BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 574
A
AUTHOR: Hill
B
AMENDED: April 23, 2009
HEARING DATE: June 17, 2009
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CONSULTANT:
7
Dunstan/sh
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SUBJECT
Health facilities: smoking
SUMMARY
Prohibits smoking in all areas of acute care hospitals,
including the general hospital campus, buildings, parking
areas, plazas, and sidewalks.
CHANGES TO EXISTING LAW
Existing law:
Prohibits smoking inside a public building, or in an
outdoor area within 20 feet of a main exit, entrance, or
operable window of a public building, which is defined as a
building owned and occupied by the state or a local
government.
Requires California employers to provide a safe and
healthful workplace under the Occupational Safety and
Health Act of 1973.
Prohibits employers from knowingly or intentionally
permitting any person from engaging in the smoking of
tobacco products in all enclosed places of employment, as
defined, with specified exceptions.
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 574 (Hill) Page
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This bill:
Prohibits smoking in all areas of acute care hospitals,
including the general hospital campus, buildings, parking
areas, plazas, and sidewalks. Excludes from the smoking
prohibition, public thoroughfares and sidewalks adjacent to
the general acute care hospital but not owned by the
hospital.
Requires a general acute care hospital to post signs
stating that smoking is prohibited on the entire hospital
campus, at building entrances and in other conspicuous
locations.
Requires a general acute care hospital to advise new
employees of this policy during orientation and inform
current employees at least 60 days prior to implementation.
Permits a city, county, or city and county to adopt and
enforce additional smoking and tobacco control ordinances,
regulations, or policies that are no less stringent than
applicable standards in this bill.
Excludes from the requirements of this bill property owned
or leased by the hospital that is distinct from, and not
part of, the principal medical campus and that is used for
purposes other than health care.
Establishes a patient-specific exemption to the bill's
smoking prohibition if authorized in writing by a treating
physician for patients whose treatment will be
substantially impaired by the denial of the use of tobacco.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, there is no direct fiscal impact to the
California Department of Public Health (DPH) to continue
oversight of health and safety in California hospitals.
BACKGROUND AND DISCUSSION
According to the author, AB 574 will extend the prohibition
STAFF ANALYSIS OF ASSEMBLY BILL 574 (Hill) Page
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in current law regarding smoking in the workplace to
include the entire hospital campus in order to encourage
hospital patients and staff to quit smoking. The author
argues that this bill will create what the sponsors refer
to as "teachable moments" on hospital campuses for patients
and their families. According to the author and sponsors,
teachable moments can occur during an acute health episode,
especially one related to smoking, which can create a
heightened awareness and concern about the impact of
tobacco on one's health and a greater motivation to quit
tobacco use. The author argues that smoke free hospital
campuses motivate patients, visitors, and employees to quit
tobacco in an environment that is both supportive and
prepared to provide cessation assistance to smokers. The
author states that there is recent research on smoke-free
work environments and their positive impact on smoking
cessation and reduced heart attacks. The author further
maintains that for hospital professionals and staff who
smoke, expanded workplace smoking restrictions emphasize
the inconvenience of smoking and encourage quitting.
Background
Under current law, more than 70 California hospitals
currently have voluntarily prohibited smoking throughout
their campuses. Approximately 1,250 hospitals nationwide
have smoke-free campuses and most also provide tobacco
cessation support services to both employees and patients.
Many of these hospitals report that they took this step
because smoking was contrary to hospitals' mission of
treating the ill and promoting public health. Research
published in the Journal of the American Medical
Association has found that the quit rate among medical
staff at hospitals with no smoking policies was higher than
at other hospitals. Numerous studies have shown that
smoke-free public places are associated with reductions in
hospital admissions for heart attacks. However, many of
these studies looked at only a year of data after the
implementation of smoke-free laws. More recent research,
released in 2008, addressed a three-year study in Colorado
and showed a sustained reduction in heart attack
hospitalizations after a smoke-free law took effect.
Smoke-free laws reduce cardiac hospitalizations by reducing
second-hand smoke exposure among non-smokers and reducing
smoking. The larger contribution to improved health has
been shown to be the reduction in second-hand smoke.
STAFF ANALYSIS OF ASSEMBLY BILL 574 (Hill) Page
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Prior legislation
AB 3010 (Blakeslee), Chapter 505, Statutes of 2008,
authorized the Director of the Department of Mental Health
(DMH) to prohibit the possession or use of tobacco products
on the grounds of state mental hospitals under specified
conditions.
AB 846 (Vargas), Chapter 342, Statutes of 2003, prohibited
smoking inside public buildings and within 20 feet of a
main exit, entrance, or operable window of a public
building.
AB 13 (Terry Friedman), Chapter 310, Statutes of 1994,
generally bans smoking in places of employment in the state
with exceptions for bars, taverns and gaming
establishments.
Arguments in support
Supporters argue that this bill will help smokers quit
while also reducing exposure to second-hand smoke. They
point out that many hospitals in California have already
taken this step and have had no problems with enforcement
and compliance. Supporters point out the dangers from
second-hand smoke and also note that for individuals who
suffer from asthma symptoms, exposure to tobacco smoke on
hospital campuses can trigger asthma attacks at the very
location that patients are seeking treatment and care.
PRIOR ACTIONS
Assembly Floor: 46-25
Assembly Appropriations:11-5
Assembly Health: 13-4
POSITIONS
Support: Breathe California (co-sponsor)
California Tobacco Control Alliance (co-sponsor)
American Lung Association
Breathe California of Los Angeles County
Breathe California of Sacramento-Emigrant Trails
STAFF ANALYSIS OF ASSEMBLY BILL 574 (Hill) Page
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California Hospital Association
California Medical Association
Coalition of Lavender Americans on Smoking and
Health
Public Health Law and Policy
Regional Asthma Management and Prevention
San Francisco Asthma Task Force
San Mateo County Tobacco Education Coalition
Sierra Vista Medical Center
Sutter Medical Center, Sacramento
Watts Healthcare Corporation
Several individuals
Oppose: None received
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