2014 -- S 2347

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LC004113

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- DENTISTS AND DENTAL

HYGIENISTS

     

     Introduced By: Senators Lynch, Conley, Ottiano, Jabour, and Sosnowski

     Date Introduced: February 12, 2014

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Sections 5-31.1-1, 5-31.1-2, 5-31.1-4, 5-31.1-11 and 5-31.1-31 of the

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General Laws in Chapter 5-31.1 entitled "Dentists and Dental Hygienists" are hereby amended to

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read as follows:

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     5-31.1-1. Definitions. -- As used in this chapter:

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      (1) "Board" means the Rhode Island board of examiners in dentistry or any committee or

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subcommittee of the board.

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      (2) "Chief of the division of oral health" means, the chief of the division of oral health of

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the Rhode Island department of health who is a licensed dentist possessing a masters degree in

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public health or a certificate in public health from an accredited program.

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      (3) "Dental administrator" means the administrator of the Rhode Island board of

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examiners in dentistry.

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      (4) "Dental hygienist" means a person with a license to practice dental hygiene in this

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state under the provisions of this chapter.

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      (5) "Dentist" means a person with a license to practice dentistry in this state under the

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provisions of this chapter.

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      (6) "Dentistry" is defined as the evaluation, diagnosis, prevention and/or treatment (non-

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surgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity,

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cranio-maxillofacial area and/or the adjacent and associated structures and their impact on the

 

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human body, provided by a dentist, within the scope of his or her education, training and

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experience, in accordance with the ethics of the profession and applicable law.

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      (7) "Department" means the Rhode Island department of health.

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     (7.1) "Direct visual supervision" means supervision by an oral and maxillofacial surgeon

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or dentist (with a permit to administer deep and general sedation) by verbal command and under

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direct line of sight.

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      (8) "Director" means the director of the Rhode Island department of health.

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      (9) "Health care facility" means any institutional health service provider licensed

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pursuant to the provisions of chapter 17 of title 23.

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      (10) "Health maintenance organization" means a public or private organization licensed

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pursuant to the provisions of chapter 17 of title 23 or chapter 41 of title 27.

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      (11) "Limited registrant" means a person holding a limited registration certificate

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pursuant to the provisions of this chapter.

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      (12) "Nonprofit medical services corporation" or "nonprofit hospital service corporation"

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or "nonprofit dental service corporation" means any corporation organized pursuant to chapter 19

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or 20 of title 27 for the purpose of establishing, maintaining and operating a nonprofit medical,

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hospital, or dental service plan.

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      (13) "Peer review board" means any committee of a state, local, dental or dental hygiene,

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association or society, or a committee of any licensed health care facility, or the dental staff of the

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committee, or any committee of a dental care foundation or health maintenance organization, or

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any staff committee or consultant of a hospital, medical, or dental service corporation, the

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function of which, or one of the functions of which is to evaluate and improve the quality of

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dental care rendered by providers of dental care service or to determine that dental care services

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rendered were professionally indicated or were performed in compliance with the applicable

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standard of care or that the cost for dental care rendered was considered reasonable by the

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providers of professional dental care services in the area and includes a committee functioning as

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a utilization review committee under the provisions of P.L. 89-97, 42 U.S.C. section 1395 et. seq.,

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(Medicare law) or as a professional standards review organization or statewide professional

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standards review council under the provisions of P.L. 92-603, 42 U.S.C. section 1301 et seq.,

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(professional standards review organizations) or a similar committee or a committee of similar

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purpose, to evaluate or review the diagnosis or treatment of the performance or rendition of dental

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services which are performed under public dental programs of either state or federal design.

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      (14) "Person" means any individual, partnership, firm, corporation, association, trust or

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estate, state or political subdivision, or instrumentality of a state.

 

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      (15) "Practice of dental hygiene." Any person is practicing dental hygiene within the

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meaning of this chapter who performs those services and procedures that a dental hygienist has

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been educated to perform and which services and procedures are, from time to time, specifically

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authorized by rules and regulations adopted by the board of examiners in dentistry. Nothing in

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this section is construed to authorize a licensed dental hygienist to perform the following:

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diagnosis and treatment planning, surgical procedures on hard or soft tissue, prescribe medication

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or administer general anesthesia or injectables other than oral local anesthesia. A dental hygienist

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is only permitted to practice dental hygiene under the general supervision of a dentist licensed

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and registered in this state under the provisions of this chapter.

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      (A) Provided, that in order to administer local injectable anesthesia to dental patients,

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dental hygienists must be under the supervision of a dentist and meet the requirements established

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by regulation of the board of examiners in dentistry including payment of a permit fee.

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      (16) (i) (A) "Practice of dentistry." Any person is practicing dentistry within the meaning

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of this chapter who:

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      (I) Uses or permits to be used, directly or indirectly, for profit or otherwise, for himself,

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herself or for any other person, in connection with his or her name, the word "dentist" or "dental

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surgeon," or the title "D.D.S." or "D.M.D." or any other words, letters, titles, or descriptive

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matter, personal or not, which directly or indirectly implies the practice of dentistry;

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      (II) Owns, leases, maintains, operates a dental business in any office or other room or

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rooms where dental operations are performed, or directly or indirectly is manager, proprietor or

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conductor of this business;

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      (III) Directly or indirectly informs the public in any language, orally, in writing, or in

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printing, or by drawings, demonstrations, specimens, signs, or pictures that he or she can perform

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or will attempt to perform dental operations of any kind;

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      (IV) Undertakes, by any means or method, gratuitously or for a salary, fee, money, or

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other reward paid or granted directly or indirectly to himself or herself or to any other person, to

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diagnose or profess to diagnose, or to treat or profess to treat, or to prescribe for or profess to

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prescribe for any of the lesions, diseases, disorders, or deficiencies of the human oral cavity,

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teeth, gums, maxilla or mandible, and/or adjacent associated structures;

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      (V) Extracts human teeth, corrects malpositions of the teeth or of the jaws;

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      (VI) Except on the written prescription of a licensed dentist and by the use of

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impressions or casts made by a licensed and practicing dentist, directly or indirectly by mail,

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carrier, personal agent, or by any other method, furnishes, supplies, constructs, reproduces, or

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repairs prosthetic dentures, bridges, appliances or other structures to be used and worn as

 

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substitutes for natural teeth;

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      (VII) Places those substitutes in the mouth and/or adjusts them;

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      (VIII) Administers an anesthetic, either general or local in the course of any of the

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previously stated dental procedures; or

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      (IX) Engages in any of the practices included in the curricula of recognized dental

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colleges;

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      (B) Provided that in order to administer any form of anesthesia, other than local, dentists

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must meet the requirements established by regulation of the board of examiners in dentistry,

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including payment of a permit fee.

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      (ii) The board shall promulgate regulations relating to anesthesia. Those regulations shall

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be consistent with the American Dental Association guidelines for the use of conscious sedation,

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deep sedation and general anesthesia in dentistry. Neither the board nor any regulation

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promulgated by the board shall require additional licensing fees for the use of nitrous oxide by

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dentists. Prior to the adoption of those regulations, dentists shall be permitted to administer

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anesthesia without restriction. From the proceeds of any fees collected pursuant to the provisions

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of this chapter, there is created a restricted receipts account which is used solely to pay for the

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administrative expenses incurred for expenses of administrating this chapter.

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      (iii) No non-dentist who operates a dental facility in the form of a licensed outpatient

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health care center or management service organization may interfere with the professional

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judgment of a dentist in the practice.

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     (17) "Direct visual supervision" means supervision by an oral and maxillofacial surgeon

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or dentist (with a permit to administer deep and general sedation) by verbal command and under

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direct line of sight.

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     5-31.1-2. Board of examiners in dentistry -- Members -- Compensation -- Funds. --

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(a) There is created within the department of health the Rhode Island board of examiners in

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dentistry, which is composed of the following members:

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      (1) Eight (8) licensed dentists, no more than three (3) shall be dental specialists as

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recognized by the American Dental Association (ADA);

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      (2) Four (4) public members not associated with the dental field;

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      (3) Two (2) licensed dental hygienists; and

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      (4) The chief of the office of dental public health, who shall serve as an ex-officio

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member of the board; and

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      (5) One certified dental assistant.

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      (b) The governor shall appoint the members of the board, except that prior to appointing

 

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the eight (8) dentist members the governor may submit a list of all candidates to the appropriate

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dental societies for comments as to their qualifications. No member shall be appointed for more

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than two (2) consecutive full terms. A member appointed for less than a full term (originally or to

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fill a vacancy) may serve two (2) full terms in addition to that part of a full term, and a former

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member is again eligible for appointment after a lapse of one or more years. All subsequent

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appointments to the board shall be for a term of three (3) years. Any member of the board may be

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removed by the governor for neglect of duty, misconduct, malfeasance, or misfeasance in office

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after being given a written statement of the charges against him or her and sufficient opportunity

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to be heard on the charges. The director of the department of health shall appoint from the

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members a chairperson who shall be a dentist duly licensed under the laws of the state of Rhode

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Island, and a vice-chairperson who shall in the absence of the chairperson exercise all powers of

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the chairperson, and secretary, who serve for one year or until their successors are appointed and

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qualified. The board shall meet at least once a month or more often upon the call of the

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chairperson, director of health or dental administrator, at any times and places that the

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chairperson designates.

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      (c) Members of the board shall not be paid for the discharge of official duties.

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      (d) The administration of the board shall be funded from annual fees. The director shall

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in consultation with the board determine the amount of the annual fee to be charged to each

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licensed dentist and dental hygienist, the payment of which is a condition to practicing dentistry

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or dental hygiene in the state. The director or the dental administrator has the authority to suspend

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or revoke the license of any dentist or dental hygienist who does not pay the annual fee. Monies

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shall be received by the department and deposited in the general fund as general revenues.

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     5-31.1-4. Powers and duties of the board of examiners in dentistry. -- The board of

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examiners in dentistry has the following duties and powers:

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      (1) To adopt, amend, and rescind any rules and regulations with the approval of the

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director of the department of health that it deems necessary to carry out the provisions of this

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chapter;

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      (2) To investigate all complaints and charges of unprofessional conduct against any

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licensed dentist, dental hygienist, or limited registrant and to hold hearings to determine whether

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those charges are substantiated or unsubstantiated;

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      (3) To direct the director of the department of health to license qualified applicants for

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licensure;

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      (4) To appoint one or more dentists or dental hygienists to act for the members of the

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board in investigating the conduct or competence of any licensed dentist, dental hygienist or

 

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limited registrant;

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      (5) To direct the director to revoke, suspend or impose other disciplinary action as to

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persons licensed or registered under this chapter;

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      (6)(i) To issue subpoenas and administer oaths in connection with any investigations,

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hearing or disciplinary proceedings held under the authority of this chapter;

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     (ii) All subpoenas issued pursuant to this section shall only be issued by a vote of the

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board of examiners in dentistry;

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     (A) Such subpoenas shall have attached to them written minutes disclosing the date and

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vote of the board of examiners in dentistry demonstrating the vote to issue said subpoena;

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     (B) All subpoenas issued by the board shall be served by a disinterested party or by a

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constable authorized by the courts to serve process;

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     (C) Subpoenas issued by the board of examiners in dentistry shall have a reasonable

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return date that will allow the recipient an opportunity to review the subpoena, consult with

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counsel, and prepare a response to the subpoena;

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     (D) All subpoenas shall be in compliance with the Rhode Island healthcare

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confidentiality act and include a patient consent when the subpoena calls for the disclosure of a

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patient record; and

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     (E) In the absence of a properly executed patient consent, subpoena requests shall only be

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made by request of the board to a court of competent jurisdiction that may issue a court order

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compelling production of confidentiality healthcare information of a patient.

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      (7) To take or cause depositions to be taken as needed in any investigation, hearing or

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proceeding;

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      (8) To summon and examine witnesses during any investigation, hearing or proceeding

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conducted by the board; and

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      (9) To adopt and publish, with the prior approval of the director, rules of procedure and

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other regulations in accordance with the Administrative Procedure Act, chapter 35 of title 42.

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     5-31.1-11. Complaints. – (a) Any person, firm, corporation, or public officer may submit

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a written complaint to the board charging the holder of a license to practice dentistry or dental

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hygiene or a limited registrant with unprofessional conduct, specifying the grounds for the

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charge.

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     (b) The board shall review all complaints and, in those instances where no referral is

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made to an investigating committee, the board of examiners in dentistry shall make a written

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finding of facts with regard to the complaint. In conducting an investigation of such complaints

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which requires an inspection of a dental office:

 

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     (1) The board of examiners in dentistry shall make such finding and it must be evidenced

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by recorded minutes showing the vote to conduct an inspection;

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     (2) The inspection team from the board of examiners in dentistry shall include a dentist

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member of the board and a hygiene member of the board;

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     (3) The scope and manner of conducting any such inspection shall be reasonably related

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to the written complaint received. Any dentist(s) whose practice is the subject of such inspection

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shall be provided by the board with a copy of the complaint or a written summary of all pertinent

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allegations prior to or at the commencement of the inspection;

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     (4) At the conclusion of the inspection and prior to leaving the dental office premises the

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board inspectors shall provide the dentist whose office has been inspected with a copy of the

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completed inspection form, noting areas of deficiency;

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     (5) Unless there is a real potential of imminent, unreasonable harm to patients or staff, the

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dentist shall have ten (10) days to remedy any deficiencies found during the inspection; and

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     (6) All inspections shall be carried out so as not to interfere with direct patient care by

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scheduling such inspections during the noon (12:00 p.m.) hour or at the end of the dental office

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workday.

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     (c) All complaints considered by the board or an investigating committee of the board

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shall be reported within six (6) months of the receipt of the complaint unless the board on a case

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by case basis, for good cause shown, in writing, extends the time for consideration; provided, that

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failure to report does not divest the board of its jurisdiction to pursue the rights and remedies

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established in this chapter.

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     (d) If the board determines that the complaint merits consideration, or if the board, on its

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own initiative without a formal complaint, has reason to believe that any holder of a license or

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limited registration to practice dentistry or of a license to practice dental hygiene may be guilty of

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unprofessional conduct, the chairperson shall designate two (2) members of the board, at least one

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of whom is a public member, to serve as a committee to investigate, and report upon the charges

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to the board. Upon the designation of an investigating committee by the board, written notice

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shall be provided to the licensee notifying him or her of the establishment of an investigating

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committee, and providing the licensee with the names of the members of the investigating

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committee and a copy of the complaint upon which the investigation was initiated.

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     If the complaint relates to a dentist one member of the committee shall be licensed as a

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dentist. If the complaint relates to a dental hygienist one member of the committee shall be

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licensed as a dental hygienist.

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     (e) Investigations shall remain confidential and all initial hearings, investigatory hearings,

 

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and full hearings before the board shall remain confidential.

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     (1) All referrals of matters arising out of a written complaint to the board of examiners in

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dentistry to the director of the department of health shall only be by a vote of the majority of the

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board of examiners in dentistry;

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     (2) The administrative staff of the board of examiners in dentistry shall not subvert the

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statutory procedures governing the referral of a matter to the director of the department of health,

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which may only be done pursuant to a vote of the majority of the board.

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     (f) In the event that a hearing takes place before the hearing committee of the board, all

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decisions of the board shall present conclusions of fact and conclusions of law applicable to the

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decision, which it has rendered.

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     (g) The board shall make public all decisions including findings of fact and conclusions

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of law, which call for any sanction against a license holder as prescribed in section 5-31.1-17.

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     (h) Following the investigation, the committee shall present its evaluations and

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recommendations to the board.

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     (i) The board shall review the committee's findings to determine whether to take further

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action, but no member of the board who participated in the investigation may participate in this

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review or any subsequent hearing or action taken by the board. The hearing committee shall

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consist of the remaining members of the board. Four (4) members of the hearing committee

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constitute a quorum for the transaction of business. The chairperson of the board shall preside

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over the hearing.

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     5-31.1-31. Dental assistant -- Definition -- Practices allowed. -- (a) As used in this

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chapter, a "dental assistant" is any person not licensed under the provisions of this chapter who

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performs dental services, procedures, or duties in aid of a licensed and registered dentist.

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      (b) No dental assistant shall perform any service, procedure, or duty which constitutes

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the practice of dentistry unless authorized by rules and regulations adopted by the board of

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examiners in dentistry, and unless that dental service, procedure, or duty is performed under the

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supervision of a dentist licensed and registered in this state. The board of examiners in dentistry

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shall establisheany establish any classification of dental assistants that are recognized by the

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American Dental Association, American Dental Assistants Association, and the American

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Association of Oral and Maxillofacial Surgeons, and to each class the board applies any of the

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rules and regulations permitted under this section that the board deems appropriate.

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      (c) Nothing in this section is construed to authorize a dental assistant to perform the

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following: diagnosis and treatment planning, surgical procedures on hard or soft tissue, prescribe

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medication, or administer injectable and/or general anesthesia, except as set forth in § 5-31.1-

 

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31(d).

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     (d) An oral and maxillofacial surgeon and a duly licensed dentist holding a permit issued

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by the board for the administration of general or deep sedation may employ and utilize the

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services of an oral surgery anesthesia assistant who has met the following criteria:

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     (1) Satisfactory evidence of completion of a dental anesthesia assistant training course

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prepared and administered by the American Association of Oral and Maxillofacial Surgeons.

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     (2) Completion of a board of examiners in dentistry-approved basic life support/cardiac

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pulmonary resuscitation course; and

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     (3) The valid general anesthesia permit of the oral and maxillofacial surgeon or dentist

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where the assistant will be performing his or her services is valid.

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     (e) Authorized functions - Supervision. –

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     (1) Any dental anesthesia assistant meeting the criteria of this section shall perform the

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functions authorized in this chapter only by delegation of authority from the oral and

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maxillofacial surgeon or dentist and under the supervision, as described in §§ 5-31.1-31(e)(2) and

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5-31.1-31-(e)(3), and provided the oral and maxillofacial surgeon or dentist is acting within the

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scope of his or her license. The responsibility for monitoring a patient and determining the

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selection of the drug, dosage, and timing of all anesthetic medications rests solely with the oral

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and maxillofacial surgeon or dentist.

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     (2) Under close supervision, the dental anesthesia assistant may:

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     (i) Discontinue an intravenous line for a patient who has received intravenous

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medications, sedation, or general anesthesia;

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     (ii) Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent

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or open; and

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     (iii) Draw up and prepare medications.

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     (3) Under direct visual supervision, the dental anesthesia assistant may:

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     (i) Follow instructions to deliver medications into;

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     (ii) Adjust the rate of intravenous fluids infusion beyond a keep open rate;

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     (iii) Adjust an electronic device to provide medications, such as an infusion pump;

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     (iv) Administer emergency medications to a patient in order to assist the oral and

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maxillofacial surgeon or dentist in an emergency.

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     (4) Any oral and maxillofacial surgeon or dentist delegating duties under this section

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must have a valid general anesthesia deep sedation permit.

 

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     SECTION 2. This act shall take effect upon passage.

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LC004113

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- DENTISTS AND DENTAL

HYGIENISTS

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     This act would amend various powers and duties relative to dentists and dental hygienists

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and the administration of the rules and regulations relating thereto.

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     This act would take effect upon passage.

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LC004113

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