Dental Anesthesia Certification Requirements for Licensed Dentists.
Purpose:
To conform regulations to the current practice of dental anesthesia administration.
Substance of proposed rule (Full text is posted at the following State website:http://www.regents.nysed.gov/meetings/2016/ 2016-02/professional-practice):
The Commissioner of Education proposes to amend section 61.10 of the Regulations of the Commissioner of Education relating to the dental anesthesia certification requirements for licensed dentists under Article 133 of the Education Law. The following is a summary of the proposed rule:
Subdivision (a) of section 61.10 of the Regulations of the Commissioner of Education is amended to update New York’s definitions to reflect those currently used in the profession and re-define the types of anesthesia used by dentists that are subject to certification.
Subdivision (b) of section 61.10 of the Regulations of the Commissioner of Education is amended to reflect the definitional changes made to certain methods of sedation and to add new certifications for administering parenteral conscious (moderate) sedation and for administering enteral conscious (moderate) sedation to pediatric patients aged 12 years old and younger. The certificates created under this section are: (1) general anesthesia; (2) dental parenteral conscious (moderate) sedation for patients 13 years old and older; (3) dental parenteral conscious (moderate) sedation for patients 12 years old and younger; (4) dental enteral conscious (moderate) sedation for patients 13 years old and older; and (5) dental enteral conscious (moderate) sedation for patients 12 years old and younger.
Subdivision (b) of section of 61.10 is also amended to delete outdated references to certificates issued prior to January 2001 as being valid until the end of their term and to provide a transition pathway for current holders of parenteral conscious sedation certificates and enteral conscious sedation certificates, who wish to continue to provide sedation to pediatric patients, until the end of their certificate term.
Subdivision (c) of section 61.10 of the Regulations of the Commissioner of Education is amended to eliminate redundant anesthesia certificate descriptions already set forth in subdivision (b) of section 61.10; incorporate the definitional changes set forth in subdivision (a) of section 61.10(a); amend the education requirements to at least 60 hours of coursework provided through didactic instruction and/or an anesthesia rotation for all certificates, with the exception of a general anesthesia certificate; amend the experience requirements for the parenteral conscious (moderate) sedation certificate and the enteral conscious (moderate) sedation certificate to include live clinical experiences with dental patients; include a requirement that post-doctoral education necessary for acquiring a certificate in dental parenteral conscious (moderate) sedation or dental enteral conscious (moderate) sedation be previously approved by the Department; include the requirements required to obtain a certificate to administer general anesthesia or conscious (moderate) sedation through endorsement from another jurisdiction; include the education and training requirements as well as the renewal requirements for the new certificates for parenteral conscious (moderate) sedation pediatric and for enteral conscious (moderate) sedation pediatric; add Advanced Cardiac Life Support (ACLS) to the parenteral and enteral conscious (moderate) sedation certificates for patients ages 13 years and older; add Pediatric Advanced Life Support (PALS) to the parenteral and enteral conscious (moderate) sedation certificates for patients ages 12 years old and younger and for those Oral Surgeons and Dental Anesthesiologists administering general anesthesia to children 12 years old and younger; and delete the provisions for licensed dentists who applied for certificates prior to January 1, 2002.
Subdivision (d) of section 61.10 is amended to reflect the definitional changes referenced in section 61.10(a); provide that a licensed dentist can administer conscious (moderate) sedation, deep sedation and general anesthesia to more than one patient at a time when supervising dental students or residents; provide that licensed dentists administering conscious (moderate) sedation, deep sedation and general anesthesia are responsible for pre-operative preparation for the patient; set forth specific pre-operative requirements for administering deep sedation and general anesthesia and separate pre-operative requirements for administering conscious (moderate) sedation; eliminate the existing requirements for monitoring during the administration of general anesthesia, deep sedation and moderate sedation, and set forth new monitoring requirements for the administration of those types of sedation; delete existing reference to dietary instructions and oral or written instructions since they would now be included in the pre-operative instructions; include an exception for a requirement for the recording of blood pressure records on patients who are being administered conscious (moderate) sedation using an enteral route; include a provision that dentists maintain proof of completing the twelve hours of education in sedation/anesthesia as required for the new provision for renewal of their certificate to administer conscious (moderate) parenteral sedation or deep sedation or general anesthesia; include a provision setting forth the overall responsibility of the dentist administering general anesthesia, deep sedation and conscious (moderate) sedation; and include guidelines for reporting mortality or irreversible morbidity to the Department.
Text of proposed rule and any required statements and analyses may be obtained from:
Kirti Goswami, State Education Department, Office of Counsel, State Education Building, Room 148, 89 Washington Ave., Albany, NY 12234, (518) 474-6400, email: legal@nysed.gov
Data, views or arguments may be submitted to:
Office of the Professions, Office of the Deputy Commissioner, State Education Department, State Education Building 2M, 89 Washington Ave., Albany, NY 12234, (518) 486-1765, email: opdepcom@nysed.gov
Public comment will be received until:
45 days after publication of this notice.
Regulatory Impact Statement
1. STATUTORY AUTHORITY:
Section 207 of the Education Law grants general rulemaking authority to the Board of Regents to carry into effect the laws and policies of the State relating to education.
Section 6504 of the Education Law authorizes the Board of Regents to supervise the admission to and regulation of the practice of the professions.
Subdivision (1) of section 6506 of the Education Law authorizes the Board of Regents to supervise the admission to the practice of the professions and to promulgate rules to carry out such supervision.
Paragraph (a) of subdivision (2) of section 6507 of the Education Law authorizes the Commissioner of Education to promulgate regulations in administering the admission to and the practice of the professions.
Section 6601 of the Education Law defines the practice of dentistry.
Subdivision (2) of section 6605-a of the Education Law authorizes the Commissioner of Education to promulgate regulations establishing standards and procedures for the issuance of dental anesthesia certificates, and practice standards and safeguards for the use of conscious sedation, deep sedation or general anesthesia.
2. LEGISLATIVE OBJECTIVES:
The proposed amendments carries out the legislative intent of the aforementioned statutes that the Board of Regents and the Department regulate the practice of dentistry and, as directed by subdivision (2) of section 6605-a of the Education Law, establish standards and procedures for the issuance of dental anesthesia certificates, as well as practice standards and safeguards for the use of conscious sedation, deep sedation or general anesthesia.
Chapter 615 of the Laws of 1999, amended section 6605-a of the Education Law to require licensed dentists to obtain a dental anesthesia certificate in order to employ conscious sedation or deep sedation in the course of their professional practices at locations other than general hospitals, such as dental offices, regardless of the route of administration. Prior to Chapter 615 of the Laws of 1999, the law required such certification only when conscious sedation or deep sedation was obtained parenterally (e.g., intravenously), despite the fact that these levels of sedation could be achieved through other routes of administration (e.g., gastrointestinally). Although, at that time, dental anesthesia administered in a dental office was considered to be a safe and cost effective procedure, the intent of Chapter 615 of the Laws of 1999 was to ensure that licensed dentists using conscious or deep sedation, regardless of the delivery route, be fully trained and certified in the use and administration of dental anesthesia in order to enhance the protection of the public. In 2001, the Board of Regents amended section 61.10 of the Regulations of the Commissioner of Education to implement Chapter 615 of the Laws of 1999 by establishing educational and training requirements for licensed dentists to be certified to employ conscious sedation, deep sedation, or general anesthesia in the practice of dentistry at any location other than a general hospital, and to establish practice requirements for the use of conscious sedation, deep sedation, or general anesthesia by such licensed dentists.
Subsequently, there were changes in the practice of dental anesthesia administration. In 2007, the American Dental Association (ADA) revised several dental anesthesia related definitions. One of these revisions was the replacement of the term “conscious sedation” with the term “moderate sedation.”
The proposed amendment to section 61.10 of the Regulations of the Commissioner of Education conforms the regulation to the current practice of dental anesthesia administration. Amendments to subdivision (a) of this section also update New York’s definitions to reflect those currently used in the profession. It further re-defines the levels of sedation and the routes of administration, as well as defines the terms “continual/continually”, “continuous/continuously”, patent, time-oriented anesthesia record and adds the American Society of Anesthesiologists (ASA) Patient Physical Status Classifications administration and, overall, improves the protection of the public.
Proposed amendments to subdivision (b) of section 61.10 of the Regulations of the Commissioner of Education reflect the definitional changes made to certain methods of sedation and add new certifications for administering parenteral conscious (moderate) sedation and for administering enteral conscious (moderate) sedation to pediatric patients aged 12 years old and younger.
Additional amendments to subdivision (b) of section of 61.10 delete outdated references to certificates issued prior to January 2001 as being valid until the end of their term and provide for the grandfathering in of current holders of parenteral conscious sedation certificates and enteral conscious sedation certificates, who wish to continue to provide sedation to pediatric patients, until the end of their certificate term.
The proposed amendments to subdivision (c) of section 61.10 of the Regulations of the Commissioner of Education would eliminate redundant anesthesia certificate descriptions already set forth in subdivision (b) of section 61.10; incorporate the definitional changes set forth in subdivision (a) of section 61.10; amend the education requirements to at least 60 hours of coursework provided through didactic instruction and/or an anesthesia rotation for all certificates, with the exception of a general anesthesia certificate; amend the experience requirements for the parenteral conscious (moderate) sedation certificate and the enteral conscious (moderate) sedation certificate to include live clinical experiences with dental patients; include a requirement that post-doctoral education necessary for acquiring a certificate in dental parenteral conscious (moderate) sedation or dental enteral conscious (moderate) sedation be previously approved by the Department; include the requirements required to obtain a certificate to administer general anesthesia or conscious (moderate) sedation through endorsement from another jurisdiction; include the education and training requirements as well as the renewal requirements for the new certificates for parenteral conscious (moderate) sedation pediatric and for enteral conscious (moderate) sedation pediatric; add Advanced Cardiac Life Support (ACLS) to the parenteral and enteral conscious (moderate) sedation certificates for patients ages 13 years and older; add Pediatric Advanced Life Support (PALS) to the parenteral and enteral conscious (moderate) sedation certificates for patients ages 12 years old and younger and for those Oral Surgeons and Dental Anesthesiologists administering general anesthesia to children 12 years old and younger; and delete the provisions for licensed dentists who applied for certificates prior to January 1, 2002.
Additionally, the proposed amendments to subdivision (d) of section 61.10 reflect the definitional changes referenced in subdivision (a) of section 61.10; provide that a licensed dentist can administer conscious (moderate) sedation, deep sedation and general anesthesia to more than one patient at a time when supervising dental students or residents; provide that licensed dentists administering conscious (moderate) sedation, deep sedation and general anesthesia are responsible for pre-operative preparation for the patient; set forth specific pre-operative requirements for administering deep sedation and general anesthesia and separate pre-operative requirements for administering conscious (moderate) sedation; eliminate the existing requirements for monitoring during the administration of general anesthesia, deep sedation and moderate sedation, and set forth new monitoring requirements for the administration of those types of sedation; delete existing reference to dietary instructions and oral or written instructions since they would now be included in the pre-operative instructions; include an exception for a requirement for the recording of blood pressure records on patients who are being administered conscious (moderate) sedation using an enteral route; include a provision that dentists maintain proof of completing the twelve hours of education in sedation/anesthesia as required for the new provision for renewal of their certificate to administer conscious (moderate) parenteral sedation or deep sedation or general anesthesia; include a provision setting forth the overall responsibility of the dentist administering general anesthesia, deep sedation and conscious (moderate) sedation; and include guidelines for reporting mortality or irreversible morbidity to the Department.
3. NEEDS AND BENEFITS:
The purpose of the proposed amendment is to conform section 61.10 of the Regulations of the Commissioner of Education to the current practice of dental anesthesia administration and improve the protection of the public by: (1) strengthening the rigor of the educational and training requirements for dental anesthesia certificates; and (2) strengthening the practice requirements relating to the use of anesthesia by certificate holders.
The proposed amendment to 61.10 of the Regulations of the Commissioner of Education will re-define the types of anesthesia used by dentists that are subject to certification by conforming the regulation’s definitions to those currently used in the profession. In addition, the proposed amendment adds new certifications for administration of parenteral conscious (moderate) sedation and enteral conscious (moderate) sedation to include a requirement for separate certifications for the administration of those types of anesthesia to pediatric patients aged 12 years old and younger. The certificates created under this section are: (1) general anesthesia; (2) dental parenteral conscious (moderate) sedation for patients 13 years old and older; (3) dental parenteral conscious (moderate) sedation for patients 12 years old and younger; (4) dental enteral conscious (moderate) sedation for patients 13 years old and older; and (5) dental enteral conscious (moderate) sedation for patients 12 years old and younger.
The proposed amendment strengthens the rigor of the established educational and training requirements for licensed dentists to obtain anesthesia certification in enteral or parenteral conscious (moderate) sedation in the practice of dentistry at any location other than a general hospital. Specifically, the amendment increases the education requirements from 18 to 60 hours for dental enteral conscious (moderate) sedation. Additionally, a licensed dentist applying for a certificate to administer enteral conscious (moderate) sedation to patients 13 years and older, will be required to possess a current Advanced Cardiac Life Support certificate. Those licensed dentists administering conscious (moderate) sedation or general anesthesia to pediatric patients 12 years old and younger will be required to possess a current Pediatric Advanced Life Support certificate in addition to the Advanced Cardiac Life Support certificate.
In addition, the proposed amendment establishes a pathway for dentists, who have practiced outside of New York State, to obtain a dental anesthesia certificate in this State through endorsement. The proposed amendment further sets forth new practice and monitoring requirements, as well as revised reporting requirements for morbidity or mortality during the administration of dental conscious (moderate) sedation.
4. COSTS:
The proposed amendment conforms section 61.10 of the Regulations of the Commissioner of Education to the current practice of dental anesthesia administration and improves the protection of the public by: (1) strengthening the rigor of the educational and training requirements for dental anesthesia certificates; and (2) strengthening the practice requirements relating to the use of anesthesia by certificate holders, which is consistent with the intent of section 6605-a of the Education Law.
(a) Costs to State government: There are no additional costs to State government.
(b) Costs to local government: There are no additional costs to local government.
(c) Costs to private regulated parties: The proposed amendment will increase educational preparation costs to meet the certification requirements for the certificates in dental parenteral conscious (moderate) sedation for patients 12 years old and younger and dental enteral conscious (moderate) sedation for patients 12 years old and younger because these are new certificates. The proposed amendment will also increase educational preparation costs to meet the certification requirements for the certificate in the dental enteral conscious (moderate) sedation for patients 13 years old and older because of the increase in the required didactic coursework hours.
However, upon contacting faculty in educational based institutions currently offering programs, it has been determined that the candidates will not be subjected to an increase in cost of the program, other than for courses in Advanced Cardiac Life Support (ACLS) or Pediatric Cardiac Life Support (PALS) because the additional coursework and hours are incorporated into the candidates specialty or residency program.
Licensed dentists who employ conscious (moderate) sedation using an enteral route with or without inhalation agents will be required to have current documentation of course completion in ACLS and PALS (for those treating patients 12 years old or younger). The previous requirement was that the enteral certificate holders only have completed a course in Basic Life Support (BLS) at a cost of approximately $65. The cost of the training for ACLS and PALS is approximately $200 each, which covers a two-year period.
(d) Costs to the regulatory agency: There may be additional costs to the State Education Department associated with processing the two additional certificates. It is anticipated that such costs will not be significant and can be absorbed using existing staff and resources.
5. LOCAL GOVERNMENT MANDATES:
The proposed amendment prescribes requirements that a licensed dentist must meet to be certified in the use of anesthesia and practice requirements relating to such use. It does not impose any program, service, duty or responsibility upon local governments.
6. PAPERWORK:
The proposed amendment requires the licensed dentist to maintain a time-oriented anesthesia record for each patient based on the level of anesthesia administered including the administration of conscious (moderate) sedation, deep sedation, or general anesthesia.
The dentist will also be responsible for maintaining records documenting completion of the appropriate life support training and other training necessary to maintain certification.
The proposed amendment requires a certificate holder to report morbidity or mortality occurring within 48 hours following, or otherwise related to the administration of anesthesia to the State Education Department within 30 days of the occurrence and the proposed amendment outlines what must be included in such a report.
7. DUPLICATION:
The proposed amendment does not duplicate other existing State or Federal requirements.
8. ALTERNATIVES:
There are no viable significant alternatives to the proposed amendment and none were considered.
9. FEDERAL STANDARDS:
Since there are no applicable Federal standards for the certification of qualified dentists in the use of conscious (moderate) sedation, deep sedation, or general anesthesia, the proposed amendment does not exceed any minimum federal standards for the same or similar subject areas.
10. COMPLIANCE SCHEDULE:
The proposed amendment is necessary to conform the regulation to the current practice of dental anesthesia administration and will become effective January 1, 2017. It is anticipated that affected parties will be able to comply with the proposed amendments by the effective date. The proposed amendment also provides a transition pathway for current holders of parenteral conscious sedation certificates and enteral conscious sedation certificates, who wish to continue to provide sedation to pediatric patients until the end of their certificate term.
Regulatory Flexibility Analysis
Chapter 615 of the Laws of 1999, amended section 6605-a of the Education Law to require licensed dentists to obtain a dental anesthesia certificate in order to employ conscious sedation or deep sedation in the course of their professional practices at locations other than general hospitals, such as dental offices, regardless of the route of administration. In 2001, the Board of Regents amended section 61.10 of the Regulations of the Commissioner of Education to implement Chapter 615 of the Laws of 1999 by establishing educational and training requirements for licensed dentists to be certified to employ conscious sedation, deep sedation, or general anesthesia in the practice of dentistry at any location other than a general hospital, and to establish practice requirements for the use of conscious sedation, deep sedation, or general anesthesia by such licensed dentists.
Subsequently, there were changes in the practice of dental anesthesia administration. In 2007, the American Dental Association (ADA) revised several dental anesthesia related definitions. One of these revisions was the replacement of the term “conscious sedation” with the term “moderate sedation.”
The proposed amendment to section 61.10 of the Regulations of the Commissioner of Education conforms the regulation to the current practice of dental anesthesia administration and improves the protection of the public. The proposed amendments to this section also update New York’s definitions to reflect those currently used in the profession. It further re-defines the levels of sedation and the routes of administration, as well as defines the terms “continual/continually”, “continuous/continuously”, patent, time-oriented anesthesia record and adds the American Society of Anesthesiologists (ASA) Patient Physical Status Classifications.
The proposed amendment re-defines the types of anesthesia used by dentists that are subject to certification, reflects the definitional changes made to certain methods of sedation and adds new certifications for administering parenteral conscious (moderate) sedation and for administering enteral conscious (moderate) sedation to pediatric patients aged 12 years old and younger.
The proposed amendment establishes the following certificates: (1) general anesthesia; (2) dental parenteral conscious (moderate) sedation for patients 13 years old and older; (3) dental parenteral conscious (moderate) sedation for patients 12 years old and younger; (4) dental enteral conscious (moderate) sedation for patients 13 years old and older; and (5) dental enteral conscious (moderate) sedation for patients 12 years old and younger.
In addition, the proposed amendment establishes a pathway for dentists, who have practiced outside of New York State, to obtain dental anesthesia certification in this State through endorsement, with requirements to ensure the protection of New Yorkers. It also deletes outdated references to certificates issued prior to January 2001 and provides a transition pathway for current holders of parenteral and enteral sedation certificates to continue providing sedation to pediatric patients, until the end of their certificate term.
The proposed amendment revises the educational and training requirements for licensed dentists to be certified to employ conscious (moderate) sedation, deep sedation, or general anesthesia in the practice of dentistry and requirements for the use of such anesthesia by the certificate holders. Additionally, the proposed amendment imposes revised practice requirements, as well as revised reporting requirements of morbidity and mortality.
The amendment will not impose any new reporting, recordkeeping, or other compliance requirements, or have any adverse economic impact, on small businesses or local governments. Because it is evident from the nature of the proposed amendment that it will not adversely affect small businesses or local governments, no affirmative steps were needed to ascertain that fact and none were taken. Accordingly, a regulatory flexibility analysis for small businesses and local governments is not required, and one has not been prepared.
Rural Area Flexibility Analysis
1. TYPES AND ESTIMATED NUMBERS OF RURAL AREAS:
The proposed amendment will apply to licensed dentists seeking to obtain a dental anesthesia certification in order to employ conscious (moderate) sedation or deep sedation in the course of their professional practices at locations other than general hospitals, such as dental offices, regardless of the route of administration, including those located in the 44 counties with less than 200,000 inhabitants and the 71 towns in urban counties with a population density of 150 per square mile or less.
2. REPORTING, RECORDINGKEEPING AND OTHER COMPLIANCE REQUIREMENTS; AND PROFESSIONAL SERVICES:
Chapter 615 of the Laws of 1999, amended section 6605-a of the Education Law to require licensed dentists to obtain a dental anesthesia certificate in order to employ conscious sedation or deep sedation in the course of their professional practices at locations other than general hospitals, such as dental offices, regardless of the route of administration. In 2001, the Board of Regents amended section 61.10 of the Regulations of the Commissioner of Education to implement Chapter 615 of the Laws of 1999 by establishing educational and training requirements for licensed dentists to be certified to employ conscious sedation, deep sedation, or general anesthesia in the practice of dentistry at any location other than a general hospital, and to establish practice requirements for the use of conscious sedation, deep sedation, or general anesthesia by such licensed dentists. Subsequently, there were changes in the practice of dental anesthesia administration. In 2007, the American Dental Association (ADA) revised several dental anesthesia related definitions. One of these revisions was the replacement of the term “conscious sedation” with the term “moderate sedation.”
The proposed amendment to section 61.10 of the Regulations of the Commissioner of Education conforms the regulation to the current practice of dental anesthesia administration and improves the protection of the public. The proposed amendments to this section also update New York’s definitions to reflect those currently used in the profession. It further re-defines the levels of sedation and the routes of administration, as well as defines the terms “continual/continually”, “continuous/continuously”, patent, time-oriented anesthesia record and adds the American Society of Anesthesiologists (ASA) Patient Physical Status Classifications.
The proposed amendment re-defines the types of anesthesia used by dentists that are subject to certification, reflects the definitional changes made to certain methods of sedation and adds new certifications for administering parenteral conscious (moderate) sedation and for administering enteral conscious (moderate) sedation to pediatric patients aged 12 years old and younger.
The proposed amendment establishes the following certificates: (1) general anesthesia; (2) dental parenteral conscious (moderate) sedation for patients 13 years old and older; (3) dental parenteral conscious (moderate) sedation for patients 12 years old and younger; (4) dental enteral conscious (moderate) sedation for patients 13 years old and older; and (5) dental enteral conscious (moderate) sedation for patients 12 years old and younger.
In addition, the proposed amendment establishes a pathway for dentists, who have practiced outside of New York State, to obtain dental anesthesia certification in this State through endorsement, with requirements to ensure the protection of New Yorkers. It also deletes outdated references to certificates issued prior to January 2001 and provides a transition pathway for current holders of parenteral and enteral sedation certificates to continue providing sedation to pediatric patients, until the end of their certificate term.
The proposed amendment revises the educational and training requirements for licensed dentists to be certified to employ conscious (moderate) sedation, deep sedation, or general anesthesia in the practice of dentistry and requirements for the use of such anesthesia by the certificate holders. Additionally, the proposed amendment imposes revised practice requirements, as well as revised reporting requirements of morbidity and mortality.
The proposed amendment requires licensed dentists to maintain a time-oriented anesthesia record for each patient based on the level of anesthesia administered including conscious (moderate) sedation, deep sedation, or general anesthesia. The dentist will also be responsible for maintaining records documenting completion of the appropriate life support training and other training necessary to maintain certification. The amendment requires a certificate holder to report morbidity or mortality occurring within 48 hours following, or otherwise related to the administration of anesthesia to the State Education Department within 30 days of the occurrence and the regulations outlines what is to be included in that report.
Beyond these requirements which apply state-wide, the proposed amendment does not impose any additional reporting, recordkeeping or other compliance requirements, or professional services requirements, on rural entities, other than those imposed throughout the State.
3. COSTS:
The proposed amendment will increase educational preparation costs to meet the certification requirements for the certificates in dental parenteral conscious (moderate) sedation for patients 12 years old and younger and dental enteral conscious (moderate) sedation for patients 12 years old and younger because these are new certificates. The proposed amendment will also increase educational preparation costs to meet the certification requirements for the certificate in dental enteral conscious (moderate) sedation for patients 13 years old and older because of the increase in the required didactic coursework hours.
However, upon contacting faculty in educational based institutions currently offering programs, it has been determined that the candidates will not be subjected to an increase in cost of the program, other than for courses in Advanced Cardiac Life Support (ACLS) or Pediatric Cardiac Life Support (PALS) because the additional coursework and hours will be incorporated into the candidates specialty or residency program.
Licensed dentists who employ conscious (moderate) sedation using an enteral route with or without inhalation agents will be required to have current documentation of course completion in ACLS and PALS (for those treating patients 12 years old and younger). The previous requirement was that the enteral certificate holders only have completed a course in Basic Life Support (BLS) at a cost of approximately $65. The cost of the training for ACLS and PALS is approximately $200 each, which covers a two-year period.
There may be additional costs to the State Education Department associated with processing the two additional certificates. It is anticipated that such costs will not be significant and can be absorbed using existing staff and resources.
4. MINIMIZING ADVERSE IMPACT:
Section 6605-a of the Education Law requires licensed dentists to be certified by the State Education Department to employ conscious sedation, deep sedation, or general anesthesia in the course of their professional practices at locations other than general hospitals. The statute makes no exception for individuals who live in rural areas. Thus, the Department has determined that the proposed amendment’s requirements should apply to all individuals regardless of their geographic location to ensure uniform standards of practice and public protection throughout the State. Because of the nature of the proposed amendment, alternative approaches for rural areas were not considered.
5. RURAL AREA PARTICIPATION:
Comments on the proposed amendment were solicited from statewide organizations representing all parties having an interest in the practice of dentistry. These organizations included the State Board for Dentistry, educational institutions that offer programs leading to dental anesthesia certification, the New York State Dental Association, and representatives for Pediatric Dentists. These groups, which have members who live, work or provide dental services in rural areas, have been provided notice of the proposed rule making and opportunity to comment on the proposed amendment.
Job Impact Statement
Chapter 615 of the Laws of 1999, amended section 6605-a of the Education Law to require licensed dentists to obtain a dental anesthesia certificate in order to employ conscious sedation or deep sedation in the course of their professional practices at locations other than general hospitals, such as dental offices, regardless of the route of administration. In 2001, the Board of Regents amended section 61.10 of the Regulations of the Commissioner of Education to implement Chapter 615 of the Laws of 1999 by establishing educational and training requirements for licensed dentists to be certified to employ conscious sedation, deep sedation, or general anesthesia in the practice of dentistry at any location other than a general hospital, and to establish practice requirements for the use of conscious sedation, deep sedation, or general anesthesia by such licensed dentists.
Subsequently, there were changes in the practice of dental anesthesia administration. In 2007, the American Dental Association (ADA) revised several dental anesthesia related definitions. One of these revisions was the replacement of the term “conscious sedation” with the term “moderate sedation.”
The proposed amendment to section 61.10 of the Regulations of the Commissioner of Education conforms the regulation to the current practice of dental anesthesia administration and improves the protection of the public. The proposed amendments to this section also update New York’s definitions to reflect those currently used in the profession. It further re-defines the levels of sedation and the routes of administration, as well as defines the terms “continual/continually”, “continuous/continuously”, patent, time-oriented anesthesia record and adds the American Society of Anesthesiologists (ASA) Patient Physical Status Classifications.
The proposed amendment re-defines the types of anesthesia used by dentists that are subject to certification, reflects the definitional changes made to certain methods of sedation and adds new certifications for administering parenteral conscious (moderate) sedation and for administering enteral conscious (moderate) sedation to pediatric patients aged 12 years old and younger.
The proposed amendment establishes the following certificates: (1) general anesthesia; (2) dental parenteral conscious (moderate) sedation for patients 13 years old and older; (3) dental parenteral conscious (moderate) sedation for patients 12 years old and younger; (4) dental enteral conscious (moderate) sedation for patients 13 years old and older; and (5) dental enteral conscious (moderate) sedation for patients 12 years old and younger.
In addition, the proposed amendment establishes a pathway for dentists, who have practiced outside of New York State, to obtain dental anesthesia certification in this State through endorsement, with requirements to ensure the protection of New Yorkers. It also deletes outdated references to certificates issued prior to January 2001 and provides a transition pathway for current holders of parenteral and enteral sedation certificates to continue providing sedation to pediatric patients, until the end of their certificate term.
The proposed amendment revises the educational and training requirements for licensed dentists to be certified to employ conscious (moderate) sedation, deep sedation, or general anesthesia in the practice of dentistry and requirements for the use of such anesthesia by the certificate holders. Additionally, the proposed amendment imposes revised practice requirements, as well as revised reporting requirements of morbidity and mortality.
The proposed amendment which updates definitions, adds new certifications, deletes outdated references, and revises educational, training and practice requirements to conform the regulation to the current practice of dental anesthesia administration, will not have a substantial adverse impact on jobs and employment opportunities. Because it is evident from the nature of the proposed amendment that it will either not affect job and employment opportunities, or have only a positive impact, no affirmative steps were needed to ascertain that fact and none were taken. Accordingly, a job impact statement is not required, and one has not been prepared.
