FILED SENATE
Apr 6, 2023
GENERAL ASSEMBLY OF NORTH CAROLINA
S.B. 723
SESSION 2023 PRINCIPAL CLERK
S D
SENATE BILL DRS45313-NB-101
Short Title: Henry's Law. (Public)
Sponsors: Senator Lee (Primary Sponsor).
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT TO ESTABLISH DENTAL SEDATION REQUIREMENTS AND TO DIRECT THE
3 COLLABORATORY TO CONDUCT A STUDY OF ANESTHESIA PROVIDER
4 REQUIREMENTS.
5 The General Assembly of North Carolina enacts:
6 SECTION 1. G.S. 90-30.1 reads as rewritten:
7 "§ 90-30.1. Standards for general anesthesia and enteral and parenteral sedation; fees
8 authorized.
9 The Subject to the requirements of G.S. 90-30.3 through G.S. 90-30.7, the North Carolina
10 Board of Dental Examiners may establish by regulation reasonable education, training, and
11 equipment standards for safe administration and monitoring of general anesthesia and enteral and
12 parenteral sedation for outpatients in the dental setting. Regulatory standards may include a
13 permit process for general anesthesia and enteral and parenteral sedation by dentists. The
14 requirements of any permit process adopted under the authority of this section shall include
15 provisions that will allow a dentist to qualify for continued use of enteral sedation, if he or she is
16 licensed to practice dentistry in North Carolina and shows the Board that he or she has been
17 utilizing enteral sedation in a competent manner for the five years preceding January 1, 2002,
18 and his or her office facilities pass an on-site examination and inspection by qualified
19 representatives of the Board. For purposes of this section, oral premedication administered for
20 minimal sedation (anxiolysis) shall not be included in the definition of enteral sedation. In order
21 to provide the means of regulating general anesthesia and enteral and parenteral sedation,
22 including examination and inspection of dental offices involved, the Board may charge and
23 collect fees established by its rules for each permit application, each annual permit renewal, and
24 each office inspection in an amount not to exceed the maximum fee amounts set forth in
25 G.S. 90-39."
26 SECTION 2.(a) Article 2 of Chapter 90 of the General Statutes is amended by adding
27 a new section to read:
28 "§ 90-30.3. Dental sedation procedure.
29 (a) Definitions. – The following definitions apply to G.S. 90-30.3 through G.S. 90-30.7:
30 (1) Adverse event. – Any of the following clinical emergencies: anaphylaxis,
31 aspiration, cardiac arrest, or unplanned advanced airway placement.
32 (2) Analgesia. – The diminution or elimination of pain.
33 (3) Anti-anxiety sedative. – A sedative agent administered in a dosage intended
34 to reduce anxiety without diminishing consciousness or protective reflexes.
35 (4) Anxiolysis. – Pharmacological reduction of anxiety through the
36 administration of a single dose of a minor psychosedative, possibly in
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 General Assembly Of North Carolina Session 2023
1 combination with nitrous oxide, to children or adults prior to commencement
2 of treatment on the day of the appointment that allows for uninterrupted
3 interactive ability in an awake patient with no compromise in the ability to
4 maintain a patent airway independently and continuously.
5 (5) ASA guidelines. – American Society of Anesthesiologists guidelines.
6 (6) BLS-certified. – Basic Life Support certified.
7 (7) General anesthesia. – The intended controlled state of a depressed level of
8 consciousness that is produced by pharmacologic agents and accompanied by
9 a partial or complete loss of protective reflexes, including the ability to
10 maintain an airway and respond to physical stimulation and verbal commands.
11 (8) Certified registered nurse anesthetist or CRNA. – A licensed registered nurse
12 who completes a program accredited by the Council on Accreditation of Nurse
13 Anesthesia Educational Programs, is credentialed as a certified registered
14 nurse anesthetist by the Council on Certification of Nurse Anesthetists, and
15 who maintains recertification through the Council on Recertification of Nurse
16 Anesthetists and performs nurse anesthesia activities in collaboration with a
17 physician, dentist, podiatrist, or other lawfully qualified health care provider.
18 (9) Credentialed surgery center. – A surgical facility accredited by the Joint
19 Commission on Accreditation of Healthcare Organizations, the Accreditation
20 Association for Ambulatory Health Care, or the American Association for
21 Accreditation of Ambulatory Surgery Facilities.
22 (10) Licensed dentist. – An individual licensed to practice dentistry under this
23 Article who holds a permit for an approved level of anesthesia under this
24 Article and issued by the Board.
25 (11) Sedation procedure. – A process beginning when any pharmacological agent
26 is first administered to a patient to induce general anesthesia or sedation and
27 continues until the dentist permit holder determines that the patient has met
28 the recovery and discharge criteria set forth in this Article.
29 (b) Dental Sedation Permit Requirements. – A licensed dentist shall hold an unexpired
30 permit issued by the Board in accordance with G.S. 90-30.1 permitting the dentist to administer
31 general anesthesia, moderate conscious sedation, or moderate pediatric conscious sedation, or
32 supervising a CRNA to administer or an RN employed to deliver anesthesia or moderate sedation.
33 Before performing sedation procedures in a facility other than a hospital or credentialed surgery
34 center, the licensed dentist shall ensure that the Board has been notified that the licensed dentist
35 intends to administer anesthesia or moderate sedation at the facility and shall ensure that the
36 facility has passed a facility inspection by the Board in accordance with this Article.
37 (c) Facility Equipment Requirements. – The licensed dentist shall ensure that the facility
38 where the sedation procedure is to be performed meets all of the following requirements at the
39 time of the sedation procedure:
40 (1) The facility must be equipped with all of the following equipment and ensure
41 that the equipment is immediately available and accessible from the operatory
42 and recovery rooms:
43 a. An operatory of size and design to permit access of emergency
44 equipment and personnel and to permit emergency management.
45 b. CPR board or dental chair suitable for providing emergency treatment.
46 c. Lighting as necessary for the procedure to be performed and backup
47 lighting.
48 d. Suction equipment as necessary for the procedure to be performed,
49 including non-electrical backup suction.
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1 e. Positive pressure oxygen delivery system, including full-face masks
2 for small, medium, and large patients, and backup E-cylinder portable
3 oxygen tanks apart from the central system.
4 f. Small, medium, and large oral and nasal airways.
5 g. Blood pressure monitoring device.
6 h. EKG monitor.
7 i. Pulse oximeter.
8 j. Automatic external defibrillator.
9 k. Capnograph.
10 l. Precordial or pretracheal stethoscope.
11 m. Thermometer.
12 n. Vascular access setup as necessary for the procedure to be performed,
13 including hardware and fluids.
14 o. A laryngoscope with working batteries.
15 p. Intubation forceps and advanced airway devices.
16 q. Tonsillar suction with backup suction.
17 r. Syringes as necessary for the procedure to be performed.
18 s. Tourniquet and tape.
19 (2) The licensed dentist shall ensure all monitoring and other equipment in the
20 facility receives preventive maintenance no less frequently than once per year,
21 including safety and function checks per the manufacturer's
22 recommendations. The licensed dentist shall maintain documentation of all
23 preventive maintenance performed and shall ensure equipment is replaced
24 upon its expiration or as clinically required.
25 (3) The licensed dentist shall ensure the following unexpired drugs are
26 immediately available and are accessible from the operatory and recovery
27 rooms:
28 a. Epinephrine.
29 b. Atropine.
30 c. An antiarrhythmic.
31 d. An antihistamine.
32 e. An antihypertensive.
33 f. A bronchodilator.
34 g. An antihypoglycemic agent.
35 h. A vasopressor.
36 i. A corticosteroid.
37 j. An anticonvulsant.
38 k. Appropriate reversal agents.
39 l. Nitroglycerine.
40 m. An antiemetic.
41 n. A neuromuscular blocking agent.
42 (4) The licensed dentist shall maintain written emergency and patient discharge
43 protocols accessible from the operatory and recovery rooms. The written
44 emergency manual shall include a protocol for activation of emergency
45 management services for life-threatening complications along with any
46 information as required by rule.
47 (5) The licensed dentist shall satisfy any additional facility requirements
48 applicable to the permit level as required by the Board or this Article.
49 (d) The licensed dentist shall ensure that the following staffing, education, and training
50 requirements are met prior to performing a sedation procedure:
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1 (1) The licensed dentist shall review and practice responding to clinical
2 emergencies with all auxiliaries as a team and in person every six months and
3 shall provide training to familiarize all auxiliaries in the treatment of clinical
4 emergencies including, at a minimum, all of the following:
5 a. Airway obstruction.
6 b. Allergic reactions.
7 c. Angina pectoris.
8 d. Apnea.
9 e. Bradycardia.
10 f. Bronchospasm.
11 g. Cardiac arrest.
12 h. Convulsions.
13 i. Emesis and aspiration.
14 j. Hypertension.
15 k. Hypoglycemia.
16 l. Hypotension.
17 m. Hypoventilation and respiratory arrest.
18 n. Hypoxemia and hypoxia.
19 o. Laryngospasm.
20 p. Myocardial infarction.
21 q. Syncope
22 (2) All auxiliaries in the facility shall be BLS-certified.
23 (3) Except as provided in subdivision (4) of this subsection, the licensed dentist
24 performing the surgical procedure or other dental procedure shall ensure that
25 a registered nurse or a BLS-certified auxiliary is dedicated to patient
26 monitoring and recording anesthesia or sedation data throughout the sedation
27 procedure.
28 (4) A licensed dentist does not need to comply with subdivision (3) of this
29 subsection if the licensed dentist or an additional sedation provider is
30 dedicated to patient care and monitoring regarding anesthesia or moderate
31 sedation throughout the sedation procedure and is not performing the surgery
32 or other dental procedure. For the purposes of this subdivision, an additional
33 sedation provider must be one of the following individuals:
34 a. A licensed dentist holding a permit or mobile permit in satisfaction of
35 this Article to administer the anesthesia or sedation level at the facility
36 where the sedation procedure is performed.
37 b. An anesthesiologist licensed and practicing in accordance with Article
38 1 of this Chapter and the rules of the North Carolina Medical Board.
39 c. A certified registered nurse anesthetist licensed and practicing in
40 accordance with the rules of the North Carolina Board of Nursing,
41 under the supervision and direction of the licensed dentist who shall
42 ensure the level of sedation administered does not exceed the level of
43 the sedation allowed by the licensed dentist's permit.
44 (5) The licensed dentist shall satisfy any additional staffing, education, and
45 training requirements applicable to the level of the permit, consistent with this
46 Article or rule approved by the Board.
47 (e) Before starting any sedation procedure, the licensed dentist shall conduct a
48 preoperative patient evaluation which shall include the following:
49 (1) Evaluating the patient for health risks relevant to the potential sedation
50 procedure.
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1 (2) Evaluating the patient's food and fluid intake following the ASA guidelines
2 for preoperative fasting applicable to elective procedures involving the
3 administration of anesthesia or moderate sedation.
4 (3) Satisfying any additional requirements for preoperative patient evaluation and
5 procedures appliable to the level of the permit as set out in this section.
6 (f) During the sedation procedure, the licensed dentist shall ensure all of the following
7 occur:
8 (1) Prescriptions intended to accomplish procedural sedation, including enteral
9 dosages, shall be administered only under the direct supervision of the permit
10 holder.
11 (2) If IV sedation is used, IV infusion shall be administered before the start of the
12 procedure and maintained until the patient is ready for discharge.
13 (3) Capnography shall be used to monitor patients unless an individual patient's
14 behavior or condition prevents use of capnography. In that event, the permit
15 holder shall document in the sedation record the clinical reason capnography
16 could not be used.
17 (4) The licensed dentist shall ensure the patient's baseline vital signs are taken and
18 recorded, including temperature, SPO2, blood pressure, and pulse.
19 (5) The licensed dentist shall ensure the patient's blood pressure, oxygen
20 saturation, ET CO2, unless capnography cannot be used, pulse, and respiration
21 rates are monitored continuously in a manner that enables the licensed dentist
22 to view vital sign trends throughout the procedure.
23 (6) The licensed dentist shall ensure the intraoperative vital sign information is
24 recorded on the anesthesia or sedation record contemporaneously throughout
25