BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2235|
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THIRD READING
Bill No: AB 2235
Author: Thurmond (D)
Amended: 6/29/16 in Senate
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 6/13/16
AYES: Hill, Bates, Block, Gaines, Galgiani, Hernandez,
Jackson, Mendoza, Wieckowski
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 76-0, 4/28/16 (Consent) - See last page for
vote
SUBJECT: Board of Dentistry: pediatric anesthesia:
committee
SOURCE: American Academy of Pediatrics, California
DIGEST: This bill requires the Dental Board of California (DBC)
to provide 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; expands the definition of unprofessional conduct to
include failure to notify the DBC about an adverse event
relating to dental sedation; encourages DBC to support a third
party public database of adverse events; establishes consent
language for the administration of general anesthesia for a
minor dental patient; requires the DBC to approve a form for the
reporting of adverse event information; and creates a penalty
for failure to report information to the DBC.
AB 2235
Page 2
ANALYSIS:
Existing law:
1) Establishes the DBC within the Department of Consumer
Affairs to administer the Dental Practice Act. (Business and
Professions Code (BPC) § 1601.1)
2) Defines the practice of "oral and maxillofacial surgery" as
the diagnosis and surgical and adjunctive treatment of
diseases, injuries, and defects which involve both functional
and esthetic aspects of the hard and soft tissues of the oral
and maxillofacial region. (BPC § 1638 (a))
3) Authorizes the DBC to issue an oral and maxillofacial
surgery permit to an applicant who has furnished evidence
satisfactory to the Board that he or she is currently
certified or eligible for certification in oral and
maxillofacial surgery by a specialty board recognized by the
Commission on Accreditation of the American Dental
Association and holds a current license in good standing to
practice medicine in the state. (BPC § 1638 (c))
4) Defines "general anesthesia" as a controlled state of
depressed consciousness or unconsciousness, accompanied by
partial or complete loss of protective reflexes, produced by
a pharmacologic or nonpharmacologic method, or a combination
thereof. (BPC § 1646)
5) Requires, for the administration of anesthesia to dental
patients on an outpatient basis, a dentist to either: (BPC §
1646.1 (a))
a) Possess a current license in good standing to practice
dentistry and holds a valid general anesthesia permit
issued by the Board; or,
b) Possesses a current oral and maxillofacial surgery
permit or a permit to perform elective facial cosmetic
surgery and holds a valid general anesthesia permit issued
by the DBC.
6) Authorizes a physician and surgeon to administer general
anesthesia in the office of a licensed dentist for dental
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Page 3
patients, without regard to whether the dentist possesses an
anesthesia permit, if the physician and surgeon holds a
current license to practice medicine in California and holds
a valid general anesthesia permit issued by the DBC. (BPC §
1646.9)
7) Defines "conscious sedation" as a minimally depressed level
of consciousness produced by a pharmacologic or
nonpharmacologic method, or a combination thereof, that
retains the patient's ability to maintain independently and
continuously an airway, and respond appropriately to physical
stimulation or verbal command. "Conscious sedation" does not
include the administration of oral medications or the
administration of a mixture of nitrous oxide and oxygen,
whether administered alone or in combination with each other.
(BPC § 1647.1)
8) Requires a dentist administering or ordering the
administration of conscious sedation on an outpatient basis
for dental patients to have either:
(BPC § 1647.2(a))
a) A current license in good standing to practice
dentistry in California and either holds a valid
anesthesia permit or obtains a permit issued by the DBC
authorizing the dentist to administer conscious sedation;
or,
b) A current oral and maxillofacial surgery permit or a
permit to perform elective facial cosmetic surgery and
either holds a valid general anesthesia permit or a permit
to administer conscious sedation.
9) Requires a dentist to take a physical evaluation and medical
history prior to the administration of conscious sedation and
oral conscious sedation of a minor, and maintain records of
the physical evaluation, medical history, and conscious
sedation procedures as required by the DBC. (BPC §§ 1647.6,
1647.14)
10)Defines "oral conscious sedation" as a minimally depressed
level of consciousness produced by oral medication that
retains the patient's ability to maintain independently and
continuously an airway, and respond appropriately to physical
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Page 4
stimulation or verbal command. The drugs and techniques used
in oral conscious sedation shall have a margin of safety wide
enough to render unintended loss of consciousness unlikely.
Further, patients whose only response is reflex withdrawal
from painful stimuli would not be considered to be in a state
of oral conscious sedation. (BPC § 1647.10 (a))
11)Defines a "minor patient" as a dental patient under the age
of 13 years.
(BPC § 1647.10 (b))
12)States that the failure to report to the DBC in writing
within seven days of any of the following is unprofessional
conduct: (BPC § 1680 (z))
a) The death of his or her patient during the performance
of any dental or dental hygiene procedure;
b) The discovery of the death of a patient whose death is
related to a dental or dental hygiene procedure performed
by him or her; or
c) Except for a scheduled hospitalization, the removal to
a hospital or emergency center for medical treatment for a
period exceeding 24 hours of any patient to whom oral
conscious sedation, conscious sedation, or general
anesthesia was administered, or any patient as a result of
dental or dental hygiene treatment.
This bill:
1) States Legislative intent for the DBC to encourage dental
sedation providers to submit data regarding pediatric
sedation events to a pediatric sedation research database
maintained by a nonprofit organization, with the goal that
the data submitted will be used to formulate a systems-based
approach to improving the quality of services provided to
pediatric dental anesthesia patients in outpatient settings.
2) Requires the DBC 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
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patients on or before January 1, 2017.
3) Requires the DBC to make the report publicly available on
its Internet Web site.
4) Requires the DBC to provide a report on pediatric deaths
related to general anesthesia in dentistry at the time of its
sunset review.
5) States that the failure to provide the following written
informed consent language in cases regarding a minor
constitutes unprofessional conduct: "The administration and
monitoring of general anesthesia may vary depending on the
type of procedure, the type of practitioner, the age and
health of the patient and the setting in which anesthesia is
provided. Risks may vary with each specific situation. You
are encouraged to explore all the options available for your
child's anesthesia for his/her dental treatment, and consult
with your dentist or pediatrician as needed."
6) Prohibits the informed consent language from being construed
to establish the reasonable standard of care for
administering or monitoring oral conscious sedation,
conscious sedation, or general anesthesia.
7) Removes the time period requirement for reporting an
incident to the DBC for a patient who was administered oral
conscious sedation, conscious sedation, or general anesthesia
and is removed to a hospital or emergency center for medical
treatment.
8) Requires the DBC to approve a form for the reporting of
adverse events related to a patient who was administered oral
conscious sedation, conscious sedation, or general anesthesia
that includes specified information.
9) Establishes a penalty of $100 per day for a licensee who
fails to report a specified adverse event to the DBC within
seven days, and allows the licensee to dispute the failure to
file the report within ten days of receiving notice that the
DBC has assessed a penalty.
Background
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Current law on dental sedation is largely a product of
recommendations from a 2003 DBC Blue Ribbon panel. The panel
reviewed all pertinent state laws and regulations pertaining to
the delivery of general anesthesia and sedation services by
California dentists, DBC data on mortalities associated with
dentistry, mortality and morbidity data from The Dentists
Insurance Company and the Southern California Society of Oral
and Maxillofacial Surgeons, recent changes in dental rules and
regulations of other states, various documents and
correspondence pertaining to anesthesia and sedation in the
dentist office, and relevant national guidelines to produce
their report.
Reports Required of the DBC. The DBC is currently preparing a
report similar to the one requested in this bill at the request
of Senator Hill. According to a DBC memorandum dated April 21,
2016, a two person subcommittee, consisting of an oral and
maxillofacial surgeon and an attorney, was appointed at the
March DBC meeting to assist staff in conducting the research.
DBC indicates the report will include the following:
A review of the present laws, regulations, and policies in
California; and a comparison of this information to other
states' and dental associations' policies.
A review of all incident reports related to pediatric
anesthesia in California for the past five years. The
specific time frame will be July 1, 2010-June 30, 2015 to
coincide with the Board reporting of its annual statistics to
the Department of Consumer Affairs.
Methodology used to review the DBC's incident reports.
Number of cases reviewed and results of the review.
Explanation of the DBC's internal policies for processing
notification of violations of Business & Professions Code
1680(z).
Explanation of the DBC's records retention policies.
Input from stakeholder groups.
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Possible recommendations for statutory or regulatory changes.
DBC staff plans to submit a draft report to the full DBC Board
at its August 18-19, 2016 meeting during which the Board and
subcommittee will solicit public comment, followed by a second
draft to be presented at the DBC's December 1-2, 2016 board
meeting. Senator Hill has asked that a report be prepared and
submitted to the Legislature by January 1, 2017.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
SUPPORT: (Verified8/2/16)
American Academy of Pediatrics, California (source)
American Society of Dentist Anesthesiologists
California Association of Nurse Anesthetists
California Dental Association
California Society of Anesthesiologists
The Children's Partnership
Numerous individuals
OPPOSITION: (Verified8/2/16)
None received
ARGUMENTS IN SUPPORT: The American Academy of Pediatrics,
California writes, "AB 2235 would require the California Dental
Board to establish a committee to formally study the safety of
pediatric anesthesia in dental offices and other states'
regulations of those procedures. The bill would also require
licensed dentists who administer anesthesia to provide
information on the differing practices and safety requirements
currently in place. Additionally, the board should facilitate
the epidemiological study of pediatric anesthesia and sedation
by requiring the Dental Board to collect more information
regarding adverse events.
"The National American Academy of Pediatrics supports efforts to
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improve regulations and guidelines for sedation used by medical
and dental practitioners for further improvement in safety and
outcomes, as noted in AAP Policy Guidelines for Monitoring and
Management of Pediatric Patients During and After Sedation."
ASSEMBLY FLOOR: 76-0, 4/28/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley, Cooper,
Dababneh, Dahle, 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, Linder, Lopez, Low, Maienschein, Mayes, McCarty,
Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell,
Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Rendon
NO VOTE RECORDED: Chávez, Daly, Mathis, Olsen
Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104
8/3/16 18:09:02
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