Annie O'Neill, Post-Gazette Marvin Merriman, of East Liverpool, Ohio, smokes his pipe on Lothrop Street outside UPMC Presbyterian Hospital in Oakland. Mr. Merriman, who is having back surgery this morning, says he doesn't think the smoking ban is fair. "They are trying to get everyone on a health kick," he said. "I can understand why nonsmokers would like it, though."

A woman clad in a flimsy hospital gown marched out of Magee-Womens Hospital yesterday afternoon and crossed Halket Street, pushing her IV stand in front of her. As soon as her feet left the UPMC property, she lit up a cigarette.

"I don't think this is right," said a man wearing a UPMC name tag. But he didn't chastise the smoking patient, for he was also smoking on the sidewalk across from the Oakland hospital. He didn't think that patient, or any patient, should have to go to such extremes or walk such a distance to smoke a cigarette.

Several blocks away, a woman wearing a Children's Hospital visitor pass lit a cigarette while sitting on a bench on Fifth Avenue, right in front of that hospital.

"My daughter is inside hooked up to life support equipment fighting for her life," said Patrice Minear of Elkins, W.Va. "I ought to be able to smoke wherever I like. I shouldn't have had to come out here last night at 2 a.m. to smoke. I don't think it's safe."

Yesterday was the first day when all of UPMC's 17 hospitals and other properties became smoke-free, inside and out.

Outside the UPMC hospitals in Oakland and Mercy Hospital on the Bluff, smokers were still smoking, but they were walking greater distances to do so.

Most of the hospital employees who were smoking were unwilling to speak to a reporter. All of them declined to give their names.

"Employees have been told they could lose their jobs if they smoke on hospital grounds," said a Beechview woman who, since March, has spent much of her time at Children's Hospital where her son is being treated for cancer. She declined to give her own name because her daughter is an employee at the hospital "and I don't want to get her in trouble."

The mother from Beechview pointed out that hospital workers wearing scrubs or lab coats -- some with stethoscopes around their necks -- were crossing four lanes of heavy traffic on Fifth Avenue to smoke on sidewalks in front of businesses across the street from Children's.

The woman was smoking as she sat on the bench with Ms. Minear on the same side of the street as the hospital "because I believe this sidewalk is public property, not UPMC property. Yes, I should quit smoking, but my son has cancer and we're all under a lot of stress. This is not a good time to try to quit smoking."

Ms. Minear has been living in the hospital for the last three weeks while her daughter, 7-month-old Cheyenne Ferrell, battles a life-threatening but still undiagnosed illness.

"Her father would like to be here with us, but he is in West Virginia working and caring for our other three children," Ms. Minear said. "I have no family or friends here with me. All that I ask is to be able to smoke my cigarettes."

At nearby UPMC Presbyterian, a man in a blood-spotted hospital gown stubbed out his cigarette on Lothrop Street and slowly made his way back to the main entrance of the hospital.

"We used to be able to smoke right there, near the entrance," said Mark, a Washington, Pa., resident who declined to give his last name. "There are a lot of patients who smoke, and I don't think this is right." He said he has been in the hospital for two weeks, expects to be in at least two more weeks and estimates he'll be making a dozen trips outside each day to smoke a cigarette.

Asked if hospital personnel try to stop him from leaving the facility, he said, "I just go anyway. I'm a patient, not a prisoner."

At Mercy Hospital, Lynn and Vanessa Smith of Hazelwood sat on a wall on Morrison Street and smoked cigarettes after she was released from the emergency room after receiving treatment.

"There have been quite a few people smoking here all day," Mr. Smith said, "including patients, nurses and doctors. No one seemed real happy and some said that starting tomorrow people won't be able to smoke where we are because this sidewalk is in front of a parking lot, which the hospital probably owns. They are taking away our freedom of choice. We're living in a dictatorship."

Excela Health facilities and its affiliates also became tobacco-free yesterday, inside and outside, including in parking lots, walkways and entrances. Excela operates facilities in Westmoreland, Fayette and Indiana counties, including Frick Hospital, Latrobe Area Hospital and Westmoreland Hospital.