Bill Text: CA AB2235 | 2015-2016 | Regular Session | Chaptered
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-Chaptered.html
BILL NUMBER: AB 2235 CHAPTERED
BILL TEXT
CHAPTER 519
FILED WITH SECRETARY OF STATE SEPTEMBER 23, 2016
APPROVED BY GOVERNOR SEPTEMBER 23, 2016
PASSED THE SENATE AUGUST 18, 2016
PASSED THE ASSEMBLY AUGUST 24, 2016
AMENDED IN SENATE AUGUST 16, 2016
AMENDED IN SENATE JUNE 29, 2016
AMENDED IN SENATE JUNE 20, 2016
AMENDED IN SENATE JUNE 9, 2016
AMENDED IN ASSEMBLY APRIL 11, 2016
AMENDED IN ASSEMBLY MARCH 31, 2016
INTRODUCED BY Assembly Member Thurmond
(Coauthor: Senator Hill)
FEBRUARY 18, 2016
An act to amend Sections 1680 and 1682 of, and to add Section
1601.4 to, the Business and Professions Code, relating to healing
arts.
LEGISLATIVE COUNSEL'S DIGEST
AB 2235, 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 January 1, 2017, to provide to the
Legislature a report on whether current statutes and regulations for
the administration and monitoring of pediatric anesthesia in
dentistry provide adequate protection for pediatric dental patients
and would require the board to make the report publicly available on
the board's Internet Web site. The bill also would require the board
to provide a report on pediatric deaths related to general anesthesia
in dentistry at the time of its sunset review by the appropriate
policy committees of the Legislature.
This bill would require that the report of the death of a patient,
or removal of a patient to a hospital or emergency center for
medical treatment, be on a form or forms approved by the board and
that the report include specified information. The bill authorizes
the board to assess a penalty on any licensee who fails to make the
required report.
This bill, with regard to obtaining written informed consent for
general anesthesia or conscious sedation in the case of a minor,
would require that the written informed consent include specified
information regarding anesthesia, as provided.
THE 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. 3. Section 1601.4 is added to the Business and Professions
Code, to read:
1601.4. (a) On or before January 1, 2017, the board shall provide
to the Legislature a report on whether current statutes and
regulations for the administration and monitoring of pediatric
anesthesia in dentistry provide adequate protection for pediatric
dental patients. The report shall be submitted in compliance with
Section 9795 of the Government Code. The requirement for submitting a
report imposed by this subdivision is inoperative on December 1,
2021, pursuant to Section 10231.5 of the Government Code. The board
shall make the report publicly available on the board's Internet Web
site.
(b) The board shall provide a report on pediatric deaths related
to general anesthesia in dentistry at the time of its sunset review
pursuant to subdivision (d) of Section 1601.1.
SEC. 4. Section 1680 of the Business and Professions Code is
amended to read:
1680. Unprofessional conduct by a person licensed under this
chapter is defined as, but is not limited to, any one of the
following:
(a) The obtaining of any fee by fraud or misrepresentation.
(b) The employment directly or indirectly of any student or
suspended or unlicensed dentist to practice dentistry as defined in
this chapter.
(c) The aiding or abetting of any unlicensed person to practice
dentistry.
(d) The aiding or abetting of a licensed person to practice
dentistry unlawfully.
(e) The committing of any act or acts of sexual abuse, misconduct,
or relations with a patient that are substantially related to the
practice of dentistry.
(f) The use of any false, assumed, or fictitious name, either as
an individual, firm, corporation, or otherwise, or any name other
than the name under which he or she is licensed to practice, in
advertising or in any other manner indicating that he or she is
practicing or will practice dentistry, except that name as is
specified in a valid permit issued pursuant to Section 1701.5.
(g) The practice of accepting or receiving any commission or the
rebating in any form or manner of fees for professional services,
radiograms, prescriptions, or other services or articles supplied to
patients.
(h) The making use by the licensee or any agent of the licensee of
any advertising statements of a character tending to deceive or
mislead the public.
(i) The advertising of either professional superiority or the
advertising of performance of professional services in a superior
manner. This subdivision shall not prohibit advertising permitted by
subdivision (h) of Section 651.
(j) The employing or the making use of solicitors.
(k) The advertising in violation of Section 651.
( l ) The advertising to guarantee any dental service,
or to perform any dental operation painlessly. This subdivision shall
not prohibit advertising permitted by Section 651.
(m) The violation of any of the provisions of law regulating the
procurement, dispensing, or administration of dangerous drugs, as
defined in Chapter 9 (commencing with Section 4000) or controlled
substances, as defined in Division 10 (commencing with Section 11000)
of the Health and Safety Code.
(n) The violation of any of the provisions of this division.
(o) The permitting of any person to operate dental radiographic
equipment who has not met the requirements of Section 1656.
(p) The clearly excessive prescribing or administering of drugs or
treatment, or the clearly excessive use of diagnostic procedures, or
the clearly excessive use of diagnostic or treatment facilities, as
determined by the customary practice and standards of the dental
profession.
Any person who violates this subdivision is guilty of a
misdemeanor and shall be punished by a fine of not less than one
hundred dollars ($100) or more than six hundred dollars ($600), or by
imprisonment for a term of not less than 60 days or more than 180
days, or by both a fine and imprisonment.
(q) The use of threats or harassment against any patient or
licensee for providing evidence in any possible or actual
disciplinary action, or other legal action; or the discharge of an
employee primarily based on the 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: (A) the death of his or her patient
during the performance of any dental or dental hygiene procedure; (B)
the discovery of the death of a patient whose death is related to a
dental or dental hygiene procedure performed by him or her; or (C)
except for a scheduled hospitalization, the removal to a hospital or
emergency center for medical treatment of any patient to whom oral
conscious sedation, conscious sedation, or general anesthesia was
administered, or any patient as a result of dental or dental hygiene
treatment. With the exception of patients to whom oral conscious
sedation, conscious sedation, or general anesthesia was administered,
removal to a hospital or emergency center that is the normal or
expected treatment for the underlying dental condition is not
required to be reported. Upon receipt of a report pursuant to this
subdivision the board may conduct an inspection of the dental office
if the board finds that it is necessary. A dentist shall report to
the board all deaths occurring in his or her practice with a copy
sent to the Dental Hygiene Committee of California if the death was
the result of treatment by a registered dental hygienist, registered
dental hygienist in alternative practice, or registered dental
hygienist in extended functions. A registered dental hygienist,
registered dental hygienist in alternative practice, or registered
dental hygienist in extended functions shall report to the Dental
Hygiene Committee of California all deaths occurring as the result of
dental hygiene treatment, and a copy of the notification shall be
sent to the board.
(2) The report required by this subdivision shall be on a form or
forms approved by the board. The form or forms approved by the board
shall require the licensee to include, but not be limited to, the
following information for cases in which patients received
anesthesia: the date of the procedure; the 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 licensee may dispute the failure to file within 10
days of receiving notice that the board had assessed a penalty
against the licensee.
(aa) Participating in or operating any group advertising and
referral services that are in violation of Section 650.2.
(ab) The failure to use a fail-safe machine with an appropriate
exhaust system in the administration of nitrous oxide. The board
shall, by regulation, define what constitutes a fail-safe machine.
(ac) Engaging in the practice of dentistry with an expired
license.
(ad) Except for good cause, the knowing failure to protect
patients by failing to follow infection control guidelines of the
board, thereby risking transmission of bloodborne infectious diseases
from dentist, dental assistant, registered dental assistant,
registered dental assistant in extended functions, dental sedation
assistant permitholder, orthodontic assistant permitholder,
registered dental hygienist, registered dental hygienist in
alternative practice, or registered dental hygienist in extended
functions to patient, from patient to patient, and from patient to
dentist, dental assistant, registered dental assistant, registered
dental assistant in extended functions, dental sedation assistant
permitholder, orthodontic assistant permitholder, registered dental
hygienist, registered dental hygienist in alternative practice, or
registered dental hygienist in extended functions. In administering
this subdivision, the board shall consider referencing the standards,
regulations, and guidelines of the State Department of Public Health
developed pursuant to Section 1250.11 of the Health and Safety Code
and the standards, guidelines, and regulations pursuant to the
California Occupational Safety and Health Act of 1973 (Part 1
(commencing with Section 6300) of Division 5 of the Labor Code) for
preventing the transmission of HIV, hepatitis B, and other
blood-borne pathogens in health care settings. The board shall review
infection control guidelines, if necessary, on an annual basis and
proposed changes shall be reviewed by the Dental Hygiene Committee of
California to establish a consensus. The committee shall submit any
recommended changes to the infection control guidelines for review to
establish a consensus. As necessary, the board shall consult with
the Medical Board of California, the California Board of Podiatric
Medicine, the Board of Registered Nursing, and the Board of
Vocational Nursing and Psychiatric Technicians, to encourage
appropriate consistency in the implementation of this subdivision.
The board shall seek to ensure that all appropriate dental
personnel are informed of the responsibility to follow infection
control guidelines, and of the most recent scientifically recognized
safeguards for minimizing the risk of transmission of bloodborne
infectious diseases.
(ae) The utilization by a licensed dentist of any person to
perform the functions of any registered dental assistant, registered
dental assistant in extended functions, dental sedation assistant
permitholder, orthodontic assistant permitholder, registered dental
hygienist, registered dental hygienist in alternative practice, or
registered dental hygienist in extended functions who, at the time of
initial employment, does not possess a current, valid license or
permit to perform those functions.
(af) The prescribing, dispensing, or furnishing of dangerous drugs
or devices, as defined in Section 4022, in violation of Section
2242.1.
SEC. 5. Section 1682 of the Business and Professions Code is
amended to read:
1682. In addition to other acts constituting unprofessional
conduct under this chapter, it is unprofessional conduct for:
(a) Any dentist performing dental procedures to have more than one
patient undergoing conscious sedation or general anesthesia on an
outpatient basis at any given time unless each patient is being
continuously monitored on a one-to-one ratio while sedated by either
the dentist or another licensed health professional authorized by law
to administer conscious sedation or general anesthesia.
(b) Any dentist with patients recovering from conscious sedation
or general anesthesia to fail to have the patients closely monitored
by licensed health professionals experienced in the care and
resuscitation of patients recovering from conscious sedation or
general anesthesia. If one licensed professional is responsible for
the recovery care of more than one patient at a time, all of the
patients shall be physically in the same room to allow continuous
visual contact with all patients and the patient to recovery staff
ratio should not exceed three to one.
(c) Any dentist with patients who are undergoing conscious
sedation to fail to have these patients continuously monitored during
the dental procedure with a pulse oximeter or similar or superior
monitoring equipment required by the board.
(d) Any dentist with patients who are undergoing conscious
sedation to have dental office personnel directly involved with the
care of those patients who are not certified in basic cardiac life
support (CPR) and recertified biennially.
(e) (1) Any dentist to fail to obtain the written informed consent
of a patient prior to administering general anesthesia or conscious
sedation. In the case of a minor, the consent shall be obtained from
the child's parent or guardian.
(2) The written informed consent, in the case of a minor, shall
include, but not be limited to, the following information:
"The administration and monitoring of general anesthesia may vary
depending on the type of procedure, the type of practitioner, the age
and health of the patient, and the setting in which anesthesia is
provided. Risks may vary with each specific situation. You are
encouraged to explore all the options available for your 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 or monitoring oral
conscious sedation, conscious sedation, or general anesthesia.
