NEW JERSEY REGISTER
VOLUME 37, NUMBER 4
TUESDAY, FEBRUARY 22, 2005
RULE PROPOSAL

LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
NEW JERSEY STATE BOARD OF DENTISTRY
PARENTERAL CONSCIOUS SEDATION; USE OF GENERAL ANESTHESIA

Proposed Amendments: N.J.A.C. 13:30-8.2 and 8.3

Authorized By: New Jersey State Board of Dentistry, Kevin B. Earle, Executive Director.

Authority: N.J.S.A. 45:6-1 et seq. and 45:1-15.1.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2005-65.

Submit written comments by May 3, 2005 to:

Kevin B. Earle, Executive Director

New Jersey State Board of Dentistry

124 Halsey Street

PO Box 45005

Newark, New Jersey 07101

The agency proposal follows:

Summary

Pursuant to its general rulemaking authority, N.J.S.A. 45:1-15.1, the New Jersey State Board of Dentistry (the Board) is proposing amendments to its rules concerning the use of parenteral conscious sedation and general anesthesia, set forth at N.J.A.C. 13:30-8.2 and 8.3, respectively, in order to make the rules consistent with recent rule changes promulgated by the State Board of Medical Examiners. Currently, N.J.A.C. 13:30-8.2(i) provides that a dentist may utilize the services of an M.D. or D.O. who is authorized to perform anesthesia services by the State Board of Medical Examiners pursuant to N.J.A.C. 13:35-4A.1, in order to provide parenteral conscious sedation services in a dental office. N.J.A.C. 13:30-8.3(m) provides that a dentist may utilize the services of an M.D. or D.O. who is a member of the anesthesiology staff of an accredited hospital in order to provide general anesthesia services in a dental office. Both N.J.A.C. 13:30-8.2(i) and 8.3(m) refer to the physician providing the referenced services as an anesthesiologist.

The State Board of Medical Examiners recently amended its rules concerning anesthesia and conscious sedation services performed in an office setting, set forth at N.J.A.C. 13:35-4A. Specifically, the Board of Medical Examiners adopted a new rule, N.J.A.C. 13:35-4A.12, which authorizes a physician to provide or supervise the administration or monitoring of anesthesia and conscious sedation even though the physician does not have privileges to perform such services as a member of the anesthesiology staff of an accredited hospital provided he or she has satisfied the alternative privileging procedures established by the State Board of Medical Examiners. Those procedures include the satisfaction of the various competency requirements established in N.J.A.C. 13:35-4A.12.

In light of these changes, the New Jersey State Board of Dentistry believes that N.J.A.C. 13:30-8.2(i) and 8.3(m) should be amended to clarify that there are now two distinct categories of physicians (those who have hospital privileges in anesthesiology and those who have been alternatively privileged by the State Board of Medical Examiners) who are authorized to provide anesthesia and conscious sedation services in a dental office. The Board is proposing that N.J.A.C 13:30-8.2(i) be amended to include a specific reference to physicians who are anesthesiology staff members of accredited hospitals and that N.J.A.C. 13:30-8.3(m) be amended to include a specific reference to physicians who are authorized to perform anesthesia services by the State Board of Medical Examiners pursuant to the rules in N.J.A.C. 13:35-4A. In addition, the references in both rules to the "anesthesiologist" performing the services is proposed to be deleted and replaced with the more appropriate reference to "M.D. or D.O."

The Board has determined that the comment period for this proposal shall be 60 days. Therefore, pursuant to N.J.A.C. 1:30-3.3(a)5, this proposal is excepted from the rulemaking calendar requirement.

Social Impact

The Board believes that the proposed amendments to N.J.A.C. 13:30-8.2 and 8.3 will have a positive impact upon certain dentists and physicians as well as the patients they serve, by clarifying who may administer and monitor parenteral conscious sedation and general anesthesia services in a dental office. The proposed amendments clarify that a physician who is not a member of the anesthesiology staff of an accredited hospital, but who has been alternatively privileged to perform general anesthesia and conscious sedation services by the State Board of Medical Examiners, is authorized to perform such services in a dental office, provided all other requirements of N.J.A.C. 13:30-8.2 and 8.3 are satisfied.

Economic Impact

The Board believes that the proposed amendments to N.J.A.C. 13:30-8.2 and 8.3 may have an economic impact upon licensed dentists who are currently utilizing the services of physicians to provide parenteral conscious sedation and general anesthesia services in their dental offices. The proposed amendments may also have an economic impact upon physicians who are not hospital anesthesiology staff members, but who have undergone the alternative privileging procedure established by the State Board of Medical Examiners and are, therefore, authorized to provide such services. Such dentists will now be able to retain the services of these physicians in place of hospital anesthesiology staff members or New Jersey State Board of Dentistry parenteral conscious sedation or general anesthesia permit holders. The proposed amendments, therefore, will expand the field of physicians eligible to provide such services in dental office settings. The increased availability of physicians to provide conscious sedation and general anesthesia services may allow more dental procedures entailing the use of such services to be performed by dentists, thereby resulting in an economic benefit to the dentists and to the physicians who will be performing the services.

Federal Standards Statement

A Federal standards analysis is not required because the proposed amendments are governed by N.J.S.A. 45:6-1 et seq., and are not subject to any Federal standards or requirements.

Jobs Impact

The Board does not believe that the proposed amendments will result in an increase or decrease in the number of jobs in the State.

Agriculture Industry Impact

The Board does not believe that the proposed amendments will have any impact on the agriculture industry in the State.

Regulatory Flexibility Analysis

The Regulatory Flexibility Act (the Act), N.J.S.A. 52:14B-16 et seq., requires the Board to provide a description of the types and an estimate of the number of small businesses to which the proposed amendments will apply. Currently, the Board licenses approximately 9,616 dentists. If these Board licensees are considered "small businesses" within the meaning of the Act, then the following analysis applies.

The Act requires the Board to set forth the reporting, recordkeeping and other compliance requirements of the proposed amendments, including the kinds of professional services likely to be needed to comply with the requirements. The Act further requires the Board to estimate the initial and annual compliance costs of the proposed amendments, to outline the manner in which it has designed the proposed amendments to minimize any adverse economic impact upon small businesses, and to set forth whether the proposed amendments establish differing compliance requirements for small businesses.

The proposed amendments to N.J.A.C. 13:30-8.2 and 8.3 will not impose any reporting or recordkeeping requirements upon licensed dentists apart from that already required by N.J.A.C. 13:30-8.7 which details the information that is to be included in the patient record. The proposed amendments will impose compliance requirements upon licensed dentists to the extent that dentists who choose to utilize the services of a physician to provide general anesthesia or parenteral conscious sedation services to their dental patients must ensure that the physician is a member of the anesthesiology staff of an accredited hospital or, in the alternative, is authorized to perform anesthesia and conscious sedation services by the State Board of Medical Examiners pursuant to the rules set forth at N.J.A.C. 13:35-4A.

No additional professional services will be needed to comply with the proposed amendments. The anticipated economic impact of the proposed amendments are discussed in the Economic Impact statement above. The Board believes that the proposed amendments should be uniformly applied to all licensed dentists in order to ensure the health, safety and welfare of the general public in the provision of dental services and, therefore, no differing compliance requirements for any licensed dentists are provided based upon the size of the business.

Smart Growth Impact

The Board does not believe that the proposed amendments will have any impact upon the achievement of smart growth or upon the implementation of the State Development and Redevelopment Plan.

Full text of the proposal follows :

<< NJ ADC 13:30-8.2 >>

13:30-8.2 Parenteral conscious sedation

(a)-(h) (No change.)

(i) A dentist who utilizes the services of a PCS permit holder or an M.D. or D.O. <<+who is a member of the anesthesiology staff of an accredited hospital or+>> who is authorized to perform anesthesia services by the Board of Medical Examiners pursuant to N.J.A.C. 13:35-4A<<-.1->> shall not be deemed to be administering PCS, provided that the PCS permit holder or <<- anesthesiologist->> <<+M.D. or D.O.+>> remains present during the administration of PCS and bears full responsibility during the entire procedure until the patient has recovered fully and has been discharged.

(j)-(m) (No change.)

<< NJ ADC 13:30-8.3 >>

13:30-8.3 Use of general anesthesia

(a)-(l) (No change.)

(m) Any dentist who utilizes the services of a <<+general anesthesia+>> permit holder or an M.D. or D.O. who is a member of the anesthesiology staff of an accredited hospital <<+or who is authorized to perform anesthesia services by the Board of Medical Examiners pursuant to N.J.A.C. 13:35-4A+>> shall not be deemed to be practicing general anesthesia provided that <<- such->> <<+the general anesthesia+>> permit holder or <<- anesthesiologist->> <<+M.D. or D.O.+>> remains present and bears full responsibility during the entire procedure and until any patient regains consciousness. Any <<+general anesthesia+>> permit holder invited by a dentist to provide general anesthesia services shall bear full responsibility for compliance with all terms and conditions of this rule including, but not limited to, the minimum requirements for equipment and assisting staff.

(n)-(p) (No change.)



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