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Senate Bill No. 580
(By Senator Stollings)
____________
[Introduced March 20, 2013; referred to the Committee on Health
and Human Resources; and then to the Committee on Government
Organization .]
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A BILL to repeal §30-4-8a, §30-4-10a, §30-4-25, §30-4-26, §30-4-27,
§30-4-28 and §30-4-29 of the Code of West Virginia, 1931, as
amended; to repeal §30-4A-6a, §30-4A-6b, §30-4A-6c, §30-4A-6d
and §30-4A-18 of said code; to repeal §30-4B-5, §30-4B-6, §30-
4B-7 and §30-4B-8 of said code; to amend and reenact §30-4-1,
§30-4-2, §30-4-3, §30-4-4, §30-4-5, §30-4-6, §30-4-7, §30-4-8,
§30-4-9, §30-4-10, §30-4-11, §30-4-12, §30-4-13, §30-4-14,
§30-4-15, §30-4-16, §30-4-17, §30-4-18, §30-4-19, §30-4-20,
§30-4-21, §30-4-22, §30-4-23 and §30-4-24 of said code; to
amend and reenact §30-4A-1, §30-4A-2, §30-4A-3, §30-4A-4, §30-
4A-5, §30-4A-6, §30-4A-7, §30-4A-8, §30-4A-9, §30-4A-10, §30-
4A-11, §30-4A-12, §30-4A-13, §30-4A-14, §30-4A-15, §30-4A-16
and §30-4A-17 of said code; and to amend and reenact §30-4B-1, §30-4B-2, §30-4B-3 and §30-4B-4 of said code, all relating to
the practice of dentistry; prohibiting the practice of
dentistry without a license; providing other applicable
sections; providing definitions; providing for board
composition; setting forth the powers and duties of the board;
clarifying rule-making authority; continuing a special revenue
account; establishing license, certification and permit
requirements; creating a scope of practice; creating a
temporary permit; establishing renewal requirements; providing
for exemptions from licensure; providing requirements for the
display of a board authorization; permitting the board to file
an injunction; setting forth grounds for disciplinary actions;
allowing for specific disciplinary actions; providing
procedures for investigation of complaints; providing for
judicial review and appeals of decisions; setting forth
hearing and notice requirements; providing for civil causes of
action; providing criminal penalties; and updating references.
Be it enacted by the Legislature of West Virginia:
That §30-4-8a, §30-4-10a, §30-4-25, §30-4-26, §30-4-27, §30-4-
28 and §30-4-29 of the Code of West Virginia, 1931, as amended, be
repealed; that §30-4A-6a, §30-4A-6b, §30-4A-6c and §30-4A-6d and
§30-4A-18 of said code be repealed; that §30-4B-5, §30-4B-6, §30-
4B-7 and §30-4B-8 of said code be repealed; that §30-4-1, §30-4-2, §30-4-3, §30-4-4, §30-4-5, §30-4-6, §30-4-7, §30-4-8, §30-4-9, §30-
4-10, §30-4-11, §30-4-12, §30-4-13, §30-4-14, §30-4-15, §30-4-16,
§30-4-17, §30-4-18, §30-4-19, §30-4-20, §30-4-21, §30-4-22, §30-4-
23 and §30-4-24 of said code be amended and reenacted; that §30-4A-
1, §30-4A-2, §30-4A-3, §30-4A-4, §30-4A-5, §30-4A-6, §30-4A-7, §30-
4A-8, §30-4A-9, §30-4A-10, §30-4A-11, §30-4A-12, §30-4A-13, §30-4A-
14, §30-4A-15, §30-4A-16 and §30-4A-17 of said code be amended and
reenacted; and that §30-4B-1, §30-4B-2, §30-4B-3 and §30-4B-4 of
said code be amended and reenacted, all to read as follows:
ARTICLE 4. WEST VIRGINIA DENTAL PRACTICE ACT.
§30-4-1. Unlawful acts.
(a) It is unlawful for any person to practice or offer to
practice dentistry or dental hygiene in this state without a
license, issued under the provisions of this article, or advertise
or use any title or description tending to convey or give the
impression that they are a dentist or dental hygienist, unless the
person is licensed under the provisions of this article.
(b) A business entity may not render any service or engage in
any activity which, if rendered or engaged in by an individual,
would constitute the practice of dentistry, except through a
licensee.
§30-4-2. Applicable law.
The practices authorized under the provisions of this article and the board of Dentistry are subject to article one of this
chapter, the provisions of this article, and any rules promulgated
hereunder.
§30-4-3. Definitions.
As used in article four, four-a and four-b, the following
words and terms have the following meanings:
(1) "AAOMS" means the American Association of Oral and
Maxillofacial Surgeons;
(2) "AAPD" means the American Academy of Pediatric Dentistry;
(3) "ACLS" means Advanced Cardiac Life Support;
(4) "ADA" means the American Dental Association;
(5) "AMA" means the American Medical Association;
(6) "ASA" means American Society of Anesthesiologists;
(7)"Anxiolysis(anxiety-free)/minimal sedation" or
premedication for anxiety - means removing, eliminating or
decreasing anxiety by the use of a single anxiety or analgesia
medication that is administered in an amount consistent with the
manufacturer's current recommended dosage for the unsupervised
treatment of anxiety, insomnia or pain, in conjunction with nitrous
oxide and oxygen. This does not include multiple dosing or
exceeding current normal dosage limits set by the manufacturer for
unsupervised use by the patient (at home), for the treatment of
anxiety;
(8) "Approved dental hygiene program" means a program that is
approved by the board and is accredited or its educational
standards are deemed by the board to be substantially equivalent to
those required by the Commission on Dental Accreditation of the
American Dental Association;
(9) "Approved dental school, college or dental department of
a university" means a dental school, college or dental department
of a university that is approved by the board and is accredited or
its educational standards are deemed by the board to be
substantially equivalent to those required by the Commission on
Dental Accreditation of the American Dental Association;
(10) "Authorize" means that the dentist is giving permission
or approval to dental auxiliary personnel to perform delegated
procedures in accordance with the dentist's diagnosis and treatment
plan;
(11) "BLS" means Basic Life Support;
(12) "Board" means the West Virginia Board of Dentistry;
(13) "Business entity" means any firm, partnership,
association, company, corporation, limited partnership, limited
liability company or other entity;
(14) "Central Nervous System Anesthesia" means an induced
controlled state of unconsciousness or depressed consciousness
produced by a pharmacologic method;
(15) "Certificate of qualification" means a certificate
authorizing a dentist to practice a specialty;
(16) "CPR" means Cardiopulmonary Resuscitation;
(17) "Conscious sedation/Moderate sedation" means an induced
controlled state of depressed consciousness, produced through the
administration of nitrous oxide and oxygen and/or the
administration of other agents whether enteral or parenteral, in
which the patient retains the ability to independently and
continuously maintain an airway and to respond purposefully to
physical stimulation and to verbal command;
(18) "CRNA" means Certified Registered Nurse Anesthetist;
(19) "Delegated procedures" means those procedures specified
by law or by rule of the board and performed by dental auxiliary
personnel under the supervision of a licensed dentist;
(20) "Dentist Anesthesiologist" means a dentist who is trained
in the practice of anesthesiology and has completed an additional
approved anesthesia education course;
(21) "Dental assistant" means a person qualified by education,
training or experience who aids or assists a dentist in the
delivery of patient care in accordance with delegated procedures as
specified by the board by rule or who may perform nonclinical
duties in the dental office;
(22) "Dental auxiliary personnel" or "auxiliary" means dental hygienists and dental assistants who assist the dentist in the
practice of dentistry;
(23) "Dental Hygiene" means the performance of educational,
preventive or therapeutic dental services and as further provided
in section nine and legislative rule;
(24) "Dental hygienist" means a person licensed by the board
to practice provides dental hygiene and other services as specified
by the board by rule to patients in the dental office and in a
public health setting;
(25) "Dental laboratory" means a business performing dental
laboratory services;
(26) "Dental laboratory services" means the fabricating,
repairing or altering of a dental prosthesis;
(27) "Dental laboratory technician" means a person qualified
by education, training or experience who has completed a dental
laboratory technology education program and who fabricates, repairs
or alters a dental prosthesis in accordance with a dentist's work
authorization;
(28) "Dental office" means the place where the licensed
dentist and dental auxiliary personnel are practicing dentistry;
(29) "Dental prosthesis" means an artificial appliance
fabricated to replace one or more teeth or other oral or peri-oral
structure in order to restore or alter function or aesthetics;
(30) "Dentist" means an individual licensed by the board to
practice dentistry;
(31) "Dentistry" means the evaluation, diagnosis, prevention
and treatment of diseases, disorders and conditions of the oral
cavity, maxillofacial area and the adjacent and associated
structures provided by a dentist;
(32) "Direct supervision" means supervision of dental
auxiliary personnel provided by a licensed dentist who is
physically present in the dental office or treatment facility when
procedures are being performed;
(33) "Facility Permit" means a permit for a facility where
sedation procedures are used that correspond with the level of
anesthesia provided;
(34) "General anesthesia" means an induced controlled state of
unconsciousness in which the patient experiences complete loss of
protective reflexes, as evidenced by the inability to independently
maintain an airway, the inability to respond purposefully to
physical stimulation, or the inability to respond purposefully to
verbal command. "Deep conscious sedation/general anesthesia"
includes partial loss of protective reflexes and the patient
retains the ability to independently and continuously maintain an
airway;
(35) "General supervision" means a dentist is not required to be in the office or treatment facility when procedures are being
performed by the auxiliary dental personnel, but has personally
diagnosed the condition to be treated, has personally authorized
the procedures and will evaluate the treatment provided by the
dental auxiliary personnel;
(36) "Good moral character" means a lack of history of
dishonesty;
(37) "Health Care Provider BLS/CPR" means Health Care Provider
Basic Life Support/Cardiopulmonary Resuscitation;
(38) "License" means a license to practice dentistry or dental
hygiene;
(39) "Licensee" means a person holding a license;
(40) "Mobile Dental Facility" any self-contained facility in
which dentistry or dental hygiene will be practiced which may be
moved, towed, or transported from one location to another;
(41) "Other dental practitioner" means those persons excluded
from the definition of the practice of dentistry under the
provisions of subsections (3), (4) and (5), section twenty-nine of
this article and also those persons who hold teaching permits which
have been issued to them under the provisions of section fourteen
of this article;
(42) "PALS" means Pediatric Advanced Life Support;
(43) "Pediatric Patient" means infants and children;
(44) "Physician Anesthesiologist" means a physician, MD or DO,
who is specialized in the practice of anesthesiology;
(45) "Portable Dental Unit" any nonfacility in which dental
equipment, utilized in the practice of dentistry, is transported to
and utilized on a temporary basis an out-of-office location,
including, but not limited to, patient's homes, schools, nursing
homes, or other institutions;
(46) "Public health practice" means treatment or procedures in
a public health setting which shall be designated by a rule
promulgated by the board to require direct, general or no
supervision of a dental hygienist by a dentist;
(47) "Public health setting" means hospitals, schools,
correctional facilities, jails, community clinics, long-term care
facilities, nursing homes, home health agencies, group homes, state
institutions under the West Virginia Department of Health and Human
Resources, public health facilities, homebound settings, accredited
dental hygiene education programs and any other place designated by
the board by rule;
(48) "Qualified Monitor" means an individual who by virtue of
credentialing and/or training checks closely and documents the
status of a patient undergoing anesthesia and observes utilized
equipment;
(49) "Relative analgesia/minimal sedation" means an induced controlled state of minimally depressed consciousness, produced
solely by the inhalation of a combination of nitrous oxide and
oxygen, or single oral premedication without the addition of
nitrous oxide and oxygen in which the patient retains the ability
to independently and continuously maintain an airway and to respond
purposefully to physical stimulation and to verbal command. Dosage
of oral premedication is not to exceed the recommended dosage
limits set by the manufacturer for the treatment of anxiety,
insomnia or pain;
(50) "Specialty" means the practice of a certain branch of
dentistry;
(51) "Subcommittee" means West Virginia Board of Dentistry
Subcommittee on Anesthesia;
(52) "Work authorization" means a written order for dental
laboratory services which has been issued by a licensed dentist or
other dental practitioner.
§30-4-4. Board of dental examiners.
(a) The "West Virginia Board of Dental Examiners" is continued
and on July 1, 2013, the board shall be renamed the "West Virginia
Board of Dentistry". The members of the board in office on the date
this section takes effect shall, unless sooner removed, continue to
serve until their respective terms expire and until their
successors have been appointed and qualified.
(b) The Governor, by and with the advice and consent of the
Senate, shall appoint:
(1) Six licensed dentists;
(2) One licensed dental hygienist;
(3) One nationally certified dental assistant or currently
practicing dental assistant with a minimum of ten years experience
and;
(4) One citizen member who is not licensed under the
provisions of this article and does not perform any services
related to the practice of dentistry.
(c) The West Virginia Dental Association may submit
recommendations to the Governor for the appointment of the licensed
dentists board members, the West Virginia Association of Dental
Hygienists may submit recommendations to the Governor for the
appointment of a Dental Hygienist board member, and the West
Virginia Dental Assistant Association may submit recommendations to
the Governor for the appointment of an Dental Assistant board
member.
(d) A person connected with a commercial entity that may
derive financial gain from the profession of dentistry and a person
employed as full-time faculty with a dental college, school or
dental department of a university are not eligible for appointment
to the board.
(e) After the initial appointment term, the appointment term
is five years. A member may not serve more than two consecutive
terms. A member who has served two consecutive full terms may not
be reappointed for at least one year after completion of his or her
second full term. A member may continue to serve until his or her
successor has been appointed and qualified.
(f) Each licensed member of the board, at the time of his or
her appointment, shall have held a license in this state for a
period of not less than five years immediately preceding the
appointment.
(g) Each member of the board shall be a resident of this state
during the appointment term.
(h) A vacancy on the board shall be filled by appointment by
the Governor for the unexpired term of the member whose office is
vacant.
(i) The Governor may remove any member from the board for
neglect of duty, incompetency or official misconduct.
(j) A licensed member of the board immediately and
automatically forfeits membership to the board if his or her
license to practice is suspended or revoked in any jurisdiction.
(k) A member of the board immediately and automatically
forfeits membership to the board if he or she is convicted of a
felony under the laws of any jurisdiction or becomes a nonresident of this state.
(l) The board shall elect annually one of its members as
president and one member as secretary who shall serve at the will
and pleasure of the board.
(m) Each member of the board is entitled to receive
compensation and expense reimbursement in accordance with article
one of this chapter.
(n) A simple majority of the membership serving on the board
at a given time is a quorum for the transaction of business.
(o) The board shall hold at least two meetings annually.
Other meetings shall be held at the call of the president or upon
the written request of four members, at the time and place as
designated in the call or request.
(p) Prior to commencing his or her duties as a member of the
board, each member shall take and subscribe to the oath required by
section five, article four of the Constitution of this state.
(q) The members of the board when acting in good faith and
without malice shall enjoy immunity from individual civil liability
while acting within the scope of their duties as board members.
§30-4-5. Powers of the board.
The board has all the powers and duties set forth in this
article, by rule, in article one of this chapter and elsewhere
in law, including:
(1) Hold meetings;
(2) Establish procedures for submitting, approving and
rejecting applications for a license, certificate and permit;
(3) Determine the qualifications of any applicant for a
license, certificate and permit;
(4) Establish the fees charged under the provisions of this
article;
(5) Issue, renew, deny, suspend, revoke or reinstate a
license, certificate and permit;
(6) Prepare, conduct, administer and grade written, oral or
written and oral examinations for a license;
(7) Contract with third parties to administer the
examinations required under the provisions of this article;
(8) Maintain records of the examinations the board or a
third party administers, including the number of persons taking
the examination and the pass and fail rate;
(9) Maintain an office, and hire, discharge, establish the
job requirements and fix the compensation of employees and
contract with persons necessary to enforce the provisions of
this article.
(10) Employ investigators, attorneys, hearing examiners,
consultants and other employees as may be necessary, who are
exempt from the classified service and who serve at the will and pleasure of the board.
(11) Investigate alleged violations of the provisions of
this article, article four-a and article four-b of this chapter,
legislative rule, orders and final decisions of the board;
(12) Conduct disciplinary hearings of persons regulated by
the board;
(13) Determine disciplinary action and issue orders;
(14) Institute appropriate legal action for the enforcement
of the provisions of this article;
(15) Maintain an accurate registry of names and addresses
of all persons regulated by the board;
(16) Keep accurate and complete records of its proceedings,
and certify the same as may be necessary and appropriate;
(17) Propose rules in accordance with the provisions of
article three, chapter twenty-nine-a of this code to implement
the provisions of this article;
(18) Sue and be sued in its official name as an agency of
this state; and
(19) Confer with the Attorney General or his or her
assistant in connection with legal matters and questions.
§30-4-6. Rule-making authority.
(a) The board shall propose rules for legislative approval,
in accordance with the provisions of article three, chapter twenty-nine-a of this code, to implement the provisions of this
article, and articles four-a and four-b of this chapter
including:
(1) Standards and requirements for licenses, certifications
and permits;
(2) Requirements for third parties to prepare and/or
administer examinations and reexaminations;
(3) Educational and experience requirements;
(4) Continuing education requirements and approval of
continuing education courses;
(5) Procedures for the issuance and renewal of licenses,
certifications and permits;
(6) Establish a fee schedule;
(7) Regulate dental specialities;
(8) Delegate procedures to be performed by a dental
hygienist;
(9) Delegate procedures to be performed by a dental
assistant;
(10) Designate the services and procedures performed under
direct supervision, general supervision in public health
practice;
(11) Designate additional public health settings;
(12) Regulate the use of firm or trade names;
(13) Regulate dental corporations;
(14) Regulate professional limited liability companies;
(15) Establish professional conduct requirements;
(16) Establish the procedures for denying, suspending,
revoking, reinstating or limiting the practice of licensees,
certifications and permitees;
(17) Establish requirements for inactive or revoked
licenses, certifications and permits;
(18) Regulate dental anesthesia, including:
(A) Fees;
(B) Evaluations;
(C) Equipment;
(D) Emergency Drugs;
(E) Definitions;
(F) Qualified Monitor Requirements; and
(G) Education;
(19) Any other rules necessary to implement this article.
(b) All of the board's rules in effect and not in conflict
with these provisions, shall remain in effect until they are
amended or rescinded.
§30-4-7. Fees; special revenue account; administrative fines.
(a) All fees and other moneys, except administrative fines,
received by the board shall be deposited in a separate special revenue fund in the State Treasury designated the "Board of
Dentists and Dental Hygienist Special Fund", which is continued
and shall be known as the "Board of Dentistry Special Fund". The
fund is used by the board for the administration of this
article. Except as may be provided in article one of this
chapter, the board retains the amount in the special revenue
account from year to year. No compensation or expense incurred
under this article is a charge against the General Revenue Fund.
(b) Any amounts received as administrative fines imposed
pursuant to this article shall be deposited into the General
Revenue Fund of the State Treasury.
§30-4-8. License to practice dentistry.
(a) The board shall issue a license to practice dentistry
to an applicant who meets the following requirements:
(1) Is at least eighteen years of age;
(2) Is of good moral character;
(3) Is a graduate of and has a diploma from a Commission on
Dental Accreditation or equivalent approved dental college,
school or dental department of a university;
(4) Has passed the National Board examination as given by
the Joint Commission on National Dental Examinations and a
clinical board as specified by the board by rule;
(5) Has not been found guilty of cheating, deception or fraud in the examination or any part of the application;
(6) Has paid the application fee specified by rule; and
(7) Not be an alcohol or drug abuser, as these terms are
defined in section eleven, article one-a, chapter twenty-seven
of this code: Provided, That an applicant in an active recovery
process, which may, in the discretion of the board, be evidenced
by participation in a twelve-step program or other similar group
or process, may be considered.
(b) A dentist may not represent to the public that he or
she is a specialist in any branch of dentistry or limit his or
her practice to any branch of dentistry unless first issued a
certificate of qualification in that branch of dentistry by the
board.
(c) A license to practice dentistry issued by the board
shall for all purposes be considered a license issued under this
section: Provided, That a person holding a license shall renew
the license.
§30-4-9. Scope of practice of a dentist.
The practice of dentistry includes the following:
(1) Coordinate dental services to meet the oral health
needs of the patient;
(2) Examine, evaluate and diagnose diseases, disorders and
conditions of the oral cavity, maxillofacial area and adjacent and associated structures;
(3) Treat diseases, disorders and conditions of the oral
cavity, maxillofacial area and the adjacent and associated
structures;
(4) Provide services to prevent diseases, disorders and
conditions of the oral cavity, maxillofacial area and the
adjacent and associated structures;
(5) Fabricate, repair or alter a dental prosthesis;
(6) Administer anesthesia in accordance with the provisions
of article four-a of this chapter;
(7) Prescribe drugs necessary for the practice of
dentistry;
(8) Execute and sign a death certificate when it is
required in the practice of dentistry;
(9) Employ and supervise dental auxiliary personnel;
(10) Authorize delegated procedures to be performed by
dental auxiliary personnel; and
(11) Perform any other work included in the curriculum of
an approved dental school, college or dental department of a
university.
§30-4-10. License to practice dental hygiene.
(a) The board shall issue a dental hygienist license to an
applicant who meets the following requirements:
(1) Is at least eighteen years of age;
(2) Is of good moral character;
(3) Is a graduate with a degree in dental hygiene from an
approved dental hygiene program of a college, school or dental
department of a university;
(4) Has passed the national board dental hygiene
examination, a regional or state clinical examination and a
state law examination that tests the applicant's knowledge of
subjects specified by the board by rule;
(5) Has not been found guilty of cheating, deception or
fraud in the examination or any part of the application;
(6) Has paid the application fee specified by rule; and
(7) Not be an alcohol or drug abuser, as these terms are
defined in section eleven, article one-a, chapter twenty-seven
of this code: Provided, That an applicant in an active recovery
process, which may, in the discretion of the board, be evidenced
by participation in a twelve-step program or other similar group
or process, may be considered.
(b) A dental hygienist license issued by the board shall
for all purposes be considered a dental hygienist license issued
under this section: Provided, That a person holding a dental
hygienist license shall renew the license.
§30-4-11. Scope of practice for a dental hygienist. The practice of dental hygiene includes the following:
(1) Perform a complete prophylaxis, including the removal
of any deposit, accretion or stain from supra and subgingival,
the surface of a tooth or a restoration;
(2) Apply a medicinal agent to a tooth for a prophylactic
purpose;
(3) Take a radiograph for interpretation by a dentist;
(4) Instruct a patient on proper oral hygiene practice;
(5) Place sealants on a patient's teeth without a prior
examination by a licensed dentist: Provided, That for this
subdivision, the dental hygienist has a public health practice
permit issued by the board, and subject to a collaborative
agreement with a supervising dentist and the patient is referred
for a dental examination within six months of sealant
application;
(6) Perform all delegated procedures of a dental hygienist
specified by rule by the board; and
(7) Performing all delegated procedures of a dental
assistant specified by rule by the board.
§30-4-12. License renewal.
(a) All persons regulated by this article shall annually or
biannually, renew his or her board authorization by completing
a form prescribed by the board and submitting any other information required by the board.
(b) The board shall charge a fee for each renewal of a
board authorization and shall charge a late fee for any renewal
not paid by the due date.
(c) The board shall require as a condition of renewal that
each licensee, certificate holder or permittee complete
continuing education.
(d) The board may deny an application for renewal for any
reason which would justify the denial of an original
application.
§30-4-13. Board authorizations shall be displayed.
(a) The board shall prescribe the form for a board
authorization, and may issue a duplicate upon payment of a fee.
(b) Any person regulated by the article shall conspicuously
display his or her board authorization at his or her principal
business location.
§30-4-14. Dental intern, resident, or teaching permit.
(a) The board may issue a dental intern or dental resident
permit to an applicant who has been accepted as a dental intern
or dental resident by a licensed hospital or dental school in
this state which maintains an established dental department
under the supervision of a licensed dentist and meets the
following qualifications:
(1) Has graduated from a Commission on Dental Accreditation
or equivalent approved dental college, school or dental
department of a university with a degree in dentistry;
(2) Has paid the application fee specified by rule; and
(3) Meets the other qualifications specified by rule.
(b) The dental intern or dental resident permit may be
renewed and expires on the earlier of:
(1) The date the permit holder ceases to be a dental intern
or dental resident; or
(2) One year after the date of issue.
(c) The board may issue a teaching permit to an applicant
who is not otherwise licensed to practice dentistry in this
state and who meets the following conditions:
(1) Shall have authorization or has been eligible for a
authorization to practice dentistry in another jurisdiction;
(2) Has met or been approved under the credentialing
standards of a dental school or an academic medical center with
which the person is to be affiliated; the dental school or
academic medical center shall be accredited by the Commission on
Dental Accreditation or Joint Commission on Accreditation of
Health Care Organizations;
(3) The permittee may teach and practice dentistry in or on
behalf of a dental school or college offering a doctoral degree in dentistry operated and conducted in this state, in connection
with an academic medical center or at any teaching hospital
adjacent to a dental school or an academic medical center;
(4) May be renewed annually with a written recommendation
from the dental school dean;
(5) Shall successfully complete the West Virginia Dental
Law Examination;
(6) Shall pay annual renewal fees to the board;
(7) Shall comply with continuing education requirements;
(8) Has had no disciplinary actions taken or pending
against him or her by any other jurisdiction; and
(9) Shall be responsible for the permit as would a regular
dental license.
(d) While in effect, a permittee is subject to the
restrictions and requirements imposed by this article. In
addition, a permittee may not receive any fee for service other
than a salary paid by the hospital or dental school.
§30-4-15. Special volunteer dentist or dental hygienist
license; civil immunity for voluntary services
rendered to indigents.
(a) There is continued a special volunteer dentist and
dental hygienist license for dentist and dental hygienists
retired or retiring from the active practice of dentistry and dental hygiene who wish to donate their expertise for the care
and treatment of indigent and needy patients in the clinic
setting of clinics organized, in whole or in part, for the
delivery of health care services without charge. The special
volunteer dentist or dental hygienist license shall be issued by
the board to dentist or dental hygienists licensed or otherwise
eligible for licensure under this article and the legislative
rules promulgated hereunder without the payment of an
application fee, license fee or renewal fee, shall be issued for
the remainder of the licensing period, and renewed consistent
with the boards other licensing requirements. The board shall
develop application forms for the special license provided in
this subsection which shall contain the dental hygienist's
acknowledgment that:
(1) The dentist or dental hygienist's practice under the
special volunteer dentist or dental hygienist license will be
exclusively devoted to providing dentistry or dental hygiene
care to needy and indigent persons in West Virginia;
(2) The dentist or dental hygienist will not receive any
payment or compensation, either direct or indirect, or have the
expectation of any payment or compensation, for any dentistry or
dental hygiene services rendered under the special volunteer
dentist or dental hygienist license;
(3) The dentist or dental hygienist will supply any
supporting documentation that the board may reasonably require;
and
(4) The dentist or dental hygienist agrees to continue to
participate in continuing professional education as required by
the board for the special volunteer dentist or dental hygienist.
(b) Any dentist or dental hygienist who renders any
dentistry or dental hygiene service to indigent and needy
patients of a clinic organized, in whole or in part, for the
delivery of health care services without charge under a special
volunteer dentist or dental hygienist license authorized under
subsection (a) of this section without payment or compensation
or the expectation or promise of payment or compensation is
immune from liability for any civil action arising out of any
act or omission resulting from the rendering of the dental
hygiene service at the clinic unless the act or omission was the
result of the dentist's or dental hygienist's gross negligence
or willful misconduct. In order for the immunity under this
subsection to apply, there shall be a written agreement between
the dentist or dental hygienist and the clinic pursuant to which
the dentist or dental hygienist will provide voluntary
uncompensated dental hygiene services under the control of the
clinic to patients of the clinic before the rendering of any services by the dentist or dental hygienist at the clinic:
Provided, That any clinic entering into such written agreement
is required to maintain liability coverage of not less than one
million dollars per occurrence.
(c) Notwithstanding the provisions of subsection (b) of
this section, a clinic organized, in whole or in part, for the
delivery of health care services without charge is not relieved
from imputed liability for the negligent acts of a dentist or
dental hygienist rendering voluntary dental hygiene services at
or for the clinic under a special volunteer dentist or dental
hygienist license authorized under subsection (a) of this
section.
(d) For purposes of this section, "otherwise eligible for
licensure" means the satisfaction of all the requirements for
licensure as listed in section ten of this article and in the
legislative rules promulgated thereunder, except the fee
requirements of subdivision six of that section and of the
legislative rules promulgated by the board relating to fees.
(e) Nothing in this section may be construed as requiring
the board to issue a special volunteer dentist or dental
hygienist license to any dental hygienist whose license is or
has been subject to any disciplinary action or to any dentist or
dental hygienist who has surrendered a license or caused such license to lapse, expire and become invalid in lieu of having a
complaint initiated or other action taken against his or her
dentist or dental hygienist license, or who has elected to place
a dentist or dental hygienist license in inactive status in lieu
of having a complaint initiated or other action taken against
his or her license, or who has been denied a dentist or dental
hygienist license.
(f) Any policy or contract of liability insurance providing
coverage for liability sold, issued or delivered in this state
to any dentist or dental hygienist covered under the provisions
of this article shall be read so as to contain a provision or
endorsement whereby the company issuing such policy waives or
agrees not to assert as a defense on behalf of the policyholder
or any beneficiary thereof, to any claim covered by the terms of
such policy within the policy limits, the immunity from
liability of the insured by reason of the care and treatment of
needy and indigent patients by a dentist or dental hygienist who
holds a special volunteer dentist or dental hygienist license.
§30-4-16. Dental corporations.
(a) Dental corporations are continued.
(b) One or more dentists may organize and become a
shareholder or shareholders of a dental corporation domiciled
within this state under the terms and conditions and subject to the limitations and restrictions specified by rule.
(c) No corporation may practice dentistry, or any of its
branches, or hold itself out as being capable of doing so
without a certificate of authorization from the board.
(d) When the Secretary of State receives a certificate of
authorization to act as a dental corporation from the board, he
or she shall attach the authorization to the corporation
application and, upon compliance with the applicable provisions
of chapter thirty-one of this code, the Secretary of State shall
issue to the incorporators a certificate of incorporation for
the dental corporation.
(e) A corporation holding a certificate of authorization
shall renew annually, on or before June 30, on a form prescribed
by the board and pay an annual fee in an amount specified by
rule.
(f) A dental corporation may practice dentistry only
through an individual dentist or dentists licensed to practice
dentistry in this state, but the dentist or dentists may be
employees rather than shareholders of the corporation.
(g) A dental corporation holding a certificate of
authorization shall cease to engage in the practice of dentistry
upon being notified by the board that any of its shareholders is
no longer a licensed dentist or when any shares of the corporation have been sold or disposed of to a person who is not
a licensed dentist: Provided, That the personal representative
of a deceased shareholder has a period, not to exceed twenty-
four months from the date of the shareholder's death, to dispose
of the shares; but nothing contained herein may be construed as
affecting the existence of the corporation or its right to
continue to operate for all lawful purposes other than the
practice of dentistry.
§30-4-17. Reinstatement.
(a) A licensee against whom disciplinary action has been
taken under the provisions of this article shall be afforded an
opportunity to demonstrate the qualifications to resume
practice. The application for reinstatement shall be in writing
and subject to the procedures specified by the board by rule.
(b) A licensee who does not complete annual renewal, as
specified by the board by rule, and whose licensed has lapsed
for one year or longer, shall make application for reinstatement
as specified by the board by rule.
(c) The board, at its discretion and for cause, may require
an applicant for reinstatement to undergo a physical and/or
mental evaluation to determine a licensee is competent to
practice or if the licensee is impaired by drugs or alcohol.
§30-4-18. Actions to enjoin violations.
(a) If the board obtains information that any person has
engaged in, is engaging in or is about to engage in any act
which constitutes or will constitute a violation of the
provisions of this article, the rules promulgated pursuant to
this article, or a final order or decision of the board, it may
issue a notice to the person to cease and desist in engaging in
the act and/or apply to the circuit court in the county of the
alleged violation for an order enjoining the act.
(b) The circuit court may issue a temporary injunction
pending a decision on the merits, and may issue a permanent
injunction based on its findings in the case.
(c) The judgment of the circuit court on an application
permitted by the provisions of this section is final unless
reversed, vacated or modified on appeal to the West Virginia
Supreme Court of Appeals.
§30-4-19. Complaints; investigations; due process procedure;
grounds for disciplinary action.
(a) The board may initiate a complaint upon receipt of
credible information, and shall upon the receipt of a written
complaint of any person, cause an investigation to be made to
determine whether grounds exist for disciplinary action under
this article or the legislative rules promulgated pursuant to
this article.
(b) After reviewing any information obtained through an
investigation, the board shall determine if probable cause
exists that the licensee, certificate holder or permittee has
violated subsection (g) of this section or rules promulgated
pursuant to this article.
(c) Upon a finding of probable cause to go forward with a
complaint, the board shall provide a copy of the complaint to
the licensee, certificate holder or permittee.
(d) Upon a finding that probable cause exists that the
licensee, certificate holder or permittee has violated
subsection (g) of this section or rules promulgated pursuant to
this article, the board may enter into a consent decree or hold
a hearing for disciplinary action against the licensee,
certificate holder or permittee. Any hearing shall be held in
accordance with the provisions of this article, and shall
require a violation to be proven by a preponderance of the
evidence.
(e) A member of the complaint committee or the executive
director of the board may issue subpoenas and subpoenas duces
tecum to obtain testimony and documents to aid in the
investigation of allegations against any person regulated by the
article.
(f) Any member of the board or its executive director may sign a consent decree or other legal document on behalf of the
board.
(g) The board may, after notice and opportunity for
hearing, deny or refuse to renew, suspend, restrict or revoke
the license, certificate or permit of, or impose probationary
conditions upon or take disciplinary action against, any
licensee, certificate holder or permittee for any of the
following reasons:
(1) Obtaining a board authorization by fraud,
misrepresentation or concealment of material facts;
(2) Being convicted of a felony or other crime involving
drugs, violent crime, or moral turpitude, or engaging in any act
involving moral turpitude or gross immorality;
(3) Being guilty of unprofessional conduct which placed the
public at risk, as defined by legislative rule of the board;
(4) Intentional violation of a lawful order or legislative
rule of the board;
(5) Having had a board authorization revoked or suspended,
other disciplinary action taken, or an application for a board
authorization denied by the proper authorities of another
jurisdiction;
(6) Aiding or abetting unlicensed practice;
(7) Engaging in an act while acting in a professional capacity which has endangered or is likely to endanger the
health, welfare or safety of the public;
(8) Incapacity that prevents a licensee from engaging in
the practice of dentistry or dental hygiene, with reasonable
skill, competence, and safety to the public;
(9) Committing fraud in connection with the practice of
dentistry or dental hygiene;
(10) Failure to report to the board one's surrender of a
license or authorization to practice dentistry or dental hygiene
in another jurisdiction while under disciplinary investigation
by any of those authorities or bodies for conduct that would
constitute grounds for action as defined in this section;
(11) Failure to report to the board any adverse judgment,
settlement, or award arising from a malpractice claim arising
related to conduct that would constitute grounds for action as
defined in this section;
(12) Being guilty of unprofessional conduct as contained in
the American Dental Association principles of ethics and code of
professional conduct. The following acts are conclusively
presumed to be unprofessional conduct:
(A) Being guilty of any fraud or deception;
(B) Committing a criminal operation or being convicted of
a crime involving moral turpitude;
(C) Abusing alcohol or drugs;
(D) Violating any professional confidence or disclosing any
professional secret;
(E) Being grossly immoral;
(F) Harassing, abusing, intimidating, insulting, degrading
or humiliating a patient physically, verbally or through another
form of communication;
(G) Obtaining any fee by fraud or misrepresentation;
(H) Employing directly or indirectly, or directing or
permitting any suspended or unlicensed person so employed, to
perform operations of any kind or to treat lesions of the human
teeth or jaws or correct malimposed formations thereof;
(I) Practicing, or offering, or undertaking to practice
dentistry under any firm name or trade name not approved by the
board;
(J) Having a professional connection or association with,
or lending his or her name to another, for the illegal practice
of dentistry, or professional connection or association with any
person, firm or corporation holding himself or herself,
themselves or itself out in any manner contrary to this article;
(K) Making use of any advertising relating to the use of
any drug or medicine of unknown formula;
(L) Advertising to practice dentistry or perform any operation thereunder without causing pain;
(M) Advertising professional superiority or the performance
of professional services in a superior manner;
(N) Advertising to guarantee any dental service;
(O) Advertising in any manner that is false or misleading
in any material respect;
(P) Soliciting subscriptions from individuals within or
without the state for, or advertising or offering to individuals
within or without the state, a course or instruction or course
materials in any phase, part or branch of dentistry or dental
hygiene in any journal, newspaper, magazine or dental
publication, or by means of radio, television or United States
mail, or in or by any other means of contacting individuals:
Provided, That the provisions of this paragraph may not be
construed so as to prohibit:
(i) An individual dentist or dental hygienist from
presenting articles pertaining to procedures or technique to
state or national journals or accepted dental publications; or
(ii) Educational institutions approved by the board from
offering courses or instruction or course materials to
individual dentists and dental hygienists from within or without
the state; or
(Q) Engaging in any action or conduct which would have warranted the denial of the license.
(13) Knowing or suspecting that a licensee is incapable of
engaging in the practice of dentistry or dental hygiene, with
reasonable skill, competence, and safety to the public, and
failing to report any relevant information to the board;
(14) Illegal use or disclosure of protected health
information;
(15) Engaging in any conduct that subverts or attempts to
subvert any licensing examination or the administration of any
licensing examination;
(16) Failure to furnish to the board or its representatives
any information legally requested by the board, or failure to
cooperate with or engaging in any conduct which obstructs an
investigation being conducted by the board;
(17) Announcing or otherwise holding himself or herself out
to the public as a specialist or as being specially qualified in
any particular branch of dentistry or as giving special
attention to any branch of dentistry or as limiting his or her
practice to any branch of dentistry without first complying with
the requirements established by the board for the specialty and
having been issued a certificate of qualification in the
specialty by the board;
(18) Failing to report to the board within 72 hours of becoming aware thereof any life threatening occurrence, serious
injury or death of a patient resulting from dental treatment or
complications following a dental procedure;
(19) Failing to report to the board any Driving Under the
Influence and/or Driving While Intoxicated offense; or
(20) Violation of any of the terms or conditions of any
order entered in any disciplinary action.
(h) For the purposes of subsection (g) of this section,
effective July 1, 2013, disciplinary action may include:
(1) Reprimand;
(2) Probation;
(3) Restrictions;
(4) Suspension;
(5) Revocation;
(6) Administrative fine, not to exceed $1,000 per day per
violation;
(7) Mandatory attendance at continuing education seminars
or other training;
(8) Practicing under supervision or other restriction; or
(9) Requiring the licensee or permittee to report to the
board for periodic interviews for a specified period of time.
(i) In addition to any other sanction imposed, the board
may require a licensee or permittee to pay the costs of the proceeding.
(j) Nothing shall be construed as barring criminal
prosecutions for violations of this article.
(k) A person authorized to practice under this article, who
reports or otherwise provides evidence of the negligence,
impairment or incompetence of another member of this profession
to the board or to any peer review organization, is not liable
to any person for making the report if the report is made
without actual malice and in the reasonable belief that the
report is warranted by the facts known to him or her at the
time.
§30-4-20. Procedures for hearing; right of appeal.
(a) Hearings are governed by the provisions of section
eight, article one of this chapter.
(b) The board may conduct the hearing or elect to have an
administrative law judge conduct the hearing.
(c) If the hearing is conducted by an administrative law
judge, at the conclusion of a hearing he or she shall prepare a
proposed written order containing findings of fact and
conclusions of law. The proposed order may contain proposed
disciplinary actions if the board so directs. The board may
accept, reject or modify the decision of the administrative law
judge.
(d) Any member or the executive director of the board has
the authority to administer oaths, examine any person under
oath.
(e) If, after a hearing, the board determines the licensee
or permittee has violated provisions of this article or the
board's rules, a formal written decision shall be prepared which
contains findings of fact, conclusions of law and a specific
description of the disciplinary actions imposed.
§30-4-21. Judicial review.
A person adversely affected by a decision of the board
denying an application or entered after a hearing may obtain
judicial review of the decision in accordance with section four,
article five, chapter twenty-nine-a of this code, and may appeal
any ruling resulting from judicial review in accordance with
article six, chapter twenty-nine-a of this code.
§30-4-22. Criminal proceedings; penalties.
(a) When, as a result of an investigation under this
article or otherwise, the board has reason to believe that a
person authorized under this article has committed a criminal
offense under this article, the board may bring its information
to the attention of an appropriate law-enforcement official.
(b) Any person who intentionally practices, or holds
himself or herself out as qualified to practice dentistry or dental hygiene, or uses any title, word or abbreviation to
indicate to or induce others to believe he or she is licensed to
practice as a dentist or dental hygienist without obtaining an
active, valid West Virginia license to practice that profession
or with a license that is:
(1) Expired, suspended or lapsed; or
(2) Inactive, revoked, suspended as a result of
disciplinary action, or surrendered, is guilty of a felony and,
upon conviction thereof, shall be fined not more than $10,000 or
imprisoned in a state correctional facility for not less than
one year nor more than five years, or both fined and imprisoned.
§30-4-23. Single act evidence of practice.
In any action brought under this article, article four-a or
article four-b any proceeding initiated under this article,
evidence of the commission of a single act prohibited by this
article is sufficient to justify a penalty, injunction,
restraining order or conviction without evidence of a general
course of conduct.
§30-4-24. Inapplicability of article.
The provisions of this article do not apply to:
(1) A licensed physician or surgeon in the practice of his
or her profession when rendering dental relief in emergency
cases, unless he or she undertakes to reproduce or reproduces lost parts of the human teeth or to restore or replace lost or
missing teeth in the human mouth;
(2) A dental laboratory in the performance of dental
laboratory services, while the dental laboratory, in the
performance of the work, conforms in all respects to the
requirements of article four-b and further does not apply to
persons performing dental laboratory services under the direct
supervision of a licensed dentist or under the direct
supervision of a person authorized under this article to perform
any of the acts in this article defined to constitute the
practice of dentistry while the work is performed in connection
with, and as a part of, the dental practice of the licensed
dentist or other authorized person and for his or her dental
patients;
(3) A student enrolled in and regularly attending any
dental college recognized by the board, provided their acts are
done in the dental college and under the direct and personal
supervision of their instructor;
(4) A student enrolled in and regularly attending any
dental college recognized by the board may practice dentistry in
a public health setting, provided their acts are done under the
direct supervision of their instructor, adjunct instructor or a
dentist;
(5) An authorized dentist of another state temporarily
operating a clinic under the auspices of a organized and
reputable dental college or reputable dental society, or to one
lecturing before a reputable society composed exclusively of
dentists; or
(6) A dentist whose practice is confined exclusively to the
service of the United States Army, the United States Navy, the
United States Air Force, The United States Coast Guard, the
United States Public Health Service, the United States Veteran's
Bureau or any other authorized United States government agency
or bureau.
ARTICLE 4A. ADMINISTRATION OF ANESTHESIA BY DENTISTS.
§30-4A-1. Requirement for anesthesia permit.
(a) No dentist may induce central nervous system anesthesia
without first having obtained an anesthesia permit for the level
of anesthesia being induced.
(b) The applicant for an anesthesia permit shall pay the
appropriate permit fees and renewal fees, submit a completed
board-approved application and consent to an office evaluation.
(c) Permits shall be issued to coincide with the annual
renewal dates.
(d) Permit holders shall report the names and
qualifications of each qualified monitor. Qualified monitors shall apply for certification and pay the appropriate
application fees and renewal fees. Qualified monitors are
required to renew annually by June 30th. Qualified monitor
requirements for each level of sedation are as specified by
rule.
(e) A dentist shall hold a class permit equivalent to or
exceeding the anesthesia level being provided, unless the
provider of anesthesia is a physician anesthesiologist or
licensed dentist who holds a current anesthesia permit issued by
the board.
§30-4A-2. Presumption of Degree of Central Nervous System
Depression.
(a) In any hearing where a question exists as to the degree
of central nervous system depression a licensee has induced
(i.e., local anesthesia, relative analgesia, anxiolysis,
conscious sedation, general anesthesia/deep conscious sedation)
the board may base its findings on, among other things, the
types, dosages and routes of administration of drugs
administered to the patient and what result can reasonably be
expected from those drugs in those dosages and routes
administered in a patient of that physical and psychological
status.
(b) No permit holder may have more than one person under conscious sedation/moderate sedation and/or general
anesthesia/deep conscious sedation at the same time, exclusive
of recovery.
§30-4A-3. Classes of anesthesia permits.
(a) The board shall issue the following permits:
(1) Class 2 Permit: A Class 2 Permit authorizes a dentist
to induce anxiolysis/minimal sedation.
(2) Class 3 Permit: A Class 3 Permit authorizes a dentist
to induce conscious sedation/moderate sedation as limited
enteral (3a) and/or comprehensive parenteral (3b), and
anxiolysis/minimal sedation.
(3) Class 4 Permit: A Class 4 Permit authorizes a dentist
to induce general anesthesia/deep conscious sedation, conscious
sedation/moderate sedation, and anxiolysis/minimal sedation.
(b) When anesthesia services are provided in dental
facilities by a MD or DO physician anesthesiologist, dentist
anesthesiologist, or CRNA, the dental facility shall be
inspected and approved for a Class 4 permit, and the dentist
shall have a minimum of a Class 2 permit. If anesthesia services
are provided by a CRNA, the dental facility shall be inspected
and approved for a Class 4 permit, and the supervising dentist
shall have the same level of permit for the level of anesthesia
provided by the CRNA.
§30-4A-4. Qualifications, standards, and continuing education
requirements for relative analgesia/minimal
sedation use.
(a) The board shall allow administration of relative
analgesia if the practitioner:
(1) Is a licensed dentist in the state;
(2) Holds valid and current documentation showing
successful completion of a Health Care Provider BLS/CPR course;
and
(3) Has completed a training course of instruction in
dental school, continuing education or as a postgraduate in the
administration of relative analgesia.
(b) A practitioner who administers relative analgesia shall
have the following facilities, equipment and drugs available
during the procedure and during recovery:
(1) An operating room large enough to adequately
accommodate the patient on an operating table or in an operating
chair and to allow delivery of age appropriate care in an
emergency situation;
(2) An operating table or chair which permits the patient
to be positioned so that the patient's airway can be maintained,
quickly alter the patient's position in an emergency, and
provide a firm platform for the administration of basic life support;
(3) A lighting system which permits evaluation of the
patient's skin and mucosa color and a backup lighting system of
sufficient intensity to permit completion of any operation
underway in the event of a general power failure;
(4) Suction equipment which permits aspiration of the oral
and pharyngeal cavities;
(5) An oxygen delivery system with adequate age appropriate
full face masks and appropriate connectors that is capable of
delivering high flow oxygen to the patient under positive
pressure, together with an adequate backup system;
(6) A nitrous oxide delivery system with a fail-safe
mechanism that will insure appropriate continuous oxygen
delivery and a scavenger system; and
(7) A defibrillator device.
All equipment used shall be appropriate for the height and
weight and age of the patient.
(c) Before inducing relative analgesia/minimal sedation by
means of nitrous oxide or a single premed agent, a practitioner
shall:
(1) Evaluate the patient;
(2) Give instruction to the patient or, when appropriate
due to age or psychological status of the patient, the patient's guardian; and
(3) Certify that the patient is an appropriate candidate
for relative analgesia/minimal sedation.
(d) A practitioner who administers relative
analgesia/minimal sedation shall see that the patient's
condition is visually monitored. At all times, the patient
shall be observed by a qualified monitor until discharge
criteria have been met.
(e) A qualified monitor's record shall include
documentation of all medications administered with dosages, time
intervals and route of administration including local
anesthesia.
(f) A discharge entry shall be made in the patient's record
indicating the patient's condition upon discharge.
(g) A qualified monitor shall hold valid and current
documentation:
(1) Showing successful completion of a Health Care Provider
BLS/CPR course; and
(2) Have received training and be competent in the
recognition and treatment of medical emergencies, monitoring
vital signs, the operation of nitrous oxide delivery systems and
the use of the sphygmomanometer and stethoscope.
(h) The practitioner shall assess the patient's responsiveness using preoperative values as normal guidelines
and discharge the patient only when the following criteria are
met:
(1) The patient is alert and oriented to person, place and
time as appropriate to age and preoperative neurological status;
(2) The patient can talk and respond coherently to verbal
questioning or to preoperative neurological status;
(3) The patient can sit up unaided or without assistance or
to preoperative neurological status;
(4) The patient can ambulate with minimal assistance or to
preoperative neurological status; and
(5) The patient does not have uncontrollable nausea,
vomiting or dizziness.
§30-4A-5. Qualifications, standards, and continuing education
requirements for a Class 2 Permit.
(a) The board shall issue a Class 2 Permit to an applicant
who:
(1) Is a licensed dentist in West Virginia;
(2) Holds valid and current documentation showing
successful completion of a Health Care Provider BLS/CPR; and
(3) Has completed a board approved course of at least six
hours didactic and clinical of either predoctoral dental school
or postgraduate instruction.
(b) A dentist who induces relative analgesia/minimal
sedation and anxiolysis/minimal sedation shall have the
following facilities, properly maintained equipment and
appropriate drugs available during the procedures and during
recovery:
(1) An operating room large enough to adequately
accommodate the patient on an operating table or in an operating
chair and to allow an operating team of at least two individuals
to freely move about the patient;
(2) An operating table or chair which permits the patient
to be positioned so the operating team can maintain the
patient's airway, quickly alter the patient's position in an
emergency, and provide a firm platform for the administration of
basic life support;
(3) A lighting system which permits evaluation of the
patient's skin and mucosa color and a backup lighting system of
sufficient intensity to permit completion of any operation
underway in the event of a general power failure;
(4) Suction equipment which permits aspiration of the oral
and pharyngeal cavities;
(5) An oxygen delivery system with adequate age appropriate
full face mask and appropriate connectors that is capable of
delivering high flow oxygen to the patient under positive pressure, together with an adequate backup system;
(6) A nitrous oxide delivery system with a fail-safe
mechanism that will insure appropriate continuous oxygen
delivery and a scavenger system;
(7) A recovery area that has available oxygen, adequate
lighting, suction and electrical outlets. The recovery area can
be the operating room;
(8) Sphygmomanometer, stethoscope, and pulse oximeter;
(9) Emergency drugs as specified by rule;
(10) A defibrillator device; and
(11) All equipment and medication dosages shall be in
accordance with the height and weight and age of the patient
being treated.
(c) Before inducing anxiolysis, a dentist shall:
(1) Evaluate the patient and certify by using the ASA
Patient Physical Status Classification of the ASA that the
patient is an appropriate candidate for anxiolysis sedation; and
(2) Obtain written informed consent from the patient or
patient's guardian for the anesthesia. The obtaining of the
informed consent shall be documented in the patient's record.
(d) The dentist shall monitor and record the patient's
condition or shall use a qualified monitor to monitor and record
the patient's condition. The documented requirements of a qualified monitor monitoring anxiolysis sedation cases are as
specified by rule. A Class 2 Permit holder may have no more than
one person under anxiolysis at the same time.
(e) The patient shall be monitored as follows:
(1) Patients shall have continuous monitoring using pulse
oximetry. The patient's blood pressure, heart rate and
respiration shall be recorded at least once before, during and
after the procedure, and these recordings shall be documented in
the patient record. At all times, the patient shall be observed
by a qualified monitor until discharge criteria have been met.
If the dentist is unable to obtain this information, the reasons
shall be documented in the patient's record. The record shall
also include documentation of all medications administered with
dosages, time intervals and route of administration including
local anesthesia.
(2) A discharge entry shall be made by the dentist in the
patient's record indicating the patient's condition upon
discharge.
(f) A permit holder who uses anxiolysis shall see that the
patient's condition is visually monitored. The patient shall be
monitored as to response to verbal stimulation, oral mucosa
color and preoperative and postoperative vital signs.
(g) The dentist shall assess the patient's responsiveness using preoperative values as normal guidelines and discharge the
patient only when the following criteria are met:
(1) Vital signs including blood pressure, pulse rate and
respiratory rate are stable;
(2) The patient is alert and oriented to person, place and
time as appropriate to age and preoperative neurological status;
(3) The patient can talk and respond coherently to verbal
questioning, or to preoperative neurological status;
(4) The patient can sit up unaided, or to preoperative
neurological status;
(5) The patient can ambulate with minimal assistance, or to
preoperative neurological status; and
(6) The patient does not have uncontrollable nausea or
vomiting and has minimal dizziness.
(h) A dentist may not release a patient who has undergone
anxiolysis/minimal sedation except to the care of a responsible
adult third party.
§30-4A-6. Qualifications, standards, and continuing education
requirements for Class 3 Anesthesia Permit.
(a) The board shall issue or renew a Class 3 Permit to an
applicant who:
(1) Is a licensed dentist in West Virginia;
(2) Holds valid and current documentation showing successful completion of a Health Care Provider BLS/CPR course,
ACLS and/or a PALS course if treating pediatric patients; and
(3) Satisfies one of the following criteria:
(A) Certificate of completion of a comprehensive training
program in conscious sedation that satisfies the requirements
described in the ADA Guidelines for Teaching Pain Control and
Sedation to Dentists and Dental Students and the ADA Guidelines
for the Use of Sedation and General Anesthesia by Dentists at
the time training was commenced.
(B) Certificate of completion of an ADA accredited
postdoctoral training program which affords comprehensive and
appropriate training necessary to administer and manage
conscious sedation, commensurate with these guidelines.
(C) In lieu of these requirements, the board may accept
documented evidence of equivalent training or experience in
conscious sedation anesthesia for Limited Enteral Permit as
Class 3a or comprehensive Parenteral Permit as Class 3b as
specified by rule.
(b) A dentist who induces conscious sedation shall have the
following facilities, properly maintained age appropriate
equipment and age appropriate medications available during the
procedures and during recovery:
(1) An operating room large enough to adequately accommodate the patient on an operating table or in an operating
chair and to allow an operating team of at least two individuals
to freely move about the patient;
(2) An operating table or chair which permits the patient
to be positioned so the operating team can maintain the
patient's airway, quickly alter the patient's position in an
emergency, and provide a firm platform for the administration of
basic life support;
(3) A lighting system which permits evaluation of the
patient's skin and mucosa color and a backup lighting system of
sufficient intensity to permit completion of any operation
underway in the event of a general power failure;
(4) Suction equipment which permits aspiration of the oral
and pharyngeal cavities and a backup suction device which will
function in the event of a general power failure;
(5) An oxygen delivery system with adequate age appropriate
full face mask and appropriate connectors that is capable of
delivering high flow oxygen to the patient under positive
pressure, together with an adequate backup system;
(6) A nitrous oxide delivery system with a fail-safe
mechanism that will insure appropriate continuous oxygen
delivery and a scavenger system;
(7) A recovery area that has available oxygen, adequate lighting, suction and electrical outlets. The recovery area can
be the operating room;
(8) Sphygmomanometer, pulse oximeter, oral and
nasopharyngeal airways, intravenous fluid administration
equipment and/or equipment required for the standard of care or
as specified by rule;
(9) Emergency drugs as specified by rule; and
(10) A defibrillator device.
(c) Before inducing conscious sedation, a dentist shall:
(1) Evaluate the patient and document, using the ASA
Patient Physical Status Classifications, that the patient is an
appropriate candidate for conscious sedation;
(2) Give written preoperative and postoperative
instructions to the patient or, when appropriate due to age or
neurological status of the patient, the patient's guardian; and
(3) Obtain written informed consent from the patient or
patient's guardian for the anesthesia.
(d) The dentist shall ensure that the patient's condition
is monitored and recorded on a contemporaneous record. The
dentist shall use a Qualified Monitor to monitor and record the
patient's condition in addition to the chair side dental
assistant. A Qualified Monitor shall be present to monitor the
patient at all times.
(e) The patient shall be monitored as follows:
(1) Patients shall have continuous monitoring using pulse
oximetry and/or equipment required for the standard of care or
as specified by rule by a Qualified Monitor until discharge
criteria have been met. The documented requirements of a
Qualified Monitor monitoring limited enteral or comprehensive
parenteral sedations cases are as specified by rule. The
patient's blood pressure, heart rate, and respiration shall be
recorded every five minutes, and these recordings shall be
documented in the patient record. The record shall also include
documentation of preoperative and postoperative vital signs, all
medications administered with dosages, time intervals and route
of administration including local anesthesia. If the dentist is
unable to obtain this information, the reasons shall be
documented in the patient's record.
(2) During the recovery phase, the patient shall be
monitored by a qualified monitor.
(3) A discharge entry shall be made by the dentist in the
patient's record indicating the patient's condition upon
discharge and the name of the responsible party to whom the
patient was discharged.
(f) A dentist may not release a patient who has undergone
conscious sedation/moderate sedation except to the care of a responsible adult third party.
(g) When discharging a pediatric patient the dentist shall
follow the current edition of AAPD Guidelines for Monitoring and
Management of Pediatric Patients During and After Sedation for
Diagnostic and Therapeutic Procedures.
(h) The dentist shall assess the patient's responsiveness
using preoperative values as normal guidelines and discharge the
patient only when the following criteria are met:
(1) Vital signs including blood pressure, pulse rate and
respiratory rate are stable;
(2) The patient is alert and oriented to person, place and
time as appropriate to age and preoperative neurological status;
(3) The patient can talk and respond coherently to verbal
questioning, or to preoperative neurological status;
(4) The patient can sit up unaided, or to preoperative
neurological status;
(5) The patient can ambulate with minimal assistance, or to
preoperative neurological status; and
(6) The patient does not have uncontrollable nausea or
vomiting and has minimal dizziness.
(i) A dentist who induces conscious sedation shall employ
the services of a Qualified Monitor and a chair side dental
assistant at all times who each shall hold a valid BLS/CPR certification and maintains certification as specified by rule.
§30-4A-7. Qualifications, standards, and continuing education
requirements for Class 4 Anesthesia Permit.
(a) A Class 4 Permit permits the use of general
anesthesia/deep conscious sedation, conscious sedation/moderate
sedation, and anxiolysis/minimal sedation.
(b) The board shall issue or renew a Class 4 Permit to an
applicant who:
(1) Is a licensed dentist in West Virginia;
(2) Holds a valid and current documentation showing
successful completion of a Healthcare Provider BLS/CPR
course, Advanced Cardiac Life Support (ACLS) and/or Pediatric
Advanced Life Support (PALS) course if treating pediatric
patients;
(3) Satisfies one of the following criteria:
(A) Completion of an advanced training program in
anesthesia and related subjects beyond the undergraduate dental
curriculum that satisfies the requirements described in the ADA
Guidelines for Teaching Pain Control and Sedation to Dentists
and Dental Students and the ADA Guidelines for the Use of
Sedation and General Anesthesia by Dentists at the time training
was commenced;
(B) Completion of an ADA or AMA accredited postdoctoral training program which affords comprehensive and appropriate
training necessary to administer and manage general anesthesia,
commensurate with these guidelines;
(C) In lieu of these requirements, the board may accept
documented evidence of equivalent training or experience in
general anesthesia/deep conscious sedation.
(c) A dentist who induces general anesthesia/deep conscious
sedation shall have the following facilities, properly
maintained age appropriate equipment and age appropriate drugs
available during the procedure and during recovery:
(1) An operating room large enough to adequately
accommodate the patient on an operating table or in an operating
chair and to allow an operating team of at least three
individuals to freely move about the patient;
(2) An operating table or chair which permits the patient
to be positioned so the operating team can maintain the
patient's airway, quickly alter the patient's position in an
emergency, and provide a firm platform for the administration of
basic life support;
(3) A lighting system which permits evaluation of the
patient's skin and mucosa color and a backup lighting system of
sufficient intensity to permit completion of any operation
underway in the event of a general power failure;
(4) Suction equipment which permits aspiration of the oral
and pharyngeal cavities and a backup suction device which will
function in the event of a general power failure;
(5) An oxygen delivery system with adequate age appropriate
full face mask and appropriate connectors that is capable of
delivering high flow oxygen to the patient under positive
pressure, together with an adequate backup system;
(6) A nitrous oxide delivery system with a fail-safe
mechanism that will insure appropriate continuous oxygen
delivery and a scavenger system;
(7) A recovery area that has available oxygen, adequate
lighting, suction and electrical outlets. The recovery area can
be the operating room;
(8) Equipment as specified by rule;
(9) Emergency drugs as specified by rule;
(10) A defibrillator device.
(d) Before inducing general anesthesia/deep conscious
sedation the dentist shall:
(1) Evaluate the patient and document, using the ASA
Patient Physical Status Classifications, that the patient is an
appropriate candidate for general anesthesia or deep conscious
sedation;
(2) Shall give written preoperative and postoperative instructions to the patient or, when appropriate due to age or
neurological status of the patient, the patient's guardian; and
(3) Shall obtain written informed consent from the patient
or patient's guardian for the anesthesia.
(e) A dentist who induces general anesthesia/deep conscious
sedation shall ensure that the patient's condition is monitored
and recorded on a contemporaneous record. The dentist shall use
a Qualified Monitor to monitor and record the patient's
condition on a contemporaneous record and a chair side dental
assistant. The documented requirements of a Qualified Monitor
monitoring general anesthesia/deep conscious sedation cases are
as specified by rule. No permit holder may have more than one
patient under general anesthesia at the same time.
(f) The patient shall be monitored as follows:
(1) Patients shall have continuous monitoring using pulse
oximetry and/or equipment required for the standard of care or
as specified by rule by a Qualified Monitor until discharge
criteria have been met. The patient's blood pressure, heart
rate and oxygen saturation shall be assessed every five minutes,
and shall be contemporaneously documented in the patient record.
The record shall also include documentation of preoperative and
postoperative vital signs, all medications administered with
dosages, time intervals and route of administration including local anesthesia. The person administering the anesthesia may
not leave the patient while the patient is under general
anesthesia;
(2) During the recovery phase, the patient shall be
monitored, including the use of pulse oximetry, by a Qualified
Monitor; and
(3) A dentist may not release a patient who has undergone
general anesthesia/deep conscious sedation except to the care of
a responsible adult third party.
(4) When discharging a pediatric patient the dentist shall
follow the current edition of AAPD Guidelines for the Monitoring
and Management of Pediatric Patients During and After Sedation
for Diagnostic and Therapeutic Procedures.
(g) The dentist shall assess the patient's responsiveness
using preoperative values as normal guidelines and discharge the
patient only when the following criteria are met:
(1) Vital signs including blood pressure, pulse rate and
respiratory rate are stable;
(2) The patient is alert and oriented to person, place and
time as appropriate to age and preoperative neurological status;
(3) The patient can talk and respond coherently to verbal
questioning, or to preoperative neurological status;
(4) The patient can sit up unaided, or to preoperative neurological status;
(5) The patient can ambulate with minimal assistance, or to
preoperative neurological status; and
(6) The patient does not have uncontrollable nausea or
vomiting and has minimal dizziness.
(7) A discharge entry shall be made in the patient's record
by the dentist indicating the patient's condition upon discharge
and the name of the responsible party to whom the patient was
discharged.
(h) A dentist who induces general anesthesia shall employ
the services of a Qualified Monitor and a chair side dental
assistant at all times, who each shall hold a valid BLS/CPR
certification and maintains certification as specified by rule.
§30-4A-8. Board to review, inspect and reinspect dentists for
issuance of permits.
(a) By making application to the board for an anesthesia
permit, a dentist consents and authorizes the board to review
his or her credentials, inspect or reinspect his or her
facilities, and investigate any alleged anesthesia mortalities,
misadventure, or other adverse occurrences. The board shall
conduct an in-office review or on-site inspection of any dentist
applying for or holding a permit to administer anesthesia.
Prior to issuing a permit, the board shall conduct an on-site inspection of facility, equipment, and auxiliary personnel
of the applicant to determine if, in fact, all the requirements
for the permit have been met. This inspection or evaluation, if
required, shall be carried out by at least two members of the
subcommittee. This evaluation is to be carried out in a manner
following the principles, but not necessarily the procedures,
set forth by the current edition of the AAOMS Office Anesthesia
Evaluation Manual. On-site inspections are required and shall be
performed for all Class 3a, 3b and 4 permitees. The board may
reinspect annually, at its discretion, but shall perform an on-
site inspection for all permit holders at least once every five
years except Class 2 permit holders. The board reserves the
right to conduct an on-site inspection whenever it deems
necessary for all permit holders. All on-site inspections shall
be held during regular business hours.
(b) Cancellation or failure to appear or be present for a
scheduled evaluation by a permit holder, for an unexplained or
unexcusable reason, shall be assessed a penalty fee two times
the permit holders normal annual renewal fee. The penalty fee
shall be separate from the annual renewal fees.
§30-4A-9. Office evaluations.
(a) The in-office evaluation shall include:
(1) Observation of one or more cases of anesthesia to determine the appropriateness of technique and adequacy of
patient evaluation and care;
(2) Inspection of facilities, which shall include, but not
be limited to, the inspection of equipment, drugs and patient
records and qualified monitor's certifications and
documentation; and
(3) The evaluation shall be performed by a team appointed
by the board and shall include a member of the subcommittee who
holds a current anesthesia permit in the same class or in a
higher class than that held by the permit holder being
evaluated.
(4) Class 2 permit holders may be audited periodically as
determined by the committee; and
(5) Class 3 and 4 permit holders shall be evaluated once
every five years.
(b) A dentist utilizing a licensed dentist who holds a
current anesthesia permit issued by the board shall have his or
her office inspected to the level of a class 4 permit as
specified by section ten of this article. The office is only
approved at that level when the anesthesia permit holder is
present and shall have the number of qualified monitors present
as required by this article.
(c) In addition to the requirements of this article a treating dentist who applies for a certificate to allow a CRNA
to administer anesthesia and sedation to a patient, shall
maintain a permit as follows:
(1) A treating dentist, who allows a CRNA to administer
limited enteral sedation to a patient, shall maintain a Class 3a
permit for themselves and the administration site shall be
inspected to a Class 4 permit level;
(2) A treating dentist, who allows a CRNA to administer
comprehensive parenteral sedation to a patient, shall maintain
a Class 3b permit for themselves and the administration site
shall be inspected to a Class 4 permit level; and
(3) A treating dentist, who allows a CRNA to administer
general anesthesia/deep conscious sedation to a patient, shall
maintain a Class 4 permit for themselves and the administration
site shall be inspected to a Class 4 permit level.
§30-4A-10. Reporting of Death, Serious Complications or Injury.
If a death, any serious complication or any injury occurs
which may have resulted from the administration of general
anesthesia/deep conscious sedation, conscious sedation/moderate
sedation, anxiolysis/minimal sedation, or relative
analgesia/minimal sedation, the licensee performing the dental
procedure shall submit a written detailed report to the board
within 72 hours of the incident along with copies of the patient's original complete dental records. If the anesthetic
agent was administered by a person other than the person
performing the dental procedure, that person shall also submit
a detailed written report. The detailed report(s) shall include:
(1) Name, age and address of patient;
(2) Name of the licensee and other persons present during
the incident along with their names and addresses;
(3) Address where the incident took place;
(4) Type of anesthesia and dosages of drugs administered to
the patient including local anesthesia;
(5) A narrative description of the incident including
approximate times and evolution of symptoms; and
(6) The anesthesia record and the signed informed consent
form for the anesthesia.
§30-4A-11. Immunity from liability.
(a) Notwithstanding any other provision of law, no person
providing information to the board or to the subcommittee may be
held, by reason of having provided the information, to be
civilly liable under any law unless the information was false
and the person providing information knew or had reason to
believe the such information was false.
(b) No member or employee of the board or the subcommittee
may be held by reason of the performance by him or her of any duty, function or activity authorized or required of the board
or the subcommittee to be civilly liable. The foregoing
provisions of this subsection do not apply with respect to any
action taken by any individual if the individual, in taking the
action, was motivated by malice toward any person affected by
the action.
§30-4A-12. Facility Inspections.
(a) The board shall perform an onsite evaluation of Class
3 and 4 applicants dental facilities, equipment, techniques, and
personnel prior to issuing a permit. The board may conduct
further on-site evaluations.
(b) The board may inspect Class 2 applicants facilities.
§30-4A-13. Issuance of regular annual permits.
Upon the recommendation of the subcommittee, the board
shall issue permits to applicable dentists. An anesthesia permit
shall be renewed annually.
§30-4A-14. Waiting period for reapplication or reinspection of
facilities.
A dentist whose application has been denied for failure to
satisfy the requirements in the application procedure or the on-
site evaluation shall wait thirty days from the date of the
denial prior to reapplying and shall submit to another on-site evaluation prior to receiving a permit. The board and the
subcommittee shall promptly reinspect the applicant dentist's
facilities, techniques, equipment, and personnel within ninety
days after the applicant has made reapplication.
§30-4A-15. Application and annual renewal of regular permits;
fees.
The board shall require an initial application fee and an
annual renewal fee for Class 2, Class 3 and 4 Permits. Permits
expire annually. The board shall renew permits for the use of
anesthesia after the permittee satisfies the application for
renewal.
§30-4A-16. Violations of article; penalties for practicing
anesthesia without a permit.
Violations of any of the provisions of this article,
whether intentional or unintentional, may result in the
revocation or suspension of the dentist's permit to administer
anesthesia; multiple or repeated violations or gross
infractions, such as practicing anesthesia without a valid
permit may result in suspension of the dentist's license to
practice dentistry for up to one year as well as other
disciplinary measures as deemed appropriate by the board.
§30-4A-17. Appointment of Subcommittee; credentials review; and on-site inspections.
(a) The board shall appoint a subcommittee to carry out the
review and on-site inspection of any dentist applying for or
renewing a permit under this article.
(b) The subcommittee shall make a recommendation for
issuing or revoking a permit under this article.
(c) This subcommittee shall be known as the "West Virginia
Board of Dentistry Subcommittee on Anesthesia," The subcommittee
shall, at a minimum, consist of one member of the board who
shall act as chairman of the subcommittee, and two members
holding a Class 4 permit and two members holding a Class 3
permit.
(d) The subcommittee shall adopt policies and procedures
related to the regulation of general anesthesia/deep conscious
sedation, conscious sedation/moderate sedation,
anxiolysis/minimal sedation, and relative analgesia/minimal
sedation with the same being approved by the board. The
subcommittee members shall be paid and reimbursed expenses
pursuant to article one of this chapter.
ARTICLE 4B. DENTAL LABORATORY SERVICES.
§30-4B-1. Unlawful acts.
(a) It is unlawful for any person, other than a dentist or
other dental practitioner, to sell, offer for sale or furnish any dental prosthesis or other dental laboratory service to any
person who is not a dentist or other dental practitioner.
(b) It is unlawful for any person to perform dental
laboratory services without a work authorization: Provided,
That this subsection does not apply to a dentist or other dental
practitioner, or to their employees working under their direct
supervision, performing dental laboratory services as a part of
their own dental practice and for their own dental patients.
(c) It is unlawful for any dental laboratory to perform any
dental laboratory service without the issuance of a work
authorization by a dentist or other dental practitioner.
(d) It is unlawful for any dental laboratory or dentist who
fabricates a full upper or full lower set of prosthetic dentures
not to affix upon the dentures, in a nonremovable manner, the
name of the patient, the initials of the dentist's state of
practice and license identification.
(e) It is unlawful for any dental laboratory either
directly or indirectly:
(1) To advertise that it is engaged in the business of
performing dental laboratory services;
(2) To advertise it performs dental laboratory services for
members of the public;
(3) To advertise a price for the performance of dental laboratory services; or
(4) To advertise techniques used or materials employed by
it in the performance of dental laboratory services: Provided,
That this subsection does not prevent dental laboratories from
advertising in dental journals or in other professional dental
publications or from communicating directly to a dentist and
other dental practitioner or from listing the dental laboratory
in business and telephone directories if the business and
telephone directory announcements are limited to name, address
and telephone number and do not occupy more than the number of
lines necessary to disclose the information, or from displaying
the trade name and address of the dental laboratory on the door
of its place of business or on name plates or door plates
exhibited on the interior or exterior of the place of business.
§30-4B-2. Work authorization required; contents; retention.
(a) No dental laboratory technician may perform any dental
laboratory service without the issuance of a work authorization
by a dentist or other dental practitioner.
(b) Each work authorization shall contain:
(1) The name and address of the dental laboratory to which
it is directed;
(2) The case identification;
(3) A specification of the materials to be used;
(4) A description of the work to be done and, if necessary,
diagrams thereof;
(5) The date of issue; and
(6) The signature and address of the dentist or other
dental practitioner issuing the work authorization.
(c) A separate work authorization shall be issued for each
patient of the dentist or other dental practitioner for whom a
dental laboratory service is to be performed.
(d) Every work authorization shall be made in duplicate
with the original being delivered to the dental laboratory to
which it is directed and the copy being retained in the office
of the issuing dentist or other dental practitioner. A work
authorization shall be saved for a period of two years from its
date of issue.
§30-4B-3. Denture identification.
A dental laboratory and a dentist who engages in dental
laboratory services and who fabricates any full upper or full
lower set of prosthetic dentures shall affix upon the dentures,
in a nonremovable manner, the name of the patient for whom the
dentures are made and the initials of the dentist's state of
practice and license identification number.
§30-4B-4. Review of dental laboratory services.
The board may review the dental laboratory services of a dental laboratory on a random and general basis without any
requirement of a formal complaint or suspicion of impropriety.
NOTE: The purpose of this bill is to update and revise the
law governing the practice of dentistry
These articles have been completely rewritten; therefore,
strike-throughs and underscoring have been omitted.
This bill was recommended for introduction and passage
during the Regular Session of the Legislature by the House
Committee on Health.