Rethinking smoking bans at hospitals

Butting out at Alberta’s medical centres will take more than just signs

The hundreds of tar-stained cigarette butts scattered just outside Calgary’s Foothills Medical Centre is a sign the hospital’s smoking ban isn’t being enforced.

But, on the other side of the Rockies, Vancouver Coastal Health Authority is making a big push to ensure a similar ban in British Columbia has teeth.

In Alberta, such a ban has been in place since 2008 when the province introduced the Tobacco Reduction Act. The Act states that it is illegal to smoke within five metres of hospital doors, and under Alberta Health Services policy smoking is prohibited from all property.

However, the butts at Foothills Medical Centre aren’t the only indication that the ban isn’t working. A 2011 academic study published in the Canadian Medical Association Journal found that enforcement of the AHS no smoking policy appeared to be lacking at the University of Alberta hospital. In fact, according to AHS senior media relations advisor Bruce Conway, there is no significant history of ban violators being ticketed and fined under the province’s Tobacco Reduction Act.

“Well, they certainly don’t take a heavy handed approach,” he said. “It’s mostly a conversational approach as opposed to confrontational, and they ask peoples’ cooperation in respect for others.”The Tobacco Reduction Act, introduced in 2008, states it is illegal to smoke within five metres of hospital doors in Alberta.

Photo by Jeremy Thompson

The Vancouver Coastal Health Authority’s chief medical officer, Dr. Patricia Daly, did a survey in 2012 at Vancouver General Hospital which found around one third of smokers on the facility’s grounds were staff.

As a result, management now patrol the hospital to discipline staff who violate the no smoking policy.

Dr. Daly says every hospital in the region screens patients when they enter, asking if they are smokers.

Those who do are offered nicotine replacement therapies as part of a provincial initiative to reduce smoking.

The authority is also one of the first to pioneer the use of a new technology in Canada to warn smokers that they are not welcome.

“We’ve installed very sensitive smoke detectors in some of the outdoor areas.” Dr. Daly said.

“These are very unique, they give off a verbal message that says ‘you can’t smoke in this area, please move off hospital grounds’ repeatedly.”

She says the alarms, which have been installed at Vancouver General Hospital, are very effective and not expensive.

Other hospitals have asked if they can have access to these smoke detectors.

The consequences of not adopting such an approach can have big downsides.

Dr. Richard Stanwick, chief medical health officer for Vancouver Island Health Authority, is concerned about patients and visitors having to run a “gauntlet” of second-hand smoke when entering hospitals.

“If you were a person with even mild or moderate asthma,” he says, “that amount of smoke could actually trigger an event that would require hospitalization.”

Dr. Stanwick thinks the issue is whether or not hospitals are willing to enforce no smoking policies with the same rigor as they would other policies.

“A visitor standing in front of one of our hospital doors swigging from a bottle of vodka would probably not be deemed particularly acceptable,” he says. “And yet for some reason there is that tolerance of tobacco, even though it is the number one preventable cause of death in this country still.”

The approach Alberta Health is taking currently doesn’t include plans for stiff penalties for staff or incorporating technologies such as smoke detectors.

However, Conway did say nicotine replacement therapies are being provided to patients in Alberta.

jthompson@cjournal.ca