As the Georgia General Assembly proceeds through the 2021 legislative session, marquee issues such as voting laws and the state budget are expected to dominate the debate under the Gold Dome. But state Sen. Kay Kirkpatrick, R-east Cobb, is working on some unfinished business from last year’s session.
On Jan. 12, Kirkpatrick filed a bill that will amend sections of state law to increase oversight and regulation of the use of anesthesia in private medical practices. If passed, she’s hopeful that the bill will provide greater protections for patients who find themselves under the knife.
“This is a patient safety bill,” Kirkpatrick told the MDJ. “It’s really just common sense.”
Of particular interest to Kirkpatrick is the use of “conscious sedation,” differing from both general and local anesthesia, in which a patient is given a sedative, but not enough to lose consciousness.
“It’s like twilight … and that has to be done very carefully, because there’s lots of complications that can happen with the airway,” Kirkpatrick said. She added that part of her concern stems from the fact that whereas local anesthesia carries relatively few risks, and general anesthesia is almost always conducted by professional anesthesiologists, that “twilight” zone can fall through the cracks of medical oversight.
The method is most commonly used in “short, straightforward procedures,” according to Johns Hopkins University School of Medicine, such as dental work, gastrointestinal endoscopies, and plastic surgery. Consequently, Kirkpatrick said, conscious sedation is frequently used in “medispas” and other cosmetic surgery clinics which are subject to less state oversight.
“They’re in the same category as a nail salon or tanning facility, or something like that … these medispas, a lot of times they’re in strip shopping centers and, you know, you just can’t cut corners when you’re sedating people.”
Little data is available on the risks associated with conscious sedation. A 2017 study in the Journal of Clinical and Diagnostic Research found that the mortality rate for all types of anesthesia use in dentistry was just three out of every 1,000,000 patients.
But if passed and signed into law, Senate Bill 5 would address conscious sedation in a major way.
The bill’s first objective is to mandate that Georgia’s medical and dental boards develop a set of rules and regulations for the administration of conscious sedation by the end of the year (at present, the boards only issue non-binding “guidelines” for sedative use).
Providers who use sedation would then be subject to those rules and regulations. The bill would also mandate that dentists and physicians using sedative procedures must be licensed by the dental or medical boards.
Kirkpatrick said that the issue came to her attention after learning of several cases where conscious sedation went awry, including two involving Kennesaw-based cosmetic surgeon Nedra Dodds. Two patients died in 2013 while undergoing surgery in Dodds’ office. Though murder charges against Dodds were ultimately dropped by the Cobb District Attorney’s office, the family of April Jenkins, one of the patients, was awarded a $60 million settlement last year.
Documents from the Georgia Composite Medical Board’s investigation, resulting in the suspension (and ultimate revocation) of Dodds’ medical license, show that Jenkins cried out in pain during the procedure despite receiving the maximum dose of sedatives. The investigation deduced that Jenkins “was not properly sedated and remained largely conscious” during the procedure that killed her.
For Kirkpatrick, a surgeon who has taught patient safety in her own practice, disciplinary action from the medical board is hardly enough to right that wrong.
“The medical board, for example, they can take somebody’s license, but they can only take it once something bad happens, right? … So what this bill does, it essentially says, if you’re going to do sedation outside of a traditional operating room … you have to follow the rules outlined by the medical board or the dental board,” she said.
“The problem is, people don’t know. Consumers don’t know. They just go to somebody’s review site, which is like the Wild West, and they don’t have any way to know if somebody is qualified to do what they’re doing,” she added. “The public needs to be protected from people who aren’t doing the right thing.”
Kirkpatrick is optimistic about the bill’s path forward in the legislature. Last year, she filed an identical bill that passed the Senate with 53 votes for and none opposed, before the COVID-19 pandemic derailed the legislative session. Assuming the same doesn’t happen this year, she’d like to get it into committee hearings as soon as possible, and from there, eventually on the books.