Register C

State surgical-smoke statutes

Twenty-two states have enacted something, seventeen have an operative mandate, and sixteen of those seventeen require a written policy rather than equipment.

The finding this register exists to state

Sixteen of the seventeen operative mandates require a facility to adopt a policy. They do not require it to own a device. Rhode Island, Colorado, Illinois, Connecticut, Oregon, New Jersey, New York, Louisiana, Missouri, Ohio, Washington, Arizona, Minnesota, Virginia, North Carolina and Delaware all impose the duty as adopt — sometimes adopt and implement — policies. What the policy has to contain, and whether it has to require evacuation at the point of origin, is left to the facility in every one of those sixteen.

One state says use the equipment. Kentucky’s regulations, and only Kentucky’s regulations, state a flat use requirement.1 And the instrument almost everyone cites for Kentucky is the wrong one: KRS 216B.153(2) directs the cabinet to promulgate rules and imposes no duty on any hospital at all.2 The facility duty lives in 902 KAR 20:016 for hospitals and 902 KAR 20:106 for ambulatory surgical centres.3

Kentucky’s sentence

Why the count everyone publishes is misleading

The figure in circulation is that twenty states, or more recently twenty-two, “require smoke evacuation.” Twenty-two states have enacted something, and that number holds — we swept every state not on the list and found no twenty-third. But the sentence a reader takes away from “twenty-two states” is that twenty-two states require evacuation, and that is not true in four separate ways at once. Two states are enacted but not yet in force. Two states appear on every published tracker with no evacuation requirement in their text at all. One has a statute whose facility-level duty lives in a rule we could not confirm was ever promulgated. And of the seventeen that are operative, sixteen require the facility to adopt a policy rather than to own a device.

The two states on every tracker with nothing in their text

California and Georgia are the correction the field most needs, because both appear on published trackers as requirement states and neither statute contains a requirement. They fail in different ways, which is why both are worth printing.

(b) Each hospital and ambulatory surgical center shall adopt policies for the reduction of human exposure to surgical smoke.

Read the as-passed bill

That subsection is the entire duty. Georgia fails by subtraction: the requirement was in the introduced bill and was taken out before passage, and the trackers never re-read the enacted text.

(c) (1) By June 1, 2027, the board shall consider for adoption a proposed regulation of the division requiring a health facility to evacuate or remove plume through the use of a plume scavenging system in all settings that employ techniques that involve the creation of plume.

Read the full section

California fails by addressee. The sentence contains the words a tracker searches for — evacuate, plume scavenging system, health facility — and the verb attaches to the board, which shall consider for adoption a proposed regulation. A California hospital has no duty under this section, and will have none unless and until the Standards Board adopts something.6

Georgia’s surgical-smoke statute and Georgia’s sewer law are unrelated, and we treat them differently for a reason. This register carries Georgia because we hold the signed bill. Register A does not carry Georgia at all, because we could not confirm a Georgia sewer provision in primary text. The same state can be verified on one subject and unread on another, and collapsing the two would be exactly the kind of error this page is documenting.

Citation traps in this subject

Every one of these cost us time, and each of them is currently reproduced somewhere a reader is likely to land.

• Kentucky. KRS 216B.153 is not the source of a hospital’s duty. 902 KAR 20:016 and 902 KAR 20:106 are.
• Michigan. The Public Act is 47, not 95. Ninety-five is the enrolled-bill sequence stamp printed on the same page.
• Arizona. July 1, 2024, not July 1, 2023. The earlier date is from the introduced bill.
• Washington. RCW 49.17.500, in the labor title. Not RCW 70.41.
• Ohio. Two citations are needed — 3727.25 for hospitals and 3702.3012 for ambulatory surgical facilities.
• Illinois. Renumbered from 210 ILCS 85/6.28 to 85/6.32, and the legislature’s older full-text URLs now return 403.
• Delaware. The session law says 9002B; the Code says 9302B.
• New York. Two sections are numbered 2830 in the Public Health Law.
• Louisiana. The enacted text requires policies for an evacuation plan, not an evacuation system. Quotations of the phrase “evacuation system” are from the introduced bill.
• Missouri. Joint Commission-accredited facilities only.
• Virginia. Hospitals only, and the duty runs through the Board of Health’s regulations.
• North Carolina. The codified statute pages lag the session laws and omit the 2026 amendment.
• West Virginia. Cite § 16B-3-21. The older article was recodified and is repealed.
• Scope, everywhere. None of the seventeen reaches a physician’s office or a medical spa. All of them are limited to licensed hospitals and licensed ambulatory surgical or outpatient surgical facilities, with Oregon’s home health and home hospice extension the only exception in either direction.

The states with no enacted law

A sweep of every state not among the twenty-two found no additional enacted law and no repeal or amendment of any of the twenty-two, as of 2026-08-06. Bills were confirmed dead or pending from official legislature status pages in Florida (CS/HB 93, died in Rules 2026-03-13), Wisconsin (AB 563 / SB 442, failed 2026-03-23), South Carolina (S.170, stalled in House committee), Pennsylvania (HB 27, in Senate Appropriations), Massachusetts (H.2442 / S.1482, in Ways and Means), Hawaii (HB 218 / SB 393, never passed both chambers), Oklahoma (HB 1887, no action), Texas (HB 513, never taken up), Arkansas (HB 1718, died at sine die) and Utah (SB 105 and HB 58, both failed). Iowa, Kansas and Maine were checked against full-session bill listings and have no surgical smoke bill at all. The remaining states were checked and are recorded as having no enacted instrument; they have no rows here because this register indexes instruments, not absences of instruments.

One column this register does not carry

Enforcement. We have not read the enforcement provisions of the seventeen operative instruments against primary text, so there is no enforcement column, and we are not going to characterise what happens to a facility that ignores its state’s statute on the strength of an impression. Our working expectation, stated as our judgment and not as a finding, is that enforcement in most of the seventeen is thin to non-existent, because a duty to adopt a policy is discovered at inspection or not at all. Turning that expectation into a column means reading seventeen enforcement provisions, and that is scheduled work rather than published work.

What would change these rows

• The six rows with nothing transcribed. Rhode Island, Colorado, New York, Washington, Virginia and Delaware carry no quotable text on this page at all, and eleven more carry only a credit or effective-date line. Transcribing each state’s duty-imposing sentence would make every row here checkable against its own words rather than against our reading, and it is the first item of the next review.
• West Virginia. A check of the West Virginia Secretary of State’s Code of State Rules database either produces a promulgated Office of the Inspector General rule, which would make it the eighteenth operative state and the second with a use requirement, or establishes that no rule exists. Either answer moves the row. This is the single largest open item on the page.
• Maryland and Michigan. Both move by the calendar. Maryland’s act takes effect 2026-10-01 and its facility duty starts 2028-01-01; Michigan’s duty starts about 2027-07-23. The 1 September and 1 March reviews exist mostly for this.
• California. If the Standards Board adopts a plume regulation following the 2026 draft, California moves from having no requirement to having the strictest one in the country, since a Cal/OSHA standard would be an equipment rule rather than a policy rule. Nothing has been proposed or approved as of 2026-08-06.
• Any new state. Twenty-two is a count with a date on it. A twenty-third enactment, or an amendment converting one of the sixteen policy states into a use state, changes the finding at the top of this page and not merely a row.
• Any of the seventeen. An amendment converting adopt policies into shall use would be the most consequential change this register could record, and it is the specific thing each review looks for first.

Where this could be wrong

The finding that sixteen of seventeen require a policy rather than equipment rests on reading the operative command of each statute, and a statute can obligate through a definition or a cross-reference as well as through its main verb. We read the operative provisions; we did not read every implementing regulation in every one of the sixteen. If a state’s licensing regulations convert its policy duty into a use duty the way Kentucky’s do, we would have missed it, and Kentucky is proof that this exact thing happens. Virginia is the most likely candidate, because its statute is explicitly a mandate on the Board of Health’s regulations rather than on facilities.

The second weakness is that a national count is a perishable good. Twenty-two is correct on 2026-08-06 and will be wrong at some point without anything on this page changing. That is why the count is not in the heading of this page, why every number here carries the date it was checked, and why the review cadence is twice a year rather than annual. A reader who quotes the number should quote the date with it.

The third is that we are one person reading fifty legislatures. Twenty-one of the twenty-two states here were re-read at source rather than taken on an earlier pass’s word, and the one exception is flagged in its own row and in a notice above. That is the best assurance we can offer, and it is not the same as an assurance that nothing was missed.

The fourth is the one a careful reader will find first, and it is the reason the verbatim column exists. For most of these rows what our retrieval log kept is the instrument’s own credit or effective-date line, and for Rhode Island, Colorado, New York, Washington, Virginia and Delaware it kept nothing quotable at all. On Registers A and B that would forbid a verdict. Here it does not, because what the row asserts is the identity and dating of an instrument rather than the content of a clause — but the two certifications are not the same thing, we have said which one this is, and until the operative commands are transcribed the Scope, and what is obligated column is our reading rather than text you can check on this page.