Anesthesia Inspection Process Update

TO: FSOMS Members

We hope this communication finds you all well. The summer has sure gotten off to a hot start. There are several important issues I need to bring to your attention.

The first issue is the Board of Dentistry’s decision to move the office anesthesia evaluations to the Bureau of Enforcement, which will now be the overseeing section of the Department of Health. There were two recent meetings discussing this change. One was a meeting of the OAE evaluators in Gainesville earlier this year and the second was a conference call held a few weeks ago. FSOMS members have been present at both meetings and provided input regarding this change.

The reasons for the oversight change were primarily money, the need for more evaluations per year and work force issues. What we heard was that the BOD will still have decision-making powers and total control of the OAE, but the BOE will organize and carry out the inspections. There is a monetary cap that the BOD was coming close to and with the BOE taking over the exams and hiring at least five full time dentists to perform the evaluations, this would not be a regulatory issue. From a monetary perspective, each of these evaluators could make upwards of $187,500 per year where the total amount spent from the BOD perspective is around $400,000. Therefore, even though the money is being shifted to a different section of the Department of Health, it does not seem to be a money issue, but more of a regulatory issue regarding how the inspectors are being paid.

The second issue is the number of inspections performed per year. The department currently performs 300 plus OAEs per year. They felt they needed to have 900 per year performed. The reason given was that not only are they inspecting primary offices but many anesthesia permit holders have more than one office that also needs to be inspected.

The third issue is related to the work force. Even though we just gave 35 names to the BOD to serve as inspectors, we were told that’s not enough inspectors to perform all the necessary inspections throughout the state. The BOE performs all anesthesia inspections except for dentistry. This would relieve the work force issue and stop the complaints of competitors inspecting geographically close anesthesia permit holders.

Finally, we were told that all new inspectors would be dentists with active anesthesia permits. Even though these will be full-time employees of the state, the BOD and BOE understands that this transition will take time and they may need some part-time evaluators to fill the gaps. FSOMS was told on the last call that at the next two Board of Dentistry meetings, there would be time to hear any comments and have further discussion.

Another important issue surrounds the recent AAP/AAPD guidelines stating that there should always be a second provider when sedating a child. The last time AAP/AAPD guidelines were updated was just prior to the time when we updated the ADA guidelines in 2015. At that time, the AAPD discussed adding this language to their guidelines. They didn’t at that time, but after further discussion and events taking place nationally, the AAP/AAPD have now included in their guidelines that they do not support the OMS TEAM approach to anesthesia.

There are a number of reasons why this happened. The nationwide use of anesthesiologists in the pediatric dental office has sparked this issue. The training of the pediatric dentist is weak in office-based general anesthesia. For the safety of the patient, the AAPD is now recommending the Pediatric Dentist use a separate provider for their anesthesia services for their patients. Some of this is due to the types of cases where morbidity and mortality has risen. The pediatric cases are more comprehensive and longer in nature. Caleb’s Law and the changes going on in California and Texas also are influencing these guidelines.

After seeing many emails going around, it is clear the FSOMS membership is concerned greatly about these issues. For these reasons, we will be scheduling a conference call in the next few weeks to further discuss both issues and decide if any and what actions should be taken by our organization.

Watch for further communications and please attend the summer meeting in Amelia Island to learn more about these important issues.

Sincerely,

Daniel J. Gesek, Jr. DMD, President
Florida Society of Oral and Maxillofacial Surgeons