July 7, 2017
The Honorable Evan Low, Chair
Assembly Business and Professions Committee
Legislative Office Building, Room 383
Sacramento, California 95814
Fax: (916) 319-3306
RE: SB 501 (Glazer): Dentistry: Anesthesia and sedation
AAP-CA Position: OPPOSE
Dear Chairman Low:
The American Academy of Pediatrics, California, representing over 5,000 board-certified pediatricians across the state, remains strongly opposed to SB 501 (Glazer) because it fails to adequately protect children undergoing anesthesia in dental offices. We respectfully urge a NO vote.
The mission of the AAP-CA is to protect and promote the health and well-being of all children and youth in California. Pediatricians have no financial interest in who administers and monitors anesthesia in a dental office. Our interest stems solely from our mission to protect and promote children’s health and well-being.
The American Academy of Pediatrics, in conjunction with the American Academy of Pediatric Dentistry, has published national guidelines that set a minimum standard of care for children undergoing sedation and anesthesia for dental procedures. These guidelines recognize that young children “are particularly vulnerable to the sedating medication’s effects,” including its rare but dangerous side effects. Their airways are smaller, and they need more anesthesia in order to remain still during painful procedures. Due to this increased vulnerability, the guidelines call for a second qualified provider to be solely dedicated to the task of monitoring a child during deep sedation and general anesthesia, as in every other health care profession in California.
For the safety of the child, it is essential that the dedicated monitor be able to evaluate and recognize warning signs early, and to assist in an emergency event affecting a child under the age of 7—which means they should have the skills and experience necessary to assess, resuscitate, and provide supportive measures for a child experiencing a life-threatening adverse reaction to anesthesia.
SB 501 (Glazer) risks making anesthesia less safe for children, because it allows unspecified “support staff” to perform the role of dedicated monitor. Dental support staff, such as dental assistants and dental sedation assistants, play valuable roles in dental offices, but are not trained or qualified to perform this highly specialized and complex task, any more than they would be qualified to perform the same task in a hospital or a surgical center.
AAP California is the sponsor of AB 224 (Thurmond), which protects children by clearly specifying which personnel are qualified to perform the role of anesthesia monitor for our state’s youngest and most vulnerable. These include: a permitted dentist, a physician and surgeon with postgraduate residency in anesthesiology, a nurse anesthetist, or a clinical nurse specialist or nurse practitioner with at least two years of pediatric critical care or recovery room experience. All of these staff have the knowledge and training to recognize adverse reactions to anesthesia in children and rescue them before it is too late. This is why we continue to urge legislators to support AB 224 (Thurmond), as it is the only bill under consideration that guarantees young children a qualified, dedicated anesthesia monitor during dental procedures.
We oppose SB 501 (Glazer) as written, as it offers a false sense of security that “something is being done” to prevent deaths of young children in dental chairs while still permitting unspecified support staff to perform a role that requires a higher standard of expertise—thus endangering children across California.
Pediatricians respectfully urge your NO vote on SB 501 (Glazer). We thank you for your public service and leadership on behalf of the health and well-being of children, youth, and families in California.
Chief Executive Officer
American Academy of Pediatrics, California
Cc: AAP-CA Leadership; Lydia Bourne; The Honorable Tony Thurmond; Members of the Assembly Business and Professions Committee