Vital Times 2017 - 31

tooth. Caleb received a combination of medications -
including ketamine, midazolam, propofol, and fentanyl
- from his oral surgeon, and stopped breathing. The oral
surgeon failed to ventilate or intubate Caleb, breaking
several of his front teeth in the process, and Caleb didn't
survive.
Caleb's heartbroken family pushed for legislation to add
transparency and safety to California dental anesthesia for
children. They wanted dentists and oral surgeons to inform
parents about exactly who would be giving anesthesia to
their children. AB 2235 eventually passed, and Governor
Brown signed it. But the bill was watered down during the
legislative process, due to the clout of the dental lobby, to
the point that it only required the Dental Board to review
outcomes data and current laws, and file a report.
Caleb's family didn't give up. The next year, AB 224
was sponsored by Assemblymember Tony Thurmond
to mandate changes in the Dental Practice Act. The
Dental Board held hearings, and to everyone's surprise,
recommended changes too. Specifically, the Board
recommended that children under the age of seven years,
who need dental procedures under deep sedation or general
anesthesia, should have a separate, qualified anesthesia
professional in attendance as well as the dentist or oral
surgeon performing the procedure.
The CSA provided expert opinion in support of AB 224,
and we were genuinely hopeful that it would prevail. Once
again, we underestimated the tenacity and the financial
muscle behind the California Dental Association and the
California Oral and Maxillofacial Surgeons' lobby. They
argued that access to care would be adversely affected,
despite the relatively small number of procedures performed
on children under the age of seven. They argued, incredibly,
that no data support the concept that it is safer to have an
independent anesthesia professional give anesthesia than to
have the same person give anesthesia and perform surgery.

A randomized trial of parachutes?
Wait. How can anyone say that there are no data to support
the concept that anesthesia is safer when given by a

person who is not also doing surgery? That is the bedrock
foundation of safe anesthesia care today. Even a boardcertified anesthesiologist who is doing an invasive pain
procedure, for instance, cannot offer anesthesia or sedation
without a separate anesthesia professional present.
The reason that dentists and oral surgeons can claim a lack of
data is that they haven't collected data. There is no national
or California database of complications, near misses, adverse
events, or deaths during dental and oral surgery procedures.
No one seems willing to fund the establishment of a
California database, and event reporting depends entirely
on the honesty of individual practitioners. The Dental
Board argues that it lacks the resources to create a more
robust inspection system, or to oversee implementation
of a comprehensive database, and the state legislature isn't
showing any interest.
What about randomized prospective trials? These aren't
likely to happen. What patient or parent would voluntarily
agree to have a procedure done without a qualified
anesthesia professional as opposed to with one? You might
as well try to enroll subjects in a prospective trial to see
whether jumping out of an airplane is safer with a parachute.
Yet the "no data" argument convinced several members of
the Assembly Business and Professions Committee. AB
224 did not succeed in passage during the 2017 legislative
session, and became a two-year bill to be revisited in the
upcoming legislative session. CSA will continue to write,
speak, and do everything else we can do in support.

Where do we go from here?
I wish I could say definitively that AB 224 will pass, and
will solve the problem for good. However, even if it passes
without any further watering down, or active sabotage, there
are other factors to worry about.
First, children under the age of seven aren't the only ones
who die, or suffer hypoxic brain damage, in dentists' and oral
surgeons' offices. Just this month, a Minnesota family settled
a case for $2 million over the 2015 death of their lovely,
15-year-old daughter, Sydney Galleger. Sydney went to an
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Table of Contents for the Digital Edition of Vital Times 2017