Medical General Anesthesia Permits to Administer Deep Sedation and General Anesthesia (Physician and Surgeon)

On January 1, 2022, Senate Bill (SB) 501 (Glazer, Chapter 929, Statutes of 2018) changed how Medical General Anesthesia (MGA) permit holders will practice in California. For MGA permits issued on or after January 1, 2022, MGA permit holders may administer deep sedation or general anesthesia to patients 7 years of age and older. MGA permit holders who wish to administer deep sedation or general anesthesia to pediatric patients under age 7 must apply to the Board for and maintain a Pediatric Endorsement. SB 501 also enacted new patient monitoring requirements for the administration of deep sedation and general anesthesia to patients under 13 years of age. Please review the information below.

“Deep sedation” means “a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.” (Business and Professions Code (BPC), § 1646.1, subd. (a).)

“General anesthesia” means “a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. ” (BPC, § 1646.1, subd. (b).)

The following provide specific information regarding MGA Permits:
Business and Professions Code, Section 1646.9
Business and Professions Code, Section 1680(z)
Business and Professions Code, Section 1682

California Code of Regulations (CCR), Title 16, Division 10, Chapter 2, Article 5 (commencing with Section 1043)

Applying for a Medical General Anesthesia Permit

The requirements for a permit to administer deep sedation and general anesthesia to a dental patient aged 7 years and older include:

  1. A completed Application for General Anesthesia Permit (GAP-1) form. (CCR, tit. 16, § 1043.1, subs. (b).)
  2. Non-refundable application fee of $524.00. (CCR, tit. 16, § 1021, subs. (q).) Check or money order made payable to the Dental Board of California.
  3. Current, active Physician and Surgeon license issued by the Medical Board of California. (BPC, § 1646.9, subd. (a).)
  4. Certificate of completion or other documentary evidence the applicant has successfully completed a postgraduate residency training program in anesthesiology that is recognized by the American Council on Graduate Medical Education. (BPC, § 1646.9, subd. (b)(2).)
  5. Documentation demonstrating that all equipment and drugs required by the Board are on the premises for use in any dental office in which the physician and surgeon administers deep sedation or general anesthesia. (BPC, § 1646.9, subd. (b)(3).)
  6. Information relative to the current membership of the applicant on hospital medical staffs. (BPC, § 1646.9, subd. (b)(4).)

The completed Application for General Anesthesia Permit (GAP-1) form, documentation, and non-refundable application fee can be submitted by mail to:

Dental Board of California
2005 Evergreen St., Suite 1550
Sacramento, CA 95815

Applying for a Pediatric Endorsement

The requirements for a Pediatric Endorsement to administer deep sedation and general anesthesia to a dental patient under the age of 7 include:

  1. A completed Courtesy Application for Pediatric Endorsement for Medical General Anesthesia Permit form. (CCR, tit. 16, §§ 1043.1, subs. (c), 1043.8.1, subs. (a).)
  2. A completed Documentation of Deep Sedation and General Anesthesia or Moderate Sedation Cases for Pediatric Endorsement (PE-1) form. (CCR, tit. 16, § 1043.8.1, subs. (a)(3).)
  3. Non-refundable application fee of $532.00. Check or money order made payable to the Dental Board of California. (CCR, tit. 16, § 1021, subs. (ag).)
  4. Certificate of completion or other documentary evidence the applicant has successfully completed a postgraduate residency training program in anesthesiology that is recognized by the American Council on Graduate Medical Education. (BPC, § 1646.9, subd. (b)(2); CCR, tit. 16, § 1043.8.1, subs. (a)(2).)
  5. Documentation, such as patient records with identifying information redacted, of 20 cases of administration of deep sedation or general anesthesia to pediatric patients under 7 years of age within the 24 months directly preceding the application. (BPC, §§ 1646.2, subd. (c)(2), 1646.9, subd. (e).)
  6. Certificate or other documentary evidence of current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) as provided by the American Red Cross, American Heart Association, or American Safety and Health Institute.(BPC, §§ 1646.2, subd. (c)(3), 1646.9, subd. (e); CCR, tit. 16, § 1043.8.1, subs. (a)(4).)

The completed Courtesy Application for Pediatric Endorsement for Medical General Anesthesia Permit form, documentation, and non-refundable application fee can be submitted by mail to:

Dental Board of California
2005 Evergreen St., Suite 1550
Sacramento, CA 95815

Patient Monitoring Requirements

Refer to the Medical Board of California, physician and surgeon acting within their scope of practice under BPC, Division 2, Chapter 5 (commencing with Section 2000).
In addition, SB 501 enacted new patient monitoring requirements for the administration of deep sedation and general anesthesia to patients under 13 years of age, as follows (BPC, § 1646.1, subd. (d)(3)):

If a dedicated permitted anesthesia provider is monitoring the patient and administering deep sedation or general anesthesia, both of the following shall apply:

  1. The anesthesia provider and the operating dentist, or one other trained personnel, shall be present throughout the procedure and shall maintain current certification in Pediatric Advanced Life Support (PALS) and airway management or other board-approved training in pediatric life support and airway management, adopted pursuant to [BPC] Section 1601.8.
  2. The anesthesia provider shall be responsible for initiating and administering any necessary emergency response and the operating dentist, or other trained and designated personnel, shall assist the anesthesia provider in emergency response.

Renewal of Your MGA Permit and Continuing Education Requirements

The MGA permit is renewed biennially, and the renewal fee is $325.00. (BPC, § 1646.10; CCR, tit. 16, §§ 1021, subs. (s), 1043.8.) The renewal application and fee can be submitted online through the BreEZe system at www.breeze.ca.gov, and will be available approximately 90 days prior to the expiration date. If you do not have a BreEZe account, you can register as a new user to create an account. If you have an existing BreEZe account but do not know your username or password, you can follow the Forgot Password?, or Forgot Username? prompts.

Your first renewal may not be valid for a full two years. Your expiration date is based on your birth month and birth year. (BPC, § 1715.) If you were born in an even year, your permit will expire in an even year. If you were born in an odd year, your permit will expire in an odd year. From the issuance of your permit, your first permit will expire on the last day of your birth month, in the first odd or even year corresponding with your birth year.

After your first renewal, your permit will expire every two years on the last day of your birth month, either in an odd or even numbered year (as based on the year of your birth). (BPC, § 1715.)

You are exempt from the continuing education requirements for your first MGA permit renewal. Beginning with your second MGA permit renewal, you are required to complete at least 24 hours of approved courses of study related to general anesthesia, which must include either: (1) an advanced cardiac life support course approved by the American Heart Association and which includes an examination on the materials presented in the course; or (2) any other advanced cardiac life support course which is identical in all respects, except for the omission of materials that relate solely to hospital emergencies or neonatology, to the course published by the American Heart Association. (BPC, § 1646.5; CCR, tit. 16, §§ 1017, subs. (d), 1043.8.)

MGA permit holders will complete a self-certification of completion of the required continuing education courses at the time of renewal. Permit holders are required to retain for certificates of course completions for at least three renewal periods. (CCR, tit. 16, §§ 1017, subs. (n), 1043.8.)

Renewal of Your MGA Permit with a Pediatric Endorsement Requirements

As a condition of renewal, a licensee who holds a MGA permit with a Pediatric Endorsement must provide proof of current certification in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) or other Board-approved training in pediatric life support and airway management. (BPC, §§ 1646.2, subd. (c)(3), 1646.9, subd.(e).) The MGA permit holder must also complete 20 cases of deep sedation or general anesthesia to pediatric patients under the age of 7 within the 24 months directly preceding the renewal and complete a self-certification at the time of the renewal. (BPC, §§ 1646.2, subd. (c)(2), 1646.9, subd.(e); CCR, tit. 16, § 1017.1, subs. (a).)

MGA permit holders with a Pediatric Endorsement shall maintain and be able to provide proof of these cases upon request by the Board for up to three permit renewal periods. (BPC, §§ 1646.2, subd. (c)(2), 1646.9, subd.(e).)

Required Onsite Inspection and Evaluation

The Board will conduct an onsite inspection and evaluation of you and your facility, equipment, personnel, and procedures utilized by you within one year of issuance of an initial permit, and every five years thereafter. (BPC, § 1646.4.) Please take notice that refusal to submit to an inspection shall result in automatic denial or revocation of the MGA permit. (Ibid.)
The fee for the onsite inspection and evaluation is $2,000.00. (CCR, tit. 16, § 1021, subs. (u).) A notice will be sent to you by mail to your Address of Record, with instructions to schedule your onsite inspection and evaluation.