The State Board of Dental Examiners (Board) adopts new rule 22 TAC §110.16, concerning Sedation/Anesthesia of High-Risk Patients. This new rule is being adopted without changes to the proposed text as published in the June 22, 2018, issue of the Texas Register (43 TexReg 4008), and the rule will not be republished. This new rule will require dentists to undergo additional didactic and clinical training prior to providing levels 2, 3, or 4 sedation/anesthesia to high-risk patients. This new rule is being adopted to comply with the requirements of Senate Bill 313 (S.B. 313) from the 85th regular session of the Texas Legislature.

The Board received three timely comments regarding the adopt of this rule.

The Texas Society of Anesthesiologists submitted a comment requesting the Board add "ASA classifications are defined as the most recently adopted American Society of Anesthesiologists physical status classification system available on their website" to the definition of ASA classifications under subsection (b). The Board disagrees with this comment. Utilizing a reference to a website that is not controlled by the Board for a standard to be applied by rule would create confusion and uncertainty about the standards being applied. Instead, the Board will regularly ensure that the definition is reviewed and updated as a result of ASA classification changes through the rule review and amendment process.

The Texas Academy of General Dentists submitted a comment requesting the Board consider an "alternative path to compliance for experienced Level 2-4 permit holders who may not have completed a university residency but have a proven track record of safely providing sedation/anesthesia to pediatric and high risk patients." The comment notes that Senate Bill 313 does not mandate a specific level of additional training, and some recognition should be given to previous training and clinical experience. The comment also notes that the September 1, 2019, compliance deadline may adversely impact access to care. After consideration, the Board disagrees with this comment. The requirements of Texas Occupations Code §258.1554(a)(1) require an applicant to "demonstrate[d] to the satisfaction of the board that the permit holder has advanced didactic and clinical training." This language does not contemplate a recognition of previous experience gained from a track record of performing successful anesthesia. Regarding previous education, the Board has determined that the advanced training required to safely administer sedation/anesthesia to these patients must comply with the requirements of the new rule being adopted. After extensive review, the Board does not believe existing educational courses outside a residency-based education provide the comprehensive training needed. In order to protect public safety, the Board must ensure that all practitioners meet these standards before administration of sedation/anesthesia. In order to facilitate a period of phase-in compliance, the Board has adopted September 1, 2019, as the deadline for this training. While any deadline for compliance will likely have some impact on access to patient care, the Board has determined that this additional year for compliance ensures a balance of protection for the Texas public and time for compliance from non-residency trained practitioners.

BresnenAssociates submitted a comment on behalf of the Association of Dental Support Organizations, generally in support of the rule as written, but proposing that Board staff utilize the time between adoption and the implementation date of September 1, 2019, to analyze methods to understand the possible reduction in access to patient care from the rule's impacts. This comment does not request a change to the rule, but the Board agrees and acknowledges the importance of protecting public access to care, and has directed Board staff to ensure impacts are analyzed and policies are crafted to protect the interests of the Texas public.

This rule is adopted under Texas Occupations Code §254.001(a), which gives the Board authority to adopt rules necessary to perform its duties and ensure compliance with state laws relating to the practice of dentistry to protect the public health and safety, and Texas Occupations Code §258.1554(b), which authorizes the Board to establish limitations on the administration of anesthesia by a permit holder to a pediatric or high-risk patient.