Some psychiatric staff at Dunedin's Wakari Hospital did not want to prevent locked-in psychiatric patients smoking, while some patients used a toaster to light up during a ban, internal Southern District Health Board meeting notes and emails reveal.
The Otago Daily Times requested correspondence about a smoking ban at Wakari's 9B, under the Official Information Act.
The material provided included information about smokefree moves in other wards, including escorting patients off the ward to smoke.
Last month, district health board member Richard Thomson complained the ban at Wakari's 9B had not been authorised.
Chief operating officer Vivian Blake stopped the "pilot", which she had not been aware of, and patients were able to smoke again.
Minutes from a May 12 staff meeting reveal there were some issues with the 9B ban.
Some patients smuggled in a lighter or used a toaster to light up.
A bid to introduce a smoking ban at 10A, a secure intellectual disability unit, was unsuccessful because of "a complaint".
Opting to send smokers off the grounds meant they could be seen "congregating together in a very public way".
In an email from charge nurse manager Paul Stewart on May 26 to three other staff members, he noted some staff in Wakari's 9A were "somewhat anti" the "smoke-free approach" and felt it "trampled on" patient rights.
Also, the "[Emergency Psychiatric Service] would not be assisting with asking patients to quit - the rationale was that patients attending EPS are too unwell for this to be undertaken."
He suggested staff might need to be "better educated or informed".
"Resistant staff" were influenced by the comments of Mr Thomson and others that seemed to suggest mental heath did not need to join the rest of the district health board in becoming smokefree.
A few days later, Mr Stewart wrote to two staff members saying direction was needed on "just what is the policy of the SDHB" on smoking.
"We seem to be caught up in a moral-ethical argument about patients' rights and somehow it seems that the need for patients to smoke is regarded as a right and as such staff have a duty of care to meet."
Psychiatric staff had said it was not their job to prevent smoking and had indicated they would need to use the Mental Health Act to stop smoking.
"What appears to be overlooked is that smoking is not a right but a choice and patients in 9A are in 9A because their mental state is such they require a controlled environment and as a result they will have a . . . reduction in choice."
There were issues with escorting patients off the grounds to smoke.
"The need to escort does cause issues as the patients can become very demanding to go for a smoke and staff can often be too busy on the ward to escort."
There was also reference to inquiries from the ODT, first lodged on June 3.
The next day, in an email between smokefree regional programme leader Rosie Gordon and public health group manager Pip Stewart, Ms Gordon expressed concerns about explaining the smokefree situation publicly, fearing a "me [versus] Richard [Thomson] debate!".
She also expressed concern at the seeming difference between the Ministry of Health's smokefree strategy for mental health, and government legislation, which permitted DHBs to make their own rules.
A few days later, regarding a similar query from the ODT, Ms Stewart sent a message to a fellow group manager saying, "How do you wish we handle this please".
Mr Thomson emailed Mrs Blake, the chief operating officer, saying he also needed clarification of what was happening.
After raising the matter a few days earlier at the full board meeting, based on unconfirmed reports, he was still unclear about the situation and was receiving media inquiries.
"I understand that someone in management gave [the ODT] the "restrictions" line but then said they were not authorised to explain what that meant!"
