Date of Hearing: April 21, 2015
Susan Bonilla, Chair
ABPCA Bill Id:AB 880
Author:(Ridley-Thomas) – As Amended Ver:March 26, 2015
SUBJECT: Dentistry: licensure: exempt.
SUMMARY: Authorizes students enrolled in their final year at a California dental school, approved by the Dental Board of California (Board), to participate and treat patients under the supervision of licensed dentists at free clinics.
Establishes the Dental Practice Act (Act), administered by the Dental Board of California (DBC), which is housed in the Department of Consumer Affairs (DCA), to license and regulate the practice of dentistry. (Business and Professions Code (BPC) Section 1600, et seq.)
Prohibits the practice of dentistry unless a person has a valid and unexpired license or special permit from the Board. (BPC Section 1926)
Exempts from that prohibition operations, in dental schools approved by the Board, of bona fide students of dentistry or dental hygiene in the school's clinical departments or laboratories or in a dental extension program. (BPC Section 1926(b))
Provides for the licensure and regulation of clinics by the State Department of Public Health, including primary care clinics, which include community clinics and free clinics. (Health and Safety Code (HSC) Section 1200 et seq.)
Defines a "free clinic" as a clinic operated by a tax-exempt, nonprofit corporation supported in whole or in part by voluntary donations, gifts, grants, government funds or contributions, and where there are no charges directly to the patient for services rendered, as specified. (HSC Section 1204(a))
Additionally exempts from dental licensure requirements the practice of dentistry by a final year student rendered or performed without compensation or expectation of compensation under the supervision of a licensed dentist in a free clinic.
Provides that these additional exemptions only apply to operations, approved by the Board, that are described in the exemption for bona fide dental students under existing law and rendered or performed under the same supervisory conditions.
Defines the following terms:
As defined in Section 1200 of the HSC, "Free clinic" is a clinic where there are no charges directly to the patient for services rendered or for drugs, medicines, appliances, or apparatuses furnished, including, but not limited to, a free clinic as defined in Section 1204 of the HSC;
"Final year student" is a student of dentistry in his or her final year of completion at dental school approved by the Board; and
"Licensed dentist" is a dentist licensed pursuant to the Act.
FISCAL EFFECT: Unknown. This bill is keyed fiscal by the Legislative Counsel.
Purpose. This bill is sponsored by the Oral and Facial Surgeons of California. According to the author, "Regular dental care is extremely important to everyone's health. However in the underserved communities in California, access to regular dental care is almost nonexistent. Since the Medi-Cal and Denti-Cal programs are underutilized, free healthcare and dental clinics are an essential source of dental care for the many members of those same communities. Since existing law already allows dental students to treat patients in clinics on the dental school campuses under supervision, it would follow that these same students should be allowed to treat similar patients, under supervision, in the free health fairs. It is very important to maintain a pool of willing volunteer providers both in the licensed professional community and in the dental schools to provide dental care in underserved communities."
Background. Board-approved dental schools are required to, among other things, have a formal system of quality assurance for their patient care program including standards of patient centered care with a focus on comprehensive care, including measurable assessment criteria and ensures the delivery of comprehensive patient care to individual patients. In addition, schools are required to ensure that students have adequate patient experiences to achieve the institution's stated goals and competencies within a reasonable time. Currently, there are six Board-approved dental schools in California: 1) University of California at San Francisco Dental School, San Francisco; 2) University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco; 3) University of California at Los Angeles School of Dentistry, Los Angeles; 4) Herman Ostrow School of Dentistry of USC, Los Angeles; 5) Loma Linda University School of Dentistry, Loma Linda; and 6)Western University of Health Sciences College of Dental Medicine, Pomona, California. This bill would only apply to dental students at one of these institutions.
Current Exemptions for Student Practice. BPC Section 1626 specifically exempts from licensure requirements, "…operations, in dental schools approved by the board, of bona fide students of dentistry…in the school's clinical departments or laboratories or in a dental extension program approved by the board." Under the California Code of Regulations, there are two types of facilities that may be approved by the Board as an adjunct to, and an extension of, the clinical and laboratory departments of an approved school: 1) an extramural dental facility, and 2) a mobile dental clinic.
An extramural dental facility as defined in 16 CCR 1025 is "…any clinical facility employed by an approved dental school for instruction in dentistry which exists outside or beyond the walls, boundaries or precincts of the primary campus of the approved dental school, and in which dental services are rendered." A mobile dental clinic as defined in 16 CCR 1026 is "…any clinical facility employed by an approved dental school for instruction in dentistry which may be moved, towed or transported from one location to another, and in which dental services are rendered."
Services that are provided by dental students to the public through an extramural dental facility or a mobile dental clinic are required to constitute a part of the dental education program. In addition, approved dental schools are required to register these facilities with the Board, and provide with that registration information relating to: a) faculty supervision; b) scope of treatment to be rendered; c) postoperative care; d) proposed itinerary showing locations by dates, for mobile dental clinics, or the name and location of the facility and date operation will commence, for extramural dental facilities; e) discipline of which such instruction is a part; and f) a brief description of the equipment and facilities available. For extramural dental facilities, the school must also provide a copy of the agreement between the approval dental school, or parent university and the affiliated institution establishing the contractual relationship. Any change in the information initially provided to the Board is required to be communicated to the Board.
According to the sponsor, the intent of the bill is to allow final year dental students to volunteer their services at free health and dental events. Currently, students are not exempt from practicing at those events because those free health care events do not fall under the definition of a mobile dental health clinic or an extramural dental facility. As a result, those health care events currently have no registration or other requirements relating to the standard of care. In addition, unlike extramural dental facilities, which are brick and mortar locations, and mobile dental clinics, which are also self-contained places to provide services, free healthcare events are fleeting and not grounded to any one location.
While existing law permits dental students to treat patients, who are usually eligible for dental services under Medi-Cal's dental program and treated under supervision, in on-campus clinics, mobile dental clinics and at dental extension programs approved by the Board, current law does not allow these same opportunities at health care events. According to the author, the ability to draw final year students to the clinics as dental service providers who work alongside licensed dentists will increase the number of volunteers available to work as these clinics and provide much needed services to underserved communities much needed services.
Current Related Legislation. AB 179 (Bonilla) of the current legislation session, would extend the sunset date of the Board until January 1, 2020. STATUS: This bill is pending in the Assembly Committee on Business and Professions.
Prior Related Legislation. SB 562 (Galgiani), Chapter 624, Statutes of 2013, authorized a dentist to operate more than one mobile dental unit, and required a mobile dental unit or a dental practice that routinely uses portable dental units to register and operate in accordance with the regulations of the Board. The bill also required any regulations adopted by the Board to require the registrant to identify a licensed dentist responsible for the mobile dental unit or portable practice, and to include requirements for availability of follow-up and emergency care, maintenance and availability of provider and patient records, and treatment information to be provided to patients and other appropriate parties.
AB 512 (Rendon), Chapter 111, Statutes of 2013, extended the sunset date for the health care practitioner exemption enacted by AB 2699 (Bass) Chapter 270, Statutes of 2010, until January 1, 2018.
AB 2699 (Bass), Chapter 270, Statutes of 2010, created a four-year exemption, from January 1, 2010, until January 1, 2014, from California licensure for health care practitioners who are licensed or certified in other states and who provide health care services on a voluntary basis to uninsured or underinsured persons in California. That bill allowed an out-of-state healthcare provider to work in California if his or her license is in good standing and he or she receives permission from, and registers with, the appropriate DCA licensing board. The entity sponsoring the free health care event is required to notify the appropriate DCA licensing board and the county health department in writing of the event and maintain a list of its healthcare volunteers.
SB 683 (Aanestad), Chapter 805, Statutes of 2006, further exempted from the prohibition against unlicensed practice of dentistry bona fide students of dentistry or dental hygiene in advanced dental education programs accredited by CODA or a national accrediting body approved by the Board.
SB 1308 (Committee on Business and Professions), Chapter 655, Statutes of 1999, changed the name of the Board of Dental Examiners to the Dental Board of California, and exempted the operations of bona fide students of registered dental assisting, registered dental assisting in extended functions, and registered dental hygiene in extended functions in the clinical departments or the laboratory of an educational program or school approved by the board, including operations by unlicensed students while engaged in clinical externship programs that have been approved by an approved educational program or school, and that are under the general programmatic and academic supervision of that educational program or school.
ARGUMENTS IN SUPPORT:
According to the Oral and Facial Surgeons of California (sponsor), "[This bill] will clarify in statute that students enrolled in their final year of completion at a California dental school approved by the [Board] are permitted to participate and treat patients, under the supervision of licensed dentists, at free healthcare clinics. The association is sponsoring this legislation in order to enhance the pool of volunteer providers at the much needed free healthcare clinics in California's many underserved communities. In addition, by allowing final year students to treat patients under the supervision of licensed dentists, these students will be getting real life healthcare treatment exposure in the EXACT same way that they are currently allowed to practice in on-campus clinics in the California dental schools. It is commonly acknowledged that regular dental care is extremely important to everyone's overall health and well-being. Yet in the all too many undeserved communities that exist in the state, access to regular dental care is almost non-existent….[This bill] goes a long way in increasing the probability that many of the most needy patients will be able [to] be seen and get the dental care they so desperately need."
The California CareForce, a 501(c)(3) that provides free healthcare clinics for the under- and uninsured population, writes in support, "Currently the six approved dental schools in California offer clinics on campus that allow dental students to treat patients who qualify for Medi-Cal or Denti-Cal at reduced fees. The free clinics offer dental care to the most severely underserved communities. The final year students are very capable and uniquely qualified to treat, under supervision of a licensed dentist, most if not all patients who would present at a free clinic. The ability to draw volunteers from these schools ensure that the pool of providers will not evaporate and that they will be fresh and eager to serve the communities."
The Dean of the UCLA School of Dentistry writes in support, "The dental schools are willing partners to be a tremendous resource for community service. Our students are highly motivated in this regard. Our mission statement is: To improve the oral and systemic health of the people of California, the national, and the world through education, research, patient care, and public service."
ARGUMENTS IN OPPOSITION:
None on file.
POLICY ISSUES FOR CONSIDERATION:
The author may consider whether it would be appropriate to allow participation from other levels of dental students, depending on the level of services that student is competently able to provide, as determined by the dental school.
Exemption for student practice at "free clinics." Currently, the bill provides that final year students are exempt from licensure requirements when practicing in a free clinic, under the supervision of a licensed dentist. The bill further defines "free clinic" as a clinic defined under the Health and Safety Code. According to the sponsors, the intent of the bill is to allow students to participate at free health care events. However, the definition of a "free clinic" under the health and safety code does not include these events; instead, it refers to a type of standing primary care clinic. As a result, the author may wish to amend the language to reflect free health care events, or "sponsored events" as defined under AB 2699 (Bass) Chapter 270, Statutes of 2010.
Exemption for operations described in existing exemptions and under the same supervisory conditions. The bill specifies that this practice exemption applies to operations "approved by the Board" and only includes those operations "described in the exemption provided in subdivision (b) of Section 1626 and "rendered or performed under the same supervisory conditions." Because that language makes it appear as if the only operations exempted are those that are already exempt under subdivision (b) of Section 1626, the author may wish to consider revising that language.
In addition, the author may wish to specify that exempt operations must not only be performed under the same supervisory conditions as those provided under the existing exemptions, but that these operations must be provided under all of the same conditions as those provided under the existing exemptions.
For example, regulations for mobile dental clinics and extramural dental facilities require these exempt operations to be a part of the school's dental education program, and require the schools to inform the Board of the following: faculty supervision; scope of treatment to be rendered; postoperative care; information about the event and the sponsoring entity; discipline of which such instruction is a part; and a brief description of the equipment and facilities available. In addition, while the regulations do not appear to specifically refer to patient recordkeeping, patient notification and consent, or liability, dental schools address these issues in the implementation of existing programs. As a result, the author may wish to specify that these exempt operations are required to be provided under the same conditions as existing exemptions, and specify any particular conditions or safeguards, as needed, to ensure adequate consumer protection (e.g., including conditions relating to faculty supervision; patient notification, consent and recordkeeping; liability; scope of practice; requiring the operations to be a part of a school's dental education program).
On page 2, line 6, after "dentist" insert: with a faculty appointment
On page 2, lines 6-7, strike:
in a free clinic and insert: at a sponsored event
On page 2, strike line 10
On page 2, line 11, strike:
On page 2, line 11, strike:
On page 2, line 12, after "conditions" insert: as operations exempt under subdivision (b) of Section 1626
On page 2, strike lines 14-20
On page 2, line 24, add
(3) “Sponsored event” means an event, not to exceed 10 calendar days, administered by either a sponsoring entity or a local government, or both, through which health care is provided to the public without compensation.
(4) “Sponsoring entity” means a nonprofit organization organized pursuant to Section 501(c)(3) of the Internal Revenue Code or a community-based organization.
Oral and Facial Surgeons of California (sponsors)
Dr. No-Hee Park, Dean of the UCLA School of Dentistry
None on file.
Analysis Prepared by: Eunie Linden / B. & P. / (916) 319-3301