Deciphering the New 2011 TSBDE Rules: Chapter 110 - Sedation and Anesthesia
Added: 06/22/11
Deciphering the New Board Rules:
Chapter 110 - Sedation and Anesthesia
By Boyd W. Shepherd, D.D.S., J.D.
New Regulations regarding requirements for obtaining and maintaining permits to administer dental anesthesia in Texas were adopted by the Texas State Board of Dental Examiners (TSBDE) at the April 2011 Board Meeting. The provisions of these new anesthesia permit regulations, found at 22 Texas Administrative Code §110, were adopted to be effective as of May 10, 2011 (36 Texas Register 2833), and will begin to be enforced starting January 1, 2012.
The aim of this article is to summarize these new legal requirements and how dentists who already hold these permits will be impacted. Texas dentists may get further and more detailed information from the TSBDE website, where a full page has been dedicated to offering details about these new requirements, including permit applications, found at the following: http://tinyurl.com/3hx9yap .
Chapter 110 of the TSBDE Rules and Regulations, titled “Sedation and Anesthesia” (previously titled “Enteral Conscious Sedation”) is exclusively devoted to new rules which are derived from the current American Dental Association (ADA) Guidelines base requirements on the level of sedation versus route of administration.
The title headings for each rule of Chapter 110 are as follows:
110.1 Definitions
110.2 Sedation/Anesthesia Permit
110.3 Nitrous Oxide/Oxygen Inhalation Sedation
110.4 Minimal Sedation
110.5 Moderate Sedation
110.6 Deep Sedation or General Anesthesia
110.7 Portability
110.8 Provisional Anesthesia and Portability Permits
110.9 Anesthesia Permit Renewal
Rule 110.1 of Chapter 110 is a list of definitions, followed by the introductory Rule 110.2, generally addressing the Sedation/Anesthesia Permit, which states as follows:
RULE §110.2 Sedation/Anesthesia Permit
(a) A dentist licensed under Chapter 101 of this title shall obtain an anesthesia permit for the following anesthesia procedures used for the purpose of performing dentistry:
(1) Nitrous Oxide/Oxygen inhalation sedation;
(2) Level 1: Minimal sedation;
(3) Level 2: Moderate sedation limited to enteral routes of administration;
(4) Level 3: Moderate sedation which includes parenteral routes of administration;
(5) Level 4: Deep sedation or general anesthesia.
(b) A dentist licensed to practice in Texas who desires to administer nitrous oxide/oxygen inhalation sedation or Level 1, Level 2, Level 3 or Level 4 sedation must obtain a permit from the State Board of Dental Examiners (Board). A permit is not required to administer Schedule II drugs prescribed for the purpose of pain control or post-operative care.
(1) A permit may be obtained by completing an application form approved by the Board.
(2) The application form must be filled out completely and appropriate fees paid.
(3) Prior to issuance of a sedation/anesthesia permit, the Board may require that the applicant undergo a facility inspection or further review of credentials. The Board may direct an Anesthesia Consultant, who has been appointed by the Board, to assist in this inspection or review. The applicant will be notified in writing if an inspection is required and provided with the name of an Anesthesia Consultant who will coordinate the inspection. The applicant must make arrangements for completion of the inspection within 180 days of the date the notice is mailed. An extension of no more than ninety (90) days may be granted if the designated Anesthesia Consultant requests one.
(4) An applicant for a sedation/anesthesia permit must be licensed by and should be in good standing with the Board. For purposes of this chapter "good standing" means that the dentist's license is not suspended, whether or not the suspension is probated. Applications from licensees who are not in good standing may not be approved.
What Do I Need To Do If Need a Permit, or If I Currently Hold a Permit?
On the same webpage explaining the new Chapter 110 (http://tinyurl.com/3hx9yap), matrices have been developed by the TSBDE staff to illustrate how your existing permit will be impacted. On this matrix, you may choose from different categories to find the summary of requirements for each level of permitting, including treatment and charting requirements that all practitioners should take note of.
However, these matrices do not clearly address what is necessary for current holders of sedation and anesthesia permits. Therefore, to learn the requirements for current sedation and anesthesia permit holders, you must return to and read each of the specific rules for each level of sedation, summarized as follows:
|
Rule |
Procedure for Current Permit Holder |
|
RULE §110.3(a)(3) Nitrous Oxide/Oxygen Inhalation Sedation |
A dentist applying for a nitrous oxide/oxygen inhalation sedation permit shall (be) a Texas licensed dentist, has a current Board-issued nitrous oxide/oxygen inhalation sedation permit, and has been using nitrous oxide/oxygen inhalation sedation in a competent manner immediately prior to the implementation of this chapter on June 1, 2011. Any dentist whose Board-issued nitrous oxide/oxygen inhalation sedation permit is active on June 1, 2011 shall automatically continue to hold this permit. |
|
RULE §110.4(a)(3) Minimal Sedation |
A dentist applying for a Level 1 Minimal Sedation permit shall (be) a Texas licensed dentist, has a current Board-issued enteral permit, and has been using minimal sedation in a competent manner immediately prior to the implementation of this chapter on June 1, 2011. Any Texas licensed dentist who was issued an enteral sedation permit before June 1, 2011 and whose enteral sedation permit was active on June 1, 2011 shall automatically have the permit reclassified as a Level 1 Minimal Sedation permit on June 1, 2011. A Texas licensed dentist whose permit is reclassified from an enteral sedation permit to a Level 1 Minimal Sedation permit on June 1, 2011 may continue to administer enteral sedation until January 1, 2013. On or before January 1, 2013, the dentist shall either provide proof that adequate education has been obtained by submitting an application for a Level 2 permit on or before that date, or shall comply with the requirements of a Level 1 permit after that date. A dentist shall always follow the standard of care and clinical requirements for the level of sedation he or she is performing. |
|
RULE §110.5(a)(1)(C) Moderate Sedation (limited to enteral route of administration) |
A dentist applying for a Level 2 Moderate Sedation permit (limited to enteral route of administration) must satisfy at least one of the following educational/professional criteria: …is a Texas licensed dentist who was issued an enteral sedation permit before June 1, 2011 and whose enteral sedation permit was active on June 1, 2011. Dentists in this category shall automatically have their permit reclassified as a Level 1 Minimal Sedation permit on June 1, 2011. A Texas licensed dentist whose permit is reclassified from an enteral sedation permit to a Level 1 Minimal Sedation permit on June 1, 2011 may continue to administer enteral sedation until January 1, 2013. On or before January 1, 2013, the dentist shall either provide proof that adequate education has been obtained by submitting an application for a Level 2 permit on or before that date, or shall comply with the requirements of a Level 1 permit after that date. A dentist shall always follow the standard of care and clinical requirements for the level of sedation he or she is performing. |
|
RULE §110.5 (a)(2)(D) Moderate Sedation (inclusive of parenteral routes of administration) |
A dentist applying for a Level 3 Moderate Sedation permit (inclusive of parenteral routes of administration) must satisfy at least one of the following educational/professional criteria: …is a Texas licensed dentist who had a current parenteral sedation permit issued by the Board and has been using parenteral sedation in a competent manner immediately prior to the implementation of this chapter on June 1, 2011. A Texas licensed dentist whose Board-issued permit to perform parenteral sedation is active on June 1, 2011 shall automatically have the permit reclassified as a Level 3 Moderate Sedation (inclusive of parenteral routes of administration) permit. |
|
RULE §110.6(a)(1)(B) Deep Sedation or General Anesthesia |
A dentist applying for a permit to administer deep sedation or general anesthesia must satisfy one of the following criteria: is a Texas licensed dentist who holds a current permit to administer deep sedation or general anesthesia issued by the Board and who has been using deep sedation or general anesthesia in a competent manner immediately prior to the implementation of this chapter on June 1, 2011. A Texas licensed dentist whose Board-issued permit to perform deep sedation or general anesthesia is active on June 1, 2011 shall automatically have the permit reclassified as a Level 4 Deep Sedation or General Anesthesia permit. |
|
RULE §110.9(a) Anesthesia Permit Renewal |
The Board shall renew an anesthesia/sedation permit annually if required fees are paid and the required emergency management training and continuing education requirements are satisfied. The Board shall not renew an anesthesia/sedation permit if, after notice and opportunity for hearing, the Board finds the permit holder has provided, or is likely to provide, anesthesia/sedation services in a manner that does not meet the minimum standard of care. If a hearing is held, the Board shall consider factors including patient complaints, morbidity, mortality, and anesthesia consultant recommendations. |
To conclude, as I often advise, it is good practice for the dental professional to be fully aware of the laws and regulations that govern the practice of dentistry in Texas, and to fully educate one’s office staff on these rules as well. To access the complete current version of the of TSBDE rules, the reader may go to http://tinyurl.com/3lp9toz .
Please look for future GHDS Journal articles which will address additional recent TSBDE rule additions and revisions.
Dr. Shepherd is a 1988 graduate of the University of Texas Dental Branch at Houston and a 1992 graduate of South Texas College of Law, and has practiced law exclusively as a Texas-licensed attorney since 1994, providing legal services and counsel to Texas dentists on a wide range of legal issues and needs, including Texas Dental Law, TSBDE issues & licensure, dental practice transitions, employment law, commercial lease review and negotiation, risk management, contracts & business transactions. An ADA and Texas Dental Association member, he is also a member of the Greater Houston Dental Society, within which he serves as legal counsel to its Board of Directors. In addition to his full time practice of law, Dr. Shepherd also directs 5 courses at the University of Texas Dental Branch in Houston, including Ethics, Communications, Law & Regulations, and two courses in Practice Management.
