SR-10-14-2014-7FCity Council Meeting: October 14, 2014
Agenda Item: 7-
To: Mayor and City Council
From: Marsha Jones Moutrie, City Attorney
Subject: Proposed Ordinance Restricting Presence in Hospital Emergency Room
Waiting Areas
Recommended Action
Staff recommends that the City Council introduce for first reading the attached
ordinance restricting presence in hospital emergency room waiting areas to those who
are awaiting services or accompanying others who are awaiting or receiving services.
Executive Summary
Members of the Santa Monica Police Department and supervising physicians from the
emergency rooms at Santa Monica UCLA and St. John's Hospitals report that persons
who are neither awaiting services nor accompanying patients sometimes linger in their
emergency room waiting areas, which are not equipped to serve as general public
gathering places or shelters. If such persons refuse requests to leave the waiting room,
hospital personnel call Santa Monica police, who deal with the situations as best they
can. But, confrontation often ensues, which further disrupts the waiting area. Hospital
personnel and members of the Police Department have therefore requested preparation
of an ordinance to help address this situation. Accordingly, legal staff has prepared the
attached ordinance. It would prohibit members of the public who are neither awaiting
services nor accompanying patients from remaining present in a hospital emergency
room waiting area.
Background
Every year, Santa Monica safety personnel transport hundreds of persons to the two
hospital emergency rooms within the City. Often, those transported by City personnel
(rather than private ambulances) are homeless and substance addicted or mentally ill,
or both. Many of the transported persons are not experiencing medical emergencies.
More often, they have minor injuries and chronic problems that would be more efficiently
or better treated elsewhere. For example, many of those transported have very minor
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injuries, but they are intoxicated and need a sobering center. Others, are experiencing
psychiatric incidents; but, the two local emergency rooms do not provide psychiatric
services. And, sometimes, the local emergency rooms have no available beds or
services are refused for other reasons. In those cases, the police must transport the
person to facilities elsewhere in the county, which takes them out of the City and away
from their primary duties for hours.
The problem of inadequate resources and the mismatches between needs and
available services have been apparent for many years. Council, City staff, health care
providers, and service providers have all expressed concerns about this use of safety
personnel time and about committing precious emergency room resources to persons
who either do not have a medical emergency at all or who have a medical problem that
the emergency room is not staffed to address.
Several years ago, members of the Police Department and other City workers created
the Santa Monica Mental Health Committee ( "the Committee ") to address this cluster of
problems. The Committee consists of representatives from Santa Monica and St.
John's hospitals (including emergency directors and physicians), the Police Department,
Fire Department, Community and Cultural Services, the City Attorney's Office, social
services providers, and County Department of Mental Health workers. The Committee
has had some successes, including identifying available resources and working out
protocols for transporting various categories of persons needing help and service to
various medical facilities and service agencies. And, the Committee continues to serve
as a forum for addressing new problems as they arise.
One of the problems identified by emergency room medical staff is that some persons
receive services and then refuse to leave the emergency room area, preferring to
shelter in place; or they simply use the waiting rooms as a shelter without seeking
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services. Disruptions often ensue. And, though police officers are summoned to assist,
the officers lack appropriate legal options because neither state nor local law squarely
addresses this situation. Accordingly, committee members requested that the City
Council consider adopting an ordinance tailored to address this specific problem. Legal
staff has researched the law and confirms that current law does not sufficiently address
this situation.
Discussion
Staff believes that the policy rationale for this proposal is strong. Emergency room
waiting areas are designed and equipped for the limited purpose of accommodating for
those seeking emergency medical services or accompanying those who are. Space is
limited. Sometimes, many people must wait in close proximity to one another for
extended periods of time. The waiting rooms are neither configured nor equipped to
serve as a public gathering space. It is certainly not designed or intended to serve as a
shelter.
Moreover, because of the function that the emergency rooms serve, order must be
maintained so that staff can focus its efforts on the task of saving lives and treating
injuries. Likewise, those awaiting services for themselves, family members or close
friends also need order and quietude to the extent possible. Whatever illness or injury
brought them to the emergency room is probably a source of stress — often acute
stress. They should not have to suffer the disruptions that arise when first hospital staff
and then police personnel must try to convince an uncooperative person, who is neither
awaiting services nor accompanying a patient, to leave.
The attached proposed ordinance would address this problem. It would prohibit
members of the public from being present in a hospital emergency room or emergency
room waiting area, unless awaiting serves or accompanying another who is awaiting
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services. Medical personnel, hospital employees and safety personnel would be
exempt from the prohibition. This proposed ordinance is somewhat similar to other laws
that the Council has adopted that address presence inappropriate for a particular
location. For example, the Council has adopted laws prohibiting being present in a park
when it is closed, being present in the Civic Center during very late night hours, being
present on the Palisade Bluffs at any time, and being present in parking structures
except when parking or "unparking" a vehicle. Of course, each of those other laws dealt
with public property. However, emergency rooms at the two local hospitals are so vital
to the community's health and safety and City safety personnel are so frequently called
to the two emergency rooms, that City staff feels that the proposed prohibition against
presence is warranted.
This law would not criminalize presence in the waiting area except in circumstances
where the person has been asked to leave the emergency room waiting area and has
refused. In such cases, the person would be subject to arrest and prosecution.
However, it is anticipated that the vast majority will leave rather than face arrest. And,
of course, for persons who need a different kind of service, other options are available
through various City sponsored programs. Police Department personnel and hospital
workers routinely share information about those options and will continue to do so.
Alternatives
Staff is not aware of options other than the proposed ordinance and the status quo.
So, if the proposed ordinance is not adopted, staff assumes that hospital and police
personnel will simply continue to try and persuade persons who do not have business in
the two emergency rooms to leave them so that the space can be devoted to those who
need the particular services that the emergency rooms offer.
S
Financial Impacts & Budget Actions
Staff anticipates no financial impacts or additional costs attendant upon the adoption of
the proposed ordinance.
Prepared by: Marsha Jones Moutrie, City Attorney
Approved: Forwarded to Council:
Attachments: Proposed Ordinance
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LL, 1:�) .n
Rod Gould
City Manager
City Council Meeting: October 14, 2014 Santa Monica, California
ORDINANCE NUMBER (CCS)
(City Council Series)
AN ORDINANCE OF THE CITY COUNCIL OF THE CITY OF SANTA MONICA
ADDING SECTION 4.08.098 TO THE SANTA MONICA MUNICIPAL CODE
PROHIBITING PRESENCE IN HOSPITAL EMERGENCY ROOM WAITING AREAS
EXCEPT FOR MEDICAL SERVICES
WHEREAS, two hospital emergency rooms provide vital services within Santa
Monica; and
WHEREAS, the primary mission of these facilities is to save lives by treating
acute illness and injury; and the community depends upon them to serve that purpose;
RTI S
WHEREAS, both facilities have limited resources in terms of personnel, space
and beds; and
WHEREAS, both are, at times, extremely busy and persons must often await
services, sometimes for lengthy periods, in specially designated waiting areas; and
WHEREAS, order must be maintained in these waiting areas so that hospital
staff can focus efficiently on the primary objective of providing emergency health care to
those suffering medical emergencies; and
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WHEREAS, order must also be maintained for the benefit of those who are
awaiting services and who may be experiencing considerable anxiety and stress and
therefore need peace and quiet; and
WHEREAS, despite the need for order and quiet in emergency room waiting
areas, disruptions occur when persons who are not awaiting medical services occupy
waiting areas, using them as lounging areas or shelters and refusing to leave upon
request by hospital personnel; and
WHEREAS, Santa Monica police are summoned to the two local emergency
rooms to restore order when such disruptions occur; and
WHEREAS, the police may lack necessary legal tools in such situations and
therefore can only attempt to persuade persons inappropriately present to leave the
waiting room area; and
WHEREAS, such interactions often escalate into disputes, which further disrupt
quietude in the waiting areas; and
WHEREAS, the City Council wishes to address this situation by establishing a
local law that will empower hospital and police personnel to efficiently address this
problem, ensure that the limited space available in hospital emergency room waiting
areas is used for its intended purpose, allow medical and other emergency room
personnel to focus their energies on addressing medical emergencies, and provide
persons awaiting care with a more peaceful and orderly environment.
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF SANTA MONICA
DOES HEREBY ORDAIN AS FOLLOWS:
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SECTION 1. Santa Monica Municipal Code Section 4.08.098 is hereby added to
read as follows:
Section 4.08.098 Restriction on Presence in waiting
areas of hospital emergencV rooms.
(a) No person other than a hospital employee,
hospital volunteer, police officer, or paramedic may be
present in the emergency room waiting area of a hospital
unless he or she is awaiting medical services or
accompanying another who is awaiting or receiving medical
services:
(b) AnV person who violates subsection (a), who
refuses to leave the emergency room waiting area after
being requested to leave by a hospital employee or a police
officer, and who is convicted, shall be guilty of a
misdemeanor, which shall be punishable by a fine of not
greater than Five Hundred Dollars ($500.00) or by
imprisonment in the County Jail for not more than six
months, or by both such fine and imprisonment.
SECTION 2. Any provision of the Santa Monica Municipal Code or appendices
thereto inconsistent with the provisions of this Ordinance, to the extent of such
inconsistencies and no further, is hereby repealed or modified to that extent necessary
to effect the provisions of this Ordinance.
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SECTION 3. If any section, subsection, sentence, clause, or phrase of this
Ordinance is for any reason held to be invalid or unconstitutional by a decision of any
court of competent jurisdiction, such decision shall not affect the validity of the
remaining portions of this Ordinance. The City Council hereby declares that it would
have passed this Ordinance and each and every section, subsection, sentence, clause,
or phrase not declared invalid or unconstitutional without regard to whether any portion
of the ordinance would be subsequently declared invalid or unconstitutional.
SECTION 4. The Mayor shall sign and the City Clerk shall attest to the passage
of this Ordinance. The City Clerk shall cause the same to be published once in the
official newspaper within 15 days after its adoption. This Ordinance shall become
effective 30 days from its adoption.
APPROVED AS TO FORM:
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