Facility Becomes First in D.C. to Implement Campuswide Ban
By Susan Levine
Washington Post Staff Writer
Sunday, January 28, 2007
The biggest notices, bright blue and unavoidable, are posted at all the driveway entrances to Providence Hospital. Outside its doors are more signs with the telltale slash mark. And on a lawn gazebo, which until Jan. 1 was one of the last remaining refuges, is this polite but firm directive:
"Providence Is Now Tobacco Free. No Smoking, Please. Thanks."
Throughout the campus of the Northeast Washington hospital, lighting up is now off-limits -- banished from porticos, walkways, even the parking areas and loading dock.
The prohibition makes Providence the first health-care facility in the District to declare its property puff-and-snuff free and one of the few in the region, joining the likes of Johns Hopkins Hospital in Baltimore, Civista Medical Center in La Plata and Mary Washington Hospital in Fredericksburg.
But the number of area facilities in this category could increase quickly. Montgomery County's five private hospitals are aiming to make the switch as a group this year. Others are in discussions.
They're all part of a national trend, one that many people say is way overdue. "Hospitals are supposed to be places of healing and health, so it only makes sense that they'd be smoke-free," said Bronson Frick, associate director of Americans for Nonsmokers' Rights. The California-based organization maintains a list of hospitals proclaiming that status -- more than 500 as of this month.
Administrators offer multiple motivations for their actions, from promoting good health and a healthy environment to boosting employee productivity and cutting maintenance costs. Not to mention, added Ronald Davis, president-elect of the American Medical Association, "the issue of our image. It's tarnished when one sees a crowd of smokers or a pile of cigarette butts outside our doors and in our courtyards."
The pioneer was the Mayo Clinic in Minnesota, which went cold turkey in 1987. It was on its own for a long time. Only in the past several years, as more cities and states passed laws against smoking in the workplace, and especially in restaurants and bars, have enough hospitals followed suit to constitute a true movement.
Last year saw a sharp spike, with such institutions as the University of Rochester Medical Center in New York signing on. In tobacco-rich states like North Carolina and South Carolina, Frick said, more than 30 hospitals extinguished cigarettes.
U.S. Surgeon General Richard H. Carmona's massive 2006 update on "The Health Consequences of Involuntary Exposure to Tobacco Smoke" was undoubtedly an impetus. "Second-hand smoke is not a mere annoyance," Carmona stated at the report's release. "It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults."
About 20 percent of Providence's employees smoke, although administrators do not have a breakdown by job description. Some health providers have higher numbers than others. Among physicians nationally, surveys show a tobacco-use rates of less than 5 percent. Use among nurses is several times that, with as many as one in four licensed vocational nurses smoking.
Providence administrators worried that the sight of staff, visitors or others outside smoking whether on break or en route to their cars, diminished the hospital's cessation efforts. And looking the other way implied tacit approval, they thought.
"There's never any legitimate reason to allow smoking," noted President Julius D. Spears Jr., whose father, a three-pack-a-day addict, died of lung cancer at 66.
In this region, the most anti-smoking activity has occurred in Maryland. Civista Medical Center does not allow tobacco products except in "the privacy of one's own vehicle." Johns Hopkins Hospital's still-evolving policy tries to be equally strict; it has barred smoking in garages or exterior areas within its campus perimeter, although the city streets and sidewalks that cut through the campus make enforcement more difficult.
The Maryland Hospital Association recently posted on its Web site a lengthy list of how-to resources from across the country. "I can see major progress," said Senior Vice President Nancy Fiedler, who estimates that a dozen facilities statewide already have forbidden all outside smoking. Another dozen are well along in their planning.
Calvert Memorial Hospital in Prince Frederick soon will dismantle several public smoking shelters and close its staff smoking zone, and by June 1 all cigarettes, cigars and pipes will be outlawed. Montgomery's hospitals haven't set their target date, but they've agreed on a united front.
"We're all going to go at the same time," said Judy Lichty, director of prevention and wellness programs for Adventist HealthCare, which itself is going to go further still. The organization will extend the ban well beyond Washington Adventist and Shady Grove Adventist hospitals to its half-dozen nursing homes and all other Maryland locations and offices.
Zero tolerance can be a challenge, though.
"This has not been an easy implementation," admitted Fred Rankin, chief executive of Medicorp Health System and its flagship Mary Washington Hospital. After decreeing an end to smoking on the hospital's sprawling grounds, officials grappled with enforcement. They finally decided to return a small, single, out-of-sight "butt hut" down the hill from the emergency department entrance. It remains restricted to non-employees who just can't manage without a cigarette while at the hospital.
"We tell them, 'Here is our policy. We encourage you to comply,' " Rankin said. But "the addiction of smoking is incredibly strong. . . . We have the occasional patients who will get out of bed and go down and stand outside in their bathrobe and have a cigarette."
There have been few scofflaws to date at Providence Hospital, which first issues verbal and then written warnings to errant workers. Not that some haven't grumbled about the campus's new designation. In 35-degree chill this week, Mike Jones stood at the curb -- on public space -- to have a smoke.
"I understand people don't want to be around us," said Jones, who works in insurance billing. He questioned whether the entire property should be marked off. "We're already outside."
According to Providence's president, only one employee has quit in protest; numerous others have enrolled in its free program to help them break their habit. "We have easels up all over the place [that advertise] 'Here's the number to call,' " Spears said.
Andrew Carroll, a 40-year-old psychology graduate, looked at the smoking edict as an opportunity. He first picked up cigarettes as a teenager and over the next quarter-century walked away from them twice, but never for good.
He has heard some at the hospital complain about feeling more alienated. But in his office in behavioral health services, Carroll feels "mostly just liberated." Between the free cessation classes, a nicotine patch, medication and aggressive exercise, he's about to pass the four-week mark.
"I'm doing all of it, everything the research says leads to a good outcome," he said. "Forty-one is going to look good."
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