Dental News - Dental anaesthesia: Legal loopholes put patient safety at risk

Dental Tribune International

Tue. 17. October 2017

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SYDNEY, Australia: The Australian and New Zealand College of Anaesthetists (ANZCA), the medical body responsible for the teaching, training and licensing of specialist anaesthetists, has raised concerns about legal loopholes in the administration of local anaesthesia. Dentistry and cosmetic surgery are two fields that may be especially vulnerable to grey areas that can be exploited, putting patients at risk.

Although there are various guidelines addressing the responsibilities and skills necessary for medical practitioners to deliver sedation, as well as patient and drug selection, the regulators of dental sedation and beauty clinics have not endorsed the body’s guidelines, Australian anaesthetist Dr Kara Allen has warned in an article published in the EconoTimes.

Allen, who is an ANZCA Fellow, stressed that general anaesthesia and sedation are generally very safe in Australia when drugs are administered by doctors with training in pharmacology, airway management and resuscitation. However, owing to gaps in regulation and inconsistent national standards, particularly regarding sedation and local anaesthesia, patients may still be put at risk by unscrupulous practitioners, she pointed out.

The article was written in response to the tragic death of a 35-year-old woman in September after undergoing a cosmetic operation for which a local anaesthetic was administered by a person with no medical qualifications in Australia.

In light of this incident, safety issues around cosmetic surgery are currently under fierce debate in Australia. In a statement, shadow health minister Walt Secord underlined that there is room to tighten legal twilight zones. “I would like to see the State Government toughen up the definition—you cannot call yourself a surgeon or perform these procedures unless you are properly trained and have accreditation,” he said.

For dental professionals, the Australian Health Practitioner Regulation Agency has published guidelines on the administration of intravenous sedation, for example when drugs are given to minimise dental anxiety during a procedure in which the patient stays awake. The guidelines exclude general anaesthesia, as dentists are not expected to put patients under during procedures. However, regulations and licensing of sites that are allowed to administer anaesthetics vary from state to state, meaning there are loopholes that can be exploited. “Because these loopholes exist in the law, what these practitioners are doing may not be illegal, although unsafe,” Allen warned.

To ensure safety is not compromised, ANZCA President Prof. David A. Scott has recommended that prospective patients choose surgery locations wisely and check that the doctor administering the sedation has the necessary qualifications and training to do so. A list of licensed medical practitioners can be accessed on the website of the Australian Health Practitioner Regulation Agency.

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