Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 5 - STATE BOARD OF DENTAL EXAMINERS › Chapter 110 - SEDATION AND ANESTHESIA › Section 110.18 - Inspection of Sedation/Anesthesia Providers

Current through Reg. 49, No. 28; July 12, 2024
(a) The Board may
				conduct inspections to enforce Chapter 110 of this title (relating to Sedation
				and Anesthesia), including inspections of a licensee, an office site,
				equipment, a facility, and any document required by Board rules. The
				inspections shall not identify violations outside the applicable
				sedation/anesthesia rules in effect for each permit level at the time of the
				inspection. The Board may employ Board staff or contract with another state
				agency or qualified person to conduct these inspections.
(b) Unless it would jeopardize an ongoing
				investigation, the Board shall provide at least ten business days' notice
				before conducting an on-site inspection under this section.
(c) Regardless of issue date, all level 2, 3
				and 4 permit holders will be subject to at least one inspection prior to
				September 1, 2022. All level 2, 3, and 4 permit holders who received their
				initial permit after March 1, 2018, must be inspected within a year of
				receiving their permit.
(d)
				Compliance/Tier 1 inspections: The initial inspection will be a compliance
				inspection, in which a Board staff member will evaluate the permit holder's
				compliance with the Board's rules through completing a checklist and auditing
				one sedation/anesthesia record of the inspector's choosing that was completed
				prior to the date the Board notified the licensee of the inspection. The record
				shall be of treatment for the highest level of sedation/anesthesia permit held
				by the permit holder, and will apply the Board rules in effect at the time the
				patient was treated. The inspector shall be a member of Board staff and will
				receive training in recognizing the checklist requirements and in evaluating
				sedation/anesthesia records. If the inspection results in the identification of
				a violation of the Board's rules found in Chapter 110, the permit holder must
				immediately cease providing sedation/anesthesia services until satisfactory
				proof is provided to Board staff that the violation has been corrected. Board
				staff shall provide contact information for both an inspector and supervisor of
				the inspector so that the permit holder may provide proof of remediation as
				soon as possible. Any violation of this cease and desist requirement shall
				represent grounds for disciplinary action. A failure by Board staff to respond
				within two business days to permit holder's satisfactory proof of remediation
				shall represent an affirmative defense to disciplinary action. Additionally,
				the permit holder shall pay an amount of not more than five hundred dollars
				($500.00) as necessary to cover the expenses of additional review and
				inspection by Board staff as a result of any violations identified during the
				initial inspection. If, after a completed Compliance/Tier 1 inspection, the
				only violation(s) identified by Board staff relate to the time-interval
				recording requirements contained in the inspection items numbered 3 and 4 of
				the "Patient Record Audit" portion of the attached graphic "Anesthesia Levels
				2-4 Inspection Form" for this section, then the violation(s) may be remedied by
				the Respondent through the execution of a sworn affidavit provided by Board
				staff. The Respondent's affidavit must attest that the Respondent shall observe
				the requirements of the applicable sedation/anesthesia rule sections requiring
				time interval recording for each permit level the Respondent holds. The
				inspection checklist can be previewed here:
Attached
				  Graphic
(e)
				Risk-based/Tier 2 inspections: A permit holder with a violation on a
				compliance/tier 1 inspection that is not remedied within thirty (30) days shall
				be referred to a risk-based inspection. Additionally, a Board member sitting on
				an informal settlement conference panel pursuant to Tex. Occ. Code
				§263.0072 may refer a permit holder to a risk-based inspection. The
				risk-based inspection will include the same factors as a compliance inspection,
				as well as a competency evaluation consisting of an audit of five
				sedation/anesthesia records of the inspector's choosing. The records shall be
				of treatment records for the highest level of sedation/anesthesia permit held
				by the permit holder, and shall apply the Board rules in effect at the time the
				patient was treated. Review of the five sedation/anesthesia records shall be
				performed by members of the Board's dental review panel process pursuant to
				Tex. Occ. Code §255.0065 who currently hold the same or higher level of
				sedation/anesthesia permit. The dental review panel reviewer shall prepare a
				report and note any violations or concerns with the permit holder's competency,
				and the report shall be reviewed following the procedure described in Tex. Occ.
				Code §255.0067. Any violation found during the risk-based inspection may
				result in the filing of a complaint and complaint resolution pursuant to the
				Board's informal disposition process in §
									107.63 of this title (relating to
				Informal Disposition and Mediation). The Executive Committee of the Board may
				order the emergency temporary suspension of a permit if the risk-based
				inspection reveals evidence of a clear, imminent, or continuing threat to the
				health or well-being of the public.
(f) Inactive status: A permit holder may
				forego an inspection if they submit a notarized, Board-issued affidavit that
				they will not administer levels 2, 3, or 4 sedation/anesthesia until first
				notifying the Board in writing that they wish to resume those activities. A
				permit holder must complete a compliance/Tier 1 inspection prior to resuming
				the administration of sedation/anesthesia at the inactive permit level. The
				permit holder must comply with continuing education and any other permit
				requirements during this time. During the period of inactive status, a permit
				holder may not delegate any inactive-status level of sedation/anesthesia to a
				certified registered nurse anesthetist or any other dental or medical
				professional except a dentist with a permit issued by the Board for the
				procedure being performed or a physician anesthesiologist licensed by the Texas
				Medical Board. If the permit holder is later found to have administered or
				delegated the administration of level 2, 3, or 4 sedation/anesthesia while in
				inactive status, the Board may pursue revocation of their dental
				license.
(g) Exempt-location
				status: The Board shall not inspect a level 2, 3, or 4 permit holder who
				provides those services exclusively in a state-licensed hospital or
				state-licensed ambulatory surgery center. The permit holder must attest to that
				fact with a notarized, Board-issued affidavit and may not provide those
				services at a non-exempt location until first notifying the Board in writing
				and successfully completing a compliance/Tier 1 inspection. During the period
				of exempt-location status, a permit holder may not delegate the administration
				of any level of sedation/anesthesia to a dental or medical professional outside
				a state-licensed hospital or state-licensed ambulatory surgery center. If they
				are later found to have administered or delegated the administration of level
				2, 3, or 4 sedation/anesthesia in a non-exempt location, the Board may pursue
				revocation of their dental license.
(h) Group practice inspections. The Board
				shall permit group practices to request an inspection of all permit holders in
				a single location during one inspection visit. Permit holders shall inform
				Board staff upon receiving notice of an inspection their wish to receive a
				combined group practice inspection, and Board staff shall accommodate this
				request as feasible while ensuring a group inspection shall not jeopardize an
				ongoing investigation. Board staff shall ensure that group practice inspection
				requests do not create unnecessary delays to the completion of the inspection
				process and may decline the request as needed to ensure timely completion of
				all scheduled inspections.