MiniMed School: Preparing experts, appreciating key healthcare laws, and stepping through neurosurgery procedures

Rachel V. Rose
Rachel V. Rose
Principal with Rachel V. Rose – Attorney at Law, P.L.L.C. (Houston, TX).

Ms. Rose has a unique background, having worked in many different facets of healthcare, securities, cybersecurity, as well as international law and business throughout her career.

Anthony John Gerard Alastra, MD, FAANS, FACS, CNSENDORFP
Anthony John Gerard Alastra, MD, FAANS, FACS, CNSENDORFP
Arrowhead Neurosurgical Medical Group, Inc.

Associate Program Director. Neurosurgery Residency Program. Desert Regional Medical Center, Palm Springs, CA.

On-Demand: January 20, 2023
MiniMed School: Preparing experts, appreciating key healthcare laws, and stepping through neurosurgery procedures

$195.00 2 hour CLE

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Program Summary

Ethical challenges can and do arise for physicians testifying as expert witnesses. From qualifying as an expert, to scope of testimony, to the application of laws such as HIPAA, lawyers and physicians need to appreciate the potential landmines of serving as an expert witness. Once this foundation has been laid by Ms. Rose, Dr. Alastra will take the audience through basic anatomy, positioning, and some common neurosurgical procedures, which often arise in lawsuits where physician expert testimony is utilized.

Article: https://journalofethics.ama-assn.org/article/ethical-challenges-medical-expert-witness/2016-03

Key topics to be discussed:

  • Physician expert witness considerations
  • Suggestions for preparing and controlling an expert witness
  • Neurologic anatomy
  • Neurosurgical procedures

Date: January 20, 2023

Closed-captioning available

Speakers

Rachel-V.-Rose_Principal-with-Rachel-V.-Rose-–-Attorney-at-Law,-P.L.L.C.Houston,-TX_myLawCLERachel V. Rose | Principal with Rachel V. Rose – Attorney at Law, P.L.L.C. (Houston, TX)

Rachel V. Rose, JD, MBA is a Principal with Rachel V. Rose – Attorney at Law, P.L.L.C. (Houston, TX)

Ms. Rose has a unique background, having worked in many different facets of healthcare, securities, cybersecurity, as well as international law and business throughout her career. For nearly a decade, her practice has focused transactional, compliance, and litigation matters related to cybersecurity, health care, securities, and Dodd-Frank/False Claims Act whistleblower claims. Ms. Rose worked on Capitol Hill when HIPAA passed in 1996 and worked at HHS in 2009 when the HITECH Act was being implemented.

In addition to being extensively published and a sought-after presenter and quoted expert, Ms. Rose holds an MBA with minors in healthcare and entrepreneurship from Vanderbilt University, and a law degree from Stetson University College of Law, where she graduated with various honors, including the National Scribes Award and The William F. Blews Pro Bono Service Award.

Ms. Rose is licensed in Texas and is a Fellow of the Federal Bar Association. Currently, she is the Chair of the Federal Bar Association’s Government Relations Committee, a board member of the Federal Bar Association’s Qui Tam Section, the co-editor of the American Health Lawyers Association’s Enterprise Risk Management Handbook for Healthcare Entities (2nd Edition), as well as a co-author of the ABA’s books The ABCs of ACOs and What Are International HIPAA Considerations?

She has been named consecutively to the Texas Bar College, the National Women Trial Lawyers Association’s Top 25, Houstonia Magazine’s Top Lawyers (healthcare), the National Trial Lawyers Association’s Top 100, as well as 1st Healthcare Compliance’s 2019 Top Presenter. Ms. Rose is also an Affiliated Member with the Baylor College of Medicine’s Center for Medical Ethics and Health Policy, where she teaches bioethics.

Federal Court Admissions: Supreme Court of the United States, CO, DC, SDTX, NDTX, EDTX and WDTX.

See www.rvrose.com for additional information.

 

Anthony John Gerard Alastra, MD, FAANS, FACS, CNSENDORFP_ Arrowhead Neurosurgical Medical Group, Inc._myLawCLEAnthony John Gerard Alastra, MD, FAANS, FACS, CNSENDORFP | Arrowhead Neurosurgical Medical Group, Inc.

Academic Appointments

  • 1/1/2022-present: Neurosurgery Section Chief. Desert Regional Medical Center, Palm Springs, CA
  • 7/1/2020-present: NIR Fellowship Director. Arrowhead Neurosurgical Medical Group
  • 5/10/2019-present: Deputy Editor. Contemporary Reviews in Neurology and Neurosurgery. Cureus Journal of Medical Science Channel 4498. ISSN #2168-8184
  • 4/1/2019-present: Associate Program Director. Neurosurgery Residency Program. Desert Regional Medical Center, Palm Springs, CA
  • 4/1/2019-present: Interim Director Spine Surgery. Neurosurgery Residency Program. Desert Regional Medical Center, Palm Springs, CA
  • 11/1/2018-present: Director Vascular and Endovascular Neurosurgery. Neurosurgery Residency Program. Desert Regional Medical Center, Palm Springs, CA
  • 9/10/2008-2009: Clinical Assistant Professor of Neurosurgery, Department of Neurosurgery. New York University School of Medicine, New York University Langone Medical Center, New York, NY
  • 11/01/2004-2008: Clinical Assistant Professor of Neurosurgery, Department of Neurosurgery. College of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY

Board Certification/Recognition

  • American Board of Neurological Surgery, May 2011 (renewal 5-2031) Certificate No. 31001
  • American Board of Neurological Surgery, Focused Practice in CNS Endovascular Surgery (RFP), June 1, 2021. Credential # CNSENDORFP-NS2668387998

Medical Licensure

  • California: CA1561324 (renewal 02/29/2024)
  • CA Fluoroscopy X-ray Supervisor & Operator License: RHC000204315 (renewal 11/30/22)
  • NPI: 1720069438
  • Past Licenses (voluntarily relinquished/not renewed)
  • New Jersey: NJ25MA07917400 (2004-2021)
  • New York: NY217720 (2000-2022)

Education

  • 2002-2004: Chief Resident, Department of Neurological Surgery. Vanderbilt University Medical Center / St. Thomas Hospital / VA Medical Center, Nashville, TN
  • 2000-2002: Fellow, Division of Interventional Neuroradiology, Department of Radiology. New York University Medical Center/Bellevue Hospital Center/Manhattan VA Medical Center, New York, NY
  • 1998-2000: Resident, Department of Neurological Surgery. Vanderbilt University Medical Center / St. Thomas Hospital / VA Medical Center, Nashville, TN
  • 1997-1998: Intern, Department of General Surgery. Vanderbilt University Medical Center / St. Thomas Hospital / VA Medical Center, Nashville, TN
  • 1992-1997: Doctor of Medicine, May 18, 1997. Case Western Reserve University School of Medicine, Cleveland, OH. Area of Concentration: Neuroscience
  • 1988-1992: Bachelor of Arts in Natural Sciences: Behavioral Biology, May 21,1992. The Johns Hopkins University, Baltimore, MD

Employment and Volunteer Work

  • October 1, 2018-present: Board Certified Neurosurgeon Member:
  • Arrowhead Neurosurgical Medical Group, Inc
  • 1080 N. Indian Canyon Dr., Suite 201 26520 Cactus Ave, Suite A-2006
  • Palm Springs, CA 92262 Moreno Valley, CA 92555
  • September 2018-present: Owner/President: Anthony Alastra, MD Inc. Palm Springs, CA
  • July 2004-Sept 2018: Board Certified Neurosurgeon, Partner: Healthcare Associates in Medicine, PC
  • 1099 Targee Street Staten Island, NY 10304
  • 1995-2003: Volunteer interviewer of prospective candidates for undergraduate admission to The Johns Hopkins University, Baltimore, MD
  • 1996: Volunteer interviewer of prospective candidates to admission to Case Western Reserve University School of Medicine, Cleveland, OH
  • 1992-1997: Research Assistant. MetroHealth Medical Center, Department of Family Medicine, Cleveland, OH
  • 1990-1992: Research Technician. Addiction Research Center, National Institute on Drug Abuse, U.S.D.H.H.S./P.H.S., Baltimore, MD
  • 1988-1990: Research Assistant. The Johns Hopkins University School of Medicine, Department of Psychiatry, Division of Behavioral Biology, Baltimore, MD

Current Hospital Privileges

  • Desert Regional Medical Center (DRMC), Palm Springs, CA
  • Riverside University Health System Medical Center (RUHS), Riverside CA
  • (Application Submitted) Arrowhead Regional Medical Center, Colton, CA

Past Hospital Privileges

  • Staten Island University Medical Center, Staten Island, NY
  • Richmond University Medical Center, Staten Island, NY
  • Boards, Committees, Panels:
  • 2019-Present: Member of DRMC Peer Review Committee
  • 2019-2021: Member of DRMC Continuing Medical Education Committee
  • 2019-Present: Member of DRMC Surgical OR Committee
  • 2020-Present: Member of DRMC Ethics Committee
  • 2022-Present: Section Chief (Neurosurgery) DRMC

Charitable Organizations

  • 2022-Present: Governing Board Member. Neuro Vitality Center, 2800 E. Alejo Rd., Palm Springs, CA 92262
  • 2022-Present: Board of Director Member, Arrowhead Neuroscience Foundation, Inc. P.O. Box 685, Colton, CA. 92324

Research Publications:

  • Albano S, Bacani M, Alastra A. (May 22, 2022) Acute Lumbar Schmorl’s Node Following Chirpractic Adjustment. Cureus 14(5): e25209. doi:10.7759/cureus.25209
  • Whitney E, Khan Y R, Alastra A, et al. (September 23, 2020) Contrast Extravasation Post Thrombectomy in Patients With Acute Cerebral Stroke: A Review and Recommendations for Future Studies. Cureus 12(9): e10616. doi:10.7759/cureus.10616
  • Fiani, B, Cathel A, Arshad M, Hadi H, Khan YR, Quadri SA, Alastra AJG, Siddiqi J. Patient Perspectives on neurosurgery Resident Physicians Participating in Their Care. Cureus 12(2): e6880. Doi:10.7759/cureus.6880
  • Ho, A, Khan YR, Whitney E, Alastra AJG, Siddiqi J. The Influence of Intraoperative Technology on Neurosurgery Training. Cureus 11(9): e5769. Doi:10.7759/cureus.5769
  • Liu B, Liu S, Alastra AJG, Mahato D, Tayag EC, Cortez VA, Siddiqi J. The 100 Most Cited vs. Most Relevant Articles in the Journal of Neurosurgery: A Bibliometric Analysis. Cureus 11(4): e4498. doi:10.7759/cureus.4498
  • Allen, J.W., A.J.G. Alastra, P.K. Nelson. Proximal Intracranial Internal Carotid Artery Branches: Prevalence and Importance for Balloon Occlusion Test. 2005. J. Neurosurgery. 102(1). 45-52
  • Nelson, P.K., S. M. Russell, H. H. Woo, A.J.G. Alastra, D.V. Vidovich. Use of a Wedged Catheter for Curative Transarterial Embolization of Complex Intracranial Dural Arteriovenous Fistulas: Indications, Endovascular Technique, and Outcome in 21 Patients. 2003. J. Neurosurgery 98(3): 498-506
  • Sannerud, C.A., R.J. Marley, S.L. Serdikoff, A.J.G. Alastra, C. Cohen, S.R. Goldberg. Tolerance to the Behavioral Effects of Chlordiazepoxide: Pharmacological and Biochemical Selectivity. 1993. J. Pharmacology & Exp. Therapeutics 267(3): 1311-1320

Book Chapters

Orbach, D. A.J.G.Alastra, A. Bose, P.K. Nelson. Neurointerventional Management of Intracranial Aneurysms. In: Management of Cerebral Aneurysms. P. Le Roux & H.R. Winn, Eds. W.B. Saunders; 1 Ed. 2004. 925-950.

Case Reports

Nakhl, F., Chang, E., Shiau, J., Alastra, A., Wrzolek, M., Odaimi, M., Raden, M., Juliano, J. A Patient with Multiple Synchronous Gliomas of Disctinctly Different Grades and Correlative Radiographic Findings. 2010. Surgical Neurology International 1(1): 48-52.

Abstracts

  • Wrzolek, MA, Kozarski, T, Alastra, AJG, Mastrangelo, E, Rosenblum, M. Papillary Tumor of the Pineal Region with Marked Nuclear Pleomorphism, Non-papillary Pattern, and Focal Oncocytic Features, American
  • Association of Neuropathologists, Inc. Abstracts of the 85th Annual Meeting June 11-14th, 2009. San Antonio, Texas. Journal of Neuropathology & Experimental Neurology 68(5): 552-593
  • Sannerud, C.A., A.J.G. Alastra, P.O. Harger. Contingent Tolerance to Chlordiazepoxide (CDP) in the Rat. Differential Effects of Benzodiazepine (BZ) and Non-BZ Drugs. 1991. Pharmacology, Biochemistry, and Behavior 39:245
  • Invited Lectures, Grand Rounds, Oral Presentations, Podcasts
    Alastra, A.J.G, Rachel Rose, JD. ‘Mini-Medical School for Lawyers: What attorneys should know about anatomy, physiology, and injuries and treatment in relation to the law” Podcast myLawCLE.com. Palm Springs, CA. October 28, 2021
  • Alastra, A.J.G. ‘Physician-Physician Incivility in the Workplace’ Grand Rounds Resident Quality Lecture. Desert Regional Medical Center, Palm Springs, CA. August 28, 2019
  • Alastra, A.J.G. ‘Spine Clearance in the Trauma Patient’ Grand Rounds Surgery and Emergency Medicine. Staten Island University Hospital, NY. August 20-21, 2014
  • Alastra, A.J.G. ‘Emerging Technologies in Neurosurgery’ Neuro Core Nursing Education Curriculum. Staten Island University Hospital. Staten Island, NY. October 20, 2010
  • Alastra, A.J.G. ‘Advances in the Treatment of High-Grade Gliomas’ Neuroscience Multidisciplinary Grand Rounds Conference. Staten Island University Hospital. Staten Island, New York. January 15, 2009
  • Alastra, A.J.G. ‘Minimally Invasive Spinal Technologies: Kyphoplasty’ Medicine Grand Rounds. Richmond University Medical Center. Staten Island, NY. June 18, 2008
  • Alastra, A.J.G. ‘Kyphoplasty’ NYSSPA 2007 Annual Conference. Turning Stone Resort. Verona, NY. October 13, 2007
  • Alastra, A.J.G. ‘Fundamentals in Neurosurgery’ Surgical Grand Rounds Conference. Staten Island University Hospital. Staten Island, NY. August 17, 2007
  • Alastra, A.J.G. ‘Vascular Malformations’ SIUH Stroke Symposium. Staten Island University Hospital. Staten Island, NY. March 30, 2007
  • Alastra, A.J.G. ‘Correction of Coagulopathy: A Neurosurgical Perspective.’ Surgical Grand Rounds Conference. Staten Island University Hospital. Staten Island, NY. November 10, 2005
  • Alastra, A.J.G. ‘Concepts in ICP and Hydrocephalus.’ Surgical Grand Rounds Conference. Staten Island University Hospital. Staten Island, NY. April 28, 2005
  • Alastra, A.J.G. ‘Current Concepts in Endovascular Neurosurgery.’ Presented at the 2003 Tennessee Neurosurgical Society Annual Meeting. Nashville, TN. August 23-24, 2003
  • Nelson, P.K., D. Vidovich, A. Hecht, H. Woo, T. Kamiryo, S. Russell, A. Alastra. ‘Assessment of Perfusion Heterogeneities in Patients with Intracranial DAVF Complicated by Cortical Venous Drainage.’ Presented at 2003 AANS/CNS-ASITN Section Meeting, Phoenix, AZ. February 19, 2003
  • Alastra, A.J.G. ‘Neurosurgery Update: Interventional Neuroradiology.’ Presented at the 2002 Vanderbilt Meacham Society Annual Meeting. Scottsdale, AZ. Nov. 1-3, 2002
  • Alastra, A.J.G. ‘Neurovascular Anatomy: Anatomic Arterial Variations and Collaterals. Using Embryology to Understand Patterns.’ Presented at the 2002 Vanderbilt Meacham Society Annual Meeting, Scottsdale, AZ. November 1-3, 2002
  • Alastra, A.J.G. ‘Transphenoidal Surgical Approach for the Management of Pituitary and Sellar Lesions.’ Presented at Vanderbilt University Neurosurgical Nursing Grand Rounds, Nashville, TN. November 19, 2002
  • Alastra, A.J.G., P.J. Sunenshine, P.K. Nelson. ‘Decussation of Pericallosal Arterial System as Demonstrated by Cerebral Angiography.’ Presented at 2002 ABC-WIN Meeting, Val d’Isere, France. January 17, 2002
  • Alastra, A.J.G. ‘Pathophysiology of Reversible Focal Ischemia.’ Presented at the 1995 Meeting of Medical Student Fellows, Howard Hughes Medical Institute, Bethesda, Maryland. May 8-10, 1995. Abstract appearing in program of same name, pg. 38

Teaching Experience

  • October 2018-present: Neurointerventional Faculty: Desert Regional Medical Center (DRMC) Director, Neurointerventional Fellowship Training Program. 1150 N Indian Canyon Dr. Palm Springs, CA 92262
  • October 2018-present: Neurosurgical Faculty: Desert Regional Medical Center (DRMC) Neurosurgery Residency Training Program. 1150 N Indian Canyon Dr. Palm Springs, CA 92262
  • March 2018-Sept 2018: “Stroke Champion” Clinical Instructor and Coordinator for Staten Island participation in the ‘Hip-Hop Stroke Program’. This joint research and educational program between Columbia University Medical Center and NYS DOH for the statewide dissemination of a school-based public stroke intervention led by Dr. Olajide Williams. Project Coordinator: Janhavi Mallaiah MBBS, MPH. 710 W 168th St., New York, NY 10032
  • March 2016-present: ATLS Instructor, ATLS, ACLS, BLS, PALS certified
  • July 2004-Sept 2018: Education Coordinator for Neurosurgery Physician Assistants (SIUH, RUMC)
  • Involving recurring lectures, presentations, case reports throughout the year
  • 2010-2018: Physician Expert Instructor for MAST (Minimal Access Spinal Technologies) courses for Medtronic Sofamor Danek. Memphis, TN

Honors and Awards

  • 2021: DRMC Neurological Surgery Residency Teaching Award
  • 2014: Induction into American College of Surgeons (ACS), San Francisco, CA
  • 1994: Howard Hughes Medical Institute/National Institutes of Health. Research Training Fellowship for Medical Students recipient
  • 1993: Crile Summer Scholar Grant recipient, Case Western Reserve University School of Medicine
  • 1992: Curt P. Richter Award in Behavioral Biology, The Johns Hopkins University
  • 1990: Psi Chi, Psychology Honor Society, The Johns Hopkins University
  • 1990: Alpha Epsilon Delta, Premedical Honor Society, The Johns Hopkins University
  • 1988-92: The Beneficial Hodson Trust Scholarship, The Johns Hopkins University

Professional Memberships

  • 2018-present: Member: California Neurosurgical Society (CANS)
  • 2018-present: Member: California Medical Association (CMA)
  • 2018-present: Member: Riverside County Medical Society (RCMS)
  • 2014-present: Member: American College of Surgeons (ACS)
  • 2014-2018: Member: American College of Surgeons: Brooklyn-Long Island Chapter
  • 2012-present: Member: American Association of Spine Physicians (AASP)
  • 2011-present: Member: AANS Cerebrovascular Section (AANS-CVS)
  • 2009-present: Member, North American Spine Society (NASS)
  • 2008-2018: Member, New York County Medical Society (NYCMS)
  • 2004-2018: Member, Richmond County Medical Society (RCMS)
  • 2004-2018: Member, New York State Medical Society (NYSMS)
  • 2002-present: Member, Society of NeuroInterventional Surgery (SNIS)
  • 1998-present: Member, American Association of Neurological Surgeons (AANS)
  • 1998-present: Member, Congress of Neurological Surgeons (CNS)
  • 1992-2010: Member, American Medical Association (AMA)
  • 1992-1997: Member, American Medical Student Association (AMSA)

Research Interests

My interests recently have become focused on:

  • The relationship between biological processes and interactions of CNS with its associated vascular system
  • Clinical disease states such as brain AVMs, aneurysms, SAH-induced vasospasm, intracranial/extracranial stenosis, dural AVF’s, and acute stroke
  • The continued development and expansion of the field of endovascular neurosurgery. I feel my unique position as both a traditional and endovascular neurosurgeon allow me to better address and study clinical research questions regarding the efficacies of both treatment modalities with less bias
  • Development, dissemination, and research into the use of minimally invasive techniques in spinal surgery (MISS)
  • Community outreach for the education and rapid identification of stroke. Provider outreach for the identification of unruptured cerebral aneurysms
  • Promotion of research metrics and evidence-based approaches in the restructuring of outpatient clinics (neurosurgery) to better respond to evolving patient, community, third-party payer government and national standard bodies (CMS/ABNS/AANS/CNS/NASS etc.) reviewers demands focusing on outcomes measures in neurosurgery practice

Research Experience

2018-present: Arrowhead Neurosurgical Medical Group, PC / Desert Regional Medical Center Neurosurgery Residency Program. Current projects include:

  • Demographic Analysis of Intracranial Aneurysms in the Coachella Valley; Impacts for Screening and Detection
  • Creation of a childhood and adolescent educational program for the rapid identification of and activation of emergency services for adult stroke
  • Retooling the outpatient neurosurgery clinic to automatically collect and track outcomes measures for research and other purposes
  • Oversight, review, and sponsorship of resident research projects
  • 1994-1997: Case Western Reserve University, University Hospitals of Cleveland. Department of Neurological Surgery, Cleveland, OH. Howard Hughes Medical Institute/National Institutes of Health, Bethesda, Maryland. Project: Pathophysiology of Reversible Focal Ischemia in Cell Cultures of Rat Brain
  • Supervisors: W.D. Lust, Ph.D., and W.R. Selman, MD
  • 1992-1997: Case Western Reserve University, MetroHealth Medical Center. Department of Family Medicine, Cleveland, OH. Project: The Effect of Family Function on Medical Outcomes in a Geriatric Population
  • Supervisor: James W. Campbell, MD, Director of Geriatric Medicine, Department of Family Medicine
  • Summer 1993: Case Western Reserve University, University Hospitals of Cleveland. Department of Neurology, Cleveland, OH. Project: Isolation and Identification of beta- Amyloid-Related in Hypoxic Rat Hippocampal Slices. Supervisor: Rajesh Kalaria, Ph.D
  • 1990-1992: Addiction Research Center, National Institute on Drug Abuse. Behavioral Pharmacology and Genetics Section, Baltimore, MD. Project: Development of Tolerance to the Behavioral Effects of the Benzodiazepines. Supervisor: Christine A. Sannerud, Ph.D
  • 1988-1990: The Johns Hopkins University School of Medicine. Department of Psychiatry, Division of Behavioral Biology, Baltimore, MD. Project: Development of Tolerance to the Behavioral Effects of Benzodiazepines. Supervisor: Christine A. Sannerud, Ph.D

Agenda

I. Physician expert witness considerations | 12:00pm – 12:30pm

II. Suggestions for preparing and controlling an expert witness | 12:30pm – 1:00pm

Break | 1:00pm – 1:10pm

III. Neurologic anatomy | 1:10pm – 1:40pm

IV. Neurosurgical procedures | 1:40pm – 2:10pm