COMMITTEE SUBSTITUTE
FOR
H. B. 2929
(By Mr. Speaker, Mr. Kiss (By Request))
[Introduced March 7, 2005; referred to the
Committee on Health and Human Resources then the judiciary.]
A BILL to amend and reenact §30-4A-1, §30-4A-2, §30-4A-3, §30-4A-4,
§30-4A-5, §30-4A-6, §30-4A-7, §30-4A-8, §30-4A-9, §30-4A-10,
§30-4A-11, §30-4A-12, §30-4A-13, §30-4A-14, §30-4A-15,
§30-4A-16 and §30-4A-17 of the Code of West Virginia, 1931, as
amended; and that said code be amended by adding thereto a new
section
§30-4A-18
, all relating to the administration of
anesthesia by dentists.
Be it enacted by the Legislature of West Virginia:
That §30-4A-1, §30-4A-2, §30-4A-3, §30-4A-4, §30-4A-5,
§30-4A-6, §30-4A-7, §30-4A-8, §30-4A-9, §30-4A-10, §30-4A-11,
§30-4A-12, §30-4A-13, §30-4A-14, §30-4A-15, §30-4A-16 and §30-4A-17
of the Code of West Virginia, 1931, as amended, be amended and
reenacted; and that said code be amended by adding thereto a new
section, designated
§30-4A-18, all
to read as follows:
ARTICLE 4A. ADMINISTRATION OF ANESTHESIA BY DENTISTS.
§30-4A-1.Legislative findings and declaration of purpose.
The Legislature hereby finds and declares that dentists are
increasingly administering anesthesia in their offices on an
out-patient basis; that the administration of anesthesia carries
with it an inherent risk and danger to the patient; that, however,
the administration of anesthesia on an out-patient basis by
dentists is necessary and for the good of the public; but that
because of the inherent dangers in the administration of, it is
necessary to insure that the persons administering and supervising
such anesthesia are competent and trained in the techniques; that
it is in the best interests of the public and the dentists of West
Virginia to prohibit dentists from administering or supervising the
administration of anesthesia unless those dentists meet certain
minimal training and competency standards in the administration and
supervision of anesthesia; and that requiring a dentist to obtain
a special certificate or permit before he or she can administer or
supervise anesthesia is the best method to preserve the use of
anesthesia by dentists on out-patients and, at the same time,
ensure that such administration and supervision is performed by
competent dentists trained in the use of such techniques.
§30-4A-2.Definitions.
(a) "General anesthesia" means an induced controlled state of
unconsciousness in which the patient experiences complete loss of
protective reflexes, as evidenced by the inability to independently
maintain an airway, the inability to respond purposefully to
physical stimulation, or the inability to respond purposefully to verbal command. "Deep conscious sedation/general anesthesia"
includes partial loss of protective reflexes and the patient
retains the ability to independently and continuously maintain an
airway.
(b) "Relative Analgesia" means an induced controlled state of
minimally depressed consciousness, produced solely by the
inhalation of a combination of nitrous oxide and oxygen, or single
oral premedication without the addition of nitrous oxide and oxygen
in which the patient retains the ability to independently and
continuously maintain an airway and to respond purposefully to
physical stimulation and to verbal command. Dosage of oral
premedication is not to exceed the recommended dosage limits set by
the manufacturer for the treatment of anxiety, insomnia or pain.
(c) "Conscious Sedation" means an induced controlled state of
depressed consciousness, produced through the administration of
nitrous oxide and oxygen and/or the administration of other agents
whether enteral or parenteral, in which the patient retains the
ability to independently and continuously maintain an airway and to
respond purposefully to physical stimulation and to verbal command.
(d) "Anxiolysis" or premedication for anxiety - means
removing, eliminating or decreasing anxiety by the use of a single
anxiolytic or analgesia medication that is administered in an
amount consistent with the manufacturer's current recommended
dosage for the unsupervised treatment of anxiety, insomnia or pain,
in conjunction with nitrous oxide and oxygen. This does not
include multiple dosing or exceeding current normal dosage limits set by the manufacturer for unsupervised use by the patient (at
home), for the treatment of anxiety.
(e) "Central Nervous System Anesthesia" means an induced
controlled state of unconsciousness or depressed consciousness
produced by a pharmacologic method.
(f) "ACLS" means Advanced Cardiac Life Support.
(g) "BLS" means Basic Life Support.
(h) "CPR" means Cardiopulmonary Resuscitation.
(i) "Health Care Provider BLS/CPR" means Health Care Provider
Basic Life Support/Cardiopulmonary Resuscitation.
(j) "PALS" means Pediatric Advanced Life Support.
(k) "Board" means West Virginia Board of Dental Examiners,
(l) "ADA" means the American Dental Association.
(m) "AMA" means the American Medical Association.
(n) "Subcommittee" means West Virginia Board of Dental
Examiners Subcommittee on Anesthesia.
§30-4A-3. Presumption of Degree of Central Nervous System
Depression
.
(1) In any hearing where a question exists as to the degree of
central nervous system depression a licensee has induced (i.e.,
general anesthesia/deep conscious sedation, conscious sedation,
anxiolysis, or relative analgesia), the Board may base its findings
on, among other things, the types, dosages and routes of
administration of drugs administered to the patient and what result
can reasonably be expected from those drugs in those dosages and routes administered in a patient of that physical and psychological
status.
(2) No permit holder may have more than one person under
conscious sedation and/or general anesthesia/deep conscious
sedation at the same time, exclusive of recovery.
§30-4A-4. Requirement for Anesthesia Certificate or Permit.
(1) No dentist may induce central nervous system anesthesia
without first having obtained an anesthesia permit under these
rules for the level of anesthesia being induced.
(2) The applicant for an anesthesia permit must pay the
appropriate permit fees and renewal fees, designated in section
six of this article, submit a completed Board-approved application
and consent to an office evaluation. The fees are to be set in
accordance with section eighteen of this article.
(3) Permits shall be issued to coincide with the applicant's
licensing period.
§30-4A-5. Classes of Anesthesia Certificates and Permits.
The Board shall issue the following certificates and/or
permits:
(1) Class 2 Certificate: A Class 2 Certificate authorizes a
dentist to induce anxiolysis.
(2) Class 3 Permit: A Class 3 Permit authorizes a dentist to
induce conscious sedation as limited enteral (3a) and/or
comprehensive parenteral (3b), and anxiolysis.
(3) Class 4 Permit: A Class 4 Permit authorizes a dentist to induce general anesthesia/deep conscious sedation, conscious
sedation, and anxiolysis.
§30-4A-6. Qualifications, Standards Applicable, and Continuing
Education Requirements for Anesthesia Certificate
or Permit.
(a) Relative Analgesia.
(1) The Board shall allow administration of relative analgesia
without a permit if the practitioner:
(A) Is a licensed dentist in the State of West Virginia;
(B) Holds valid and current documentation showing successful
completion of a Health Care Provider BLS/CPR course; and
(C) Has completed a training course of instruction in dental
school, continuing education or as a postgraduate in the
administration of relative analgesia.
(2) A practitioner who administers relative analgesia shall
have the following facilities, equipment and drugs available during
the procedure and during recovery:
(A) An operating room large enough to adequately accommodate
the patient on an operating table or in an operating chair and to
allow delivery of age appropriate care in an emergency situation;
(B) An operating table or chair which permits the patient to
be positioned so that the patient's airway can be maintained,
quickly alter the patient's position in an emergency, and provide
a firm platform for the administration of basic life support;
(C) A lighting system which permits evaluation of the patient's skin and mucosal color and a backup lighting system of
sufficient intensity to permit completion of any operation underway
in the event of a general power failure;
(D) Suction equipment which permits aspiration of the oral and
pharyngeal cavities;
(E) An oxygen delivery system with adequate full face masks
and appropriate connectors that is capable of delivering high flow
oxygen to the patient under positive pressure, together with an
adequate backup system;
(F) A nitrous oxide delivery system with a fail-safe mechanism
that will insure appropriate continuous oxygen delivery and a
scavenger system.
(G) All equipment used must be appropriate for the height and
weight of the patient.
(3) Before inducing nitrous oxide sedation, a practitioner
shall:
(A) Evaluate the patient;
(B) Give instruction to the patient or, when appropriate due
to age or psychological status of the patient, the patient's
guardian;
(C) Certify that the patient is an appropriate candidate for
relative analgesia.
(4) A practitioner who administers relative analgesia shall
see that the patient's condition is visually monitored. At all
times the patient shall be observed by trained personnel until
discharge criteria have been met. Trained personnel shall be certified in both adult and pediatric CPR. Documentation of
credentials and training must be maintained in the personnel
records of the trained personnel. The patient shall be monitored as
to response to verbal stimulation and oral mucosal color.
(5) The record must include documentation of all medications
administered with dosages, time intervals and route of
administration.
(6) A discharge entry shall be made in the patient's record
indicating the patient's condition upon discharge.
(7) Hold valid and current documentation:
(A) Showing successful completion of a Health Care Provider
BLS/CPR course; and
(B) Have received training and be competent in the recognition
and treatment of medical emergencies, monitoring vital signs, the
operation of nitrous oxide delivery systems and the use of the
sphygmomanometer and stethoscope.
(8) The practitioner shall assess the patient's responsiveness
using preoperative values as normal guidelines and discharge the
patient only when the following criteria are met:
(A) The patient is alert and oriented to person, place and
time as appropriate to age and preoperative neurological status;
(B) The patient can talk and respond coherently to verbal
questioning or to preoperative neurological status;
(C) The patient can sit up unaided or without assistance or to
preoperative neurological status;
(D) The patient can ambulate with minimal assistance or to preoperative neurological status; and
(E) The patient does not have nausea, vomiting or dizziness.
(b)Class 2 Certificate.
Class 2 Certificate: Anxiolysis.
(1) The Board shall issue a Class 2 Certificate to an
applicant who:
(A) Is a licensed dentist in West Virginia;
(B) Holds valid and current documentation showing successful
completion of a Health Care Provider BLS/CPR; and
(C) Has completed a board approved course of at least 6 hours
didactic and clinical of either predoctoral dental school or
postgraduate instruction.
(2) A dentist who induces anxiolysis shall have the following
facilities, properly maintained equipment and appropriate drugs
available during the procedures and during recovery:
(A) An operating room large enough to adequately accommodate
the patient on an operating table or in an operating chair and to
allow an operating team of at least two individuals to freely move
about the patient;
(B) An operating table or chair which permits the patient to
be positioned so the operating team can maintain the patient's
airway, quickly alter the patient's position in an emergency, and
provide a firm platform for the administration of basic life
support;
(C) A lighting system which permits evaluation of the
patient's skin and mucosal color and a backup lighting system of sufficient intensity to permit completion of any operation underway
in the event of a general power failure;
(D) Suction equipment which permits aspiration of the oral and
pharyngeal cavities;
(E) An oxygen delivery system with adequate full face mask and
appropriate connectors that is capable of delivering high flow
oxygen to the patient under positive pressure, together with an
adequate backup system;
(F) A nitrous oxide delivery system with a fail-safe mechanism
that will insure appropriate continuous oxygen delivery and a
scavenger system;
(G) A recovery area that has available oxygen, adequate
lighting, suction and electrical outlets. The recovery area can be
the operating room;
(H) Sphygmomanometer, stethoscope, and pulse oximeter;
(I) Emergency drugs; and
(J) A defibrillator device is recommended.
(K) All equipment and medication dosages must be in accordance
with the height and weight of the patient being treated.
(3) Before inducing anxiolysis, a dentist shall:
(A) Evaluate the patient;
(B) Certify that the patient is an appropriate candidate for
anxiolysis sedation; and
(C) Obtain written informed consent from the patient or
patient's guardian for the anesthesia. The obtaining of the
informed consent shall be documented in the patient's record.
(4) The dentist shall monitor and record the patient's
condition or shall use trained personnel qualified as a monitor to
monitor and record the patient's condition. The trained personnel
must have a certificate showing successful completion in the last
two years of BLS/CPR training.
A Class 2 Certificate holder shall
have no more than one person under anxiolysis at the same time.
(5) The patient shall be monitored as follows:
(A) Patients must have continuous monitoring using pulse
oximetry. The patient's blood pressure, heart rate, and
respiration shall be recorded at least once before, during and
after the procedure, and these recordings shall be documented in
the patient record. At all times the patient shall be observed by
trained personnel until discharge criteria have been met. If the
dentist is unable to obtain this information, the reasons shall be
documented in the patient's record. The record must also include
documentation of all medications administered with dosages, time
intervals and route of administration.
(B) A discharge entry shall be made by the dentist in the
patient's record indicating the patient's condition upon discharge.
(6) A permit holder who uses anxiolysis shall see that the
patient's condition is visually monitored. The patient shall be
monitored as to response to verbal stimulation, oral mucosal color
and preoperative and postoperative vital signs.
(7) The dentist shall assess the patient's responsiveness
using preoperative values as normal guidelines and discharge the
patient only when the following criteria are met:
(A) Vital signs including blood pressure, pulse rate and
respiratory rate are stable;
(B) The patient is alert and oriented to person, place and
time as appropriate to age and preoperative neurological status;
(C) The patient can talk and respond coherently to verbal
questioning, or to preoperative neurological status;
(D) The patient can sit up unaided, or to preoperative
neurological status;
(E) The patient can ambulate with minimal assistance, or to
preoperative neurological status; and
(F) The patient does not have uncontrollable nausea or
vomiting and has minimal dizziness.
(G) A dentist shall not release a patient who has undergone
anxyolysis except to the care of a responsible adult third party.
(c) Class 3 Permit (includes a limited (enteral) and a
comprehensive (parenteral) permit);
Class 3 Permit: Conscious sedation and anxiolysis.
(1) The Board shall issue or renew a Class 3 Permit to an
applicant who:
(A) Is a licensed dentist in West Virginia;
(B) Holds valid and current documentation showing successful
completion of a Health Care Provider BLS/CPR course, ACLS and/or a
PALS course if treating pediatric patients; and
(C) Satisfies one of the following criteria:
(i) Certificate of completion of a comprehensive training
program in conscious sedation that satisfies the requirements described in Part III of the ADA Guidelines for Teaching the
Comprehensive Control of Pain and Anxiety in Dentistry at the time
training was commenced.
(ii) Certificate of completion of an ADA accredited
postdoctoral training program which affords comprehensive and
appropriate training necessary to administer and manage conscious
sedation, commensurate with these guidelines.
(iii) In lieu of these requirements, the Board may accept
documented evidence of equivalent training or experience in
conscious sedation anesthesia:
(I) Limited (Enteral) Permit (3(a)) must have a Board approved
course of at least eighteen hours didactic and twenty mentored
clinical cases (PALS or ACLS course).
(II) Comprehensive (Parenteral) Permit (3(b)) must have a
Board approved course of at least sixty hours didactic and twenty
mentored clinical cases (ACLS course).
(2) A dentist who induces conscious sedation shall have the
following facilities, properly maintained age appropriate equipment
and age appropriate medications available during the procedures and
during recovery:
(A) An operating room large enough to adequately accommodate
the patient on an operating table or in an operating chair and to
allow an operating team of at least two individuals to freely move
about the patient;
(B) An operating table or chair which permits the patient to
be positioned so the operating team can maintain the patient's airway, quickly alter the patient's position in an emergency, and
provide a firm platform for the administration of basic life
support;
(C) A lighting system which permits evaluation of the
patient's skin and mucosal color and a backup lighting system of
sufficient intensity to permit completion of any operation underway
in the event of a general power failure;
(D) Suction equipment which permits aspiration of the oral and
pharyngeal cavities and a backup suction device which will function
in the event of a general power failure;
(E) An oxygen delivery system with adequate full face mask and
appropriate connectors that is capable of delivering high flow
oxygen to the patient under positive pressure, together with an
adequate backup system;
(F) A nitrous oxide delivery system with a fail-safe mechanism
that will insure appropriate continuous oxygen delivery and a
scavenger system;
(G) A recovery area that has available oxygen, adequate
lighting, suction and electrical outlets. The recovery area can be
the operating room;
(H) Sphygmomanometer, pulse oximeter, oral and nasopharyngeal
airways, intravenous fluid administration equipment;
(I) Emergency drugs including, but not limited to:
pharmacologic antagonists appropriate to the drugs used,
vasopressors, corticosteroids, bronchodilators, antihistamines,
antihypertensives and anticonvulsants; and
(J) A defibrillator device.
(3) Before inducing conscious sedation, a dentist shall:
(A) Evaluate the patient and document, using the American
Society of Anesthesiologists Patient Physical Status
Classifications, that the patient is an appropriate candidate for
conscious sedation;
(B) Give written preoperative and postoperative instructions
to the patient or, when appropriate due to age or neurological
status of the patient, the patient's guardian; and
(C) Obtain written informed consent from the patient or
patient's guardian for the anesthesia.
(4) The dentist shall monitor and record the patient's
condition or shall use an assistant qualified as a monitor to
monitor and record the patient's condition. A qualified monitor
shall be present to monitor the patient at all times.
(5) The patient shall be monitored as follows:
(A) Patients must have continuous monitoring using pulse
oximetry. At no time shall the patient be unobserved by trained
personnel until discharge criteria have been met. The trained
personnel must have a certificate showing successful completion in
the last two years of BLS/CPR training and the American Association
of Oral and Maxillofacial Surgeon Office Anesthesia Assistant
certification or an equivalent. The patient's blood pressure, heart
rate, and respiration shall be recorded every 5 minutes, and these
recordings shall be documented in the patient record. The record
must also include documentation of preoperative and postoperative vital signs, all medications administered with dosages, time
intervals and route of administration. If the dentist is unable to
obtain this information, the reasons shall be documented in the
patient's record.
(B) During the recovery phase, the patient must be monitored
by a qualified monitor.
(C) A discharge entry shall be made by the dentist in the
patient's record indicating the patient's condition upon discharge
and the name of the responsible party to whom the patient was
discharged.
(6) A dentist shall not release a patient who has undergone
conscious sedation except to the care of a responsible adult third
party.
(7) The dentist shall assess the patient's responsiveness
using preoperative values as normal guidelines and discharge the
patient only when the following criteria are met:
(A) Vital signs including blood pressure, pulse rate and
respiratory rate are stable;
(B) The patient is alert and oriented to person, place and
time as appropriate to age and preoperative neurological status;
(C) The patient can talk and respond coherently to verbal
questioning, or to preoperative neurological status;
(D) The patient can sit up unaided, or to preoperative
neurological status;
(E) The patient can ambulate with minimal assistance, or to preoperative neurological status; and
(F) The patient does not have uncontrollable nausea or
vomiting and has minimal dizziness.
(8) A dentist who induces conscious sedation shall employ the
services of an assistant at all times who holds a valid BLS/CPR
certification and maintains such certification.
(9) A dentist granted a Class 3 Permit must hold a valid
Health Care Provider BLS/CPR and ACLS certification for
Comprehensive (3(a)) Permit and ACLS or PALS certification for
Limited (3(b)) Permit and maintain such certification.
(d) Class 4 Permit
Class 4 Permit: general anesthesia/deep conscious sedation,
conscious sedation, and anxiolysis.
(1) The Board shall issue a Class 4 Permit to an applicant
who:
(A) Is a licensed dentist in West Virginia;
(B) Has a current Advanced Cardiac Life Support (ACLS)
Certificate;
(C) Satisfies one of the following criteria:
(i) Completion of an advanced training program in anesthesia
and related subjects beyond the undergraduate dental curriculum
that satisfies the requirements described in Part II of the ADA
Guidelines for Teaching the Comprehensive Control of Pain and
Anxiety in Dentistry at the time training was commenced;
(ii) Completion of an ADA or AMA accredited postdoctoral
training program which affords comprehensive and appropriate training necessary to administer and manage general anesthesia,
commensurate with these Guidelines;
(iii) In lieu of these requirements, the Board may accept
documented evidence of equivalent training or experience in general
anesthesia.
(2) A dentist who induces general anesthesia/deep conscious
sedation shall have the following facilities, properly maintained
age appropriate equipment and age appropriate drugs available
during the procedure and during recovery:
(A) An operating room large enough to adequately accommodate
the patient on an operating table or in an operating chair and to
allow an operating team of at least three individuals to freely
move about the patient;
(B) An operating table or chair which permits the patient to
be positioned so the operating team can maintain the patient's
airway, quickly alter the patient's position in an emergency, and
provide a firm platform for the administration of basic life
support;
(C) A lighting system which permits evaluation of the
patient's skin and mucosal color and a backup lighting system of
sufficient intensity to permit completion of any operation underway
in the event of a general power failure;
(D) Suction equipment which permits aspiration of the oral and
pharyngeal cavities and a backup suction device which will function
in the event of a general power failure;
(E) An oxygen delivery system with adequate full face mask and appropriate connectors that is capable of delivering high flow
oxygen to the patient under positive pressure, together with an
adequate backup system;
(F) A nitrous oxide delivery system with a fail-safe mechanism
that will insure appropriate continuous oxygen delivery and a
scavenger system;
(G) A recovery area that has available oxygen, adequate
lighting, suction and electrical outlets. The recovery area can be
the operating room;
(H) Sphygmomanometer, pulse oximeter, electrocardiograph
monitor, defibrillator or automated external defibrillator,
laryngoscope with endotracheal tubes, oral and nasopharyngeal
airways, intravenous fluid administration equipment;
(I) Emergency drugs including, but not limited to:
pharmacologic antagonists appropriate to the drugs used,
vasopressors, corticosteroids, bronchodilators, intravenous
medications for treatment of cardiac arrest, narcotic antagonist,
antihistaminic, antiarrhythmics, antihypertensives and
anticonvulsants; and
(J) A defibrillator device.
(3) Before inducing general anesthesia/deep conscious sedation
the dentist shall:
(A) Evaluate the patient and document, using the American
Society of Anesthesiologists Patient Physical Status
Classifications, that the patient is an appropriate candidate for
general anesthesia or deep conscious sedation;
(B) Shall give written preoperative and postoperative
instructions to the patient or, when appropriate due to age or
neurological status of the patient, the patient's guardian; and
(C) Shall obtain written informed consent from the patient or
patient's guardian for the anesthesia.
(4) A dentist who induces general anesthesia/deep conscious
sedation shall monitor and record the patient's condition on a
contemporaneous record or shall use an assistant qualified as a
monitor to monitor and record the patient's condition on a
contemporaneous record. The trained personnel must have a
certificate showing successful completion in the last two years of
BLS/CPR training and the American Association of Oral and
Maxillofacial Surgeon Office Anesthesia Assistant certification or
an equivalent. No permit holder shall have more than one patient
under general anesthesia at the same time.
(5) The patient shall be monitored as follows:
(A) Patients must have continuous monitoring of their heart
rate, oxygen saturation levels and respiration. At no time shall
the patient be unobserved by trained personnel until discharge
criteria have been met. The patient's blood pressure, heart rate
and oxygen saturation shall be assessed every five minutes, and
shall be contemporaneously documented in the patient record. The
record must also include documentation of preoperative and
postoperative vital signs, all medications administered with
dosages, time intervals and route of administration. The person
administering the anesthesia may not leave the patient while the patient is under general anesthesia;
(B) During the recovery phase, the patient must be monitored,
including the use of pulse oximetry, by a qualified individual to
monitor patients recovering from general anesthesia.
(6) A dentist shall not release a patient who has undergone
general anesthesia/deep conscious sedation except to the care of a
responsible adult third party.
(7) The dentist shall assess the patient's responsiveness
using preoperative values as normal guidelines and discharge the
patient only when the following criteria are met:
(A) Vital signs including blood pressure, pulse rate and
respiratory rate are stable;
(B) The patient is alert and oriented to person, place and
time as appropriate to age and preoperative neurological status;
(C) The patient can talk and respond coherently to verbal
questioning, or to preoperative neurological status;
(D) The patient can sit up unaided, or to preoperative
neurological status;
(E) The patient can ambulate with minimal assistance, or to
preoperative neurological status; and
(F) The patient does not have nausea or vomiting and has
minimal dizziness.
(8) A discharge entry shall be made in the patient's record by
the dentist indicating the patient's condition upon discharge and
the name of the responsible party to whom the patient was
discharged.
(9) A dentist who induces general anesthesia shall employ the
services of a qualified dental assistant who holds a valid BLS/CPR
certification and maintains such certification.
(10) A Class 4 permit holder must hold a valid Health Care
Provider BLS/CPR and ACLS certification and maintain such
certification.
§30-4A-7. Authority of the West Virginia Board of Dental
Examiners to review, inspect and reinspect dentists
for issuance of permits.
On-site inspection by West
Virginia Board of Dental Examiners.
By making application to the Board for an anesthesia permit,
said dentist consents and authorizes the Board to review his or her
credentials, inspect or reinspect his or her facilities, and
investigate any alleged anesthesia mortalities, misadventure, or
other adverse occurrences which the Board feels is justified in the
best interest of the public and the Board. The Board shall have
the authority and right to conduct an in-office review or on-site
inspection of any dentist applying for or holding a permit to
administer anesthesia at any time the Board deems necessary.
Prior to issuing a permit, the Board has the right to conduct
an on-site inspection of facility, equipment, and auxiliary
personnel of the applicant to determine if, in fact, all the
requirements for such permit have been met. This inspection or
evaluation, if required, shall be carried out by at least two
members of the subcommittee directly appointed by the Board as prescribed in section eight of this article. This evaluation is to
be carried out in a manner following the principles, but not
necessarily the procedures, set forth by the current edition of the
Office Anesthesia Evaluation Manual of the West Virginia Board of
Dental Examiners. On-site inspections are required and shall be
performed for all Class 3(a), 3(b) and 4 Permit Holders.
Thereafter, the Board may reinspect annually, at its discretion,
but must perform an on-site inspection for all permit holders at
least once every five years excepting Class 2 Certificate holders.
The Board reserves the right to conduct an on-site inspection
whenever it deems necessary for all permit or certificate holders.
However, all on-site inspections shall be held during regular
business hours.
§30-4A-8. Office Evaluations.
(1) The in-office evaluation shall include:
(a) Observation of one or more cases of anesthesia to
determine the appropriateness of technique and adequacy of patient
evaluation and care;
(b) Inspection of facilities, equipment, drugs and records;
and
(2) The evaluation shall be performed by a team appointed by
the Board and shall include:
(a) A permit holder who has the same type of license as the
licensee to be evaluated and who holds a current anesthesia permit
in the same class or in a higher class than that held by the licensee being evaluated;
(b) A member of the Board's Anesthesia Committee;
(c) Class 2 Certificate Holders may be audited periodically as
determined by the committee; and
(d) Class 3 and 4 Permit holders shall be evaluated once every
five years.
§30-4A-9. Reporting of Death, Serious Complications or Injury.
If a death, any serious complication or any injury occurs
which may have resulted from the administration of general
anesthesia/deep conscious sedation, conscious sedation, anxiolysis,
or relative analgesia, the licensee performing the dental procedure
must submit a written detailed report to the Board within five days
of the incident along with copies of the patient's original
complete dental records. If the anesthetic agent was administered
by a person other than the person performing the dental procedure,
that person must also submit a detailed written report. The
detailed report(s) must include:
(1) Name, age and address of patient;
(2) Name of the licensee and other persons present during the
incident;
(3) Address where the incident took place;
(4) Type of anesthesia and dosages of drugs administered to
the patient;
(5) A narrative description of the incident including
approximate times and evolution of symptoms; and
(6) The anesthesia record and the signed informed consent form
for the anesthesia when required.
§30-4A-10. Immunity from liability.
(a) Notwithstanding any other provision of law, no person
providing information to the Board of Dental Examiners or to the
Subcommittee may be held, by reason of having provided such
information, to be civilly liable under any law unless such
information was false and the person providing such information
knew or had reason to believe that such information was false.
(b) No member or employee of the Board of Dental Examiners or
the Subcommittee may be held by reason of the performance by him or
her of any duty, function or activity authorized or required of the
Board or the Subcommittee to be civilly liable. The foregoing
provisions of this subsection shall not apply with respect to any
action taken by any individual if such individual, in taking such
action, was motivated by malice toward any person affected by such
action.
§30-4A-11. Effect on practicing dentists who are currently
administering or supervising general anesthesia or
parenteral conscious sedation.
Existing parenteral conscious sedation permits shall become
Class 3(b) Permits and general anesthesia permits shall become
Class 4 Permits.
§30-4A-12. New applicants.
On the effective date of this article and from that date forward, any dentist not previously administering or supervising
Class 2, 3 or 4 anesthesia or techniques but wishing to do so,
shall make application to the Board as prescribed herein. The
Board and the Subcommittee shall then review the applicant's
credentials and further will require an on-site evaluation of the
dentist's facilities, equipment, techniques, and personnel prior to
issuing a regular annual permit or certification. After the
initial on-site inspection, the Board, at its discretion, will
conduct further on-site evaluations.
§30-4A-13. Issuance of regular annual permits.
Upon the recommendation of the Subcommittee to the Board of
Dental Examiners, the Board shall issue regular permits to
applicable dentists. An anesthesia permit or certification must be
renewed annually as described in section fifteen of this article.
§30-4A-14.
Waiting period for reapplication or reinspection of
facilities.
A dentist whose application has been denied for failure to
satisfy the requirements in the application procedure or the
on-site evaluation must wait thirty days from the date of such
denial prior to reapplying and must submit to another on-site
evaluation prior to receiving a regular annual permit. It is the
responsibility of the Board and the Subcommittee to promptly
reinspect the applicant dentist's facilities, techniques,
equipment, and personnel within ninety days after said applicant
has made reapplication.
§30-4A-15. Application and Annual renewal of regular permits;
fees.
The Board of Dental Examiners shall require an initial
application fee and an annual renewal fee for Class 2 Certificate
and Class 3 and 4 Permits. Provided, however, that a person
currently holding a general anesthesia and/or parenteral conscious
sedation permit shall make application without an application fee
as set forth hereinabove. All permits shall expire on June 30th of
every year and renewal fees shall be due on or before June 30th of
every year. The Board shall renew permits for the use of
anesthesia after receiving the renewal fee unless the permit holder
has been informed in writing within sixty days prior to such
renewal date that a reevaluation of his or her credentials is
required. In determining whether such reevaluation is necessary,
the Board may consider such factors as it deems appropriate,
including, but not limited to patient, dentist or physician
complaints and reports of adverse occurrence or misadventures.
Reevaluation may also include a yearly on-site inspection of the
facility, equipment, personnel, licentiate and procedures utilized
by the holder of such permit. However, an on-site inspection of
the facility, equipment, personnel, licentiate and procedures
utilized by the holder of such a permit will be required for all
Class 3 and 4 Permit Holders within a five-year period from the
permit holder's last on-site inspection.
§30-4A-16. Violations of article; penalties for practicing anesthesia without a permit.
Violations of any of the provisions of this article, whether
intentional or unintentional, may result in the revocation or
suspension of the dentist's permit to administer anesthesia;
multiple or repeated violations or gross infractions, such as
practicing anesthesia without a valid permit may result in
suspension of the dentist's license to practice dentistry for up to
one year as well as other disciplinary measures as deemed
appropriate by the Board of Dental Examiners.
§30-4A-17.
Appointment of Subcommittee by the West Virginia Board
of Dental Examiners; credentials review; and on-site
inspections.
(1) The West Virginia Board of Dental Examiners shall appoint
a minimum of a four member Subcommittee to carry out the review and
on-site inspection of any dentist applying for or renewing a permit
under this article. The Subcommittee shall also make a
recommendation for issuing or revoking a permit under this article.
This Subcommittee shall be known as the "West Virginia Board of
Dental Examiners Subcommittee on Anesthesia," hereinafter referred
to as the "Subcommittee." The Subcommittee shall consist of one
member of the Board of Dental Examiners who shall act as chairman
of the Subcommittee, and two members holding a Class 4 permit and
two members holding a Class 3 permit. Further, the Board may
appoint additional members to this Subcommittee provided they have
the same credentials set forth hereinabove as necessary to carry out the duties of the Subcommittee.
(2) The Subcommittee shall have the authority to adopt
policies and procedures related to the regulation of general
anesthesia/deep conscious sedation, conscious sedation, anxiolysis,
and relative analgesia with the same being approved by the Board.
Said subcommittee members shall be paid and reimbursed expenses
pursuant to article four of this chapter.
§30-4A-18. Rule-making authority.
The board shall propose additional rules for legislative
approval in accordance with the provisions of article three,
chapter twenty-nine-a of this code to implement the provisions of
this article including, but not limited to, the following:
(a)Fees;
(b)Evaluations;
(c)Equipment; and
(d)Education.
NOTE: The purpose of this bill is to rewrite the law regarding the
administration of anesthesia by dentists.
This article has been rewritten; therefore, strike-throughs
and underscoring have been omitted.