BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1278
AUTHOR: Hill
AMENDED: January 26, 2012
HEARING DATE: June 13, 2012
CONSULTANT: Marchand
SUBJECT : Health facilities: smoking.
SUMMARY : Expands the prohibition on smoking in general acute
care hospitals to include the entire hospital campus, including
plazas, sidewalks and parking areas.
Existing law (Health and Safety Code):
1.Provides for the licensure and regulation of health facilities
by the Department of Public Health (DPH), including general
acute care hospitals, which are defined in part as providing
24-hour inpatient care, including the following basic
services: medical, nursing, surgical, anesthesia, laboratory,
radiology, pharmacy, and dietary services.
2.Prohibits smoking in patient care areas, waiting rooms, and
visiting rooms of a health facility, except those areas
specifically designated as smoking areas, and in patient rooms
where all persons assigned to the room have requested smoking
to be permitted. Specifies that any person who violates this
provision of law is guilty of an infraction and subject to a
fine of not more than $100.
Existing law (Labor Code):
1.Prohibits an employer from knowingly or intentionally
permitting the smoking of tobacco products in an enclosed
space at a place of employment.
2.Exempts certain places of employment from the prohibition on
smoking tobacco products in an enclosed space, including the
following:
a. Up to 50 percent of the area of a hotel or motel lobby,
depending on the size of the lobby;
b. Meeting and banquet rooms in hotels or motels, except
when food and beverage functions are taking place or when
being used for an exhibit;
c. Retail or wholesale tobacco shops and private smokers'
lounges, as defined;
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d. Warehouse facilities, as defined;
e. Medical research or treatment sites, if smoking is part
of the research and treatment;
f. Patient smoking areas in long-term health care
facilities;
g. Break rooms designated for smoking by an employer; and
h. Employers with five or fewer employees, subject to
specified requirements.
3.Establishes a $100 fine for the first violation, a $200 fine
for the second violation, and a $500 fine for the third and
subsequent violations of the above provisions.
4.Requires enforcement of the smoking prohibition by local law
enforcement agencies. Requires an investigation by the
Division of Occupational Safety and Health in the case that an
employer has been found guilty of three or more violations.
This bill:
1.Prohibits, beginning March 1, 2013, smoking in all areas of a
general acute care hospital and throughout the entire hospital
campus, including, but not limited to, buildings, parking
areas, plazas, vehicles, underground passages, and sidewalks,
unless there is a government-mandated exception.
2.Exempts public thoroughfares and sidewalks adjacent to the
general acute care hospital but not owned by the hospital from
the prohibition on smoking on a hospital campus.
3.Exempts property owned or leased by a hospital that is
distinct from, and not part of, the principal medical campus
if the property is used for purposes unrelated to health care.
4.Permits smoking on a hospital campus by a patient if the
treating physician determines that the patient's treatment
will be substantially impaired by the denial of tobacco, and
the physician enters a written order permitting the use of
tobacco by that patient.
5.Requires general acute care hospitals to post signs stating
that smoking is prohibited on the entire hospital campus at
building entrances and in other conspicuous locations.
6.Requires new employees of general acute care hospitals to be
advised of the nonsmoking policy during orientation and
requires current employees to be informed of the policy at
least 60 days prior to implementation.
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7.Permits general acute care hospitals to provide interested
patients, visitors, and staff with information on, or refer
them to, smoking cessation services.
8.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 the
provisions of this bill.
9.Exempts violations of this bill from specified provisions of
law establishing penalties for violations of the laws
pertaining to hospitals, including a $100 fine for violating
existing provisions of law prohibiting smoking in certain
areas of a hospital, and misdemeanor penalties of up to a
$1,000 fine and up to one year in jail for other violations of
the laws pertaining to hospitals.
10.States the intent of the Legislature to encourage and assist
smokers to quit tobacco use and to reduce the associated risks
of tobacco and secondhand smoke to hospital patients, staff,
and visitors.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, negligible state fiscal impact to DPH to continue
oversight of hospital licensure. Also, to the extent this more
comprehensive smoking ban on hospital campuses reduces the
number of cigarettes purchased, there could be a minor reduction
in revenues to various state tobacco funds, but it would likely
be minimal.
PRIOR VOTES :
Assembly Health 12- 5
Assembly Appropriations: 12- 5
Assembly Floor: 48- 26
COMMENTS :
1.Author's statement. Hospitals should be standard bearers of
healthy practices. While smoking is already prohibited in many
areas of hospitals, it seems contrary to their mission of good
health that smoking should be permitted anywhere on their
campus. This bill simply extends the existing ban on smoking
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to all areas of a hospital. In addition to setting the
appropriate example, it will also reduce exposure to
second-hand smoke for patients, their families, hospital
workers, and all visitors.
2.Related legislation. SB 575 (DeSaulnier) would eliminate most
of the exemptions in the workplace smoking prohibition,
including the exemption for patient smoking areas in long-term
health care facilities. SB 575 was held in Assembly
Governmental Organization Committee without recommendation.
AB 217 (Carter) would further restrict smoking in long-term
health care facilities by only allowing smoking in a
designated patient smoking area that is outdoors and in an
area that reasonably prevents smoke from entering the facility
or patient rooms. AB 217 passed by a vote of 7-2 when it was
heard in Senate Health Committee on June 6, 2012.
3.Prior legislation. AB 574 (Hill) of 2009 is substantially
similar to this bill. AB 574 was vetoed by Governor
Schwarzenegger.
AB 1467 (DeSaulnier) of 2007 would have eliminated most of the
exemptions in the workplace smoking prohibition, but did not
propose to eliminate the exemption for patient smoking areas
in long-term health care facilities. AB 1467 was vetoed by
Governor Schwarzenegger.
AB 2067 (Oropeza), Chapter 736, Statutes of 2006, prohibits
smoking in covered parking lots, and adds to the definition of
"enclosed spaces" lobbies, lounges, waiting areas, elevators,
stairwells and restrooms that are a structural part of the
building, thereby prohibiting smoking in those areas.
AB 13 (T. Friedman), Chapter 310, Statutes of 1994, prohibits
employers from knowingly or intentionally permitting, or any
person from engaging in, the smoking of tobacco products in
enclosed places of employment, with specific exemptions.
4.Support. This bill is sponsored by Breathe California, which
states that there are more than 73 smoke-free hospital
campuses in California, including all Kaiser affiliated
hospital campuses. According to Breathe California,
hospitalization for treatment of an acute health problem,
particularly an illness related to tobacco use, represents for
many patients a teachable moment and a time of heightened
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5
motivation to quit smoking. Breathe California states that
research published in the Journal of the American Medical
Association confirms that the quit ratio is greater for
hospital employees in smoke-free environments than employees
in hospitals without smoking restrictions. The California
Hospital Association also supports this bill, stating that
California hospitals see the negative effects smoking can have
on the health of their patients and the increased costs it can
have on the health system. The California Medical Association
states in support that their physicians are strongly
supportive of working toward a smoke-free California.
5.Policy comment. The existing provisions of law in the Health
and Safety Code restricting smoking to certain areas of a
health facility, described in existing law above, were passed
in 1980. In 1994, a general prohibition on smoking in
enclosed spaces at places of employment was added to the Labor
Code. While this law included limited exceptions, including
patient smoking areas in long-term care facilities, in all
respects the Labor Code is more restrictive than the existing
Health and Safety Code, rendering these existing provisions
outdated.
This bill proposes to leave the existing language restricting
smoking in health facilities in the Health and Safety Code
intact, and add a new section to the Health and Safety Code
that is specific to general acute care hospitals. To reduce
confusion, the author should consider deleting the outdated
provision of existing law that establishes a smoking standard
for all other health facilities that is less restrictive than
the Labor Code's general prohibition on smoking in any place
of employment.
SUPPORT AND OPPOSITION :
Support: Breathe California (sponsor)
California Black Health Network
California Hospital Association
California Medical Association
Coalition for a Tobacco-Free Monterey County
Santa Clara County Board of Supervisors
One individual
Oppose: None received.
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