Amended in Senate August 16, 2016

Amended in Senate June 29, 2016

Amended in Senate June 20, 2016

Amended in Senate June 9, 2016

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

begin insert

(Coauthor: Senator Hill)

end insert

February 18, 2016


An act to amend Sections 1680 and 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 a licensee to fail to report the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, that is related to a dental procedure, as specified. The act also 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 January 1, 2017, to provide to the Legislature a report on whether current statutes and regulations for the administration and monitoring of pediatric anesthesia in dentistry provide adequate protection for pediatric dental patients and would require the board to 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 in dentistry at the time of its sunset review by the appropriate policy committees of the Legislature.

This bill would require that the report of the death of a patient, or removal of a patient to a hospital or emergency center for medical treatment, be on a form or forms approved by the board and that the report include specified information. The bill authorizes the board to assess a penalty on any licensee who fails to make the required report.

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 specified information regarding anesthesia, as provided.

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.  

It is the Legislature’s intent, to the extent that funds
4are appropriated for this purpose, that the board encourage all
5dental sedation providers in California to submit data regarding
P3    1pediatric sedation events to a pediatric sedation research database
2maintained by a nonprofit organization. It is the goal of the
3Legislature that the data submitted will be used to formulate a
4systems-based approach to improve the quality of services provided
5to pediatric dental anesthesia patients in outpatient settings.

6

SEC. 3.  

Section 1601.4 is added to the Business and Professions
7Code
, to read:

8

1601.4.  

(a) On or before January 1, 2017, the board shall
9provide to the Legislature a report on whether current statutes and
10regulations for the administration and monitoring of pediatric
11anesthesia in dentistry provide adequate protection for pediatric
12dental patients. The report shall be submitted in compliance with
13 Section 9795 of the Government Code. The requirement for
14submitting a report imposed by this subdivision is inoperative on
15December 1, 2021, pursuant to Section 10231.5 of the Government
16Code. The board shall make the report publicly available on the
17board’s Internet Web site.

18(b) The board shall provide a report on pediatric deaths related
19to general anesthesia in dentistry at the time of its sunset review
20pursuant to subdivision (d) of Section 1601.1.

21

SEC. 4.  

Section 1680 of the Business and Professions Code is
22amended to read:

23

1680.  

Unprofessional conduct by a person licensed under this
24chapter is defined as, but is not limited to, any one of the following:

25(a) The obtaining of any fee by fraud or misrepresentation.

26(b) The employment directly or indirectly of any student or
27suspended or unlicensed dentist to practice dentistry as defined in
28this chapter.

29(c) The aiding or abetting of any unlicensed person to practice
30dentistry.

31(d) The aiding or abetting of a licensed person to practice
32dentistry unlawfully.

33(e) The committing of any act or acts of sexual abuse,
34misconduct, or relations with a patient that are substantially related
35to the practice of dentistry.

36(f) The use of any false, assumed, or fictitious name, either as
37an individual, firm, corporation, or otherwise, or any name other
38than the name under which he or she is licensed to practice, in
39advertising or in any other manner indicating that he or she is
P4    1practicing or will practice dentistry, except that name as is specified
2in a valid permit issued pursuant to Section 1701.5.

3(g) The practice of accepting or receiving any commission or
4the rebating in any form or manner of fees for professional services,
5radiograms, prescriptions, or other services or articles supplied to
6patients.

7(h) The making use by the licensee or any agent of the licensee
8of any advertising statements of a character tending to deceive or
9mislead the public.

10(i) The advertising of either professional superiority or the
11advertising of performance of professional services in a superior
12manner. This subdivision shall not prohibit advertising permitted
13by subdivision (h) of Section 651.

14(j) The employing or the making use of solicitors.

15(k) The advertising in violation of Section 651.

16(l) The advertising to guarantee any dental service, or to perform
17any dental operation painlessly. This subdivision shall not prohibit
18advertising permitted by Section 651.

19(m) The violation of any of the provisions of law regulating the
20procurement, dispensing, or administration of dangerous drugs,
21as defined in Chapter 9 (commencing with Section 4000) or
22controlled substances, as defined in Division 10 (commencing
23with Section 11000) of the Health and Safety Code.

24(n) The violation of any of the provisions of this division.

25(o) The permitting of any person to operate dental radiographic
26equipment who has not met the requirements of Section 1656.

27(p) The clearly excessive prescribing or administering of drugs
28or treatment, or the clearly excessive use of diagnostic procedures,
29or the clearly excessive use of diagnostic or treatment facilities,
30as determined by the customary practice and standards of the dental
31profession.

32Any person who violates this subdivision is guilty of a
33misdemeanor and shall be punished by a fine of not less than one
34hundred dollars ($100) or more than six hundred dollars ($600),
35or by imprisonment for a term of not less than 60 days or more
36than 180 days, or by both a fine and imprisonment.

37(q) The use of threats or harassment against any patient or
38licensee for providing evidence in any possible or actual
39disciplinary action, or other legal action; or the discharge of an
P5    1employee primarily based on the employee’s attempt to comply
2with the provisions of this chapter or to aid in the compliance.

3(r) Suspension or revocation of a license issued, or discipline
4imposed, by another state or territory on grounds that would be
5the basis of discipline in this state.

6(s) The alteration of a patient’s record with intent to deceive.

7(t) Unsanitary or unsafe office conditions, as determined by the
8customary practice and standards of the dental profession.

9(u) The abandonment of the patient by the licensee, without
10written notice to the patient that treatment is to be discontinued
11and before the patient has ample opportunity to secure the services
12of another dentist, registered dental hygienist, registered dental
13hygienist in alternative practice, or registered dental hygienist in
14extended functions and provided the health of the patient is not
15jeopardized.

16(v) The willful misrepresentation of facts relating to a
17disciplinary action to the patients of a disciplined licensee.

18(w) Use of fraud in the procurement of any license issued
19pursuant to this chapter.

20(x) Any action or conduct that would have warranted the denial
21of the license.

22(y) The aiding or abetting of a licensed dentist, dental assistant,
23registered dental assistant, registered dental assistant in extended
24functions, dental sedation assistant permitholder, orthodontic
25assistant permitholder, registered dental hygienist, registered dental
26hygienist in alternative practice, or registered dental hygienist in
27extended functions to practice dentistry in a negligent or
28incompetent manner.

29(z) (1) The failure to report to the board in writing within seven
30days any of the following: (A) the death of his or her patient during
31the performance of any dental or dental hygiene procedure; (B)
32the discovery of the death of a patient whose death is related to a
33dental or dental hygiene procedure performed by him or her; or
34(C) except for a scheduled hospitalization, the removal to a hospital
35or emergency center for medical treatment of any patient to whom
36oral conscious sedation, conscious sedation, or general anesthesia
37was administered, or any patient as a result of dental or dental
38hygiene treatment. With the exception of patients to whom oral
39conscious sedation, conscious sedation, or general anesthesia was
40administered, removal to a hospital or emergency center that is
P6    1the normal or expected treatment for the underlying dental
2condition is not required to be reported. Upon receipt of a report
3pursuant to this subdivision the board may conduct an inspection
4of the dental office if the board finds that it is necessary. A dentist
5shall report to the board all deaths occurring in his or her practice
6with a copy sent to the Dental Hygiene Committee of California
7if the death was the result of treatment by a registered dental
8hygienist, registered dental hygienist in alternative practice, or
9registered dental hygienist in extended functions. A registered
10dental hygienist, registered dental hygienist in alternative practice,
11or registered dental hygienist in extended functions shall report to
12the Dental Hygiene Committee of California all deaths occurring
13as the result of dental hygiene treatment, and a copy of the
14notification shall be sent to the board.

15(2) The report required by this subdivision shall be on a form
16or forms approved by the board. The form or forms approved by
17the board shall require the licensee to include, but not be limited
18to, the following information for cases in which patients received
19anesthesia: the date of the procedure; the patient’s age in years
20and months, weight, and sex; the patient’s American Society of
21Anesthesiologists (ASA) physical status; the patient’s primary
22diagnosis; the patient’s coexisting diagnoses; the procedures
23performed; the sedation setting; the medications used; the
24monitoring equipment used; the category of the provider
25 responsible for sedation oversight; the category of the provider
26delivering sedation; the category of the provider monitoring the
27patient during sedation; whether the person supervising the sedation
28performed one or more of the procedures; the planned airway
29management; the planned depth of sedation; the complications
30that occurred; a description of what was unexpected about the
31airway management; whether there was transportation of the patient
32during sedation; the category of the provider conducting
33resuscitation measures; and the resuscitation equipment utilized.
34Disclosure of individually identifiable patient information shall
35be consistent with applicable law. A report required by this
36subdivision shall not be admissible in any action brought by a
37patient of the licensee providing the report.

38(3) For the purposes of paragraph (2), categories of provider
39are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist
40Anesthesiologist, Physician Anesthesiologist, Dental Assistant,
P7    1Registered Dental Assistant, Dental Sedation Assistant, Registered
2Nurse, Certified Registered Nurse Anesthetist, or Other.

3(4) The form shall state that this information shall not be
4considered an admission of guilt, but is for educational, data, or
5investigative purposes.

6(5) The board may assess a penalty on any licensee who fails
7to report an instance of an adverse event as required by this
8subdivision.begin delete The penalty is a maximum fine of one hundred dollars
9($100) per day not reported after the initial seven-day reporting
10period.end delete
The licensee may dispute the failure to file within 10 days
11of receiving notice that the board had assessed a penalty against
12the licensee.

13(aa) Participating in or operating any group advertising and
14referral services that are in violation of Section 650.2.

15(ab) The failure to use a fail-safe machine with an appropriate
16exhaust system in the administration of nitrous oxide. The board
17shall, by regulation, define what constitutes a fail-safe machine.

18(ac) Engaging in the practice of dentistry with an expired license.

19(ad) Except for good cause, the knowing failure to protect
20patients by failing to follow infection control guidelines of the
21board, thereby risking transmission of bloodborne infectious
22diseases from dentist, dental assistant, registered dental assistant,
23registered dental assistant in extended functions, dental sedation
24assistant permitholder, orthodontic assistant permitholder,
25registered dental hygienist, registered dental hygienist in alternative
26practice, or registered dental hygienist in extended functions to
27patient, from patient to patient, and from patient to dentist, dental
28assistant, registered dental assistant, registered dental assistant in
29extended functions, dental sedation assistant permitholder,
30orthodontic assistant permitholder, registered dental hygienist,
31registered dental hygienist in alternative practice, or registered
32dental hygienist in extended functions. In administering this
33subdivision, the board shall consider referencing the standards,
34regulations, and guidelines of the State Department of Public
35Health developed pursuant to Section 1250.11 of the Health and
36Safety Code and the standards, guidelines, and regulations pursuant
37to the California Occupational Safety and Health Act of 1973 (Part
381 (commencing with Section 6300) of Division 5 of the Labor
39Code) for preventing the transmission of HIV, hepatitis B, and
40other blood-borne pathogens in health care settings. The board
P8    1shall review infection control guidelines, if necessary, on an annual
2basis and proposed changes shall be reviewed by the Dental
3Hygiene Committee of California to establish a consensus. The
4committee shall submit any recommended changes to the infection
5control guidelines for review to establish a consensus. As
6necessary, the board shall consult with the Medical Board of
7California, the California Board of Podiatric Medicine, the Board
8of Registered Nursing, and the Board of Vocational Nursing and
9Psychiatric Technicians, to encourage appropriate consistency in
10the implementation of this subdivision.

11The board shall seek to ensure that all appropriate dental
12personnel are informed of the responsibility to follow infection
13control guidelines, and of the most recent scientifically recognized
14safeguards for minimizing the risk of transmission of bloodborne
15infectious diseases.

16(ae) The utilization by a licensed dentist of any person to
17perform the functions of any registered dental assistant, registered
18dental assistant in extended functions, dental sedation assistant
19permitholder, orthodontic assistant permitholder, registered dental
20hygienist, registered dental hygienist in alternative practice, or
21registered dental hygienist in extended functions who, at the time
22of initial employment, does not possess a current, valid license or
23permit to perform those functions.

24(af) The prescribing, dispensing, or furnishing of dangerous
25drugs or devices, as defined in Section 4022, in violation of Section
262242.1.

27

SEC. 5.  

Section 1682 of the Business and Professions Code is
28amended to read:

29

1682.  

In addition to other acts constituting unprofessional
30conduct under this chapter, it is unprofessional conduct for:

31(a) Any dentist performing dental procedures to have more than
32one patient undergoing conscious sedation or general anesthesia
33on an outpatient basis at any given time unless each patient is being
34continuously monitored on a one-to-one ratio while sedated by
35either the dentist or another licensed health professional authorized
36by law to administer conscious sedation or general anesthesia.

37(b) Any dentist with patients recovering from conscious sedation
38or general anesthesia to fail to have the patients closely monitored
39by licensed health professionals experienced in the care and
40resuscitation of patients recovering from conscious sedation or
P9    1general anesthesia. If one licensed professional is responsible for
2the recovery care of more than one patient at a time, all of the
3patients shall be physically in the same room to allow continuous
4visual contact with all patients and the patient to recovery staff
5ratio should not exceed three to one.

6(c) Any dentist with patients who are undergoing conscious
7sedation to fail to have these patients continuously monitored
8during the dental procedure with a pulse oximeter or similar or
9superior monitoring equipment required by the board.

10(d) Any dentist with patients who are undergoing conscious
11sedation to have dental office personnel directly involved with the
12care of those patients who are not certified in basic cardiac life
13support (CPR) and recertified biennially.

14(e) (1) Any dentist to fail to obtain the written informed consent
15of a patient prior to administering general anesthesia or conscious
16sedation. In the case of a minor, the consent shall be obtained from
17the child’s parent or guardian.

18(2) The written informed consent, in the case of a minor, shall
19include, but not be limited to, the following information:

20“The administration and monitoring of general anesthesia may
21vary depending on the type of procedure, the type of practitioner,
22the age and health of the patient, and the setting in which anesthesia
23is provided. Risks may vary with each specific situation. You are
24encouraged to explore all the options available for your child’s
25anesthesia for his or her dental treatment, and consult with your
26dentist or pediatrician as needed.”

27(3) Nothing in this subdivision shall be construed to establish
28the reasonable standard of care for administering or monitoring
29oral conscious sedation, conscious sedation, or general anesthesia.



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