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7 LONG TITLE
8 General Description:
9 This bill amends professional licensing acts in the Division of Occupational and
10 Professional Licensing Act to require increased monitoring, in certain circumstances,
11 of patients who are sedated.
12 Highlighted Provisions:
13 This bill:
14 ▸ requires the Division of Occupational and Professional Licensing to:
15 • create a database of adverse events from the administration of sedation or
16 general anesthesia in outpatient settings; and
17 • publish a report regarding the number of adverse events by types of provider and
18 facility;
19 ▸ defines terms;
20 ▸ prohibits certain health care providers from administering sedation or general
21 anesthesia and performing therapeutic or diagnostic procedures on a patient without
22 another qualified health care provider present to monitor the patient's anesthesia
23 care;
24 ▸ prohibits a nurse, who is not a certified registered nurse anesthetist, from
25 administering deep sedation or general anesthesia to a patient unless:
26 • the nurse has a medical order for the deep sedation or general anesthesia; and
27 • the patient is intubated and in an intensive care unit of a general acute hospital;
28 and
29 ▸ requires a professional who administers sedation to have access to a crash cart
30 during a sedation procedure.
31 Money Appropriated in this Bill:
32 None
33 Other Special Clauses:
34 None
35 Utah Code Sections Affected:
36 AMENDS:
37 58-5a-102, as last amended by Laws of Utah 2015, Chapter 230
38 58-31b-501, as last amended by Laws of Utah 2006, Chapter 291
39 58-67-501, as last amended by Laws of Utah 2015, Chapter 110
40 58-68-501, as last amended by Laws of Utah 2015, Chapter 110
41 58-69-501, as last amended by Laws of Utah 2015, Chapter 343
42 ENACTS:
43 58-1-112, Utah Code Annotated 1953
44 58-5a-308, Utah Code Annotated 1953
45 58-31b-804, Utah Code Annotated 1953
46 58-67-807, Utah Code Annotated 1953
47 58-68-807, Utah Code Annotated 1953
48 58-69-807, Utah Code Annotated 1953
49
50 Be it enacted by the Legislature of the state of Utah:
51 Section 1. Section 58-1-112 is enacted to read:
52 58-1-112. Reports of anesthesia adverse events.
53 (1) (a) Beginning January 1, 2018, the division shall create a database of deaths and
54 adverse events from the administration of sedation or general anesthesia in outpatient settings
55 in the state.
56 (b) The database required by Subsection (1)(a) shall include reports submitted by
57 licensees under Sections 58-5a-307, 58-31b-804, 58-67-807, 58-68-807, and 58-69-807.
58 (2) The division may adopt administrative rules under Title 63G, Chapter 3, Utah
59 Administrative Rulemaking Act, regarding:
60 (a) the format of the reports; and
61 (b) what constitutes a reportable adverse event, which shall include at least a sedation
62 when there is:
63 (i) an escalation of care required for the patient; or
64 (ii) a rescue of a patient from a deeper level of sedation than was intended.
65 (3) (a) Information the division receives under this section that identifies a particular
66 individual is subject to Title 63G, Chapter 2, Government Records Access and Management
67 Act, and the federal Health Insurance Portability and Accountability Act of 1996.
68 (b) Beginning July 1, 2018, and on or before July 1 of each year thereafter, the division
69 shall publicly report:
70 (i) the number of deaths and adverse events under Subsection (1);
71 (ii) the type of providers, by license category and specialty, who submitted reports
72 under Subsection (1); and
73 (iii) the type of facility in which the death or adverse event took place.
74 Section 2. Section 58-5a-102 is amended to read:
75 58-5a-102. Definitions.
76 In addition to the definitions under Section 58-1-102, as used in this chapter:
77 (1) "Board" means the Podiatric Physician Board created in Section 58-5a-201.
78 (2) "Indirect supervision" means the same as that term is defined by the division by
79 rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
80 (3) "Medical assistant" means an unlicensed individual working under the indirect
81 supervision of a licensed podiatric physician and engaging in specific tasks assigned by the
82 licensed podiatric physician in accordance with the standards and ethics of the podiatry
83 profession.
84 (4) "Practice of podiatry" means the diagnosis and treatment of conditions affecting the
85 human foot and ankle and their manifestations of systemic conditions by all appropriate and
86 lawful means, subject to Section 58-5a-103.
87 (5) "Unlawful conduct" includes:
88 (a) the conduct that constitutes unlawful conduct under Section 58-1-501; and
89 (b) for an individual who is not licensed under this chapter:
90 (i) using the title or name podiatric physician, podiatrist, podiatric surgeon, foot doctor,
91 foot specialist, or D.P.M.; or
92 (ii) implying or representing that the individual is qualified to practice podiatry.
93 (6) "Unprofessional conduct" includes, for an individual licensed under this chapter:
94 (a) the conduct that constitutes unprofessional conduct under Section 58-1-501;
95 (b) communicating to a third party, without the consent of the patient, information the
96 individual acquires in treating the patient, except as necessary for professional consultation
97 regarding treatment of the patient;
98 (c) allowing the individual's name or license to be used by an individual who is not
99 licensed to practice podiatry under this chapter;
100 (d) except as described in Section 58-5a-306, employing, directly or indirectly, any
101 unlicensed individual to practice podiatry;
102 (e) using alcohol or drugs, to the extent the individual's use of alcohol or drugs impairs
103 the individual's ability to practice podiatry;
104 (f) unlawfully prescribing, selling, or giving away any prescription drug, including
105 controlled substances, as defined in Section 58-37-2;
106 (g) gross incompetency in the practice of podiatry;
107 (h) willfully and intentionally making a false statement or entry in hospital records,
108 medical records, or reports;
109 (i) willfully making a false statement in reports or claim forms to governmental
110 agencies or insurance companies with the intent to secure payment not rightfully due;
111 (j) willfully using false or fraudulent advertising; [
112 (k) conduct the division defines as unprofessional conduct by rule made in accordance
113 with Title 63G, Chapter 3, Utah Administrative Rulemaking Act[
114 (l) administering sedation or general anesthesia in violation of Section 58-5a-308.
115 Section 3. Section 58-5a-308 is enacted to read:
116 58-5a-308. Anesthesia practice standards.
117 (1) For purposes of this section:
118 (a) (i) "Deep sedation" means a pharmacological induced depression of consciousness
119 during which:
120 (A) the patient cannot easily be aroused, but will respond purposefully, other than a
121 reflex withdrawal response, to repeated or painful stimulation;
122 (B) the patient's ability to independently maintain ventilatory function may be impaired
123 or spontaneous ventilation may be inadequate, and the patient may require assistance to
124 maintain an airway; and
125 (C) the patient's cardiovascular function is maintained.
126 (ii) "Deep sedation" includes administering a drug classified as a general anesthetic
127 under Subsection 58-31b-804(1)(a).
128 (b) "General anesthesia" means a pharmacological induced loss of consciousness
129 during which:
130 (i) the patient cannot be aroused, even with painful stimulation;
131 (ii) the patient's ability to independently maintain ventilatory function may be
132 impaired;
133 (iii) spontaneous ventilation may be inadequate;
134 (iv) the patient may require positive pressure ventilation assistance to maintain an
135 airway because of depressed spontaneous ventilation or pharmacological induced depression of
136 neuromuscular function; and
137 (v) the patient's cardiovascular function may be impaired.
138 (c) "Minimal sedation" means a pharmacological induced state of consciousness during
139 which:
140 (i) the patient responds normally to verbal commands;
141 (ii) the patient's cognitive function and physical coordination may be impaired; and
142 (iii) airway reflexes, ventilatory function, and cardiovascular function are not impaired.
143 (d) "Moderate sedation" means a pharmacological induced depression of consciousness
144 during which a patient responds purposefully to verbal commands, either alone or accompanied
145 by light tactile stimulation, and during which no interventions are required to maintain an
146 airway.
147 (2) (a) A podiatric physician licensed under this chapter may not administer deep
148 sedation or general anesthesia to a patient and perform a diagnostic or therapeutic procedure on
149 the patient while the patient is under deep sedation or general anesthesia, unless the podiatric
150 physician has one of the following present during the procedure for the sole purpose of
151 monitoring and managing the sedation care of the patient:
152 (i) another podiatric physician;
153 (ii) a physician licensed under Chapter 67, Utah Medical Practice Act, or Chapter 68,
154 Utah Osteopathic Medical Practice Act;
155 (iii) a dentist licensed under Chapter 69, Dentist and Dental Hygienist Practice Act:
156 (A) who holds a current permit issued by the division authorizing the dentist to
157 administer the type of anesthesia administered to the patient; and
158 (B) if the procedure for which the sedation is administered is within the scope of
159 practice for the dentist; or
160 (iv) a certified registered nurse anesthetist licensed as a certified registered nurse
161 anesthetist under Chapter 31b, Nurse Practice Act.
162 (b) A podiatric physician, licensed under this chapter, may not administer moderate
163 sedation or minimal sedation to a patient intravenously and perform a diagnostic or therapeutic
164 procedure on the patient while the patient is under moderate or minimal sedation, unless the
165 podiatric physician has one of the practitioners listed in Subsection (2)(a), or a nurse licensed
166 under Chapter 31b, Nurse Practice Act, present during the procedure for the sole purpose of
167 monitoring and managing the sedation care of the patient.
168 (3) A licensed podiatric physician under this chapter may not administer intravenous
169 sedation to a patient without having access during the procedure to an advanced cardiac life
170 support crash cart with equipment that is regularly maintained according to guidelines
171 established by the American Hospital Association.
172 (4) Beginning January 1, 2018, a podiatric physician shall report to the division any
173 deaths or adverse events from the administration of sedation or general anesthesia in an
174 outpatient setting. The report shall be submitted to the division in accordance with Section
175 58-1-112.
176 Section 4. Section 58-31b-501 is amended to read:
177 58-31b-501. Unlawful conduct.
178 "Unlawful conduct" includes:
179 (1) using the following titles, names or initials, if the user is not properly licensed or
180 certified under this chapter:
181 (a) nurse;
182 (b) licensed practical nurse, practical nurse, or L.P.N.;
183 (c) medication aide certified, or M.A.C.;
184 (d) registered nurse or R.N.;
185 (e) registered nurse practitioner, N.P., or R.N.P.;
186 (f) registered nurse specialist, N.S., or R.N.S.;
187 (g) registered psychiatric mental health nurse specialist;
188 (h) advanced practice registered nurse;
189 (i) nurse anesthetist, certified nurse anesthetist, certified registered nurse anesthetist, or
190 C.R.N.A.; or
191 (j) other generally recognized names or titles used in the profession of nursing;
192 (2) (a) using any other name, title, or initials that would cause a reasonable person to
193 believe the user is licensed or certified under this chapter if the user is not properly licensed or
194 certified under this chapter; and
195 (b) for purposes of Subsection (2)(a), it is unlawful conduct for a medication aide
196 certified to use the term "nurse"; [
197 (3) conducting a nursing education program in the state for the purpose of qualifying
198 individuals to meet requirements for licensure under this chapter without the program having
199 been approved under Section 58-31b-601[
200 (4) administering sedation or general anesthesia in violation of Section 58-31b-804.
201 Section 5. Section 58-31b-804 is enacted to read:
202 58-31b-804. Anesthesia practice standards.
203 (1) For purposes of this section:
204 (a) (i) "Deep sedation" means a pharmacological induced depression of consciousness
205 during which:
206 (A) the patient cannot easily be aroused, but will respond purposefully, other than a
207 reflex withdrawal response, to repeated or painful stimulation;
208 (B) the patient's ability to independently maintain ventilatory function may be impaired
209 or spontaneous ventilation may be inadequate, and the patient may require assistance to
210 maintain an airway; and
211 (C) the patient's cardiovascular function is maintained.
212 (ii) "Deep sedation" includes administering to a patient a drug classified by the
213 division, by administrative rule, as a general anesthetic, such as propofol, ketamine, etomidate,
214 pentathol, brevital, and fospropofol.
215 (b) "General anesthesia" means a pharmacological induced loss of consciousness
216 during which:
217 (i) the patient cannot be aroused, even with painful stimulation;
218 (ii) the patient's ability to independently maintain ventilatory function may be
219 impaired;
220 (iii) spontaneous ventilation may be inadequate;
221 (iv) the patient may require positive pressure ventilation assistance to maintain an
222 airway because of depressed spontaneous ventilation or pharmacological induced depression of
223 neuromuscular function; and
224 (v) the patient's cardiovascular function may be impaired.
225 (c) "Minimal sedation" means a pharmacological induced state of consciousness during
226 which:
227 (i) the patient responds normally to verbal commands;
228 (ii) the patient's cognitive function and physical coordination may be impaired; and
229 (iii) airway reflexes, ventilatory function and cardiovascular function are not impaired.
230 (d) "Moderate sedation" means a pharmacological induced depression of consciousness
231 during which a patient responds purposefully to verbal commands, either alone or accompanied
232 by light tactile stimulation, and during which no interventions are required to maintain an
233 airway.
234 (2) (a) A nurse licensed under this chapter may not administer deep sedation or general
235 anesthesia unless:
236 (i) the nurse is a certified registered nurse anesthetist administering anesthesia within
237 the scope of practice of a certified registered nurse anesthetist; or
238 (ii) the nurse is administering the deep sedation or general anesthesia under medical
239 orders, to a patient who is intubated and in the intensive care unit of a general acute hospital.
240 (b) A nurse licensed under this chapter may administer moderate sedation or minimal
241 sedation:
242 (i) if the administration of the sedation is otherwise within the scope of practice for the
243 nurse; and
244 (ii) if the sedation is administered intravenously, if the nurse is present during the
245 procedure for the sole purpose of monitoring the sedation care of the patient.
246 (3) A licensed nurse under this chapter may not administer intravenous sedation to a
247 patient without having access during the procedure to an advanced cardiac life support crash
248 cart with equipment that is regularly maintained according to guidelines established by the
249 American Hospital Association.
250 (4) The division shall, with the advice of the board, designate the drugs that should be
251 classified as general anesthesia drugs under Subsection (1)(a)(ii).
252 Section 6. Section 58-67-501 is amended to read:
253 58-67-501. Unlawful conduct.
254 (1) "Unlawful conduct" includes, in addition to the definition in Section 58-1-501:
255 (a) buying, selling, or fraudulently obtaining, any medical diploma, license, certificate,
256 or registration;
257 (b) aiding or abetting the buying, selling, or fraudulently obtaining of any medical
258 diploma, license, certificate, or registration;
259 (c) substantially interfering with a licensee's lawful and competent practice of medicine
260 in accordance with this chapter by:
261 (i) any person or entity that manages, owns, operates, or conducts a business having a
262 direct or indirect financial interest in the licensee's professional practice; or
263 (ii) anyone other than another physician licensed under this title, who is engaged in
264 direct clinical care or consultation with the licensee in accordance with the standards and ethics
265 of the profession of medicine; [
266 (d) entering into a contract that limits a licensee's ability to advise the licensee's
267 patients fully about treatment options or other issues that affect the health care of the licensee's
268 patients[
269 (e) administering anesthesia in the practice of medicine in violation of Section
270 58-67-807.
271 (2) "Unlawful conduct" does not include:
272 (a) establishing, administering, or enforcing the provisions of a policy of accident and
273 health insurance by an insurer doing business in this state in accordance with Title 31A,
274 Insurance Code;
275 (b) adopting, implementing, or enforcing utilization management standards related to
276 payment for a licensee's services, provided that:
277 (i) utilization management standards adopted, implemented, and enforced by the payer
278 have been approved by a physician or by a committee that contains one or more physicians; and
279 (ii) the utilization management standards does not preclude a licensee from exercising
280 independent professional judgment on behalf of the licensee's patients in a manner that is
281 independent of payment considerations;
282 (c) developing and implementing clinical practice standards that are intended to reduce
283 morbidity and mortality or developing and implementing other medical or surgical practice
284 standards related to the standardization of effective health care practices, provided that:
285 (i) the practice standards and recommendations have been approved by a physician or
286 by a committee that contains one or more physicians; and
287 (ii) the practice standards do not preclude a licensee from exercising independent
288 professional judgment on behalf of the licensee's patients in a manner that is independent of
289 payment considerations;
290 (d) requesting or recommending that a patient obtain a second opinion from a licensee;
291 (e) conducting peer review, quality evaluation, quality improvement, risk management,
292 or similar activities designed to identify and address practice deficiencies with health care
293 providers, health care facilities, or the delivery of health care;
294 (f) providing employment supervision or adopting employment requirements that do
295 not interfere with the licensee's ability to exercise independent professional judgment on behalf
296 of the licensee's patients, provided that employment requirements that may not be considered to
297 interfere with an employed licensee's exercise of independent professional judgment include:
298 (i) an employment requirement that restricts the licensee's access to patients with
299 whom the licensee's employer does not have a contractual relationship, either directly or
300 through contracts with one or more third-party payers; or
301 (ii) providing compensation incentives that are not related to the treatment of any
302 particular patient;
303 (g) providing benefit coverage information, giving advice, or expressing opinions to a
304 patient or to a family member of a patient to assist the patient or family member in making a
305 decision about health care that has been recommended by a licensee;
306 (h) in compliance with Section 58-85-103:
307 (i) obtaining an investigational drug or investigational device;
308 (ii) administering the investigational drug to an eligible patient; or
309 (iii) treating an eligible patient with the investigational drug or investigational device;
310 or
311 (i) any otherwise lawful conduct that does not substantially interfere with the licensee's
312 ability to exercise independent professional judgment on behalf of the licensee's patients and
313 that does not constitute the practice of medicine as defined in this chapter.
314 Section 7. Section 58-67-807 is enacted to read:
315 58-67-807. Anesthesia practice standards.
316 (1) For purposes of this section:
317 (a) (i) "Deep sedation" means a pharmacological induced depression of consciousness
318 during which:
319 (A) the patient cannot easily be aroused, but will respond purposefully, other than a
320 reflex withdrawal response, to repeated or painful stimulation;
321 (B) the patient's ability to independently maintain ventilatory function may be impaired
322 or spontaneous ventilation may be inadequate, and the patient may require assistance to
323 maintain an airway; and
324 (C) the patient's cardiovascular function is maintained.
325 (ii) "Deep sedation" includes administering a drug classified as a general anesthetic
326 under Subsection 58-31b-804(1)(a).
327 (b) "General anesthesia" means a pharmacological induced loss of consciousness
328 during which:
329 (i) the patient cannot be aroused, even with painful stimulation;
330 (ii) the patient's ability to independently maintain ventilatory function may be
331 impaired;
332 (iii) spontaneous ventilation may be inadequate;
333 (iv) the patient may require positive pressure ventilation assistance to maintain an
334 airway because of depressed spontaneous ventilation or pharmacological induced depression of
335 neuromuscular function; and
336 (v) the patient's cardiovascular function may be impaired.
337 (c) "Minimal sedation" means a pharmacological induced state of consciousness during
338 which:
339 (i) the patient responds normally to verbal commands;
340 (ii) the patient's cognitive function and physical coordination may be impaired; and
341 (iii) airway reflexes, ventilatory function, and cardiovascular function are not impaired.
342 (d) "Moderate sedation" means a pharmacological induced depression of consciousness
343 during which a patient responds purposefully to verbal commands, either alone or accompanied
344 by light tactile stimulation, and during which no interventions are required to maintain an
345 airway.
346 (2) (a) A physician licensed under this chapter may not administer deep sedation or
347 general anesthesia to a patient and perform a diagnostic or therapeutic procedure on the patient
348 while the patient is under deep sedation or general anesthesia, unless the physician has one of
349 the following present during the procedure for the sole purpose of monitoring and managing
350 the sedation care of the patient:
351 (i) another physician licensed under this chapter, or Chapter 68, Utah Osteopathic
352 Medical Practice Act;
353 (ii) a dentist licensed under Chapter 69, Dentist and Dental Hygienist Practice Act:
354 (A) who holds a current permit issued by the division authorizing the dentist to
355 administer the type of anesthesia administered to the patient; and
356 (B) if the procedure for which the sedation is administered is within the scope of
357 practice for the dentist; or
358 (iii) a certified registered nurse anesthetist licensed as a certified registered nurse
359 anesthetist under Chapter 31b, Nurse Practice Act.
360 (b) A physician licensed under this chapter may not administer moderate sedation or
361 minimal sedation to a patient intravenously and perform a diagnostic or therapeutic procedure
362 on the patient while the patient is under moderate or minimal sedation, unless the physician has
363 one of the practitioners listed in Subsection (2)(a), or a nurse licensed under Chapter 31b,
364 Nurse Practice Act, present during the procedure for the sole purpose of monitoring and
365 managing the sedation care of the patient.
366 (3) A licensed physician under this chapter may not administer intravenous sedation to
367 a patient without having access during the procedure to an advanced cardiac life support crash
368 cart with equipment that is regularly maintained according to guidelines established by the
369 American Hospital Association.
370 (4) Beginning January 1, 2018, a physician shall report to the division any deaths or
371 adverse events from the administration of sedation or general anesthesia in an outpatient
372 setting. The report shall be submitted to the division in accordance with Section 58-1-112.
373 Section 8. Section 58-68-501 is amended to read:
374 58-68-501. Unlawful conduct.
375 (1) "Unlawful conduct" includes, in addition to the definition in Section 58-1-501:
376 (a) buying, selling, or fraudulently obtaining any osteopathic medical diploma, license,
377 certificate, or registration; and
378 (b) aiding or abetting the buying, selling, or fraudulently obtaining of any osteopathic
379 medical diploma, license, certificate, or registration;
380 (c) substantially interfering with a licensee's lawful and competent practice of medicine
381 in accordance with this chapter by:
382 (i) any person or entity that manages, owns, operates, or conducts a business having a
383 direct or indirect financial interest in the licensee's professional practice; or
384 (ii) anyone other than another physician licensed under this title, who is engaged in
385 direct clinical care or consultation with the licensee in accordance with the standards and ethics
386 of the profession of medicine; [
387 (d) entering into a contract that limits a licensee's ability to advise the licensee's
388 patients fully about treatment options or other issues that affect the health care of the licensee's
389 patients[
390 (e) administering anesthesia in the practice of medicine in violation of Section
391 58-68-807.
392 (2) "Unlawful conduct" does not include:
393 (a) establishing, administering, or enforcing the provisions of a policy of accident and
394 health insurance by an insurer doing business in this state in accordance with Title 31A,
395 Insurance Code;
396 (b) adopting, implementing, or enforcing utilization management standards related to
397 payment for a licensee's services, provided that:
398 (i) utilization management standards adopted, implemented, and enforced by the payer
399 have been approved by a physician or by a committee that contains one or more physicians; and
400 (ii) the utilization management standards does not preclude a licensee from exercising
401 independent professional judgment on behalf of the licensee's patients in a manner that is
402 independent of payment considerations;
403 (c) developing and implementing clinical practice standards that are intended to reduce
404 morbidity and mortality or developing and implementing other medical or surgical practice
405 standards related to the standardization of effective health care practices, provided that:
406 (i) the practice standards and recommendations have been approved by a physician or
407 by a committee that contains one or more physicians; and
408 (ii) the practice standards do not preclude a licensee from exercising independent
409 professional judgment on behalf of the licensee's patients in a manner that is independent of
410 payment considerations;
411 (d) requesting or recommending that a patient obtain a second opinion from a licensee;
412 (e) conducting peer review, quality evaluation, quality improvement, risk management,
413 or similar activities designed to identify and address practice deficiencies with health care
414 providers, health care facilities, or the delivery of health care;
415 (f) providing employment supervision or adopting employment requirements that do
416 not interfere with the licensee's ability to exercise independent professional judgment on behalf
417 of the licensee's patients, provided that employment requirements that may not be considered to
418 interfere with an employed licensee's exercise of independent professional judgment include:
419 (i) an employment requirement that restricts the licensee's access to patients with
420 whom the licensee's employer does not have a contractual relationship, either directly or
421 through contracts with one or more third-party payers; or
422 (ii) providing compensation incentives that are not related to the treatment of any
423 particular patient;
424 (g) providing benefit coverage information, giving advice, or expressing opinions to a
425 patient or to a family member of a patient to assist the patient or family member in making a
426 decision about health care that has been recommended by a licensee;
427 (h) in compliance with Section 58-85-103:
428 (i) obtaining an investigational drug or investigational device;
429 (ii) administering the investigational drug to an eligible patient; or
430 (iii) treating an eligible patient with the investigational drug or investigational device;
431 or
432 (i) any otherwise lawful conduct that does not substantially interfere with the licensee's
433 ability to exercise independent professional judgment on behalf of the licensee's patients and
434 that does not constitute the practice of medicine as defined in this chapter.
435 Section 9. Section 58-68-807 is enacted to read:
436 58-68-807. Anesthesia practice standards.
437 (1) For purposes of this section:
438 (a) (i) "Deep sedation" means a pharmacological induced depression of consciousness
439 during which:
440 (A) the patient cannot easily be aroused, but will respond purposefully, other than a
441 reflex withdrawal response, to repeated or painful stimulation;
442 (B) the patient's ability to independently maintain ventilatory function may be impaired
443 or spontaneous ventilation may be inadequate, and the patient may require assistance to
444 maintain an airway; and
445 (C) the patient's cardiovascular function is maintained.
446 (ii) "Deep sedation" includes administering a drug classified as a general anesthetic
447 under Subsection 58-31b-804(1)(a).
448 (b) "General anesthesia" means a pharmacological induced loss of consciousness
449 during which:
450 (i) the patient cannot be aroused, even with painful stimulation;
451 (ii) the patient's ability to independently maintain ventilatory function may be
452 impaired;
453 (iii) spontaneous ventilation may be inadequate;
454 (iv) the patient may require positive pressure ventilation assistance to maintain an
455 airway because of depressed spontaneous ventilation or pharmacological induced depression of
456 neuromuscular function; and
457 (v) the patient's cardiovascular function may be impaired.
458 (c) "Minimal sedation" means a pharmacological induced state of consciousness during
459 which:
460 (i) the patient responds normally to verbal commands;
461 (ii) the patient's cognitive function and physical coordination may be impaired; and
462 (iii) airway reflexes, ventilatory function, and cardiovascular function are not impaired.
463 (d) "Moderate sedation" means a pharmacological induced depression of consciousness
464 during which a patient responds purposefully to verbal commands, either alone or accompanied
465 by light tactile stimulation, and during which no interventions are required to maintain an
466 airway.
467 (2) (a) A physician licensed under this chapter may not administer deep sedation or
468 general anesthesia to a patient and perform a diagnostic or therapeutic procedure on the patient
469 while the patient is under deep sedation or general anesthesia, unless the physician has one of
470 the following present during the procedure for the sole purpose of monitoring and managing
471 the sedation care of the patient:
472 (i) another physician licensed under this chapter or Chapter 67, Utah Medical Practice
473 Act;
474 (ii) a dentist licensed under Chapter 69, Dentist and Dental Hygienist Practice Act:
475 (A) who holds a current permit issued by the division authorizing the dentist to
476 administer the type of anesthesia administered to the patient; and
477 (B) if the procedure for which the sedation is administered is within the scope of
478 practice for the dentist; and
479 (iii) a certified registered nurse anesthetist licensed as a certified registered nurse
480 anesthetist under Chapter 31b, Nurse Practice Act.
481 (b) A physician licensed under this chapter may not administer moderate sedation or
482 minimal sedation to a patient intravenously and perform a diagnostic or therapeutic procedure
483 on the patient while the patient is under moderate or minimal sedation, unless the physician has
484 one of the practitioners listed in Subsection (2)(a), or a nurse licensed under Chapter 31b,
485 Nurse Practice Act, present during the procedure for the sole purpose of monitoring and
486 managing the sedation care of the patient.
487 (3) A licensed physician under this chapter may not administer intravenous sedation to
488 a patient without having access during the procedure to an advanced cardiac life support crash
489 cart with equipment that is regularly maintained according to guidelines established by the
490 American Hospital Association.
491 (4) Beginning January 1, 2018, an osteopathic physician shall report to the division any
492 deaths or adverse events from the administration of sedation or general anesthesia in an
493 outpatient setting. The report shall be submitted to the division in accordance with Section
494 58-1-112.
495 Section 10. Section 58-69-501 is amended to read:
496 58-69-501. Unlawful conduct.
497 "Unlawful conduct" includes, in addition to the definition in Section 58-1-501:
498 (1) administering anesthesia or analgesia in the practice of dentistry or dental hygiene
499 if:
500 (a) the individual does not hold a current permit issued by the division authorizing that
501 individual to administer the type of anesthesia or analgesia used; or
502 (b) the individual administers anesthesia in violation of Section 58-69-807;
503 (2) practice of dental hygiene by a licensed dental hygienist when not under the
504 supervision of a dentist, or under a written agreement with a dentist who is licensed under this
505 chapter and who is a Utah resident, in accordance with the provisions of this chapter; or
506 (3) directing or interfering with a licensed dentist's judgment and competent practice of
507 dentistry.
508 Section 11. Section 58-69-807 is enacted to read:
509 58-69-807. Anesthesia practice standards.
510 (1) For purposes of this section:
511 (a) (i) "Deep sedation" means a pharmacological induced depression of consciousness
512 during which:
513 (A) the patient cannot easily be aroused, but will respond purposefully, other than a
514 reflex withdrawal response, to repeated or painful stimulation;
515 (B) the patient's ability to independently maintain ventilatory function may be impaired
516 or spontaneous ventilation may be inadequate, and the patient may require assistance to
517 maintain an airway; and
518 (C) the patient's cardiovascular function is maintained.
519 (ii) "Deep sedation" includes administering a drug classified as a general anesthetic
520 under Subsection 58-31b-804(1)(a).
521 (b) "General anesthesia" means a pharmacological induced loss of consciousness
522 during which:
523 (i) the patient cannot be aroused, even with painful stimulation;
524 (ii) the patient's ability to independently maintain ventilatory function may be
525 impaired;
526 (iii) spontaneous ventilation may be inadequate;
527 (iv) the patient may require positive pressure ventilation assistance to maintain an
528 airway because of depressed spontaneous ventilation or pharmacological induced depression of
529 neuromuscular function; and
530 (v) the patient's cardiovascular function may be impaired.
531 (c) "Minimal sedation" means a pharmacological induced state of consciousness during
532 which:
533 (i) the patient responds normally to verbal commands;
534 (ii) the patient's cognitive function and physical coordination may be impaired; and
535 (iii) airway reflexes, ventilatory function, and cardiovascular function are not impaired.
536 (d) "Moderate sedation" means a pharmacological induced depression of consciousness
537 during which a patient responds purposefully to verbal commands, either alone or accompanied
538 by light tactile stimulation, and during which no interventions are required to maintain an
539 airway.
540 (2) (a) A dentist licensed under this chapter may not administer deep sedation or
541 general anesthesia to a patient and perform a diagnostic or therapeutic procedure on the patient
542 while the patient is under deep sedation or general anesthesia, unless the dentist has one of the
543 following present during the procedure for the sole purpose of monitoring and managing the
544 sedation care of the patient:
545 (i) a physician licensed under Chapter 67, Utah Medical Practice Act, or Chapter 68,
546 Utah Osteopathic Medical Practice Act;
547 (ii) another dentist licensed under this chapter who holds a current permit issued by the
548 division authorizing the dentist to administer the type of anesthesia administered to the patient;
549 or
550 (iii) a certified registered nurse anesthetist licensed as a certified registered nurse
551 anesthetist under Chapter 31b, Nurse Practice Act.
552 (b) A dentist licensed under this chapter may not administer moderate sedation or
553 minimal sedation to a patient intravenously and perform a diagnostic or therapeutic procedure
554 on the patient while the patient is under moderate or minimal sedation, unless the dentist has
555 one of the practitioners listed in Subsection (2)(a), or a nurse licensed under Chapter 31b,
556 Nurse Practice Act, present during the procedure for the sole purpose of monitoring and
557 managing the sedation care of the patient.
558 (3) A licensed dentist under this chapter may not administer intravenous sedation to a
559 patient without having access during the procedure to an advanced cardiac life support crash
560 cart with equipment that is regularly maintained according to guidelines established by the
561 American Hospital Association.
562 (4) Beginning January 1, 2018, a dentist shall report to the division any deaths or
563 adverse events from the administration of sedation or general anesthesia in an outpatient
564 setting. The report shall be submitted to the division in accordance with Section 58-1-112.
Legislative Review Note
Office of Legislative Research and General Counsel