A Dozen Area Hospitals Are Going Tobacco-Free

Even Outside, Smoking Will Be Barred

A dozen hospitals in Montgomery County, Frederick and Northern Virginia will declare themselves "tobacco-free health zones" starting tomorrow, a pointed and sweeping move that will apply to employees, patients and visitors alike.

The use of tobacco products will be prohibited anywhere on the hospitals' grounds -- outside entrances, on walkways or in parking lots and garages. Gazebos where smoking has been permitted are being dismantled, and cans for cigarette butts will disappear.

The ban, which takes effect on the American Cancer Society's 31st annual Great American Smokeout, affects Frederick Memorial Hospital, all five Montgomery hospitals and the entire Inova Health System. They join more than 500 health-care institutions across the country that have forbidden tobacco on their property. The number has increased exponentially in the past several years, though with relatively little momentum in the Washington region.

"The science is behind us. The public health needs and opportunities are behind us," said Kevin Sexton, president of Holy Cross Hospital, where large countdown banners have hung prominently for several weeks.

In suburban Maryland, the collective nature of the hospitals' action is meant to amplify the message. The six facilities planned the change together, bringing in experts from the Mayo Clinic to train tobacco-cessation counselors this summer and agreeing to offer certain benefits, from stop-smoking classes to nicotine patches and medications.

They also printed small cards with "scripts" for staff members to follow if they see a colleague, visitor, patient or family member puffing away. The suggested dialogue is more courteous than curt, but employees could face disciplinary action for repeated violations. A worker with clothes smelling of tobacco might be issued disposable coveralls or asked to go home and change.

"We're health-care professionals, and so you have to treat this as an addiction. You're not going to treat it as a crime," said Brian A. Gragnolati, Suburban Hospital's president.

Although the days are long gone when nurses and doctors lighted up outside patients' rooms, he and his counterparts estimate that up to 20 percent of their employees smoke.

The hospitals acknowledge that they are playing catch-up. Montgomery passed a no-smoking law for bars and restaurants more than four years ago, and a statewide prohibition will take effect in February. Officials now peg Maryland health-care costs related to smoking at $2 billion.

"To permit an act to occur on our campuses that is recognized as the single most common cause of death and disease was simply a disconnect that none of us could allow to continue," Thomas A. Kleinhanzl, president of Frederick Memorial, explained yesterday at a news conference.

Going tobacco-free may pack more punch in Northern Virginia. No jurisdiction there has outlawed smoking in restaurants and bars, a reflection of the state's tobacco heritage and the influence the industry retains. Inova's action will cover its entire sprawling system, including medical office buildings and two nursing homes. Its program will offer personal Web-based "quit coaches" and a support group called "Knock Out Nicotine."

"We have to be compassionate but firm," said Kylanne Green, Inova's chief administrative officer.

Studies have concluded that when smoking is banned from public spaces, workplaces and similar settings, smokers are more likely to quit. Given recent statistics showing that smoking rates have hit a plateau after declining for decades, the hospitals hope their decision will make a difference.

Noted Alfred Munzer, director of pulmonary medicine at Washington Adventist Hospital, "The hospitals really set the tone for the community, and that is very important."