FEDERATION OF STATE MEDICAL BOARDS (FSMB)
Candidates for the FSMB Leadership | 2013—14
Positions to be filled in 2013 are as follows:
Chair Elect – 1 Fellow, to be elected for 3 years: one year as chair-elect; one year as chair; and one year as immediate past chair
Board of Directors – 3 Fellows, each to be elected for a three-year term
Nominating Committee – 3 Fellows, each to be elected for a two-year term*
*No two Nominating Committee members shall be from the same member board. Continuing members of the Committee will be from Arizona Osteopathic, Minnesota and Wisconsin.
Chair—elect and Immediate Past Chair
Galicano F. Inguito, Jr., MD, MBA — Delaware
Donald H. Polk, DO — Tennessee Osteo
BOARD OF DIRECTORS
Mohammed A. Arsiwala, MD — Michigan Medical Ralph C. Loomis, MD — North Carolina Leticia J. San Diego, PhD — Michigan Medical Datta G. Wagle, MD — New York PMC Michael D. Zanolli, MD — Tennessee Medical
NOMINATING COMMITTEE
Deeni Bassam, MD — Virginia Tariq H. Butt, MD — Illinois Disciplinary Anna Z. Hayden, DO — Florida Osteo
Galicano F. Inquito, Jr., MD, MBA - Delaware
FSMB Board Treasurer 2012-present
FSMB Board of Directors 2009-2012, Executive Committee 2011-2012
FSMB Liaison to the Federation Credentials Verification Service 2011-2012
FSMB Nominating Committee 2005-2007
USMLE Step 3 Committee 2005-2008, 2008-2011
Master of Business Administration, University of Delaware Executive MBA
PERSONAL STATEMENT
Since I attended my first Federation of State Medical Boards meeting in San Diego in 2002, I have wanted to become more involved in the organization. It has been an honor and a privilege to serve on my state licensing board. I have been fortunate to serve on the FSMB’s Nominating Committee (2005-2007), the FSMB Board of Directors (2009-2012), and I currently serve as the FSMB Treasurer. I have been a member of the FSMB Executive Committee for the past 2 years, United States Medical Licensing Examination (USMLE) Step 3 Committee, Accreditation Council for Continuing Medical Education Board of Directors (ACCME), FSMB Governance and Planning Committees.
I graduated from Jefferson Medical College and completed my residency in Family Medicine at the Eastern Virginia School of Medicine – Ghent Family Practice. I am a practicing Board-certified family physician. I am committed to promoting and maintaining high standards of performance and a commitment to continuous quality improvement. I completed a Master of Business Administration degree in 2002. I would like to utilize my clinical and business knowledge to further meet the challenges of the FSMB.
I would very much like to use my experiences to look out for the best interests of the FSMB and its state member boards. You will find me accessible and interested in all viewpoints. My willingness to listen and to work within the FSMB’s structure will allow me to be an effective Chair. New concerns mandate creative solutions, and I am willing to invest the time and energy to serve.
It is with great anticipation that I am running for Chair-elect. I have the desire, the ability and the commitment to serve the FSMB. My qualifications are broad and strong, which will allow me to function well within a system that is focused on licensure, discipline, and protection of the public. It has been an honor and a privilege to serve you. I look forward to meeting and talking with you in Boston.
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Donald H. Polk, DO - Tennessee Osteo
Selected by FSMB Board of Directors to EXECUTIVE Committee (2012-13)
Elected to FSMB Board of Directors (2010-Present)
Appointed to Tennessee Board of Osteopathic Examination (1996-Present)
President Tennessee Academy of Family of Physicians (2000-01)
Selected - TAFP PHYSICIAN OF THE YEAR (1999)
President Tennessee Osteopathic Medical Association (1991)
Served 28 years Tennessee Army National Guard - Retiring as Brigadier General
Awarded - THE LEGION OF MERIT by US Secretary of the Army
PERSONAL STATEMENT
My medical career is that of service, as a Family Physician, to my patients and community in a small rural town in South Central Tennessee.
Service to our country has been a major part of my career, having served 28 years in the Tennessee Army National Guard. Commissioned as Captain – Medical Corp., I provided hands on care to our soldiers. My appointment as State Surgeon allowed me to provide leadership and service throughout our entire state. Following graduation from the US Army War College, I was promoted to Brigadier General and was appointed Deputy STARC Commander. It was my honor to be awarded the LEGION OF MERIT.
Leadership through service in medical organizations has given me the opportunity to participate in the strategic environment of health care planning. I am an active member of the Tennessee Osteopathic Medical Association and Tennessee Academy of Family Physicians. Serving on committees and in elective leadership positions prepared me to serve as President of these state physician organizations. Serving as Delegate to the AOA and AAFP provided interaction at the national level.
Service in medical licensure began with my appointment to the Tennessee Board of Osteopathic Examination in 1996. I continue to serve on that Board and have held the positions of Secretary and Vice-President. Serving on the Tennessee Controlled Substance Database Advisory Committee we developed our state Controlled Substance Monitoring and Tracking System.
Involvement with the FSMB began when I was selected as the Tennessee DO Board Delegate in 1997 and from 2006 – present. I have served on the Emergency Preparedness Workgroup, Bylaws Committee, Chair of Reference Committee at the 2009 FSMB Annual Meeting, Readiness and Response Workgroup, and the FSMB/ Uniformed Services Workgroup.
Three years ago I asked for your support and was elected to the FSMB Board of Directors. This has been three years of tremendous work, growth, and involvement in representing and supporting state medical boards. Appointment and service on the Governance, Investment, Finance, and Compensation Committees of the FSMB Board have given me a broad based knowledge and perspective of our organization. It was my honor this year to be selected by my fellow Board of Directors to serve on the Executive Committee.
LEADERSHIP through SERVICE with EXCELLENCE will continue to be my mission and vision as I submit my nomination for Chair-elect of the FSMB. I will strive to engage Communication, pursue Cooperation, and develop Consensus as the FSMB continues to be the premier organization that represents, leads, and supports our state medical boards. I have the time, desire, ability, and commitment to serve.
I humbly seek your consideration, advice and support.
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Mohammed A. Arsiwala, MD - Michigan Medical
Leadership: served as chair of MD PAC for Michigan State Medical Society there by promoting and advocating the very critical issues in medicine to state and national legislature.
Social issues: two resolutions dealing with energy drinks and female genital mutilation strengthened our AMA policy nationally.
Mentoring: over a decade to high school kids via career internship program to encourage them to pursue the field of medicine.
Service: volunteer at a charity clinic for over a decade to serve the health care needs of poor and needy.
Entrepreneurship: built the largest urgent care company in the state of Michigan providing clinical care to nearly 100,000 patients every year in five counties.
PERSONAL STATEMENT I have volunteered for over 10 years at St. Vincent Department Health Center taking care of indigent patients.
In January 2012 I was appointed by Governor Rick Snyder to Board of Medicine and in March 2012 to the Advisory Committee on Controlled Substance.
My passion is in the area of legislative and advocacy. I have served on the Board of Michigan State Medical Society on the Legislative & Regulating Subcommittee for 8 years and as Chair of MDPAC for State of Michigan.
On the Board of Medicine I am serving on the Process Committee and helping develop “Reentry into Practice”, “Substance Abuse Problems in Physicians”, “Questionnaire for Licensure” (new and reinstatements).
I have always served my current positions on multiple boards with hard work, dedication, and an unwavering attitude to do the best. I pledge to do the same for the Federation of State Medical Boards.
Thank you for considering me as a candidate and hope I can find your support in this endeavor.
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Ralph C. Loomis, MD - North Carolina
Chair, FSMB Bylaws Committee 2010-present; major bylaws overhaul 2011
Member, FSMB Bylaws Committee 2007-2010
President, North Carolina Medical Board 2011-2012
Member, North Carolina Medical Board 2005-2008, 2009-2012
30 years of community neurosurgery practice and continuous level II trauma call
PERSONAL STATEMENT Commitment to professionalism is acknowledgment of the honor and responsibility we have as medical practitioners. It is unequivocal and enduring. Professionalism encompasses principles of unselfish concern for others, dedication to quality patient care and commitment to patient autonomy and confidentiality. I can think of few qualities that are more essential to the mission of the Federation.
As a Board Director, I will challenge every Federation fellow to recommit to the values outlined above. I feel my FSMB and North Carolina experience will allow me to enhance the FSMB mission.
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Leticia J. San Diego, PhD - Michigan Medical
FSMB Editorial Committee 2008-11, 2011-14 (editorial “Professionalism: Expression of Mission, Vision and Values”); SB Voting Delegate; Member, FSMB Advocacy Network
Member, Michigan Board of Medicine since 2005; served Disciplinary Committee; Chaired Nomination Committee; Chaired and Member, Investigation and Allegation Committee
Founder, Health Care Management Development Center: President, Administrator and Consultant; Consultant in CLIA regulation, Compliance, State and Federal regulations
Books authored “IAMLT: Linking CLS to the 21st Century Technologies” (winner of an International Award in 1994), “Effective Management Strategies for ALS (Amyotrophic Lateral Sclerosis): A Quest for Cure ,Understanding Clinical Syndromes and its Amelioration”, Keynote speaker –IAMLT
Past President MSCLS; Consultant Certification Board-American Medical Technologists;
Chaired-Consultant Forum Scientific Assembly; American Society for Clinical Laboratory Science; Speaker and many articles written on, Administration, Hematology, Patient Safety, Contributing author -A Plan to Improve Patient Safety in MI Health Care System Advisor, Point of Care and Hemostasis: Clinical and Laboratory Standard Institute
Awards and Recognition: Scientific Award 1998, 2000, 2002, 2004; International Award 1994; Theriot Award in Media Development
Recognition by the MI Legislature for medical and health services 2004; US Congressional Recognition 2006; Presented with USA flag flown at US Capitol, ASCLS Presidential Award 2012; Recognition Macomb Center of the Performing Arts 2012
PERSONAL STATEMENT My medical, health career began at the University of Michigan Medical Center involved in a profession advancing the standards essential for diagnostic testing as a staff member in Pediatric Hematology. I became the Section Head of Laboratory Medicine at Children’s Hospital of Michigan and Founder, President of Health Care Management Development Center an institution devoted to improving laboratory medicine providing professional, administrative, management consultation in medical laboratory practice, POL’s, POCT, regulatory compliance state and federal regulation, Health and Human Services and patient safety.
As a longtime active member of the medical/clinical laboratory community, I have served in various leadership positions that include: Chair ASCLS Consultant Forum Scientific Assembly, authored the Consultant Body of Knowledge, a member of the AMT Certification Board, CLSI Advisor on Point of Care and Hemostasis Testing, developing consensus guidelines to improve patient care and safety, and President of MSCLS.
My experiences with regulation and professional licensure began in 1997as a member of the AMT Certification Board, ASCP and ASCLS licensure efforts. I am an advocate of the value of licensure, regulation, health policy and patient safety. I testified to the legislature, to Blue Cross Blue Shield and on the Commission on Patient Safety. Contributing author of “Call to Action to Make Health Care System in Michigan Safe”, leading to the passage of Patient Safety Legislation that became Michigan Public Health Code 119- 04.
I was appointed to the Michigan Board of Medicine in 2005, served on the Disciplinary Sub committee, Chaired the Nomination Sub Committee, Chaired the Investigation and Allegation Committee for two terms. I learned much about the physician licensure process and on going assessment of practicing physician’s competencies. As a public member, my responsibility is to assure that not only the public is safeguarded but also in consideration of the most effective ways to promote the physical and mental well being of those being monitored by the system.
Given the wide range of experiential responsibilities I have fulfilled during my career and my multi disciplinary educational background I am bringing to FSMB, I am in a position to lead passionately in the oversight of a regulatory organization with a wide variety of perspectives. I have lobbied in Washington D.C. as both a provider and consumer of health care for the benefit of all citizens.
It is with my public servant, scientist, administrator, patient safety advocate, and leader mindset that I am running for the FSMB BOD. I will commit my time in dedication to accomplish the mission, vision and value of FSMB. My organizational experiences and strategic financial qualifications are strong which will allow me to function at a standard of highest quality level of excellence with in the national system centered on licensure, discipline and public protection.
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Datta G. Wagle, MD - New York PMC
Board Certification in General Surgery and Urology; advanced training in kidney transplantation, hemodialysis, and urologic chemotherapy at Roswell Park Cancer Institute and Cleveland Clinic
President of the following Urologic Societies: Buffalo Urologic Society, New York State Urologic Society, American Association of Clinical Urologists (AACU), Northeastern Section of American Urological Association (NS AUA), American Urological Association (AUA – National Association of Urology)
Also, as President of the National Urology Political Action Committee (UROPAC 2005‐2009)
Introduced in US Congress urotrauma (Iraq and Afghanistan wars) and prostate cancer bills
Raised funds for urologic research and scholarships at the national and sectional (including Canada) levels
Honorary Life Memberships in the international societies of Brazil, Canada, Hungary, Japan, Mexico, and India, in addition to the AUA and AACU
Inducted by the Canadian Journal of Urology (an indexed journal) as a “Legend in Urology”, April 2012, a rare honor
PERSONAL STATEMENT I have been a member of the New York State Office of Professional Medical Conduct from 1991 to date. When I was asked to serve on the Administrative Review Board for Public Safety and Physician Discipline in 2003, I enthusiastically accepted. My vast experience in maintaining the highest standards of medical practice has been invaluable as I continue to serve on this prestigious board.
As a member of the Northeastern Section of the AUA, I, along with my colleagues, was successful in raising funds and awareness for scholarships, research, education and academic careers in urology. I continued this work at the national level as a Board member, and later, as President of the AUA.
I am familiar with the objectives and goals of the FSMB, having served on its nominating and program (editorial) committees. I wholeheartedly support the vision, mission, values, and strategic goals of the FSMB and if chosen, will faithfully and diligently serve the Board.
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Michael D. Zanolli, MD — Tennessee Medical
Professional Academic: Wake Forest University, Assistant Professor; Vanderbilt University Medical Center, Associate Professor
Professional Practice Settings: University practice; Employed by hospital system; Solo practice (small business owner); Multispecialty practice setting
Teaching: Founding faculty member, Dept of Dermatology of Wake Forest University; Founding faculty member, ACGME approved training program at Wake Forest; Faculty member, Vanderbilt Division of Dermatology
Service: Local, state, national, international organizations with leadership roles at each level; Interaction with physicians from various medical specialties and primary care; Representation of my own specialty and also physicians who practice in my city and state; BME activities
Political: Delegate to TN Medical Association annual meeting from the Nashville Academy of Medicine;
Submitted resolutions to the TMA which led directly to state legislative action and new statues regulating the practice of medicine in TN; Chairman for two years of SkinPAC, the federal political action committee of the American Academy of Dermatology; Media training and experience with representation and lobbying of state and U.S. congressman and senators
Social: Spouse of 27 years, Julie Sandine, Asst Dean for Student Affairs, Vanderbilt University Law School; Fairfax Avenue Book club - one of the founding members; 2000 Class A United State Open shotgun shooting FITASC champion
PERSONAL STATEMENT
As the voting representative from the TN BME to the FSMB House of Delegates since 2009, I have come to know many of you and comprehend the importance of the voice and actions of our FSMB on the state and national level. This type of advocacy and degree of influence is not apparent to the average physician whose focus is on patient care and daily duties. I have been fortunate to be a member of the FSMB Bylaws Committee for the past two years giving me insight into the structure and administration of our federation. The FSMB is entering into a new century with dedicated and skilled administrative staff providing a solid foundation from which the elected leadership works to fulfill the FSMB’s mission in national and international arenas. The example given by the elected leaders of the FSMB, as well as its recent past chairs, has inspired me to seek election to the Board.
I have been active in the American Academy of Dermatology working to help organize state societies, reviewing proposed federal legislation while on the Congressional Policy Committee, and have been engaged in advocacy related to the practice of medicine. I served a two-year term as chairman of SkinPAC, the federal political action committee of the American Academy of Dermatology Association. The term as chairman of SkinPAC, which ended in December 2010, corresponds to the congressional election cycle. This experience has given me appreciation of the importance of the FSMB Washington office and direct interaction with members of the US Congress.
To move forward and apply my experience and inherent abilities, I need your support. I will act with civility but promote the qualities and capabilities of a representative of the FSMB if elected. I humbly ask for your consideration for election to the Board of the FSMB. I look forward to meeting you and having a conversation at the 2013 annual meeting in Boston.
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Deeni Bassam, MD — Virginia
Board certified anesthesiologist and pain management specialist in private practice since 2002
Founding partner of The Spine Care Center; a multi-specialty physician medical group offering comprehensive care for adult spinal disorders in Northern Virginia since 2005
Past President, Prince William County Medical Society
Member, Virginia Board of Medicine since 2009
Husband and father of four children
PERSONAL STATEMENT
I believe sincerely that successful individuals have a responsibility to contribute their time and expertise in the betterment of their communities. If given the opportunity to serve in this position, I hope to be an active participant in executing the mission of the committee.
Thank you for your consideration of my application.
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Tariq H. Butt, MD — Illinois Disciplinary
I have worked and served in Leadership positions with Chicago State Medical society to partner with legislators to come up with practical solutions to support physicians while maintaining patient safety
I served as Member of Chicago Public Schools third largest district and introduced health curriculum and concept of significance of health and educational outcome
Initiated and integrated Academics into community health centers. I was part of team to start family Medicine training Program at Mount Sinai Hospital at Chicago
Participate in Health care Forums as Speaker with Local and National Health care Leaders
As Chairman of Illinois Medical Disciplinary Board Inform Physicians and opened doors for dialogue to work in partnership and cohesion
PERSONAL STATEMENT
It would be a distinct honor to serve on the Nominating Committee and given the opportunity I will make every effort to fulfill the mission of the FSMB in ways that make everybody proud. I have experience in various capacities to contribute in humble ways.
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Anna Z. Hayden, DO — Florida Osteo
Married 25 years
Two children, ages 19 and 21
President, Florida Osteopathic Medical Association 2008-2009
Health Policy Fellow 2008-2009
Chair, Florida Board of Osteopathic Medicine 2011-2012
Clinical Associate Professor, Nova Southeastern University College of
Osteopathic Medicine
Numerous volunteer projects for the community
PERSONAL STATEMENT
I completed the health policy fellowship (HPF) through Ohio University/NYIT at the same time I was President of FOMA. I learned how to analyze health policy in terms of cost, access and quality to patient care. Think of unintended consequences and reach for the high ground. I also learned nothing happens in our state until all the stakeholders can agree with the issues at hand. As I look back at life’s challenges I learned how to better analyze them with this training.
Continuing my involvement with the FSMB to achieve the goal of improving health care quality and thus improving the public well being and safety will be a great opportunity for me to use my skills at the national level. With my health policy fellowship training I will strive to achieve that the processes remain balanced and equitable by using the values learned in the HPF. The Nominating Committee is a perfect slot for me to start my involvement as I can spot and engage other talented individuals to get on board. I look forward to the rewarding challenges facing the FSMB and in creating a positive change in medicine. I humbly ask for your support.
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