Bartlett Hospital mulls smoking ban

Physician worries about stress on patients

Posted: Wednesday, October 25, 2006

Cigarettes can be used as a "carrot at the end of a stick" to help subdue some unruly patients who come to the hospital for care, emergency room physician Nathan Peimann said.

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The Bartlett Regional Hospital Board of Directors is considering a ban on all smoking on the hospital campus, but Peimann was among those who argued smoking needs to be allowed outside on hospital grounds.

"We have people who come in either emotionally disturbed or mentally unfit and those folks sometimes need a break. And sometimes that break that they want is to go out and smoke a cigarette," he said. "A lot of times that helps in their behavior after."

Hospital administrator Robert Valiant introduced the proposed smoking ban to the board Tuesday night under the recommendation of Dr. Richard Mandsager, the state's director of public health. Last month Mandsager challenged all health-care facilities in Alaska to establish 100 percent tobacco-free policies by November 2007.

Bartlett is a smoke-free building with additional smoke-free zones, but patients and staff are allowed to smoke in the open air on the hospital's premises. This is the fourth time a similar smoking ban on the hospital campus has come before the board.

"Through the years we have had something going on where we didn't feel like pushing it through until everybody was on board," said Bob Urata, board chairman and a family practice physician.

The ordinance is expected to come before the Hospital Board for a vote at its next regular meeting at 5:15 p.m. Nov. 28 in the administrative board room. The meeting is open to the public.

Peimann, also a board member, said he is opposed to cigarette smoking but objects to banning smoking entirely from the hospital campus.

Although difficult to scientifically prove, he said preventing people from smoking under certain emotional distress could lead to violence and an unsafe work environment.

"It's a freedom that I don't necessarily want to take away from every patient every time they are in crisis," Peimann said.

Information provided by the state at Tuesday's meeting said tobacco costs Alaska about $169 million annually in direct medical expenditures. More people die from smoking cigarettes in Alaska "than from suicide, motor vehicle crashes, homicide, HIV/AIDS and influenza combined."

Urata said nicotine addiction caused by cigarettes is so powerful that some very sick people will continue doing so even though it could "have a significant impact on the healing process."

"Even though you're really sick, the addiction clouds your judgment so when you're physically able to go outside and smoke, that is what you do," he said.

Urata said he has had patients with pneumonia who have checked out of the hospital early or sneak out to the parking lot in the middle of the night just to smoke a cigarette. Unless people are using oxygen tanks or can't physically move, it's difficult for the hospital to stop patients from smoking outside, he said.

"It's like talking to a brick wall, so it's frustrating for them. It's frustrating for you. So the hospital continues to let patients go outside if they can get outside and it's safe," Urata said.

Letting visitors and patients smoke in the open air when dealing with the stress that comes along with a hospital visit is a recourse they should be free to exercise, Peimann said.

"I'm not saying it's the only recourse that they have, but it's an important ability for them to exercise that freedom when they are coming to an environment where most of their freedoms in some way are being taken away," he said.

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