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

The FSOMS Presents the 2019 Lebowitz Award

On May 11th, 2019, the FSOMS annual Lebowitz Award was presented to Olga Saniukovich, the very first female to have received this prestigious award.

Olga was born in Belarus, and moved to the United States with her family at age four. She has lived in the Tampa Bay, Florida area with her parents and younger brother since 2000. Her mother was in dental school when Olga was born. Olga has known that she was destined to be a dental clinician since she first insisted on trying on her mother’s lab coat at age two. Her curiosity quickly bloomed into passion and before long, she was traveling with her general dentist mother, Dr. Victoria Saniukovich, attending various CE courses, and discussing new surgical techniques at the dinner table, sometimes to the dining disgust of Alex her dad and her brother, Daniel. Olga’s father is a software engineer, and her brother is a college student majoring in biomedical engineering. They have both wholeheartedly supported Olga’s academic interests. Unfortunately, Olga’s Mon passed away last October, but certainly the influence of her mother’s love, support and professional example will enlighten Olga for her remaining lifetime.

Olga graduated Magna Cum Laude from the University of South Florida in 2015 with a BS degree in Biomedical Sciences and a BA degree in Psychology. This past May, she also graduated from the University of Florida College of Dentistry with an overall 3.87 GPA; ranking her #18 out of 94 in her class. She has also been inducted into the Omicron Kappa Upsilon National Dental Honor Society as an alumni member.

Olga has dedicated her adult life to become a professional who provides availability and affability where-ever she goes. She gives assistance to her fellow colleaques as well as providing dental care to the general public. For several years prior to starting dental school, Olga worked as a dental assistant in both corporate and private dental practices. She actively seeks out opportunities to help others learn and grow — working as a Tutor and a Teaching Assistant in both didactic and preclinical courses, in addition to consistently volunteering her free time to mentor her peers in their clinical procedures.

Since her first semester of dental school, Olga has continued to volunteer in many dental clinics and missions, including Ocala’s FreeD.O.M. and Alachua County’s We Care Clinic – both for patients living 200% below the poverty level and also to Gainesville’s Florida Mission of Mercy. Olga was one of two students who booked the flights, obtained the insurance and visas for the students and faculty, made the hostel arrangements and coordinated all the clinical and non-clinical activities for a Cuba Dental Service Trip. She led the fundraising efforts that culminated in $16,000 for supplies, coordinated the US and Cuban dental school faculty for student rotation, selected the patients for student treatment and ensured that all students received credit at UF for procedures they performed. She interviewed, selected, trained and coordinated student and faculty teams and help perform operative procedures in endodontics and simple surgical extractions. This “first ever” Cuba Dental Educational Service Trip was in July 2017.

Olga has done Externships at the University of Texas Health Science Center and in the University of Florida College of Dentistry’s Oral and Maxillofacial Surgery program. She has been a “Teaching Assistant” at U of F College of Dentistry in Fixed Prosthodontics, a “Peer Mentor” for the U of F College of Dentistry Tutoring Service, been an “Admissions Outreach Ambassador” for the U of F College of Dentistry Admissions, been a “Program Assistant” for the U of F College of Dentistry’s Executive Practice Management program, has worked on the “Executive Planning Board” of the U of F SNDA Impressions Program, and was the “Student Representative” for the Wellness Advisory Council.

Olga’s Professional Memberships include: 1. American Student Dental Association 2. Student National Dental Association 3. Student Member of the American Dental Association: 4. Student Member of the Florida Dental Association and 5. Student Member of the Academy of General Dentistry.

In her “spare time,” Olga relaxes by playing the piano and jumping out of airplanes. She earned her skydiving license in 2015, and has logged over 30 solo skydives, despite a life-long fear of heights. Pushing herself to conquer that deep-seated fear has changed Olga’s perspective and approach to everything else in life. Rather than shying away from obstacles, she now sees each new challenge as an opportunity for personal growth.

Presently, Olga has been accepted into a one-year Oral and Maxillofacial Surgery preliminary internship at Massachusetts General Hospital. After completing this program, Olga plans to pursue a 4-year Oral and Maxillofacial Surgery residency, and ultimately hopes to work in both an oral surgical practice, treating patients, and helping to train the next generation of dental surgical professionals in an academic setting.

It is indeed a awesome pleasure for the Members of the Florida Society of Oral and Maxillofacial Surgeons to provide the Lebowitz award in honor of your meritorious efforts, and to simply say: “YOU GO GIRL,” as you pursue your planned continuing education to fulfill your desire for lifelong service to patients and to further the dental profession!

Lawrence K. Cook, D.D.S.
Awards Chairman

A Report from Gray Robinson on the 2019 Florida Legislative Session

The Legislature adjourned for the 2019 Session – known as Sine Die – on Saturday, May 4, after voting on the 2019-20 fiscal year spending plan. Lawmakers had planned to wrap up their work by Friday but had to extend one more day to give members a mandatory 72-hour review period for the budget, which is required by the State Constitution. Governor DeSantis wields line-item veto power, meaning he can remove individual appropriations from the budget.

The Legislature tackled several major issues this session. The measures that prompted the most debate include an immigration enforcement bill; a bill to implement Amendment 4 – restoring voting rights to felons; and legislation that implements the recommendations of a school safety panel that was commissioned after the Parkland shooting, including a provision that gives school districts the option to train and arm willing teachers.

House Speaker Jose Oliva successfully pursued a number of health care changes that the House believed would reduce patient costs. The Legislature as a whole passed legislation that expands telemedicine, removes certain health provider certifications, increases health care competition, and creates new opportunities to import foreign, less expensive prescription drugs.

Senate President Bill Galvano had identified a series of toll-road projects as one of his top priorities and the Legislature followed through by supporting a multi-year plan to dedicate state dollars toward three major highway constructions or expansions, including bringing the Suncoast Parkway, which starts in Tampa, up to the Florida-Georgia border; and, connecting the Florida Turnpike to Suncoast Parkway.

Thanks to our outstanding lobbying team from Gray Robinson, Mike Huey, Todd Steibly, and Jessica Love, our legislative committee chaired by Dr. Bill Storoe, dentistry and OMS for a very successful session.


Following are the Highlights:

BUDGET & TAX PACKAGE

The $91.1 billion spending plan lawmakers approved Saturday is the largest budget in state history and @2.4 billion more than the current year budget. The final number is closer to Governor DeSantis recommended budget – $91.3 billion – than is to the initial spending plans passed earlier this year by the House and Senate.

Lawmakers provided historic funding for the environment and education in the budget. Per-pupil student spending in K-12 schools, for example, is $243 higher than it was last year. The budget also exceeds the $625 million investment in the Everglades and water quality initiatives that DeSantis requested.

For Hurricane Michael, the Legislature agreed to spend $1.8 billion on relief and recovery. There was little debate over that dollar figure, with most lawmakers criticizing the federal government’s lack of response to the disaster.

The legislature also passed a tax package which will cut revenue by $86 million in the first year and $72 million annually after. The most expensive portion of the package was a reduction in the business rent tax rate, which dropped from 5.7 percent to 5.5 percent. The legislation also includes a 5 day back-to-school sales tax holiday (August 2-6, 2019) and a 7-day hurricane preparedness tax holiday (May 31- June 6, 2019).

HIGH PRIORITY LEGISLATION

Continuing Education for Dentists- PASSED
HB 549 by Rep. Tyler Sirois
SB 648 by Sen. Debbie Mayfield

Legislation which passed during the 2018 Legislative Session (HB 21) required all health care providers who are registered with the Drug Enforcement Agency to take a two-hour continuing education (CE) course on the prescribing of controlled substances. The legislation limited the groups which could provide the course to only those affiliated with a statewide professional association of physicians (s. 456.0301, F.S.), unless a licensee’s practice act requires them to take a two-hour course on safe and effective prescribing of controlled substances, then the licensee is exempt from the requirements of 456.0301.

We approached Representative Tyler Sirois and Senator Debbie Mayfield to file legislation that would insert language into the dental proactive act requiring dentist to complete the two-hour course as part of their required 30 hours of continuing education for biennial licensure renewal. FSOMS worked these bills through the House and Senate committee process without receiving a negative vote. On April 23, the Legislature passed HB 549 which is awaiting action by the Governor, who will sign the bill, let it become law without his signature, or veto it.

This was Representative Sirois’ first bill that he passed as a freshman legislator and we are proud to have worked with him on this issue. We are currently focusing our efforts on the Governor’s Office, advocating that the Governor sign this important legislation to allow dental affiliated groups who understand the specialty of dentistry and oral and maxillofacial surgery to provide these continuing education courses directly.

Dental Therapy- FAILED
HB 649 by Rep. Rene “Coach P” Plasencia
SB 684 by Sen. Jeff Brandes

This legislation would have created a new category of licensees, dental therapists, in Florida. Many educational models recommend two years or less or post-high school education for dental therapist. These bills would have authorized the Department of Health (DOH) to issue a dental therapist license to an applicant who possesses a degree or certificate in dental therapy from an accredited program. The bills authorized a licensed dental therapist to perform remediable tasks under the general supervision of a dentist, and authorized Medicaid to reimburse for dental services provided in a mobile dental unit owned by the health access setting. The Senate bill received only one committee hearing, while the House measure was worshipped by the House Health Quality Subcommittee without going to a vote. We fully anticipate this legislation to be filed again for consideration during the 2020 Session.


OTHER LEGISLATIVE ISSUES

Legislation Which Passed:

Certificate of Need – PASSED
HB 21 by Rep. Heather Fitzenhagen
SB 1712 by Sen. Gayle Harrell

A top priority of House Speaker Oliva, certificate-of-need (CON) repeal, became one of the most contentious pieces of legislation. If approved by the Governor, the bill will eliminate the CON requirement for specialty hospitals in 2021. Earlier this Session, the Senate presented a proposal that would have eliminated CON, but would have imposed additional requirements on any new hospitals, such as mandating that they have an emergency room, accept Medicare and Medicaid patients, and provide a certain percentage of charity care, among other requirements. However, during the last few days of Session, those requirements were removed from the bill, reflecting the House position. The measure, as passed, will also require the Office of Program Policy Analysis and Government Accountability (OPPAGA) to review federal and other state licensure statues regarding tertiary health services and to make recommendations to the legislature by November 1, 2019, regarding best practices as it pertains to the establishment of licensure standards for such programs.

The legislation also includes language establishing the dental student loan repayment program (HB 465), to eligible dentists actively employed in a public health program that services Medicaid recipients and other low-income patients located in medically underserved areas and health professional shortage areas. Each year, DOH may grant up to 10 eligible dentists up to $50,000 in student loan repayment per year for a maximum of five years for a total of $250,000. The bill also requires DOH to establish the Donated Dental Services Programs, a network of volunteer dental providers who will provide free dental services to needy, disabled, elderly, and medically compromised individual who cannot afford necessary treatment but are ineligible for public assistance.

Telehealth – PASSED
HB 23 by Rep. Clay Yarborough
SB 1526 by Sen. Gayle Harrell

Another House propriety, authorizing telehealth services in Florida, passed the legislature this year. The bill established new telehealth practice standards, requires out-of-state practitioners without a Florida license to register with the DOH in order to deliver health care services within their scope of practice to Florida patients, and provides for reimbursement of such services. Providers are defined as licensed physicians, podiatrists, optometrists, nurses, nurse practitioners, pharmacists, dentists, chiropractors, as well as many other professionals, such as acupuncturists, physical therapists, psychologists, behavior analysts and others. These practitioners must maintain an active, unencumbered license issued by another state that is substantially similar to Florida’s license, and must not have been the subject of disciplinary.

IMPORTATION of PRESCRIPTION DRUGS – PASSED
HB 19 Rep. Tom Leek
SB 1452 by Sen. Joe Gruters

This legislation will create a Canadian drug importation program for the state and an international drug importation program for the commercial market. The international program is limited to other counties with similar pharmaceutical standards as the United States.

Documentation of a drug’s manufacturing is required for both importation programs and must be maintained for seven years. This legislation required Federal authorization, and President Trump has directed Alex Azar, Secretary of Health and Human Services, to work with Governor DeSantis on the plan, which must be submitted by July 1, 2020.

ELECTRONIC PRESCRIBING – PASSED
HB 831 by Rep. Amber Mariano
SB 1192 by Sen. Aaron Bean

House Bill requires certain health care practitioners who maintain a system of electronic health records to electronically generate and transmit prescriptions for medicinal drugs upon license renewal, or by July 1, 2021, with a few exceptions. DOH must consult with the Board of Dentistry to adopt rules to implement this language.


Legislation Which Failed:

Department of Health- FAILED
HB 7031 by House Health Quality Subcommittee
SB 188 by Sen. Gayle Harrell

The DOH package once again failed to pass this Session. The bill would have removed language that allows only a “Florida licensed dentist” to grade dental exams for licensure and required dental labs to be inspected once a year in the biennial rather than every year. It also would have required a representation of dental laboratories to consult with a dentist online during a procedure and extended to repeal of the health access dental license from 2020 to 2025.

Opioid Drug Abuse Task Force
HB 875 by Rep. Tyler Sirois
SB 1658 by Sen. Wilton Simpson

This legislation would have established a statewide task force to research Florida’s opioids drug abuse problem. The task force was to be comprised of 25 members, including:

  • One member each from the Department of Education, Florida Department of Law Enforcement,
  • Department of Children and Families, Agency for Healthcare Administration, Department of Corrections, Department of Juvenile Justice, and State Courts Administrator;
  • One member appointed by the President of the Senate;
  • One member appointed by the Speaker of the House;
  • Three members from addiction and recovery associations;
  • Two sheriffs, two police chiefs, two state attorneys, and two public defenders; and
  • One representative each from the Florida Medical Associations, Florida Pharmacy Association, and the insurance industry.

We worked with the House sponsor, Representative Tyler Sirois, to add an oral surgeon to task force, however HB 875 was not heard again in committee. The Senate bill never received a hearing. We will continue to work with both sponsors in the event similar legislation is filed again next year.


NEXT SESSION

The 2020 Legislative Session will begin January 14, 2020, and we expect that committee hearings will begin September 2019. We sincerely appreciate the opportunity of representing FSOMS and comment you for your tireless commitment to the legislative process watch and every Session. Should you have any questions concerning the information provided in this report, please do not hesitate to contact us.

Summer Meeting 2019

August 8, 2019
Pre-Conference Sessions

( ACLS/BLS and Airways and Office Emergencies)

August 9-11, 2019
2019 Summer Meeting
Ritz Carlton
Amelia Island

 REGISTER NOW


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HOTEL ACCOMMODATIONS

Featuring 446 guest rooms and suites all with a private balcony, four restaurants and lobby lounge, the Ritz- Carlton spa, 24-hour fitness center, on-site tennis facilities and 18 holes of private championship golf just outside our front door. When making hotel reservations in our room block, please book your room online, go to the web site:

https://book.passkey.com/go/FMOMS2019

OR call 1-888-239-1217 and refer to the Florida Society of Oral and Maxillofacial Surgeons Summer Meeting to receive the group rate.

The rate for single or double occupancy is $279 per night. The room block will be released Friday, July 5, 2019

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Pediatric Office-Based Emergencies and Newer Developments in Pediatric Anesthesia

 

Andrew Herlich, DMD, MD, FAAP, FASA
Professor and Special Assistant to the Chair
for Academic and Faculty Affairs
Staff Anestheisologist, UPMC Mercy, Pittsburgh, PA

 

 


Also offering these Required Courses:

(classes based on a minimum number of registrations and are subject to
cancellation if minimums are not met.)

  • ACLS and BLS sessions
  • Advanced Airway Complications & Management for the OMS
  • OMS Office Emergencies–Simulation Course

Annual Meeting 2019

November 1-3, 2019
2019 Annual Meeting
The Breakers
West Palm Beach


 

  • Medical Errors
  • Anthony G. Sclar, DMD

 

Sponsored by Geistlich and Osteo Science Foundation

 

Summer Meeting 2020

SAVE THE DATE

July 9 – 12, 2020
Embassy Suites by Hilton,
St. Augustine, FL

 

Annual Meeting 2020

SAVE THE DATE

October 23 – 25, 2020
Marriott Tampa Water Street

Dental Anesthesiology Recognized As Dental Specialty

ADA has announced that dental anesthesiology has become “the 10th dental specialty recognized by the National Commission on Recognition of Dental Specialties and Certifying Boards.” On March 11, the National Commission “adopted a resolution based on an application from the American Society of Dentist Anesthesiologists to recognize dental anesthesiology as a dental specialty.”

Dr. James Tom, president of the American Society of Dentist Anesthesiologists, said, “This historic vote by the National Commission certainly reflects the ADA’s ongoing efforts towards improved patient care and safety in the areas of dental sedation, dental anesthesiology and access for those with special health care needs.”

In addition to dental anesthesiology, other recognized dental specialties include dental public health, endodontics, oral and maxillofacial pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, and prosthodontics.

FDH Changes the Rules regarding the Dental Sedation Inspection Program

After over 35 FSOMS members responded to our request for volunteers to perform office anesthesia inspections, the Florida Department of Health changed the rules. They now plan to hire full time inspectors to perform the evaluations and cease contracting with permitted dentists.

Following is a copy of an email sent current inspectors from FDH Executive Director Jennifer Wenhold explaining the changes.


Dear Dental Inspectors:

We appreciate the feedback received at the sedation workshop regarding the future of the dental inspection program and understand the importance of having dentists perform the inspections. Unlike the Board office, the Bureau of Enforcement’s infrastructure is designed to properly and efficiently manage inspection programs. The Department’s infrastructure is designed this way to alleviate liability and conflicts with the Boards. Based on this, as well as the other concerns I have already shared with you, we are in the process of transitioning the dental sedation program to this office. The program will essentially remain the same with the exception of creating full time positions (to be held by permitted dentists) as opposed to contracting with permitted dentists.

I am working closely with my colleagues to transition this smoothly. What this means for you is business will continue as normal. Nothing is changing with regards to how inspections are being performed and the Board remains in control of the rules which outline how inspections are and will be conducted. We will be running congruently until the program is successfully transitioned within the Department and the full time positions are established and working. At this time we do not have a date set for this to occur but it will likely be at the start of the next fiscal year, after July 1.

Thank you for your feedback and contributions to making Florida the safest state for dental anesthesia.

Regards,

Jennifer L. Wenhold, MSW, Executive Director-
Florida Department of Health
Florida Boards of Dentistry, Clinical Social Work, Marriage & Family Therapy
and Mental Health Counseling, Opticianry, Hearing Aid Specialists and Athletic Training

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850.921.5389 (fax)

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727-639-4716
emery@aberdeenadvisors.com

 

Posted 3-5-19