Coverage for the chair and the practice.

Sedation permits shape the application

Underwriters ask about sedation separately, and the permit a dentist holds decides which levels of sedation the practice can offer, and to whom. These are the California rules I check before I describe your practice to a carrier:

• Deep sedation and general anesthesia. Business and Professions Code 1646.1 requires an active general anesthesia permit and current ACLS certification. The dentist who administers or orders it must be physically present while the patient is under, and patients under 7 require a pediatric endorsement.
• Patients under 13 under general anesthesia. The operating dentist and at least two additional personnel must be present throughout. When the operating dentist is the permitted anesthesia provider, the dentist and one staff member need current PALS or board-approved equivalent training, and that staff member is dedicated to monitoring.
• Moderate sedation. Section 1647.2 requires a moderate sedation or general anesthesia permit and a pediatric endorsement before sedating anyone under 13. For those patients, two support personnel besides the operating dentist must be present, with PALS or equivalent training for the dentist and the monitoring staff member.
• Training and case counts. Under section 1647.3, training must include at least 60 hours of instruction and 20 moderate sedation cases. The pediatric endorsement requires 20 cases on patients under 13 at application and renewal, plus 20 cases under age 7 in the prior 24 months to sedate that age group.
• Visiting anesthesiologists. A physician giving deep sedation or general anesthesia in your office needs a Dental Board general anesthesia permit (section 1646.9), with an onsite inspection at least once every five years.

Send me the permit holders, who administers and monitors, and your patients' age mix. Permit rules vary by state. For how California caps and time-limits malpractice claims, see medical malpractice insurance.

Infection control: the Dental Board's minimum standards

The Dental Board's minimum infection control standards are in Title 16, California Code of Regulations, section 1005. They apply to all dental healthcare personnel who might be occupationally exposed, including administrative, clerical and housekeeping staff. The parts that leave a paper trail:

• A written protocol for instrument processing, operatory cleanliness and management of injuries, periodically updated and available to all staff.
• The regulation posted conspicuously in each dental office.
• Weekly spore testing. Every sterilizer is verified at least weekly with a biological indicator such as a spore test, and results are kept for 12 months.
• Labeled packs. Critical and semi-critical instruments are packaged and sterilized after each use, kept sealed, and labeled with the sterilization date, plus which sterilizer if the office has more than one.
• Waterlines. Dental unit water lines must be anti-retractive. Lines are purged with air or flushed with water for at least two minutes at the start of each workday and flushed for at least 20 seconds between patients.

When a patient alleges an infection after treatment, the spore log and protocol are the records that show what the office did. For a multi-location group, I'd keep both at each site.

When a patient asks for their records

California sets short deadlines for patient records requests. Under Health and Safety Code 123110:

• Inspection within five working days after you receive the request, during business hours. The patient or representative may bring one other person.
• Copies within 15 days after you receive the request. Any copy fee is limited to the cost items the statute lists.
• The requested format if readily producible; otherwise, for electronic records, a readable electronic format you both agree on.
• X-rays. Copies need not go to the patient if the originals are sent to another provider on the patient's written request within 15 days.
• No holding records for an unpaid bill. The statute bars it, and a willful violation is grounds for discipline.

A request from a patient unhappy with a crown may come before any claim, so check your malpractice policy's notice terms for what counts as a reportable circumstance. Exposed electronic records also bring HIPAA breach-notice deadlines, set out on medical office insurance, with the coverage designed to respond under cyber liability insurance.

Official sources

• California Business and Professions Code 1646.1 (general anesthesia permit)
• California Business and Professions Code 1646.9 (physician anesthesia providers in dental offices)
• California Business and Professions Code 1647.2 (moderate sedation)
• California Business and Professions Code 1647.3 (moderate sedation permit and pediatric endorsement)
• California Business and Professions Code 1680 (unprofessional conduct; seven-day reports)
• 16 CCR 1005, Minimum Standards for Infection Control (Cornell LII)
• Cal/OSHA Title 8, Section 5193, Bloodborne Pathogens
• California Health and Safety Code 123110 (patient access to records)