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Smokers who refuse to stop puffing away at Darent Valley Hospital could find themselves being barred from being treated.
The tough stance has come as the Dartford hospital bans both smoking and vaping in its grounds.
Staff were already prohibited from lighting up but the ban has been extended to patients and visitors.
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Wardens have been patrolling the grounds during the first week.
Anyone who refuses to stop smoking when asked by a warden will be issued with a yellow card.
If they continue to smoke after that, the hospital will block them from receiving any non-emergency treatment.
The Dartford Messenger revealed in August chief executive Susan Acott wanted to clamp down on smokers and vapers to promote healthy behaviour and protect others from passive smoking.
At the time, she said the ban was not being brought in “to be awkward” and the hospital simply wanted to discourage smoking and help people break the habit.
“I am hoping most people will understand why we are doing it and will be reasonable about it, and will walk further away from the hospital or wait until they get in their cars,” she said.
Since then the move has been met with mixed reactions, but since it came into force on Monday, wardens tasked with enforcing the ban are said to have found people “very co-operative and responsive”.
Although there were signs around the hospital grounds requesting smokers use the designated area, people did not always follow the rule with many sparking up outside the hospital entrance.
Designated smoking areas have been removed, meaning there is nowhere to light up in the hospital grounds whether indoors or outside.
Patients and visitors who cannot or do not want to give up their habit can ask staff for nicotine replacement therapy to reduce cravings.
Despite some viewing e-cigarettes and vaping as a healthier alternative, the hospital has said there is not enough evidence to prove it and has banned those too.
It marks the start of the hospital’s ‘Stoptober’ campaign to raise awareness of the dangers of smoking and help and encourage people to give up.
A hospital spokesman said: “We are committed to creating a healthier place for patients, visitors and staff and need support from everyone to keep the hospital and grounds smoke free.”
