The American Association of Neurological Surgeons (AANS) is the primary organization for neurosurgeons with over 12,000 members, including neurosurgeons, medical students, and associated health professionals.[ 3 ] In their own words, the AANS is involved in “Advancing the specialty of neurological surgery through education, research and advocacy, while promoting the highest quality of patient care (Italics added by author)”[ 1 ]

However, in a turn to the dark side, the AANS in 2003 modified its bylaws to change from a 501c3 charitable association to a 501c6 trade association under the US Internal Revenue Code (IRC). However, Watts, both a neurosurgeon and lawyer pointed out, as a trade association it became, “...a nonprofit association founded and operated to provide services to its members,” and “...to further the business interests of its members’ businesses”.[ 10 ]

But here is the problem. There is a potential conflict for an organization that on the one hand is a trade organization and on the other seeks to promote the “highest quality of patient care”. It is an understatement to say that the AANS does not balance this conflict well, as illustrated by its Professional Conduct Committee (PCC).

According to the AANS, the PCC was created in 1983,“...to provide a forum and due process procedures to evaluate complaints by one AANS member against another and to make recommendations to the AANS Board of Directors for action (dismissal or sanctions) on such complaints.”[ 1 ] The AANS stated[ 1 ]: “The rules are intended to ensure a standard of quality and impartiality in expert testimony provided by neurosurgeons on either side of professional liability cases (italics added by author).” The evidence, however, strongly indicates otherwise.

In fact, the evidence suggests that the AANS is not interested in allowing neurosurgeons to provide expert testimony on both sides. Kesselheim and Studdert analyzed the complaints heard by the PCC between 1992 and 2006; 57 of 59 (97%) complaints involved testimony from surgeons acting for patients (i.e., plaintiffs’ experts).[ 7 ] Of the 59 complaints, the AANS PCC dismissed 19 (32%) complaints, while 40 (68%) resulted in sanctions ranging from censure to expulsion from the AANS. These latter 40 cases all involved sanctions against surgeons who testified for patients (i.e., plaintiffs). Kesselheim and Studdert further found that between 1992 and 2002, the PCC dealt with 4 or fewer (average of 2 per year) complaints per year. However, from 2003, the year the AANS became a trade association, through 2006, the PCC managed an average of 9.25 complaints per year, an increase of over 4.5-fold. Further, the PCC process resulted in a statistically significant increase in the severity of sanctions after 2002.

The Kesselheim and Studdert study covered the period from 1992 to 2009. In 2022, as part of a legal case I was involved in as an expert witness, the AANS was required to supply data for the PCC complaints (Grievances) filed from 2014 to 2022[ 2 ] [ Supplemental Information 1 ]. During this later period, the PCC received 29 grievances; 28 were against the patient’s expert.

It is important to note that in 2009 Kesselheim and Studdert had warned the AANS; “...may be seen as organized medicine preventing physicians from testifying to the truth”, which puts “...high degrees of pressure on doctors not to testify at all”.[ 7 ] To mitigate the consequences, these authors suggested “...opening review programs to nonmember complaints, or instituting guidelines to ensure that penalties are meted out equitably may further enhance the fairness and legitimacy of professional society involvement in this field.” However, their suggestions appeared to have had no impact on the AANS’ PCC complaint/Grievance process/procedures. In fact, their findings did not stop Dr. Shelly Timmons, President of AANS 2018-2019, from claiming in 2020, “The Rules for Neurosurgical Medical/Legal Expert Opinion Services also serve to ensure that expert testimony is available to all litigants” [ Supplemental Information 2 ].[ 9 ]

However, the data above document that it is a farce to suggest that the AANS’ PCC process serves “...to ensure that expert testimony is available to all litigants.” Dr. Timmons wrote that the Rules for Neurosurgical Medical/Legal Expert Opinion Services are “...impartial and apply equally whether the member testifies for a plaintiff or a defendant.”[ 9 ] Further, she stated, “The rules do not favor defendants in medical malpractice cases over patients, nor do they deter members from testifying against other neurosurgeons.” These statements are disingenuous at best, as the PCC rules were likely put in place for exactly that reason. In other words, the PCC process is clearly a mechanism to intimidate neurosurgeons from testifying against defendant neurosurgeons who have harmed patients, making it difficult for injured patients to find adequate representation[ 4 ] [ Supplemental Information 3 ].

It is critical to note that the AANS cannot remove board certification or impair a neurosurgeon’s ability to practice medicine; only the American Board of Neurological Surgery (ABNS) controls board certification. Therefore, to deter neurosurgeons from testifying against defendant neurosurgeons, the AANS’ PCC resorted to public embarrassment of plaintiffs’ experts to discourage their testimony for patients harmed by neurosurgeons. In any case, the real casualties of the AANS sanctions are the patients, who in many cases are already harmed, and in some cases, even paralyzed by the actions of defendant neurosurgeons.

To add insult to injury, the AANS’ PCC obvious bias against surgeons testifying for patients has been adopted by other organizations who have modeled their own PCC processes after those of the AANS.[ 5 , 6 , 8 ]

Unfortunately, while the AANS claims it is “promoting the highest quality of patient care,”[ 1 ] its PCC spends its time going after neurosurgeons testifying for often severely injured patients (i.e., quadriplegic, paraplegic,[ 4 ] or dead) due to the negligence of defendant neurosurgeons. If the AANS really cared about our patients, it would have the PCC discipline negligent neurosurgeons instead of focusing on the “business interests of its members”. Further, the AANS should spend its time teaching neurosurgeons how to avoid malpractice suits and prevent them from making poor neurosurgical decisions, which lead to adverse events and patient complaints against neurosurgeons.

COMMENTARIES

Commentary By Byron Miller Esq

“There is a conspiracy of silence in Texas as to physician experts testifying on the behalf of injured and deceased patients. The problem extends to, not only treating physicians that may have testimony that identifies and supports medical errors that may have occurred, but also to an unwritten code that physicians may not provide testimony that may be detrimental to another physician.

The local climate that perpetuates this conspiracy of silence is caused by many factors, not the least of which include: broad quality assurance privileges that often mask facts from the medical record; a fraternal code ensuring no one physician testifies against another; lack of desire to be involved in litigation to support a patient’s claims; as well as the Texas Medical Board’s lack of teeth in investigating and vetting physicians, which has allowed for physicians like Christopher Duntsch, MD (“Dr. Death”) to practice much longer than should have been allowed.

Beyond the failure to offer testimony, expert physicians have testified that there is a code of silence in the medical community. It is the primary driving factor as to why our investigations almost exclusively require discussing potential medical missteps with physician experts outside of Texas.

The double standard with competing plaintiff and defense experts is real. There appears to be a much laxer standard for defense expert testimony. I have heard testimony time and time again that flies in the face of peer-reviewed literature, promulgated texts, and basic standard of care with little to no explanation. In one instance, a pulmonologist (under oath) laughed when he re-iterated previous testimony from 20 years prior testifying that second-hand smoke presents no health risks. This lack of enforcement on the defense side has encouraged a distortion of the truth beyond any reasonable comprehension, which unfortunately has become much more familiar in this time and age.”

It’s their duty: Nurses’ primary responsibility is to the patients, not doctors

“Dr. Death” reform law shows the importance of investigating state licensing boards | Association of Health Care Journalists

Byron B. Miller, Law Offices of Byron Miller, PLLC

935. S. Alamo St., San Antonio, Texas 78205 Phone: (210) 452-8989, Fax: (210) 634-2244 Email: byron@millermedmal.com, www.millermedicalmalpractice.com

Commentary By John Polewski Esq

Trade groups which exist for the benefit of their members don’t get to say they have no bias in favor of their members. It is what they are and what they do. Of course the AANS only hears complaints from AANS members complaining about other AANS members who testify against AANS members. First, who else besides a defendant AANS member would ever complain, and how would they do so? Oh, that’s right: only AANS members can complain and only against other AANS members. Second, who decides what happens when a complaint is made Are they all investigated? Funny. Fairly and fully investigated? Hilarious. Investigated by friends of those being investigated? Likely. Let’s see those procedures and name those names. Otherwise we’re just a club issuing what amounts to press releases excusing bad conduct by our members and punishing members for criticizing other members. How is that different from the local Republican Party sanctioning a party member for publicly criticizing Trump? Or the jury of lions deciding whether the lamb had been treated appropriately by other lions?

Third, the plaintiffs in these cases are without exception lay people--and oh yeah, lets not forget that they are also horribly injured or dead and don’t have the ability or the resources to complain to the AANS Star Chamber. “Please sir, will you investigate your buddy who gave medically absurd testimony to support your other buddy who killed my dad?” You bet. We’ll get right on it.

Supposing that an injured patient or his survivors did know how to make this complaint and they did have the resources and contacts to do so, and supposing they were not overwhelmed by their injuries, why would they complain to the AANS? What would be the goal? “I had a great malpractice case but a dishonest and evasive AANS member persuaded a jury to think I didn’t”. The AANS would never get such a complaint in the first place, and would never look at that complaint because the plaintiff lost, meaning the AANS member won. A trade group’s mission would never be advanced by establishing that one of their members had been negligent when a jury had been convinced that he wasn’t. The AANS trade group in such a case would have to act against two members of the group who were trying to protect the group--the negligent AANS defendant and the dishonest AANS defense witness. Never, ever, ever going to happen.

And if, after the expenditure of tens of thousands of dollars injured patients or their survivors don’t have and can’t get, the AANS (by some miracle which has never and will never happen) “sanctions” the doctor who conspired with a neurosurgeon defense attorney to prevent an injured party from getting justice, would the injured person get another chance at a fair trial? No.

So patients have no ability or motivation to make such a complaint to the AANS, even if they were allowed to do so.

In acting against only plaintiff ’s experts, the AANS trade group is protecting the group--not good medicine, not justice and for sure not patients. The goal is to prevent neurosurgeons from being sued, regardless of how bad their conduct, and to do so by suppressing honest testimony against negligent AANS members. To pretend otherwise is silly.

John Polewski, POLEWSKI & ASSOCIATES, P.C. Arkansas Office: 620 W 3^rd St, Suite 404, Little Rock, AR 72201

*Texas Office: 540 E. Pleasant Run Road, DeSoto, TX 75115

CALL: 972-230-6200

Commentary By John Lancione

I love your editorial. I would not change anything. I applaud your courage for standing up for those injured by negligent neurosurgeons. Thanks for sharing.

John A. Lancione, The Lancione Law Firm 619. Linda Street, Suite 201, Rocky River, Ohio 44116

(440) 331-6100, (440) 331-6101 (fax) jal@lancionelaw.com, www.lancionelaw.com

Commentary By Leland Dempsey Esq

On behalf of patients unnecessarily victimized by care falling below acceptable standards of conduct, thank you for taking the time to bring this important matter to the attention of your peers.

Leland Dempsey, Dempsey Kingsland & Osteen, P.C. Lightwell Building, Suite 1860, 1100 Main Street, Kansas City, Missouri 64105

Phone: (816) 421-6868, Fax: (816) 421-2610 Email: leland@dko-law.com, www.dko-law.com

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.

References

1. AANS. Available from: https://www.aans.org/about/leadership-governance/bylaws-codes-and-guidelines/theaans-professional-conduct-program [Last accessed on 2025 Apr 05].

2. Amended Declaration of Frederick, editors. Knape (legal counsel to American association of neurological surgeons (AANS) professional conduct committee (PCC) Case No. 20-L-218. The circuit court of the seventh judicial circuit Sangamon County. Illinois: Frederick T. Knape, Esq; 2022. p. 1-6

3. . Available from: https://en.wikipedia.org/wiki/american-association-of-neurological-surgeons [Last accessed on 2025 Apr 05], p. 1.

4. Epstein NE. The American association of neurological surgeons (AANS) suspends surgeon for arguing against unnecessarily extensive spine surgery; was this appropriate?. Surg Neurol Int. 2018. 9: 265

5. Feld AD, Carey WD. Expert witness malfeasance: How should specialty societies respond?. Am J Gastroenterol. 2005. 100: 991-5

6. Iverson D. On regulating expert testimony. Neurol Today. 2007. 7: 3

7. Kesselheim AS, Studdert DM. Professional oversight of physician expert witnesses; an analysis of complaints to the professional conduct committee of the American association of neurological surgeons 1992-2006. Ann Surg. 2009. 249: 168-72

8. Mencimer S. The white wall; a new code of conduct is taking hold of the medical profession: First do no harm to your colleagues. Legal Affairs. 2004. 65: 1-4

9. Timmons SD, Knape FT. Medical expert witness testimony and the need for professional self-regulation. AANS Neurosurgeon. 2020. 29: 1-8

10. Watts C, editors. Editorial: Neurosurgery: A profession or a technical trade?. Surg Neurol Int. 2014. 5: 168