Amended IN Assembly April 08, 2024 Amended IN Assembly March 18, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2526Introduced by Assembly Member GipsonFebruary 13, 2024An act to amend Sections 1646, 1646.1, 1646.2, 1646.3, 1646.7, 1646.10, and 1646.11 of 2827, 2833, and 2833.3 of, and to add Sections 1646.14 and 2831.5 to, the Business and Professions Code, relating to healing arts. LEGISLATIVE COUNSEL'S DIGESTAB 2526, as amended, Gipson. Dentistry: deep sedation and general anesthesia: dedicated permitted anesthesia provider. Nurse anesthetists.Existing law, the Nurse Anesthetists Act, provides for the certification and regulation of nurse anesthetists by the Board of Registered Nursing within the Department of Consumer Affairs. If a general anesthetic agent is administered in a dental office, existing law requires the dentist to hold a permit authorized by the provisions governing a dentists use of deep sedation and general anesthesia. Existing law provides that nothing under the act is to be construed to limit a certified nurse anesthetists ability to practice nursing.This bill would delete the above-described requirement that a dentist hold a specified permit if a general anesthetic agent is administered in a dental office and would instead prescribe specified circumstances in which general anesthesia or deep sedation is to be administered in a dental office by a nurse anesthetist.This bill would also provide that a certified registered nurse anesthetist who is licensed under the act and is registered with the federal Drug Enforcement Agency has prescriptive authority to select, order, or administer prescription drugs, as defined, upon a request issued by a dentist as specified. The bill would authorize a nurse anesthetist to prescribe prescription drugs only for an individual whom the nurse anesthetist has established a client or patient record at the time of the prescription. The bill would require a nurse anesthetist to complete training set forth by the agency upon registration or renewal of registration with the agency. The bill would provide that nothing under the Nursing Practice Act affects the authority of a licensed nurse anesthetist to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. Existing law authorizes a licensed physician and surgeon to administer deep sedation or general anesthesia in the office of a licensed dentist for dental patients if specified conditions are met, including that they hold a valid general anesthesia permit issued by the board as prescribed.This bill would authorize a certified registered nurse anesthetist to administer general anesthesia or deep sedation in the office of a licensed dentist for dental patients if specified conditions are met, including that they hold a valid general anesthesia permit issued by the board as prescribed. To obtain that permit, the bill would require a nurse anesthetist to apply to the board on an application form prescribed by the board and to submit, among other things, payment of an application fee. Prior to issuance or renewal of a permit pursuant to these provisions, the bill authorizes the board to require an onsite inspection and evaluation of the facility, equipment, and personnel, as specified. If a nurse anesthetist fails an onsite inspection and evaluation, the bill would require their permit be automatically suspended for 30 days, as specified. The bill would authorize a nurse anesthetist who additionally meets certain requirements to apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under 7 years of age.By expanding the scope of existing crimes under the Nurse Anesthetists Act and the Dental Practice Act, this bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. Under existing law, a dentist is required to possess certain permits, as prescribed, to administer or order the administration of deep sedation or general anesthesia, as those terms are defined, on an outpatient basis for dental patients. Existing law requires a dentist who desires to administer or order the administration of deep sedation or general anesthesia to apply to the board on an application form prescribed by the board. As part of their application, existing law requires a dentist to submit an application fee and produce evidence showing that they have successfully completed specified requirements.This bill would revise existing permit requirements to require a dentist to possess, among other things, a general anesthesia administration or ordering permit issued by the board for the purpose of administering or ordering the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, as defined. For a permit to order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, the bill would require a dentist to apply to the board on the appropriate application form prescribed by the board, submit an application fee, and include documentation that required equipment and drugs are on the premises. The bill would, in addition to any other requirement imposed by law, provide that a dedicated permitted anesthesia provider, other than the operating dentist, who administers deep sedation or general anesthesia to dental patients under seven years of age, provide proof of specified information.Existing law requires any dentist that holds a general anesthesia permit to maintain specified information, including medical history and general anesthesia records as required by board regulations.This bill would provide, in addition to any dentist that holds a general anesthesia permit, that any dentist whose office administers deep sedation or general anesthesia is also required to maintain the specified information.Existing law makes a violation of specified provisions grounds for suspension or revocation of a physician and surgeons permit issued as specified. Existing law requires the board to refer a violation by a physician and surgeon to the Medical Board of California, as specified.This bill would delete the provision that requires the board to refer a violation by a physician and surgeon to the Medical Board of California, make a violation of specified provisions by a dentist grounds for suspension or revocation of the dentists permit issued by the board, and authorize the board to investigate and consider the violation as unprofessional conduct. The bill would authorize the Medical Board of California and the Board of Registered Nursing to investigate violations of specified provisions by a physician and surgeon or a certified nurse anesthetist, respectively, and to consider the violation as unprofessional conduct.Existing law requires a general anesthesia permit to expire on a prescribed date that next occurs after the permits issuance, unless the permit is renewed as specified. Existing law authorizes a general anesthesia permitholder who has a permit that was issued before January 1, 2022, to follow the terms of that existing permit until it expires. Existing law requires any permit issued or renewed, as specified, on or after January 1, 2022, to require the permitholder to follow new requirements.This bill would revise the expiration provision to provide that a general anesthesia administration or ordering permit is required to expire on a prescribed date, as specified. The bill would provide that a physician and surgeon who has a permit to administer general anesthesia in the office of a dentist before January 1, 2025, may follow the terms of that existing permit until it expires. The bill would require the board to adopt emergency regulations to implement these provisions.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOYES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1646.14 is added to the Business and Professions Code, to read:1646.14. (a) Notwithstanding any other law, including, but not limited to, Sections 1646.1 and 1647.2, a certified registered nurse anesthetist licensed pursuant to Chapter 6 (commencing with Section 2700) and certified as a nurse anesthetist pursuant to Article 7 (commencing with Section 2825) of Chapter 6 may administer general anesthesia or deep sedation in the office of a licensed dentist to dental patients without regard to whether the dentist possesses a permit issued pursuant to this article, if both of the following conditions are met:(1) The nurse anesthetist holds a valid general anesthesia permit issued by the Dental Board of California pursuant to subdivision (b).(2) The nurse anesthetist meets the requirements of subdivision (d) of Section 1646.1.(b) A certified registered nurse anesthetist who desires to administer general anesthesia or deep sedation under subdivision (a) shall apply to the board on an application form prescribed by the board and shall submit all of the following:(1) Payment of an application fee prescribed by this article.(2) Evidence satisfactory to the board and the Board of Registered Nursing showing that the applicant has successfully completed an accredited program as defined in subdivision (b) of Section 2826.(3) Documentation demonstrating that all equipment and drugs required by the board are on the premises for use in any dental office in which the nurse anesthetist administers general anesthesia or deep sedation.(c) Prior to issuance or renewal of a permit pursuant to this section, the board may at its discretion require an onsite inspection and evaluation of the facility, equipment, and personnel, including, but not limited to, the certified registered nurse anesthetist and procedures utilized. At least one of the people evaluating the procedures utilized by the nurse anesthetist shall be a certified registered nurse anesthetist expert in outpatient general anesthesia or deep sedation who has been authorized or retained under contract by the board for this purpose.(d) A certified registered nurse anesthetist who has failed an onsite inspection and evaluation shall have their permit automatically suspended for 30 days after the date on which the board notifies the nurse anesthetist of the failure unless within that time period the nurse anesthetist has retaken and passed an onsite inspection and evaluation. A nurse anesthetist who is issued a permit under this article shall be subject to an onsite inspection and evaluation at least once every five years. Refusal to submit to an inspection shall result in automatic denial or revocation of the permit.(e) A certified registered nurse anesthetist who additionally meets the requirements of paragraphs (2) and (3) of subdivision (c) of Section 1646.2 may apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under seven years of age. A nurse anesthetist without sufficient cases to obtain a pediatric endorsement may qualify for the endorsement pursuant to the requirements of subdivision (d) of Section 1646.2.SEC. 2. Section 2827 of the Business and Professions Code is amended to read:2827. (a) The utilization of a nurse anesthetist to provide anesthesia services in an acute care facility shall be approved by the acute care facility administration and the appropriate committee, and at the discretion of the physician, dentist or podiatrist. If a general anesthetic agent is administered in a dental office, the dentist shall hold a permit authorized by Article 2.7 (commencing with Section 1646) of Chapter 4 or, commencing January 1, 2022, Article 2.75 (commencing with Section 1646) of Chapter 4.(b) General anesthesia or deep sedation administered in a dental office by a nurse anesthetist shall be in accordance with both of the following:(1) Article 2.75 (commencing with Section 1646) of Chapter 4.(2) Paragraph (2) of subdivision (b) of Section 2725.SEC. 3. Section 2831.5 is added to the Business and Professions Code, to read:2831.5. (a) As used in this section, the following definitions apply:(1) Order means the process of directing a licensed individual, pursuant to their statutory authority, to directly administer a drug or to dispense, deliver, or distribute a drug for the purpose of direct administration to a patient, under instructions of the certified registered nurse anesthetist to provide prescription drugs.(2) Prescription drugs includes Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code).(3) Select means the decisionmaking process of choosing a drug, dosage, route, and time of administration.(b) (1) A certified registered nurse anesthetist who is licensed pursuant to this article and is registered with the federal Drug Enforcement Agency shall have prescriptive authority to select, order, or administer prescription drugs upon a request issued by a dentist under Article 2.75 (commencing with Section 1646) of Chapter 4 to administer anesthesia for diagnostic, operative, or therapeutic procedures in an outpatient dental setting.(2) A certified registered nurse anesthetist under paragraph (1) shall prescribe prescription drugs based on their level of professional education, training, and certification by the National Board of Certification and Recertification for Nurse Anesthetists, or a successor national professional organization approved by the board.(c) A certified registered nurse anesthetist shall only prescribe prescription drugs under subdivision (b) for an individual whom the certified registered nurse anesthetist has, at the time of the prescription, established a client or patient record.SEC. 4. Section 2833 of the Business and Professions Code is amended to read:2833. (a) Each certificate issued pursuant to this article shall be renewable biennially, and each person holding a certificate under this article shall apply for a renewal of their certificate and pay the biennial renewal fee required by Section 2830.7 every two years on or before the last day of the month following the month in which their birthday occurs, beginning with the second birthday following the date on which the certificate was issued, whereupon the board shall renew the certificate.(b) Each certificate not renewed in accordance with this section shall expire but may within a period of eight years thereafter be reinstated upon payment of the biennial renewal fee and penalty fee required by Section 2830.7 and upon submission of proof of the applicants qualifications as may be required by the board. During the eight-year period, no examination shall be required as a condition for the reinstatement of any expired certificate that has lapsed solely by reason of nonpayment of the renewable fee. After the expiration of the eight-year period the board may require, as a condition of reinstatement, that the applicant pass an examination as it deems necessary to determine their present fitness to resume the practice of nurse anesthesia.(c) Upon registration or renewal of registration with the federal Drug Enforcement Agency, a certified registered nurse anesthetist shall complete the required training as set forth by the agency.SEC. 5. Section 2833.3 of the Business and Professions Code is amended to read:2833.3. (a) Nothing in this article shall be construed to limit a certified nurse anesthetists ability to practice nursing.(b) Nothing in this chapter shall affect the authority of a certified registered nurse anesthetist licensed pursuant to this article to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.SEC. 6. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.SECTION 1.Section 1646 of the Business and Professions Code is amended to read:1646.As used in this article, the following definitions apply:(a)Deep sedation means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.(b)General anesthesia means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.(c)Dedicated permitted anesthesia provider means any of the following:(1)A physician and surgeon who has successfully completed a postgraduate residency training program in anesthesiology that is recognized by the Accreditation Council on Graduate Medical Education pursuant to Section 2079.(2)A certified nurse anesthetist licensed under Article 2 (commencing with Section 2725) or Article 7 (commencing with Section 2825) of Chapter 6.(3)A dentist licensed under this chapter who possesses a general anesthesia administration permit from the board pursuant to this article.SEC. 2.Section 1646.1 of the Business and Professions Code is amended to read:1646.1.(a)A dentist shall possess either a current license in good standing and a general anesthesia administration or ordering permit issued by the board or a permit under Section 1638 or 1640 and a general anesthesia administration or ordering permit issued by the board to administer or order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider on an outpatient basis for dental patients.(b)A dentist shall possess a pediatric endorsement of their general anesthesia permit to administer or order the administration of deep sedation or general anesthesia to patients under seven years of age.(c)A dentist shall be physically within the dental office at the time of ordering, and during the administration of, general anesthesia or deep sedation.(d)For patients under 13 years of age, all of the following shall apply:(1)The operating dentist and at least two additional personnel shall be present throughout the procedure involving deep sedation or general anesthesia.(2)If the operating dentist is the permitted anesthesia provider, then both of the following shall apply:(A)The operating dentist and at least one of the additional personnel shall maintain current certification in Pediatric Advanced Life Support (PALS) or other board-approved training in pediatric life support and airway management, adopted pursuant to Section 1601.8. The additional personnel who is certified in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management shall be solely dedicated to monitoring the patient and shall be trained to read and respond to monitoring equipment including, but not limited to, pulse oximeter, cardiac monitor, blood pressure, pulse, capnograph, and respiration monitoring devices.(B)The operating dentist shall be responsible for initiating and administering any necessary emergency response.(3)If a dedicated permitted anesthesia provider other than the operating dentist is monitoring the patient and administering deep sedation or general anesthesia, both of the following shall apply:(A)The anesthesia provider and the operating dentist, or one other trained personnel, shall be present throughout the procedure and shall maintain current certification in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management, adopted pursuant to Section 1601.8.(B)The anesthesia provider shall be responsible for initiating and administering any necessary emergency response and the operating dentist, or other trained and designated personnel, shall assist the anesthesia provider in emergency response.(e)This article does not apply to the administration of local anesthesia, minimal sedation, or moderate sedation.SEC. 3.Section 1646.2 of the Business and Professions Code is amended to read:1646.2.(a)A dentist who desires to administer or order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider shall apply to the board on the appropriate administration or ordering permit application form prescribed by the board.(b)(1)For a permit to administer deep sedation or general anesthesia, a dentist shall submit an application fee and produce evidence showing that they have successfully completed a minimum of one year of advanced training in anesthesiology and related academic subjects approved by the board, or equivalent training or experience approved by the board, beyond the undergraduate school level.(2)If the deep sedation or general anesthesia is to be administered in the dentists office, the application shall also include documentation that equipment and drugs required by the board are on the premises.(c)For a permit to order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, a dentist shall submit an application fee and include documentation that equipment and drugs required by the board are on the premises. (d)A dentist may apply for a pediatric endorsement for the general anesthesia permit by providing proof of successful completion of all of the following:(1)A Commission on Dental Accreditation (CODA)-accredited or equivalent residency training program that provides competency in the administration of deep sedation and general anesthesia on pediatric patients.(2)At least 20 cases of deep sedation or general anesthesia to patients under seven years of age in the 24-month time period directly preceding application for a pediatric endorsement to establish competency, both at the time of initial application and at renewal. The applicant or permitholder shall maintain and be able to provide proof of these cases upon request by the board for up to three permit renewal periods.(3)Current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) or other board-approved training in pediatric life support and airway management, pursuant to Section 1601.8, for the duration of the permit.(e)Applicants for a pediatric endorsement who otherwise qualify for the pediatric endorsement but lack sufficient cases of pediatric sedation to patients under seven years of age may administer deep sedation and general anesthesia to patients under seven years of age under the direct supervision of a general anesthesia permitholder with a pediatric endorsement. The applicant may count these cases toward the 20 cases required to qualify for the applicants pediatric endorsement.(f)In addition to any other requirement imposed by law, a dedicated permitted anesthesia provider, other than the operating dentist, who administers deep sedation or general anesthesia to dental patients under seven years of age shall provide proof of all of the following:(1)At least 20 cases of deep sedation or general anesthesia to patients under seven years of age in the prior 24-month time period.(2)Current certification in ACLS and PALS.SEC. 4.Section 1646.3 of the Business and Professions Code is amended to read:1646.3.(a)A physical evaluation and medical history shall be taken before the administration of deep sedation or general anesthesia.(b)Any dentist holding a permit and in whose office the deep sedation or general anesthesia is administered shall maintain medical history, physical evaluation, deep sedation, and general anesthesia records as required by board regulations.SEC. 5.Section 1646.7 of the Business and Professions Code is amended to read:1646.7.(a)A violation of this article constitutes unprofessional conduct and is grounds for the revocation or suspension of the dentists permit or license, or both. The board shall issue probationary terms only for violations that do not result in bodily harm.(b)(1)A violation of any provision of this article or Section 1682 by a dentist is grounds for suspension or revocation of the dentists permit issued pursuant to this article and may be investigated and considered as unprofessional conduct by the board.(2)A violation of any provision of this article by a physician and surgeon or a certified nurse anesthetist may be investigated and considered as unprofessional conduct by the Medical Board of California, pursuant to Chapter 5 (commencing with Section 2000) or the Board of Registered Nursing, pursuant to Chapter 6 (commencing with Section 2700), as appropriate.(c)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.SEC. 6.Section 1646.10 of the Business and Professions Code is amended to read:1646.10.A general anesthesia administration or ordering permit issued by the board under this article shall expire on the date provided in Section 1715 that next occurs after its issuance, unless it is renewed as provided in this article.SEC. 7.Section 1646.11 of the Business and Professions Code is amended to read:1646.11.(a)A general anesthesia permitholder who has a permit that was issued before January 1, 2022, may follow the terms of that existing permit until it expires. Any permit issued or renewed pursuant to this article on or after January 1, 2025, shall require the permitholder to follow the new requirements of this article.(b)A physician and surgeon who has a permit to administer general anesthesia in the office of a dentist, pursuant to Section 2079, before January 1, 2025, may follow the terms of that existing permit until it expires and shall not be required to obtain a new permit until the expiration of the existing permit. Any permit issued or renewed pursuant to this article on or after January 1, 2025, shall require the permitholder to follow the new requirements of this article.(c)The board shall revise its current regulations and adopt new regulations to implement this article. The adoption, amendment, repeal, or readoption of a regulation authorized by this section is deemed to address an emergency, for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the board is hereby exempted for this purpose from the requirements of subdivision (b) of Section 11346.1 of the Government Code.
Amended IN Assembly April 08, 2024 Amended IN Assembly March 18, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2526Introduced by Assembly Member GipsonFebruary 13, 2024An act to amend Sections 1646, 1646.1, 1646.2, 1646.3, 1646.7, 1646.10, and 1646.11 of 2827, 2833, and 2833.3 of, and to add Sections 1646.14 and 2831.5 to, the Business and Professions Code, relating to healing arts. LEGISLATIVE COUNSEL'S DIGESTAB 2526, as amended, Gipson. Dentistry: deep sedation and general anesthesia: dedicated permitted anesthesia provider. Nurse anesthetists.Existing law, the Nurse Anesthetists Act, provides for the certification and regulation of nurse anesthetists by the Board of Registered Nursing within the Department of Consumer Affairs. If a general anesthetic agent is administered in a dental office, existing law requires the dentist to hold a permit authorized by the provisions governing a dentists use of deep sedation and general anesthesia. Existing law provides that nothing under the act is to be construed to limit a certified nurse anesthetists ability to practice nursing.This bill would delete the above-described requirement that a dentist hold a specified permit if a general anesthetic agent is administered in a dental office and would instead prescribe specified circumstances in which general anesthesia or deep sedation is to be administered in a dental office by a nurse anesthetist.This bill would also provide that a certified registered nurse anesthetist who is licensed under the act and is registered with the federal Drug Enforcement Agency has prescriptive authority to select, order, or administer prescription drugs, as defined, upon a request issued by a dentist as specified. The bill would authorize a nurse anesthetist to prescribe prescription drugs only for an individual whom the nurse anesthetist has established a client or patient record at the time of the prescription. The bill would require a nurse anesthetist to complete training set forth by the agency upon registration or renewal of registration with the agency. The bill would provide that nothing under the Nursing Practice Act affects the authority of a licensed nurse anesthetist to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. Existing law authorizes a licensed physician and surgeon to administer deep sedation or general anesthesia in the office of a licensed dentist for dental patients if specified conditions are met, including that they hold a valid general anesthesia permit issued by the board as prescribed.This bill would authorize a certified registered nurse anesthetist to administer general anesthesia or deep sedation in the office of a licensed dentist for dental patients if specified conditions are met, including that they hold a valid general anesthesia permit issued by the board as prescribed. To obtain that permit, the bill would require a nurse anesthetist to apply to the board on an application form prescribed by the board and to submit, among other things, payment of an application fee. Prior to issuance or renewal of a permit pursuant to these provisions, the bill authorizes the board to require an onsite inspection and evaluation of the facility, equipment, and personnel, as specified. If a nurse anesthetist fails an onsite inspection and evaluation, the bill would require their permit be automatically suspended for 30 days, as specified. The bill would authorize a nurse anesthetist who additionally meets certain requirements to apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under 7 years of age.By expanding the scope of existing crimes under the Nurse Anesthetists Act and the Dental Practice Act, this bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. Under existing law, a dentist is required to possess certain permits, as prescribed, to administer or order the administration of deep sedation or general anesthesia, as those terms are defined, on an outpatient basis for dental patients. Existing law requires a dentist who desires to administer or order the administration of deep sedation or general anesthesia to apply to the board on an application form prescribed by the board. As part of their application, existing law requires a dentist to submit an application fee and produce evidence showing that they have successfully completed specified requirements.This bill would revise existing permit requirements to require a dentist to possess, among other things, a general anesthesia administration or ordering permit issued by the board for the purpose of administering or ordering the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, as defined. For a permit to order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, the bill would require a dentist to apply to the board on the appropriate application form prescribed by the board, submit an application fee, and include documentation that required equipment and drugs are on the premises. The bill would, in addition to any other requirement imposed by law, provide that a dedicated permitted anesthesia provider, other than the operating dentist, who administers deep sedation or general anesthesia to dental patients under seven years of age, provide proof of specified information.Existing law requires any dentist that holds a general anesthesia permit to maintain specified information, including medical history and general anesthesia records as required by board regulations.This bill would provide, in addition to any dentist that holds a general anesthesia permit, that any dentist whose office administers deep sedation or general anesthesia is also required to maintain the specified information.Existing law makes a violation of specified provisions grounds for suspension or revocation of a physician and surgeons permit issued as specified. Existing law requires the board to refer a violation by a physician and surgeon to the Medical Board of California, as specified.This bill would delete the provision that requires the board to refer a violation by a physician and surgeon to the Medical Board of California, make a violation of specified provisions by a dentist grounds for suspension or revocation of the dentists permit issued by the board, and authorize the board to investigate and consider the violation as unprofessional conduct. The bill would authorize the Medical Board of California and the Board of Registered Nursing to investigate violations of specified provisions by a physician and surgeon or a certified nurse anesthetist, respectively, and to consider the violation as unprofessional conduct.Existing law requires a general anesthesia permit to expire on a prescribed date that next occurs after the permits issuance, unless the permit is renewed as specified. Existing law authorizes a general anesthesia permitholder who has a permit that was issued before January 1, 2022, to follow the terms of that existing permit until it expires. Existing law requires any permit issued or renewed, as specified, on or after January 1, 2022, to require the permitholder to follow new requirements.This bill would revise the expiration provision to provide that a general anesthesia administration or ordering permit is required to expire on a prescribed date, as specified. The bill would provide that a physician and surgeon who has a permit to administer general anesthesia in the office of a dentist before January 1, 2025, may follow the terms of that existing permit until it expires. The bill would require the board to adopt emergency regulations to implement these provisions.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOYES
Amended IN Assembly April 08, 2024 Amended IN Assembly March 18, 2024
Amended IN Assembly April 08, 2024
Amended IN Assembly March 18, 2024
CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION
Assembly Bill
No. 2526
Introduced by Assembly Member GipsonFebruary 13, 2024
Introduced by Assembly Member Gipson
February 13, 2024
An act to amend Sections 1646, 1646.1, 1646.2, 1646.3, 1646.7, 1646.10, and 1646.11 of 2827, 2833, and 2833.3 of, and to add Sections 1646.14 and 2831.5 to, the Business and Professions Code, relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2526, as amended, Gipson. Dentistry: deep sedation and general anesthesia: dedicated permitted anesthesia provider. Nurse anesthetists.
Existing law, the Nurse Anesthetists Act, provides for the certification and regulation of nurse anesthetists by the Board of Registered Nursing within the Department of Consumer Affairs. If a general anesthetic agent is administered in a dental office, existing law requires the dentist to hold a permit authorized by the provisions governing a dentists use of deep sedation and general anesthesia. Existing law provides that nothing under the act is to be construed to limit a certified nurse anesthetists ability to practice nursing.This bill would delete the above-described requirement that a dentist hold a specified permit if a general anesthetic agent is administered in a dental office and would instead prescribe specified circumstances in which general anesthesia or deep sedation is to be administered in a dental office by a nurse anesthetist.This bill would also provide that a certified registered nurse anesthetist who is licensed under the act and is registered with the federal Drug Enforcement Agency has prescriptive authority to select, order, or administer prescription drugs, as defined, upon a request issued by a dentist as specified. The bill would authorize a nurse anesthetist to prescribe prescription drugs only for an individual whom the nurse anesthetist has established a client or patient record at the time of the prescription. The bill would require a nurse anesthetist to complete training set forth by the agency upon registration or renewal of registration with the agency. The bill would provide that nothing under the Nursing Practice Act affects the authority of a licensed nurse anesthetist to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. Existing law authorizes a licensed physician and surgeon to administer deep sedation or general anesthesia in the office of a licensed dentist for dental patients if specified conditions are met, including that they hold a valid general anesthesia permit issued by the board as prescribed.This bill would authorize a certified registered nurse anesthetist to administer general anesthesia or deep sedation in the office of a licensed dentist for dental patients if specified conditions are met, including that they hold a valid general anesthesia permit issued by the board as prescribed. To obtain that permit, the bill would require a nurse anesthetist to apply to the board on an application form prescribed by the board and to submit, among other things, payment of an application fee. Prior to issuance or renewal of a permit pursuant to these provisions, the bill authorizes the board to require an onsite inspection and evaluation of the facility, equipment, and personnel, as specified. If a nurse anesthetist fails an onsite inspection and evaluation, the bill would require their permit be automatically suspended for 30 days, as specified. The bill would authorize a nurse anesthetist who additionally meets certain requirements to apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under 7 years of age.By expanding the scope of existing crimes under the Nurse Anesthetists Act and the Dental Practice Act, this bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. Under existing law, a dentist is required to possess certain permits, as prescribed, to administer or order the administration of deep sedation or general anesthesia, as those terms are defined, on an outpatient basis for dental patients. Existing law requires a dentist who desires to administer or order the administration of deep sedation or general anesthesia to apply to the board on an application form prescribed by the board. As part of their application, existing law requires a dentist to submit an application fee and produce evidence showing that they have successfully completed specified requirements.This bill would revise existing permit requirements to require a dentist to possess, among other things, a general anesthesia administration or ordering permit issued by the board for the purpose of administering or ordering the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, as defined. For a permit to order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, the bill would require a dentist to apply to the board on the appropriate application form prescribed by the board, submit an application fee, and include documentation that required equipment and drugs are on the premises. The bill would, in addition to any other requirement imposed by law, provide that a dedicated permitted anesthesia provider, other than the operating dentist, who administers deep sedation or general anesthesia to dental patients under seven years of age, provide proof of specified information.Existing law requires any dentist that holds a general anesthesia permit to maintain specified information, including medical history and general anesthesia records as required by board regulations.This bill would provide, in addition to any dentist that holds a general anesthesia permit, that any dentist whose office administers deep sedation or general anesthesia is also required to maintain the specified information.Existing law makes a violation of specified provisions grounds for suspension or revocation of a physician and surgeons permit issued as specified. Existing law requires the board to refer a violation by a physician and surgeon to the Medical Board of California, as specified.This bill would delete the provision that requires the board to refer a violation by a physician and surgeon to the Medical Board of California, make a violation of specified provisions by a dentist grounds for suspension or revocation of the dentists permit issued by the board, and authorize the board to investigate and consider the violation as unprofessional conduct. The bill would authorize the Medical Board of California and the Board of Registered Nursing to investigate violations of specified provisions by a physician and surgeon or a certified nurse anesthetist, respectively, and to consider the violation as unprofessional conduct.Existing law requires a general anesthesia permit to expire on a prescribed date that next occurs after the permits issuance, unless the permit is renewed as specified. Existing law authorizes a general anesthesia permitholder who has a permit that was issued before January 1, 2022, to follow the terms of that existing permit until it expires. Existing law requires any permit issued or renewed, as specified, on or after January 1, 2022, to require the permitholder to follow new requirements.This bill would revise the expiration provision to provide that a general anesthesia administration or ordering permit is required to expire on a prescribed date, as specified. The bill would provide that a physician and surgeon who has a permit to administer general anesthesia in the office of a dentist before January 1, 2025, may follow the terms of that existing permit until it expires. The bill would require the board to adopt emergency regulations to implement these provisions.
Existing law, the Nurse Anesthetists Act, provides for the certification and regulation of nurse anesthetists by the Board of Registered Nursing within the Department of Consumer Affairs. If a general anesthetic agent is administered in a dental office, existing law requires the dentist to hold a permit authorized by the provisions governing a dentists use of deep sedation and general anesthesia. Existing law provides that nothing under the act is to be construed to limit a certified nurse anesthetists ability to practice nursing.
This bill would delete the above-described requirement that a dentist hold a specified permit if a general anesthetic agent is administered in a dental office and would instead prescribe specified circumstances in which general anesthesia or deep sedation is to be administered in a dental office by a nurse anesthetist.
This bill would also provide that a certified registered nurse anesthetist who is licensed under the act and is registered with the federal Drug Enforcement Agency has prescriptive authority to select, order, or administer prescription drugs, as defined, upon a request issued by a dentist as specified. The bill would authorize a nurse anesthetist to prescribe prescription drugs only for an individual whom the nurse anesthetist has established a client or patient record at the time of the prescription. The bill would require a nurse anesthetist to complete training set forth by the agency upon registration or renewal of registration with the agency. The bill would provide that nothing under the Nursing Practice Act affects the authority of a licensed nurse anesthetist to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.
Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. Existing law authorizes a licensed physician and surgeon to administer deep sedation or general anesthesia in the office of a licensed dentist for dental patients if specified conditions are met, including that they hold a valid general anesthesia permit issued by the board as prescribed.
This bill would authorize a certified registered nurse anesthetist to administer general anesthesia or deep sedation in the office of a licensed dentist for dental patients if specified conditions are met, including that they hold a valid general anesthesia permit issued by the board as prescribed. To obtain that permit, the bill would require a nurse anesthetist to apply to the board on an application form prescribed by the board and to submit, among other things, payment of an application fee. Prior to issuance or renewal of a permit pursuant to these provisions, the bill authorizes the board to require an onsite inspection and evaluation of the facility, equipment, and personnel, as specified. If a nurse anesthetist fails an onsite inspection and evaluation, the bill would require their permit be automatically suspended for 30 days, as specified. The bill would authorize a nurse anesthetist who additionally meets certain requirements to apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under 7 years of age.
By expanding the scope of existing crimes under the Nurse Anesthetists Act and the Dental Practice Act, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. Under existing law, a dentist is required to possess certain permits, as prescribed, to administer or order the administration of deep sedation or general anesthesia, as those terms are defined, on an outpatient basis for dental patients. Existing law requires a dentist who desires to administer or order the administration of deep sedation or general anesthesia to apply to the board on an application form prescribed by the board. As part of their application, existing law requires a dentist to submit an application fee and produce evidence showing that they have successfully completed specified requirements.
This bill would revise existing permit requirements to require a dentist to possess, among other things, a general anesthesia administration or ordering permit issued by the board for the purpose of administering or ordering the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, as defined. For a permit to order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, the bill would require a dentist to apply to the board on the appropriate application form prescribed by the board, submit an application fee, and include documentation that required equipment and drugs are on the premises. The bill would, in addition to any other requirement imposed by law, provide that a dedicated permitted anesthesia provider, other than the operating dentist, who administers deep sedation or general anesthesia to dental patients under seven years of age, provide proof of specified information.
Existing law requires any dentist that holds a general anesthesia permit to maintain specified information, including medical history and general anesthesia records as required by board regulations.
This bill would provide, in addition to any dentist that holds a general anesthesia permit, that any dentist whose office administers deep sedation or general anesthesia is also required to maintain the specified information.
Existing law makes a violation of specified provisions grounds for suspension or revocation of a physician and surgeons permit issued as specified. Existing law requires the board to refer a violation by a physician and surgeon to the Medical Board of California, as specified.
This bill would delete the provision that requires the board to refer a violation by a physician and surgeon to the Medical Board of California, make a violation of specified provisions by a dentist grounds for suspension or revocation of the dentists permit issued by the board, and authorize the board to investigate and consider the violation as unprofessional conduct. The bill would authorize the Medical Board of California and the Board of Registered Nursing to investigate violations of specified provisions by a physician and surgeon or a certified nurse anesthetist, respectively, and to consider the violation as unprofessional conduct.
Existing law requires a general anesthesia permit to expire on a prescribed date that next occurs after the permits issuance, unless the permit is renewed as specified. Existing law authorizes a general anesthesia permitholder who has a permit that was issued before January 1, 2022, to follow the terms of that existing permit until it expires. Existing law requires any permit issued or renewed, as specified, on or after January 1, 2022, to require the permitholder to follow new requirements.
This bill would revise the expiration provision to provide that a general anesthesia administration or ordering permit is required to expire on a prescribed date, as specified. The bill would provide that a physician and surgeon who has a permit to administer general anesthesia in the office of a dentist before January 1, 2025, may follow the terms of that existing permit until it expires. The bill would require the board to adopt emergency regulations to implement these provisions.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 1646.14 is added to the Business and Professions Code, to read:1646.14. (a) Notwithstanding any other law, including, but not limited to, Sections 1646.1 and 1647.2, a certified registered nurse anesthetist licensed pursuant to Chapter 6 (commencing with Section 2700) and certified as a nurse anesthetist pursuant to Article 7 (commencing with Section 2825) of Chapter 6 may administer general anesthesia or deep sedation in the office of a licensed dentist to dental patients without regard to whether the dentist possesses a permit issued pursuant to this article, if both of the following conditions are met:(1) The nurse anesthetist holds a valid general anesthesia permit issued by the Dental Board of California pursuant to subdivision (b).(2) The nurse anesthetist meets the requirements of subdivision (d) of Section 1646.1.(b) A certified registered nurse anesthetist who desires to administer general anesthesia or deep sedation under subdivision (a) shall apply to the board on an application form prescribed by the board and shall submit all of the following:(1) Payment of an application fee prescribed by this article.(2) Evidence satisfactory to the board and the Board of Registered Nursing showing that the applicant has successfully completed an accredited program as defined in subdivision (b) of Section 2826.(3) Documentation demonstrating that all equipment and drugs required by the board are on the premises for use in any dental office in which the nurse anesthetist administers general anesthesia or deep sedation.(c) Prior to issuance or renewal of a permit pursuant to this section, the board may at its discretion require an onsite inspection and evaluation of the facility, equipment, and personnel, including, but not limited to, the certified registered nurse anesthetist and procedures utilized. At least one of the people evaluating the procedures utilized by the nurse anesthetist shall be a certified registered nurse anesthetist expert in outpatient general anesthesia or deep sedation who has been authorized or retained under contract by the board for this purpose.(d) A certified registered nurse anesthetist who has failed an onsite inspection and evaluation shall have their permit automatically suspended for 30 days after the date on which the board notifies the nurse anesthetist of the failure unless within that time period the nurse anesthetist has retaken and passed an onsite inspection and evaluation. A nurse anesthetist who is issued a permit under this article shall be subject to an onsite inspection and evaluation at least once every five years. Refusal to submit to an inspection shall result in automatic denial or revocation of the permit.(e) A certified registered nurse anesthetist who additionally meets the requirements of paragraphs (2) and (3) of subdivision (c) of Section 1646.2 may apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under seven years of age. A nurse anesthetist without sufficient cases to obtain a pediatric endorsement may qualify for the endorsement pursuant to the requirements of subdivision (d) of Section 1646.2.SEC. 2. Section 2827 of the Business and Professions Code is amended to read:2827. (a) The utilization of a nurse anesthetist to provide anesthesia services in an acute care facility shall be approved by the acute care facility administration and the appropriate committee, and at the discretion of the physician, dentist or podiatrist. If a general anesthetic agent is administered in a dental office, the dentist shall hold a permit authorized by Article 2.7 (commencing with Section 1646) of Chapter 4 or, commencing January 1, 2022, Article 2.75 (commencing with Section 1646) of Chapter 4.(b) General anesthesia or deep sedation administered in a dental office by a nurse anesthetist shall be in accordance with both of the following:(1) Article 2.75 (commencing with Section 1646) of Chapter 4.(2) Paragraph (2) of subdivision (b) of Section 2725.SEC. 3. Section 2831.5 is added to the Business and Professions Code, to read:2831.5. (a) As used in this section, the following definitions apply:(1) Order means the process of directing a licensed individual, pursuant to their statutory authority, to directly administer a drug or to dispense, deliver, or distribute a drug for the purpose of direct administration to a patient, under instructions of the certified registered nurse anesthetist to provide prescription drugs.(2) Prescription drugs includes Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code).(3) Select means the decisionmaking process of choosing a drug, dosage, route, and time of administration.(b) (1) A certified registered nurse anesthetist who is licensed pursuant to this article and is registered with the federal Drug Enforcement Agency shall have prescriptive authority to select, order, or administer prescription drugs upon a request issued by a dentist under Article 2.75 (commencing with Section 1646) of Chapter 4 to administer anesthesia for diagnostic, operative, or therapeutic procedures in an outpatient dental setting.(2) A certified registered nurse anesthetist under paragraph (1) shall prescribe prescription drugs based on their level of professional education, training, and certification by the National Board of Certification and Recertification for Nurse Anesthetists, or a successor national professional organization approved by the board.(c) A certified registered nurse anesthetist shall only prescribe prescription drugs under subdivision (b) for an individual whom the certified registered nurse anesthetist has, at the time of the prescription, established a client or patient record.SEC. 4. Section 2833 of the Business and Professions Code is amended to read:2833. (a) Each certificate issued pursuant to this article shall be renewable biennially, and each person holding a certificate under this article shall apply for a renewal of their certificate and pay the biennial renewal fee required by Section 2830.7 every two years on or before the last day of the month following the month in which their birthday occurs, beginning with the second birthday following the date on which the certificate was issued, whereupon the board shall renew the certificate.(b) Each certificate not renewed in accordance with this section shall expire but may within a period of eight years thereafter be reinstated upon payment of the biennial renewal fee and penalty fee required by Section 2830.7 and upon submission of proof of the applicants qualifications as may be required by the board. During the eight-year period, no examination shall be required as a condition for the reinstatement of any expired certificate that has lapsed solely by reason of nonpayment of the renewable fee. After the expiration of the eight-year period the board may require, as a condition of reinstatement, that the applicant pass an examination as it deems necessary to determine their present fitness to resume the practice of nurse anesthesia.(c) Upon registration or renewal of registration with the federal Drug Enforcement Agency, a certified registered nurse anesthetist shall complete the required training as set forth by the agency.SEC. 5. Section 2833.3 of the Business and Professions Code is amended to read:2833.3. (a) Nothing in this article shall be construed to limit a certified nurse anesthetists ability to practice nursing.(b) Nothing in this chapter shall affect the authority of a certified registered nurse anesthetist licensed pursuant to this article to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.SEC. 6. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.SECTION 1.Section 1646 of the Business and Professions Code is amended to read:1646.As used in this article, the following definitions apply:(a)Deep sedation means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.(b)General anesthesia means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.(c)Dedicated permitted anesthesia provider means any of the following:(1)A physician and surgeon who has successfully completed a postgraduate residency training program in anesthesiology that is recognized by the Accreditation Council on Graduate Medical Education pursuant to Section 2079.(2)A certified nurse anesthetist licensed under Article 2 (commencing with Section 2725) or Article 7 (commencing with Section 2825) of Chapter 6.(3)A dentist licensed under this chapter who possesses a general anesthesia administration permit from the board pursuant to this article.SEC. 2.Section 1646.1 of the Business and Professions Code is amended to read:1646.1.(a)A dentist shall possess either a current license in good standing and a general anesthesia administration or ordering permit issued by the board or a permit under Section 1638 or 1640 and a general anesthesia administration or ordering permit issued by the board to administer or order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider on an outpatient basis for dental patients.(b)A dentist shall possess a pediatric endorsement of their general anesthesia permit to administer or order the administration of deep sedation or general anesthesia to patients under seven years of age.(c)A dentist shall be physically within the dental office at the time of ordering, and during the administration of, general anesthesia or deep sedation.(d)For patients under 13 years of age, all of the following shall apply:(1)The operating dentist and at least two additional personnel shall be present throughout the procedure involving deep sedation or general anesthesia.(2)If the operating dentist is the permitted anesthesia provider, then both of the following shall apply:(A)The operating dentist and at least one of the additional personnel shall maintain current certification in Pediatric Advanced Life Support (PALS) or other board-approved training in pediatric life support and airway management, adopted pursuant to Section 1601.8. The additional personnel who is certified in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management shall be solely dedicated to monitoring the patient and shall be trained to read and respond to monitoring equipment including, but not limited to, pulse oximeter, cardiac monitor, blood pressure, pulse, capnograph, and respiration monitoring devices.(B)The operating dentist shall be responsible for initiating and administering any necessary emergency response.(3)If a dedicated permitted anesthesia provider other than the operating dentist is monitoring the patient and administering deep sedation or general anesthesia, both of the following shall apply:(A)The anesthesia provider and the operating dentist, or one other trained personnel, shall be present throughout the procedure and shall maintain current certification in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management, adopted pursuant to Section 1601.8.(B)The anesthesia provider shall be responsible for initiating and administering any necessary emergency response and the operating dentist, or other trained and designated personnel, shall assist the anesthesia provider in emergency response.(e)This article does not apply to the administration of local anesthesia, minimal sedation, or moderate sedation.SEC. 3.Section 1646.2 of the Business and Professions Code is amended to read:1646.2.(a)A dentist who desires to administer or order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider shall apply to the board on the appropriate administration or ordering permit application form prescribed by the board.(b)(1)For a permit to administer deep sedation or general anesthesia, a dentist shall submit an application fee and produce evidence showing that they have successfully completed a minimum of one year of advanced training in anesthesiology and related academic subjects approved by the board, or equivalent training or experience approved by the board, beyond the undergraduate school level.(2)If the deep sedation or general anesthesia is to be administered in the dentists office, the application shall also include documentation that equipment and drugs required by the board are on the premises.(c)For a permit to order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, a dentist shall submit an application fee and include documentation that equipment and drugs required by the board are on the premises. (d)A dentist may apply for a pediatric endorsement for the general anesthesia permit by providing proof of successful completion of all of the following:(1)A Commission on Dental Accreditation (CODA)-accredited or equivalent residency training program that provides competency in the administration of deep sedation and general anesthesia on pediatric patients.(2)At least 20 cases of deep sedation or general anesthesia to patients under seven years of age in the 24-month time period directly preceding application for a pediatric endorsement to establish competency, both at the time of initial application and at renewal. The applicant or permitholder shall maintain and be able to provide proof of these cases upon request by the board for up to three permit renewal periods.(3)Current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) or other board-approved training in pediatric life support and airway management, pursuant to Section 1601.8, for the duration of the permit.(e)Applicants for a pediatric endorsement who otherwise qualify for the pediatric endorsement but lack sufficient cases of pediatric sedation to patients under seven years of age may administer deep sedation and general anesthesia to patients under seven years of age under the direct supervision of a general anesthesia permitholder with a pediatric endorsement. The applicant may count these cases toward the 20 cases required to qualify for the applicants pediatric endorsement.(f)In addition to any other requirement imposed by law, a dedicated permitted anesthesia provider, other than the operating dentist, who administers deep sedation or general anesthesia to dental patients under seven years of age shall provide proof of all of the following:(1)At least 20 cases of deep sedation or general anesthesia to patients under seven years of age in the prior 24-month time period.(2)Current certification in ACLS and PALS.SEC. 4.Section 1646.3 of the Business and Professions Code is amended to read:1646.3.(a)A physical evaluation and medical history shall be taken before the administration of deep sedation or general anesthesia.(b)Any dentist holding a permit and in whose office the deep sedation or general anesthesia is administered shall maintain medical history, physical evaluation, deep sedation, and general anesthesia records as required by board regulations.SEC. 5.Section 1646.7 of the Business and Professions Code is amended to read:1646.7.(a)A violation of this article constitutes unprofessional conduct and is grounds for the revocation or suspension of the dentists permit or license, or both. The board shall issue probationary terms only for violations that do not result in bodily harm.(b)(1)A violation of any provision of this article or Section 1682 by a dentist is grounds for suspension or revocation of the dentists permit issued pursuant to this article and may be investigated and considered as unprofessional conduct by the board.(2)A violation of any provision of this article by a physician and surgeon or a certified nurse anesthetist may be investigated and considered as unprofessional conduct by the Medical Board of California, pursuant to Chapter 5 (commencing with Section 2000) or the Board of Registered Nursing, pursuant to Chapter 6 (commencing with Section 2700), as appropriate.(c)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.SEC. 6.Section 1646.10 of the Business and Professions Code is amended to read:1646.10.A general anesthesia administration or ordering permit issued by the board under this article shall expire on the date provided in Section 1715 that next occurs after its issuance, unless it is renewed as provided in this article.SEC. 7.Section 1646.11 of the Business and Professions Code is amended to read:1646.11.(a)A general anesthesia permitholder who has a permit that was issued before January 1, 2022, may follow the terms of that existing permit until it expires. Any permit issued or renewed pursuant to this article on or after January 1, 2025, shall require the permitholder to follow the new requirements of this article.(b)A physician and surgeon who has a permit to administer general anesthesia in the office of a dentist, pursuant to Section 2079, before January 1, 2025, may follow the terms of that existing permit until it expires and shall not be required to obtain a new permit until the expiration of the existing permit. Any permit issued or renewed pursuant to this article on or after January 1, 2025, shall require the permitholder to follow the new requirements of this article.(c)The board shall revise its current regulations and adopt new regulations to implement this article. The adoption, amendment, repeal, or readoption of a regulation authorized by this section is deemed to address an emergency, for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the board is hereby exempted for this purpose from the requirements of subdivision (b) of Section 11346.1 of the Government Code.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 1646.14 is added to the Business and Professions Code, to read:1646.14. (a) Notwithstanding any other law, including, but not limited to, Sections 1646.1 and 1647.2, a certified registered nurse anesthetist licensed pursuant to Chapter 6 (commencing with Section 2700) and certified as a nurse anesthetist pursuant to Article 7 (commencing with Section 2825) of Chapter 6 may administer general anesthesia or deep sedation in the office of a licensed dentist to dental patients without regard to whether the dentist possesses a permit issued pursuant to this article, if both of the following conditions are met:(1) The nurse anesthetist holds a valid general anesthesia permit issued by the Dental Board of California pursuant to subdivision (b).(2) The nurse anesthetist meets the requirements of subdivision (d) of Section 1646.1.(b) A certified registered nurse anesthetist who desires to administer general anesthesia or deep sedation under subdivision (a) shall apply to the board on an application form prescribed by the board and shall submit all of the following:(1) Payment of an application fee prescribed by this article.(2) Evidence satisfactory to the board and the Board of Registered Nursing showing that the applicant has successfully completed an accredited program as defined in subdivision (b) of Section 2826.(3) Documentation demonstrating that all equipment and drugs required by the board are on the premises for use in any dental office in which the nurse anesthetist administers general anesthesia or deep sedation.(c) Prior to issuance or renewal of a permit pursuant to this section, the board may at its discretion require an onsite inspection and evaluation of the facility, equipment, and personnel, including, but not limited to, the certified registered nurse anesthetist and procedures utilized. At least one of the people evaluating the procedures utilized by the nurse anesthetist shall be a certified registered nurse anesthetist expert in outpatient general anesthesia or deep sedation who has been authorized or retained under contract by the board for this purpose.(d) A certified registered nurse anesthetist who has failed an onsite inspection and evaluation shall have their permit automatically suspended for 30 days after the date on which the board notifies the nurse anesthetist of the failure unless within that time period the nurse anesthetist has retaken and passed an onsite inspection and evaluation. A nurse anesthetist who is issued a permit under this article shall be subject to an onsite inspection and evaluation at least once every five years. Refusal to submit to an inspection shall result in automatic denial or revocation of the permit.(e) A certified registered nurse anesthetist who additionally meets the requirements of paragraphs (2) and (3) of subdivision (c) of Section 1646.2 may apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under seven years of age. A nurse anesthetist without sufficient cases to obtain a pediatric endorsement may qualify for the endorsement pursuant to the requirements of subdivision (d) of Section 1646.2.
SECTION 1. Section 1646.14 is added to the Business and Professions Code, to read:
### SECTION 1.
1646.14. (a) Notwithstanding any other law, including, but not limited to, Sections 1646.1 and 1647.2, a certified registered nurse anesthetist licensed pursuant to Chapter 6 (commencing with Section 2700) and certified as a nurse anesthetist pursuant to Article 7 (commencing with Section 2825) of Chapter 6 may administer general anesthesia or deep sedation in the office of a licensed dentist to dental patients without regard to whether the dentist possesses a permit issued pursuant to this article, if both of the following conditions are met:(1) The nurse anesthetist holds a valid general anesthesia permit issued by the Dental Board of California pursuant to subdivision (b).(2) The nurse anesthetist meets the requirements of subdivision (d) of Section 1646.1.(b) A certified registered nurse anesthetist who desires to administer general anesthesia or deep sedation under subdivision (a) shall apply to the board on an application form prescribed by the board and shall submit all of the following:(1) Payment of an application fee prescribed by this article.(2) Evidence satisfactory to the board and the Board of Registered Nursing showing that the applicant has successfully completed an accredited program as defined in subdivision (b) of Section 2826.(3) Documentation demonstrating that all equipment and drugs required by the board are on the premises for use in any dental office in which the nurse anesthetist administers general anesthesia or deep sedation.(c) Prior to issuance or renewal of a permit pursuant to this section, the board may at its discretion require an onsite inspection and evaluation of the facility, equipment, and personnel, including, but not limited to, the certified registered nurse anesthetist and procedures utilized. At least one of the people evaluating the procedures utilized by the nurse anesthetist shall be a certified registered nurse anesthetist expert in outpatient general anesthesia or deep sedation who has been authorized or retained under contract by the board for this purpose.(d) A certified registered nurse anesthetist who has failed an onsite inspection and evaluation shall have their permit automatically suspended for 30 days after the date on which the board notifies the nurse anesthetist of the failure unless within that time period the nurse anesthetist has retaken and passed an onsite inspection and evaluation. A nurse anesthetist who is issued a permit under this article shall be subject to an onsite inspection and evaluation at least once every five years. Refusal to submit to an inspection shall result in automatic denial or revocation of the permit.(e) A certified registered nurse anesthetist who additionally meets the requirements of paragraphs (2) and (3) of subdivision (c) of Section 1646.2 may apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under seven years of age. A nurse anesthetist without sufficient cases to obtain a pediatric endorsement may qualify for the endorsement pursuant to the requirements of subdivision (d) of Section 1646.2.
1646.14. (a) Notwithstanding any other law, including, but not limited to, Sections 1646.1 and 1647.2, a certified registered nurse anesthetist licensed pursuant to Chapter 6 (commencing with Section 2700) and certified as a nurse anesthetist pursuant to Article 7 (commencing with Section 2825) of Chapter 6 may administer general anesthesia or deep sedation in the office of a licensed dentist to dental patients without regard to whether the dentist possesses a permit issued pursuant to this article, if both of the following conditions are met:(1) The nurse anesthetist holds a valid general anesthesia permit issued by the Dental Board of California pursuant to subdivision (b).(2) The nurse anesthetist meets the requirements of subdivision (d) of Section 1646.1.(b) A certified registered nurse anesthetist who desires to administer general anesthesia or deep sedation under subdivision (a) shall apply to the board on an application form prescribed by the board and shall submit all of the following:(1) Payment of an application fee prescribed by this article.(2) Evidence satisfactory to the board and the Board of Registered Nursing showing that the applicant has successfully completed an accredited program as defined in subdivision (b) of Section 2826.(3) Documentation demonstrating that all equipment and drugs required by the board are on the premises for use in any dental office in which the nurse anesthetist administers general anesthesia or deep sedation.(c) Prior to issuance or renewal of a permit pursuant to this section, the board may at its discretion require an onsite inspection and evaluation of the facility, equipment, and personnel, including, but not limited to, the certified registered nurse anesthetist and procedures utilized. At least one of the people evaluating the procedures utilized by the nurse anesthetist shall be a certified registered nurse anesthetist expert in outpatient general anesthesia or deep sedation who has been authorized or retained under contract by the board for this purpose.(d) A certified registered nurse anesthetist who has failed an onsite inspection and evaluation shall have their permit automatically suspended for 30 days after the date on which the board notifies the nurse anesthetist of the failure unless within that time period the nurse anesthetist has retaken and passed an onsite inspection and evaluation. A nurse anesthetist who is issued a permit under this article shall be subject to an onsite inspection and evaluation at least once every five years. Refusal to submit to an inspection shall result in automatic denial or revocation of the permit.(e) A certified registered nurse anesthetist who additionally meets the requirements of paragraphs (2) and (3) of subdivision (c) of Section 1646.2 may apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under seven years of age. A nurse anesthetist without sufficient cases to obtain a pediatric endorsement may qualify for the endorsement pursuant to the requirements of subdivision (d) of Section 1646.2.
1646.14. (a) Notwithstanding any other law, including, but not limited to, Sections 1646.1 and 1647.2, a certified registered nurse anesthetist licensed pursuant to Chapter 6 (commencing with Section 2700) and certified as a nurse anesthetist pursuant to Article 7 (commencing with Section 2825) of Chapter 6 may administer general anesthesia or deep sedation in the office of a licensed dentist to dental patients without regard to whether the dentist possesses a permit issued pursuant to this article, if both of the following conditions are met:(1) The nurse anesthetist holds a valid general anesthesia permit issued by the Dental Board of California pursuant to subdivision (b).(2) The nurse anesthetist meets the requirements of subdivision (d) of Section 1646.1.(b) A certified registered nurse anesthetist who desires to administer general anesthesia or deep sedation under subdivision (a) shall apply to the board on an application form prescribed by the board and shall submit all of the following:(1) Payment of an application fee prescribed by this article.(2) Evidence satisfactory to the board and the Board of Registered Nursing showing that the applicant has successfully completed an accredited program as defined in subdivision (b) of Section 2826.(3) Documentation demonstrating that all equipment and drugs required by the board are on the premises for use in any dental office in which the nurse anesthetist administers general anesthesia or deep sedation.(c) Prior to issuance or renewal of a permit pursuant to this section, the board may at its discretion require an onsite inspection and evaluation of the facility, equipment, and personnel, including, but not limited to, the certified registered nurse anesthetist and procedures utilized. At least one of the people evaluating the procedures utilized by the nurse anesthetist shall be a certified registered nurse anesthetist expert in outpatient general anesthesia or deep sedation who has been authorized or retained under contract by the board for this purpose.(d) A certified registered nurse anesthetist who has failed an onsite inspection and evaluation shall have their permit automatically suspended for 30 days after the date on which the board notifies the nurse anesthetist of the failure unless within that time period the nurse anesthetist has retaken and passed an onsite inspection and evaluation. A nurse anesthetist who is issued a permit under this article shall be subject to an onsite inspection and evaluation at least once every five years. Refusal to submit to an inspection shall result in automatic denial or revocation of the permit.(e) A certified registered nurse anesthetist who additionally meets the requirements of paragraphs (2) and (3) of subdivision (c) of Section 1646.2 may apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under seven years of age. A nurse anesthetist without sufficient cases to obtain a pediatric endorsement may qualify for the endorsement pursuant to the requirements of subdivision (d) of Section 1646.2.
1646.14. (a) Notwithstanding any other law, including, but not limited to, Sections 1646.1 and 1647.2, a certified registered nurse anesthetist licensed pursuant to Chapter 6 (commencing with Section 2700) and certified as a nurse anesthetist pursuant to Article 7 (commencing with Section 2825) of Chapter 6 may administer general anesthesia or deep sedation in the office of a licensed dentist to dental patients without regard to whether the dentist possesses a permit issued pursuant to this article, if both of the following conditions are met:
(1) The nurse anesthetist holds a valid general anesthesia permit issued by the Dental Board of California pursuant to subdivision (b).
(2) The nurse anesthetist meets the requirements of subdivision (d) of Section 1646.1.
(b) A certified registered nurse anesthetist who desires to administer general anesthesia or deep sedation under subdivision (a) shall apply to the board on an application form prescribed by the board and shall submit all of the following:
(1) Payment of an application fee prescribed by this article.
(2) Evidence satisfactory to the board and the Board of Registered Nursing showing that the applicant has successfully completed an accredited program as defined in subdivision (b) of Section 2826.
(3) Documentation demonstrating that all equipment and drugs required by the board are on the premises for use in any dental office in which the nurse anesthetist administers general anesthesia or deep sedation.
(c) Prior to issuance or renewal of a permit pursuant to this section, the board may at its discretion require an onsite inspection and evaluation of the facility, equipment, and personnel, including, but not limited to, the certified registered nurse anesthetist and procedures utilized. At least one of the people evaluating the procedures utilized by the nurse anesthetist shall be a certified registered nurse anesthetist expert in outpatient general anesthesia or deep sedation who has been authorized or retained under contract by the board for this purpose.
(d) A certified registered nurse anesthetist who has failed an onsite inspection and evaluation shall have their permit automatically suspended for 30 days after the date on which the board notifies the nurse anesthetist of the failure unless within that time period the nurse anesthetist has retaken and passed an onsite inspection and evaluation. A nurse anesthetist who is issued a permit under this article shall be subject to an onsite inspection and evaluation at least once every five years. Refusal to submit to an inspection shall result in automatic denial or revocation of the permit.
(e) A certified registered nurse anesthetist who additionally meets the requirements of paragraphs (2) and (3) of subdivision (c) of Section 1646.2 may apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under seven years of age. A nurse anesthetist without sufficient cases to obtain a pediatric endorsement may qualify for the endorsement pursuant to the requirements of subdivision (d) of Section 1646.2.
SEC. 2. Section 2827 of the Business and Professions Code is amended to read:2827. (a) The utilization of a nurse anesthetist to provide anesthesia services in an acute care facility shall be approved by the acute care facility administration and the appropriate committee, and at the discretion of the physician, dentist or podiatrist. If a general anesthetic agent is administered in a dental office, the dentist shall hold a permit authorized by Article 2.7 (commencing with Section 1646) of Chapter 4 or, commencing January 1, 2022, Article 2.75 (commencing with Section 1646) of Chapter 4.(b) General anesthesia or deep sedation administered in a dental office by a nurse anesthetist shall be in accordance with both of the following:(1) Article 2.75 (commencing with Section 1646) of Chapter 4.(2) Paragraph (2) of subdivision (b) of Section 2725.
SEC. 2. Section 2827 of the Business and Professions Code is amended to read:
### SEC. 2.
2827. (a) The utilization of a nurse anesthetist to provide anesthesia services in an acute care facility shall be approved by the acute care facility administration and the appropriate committee, and at the discretion of the physician, dentist or podiatrist. If a general anesthetic agent is administered in a dental office, the dentist shall hold a permit authorized by Article 2.7 (commencing with Section 1646) of Chapter 4 or, commencing January 1, 2022, Article 2.75 (commencing with Section 1646) of Chapter 4.(b) General anesthesia or deep sedation administered in a dental office by a nurse anesthetist shall be in accordance with both of the following:(1) Article 2.75 (commencing with Section 1646) of Chapter 4.(2) Paragraph (2) of subdivision (b) of Section 2725.
2827. (a) The utilization of a nurse anesthetist to provide anesthesia services in an acute care facility shall be approved by the acute care facility administration and the appropriate committee, and at the discretion of the physician, dentist or podiatrist. If a general anesthetic agent is administered in a dental office, the dentist shall hold a permit authorized by Article 2.7 (commencing with Section 1646) of Chapter 4 or, commencing January 1, 2022, Article 2.75 (commencing with Section 1646) of Chapter 4.(b) General anesthesia or deep sedation administered in a dental office by a nurse anesthetist shall be in accordance with both of the following:(1) Article 2.75 (commencing with Section 1646) of Chapter 4.(2) Paragraph (2) of subdivision (b) of Section 2725.
2827. (a) The utilization of a nurse anesthetist to provide anesthesia services in an acute care facility shall be approved by the acute care facility administration and the appropriate committee, and at the discretion of the physician, dentist or podiatrist. If a general anesthetic agent is administered in a dental office, the dentist shall hold a permit authorized by Article 2.7 (commencing with Section 1646) of Chapter 4 or, commencing January 1, 2022, Article 2.75 (commencing with Section 1646) of Chapter 4.(b) General anesthesia or deep sedation administered in a dental office by a nurse anesthetist shall be in accordance with both of the following:(1) Article 2.75 (commencing with Section 1646) of Chapter 4.(2) Paragraph (2) of subdivision (b) of Section 2725.
2827. (a) The utilization of a nurse anesthetist to provide anesthesia services in an acute care facility shall be approved by the acute care facility administration and the appropriate committee, and at the discretion of the physician, dentist or podiatrist. If a general anesthetic agent is administered in a dental office, the dentist shall hold a permit authorized by Article 2.7 (commencing with Section 1646) of Chapter 4 or, commencing January 1, 2022, Article 2.75 (commencing with Section 1646) of Chapter 4.
(b) General anesthesia or deep sedation administered in a dental office by a nurse anesthetist shall be in accordance with both of the following:
(1) Article 2.75 (commencing with Section 1646) of Chapter 4.
(2) Paragraph (2) of subdivision (b) of Section 2725.
SEC. 3. Section 2831.5 is added to the Business and Professions Code, to read:2831.5. (a) As used in this section, the following definitions apply:(1) Order means the process of directing a licensed individual, pursuant to their statutory authority, to directly administer a drug or to dispense, deliver, or distribute a drug for the purpose of direct administration to a patient, under instructions of the certified registered nurse anesthetist to provide prescription drugs.(2) Prescription drugs includes Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code).(3) Select means the decisionmaking process of choosing a drug, dosage, route, and time of administration.(b) (1) A certified registered nurse anesthetist who is licensed pursuant to this article and is registered with the federal Drug Enforcement Agency shall have prescriptive authority to select, order, or administer prescription drugs upon a request issued by a dentist under Article 2.75 (commencing with Section 1646) of Chapter 4 to administer anesthesia for diagnostic, operative, or therapeutic procedures in an outpatient dental setting.(2) A certified registered nurse anesthetist under paragraph (1) shall prescribe prescription drugs based on their level of professional education, training, and certification by the National Board of Certification and Recertification for Nurse Anesthetists, or a successor national professional organization approved by the board.(c) A certified registered nurse anesthetist shall only prescribe prescription drugs under subdivision (b) for an individual whom the certified registered nurse anesthetist has, at the time of the prescription, established a client or patient record.
SEC. 3. Section 2831.5 is added to the Business and Professions Code, to read:
### SEC. 3.
2831.5. (a) As used in this section, the following definitions apply:(1) Order means the process of directing a licensed individual, pursuant to their statutory authority, to directly administer a drug or to dispense, deliver, or distribute a drug for the purpose of direct administration to a patient, under instructions of the certified registered nurse anesthetist to provide prescription drugs.(2) Prescription drugs includes Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code).(3) Select means the decisionmaking process of choosing a drug, dosage, route, and time of administration.(b) (1) A certified registered nurse anesthetist who is licensed pursuant to this article and is registered with the federal Drug Enforcement Agency shall have prescriptive authority to select, order, or administer prescription drugs upon a request issued by a dentist under Article 2.75 (commencing with Section 1646) of Chapter 4 to administer anesthesia for diagnostic, operative, or therapeutic procedures in an outpatient dental setting.(2) A certified registered nurse anesthetist under paragraph (1) shall prescribe prescription drugs based on their level of professional education, training, and certification by the National Board of Certification and Recertification for Nurse Anesthetists, or a successor national professional organization approved by the board.(c) A certified registered nurse anesthetist shall only prescribe prescription drugs under subdivision (b) for an individual whom the certified registered nurse anesthetist has, at the time of the prescription, established a client or patient record.
2831.5. (a) As used in this section, the following definitions apply:(1) Order means the process of directing a licensed individual, pursuant to their statutory authority, to directly administer a drug or to dispense, deliver, or distribute a drug for the purpose of direct administration to a patient, under instructions of the certified registered nurse anesthetist to provide prescription drugs.(2) Prescription drugs includes Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code).(3) Select means the decisionmaking process of choosing a drug, dosage, route, and time of administration.(b) (1) A certified registered nurse anesthetist who is licensed pursuant to this article and is registered with the federal Drug Enforcement Agency shall have prescriptive authority to select, order, or administer prescription drugs upon a request issued by a dentist under Article 2.75 (commencing with Section 1646) of Chapter 4 to administer anesthesia for diagnostic, operative, or therapeutic procedures in an outpatient dental setting.(2) A certified registered nurse anesthetist under paragraph (1) shall prescribe prescription drugs based on their level of professional education, training, and certification by the National Board of Certification and Recertification for Nurse Anesthetists, or a successor national professional organization approved by the board.(c) A certified registered nurse anesthetist shall only prescribe prescription drugs under subdivision (b) for an individual whom the certified registered nurse anesthetist has, at the time of the prescription, established a client or patient record.
2831.5. (a) As used in this section, the following definitions apply:(1) Order means the process of directing a licensed individual, pursuant to their statutory authority, to directly administer a drug or to dispense, deliver, or distribute a drug for the purpose of direct administration to a patient, under instructions of the certified registered nurse anesthetist to provide prescription drugs.(2) Prescription drugs includes Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code).(3) Select means the decisionmaking process of choosing a drug, dosage, route, and time of administration.(b) (1) A certified registered nurse anesthetist who is licensed pursuant to this article and is registered with the federal Drug Enforcement Agency shall have prescriptive authority to select, order, or administer prescription drugs upon a request issued by a dentist under Article 2.75 (commencing with Section 1646) of Chapter 4 to administer anesthesia for diagnostic, operative, or therapeutic procedures in an outpatient dental setting.(2) A certified registered nurse anesthetist under paragraph (1) shall prescribe prescription drugs based on their level of professional education, training, and certification by the National Board of Certification and Recertification for Nurse Anesthetists, or a successor national professional organization approved by the board.(c) A certified registered nurse anesthetist shall only prescribe prescription drugs under subdivision (b) for an individual whom the certified registered nurse anesthetist has, at the time of the prescription, established a client or patient record.
2831.5. (a) As used in this section, the following definitions apply:
(1) Order means the process of directing a licensed individual, pursuant to their statutory authority, to directly administer a drug or to dispense, deliver, or distribute a drug for the purpose of direct administration to a patient, under instructions of the certified registered nurse anesthetist to provide prescription drugs.
(2) Prescription drugs includes Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code).
(3) Select means the decisionmaking process of choosing a drug, dosage, route, and time of administration.
(b) (1) A certified registered nurse anesthetist who is licensed pursuant to this article and is registered with the federal Drug Enforcement Agency shall have prescriptive authority to select, order, or administer prescription drugs upon a request issued by a dentist under Article 2.75 (commencing with Section 1646) of Chapter 4 to administer anesthesia for diagnostic, operative, or therapeutic procedures in an outpatient dental setting.
(2) A certified registered nurse anesthetist under paragraph (1) shall prescribe prescription drugs based on their level of professional education, training, and certification by the National Board of Certification and Recertification for Nurse Anesthetists, or a successor national professional organization approved by the board.
(c) A certified registered nurse anesthetist shall only prescribe prescription drugs under subdivision (b) for an individual whom the certified registered nurse anesthetist has, at the time of the prescription, established a client or patient record.
SEC. 4. Section 2833 of the Business and Professions Code is amended to read:2833. (a) Each certificate issued pursuant to this article shall be renewable biennially, and each person holding a certificate under this article shall apply for a renewal of their certificate and pay the biennial renewal fee required by Section 2830.7 every two years on or before the last day of the month following the month in which their birthday occurs, beginning with the second birthday following the date on which the certificate was issued, whereupon the board shall renew the certificate.(b) Each certificate not renewed in accordance with this section shall expire but may within a period of eight years thereafter be reinstated upon payment of the biennial renewal fee and penalty fee required by Section 2830.7 and upon submission of proof of the applicants qualifications as may be required by the board. During the eight-year period, no examination shall be required as a condition for the reinstatement of any expired certificate that has lapsed solely by reason of nonpayment of the renewable fee. After the expiration of the eight-year period the board may require, as a condition of reinstatement, that the applicant pass an examination as it deems necessary to determine their present fitness to resume the practice of nurse anesthesia.(c) Upon registration or renewal of registration with the federal Drug Enforcement Agency, a certified registered nurse anesthetist shall complete the required training as set forth by the agency.
SEC. 4. Section 2833 of the Business and Professions Code is amended to read:
### SEC. 4.
2833. (a) Each certificate issued pursuant to this article shall be renewable biennially, and each person holding a certificate under this article shall apply for a renewal of their certificate and pay the biennial renewal fee required by Section 2830.7 every two years on or before the last day of the month following the month in which their birthday occurs, beginning with the second birthday following the date on which the certificate was issued, whereupon the board shall renew the certificate.(b) Each certificate not renewed in accordance with this section shall expire but may within a period of eight years thereafter be reinstated upon payment of the biennial renewal fee and penalty fee required by Section 2830.7 and upon submission of proof of the applicants qualifications as may be required by the board. During the eight-year period, no examination shall be required as a condition for the reinstatement of any expired certificate that has lapsed solely by reason of nonpayment of the renewable fee. After the expiration of the eight-year period the board may require, as a condition of reinstatement, that the applicant pass an examination as it deems necessary to determine their present fitness to resume the practice of nurse anesthesia.(c) Upon registration or renewal of registration with the federal Drug Enforcement Agency, a certified registered nurse anesthetist shall complete the required training as set forth by the agency.
2833. (a) Each certificate issued pursuant to this article shall be renewable biennially, and each person holding a certificate under this article shall apply for a renewal of their certificate and pay the biennial renewal fee required by Section 2830.7 every two years on or before the last day of the month following the month in which their birthday occurs, beginning with the second birthday following the date on which the certificate was issued, whereupon the board shall renew the certificate.(b) Each certificate not renewed in accordance with this section shall expire but may within a period of eight years thereafter be reinstated upon payment of the biennial renewal fee and penalty fee required by Section 2830.7 and upon submission of proof of the applicants qualifications as may be required by the board. During the eight-year period, no examination shall be required as a condition for the reinstatement of any expired certificate that has lapsed solely by reason of nonpayment of the renewable fee. After the expiration of the eight-year period the board may require, as a condition of reinstatement, that the applicant pass an examination as it deems necessary to determine their present fitness to resume the practice of nurse anesthesia.(c) Upon registration or renewal of registration with the federal Drug Enforcement Agency, a certified registered nurse anesthetist shall complete the required training as set forth by the agency.
2833. (a) Each certificate issued pursuant to this article shall be renewable biennially, and each person holding a certificate under this article shall apply for a renewal of their certificate and pay the biennial renewal fee required by Section 2830.7 every two years on or before the last day of the month following the month in which their birthday occurs, beginning with the second birthday following the date on which the certificate was issued, whereupon the board shall renew the certificate.(b) Each certificate not renewed in accordance with this section shall expire but may within a period of eight years thereafter be reinstated upon payment of the biennial renewal fee and penalty fee required by Section 2830.7 and upon submission of proof of the applicants qualifications as may be required by the board. During the eight-year period, no examination shall be required as a condition for the reinstatement of any expired certificate that has lapsed solely by reason of nonpayment of the renewable fee. After the expiration of the eight-year period the board may require, as a condition of reinstatement, that the applicant pass an examination as it deems necessary to determine their present fitness to resume the practice of nurse anesthesia.(c) Upon registration or renewal of registration with the federal Drug Enforcement Agency, a certified registered nurse anesthetist shall complete the required training as set forth by the agency.
2833. (a) Each certificate issued pursuant to this article shall be renewable biennially, and each person holding a certificate under this article shall apply for a renewal of their certificate and pay the biennial renewal fee required by Section 2830.7 every two years on or before the last day of the month following the month in which their birthday occurs, beginning with the second birthday following the date on which the certificate was issued, whereupon the board shall renew the certificate.
(b) Each certificate not renewed in accordance with this section shall expire but may within a period of eight years thereafter be reinstated upon payment of the biennial renewal fee and penalty fee required by Section 2830.7 and upon submission of proof of the applicants qualifications as may be required by the board. During the eight-year period, no examination shall be required as a condition for the reinstatement of any expired certificate that has lapsed solely by reason of nonpayment of the renewable fee. After the expiration of the eight-year period the board may require, as a condition of reinstatement, that the applicant pass an examination as it deems necessary to determine their present fitness to resume the practice of nurse anesthesia.
(c) Upon registration or renewal of registration with the federal Drug Enforcement Agency, a certified registered nurse anesthetist shall complete the required training as set forth by the agency.
SEC. 5. Section 2833.3 of the Business and Professions Code is amended to read:2833.3. (a) Nothing in this article shall be construed to limit a certified nurse anesthetists ability to practice nursing.(b) Nothing in this chapter shall affect the authority of a certified registered nurse anesthetist licensed pursuant to this article to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.
SEC. 5. Section 2833.3 of the Business and Professions Code is amended to read:
### SEC. 5.
2833.3. (a) Nothing in this article shall be construed to limit a certified nurse anesthetists ability to practice nursing.(b) Nothing in this chapter shall affect the authority of a certified registered nurse anesthetist licensed pursuant to this article to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.
2833.3. (a) Nothing in this article shall be construed to limit a certified nurse anesthetists ability to practice nursing.(b) Nothing in this chapter shall affect the authority of a certified registered nurse anesthetist licensed pursuant to this article to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.
2833.3. (a) Nothing in this article shall be construed to limit a certified nurse anesthetists ability to practice nursing.(b) Nothing in this chapter shall affect the authority of a certified registered nurse anesthetist licensed pursuant to this article to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.
2833.3. (a) Nothing in this article shall be construed to limit a certified nurse anesthetists ability to practice nursing.
(b) Nothing in this chapter shall affect the authority of a certified registered nurse anesthetist licensed pursuant to this article to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.
SEC. 6. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 6. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 6. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
### SEC. 6.
As used in this article, the following definitions apply:
(a)Deep sedation means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
(b)General anesthesia means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
(c)Dedicated permitted anesthesia provider means any of the following:
(1)A physician and surgeon who has successfully completed a postgraduate residency training program in anesthesiology that is recognized by the Accreditation Council on Graduate Medical Education pursuant to Section 2079.
(2)A certified nurse anesthetist licensed under Article 2 (commencing with Section 2725) or Article 7 (commencing with Section 2825) of Chapter 6.
(3)A dentist licensed under this chapter who possesses a general anesthesia administration permit from the board pursuant to this article.
(a)A dentist shall possess either a current license in good standing and a general anesthesia administration or ordering permit issued by the board or a permit under Section 1638 or 1640 and a general anesthesia administration or ordering permit issued by the board to administer or order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider on an outpatient basis for dental patients.
(b)A dentist shall possess a pediatric endorsement of their general anesthesia permit to administer or order the administration of deep sedation or general anesthesia to patients under seven years of age.
(c)A dentist shall be physically within the dental office at the time of ordering, and during the administration of, general anesthesia or deep sedation.
(d)For patients under 13 years of age, all of the following shall apply:
(1)The operating dentist and at least two additional personnel shall be present throughout the procedure involving deep sedation or general anesthesia.
(2)If the operating dentist is the permitted anesthesia provider, then both of the following shall apply:
(A)The operating dentist and at least one of the additional personnel shall maintain current certification in Pediatric Advanced Life Support (PALS) or other board-approved training in pediatric life support and airway management, adopted pursuant to Section 1601.8. The additional personnel who is certified in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management shall be solely dedicated to monitoring the patient and shall be trained to read and respond to monitoring equipment including, but not limited to, pulse oximeter, cardiac monitor, blood pressure, pulse, capnograph, and respiration monitoring devices.
(B)The operating dentist shall be responsible for initiating and administering any necessary emergency response.
(3)If a dedicated permitted anesthesia provider other than the operating dentist is monitoring the patient and administering deep sedation or general anesthesia, both of the following shall apply:
(A)The anesthesia provider and the operating dentist, or one other trained personnel, shall be present throughout the procedure and shall maintain current certification in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management, adopted pursuant to Section 1601.8.
(B)The anesthesia provider shall be responsible for initiating and administering any necessary emergency response and the operating dentist, or other trained and designated personnel, shall assist the anesthesia provider in emergency response.
(e)This article does not apply to the administration of local anesthesia, minimal sedation, or moderate sedation.
(a)A dentist who desires to administer or order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider shall apply to the board on the appropriate administration or ordering permit application form prescribed by the board.
(b)(1)For a permit to administer deep sedation or general anesthesia, a dentist shall submit an application fee and produce evidence showing that they have successfully completed a minimum of one year of advanced training in anesthesiology and related academic subjects approved by the board, or equivalent training or experience approved by the board, beyond the undergraduate school level.
(2)If the deep sedation or general anesthesia is to be administered in the dentists office, the application shall also include documentation that equipment and drugs required by the board are on the premises.
(c)For a permit to order the administration of deep sedation or general anesthesia by a dedicated permitted anesthesia provider, a dentist shall submit an application fee and include documentation that equipment and drugs required by the board are on the premises.
(d)A dentist may apply for a pediatric endorsement for the general anesthesia permit by providing proof of successful completion of all of the following:
(1)A Commission on Dental Accreditation (CODA)-accredited or equivalent residency training program that provides competency in the administration of deep sedation and general anesthesia on pediatric patients.
(2)At least 20 cases of deep sedation or general anesthesia to patients under seven years of age in the 24-month time period directly preceding application for a pediatric endorsement to establish competency, both at the time of initial application and at renewal. The applicant or permitholder shall maintain and be able to provide proof of these cases upon request by the board for up to three permit renewal periods.
(3)Current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) or other board-approved training in pediatric life support and airway management, pursuant to Section 1601.8, for the duration of the permit.
(e)Applicants for a pediatric endorsement who otherwise qualify for the pediatric endorsement but lack sufficient cases of pediatric sedation to patients under seven years of age may administer deep sedation and general anesthesia to patients under seven years of age under the direct supervision of a general anesthesia permitholder with a pediatric endorsement. The applicant may count these cases toward the 20 cases required to qualify for the applicants pediatric endorsement.
(f)In addition to any other requirement imposed by law, a dedicated permitted anesthesia provider, other than the operating dentist, who administers deep sedation or general anesthesia to dental patients under seven years of age shall provide proof of all of the following:
(1)At least 20 cases of deep sedation or general anesthesia to patients under seven years of age in the prior 24-month time period.
(2)Current certification in ACLS and PALS.
(a)A physical evaluation and medical history shall be taken before the administration of deep sedation or general anesthesia.
(b)Any dentist holding a permit and in whose office the deep sedation or general anesthesia is administered shall maintain medical history, physical evaluation, deep sedation, and general anesthesia records as required by board regulations.
(a)A violation of this article constitutes unprofessional conduct and is grounds for the revocation or suspension of the dentists permit or license, or both. The board shall issue probationary terms only for violations that do not result in bodily harm.
(b)(1)A violation of any provision of this article or Section 1682 by a dentist is grounds for suspension or revocation of the dentists permit issued pursuant to this article and may be investigated and considered as unprofessional conduct by the board.
(2)A violation of any provision of this article by a physician and surgeon or a certified nurse anesthetist may be investigated and considered as unprofessional conduct by the Medical Board of California, pursuant to Chapter 5 (commencing with Section 2000) or the Board of Registered Nursing, pursuant to Chapter 6 (commencing with Section 2700), as appropriate.
(c)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.
A general anesthesia administration or ordering permit issued by the board under this article shall expire on the date provided in Section 1715 that next occurs after its issuance, unless it is renewed as provided in this article.
(a)A general anesthesia permitholder who has a permit that was issued before January 1, 2022, may follow the terms of that existing permit until it expires. Any permit issued or renewed pursuant to this article on or after January 1, 2025, shall require the permitholder to follow the new requirements of this article.
(b)A physician and surgeon who has a permit to administer general anesthesia in the office of a dentist, pursuant to Section 2079, before January 1, 2025, may follow the terms of that existing permit until it expires and shall not be required to obtain a new permit until the expiration of the existing permit. Any permit issued or renewed pursuant to this article on or after January 1, 2025, shall require the permitholder to follow the new requirements of this article.
(c)The board shall revise its current regulations and adopt new regulations to implement this article. The adoption, amendment, repeal, or readoption of a regulation authorized by this section is deemed to address an emergency, for purposes of Sections 11346.1 and 11349.6 of the Government Code, and the board is hereby exempted for this purpose from the requirements of subdivision (b) of Section 11346.1 of the Government Code.