exempt

                                                       (REPRINTED WITH ADOPTED AMENDMENTS)

 

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.

 

~

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

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;  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, the state dental

2-5  health officer shall devote all of his time to the business of his office and

2-6  shall not pursue any other business or vocation or hold any other office

2-7  of profit. Notwithstanding the provisions of NRS 281.127 and 284.143,

2-8  the state dental health officer may engage in academic instruction,

2-9  research and studies at a dental school of the University and Community

2-10  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  3.  Except as otherwise provided in this subsection, the state public

2-29  health dental hygienist shall devote all of his time to the business of his

2-30  office and shall not pursue any other business or vocation or hold any

2-31  other office of profit. Notwithstanding the provisions of NRS 281.127

2-32  and 284.143, the state public health dental hygienist may engage in

2-33  academic instruction, research and studies in a program of the

2-34  University and Community College System of Nevada.

2-35  Sec. 3.5  Chapter 396 of NRS is hereby amended by adding thereto a

2-36  new section to read as follows:

2-37  The board of regents may, to the extent that money is available,

2-38  develop the curriculum and standards required for a student in the

2-39  system to earn a bachelor of science degree in dental hygiene or a

2-40  master’s degree in public health dental hygiene.

2-41    Sec. 4.  Chapter 631 of NRS is hereby amended by adding thereto the

2-42  provisions set forth as sections 5, 6 and 7 of this act.

2-43    Sec. 5. “Conscious sedation” means a minimally depressed level of

2-44  consciousness, produced by a pharmacologic or nonpharmacologic

2-45  method or a combination thereof, in which the patient retains the ability

2-46  independently and continuously to maintain an airway and to respond

2-47  appropriately to physical stimulation and verbal commands.

2-48    Sec. 6. “Deep sedation” means a controlled state of depressed

2-49  consciousness, produced by a pharmacologic or nonpharmacologic

3-1  method or a combination thereof, and accompanied by a partial loss of

3-2  protective reflexes and the inability to respond purposefully to verbal

3-3  commands.

3-4    Sec. 7. 1.  The board shall, upon application by a dental hygienist

3-5  who is licensed pursuant to this chapter and has such qualifications as

3-6  the board specifies by regulation, issue a special endorsement of his

3-7  license allowing him to practice public health dental hygiene pursuant to

3-8  subsection 2.

3-9    2.  The state dental health officer may authorize a person who holds a

3-10  special endorsement issued pursuant to subsection 1 to provide or cause

3-11  to be provided such services for the promotion of public health dental

3-12  hygiene as the state dental health officer deems appropriate. Such

3-13  services:

3-14    (a) May be provided at schools, community centers, hospitals, nursing

3-15  homes and such other locations as the state dental health officer deems

3-16  appropriate.

3-17    (b) May not be provided at a dental office that is not operated by a

3-18  public or nonprofit entity.

3-19    Sec. 8. NRS 631.005 is hereby amended to read as follows:

3-20    631.005  As used in this chapter, unless the context otherwise requires,

3-21  the words and terms defined in NRS 631.015 to 631.105, inclusive, and

3-22  sections 5 and 6 of this act have the meanings ascribed to them in those

3-23  sections.

3-24    Sec. 9. NRS 631.265 is hereby amended to read as follows:

3-25    631.265  1.  No licensed dentist or person who holds a restricted

3-26  license issued pursuant to NRS 631.275 may administer or supervise

3-27  directly the administration of general anesthesia, conscious sedation or

3-28  deep sedation to dental patients unless he has been issued a permit

3-29  authorizing him to do so by the board.

3-30    2.  The board may issue a permit authorizing a licensed dentist or

3-31  person who holds a restricted license issued pursuant to NRS 631.275 to

3-32  administer or supervise directly the administration of general anesthesia,

3-33  conscious sedation or deep sedation to dental patients under such

3-34  standards, conditions and other requirements as the board shall by

3-35  regulation prescribe.

3-36    [3.  As used in this section:

3-37    (a) “Conscious sedation” means a minimally depressed level of

3-38  consciousness, produced by a pharmacologic or nonpharmacologic method

3-39  or a combination thereof, in which the patient retains the ability

3-40  independently and continuously to maintain an airway and to respond

3-41  appropriately to physical stimulation and verbal commands.

3-42    (b) “Deep sedation” means a controlled state of depressed

3-43  consciousness, produced by a pharmacologic or nonpharmacologic method

3-44  or a combination thereof, and accompanied by a partial loss of protective

3-45  reflexes and the inability to respond purposefully to verbal commands.]

3-46    Sec. 10. NRS 631.275 is hereby amended to read as follows:

3-47    631.275  1.  Except as otherwise provided in subsection 2, the board

3-48  shall, without examination, issue a restricted license to practice dentistry to

3-49  a person who:

4-1    (a) Has a valid license to practice dentistry issued pursuant to the laws

4-2  of another state or the District of Columbia;

4-3    (b) Has received a degree from a dental school or college accredited by

4-4  the [American Dental Association] Commission on Dental Accreditation

4-5  [,] of the American Dental Association or its successor organization; and

4-6    (c) Has entered into a contract with a facility approved by the health

4-7  division of the department of human resources to provide publicly funded

4-8  dental services exclusively to persons of low income for the duration of the

4-9  restricted license.

4-10    2.  The board shall not issue a restricted license to a person:

4-11    (a) Who has failed to pass the examination of the board;

4-12    (b) Who has been refused a license in this state, another state or territory

4-13  of the United States or the District of Columbia; or

4-14    (c) Whose license to practice dentistry has been revoked in this state,

4-15  another state or territory of the United States or the District of Columbia.

4-16    3.  A person to whom a restricted license is issued pursuant to

4-17  subsection 1:

4-18    (a) May perform dental services only:

4-19      (1) Under the general supervision of the state dental health officer

4-20  or the supervision of a dentist who is licensed to practice dentistry in this

4-21  state and appointed by the health division of the department of human

4-22  resources to supervise dental care that is provided in a facility which has

4-23  entered into a contract with the person to whom a restricted license is

4-24  issued and which is approved by the health division ; [of the department;]

4-25  and

4-26      (2) In accordance with the contract required pursuant to paragraph (c)

4-27  of that subsection.

4-28    (b) Shall not, for the duration of the restricted license, engage in the

4-29  private practice of dentistry, which includes, without limitation, providing

4-30  dental services to a person who pays for the services.

4-31    4.  A person who receives a restricted license must pass the

4-32  examination of the board within 3 years after receiving his restricted

4-33  license. If the person fails to pass that examination, the board shall revoke

4-34  the restricted license.

4-35    5.  The board may revoke a restricted license at any time.

4-36    Sec. 11. NRS 631.290 is hereby amended to read as follows:

4-37    631.290  1.  Any person is eligible to take an examination for a

4-38  license to practice dental hygiene in this state who:

4-39    (a) Is of good moral character;

4-40    (b) Is over 18 years of age;

4-41    (c) Is a citizen of the United States or is lawfully entitled to remain and

4-42  work in the United States; and

4-43    (d) Is a graduate of [an accredited] a school of dental hygiene [.] or

4-44  other institution that awards at least an associate degree upon

4-45  completion of the program and that is accredited by a regional

4-46  educational accrediting organization that is recognized by the United

4-47  States Department of Education. The program of dental hygiene must:

5-1       (1) Be accredited by the Commission on Dental Accreditation of the

5-2  American Dental Association or its successor specialty accrediting

5-3  organization; and

5-4       (2) Include a curriculum of not less than 2 years of academic

5-5  instruction in dental hygiene or its academic equivalent.

5-6    2.  To determine whether a person has good moral character the board

5-7  may consider whether his license to practice dental hygiene in another state

5-8  has been suspended or revoked or whether he is currently involved in any

5-9  disciplinary action concerning his license in that state.

5-10    Sec. 12. NRS 631.300 is hereby amended to read as follows:

5-11    631.300  1.  Any person desiring to obtain a license to practice dental

5-12  hygiene, after having complied with the regulations of the board to

5-13  determine eligibility, must [be] :

5-14    (a) Hold a certificate issued by the National Board of Dental

5-15  Examiners that contains a notation that the applicant has passed the

5-16  examination of the board with a score of at least 75; and

5-17    (b) Be examined by the board upon such subjects as the board deems

5-18  necessary, and, except as otherwise provided in NRS 631.271, be given a

5-19  practical examination in dental hygiene, including, but not limited to, the

5-20  removal of deposits from, and the polishing of, the exposed surface of the

5-21  teeth.

5-22    2.  The examination must be:

5-23    (a) Written, oral or a combination of both; and

5-24    (b) Practical, as in the opinion of the board is necessary to test the

5-25  qualifications of the applicant.

5-26    3.  The board shall examine each applicant in writing on the contents

5-27  and interpretation of chapter 631 of NRS and the regulations of the board.

5-28    [4.  In lieu of the written examination which may be required by

5-29  subsection 2, the board shall recognize a certificate from the National

5-30  Board of Dental Examiners which contains a notation that the applicant has

5-31  passed the examination of the board with a score of at least 75.]

5-32    Sec. 13.  NRS 631.310 is hereby amended to read as follows:

5-33    631.310  1.  Except as otherwise provided in NRS 631.271[,] and

5-34  section 7 of this act, the holder of a license or renewal certificate to

5-35  practice dental hygiene may practice dental hygiene in this state in the

5-36  following places:

5-37    (a) In the office of any licensed dentist.

5-38    (b) In a clinic or in clinics in the public schools of this state as an

5-39  employee of the health division of the department of human resources.

5-40    (c) In a clinic or in clinics in a state institution as an employee of the

5-41  institution.

5-42    (d) In a clinic established by a hospital approved by the board as an

5-43  employee of the hospital where service is rendered only to patients of the

5-44  hospital, and upon the authorization of a member of the dental staff.

5-45    (e) In an accredited school of dental hygiene.

5-46    (f) In other places if specified in a regulation adopted by the board.

5-47    2.  A dental hygienist may perform only the services which are

5-48  authorized by a dentist licensed in the State of Nevada, unless otherwise

5-49  provided in a regulation adopted by the board.

6-1    3.  Except as otherwise provided in section 7 of this act or specifically

6-2  authorized by a regulation adopted by the board, a dental hygienist shall

6-3  not provide services to a person unless that person is a patient of the dentist

6-4  who authorized the performance of those services.

6-5    Sec. 14.  NRS 631.313 is hereby amended to read as follows:

6-6    631.313  1.  A licensed dentist may assign to a person in his employ

6-7  who is a dental hygienist, dental assistant or other person directly or

6-8  indirectly involved in the provision of dental care only such intraoral tasks

6-9  as may be permitted by a regulation of the board or by the provisions of

6-10  this chapter.

6-11    2.  The performance of these tasks must be:

6-12    (a) If performed by a dental assistant or a person, other than a dental

6-13  hygienist, who is directly or indirectly involved in the provision of dental

6-14  care, under the supervision of the licensed dentist who made the

6-15  assignment.

6-16    (b) If performed by a dental hygienist, authorized by the licensed dentist

6-17  of the patient for whom the tasks will be performed[.] , except as

6-18  otherwise provided in section 7 of this act.

6-19    3.  No such assignment is permitted that requires:

6-20    (a) The diagnosis, treatment planning, prescribing of drugs or

6-21  medicaments, or authorizing the use of restorative, prosthodontic or

6-22  orthodontic appliances.

6-23    (b) Surgery on hard or soft tissues within the oral cavity or any other

6-24  intraoral procedure that may contribute to or result in an irremediable

6-25  alteration of the oral anatomy.

6-26    (c) The administration of general [anesthetics other than by an

6-27  anesthetist or anesthesiologist licensed in this state.] anesthesia, conscious

6-28  sedation or deep sedation except as otherwise authorized by regulations

6-29  adopted by the board.

6-30    (d) The performance of a task outside the authorized scope of practice

6-31  of the employee who is being assigned the task.

6-32    4.  A dental hygienist may, pursuant to regulations adopted by the

6-33  board, administer local anesthesia or nitrous oxide in a health care facility,

6-34  as defined in NRS 449.800, if:

6-35    (a) He is so authorized by the licensed dentist of the patient to whom the

6-36  local anesthesia or nitrous oxide is administered; and

6-37    (b) The health care facility has licensed medical personnel and

6-38  necessary emergency supplies and equipment available when the local

6-39  anesthesia or nitrous oxide is administered.

6-40    Sec. 15.  NRS 631.346 is hereby amended to read as follows:

6-41    631.346  The following acts, among others, constitute unprofessional

6-42  conduct:

6-43    1.  Employing, directly or indirectly, any student or any suspended or

6-44  unlicensed dentist or dental hygienist to perform operations of any kind to

6-45  treat or correct the teeth or jaws, except as provided in this chapter;

6-46    2.  [Giving] Except as otherwise provided in section 7 of this act,

6-47  giving a public demonstration of methods of practice any place other than

6-48  the office where the licensee is known to be regularly engaged in this

6-49  practice;

7-1    3.  Employing, procuring, inducing, aiding or abetting a person not

7-2  licensed or registered as a dentist to engage in the practice of dentistry, but

7-3  a patient shall not be deemed to be an accomplice, employer, procurer,

7-4  inducer, aider or abettor;

7-5    4.  For a dental hygienist, practicing in any place not authorized [by]

7-6  pursuant to this chapter; or

7-7    5.  Practicing while his license is suspended or without a renewal

7-8  certificate.

7-9    Sec. 16.  Notwithstanding the provisions of sections 2 and 3 of this act:

7-10  1.  The health division shall, not later than October 1, 2001, appoint a

7-11  state dental health officer and a state public health dental hygienist from

7-12  the lists of names submitted by the board of regents of the University of

7-13  Nevada for terms expiring on June 30, 2003. If the board of regents fails to

7-14  submit a list for any position, the health division may appoint any qualified

7-15  person.

7-16  2.  Each person appointed pursuant to subsection 1 shall carry out the

7-17  duties set forth in sections 2 and 3 of this act, without additional

7-18  compensation and using the office, equipment, staff and other resources

7-19  provided to him by the University and Community College System of

7-20  Nevada for his existing position.

7-21  Sec. 17.  This act becomes effective on July 1, 2001.

7-22  H