For the past 20 years I have looked forward to attending whenever possible the meetings of the California Association of Neurological Surgeons (CANS).

These meetings remind me that like most of us, I wear many hats, and at CANS I can glimpse how practicing medicine, supporting patients, and the reality of operating a hospital all come together. Each year I usually return charged up about at least one issue. This year was no exception.

CANS focuses on statewide socioeconomic issues affecting the practice of neurological surgeons and the care of our patients. (Our Stanford connection with CANS is notable. A medical staff colleague, Michael Edwards, served as president this past year, and at January’s meeting we enjoyed an upbeat talk by Martha Marsh, our CEO, on the symbiotic role of neurosurgeons and hospitals.)

CANS’ colorful history began in the 1970s primarily in response to the malpractice crisis. The organization helped develop and supported the MICRA malpractice compromise capping noneconomic damages in personal injury cases.

The group keeps its ear to the ground, anticipating each new crisis. The Board of Directors keeps abreast of pending state legislation and works hard to make sure that the voice of our specialty is heard, especially whenever our ability to care for patients is at risk.

This year’s hot topic involved the growing crisis of the emergency care of patients with neurosurgical illness and effects of EMTALA, the federal Emergency Medical Treatment and Active Labor Act — also known as the patient anti-dumping law.

This issue has been a hot topic with members of my department as we find ourselves inundated with calls to accept patients from as far away as Bakersfield or Reno from hospitals reporting they have no neurosurgeon and/or a bed available for a patient believed to have a neurosurgical issue. One of my associates recalls he received 18 such requests through our Transfer Center in a single day.

The situations can become bizarre.

I once had to accept a brain tumor patient from an emergency room in Sacramento, where a bed in a hospital with a practicing neurosurgeon couldn’t be found. After the woman was brought in by medical helicopter, we verified that she was stable, in no need of acute hospitalization, and she had no inclination to change from her provider at a University of California facility near her home. Appropriately the patient was released for outpatient follow-up with her Sacramento neurosurgeon — but only after a needless and costly helicopter ride. And the next day her family had to drive down to take her back to Sacramento.

Another colleague once had to accept a transfer patient brought here to be declared brain dead because the physicians at the transferring facility did not feel comfortable performing that exam and declaration.

Too often we accept patients on reasonable grounds only to find that CT scans or physical exams have been reported inaccurately and the patient’s condition was routine — no transfer was warranted.

At the CANS meeting, attendees from all the major neurosurgical centers had similar stories.

This health care crisis is multilayered. Economically and medically there is a crisis of appropriate beds and staff to care for complex patients. But beyond that, we are wrestling with the socioeconomic extravagances and inconveniences of needless helicopter rides and emergency medical transfers of the deceased.

On one hand you might think that it’s good for our hospital to be on the receiving end of all these requests, even when the circumstances strike us as bizarre. However, with a hospital as full as ours has been, care of nonpatients can be disruptive to the care of other patients — those who aren’t corpses or waiting to see their own doctors at home.

At Stanford an alert is sent almost daily to announce a critical shortage of ICU and regular medical/surgical beds. Postsurgical patients have been held for prolonged periods in recovery rooms awaiting beds that are being vacated by late discharges.

The situation requires a three-pronged attack. First, we are keeping track of transfers and will certainly give feedback to those hospitals and physicians who seem frequently to be transferring patients who don’t truly need our care.

Second, we need continually to improve our efficiency to help patients through our system, if only because inpatients at SHC continue to escalate and we have no immediate plans to increase beds. We will continue to move discharges to earlier in the day to make more beds available for late morning or early afternoon admissions. Facilitating a quick turnover of beds for patient admissions is labor intensive, but that seems to be our best option now. And we need to engineer our processes to ensure that we can care for our patients in a manner that avoids delays, postponements or cancellations of scheduled admissions, diagnostic tests or operative procedures. Put simply, we need to use our beds efficiently.

Third, as my trip to the San Diego CANS meeting reminded me, we are part of a larger fabric. We need to explore state, regional and probably federal solutions to ease the socioeconomic and political causes that are driving transfers for nonmedical reasons.

Broader planning and cooperation — including, perhaps, enabling legislation — can help us use our resources, including our Transfer Center, so that our role as a “safety net” is not abused. We need to see this issue and act on it as good physicians, great patient advocates and responsible citizens. We have more than one role here and it takes all of them to provide quality, effective patient care.

lshuer@stanford.edu