BILL ANALYSIS                                                                                                                                                                                                    Ó






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          |SENATE RULES COMMITTEE            |                        AB 880|
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                                   THIRD READING 


          Bill No:  AB 880
          Author:   Ridley-Thomas (D), et al.
          Amended:  7/1/15 in Senate
          Vote:     21  

           SENATE BUS, PROF. & ECON. DEV. COMMITTEE:  8-0, 6/29/15
           AYES:  Hill, Bates, Block, Galgiani, Hernandez, Jackson,  
            Mendoza, Wieckowski
           NO VOTE RECORDED:  Berryhill

           SENATE APPROPRIATIONS COMMITTEE:  Senate Rule 28.8

           ASSEMBLY FLOOR:  78-0, 5/14/15 (Consent) - See last page for  
            vote

           SUBJECT:   Dentistry: licensure: exemption


          SOURCE:    Oral and Facial Surgeons of California


          DIGEST:  This bill authorizes final year dental students to  
          practice dentistry at free sponsored events under supervision  
          and under specified conditions.  


          ANALYSIS:   


          Existing law:

          1)Establishes the Dental Practice Act, administered by the  
            Dental Board of California (DBC), which is under the  








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            Department of Consumer Affairs, to license and regulate the  
            practice of dentistry.  (Business and Professions Code (BPC)  
            §§ 1600 et seq.) 

          2)Prohibits the practice of dentistry unless a person has a  
            valid and unexpired license or special permit from the DBC.   
            (BPC § 1626)

          3)Exempts from that prohibition, operations in dental schools of  
            bona fide students of dentistry or dental hygiene in the  
            school's clinical departments or laboratories or in a dental  
            extension program if approved by the DBC.  
          (BPC § 1626(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) §§ 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 § 1204(a))

          6)Exempts specified health care practitioners from California  
            licensure 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 until January  
            1, 2018, as specified.  (BPC § 901) 

          This bill:

          1)Exempts final year dental students from provisions of law  
            prohibiting the practice of dentistry without a license for  
            students who volunteer at a sponsored event under the  
            supervision of dental school faculty.

          2)Specifies that the exemptions only include those operations  
            approved by the DBC that are rendered or performed under the  
            same conditions as operations in a student's dental program.

          3)Defines the following terms:








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             a)   "Final year student" means a student of dentistry in his  
               or her final year of completion at a dental school approved  
               by the DBC.  "Final year student" also includes a dental  
               student enrolled in an advanced program.

             b)   "Licensed dentist" means a dentist licensed by the DBC.

             c)   "Sponsored event" means an event, not to exceed 10  
               calendar days, administered by a sponsoring entity or a  
               local governmental entity, or both, through which health  
               care is provided to the public without compensation, or  
               expectation of compensation.

             d)   "Sponsoring entity" means a nonprofit organization  
               pursuant to Section 501(c)(3) of the Internal Revenue Code,  
               or a community-based organization.

          4)Requires the volunteer practice of dentistry by students to  
            comply with all of the following requirements:

             a)   Each patient shall be sufficiently informed that a  
               dental student may be providing some of the treatment that  
               he or she will be receiving.

             b)   Any information provided to the patient to give informed  
               consent shall offer the patient the option to decline to be  
               treated by the student.

             c)   The volunteer practice of a student shall be supervised  
               by faculty from the dental school in which the student is  
               enrolled.

             d)   Each volunteer student shall wear an identification  
               badge that clearly identifies the student as a dental  
               student.  The identification badge shall display the  
               student's name, the name of the student's dental school,  
               and the name and the telephone number of the DBC.  That  
               information shall be displayed in 14-point font, at  
               minimum.

             e)   Requires that supervision ratios and student oversight  
               be at least as stringent as required to meet the standards  
               of the Commission on Dental Accreditation at each school's  
               clinical department, laboratory, or dental extension  







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               program.

             f)   Requires that supervision ratios be appropriate for the  
               procedure being performed by the student.

             g)   Requires the student to perform only those procedures in  
               which he or she is credentialed or those procedures he or  
               she is permitted to perform in the school's clinical  
               department, laboratory, or dental extension program.

          5)Requires the sponsoring entity of the sponsored event to  
            provide the DBC with a list of the names of the volunteer  
            students, the name of the school of enrollment of those  
            students, and the name and license number of the supervising  
            licensed dentist.

          

          Background

          Access to Dental Dare and Denti-Cal.  According to a 2012 report  
          by the California Dental Association (CDA), an estimated 11  
          million of California's 
          38 million people lack any form of dental benefits.  For those  
          seven million who qualify for dental services through Medi-Cal,  
          that coverage does not necessarily translate into access; the  
          California State Auditor reported in December 2014 that over  
          half the children in Denti-Cal (Medi-Cal's dental program) do  
          not get regular services.  The Auditor determined that this was  
          primarily due to the lack of providers deterred by low  
          reimbursement rates.  

          Free Dental Health Care Events.  In addition to the lack of  
          participating providers in Denti-Cal, CDA also reports that  
          there is a misdistribution of the current supply; California has  
          over 200 dental professional shortage areas; areas where the  
          ratio of dentists to the population is so low that the state  
          considers the area underserved. 

          Several not-for-profit entities have entered the market to  
          provide free or low-cost healthcare to underserved individuals:   
          CDA Cares, California CareForce, Remote Area Medical, and Care  
          Harbor are a few of the major providers in this space that offer  
          dental care (and/or other medical care, depending on the event)  







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          to the underserved population.  These entities primarily rely on  
          volunteers to provide services, frequently in a temporary  
          medical space set up in a convention hall, fairground, or other  
          public space.  These volunteers are subject to professional  
          regulation and are held to the same standard of care as in a  
          traditional setting. 

          This bill increases the potential pool of volunteers by allowing  
          final year dental students to provide services at free sponsored  
          healthcare events under supervision.  

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No


          SUPPORT:   (Verified7/14/15)


          Oral and Facial Surgeons of California (source)
          California CareForce
          Dental Hygiene Committee of California
          Loma Linda University School of Dentistry
          University of California, Los Angeles School of Dentistry
          University of California, San Francisco School of Dentistry
          University of the Pacific, Arthur A. Dugoni School of Dentistry
          University of Southern California
          Western University of Health Sciences College of Dental Medicine


          OPPOSITION:   (Verified7/14/15)


          None received

          ARGUMENTS IN SUPPORT:  The Oral and Facial Surgeons of  
          California write, "[We are] 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."








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          The University of the Pacific, Arthur A. Dugoni School of  
          Dentistry writes, "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.  Free clinics and health fairs offer dental care to the  
          most severely underserved communities.  The ability to draw  
          volunteers (both faculty and students) from schools ensures that  
          the pool of providers will not evaporate and that they will be  
          fresh and eager to serve the community."

          ASSEMBLY FLOOR:  78-0, 5/14/15
          AYES:  Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,  
            Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,  
            Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,  
            Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina  
            Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,  
            Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,  
            Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Lopez, Low,  
            Maienschein, Mathis, Mayes, McCarty, Melendez, Mullin,  
            Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,  
            Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,  
            Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,  
            Wilk, Williams, Wood, Atkins
          NO VOTE RECORDED:  Linder, Medina

          Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104
          7/15/15 15:14:07


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