BILL ANALYSIS Ó
AB 880
Page 1
Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Susan Bonilla, Chair
AB 880
(Ridley-Thomas) - As Amended March 26, 2015
SUBJECT: Dentistry: licensure: exempt.
SUMMARY: Authorizes students enrolled in their final year at a
California dental school, approved by the Dental Board of
California (Board), to participate and treat patients under the
supervision of licensed dentists at free clinics.
EXISTING LAW:
1)Establishes the Dental Practice Act (Act), administered by the
Dental Board of California (DBC), which is housed in the
Department of Consumer Affairs (DCA), to license and regulate
the practice of dentistry. (Business and Professions Code
(BPC) Section 1600, et seq.)
2)Prohibits the practice of dentistry unless a person has a
valid and unexpired license or special permit from the Board.
(BPC Section 1926)
3)Exempts from that prohibition operations, in dental schools
approved by the Board, of bona fide students of dentistry or
dental hygiene in the school's clinical departments or
laboratories or in a dental extension program. (BPC Section
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1926(b))
4)Provides for the licensure and regulation of clinics by the
State Department of Public Health, including primary care
clinics, which include community clinics and free clinics.
(Health and Safety Code (HSC) Section 1200 et seq.)
5)Defines a "free clinic" as a clinic operated by a tax-exempt,
nonprofit corporation supported in whole or in part by
voluntary donations, gifts, grants, government funds or
contributions, and where there are no charges directly to the
patient for services rendered, as specified. (HSC Section
1204(a))
THIS BILL:
1)Additionally exempts from dental licensure requirements the
practice of dentistry by a final year student rendered or
performed without compensation or expectation of compensation
under the supervision of a licensed dentist in a free clinic.
2)Provides that these additional exemptions only apply to
operations, approved by the Board, that are described in the
exemption for bona fide dental students under existing law and
rendered or performed under the same supervisory conditions.
3)Defines the following terms:
a) As defined in Section 1200 of the HSC, "Free clinic" is
a clinic where there are no charges directly to the patient
for services rendered or for drugs, medicines, appliances,
or apparatuses furnished, including, but not limited to, a
free clinic as defined in Section 1204 of the HSC;
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b) "Final year student" is a student of dentistry in his or
her final year of completion at dental school approved by
the Board; and
c) "Licensed dentist" is a dentist licensed pursuant to the
Act.
FISCAL EFFECT: Unknown. This bill is keyed fiscal by the
Legislative Counsel.
COMMENTS:
1)Purpose. This bill is sponsored by the Oral and Facial
Surgeons of California . According to the author, "Regular
dental care is extremely important to everyone's health.
However in the underserved communities in California, access
to regular dental care is almost nonexistent. Since the
Medi-Cal and Denti-Cal programs are underutilized, free
healthcare and dental clinics are an essential source of
dental care for the many members of those same communities.
Since existing law already allows dental students to treat
patients in clinics on the dental school campuses under
supervision, it would follow that these same students should
be allowed to treat similar patients, under supervision, in
the free health fairs. It is very important to maintain a
pool of willing volunteer providers both in the licensed
professional community and in the dental schools to provide
dental care in underserved communities."
2)Background. Board-approved dental schools are required to,
among other things, have a formal system of quality assurance
for their patient care program including standards of patient
centered care with a focus on comprehensive care, including
measurable assessment criteria and ensures the delivery of
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comprehensive patient care to individual patients. In
addition, schools are required to ensure that students have
adequate patient experiences to achieve the institution's
stated goals and competencies within a reasonable time.
Currently, there are six Board-approved dental schools in
California: 1) University of California at San Francisco
Dental School, San Francisco; 2) University of the Pacific
Arthur A. Dugoni School of Dentistry, San Francisco; 3)
University of California at Los Angeles School of Dentistry,
Los Angeles; 4) Herman Ostrow School of Dentistry of USC, Los
Angeles; 5) Loma Linda University School of Dentistry, Loma
Linda; and 6)Western University of Health Sciences College of
Dental Medicine, Pomona, California. This bill would only
apply to dental students at one of these institutions.
Current Exemptions for Student Practice. BPC Section 1626
specifically exempts from licensure requirements,
"?operations, in dental schools approved by the board, of bona
fide students of dentistry?in the school's clinical
departments or laboratories or in a dental extension program
approved by the board." Under the California Code of
Regulations, there are two types of facilities that may be
approved by the Board as an adjunct to, and an extension of,
the clinical and laboratory departments of an approved school:
1) an extramural dental facility, and 2) a mobile dental
clinic.
An extramural dental facility as defined in 16 CCR 1025 is
"?any clinical facility employed by an approved dental school
for instruction in dentistry which 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." A mobile dental clinic as defined in 16 CCR 1026
is "?any clinical facility employed by an approved dental
school for instruction in dentistry which may be moved, towed
or transported from one location to another, and in which
dental services are rendered."
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Services that are provided by dental students to the public
through an extramural dental facility or a mobile dental
clinic are required to constitute a part of the dental
education program. In addition, approved dental schools are
required to register these facilities with the Board, and
provide with that registration information relating to: a)
faculty supervision; b) scope of treatment to be rendered; c)
postoperative care; d) proposed itinerary showing locations by
dates, for mobile dental clinics, or the name and location of
the facility and date operation will commence, for extramural
dental facilities; e) discipline of which such instruction is
a part; and f) a brief description of the equipment and
facilities available. For extramural dental facilities, the
school must also provide a copy of the agreement between the
approval dental school, or parent university and the
affiliated institution establishing the contractual
relationship. Any change in the information initially
provided to the Board is required to be communicated to the
Board.
According to the sponsor, the intent of the bill is to allow
final year dental students to volunteer their services at free
health and dental events. Currently, students are not exempt
from practicing at those events because those free health care
events do not fall under the definition of a mobile dental
health clinic or an extramural dental facility. As a result,
those health care events currently have no registration or
other requirements relating to the standard of care. In
addition, unlike extramural dental facilities, which are brick
and mortar locations, and mobile dental clinics, which are
also self-contained places to provide services, free
healthcare events are fleeting and not grounded to any one
location.
While existing law permits dental students to treat patients,
who are usually eligible for dental services under Medi-Cal's
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dental program and treated under supervision, in on-campus
clinics, mobile dental clinics and at dental extension
programs approved by the Board, current law does not allow
these same opportunities at health care events. According to
the author, the ability to draw final year students to the
clinics as dental service providers who work alongside
licensed dentists will increase the number of volunteers
available to work as these clinics and provide much needed
services to underserved communities much needed services.
3)Current Related Legislation. AB 179 (Bonilla) of the current
legislation session, would extend the sunset date of the Board
until January 1, 2020. STATUS: This bill is pending in the
Assembly Committee on Business and Professions.
4)Prior Related Legislation. SB 562 (Galgiani), Chapter 624,
Statutes of 2013, authorized a dentist to operate more than
one mobile dental unit, and required a mobile dental unit or a
dental practice that routinely uses portable dental units to
register and operate in accordance with the regulations of the
Board. The bill also required any regulations adopted by the
Board to require the registrant to identify a licensed dentist
responsible for the mobile dental unit or portable practice,
and to include requirements for availability of follow-up and
emergency care, maintenance and availability of provider and
patient records, and treatment information to be provided to
patients and other appropriate parties.
5)AB 512 (Rendon), Chapter 111, Statutes of 2013, extended the
sunset date for the health care practitioner exemption enacted
by AB 2699 (Bass) Chapter 270, Statutes of 2010, until January
1, 2018.
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AB 2699 (Bass), Chapter 270, Statutes of 2010, created a
four-year exemption, from January 1, 2010, until January 1,
2014, from California licensure for health care practitioners
who are licensed or certified in other states and who provide
health care services on a voluntary basis to uninsured or
underinsured persons in California. That bill allowed an
out-of-state healthcare provider to work in California if his
or her license is in good standing and he or she receives
permission from, and registers with, the appropriate DCA
licensing board. The entity sponsoring the free health care
event is required to notify the appropriate DCA licensing
board and the county health department in writing of the event
and maintain a list of its healthcare volunteers.
SB 683 (Aanestad), Chapter 805, Statutes of 2006, further
exempted from the prohibition against unlicensed practice of
dentistry bona fide students of dentistry or dental hygiene in
advanced dental education programs accredited by CODA or a
national accrediting body approved by the Board.
SB 1308 (Committee on Business and Professions), Chapter 655,
Statutes of 1999, changed the name of the Board of Dental
Examiners to the Dental Board of California, and exempted the
operations of bona fide students of registered dental
assisting, registered dental assisting in extended functions,
and registered dental hygiene in extended functions in the
clinical departments or the laboratory of an educational
program or school approved by the board, including operations
by unlicensed students while engaged in clinical externship
programs that have been approved by an approved educational
program or school, and that are under the general programmatic
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and academic supervision of that educational program or
school.
ARGUMENTS IN SUPPORT:
According to the Oral and Facial Surgeons of California
(sponsor), "[This bill] will clarify in statute that students
enrolled in their final year of completion at a California
dental school approved by the [Board] are permitted to
participate and treat patients, under the supervision of
licensed dentists, at free healthcare clinics. The association
is sponsoring this legislation in order to enhance the pool of
volunteer providers at the much needed free healthcare clinics
in California's many underserved communities. In addition, by
allowing final year students to treat patients under the
supervision of licensed dentists, these students will be getting
real life healthcare treatment exposure in the EXACT same way
that they are currently allowed to practice in on-campus clinics
in the California dental schools. It is commonly acknowledged
that regular dental care is extremely important to everyone's
overall health and well-being. Yet in the all too many
undeserved communities that exist in the state, access to
regular dental care is almost non-existent?.[This bill] goes a
long way in increasing the probability that many of the most
needy patients will be able [to] be seen and get the dental care
they so desperately need."
The California CareForce , a 501(c)(3) that provides free
healthcare clinics for the under- and uninsured population,
writes in support, "Currently the six approved dental schools in
California offer clinics on campus that allow dental students to
treat patients who qualify for Medi-Cal or Denti-Cal at reduced
fees. The free clinics offer dental care to the most severely
underserved communities. The final year students are very
capable and uniquely qualified to treat, under supervision of a
licensed dentist, most if not all patients who would present at
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a free clinic. The ability to draw volunteers from these
schools ensure that the pool of providers will not evaporate and
that they will be fresh and eager to serve the communities."
The Dean of the UCLA School of Dentistry writes in support, "The
dental schools are willing partners to be a tremendous resource
for community service. Our students are highly motivated in
this regard. Our mission statement is: To improve the oral and
systemic health of the people of California, the national, and
the world through education, research, patient care, and public
service."
ARGUMENTS IN OPPOSITION:
None on file.
POLICY ISSUES FOR CONSIDERATION:
The author may consider whether it would be appropriate to allow
participation from other levels of dental students, depending on
the level of services that student is competently able to
provide, as determined by the dental school.
IMPLEMENTATION ISSUES:
Exemption for student practice at "free clinics." Currently,
the bill provides that final year students are exempt from
licensure requirements when practicing in a free clinic, under
the supervision of a licensed dentist. The bill further defines
"free clinic" as a clinic defined under the Health and Safety
Code. According to the sponsors, the intent of the bill is to
allow students to participate at free health care events.
However, the definition of a "free clinic" under the health and
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safety code does not include these events; instead, it refers to
a type of standing primary care clinic. As a result, the author
may wish to amend the language to reflect free health care
events, or "sponsored events" as defined under AB 2699 (Bass)
Chapter 270, Statutes of 2010.
Exemption for operations described in existing exemptions and
under the same supervisory conditions. The bill specifies that
this practice exemption applies to operations "approved by the
Board" and only includes those operations "described in the
exemption provided in subdivision (b) of Section 1626 and
"rendered or performed under the same supervisory conditions."
Because that language makes it appear as if the only operations
exempted are those that are already exempt under subdivision (b)
of Section 1626, the author may wish to consider revising that
language.
In addition, the author may wish to specify that exempt
operations must not only be performed under the same supervisory
conditions as those provided under the existing exemptions, but
that these operations must be provided under all of the same
conditions as those provided under the existing exemptions.
For example, regulations for mobile dental clinics and
extramural dental facilities require these exempt operations to
be a part of the school's dental education program, and require
the schools to inform the Board of the following: faculty
supervision; scope of treatment to be rendered; postoperative
care; information about the event and the sponsoring entity;
discipline of which such instruction is a part; and a brief
description of the equipment and facilities available. In
addition, while the regulations do not appear to specifically
refer to patient recordkeeping, patient notification and
consent, or liability, dental schools address these issues in
the implementation of existing programs. As a result, the
author may wish to specify that these exempt operations are
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required to be provided under the same conditions as existing
exemptions, and specify any particular conditions or safeguards,
as needed, to ensure adequate consumer protection (e.g.,
including conditions relating to faculty supervision; patient
notification, consent and recordkeeping; liability; scope of
practice; requiring the operations to be a part of a school's
dental education program).
AMENDMENTS:
On page 2, line 6, after "dentist" insert: with a faculty
appointment
On page 2, lines 6-7, strike: in a free clinic and insert: at a
sponsored event
On page 2, strike line 10
On page 2, line 11, strike: 1626 and
On page 2, line 11, strike: supervisory
On page 2, line 12, after "conditions" insert: as operations
exempt under subdivision (b) of Section 1626
On page 2, strike lines 14-20
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On page 2, line 24, add
(3) "Sponsored event" means an event, not to exceed 10
calendar days, administered by either a sponsoring entity or a
local government, or both, through which health care is
provided to the public without compensation.
(4) "Sponsoring entity" means a nonprofit organization
organized pursuant to Section 501(c)(3) of the Internal
Revenue Code or a community-based organization.
REGISTERED SUPPORT:
Oral and Facial Surgeons of California (sponsors)
California CareForce
Dr. No-Hee Park, Dean of the UCLA School of Dentistry
REGISTERED OPPOSITION:
None on file.
Analysis Prepared by:Eunie Linden / B. & P. / (916) 319-3301
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