(REPRINTED WITH ADOPTED AMENDMENTS)
FIRST REPRINTS.B. 208
Senate Bill No. 208–Senator Rawson
February 20, 2001
____________
Referred to Committee on Human Resources and Facilities
SUMMARY—Makes various changes to provisions concerning public dental health. (BDR 40‑738)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State: Contains Appropriation not included in Executive Budget.
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EXPLANATION
– Matter in bolded italics is new; matter
between brackets [omitted material] is material to be omitted.
Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).
AN ACT relating to public dental health; providing for the appointment of a state dental health officer and a state public health dental hygienist; establishing their duties; providing for the authorization of a person to practice public health dental hygiene; making appropriations; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
1-1 Section 1. Chapter 439 of NRS is hereby amended by adding thereto
1-2 the provisions set forth as sections 2 and 3 of this act.
1-3 Sec. 2. 1. The health division shall appoint a state dental health
1-4 officer, who is in the unclassified service of the state. The state dental
1-5 health officer must:
1-6 (a) Be a resident of this state;
1-7 (b) Hold a current license to practice dentistry issued pursuant to
1-8 chapter 631 of NRS; and
1-9 (c) Be appointed on the basis of his education, training and
1-10 experience and his interest in public dental health and related programs.
1-11 2. The state dental health officer shall:
1-12 (a) Determine the needs of the residents of this state for public dental
1-13 health;
1-14 (b) Provide the health division with advice regarding public dental
1-15 health;
1-16 (c) Make recommendations to the health division and the legislature
1-17 regarding programs in this state for public dental health;
1-18 (d) Supervise the activities of the state public health dental hygienist;
1-19 and
2-1 (e) Seek such information and advice from a dental school of the
2-2 University and Community College System of Nevada as necessary to
2-3 carry out his duties.
2-4 3. Except as otherwise provided in this subsection and NRS 284.143,
2-5 the state dental health officer shall devote all of his time to the business
2-6 of his office and shall not pursue any other business or vocation or hold
2-7 any other office of profit. Notwithstanding the provisions of NRS
2-8 281.127, the state dental health officer may engage in academic
2-9 instruction, research and studies at a dental school of the University and
2-10 Community College System of Nevada.
2-11 Sec. 3. 1. The health division shall appoint a state public health
2-12 dental hygienist, who is in the unclassified service of the state. The state
2-13 public health dental hygienist must:
2-14 (a) Be a resident of this state;
2-15 (b) Hold a current license to practice dental hygiene issued pursuant
2-16 to chapter 631 of NRS with a special endorsement issued pursuant to
2-17 section 7 of this act; and
2-18 (c) Be appointed on the basis of his education, training and
2-19 experience and his interest in public health dental hygiene and related
2-20 programs.
2-21 2. The state public health dental hygienist:
2-22 (a) Shall assist the state dental health officer in carrying out his
2-23 duties; and
2-24 (b) May:
2-25 (1) Make recommendations to the health division regarding
2-26 programs in this state for public health dental hygiene; and
2-27 (2) Perform any acts authorized pursuant to section 7 of this act.
2-28 Sec. 4. Chapter 631 of NRS is hereby amended by adding thereto the
2-29 provisions set forth as sections 5, 6 and 7 of this act.
2-30 Sec. 5. “Conscious sedation” means a minimally depressed level of
2-31 consciousness, produced by a pharmacologic or nonpharmacologic
2-32 method or a combination thereof, in which the patient retains the ability
2-33 independently and continuously to maintain an airway and to respond
2-34 appropriately to physical stimulation and verbal commands.
2-35 Sec. 6. “Deep sedation” means a controlled state of depressed
2-36 consciousness, produced by a pharmacologic or nonpharmacologic
2-37 method or a combination thereof, and accompanied by a partial loss of
2-38 protective reflexes and the inability to respond purposefully to verbal
2-39 commands.
2-40 Sec. 7. 1. The board shall, upon application by a dental hygienist
2-41 who is licensed pursuant to this chapter and has such qualifications as
2-42 the board specifies by regulation, issue a special endorsement of his
2-43 license allowing him to practice public health dental hygiene pursuant to
2-44 subsection 2.
2-45 2. The state dental health officer may authorize a person who holds a
2-46 special endorsement issued pursuant to subsection 1 to provide or cause
2-47 to be provided such services for the promotion of public health dental
2-48 hygiene as the state dental health officer deems appropriate. Such
2-49 services:
3-1 (a) May be provided at schools, community centers, hospitals, nursing
3-2 homes and such other locations as the state dental health officer deems
3-3 appropriate.
3-4 (b) May not be provided at a dental office that is not operated by a
3-5 public or nonprofit entity.
3-6 Sec. 8. NRS 631.005 is hereby amended to read as follows:
3-7 631.005 As used in this chapter, unless the context otherwise requires,
3-8 the words and terms defined in NRS 631.015 to 631.105, inclusive, and
3-9 sections 5 and 6 of this act have the meanings ascribed to them in those
3-10 sections.
3-11 Sec. 9. NRS 631.265 is hereby amended to read as follows:
3-12 631.265 1. No licensed dentist or person who holds a restricted
3-13 license issued pursuant to NRS 631.275 may administer or supervise
3-14 directly the administration of general anesthesia, conscious sedation or
3-15 deep sedation to dental patients unless he has been issued a permit
3-16 authorizing him to do so by the board.
3-17 2. The board may issue a permit authorizing a licensed dentist or
3-18 person who holds a restricted license issued pursuant to NRS 631.275 to
3-19 administer or supervise directly the administration of general anesthesia,
3-20 conscious sedation or deep sedation to dental patients under such
3-21 standards, conditions and other requirements as the board shall by
3-22 regulation prescribe.
3-23 [3. As used in this section:
3-24 (a) “Conscious sedation” means a minimally depressed level of
3-25 consciousness, produced by a pharmacologic or nonpharmacologic method
3-26 or a combination thereof, in which the patient retains the ability
3-27 independently and continuously to maintain an airway and to respond
3-28 appropriately to physical stimulation and verbal commands.
3-29 (b) “Deep sedation” means a controlled state of depressed
3-30 consciousness, produced by a pharmacologic or nonpharmacologic method
3-31 or a combination thereof, and accompanied by a partial loss of protective
3-32 reflexes and the inability to respond purposefully to verbal commands.]
3-33 Sec. 10. NRS 631.275 is hereby amended to read as follows:
3-34 631.275 1. Except as otherwise provided in subsection 2, the board
3-35 shall, without examination, issue a restricted license to practice dentistry to
3-36 a person who:
3-37 (a) Has a valid license to practice dentistry issued pursuant to the laws
3-38 of another state or the District of Columbia;
3-39 (b) Has received a degree from a dental school or college accredited by
3-40 the [American Dental Association] Commission on Dental Accreditation
3-41 [,] of the American Dental Association or its successor organization; and
3-42 (c) Has entered into a contract with a facility approved by the health
3-43 division of the department of human resources to provide publicly funded
3-44 dental services exclusively to persons of low income for the duration of the
3-45 restricted license.
3-46 2. The board shall not issue a restricted license to a person:
3-47 (a) Who has failed to pass the examination of the board;
3-48 (b) Who has been refused a license in this state, another state or territory
3-49 of the United States or the District of Columbia; or
4-1 (c) Whose license to practice dentistry has been revoked in this state,
4-2 another state or territory of the United States or the District of Columbia.
4-3 3. A person to whom a restricted license is issued pursuant to
4-4 subsection 1:
4-5 (a) May perform dental services only:
4-6 (1) Under the general supervision of the state dental health officer
4-7 or the supervision of a dentist who is licensed to practice dentistry in this
4-8 state and appointed by the health division of the department of human
4-9 resources to supervise dental care that is provided in a facility which has
4-10 entered into a contract with the person to whom a restricted license is
4-11 issued and which is approved by the health division ; [of the department;]
4-12 and
4-13 (2) In accordance with the contract required pursuant to paragraph (c)
4-14 of that subsection.
4-15 (b) Shall not, for the duration of the restricted license, engage in the
4-16 private practice of dentistry, which includes, without limitation, providing
4-17 dental services to a person who pays for the services.
4-18 4. A person who receives a restricted license must pass the
4-19 examination of the board within 3 years after receiving his restricted
4-20 license. If the person fails to pass that examination, the board shall revoke
4-21 the restricted license.
4-22 5. The board may revoke a restricted license at any time.
4-23 Sec. 11. NRS 631.290 is hereby amended to read as follows:
4-24 631.290 1. Any person is eligible to take an examination for a
4-25 license to practice dental hygiene in this state who:
4-26 (a) Is of good moral character;
4-27 (b) Is over 18 years of age;
4-28 (c) Is a citizen of the United States or is lawfully entitled to remain and
4-29 work in the United States; and
4-30 (d) Is a graduate of [an accredited] a school of dental hygiene [.] or
4-31 other institution that awards at least an associate degree upon
4-32 completion of the program and that is accredited by a regional
4-33 educational accrediting organization that is recognized by the United
4-34 States Department of Education. The program of dental hygiene must:
4-35 (1) Be accredited by the Commission on Dental Accreditation of the
4-36 American Dental Association or its successor specialty accrediting
4-37 organization; and
4-38 (2) Include a curriculum of not less than 2 years of academic
4-39 instruction in dental hygiene or its academic equivalent.
4-40 2. To determine whether a person has good moral character the board
4-41 may consider whether his license to practice dental hygiene in another state
4-42 has been suspended or revoked or whether he is currently involved in any
4-43 disciplinary action concerning his license in that state.
4-44 Sec. 12. NRS 631.300 is hereby amended to read as follows:
4-45 631.300 1. Any person desiring to obtain a license to practice dental
4-46 hygiene, after having complied with the regulations of the board to
4-47 determine eligibility, must [be] :
5-1 (a) Hold a certificate issued by the National Board of Dental
5-2 Examiners that contains a notation that the applicant has passed the
5-3 examination of the board with a score of at least 75; and
5-4 (b) Be examined by the board upon such subjects as the board deems
5-5 necessary, and, except as otherwise provided in NRS 631.271, be given a
5-6 practical examination in dental hygiene, including, but not limited to, the
5-7 removal of deposits from, and the polishing of, the exposed surface of the
5-8 teeth.
5-9 2. The examination must be:
5-10 (a) Written, oral or a combination of both; and
5-11 (b) Practical, as in the opinion of the board is necessary to test the
5-12 qualifications of the applicant.
5-13 3. The board shall examine each applicant in writing on the contents
5-14 and interpretation of chapter 631 of NRS and the regulations of the board.
5-15 [4. In lieu of the written examination which may be required by
5-16 subsection 2, the board shall recognize a certificate from the National
5-17 Board of Dental Examiners which contains a notation that the applicant has
5-18 passed the examination of the board with a score of at least 75.]
5-19 Sec. 13. NRS 631.310 is hereby amended to read as follows:
5-20 631.310 1. Except as otherwise provided in NRS 631.271[,] and
5-21 section 7 of this act, the holder of a license or renewal certificate to
5-22 practice dental hygiene may practice dental hygiene in this state in the
5-23 following places:
5-24 (a) In the office of any licensed dentist.
5-25 (b) In a clinic or in clinics in the public schools of this state as an
5-26 employee of the health division of the department of human resources.
5-27 (c) In a clinic or in clinics in a state institution as an employee of the
5-28 institution.
5-29 (d) In a clinic established by a hospital approved by the board as an
5-30 employee of the hospital where service is rendered only to patients of the
5-31 hospital, and upon the authorization of a member of the dental staff.
5-32 (e) In an accredited school of dental hygiene.
5-33 (f) In other places if specified in a regulation adopted by the board.
5-34 2. A dental hygienist may perform only the services which are
5-35 authorized by a dentist licensed in the State of Nevada, unless otherwise
5-36 provided in a regulation adopted by the board.
5-37 3. Except as otherwise provided in section 7 of this act or specifically
5-38 authorized by a regulation adopted by the board, a dental hygienist shall
5-39 not provide services to a person unless that person is a patient of the dentist
5-40 who authorized the performance of those services.
5-41 Sec. 14. NRS 631.313 is hereby amended to read as follows:
5-42 631.313 1. A licensed dentist may assign to a person in his employ
5-43 who is a dental hygienist, dental assistant or other person directly or
5-44 indirectly involved in the provision of dental care only such intraoral tasks
5-45 as may be permitted by a regulation of the board or by the provisions of
5-46 this chapter.
5-47 2. The performance of these tasks must be:
5-48 (a) If performed by a dental assistant or a person, other than a dental
5-49 hygienist, who is directly or indirectly involved in the provision of dental
6-1 care, under the supervision of the licensed dentist who made the
6-2 assignment.
6-3 (b) If performed by a dental hygienist, authorized by the licensed dentist
6-4 of the patient for whom the tasks will be performed[.] , except as
6-5 otherwise provided in section 7 of this act.
6-6 3. No such assignment is permitted that requires:
6-7 (a) The diagnosis, treatment planning, prescribing of drugs or
6-8 medicaments, or authorizing the use of restorative, prosthodontic or
6-9 orthodontic appliances.
6-10 (b) Surgery on hard or soft tissues within the oral cavity or any other
6-11 intraoral procedure that may contribute to or result in an irremediable
6-12 alteration of the oral anatomy.
6-13 (c) The administration of general [anesthetics other than by an
6-14 anesthetist or anesthesiologist licensed in this state.] anesthesia, conscious
6-15 sedation or deep sedation except as otherwise authorized by regulations
6-16 adopted by the board.
6-17 (d) The performance of a task outside the authorized scope of practice
6-18 of the employee who is being assigned the task.
6-19 4. A dental hygienist may, pursuant to regulations adopted by the
6-20 board, administer local anesthesia or nitrous oxide in a health care facility,
6-21 as defined in NRS 449.800, if:
6-22 (a) He is so authorized by the licensed dentist of the patient to whom the
6-23 local anesthesia or nitrous oxide is administered; and
6-24 (b) The health care facility has licensed medical personnel and
6-25 necessary emergency supplies and equipment available when the local
6-26 anesthesia or nitrous oxide is administered.
6-27 Sec. 15. NRS 631.346 is hereby amended to read as follows:
6-28 631.346 The following acts, among others, constitute unprofessional
6-29 conduct:
6-30 1. Employing, directly or indirectly, any student or any suspended or
6-31 unlicensed dentist or dental hygienist to perform operations of any kind to
6-32 treat or correct the teeth or jaws, except as provided in this chapter;
6-33 2. [Giving] Except as otherwise provided in section 7 of this act,
6-34 giving a public demonstration of methods of practice any place other than
6-35 the office where the licensee is known to be regularly engaged in this
6-36 practice;
6-37 3. Employing, procuring, inducing, aiding or abetting a person not
6-38 licensed or registered as a dentist to engage in the practice of dentistry, but
6-39 a patient shall not be deemed to be an accomplice, employer, procurer,
6-40 inducer, aider or abettor;
6-41 4. For a dental hygienist, practicing in any place not authorized [by]
6-42 pursuant to this chapter; or
6-43 5. Practicing while his license is suspended or without a renewal
6-44 certificate.
6-45 Sec. 16. 1. There is hereby appropriated from the state general fund
6-46 to the state board of health the sum of $568,244 to carry out the provisions
6-47 of sections 2 and 3 of this act.
6-48 2. Any remaining balance of the appropriation made by subsection 1
6-49 must not be committed for expenditure after June 30, 2003, and reverts to
7-1 the state general fund as soon as all payments of money committed have
7-2 been made.
7-3 Sec. 17. 1. There is hereby appropriated from the state general fund
7-4 to the board of regents of the University of Nevada the sum of $250,000 to
7-5 develop the curriculum and standards necessary for a student in the
7-6 University and Community College System of Nevada to earn a bachelor
7-7 of science degree in dental hygiene or a master’s degree in public health
7-8 dental hygiene.
7-9 2. Any remaining balance of the appropriation made by subsection 1
7-10 must not be committed for expenditure after June 30, 2003, and reverts to
7-11 the state general fund as soon as all payments of money committed have
7-12 been made.
7-13 Sec. 18. 1. This section and sections 16 and 17 of this act become
7-14 effective upon passage and approval.
7-15 2. Sections 1 to 15, inclusive, of this act become effective on July 1,
7-16 2001.
7-17 H