BILL NUMBER: SB 1546 CHAPTERED 09/21/04 CHAPTER 667 FILED WITH SECRETARY OF STATE SEPTEMBER 21, 2004 APPROVED BY GOVERNOR SEPTEMBER 21, 2004 PASSED THE SENATE AUGUST 25, 2004 PASSED THE ASSEMBLY AUGUST 23, 2004 AMENDED IN ASSEMBLY AUGUST 19, 2004 AMENDED IN ASSEMBLY JULY 2, 2004 AMENDED IN ASSEMBLY JUNE 15, 2004 AMENDED IN SENATE APRIL 15, 2004 AMENDED IN SENATE APRIL 12, 2004 INTRODUCED BY Senator Figueroa (Coauthors: Senators Aanestad and Vincent) (Coauthors: Assembly Members Correa, Nation, and Runner) FEBRUARY 19, 2004 An act to amend Sections 853, 1601.1, 1616.5, and 1742 of, to amend and repeal Sections 1753.5, 1754, and 1756 of, to amend, repeal, and add Sections 1750, 1751, 1752, 1753, and 1770 of, to add Sections 1750.1, 1750.2, 1750.3, 1752.5, 1753.1, and 1777 to, and to repeal and add Section 1757 of, the Business and Professions Code, relating to healing arts, and making an appropriation therefor. LEGISLATIVE COUNSEL'S DIGEST SB 1546, Figueroa. Dentistry. Existing law, the Dental Practice Act, provides for the licensure and regulation of the practice of dentistry by the Dental Board of California, and authorizes the board to appoint a person exempt from civil service as an executive officer. Existing law also establishes the Committee on Dental Auxiliaries within the jurisdiction of the board. The provisions establishing the board, authorizing the board to appoint an executive officer, and establishing the committee are repealed as of January 1, 2006. This bill would instead make those provisions inoperative on July 1, 2006, and repeal them on January 1, 2007. Existing law requires the board to license persons meeting specified requirements as various types of dental auxiliaries, and requires the board to enact certain regulations with respect to those licensees. Existing law also describes the functions that those licensees are permitted to perform and imposes specified requirements on them. Existing law prohibits a dentist from utilizing more than 2 dental auxiliaries in extended functions. Under existing law, fees collected in connection with the practice of a dental auxiliary are deposited into the State Dental Auxiliary Fund, which is continuously appropriated. This bill would, on January 1, 2007, revise the requirements imposed on, and the functions that may be performed by, a dental assistant or a dental assistant in extended functions. The bill would also, on and after January 1, 2007, require the board to license a person who meets specified requirements as a registered dental assistant, registered orthodontic assistant, registered surgery assistant, registered restorative assistant, registered dental assistant in extended functions, or registered restorative assistant in extended functions. This bill would require the board, upon recommendation of the committee, to adopt implementing regulations regarding education and training requirements that those licensees and registered dental hygienists are required to meet and procedures they may perform. The bill would also require the board to report periodically to the Joint Committee on Boards, Commissions, and Consumer Protection regarding the regulations imposed on licensees. The bill, on and after January 1, 2007, would authorize a dentist to utilize up to 3 dental auxiliaries in extended functions. The bill would also make other related changes. Because this bill would increase the number of licensees paying licensing fees deposited into the State Dental Auxiliary Fund, a continuously appropriated fund, it would make an appropriation. Existing law creates the Licensed Physicians and Dentists from Mexico Pilot Program. Under existing law, the program is required to be developed in consultation with representatives of community clinics, approved dental schools, and the National Autonomous University of Mexico School of Faculty Dentistry. Existing law requires an evaluation of the program to be undertaken 12 months after the program has commenced and to be conducted jointly by specified entities. This bill would change the consultation criteria for the development of the program. The bill would also revise the entities required to be involved in conducting the program evaluation. Appropriation: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 853 of the Business and Professions Code is amended to read: 853. (a) The Licensed Physicians and Dentists from Mexico Pilot Program is hereby created. This program shall allow up to 30 licensed physicians specializing in family practice, internal medicine, pediatrics, and obstetrics and gynecology, and up to 30 licensed dentists from Mexico to practice medicine or dentistry in California for a period not to exceed three years. The program shall also maintain an alternate list of program participants. (b) The Medical Board of California shall issue three-year nonrenewable licenses to practice medicine to licensed Mexican physicians and the Dental Board of California shall issue three-year nonrenewable permits to practice dentistry to licensed Mexican dentists. (c) Physicians from Mexico eligible to participate in this program shall comply with the following: (1) Be licensed, certified or recertified, and in good standing in their medical specialty in Mexico. This certification or recertification shall be performed, as appropriate, by the Consejo Mexicano de Ginocologia y Obstetricia, A.C., the Consejo Mexicano de Certificacion en Medicina Familiar, A.C., the Consejo Mexicano de Medicina Interna, A.C., or the Consejo Mexicano de Certificacion en Pediatria, A.C. (2) Prior to leaving Mexico, each physician shall have completed the following requirements: (A) Passed the board review course with a score equivalent to that registered by United States applicants when passing a board review course for the United States certification examination in each of his or her specialty areas and passed an interview examination developed by the National Autonomous University of Mexico (UNAM) for each specialty area. Family practitioners who shall include obstetrics and gynecology in their practice shall also be required to have appropriately documented, as specified by United States standards, 50 live births. Mexican obstetricians and gynecologists shall be fellows in good standing of the American College of Obstetricians and Gynecologists. (B) (i) Satisfactorily completed a six-month orientation program that addressed medical protocol, community clinic history and operations, medical administration, hospital operations and protocol, medical ethics, the California medical delivery system, health maintenance organizations and managed care practices, and pharmacology differences. This orientation program shall be approved by the Medical Board of California to ensure that it contains the requisite subject matter and meets appropriate California law and medical standards where applicable. (ii) Additionally, Mexican physicians participating in the program shall be required to be enrolled in adult English-as-a-second-language (ESL) classes that focus on both verbal and written subject matter. Each physician participating in the program shall have transcripts sent to the Medical Board of California from the appropriate Mexican university showing enrollment and satisfactory completion of these classes. (C) Representatives from the National Autonomous University of Mexico (UNAM) in Mexico and a medical school in good standing or a facility conducting an approved medical residency training program in California shall confer to develop a mutually agreed upon distant learning program for the six-month orientation program required pursuant to subparagraph (B). (3) Upon satisfactory completion of the requirements in paragraphs (1) and (2), and after having received their three-year nonrenewable medical license, the Mexican physicians shall be required to obtain continuing education pursuant to Section 2190 of the Business and Professions Code. Each physician shall obtain an average of 25 continuing education units per year for a total of 75 units for a full three years of program participation. (4) Upon satisfactory completion of the requirements in paragraphs (1) and (2), the applicant shall receive a three-year nonrenewable license to work in nonprofit community health centers and shall also be required to participate in a six-month externship at his or her place of employment. This externship shall be undertaken after the participant has received a license and is able to practice medicine. The externship shall ensure that the participant is complying with the established standards for quality assurance of nonprofit community health centers and medical practices. The externship shall be affiliated with a medical school in good standing in California. Complaints against program participants shall follow the same procedures contained in the Medical Practice Act (Chapter 5 (commencing with Section 2000)). (5) After arriving in California, Mexican physicians participating in the program shall be required to be enrolled in adult English-as-a-second-language (ESL) classes at institutions approved by the Bureau of Private Post Secondary and Vocational Education or accredited by the Western Association of Schools and Colleges. These classes shall focus on verbal and written subject matter to assist a physician in obtaining a level of proficiency in English that is commensurate with the level of English spoken at community clinics where he or she will practice. The community clinic employing a physician shall submit documentation confirming approval of an ESL program to the Medical Board of California for verification. Transcripts of satisfactory completion of the ESL classes shall be submitted to the Medical Board of California as proof of compliance with this provision. (6) (A) Nonprofit community health centers employing Mexican physicians in the program shall be required to have medical quality assurance protocols and either be accredited by the Joint Commission on Accreditation of Health Care Organizations or have protocols similar to those required by the Joint Commission on Accreditation of Health Care Organizations. These protocols shall be submitted to the Medical Board of California prior to the hiring of Mexican physicians. (B) In addition, after the program participant successfully completes the six-month externship program, a free standing health care organization that has authority to provide medical quality certification, including, but not limited to, health plans, hospitals, and the Integrated Physician Association, shall be responsible for ensuring and overseeing the compliance of nonprofit community health centers medical quality assurance protocols, conducting site visits when necessary, and developing any additional protocols, surveys, or assessment tools to ensure that quality of care standards through quality assurance protocols are being appropriately followed by physicians participating in the program. (7) Participating hospitals shall have the authority to establish criteria necessary to allow individuals participating in this three-year pilot program to be granted hospital privileges in their facilities. (8) The Medical Board of California shall provide oversight review of both the implementation of this program and the evaluation required pursuant to subdivision (j). The board shall consult with the medical schools applying for funding to implement and evaluate this program, executive and medical directors of nonprofit community health centers wanting to employ program participants, and hospital administrators who will have these participants practicing in their hospital, as it conducts its oversight responsibilities of this program and evaluation. Any funding necessary for the implementation of this program, including the evaluation and oversight functions, shall be secured from nonprofit philanthropic entities. Implementation of this program may not proceed unless appropriate funding is secured from nonprofit philanthropic entities. The Medical Board of California shall report to the Legislature every January during which the program is operational regarding the status of the program and the ability of the program to secure the funding necessary to carry out its required provisions. Notwithstanding Section 11005 of the Government Code, the board may accept funds from nonprofit philanthropic entities. The board shall, upon appropriation in the annual Budget Act, expend funds received from nonprofit philanthropic entities for this program. (d) (1) Dentists from Mexico eligible to participate in this program shall comply with the following requirements or the requirements contained in paragraph (2): (A) Be graduates from the National Autonomous University of Mexico School of Faculty Dentistry (Facultad de Odontologia). (B) Meet all criteria required for licensure in Mexico that is required and being applied by the National Autonomous University of Mexico School of Faculty Dentistry (Facultad de Odontologia), including, but not limited to: (i) A minimum grade point average. (ii) A specified English language comprehension and conversational level. (iii) Passage of a general examination. (iv) Passage of an oral interview. (C) Enroll and complete an orientation program that focuses on the following: (i) Practical issues in pharmacology that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California. (ii) Practical issues and diagnosis in oral pathology that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California. (iii) Clinical applications that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California. (iv) Biomedical sciences that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California. (v) Clinical history management that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California. (vi) Special patient care that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California. (vii) Sedation techniques that shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California. (viii) Infection control guidelines which shall be taught by an instructor who is affiliated with a California dental school approved by the Dental Board of California. (ix) Introduction to health care systems in California. (x) Introduction to community clinic operations. (2) (A) Graduate within the three-year period prior to enrollment in the program, from a foreign dental school that has received provisional approval or certification by November of 2003 from the Dental Board of California under the Foreign Dental School Approval Program. (B) Enroll and satisfactorily complete an orientation program that focuses on the health care system and community clinic operations in California. (C) Enroll and satisfactorily complete a course taught by an approved foreign dental school on infection control approved by the Dental Board of California. (3) Upon satisfactory completion to a competency level of the requirements in paragraph (1) or (2), dentists participating in the program shall be eligible to obtain employment in a nonprofit community health center pursuant to subdivision (f) within the structure of an extramural dental program for a period not to exceed three years. (4) Dentists participating in the program shall be required to complete the necessary continuing education units required by the Dental Practice Act (Chapter 4 (commencing with Section 1600)). (5) The program shall accept 30 participating dentists. The program shall also maintain an alternate list of program applicants. If an active program participant leaves the program for any reason, a participating dentist from the alternate list shall be chosen to fill the vacancy. Only active program participants shall be required to complete the orientation program specified in subparagraph (C) of paragraph (1). (6) (A) Additionally, an extramural dental facility may be identified, qualified, and approved by the board as an adjunct to, and an extension of, the clinical and laboratory departments of an approved dental school. (B) As used in this subdivision, "extramural dental facility" includes, but is not limited to, any clinical facility linked to an approved dental school for the purposes of monitoring or overseeing the work of a dentist licensed in Mexico participating in this program and that is employed by an approved dental school for instruction in dentistry that 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. These facilities shall include nonprofit community health centers. (C) Dental services provided to the public in these facilities shall constitute a part of the dental education program. (D) Approved dental schools shall register extramural dental facilities with the board. This registration shall be accompanied by information supplied by the dental school pertaining to faculty supervision, scope of treatment to be rendered, arrangements for postoperative care, the name and location of the facility, the date operations shall commence at the facility, and a description of the equipment and facilities available. This information shall be supplemented with a copy of the agreement between the approved dental school and the affiliated institution establishing the contractual relationship. Any change in the information initially provided to the board shall be communicated to the board. (7) The program shall also include issues dealing with program operations, and shall be developed in consultation by representatives of community clinics, approved dental schools, or the National Autonomous University of Mexico School of Faculty Dentistry (Facultad de Odontologia). (8) The Dental Board of California shall provide oversight review of the implementation of this program and the evaluation required pursuant to subdivision (j). The dental board shall consult with dental schools in California that have applied for funding to implement and evaluate this program and executive and dental directors of nonprofit community health centers wanting to employ program participants, as it conducts its oversight responsibilities of this program and evaluation. Implementation of this program may not proceed unless appropriate funding is secured from nonprofit philanthropic entities. The Dental Board of California shall report to the Legislature every January during which the program is operational regarding the status of the program and the ability of the program to secure the funding necessary to carry out its required provisions. Notwithstanding Section 11005 of the Government Code, the board may accept funds from nonprofit philanthropic entities. (e) Nonprofit community health centers that employ participants shall be responsible for ensuring that participants are enrolled in local English-language instruction programs and that the participants attain English-language fluency at a level that would allow the participants to serve the English-speaking patient population when necessary and have the literacy level to communicate with appropriate hospital staff when necessary. (f) Physicians and dentists from Mexico having met the applicable requirements set forth in subdivisions (c) and (d) shall be placed in a pool of candidates who are eligible to be recruited for employment by nonprofit community health centers in California, including, but not limited to, those located in the Counties of Ventura, Los Angeles, San Bernardino, Imperial, Monterey, San Benito, Sacramento, San Joaquin, Santa Cruz, Yuba, Orange, Colusa, Glenn, Sutter, Kern, Tulare, Fresno, Stanislaus, San Luis Obispo, and San Diego. The Medical Board of California shall ensure that all Mexican physicians participating in this program have satisfactorily met the requirements set forth in subdivision (c) prior to placement at a nonprofit community health center. (g) Nonprofit community health centers in the counties listed in subdivision (f) shall apply to the Medical Board of California and the Dental Board of California to hire eligible applicants who shall then be required to complete a six-month externship that includes working in the nonprofit community health center and a corresponding hospital. Once enrolled in this externship, and upon payment of the required fees, the Medical Board of California shall issue a three-year nonrenewable license to practice medicine and the Dental Board of California shall issue a three-year nonrenewable dental special permit to practice dentistry. For purposes of this program, the fee for a three-year nonrenewable license to practice medicine shall be nine hundred dollars ($900) and the fee for a three-year nonrenewable dental permit shall be five hundred forty-eight dollars ($548). A licensee or permitholder shall practice only in the nonprofit community health center that offered him or her employment and the corresponding hospital. This three-year nonrenewable license or permit shall be deemed to be a license or permit in good standing pursuant to the provisions of this chapter for the purpose of participation and reimbursement in all federal, state, and local health programs, including managed care organizations and health maintenance organizations. (h) The three-year nonrenewable license or permit shall terminate upon notice by certified mail, return receipt requested, to the licensee's or permitholder's address of record, if, in the Medical Board of California or Dental Board of California's sole discretion, it has determined that either: (1) The license or permit was issued by mistake. (2) A complaint has been received by either board against the licensee or permitholder that warrants terminating the license or permit pending an investigation and resolution of the complaint. (i) All applicable employment benefits, salary, and policies provided by nonprofit community health centers to their current employees shall be provided to medical and dental practitioners from Mexico participating in this pilot program. This shall include nonprofit community health centers providing malpractice insurance coverage. (j) Beginning 12 months after this pilot program has commenced, an evaluation of the program shall be undertaken with funds provided from philanthropic foundations. The evaluation shall be conducted jointly by one medical school and one dental school in California and either the National Autonomous University of Mexico or a foreign dental school approved by the board, in consultation with the Medical Board of California and the Dental Board of California. If the evaluation required pursuant to this section does not begin within 15 months after the pilot project has commenced, the evaluation may be performed by an independent consultant selected by the Director of the Department of Consumer Affairs. This evaluation shall include, but not be limited to, the following issues and concerns: (1) Quality of care provided by doctors and dentists licensed under this pilot program. (2) Adaptability of these licensed practitioners to California medical and dental standards. (3) Impact on working and administrative environment in nonprofit community health centers and impact on interpersonal relations with medical licensed counterparts in health centers. (4) Response and approval by patients. (5) Impact on cultural and linguistic services. (6) Increases in medical encounters provided by participating practitioners to limited-English-speaking patient populations and increases in the number of limited-English-speaking patients seeking health care services from nonprofit community health centers. (7) Recommendations on whether the program should be continued, expanded, altered, or terminated. (8) Progress reports on available data listed shall be provided to the Legislature on achievable time intervals beginning the second year of implementation of this pilot program. An interim final report shall be issued three months before termination of this pilot program. A final report shall be submitted to the Legislature at the time of termination of this pilot program on all of the above data. The final report shall reflect and include how other initiatives concerning the development of culturally and linguistically competent medical and dental providers within California and the United States are impacting communities in need of these health care providers. (k) Costs for administering this pilot program shall be secured from philanthropic entities. (l) Program applicants shall be responsible for working with the governments of Mexico and the United States in order to obtain the necessary three-year visa required for program participation. SEC. 2. Section 1601.1 of the Business and Professions Code is amended to read: 1601.1. (a) There shall be in the Department of Consumer Affairs the Dental Board of California in which the administration of this chapter is vested. The board shall consist of eight practicing dentists, one registered dental hygienist, one registered dental assistant, and four public members. Of the eight practicing dentists, one shall be a member of a faculty of any California dental college and one shall be a dentist practicing in a nonprofit community clinic. The appointing powers, described in Section 1603, may appoint to the board a person who was a member of the prior board. The board shall be organized into standing committees dealing with examinations, enforcement, and other subjects as the board deems appropriate. (b) For purposes of this chapter, any reference in this chapter to the Board of Dental Examiners shall be deemed to refer to the Dental Board of California. (c) The board shall have all authority previously vested in the existing board under this chapter. The board may enforce all disciplinary actions undertaken by the previous board. (d) This section shall become inoperative on July 1, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute that is enacted before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. The repeal of this section renders the board subject to the review required by Division 1.2 (commencing with Section 473). SEC. 3. Section 1616.5 of the Business and Professions Code is amended to read: 1616.5. (a) The board, by and with the approval of the director, may appoint a person exempt from civil service who shall be designated as an executive officer and who shall exercise the powers and perform the duties delegated by the board and vested in him or her by this chapter. (b) This section shall become inoperative on July 1, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute that is enacted before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. SEC. 4. Section 1742 of the Business and Professions Code is amended to read: 1742. (a) There is within the jurisdiction of the board a Committee on Dental Auxiliaries. (b) The Committee on Dental Auxiliaries shall have the following areas of responsibility and duties: (1) The committee shall have the following duties and authority related to education programs and curriculum: (A) Shall evaluate all dental auxiliary programs applying for board approval in accordance with board rules governing the programs. (B) May appoint board members to any evaluation committee. Board members so appointed shall not make a final decision on the issue of program or course approval. (C) Shall report and make recommendations to the board as to whether a program or course qualifies for approval. The board retains the final authority to grant or deny approval to a program or course. (D) Shall review and document any alleged deficiencies that might warrant board action to withdraw or revoke approval of a program or course, at the request of the board. (E) May review and document any alleged deficiencies that might warrant board action to withdraw or revoke approval of a program or course, at its own initiation. (2) The committee shall have the following duties and authority related to applications: (A) Shall review and evaluate all applications for licensure in the various dental auxiliary categories to ascertain whether a candidate meets the appropriate licensing requirements specified by statute and board regulations. (B) Shall maintain application records, cashier application fees, and perform any other ministerial tasks as are incidental to the application process. (C) May delegate any or all of the functions in this paragraph to its staff. (D) Shall issue auxiliary licenses in all cases, except where there is a question as to a licensing requirement. The board retains final authority to interpret any licensing requirement. If a question arises in the area of interpreting any licensing requirement, it shall be presented by the committee to the board for resolution. (3) The committee shall have the following duties and authority regarding examinations: (A) Shall advise the board as to the type of license examination it deems appropriate for the various dental auxiliary license categories. (B) Shall, at the direction of the board, develop or cause to be developed, administer, or both, examinations in accordance with the board's instructions and periodically report to the board on the progress of those examinations. The following shall apply to the examination procedure: (i) The examination shall be submitted to the board for its approval prior to its initial administration. (ii) Once an examination has been approved by the board, no further approval is required unless a major modification is made to the examination. (iii) The committee shall report to the board on the results of each examination and shall, where appropriate, recommend pass points. (iv) The board shall set pass points for all dental auxiliary licensing examinations. (C) May appoint board members to any examination committee established pursuant to subparagraph (B). (4) The committee shall periodically report and make recommendations to the board concerning the level of fees for dental auxiliaries and the need for any legislative fee increase. However, the board retains final authority to set all fees. (5) The committee shall be responsible for all aspects of the license renewal process, which shall be accomplished in accordance with this chapter and board regulations. The committee may delegate any or all of its functions under this paragraph to its staff. (6) The committee shall have no authority with respect to the approval of continuing education providers; the board retains all of this authority. (7) The committee shall advise the board as to appropriate standards of conduct for auxiliaries, the proper ordering of enforcement priorities, and any other enforcement-related matters that the board may, in the future, delegate to the committee. The board shall retain all authority with respect to the enforcement actions, including, but not limited to, complaint resolution, investigation, and disciplinary action against auxiliaries. (8) The committee shall have the following duties regarding regulations: (A) To review and evaluate all suggestions or requests for regulatory changes related to dental auxiliaries. (B) To report and make recommendations to the board, after consultation with departmental legal counsel and the board's executive officer. (C) To include in any report regarding a proposed regulatory change, at a minimum, the specific language of the proposed changes and the reasons for and facts supporting the need for the change. The board has the final rulemaking authority. (c) This section shall become inoperative on July 1, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute which becomes effective on or before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. The repeal of this section renders the committee subject to the review required by Division 1.2 (commencing with Section 473). SEC. 5. Section 1750 of the Business and Professions Code is amended to read: 1750. (a) A dental assistant is a person who may perform basic supportive dental procedures as authorized by this article under the supervision of a licensed dentist and who may perform basic supportive procedures as authorized pursuant to subdivision (b) of Section 1751 under the supervision of a registered dental hygienist in alternative practice. (b) This section shall become inoperative on December 31, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute, that is enacted before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. SEC. 6. Section 1750 is added to the Business and Professions Code, to read: 1750. (a) A dental assistant is an individual who, without a license, may perform basic supportive dental procedures, as authorized by this article and by regulations adopted by the board, under the supervision of a licensed dentist. "Basic supportive dental procedures" are those procedures that have technically elementary characteristics, are completely reversible, and are unlikely to precipitate potentially hazardous conditions for the patient being treated. These basic supportive dental procedures may be performed under general supervision. These basic supportive dental procedures do not include those procedures authorized in Section 1750.3 or Section 1753.1, or by the board pursuant to Section 1751 for registered assistants. (b) The supervising licensed dentist shall be responsible for determining the competency of the dental assistant to perform the basic supportive dental procedures authorized pursuant to subdivision (a). (c) The supervising licensed dentist shall be responsible for assuring that each dental assistant, registered orthodontic assistant, registered surgery assistant, registered restorative assistant, registered restorative assistant in extended functions, registered dental assistant, and registered dental assistant in extended functions, who is in his or her continuous employ for 120 days or more, has completed both of the following within a year of the date of employment: (1) Board-approved courses in infection control and California law. (2) A course in basic life support offered by the American Red Cross, the American Heart Association, or any other course approved by the board as equivalent. (d) Prior to operating radiographic equipment or applying for licensure as a registered dental assistant under Section 1752.5, an auxiliary described in subdivision (c) shall successfully complete a radiation safety course approved by the board. (e) This section shall become operative on January 1, 2007. SEC. 7. Section 1750.1 is added to the Business and Professions Code, to read: 1750.1. (a) The practice of dental assisting does not include any of the following procedures: (1) Diagnosis and comprehensive treatment planning. (2) Placing, finishing, or removing permanent restorations, except as provided in Section 1753.1. (3) Surgery or cutting on hard and soft tissue including, but not limited to, the removal of teeth and the cutting and suturing of soft tissue. (4) Prescribing medication. (5) Starting or adjusting local or general anesthesia or oral or parenteral conscious sedation, except for the administration of nitrous oxide and oxygen, whether administered alone or in combination with each other and except as otherwise provided in this article. (b) This section shall become operative on January 1, 2007. SEC. 8. Section 1750.2 is added to the Business and Professions Code, to read: 1750.2. (a) The board shall license as a "registered orthodontic assistant," "registered surgery assistant," or "registered restorative assistant" any person who submits written evidence of satisfactory completion of a course or courses approved by the board pursuant to subdivision (b) that qualifies him or her in one of these specialty areas of practice. (b) The board shall adopt regulations for the approval of postsecondary specialty registration programs in the specialty areas specified in this section. The regulations shall define the minimum education and training requirements necessary to achieve proficiency in the procedures authorized for each specialty registration, taking into account the combinations of classroom and practical instruction, clinical training, and supervised work experience that are most likely to provide the greatest number of opportunities for improving dental assisting skills efficiently. (c) A person who holds a specialty registration pursuant to this section shall be subject to the continuing education requirements established by the board pursuant to Section 1645 and the renewal requirements of Article 6 (commencing with Section 1900). (d) This section shall become operative on January 1, 2007. SEC. 9. Section 1750.3 is added to the Business and Professions Code, to read: 1750.3. (a) A registered orthodontic assistant may perform all of the following dental procedures, as well as those authorized by board regulations adopted pursuant to Section 1751: (1) Any duties that a dental assistant may perform. (2) Placing and removing orthodontic separators. (3) Placing and removing ligatures and arch wires. (4) Taking orthodontic impressions. (5) Sizing, fitting, adjusting, prepositioning, curing in a position approved by the supervising dentist, and removal of orthodontic bands and brackets. (6) Coronal polishing. (7) Removing excess cement from supragingival surfaces of teeth. (8) Preparing teeth for bonding. (9) Activating bleaching agents with nonlaser, light-curing devices. (10) Removal of excess cement from coronal surfaces of teeth under orthodontic treatment by means of an ultrasonic scaler. (b) A registered surgery assistant may perform the following dental procedures, as well as those authorized by board regulations adopted pursuant to Section 1751: (1) Any duties that a dental assistant may perform. (2) Monitoring of patients during the preoperative, intraoperative, and postoperative phases, using noninvasive instrumentation such as pulse oximeters, electrocardiograms, and capnography. (3) Taking impressions for surgical splints and occlusal guards. (4) Placement and removal of surgical dressings and removal of sutures. (5) Adding medications to intravenous lines, in the presence of a licensed dentist. (6) Removal of intravenous lines. (c) A registered restorative assistant may perform all of the following dental procedures, as well as those authorized by board regulations adopted pursuant to Section 1751: (1) Any duties that a dental assistant may perform. (2) Sizing, fitting, adjusting, intraorally fabricating, temporarily cementing, and removing temporary crowns. (3) Placing bases and liners on sound dentin. (4) Removing excess cement from supragingival surfaces of teeth. (5) Taking facebow transfers and bite registrations for diagnostic models for case study only. (6) Taking impressions for space-maintaining appliances and occlusal guards. (7) Coronal polishing. (8) Applying pit and fissure sealants. (9) Placing and removing temporary restorations. (10) Activating bleaching agents with nonlaser, light-curing devices. (d) The supervising dentist shall be responsible for determining the level of supervision required for assistants registered pursuant to this section. (e) This section shall become operative on January 1, 2007. SEC. 10. Section 1751 of the Business and Professions Code is amended to read: 1751. (a) By September 15, 1993, the board, upon recommendation of the committee, consistent with this article, standards of good dental practice, and the health and welfare of patients, shall adopt regulations relating to the functions that may be performed by dental assistants under direct or general supervision, and the settings within which dental assistants may work. At least once every seven years thereafter, the board shall review the list of functions performable by dental assistants, the supervision level, and settings under which they may be performed, and shall update the regulations as needed to keep them current with the state of the practice. (b) Under the supervision of a registered dental hygienist in alternative practice, a dental assistant may perform intraoral retraction and suctioning. (c) This section shall become inoperative on December 31, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute, that is enacted before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. SEC. 11. Section 1751 is added to the Business and Professions Code, to read: 1751. (a) The board, upon recommendation of the committee, shall adopt regulations governing the procedures that dental assistants, registered orthodontic assistants, registered surgery assistants, registered restorative assistants, registered dental assistants, registered restorative assistants in extended functions, and registered dental assistants in extended functions are authorized to perform consistent with and necessary to implement the provisions of this article, and the settings within which each may practice. (b) The board shall conduct an initial review of the procedures, supervision level, settings under which they may be performed, and utilization of extended functions dental auxiliaries by January 1, 2011. The board shall submit the results of its review to the Joint Committee on Boards, Commissions, and Consumer Protection. After the initial review, a review shall be conducted at least once every five to seven years thereafter and the board shall update regulations as necessary to keep them current with the state of dental practice. (c) This section shall become operative on January 1, 2007. SEC. 12. Section 1752 of the Business and Professions Code is amended to read: 1752. (a) The supervising licensed dentist shall be responsible for determining the competency of the dental assistant to perform allowable functions. (b) This section shall become inoperative on December 31, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute, that is enacted before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. SEC. 13. Section 1752 is added to the Business and Professions Code, to read: 1752. (a) A "registered dental assistant in extended functions" is an individual licensed pursuant to this article who may perform basic restorative services and direct patient care, as authorized by Sections 1750, 1750.3, and 1753.1, and by the board regulations adopted pursuant to Section 1751 under the supervision of a licensed dentist. (b) A "registered restorative assistant in extended functions" is an individual licensed pursuant to this article who may perform basic restorative services and direct patient care, as authorized by Section 1750, subdivision (c) of Section 1750.3, and Section 1753.1, and by board regulations adopted pursuant to Section 1751 under the supervision of a licensed dentist. (c) This section shall become operative on January 1, 2007. SEC. 14. Section 1752.5 is added to the Business and Professions Code, to read: 1752.5. (a) A person may apply for and be issued a license as a Registered Dental Assistant upon providing evidence to the board of one of the following: (1) Successful completion of a board-approved educational program in registered dental assisting. (2) Successful completion of: (A) Twelve months of satisfactory work experience as a dental assistant in California or another state. The board shall give credit toward the 12 months of work experience to persons who have graduated from a dental assisting program in a postsecondary institution, secondary institution, regional occupational center, or regional occupation program that are not approved by the board. The credit shall equal the total weeks spent in classroom training and internship on a week-for-week basis not to exceed 16 weeks. (B) The three board-approved specialty registration programs, as defined in Section 1750.2, for registration as a registered orthodontic assistant, registered surgery assistant, and registered restorative assistant. (C) A board-approved radiation safety program. (b) A registered dental assistant may perform all duties and procedures that a dental assistant, registered orthodontic assistant, registered surgery assistant, and a registered restorative assistant are allowed to perform, as well as those procedures authorized by regulations adopted pursuant to Section 1751, except that a registered dental assistant licensed on or before December 31, 2006, may only apply pit and fissure sealants if he or she has provided evidence to the board of having completed a board-approved course in the application of pit and fissure sealants. (c) The supervising dentist shall be responsible for determining the level of supervision required for authorized procedures performed by registered dental assistants. (d) This section shall become operative on January 1, 2007. SEC. 15. Section 1753 of the Business and Professions Code is amended to read: 1753. (a) The board shall license as a registered dental assistant a person who submits written evidence, satisfactory to the board, of either one of the following requirements: (1) Graduation from an educational program in dental assisting approved by the board, and satisfactory performance on a written examination required by the board. On and after January 1, 1984, an applicant seeking licensure as a registered dental assistant pursuant to this subdivision shall provide evidence of his or her satisfactory performance on a written and practical examination required by the board. (2) Satisfactory work experience of more than 12 months as a dental assistant in California or another state and satisfactory performance on a written and practical examination required by the board. The board shall give credit toward the 12 months work experience referred to in this subdivision to persons who have graduated from a dental assisting program in a postsecondary institution approved by the Department of Education or in a secondary institution, regional occupational center, or regional occupational program, that are not, however, approved by the board pursuant to subdivision (a). The credit shall equal the total weeks spent in classroom training and internship on a week-for-week basis not to exceed 16 weeks. The board, in cooperation with the Superintendent of Public Instruction, shall establish the minimum criteria for the curriculum of nonboard-approved programs. Additionally, the board shall notify those programs only if the program's curriculum does not meet established minimum criteria, as established for board-approved registered dental assistant programs, except any requirement that the program be given in a postsecondary institution. Graduates of programs not meeting established minimum criteria shall not qualify for satisfactory work experience as defined by this section. (b) This section shall become inoperative on December 31, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute, that is enacted before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. SEC. 16. Section 1753 is added to the Business and Professions Code, to read: 1753. (a) The board shall license as a registered dental assistant in extended functions a person who submits written evidence, satisfactory to the board, of all of the following: (1) Current licensure as a registered dental assistant, or completion of the requirements for licensure as a registered dental assistant, as provided in Section 1752.5. (2) Successful completion of an extended functions postsecondary program approved by the board in all of the procedures specified in Section 1753.1. (3) Successful completion of board-approved courses in radiation safety and, within the last two years, courses in infection control, California dental law, and basic life support. (4) Satisfactory performance on a written examination and a clinical or practical examination specified by the board. (b) The board shall license as a registered restorative assistant in extended functions a person who submits written evidence, satisfactory to the board, of all of the following: (1) Completion of 12 months of satisfactory work experience as a dental assistant in California or another state. The board shall give credit toward the 12 months of work experience to persons who have graduated from a dental assisting program in a postsecondary institution, secondary institution, regional occupational center, or regional occupation program that are not approved by the board. The credit shall equal the total weeks spent in classroom training and internship on a week-for-week basis, not to exceed 16 weeks. (2) Successful completion of a board-approved course in radiation safety, and, within the last two years, courses in infection control, California dental law, and basic life support. (3) Successful completion of a postsecondary program approved by the board for restorative dental assisting specialty registration specified in subdivision (c) of Section 1750.3. (4) Successful completion of an extended functions postsecondary program approved by the board in all of the procedures specified in Section 1753.1. (5) Satisfactory performance on a written examination and a clinical or practical examination specified by the board. (c) In approving extended functions postsecondary programs required to be completed for licensure pursuant to this section, the board shall require that the programs be taught by persons having prior experience teaching the applicable procedures specified in Section 1753.1, or procedures otherwise authorized by the board pursuant to Section 1751, in a dental school approved either by the Commission on Dental Accreditation or a comparable organization approved by the board. Approved programs shall include didactic, laboratory, and clinical modalities. (d) This section shall become operative on January 1, 2007. SEC. 17. Section 1753.1 is added to the Business and Professions Code, to read: 1753.1. (a) A registered dental assistant in extended functions is authorized to perform the following procedures under direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist: (1) Cord retraction of gingivae for impression procedures. (2) Taking impressions for cast restorations. (3) Formulating indirect patterns for endodontic post and core castings. (4) Fitting trial endodontic filling points. (5) Drying canals previously opened by the supervising dentist, with absorbent points. (6) Testing pulp vitality. (7) Removing excess cement from subgingival tooth surfaces with a hand instrument. (8) Fitting and cementing stainless steel crowns. (9) Placing, condensing, and carving amalgam restorations. (10) Placing class I, III, and V composite restorations. (11) Taking facebow transfers and bite registrations for fixed prostheses. (12) Taking final impressions for tooth-borne, removable prostheses. (13) Placing and adjusting permanent crowns for cementation by the dentist. (14) Applying etchants for bonding restorative materials. (15) Other procedures authorized by regulations adopted by the board pursuant to Section 1751. (b) All procedures required to be performed under direct supervision shall be checked and approved by the supervising dentist prior to the patient's dismissal from the office. (c) This section shall become operative on January 1, 2007. SEC. 18. Section 1753.5 of the Business and Professions Code is amended to read: 1753.5. (a) In addition to the requirements of Section 1753, an applicant for registered dental assistant licensure on or after July 1, 2002, shall provide evidence of having successfully completed board-approved courses in radiation safety and coronal polishing as a condition of licensure. The length and content of the courses shall be governed by applicable board regulations. (b) This section shall become inoperative on December 31, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute, that is enacted before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. SEC. 19. Section 1754 of the Business and Professions Code is amended to read: 1754. (a) By September 15, 1993, the board, upon recommendation of the committee and consistent with this article, standards of good dental practice, and the health and welfare of patients, shall adopt regulations relating to the functions which may be performed by registered dental assistants under direct or general supervision, and the settings within which registered dental assistants may work. At least once every seven years thereafter, the board shall review the list of functions performable by registered dental assistants, the supervision level, and settings under which they may be performed, and shall update the regulations as needed to keep them current with the state of the practice. (b) This section shall become inoperative on December 31, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute, that is enacted before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. SEC. 20. Section 1756 of the Business and Professions Code is amended to read: 1756. (a) The board shall license as a registered dental assistant in extended functions a person who satisfies all of the following requirements: (1) Status as a registered dental assistant. (2) Completion of clinical training approved by the board in a facility affiliated with a dental school under the direct supervision of the dental school faculty. (3) Satisfactory performance on an examination required by the board. (b) This section shall become inoperative on December 31, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute, that is enacted before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. SEC. 21. Section 1757 of the Business and Professions Code is repealed. SEC. 22. Section 1757 is added to the Business and Professions Code, to read: 1757. (a) Each person who holds a license as a registered dental assistant in extended functions on the effective date of this section may only perform those procedures that a registered dental assistant is allowed to perform, and the procedures listed in paragraphs (1), (2), (3), (4), (7), and (14) of subdivision (a) of Section 1753.1, until he or she provides evidence of having completed a board-approved course or courses in the additional functions specified in Section 1753.1, and an examination in the additional functions as specified by the board. (b) This section shall become operative on January 1, 2007. SEC. 23. Section 1770 of the Business and Professions Code is amended to read: 1770. (a) A licensed dentist may simultaneously utilize in his or her practice no more than two dental auxiliaries in extended functions licensed pursuant to Sections 1756 and 1768. (b) This section shall become inoperative on December 31, 2006, and, as of January 1, 2007, is repealed, unless a later enacted statute, that is enacted before January 1, 2007, deletes or extends the dates on which it becomes inoperative and is repealed. SEC. 24. Section 1770 is added to the Business and Professions Code, to read: 1770. (a) A licensed dentist may simultaneously utilize in his or her practice no more than three dental auxiliaries in extended functions licensed pursuant to Sections 1753 and 1768. (b) This section shall become operative on January 1, 2007. SEC. 25. Section 1777 is added to the Business and Professions Code, to read: 1777. While employed by or practicing in a primary care clinic or specialty clinic licensed pursuant to Section 1204 of the Health and Safety Code, in a primary care clinic exempt from licensure pursuant to subdivision (c) of Section 1206 of the Health and Safety Code, or a clinic owned and operated by a hospital that maintains the primary contract with a county government to fill the county's role under Section 17000 of the Welfare and Institutions Code, a registered dental assistant or a registered dental assistant in extended functions may perform the following procedures under the direct supervision of a registered dental hygienist, pursuant to subdivision (b) of Section 1763: (a) Coronal polishing, after providing evidence to the board of having completed a board-approved course in that procedure. (b) Application of topical fluoride. (c) Application of sealants, after providing evidence to the board of having completed a board-approved course in that procedure.