Amended in Assembly March 31, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 2235

Introduced by Assembly Member Thurmond

February 18, 2016

An act to begin insert amend Section 1682 of, and to end insert add Section 1601.4 begin delete to end delete begin insert to, end insert the Business and Professions Code, relating to healing arts.

LEGISLATIVE COUNSEL’S DIGEST

AB 2235, as amended, Thurmond. Board of Dentistry: pediatric anesthesia: committee.

The Dental Practice Act provides for the licensure and regulation of dentists by the Dental Board of California. That act authorizes a committee of the board to evaluate all suggestions or requests for regulatory changes related to the committee and to hold informational hearings in order to report and make appropriate recommendations to the board, after consultation with departmental legal counsel and the board’s chief executive officer. The act requires a committee to include in any report regarding a proposed regulatory change, at a minimum, the specific language or the proposed change or changes and the reasons therefor, and any facts supporting the need for the change.

The act governs the use of general anesthesia, conscious sedation, and oral conscious sedation for pediatric and adult patients. begin insert The act makes it unprofessional conduct for any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the act requires that the consent be obtained from the child’s parent or guardian. end insert

This begin delete bill end delete begin insert bill, which would be known as “Caleb’s Law, end insert begin insert ” end insert would require the board, on or before March 31, 2017, to establish a committee to investigate whether the current laws, regulations, and policies of the state are sufficient to begin delete guard against unnecessary use of anesthesia for young patients and potential injury or death. end delete begin insert minimize the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients. end insert The bill would require the committee, on or before begin delete December end delete begin insert September end insert 1, 2017, to review all incident reports related to pediatric anesthesia in dentistry in the state for the years 2011 through 2016, inclusive, and to review the policies of other states and dental associations to ensure that this state has regulation and policies in place to do everything feasible to protect young patients. begin insert The bill would require the committee, on or before January 1, 2018, to recommend to the board any measures that would further reduce the potential for injury or death in minors from the administration of general anesthesia or deep sedation for dental patients. The bill would require the board, on or before January 1, 2018, to report the committee’s recommendations to the Legislature and make the report publicly available end insert begin insert on the board’s Internet Web site. end insert

begin insert

This bill, with regard to obtaining written informed consent for general anesthesia or conscious sedation in the case of a minor, would require that the written informed consent include a form or forms approved by the board, containing specified information regarding the risk of an adverse event.

end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert This act shall be known, and may be cited, as
“Caleb’s Law.” end insert

begin delete SECTION 1. end delete

begin insert SEC. 2. end insert   

Section 1601.4 is added to the Business and Professions
Code, to read:

1601.4.  

begin insert (a) end insert begin insert   end insert The board, on or before March 31, 2017, shall
establish a committee to investigate whether the current laws,
regulations, and policies of the state are sufficient to begin delete guard against
unnecessary use of anesthesia for young patients and end delete begin insert minimize the end insert
potential begin insert for end insert injury or begin delete death. end delete begin insert death in minors from the
administration of general anesthesia or deep sedation for dental
patients. end insert begin delete On end delete

begin insert (b) end insert begin insert   end insert begin insert On end insert or before begin delete December end delete begin insert September end insert 1, 2017, the committee
shall review all incident reports related to pediatric anesthesia in
dentistry in the state for the years 2011 through 2016, inclusive,
and shall review the policies of other states and dental associations
to ensure that this state has regulation and policies in place to do
everything feasible to protect young patients.

begin insert

(c) On or before January 1, 2018, the committee shall
recommend to the board any measures that would further reduce
the potential for injury or death in minors from the administration
of general anesthesia or deep sedation for dental patients.

end insert begin insert

(d) On or before January 1, 2018, the board shall report to the
Legislature the recommendations of the committee pursuant to
subdivision (c). The report shall be submitted in compliance with
Section 9795 of the Government Code. The requirement for
submitting a report imposed by this subdivision is inoperative on
December 1, 2021, pursuant to Section 10231.5 of the Government
Code. The board shall make the report publicly available on the
board’s Internet Web site.

end insert

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 1682 of the end insert begin insert Business and Professions Code end insert begin insert is
amended to read: end insert

1682.  

In addition to other acts constituting unprofessional
conduct under this chapter, it is unprofessional conduct for:

(a) Any dentist performing dental procedures to have more than
one patient undergoing conscious sedation or general anesthesia
on an outpatient basis at any given time unless each patient is being
continuously monitored on a one-to-one ratio while sedated by
either the dentist or another licensed health professional authorized
by law to administer conscious sedation or general anesthesia.

(b) Any dentist with patients recovering from conscious sedation
or general anesthesia to fail to have the patients closely monitored
by licensed health professionals experienced in the care and
resuscitation of patients recovering from conscious sedation or
general anesthesia. If one licensed professional is responsible for
the recovery care of more than one patient at a time, all of the
patients shall be physically in the same room to allow continuous
visual contact with all patients and the patient to recovery staff
ratio should not exceed three to one.

(c) Any dentist with patients who are undergoing conscious
sedation to fail to have these patients continuously monitored
during the dental procedure with a pulse oximeter or similar or
superior monitoring equipment required by the board.

(d) Any dentist with patients who are undergoing conscious
sedation to have dental office personnel directly involved with the
care of those patients who are not certified in basic cardiac life
support (CPR) and recertified biennially.

(e)  begin insert (1) end insert begin insert   end insert Any dentist to fail to obtain the written informed consent
of a patient prior to administering general anesthesia or conscious
sedation. In the case of a minor, the consent shall be obtained from
the child’s parent or guardian.

begin insert

(2) The written informed consent, in the case of a minor, shall
include a form or forms approved by the board, which shall contain
the following information:

end insert begin insert

(A) If the licensee will both perform the procedure and
administer general anesthesia or deep sedation, that there is a
greater risk of an adverse event, including but not limited to death,
if the same person is performing the procedure and administering
general anesthesia or deep sedation.

end insert begin insert

(B) If the monitoring technologies recommended by the
American Academy of Pediatric Dentistry will not be used, that
doing so may increase the risk of an adverse event, including but
not limited to death.

end insert begin insert

(3) For the purpose of this subdivision, administering general
anesthesia or deep sedation shall include, but is not limited to,
directing the administration of general anesthesia or deep sedation.
Nothing in this subdivision shall be construed to establish the
reasonable standard of care for administering general anesthesia
or deep sedation.

end insert