business

Growing number of hospitals ban hiring smokers

The policy, an attempt to bolster employee wellness, is illegal in many states.

By Victoria Stagg Elliott — Posted April 5, 2011

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

More hospitals are refusing to hire smokers. Not all states allow this, and some anti-tobacco activists are uncomfortable with this trend.

"We hope that people will be encouraged to quit smoking and quit using nicotine products and build a healthy life for themselves," said Julie Uehara, spokeswoman for Summa Health System in Akron, Ohio, which implemented a nicotine-free hiring policy in January.

No studies show how many hospitals have banned hiring smokers. However, more hospitals have reported instituting such restrictions. For example:

  • ProMedica, which owns several hospitals in Michigan and Ohio.
  • St. Francis Medical Center in Cape Girardeau, Mo.
  • Crittenton Hospital Medical Center in Rochester, Mich.

These institutions have been smoke-free for years, and the restrictive policies follow the Cleveland Clinic, which in 2007 became one of the first health care institutions to stop hiring smokers.

Though some nonhospital employers have reported saving money on health expenditures as a reason for instituting bans on the hiring smokers, "this was not to reduce costs," said Paul Terpeluk, DO, medical director of Cleveland Clinic's employee health services.

"Having health care providers and caregivers model healthy behaviors was really the goal," he said. "We heard from patients who said they did not like nurses to smell like cigarettes. Caregivers are different. They have to meet a higher standard."

The policies usually apply only to new hires. Potential hires are informed of the policy at the time of application, with the smoking status assessed by nicotine testing during the pre-employment physical. Applicants whose job offers are rescinded usually can reapply after a certain period.

Physician practices interested in instituting such a policy are advised to check their state and local laws, because banning the hiring of smokers is illegal in many jurisdictions.

Twenty-nine states and the District of Columbia legally protect smokers. This is done most commonly through laws prohibiting employers from discriminating against employees who smoke outside work hours and off an employer's property. Some states have broader legislation protecting people who engage in lawful activity or use legal products outside the workplace.

At the federal level, a spokeswoman for the U.S. Equal Employment Opportunity Commission said such policies were unlikely to run afoul of the Americans With Disabilities Act. Other employment laws may come into play, and testing for nicotine can be carried out only after a job offer has been made. The EEOC has not issued guidance on this subject.

"Testing also needs to be consistent for everybody," said Joyce Walker-Jones, an EEOC senior attorney. "Employers could not single out people for testing, but not very much case law has been developed."

Some people who work to limit tobacco use question whether refusing to hire smokers is the best way to improve employee wellness and reduce smoking in the community.

"I'm a very strong supporter of smoke-free workplaces, but I'm not in favor of not hiring smokers," said Michael Siegel, MD, MPH, a professor at Boston University School of Public Health. "Being unemployed is also a health risk. If [hospitals] really are concerned about the health of the population, they should hire smokers and offer them smoking cessation classes. Denying them employment doesn't help."

Back to top


ADDITIONAL INFORMATION

Can physicians refuse to hire smokers?

Some hospitals and health systems are implementing policies that smokers, even outside the workplace, will not be hired. This is allowed in some states but not in others. Here is a state-by-state breakdown:

Alabama: No relevant legislation.
Alaska: No relevant legislation.
Arizona: No relevant legislation.
Arkansas: No relevant legislation.
California: Legal protection for employees who engage in lawful activities outside the workplace.
Colorado: Legal protection for employees who engage in lawful activities outside the workplace.
Connecticut: Legal protection for those who smoke or use tobacco products outside the workplace.
Delaware: No relevant legislation.
District of Columbia: Legal protection for those who use tobacco outside the workplace.
Florida: No relevant legislation.
Georgia: No relevant legislation.
Hawaii: No relevant legislation.
Idaho: No relevant legislation.
Illinois: Legal protection for employees who use lawful products outside the workplace.
Indiana: Legal protection for those who use tobacco products outside the workplace.
Iowa: No relevant legislation.
Kansas: No relevant legislation.
Kentucky: Legal protection for those who smoke or use tobacco products outside the workplace.
Louisiana: Legal protection for those who smoke or use tobacco products outside the workplace.
Maine: Legal protection for those who use tobacco products outside the workplace.
Maryland: No relevant legislation.
Massachusetts: No relevant legislation.
Michigan: No relevant legislation.
Minnesota: Legal protection for employees who use lawful products outside the workplace.
Mississippi: Legal protection for those who smoke or use tobacco products outside the workplace.
Missouri: Legal protection for employees who use lawful products outside the workplace.
Montana: Legal protection for employees who use lawful products outside the workplace.
Nebraska: No relevant legislation.
Nevada: Legal protection for employees who use lawful products outside the workplace.
New Hampshire: Legal protection for those who use tobacco products outside the workplace.
New Jersey: Legal protection for those who smoke or use tobacco products outside the workplace.
New Mexico: Legal protection for those who use tobacco outside the workplace.
New York: Legal protection for employees who engage in lawful activities outside the workplace.
North Carolina: Legal protection for employees who use lawful products outside the workplace.
North Dakota: Legal protection for employees who engage in lawful activities outside the workplace.
Ohio: No relevant legislation.
Oklahoma: Legal protection for those who smoke or use tobacco products outside the workplace.
Oregon: Legal protection for those who use lawful tobacco products outside the workplace.
Pennsylvania: No relevant legislation.
Rhode Island: Legal protection for those who smoke or use tobacco products outside the workplace.
South Carolina: Legal protection for those who use tobacco products outside the workplace.
South Dakota: Legal protection for those who use tobacco products outside the workplace.
Tennessee: Legal protection for employees who use lawful products outside the workplace.
Texas: No relevant legislation.
Utah: No relevant legislation.
Vermont: No relevant legislation.
Virginia: Legal protection for those who smoke or use tobacco products outside the workplace.
Washington: No relevant legislation.
West Virginia: Legal protection for those who use tobacco products outside the workplace.
Wisconsin: Legal protection for employees who use lawful products outside the workplace.
Wyoming: Legal protection for those who use tobacco products outside the workplace.

Source: "Discrimination Laws Regarding Off-Duty Conduct," National Conference of State Legislatures, Oct. 18, 2010 (link)

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story