(a) For purposes of this rule, the following definitions apply:      
        (1) "High-risk patient" means a patient who has a level 3 or 4 classification according to the American Society of Anesthesiologists Physical Status Classification System (ASA).       
        (2) "Board-approved education program" means an in-person or online program provided by a recognized continuing education provider pursuant to Board rule 22 TAC §104.2 of this title (relating to Providers) and any subsequent amendments.       
      (b) For the purposes of this chapter, ASA classifications are defined as follows:      
        (1) ASA I: a normal healthy patient.       
        (2) ASA II: a patient with mild systemic disease.       
        (3) ASA III: a patient with severe systemic disease.       
        (4) ASA IV: a patient with severe systemic disease that is a constant threat to life.       
      (c) On or after September 1, 2019, a permit holder may not administer sedation/anesthesia under a level 2, level 3, or level 4 permit to a high-risk patient unless the permit holder has completed the requirements of paragraph (1) or (2) of this subsection. Permit holders must have:      
        (1) completed a university or hospital-based residency at least 12 months in length. All permit holders completing a university or hospital-based residency after September 1, 2019, must confirm that during the residency, the permit holder completed satisfactory management of sedation/anesthesia in at least ten (10) cases involving high-risk patients sedated/anesthetized at the highest level of permit held. At least five (5) of the cases must involve the hands-on administration of sedation/anesthesia as the primary provider. No more than five (5) cases may be observed. The ten (10) cases must involve either live patients and/or high-fidelity emergency sedation/anesthesia simulations; or       
        (2) completed a board-approved education program that includes a minimum of sixteen (16) hours of didactic training and instruction in sedation/anesthesia of high-risk patients. The entire board-approved education program, including all didactic and clinical requirements, must be completed within a two-year period of beginning the Board-approved program. Successful completion of the program must include passing an evaluation to demonstrate satisfactory completion of the course requirements. Didactic education must include:                  (A) pre-anesthetic patient assessment/evaluation for medically compromised and geriatric patients;                   (B) physical evaluation and medical history of high-risk patients, including obesity, pregnancy, and obstructive sleep apnea syndrome, cardiovascular disease, metabolic or genetic disorders, hematologic disorders, and other systemic diseases/conditions affecting sedation/anesthesia;                   (C) high-risk patient anatomical and/or physiological differences;                   (D) medical consultations;                   (E) high-risk respiratory assessment, including airway anatomy, physiology, and management;                   (F) informed consent by patient, parent, or guardian;                   (G) sedation/anesthesia pharmacology;                   (H) sedation/anesthesia management of patients identified with special health care needs;                   (I) high-risk patient monitoring;                   (J) peri-operative complications and emergencies;                   (K) emergency management of high-risk patients, including high-risk anesthesia equipment and resuscitation supplies;                   (L) sedation/anesthesia technique;                   (M) sedation/anesthesia record keeping;                   (N) patient recovery and discharge;                   (O) appropriate patient selection; and                   (P) permit holders shall have completed satisfactory management of sedation/anesthesia in at least ten (10) cases involving high-risk patients sedated/anesthetized at the highest level of permit held. At least five (5) of the cases must involve the hands-on administration of sedation/anesthesia as the primary provider. No more than five (5) cases may be observed. The ten (10) cases must involve either live patients and/or high-fidelity emergency sedation/anesthesia simulations. All of the cases must be performed and documented under the on-site instruction and direct supervision of a licensed dentist authorized to administer sedation/anesthesia to high-risk patients.         
      (d) A permit holder is authorized to administer sedation/anesthesia under a level 2, level 3, or level 4 permit to a high-risk patient if they have completed the requirements above and have requested and received authorization from the Board to administer sedation/anesthesia to high-risk patients. Board staff shall promulgate appropriate forms for permit holders qualifying under subsection (c)(1) and (c)(2) of section. The permit holder must attest to their advanced training satisfying the requirements of subsection (c)(1) or (c)(2) of this section, and will be required to produce proof of completion as part of a permit inspection or an investigation of a complaint involving sedation/anesthesia of a high-risk patient.     
      (e) The education hours described in subsection (c)(2) of this section can be applied towards the permit holder's continuing education requirement for maintaining a sedation/anesthesia permit.     
      (f) If qualifying under subsection (c)(2) of this section, the didactic and clinical training described in subsection (c)(2) of this section may not be fulfilled by the same didactic and clinical training used to fulfill the requirements for initial sedation/anesthesia permit issuance.     
     Source Note:        The provisions of this §110.16 adopted to be effective September 24, 2018, 43 TexReg 6277