SB210INTRODUCED
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4UKBRR-1
By Senator Roberts
RFD: Healthcare
First Read: 12-Apr-23
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SYNOPSIS:
This bill would provide for the regulation of
licensed dentists performing teledentistry orthodontia
services in the state by the Board of Dental Examiners.
This bill would require patients to have
in-person visits with a dentist before starting, and
annually during teledentistry treatments.
This bill would require advertisements relating
to teledentistry to contain certain disclaimers.
This bill would also require the board to adopt
rules relating to teledentistry.
A BILL
TO BE ENTITLED
AN ACT
Relating to the practice of dentistry; to amend
Sections 34-9-1, 34-9-3, 34-9-6, 34-9-13, 34-9-15.1, and
34-9-18, Code of Alabama 1975, and to add Sections 34-9-6.2
and 34-9-19.2 to the Code of Alabama 1975, to provide for the
use of teledentistry orthodontia services in the state by
licensed dentists; to provide certain requirements for
advertisements featuring teledentistry; and to require the
Board of Dental Examiners of Alabama to adopt rules relating
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to teledentistry.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Sections 34-9-1, 34-9-3, 34-9-6, 34-9-13,
34-9-15.1, and 34-9-18 of the Code of Alabama 1975, are
amended to read as follows:
"§34-9-1
For the purposes of this chapter, the following terms
shall have the respective meanings ascribed by this section:
(1) ANNUAL REGISTRATION. The documentary evidence that
the board has renewed the authority of the licensee to
practice dentistry or dental hygiene in this state.
(2) ASYNCHRONOUS TECHNOLOGY. Store-and-forward
technology that allows a licensed dentist to transmit a
patient's health information to another licensed dentist for
viewing at a later time.
(2)(3) BOARD. The Board of Dental Examiners of Alabama.
(3)(4) COMMERCIAL DENTAL LABORATORY. A technician or
group of technicians available to any or all licensed dentists
for construction or repair of dental appliances.
(4)(5) GENERAL ANESTHESIA. A controlled state of
unconsciousness, accompanied by a partial or complete loss of
protective reflexes, including inability to independently
maintain an airway and respond purposefully to physical
stimulation or verbal command, produced by a pharmacologic
method.
(5)(6) INFILTRATION ANESTHESIA. A form of local
anesthesia wherein the terminal or peripheral sensory portion
of either the maxillary or mandibular branch of the trigeminal
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nerve endings are anesthetized by injecting a solution
submucosally into an intra-oral circumscribed area for the
relief or prevention of pain.
(6)(7) LICENSE. The grant of authority by the board to
a person an individual to engage in the practice of dentistry ,
teledentistry, or dental hygiene.
(7)(8) LICENSE CERTIFICATE. The documentary evidence
under seal of the board that the board has granted authority
to the licensee to practice dentistry , teledentistry, or
dental hygiene in this state.
(8)(9) LICENSED DENTIST. A dentist who holds a current
license certificate from the board.
(9)(10) LICENSED HYGIENIST. A hygienist who holds a
current license certificate from the board.
(10)(11) LOCAL ANESTHESIA. The elimination of
sensations, especially pain in one part of the body , by
topical application or regional injection of a drug.
(11)(12) PATIENT ABANDONMENT. The termination of dental
treatment without giving the patient adequate notice of at
least 15 days before the termination of dental treatment.
Adequate notice includes informing the patient of the
availability of emergency treatment and providing the patient
with an opportunity to obtain the services of another dentist
during the notice period. Abandonment may also occur if the
dentist jeopardizes the health of the patient during the
termination process.
(12)(13) PRACTICE OF DENTISTRY ACROSS STATE LINES.
a. The practice of dentistry as defined in Section
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34-9-6 as it applies to the following:
1. The rendering of a written or otherwise documented
professional opinion concerning the diagnosis or treatment of
a patient located within this state by a dentist located
outside this state as a result of transmission of individual
patient data by electronic or other means from within this
state to the dentist or his or her agent.
2. The rendering of treatment to a patient located
within this state by a dentist located outside this state as a
result of transmission of individual patient data by
electronic or other means from this state to the dentist or
his or her agent.
3. The holding of himself or herself out as qualified
to practice dentistry, or use of any title, word, or
abbreviation to indicate or induce others to believe that he
or she is licensed to practice dentistry across state lines.
b. This definition is not intended to include an
informal consultation between a licensed dentist located in
this state and a dentist located outside this state , provided
that the consultation is conducted without compensation or the
expectation of compensation to either dentist, and does not
result in the formal rendering of a written or otherwise
documented professional opinion concerning the diagnosis or
treatment of a patient by the dentist located outside the
state.
(13)(14) PRIVATE TECHNICIANS. A technician employed by
a dentist or group of dentists for a specified salary.
(14)(15) SEDATION. A depressed level of consciousness
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that retains the patient's ability to independently and
continuously maintain an airway and respond appropriately to
physical stimulation or verbal command, produced by a
pharmacologic method.
(16) SYNCHRONOUS TECHNOLOGY. Two-way audiovisual
technology that allows a licensed dentist to see and
communicate in real time with a patient who is located in a
different physical location.
(17) TELEDENTISTRY. a. The practice of dentistry or the
delivery of dental care services through asynchronous or
synchronous technology including any of the following:
1. The use of interactive audio and video technology,
permitting real-time communication between the patient at the
originating site and the provider to provide dental services,
within their scope of practice including, but not limited to,
assessment, diagnosis, consultation, treatment, and monitoring
of a patient; transfer of medical data; patient and
professional dental-related education; public dental services;
and dental administration.
2. Asynchronous, store-and-forward technology for the
transmission and acquisition of images, diagnostics, data, and
dental information.
b. The term does not include Internet questionnaires,
email messages, or facsimile transmissions. "
"§34-9-3
It shall be unlawful for any person individual to
practice dentistry or teledentistry in the State of Alabama
except the following:
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(1) Those who are now duly licensed or permitted
dentists, pursuant to law.
(2) Those who may be hereafter duly licensed or
permitted and who are currently registered as dentists,
pursuant to this chapter.
(3) Those nonresident dentists who have been issued a
special purpose license to practice dentistry across state
lines in accordance with Section 34-9-10. This subdivision
shall not apply to those dentists who hold a full,
unrestricted, and current license or permit issued pursuant to
Section 34-9-8 or Section 34-9-10."
"§34-9-6
Any person individual shall be deemed to be practicing
dentistry, including teledentistry, who does any of the
following:
(1) Performs, or attempts or professes to perform, any
dental operation or dental service of any kind, gratuitously
or for a salary, fee, money, or other remuneration paid, or to
be paid, directly or indirectly, to himself or herself, or to
any person individual in his or her behalf, or to any agency
which is a proprietor of a place where dental operations or
dental services are performed.
(2) Directly or indirectly, by any means or method,
makes impression of the human tooth, teeth, jaws, or adjacent
tissue, or performs any phase of any operation incident to the
replacement of a tooth or any part thereof.
(3) Supplies artificial substitutes for the natural
teeth, and who furnishes, supplies, constructs, reproduces, or
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repairs any prosthesis (fixed or removable), appliance, or any
other structure to be worn in the human mouth.
(4) Places such an appliance or structure in the human
mouth, or adjusts, attempts, or professes to adjust the same,
or delivers the same to any person individual other than the
dentist upon whose prescription the work was performed.
(5) Professes to the public by any method to furnish,
supply, construct, reproduce, or repair any prosthesis (fixed
or removable), appliance, or other structure to be worn in the
human mouth, or who diagnoses, or professes to diagnose,
prescribe prescribes for, professes to prescribe for, treats
or professes to treat disease, pain, deformity, deficiency,
injury, or physical condition of the human teeth or jaws, or
adjacent structure, or who extracts or attempts to extract
human teeth, or removes tumors, abnormal growths, or other
lesions from the human gums, jaws, and adjacent structures, or
who operates for cleft lip or palate, or both; or who treats
surgically or mechanically fractures of the human jaw; or who
administers local or general anesthetics in the treatment of
any dental lesion.
(6) Repairs or fills cavities in the human teeth.
(7) Uses a roentgen, radiograph, or digital imaging
machine for the purpose of making dental roentgenograms,
radiographs, or digital images, or who gives, or professes to
give, interpretations or readings of dental roentgenograms,
radiographs, or digital images, or radiographic or roentgen
therapy.
(8) Administers an anesthetic of any nature in
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connection with a dental procedure.
(9) Uses the words "dentist," "dental surgeon," "oral
surgeon," or the letters "D.D.S.," "D.M.D." or any other
words, letters, title, or descriptive matter which in any way
represents him or her as being able to diagnose, treat,
prescribe, or operate for any disease, pain, deformity,
deficiency, injury, or physical condition of the teeth or
jaws, or adjacent structures.
(10) States, or professes, or permits to be stated or
professed by any means or method whatsoever that he or she can
perform or will attempt to perform dental procedures, or
render a diagnosis connected therewith.
(11) Performs any clinical operation included in the
curricula of recognized dental colleges; provided, that
members of the faculty, teachers, instructors, fellows,
interns, residents, dental students, and student dental
hygienists who are employed by or who are taking courses or
instructions at the University of Alabama School of Dentistry
or such other dental colleges, hospitals, or institutions in
Alabama, as may be approved by the board; and provided, that
the work of fellows, interns, residents, dental students, and
student dental hygienists is performed within the facilities
of such the dental colleges, hospitals, and institutions under
the supervision of an instructor and as an adjunct to his or
her course of study or training, shall not be required to take
examination or obtain a license certificate and renewal
license certificate when all of such the work, dental
procedures, and activities are confined to his or her work in
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the college, hospital, or other institution and the work is
done without remuneration other than the regular salary or
compensation paid by such the colleges, hospitals, or other
institutions.
(12) Professes to the public by any method to bleach
human teeth, performs bleaching of the human teeth alone or
within his or her business, or instructs the public within his
or her business, or through any agent or employee of his or
her business, in the use of any tooth bleaching product."
"§34-9-13
(a) Every practitioner of dentistry and dental hygiene
within the meaning of this chapter shall have in his or her
possession and posted in a visible location a license
certificate and an annual registration certificate in the
office wherein he or she practices. A licensed practitioner
who practices in more than one location may reproduce the
annual registration certificate as needed; however, the
practitioner may not reproduce the license certificate. Copies
of the license certificate may be requested by the
practitioner from the board as necessary.
(b) Every patient who is receiving dental services
shall be provided with the name, contact telephone number,
after hours contact information for emergencies and, upon the
patient's request, the license information for any licensed
dentist who is providing dental services to a patient. "
"§34-9-15.1
(a) Upon the request of a patient or authorized agent
of a patient, a dentist shall promptly release to the patient
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or his or her authorized agent legible and accurate copies of
all records of the patient regardless of how they are
generated or maintained. The reasonable costs of reproducing
copies shall not be more than the amounts authorized by
statute and in the absence of any statutory authority no more
than the actual cost of the reproduction.
(b) The release of records under this section shall not
be made contingent upon the payment of any fee or charge owed
by the patient.
(c) The provisions of the section shall survive the
closing of a dental office or practice for any reason ,
including, but not limited to, sale of practice, any
disciplinary action, retirement, disability, or death.
(d)(1) The dentist-patient relationship shall terminate
when either the dentist of record or the patient, or both,
provides express notice that he or she intends to terminate
the dentist-patient relationship. If no express notification
is provided, the relationship is considered terminated, and
the dentist of record is relieved of responsibility, when
there is no longer a reasonable expectation from either the
dentist or the patient of continuing treatment with that
dentist.
(2) For a patient being treated utilizing
teledentistry, the licensed dentist of record is primarily
responsible for all dental treatment on a patient regardless
of whether the treatment is rendered by the licensed dentist
of record or by another licensed dentist or dental hygienist
rendering treatment in conjunction with, at the direction or
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request of, or under the supervision of the licensed dentist
of record.
a. Any individual, partnership, corporation, or other
entity that provides dental services through teledentistry
shall make available the name, telephone number, practice
address, and state license number of any licensed dentist who
will be involved in providing services to a patient before the
rendering of services and when requested by the patient.
b. This section shall not be construed to assign any
responsibility to a licensed dentist of record for treatment
rendered pursuant to a proper referral to another licensed
dentist not in practice with the licensed dentist of record or
to prohibit a patient from voluntarily selecting a new
licensed dentist without permission of the licensed dentist of
record."
"§34-9-18
(a) The board may invoke disciplinary action as
outlined in subsection (b) whenever it shall be established to
the satisfaction of the board, after a hearing as hereinafter
provided, that any dentist or dental hygienist has been guilty
of is, or has been, any of the following:
(1) Fraud Guilty of fraud , deceit, or misrepresentation
in obtaining any license, license certificate, annual
registration certificate, money, or other thing of value.
(2) Gross Guilty of gross immorality.
(3) Is a A menace to the public health or to patients
or others by reason of a disease.
(4) Is an An habitual user of intoxicants or drugs
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rendering him or her unfit for the practice of dentistry or
dental hygiene.
(5) Has been convicted for violation of Convicted of
violating federal or state narcotics or barbiturate laws.
(6) Is guilty Guilty of negligence or gross negligence.
a. For the purposes of this subdivision, negligence is
defined as the failure to do what a reasonably prudent dentist
or dental hygienist would have done under the same or similar
circumstances or the doing of that which a reasonably prudent
practitioner would not have done under the same or similar
circumstances.
b. For the purposes of this subdivision, gross
negligence is defined as willful or wanton conduct with
reckless, malicious, or conscious disregard for the rights or
safety of others, or conduct that is so deliberate,
outrageous, and callous as to display total indifference to
the health or safety of a patient, that could result in
serious bodily injury or death.
(7) Is guilty Guilty of employing, allowing, or
permitting any unlicensed person or persons individual to
perform any work in his or her office which, under this
chapter, can only be legally done by a person or persons an
individual holding a license to practice dentistry or dental
hygiene.
(8) Willfully Guilty of willfully or negligently
violates violating the rules of the State Alabama Department
of Public Health or of the board regarding sanitation.
(9) Is guilty Guilty of division of fees, or agreeing
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to split or divide the fee received for dental service with
any person individual for bringing or referring a patient
without the knowledge of the patient or his or her legal
representative, except the division of fees between dentists
practicing in a partnership and sharing professional fees, or
in case of one licensed dentist employing another.
(10) Is guilty Guilty of professional connection or
association with or lending his or her name to anyone who is
engaged in the illegal practice of dentistry or dental
hygiene.
(11) Conviction Convicted in any court of competent
jurisdiction of a felony or a misdemeanor involving moral
turpitude.
(12)a. A dental hygienist using or attempting to use in
any manner whatsoever any prophylactic list, call list,
records, reprints, or copies of same, or information gathered
therefrom, of the names of patients whom the dental hygienist
served in the office of a prior employer, unless the names
appear upon the bona fide call or prophylactic list of his or
her present employer and were caused to appear through the
legitimate practice of dentistry or dental hygiene as provided
for in this chapter.
b. A licensed dentist who aids or abets or encourages a
dental hygienist employed by him or her to make use of a
prophylactic list or the calling by telephone or by the use of
letters transmitted through the mails to solicit patronage
from patients formerly served in the office of any dentist
employing the hygienist.
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(13) Pertaining to licensed dentists only, the guilty
of prescribing, administering , or dispensing of any controlled
substances enumerated in Schedules I through V contained in
the Alabama Uniform Controlled Substances Act, Chapter 2 of
Title 20, or any amendment or successor thereto, or any drug
not prescribed for any dentally or facially related condition,
and/or or for any necessary medication during the course of
treatment rendered directly by the dentist, for any person
individual not under his or her treatment in the regular
practice of his or her profession.
(14) Irregularities Guilty of irregularities in billing
an insurance company or other third party payer for services
rendered to a patient. For the purposes of this section
subsection, irregularities in billing shall include any of the
following: Reporting charges for the purpose of obtaining a
total payment in excess of that usually received by the
dentist for the services rendered; falsely reporting treatment
dates for the purpose of obtaining payment; falsely reporting
charges for services not rendered; falsely reporting services
rendered for the purpose of obtaining payment; or failing to
advise any third party payer that the copayment provisions of
a contract have been abrogated by accepting the payment
received from the third party payer as full payment.
(15) Pertaining to licensed dentists only, guilty of
patient abandonment.
(16) Violating Guilty of violating any rule adopted by
the board.
(17) Has had Guilty of having his or her license or
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permit to practice dentistry or dental hygiene from another
state suspended or revoked based upon acts similar to those
described in this section. A certified copy of the record of
suspension or revocation of the state making the suspension or
revocation shall be conclusive evidence thereof.
(18) As the licensed dentist of record, and before the
initial diagnosis and correction of malpositions of human
teeth or initial use of orthodontic appliances, is guilty of
failing to perform an examination of the patient, which
includes a physical examination of the patient as well as a
review of the most recent diagnostic digital or conventional
radiographs of the patient, or other equivalent bone imaging
suitable for orthodontia.
(18) Violating(19) Is guilty of violating any provision
of this chapter.
(b) When the board finds any dentist or dental
hygienist guilty of any of the grounds set forth in subsection
(a), it the board may enter an order imposing one or more of
the following penalties:
(1) Refuse to issue the dentist or dental hygienist any
license or permit provided for in this chapter.
(2) With the exception of negligence , as defined in
paragraph (a)(6)a. , revoke the license or permit of any
dentist or dental hygienist.
(3) Suspend the license or permit of any dentist or
dental hygienist.
(4) Enter a censure.
(5) Issue an order fixing a period and terms of
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probation best adapted to protect the public health and safety
and to rehabilitate the dentist or dental hygienist.
(6) Impose an administrative fine not to exceed five
thousand dollars ($5,000) for each count or separate offense.
(7) Impose restrictions on the scope of practice.
(8) Impose peer review or professional education
requirements.
(9) Assess the costs of the disciplinary proceedings.
(c) Failure to comply with any order of the board ,
including, but not limited to, an order of censure or
probation, is cause for suspension or revocation of a license.
(d)(1) No disciplinary action as outlined in subsection
(b) or (c) shall be invoked or entered except after a hearing
by the board as provided in this chapter, and such any order
is subject to judicial review as provided by this chapter.
(2) No order of suspension or revocation provided in
this section shall be made or entered except after a hearing
by the board as provided in this chapter, and the order shall
be subject to judicial review as provided by this chapter.
(e)(1) The board may temporarily suspend a special
purpose license to practice dentistry across state lines
without a hearing on either of the following grounds:
a. The failure of the licensee to appear or produce
records or materials as requested by the board.
b. The initiation of a disciplinary action against the
licensee by any state or territorial licensing jurisdiction in
which the licensee holds a license to practice dentistry.
(2) Notwithstanding any other provision of law,
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including the Alabama Administrative Procedure Act, the
temporary suspension provided herein by this subsection shall
remain in effect until either the licensee has complied with
the request of the board or the disciplinary action pending
against the licensee has been terminated in favor of the
licensee and the temporary suspension has been terminated by a
written order of the board. A special purpose license to
practice dentistry across state lines is subject to each of
the grounds for disciplinary action provided in this section
subsection in accordance with the procedures of Section
34-9-24 and the Alabama Administrative Procedure Act.
(f) Members of the board, any agent, employee,
consultant, or attorney for the board, and the members of any
committee of dentists or dental hygienists impaneled by the
board, shall be immune from suits for any conduct in the
course of their official duties with respect to investigations
or hearings; provided, that the persons individuals act
without malice and in good faith that such any investigations
or hearings are warranted by the facts, known to them after
diligent effort to obtain the facts of the matter relative to
the investigations or hearings.
(g) Nothing in this chapter shall be interpreted to
limit or restrict the authority of the board to discipline any
dentist licensed to practice in this state who violates this
chapter while engaging in the practice of dentistry within
this or any other state.
(h) The board shall have the authority to may adopt
rules imposing a non-disciplinary administrative penalty for
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designated violations of this chapter."
Section 2. Sections 34-9-6.2 and 34-9-19.2 are added to
the Code of Alabama 1975, to read as follows:
§34-9-6.2
(a) The standard of dental care a licensed dentist
provides through teledentistry shall be the same as the
standard of dental care a licensed dentist provides in a
traditional physical setting.
(b)(1) A treating licensed dentist may use
teledentistry to collaborate with a licensed hygienist within
the relevant applicable scopes of practice and under the
appropriate level of dentist supervision, in accordance with
this chapter.
(2) A licensed hygienist or any other teledentistry
provider may not carry out any duties through teledentistry
that require the in-person supervision of a licensed dentist.
(c) A licensed dentist may not conduct a dental
examination using teledentistry if the standard of care
necessitates a traditional physical dental examination.
(d) A licensed dentist may provide dental services
using teledentistry, including any of the following:
(1) Collaborating with a licensed dentist in the
completion of any of the following at a public health setting,
generally with a written collaborative agreement, directly or
indirectly, in accordance with this chapter:
a. Gathering diagnostic information to be used by the
licensed dentist at a remote location to form a tentative
basic treatment plan and provide appropriate preventive or
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urgent prescriptions.
b. Perform preventive dental procedures.
c. Provide oral health education.
d. Perform any palliative or interim treatment or
caries arresting treatment outlined in the treatment plan and
authorized by the licensed dentist, in accordance with this
chapter and rules adopted pursuant to this chapter.
(2) At a remote location, using records and diagnostic
information that a licensed hygienist provides to form a
tentative treatment plan for basic dental procedures.
(e)(1) Prior to the diagnosis and correction of
malpositions of human teeth or initial use of orthodontic
appliances, a treating dentist shall do all of the following:
a. Perform a physical examination of the patient that
includes the review of the most recent diagnostic digital or
conventional radiographs of the patient, or other equivalent
bone imaging suitable for orthodontia and that meets the
standard of care. New radiographs or other equivalent bone
imaging shall be ordered if deemed appropriate by the treating
dentist.
b. Perform diagnosis and treatment planning in
consultation with the patient.
(2) A patient receiving orthodontia services through
teledentistry shall be provided with the name, direct
telephone number, emergency contact telephone number, physical
practice address, and state license number of the treating
dentist who will be involved in the teledentistry services.
The information shall be provided to the patient both before
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services are provided and during treatment.
(3) A dentist who provides orthodontia services to a
patient through teledentistry must provide the patient with a
timely opportunity to have follow-up care to address any
concerns regarding the services provided and describe to the
patient the protocols for emergencies or follow-up care where
the patient needs to be seen by the treating dentist in
person.
(f) A licensed dentist or any entity employing a
licensed dentist may not require a patient to sign an
agreement that limits the ability of the patient to file a
complaint with the board, subjects the patient to a
nondisclosure agreement concerning the outcome of his or her
treatment, forfeits his or her right to participate in a class
action lawsuit, limits the liability of a licensed dentist to
the patient, or waives his or her right to a trial by jury.
(g) When a licensed dentist uses teledentistry, the
licensed dentist shall ensure informed consent covers all of
the following additional information:
(1) A description of the types of dental care services
provided through teledentistry, including limitations on
services.
(2) The name, contact information, licensure,
credentials, and qualifications of all licensed dentists and
licensed hygienists involved in the dental care of the patient
and opportunities for the patient to directly communicate with
those individuals, whether in person, by telephone, or through
synchronous teledentistry technology, so that the patient may
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ask questions about the treatment to be provided.
(3) Precautions and protocols for technological
failures or emergency situations.
(h) To be eligible to participate in and receive
teledentistry services, a patient shall complete at least one
in-person visit with a licensed dentist annually.
(i) The board, by rule, shall establish additional
requirements and parameters regarding teledentistry to ensure
the safe use of teledentistry including, but not limited to,
all of the following:
(1) Transparency, disclosure, and informed consent.
(2) Standard of care.
(3) Proper documentation.
(4) Supervision and scope of practice.
(5) Patient complaints.
(6) Protocols for referrals.
§34-9-19.2
(a) For the purposes of this section, an advertisement
is information communicated in a manner designed to attract
public attention to the practice of a licensed dentist.
(b) In addition to complying with all applicable
advertising requirements provided in Sections 34-9-19 and
34-9-19.1, an advertisement for dental services provided
through teledentistry shall include the following conspicuous
disclaimer:
"An in-person examination with a licensed dentist is
recommended in order to prevent injury or harm before
beginning treatment for the following services:
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(1) The taking of an impression or digital scanning of
the human tooth, teeth, or jaws directly or indirectly and by
any means or method.
(2) Furnishing, supplying, constructing, reproducing,
or repairing any prosthetic denture, bridge, appliance, or any
structure designed to be worn in the human mouth.
(3) The placing of an appliance or structure in the
human mouth or the adjusting or attempting to adjust the same.
(4) Correcting or attempting to correct malformations
of teeth or of jaws."
Section 3. This act shall become effective on the first
day of the third month following its passage and approval by
the Governor, or its otherwise becoming law.
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