The VA’s New Smoking Ban Is Sparking Complaints From Some Veterans And Employees

Speaker 1: 00:00 The department of veterans affairs has banned smoking at its medical facilities, eliminating designated smoking areas at hospitals and clinics. The change went into effect for patients and visitors in October and as of January 1st it also includes employees. The VA is one of the last medical providers to ban tobacco and it's been a difficult transition for some veterans from Tampa. Stephanie Colombini reports for the American Homefront project, Speaker 2: 00:30 70 year old air force veteran. Ronald West sits in his wheelchair just outside the fence that encloses the Tampa VA grounds. It's a cold day for Florida, so he's wearing a sweatshirt, a winter hat and is wrapped in a blanket. He lights up a Newport cigarette his second since wheeling himself out of his hospital room for a smoke. It was West third week there for a spinal cord injury and he says he comes out here a few times a day since he's no longer allowed to smoke on the property. Speaker 3: 00:59 You're actually sucks. You had designated smoking areas and that's what the veterans are just inherent to. But now no smoking on the campus. Come on. [inaudible] Speaker 2: 01:11 West isn't alone on this sidewalk. The hospital fence is lined with smokers, most sporting employee badges and wearing scrubs plus a few more patients. Army veteran, Tom Rogers comes to the VA for his lung disease and other medical needs. He was angry to find out about the Smokefree policy. Speaker 3: 01:28 The British got lives in Vietnam over 50 years ago and they tell him that he cannot be shaker [inaudible] Speaker 2: 01:35 patients aren't the only ones griping. When the VA announced the ban would also apply to staff, the American Federation of government employees filed a grievance saying it violates a union contract that allows workers to smoke in designated areas. The issue was not everyone was sticking to those areas. According to dr Don Johnson, she promotes smoking cessation at the Tampa VA. we had a lot of problems where patients would be walking in to their medical appointments and would have to walk through people smoking, replacing smoking areas or signs throughout the campus, informing people about the change. There are still smokers who miss the message, but when hospital police or staff like Johnson spot them, they asked them to put out their cigarette and offer quick cards. That list ways to get help. Eventually VA hospitals will enforce the policy with citations and fines, but many like Tampa's are taking time to educate first. Speaker 2: 02:31 Some of our patients only come here once a year and if they didn't hear about it, we can hold them responsible for it. Smoking is already banned at thousands of other healthcare facilities. Research shows that improves public health and doesn't affect employer retention. Three other VA unions agreed to the change. Still smoking has long been connected with military culture. The centers for disease control and prevention says more than a third of veterans started using tobacco after they the service, although less than 15% who use the VA smoke. Now veteran Colleen Danielson was already smoking before she joined the Marines in the 80s but says it was a huge part of her life. I used it, I thought as stress management, you know, in the Marines we we, we got a few extra breaks for, you know, when we smoked outside a little bit more. Danielson quit cold Turkey years ago. Now she's a VA peer support specialist who helps other vets quit. The VA also offers counseling, a helpline and nicotine replacement products like patches and gum. Speaker 3: 03:37 [inaudible]. Speaker 2: 03:37 The two veterans smoking on the sidewalk say they have no interest in quitting. Still both say the policy isn't going to stop them from going to the VA. Ronald West, Speaker 3: 03:47 there's state rules and taking care of man. So you know, I'm following Speaker 2: 03:53 health workers in Tampa. Say they're not asking every vet to quit smoking. Just do it on the other side of the fence. Joining me is reporter Stephanie Colombini with the American Homefront project in Tampa. And Stephanie, welcome to the program. Thank you. The VA San Diego health care system here also went to a smoke free campus back in October of last year. Can you explain a bit more why the designated smoking areas weren't working for the VA? Well, from what I heard from providers in Tampa, it was that they weren't really staying designated. It's kind of hard to enforce that out, especially on these big hospital campuses. So kind of wherever there might've been a picnic bench shore, um, you know, any place to congregate outdoors, people were smoking. And so, you know, while they tried to create these designated smoking areas in certain corners of the campus, it was, you know, kind of a free for all. Speaker 2: 04:50 Even when I went to the Tampa campus after the ban had been implemented, you know, I saw some people around the parking lots and you know, walking around smoking and that's kind of part of what providers were saying. They're still in the education process and when, you know, they catch someone doing that, they inform them about the change, but it just shows that kind of people outdoors will smoke wherever they want. And so it was hard to enforce that designated area. It seems that change was met with the, some anger at the hospital you profile from both patients and staff. Yeah, and I noticed that kind of nationwide, I saw that in other cities and new England. Um, so different reports where, you know, vets were upset and a lot of it has to do with, you know, and what I heard from patients was I smoked in the military. Speaker 2: 05:36 You know, I'm, one guy told me that we heard in the story, we were in Vietnam risking our lives and now you're telling me I can't have a cigarette. And so, you know, there was a lot of frustration, um, with staff. I kinda got some off the record bickering, but I think it was a little bit easier for, you know, employees to take their typical break and just take a walk outside the fence line and go smoke. I think with veterans it's a little more personal. Um, and there is that one union that is challenging. Um, this ban not really successfully so far, but there are three other unions that did go along with this policy. So it's kind of a mixed bag with um, employees studies that show. Um, I've seen studies that look at how, um, hospitals that have put in smoke-free campus policies, how that's gone. Speaker 2: 06:24 Um, usually it does have majority support with patients and staff. So you know, you would expect the smokers would be the ones that are quick to gripe, but the people that don't smoke are happy about it. How far away from the hospital campus do the smokers have to go to light up? Really depends where you are located. It's a huge campus. So a lot of buildings. So if you're in one of those buildings right near, um, cause there's really one side of the perimeter that is easy to sort of access the street and you're standing on the sidewalk and it's normal everywhere else. You're either bordering, you know, an apartment complex or shopping's you know, it's not easy to just get out the fence. So if you were on that one side of the perimeter, maybe it's like a five minute walk. But if you're talking about being on the other corner of campus, that's quite a hike. Speaker 2: 07:13 Right. And it must be difficult for nurses and doctors to watch a 70 year old patient in a wheelchair go out in the cold to smoke cigarettes. Is there any kind of intervention they might use to stop those cravings in the hospital? There is um, I talked to, uh, dr Don Johnson who leads the smoking cessation programs at the Tampa VA said for years the VA has offered nicotine replacement to patients that, you know, they're inpatient, they can't get out of their bed. They're probably going to be starting to go through nicotine withdrawals. There are laws and judges, there's patches, other forms of nicotine replacement to help curb those cravings within the hospital as well as counseling and whatever patients may need. But at the same time, you know, patients do have the right, if a 70 year old patient is able to get around on his own and is saying, look, I have no interest in quitting. Speaker 2: 08:08 I don't want your nicotine replacement, then you know, they can't stop him from going out for a quick smoke. Do we have any idea how successful the VA programs have been in getting veterans to stop smoking? I saw some figures from 2016 that said about 25% of veterans went through, um, who have gone through the VA programs did quit successfully. It wasn't clear. You know, which method they use, whether it was a mix of nicotine replacement and counseling or one designated program. But I have seen about, um, that was the one figure I did see was uh, 25% providers I spoke with said, you know, it is a solid mix and it, the amount of VA users, um, veterans who use the VA who 14% is much lower than the 30% figures we hear from the CDC of how many veterans in general smoke. So, you know, they like to think that that is due to some of the resources that they offer. And I'm sure it is to a certain extent, but it's hard to say which veterans aren't just quitting cold Turkey or aren't seeking the VA to help with that process. Speaker 1: 09:19 You referenced a veterans saying, uh, I went into the military, I learned how to smoke there. I risked my life. I'm, I'm entitled to smoke. Is smoking as connected with military culture now as it used to be? Speaker 2: 09:33 I would say no. And because, and smoking in general, I think with, you know, civilian culture has not been what it used to be. But, um, the latest figures I've seen from the DOD was I believe 2011 was less than a quarter of active duty military, uh, smoke. I would imagine during the days of world war II, Vietnam that figure was much higher. Um, one thing I that came up in my research that was interesting and I think has a lot to do with maybe this increasing disconnect between smoking in the military and, and kind of the department of defense taking an active role in this up until 2016 was when the defense secretary issued a memo saying that cigarettes sold on military basis had to be, you know, competitive with the community, whatever the price was in that, you know, city or town is what the cigarettes needed to be. Speaker 2: 10:26 So for prior to that, you could get cigarettes on a military base for next to nothing, you know, almost half of what it would cost, market rate. And so that was a big contributor. Even veterans who had access to the base could go there to get cheap cigarettes. And so, you know, um, the centers for disease control says that the cost of smoking is one of the biggest deterrent to, you know, if you want to get people to quit, raise the price, make it economically impossible for them to smoke, that's one of the most successful ways you can combat smoking addiction. And so by the department taking that step. Um, I've seen reports that the sales of cigarettes have dropped almost 50% in some branches of the military. Um, so I don't have the exact numbers for each branch, but we have seen a reduction in the amount of cigarette purchases, and I'm sure that's because the price is higher. Speaker 1: 11:16 Interesting. I've been talking with reporters, Stephanie Calambini, with the American Homefront project and Stephanie, thank you. Speaker 2: 11:24 Thank you.