Hospital Smoking Ban Policy Enforcment And The Doctors, Nurses, Family and Patients That Can't Wait To Get Their Nicotine Fix

by The Happy Hospitalist

Happy's hospital has been a smoke free campus for several years now with a campus wide hospital smoking ban policy in place.  And let me tell you, it has been Heaven on Earth.  When I first became a hospitalist seven years ago, I had to endure a daily battle with patients requesting to go outside and smoke.  These were patients hooked up to cardiac monitoring devices, IV fluids and continuous narcotic pain drips.  It seemed so silly to interrupt my daily work flow to address such nonsense. 

Now I don't have to deal with any of that.   Happy's hospital campus has a hospital smoking ban policy in place for the entire campus.  That means no smoking anywhere on the hospital grounds, indoor or outdoor.  There is no smoking by the tree in the courtyard.  There is no smoking in the parking garage.  There is even no smoking in your car, even with your windows rolled up.  

This hospital smoking ban policy applies to all patrons on the hospital grounds.  No smoking by the sixth floor ward secretary.  No smoking by the second floor ICU nurse.  No smoking by the cardiac transplant patient hooked up to a dobutamine drip.  No smoking by the girlfriend of the meth addict admitted to the ICU with severe sepsis and shock from endocarditis.  If you want to smoke you'll have to leave the hospital grounds. If you are a patient, that means you'll be discharged against medical advice should you chose to go smoke. 

Every day I drive to and from work, I see nurses huddled in an alleyway puffing away by the large dumpsters filled with garbage from local businesses.   I see patients and families in a sort of ritual group circle puff.  I can only imagine what they're talking about

Family Exhibit A:  My dad is in the ICU on the breathing machine with an emphysema attack.Family Exhibit B:  My mom is here  getting a four vessel cabbage.Family Exhibit C:  My daughter is here with an asthma attack.Family Exhibit D:  I'm actually a patient here, getting chemotherapy for lung cancer.   Don't tell my doc, ha ha ha ha !

Some of my medical student friends smoked long after they completed their residency.  Some of them would even sneak in puffs at work while rounding.  I've heard of cardiovascular surgeons smoking, cardiologists smoking, pulmonologists smoking.  Even oncologists smoking.  

In this day and age, there is no excuse for any of that.  If you are a doctor, nurse or respiratory therapist, I'd screen you for nicotine and not even consider hiring you if you tested positive.  That's exactly what Scotts Lawn care is doing and their health care expenses have plummeted. 

How does Happy's hospital enforce their campus wide smoking ban?  I have no idea.  I don't presume we have an army of anti-smoking officers on patrol.  To some degree the enforcement is a combination of  security officers, self respect for the rules, and bystander education.  Yesterday, I found myself in the role of bystander edumacating the public.

I came upon an elderly women sitting on a bench right outside the entrance to my hospital.  She was sitting with an eight year old kid.  And I saw her light up as I walked toward the entrance.  I thought about whether I should say something or not.  Disciplining a stranger cam be a tad bit uncomfortable.  But  I thought to myself, if I don't say something, who will? She is not supposed to smoke on the hospital grounds.  So I looked at her and said:

Happy:  Ma'am, Happy's hospital is a nonsmoking campus.  If you need to smoke, you'll have to walk several blocks to the edge of the hospital grounds. 

Ma'am:  Oh, I didn't know that.  I'll put it out.

I walked into the hospital for some brief business.  When I came out, I noticed the woman and child were gone.  It was almost 100 degrees outside, so I can't imagine she would leave the shade to go stand in the noon sun and smoke with an eight year old.  Maybe she decided not to smoke.  Maybe she did decide to walk off the hospital grounds to smoke.  Maybe she decided to go somewhere else on campus to smoke.  Regardless,  I felt sorry for that little kid to have to put up with this type of legal child abuse.

Hospital smoking bans are the right thing to do. If we are going to have success with implementing a no tolerance policy, it's going to require bystanders to educate  and intervene when families light up.

If you saw a stranger lighting up on your hospital grounds, what would you do??