Amended in Assembly April 11, 2016

Amended in Assembly March 31, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 2235


Introduced by Assembly Member Thurmond

February 18, 2016


An act to amend Section 1682 of, and to add Section 1601.4 to, 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. 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.

This bill, which would be known as “Caleb’s Law,” 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 minimize 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 committee, on or before September 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. 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 on the board’s Internet Web site.begin insert The bill also would require the board to provide a report on pediatric deaths related to general anesthesia or deep sedation in dentistry at the time of its sunset review by the appropriate policy committees of the Legislature.end 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 thebegin delete risk of an adverse event.end deletebegin insert risks of sedation and anesthesia medications and that use of appropriate monitoring equipment is required.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:

P2    1

SECTION 1.  

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

3

SEC. 2.  

Section 1601.4 is added to the Business and Professions
4Code
, to read:

5

1601.4.  

(a) The board, on or before March 31, 2017, shall
6establish a committee to investigate whether the current laws,
7regulations, and policies of the state are sufficient to minimize the
P3    1potential for injury or death in minors from the administration of
2general anesthesia or deep sedation for dental patients.

3(b) On or before September 1, 2017, the committee shall review
4all incident reports related to pediatric anesthesia in dentistry in
5the state for the years 2011 through 2016, inclusive, and shall
6review the policies of other states and dental associationsbegin insert as well
7as studies regarding the use of pediatric anesthesiaend insert
to ensure that
8this state has regulation and policies in place to do everything
9feasible to protect young patients.

10(c) On or before January 1, 2018, the committee shall
11recommend to the board any measures that would further reduce
12the potential for injury or death in minors from the administration
13of general anesthesia or deep sedation for dental patients.

14(d) On or before January 1, 2018, the board shall report to the
15Legislature the recommendations of the committee pursuant to
16subdivision (c). The report shall be submitted in compliance with
17Section 9795 of the Government Code. The requirement for
18submitting a report imposed by this subdivision is inoperative on
19December 1, 2021, pursuant to Section 10231.5 of the Government
20Code. The board shall make the report publicly available on the
21board’s Internetbegin delete Web site.end deletebegin insert Web site, and shall include, but is not
22limited to, the following anonymized demographic data of each
23patient reviewed: his or her age, weight, and sex; his or her
24primary diagnosis; the procedures performed; the sedation setting;
25the medications used; the monitoring equipment used; the provider
26responsible for sedation oversight; the provider delivering
27sedation; the provider monitoring the patient during sedation; and
28whether the sedation supervision performed one or more of the
29procedures.end insert

begin insert

30
(e) The board shall provide a report on pediatric deaths related
31to general anesthesia or deep sedation in dentistry at the time of
32its sunset review pursuant to subdivision (d) of Section 1601.1.

end insert
33

SEC. 3.  

Section 1682 of the Business and Professions Code is
34amended to read:

35

1682.  

In addition to other acts constituting unprofessional
36conduct under this chapter, it is unprofessional conduct for:

37(a) Any dentist performing dental procedures to have more than
38one patient undergoing conscious sedation or general anesthesia
39on an outpatient basis at any given time unless each patient is being
40continuously monitored on a one-to-one ratio while sedated by
P4    1either the dentist or another licensed health professional authorized
2by law to administer conscious sedation or general anesthesia.

3(b) Any dentist with patients recovering from conscious sedation
4or general anesthesia to fail to have the patients closely monitored
5by licensed health professionals experienced in the care and
6resuscitation of patients recovering from conscious sedation or
7general anesthesia. If one licensed professional is responsible for
8the recovery care of more than one patient at a time, all of the
9patients shall be physically in the same room to allow continuous
10visual contact with all patients and the patient to recovery staff
11ratio should not exceed three to one.

12(c) Any dentist with patients who are undergoing conscious
13sedation to fail to have these patients continuously monitored
14during the dental procedure with a pulse oximeter or similar or
15superior monitoring equipment required by the board.

16(d) Any dentist with patients who are undergoing conscious
17sedation to have dental office personnel directly involved with the
18care of those patients who are not certified in basic cardiac life
19support (CPR) and recertified biennially.

20(e) (1) Any dentist to fail to obtain the written informed consent
21of a patient prior to administering general anesthesia or conscious
22sedation. In the case of a minor, thebegin insert written informedend insert consent shall
23
begin delete be obtained from the child’s parent or guardian.end deletebegin insert include a form or
24forms approved by the board, which shall contain the following
25information:end insert

begin delete

26(2) The written informed consent, in the case of a minor, shall
27include a form or forms approved by the board, which shall contain
28the following information:

29(A) If the licensee will both perform the procedure and
30administer general anesthesia or deep sedation, that there is a
31greater risk of an adverse event, including but not limited to death,
32if the same person is performing the procedure and administering
33general anesthesia or deep sedation.

34(B) If the monitoring technologies recommended by the
35American Academy of Pediatric Dentistry will not be used, that
36doing so may increase the risk of an adverse event, including but
37not limited to death.

end delete
begin insert

38
“All sedation and anesthesia medications involve risks of
39complications and serious possible damage to vital organs such
40as the brain, heart, lung, liver, and kidney, and in some cases use
P5    1of these medications may result in paralysis, cardiac arrest, or
2death from both known and unknown causes. Therefore, use of
3appropriate monitoring equipment, as described in subdivision
4(c) of Section 1682, is required.”

end insert
begin delete

5(3)

end delete

6begin insert(2)end insert For the purpose of this subdivision, administering general
7anesthesia or deep sedation shall include, but is not limited to,
8directing the administration of general anesthesia or deep sedation.
9Nothing in this subdivision shall be construed to establish the
10reasonable standard of care for administering general anesthesia
11or deep sedation.



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