The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, and prohibits the practice of dentistry by any person without a valid license, except in certain circumstances.

This bill would additionally exempt from that prohibition the practice of dentistry, as specified and as approved by the board, by a final year student, as defined, without compensation or expectation of compensation and under the supervision of a licensed dentist with a clinical faculty appointment at a sponsored event, as defined, if specified conditions are met. This bill would require the sponsoring entity of the sponsored event to provide the board with a list of the names of the students practicing dentistry exempted pursuant to this bill at the sponsored event, the name of the school of enrollment of those students, and the name and license number of the supervising licensed dentist.

The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, and prohibits the practice of dentistry by any person without a valid license, except in certain circumstances.

This bill would additionally exempt from that prohibition the practice of dentistry, as specified and as approved by the board, by a final year student, as defined, without compensation or expectation of compensation and under the supervision of a licensed dentist with a clinical faculty appointment at a sponsored event, as defined, if specified conditions are met. This bill would require the sponsoring entity of the sponsored event to provide the board with a list of the names of the students practicing dentistry exempted pursuant to this bill at the sponsored event, the name of the school of enrollment of those students, and the name and license number of the supervising licensed dentist.

The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, and prohibits the practice of dentistry by any person without a valid license, except in certain circumstances.

This bill would additionally exempt from that prohibition the practice of dentistry, as specified and as approved by the board, by a final year student, as defined, without compensation or expectation of compensation and under the supervision of a licensed dentist with a clinical faculty appointment at a sponsored event, as defined, if specified conditions are met. This bill would require the sponsoring entity of the sponsored event to provide the Dental Board of California with a list of the names of the students practicing dentistry exempted pursuant to this bill at the sponsored event, the name of the school of enrollment of those students, and the name and license number of the supervising licensed dentist.

The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, and prohibits the practice of dentistry by any person without a valid license, except in certain circumstances.

This bill would additionally exempt from that prohibition the practice of dentistry, as specified and as approved by the board, by a final year student, as defined, without compensation or expectation of compensation and under the supervision of a licensed dentist with a faculty appointment at a sponsored event, as defined, if specified conditions are met. This bill would require the administering sponsoring entity of the sponsored event to provide the Dental Board of California with a list of the names of the students practicing dentistry exempted pursuant to this bill at the sponsored event, the name of the school of enrollment of those students, and the name and license number of the supervising licensed dentist.

The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, and prohibits the practice of dentistry by any person without a valid license, except in certain circumstances.

This bill would additionally exempt from that prohibition the practice of dentistry, as specified and as approved by the board, by a final year student student, as defined, without compensation or expectation of compensation and under the supervision of a licensed dentist with a faculty appointment at a sponsored event, as defined. defined, if specified conditions are met. This bill would require the administering entity of the sponsored event to provide the Dental Board of California with a list of the names of the students practicing dentistry exempted pursuant to this bill at the sponsored event, the name of the school of enrollment of those students, and the name and license number of the supervising licensed dentist.

The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California, and prohibits the practice of dentistry by any person without a valid license, except in certain circumstances.

This bill would additionally exempt from that prohibition the practice of dentistry, as specified and as approved by the board, by a final year student without compensation or expectation of compensation and under the supervision of a licensed dentist in a free clinic. with a faculty appointment at a sponsored event, as defined.

The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California. The act 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 provides that a person practices dentistry if that person performs various specified acts., and prohibits the practice of dentistry by any person without a valid license, except in certain circumstances.

The Dental Practice Act provides for the licensure and regulation of persons engaged in the practice of dentistry by the Dental Board of California. The act 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 provides that a person practices dentistry if that person performs various specified acts.

This bill would make nonsubstantive changes to those provisions.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 880

Author:(Ridley-Thomas)

As Amended Ver:August 18, 2015

Majority vote

Original Committee Reference: B. & P.

SUMMARY: Authorizes students enrolled in their final year at a California dental school, approved by the Dental Board of California (Board), to practice dentistry under the supervision of licensed dentists at free sponsored events, as specified.

The Senate amendments:

1. Require that each patient be informed that a dental student may be providing some of the treatment that he or she will be receiving, and offer the patient the option to decline to be treating by the student.

2. Require the student to be supervised by clinical faculty from the dental school in which he or she is enrolled and practice under specified supervision ratios and oversight.

3. Limit a student to performing only those procedures in which he or she is credentialed or that he or she is already permitted to perform, as specified.

4. Require the sponsoring entity of the sponsored event to provide specified information to the Board.

5. Require the student or the student's sponsoring dental school to ensure liability insurance coverage is obtained that covers all services provided by the student, including diagnosis, treatment, and evaluation.

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

COMMENTS:

Purpose. This bill is sponsored by the Oral and Facial Surgeons of California. According to the author, "Regular dental care is extremely important to everyone's health. However in the underserved communities in California, access to regular dental care is almost nonexistent. Since the Medi-Cal and Denti-Cal programs are underutilized, free healthcare and dental clinics are an essential source of dental care for the many members of those same communities. Since existing law already allows dental students to treat patients in clinics on the dental school campuses under supervision, it would follow that these same students should be allowed to treat similar patients, under supervision, in the free health fairs. It is very important to maintain a pool of willing volunteer providers both in the licensed professional community and in the dental schools to provide dental care in underserved communities."

Background. Board-approved dental schools are required to, among other things, have a formal system of quality assurance for their patient care program including standards of patient centered care with a focus on comprehensive care, including measurable assessment criteria and ensures the delivery of comprehensive patient care to individual patients. In addition, schools are required to ensure that students have adequate patient experiences to achieve the institution's stated goals and competencies within a reasonable time. Currently, there are six Board-approved dental schools in California. This bill would only apply to dental students at one of these institutions.

Current Exemptions for Student Practice. Business and Professions Code Section 1626 specifically exempts from licensure requirements, "… operations, in dental schools approved by the board, of bona fide students of dentistry… in the school's clinical departments or laboratories or in a dental extension program approved by the board." Under the California Code of Regulations, there are two types of facilities that may be approved by the Board as an adjunct to, and an extension of, the clinical and laboratory departments of an approved school: 1) an extramural dental facility, and 2) a mobile dental clinic. An extramural dental facility as defined in 16 California Code of Regulations 1025 is "… any clinical facility employed by an approved dental school for instruction in dentistry which exists outside or beyond the walls, boundaries or precincts of the primary campus of the approved dental school, and in which dental services are rendered." A mobile dental clinic as defined in 16 California Code of Regulations 1026 is "… any clinical facility employed by an approved dental school for instruction in dentistry which may be moved, towed or transported from one location to another, and in which dental services are rendered."

Services that are provided by dental students to the public through an extramural dental facility or a mobile dental clinic are required to constitute a part of the dental education program. In addition, approved dental schools are required to register these facilities with the Board, and provide with that registration information relating to: 1) faculty supervision; 2) scope of treatment to be rendered; 3) postoperative care; 4) proposed itinerary showing locations by dates, for mobile dental clinics, or the name and location of the facility and date operation will commence, for extramural dental facilities; 5) discipline of which such instruction is a part; and 6) a brief description of the equipment and facilities available. For extramural dental facilities, the school must also provide a copy of the agreement between the approval dental school, or parent university and the affiliated institution establishing the contractual relationship. Any change in the information initially provided to the Board is required to be communicated to the Board.

According to the sponsor, the intent of this bill is to allow final year dental students to volunteer their services at free health and dental events. Currently, students are not exempt from practicing at those events because those free health care events do not fall under the definition of a mobile dental health clinic or an extramural dental facility. As a result, those health care events currently have no registration or other requirements relating to the standard of care. In addition, unlike extramural dental facilities, which are brick and mortar locations, and mobile dental clinics, which are also self-contained places to provide services, free healthcare events are fleeting and not grounded to any one location. While existing law permits dental students to treat patients, who are usually eligible for dental services under Medi-Cal's dental program and treated under supervision, in on-campus clinics, mobile dental clinics and at dental extension programs approved by the Board, current law does not allow these same opportunities at health care events. According to the author, the ability to draw final year students to the clinics as dental service providers who work alongside licensed dentists will increase the number of volunteers available to work as these clinics and provide much needed services to underserved communities much needed services.

Analysis Prepared by: Eunie Linden / B. & P. / (916) 319-3301 FN: 0001468

 THIRD READING  

Bill No: AB 880

Author: Ridley-Thomas (D), et al.

Amended: 8/18/15 in Senate

Vote: 21

SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 8-0, 6/29/15

AYES: Hill, Bates, Block, Galgiani, Hernandez, Jackson, Mendoza, Wieckowski

NO VOTE RECORDED: Berryhill

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 78-0, 5/14/15 (Consent) - See last page for vote

SUBJECT: Dentistry: licensure: exemption

SOURCE: Oral and Facial Surgeons of California

DIGEST: This bill authorizes final year dental students to practice dentistry at free sponsored events under supervision and under specified conditions.

Senate Floor Amendments of 8/18/15 clarify consumer safety provisions for individuals participating in free dental events.

ANALYSIS:

Existing law:

1. Establishes the Dental Practice Act, administered by the Dental Board of California (DBC), which is under the Department of Consumer Affairs, to license and regulate the practice of dentistry. (Business and Professions Code (BPC) §§ 1600 et seq.)
   
   

2. Prohibits the practice of dentistry unless a person has a valid and unexpired license or special permit from the DBC. (BPC § 1626)
   
   

3. Exempts from that prohibition, operations in dental schools of bona fide students of dentistry or dental hygiene in the school's clinical departments or laboratories or in a dental extension program if approved by the DBC.
   (BPC § 1626(b))

4. Provides for the licensure and regulation of clinics by the State Department of Public Health, including primary care clinics, which include community clinics and free clinics. (Health and Safety Code (HSC) §§ 1200 et seq.)
   
   

5. Defines a "free clinic" as a clinic operated by a tax-exempt, nonprofit corporation supported in whole or in part by voluntary donations, gifts, grants, government funds or contributions, and where there are no charges directly to the patient for services rendered, as specified. (HSC § 1204(a))

6. Exempts specified health care practitioners from California licensure who are licensed or certified in other states and who provide health care services on a voluntary basis to uninsured or underinsured persons in California until January 1, 2018, as specified. (BPC § 901)

This bill:

1. Exempts final year dental students from provisions of law prohibiting the practice of dentistry without a license for students who volunteer at a sponsored event under the supervision of dental school clinical faculty.

2. Specifies that the exemptions only include those operations approved by the DBC that are rendered or performed under the same conditions as operations in a student’s dental program.

3. Defines the following terms:

1. “Final year student” means a student of dentistry in his or her final year of completion at a dental school approved by the DBC. “Final year student” also includes a dental student enrolled in an advanced dental program.

2. “Licensed dentist” means a dentist licensed by the DBC.

3. “Patient” means a dental patient or, in the case of a minor, the patient’s representative.

4. “Sponsored event” means an event, not to exceed 10 calendar days, administered by a sponsoring entity or a local governmental entity, or both, through which health care is provided to the public without compensation, or expectation of compensation.

5. “Sponsoring dental school” means a dental school that sanctions student and clinical faculty participation at a sponsored event.

6. “Sponsoring entity” means a nonprofit organization pursuant to Section 501(c)(3) of the Internal Revenue Code, or a community-based organization.

4. Requires the volunteer practice of dentistry by students to comply with all of the following requirements:

1. Each patient shall be sufficiently informed that a dental student may be providing some of the treatment that he or she will be receiving.

2. Any information provided to the patient to give informed consent shall offer the patient the option to decline to be treated by the student.

3. The volunteer practice of a student shall be supervised by clinical faculty from the dental school in which the student is enrolled.

4. Each volunteer student shall wear an identification badge that clearly identifies the student as a dental student. The identification badge shall display the student’s name, the name of the student’s dental school, and the name and the telephone number of the DBC. That information shall be displayed in 14-point font, at minimum.

5. Supervision ratios and student oversight shall be at least as stringent as the standards set for the procedure being performed by the student and the age of the patient, in accordance with standards at the sponsoring dental school’s clinical department, laboratory, or dental extension program.

6. The student shall perform only those procedures in which he or she is credentialed or those procedures he or she is permitted to perform in the school’s clinical department, laboratory, or dental extension program.

5. Requires that the student or the student’s sponsoring dental school shall ensure liability insurance coverage is obtained that covers all services provided by the student, including diagnosis, treatment, and evaluation.

6. Requires the sponsoring entity of the sponsored event to provide the DBC with a list of the names of the volunteer students, the name of the school of enrollment of those students, and the name and license number of the supervising licensed dentist.

Background

Access to Dental Care and Denti-Cal. According to a 2012 report by the California Dental Association (CDA), an estimated 11 million of California’s
38 million people lack any form of dental benefits. For those seven million who qualify for dental services through Medi-Cal, that coverage does not necessarily translate into access; the California State Auditor reported in December 2014 that over half the children in Denti-Cal (Medi-Cal’s dental program) do not get regular services. The Auditor determined that this was primarily due to the lack of providers deterred by low reimbursement rates.

Free Dental Health Care Events. In addition to the lack of participating providers in Denti-Cal, CDA also reports that there is a misdistribution of the current supply; California has over 200 dental professional shortage areas; areas where the ratio of dentists to the population is so low that the state considers the area underserved.

Several not-for-profit entities have entered the market to provide free or low-cost healthcare to underserved individuals: CDA Cares, California CareForce, Remote Area Medical, and Care Harbor are a few of the major providers in this space that offer dental care (and/or other medical care, depending on the event) to the underserved population. These entities primarily rely on volunteers to provide services, frequently in a temporary medical space set up in a convention hall, fairground, or other public space. These volunteers are subject to professional regulation and are held to the same standard of care as in a traditional setting.

This bill increases the potential pool of volunteers by allowing final year dental students to provide services at free sponsored healthcare events under supervision.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/19/15)

Oral and Facial Surgeons of California (source)

California CareForce

California Society of Pediatric Dentistry

Dental Hygiene Committee of California

Loma Linda University School of Dentistry

University of California, Los Angeles School of Dentistry

University of California, San Francisco School of Dentistry

University of the Pacific, Arthur A. Dugoni School of Dentistry

University of Southern California

Western University of Health Sciences College of Dental Medicine

OPPOSITION: (Verified 8/19/15)

None received

ARGUMENTS IN SUPPORT: The Oral and Facial Surgeons of California write, “[We are] sponsoring this legislation in order to enhance the pool of volunteer providers at the much needed free healthcare clinics in California’s many underserved communities. In addition, by allowing final year students to treat patients under the supervision of licensed dentists, these students will be getting real life healthcare treatment exposure in the EXACT same way that they are currently allowed to practice in on-campus clinics in the California dental schools.”

The University of the Pacific, Arthur A. Dugoni School of Dentistry writes, “Currently the six approved dental schools in California offer clinics on campus that allow dental students to treat patients who qualify for Medi-Cal or Denti-Cal at reduced fees. Free clinics and health fairs offer dental care to the most severely underserved communities. The ability to draw volunteers (both faculty and students) from schools ensures that the pool of providers will not evaporate and that they will be fresh and eager to serve the community.”

ASSEMBLY FLOOR: 78-0, 5/14/15

AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, 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, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins

NO VOTE RECORDED: Linder, Medina

Prepared by: Sarah Huchel / B., P. & E.D. / (916) 651-4104

8/19/15 20:34:26

**** END ****

 THIRD READING  

Bill No: AB 880

Author: Ridley-Thomas (D), et al.

Amended: 7/1/15 in Senate

Vote: 21

SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 8-0, 6/29/15

AYES: Hill, Bates, Block, Galgiani, Hernandez, Jackson, Mendoza, Wieckowski

NO VOTE RECORDED: Berryhill

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 78-0, 5/14/15 (Consent) - See last page for vote

SUBJECT: Dentistry: licensure: exemption

SOURCE: Oral and Facial Surgeons of California

DIGEST: This bill authorizes final year dental students to practice dentistry at free sponsored events under supervision and under specified conditions.

ANALYSIS:

Existing law:

1. Establishes the Dental Practice Act, administered by the Dental Board of California (DBC), which is under the Department of Consumer Affairs, to license and regulate the practice of dentistry. (Business and Professions Code (BPC) §§ 1600 et seq.)
   
   

2. Prohibits the practice of dentistry unless a person has a valid and unexpired license or special permit from the DBC. (BPC § 1626)
   
   

3. Exempts from that prohibition, operations in dental schools of bona fide students of dentistry or dental hygiene in the school's clinical departments or laboratories or in a dental extension program if approved by the DBC.
   (BPC § 1626(b))

4. Provides for the licensure and regulation of clinics by the State Department of Public Health, including primary care clinics, which include community clinics and free clinics. (Health and Safety Code (HSC) §§ 1200 et seq.)
   
   

5. Defines a "free clinic" as a clinic operated by a tax-exempt, nonprofit corporation supported in whole or in part by voluntary donations, gifts, grants, government funds or contributions, and where there are no charges directly to the patient for services rendered, as specified. (HSC § 1204(a))

6. Exempts specified health care practitioners from California licensure who are licensed or certified in other states and who provide health care services on a voluntary basis to uninsured or underinsured persons in California until January 1, 2018, as specified. (BPC § 901)

This bill:

1. Exempts final year dental students from provisions of law prohibiting the practice of dentistry without a license for students who volunteer at a sponsored event under the supervision of dental school faculty.

2. Specifies that the exemptions only include those operations approved by the DBC that are rendered or performed under the same conditions as operations in a student’s dental program.

3. Defines the following terms:

1. “Final year student” means a student of dentistry in his or her final year of completion at a dental school approved by the DBC. “Final year student” also includes a dental student enrolled in an advanced program.

2. “Licensed dentist” means a dentist licensed by the DBC.

3. “Sponsored event” means an event, not to exceed 10 calendar days, administered by a sponsoring entity or a local governmental entity, or both, through which health care is provided to the public without compensation, or expectation of compensation.

4. “Sponsoring entity” means a nonprofit organization pursuant to Section 501(c)(3) of the Internal Revenue Code, or a community-based organization.

4. Requires the volunteer practice of dentistry by students to comply with all of the following requirements:

1. Each patient shall be sufficiently informed that a dental student may be providing some of the treatment that he or she will be receiving.

2. Any information provided to the patient to give informed consent shall offer the patient the option to decline to be treated by the student.

3. The volunteer practice of a student shall be supervised by faculty from the dental school in which the student is enrolled.

4. Each volunteer student shall wear an identification badge that clearly identifies the student as a dental student. The identification badge shall display the student’s name, the name of the student’s dental school, and the name and the telephone number of the DBC. That information shall be displayed in 14-point font, at minimum.

5. Requires that supervision ratios and student oversight be at least as stringent as required to meet the standards of the Commission on Dental Accreditation at each school’s clinical department, laboratory, or dental extension program.

6. Requires that supervision ratios be appropriate for the procedure being performed by the student.

7. Requires the student to perform only those procedures in which he or she is credentialed or those procedures he or she is permitted to perform in the school’s clinical department, laboratory, or dental extension program.

5. Requires the sponsoring entity of the sponsored event to provide the DBC with a list of the names of the volunteer students, the name of the school of enrollment of those students, and the name and license number of the supervising licensed dentist.

Background

Access to Dental Dare and Denti-Cal. According to a 2012 report by the California Dental Association (CDA), an estimated 11 million of California’s
38 million people lack any form of dental benefits. For those seven million who qualify for dental services through Medi-Cal, that coverage does not necessarily translate into access; the California State Auditor reported in December 2014 that over half the children in Denti-Cal (Medi-Cal’s dental program) do not get regular services. The Auditor determined that this was primarily due to the lack of providers deterred by low reimbursement rates.

Free Dental Health Care Events. In addition to the lack of participating providers in Denti-Cal, CDA also reports that there is a misdistribution of the current supply; California has over 200 dental professional shortage areas; areas where the ratio of dentists to the population is so low that the state considers the area underserved.

Several not-for-profit entities have entered the market to provide free or low-cost healthcare to underserved individuals: CDA Cares, California CareForce, Remote Area Medical, and Care Harbor are a few of the major providers in this space that offer dental care (and/or other medical care, depending on the event) to the underserved population. These entities primarily rely on volunteers to provide services, frequently in a temporary medical space set up in a convention hall, fairground, or other public space. These volunteers are subject to professional regulation and are held to the same standard of care as in a traditional setting.

This bill increases the potential pool of volunteers by allowing final year dental students to provide services at free sponsored healthcare events under supervision.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 7/14/15)

Oral and Facial Surgeons of California (source)

California CareForce

Dental Hygiene Committee of California

Loma Linda University School of Dentistry

University of California, Los Angeles School of Dentistry

University of California, San Francisco School of Dentistry

University of the Pacific, Arthur A. Dugoni School of Dentistry

University of Southern California

Western University of Health Sciences College of Dental Medicine

OPPOSITION: (Verified 7/14/15)

None received

ARGUMENTS IN SUPPORT: The Oral and Facial Surgeons of California write, “[We are] sponsoring this legislation in order to enhance the pool of volunteer providers at the much needed free healthcare clinics in California’s many underserved communities. In addition, by allowing final year students to treat patients under the supervision of licensed dentists, these students will be getting real life healthcare treatment exposure in the EXACT same way that they are currently allowed to practice in on-campus clinics in the California dental schools.”

The University of the Pacific, Arthur A. Dugoni School of Dentistry writes, “Currently the six approved dental schools in California offer clinics on campus that allow dental students to treat patients who qualify for Medi-Cal or Denti-Cal at reduced fees. Free clinics and health fairs offer dental care to the most severely underserved communities. The ability to draw volunteers (both faculty and students) from schools ensures that the pool of providers will not evaporate and that they will be fresh and eager to serve the community.”

ASSEMBLY FLOOR: 78-0, 5/14/15

AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, 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, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins

NO VOTE RECORDED: Linder, Medina

Prepared by: Sarah Huchel / B., P. & E.D. / (916) 651-4104

7/15/15 15:14:07

**** END ****

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2015 - 2016 Regular

Bill No: AB 880 Hearing Date: June 29, 2015

Subject: Dentistry: licensure: exemption.

SUMMARY:

Authorizes final year dental students to practice dentistry at free sponsored events under supervision and under specified conditions.

Existing law:

1. Establishes the Dental Practice Act (Act), administered by the Dental Board of California (DBC), which is under the Department of Consumer Affairs (DCA), to license and regulate the practice of dentistry. (Business and Professions Code (BPC) §§ 1600 et seq.)
   
   

2. Prohibits the practice of dentistry unless a person has a valid and unexpired license or special permit from the Board. (BPC § 1626)
   
   

3. Exempts from that prohibition, operations in dental schools of bona fide students of dentistry or dental hygiene in the school's clinical departments or laboratories or in a dental extension program if approved by the Board. (BPC § 1626(b))

4. Provides for the licensure and regulation of clinics by the State Department of Public Health, including primary care clinics, which include community clinics and free clinics. (Health and Safety Code (HSC) §§ 1200 et seq.)
   
   

5. Defines a "free clinic" as a clinic operated by a tax-exempt, nonprofit corporation supported in whole or in part by voluntary donations, gifts, grants, government funds or contributions, and where there are no charges directly to the patient for services rendered, as specified. (HSC § 1204(a))

6. Exempts specified health care practitioners from California licensure who are licensed or certified in other states and who provide health care services on a voluntary basis to uninsured or underinsured persons in California until January 1, 2018, as specified. (BPC § 901)

This bill:

1. Exempts final year dental students from provisions of law prohibiting the practice of dentistry without a license for students who volunteer at a sponsored event under the supervision of dental school faculty.

2. Specifies that the exemptions only include those operations approved by the DBC that are rendered or performed under the same conditions as operations in a student’s dental program.

3. Defines the following terms:

1. “Final year student” means a student of dentistry in his or her final year of completion at a dental school approved by the DBC. “Final year student” also includes a dental student enrolled in an advanced program.

2. “Licensed dentist” means a dentist licensed by the DBC.

3. “Sponsored event” means an event, not to exceed 10 calendar days, administered by a sponsoring entity or a local governmental entity, or both, through which health care is provided to the public without compensation, or expectation of compensation.

4. “Sponsoring entity” means a nonprofit organization pursuant to Section 501(c)(3) of the Internal Revenue Code, or a community-based organization.

4. Requires the volunteer practice of dentistry by students to comply with all of the following requirements:

1. Each patient shall be sufficiently informed that a dental student may be providing some of the treatment that he or she will be receiving.

2. Any information provided to the patient to give informed consent shall offer the patient the option to decline to be treated by the student.

3. The volunteer practice of a student shall be supervised by faculty from the dental school in which the student is enrolled.

4. Each volunteer student shall wear an identification badge that clearly identifies the student as a dental student. The identification badge shall display the student’s name, the name of the student’s dental school, and the name and the telephone number of the DBC. That information shall be displayed in 14-point font, at minimum.

5. Requires that supervision ratios and student oversight be at least as stringent as required to meet the standards of the Commission on Dental Accreditation at each school’s clinical department, laboratory, or dental extension program.

6. Requires that supervision ratios be appropriate for the procedure being performed by the student.

7. Requires the student to perform only those procedures in which he or she is credentialed or those procedures he or she is permitted to perform in the school’s clinical department, laboratory, or dental extension program.

5. Requires the administering entity of the sponsored event to provide the DBC with a list of the names of the volunteer students, the name of the school of enrollment of those students, and the name and license number of the supervising licensed dentist.

FISCAL EFFECT:

This bill is keyed “fiscal” by Legislative Counsel. According to the Assembly Appropriations Committee analysis dated May 6, 2015, any costs to the DBC caused by this bill are minor and absorbable.

COMMENTS:

1. Purpose. This bill is sponsored by the California Association of Oral and Maxillofacial Surgeons. According to the Author’s office, “Regular dental care is extremely important to everyone’s overall health. However in the underserved communities in California, access to regular dental care is almost non-existent.

“Since the Medi-Cal and Denti-Cal programs are underutilized, free healthcare and dental clinics are an essential source of dental care for the many members of those same communities. Since existing law already allows dental students to treat patients in clinics on the dental school campuses under supervision, it would follow that these same students should be allowed to treat similar patients, under supervision, in the free health fairs. It is very important to maintain a pool of willing volunteer providers both in the licensed professional community and in the dental schools to provide dental care in underserved communities.”

2. Access to Dental Dare and Denti-Cal. According to a 2012 report by the California Dental Association (CDA), an estimated 11 million of California’s 38 million people lack any form of dental benefits. For those 7 million who qualify for dental services through Medi-Cal, that coverage does not necessarily translate into access; the California State Auditor reported in December 2014 that over half the children in Denti-Cal (Medi-Cal’s dental program) do not get regular services. The auditor determined that this was primarily due to the lack of providers deterred by low reimbursement rates.

3. Free Dental Health Care Events. In addition to the lack of participating providers in Denti-Cal, CDA also reports that there is a misdistribution of the current supply; California has over 200 dental professional shortage areas; areas where the ratio of dentists to the population is so low that the state considers the area underserved.

Several not-for-profit entities have entered the market to provide free or low-cost healthcare to underserved individuals: CDA Cares, California CareForce, Remote Area Medical, and Care Harbor are a few of the major providers in this space that offer dental care (and/or other medical care, depending on the event) to the underserved population. These entities primarily rely on volunteers to provide services, frequently in a temporary medical space set up in a convention hall, fairground, or other public space. These volunteers are subject to professional regulation and are held to the same standard of care as in a traditional setting.

This bill would increase the potential pool of volunteers by allowing final year dental students to provide services at free sponsored healthcare events under supervision.

4. Previous Legislation. AB 2699 (Bass) Chapter 270, Statutes of 2010, exempts specified health care practitioners from California licensure who are licensed or certified in other states and who provide health care services on a voluntary basis to uninsured or underinsured persons in California until January 1, 2014, as specified.

AB 512 (Rendon) Chapter 111, Statutes of 2013, extended the sunset date on
AB 2699 (above) until 2018.

5. Arguments in Support. The Oral and Facial Surgeons of California write, “[We are] sponsoring this legislation in order to enhance the pool of volunteer providers at the much needed free healthcare clinics in California’s many underserved communities. In addition, by allowing final year students to treat patients under the supervision of licensed dentists, these students will be getting real life healthcare treatment exposure in the EXACT same way that they are currently allowed to practice in on-campus clinics in the California dental schools.”

The University of the Pacific, Arthur A. Dugoni School of Dentistry writes, “Currently the six approved dental schools in California offer clinics on campus that allow dental students to treat patients who qualify for Medi-Cal or Denti-Cal at reduced fees. Free clinics and health fairs offer dental care to the most severely underserved communities. The ability to draw volunteers (both faculty and students) from schools ensures that the pool of providers will not evaporate and that they will be fresh and eager to serve the community.”

6. Recommended Technical Amendment. The following amendment is recommended to align terms within this bill.

On page 3, line 24, delete “administering” and add “sponsoring”

SUPPORT AND OPPOSITION:

Support:

Oral and Facial Surgeons of California (Sponsor)

California CareForce

Dental Hygiene Committee of California

Loma Linda University School of Dentistry

University of California, Los Angeles School of Dentistry

University of California, San Francisco School of Dentistry

University of the Pacific, Arthur A. Dugoni School of Dentistry

University of Southern California

Western University of Health Sciences College of Dental Medicine

Opposition: None on file as of June 23, 2015.

-- END --

Date of Hearing: May 6, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 880

Author:(Ridley-Thomas) – As Amended Ver:April 28, 2015

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill allows a final year student in dental school to practice dentistry at events not to exceed 10 calendar days (health fairs), under the supervision of a dentist.

FISCAL EFFECT:

Any costs to the Dental Board of California are minor and absorbable.

COMMENTS:

Purpose. This bill will expand access to free dental care while providing valuable training opportunities for dental students.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 21, 2015

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Susan Bonilla, Chair

ABPCA Bill Id:AB 880

Author:(Ridley-Thomas) – As Amended Ver:March 26, 2015

SUBJECT: Dentistry: licensure: exempt.

SUMMARY: Authorizes students enrolled in their final year at a California dental school, approved by the Dental Board of California (Board), to participate and treat patients under the supervision of licensed dentists at free clinics.

EXISTING LAW:

1. Establishes the Dental Practice Act (Act), administered by the Dental Board of California (DBC), which is housed in the Department of Consumer Affairs (DCA), to license and regulate the practice of dentistry. (Business and Professions Code (BPC) Section 1600, et seq.)
   
   

2. Prohibits the practice of dentistry unless a person has a valid and unexpired license or special permit from the Board. (BPC Section 1926)
   
   

3. Exempts from that prohibition operations, in dental schools approved by the Board, of bona fide students of dentistry or dental hygiene in the school's clinical departments or laboratories or in a dental extension program. (BPC Section 1926(b))
   
   

4. Provides for the licensure and regulation of clinics by the State Department of Public Health, including primary care clinics, which include community clinics and free clinics. (Health and Safety Code (HSC) Section 1200 et seq.)
   
   

5. Defines a "free clinic" as a clinic operated by a tax-exempt, nonprofit corporation supported in whole or in part by voluntary donations, gifts, grants, government funds or contributions, and where there are no charges directly to the patient for services rendered, as specified. (HSC Section 1204(a))

THIS BILL:

1. Additionally exempts from dental licensure requirements the practice of dentistry by a final year student rendered or performed without compensation or expectation of compensation under the supervision of a licensed dentist in a free clinic.

2. Provides that these additional exemptions only apply to operations, approved by the Board, that are described in the exemption for bona fide dental students under existing law and rendered or performed under the same supervisory conditions.

3. Defines the following terms:

   1. As defined in Section 1200 of the HSC, "Free clinic" is a clinic where there are no charges directly to the patient for services rendered or for drugs, medicines, appliances, or apparatuses furnished, including, but not limited to, a free clinic as defined in Section 1204 of the HSC;

   2. "Final year student" is a student of dentistry in his or her final year of completion at dental school approved by the Board; and

   3. "Licensed dentist" is a dentist licensed pursuant to the Act.

FISCAL EFFECT: Unknown. This bill is keyed fiscal by the Legislative Counsel.

COMMENTS:

1. Purpose. This bill is sponsored by the Oral and Facial Surgeons of California. According to the author, "Regular dental care is extremely important to everyone's health. However in the underserved communities in California, access to regular dental care is almost nonexistent. Since the Medi-Cal and Denti-Cal programs are underutilized, free healthcare and dental clinics are an essential source of dental care for the many members of those same communities. Since existing law already allows dental students to treat patients in clinics on the dental school campuses under supervision, it would follow that these same students should be allowed to treat similar patients, under supervision, in the free health fairs. It is very important to maintain a pool of willing volunteer providers both in the licensed professional community and in the dental schools to provide dental care in underserved communities."

2. Background. Board-approved dental schools are required to, among other things, have a formal system of quality assurance for their patient care program including standards of patient centered care with a focus on comprehensive care, including measurable assessment criteria and ensures the delivery of comprehensive patient care to individual patients. In addition, schools are required to ensure that students have adequate patient experiences to achieve the institution's stated goals and competencies within a reasonable time. Currently, there are six Board-approved dental schools in California: 1) University of California at San Francisco Dental School, San Francisco; 2) University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco; 3) University of California at Los Angeles School of Dentistry, Los Angeles; 4) Herman Ostrow School of Dentistry of USC, Los Angeles; 5) Loma Linda University School of Dentistry, Loma Linda; and 6)Western University of Health Sciences College of Dental Medicine, Pomona, California. This bill would only apply to dental students at one of these institutions.

Current Exemptions for Student Practice. BPC Section 1626 specifically exempts from licensure requirements, "…operations, in dental schools approved by the board, of bona fide students of dentistry…in the school's clinical departments or laboratories or in a dental extension program approved by the board." Under the California Code of Regulations, there are two types of facilities that may be approved by the Board as an adjunct to, and an extension of, the clinical and laboratory departments of an approved school: 1) an extramural dental facility, and 2) a mobile dental clinic.

An extramural dental facility as defined in 16 CCR 1025 is "…any clinical facility employed by an approved dental school for instruction in dentistry which exists outside or beyond the walls, boundaries or precincts of the primary campus of the approved dental school, and in which dental services are rendered." A mobile dental clinic as defined in 16 CCR 1026 is "…any clinical facility employed by an approved dental school for instruction in dentistry which may be moved, towed or transported from one location to another, and in which dental services are rendered."

Services that are provided by dental students to the public through an extramural dental facility or a mobile dental clinic are required to constitute a part of the dental education program. In addition, approved dental schools are required to register these facilities with the Board, and provide with that registration information relating to: a) faculty supervision; b) scope of treatment to be rendered; c) postoperative care; d) proposed itinerary showing locations by dates, for mobile dental clinics, or the name and location of the facility and date operation will commence, for extramural dental facilities; e) discipline of which such instruction is a part; and f) a brief description of the equipment and facilities available. For extramural dental facilities, the school must also provide a copy of the agreement between the approval dental school, or parent university and the affiliated institution establishing the contractual relationship. Any change in the information initially provided to the Board is required to be communicated to the Board.

According to the sponsor, the intent of the bill is to allow final year dental students to volunteer their services at free health and dental events. Currently, students are not exempt from practicing at those events because those free health care events do not fall under the definition of a mobile dental health clinic or an extramural dental facility. As a result, those health care events currently have no registration or other requirements relating to the standard of care. In addition, unlike extramural dental facilities, which are brick and mortar locations, and mobile dental clinics, which are also self-contained places to provide services, free healthcare events are fleeting and not grounded to any one location.

While existing law permits dental students to treat patients, who are usually eligible for dental services under Medi-Cal's dental program and treated under supervision, in on-campus clinics, mobile dental clinics and at dental extension programs approved by the Board, current law does not allow these same opportunities at health care events. According to the author, the ability to draw final year students to the clinics as dental service providers who work alongside licensed dentists will increase the number of volunteers available to work as these clinics and provide much needed services to underserved communities much needed services.

3. Current Related Legislation. AB 179 (Bonilla) of the current legislation session, would extend the sunset date of the Board until January 1, 2020. STATUS: This bill is pending in the Assembly Committee on Business and Professions.
   
   

4. Prior Related Legislation. SB 562 (Galgiani), Chapter 624, Statutes of 2013, authorized a dentist to operate more than one mobile dental unit, and required a mobile dental unit or a dental practice that routinely uses portable dental units to register and operate in accordance with the regulations of the Board. The bill also required any regulations adopted by the Board to require the registrant to identify a licensed dentist responsible for the mobile dental unit or portable practice, and to include requirements for availability of follow-up and emergency care, maintenance and availability of provider and patient records, and treatment information to be provided to patients and other appropriate parties.
   
   
   

5. AB 512 (Rendon), Chapter 111, Statutes of 2013, extended the sunset date for the health care practitioner exemption enacted by AB 2699 (Bass) Chapter 270, Statutes of 2010, until January 1, 2018.

AB 2699 (Bass), Chapter 270, Statutes of 2010, created a four-year exemption, from January 1, 2010, until January 1, 2014, from California licensure for health care practitioners who are licensed or certified in other states and who provide health care services on a voluntary basis to uninsured or underinsured persons in California. That bill allowed an out-of-state healthcare provider to work in California if his or her license is in good standing and he or she receives permission from, and registers with, the appropriate DCA licensing board. The entity sponsoring the free health care event is required to notify the appropriate DCA licensing board and the county health department in writing of the event and maintain a list of its healthcare volunteers.

SB 683 (Aanestad), Chapter 805, Statutes of 2006, further exempted from the prohibition against unlicensed practice of dentistry bona fide students of dentistry or dental hygiene in advanced dental education programs accredited by CODA or a national accrediting body approved by the Board.

SB 1308 (Committee on Business and Professions), Chapter 655, Statutes of 1999, changed the name of the Board of Dental Examiners to the Dental Board of California, and exempted the operations of bona fide students of registered dental assisting, registered dental assisting in extended functions, and registered dental hygiene in extended functions in the clinical departments or the laboratory of an educational program or school approved by the board, including operations by unlicensed students while engaged in clinical externship programs that have been approved by an approved educational program or school, and that are under the general programmatic and academic supervision of that educational program or school.

ARGUMENTS IN SUPPORT:

According to the Oral and Facial Surgeons of California (sponsor), "[This bill] will clarify in statute that students enrolled in their final year of completion at a California dental school approved by the [Board] are permitted to participate and treat patients, under the supervision of licensed dentists, at free healthcare clinics. The association is sponsoring this legislation in order to enhance the pool of volunteer providers at the much needed free healthcare clinics in California's many underserved communities. In addition, by allowing final year students to treat patients under the supervision of licensed dentists, these students will be getting real life healthcare treatment exposure in the EXACT same way that they are currently allowed to practice in on-campus clinics in the California dental schools. It is commonly acknowledged that regular dental care is extremely important to everyone's overall health and well-being. Yet in the all too many undeserved communities that exist in the state, access to regular dental care is almost non-existent….[This bill] goes a long way in increasing the probability that many of the most needy patients will be able [to] be seen and get the dental care they so desperately need."

The California CareForce, a 501(c)(3) that provides free healthcare clinics for the under- and uninsured population, writes in support, "Currently the six approved dental schools in California offer clinics on campus that allow dental students to treat patients who qualify for Medi-Cal or Denti-Cal at reduced fees. The free clinics offer dental care to the most severely underserved communities. The final year students are very capable and uniquely qualified to treat, under supervision of a licensed dentist, most if not all patients who would present at a free clinic. The ability to draw volunteers from these schools ensure that the pool of providers will not evaporate and that they will be fresh and eager to serve the communities."

The Dean of the UCLA School of Dentistry writes in support, "The dental schools are willing partners to be a tremendous resource for community service. Our students are highly motivated in this regard. Our mission statement is: To improve the oral and systemic health of the people of California, the national, and the world through education, research, patient care, and public service."

ARGUMENTS IN OPPOSITION:

None on file.

POLICY ISSUES FOR CONSIDERATION:

The author may consider whether it would be appropriate to allow participation from other levels of dental students, depending on the level of services that student is competently able to provide, as determined by the dental school.

IMPLEMENTATION ISSUES:

Exemption for student practice at "free clinics." Currently, the bill provides that final year students are exempt from licensure requirements when practicing in a free clinic, under the supervision of a licensed dentist. The bill further defines "free clinic" as a clinic defined under the Health and Safety Code. According to the sponsors, the intent of the bill is to allow students to participate at free health care events. However, the definition of a "free clinic" under the health and safety code does not include these events; instead, it refers to a type of standing primary care clinic. As a result, the author may wish to amend the language to reflect free health care events, or "sponsored events" as defined under AB 2699 (Bass) Chapter 270, Statutes of 2010.

Exemption for operations described in existing exemptions and under the same supervisory conditions. The bill specifies that this practice exemption applies to operations "approved by the Board" and only includes those operations "described in the exemption provided in subdivision (b) of Section 1626 and "rendered or performed under the same supervisory conditions." Because that language makes it appear as if the only operations exempted are those that are already exempt under subdivision (b) of Section 1626, the author may wish to consider revising that language.

In addition, the author may wish to specify that exempt operations must not only be performed under the same supervisory conditions as those provided under the existing exemptions, but that these operations must be provided under all of the same conditions as those provided under the existing exemptions.

For example, regulations for mobile dental clinics and extramural dental facilities require these exempt operations to be a part of the school's dental education program, and require the schools to inform the Board of the following: faculty supervision; scope of treatment to be rendered; postoperative care; information about the event and the sponsoring entity; discipline of which such instruction is a part; and a brief description of the equipment and facilities available. In addition, while the regulations do not appear to specifically refer to patient recordkeeping, patient notification and consent, or liability, dental schools address these issues in the implementation of existing programs. As a result, the author may wish to specify that these exempt operations are required to be provided under the same conditions as existing exemptions, and specify any particular conditions or safeguards, as needed, to ensure adequate consumer protection (e.g., including conditions relating to faculty supervision; patient notification, consent and recordkeeping; liability; scope of practice; requiring the operations to be a part of a school's dental education program).

AMENDMENTS:

On page 2, line 6, after "dentist" insert: with a faculty appointment

On page 2, lines 6-7, strike: in a free clinic and insert: at a sponsored event

On page 2, strike line 10

On page 2, line 11, strike: 1626 and

On page 2, line 11, strike: supervisory

On page 2, line 12, after "conditions" insert: as operations exempt under subdivision (b) of Section 1626

On page 2, strike lines 14-20

On page 2, line 24, add

(3) “Sponsored event” means an event, not to exceed 10 calendar days, administered by either a sponsoring entity or a local government, or both, through which health care is provided to the public without compensation.

(4) “Sponsoring entity” means a nonprofit organization organized pursuant to Section 501(c)(3) of the Internal Revenue Code or a community-based organization.

REGISTERED SUPPORT:

Oral and Facial Surgeons of California (sponsors)

California CareForce

Dr. No-Hee Park, Dean of the UCLA School of Dentistry

REGISTERED OPPOSITION:

None on file.

Analysis Prepared by: Eunie Linden / B. & P. / (916) 319-3301