Bill Text: FL S0490 | 2010 | Regular Session | Introduced
Bill Title: Dentistry [SPSC]
Sponsorship: Partisan Bill (Democrat 1)
Status: (Failed) 2010-04-30 - Died in Committee on Health Regulation [S0490 Detail]
Download: Florida-2010-S0490-Introduced.html
Florida Senate - 2010 SB 490 By Senator Smith 29-00507-10 2010490__ 1 A bill to be entitled 2 An act relating to the practice of dentistry; amending 3 s. 466.003, F.S.; defining the term “public health 4 supervision” and redefining the term “health access 5 settings” to include school-based prevention programs; 6 amending ss. 466.006 and 466.0067, F.S.; conforming 7 cross-references; amending s. 466.00775, F.S.; 8 conforming a cross-reference; requiring the Board of 9 Dentistry to adopt additional rules; amending s. 10 466.023, F.S.; authorizing dental hygienists to 11 perform certain additional dental hygiene services 12 under public health supervision; authorizing dental 13 hygienists to perform fluoride treatments without 14 supervision; authorizing the board to adopt rules; 15 amending s. 466.024, F.S.; providing that certain 16 tasks are remediable and delegable to dental 17 hygienists in certain settings; prohibiting a dentist 18 from delegating irremediable tasks to a dental 19 hygienist; authorizing a dentist to delegate 20 remediable tasks to a dental hygienist under certain 21 conditions; providing a list of remediable and 22 delegable tasks; authorizing the board to adopt rules; 23 providing an effective date. 24 25 WHEREAS, tooth decay is one of the most prevalent chronic 26 diseases of childhood, and 27 WHEREAS, oral diseases are associated with a variety of 28 systemic diseases, including cardiovascular disease, diabetes, 29 and cancer, and 30 WHEREAS, oral disease in pregnant women is associated with 31 preterm birth and low birth weight, and 32 WHEREAS, early dental care helps to prevent oral disease 33 and its associated pain, risks, and high costs to individuals, 34 and 35 WHEREAS, the placement of dental sealants and fluorides are 36 a central and critical aspect of preventive oral health care, 37 especially for children, and 38 WHEREAS, dental care for low-income and other underserved 39 patients is provided primarily through publicly funded programs, 40 and 41 WHEREAS, the current public health infrastructure is 42 inadequate to provide access to preventive and interventional 43 oral health care services, and 44 WHEREAS, current dental licensure statutes and rules in 45 Florida create barriers for dentists licensed in other states 46 who are willing to serve in public health settings from doing 47 so, and 48 WHEREAS, Florida’s current statutes and rules restrict the 49 ability of dental hygienists to deliver needed care to low 50 income and other underserved patients cost-effectively, and 51 WHEREAS, Florida is one of four states and the U.S. Virgin 52 Islands that does not offer a process by which dentists from 53 other states may achieve licensure by credentials to practice in 54 public or private settings, and 55 WHEREAS, Florida is one of nine states to prohibit dental 56 hygienists from placing dental sealants without the physical 57 presence of a dentist, and 58 WHEREAS, the membership of the Florida Board of Dentistry 59 does not require any of its members to have a background in or 60 experience in a public health setting, NOW, THEREFORE, 61 62 Be It Enacted by the Legislature of the State of Florida: 63 64 Section 1. Present subsections (11), (12), (13), and (14) 65 of section 466.003, Florida Statutes, are redesignated as 66 subsections (12), (13), (14), and (15), respectively, and 67 amended, and a new subsection (11) is added to that section, to 68 read: 69 466.003 Definitions.—As used in this chapter: 70 (11) “Public health supervision” means administrative 71 supervision whereby a dental hygienist in a health access 72 setting, without supervision or the presence of a dentist, 73 provides remedial services as established under s. 466.024. The 74 board may authorize additional services by rule. 75 (12)(11)“Irremediable tasks” are those intraoral treatment 76 tasks thatwhich, when performed, are irreversible and create 77 unalterable changes within the oral cavity or the contiguous 78 structures or thatwhichcause an increased risk to the patient. 79 The administration of anesthetics other than topical anesthesia 80 is considered to be an“irremediable task”for purposes of this 81 chapter. 82 (13)(12)“Remediable tasks” are those intraoral treatment 83 tasks thatwhichare reversible and do not create unalterable 84 changes within the oral cavity or the contiguous structures and 85 thatwhichdo not cause an increased risk to the patient. 86 (14)(13)“Oral and maxillofacial surgery” means the 87 specialty of dentistry involving diagnosis, surgery, and 88 adjunctive treatment of diseases, injuries, and defects 89 involving the functional and esthetic aspects of the hard and 90 soft tissues of the oral and maxillofacial regions. This term 91 doesmaynotbe construed toapply with respect to any 92 individual exempt under s. 466.002(1). 93 (15)(14)“Health access settings” means programs and 94 institutions of the Department of Children and Family Services, 95 the Department of Health, the Department of Juvenile Justice, 96 nonprofit community health centers, Head Start centers, 97 federally qualified health centers (FQHCs), FQHC look-alikes as 98 defined by federal law, school-based prevention programs, and 99 clinics operated by accredited colleges of dentistry in this 100 state if such community service programs and institutions 101 immediately report to the Board of Dentistry all violations of 102 s. 466.027, s. 466.028, or other practice act or standard of 103 care violations related to the actions or inactions of a 104 dentist, dental hygienist, or dental assistant engaged in the 105 delivery of dental care in such settings. 106 Section 2. Paragraph (c) of subsection (2) of section 107 466.006, Florida Statutes, is amended to read: 108 466.006 Examination of dentists.— 109 (2) An applicant shall be entitled to take the examinations 110 required in this section to practice dentistry in this state if 111 the applicant: 112 (c)1. Has successfully completed the National Board of 113 Dental Examiners dental examination within 10 years of the date 114 of application; or 115 2. Has an active health access dental license in this 116 state; and 117 a. The applicant has at least 5,000 hours within 4 118 consecutive years of clinical practice experience providing 119 direct patient care in a health access setting as defined in s. 120 466.003(14); the applicant is a retired veteran dentist of any 121 branch of the United States Armed Services who has practiced 122 dentistry while on active duty and has at least 3,000 hours 123 within 3 consecutive years of clinical practice experience 124 providing direct patient care in a health access setting as 125 defined in s. 466.003(14); or the applicant has provided a 126 portion of his or her salaried time teaching health profession 127 students in any public education setting, including, but not 128 limited to, a community college, college, or university, and has 129 at least 3,000 hours within 3 consecutive years of clinical 130 practice experience providing direct patient care in a health 131 access setting as defined in s. 466.003(14); 132 b. The applicant has not been disciplined by the board, 133 except for citation offenses or minor violations; 134 c. The applicant has not filed a report pursuant to s. 135 456.049; and 136 d. The applicant has not been convicted of or pled nolo 137 contendere to, regardless of adjudication, any felony or 138 misdemeanor related to the practice of a health care profession. 139 Section 3. Section 466.0067, Florida Statutes, is amended 140 to read: 141 466.0067 Application for health access dental license.—The 142 Legislature finds that there is an important state interest in 143 attracting dentists to practice in underserved health access 144 settings in this state and further, that allowing out-of-state 145 dentists who meet certain criteria to practice in health access 146 settings without the supervision of a dentist licensed in this 147 state is substantially related to achieving this important state 148 interest. Therefore, notwithstanding the requirements of s. 149 466.006, the board shall grant a health access dental license to 150 practice dentistry in this state in health access settings as 151 defined in s. 466.003(14)to an applicant that: 152 (1) Files an appropriate application approved by the board; 153 (2) Pays an application license fee for a health access 154 dental license, laws-and-rule exam fee, and an initial licensure 155 fee. The fees specified in this subsection may not differ from 156 an applicant seeking licensure pursuant to s. 466.006; 157 (3) Has not been convicted of or pled nolo contendere to, 158 regardless of adjudication, any felony or misdemeanor related to 159 the practice of a health care profession; 160 (4) Submits proof of graduation from a dental school 161 accredited by the Commission on Dental Accreditation of the 162 American Dental Association or its successor agency; 163 (5) Submits documentation that she or he has completed, or 164 will obtain prior to licensure, continuing education equivalent 165 to this state’s requirement for dentists licensed under s. 166 466.006 for the last full reporting biennium before applying for 167 a health access dental license; 168 (6) Submits proof of her or his successful completion of 169 parts I and II of the dental examination by the National Board 170 of Dental Examiners and a state or regional clinical dental 171 licensing examination that the board has determined effectively 172 measures the applicant’s ability to practice safely; 173 (7) Currently holds a valid, active, dental license in good 174 standing which has not been revoked, suspended, restricted, or 175 otherwise disciplined from another of these United States, the 176 District of Columbia, or a United States territory; 177 (8) Has never had a license revoked from another of these 178 United States, the District of Columbia, or a United States 179 territory; 180 (9) Has never failed the examination specified in s. 181 466.006, unless the applicant was reexamined pursuant to s. 182 466.006 and received a license to practice dentistry in this 183 state; 184 (10) Has not been reported to the National Practitioner 185 Data Bank, unless the applicant successfully appealed to have 186 his or her name removed from the data bank; 187 (11) Submits proof that he or she has been engaged in the 188 active, clinical practice of dentistry providing direct patient 189 care for 5 years immediately preceding the date of application, 190 or in instances when the applicant has graduated from an 191 accredited dental school within the preceding 5 years, submits 192 proof of continuous clinical practice providing direct patient 193 care since graduation; and 194 (12) Has passed an examination covering the laws and rules 195 of the practice of dentistry in this state as described in s. 196 466.006(4)(a). 197 Section 4. Section 466.00775, Florida Statutes, is amended 198 to read: 199 466.00775 Rulemaking.—The board shall adopt rules pursuant 200 to ss. 120.536(1) and 120.54 to administer ss. 466.003(15) 201466.003(14), 466.004(1), 466.0067, 466.00671, 466.00672, 202 466.00673, 466.011, 466.021, and 466.032. 203 Section 5. Subsections (1), (2), and (3) of section 204 466.023, Florida Statutes, are amended, and subsection (7) is 205 added to that section, to read: 206 466.023 Dental hygienists; scope and area of practice.— 207 (1) Except as otherwise provided in s. 466.024, only dental 208 hygienists may be delegated the task of removing calculus 209 deposits, accretions, and stains from exposed surfaces of the 210 teeth and from the gingival sulcus and the task of performing 211 root planing and curettage. In addition, dental hygienists may 212 expose dental X-ray films, apply topical preventive or 213 prophylactic agents, and perform all tasks delegable by the 214 dentist in accordance with s. 466.024.The board by rule shall215determine whether such functions shall be performed under the216direct, indirect, or general supervision of the dentist.217 (2) Dental hygienists may perform their duties: 218 (a) In the private office of a licensed dentist wherein the 219 board shall determine by rule whether the functions in 220 subsection (1) must be performed under the direct, indirect, or 221 general supervision of the dentist; 222 (b) Inpublichealth access settings,programs and223institutions of the Department of Children and Family Services,224Department of Health, and Department of Juvenile Justiceunder 225 public health supervision, as defined in s. 466.003. Dental 226 hygienists in health access settings under public health 227 supervision may perform the duties delineated in this section, 228 ss. 466.0235 and 466.024, and any other duties as prescribed by 229 this chapterthe general supervision of a licensed dentist; or 230 (c) Upon a patient of record of a dentist who has issued a 231 prescription for the services of a dental hygienist, which 232 prescription isshall bevalid for 2 years unless a shorter 233 length of time is designated by the dentist, in: 234 1. Licensed public and private health facilities; 235 2. Other public institutions of the state and federal 236 government; 237 3. Public and private educational institutions; 238 4. The home of a nonambulatory patient; and 239 5. Other places in accordance with the rules of the board. 240 241 However, the dentist issuing such prescription remainsshall242remainresponsible for the care of such patient. As used in this 243 subsection, “patient of record” means a patient upon whom a 244 dentist has taken a complete medical history, completed a 245 clinical examination, recorded any pathological conditions, and 246 prepared a treatment plan. 247 (3) Dental hygienists may, without supervision, provide 248 educational programs, faculty or staff training programs, 249 authorized fluoride rinse programs, and fluoride treatments, 250 including fluoride varnish applications. Dental hygienists may 251 also, without supervision, instruct patients in oral hygiene 252 care and provide other services thatwhichdo not involve 253 diagnosis or treatment of dental conditions andwhich services254 are approved by rule of the board. 255 (7) The board may adopt rules to administer this section. 256 Section 6. Section 466.024, Florida Statutes, is amended to 257 read: 258 466.024 Delegation of duties; expanded functions.— 259 (1) A dentist may not delegate irremediable tasks to a 260 dental hygienist or dental assistant, except as provided by law. 261 A dentist may delegate remediable tasks to a dental hygienist or 262 dental assistant when such tasks pose no risk to the patient. A 263 dentist mayonlydelegate only those remediable tasks that are 264sodefined by law or rule of the board. The board by rule shall 265 designate which tasks are remediable and delegable, except that 266 the following are by law found to be remediable and delegable to 267 dental hygienists in settings defined in s. 466.023(2)(a) and 268 (c): 269 (a) Taking impressions for study casts but not for the 270 purpose of fabricating any intraoral restorations or orthodontic 271 appliance. 272 (b) Placing periodontal dressings. 273 (c) Removing periodontal or surgical dressings. 274 (d) Removing sutures. 275 (e) Placing or removing rubber dams. 276 (f) Placing or removing matrices. 277 (g) Placing or removing temporary restorations. 278 (h) Applying cavity liners, varnishes, or bases. 279 (i) Polishing amalgam restorations. 280 (j) Polishing clinical crowns of the teeth for the purpose 281 of removing stains but not changing the existing contour of the 282 tooth. 283 (k) Obtaining bacteriological cytological specimens not 284 involving cutting of the tissue. 285 286Nothing inThis subsection does notshall be construed tolimit 287 delegable tasks to those specified herein. 288 (2) A dentist may not delegate irremediable tasks to a 289 dental hygienist except as provided by law. A dentist may 290 delegate remediable tasks to a dental hygienist when such tasks 291 pose no risk to the patient. A dentist may delegate only those 292 remediable tasks that are defined by law or rule of the board. 293 The following tasks are remediable and delegable in settings 294 defined in s. 466.023(2)(a) and (c): 295 (a) All duties listed in s. 466.023(1). 296 (b) Applying topical fluorides, which includes fluoride 297 varnish. 298 (c) Applying dental sealants. 299 300 This subsection does not limit delegable tasks to those 301 specified herein. 302 (3)(2)Notwithstanding subsection (1) or subsection (2), a 303 dentist may delegate the tasks of gingival curettage and root 304 planing to a dental hygienist but not to a dental assistant. 305 (4)(3)All other remediable tasks shall be performed under 306 the direct, indirect, or general supervision of a dentist, as 307 determined by rule of the board, or by dental hygienists under 308 public health supervision in a health access setting, and after 309 such formal or on-the-job training by the dental hygienist or 310 dental assistant as the board by rule may require. The board by 311 rule may establish a certification process for expanded-duty 312 dental assistants, establishing such training or experience 313 criteria or examinations as it deems necessary and specifying 314 which tasks may be delegable only to such assistants. If the 315 board does establish such a certification process, the 316 department shall implement the application process for such 317 certification and administer any examinations required. 318 (5)(4)Notwithstanding subsection (1) or subsection (2), a 319 dentist may not delegate to anyone other than another licensed 320 dentist: 321 (a) Any prescription of drugs or medications requiring the 322 written order or prescription of a licensed dentist or 323 physician. 324 (b) Any diagnosis for treatment or treatment planning. 325 (6)(5)Notwithstanding any other provision of law, a 326 dentist is primarily responsible for all procedures delegated by 327 her or him. 328 (7)(6)ANodental assistant may notshallperform an 329 intraoral procedure except after such formal or on-the-job 330 training as the board prescribes by ruleshall prescribe. 331 (8) The board may adopt rules to administer this section. 332 Section 7. This act shall take effect July 1, 2010.
