BILL ANALYSIS Ó
AB 2235
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CONCURRENCE IN SENATE AMENDMENTS
AB
2235 (Thurmond)
As Amended August 16, 2016
Majority vote
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|ASSEMBLY: | |(April 28, |SENATE: |38-0 |(August 18, |
| | |2016) | | |2016) |
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(vote not relevant)
Original Committee Reference: B. & P.
SUMMARY: Declares the Legislature's intent that the Dental
Board of California (DBC) encourage dental sedation providers in
this state to submit data regarding pediatric sedation events to
a research database in order to improve the quality of services
provided to pediatric dental anesthesia patients, as specified;
requires the DBC, on or before January 1, 2017, to provide a
report to the Legislature on whether current statutes and
regulations for the administration and monitoring of pediatric
anesthesia in dentistry provides adequate protection of
pediatric dental patients; specifies the minimum information
that a licensee must report to the DBC in the event of a death
of his or her patient or removal of a sedation or anesthesia
patient to a hospital or emergency center for medical treatment,
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except as specified, and defines the categories of providers
that are required to be specified; specifies that the
information provided in this report is not an admission of
guilt; authorizes the DBC to assess a fine on any licensee that
fails to report an adverse event within a seven-day period and
provides that the licensee may dispute a penalty within ten
days; and, specifies the minimum information that a licensee
include on the written informed consent in the case of a minor.
The Senate amendments delete the Assembly version of this bill,
and instead:
1)Declare the Legislature's intent that the DBC encourage all
dental sedation providers in this state to submit data
regarding pediatric sedation events to a research database
maintained by a nonprofit organization to formulate a
systems-based approach to improve the quality of services
provided to pediatric dental anesthesia patients in outpatient
settings.
2)Require the DBC, on or before January 1, 2017, to make provide
a report to the Legislature on whether current statutes and
regulations for the administration and monitoring of pediatric
anesthesia in dentistry provides adequate protection of
pediatric dental patients and requires that this report be
made available on the DBC's Internet Web site.
3)Specify the minimum information that a licensee must report to
the DBC within a seven-day reporting period of an a death of
his or her patient or the removal of a sedation or anesthesia
patient to a hospital or emergency center for medical
treatment, except as specified, is required to include, but
not limited to:
a) The date of the procedure; the patient's age in years
and months, weight, and sex; the patient's American Society
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of Anesthesiologists (ASA) physical status; the patient's
primary diagnosis; the patient's coexisting diagnoses; the
procedures performed; the sedation setting; the medications
used; the monitoring equipment used;
b) The category of the provider responsible for sedation
oversight; the category of the provider delivering
sedation; the category of the provider monitoring the
patient during sedation; whether the person supervising the
sedation performed one or more of the procedures;
c) The planned airway management; the planned depth of
sedation; the complications that occurred; a description of
what was unexpected about the airway management; whether
there was transportation of the patient during sedation;
d) The category of the provider conducting resuscitation
measures; and, the resuscitation equipment utilized.
4)Provide that the disclosure of individually identifiable
patient included in this report is limited to applicable law.
5)Provide that that this report is not admissible in any action
brought by a patient of the licensee providing the report.
6)Define the categories of providers as General Dentist,
Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist,
Physician Anesthesiologist, Dental Assistant, Registered
Dental Assistant, Dental Sedation Assistant, Registered Nurse,
Certified Registered Nurse Anesthetist, or Other.
7)Specify that the information provided in this report is not an
admission of guilt.
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8)Authorize the DBC to assess a fine on any licensee that fails
to report an adverse event not reported after the initial
seven-day reporting period; provides that the licensee may
dispute the failure to file a penalty within 10 days of
receiving notice of the penalty.
9)Require a dentist who is permitted to administer general
anesthesia or deep sedation to obtain written informed consent
of a minor patient's parent or guardian on a form or forms
approved the DBC that contains the following information:
a) "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 or her dental treatment, and consult
with your dentist or pediatrician as needed."
b) Provides that the information listed in the informed
consent, in the case of a minor, is not to be construed as
reasonable standard of care administering general
anesthesia or deep sedation.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, this bill will result
in negligible state costs.
COMMENTS: Purpose. According to the author, "Dentists,
including oral surgeons, are administering anesthesia, including
general anesthesia and sedation, more frequently to children and
are using more powerful drugs in their procedures. Dentists are
also the only healthcare professionals allowed to perform
procedures while simultaneously administering anesthesia. Other
healthcare professions require a separate person extensively
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trained in anesthesia, to administer anesthesia and to monitor
the patient. Dentists are also less likely to use recommended
monitoring technologies, such as capnography or EKG, when
administering anesthesia. As a result, there are a
disproportionate number of deaths and injuries, especially of
children, linked to dental anesthesia.
"To date, data collection regarding the administration of
anesthesia while performing dental operations has been
unscientific, unreliable, and inaccessible. Based on their
experience with medical professionals, parents do not understand
their children are being exposed to additional risks when
anesthesia is administered during a dental procedure."
Background. Use of Anesthesia. Previous to 1980, state laws
described separate and distinct definitions for general
anesthesia and the state of consciousness. Since then, the
Legislature has declared that there exists a continuum of
consciousness that may not be predictable in every case.
However, in most instances, the level of consciousness is
correlated with the level of sedation. Currently, the state
does not delineate the minimum number of people involved in
administering general anesthesia during a dental procedure, only
that the operating room be large enough to accommodate at least
three people. The author cites more than 20 states that require
a person to solely monitor the vital signs of a patient while a
separate person performs the dental procedure. The author also
asserts that other health professions that administer general
anesthesia are required to have the same model.
DBC Subcommittee. On February 8, 2016, the Chair of the Senate
Committee on Business, Professions and Economic Development
(BPED) sent a letter to DBC requesting that the DBC form a
subcommittee to investigate pediatric anesthesia in dentistry,
and requested that information from that investigation be
reported back to the BPED Committee no later than January 1,
2017. The DBC voluntarily created subcommittee, pursuant to the
request of the Chair of the BPED Committee. The subcommittee is
charged with reviewing all incident reports related to pediatric
anesthesia in California for the years 2011 through 2016,
inclusive, and will also assess the policies used by other
states and dental associations to ensure that California is
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protecting young patients.
According to the DBC, "Over the last several months, a
two-person subcommittee of the [DBC] has been doing a great deal
of research into whether or not California's present laws,
regulations, and policies are sufficient to provide protection
of pediatric patients during dental sedation; reviewing the
present laws, regulations, and policies in California and
comparing these findings not only with the information available
in other states, but also with dental associations' policies
related to sedation. In addition, [the DBC] staff has been
compiling six years of statistics (January 1, 2010-December 31,
2015) related to incidents that have occurred where all methods
of sedation, including oral conscious sedation, conscious
sedation, and general anesthesia have been used for pediatric
patients 21 years of age and younger. Board staff also included
incident reports related to the use of local anesthetic in the
statistical analysis." The information is available to
interested parties in the form of a "working document"; however,
there are no recommendations for statutory and/or regulatory
changes from the subcommittee at this time.
Stakeholders were invited to meet with the subcommittee on
Thursday, July 28, 2016, prior to its August board meeting to
discuss the working document. Testimony was taken at this time
from interested parties. Following the August meeting, the
subcommittee will continue to refine the "working document"
based on public comments. A final draft of the report will be
submitted to the Board for discussion and possible action at the
December 1-2, 2016 board meeting.
Analysis Prepared by: Le Ondra Clark Harvey Ph.D. / B. & P. /
(916) 319-3301 FN: 0004598
Gabby
Nepomuceno
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