BG C.S.S.B. 877 75(R)BILL ANALYSIS PUBLIC HEALTH C.S.S.B. 877 By: Sibley (Berlanga) 5-1-97 Committee Report (Substituted) BACKGROUND The State Board of Dental Examiners (board) was reestablished by the passage of S.B. 18 during the 74th Legislature in order to govern the Dental Practices Act (Chapter 9, Title 71, Vernon's Texas Civil Statutes). The law added by S.B. 18 is unclear in some sections. PURPOSE S.B. 877 revises various regulations concerning the practice of dentistry to be enforced by the State Board of Dental Examiners. RULEMAKING AUTHORITY It is the committee's opinion that in this bill additional State Board of Dental Examiners' rulemaking authority is both granted and/or referenced in SECTION 3 (Article 4545a-(a)(3) and (a)(8), Revised Statutes), in SECTION 9 (Chapter 9, Title 71, Article 4548k, Sec. 1(a), and Sec. 2, Revised Statutes). SECTION 27 requires adoption of those rules by December 1, 1997. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 1(a), Article 4544, Revised Statutes, to delete text requiring the examination to be given either orally or in writing, or by giving a practical demonstration of the applicant's skill, or any combination of such methods or subjects as the board may require. SECTION 2. Amends Section 4545, Revised Statutes, to add to the requirement that each applicant for a license to practice dentistry be no less than 21 years old, to also require that the applicant present evidence of good moral character and proof of graduation from a dental school accredited by the Commission on Dental Accreditation of the American Dental Association (commission); or proof of graduation from a dental school that is not accredited by the commission and successful completion of training in an American Dental Association approved specialty in an education program accredited by the commission and that consists of at least two years of training as specified by the Council on Dental Education. Omits language concerning the concept of a reputable dental college. SECTION 3. Amends Article 4545a, Revised Statutes, as follows: Art. 4545a. New heading: LICENSING BY CREDENTIALS. Adds "approved by the board according to rules established by the board" to one of the qualifying clauses for granting a license to a dentist or dental hygienist who has graduated from a school that is accredited as specified. Adds language regarding being qualified for licensure as a dental educator, to clarify it to be at a dental school or dental hygiene school accredited by the Commission on Dental Accreditation of the American Dental Association, and specifies it to be for the five years immediately preceding the date of the license application. Also adds "has met any additional criteria established by board rule" to the list of qualifiers. Removes language regarding two years of service under the National Health Service Corps or other program as specified. Deletes Section 2, relating to licensing of foreign trained dentists. Makes conforming changes. SECTION 4. Amends Article 4548c, Revised Statutes, to change language regarding the prohibition on a person whose license to practice dentistry in this state has been revoked by a district court or by the board from practicing or attempting to practice dentistry or dental surgery to make it a permissive prohibition using the word "may" not instead of "shall" not. SECTION 5. Amends Article 4548e, Revised Statutes, to revise language to allow a person, corporation, company, or association to use a corporation, company, association, or trade name. Requires any advertisement by the corporation, company, association, or trade name to include prominently the name of at least one dentist practicing under such name. Requires the person, corporation, company, or association to file with the board a list of each dentist who practices under the name and a list of each trade name used if the trade name is different from the corporation, company, or association name. Establishes that the list must be updated and filed with the board by the 30th day after any change. Deletes text that made it unlawful to use certain trade names. SECTION 6. Amends Section 1, Chapter 501, Acts of the 45th Legislature, Regular Session, 1937 (Article 4548h, Vernon's Texas Civil Statutes), by amending Subsections (f)-(j) and adding Subsections (k)-(l), as follows: Subsection (f) requires a complaint received under this article to be filed with the board and reviewed to determine jurisdiction. Requires the board, if it has jurisdiction, to require an investigation of the complaint. Subsections (g)-(k) makes conforming changes. Subsection (l) allows the board to only consider a complaint that is filed with the board no later than the fourth anniversary of the date of the complained-about act, as specified. SECTION 7. Amends Sections 2 and 3, Chapter 501, Acts of the 45th Legislature, Regular Session, 1937 (Article 4548h, Vernon's Texas Civil Statutes) as follows: Sec. 2. Removes the word "cancel" from the requirement that the board revoke, cancel or suspend a license as specified. Adds language regarding the board imposing a fine on a license holder, and placing conditions and probation on a person whose license has been suspended. Clarifies that notice of hearing issued by the board is required to be made in writing. Removes text referring to complaints to be considered under this article. Provides that all proceedings under this section are subject to Chapter 2001, Government Code. Deletes text referring to a 4 year period in which complaints considered by the board must be filed. Makes conforming changes. Sec. 3. Adds "as provided by Chapter 2001, Government Code" to the provision that an aggrieved person has the right to appeal. Deletes text relating to the place of the court, the process of the appeal, and the staying of enforcement of penalty or punishment during the appeals process. Makes conforming changes. SECTION 8. Amends Article 4548i(b), Revised Statutes to increase the maximum amount of the civil penalty to $5,000, rather than $2,500. SECTION 9. Amends Chapter 9, Title 71, Revised Statutes, by adding Article 4548k, as follows: Art. 4548k. CONTRACTUAL AND ORGANIZATIONAL AGREEMENTS Sec. 1. Requires a person or organization to report certain specified information to the board, under rules adopted by the board. Provides that a person or organization who practices dentistry with one or more other dentists is responsible for all professional acts as specified. Establishes that this article does not affect an individual license holder's responsibilities and rights under this chapter. Sec. 2. Prohibits construing a statute related to the practice of dentistry in this state as a prohibition on maintaining any number of offices in this state if the dentist assumes responsibility and liability as specified and complies with prescribed requirements as specified. SECTION 10. Amends Section 1, Article 4549, Revised Statutes, to delete the words "involving moral turpitude" in reference to proof of conviction of a felony being a cause for the examining board's refusal as specified. SECTION 11. Amends Section 2, Article 4549, Revised Statutes, to add "to impose a fine on a person licensed under this chapter" and to place on probation "with conditions" to list the actions the board is in a position and authorized to take after notice and hearing as specified. Adds language regarding "failure to treat a patient according to the standard of care" to the cause of action over the license holder being guilty of dishonorable conduct, malpractice, or gross incompetency. Makes conforming change. SECTION 12. Amends Section 3(a), Article 4549, Revised Statutes, to revise language to the refusal to examine provision to establish that the hearing is under "Chapter 2001, Government Code" rather than "before the board." Adds language about the board proposing to suspend or revoke a license, to impose a fine, to place on probation a person whose license has been suspended, or to reprimand a license holder, as conditions which entitle the person to a hearing. SECTION 13. Amends Article 4549-1, Revised Statutes, to update the cited reference to Chapter 2001, Government Code. SECTION 14. Amends Article 4550, Revised Statutes, to change an "or " to an "and" in terms of registered information kept in board records. as provided by law. Adds that any change of owners of the laboratory be among the changes that need timely notification. SECTION 15. Amends Article 4551(b), Revised Statutes, to remove language which prohibited the board from setting a fee amount less than the fee amount of as it was September 1, 1993. SECTION 16. Amends Article 4551a, Revised Statutes, by amending subdivisions (1) and (7), and adding subdivision (9) as follows: Subdivision (1) adds "including use of the terms denturist or denturism" to the names and titles which convey the meaning specified or is regarded as a public professing of the practicing dentistry. Subdivision (7) removes the word "Texas" from the reference to the "State Board of Dental Examiners." Subdivision (9) adds the condition of the person holding himself out to be a denturist or using another title intended to publicly convey that services offered are within the practice of dentistry. SECTION 17. Amends Section 11, Chapter 244, General Laws, Acts of the 44th Legislature, Regular Session, 1935 (Article 4551b, Vernon's Texas Civil Statutes) by adding "dental hygiene" to the clause which provided that the definition of dentistry as specified is not applicable to members of a reputable dental "or dental hygiene" college or school faculty as specified. Updates statutory references and the reference to the title of the board. SECTION 18. Amends Section 2, Chapter 475, Acts of the 52nd Legislature, 1951 (Article 4551e, Vernon's Texas Civil Statutes) to revise the language concerning a dental hygienist's qualifications to clarify that it is necessary to be a graduate of a recognized school or college of dentistry or dental hygiene accredited by the commission and approved by the board. Makes conforming change and removes previous text relating to qualification of a dental hygienist. SECTION 19. Amends Section 5(a), Chapter 475, Acts of the 52nd Legislature, 1951 (Article 4551e, Vernon's Texas Civil Statutes) to conform to the change made in SECTION 1 of this bill. SECTION 20. Amends Articles 4551e-1(a) and (b), Revised Statutes, as follows: Subsection (a) is revised to allow a dental assistant who is not professionally licensed to be employed by and work in the office of a licensed and practicing dentist and perform one or more delegated dental acts under the direct supervision of such dentist. Defines direct supervision, direction, and responsibility, as used in this article. Subsection (b) adds the word "direct" to a dentist's supervision. Adds Subdivision (4) concerning the prohibition against delegation of the authority to administer local anesthetic agents, inhalation or parenteral sedatives or general anesthesia as specified. Makes conforming changes. SECTION 21. Amends Section 6(b), Article 4551f, Revised Statutes, to increase the hours of continuing education to be completed to at least 12, rather than 10, as specified and add "or is a certified technician" to the condition for renewal of a dental laboratory registration. SECTION 22. Amends Section 8, Article 4551f, Revised Statutes, by as follows: Subsection (a) is revised to allow the board to impose a fine, or probate all or part of the suspension as well as refusing to issue, suspend or revoke a certification as specified. Replaces the words "has violated this article" with language that clarifies it to be an action which violated or aided another person in violating any law regulating the practice of dentistry or has required or allowed a person under the direction or control of the applicant or certificate holder to violate any law regulating the practice of dentistry. Subsection (g) is added to provides that a person as used in this section includes someone applying for or holding a certificate of registration that has 20 percent or greater ownership interest or is the general partner or managing partner in a dental laboratory as specified. SECTION 23. Amends Article 4551n, Revised Statutes, as follows: Sec. 1. Makes conforming changes. Sec. 2. Added to allow a dentist licensed by the board to be employed by or contract to with a governmental entity providing dental services under federal or state law. Sec. 3. Added to allow a dentist licensed by the board to be employed by or contract with an organization if the organization is a nonprofit corporation as specified and approved by the board as an organization that provides services to under served populations for no fee or a reduced fee, or a clinic that provides dental services primarily to individuals who have the human immunodeficiency virus. SECTION 24. Amends Section 467.004(a), Health and Safety Code, to increase the surcharge a licensing or disciplinary authority may add to its licensure fees in order to fund an approved peer assistance programs to be not more than $10, rather than $5. SECTION 25. Amends Section 467.0041(b), Health and Safety Code, to conform. SECTION 26. Repeals Section 4, Chapter 501, Acts of the 45th Legislature, Regular Session, 1937 (Article 4548h, Vernon's Texas Civil Statutes) and Section 2A(f), Article 4550a, Revised Statutes. SECTION 27. Establishes the effective date: September 1, 1997. Requires the board to adopt rules required under this Act by December 1, 1997. Makes application of this Act prospective. SECTION 28. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE The Substitute bill folds in language relating to AIDS dental clinics and indigent dental clinics. In Section 23 of the bill, Article 4551n, Sec. 3 of the original bill has been replaced with language stating that a dentist may be employed or contract with a nonprofit 501(c)(3) if the organization provides services to under served populations for no fee or a reduced fee or if the organization provides dental services primarily to individuals with HIV and AIDS.