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COVID-19: Local Public Health Orders

What should hospitals do if a local public health order contains a requirement that differs from state guidance?

First, read the local public health “order” very carefully. Many documents issued by public health officers (PHOs) are actually “advisories” or “guidance,” rather than orders that carry the force of law. CHA has reviewed PHO documents that have the word “order” at the top of the first page, but the wording of the document instead includes “recommendations” rather than mandates, or discuses activities or actions the hospital “should” take, rather than “must” or “shall” take. 

The hospital also should understand the local PHO’s jurisdiction. A county PHO has jurisdiction only over unincorporated areas of the county, unless incorporated cities have — by ordinance, resolution, or contract — given the county PHO jurisdiction over the city. You may wish to clarify your local PHO’s jurisdiction if your hospital is in an incorporated city. (The cities of Berkeley, Pasadena, and Long Beach have their own city PHOs with jurisdiction over the city.)

Hospitals should be aware that on July 15, the California Department of Public Health (CDPH) advised all local PHOs that, “It is critical for local health officers to coordinate with the State on public health orders…” Hospitals may wish to bring this CDPH document to the attention of its local public health officer.

The CDPH guidance also clarifies that counties should consider the impact of local health orders that cancel scheduled surgeries and non-emergency procedures, or furlough potentially exposed asymptomatic health care workers, on the ability to provide medically necessary care.

Hospitals should also consult their Regional Association (Hospital Council–Northern & Central California, Hospital Association of Southern California, and Hospital Association of San Diego & Imperial Counties) about PHO orders. (9/22)

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