Board of Dentistry Anesthesia Rule Changes – Nov. 16, 2018 Meeting

Following is a report from Dr. Clive Rayner, Chair of the FSOMS Anesthesia Committee, who attended the November 16 Board of Dentistry anesthesia committee meeting, which followed the full Board of Dentistry meeting:

Prior to the anesthesia committee meeting, the full Board met and passed a resolution requested by Board staff to begin charging a fee for the initial anesthesia office inspection. Most states across the nation already charge for the initial office inspection, but Florida has not until now. The board estimated that the initial inspection process costs the state ~ $1900 per office inspected. Therefore, the board established a fee of $2000 going forward for the initial inspection. If the examinee fails the initial inspection, he will be charged for repeat inspection. There is no plan to charge for the regular re-inspections. If there are multiple office locations, there is no additional fee proposed at this time.
Following the full Board meeting, the anesthesia committee met. Members of the anesthesia committee present included Drs. T.J. Tejera, myself (Clive Rayner), Nick White (pediatric dentist, moderate sedation permit holder), Claudio Miro (general dentist, moderate sedation provider, anesthesia committee chair, and incoming Board of Dentistry chairman), Charles Llano (general dentist, moderate sedation provider), James Betancourt (periodontist & paramedic; moderate sedation provider), Fernando Munoz (dentist anesthesiologist & pediatric dentist, GA provider). Also present were David Flynn (Board attorney), Jennifer Wenhold (Board director), and Jessica Sapp (anesthesia programs administrator).
The purpose of the committee meeting was to review the previously proposed updates to the Board of Dentistry anesthesia rules. These updates had been proposed by the Board’s attorney and staff to resolve internal rule inconsistencies, update Florida’s rules to be more consistent with state anesthesia rules nationwide, and to be consistent with anesthesia best practices. These had been presented to the anesthesia committee at the prior meeting in August at which time they underwent lengthy debate and discussion. Most of this meeting was word-smithing and clarifying existing rules, but a few new items were passed.

Re-inspections will now be done every 3 years; again at no charge. AAOMS requires office inspections every 5 years, so the state inspections will still suffice for AAOMS, as the Board uses the AAOMS office inspection guidelines already.


Most states already require that a sedation provider who sedates “children” have PALS training, and that a sedation provider who treats “adults” have ACLS. The difficulty lies in defining a “child” vs. “adult.” The board staff, members of the committee and the Board’s attorney researched the issue and determined that although various organizations have a variety of definitions of a “child,” the most logical thing to do was to use the American Heart Association’s own definition since they are the PALS/ACLS course provider, which is that PALS is the appropriate course “until puberty.” Obviously, this is very individual and difficult thing to determine, so the age of 12 was chosen by the committee as being an acceptable compromise. The dentist anesthesiologist, pediatric dentist, and periodontists (who is also a practicing Paramedic) on the committee argued strongly in favor of this definition as being in the best interest of patient safety.  PALS and/or ACLS if applicable to the individual provider will therefore be required every CE biennium effective the biennium ending in 2020.


The issue of using EMTs as sedation providers was again discussed at length, as it is apparently the practice of some OMS offices to hire EMTs as sedation providers. The Board’s attorney reiterated that under Florida statute, an EMS’s ability to practice falls under the medical license, not a dental license. Therefore, an EMS provider (either EMT or Paramedic) can function as a surgical assistant, and can function as an anesthesia assistant to monitor and maintain the airway under sedation, and can monitor a patient following sedation in recovery. But an EMS provider CANNOT start IVs, NORadminister sedative drugs under the direction of a dental licensee. The dentist anesthesiologist and periodontist (who is also a practicing Paramedic) on the committee confirmed this.


The committee again discussed requiring dental assistants to get regular continuing education to function as anesthesia assistants and be part of the “dental anesthesia team model.” Many states now require such CE for staff assisting in sedation, and some specifically require DAANCE training. But the anesthesia committee did not move these recommendations forward.


Ryanodex is now acceptable as an alternative to Dantrolene, if the office provides volatile gas anesthesia. Dexmedetomidine was added to the list of drugs only to be used by GA permit holders.


The Board staff clarified the two sedation CE requirements for sedation providers that continue to cause confusion:
  • CE Rule #1- 4 hours of didactic lecture in anesthesia and/or medical emergencies
  • CE Rule #2- 4 hours of live “hands-on” airway training and/or live “hands-on anesthesia emergency simulation training.”
These courses were originally proposed to be required every 2 years, but after objections, it was re-interpreted to mean one of these courses every other biennium. Now the Board will allow these courses to be taken in the same biennium OR in different biennium, and each course is good for 4 years.

The Board staff commented that they still have a shortage of office anesthesia inspectors in the Orlando and Sarasota areas, and requested any interested OMSs to contact the Board.


The Board announced that its staff will be conducting an educational presentation on Florida’s sedation rules and inspections, on February 14, 2019 in Gainesville, which is the day prior to the full board meeting. The purpose of this presentation is to educate dental sedation permit holders, applicants, residents, office inspectors, and all interested parties on Florida sedation rules and the inspection process.

 

“The Department has previously offered these type of workshops for pharmacies and office surgery site centers and this will be our first year including dental sedation. The purpose is to invite all permit holders in Florida and future permit holders (i.e. residents) to attend to learn more about our inspection program, what we look for during initial and routine inspections, who performs the inspections, common deficiencies, etc. We will be giving PowerPoint presentations and have a panel of experts (including inspectors, the Anesthesia Committee Chair, Board Chair, Board attorney, Enforcement staff, etc.) to answer questions from the audience.”

 

For more information, contact:
Jessica Sapp
Program Operations Administrator
Department of Health | Division of Medical Quality Assurance
Bureau of Health Care Practitioner Regulation | Board of Dentistry
4052 Bald Cypress Way Bin C-08
Tallahassee, FL 32399-1708
Phone 850/245-4463