Sec. 10.44.12.21. Renewal of Class III Permits

A. The Board shall mail a renewal application to each individual holding a Class III permit at least 180 days before the expiration of the permit.

B. Before a permit expires, an applicant may apply to renew the permit for an additional 5-year term if the applicant:

(1) Submits to the Board, at least 90 days before the expiration of the permit, a renewal application on a form provided by the Board;

(2) Passes a renewal evaluation in each facility for which the applicant wishes to renew a permit;

(3) Pays the renewal fee set by the Board in COMAR 10.44.20;

(4) Provides an affidavit to the Board indicating whether the applicant, since the issuance of the original permit or renewal, whichever is later, has treated a patient under deep sedation or general anesthesia with an incident requiring admission to a hospital either for a period greater than 24 hours, or for purposes other than observation;

(5) Provides evidence satisfactory to the Board that the applicant meets the continuing education requirements outlined in Regulation .29 of this chapter; and

(6) Submits any other pertinent documents or information requested by the Board.

C. An affidavit provided to the Board under §B(4) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter.

D. The renewal evaluation outlined in §B(2) of this regulation shall consist of an evaluation of an administration evaluation that consists of an office inspection and clinical evaluation.

E. The clinical evaluation required by §D of this regulation shall:

(1) Require the participation of the clinical office staff; and

(2) Evaluate the technical competency of the dentist to:

(a) Safely administer general anesthesia, deep sedation, and moderate parenteral sedation; and

(b) Effectively respond to simulated anesthesia related emergencies with the participation of the clinical office staff trained to handle emergencies.

F. The clinical evaluation outlined in §E of this regulation shall include evaluating the treatment of at least the following:

(1) Laryngospasm;

(2) Foreign body airway obstruction;

(3) Emergency airway management;

(4) Emesis and aspiration;

(5) Acute allergic reaction;

(6) Asthmatic attack;

(7) Bronchospasm;

(8) Angina;

(9) Conditions requiring advanced cardiac life support, including:

(a) Bradycardia;

(b) Tachycardia;

(c) Ventricular fibrillation; and

(d) Cardiac arrest;

(10) Hypotension;

(11) Hypoglycemia;

(12) Hypertension;

(13) Seizure; and

(14) Syncope.

G. In addition to the requirements of §D of this regulation, a dentist who wishes to renew a Class III permit shall pass a facility evaluation of facility equipment, medications, and clinical records to include at least the following:

(1) Oxygen and gas delivery system, backup system, back-up system fail-safe;

(2) Gas storage facility;

(3) Safety indexed gas system;

(4) Suction and backup system;

(5) Auxiliary lighting system;

(6) Suitability of operating room:

(a) Size;

(b) Lighting;

(c) Communications; and

(d) EMT accessibility;

(7) Recovery area, including oxygen, suction, and visual and electronic monitoring, which may include the operating room;

(8) Appropriate emergency drugs;

(9) Nonexpired drugs;

(10) Appropriate devices to maintain an airway with positive pressure ventilation;

(11) Preoperative medical history and physical evaluation form;

(12) Anesthesia records, including monitoring and discharge records;

(13) Monitoring equipment, including pulse oximeter and blood pressure monitoring;

(14) Electrocardiogram (EKG);

(15) Anesthesia and monitoring equipment to ensure that they are in proper working order;

(16) Defibrillator or automated external defibrillator (AED);

(17) Capnograph measuring device; and

(18) In addition to the requirements of this section, for deep sedation or general anesthesia in pediatric patients a dentist shall have a pulse oximeter and either a:

(a) Precordial stethoscope; or

(b) Pretracheal stethoscope.

H. The applicant and the applicant’s staff shall be present in the operatory during the evaluation.

I. If an applicant for the renewal of a Class III permit returns a renewal application to the Board at least 90 days before the expiration of the permit, and the Board is unable to approve or deny the application before the expiration of the permit through no fault of the applicant, the permit shall remain in effect until the Board:

(1) Renews the permit; or

(2) Denies renewal of the permit.

J. Failure to receive the Board's renewal application does not relieve the permit holder from the requirement to submit a renewal application to the Board at least 90 days before the expiration of the permit.

K. The Board may issue a renewal of a Class III permit to an applicant for a specific practice location after the Board's review of:

(1) The applicant's renewal application and accompanying affidavit;

(2) The applicant's qualifications;

(3) The renewal evaluation; and

(4) Any other pertinent documents or information, including, but not limited to, patient complaints that may affect the applicant's ability to safely and effectively administer anesthesia and sedation.