SECTIONS 1647-1647.9 - California Statutes

BUSINESS AND PROFESSIONS CODE

SECTION 1647-1647.9

1647. (a) The Legislature finds and declares that a commendable
patient safety record has been maintained in the past by dentists and
those other qualified providers of anesthesia services who, pursuant
to a dentist's authorization, administer patient sedation, and that
the increasing number of pharmaceuticals and techniques used to
administer them for patient sedation require additional regulation to
maintain patient safety in the future.
(b) The Legislature further finds and declares all of the
following:
(1) That previous laws enacted in 1980 contained separate and
distinct definitions for general anesthesia and the state of
consciousness.
(2) That in dental practice, there is a continuum of sedation used
which cannot be adequately defined in terms of consciousness and
general anesthesia.
(3) That the administration of sedation through this continuum
results in different states of consciousness that may or may not be
predictable in every instance.
(4) That in most instances, the level of sedation will result in a
predictable level of consciousness during the entire time of
sedation.
(c) The Legislature further finds and declares that the
educational standards presently required for general anesthesia
should be required when the degree of sedation in the continuum of
sedation is such that there is a reasonable possibility that loss of
consciousness may result, even if unintended. These degrees of
sedation have been referred to as "deep sedation" and "light general
anesthesia" in dental literature. However, achieving the degree of
sedation commonly referred to as "light conscious sedation," where a
margin of safety exists wide enough to render unintended loss of
consciousness unlikely, requires educational standards appropriate to
the administration of the resulting predictable level of
consciousness.

1647.1. (a) As used in this article, "conscious sedation" means 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.
(b) The drugs and techniques used in 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 shall not be considered to be
in a state of conscious sedation.
(c) For the very young or handicapped individual, incapable of the
usually expected verbal response, a minimally depressed level of
consciousness for that individual should be maintained.

1647.2. (a) No dentist shall administer or order the administration
of, conscious sedation on an outpatient basis for dental patients
unless one of the following conditions is met:
(1) The dentist possesses a current license in good standing to
practice dentistry in California and either holds a valid general
anesthesia permit or obtains a permit issued by the board authorizing
the dentist to administer conscious sedation.
(2) The dentist possesses a current permit under Section 1638 or
1640 and either holds a valid anesthesia permit or obtains a permit
issued by the board authorizing the dentist to administer conscious
sedation.
(b) A conscious sedation permit shall expire on the date specified
in Section 1715 which next occurs after its issuance, unless it is
renewed as provided in this article.
(c) This article shall not apply to the administration of local
anesthesia or to general anesthesia.
(d) A dentist who orders the administration of conscious sedation
shall be physically present in the treatment facility while the
patient is sedated.

1647.3. (a) A dentist who desires to administer or order the
administration of conscious sedation, shall apply to the board on an
application form prescribed by the board. The dentist shall submit an
application fee and produce evidence showing that he or she has
successfully completed a course of training in conscious sedation
that meets the requirements of subdivision (c).
(b) The application for a permit shall include documentation that
equipment and drugs required by the board are on the premises.
(c) A course in the administration of conscious sedation shall be
acceptable if it meets all of the following as approved by the board:
(1) Consists of at least 60 hours of instruction.
(2) Requires satisfactory completion of at least 20 cases of
administration of conscious sedation for a variety of dental
procedures.
(3) Complies with the requirements of the Guidelines for Teaching
the Comprehensive Control of Anxiety and Pain in Dentistry of the
American Dental Association.

1647.5. A permittee shall be required to complete 15 hours of
approved courses of study related to conscious sedation as a
condition of renewal of a permit. Those courses of study shall be
credited toward any continuing education required by the board
pursuant to Section 1645.

1647.6. A physical evaluation and medical history shall be taken
before the administration of conscious sedation. Any dentist holding
a permit shall maintain records of the physical evaluation, medical
history, and conscious sedation procedures used as required by board
regulations.

1647.7. (a) Prior to the issuance or renewal of a permit to
administer conscious sedation, 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 in every six years. Refusal to submit to an inspection
shall result in automatic denial or revocation of the permit.
(b) An applicant who has successfully completed the course
required by Section 1647.3 may be granted a one-year temporary permit
by the board prior to the onsite inspection and evaluation. Failure
to pass the inspection and evaluation shall result in the immediate
and automatic termination of the temporary permit.
(c) The board may contract with public or private organizations or
individuals expert in dental outpatient conscious sedation 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.

1647.8. (a) The application fee for a permit or renewal under this
article shall not exceed two hundred fifty dollars ($250).
(b) The fee for an onsite inspection shall not exceed three
hundred fifty dollars ($350).
(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.

1647.9. A violation of any provision of this article constitutes
unprofessional conduct and is grounds for the revocation or
suspension of the dentist's permit, license, or both, or the dentist
may be reprimanded or placed on probation. 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.