Bill Text: CA AB2235 | 2015-2016 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Board of Dentistry: pediatric anesthesia: committee.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Passed) 2016-09-23 - Chaptered by Secretary of State - Chapter 519, Statutes of 2016. [AB2235 Detail]

Download: California-2015-AB2235-Amended.html

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BILL NUMBER: AB 2235	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 9, 2016
	AMENDED IN ASSEMBLY  APRIL 11, 2016
	AMENDED IN ASSEMBLY  MARCH 31, 2016

INTRODUCED BY   Assembly Member Thurmond

                        FEBRUARY 18, 2016

   An act to amend  Section 1682   Sections 1680
an   d 1682  of, and to add Section 1601.4 to, the
Business and Professions Code, relating to healing arts.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2235, as amended, Thurmond. Board of Dentistry: pediatric
anesthesia: committee.
   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
board's 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 child's parent or
guardian.
   This bill, which would be known as "Caleb's 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 st   udies, to ensure that
 this state has regulation and policies in place to do
everything feasible to protect young patients.   the
state's 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 committee's  recommendations to the Legislature 
 recommendations, an evaluation of the committee's report, and
the board's own recommendations  and  to  make the
report publicly available on the board's 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. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  This act shall be known, and may be cited, as "Caleb's
Law."
   SEC. 2.    It is the Legislature's 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 state's 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 board's 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 board's
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 board's possession, custody, or
control, including investigatory reports: the age of the patient; the
patient's 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 employee's 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 patient's 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 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. 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 child's 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 child's
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.