Calif. approves bill on pediatric sedation oversight

California lawmakers have approved a bill to increase oversight of pediatric sedation during dental procedures after a 6-year-old boy died while under general anesthesia for an extraction in 2015.

The bill, AB 2235, to be known as Caleb's Law, would tighten requirements for dentist supervision of sedated patients and also require dentists to inform parents of an increased risk when general anesthesia is used. In addition, the bill would require the Dental Board of California to investigate state laws on sedation and issue public reports on the deaths and injuries of children from dental anesthesia.

Complaint

The measure is in response to a March 2015 extraction procedure by Michael J. Doucet, DDS, an oral surgeon in Albany, CA, during which 6-year-old Caleb Sears died. The boy's parents claimed that there were no personnel trained to handle the situation, nor was there sufficient monitoring equipment for emergencies during the treatment.

The dental board filed a complaint on February 24, 2016, that accused Dr. Doucet of "inadequate and constituted incompetence" and "gross negligence and repeated acts of negligence" during the procedure. The complaint seeks to revoke or suspend Dr. Doucet's license. Dr. Doucet declined to comment on the case.

Too much sedation?

Jay W. Friedman, DDS, MPH, a former dental director of large group practices, asserts that very few children or adults require deep sedation or general anesthesia.

"General anesthesia and IV sedation are overused for both children and adults," Dr. Friedman told DrBicuspid.com. "It's an easy way out for both dentists and patients. A child that is fearful but not hysterical usually can be talked into cooperating, the same as an adult."

Dr. Friedman acknowledged that some very young children may require general anesthesia or IV sedation, but he emphasized that it should be done in an appropriate setting.

"These children/infants should be treated in a hospital setting or a specialty outpatient surgical center staffed with anesthesiologists and nurse practitioners and fully equipped to handle anesthetic emergencies," he said.

A specially trained person, in addition to the dentist, should be present to monitor patients who receive general anesthesia and IV sedation, Dr. Friedman said.

"Protocols should be developed that specifically prescribe that general anesthesia and IV sedation should be administered and monitored by a separate person -- an anesthesiologist or nurse anesthetist -- other than the dentist performing the clinical procedures," he said.

The measure, which now has the support of the California Dental Association, was sent to Gov. Jerry Brown for his signature.