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ARIZONA STATE SENATE
Fifty-Sixth Legislature, First Regular Session
AMENDED
dental anesthesia; requirements
Purpose
An emergency measure that allows a qualified anesthesia provider to administer general anesthesia and sedation in dental offices and clinics. Outlines requirements for administering general anesthesia and sedation in dental offices and clinics.
Background
The Arizona State Board of Dental Examiners (BODEX) is established to promote the safe and professional practice of dentistry. The mission of BODEX is to provide professional, courteous service and information to the dental profession and the general public through: 1) the examination and licensure process; 2) the complaint adjudication and enforcement processes; and 3) the protection of oral health, safety and welfare of Arizona citizens through a fair and impartial system.
BODEX is charged with the investigation of complaints regarding dental professionals and related business entities, which are resolved through: 1) the issuing of a letter of concern; 2) the issuing of decrees of censure; 3) fixing periods and terms of probation; 4) suspending or revoking licenses, certificates and restricted permits; and 5) reinstating licenses, certificates and restricted permits in proper cases.
Statute also directs BODEX by rule to: 1) require that a dental licensee obtain a permit for applying general anesthesia, semiconscious sedation or conscious sedation; 2) establish and collect a fee of not more than $300 to cover administrative costs connected with issuing the permit; and 3) conduct inspections to ensure compliance (A.R.S. § 32-1207).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
Qualified Anesthesia Providers
1. Authorizes the Arizona Medical Board (AMB) to issue registrations to administer general anesthesia and sedation in dental offices and clinics to doctor of medicine who have completed residency training in anesthesiology.
2. Authorizes the Arizona Board of Osteopathic Examiners in Medicine and Surgery (ABOE) to issue registrations to administer general anesthesia and sedation in dental offices and clinics to physicians who have completed residency training in anesthesiology.
3. Authorizes the Arizona Board of Nursing (AZBN) to issue registrations to administer general anesthesia and sedation in dental offices and clinics to certified registered nurse anesthetists who have certification in anesthesiology.
4. Requires a dental office or clinic, at which general anesthesia or sedation is administered as prescribed by BODEX in rule that is consistent with the standards and practices recommended by the American Heart Association, to:
a) contain properly operating equipment and supplies as prescribed by BODEX in rule; and
5. Asserts that a qualified anesthesia provider who is licensed by BODEX that fails to comply with dental anesthesia requirements or applicable BODEX rules commits an act that constitutes a danger to the health, welfare or safety of the public.
Duty to Report
6. Requires BODEX to promptly report a qualified anesthesia provider to the regulatory board that licenses the provider if the provider who is not licensed by BODEX fails to comply with the dental anesthesia requirements.
7. Requires BODEX to promptly report an adverse anesthesia outcome to the regulatory board that licenses the qualified anesthesia provider, if the adverse outcome involves a provider who is not licensed by BODEX.
8. Requires the treating dentist, if a death or incident requiring emergency medical response occurs, to submit a report of the incident to BODEX within seven business days after the occurrence.
9. Requires BODEX, if the incident involves a qualified anesthesia provider who is not licensed by BODEX, to immediately forward a copy of the incident report to the applicable regulatory board that licenses the qualified anesthesia provider.
10. Requires a doctor of medicine, doctor of osteopathic medicine or certified registered nurse anesthetist, if a death or an incident requiring emergency medical response occurs in a dental office or clinic, to report the death or incident to the licensee's regulatory board within seven business days after the occurrence.
BODEX's Anesthesia and Sedation Committee
12. Requires BODEX's Anesthesia and Sedation Committee, by September 1, 2023, to submit to BODEX its final recommendations to improve the general anesthesia and sedation permit requirements as provided in BODEX's existing administrative rules.
13. Stipulates that the final recommendations are for the purpose of increasing patient safety when general anesthesia or sedation is being administered by an anesthesia provider within:
a) a dental practice; or
b) a similar setting that is under the jurisdiction of BODEX.
14. Requires BODEX's Anesthesia and Sedation Committee to consider ways to create equitable access for all qualified anesthesia providers and improve access to dental anesthesia services for patients.
15. Requires BODEX, within 60 days after receipt of BODEX's Anesthesia and Sedation Committee's final recommendations, to approve, modify or reject the recommendations.
16. Exempts BODEX, for the purpose of general anesthesia or sedation requirements, from statutory rulemaking requirements for one year.
17. Repeals the final recommendations requirements for BODEX's Anesthesia and Sedation Committee on January 1, 2025.
Miscellaneous
18. Defines qualified anesthesia provider as:
a) a licensee who hold a permit to administer anesthesia and sedation by BODEX;
b) a physician who has completed residency training in anesthesiology and who is licensed by the AMB or the ABOE and registered to administer anesthesia in dental offices or clinics; and
c) a certified registered nurse anesthetist who has a national board certification in anesthesiology and who is licensed by the AZBN and registered to administer anesthesia in dental offices and clinics.
19. Makes technical and conforming changes.
20. Becomes effective on signature of the Governor, if the emergency is enacted.
Amendments Adopted by Committee of the Whole
1. Specifies that a licensee who has obtained a permit from BODEX for applying general anesthesia or sedation may perform dental procedures on a patient who receives anesthesia or sedation administered by a qualified anesthesia provider.
2. Authorizes the AMB, the ABOE and the AZBN to issue registrations, rather than permits, to administer anesthesia or sedation in dental offices and clinics.
4. Requires a dental office or clinic that uses a qualified anesthesia provider to confirm that the provider holds a valid, current license in good standing with no restrictions and a permit or is registered to administer general anesthesia or sedation in that setting.
a) contain properly operating equipment and supplies as prescribed by BODEX in rule; and
b) have proper emergency response protocols in place, including advance cardiac life support and airway management.
6. Eliminates provisions that specify the requirements for proper equipment and emergency procedure in a dental office or clinic at which general anesthesia or sedation is being administered.
8. Requires BODEX, if the incident involves a qualified anesthesia provider who is not licensed by BODEX, to immediately forward a copy of the incident report to the applicable regulatory board that licenses the qualified anesthesia provider.
9. Requires a doctor of medicine, doctor of osteopathic medicine or certified registered nurse anesthetist, if a death or an incident requiring emergency medical response occurs in a dental office or clinic, to report to the death or incident to the licensee's regulatory board within three business days after the occurrence.
10. Allows any other person, if a death or an incident requiring emergency medical response occurs in a dental office or clinic, to report to the death or incident to licensee's applicable regulatory board within three business days after the occurrence.
11. Eliminates the requirement for the applicable regulatory board to suspend a qualified anesthesia provider's permit until after an investigation into an adverse anesthesia outcome that results in death of a patient.
12. Requires the BODEX's Anesthesia and Sedation Committee, by September 1, 2023, to submit to BODEX its final recommendations to improve the general anesthesia and sedation permit requirements as provided in BODEX's existing administrative rules.
13. Stipulates that the final recommendations are for the purpose of increasing patient safety when general anesthesia or sedation is being administered by an anesthesia provider within:
a) a dental practice; or
b) a similar setting that is under the jurisdiction of BODEX.
14. Requires that the recommendations:
a) ensure that at least two people are properly trained in advanced cardiac life support and airway management and pediatric advance life support, as applicable, in any dental office or clinic at which general anesthesia or sedation is administered; and
b) include a methodology to expedite the review of and response to deaths and incidents requiring emergency medical response during the administration of or recovery from general anesthesia or sedation.
15. Requires BODEX, within 60 days after receipt of BODEX's Anesthesia and Sedation Committee's final recommendations, to approve, modify or reject the recommendations.
16. Exempts BODEX, for the purpose of general anesthesia or sedation requirements, from statutory rulemaking requirements for one year.
17. Repeals the final recommendations requirements for BODEX's Anesthesia and Sedation Committee on January 1, 2025.
18. Makes technical and conforming changes.
Amendments Adopted by the House of Representatives
2. Specifies that the proper emergency response protocols a dental office or clinic must have in place are as prescribed by BODEX in rule that is consistent with the standards and practices recommended by the American Heart Association.
3. Clarifies that the proper emergency response protocols a dental office or clinic must have in place include pediatric advance life support, as applicable.
4. Removes the requirement for a qualified anesthesia provider to confirm that the dentist who owns the dental office or clinic where general anesthesia or sedation is being administered holds the required permit issued by BODEX.
5. Removes the requirement for a dental office or clinic that uses a qualified anesthesia provider to confirm that the qualified anesthesia provider:
a) holds a valid, current license in good standing with no restrictions; and
b) holds a permit or is registered to administer general anesthesia or sedation in that setting.
6. Specifies that a qualified anesthesia provider who is licensed by BODEX and who fails to comply with applicable BODEX rules commits an act that constitutes a danger to the health, welfare or safety of the public.
7. Specifies that the treating dentist, if a death or incident requiring emergency medical response occurs in a dental office or clinic during the administration of general anesthesia or sedation by a qualified anesthesia provider, must submit a report of the incident to BODEX, rather than a complete report, within three days after the occurrence.
8. Removes the requirement that the final recommendations of BODEX's Anesthesia and Sedation Committee:
a) ensure that at least two people are properly trained in advanced cardiac life support and airway management and pediatric advance life support, as applicable, in any dental office or clinic at which general anesthesia or sedation is administered; and
b) include a methodology to expedite the review of and response to deaths and incidents requiring emergency medical response during the administration of or recovery from general anesthesia or sedation.
10. Requires the treating dentist, if a death or incident requiring emergency medical response occurs, to submit a report of the incident to BODEX within seven business days after the occurrence, rather than three business days.
11. Requires a doctor of medicine, doctor of osteopathic medicine or certified registered nurse anesthetist, if a death or an incident requiring emergency medical response occurs in a dental office or clinic, to report the death or incident to the licensee's regulatory board within seven business days after the occurrence, rather than three business days.
12. Allows any other person, if a death or an incident requiring emergency medical response occurs in a dental office or clinic, to report the death or incident to a licensee's applicable regulatory board within seven business days after the occurrence, rather than three business days.
13. Adds an emergency clause.
14. Makes conforming changes.
Senate Action House Action
COM 2/15/23 DP 4-3-0 HHS 3/27/23 DPA 7-2-0
3rd Read 3/14/23 16-12-2 3rd Read 5/15/23 47-11-1-0-1
Prepared by Senate Research
May 15, 2023
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