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New Mexico Dental Health Care
REGULAR BOARD MEETING
April 7, 2017
8:00 A.M.
Albuquerque, NM
MEETING MINUTES
CALL TO ORDER
At 8:51 a.m. the Board Chair, Dr. Charles Schumacher, DDS, called the New Mexico Board of Dental Health Care April 7, 2017 meeting to order.
ROLL CALL
MEMBERS PRESENT: Charles Schumacher, DDS
Burrell Tucker, DDS
David Warren III, DMD
Leo Paul Balderamos, DDS
Jolynn Galvin, DDS
Ermelinda Baca, RDH
Paula Jenkins, RDH
MEMBERS ABSENT:
OTHERS PRESENT: Lori Chavez, Assistant Attorney General
STAFF PRESENT: Roberta Perea, Board Administrator
Melissa Saiz, Administrative Assistant
Vanessa Montoya, Compliance Liaison
Roll Call was taken by Roberta Perea and a quorum was determined present.
APPROVAL OF AGENDA – (Attachment A)
Ms. Ermelinda Baca, RDH made a MOTION to approve the agenda as amended. The amendment was to remove case 15-32-INC from the agenda this case will not be discussed during this meeting. Dr. Burrell Tucker, DDS SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
1. APPROVAL OF MEETING MINUTES
January 27, 2017 Regular Board Meeting Minutes
Ms. Ermelinda Baca, RDH made a MOTION to approve the minutes of the January 27, 2017 Regular Meeting as written. Dr. David Warren, DDS SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
January 27, 2017 Rule Hearing Transcripts
Dr. Burrell Tucker, DDS made a MOTION to approve the minutes/transcripts of the January 27, 2017 Regular Meeting as written. Ms. Ermelinda Baca, RDH SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
2. ORDER TO SHOW CAUSE 11-59-COM AND 12-37-COM – Dr. William Gardner, DDS
Ms. Paula Jenkins, RDH made a MOTION to grant the stay contingent upon the Respondent placing the penalty and fees in a trust within 10 days and setting a hearing within 45 days. If the Respondent does not comply with these contingencies, a NCA will be issued for failure to comply with a Board Order. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
3. REPORTS
A. Chair’s Report – Dr. Charles Schumacher, DDS
Verbal Report
B. Secretary’s Report – Dr. Burrell Tucker, DDS
Dr. Burrell Tucker, DDS reported to the board that from January 7, 2017 through March 15, 2017 the following licenses were issued:
10 Dental licenses issued by Examination
10 Dental licenses issued by Credentials
42 Dental Assistant Certificates
0 Expanded Function Dental Auxiliary Certificates
0 Community Dental Health Coordinator Certificates
0 Non-Dentist Owner
Dr. Paul Balderamos, DDS made a MOTION to ratify the Boards Secretaries report and licensees into record. Dr. David Warren, DDS SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
C. Dental Hygienist Committee Report – Ms. Ermelinda Baca, RDH
Dr. Burrell Tucker, DDS made a MOTION to ratify the recommendations of the Dental Hygienist Committee. Dr. Paul Balderamos, DDS SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
Licenses Issued for Period 01/07/17 thru 03/15/2017
0 Dental Hygienists by Examination
1 Dental Hygienists by Credentials
0 Dental Hygienists by Collaborative Practice
D. Anesthesia Committee Report – Dr. Jason Flores, DDS
Written Report – (Attachment B)
Dr. Jason Flores, DDS reported to the board that from January 7, 2017 thru March 15, 2017 the following permits were issued:
4 Nitrous Oxide Permits,
1 Conscious Sedation I permit,
0 Conscious Sedation II permits
0 Deep Sedation/General Anesthesia permits
Dr. Burrell Tucker, DDS made a MOTION to ratify the Anesthesia Committee’s report and licensees into the record. Ms. Ermelinda Baca, RDH SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
E. Administrator’s Report – Ms. Roberta Perea
Written Report – (Attachment C)
F. Compliance Liaison Report – Ms. Vanessa Montoya
Verbal Report
G. CODA Report. Charles Schumacher, DDS
No Report
H. NMDHA Report – Ms. Cindy Vigil, RDH
Written Report – (Attachment D)
I. NMDA Report –
No Report
J. NM Department of Health Report – Rudy Blea
Written & Verbal Report – (Attachment E)
K. NM Health Services Medicaid Report – Dr. Devi Gajapathi
No Report
L. PIMA Report – Ms. Melissa McDougal-Plese
No Report
M. AADB –
No Report
N. WREB Report – Ms. Ermelinda Baca, RDH
No Report
O. CRDTS Report –Ms. Ermelinda Baca, RDH
No Report
P. SRTA Report –
No Report
Q. ADEX Report –
No Report
R. CITA Report – Ms. Ermelinda Baca, RDH
No Report
S. Prescription Drug Misuse and Overdose Prevention and Pain Management Advisory Council Report – Dr. Balderamos
Verbal Report
T. Rules Committee – Dr. Charles Schumacher, DDS
Verbal Report
U. Statutes Committee – Dr. Charles Schumacher, DDS
No Report
V. Ad Hoc Committees
No Report
6. NEW BUSINESS
a) Election of Board Officers
Chair
Dr. Paul Balderamos, DDS made a MOTION to nominate Dr. Charles Schumacher, DDS as Chair of the NM Board of Dental Health Care. Dr. Jolynn Galvin, DDS SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
Vice Chair
Dr. Burrell Tucker, DDS made a MOTION to nominate Dr. Paul Balderamos, DDS as Vice Chair of the NM Board of Dental Health Care. Dr. Jolynn Galvin, DDS SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
Secretary
Dr. Paul Balderamos, DDS made a MOTION to nominate Dr. Burrell Tucker, DDS Secretary of the NM Board of Dental Health Care. Dr. David Warren, DDS SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
Election of Two (2) Board Representatives for Dental Hygienists Committee
Dr. David Warren, DDS made a MOTION to nominate Dr. Burrell Tucker, DDS and Dr. Jolynn Galvin, DDS as Representative from the NM Board of Dental Health Care to the NM Dental Hygienist Committee. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
b) EFDA Programs
No Action Taken
c) Approval of Regional Board Examination
Dr. Paul Balderamos, DDS made a MOTION to accept all current Regional Board Examinations. Dr. Burrell Tucker, DDS SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
d) Appoint Unfilled Positions to all Testing Agencies
Ms. Ermelinda Baca, RDH made a MOTION to appoint Dr. David Warren, DDS and Dr. Charles Schumacher, DDS to CDCA’s Steering Committee. Dr. Burrell Tucker, DDS SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
e) Insurance Requirements for Specialty Licenses
No Action Taken
f) Letter from Complaint Committee
Tabled for July board meeting
7. NEW BUSINESS
a) Confirm Future Meeting Dates and Locations
July Board Meeting – July 28, 2017 – Albuquerque
October Board Meeting – October 13, 2017 – Santa Fe
January Board Meeting – January ____, 2018 – Santa Fe
April Board Meeting – April ____, 2018, Albuquerque
b). Dry Needle Therapy
Tabled to July board meeting
8. PUBLIC COMMENT
None
9. EXECUTIVE SESSION
Ms. Ermelinda Baca, RDH mad a MOTION that the New Mexico Dental Health Care Board close this meeting in order to enter into Executive Session to discuss the items listed in the agenda. Pursuant to Sections 10-15-1.H (1) and (7) of the Open Meetings Act authorizing closed sessions for matters related to issuance, suspension, renewal, revocation of a license. Dr. David Warren, DDS SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
Roll Call Vote:
Charles Schumacher, DDS
Burrell Tucker, DDS
David Warren III, DMD
Leo Paul Balderamos, DDS
Jolynn Galvin, DDS
Ermelinda Baca, RDH
Paula Jenkins, RDH
The motion is approved by a unanimous approval. Let the record show that at 10:25 p.m. the Board entered into closed session and the recorder has been turned off.
Back in Open Session
Let the record show that the recorder is back on. The New Mexico Board of Dental Health Care is back in open session. The time is 1:45 p.m. Pursuant to 10-15-1 H (1) & (7) of the Open Meetings Act the matters discussed in the closed meeting were limited only to the items listed in the motion.
The board recessed from executive session from 12:30 p.m. – 1:00 p.m. to hear the ORDER TO SHOW CAUSE 11-59-COM AND 12-37-COM – Dr. William Gardner, DDS and went back into executive session at 1:00 p.m.
10. BOARD ACTION ON MATTERS DISCUSSED IN EXECUTIVE SESSION
Complaints
Ms. Paula Jenkins, RDH made a MOTION to close the following case(s): D-16-50-COM, D-16-61-COM, D-16-66-COM, D-16-71-COM, D-16-74-COM, D-16-84-COM, D-16-85-COM. D-17-2-COM, D-17-3-COM, D-17-6-COM, D-17-7-COM and D-17-15-COM. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED with Board Members Ms. Ermelinda Baca, RDH and Dr. Jolynn Galvin, DDS abstaining.
Ms. Paula Jenkins, RDH made a MOTION to close the following case with an advisory letter: 15-57-COM, D-16-14-COM, D-16-81-COM, D-17-4-COM, D-17-5-COM and D-17-12-COM. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED with Board Members Ms. Ermelinda Baca, RDH and Dr. Jolynn Galvin, DDS abstaining.
Ms. Paula Jenkins, RDH made a MOTION to refer D-16-37-COM to the AGO for the issuance of a NCA for violation of 16.5.16.10B(30) with the following terms of proposed early resolution: $1000 fine payable within 30 days and take and pass the NM Jurisprudence Exam within 30 days. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED with Board Members Ms. Ermelinda Baca, RDH and Dr. Jolynn Galvin, DDS abstaining.
Ms. Paula Jenkins, RDH made a MOTION to refer D-16-43-COM to the AGO for the issuance of a NCA for violation of 16.5.16.10B (26) and 61-5A-21(A) (2) with the following terms of proposed early resolution: Revocation of license upon conviction based on rule 16.5.16.9. Dr. Paul Balderamos,DDS SECONDED the motion. Motion PASSED with Board Members Ms. Ermelinda Baca, RDH and Dr. Jolynn Galvin, DDS abstaining.
Complaints D-16-58-COM, D-16-59-COM & D-16-60-COM were tabled for further information.
Ms. Paula Jenkins, RDH made a MOTION to refer D-16-83 to the AGO for the issuance of a NCA for violation of 61-5A-21(A)(3), 16.5.16.10A and 16.5.16.10B(13) and Section 2 of the ADA Code of Ethics with the following terms of proposed early resolution: $1000 fine per violation($3000 total) payable within 30 days, 12 hours of Continuing Education in Fixed Pros within 90 days and take and pass the NM Jurisprudence Exam within 30 days. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED with Board Members Ms. Ermelinda Baca, RDH and Dr. Jolynn Galvin, DDS abstaining.
Ms. Paula Jenkins, RDH made a MOTION to refer D-17-8-COM, D-17-9-COM and D-17-16-MAL to the AGO for the issuance of a NCA for violation of 16.5.16.10B(19) with the following terms of proposed early resolution: $1000 fine per violation payable within 30 days and take and pass the NM Jurisprudence Exam within 30 days. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED with Board Members Ms. Ermelinda Baca, RDH and Dr.Jolynn Galvin, DDS abstaining.
Ms. Paula Jenkins, RDH made a MOTION to grant the stay contingent upon the Respondent placing the penalty and fees being placed in a trust within 10 days and setting a hearing within 45 days. If the Respondent does not comply with these contingencies, a NCA will be issued for failure to comply with a Board Order. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
12-68-COM
Ms. Paula Jenkins, RDH made a MOTION to grant the stay contingent upon the penalty & fees being placed in a trust and the Respondent provide evidence to the Board within 10 days. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
15-57-COM
Ms. Paula Jenkins, RDH made a MOTION to accept the proposed Settlement Agreement. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-1-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-2-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-3-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-4-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-5-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-6-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-7-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-8-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-9-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-10-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-11-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-12-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-13-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
D-17-14-APP
D-17-15-APP
Ms. Paula Jenkins, RDH made a MOTION to approve this application. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED.
REPORTS:
New Mexico Monitored Treatment Quarterly Report – FYI Only
11. ADJOURNMENT
There being no other business to come before the Dental Board, Ms. Ermelinda Baca, RDH made a MOTION to adjourn the meeting at 2:02 p.m. Ms. Paula Jenkins, RDH SECONDED the motion. All in Favor. All Opposed. All Abstained. Motion PASSED by UNANIMOUS APPROVAL.
Submitted by: Roberta Perea 7/28/17
Roberta Perea, Board Administrator Date
Approved by: [pic] 7/28/17
Charles Schumacher, DDS, Chair Date
(ATTACHMENT A)
REGULAR BOARD MEETING
April 7, 2017
8:00 A.M.
Regulation and Licensing Department
5500 San Antonio Dr. NE Suite B
Albuquerque, NM 87109
Meeting to commence immediately following Dental Hygiene Committee Meeting
Dental Hygienist Committee Meeting begins at 8:00AM.
AGENDA
1. CALL MEETING TO ORDER
2. APPROVAL OF AGENDA
3. APPROVAL OF MINUTES
a) January 27, 2017 Regular Board Meeting Minutes
b) January 27, 2017 Rule Hearing Transcripts
4. ORDER TO SHOW CAUSE 11-59-COM and 12-37-COM – Dr. William Gardner, DDS
5. COMMITTEE REPORTS – The following agenda items are for discussion and possible action:
a) NMBDHC Chair Report – Dr. Charles Schumacher, DDS
b) Secretary’s Report – Dr. Burrell Tucker, DDS
Ratify Licenses Issued for Period 01/07/17 thru 03/15/17
10 Dentists by Examination
10 Dentists by Credentials
42 Dental Assistants
0 Expanded Function Dental Auxiliary (EFDA)
0 Community Dental Health Coordinator (CDHC)
0 Non-Dentist Owner
c) Dental Hygienist Committee Report – Ms. Ermelinda Baca, RDH
Licenses Issued for Period 01/07/17 thru 03/15/17
0 Dental Hygienists by Examination
1 Dental Hygienists by Credentials
0 Dental Hygienists by Collaborative Practice
d) Anesthesia Committee Report – Dr. Jason Flores, DDS
e) Administrator’s Report – Ms. Roberta Perea
f) Compliance Liaison Report – Ms. Vanessa Montoya
g) CODA Report – Dr. Charles Schumacher, DDS
h) NMDHA Report – Ms. Cindy Vigil, RDH
i) NMDA Report –
j) Dept. of Health Report –
k) NM Health Services Medicaid Report – Dr. Devi Gajapathi
l) PIMA Report – Ms. Melissa McDougal-Plese
m) AADB Report –
n) WREB Report – Ms. Ermelinda Baca, RDH
o) CRDTS Report – Ms. Ermelinda Baca, RDH
p) SRTA Report –
q) CITA Report – Ms. Ermelinda Baca, RDH
r) ADEX Report –
s) Prescription Drug Misuse and Overdose Prevention and Pain Management Advisory Council
Report – Dr. Paul Balderamos, DDS
t) Rules Committee – Dr. Charles Schumacher, DDS
u) Statutes Committee – Dr. Charles Schumacher, DDS
v) Ad-Hoc Reports -
6. NEW BUSINESS
a) Election of Board Officers
• Chair
• Vice Chair
• Secretary
• Election of Two Board Representatives for Dental Hygienists Committee
b) EFDA Programs – Dr. Charles Schumacher, DDS
c) Approval of Regional Board Examinations (Attachment 1) (Attachment 2)– Dr. Charles Schumacher
d) Appoint Unfilled Positions to all Testing Agencies – Dr. Charles Schumacher, DDS
e) Insurance Requirements for Specialty Licenses – Dr. Charles Schumacher, DDS
f) Letter from Complaint Committee – Ms. Ermelinda Baca, RDH
7. OLD BUSINESS
a) Confirm Future Meeting Dates
• July Committee Meeting – July 28, 2017, Albuquerque
• October Committee Meeting – October 13, 2017 – Santa Fe
• January Committee Meeting – January ____, 2018 – Santa Fe
• April Committee Meeting – April ____, 2018, Albuquerque
b) Dry Needle Therapy – Dr. Charles Schumacher, DDS
8. PUBLIC COMMENT
9. EXECUTIVE SESSION
a) Complaints
15-32-INC; 15-57-COM; 15-67-COM; D-16-14-COM; D-16-37-COM; D-16-43-COM;
D-16-50-COM; D-16-58-COM; D-16-59-COM; D-16-60-COM; D-16-61-COM; D-16-66-COM; D-16-71-COM; D-16-74-COM; D-16-81-COM; D-16-83-COM; D-16-84-COM; D-16-85-COM; D-17-2-COM; D-17-3-COM; D-17-4-COM; D-17-5-INC; D-17-6-INC; D-17-7-COM; D-17-8-COM; D-17-9-COM; D-17-12-COM; D-17-15-INC; D-17-16-MAL; 12-68-COM
b) Applications
D-17-1-APP; D-17-2-APP; D-17-3-APP; D-17-4-APP; D-17-5-APP; D-17-6-APP; D-17-7-APP;
D-17-8-APP; D-17-9-APP; D-17-10-APP; D-17-11-APP; D-17-12-APP; D-17-13-APP;
D-17-14-APP; D-17-15-APP
c) Reports
New Mexico Monitored Treatment Quarterly Report – FYI Only
10. BOARD ACTION ON MATTERS DISCUSSED IN EXECUTIVE SESSION
11. ADJOURN
(Attachment B)
NM Anesthesia Committee Board Report
March 14, 2017
1. Current Significant Issues
• Anesthesia affidavit review - Refer to Appendix A
• Anesthesia Inspector job description review - Refer to Appendix B
• Non-anesthesia permit holders overseeing a CRNA in the dental office. Refer to Appendix C
• NM CSII Sedation Guidelines – Draft, request from NM Dental Board. Refer to Appendix D
• Continuing to issue temporary permits. (Problem will be timely office inspections. An affidavit system would relieve this.)
• Review of NMAC TITLE 16; CHAP. 5; PART 15. DENTISTS, ANESTHESIA ADMINISTRATION revisions in accordance with new 10/2016 ADA Sedation/GA guidelines. Refer to Appendix E
2. Matters for Board Review/Approval
• Anesthesia affidavit review
• Anesthesia Inspector job description review
• Non-anesthesia permit holders overseeing a CRNA in the dental office.
• NM CSII Sedation Guidelines – Draft, request from NM Dental Board.
• Issuing of temporary permits and timely office inspections
• Review of NMAC TITLE 16; CHAP. 5; PART 15. DENTISTS, ANESTHESIA ADMINISTRATION revisions in accordance with updated 10/2016 ADA Sedation/GA guidelines.
3. Updates on Current Permit Approvals
A. Nitrous Oxide/ Oxygen:
a. Christopher Roclevitch New Mexico, city not specified
b. Melissa Jackson Albuquerque
c. Nima Astaraee Roswell
d. David Greene Albuquerque
e. Jajung Yoon Hobbs
B. CSI:
a. Kelly Hendricks Santa Fe Permanent (Initial)
b. Supreet Arora Carlsbad Permanent (Initial)
C. CSII
a. Marc McRae Albuquerque Permanent (pending)
b. Oghenejiro Akpobome Bloomfield Permanent
D. DS/GA:
a. Brett Schow ABQ Temporary
4. Future Issues
• NM revisions of NMAC TITLE 16; CHAP. 5; PART 15. DENTISTS, ANESTHESIA ADMINISTRATION in accordance with updated 10/2016 ADA Sedation/GA guidelines
Appendix A
APPLICANT NAME _____________________________
AFFIDAVIT OF APPLICANT APPLICATION
CONSCIOUS SEDATION 1, CONSCIOUS SEDATION 2,
DEEP SEDATION/GENERAL ANESTHESIA PERMITS
I, the below named applicant, hereby declare under penalty of perjury that I am the person described and identified in this application and that my answers and all statements made by me on this application and accompanying attachments are true and correct. Should I furnish any false information, or have substantial omission, I hereby agree that such an act shall constitute cause for denial, suspension, or revocation of my license or personal/ facility permit to provide Conscious Sedation 1, Conscious Sedation 2, or Deep Sedation/General Anesthesia permanently and without recourse for reapplication. I also declare that if I did not personally complete the foregoing application that I have fully read and confirmed that I have fully read and confirmed each question and accompanying answer, and take full responsibility for all answers contained in this application.
I understand that I have no legal authority to administer Conscious Sedation 1, Conscious Sedation 2, or Deep Sedation/General Anesthesia until a permit has been granted.
I certify that I am trained and capable of administering Basic Life Support and certify that I am trained and capable of administering Advanced Cardiac Life Support if I provide sedation exclusively for adult patients and certify that I am trained and capable of administering Pediatric Advanced Life Support if I provide sedation for children under twelve (12) years of age or younger.
I certify that I employ qualified auxiliary personnel that are trained in and are capable of monitoring vital signs, assisting in emergency procedures, and administering basic life support.
I understand that if a patient enters a deeper level of sedation than what I am qualified to provide, I must stop the dental procedure until the patient returns to the intended level of sedation. I understand that I am responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies and providing the equipment and protocols for patient rescue. I understand that I must be able to rescue patients who enter a deeper state of sedation than intended and must be prepared to treat emergencies that may arise.
I understand that if I perform a procedure for which Conscious Sedation 1, Conscious Sedation 2, is being employed I shall not administer the pharmacologic agents prohibited in TITLE 16. OCCUPATIONAL AND PROFESSIONAL LICENSING, CHAPTER 5. DENTISTRY. PART 15. DENTISTS, ANESTHESIA ADMINISTRATION and shall not administer pharmacologic agents or monitor the patient without the presence and assistance of at least one additional person trained in Basic Life Support for Healthcare Providers.
I understand that if I perform a procedure for which Deep Sedation/General Anesthesia is being employed that I shall not administer the pharmacologic agents and monitor the patient without the presence and assistance of two additional individuals who have current certification in Basic Life Support for Healthcare Providers.
I am aware that in signing this form, I declare that the appropriate (defined by current standards of care set by the AAOMS, Office Anesthesia Evaluation Manual, current edition, ASDA, ADA, ASA) equipment, emergency supplies, and conditions are met for each facility in which anesthesia is performed, including but not limited to:
- Appropriate history and pre-sedation preparation of each patient
- Appropriate vital monitors for each patient with direct writing capability
- Appropriate agents used, including non-expired drugs and Controlled Substance logs in compliance
with TITLE 16. OCCUPATIONAL AND PROFESSIONAL LICENSING, CHAPTER 19.
- Appropriate infection control techniques
- Appropriate monitoring for patient recovery and transport
- Adequate knowledge of emergencies related to anesthesia administration and associated age/size
appropriate rescue equipment and reserve oxygen in working order and easily accessible
- Appropriate logs kept of regular equipment checks
- Appropriate safety and fire rescue equipment per Code of Federal Regulations, OSHA Standards, OSHA
3187- 09R, Title 29.
- Appropriate compressed gases safety per OSHA Safety Regulations, 29CFR, Part 1910, Subpart: H,
Hazardous
Materials, 1910.101, Compressed gases
- Appropriate office emergency protocols, including Emergency Procedure Record form and emergency
phone numbers
I understand that all aspects of the facility and provider that pertain to the use of anesthesia, including previous sedation records, are subject to inspection, scheduled or unannounced.
I am aware that pursuant to TITLE 16. OCCUPATIONAL AND PROFESSIONAL LICENSING, CHAPTER 5. DENTISTRY. PART 15. DENTISTS, ANESTHESIA ADMINISTRATION 16.5.15.13 REPORTING ADVERSE INCIDENTS, I must report any adverse occurrences related to the use of sedation.
I hereby authorize the release of any and all information and records the Board shall deem pertinent to the evaluation of this application, and shall supply to the Board such records and information as requested for evaluation of my qualifications for a permit to administer Conscious Sedation 1, Conscious Sedation 2, Deep Sedation/General Anesthesia in the State of New Mexico.
I understand that based on evaluation of credentials, facilities, equipment, personnel, and procedures, the Board may place restrictions on the permit, or revoke the personal/facility anesthesia permit(s) or dental license entirely.
I further state that I have read the rules related to the use of anesthesia and sedation, as described in TITLE 16, CHAPTER 5, of the New Mexico Occupational and Professional Licensing Code. I hereby agree to abide by the laws and rules pertaining to the practice of dentistry and anesthesia/sedation in the State of New Mexico and that failure to do so may result in the Board placing restrictions on the permit, or revocation of my personal/facility anesthesia permit(s) or dental license entirely.
MUST BE SIGNED
IN THE PRESENCE
OF A NOTARY PUBLIC
SIGNATURE OF APPLICANT: ______________________________________________________
SUBSCRIBED AND SWORN BEFORE ME, THIS
_______________ DAY OF ______________,
YEAR ________________.
(NOTARY SEAL)
NOTARY PUBLIC SIGNATURE: ______________________________________________________
NOTARY PUBLIC NAME
(TYPED OR PRINTED):____________________________________________________________
MY COMMISSION EXPIRES: ________________________________________________________
Appendix B
Establish a Price Agreement (Agreement) to hire a dentist to perform anesthesia evaluations at dental offices for applicants in rural areas throughout New Mexico who are applying for CSII (Conscious Sedation II) or Deep Sedation/General Anesthesia permits. The evaluator will verify the safety and quality of sedation permit holders pursuant to NM Dental Board rules 16.5.15.16 NMAC. The selected vendor will be expected to be a firm advocate of safety and quality in the State of New Mexico. The selected vendor will work closely with the Board of Dental Health Care Anesthesia Committee and is expected to attend regularly scheduled anesthesia committee meetings either in person or telephonically. Evaluations will be submitted to the committee for board recommendations.
The selected vendor must be a NM Dental Board licensed dentist whose license is in good standing and who possesses or has possessed one of the following for a minimum of two (2) years:
• Deep Sedation/General Anesthesia permit; or
• CSII (Conscious Sedation II) permit holder who will be in consult with a Deep Sedation/General Anesthesia permit holder licensed in New Mexico.
The selected vendor must be familiar with OSHA, AAMOS, ASDA, ADA, ASA safety details and have in-depth knowledge and comprehension of anesthesia quality standards. The goal is to ensure that NM sedation practitioners provide the safest environment with well-functioning equipment and proper patient monitoring. The anesthesia committee will assign the vendors to the office evaluation sites, the committee will work with the vendor to ensure that the evaluations are selected equally and assigned on a case by case basis.
A single office evaluation shall not exceed $1,000.00 per office. A vendor will be paid up to or no more than $1,000.00 for conducting a single evaluation. If two evaluators attend one office evaluation, each vendor must charge $500.00 for the office evaluation for a total of $1,000.00. The $1,000.00 covers the office evaluation, any mileage, and lodging expenses. This contract shall not exceed $11,000.00 per fiscal year (July 1st – June 30th of the following year). If contract is awarded to two vendors the contract will not exceed $5,500.00 per fiscal year, per vendor.
Term:
The term of this Agreement shall be for one (1) year from the date of award with the option to extend for a period of three (3) additional years, on a year-to-year basis, by mutual agreement of all parties and with the approval of the New Mexico State Purchasing Agent (SPA) at the same price, terms, and conditions stated herein. This Agreement shall not exceed four (4) years.
Method of award:
The lowest bid or bids meeting specifications will be awarded; however, the SPA reserves the right to award this Agreement in a manner that serves the best interest of the State of New Mexico and its user agency. Due to the user agency’s requirements and to best serve the needs of the user agency, this bid may be awarded to two vendors. In fact, this method will allow the user agency the option of selecting the vendor or vendors that best meet its needs.
Specifications:
Anesthesia Inspector Responsibilities
Include:
• Assuring that the office is neat, clean, and easily accessible to emergency response
• Verifying ACLS/BLS/(PALS if applicable) status of the doctors and sedation support staff
• Chart review for 10 random charts to identify past sedative procedures
• Verifying types of patients the provider sedates
• Body types, ages, procedures performed, medical history obtained, proper pre-work
• Verifying the types and proper use of the sedatives being used
• Verifying the provider and office are providing sedation for appropriate patient populations
Responsibilities
• Observe
• Staff preparation procedures prior to patient arrival
• Patient arrival: NPO status verified, allergies and med hx documented, heart/lung sounds evaluated, airway evaluated, medications recorded, consents signed, surgery reviewed
• Operatory prepared for sedation
• Staff duties
• Equipment present and in good working condition (emergency batteries charged)
• Emergency cart, suction, AED, airway rescue equipment, B/P, EKG, pulse oximetry, respiratory monitoring
• Appropriately sized airway equipment
• O2 tanks with delivery system
• Bag valve masks (BVMs)
• Nasal cannulas
• ETT or LMAs
• McGill’s forceps
• Laryngoscope
• Tracheostomy kits
• Naso/Oro-pharyngeal airways
• Maintain records of emergency procedures, equipment information, drug log, and previous anesthetics delivered
• Inspect procedures to ensure proper infection control guidelines are being followed
• Monitor the use of equipment to ensure it is safe and well-maintained
• Fullfill the requirements of the New Mexico Board of Dental Health Care Office Anesthesia Evaluation Form
• Prepare and submit any reports required by the New Mexico Board of Dental Health Care
Special Accommodations:
N/A
Compliance with bid instructions:
The New Mexico SPA reserves the right to reject any or all bids.
All bid requirements as issued shall apply.
The vendor's signature is certification that items bid meet or exceed specifications.
Appendix C
Is having an untrained, unknowledgeable, anesthesia team leader the safest situation in a dental office.
Reference material:
16.5.15.13 PERMIT REQUIREMENTS:
B. Conscious sedation II:
(a) Administration of enteral or combination inhalation-enteral conscious sedation (combined conscious sedation) by another duly qualified dentist, physician or certified registered nurse anesthetist (CRNA) requires the operating dentist and his/her clinical staff to maintain current expertise in basic life support (BLS). The operating dentist shall ensure that the acting anesthetist is duly licensed in New Mexico to provide anesthesia and be a member in good standing of the staff of an accredited New Mexico hospital in the community in which the anesthesia occurs. The operating dentist shall be responsible for notifying the anesthesia committee of the New Mexico board of dental health care of all anesthetists used.
(c) A dental facility utilizing dentist, physician or CRNA anesthetists shall be registered with the board as a conscious sedation II facility and the facility and staff shall be evaluated as such.
(d) The operating dentist must ensure that the anesthesia permit holder/provider is responsible for the anesthetic management, adequacy of the facility, and the treatment of emergencies associated with the administration of parenteral conscious sedation, including immediate access to pharmacologic antagonists, if any, and appropriately sized equipment for establishing a patent airway and providing positive pressure ventilation with oxygen.
(and)
NM Nursing Practice Act
61-3-23.3. Certified registered nurse anesthetist; qualifications; licensure; practice; endorsement.
C. Certified registered nurse anesthetists shall function in an interdependent role as a member of a health care team in which the medical care of the patient is directed by a licensed physician, osteopathic physician, dentist or podiatrist licensed in New Mexico pursuant to Chapter 61, Article 5A, 6, 8 or 10 NMSA 1978.
Does a dentist and his/her facility qualify for a CS II permit, even though they do not possess this level of training?
Does this automatically disqualify them since they cannot “be evaluated as such.”?
and
The Nurse Practice act acknowledges that the dentist is the director (leader), of the care being provided, but in an anesthesia emergency, will the non-anesthesia trained dentist be able to help rescue. Is having an untrained team leader (and lone rescuer) the safest situation in a dental office?
Appendix D
NM CSII Sedation Guidelines
Based on ADA GUIDELINES for Teaching Pain Control and Sedation to Dentists and Dental Students
• The course must meet the most current version of the ADA GUIDELINES for Teaching Pain Control and Sedation to Dentists and Dental Students.
• A minimum of 60 hours of instruction plus administration of sedation for at least 20 individually managed patients.
• Certification and documentation of competence in moderate sedation technique(s).
• Certification and documentation of competence in rescuing patients from a deeper level of sedation than intended including managing the airway, intravascular or intraosseous access, and reversal medications.
• Provision and documentation by course director or faculty of additional clinical experience if participant competency has not been achieved in time allotted.
• Records of instruction and 20 individual clinical experiences (i.e., number of patients managed by each participant in each modality/route) that are maintained and available for participant review.
Documentation of Instruction
• The course director must certify the competency of participants upon satisfactory completion of training in each moderate sedation technique, including instruction, clinical experience, managing the airway, intravascular/intraosseous access, and reversal medications.
Faculty
• Course should be directed by a dentist or physician qualified by experience and training. This individual should possess a current permit or license to administer moderate or deep sedation and general anesthesia in at least one state, have had at least three years of experience, including formal postdoctoral training in anxiety and pain control.
• Dental faculty should have a broad clinical experience in the particular aspect of sedation.
• Participation of highly qualified individuals in related fields, such as anesthesiologists, pharmacologists, internists, cardiologists and psychologists, should be encouraged.
• Participant-faculty ratio of not more than four-to-one when moderate sedation is being taught.
• One-to-one ratio is recommended during the early stage of participation.
• Courses in moderate sedation must be presented where adequate facilities are available for proper patient care, including drugs and equipment for the management of emergencies. These facilities may include dental and medical schools/offices, hospitals and surgical centers.
Appendix E
TITLE 16 OCCUPATIONAL AND PROFESSIONAL LICENSING
CHAPTER 5 DENTISTRY (DENTISTS, DENTAL HYGIENISTS, ETC.)
PART 15 DENTISTS, ANESTHESIA ADMINISTRATION
16.5.15.1 ISSUING AGENCY: New Mexico Board of Dental Health Care.
[16.5.15.1 NMAC - Rp, 16.5.15.1 NMAC, 3-17-05]
16.5.15.2 SCOPE: The provisions of Part 15 of Chapter 5 apply to all dentists who hold or who are applying for certification to administer anesthesia or analgesia.
[16.5.15.2 NMAC - Rp, 16.5.15.2 NMAC, 3-17-05]
16.5.15.3 STATUTORY AUTHORITY: Part 15 of Chapter 5 is promulgated pursuant to the Dental Health Care Act, NMSA 1978, 61-5A-22 (1996 Repl. Pamp.).
[16.5.15.3 NMAC - Rp, 16.5.15.3 NMAC, 3-17-05]
16.5.15.4 DURATION: Permanent.
[16.5.15.4 NMAC - Rp, 16.5.15.4 NMAC, 3-17-05]
16.5.15.5 EFFECTIVE DATE: March 17, 2005, unless a later date is cited at the end of a section.
[16.5.15.5 NMAC - Rp, 16.5.15.5 NMAC, 3-17-05]
16.5.15.6 OBJECTIVE:
A. To establish guidelines and procedures for the regulation of dentists who administer nitrous oxide inhalation analgesia, conscious sedation, deep sedation, or general anesthesia in an office located in New Mexico.
B. These guidelines are not meant to regulate the existing precedent where New Mexico licensed dentists may have hospital privileges to provide anesthesia/sedation to dental patients in the operating room or emergency room based on their training, education and policy of the hospital.
[16.5.15.6 NMAC - Rp, 16.5.15.6 NMAC, 3-17-05]
16.5.15.7 DEFINITIONS:
A. “Anxiolysis” the diminution or elimination or reduction of anxiety.
B. “Combination inhalation-enteral sedation (combined conscious sedation)” - conscious sedation using
inhalation and enteral agents. Nitrous oxide/oxygen when used in combination with sedative agents
may produce anxiolysis, conscious or deep sedation or general anesthesia
A. Minimal Sedation - a minimally depressed level of consciousness, produced by a pharmacological method that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile and verbal commands. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected.
- If more than one enteral drug is administered to achieve the desired sedation effect, with or without the concomitant use of nitrous oxide, the guidelines for moderate sedation must apply.
- The administration of enteral drugs exceeding the maximum recommended dose during a single appointment is considered to be moderate sedation and the moderate sedation guidelines apply.
C. “Conscious sedation” means a minimally depressed level of consciousness that retains the patients’
ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command. Conscious sedation is produced by a pharmacologic or non-pharmacologic method or combination thereof. In accord with this particular definition, the drugs and techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Further, patients whose only response is reflex withdrawal from repeated painful stimuli would be considered to be in a deeper state of anesthesia than conscious sedation.
B. Moderate Sedation – a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
- In accord with this particular definition, the drugs and/or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.
D.C “Deep sedation” means an induced state of depressed consciousness accompanied by partial loss of protective reflexes, including the inability to continually maintain an airway independently and to respond purposefully to verbal command. Deep sedation is produced by a pharmacologic or non-pharmacologic method or combination thereof.
E.D “Enteral” means any technique of administration in which the agent is absorbed through the gastrointestinal tract or oral mucosa. (ie oral, rectal, sublingual)
F.E “General anesthesia” means a an induced state of unconsciousness, accompanied by partial or complete loss of protective reflexes, including the inability to continually maintain an airway independently and respond purposefully to physical stimulation or verbal command. General anesthesia is produced by a pharmacologic or non-pharmacologic method or combination thereof.
G.F “Monitor” means to watch or check on.
H.G “Nitrous oxide inhalation analgesia” means the administration by inhalation of a combination of
nitrous oxide and oxygen, producing an altered level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command.
I.H “Prescribed administration” means the nitrous oxide is administered by a dental hygienist or dental assistant under the indirect supervision of the dentist with the dentist's authorization.
[16.5.15.7 NMAC - Rp, 16.5.15.7 NMAC, 3-17-05; A, 07-16-07; A, 01-09-12]
16.5.15.8 REQUIREMENT TO BE REGISTERED OR CERTIFIED: Dentists who administer nitrous oxide inhalation analgesia in New Mexico are required to be registered with the board. Dentists who administer conscious sedation, deep sedation, or general anesthesia in New Mexico are required to obtain an anesthesia permit from the board. Any dentist who fails to comply with these rules may be subject to disciplinary action by the board. Anesthesia permits valid on the effective date of this rule continue to be valid until the expiration date indicated on the permit.
[16.5.15.8 NMAC - Rp, 16.5.15.8 NMAC, 3-17-05]
16.5.15.9 ANESTHESIA COMMITTEE:
A. Appointment: All members of the anesthesia committee serve at the pleasure of the board. The board chair will appoint members to serve on the anesthesia committee for 5 year terms beginning on July 1. Individuals for consideration may be nominated by the New Mexico dental association, any local dental society, or the anesthesia committee.
B. Terms: Each member shall be appointed to serve a term of five years, however, the appointments shall be staggered so that no more than forty percent of the members will expire in any given year.
C. Committee composition: The anesthesia committee shall consist of licensed dentists, including at least 1 board certified oral and maxillofacial surgeon, 1 general dentist, 1 dentist board member, 1 dentist not engaged in the use of sedation techniques, and when possible, representatives of other interested dental specialties. Each anesthesia committee member should be currently practicing some form of sedation and be currently qualified as an examiner, except the non-sedating dentist.
D. Duties: Establish policies and procedures for the evaluation of applications, inspections of facilities, and examination of applicants; make recommendations to the board in regard to each application; report to the board, as needed, at regularly scheduled board meetings the status of activities of the anesthesia committee; Inform the board of any licensee who fails to cooperate with the requirements for application, registration or renewal of permits; inspect facilities upon request of the board; and upon request, assist the board in the investigation of complaints concerning the administration of anesthesia or analgesia.
E. Designated examiners: The anesthesia committee chair may appoint a designated examiner with an anesthesia permit of an equal or greater level to perform evaluations on licensed dental applicants to serve at the pleasure of the New Mexico Board of Dental Health Care (NMBODHC) chair. This designated examiner must be actively practicing his anesthesia level to be considered by the board.
[16.5.15.9 NMAC - Rp, 16.5.15.9 NMAC, 3-17-05; A, 07-16-07; A, 12-16-15]
16.5.15.10 PEDIATRIC GUIDELINES: Unless otherwise described in this section, all anesthesia for patients 12 years and under shall follow the current American Academy of Pediatric Dentistry’s “Guideline for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures”.
[16.5.15.10 NMAC - N, 12-16-15]
16.5.15.11 ADMINISTRATION OF NITROUS OXIDE OR ENTERAL ANXIOLYSIS (MINIMAL SEDATION) ANALGESIA MINIMAL SEDATION:
A. NITROUS OXIDE:
(1) Registration required: Each licensed dentist who administers or supervises the prescribed administration of nitrous oxide inhalation analgesia shall be registered with the board. A registration form will be provided upon initial application or upon request, and contain information to verify the dentist, facility, and staff meet the requirements specified in Paragraph (2) of Subsection A of 16.5.15.10 NMAC. When the registration has been approved by the secretary-treasurer of the board the applicant will be sent a wall certificate which does not expire. Administration of nitrous oxide inhalation analgesia without registration is a violation of these rules and may result in disciplinary action against the licensee.
(2) Requirements for registration: Each licensed dentist who administers or prescribes administration of nitrous oxide inhalation analgesia shall meet the following requirements:
(a) completed a course of training leading to competency while a student in an accredited school of dentistry or through postgraduate training;
(b) have adequate equipment which includes fail-safe features and a 25% minimum oxygen flow and an effective scavenging system;
(c) each dentist and auxiliary personnel who monitors the use of, or administers nitrous oxide shall have current basic life support certification;
(d) all use of nitrous oxide inhalation analgesia shall be under the indirect supervision of a licensed dentist;
(e) the patient's record shall reflect evidence of appropriate monitoring of vital signs, including blood pressure, pulse, and respiratory rate; and
(f) current permit holder’s education would be grandfathered by New Mexico laws in effect at the
time of original issue of their permit. However, safety standards must be updated to current state
and ADA guidelines.
B. ENTERAL ANXIOLYSIS MINIMAL ENTERAL SEDATION: The following requirements for anxiolysis minimal sedation do not require a conscious moderate sedation permit. Each licensed dentist who holds a non-restricted drug enforcement administration (DEA) license and who administers or supervises the administration of enteral anxiolytic minimal enteral sedation medication shall be responsible for the following:
(1) completed a course of training while a student in an accredited school of dentistry or through postgraduate training;
(2) have adequate equipment to monitor patient’s vital signs;
(3) each dentist and auxiliary personnel who monitors shall have current basic life certification;
(4) all use of enteral medication shall be under the indirect supervision of a licensed dentist;
(5) the patient's record shall reflect evidence of appropriate monitoring of vital signs, including
blood pressure, pulse, pulse oximetery, and respiratory rate during procedures and effect of
medication;
(6) shall verify the patient has other means of transportation to be released from the office;
(7) administration of minimal enteral anxiolytic sedation medications in doses that do not
exceed the normal therapeutic dosage recommended by the manufacturer in published literature
and that are within the accepted scope of the practice and prescriptive authority of the dentist so
as not to produce conscious sedation; does not require the dentist to hold a conscious sedation I
moderate enteral permit.
(8) If more than one enteral drug is administered to achieve the desired anxiolytic/sedation
effect, with or without the concomitant use of nitrous oxide, the guidelines for moderate enteral
sedation must apply.
(9) The administration of enteral drugs exceeding the manufacture’s recommended dose during
a single appointment is considered to be moderate sedation and the moderate sedation guidelines
apply.
(10) These guidelines are in accordance with part II, III, IV, Teaching Administration of
Minimal Sedation, of the current ADA Guidelines for the Use of Sedation and General
Anesthesia by Dentists
[16.5.15.10 NMAC - Rp, 16.5.15.10 NMAC, 3-17-05; A, 07-16-07; A, 01-09-12; A, 06-14-12; Rn & A, 16.5.15.11 NMAC, 12-16-15]
16.5.15.12 ADMINISTRATION OF CONSCIOUS MODERATE AND DEEP SEDATION: The following three categories of anesthesia shall not be administered in a dental facility unless the licensed dentist has obtained a permit from the board. The conscious sedation II moderate and deep sedation/general anesthesia permits are issued to the dentist for a specific practice location, unless the anesthesia provider holds an anesthesia permit at large. Administration without a permit is grounds for disciplinary action against the licensee.
A. Conscious sedation I Moderate enteral sedation permit allows a licensed dentist to use only oral or rectal medications or combined inhalation-enteral conscious sedation to obtain conscious moderate sedation on an outpatient basis for dental patients.
B. Conscious sedation II Moderate parenteral sedation permit allows a licensed dentist to use parenteral injection to obtain conscious moderate sedation on an outpatient basis for dental patients. Conscious sedation II Moderate parenteral facility permits shall only allow medications designed for conscious moderate sedation and not deep sedation, regardless of the licensee providing the anesthesia.
(1) A dentist with a conscious sedation II moderate parenteral sedation permit shall not administer or employ any agent(s) which has a narrow margin for maintaining consciousness, or is federally classified as a general anesthetic including, but not limited to:
(a) Ultra short acting barbiturates including, but not limited to, sodium methohexital, thiopental, and thiamylal;
(b) Alkylphenols - propofol (Diprivan) including precursors or derivatives;
(c) Neuroleptic agents;
(d) Dissociative agents - i.e. ketamine;
(e) Etomidate, and similarly acting drugs;
(f) Volatile inhalational agents; or
(g) Any quantity of agent(s) or technique(s), or any combination thereof, that renders a
patient deeply sedated or generally anesthetized.
(2) The drugs/techniques enumerated in paragraph 1 of subsection B of 16.5.15 NMAC are
presumed to produce general anesthesia and may only be used by a licensee holding a valid deep sedation/general anesthesia permit issued by the board, or by a corresponding licensing board if the licensee is not a dentist (eg., MD, CRNA).
C. If a dentist utilizes a CRNA, he/she can only administer sedation up to the anesthesia permit level
held by the supervising dentist.
C. D. Deep sedation/general anesthesia permit allows a licensed dentist to use deep sedation or general anesthesia on an outpatient basis for dental patients.
D. E. Permit levels: The level of permits in order of increasing complexity are conscious sedation I moderate enteral sedation, conscious sedation II moderate parenteral sedation, and deep sedation/general anesthesia. When a permit is issued for a higher level, all levels of lesser complexity are considered within the scope of that permit.
[16.5.15.11 NMAC - Rp, 16.5.15.11 NMAC, 3-17-05; Rn & A, 16.5.15.12 NMAC, 12-16-15]
16.5.15.13 PERMIT REQUIREMENTS:
A. Conscious sedation I Moderate enteral sedation:
(1) To administer enteral or combination inhalation-enteral conscious moderate sedation (combined
conscious sedation) the dentist must satisfy one of the following criteria:
(a) must have completed training to the level of competency in enteral or combination inhalation-
enteral conscious moderate sedation (combined conscious sedation) consistent with the that
prescribed in part I and part III V, Teaching Administration of Moderate Sedation, of the current
ADA guidelines for teaching the comprehensive control of anxiety and pain in dentistry
Guidelines for the Use of Sedation and General Anesthesia by Dentists;
(b) completion of an ADA accredited post-doctoral training program, which affords comprehensive
and appropriate training necessary to administer and manage enteral or combination inhalation-
enteral conscious moderate sedation (combined conscious sedation) consistent with that prescribed
in part II V, Teaching Administration of Moderate Sedation, of the current ADA Guidelines for the
Use of Sedation and General Anesthesia by Dentists; guidelines for teaching the comprehensive
control of anxiety and pain in dentistry;
(c) current permit holder’s sedation education would be grand-fathered by New Mexico laws in
effect at the time of original issue of their permit. However, safety standards must be updated to
current state and ADA guidelines.
(2) The dentist maintains a properly equipped facility for the administration of conscious moderate
enteral sedation, staffed with supervised clinical auxiliary personnel capable of handling procedures,
problems and emergencies.
(3) The dentist and auxiliary clinical personnel must have current basic life support certification.
(4) The patient's record shall reflect that the pre-operative patient evaluation, pre-operative preparation,
monitoring, recovery, discharge and documentation was performed.
(5) The following rules shall apply to the administration of enteral or combination inhalation-enteral
conscious moderate enteral sedation (combined conscious sedation) in the dental office.
(a) Administration of enteral or combination inhalation-enteral conscious moderate enteral sedation (combined conscious sedation) by another duly qualified dentist, physician or certified registered nurse anesthetist (CRNA) requires the operating dentist and his/her clinical staff to maintain current expertise in basic life support (BLS). The operating dentist shall ensure that the acting anesthetist is duly licensed in New Mexico to provide anesthesia and be a member in good standing of the staff of an accredited New Mexico hospital in the community in which the anesthesia occurs. The operating dentist shall be responsible for notifying the anesthesia committee of the New Mexico board of dental health care of all anesthetists used.
(b) A dentist administering enteral or combination inhalation-enteral conscious moderate sedation
(combined conscious sedation) must document current successful completion of a basic life
support (BLS) course.
(c) A dental facility shall be registered with the board as a conscious sedation I moderate sedation
facility.
(d) A dentist utilizing a CRNA for moderate enteral sedation is responsible for the sedation
environment and safety of the patient.
(d)(e) The operating dentist must ensure that the anesthesia permit holder/provider provides for
the anesthetic management, adequacy of the facility, and the treatment of emergencies associated
with the administration of enteral or combined conscious moderate sedation, including immediate
access to pharmacologic antagonists, if any, and appropriately sized equipment for establishing a
patent airway and providing positive pressure ventilation with oxygen.
B. Conscious sedation II Moderate parenteral sedation:
(1) To administer moderate parenteral conscious sedation the dentist must satisfy one of the following
criteria:
(a) completion of a comprehensive training program in moderate parenteral conscious sedation that
satisfies the requirements described in part III V, Teaching Administration of Moderate Sedation,
of the current ADA guidelines for teaching the comprehensive control of anxiety and pain in
dentistry; Guidelines for the Use of Sedation and General Anesthesia by Dentists;
(b) completion of an ADA accredited post-doctoral training program (e.g. general practice
residency), which affords comprehensive and appropriate training necessary to administer and
manage moderate parenteral conscious sedation;
(c) current permit holder’s sedation education would be grandfathered by New Mexico laws in
effect at the time of original issue of their permit. However, safety standards must be updated to
current state and ADA guidelines.
(2) The dentist maintains a properly equipped facility for the administration of conscious
moderate parenteral sedation in accordance with the current ADA guidelines for the use of
conscious sedation, deep sedation and general anesthesia for dentists. Guidelines for the Use of
Sedation and General Anesthesia by Dentists
(3) The office is staffed with supervised clinical auxiliary personnel capable of handling
procedures, problems and emergencies incident thereto.
(4) The dentist must have current advanced cardiac life support certification and auxiliary
clinical personnel have current basic life support certification.
(5) The patient's record shall reflect that the pre-operative patient evaluation, pre-operative
preparation, EKG, pulse oximetery, blood pressure, and ETCO2 capnography monitoring,
recovery, discharge and documentation was performed in accordance with the current ADA
guidelines for the use of conscious sedation, deep sedation and general anesthesia for dentists.
Guidelines for the Use of Sedation and General Anesthesia by Dentists.
(6) The dentist passes the examination and receives approval after facility inspection by the
anesthesia committee or designated examiner(s).
(7) The following requirements shall apply to the administration of moderate parenteral
conscious sedation in the dental office.
(a) Administration of parenteral conscious sedation by another duly qualified dentist,
physician or CRNA requires the operating dentist to maintain current expertise in advanced
cardiac life support certification and his/her clinical staff to maintain current expertise in
basic life support (BLS). The operating dentist shall ensure that the acting anesthetist is
certified in advanced cardiac life support (ACLS), is duly licensed in New Mexico to
provide anesthesia and is a member in good standing of the staff of an accredited New
Mexico hospital. The operating dentist shall be responsible for notifying the anesthesia
committee of the New Mexico board of dental health care of all anesthetists used.
(b) A dentist administering moderate parenteral conscious sedation must document
current successful completion of:
(i) a basic life support (BLS) course;
(ii) advanced cardiac life support (ACLS) or an appropriate equivalent as
approved by the anesthesia committee.
(c) A dental facility utilizing dentist, physician or CRNA anesthetists shall be
registered with the board as a conscious moderate parenteral sedation II facility and
the facility and staff shall be evaluated as such.
(d) A dentist utilizing a CRNA for moderate parenteral sedation is responsible for the
sedation environment and safety of the patient.
(d) (e) The operating dentist must ensure that the anesthesia permit holder/provider is
responsible for the anesthetic management, adequacy of the facility, and the treatment
of emergencies associated with the administration of moderate parenteral conscious
sedation, including immediate access to pharmacologic antagonists, if any, and
appropriately sized equipment for establishing a patent airway and providing positive
pressure ventilation with oxygen.
C. Deep sedation/general anesthesia:
(1) To administer deep sedation/general anesthesia, the dentist must satisfy one of the following
criteria:
(a) completion of an advanced training program in anesthesia and related subjects beyond the
undergraduate dental curriculum that satisfies the requirements described in part II III C, Deep
Sedation of General Anesthesia, of the current ADA guidelines for teaching and comprehensive
control of anxiety and pain in dentistry Guidelines for the Use of Sedation and General Anesthesia
by Dentists;
(b) completion of an ADA accredited post-doctoral training program (e.g. oral and maxillofacial
surgery, dental anesthesiology), which affords comprehensive and appropriate training necessary
to administer and manage deep sedation/general anesthesia, commensurate with these rules;
(c) current permit holder’s sedation education would be grandfathered by New Mexico laws in
effect at the time of original issue of their permit. However, safety standards must be updated to
current state and ADA guidelines.
(2) The dentist maintains a properly equipped facility for the administration of deep sedation or general
anesthesia in accordance with the current ADA guidelines for the use of conscious sedation, deep
sedation and general anesthesia for dentists. Guidelines for the Use of Sedation and General
Anesthesia by Dentists.
(3) The office is staffed with supervised clinical auxiliary personnel capable of handling procedures,
problems and emergencies incident thereto.
(4) The dentist must have current advanced cardiac life support certification and auxiliary clinical
personnel have current basic life support certification.
(5) The patient's record shall reflect that the pre-operative patient evaluation, pre-operative
preparation, EKG, pulse oximetery, blood pressure, and ETCO2 capnography monitoring recovery,
discharge and documentation was performed in accordance with the current ADA guidelines for the
use of conscious sedation, deep sedation and general anesthesia for dentists. Guidelines for the Use of
Sedation and General Anesthesia by Dentists.
(6) The dentist passes the examination and receives approval after facility inspection by the anesthesia
committee or designated examiner(s).
(7) The following rules shall apply to the administration of deep sedation/general anesthesia in the
dental office.
(a) Administration of deep sedation/general anesthesia by another duly qualified dentist,
physician or CRNA requires the operating dentist to maintain current expertise in advanced
cardiac life support certification and his/her clinical staff to maintain current expertise in basic life
support (BLS). The operating dentist shall ensure that the acting anesthetist is certified in
advanced cardiac life support (ACLS), is duly licensed in New Mexico to provide anesthesia and
is a member in good standing of the staff of an accredited New Mexico hospital. The operating
dentist shall be responsible for notifying the anesthesia committee of the New Mexico board of
dental health care of all anesthetists used.
(b) A dentist administering deep sedation/general anesthesia must document current, successful
completion of an advanced cardiac life support (ACLS) course, or an equivalent as approved by
the anesthesia committee.
(c) A dental facility utilizing dentist, physician or CRNA anesthetists shall be registered with the
board as a deep sedation/general anesthesia facility and the facility and staff shall be evaluated as
such.
(d) The operating dentist must ensure that the anesthesia permit holder/provider is responsible
for the anesthetic management, adequacy of the facility, and the treatment of emergencies
associated with the administration of deep sedation and general anesthesia, including immediate
access to pharmacologic antagonists and appropriately sized equipment for establishing a patent
airway and providing positive pressure ventilation with oxygen. Advanced airway equipment,
resuscitation medications and a defibrillator must also be immediately available. Appropriate
pharmacologic agents must be immediately available if known triggering agents of malignant
hyperthermia are part of the anesthesia plan.
D. Anesthesia permit at large: This permit allows the holder to provide anesthesia services to patients in
dental offices on an out-patient basis. The holder of the "anesthesia permit at large" assumes all
responsibility for the administration of the sedation or anesthesia in the dental office.
(1) To hold an "anesthesia permit at large" a dentist must meet the requirements of Subsection C of
16.5.12 NMAC deep sedation/general anesthesia.
(2) The holder of a "permit at large" may be evaluated and inspected by the anesthesia committee as
deemed necessary to assure safety to the public.
(3) The holder of such a permit agrees to have available at all times all monitors, emergency
equipment, and other necessary drugs and materials when administering conscious sedation, deep
sedation, and general anesthesia.
(4) The permit holder will inform the board of all dental facilities where anesthesia services are to be
provided and follow all other procedures as outlined in Subsection C of 16.5.15.12 NMAC, deep
sedation/general anesthesia.
[16.5.15.12 NMAC - Rp, 16.5.15.12 NMAC, 3-17-05; A, 07-16-07; Rn & A, 16.5.15.13 NMAC, 12-16-15]
16.5.15.14 REPORTING ADVERSE INCIDENTS: Each licensed dentist must submit a written report to the board within a period of thirty days of any significant morbidity or mortality or other incident which results in temporary or permanent physical or mental injury of a patient during, or as a result of, nitrous oxide inhalation analgesia, conscious moderate sedation administered via oral, rectal, inhalation, or parenteral routes, deep sedation, or general anesthesia. The report is required regardless of the need for hospitalization after the incident and shall include the following:
A. description of the dental procedure;
B. description of the pre-operative physical condition of the patient;
C. list of drugs and dosage administered and route of administration;
D. description in detail of techniques utilized in administering the drugs utilized;
E. the names of auxiliary personnel in attendance; and
F. description of the adverse occurrence to include the following: detailed description of symptoms, of any
incident; treatment initiated on the patient; response of the patient to the treatment; description of
the patients patient’s condition on termination of treatment; and, copies of the patient record, medical
history and operative report.
[16.5.15.13 NMAC - Rp, 16.5.15.13 NMAC, 3-17-05; Rn, 16.5.15.14 NMAC, 12-16-15]
16.5.15.15 FAILURE TO REPORT: Failure to comply with the reporting requirements of 16.5.15.13 NMAC of this part shall be grounds for disciplinary action against the licensee. In accordance with the provisions of the Uniform Licensing Act, the board may take any actions enumerated in 16.5.16 NMAC, as well as revoke the anesthesia permit.
[16.5.15.14 NMAC - Rp, 16.5.15.14 NMAC, 3-17-05; Rn, 16.5.15.15 NMAC, 12-16-15]
16.5.15.16 PERMIT APPLICATION PROCEDURE:
A. Applications may be obtained from the board office. The completed application, accompanied by the
required permit fee as defined in 16.5.5 NMAC, is forwarded to the anesthesia committee for evaluation.
B. Temporary permits: The anesthesia committee evaluates the application and identifies any additional
information required. If the application appears to be in order, the anesthesia committee may recommend
the board issue a temporary permit. Temporary permits allow time to complete processing of the
application, administer the examination and inspect the facility.
(1) A dentist having a valid temporary dental license in good standing may apply for a CSI, CSII and
moderate enteral, moderate parenteral or deep sedation/GA temporary anesthesia permit not to exceed
the term of the first temporary license. After receipt of proper documentation, and at the discretion of
the anesthesia committee or anesthesia designator, the application may be approved by the board at the
next regular scheduled meeting.
(2) The temporary permit shall not be valid for more than 12 months.
(3) The permit application fee includes the cost of the temporary permit and the initial permit.
(4) A temporary permit shall expire automatically on the following grounds:
(a) the applicant fails the anesthesia committee's examination;
(b) the applicant is found to be practicing outside the recognized standard of care in regard to
administration of anesthesia;
(c) or the applicant fails to cooperate with the timely scheduling of the examination and facility
inspection.
C. Examination/evaluation: The anesthesia committee will schedule the examination and facility
inspection, when required, with the applicant. The anesthesia committee uses the American association of
oral and maxillofacial surgeons American Association of Oral Maxillofacial Surgeons’ office anesthesia
evaluation manual as a guide for the examinations. Incomplete applications will be returned by the
anesthesia committee to the board office with a clear indication of the deficient areas.
D. Final approval: After final evaluation of the application and examination results, the anesthesia
committee recommends final action on the application to the board. The board makes the final
determination on approval of the permit. If an application is denied for failure to meet the requirements of
16.5.15.10 NMAC the areas of non-compliance will be identified and the applicant may re-apply when the
requirements are met.
[16.5.15.15 NMAC - Rp, 16.5.15.15 NMAC, 3-17-05; A, 07-16-07; A, 07-17-08; Rn & A, 16.5.15.16 NMAC, 12-16-15]
16.5.15.17 PERMIT EXPIRATION AND RENEWAL:
A. Expiration: Anesthesia permits are issued for six years from the last day of the month in which the initial permit was issued.
B. Renewal: Renewal applications will be sent to each dentist prior to the expiration date of the anesthesia permit. The completed application, along with the required fee must be returned to the board office prior to permit expiration. The permit renewal application will be forwarded to the anesthesia committee, which will schedule a re-examination for holders of conscious sedation II moderate parenteral and deep sedation/general anesthesia permits.
C. Education requirements: Any holders of any permit level holding CSI, CSII, moderate enteral, moderate parenteral, deep sedation and general anesthesia AAL are required to have a minimum of five hours of continuing education for the permit renewal for every six years in medical emergencies, air way management, pharmacology, or anesthesia related topics.
D. New facility evaluation: A dentist who holds a conscious sedation II moderate parenteral or deep sedation/general anesthesia permit and who relocates his practice requires a new permit based on re-examination. The permit fee will be charged and the new permit will be issued in accordance with Subsection B or C of 16.5.15.12 NMAC.
E. Re-examination/evaluation: The board may require a re-examination or a re-evaluation of the credentials, facilities, equipment, personnel, and procedures of a permit holder to determine if the dentist is currently qualified to administer anesthesia. The board or its agents shall notify the dentist to be re-examined or re-evaluated 180 days in advance of permit expiration. The notification will indicate the content and format of the examination/evaluation.
F. Permit Expiration: Failure of a dentist to renew his license and permit, or to schedule a required office re-evaluation within thirty days of receipt of the notification, or failure on the part of the licensee to successfully complete the examination/evaluation, will cause the permit to expire.
G. Verification of continuing education: The board will select renewal application for verification of continuing education. Audit requests will be included with the renewal notice and those selected individuals will be asked to submit proof of compliance with the continuing education requirements. Continuing education records may be audited by the board at any time. The records identified in Subsection F of 16.5.1.15 NMAC are considered acceptable forms of documentation. Continuing education records must be maintained for one year following the renewal cycle in which they are earned. Additionally and at renewal time, holders of any permit level may be requested to demonstrate competency in maintenance of airway patency to the anesthesia committee, it’s designated examiner or the board either on a “board approved” simulator, or other device as may be acceptable to the board. There may be an announced audit of any permit holder by the anesthesia committee or by the board designated examiner during the permitted time for the purpose of demonstrating airway management and airway competency, either on the board designated model or other device approved by the board.
[16.5.15.16 NMAC - Rp, 16.5.15.16 NMAC, 3-17-05; A, 07-16-07; Rn, 16.5.15.17 NMAC, 12-16-15]
HISTORY OF 16.5.15 NMAC:
Pre NMAC History:
Material in this part was derived from that previously filed with the commission of public records - state records center and archives as:
Article XIV, Administration Of Nitrous Oxide Inhalation Analgesia, Conscious Sedation, Deep Sedation, And General Anesthesia, filed 09-04-86;
BOD Rule 13, Administration Of Nitrous Oxide Inhalation Analgesia, Conscious Sedation, Deep Sedation, And General Anesthesia, filed 02-09-89;
BODHC Rule DS 8-95, Dentists, Analgesia Administration, filed 07-31-95.
History of Repealed Material: 85-1, Repealer, filed 10-29-85.
16 NMAC 5.15, Dentists, Analgesia Administration (filed 09-17-96), repealed 05-31-2002.
Other History:
BODHC Rule DS 8-95, Dentists, Analgesia Administration (filed 07-31-95); renumbered, reformatted and replaced by 16 NMAC 5.15, Dentists, Analgesia Administration, effective 09-30-96;
16 NMAC 5.15, Dentists, Analgesia Administration (filed 09-17-96), replaced by 16.5.15 NMAC, Dentists, Analgesia Administration, effective 05-31-2002.
(Attachment C)
Board status sheet
Board of Dental Health Care 4/7/2017
Board membership
|Member |Name |Start Date |Expiration Date |Term # |
|Professional Member, Board Chair |Charles Schumacher, DDS |09/06/2013 |07/01/2018 |1 |
|Professional Member, Vice Chair |Leo Paul Balderamos, DDS |12/10/2013 |07/01/2017 |1 |
|Professional Member, Secretary |Burrell Tucker, DDS | |07/01/2016 |2 |
|Professional Member |David Warren III, DDS |07/01/2015 |07/01/2020 |1 |
|Professional Member |Jolynn Galvin, DDS |11/07/2013 |07/01/2019 |2 |
|Dental Hygiene Committee Representative Chair of the |Ermelinda Baca, RDH |12/17/2012 |07/01/2021 |2 |
|Hygiene Committee | | | | |
|Dental Hygiene Committee Representative Vice Chair of |Paula Jenkins, RDH |09/03/2014 |07/01/2018 |1 |
|Hygiene Committee | | | | |
|Professional Member of Dental Hygiene Committee |Melissa Barbara, RDH |06/06/2013 |07/01/2014 |1 |
|Professional Member of Dental Hygiene Committee |Denise Teague-Myrick, RDH |11/28/2012 |07/01/2015 |1 |
|Professional Member of Dental Hygiene Committee |Sarah Thiel, RDH |04/15/2014 |07/01/2017 |1 |
|Public (Vacant) | | | | |
|Public (Vacant) | | | | |
CURRENT board ISSUES:
• The board is seeking persons who are interested in serving on the board as either a Professional Member or a Public Member
• Licensing Clerk position is now vacant
the numbers
• Total Number of Licenses: 5,493
• Total Number by Type:
Dental Assistants = 2,706 Dental Hygienists = 1,290 Non-Dentist Owners = 27
Dentists = 1,458 Community Dental Health Coordinator = 3 Expanded Function Dental Auxiliary = 9
• Total Number of Complaints Received since last board meeting: 13
• Total Number of Complaints Received year to date: 20
• Total Number of NCA’s Issued since last board meeting: 3
• Total Number of NCA’s Issued year to date: 4
• Renewal cycles: June 30th.
(Attachment D)
Report to the NM Board of Dental Healthcare and Dental Hygienists’ Committee
April 7, 2017
Since January 27, 2017 BDCH/DHC meeting:
• NMDHA actively partnered with NMDA on HB 264 Dental Care Access bill and will continue to collaborate in future efforts to improve oral health in New Mexico.
• February 10, 2017 - Participated and supported PMI Poster Session with a judging team and awards.
• February 17, 2017 - NMDHA’s Advocacy Day in Santa Fé.
• March 3, 2017 - High Desert component annual CE, Albuquerque Day was held in Albuquerque.
• April 1, 2017 - NMDHA’s MidYear CE, General Membership meeting & elections were held in Albuquerque.
Respectfully submitted,
Cindy Vigil RDH BS NMDHA President cindyvigil@aol..com
(Attachment E)
April 6, 2017
Office of Oral Health
• Recruiting for a dental assistant for ABQ office.
o NM SPO
• Program continuing as of December 2016:
State Contractors.
|Encounter | |
|Age 0-4 |1 |
|5-19 |736 |
|20-64 |1204 |
|65+ |819 |
| |2760 |
| | |
State Staff:
• Oral Health Program
• Head Start 660
• Dental Sealants
o Screened 3,158
o Sealed 2,126
o Decay rate 14%
• February 2017 Children’s Oral Health Month
o Governor Proclamation
o City of Espanola
o City of Las Cruces
o Santa Fe CC Dental Assistant Free Clinic
o Smile Campaign
▪ Partnership KOAT TV, NM Delta Dental (awards)
▪ Promote oral health – message included DOH and DD logos
▪ 3 broadcast oral health PSA (English/Spanish) daily 2 weeks
▪ Smile Campaign 2,980 photos
▪ 4 winners
▪ Campaign was viewed by 620,639 adults 34% of KOAT TV viewers
▪ 800,000 digital impressions delivered
o NM Lobo’s Reading Campaign
o Purpose: to engage 1st through 3rd grade children to increase their reading capacity
o Purpose: to bring awareness of the importance of oral health and overall health
o APS 199 children read over 50 books within a selected time frame reading to include selected heath books provided by the NM Healthy Kids program.
o Winning Schools
o Whittier Elementary
o Double Eagle Elementary School
o Longfellow Elementary School
o 12 children received awards including a certificate, tooth brush/tooth paste and a set of the “Dinky” health books. Children attended a women’s basketball game and were presented to the audience.
o Sponsors were: Lobo Sports Properties, NM Maternal and Child Health Branch, NM Health Kids, and Office of Oral Health.
o A similar campaign is underway in the Santa Fe School District.
o A similar campaign is planned for the Las Cruces School District with NM State.
• April 24 – 26, 2017 is the National Oral Health Conference.
o Over 600 registrants
o Secretary Lynn Gallagher to make opening remarks
o CWF meeting to be held with city leadership, water board members, local community, DOH, and CWF leaders from across the country to strategize on having ABQ reinstate CWF.
o DOH has been actively involved in the planning of the conference.
-----------------------
New Mexico Regulation and Licensing Department
BOARDS AND COMMISSIONS DIVISION
New Mexico Board of Dental Health Care and
New Mexico Dental Hygienist Committee
Toney Anaya Building ª% P.O. Box 25101 ª% Santa Fe, New Mexico 87505
(505) 476-4680ª% Fax (505) 476-4545 ª% rld.state.nm.us
naya Building ▪ P.O. Box 25101 ▪ Santa Fe, New Mexico 87505
(505) 476-4680▪ Fax (505) 476-4545 ▪ rld.state.nm.us
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