|
Join The List
|
 |
|
 |
Dr. Ronald Davies is medically trained in Anesthesiology and double Board Certified in his field. He has an unsurpassed 30 year safety record. - General Anesthesia Evaluator for the Dental Board
- Past Associate Professor in Anesthesia at LLU, UCLA and USC
- Past President: American Society of Dentist Anesthesiologists, California Society of Dentist Anesthesiologists
- Member: ADA, CDA, OCDS, OCDA, JADE, ASDA, ADSA, CSDA
|
|
|
|
Good Morning
|
How would you feel if you referred a patient or loved one for dentistry performed under general anesthesia and they had a major anesthetic complication and died? Then what would your reaction be at discovering that the person who labeled the syringes, drew up the drugs, injected the medications and monitored the patient under the "supervision" of the dentist was an assistant with only a high school diploma and 3 weeks of training in anesthesia? The final insult would be discovering that your patient was charged more for the anesthesia than if a boarded dental or medical anesthesiologist had been in attendance protecting your patient.
Of course nothing like this could happen in a hospital because of rational laws protecting patients, but shockingly that's exactly what may happen soon here in California dental offices.
|
|
HOW COULD THIS HAPPEN?
|
It was kept very quiet.
California Oral
Surgeons, acting with the support of the CDA passed changes to the
Dental Practice Act (1750.5) via AB 2637, creating the Dental Sedation Assistant Permit. It slipped by parties with anesthesia
training because it was inserted into dental assistant duties
instead of the General Anesthesia section where one would expect to monitor such a major change in public safety.
What is the minimum training for someone to "supervise" these assistants while also performing the surgery?
It depends on the permit level of the dentist. If the dentist has a GA permit then the assistant can monitor the GA.
If they have an IV Sedation permit, they can monitor sedation. GA
permits can be issued to Oral Surgeons with as little as four months of
anesthesia training (see Commission on Dental Accreditation, CODA) or other dentists with a year of training. Section 4.9 of CODA for OS states "The off-service rotation in
anesthesia", "requires familiarity...in ambulatory techniques of general
anesthesia." Familiarity is defined by CODA as "A simplified knowledge for the purposes of orientation and recognition
of general principles."
Simplified knowledge and general principles to supervise someone
with only 3 weeks of training? The Veterinary Board
recognizes the critical importance of anesthesia by requiring up to 3 years
(not weeks) of training for Registered Veterinary Technicians. In my
opinion your pet will be safer in surgery than the patient you refer to
an office using a Sedation Assistant.
|
|
WHY THIS AFFECTS YOU!
|
 Pandora's Box
How could CDA support such an obviously dangerous law? The primary reason I've been given is that some oral surgeons have been illegally instructing their assistants to inject drugs for years, so this law is just a "clean up" measure. I cannot think of a more obscene reason for a law. Many of you might think that this doesn't affect you since you don't use general anesthesia. But it will. Historically, as you expand assistant duties you start at the bottom of risk and work your way slowly up. However, the CDA and OS picked the most
potentially dangerous and life threatening area of dentistry to denigrate; anesthesia. Closed claim insurance reviews have
consistently listed the main reasons for anesthetic morbidity and mortality are lack of
monitoring, training and equipment failure. One British study showed it was 2.8 times safer to have a separate trained professional administer and monitor anesthesia in dental offices. Imagine the potential risk of an untrained assistant. In Alaska or Great Britain you can't even be an operator-anesthetist with or without a 110hr assistant.
How this affects you: If the Board and the CDA believe that a high school graduate
can be trained to deliver and monitor general anesthesia under "supervision" because some OS have been doing it illegally, then they must accept that it is perfectly reasonable for other special interest
groups to license their assistants in 110
hours to either cut preps or place implants or clean teeth or root canals or even extractions
under direct "supervision". The CDA has opened the Pandora's Box of expanded duties with this law. All of the procedures mentioned above have far less
risk of permanent injury than general anesthesia. Expect clinics to easily pass similar legislation which will affect your practice over the feeble objections of the CDA. In Minnesota an Advanced Practice Dental Therapist CAN extract permanent teeth under "general supervision". They can, with indirect supervision, do cavity preps, pulpotomies and extractions of primary teeth. This law must be revoked before this happens to CA dentistry.
|
|
A DONE DEAL?
|
 What you can do....
Although this Bill was intentionally kept below the radar of opposing parties, there is still one last step before the law becomes fully in force in January 2010. The Dental Board must approve these 110 hour courses and create the exams. I have already written to each of the Board Members asking them not to approve any course. Their general contact information is here. My full letter with documentation of the dangers, the CODA required training of oral surgeons, other providers in dentistry, and other fields can be read here. A strong letter to both the Board and CDA from you might save a life and the practice of dentistry from being turned into an assembly line of assistants with "special" and very limited skills.
This Bill does not affect me financially as I do not work with Oral Surgeons. Also, not all Oral Surgeons will use this model. Some will continue to act as operator-anesthetists, performing and charging for both duties simultaneously but not depending on assistants to monitor patients. When I refer a patient to an Oral Surgeon, I'll ask if they do it themselves (fine), use a dental/medical anesthesiologist or CRNA (better) or a Dental Sedation Assistant (will NOT refer).
In this litigious climate I believe that a case could be made that if you refer a patient to an office using a sedation assistant you might ethically or legally need to say to your patient: "I am referring you to Dr. X for your dentistry under general anesthesia. While you are under anesthesia your vital signs will be monitored by an assistant with 110 hours of anesthesia training who has drawn up and labeled the drugs they will inject into you. While concentrating on your surgery, your dentist will also "supervise" this assistant. You may also be charged the same for the anesthesia as if you had a boarded anesthesiologist in attendance." Sounds uncomfortable, doesn't it?
What, exactly, was the CDA thinking when they supported this Bill? Why don't you ask them?
|
|
Tips and Tricks in Anesthesia
|
Remove that bulky IV pole. Just hang the bag from a metal patient towel clip over the arm of the light.
Fix oxygen leaks for just a few dollars: If you find you are having to replace the O2 tanks more frequently on your nitrous/oxygen system, first try putting a lock on the valve of the nitrous tanks. A common cause of increased oxygen use comes from someone using the gases for a "high" when you are not around.
Problem getting patients' ride to return on time after oral or IV cases? Give the ride a "return by time". IE take the "monkey" off your receptionist's back and (gently) drop it onto the person responsible for returning for your patient. Let them know you will only call them if you are running ahead or behind of schedule.
Can't find a good vein for an IV? Since the patient is NPO they are "dry" and veins will be harder to find. Next time have the patient wear a jacket over short sleeves, gloves and a hat. Tell them to expect to be uncomfortably warm in the waiting room. Have them disrobe just before they sit down, add 20% nitrous and those veins will pop right up.
|
Save a Life
|
 Take Your Patients' Blood Pressure Often
" Trip to Dentist Saves Life of Teen With Unknown Heart Condition" A recent Fox News article said " Most people dread going to the dentist, but in Anna Campbell's case, it saved it her life.
The
15-year-old was supposed to have four teeth removed, but she never got
that far - a routine test showed her blood pressure was sky high,
London's Daily Telegraph reported. Instead, Anna went straight to the
hospital where more tests showed her aorta was shockingly narrow." Dr. Malamed told me recently that an insurance company survey indicated only "2% of GP dentists record blood pressure on a routine basis on all patients." Dentists should take blood pressures prior to every appointment where epinephrine is planned in addition to other indications.
|
Safe Anesthesia is Affordable
|
- NO Set-up, Front Loaded Charges
- NO Pharmacy/Equipment Charges
- NO Minimum Charges (South Orange County)
- NO Travel Charges
We Match Any Percent Discount You Offer Your Patient
We Accept VISA, MC, Amex and Care Credit.
|
Previous Newsletters
Click Here to access previous newsletters
|
|
|
|
|
|
