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AB-1998 Dental Practice Act: unprofessional conduct.(2019-2020)



Current Version: 06/03/20 - Amended Assembly

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AB1998:v98#DOCUMENT

Amended  IN  Assembly  June 03, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 1998

Introduced by Assembly Member Low

January 27, 2020

An act to amend Section 1680 of Sections 1680, 1683.1, and 1683.2 of, and to add Section 1684.1.1 to, the Business and Professions Code, relating to healing arts.


LEGISLATIVE COUNSEL'S DIGEST


AB 1998, as amended, Low. Dental Practice Act: unprofessional conduct: patient of record. conduct.
Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists and dental assistants by the Dental Board of California. The act specifies unprofessional conduct by a licensee to include, among other things, the failure by a treating dentist, prior to the initial diagnosis and correction of malpositions of human teeth or the initial use of orthodontic appliances, to perform an examination pursuant to that required of a patient of record. record, including the review of the patient’s most recent diagnostic digital or conventional radiographs or other equivalent bone imaging suitable for orthodontia. The act requires new radiographs or other equivalent bone imaging to be ordered if deemed appropriate by the treating dentist. The act defines a patient of record to mean a patient who has been examined, has had a medical and dental history completed and evaluated, and has had oral conditions diagnosed and a written plan developed by the licensed dentist. The act also specifies unprofessional conduct by a licensee to include the advertising of either professional superiority or the advertising of performance of professional services in a superior manner.
This bill would revise that unprofessional conduct provision described above to provide that the failure of a treating dentist to perform an in-person examination pursuant to that required of a patient of record is unprofessional conduct under the act. require new radiographs or other equivalent bone imaging to be ordered if no radiographs are available for diagnostic review. The bill would provide that, for purposes of that unprofessional conduct provision, the correction of malpositions includes any movement of the teeth, including the treatment of malocclusions. The bill would also specify unprofessional conduct by a licensee to include the destruction of patient records before 10 years have elapsed from the date a dental service was last provided if the patient is an adult or 7 years have elapsed from the date a dental service was last provided, or one year has elapsed from the patient’s 18th birthday, whichever is longer, if the patient is a minor. The bill would additionally specify unprofessional conduct by a licensee to include the advertising of performance of professional services in a more expeditious manner.
Existing law requires an individual, partnership, corporation, or other entity providing dental services through telehealth, prior to the rendering of services and when requested by a patient, to make available the name, telephone number, practice address, and California state license number of any dentist who will be involved in the provision of services to a patient, and makes a violation of that provision unprofessional conduct.
This bill would require the information described above to be provided to the patient at the time that the patient receives the recommended treatment plan for services involving the diagnosis and correction of malpositions of human teeth or initial use of orthodontic appliances, as specified.
Existing law prohibits a provider of dental services from requiring a patient to sign an agreement limiting the patient’s ability to file a complaint with the board.
This bill would prohibit a licensed dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, registered dental hygienist in extended functions, or other person from being required to sign an agreement that limits the signatory’s ability to file a complaint or provide information to the board.
Existing law requires a licensee who fails or refuses to comply with a request for the dental records of a patient, that is accompanied by that patient’s written authorization for release of record to the board, within 15 days of receiving the request and authorization, to pay to the board a civil penalty of $250 per day for each day that the documents have not been produced after the 15th day, up to a maximum of $5,000, unless the licensee is unable to provide the documents within this time period for good cause.
This bill would specify unprofessional conduct by a licensed dentist to include failure to comply with a written request of a patient to receive a copy of any patient-signed documents within 15 days of receiving the request.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 1680 of the Business and Professions Code is amended to read:

1680.
 Unprofessional conduct by a person licensed under this chapter is defined as, but is not limited to, any one of the following:
(a) The obtaining of any fee by fraud or misrepresentation.
(b) The employment directly or indirectly of any student or suspended or unlicensed dentist to practice dentistry as defined in this chapter.
(c) The aiding or abetting of any unlicensed person to practice dentistry.
(d) The aiding or abetting of a licensed person to practice dentistry unlawfully.
(e) The committing of any act or acts of sexual abuse, misconduct, or relations with a patient that are substantially related to the practice of dentistry.
(f) The use of any false, assumed, or fictitious name, either as an individual, firm, corporation, or otherwise, or any name other than the name under which the person is licensed to practice, in advertising or in any other manner indicating that the person is practicing or will practice dentistry, except that name as is specified in a valid permit issued pursuant to Section 1701.5.
(g) The practice of accepting or receiving any commission or the rebating in any form or manner of fees for professional services, radiograms, prescriptions, or other services or articles supplied to patients.
(h) The making use by the licensee or any agent of the licensee of any advertising statements of a character tending to deceive or mislead the public.
(i) The advertising of either professional superiority or the advertising of performance of professional services in a superior or more expeditious manner. This subdivision shall not prohibit advertising permitted by subdivision (h) of Section 651.
(j) The employing or the making use of solicitors.
(k) The advertising in violation of Section 651.
(l) The advertising to guarantee any dental service, or to perform any dental operation painlessly. This subdivision shall not prohibit advertising permitted by Section 651.
(m) The violation of any of the provisions of law regulating the procurement, dispensing, or administration of dangerous drugs, as defined in Chapter 9 (commencing with Section 4000) or controlled substances, as defined in Division 10 (commencing with Section 11000) of the Health and Safety Code.
(n) The violation of any of the provisions of this division.
(o) The permitting of any person to operate dental radiographic equipment who has not met the requirements of Section 1656.
(p) The clearly excessive prescribing or administering of drugs or treatment, or the clearly excessive use of diagnostic procedures, or the clearly excessive use of diagnostic or treatment facilities, as determined by the customary practice and standards of the dental profession.
Any person who violates this subdivision is guilty of a misdemeanor and shall be punished by a fine of not less than one hundred dollars ($100) or more than six hundred dollars ($600), or by imprisonment for a term of not less than 60 days or more than 180 days, or by both a fine and imprisonment.
(q) The use of threats or harassment against any patient or licensee for providing evidence in any possible or actual disciplinary action, or other legal action; or the discharge of an employee primarily based on the employee’s attempt to comply with the provisions of this chapter or to aid in the compliance.
(r) Suspension or revocation of a license issued, or discipline imposed, by another state or territory on grounds that would be the basis of discipline in this state.
(s) The alteration of a patient’s record with intent to deceive.
(t) Unsanitary or unsafe office conditions, as determined by the customary practice and standards of the dental profession.
(u) The abandonment of the patient by the licensee, without written notice to the patient that treatment is to be discontinued and before the patient has ample opportunity to secure the services of another dentist, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions and provided the health of the patient is not jeopardized.
(v) The willful misrepresentation of facts relating to a disciplinary action to the patients of a disciplined licensee.
(w) Use of fraud in the procurement of any license issued pursuant to this chapter.
(x) Any action or conduct that would have warranted the denial of the license.
(y) The aiding or abetting of a licensed dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to practice dentistry in a negligent or incompetent manner.
(z) (1) The failure to report to the board in writing within seven days any of the following: (A) the death of the licensee’s patient during the performance of any dental or dental hygiene procedure; (B) the discovery of the death of a patient whose death is related to a dental or dental hygiene procedure performed by the licensee; or (C) except for a scheduled hospitalization, the removal to a hospital or emergency center for medical treatment of any patient to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, or any patient as a result of dental or dental hygiene treatment. With the exception of patients to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, removal to a hospital or emergency center that is the normal or expected treatment for the underlying dental condition is not required to be reported. Upon receipt of a report pursuant to this subdivision the board may conduct an inspection of the dental office if the board finds that it is necessary. A dentist shall report to the board all deaths occurring in the licensee’s practice with a copy sent to the Dental Hygiene Board of California if the death was the result of treatment by a registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. A registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions shall report to the Dental Hygiene Board of California all deaths occurring as the result of dental hygiene treatment, and a copy of the notification shall be sent to the board.
(2) The report required by this subdivision shall be on a form or forms approved by the board. The form or forms approved by the board shall require the licensee to include, but not be limited to, the following information for cases in which patients received anesthesia: the date of the procedure; the patient’s age in years and months, weight, and sex; the patient’s American Society of Anesthesiologists (ASA) physical status; the patient’s primary diagnosis; the patient’s coexisting diagnoses; the procedures performed; the sedation setting; the medications used; the monitoring equipment used; the category of the provider responsible for sedation oversight; the category of the provider delivering sedation; the category of the provider monitoring the patient during sedation; whether the person supervising the sedation performed one or more of the procedures; the planned airway management; the planned depth of sedation; the complications that occurred; a description of what was unexpected about the airway management; whether there was transportation of the patient during sedation; the category of the provider conducting resuscitation measures; and the resuscitation equipment utilized. Disclosure of individually identifiable patient information shall be consistent with applicable law. A report required by this subdivision shall not be admissible in any action brought by a patient of the licensee providing the report.
(3) For the purposes of paragraph (2), categories of provider are: General Dentist, Pediatric Dentist, Oral Surgeon, Dentist Anesthesiologist, Physician Anesthesiologist, Dental Assistant, Registered Dental Assistant, Dental Sedation Assistant, Registered Nurse, Certified Registered Nurse Anesthetist, or Other.
(4) The form shall state that this information shall not be considered an admission of guilt, but is for educational, data, or investigative purposes.
(5) The board may assess a penalty on any licensee who fails to report an instance of an adverse event as required by this subdivision. The licensee may dispute the failure to file within 10 days of receiving notice that the board had assessed a penalty against the licensee.
(aa) Participating in or operating any group advertising and referral services that are in violation of Section 650.2.
(ab) The failure to use a fail-safe machine with an appropriate exhaust system in the administration of nitrous oxide. The board shall, by regulation, define what constitutes a fail-safe machine.
(ac) Engaging in the practice of dentistry with an expired license.
(ad) Except for good cause, the knowing failure to protect patients by failing to follow infection control guidelines of the board, thereby risking transmission of bloodborne infectious diseases from dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions to patient, from patient to patient, and from patient to dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions. In administering this subdivision, the board shall consider referencing the standards, regulations, and guidelines of the State Department of Public Health developed pursuant to Section 1250.11 of the Health and Safety Code and the standards, guidelines, and regulations pursuant to the California Occupational Safety and Health Act of 1973 (Part 1 (commencing with Section 6300) of Division 5 of the Labor Code) for preventing the transmission of HIV, hepatitis B, and other bloodborne pathogens in health care settings. The board shall review infection control guidelines, if necessary, on an annual basis and proposed changes shall be reviewed by the Dental Hygiene Board of California to establish a consensus. The hygiene board shall submit any recommended changes to the infection control guidelines for review to establish a consensus. As necessary, the board shall consult with the Medical Board of California, the Podiatric Medical Board of California, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians, to encourage appropriate consistency in the implementation of this subdivision.
The board shall seek to ensure that all appropriate dental personnel are informed of the responsibility to follow infection control guidelines, and of the most recent scientifically recognized safeguards for minimizing the risk of transmission of bloodborne infectious diseases.
(ae) The utilization by a licensed dentist of any person to perform the functions of any registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions who, at the time of initial employment, does not possess a current, valid license or permit to perform those functions.
(af) The prescribing, dispensing, or furnishing of dangerous drugs or devices, as defined in Section 4022, in violation of Section 2242.1.
(ag) Using water, or other methods used for irrigation, that are not sterile or that do not contain recognized disinfecting or antibacterial properties when performing dental procedures on exposed dental pulp.
(ah) (1) The failure by the treating dentist, prior to the initial diagnosis and correction of malpositions of human teeth or initial use of orthodontic appliances, to perform an in-person examination pursuant to subdivision (b) of Section 1684.5, including the review of the patient’s most recent diagnostic digital or conventional radiographs or other equivalent bone imaging suitable for orthodontia. New radiographs or other equivalent bone imaging shall be ordered if deemed appropriate by the treating dentist. no radiographs are available for diagnostic review.
(2) For purposes of paragraph (1), the correction of malpositions includes any movement of the teeth, including the treatment of malocclusions. This paragraph is intended to clarify existing law.
(ai) The destruction of patient records before either of the following has occurred:
(1) Ten years have elapsed from the date a dental service was last provided if the patient is an adult.
(2) Seven years have elapsed from the date a dental service was last provided if the patient is a minor, or one year has elapsed from the patient’s 18th birthday, whichever is longer.

SEC. 2.

 Section 1683.1 of the Business and Professions Code is amended to read:

1683.1.
 (a) Any individual, partnership, corporation, or other entity that provides dental services through telehealth shall make available the name, telephone number, practice address, and California state license number of any dentist who will be involved in the provision of services to a patient prior to the rendering of services and when requested by a patient.
(b) For services involving the diagnosis and correction of malpositions of human teeth or initial use of orthodontic appliances, as described in subdivision (ah) of Section 1680, the information required by subdivision (a) of this section shall be provided to the patient at the time that the patient receives the recommended treatment plan.

(b)

(c) A violation of this section shall constitute unprofessional conduct.

SEC. 3.

 Section 1683.2 of the Business and Professions Code is amended to read:

1683.2.
 (a) A provider of dental services shall not require a patient to sign an agreement that limits the patient’s ability to file a complaint with the board.
(b) A licensed dentist, dental assistant, registered dental assistant, registered dental assistant in extended functions, dental sedation assistant permitholder, orthodontic assistant permitholder, registered dental hygienist, registered dental hygienist in alternative practice, registered dental hygienist in extended functions, or other person shall not be required to sign an agreement that limits the signatory’s ability to file a complaint or provide information to the board.

SEC. 4.

 Section 1684.1.1 is added to the Business and Professions Code, to read:

1684.1.1.
 In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for a licensed dentist to fail to comply with a written request of a patient to receive a copy of any patient-signed documents within 15 days of receiving the request. Copies of requested documents may be provided to the patient electronically.