People Ban: Canada Hospitals
Capital Health’s smoke-free policy expands to homes
Sep 02, 2014
New policy, effective Oct. 20, covers cigarettes and e-cigarettes
Capital Health says many patients who smoke already avoid lighting up when their caregiver visits.
Capital Health is expanding its no-smoking policy to patients’ homes this fall after home-care workers complained about secondhand smoke.
Patients are already banned from smoking inside or near Halifax hospitals, but as of Oct. 20 health-care workers who make home visitswill have the same protection.
Kevin Robson has had in-home care for several years. A worker comes to change the bandages on his diabetic ulcers three times a week.
He smokes, but he says never when the caregiver is there.
“They have always asked me, ‘Do you smoke’? and I say, ‘Yes.’ ‘Do you mind not smoking while they’re there?’ and I say, ‘Absolutely don’t mind that a bit.’ I think that’s proper because they’re health-care workers,” he said.
Capital Health says the change was requested by employees who had health concerns about secondhand smoke. The policy covers cigarettes and e-cigarettes.
“Staff who are providing in-home services are in contact with patients and clients or their families before the visit and as part of that assessment they ask if there is any smoking or vapour use in the home and if so, ask that the patient, client, and any others present don’t smoke or use e-cigarettes while the staff member is providing care in the home,” said Sharon MacIntosh, the health authority’s health promotion co-ordinator.
MacIntosh says many patients who smoke already avoid lighting up when their caregiver visits. She doesn’t anticipate any issues.
Robson says he’s fine with the impending changes.
“They’re there to help me so I don’t mind putting the cigarettes down for a half hour or even an hour. No trouble at all. I think that’s only common courtesy, really,” he said.
Capital Health employees make home visits for a wide range of services, including light housekeeping and physiotherapy
Victorian Order of Nurses who visit homes have had a smoke-free policy since at least 2005.
Removing psychiatric patients’ cigarettes deepens their trauma: DiManno
The Centre for Addiction and Mental Health’s cigarette ban fails to realize how smokes can soothe a troubled patient.
By: Rosie DiManno Columnist
Apr 18 2014
First they said no smoking — and that was the law of the land.
Then they said tobacco products could not be kept in one’s room or on one’s person — and that was the law of CAMH, the Centre for Addiction and Mental Health.
Finally they said these items would no longer be stored in patient storage lockers, under lock and key — lock and key, like morphine or psychotropic drugs — and that is a proscription entirely too far.
Some people, some institutions, are simply addicted to power. That is the irony of CAMH, which can wrap itself in a shroud of virtue. It exists to break individuals of their will, which is the pathology of addiction. They would never admit to their own pathology because they invented the language, they make all the rules, they can act as coercively as they please against some of the most vulnerable people among us and call it a matter of health.
As of April 30, keeping cigarettes — a legal product — in a patient storage locker will be forbidden. Any resident patient with off-site privileges who might wish to step outdoors for a puff — beyond the property, on the sidewalk, or across the street because smoking is not permitted on the grounds — would therefore have to buy a pack from a nearby convenience story each time the nicotine itch hits, then throw it away before re-entering.
CAMH includes smoke cessation programs on its mental health menu. But most people who end up at any of its three primary Toronto locations are not there because of a nicotine addiction. Their mental health issues are far more complex, often paralyzing. They are in crisis, fearful, fraying. A cigarette is indeed a crutch but it does soothe and calm. It is also, frankly, a pleasure and many of these patients have precious little in their lives to comfort the churning mind, the twitching hands, the racing heart.
From the very onset of provincial and municipal antismoking legislation, the one-size-fits-all ban was jackboot oppressive. It made no exception for exceptional circumstances — psychiatric facilities most particularly.
It is institutional bullying against frail, emotionally and psychologically brittle souls.
CAMH has taken this crusade to appalling lengths. A cigarette, any nicotine product, is no less contraband than a switchblade knife, a crack pipe or a bottle of hooch. A memorandum circulated by Kim Bellissimo, human resources vice-president, stipulates that a “Tobacco Free CAMH” includes “removing the inpatient tobacco storage lockers at all CAMH Sites.”
Tobacco becomes a “prohibited” item. Compliance — a chilling word much beloved by autocrats — is mandatory. Unable to store their tobacco in lockers, doubtless some patients will seek other means to keep their smokes close by, making (rightfully) paranoid lawbreakers out of impotent men and women, victimizing people who are largely incapable of advocating for themselves.
They’re so easy to browbeat, the mentally fragile, to metaphorically lobotomize via needlessly and heedlessly harsh regimens. Offenders who don’t fly straight will face consequences, to the point — if it comes to that — of exile. That’s not therapy; it’s brute force.
“We’ve been trying to address this for 10 years,” argues Dr. Peter Selby, chief of the addictions division at CAMH.
Selby asserts that tobacco manufacturers “specifically target the mentally ill in their advertising” — smoking for the stupid is how the campaign has been characterized in industry literature, he says. In fact, tobacco companies can’t advertise their products at all, nor even sponsor sports and entertainment events in most countries. Those Mad Men days are over.
Selby tries a different tact: “Our patients die 25 years before the rest of the population. It’s tobacco that accounts for the lion’s share of those deaths. We, as mental health professionals, said: ‘Wait a minute. We’re helping our patients get better mentally but they’re dying right in front of our eyes.’ ”
Well, we’re all dying, right in front of each other’s eyes. But in the moment — for today, this week, these months, perhaps many years ahead — it’s the coping with life, as best we can under circumstances so fraught with pain and despair that we’ve landed in a mental hospital, which is the immediate trauma. A psychiatric institution should not be in the business of further traumatizing those who are already suffering, and certainly not by all but criminalizing an off-premises smoke break.
Selby sounds genuinely upset when he describes patients “picking up cigarette butts from the sidewalk” out front. What’s more stunning is that an expert in addiction could look at that scene and see only the addiction, not the need, not the gentling of other compulsions, not the blessed momentary relief.
By his own admission, most CAMH patients are not there because they want to quit smoking. They’ve fallen apart, lacerated by the struggle of existence. They’re sad and shattered and angry and overwhelmed. Some are drug addicts, some are alcoholics. All need help and compassion, therapeutic intervention, a temporary refuge from the inner storm.
They’re not smoking in their rooms. Their smoke lounges were removed in 2003. It’s the institution employees who don’t like walking through “a wall of smoke” to get into the building and complained about it to the Ministry of Labour. From smoke-free to empty your pockets to empty your lockers.
It’s the maniacs — and their bureaucratic enablers — who’ve taken over the asylum.
SEE ALSO HER 2010 COLUMN WHICH INCLUDES THE FOLLOWING:
Smoking has kept me sane.
Whatever damage has accrued to my lungs is the price I’m willing to pay for the calming balm of nicotine.
Cigarettes alleviate anxiety, quell angst and, frankly, propel me from top to bottom of every column I write.
They are my friends, my comfort, my crutch — which doesn’t make me crazy. But plenty of “crazed’’ people are smokers, by which I mean individuals in mental and emotional crisis, shattered by depression and anxiety, some with bred-in-the-brain illnesses and addictions. It is mean to deny them the soothing panacea of nicotine — often the only activity that will still trembling fingers or help focus jittery thoughts — especially when simultaneously dispensing Big Pharmacy nostrums that can be just as addictive and harmful.
Smoking bans backfiring at some hospitals: Study
Oct. 31st, 2011
By Sharon Kirkey
Policies banning smoking on hospital property are leading to unintended safety consequences for patients, new Canadian research shows.
To wit: IV lines and electronic pumps malfunctioning in extreme cold; patients in wheelchairs accidentally being locked out of entrances during a winter night; immobilized patients smoking in their beds when they can’t get help leaving the ward; nurses not knowing where their patients are when they leave the unit for a smoke.
“We report the lived experiences of the people directly affected by these policies,” researchers from the University of Manitoba, University of Alberta and the Winnipeg Regional Health Authority said in a study published in this week’s issue of the Canadian Medical Association Journal.
At the two hospitals studied — the University of Alberta Hospital in Edmonton and Winnipeg’s Health Sciences Centre — the team found “ample” evidence that patients as well as staff continue to smoke on hospital property despite polices banning smoking inside all buildings, entrances and on all hospital grounds.
People were seen smoking directly under signs forbidding smoking. Smokers were usually spotted near entrances or in places allowing them to hide while they smoked, researchers wrote.
“Staff who had reportedly been seen smoking on hospital property included security guards, ambulance drivers, nurses and doctors.”
Enforcement efforts, they said, were reportedly minimal.
Cleaners described picking up five to 10 pounds of discarded cigarette butts some days.
The researchers stressed that hospital smoke-free policies make sense. Tobacco is the leading cause of disease and premature death. What’s more, patients who smoke have more post-operative complications and a worsening of their health conditions while in hospital than non-smokers, they say.
But smoking needs to be framed as an addiction and not a habit, said lead author Annette Schultz, an assistant professor at the University of Manitoba’s faculty of nursing.
Smokers — already feeling vulnerable and stressed because of being in hospital — need to be offered help coping with withdrawal, such as nicotine patches and gum. However nicotine-replacement therapy wasn’t consistently offered, the researchers said, and even those smokers who requested it had difficulty obtaining it.
“Although some patients abstained from smoking while in hospital, many received minimal or no support in doing so,” the team wrote in the Canadian Medical Association Journal.
And they faced “a variety of safety concerns as a result.”
In interviews, patients said they felt unsafe going outside alone to smoke. A few worried “about getting suddenly sick while smoking outside.” Some risked frostbite. Security guards described patients “pushing this IV pole all the day down the sidewalk in the snow” after being told not to smoke on hospital grounds.
Comments from health-care workers included, “I have zero understanding on the drive to make a person get out of there, have that cigarette when they’re obviously having pain.”
Other expressed compassion for smokers. “We need to address these people, because it is a stressful time to give up your bad habit.”
In an accompanying commentary, Dr. Sharon Lawn, of Flinders University, South Australia, said the study illustrates “how the notion of responsibility can become distorted when smoking is viewed as a morally interpreted behaviour — a lifestyle choice — rather than an addiction that requires clinical support.”
She said it was “immediately striking” how little staff felt “that enforcing the smoke-free policy was their responsibility.”
Just having signs is no longer sufficient: OUR OPINION
Does it really have to come to this, that Barrie’s Royal Victoria Hospital needs smoke police?
Evidently it does.
A couple who had just had a baby at RVH, Mark and Olivia Saunders, have complained about facing a cloud of smoke as they entered and left the Georgian Drive hospital.
They don’t want to be exposed to cigarette smoke, nor have their little girl breathe tobacco fumes — a perfectly reasonable expectation.
And the law is on their side.
The Smoke-Free Ontario Act prohibits smokers from lighting up with nine metres, or almost 30 feet, from any hospital entrance. There’s an initial fine of $305 for those who flaunt the law.
And since 2006, RVH and its property became smoke-free with the Exceptional Air campaign. Smokers need to leave the property to light up.
This isn’t happening. The Saunders have gone on record to complain, but there are undoubtedly many others who feel the same way.
RVH security director Carol Holden said smokers are obviously breaking the rules, and the law, on hospital property.
Holden said the original enforcement plan was to have all RVH employees responsible, but that didn’t work. Smokers were verbally abusive and hospital staff didn’t want to take it.
And who can blame them? It’s not a nurse’s job to tell a smoker to butt out. There are signs telling people not to smoke, but they are ignored.
The hospital has security officers and they enforce the ban while on routine patrol, but they can’t be everywhere at once.
Canada is not a police state. There aren’t police officers or soldiers on every corner to ensure the letter of the law is followed.
Laws are made by governments elected by the people, these laws are publicized and they are expected to be followed. That’s the way our society works and most of the time it works pretty well.
But it’s not perfect.
Our highways and streets have speed limit signs, for example, but drivers still speed. When they speed excessively the police often catch them doing it, then arrest or fine them as a deterrent to doing it again.
It’s the same for those who rob or steal or assault or harass others; that’s why we have police departments.
Granted, smoking in no-smoking zones is not the same type of infraction — although those who have suffered the effects of second-hand smoke might disagree.
The responsibility for enforcing the smoking ban clearly lies with RVH officials. The hospital has to look after its own property and enforce the laws there.
It’s not good enough to just put up signs and keep badgering people — be they patients, visitors or even some hospital staff. RVH security has to start fining smokers on the property, hit them in their pocket books.
This isn’t a difficult tactic to rationalize.
Hospitals are health-care facilities. Smoking is bad for people’s health. Just ask any doctor or nurse.
Nobody likes a heavy-handed approach, but sometimes it’s the only method which works. Maybe if enough smokers get fined for doing it at RVH, the message will sink in.
RVH is newly expanded and has added a regional cancer care centre. It’s this area’s most comprehensive health-care facility, designed to serve people in this entire area.
But it looks really bad when RVH officials can’t even keep people from smoking on the premises.
Alberta Hospital patient’s body found a week after she went missing
Fatality inquiry hears she left building in a blizzard to have a cigarette
June 22nd, 2011
By Alexandra Zabjek
EDMONTON – It remains unclear when security staff at Alberta Hospital started a concentrated ground search for a 68-year-old psychiatric patient who went missing from the facility during a 2008 snow storm and was found dead one week later.
“I got the impression they’d done an exterior search of the compound,” Busby said.
The weather conditions that December night were cold and snowy, “a complete blizzard,” Busby said. After talking to hospital staff, police decided to concentrate their search beyond the grounds and checked local businesses in the area.
Her body was frozen solid.
“When everything’s said and done, we just hope this situation doesn’t happen to someone else’s mother or father when they’re put in a place like….a hospital that they need to be at,” Michelle Adolph said outside court.
Hospital to ban smoking on all property
Even parking lot will be off-limits to smokers at Markham Stouffville Hospital come May 31
May 02, 2011
L.H. Tiffany Hsieh
You have one more month to kick the habit or take a walk the next time you feel an urge to light a cigarette while you are at Markham Stouffville Hospital.
A total smoking ban for both hospital campuses in Markham and Uxbridge is effective May 31 and anyone wishing to smoke must leave the hospital property, including the parking lots.
The ban applies to all patients, visitors, staff, volunteers and physicians.
While the quest to become a 100-per-cent smoke-free property won’t be implemented in phases, hospital administrators say the plan has been in the works for a year and all parties have been informed of the new rule through “extensive” communications and consultations over the last several months.
“People are pleased,” said Julia Scott, the hospital’s vice-president of clinical programs and chief nursing executive.
Ms Scott said the ban is a result of the hospital’s commitment to providing a smoke-free environment for visitors, patients and staff as well as to the health and well-being of the surrounding communities.
She said people are aware of health risks associated with second-hand smoke and patients are being informed of the ban prior to their appointments.
Currently, you can smoke nine metres away from the hospital’s entrance outdoors and in the two designated smoking “huts” at the Markham site.
Designated smoking areas will be eliminated with the ban and people caught smoking on hospital grounds after May 31 will be asked to butt out without penalty, Ms Scott said.
However, those smoking within nine metres of the entrance, as prohibited by the province’s Smoke-Free Act, could be fined by Public Health, Ms Scott said.
In 2002, Calgary Health Region became the first health organization in Canada to ban smoking. Since then, other hospitals, including York Central Hospital in 2008 and the Southlake Regional Health Centre in 2009, have followed suit.
But at least one hospital has decided not to pursue a smoking ban. Last November, the Dryden Regional Health Centre in northwestern Ontario rejected its medical advisory committee’s recommendations to go smoke-free, citing respect for patient rights and concern about enforcement.
However, that argument isn’t enough to persuade some antismokers.
“Smoking is not a right, it’s a privilege,” said Pippa Beck, a policy analyst with the Non-Smokers’ Rights Association, a national tobacco control organization in Canada.
Ms Beck called cigarette “a lethal consumer product” and the movement to ban it inside and out of hospitals a trend.
She said there are good reasons, including financial savings, to implement a smoke ban in hospitals, where “vulnerable people are coming and going”.
She said lots of hospitals want to make a statement in the community that they are socially responsible by moving away from designated smoking areas.
“We know smoking affects every single cell in your body,” Ms Beck said. “A smoke-free environment helps smokers gain control over addiction. Most smokers want to quit, even the most hardcore smokers.”
Michael J. McFadden disagrees.
A 45-year smoker by choice and the author of Dissecting Antismokers’ Brains, Mr. McFadden is a member of the Smokers Club and Citizens Freedom Alliance, a non-profit group not funded by the tobacco industry.
He questioned whether or not hospitals have the right to “dictate” patient behaviour that’s “not deeply, immediately and fundamentally affecting their treatment at the hospital”.
“Smoking used to be enjoyable, but now we have to stand in the rain to smoke,” he said. “We are not rats. We don’t need to be conditioned.”
Dryden hospital won’t go smoke-free: board
Revelations and Re-evaluations
October 7, 2010
After all these years of being told that the purpose of banning smoking was to “protect the workers” and “protect the children” from “deadly Toxic Tobacco Smoke,”? Wednesday’s letter from Anne Marie Cyr now gives an open admission that the real “purpose of making outdoor spaces smoke-free is to de-normalize tobacco product use.” While her competing interest was not noted, Ms. Cyr’s history as Tobacco Program Manager with the HKPR District Health Unit lends sufficient weight to those words that we should be led to an obvious question:? If they lied to us for all these years about the real goals of their smoking bans, why should we have any faith at all in what they’ve told us while leading us down that garden path??
Antismoking advocates are eternally fond of waving their hands vaguely in the air while proclaiming that “mountains of studies show the deadly threat of secondhand smoke” but those mountains disappear when they are asked to name specific research.? Usually all they can come up with aside from generalized reports, fact sheets, and statements of opinion from other advocates are products of wild statistical epidemiological models or projects involving intensive exposures to smoke concentrations that would virtually never be encountered in the real world.
And yet it was on the basis of such supposed research that the initial smoking bans were justified and instituted with protestations from their supporters that their only concerns were protecting the health of innocents, buttressed by claims that they had no thoughts of social engineering, behavior modification of populations, or the shadow of Big Brother to “adjust” us to membership in the perfect race.
People need to read beyond the paid sound bites that pervade the media and actually look at the lack of substance behind? the justifications for most smoking bans and at the harm those bans have caused.? The base motivations, long heralded by Free-Choice activists in Canada, the US, and Europe, are now finally being openly admitted.
That revelation should lead to re-evaluation:? Universal public government-imposed smoking bans are bad laws based upon lies and need to be overturned or at least strongly amended.
Michael J. McFadden
Author of “Dissecting Antismokers’ Brains”
Reduced visibility of people smoking means fewer will smoke?
Oct 6, 2010
To the editor,
I am writing in support of the HHHS board and their intent to pursue smoke-free grounds. The purpose of making outdoor spaces smoke-free is to de-normalize tobacco product use. Research has shown us that if we reduce the visibility of smoking behaviour, children and young adults are less likely to smoke and will view the behaviour as “not normal.” The evidence is so strong that no one is allowed to smoke on any school ground in Ontario. Recent surveys of children in our our school board (and schools across Ontario) indicate that they over-estimate the normality of smoking and perceive that more people, including their peers, are smoking than is the case.
In addition to reducing exposure to toxic second-hand smoke, the Smoke-Free Ontario Act (2006) has reduced visibility of smoking in public places and it is no longer the norm to see smoking indoors. Compliance with the Smoke-Free Ontario Act is well over 90 per cent and indicates that the majority respect and support the legislation. The local health unit monitors public opinion for smoke-free outdoor spaces. Over 80 per cent of residents surveyed supported bylaws to restrict smoking in public parks, playgrounds, sports fields and beaches. I think this indicates that the majority of us want smoke-free public spaces.
In conjunction with other public heath measures, such as increased cost (taxation), restricting sales of tobacco to minors, education in schools and in the community and limiting tobacco company marketing we have reduced youth smoking rates to an all-time low of approximately 11 per cent. I am sure everyone in Haliburton County wants to do anything within their means to prevent any child from becoming addicted to tobacco products. We are making a difference, so let’s go the final lap and reduce that number even more.
Mr. Ingram expressed concern for patients and residents who smoke. So what can be done for patients who are hospitalized and and are addicted to the nicotine in tobacco? Physicians can prescribe nicotine replacement therapy and other medication to patients and to residents of long-term care facilities to help ease them off their dependence. Combined with counselling, research has proven that this approach can greatly assist with nicotine addiction.
Midland/Penetenguishene Mental Health Facility decided to make their grounds smoke-free because it reduced operating costs. They estimated it would cost them $500,000 a year to escort patients outside to smoke, fiscally this was not responsible and so the decision was made that residents (and staff) would not smoke anywhere on the facility. The majority of hospitals in the CE LHIN either have or are in the process of developing policy for smoke-free grounds. Indeed hospitals across Ontario and Canda are making the ethical decision to make their grounds smoke-free.
In supporting our hospital board, we need to ask ourselves the following questions. Can a healthcare facility ethically favour a harmful activity? Can individual healthcare providers, all of whom belong to professional colleges that instruct their members to do their patients no harm, ethically facilitate smoking? Given the health and safety, operational and ethical issues surrounding smoking, I believe the HHHS baord needs to make the only responsible decision and ban smoking on hospital grounds. So let’s support them and work together to de-normalize tobacco use, help put supports in place for smokers who want to quit and support the HHHS board with implementing smoke-free hospital grounds.
Anne-Marie Cyr Minden
By MICHELLE THOMPSON, Edmonton Sun
12th January 2010
Kicking a bad habit at the Glenrose is about to get easier.
At the end of this month, the 10230 111 Ave. hospital will become the first rehabilitation centre in Canada to launch an anti-smoking program for patients.
“We as health care providers need to do everything in our power to help them with their nicotine addiction,” said Dr. Hubert Kammerer, who leads the hospital’s geriatrics ward.
“It’s a complex problem. It’s not easy to smoke now,” he said. “The people who smoke now are hard-core addicts and they need a comprehensive program to help with their addiction.”
While announcing the news Tuesday, Kammerer said the program will be modelled after a similar one at the University of Ottawa Heart Institute.
That hospital’s program has been in place for 10 years and has seen a success rate of 50% among patients who stuck with the plan for 12 months.
About 50 hospitals throughout Ontario offer similar programs — as does one in Calgary — but until now, it has not been offered in a Canadian rehabilitation centre.
“It’s slowly coming west,” said Kammerer. “I think it’s going to be much more widespread.”
The program at Glenrose is targeted toward two groups of patients — one that wants to quit, and another that isn’t ready and needs help coping with withdrawals while in hospital.
After being admitted into the Glenrose, smokers will be approached by one of two nurses tasked with helping them kick their deadly habit.
If patients are willing to quit, they’ll be offered counselling and medicines designed to help minimize cravings.
The average patient stays at Glenrose for about a month.