facebook

Do I Need A Permit to Utilize Sedation Dentistry in Florida?

What is Sedation Dentistry?

Sedation Dentistry is a mild to moderate level of sedation used to assist dental patients with attaining a temporary insensitivity to pain while remaining conscious. Typically, this is used for lengthier procedures and is also found to be very beneficial for patients that suffer from anxiety about having dental work done.

What are the different types of Sedation Used?

There are a few different types of sedation that can be used for dental procedures. The kind of sedation used depends on the treatment or procedure at hand and the level of anxiety the patient suffers from. There are also varying factors such as the patient’s weight and medical history.

Oral Sedation: With oral sedation, a pill is administered about one hour before a procedure so it has time to take effect. Usually, patients will feel tired and dazed. This is considered “minimal sedation”. It is possible to fall asleep while under oral sedation but not common. At most, it would be a light sleep and the patient can be easily awakened. This type of sedation is ideal for patients with fear or anxiety. It will affect memory and motor skills and, accordingly, patients must be advised against driving themselves home.

Inhalation Sedation: This is typically known as “laughing gas”. Nitrous Oxide is administered through a mask or nosepiece. It is a gas and the dosage is controlled by the dentist and begins to take effect almost instantly (within 3 to 5 minutes). This method merely calms the patient to sit through the procedure and may provide mild pain relief. Oral injections can be provided simultaneously with nitrous oxide. Once finished, oxygen is passed through the mask or nosepiece and the nitrous oxide is flushed out of the system. This is also considered “minimal sedation”.

Intravenous Sedation: Sedative Medications are pumped into the veins of a patient and through the bloodstream. This requires the monitoring of blood pressure, oxygen levels, and heart rate and is the most intense form of sedation allowed to be used in a dental office. This is considered “moderate sedation”. Patients typically fall asleep and have no memory of the procedure afterwards. It is not recommended to operate a motor vehicle after intravenous sedation. Patients should be advised to not eat or drink for 6 hours before having intravenous sedation.

General anesthesia can be used in a hospital or ambulatory setting. It is an unconscious sedation, and an anesthesiologist must be present. This is not very common for a dental procedure and cannot be performed in dental office.

When is Sedation Used in Dentistry?

Sedation is usually offered to patients who have some sort of anxiety about a procedure. It is also offered to minimize the amount of pain felt during a procedure. For lengthier or more painful procedures such as root canals, it is always recommended.

Who Can Utilize Sedation Dentistry?

The Florida Board of Dentistry allows dentists to administer a small dose of oral sedation without having advanced training or permitting. A single dose of a medicine is allowed up to the maximum dosage per patient weight. Dentists are also allowed to supplement with nitrous oxide. This is considered “minimal sedation”. Formal advanced training in sedation is required to administer “moderate sedation”. This is done through an internship or an approved course. Dental professionals must complete 60 hours of didactic instruction on a minimum of 20 patients, and an inspection of the office must be performed including a demonstration of an emergency drill before any permit is issued with the Board of Dentistry. To administer “deep sedation” or general anesthesia, a dentist must complete a residency in General Anesthesia an receive a permit from the Board of Dentistry. Pediatric sedation requires a completely separate permit and training requirements.

*****************************************************

It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Do I Need a Biomedical Waste Permit for my Clinic?

Biomedical Waste Permit Regulations

Biomedical waste is the inevitable outcome in most health care offices. Professionals in the health care field need to keep up to date information on the regulations for handling any type of biomedical or hazardous/chemical waste that is a result of services provided. While the most obvious concerns are those of public safety and possible health risks, if not stored or disposed of properly, this waste can also result in thousands of dollars in fines.  There are many types of health care waste to consider: biohazard, chemical, pathological, chemotherapy waste, etc. The waste produced by each office will determine the proper treatment and disposal. The Department of Health along with the state’s environmental and health departments regulate the storage, containment, treatment, and disposal of biomedical waste.

What is Biomedical Waste?

According to the State of Florida’s Bureau of Community Environmental Health, Biomedical waste is defined as any solid or liquid waste that may present a threat of infection to humans. The term includes, but is not limited to, nonliquid human tissue and body parts; laboratory and veterinary waste that contains human-disease-causing agents; discarded disposable sharps; human blood and human blood products and body fluids; and other materials that in the opinion of the Department of Health represent a significant risk of infection to persons outside the generating facility. The term does not include human remains that are disposed of by persons licensed under Chapter 497.

Biomedical Waste Storage and Containment

In Florida, biomedical waste generated from a facility cannot be stored for more than 30 days. The period of allowable storage begins from the moment a non-sharp article of biomedical waste is thrown into a red bag or a sharps container or when a sharps container is sealed. All containers, bags, or packages of waste must be clearly identifiable with the international biomedical waste symbol. All contained waste must remain sealed until treatment occurs. If a container should be ruptured, the original package must be placed into a new container without disrupting the original packaging. Any indoor storage area for biomedical waste must have restricted access and be described in the operating plan.  Outdoor storage areas must be clearly identifiable with the international biomedical waste symbol and have some form of security or protection against theft or vandalism. All symbols must be red, orange, or black and have a contrasting background color. All symbols must be a minimum of 6 inches in diameter.

Disposal of Biomedical Waste

Packages that are compacted should be incinerated or treated via approved treatment process. Other treatments must be approved via written request by the Department of Health. There are various treatment options available: treatments by gas, steam, chemical, dry temperatures, or microwaving are all approved and available. Waste may be disposed by transporting to a sanitary sewer system, an onsite sewage treatment disposal system. The disposal systems must be approved by the Department of Environmental Protection or the Department of Health.

Permitting

All facilities housing biomedical waste shall obtain an annual permit from the Department of Health. The form DH 4089, Application for Biomedical Waste Generator Permit/Exemption and the corresponding fees should be submitted to the local Department of Health facility. This permit needs to be renewed annually no later than September 30th of every year. If any facility eliminates less than 25 lbs of biomedical waste within a 30 day period, it is exempt from having to obtain permits and fee requirements. To qualify for exemption, documentation proving the weight of the waste generated for a 30 day period must be provided. After applications are submitted, the Department of Health will conduct an inspection of the facility to ensure compliance with section 381.0098 of the Florida Statutes. After inspection, the Department will notify if the facility is eligible to receive exemption.

Sharps Storage, Containment and Disposal

A permanently mounted sharps container is mandated by the state of Florida for businesses that use and dispose of needles. It must be labeled with the approved phrases of the international biomedical waste regulations. Containers must always be readily available and as close to the location of use as possible. The container should be disposed of once ¾ full to avoid any potentially dangerous contamination.

*****************************************************

It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Law Student of the Year – Pierre Gerard Craig, III

We are proud to announce that Pierre Gerard Craig, III is the Health Law Section of the Florida Bar’s Law Student of the Year for 2022!

Mr. Craig joined the Health Law Section’s mentorship program a year ago and has established a relationship with his mentor, Jamaal R. Jones, Esq. They continue to meet and speak regularly.

We want to congratulate Mr. Craig on his wonderful achievement and wish him continued success.

Do I need to Register to Perform In-Office Surgeries in Florida

Developments of new drugs and medical technology have enabled physicians to perform treatments and procedures in the comfort of medical offices that were once only able to be performed in hospital settings. To confirm whether obtaining an Office Surgery License is required for your office to perform these surgeries you must carefully examine the rules on office surgeries because they have changed recently.

 

The Office Surgery Rule

On June 25, 2019, Governor Ron DeSantis signed Senate Bill 732 into law. This rule provides guidance on how office procedures can be performed. It also delivers certain standards for these offices and requires that any office performing office surgery procedures be registered with the Department of State. As of January 2020, all offices performing liposuctions over 1000ccs, or Level 2 or Level 3 surgeries must register and comply with statute requirements. According to the Florida Board of Medicine, any office performing “Level 2 procedures lasting more than 5 minutes, and all level 3 surgical procedures in an office setting must register the office with the department unless that office is licensed as a facility under chapter 395, 458.309(3) F.A.C.)”. In any case, office surgical procedures should not result in blood loss of more than 10 percent of estimated blood volume in a patient or directly engage any main blood vessels, or be considered life threatening in nature.

 

What are the levels of Office Surgery?

Level 1 Surgeries are procedures that require none to minimal pre-operative medications or tranquilizations. Any anesthesia used must be local and conscious altering medication is not administered. This includes but is not limited to excision of moles, warts, lesions, cysts; liposuction, removing less than 4000cc of fat, skin biopsies, drainage of superficial abscesses, etc.

Level 2 Surgeries can use sedation or peri-operative medicines that alter levels of consciousness which, in turn, require some post-operative monitoring. These procedures include, but are not limited to breast biopsies, colonoscopies, hernia repair, etc.

Level 3 Surgeries are procedures that absolutely should utilize general anesthesia or pre-operative sedation. This can include intravenous sedation, major conductive anesthesia, and general anesthesia.

For each level, there are specific outlines for medication, equipment, and registration requirements which can be found by visiting: http://www.doh.state.fl.us/mqa/medical/osr_home.html.

 

Pain Management Facilities

While anesthesia blocks are considered ‘surgical procedures’ by the Florida Board of Medicine, the level of sedation would determine the surgery procedure level.

 

How to Register for an Office Surgery License

The registering Surgeon should submit an Office Surgery Registration form with an original signature. The office must also provide proof of completion of necessary training (i.e. certificates/diplomas) by all physicians. If any physicians that will also be performing Level 2 or Level 3 surgeries are hired to the office after the approval, the Department must be notified immediately to update records.

 

Other Requirements

If an office plans to engage in surgeries that require a license and recognition with the Department of Health, there are ethics standards to be upheld and requirements that must be complied with. The requesting medical offices are subject to be inspected by the Department of Health and each office should have a designated physician responsible for ensuring compliance. Medical offices also need to exhibit the required minimal financial responsibility as outlined by the State.

*****************************************************

It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

How to Open a Group Home for Children, Disabled Persons, and the Elderly in Florida

What is A Group Home?

A group home by definition is a residence that offers full time care for those who are unable to care for themselves. Group homes offer assistance for those who are unable to care for themselves due to age or medical disability and can’t be cared for by family members.

Group homes are usually smaller than other care facilities with more centralized care and fewer residents (usually 6 beds or under). Typically, 24-hour care and supervision is provided by at least one caregiver around the clock. Group Homes are not typically responsible for the personal care of residents such as bathing or using facilities. While health insurance does not typically cover the cost of a group home, long term care insurance might.

Who Can A Group Home Serve?

Children. Children who are unable to safely remain in their homes and have been removed from their parent or guardian may be placed in a home with full time supervision. They are placed in the custody of the Department of Children and Families and are then placed in a group home if foster is not a viable fit.

Disabled persons. Persons with disabilities who are unable to care for themselves may also find support in a group home. These facilities can offer training and basic life skills for individuals with intellectual and developmental disabilities. This experience can provide an opportunity for education and growth of social skills and basic life functions.

Elderly. Finding the right care for an aging family member can be a difficult decision to make. When there is an aging loved one with special medical needs in the family, it can take a toll on everyone. A group home is a great option for a more personalized care setting. In Florida, group homes offer medical care including transportation to health-related appointments. This setting also promotes socialization and a familiar cozy mood unlike the feel of a sterile nursing home. This can reduce the possibility of loneliness and depression.

Steps to Opening A Facility

Applicants will need to provide their licensing department with a business plan and operations manual along with the prospective location and community plan, geographical plan, zoning requirements, etc. Applicants may be eligible to receive Community Development Grant Block Funding to set up their home. Local community offices provide information on funding and assistance for group homes.

The Department of Children and Families licenses those homes for children under 19 years old without disabilities. In addition to the standard requirements, a group home for minors requires pre-approved menus from a licensed dietician, educational schedules, and daily activities.

The Agency for Health Care Administration is the licensing office for group homes with elderly and disabled patients.

The Department of Health frequently inspects homes unannounced to confirm the standard of living for residents. If the home assists with disabled persons, the Agency for Persons with Disabilities will also offer guidance and provide monthly monitoring visits to ensure that all requirements are met. Staff is usually rotated on a semi-monthly basis to maximize the efficiency of care. Depending on the type of home and number of patients, specialized permits and licensing may be required. Background checks on staffing is always required.

*****************************************************

It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.

Florida LLC Conversion: Relocating a Business from another state to Florida

Transitioning out of state is a major business decision. As a business owner, there are usually numerous difficult decisions to be made with a permanent or long-term move. Not only can relocating your business to a different state be more convenient, but it can be beneficial for numerous reasons.

Benefits of Relocation

Some of the potential benefits include: (1) reduced or no state income taxes and (2) paying less for services or merchandise. Fortunately, in Florida the transition is not difficult. Another major benefit to conversion is that the company is allowed to maintain the original Tax ID. For an established company, maintaining the tax identification number (EIN number) is a major advantage because the company’s credit history can remain intact and any existing bank accounts can also remain active.

Difference between Conversion and Domestication

Florida allows for conversion of a business from another state. The terms ‘conversion’ and ‘domestication’ can be used interchangeably depending on the state you are in but there are a few differences that should be noted. The most notable difference is that conversion allows for a change in entity type.  Florida allows for LLCs to change the applicable governing law and convert into a Florida corporation (an S Corp). The company is then treated as though it was originally formed in Florida. This might provide tax benefits for the business owner. Domestication of a company merely allows for the company to relocate. In Florida, the term ‘domestication’ refers to the move of a company formed internationally into the state and is a more complex procedure.

Conversion Process in Florida

Conversion allows the business owner to only pay one set of fees (annual reports, renewal fees, etc). For the conversion to be acceptable, both states must allow conversion (or domestication). Terms and definitions can complicate the process slightly since every state behaves differently. Not all states allow conversion or domestication.

If allowed, the process and legal effects of Florida conversion are straightforward and nearly effortless. The filing fees are $150 and forms can be found on www.sunbiz.org. The company’s membership interests remain the same, any out-of-state property continues to be held by the company, and any debts also remain due by the company. The process of conversion permits the company to continue the day-to-day operations without any significant interruptions. Florida requires a Plan of Conversion which includes proposed Articles of Organization and Operating Agreements. Each member must consent in writing for the Plan of Conversion to be approved. After the plan of conversion is approved, members can file the Articles of Conversion with the Florida Division of Corporations.

Alternatives to Conversion

Alternatively, business owners can register as foreign LLC’s, dissolve the company and form a new company, or go through a merger in their new state if conversion is not allowed. However, these methods can be more costly and don’t have the added benefits previously mentioned.

It is recommended that an attorney assist with the process to ensure the forms are submitted accurately. At Jones Health law, we have experienced attorneys that can provide legal support during the conversion process.

*****************************************************

It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.

 

All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.