS Legislative Committee MEETING MINUTES - Wednesday, April 16, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Thu, 17 Apr 2025 19:57:08 GMT

The team discusses their upcoming meeting on April 30th at the Citizen Hotel

Quick recap

The team discussed their upcoming meeting on April 30th at the Citizen Hotel, where they would form final meeting groups for May 1st and meet with legislators and their staff. They also prepared for a potential presentation, with flexibility to adjust based on group size, and discussed the need for a basic script for each person to follow during the meetings. The team also discussed their plans for adding legislative interests, focusing on issues: duty of care, epilepsy transportation, and youth tackle football, and the potential involvement of the YAWE team in the capitol presentations.

Next Steps

Selim to update and print out the document with all bills CNS is tracking, including their stance and current status, for the April 30th meeting.
Steve and Selim to coordinate on contacting Assembly member Tangipa's office to confirm his attendance at the conference.
Joanna to write up a paragraph about the epilepsy transportation issue and send it to the group for review.
Dorian to update the website with information about the Capitol tour, including a brief description and a link to register.
Selim to include the youth tackle football resolution in the folder for legislators' offices.
Joanna to prepare a 5-minute presentation with slides on the epilepsy transportation issue, to be inserted between Richard Pan and Jeff Klingman's talks on May 1st.
Dorian to update the May 1st conference schedule, moving Richard Pan's talk to 10:20 AM.
All members to meet next week at 7 PM to finalize and approve all written materials for the conference.
Joanna to submit her presentation slides to Priscilla Graham for CME approval.
Selim to follow up weekly with Assembly member Tangipa's office to remind them about the conference and reception.

Summary

Upcoming Meeting at Citizen Hotel

Stella, Steven, Dorian, Selim, Steve, and Johanna discussed their upcoming meeting on April 30th at the Citizen Hotel. The agenda included forming final meeting groups for May 1st, when they would meet with legislators and their staff. Selim mentioned that the meeting would be in person and start at 6 pm. Stella also mentioned the use of AI to record and take notes during the meeting. Johanna had sent prior meeting minutes; tonight’s which Stella would forward for approval and Dorian's posting.

Planning Office Visits and Meetings

In the meeting, Johanna and Stella agreed to prepare for a potential presentation, with flexibility to adjust based on group size. Selim outlined the plan to visit five offices, with two meetings at 1:30 PM and two at 2 PM, and one after that. The groups would consist of three to four people. Stella and Selim discussed the need to form meeting groups and the schedule for the visits. They also discussed the need for a basic script for each person to follow during the meetings. Selim confirmed that they have handouts summarizing each topic and letters of support or opposition. The team agreed to finalize the details during their meeting on April 30th.

Patient Stories for Legislative Presentation

In the meeting, Steven, Stella, Steve, and Selim discussed the preparation for a presentation to legislators. They agreed that each person should present a patient story related to a specific issue, such as Parkinson's, youth football, or brain computer interface. The stories should be rehearsed ahead of time to avoid any surprises during the presentation. Stella emphasized the importance of patient consent in the context of brain computer interface. The group also discussed the need for each issue to be presented briefly, with a total of 10 minutes allocated for all three issues. The conversation ended with the group agreeing to identify the presenters for each issue on April 30th.

Legislative Event Planning and Materials

The group discusses plans for an upcoming legislative event and related materials. They decide to create handouts for both legislators and their own group, covering their main focus issues as well as other neurology-related bills. Selim and Steve will collaborate on preparing a concise summary of relevant bills, including those supported by the California Medical Association. Johanna suggests inviting the authors and staff members of neurology-related bills to their reception, and Selim confirms he has received postcards to send out invitations.

Epilepsy, Duty of Care, and Youth Tackle Football

The team discussed their upcoming event, focusing on three key issues: duty of care, epilepsy transportation, and youth tackle football. They decided to invite a representative from the Republican party to the event, despite not having a direct connection to their issues. The team also discussed the possibility of overriding the governor's veto on duty of care. They agreed to stick to the three issues and use creative patient stories to support their cause. The team also discussed the potential of adding a resolution regarding youth tackle football, using the NFL's flag football solution as a template.

Planning for Upcoming Event Discussion

Stella, Selim, Johanna, and others discussed their plans for the upcoming event. They decided to include a talk by Scott about the conference calendar, a session on how to make a bill happen by Garrett Jensen, and a discussion on how CMA and CNS can work together led by Stuart Thompson. They also planned to involve young adults with epilepsy in their grassroots efforts. Jeff was assigned to give an overview of CTE and concussions, while Richard Pan was to share his experience as a legislator. The team also discussed the possibility of making a resolution happen.

CMA's Legislative Agenda and Influence

In the meeting, Steven expressed the need for the California Medical Association (CMA) to be more aware of the aggressive legislative agenda of their organization. Stella suggested that the CMA could gain more influence if they understood their efforts. Steve mentioned that Stuart Thompson, who is ahead of the advocacy unit, would be speaking on Thursday. Selim confirmed that Assembly member Tangipa had registered for the conference. The team discussed the need to follow up with Tangipa and other attendees. They also discussed the possibility of a capital tour and the need to register for it. Selim suggested that the resolutions folder should include the youth tackle resolution and the epilepsy transportation act. The team agreed to finalize the resolutions and leave them with the offices.

Epilepsy Transportation Issue Paper Discussion

In the meeting, Steven discussed the strategy of including a packet with their interpersonal presentation to legislators. He emphasized the importance of not overloading the packet and suggested including teasers to draw the legislators' interest. Johanna proposed writing an issue paper on epilepsy transportation and suggested a meeting to discuss and finalize the content. Stella suggested including a young adult with epilepsy in the group to present their separate issue. Steve agreed to the idea of introducing a spokesperson to discuss the difficulties faced by those dealing with transportation issues. The team agreed to meet again to finalize the content and strategy.

YAWE Team Involvement in Conference

In the meeting, Stella, Johanna, Steve, and Dorian discussed the upcoming conference and the potential involvement of the YAWE team. They agreed to have the YAWE team present at the conference and Johanna proposed to present a 5-minute talk about the finances of having a driver's license taken away, losing a job, and where the tax money is going. They also discussed the possibility of inviting the YAWE team to the conference reception. The team decided to move Dr. Pan's talk to 10:20 and Johanna eventually agreed to be a backup presenter if someone cancels. They also discussed the potential for Johanna and Jeff to share a slot in the conference. The team agreed to meet again next week to finalize the conference program and flyers.

CNS Legislative Committee MEETING MINUTES - Wednesday, March 26, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Thu, 17 Apr 2025 19:11:37 GMT

CNS Reviews Bills and Votes on Measures of Support or Opposition

For Michelle Rodriguez, AB 369 the bill is for a lay person administering seizure medication if the parents have delegated to, for example the teacher or the school nurse. Her Health staffer Nicholas Tapio will be at our conference so we will have a chance to speak with him. Her husband Freddie Rodriguez was on the California Health Care Committee. They are both health care advocates and were EMT’s.

We have been trying to get someone from Gavin Newsom’s office. Robyn has a name and will try. Steve Cattolica knows Dawn, a patient of Robyn, and she may have a connection.

That person may be a connection. But Dawn will not want to hear about Duty of Care, counterproductive.

The next bill not related to Neurology it is about protecting the youth; youth not being allowed to hold firearms before a certain age. The bill is about limiting firearms, it is already in place, and we voted that we want to support their bill. We also voted to send a letter of support; we voted to invite them to come and speak at our meeting by sending a postcard.

Next bill has to do with Youth Tackle Football ‘It is about “soft shells” The Bill has Add On’s

It was approved by the CMA-COL and we sent a letter acknowledging that we approved the bill but….paraphrase … we felt flag was better. It does help lower the chances of severe injuries. Do we want to ask Valencia to come to our Legislative meeting? Will he come? He has a “floor session” on Thursday morning, Selim is confident that they will stay in touch.

We have invited them and Robyn said there is a preliminary budget that is approved. 2-3 weeks before the event we must tell Ginnie how many Legislative people will come? Send out postcards? 20 planned for 40.

Steve Cattolica asked about “708” Who is the sponsor? Are we listed as sponsors? We are listed as sponsors. We identify with the issue. We need to make handouts that describe what the bill is about. We need Selim to have a one-page handout about each bill with an explanation and our position. The folders are on order. Stella ordered a folder with CNS Logo that we can take to the Legislators.

For the folders we can put 3 bills into the folder that we want to take to the legislators' offices.

Robert Weinmann MD asked about 708. He heard nothing about the escalating annual cost for football helmets, do we care about that? Selim had asked Valencia’s staff about it. The Judiciary Committee asked Valencia to make it a revision, they wanted the parents to not be responsible for Attorney fees, if there was a lawsuit, they wanted the sports organization to be responsible for attorney fees. They wanted to move language about parents. Each football helmet repurposed and reconditioned each year. Steve Cattolica thought that it would put the bill into appropriations. Now they have another revision, so they might be able to take it out. Selim stated that the Sports committee amended the bill, but it is not uploaded at this time. Selim will find it.

Bill 829 Parkinson’s Disease Research funds; voluntarily, we have already written them a letter of support. It is one of our three issues. We are a sponsor. Selim is trying to ask them to come and be a sponsor. Some legislators let you work through a portal some you can just ask. Try to get them Selim.

Resolution health advantages of permanent Standard time or Daylight Savings time. The bill is to adopt Standard Time. Neiler wants to do the Bill as Standard time? Is that better for the brain. Robyn pointed out that Arizona only uses Standard Daylight Time.

Per Steve Cattolica: He is a ranking Senator and a Republican. It is a harmless way of providing him some support, we need him to be sympathetic, where is he from?

Do we want to discuss it with Neuroendocrinology or Sleep in November?

The resolution is passing but the Bill is still operational. He will probably be helpful on our other bills. He is Steve Cattolica’s representative. Let’s invite him to our reception and offer him a chance to speak to offer him support and get to know him, it puts us in a good light for our concerns. Recommend Selim contacting him or his staff and inviting them to the reception. His references will be available. Share the bill SCR 7 text. It is a resolution.

Bill was shown; let’s invite his staff to our ledge meeting about it next meeting.

Meeting started, discussed Members coming and hotel coverages

Stella asked for me to record the names of meeting attendees.

Robyn, Selim, Stella, Johanna, ...

We discussed the Football and Helmet bill and risk of head trauma; this is something we want to support.

The first bill discussed Bill number has to do with family having a claim on recovering income after Medical Malpractice. It is “to do with Micra” SB9 CMA opposes, we decided to just have the CMA carry that bill forward, decided not to interact with the people that are promulgating it.

A bill came up at the CMA COL and we opposed small shops setting up places to sell Psychedelic drugs for depression.

Meeting with Nick Tapio (Asm. Michelle Rodriguez) on Feb 13, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:35 GMT

Quick recap

The team discussed the financial implications of transportation for people with epilepsy and proposed potential solutions, including allocating a dollar from truck registration towards retraining or local transportation budgets. They also discussed healthcare policies, particularly a bill aiming to align the standards of administering life-saving medicines to people with seizures in adult day centers with FDA standards. Lastly, they discussed the risks of head injuries in children playing tackle football and the potential for introducing a bill to raise awareness about the impact of head injuries on children's brain development.

Next steps

Selim to send conference information to Sean Porter.
Selim to create or coordinate creation of a formal invitation for the legislative reception on May 1st.
Johanna to contact Sean Porter about potential legislation sponsorship and discuss the epilepsy transportation issue.
Stella to write a letter to the NFL praising them for flag football and encouraging them to promote safety in youth football.
Johanna to resubmit the full CMA resolution documents, ensuring all content fits within the submission guidelines.
Selim to contact the Governor's office and healthcare representatives to invite them to speak at the May 1st legislative day.
Johanna to attend the CMA legislative day on May 21st, arriving the night before.
Jeff to attend the CMA legislative day on May 21st.
Legislative team to continue pursuing the head injury bill with potential sponsors.
Johanna to follow up with Michelle Rodriguez's office about attending the May 1st reception and potentially meeting with the team.

Summaries

Transportation Funding for Epilepsy Patients

Johanna discussed the financial implications of transportation for people with epilepsy, suggesting that those who cannot drive due to their condition should receive a portion of the taxes paid by those who can drive. She proposed a potential solution of allocating a dollar from the registration of 18-wheeler trucks towards retraining or budget for local transportation departments. Steve agreed with Johanna's points about the funding and taxation system, but expressed concerns about the feasibility of taxing truck drivers due to their strong union. The conversation ended with Stella and Nick joining the conversation.

Healthcare Policy Discussion and Support

Selim, Dr. Stella Legarda, Dr. Joanna Rosenthal, and Steve Cattolica met with Nick, a legislative representative, to discuss healthcare policies. They expressed support for a bill, Assembly Bill 369, which aims to align the standards of who can administer life-saving medicines to people with seizures in adult day centers with FDA standards. They also discussed the possibility of Nick's office giving a talk about the bill at their upcoming conference in Sacramento. Additionally, they mentioned a previous bill, the Levine Bill, which they supported and was recently passed.

Addressing Tackle Football Risks in Children

Johanna and Stella discussed the risks of head injuries in children playing tackle football, particularly in the developing brain. They mentioned a bill that partially went through last year, which required parents to sign a waiver acknowledging the risks. They also discussed a study by Boston University's CTE Center, which found that 100% of professional football players under 30 had chronic traumatic encephalopathy (CTE). Stella suggested that the National Football League should prioritize long-term brain health in children and proposed a joint resolution between the House and Senate to create an age limit for tackle football, similar to other contact sports.

Addressing Head Injuries and Epilepsy

In the meeting, Johanna, Stella, and Nick discussed the possibility of introducing a bill to raise awareness about the impact of head injuries on children's brain development and the subsequent challenges faced by those affected. They agreed that the bill should be the primary focus, with a resolution as a fallback option. Nick committed to discussing the idea with his team and superiors, acknowledging the challenge of securing funding in the current budget deficit. The team also discussed the potential for job training programs and transportation assistance for individuals with epilepsy who lose their driver's licenses. The conversation ended with the understanding that the issue is underserved and needs to be addressed.

Bill Language and Legislative Session

Nick agreed to follow up on the ideas discussed with his team and send the bill language to Stella for support. Johanna reminded Nick of a February 21st deadline for new legislation and asked about the number of bills his department was sponsoring. Nick clarified that they were limited due to the shortened session and the new member's role. Johanna proposed an invitation for Nick's department to attend the legislative session on May 1st and visit the office in the Capitol. Nick agreed to this and provided Selim with the scheduler's email. Steve expressed his appreciation for the bill and the progress it aimed to achieve.

State Funding and Project Income

Johanna and Stella discussed the challenges of generating income for their projects and the need to approach the state for funding. They also discussed their interactions with the Principal Consultant on the Senate Transportation Committee, Melissa White, who advised them against asking for money, suggesting instead to extend the service to the population. Johanna expressed her belief that they could find a workaround and generate income from the state, while Stella emphasized the importance of presenting their goals clearly and avoiding the perception of asking for extra money. They agreed to continue their efforts and to invite the legislative assistant to a meeting to further discuss their plans.

Youth Sports Concussion Prevention Efforts

Stella, Johanna, and Selim discussed the committee's legislative efforts, particularly focusing on concussion prevention in youth sports. They agreed on the need for a joint resolution between the House and the Senate to limit contact sports for under-12s, rather than a bill. They also discussed the potential for using the legislation as a bargaining chip with the NFL. Johanna mentioned that she had sent letters to the NFL and other organizations, and Stella suggested writing a letter to the NFL praising their adoption of flag football. The team also discussed the importance of Selim speaking up in meetings, as he has a strong understanding of the legislative process. Lastly, they planned to invite representatives from the Governor's office to their upcoming legislative day.

Epilepsy Medication and Transportation Discussion

Johanna, Stella, Jeff, and Selim discussed various topics, including epilepsy medication, transportation for epilepsy patients, and potential legislation. Stella mentioned a bill she was involved with last year, which allowed school personnel to administer epilepsy medication to students. Johanna suggested a new approach to claw back some of the money epilepsy patients pay for transportation they can't use. Jeff agreed, stating that it wouldn't cost much for transportation agencies to provide free transportation for epilepsy patients. They also discussed the possibility of bringing the issue to a state level, as opposed to individual municipalities. Selim asked about reaching out to Sean Porter, and Johanna agreed to do so. Lastly, they discussed the upcoming CMA resolutions and the possibility of attending a legislative day on May 21st.

CNS Legislative Committee MEETING MINUTES - January 29, 2025

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:34 GMT

Legislative Committee Meeting Minutes

Here is a summary of the meeting:

Steve C:

Set up a May 1 meeting with the governor’s office Health staffer.
Start a template letter for staffers to present.
Start a template letter to write to the DOJ regarding MOC, to co-author with Bob and Stella.

Selim:

Contact offices of representatives to request 15-minute meetings on May 1.
Sign the organization onto CapitolTrack, with Jeff and Stella covering the monthly charge until Robyn Treasurer takes over.
Organize Capitol visits to member offices with Johanna.

Jeff K:

Contact the CMA chief lobbyist to discuss closer cooperation on health bills on May 1.
Contact Rebekah about resurrecting the youth tackle bill.
Contact Ramos of Appropriations to discuss the $2M budget and also reach out to the Surgeon General.
Find a speaker for an update on neuromuscular disease for the program meeting on Tuesday.

Stella:

Send a letter invitation to Ravindra Chandrashekh to speak on May 1 about MOC and its negative impact on patient care.
Work with Johanna on the May 1 agenda, tentatively including:

8:00 -8:15 AM: "Making the Sausage" with Garrett Jansen
8:15 to 8:30 AM: "Working Together" with a CMA lobbyist
8:30 -9:00 AM: presentations about each BIll
Concussion
Epilepsy
Prior auth and UR
10:00 AM: Questions
part of the team visits offices,
anyone else can stay for
AAN and General neurologist
MOC
11:30 AM: Lunch break
1:00 pm - 2:30 PM: Capitol tour
3:00 PM: Break
3:30 PM - 6:30 PM: CNS Reception

Request an AAN speaker to discuss the need for general neurologist training emphasis while at Neurology on the Hill.

Johanna:

Add the need for general neurologist training emphasis to the survey.
Add other items to the survey.
Prepare meeting minutes with Dorian.

Medical Economics Reports on MOC in 2024

Fri, 04 Apr 2025 16:28:33 GMT

ABMS Maintenance of Certification (MOC) is a proprietary continuing education product that to date has no high-quality evidence that it improves patient care. The cost and burden associated with MOC remains a significant factor driving physicians out of medicine.

Key Takeaways

• ABMS's MOC program is criticized for lacking evidence of improving patient care and contributing to physician burnout and exit from practice.

• MOC is effectively mandatory due to its integration into national credentialing systems, despite being labeled as voluntary.

• Surveys show most physicians view MOC as unnecessary and financially motivated, with little clinical value beyond existing CME requirements.

• The MOC program exacerbates physician shortages, impacting patient care access, especially in Healthcare Professional Shortage Areas.

Editor's note: 2024 has been a year of innovation in primary care, from advancements in artificial intelligence to the growing role of value-based care. As we close out the calendar year, our "Best of 2024" series highlights Medical Economics' coverage of the past year's health care trends that have paved the way towards better patient care.

The largest board certification organization in the United States, the American Board of Medical Specialties (ABMS), recently announced a record-breaking number of ABMS-certified physicians in the United States – 988,737 out of 989,323 physicians to be exact – easily cementing its monopoly status for its physician certification enterprise. Amidst their highly profitable business model is a significant, but little known, driver that is exacerbating burnout and hastening the exit of physicians from clinical practice. ABMS Maintenance of Certification (MOC) is a proprietary continuing education product that to date has no high-quality evidence that it improves patient care. The cost and burden associated with MOC remains a significant factor driving physicians out of medicine.

READ THE FULL ARTICLE HERE

CNS Legislative Committee MEETING MINUTES - November 20, 2024

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:32 GMT

Legislative Committee Meeting Minutes

Here is a summary of the meeting:

The UAPD, celebrating 52 years in business and present in six states, primarily consists of MDs, NPs, mid-levels, and some dentists. George Osborne, hired by Dr. Weinmann over 20 years ago, attended the meeting. Two UAPD-sponsored bills were signed by the governor, but SB636, despite multiple attempts over 20 years, remains vetoed. Private sector doctors can join UAPD for an annual fee of $477. The governor signed AB310, addressing data collection disparities between private and public sector services. LA County doctors, with about 1,200 members, considered a strike last year. UAPD successfully introduced AB2889 to remove punitive sanctions for unlawful strikes. The state is hiring private doctors over civil service ones, leading to a disparity in pay. Current bills include one from Assemblywoman Baines and another from Dr. Joaquin Arrambula, an ER doctor. Dr. Weber, a pediatrician from San Diego, is also involved. The supervision of NPs has been a long-standing issue, with full autonomy at the county level but not at the state level. The UAPD is concerned about scope creep and the increasing roles of mid-levels. Psychiatry needs more doctors, and there is a high turnover due to term limits. The Medical Board, now more political, is seen as disciplining doctors rather than supporting them. Dr. Klingman discussed the need for supervision of NPs. Johanna raised concerns about Medicare privatization and lack of oversight. Dr. Klingman suggested a union for private doctors. Specialists face billing challenges, and Blue Cross and Blue Shield are accused of defrauding Medicare. Hospitals are losing money and closing. The Workers Compensation doctors are exempt from duty of care. The UAPD is considering a lawsuit for discrimination and working with the California Chamber of Commerce. The idea is to involve Public Employees in Workers Compensation cases. Newsom, seen as healthcare-friendly, will be replaced in 2026. The UAPD's agenda includes engaging neurologists in the legislature and addressing issues like drug expenses and transportation for epilepsy patients. Prior authorization for neurology should involve independent neurologists, and there are concerns about the cost and effectiveness of prior authorizations. The UAPD is considering a referendum on concussions.

CNS Legislative Committee MEETING MINUTES - September 19, 2024

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:31 GMT

The September 19, 2024, LEDGE meeting focused on addressing challenges in physician board certification and advocating for increased choice among certification boards. The discussion, led by Paul Matthews, centered on empowering physicians to select from multiple recertification options, emphasizing the need for competition to improve the healthcare system.

Summary of LEDGE Meeting Minutes (September 19, 2024)

1. Main Topic: Physician Choice in Certification

◦ Discussion led by Paul Matthews emphasized advocating for physician options among certification boards (AOA, ABPN, NBPS).

◦ The goal is to address the lack of competition in the certification space, arguing that physicians deserve multiple recertification choices.

◦ Highlighted the existing precedent: AAN endorses multiple boards (e.g., UCNS and ABPN for Neurocritical Care).

2. Action Plan and Contributors:

◦ Letter Drafting: A key strategy is to draft a letter co-signed by state neurological societies, spearheaded by Dorian , Stella , and Johanna .

◦ The letter will articulate unified support for board certification options, targeting the AAN and CMA.

◦ Paul Matthews suggested leveraging media outlets like Practical Neurology and Neurology Reviews, with potential support from Allan Rapaport, to publicize efforts.

3. Next Steps:

◦ Initial focus on collaboration with the Massachusetts Neurology Society and California Neurology Society .

◦ October 2024 is a target to engage with the California Medical Association (CMA) to build broader support.

◦ Use CMA’s House of Delegates to push for rule changes, as most delegates are reportedly sympathetic.

4. Challenges:

◦ Steve Holtz pointed out that the CMA's historical focus on surgeons and generalists limits their attention to neurology issues.

◦ Holtz emphasized prioritizing state society endorsements to "build the armory" before approaching broader entities like the AAN.

5. Key Recommendations:

◦ Garner letters of support from additional state neurology societies to create national momentum.

◦ Engage with organizations like the United Council of Neurological Subspecialties (UCNS) , already endorsed by AAN, as potential allies.

◦ Address independent boards such as the American Board of Clinical Neurophysiology and Neurodiagnostic Medicine as part of broader coalition-building efforts.

6. Conclusion:

◦ The consensus is that a coordinated, state-led initiative is crucial for influencing national organizations like the AAN.

◦ Paul Matthews stressed the importance of making the letter widely known to generate visibility and pressure that cannot be ignored.

Senate Bill 636 Vetoed by Gavin Newsom

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:27 GMT

California Senate Bill 636 (SB-636) focuses on workers' compensation and the utilization review (UR) process. Introduced by Senator Cortese, the bill amends Section 4610 of the California Labor Code.

Here are some key points:

• Medical Professional Licensing: SB-636 requires that medical professionals performing UR for California workers' compensation claims be licensed in California

• Fairness and Transparency: The bill aims to enhance fairness, transparency, and accountability within the UR process by ensuring that evaluations of medical necessity and appropriateness of treatments are conducted by qualified professionals

• Governor's Veto: The bill was vetoed by Governor Newsom, citing concerns about its implementation

Click here to read the Governor's letter regarding Senate Bill 636

Downloadable: CNS Position Statement on the Epilepsy Transportation Accessibility Act

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:26 GMT

Supporting the Epilepsy Transportation Accessibility Act is indeed crucial. This legislation aims to provide free transportation to young adults living with epilepsy, a group that faces social stigma, isolation, and underemployment despite their talents and achievements. By offering accessible transportation, we can empower them to succeed in various aspects of life.

Download these resources to understand and send to your local representative:

- Epilepsy Transportation Accessibility Act - Read the act definitions.

- Position Statement - Learn about why we believe this legislation is imperative.

- Support Letter - Download an editable support letter to send to your legislator or assembly member.

CNS Legislative Committee MEETING MINUTES - August 21, 2024

exhibits@californianeurologyconferences.com (CNS Exhibits) — Fri, 04 Apr 2025 16:28:24 GMT

Legislative Committee Meeting Minutes

Here is a summary of the meeting:

1. Introduction of Dorian Capers : Stella, the President, introduced Dorian Capers as the Online Logistics Specialist who will assist with communications at the Ledge Meetings.

2. MOC (Maintenance of Certification) Concerns : There were complaints from younger neurologists about the difficulty and cost of MOC, which negatively impacts patient care. Older members are “grandfathered” with lifetime certification, but younger doctors face burdens, especially with tests covering areas outside their subspecialty.

3. Discussion on SB 636 : Steve shared updates on SB 636 , which requires prior authorization to be done only by credentialed and licensed doctors in California. The bill's progress is slowed by a proposed expensive study, but there’s hope for its continuation.

4. McCarty’s Bill on Head Injuries : Due to high study costs, McCarty's bill is stalled. Suggestions included public outreach and working on new approaches for next year, including collaborating with the media to raise awareness.

5. MOC Reform and Conflict of Interest : Concerns about conflicts of interest between the AAN, ABPN, and ABMS, which benefit financially from certification, were raised. Paul Mathew, an expert on MOC reform, was recommended to help navigate these issues and push for changes that reduce costs and burdens on neurologists.

6. Epilepsy Transportation Act : Stella inquired about Cortese’s interest in the Epilepsy Transportation Act, but it is not the right time for him to engage because this is an election cycle.

7. Future Advocacy Efforts : There was a strong emphasis on organizing for the next year, building coalitions with stakeholders, and creating materials like a white paper to argue for reform in MOC, Utilization, and healthcare system issues.

8. Board Certification Reform : Suggestions included rebranding board certification as a lifelong title, separating it from continuing education, and reducing the burden of current certification maintenance requirements.

9. Next Steps : Further efforts will focus on outreach, legislation, and collaboration with figures like Paul Mathew to explore alternatives to current certification processes.

---

The meeting started with Stella, our President introducing Dorian Capers. He is going to be the Online Logistics Specialist and will be coming to the Ledge Meetings and help with communications.

We have a concern for MOC Maintenance of Certification. The older members of the CNS have all been “Grandfathered In” meaning that when we took our Boards, it was a lifetime Certification. MOC came out later and Stella has received many angry emails from younger members that it is too difficult to prepare for MOC due to the changes in Neurology from sub-specialization, the inordinate fees are burdensome on young families, doctors first obligation is to patient care which suffers when doctors are required to study in a field outside of their subspecialty field, for example a stroke neurologist being tested on neuromuscular information, when the doctor has only taken care of stroke patients for 10 years.

Steve had mailed 2 articles to us about Utilization and Duty of Care SB 636 that called for prior authorization to be done only by Doctors Credentialed and Licensed in California. The Bill is back on the board due to the fact that there was a technicality in the Labor Code, and so it was different from what we cited. Currently lay people (without a medical license) are doing UR. The other part is that the Medical Board suggested that we put out the date of implementation farther out, giving everyone breathing room. This would put us in another fiscal year. The Surgeon General recommended a study that would cost several million dollars, and that would be easier to obtain in the next fiscal year. If the senator is interested in putting it out there. The Medical Board is already following the bill. The Senator’s staff contacted them. The Medical Board has its own legislative advocacy group.

The Medical Board has always been following this issue. If the cost issue can be deflected by putting the implementation date out - Will probably find out around August 31, 2024.

The bill language from the Surgeon General calls for a study. Why was it going to cost $4 million dollars over 2 years, seems excessive. Did someone delay by making a demand for a large amount of money for a study. We should investigate whether this was a blocking technique. The data belongs to the insurance companies, specifically the Workers Comp carrier who will be sure the study is done properly per Steve Cattolica, we need to have oversight. They made the bill look so expensive to implement that it got sidelined.

The topic changed to McCarty’s bill; the Legislature is not moving forward because of the cost of study about head injuries, the Surgeon General cited a large cost of the study. Steve asked for the research in a Public Information act.

Steve Holtz was questioned about the studies and what should be done, recommended trying public outreach. Need the studies for both Cortese and McCarty bills. The forces against us make money with Utilization and also make money from children’s sports. The only approach is to share and explain to the constituents. Steve pointed out that it is not going to the floor with 8 days left to review 700 bills. So now we can restart the bills again. Take your foot off the gas, take a deep breath, put the car in a different gear.

Per Steve Holtz, need to look at next year look at all the large groups of lay people that have a stake in this that we can get to line up and send representatives and lobbyists to the actual legislators, or public commercials, with kids getting knocked out?? Publicity $$$???? Steve Cattolica recommended writing a 3–4-page analysis of the problem from a medical perspective and use that as the basis for coming back and having another bill. The number of kids playing youth tackle football is diminishing, and parents and rec departments and the changes are already being done. We have to leave it up to the parents, “it is already happening and here are the reasons, it is from the injury rate, the human trauma, the cost, We need to come up with a “white paper” short enough that people will read it.”

Does McCarty know someone else that would sponsor the bill. Steve Holtz says contact every newspaper, specifically, the component that investigates issues related to public welfare. Approach the newspapers in the Bay Area etc. Costs nothing. The parents have an interest. Dorian can make the contact and have Dorian submit to the Newspapers. This is for next year we need to get partners on our side. There will be significant interest because it has to do with the welfare of kids, the investigators are not influenced by the money interests.

Stella was puzzled about how there was an analysis of the bill that talked about the need for the Surgeon General to do a study. Steve Cattolica has already requested the analysis. Johanna asked if we know of a legislator that will take on a new bill next year (Cortese will be Mayor of Sacramento). Steve Cattolica pointed out that they are up for re-election. Again, we have to talk to the legislators. In Palm Springs, see if anyone knows of someone that will take over this topic.

Paul Mathew, MD will be talking about Headaches and also talking about the MOC programs at our spring 2025 Calif Neuro Soc meeting. We had been considering changing the mission statement about empowering all of us to do our jobs.

Stella wondered about Cortese and whether he was interested in the Epilepsy Transportation Act. He is sympathetic to the whole concept, but it is not a good time.

The American Academy of Neurology (AAN) has a mission statement about empowering Neurologists for us to be all that we can be and do and be our best at our jobs. If they are going to fulfill that they should align with us on maintenance of certification and maintenance of care evolution . The AAN, American Board of Psychiatry and Neurology (ABPN) and the American Board of Medical Specialties (ABMS) are financially connected, so there is considerable conflict of interest, the AAN is benefiting financially from certification, so they are not necessarily looking out for the quality of life and best interest of the individual doctors, so there is a conflict of interest.

Steve Holtz pointed out that Paul Mathew is an expert about conflict of interest and recommended seeking his guidance. The AAN has been considering this issue for more than 10 years. There are many forces that want Neurologists to demonstrate competency and stay up to date. Young people are in favor of this but wish it was less expensive as far as dollars and time. Paul has worked with NBPS, National Board of Physicians for Surgeons to provide an alternate path of certification. Hospital boards and insurance companies would have to accept the alternative certification. Paul is more up to date. Stella pointed out that on the NBPS website it states that the individual neurologist has to work with their own hospital for the hospitals to accept the NBPS certification so it has to be a grassroots effort. Stella pointed out that the younger neurologist that are affected have to persuade their hospitals to accept the NBPS certification it’s not really the responsibility of the older neurologists that are grandfathered in. The younger neurologists are too busy with patient care to assert themselves with the hospital so they’ll just pay the money and take the test. Paul has been president of the NBPS. Steve recommended having Paul Mathew there at the same time that a representative from the ABPN is there that would be the first step.

A business person in charge of any county budget now makes decisions for nurse practitioners and physician’s assistants are currently credentialed in writing prescriptions for neurology patients although they don’t for example know the difference between the second and the third nerve and they don’t know how to pronounce the name of the seizure medicines and they don’t know the numbness in the feet the Babinski and the relationship to the cortical spinal tract. Interestingly board-certified neurologist have to maintain certification but physician’s assistants that haven’t done a neurology residency have been board-certified are now writing prescriptions in outpatient clinics because a businessperson decided the doctor was too expensive. Johanna pointed out that Robert Weinmann warned us to prevent this from happening that we were all too busy to fight the nurse practitioners and physician’s assistants Steve Cattolica pointed out that we need to reverse this and go back and change that policy.

Roger Bertoldi pointed out that the concept of Board Certification should be done once, like “being knighted” and then the concept of refresher courses should be separated from the Board Certification. The CME should use different lingo to dissociate the concepts, we should use mild tame words for “refresher courses, continuing education, and staying up to date” instead of MOC to start dissociating the two.

Stella was thinking of how to best approach the AAN to help us with changing MOC. Write a letter to the AAN, Charlene, on behalf of CNS, but first have Paul and the ABPS and CNS all as a group then ask a representative of the AAN to meet with us, Dr. Brooks Kayel and Paul and have them to a crossfire but meet with Paul fist. Stella has met with Dr. Mathew and needs a crossfire at the meeting in the spring. With the 2 then talk to Charlene the AAN president.

Next topic: epilepsy transportation. Steve Cattolica had contacted the board of the Epilepsy Foundation. She, Natalia, will get back to us. Stella had contacted them.

Johanna suggested that rather than utilization, change the entire health care system. Any insurance that receives government funds must have an 80/20 ratio of patient care to administration and overhead ratio. It must be “nonprofit” and not sold on the stock exchange as a source of profit if they receive any tax generated dollars. There could still be Medicare for older, Medicaid for people who are ill and can’t work and since there are many types of people that might want a truly private insurance opaque to the public and sold on the stock exchange, the Aetna and Blue Cross etc., can still have purely private plans.

The bill to reverse mandatory reporting is on Assembly third reading and it will go to the Governor to get signed. CMA will be trying to persuade. It is not our bill there are people trying hard to move that bill along. It is on its last pass through the Senate.

Gun epidemic - the resolution is being submitted and CMA is doing an analysis. We need to have Steve make a file on our resolution and he can send it out, Stella needs to receive a CC when we send these things out.

Steve Holtz pointed out that the Doctors are worrying about what is good for the patient, but in political situations that is not what the political process is about. The people in charge think about what is good for the public. The people in power are thinking about what is good for them in order to continue having power. The people in power see everything from a different perspective.

Roger Bertoldi recommended that Board Certification be changed to a Title, can’t be taken away, like being knighted. Basically is it legal to “strip people of their Title”. Steve Holtz stated that Paul Mathew has already scoped out the Legal implications and the best approaches used by the NBPS -- we need to work with Paul. Stella pointed out that NBPS does not receive income (Paul Mathew). The AAN wants to make money off Neurologists, Johanna suggested having them certify NP and PA’s as a boondoggle in exchange for having Neurologists given a one time certification and only required to “update” or refresh in a mechanism that is 1/3 of the current obligation. Stella pointed out that they can run the AI program, customized updates that she is recommending. Steve Cattolica agreed that if the AAN could sustain their revenue stream they might make these modifications.

Roger Bertoldi was asking if we could have Legal Counsel available. There is a third category “title” that needs to exist Steve Holtz pointed out that the AAN and Paul have already gone over all the legal issues. We probably don’t need to spend money on a lawyer at this point. Why wouldn’t the AAN lawyers work for us???

Our interests are not really aligned. Paul started with Palatucci, but then became the Guru of MOC.

Would Paul be “our representative” why was our title given away is that even legal. Can we work out a plan with him. Allow Paul to do a presentation followed by questions and answers. We need the history and current status of MOC. Stella states that she sent a letter and covered all the issues, and we may want to hear the legalese. Stella feels that she has already covered all the issues and requested that everyone read the letter and that we should ask him.

“NEXT STEPS MOC”.

CNS Legislative Committee MEETING MINUTES - September 4, 2024

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:23 GMT

September 4, 2024

Legislative Committee Meeting Minutes

Lecture by Paul Matthews, MD, NBPAS, FAAN, FAHS

Here is a summary of the meeting:

1. Background on Grandfathering and Certification:

- Historical use of the term “grandfathered in” and its implications in the medical community.

- Current statistics: 80% of grandfathered physicians are white and 70% male.

- Lifetime certificates by ABMS grant elite status to physicians, leading to disparities.

2. Introduction of MOC (Maintenance of Certification):

- Instituted in 2007 to ensure continuous education, requiring recertification through self-assessment, improvement modules, and CME.

- Criticism: Increased workload on physicians with no clear evidence of improving patient care or physician competence.

3. Impact of MOC on Physicians:

- MOC added stress amidst existing responsibilities like patient care, prior authorizations, research, EHR compliance, and teaching.

- Studies, including Mayo Clinic, showed limited efficacy of MOC. Less than 15% of doctors found it beneficial.

4. Economic and Workload Burdens:

- Cost analysis (Annals of Internal Medicine, 2014) showed significant financial burdens:

- Internists: $16,000 over 10 years.

- Hematologist-Oncologists: $40,000 over 10 years.

- Physicians lose substantial time from patient care due to MOC courses and assessments.

- Total burden estimated at 5.7 billion in fees and 33 million hours lost from 2015 to 2025.

5. ABMS and ABPN Conflicts:

- Lack of reform despite criticisms and calls for changes to MOC.

- Revenue and administrative expansion are driving factors for continued MOC requirements.

- Financial discrepancies in ABIM, with millions in salaries and losses but no tangible benefit for physicians.

6. Rise of NBPAS (National Board of Physicians and Surgeons):

- Founded in 2015 by 20 physicians as an alternative to ABMS.

- Offers streamlined, evidence-based CME certification without contributing to physician burnout.

- Costs: $169 per year for two years, covering all specialties.

- Accepted by over 200 hospitals and health systems. NCQA and The Joint Commission also recognize it.

7. Physician Burnout and Retaliation:

- MOC contributes to burnout, with 25% of physicians leaving practice within 5 years.

- NBPAS offers a sustainable model and encourages physicians to use their certification for advocacy.

8. New Developments in MOC:

- ABPN introduced “MOC 2.0,” offering the option to complete assessments every three years or take an exam every 10 years.

- AMA passed a resolution on MOC but took no significant action.

9. Advocacy and Legislative Action:

- Push for hospitals to recognize NBPAS as an alternative to ABPN certification.

- Leadership in organizations like AAN and APA is becoming more inclusive and may be more open to reform.

- Discussion on integrating certification reforms into legislative efforts (e.g., SB636).

10. Next Steps and Strategies:

- Continue collaborating with other state neurological societies to urge reform.

- Encourage physicians to promote NBPAS certification within their hospitals.

- Engage hospital credentialing committees using the available NBPAS resources for bylaw changes.

- Explore advocacy efforts within CMA and national organizations to support certification reform.

---

Action Items:

1. Collaboration with Hospitals:

- Explore strategies to persuade hospitals to adopt NBPAS certification for recruitment and retention purposes.

2. Support for Physicians:

- Advocate for reducing the burden of MOC and push for more evidence-based, cost-effective CME options.

3. Legislative Advocacy:

- Consider adding board certification requirements to legislative efforts like SB636.

- Leverage support from other physician groups, such as APA and CMA, in these reform efforts.

4. Follow-up Meetings:

- Next discussion scheduled for September 18, 2024, to further address certification and legislative strategies.

---

The term Grandfather or “Grandfathered In” is an old term that was used to describe people that had bypassed voter registration laws.

Currently, the doctors that are “grandfathered in” as Board Certified by the AAN are 80% white and 70% male.

The policy was driven by contracts between the ABMS and the physicians with lifetime certificates still grant an unjustified elite status.

In 2007, the decision was made to institute MOC programs, and doctors certified AFTER that date were required to do MOC

recertification plus CME

· self-assessment modules and improvement in medical practice modules

· the change from recertification to MOC to strengthen the program and guarantee that physicians were current in ways not immediately available for testing

Someone thought that physicians have nothing better to do with all that free time [but in reality they have]:

· patient care,

· more patients

· less reimbursement

· prior authorizations

· scheduling peer-to-peer

· spending time on peer-to-peer

· research

· teaching trainees

· EHR compliance ICD 10 so

· CME

· family and social commitments

· institutional compliance modules

Coping strategies such as career counseling meditation and yoga don’t decrease the burden of the workload.

In 2014 ABPN/ABMS MOC information session

· who came up with the modules

· why the modules recommended

· what evidence is there that the modules improve

· why should I pay for modules pay for CME and pay $1500 to take the exam

· Mayo Clinic showed no hard evidence of benefit less than 15% of doctors thought the modules were helpful or that MOC was worth the time and effort

It was like marketing a new drug without testing for efficacy or side effects, but the ABMS employees received a large amount of money for crafting the institutional policy.

Annals of IM study 2014

· Cost analysis 10-year dollars cost analysis for Internists $16,000 dollars

· 10-year run for Hematologist Oncologist was $40,000 dollars

· Revenues far larger than actual cost of the programs

· One institution 1200 physicians and $2000 a year was 2.4 million every 10 years or 240,000 per year the money would be better spent on opioid crisis or covid or patient centered activities, there were Dr days lost to the hospitals

Lost Days from physicians taking time off for the courses less time for conferences, continuing ed, patients, personal time off.

The total was 5.7 billion in physician fees from 2015 to 2025 and 33 million hours over 10 years. This was equivalent to the workload of 1785 physicians over 10 years or not graduating eight medical school classes of physicians.

ABPN receives grants from ABMS to provide more products.

ABIM 6.5 million transferred to foreign accounts[?!]

The ABIM and The ABIM foundation lost $39.8 million [in] 2013, but during the same year paid $125.7 million to senior officers ABPN CEO making $3 million per year. Officers $300,000.00 to $400,000.

NBMS does use ABPN for initial certification.

ABMS gives money to ABPN for providing the modules ABPN would not accept a request for reform

http://www.changeboardrecert.com this group includes Dept Chair, Chief of Divisions, Members of NIH, Disciplines outside of Neurology,

but ABPN did not listen, Feb 3, 2015, ABIM announced apology and suspension of modules,

Feb 16, 2015, 9 letters with 1,100 signatures.

www.endmoc.com website established, no response from ABPN

The AAN agreed that Part IV was onerous, and urged repeal of Part IV of MOC and calls on ABPN to respond positively.

The APA position statement representing 36,000 Psychiatrists supported the elimination of Part IV of MOC

The ABPN said it had no recourse. “The ABPN believes strongly that it is bound to follow the ABMS MOC standards. On its own, the ABPN does not have the authority to eliminate any Part of the MOC without risking censure by the ABMS and jeopardizing the value of our diplomates’ certificates.”

From 1970 to 2015, the growth of management and administration, was 2500%

· Physician growth was less than 500%

Since the ABMS and the ABPN had no incentive to change, NBPS was formed.

· Initial certification by ABMS

· Valid License

· At least 50 hours of ACCME accredited CME

· Active hospital privileges

· Clinical privileges have not been permanently revoked

· Cost $169.00 per year for 2 years certifies all specialties by ABMS and AOA

· Must have active privileges in a hospital in that specialty so that you are not just a good test taker

· Multiple specialties, multiple institutional representation Harvard, Mayo, Dartmouth, UCLA, NYU

· Pro physician movement, the more support the better, can be ABPN and NBPS, DO’s that pass the AOA

· Think of NBPAS as a PAC donation

· Mathews Paul MD FAAN, multiple articles in multiple journals

ABIM retaliated, what do they have to hide www.newsweek.com/certified-medicalcontroversy-320495?pianot

2022 a new compromise from ABPN, they came out with “MOC2.0”, you can do a Complete Article Assessment every 3 years or an exam every 10 years

30 for one certificate, 50 for two certificates, 70 for 3 certificates 90 for 4 certificates

The AMA did pass a resolution, about MOC, but did not take any action

NBPS A nonprofit, founded in 2015 by 20 physicians, thought leaders in clinical and academic science

Goal support continuing and rigorous lifelong learning, clinical excellence professionalism, and patient care through evidence-based CME, streamlined, does not contribute to burnout, certifies 11,000 physicians in 50 states

Accepted by over 200 hospitals and health systems

The Joint Commission and the NCQA both certify

The NCQA also certifies it certifies insurance companies. And says it is acceptable for certification

CAQH, Medicare and Medicaid, CAQH URAC

NBPS Annual revenue $433,000. Dollars. ABIM 64.3 million, ABPN 23.1 million will all be a short one

25% of physicians leaving practice from burn out within 5 years of entering practice

Physician Side Gig group on Facebook $155,000 plus looking to build a career outside of Medicine

Physician shortage growing by 124,000 by 2034

Become an NBPAS diplomate where the pin on your lapel, put it DNBPS after MD or DO on your title start petitions at your hospital forms and petitions are available at NBPAS.org

Over hundred 47 hospitals excepting and BPA

Column A and 3 items from Column B

Credentialing is easier, NBPS in now Column A

Although the bylaws are not changed, the hospitals may be able to take NBPS

Paul Mathews has sample of bylaws change formats that you can send to your hospital

American Psychiatric Association now allows certification with ABPN and or NBPS

Low lying fruit: try to work with the other State Neurological Societies have them sign on to a letter to the AAN this is how the state societies and memberships feel

How is the best way to persuade the hospitals? Point to the other hospitals, for recruitment and retention, we need to follow suit.

This will save the hospital money and generate income power points available on the NBPS website.

Also, now on the NBPS? Website, information about insurance and NBMS credentials

What should CNS do? work with CMA leadership NBPS leadership in La Jolla at Scripps. The leadership in AMA not on board, but in the HOD the membership wants the change.

Leadership in AAN getting funds for membership, committees, until 10 years ago they were the prime members not for any dishonorable reason but became “attached “to the reimbursement. The AAN had a lot of pressure from Paul Matthews, as younger generation move into position, but also APA may be understanding the burn out and are more able to understand it.

Leadership in AAN more diverse and inclusive. If there is an argument to encourage NBPS instead of MOC it has more of a chance to be successful.

PA and NP’s what to do about the lack of skill?

Try to get hospitals to use doctors that did not match instead.

· 10,000 physicians enter the match and don’t match sidelined for a year Oregon and Missouri they can get a license and work under a licensed physician.

Tell the hospitals that they can get these employees, and then they can work with a graduated salary structure to make money pay off loans if you hire them instead of NP and PAs now are mostly getting a PGL would be better than a NP or PA,

There are not enough residency slots Medicare and Medicaid fund the slots, Biden has passed a bill to increase. Unmatched are not all FMG

Often FMG’s are doctors in their own country, and their skills are outstanding.

He will be at our Spring 2025 conference clinical and Advocacy

For Credentialing, there are slide sets for NBPS on the website about MOC, credentialing, advocacy etc.

For a short amount of time Independent Medical Board, weakened the idea of ABPN and ABMS, so they did not continue with Independent Medical Board, ?? UCNS not recognized, so now headache Neuroctit will have to be ABPN

Bob Weinberg brought up SB636 the AAN has “calls for action,” where you get an email, and it leads to a letter to your own legislator” Paul will be sending out the article.

Should we add board certification to SB636, licensed and Board Certified?

We may want to do a preset letter on our website for objectives

The Ledge meeting 3rd Wednesday can take up these themes again September 18, topic on our Agenda Wednesday

for DOJ and FTC and

Steve Holtz suggested e mailing Paul and asking him

for some more specific game plans for recertification

Step A , B , C

For the September 18, 2024 meeting

Vote on whether we want to do each of these steps:

a) Have a formal letter and preset information to give to our own hospitals on our website, the best way to encourage the hospitals is to remind them about the other hospitals that have mad changes. A Headache specialist just got up a petition to his hospital we can use powerpooints from the NBPS and use the other stakeholders that have already agreed to this particularly documenting the insurance.

b) Try to do a joint project with CMA about changing from ABMS to NBPS in California

c) Have The NBPS Board president from SCRIPPS come and talk to our meeting

d) Try to do a joint project with the AMA about switching all credentialing after passing ABMS

To NBPS

e) Send a letter from CNS to the Joint Commission for Hospital Accreditation

f) Reiterate that we want to be a viable alternative

g) Reach out to other State Neurology Societies to get our National AAN and ABPN to change so that as a group we affect the leadership of the AAN and ABPN

Medical Injury Compensation Reform Act (MICRA)

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:22 GMT

Updated key provisions in response to the Fairness for Injured Patients Act (FIPA) initiative

Next Steps: from California Medical Association Leadership

Our broad coalition is working with the California State Legislature to ensure this modernized approach, that will provide a sustainable solution is enacted and signed into law as Assembly Bill 35.

Upon approval by the Governor and Legislature, this watershed agreement will serve as a national model and preclude another costly and unpredictable ballot fight in November.

As part of the agreement, the initiative will be withdrawn from the November 2022 ballot.

Physician Mandatory Reporting - SB 357

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:19 GMT

March 10, 2023

The Honorable Anthony J. Portantino

California State Senate 1021 0 Street, Suite 7630

Sacramento, CA 95814

RE: SB 357 - SUPPORT

Dear Senator Portantino:

On behalf of the California Neurological Society (CNS), I write in support of SB 357. Current law mandates the overly broad reporting of guy condition characterized by loss of consciousness or motor control even if the condition is under medical control, represents no threat to safe driving or the reporting physician judges such reporting to not be in the best interest of the patient or the public's safety. California is one of only 6 states requiring mandatory reporting leaving it optional in the other 44 states.

There is no evidence of an increase in traffic accidents related to this policy difference. In fact, mandatory reporting has revealed patient reluctance to inform their physicians if they have a seizure and/or patients driving without a license regardless.

Successful passage of this bill revokes officious driving-related constraints, upholds implicit trust in the doctor-patient relationship and removes the unsubstantiated requirement that doctors must report.

We stand with the American Academy of Neurology and California Medical Association in favoring voluntary vs mandatory reporting.

Thank you for your discernment and support for evidence-based effective health care in California.

Cordially,

Stephen Cattolica

SC Advocates

Cc: Stella Legarda, MD, President CNS

Jeff Klingman, MD, President Elect, CNS

URAC Accreditation, Utilization Review, and the California Treating Physician

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:17 GMT

A free one-hour seminar that will open eyes and empower California’s workers compensation treating physicians!

Since 2016, URAC accreditation has been required of all utilization review organizations and end-to-end for the procedures they implement to approve, modify, delay, or deny a request for authorization submitted by California treating physicians. The DWC presumes compliance is 100%.

However, treating physicians throughout the state have a wide range of opinions about UR and virtually none have any idea what URAC accreditation means to them and their staff who must navigate the labyrinth of California UR.

This webinar will fill in that gap.

Treating physicians and staff will learn directly from URAC, what a URAC accredited UR program is required to do as it processes and responds to a “Request for Authorization.”

More importantly, they will also learn what questions to ask and what rights to claim when the process appears not to follow what the Labor Code requires, for example peer review.

Click on this link to register for the free, one hour webinar February 9, 2022 beginning at 12 noon, PST presented by URAC staff.

Submit your questions about URAC procedures, peer review and similar procedural situations. Webinar faculty cannot provide legal advice nor can they "settle" issues. They WILL equip us with practical knowledge and actions that can produce results.

If you treat injured workers in California, after this seminar you will be better equipped to successfully handle California's URAC Accredited URprocess and the individuals with whom you must interact to successfully treat your workers compensation patients.

Pass this notice along to your colleagues who treat injured workers whether they are PTPs or not. They'll be glad you did!

Addressing America's Gun Epidemic

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:16 GMT

Resolution being submitted to CMA

Addressing America’s Gun Violence Crisis

WHEREAS , the United States is facing a gun violence epidemic, with firearms now the top cause of death for children three years in a row [1] signaling a critical national crisis; and

WHEREAS , the fundamental right to life for all Americans can be undermined by the unfettered availability and easy access to automatic firearms, which fuel the rising prevalence of gun violence causing severe injuries, lasting disabilities and premature deaths; and

WHEREAS , our nation's growing dependence on advanced security measures [2] implies a path toward a dystopian future marked by the constant mobilization of military units, armored vehicles, and extensive surveillance systems, cumulatively undermining our civil liberties and ironically escalating the use of automatic firearms; and

WHEREAS, a significant majority of Americans, including firearm owners, [3] agree there is a growing divergence from the Second Amendment’s core principles [4] regarding civilian possession of military-style weapons; [5] and

WHEREAS, our leaders' habitual inaction, alongside reactionary and narrow-focused strategies employed, has led to a rapid erosion of the Second Amendment’s core objective, transforming its noble purpose into a pretext for unconstrained gun ownership; and

WHEREAS, the principles enshrined in our Declaration of Independence [6] and Preamble bestow upon the citizenry the power to instigate reform when governmental protections falter ; and

WHEREAS, medical professionals have historically partnered with governmental bodies to combat public health crises such as malaria, tuberculosis, AIDS, and Covid19, setting a strong precedent for collective action; and

WHEREAS the California Medical Association is recognized for its longstanding and evolving positions on gun use and ownership; now, therefore, be it

RESOLVED, that the current epidemic of gun violence demands a cohesive and robust response to diminish its toll, through a coalition of healthcare professionals and government bodies in united action; and be it

FURTHER RESOLVED, that this campaign, grounded in shared ethical responsibility and the courage to act for the betterment of society, must engage healthcare experts morally compelled to openly work with legislators, incorporating medical knowledge into the formulation and implementation of policies aimed at reducing gun violence; and be it

FURTHER RESOLVED, that healthcare professionals, using their expertise, can highlight the complex health effects of gun violence, helping to create compassionate, comprehensive and effective policy solutions; and be it

FURTHER RESOLVED, that from its position of historic leadership on this issue, the California Medical Association joins the growing national colaition of doctors for gun safety [7] in spearheading a statewide medical education initiative focused on the health ramifications of gun violence, leveraging medical insights to raise public awareness, foster informed discussions and catalyze proactive remedies to reverse the rising trend of gun violence in society.
[1] https://doi.org/10.1016/j.jpeds.2022.05.029

[2] https://www.goodreads.com/book/show/299835.More_Guns_Less_Crime

[3] https://www.cbsnews.com/philadelphia/news/poll-most-in-us-say-they-want-stricter-gun-laws/

[4] https://ssrn.com/abstract=2549244

[5] https://www.vpc.org/studies/militarization.pdf

[6] https://www.uscis.gov/sites/default/files/document/guides/M-654.pdf

[7] https://doctors4gunsafety.org/

Epidemic of Gun Violence: CNS Position

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:14 GMT

Position Statement on America’s Gun Violence Epidemic

In the face of escalating tragedies that shake the very fabric of our nation we issue this statement on senseless pervasive gun violence imploring our federal government to rigorously and uncompromisingly confront this crisis. We extend a fervent request to our counterparts in state and national medical associations to amplify this urgent plea.

Our nation reels, paralyzed by a palpable deficit in ethical leadership. As stewards of healthcare we are morally obligated to articulate truth unflinchingly to those in power. This obligation transcends mere professional duty; it is nurtured by our unwavering commitment to the wellbeing of our patients, their grieving families, and to all survivors grappling with the aftermath of senseless gun violence. Undeniably, it is inspired by the heroism of our first responders who stand undaunted in the face of recurrent strategies. Not least, this motivation rises from a deep sense of citizenship responsibility to preserve the dignity of this sacred land and the privileges we so profoundly cherish.

Continuous and unscrupulous exploitation of the Second Amendment's provisions has engendered a grim reality : a senseless cascade of profound injuries, lifelong disabilities, and untimely deaths sidelining the intrinsic right to life in favor of unrestrained firearm accessibility. Our government, which embodies the spirit and will of its citizens, must be spurred to reclaim the true essence of the Second Amendment: fostering a "well-regulated militia” conducive to responsible firearm ownership. The vast majority of citizens agree the current state of gun ownership has strayed perilously far from this directive: 65% of Americans support stricter gun laws, and 67% of Americans support stricter regulation of firearms sales (CBS News poll/margin of error of +/- 4%; March 2018).

Our current trajectory in ever-heightened security measures (“the answer to guns is more guns”) threatens to engender a dystopian reality where every facet of public life is overshadowed by the looming presence of armed guards, armored vehicles, security fences, and intrusive surveillance. A grim future wherein our liberties are sacrificed and the firearm reigns supreme.

Provisional CDC reports from 2022 illustrate an alarming trend where firearms have emerged as the leading cause of death in children for three consecutive years. This grim statistic rings an urgent alarm, urging us to act: the sanctity of life, our primary unalienable right delineated in the Declaration of Independence, is under siege. Our governing structures, designed to safeguard our liberties and champion our wellbeing have faltered, leaving our youngest and most vulnerable exposed to unimaginable dangers.

Our foundational texts empower us, We the People, to usher in change when governance fails to uphold our intrinsic rights. This clarion call must resonate with every citizen. The responsibility weighs heavily on our collective conscience. Now is the moment for cohesive, deliberate action. We must galvanize our elected representatives to institute sensible, urgently needed “well-regulated” gun ownership reforms without delay.

Historically in our role as medical professionals, we have collaborated with government agencies to curb the spread of diseases such as malaria, tuberculosis, and AIDS. Today, our nation requires an equal resurgence of resilience and unity to counteract this plague of gun violence . We stand ready to join forces with all sectors of government to arrest this epidemic .

In the spirit of unity and faith, we entreat wisdom and strength in moral courage to prevail upon our great nation.

God Bless America.

Authored: January 2023

Dr. Stella Legarda

President, California Neurology Society

Support for SB 636 (Cortese) - California's workers' compensation UR system under CA Medical Board

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:13 GMT

This is a subtitle for your new post

Honorable Dave Cortese

1021 O Street, Room 6630

Sacramento, CA 95814

AB 636 - Utilization Review

Position - Co-Sponsorship

Dear Senator Cortese,

The California Neurology Society CNS) is proud to co-sponsor SB 636, your bill that will bring a new and much needed level of parity and safety to California’s utilization review system that has never been present before for employees in the private sector.

SB 636 will establish parity by requiring California licensure and oversight by the Medical Board of California to be the law of the land within California’s workers compensation utilization review system. For the first time, the safety net of California licensure and Medical Board oversight will be present for private sector employees when one of them is determined to be ill or injured because of their employment.

The California Supreme Court dealt with this issue in its King v CompPartners decision of 2018. Here, the Court decided against injured worker Kirk King, even though the utilization review process failed to protect King from catastrophic health emergencies caused by the sudden withdrawal of a vital prescription medicine due to a denial of said prescription ordered by an out-of-state licensed utilization review physician. Recognizing the constraint that current statute put upon its decision, the Court took great care to include a concurring opinion by Justice Liu wherein he wrote [1] , “…the undisputed facts in this case suggest that the workers’ compensation system and the utilization review process in particular, may not be working as the Legislature intended.” Before closing his concurring remarks, Justice Liu repeated his suggestion by writing [2] , “The limited record here raises doubts as to whether King’s utilization review was handled properly. The Legislature may wish to examine whether the existing safeguards provide sufficient incentives for competent and careful utilization review.”

Justice Cuѐllar, in his own concurring opinion providing an analysis of the statutory constraints within which the Court considered the King case, speaking to various safeguards, incentives and remedies made available by the Legislature, concluded [3] , “Even now, those safeguards and remedies may not be set at optimal levels and the Legislature may find it makes sense to change them.”

SB 636 represents the opportunity to act on the Supreme Court’s explicit appeal by establishing the duty of care accountability lacking in California’s workers compensation utilization review system.

Cordially,

California Neurology Society

[1] “Concurring Opinion, Liu, J” page two

[2] “Concurring Opinion, Liu, J” page three

[3] “Concurring Opinion by Cuѐllar, J” page 6

CNS Legislative Committee MEETING MINUTES

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:28:06 GMT

When the HOD comes up in October, is there a focus or a position that we want to have ready for discussion and hopefully CMA will take on these topics.

Minutes of the July 17, 2024, LEDGE meeting

Maintenance of Certification per Jeff Klingman (previously Chairman of Neurology at Kaiser Permanente, Northern California):

"Previously hospitals and probably insurance companies came up with the idea that continued certification would prove that you were still competent. Previously it was thought that if you just continued practicing and continued your education you would still be competent. Before 1990 it was thought that if you were still doing medicine, you would be okay.

The perception was that you needed some sort of proof that you were still competent. That was confiscated by the American Board of medical specialties which turned it into a huge moneymaking operation. Previously you were certified once and then were done with the continuing certification which turned out to be a huge cash flow situation. The board was making a fortune off particularly medical subspecialties. There was a scandal over the cost of it.

They came up with an alternative, the Medical Board of Physicians and Surgeons (MBPAS) and this was presented to the CMA. The MBPAS has only required the doctors maintain their education and the doctors will be happy with it, but the problem was that you need the hospitals and medical groups to be on board. So, if you work for Permanente, the largest group in the state, you can’t become a senior physician unless you have your ABMS as certification. Some doctors in our group don’t keep up the maintenance of certification which is fine if you have a hospital that will keep you on staff, but a lot of the hospitals and medical groups will only recognize the American Board of Medical Specialties (ABMS). So, if a doctor tells Kaiser Permanente that they’re just going to be with the MBPAS, Kaiser Permanente won't accept that and they need to be certified by the ABMS."

Jeff Klingman suggested approaching the American Board of Psychiatry & Neurology (ABPN) and explaining to them that what they’re doing is onerous and there’s no evidence that it improves medical care and recommend that the American Board of Psychiatry and Neurology come up with something that makes more sense. There is no proof that it’s beneficial and what they have done in certain boards, for example obstetrics, you just must read a certain number of cases you don’t have to take a big test. Stella pointed out that they are surgeons and what if they haven’t been in the operating room for 10 years? Dr. Klingman mentioned that they probably do have to document their cases. Stella presented the organizational chart attached.

Stella presented the cons of being a neurologist requiring extensive and expensive educational requirements, long hours and shifts, frustrations about our patients not getting well sometimes, lack of autonomy and control, utilization review, ever-increasing time management, complications of EHR, lack of professionalism in the workplace, stress of group practice, striking a work-life balance to prevent physician burnout and early retirement, absent parenting, difficulty with relationships, divorce, and suicide.

The maintenance of certification should be Maintenance of Care. The focus should be on our own field that we're doing so that a headache specialist only has to certify on their specialty relating to headaches. An MS specialist must keep up with MS related medical issues, for example.

There are compassion tools for physicians and patients. Physicians need to support their own well-being, which is part of professional development. There should be a paradigm shift to Maintenance of Care of both patients and physicians, utilizing artificial intelligence (AI) programs to assist in physician development and testing. AI could shift to what is individual for each physician’s practice and everyone could have AI generated modules just for their unique recertification.

Stella made a Diagram about AI generated individualized certification and self-care programs. Roger commented on Stella’s approach to the board. The ABPN is controlling both the initial certification in neurology and the continuation of certification.

Jeff pointed out that his wife gave up certification because her hospital did not require it, most of the recertifying examination questions were research oriented. For example, adult neurologists do not need to keep up with Pediatric Neurology. We can advocate all we want, but how do we persuade the ABPN? How do we work with them? This is a 40-year-old approach. Johanna tried to say, “What do we want to do about this? Start with a letter to the American Academy of Neurology (AAN) writing a version of Stella’s committee presentation. We must start someplace.

Roger and Jeff pointed out that the public wanted to know if the doctors were competent, but somehow this became mixed with maintenance of certification, the two issues were mixed, but the Board should only Certify and not necessarily Maintain certification.

Steve Cattolica took a turn pointing out that we have dissected the issues but the way to get it done is to get people on our side. No matter how complete the idea is, it will be irrelevant unless we have more people with us. We must involve more people, and those people must feel like they have contributed. The AAN has a vision statement that must be lived up to if they are going to be any part of this. The maintenance of certification issue is indispensable to AAN, because it is indispensable cash flow and so they are not going to change. How are we going to set things up so they don't incur losses on recertification? Steve Cattolica says invite AAN to the TABLE and write them a letter first.

Next meeting will start with HOW DO WE CHANGE MOC to MAINTENANCE OF CERTIFICATION?

CNS Legislative Committee MEETING MINUTES

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:26:51 GMT

Minutes of Last Meeting June 19, 2024

The first item on the Agenda

When the HOD comes up in October, is there a focus or a position that we want to have ready for dis cussion? and hopefully CMA will take on these topics

The Epilepsy and transportation letter from Stella may be a great choice We can discuss these paragraphs and approve them topic by topic

Discussion of

EPILEPSY TRANSPORTATION AVAILABILITY

Epilepsy Transportation Accessibility Act

Section 1.

Epilepsy Transportation Accessibility Act of 2024

Section 2. Statement of Purpose

The purpose of this Act is to ensure that working adults living with epilepsy have affordable and

equitable access to public transportation and private ride services. This is intended to enhance their

mobility, enable full participation in the workforce, and ensure consistent access to medical care.

The Legislature finds that:

a. Epilepsy is a neurological condition that significantly affects various aspects of an individual’s life,

including their ability to engage in day-to-day activities such as driving.

b. Young adults living with epilepsy often face intermittent or permanently limited ability to drive,

necessitating alternative transportation options to support their independence and participation in

society and the workforce.

c. Providing affordable and accessible transportation options is essential to ensuring that these

individuals can maintain employment and access necessary medical care.

Section 3. Definitions

For the purposes of this Act:

1. "Epilepsy" refers to a neurological condition characterized by recurrent, unprovoked seizures that

result from sudden disturbances in the brain’s electrical activity. These seizures can present as

sensory, motor, or autonomic disturbances and may occur with or without impaired consciousness.

Each seizure transiently impairs an individual's control over cognitive and physical functions and

exhibits a consistently recognizable pattern of behavior. This condition reflects an underlying,

intermittent disturbance in brain network functioning that occasionally disrupts normal neural activity.

Young adults living with epilepsy have either intermittent or permanently limited ability to drive.

2. "Working adult" is defined as any individual aged 18 or older who is employed for a minimum of 20

hours per week.

3. "Public transportation" includes buses, trains, subways, and other forms of mass transit provided

by a government or municipal entity.

4. "Private ride services" refer to privately owned transportation services, including but not limited to

taxi cabs, ridesharing companies such as Uber and Lyft.

Section 4. Public Transportation Benefits

1. All working adults diagnosed with epilepsy shall be eligible for a ride pass that allows unlimited use

of public transportation at no cost.

2. These ride passes shall be issued by the appropriate government transportation authority.

Section 5. Private Ride Service Fare Cap

1. A fare cap of $10 per ride shall be applied to all private ride services for eligible working adults

diagnosed with epilepsy.

2. This fare cap applies to rides within the metropolitan area of the individual’s residence and is

limited to 30 rides per month.

Section 6. Funding

Funding for the provisions set forth in Sections 4 and 5 shall be provided through [specify funding

sources, such as federal grants, state budget allocations, etc.].

Section 7. Implementation

1. The [Name of Relevant Government Department] shall be responsible for implementing this Act,

including the distribution of ride passes and coordination with private ride services.

2. This department shall also establish a registration process for eligible individuals to apply for

benefits under this Act.

Section 8. Regulations

The [Name of Relevant Government Department] is authorized to promulgate regulations necessary

to implement and enforce this Act.

Section 9. Reporting

The department shall submit annual reports to [legislative body] on the usage, costs, and

effectiveness of the transportation benefits provided under this Act.

Section 10. Effective Date

This Act shall take effect 90 days after its enactment.

UTILIZATION PA AND DUTY OF CARE

At the last meeting, it seemed that we are in a DAVID and Goliath situation. There is a new study showing that hospitals are losing 20 billion a year due to unfounded denials from prior Auth issues

Do we want to keep going and try to fight fire with fire ie Financial vs Financial ???

Review of our 2 year goal

Utilization Review and Duty of Care

Review of Youth Tackle Football

Steve Cattolica to update

us on the latest with this legislation

Review of Mandatory Reporting the progress of the bill This is a copy of the different aspects

SB 357, as amended, Portantino. Vehicles: physician and surgeon reporting.

Existing law requires a physician and surgeon to report in writing immediately to the local health officer, the name, date of birth, and address of every patient at least 14 years of age or older whom the physician and surgeon has diagnosed as having a disorder characterized by lapses of consciousness. Existing law requires the local health officer to report this information in writing to the Department of Motor Vehicles. Existing law authorizes the department to refuse to issue to, or renew a driver’s license of, a person who has a disorder characterized by lapses of consciousness or who has experienced, within the last 3 years, either a lapse of consciousness or an episode of marked confusion caused by any condition that may bring about recurrent lapses.

This bill would delete these existing provisions on January 1, 2030, and instead would authorize, until January 1, 2029, January 1, 2037, a physician and surgeon to report in writing immediately to the department the name, date of birth, and address of every patient at least 15 years of age, or 14 years of age if the patient has a junior permit, whom the physician and surgeon has diagnosed as having any physical or mental disability, disease, or disorder that could affect the safe operation of a motor vehicle, condition severe enough to be likely to impair the patient’s ability to operate a motor vehicle if a physician and surgeon reasonably and in good faith believes that reporting the patient will serve the public interest. This bill would require a physician and surgeon to report in writing every above-described patient whom the physician and surgeon has diagnosed as having Alzheimer’s disease or a related disorder.

This bill would also require, until January 1, 2029, January 1, 2037, the department, in cooperation with the State Department of Public Health and in consultation with appropriate professional medical organizations, Health, to guide reporting so that diagnosed cases reported are only those where there is reason to believe that the patients’ conditions are likely to impair their ability to operate a motor vehicle. The bill would also exempt, until January 1, 2029, January 1, 2037, a health care provider or health care entity from specified liability, including, among others, civil or criminal liability, for making or not making, or in relation to or arising from making or not making, the report.

This bill would require the Department of Motor Vehicles, by January 1, 2027, 2035, to submit a report to the Legislature evaluating the impact of transitioning to a discretionary reporting system. The bill would require the department’s report, among other things, to compare the number of reports submitted by physicians and surgeons to the department, before and after this transition. The bill would repeal the department’s reporting requirement on January 1, 2029. January 1, 2037.

This bill would would, beginning on January 1, 2029, January 1, 2037, revert to the physician and surgeon reporting requirements in existing law, except the bill would provide a specific definition of “disorders characterized by lapses of consciousness.”

Steve Cattolica can update us about The letter we have sent for CoRTESE

dave Cortese’s bill about Fentanyl OD in Children

Cortese’s Fentanyl Bill SB 908

What does everyone think about the ABMS ???

Colleagues:

I am reaching out to alert you to an unprecedented opportunity for physicians to share how their lives and livelihoods have been impacted by ABMS MOC. It is critical that all physicians comment immediately.

Brief background: Last September, NBPAS formally asked the Federal Trade Commission (FTC) for relief from what it believes is an effort by ABMS and its constituent boards to use their monopoly power to exclude or eliminate competitors from the continuing certification market.

Last week, the FTC, the U.S. Department of Justice (DOJ), and the U.S. Department of Health and Human Services (HHS) jointly requested public input on anticompetitive and monopolistic practices in health care including recertification requirements imposed by certifying bodies.

Below is an example provided by the FTC on their website:

Unnecessary Healthcare Provider Recertification or Accreditation Requirements:

Certifying bodies or accreditation organizations can impose unnecessary requirements on healthcare providers. Unnecessary requirements can raise the costs of practicing medicine. They can also reduce the number of healthcare practitioners participating in the marketplace. These requirements can harm competition and increase the cost of healthcare services.

From the very beginning of NBPAS, many of you have shared your experiences about irrelevant testing, being shut out of insurance plans, denial of employment, excessive costs, and lack of clinical relevance. This is a critical opportunity to have your stories heard.

Please submit your comments (in your own words) directly to the FTC portal here, share this information with every physician that you know, and urge them to participate.

We must speak now or forever hold our MOC.

Last topic with the Supreme court approving

Bump stock for Assault rifles maybe we should be martyrs and take on gun violence, largest cause of neuro death and disease in children

Should we just try to ban assault type weapons and how would that look remembering that Bob Weinmann pointed out that it is not a good idea to have a list of people that don’t have weapons

LEDGE Metting minutes from February 21, 2024

Topic 1

Johanna brought up sending a letter to groups supporting low income housing. If government and tax dollars are set aside for low income housing, wanted to send letters of support for putting the low income housing near public transportation so that our neurologically disabled patients (that usually can’t work) have access to mobility. The group thought too peripheral, not so much about neurology, and recommended that could see if the Epilepsy Society was interested in this issue.

Topic 2

Youth Tackle Football

There was information from Steve Holtz, he had met with an AAN affiliate. Steve sent a summary in the e mail to our CNS group, discussing the concussion issues and included the information from the representative from AAN. The AAN Advocacy committee has a position statement, they feel that with K-12 concussions, that there should be an information sheet that parents have to sign before the parents let kids play contact sports. We can send an official letter to the AAN Advocacy Committee and support this position. Stella also wanted to emphasize CTE in addition to concussions.

Steve Holtz wanted CNS to send a letter to the AAN Advocacy committee, supporting their position and also documenting how California Neurology Society is sponsoring legislation. Steve Holtz pointed out that the best “sound bite” to promote this is the phrase, “KEEP THE KIDS SAFE”.

Jeff Klingman wanted to add concussion and CTE both as well as recommending delaying playing tackle football until age 12. Stella wanted to emphasize the importance of NEW information. As a group it seems that we want to substitute flag football as opposed to stopping football entirely. Did we want to include other contact sports ? in our position statement?????

Stella wanted to have the CNS work with the CMA and also to have the CMA take up a position on Youth Tackle Football

Topic number 3

mandatory reporting. Jeff Klingman pointed out the reporting is voluntary in other states and that is in alignment with the CMA and the AAN already. Schwartzenegger actually vetoed the bill most recently. A colleague of Jeff Klingman cared for a retired AG, and the doctor reported the person even though the patient had not had a seizure for many years, The AG was off driving for 3 months and it was difficult. Also syncope patients may only have a LOC with prolonged standing, so unfortunately license temporarily suspended even though unnecessary.

Jeff was going to write a letter in support of the bill. Johanna will try to get a CHP person at the May meeting to get to know the opposition.

Robyn pointed out that she documents “seizures controlled” or information about the medical status only and lets DMV make an administrative decision about the driver’s license. Jeff pointed out that the medical issues are nuanced and doctors are responsible and can report accordingly.

Stella brought up a resolution of Gun Control. The AAN and the CMA have outdated policies. Stella wanted to work with CMA about it.

Hopefully Stella will post on our website

Steve Holtz pointed out that the AMA is very likely to support legislation about gun violence. The AAN may also take up the position. Stella pointed out that we should emphasize gun violence and spinal cord brain and nerve injuries, that is why our concern is related and in the CNS focus.

Jeff Klingman states that it is always beneficial to support education about the medical aspects.

Topic 4 from the HOD,

At the HOD, there was extensive discussion the medical industry causes 13% (supposedly) of the impetus towards Climate change.

Johanna brought up Solar Panels in the Parking lots for medical clinics. The CMA HOD already took up all the issues on climate change, no need for CNS to take up the cause.

Environmentally sophisticated our fearless treasure, Robyn installed solar panels at her home., after solar panels, Robyn has zero electricity expenses, and occasionally gets reimbursed. So we decided to not take this issue up (as far as our group) since CMA is so involved.

The Steves both said that it was too far off focus for the California Neurology Society, and that we need to focus on more patient centered issues.

M/C is cutting reimbursements 3.7% it has to do with Sequestration due to chaos in Congress

, M/C used to pay 80% and now B/C won’t pay the 20%

Jeff Klingman said to contact our legislators and stop taking insurances if we are not being paid, we have to tell them to contact the legislators. The patients won’t believe us that we are underpaid until we stop seeing patients.

The insurance companies were paid premiums during the pandemic, but not paying for patient visits.

Steve Holtz suggested a meeting about reimbursements.

Next meeting March 20, third Wednesday 7:00 to 8:00 PM

LEDGE Minutes from the meeting January 24, 2024

First, the Discusson was about the Bill AB 734. To do with Concussions in Children

Steve Holtz suggested that we

“ally ourselves with the parents, since they will never object to making the kids safer”

The bill has turned into a “2 year Bill” per Steve Cattolica, as a successor bill evolves during the second year, we will have input, but lay people may perceive some of our ideas as “minutiae” and so we have to be realistic about what will go into the bill. The parents will not listen to excruciating discussions about scientific details

Roger Bertoldi asked if Football had a program like “AYSO SOCCER”? none as far as we know.

Robert Weinman noted that at first the National Football League opposed the bill stating that later in life there would be fewer people wanting to play football. We could state that with the brain protected at a young age, that later people would be in better condition due to reduced injuries early in life, to play football and would increase the number of football players.

Pop Warner is ? ? a local or national organization?

Steve Cattolica noted that in Orange County 1000 kids play “flag” vs 60 playing “tackle”.

Should the new bill focus on “”SAFETY FOR CHILDREN UNDER 12”

or “EDUCATION FOR THE PARENTS”???

The prior bill will be pulled off the table, it has to be rewritten and restarted, McCarty’s people are talking about what the new bill will say? Yes we are discussing and communicating with the sponsors

Stella LeGarda pointed out that rather than shutting down programs and getting hardline about this we can let the programs die by attrition as we focus on education. We need to let people make informed decisions.

Johanna Rosenthal suggested an educational video to show when we talk about the bill. Steve pointed out that we can’t make it for the bill, but we could have it available about our content and education. We can post it on U tube. Steve can contact McCarty’s office about it to coordinate and not intrude, and to work together. We can present a video ?10-20 minutes as a resource e for those in favor of the bill and we can also have another video geared more for the parents to watch before football season.

Johanna was thinking about a video that parents “have to watch and then sign a waiver” before their children play on public grounds. The Pop Warner programs play on School and Park fields, they probably have contracts with the Park Department and the school districts. The new bill could say that the parents have to sign that they have watched an educational video in order for Pop Warner to use Public property, and then the school and park department contracts would have to include that language. It could be argued that society is providing the parks and so society will also have to provide for all the people with frontal lobe injuries that become INCORRIGIBLE

The other idea was to make a 20 minute canned video for McCarty to have where the California Neurology Society actually presents the issues. The video would be for McCarty to use when he presents his information to the public at meetings or Legislative committee meetings. He has the information, but it would be great if he had a good video to use to SELL THE SCIENCE behind the bill. Also it would be good for California Neurology Society to “PUT OUR BRAND” on this information.

Stella is a great Movie Producer and she has a presentation that she already gave at the Hearing on this bill. If there is a video recording from her talk at the hearing, it could be remanufactured into the Official CNS video. Zoltan Mocsary might be a good STAR with the great Accent that will sound scientific and can find some clips on Google

SB357 The Driving and reporting Lapses of Consciousness bill

Per Steve it is a “2 Year Bill” It’s next step is to go through Committee. Per Jeffrey Klingman the only opposition was the CHP the California Highway Patrol and that is why Schwarzeneggar vetoed it. Jeff wants to know about the opposition. Steve Cattolica will contact Cortino’s office to check on it. Jeff feels there is disinformation. Let’s meet with the Highway Patrol We will still be reporting. Per Steve that is an option

Per Steve Cattolica it is on the “Inactive File” Unless the Cortino office takes an action, it may not move ahead.

CAN WE INVITE A REPRESENTATIVE FROM THE CHP TO THE LEDGE session in May? For a discussion???

Duty of Care and SB 636 CORTESE

Per Steve Cattolica, The “Ask Me” folks and staff in the Governor’s Office are meeting in a week or 2. Now ‘THE STICKING POINT IS DATA” that someone can look at and count, that a non California Physician is actually doing the UR.

Steve is trying to get Data,

Robert Weinmann pointed out the BILL can be STARTED by pointing out the SUPREME COURT has already expressed an opinion and why do we need a different approach??

Stella will say that the doctors are “supervised “ by someone already licensed in California

How do we counter the argument when opposing factions do not want the governor to sign the bill ???

Robert Bartoldi took the position that now is the time to start preventing AI from performing “Utilization REVIEW” Stella said let’s keep it simple.

Robyn said “it is not an AI issue”. Robyn said that a patient had to have catheters to void and it was denied, and that has to be reported to the board as malpractice. She had a bad experience with “CARILON” a new division of BC that is doing denials she was unable to obtain a peer to peer, with a neurologist or a medical director, and was only able to speak to a pharmacy tech. It wasn’t a doctor now a PHARMACY TECH is considered a Medical Provider. Robyn testified previously in a lawsuit against BC and they settled for 8 million dollars

After she reminded them of her litigation

(and the 8 million dollars),

a pediatrician called back and approved the prior authorization

Robert Weinmann reviewed the King decision

Johanna Rosenthal pointed out that a safety net hospital paid by County Tax dollars loses money on Workers Compensation Denials. Each hospital probably knows what percentage of their total income is lost to Workers Compensation Denials, we can ask our hospitals to give us financial information about denials.

The reason we want to know about the losses to publicly funded hospitals,

is because the Governor wants to keep everyone happy.

He needs to keep insurance companies happy so that someone provides insurance in California

. He wants to keep the doctors happy.

The insurance companies are selling the idea to the governor that the bill about UR and DUTY of CARE should not pass.

The insurance companies are telling the governor NOT TO SIGN THE BILL, because it will cost more money to the public when the public pays for insurance. So if we can point out the the bill will save money for the public, because the hospitals will be paid so the taxpayers don’t have to pay for the denials, then the Governor has an argument and CAN push back with the insurance companies.

Jeff Klingman wants to take on all the denials in W/C but also to take up the issues with all UR.

Robyn reviewed a case that was litigated. GO Robyn please write up what happened and what u did and let’s put it on our WEBSITE.

Steve is meeting with the GUV

Steve Cattolica had the last word.

Steve Cattolica said to use

the Department of Managed Care

The Department of Managed Care will help

it will take on single cases.

The data will come from small sources.

The LEDGE Is on the EDGE !!!!!l

All these issues ! !!!!!!

Johanna is using INSTAGRAM SPEAK

and trying to “GLAM UP our BRAND”

Wednesday Next meeting February 21, 2024

GO STEVE with the GUV

our next meeting will be on Wednesday February 21, 2024

7 to 8:00

prepared by Dr Johanna Rosenthal

--------

LEDGE Meeting Minutes 12/20/2023

1.Presence roll call: Steve C, Steve H, Jeff K, Bob W, Robyn Y, Stella L

2.Minutes of last meeting -approved

3.Duty of Care/Utilization Review

Steve C: Steve shared current status in SAC and recommends to put this topic as a LEDGE concern “In wait mode”

Licensure: (Bob): UR docs are exempt from duty of care mandate of CA Board

Jeff: standard of care incommunity/out of state NOT in community

Stella: start collecting data/examples of UR failures LIVE as it happens

4.Tackle FootballSteve C: stated next hearing is set for 10th Jan 9 AM room 127 in the Capitol to vote on whether to move the Bill forward

Steve H: Will send Stella email with specific patient example Jan 9th

– Steve C having his shoulder replaced

Hearing preparation:

a.start with story-case

b.Follow up with statistics/new data

c.Why young brains are different

Steve H: Death from second impacts: systemic reaction augmented in younger brains/immune system, shuts system down

d.human perspective important Think as a parent

5.Dr Rosenthal’s letter – Table until next meeting

6.Gun position statement – Stella and Steve C will work to draft a Resolution to include:

Common sense Lifelong injuries (not just deaths) Impacts medical issues.

AR 15/magazine capabilities Increase cost of medicine

Disability Increases tax burden on the State Young, uninsured or lose it with disability

No CMA action for a while

Shot in head or spinal cord** greater impact than shot in the stomach or leg

Mental health consequences

7.Next meeting: Wednesday January 24, 2024 at 7 PM8.Meeting adjourned 7:00 PM

Prepared by Stella Legarda, MD

------

Minutes from CNS Legislative Committee Meeting July 12, 2023

Bob Weinmann and Steve Cattolica state that we are not getting discussion pieces about the legislation out to the body of Neurologists on our mailing list,

Whenever we do email group mailings to all the California Neurologists, we can send the minutes of our Legislative meeting and then say if anyone needs more information,

e mail to Johanna Rosenthal MD or Steve Cattolica about the Legislation

at cnslegcomte@gmail.com

SB 636 had passed the Assembly Insurance Committee

Was in the Assembly Appropriations Committee

not expecting to fail since it had no effect on public funds

Planned to go through the Senate Committee’s in late Aug or early September not expected to have unusual difficulties.

Per Steve Cattolica the California State Legislature went on Summer Holiday Break July 14, 2023 and not scheduled to return until August 14, 2023. One month to complete all voting bySeptember 15, 2023

, Governor has only 1 month to sign or benign neglect veto.

Dr. Weinman thought we needed representation in Sacramento instead of recruiting our members that live far away, Stella suggested getting CNS members that live in Sacramento to be there for the committee and legislative meetings where it would be good to have additional voices, (besides Steve Cattolica)

Steve pointed out that we can contact the local offices because the legislators will be in their own offices in the local areas, during August. So instead of talking to a legislator when they are in Sacramento, knock on the door when they are down the block.

SB 357 Passing Assembly Judiciary and Transport, expected to pass Appropriations

SB 525 Hospital minimum wage requirement $21x one year then $25

Passed Assembly Labor sent to Appropriations expected similar path through the Senate

Steve Holtz pointed out the the AAN sends out the Capitol Report about what the AAN is doing as far as

National Legislation to advocate for Neurologists, and we can do that for CNS

What is the best format. Seems to be advisable to send with the constant e mails

as well as to post the latest minutes on the CNS link to advocacy that Stella started previously

SB 1278 is now a 2-year bill, about Work Comp MPN

SB 652 (Umberg) special language for Expert Witnesses to use

Signed by the Gov June of 2023 and in force as of 01-01-24

Roger Bertoli joined the Legislative meeting and expressed his interest. He is from Los Angeles.

Steve Cattolica came up with the idea of being able to go on

the CNS website>>>>>then click on the link to

the Advocacy Website/LEDGE>>>>>

then click on the link that has a

pop up connection to the site where you put in your ZIPCODE and

out pops the name of your California STATE Assembly Person

and the name of your California STATE Senator

and after reading all your EEG’s, signing charts, and continuing Education you can make an appointment with your local legislators, and let them know that you are a “go to” person about the CNS and legislation that we are interested in.

this is your opportunity to GO VISIT

AB 796 increasing scope of Athletic trainers 2 year bill

AB784 2 year bill

AB582 2 year bill

SB 598 Important for our group. This would allow doctors that have obtained multiple approved prior authorizations from the insurance companies to be allowed to order testing and treatment (in the same pattern) without having to get a PA

AB815 This is one that needs to be discussed at the next meeting.

It sets up a parallel credentialing process Existing law requires requirements for provider credentialing by a health care service plan or health insurer.

We might want to use this bill as ammunition for Cortese’s bill, What is the point of setting up more credentialing if doctors that don’t even have a license in California can practice medicine here.

We could point out that someone somewhere thinks it is good to have credentialling so why not make sure that doctors must have a CALIFORNIA license.

Also, these other boards may use incorrect criteria, because the entities will be controlling the process, such as …..don’t give the doctor a good rating if they put sick patients in the hospital (cheaper as outpatient)

AB101 and SB 101 We are counting on Steve Cattolica that there are no hidden agenda bills in the budget

AB 470 is another bill that we can use as a weapon to fight for DUTY OF Care. It is trying to have doctors improve their communication skills

Here is another bill trying to improve doctors by more continuing education, but we can point out that doctors providing, supervising and reviewing treatment in California must be licensed in California and that the Medical Board of California already has Continuing Medical Education protocols in place and that there are doctors coming into the state that are not subject to the Education requirements.

Does this group even know about the KING trial? Or the judges opinion, are they good allies?

AB 931 has something to do with Physical therapy authorizations will put on agenda for discussion next meeting

AB 616 Medical group financial transparency Act also requires some in depth analysis (Rodriguez) will put on the next meeting agenda

Prepared by Johanna Rosenthal MD

Youth Tackle Football - CNS sponsors the McCarty Bill AB 734, now AB 3047

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:26:49 GMT

Developments since the last hearing have resulted in a new bill AB 3047 which more clearly associates youth tackle football with CTE. An upcoming hearing is slated for April 16, 2024; here is our brief testimony as sponsors of this bill, to be presented by our legislative representative Steve Cattolica:

Brief Testimony: serious vulnerabilities inherent in youth tackle football.

I represent the California Neurology Society (CNS), a sponsor of AB-3047, and hereby submit this testimony to clarify the inherent risks associated with repetitive head impacts in tackle football, particularly among young athletes.

Pediatric populations exhibit heightened vulnerability to repetitive head impacts due to their anatomical and physiological characteristics, such as relatively flexible necks and spines predisposing them to acceleration-deceleration injuries even in the absence of overt trauma. Disturbingly, while there are just 1700 NFL players In the United States there are over 4 million children under the age of 14 playing tackle football, over 1 million of them in California alone.

The CNS endorses strategies to mitigate head injury risks in later childhood, vital for the ongoing development of brain functions in regulating behavior, emotions, and executive faculties. This perspective aligns with measures already adopted in other sports, such as the prohibition of headers in soccer players under age 12 and the ban on checking in ice hockey until age 14. No such measure exists in youth tackle football. And yet research studies consistently identify tackle football as the contact sport most associated with repetitive head impacts.

Cumulative head impacts can lead to traumatic encephalopathy syndrome (TES), a disorder that emerges within ten to twenty years, causing severe mental and emotional difficulties for afflicted individuals and their families. These challenges tend to worsen over time, are frequently unresponsive to treatment, and can have fatal consequences. Autopsies of young athletes with TES have revealed findings consistent with chronic traumatic encephalopathy (CTE) and other early neurodegenerative changes, even in individuals who were never diagnosed with a concussion during their lifetime. Autopsy findings of Chronic Traumatic Encephalopathy (CTE) across all age groups show a correlation with Traumatic Encephalopathy Syndrome (TES) experienced during the individual's lifetime.

The CNS champions parents’ rights and their role in nurturing their children's well-being. We underscore the need for young athletes and their custodians to be fully informed about the inherent risks of youth tackle football potentially impacting their future as young adults. These risks are too often not fully appreciated by families and schools until after children are physically full-grown, graduate, and leave home.

The CNS strongly supports this legislative initiative to reduce the unnecessary risks that over 1 million children in California face each year by participating in tackle football, a practice that risks causing lasting harm to their developing brains.

Authored by:

Stella B Legarda, MD

President, California Neurology Society

Neurologist specializing in child neurology, epilepsy, and clinical neurophysiology

Monday April 1, 2024

In the last six months, Dr. Stella Legarda, the current President of the California Neurology Society (CNS) and a pediatric neurologist specializing in epilepsy and clinical neurophysiology has participated in two significant hearings at the State Capitol.

1. On October 3, 2023, Dr. Legarda presented on the topic "Youth Tackle Football and the Developing Brain," emphasizing the significant risks and the potential for serious neurological consequences associated with tackle football for children. Despite there being only 1,696 NFL players, more than 4 million children under the age of 14 play tackle football in the Untied States. It was pointed out that children are particularly vulnerable due to their developing physical structures, including more flexible necks and spines, which increase the likelihood of acceleration-deceleration head impacts during play. These impacts often occur without visible injury. Dr. Legarda presented findings from MRI scans showing white matter changes in children who participated in a season of tackle football, none of whom had suffered a concussion. Additionally, she shared the life histories and brain analyses of deceased athletes, highlighting their reduced resilience to neurodegenerative diseases such as Alzheimer's, Parkinson's, and CTE. She noted that those who were first exposed to tackle football before the age of 12 exhibited earlier onset of severe symptoms and had shorter life expectancies.

Other presenters included Chris Nowinski, PhD, Cofounder and CEO of the Concussion Legacy Foundation at Boston University who presented findings on repetitive head impacts and CTE, and shared a moving story of his college football friend who died in his 40s of CTE.

2. On January 10, 2024 a second hearing was convened to vote on AB 734, where Dr Legarda provided expert testimony on behalf of the state's neurology specialty in support of the bill. (Read full testimony below)

There was one other poignant testimony given by a mother whose son, a former college and NFL football player, died at age 40 from CTE, confirmed by brain autopsy.

The Committee voted 5-2 to advance the bill to the Assembly Floor for voting. This decision came after a notable bill hearing, which saw significant opposition from parents and youth players. In the days that followed, the bill gained wide national media attention.

CNS Position Statement:

The Calfironia Neurology Society emphasizes that tackle football carries the highest risk of repetitive head impacts among all contact sports. To ensure the healthy development of the brain, particularly in critical areas responsible for decision-making in individuals from adolescence to adulthood, it is vital to minimize unnecessary risks. This philosophy is reflected in other sports, such as soccer, which bans heading for players under 12, and ice hockey, which prohibits checking until age 14. Comparable safety standards are in place across various contact sports to protect young athletes. Even the NFL endorses flag football as the official format during Pro Bowl play as a safer alternative.

The CNS firmly believes in upholding parents' rights and their role as primary decision-makers in their children's welfare. Furthermore, the CNS has endorsed that AB 734 would be further enhanced by incorporating an educational component, ensuring that parents and young athletes are well-informed about the risks involved. To better understand our position and recommendations, we invite you to read the testimony provided during the bill hearing:

Assembly Arts, Entertainment, Sports, and Tourism Committee California State Capitol – Room 127 January 10, 2024

Good morning, I am Dr. Stella Legarda, a pediatric neurologist practicing in Monterey and current President of the California Neurology Society (CNS). It is my honor to represent our specialty as sponsors of Assembly Bill 734.

Last Fall it was my privilege to provide testimony before this Committee on the subject of “Youth Tackle Football and the Developing Brain.” The source data provided to Committee offers significant insights for policymakers regarding the unnecessary risks faced by nearly four million young children who engage in tackle football each year (nationally), causing potential irreparable harm to their still developing brains.

Last week you were provided a scientific report published October 2023 on 152 deceased contact sports athletes under the age of 30. All were diagnosed in life with traumatic encephalopathy syndrome (TES). Chronic traumatic encephalopathy (CTE) was diagnosed in 63; the other brains revealed traumatic brain injury (TBI)-related abnormalities not meeting CTE criteria. CTE was diagnosed in athletes who played a mean of 3 years longer than athletes whose brain findings did not meet CTE criteria. Causes of death were #1 suicide #2 unintentional overdose, regardless of autopsy findings. The author highlights that CTE is also detectable in the brains of amateur contact sports players, not just professional players.

Findings from this study gained media coverage in a New York Times article, also provided you, which includes poignant real-life testimony from a deceased teenage athlete recording a farewell video to his parents explaining his suicide. He urges his parents to donate his brain to science, believing his tormented state to be the result of brain damage from playing tackle football. Autopsy findings indeed confirmed he had CTE, at the age of 18. Other parents of deceased athletes with CTE share their witness to the challenges their children faced before their untimely deaths.

This wealth of data is straightforward. Revelations published in the New York Times exposé are glaringly apparent. While the medical data seems complex, study results are convincingly clear.

The medical and scientific communities unanimously agree that repetitive head impacts, regardless of impact severity, lays the foundation for brain injury. Autopsy findings of TBI and CTE align with the diagnosis during life of Traumatic Encephalopathy Syndrome (TES).

Our focus, therefore, should be on preventing Traumatic Encephalopathy Syndrome (TES), a diagnosis in life that arises from the accumulation of repeated, sometimes seemingly mild head trauma often too easily dismissed by coaches, parents, and simply “shaken off” by the players themselves.

Assembly Bill 734 represents a significant step towards mitigating the accrual of such trauma. It will serve to educate and inform the public, our educational institutions, and help safeguard our youth from the burden of daily struggles with cognitive and mental health issues.

When the NFL takes measures to protect its players by playing flag football in the Pro Bowl, it is not just safeguarding its multi-million-dollar investments; it delivers the clear message that impact injuries and cumulative head trauma are perilous and should be minimized. Other youth contact sport organizations have already made mitigating decisions to safeguard their young athletes.

I want to underscore… the data is clear and unambiguous. For young children especially, accumulated blows to the head of any magnitude must be prevented.

With your help, AB 734 will be the starting point.

I look forward to your questions as the Chair allows. I also encourage any inquiries you may make to my office and to the CNS itself.

Sports-Related Brain Injuries - working with Neurology on the Hill

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:26:48 GMT

The CNS is working with Neurology on the Hill to update the AAN Position on Sports Concussion:

Position on Sports-Related Brain Injuries: Repetitive Head Impact (RHI), Concussion, Traumatic Encephalopathy Syndrome (TES), and Chronic Traumatic Encephalopathy (CTE)

Background

The American Academy of Neurology (AAN), representing over 36,000 neurology professionals, champions policy measures that ensure the safety and high-quality care of individuals in sports and physical activities. While acknowledging the health benefits of sports, neurologists bring specialized knowledge to the management of neurological injuries athletes may encounter.

Issue Description

The brain's intricate cellular and fibrous network is susceptible to lasting damage from traumatic brain injuries (TBIs), even those classified as “mild” (mTBI). This vulnerability is featured within a spectrum of injury severity, ranging from Repetitive Head Impact (RHI) and Concussion to Traumatic Encephalopathy Syndrome (TES). Mild TBI can lead to significant long-term neuropathological changes: diffuse axonal injury, demyelination, and Wallerian degeneration. *a Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative condition (tauopathy) identified after death, linked to recurrent traumatic brain injuries. A pathology review of the brains of deceased young athletes across a variety of contact sports disclosed that as many as 42% also met criteria for Chronic Traumatic Encephalopathy (CTE).*b Athletes as young as age 17 have been diagnosed with CTE. *c

Traumatic Encephalopathy Syndrome (TES) - Expanded Insight

Traumatic Encephalopathy Syndrome (TES) *d,e is a critical component of the dialogue on sports-related brain injuries. Characteristically delayed in its clinical presentation, TES is indicative of a complex and progressive neurological condition resulting from repetitive brain injury. The range of symptoms in TES comprise cognitive impairments, mood disorders, behavioral changes, and movement disorders reflecting the enduring consequences of prior repeat concussions and sub-concussive impacts.

TES is intricately linked with CTE. The diagnosis of TES in living patients requires the identification of a delayed emergence of severe symptoms or the progression of milder ones, supported by relevant clinical history. The importance of early detection cannot be overstated, as it enables prompt intervention and advanced management for those at risk of developing TES.

Understanding and addressing TES involves a comprehensive approach that encompasses preventive strategies to minimize head impacts, early detection, and targeted treatments for affected individuals. By focusing on TES as part of the broader spectrum of sports-related brain injuries, healthcare providers, coaches, and policymakers can better protect athletes and support their long-term health and well-being. Incorporating TES awareness into concussion policies and health recommendations is crucial, demanding rigorous pre-participation evaluations, ongoing education on the risks of head impacts, and the adoption of safer sports practices. Supporting research into TES and related conditions is essential for developing effective diagnostics and early interventions, ultimately improving outcomes for those impacted by sports-related brain injuries.

Legislative Actions and Further Recommendations

With Special Considerations for Youth

With a particular focus on youth, legislation nationwide aims to mitigate the adverse effects of sport-related repetitive head impacts and concussions. Given their developing physiology, children are at heightened risk. Therefore, protective measures, such as the prohibition of heading in soccer for children under 12, are imperative. However, protective legislation for young athletes in tackle football remains insufficient. The AAN advocates for legislative action to extend protections, including delaying tackle football participation in our very young. The AAN advocates a safer alternative, flag football for children under 12.

Updating policies to reflect current research is essential for improving concussion and head injury information protocols, standardizing head injury assessment tools, and promoting quality sports brain injury registries, collectively advancing our understanding and management of these injuries and their long-term impact on our youth.

Concussion Policies and Recommendations

The AAN advocates for comprehensive concussion education, the immediate removal from play following a suspected concussion, and a cautious return to play only after clearance by a healthcare provider skilled in concussion management. This protocol applies to organized sports and recreational play alike, emphasizing informed consent, academic support during recovery, and legal protections for healthcare volunteers.

Adopting evidence-based policies is crucial for preventing concussions and their potentially devastating outcomes, significantly reducing the risks associated with sports-related brain injuries.

Conclusion with Emphasis on TES

Addressing Traumatic Encephalopathy Syndrome (TES) in discussions on sports-related brain injuries highlights the need for a nuanced understanding of the long-term effects of repetitive head impacts. Through education, prevention, and research, the neurological health of athletes can be better protected, fostering safer sports environments. Neurologists are key to diagnosing, managing, and researching TES, emphasizing the importance of specialized care and informed policymaking in safeguarding sport athletes.

The American Academy of Neurology (AAN) acknowledges the occurrence of brain injuries in settings beyond athletic activities. This includes military exercises where the nature of training and operational activities can expose individuals to traumatic brain injury (TBI) risks. Brain injuries can also arise from accidents in daily life, occupational hazards, and civil discord. The AAN extends its position to encompass these scenarios, emphasizing the need for awareness, prevention strategies, and appropriate medical responses to brain injuries regardless of their origin. This broad perspective underlines the AAN's commitment to the health and safety of all individuals who might be at risk of brain injuries, not just athletes, highlighting the importance of a comprehensive approach to brain injury prevention, diagnosis, and treatment.

References

Added:

*a Wallerian degeneration as a therapeutic target in traumatic brain injury

Curr Opin Neurol 2019;32(6):786-795

*b Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts JAMA Neurol. 2023;80(10):1037-1050

*c The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136 :43-64

*d Clinical subtypes of chronic traumatic encephalopathy: literature review and proposed research diagnostic criteria for traumatic encephalopathy syndrome. Alzheimer's Research & Therapy 2014, 6:68

*e NINDS Consensus Diagnostic Criteria for Traumatic Encephalopathy Syndrome

Neurology. 2021;96(18):848-863

Original:

1 Langlois JA, Rutland-Brown W, Wald M. The epidemiology and impact of traumatic brain injury: a brief overview. Journal of Head Trauma

Rehabilitation. 2006;21(5):375-8.

2 Abrahams S, Fie SM, Patricios J, Posthumus M, September AV. Risk factors for sports concussion: an evidence-based systematic review. Br J Sports

Med. 2014 Jan;48(2):91-7.

3 Sarmiento K, Thomas KE, Daugherty J, et al. Emergency Department Visits for Sports- and Recreation-Related Traumatic Brain Injuries Among

Children — United States, 2010–2016. MMWR Morb Mortal Wkly Rep 2019;68:237–242. DOI: http://dx.doi.org/10.15585/mmwr.mm6810a2external icon.

4 DePadilla L, Miller GF, Jones SE, Peterson AB, Breiding MJ. Self-Reported Concussions from Playing a Sport or Being Physically Active Among High

School Students — United States, 2017. MMWR Morb Mortal Wkly Rep 2018;67:682–685. DOI: http://dx.doi.org/10.15585/mmwr.mm6724a3external icon.

5 “Heads Up: Concussion in Youth Sports,” Centers for Disease Control and Prevention. https://www.cdc.gov/headsup/youthsports/index.html

6 McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in

Berlin, October 2016. British Journal of Sports Medicine. 2017; 51:838-847.

7 Harmon KG, Clugston JR, Dec K, et al. American Medical Society for Sports Medicine position statement on concussion in sport. British Journal of Sports Medicine. 2019; 53:213-225.

Duty of Care in Workers Compensation potential legislation

sales@associationsphere.com (Blue Hill) — Fri, 04 Apr 2025 16:26:38 GMT

The body content of your post goes here. To edit this text, click on it and delete this default text and start typing your own or paste your own from a different source.

A letter to all California Neurologists

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:26:23 GMT

Dear California Neurologist,

Bob Weinmann here, your current President of the California

Neurology Society.

It is very likely you have patients who have been injured on the job.

Please be aware that your injured patients, especially those engaged in industrial occupations sustain the most frequent damage not only from cutback Utilization Review practices but also from purposive neglect of Duty of Care that YOU, as their neurologist working in California, are legally bound to provide.

Here's a case summary: Kirk King sustained back injury in 2008. Medication was prescribed by the treating doctor. Then the Utilization Review (UR) doctor (licensed out of state) revoked the authorization so the medication was stopped. King developed convulsive seizures because of the UR doctor's acute withdrawal of medication (clonazepam). The patient sued (a tort claim). The case reached the California Supreme Court where it was decided that the exclusive remedy for this type of dispute was entirely within the purview of the utilization review process, but not all of the justices were entirely on board. Justice Mariano-Florentino Cuellar was quoted to have said that protections for injured workers "may not be set at optimal levels and the legislature may find it makes sense to change them" .

THAT is what I am asking all California neurologists to take note of and support. We MUST require that physicians who perform UR in California be licensed in California and subjected to the same duty of care requirements as YOU are for your patient’s well-being.

Go to our CNS website for more details here:

https://cnslegislativecommittee.org/what-you-can-do

It is recommended you write a generic cover letter of your own in regard to your injured patient and send it to your own state senator and assembly representative with a copy of this King report. Be guided by the information available on the CNS legislative website; feel free to use the letter template provided.

Explore the website; stay informed of how legislative matters impact you, your patient, your practice.

It is my honor to represent you every day,

Yours sincerely,

Robert Weinmann, MD

President

California Medical Society

Chair, Legislative Committee

Ref: "Weinmann: UR Physicians Do Not Owe Injured Workers Duty of Care," Workcompcentral, 09/18/2018

Letter from the current President of California Neurology Society

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:26:07 GMT

Dear Colleagues,

Thank you for the honor of serving as President of the California Neurology Society (CNS) for the next two years (2023-2024).

I am humbled by the trust placed in me to serve in this capacity.

The CNS continues to host excellent conferences in cutting edge neurology practice and research. Please allow me to share my vision with you in spurring our other organizational mission: to strengthen the collective voice for all neurologists in California.

First of all, I would like to invite you to join our Spring Conference meeting to be held this May 4-7, 2023 at the Carmel Mission Inn in beautiful Carmel-by-the-Sea. Registration is still open but is filling fast; hotel registration will be closed a month before the meeting. Don’t miss out on this excellent agenda (see email invites) and the ability to earn 50% of your required annual CMEs right here in your home state.

We also hold a Fall Conference annually which provides the other 50% of our annual required CMEs (the ABPN maintenance of certification and California medical licensing board collectively require 30 CME units annually or 300 CME units every 10 years). At both conferences we host a timed open forum opportunity for any of us to discuss neurology practice issues.

Independently practicing neurologists should be feeling most supported by the CNS. Together with physicians in other fields of medicine, independent practitioners are the vanguard of continued democracy in medical practice because we are beholden to no one else for our productivity and for the way we choose to practice with our revered patients.

The voices of independently practicing neurologists need to be collectively driving the voice of the CNS and the organization needs to hear from each and every one of us.

My vision is that this voice represents the vast diversity of our specialty not only in terms of subspecialty and vocation, background culture, religion, and country of origin but also and especially in terms of opinion.

Our specialty attracts thought leaders; we are cognizant of the wonders of the unique brain that we have to manage in each and every patient we interact with. We respect individuality, as we are in touch with our own individuality. Holism is us.

As you know membership is free to the organization; you simply need to be a neurologist practicing in California to be heard. Should you decide to pay or are already paying our small membership annual fee (see our website californianeurologysociety.org) , you earn a bigger vote in how things go by becoming eligible for committee and board positions, however your voices still and always will matter. So, please speak up! Let us hear from you!

The CNS works to represent our collective voice not only in Sacramento but also with our medical colleagues at the California Medical Association, with our collective patients, and with raising societal awareness of the complex neurological conditions we manage. All right here in your backyard, in California.

Recent examples of how the CNS is representing our collective voice:

· Removing the requirement that physicians report seizures to the DMV, a law not active in 44 other states (SB 357)

· Utilization review physicians’ practice impacting our medical decisions and treatments and Duty of Care (SB 636)

· Empowering children with epilepsy in the school setting to immediately receive the same acute remedies they would receive at home, keeping them in their learning and social environment (now law)

· Prohibiting tackle football in children less than 12 years old (AB 734)

We welcome any issues you might be dealing with in your practice that we need to address. Please come to the meetings to get the largest audience and gain collective action.

I look forward to meeting you at our meetings; also feel free to contact me directly with any specific questions you might have about our organization and membership in general.

Very truly yours,

Stella B. Legarda, MD

President, California Neurology Society

Specialty Delegate, California Medical Association

Chair, Membership Committee cnslegcomte@gmail.com

CNS March 2023 Legislation Update – Steve Cattolica

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:25:49 GMT

Please read below on the following Bills we are following in the interest of all neurologists practicing in California

CNS Co-sponsors SB 636 (Cortese)

Senator Cortese is Chair of the policy committee that debates and then votes on bills dealing with insurance and employee relations issues – specifically workers compensation issues. Through the efforts of both the Union of American Physicians and Dentists (UAPD ), a group our own Dr. Bob Weinmann served as President, and The American Federation of State, County and Municipal Employees (AFSCME), Senator Cortese has authored SB 636. SB 636 is a bill that will require Duty of Care and a California medical license be the law of the land for all utilization review physicians in our workers compensation system. For the first time since utilization review became part of California’s work comp system, the oversight of utilization review physicians will be the same whether the individual is hurt at work or not.

The California Supreme Court in the case, King v CompPartners made a special point to urge the Legislature to realize “the workers’ compensation system and the utilization review process in particular, may not be working as the Legislature intended.” It later repeated the request by writing, “The limited record here raises doubts as to whether King’s utilization review was handled properly. The Legislature may wish to examine whether the existing safeguards provide sufficient incentives for competent and careful utilization review.” SB 636 will right the wrong and the blatant lack of accountability that nearly killed Mr. King when an out of state UR physician cut off his medications with no warning or contingency plan…and no way in current law to hold that doctor accountable.

The CNS co-sponsors SB 636 along with the UAPD . CNS will be reaching out to members and others in the medical community (CMA supports the bill as well) to urge their representatives to vote aye on SB 636.

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CNS Sponsors AB 734 (McCarty)

Assembly Bill 734 by Assemblymember Kevin McCarty (Sacramento) will r estrict youngsters 12 and under, from playing organized tackle football because of the increased propensity to TBIs at that age.

In its sponsorship letter to Assemblymember McCarty, CNS makes the point that, “Compared to other sports for youth, tackle football is associated with the highest incidence of so-called “mild” traumatic brain injury (mTBI). A child who plays tackle football is likely to sustain 23 times more significant head impacts (concussions) than a child who plays flag or “touch” football. Concussion symptoms, while seemingly mild in some cases, are overt signs of brain injury.”

CNS goes on to comment that, “The National Football League (NFL) itself protects its players with multimillion dollar padding systems, artificial intelligence analytics and even requires flag football be played in its final event each year, the “Pro Bowl.”

Granted the pros are grown adults, but safety has become a driving force in this, one of the most violent and injury-prone of sports. There’s a lot of money at stake in the pro game….and many, many past players are paying a horrific price, and much is now known about why.

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SB 357 (Portantino) –

CNS has written a letter to Senator Portantino in support of SB 357 which would change California’s mandated reporting of any condition characterized by loss of consciousness or motor control regardless of whether the condition is currently under medical control, truly represents a threat to safe driving or is judged by the reporting physician to be in the best interest of the patient or public safety.

The bill reflects the fact there is no evidence of an increase in traffic accidents related to this policy difference. In fact, mandatory reporting has been shown to result in more patients with seizures driving without a license and expressing reluctance to inform their physicians if they do have a seizure.

Successful passage of this bill will reinforce implicit trust in the doctor-patient relationship and removes the unsubstantiated requirement of doctors to report. The CNS position for voluntary rather than mandatory reporting is in kind with both the American Academy of Neurology and California Medical Association in favoring voluntary vs mandatory reporting.

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CNS support has been formally requested by Dr. Steven Holtz for SB 652 (Umberg). Senator Umberg’s bill is sponsored by the Consumer Attorneys of California (CAOC), the professional association for plaintiffs’ attorneys.

Their bill will codify longstanding law regarding the proper standard for expert witness testimony. CAOC has asked the CNS for a letter in support of the bill at its first opportunity.

The fact sheet states that at the present time, because of a faulty court finding in August 2022, a two-tier definition of “expert witness” has evolved. Since expert witness testimony can be the basis to grant or deny TBI benefits (for example), two different definitions of “expert” - a stricter one for plaintiffs than the defense –would likely yield a finding in the plaintiff's favor. In other words, the defense and plaintiff are held to two different definitions of "expert witness." The result grants the defense the upper hand.

Of course, TBI is not the only injury that might be involved in such a lawsuit, and it may not be involved at all sometimes. CAOC is seeking CNS support because TBI would be an injury where a neurologist might certainly be considered an expert.

Doctor Holtz presented the AAN course on testimony by medical experts for 5 years and sees the importance of supporting an even playing field.

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CNS is also considering a position on AB 387 (Aguiar-Curry)

AB 387 would amend the Health and Safety Code by expanding the number of members serving on the Alzheimer’s Disease and Related Disorders Advisory Committee from 14 to at least 21, but not more than 25, members. The bill would also specify the qualifications of certain members on the committee. The bill would revise (expand) references to Alzheimer’s disease to include related disorders.

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Duty of Care Resolution (adopted by the California Medical Association 2022)

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:25:38 GMT

Resolution submitted to CMA Duty of Care: Requisite Principle in All Healthcare Contractual Language

WHEREAS, Duty of care is a fundamental principle guiding all licensed physicians as they administer or participate in the administration of care to patients within many different settings and physician/patient relationships; and

WHEREAS, Those settings and relationships may be direct with a patient but often are established within the scope of consulting with and advising other physicians, specifically within the care review process commonly referred to as “utilization review”; and

WHEREAS, Duty of care extends to all healthcare providers and allied workers wherein every individual involved is expected to do no harm when making decisions that potentially impact a patient’s care; and

WHEREAS, Duty of care is not restricted to physicians and allied healthcare workers and is a responsibility and obligation that extends to all individuals in society wherein every individual is expected to exercise reasonable judgment and accept responsibility for the result of their decisions that potentially impact the public good; and WHEREAS, Decisions of care are often rendered in the course of “utilization review” as defined in both commercial health care plans as well as in the course of providing health care in the workers’ compensation system; and

WHEREAS, Recent court decisions regarding utilization review within California’s workers compensation system perpetuate potential disregard for adverse outcomes to patients following error-filled utilization review decisions by some health-related entities and physicians making those decisions; and

WHEREAS, Those adverse impacts and resulting patient harm are causes of constant administrative and legal disputes, eroding the patient’s trust in their physician and in the “grand bargain” that the workers compensation system represents; and,

WHEREAS, As a direct result, the California Supreme Court, in its decision in King v. CompPartners, advised the California Legislature to consider amending the workers’ compensation utilization system to remove ambiguities surrounding Duty of Care and specifically, the professional responsibility of utilization review doctors who render such decisions without California licenses and thus without the oversight, and opportunity to be disciplined by the Medical Board of California for unprofessional conduct because they aren't under board jurisdiction; and

WHEREAS, Because of the lack of oversight and opportunity for discipline they cannot be prosecuted in the states in which they do have licenses because those states don't have jurisdiction in California, be it

RESOLVED, That the California Medical Association stands for the requirement that all healthcare entities and health-related lay entities include language in contractual arrangements that basic duty of care be exercised as the guiding principle and leading priority when making patient management decisions; and be it

RESOLVED, That all physicians who participate in any way within a utilization review system, whether workers compensation or in the private sector shall be subject to the same duty of care laws and requirements that apply to treating physician(s) and health care providers; and be it

FURTHER RESOLVED, That to accomplish this end, all utilization review physicians participating in that process, or actually rendering decisions regarding care for patients residing or being treated within the state of California shall be licensed in the state of California and, therefore, shall be subject to the jurisdiction of the Medical Board of California.

This Resolution language has been - endorsed by the Specialty Delegation of the California Medical Association (CMA) - accepted by the CMA Council of Medical Services - approved by the CMA Board of Trustees (updated January 30, 2022) Duty of Care is now official California Medical Association policy

California Supreme Court has signaled the legislature; we must act

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:25:27 GMT

Please go to this website to read an important blog post by Chair Weinmann (October 2018)

http://politicsofhealthcare.blogspot.com/2018/10/

..."Justice Mariano-Florentino Cuellar said that the protections for injured workers "may not be set at optimal levels and the legislature may find it makes sense to change them."

The California Neurology society Duty of Care resolution was written with the joint spirit of this intent. Please read my full blog by following the link (above).

Robert L. Weinmann, MD

Past President, CNS

Past Chair, CNS Legislative Committee

First Blog EVER from CNS Legislative Committee

info@caneurologysociety.org (California Neurology Society CNS) — Fri, 04 Apr 2025 16:25:07 GMT

Welcome to our NEW Legislative Committee adjunct website to the California Neurology Society

At the April 2022 CNS meeting we will have a one-hour legislative meeting.

Please check the Blog page for updated activities of the CNS Legislative Committee between meetings.

Senator Schmitt Announces Senate Epilepsy Caucus

info@caneurologysociety.org (California Neurology Society CNS) — Sat, 17 Feb 2024 16:16:08 GMT

Watch this video announcing the creation of a Senate Epilepsy Caucus :

Let us each do our part; please add your thumbs up to the video in supporting the empowerment of our patients living with epilepsy

california-neurology-society

CNS Advocacy Day 2026 Wrap Up

A reminder of the impact neurologists can have when they speak with a unified voice

CNS Guest Blog: Understanding Neurogenic Stunned Myocardium

Motor vehicle accident complicated by neurogenic stunned myocardium and neurogenic shock

Abstract

Support the Multiple Sclerosis Registry

The registry aims to provide clinicians with meaningful insights into treatment response, support evidence‑based use of high‑cost therapies, and create a long‑term resource for research

Spend a Night with Venus and an Eternity with Mercury: The Rise and Fall of Syphilis/Neurosyphilis

Join CNS for a special session during Saturday Night's ticketed dinner

Learning objectives

Questions to ponder

CNS at the Global CTE Summit

Together, we are making California a safer place for every young athlete

United for Access: Leading Medical and Advocacy Groups Rally Behind Epilepsy Transportation Reform

The Epilepsy Transportation Endorsement Form initiative is gaining powerful momentum, with 23 endorsements received to date—including resounding support from some of California’s most respected medical, neurological, and advocacy organizations. ﻿

A Coalition of Credibility

Neurological Leadership Speaks Out

Academic Excellence Joins the Effort

HHS Actions Undermining Vaccine Safety and Efficacy

CNS must voice its deep concern regarding recent actions by the U.S. Department of Health and Human Services under Secretary Robert F. Kennedy Jr.

CNS Legislative Committee MEETING MINUTES - Wednesday, September 24, 2025

Medicare coverage changes, legislative initiatives, and CTE Education

California Neurology Society 2025 Legislative Session Recap: Advancing Neurological Care and Patient Rights

Stay informed on our ongoing advocacy efforts

CNS Legislative Committee MEETING MINUTES - Wednesday, September 10, 2025

CTE, Epilepsy Advocacy, and Legislative Updates

Special Event Spotlight at the CNS Fall Conference: Dr. Chris Nowinski to Deliver Keynote on the Latest Neuroscience Behind CTE

Dr. Nowinski is a former Harvard football player and WWE wrestler turned leading advocate and expert in traumatic brain injury.

A Major Victory for the Parkinson's Community: AB 829 approved by Governor Newsom and chaptered by Secretary of State

The impact of this new funding stream will be profound.

LEDGE News: Assembly Bill 369 has been signed into law by Governor Newsom

This law makes public spaces and workplaces safer for individuals with epilepsy and supports neurologists by extending protection beyond the clinic.

CNS Legislative Committee MEETING MINUTES - Wednesday, August 20, 2025

The group discussed several legislative updates, including AB 350, AB 369, and more

CNS Legislative Committee MEETING MINUTES - Wednesday, August 6, 2025

Advocacy efforts for epilepsy care, CTE education, and navigating relationships with epilepsy organizations

The California Medical Association (CMA) adopts CNS Resolution on 'Expanding Transportation Access for Working Adults with Epilepsy'

As CMA indicated at the most recent HOD meeting in Sacramento, it has adopted the resolution that CNS put forward on the subject

Board Actions on Q3 Council Reports

CNS Legislative Committee MEETING MINUTES - Wednesday, July 16, 2025

Legislative advocacy efforts, including support for various bills and planning for upcoming meetings with legislators

Why you should attend the California Neurology Society’s NeuroImmunology and Beyond at the DoubleTree by Hilton Berkeley Marina in Berkeley, Ca from November 6 to November 9, 2025

Why you should attend the California Neurology Society’s NeuroImmunology and Beyond at the DoubleTree by Hilton Berkeley Marina in Berkeley, Ca from November 6 to November 9, 2025

CNS Legislative Committee MEETING MINUTES - Wednesday, July 2, 2025

Concussion awareness, CTE prevention, and epilepsy-related issues, with an emphasis on youth sports safety and transportation access for adults with epilepsy

Quick recap

Summary

CNS Legislative Committee MEETING MINUTES - Wednesday, June 18, 2025

Reviewing two CMA Resolutions for the upcoming board meeting

Quick recap

CNS Legislative Committee MEETING MINUTES - Wednesday, June 4, 2025

Reviewing several legislative updates and bills, and discussions about transportation and infrastructure challenges in California

Quick recap

Summary

CNS Legislative Committee MEETING MINUTES - Wednesday, May 7, 2025

Lobbying Efforts & The Importance of Building Relationships with Legislators

Quick Recap

Next steps

Summary

MAINTENANCE OF CERTIFICATION - Exciting Developments

UnitedHealthcare and HCSC Accept NBPAS Certification

CNS Legislative Committee MEETING MINUTES - Wednesday, April 24, 2025

One week until Conference and Legislative Day

CNS Legislative Committee MEETING MINUTES - Wednesday, April 16, 2025

The team discusses their upcoming meeting on April 30th at the Citizen Hotel

Quick recap

Next Steps

Summary

CNS Legislative Committee MEETING MINUTES - Wednesday, March 26, 2025

CNS Reviews Bills and Votes on Measures of Support or Opposition

Meeting with Nick Tapio (Asm. Michelle Rodriguez) on Feb 13, 2025

CNS Legislative Committee MEETING MINUTES - January 29, 2025

Medical Economics Reports on MOC in 2024

CNS Legislative Committee MEETING MINUTES - November 20, 2024

CNS Legislative Committee MEETING MINUTES - September 19, 2024

Senate Bill 636 Vetoed by Gavin Newsom

Downloadable: CNS Position Statement on the Epilepsy Transportation Accessibility Act

CNS Legislative Committee MEETING MINUTES - August 21, 2024

CNS Legislative Committee MEETING MINUTES - September 4, 2024

The Epilepsy Transportation Endorsement Form initiative is gaining powerful momentum, with 23 endorsements received to date—including resounding support from some of California’s most respected medical, neurological, and advocacy organizations.