BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 2235| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 2235 Author: Thurmond (D), et al. Amended: 8/16/16 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 authorizes a penalty for failure to report information to the DBC. AB 2235 Page 2 Senate Floor Amendments of 8/16/16 delete the maximum fine for failure to report and defer to the DBC existing fine authority. 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)) AB 2235 Page 3 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 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 AB 2235 Page 4 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 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)Authorizes the DBC to issue administrative fines up to $5,000. (BPC § 125.9; Title 16 California Code of Regulations § 1023.2) 13)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 AB 2235 Page 5 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 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 AB 2235 Page 6 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) Authorizes DBC to assess a penalty on any licensee who fails to report an instance of an adverse event. The licensee may dispute the failure to file within 10 days of receiving notice of a penalty. Background 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 AB 2235 Page 7 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. 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: (Verified8/17/16) 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: (Verified8/17/16) AB 2235 Page 8 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 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 8/18/16 9:24:46 **** END **** AB 2235 Page 9