Hiring at ProMedica to exclude smokers

Two years after ProMedica Health System was among those to ban smoking everywhere on their hospital grounds, officials have taken the next step: not hiring anyone who uses tobacco products.

Many persons are smoking brands liek Kiss cigarettes or Winston cigarettes.

ProMedica, along with St. Rita's Medical Center in Lima, Ohio, this month became the latest local employers in the health-care industry to shun those who smoke and use other tobacco. Such policies not only set an example for the community, but they also are expected to eventually help lower insurance costs as the overall work force becomes healthier, officials said.

"We are a health-care organization — we should be promoting health," said registered nurse Laura Ritzler, director of corporate and employee wellness at ProMedica. "We should have people role-modeling healthy behavior."

Medical Mutual of Ohio, which has about 500 employees in Toledo, adopted a similar policy three years ago. The Cleveland insurance company since has been joined by Cleveland Clinic and others in the health-care industry statewide.

Firms in other fields also have refused to hire smokers, including Scott's Miracle-Gro Co. of Marysville, one employer studied by ProMedica as its policy was formulated. ProMedica and Medical Mutual, meanwhile, are among those providing free smoking-cessation assistance for existing employees, which has helped reduce the ranks of tobacco users.

A matter of concern
At ProMedica, job applicants are asked about their tobacco use, and if their screening is positive after denying use, they will not be hired. Those who declare tobacco use or do not pass the screening can reapply for a position after 90 days.

It can take varying amounts of time for nicotine to leave the body based on frequency and length of use.

The American Civil Liberties Union of Ohio dislikes policies monitoring what employees do off the clock, said spokesman Mike Brickner. Because Ohio is an "at-will" state, meaning employees can be fired for any reason without proving just cause, that dislike has no effect when it comes to not hiring smokers, he said.

"It's definitely something we have seen an increase in around the state and nationally," Mr. Brickner said. "There's not a lot legally [here] that can be done."

Michigan also is an "at will" employment state. It also has employers that have adopted policies against hiring tobacco users, and improving wellness and financial issues certainly have played a part.

The cost of tobacco use
Tobacco use nationwide costs an estimated $193 billion annually, including $97 billion from loss of productivity because of premature death and $96 billion in smoking-related health-care costs, according to the latest statistics from the Centers for Disease Control and Prevention.

Within nine months of quitting, people experience less coughing, sinus congestion, and other problems. And five to 15 years after quitting, the stroke risk for former smokers is equal to nonsmokers; at 15 years, their risk of coronary heart disease also is the same, according to information from the American Cancer Society.

The possibility of being able to lower health-care costs and increase productivity is among benefits that have drawn interest in Medical Mutual's policy from employers in various fields, said Sarah Susalla, Medical Mutual's manager of health promotion and wellness.

"It's a fairly common question," said Ms. Susalla, a registered nurse. "We can certainly provide some direction."

Area hospitals
St. Rita's is one of Catholic Health Partners' first hospitals to adopt a policy against not hiring tobacco users. The hospital and Lima Memorial Health System, which is part of ProMedica, started enforcing the policy Jan. 1.

Mercy, a fellow Catholic Health Partners entity with several hospitals in northwest Ohio, does not have a similar policy. Neither does the University of Toledo Medical Center, formerly the Medical College of Ohio.

St. Rita's policy was questioned upon its announcement last month, but the furor has died down, said Jennifer Van Tilburgh, the hospital's human resources director.

"It really is legal, and it really is in our rights to do it," she said.

Mixed reaction
ProMedica's policy has drawn mixed reaction.

For Toledo Hospital's Cheryl Gomez, a patient safety specialist, the policy was a wake-up call to stop smoking after about three decades.

"There's no denying the evidence — the medical evidence — that smoking is not a healthy habit," Ms. Gomez said. "All of a sudden it just kind of hit me, ‘It's time.' "

Ms. Gomez stopped smoking Dec. 21, less than a month after ProMedica's policy was announced.

She is using nicotine replacement products, and she started getting smoking-cessation counseling last week from a certified tobacco treatment specialist.

"It's hard to say to your patients ‘You have to stop smoking' when you haven't done it yourself," said Ms. Gomez, adding that her clothes and hair formerly smelled of smoke. "No matter how quiet you are about it, people know when you smoke."

So-called third-hand smoke, toxic residue that remains on clothing and other items, was another concern for ProMedica, said Ms. Ritzler, the wellness director. It can be especially harmful to children, she said.

Among others who have weighed in on the debate is John Kirkbride, a retired Washington Local Schools educator and administrator. He said that instead of not hiring smokers, officials should hire them under the condition that they quit, he said.

"I don't care whether my doctor smokes or not — I would prefer they hire the best doctor," Mr. Kirkbride said. "I want the best doctor, or nurse, or health professional that I can have."

Ms. Ritzler said maintaining such a policy would be complicated, and ProMedica used existing policies as models.

ProMedica's position is clear cut, and Southwestern College in Toledo, which offers training for medical-related careers, has posted the policy and encouraged students to refrain from smoking, she said.

What's next?
The next step will not be refusing to hire people because they are obese, a charge made by some opponents, although weight-loss efforts will continue for willing employees needing help, Ms. Ritzler and others said.

Going tobacco-free on hospital campuses and elsewhere two years ago was harder to accomplish than not hiring smokers, Ms. Ritzler said. Employees were given six months to prepare for the tobacco-free change, and some cut down smoking dramatically even if they haven't totally quit, she said.

"We've always had a mission to improve the health of our own employees and the community as well," Ms. Ritzler said.