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REFERENCE TITLE: dentists' responsibility; sedation; informed consent |
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State of Arizona Senate Fifty-seventh Legislature Second Regular Session 2026
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SB 1637 |
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Introduced by Senator Shope
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AN ACT
Amending sections 32-1201 and 32-1272, Arizona Revised Statutes; amending title 32, chapter 11, article 3, Arizona Revised Statutes, by adding sections 32-1272.01, 32-1272.02 and 32-1273; Amending sections 32-1459, 32-1664 and 32-1855.02, Arizona Revised Statutes; relating to the state board of dental examiners.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 32-1201, Arizona Revised Statutes, is amended to read:
32-1201. Definitions
In this chapter, unless the context otherwise requires:
1. "Adverse event" means any incident that occurs in a dental office or dental clinic during or as a result of the administration of general anesthesia, deep sedation or moderate sedation and that results in or requires an emergency medical response.
1. 2. "Affiliated practice dental hygienist" means any licensed dental hygienist who is able, pursuant to section 32-1289.01, to initiate treatment based on the dental hygienist's assessment of a patient's needs according to the terms of a written affiliated practice agreement with a dentist, to treat the patient without the presence of a dentist and to maintain a provider-patient relationship.
2. 3. "Auxiliary personnel" means all dental assistants, dental technicians, dental x-ray technicians and other persons employed by dentists or firms and businesses providing dental services to dentists.
3. 4. "Board" means the state board of dental examiners.
4. 5. "Business entity" means a business organization that has an ownership that includes any persons who are not licensed or certified to provide dental services in this state, that offers to the public professional services regulated by the board and that is established pursuant to the laws of any state or foreign country.
5. 6. "Dental assistant" means any person who acts as an assistant to a dentist, dental therapist or dental hygienist by rendering personal services to a patient that involve close proximity to the patient while the patient is under treatment or observation or undergoing diagnostic procedures.
6. 7. "Dental hygienist" means any person who is licensed and engaged in the general practice of dental hygiene and all related and associated duties, including educational, clinical and therapeutic dental hygiene procedures.
7. 8. "Dental incompetence" means lacking in sufficient dentistry knowledge or skills, or both, in that field of dentistry in which the dentist, dental therapist, denturist or dental hygienist concerned engages, to a degree likely to endanger the health of that person's patients.
8. 9. "Dental laboratory technician" means any person, other than a licensed dentist, who, pursuant to a written work order of a dentist, fabricates artificial teeth, prosthetic appliances or other mechanical and artificial contrivances designed to correct or alleviate injuries or defects, both developmental and acquired, disorders or deficiencies of the human oral cavity, teeth, investing tissues, maxilla or mandible or adjacent associated structures.
9. 10. "Dental therapist" means any person who is licensed and engaged in the general practice of dental therapy and all related and associated duties, including educational, clinical and therapeutic dental therapy procedures.
10. 11. "Dental x-ray laboratory technician" means any person, other than a licensed dentist, who, pursuant to a written work order of a dentist, performs dental and maxillofacial radiography, including cephalometrics, panoramic and maxillofacial tomography and other dental related nonfluoroscopic diagnostic imaging modalities.
11. 12. "Dentistry", "dentist" and "dental" mean the general practice of dentistry and all specialties or restricted practices of dentistry.
12. 13. "Denturist" means a person practicing denture technology pursuant to article 5 of this chapter.
13. 14. "Disciplinary action" means regulatory sanctions that are imposed by the board in combination with, or as an alternative to, revocation or suspension of a license and that may include:
(a) Imposition of an administrative penalty in an amount not to exceed $2,000 for each violation of this chapter or rules adopted under this chapter.
(b) Imposition of restrictions on the scope of practice.
(c) Imposition of peer review and professional education requirements.
(d) Imposition of censure or probation requirements best adapted to protect the public welfare, which may include a requirement for restitution to the patient resulting from violations of this chapter or rules adopted under this chapter.
15. "Emergency medical response" includes:
(a) The initiation of emergency medical services by dialing the telephone number 911 or a similar public dispatch.
(b) A patient transport to a hospital or other emergency health care facility for medical treatment, whether requested by the patient or not.
14. 16. "Irregularities in billing" means submitting any claim, bill or government assistance claim to any patient, responsible party or third-party payor for dental services rendered that is materially false with the intent to receive unearned income as evidenced by any of the following:
(a) Charges for services not rendered.
(b) Any treatment date that does not accurately reflect the date when the service and procedures were actually completed.
(c) Any description of a dental service or procedure that does not accurately reflect the actual work completed.
(d) Any charge for a service or procedure that cannot be clinically justified or determined to be necessary.
(e) Any statement that is material to the claim and that the licensee knows is false or misleading.
(f) An abrogation of the copayment provisions of a dental insurance contract by a waiver of all or a part of the copayment from the patient if this results in an excessive or fraudulent charge to a third party or if the waiver is used as an enticement to receive dental services from that provider. This subdivision does not interfere with a contractual relationship between a third-party payor and a licensee or business entity registered with the board.
(g) Any other practice in billing that results in excessive or fraudulent charges to the patient.
15. 17. "Letter of concern" means an advisory letter to notify a licensee or a registered business entity that, while the evidence does not warrant disciplinary action, the board believes that the licensee or registered business entity should modify or eliminate certain practices and that continuation of the activities that led to the information being submitted to the board may result in board action against the practitioner's license or the business entity's registration. A letter of concern is not a disciplinary action. A letter of concern is a public document and may be used in a future disciplinary action.
16. 18. "Licensed" means licensed pursuant to this chapter.
17. 19. "Place of practice" means each physical location at which a person who is licensed pursuant to this chapter performs services subject to this chapter.
18. 20. "Primary mailing address" means the address on file with the board and to which official board correspondence, notices or documents are delivered in a manner determined by the board.
19. 21. "Qualified anesthesia provider" means any of the following:
(a) A licensee who holds a permit to administer anesthesia and sedation from the board pursuant to section 32-1207.
(b) A physician who has completed residency training in anesthesiology, who is licensed pursuant to chapter 13 or 17 of this title and who is registered with the Arizona medical board or the Arizona board of osteopathic examiners in medicine and surgery to administer anesthesia in dental offices and dental clinics pursuant to section 32-1403 or 32-1803.
(c) A certified registered nurse anesthetist who has a national board certification in anesthesiology, who is licensed pursuant to chapter 15 of this title and who is registered with the Arizona state board of nursing to administer anesthesia in dental offices and dental clinics pursuant to section 32-1606.
20. 22. "Recognized continuing dental education" means continuing dental education as prescribed by the board in rule.
21. 23. "Recognized dental hygiene school" means a school that has a dental hygiene program with a minimum two academic year curriculum, or the equivalent of four semesters, and that is approved by the board and accredited by the American dental association commission on dental accreditation.
22. 24. "Recognized dental school" means a dental school that is accredited by the American dental association commission on dental accreditation.
23. 25. "Recognized dental therapy school" means a school that is accredited or that has received initial accreditation by the American dental association commission on dental accreditation.
24. 26. "Recognized denturist school" means a denturist school that maintains standards of entrance, study and graduation and that is accredited by the United States department of education or the council on higher education accreditation.
25. 27. "Supervised personnel" means all dental hygienists, dental assistants, dental laboratory technicians, dental therapists, denturists, dental x-ray laboratory technicians and other persons supervised by licensed dentists.
26. 28. "Teledentistry" means the use of data transmitted through interactive audio, video or data communications for the purposes of examination, diagnosis, treatment planning, consultation and directing the delivery of treatment by dentists and dental providers in settings permissible under this chapter or specified in rules adopted by the board.
Sec. 2. Section 32-1272, Arizona Revised Statutes, is amended to read:
32-1272. Dental anesthesia; requirements; adverse events
A. A dental office or dental clinic at which general anesthesia or sedation is administered must contain properly operating equipment and supplies as prescribed by the board in rule and have proper emergency response protocols in place, including advanced cardiac life support and airway management and pediatric advanced life support, as applicable, when administering general anesthesia or sedation as prescribed by the board in rule that is consistent with the standards and practices recommended by the American heart association.
B. A qualified anesthesia provider who is licensed by the board and who fails to comply with the requirements of this section or applicable board rules commits an act that constitutes a danger to the health, welfare or safety of the public pursuant to section 32-1201.01.
C. If a qualified anesthesia provider who is not licensed by the state board of dental examiners fails to comply with the requirements of this section or applicable board rules, the state board of dental examiners shall promptly report the qualified anesthesia provider's conduct to the regulatory board that licenses the qualified anesthesia provider. If an adverse anesthesia outcome event involves a qualified anesthesia provider who is not licensed by the state board of dental examiners, the state board of dental examiners shall promptly report the adverse anesthesia outcome event to the regulatory board that licenses the qualified anesthesia provider.
D. If a death or an incident requiring emergency medical response occurs in a dental office or dental clinic during the administration of or recovery from general anesthesia or sedation by a qualified anesthesia provider, the treating dentist shall submit a report of the incident to the state board of dental examiners within seven business days after the occurrence. If the incident involves a qualified anesthesia provider who is not licensed by the state board of dental examiners, the state board of dental examiners shall immediately forward a copy of the incident report to the regulatory board that licenses the qualified anesthesia provider.
Sec. 3. Title 32, chapter 11, article 3, Arizona Revised Statutes, is amended by adding sections 32-1272.01, 32-1272.02 and 32-1273, to read:
32-1272.01. Anesthesia and sedation informed consent; form requirements
A. Before administering general anesthesia, deep sedation or moderate sedation in a dental office, the dentist of record shall obtain, or verify that the qualified anesthesia provider has obtained, a separate written informed consent for the anesthesia or sedation.
B. Informed consent obtained under subsection A of this section must be documented on a form distinct from the consent for the dental treatment and must, at a minimum:
1. Identify the specific level of anesthesia or sedation to be administered.
2. Identify by name and professional license type the qualified anesthesia provider who is responsible for administering the anesthesia or sedation.
3. Disclose the material risks, benefits and alternatives associated with the proposed anesthesia or sedation.
4. Confirm that the patient has received and understands all preoperative and postoperative instructions.
32-1272.02. Adverse events; failure to report; practice restrictions
A. If an adverse event occurs in a dental office or dental clinic during the administration of or recovery from anesthesia or sedation:
1. The treating dentist of record shall submit a complete written report of the incident to the board within seven business days after the adverse event occurs.
2. The qualified anesthesia provider shall submit a complete written report of the adverse event to that provider's own respective health profession regulatory board within seven business days after the adverse event occurs.
B. If a dentist fails to report an adverse event as required by this section, on review and a finding by the board that the dentist knowingly failed to report, the board shall impose a mandatory practice restriction on the dentist's license.
C. The failure of a qualified anesthesia provider to report an adverse event as required by this section shall be reported by the state board of dental examiners to the health profession regulatory board that licenses the qualified anesthesia provider. The state board of dental examiners shall recommend that the health profession regulatory board that licenses the qualified anesthesia provider impose a mandatory practice restriction for the failure to report.
32-1273. Dentists of record; responsibility; patient care
A. Each patient shall have a dentist of record. The dentist of record is the dentist who is ultimately responsible for the dental treatment of the patient. The dentist of record must be identified in the patient's dental record.
B. The dentist of record retains ultimate responsibility for the overall safety and welfare of the patient during any dental procedure, including procedures involving anesthesia or sedation.
C. This section does not relieve a qualified anesthesia provider of the qualified anesthesia provider's responsibility for the safe delivery of anesthesia or sedation and for the management of the patient's anesthetic care. The authority to delegate the administration of anesthesia or sedation to a qualified anesthesia provider does not relieve the dentist of record from the ultimate responsibility for the care of the patient.
Sec. 4. Section 32-1459, Arizona Revised Statutes, is amended to read:
32-1459. Duty to report; definition
A. If a death or an incident requiring emergency medical response an adverse event occurs in a dental office or dental clinic during the administration of or recovery from general anesthesia or sedation by a doctor of medicine, the doctor of medicine shall, and any other person may, report the death or incident adverse event to the board within seven business days after the occurrence.
B. For the purposes of this section, "adverse event" has the same meaning prescribed in section 32-1201.
Sec. 5. Section 32-1664, Arizona Revised Statutes, is amended to read:
32-1664. Investigation; hearing; notice; definition
A. In connection with an investigation, the board or its duly authorized agents or employees may obtain any documents, reports, records, papers, books and materials, including hospital records, medical staff records and medical staff review committee records, or any other physical evidence that indicates that a person or regulated party may have violated this chapter or a rule adopted pursuant to this chapter:
1. By entering the premises, at any reasonable time, and inspecting and copying materials in the possession of a regulated party that relate to nursing competence, unprofessional conduct or the mental or physical ability of a licensee to safely practice nursing.
2. By issuing a subpoena under the board's seal to require the attendance and testimony of witnesses or to demand the production for examination or copying of documents or any other physical evidence. Within five days after a person is served with a subpoena, that person may petition the board to revoke, limit or modify the subpoena. The board shall do so if in its opinion the evidence required does not relate to unlawful practices covered by this chapter, is not relevant to the charge that is the subject matter of the hearing or investigation or does not describe with sufficient particularity the physical evidence whose production is required.
3. By submitting a written request for the information.
4. In the case of an applicant's or a regulated party's personal medical records, as defined in section 12-2291, by any means allowed by this section if the board either:
(a) Obtains from the applicant or regulated party, or the health care decision maker of the applicant or regulated party, a written authorization that satisfies the requirements of title 12, chapter 13, article 7.1.
(b) Reasonably believes that the records relate to information already in the board's possession regarding the competence, unprofessional conduct or mental or physical ability of the applicant or regulated party as it pertains to safe practice. If the board adopts a substantive policy statement pursuant to section 41-1091, it may authorize the executive director, or a designee in the absence of the executive director, to make the determination of reasonable belief.
B. A regulated party and a health care institution as defined in section 36-401 shall, and any other person may, report to the board any information the licensee, certificate holder, health care institution or individual may have that appears to show that a regulated party or applicant is, was or may be a threat to the public health or safety.
C. If a death or an incident requiring emergency medical response an adverse event occurs in a dental office or dental clinic during the administration of or recovery from general anesthesia or sedation by a certified registered nurse anesthetist, the certified registered nurse anesthetist shall, and any other person may, report the death or incident adverse event to the board within seven business days after the occurrence.
D. The board retains jurisdiction to proceed with an investigation or a disciplinary proceeding against a regulated party whose license or certificate expired not more than five years before the board initiates the investigation.
E. Any regulated party, health care institution or other person that reports or provides information to the board in good faith is not subject to civil liability. If requested the board shall not disclose the name of the reporter unless the information is essential to proceedings conducted pursuant to this section.
F. Any regulated party or person who is subject to an investigation may obtain representation by counsel.
G. On determination of reasonable cause, the board, or if delegated by the board the executive director, may require a licensee, certificate holder or applicant to undergo at the expense of the licensee, certificate holder or applicant any combination of mental, physical or psychological examinations, assessments or skills evaluations necessary to determine the person's competence or ability to practice safely. These examinations may include bodily fluid testing and other examinations known to detect the presence of alcohol or drugs. If the executive director orders the licensee, applicant or certificate holder to undertake an examination, assessment or evaluation pursuant to this subsection, and the licensee, certificate holder or applicant fails to affirm to the board in writing within fifteen days after receipt of the notice of the order that the licensee, certificate holder or applicant intends to comply with the order, the executive director shall refer the matter to the board to allow the board to determine whether to issue an order pursuant to this subsection. At each regular meeting of the board the executive director shall report to the board data concerning orders issued by the executive director pursuant to this subsection since the last regular meeting of the board and any other data requested by the board.
H. The board shall provide the investigative report if requested pursuant to section 32-3206.
I. If after completing its investigation the board finds that the information provided pursuant to this section is not of sufficient seriousness to merit disciplinary action against the regulated party or applicant, it may take either of the following actions:
1. Dismiss if in the opinion of the board the information is without merit.
2. File a letter of concern if in the opinion of the board there is insufficient evidence to support disciplinary action against the regulated party or applicant but sufficient evidence for the board to notify the regulated party or applicant of its concern.
J. Except as provided pursuant to section 32-1663, subsection F and subsection K of this section, if the investigation in the opinion of the board reveals reasonable grounds to support the charge, the regulated party is entitled to an administrative hearing pursuant to title 41, chapter 6, article 10. If notice of the hearing is served by certified mail, service is complete on the date the notice is placed in the mail.
K. A regulated party shall respond in writing to the board within thirty days after notice of the hearing is served as prescribed in subsection J of this section. The board may consider a regulated party's failure to respond within this time as an admission by default to the allegations stated in the complaint. The board may then take disciplinary actions allowed by this chapter without conducting a hearing.
L. An administrative law judge or a panel of board members may conduct hearings pursuant to this section.
M. In any matters pending before it, the board may issue subpoenas under its seal to compel the attendance of witnesses.
N. Patient records, including clinical records, medical reports, laboratory statements and reports, any file, film, other report or oral statement relating to diagnostic findings or treatment of patients, any information from which a patient or a patient's family might be identified or information received and records kept by the board as a result of the investigation procedure outlined in this chapter are not available to the public and are not subject to discovery in civil or criminal proceedings.
O. Hospital records, medical staff records, medical staff review committee records, testimony concerning these records and proceedings related to the creation of these records shall not be available to the public. They shall be kept confidential by the board and shall be subject to the same provisions concerning discovery and use in legal actions as are the original records in the possession and control of hospitals, their medical staffs and their medical staff review committees. The board shall use these records and testimony during the course of investigations and proceedings pursuant to this chapter.
P. If the regulated party is found to have committed an act of unprofessional conduct or to have violated this chapter or a rule adopted pursuant to this chapter, the board may take disciplinary action.
Q. The board may subsequently issue a denied license or certificate and may reissue a revoked or voluntarily surrendered license or certificate.
R. On application by the board to any superior court judge, a person who without just cause fails to comply with a subpoena issued pursuant to this section may be ordered by the judge to comply with the subpoena and punished by the court for failing to comply. Subpoenas shall be served by regular or certified mail or in the manner required by the Arizona rules of civil procedure.
S. The board may share investigative information that is confidential under subsections N and O of this section with other state, federal and international health care agencies and with state, federal and international law enforcement authorities if the recipient is subject to confidentiality requirements similar to those established by this section. A disclosure made by the board pursuant to this subsection is not a waiver of the confidentiality requirements established by this section.
T. For the purposes of this section, "adverse event" has the same meaning prescribed in section 32-1201.
Sec. 6. Section 32-1855.02, Arizona Revised Statutes, is amended to read:
32-1855.02. Physicians; duty to report; definition
A. If a death or an incident requiring emergency medical response an adverse event occurs in a dental office or dental clinic during the administration of or recovery from general anesthesia or sedation by a physician, the physician shall, and any other person may, report the death or incident adverse event to the board within seven business days after the occurrence.
B. For the purposes of this section, "adverse event" has the same meaning prescribed in section 32-1201.