Haw. Code R. § 16-79-78 - Administration of general anesthesia and sedation
(a) A
licensed dentist shall administer general anesthesia and sedation consistent
with the current guidelines and recommendations of the American Dental
Association Guidelines for the Use Of Sedation and General Anesthesia by
Dentist; provided that for pediatric patients the American Academy of
Pediatrics and the American Academy of Pediatric Dentistry Guidelines for
Monitoring and Management of Pediatric Patients During and After Sedation for
Diagnostic and Therapeutic Procedures shall be followed. No licensed dentist
shall administer or employ another person, such as a nurse anesthetist or a
physician, who is otherwise qualified in this State to administer general
anesthesia, deep sedation, or moderate (conscious) sedation for dental
patients, unless the licensed dentist possesses a written authorization or
permit from the board. Sedation is continuum and it is not always possible to
predict how an individual will respond. Therefore, a licensed dentist intending
to produce a given level of sedation shall have the capability to rescue
patients whose level of sedation becomes deeper than initially intended.
(b) In order to receive a written
authorization or permit, the licensed dentist shall apply to the board, pay an
application fee, and submit documentary evidence showing that the following
requirements are met:
(1) Educational
training requirements.
(A) General anesthesia
and deep sedation: Applicant has completed an advanced dental education program
accredited by CODA and approved by the board that provides comprehensive
training necessary to administer deep sedation or general anesthesia and
includes documented proficiency in Basic Life Support for Healthcare Providers
and Advanced Cardiac Life Support or Pediatric Advanced Life Support as
required pursuant to subsection
16-79-141(a)(2).
Evidence of that comprehensive training shall include but not be limited to:
being a Diplomate of the American Board of Oral and Maxillofacial Surgery, a
Fellow/member of the American Association of Oral and Maxillofacial Surgery or
completion of an ADA accredited residency in Oral and Maxillofacial Surgery or
Dental Anesthesiology and shall practice in compliance with that
training.
(B) Moderate (conscious)
sedation: Applicant has completed a comprehensive training program at the
postgraduate level that meets the moderate (conscious) sedation program
objectives and content as outlined in the current ADA Guidelines for Teaching
Pain Control and Sedation to Dentists and Dental Students. The training program
shall be a minimum of sixty hours of instruction, include supervised management
of at least twenty moderate (conscious) sedation patients with clinical
experience in managing the compromised airway and establishment of intravenous
access, and provide current documented proficiency in Basic Life Support for
Healthcare Providers and Advanced Cardiac Life Support or Pediatric Advanced
Life Support as required pursuant to sub section
16-79-141(a)(2).
(C) A dentist administering
general anesthesia or moderate sedation shall be required to complete the
Advanced Cardiac Life Support course or if treating pediatric patients, the
Pediatric Advanced Life Support course; provided that both courses shall be
completed if the dentist is treating pediatric patients and minors thirteen
years or older.
(2) In
lieu of the requirements in paragraph (1)(A) and (B), a licensed dentist may
receive a written authorization or permit to use general anesthesia, deep
sedation or moderate (conscious) sedation, if the licensed dentist employs or
works in conjunction with a physician licensed pursuant to chapter 453, HRS,
who specializes in anesthesiology or a certified registered nurse anesthetist
who holds a license in good standing pursuant to chapter 457, HRS, provided
that the physician who specializes in anesthesiology or certified registered
nurse anesthetist shall remain on the premises of the dental facility until the
patient is fully recovered and discharged from the facility.
(3) Facilities and staff requirements.
Applicant has a properly equipped facility for the administration of general
anesthesia, deep sedation, or moderate (conscious) sedation staffed with a
supervised team of auxiliary personnel capable of reasonably handling
anesthesia procedures, problems, and emergencies incident thereto. The current
ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists and
the current American Association of Oral and Maxillofacial Surgery Office
Anesthesia Evaluation Manual are referenced as minimum standards of care.
Adequacy of the facility and competence of the anesthesia team may be
determined by the consultants appointed by the board as outlined below in this
chapter.
(c) Prior to
the issuance of a written authorization or permit, the board may, at its
discretion, require an on-site inspection of the facility, equipment, and
personnel to determine whether the facilities and staff requirements have been
met. This evaluation to determine whether the facility is adequate and properly
equipped, may be carried out in a manner and generally following the
guidelines, standards, requirements, and basic principles as described in the
current American Association of Oral and Maxillofacial Surgeons Office
Anesthesia Manual. The inspection and evaluation shall be carried out by a team
of consultants appointed by the board.
(d) The board shall appoint a team of
advisory consultants to conduct the on-site inspection and evaluation of the
facilities, equipment, and personnel of a licensed dentist applying for a
written authorization or permit to administer or to employ a qualified person
to administer general anesthesia, deep sedation, or moderate (conscious)
sedation; thereafter, re-inspections may be conducted. The advisory consultants
shall also aid the board in the adoption of criteria and standards relative to
the regulation and control of general anesthesia, deep sedation, or moderate
(conscious) sedation.
(e) A
licensed dentist who has received a written authorization or permit to
administer or to employ a qualified person to administer general anesthesia,
deep sedation, or moderate (conscious) sedation shall renew the authorization
or permit biennially and pay a biennial fee.
(f) The board may, at any time, reevaluate
the credentials, facilities, equipment, personnel, and procedures of a licensed
dentist who has previously received a written authorization or permit from the
board to determine if the dentist is still qualified to have a written
authorization or permit. If the board determines that the licensed dentist is
no longer qualified to have a written authorization or permit, it may revoke or
refuse to renew the authorization, after an opportunity for a hearing is given
to the licensed dentist.
(g) A
licensed dentist who currently has a written authorization or permit to
administer general anesthesia or sedation may continue to administer general
anesthesia or sedation without the need to meet the additional requirements
under subsection (b). However, if that dentist's license becomes forfeited that
dentist shall file a new application and comply with all of the requirements of
this section in existence at the time of the application.
Notes
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