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    4.  The health division may solicit and accept gifts and grants to pay

2-12  the costs associated with the position of state dental health officer.

2-13    Sec. 3.  1.  The health division shall appoint a state public health

2-14  dental hygienist, who is in the unclassified service of the state. The state

2-15  public health dental hygienist must:

2-16    (a) Be a resident of this state;

2-17    (b) Hold a current license to practice dental hygiene issued pursuant

2-18  to chapter 631 of NRS with a special endorsement issued pursuant to

2-19  section 7 of this act; and

2-20    (c) Be appointed on the basis of his education, training and

2-21  experience and his interest in public health dental hygiene and related

2-22  programs.

2-23    2.  The state public health dental hygienist:

2-24    (a) Shall assist the state dental health officer in carrying out his

2-25  duties; and

2-26    (b) May:

2-27      (1) Make recommendations to the health division regarding

2-28  programs in this state for public health dental hygiene; and

2-29      (2) Perform any acts authorized pursuant to section 7 of this act.

2-30    3.  Except as otherwise provided in this subsection, the state public

2-31  health dental hygienist shall devote all of his time to the business of his

2-32  office and shall not pursue any other business or vocation or hold any

2-33  other office of profit. Notwithstanding the provisions of NRS 281.127

2-34  and 284.143, the state public health dental hygienist may engage in

2-35  academic instruction, research and studies in a program of the

2-36  University and Community College System of Nevada.

2-37    4.  The health division may solicit and accept gifts and grants to pay

2-38  the costs associated with the position of state public health dental

2-39  hygienist.

2-40    Sec. 3.5  Chapter 396 of NRS is hereby amended by adding thereto a

2-41  new section to read as follows:

2-42    The board of regents may, to the extent that money is available,

2-43  develop the curriculum and standards required for a student in the

2-44  system to earn a bachelor of science degree in dental hygiene or a

2-45  master’s degree in public health dental hygiene.

2-46    Sec. 4.  Chapter 631 of NRS is hereby amended by adding thereto the

2-47  provisions set forth as sections 5, 6 and 7 of this act.

2-48    Sec. 5. “Conscious sedation” means a minimally depressed level of

2-49  consciousness, produced by a pharmacologic or nonpharmacologic

3-1  method or a combination thereof, in which the patient retains the ability

3-2  independently and continuously to maintain an airway and to respond

3-3  appropriately to physical stimulation and verbal commands.

3-4    Sec. 6. “Deep sedation” means a controlled state of depressed

3-5  consciousness, produced by a pharmacologic or nonpharmacologic

3-6  method or a combination thereof, and accompanied by a partial loss of

3-7  protective reflexes and the inability to respond purposefully to verbal

3-8  commands.

3-9    Sec. 7. 1.  The board shall, upon application by a dental hygienist

3-10  who is licensed pursuant to this chapter and has such qualifications as

3-11  the board specifies by regulation, issue a special endorsement of his

3-12  license allowing him to practice public health dental hygiene pursuant to

3-13  subsection 2.

3-14    2.  The state dental health officer may authorize a person who holds a

3-15  special endorsement issued pursuant to subsection 1 to provide or cause

3-16  to be provided such services for the promotion of public health dental

3-17  hygiene as the state dental health officer deems appropriate. Such

3-18  services:

3-19    (a) May be provided at schools, community centers, hospitals, nursing

3-20  homes and such other locations as the state dental health officer deems

3-21  appropriate.

3-22    (b) May not be provided at a dental office that is not operated by a

3-23  public or nonprofit entity.

3-24    Sec. 8. NRS 631.005 is hereby amended to read as follows:

3-25    631.005  As used in this chapter, unless the context otherwise requires,

3-26  the words and terms defined in NRS 631.015 to 631.105, inclusive, and

3-27  sections 5 and 6 of this acthave the meanings ascribed to them in those

3-28  sections.

3-29    Sec. 9. NRS 631.265 is hereby amended to read as follows:

3-30    631.265  1.  No licensed dentist or person who holds a restricted

3-31  license issued pursuant to NRS 631.275 may administer or supervise

3-32  directly the administration of general anesthesia, conscious sedation or

3-33  deep sedation to dental patients unless he has been issued a permit

3-34  authorizing him to do so by the board.

3-35    2.  The board may issue a permit authorizing a licensed dentist or

3-36  person who holds a restricted license issued pursuant to NRS 631.275 to

3-37  administer or supervise directly the administration of general anesthesia,

3-38  conscious sedation or deep sedation to dental patients under such

3-39  standards, conditions and other requirements as the board shall by

3-40  regulation prescribe.

3-41    [3.  As used in this section:

3-42    (a) “Conscious sedation” means a minimally depressed level of

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

3-44  or a combination thereof, in which the patient retains the ability

3-45  independently and continuously to maintain an airway and to respond

3-46  appropriately to physical stimulation and verbal commands.

3-47    (b) “Deep sedation” means a controlled state of depressed

3-48  consciousness, produced by a pharmacologic or nonpharmacologic method

4-1  or a combination thereof, and accompanied by a partial loss of protective

4-2  reflexes and the inability to respond purposefully to verbal commands.]

4-3    Sec. 10. NRS 631.275 is hereby amended to read as follows:

4-4    631.275  1.  Except as otherwise provided in subsection 2, the board

4-5  shall, without examination, issue a restricted license to practice dentistry to

4-6  a person who:

4-7    (a) Has a valid license to practice dentistry issued pursuant to the laws

4-8  of another state or the District of Columbia;

4-9    (b) Has received a degree from a dental school or college accredited by

4-10  the [American Dental Association] Commission on Dental Accreditation

4-11  [,] of the American Dental Association or its successor organization; and

4-12    (c) Has entered into a contract with a facility approved by the health

4-13  division of the department of human resources to provide publicly funded

4-14  dental services exclusively to persons of low income for the duration of the

4-15  restricted license.

4-16    2.  The board shall not issue a restricted license to a person:

4-17    (a) Who has failed to pass the examination of the board;

4-18    (b) Who has been refused a license in this state, another state or territory

4-19  of the United States or the District of Columbia; or

4-20    (c) Whose license to practice dentistry has been revoked in this state,

4-21  another state or territory of the United States or the District of Columbia.

4-22    3.  A person to whom a restricted license is issued pursuant to

4-23  subsection 1:

4-24    (a) May perform dental services only:

4-25      (1) Under the general supervision of the state dental health officer

4-26  or the supervision of a dentist who is licensed to practice dentistry in this

4-27  state and appointed by the health division of the department of human

4-28  resources to supervise dental care that is provided in a facility which has

4-29  entered into a contract with the person to whom a restricted license is

4-30  issued and which is approved by the health division ; [of the department;]

4-31  and

4-32      (2) In accordance with the contract required pursuant to paragraph (c)

4-33  of that subsection.

4-34    (b) Shall not, for the duration of the restricted license, engage in the

4-35  private practice of dentistry, which includes, without limitation, providing

4-36  dental services to a person who pays for the services.

4-37    4.  A person who receives a restricted license must pass the

4-38  examination of the board within 3 years after receiving his restricted

4-39  license. If the person fails to pass that examination, the board shall revoke

4-40  the restricted license.

4-41    5.  The board may revoke a restricted license at any time.

4-42    Sec. 11. NRS 631.290 is hereby amended to read as follows:

4-43    631.290  1.  Any person is eligible to take an examination for a

4-44  license to practice dental hygiene in this state who:

4-45    (a) Is of good moral character;

4-46    (b) Is over 18 years of age;

4-47    (c) Is a citizen of the United States or is lawfully entitled to remain and

4-48  work in the United States; and

5-1    (d) Is a graduate of [an accredited] a school of dental hygiene [.] or

5-2  other institution that awards at least an associate degree upon

5-3  completion of the program and that is accredited by a regional

5-4  educational accrediting organization that is recognized by the United

5-5  States Department of Education. The program of dental hygiene must:

5-6       (1) Be accredited by the Commission on Dental Accreditation of the

5-7  American Dental Association or its successor specialty accrediting

5-8  organization; and

5-9       (2) Include a curriculum of not less than 2 years of academic

5-10  instruction in dental hygiene or its academic equivalent.

5-11    2.  To determine whether a person has good moral character the board

5-12  may consider whether his license to practice dental hygiene in another state

5-13  has been suspended or revoked or whether he is currently involved in any

5-14  disciplinary action concerning his license in that state.

5-15    Sec. 12. (Deleted by amendment.)

5-16    Sec. 13.  NRS 631.310 is hereby amended to read as follows:

5-17    631.310  1.  Except as otherwise provided in NRS 631.271[,] and

5-18  section 7 of this act, the holder of a license or renewal certificate to

5-19  practice dental hygiene may practice dental hygiene in this state in the

5-20  following places:

5-21    (a) In the office of any licensed dentist.

5-22    (b) In a clinic or in clinics in the public schools of this state as an

5-23  employee of the health division of the department of human resources.

5-24    (c) In a clinic or in clinics in a state institution as an employee of the

5-25  institution.

5-26    (d) In a clinic established by a hospital approved by the board as an

5-27  employee of the hospital where service is rendered only to patients of the

5-28  hospital, and upon the authorization of a member of the dental staff.

5-29    (e) In an accredited school of dental hygiene.

5-30    (f) In other places if specified in a regulation adopted by the board.

5-31    2.  A dental hygienist may perform only the services which are

5-32  authorized by a dentist licensed in the State of Nevada, unless otherwise

5-33  provided in a regulation adopted by the board.

5-34    3.  Except as otherwise provided in section 7 of this act or specifically

5-35  authorized by a regulation adopted by the board, a dental hygienist shall

5-36  not provide services to a person unless that person is a patient of the dentist

5-37  who authorized the performance of those services.

5-38    Sec. 14.  NRS 631.313 is hereby amended to read as follows:

5-39    631.313  1.  A licensed dentist may assign to a person in his employ

5-40  who is a dental hygienist, dental assistant or other person directly or

5-41  indirectly involved in the provision of dental care only such intraoral tasks

5-42  as may be permitted by a regulation of the board or by the provisions of

5-43  this chapter.

5-44    2.  The performance of these tasks must be:

5-45    (a) If performed by a dental assistant or a person, other than a dental

5-46  hygienist, who is directly or indirectly involved in the provision of dental

5-47  care, under the supervision of the licensed dentist who made the

5-48  assignment.

6-1    (b) If performed by a dental hygienist, authorized by the licensed dentist

6-2  of the patient for whom the tasks will be performed[.] , except as

6-3  otherwise provided in section 7 of this act.

6-4    3.  No such assignment is permitted that requires:

6-5    (a) The diagnosis, treatment planning, prescribing of drugs or

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

6-7  orthodontic appliances.

6-8    (b) Surgery on hard or soft tissues within the oral cavity or any other

6-9  intraoral procedure that may contribute to or result in an irremediable

6-10  alteration of the oral anatomy.

6-11    (c) The administration of general [anesthetics other than by an

6-12  anesthetist or anesthesiologist licensed in this state.] anesthesia, conscious

6-13  sedation or deep sedation except as otherwise authorized by regulations

6-14  adopted by the board.

6-15    (d) The performance of a task outside the authorized scope of practice

6-16  of the employee who is being assigned the task.

6-17    4.  A dental hygienist may, pursuant to regulations adopted by the

6-18  board, administer local anesthesia or nitrous oxide in a health care facility,

6-19  as defined in NRS 449.800, if:

6-20    (a) He is so authorized by the licensed dentist of the patient to whom the

6-21  local anesthesia or nitrous oxide is administered; and

6-22    (b) The health care facility has licensed medical personnel and

6-23  necessary emergency supplies and equipment available when the local

6-24  anesthesia or nitrous oxide is administered.

6-25    Sec. 15.  NRS 631.346 is hereby amended to read as follows:

6-26    631.346  The following acts, among others, constitute unprofessional

6-27  conduct:

6-28    1.  Employing, directly or indirectly, any student or any suspended or

6-29  unlicensed dentist or dental hygienist to perform operations of any kind to

6-30  treat or correct the teeth or jaws, except as provided in this chapter;

6-31    2.  [Giving] Except as otherwise provided in section 7 of this act,

6-32  giving a public demonstration of methods of practice any place other than

6-33  the office where the licensee is known to be regularly engaged in this

6-34  practice;

6-35    3.  Employing, procuring, inducing, aiding or abetting a person not

6-36  licensed or registered as a dentist to engage in the practice of dentistry, but

6-37  a patient shall not be deemed to be an accomplice, employer, procurer,

6-38  inducer, aider or abettor;

6-39    4.  For a dental hygienist, practicing in any place not authorized [by]

6-40  pursuant to this chapter; or

6-41    5.  Practicing while his license is suspended or without a renewal

6-42  certificate.

6-43    Sec. 16.  Section 7.5 of Senate Bill No. 133 of this session is hereby

6-44  amended to read as follows:

6-45    Sec. 7.5  NRS 631.290 is hereby amended to read as follows:

6-46     631.290  1.  Any person is eligible to [take an examination]

6-47  apply for a license to practice dental hygiene in this state who:

6-48    (a) Is of good moral character;

6-49    (b) Is over 18 years of age;

7-1    (c) Is a citizen of the United States or is lawfully entitled to remain

7-2  and work in the United States; and

7-3    (d) Is a graduate of a school of dental hygiene or other institution

7-4  that awards at least an associate degree upon completion of the

7-5  program and that is accredited by a regional educational accrediting

7-6  organization that is recognized by the United States Department of

7-7  Education. The program of dental hygiene must:

7-8       (1) Be accredited by the Commission on Dental Accreditation of

7-9  the American Dental Association or its successor specialty accrediting

7-10  organization; and

7-11      (2) Include a curriculum of not less than 2 years of academic

7-12  instruction in dental hygiene or its academic equivalent.

7-13    2.  To determine whether a person has good moral character , the

7-14  board may consider whether his license to practice dental hygiene in

7-15  another state has been suspended or revoked or whether he is

7-16  currently involved in any disciplinary action concerning his license in

7-17  that state.

7-18    Sec. 17.  Notwithstanding the provisions of sections 2 and 3 of this act,

7-19  for the fiscal years 2001-2002 and 2002-2003:

7-20    1.  The health division may, in lieu of complying with the provisions of

7-21  sections 2 and 3 of this act, appoint a state dental health officer and a state

7-22  public health dental hygienist from the lists of names submitted by the

7-23  board of regents of the University of Nevada for terms expiring on June 30,

7-24  2003. If the board of regents fails to submit a list for any position, the

7-25  health division may appoint any qualified person.

7-26    2.  Unless the health division provides otherwise, each person

7-27  appointed pursuant to subsection 1 shall carry out the duties set forth in

7-28  sections 2 and 3 of this act without additional compensation and using the

7-29  office, equipment, staff and other resources provided to him by the

7-30  University and Community College System of Nevada for his existing

7-31  position.

7-32    Sec. 18.  This act becomes effective on July 1, 2001.

7-33  H