Use Of Deep Sedation And General Anesthesia - Dentistry - Business & Professions - CA

Section § 1646

This law section defines some key terms related to anesthesia in medical settings. 'Deep sedation' is when a person is not fully conscious and may need help with breathing. 'General anesthesia' means a deeper unconsciousness where the person cannot wake up even with pain, and they often need assistance with breathing. 'Good standing' describes a professional status without any disciplinary issues or complaints.

As used in this article, the following definitions apply:

(a) “Deep sedation” means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

(b) “General anesthesia” means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.

(c) “Good standing” means the license or permit is active and unrestricted by disciplinary action taken pursuant to Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, is not the subject of an unresolved complaint or review procedure, and is not the subject of any unresolved disciplinary proceeding.

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Section § 1646.1

If a dentist wants to give deep sedation or general anesthesia to patients on an outpatient basis, they must have a valid dental license, a special permit, and certification in advanced life support. For patients under seven, they need a special pediatric endorsement, and for patients under 13, specific team requirements and certifications in pediatric life support are required. The dentist must be present during anesthesia and take part in emergency responses. This law doesn’t cover local, minimal, or moderate sedation.

(a) A dentist shall possess an active dentist license or a permit under Section 1638 or 1640 issued by the board and an active general anesthesia permit in order to administer or order the administration of deep sedation or general anesthesia on an outpatient basis for dental patients.

(b) A dentist shall maintain current certification in Advanced Cardiac Life Support (ACLS).

(c) A dentist shall possess a pediatric endorsement of their general anesthesia permit to administer or order the administration of deep sedation or general anesthesia to patients under seven years of age.

(d) A dentist who administers or orders the administration of general anesthesia or deep sedation shall be physically present in the treatment facility while the patient is under general anesthesia or deep sedation.

(e) For patients under 13 years of age, all of the following shall apply:

(1) The operating dentist and at least two additional personnel shall be present throughout the procedure involving deep sedation or general anesthesia.

(2) If the operating dentist is the permitted anesthesia provider, then both of the following shall apply:

(A) The operating dentist and at least one of the additional personnel shall maintain current certification in Pediatric Advanced Life Support (PALS) or other board-approved training in pediatric life support and airway management, adopted pursuant to Section 1601.8. The additional personnel who is certified in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management shall be solely dedicated to monitoring the patient and shall be trained to read and respond to monitoring equipment including, but not limited to, pulse oximeter, cardiac monitor, blood pressure, pulse, capnograph, and respiration monitoring devices.

(B) The operating dentist shall be responsible for initiating and administering any necessary emergency response.

(3) If a dedicated permitted anesthesia provider is monitoring the patient and administering deep sedation or general anesthesia, both of the following shall apply:

(A) The anesthesia provider and the operating dentist, or one other trained personnel, shall be present throughout the procedure and shall maintain current certification in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management, adopted pursuant to Section 1601.8.

(B) The anesthesia provider shall be responsible for initiating and administering any necessary emergency response and the operating dentist, or other trained and designated personnel, shall assist the anesthesia provider in emergency response.

(f) This article does not apply to the administration of local anesthesia, minimal sedation, or moderate sedation.

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Section § 1646.2

If a dentist wants to give deep sedation or general anesthesia, they need to apply for a special permit. The dentist must have a good-standing license, pay a fee, complete specific anesthesia training, and have advanced life support certification. For pediatric anesthesia, a dentist must prove successful training, experience with young children, and hold a pediatric life support certification. If lacking experience with enough pediatric cases, they can gain supervised practice with a qualified dentist.

(a) A dentist who desires to administer or order the administration of deep sedation or general anesthesia shall apply to the board on an application form prescribed by the board. The dentist shall possess a dentist license or a permit under Section 1638 or 1640 issued by the board that is in good standing, submit an application fee and produce evidence showing that the dentist has successfully completed a minimum of one year of advanced training in anesthesiology and related academic subjects approved by the board, or equivalent training or experience approved by the board, beyond the undergraduate school level, and current certification in Advanced Cardiac Life Support (ACLS).

(b) The application for a permit shall include documentation that equipment and drugs required by the board are on the premises.

(c) A dentist may apply for a pediatric endorsement for the general anesthesia permit by providing proof of successful completion of all of the following:

(1) A Commission on Dental Accreditation (CODA)-accredited or equivalent residency training program that provides competency in the administration of deep sedation and general anesthesia on pediatric patients.

(2) At least 20 cases of deep sedation or general anesthesia to patients under seven years of age in the 24-month time period directly preceding application for a pediatric endorsement to establish competency, both at the time of initial application and at renewal. The applicant or permitholder shall maintain and be able to provide proof of these cases upon request by the board for up to three permit renewal periods. Patient records submitted to the board pursuant to this paragraph shall be confidential and shall not be disclosed pursuant to any state law, including, but not limited to, the California Public Records Act (Division 10 (commencing with Section 7920.000) of the Government Code), except for disclosure pursuant to a lawfully issued subpoena or a written request from a government agency responsible for either enforcement of civil or criminal laws or the professional licensing of individuals that is conducting an investigation about the applicant.

(3) Current certification in Pediatric Advanced Life Support (PALS) or other board-approved training in pediatric life support and airway management, pursuant to Section 1601.8, for the duration of the permit.

(d) Applicants for a pediatric endorsement who otherwise qualify for the pediatric endorsement but lack sufficient cases of pediatric sedation to patients under seven years of age may administer deep sedation and general anesthesia to patients under seven years of age under the direct supervision of a general anesthesia permitholder with a pediatric endorsement. The applicant may count these cases toward the 20 cases required to qualify for the applicant’s pediatric endorsement.

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Section § 1646.3

Before a patient is given deep sedation or general anesthesia, a doctor must complete a physical evaluation and review the patient's medical history. Records of these evaluations and the sedation or anesthesia given must be kept according to specific rules set by the board.

(a) A physical evaluation and medical history shall be taken before the administration of deep sedation or general anesthesia.

(b) Medical history, physical evaluation, deep sedation, and general anesthesia records shall be maintained as required by board regulations.

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Section § 1646.4

This law states that before a dentist can either get or renew a permit to use deep sedation or general anesthesia, the dental board may require an on-site inspection of the dentist and their facilities, equipment, and staff. If a dentist fails this inspection, their permit will be suspended in 30 days unless they pass a re-inspection within that time. Dentists must undergo these inspections at least once every five years. Refusing an inspection leads to permit denial or revocation.

The board can hire experts to conduct inspections but retains the final say on permit issuance and who gets inspected. The law requires the board to have enough staff to manage this process, with fees covering the costs of administration and enforcement.

(a) Prior to the issuance or renewal of a permit for the use of deep sedation or general anesthesia, the board may, at its discretion, require an onsite inspection and evaluation of the licentiate and the facility, equipment, personnel, and procedures utilized by the licentiate. The permit of any dentist who has failed an onsite inspection and evaluation shall be automatically suspended 30 days after the date on which the board notifies the dentist of the failure, unless within that time period the dentist has retaken and passed an onsite inspection and evaluation. Every dentist issued a permit under this article shall have an onsite inspection and evaluation at least once every five years. Refusal to submit to an inspection shall result in automatic denial or revocation of the permit.

(b) The board may contract with public or private organizations or individuals expert in dental outpatient general anesthesia to perform onsite inspections and evaluations. The board may not, however, delegate its authority to issue permits or to determine the persons or facilities to be inspected.

(c) It is the intent of the Legislature that the board hire sufficient staff to administer the program and that the fees established pursuant to this section be equivalent to administration and enforcement costs incurred by the board in carrying out this article.

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Section § 1646.5

If you have a permit to administer deep sedation or general anesthesia, you need to complete at least 24 hours of specific courses related to these practices to renew your permit. These course hours also count toward your overall continuing education requirements.

A permittee shall be required to complete 24 hours of approved courses of study related to deep sedation or general anesthesia as a condition of renewal of a permit. Those courses of study shall be credited toward the total continuing education hours required by the board pursuant to Section 1645.

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Section § 1646.6

This law states that the fees for applying for or renewing certain permits, as well as fees for inspections, cannot be more than what's specified in another section (Section 1724). These fees should cover the costs of administration and enforcement. Also, a contractor hired by the board might collect and keep the inspection fees, at the board's discretion.

(a) The application fee for a permit or renewal under this article shall not exceed the amount prescribed in Section 1724.

(b) The fee for an onsite inspection shall not exceed the amount prescribed in Section 1724.

(c) It is the intent of the Legislature that fees established pursuant to this section be equivalent to administrative and enforcement costs incurred by the board in carrying out this article.

(d) At the discretion of the board, the fee for onsite inspection may be collected and retained by a contractor engaged pursuant to subdivision (b) of Section 1646.4.

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Section § 1646.7

If a dentist or doctor violates this law, it's considered unprofessional conduct and can lead to having their professional license suspended or revoked. The board may allow probation instead of harsher penalties, but only if no physical harm occurred. For doctors, if this rule is broken, the Medical Board of California could get involved to decide if further disciplinary action is needed. Any legal proceedings under this law will follow specific government procedures.

(a) A violation of this article constitutes unprofessional conduct and is grounds for the revocation or suspension of the dentist’s permit or license, or both. The board shall issue probationary terms only for violations that do not result in bodily harm.

(b) A violation of any provision of this article or Section 1682 is grounds for suspension or revocation of the physician and surgeon’s permit issued pursuant to this article by the board. The exclusive enforcement authority against a physician and surgeon by the board shall be to suspend or revoke the permit issued pursuant to this article. The board shall refer a violation of this article by a physician and surgeon to the Medical Board of California for its consideration as unprofessional conduct and further action, if deemed necessary by the Medical Board of California, pursuant to Chapter 5 (commencing with Section 2000). A suspension or revocation of a physician and surgeon’s permit by the board pursuant to this article shall not constitute a disciplinary proceeding or action for any purpose except to permit the initiation of an investigation or disciplinary action by the Medical Board of California, as authorized by Section 2220.5.

(c) The proceedings under this section shall be conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, and the board shall have all the powers granted therein.

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Section § 1646.8

This law makes it clear that dentists are only allowed to administer or supervise general anesthesia or deep sedation when it's for dental work, as outlined in another specific part of the law.

Nothing in this chapter shall be construed to authorize a dentist to administer or directly supervise the administration of general anesthesia or deep sedation for reasons other than dental treatment, as defined in Section 1625.

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Section § 1646.9

This law allows doctors with specific qualifications to give deep sedation or general anesthesia in a dentist's office, even if the dentist doesn't have a special permit. The doctor must have a valid medical license, an anesthesia permit from the Dental Board, and meet other specific requirements. They must also apply with a license history, pay a fee, and show completion of anesthesiology training. The dental office must have the right equipment and drugs, and the doctor's hospital affiliations must be provided. The Dental Board may inspect the office and the doctor at any time and can revoke permits if requirements aren't met. Doctors can also apply for a special endorsement to treat young children if they meet further criteria.

(a) A physician and surgeon licensed by the Medical Board of California or Osteopathic Medical Board of California pursuant to Chapter 5 (commencing with Section 2000) may administer deep sedation or general anesthesia in the office of a licensed dentist for dental patients, without regard to whether the dentist possesses a permit issued pursuant to this article, if all of the following conditions are met:

(1) The physician and surgeon possesses an active license to practice medicine in this state.

(2) The physician and surgeon holds an active general anesthesia permit issued by the Dental Board of California pursuant to subdivision (b).

(3) The physician and surgeon meets the requirements of subdivision (e) of Section 1646.1.

(b) A physician and surgeon who desires to administer deep sedation or general anesthesia as set forth in subdivision (a) shall possess a license issued by the Medical Board of California or the Osteopathic Medical Board of California, as applicable, that is in good standing, shall apply to the board on an application form prescribed by the board, and shall submit all of the following:

(1) Certified license history issued by the Medical Board of California or Osteopathic Medical Board of California, as applicable to the applicant’s license, showing the physician and surgeon license number and current license status.

(2) The payment of an application fee prescribed by this article.

(3) Evidence showing that the applicant has successfully completed a postgraduate residency training program in anesthesiology that is recognized by the Accreditation Council for Graduate Medical Education.

(4) Documentation demonstrating that all equipment and drugs required by the board are on the premises for use in any dental office in which the applicant administers deep sedation or general anesthesia.

(5) Information relative to the current membership of the applicant on hospital medical staffs.

(c) Prior to issuance or renewal of a permit pursuant to this section, the board may, at its discretion, require an onsite inspection and evaluation of the facility, equipment, personnel, including, but not limited to, the physician and surgeon, and procedures utilized. At least one of the persons evaluating the procedures utilized by the physician and surgeon shall be a licensed physician and surgeon expert in outpatient deep sedation or general anesthesia who has been authorized or retained under contract by the board for this purpose.

(d) The permit of a physician and surgeon who has failed an onsite inspection and evaluation shall be automatically suspended 30 days after the date on which the board notifies the physician and surgeon of the failure unless within that time period the physician and surgeon has retaken and passed an onsite inspection and evaluation. Every physician and surgeon issued a permit under this article shall have an onsite inspection and evaluation at least once every five years. Refusal to submit to an inspection shall result in automatic denial or revocation of the permit.

(e) A physician and surgeon who additionally meets the requirements of paragraphs (2) and (3) of subdivision (c) of Section 1646.2 may apply to the board for a pediatric endorsement to provide deep sedation or general anesthesia to a child under seven years of age. A physician and surgeon without sufficient cases to obtain a pediatric endorsement may qualify for the endorsement pursuant to the requirements of subdivision (d) of Section 1646.2.

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Section § 1646.10

This law states that a permit for general anesthesia will expire on a set date unless it's renewed according to the rules in the same legal article.

A general anesthesia permit shall expire on the date provided in Section 1715 that next occurs after its issuance, unless it is renewed as provided in this article.

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Section § 1646.11

If you have a permit for general anesthesia that was issued before January 1, 2022, you can keep using it under the old rules until it expires. However, any permits that are issued or renewed from January 1, 2022, onwards must meet the new requirements of this section.

A general anesthesia permitholder who has a permit that was issued before January 1, 2022, may follow the terms of that existing permit until it expires. Any permit issued or renewed pursuant to this article on or after January 1, 2022, shall require the permitholder to follow the new requirements of this article.

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Section § 1646.12

If you have a pediatric endorsement, it will expire on a specific date after it's issued, unless you renew it according to the rules in this article.

A pediatric endorsement shall expire on the date specified in Section 1715 that next occurs after its issuance, unless it is renewed as provided in this article.

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Section § 1646.13

This part of the law goes into effect starting January 1, 2022.

This article shall become operative on January 1, 2022.

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Dentistry

DentistryUse of Deep Sedation and General Anesthesia