How does the state’s face covering order impact hospital patients and visitors?
The face covering order requires Californians to wear face coverings when they are obtaining services from the health care sector in settings including, but not limited to, a hospital, pharmacy, medical clinic, laboratory, physician or dental office, veterinary clinic, or blood bank, unless directed otherwise by an employee or healthcare provider. Please refer to other FAQs to learn the exceptions to this requirement, and the requirement for hospital employees. (7/1)
What are the exceptions under the State Health Officer’s face covering order?
The state has identified the following exceptions:
- When directed otherwise by a health care provider or other employee of the hospital, pharmacy, clinic, lab, physician or dental office, or blood bank
- Children age two or younger. These very young children must not wear a face covering because of suffocation risk.
- Anyone with a medical or mental health condition, or a disability that prevents wearing a face covering. This includes those with a medical condition for whom wearing a face covering could obstruct breathing or who are unconscious, incapacitated, or otherwise unable to remove a face covering without assistance.
- Persons who are hearing impaired, or communicating with a person who is hearing impaired, where the ability to see the mouth is essential for communication.
- Anyone receiving a service involving the nose or face for which temporary removal of the face covering is necessary to perform the service.
When does the State Health Officer order require hospital employees to wear a face covering?
Hospital employees must wear a face covering when they are engaged in work, whether at the workplace or performing work off-site, when:
• Interacting in-person with any member of the public
• Working in any space visited by members of the public, regardless of whether anyone from the public is present at the time
• Working in any space where food is prepared or packaged for sale or distribution to others
• Working in or walking through common areas, such as hallways, stairways, elevators, and parking facilities
• In any room or enclosed area where other people (except for members of the person’s own household or residence) are present when unable to physically distance
This is a face covering requirement, not a requirement to wear an N95 mask. (7/1)
Are hospitals required to provide face coverings to patients or visitors?
There is no legal requirement for hospitals to provide face coverings to patients or visitors. However, as a practical matter, hospitals may need to provide them, at least to some patients and visitors. For example:
- Inpatients may have no other way to obtain face coverings.
- A visitor may have received the news that a loved one was hospitalized and rushed to the hospital without thinking of bringing a face covering.
- The parent of a pediatric patient may accidentally drop his or her face covering or get it wet.
- If a hospital chooses not to provide face coverings to outpatients, it may experience many last-minute cancelled appointments.
The guidelines issued by the Centers for Medicare & Medicaid Services (CMS) for resuming non-emergency care state, “Facilities should be prepared to provide cloth face coverings or facemasks for patients and visitors, which may include family members or caregivers, who do not have one upon entry.”
Because there will likely be situations where hospitals will want to provide a face covering even though it is not legally required, hospitals should develop a policy on when and to whom they will provide face coverings and how they will communicate face covering requirements. Hospitals are advised to place signage about face covering requirements at entrances. They may also find it helpful to let outpatients and visitors know about a nearby store that sells face coverings or sell face coverings themselves in their gift shop or cafeteria.
Are inpatients required to wear face coverings too?
The State Health Officer has directed people to wear face coverings when obtaining hospital services, “unless directed otherwise” by a hospital employee or health care provider. Hospitals should work with their medical staff and infection control professionals to develop guidelines on when inpatients must wear face coverings and when they need not do so.
What should we do if a patient refuses to wear a face covering?
There is no guidance on this question from the California Department of Public Health (CDPH). The hospital should talk to the patient and their physician to determine whether the patient has a medical condition, mental health condition, or disability that prevents wearing a face covering, or if another exception listed above applies. If no exception applies, the hospital should consult with the patient’s physician to determine the appropriate steps to take. Many hospitals have policies addressing non-compliant patients. These policies should be followed as appropriate.
Considering EMTALA, can a hospital decline to provide a medical screening exam and stabilizing treatment for a patient who refuses to wear a face covering?
Hospitals are advised to follow the Emergency Medical Treatment and Labor Act (EMTALA) and provide a medical screening exam and stabilizing treatment, even if the patient refuses to wear a face covering. When the emergency physician or other qualified professional determines whether the patient has an emergency medical condition or another condition/disability that prevents wearing a face covering, the hospital can determine the best approach to work with the patient to achieve compliance or release/transfer the patient appropriately. Hospitals are reminded that some provisions of EMTALA are currently waived; CMS has issued a memo and Frequently Asked Questions on this waiver.
What should we do if a visitor refuses to wear a face covering?
If the visitor does not fit into one of the exceptions listed above (age 2 or younger, condition/disability that prevents wearing a face covering, hearing impaired, etc.), the visitor may be excluded from the hospital.
Can we require evidence from a person who claims to have a medical condition, mental health condition, or disability that prevents wearing a face covering?
Yes, you can require a doctor’s note or psychologist/therapist’s note. CHA is aware of visitors who have displayed official-looking badges to hospital personnel that “prove” that the wearer has a disability, is not required to wear a mask, and may not be questioned about his/her disability. The badge bears the phone number of the U.S. Department of Justice’s (DOJ) Americans with Disabilities Act information line. CHA legal counsel has talked to the DOJ, which does not issue such badges. DOJ has posted the following alert on its website:
*COVID-19 ALERT: Fraudulent Facemask Flyers*
The Department of Justice has been made aware of postings or flyers on the internet regarding the Americans with Disabilities Act (ADA) and the use of face masks due to the COVID-19 pandemic, many of which include the Department of Justice’s seal.
These postings were not issued by the Department and are not endorsed by the Department.
The Department urges the public not to rely on the information contained in these postings and to visit ADA.gov for ADA information issued by the Department.
For more information and technical assistance about the ADA, please contact the ADA Information Line at 800-514-0301 (voice) and 800-514-0383 (TTY).
DOJ has stated that it is permissible to require a doctor’s note as evidence of a condition/disability that prevents the use of a face covering. If a visitor does not provide a note, the visitor may be excluded from the hospital. In a DOJ press release dated June 30, DOJ stated that the “ADA does not provide a blanket exemption to people with disabilities from complying with legitimate safety requirements necessary for safe operations.” A thorough discussion of the legal issues raised by a face covering requirement is here. (7/20)
Will CDPH cite a hospital if a surveyor sees patients or visitors without face coverings inside hospitals or clinics?
CDPH expects hospitals to make reasonable efforts to implement universal source control in their facilities. CHA has spoken to CDPH about the problems with noncompliant patients/visitors and does not believe CDPH will cite a hospital if rogue patients or visitors refuse to follow the State Health Officer’s face covering mandate. This mandate applies to individuals and does not require hospitals or other businesses to become law enforcement officers.