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AB-2526 Nurse anesthetists: general anesthesia or deep sedation.(2023-2024)

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Date Published: 04/17/2024 09:00 PM
AB2526:v96#DOCUMENT

Amended  IN  Assembly  April 17, 2024
Amended  IN  Assembly  April 08, 2024
Amended  IN  Assembly  March 18, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill
No. 2526

Introduced by Assembly Member Gipson

February 13, 2024

An act to amend Sections 2827, 2833, and 2833.3 of, and to add Sections 1646.14 and 2831.5 to, Section 2827 of, and to add Section 1646.14 to, the Business and Professions Code, relating to healing arts.


LEGISLATIVE COUNSEL'S DIGEST


AB 2526, as amended, Gipson. Nurse anesthetists. anesthetists: general anesthesia or deep sedation.

Existing law, the Nurse Anesthetists Act, provides for the certification and regulation of nurse anesthetists by the Board of Registered Nursing within the Department of Consumer Affairs. If a general anesthetic agent is administered in a dental office, existing law requires the dentist to hold a permit authorized by the provisions governing a dentist’s use of deep sedation and general anesthesia. Existing law provides that nothing under the act is to be construed to limit a certified nurse anesthetist’s ability to practice nursing.

This bill would delete the above-described requirement that a dentist hold a specified permit if a general anesthetic agent is administered in a dental office and would instead prescribe specified circumstances in which general anesthesia or deep sedation is to be administered in a dental office by a nurse anesthetist.

This bill would also provide that a certified registered nurse anesthetist who is licensed under the act and is registered with the federal Drug Enforcement Agency has prescriptive authority to select, order, or administer prescription drugs, as defined, upon a request issued by a dentist as specified. The bill would authorize a nurse anesthetist to prescribe prescription drugs only for an individual whom the nurse anesthetist has established a client or patient record at the time of the prescription. The bill would require a nurse anesthetist to complete training set forth by the agency upon registration or renewal of registration with the agency. The bill would provide that nothing under the Nursing Practice Act affects the authority of a licensed nurse anesthetist to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.

Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. Existing law authorizes a licensed physician and surgeon to administer deep sedation or general anesthesia in the office of a licensed dentist for dental patients if specified conditions are met, including that they hold a valid general anesthesia permit issued by the board as prescribed.
Existing law, the Nurse Anesthetists Act, provides for the certification and regulation of nurse anesthetists by the Board of Registered Nursing within the Department of Consumer Affairs. Existing law requires the utilization of a nurse anesthetist to provide anesthesia services in an acute care facility to be approved by the acute care facility administration and the appropriate committee, and at the discretion of the physician, dentist, or podiatrist.
This bill would authorize a certified registered nurse anesthetist to administer general anesthesia or deep sedation in the office of a licensed dentist for dental patients if specified conditions are met, including that they hold a valid general anesthesia permit issued by the board as prescribed. To obtain that permit, the bill would require a nurse anesthetist to apply to the board on an application form prescribed by the board and to submit, among other things, payment of an application fee. Prior to issuance or renewal of a permit pursuant to these provisions, the bill authorizes the board to require an onsite inspection and evaluation of the facility, equipment, and personnel, as specified. If a nurse anesthetist fails an onsite inspection and evaluation, the bill would require their permit be automatically suspended for 30 days, as specified. The bill would authorize a nurse anesthetist who additionally meets certain requirements to apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under 7 years of age.
The bill would require the administration of general anesthesia or deep sedation in a dental office by a nurse anesthetist at the request of a dentist to be in accordance with prescribed requirements, including, among other things, registering with the federal Drug Enforcement Administration and ensuring that the facilities, equipment, personnel, and procedures utilized meet the Dental Board of California’s onsite inspection requirements, as specified. The bill would provide that failure of an onsite inspection constitutes unprofessional conduct and is grounds for disciplinary action by the Board of Registered Nursing.
By expanding the scope of existing crimes under the Nurse Anesthetists Act and the Dental Practice Act, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1646.14 is added to the Business and Professions Code, to read:

1646.14.
 (a) Notwithstanding any other law, including, but not limited to, Sections 1646.1 and 1647.2, a certified registered nurse anesthetist licensed pursuant to Chapter 6 (commencing with Section 2700) and certified as a nurse anesthetist pursuant to Article 7 (commencing with Section 2825) of Chapter 6 may administer general anesthesia or deep sedation in the office of a licensed dentist to dental patients without regard to whether the dentist possesses a permit issued pursuant to this article, if both all of the following conditions are met:
(1) The nurse anesthetist meets the requirements of paragraph (2) of subdivision (b) of Section 2827.

(1)

(2) The nurse anesthetist holds a valid general anesthesia permit issued by the Dental Board of California pursuant to subdivision (b).

(2)

(3) The nurse anesthetist meets the requirements of subdivision (d) of Section 1646.1.
(b) A certified registered nurse anesthetist who desires to administer general anesthesia or deep sedation under subdivision (a) shall apply to the board on an application form prescribed by the board and shall submit all of the following:
(1) Payment of an application fee prescribed by this article.
(2) Evidence satisfactory to the board and the Board of Registered Nursing showing that the applicant has successfully completed an accredited program as defined in subdivision (b) of Section 2826.
(3) Documentation demonstrating that all equipment and drugs required by the board are on the premises for use in any dental office in which the nurse anesthetist administers general anesthesia or deep sedation.
(c) Prior to issuance or renewal of a permit pursuant to this section, the board may at its discretion require an onsite inspection and evaluation of the facility, equipment, and personnel, including, but not limited to, the certified registered nurse anesthetist and procedures utilized. At least one of the people evaluating the procedures utilized by the nurse anesthetist shall be a certified registered nurse anesthetist expert in outpatient general anesthesia or deep sedation who has been authorized or retained under contract by the board for this purpose.
(d) A certified registered nurse anesthetist who has failed an onsite inspection and evaluation shall have their permit automatically suspended for 30 days after the date on which the board notifies the nurse anesthetist of the failure unless within that time period the nurse anesthetist has retaken and passed an onsite inspection and evaluation. A nurse anesthetist who is issued a permit under this article shall be subject to an onsite inspection and evaluation at least once every five years. Refusal to submit to an inspection shall result in automatic denial or revocation of the permit.
(e) A certified registered nurse anesthetist who additionally meets the requirements of paragraphs (2) and (3) of subdivision (c) of Section 1646.2 may apply to the board for a pediatric endorsement to provide general anesthesia or deep sedation to a child under seven years of age. A nurse anesthetist without sufficient cases to obtain a pediatric endorsement may qualify for the endorsement pursuant to the requirements of subdivision (d) of Section 1646.2.

SEC. 2.

 Section 2827 of the Business and Professions Code is amended to read:

2827.
 (a) The utilization of a nurse anesthetist to provide anesthesia services in an acute care facility shall be approved by the acute care facility administration and the appropriate committee, and at the discretion of the physician, dentist dentist, or podiatrist.
(b) General anesthesia or deep sedation administered in a dental office at the request of a dentist by a nurse anesthetist shall be in accordance with both of the following:
(1) Article 2.75 (commencing with Section 1646) of Chapter 4.
(2) Paragraph (2) of subdivision (b) of Section 2725. (A) If administering general anesthesia or deep sedation to dental patients in the office of a licensed dentist who does not possess a permit issued pursuant to Article 2.75 (commencing with Section 1646) of Chapter 4, the nurse anesthetist shall do all of the following:
(i) Register with the United States Drug Enforcement Administration.
(ii) Practice within the scope of their clinical and professional education and training.
(iii) Establish a plan for referral of complex cases and emergencies.
(iv) Decline or refer a patient with a preexisting disease or condition that is not optimized and may adversely interact with general anesthesia or deep sedation.
(v) Ensure that the facilities, equipment, personnel, and procedures utilized by the nurse anesthetist meet the Dental Board of California’s onsite inspection requirements under subdivision (c) of Section 1646.14. Failure of an onsite inspection constitutes unprofessional conduct and is grounds for disciplinary action by the board.
(B) This paragraph shall not be construed to require the Dental Board of California to enforce the requirements of this paragraph or verify compliance with this paragraph for purposes of Section 1646.14.

SEC. 3.Section 2831.5 is added to the Business and Professions Code, to read:
2831.5.

(a)As used in this section, the following definitions apply:

(1)“Order” means the process of directing a licensed individual, pursuant to their statutory authority, to directly administer a drug or to dispense, deliver, or distribute a drug for the purpose of direct administration to a patient, under instructions of the certified registered nurse anesthetist to provide prescription drugs.

(2)“Prescription drugs” includes Schedule II through Schedule V controlled substances under the California Uniform Controlled Substances Act (Division 10 (commencing with Section 11000) of the Health and Safety Code).

(3)“Select” means the decisionmaking process of choosing a drug, dosage, route, and time of administration.

(b)(1)A certified registered nurse anesthetist who is licensed pursuant to this article and is registered with the federal Drug Enforcement Agency shall have prescriptive authority to select, order, or administer prescription drugs upon a request issued by a dentist under Article 2.75 (commencing with Section 1646) of Chapter 4 to administer anesthesia for diagnostic, operative, or therapeutic procedures in an outpatient dental setting.

(2)A certified registered nurse anesthetist under paragraph (1) shall prescribe prescription drugs based on their level of professional education, training, and certification by the National Board of Certification and Recertification for Nurse Anesthetists, or a successor national professional organization approved by the board.

(c)A certified registered nurse anesthetist shall only prescribe prescription drugs under subdivision (b) for an individual whom the certified registered nurse anesthetist has, at the time of the prescription, established a client or patient record.

SEC. 4.Section 2833 of the Business and Professions Code is amended to read:
2833.

(a)Each certificate issued pursuant to this article shall be renewable biennially, and each person holding a certificate under this article shall apply for a renewal of their certificate and pay the biennial renewal fee required by Section 2830.7 every two years on or before the last day of the month following the month in which their birthday occurs, beginning with the second birthday following the date on which the certificate was issued, whereupon the board shall renew the certificate.

(b)Each certificate not renewed in accordance with this section shall expire but may within a period of eight years thereafter be reinstated upon payment of the biennial renewal fee and penalty fee required by Section 2830.7 and upon submission of proof of the applicant’s qualifications as may be required by the board. During the eight-year period, no examination shall be required as a condition for the reinstatement of any expired certificate that has lapsed solely by reason of nonpayment of the renewable fee. After the expiration of the eight-year period the board may require, as a condition of reinstatement, that the applicant pass an examination as it deems necessary to determine their present fitness to resume the practice of nurse anesthesia.

(c)Upon registration or renewal of registration with the federal Drug Enforcement Agency, a certified registered nurse anesthetist shall complete the required training as set forth by the agency.

SEC. 5.Section 2833.3 of the Business and Professions Code is amended to read:
2833.3.

(a)Nothing in this article shall be construed to limit a certified nurse anesthetist’s ability to practice nursing.

(b)Nothing in this chapter shall affect the authority of a certified registered nurse anesthetist licensed pursuant to this article to select, order, or administer prescription drugs for the delivery of perioperative anesthesia services beyond the outpatient dental setting.

SEC. 6.SEC. 3.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.