BILL NUMBER: AB 2235	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 11, 2016
	AMENDED IN ASSEMBLY  MARCH 31, 2016

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.  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. 
   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.   risks
of sedation and anesthesia medications and that use of appropriate
monitoring equipment is required. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  This act shall be known, and may be cited, as "Caleb's
Law."
  SEC. 2.  Section 1601.4 is added to the Business and Professions
Code, to read:
   1601.4.  (a) 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 minimize the
potential for injury or death in minors from the administration of
general anesthesia or deep sedation for dental patients.
   (b) On or before September 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  as well as
studies regarding the   use of pediatric anesthesia  to
ensure that this state has regulation and policies in place to do
everything feasible to protect young patients.
   (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.
   (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.   Web site, and shall include, but is
not limited to, the following anonymized demographic data of each
patient reviewed: his or her age, weight, and sex; his or her primary
diagnosis; the procedures performed; the sedation setting; the
medications used; the monitoring equipment used; the provider
responsible for sedation oversight; the provider delivering sedation;
the provider monitoring the patient during sedation; and whether the
sedation supervision performed one or more of the procedures. 

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

  SEC. 3.  Section 1682 of the Business and Professions Code is
amended to read:
   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) (1) 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  written informed 
consent shall  be obtained from the child's parent or
guardian.   include a form or forms approved by the
board, which shall contain the following information:  
   (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:  
   (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. 
   (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.  
   "All sedation and anesthesia medications involve risks of
complications and serious possible damage to vital organs such as the
brain, heart, lung, liver, and kidney, and in some cases use of
these medications may result in paralysis, cardiac arrest, or death
from both known and unknown causes. Therefore, use of appropriate
monitoring equipment, as described in subdivision (c) of Section
1682, is required."  
   (3) 
    (2)  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.