HOUSE BILL REPORT

HB 1576

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Background:

Dentists are licensed and subject to discipline by the Dental Quality Assurance Commission (DQAC). The practice of dentistry includes the performance of maxillofacial surgery, which is a specialty that includes the diagnosis and surgical and adjunctive treatment of diseases, injuries, and defects of the hard and soft tissues of the oral and maxillofacial region.

Licensed dentists may also perform conscious sedation and general anesthesia under certain circumstances. For example, to administer moderate or general anesthesia, a dentist must obtain a permit of authorization from the DQAC. In order to obtain a permit, the dentist must meet education and training requirements that vary depending on the type of anesthesia involved.

When a dentist administers an anesthetic to a patient, a trained individual must be present to monitor the patient's cardiac and respiratory functions (for deep sedation and general anesthesia, the dentist may serve as the monitor). A monitor must have at least 14 hours of training in the use of certain equipment, basic sciences, evaluation and preparation of patients with systemic diseases, anesthetic drugs and techniques, anesthesia equipment and monitoring, and office anesthesia emergencies.

If the dentist does not have an anesthesia permit, another licensed dentist, a certified nurse anesthetist, or a physician anesthesiologist may provide the anesthesia services. The provider who provides the services is responsible for the anesthetic management of the patient. Dental assistants and expanded function dental auxiliaries may not administer any general or local anesthetic.

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Summary of Substitute Bill:

No person may practice or represent himself or herself as a certified dental anesthesia assistant (CDAA) without being certified by the DQAC. A CDAA may perform the following services under the supervision of an oral and maxillofacial surgeon or a dental anesthesiologist with a general anesthesia permit:

Under close supervision, the CDAA may: (a) initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medications, sedation, or general anesthesia; and (b) adjust the rate of intravenous fluids infusion.
Under direct visual supervision the CDAA may: (a) follow instructions to deliver medication into an intravenous line upon verbal command; (b) adjust an electronic device to provide medications; and (c) administer emergency medications.

The responsibility for monitoring a patient and determining the selection of the drug, dosage, and timing of all anesthetic medications rests solely with the oral maxillofacial surgeon or dental anesthesiologist.

A dental assistant or an expanded function dental auxiliary may be certified as a CDAA if he or she:

completes a DQAC-approved dental anesthesia assistant training course, including intravenous access or phlebotomy;
completes a DQAC-approved basic life support/cardiac pulmonary resuscitation course; and
provides proof that the dentist where he or she will work possesses a valid general anesthesia permit.

Substitute Bill Compared to Original Bill:

The substitute bill:

clarifies that the responsibility for monitoring a patient and determining the selection of the drug, dosage, and timing of all anesthetic medications rests solely with the oral maxillofacial surgeon or dental anesthesiologist;
clarifies that the DQAC is the disciplining authority for dental anesthesia assistants;
clarifies that the practice of a dental anesthesia assistant does not constitute the unlicensed practice of dentistry;
adds dental anesthesia assistants to the definition of "health professions" for purposes of sunrise review; and
makes dental anesthesia assistants a type of dental assistant/expanded function dental auxiliary, as opposed to a standalone profession.

Staff Summary of Public Testimony:

(In support) Oral surgeons provide a wide variety of services to patients. Oral surgeons and dental anesthesiologists must meet stringent educational and training requirements to provide anesthesia. The purpose of a CDAA is to monitor and assist in administering medications. These professionals are well trained and educated. A CDAA will work under the supervision of the oral surgeon or dental anesthesiologist and may only perform delegated tasks; they are extensions of the dental surgeon or dental anesthesiologist's hands not his or her mind. This bill implements the recommendations of the DQAC. The bill provides adequate training, protects patients from cross-contamination, provides assistants to dental surgeons and dental anesthesiologists in emergencies, and will lead to safe and cost-effective dental anesthesia.

(Neutral) This bill should be amended to clarify who has the responsibility for monitoring a patient and determining the selection of the drug, dosage, and timing of all anesthetic medications.

(Opposed) None.