Board committee approves amended RDHAP facility registration language; public commenters raise AED and oxygen access concerns

The Legislation & Regulatory Committee of the Dental Hygiene Board of California on a unanimous vote recommended that the full board approve amended text and an updated Form 4 to clarify registration duties under California Code of Regulations, Title 16, section 1116.5 for registered dental hygienists in alternative practice (RDHAPs).

The committeevote follows a staff-drafted change that distinguishes RDHAPs who merely maintain portable equipment at a physical location from RDHAPs who treat patients at a fixed facility. Dr. Edina Petty, presenting the item, said the amendments make clear that RDHAPs who only store or sterilize portable equipment need not meet facility requirements such as ADA access, on-site toilet facilities or a working AED; RDHAPs who treat patients at a fixed facility must still meet those requirements. She also noted that if an RDHAP does not administer local anesthesia under 16 CCR section 1118, a self-contained portable oxygen unit would not be required for a portable-equipment-only registration.

The measure directs staff to submit the regulatory text to the Director of the Department of Consumer Affairs and the Business, Consumer Services and Housing Agency for review and to begin the rulemaking process. The motion, made by Board Member Michael Long and seconded by Sonia Pat Hansen, authorized the executive officer to take all steps necessary to initiate rulemaking, make technical or non-substantive changes, and set a hearing if requested. The roll-call recorded Ayes from Lolly Agarwal, Julie Elginer, Sonia Pat Hansen, Michael Long and Sridevi Panala.

Public commenters raised practical barriers in the rule as drafted. Kirsten Anderson, describing herself as a practicing RDHAP in rural Ridgecrest, said she has been unable to obtain a prescription-required portable oxygen unit because RDHAPs cannot write prescriptions and remote practice settings make establishing a prescribing dentist relationship difficult: "I've been running into issues getting this for my brick-and-mortar practice because it does require a prescription." Elena Francisco and other RDHAP commenters said they felt "blindsided" by the requirement to have AEDs and oxygen, and asked where the original justification appeared in the record. Jennifer Nowatney, an RDHAP with portable equipment only, questioned the requirement that AEDs be mandatory when dentists' offices are not uniformly required to carry them.

Executive Officer Anthony Lum and Dr. Petty responded with process and statutory context. Dr. Petty said the oxygen requirement stems from legislation (SB 534) tied to administration of local anesthesia and that prescriptive authority would require statutory change: "any changes like that, any kind of prescriptive ability would have to go through legislatively. We can't do it; it would have to be statutory." Lum noted the regulatory package had previously been approved by the board on Nov. 19, 2022, filed for notice Jan. 23, 2024 and published Feb. 2, 2024 for a 45-day public comment period; he advised commenters that all posted materials and the November 2022 minutes are available on the boardwebsite.

The committee and commenters discussed next steps. Dr. Petty and staff said the board will consider public comments received during the 45-day comment period, and that the board could revise the language again after that period before final adoption. Several committee members said they wanted staff to provide the composition of the inter-board work group that drafted the language.

The committee's action was limited to recommending the amended language and directing staff to proceed with the rulemaking process; no new statute was created and no change to prescriptive authority was enacted by the vote.