22 Tex. Admin. Code § 110.18 - Inspection of Sedation/Anesthesia Providers
(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:
(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.
Notes
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