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Based upon 7.2% of the Eligible Voting Members, the American Association of Neurological Surgeons (AANS) Suspended Dr. Nancy E. Epstein for Arguing Against Unnecessarily Extensive Spine Surgery

Professor of Clinical Neurosurgery, School of Medicine, State University of New York at Stony Brook and Chief of Neurosurgical Spine and Education, NYU Winthrop Hospital, NYU Winthrop NeuroScience/Neurosurgery, Mineola, New York 11501, USA.
Corresponding author: Nancy E. Epstein, M.D., NYU Winthrop Hospital, NYU Winthrop NeuroScience/ Neurosurgery, 200 Old Country Rd. Suite 485, Mineola, NY 11501, USA.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Epstein NE. The AANS suspends Editor in Chief, Nancy Epstein, for telling the truth about spine surgery. Surg Neurol Int 2019;10:132.

This is the fourth and final editorial describing my experience with the AANS and the AANS Expert Witness Rules. As explained in my first editorial (“Why I testify for some patients/ plaintiffs, and against some doctors/defendants”), I testify in cases in which I believe the plaintiff/ patient was a victim of unnecessary, inappropriate, and/or negligent surgery. In my second editorial (“Does the American Association of Neurological Surgeons seek to limit members from testifying for patients/plaintiffs through proceedings resembling a kangaroo court and/or star chamber?”), I supplied evidence for my opinion that the answer to that question is YES! Finally, in the third editorial (“The American Association of Neurological Surgeons (AANS) Suspends Surgeon for Arguing Against Unnecessarily Extensive Spine Surgery; Was this Appropriate?”), I detailed the AANS’ actions up to and including the Nov. 16, 2018 AANS’ Board of Directors’ decision that I be suspended for 6 months. Here is what happened next.

According to the AANS rules, after the Board of Directors recommends a suspension, I can appeal their decision to the membership, which I did. Until recently the members voted on the appeal at the general business meeting. Interestingly, these rules were changed in 2018. According to the new procedures, members are now asked to vote electronically without the benefit of any discussion at the business meeting. In any case, consistent with the new AANS procedures, I wrote a letter stating my case (attachment A) and the President of the AANS wrote a letter to the members (attachment B) in response. Upon viewing the Presidents letter, I sent an email to the President (attachment C) detailing several misleading statements, and in some cases frank misrepresentations of the truth. Both attachments A and B were available on the internet for the voting members of the AANS to see prior to their voting electronically, but attachment C was not.

There are several troubling aspects of what ensued. First, my corrections, attachment C, regarding the inaccuracy in the President’s letter, were never conveyed to the membership. Second, I documented that two members of the AANS Board had clear conflicts of interest (COI). In one case, in April 2018, I had previously alerted the AANS of Dr. Haid’s COI, yet he was at the Nov 16th Board meeting, although he allegedly abstained from the vote (see appendix A). In the second case, I only learned after the Nov. 16th meeting that another member of the Board, Dr. Schaffrey, the President-elect of the AANS at that time, had a clear COI, having received substantial money from the manufacturer of the instrumentation involved in the TLIF, according to ProPublica. Yet, he took an active part in the proceedings of Nov 16th, including questioning me, although he did “abstain” for the vote. The AANS lawyer, informed us via letter that “The AANS requires members serving on committees to submit conflict of interest disclosure forms in connection with their service.” However, either this was not true in this case or the AANS allows individuals to take part in discussions when they have a clear COI. As the current President, Dr. Schaffrey signed the letter suspending me based upon “a majority vote of those voting members of the AANS casting ballots”. Finally, we learned from the AANS lawyer that only 500 of the 5400 AANS members eligible to vote actually voted; 389 voted in favor of the Board’s recommendation, 104 voted against it (in my favor), and 7 ballots were without a vote. Thus, I was suspended based upon the vote of 7.2% of the AANS members!


The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Journal or its management.

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