Rules banning smoking outside Victoria's public hospitals could be reviewed because health workers are being attacked and abused while trying to police the policy.
Calls for an audit of the ban are being led by the Australian Nursing and Midwifery Federation, which is concerned nurses are being put in danger.
"We're hearing that the policing of the ban actually leads to violence and aggression against our members," union state secretary Lisa Fitzpatrick said.
The calls come after the death of Melbourne heart surgeon Patrick Pritzwald-Stegmann, who was allegedly punched in the head in the foyer of Box Hill Hospital after expressing concern about people smoking near the hospital entrance.
Last month two patient transport officers were reportedly assaulted outside Dandenong Hospital after refusing a request for a cigarette.
Ambulance union state secretary Steve McGhie said one of the officers had surgery because of an injury sustained in the assault.
Mr McGhie said altercations about smoking did lead to violence and aggression against healthcare workers.
He said there was no easy fix, especially as some offenders were drug affected or had mental health problems.
"Smoking rooms may address some issues, but bystanders and relatives at hospital, quite often because of their agitation and concern, may just smoke outside front doors of hospitals," he said.
A review revisiting how to best protect health workers has broad support of the ambulance union and the Australian Medical Association, though the AMA does not want to see the smoking ban overturned or relaxed.
AMA Victorian president Lorraine Baker said doctors had told her they felt reluctant to get into "any discussion" with anyone smoking in an area where smoking was banned.
"We support local government and the Victorian government working together to find strategies that will allow for responsible and safe enforcement of a smoking ban," Dr Baker said.
The ban was introduced by the Andrews government in April 2015 and prevents people from lighting up within four metres of an entrance to a public hospital. Many hospitals also have their own smoke-free zones that go beyond what is required by law.
Victoria's councils have been given money from the government to enforce the four-metre ban and for other anti-smoking initiatives.
But it appears that council officers are rarely, if ever, handing out fines.
The City of Melbourne has not issued any infringements for smoking outside the six public hospitals in its jurisdiction since the ban begun, despite saying officers regularly patrol around hospitals.
"We have very few complaints from hospitals or the public regarding breaches of the ban and find that smokers are generally respectful of the rules," a spokeswoman said.
The peak body for Victoria's councils said it was difficult to catch people in the act of smoking.
Municipal Association of Victoria president Mary Lalios said that, as a result, councils tended to focus their attention on matters such as proper signage.
"Councils respond to complaints from the public, but do not have the resources to place staff out on the beat permanently policing every venue where a smoking ban applies," Cr Lalios said.
Opposition health spokeswoman Mary Wooldridge said hospitals often phoned for help "but the smokers have left before council enforcement officers arrive".
Health Minister Jill Hennessy's office did not say whether the government would consider reviewing the smoking ban. But a spokeswoman said that this financial year "around $1.8 million was provided to councils to undertake tobacco education and enforcement activities, including the new outdoor smoking bans".
Ms Fitzpatrick said the nurses' union was calling for research into who was enforcing the hospital smoking ban and if it was reducing smoking.
"We want to see if there is a way of reducing violence and protecting health workers from secondary smoke inhalation," she said.
People caught smoking near a public hospital entrance can be fined $159.
- The Age