Hospitals are facing threats to their autonomy as a growing number of state lawmakers seek to limit their ability to restrict visitors during a pandemic.
Many hospitals and healthcare facilities have restricted visitors to curb transmission of the coronavirus. In many instances, limiting visitors sometimes meant patients died without loved ones by their side, resulting in tearful goodbyes through video calls, or sometimes without any communication at all.
In state houses across the country, family members have made emotional pleas to legislators to intervene and guarantee access.
Legislators themselves have shared personal anecdotes of their own, voicing support to put in place at least a minimum standard guaranteeing visitations even amid a pandemic.
This year, visitor bills have been proposed and passed in numerous states including Colorado, Illinois, Missouri and Florida.
Last year, governors in North Carolina, Oklahoma and Arkansas signed the measures into law.
The laws are largely similar. Some state hospital associations have opposed them, citing concerns of reduced flexibility to keep patients safe. The American Hospital Association declined to comment on the legislative activity in numerous states.
Infection prevention in hospitals has come a long way over the past few decades, the adoption of single patient rooms chief among them, said Linda Dickey, president of the Association for Professionals in Infection Control and Epidemiology.
Allowing visits during an outbreak and maintaining compliance measures to interrupt the spread of infection is not always as easy as it seems, Dickey said.
"I don't think there is anyone within healthcare who isn't supportive of having patients have visitors ... But we also understand that we need to protect the health of the visitors and the staff, so trying to keep all of that in mind is the aim," Dickey said.
Gov. Ron DeSantis of Florida signed the No Patient Left Alone Act in April, putting into place a minimum set of standards for allowing patient visitors into the state's healthcare facilities.
"If you're hospitalized or in a long-term care facility, you have the right to have your family members present with you," DeSantis said.
The law allows patients to designate someone as an "essential caregiver," who is entitled to at least a two-hour daily visit, according to the law.
The Florida legislation prohibits facilities from requiring proof of any vaccination in order to visit a patient. However, the bill does not allow blanket access. It gives facilities the ability to set their own policies and procedures in place for infection prevention, allowing them to screen visitors and require personal protective equipment among other items.
The issue hit close to home for DeSantis, whose wife recently finished treatment for breast cancer. He was able to visit her during treatment, which he said he believes made a difference.
"If I had not been there it would have been more difficult for her," DeSantis said during the April bill signing.
Visitor bills are advancing in blue states, too.
Illinois lawmakers passed and sent a patient visitation bill to Gov. J.B. Pritzker's desk on May 5, according to the Illinois General Assembly.
Similar to other bills, healthcare facilities in Illinois would have to allow at least one visitor designated by the patient, and facilities could continue screenings and require visitors to wear PPE. A clergy member would not be counted toward any limit set by the healthcare facility, according to the bill.
Dan McConchie, a republican senator and minority leader, sponsored the bill alongside his house counterpart, Republican Chris Bos.
The Illinois Hospital Association said it did work with the sponsors on the bill but was "neutral" on the final language headed to the governor's desk.
IHA said that under the bill hospitals will be able to make decisions on visitation policy for the overall safety of workers and patients.
"When visitors were limited during times of high virus transmission, hospitals and healthcare facilities always did their best to strike the balance between the important health and healing aspects of visitation," IHA said in a statement.
Lawmakers in Colorado, a decisively blue state, passed a similar bill.
Colorado Sen. Jerry Sonnenberg, a Republican, expected his visitor bill to die in committee.
Instead, the measure ultimately passed both chambers during the legislative session that ended May 11.
The bill survived the "kill committee" for Republican measures after the Democratic chairwoman tearfully recounted her own experience of not being able to see loved ones during the pandemic. Sonnenberg told Healthcare Dive it was the vote he needed to advance the bill out of the initial committee.
In Sonnenberg's bill, patients are entitled to at least one visitor during the duration of their stay. Hospitals and healthcare facilities could put measures in place to reduce the spread of transmission such as requiring visitors to wear masks and other PPE. Facilities could also restrict access if a visitor has symptoms, and hospitals may restrict access if a visitor is menacing or physically assaulting staff, highlighting an ongoing safety issue that has been exacerbated by the pandemic.
The Colorado Hospital Association opposed the bill, concerned about not having enough flexibility to evolve to ongoing public health crises.
"Clinical decisions to put restrictions in place over the past two years were not made lightly," the Colorado Hospital Association said in a statement to Healthcare Dive.
"Unfortunately, the spread of COVID-19 inside health care facilities was and continues to be a real concern," CHA added.
Colorado Gov. Jared Polis will review the bill once if reaches his desk, his press secretary said.
Rep. Ed Lewis of Missouri, a Republican, wasn't allowed to see his 89-year-old mother in the hospital until she was dying after suffering a fall that injured her hip. He co-sponsored a bill in an attempt to prevent others from facing a similar experience that passed both chambers as the legislative session ended last week.
It was hard for Lewis' family to communicate with his mother, who struggled to hear, especially while on the phone, after the hospital went on lockdown shortly into her stay.
Lewis believes guaranteeing visitor access is important and believes the bill offers a reasonable approach amid public health concerns.
"You can't provide the best care if a person doesn't have their loved one that's their advocate," Lewis said.
Similar to bills proposed and enacted elsewhere, the bill that passed would allow "at least two compassionate care visitors simultaneously," according to the final bill language. These visitors are entitled to at least six-hour visits that include evenings, weekends and holidays. The facility may not require visitors to go through screening that isn't required of employees.
There are instances when a healthcare facility may limit visitors.
The Missouri Hospital Association testified in opposition to the bill in January, according to a witness form and a video recording of the hearing.
Bill Anderson, vice president of state legislation for the hospital association, said he empathized with family members and acknowledged there are positive health benefits to visitations, according to the video recording.
Hospitals want visitation to happen, he said, but they need flexibility to be able to keep patients safe. During his remarks, made on Jan. 19, he said hospitalizations in Missouri were the highest so far in the entire pandemic.
The association's concern is with the way the legislation is written.
"You could interpret it to say a hospital couldn't have visitation hours, or put any limitations on how that traffic goes in and out of our facilities," Anderson said.