Infographic: Telehealth

1. Brief description of the policy challenge the team has chosen and the nursing association that was identified.

AB 2235, referred to as “Caleb’s Law”, amends the Dental Practice Act to require the Dental Board to:

· Generate a report on whether current regulations for pediatric dental anesthesia provide adequate protection to the pediatric dental patient

· Require dentists to report a pediatric death or transportation to a hospital related to general anesthesia

· Require that written informed consent forms contain certain language

AB 224, the follow-up pediatric sedation bill, has been tabled for this year. It is a two-year bill, and since it was not defeated, it could return next year for consideration.

AD 224 redefines “general anesthesia” and defines “deep sedation.” AB 224 also includes these requirements for any dental procedure involving general anesthesia or deep sedation:

· For patients under 7 years of age, there must be present the operating dentist, a dental sedation assistant and a dedicated monitor, all of whom possess the appropriate Dental Board permits and life support and airway management training.

· For children between 7 and 13 years of age, the operating dentist must have present at least two support staff of which at least one must possess the appropriate life support and airway management training.

https://fyi-online.com/2017/05/q-review/

2. Describe the “Agenda” for the identified policy challenge. Include how the policy issue was identified, (Did the organization complete a review of the literature, an environmental scan and/or a SWOT analysis, etc.?)

In response to the tragic deaths of two otherwise healthy children who received dental treatment while under anesthesia in 2015 and 2016, California Governor Jerry Brown signed Assembly Bill 2235 into effect on January 1, 2017.

3. Brief description of key stakeholders (those who will be affected and those who can effect change), ie, interest groups, opposition groups/individuals or coalitions.

Supporters 

American Academy of Pediatrics  - CA (Bill sponsor)    

American Society of Dentist Anesthesiologists    

California Society of Anesthesiologists 

The California Society of Pediatric Dentistry

PDI Surgery Center 

Hapy Bear Surgery Center   

The Family of Caleb Sears (2008–2015)

Opposition

The California Dental Association

The California Association of Oral and Maxillofacial Surgeons

4. List the different strategies that the organization plans to or has already used to inform/lobby legislators, ie, e-mail campaign, in-person visit, testimony, protest, etc.

The initial attempt to change California law that governs the administration and monitoring of anesthesia and sedation provided by dentists/oral surgeons was spear-headed by Caleb’s aunt Anna Kaplan, MD, resulted in the passage of AB 2235 authored by former Assembly Member Tony Thurmond (D-Richmond) that required the Dental Board of California (DBC) to review and report on the laws and regulations governing dental anesthesia at that time. This was known as Caleb’s Law Part 1.

The next step was to codify all the recommendations made by the DBC, which included the provision of a separate dedicated and independent anesthesia provider for children < 7 years of age undergoing deep sedation or general anesthesia.  AB 224 (Thurmond, Caleb’s Law Part 2) was proposed in the California Assembly in Jan 2017 and included a complete representation of all the patient safety recommendations from the DBC. It was sponsored by the American Academy of Pediatrics-California Chapter (AAP-CA), the California Society of Anesthesiologists (CSA) and the California Society of Dentist Anesthesiology (CSDA). At the same time, SB 501 authored by Senator Steve Glazer (D-Orinda) was also introduced and was sponsored by the California Association of Oral and Maxillofacial Surgeons (CALOMS) and strongly supported by the California Dental Association (CDA). The full details of the struggle to pass meaningful legislation is chronicled in a series of excellent reports by CSA lobbyists Bryce Docherty and Vanessa Cajina in the Under the Dome series. 

5. List and describe any non-legislative strategies that were used or plan to be used to support the initiative.

When Dr. Annie Kaplan’s nephew passed away during routine oral surgery, she turned her grief into action. Through tireless advocacy, she helped pass Caleb’s Law in the California State Assembly, which is the first step in creating guidelines for dental anesthetic use on children. Recently, she shared her story and strategies for legislative advocacy in healthcare with physicians, faculty, and administrators from the Weinberg Family Cerebral Palsy Center and Columbia University Medical Center.

Identify the Issue

There are many healthcare and quality of life issues affecting people with cerebral palsy (CP) – so which one to advocate? Before jumping in, Dr. Kaplan suggests deciding on what has the best chance of passing and bringing the most change in the least amount of time.

“Finding small things that you can win quickly makes the issue present in everyone’s mind,” said Dr. Kaplan. “A big advocacy push could be just writing policy guidelines for transitional CP care. This could be parlayed into legislation and grassroots action.”

Assemble a Team

Putting together a strong coalition is what can make or break a bill. There’s strength in numbers and everyone on the team should, ideally, be out to achieve the same goal. Coalitions are built from a wide-swath of people and organizations: there are lobbying groups, lawmakers, regulatory agencies, academia, and influential, public personalities. All of them are essential to shepherd the bill through numerous stages of the legislative process and make it a reality.

“For Caleb’s Law, we now have a huge coalition that is moving in all different directions,” said Dr. Kaplan. “Policy is being made. There’s a start-up that just started fulfilling needs for dental anesthesia. We’re making the change we want while the legislature is working it out as well. The change is there.”

While researching what issue to get behind, it’s advantageous to research any groups that may be interested in or may lobby against the bill. Even seemingly benign legislation could generate some controversy in certain sectors. There are ways of making oppositional interests work for the bill – either through chipping away at their coalition or talking with them.

“You should engage with the opposition and see how you can get to a place where everyone can treat their patients fairly,” said Dr. Kaplan.

Start Small with Legislative Advocacy

Once there’s solid groundwork, it’s time to make those small wins happen. That includes regularly engaging with lawmakers and public interests and pushing them to the finish line. The best way to do that is to break down what can be passed now and what can be passed later.

“Incremental change is more successful in the end,” said Dr. Kaplan. “When I started, I should’ve moved slower. I went for the big change right away and it brought on more opposition.”

One of the more challenging aspects of this step is building a persuasive argument that will convince key decision makers that this bill is the right thing to pass and this is the right time to do it. If you’re leading this advocacy push, Dr. Kaplan highly recommends that you should make yourself the expert on that issue and understand it inside and out. That way if anyone ever has a question, you’ll have the answer or know the right person who has the answer. It may also convince anyone on the fence to join your cause.

“A great way to convince policy makers is to have real life stories available, so they can see the problem that needs to be fixed, and how passing this legislation can make it better,” said Dr. Kaplan.

Keep the Momentum Going

Change rarely happens overnight. Progress will be slow for any legislative effort and, when or if it is passed, there may be other legislation required to strengthen the original bill. How do you keep your coalition engaged and your bill top of mind as days turn into months? Just keep moving.

“Don’t take your foot off the gas,” said Dr. Kaplan. “Keep advocating, keep the process moving, and you’ll see the smaller wins as you get to your end goal.”

6. Describe where this policy challenge is in the legislative process and its implications for the future.

AB 224 (Thurmond) failed to reach Governor Brown’s desk, largely due to fierce opposition from CALOMS and the CDA. The CDA was able to convince the Legislature that having additional personnel in the dental office dedicated to ensuring proper monitoring of the dental anesthesia would make access more difficult for children seeking these dental procedures and significantly increase costs. Only after much debate and significant amendments to strengthen several provisions, SB 501 (Glazer) was eventually signed into law by Governor Brown in October 2018.

· Identify the Issue

· Assemble a Team

· Start Small with Legislative Advocacy

· Keep the Momentum Going