Wednesday, December 29, 2010

In New Year, Two Florida Hospitals Will Not Even Hire Certain Ex-Smokers

Two central Florida hospitals have a New Year's gift for smokers who successfully carry through on their New Year's resolutions to quit smoking and do so by using nicotine replacement therapy or electronic cigarettes: ineligibility for employment.

Starting January 1, not only will Florida Hospital Waterman in Tavares and Florida Hospital Fish Memorial in Orange City refuse to hire smokers, they will also refuse to hire ex-smokers who successfully quit using nicotine replacement products or electronic cigarettes and who are still using those smoking cessation products.

Thus, smokers who follow national guidelines and the advice of anti-smoking groups and use nicotine replacement products to quit smoking will not be eligible for employment, unless they discontinue the NRT and put themselves at risk of returning to smoking.

According to an article in the Orlando Sentinel, the director of employee health at the Cleveland Clinic described the rationale for these policies as follows: "The health-care organization should model health-care behavior. Therefore, health-care workers should not be smoking. When you're a provider of care, you have to be the best possible model you can be."

The Rest of the Story

If health care organizations should be modeling health care behavior, then why should they hire people who are overweight or obese? Shouldn't they also put prospective employees on a scale and throw out their applications if their body mass index is above healthy levels? After all, these organizations are supposed to be the best possible model they can be. Having overweight staff walking around is not exactly serving as the best possible model for the public.

In fact, the rationale for not hiring overweight people is much stronger than that for not hiring smokers. For the most part, the public is not going to know who the smokers are, because they are not smoking in the hospital. But it will be very clear to the public if an employee is overweight or obese. That will truly not serve as the best possible model for healthy behavior for the public.

Let's face it. Obesity is a severe public health problem whose costs rival those of smoking. The Centers for Disease Control and Prevention estimates that overweight and obesity are responsible for 9.1% of all medical costs in the nation. The CDC estimates that obesity costs the nation $147 billion per year.

Adding insult to injury, these Florida hospitals are actually penalizing the very behavior they purport to reward: smoking cessation. Smokers who successfully quit - and do so by using and maintaining themselves on NRT - are ineligible for employment. The only way for them to make themselves eligible is to discontinue the NRT, which would likely lead them to return to smoking. Thus, Orlando-area residents who make a New Year's resolution to quit smoking, use NRT as recommended, and succeed have are punished by these two hospitals, rather than rewarded. It seems to me that these hospitals should be welcoming ex-smokers, rather than turning them away (regardless of whether they quit using NRT or not).

The fact that these hospitals are making a statement against nicotine use, rather than against smoking, means that the policy is based on ideology or a sort of religion, rather than on health. This is an abstinence movement, not a health movement.

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