The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. The act, among other things, prescribes requirements for a dentist who administers or orders the administration of general anesthesia on an outpatient basis for dental patients, including a requirement that the dentist holds a valid anesthesia permit issued by the board.

This bill, on or before January 1, 2019, would require the board to provide to the Legislature a report and analysis, as specified, of the effects on access to care for pediatric dental patients specifically as it relates to requiring the addition of a 2nd general anesthesia permitholder to be present during the administration of general anesthesia on a patient 7 years of age or younger, if the provider is currently a general anesthesia permitholder.

(1)The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. The act, among other things, prescribes requirements for a dentist who administers or orders the administration of general anesthesia on an outpatient basis for dental patients, including a requirement that the dentist holds a valid anesthesia permit issued by the board.

This bill, on or before January 1, 2019, would require the board to provide to the Legislature a report and analysis, as specified, of the effects on access to care for pediatric dental patients specifically as it relates to requiring the addition of a 2nd general anesthesia permitholder to be present during the administration of general anesthesia on a patient 7 years of age or younger, if the provider is currently a general anesthesia permitholder.

The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. The act, among other things, prescribes requirements for dentists who administer or order a dentist who administers or orders the administration of general anesthesia and defines general anesthesia in this regard. anesthesia on an outpatient basis for dental patients, including a requirement that the dentist holds a valid anesthesia permit issued by the board.

The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. The act, among other things, prescribes requirements for dentists who administer or order the administration of general anesthesia and defines general anesthesia in this regard.

This bill would make a nonsubstantive change to the provision that defines general anesthesia.

 THIRD READING  

Bill No: SB 392

Author:

:

Vote:

SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 8-1, 4/24/17

AYES: Hill, Fuller, Dodd, Galgiani, Glazer, Hernandez, Pan, Wilk

NOES: Newman

SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/25/17

AYES: Lara, Bates, Beall, Bradford, Hill, Nielsen, Wiener

SUBJECT: Dentistry: report: access to care: pediatric dental patients

SOURCE: California Association of Oral and Maxillofacial Surgeons

DIGEST:

This bill requires the Dental Board of California to provide a report on access to care for pediatric patients requiring general anesthesia by January 1, 2019.

ANALYSIS:

Existing law:

1. Establishes the Dental Board of California (DBC) to administer and enforce the provisions of the Dental Practice Act. (Business and Professions Code (BPC) § 1601.1)
2. Requires the DBC to provide a report to the Legislature as to whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients by January 1, 2017. (BPC § 1601.4 (a))
3. Requires the DBC to provide a report on pediatric deaths related to general anesthesia (GA) in dentistry at the time of its 2020 sunset review. (BPC § 1601.4)
4. Establishes requirements for the administration of GA and conscious sedation in adults and pediatric patients. (BPC §§ 1646 et seq)

This bill:

1. Requires the DBC to provide a report and analysis to the Legislature of the effects on access to care for pediatric dental patients specifically as it relates to requiring the addition of a second GA permitholder to be present during the administration of GA on a patient seven years of age or younger, if the provider is currently a general anesthesia permitholder, by January 1, 2019.
2. Requires the analysis to include costs of sedation and anesthesia, resource constraints of the healthcare system, including Denti-Cal compared to private insurance, and feasibility issues that include, but are not limited to, time, skills, staff availability, and equipment availability for the provider to carry out necessary dental procedures.
3. Requires the DBC to make the report publicly available on its Internet Web site.

Background

The DBC prepared its Pediatric Anesthesia Study, issued December 2016, in response to a February 8, 2016 letter from Senator Jerry Hill, Chair of this Committee, requesting a DBC subcommittee investigate California’s present laws, regulations and policies related to pediatric dental anesthesia to determine whether they were sufficient to ensure patient safety.

The report determined that California dental sedation and anesthesia laws are similar to laws in other states and differ primarily in the area of personnel requirements.

Although the subcommittee drafting the report noted that there are few, if any, high quality studies of pediatric dental sedation, they reviewed the available medical and dental literature and found that available data do not reveal an association between adverse outcomes and the type of provider or practice model.

DBC recommended updating terminology, staffing requirements, educational requirements, and monitoring standards in an effort to improve the safety of pediatric dental anesthesia and sedation. However, the subcommittee which wrote the report issued recommendations that differed from the full board’s recommendations in that the subcommittee did not require the presence of a separate GA provider for children under seven.

DBC acknowledged that “the manpower and economic considerations for pediatric dental sedation are beyond the scope of the present report. These considerations will be critical to the successful implementation of any changes to dental sedation laws. DBC therefore recommends that there be an analysis of the effects of any proposed new legislation or regulation on access to care for pediatric dental patients prior to the implementation of any changes.”

This bill directs the DBC to report to the Legislature on this issue by January 1, 2019.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

According to the Senate Appropriations Committee, this bill will have one-time costs of about $1 million for the preparation of a report regarding the impact on access to care for pediatric dental patients (State Dentistry Fund).

SUPPORT: (Verified 5/25/17)

California Association of Oral and Maxillofacial Surgeons (source)

California Dental Association

OPPOSITION: (Verified 5/25/17)

American Academy of Pediatrics, California

ARGUMENTS IN SUPPORT: The California Association of Oral and Maxillofacial Surgeons (CALAOMS) write, “While CALAOMS is very supportive of most of the DBC’s recent recommendations regarding pediatric dental anesthesia, there is one provision that is particularly problematic. The recommendation to require a second GA permit holder to be involved in GA procedures on patients under seven years of age, if the dental provider already has a GA permit, is not needed. CALAOMS is strongly committed to patient safety for all levels of anesthesia. However, the addition of a second GA permit holder in an over-abundance of caution will impede access to pediatric care. CALAOMS believes the DBC should analyze how that recommendation will affect access to pediatric dental care and report its findings to the Legislature prior to enacting any new GA permit requirements.”

ARGUMENTS IN OPPOSITION: The American Academy of Pediatrics, California writes, “SB 392’s requirement that the Dental Board provide to the Legislature a report and analysis of the effects on access to care for pediatric dental patients of these recommendations does a disservice to children undergoing dental anesthesia, who will be unnecessarily subjected to a lower and riskier standard of care during the report’s lengthy preparation time. Further, such a report is unnecessary, as current workforce data clearly show that implementing the Dental Board of California’s recommendations would NOT have a negative effect on access. There are ample qualified anesthesia providers in California to meet the Dental Board’s recommended staffing for anesthesia procedures in dental offices for children under age 7.”

Prepared by:

5/27/17 17:21:30

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SENATE COMMITTEE ON

Senator Ricardo Lara, Chair

2017 - 2018 Regular Session

SB 392 (Bates) - Dentistry: report: access to care: pediatric dental patients: continuing education

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on May 25, 2017

Bill Summary:

SB 392 would require the Dental Board to report to the Legislature on access to care for pediatric dental patients. The bill would also require the Dental Board to develop a course in pediatric life support.

Fiscal Impact:

• One-time costs of about $1 million for the preparation of a report regarding the impact on access to care for pediatric dental patients (State Dentistry Fund).

Committee Amendments:

Delete the requirement that the Dental Board develop a course on pediatric life support.

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SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2017 - 2018 Regular Session

SB 392 (Bates) - Dentistry: report: access to care: pediatric dental patients: continuing education

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

SB 392 would require the Dental Board to report to the Legislature on access to care for pediatric dental patients. The bill would also require the Dental Board to develop a course in pediatric life support.

Fiscal Impact:

• One-time costs of about $1 million for the preparation of a report regarding the impact on access to care for pediatric dental patients (State Dentistry Fund).
• Unknown costs for the Dental Board to develop a continuing education course in pediatric life support (State Dentistry Fund). Because the Dental Board does not currently create educational courses for dentists or dental assistants, the costs to develop the required course are not well known. According to the Dental Board, the costs could be as high as $1 million.

Background:

Under current law, dentists are licensed and regulated by the Dental Board of California. In order to administer general anesthesia to a dental patient, a licensed dentist must also have a General Anesthesia permit from the Dental Board. (This requirement also applies to licensed physicians who administer general anesthesia in a dental office.) In order for a dentist to administer drugs that result in conscious sedation, a dentist must have either a general anesthesia permit or a conscious sedation permit from the Dental Board. Current law and regulation provide for regulatory standards for the administration of both general anesthesia and conscious sedation by dentists (or physicians operating in a dental office).

AB 2235 (Thurmond, Statutes of 2016) requires the Dental Board to provide a report to the Legislature on current statutes and regulations relating to the use of anesthesia on pediatric dental patients, amongst other requirements. The Dental Board has completed the required report. In the development of the report, the Dental Board created a subcommittee of its members to study the issue and report to the full Board. The subcommittee report generally recommended changes to current law included in this bill and recommended a study be performed on the potential implications on access to dental care if current law was further amended to require a second dentist or physician with a general anesthesia permit to be present when anesthesia is used on a pediatric patient. The full Dental Board adopted the recommendations of the subcommittee, but also adopted a recommendation that a second permitted dentist or physician be present when general anesthesia is administered to a pediatric patient.

Proposed Law:

SB 392 would require the Dental Board to report to the Legislature on access to care for pediatric dental patients. Specifically, the report would focus on the effects on access to care as it relates to proposals to require a second general anesthesia permit holder to be present during the administration of general anesthesia to patients under seven years of age.

The bill would also require the Dental Board to develop a course in pediatric life support.

Related Legislation:

• SB 501 (Glazer) would revise the existing requirements for the administration of outpatient sedation by dentists. That bill includes a requirement for the Dental Board to prepare a report on access to care for pediatric patients. That bill will be heard in this committee.
• AB 224 (Thurmond) is substantially similar to SB 501 (Glazer) That bill is pending in the Assembly Appropriations Committee.

Staff Comments:

In recent years, there has been substantial interest by the Legislature regarding the use of anesthesia in pediatric dental patients and the implications of current law and regulation on patient safety. There have been several deaths in recent years of pediatric patients under anesthesia in dental offices. Under current law and regulation, a single dentist with a general anesthesia permit is allowed to both administer anesthesia and perform the underlying dental procedure. This is not the case for physicians performing surgery, where current law and regulation require a separate person to be responsible for administering general anesthesia and monitoring a patient’s vital signs during the operation.

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SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2017 - 2018 Regular

Bill No: Hearing Date: April 24, 2017

Subject:

SUMMARY:

Requires the Dental Board of California to provide a report on access to care for pediatric patients requiring general anesthesia, and to develop a course in pediatric life support by January 1, 2019.

Existing law:

1. Establishes the Dental Board of California (DBC) to administer and enforce the provisions of the Dental Practice Act. (Business and Professions Code (BPC) § 1601.1)
2. Requires the DBC to provide a report to the Legislature as to whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients by January 1, 2017. (BPC § 1601.4 (a))
3. Requires the DBC to provide a report on pediatric deaths related to general anesthesia (GA) in dentistry at the time of its 2020 sunset review. (BPC § 1601.4)
4. Establishes requirements for the administration of GA and conscious sedation in adults and pediatric patients. (BPC §§ 1646 et seq)

This bill:

1. Requires the DBC to provide a report and analysis to the Legislature of the effects on access to care for pediatric dental patients specifically as it relates to requiring the addition of a second GA permitholder to be present during the administration of GA on a patient seven years of age or younger, if the provider is currently a general anesthesia permitholder, by January 1, 2019.
2. Requires the analysis to include costs of sedation and anesthesia, resource constraints of the healthcare system, including Denti-Cal compared to private insurance, and feasibility issues that include, but are not limited to, time, skills, staff availability, and equipment availability for the provider to carry out necessary dental procedures.
3. Requires the DBC to make the report publicly available on its Internet Web site.
   
4. Requires the DBC, by January 1, 2019, to develop a course in pediatric life support and airway management equivalent to the American Academy of Pediatrics and American Academy of Pediatric Dentistry guidelines, or guidelines determined by the DBC, in order to protect the public health and safety, as specified. The DBC shall have discretion, consistent with the guidelines, over the solicitation and subsequent acceptance of proposals from continuing education vendors to provide the course.

FISCAL EFFECT:

Unknown. This bill is keyed “fiscal” by the Legislative Counsel.

COMMENTS:

1. Purpose. This bill is sponsored by the California Association of Oral and Maxillofacial Surgeons. According to the Author’s office, this bill is necessary because “In response to Assembly Bill 2235 (Thurmond, Chapter 519, Statutes of 2016), the DBC was required to provide to the Legislature a report on whether the current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients.”

“As a result, the DBC prepared a letter on December 30, 2016, for the Senate Business, Professions & Economic Development Committee that outlined several enhancements to current statute to provide an even greater level of public protection.”

“Although most of the recommendations were approved and vetted by the Dental Board Subcommittee assigned to study the anesthesia statutes, the final recommendation about the additional general anesthesia permit holder was not vetted or researched as to its need or effect on access to pediatric dental care.”

1. Background. The DBC prepared its Pediatric Anesthesia Study, issued December 2016, in response to a February 8, 2016 letter from Senator Jerry Hill, Chair of this Committee, requesting a DBC subcommittee investigate California’s present laws, regulations and policies related to pediatric dental anesthesia to determine whether they were sufficient to ensure patient safety.

The report determined that California dental sedation and anesthesia laws are similar to laws in other states and differ primarily in the area of personnel requirements.

Although the subcommittee drafting the report noted that there are few, if any, high quality studies of pediatric dental sedation, they reviewed the available medical and dental literature and found that available data do not reveal an association between adverse outcomes and the type of provider or practice model.

DBC recommended updating terminology, staffing requirements, educational requirements, and monitoring standards in an effort to improve the safety of pediatric dental anesthesia and sedation. However, the subcommittee that wrote the report issued recommendations that differed from the full board recommendations in that the subcommittee did not require the presence of a separate GA provider for children under seven.

DBC acknowledged that “the manpower and economic considerations for pediatric dental sedation are beyond the scope of the present report. These considerations will be critical to the successful implementation of any changes to dental sedation laws. DBC therefore recommends that there be an analysis of the effects of any proposed new legislation or regulation on access to care for pediatric dental patients prior to the implementation of any changes.”

This bill directs the examination of this issue and requires the DBC to develop a course in pediatric life support.

1. Related Legislation. SB 501 (Glazer) requires a report similar to the one required in this bill, and places in statute the recommendations of the DBC subcommittee on issued December 1, 2016 as a result of the Pediatric Anesthesia Study. (Status: This bill is currently pending in the Senate Business, Professions and Economic Development Committee)

AB 224 (Thurmond) contains the recommendations of the full DBC as a result of the Pediatric Anesthesia Study, as voted on December 30, 2016. (Status: This bill is currently pending in the Assembly Business and Professions Committee.)

1. Previous Legislation. AB 2235 (Thurmond, Chapter 519, Statutes of 2016) required the DBC to provide a report to the Legislature 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 GA 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.
2. Arguments in Support. The California Association of Oral and Maxillofacial Surgeons (CALAOMS) write, “While CALAOMS is very supportive of most of the DBC’s recent recommendations regarding pediatric dental anesthesia, there is one provision that is particularly problematic. The recommendation to require a second GA permit holder to be involved in GA procedures on patients under seven years of age, if the dental provider already has a GA permit, is not needed. CALAOMS is strongly committed to patient safety for all levels of anesthesia. However, the addition of a second GA permit holder in an over-abundance of caution will impede access to pediatric care. CALAOMS believes the DBC should analyze how that recommendation will affect access to pediatric dental care and report its findings to the Legislature prior to enacting any new GA permit requirements.”

SUPPORT AND OPPOSITION:

Support:

California Association of Oral and Maxillofacial Surgeons (Sponsor)

Opposition:

None on file as of April 19, 2017

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