1-1     By:  Carona                                            S.B. No. 539
 1-2           (In the Senate - Filed February 5, 2001; February 7, 2001,
 1-3     read first time and referred to Committee on Health and Human
 1-4     Services; March 19, 2001, reported adversely, with favorable
 1-5     Committee Substitute by the following vote:  Yeas 8, Nays 0;
 1-6     March 19, 2001, sent to printer.)
 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 539                   By:  Carona
 1-8                            A BILL TO BE ENTITLED
 1-9                                   AN ACT
1-10     relating to regulating the enteral administration of anesthesia  in
1-11     connection with the practice of dentistry.
1-12           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13           SECTION 1.  Chapter 258, Occupations Code, is amended by
1-14     adding Subchapter D to read as follows:
1-15             SUBCHAPTER D.  ENTERAL ADMINISTRATION OF ANESTHESIA
1-16           Sec. 258.151.  DEFINITION.  In this subchapter, "enteral"
1-17     means any technique of administering anesthesia in which the
1-18     anesthetic is absorbed through the gastrointestinal tract or oral
1-19     mucosa.  Examples of enterally administering anesthesia include
1-20     administering an anesthetic orally, rectally, sublingually, or
1-21     intranasally.
1-22           Sec. 258.152.  APPLICABILITY.  Rules adopted by the board
1-23     under this subchapter do not apply to:
1-24                 (1)  the regional injection of an anesthetic to reduce
1-25     or eliminate sensation, especially pain, in one part of the body;
1-26     or
1-27                 (2)  the administration of anxiolytics and analgesics
1-28     that are not being used in conjunction with the administration of
1-29     nitrous oxide and that are administered in doses that do not have
1-30     the probability of placing the dental patient at risk for loss of
1-31     the dental patient's life-preserving protective reflexes.
1-32           Sec. 258.153.  RULES.  (a)  The board shall establish by rule
1-33     the minimum standards for the enteral administration of anesthesia
1-34     by a dentist.
1-35           (b)  The rules must be designed to protect the health,
1-36     safety, and welfare of the public and must include requirements
1-37     relating to:
1-38                 (1)  the methods used to enterally administer an
1-39     anesthetic and the anesthetic agents that may be used;
1-40                 (2)  dental patient evaluation, diagnosis, counseling,
1-41     and preparation;
1-42                 (3)  dental patient monitoring to be performed and
1-43     equipment to be used during a procedure and during postprocedure
1-44     monitoring;
1-45                 (4)  emergency procedures, drugs, and equipment,
1-46     including education, training, and certification of personnel, as
1-47     appropriate, and including protocols for transfers to a hospital;
1-48                 (5)  the documentation necessary to demonstrate
1-49     compliance with this subchapter; and
1-50                 (6)  the period in which protocols or procedures
1-51     covered by rules of the board shall be reviewed, updated, or
1-52     amended.
1-53           Sec. 258.154.  COMPLIANCE WITH ANESTHESIA RULES.  (a)  On and
1-54     after August 31, 2002, a dentist who practices dentistry in this
1-55     state and who enterally administers anesthesia or performs a
1-56     procedure for which anesthesia is enterally administered shall
1-57     comply with the rules adopted under this subchapter.
1-58           (b)  The board may require a dentist to submit and comply
1-59     with a corrective action plan to remedy or address any current or
1-60     potential deficiencies with the dentist's enteral administration of
1-61     anesthesia in accordance with this subtitle or rules of the board.
1-62           Sec. 258.155.  ANNUAL PERMIT.  (a)  Not later than September
1-63     1, 2002, the board shall require each dentist who enterally
1-64     administers anesthesia or performs a procedure for which anesthesia
 2-1     is enterally administered to annually obtain a permit from the
 2-2     board by completing a form prescribed by the board.  The board
 2-3     shall set and impose a fee for the permit in an amount designed to
 2-4     recover the costs of regulating a permit holder under this
 2-5     subchapter.
 2-6           (b)  The board shall coordinate the times at which a permit
 2-7     must be renewed with the times at which a dentist's license must be
 2-8     renewed under Chapter 257 so that the times of registration,
 2-9     payment, notice, and imposition of penalties for late payment are
2-10     similar and provide a minimum of administrative burden to the board
2-11     and to dentists.
2-12           Sec. 258.156.  INSPECTIONS.  (a)  The board may conduct
2-13     inspections to enforce this subchapter, including inspections of an
2-14     office site and of documents of a dentist's practice that relate to
2-15     the enteral administration of anesthesia.  The board may contract
2-16     with another state agency or qualified person to conduct these
2-17     inspections.
2-18           (b)  Unless it would jeopardize an ongoing investigation, the
2-19     board shall provide at least five business days' notice before
2-20     conducting an on-site inspection under this section.
2-21           (c)  This section does not require the board to make an
2-22     on-site inspection of a dentist's office.
2-23           Sec. 258.157.  REQUESTS FOR INSPECTION AND ADVISORY OPINION.
2-24     (a)  The board may consider a request by a dentist for an on-site
2-25     inspection.  The board may, in its discretion and on payment of a
2-26     fee in an amount established by the board, conduct the inspection
2-27     and issue an advisory opinion.
2-28           (b)  An advisory opinion issued by the board under this
2-29     section is not binding on the board, and the board, except as
2-30     provided by Subsection (c), may take any action under this subtitle
2-31     in relation to the situation addressed by the advisory opinion that
2-32     the board considers appropriate.
2-33           (c)  A dentist who requests and relies on an advisory opinion
2-34     of the board may use the opinion as mitigating evidence in an
2-35     action or proceeding to impose an administrative or civil penalty
2-36     under this subtitle.  The board or court, as appropriate, shall
2-37     take proof of reliance on an advisory opinion into consideration
2-38     and mitigate the imposition of administrative or civil penalties
2-39     accordingly.
2-40           SECTION 2.  (a)  The rules required under Subchapter D,
2-41     Chapter 258, Occupations Code, as added by this Act, must be
2-42     adopted by the State Board of Dental Examiners not later than
2-43     January 8, 2002.
2-44           (b)  The State Board of Dental Examiners shall report to the
2-45     speaker of the house of representatives and the lieutenant governor
2-46     on the implementation and enforcement of those rules and of the law
2-47     added by this Act not later than January 1, 2003.  The report must
2-48     include any suggested amendments or changes to the law added by
2-49     this Act to make the law more effective or efficient.
2-50           SECTION 3.  This Act takes effect September 1, 2001.
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