Vital Times: The CSA Podcast

Dr. Ludwig Lin and Dr. Rita Agarwal

Dive into a world of insightful and engaging content with the California Society of Anesthesiologists' podcast, Vital Times! Tune in every second Tuesday of the month with your hosts Ludwig Lin, MD, and Rita Agarwal, MD, FAAP, FASA, to explore a variety of topics that are not only educational and experiential but also inspirational and entertaining. Whether you're looking to stay informed on the latest in anesthesia, learn from experts in the field, or simply enjoy some captivating stories, Vital Times is your go-to source. Join our community of listeners and enrich your knowledge and experience with every episode!  *Views expressed in the podcast are those of the individual guests and hosts. 

  1. MAR 10

    Anesthetic Consideration in Patients of Venezuelan Ancestry

    if you have any feedback, please send us a text! Thank you! Welcome to another episode of Vital Times. In January 2026 the American Society of Anesthesiologists (ASA) and the Society for Pediatric Anesthesia (SPA) issued an updated joint communication regarding severe neurologic complications, including stroke and death, in healthy young adult (oldest reported so far is 36) and pediatric patients of Venezuelan ancestry following routine general anesthesia. There have been about 36 known or suspected cases worldwide although that number seems to be regularly increasing. The majority of cases have occurred in South American countries, with six reported in in the United States and eight in Europe. Genetic testing on a subset of the patients found a genetic mutation in mitochondrial DNA, known as the ND4 mutation. (for an interview with the physician and mother listen here https://www.instagram.com/reel/DUb4tYGjfdM/?utm_source=ig_web_copy_link . In July 2025, anecdotal communications from South American anesthesiology societies described cases of patients having severe complications from general anesthesia. Despite incomplete and emerging clinical and scientific information, ASA and SPA felt the severity of the cases warrant an expert opinion communication to inform anesthesiologists and their patients. Detailed family histories of patients who were recently affected revealed that all were of Venezuelan heritage and several had family members who also had adverse outcomes after an otherwise uneventful anesthetic. Four anesthesiologists at the leading edge of this newly discovered condition joined the show today to explain how it was discovered, what is known and what we can do about it.  Dr. Jim Fehr is the past President of the Society for Pediatric Anesthesia, and the Division chief of Pediatric Anesthesia at Stanford Lucile Packard Children’s Hospital. He is one of the coauthors of the joint statement, a member of the Society for PEdiatri Anesthesia’s Wake Up Safe initiative and very involved with Patient Safety.  Dr. Veronica Zoghbi is a Venezuelan pediatric anesthesiologist and Director of Pediatric Regional Anesthesia at the University of Miami in Miami, Florida.  South Florida and Miami have one of the highest concentrations of people from Venezuela in the USA. She and our other 2 guests are members of VAPOR (Venezuelan Anesthesiologist Perioperative Risk Reduction)  Dr. Claudia Bruguera Torres is a pediatric anesthesiologist from Venezuela and Assistant Professor at Cincinnati Children's Hospital.  Dr. Luis Rodriguez is a Venezuelan Pediatric Anesthesiologist from Miami FL, and currently serves as the Vice President for the Florida Society of Anesthesiologists Finally, if complications occur in patients with the ND4 mutation, anesthesiologists should report the case to their institutions’ patient safety organization and the Anesthesia Incident Reporting System of the Anesthesia Quality Institute.

    1h 6m
  2. JAN 13

    Helping Mothers and Babies Thrive: How to Improve Maternal Mortality

    if you have any feedback, please send us a text! Thank you! Today’s episode features a truly special conversation with Dr. Diana Ramos, California Surgeon General, and Dr. Calvin Johnson, Professor of Anesthesiology—both dedicated advocates for improving maternal health. Dr. Ramos is a distinguished public health leader who earned her medical degree from the Keck School of Medicine at USC and completed her OB-GYN training at the LA County–USC Medical Center. She also holds a Master of Public Health from UCLA and an MBA from the UC Irvine Paul Merage School of Business. Dr. Ramos has received numerous honors, including the Latino Spirit Award for Achievement in Public Service (2024) and the Public Health Leadership Award (2025) from All Children Thrive. She is deeply passionate about reducing maternal morbidity and mortality in California and across the nation, as well as improving health outcomes for children. Dr. Johnson is a Professor of Anesthesiology at Cedars-Sinai Medical School in Los Angeles. He is triple board-certified in Anesthesiology, Pediatric Anesthesiology, and Pain Medicine. He is an active member of the California Society of Anesthesiologists and serves on the California Pregnancy-Associated Review Committee. Maternal mortality remains a critical issue, with an incidence of 33 per 100,000 births in the United States and 15 per 100,000 in California. What are the most common causes of maternal mortality? How many of these deaths are preventable? What factors increase the risk of morbidity and mortality, and how have anesthesiologists played a role in reducing these risks? In this episode, Drs. Ramos and Johnson discuss why maternal mortality persists, current incidence rates, and what can be done to address this urgent issue. They also explore Adverse Childhood Experiences (ACEs) and their impact on children’s immediate and long-term health. Together, they emphasize the critical importance of collaboration across multiple specialties—including public health, nursing, community medicine, and preconception and prenatal care—to improve outcomes for mothers and children. Selected Resources: https://osg.ca.gov/ https://osg.ca.gov/aces-in-youth/ https://osg.ca.gov/prema/

    46 min
  3. 12/09/2025

    Who Gets to Be Called ‘Doctor’? Inside California’s Defining Ruling

    if you have any feedback, please send us a text! Thank you! Welcome to another episode of the CSA’s Podcast Vital Times  In September 2025, a landmark ruling by a California judge stated that nonphysicians could not use the term “Doctor” in a clinical setting. This was a ruling in response to a lawsuit filed by Three California-based nurse practitioners. They challenged California Business and Professions Code Section 2052, which makes it a misdemeanor for nonphysicians to use “Dr” in clinical settings or advertisements. Judge Jesus G. Bernal wrote in the opinion that using the title “Dr.” by nonphysicians in clinical contexts is “inherently misleading” and amounts to regulated commercial speech. Because of that, it does not fall under free speech protections. The court sided with the state, which argued that allowing nonphysicians to use “Dr.” could confuse patients about who is providing their care. Bernal cited an American Medical Association (AMA) survey showing: 39% of patients mistakenly believed that DNPs are physicians. He concluded that even when nurses disclose their credentials, the risk of confusion remains high in healthcare settings. To help us understand the importance of both the law and the ruling - 3 amazing patient advocates ae joining the show today. Dr. Rebekah Bernard is a family physician in Fort Myers, Florida. She's a founding member and past president of Physicians for Patient Protection, a grassroots advocacy group focused on ensuring physician-led care for all patients and truth and transparency among healthcare practitioners, and has authored two books on scope of practice. Dr. Antonio Hernandez Conte -- Former Chair of CSA Legislative and Practice Affairs Division from 2019 to 2022. Hhen served as President from 2023-2024 and is now a Past-President. Dr. Hernandez Conte is also a Partner with the Southern California Permanente Medical Group and a Clinical Professor at the Kaiser Permanente Bernard J. Tyson School of Medicine. Dr. Christina Menor is a board-certified anesthesiologist in private practice in Los Angeles. She specializes in ambulatory, pediatric and obstetric anesthesiology. Dr. Menor currently serves as the President for the California Society of Anesthesiologists. She coauthored an article describing California survey data about medical titles. She is a member of Physicians Protecting Patients and is an active advocate for physician led care and title transparency.

    53 min

Ratings & Reviews

5
out of 5
8 Ratings

About

Dive into a world of insightful and engaging content with the California Society of Anesthesiologists' podcast, Vital Times! Tune in every second Tuesday of the month with your hosts Ludwig Lin, MD, and Rita Agarwal, MD, FAAP, FASA, to explore a variety of topics that are not only educational and experiential but also inspirational and entertaining. Whether you're looking to stay informed on the latest in anesthesia, learn from experts in the field, or simply enjoy some captivating stories, Vital Times is your go-to source. Join our community of listeners and enrich your knowledge and experience with every episode!  *Views expressed in the podcast are those of the individual guests and hosts. 

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