Patients at health centers have a right to smoke 

Smokers have been banned from smoking near buildings, shunned at parks and beaches, and restricted in many other ways.

But there is an unlikely place where officials have not been able to snuff out cigarettes — public medical facilities.

A little-known 1982 state law requires skilled-nursing facilities — such as the San Mateo County-run Burlingame Long-Term Care center and Laguna Honda Hospital in San Francisco — to provide “designated areas for smoking.”

In the Burlingame center’s case, that area is a second-story smoking patio where a 67-year-old resident dropped a cigarette on his gown and set himself ablaze last month, according to public records. As reported by The San Francisco Examiner, Bruce Smith died three days after the Dec. 23 incident from severe burns to his head, torso and arms, according to authorities.

As state and county investigations into the facility continue, county officials have declined to say whether they will revise the center’s smoking policies, which require evaluations of patients to determine if they are capable of smoking independently.

But for now, officials say the county — despite pushing smoking cessation programs for its patients — cannot ban tobacco at the Burlingame center, which is plastered on the outside with no-smoking signs.

“We of course believe smoking is unhealthy,” said Dr. Susan Ehrlich, the chief of the county’s San Mateo Medical Center, “but at the same time, we have to abide by state laws, and state laws are fundamentally going to overrule our local ordinances.”

Assemblyman Jerry Hill, D-San Mateo, said he is considering legislation that would further restrict smoking at long-term care facilities, though the details are not finalized.

“You shouldn’t be smoking anywhere on a campus of a health facility, and hospitals and long-term care facilities are just examples of that,” said Hill, who successfully pushed expanded smoking bans as a county supervisor. “But we want to make sure it’s something that could work.”

California’s landmark 1994 law that banned smoking in most enclosed workplaces has more than a dozen exemptions, including one for long-term care facilities.

However, anti-smoking advocates say the employees of the facilities should not have to be exposed to tobacco smoke.

“For people who work in those facilities, they deserve, like everybody else, the right to a smoke-free work environment,” said Paul Knepprath, the vice president for advocacy and health initiatives for the American Lung Association in California.

About 30 of the Burlingame center’s roughly 200 residents smoke, Ehrlich said. At Laguna Honda, 77 of some 780 residents are smokers.

Laguna Honda provides smoking cessation programs and an outdoor smoking area, though the area is constantly monitored by staff, spokesman Marc Slavin said.

“Our basic position is people shouldn’t smoke,” Slavin said, “and in the meantime, if people need to have a place where they smoke, we provide that.”

Burned out

An overview of smoking locally and statewide:

13.1: Percentage of people in California who smoke, second-lowest after Utah
13.5: Percentage of San Francisco residents who smoke
9.6: Percentage of San Mateo County residents who smoke
42: Percentage decline in Asian-American smoking rate in California since 1988
41: Percentage decline in both black and Hispanic smoking rate in California since 1988
43,000: Californians who prematurely die each year from a tobacco-related disease

Source: California Department of Public Health

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Shaun Bishop

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