BY NORM TOLLINSKY
Hospital workers, visitors and patients intent on lighting up will have to put on their hiking boots, get serious about quitting or risk paying fines of up to $305 following the introduction of tough new no-smoking policies at Sault Area Hospital and the North Bay Regional Health Centre.
By early May, 10 or 11 tickets had already been issued at Sault Area Hospital. “I don’t know what the number is today, but the word has gotten out and I believe everyone – patients, visitors and staff – understand that there will be enforcement action taken,” said Mario Paluzzi, director of communications and public affairs.
The no smoking policy applies to the entire property, including the ring road, parking lots, grounds and even a wilderness area around the new Sault Area Hospital.
“We were actually a smoke-free property – or claimed to be – before the move (to the new hospital), but we didn’t do a very good job of enforcing it,” said Paluzzi. “We were still only covered under the provincial legislation that bans smoking within nine metres of the hospital.”
The move to the new hospital on the outskirts of the city was seen as an ideal opportunity “to press the reset button, so we applied to have the City’s smoking bylaw amended for our property,” said Paluzzi.
Now, Algoma Public Health tobacco control officers can ticket people for smoking anywhere on hospital property.
The new policy was widely communicated through an awareness campaign, “but given our previous history and lack of enforcement, we felt that the only way we were going to make this work was to demonstrate that we meant what we said.”
At first, warnings were issued, but some people didn’t get the message.
The hospital doesn’t have to rely on tobacco control officers being physically present to issue a ticket.
Hospital security staff or anyone else can fill out a witness statement and submit it to Algoma Public Health for a ticket to be issued. Evidence from the hospital’s video surveillance system is available to help identify smokers.
“I don’t want it to sound like the role of video surveillance is to check for smokers,” said Paluzzi. “Video surveillance is there for security reasons. However, we have 40, 50 60 cameras on the property. They’re very high-resolution – generations removed from what we had at the old sites. You can literally look into people’s cars to see if they’re smoking.”
If staff want to smoke in their cars, they have to drive them off the property.
“The fact that you are in a vehicle does not make the otherwise illegal activity legal,” said Paluzzi. “It’s not just the second hand smoke that’s a problem. There are other byproducts to smoking. In this day and age, it’s difficult to even buy a vehicle with an ashtray. Virtually everyone I see smoking in a vehicle is doing so with the window rolled down and virtually 99.9 percent of the time, the cigarette butt ends up out the window. Our property is smoke free. Being in a vehicle doesn’t change that.”
North Bay
Strict no smoking policies took effect at the new North Bay Regional Health Centre in April for staff and visitors and will apply to patients beginning July 1. Like Sault Ste. Marie, North Bay got the City to pass a bylaw banning smoking on hospital property. Passed in mid-April, the bylaw “adds a measure of clout to the enforcement” and empowers hospital security staff to issue tickets, said Bob Cunningham, the hospital’s executive vice-president.
The no smoking policy in North Bay was supposed to apply immediately to visitors and staff and within a two-year time frame for patients, but no smoking advocates led by physicians pushed for a more aggressive timeline.
“There was quite a range of views about what to do and how to do it,” said Cunningham. There were concerns about the safety of patients leaving the property to light up and questions about the support programs for those who wished to quit smoking. A few board members even questioned the ethics of a complete ban.
“Trying to be one of the senior leaders supporting the board through (the discussions) was a challenge,” said Cunningham.
Physicians pushed hard to change the original decision to exempt patients from an immediate ban, even going to the extent of publishing an open letter to the Minister of Health and Long-Term Care asking for a change in the regulations under the Public Hospitals Act that would require all new hospitals to be completely smoke free. Signed by Dr. Vicky Beddage on behalf of the Mental Health Centre’s medical staff association, the letter was critical of the board’s decision to reject the advice of the physician-led smoking advisory committee for an outright ban on smoking.
“We believe our public hospitals should be devoted to healing and we view it as inappropriate to set aside areas on hospital property for patients to engage in an activity that harms their health,” wrote Beddage.
The size of a hospital’s property and the distance to the property line has a strong bearing on the effectiveness of no smoking policies.
“If the property line is close, it’s almost as if there is no policy,” said Cunningham. Patients, staff and visitors can just walk a short distance to the sidewalk or bus shelter and light up. In North Bay and Sault Ste. Marie, it’s much more of a hike for hospital staff to take a smoke break and return to work on time. For patients in flimsy hospital gowns pushing an IV pole, it’s almost out of the question.
Enforcing a no smoking policy at hospitals serving mental health and long-term care patients can be especially challenging.
North Bay, for example, has a secure forensic unit for mental health patients who are usually referred to the hospital from the criminal justice system.
“Most of these individuals come to us directly from jail, where there is no smoking allowed,” said Cunningham. “Some of them have gone through a long period of (abstinence), probably without much in the way of support, so when they arrive here, it’s not really much of an issue.”
However, mental health patients are free to leave the hospital property once they are released from the forensic unit. At first, they may require an escort, but the whole point of their treatment is to provide them with rehabilitation services and assist them in re-entering the community, said Cunningham.
“If these patients are able to ambulate, they can walk to the property line and have a smoke.”
If they just step outside and light up, they’ll be in contravention of the bylaw and at risk of being ticketed.
However, with smoking cessation programs and nicotine replacement therapy available, the hope is that most long-stay patients will take advantage of the opportunity to quit for good.
Thunder Bay
The other three large urban hospitals in Northern Ontario are at various stages of implementing no smoking policies.
“We have a huge dilemma here,” said Don Edwards, vice-president of communications and engagement with the Thunder Bay Regional Health Sciences Centre. “We have gone to the nth degree to tell people not to smoke on our property, but they still do, so we have a policy, we have an expectation, and we have an enforcement issue.”
Mounds of cigarette butts litter the entrances to the hospital, said Edwards. “We have mental health patients and other patients who say ‘I’m going outside to smoke. I’m 27 feet away from the nearest door, therefore I’m outside the purview of the law.’”
Thunder Bay police don’t have the resources to enforce the nine metre smoking ban and the health unit’s tobacco enforcement officers “haven’t got time to stand around all day waiting for people to smoke, so it’s hit and miss,” said Edwards.
The whole notion of fining mental health patients and nursing home residents who have smoked for 50 years or more further complicates the enforcement of no smoking policies.
“It’s quite an ethical issue,” but it’s due to go back to the board shortly for further consideration, said Edwards.
Timmins
Timmins District Hospital is also revisiting its no smoking policies. Currently, smokers light up in a small shelter at the back of the building and on the sidewalk outside the main entrance.
“A volunteer spends part of every day picking up cigarette butts,” said hospital president and CEO Roger Walker. “I was talking to him last week and he said he could spend five, six hours a day picking up butts.
“We don’t stand for that. We stand for health, so we’re actively looking at this. We’ve raised it with our managers, our wellness committee is working on it and we expect to have a new policy or more aggressive enforcement of the existing policy by summer.”
But it won’t be easy, he warned.
“We have long-term care patients under our roof…You’ve got the hard rock miner who’s been a smoker all his life who’s now in long-term care. It’s pretty hard to say ‘Hey, you gotta stop.’ Do we kill the person by getting him to stop, knowing darn well that smoking is going to kill him eventually anyway? So, it’s a bit of a dilemma.”
Sudbury
Sudbury Regional Hospital went smoke free last July for employees, physicians, volunteers and visitors, but decided to allow patients to continue to smoke in designated shelters until the necessary supports are in place.
There is no municipal bylaw prohibiting smoking on hospital property and no tickets or fines are issued. Instead, the hospital relies on its Internal Responsibilty System, “whereby each and every one of us…is responsible for enforcement,” said Lynda Parks Sahadat, vice-president and chief human resources officer.
“If I’m coming in or out of the building and I see someone smoking, I have a right and a responsibility to mention to that person that it is a smoke-free property. If they are a patient, I direct them to one of the smoking shelters. If they’re not a patient, I advise them that if they want to smoke, they need to leave the property.”
Most of the smokers she encounters are visitors from out of town who aren’t familiar with the policy. In most cases, they apologize and either put out their cigarette or leave the property, she said.
Sudbury Regional reimburses employees and anyone else residing in an employee’s household up to $500 for smoking cessation products.
“If an employee is a smoker and is serious about quitting, it just makes sense to offer support to others living in the same home because it increases the chances of success for our employee,” said Parks Sahadat.
The hospital is working on refinements to its computer system to identify smokers as part of the admissions process and will extend the smoking ban to patients once supports are in place.
Parks Sahadat is aware of the tougher line taken by Sault Area Hospital, but is content to let the Sault take the lead on enforcement.
“Some are trendsetters and others watch the trends and come along at a time that’s appropriate for them,” she said.
