Hospitals to banish smoking

Tobacco-free rule kicks in July 4

For years, medical staff, patients and visitors have clustered around hospital entryways, dragging on cigarettes before returning to the clean air inside.

Next summer, that scene will disappear.

On Tuesday, the Triangle's three major health systems teamed up to announce one of the biggest tobacco bans in state history.

The announcement by Duke University Medical Center, WakeMed Health & Hospitals and UNC Health Care, which owns Rex Healthcare, nearly equals the impact of North Carolina's previous 48 hospital campuses to go tobacco-free, said Melva Fager Okun, manager of the Healthy Hospital Initiative.

"I cannot think of anything that is a bigger moment in tobacco cessation for the history of the state," she said. "I feel like I'm riding a tidal wave."

Smoke-free policies at those 48 hospitals protect patients during about 4 million visits each year, Okun said. Duke, WakeMed and UNC add another 40,000 employees and 3 million annual patient visits, plus the people who come to see them.

The ban, which starts July 4, will affect seven hospitals in Durham, Orange and Wake counties, as well as most of their affiliated medical facilities in the Triangle. The hospitals already prohibit smoking inside; the new policies will ban tobacco anywhere on the property.

It's inconsistent with hospitals' missions to allow smokers to hurt not only themselves, but also those who breathe their second-hand smoke, said Steve Smith, chief human resources officer for Duke Medicine.

"We're in the business of healing and caring for people," he said. "Why would we not take steps that reflect those values?"

Hospitals have recognized for decades that they should ban smoking throughout their facilities, said Mel Hurston, the senior vice president for operations at UNC's health system. Hurston was at UNC when it banned indoor smoking in 1989, and he has been pushing for a tobacco-free campus ever since.

The idea has faced resistance from physicians who worried about the extra stress that withdrawal could have on patients who smoke, he said. Figuring out how to enforce the rules with visitors and going up against North Carolina's tobacco culture held up plans, as well.

But today, there's scientific evidence of the dangers of second-hand smoke. What's more, society is more accepting of efforts to prohibit smoking in public. An Elon University poll released Tuesday showed that 86 percent of 649 North Carolinians surveyed last week supported nonsmoking workplaces.

"A lot of actors and forces have converged to make this the right time," Hurston said. About 65 percent of UNC health employees who responded to an internal survey also were in favor of the no-tobacco approach, he said.

Amy Pickens understands why WakeMed is going tobacco-free next year. But that doesn't mean the executive assistant, who goes outside three times each day to smoke, isn't frustrated.

If WakeMed and other hospitals were that concerned with promoting health, they should get rid of fried food in the hospital's cafeteria, too, she said.

Other hospital staff share that frustration, said Gail Reaves, a nurse educator and supervisor at WakeMed who smokes. She's not too upset, but said that some colleagues had threatened to go work elsewhere in the Triangle until they learned those hospitals were banning smoking, too.

Over the next nine months, the hospitals will be drawing up support programs for employees and patients, figuring out how to enforce the policies with visitors and -- in the case of Duke and UNC -- defining exactly where their medical campuses end and universities begin.

They also hope workers will use the time to quit smoking. The hospitals will offer smoking cessation programs for staff members and patients. UNC and WakeMed will ask doctors to offer nicotine patches to patients; they'll be free at UNC and billed like other drugs at WakeMed. Duke hasn't determined the features of its patient smoking cessation program.

Reaves and some of her friends plan to wean themselves off their smoking breaks. But Pickens doubts the new policies will induce employees to quit smoking.

"You can't do it for anyone else. You have to want it for yourself," she said. "They'll go eight hours here without smoking and go home and smoke like freight trains."

While Hurston doesn't expect visitors to quit smoking, he hopes that with enough warning, they will comply with the new policies.

Pierre Saunders, 51, has smoked since she was 12. On Tuesday afternoon, she perched on a wall of the WakeMed parking deck, smoking a cigarette. She would be OK without her cigarettes, but she predicted other visitors would find it difficult.

"When you come to the hospital, a lot of people are under stress," said Saunders, whose father is being treated for smoking-related lung disease. "I'm pretty sure a lot of people will say they need someplace where they can go to smoke."