Candidate for Chair-Elect Sarvam P. Terkonda, MD Florida Medical

Nominating_2021F (HOD) - Tab A - Candidate for Chair-elect SARVAM P. TERKONDA, MD (incumbent)

Candidate for Chair-elect

Sarvam P. TerKonda, MD Florida Medical

1 Nominating_2021F (HOD) - Tab A - Candidate for Chair-elect SARVAM P. TERKONDA, MD (incumbent)

DocuSign Envelope ID: 0B1715B2-79CA-457A-BCE0-DF1B45D4647B

FLORIDA Board ofMedicine Governor Scott A. Rivkees, MD State Surgeon General

Chair Zachariab Zachariah, MD November 18, 2020 Fort Lauderdale, Florida

Vice Chair Hector Vila, MD Tampa, Florida Scott A. Steingard, DO, Chair Members Scot N. Ackerman, MD FSMB Nominating Committee Jacksonville, Florida

Kevin Cairns, MD Dr. Steingard: Fort Lauderdale, Florida

David A. Diamond, MD It is my honor and pleasure to write this letter on behalf of Dr. Sarvam Winter Park, Florida TerKonda for the position of Chair-elect as a Board Member Fellow ofthe Shailesh Gupta, MD Federation of State Medical Boards (Federation). Dr. TerKonda has tremendous Lighthouse Point, Florida motivation to serve the medical profession, assure competent physicians, and protect Robert London, MD the public health and safety of patients. His unique credentials and abilities, together Maitland, Florida with a powerful desire to serve, make him a superior candidate. He is fuily qualified Jorge J. Lopez, MD to run for this important position and the Florida Board ofMedicine fully endorses Maitland, Florida his candidacy. Luz Marina Pages, MD Miami Beach, Florida Dr. TerKonda is an energetic, highly motivated, thoughtful person who has Andre M. Perez the personal characteristics and experience to be a member ofthe Federation's Miami, Florida leadership team. His collaborative approach would be an asset to any organization. Eleonor Pimentel, MD His sound judgment and career experience provide an expert framework to provide Miami, Florida the leadership essential for the Federation's continuing success and positive Nicholas W. Romanello influence on medical regulation. Melbourne, Florida

Sarvam TerKonda, MD His knowledge, working experience, and service demonstrates his support of Jacksonville, Florida the mission, vision, and core values ofthe Federation. He has demonstrated the Executive Director personal integrity and positive outlook for state medical boards and has the Claudia Kemp, JD leadership skills necessary to serve. His leadership experiences within Mayo Clinic Florida, Florida Board of Medicine and the Federation provide him with an excellent foundation to be Chair-Elect.

Dr. TerKonda was appointed to the Florida Board of Medicine in 2013. He served and chaired several committees including the Credentials Committee, Rules and Legislative Committee, Telemedicine Committee, Probation Committee and the Surgical Care/Quality Assurance Committee. He also served as the Chair ofthe Joint Boards of Medicine and Osteopathic Medicine Office Surgery Rule Subcommittee. He was elected to serve as Vice Chair in 2015 and as Chair in 2016.

4052 Bald Cypress Way, Bin C-03 Tallahassee, Florida 32399-3253 Phone: 850/245-4131 i{orida Fax: 850/488-0596 or 850/412-1268 HEALTH https://www.FLBoardoflvledicine.gov

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Dr. Scott A. Steingard Page 2 November 18, 2020

In 2016, he was appointed by the Florida State Surgeon General to serve on the Telehealth Advisory Council which was charged with developing recommendations intended to increase the use and accessibility of services provided by telehealth within the State of Florida. He has also served as a member ofthe Board of Governors for the Florida Medical Association since 2018. Dr. TerKonda has a diverse set of leadership experiences that will allow him to serve the Federation in carrying out its mission, vision, and core values and contribute to establishing future goals.

Dr. TerKonda's medical career includes experience in both private practice and academic medicine. Over the past 20 years as a plastic surgeon at Mayo Clinic, he has served in leadership positions that emphasized medical education and clinical practice. His leadership experience includes serving as past Chair of Plastic Surgery and Chair ofthe Marketing Committee. He presently serves as the Medical Director for the Resource and Referral Panel (physician weilness and acute crisis), Chair of the International Committee Regional Demand Generation Committee for India and Southeast Asia and Co-Director ofthe Mayo Clinic Cosmetic Center. As Medical Director for the Center for Connected Care (Telehealth), the group led the rapid adoption oftelehealth and the innovation of new care delivery models.

Dr. TerKonda was introduced to medical regulation at a national level at the 2014 Federation annual meeting and has attended every annual meeting since that time. He has served in several positions including the Ethics and Professionalism Committee. In 2018, he was elected to the Board ofDirectors and has served on the Executive Committee, Governance Committee, Investment Committee, Planning Committee and the Compensation Committee. In 2019, he was appointed Chair of the Artificial Intelligence Taskforce whose work is ongoing.

These experiences have provided him with a broad-based understanding ofthe Federation's mission and vision and have prepared him to be a leader who will work side by side with others in bringing the Federation's current goals to fruition and ensuring a robust future.

Thank you for the opportunity to write in support of Dr. TerKonda as a candidate for Chair-elect. I've enjoyed working with him during his tenure as a board member and have faith in his ability to continue to be an invaluable asset to the Federation.

Sincerely,

Zachariah Zachariah, MD Chair, Florida Board of Medicine

3 Nominating_2021F (HOD) - Tab A - Candidate for Chair-elect SARVAM P. TERKONDA, MD (incumbent)

DocuSign Envelope ID: 0B1715B2-79CA-457A-BCE0-DF1B45D4647B CANDIDATE’S SIGNATORY PAGE

MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? Florida Board of Medicine ______

If not serving, when did you leave the board? Month: Day: Year:

How long have you served (did you serve) on your Member Medical Board? ______8 years

• I will be a Board Member Fellow as defined by the FSMB Bylaws at the time of the election on Saturday, May 1, 2021 and understand that only an individual who is a Board Member Fellow at the time of the individual’s election shall be eligible for election. Board Member Fellows of the FSMB are defined in the Bylaws, Article II, Section B. as:

“A Board Member Fellow is an individual member who as a result of appointment or confirmation is designated to be a member of a Member Medical Board. A Board Member Fellow shall be a Fellow of the FSMB during the member’s period of service on a Member Medical Board, and for a period of thirty-six months thereafter.”

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE: ______

Potential Conflict(s) of Interest:

None

A confirmation acknowledging receipt of the nomination materials will be sent within two business days. If you do not receive confirmation, or for questions, please contact Pam Huffman at [email protected] or 817-868-4060.

4 Nominating_2021F (HOD) - Tab A - Candidate for Chair-elect SARVAM P. TERKONDA, MD (incumbent)

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2021 Bullet Points Sarvam P. TerKonda, MD CANDIDATE FOR: Chair-elect

FSMB Service: Board of Directors 2018-present; Executive Committee 2019-present; Investment Committee 2019-present; Chair, Artificial Intelligence Taskforce 2019-present; Compensation Committee 2019-present; Planning Committee 2020-present; Governance Committee 2018-2020; Ethics & Professionalism Committee 2016-2018; Annual Meeting 2014, 2015, 2016 (Voting Delegate), 2017 2018, 2019, 2020

Florida Board of Medicine

o Vice-Chair 2015 o Chair 2016 o Chair, Joint Boards of Medicine & Osteopathic Medicine Office Surgery Rule Subcommittee o Rules & Legislative Committee, Credentials Committee o Surgical Care & Quality Assurance Committee, Probations Committee

Associated Involvement and Experience

o Florida Telehealth Advisory Council: appointed by Florida Governor o Past-Chair, Division of Plastic Surgery, Mayo Clinic Florida o Medical Director, Center for Connected Care, Mayo Clinic Florida o Co-Director, Mayo Clinic Florida Cosmetic Center o Medical Director, Physician Resource & Referral Panel (Physician Wellness), Mayo Clinic Florida

o Chair, International Committee Regional Demand Generation, India & Southeast Asia, Mayo Clinic

o Chair, Demand & Marketing Subcommittee, Mayo Clinic Florida: implemented a five- million-dollar marketing plan

o Bioinformatics Fellow, National Library of Medicine 2017 o Recipient, American Society of Plastic Surgeons’ Pathways to Leadership Award

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2021 Personal Statement Sarvam P. TerKonda, MD CANDIDATE FOR: Chair-elect

2020 is a year we will always remember. The challenges of the pandemic have touched us personally and professionally. The true strength of an individual or organization is highlighted during times of challenge not during times of prosperity. The challenges of COVID demonstrated the strength of our organization. Successful leadership during crises requires diverse expertise and the ability to adapt and innovate. My leadership experiences within Mayo Clinic Florida, Florida Board of Medicine and the FSMB provide me an excellent foundation to be Chair-Elect.

My medical career includes experience in both private practice and academic medicine. Over the past 20 years as a plastic surgeon at Mayo Clinic, I have had the privilege of serving in leadership positions emphasizing medical education and clinical practice. My leadership experience includes serving as past Chair of Plastic Surgery and Chair of the Marketing Committee. Presently, I serve as the Medical Director for the Resource and Referral Panel (physician wellness and acute crisis), Chair of the International Committee Regional Demand Generation Committee for India and Southeast Asia and Co-Director of the Mayo Clinic Cosmetic Center. As Medical Director for the Center for Connected Care (Telehealth), our group led the rapid adoption of telehealth and the innovation of new care delivery models. With leadership comes the opportunity to learn, to innovate and to grow.

Appointment to the Florida Board of Medicine in 2013 began my journey with the challenges of medical regulation. I served and chaired a number of committees including the Credentials Committee, Rules/Legislative Committee, Telemedicine Committee, Probation Committee and the Surgical Care/Quality Assurance Committee. I also served as the Chair of the Joint Boards of Medicine and Osteopathic Medicine Office Surgery Rule Subcommittee. Subsequently, I was elected Vice Chair in 2015 and as Chair in 2016. In 2016, I was appointed by the Florida State Surgeon General to serve on the Telehealth Advisory Council which was charged with developing recommendations intended to increase the use and accessibility of services provided by telehealth within the State of Florida. Additionally, I have served as a member of the Board of Governors for the Florida Medical Association since 2018. These appointments have provided diverse experiences in leadership that will allow me to serve our FSMB well.

I attended my first annual meeting of the FSMB in 2014 which provided an introduction into medical regulation at a national level. Attending every annual meeting since, I have served in a number of positions including the Ethics and Professionalism Committee. In 2018, I was elected to the Board of Directors and have served on the Executive Committee, Governance Committee, Investment Committee, Planning Committee and the Compensation Committee. In 2019, I was appointed Chair of the Artificial Intelligence Taskforce whose work is continuing.

All of these experiences have provided an important understanding of our mission and vision of and have prepared me to lead the FSMB.

I look forward with enthusiasm to serve as your Chair-Elect to meet the challenges and create opportunities for the FSMB and our medical boards.

6 Nominating_2021F (HOD) - Tab A - Candidate for Chair-elect SARVAM P. TERKONDA, MD (incumbent)

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Curriculum Vitae

Sarvam P. TerKonda, MD

Personal Information Place of Birth: Madurai, India Citizenship: United States of America Work Address: Mayo Clinic Jacksonville 4500 San Pablo Rd S Jacksonville, FL 32224-1865 904-953-1491 Email Address: [email protected]

Present Academic Rank and Position

Assistant Professor of Plastic Surgery - Mayo Clinic College of Medicine and 04/2002 - Present Science Consultant - Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 02/2004 - Present Jacksonville, Florida Board Member - Federation of State Medical Boards, Euless, Texas 2013 - Present Fellow of the FSMB Board Member - Florida Board of Medicine, Department of State Florida, Florida 2013 - Present Medical Director - Mayo Clinic Center for Connected Care, Jacksonville, Florida 2015 - Present Co-Director - Mayo Clinic Cosmetic Surgery Center, Mayo Clinic 2017 - Present Board of Governors - Florida Medical Association, Tallahassee, Florida 2018 - Present Board of Directors - Federation of State Medical Boards, Euless, Texas 2018 - Present Medical Director - Resource and Referral Panel, Mayo Clinic Florida 2019 - Present Committees, Mayo Clinic, Jacksonville, Florida

Education Washington University in St. Louis, St. Louis, Missouri - Pre-Medical 1979 University of Missouri, Rolla, Rolla, Missouri - Pre-Medical 1980 - 1981 Case Western Reserve University, Cleveland, Ohio - BS, Biomedical Engineering 1981 - 1984 Applied Neural Control Laboratory, Case Western Reserve University, Case 1983 Western Reserve School of Medicine - Research Student School of Medicine, University of Missouri, Columbia, University of Missouri- 1984 - 1989 Columbia, Missouri - MD Dalton Research Center, Columbia, Missouri - Research Fellowship, Summer 1985 Research Fellowship University of Texas Health Science Center at San Antonio, San Antonio, Texas - 1986 - 1987 Research Fellowship, American Heart Association Research Fellowship Department of Surgery, Mayo Graduate School of Medicine, Mayo Clinic College 1989 - 1994 of Medicine, Mayo Clinic Rochester, Mayo Graduate School, Minnesota - Resident, General Surgery Department of Plastic Surgery, Mayo Graduate School of Medicine, Mayo Clinic 1994 - 1996

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Sarvam P Terkonda, MD Page 2 of 5

College of Medicine, Mayo Clinic Rochester, Mayo Graduate School, Minnesota - Fellow, Plastic Surgery School of Medicine, University of Alabama, Birmingham, Birmingham, Alabama - 1996 - 1997 Fellow, Aesthetic Surgery and Endoscopic Plastic Surgery National Library of Medicine, Bethesda, MD - Fellow, Bioinformatics Course with 2017 Medical College of Georgia at Augusta University

Certification Board Certifications American Board of Plastic Surgery Diplomate 1999 - 2029 American Board of Surgery Diplomate 1995 - 2015 National Board of Medical Examiners (NBME) Diplomate 1990 - Present Mayo Clinic Quality Academy Mayo Clinic Quality Fellow: Bronze Level Certification 2010 Mayo Clinic Quality Fellow: Silver Level Certification 2010

Licensure Minnesota 33658 (Medical) 1992 - 1996 Alabama 20029 (Medical) 1996 - 1998 Georgia 73161 (Medical) 2014 - 2016 Florida ME 063330 (Medical) 1997 - 2022

Honors and Awards Honor Roll - Washington University, St. Louis, Missouri 1979 Dean's Honor Roll - University of Missouri, Rolla, Rolla, Missouri 1980 - 1981 Phi Eta Sigma-Freshman Honorary Society - University of Missouri, Rolla, 1980 Rolla, Missouri Phi Kappa Phi-Outstanding Freshman of 1979 - University of Missouri, Rolla, 1980 Rolla, Missouri Highest Honors - Case Western Reserve University, Cleveland, Ohio 1981 - 1984 Tau Beta Pi-National Engineering Honorary Society - Case Western Reserve 1983 University, Cleveland, Ohio Warren L. Morris Scholarship for Academic Excellence - Case Western 1983 Reserve University, Cleveland, Ohio Curator's Scholarship - School of Medicine, University of Missouri, Columbia, 1984 Columbia, Missouri Mark E. Bernstein Award for Academic Excellence and Outstanding 1984 Personal Qualities - Case Western Reserve University, Cleveland, Ohio Dalton Research Center Summer Research Fellowship - School of Medicine, 1985

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University of Missouri, Columbia, Columbia, Missouri American Heart Association Medical Student Research Fellowship - 1986 - 1987 University of Texas Health Science Center at San Antonio, San Antonio, Texas Selected Participant for the 74th Annual Clinical Congress Special Student 1988 Program - American College of Surgeons, Chicago, Illinois Student Research Day-First Place Award. “Effects of Atrial Natriuretic 1988 Peptide on the Baroreflex Control of Renal Sympathetic Activity" - School of Medicine, University of Missouri, Columbia, Columbia, Missouri Michael E. DeBakey Scholar in Cardiothoracic Surgery - School of Medicine, 1989 University of Missouri, Columbia, Columbia, Missouri Winner's Circle - Cystic Fibrosis Foundation, Jacksonville, Florida 2001 Charity Award Top Docs, Jacksonville Magazine, Jacksonville, Florida 2002 - Present Recognized yearly since 2002, for the past 18 years Pathways to Leadership - American Society of Plastic Surgeons, Arlington 2009 - 2010 Heights, Illinois Award from the American Society for Aesthetic Plastic Surgery Outstanding Faculty Member 2010 - Mayo School of Continuous Professional 2010 Development, Mayo Clinic College of Medicine Department of Medicine Innovation Award 2011 - Breast Clinic, Mayo Clinic 2011 Florida Service Excellence Award - Breast Clinic, Mayo Clinic Florida 2012 Service Excellence Award - Breast Clinic, Mayo Clinic Florida 2013 Editor's Choice Award for Aesthetic Surgery Journal Article - Oxford 2016 University Press, Cary, North Carolina

Professional Memberships and Societies

Professional Memberships and Services American Society for Aesthetic Plastic Surgery Member 2001 - Present Advocacy Relations Committee Member 2019 - Present Bylaws Committee Chair 2014 - Present CME Committee Member 2016 - Present Government Affairs Committee Representative 2012 - 2014 Industry Exhibits Committee Member 2012 - 2016 International Committee Member 2005 - 2007 Patient Safety Committee Member 2011 - 2018

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Product Development Committee Member 2012 - 2014 American Society of Plastic Surgeons Member 1999 - Present Breast Reconstruction Performance Measure Work Group Member 2014 - 2017 Clinical Symposia Member 2009 - 2011 Cosmetic Specialty Specific Examination Committee Exam Author 2018 - Present In-Service Examination Committee Exam Author 2009 - Present Legislative Advocacy Committee Member 2014 - Present Panniculectomy and Abdominoplasty Clinical Practice Work Group Member 2019 - Present Pathways to Leadership Member 2009 - Present Public Education Committee Member 2009 - 2013 Technology, Innovation and Disruption Task Force Member 2020 - Present Duval County Medical Society Member 1998 - 2001 Federation of State Medical Boards Fellow 2013 - Present Federation of State Medical Boards, Ethics and Professionalism Committee Member 2016 - 2019 Federation of State Medical Boards Compensation Committee Member 2019 - Present Executive Committee Member 2019 - Present FSMB-NBME Subcommitee Member 2019 - 2020 Governance Committee Member 2018 - 2020 Investment Committee Member 2019 - Present Planning Committee Member 2020 - Present Taskforce on Artificial Intelligence Chair 2019 - Present Florida Board of Medicine

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Member 2013 - Present Delegate to FSMB 2017 - 2019 Credentials Committee Member 2013 - 2019 Joint Medical Marijuana Physician Certification Pattern Review Panel Member 2018 - 2019 Office Surgery Rule Subcommittee (Florida Board of Medicine and Osteopathic Board of Medicine) Chair 2013 - 2015 Member 2013 - 2018 Probable Cause Panel Member 2013 - Present Probations Committee Member 2015 Rules and Legislative Committee Member 2014 - Present Chair 2019 - Present Surgical Care and Quality Assurance Committee Member 2013 - Present Vice Chair 2016 - 2017 Telemedicine Subcommittee Member 2013 - 2018 Chair 2017 - 2018 Florida Society of Plastic Surgeons Member 2008 - Present Phi Eta Sigma National Honor Society Member 1981 - 1984 Priestley Society Member 2002 - Present Tau Beta Pi, The Engineering Honor Society Member 1983 - Present The Greater Jacksonville Society of Plastic Surgeons Member 1998 - Present

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11 Nominating_2021F (HOD) - Tab B - Candidate for Treasurer JONE C. GEIMER-FLANDERS, DO (incumbent)

Candidate for Treasurer

Jone C. Geimer-Flanders, DO Hawaii

1 Nominating_2021F (HOD) - Tab B - Candidate for Treasurer JONE C. GEIMER-FLANDERS, DO (incumbent)

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DAVID Y. IGE CATHERINE P. AWAKUNI COLόN GOVERNOR DIRECTOR

JOSH GREEN LIEUTENANT GOVERNOR CHARLENE L.K. TAMANAHA LICENSING ADMINISTRATOR

HAWAII MEDICAL BOARD

PROFESSIONAL AND VOCATIONAL LICENSING DIVISION DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS P.O. BOX 3469 HONOLULU, HAWAII 96801 www. hawaii.gov/dcca/pvl

November 10, 2020

Email Only

Scott A. Steingard, D.O. Nominating Committee Chair c/o Pamela Huffman, Governance Support Associate Federation of State Medical Boards 400 Fuller Wiser Road, Suite 300 Euless, Texas 76039-3855 [email protected]

Dear Dr. Steingard:

Please accept this letter of nomination of Jone Geimer-Flanders, D.O., FACP, FACC, Chairperson, Hawaii Medical Board.

Please consider Dr. Geimer-Flanders for nomination for Treasurer of the Federation of State Medical Boards. The candidate has six years of service to the Hawaii Medical Board, has been active in the State’s Medical Association as well as the Hawaii Association of Osteopathic Physicians and Surgeons. As a member of the Hawaii Medical Board’s Legislative Committee, Dr. Geimer-Flanders has availed herself to testify on Board activities in the State’s Legislature and has remained active in the regulatory issues regarding licensure in the State of Hawaii. She serves as Associate Clinical Faculty at the University of Hawaii John A. Burns School of Medicine and is an immediate past member of the Admissions committee there. Dr. Geimer-Flanders is active in most aspects of the medical education and training of the students and medical residents in Hawaii.

Dr. Geimer-Flanders has agreed to the submission of her name for potential nomination and is aware of the time commitment required for the position to which she may be elected. Dr. Geimer-Flanders’s mailing address, daytime telephone number, and email address are:

68-1831 Pakanu Street Waikoloa, HI 96738 808-333-4580 (Mobile) [email protected]

2 Nominating_2021F (HOD) - Tab B - Candidate for Treasurer JONE C. GEIMER-FLANDERS, DO (incumbent)

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Scott A. Steingard, D.O. November 10, 2020 Page 2

Thank you for your consideration and attention to this matter. Should you have any questions or desire further information, please contact the Hawaii Medical Board’s Executive Officer, Ahlani Quiogue at (808) 586-2699 or by email at [email protected].

Very truly yours,

Ahlani K. Quiogue Executive Officer

AKQ:jy

3 Nominating_2021F (HOD) - Tab B - Candidate for Treasurer JONE C. GEIMER-FLANDERS, DO (incumbent)

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MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? Hawaii Medical Board ______

If not serving, when did you leave the board? Month: Day: Year:

How long have you served (did you serve) on your Member Medical Board? ______6 years

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE: ______

Potential Conflict(s) of Interest:

on file with FSMB

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2021 Bullet Points Jone C. Geimer-Flanders, DO CANDIDATE FOR: Treasurer

FSMB Service: Board of Directors 2019-2022: Audit Committee 2020-2021; Education Committee 2018-2019; Nominating Committee 2016-2018; Planning Committee 2019-2020; FSMB Liaison to the ACCME Board of Directors 2020-2023

Hawaii Medical Board

o Chair 2017-present o Member, Legislative Committee 2014-present

Associated Community Involvement and Experience

o Treasurer, Hawaii Chapter American College of Physicians 2012-2016 o Fiduciary Member, Blood Bank of Hawaii o Past President, Honolulu County Medical Association o Hawaii Delegate, American Medical Association o Hawaii Delegate, American Osteopathic Association

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2021 Personal Statement Jone C. Geimer-Flanders, DO CANDIDATE FOR: Treasurer

It is a great privilege and honor to be nominated as a candidate for Treasurer of the Board for the Federation of State Medical Boards (FSMB), which now represents 71 State and Territorial Medical and Osteopathic Boards.

I have been a practicing Cardiologist for most of my adult life, mid-career I had the experience of being a patient and getting to see the healthcare system from the other side. I got to see immeasurable commitment and dedication as well as some of the frightening patient safety pitfalls in that system. Fortunately, I got through that period. Since then I have had the opportunity to serve my state on the Medical Board and have found this to be the most gratifying experience of my life.

I do not want to list my qualifications, that is what my CV is for you can see the fiscal roles and financial committees that I have served on throughout my career. What I do want is to highlight is my commitment to quality, integrity and service. I invite you to ask my fellow Board Members, the current Treasurer, the FSMB Staff, my Fellow Delegates and our colleagues who know me and can attest to my commitment to service.

Our healthcare system and its regulatory infrastructure has never been challenged as it is today. We must flex to deliver products and services to our Member Boards, who themselves are being stressed while also experiencing the financial fallout from the respondent economic impact of the Pandemic. These are uncertain financial times, for sure. Never has it been more important for the FSMB to serve its member boards to ensure public safety.

I will tirelessly serve this Board and this Organization, dedicating all of my efforts to steer the organization throughout the next three years. The FSMB Board Treasurer works closely with the Chief Financial Officer in budgeting, finance administration and investments for the FSMB to protect its financial health and ensure the mission of the organization can be maintained. I feel that our future has never been brighter, we have already responded with new products and new opportunities to serve the States as they navigate unprecedented stressors to the infrastructure.

So as the global landscape evolves the FSMB will be poised to lead policy in patient safety and medical regulation. I am excited about the I look forward to serving You, our Member Boards and the FSMB. Therefore, I respectfully ask for your vote for Treasurer.

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Jone Geimer-Flanders, D.O., F.A.C.P., F.A.C.C.

343 Hobron Lane Honolulu, HI 96815 68-1831 Pakanu Street Waikoloa, HI 96738 800-450-7281 (Office) 779-213-0319 (Fax) 808-333-4580 (Mobile)

EMPLOYMENT

6-2020- Current Healthcare Consulting Cardiology

5- 2009-5-2020 Staff Cardiologist Tripler Army Medical Center

December 2011-present Chief of Inpatient Medicine Services May 2010-November 2011 University of Hawaii MS3 Clerkship Site Coordinator January 2010-November 2011 Chief of Cardiac Catheterization Lab April 2009-present Staff Cardiologist

Concurrent with above. Currently run the Hospital Inpatient Medicine Department at a 210 bed hospital, supervising 8 hospitalists, 3 active duty internists, approximately 60 residents and 3 physician assistants. There are approximately 75,000 active duty and 500,000 beneficiaries served with an average of 30 admissions per day. Supervision of the Internal Medicine Teaching Faculty Hospitalists. General invasive cardiology, Faculty and Teaching responsibilities residency program and in house hospital coverage for emergency room, CCU, general ward and telemetry units. Provision of Continuing Medical Education under the current American College of Graduate Medical Education rules. Projects have included heart failure clinic program and cardiac rehabilitation implementation, compliance programs for all of the core measures, Joint Commission Standards readiness among others. As chief of the cardiac catheterization lab responsible for staffing, hiring actions as well as all compliance with the hospital radiation safety, registry and ACC/AHA standards. As Clerkship site coordinator was involved with all aspects of LCCME and ACGME standards for medical education. Periodic review of the system, training the replacement faculty and evaluation of medical trainees.

2007-4-2009 Staff Cardiologist - Kona Community Hospital Kealakekua, HI 96750 (Kona Hawaii)

Tele-imaging coverage, maintained staff privileges for consultation. Medical director of cardiology and cardiac imaging. General internal medicine and cardiology, emergency coverage and critical care responsibilities.

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2007-6-2008 Medical Director Hawaii Heart Brain Center

Responsible for creating a cardiology department at North Hawaii Community Hospital. Set up of nuclear and echocardiography in the hospital setting. Implementation of cardiac CT program.

2003-2009 Contractor/Cardiologist, Brook Army Medical Center

Telemedicine echocardiogram interpretation for all of the Great Plains, Faculty and Attending Cardiologist, teaching responsibilities in the fellowship and residency program from 2005-2007.

2003-2007 Staff Cardiologist, Private Practice

General internal medicine and cardiology, emergency coverage and critical care responsibilities.

2001-2003 Staff Cardiologist, Heart and Vascular Institute of Texas

General internal medicine and cardiology, emergency coverage and critical care responsibilities

2000-2001 Staff Cardiologist, Haller Clinic Cheyenne WY

General internal medicine and cardiology, emergency coverage and critical care responsibilities. Reference: Dr. James Haller, MD founder

1997-2000 Fellowship Cardiology, University of Texas Health Science Center San Antonio, TX

Extensive cardiology training in all aspects of cardiac, emergency medicine and critical care. Reference: Dr. Greg Freeman, MD

1992-1997 Internship and residency University of Texas Health Science Center San Antonio, TX

General internal medicine and cardiology, emergency coverage and critical care responsibilities. Reference: Dr. Janet Hays, MD

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CONSULTANTSHIP

2012-2016 Medical Director Mountain Pacific Quality Health (Medicare QIO) Concurrent with above. Have received special training in CMS programs to include financial, quality and peer review. Current part time medical director provides clinical direction and guidance for the State’s Medicare Quality Improvement Organization. This position requires training in all applicable CMS quality and Medicare compliance measures. Conducts reviews of hospital-based systems, medical records and accreditation of health care organizations, providing guidance for quality improvement and compliance of Medicare Mandated programs under the conditions of participation for the CMS accredited hospitals in Hawaii, Guam, Saipan and American Samoa. Represent and advocate for client hospitals in their preparation for review. Serve as a field expert for training of staff. Provides guidance and training for documentation requirements and adherence to all applicable accreditation standards.

EDUCATION

1988-1992 Doctor of Osteopathic Medicine, University of Osteopathic Medicine and

Health Science, Des Moines, IA 50312

1983-1988 Indiana University Purdue University Intercampus, Northwest Campus and Indianapolis, IN 46052

UNIVERSITY FACULTY APPOINTMENTS

2010-present University of Hawaii John A Burns School of Medicine Assistant Clinical Professor – Honolulu, HI 2011-present A.T. Stills University College of Osteopathic Medicine Adjunct Clinical Professor - Arizona

COMMUNITY & PROFFESIONAL AFFILIATIONS

2020-present Accreditation Council for Continuing Medical Education, Board Member 2019-present Blood Bank Hawaii, Board Member 2019-2020 Honolulu County Medical Association, President 2019-present Federation of State Medical Boards, Board Member 2017-present Hawaii State Board of Medical Examiners, Chairman 2017-present American Medical Association, Hawaii Delegate 2016-2018 Federation of State Medical Boards, Nominating Committee 2016-2019 Hawaii State Board of Medical Examiners, Delegate to the FSMB 2016-2017 American Medical Association, Alternate Hawaii Delegate 2015-present Advisory Board Consultant to Aloha Care-Honolulu, HI 2015-present AOA Delegate for American Osteopathic Association, Delegate Hawaii 2015-2018 Hawaii American Medical Association Political Action Committee, Co-chair

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2014-present Hawaii State Board of Medical Examiners, Board Member 2014-present AMA Delegate for Association of American Medical Colleges-Hawaii 2014-2017 Consultant for Cardiovascular Diseases, Islands Hospice, Honolulu, HI 2012-2015 Admission’s Committee, JABSOM, University of Hawaii, Honolulu, HI 2012-2013 Council Hawaii Chapter, American College of Cardiology, Honolulu, HI 2012-2018 Treasurer Hawaii Chapter, American College of Physicians, Hawaii 2011-2013 President, American Heart Association Board– Honolulu, HI 2010-present Fellow American College of Physicians, Hawaii Chapter Member 2010-present Representative, Hawaii Medical Association to the U.S. Pharmacopeia 2010-2013 Board Member, American Heart Association– Honolulu, HI 2007-2013 National Speaker, American Heart Association–Pacific Mountain Region 2009-2010 Secretary, West Hawaii County Medical Society 2005-2007 Facilitator, Communities of Practice Texas Medical Association 2004-2005 President, Comal County Medical Society of the Texas Medical Association 2004-2006 Board of Directors, American Heart Association – San Antonio Region 2004-2006 Lions International New Braunfels Chapter 2003-2004 Secretary/Treasurer, Comal County Medical Society 2001-2006 Texas Medical Association, committee member 2000-2013 American Heart Association Council of Women in Cardiology 1999-present Fellow American College of Cardiology 1997-2007 San Antonio Society of Cardiology, Member

LICENSURE/CERTIFICATION

2016-present Certification, Hospice Medical Directors Certification Board 2014-present Fellow, Federation of State Medical Boards 2014-present Fellow, National Board of Osteopathic Medical Examiners 2009 Board Certification Cardiac CT Angiography 2006-present Hawaii Medical Board License 2006 Level 2 Certification CT Angiography 2000-present Nuclear License State of Texas 2002-present Fellow, American College of Cardiology 2001-present Diplomat, American Board of Internal Medicine Cardiovascular Disease 1999-2019 Diplomat, American Board of Internal Medicine 1985-present ACLS Instructor/BLS Provider 1993-present Texas State Board of Medical Examiners

PUBLICATIONS

Corcoran GR, Al-Abdel HM, Flanders CD, Geimer J, and Patterson TF: Markedly elevated serum lactate dehydrogenase (LDH) levels in disseminated histoplasmosis in AIDS: A clinical diagnostic clue. Clin Infect Dis 1997, 24(5): 942-44.

Geimer, J and Freeman, GL: Atherosclerotic Coronary Artery Aneurysm, Clin. Cardiol. 23, 786 (2000).

Chandrasekar B, Colston JT, Geimer J, Cortez D, Freeman GL: Induction of nuclear factor kB but not kB-responsive cytokine expression during myocardial reperfusion injury after neutropenia. Free Radic Biol Med. 2000; 28: 1579-88.

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Geimer-Flanders, JG “Cancer Survivor Right”, San Antonio Medicine. April 2006, Web 6 Feb 2014

Flanders, JG: “Creating a healing environment: Rationale and research overview” Cleve Clin J Med 2009;76: S66-S69

CPT David Hostler, MD (Associate), Jone Geimer-Flanders, DO, FACC, FACP, “Grafts Gone Wild: Severely Aneurysmal Thrombosed Coronary Artery Bypass Graft Presenting As ST-Elevation Myocardial Infarction” Break-Out Session Submission for Army ACP 2010, Tripler Army Medical Center, Honolulu, Hawaii.

Bijan Nik Moradi, MD (Associate), Jone Flanders, DO, FACC, FACP, “Does Miracle Drug Predispose to Viral Cardiomyopathy?” Poster Presentation for Hawaii ACP 2010, Department of Medicine, Tripler Army Medical Center, Honolulu, HI.

Carin Smith MD; Marc Hunt MD; and Jone Geimer-Flanders DO, FACC, FACP, “An Incidentally Discovered Left Atrial Appendage Membrane: Case Report and Literature Review” Hawaii J Med Public Health. 2012 Apr;71(4):103-5.

Diane Elegino-Steffens, Amy Stratton, and Jone Geimer-Flanders, “Subacute Staphylococcus epidermidis Bacterial Endocarditis Complicated by Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm,” Case Reports in Cardiology, vol. 2012, Article ID 467210, 4 pages, 2012. doi:10.1155/2012/467210

PRESENTATIONS

Faculty Development Course in Medical Simulation, Ongoing Quarterly Classes 5/2017-present. Speaker/Presenter Guam Medical Association International Conference on Early Detection, 10/2014 “Update on Heart Failure and ACS Management, Coding and Compliance” Grand Rounds, Guam Memorial Hospital. Guest Speaker, Guam Diabetes Conference, “Diabetes and the Heart” November 10, 2013 “Update on Aortic Stenosis” Jan 7, 2012- 2012 Hawaii Chapter, American College of Physicians, Scientific Meeting, Kaneohe, Hawaii Multiple Grand Rounds-CME Presentations on Integrated Treatment of Cardiovascular disease-PaliMomi Medical Center & Hawaii Medical Center West 2008 “Creating a Healing Environment” June 5, 2008-Cleveland Clinic Heart Brain Summit “Beyond Listservs, Technology in Medicine” May 5, 2006 Houston TexMed (TMA meeting) “Putting Your Heart into Your Health” February 28, 2006 - Cancer Care Center South Texas “Workshop on Women’s Cardiovascular Disease” February 3, 2006 - Ft. Sam Houston “Women & Heart Disease” November 15, 2005 – CME Baptist Health System “Adult Congenital Heart Disease” 11/06/05 Cardiovascular Update CME Baptist Health System “Women & Heart Disease” October 19, 2005 - Methodist Health System

REFERENCES

Available upon request

Revised 9/2020

11 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors ANDREA A. ANDERSON, MD

Candidate for Board of Directors

Andrea A. Anderson, MD District of Columbia

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December 29, 2020

Dr. Scott Steingard, DO Chair, 2020-2021 Nomination Committee Federation of State Medical Boards

Re: Nomination of Dr. Andrea Anderson

It gives us great pleasure to support the nomination of our Chair, Dr Andrea Anderson as a candidate for the Board of Directors of the Federation of State Medical Boards. Dr. Anderson has been a tireless worker on the medical regulation stage for the past eight (8) years. We have benefitted from her energy and vision here in DC and look forward to a greater role for her on the national landscape.

Dr Anderson came to the Board in 2012, appointed by the Mayor and unanimously approved by the DC Council. Dr. Anderson has made a noticeable impact since joining the DC Board of Medicine (Board); she is reliable and engaged, with a near perfect record of attendance and participation in subcommittee and hearing appointments and assignments. The two (2) meetings Dr. Anderson missed over her eight (8) years as a member were for the births of her two (2) lovely children - Caleb and Caris. As a physician member, Dr. Anderson was active in crafting policy on licensing of the aging physician and on use of social media for licensees.

This distinguished track record did not go unnoticed and in 2017 Dr. Anderson was appointed to the role of Chair with the Board following the expiration of prior chair’s term - Dr. Janis Orlowski, 2018 FSMB winner of the John H. Clark Leadership award. Dr. Anderson has been a tireless ambassador for teaching professionalism, going out to hospital medical society meetings, medical schools and residency programs alike. As Chair, Dr. Anderson has also continued the practice she initiated of inviting area medical students and residents to the open session of the Board’s meetings. For years, Dr. Anderson has continued this practice to introduce the next generation of physicians to the process of medical regulation and professionalism.

Perhaps most notable are Dr. Anderson’s contributions on a national stage, both to the Federation of State Medical Boards (FSMB) and beyond. As you know, Dr. Anderson has served on the Ethics and Professionalism Committee with the FSMB and in 2019 was selected to serve as Chair of Reference Committee B. Dr. Anderson has been the DC voting delegate to the FSMB House of Delegates for the past four (4) years, including one year she had to participate remotely as a result of DC’s travel ban to North Carolina. What sets Dr. Anderson apart is her additional service in the realm of professionalism and certification; she was appointed to the Board of Directors of the American Board of Family Medicine in 2019 and also represents the FSMB to the Management Committee of the USMLE and other NBME item writing and review committees.

In sum, we enthusiastically support Dr. Anderson’s candidacy to the FSMB Board of Directors. Dr. Anderson stands poised to bring new energy and vision to the Board, one informed by years of dedication

899 North Capitol Street NE | 2nd Fl, Washington, DC 20002 | P 202-724-8800 | dchealth.dc.gov

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to medical regulation. Dr. Anderson is relatable and reflective, and has as passion for teaching professionalism, especially to students and residents and demystifying the process of medical regulation. As a Staff Fellow of the FSMB Board of Directors, I am familiar with the rigors of the position and wholeheartedly endorse Dr. Anderson’s candidacy.

Thank you for your time and attention. If you have any questions or concerns, I can be reached at [email protected].

Sincerely,

Frank B. Meyers, JD Executive Director DC Board of Medicine

Associate Director Office of Health Professional Licensing Boards

899 North Capitol Street NE | 2nd Fl, Washington, DC 20002 | P 202-724-8800 | dchealth.dc.gov

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MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? DC Board of Medicine ______

If not serving, when did you leave the board? Month: Day: Year:

How long have you served (did you serve) on your Member Medical Board? ______almost 9 years

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE: ______

Potential Conflict(s) of Interest:

None

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2021 Bullet Points Andrea A. Anderson, MD CANDIDATE FOR: Board of Directors

FSMB Service: Awards Committee 2015-2016, 2017-2018; Ethics & Professionalism Committee 2019-2020, 2020-present; Chair, Reference Committee B 2019; SMB Advisory Panel to the USMLE 2018-2019, 2019-2020; Voting Delegate 2017, 2018, 2019, 2020; DC Representative, National Telehealth Workgroup 2012

District of Columbia Board of Medicine

o Chair 2017-present o Physician Member 2013-2017 o Initiated Learner Visitation Program to teach Professionalism & Medical Regulation

American Board of Family Medicine

o Member, National Board of Directors [16-member Board of Directors for <97,000 family physicians] October 2019

o Board Subcommittee Appointments: Professionalism Committee, Certification, Strategy Implementation & Operations

o Board Taskforces: Budget, Governance, Board Development

District of Columbia Department of Health

o Appointed Member, DC Health Scientific Advisory Committee for the Development & Implementation of a Safe, Effective, & Equitable COVID-19 Vaccine Distribution Program in the District of Columbia

o Sub-Committee Appointment: Ethics

National Board of Medical Examiners

o Member, Step 3 Computer-based Case Simulation Interdisciplinary Review Committee 2019-present

o Member, USMLE Management Committee [responsible for making content & vision recommendations for the USMLE] 2018-present

o Member, USMLE Introduction to Clinical Medicine, Physical Diagnosis, & Communication TMDC 2018-present

o Member, USMLE National Test Item Question Content Writing Committee 2018-present

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2021 Personal Statement Andrea A. Anderson, MD CANDIDATE FOR: Board of Directors

Close to 20 years ago, I arrived at a large urban Federally Qualified Health Center in Washington, DC, as a National Health Service Corps Scholar. This began my career in clinical medicine and professionalism. Currently, I am the Associate Chief of Family Medicine at the GW School of Medicine and Health Sciences where I have been instrumental in working to restore Family Medicine. In 2012, I was appointment to service on the DC Board of Medicine. I accepted the role, albeit tentatively at first, somewhat influenced by scary campfire stories of draconian SMBs that often haunt physician minds. I found that those myths could not be further from reality. Since then, I have served in many capacities, including my current second term as Chair, establishing policies and licensing a medical workforce of approximately 13,000.

My interests in professionalism continue with my service to the FSMB. Since 2012, I have served in various leadership capacities including as an Appointee to the National Ethics and Professionalism Committee, a Voting Delegate to the Annual meeting, and 2019 Reference Committee Chair. Locally, my work in public health includes my appointment to the DC Health Scientific Advisory Committee for the Development and Implementation of a Safe, Effective, and Equitable COVID-19 Vaccine Distribution Program in the District of Columbia working with stakeholders to advise vaccine policy. Over time, I have testified before the DC Council on numerous topics including healthcare funding for medically vulnerable residents.

In 2019, I was appointed to the Board of Directors of the American Board of Family Medicine (ABFM) which certifies 97,000 Board Certified Family Physicians. I serve on several subcommittees including Professionalism, Strategic Planning, and Budget closely examining national policy. As the first African American female physician to be appointed to the Board in its 50 year history, this role continues my unique experience in the continuum of professionalism along the entire arc of physician development.

My work with the National Board of Medical Examiners as a member of the Management Committee of the USMLE, and a test material item writer has familiarized me with common standards of medical student competencies from a licensing standpoint. During my tenure the committee has passed landmark decisions, including changing USMLE Step 1 to a Pass/Fail grading structure by 2022.

Finally, I represent the Society of Teachers of Family Medicine (STFM) to the national Academic Family Medicine Advocacy Committee, a coalition of appointed representatives from the six major Family Medicine academic organizations charged to advocate politically for national and state academic policy. We have developed a national advocacy curriculum and were instrumental in the 2019 adoption of advocacy training as a required Family Medicine residency competency. My national service to STFM also includes appointment to the National Underrepresented Minority Faculty Development and Retention Task Force.

Over my career, I have challenged myself with the question of how do we as a profession train, assess and produce physicians who can maintain the social contract? How can we maintain public trust and professional accountability? I believe it is clear I have the energy, enthusiasm and experience to represent the FSMB and function well within a system that is focused on licensure, discipline and protection of the public. I look forward to the opportunity

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Andrea A. Anderson, MD, FAAFP 2120 L Street NW, Suite 450  Washington, DC 20037 (310) 770-3125  [email protected]

EDUCATION

M.Ed., Graduate School of Education and Human Development, George Washington 2022 anticipated University, Washington, DC Master Teacher Leadership Development Program, Graduate School of Education 2016-2017 and Human Development, George Washington University, Washington, DC Fellowship, Primary Care Faculty Development, Harbor-UCLA Medical Center, 2003-2004 Los Angeles, CA Residency, Family Medicine, Harbor-UCLA Medical Center, Los Angeles, CA 2000-2004 M.D., Brown University School of Medicine, Providence, RI 1996-2000 B.A. Cum Laude, Brown University, Providence, RI (Human Biology; African 1992-1996 American Studies; Keynote Graduation Speaker for class of 1400)

CURRENT POSITION

Associate Chief and Assistant Professor, Division of Family Medicine, George 2019-Present Washington University School of Medicine, Washington, DC Associate chief of new Division of Family Medicine at an urban medical school previously without a family medicine presence. Assists with strategies to establish clinical, educational, and advocacy opportunities within the division. As assistant professor, is course director, Transition to Residency/Practice of Medicine IV; instructor, Practice of Medicine: Clinical Skills and Reasoning; instructor, Practice of Medicine: Professional Development Mentor; preceptor, Primary Care Clerkship; and co-director, Health Policy Scholarly Concentration.

SELECT PRIOR PROFESSIONAL EXPERIENCE

Unity Health Care, Inc., Washington, DC Medical Director of Family Medicine 2009-2019 Bilingual Family Physician 2004-2019 Upper Cardozo Health Center, Unity Health Care, Inc., Washington, DC Medical Director 2012-2016 Assistant Medical Director 2008-2012 The National Family Medicine Residency Core Faculty Member/Assistant Clinical Professor, The National Family Medicine 2015-2019 Residency/ Unity Health Care Teaching Health Center /Graduate Medical Education program, AT Still School of Osteopathic Medicine Designed and Directed Leadership and Advocacy COPC rotation

SELECT PROFESSIONAL MEMBERSHIPS AND ACTIVITIES

American Board of Family Medicine: National Board of Directors, 2019-Present National Board of Medical Examiners: Committee Member, Step 3 Computer-Based Case Simulation Interdisciplinary Review Committee (2020-Present); United States Medical Licensing Examination (USMLE) Management Committee (2019-Present); USMLE Introduction to Clinical

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Medicine, Physical Diagnosis, and Communication Test Material Development Committee (2018- Present); Internal Medicine Subject Test Committee (2018-Present) Federation of State Medical Boards: Appointee, National Ethics and Professionalism Committee (2019-Present), Chair, Reference Committee (2019); Appointee, State Board Advisory Panel to the USMLE (2018-Present); DC Voting Delegate (2018-2020); Appointee, National Awards Committee (2016-2018), DC Representative, National Telehealth Workgroup Meeting (2012) Society of Teachers of Family Medicine: Member, National Underrepresented Minority Faculty Development and Retention Task Force (2020-Present); Appointee, National Academic Family Medicine Advocacy Committee (2019-Present); Appointee, Starfield Summit Advisory Committee (2016-2017); General Member (2015-Present) District of Columbia Board of Medicine: Chair of the Board (2017-Present); Voting Physician Member (2013-Present) DC Health Scientific Advisory Committee DC Health Scientific Advisory Committee for the Development and Implementation of a Safe, Effective, and Equitable COVID-19 Vaccine Distribution Program in the District of Columbia (2020-Present) Transitions to Residency Educators: National Grand Rounds Director (2020-Present); Conference Planning Committee (2020) Association of American Medical Colleges: Member, Group on Educational Affairs (2019-Present); Reviewer, 2020 Annual Meeting Session Submissions (2020); Invited Presenter, Transitions to Residency Course Best Practices Webinar (2020) Centers for Medicare and Medicaid Services: National EPSDT Improvement Workgroup (2010-2012) Family Medicine Education Consortium: Trustee, Regional Board of Trustees (2019-Present); 2020 Regional Conference Co-Chair American Academy of Family Physicians: Advocate and Attendee, National Family Medicine Advocacy Summit (2015-Present) DC Academy of Family Physicians: Various Board Positions (2004-Present) Capital City Area Health Education Center: Board Member, Board of Directors (2008-2010)

SELECT HONORS AND AWARDS George Washington University School of Medicine and Health Sciences Academy of Education Scholars (2020) National Advocate Award, Society of Teachers of Family Medicine (2019) Top Doctor, Washingtonian Magazine (2016-2020) Emerging Leaders Fellowship, Society for Teachers of Family Medicine (2017-2018) Quality Mentoring Fellowship, Society for Teachers of Family Medicine (2015-2017) Early Achievement Award, Brown University Alpert Medical School (2015) National Health Service Corps: Scholarship (1997) Loan Repayment Award (2006-2009) St. Angela Alumnae Excellence Award, The Ursuline School (2010) Spirit of Unity Award, Unity Health, Inc. (2009) Bristol Myer Squibb Graduate Medical Education Award, American Academy of Family Physicians (2002) Ralph Ellison Award of Excellence, National Medical Fellowships (2000) Janice M. Glasgow Award, American Medical Women’s Association (2000)

PUBLICATIONS 1. Anderson A, Haywood Y, Henry G, Lee J, Ranniger C. Passing the baton: the role of targeted transition programs in medical education at an urban medical school. In Gotian R, Kang Y, Safdieh J, eds. Handbook of Research on the Efficacy of Training Programs and Systems in Medical Education. Hershey, PA: IGI Global; 2020:197-220. 2. Teaching About Racism in the Context of Persistent Health and Healthcare Disparities: How Educators Can Enlighten Themselves and Their Learners. Collaborative Publication. May 2016 Society of Teachers of Family Medicine (STFM) FMDRL at http://resourcelibrary.stfm

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3. Anderson A, Washington J, Brown-Speights J. Am I My Sister’s Mentor? Why Mentoring Underrepresented Minority Medical and Public Health Faculty can Improve the Health of Black Women. Albany, NY: SUNY Press (Forthcoming).

GRAND ROUNDS PRESENTATIONS 1. Anderson A. It could never happen to me: avoiding license restriction and loss of board certification. Grand Rounds, Medstar Georgetown Department of Family Medicine, September 2020. 2. Anderson A. It could never happen to me: avoiding license restriction and loss of board certification. Grand Rounds, George Washington Department of Internal Medicine, April 2019. SELECT NATIONAL PRESENTATIONS 1. Invited Presenter. iCollaborative, clinical teaching and learning experiences without physical patient content. Association of American Medical Colleges, May 2020. 2. Gravel J, Anderson A, Douglass A. What do I do now? Current and former residents in regulatory difficulty. AAFP Program Directors Workshop, April 2019, 2020. 3. Anderson A, Gravel J, Lin K. Advocacy 101. Family Medicine Education Consortium Annual Meeting, October 2019. 4. Anderson A, O’Donovan E, Shiraki J. Are you thinking what I’m thinking? A new approach to the dreaded CCC. Society of Teachers of Family Medicine Annual Conference, May 2019. 5. Bullock K, Anderson A, Roberson K. Spark connection: a quick way for underrepresented in medicine faculty to expand their professional support network and contacts. Society of Teachers of Family Medicine Annual Conference, May 2019. 6. Anderson A. Expeditionary learning in leadership and advocacy. Society of Teachers of Family Medicine Annual Conference, May 2019. 7. Anderson A, Taskier M, Yang L, Davis C, Howard L. Going in blind: How do family medicine medical students make meaning of their experiences at target medical schools? Society of Teachers of Family Medicine Annual Medical Student Education Conference, Oral Session Presentation, May 2019. 8. Anderson A, O’Donovan E. Growing family medicine advocates through expeditionary learning. American Association of Osteopathic Medicine, May 2019. 9. Gravel J, Anderson A. It could never happen to me: avoiding license restriction and loss of board certification. Family Medicine Education Consortium Regional Conference, Oral Presentation, November 2018. 10. Invited Co-Presenter. Physician advocacy in the community. Latin American Medical Student Association National Health Policy Summit, 2018. 11. Anderson A. Expeditionary learning in leadership and advocacy one year in: can we teach leadership? Society of Teachers of Family Medicine 2017 Annual Conference, Oral Presentation, May 2017. 12. Anderson A, O’Donovan E. Your license is a privilege, not a right: teaching medical regulation and professional medical ethics. Society of Teachers of Family Medicine 2017 Annual Conference, Oral Presentation, May 2017. 13. Anderson A, Lawrence D, Egan K. Did you get my text? Advising in the millennial generation. Society of Teachers of Family Medicine 2017 Annual Conference, Oral Presentation, May 2017. 14. Anderson A, Strothers H. Teaching self-directed learning: finding the right match for our learners. Society of Teachers of Family Medicine 2017 Annual Conference, Oral Presentation, May 2017. 15. Huang J, Anderson A. Achieving the community-oriented primary care competencies: an innovative multifaceted curriculum. Society of Teachers of Family Medicine Annual Conference, Poster Presentation, May 2017. 16. Figueroa E, Bullock K, Roberson K, Anderson A. Building resilience—tools for underrepresented minority faculty to thrive. Society of Teachers of Family Medicine 2017 Annual Conference, Oral Presentation, May 2017.

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17. Invited Panelist. The health determinants of early school success. Leveraging Medicaid for Impact, national workshop co-sponsored by the Campaign for Grade-Level Reading, November 2016 18. O’Donovan E, Anderson A, Howell A. MD on the DL: how can MD’s teach DO residents? American Osteopathic Association National Conference, Oral Presentation, April 2015. 19. Invited Panelist. Healthcare innovation and teaching at the hospital, in the home, and across the globe. American Medical Student Association National Conference, February 2015 20. Invited Panelist. Road to Essence music festival: Colgate Mid-Atlantic panel on total health. Essence Magazine, May 2014 21. Invited Panelist. The Affordable Care Act from a policy and advocacy perspective. 2014 National Meeting of the National Association of Black Journalists, April 2014 22. Anderson A, Westpheling K. Public health and you: public health at its finest. American Medical Student Association National Conference, 2013. 23. Invited Panelist. Children’s Defense Fund Mother’s Day watch. Partnered with Dr. Marion Wright Edelman and noted celebrities to lobby Congress to keep children’s healthcare issues, specifically increased Medicaid coverage ceilings, in the health insurance reform debate.

SELECT GOVERNMENT TESTIMONY

Federal Government and Government Agency Testimony 1. Invited Witness. US Senate Committee on Housing, Education, Law, and Pensions, 116th Congress, 2nd Session. Hearing on access to care: health centers and providers in underserved communities, January 29, 2019 [Statement representing the Association of Clinicians for the Underserved]. https://www.help.senate.gov/hearings/access-to-care-health-centers-and-providers- in-underserved-communities/https://www.help.senate.gov/imo/media/doc/Anderson6.pdf/ http://clinicians.org/senate-help-committee-hearing/ 2. Invited Panelist. Physician community conversation on medication-assisted treatment for the opioid epidemic, Department of Health and Human Services. Invited to represent the Federation of State Medical Boards in a national conversation with HHS Surgeon General, HHS Assistant Secretary, Office of National Drug Control Policy Deputy Director, and DEA Assistant Administrator, October 2018. 3. Invited Panelist. Health and Human Services Cabinet Secretary Tom Price community health center visit, Unity Health Care, October 2017. 4. Invited Panelist. Testimony to continue funding for National Health Service Corps. Congressional briefing panel sponsored by the American Academy of Family Physicians and the Association for Clinicians for the Underserved, 115th US Congress, August 2017. https://www.aafp.org/news/government-medicine/20170804nhsc.html/ 5. Invited Panelist. Impact of early education outside of the classroom. Briefing for the House Congressional Pre-K Caucus, 114th Congress, Labor/HHS/Education Committee, September 2016. https://prekcaucus-castro.house.gov/media-center/photo-galleries/panel-discussion-on- capitol-hill/ 6. Invited Panelist. Community diary: how Medicaid and CHIP are making lives better every day. Annual meeting of the Center for Medicaid and CHIP Services, February 2014. 7. Invited Panelist. Health and Human Services Cabinet Secretary Kathleen Sebelius community health center visit, Upper Cardozo Health Center, October 2012. 8. Invited Panelist. White House physician conversation on care coordination, Centers for Medicare and Medicaid Services, June 2012. 9. Invited Panelist. The impact of federal and state interventions in the underserved and communities of color: successes, challenges, and next steps. Congressional briefings, Association of Clinicians for the Underserved, September 2010. 10. Invited Panelist. Building a healthier community: one community at a time. Video conversation with HHS Secretary Kathleen Sebelius, HRSA Administrator Mary Wakefield, and two community health leaders, August 2010.

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11. Invited Panelist. Providing a Coordinated System of Care, Congressional staff briefings: Partnership for primary care workforce. 111th Congress, January 2009. 12. Selected Speaker. First Lady Michelle Obama community health center visit. One of three physicians who participated in a 10-person roundtable discussion with First Lady Michelle Obama and HRSA director. Presented on early childhood literacy, advocacy, and strategies for primary care workforce recruitment issues, June 2009. https://thecaucus.blogs.nytimes.com/2009/ 06/29/first-lady-tours-a-health-clinic/ https://obamawhitehouse.archives.gov/the-press-office/first-lady-michelle-obama-announces- release-851-million-recovery-act-upgrade-expand/ https://obamawhitehouse.archives.gov/realitycheck/the-press-office/remarks-first-lady-unity- health-care-center/

State Government Testimony: Invited Witness 1. DC City Council, Hearing on the Continuing Nutrition Education Amendment Act of 2019, November 2019. https://dccouncil.us/event/health-public-hearing-15/ 2. DC City Council, Hearing on the Performance Oversight of the Department of Health Care Finance, January 2019. 3. DC City Council, Hearing on the Performance of the Department of Health Care Finance, April 2018. 4. DC City Council, Hearing on Books from Birth Establishment Amendment Act of 2015 and Early Education Literacy, March 2015. https://lims.dccouncil.us/downloads/LIMS/33257/Hearing_Record/B21-0034- HearingRecord1.pdf/

SELECT MEDIA INTERVIEWS AND INVITED BLOG POSTS 1. A needed role model and advocate for family medicine. American Academy of Family Physicians, May 2020. https://www.aafp.org/news/family-doc-focus/20200511fdf-anderson.html 2. Fierce women and new stars. Society of Teachers of Family Medicine Blog, December 2019. https://blog.stfm.org/2019/12/18/fierce-women-and-new-stars/ 3. Guest Blog: Creating a More Equitable Health System for All DC Residents. DC Fiscal Policy Institute, May 17, 2018. https://www.dcfpi.org/all/guest-blog-creating-a-more-equitable-health- system-for-all-dc-residents/ 4. For doctors in training, a dose of health policy helps the medicine go down. All Things Considered, National Public Radio, June 2016. https://www.npr.org/sections/health- shots/2016/06/09/481207153/for-doctors-in-training-a-dose-of-health-policy-helps-the-medicine- go-down/ 5. The Affordable Care Act and federally qualified health centers. Washington Journal, C-SPAN, March 2014. https://www.c-span.org/video/?318342-4/washington-journal-federally-qualified- health-centers-medical-services/ 6. Group prenatal care: finding strength in numbers. All Things Considered, National Public Radio, June 2011. https://www.npr.org/2011/07/13/137746002/group-prenatal-care-finding-strength-in- numbers/ 7. At-risk federal funds cover far more than the pill. Morning Edition, National Public Radio, April 2011. https://www.npr.org/2011/04/01/135018313/at-risk-federal-funds-cover-far-more-than-the- pill/

SELECT PROFESSIONAL COMMUNITY ACTIVITIES Latin American Montessori Bilingual Public Charter School: Appointed Member, School Performance Committee (2018-2019) DC Language Immersion Project: Volunteer Physician and Parent Advocate (2016-2017) Reach Out and Read, Inc.: Appointed Committee Member, National Leyendo Juntos Advisory (2009- 2013); National Business Model Working Group (2009-2010); Medical Director, Metro DC (2008-2012) Network to End Domestic Violence and Sexual Assault: (1996-2000)

11 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors MOHAMMED A. ARSIWALA, MD (incumbent)

Candidate for Board of Directors

Mohammed A. Arsiwala, MD Michigan Medical

1 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors MOHAMMED A. ARSIWALA, MD (incumbent)

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STATE OF MICHIGAN GRETCHEN WHITMER DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS ORLENE HAWKS GOVERNOR DIRECTOR LANSING

December 3, 2020

Scott A. Steingard, DO Chair, Nominating Committee Federation of State Medical Boards 400 Fuller Wiser Road Euless, Texas 76039

Dear Dr. Steingard:

Speaking as Chair of the Michigan Board of Medicine it is my honor to nominate Mohammed Arsiwala, MD to a board seat on Federation of State Medical Boards (FSMB).

Dr. Arsiwala has been a licensed physician in the state of Michigan for many years. He currently serves as an officer in the Unites States Navy and the President of the Michigan State Medical Society. From 2017 -2019, Dr. Arsiwala served as the chair of the Michigan Board of Medicine.

As you know, he has been very involved in charitable organizations at home and overseas. He is very generous with his time and takes pride in bringing medical care to places in the world that are less fortunate to help those in need.

Dr. Arsiwala has been on the Board of FSMB, and I proudly nominate him to continue to serve in that position.

Sincerely,

Michael Chafty MD Chair, Michigan Board of Medicine Bureau of Professional Licensing Michigan Department of Licensing and Regulatory Affairs

BUREAU OF PROFESSIONAL LICENSING 611 W. OTTAWA • P.O. BOX 30670 • LANSING, MICHIGAN 48909 www.michigan.gov/bpl • 517-241-0199 LARA is an equal opportunity employer/program

2 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors MOHAMMED A. ARSIWALA, MD (incumbent)

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MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? None ______

If not serving, when did you leave the board? Month: Day: Year: 12 31 2019 How long have you served (did you serve) on your Member Medical Board? ______8 years

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE: ______

Potential Conflict(s) of Interest:

Arsiwala MD, Mohammed A. American Medical Association ‒ Delegate J8 Medicare Contractor Advisory Committee ‒ Michigan Alternate Representative for Internal Medicine

Journal of Nursing Regulation

‒ Editorial Advisory Board Michigan Board of Medicine ‒ Past Chairman Michigan State Medical Society ‒ Past President

3 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors MOHAMMED A. ARSIWALA, MD (incumbent)

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2021 Bullet Points Mohammed A. Arsiwala, MD CANDIDATE FOR: Board of Directors (incumbent)

FSMB SERVICE: Board of Directors 2018-Current; Compensation, Executive & Investment Committees 2020-Current; Audit Committee 2019-2020; Awards Committee 2018-2019; Editorial Committee 2013-2015; Education Committee 2018-2019; Nominating Committee 2015-2017; Planning Committee 2019-2020; Advisory Council on Professionalism in Medical Practice 2019-2020; Workgroup on Physician Wellness & Burnout 2017-2018; Chair, Workgroup on Study Risk & Support Factors Affecting Physician Performance 2019-Current

Michigan Board of Medicine o Member 2012, 2015 o Vice Chairman 2012, 2015, 2016, 2018 o Chairman 2019 o Member, Disciplinary Subcommittee for the State of Michigan

Social Issues o Support educational activities of underserved children to pursue higher education via HELP Foundation in Afghanistan, Africa and India

Mentoring o Over two decades of mentoring high school kids “via” career internship program to encourage them to pursue a career in medicine; teaching medical students and residents in field of medicine, Adjust Professor at Michigan State University, University of Michigan and Wayne State University

Service o Continuous volunteer work in Africa, Afghanistan, India, USA and Haiti by providing health care to the people, served over 100,000 individuals and five years of service; served in United States Navy as a Lieutenant Commander

Entrepreneurship o Built the largest urgent care company in the state of Michigan providing clinical care to nearly 120,000 patients every year in five counties

Social Issues o Support educational activities of underserved children to pursue higher education via HELP Foundation in Afghanistan, Africa and India

4 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors MOHAMMED A. ARSIWALA, MD (incumbent)

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2021 Personal Statement Mohammed A. Arsiwala, MD CANDIDATE FOR: Board of Directors (incumbent)

I am a candidate for the FSMB Board of Directors. For 20 years I have practiced in my community as an urgent care physician.

To me the Doctor/Patient relationship is the most sacred relationship. As a Doctor, I have done my best to better the lives of my patients. Also, as a physician leader I have demonstrated my entrepreneurship by expanding one urgent care network to 9 urgent care centers in five counties in Michigan.

I have volunteered for over 10 years at St. Vincent DePaul Health Center, HUDA clinic taking care of indigent patients and for the last five years have done multiple medical mission trips to Haiti, India, Afghanistan and Africa. I am in the process of building a 100 bed hospital in Afghanistan in the most dangerous war torn area to provide much needed healthcare services to reduce infant/child mortality and perinatal death in women. The hospital will service a remote geographic area of Afghanistan. In Uganda, Africa, I have created a sustainable agricultural solution and empowered over 100 farmers by tilling their farmlands to decrease poverty and increase self-sustenance.

My service to FSMB has always been a service of dedication to the mission, vision and the high value that our FSMB holds in the area of health care regulation and support to State Medical Boards.

Currently I serve on the FSMB Board and Executive Board and chairman of work group on Study Risk and Support Factor Affecting Physician Performance, I have served FSMB on the editorial committee and nominating committee.

I am willing to work hard for the FSMB with dedication and to the best of my ability; serve with honor, integrity and mutual respect for my colleagues.

Thank you for considering me as a candidate for FSMB Board of Directors.

5 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors MOHAMMED A. ARSIWALA, MD (incumbent)

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MOHAMMED A. ARSIWALA, MD LCDR, US NAVY, MC 914 Pond Island Court • Northville, MI 48167 • 734.674.8562 [email protected] . 17197 N. Laurel Park Drive, Suite 107 • Livonia, MI 48152 • 737.338.8300

EDUCATION/TRAINING Wayne State University/Detroit Medical Center, Grace Hospital, Detroit, MI Residency in internal medicine, 1995-1998

US Medical Licensing Exam Step 1, 2, 3; 1994

Deccan College of Medical Sciences, Hyderabad, India Bachelor of Medicine, Bachelor of Surgery

CERTIFICATIONS/LICENSE Diplomat American College of Internal Medicine, 1998 (Recertified 2019) PALS, ACLS and BLS Certified State of Michigan License

EMPLOYMENT HISTORY Michigan Urgent Care Centers (Business Health Solutions), Livonia, MI President and Owner, July 1999-Present

Providence Hospital, Livonia, MI Urgent Care Practitioner, July 1998 – April 1999

PROFESSIONAL ORGANIZATIONS Member, American Medical Association Member, Michigan State Medical Society Member, Wayne State Alumni

Military Service Lieutenant Commander, US Navy – Commissioned Officer – Medical Core Active Reserve, serving with San Diego Seabees, NCR-30 Regimen, In Charge Physicians

BOARD POSITIONS J8 Medicare Contractor Advisory Committee – Alternate Representative appointed 2020 Federation State Medical Board (FSMB) Executive Board 2019 to current Federation State Medical Board (FSMB) Board of Director - elected April 2018 thru May 2021 Past President, Michigan State Medical Society Past Chairman, State of Michigan Board of Medicine, appointed 1/2012, reappointed 12/2015, elected 1/2018 Board Member, State of Michigan Drug Utilization Board, currently serving Current Fellow and Board Member of Federation of State Medical Board Chairman, FSMB Work Group to Study Risk and Support Factors Affecting Physicians Performance FSMB Work Group on Physician Wellness and Burnout, Committee Member Delegate, AMA Past Board Member, Michigan Area Health Education Center (AHEC)

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Arsiwala, MD 2

Past Board Member, Asian and Pacific Islander American Vote – Michigan (APIA Vote-MI) Board Advisor, Vista Maria Board Member, Infant Mortality Project Board Member, Journal of Nursing Regulation, NCSBN Adjunct Assistant Professor, Michigan University College of Nursing Preceptor, Wayne State University School of Medicine, School of Nursing

Past Committee Member, Nominating Committee, Federation of State Medical Board Past Committee Member, Editorial Committee, Federation of State Medical Board Past Board of Directors, Michigan State Medical Society (MSMS), Lansing, Michigan Past Board Member, Controlled Substance Advisory Commission, appointed by Governor Snyder 3/2012, and reappointed 12/2015 Past Chair of Legislative & Regulatory Committee, Board of MSMS Past President, Wayne County Medical Society Past President, Urgent Care Association of Michigan (UCAOM) Past Board Member, Michigan Associations of Physicians of Indian Origin (FOMAPI) Past Board Member, Mission Health Advisory Counsel Past Chair MDPAC (MSMS), Lansing, MI Past Chair Young Physician, Wayne County Medical Society (WCMS), Detroit, Michigan Past Board Member for capital campaign committee St. John Providence Park, Novi, Michigan Past Board Member, YMCA & Strong Kids Foundation Past Previous Chair Young Physician, MSMS, Lansing, Michigan

AWARDS Mridha International Physician Volunteer Award, by MSMS Foundation, October 2017 Humanitarian Award, by Uganda Community of Michigan, October 2016 Outstanding Child Advocate, Vista Maria, June 2014 Wings over Uganda Award, Malayka International, November 2014 2012 Parent Pick Award, Metro Parent’s Parent Pick, 2012 Shining Star Award, MI-AHEC, April, 2012 Best of Safety Net Award, Detroit Wayne County Health Authority, December, 2011

PRESENTATIONS Arsiwala M., Lesser, B., Weyhing, B., Scharer, K: Congenital Partial Absence of Pericardium Presenting as Presumptive Left Lower Lobe Atelectasis. Oral presentation at American College of Physicians Meeting, 1996.

Arsiwala M., Goswami, K., Desai, C.: Thoracic Traumatic Myelopathy without Spinal Fracture. Poster presentation at American College of Physicians Meeting 1996.

Arsiwala, M., Lesser, B., Weyhing, B.: Atypical Presentation of Sarcoid “What Else Is New”. Poster presentation at American College of Physicians Meeting, 1996.

Arsiwala, M., Polidori, G.; Siddique, M.: A Rare Case Presentation of Pancreatic Divisum and Choledochal Cyst. American College of Physicians Meeting, Michigan Chapter, 1997.

Arsiwala, M., Charochak, A.: Iga Nephropathy, Rare Presentation in Elderly African American Male. American College of Physicians Meeting, Michigan Chapter, 1997.

Arsiwala, M., Siddique, M.: Cervical Actinomycosis, Case Presentation and Review of Literature. American College of Physicians Meeting, Michigan Chapter, 1997.

COMMUNITY SERVICE

7 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors MOHAMMED A. ARSIWALA, MD (incumbent)

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Arsiwala, MD 3

Founded HELP FOUNDATION IN 2014  Currently building a 100 bed hospital in war torn area of Afghanistan. Provide personally medical camps in remote parts of Afghanistan once a year.  Build a dental clinic in Haiti 2014.  Currently provide medical and surgical care camps in Tororo region of Uganda Africa there by treating 4500 individuals in medical camps and 750 individuals in surgical camps every year since 2014.  Started a farmer's cooperative in Uganda Africa providing them much needed infrastructure to farm effectively and eliminate poverty, thereby creating micro-economics to improve community outcomes in childhood education, health and Economic situation of individual farmers.  Build a grain mill in December of 2014, to create certified organic grain facility in Uganda Africa.  Educate 16,000 kids in rural western India by creating a sustainable program by using mobile laptop based educational software material and hiring 11 teachers that visit each individual villages and teach children language arts, math, science and technical skills.  Teach computer based learning to teach organic farming to farmers in western part of India to improve crops yield and reduce diseases in crops.  Started medical camps in India in 2014 in Goa, India by working with rotary club.  Dr. Arsiwala/HELP Foundation, annual educational grants for high school kids headed to college, given to students of low income in Metro Detroit area -10 scholarships every year starting 2016

Career Intern Program, Livonia Public Schools, Livonia, MI Since 2000, served as a mentor to college-bound seniors pursuing careers in the field of medicine.

Volunteer at HUDA Clinic in Detroit, treating uninsured and under deserved individuals.

Past Physicians Who Care Project, St. Vincent de Paul, Detroit, MI Voluntary provide free health care services to uninsured adults.

Past Pipeline Outreach Enrichment Program K-12 Engage students, in underrepresented areas, and inspire them to pursue careers in medicine.

Past Special Personal Assistance Program, Samaritan Center, Detroit, MI Provide program sponsorship and supply hygiene kits, towels, and clothing to victims of homelessness.

Past Islamic Medical Association of North America (IMANA) Yearly mission trip to Haiti to provide medical aid and assistance to those in need.

EDUCATOR Adjunct Assistant Professor Michigan State University College of Nursing Preceptor, Wayne State University College of Nursing, School of Medicine Providence Hospital, St John Health System; Resident Training University of Detroit Mercy, Detroit, MI; Master’s Program; Neurology Training Business Health Solutions/Michigan Urgent Care, Livonia, MI; Peer Review Actively teach, rotating residents, student Nurse Practitioners, Physician Assistants & High School students in the area of medicine. Rehabilitating orphanages & educational centers in Uganda, Africa and India to improve the educational outcomes with better infrastructures and computer based learning programs.

Clinical experience I have worked clinically taking care of infants to adults in the area of urgent care medicine for the last 22 years since 1998. I can treat all illness and also very proficient in all minor surgical procedures, including complex laceration repairs. I have international health care experience in Afghanistan, Africa, Haiti and India, during my multiple medical mission trips around the world. I can provide acute, sub-acute and chronic care management. I can provide pediatric and women’s health.

8 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors WILLIAM "WILL" K. HOSER, MS, PA-C

Candidate for Board of Directors

William “Will” K. Hoser, MS, PA-C Vermont Medical

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______

State of Vermont [phone] 802-657-4220 Agency of Human Services Department of Health [fax] 802-657-4227 Vermont Board of Medical Practice 108 Cherry St-PO Box 70 Burlington, VT 05402-0070 HealthVermont.gov December 31, 2020

Scott A.Steingard, DO Chair, FSMB Nominating Committee Federation of State Medical Boards 400 Fuller Wiser Road Euless, TX 76039

Re: Nomination of William K. Hoser, MS, PA-C for FSMB Board of Directors

Dear Dr. Steingard:

On behalf of the Vermont Board of Medical Practice, it is my great pleasure to nominate William K. Hoser, MS, PA-C to be a candidate for election to the Board of Directors of the Federation of State Medical Boards. Will Hoser has long demonstrated strong commitment to the Vermont Board of Medical Practice, the Federation of State Medical Boards, and their shared goal of excellent regulation of medical professionals to promote the delivery of quality medical care and safety for patients.

Will displays each of the core competencies, as shown over the years through his participation with both our Board and the FSMB.

He has a clear understanding of and has worked hard to support the vision, mission, and goals of the FSMB. His hard work and knowledge of the Federation’s tenets are seen in his rich history of involvement with FSMB programs. Will not only attended the annual meetings from 2015 through 2019, but also served as the PA Forum Co- Chair each year from 2016 through 2019, and was on Reference Committees in 2016, 2017, and 2019. His participation with FSMB was not limited to the annual meetings, but continued throughout the year with: the PDMP Workgroup 2018; BEST Committee 2019-2020; Special Committee for Strategic Planning 2020; and, Education Committee beginning in 2020. In addition to FSMB service, Will has served continuously on the Vermont Board since 2008, including service as Chair from 2015 through 2020.

Will has a highly positive outlook on the role and function of medical boards. His long service to our Board and participation with FSMB say it all. Moreover, Will’s enthusiastic belief in the ability of regulatory boards to simultaneously protect patients and improve the medical profession for all its members is evident to all who

2 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors WILLIAM "WILL" K. HOSER, MS, PA-C

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Nomination of William K. Hoser December 31, 2020 Page 2

get to see him in any of the many leadership roles he has held. Will brings not only his own enthusiasm, but the ability to make others excited about the field as well.

Mr. Hoser offers a broad, national perspective on medical practice. Although he has been in Vermont for many years, he has previously practiced in New York and New Jersey, and has long been active in the American Academy of Physician Assistants and the Physician Assistant Academy of Vermont. Whenever there is a discussion about emerging issues, Will is likely to be the one who has done the research to understand how other jurisdictions have responded to new challenges.

Will takes on his Board responsibilities with great professionalism. I do not understand how he manages to meet all the many demands on his time, but invariably he does. When I needed him to be at the Statehouse to testify on short notice, he would be there. When Board members were needed for hearings, or liaison committees, or ad hoc study committees, Will raised his hand. When there was a need for people to step up for FSMB Committees and Workgroups, he has volunteered. Especially now that he has stepped down as Chair of our Board because of our term limits, he will be able to fulfill the responsibility of being on the FSMB Board of Directors.

Will Hoser is a true professional with great personal integrity. Simply put, Will does the right thing. His professionalism and integrity are part of what makes Will so effective a leader – people want to follow him in doing the right thing. The other key ingredient is that he knows how to have fun. Hard work is hard work, but Will is charismatic and genuinely cares about people. He makes others feel appreciated for their contributions. He makes hard work seem less so, and he understands the human need to relax and restore oneself in order to continue to succeed. All of that makes for a leader who works very effectively with others.

Mr. Hoser has agreed to have his name submitted for potential nomination, and he has affirmed to me that he is aware of the time commitment should he be elected to the Board of Directors. The requested contact information follows:

Mailing address: 1623 Trebo Road, Chester, VT 05143 Daytime telephone: (802) 384-6176 Email address: [email protected]

Please do not hesitate to contact me if there is anything else you need with regard to this nomination.

Sincerely,

David K. Herlihy Executive Director

3 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors WILLIAM "WILL" K. HOSER, MS, PA-C

DocuSign Envelope ID: 1B8513DD-F140-4CFB-A2B2-CA6755D79952 CANDIDATE’S SIGNATORY PAGE

MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? Vermont Medical ______

If not serving, when did you leave the board? Month: Day: Year:

How long have you served (did you serve) on your Member Medical Board? ______12

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE: ______

Potential Conflict(s) of Interest:

None

4 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors WILLIAM "WILL" K. HOSER, MS, PA-C

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2021 Bullet Points William “Will” K. Hoser, MS, PA-C CANDIDATE FOR: Board of Directors

FSMB Service: Fellow 2011-present; Voting Delegate 2015-2019; Reference Committees 2016, 2017, 2019; Co-Chair PA Forum 2016-2019; Uniform Application for PAs 2018; Prescription Drug Monitoring Program Workgroup 2018; BEST Workgroup 2019-2020; Special Committee for Strategic Planning 2019-2020; Education Committee 2020-present; License Portability for PAs 2019-2020

Vermont Board of Medical Practice

o PA Representative 2008-present o Vice Chair 2011-2015 o Chair 2015-2019 o Rules & Regulations Committee 2016 o VT Practitioner Health Program Liaison Committee 2015-2019 o VT Opioid Taskforce 2016

American Academy of Physician Assistant

o Fellow Member 1993-present o House of Delegates Vermont Representative 1999-2000 o Capital Constituent Organizational Workshop 1998 o Leadership & Advocacy Summit 2018 o Governance Commission 2018-present

Physician Assistant Academy of Vermont

o Fellow Member 1996-present o President 1998-2001 o Legislative Representative 2002-2008 o CME Committee 2011-present o Director-at-Large 2019-present

Society of Emergency Physician Assistants

o Fellow Member 2002-present o Legislative Regulatory Committee 2006-2008 o Emergency Department Directors Academy 2015

Springfield Medical Care Systems

o Medical Staff Member 2014-present o Medical Staff Secretary/Treasurer 2016-2019 o Pharmacy & Therapeutics Committee 2015-2019 o COVID Workgroup

5 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors WILLIAM "WILL" K. HOSER, MS, PA-C

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2021 Personal Statement William “Will” K. Hoser, MS, PA-C CANDIDATE FOR: Board of Directors

I am enthusiastically seeking nomination to the Board of Directors of the Federation of State Medical Boards (FSMB). It is my strong desire to continue my service to the FSMB in this capacity and hope to provide some valuable diversity as a Physician Assistant.

I have been practicing Emergency Medicine and recently also Urgent Care Medicine as a PA for 25 years. Having trained in New Jersey during the period that PAs had not yet become a legalized profession in that jurisdiction I was exposed as a student to the legislative and regulatory importance of licensed professionals. Although I have practiced most of my career licensed in Vermont, I also currently am licensed and practicing in New Hampshire and previously practiced in New Jersey and New York.

My oﬃcial involvement in medical regulation began in 2008 when I was appointed to the Vermont Board Of Medical Practice as the PA representative. I was privileged to serve as Vice Chair and then Chair from 2015 through 2019. This aﬀorded me the opportunity to attend the FSMB annual meeting in 2015 as the voting delegate and participate in the House of Delegates for five years.

Service in the FSMB has been one of the high points in my professional career and given me the opportunity to broaden my knowledge of patient safety, public protection and support of quality healthcare. I have enjoyed Co-Chairing the PA Forum at the annual meetings from 2016 through 2019 and have been pleased with the continued increase in attendance and interest in those forums. I have served on three reference committees and presented before the House of Delegates. I have served as a member of the Prescription Drug Monitoring Program Work Group, Special Committee for Strategic Planning, supported the Uniform Application for PAs and am currently serving on the BEST Committee and Education Committee as well as involved with license portability for PAs.

As a member of the Physician Assistant Academy of Vermont since 1996 I have served as President from 1998 through 2000, attended our national conference as a delegate in the HOD and also been involved in legislative updates modernizing PA practice. Currently I am serving as a Director at Large and have been on the CME Committee since 2011.

Additionally, I have been a fellow in the American Academy of Physician Assistants since 1993 and have been serving on the Governance Commission since 2018. I have participated in the Capital Constituent Organization Workshop in 1998 and was a panelist speaker at the Leadership and Advocacy Summit in 2018 both of which involved “hill visits” in Washington DC.

With the ever-changing landscape of healthcare, now at crisis level caused by the pandemic, medical regulation, public safety and best practices for supporting quality healthcare are of paramount importance. I pledge to passionately support the mission, vision and strategic goals of the FSMB and graciously solicit your support for election to the Board of Directors.

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William Hoser

1623 Trebo Road • Chester, Vermont • 05143

Professional Background

University trained Physician Assistant with a background in pre-hospital emergency medical service. Currently practicing Emergency Medicine and WalkIn Care with a commitment to high quality, patient centered medical care and serving the public good through medical oversight and regulation.

Education and Training 1999 University of Medicine and Dentistry of New Jersey Piscataway, NJ Master of Science, Physician Assistant Studies 1993 Rutgers, The State University of New Jersey New Brunswick, NJ Bachelor of Science, Health Related Professions 1986 Daytona State College Daytona Beach, FL Associate of Science, Emergency Medicine Services Graduated with honors 1982 The Ohio State University Columbus, OH Bachelor of Science, Vocational Education/Animal Science

Professional Experience 1995 - Present Emergency Services of New England Chester, VT

Staff EM PA in the Emergency Department at Springield Hospital, Springield, Vermont 1995-2019, and Mount Ascutney Hospital, Windsor, Vermont 2000-present. Springield Medical Care Systems Walk In Clinic, Springield, Vermont. Staffed the Mount Snow Ski Clinic from 2006-2009. Administratively supervise and mentor 21 full time and per diem PAs.

1994 - 1995 Delaware Valley Hospital Walton, NY

Staff EM PA in the Emergency Department of a community hospital.

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1993 – 1994 W. Keith Stafford, MD-Family Practice and Obstetrics Flemington, NJ Provided primary care and obstetrical services in a family practice setting. 1986 – 1993 Hunterdon Medical Center Flemington, NJ Provided pre-hospital advanced life support and emergency services in a hospital based countywide coverage area in central New Jersey as a paramedic. 1989 -1993 Helene Fuld Medical Center Trenton, NJ Provided pre-hospital advanced life support and emergency services in a hospital based countywide coverage area in central New Jersey as a paramedic.

1985 - 1986 EVAC Ambulance Service Daytona Beach, FL Provided pre-hospital advanced life support, emergency services and inter-facility medical transfers with a private ambulance service in northeastern Florida.

Certiications • NCCPA continuously since 1993 • ACLS provider • BLS provider and instructor • PALS provider • ATLS provider • Advanced Airway training • Ultrasound training

Professional Activities/Organizations

Federation of State Medical Boards • PA Forum Co-Chair 2016-2019

• Reference Committee A 2016, 2017

• Reference Committee B 2019

• Vermont Delegate 2015 - 2019

• Fellow Member since 2011

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• Prescription Drug Monitoring Program Workgroup 2018 • Board Education Service and Training (BEST) Workgroup 2019-2020 • Special Committee on Strategic Planing (FSMB Strategic Plan) 2019-2020. • Education Committee FY 2021 2020 Vermont Board of Medical Practice • Chair 2015-2019 • Rules and Regulation committee 2016 • Vice Chair 2011-2015 • PA representative 2008-Present • Vermont Practitioner Health Program Liaison Committee 2016-2019 Vermont State Opioid Task Force 2016

Physician Assistant Academy of Vermont • CME Conference Committee 2011-Present • Legislative Update Committee 2010-2011 • BOMP Representative 2008-Present • Legislative Representative 2002-2008 • President 1998-2001 • Fellow Member since 1996 Society of Emergency Physician Assistants • Emergency Department Directors Academy (Phase One) 2015 • State Legislative/Regulatory Committee 2006-2008

• Fellow Member since 2002 American Academy of Physician Assistants

• HOD Representative (Vermont) 1999 and 2000

• Capital Constituent Organizational Workshop 1998

• Leadership and Advocacy Summit (Panelist Speaker) 2018 • Fellow Member since 1993

Springield Medical Care Systems

9 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors WILLIAM "WILL" K. HOSER, MS, PA-C

DocuSign Envelope ID: 1B8513DD-F140-4CFB-A2B2-CA6755D79952

• Medical Staff Secretary/Treasurer 2016-2019 • Pharmacy and Therapeutics Committee 2015-2019 • COVID Work Group 3/2020 • Medical Staff Member since 2014 Mount Ascutney Hospital • Medical Staff Member 2014-Present Emergency Services of New England • Board of Directors Representative, Mount Ascutney Hospital 2016-Present • Mentoring Committee Chair 2013-2015 • Recruitment Manager 2005-Present • Co-owner & Board of Directors 2003-Present

Medical Volunteer Experience Medical Mission to the Dominican Republic June 2015 Vermont 100 Endurance Race 2004-2006

Lecturer Franklin Pierce University, Lebanon, New Hampshire PA regulation and hiring 2015, 2016 & 2018

10 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors DENISE PINES, MBA

Candidate for Board of Directors

Denise Pines, MBA California Medical

1 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors DENISE PINES, MBA

DocuSign Envelope ID: 116E9FB3-22B2-4C97-868D-EC861CFC8D8F

Executive Office 2005 Evergreen Street, Suite 1200 MEDICAL BOARD Sacramento, CA 95815-5401 Phone: (916) 263-2382 OF CALIFORNIA Fax: (916) 263-2944 Protecting consumers by advancing high quality, safe medical care. www.mbc.ca.gov

Gavin Newsom, Governor, State of California | Business, Consumer Services and Housing Agency | Department of Consumer Affairs

January 4, 2021

Scott A. Steingard, Chair FSMB Nominating Committee

Re: Board of Directors Nomination-Denise Pines

Dear Scott,

It is my honor to nominate Denise Pines for the FSMB Board of Directors. Ms. Pines has served at President of the Medical Board of California for three terms.

Ms. Pines possess the leadership and the medical regulatory knowledge that would make her successful in a national Board of Director’s role with FSMB. She is highly regarded by her Board member peers, appreciated by Medical Board staff and respected by the public which demonstrates her ability to work effectively with others. As a leader, she was instrumental in forming the current vision for the board that drives our current strategic plan and she will bring this type of fortitude to FSMB.

Denise Pines is aware and in agreement to this nomination and looks forward to extending her time and commitment of service if elected to FSMB Board of Directors.

Contact information for Denise Pines 4074 Mantova Drive, Los Angeles, CA 90008; Tel. 323-290-1182; [email protected]

Sincerely,

William Prasifka, Executive Director Medical Board of California

2 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors DENISE PINES, MBA

DocuSign Envelope ID: 116E9FB3-22B2-4C97-868D-EC861CFC8D8F CANDIDATE’S SIGNATORY PAGE

MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? California ______

If not serving, when did you leave the board? Month: Day: Year: 12 1 2020 How long have you served (did you serve) on your Member Medical Board? ______8 years and 6m

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE: ______

Potential Conflict(s) of Interest:

I have not conflict of interest.

3 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors DENISE PINES, MBA

DocuSign Envelope ID: 116E9FB3-22B2-4C97-868D-EC861CFC8D8F

2021 Bullet Points Denise Pines, MBA CANDIDATE FOR: Board of Directors

FSMB Service: Education Committee 2020; Chair, Reference Committee 2020; Workgroup on Emergency Preparedness & Response 2020-present; Annual Meeting 2015, 2019 (Voting Delegate), 2020 (Voting Delegate)

Medical Board of California

o President 2018-2020; Vice President 2016-2018; Secretary 2014-2016; Member 2012-2020 o Shortly after joining the Medical Board of California in 2012, we began dealing with the realities of skyrocketing abuse of prescription-opioid medications & the resulting national health crisis; we finished this last year trying to manage & plan for the impact of COVID-19. In between, the Board & I accomplished a lot & I’d like to take this moment to shine the spotlight on some of our achievements. • In 2013, we were the first board to use teleconferencing to address consumer access during all board meetings; • The Board dramatically improved its website – named the number one most user-friendly site by US Consumer Products; • With the introduction of the Medical Board of California app, the Board became the only state medical board with our own licensing notification app; • The Board launched the Look Up Your Doctor’s License campaign; • The Board introduced Patient Advocate Talks, giving health care consumers the opportunity to voice their concerns; • Each spring, Board members and Board leadership attend Legislative Day at the state capitol to educate legislators about the Board and its processes and mission.

o The Patient’s Right to Know Act of 2018 (SB 1448), which took effect in 2019, was one the most important pieces of legislation during my term. The bill requires physicians placed on probation for certain offenses to notify their patients of their probationary statuses. Along with the other work listed above, this act helped us greatly improve our communications and transparency.

o In 2013, several African American physicians brought to my attention disciplinary disparities. It turned out to be true. I am also quite proud of how we responded when, in 2017, we received the Demographics of Disciplinary Action by the Medical Board of California for the years of 2003 to 2013 – an observational report conducted by the California Research Bureau that revealed alarming racial disparities. The Board immediately responded by convening a Task Force; conducting a review of existing investigation, complaint, and disciplinary processes; engaging relevant policymakers to ensure the Board had adequate funding and/or legislative support for the recommended changes.

o The Board mandated annual implicit bias training for Board staff, members, investigators, attorneys at the Attorney General’s Office, and the judges that preside over our cases.

4 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors DENISE PINES, MBA

DocuSign Envelope ID: 116E9FB3-22B2-4C97-868D-EC861CFC8D8F

2021 Personal Statement Denise Pines, MBA CANDIDATE FOR: Board of Directors

I am a candidate for Board of Directors.

As a longtime community health advocate and media pioneer, I have become a trusted resource for women as they pursue midlife wellness and founded WisePause a pro-aging health and education platform focused on perimenopause and menopausal women co-author of FemAging 2020 a 70+ page report that introduces a new industry sector, FemAging Tech.

In 2012, I joined the Medical Board of California (Board) in 2012, and over the intervening years, I served in many capacities-President (three terms), Vice President and Secretary, Licensing, Enforcement, Education and Editorial committees.

Additionally, I have had the honor to serve the FSMB, which have included the Education Committee, Chaired the Reference Committee during the annual 2020 board meeting and currently the Workgroup on Emergency Preparedness and Response.

I am excited to run for Board of Directors. I have the commitment to service and experience to represent FSMB. My qualifications as a Public Board of Directors nominee are unique, yet effective for me to protect the public on regulations of licensure and discipline.

5 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors DENISE PINES, MBA

DocuSign Envelope ID: 116E9FB3-22B2-4C97-868D-EC861CFC8D8F Denise Pines, MBA Age Enthusiast CEO, AUTHOR, SPEAKER, FILMMAKER, HEALTH ADVOCATE

A longtime community health advocate and media pioneer, Denise Pines is a trusted resource for women as they pursue midlife wellness. She is dedicated to exploring and promoting fresh concepts for combatting weight gain, wrinkles, and confused libido, and she demonstrates that menopause can be the best time of a woman’s life. Pines believes women are poised for breakthroughs during their WisePause life cycles when they are armed with the right information and make wiser, healthier, and more self-affirming choices. She’s the founder of WisePause Lifestyle Summit, a tour for premenopausal women and the FemAging 2020 Tech Index, a report that combines key trends and survey data focusing on diverse 6709 La Tijera Blvd, #912 Los Angeles, CA 90045 women’s preferences for products and services in the tech sector.

Pines is immediate past president of the Medical Board of California 323.290.1182 and serves on the Martin Luther King Community Hospital

Foundation board. She is a member of and serves in leadership

positions in the California University of Science and Medicine [email protected] (CUSM) School of Medicine, the Triple Step Toward the Cure, and @deniselpines the Taiwan Tea Manufacturers Association. Pines is an award-

winning marketer and serial entrepreneur, and she has participated www.wisepausetour.com in 10 startups, including multimedia companies and foundations. For www.teabotanics.com PBS and NPR, she has been the creative consultant for several talk @teabotanics shows including one with a 14-year run and 11 documentaries @hotflashtea including the award-winning film “PUSHOUT”. She’s produced over @wisepause 200 experiential events nationwide and designed the marketing

strategy that put three books on the New York Times best-seller’s list in one year. She is called upon frequently to share her expertise and insight at important conferences.

EDUCATION San Francisco State University (BS) John F. Kenney University (MBA), Stanford University (MBA)

6 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SANDRA L. SCHWEMMER, DO

Candidate for Board of Directors

Sandra L. Schwemmer, DO Florida Osteopathic

1 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SANDRA L. SCHWEMMER, DO DocuSign Envelope ID: 14D2A3AC-7F36-4CF7-9D75-FF54F1A48D8A FLORIDA Board of Osteopathic Medicine Ron DeSantis Governor Scott A. Rivkees, MD State Surgeon General

Chair Joel Rose, D.O. Tampa, Florida December 30, 2020

Members Sandra Schwemmer, D.O. Re: Sandra Schwemmer

Palm Beach Gardens, Dear Dr. Steingard: Florida Vice Chair I am writing this letter of nomination for Sandra Schwemmer, DO on Bridget Bellingar, D.O. behalf of the Florida Board of Osteopathic Medicine in support of Seminole, Florida her candidacy for a position on the Board of Directors of FSMB.

Michelle Mendez, D.O. Jacksonville, Florida Dr. Schwemmer is currently our Vice-Chair and she will become our next Chair on 1/1/21. Dr. Schwemmer has served multiple terms as a Board Anna Hayden, D.O. Member having been appointed by several Governors with Florida Senate Oakland Park, Florida Confirmation each time. She has admirably previously served several Valerie Jackson. terms as Vice-Chair and Chair of the Board. She is a well-respected and Jupiter, Florida qualified Board Certified Emergency Physician, Pre-Hospital Emergency Medical Services and Trauma Agency Director, quality advisor and possesses superlative executive skills. Executive Director Kama Monroe She will be an asset to the Federation.

Should you have any questions please contact me on my cell phone: (813) 391-5872.

Sincerely,

Joel B. Rose, DO Diplomate American Osteopathic Board of Family Physicians Fellow Federation of State Medical Boards Chairman, Florida Board of Osteopathic Medicine

4052 Bald Cypress Way, Bin C06 Tallahassee, Florida 32399-3253 Phone: (850) 245-4161 • Fax: (850) 921-6184 http://www.FLBoardofOsteopathicMedicine.gov

2 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SANDRA L. SCHWEMMER, DO

DocuSign Envelope ID: 14D2A3AC-7F36-4CF7-9D75-FF54F1A48D8A

CANDIDATE’S SIGNATORY PAGE

MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? Florida Board of Osteopathic Medicine

If not serving, when did you leave the board? Month: Day: Year:

How long have you served (did you serve) on your Member Medical Board? 13

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE:

Potential Conflict(s) of Interest: None known.

3 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SANDRA L. SCHWEMMER, DO

DocuSign Envelope ID: 14D2A3AC-7F36-4CF7-9D75-FF54F1A48D8A

2021 Bullet Points Sandra L. Schwemmer, DO CANDIDATE FOR: Board of Directors

FSMB Service: Annual Meeting Voting Delegate 1990, 1991, 2018; Bylaws Committee 2019- 2020, 2020-present

Florida Board of Osteopathic Medicine o Chair 1990, 1991, 2018, 2020, 2021 o Member 2014-present o First Emergency Physician appointed to the FL Board of Osteopathic Medicine

Associated Community Involvement and Experience o Fellow, AAOE: 2015-2020 o Chair, FL Panel and Joint Board Committee Medical Marijuana: 2018- 2020, producing comprehensive annual report to Governor, Senate President, Speaker of the House.

o Distinguished Fellow, American College of Osteopathic Emergency Physicians o First woman certified in Emergency Medicine by ABOEM o Health Care Risk Manager o Initiated Emergency Physician staffing of emergency departments, EMS services and helicopter air medical service (Trauma Star) in the Florida Keys

o Established first pre-hospital programs in FL using telemedicine for field identification and transport of STROKE and STEMI patients

o CMO Prestige Health Choice, FL Medicaid Managed Care plan, part of Amerihealth Caritas Family of Companies

o Board of Governors, Health Professions Division and Foundation Nova Southeastern University

o Medical Director Monroe County Trauma Star Air Medical transport used as statewide example to support CS/HB 747 2019 FL legislation removing egregious patient balance billing from air medical transports: https://www.flsenate.gov/Session/Bill/2020/747/BillText/er/PDF

o Developed FL DOH Region 5 comprehensive Trauma Agency Plan o Finalist for FL Surgeon General, FL Dept of Health

4 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SANDRA L. SCHWEMMER, DO

DocuSign Envelope ID: 14D2A3AC-7F36-4CF7-9D75-FF54F1A48D8A

2021 Personal Statement Sandra L. Schwemmer, DO CANDIDATE FOR: Board of Directors

I write this to express my interest in volunteering for work in appointed or elected positions within FSMB.

I have served Florida Department of Health is various positions for over thirty years and have gained an understanding of the complexities within and around regulating healthcare. My background is diverse having owned and managed an ED physician group staffing urban and rural EDs, guiding and directing pre-hospital EMS agencies in ground and air response and transports, initiating pre-hospital telemedicine programs advancing stroke and STEMI care in rural areas, leading Trauma quality review and activities for Level 1 trauma centers and other trauma providers, as well as providing leadership in identifying healthcare disparities in population health and provider quality of service as Chief Medical Officer of a FL managed care plan that is part of a national company.

This experience allows me a broad understanding of evolving issues from both an administrative and provider perspective which has helped bring provider groups together, evaluate existing resources, avoid unnecessary duplication, and build bridges to facilitate collaboration in order to continue to focus on improve healthcare with appropriate legislation.

I welcome the opportunity to serve FSMB in the areas or capacity you may need in order to further the goals and advancement of the organization.

5 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SANDRA L. SCHWEMMER, DO DocuSign Envelope ID: 14D2A3AC-7F36-4CF7-9D75-FF54F1A48D8A

SANDRA SCHWEMMER, D.O., FACOEP-D, FACEP, FAAOE, HCRM 3577 NW Clubside Circle 160 Key Heights Drive Boca Raton, FL 33496 Tavernier, FL 33070 [email protected]

CERTIFICATIONS: 1986-2020 Board Certified, Emergency Medicine, American Board of Osteopathic Emergency Medicine 1990-2020 Fellow, American College of Osteopathic Emergency Physicians 2016-2020 Distinguished Fellow, American College of Osteopathic Emergency Physicians 1996-2010 Certification of Additional Qualification in EMS, American Board of Osteopathic Emergency Medicine 1999-2009 Certification of Additional Qualification, Occupational/Preventive Medicine American Osteopathic Board of Preventive Medicine 2015-2020 Fellow, American Association of Osteopathic Medical Examiners (AAOE) 1994-2004 Board Certified, Emergency Medicine, American Board of Emergency Medicine 1995-2020 Fellow, American College of Emergency Physicians

LICENSURE: #4022 Florida License, Active since 7/2/1979. Current license expires 3/31/2022 #RIA97 Missouri License, Active since 2/22/1980. Current license expires 1/31/2021 #05-27610 Kansas License, Exempt since 6/13/1998. Current license expires 10/31/2020 #5505535 Healthcare Risk Manager, FL, expired 10/3/2018 (AHCA discontinued licensure)

PROFESSIONAL AFFILIATIONS and AWARDS: 1979-2020 American Osteopathic Association 1979-2020 American College of Osteopathic Emergency Physicians 1997-2002 Member, National Board of Directors ACOEP 1998, 2001-2 Governmental Affairs Committee 1998 Nominating Committee 1998 Strategic Planning Committee 2001, 2003 Practice Management Committee 2003 Meritorious Service Award 2006 Lifetime Membership Award 2017 Willoughby Leadership Award-awarded by the National Council of Women in Emergency Medicine to a woman recognized as a role model and leader reshaping the future of women in Emergency Medicine. 1979-2020 Florida Osteopathic Medical Association 2008-2020 Florida Medical Association 2008-2017 Palm Beach County Medical Assn. 1981-2020 American College of Emergency Physicians (ACEP). Sections: EMS-Prehospital; Trauma and injury prevention; Telemedicine; Air Transport Medicine; Freestanding EDs 1981-2020 Florida Chapter, ACEP 1999-2005 Member, Board of Directors 1982 Member, Public Relations Committee 1986-1988 Member EMS/Trauma Committee 2016-2018 FEMF FL Emergency Medicine Foundation Board of Directors 1982-1985 Physician Sponsor Southeastern College of Osteopathic Medicine, Psi Chapter, Delta Omega Sorority Organized the medical women’s sorority for the Osteopathic Medical School to further collaboration and advancement of women in medicine. 1989-2020 Florida Association of EMS Medical Directors

6 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SANDRA L. SCHWEMMER, DO

1989-2020 National Association of EMS Medical Directors, #20448 1995-2009 Lower Keys Physician Health Alliance (PHO) 1997-2019 American Osteopathic College of Occupational & Preventive Medicine 2003-2020 Air Medical Physician Association 2016-2019 American College of Healthcare Executives South Florida Healthcare Executive Forum

MEDICAL DIRECTORSHIP EXPERIENCE: Hospital Emergency Departments 1983-1984 Fishermen's Hospital, Marathon, Florida 1984-1985 Mariner's Hospital, Tavernier, Florida 1984-1986 DePoo Hospital, Key West, Florida 1986-1987 Wellington Regional Medical Center, West Palm Beach, Florida Emergency Medical Services *In addition to personally serving as Medical Director of the above Emergency Departments, I trained multiple physician Medical Directors over a 15 year period to serve in Hospital Emergency Departments under contract with PES.

EMS Agencies 2001-2020 Monroe County Trauma Star Air Medical Transport, Marathon, Florida Worked with Monroe County Sheriff to initiate rotor wing air transport for critically ill and injured patients in Monroe County allowing emergency access to Ryder Trauma Center and other Miami mainland healthcare facilities. The program initiated telemedicine use in 2010 to assist in the evaluation and treatment of STROKE and STEMI patients. The program received national attention in 2015 as a model for a public program that was financially self- sufficient. 1986-2020 Monroe County Fire Rescue (ALS), Marathon, FL (ALS) 1989-2004 Ocean Reef Club Emergency Medical Services (ALS), Department of Public Safety, Key Largo, Florida Assisted Community Manager David Ritz and the Ocean Reef Board of Directors in starting their own EMS department, beginning with BLS FF/EMT’s and security detail, and later full fire ALS EMT/P service. 1999-2020 Islamorada, Village of Islands, Fire Rescue (ALS) Assisted Fire Chief Wm Wagner in the initial start-up of this municipality’s EMS agency; as Medical Director continue to advance paramedic expanded roles and sponsor innovative programs to advance prehospital community care. 2001-2020 Marathon Fire/Rescue (ALS) Assisted Fire Chief Hans Wagner in the initial start up of this municipal EMS agency; serving as Medical Director. 2012-2019 US Border Patrol, Miami Sector, Dept of Homeland Security Provide volunteer Medical Direction for the BLS trained agents

EMT Programs 2009-2014 Florida Keys Community College- EMT Program EMT training local and regional nurses, and students

Trauma Agency, Florida 2007-2016 Medical Director, Palm Beach County Trauma Agency and Trauma Division Healthcare District Palm Beach County, West Palm Beach, FL Oversaw quality management and day to day operations of Palm Beach County Trauma Agency with responsibility over county trauma system consisting of two Level I trauma centers, over 200 trauma specialty providers contracted with the Healthcare District, 13 acute care hospitals, 11 EMS agencies, 3 freestanding EDs; medical oversight of 2 rotor-wing air ambulances, and the trauma registry

7 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SANDRA L. SCHWEMMER, DO

data; wrote the PBC Trauma Transport Protocols and Trauma Interfacility Transport Criteria; coordinate out of county trauma care needs, and post injury rehabilitation; Chaired the multidisciplinary county Trauma Quality Improvement Committee, represented Trauma Agency at multiple community and governmental agencies for 9 yrs; active participation in FL Trauma and EMS FAC rule making process. Healthcare Insurance Agencies, Health Maintenance Organizations (HMO’s) 2002-2016 CMO/ Medical Director, Healthy Palm Beaches [Personal Health Plan Medicaid HMO, VITA Medicaid FLEX plan], and Coordinated Care program for the Health Care District of Palm Beach County, West Palm Beach, FL Oversaw the transition of over 20,000 Medicaid patients during sale of PHP to Molina in 2014; oversaw management of medical policies and treatment guidelines and services in VITA plans until closure 2015; managed all provider contracts and was the medical expert that oversaw treatment guidelines, provider and patient issues, and Chaired the Pharmacy, Credentialing and Risk/Quality committees. 2017-present Market Chief Medical Officer, Prestige Health Choice Prestige is a Medicaid managed care organization operated in 55 counties in FL, owned by FL True Blue and Amerihealth Caritas until 2019, now solely owned by Amerihealth Caritas Family of Companies, Philadelphia, PA--a medical insurance company doing business in multiple states. In 2018, Prestige was awarded FL Medicaid contract for ACHA Regions 9 and 11. I oversee Prestige potentially preventable events (PPEs including admissions, re-admissions, ED visits, and birth outcomes including C-section, preterm births and NAS rates), quality/risk management, credentialing and SBIRT program (adolescent drug screening training tool) and participate in ACHA PPE and BO workgroups, and actively participate with FL Assn of Health Plans (FAHP)

APPOINTMENTS: 1988-1992 Appointed by Governor Martinez to the Board of Osteopathic Medicine, Department of Professional Regulation, State of Florida. Physician Assistant Advisory Committee, 1989-1995-developed rules for PA practice Education Committee, 1989. Vice-Chairman, 1989. Board Chair, 1990-1991; 1991-1992 1992-1996 Re-appointed by Governor Chiles to the Board of Osteopathic Medicine, Department of Business and Professional Regulation. Legislative Committee (Laws and Rules), 1992-1994. Voting Delegate, National Federation of State Medical Boards,1991 and 1995. 2015-2020 Appointed by Governor Rick Scott-Board of Osteopathic Medicine FL Dept. of Health Board Vice Chair 2017 and 2020; Board Chair 2018 and 2021 Office Surgery Joint Board Rules Committee 2015-20 Telemedicine Joint Board Committee 2015-2017 Boards of Medicine and Osteopathic Medicine Joint Committee on Medical Marijuana 2017- 2020 (developed consent form allowing physicians to begin registering patients for medical marijuana) Vice Chair 2018-9, Chair 2019-20 Physician Certification Pattern Review Panel 2018-2020 (provides annual report to Governor, Senate President and Speaker of the House on the details of medical marijuana ordering) Vice Chair 2018-2019, Chair 2019-2020 Joint Health History Work Group 2017-2020 (to review and establish more efficient licensure process with less intrusive health history questions) Multi Board Joint Committee on Controlled Substances 2017-2019 (to address HB 21) Board Liaison for Unlicensed Activity 2015-2020

8 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SANDRA L. SCHWEMMER, DO

2018-2020 Federation of State Medical Boards FL voting delegate 2018 By-Laws Committee—appointed by Chair Scott Steingard 2019 1993-1994 Florida Department of Health and Rehabilitative Services, Emergency Medical Services Advisory Council EMS Grant Evaluation Committee 1993-1999 Rural Health Care District Board, Monroe County, Florida 1993 Rural Hospital Professional Licensing Flexibility Advisory Committee 1995-1996 Appointed by Board of County Commissioners, Monroe County Health and Human Services Board, District 11 1995-2002 Physician Advisor, Florida Medical Quality Assurance 1996-2020 Board of Governors, Health Professions Board Division, Nova Southeastern University, Fort Lauderdale, Florida 1996-2020 Member, Foundation for Health Professions Division, Nova Southeastern University, Fort Lauderdale, Florida 1997-2000 Executive Board of Directors, EmCare Holdings, Inc., Dallas, TX (publicly traded company NASDAC) 1997-2002 Appointed by Governor Chiles as a Member of the EMSC Advisory Panel, EMSC/SAFE Kids Program, Florida State Department of Health 1997-2006 President, Healthcare Insurance Purchasing Group and Staff Physicians Purchasing Group Gallagher-Health Care Insurance Services, Houston, TX (Offshore Insurance Captives insuring malpractice liability) 1997-1999 Consultant, Correctional Medical Services, Inc., St. Louis, Missouri 1999-2006 Healthcare Risk Manager Advisory Council; FL Established to recommend healthcare risk review policies and rules for FL Appointed by Ruben King-Shaw, FL Agency for Healthcare Administration 2000–2003 Appointed by FL Senate President, Toni Jennings, to the Women and Heart Disease Task Force, representing Florida Osteopathic Medical Association 2002-2011 Board of Directors, HSAG/Florida Medical Quality Assurance, Inc., Tampa, FL HSAG contracts with CMS and FL Medicaid, AHCA to provide comprehensive health care review, payment error prevention projects, and quality improvement programs 2007-2009 Board of Directors, Emergency Medicine Learning and Resource Center (EMLRC), Foundation of Florida College of Emergency Physicians, Orlando, FL 2011-2017 Emergency Medical Services Advisory Council, Palm Beach County, FL Appointed by Board of County Commissioners Palm Beach County to represent the Palm Beach County Trauma Agency and the Healthcare District of Palm Beach County EMS Ordinance Subcommittee 2016-17 2015-2018 Florida Committee on Trauma, Trauma Agency Subcommittee Appointed by the Trauma Surgeon President of the ACS Florida Committee on Trauma to work with trauma center medical directors to create standards for development of Trauma Agencies within the State. 2019 Considered/interviewed for FL Surgeon General by Governor Ron DeSantis and Lt Governor Jeanette Nunez AWARDS: 11/2017 Willoughby Leadership Award National ACOEP award recognizing one woman annually for leadership and serving as a role model and leader reshaping the future of women in Emergency Medicine ACADEMIC: 1982 Clinical Instructor, Department of Emergency Medicine, Southeastern College of Osteopathic Medicine. 1980-1984 Clinical Faculty, Family Practice Residency, SECOM/NSU

9 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SANDRA L. SCHWEMMER, DO

1986-1988 Chairman, Department of Emergency Medicine, Wellington Regional Medical Center. 1993-1996 Board of Trustees and Foundation, Southeastern University of Health Sciences, N. Miami Beach, FL 1996-2020 Board of Governors, Health Professions Division Nova Southeastern University, Ft. Lauderdale, FL

PUBLICATIONS: Pre-hospital/EMS: 2013 UM Gordon Center: “Correlation of the MEND Exam performed in the field by paramedics with abnormal NIHSS and final diagnosis of stroke for patients airlifted from the scene.” International Stroke Conference – LA 2016 UM Gordon Center: “The Use of Prehospital Telemedicine to Perform the NIHSS and Triage Patients.” International Stroke Conference - CA

PROFESSIONAL/BUSINESS: 1982-2020 Founder, President Professional Emergency Services, Inc. (PES), 10 High Point Rd., Tavernier, FL A Florida Corporation providing EMS Medical Direction, EMS/Trauma consultative services. PES initiated full time Emergency Physician staffing and management in the FL Keys, managing over 100 physicians, ARNPs, and PAs that provided community emergency department services until the assets were acquired by EMCARE, Dallas, TX, in 1999. 2018 PES awarded FL DOH contract to write a comprehensive Trauma Plan for the Region 5 Central FL Regional Disaster Medical Coalition for development of a Trauma Agency which includes 9 counties, 6 trauma centers, 6 Freestanding EDs, 19 EMS agencies, 9 air medical service providers in various counties. The coalition is active today coordinating trauma care in Region 5. 1991-1998 Founder, President, PES Medical Management Services, Inc. A Florida Corporation established to provide medical billing and collection services and practice management services 1990-1998 Founder, Director, PES Physician Resources, Inc. A Florida Corporation established in 1990 to provide primary and specialty physician placement and locum tenens services. 1995-1999 President, Co-Founder, Hospital Physicians, Inc. A Florida Corporation established to provide inpatient physicians (Hospitalists) for Homestead Hospital. The Hospital was a community hospital with a large number of seriously ill, uninsured patients that needed appropriate, coordinated care, along with quality ICU care and inpatient physician/ARNP services. Hospital Physicians, Inc. partnered with the Hospital to recruit, staff, train and manage the physicians and nurses who would attend ICU and ER admitted patients and monitor their care and length of stay. The goal was to efficiently treat patients and secure appropriate post-discharge management, in order to reduce Hospital costs and readmissions. Treatment plans were created based upon diagnosis codes and submitted for utilization management and continuous quality management. This was the first inpatient hospitalist program in Dade County. The program was extremely successful pilot and continues today in Baptist Health systems. 1997-2000 Vice-President, EmCare, now Envision The assets of Professional Emergency Services, Inc. and PES Medical Management Services, Inc. were acquired by EmCare Holdings, Inc., Dallas, TX, a publicly traded Company. EmCare is now known as Envision and provides emergency physician staffing and management to hospitals nationwide.

10 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SHERIF Z. ZAAFRAN, MD

Candidate for Board of Directors

Sherif Z. Zaafran, MD Texas

1 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SHERIF Z. ZAAFRAN, MD

DocuSign Envelope ID: 364888DB-F79C-489F-B510-DE1A3F53EE8B

Texas Medical Board 333 GUADALUPE, TOWER 3, SUITE 610 P.O. BOX 2018 • AUSTIN TX 78701 PHONE: (512) 305-7084 Stephen Brint Carlton, J.D., Executive Director

Dr. Sherif Zaafran 31 December 2020

Scott A. Steingard, DO Chair, FSMB Nominating Committee

Dear Dr. Steingard:

I have the pleasure of nominating Sherif Zaafran, M.D. to you as a FSMB Board Member Fellow Candidate. Dr. Zaafran is the President of the Texas Medical Board (TMB) and has been with us since 2017. He possesses a wealth of knowledge, education, and experience in the practice of medicine, health care regulation, business, and leadership. Dr. Zaafran is also young, energetic, and ready to take on any challenge. He would be a perfect addition to the FSMB Board of Directors.

While Dr. Zaafran’s resume provides a more comprehensive list of his background, continuing education, and accomplishments, his personage lends more than his experience and knowledge of medicine and health care regulation. He has a passion for helping health care professionals, safely treating patients, and providing high-quality health care services. Dr. Zaafran does this through the implementation of strategic goals via a collaborative, team-oriented process and open communications. These improvements, along with a focus on achieving greater levels of effectiveness and efficiency, ultimately help patients receive the best, safest, and most cost- effective health care and services possible. There are many illustrations of how Dr. Zaafran has upheld these standards and morals with his involvement across multiple platforms and organizations.

For example, Dr. Zaafran’s efforts to combat the opioid epidemic at both the state and federal levels include his involvement in the Opioid Taskforces of the Texas Medical Board and the U.S. Department of Health and Human Services respectively. At the TMB, Dr. Zaafran holds annual workgroup meetings to ensure pertinent and reliable information is being used in a preemptive manner against excessive opioid prescribing. Additionally, Dr. Zaafran prioritizes the fight against sexual misconduct in the workplace with his work at the TMB on the Boundaries Taskforce. Staff and board members have the benefit of biannual trainings to hear from colleagues at the Texas Association Against Sexual Assault (TAASA). These trainings allowed the TMB access to intimate knowledge into survivors’ perspective, interview tactics, and general statistics of victims and attackers alike in order to help the panel identify nuances that might have previously been overlooked if not for the efforts of the Boundaries Taskforce. Moreover, dialogue around licensure and renewal at the TMB is continuously at the forefront of such workgroup meetings. One example of how Dr. Zaafran improved the relationship between the Board and the public was the TMB’s adoption of the FSMB wording of impairment questions. By doing this, Dr. Zaafran ushered in a level of assurance that there is efficient, yet appropriate, collaboration between the public, the TMB, FSMB, and the Texas Physician Health Program.

2 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SHERIF Z. ZAAFRAN, MD

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Undoubtedly, leadership skills in the state, federal, and international spheres have been tested during this unprecedented COVID-19 world. Dr. Zaafran proactively prepared his staff and board members in order to build a stable, yet adaptable, continuity plan for the TMB. This allowed for his team to be ready to support interagency collaboration across the State of Texas. This robust, structural approach has proven to be successful in maintaining not only a productive work environment, but an equally safe one as well. His coordination with the Office of the Governor, the Office of the Attorney General, the Health and Human Services Commission, the Nursing Board, the Texas Medical Association, and other Texas agencies, entities, and stakeholders helped Texas ease regulatory burdens, increase the number of licensees in the state, helped to slow the spread of COVID-19 and preserved critical PPE and hospital capacity. Through these times that it is most imperative, Dr. Zaafran places an emphasis on upholding the mission of the TMB while collaborating with any and all platforms to continuously improve the quality and integrity of healthcare.

Dr. Zaafran is committed to servant-leadership and, if appointed by the Board, will be a tremendous asset for the FSMB Board of Directors. Should you have any questions regarding Dr. Zaafran, please do not hesitate to contact me at [email protected]. Thank you for your time and consideration.

STEPHEN BRINT CARLTON, J.D. Executive Director Texas Medical Board

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CANDIDATE’S SIGNATORY PAGE

MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? Texas Medical Board

If not serving, when did you leave the board? Month: Day: Year:

4 Years

How long have you served (did you serve) on your Member Medical Board?

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE:

Potential Conflict(s) of Interest: None

4 Nominating_2021F (HOD) - Tab C - Candidate for Board of Directors SHERIF Z. ZAAFRAN, MD

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2021 Bullet Points Sherif Z. Zaafran, MD CANDIDATE FOR: Board of Directors

FSMB Service: Annual Meeting Voting Delegate 2017, 2018, 2019, 2020; Education Committee 2018-2019; Chair, Reference Committee A 2018; Special Committee on Strategic Planning 2019-2020; Workgroup on Emergency Preparedness & Response 2020-present

Texas Medical Board o Dr. Zaafran was appointed by the Governor of Texas as the President of the Texas Medical Board in January of 2017

Associated Community Involvement and Experience o Sherif Zaafran, MD is an Anesthesiologist who graduated from McGovern Medical School in 1995 and completed his anesthesia residency in 1999

o Dr. Zaafran served on the Congressionally mandated US Dept. of Health and Human Services Interagency Pain Management Taskforce

o Dr. Zaafran is a senior partner with US Anesthesia Partners and serves as the Vice- Chair of US Anesthesia Partners in South Texas overseeing over 500 physicians, nurse anesthetists, and Anesthesiologists Assistants

o Dr. Zaafran serves in a variety of leadership roles within the Texas Society of Anesthesiologists, American Society of Anesthesiologists, Texas Medical Association, and the American Medical Association

o Dr. Zaafran serves on the FDA Advisory Board for Anesthesia and Analgesia Drug Product Advisory Committee

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2021 Personal Statement Sherif Z. Zaafran, MD CANDIDATE FOR: Board of Directors

Health care today in the United States is in a state of flux with many different forces positioning to define its structure and form of delivery as we move into an era of new technologies, extensive disease complexities, cost containment with finite resources, and corporate interests redefining health care delivery models.

The FSMB plays a unique and important role in defining the regulatory framework in which all these changes will occur. A careful balance must always be observed in protecting patients in an ever- changing delivery model for health care while allowing for innovation in the health care structure. This must be done while also being cognizant of critical issues with those we regulate, especially as they wade through the stress and challenge of a constantly shifting regulatory environment.

Never have so many simultaneous complex issues faced us as regulators. COVID-19 has been a unique stress test on how our regulations may or not be consistent with the challenges licensees face during the crises that healthcare has faced in the past year. I have been honored to serve on the FSMB Emergency Preparedness and Response Workgroup to assess gaps and opportunities on how we have approached issues during this pandemic, and how we should address general emergency scenarios in the future. Not only must we manage a shifting model for health care delivery and the regulatory environment that surrounds it, but we must also deal with significant issues such as the physician stress, wellness, the shifting need for physician manpower across State borders, the expansion of telehealth during the pandemic, along with many other issues.

The FSMB has been a leader in educating physicians on new delivery mechanisms. Forums on telemedicine, augmented and artificial intelligence, stem cell therapies, etc., have laid out the groundwork for the vision of what this structure may look like moving into the future. But never before have we recently faced such a monumental health care crisis that needs the full effort of our regulatory agencies to accommodate the fast moving regulatory environment this has created. One of the critical issues that warrants ideas for solutions is the notion that these delivery models break through the typical State to State barriers with one that is mobile and doesn’t necessarily follow these types of borders. How we purport to create a proper regulatory environment within the constraints of regulation at a State by State level while encouraging these mobile delivery models will certainly be a challenge but will require consensus and dialogue between all of us.

Other social issues continue in spite of the pandemic, such as the opioid crises, and are examples of the importance of collaboration across State lines. National retailers, as well as different federal and state regulatory agencies, have all weighed in with a myriad of rules and policies that in many instances conflict with the ability for patients to receive the care they require, as well as physicians to be able to properly manage their patients’ conditions while under the cloud of different regulatory rules. The FSMB can play a unique role as a convener of all these entities to make sure that the rules and regulations are consistent in providing the safeguards and guidelines required for patients as well as providers.

All these issues require a board that is active, engaged, innovative, and creative in its approach. In Texas, as President of the Medical Board, I have sought to present solutions and guidance in many of these issues. We have held multiple emergency meetings during the pandemic to adopt measures around emergency executive orders. We have tackled the issue of telemedicine making sure that the rules are consistent with a safe delivery of care for our patients such as waivers for prescribing opioids for patients who can’t physically see their physician during lockdowns. We have tried to manage licensing physicians who haven’t been able to complete their oral exams due to suspension of exams during covid-19, along with many other regulatory challenges that this crises has exposed. I believe I bring a wealth of knowledge to the Board in addressing all these issues in a thoughtful, innovative way, that reaches across the divide of stakeholders to bring about ideas and solutions for these complex issues that face us.

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Curriculum Vitae

Sherif Zaafran, M.D. 1500 City West Blvd, Suite 300 Houston, Texas 77042 [email protected]

Present Positions

US Anesthesia Partners – Gulf Coast Vice-Chair, Clinical Governance Board

USAP National Legislative Liaison

President of the Texas Medical Board January 2017 – Present

FDA, Anesthesia and Analgesia Drug Product Advisory Committee April 2020 - Present

Chair, Acute and Chronic Pain Taskforce January 2013 - Present Memorial Hermann Healthcare System, Houston

Biographical

• Birth Date: June 4, 1970 • Citizenship: United States of America Education

• The University of Texas Medical School at Houston Doctor of Medicine, 1995 • The University of Texas at Austin

Postgraduate Training

• University of Texas Medical School at Houston Resident, Department of Anesthesia, 1996-1999 • University of Texas Medical School at Houston, mini fellowship Cardiovascular Anesthesia, 1998-1999 • Baylor College of Medicine Transitional Program, 1995-1996 Professional Employment

• US Anesthesia Partners – Houston, Texas o September 1999 – Present o USAP National Legislative Liaison, 2017-Present o Vice-Chair USAP Gulf Coast Clinical Governance Board, 2019-Present o President Memorial Hermann Pillar, 2015-2018 o USAP-Houston Chair, Legislative Committee, 2009-Present • Memorial Hermann the Woodlands o Chair, Rules and Bylaws, 2015-Present o President of Medical Staff, 2013-2014

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o Chair, MH Division Quality, 2014 o Chair of Patient Care Resource Management Committee, 2011-2012 o Chair of Anesthesiology, 2006-2010 o Chair of Surgery, 2009-2010

State and Federal Appointments

• Subcommittee Chair, US Dept of HHS Interagency Pain Management Taskforce, 2018-Present

• President, Texas Medical Board 1/2017-Present

• Subcommittee Chair, US Dept. HHS Interagency Pain Management Taskforce

June 2018- June 2019 Board Certification

• Board Certified • The American Board of Anesthesiology 2002-Present • Fellow American Society of Anesthesiology 2017-Present Licensure Information

• Texas Medical Board • Texas Medical License # K1326 Publications and Conference Lectures

• American Society of Anesthesiologists Practice Management 2017 o Pre-Conference 5: Billing, Coding and Compliance - Update on Out-of-Network Payment Activities • American Society of Anesthesiologists Practice Management 2017 o Out-of-Network Payment Activities • Kevin MD o Surprise Billing Surprises Everyone, Except the Insurance Companies • ASA Monitor July 2016 o Physician Leadership as a Crucial Component of a Drastically Changing Health Care System • American Society of Anesthesiologists Annual Meeting 2013 o The Surgical Home Concept in the Era of ACOs and Bundled Payments • Dignity Health o Perioperative Surgical Home – Beyond Opioids – Multimodal Options

Professional Societies

• Harris County Medical Society (HCMS) o Member, Board of Socioeconomics, 2020-Present o Chair, HCMS Delegation to the Texas Medical Association, 2017-2019 o Chair, Board of Medical Legislation, 2013-2014 • HCMS Health Plan Liaison Committee, 2010-2011 • Texas Medical Association (TMA) o Delegate, 2003-Present

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o Member, Speaker’s Advisory Council, 2016-Present o Chair, Council on Health Promotions, 2014-2015 o Committee on membership, 2002-2008 • TexPac Chair and Director, District 15 • TSAPAC, Board of Directors, 2016-Present • Texas Society of Anesthesiologists (TSA), o Assistant Treasurer, 2015-2017 o Chair, Government Affairs Committee, 2012-2019 o Delegate 2003-2009, 2011-Present • American Society of Anesthesiologists (ASA) o Delegate, 2017-Present o Chair, Taskforce on OON Billing, 2015-2018 o Member, Committee on Government Affairs, 2013-Present o Member, Committee on Future Models Anesthesia, 2015-2016 • American Medical Association (AMA) o Alternate Delegate, 2018-Present

9 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee ALEXIOS G. CARAYANNOPOULOS, DO, MPH

Candidate for Nominating Committee

Alexios G. Carayannopoulos, DO, MPH Rhode Island

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James V. McDonald M.D., M.P.H. Rhode Island Department of Health 3 Capitol Hill Providence, Rhode Island 02908

December 16, 2020

Federation of State Medical Boards c/o Scott A. Steingard, Chair FSMB Nominating Committee 400 Fuller Wiser Road Euless, TX 76039

Please accept this letter as my nomination of Dr. Alexios Carayannopoulos for a position on the FSMB Nominating Committee. In Accordance with the FSMB Bylaws, Dr. Carayannopoulos has achieved the core competencies required to serve on this committee. The core competencies required being:  Having a clear understanding of the vision, mission, and strategic goals of the FSMB;  Possessing a positive outlook on the role and function of Member Medical Boards in the medical regulatory field;  Bringing a broad, national perspective to specific issues;  Having adequate time and commitment necessary to fulfill the responsibilities of the office; and  Demonstrating professionalism, personal integrity, and the ability to work effectively with others.

I have worked with Alexios at the Department of Health for more than three years, where he serves as a board member on both the combined MD/DO Rhode Island Board of Medical Licensure and Discipline, as well the Board of Occupational Therapy. He has maintained a very active interest in the FSMB and has attended the last two annual meetings as the RI Voting Delegate. He is also Vice President of the American Association of Osteopathic Examiners (AAOE), which has a mission similar to the FSMB within the osteopathic medical community. His knowledge, commitment, and professionalism have earned him an international reputation as a leader in both Physical Medicine and Rehabilitation, as well as Pain Medicine. He is an Associate Professor of Neurosurgery at the Warren Alpert School of Medicine and Brown University and has had a very productive academic career. He is also very engaged in community outreach through the Department of Health, where he has served on several committees.

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I have full confidence that he will make an excellent addition to the Nominating Committee. Please do not hesitate to contact me should you have any questions.

Nominee: Alexios Carayannopoulos Address: 20 Stone Tower Lane, Barrington, RI 02806 Phone: 617-699-4149 Email Address: [email protected]

Respectfully,

James V. McDonald M.D., M.P.H. Medical Director COVID unit Chief Administrative Officer, Board of Medical Licensure & Discipline Medical Director, Center for Customer Services Medical Director, Health Policy, Informatics and Communications Medical Director, Drug Overdose Prevention Program Rhode Island Department of Health 3 Capitol Hill Providence, Rhode Island 02908

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DocuSign Envelope ID: F7BA1F34-9FE0-4797-A674-6F337F4383C5 CANDIDATE’S SIGNATORY PAGE

MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? RI Board of Medical Licensure and Discipline and RI Board of Occ. Therapy ______

If not serving, when did you leave the board? Month: Day: Year:

How long have you served (did you serve) on your Member Medical Board? ______2017

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE: ______

Potential Conflict(s) of Interest:

None

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2021 Bullet Points Alexios G. Carayannopoulos, DO, MPH CANDIDATE FOR: Nominating Committee

FSMB Service: Annual Meeting Voting Delegate 2019, 2020

Rhode Island Board of Medical Licensure & Discipline o Member 2017-2020

Relevant Professional Accomplishments o Well Decorated Military Service Exhibiting Proven Leadership o Notable Academic Productivity and Achievements Including Numerous Publications and Peer Reviewed Journals, Participation in Writing and Editing Major Textbooks and Leading Clinical Trials o Significant Community Engagement in Promoting Awareness of Comprehensive Pain Management and Safe Opioid Treatment Paradigms o Medical Society Engagement with Revealing Significant Collaboration at the National and International Level Promoting Awareness of Safety and Ethical Treatment of Pain and Rehabilitation o Significant Engagement in Department of Health to include Boards and Committees Advocating for Public Health Principles o Extensive Professional Development and Career Milestone Achievements

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2021 Personal Statement Alexios G. Carayannopoulos, DO, MPH CANDIDATE FOR: Nominating Committee

It is with great excitement that I accept the nomination of James McDonald, MD, MPH for election to the FSMB Nominating Committee. I am a strong candidate with years of experience in various domains of public health and medicine. As fellow of the FSMB since 2017, I’ve attended the last two annual meetings, proudly representing the state of Rhode Island as the voting delegate. This experience has given me a solid understanding of the FSMB’s missions and goals, as well as expected core competencies for elected office.

My exposure to health regulation began in 1994, while obtaining a master’s degree in public health. Focusing on health policy and management, I was immersed in healthcare legislation and regulation on Capitol Hill. I learned about healthcare law and acquired analytical and transformative skills useful in reducing preventable patient harm and improving clinical outcomes.

Then, through 13 years serving as a US Navy submarine, diving, and medical officer, I gained leadership skills to uphold and maintain the highest standards of ethics and professionalism. Additionally, I learned the critical importance of a coordinated team-based approach to accomplish the “mission” successfully.

Currently, as Chief of the Department of Physical Medicine and Rehabilitation at multiple academic institutions of Brown University School of Medicine in Providence RI, I’m responsible for all administrative, clinical, educational, and research activities of the department. Given that physicians maintain authority and responsibility for patient care to assure safety and quality, I’ve worked diligently with my providers to imbue an understanding and appreciation that this ultimate duty rests with them. Thus far, we’ve collectively implemented and continue to maintain quality- control programs for delivering care safely, efficiently, and ethically in our PM&R team-based approach.

My experience in medical licensure began in 2007, when I was first appointed to credentials committees and eventually medical executive committees of various healthcare systems, which I continue to serve on today. Most recently, I was appointed to the Rhode Island Board of Medical Licensure and Discipline in 2017 and additionally the Board of Occupational Medicine in 2019. That year, I was also elected Vice President of the American Academy of Osteopathic Examiners. Since my appointment to the state boards at the RI Department of Health, I have served as advisor to the Governor’s Opioid Task force and the state’s Primary Care Physician’s Advisory Committee on pain management. Additionally, I maintain leadership positions on multiple national and international medical societies.

Should I have the honor of being elected, I pledge to devote the time and assume the responsibility of representing the FSMB faithfully and to the best of my ability. My qualifications are broad and strong. Through my experience, I offer a national multi-dimensional perspective. If elected, I am confident that I would add valuable insight and point of view to the Nominating Committee, consistent with the mission of the FSMB as it continues to focus on licensure, discipline and protection of the public.

6 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee ALEXIOS G. CARAYANNOPOULOS, DO, MPH

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CURRICULUM VITAE

ALEXIOS GEORGE CARAYANNOPOULOS, DO, MPH, DABPMR, FAAPMR, FFSMB, FAAOE

CHIEF Department of Physical Medicine and Rehabilitation Rhode Island Hospital Newport Hospital Lifespan Physician Group 593 Eddy Street 20 Powell Avenue 593 Eddy Street Providence, RI 02903 Newport, RI 02840 Providence, RI 02903

EDUCATION Undergraduate Medical School Other Advanced Degrees Bachelor of Arts: Doctor of Osteopathic Medicine Master of Public Health: Connecticut College, Major: Candidate: Johns Hopkins University, English Literature, Minor: New York College of School of Public Health, Focus: Chemistry, graduated with Osteopathic Medicine, 1995- Health Policy and Management, “Distinction in Major Field”, 1997 Epidemiology, 1995 1992 Doctor of Osteopathic Medicine: Nova Southeastern University, College of Osteopathic Medicine, 1997-1999

POSTGRADUATE TRAINING (PGY-1): Internship: Transitional Medicine, National Naval Medical Center, Bethesda, MD (PGY-2): Residency 1: Undersea Medicine, Undersea Medicine, Naval Undersea Medical Institute, Groton, CT (PGY 3-5): Residency 2: Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA (PGY 4-5): Certification: Medical Acupuncture, (300 Hours), Harvard Medical School, Boston, MA (PGY-6): Fellowship: Pain Medicine, Dartmouth Medical School, Lebanon, NH (PGY-7): Fellowship: PM&R Leadership, American Academy of Physical Medicine and Rehabilitation, 2015 Professional Fellowship: Federation of State Medical Boards, 2017 - Present Professional Fellowship: American Association of Osteopathic Examiners, 2018- Present. Professional Fellowship: American Academy of Physical Medicine and Rehabilitation , 2007 - Present

CIVILIAN HONORS AND AWARDS Top Doc, Pain Management: Rhode Island Monthly, 2019 America’s Most Honored Professionals: Vitals, The American Registry, 2017 America’s Most Honored Professionals, Top 10%: Vitals, The American Registry, 2016 Distinguished Doctor: Expert Network, Induction 2016 Pinnacle Professional Member: Continental Who’s Who: Induction 2016 Top 10 Pain Specialists, Massachusetts: Vitals, The American Registry, 2014 Most Compassionate Doctor: (2010, 2011, 2012, 2013, 2018, 2018) Vitals, The American Registry, Certificate of Appreciation Patient’s Choice Award 5th Anniversary, 2008-2012: Vitals, The American Registry Patient’s Choice Award (2008, 2009, 2010, 2011, 2012, 2018: Vitals, The American Registry First Place, Resident Writing Award: American Osteopathic College of Physical Medicine and Rehabilitation, 2007 Finalist, Resident Writing Award: American Osteopathic College of Physical Medicine and Rehabilitation, 2004

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MILITARY SERVICE Ensign: United States Navy, 1994-1999 Lieutenant: 1999-2003 Lieutenant Commander: 2003-2007

MILITARY QUALIFICATIONS United States Navy Medical Officer: United States Naval Base, Newport, R.I. 08/1997, Graduation with Honors, Navy Officer, 1997 Qualified Submarine Medical Officer: Commander Submarine Squadron 22, 2002 Qualified Diving Medical Officer: United States Naval Diving and Salvage Training Center, 2000 United States Navy Diver: United States Naval Dive & Salvage Training Center, “Graduation with Honors”, 2000 United States Navy Submarine Officer, United States Navy Submarine School, 12/2000, “Graduation with Honors”, 2000

MILITARY AWARDS Navy and Marine Corps Commendation Medal Global War on Terrorism Expeditionary Medal Navy Meritorious Unit Commendation Medal Global War on Terrorism Service Medal Navy and Marine Corps Achievement Medal Navy and Marine Corps Overseas Service Ribbon National Defense Service Medal (Bronze Star) NATO Kosovo Medal Iraq Campaign Medal Navy Expert Rifleman Ribbon Navy Expert Pistol Medal

PROFESSIONAL LICENSURE BOARD CERTIFICATION Full Medical License, Rhode Island, (active) Physical Medicine and Rehabilitation (ABPMR): 2007; Recertification 2015 Full Medical License, Massachusetts, (inactive/expired) Pain Medicine (ABPMR): 2007; Recertification 2017

Full Medical License, Florida (inactive/expired) Training License, New Hampshire (inactive/expired) Training License, Virginia (inactive/expired)

ACADEMIC APPOINTMENTS Clinical Associate Professor of Neurosurgery, Division of Biology and Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI: 2014 – present

FACULTY APPOINTMENTS Virtual Annual Meeting of the American Society of Pain Brown University, 3rd Annual Cerebrospinal Fluid and Neuroscience (ASPN), September 18-20, 2020 Disorders Symposium, Providence RI, June 2018 Virtual Think Tank Meeting of the American Society of American Society of Regional Anesthesia, Associate Pain and Neuroscience (ASPN), September 18-20, 2020 Clinical Faculty, World Congress, New York, NY April 2018 Watson Institute International and Public Affairs, Brown London Pain Forum, Clinical Faculty, Winter Pain University Conference on Pain, Relief, and the Role of Symposium, Tignes France, January 2016 the Physician. Providence, RI. January 2020 American Academy of Physical Medicine and International Association of Pain, Clinical Faculty, Rehabilitation, Annual Meeting, San Antonio, TX, Annual Meeting, New York, NY, Clinical Teaching November 2019. Faculty, May 2016 American Osteopathic College of Physical Medicine Chiari & Syringomyelia Foundation, Research and Rehabilitation, Annual Meeting, Baltimore, MD, Colloquium, San Diego, CA Sep 2016 October 2019

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Brown University, Program Director, Interdisciplinary American Society of Regional Anesthesia, Associate Spine Conference, Providence RI, 9/2016, 2017, 2018, Faculty Annual Meeting, San Francisco CO, November 2019 2014 American Society of Pain and Neuroscience, Annual North American Neuromodulation Society, Clinical Meeting, Miami, FL July 2019 Faculty, Annual Meeting, Las Vegas, NV, December 2015 Health-centric Advisors New England Program, Project Boston Scientific Company, Neuromodulation ECHO ROPE, Providence RI, Feb - May 2019 Division, Natick, MA: 2010-2014 Rhode Island Department of Labor and Training Clinical Teaching Faculty, St. Jude Medical, Worker’s Compensation Division: Arrigan Center Neuromodulation Division, Plano, TX: 2008 - 2014 Conference, Innovations in Rehabilitation of Chronic Pain & Disability, Warwick, RI April 2019 Rhode Island Governor’s Council on Behavioral Clinical Teaching Faculty, Vertos Medical, Aliso Healthcare’s Advisory Committee: PREVCON Viejo, CA: 2013 Conference, January 2019 Chief Resident, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA: 2005-2006

HOSPITAL APPOINTMENTS Chief, Department of Physical Medicine and Medical Director, Lahey at Emerson Spine Program, Rehabilitation, Newport Hospital, Newport, RI, January Department of Medicine, Emerson Hospital, Concord, 2020 – present MA, 2007-2014 Medical Executive Board Member, Newport Hospital, House-staff (Fellow), Pain Clinic, Department of Newport, RI, January 2020 – present Anesthesiology Dartmouth Hitchcock Medical Center, Lebanon, N.H., 2006-2007 Chief, Division of Physical Medicine and Physician (Moonlighter), Department of Medicine, Rehabilitation, Lifespan Physician Group, Providence, HealthSouth/New England Rehabilitation Hospital, RI, May 2019 – present Woburn, MA, 2005-2007 Chief, Department of Physical Medicine and Physician (Moonlighter), Department of Medicine, Rehabilitation, Rhode Island Hospital, Providence, RI, HealthSouth/Braintree Rehabilitation Hospital, December 2018 – present Braintree MA, 2005-2007 Medical Director, Comprehensive Spine Center, House-staff (Resident), Department of Physical Division Director Pain and Rehabilitation Medicine, Medicine and Rehabilitation, Spaulding Rehabilitation Department of Neurosurgery, Newport Hospital, Hospital, Boston, MA, 2003-2006 Newport, R.I., 2017 – 2020 Medical Director, Comprehensive Spine Center, Undersea Medical Officer, Department of Medicine, Division Director Pain and Rehabilitation Medicine, U.S. Naval Hospital, Naples Italy, 2001-2003 Department of Neurosurgery, Rhode Island Hospital, Providence, R.I., 2014 – 2020 Medical Director, Spine Center, Department of House-staff (Intern), Department of Transitional Neurosurgery, Lahey Hospital and Medical Center, Medicine, National Naval Medical Center, Bethesda, Burlington, MA, 2007-2014 MD 1999-2000

LOCAL/REGIONAL COMMITTEES Board Member, Rhode Island Department of Health. Board of Occupational Therapy. Appointed by Governor Gina Raimondo, August 2020 through August 2022 Board Member, Rhode Island Department of Health. Board of Medical Licensure and Discipline. Appointed by Governor Gina Raimondo, November 30, 2017- January 1, 2020.

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Member-at-large, Governor of Rhode Island Opioid Overdose Prevention and Intervention Task Force, September 2014 - present. Physician Advisory Board, Rhode Island Department of Health PCPAC- Primary Care Physicians Advisory Committee May 2016- present. Physician Advisory Board, Rhode Island Department of Health Buprenorphine Advisory Board May 2016 - present . NATIONAL COMMITTEES Leadership Council: American Society of Pain and Neuroscience, 2020 – present. Committee Member: International Neuromodulation Society (INS), Poly-analgesic Consensus Committee 2021 (PACC 2021), 2020 – present. Committee Member: North American Neuromodulation Society (NANS), Advocacy Coverage Task Force, 2020 – present. Committee Member: North American Neuromodulation Society (NANS), APC Radiofrequency Sacroiliac Joint Task Force, 2020 – present. Co- Chair: International Neuromodulation Society (INS) Education & CME Committee Neuromodulation Curriculum, 2020 – present. Committee Member: North American Neuromodulation Society (NANS), Neuromodulation Centers of Excellence Committee, 2020 – present. Committee Member: North American Neuromodulation Society (NANS), Educational Curriculum Committee, 2020 – present. Vice-Chair: American Society of Regional Anesthesia (ASRA), Neuromodulation Special Interest Group, March 2019 - present President: Rhode Island Society of Interventional Pain Physicians, Inc., February 2019- present Board of Directors: American Society of Pain and Neuroscience, 2018 – present Committee Member: American Academy of Physical Medicine and Rehabilitation, Evidence Committee, 2018- present Committee Co-Chair: International Neuromodulation Society (INS), Young Neuromodulator Committee, 2016- 2018 Committee Member: American Society of Regional Anesthesia (ASRA), Research Committee, 2016-2018 Continuing Medical Education Liaison: American Society of Regional Anesthesia (ASRA), Neuromodulation Special Interest Group, 2016-2018 Committee Member: American Society of Interventional Pain Physician, Committee on Education and Research, 2015-2017 Committee Member: American Society of Interventional Pain Physician, Committee on Personal Development, Membership, Young Physicians, 2015-2017 Committee Member: American Society of Interventional Pain Physician, Spinal Cord Stimulation Advisory Board/ Special Interest Group Committee, 2014-present Information Systems Liaison: American Academy of Physical Medicine and Rehabilitation, Resident Physician Council, 2003-2006

NATIONAL EDITORIAL BOARDS Editorial Board Member: PM&R Knowledge Now, Pain/ Neuromuscular Rehabilitation, 2009-present Editorial Board Member: Neuromodulation Journal, Technology at the Neural Interface Journal (Spinal Cord Stimulation, Peripheral Nerve Stimulation), 2010-present Editorial Board Member: Physical Medicine and Rehabilitation Journal (Pain, Spine Rehabilitation, Musculoskeletal Medicine), 2008-present Editorial Board Member: British Medical Journal, Point of Care, 2007 – 2010

10 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee ALEXIOS G. CARAYANNOPOULOS, DO, MPH

DocuSign Envelope ID: F7BA1F34-9FE0-4797-A674-6F337F4383C5

Regional Managing Editor: Rehab in Review, Harvard Medical School, Department of Physical Medicine and Rehabilitation, 2004-2006

Other Consultant: United States Department of Defense Health Program Congressionally Directed Medical Research Programs, Joint Program Committee 8/Clinical and Rehabilitative Medicine Research Program, Psychological Committee Member: Health and Traumatic Brain Injury Research Program, 2016-2017 Medical Liaison: United Stated National Oceanic and Atmospheric Association, “Aquarius Mission”, Key Largo, FL, 2002

HOSPITAL COMMITTEES Rhode Island Hospital Credentials Committee, 2016- present Neurovascular Steering Committee, 2016 – present Neurovascular Education Sub-Committee, 2017 - present Pain Committee, 2018-present Lahey Hospital and Medical Center Website Steering Committee, 2009-2010 Personnel Committee, 2010 - 2012 Pain Committee, 2010 – 2014 Studer Committee, 2011- 2013 EPIC Medical Record Committee, 2013 – 2014 Dartmouth Hitchcock Medical Center Professional Practice Committee, 2006-2007 New Hampshire Pain Initiative, 2006-2007 Spaulding Rehabilitation Hospital Residency Selection Board Committee, 2004-2005 Massachusetts Pain Initiative, 2005-2006

ACTIVE MEMBERSHIP IN SOCIETIES American Society of Pain and Neuroscience (ASPN) American Academy of Physical Medicine and Rehabilitation (AAPM&R) North American Neuromodulation Society (NANS) International Neuromodulation Society (INS) American Society of Regional Anesthesia (ASRA) American Society of Interventional Pain Physicians (ASIPP) Rhode Island Society of Osteopathic Physicians and Surgeons (RISOPS)

ACADEMIC PRODUCTIVITY 29 Publications in Peer Review Journals 19 Book Chapters 15 Primary/Co-Investigator Clinical Trials 64 National/International Invited Presentations

11 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee AMY J. DERICK, MD

Candidate for Nominating Committee

Amy J. Derick, MD Illinois

1 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee AMY J. DERICK, MD DocuSign Envelope ID: 7439977C-8B5F-4184-AB40-8B187D9704D3

Illinois Department of Financial and Professional Regulation Division of Professional Regulation

JB PRITZKER DEBORAH HAGAN Governor Secretary CECILIA ABUNDIS Acting Director Division of Professional Regulation

December 28, 2020

Scott A. Steingard, D.O., Chair FSMB Nominating Committee Federation of State Medical Boards 400 Fuller Wise Road, Suite 300 Euless, TX 76039

RE: Letter of Nomination Nominee: Amy Derick, M.D. 1660 Balmoral Circle Inverness, Illinois 60067 847-381-8899 [email protected]

Dear Dr. Steingard:

Dr. Amy Derick was appointed to the Illinois State Medical Disciplinary Board in May 2019. Presently, she is our Vice-Chair (2019-2020), and on January 1, 2021, she will become Chair. Without a doubt, this physician has all the necessary leadership qualifications.

Dr. Derick was named a Fellow for FSMB (June 2019) and attended the 2020 Annual Meeting virtually.

While she is somewhat new to the regulatory world, Dr. Derick has been exciting to work with on the Medical Disciplinary Board. Dr. Derick has many new ideas to try to streamline processes and possesses a fine mind and boundless energy. She is experienced in a variety of leadership roles for both state and national non-profit societies, and she has an established track record of recruiting diverse and engaged members to serve on committees.

Dr. Derick has an excellent educational background graduating with a Bachelor of Science Degree from the University of Notre Dame and a Medical Degree from the University of Chicago. She is a Clinical Instructor of Dermatology at Northwestern University and Academic Associate Member of Dermatology at the University of Chicago. She has lectured extensively about medical licensure and “best practices” to physicians and residents-in-training across the country.

Dr. Derick is a board-certified dermatologist, founder and CEO of Derick Dermatology; a 14-location private practice in Chicagoland with 250 employees (90% female) with a focus on early skin cancer detection and treatment. Derick Dermatology sees over 100,000 patient appointments per year.

www.facebook.com/ILDFPR www.idfpr.com http://twitter.com/#!/IDFPR

2 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee AMY J. DERICK, MD

DocuSign Envelope ID: 7439977C-8B5F-4184-AB40-8B187D9704D3

Letter of Nomination Dr. Amy Derick, Nominee Page 2

Dr. Derick presently is the President of the Illinois Dermatologic Society, Chairwoman of the Illinois Dermatologic PAC, and Trustee of the Illinois State Medical Society.

Dr. Derick has been awarded Advocate of the Year (2021) and given a Presidential Citation for Commitment (2020) by the American Academy of Dermatology Association. Added to her accomplishments are the Excellence in Prevention Award from the Melanoma Research Foundation, Exceptional Women in Medicine, Top Doctor for Cancer by both the Chicago Magazine and Western Suburban Living, Distinguished Service Award for Early Achievement University of Chicago, Athena Award by the Barrington area Chamber of Commerce, Top 40 Under 40 Award, and various other awards including the University of Notre Dame Scholar award.

Dr. Derick is in full agreement to the submission of her application for the nominating committee, and I am confident she will demonstrate a remarkable time commitment required for a FSMB position on the nominating committee.

It is with great honor to present Dr. Amy Derick for nomination to the FSMB.

Best Regards,

John Zander, M.D. Acting Chief Medical Coordinator Illinois Department of Financial and Professional Regulation

www.facebook.com/ILDFPR www.idfpr.com http://twitter.com/#!/IDFPR

3 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee AMY J. DERICK, MD

DocuSign Envelope ID: 7439977C-8B5F-4184-AB40-8B187D9704D3 CANDIDATE’S SIGNATORY PAGE

MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? Illinois State Medical Disciplinary Board ______

If not serving, when did you leave the board? Month: Day: Year:

How long have you served (did you serve) on your Member Medical Board? ______18 months

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE: ______

Potential Conflict(s) of Interest:

None

4 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee AMY J. DERICK, MD

DocuSign Envelope ID: 7439977C-8B5F-4184-AB40-8B187D9704D3

2021 Bullet Points Amy J. Derick, MD CANDIDATE FOR: Nominating Committee

FSMB Service: Member Board Fellow 2019; Annual Meeting Voting Delegate 2020

Illinois State Medical Disciplinary Board

o Appointed as Member to the Illinois St at e Medical Disciplinary Board 2019 o Vice-Chair 2019-2020 o Chai r 2021

Associated Affiliations and Projects

o Experienced in a variety of leadership roles for both state and national non-profit societies o Established track record of recruiting diverse and engaged members to serve on committees

o Lectured extensively about medical licensure and " best practices" to physicians and residentsin-training across the country

o Board-certified dermatologist with 14-location private practice in Chicagoland with 250 employees (90% female) with a focus on early skin cancer detection and treatment

o Clinical Instructor of Dermatology at Northwestern University and Academic Associate Member of Dermatology at the University of Chicago

o Awarded Advocate of the Year 2021 and given a Presidential Citation for Commitment (2020) by the American Academy of Dermatology Association

5 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee AMY J. DERICK, MD

DocuSign Envelope ID: 7439977C-8B5F-4184-AB40-8B187D9704D3

2021 Personal Statement Amy J. Derick, MD CANDIDATE FOR: Nominating Committee

Please accept my application for the FSMB Nominating Committee.

A nominating committee is one of the most important committees in a non-profit professional society. Without the nominating committee's recruitment of talented and committed officers, an organization could fail to achieve its strategic goals. I believe that I can be a productive and valuable member of the FSMB's Nominating Committee.

Recruiting other professionals to become more active (with time and/or money) in non-profit professional medical societies is a strength of mine. I recruited over 1300 physicians as new members to the Illinois State Medical Society-approximately 300 of these physicians were dermatologists.

As the President of the Illinois Dermatological Society, I prioritized the recruitment of dermatologists to serve on committees at the Illinois State Medical Society. We now have at least one dermatologist on 8 of 13 committees who is engaged and active, including residentsin-training. One of the goals of the state medical society was to prioritize diversity on its committees, and our newly recruited committee members included women and underrepresented minorities.

Due to my advocacy work at both the state and national level , I received the 2021 Advocate of the Year Award from the American Academy of Dermatology.

I serve on multiple important committees and am the Vice-Chair of the Advisory Board-a group of state leaders from every state who meet on important issues impacting dermatologists and the patients we serve.

I was appointed to the Illinois State Medical Board in 2019 by Governor JB Pritzker for a four-year term. Later in 2019, I was elected to serve as the Vice-Chair. In 2020, I was elected to be the Chair of the Board for 2021. I have honored my commitment to always attend meetings prepared and with clear focus. I have only missed one board meeting since my term began on the board almost two years ago.

In 2020, I recruited physicians across the country to consider service on their state' s medical board; I gave lectures to other professional societies, at dermatology meetings, and at Grand Rounds.

In addition, I have been a participant in the American Society of Dermatologic Surgery's Medical Board Academy where myself and two other current or former medical board members in other states emphasize the importance of medical boards to protect the public and promote quality health care.

I look forward to increasing my involvement with FSMB. Although I had to attend the 2020 Annual Meeting virtually, I was impressed with quality of the meeting. Learning from other state's medical boards will make our board in Illinois stronger.

I support the mission, vision and strategic goals of the FSMB and recognize the importance of the role of the state medical boards to achieve the strategic goals of the FSMB. I hope that my experience will be an asset to the Nominating Committee of the FSMB.

6 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee AMY J. DERICK, MD

DocuSign Envelope ID: 7439977C-8B5F-4184-AB40-8B187D9704D3

7 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee AMY J. DERICK, MD

DocuSign Envelope ID: 7439977C-8B5F-4184-AB40-8B187D9704D3

AMY J. DERICK, M.D.

AWARDS

ADVOCATE OF THE YEAR TOP DOCTOR – DERMATOLOGY American Academy of Dermatology Western Suburban Living (2021) (2018)

PRESIDENTIAL CITATION AWARD: DISTINGUISHED SERVICE AWARD COMMITMENT FOR EARLY ACHIEVEMENT In recognition for being instrumental in passing the first state legislation in the US classifying a skin cancer screening as University of Chicago preventative care without any patient out of pocket costs (2015) American Academy of Dermatology (2020) ATHENA AWARD Barrington Area Chamber of Commerce ENTREPRENEUR OF THE YEAR 2019 (2015) MIDWEST, BOOTSTRAPPER CATEGORY EY TOP 40 UNDER 40 AWARD (2019) McHenry County (2014) SkinPAC FUNDRAISER OF THE YEAR American Academy of Dermatology DISTINGUISHED GRADUATE AWARD (2019) William Fremd High School (2011) PATIENT SAFETY HERO For the Illinois Dermatological Society MENTORSHIP AWARD WINNER American Society for Dermatologic Surgery American Society for Dermatologic Surgery (2019) MENTORSHIP AWARD RECIPIENT STATE SOCIETY SPECIAL Women’s Dermatologic Society RECOGNITION AWARD AWARD TO A FEMALE MEDICAL For the Illinois Dermatological Society STUDENT FOR OUTSTANDING American Academy of Dermatology SCHOLASTIC ACHIEVEMENT (2019) American Medical Women’s Association EXCELLENCE IN PREVENTION AWARD CATHERINE DOBSON PRIZE Melanoma Research Foundation For best oral presentation at the 56th Annual Senior Scientific Session (2019) by a non-PhD student in the area of clinical investigation of research done in medical school TOP DOCTOR AWARD STUDENT SUMMER RESEARCH AWARD Castle Connolly NIH (2014, 2015, 2016, 2017 and 2018) PHI BETA KAPPA EXCEPTIONAL WOMEN IN MEDICINE (1997) Castle Connolly (2017) NOTRE DAME SCHOLAR TOP DOCTOR FOR CANCER – DERMATOLOGY Chicago Magazine (2017)

8 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RUP K. NAGALA, MD

Candidate for Nominating Committee

Rup K. Nagala, MD North Dakota

1 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RUP K. NAGALA, MD

DocuSign Envelope ID: 9A72A6D5-1B75-4B30-AB42-5687B13E5646

2 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RUP K. NAGALA, MD

DocuSign Envelope ID: 9A72A6D5-1B75-4B30-AB42-5687B13E5646

3 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RUP K. NAGALA, MD

DocuSign Envelope ID: 9A72A6D5-1B75-4B30-AB42-5687B13E5646

CANDIDATE’S SIGNATORY PAGE

MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? ND

If not serving, when did you leave the board? Month: Day: Year:

6 years

How long have you served (did you serve) on your Member Medical Board?

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE:

Potential Conflict(s) of Interest: No conflicts of interest.

4 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RUP K. NAGALA, MD

DocuSign Envelope ID: 9A72A6D5-1B75-4B30-AB42-5687B13E5646

2021 Bullet Points Rup K. Nagala, MD CANDIDATE FOR: Nominating Committee

FSMB Service: Audit Committee 2018-2019; Attended three Annual Meetings

North Dakota Board of Medicine

o Chair 2019-present o Treasurer 2017-2019 o Member 2015-present o Served in numerous committees, sub committees, including budget, recruitment of members and Executive Directors, PA, FNP, questionnaire, real estate relocation, Chairman of Complaints panel A

Associated Affiliations and Projects

o Serve on the ILMCC as Commissioner o Served on USMLE Exam Development Informational Committee o Very keenly interested in medical regulation, license reciprocity and fair treatment of its providers and members

o Have held many leadership positions within our clinic, hospital, and state organizations o Have been a Pioneer and Innovator in rural health care delivery receiving awards and felicitations form our Governor and Senators. Received Pioneer award from Sanford health, the largest rural system in USA

o Recipient of National award of Runner up “American Family Physician” from AAFP and “Rural Provider” of the year from National Rural Health association of USA

o Have the interest, experience, intellect, energy, collaborative nature and leadership qualities for the position

5 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RUP K. NAGALA, MD

DocuSign Envelope ID: 9A72A6D5-1B75-4B30-AB42-5687B13E5646

2021 Personal Statement Rup K. Nagala, MD CANDIDATE FOR: Nominating Committee

I would like to submit myself as a candidate for a position on the FSMB Nominating Committee.

I started my medical career in a town of 2000 in 1978 and have been there since that time. Over the past four decades, I have been a Champion in “fair” medical licensing and regulation having myself been a victim of unfair regulation many years ago. I have been the recipient of numerous awards in my State, my employer Sanford Health, (the largest rural provider in the country) and have been felicitated by the Governor and Senators of ND for my compassionate and forward thinking views in rural health care delivery, teaching of medical students , residents, PA’s, NP’s and other medical personnel. I have served as Presidents of Family Medicine, OB/GYN, and Interventional Pain.

I have also served as a Counsellor in NDMA and have received numerous awards by North Dakota Medical Association. I have been entrepreneurial in starting the area’s first Dialysis Center, Assisted Living center, helping develop a new Hospital and a hub and spoke model for delivery of primary and subspeciality care in rural southeastern North Dakota.

I have served the North Dakota Board of Medicine for the past six years and currently serve as its Chairman. I have served the Board in many committees including finance, budget, technology, recruitment and search of our Executive Director, relocation, real estate, PA rules, questionnaire and many other committees. I have attended three FSMB meetings and have served on the Audit Committee and currently serve on the ILMCC committee. I have also attended the USMLE committee for exam preparation and process of developing questions for the exam in Philadelphia.

I consider it a great privilege to be working with FSMB and I have the energy, experience, qualifications to function very well in a system that is focused on licensure, discipline, and foremost, protection of the public.

6 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RUP K. NAGALA, MD

DocuSign Envelope ID: 9A72A6D5-1B75-4B30-AB42-5687B13E5646

CURRICULUM VITAE

Rup Kumar Nagala, M.D. FAAFP Sanford Health Oakes Clinic 420 S 7th Street Oakes, ND 58474

Board Certification American Board of Family Medicine American Board of Interventional Pain Management American Board of Venous and Lymphatic Medicine Certificate of Added Qualifications in Sports Medicine Certificate of Added Qualifications in Geriatrics

Medical Licensure North Dakota, South Dakota, Colorado, Nevada

Clinical Practice Sanford Health Oakes Clinic, Oakes, ND 1978 to present Assistant Chief of Staff, Chief of Surgery Oakes Community Hospital, Oakes, ND 1978 to present

Academic Position Clinical Assistant Professor, Dept. of Family Medicine Clinical Assistant Professor of Geriatrics at the University of North Dakota School of Medicine

Awards National Rural Health Physician of the Year Award, 2010 American Academy of Family Practice, National Family Physician of the Year, 2003 Finalist North Dakota Medical Association Physician Community and Professional Lifetime Service Award, 2003 North Dakota Family Physician of the Year, 2001 North Dakota Chamber of Commerce Leadership Award, 1996 Outstanding Rural Health Provider, University of North Dakota Center for Rural Health, 1993 Recipient of Pioneer Award, Sanford Health, 2020 NDMA-Lifetime Dedication to Rural Medicine, 2020

Medical Directorship Medical Director, Good Samaritan Society, Oakes, ND Medical Director, Oakes Ambulance Service Medical Director, Forman Ambulance Service Dickey County Health Officer Sargent County Health Officer

7 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RUP K. NAGALA, MD

DocuSign Envelope ID: 9A72A6D5-1B75-4B30-AB42-5687B13E5646

Professional Memberships American Academy of Family Physicians North Dakota Academy of Family Physicians North Dakota Medical Association North Dakota Society of Obstetrics and Gynecology American Society of Interventional Pain Physicians

Statewide Committee Work President, North Dakota Society of Interventional Pain Physicians (NDSIPP), 2010 President, North Dakota Academy of Family Physicians Foundation,2009 Chairman of Board, North Dakota Academy of Family Practice, 1998 President, North Dakota Academy of Family Physicians, 1997 President, North Dakota Academy of Obstetrics & Gynecology, 2002 Board of Governors, Society of Obstetrics & Gynecology, 1999- 2001 Member, North Dakota Board of Medical Examiners, 2015- present Representative, North Dakota Board of Medical Examiners at Federation of State Medical Boards Treasurer, ND Board of Medical Examiners Chief of Complaints Panel A of ND Board of Medical Examiners Medical Consultant for the Nevada and Colorado Board of Medical Examiners Commissioner, Interstate Medical Licensure Commissioner, 2020 Chairman, ND Board of Medicine, 2019

Other Activities Instrumental in the construction of a brand new hospital in Oakes, ND Developed Assisted Living Center in Oakes, ND Developed DaVita Dialysis Center in Oakes, ND Developed many rural clinics in North Dakota; Edgeley, Ellendale, Forman, Gwinner, Hankinson, Lidgerwood, Lisbon

Mentorship, Teaching & Service Supervised and Taught many Residents, Medical Students, PA, NP and PT Students throughout career

8 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RUP K. NAGALA, MD

DocuSign Envelope ID: 9A72A6D5-1B75-4B30-AB42-5687B13E5646

Expertise Rural Primary Healthcare Delivery Inpatient and Outpatient Procedural Medicine

Personal Data Married to Vani Nagala, M.D. FACP 4 children; Sarala, Sonia, Jayant and Vikram

Humanitarian Service Service mission to provide Phlebology procedures to the people of Honduras with the Hemwall Hackett Foundation of Madison, Wisconsin in 2009

Philanthropic Activies Made Donations to several local organizations in the Oakes and surrounding communities.

9 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RAMANTHAN RAJU, MD, MBA

Candidate for Nominating Committee

Ramanathan Raju, MD, MBA New York

1 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RAMANTHAN RAJU, MD, MBA

DocuSign Envelope ID: EAE355B6-0673-43B2-8123-A5A1E0B7C7EB

THE STATE EDUCATION DEPARTMENT I THE UNIVERSITY OF THE STATE OF NEW YORK

State Board lor Medicine 89 Washington Avenue, 2'd Floor West Albany, NY 12234 Tel. (518) 474.3817, Ext. 560 Fax: (518) 486.4846 E.mail: [email protected]

October 27, 2020

Scott A.Steingard, Chair FSMB Nominating Committee Federation of State Medical Boards 400 Fuller Wiser Road Euless, Texas 76039

Dear Dr. Steingard,

I'd like to take this opportunity to offer my very strong support for the nomination of Dr. Ramanathan (Ram) Raju, M.D., M.B.A., FACS, FACHE, of New York as a member of the Nominating Committee of the Federation of State Medical Boards. Dr. Raju is aware of this nomination, agrees to its submission, and is fully aware of the responsibilities and time commitment expected of a member of the FSMB Nominating Committee, as explained in the 2020-2021 Nominations Announcement.

Since December of 20 17, Dr. Raju has served as a physician member of the New York State Board for Medicine, appointed by the New York State Board of Regents. He has been a frequent and valued contributor to the Board, most notably with his sage advice offered at quarterly board meetings, and as a member of the NYS Board for Medicine IMG Workgroup, responsible for evaluation and recommendations regarding the acceptance of licensure applications from international medical graduates. He is always readily available for board-related consultations and is known for the depth of his experience in healthcare and his apt common-sense views on often complex topics.

Dr. Raju has also enthusiastically worked in various capacities with FSMB. For the past two years, he has participated in the FSMB annual meetings as an alternate delegate from New York State. He serves on the Finance Committee, Education Committee, and the Ethics and Professionalism committee. In addition, Dr. Raju served as the subject matter expert on behalf of the FSMB for the Greenwall Foundation funded project, "Helping State Medical Boards Effectively Protect Patients by Identifying and Promulgating Promising Practices and Essential Resources."

You will find that Dr. Raju presents a rich CV in a career dedicated to medicine and public services. While the breadth of his experience is long and impossible to summarize in this letter, a few highlights include practice as a surgeon in NYC; Chief Operating Officer and Medical Director of Coney Island Hospital; Executive Vice President,. Chief Operating Officer and Chief Medical Officer for the NYC Health and Hospital Corporation; Chief Executive Officer of the Cook County Health and Hospital System, President of the NYC Health and Hospital

2 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RAMANTHAN RAJU, MD, MBA

DocuSign Envelope ID: EAE355B6-0673-43B2-8123-A5A1E0B7C7EB

Corporation; and most recently as Senior Vice President and Community Health Investment Officer for Northwell Health. His CV is rich with awards, affiliations and recognition of a dedicated and respected leader in medicine.

Dr. Raju's address is 25 Windy Hollow Way, Staten Island, New York, 10304 .. His email address is [email protected]. His cell number is 718-207-0526.

Thank you for the opportunity to present this nomination. We are fully confident that Dr. Raju will continue his much valued and respected service on the FSMB Nominating Committee. Please don't hesitate to contact me should you like any additional information regarding this nomination. ;l~J Stephen J. Boese Executive Secretary New York State Boards Medicine, Veterinary Medicine, Athletic Training, Medical Physics, Perfusion, and Pathologists' Assistants

3 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RAMANTHAN RAJU, MD, MBA

DocuSign Envelope ID: EAE355B6-0673-43B2-8123-A5A1E0B7C7EB CANDIDATE’S SIGNATORY PAGE

MEMBER MEDICAL BOARD ACTIVITIES

On which Member Medical Board are you currently serving? NY State Board of Medicne ______

If not serving, when did you leave the board? Month: Day: Year:

How long have you served (did you serve) on your Member Medical Board? ______5 years

• I am aware of the time commitment for the position I wish to be elected.

• I am disclosing any potential conflict(s) of interest.

SIGNATURE: ______

Potential Conflict(s) of Interest:

none

4 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RAMANTHAN RAJU, MD, MBA

DocuSign Envelope ID: EAE355B6-0673-43B2-8123-A5A1E0B7C7EB

2021 Bullet Points Ramanathan Raju, MD, MBA CANDIDATE FOR: Nominating Committee

FSMB Service: Education Committee 2020-2021; Ethics & Professionalism Committee 2018- 2019; Finance Committee 2019-2020; Annual Meeting Attendee 2019

New York State Board for Medicine o Member 2018-present

Relevant Professional Work

o Member, New York State Office of Professional Medical Conduct 2017-present o Distinguished career as the Healthcare Leader in this country having effectively ran two of the largest public systems in the country

o Nationally recognized expert on Health Equity and Social Determinants of health o National Spokesperson for Health equity and Health care reforms o Distinguished career as a practicing surgeon, medical educator, and researcher o Long term experience of being an effective board member having served in some of prestigious National State and regional boards

o Active member in the community member of community board 2 and land use committee and Chairman of American Diabetes association (NY NJ)

o Member of World Trade Center Medical panel that culminated in Congress allocating funds for the WTC victims medical conditions

5 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RAMANTHAN RAJU, MD, MBA

DocuSign Envelope ID: EAE355B6-0673-43B2-8123-A5A1E0B7C7EB

2021 Personal Statement Ramanathan Raju, MD, MBA CANDIDATE FOR: Nominating Committee

With deep humility and greatest enthusiasm, I submit my name for the candidacy for the Nominating Committee.

I consider is a privilege to join some of the most distinguished candidates

Having immigrated to this great nation over 40 years ago, I built a successful surgical practice which culminated in serving as the Chief of Surgery and the Founder Director of Level I Trauma Center in Brooklyn NY. My experience included academic appointments in medical schools, Director of Medical Education in 3 different hospital systems, and extensive surgical research culminating in numerous scientific publications.

After nearly over 20 years of surgical practice I became a leading proponent of health equity and that journey took me to serving some of the most vulnerable population in NY and Chicago. I served as the President and CEO of two largest public Healthcare Systems in this country-Cook County Health and Hospitals System and NYC Health and Hospital System-the largest public Healthcare system in our country

My work on fighting for health and social equity have given me opportunities to serve in the Boards of some of the most prestigious national, state, regional and local health care institutions such as AHRQ, American Diabetic Association (NY & NJ) American Hospital Association, Vice Chair of Greater NY Hospital Association, HealthCare Association of NY State, National Association of Public Hospitals, Past President of Asian Healthcare Leaders forum of American College of Healthcare Executives and Institute of Healthcare Diversity.

I am a leading National spokesman for the Health Equity and Social Determinants of Health having delivered over 300 keynote addresses in national and international conferences.

I am serving as a director of both OPMC and Board of Health of NY state. I continue to serve in many Disciplinary and License restoration hearings.

I am a member of IMG workgroup responsible for recommendations regarding the acceptance of licensure applications from IMGs and a member of task force on developmental disabilities.

I have served in the Ethics and Professionalism Committee, Finance Committee and the Education Committee of FSMB.

I have served as the subject matter expert on behalf of FSMB for the Greenwood Foundation funded project “Helping State Medical Boards Effectively Protect Patients By Identifying And Promulgating Promising Practices and Essential Resources”

I believe with my background I could be an effective nominating committee member.

I appreciate your consideration.

6 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RAMANTHAN RAJU, MD, MBA

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RAM RAJU MD, MBA, FACS, FRCS, CPE, FACHE

EDUCATION FACHE CPE- Certifying Commission in Medical Management – 2001 MBA – Physician’s Executive Program - Magna Cum Laude – 4.0 GPA, 2000 UNIVERSITY OF TENNESSEE, Knoxville, Tennessee FELLOW, ROYAL COLLEGE OF SURGEONS, FRCS, Glasgow & Edinburgh UK 1981 Master of Surgery – General Surgery, 1979; MD, 1976 MADRAS MEDICAL COLLEGE, Madras, India

PROFESSIONAL CREDENTIALS Licensed Physician, Current NEW YORK,

CERTIFICATION & RECERTIFICATION, Current AMERICAN BOARD OF SURGERY FELLOW, AMERICAN COLLEGE OF SURGEONS – FACS, 1992 FELLOW, ROYAL COLLEGE OF SURGEONS, FRCS, Glasgow & Edinburgh UK 1981 FELLOW, AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES

MEDICAL LEADERSHIP COMMITTEES  Member of Boards AHA HANYS AHCLA, GYNHA (Vice chair) & America’s Essential Hospitals  Chairman EOC committee AHA  ACHE Chairman of Research Committee and Chairman, CEO Committee  Member, NYC Board of Health  AHA Region 2 Board and Region 5 Board  CHEF Board of Regents  AHA President’s Forum on Post-Acute Care  NQF...Emergency Dept. Standards  Chair elect ACHLA  Director Illinois Hospital Association  Delegate Illinois Medical Society  American College of Surgeons Past Director  Chicago Medical Society Counselor  Member World Trade Center Medical Task Force  Fellow of Institute of Medicine of Chicago  Member, Illinois State Healthcare Transformation Committee  Healthcare Committee, Urban League Club of Chicago  Member Economic Club Chicago  Advisory Board xG Health Solutions

PROFESSIONAL AFFILIATIONS  Fellow, American College of Surgeons  Fellow, American Society of Pain Management  Fellow, International College of Angiology  Fellow, International College of Surgeons  Fellow, Royal College of Surgeons: Edinburgh, Glasgow  Fellow, American College of Health Care Executives  American College of Physician Executives  American Medical Association; British Medical Association; Indian Medical Association  American Association for the Advancement of Science  American Trauma Society

7 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RAMANTHAN RAJU, MD, MBA

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 American Society of General Surgeons  American College of Abdominal Surgeons  American Society of Breast Surgeons  International Society for Endovascular Surgery  Association for Academic Surgery  Association for Surgical Education  Association of Surgeons of India  Chicago Surgical Society  Eastern Associates for Surgery of Trauma  NY Academy of Science  NY Academy of Medicine  NY Surgical Society  Society of Clinical vascular Surgery  Society of Laparoendoscopic Surgeons  Society of Vascular Surgery

AWARDS  Recognized as one of the Best Doctors- multiple publications– since 1997  Physician of the Year – Pesha Elias Bikur Cholim D’Bobov, Brooklyn, New York, 1999  Attending Physician of the Year & Teacher of the Year – Brooklyn Southwest Surgical Residency, 1995, 1999 and 2000  Core Value Star of the Millennium Lutheran Medical Center  Leadership Award University Group medical Associates and Coney Island Hospital  Leadership award Mount Sinai Medical School  Professional Achievement Award- Medical Society of the County of Kings  Community Leadership award- American Russian Foundation  Humanitarian award Metropolitan Hospital Auxiliary  Leadership Award HHC Board of Directors  Standing on our Fathers shoulders: Citation Entered in to Congressional Record for public service  Public Service award Association of Tamil Nadu Medical Association  Top 25 Minority Executive – Modern Healthcare 2012, 2014, 2016  Healing Hands award –Chicago Family Health Center  Nation’s 50 Most Influential Physician Executives – Modern Health Care and Modern Physician 2013, 2014 2015&2016  Chicago United’s Business Leaders of Color for 2013.  Fellow of Institute of Medicine Chicago 2013  Who is Who in Chicago… Chicago’s most influential people Crain’s Business 2012 and 2013  Becker’s Top Physician Executives 2013and 2014  Becker’s 20 Hospital and Health System Leaders to Follow on Twitter 2013  Distinguished Physician Award IAMA 2013  Leadership Award CCHHS University 2013  Provider of Year Campaign for Better Health care Illinois 2013  Doctor of Humane Letters NYCPM 2014  100 Most Influential Leaders in Health Care – Modern Health care 2014, 2015 &2016  NYC Public Advocate’s Award for Public Service 2014  NYC Pakistani Civic Association Community Service Award 2014  Leadership Excellence Award QLI APPI 2014  Tamil Ratna US Tamil Sangam 2014  Leadership and Service Award TANA 2015  Justice and Opportunity Award NY Immigration Coalition 2015  Leadership Award Indian Association of Long Island 2015  Tamil Pioneer Award Federation of Tamil Sangams US 2015  Visionary of the Year American Hispanic health Leaders Association 2015

8 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RAMANTHAN RAJU, MD, MBA

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 President’s Award APPI USA 2015  Community Service Award Touro College 2015  Award of Honor, AIIMSoniams 2015  Healthcare Visionary award Communilife 26th anniversary Breakfast 2015  Community Service Award New York Tamil Sangam; 2015  Distinguished Leader of Indian Origin AAPIQLI Gala 2015  Hispanic Health Leadership Award National Hispanic Health Foundation 2015  Excellence in Health services Award; Concerned Women of Brooklyn 36 Annual Recognition Day celebrations 2015  Crown Heights Jewish Community Council Humanitarian Award 2016  National Minority Quality Forum: Booker T Washington Award for promoting Diversity at all levels and reduce healthcare disparities at a national level 2016  Wheel Chair Charities: Health Care Visionary Award 2016  Primary Care Development Corporation Leadership award 2016  CRAIN 100- 100 Innovators, Disruptors and Change-Makers in Business 2016  South Asian Council for Social Services SACSS; Award in recognition of service to immigrant communities 2016  Assoc. of Operations & Supply chain NYC-LI chapter Award 2016  Union Settlement Award for Life time support of Public Health 2016  Healthcare Leaders of New York Award of Distinction 2017  Human Services Council of New York, Changemaker of New York Honoree 2018

Northwell Health, New Hyde Park, NY Senior Vice President, Community Investment Officer 2017 – 2020

Northwell Health is New York State’s largest health care provider and private employer, with 21 hospitals and over 550 outpatient facilities. We care for more than two million people annually in the metro New York area and beyond, thanks to philanthropic support from our communities. Our 61,000 employees – 15,000+ nurses and nearly 3,400 physicians, including nearly 2,700 members of Northwell Health Physician Partners -- are working to change health care for the better. We’re making breakthroughs in medicine at the Feinstein Institute. We're training the next generation of medical professionals at the visionary Hofstra Northwell School of Medicine and the School of Graduate Nursing and Physician Assistant Studies. And we offer health insurance through CareConnect. For information on our more than 100 medical specialties, visit Northwell.edu.

As senior vice president and community health investment officer reporting to the CEO and President of the system, my job is to evaluate the needs of the most-vulnerable communities Northwell Health serves, assess programs that enhance the health system’s ability to respond to those needs and collaborate with community-based organizations to create problem- solving solutions. To collaborate on Population Health Strategies and work with the other stakeholders to improve community health outcomes.

New York City Health and Hospitals Corporation, New York, NY President and Chief Executive Officer 2014- 2016 The New York City Health and Hospitals Corporation (HHC) is a $6.7 billion integrated healthcare delivery system and is the largest municipal healthcare organization in the country. HHC provides a wide range of high quality and affordable healthcare services to 1.4 million New Yorkers every year and more than 475,000 are uninsured. HHC offers medical, mental health and substance abuse services, as well as specialized care for a wide range of health conditions through its 11 Centers of Excellence. Comprehensive, personalized care is available to all New Yorkers at HHC's 11 acute care hospitals, five skilled nursing facilities, six large diagnostic and treatment centers and more than 70 community based clinics. HHC Health and Home Care also provides in-home services for New Yorkers. HHC's own MetroPlus Health Plan is one of the New York area's largest providers of government-sponsored health insurance and is the plan of choice for nearly half a million New Yorkers. HHC was the 2008 recipient of the National Quality Forum and The Joint Commission's John M. Eisenberg Award for Innovation in Patient Safety and Quality. Several HHC facilities have been recognized nationally for clinical excellence and commitment to quality achievements.

9 Nominating_2021F (HOD) - Tab D - Candidate for Nominating Committee RAMANTHAN RAJU, MD, MBA

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During the past 24 months successfully negotiated the past UPL payments totaling 2.8 billion dollars with CMS .Successfully obtained 1.7 billion from FEMA for rebuilding Sandy related damage to HHC. Set the “2020 vison” the strategic plan to make HHC financially viable. Led the workforce strategy to develop 21st century workforce by training and education. Successfully renegotiated all expired labor contracts with City OLR. Successfully managed the first Ebola patient in NYC. Successfully negotiated FQHS look alike status for all our D&TCs. Successful ACO ranked top quartile nationally was awarded $13+ in shared savings. Fitch bond rating affirmed A+ by acknowledging improved revenue growth. Successfully implemented the phase 1 of Epic as EMR Led the largest transformation of the public healthcare with mayor city hall officials, labor and community leaders http://www1.nyc.gov/assets/home/downloads/pdf/reports/2016/Health-and-Hospitals-Report.pdf For more information, visit www.nyc.gov/hhc or find us on facebook.com/nycHHC or twitter.com/HHCnyc. Cook County Health and Hospitals System, Chicago, Illinois Chief Executive Officer 2011- 2014

Third largest public health system with strong ties to academic medical centers over billion dollars in revenue and employs 6000FTEs. The Cook County Health & Hospitals Systems oversees a comprehensive, integrated system of healthcare throughout Chicago and suburban Cook County. CCHHS is made up of seven affiliates – two hospitals, a growing ambulatory and community health network, a public health department, a correctional healthcare facility, and nationally renowned CORE center- an outpatient HIV and infectious disease center. I report to the CCHHS Board of Directors and have oversight responsibility for each of these institutions. (cookcountyhhs.org)

During the 22 months tenure turned around the financial slump from a 169 million dollars deficit to break even. Worked to improve revenue cycles and improved the recruitment and retention. Instituted physician billing and implemented supply chain efficiencies by saving 25 million. Negotiated Medicaid rate increase and negotiated DSH and UPL payments to balance the budget. Presented a strategic vision to transform the health care system to be effective in the post health care reform market. Obtained 1115 waiver from the CMS for early enrollment and empanelling them into medical homes. Architect of “County care” which gave access to over 180K cook county residents. Developed fine reputation from the local leaders, press and politicians for a being a transformative leader. Implemented new table of organization and recruited national talent. (See attached one pager)

New York City Health and Hospital Corporation, New York, NY Executive Vice President, Chief Operating Officer and Chief Medical Officer 2006- 2011 Senior Executive Position (No.2 position) reporting to the president of the largest public hospital corporation in USA. NYCHHC is 6.2 billion dollars corporation which treats 1.2 million patients (one out of every 6 New Yorkers) a year and employees over 40.000 people (visit nyc.gov/hhc). The executive vice president officiates as the President in his /her absence and represents him as the voting member of the board in his absence. The EVP is in charge of the entire operations of the organization, Medical and Professional affairs, Capital and infrastructure development, Metroplus Health Plan, HR, Union relations, Medical school affiliations and Information Technology. Led the corporate Medical and Professional affairs which incorporates the medical affairs, nursing , research , patient safety, quality , health promotions , Behavioral health, credentialing, JCACHO and multitude of the medical divisions .EVP has over 18 M&PA divisional senior staff reporting to him. The SVP of the operations reported to the EVP thereby making the position in charge of the entire operations of the organization including Medical school and physician group affiliation, contracting and procurement, labor relations, union negotiations, and Human Resources. .EVP oversaw the 1.2 billion dollars capital projects. As the person in charge of IT the EVP spearheaded the migration of EMR to a new system. Metroplus, the Medicaid managed care plan owned by the corporation (enrollees ~500k) reports to the EVP. EVP also sits in the Metroplus Board as a voting member. I also sit in the important city, state and federal committees regarding Health care (Mayor’s Medical taskforce on WTC, National Quality Forum, Hanys and GYNHA task forces and SDOH task forces on “Never events” and ED overcrowding). Undertook to close the deficit of 1.2 dollars and successfully implemented the changes needed to achieve the target... Worked closely with the CFO in improving Revenue cycle by better documentation and charge capture in the ED. Worked with legal in organizing the grand rounds and educational seminars to reduce malpractice claims. Major collaboration with the marketing and Public relations to represent corporation views on various issues and commented on major health care policy decisions. Overall budget responsibility is over 1 billion dollars

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CONEY ISLAND HOSPITAL, Brooklyn, NY Chief Operating Officer and Medical Director 2005 - 2006 Senior Executive position (No.2 Position) Chief Deputy to the CEO in charge of the daily operations of the hospital with the all clinical service lines directly reporting to me. This is in addition to the all the duties and responsibilities of the Medical Director. In charge of capital planning and worked closely with the CEO on various revenue initiatives. Oversaw the move into the new bed tower. Closely worked with the CFO in monitoring the revenues and expenditures. Regularly met with the leaders of the financial dept in E&R meeting. Member of Vacancy Control Board and closely regulated the hiring of the employees. Involved in the negotiations of the union. Member of the network compliance committee. Intimately involved in the employee recognition and did the executive walk around to energize the employees. Played an active role in the patient safety activities and started the “near miss” campaign. Spearheaded the JCAHO preparations. Revitalized the employee recognition program. Led the hospital in the QA indicators and got the first rank in the city. Recognized for the leading the organization to the lime light in the AMI and CHF indicators. Selected by the network SVP to undergo Patient safety Executive training program of IHI. Won multiple honorable mentions in the HANYS for the various risk reduction programs. Instrumental in t developing palliative care program and won acclaim from the united hospital fund. Won the IPRO award for the hospital with the best community service. Led the organization for the best network performance in the Metroplus QARR indicators. Led the organization to be named as one of the Top 50 patient safe hospitals in the country by consumer digest. Won the NAPH award the Implementing and leading the E Team concept. Devised and led the most effective Community Physician program in the Corporation.

CONEY ISLAND HOSPITAL, Brooklyn, NY MEDICAL DIRECTOR AND DIRECTOR OF MEDICAL EDUCATION 2002 to 2005 Senior Executive with the responsibility for Quality, Risk Management, Medical Affairs, Utilization review, Credentialing, Medical education, Patient safety and Medical informatics for a 300+ bed acute care safety net hospital serving about 2 million people of southern Brooklyn. Total operational budget of approximately 250 million and employs over 2000 people. Also the First Vice president of its affiliate, University Group Medical Associates, a not for profit Medical Corporation employing over 300 physicians. Member of the financial and Audit committees of the PC. I chair over 10 important committees of the hospital and intimately involved in Case Mix index and LOS initiatives. Brought the case mix index by more than 15% and reduced the average LOS to 4.2 days. Supervised a team of clinical chairs and multiple non clinical departmental directors and successfully hired 5 chairpersons. Reorganized 3 clinical departments and successfully recruited over 75 physicians and over 59 allied health professionals. Conceptualized and introduced Physician incentive payments based on productivity for the first time in the history of the PC. I successfully led the hospital through JACHO and NYS validation surveys with no type I recommendations and a score of 97 in the JACHO survey. Won the leadership award for the successfully leading the organization through the surveys. Reorganized the medical education and successfully initiated new programs. Got the institution compliant with NYS residents work hour rule (405). Led the chronic disease collaborative programs and community physician recruitments with success. Played an important role in the various initiative of the corporation such as Ambulatory care redesign, chronic disease collaborative with IHI and strategic committee of the HHC foundation.

LUTHERAN MEDICAL CENTER, Brooklyn, NY SENIOR VICE PRESIDENT AND DIRECTOR OF MEDICAL EDUCATION ASSOCIATE CHAIRMAN OF SURGERY – CHIEF OF SURGERY-DIRECTOR OF TRAUMA - DIRECTOR OF SURGICAL RESEARCH 1988 to 2002

KUMAR & RAJU, MD, PC, Brooklyn, NY PRESIDENT 1988 to 2000 Launched this three-member practice specializing in state-of-the-art surgical services (general, vascular, pediatric, minimally invasive) for several area communities. Developed strategic business, financial and marketing plans and recruited/trained support staff to facilitate starting the business, capture competitive market positioning and strengthen financial returns; first-year revenue exceeded $1 million.