AB 2235: Board of Dentistry: pediatric anesthesia: committee.
- Session Year: 2015-2016
- House: Assembly
- Latest Version Date: 2016-09-23
The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. That act authorizes a committee of the board to evaluate all suggestions or requests for regulatory changes related to the committee and to hold informational hearings in order to report and make appropriate recommendations to the board, after consultation with departmental legal counsel and the boards chief executive officer. The act requires a committee to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor, and any facts supporting the need for the change.
The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. The act makes it unprofessional conduct for a licensee to fail to report the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, that is related to a dental procedure, as specified. The act also makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the act requires that the consent be obtained from the childs parent or guardian.
This bill, which would be known as Calebs Law, would require the board, on or before January 1, 2017, to provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients and would require the board to make the report publicly available on the boards Internet Web site. The bill also would require the board to provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review by the appropriate policy committees of the Legislature.
This bill would require that the report of the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, be on a form or forms approved by the board and that the report include specified information. The bill authorizes the board to assess a penalty on any licensee who fails to make the required report.
This bill, with regard to obtaining written informed consent for general anesthesia or conscious sedation in the case of a minor, would require that the written informed consent include specified information regarding anesthesia, as provided.
The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. That act authorizes a committee of the board to evaluate all suggestions or requests for regulatory changes related to the committee and to hold informational hearings in order to report and make appropriate recommendations to the board, after consultation with departmental legal counsel and the boards chief executive officer. The act requires a committee to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor, and any facts supporting the need for the change.
The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. The act makes it unprofessional conduct for a licensee to fail to report the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, that is related to a dental procedure, as specified. The act also makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the act requires that the consent be obtained from the childs parent or guardian.
This bill, which would be known as Calebs Law, would require the board, on or before January 1, 2017, to provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients and would require the board to make the report publicly available on the boards Internet Web site. The bill also would require the board to provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review by the appropriate policy committees of the Legislature.
This bill would require that the report of the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, be on a form or forms approved by the board and that the report include specified information. The bill authorizes the board to assess a penalty on any licensee who fails to make the required report.
This bill, with regard to obtaining written informed consent for general anesthesia or conscious sedation in the case of a minor, would require that the written informed consent include specified information regarding anesthesia, as provided.
The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. That act authorizes a committee of the board to evaluate all suggestions or requests for regulatory changes related to the committee and to hold informational hearings in order to report and make appropriate recommendations to the board, after consultation with departmental legal counsel and the boards chief executive officer. The act requires a committee to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor, and any facts supporting the need for the change.
The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. The act makes it unprofessional conduct for a licensee to fail to report the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, that is related to a dental procedure, as specified. The act also makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the act requires that the consent be obtained from the childs parent or guardian.
This bill, which would be known as Calebs Law, would require the board, on or before January 1, 2017, to provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients and would require the board to make the report publicly available on the boards Internet Web site. The bill also would require the board to provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review by the appropriate policy committees of the Legislature.
This bill would require that the report of the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, be on a form or forms approved by the board and that the report include specified information. The bill authorizes the board to assess a penalty on any licensee who fails to make the required report.
This bill, with regard to obtaining written informed consent for general anesthesia or conscious sedation in the case of a minor, would require that the written informed consent include specified information regarding anesthesia, as provided.
The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. That act authorizes a committee of the board to evaluate all suggestions or requests for regulatory changes related to the committee and to hold informational hearings in order to report and make appropriate recommendations to the board, after consultation with departmental legal counsel and the boards chief executive officer. The act requires a committee to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor, and any facts supporting the need for the change.
The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. The act makes it unprofessional conduct for a licensee to fail to report the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, that is related to a dental procedure, as specified. The act also makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the act requires that the consent be obtained from the childs parent or guardian.
This bill, which would be known as Calebs Law, would require the board, on or before February 1, 2017, to establish a committee to investigate whether the current statutes and regulations for the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia provide adequate protection for pediatric dental patients. The bill would require the committee, on or before August 1, 2017, to review all incident reports and relevant investigatory information related to pediatric anesthesia in dentistry in the state for the years 2010 to 2016, inclusive, and to review the policies and guidelines of other states and national dental associations, as well as studies, to ensure that the states statutes and regulations adequately protect pediatric dental patients. The bill would require the committee, on or before November 1, 2017, to present its findings in a report to the board, including any recommendations necessary to improve safety. The bill would require the board, on or before January 1, 2018, to provide to the Legislature the committees recommendations, an evaluation of the committees report, and the boards own recommendations and to make the report publicly available on the boards Internet Web site. The bill also would require the board to provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review by the appropriate policy committees of the Legislature.
This bill, which would be known as Calebs Law, would require the board, on or before January 1, 2017, to provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients and would require the board to make the report publicly available on the boards Internet Web site. The bill also would require the board to provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review by the appropriate policy committees of the Legislature.
This bill would require that the report of the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, be on a form or forms approved by the board and that the report include specified information. The bill authorizes the board to assess a penalty on any licensee who fails to make the required report.
This bill, with regard to obtaining written informed consent for general anesthesia or conscious sedation in the case of a minor, would require that the written informed consent include specified information regarding anesthesia, as provided.
The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. That act authorizes a committee of the board to evaluate all suggestions or requests for regulatory changes related to the committee and to hold informational hearings in order to report and make appropriate recommendations to the board, after consultation with departmental legal counsel and the boards chief executive officer. The act requires a committee to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor, and any facts supporting the need for the change.
The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. The act makes it unprofessional conduct for a licensee to fail to report the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, that is related to a dental procedure, as specified. The act also makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the act requires that the consent be obtained from the childs parent or guardian.
This bill, which would be known as Calebs Law, would require the board, on or before February 1, 2017, to establish a committee to investigate whether the current statutes and regulations for the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia provide adequate protection for pediatric dental patients. The bill would require the committee, on or before August 1, 2017, to review all incident reports and relevant investigatory information related to pediatric anesthesia in dentistry in the state for the years 2010 to 2016, inclusive, and to review the policies and guidelines of other states and national dental associations, as well as studies, to ensure that the states statutes and regulations adequately protect pediatric dental patients. The bill would require the committee, on or before November 1, 2017, to present its findings in a report to the board, including any recommendations necessary to improve safety. The bill would require the board, on or before January 1, 2018, to provide to the Legislature the committees recommendations, an evaluation of the committees report, and the boards own recommendations and to make the report publicly available on the boards Internet Web site. The bill also would require the board to provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review by the appropriate policy committees of the Legislature.
This bill would require that the report of the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, be on a form or forms approved by the board and that the report include specified information. The bill authorizes the board to assess a penalty on any licensee who fails to make the required report.
This bill, with regard to obtaining written informed consent for general anesthesia or conscious sedation in the case of a minor, would require that the written informed consent include specified information regarding anesthesia, as provided.
The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. That act authorizes a committee of the board to evaluate all suggestions or requests for regulatory changes related to the committee and to hold informational hearings in order to report and make appropriate recommendations to the board, after consultation with departmental legal counsel and the boards chief executive officer. The act requires a committee to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor, and any facts supporting the need for the change.
The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. The act makes it unprofessional conduct for a licensee to fail to report the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, that is related to a dental procedure, as specified. The act also makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the act requires that the consent be obtained from the childs parent or guardian.
This bill, which would be known as Calebs Law, would require the board, on or before March 31, 2017, February 1, 2017, to establish a committee to investigate whether the current laws, regulations, and policies of the state are sufficient to minimize the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients. statutes and regulations for the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia provide adequate protection for pediatric dental patients. The bill would require the committee, on or before September 1, 2017, August 1, 2017, to review all incident reports and relevant investigatory information related to pediatric anesthesia in dentistry in the state for the years 2011 through 2010 to 2016, inclusive, and to review the policies and guidelines of other states and national dental associations associations, as well as studies, to ensure that this state has regulation and policies in place to do everything feasible to protect young patients. the states statutes and regulations adequately protect pediatric dental patients. The bill would require the committee, on or before January 1, 2018, November 1, 2017, to recommend to the board any measures that would further reduce the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients. present its findings in a report to the board, including any recommendations necessary to improve safety. The bill would require the board, on or before January 1, 2018, to report provide to the Legislature the committees recommendations to the Legislature recommendations, an evaluation of the committees report, and the boards own recommendations and to make the report publicly available on the boards Internet Web site. The bill also would require the board to provide a report on pediatric deaths related to general anesthesia or deep sedation in dentistry at the time of its sunset review by the appropriate policy committees of the Legislature.
This bill would require that the report of the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, be on a form or forms approved by the board and that the report include specified information. The bill authorizes the board to assess a penalty on any licensee who fails to make the required report.
This bill, with regard to obtaining written informed consent for general anesthesia or conscious sedation in the case of a minor, would require that the written informed consent include a form or forms approved by the board, containing specified information regarding the risks of sedation and anesthesia medications and that use of appropriate monitoring equipment is required. specified information regarding anesthesia, as provided.
The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. That act authorizes a committee of the board to evaluate all suggestions or requests for regulatory changes related to the committee and to hold informational hearings in order to report and make appropriate recommendations to the board, after consultation with departmental legal counsel and the boards chief executive officer. The act requires a committee to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor, and any facts supporting the need for the change.
The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. The act makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the act requires that the consent be obtained from the childs parent or guardian.
This bill, which would be known as Calebs Law, would require the board, on or before March 31, 2017, to establish a committee to investigate whether the current laws, regulations, and policies of the state are sufficient to minimize the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients. The bill would require the committee, on or before September 1, 2017, to review all incident reports related to pediatric anesthesia in dentistry in the state for the years 2011 through 2016, inclusive, and to review the policies of other states and dental associations to ensure that this state has regulation and policies in place to do everything feasible to protect young patients. The bill would require the committee, on or before January 1, 2018, to recommend to the board any measures that would further reduce the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients. The bill would require the board, on or before January 1, 2018, to report the committees recommendations to the Legislature and make the report publicly available on the boards Internet Web site. The bill also would require the board to provide a report on pediatric deaths related to general anesthesia or deep sedation in dentistry at the time of its sunset review by the appropriate policy committees of the Legislature.
This bill, with regard to obtaining written informed consent for general anesthesia or conscious sedation in the case of a minor, would require that the written informed consent include a form or forms approved by the board, containing specified information regarding the risk of an adverse event. risks of sedation and anesthesia medications and that use of appropriate monitoring equipment is required.
The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. That act authorizes a committee of the board to evaluate all suggestions or requests for regulatory changes related to the committee and to hold informational hearings in order to report and make appropriate recommendations to the board, after consultation with departmental legal counsel and the boards chief executive officer. The act requires a committee to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor, and any facts supporting the need for the change.
The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. The act makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the act requires that the consent be obtained from the childs parent or guardian.
This bill bill, which would be known as Calebs Law, would require the board, on or before March 31, 2017, to establish a committee to investigate whether the current laws, regulations, and policies of the state are sufficient to guard against unnecessary use of anesthesia for young patients and potential injury or death. minimize the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients. The bill would require the committee, on or before December September 1, 2017, to review all incident reports related to pediatric anesthesia in dentistry in the state for the years 2011 through 2016, inclusive, and to review the policies of other states and dental associations to ensure that this state has regulation and policies in place to do everything feasible to protect young patients. The bill would require the committee, on or before January 1, 2018, to recommend to the board any measures that would further reduce the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients. The bill would require the board, on or before January 1, 2018, to report the committees recommendations to the Legislature and make the report publicly available on the boards Internet Web site.
This bill, with regard to obtaining written informed consent for general anesthesia or conscious sedation in the case of a minor, would require that the written informed consent include a form or forms approved by the board, containing specified information regarding the risk of an adverse event.
The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. That act authorizes a committee of the board to evaluate all suggestions or requests for regulatory changes related to the committee and to hold informational hearings in order to report and make appropriate recommendations to the board, after consultation with departmental legal counsel and the boards chief executive officer. The act requires a committee to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor, and any facts supporting the need for the change.
The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients.
This bill would require the board, on or before March 31, 2017, to establish a committee to investigate whether the current laws, regulations, and policies of the state are sufficient to guard against unnecessary use of anesthesia for young patients and potential injury or death. The bill would require the committee, on or before December 1, 2017, to review all incident reports related to pediatric anesthesia in dentistry in the state for the years 2011 through 2016, inclusive, and to review the policies of other states and dental associations to ensure that this state has regulation and policies in place to do everything feasible to protect young patients.
This act shall be known, and may be cited, as Calebs Law.
SEC. 2.It is the Legislatures intent, to the extent that funds are appropriated for this purpose, that the board encourage all dental sedation providers in California to submit data regarding pediatric sedation events to a pediatric sedation research database maintained by a nonprofit organization. It is the goal of the Legislature that the data submitted will be used to formulate a systems-based approach to improve the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
SEC. 3.Section 1601.4 is added to the Business and Professions Code, to read:1601.4.(a)On or before January 1, 2017, the board shall provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients. The report shall be submitted in compliance with Section 9795 of the Government Code. The requirement for submitting a report imposed by this subdivision is inoperative on December 1, 2021, pursuant to Section 10231.5 of the Government Code. The board shall make the report publicly available on the boards Internet Web site.
(b)The board shall provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review pursuant to subdivision (d) of Section 1601.1.
SEC. 4.Section 1680 of the Business and Professions Code is amended to read:1680.Unprofessional conduct by a person licensed under this chapter is defined as, but is not limited to, any one of the following:
(a)The obtaining of any fee by fraud or misrepresentation.
(b)The employment directly or indirectly of any student or suspended or unlicensed dentist to practice dentistry as defined in this chapter.
(c)The aiding or abetting of any unlicensed person to practice dentistry.
(d)The aiding or abetting of a licensed person to practice dentistry unlawfully.
(e)The committing of any act or acts of sexual abuse, misconduct, or relations with a patient that are substantially related to the practice of dentistry.
(f)The use of any false, assumed, or fictitious name, either as an individual, firm, corporation, or otherwise, or any name other than the name under which he or she is licensed to practice, in advertising or in any other manner indicating that he or she is practicing or will practice dentistry, except that name as is specified in a valid permit issued pursuant to Section 1701.5.
(g)The practice of accepting or receiving any commission or the rebating in any form or manner of fees for professional services, radiograms, prescriptions, or other services or articles supplied to patients.
(h)The making use by the licensee or any agent of the licensee of any advertising statements of a character tending to deceive or mislead the public.
(i)The advertising of either professional superiority or the advertising of performance of professional services in a superior manner. This subdivision shall not prohibit advertising permitted by subdivision (h) of Section 651.
(j)The employing or the making use of solicitors.
(k)The advertising in violation of Section 651.
(l)The advertising to guarantee any dental service, or to perform any dental operation painlessly. This subdivision shall not prohibit advertising permitted by Section 651.
(m)The violation of any of the provisions of law regulating the procurement, dispensing, or administration of dangerous drugs, as defined in Chapter 9 (commencing with Section 4000) or controlled substances, as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code.
(n)The violation of any of the provisions of this division.
(o)The permitting of any person to operate dental radiographic equipment who has not met the requirements of Section 1656.
(p)The clearly excessive prescribing or administering of drugs or treatment, or the clearly excessive use of diagnostic procedures, or the clearly excessive use of diagnostic or treatment facilities, as determined by the customary practice and standards of the dental profession.
Any person who violates this subdivision is guilty of a misdemeanor and shall be punished by a fine of not less than one hundred dollars ($100) or more than six hundred dollars ($600), or by imprisonment for a term of not less than 60 days or more than 180 days, or by both a fine and imprisonment.
(q)The use of threats or harassment against any patient or licensee for providing evidence in any possible or actual disciplinary action, or other legal action; or the discharge of an employee primarily based on the employees attempt to comply with the provisions of this chapter or to aid in the compliance.
(r)Suspension or revocation of a license issued, or discipline imposed, by another state or territory on grounds that would be the basis of discipline in this state.
(s)The alteration of a patients record with intent to deceive.
(t)Unsanitary or unsafe office conditions, as determined by the customary practice and standards of the dental profession.
(u)The abandonment of the patient by the licensee, without written notice to the patient that treatment is to be discontinued and before the patient has ample opportunity to secure the services of another dentist, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions and provided the health of the patient is not jeopardized.
(v)The willful misrepresentation of facts relating to a disciplinary action to the patients of a disciplined licensee.
(w)Use of fraud in the procurement of any license issued pursuant to this chapter.
(x)Any action or conduct that would have warranted the denial of the license.
(y)The aiding or abetting of a licensed dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to practice dentistry in a negligent or incompetent manner.
(z)(1)The failure to report to the board in writing within seven days any of the following: (A) the death of his or her patient during the performance of any dental or dental hygiene procedure; (B) the discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by him or her; or (C) except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment. With the exception of patients to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, removal to a hospital or emergency center that is the normal or expected treatment for the underlying dental condition is not required to be reported. Upon receipt of a report pursuant to this subdivision the board may conduct an inspection of the dental office if the board finds that it is necessary. A dentist shall report to the board all deaths occurring in his or her practice with a copy sent to the Dental Hygiene Committee of California if the death was the result of treatment by a registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. A registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions shall report to the Dental Hygiene Committee of California all deaths occurring as the result of dental hygiene treatment, and a copy of the notification shall be sent to the board.
(2)The report required by this subdivision shall be on a form or forms approved by the board. The form or forms approved by the board shall require the licensee to include, but not be limited to, the following information for cases in which patients received anesthesia: the date of the procedure; the patients age in years and months, weight, and sex; the patients American Society of Anesthesiologists (ASA) physical status; the patients primary diagnosis; the patients coexisting diagnoses; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; whether the person supervising the sedation performed one or more of the procedures; the planned airway management; the planned depth of sedation; the complications that occurred; a description of what was unexpected about the airway management; whether there was transportation of the patient during sedation; the category of the provider conducting resuscitation measures; and the resuscitation equipment utilized. Disclosure of individually identifiable patient information shall be consistent with applicable law. A report required by this subdivision shall not be admissible in any action brought by a patient of the licensee providing the report.
(3)For the purposes of paragraph (2), categories of provider are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
(4)The form shall state that this information shall not be considered an admission of guilt, but is for educational, data, or investigative purposes.
(5)The board may assess a penalty on any licensee who fails to report an instance of an adverse event as required by this subdivision. The licensee may dispute the failure to file within 10 days of receiving notice that the board had assessed a penalty against the licensee.
(aa)Participating in or operating any group advertising and referral services that are in violation of Section 650.2.
(ab)The failure to use a fail-safe machine with an appropriate exhaust system in the administration of nitrous oxide. The board shall, by regulation, define what constitutes a fail-safe machine.
(ac)Engaging in the practice of dentistry with an expired license.
(ad)Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of bloodborne infectious diseases from dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to patient, from patient to patient, and from patient to dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Public Health developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. The board shall review infection control guidelines, if necessary, on an annual basis and proposed changes shall be reviewed by the Dental Hygiene Committee of California to establish a consensus. The committee shall submit any recommended changes to the infection control guidelines for review to establish a consensus. As necessary, the board shall consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision.
The board shall seek to ensure that all appropriate dental personnel are informed of the responsibility to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of bloodborne infectious diseases.
(ae)The utilization by a licensed dentist of any person to perform the functions of any registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions who, at the time of initial employment, does not possess a current, valid license or permit to perform those functions.
(af)The prescribing, dispensing, or furnishing of dangerous drugs or devices, as defined in Section 4022, in violation of Section 2242.1.
SEC. 5.Section 1682 of the Business and Professions Code is amended to read:1682.In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for:
(a)Any dentist performing dental procedures to have more than one patient undergoing conscious sedation or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia.
(b)Any dentist with patients recovering from conscious sedation or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
(c)Any dentist with patients who are undergoing conscious sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board.
(d)Any dentist with patients who are undergoing conscious sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially.
(e)(1)Any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the consent shall be obtained from the childs parent or guardian.
(2)The written informed consent, in the case of a minor, shall include, but not be limited to, the following information:
The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your childs anesthesia for his or her dental treatment, and consult with your dentist or pediatrician as needed.
(3)Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
This act shall be known, and may be cited, as Calebs Law.
SEC. 2.It is the Legislatures intent, to the extent that funds are appropriated for this purpose, that the board encourage all dental sedation providers in California to submit data regarding pediatric sedation events to a pediatric sedation research database maintained by a nonprofit organization. It is the goal of the Legislature that the data submitted will be used to formulate a systems-based approach to improve the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
SEC. 3.Section 1601.4 is added to the Business and Professions Code, to read:1601.4.(a)On or before January 1, 2017, the board shall provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients. The report shall be submitted in compliance with Section 9795 of the Government Code. The requirement for submitting a report imposed by this subdivision is inoperative on December 1, 2021, pursuant to Section 10231.5 of the Government Code. The board shall make the report publicly available on the boards Internet Web site.
(b)The board shall provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review pursuant to subdivision (d) of Section 1601.1.
SEC. 4.Section 1680 of the Business and Professions Code is amended to read:1680.Unprofessional conduct by a person licensed under this chapter is defined as, but is not limited to, any one of the following:
(a)The obtaining of any fee by fraud or misrepresentation.
(b)The employment directly or indirectly of any student or suspended or unlicensed dentist to practice dentistry as defined in this chapter.
(c)The aiding or abetting of any unlicensed person to practice dentistry.
(d)The aiding or abetting of a licensed person to practice dentistry unlawfully.
(e)The committing of any act or acts of sexual abuse, misconduct, or relations with a patient that are substantially related to the practice of dentistry.
(f)The use of any false, assumed, or fictitious name, either as an individual, firm, corporation, or otherwise, or any name other than the name under which he or she is licensed to practice, in advertising or in any other manner indicating that he or she is practicing or will practice dentistry, except that name as is specified in a valid permit issued pursuant to Section 1701.5.
(g)The practice of accepting or receiving any commission or the rebating in any form or manner of fees for professional services, radiograms, prescriptions, or other services or articles supplied to patients.
(h)The making use by the licensee or any agent of the licensee of any advertising statements of a character tending to deceive or mislead the public.
(i)The advertising of either professional superiority or the advertising of performance of professional services in a superior manner. This subdivision shall not prohibit advertising permitted by subdivision (h) of Section 651.
(j)The employing or the making use of solicitors.
(k)The advertising in violation of Section 651.
(l)The advertising to guarantee any dental service, or to perform any dental operation painlessly. This subdivision shall not prohibit advertising permitted by Section 651.
(m)The violation of any of the provisions of law regulating the procurement, dispensing, or administration of dangerous drugs, as defined in Chapter 9 (commencing with Section 4000) or controlled substances, as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code.
(n)The violation of any of the provisions of this division.
(o)The permitting of any person to operate dental radiographic equipment who has not met the requirements of Section 1656.
(p)The clearly excessive prescribing or administering of drugs or treatment, or the clearly excessive use of diagnostic procedures, or the clearly excessive use of diagnostic or treatment facilities, as determined by the customary practice and standards of the dental profession.
Any person who violates this subdivision is guilty of a misdemeanor and shall be punished by a fine of not less than one hundred dollars ($100) or more than six hundred dollars ($600), or by imprisonment for a term of not less than 60 days or more than 180 days, or by both a fine and imprisonment.
(q)The use of threats or harassment against any patient or licensee for providing evidence in any possible or actual disciplinary action, or other legal action; or the discharge of an employee primarily based on the employees attempt to comply with the provisions of this chapter or to aid in the compliance.
(r)Suspension or revocation of a license issued, or discipline imposed, by another state or territory on grounds that would be the basis of discipline in this state.
(s)The alteration of a patients record with intent to deceive.
(t)Unsanitary or unsafe office conditions, as determined by the customary practice and standards of the dental profession.
(u)The abandonment of the patient by the licensee, without written notice to the patient that treatment is to be discontinued and before the patient has ample opportunity to secure the services of another dentist, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions and provided the health of the patient is not jeopardized.
(v)The willful misrepresentation of facts relating to a disciplinary action to the patients of a disciplined licensee.
(w)Use of fraud in the procurement of any license issued pursuant to this chapter.
(x)Any action or conduct that would have warranted the denial of the license.
(y)The aiding or abetting of a licensed dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to practice dentistry in a negligent or incompetent manner.
(z)(1)The failure to report to the board in writing within seven days any of the following: (A) the death of his or her patient during the performance of any dental or dental hygiene procedure; (B) the discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by him or her; or (C) except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment. With the exception of patients to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, removal to a hospital or emergency center that is the normal or expected treatment for the underlying dental condition is not required to be reported. Upon receipt of a report pursuant to this subdivision the board may conduct an inspection of the dental office if the board finds that it is necessary. A dentist shall report to the board all deaths occurring in his or her practice with a copy sent to the Dental Hygiene Committee of California if the death was the result of treatment by a registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. A registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions shall report to the Dental Hygiene Committee of California all deaths occurring as the result of dental hygiene treatment, and a copy of the notification shall be sent to the board.
(2)The report required by this subdivision shall be on a form or forms approved by the board. The form or forms approved by the board shall require the licensee to include, but not be limited to, the following information for cases in which patients received anesthesia: the date of the procedure; the patients age in years and months, weight, and sex; the patients American Society of Anesthesiologists (ASA) physical status; the patients primary diagnosis; the patients coexisting diagnoses; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; whether the person supervising the sedation performed one or more of the procedures; the planned airway management; the planned depth of sedation; the complications that occurred; a description of what was unexpected about the airway management; whether there was transportation of the patient during sedation; the category of the provider conducting resuscitation measures; and the resuscitation equipment utilized. Disclosure of individually identifiable patient information shall be consistent with applicable law. A report required by this subdivision shall not be admissible in any action brought by a patient of the licensee providing the report.
(3)For the purposes of paragraph (2), categories of provider are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
(4)The form shall state that this information shall not be considered an admission of guilt, but is for educational, data, or investigative purposes.
(5)The board may assess a penalty on any licensee who fails to report an instance of an adverse event as required by this subdivision. The licensee may dispute the failure to file within 10 days of receiving notice that the board had assessed a penalty against the licensee.
(aa)Participating in or operating any group advertising and referral services that are in violation of Section 650.2.
(ab)The failure to use a fail-safe machine with an appropriate exhaust system in the administration of nitrous oxide. The board shall, by regulation, define what constitutes a fail-safe machine.
(ac)Engaging in the practice of dentistry with an expired license.
(ad)Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of bloodborne infectious diseases from dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to patient, from patient to patient, and from patient to dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Public Health developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. The board shall review infection control guidelines, if necessary, on an annual basis and proposed changes shall be reviewed by the Dental Hygiene Committee of California to establish a consensus. The committee shall submit any recommended changes to the infection control guidelines for review to establish a consensus. As necessary, the board shall consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision.
The board shall seek to ensure that all appropriate dental personnel are informed of the responsibility to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of bloodborne infectious diseases.
(ae)The utilization by a licensed dentist of any person to perform the functions of any registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions who, at the time of initial employment, does not possess a current, valid license or permit to perform those functions.
(af)The prescribing, dispensing, or furnishing of dangerous drugs or devices, as defined in Section 4022, in violation of Section 2242.1.
SEC. 5.Section 1682 of the Business and Professions Code is amended to read:1682.In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for:
(a)Any dentist performing dental procedures to have more than one patient undergoing conscious sedation or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia.
(b)Any dentist with patients recovering from conscious sedation or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
(c)Any dentist with patients who are undergoing conscious sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board.
(d)Any dentist with patients who are undergoing conscious sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially.
(e)(1)Any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the consent shall be obtained from the childs parent or guardian.
(2)The written informed consent, in the case of a minor, shall include, but not be limited to, the following information:
The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your childs anesthesia for his or her dental treatment, and consult with your dentist or pediatrician as needed.
(3)Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
This act shall be known, and may be cited, as Calebs Law.
SEC. 2.It is the Legislatures intent, to the extent that funds are appropriated for this purpose, that the board encourage all dental sedation providers in California to submit data regarding pediatric sedation events to a pediatric sedation research database maintained by a nonprofit organization. It is the goal of the Legislature that the data submitted will be used to formulate a systems-based approach to improve the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
SEC. 3.Section 1601.4 is added to the Business and Professions Code, to read:1601.4.(a)On or before January 1, 2017, the board shall provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients. The report shall be submitted in compliance with Section 9795 of the Government Code. The requirement for submitting a report imposed by this subdivision is inoperative on December 1, 2021, pursuant to Section 10231.5 of the Government Code. The board shall make the report publicly available on the boards Internet Web site.
(b)The board shall provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review pursuant to subdivision (d) of Section 1601.1.
SEC. 4.Section 1680 of the Business and Professions Code is amended to read:1680.Unprofessional conduct by a person licensed under this chapter is defined as, but is not limited to, any one of the following:
(a)The obtaining of any fee by fraud or misrepresentation.
(b)The employment directly or indirectly of any student or suspended or unlicensed dentist to practice dentistry as defined in this chapter.
(c)The aiding or abetting of any unlicensed person to practice dentistry.
(d)The aiding or abetting of a licensed person to practice dentistry unlawfully.
(e)The committing of any act or acts of sexual abuse, misconduct, or relations with a patient that are substantially related to the practice of dentistry.
(f)The use of any false, assumed, or fictitious name, either as an individual, firm, corporation, or otherwise, or any name other than the name under which he or she is licensed to practice, in advertising or in any other manner indicating that he or she is practicing or will practice dentistry, except that name as is specified in a valid permit issued pursuant to Section 1701.5.
(g)The practice of accepting or receiving any commission or the rebating in any form or manner of fees for professional services, radiograms, prescriptions, or other services or articles supplied to patients.
(h)The making use by the licensee or any agent of the licensee of any advertising statements of a character tending to deceive or mislead the public.
(i)The advertising of either professional superiority or the advertising of performance of professional services in a superior manner. This subdivision shall not prohibit advertising permitted by subdivision (h) of Section 651.
(j)The employing or the making use of solicitors.
(k)The advertising in violation of Section 651.
(l)The advertising to guarantee any dental service, or to perform any dental operation painlessly. This subdivision shall not prohibit advertising permitted by Section 651.
(m)The violation of any of the provisions of law regulating the procurement, dispensing, or administration of dangerous drugs, as defined in Chapter 9 (commencing with Section 4000) or controlled substances, as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code.
(n)The violation of any of the provisions of this division.
(o)The permitting of any person to operate dental radiographic equipment who has not met the requirements of Section 1656.
(p)The clearly excessive prescribing or administering of drugs or treatment, or the clearly excessive use of diagnostic procedures, or the clearly excessive use of diagnostic or treatment facilities, as determined by the customary practice and standards of the dental profession.
Any person who violates this subdivision is guilty of a misdemeanor and shall be punished by a fine of not less than one hundred dollars ($100) or more than six hundred dollars ($600), or by imprisonment for a term of not less than 60 days or more than 180 days, or by both a fine and imprisonment.
(q)The use of threats or harassment against any patient or licensee for providing evidence in any possible or actual disciplinary action, or other legal action; or the discharge of an employee primarily based on the employees attempt to comply with the provisions of this chapter or to aid in the compliance.
(r)Suspension or revocation of a license issued, or discipline imposed, by another state or territory on grounds that would be the basis of discipline in this state.
(s)The alteration of a patients record with intent to deceive.
(t)Unsanitary or unsafe office conditions, as determined by the customary practice and standards of the dental profession.
(u)The abandonment of the patient by the licensee, without written notice to the patient that treatment is to be discontinued and before the patient has ample opportunity to secure the services of another dentist, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions and provided the health of the patient is not jeopardized.
(v)The willful misrepresentation of facts relating to a disciplinary action to the patients of a disciplined licensee.
(w)Use of fraud in the procurement of any license issued pursuant to this chapter.
(x)Any action or conduct that would have warranted the denial of the license.
(y)The aiding or abetting of a licensed dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to practice dentistry in a negligent or incompetent manner.
(z)(1)The failure to report to the board in writing within seven days any of the following: (A) the death of his or her patient during the performance of any dental or dental hygiene procedure; (B) the discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by him or her; or (C) except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment. With the exception of patients to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, removal to a hospital or emergency center that is the normal or expected treatment for the underlying dental condition is not required to be reported. Upon receipt of a report pursuant to this subdivision the board may conduct an inspection of the dental office if the board finds that it is necessary. A dentist shall report to the board all deaths occurring in his or her practice with a copy sent to the Dental Hygiene Committee of California if the death was the result of treatment by a registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. A registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions shall report to the Dental Hygiene Committee of California all deaths occurring as the result of dental hygiene treatment, and a copy of the notification shall be sent to the board.
(2)The report required by this subdivision shall be on a form or forms approved by the board. The form or forms approved by the board shall require the licensee to include, but not be limited to, the following information for cases in which patients received anesthesia: the date of the procedure; the patients age in years and months, weight, and sex; the patients American Society of Anesthesiologists (ASA) physical status; the patients primary diagnosis; the patients coexisting diagnoses; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; whether the person supervising the sedation performed one or more of the procedures; the planned airway management; the planned depth of sedation; the complications that occurred; a description of what was unexpected about the airway management; whether there was transportation of the patient during sedation; the category of the provider conducting resuscitation measures; and the resuscitation equipment utilized. Disclosure of individually identifiable patient information shall be consistent with applicable law. A report required by this subdivision shall not be admissible in any action brought by a patient of the licensee providing the report.
(3)For the purposes of paragraph (2), categories of provider are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
(4)The form shall state that this information shall not be considered an admission of guilt, but is for educational, data, or investigative purposes.
(5)The board may assess a penalty on any licensee who fails to report an instance of an adverse event as required by this subdivision. The penalty is a maximum fine of one hundred dollars ($100) per day not reported after the initial seven-day reporting period. The licensee may dispute the failure to file within 10 days of receiving notice that the board had assessed a penalty against the licensee.
(aa)Participating in or operating any group advertising and referral services that are in violation of Section 650.2.
(ab)The failure to use a fail-safe machine with an appropriate exhaust system in the administration of nitrous oxide. The board shall, by regulation, define what constitutes a fail-safe machine.
(ac)Engaging in the practice of dentistry with an expired license.
(ad)Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of bloodborne infectious diseases from dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to patient, from patient to patient, and from patient to dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Public Health developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. The board shall review infection control guidelines, if necessary, on an annual basis and proposed changes shall be reviewed by the Dental Hygiene Committee of California to establish a consensus. The committee shall submit any recommended changes to the infection control guidelines for review to establish a consensus. As necessary, the board shall consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision.
The board shall seek to ensure that all appropriate dental personnel are informed of the responsibility to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of bloodborne infectious diseases.
(ae)The utilization by a licensed dentist of any person to perform the functions of any registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions who, at the time of initial employment, does not possess a current, valid license or permit to perform those functions.
(af)The prescribing, dispensing, or furnishing of dangerous drugs or devices, as defined in Section 4022, in violation of Section 2242.1.
SEC. 5.Section 1682 of the Business and Professions Code is amended to read:1682.In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for:
(a)Any dentist performing dental procedures to have more than one patient undergoing conscious sedation or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia.
(b)Any dentist with patients recovering from conscious sedation or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
(c)Any dentist with patients who are undergoing conscious sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board.
(d)Any dentist with patients who are undergoing conscious sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially.
(e)(1)Any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the consent shall be obtained from the childs parent or guardian.
(2)The written informed consent, in the case of a minor, shall include, but not be limited to, the following information:
The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your childs anesthesia for his or her dental treatment, and consult with your dentist or pediatrician as needed.
(3)Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
This act shall be known, and may be cited, as Calebs Law.
SEC. 2.It is the Legislatures intent, to the extent that funds are appropriated for this purpose, that the board encourage all dental sedation providers in California to submit data regarding pediatric sedation events to a pediatric sedation research database maintained by a nonprofit organization. It is the goal of the Legislature that the data submitted will be used to formulate a systems-based approach to improve the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
SEC. 3.Section 1601.4 is added to the Business and Professions Code, to read:1601.4.(a)The board, on or before February 1, 2017, shall establish a committee to investigate whether current statutes and regulations for the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia provide adequate protection for pediatric dental patients. For the purpose of this section, a pediatric dental patient is a person under 21 years of age.
(b)On or before August 1, 2017, the committee shall review all incident reports and relevant investigatory information related to pediatric anesthesia in dentistry in the state for the years 2010 to 2016, inclusive, and shall review the policies and guidelines of other states and national dental associations as well as studies regarding the use of pediatric anesthesia to ensure that the states statutes and regulations adequately protect pediatric dental patients. The committee also shall review statutory and regulatory definitions relating to sedation and anesthesia and recommend any necessary revisions. The members of the committee shall agree not to disclose any confidential, privileged, or personally identifiable information contained in the dental board records, except as permitted by law.
(c)On or before November 1, 2017, the committee shall present its findings to the board in a report which shall include any recommendations necessary to improve safety during the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia for pediatric dental patients.
(d)On or before January 1, 2018, the board shall provide to the Legislature the recommendations of the committee pursuant to subdivision (c), an evaluation of the report, and the boards own recommendations. The report shall be submitted in compliance with Section 9795 of the Government Code. The requirement for submitting a report imposed by this subdivision is inoperative on December 1, 2021, pursuant to Section 10231.5 of the Government Code. The board shall make the report publicly available on the boards Internet Web site, and shall include, but is not limited to, the following anonymized data from each incident reviewed, if available from records in the boards possession, custody, or control, including investigatory reports: the age of the patient; the patients primary diagnosis; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; whether the person supervising the sedation performed one or more of the procedures; the category of the provider conducting resuscitation measures; and the resuscitation equipment utilized.
(e)For the purposes of subdivision (d), categories of provider are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
(f)The board shall provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review pursuant to subdivision (d) of Section 1601.1.
(a)On or before January 1, 2017, the board shall provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients. The report shall be submitted in compliance with Section 9795 of the Government Code. The requirement for submitting a report imposed by this subdivision is inoperative on December 1, 2021, pursuant to Section 10231.5 of the Government Code. The board shall make the report publicly available on the boards Internet Web site.
(b)The board shall provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review pursuant to subdivision (d) of Section 1601.1.
SEC. 4.Section 1680 of the Business and Professions Code is amended to read:1680.Unprofessional conduct by a person licensed under this chapter is defined as, but is not limited to, any one of the following:
(a)The obtaining of any fee by fraud or misrepresentation.
(b)The employment directly or indirectly of any student or suspended or unlicensed dentist to practice dentistry as defined in this chapter.
(c)The aiding or abetting of any unlicensed person to practice dentistry.
(d)The aiding or abetting of a licensed person to practice dentistry unlawfully.
(e)The committing of any act or acts of sexual abuse, misconduct, or relations with a patient that are substantially related to the practice of dentistry.
(f)The use of any false, assumed, or fictitious name, either as an individual, firm, corporation, or otherwise, or any name other than the name under which he or she is licensed to practice, in advertising or in any other manner indicating that he or she is practicing or will practice dentistry, except that name as is specified in a valid permit issued pursuant to Section 1701.5.
(g)The practice of accepting or receiving any commission or the rebating in any form or manner of fees for professional services, radiograms, prescriptions, or other services or articles supplied to patients.
(h)The making use by the licensee or any agent of the licensee of any advertising statements of a character tending to deceive or mislead the public.
(i)The advertising of either professional superiority or the advertising of performance of professional services in a superior manner. This subdivision shall not prohibit advertising permitted by subdivision (h) of Section 651.
(j)The employing or the making use of solicitors.
(k)The advertising in violation of Section 651.
(l)The advertising to guarantee any dental service, or to perform any dental operation painlessly. This subdivision shall not prohibit advertising permitted by Section 651.
(m)The violation of any of the provisions of law regulating the procurement, dispensing, or administration of dangerous drugs, as defined in Chapter 9 (commencing with Section 4000) or controlled substances, as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code.
(n)The violation of any of the provisions of this division.
(o)The permitting of any person to operate dental radiographic equipment who has not met the requirements of Section 1656.
(p)The clearly excessive prescribing or administering of drugs or treatment, or the clearly excessive use of diagnostic procedures, or the clearly excessive use of diagnostic or treatment facilities, as determined by the customary practice and standards of the dental profession.
Any person who violates this subdivision is guilty of a misdemeanor and shall be punished by a fine of not less than one hundred dollars ($100) or more than six hundred dollars ($600), or by imprisonment for a term of not less than 60 days or more than 180 days, or by both a fine and imprisonment.
(q)The use of threats or harassment against any patient or licensee for providing evidence in any possible or actual disciplinary action, or other legal action; or the discharge of an employee primarily based on the employees attempt to comply with the provisions of this chapter or to aid in the compliance.
(r)Suspension or revocation of a license issued, or discipline imposed, by another state or territory on grounds that would be the basis of discipline in this state.
(s)The alteration of a patients record with intent to deceive.
(t)Unsanitary or unsafe office conditions, as determined by the customary practice and standards of the dental profession.
(u)The abandonment of the patient by the licensee, without written notice to the patient that treatment is to be discontinued and before the patient has ample opportunity to secure the services of another dentist, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions and provided the health of the patient is not jeopardized.
(v)The willful misrepresentation of facts relating to a disciplinary action to the patients of a disciplined licensee.
(w)Use of fraud in the procurement of any license issued pursuant to this chapter.
(x)Any action or conduct that would have warranted the denial of the license.
(y)The aiding or abetting of a licensed dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to practice dentistry in a negligent or incompetent manner.
(z)(1)The failure to report to the board in writing within seven days any of the following: (A) the death of his or her patient during the performance of any dental or dental hygiene procedure; (B) the discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by him or her; or (C) except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment. With the exception of patients to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, removal to a hospital or emergency center that is the normal or expected treatment for the underlying dental condition is not required to be reported. Upon receipt of a report pursuant to this subdivision the board may conduct an inspection of the dental office if the board finds that it is necessary. A dentist shall report to the board all deaths occurring in his or her practice with a copy sent to the Dental Hygiene Committee of California if the death was the result of treatment by a registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. A registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions shall report to the Dental Hygiene Committee of California all deaths occurring as the result of dental hygiene treatment, and a copy of the notification shall be sent to the board.
(2)The report required by this subdivision shall be on a form or forms approved by the board. The form or forms approved by the board shall require the licensee to include, but not be limited to, the following information for cases in which patients received anesthesia: the date of the procedure; the patients age in years and months, weight, and sex; the patients American Society of Anesthesiologists (ASA) physical status; the patients primary diagnosis; the patients coexisting diagnoses; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; whether the person supervising the sedation performed one or more of the procedures; the planned airway management; the planned depth of sedation; the complications that occurred; a description of what was unexpected about the airway management; whether there was transportation of the patient during sedation; the category of the provider conducting resuscitation measures; and the resuscitation equipment utilized. Disclosure of individually identifiable patient information shall be consistent with applicable law. A report required by this subdivision shall not be admissible in any action brought by a patient of the licensee providing the report.
(3)For the purposes of paragraph (2), categories of provider are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
(4)The form shall state that this information shall not be considered an admission of guilt, but is for educational, data, or investigative purposes.
(5)The board may assess a penalty on any licensee who fails to report an instance of an adverse event as required by this subdivision. The penalty is a maximum fine of one hundred dollars ($100) per day not reported after the initial seven-day reporting period. The licensee may dispute the failure to file within 10 days of receiving notice that the board had assessed a penalty against the licensee.
(aa)Participating in or operating any group advertising and referral services that are in violation of Section 650.2.
(ab)The failure to use a fail-safe machine with an appropriate exhaust system in the administration of nitrous oxide. The board shall, by regulation, define what constitutes a fail-safe machine.
(ac)Engaging in the practice of dentistry with an expired license.
(ad)Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of bloodborne infectious diseases from dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to patient, from patient to patient, and from patient to dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Public Health developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. The board shall review infection control guidelines, if necessary, on an annual basis and proposed changes shall be reviewed by the Dental Hygiene Committee of California to establish a consensus. The committee shall submit any recommended changes to the infection control guidelines for review to establish a consensus. As necessary, the board shall consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision.
The board shall seek to ensure that all appropriate dental personnel are informed of the responsibility to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of bloodborne infectious diseases.
(ae)The utilization by a licensed dentist of any person to perform the functions of any registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions who, at the time of initial employment, does not possess a current, valid license or permit to perform those functions.
(af)The prescribing, dispensing, or furnishing of dangerous drugs or devices, as defined in Section 4022, in violation of Section 2242.1.
SEC. 5.Section 1682 of the Business and Professions Code is amended to read:1682.In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for:
(a)Any dentist performing dental procedures to have more than one patient undergoing conscious sedation or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia.
(b)Any dentist with patients recovering from conscious sedation or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
(c)Any dentist with patients who are undergoing conscious sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board.
(d)Any dentist with patients who are undergoing conscious sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially.
(e)(1)Any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the consent shall be obtained from the childs parent or guardian.
(2)The written informed consent, in the case of a minor, shall include, but not be limited to, the following information:
The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your childs anesthesia for his or her dental treatment, and consult with your dentist or pediatrician as needed.
(3)Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
This act shall be known, and may be cited, as Calebs Law.
SEC. 2.It is the Legislatures intent, to the extent that funds are appropriated for this purpose, that the board encourage all dental sedation providers in California to submit data regarding pediatric sedation events to a pediatric sedation research database maintained by a nonprofit organization. It is the goal of the Legislature that the data submitted will be used to formulate a systems-based approach to improve the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
SEC. 3.Section 1601.4 is added to the Business and Professions Code, to read:1601.4.(a)The board, on or before February 1, 2017, shall establish a committee to investigate whether current statutes and regulations for the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia provide adequate protection for pediatric dental patients. For the purpose of this section, a pediatric dental patient is a person under 21 years of age.
(1)The committee shall consist of the following:
(A)A physician anesthesiologist who holds a general anesthesia permit from the board chosen from a list provided by the California Society of Anesthesiologists.
(B)A pediatrician chosen from a list provided by the American Academy of Pediatrics, California.
(C)An oral surgeon chosen from a list provided by the Oral and Facial Surgeons of California.
(D)A pediatric dentist chosen from a list provided by the California Society of Pediatric Dentistry.
(E)A dentist who has completed a dental anesthesiology residency chosen from a list provided by the American Society of Dentist Anesthesiologists.
(F)A general dentist chosen from a list provided by the California Dental Association.
(2)The board shall select at least one member of the committee, proposed by the Oral and Facial Surgeons of California, California Society of Pediatric Dentistry, or California Dental Association, who is, at the time the lists are provided, employed at an accredited dental school, provided that such a candidate is provided on the lists of candidates submitted to the board.
(3)The board shall select a pediatric dentist and general dentist who hold at least one sedation permit from the board, provided that such a candidate is provided on the lists of candidates submitted to the board.
(b)On or before August 1, 2017, the committee shall review all incident reports and relevant investigatory information related to pediatric anesthesia in dentistry in the state for the years 2010 to 2016, inclusive, and shall review the policies and guidelines of other states and national dental associations as well as studies regarding the use of pediatric anesthesia to ensure that the states statutes and regulations adequately protect pediatric dental patients. The committee also shall review statutory and regulatory definitions relating to sedation and anesthesia and recommend any necessary revisions. The members of the committee shall agree not to disclose any confidential, privileged, or personally identifiable information contained in the dental board records, except as permitted by law.
(c)On or before November 1, 2017, the committee shall present its findings to the board in a report which shall include any recommendations necessary to improve safety during the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia for pediatric dental patients.
(d)On or before January 1, 2018, the board shall provide to the Legislature the recommendations of the committee pursuant to subdivision (c), an evaluation of the report, and the boards own recommendations. The report shall be submitted in compliance with Section 9795 of the Government Code. The requirement for submitting a report imposed by this subdivision is inoperative on December 1, 2021, pursuant to Section 10231.5 of the Government Code. The board shall make the report publicly available on the boards Internet Web site, and shall include, but is not limited to, the following anonymized data from each incident reviewed, if available from records in the boards possession, custody, or control, including investigatory reports: the age of the patient; the patients primary diagnosis; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; whether the person supervising the sedation performed one or more of the procedures; the category of the provider conducting resuscitation measures; and the resuscitation equipment utilized.
(e)For the purposes of subdivision (d), categories of provider are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
(f)The board shall provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review pursuant to subdivision (d) of Section 1601.1.
SEC. 4.Section 1680 of the Business and Professions Code is amended to read:1680.Unprofessional conduct by a person licensed under this chapter is defined as, but is not limited to, any one of the following:
(a)The obtaining of any fee by fraud or misrepresentation.
(b)The employment directly or indirectly of any student or suspended or unlicensed dentist to practice dentistry as defined in this chapter.
(c)The aiding or abetting of any unlicensed person to practice dentistry.
(d)The aiding or abetting of a licensed person to practice dentistry unlawfully.
(e)The committing of any act or acts of sexual abuse, misconduct, or relations with a patient that are substantially related to the practice of dentistry.
(f)The use of any false, assumed, or fictitious name, either as an individual, firm, corporation, or otherwise, or any name other than the name under which he or she is licensed to practice, in advertising or in any other manner indicating that he or she is practicing or will practice dentistry, except that name as is specified in a valid permit issued pursuant to Section 1701.5.
(g)The practice of accepting or receiving any commission or the rebating in any form or manner of fees for professional services, radiograms, prescriptions, or other services or articles supplied to patients.
(h)The making use by the licensee or any agent of the licensee of any advertising statements of a character tending to deceive or mislead the public.
(i)The advertising of either professional superiority or the advertising of performance of professional services in a superior manner. This subdivision shall not prohibit advertising permitted by subdivision (h) of Section 651.
(j)The employing or the making use of solicitors.
(k)The advertising in violation of Section 651.
(l)The advertising to guarantee any dental service, or to perform any dental operation painlessly. This subdivision shall not prohibit advertising permitted by Section 651.
(m)The violation of any of the provisions of law regulating the procurement, dispensing, or administration of dangerous drugs, as defined in Chapter 9 (commencing with Section 4000) or controlled substances, as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code.
(n)The violation of any of the provisions of this division.
(o)The permitting of any person to operate dental radiographic equipment who has not met the requirements of Section 1656.
(p)The clearly excessive prescribing or administering of drugs or treatment, or the clearly excessive use of diagnostic procedures, or the clearly excessive use of diagnostic or treatment facilities, as determined by the customary practice and standards of the dental profession.
Any person who violates this subdivision is guilty of a misdemeanor and shall be punished by a fine of not less than one hundred dollars ($100) or more than six hundred dollars ($600), or by imprisonment for a term of not less than 60 days or more than 180 days, or by both a fine and imprisonment.
(q)The use of threats or harassment against any patient or licensee for providing evidence in any possible or actual disciplinary action, or other legal action; or the discharge of an employee primarily based on the employees attempt to comply with the provisions of this chapter or to aid in the compliance.
(r)Suspension or revocation of a license issued, or discipline imposed, by another state or territory on grounds that would be the basis of discipline in this state.
(s)The alteration of a patients record with intent to deceive.
(t)Unsanitary or unsafe office conditions, as determined by the customary practice and standards of the dental profession.
(u)The abandonment of the patient by the licensee, without written notice to the patient that treatment is to be discontinued and before the patient has ample opportunity to secure the services of another dentist, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions and provided the health of the patient is not jeopardized.
(v)The willful misrepresentation of facts relating to a disciplinary action to the patients of a disciplined licensee.
(w)Use of fraud in the procurement of any license issued pursuant to this chapter.
(x)Any action or conduct that would have warranted the denial of the license.
(y)The aiding or abetting of a licensed dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to practice dentistry in a negligent or incompetent manner.
(z)(1)The failure to report to the board in writing within seven days any of the following: (A) the death of his or her patient during the performance of any dental or dental hygiene procedure; (B) the discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by him or her; or (C) except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment. With the exception of patients to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, removal to a hospital or emergency center that is the normal or expected treatment for the underlying dental condition is not required to be reported. Upon receipt of a report pursuant to this subdivision the board may conduct an inspection of the dental office if the board finds that it is necessary. A dentist shall report to the board all deaths occurring in his or her practice with a copy sent to the Dental Hygiene Committee of California if the death was the result of treatment by a registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. A registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions shall report to the Dental Hygiene Committee of California all deaths occurring as the result of dental hygiene treatment, and a copy of the notification shall be sent to the board.
(2)The report required by this subdivision shall be on a form or forms approved by the board. The form or forms approved by the board shall require the licensee to include, but not be limited to, the following information for cases in which patients received anesthesia: the date of the procedure; the patients age in years and months, weight, and sex; the patients American Society of Anesthesiologists (ASA) physical status; the patients primary diagnosis; the patients coexisting diagnoses; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; whether the person supervising the sedation performed one or more of the procedures; the planned airway management; the planned depth of sedation; the complications that occurred; a description of what was unexpected about the airway management; whether there was transportation of the patient during sedation; the category of the provider conducting resuscitation measures; and the resuscitation equipment utilized. Disclosure of individually identifiable patient information shall be consistent with applicable law. A report required by this subdivision shall not be admissible in any action brought by a patient of the licensee providing the report.
(3)For the purposes of paragraph (2), categories of provider are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
(4)The form shall state that this information shall not be considered an admission of guilt, but is for educational, data, or investigative purposes.
(5)The board may assess a penalty on any licensee who fails to report an instance of an adverse event as required by this subdivision. The penalty is a maximum fine of one hundred dollars ($100) per day not reported after the initial seven-day reporting period. The licensee may dispute the failure to file within 10 days of receiving notice that the board had assessed a penalty against the licensee.
(aa)Participating in or operating any group advertising and referral services that are in violation of Section 650.2.
(ab)The failure to use a fail-safe machine with an appropriate exhaust system in the administration of nitrous oxide. The board shall, by regulation, define what constitutes a fail-safe machine.
(ac)Engaging in the practice of dentistry with an expired license.
(ad)Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of bloodborne infectious diseases from dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to patient, from patient to patient, and from patient to dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Public Health developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. The board shall review infection control guidelines, if necessary, on an annual basis and proposed changes shall be reviewed by the Dental Hygiene Committee of California to establish a consensus. The committee shall submit any recommended changes to the infection control guidelines for review to establish a consensus. As necessary, the board shall consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision.
The board shall seek to ensure that all appropriate dental personnel are informed of the responsibility to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of bloodborne infectious diseases.
(ae)The utilization by a licensed dentist of any person to perform the functions of any registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions who, at the time of initial employment, does not possess a current, valid license or permit to perform those functions.
(af)The prescribing, dispensing, or furnishing of dangerous drugs or devices, as defined in Section 4022, in violation of Section 2242.1.
SEC. 5.Section 1682 of the Business and Professions Code is amended to read:1682.In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for:
(a)Any dentist performing dental procedures to have more than one patient undergoing conscious sedation or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia.
(b)Any dentist with patients recovering from conscious sedation or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
(c)Any dentist with patients who are undergoing conscious sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board.
(d)Any dentist with patients who are undergoing conscious sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially.
(e)(1)Any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the consent shall be obtained from the childs parent or guardian.
(2)The written informed consent, in the case of a minor, shall include, but not be limited to, the following information:
The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your childs anesthesia for his or her dental treatment, and consult with your dentist or pediatrician as needed.
(3)Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
This act shall be known, and may be cited, as Calebs Law.
SEC. 2.It is the Legislatures intent, to the extent that funds are appropriated for this purpose, that the board encourage all dental sedation providers in California to submit data regarding pediatric sedation events to a pediatric sedation research database maintained by a nonprofit organization. It is the goal of the Legislature that the data submitted will be used to formulate a systems-based approach to improve the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
SEC. 2.SEC. 3.Section 1601.4 is added to the Business and Professions Code, to read:1601.4.(a)The board, on or before March 31, 2017, February 1, 2017, shall establish a committee to investigate whether the current laws, regulations, and policies of the state are sufficient to minimize the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients. current statutes and regulations for the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia provide adequate protection for pediatric dental patients. For the purpose of this section, a pediatric dental patient is a person under 21 years of age.
(1)The committee shall consist of the following:
(A)A physician anesthesiologist who holds a general anesthesia permit from the board chosen from a list provided by the California Society of Anesthesiologists.
(B)A pediatrician chosen from a list provided by the American Academy of Pediatrics, California.
(C)An oral surgeon chosen from a list provided by the Oral and Facial Surgeons of California.
(D)A pediatric dentist chosen from a list provided by the California Society of Pediatric Dentistry.
(E)A dentist who has completed a dental anesthesiology residency chosen from a list provided by the American Society of Dentist Anesthesiologists.
(F)A general dentist chosen from a list provided by the California Dental Association.
(2)The board shall select at least one member of the committee, proposed by the Oral and Facial Surgeons of California, California Society of Pediatric Dentistry, or California Dental Association, who is, at the time the lists are provided, employed at an accredited dental school, provided that such a candidate is provided on the lists of candidates submitted to the board.
(3)The board shall select a pediatric dentist and general dentist who hold at least one sedation permit from the board, provided that such a candidate is provided on the lists of candidates submitted to the board.
(b)On or before September 1, 2017, August 1, 2017, the committee shall review all incident reports and relevant investigatory information related to pediatric anesthesia in dentistry in the state for the years 2011 through 2016, 2010 to 2016, inclusive, and shall review the policies and guidelines of other states and national dental associations as well as studies regarding the use of pediatric anesthesia to ensure that this state has regulation and policies in place to do everything feasible to protect young patients. the states statutes and regulations adequately protect pediatric dental patients. The committee also shall review statutory and regulatory definitions relating to sedation and anesthesia and recommend any necessary revisions. The members of the committee shall agree not to disclose any confidential, privileged, or personally identifiable information contained in the dental board records, except as permitted by law.
(c)On or before January 1, 2018, November 1, 2017, the committee shall recommend to the board any measures that would further reduce the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients. present its findings to the board in a report which shall include any recommendations necessary to improve safety during the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia for pediatric dental patients.
(d)On or before January 1, 2018, the board shall report provide to the Legislature the recommendations of the committee pursuant to subdivision (c). (c), an evaluation of the report, and the boards own recommendations. The report shall be submitted in compliance with Section 9795 of the Government Code. The requirement for submitting a report imposed by this subdivision is inoperative on December 1, 2021, pursuant to Section 10231.5 of the Government Code. The board shall make the report publicly available on the boards Internet Web site, and shall include, but is not limited to, the following anonymized demographic data of each patient reviewed: his or her age, weight, and sex; his or her primary diagnosis; data from each incident reviewed, if available from records in the boards possession, custody, or control, including investigatory reports: the age of the patient; the patients primary diagnosis; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; and whether the sedation supervision person supervising the sedation performed one or more of the procedures. procedures; the category of the provider conducting resuscitation measures; and the resuscitation equipment utilized.
(e)For the purposes of subdivision (d), categories of provider are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
(e)
(f)The board shall provide a report on pediatric deaths related to general anesthesia or deep sedation in dentistry at the time of its sunset review pursuant to subdivision (d) of Section 1601.1.
SEC. 4.Section 1680 of the Business and Professions Code is amended to read:1680.Unprofessional conduct by a person licensed under this chapter is defined as, but is not limited to, any one of the following:
(a)The obtaining of any fee by fraud or misrepresentation.
(b)The employment directly or indirectly of any student or suspended or unlicensed dentist to practice dentistry as defined in this chapter.
(c)The aiding or abetting of any unlicensed person to practice dentistry.
(d)The aiding or abetting of a licensed person to practice dentistry unlawfully.
(e)The committing of any act or acts of sexual abuse, misconduct, or relations with a patient that are substantially related to the practice of dentistry.
(f)The use of any false, assumed, or fictitious name, either as an individual, firm, corporation, or otherwise, or any name other than the name under which he or she is licensed to practice, in advertising or in any other manner indicating that he or she is practicing or will practice dentistry, except that name as is specified in a valid permit issued pursuant to Section 1701.5.
(g)The practice of accepting or receiving any commission or the rebating in any form or manner of fees for professional services, radiograms, prescriptions, or other services or articles supplied to patients.
(h)The making use by the licensee or any agent of the licensee of any advertising statements of a character tending to deceive or mislead the public.
(i)The advertising of either professional superiority or the advertising of performance of professional services in a superior manner. This subdivision shall not prohibit advertising permitted by subdivision (h) of Section 651.
(j)The employing or the making use of solicitors.
(k)The advertising in violation of Section 651.
(l)The advertising to guarantee any dental service, or to perform any dental operation painlessly. This subdivision shall not prohibit advertising permitted by Section 651.
(m)The violation of any of the provisions of law regulating the procurement, dispensing, or administration of dangerous drugs, as defined in Chapter 9 (commencing with Section 4000) or controlled substances, as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code.
(n)The violation of any of the provisions of this division.
(o)The permitting of any person to operate dental radiographic equipment who has not met the requirements of Section 1656.
(p)The clearly excessive prescribing or administering of drugs or treatment, or the clearly excessive use of diagnostic procedures, or the clearly excessive use of diagnostic or treatment facilities, as determined by the customary practice and standards of the dental profession.
Any person who violates this subdivision is guilty of a misdemeanor and shall be punished by a fine of not less than one hundred dollars ($100) or more than six hundred dollars ($600), or by imprisonment for a term of not less than 60 days or more than 180 days, or by both a fine and imprisonment.
(q)The use of threats or harassment against any patient or licensee for providing evidence in any possible or actual disciplinary action, or other legal action; or the discharge of an employee primarily based on the employees attempt to comply with the provisions of this chapter or to aid in the compliance.
(r)Suspension or revocation of a license issued, or discipline imposed, by another state or territory on grounds that would be the basis of discipline in this state.
(s)The alteration of a patients record with intent to deceive.
(t)Unsanitary or unsafe office conditions, as determined by the customary practice and standards of the dental profession.
(u)The abandonment of the patient by the licensee, without written notice to the patient that treatment is to be discontinued and before the patient has ample opportunity to secure the services of another dentist, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions and provided the health of the patient is not jeopardized.
(v)The willful misrepresentation of facts relating to a disciplinary action to the patients of a disciplined licensee.
(w)Use of fraud in the procurement of any license issued pursuant to this chapter.
(x)Any action or conduct that would have warranted the denial of the license.
(y)The aiding or abetting of a licensed dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to practice dentistry in a negligent or incompetent manner.
(z)(1)The failure to report to the board in writing within seven days any of the following: (1) (A) the death of his or her patient during the performance of any dental or dental hygiene procedure; (2) (B) the discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by him or her; or (3) (C) except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment for a period exceeding 24 hours of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment. With the exception of patients to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, removal to a hospital or emergency center that is the normal or expected treatment for the underlying dental condition is not required to be reported. Upon receipt of a report pursuant to this subdivision the board may conduct an inspection of the dental office if the board finds that it is necessary. A dentist shall report to the board all deaths occurring in his or her practice with a copy sent to the Dental Hygiene Committee of California if the death was the result of treatment by a registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. A registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions shall report to the Dental Hygiene Committee of California all deaths occurring as the result of dental hygiene treatment, and a copy of the notification shall be sent to the board.
(2)The report required by this subdivision shall be on a form or forms approved by the board. The form or forms approved by the board shall require the licensee to include, but not be limited to, the following information for cases in which patients received anesthesia: the date of the procedure; the patients age in years and months, weight, and sex; the patients American Society of Anesthesiologists (ASA) physical status; the patients primary diagnosis; the patients coexisting diagnoses; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; whether the person supervising the sedation performed one or more of the procedures; the planned airway management; the planned depth of sedation; the complications that occurred; a description of what was unexpected about the airway management; whether there was transportation of the patient during sedation; the category of the provider conducting resuscitation measures; and the resuscitation equipment utilized. Disclosure of individually identifiable patient information shall be consistent with applicable law. A report required by this subdivision shall not be admissible in any action brought by a patient of the licensee providing the report.
(3)For the purposes of paragraph (2), categories of provider are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
(4)The form shall state that this information shall not be considered an admission of guilt, but is for educational, data, or investigative purposes.
(5)The board may assess a penalty on any licensee who fails to report an instance of an adverse event as required by this subdivision. The penalty is a maximum fine of one hundred dollars ($100) per day not reported after the initial seven-day reporting period. The licensee may dispute the failure to file within 10 days of receiving notice that the board had assessed a penalty against the licensee.
(aa)Participating in or operating any group advertising and referral services that are in violation of Section 650.2.
(ab)The failure to use a fail-safe machine with an appropriate exhaust system in the administration of nitrous oxide. The board shall, by regulation, define what constitutes a fail-safe machine.
(ac)Engaging in the practice of dentistry with an expired license.
(ad)Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of bloodborne infectious diseases from dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to patient, from patient to patient, and from patient to dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Public Health developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other blood-borne pathogens in health care settings. The board shall review infection control guidelines, if necessary, on an annual basis and proposed changes shall be reviewed by the Dental Hygiene Committee of California to establish a consensus. The committee shall submit any recommended changes to the infection control guidelines for review to establish a consensus. As necessary, the board shall consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision.
The board shall seek to ensure that all appropriate dental personnel are informed of the responsibility to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of bloodborne infectious diseases.
(ae)The utilization by a licensed dentist of any person to perform the functions of any registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions who, at the time of initial employment, does not possess a current, valid license or permit to perform those functions.
(af)The prescribing, dispensing, or furnishing of dangerous drugs or devices, as defined in Section 4022, in violation of Section 2242.1.
SEC. 3.SEC. 5.Section 1682 of the Business and Professions Code is amended to read:1682.In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for:
(a)Any dentist performing dental procedures to have more than one patient undergoing conscious sedation or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia.
(b)Any dentist with patients recovering from conscious sedation or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
(c)Any dentist with patients who are undergoing conscious sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board.
(d)Any dentist with patients who are undergoing conscious sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially.
(e)(1)Any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the written informed consent shall include a form or forms approved by the board, which shall contain the following information: consent shall be obtained from the childs parent or guardian.
All sedation and anesthesia medications involve risks of complications and serious possible damage to vital organs such as the brain, heart, lung, liver, and kidney, and in some cases use of these medications may result in paralysis, cardiac arrest, or death from both known and unknown causes. Therefore, use of appropriate monitoring equipment, as described in subdivision (c) of Section 1682, is required.
(2)For the purpose of this subdivision, administering general anesthesia or deep sedation shall include, but is not limited to, directing the administration of general anesthesia or deep sedation. Nothing
(2)The written informed consent, in the case of a minor, shall include, but not be limited to, the following information:
The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your childs anesthesia for his or her dental treatment, and consult with your dentist or pediatrician as needed.
(3)Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering general anesthesia or deep sedation. or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
This act shall be known, and may be cited, as Calebs Law.
SEC. 2.Section 1601.4 is added to the Business and Professions Code, to read:1601.4.(a)The board, on or before March 31, 2017, shall establish a committee to investigate whether the current laws, regulations, and policies of the state are sufficient to minimize the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients.
(b)On or before September 1, 2017, the committee shall review all incident reports related to pediatric anesthesia in dentistry in the state for the years 2011 through 2016, inclusive, and shall review the policies of other states and dental associations as well as studies regarding the use of pediatric anesthesia to ensure that this state has regulation and policies in place to do everything feasible to protect young patients.
(c)On or before January 1, 2018, the committee shall recommend to the board any measures that would further reduce the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients.
(d)On or before January 1, 2018, the board shall report to the Legislature the recommendations of the committee pursuant to subdivision (c). The report shall be submitted in compliance with Section 9795 of the Government Code. The requirement for submitting a report imposed by this subdivision is inoperative on December 1, 2021, pursuant to Section 10231.5 of the Government Code. The board shall make the report publicly available on the boards Internet Web site. Web site, and shall include, but is not limited to, the following anonymized demographic data of each patient reviewed: his or her age, weight, and sex; his or her primary diagnosis; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the provider responsible for sedation oversight; the provider delivering sedation; the provider monitoring the patient during sedation; and whether the sedation supervision performed one or more of the procedures.
(e)The board shall provide a report on pediatric deaths related to general anesthesia or deep sedation in dentistry at the time of its sunset review pursuant to subdivision (d) of Section 1601.1.
SEC. 3.Section 1682 of the Business and Professions Code is amended to read:1682.In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for:
(a)Any dentist performing dental procedures to have more than one patient undergoing conscious sedation or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia.
(b)Any dentist with patients recovering from conscious sedation or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
(c)Any dentist with patients who are undergoing conscious sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board.
(d)Any dentist with patients who are undergoing conscious sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially.
(e)(1)Any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the written informed consent shall be obtained from the childs parent or guardian. include a form or forms approved by the board, which shall contain the following information:
(2)The written informed consent, in the case of a minor, shall include a form or forms approved by the board, which shall contain the following information:
(A)If the licensee will both perform the procedure and administer general anesthesia or deep sedation, that there is a greater risk of an adverse event, including but not limited to death, if the same person is performing the procedure and administering general anesthesia or deep sedation.
(B)If the monitoring technologies recommended by the American Academy of Pediatric Dentistry will not be used, that doing so may increase the risk of an adverse event, including but not limited to death.
All sedation and anesthesia medications involve risks of complications and serious possible damage to vital organs such as the brain, heart, lung, liver, and kidney, and in some cases use of these medications may result in paralysis, cardiac arrest, or death from both known and unknown causes. Therefore, use of appropriate monitoring equipment, as described in subdivision (c) of Section 1682, is required.
(3)
(2)For the purpose of this subdivision, administering general anesthesia or deep sedation shall include, but is not limited to, directing the administration of general anesthesia or deep sedation. Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering general anesthesia or deep sedation.
This act shall be known, and may be cited, as Calebs Law.
SECTION 1.SEC. 2.Section 1601.4 is added to the Business and Professions Code, to read:1601.4.(a)The board, on or before March 31, 2017, shall establish a committee to investigate whether the current laws, regulations, and policies of the state are sufficient to guard against unnecessary use of anesthesia for young patients and minimize the potential for injury or death. death in minors from the administration of general anesthesia or deep sedation for dental patients. On
(b)On or before December September 1, 2017, the committee shall review all incident reports related to pediatric anesthesia in dentistry in the state for the years 2011 through 2016, inclusive, and shall review the policies of other states and dental associations to ensure that this state has regulation and policies in place to do everything feasible to protect young patients.
(c)On or before January 1, 2018, the committee shall recommend to the board any measures that would further reduce the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients.
(d)On or before January 1, 2018, the board shall report to the Legislature the recommendations of the committee pursuant to subdivision (c). The report shall be submitted in compliance with Section 9795 of the Government Code. The requirement for submitting a report imposed by this subdivision is inoperative on December 1, 2021, pursuant to Section 10231.5 of the Government Code. The board shall make the report publicly available on the boards Internet Web site.
SEC. 3.Section 1682 of the Business and Professions Code is amended to read:1682.In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for:
(a)Any dentist performing dental procedures to have more than one patient undergoing conscious sedation or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia.
(b)Any dentist with patients recovering from conscious sedation or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
(c)Any dentist with patients who are undergoing conscious sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board.
(d)Any dentist with patients who are undergoing conscious sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially.
(e)(1)Any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the consent shall be obtained from the childs parent or guardian.
(2)The written informed consent, in the case of a minor, shall include a form or forms approved by the board, which shall contain the following information:
(A)If the licensee will both perform the procedure and administer general anesthesia or deep sedation, that there is a greater risk of an adverse event, including but not limited to death, if the same person is performing the procedure and administering general anesthesia or deep sedation.
(B)If the monitoring technologies recommended by the American Academy of Pediatric Dentistry will not be used, that doing so may increase the risk of an adverse event, including but not limited to death.
(3)For the purpose of this subdivision, administering general anesthesia or deep sedation shall include, but is not limited to, directing the administration of general anesthesia or deep sedation. Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering general anesthesia or deep sedation.
The board, on or before March 31, 2017, shall establish a committee to investigate whether the current laws, regulations, and policies of the state are sufficient to guard against unnecessary use of anesthesia for young patients and potential injury or death. On or before December 1, 2017, the committee shall review all incident reports related to pediatric anesthesia in dentistry in the state for the years 2011 through 2016, inclusive, and shall review the policies of other states and dental associations to ensure that this state has regulation and policies in place to do everything feasible to protect young patients.
|
Date
|
Status
|
|---|---|
| Jun 1, 2016 | In committee: Hearing postponed by committee. |
| Aug 31, 2016 | Enrolled and presented to the Governor at 4 p.m. |
| Aug 24, 2016 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 80. Noes 0. Page 6194.). |
| Aug 24, 2016 | Senate amendments concurred in. To Engrossing and Enrolling. |
| Aug 19, 2016 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after August 21 pursuant to Assembly Rule 77. |
| Aug 18, 2016 | Read third time. Passed. Ordered to the Assembly. (Ayes 38. Noes 0.). |
| Aug 18, 2016 | Read third time. Passed. Ordered to the Assembly. (Ayes 38. Noes 0. Page 5128.). |
| Aug 18, 2016 | Read third time. Passed. Ordered to the Assembly. |
| Aug 17, 2016 | Read second time. Ordered to third reading. |
| Aug 16, 2016 | Read third time and amended. Ordered to second reading. |
| Aug 2, 2016 | Read second time. Ordered to third reading. |
| Aug 1, 2016 | From committee: Be placed on second reading file pursuant to Senate Rule 28.8. |
| Jun 29, 2016 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on APPR. |
| Jun 20, 2016 | Read second time and amended. Re-referred to Com. on APPR. |
| Jun 16, 2016 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (June 13). |
| Jun 9, 2016 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on B., P. & E.D. |
| Feb 18, 2016 | Read first time. To print. |
| May 5, 2016 | Referred to Com. on B., P. & E.D. |
| Apr 28, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 76. Noes 0.) |
| Apr 28, 2016 | Read third time. Passed. Ordered to the Senate. (Ayes 76. Noes 0. Page 4595.) |
| Apr 28, 2016 | Read third time. Passed. Ordered to the Senate. |
| Apr 28, 2016 | In Senate. Read first time. To Com. on RLS. for assignment. |
| Apr 21, 2016 | Read second time. Ordered to Consent Calendar. |
| Apr 20, 2016 | From committee: Do pass. To Consent Calendar. (Ayes 16. Noes 0.) (April 20). |
| Apr 12, 2016 | Re-referred to Com. on APPR. |
| Apr 11, 2016 | Read second time and amended. |
| Apr 7, 2016 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (April 5). |
| Apr 4, 2016 | Re-referred to Com. on B. & P. |
| Mar 31, 2016 | From committee chair, with author's amendments: Amend, and re-refer to Com. on B. & P. Read second time and amended. |
| Mar 29, 2016 | In committee: Set, first hearing. Hearing canceled at the request of author. |
| Mar 3, 2016 | Referred to Com. on B. & P. |
| Feb 19, 2016 | From printer. May be heard in committee March 20. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 24, 2016 | AB 2235 THURMOND Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Aug 18, 2016 | Assembly 3rd Reading AB2235 Thurmond By Hill | Senate Floor |
Passed |
|
| Jun 13, 2016 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Business, Professions and Economic Development |
Passed |
|
| Apr 28, 2016 | AB 2235 THURMOND Consent Calendar Second Day Regular Session | Assembly Floor |
Passed |
|
| Apr 20, 2016 | Do pass. To Consent Calendar. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 5, 2016 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Business and Professions |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| American Academy Of Pediatrics, California | ** Support | Aug 18, 2016 |
| American Society of Dentist Anesthesiologists | ** Support | Aug 18, 2016 |
| California Association of Nurse Anesthetists | ** Support | Aug 18, 2016 |
| California Dental Association | ** Support | Aug 18, 2016 |
| California Society Of Anesthesiologists, Inc. | ** Support | Aug 18, 2016 |
| Support: | ** Against | Aug 18, 2016 |
| The Children's Partnership | ** Support | Aug 18, 2016 |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 2235
Author:(Thurmond)
As Amended Ver:August 16, 2016
Majority vote
ASSEMBLY: |
| (April 28, 2016) | SENATE: | 38-0 | (August 18, 2016) |
(vote not relevant)
Original Committee Reference: B. & P.
SUMMARY: Declares the Legislature's intent that the Dental Board of California (DBC) encourage dental sedation providers in this state to submit data regarding pediatric sedation events to a research database in order to improve the quality of services provided to pediatric dental anesthesia patients, as specified; requires the DBC, on or before January 1, 2017, to provide a report to the Legislature on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provides adequate protection of pediatric dental patients; specifies the minimum information that a licensee must report to the DBC in the event of a death of his or her patient or removal of a sedation or anesthesia patient to a hospital or emergency center for medical treatment, except as specified, and defines the categories of providers that are required to be specified; specifies that the information provided in this report is not an admission of guilt; authorizes the DBC to assess a fine on any licensee that fails to report an adverse event within a seven-day period and provides that the licensee may dispute a penalty within ten days; and, specifies the minimum information that a licensee include on the written informed consent in the case of a minor.
The Senate amendments delete the Assembly version of this bill, and instead:
- Declare the Legislature's intent that the DBC encourage all dental sedation providers in this state to submit data regarding pediatric sedation events to a research database maintained by a nonprofit organization to formulate a systems-based approach to improve the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
- Require the DBC, on or before January 1, 2017, to make provide a report to the Legislature on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provides adequate protection of pediatric dental patients and requires that this report be made available on the DBC's Internet Web site.
- Specify the minimum information that a licensee must report to the DBC within a seven-day reporting period of an a death of his or her patient or the removal of a sedation or anesthesia patient to a hospital or emergency center for medical treatment, except as specified, is required to include, but not limited to:
- The date of the procedure; the patient's age in years and months, weight, and sex; the patient's American Society of Anesthesiologists (ASA) physical status; the patient's primary diagnosis; the patient's coexisting diagnoses; the procedures performed; the sedation setting; the medications used; the monitoring equipment used;
- The category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; whether the person supervising the sedation performed one or more of the procedures;
- The planned airway management; the planned depth of sedation; the complications that occurred; a description of what was unexpected about the airway management; whether there was transportation of the patient during sedation;
- The category of the provider conducting resuscitation measures; and, the resuscitation equipment utilized.
- Provide that the disclosure of individually identifiable patient included in this report is limited to applicable law.
- Provide that that this report is not admissible in any action brought by a patient of the licensee providing the report.
- Define the categories of providers as General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
- Specify that the information provided in this report is not an admission of guilt.
- Authorize the DBC to assess a fine on any licensee that fails to report an adverse event not reported after the initial seven-day reporting period; provides that the licensee may dispute the failure to file a penalty within 10 days of receiving notice of the penalty.
- Require a dentist who is permitted to administer general anesthesia or deep sedation to obtain written informed consent of a minor patient's parent or guardian on a form or forms approved the DBC that contains the following information:
- "The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child's anesthesia for his or her dental treatment, and consult with your dentist or pediatrician as needed."
- Provides that the information listed in the informed consent, in the case of a minor, is not to be construed as reasonable standard of care administering general anesthesia or deep sedation.
FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, this bill will result in negligible state costs.
COMMENTS: Purpose. According to the author, "Dentists, including oral surgeons, are administering anesthesia, including general anesthesia and sedation, more frequently to children and are using more powerful drugs in their procedures. Dentists are also the only healthcare professionals allowed to perform procedures while simultaneously administering anesthesia. Other healthcare professions require a separate person extensively trained in anesthesia, to administer anesthesia and to monitor the patient. Dentists are also less likely to use recommended monitoring technologies, such as capnography or EKG, when administering anesthesia. As a result, there are a disproportionate number of deaths and injuries, especially of children, linked to dental anesthesia.
"To date, data collection regarding the administration of anesthesia while performing dental operations has been unscientific, unreliable, and inaccessible. Based on their experience with medical professionals, parents do not understand their children are being exposed to additional risks when anesthesia is administered during a dental procedure."
Background. Use of Anesthesia. Previous to 1980, state laws described separate and distinct definitions for general anesthesia and the state of consciousness. Since then, the Legislature has declared that there exists a continuum of consciousness that may not be predictable in every case. However, in most instances, the level of consciousness is correlated with the level of sedation. Currently, the state does not delineate the minimum number of people involved in administering general anesthesia during a dental procedure, only that the operating room be large enough to accommodate at least three people. The author cites more than 20 states that require a person to solely monitor the vital signs of a patient while a separate person performs the dental procedure. The author also asserts that other health professions that administer general anesthesia are required to have the same model.
DBC Subcommittee. On February 8, 2016, the Chair of the Senate Committee on Business, Professions and Economic Development (BPED) sent a letter to DBC requesting that the DBC form a subcommittee to investigate pediatric anesthesia in dentistry, and requested that information from that investigation be reported back to the BPED Committee no later than January 1, 2017. The DBC voluntarily created subcommittee, pursuant to the request of the Chair of the BPED Committee. The subcommittee is charged with reviewing all incident reports related to pediatric anesthesia in California for the years 2011 through 2016, inclusive, and will also assess the policies used by other states and dental associations to ensure that California is protecting young patients.
According to the DBC, "Over the last several months, a two-person subcommittee of the [DBC] has been doing a great deal of research into whether or not California's present laws, regulations, and policies are sufficient to provide protection of pediatric patients during dental sedation; reviewing the present laws, regulations, and policies in California and comparing these findings not only with the information available in other states, but also with dental associations' policies related to sedation. In addition, [the DBC] staff has been compiling six years of statistics (January 1, 2010-December 31, 2015) related to incidents that have occurred where all methods of sedation, including oral conscious sedation, conscious sedation, and general anesthesia have been used for pediatric patients 21 years of age and younger. Board staff also included incident reports related to the use of local anesthetic in the statistical analysis." The information is available to interested parties in the form of a "working document"; however, there are no recommendations for statutory and/or regulatory changes from the subcommittee at this time.
Stakeholders were invited to meet with the subcommittee on Thursday, July 28, 2016, prior to its August board meeting to discuss the working document. Testimony was taken at this time from interested parties. Following the August meeting, the subcommittee will continue to refine the "working document" based on public comments. A final draft of the report will be submitted to the Board for discussion and possible action at the December 1-2, 2016 board meeting.
Analysis Prepared by: Le Ondra Clark Harvey Ph.D. / B. & P. / (916) 319-3301 FN: 0004598
Gabby Nepomuceno
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 2235
:
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 6/13/16
AYES: Hill, Bates, Block, Gaines, Galgiani, Hernandez, Jackson, Mendoza, Wieckowski
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 76-0, 4/28/16 (Consent) - See last page for vote
SOURCE: American Academy of Pediatrics, California
DIGEST: This bill requires the Dental Board of California (DBC) to provide a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients; expands the definition of unprofessional conduct to include failure to notify the DBC about an adverse event relating to dental sedation; encourages DBC to support a third party public database of adverse events; establishes consent language for the administration of general anesthesia for a minor dental patient; requires the DBC to approve a form for the reporting of adverse event information; and authorizes a penalty for failure to report information to the DBC.
Senate Floor Amendments of 8/16/16 delete the maximum fine for failure to report and defer to the DBC existing fine authority.
Existing law:
- Establishes the DBC within the Department of Consumer Affairs to administer the Dental Practice Act. (Business and Professions Code (BPC) § 1601.1)
- Defines the practice of “oral and maxillofacial surgery” as the diagnosis and surgical and adjunctive treatment of diseases, injuries, and defects which involve both functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. (BPC § 1638 (a))
- Authorizes the DBC to issue an oral and maxillofacial surgery permit to an applicant who has furnished evidence satisfactory to the Board that he or she is currently certified or eligible for certification in oral and maxillofacial surgery by a specialty board recognized by the Commission on Accreditation of the American Dental Association and holds a current license in good standing to practice medicine in the state. (BPC § 1638 (c))
- Defines “general anesthesia” as a controlled state of depressed consciousness or unconsciousness, accompanied by partial or complete loss of protective reflexes, produced by a pharmacologic or nonpharmacologic method, or a combination thereof. (BPC § 1646)
- Requires, for the administration of anesthesia to dental patients on an outpatient basis, a dentist to either: (BPC § 1646.1 (a))
- Possess a current license in good standing to practice dentistry and holds a valid general anesthesia permit issued by the Board; or,
- Possesses a current oral and maxillofacial surgery permit or a permit to perform elective facial cosmetic surgery and holds a valid general anesthesia permit issued by the DBC.
- Authorizes a physician and surgeon to administer general anesthesia in the office of a licensed dentist for dental patients, without regard to whether the dentist possesses an anesthesia permit, if the physician and surgeon holds a current license to practice medicine in California and holds a valid general anesthesia permit issued by the DBC. (BPC § 1646.9)
- Defines “conscious sedation” as a minimally depressed level of consciousness produced by a pharmacologic or nonpharmacologic method, or a combination thereof, that retains the patient’s ability to maintain independently and continuously an airway, and respond appropriately to physical stimulation or verbal command. “Conscious sedation” does not include the administration of oral medications or the administration of a mixture of nitrous oxide and oxygen, whether administered alone or in combination with each other.
(BPC § 1647.1) - Requires a dentist administering or ordering the administration of conscious sedation on an outpatient basis for dental patients to have either:
(BPC § 1647.2(a))- A current license in good standing to practice dentistry in California and either holds a valid anesthesia permit or obtains a permit issued by the DBC authorizing the dentist to administer conscious sedation; or,
- A current oral and maxillofacial surgery permit or a permit to perform elective facial cosmetic surgery and either holds a valid general anesthesia permit or a permit to administer conscious sedation.
- Requires a dentist to take a physical evaluation and medical history prior to the administration of conscious sedation and oral conscious sedation of a minor, and maintain records of the physical evaluation, medical history, and conscious sedation procedures as required by the DBC. (BPC §§ 1647.6, 1647.14)
- Defines “oral conscious sedation” as a minimally depressed level of consciousness produced by oral medication that retains the patient’s ability to maintain independently and continuously an airway, and respond appropriately to physical stimulation or verbal command. The drugs and techniques used in oral conscious sedation shall have a margin of safety wide enough to render unintended loss of consciousness unlikely. Further, patients whose only response is reflex withdrawal from painful stimuli would not be considered to be in a state of oral conscious sedation. (BPC § 1647.10 (a))
- Defines a “minor patient” as a dental patient under the age of 13 years.
(BPC § 1647.10 (b)) - Authorizes the DBC to issue administrative fines up to $5,000. (BPC § 125.9; Title 16 California Code of Regulations § 1023.2)
- States that the failure to report to the DBC in writing within seven days of any of the following is unprofessional conduct: (BPC § 1680 (z))
- The death of his or her patient during the performance of any dental or dental hygiene procedure;
- The discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by him or her; or
- Except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment for a period exceeding 24 hours of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment.
This bill:
- States legislative intent for the DBC to encourage dental sedation providers to submit data regarding pediatric sedation events to a pediatric sedation research database maintained by a nonprofit organization, with the goal that the data submitted will be used to formulate a systems-based approach to improving the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
- Requires the DBC to provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients on or before January 1, 2017.
- Requires the DBC to make the report publicly available on its Internet Web site.
- Requires the DBC to provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review.
- States that the failure to provide the following written informed consent language in cases regarding a minor constitutes unprofessional conduct: “The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for his/her dental treatment, and consult with your dentist or pediatrician as needed.”
- Prohibits the informed consent language from being construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
- Removes the time period requirement for reporting an incident to the DBC for a patient who was administered oral conscious sedation, conscious sedation, or general anesthesia and is removed to a hospital or emergency center for medical treatment.
- Requires the DBC to approve a form for the reporting of adverse events related to a patient who was administered oral conscious sedation, conscious sedation, or general anesthesia that includes specified information.
- Authorizes DBC to assess a penalty on any licensee who fails to report an instance of an adverse event. The licensee may dispute the failure to file within 10 days of receiving notice of a penalty.
Background
Current law on dental sedation is largely a product of recommendations from a 2003 DBC Blue Ribbon panel. The panel reviewed all pertinent state laws and regulations pertaining to the delivery of general anesthesia and sedation services by California dentists, DBC data on mortalities associated with dentistry, mortality and morbidity data from The Dentists Insurance Company and the Southern California Society of Oral and Maxillofacial Surgeons, recent changes in dental rules and regulations of other states, various documents and correspondence pertaining to anesthesia and sedation in the dentist office, and relevant national guidelines to produce their report.
Reports Required of the DBC. The DBC is currently preparing a report similar to the one requested in this bill at the request of Senator Hill. According to a DBC memorandum dated April 21, 2016, a two person subcommittee, consisting of an oral and maxillofacial surgeon and an attorney, was appointed at the March DBC meeting to assist staff in conducting the research.
DBC indicates the report will include the following:
- A review of the present laws, regulations, and policies in California; and a comparison of this information to other states’ and dental associations’ policies.
- A review of all incident reports related to pediatric anesthesia in California for the past five years. The specific time frame will be July 1, 2010-June 30, 2015 to coincide with the Board reporting of its annual statistics to the Department of Consumer Affairs.
- Methodology used to review the DBC’s incident reports.
- Number of cases reviewed and results of the review.
- Explanation of the DBC’s internal policies for processing notification of violations of Business & Professions Code 1680(z).
- Explanation of the DBC’s records retention policies.
- Input from stakeholder groups.
- Possible recommendations for statutory or regulatory changes.
DBC staff plans to submit a draft report to the full DBC Board at its August 18-19, 2016 meeting during which the Board and subcommittee will solicit public comment, followed by a second draft to be presented at the DBC’s December 1-2, 2016 board meeting. Senator Hill has asked that a report be prepared and submitted to the Legislature by January 1, 2017.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
American Academy of Pediatrics, California (source)
American Society of Dentist Anesthesiologists
California Association of Nurse Anesthetists
California Dental Association
California Society of Anesthesiologists
The Children’s Partnership
Numerous individuals
OPPOSITION: (Verified 8/17/16)
None received
ARGUMENTS IN SUPPORT: The American Academy of Pediatrics, California writes, “AB 2235 would require the California Dental Board to establish a committee to formally study the safety of pediatric anesthesia in dental offices and other states’ regulations of those procedures. The bill would also require licensed dentists who administer anesthesia to provide information on the differing practices and safety requirements currently in place. Additionally, the board should facilitate the epidemiological study of pediatric anesthesia and sedation by requiring the Dental Board to collect more information regarding adverse events.
“The National American Academy of Pediatrics supports efforts to improve regulations and guidelines for sedation used by medical and dental practitioners for further improvement in safety and outcomes, as noted in AAP Policy Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation.”
ASSEMBLY FLOOR: 76-0, 4/28/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
NO VOTE RECORDED: Chávez, Daly, Mathis, Olsen
8/18/16 9:24:46
**** END ****
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 2235
:
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 6/13/16
AYES: Hill, Bates, Block, Gaines, Galgiani, Hernandez, Jackson, Mendoza, Wieckowski
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 76-0, 4/28/16 (Consent) - See last page for vote
SOURCE: American Academy of Pediatrics, California
DIGEST: This bill requires the Dental Board of California (DBC) to provide a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients; expands the definition of unprofessional conduct to include failure to notify the DBC about an adverse event relating to dental sedation; encourages DBC to support a third party public database of adverse events; establishes consent language for the administration of general anesthesia for a minor dental patient; requires the DBC to approve a form for the reporting of adverse event information; and creates a penalty for failure to report information to the DBC.
Existing law:
- Establishes the DBC within the Department of Consumer Affairs to administer the Dental Practice Act. (Business and Professions Code (BPC) § 1601.1)
- Defines the practice of “oral and maxillofacial surgery” as the diagnosis and surgical and adjunctive treatment of diseases, injuries, and defects which involve both functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. (BPC § 1638 (a))
- Authorizes the DBC to issue an oral and maxillofacial surgery permit to an applicant who has furnished evidence satisfactory to the Board that he or she is currently certified or eligible for certification in oral and maxillofacial surgery by a specialty board recognized by the Commission on Accreditation of the American Dental Association and holds a current license in good standing to practice medicine in the state. (BPC § 1638 (c))
- Defines “general anesthesia” as a controlled state of depressed consciousness or unconsciousness, accompanied by partial or complete loss of protective reflexes, produced by a pharmacologic or nonpharmacologic method, or a combination thereof. (BPC § 1646)
- Requires, for the administration of anesthesia to dental patients on an outpatient basis, a dentist to either: (BPC § 1646.1 (a))
- Possess a current license in good standing to practice dentistry and holds a valid general anesthesia permit issued by the Board; or,
- Possesses a current oral and maxillofacial surgery permit or a permit to perform elective facial cosmetic surgery and holds a valid general anesthesia permit issued by the DBC.
- Authorizes a physician and surgeon to administer general anesthesia in the office of a licensed dentist for dental patients, without regard to whether the dentist possesses an anesthesia permit, if the physician and surgeon holds a current license to practice medicine in California and holds a valid general anesthesia permit issued by the DBC. (BPC § 1646.9)
- Defines “conscious sedation” as a minimally depressed level of consciousness produced by a pharmacologic or nonpharmacologic method, or a combination thereof, that retains the patient’s ability to maintain independently and continuously an airway, and respond appropriately to physical stimulation or verbal command. “Conscious sedation” does not include the administration of oral medications or the administration of a mixture of nitrous oxide and oxygen, whether administered alone or in combination with each other. (BPC § 1647.1)
- Requires a dentist administering or ordering the administration of conscious sedation on an outpatient basis for dental patients to have either:
(BPC § 1647.2(a))- A current license in good standing to practice dentistry in California and either holds a valid anesthesia permit or obtains a permit issued by the DBC authorizing the dentist to administer conscious sedation; or,
- A current oral and maxillofacial surgery permit or a permit to perform elective facial cosmetic surgery and either holds a valid general anesthesia permit or a permit to administer conscious sedation.
- Requires a dentist to take a physical evaluation and medical history prior to the administration of conscious sedation and oral conscious sedation of a minor, and maintain records of the physical evaluation, medical history, and conscious sedation procedures as required by the DBC. (BPC §§ 1647.6, 1647.14)
- Defines “oral conscious sedation” as a minimally depressed level of consciousness produced by oral medication that retains the patient’s ability to maintain independently and continuously an airway, and respond appropriately to physical stimulation or verbal command. The drugs and techniques used in oral conscious sedation shall have a margin of safety wide enough to render unintended loss of consciousness unlikely. Further, patients whose only response is reflex withdrawal from painful stimuli would not be considered to be in a state of oral conscious sedation. (BPC § 1647.10 (a))
- Defines a “minor patient” as a dental patient under the age of 13 years.
(BPC § 1647.10 (b)) - States that the failure to report to the DBC in writing within seven days of any of the following is unprofessional conduct: (BPC § 1680 (z))
- The death of his or her patient during the performance of any dental or dental hygiene procedure;
- The discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by him or her; or
- Except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment for a period exceeding 24 hours of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment.
This bill:
- States Legislative intent for the DBC to encourage dental sedation providers to submit data regarding pediatric sedation events to a pediatric sedation research database maintained by a nonprofit organization, with the goal that the data submitted will be used to formulate a systems-based approach to improving the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
- Requires the DBC to provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients on or before January 1, 2017.
- Requires the DBC to make the report publicly available on its Internet Web site.
- Requires the DBC to provide a report on pediatric deaths related to general anesthesia in dentistry at the time of its sunset review.
- States that the failure to provide the following written informed consent language in cases regarding a minor constitutes unprofessional conduct: “The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for his/her dental treatment, and consult with your dentist or pediatrician as needed.”
- Prohibits the informed consent language from being construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
- Removes the time period requirement for reporting an incident to the DBC for a patient who was administered oral conscious sedation, conscious sedation, or general anesthesia and is removed to a hospital or emergency center for medical treatment.
- Requires the DBC to approve a form for the reporting of adverse events related to a patient who was administered oral conscious sedation, conscious sedation, or general anesthesia that includes specified information.
- Establishes a penalty of $100 per day for a licensee who fails to report a specified adverse event to the DBC within seven days, and allows the licensee to dispute the failure to file the report within ten days of receiving notice that the DBC has assessed a penalty.
Background
Current law on dental sedation is largely a product of recommendations from a 2003 DBC Blue Ribbon panel. The panel reviewed all pertinent state laws and regulations pertaining to the delivery of general anesthesia and sedation services by California dentists, DBC data on mortalities associated with dentistry, mortality and morbidity data from The Dentists Insurance Company and the Southern California Society of Oral and Maxillofacial Surgeons, recent changes in dental rules and regulations of other states, various documents and correspondence pertaining to anesthesia and sedation in the dentist office, and relevant national guidelines to produce their report.
Reports Required of the DBC. The DBC is currently preparing a report similar to the one requested in this bill at the request of Senator Hill. According to a DBC memorandum dated April 21, 2016, a two person subcommittee, consisting of an oral and maxillofacial surgeon and an attorney, was appointed at the March DBC meeting to assist staff in conducting the research.
DBC indicates the report will include the following:
- A review of the present laws, regulations, and policies in California; and a comparison of this information to other states’ and dental associations’ policies.
- A review of all incident reports related to pediatric anesthesia in California for the past five years. The specific time frame will be July 1, 2010-June 30, 2015 to coincide with the Board reporting of its annual statistics to the Department of Consumer Affairs.
- Methodology used to review the DBC’s incident reports.
- Number of cases reviewed and results of the review.
- Explanation of the DBC’s internal policies for processing notification of violations of Business & Professions Code 1680(z).
- Explanation of the DBC’s records retention policies.
- Input from stakeholder groups.
- Possible recommendations for statutory or regulatory changes.
DBC staff plans to submit a draft report to the full DBC Board at its August 18-19, 2016 meeting during which the Board and subcommittee will solicit public comment, followed by a second draft to be presented at the DBC’s December 1-2, 2016 board meeting. Senator Hill has asked that a report be prepared and submitted to the Legislature by January 1, 2017.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
American Academy of Pediatrics, California (source)
American Society of Dentist Anesthesiologists
California Association of Nurse Anesthetists
California Dental Association
California Society of Anesthesiologists
The Children’s Partnership
Numerous individuals
None received
ARGUMENTS IN SUPPORT: The American Academy of Pediatrics, California writes, “AB 2235 would require the California Dental Board to establish a committee to formally study the safety of pediatric anesthesia in dental offices and other states’ regulations of those procedures. The bill would also require licensed dentists who administer anesthesia to provide information on the differing practices and safety requirements currently in place. Additionally, the board should facilitate the epidemiological study of pediatric anesthesia and sedation by requiring the Dental Board to collect more information regarding adverse events.
“The National American Academy of Pediatrics supports efforts to improve regulations and guidelines for sedation used by medical and dental practitioners for further improvement in safety and outcomes, as noted in AAP Policy Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation.”
ASSEMBLY FLOOR: 76-0, 4/28/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
NO VOTE RECORDED: Chávez, Daly, Mathis, Olsen
8/3/16 18:09:02
**** END ****
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2015 - 2016 Regular
Bill No: Hearing Date: June 13, 2016
Author: | |||
Version: | June 9, 2016 Amended | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Sarah Huchel | ||
Subject:
SUMMARY:
Requires the Dental Board of California (DBC) to establish a committee, as specified, to review specified information to ensure that California’s statutes and regulations adequately protect pediatric dental patients; expands the definition of unprofessional conduct to include failure to notify the DBC about an adverse event relating to dental sedation; encourages DBC to support a third party public database of adverse events; establishes consent language for the administration of general anesthesia for a minor dental patient; requires the DBC to approve a form for the reporting of adverse event information; and creates a penalty for failure to report information to the DBC.
Existing law:
- Establishes the DBC within the Department of Consumer Affairs to administer the Dental Practice Act. (Business and Professions Code (BPC) § 1601.1)
- States that protection of the public shall be the DBC’s highest priority in exercising its licensing, regulatory, and disciplinary functions. Whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount. (BPC § 1601.2)
- Defines the practice of “oral and maxillofacial surgery” as the diagnosis and surgical and adjunctive treatment of diseases, injuries, and defects which involve both functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. (BPC § 1638 (a))
- Authorizes the DBC to issue an oral and maxillofacial surgery permit to an applicant who has furnished evidence satisfactory to the Board that he or she is currently certified or eligible for certification in oral and maxillofacial surgery by a specialty board recognized by the Commission on Accreditation of the American Dental Association and holds a current license in good standing to practice medicine in the state. (BPC § 1638 (c))
- Defines “general anesthesia” as a controlled state of depressed consciousness or unconsciousness, accompanied by partial or complete loss of protective reflexes, produced by a pharmacologic or nonpharmacologic method, or a combination thereof. (BPC § 1646)
- Requires, for the administration of anesthesia to dental patients on an outpatient basis, a dentist to either: (BPC § 1646.1 (a))
- Possess a current license in good standing to practice dentistry and holds a valid general anesthesia permit issued by the Board; or,
- Possesses a current oral and maxillofacial surgery permit or a permit to perform elective facial cosmetic surgery and holds a valid general anesthesia permit issued by the DBC.
- Requires a dentist ordering the administration of general anesthesia to be physically within the dental office at the time of the administration. (BPC § 1646.1 (b))
- Authorizes the DBC to require an onsite inspection and evaluation of the licentiate and the facility, equipment, personnel, and procedures utilized by the licentiate prior to the issuance or renewal of a permit for the use of general anesthesia or conscious sedation. (BPC §§ 1646.4, 1647.7)
- Requires a dentist holding a permit to administer general anesthesia to maintain medical history, physical evaluation, and general anesthesia records as required by DBC regulations. (BPC § 1646.3)
- Authorizes a physician and surgeon to administer general anesthesia in the office of a licensed dentist for dental patients, without regard to whether the dentist possesses an anesthesia permit, if the physician and surgeon holds a current license to practice medicine in California and holds a valid general anesthesia permit issued by the DBC. (BPC § 1646.9)
- Defines “conscious sedation” as a minimally depressed level of consciousness produced by a pharmacologic or nonpharmacologic method, or a combination thereof, that retains the patient’s ability to maintain independently and continuously an airway, and respond appropriately to physical stimulation or verbal command. “Conscious sedation” does not include the administration of oral medications or the administration of a mixture of nitrous oxide and oxygen, whether administered alone or in combination with each other. (BPC § 1647.1)
- Requires a dentist administering or ordering the administration of conscious sedation on an outpatient basis for dental patients to have either: (BPC § 1647.2(a))
- A current license in good standing to practice dentistry in California and either holds a valid anesthesia permit or obtains a permit issued by the DBC authorizing the dentist to administer conscious sedation; or,
- A current oral and maxillofacial surgery permit or a permit to perform elective facial cosmetic surgery and either holds a valid general anesthesia permit or a permit to administer conscious sedation.
- Requires a dentist ordering the administration of conscious sedation to be physically present in the treatment facility while the patient is sedated. (BPC § 1647.2 (d))
- Requires a dentist to take a physical evaluation and medical history prior to the administration of conscious sedation and oral conscious sedation of a minor, and maintain records of the physical evaluation, medical history, and conscious sedation procedures as required by the DBC. (BPC §§ 1647.6, 1647.14)
- Defines “oral conscious sedation” as a minimally depressed level of consciousness produced by oral medication that retains the patient’s ability to maintain independently and continuously an airway, and respond appropriately to physical stimulation or verbal command. The drugs and techniques used in oral conscious sedation shall have a margin of safety wide enough to render unintended loss of consciousness unlikely. Further, patients whose only response is reflex withdrawal from painful stimuli would not be considered to be in a state of oral conscious sedation. (BPC § 1647.10 (a))
- States that, for very young or handicapped individuals, incapable of the usually expected verbal response, a minimally depressed level of consciousness should be maintained. (BPC § 1647.10 (a))
- Defines a “minor patient” as a dental patient under the age of 13 years.
(BPC § 1647.10 (b)) - States that the failure to report to the DBC in writing within seven days of any of the following is unprofessional conduct: (BPC § 1680 (z))
- The death of his or her patient during the performance of any dental or dental hygiene procedure;
- The discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by him or her; or
- Except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment for a period exceeding 24 hours of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment.
This bill:
- States Legislative intent for the DBC to encourage dental sedation providers to submit data regarding pediatric sedation events to a pediatric sedation research database maintained by a nonprofit organization, with the goal that the data submitted will be used to formulate a systems-based approach to improving the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
- Requires the DBC to establish a committee to investigate whether current statutes and regulations for the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia provide adequate protection for pediatric dental patients.
- Establishes the committee as follows, and requires the DBC to select at least one member of the committee as proposed by the entities represented by (c), (d), or (f), who, at the time the lists are provided, who is employed at an accredited dental school and someone from (d) and/or (f) who holds at least one sedation permit.
- A physician anesthesiologist who holds a general anesthesia permit from the DBC, chosen from a list provided by the California Society of Anesthesiologists.
- A pediatrician, chosen from a list provided by the American Academy of Pediatrics, California.
- An oral surgeon, chosen from a list provided by the Oral and Facial Surgeons of California.
- A pediatric dentist, chosen from a list provided by the California Society of Pediatric Dentistry.
- A dentist who has completed a dental anesthesiology residency, chosen from a list provided by the American Society of Dentist Anesthesiologists.
- A general dentist, chosen from a list provided by the California Dental Association.
- Defines a pediatric dental patient as a person under 21 years old.
- Requires the committee to do the following to ensure that California’s statutes and regulations adequately protect pediatric dental patients:
- Review all incident reports and relevant investigatory information related to pediatric anesthesia in dentistry in California for the years 2010 through 2016, by August 1, 2017.
- Review the policies and guidelines of other states and national dental associations, and studies regarding the use of pediatric anesthesia.
- Review California’s statutory and regulatory definitions relating to sedation and anesthesia and recommend any necessary revisions.
- Not disclose any confidential, privileged, or personally identifiable information contained in the DBC’s records, except as permitted by law.
- Requires the committee to present its findings in a report to the DBC by November 1, 2017, which shall include any recommendations necessary to improve safety during the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia for pediatric dental patients.
- Requires the DBC to provide the committee’s report to the Legislature with the DBC’s evaluation of the report and its own recommendations.
- Requires the DBC to post the report on its Internet Web site and include anonymized data from each incident reviewed, if available from records in the DBC’s possession, custody, or control, including investigatory reports, as specified.
- Requires the DBC to provide a report on pediatric deaths related to general anesthesia in dentistry as part of its Sunset Review.
- States that the failure to provide the following written informed consent language in cases regarding a minor constitutes unprofessional conduct: “The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for his/her dental treatment, and consult with your dentist or pediatrician as needed.”
- Prohibits the informed consent language from being construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
- Removes the time period requirement for reporting an incident to the DBC for a patient who was administered oral conscious sedation, conscious sedation, or general anesthesia and is removed to a hospital or emergency center for medical treatment.
- Requires the DBC to approve a form for the reporting of adverse events related to a patient who was administered oral conscious sedation, conscious sedation, or general anesthesia that includes specified information.
- Establishes a penalty of $100 per day for a licensee who fails to report a specified adverse event to the DBC within seven days, and allows the licensee to dispute the failure to file the report within ten days of receiving notice that the DBC has assessed a penalty.
FISCAL EFFECT:
This bill is keyed “fiscal” by the Legislative Counsel. According to the Assembly Appropriations Committee analysis dated April 20, 2015, this bill will have
minor increased staff and IT support costs, under $50,000 per year for two years, to perform required activities including tracking and researching incidents, promulgating regulations, and creating a consent form (State Dentistry Fund).
COMMENTS:
- Purpose. This bill is sponsored by the Author. According to the Author’s office, this legislation is necessary to require the DBC to reevaluate California’s statutes and regulations regarding dental sedation in light of the recent tragedy of a young boy who died while undergoing dental work. Statutes haven’t been evaluated in over a decade, and the Author states that “There are legislation and regulations in many other states that increases the safety of anesthesia and sedation for dental procedures in outpatient settings. For example, 20 other states require a third person to participate in every dental procedure requiring anesthesia or sedation whose sole responsibility is to monitor patients’ vital signs and direct the anesthesia or sedation. Several other states also require that dental licentiates use specific monitoring technologies when administering anesthesia and sedation. It does not appear, however, that other states have adopted similar requirements for study and informed consent.”
This bill also requires dentists and oral surgeons to use specified language in their written consent form and encourages licensees to participate in a statewide database.
- Dental Sedation. Current law on dental sedation is largely a product of recommendations from a 2003 DBC Blue Ribbon panel. This panel was chaired by a dental anesthesiologist and consisted of dentists recommended by the following associations:
- California Association of Oral and Maxillofacial Surgeons
- California Dental Association
- California Dental Society of Anesthesiology
- California Society of Dentist Anesthesiologists
- California Society of Pediatric Dentists
- California Society of Periodontists
The panel also included dentists using oral sedation protocols of the Dental Organization for Conscious Sedation. These individuals reviewed all pertinent state laws and regulations pertaining to the delivery of general anesthesia and sedation services by California dentists, DBC data on mortalities associated with dentistry, mortality and morbidity data from The Dentists Insurance Company and the Southern California Society of Oral and Maxillofacial Surgeons, recent changes in dental rules and regulations of other states, various documents and correspondence pertaining to anesthesia and sedation in the dentist office, and relevant national guidelines published by the following:
- American Academy of Pediatric Dentistry
- American Academy of Periodontology
- American Association of Oral and Maxillofacial Surgeons
- American Dental Association
- American Society of Anesthesiologists
- Current Board Activity. The DBC is currently preparing a report similar to the one requested in this bill at the request of Senator Hill. According to a memorandum dated April 21, 2016 prepared for the DBC’s May 2016 board meeting, a two person subcommittee of the DBC, consisting of an oral and maxillofacial surgeon and an attorney, was appointed at the March board meeting to assist staff in conducting the research.
DBC indicates the report will include the following:
- A review of the present laws, regulations, and policies in California; and a comparison of this information to other states’ and dental associations’ policies.
- A review of all incident reports related to pediatric anesthesia in California for the past five years. The specific time frame will be July 1, 2010-June 30, 2015 to coincide with the Board reporting of its annual statistics to the Department of Consumer Affairs.
- Methodology used to review the DBC’s incident reports.
- Number of cases reviewed and results of the review.
- Explanation of the DBC’s internal policies for processing notification of violations of Business & Professions Code 1680(z).
- Explanation of the DBC’s records retention policies.
- Input from stakeholder groups.
- Possible recommendations for statutory or regulatory changes.
DBC staff plans to submit a draft report to the full DBC Board at its August 18-19, 2016 meeting during which the Board and subcommittee will solicit public comment, followed by a second draft to be presented at the DBC’s December 1-2, 2016 board meeting. Senator Hill has asked that a report be prepared and submitted to the Legislature by January 1, 2017.
- Prior Related Legislation. AB 1386 (Laird, Chapter 539, Statutes of 2005) revised the Dental Practice Act relating to general anesthesia, conscious sedation, and oral conscious sedation of minors and further establishes specific provisions relating to oral conscious sedation for adults.
- Arguments in Support. The Children’s Partnership writes, “Although the Dental Board of California has voluntarily responded to requests from the Legislature to examine the issue pediatric dental anesthesia and the best safety practices of other states, it is entirely appropriate that this examination be codified, based on actual recent California epidemiological data, and with the results reported back to the Legislature for further consideration and made available to the public on the Board’s website, as required in AB 2235.
“The tragic child death that precipitated introduction of this bill resulted in a finding of gross negligence on the part of the attending dentist, Dental Board discipline, and a malpractice lawsuit under the current law. But the lack of current data that might indicate how often such tragedies or other adverse outcomes occur must be addressed, along with a reexamination of current safety procedures and medical protocols. These steps are essential to understanding whether additional regulation is necessary to prevent child injury or deaths in the future.”
The American Academy of Pediatrics, California is sponsoring this measure and writes, “AB 2235 would require the California Dental Board to establish a committee to formally study the safety of pediatric anesthesia in dental offices and other states’ regulations of those procedures. The bill would also require licensed dentists who administer anesthesia to provide information on the differing practices and safety requirements currently in place. Additionally, the board should facilitate the epidemiological study of pediatric anesthesia and sedation by requiring the Dental Board to collect more information regarding adverse events.
“The National American Academy of Pediatrics supports efforts to improve regulations and guidelines for sedation used by medical and dental practitioners for further improvement in safety and outcomes, as noted in AAP Policy Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation.”
- Arguments in Opposition: The Oral and Facial Surgeons of California (OFSOC) oppose this bill unless amended to remove the makeup of the committee, stating, “The most recent amendments require a statutorily prescribed makeup of the membership of the committee to be established by the Dental Board of California. OFSOC opposes the perceived stacking of the committee by healthcare providers who either do not have an expertise in the pertinent issues; have previously stated publically of the existence of a serious problem; or have vested financial interests in changing the status quo. OFSOC strongly believes the purpose of the proposed committee is to objectively and reasonably review the available data regarding dental anesthesia specifically as it relates to minors and subsequently make appropriate recommendations. In order to achieve that objectivity, OFSOC prefers that the Dental Board of California unilaterally establish an investigatory committee that will meet the criteria set forth in the provisions of AB 2235.”
The California Dental Association (CDA) expresses support if the Author accepts the committee amendment below, stating, “CDA and our community of providers are deeply saddened by the tragic loss of a young child. CDA is dedicated to keeping general anesthesia and sedation in dentistry safe and reducing the risks of adverse outcomes. All patients should be able to access safe anesthesia and sedation needed to maintain their oral health. While this bill arose out of a tragic situation and we must always strive to improve safety, all proposed solutions must arise from a thorough and evidence-based process.”
- Recommended Amendment. The Author may wish to consider removing the amendments prescribing the composition of the committee, and allowing the DBC to decide the makeup of the committee. The DBC’s efforts to convene stakeholder groups to evaluate dental issues have proven effective in the past, and establishing a predetermined cast diminishes the DBC’s authority and responsibility in this area.
SUPPORT AND OPPOSITION:
Support:
American Academy of Pediatrics, California (Sponsor)
American Society of Dentist Anesthesiologists
California Association of Nurse Anesthetists
California Society of Anesthesiologists
The Children’s Partnership
Numerous individuals
Support if amended:
California Dental Association
Oppose unless amended:
Oral and Facial Surgeons of California
-- END --
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2015 - 2016 Regular
Bill No: AB 2235 Hearing Date: June 13, 2016
Author: | Thurmond | ||
Version: |
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Urgency: | Fiscal: | ||
Consultant: | |||
Subject: Board of Dentistry: pediatric anesthesia: committee
SUMMARY:
Requires the Dental Board of California (DBC) to establish a committee, as specified, to review specified information to ensure that California’s statutes and regulations adequately protect pediatric dental patients; expands the definition of unprofessional conduct to include failure to notify the DBC about an adverse event relating to dental sedation; encourages DBC to support a third party public database of adverse events; establishes consent language for the administration of general anesthesia for a minor dental patient; requires the DBC to approve a form for the reporting of adverse event information; and creates a penalty for failure to report information to the DBC.
Existing law:
- Establishes the DBC within the Department of Consumer Affairs to administer the Dental Practice Act. (Business and Professions Code (BPC) § 1601.1)
- States that protection of the public shall be the DBC’s highest priority in exercising its licensing, regulatory, and disciplinary functions. Whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount. (BPC § 1601.2)
- Defines the practice of “oral and maxillofacial surgery” as the diagnosis and surgical and adjunctive treatment of diseases, injuries, and defects which involve both functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. (BPC § 1638 (a))
- Authorizes the DBC to issue an oral and maxillofacial surgery permit to an applicant who has furnished evidence satisfactory to the Board that he or she is currently certified or eligible for certification in oral and maxillofacial surgery by a specialty board recognized by the Commission on Accreditation of the American Dental Association and holds a current license in good standing to practice medicine in the state. (BPC § 1638 (c))
- Defines “general anesthesia” as a controlled state of depressed consciousness or unconsciousness, accompanied by partial or complete loss of protective reflexes, produced by a pharmacologic or nonpharmacologic method, or a combination thereof. (BPC § 1646)
- Requires, for the administration of anesthesia to dental patients on an outpatient basis, a dentist to either: (BPC § 1646.1 (a))
- Possess a current license in good standing to practice dentistry and holds a valid general anesthesia permit issued by the Board; or,
- Possesses a current oral and maxillofacial surgery permit or a permit to perform elective facial cosmetic surgery and holds a valid general anesthesia permit issued by the DBC.
- Requires a dentist ordering the administration of general anesthesia to be physically within the dental office at the time of the administration. (BPC § 1646.1 (b))
- Authorizes the DBC to require an onsite inspection and evaluation of the licentiate and the facility, equipment, personnel, and procedures utilized by the licentiate prior to the issuance or renewal of a permit for the use of general anesthesia or conscious sedation. (BPC §§ 1646.4, 1647.7)
- Requires a dentist holding a permit to administer general anesthesia to maintain medical history, physical evaluation, and general anesthesia records as required by DBC regulations. (BPC § 1646.3)
- Authorizes a physician and surgeon to administer general anesthesia in the office of a licensed dentist for dental patients, without regard to whether the dentist possesses an anesthesia permit, if the physician and surgeon holds a current license to practice medicine in California and holds a valid general anesthesia permit issued by the DBC. (BPC § 1646.9)
- Defines “conscious sedation” as a minimally depressed level of consciousness produced by a pharmacologic or nonpharmacologic method, or a combination thereof, that retains the patient’s ability to maintain independently and continuously an airway, and respond appropriately to physical stimulation or verbal command. “Conscious sedation” does not include the administration of oral medications or the administration of a mixture of nitrous oxide and oxygen, whether administered alone or in combination with each other. (BPC § 1647.1)
- Requires a dentist administering or ordering the administration of conscious sedation on an outpatient basis for dental patients to have either: (BPC § 1647.2(a))
- A current license in good standing to practice dentistry in California and either holds a valid anesthesia permit or obtains a permit issued by the DBC authorizing the dentist to administer conscious sedation; or,
- A current oral and maxillofacial surgery permit or a permit to perform elective facial cosmetic surgery and either holds a valid general anesthesia permit or a permit to administer conscious sedation.
- Requires a dentist ordering the administration of conscious sedation to be physically present in the treatment facility while the patient is sedated. (BPC § 1647.2 (d))
- Requires a dentist to take a physical evaluation and medical history prior to the administration of conscious sedation and oral conscious sedation of a minor, and maintain records of the physical evaluation, medical history, and conscious sedation procedures as required by the DBC. (BPC §§ 1647.6, 1647.14)
- Defines “oral conscious sedation” as a minimally depressed level of consciousness produced by oral medication that retains the patient’s ability to maintain independently and continuously an airway, and respond appropriately to physical stimulation or verbal command. The drugs and techniques used in oral conscious sedation shall have a margin of safety wide enough to render unintended loss of consciousness unlikely. Further, patients whose only response is reflex withdrawal from painful stimuli would not be considered to be in a state of oral conscious sedation. (BPC § 1647.10 (a))
- States that, for very young or handicapped individuals, incapable of the usually expected verbal response, a minimally depressed level of consciousness should be maintained. (BPC § 1647.10 (a))
- Defines a “minor patient” as a dental patient under the age of 13 years.
(BPC § 1647.10 (b)) - States that the failure to report to the DBC in writing within seven days of any of the following is unprofessional conduct: (BPC § 1680 (z))
- The death of his or her patient during the performance of any dental or dental hygiene procedure;
- The discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by him or her; or
- Except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment for a period exceeding 24 hours of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment.
This bill:
- States Legislative intent for the DBC to encourage dental sedation providers to submit data regarding pediatric sedation events to a pediatric sedation research database maintained by a nonprofit organization, with the goal that the data submitted will be used to formulate a systems-based approach to improving the quality of services provided to pediatric dental anesthesia patients in outpatient settings.
- Requires the DBC to establish a committee to investigate whether current statutes and regulations for the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia provide adequate protection for pediatric dental patients.
- Establishes the committee as follows, and requires the DBC to select at least one member of the committee as proposed by the entities represented by (c), (d), or (f), who, at the time the lists are provided, who is employed at an accredited dental school and someone from (d) and/or (f) who holds at least one sedation permit.
- A physician anesthesiologist who holds a general anesthesia permit from the DBC, chosen from a list provided by the California Society of Anesthesiologists.
- A pediatrician, chosen from a list provided by the American Academy of Pediatrics, California.
- An oral surgeon, chosen from a list provided by the Oral and Facial Surgeons of California.
- A pediatric dentist, chosen from a list provided by the California Society of Pediatric Dentistry.
- A dentist who has completed a dental anesthesiology residency, chosen from a list provided by the American Society of Dentist Anesthesiologists.
- A general dentist, chosen from a list provided by the California Dental Association.
- Defines a pediatric dental patient as a person under 21 years old.
- Requires the committee to do the following to ensure that California’s statutes and regulations adequately protect pediatric dental patients:
- Review all incident reports and relevant investigatory information related to pediatric anesthesia in dentistry in California for the years 2010 through 2016, by August 1, 2017.
- Review the policies and guidelines of other states and national dental associations, and studies regarding the use of pediatric anesthesia.
- Review California’s statutory and regulatory definitions relating to sedation and anesthesia and recommend any necessary revisions.
- Not disclose any confidential, privileged, or personally identifiable information contained in the DBC’s records, except as permitted by law.
- Requires the committee to present its findings in a report to the DBC by November 1, 2017, which shall include any recommendations necessary to improve safety during the administration and monitoring of oral conscious sedation, conscious sedation, and general anesthesia for pediatric dental patients.
- Requires the DBC to provide the committee’s report to the Legislature with the DBC’s evaluation of the report and its own recommendations.
- Requires the DBC to post the report on its Internet Web site and include anonymized data from each incident reviewed, if available from records in the DBC’s possession, custody, or control, including investigatory reports, as specified.
- Requires the DBC to provide a report on pediatric deaths related to general anesthesia in dentistry as part of its Sunset Review.
- States that the failure to provide the following written informed consent language in cases regarding a minor constitutes unprofessional conduct: “The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for his/her dental treatment, and consult with your dentist or pediatrician as needed.”
- Prohibits the informed consent language from being construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia.
- Removes the time period requirement for reporting an incident to the DBC for a patient who was administered oral conscious sedation, conscious sedation, or general anesthesia and is removed to a hospital or emergency center for medical treatment.
- Requires the DBC to approve a form for the reporting of adverse events related to a patient who was administered oral conscious sedation, conscious sedation, or general anesthesia that includes specified information.
- Establishes a penalty of $100 per day for a licensee who fails to report a specified adverse event to the DBC within seven days, and allows the licensee to dispute the failure to file the report within ten days of receiving notice that the DBC has assessed a penalty.
FISCAL EFFECT:
This bill is keyed “fiscal” by the Legislative Counsel. According to the Assembly Appropriations Committee analysis dated April 20, 2015, this bill will have
minor increased staff and IT support costs, under $50,000 per year for two years, to perform required activities including tracking and researching incidents, promulgating regulations, and creating a consent form (State Dentistry Fund).
COMMENTS:
- Purpose. This bill is sponsored by the Author. According to the Author’s office, this legislation is necessary to require the DBC to reevaluate California’s statutes and regulations regarding dental sedation in light of the recent tragedy of a young boy who died while undergoing dental work. Statutes haven’t been evaluated in over a decade, and the Author states that “There are legislation and regulations in many other states that increases the safety of anesthesia and sedation for dental procedures in outpatient settings. For example, 20 other states require a third person to participate in every dental procedure requiring anesthesia or sedation whose sole responsibility is to monitor patients’ vital signs and direct the anesthesia or sedation. Several other states also require that dental licentiates use specific monitoring technologies when administering anesthesia and sedation. It does not appear, however, that other states have adopted similar requirements for study and informed consent.”
This bill also requires dentists and oral surgeons to use specified language in their written consent form and encourages licensees to participate in a statewide database.
- Dental Sedation. Current law on dental sedation is largely a product of recommendations from a 2003 DBC Blue Ribbon panel. This panel was chaired by a dental anesthesiologist and consisted of dentists recommended by the following associations:
- California Association of Oral and Maxillofacial Surgeons
- California Dental Association
- California Dental Society of Anesthesiology
- California Society of Dentist Anesthesiologists
- California Society of Pediatric Dentists
- California Society of Periodontists
The panel also included dentists using oral sedation protocols of the Dental Organization for Conscious Sedation. These individuals reviewed all pertinent state laws and regulations pertaining to the delivery of general anesthesia and sedation services by California dentists, DBC data on mortalities associated with dentistry, mortality and morbidity data from The Dentists Insurance Company and the Southern California Society of Oral and Maxillofacial Surgeons, recent changes in dental rules and regulations of other states, various documents and correspondence pertaining to anesthesia and sedation in the dentist office, and relevant national guidelines published by the following:
- American Academy of Pediatric Dentistry
- American Academy of Periodontology
- American Association of Oral and Maxillofacial Surgeons
- American Dental Association
- American Society of Anesthesiologists
- Current Board Activity. The DBC is currently preparing a report similar to the one requested in this bill at the request of Senator Hill. According to a memorandum dated April 21, 2016 prepared for the DBC’s May 2016 board meeting, a two person subcommittee of the DBC, consisting of an oral and maxillofacial surgeon and an attorney, was appointed at the March board meeting to assist staff in conducting the research.
DBC indicates the report will include the following:
- A review of the present laws, regulations, and policies in California; and a comparison of this information to other states’ and dental associations’ policies.
- A review of all incident reports related to pediatric anesthesia in California for the past five years. The specific time frame will be July 1, 2010-June 30, 2015 to coincide with the Board reporting of its annual statistics to the Department of Consumer Affairs.
- Methodology used to review the DBC’s incident reports.
- Number of cases reviewed and results of the review.
- Explanation of the DBC’s internal policies for processing notification of violations of Business & Professions Code 1680(z).
- Explanation of the DBC’s records retention policies.
- Input from stakeholder groups.
- Possible recommendations for statutory or regulatory changes.
DBC staff plans to submit a draft report to the full DBC Board at its August 18-19, 2016 meeting during which the Board and subcommittee will solicit public comment, followed by a second draft to be presented at the DBC’s December 1-2, 2016 board meeting. Senator Hill has asked that a report be prepared and submitted to the Legislature by January 1, 2017.
- Prior Related Legislation. AB 1386 (Laird, Chapter 539, Statutes of 2005) revised the Dental Practice Act relating to general anesthesia, conscious sedation, and oral conscious sedation of minors and further establishes specific provisions relating to oral conscious sedation for adults.
- Arguments in Support. The Children’s Partnership writes, “Although the Dental Board of California has voluntarily responded to requests from the Legislature to examine the issue pediatric dental anesthesia and the best safety practices of other states, it is entirely appropriate that this examination be codified, based on actual recent California epidemiological data, and with the results reported back to the Legislature for further consideration and made available to the public on the Board’s website, as required in AB 2235.
“The tragic child death that precipitated introduction of this bill resulted in a finding of gross negligence on the part of the attending dentist, Dental Board discipline, and a malpractice lawsuit under the current law. But the lack of current data that might indicate how often such tragedies or other adverse outcomes occur must be addressed, along with a reexamination of current safety procedures and medical protocols. These steps are essential to understanding whether additional regulation is necessary to prevent child injury or deaths in the future.”
The American Academy of Pediatrics, California is sponsoring this measure and writes, “AB 2235 would require the California Dental Board to establish a committee to formally study the safety of pediatric anesthesia in dental offices and other states’ regulations of those procedures. The bill would also require licensed dentists who administer anesthesia to provide information on the differing practices and safety requirements currently in place. Additionally, the board should facilitate the epidemiological study of pediatric anesthesia and sedation by requiring the Dental Board to collect more information regarding adverse events.
“The National American Academy of Pediatrics supports efforts to improve regulations and guidelines for sedation used by medical and dental practitioners for further improvement in safety and outcomes, as noted in AAP Policy Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation.”
- Arguments in Opposition: The Oral and Facial Surgeons of California (OFSOC) oppose this bill unless amended to remove the makeup of the committee, stating, “The most recent amendments require a statutorily prescribed makeup of the membership of the committee to be established by the Dental Board of California. OFSOC opposes the perceived stacking of the committee by healthcare providers who either do not have an expertise in the pertinent issues; have previously stated publically of the existence of a serious problem; or have vested financial interests in changing the status quo. OFSOC strongly believes the purpose of the proposed committee is to objectively and reasonably review the available data regarding dental anesthesia specifically as it relates to minors and subsequently make appropriate recommendations. In order to achieve that objectivity, OFSOC prefers that the Dental Board of California unilaterally establish an investigatory committee that will meet the criteria set forth in the provisions of AB 2235.”
The California Dental Association (CDA) expresses support if the Author accepts the committee amendment below, stating, “CDA and our community of providers are deeply saddened by the tragic loss of a young child. CDA is dedicated to keeping general anesthesia and sedation in dentistry safe and reducing the risks of adverse outcomes. All patients should be able to access safe anesthesia and sedation needed to maintain their oral health. While this bill arose out of a tragic situation and we must always strive to improve safety, all proposed solutions must arise from a thorough and evidence-based process.”
- Recommended Amendment. The Author may wish to consider removing the amendments prescribing the composition of the committee, and allowing the DBC to decide the makeup of the committee. The DBC’s efforts to convene stakeholder groups to evaluate dental issues have proven effective in the past, and establishing a predetermined cast diminishes the DBC’s authority and responsibility in this area.
SUPPORT AND OPPOSITION:
Support:
American Academy of Pediatrics, California (Sponsor)
American Society of Dentist Anesthesiologists
California Association of Nurse Anesthetists
California Society of Anesthesiologists
The Children’s Partnership
Numerous individuals
Support if amended:
California Dental Association
Oppose unless amended:
Oral and Facial Surgeons of California
-- END --
Date of Hearing: April 20, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
ABPCA Bill Id:AB 2235
Author:(Thurmond) – As Amended Ver:April 11, 2016
Policy Committee: | Business and Professions | Vote: | 16 - 0 |
|
| ||
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Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill requires the Dental Board of California (DBC), on or before March 31, 2017, to establish a committee to investigate current laws and regulations for the use of pediatric anesthesia in dentistry. Specifically, this bill:
- Requires the committee to review all incident reports for the last five years, make recommendations, and report to the Legislature by January 1, 2018 as well as at its next sunset review.
- Specifies that administration of sedation by a dentist includes directing the administration of sedation, and specifies information related to sedation that must be provided in a parental consent form for a minor.
FISCAL EFFECT:
Minor increased staff and IT support costs, under $50,000 per year for two years, to perform required activities including tracking and researching incidents, promulgating regulations, and creating a consent form (State Dentistry Fund).
COMMENTS:
- Purpose. According to the author, parents do not understand the unique risks posed by pediatric general anesthesia and sedation in a dental setting. The author explains dentists are the only healthcare professionals allowed to perform procedures while simultaneously administering anesthesia. This is unlike the medical setting, where anesthesia is performed by a separate individual who is monitoring the patient. This bill is intended to provide a thorough review of the safety of pediatric anesthesia in a dental setting. Anesthesiologists, a surgery center, and number of individuals support this bill, and it has no formal opposition.
- Background. According to the DBC, at its March 4, 2016, board meeting, a subcommittee was created to address the issue this bill requires, pursuant to a request received by the Chair of the Senate Committee on Business, Professions and Economic Development. Current data appear too limited to conclusively demonstrate adverse outcomes or prove current practice optimizes safety. Any sedation and anesthesia procedure carries some risk of serious side effects.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing:
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Rudy Salas, Chair
ABPCA Bill Id:AB 2235
Author:(Thurmond) – As Amended Ver:March 31, 2016
SUBJECT: Board of Dentistry: pediatric anesthesia: committee.
SUMMARY: Requires the Dental Board of California (DBC), on or before March 31, 2017, to establish a committee to investigate current laws and regulations for the use of pediatric anesthesia in dentistry; requires the committee, on or before September 1, 2017 to review all pediatric anesthesia incidents between the years of 2011 and 2016 and further requires the committee to review the policies of other states and dental associations, as specified; provides that the committee makes recommendations to the DBC on measures to reduce potential injury or death; provides that the DBC submit a report to the Legislature on or before January 1, 2018, detailing the committee’s recommendations and specifies that this report be made publically available; requires a dentist who is permitted to administer general anesthesia or deep sedation to obtain written informed consent, as specified.
EXISTING LAW:
- Provides that the DBC and the Dental Practice Act licenses and regulates those engaged in the practice of dentistry. (Business and Professions Code (BPC) §1600 et seq.)
- Authorizes all committees of the DBC to evaluate all suggestions or requests for regulatory changes related to their committee, and requires the committees to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor and any facts supporting the need for the change. (BPC §1601.3)
- Defines "dentistry" as the diagnosis or treatment, by surgery or other method, of diseases and lesions and the correction of malpositions of the human teeth, alveolar process, gums, jaws, or associated structures; and such diagnosis or treatment may include all necessary related procedures as well as the use of drugs, anesthetic agents, and physical evaluation. (BPC §1625)
- Defines “general anesthesia,” as a controlled state of depressed consciousness or unconsciousness, accompanied by partial or complete loss of protective reflexes, produced by a pharmacologic or nonpharmacologic method, or a combination thereof. (BPC §1646)
- Provides that that the educational standards presently required for general anesthesia should be required when the degree of sedation in the continuum of sedation is such that there is a reasonable possibility that loss of consciousness may result, even if unintended. These degrees of sedation have been referred to as “deep sedation” and “light general anesthesia” in dental literature. (BPC §1647(c))
- Provides that a licensed physician and surgeon may administer general anesthesia in the office of a licensed dentist for dental patients, without regard to whether the dentist possesses a permit if he or she possesses a current license in good standing to practice medicine in this state, and holds a valid general anesthesia permit issued by the DBC, as specified. (BPC §1646.9(a))
- Requires an applicant for a permit to administer general anesthesia or order the administration of general anesthesia by a nurse anesthetist must be a licensed dentist in California who:
- Has completed a residency program in general anesthesia at least one calendar year; or,
- Has completed a graduate program in oral and maxillofacial surgery which has been approved by the Commission on Dental Accreditation. (Title 16, California Code of Regulations Section (16 CCR) 1043.1)
- Provides that the office in which general anesthesia is conducted must meet standards of facility and equipment, records maintenance, and emergency drugs on hand, as specified. (16 CCR 1043.3)
- Provides that a dental procedure utilizing general anesthesia administered by an applicant for a general anesthesia permit must be observed and evaluated for his or her demonstration that he or she has knowledge of the uses of the equipment required by 16 CCR 1043.3(a) and is capable of using that equipment. (16 CCR 1043.4(a))
- Provides that an applicant for a general anesthesia permit must have knowledge of and must physically demonstrate that the applicant (i.e. dentist) and his or her operating team can respond to simulated emergencies, as specified. (16 CCR 1043.4)
- Provides that a general anesthesia permit must be renewed biennially upon certification by the permit holder that he or she has met all applicable continuing education requirements, has paid the required fee and if required, has successfully completed an onsite inspection and evaluation. (16 CCR 1043.8)
- Requires a physical evaluation and medical history to be taken before the administration of conscious sedation, and further requires a dentist holding a permit to maintain records of the physical evaluation, medical history, and conscious sedation procedures used as required by board regulations. (BPC §1647.6)
- Provides that it is unprofessional conduct for a dentist to: (BPC §1682)
- Perform dental procedures having more than one patient undergoing conscious sedation or general anesthesia, on an outpatient basis at any given time, unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia.
- Fail to have the patients recovering from conscious sedation or general anesthesia closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients must be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one.
- Fail to have patients who are undergoing conscious sedation continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board.
- Have dental office personnel, who are not certified in basic cardiac life support (CPR) and recertified biennially, directly involved with the care of those patients who are undergoing conscious sedation.
- Fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the consent must be obtained from the child’s parent or guardian.
- Requires a dentist, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to report to the board all deaths occurring in his or her practice with a copy sent to the Dental Hygiene Committee of California if the death was the result of treatment by a licensed dentistry professional, as specified. (BPC §1680(z))
- States that for general anesthesia, conscious sedation or oral conscious sedation, a minimally depressed level of consciousness should be maintained for that a very young or handicapped individual incapable of the usually expected verbal response. (BPC §§1647.1(c), 1647.10(2) and 1647.18(2))
THIS BILL:
- Requires the Dental Board of California (DBC), on or before March 31, 2017, to establish a committee to investigate current laws and regulations for the use of pediatric anesthesia in dentistry.
- Requires the committee, on or before September 1, 2017 to review all pediatric anesthesia incidents between the years of 2011 and 2016 and further requires the committee to review the policies of other states and dental associations.
- Requires the committee, on or before January 1, 2018, to make recommendations to the DBC measures to reduce potential injury or death of minors.
- Requires the DBC to report, on or before January 1, 2018, to the Legislature committee’s recommendations and make this report publically available on its Internet Web site.
- Requires a dentist who is permitted to administer general anesthesia or deep sedation to obtain written informed consent of a minor patient’s parent or guardian on a form or forms approved the DBC that contains information regarding:
- Increased risk associated with one person simultaneously administering general anesthesia or deep sedation and performing the dental procedure, and
- Increased risk associated with deviating from the use of monitoring technologies that are recommended by the American Academy of Pediatric Dentists.
- Specifies that administering general anesthesia or deep sedation includes, but is not limited to, directing the administration of general anesthesia or deep sedation,
- Provides that the information listed in the informed consent, in the case of a minor, is not to be construed as reasonable standard of care administering general anesthesia or deep sedation.
FISCAL EFFECT: Unknown. This bill is keyed fiscal by the Legislative Counsel.
COMMENTS:
Purpose. According to the author, “Dentists, including oral surgeons, are administering anesthesia, including general anesthesia and sedation, more frequently to children and are using more powerful drugs in their procedures. Dentists are also the only healthcare professionals allowed to perform procedures while simultaneously administering anesthesia. Other healthcare professions require a separate person extensively trained in anesthesia, to administer anesthesia and to monitor the patient. Dentists are also less likely to use recommended monitoring technologies, such as capnography or EKG, when administering anesthesia. As a result, there are a disproportionate number of deaths and injuries, especially of children, linked to dental anesthesia.
To date, data collection regarding the administration of anesthesia while performing dental operations has been unscientific, unreliable, and inaccessible. Based on their experience with medical professionals, parents do not understand their children are being exposed to additional risks when anesthesia is administered during a dental procedure.”
It is the intent of the author, as this bill moves forward, to make the anonymized data collected in the DBC’s review of pediatric anesthesia in dentistry available to the public and to facilitate the epidemiological study of pediatric anesthesia and sedation. The author wishes to establish and maintain a database of adverse events related to pediatric anesthesia and sedation in outpatient settings.
Use of Anesthesia. Pursuant to BPC §1647(a), the Legislature has found, “a commendable patient safety record has been maintained in the past by dentists and those other qualified providers of anesthesia services who, pursuant to a dentist’s authorization, administer patient sedation, and that the increasing number of pharmaceuticals and techniques used to administer them for patient sedation require additional regulation to maintain patient safety in the future.”
Previous to 1980, state laws described separate and distinct definitions for general anesthesia and the state of consciousness. Since then, the Legislature has declared that there exists a continuum of consciousness that may not be predictable in every case. However, in most instances, the level of consciousness is correlated with the level of sedation.
According to the author, hard data for the use of pediatric anesthesia in dentistry related incidents of injury or death, is unavailable or inaccessible from the DBC.
Currently, the state does not delineate the minimum number of people involved in administering general anesthesia during a dental procedure, only that the operating room be large enough to accommodate at least three people. The author cites more than 20 states that require a person to solely monitor the vital signs of a patient while a separate person performs the dental procedure. The author also asserts that other health professions that administer general anesthesia are required to have the same model.
DBC Subcommittee. On February 8, 2016, the Chair of the Senate Committee on Business, Professions and Economic Development (BPED) sent a letter to DBC requesting that the DBC form a subcommittee to investigate pediatric anesthesia in dentistry, and requested that information from that investigation be reported back to the BPED Committee no later than January 1, 2017.
According to the DBC, at its March 4th, board meeting, a subcommittee was voluntarily created, pursuant to the request of the Chair of the BPED Committee, and two members were appointed to the subcommittee by the DBC Chair, Dr. Morrow: 1) Dr. Bruce Whitcher (Oral and Maxillofacial Surgeon), and 2) Ms. Meredith McKenzie (attorney and public member).
The subcommittee is charged with reviewing all incident reports related to pediatric anesthesia in California for the years 2011 through 2016, inclusive. The subcommittee will also assess the policies used by other states and dental associations to ensure that California is protecting young patients.
ARGUMENTS IN SUPPORT:
PDI Surgery Center writes in support, “There is no reason that the California Dental Board should not have patient safety, especially for children, as its first priority. To enable the Dental Board to make the right decisions concerning how to improve patient safety, it needs information about what is happening during adverse events with dental anesthesia. I support creating a database of adverse events that is publicly available to facilitate epidemiological study of dental
anesthesia. We also support requiring dentists accurately to inform patients, or their parents or guardians, of the risks associated with having the same person perform a procedure and administer anesthesia, or of failing to use appropriate monitoring technologies. Many people believe that general anesthesia and sedation is safe, because in many instances it is safe. But those instances involve a person whose only job during the procedure is to administer the anesthesia and monitor the patient. The American Society of Anesthesiology has specifically warned against having the same person perform a procedure and administer anesthesiology. Patients should be clearly informed if their dentist is not going to follow that basic safety requirement. Patients should also be clearly informed if their dentist is not using proper monitoring technology.”
California Society of Anesthesiologists write in support, “We strongly believe that the standard of care regarding the administration and monitoring of anesthesia services must be consistent whether that patient is six or 60 or receiving anesthesia care in a dentist office, ambulatory surgery center, or acute care hospital”
ARGUMENTS IN OPPOSITION:
California Dental Association writes in opposition, “The DBC’s urgent attention to this issue, combined with its recent disciplinary action for the incident prompting this legislation, negates the need for [the] amendments. These amendments step out ahead of the review and would hinder meaningful solutions that could come from a thoroughly researched and vetted DBC recommendation.
Oral and Facial Surgeons of California writes in opposition, “The declaratory statements in [these] amendments cannot be factually substantiated. In addition, codifying technologies of a private professional health association is very problematic and is not an established legislative practice.”
POLICY ISSUE(S) FOR CONSIDERATION:
- The committee established by this bill is charged with reviewing incidents, as specified, in California, the policies and procedures of this state, as well as the policies of other states and dental associations. In order to gain a comprehensive understanding of the use of pediatric anesthesia in dentistry, the author may wish to consider including studies published about pediatric anesthesia.
- For purposes of the Dental Practice Act, a “minor patient” is one who is younger than 13 years of age. In many other related professions, namely the medical field, a pediatric patient is one who is younger than 18 years of age, unless otherwise specified. In addition, Family Code 6500 et seq. defines a minor as an individual who is under 18 years of age. The author may wish to consider expanding the committee’s research to include patients who are not minors according to the Dental Practice Act, but are statutorily defined as minors in other instances.
- It is unclear what influenced the decision for reviews to only cover the past five years. The author may wish to expand this review to include all incidents on record with the DBC in order to provide a more comprehensive report of incidents.
- Should this bill be enacted, a permanent committee will be established within the DBC. It is unclear whether the current voluntary subcommittee will be converted to the permanent committee mandated by this bill, or if a new committee will be formed in addition to the subcommittee.
- The membership of the committee is not specified in this bill; however, the DBC’s voluntary subcommittee is currently comprised of an oral and maxillofacial surgeon and an attorney. The data collected in the committee’s review may shed light on the use of pediatric anesthesia in dentistry, which directly involves the scope of practice of a dental anesthesiologist. As such, the author may wish to request that the DBC include a dental anesthesiologist.
- Some national professional organizations recommend that while a person performs a dental procedure involving general anesthesia or deep sedation, a separate person should solely monitor the vital signs of the patient. However, not all professional associations agree that a separate person is necessary because a dentist who has been granted a general anesthesia permit by the DBC has extensive training in administering general anesthesia and associated response to emergency situations. Currently, data to substantiate either model (i.e. a single operator-anesthetist or a separate person to solely monitor vital signs) is difficult to access or is inconsistent. The goal of the committee is to review the data related to pediatric anesthesia in dentistry and make it publically available through a report to the DBC and the Legislature.
AMENDMENTS:
- To address the issue of breadth, the author should amend the bill as follows:
On page 3, line 4, after “dental associations” insert “as well as studies regarding the use of pediatric anesthesia”
- The report that the DBC submits to the legislature should have, at minimum, anonymized patient information regarding his or her demographic, primary diagnosis and conditions of the procedure. The author should amend the bill as follows:
On page 3, line 18, strike “Web site.” and insert
“Web site, and shall include, but is not limited to, the following anonymized demographic data of each patient reviewed: his or her age, weight and sex; his or her primary diagnosis; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the provider responsible for sedation oversight; the provider delivering sedation; the provider monitoring the patient during sedation; whether the sedation supervision performed one or more of the procedures.”
- The information gathered in the committee’s review will be a snapshot of information regarding the incidents of deaths connected to pediatric anesthesia. In order for the DBC to continue monitoring the use of pediatric anesthesia, a report of pediatric deaths related to general anesthesia or deep sedation in dentistry should be submitted each time the DBC is reviewed pursuant to BPC Section 1601.1(d). The author should amend the bill as follows:
After Section 1601.4, insert
“The board shall provide a report on pediatric deaths related to general anesthesia or deep sedation in dentistry at the time of its regular review as referenced in Business and Professions Code Section 1601.1(d).”
- The committee should be allowed to conduct its review and submit its findings to the DBC and the Legislature in order to provide evidence of greater risk involving a single person administering anesthesia while simultaneously performing the dental procedure. Additionally, the recommendations provided by the AAPD may change without regard to state law. The author should amend the bill as follows:
On page 4, lines 9-10, strike “be obtained from the child’s parent or guardian.” and insert “contain the following information:”
and on page 4, strike lines 14-22 and insert
“All sedation and anesthesia medications involve risks of complications and serious possible damage to vital organs such as the brain, heart, lung, liver, and kidney, and in some cases use of these medications may result in paralysis, cardiac arrest, or death from both known and unknown causes. As such, use of appropriate monitoring equipment, as referenced in Business and Professions Code Section 1682(c), is required.”
REGISTERED SUPPORT:
PDI Surgery Center
California Society of Anesthesiologists
39 individuals
REGISTERED OPPOSITION:
California Dental Association
Oral and Facial Surgeons of California
Analysis Prepared by: Gabby Nepomuceno / B. & P. / (916) 319-3301
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