Topic: Defiance

By Jonathan On Jul 5, 2017

Patients ‘ignore’ Bristol Southmead Hospital smoking ban
May 26, 2015
Patients and visitors at a Bristol hospital are routinely ignoring a site-wide smoking ban, its chief executive has said.
Andrea Young said there was a “particular problem” around Southmead Hospital’s main entrance, despite staff challenging smokers.
About half put out their cigarettes when challenged, she said, but others responded in a “less positive” way.
A task force is assessing if a smoking shelter can be provided.
Southmead Hospital in north Bristol is a designated smoke-free site, in line with NHS guidelines.
But one woman, whose husband receives regular oxygen treatment for a chronic lung condition, told BBC Radio Bristol she had to wave away clouds of smoke when they attend his regular appointments.
Ms Young, chief executive of North Bristol NHS Trust, told said it was often difficult for staff to challenge patients or visitors who may already be under a lot of stress. “We have just re-established our task force to look at smoking because we need to revisit the decision about whether we should have a smoking space for patients and their families,” she said.
“Because of the nature of the things we do in our hospital, some of the trauma cases, for some people, it seems to be very very difficult for them not to have a cigarette. “What we are doing is reviewing whether we should have a smoking shelter somewhere.”

NHS Devon surgery restriction for smokers and obese plan revealed
December 3, 2014
Smokers and the morbidly obese in Devon will be denied routine surgery unless they quit smoking or lose weight.
Patients with a BMI of 35 or above will have to shed 5% of their weight while smokers will have to quit eight weeks before surgery.
The NHS in Devon has a 14.5m deficit and says the cuts are needed to help it meet waiting list targets.
The measures were announced the same day government announced an extra 2bn of annual NHS funding.
‘Urgent and necessary’
Document: PDF downloadNEW Devon CCG measures to prioritise services[1.77 MB]
The Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) organises most NHS treatment in the area.
It announced a range of cost-cutting measures on Wednesday including only providing one hearing aid, instead of the normal two, to people with hearing loss.
Shoulder surgery will also be restricted.
What is morbid obesity?
?People with a body mass index (BMI) of 35 or more are considered morbidly obese by medical professionals
?BMI is calculated by dividing weight in kilograms by height in metres, then dividing the answer by height again
?Women of average height, 1.62 metres (5ft 3ins), are considered morbidly obese if they weigh more than 91.5kg (14st 6lb)
?Men of average height, 1.75 metres (5ft 9ins), are considered morbidly obese if they weigh more than 108kg (17st)
In November, the CCG said it would take “urgent and necessary” measures to prioritise major treatment.
That included delaying hip and knee operations for the morbidly obese, but Wednesday’s announcement applies to all routine procedures.
NEW Devon CCG said it would not restrict IVF treatment or caesarean sections carried out on medical grounds.
A statement said all the decisions were “interim commissioning positions” and would require further consultation.
Patients with a date for surgery will not be affected but will be offered weight management or quit smoking support.
Dr Tim Burke, Chair of NEW Devon CCG, said: “All of these temporary measures relate to planned operations and treatments, not those which must be done as an emergency or to save lives.
“We recognise that each patient is an individual and where their GP or consultant feels that there are exceptional circumstances we will convene a panel of clinicians to consider the case.”
NEW Devon CCG said it would announce another round of cost-cutting measures “in due course”.
“We don’t under estimate how difficult it will be for some people to lose weight or stop smoking and we will continue to support them,” said Dr Burke.
“The CCG has a legal duty to live within its financial resources and the prioritisation of services is helping us to do that.”
In a statement the Royal College of Surgeons said it was “concerned” by the move and warned the region was merely storing up “greater pressures” for the future.
It said: “The need for an operation should always be judged by a surgeon based on their clinical assessment of the patient and the risks and benefits of the surgery – not determined by arbitrary criteria.
“Losing weight, or giving up smoking is an important consideration for patients undergoing surgery in order to improve their outcomes, but for some patients these steps may not be possible.
“A blanket ban on scheduled operations for those who cannot follow these measures is unacceptable and too rigid a measure for ensuring patients receive the best care possible.”

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BRITISH SMOKERS BEING DENIED TREATMENT BY STATE-RUN HEALTHCARE SERVICE
11 Aug 2014
by DAVID ATHERTON
Scotland's second largest health board, NHS Lothian, will not be giving further treatment to smokers for non-urgent cases, with referrals from GPs being refused.
Dr. Zahid Raza said: "In Edinburgh, we will not see patients at the clinic that are still smoking. Evidence shows that they would not do well with the treatment." He also went onto say: "We try to avoid intervention and, in around 80 percent of cases, a smoker’s condition will improve just simply by stopping smoking and smoking other lifestyle changes."
Dr Jean Turner of the Scotland Patients Association said that she was "extremely disappointed", adding: "I'm really quite shocked. You should not refuse to see anybody and certainly not penalise patients who are smoking.
"It is very God like and highly unfair to refuse to see anybody referred…Doctors are there to see if they can help and relieve symptoms."
NHS Lothian is by no means unique. NHS Hertfordshire back in January 2012 also withdrew treatment to smokers and, as an ominous sign of the slippery slope, those with a Body Mass Index (BMI) of over 30 – i.e. the obese – are refused services too.
Smokers may well have a case of righteous indignation.
The average smoker smoking a packet a day will contribute £2,000 a year in additional taxation in VAT, income tax and National Insurance. That contribution amounts to £3,000 year, hence smokers pay nearly twice over. The aggregate total of tobacco taxes are £12.3 billion in 2012-2013.
It is also estimated that 70-80,000 people are directly and indirectly employed in the tobacco industry, adding a further £10 billion to government coffers.
Also, successive governments not only raised tobacco taxation in excess of inflation but also specifically ring fenced it to be spent on the NHS.
Despite the best endeavours of the anti smoking lobby, what is little known is that the only objective research done into the lifetime costs of treating smokers compared to other lifestyles was completed in 2008 by the Dutch Health Ministry.
The results calculated by actuaries found the lifetime cost from the age of twenty was the following:
Healthy: €281,000
Obese: €250,000
Smokers: €220,000
Yes, smokes are 22 percent cheaper to treat throughout their lifetime, mainly from premature mortality.
Smokers probably have every right to be aggrieved. Given how much they contribute to UK PLC, being denied services seems outrageous. Maybe they should have the option of opting out of the NHS and going private and being able to buy a packet of cigarettes free of taxation.
A £7.00 pack will drop to less than a £1.00. Also, perhaps the NHS can do some sums in offering a refund to smokers, while taking away the cost of treating them so far. It seems they will have handsome refunds.
Also, smokers may well be also unhappy that they are being victimised, although as I hinted the obese are discriminated against too. Why should other groups like drug addicts, people with sports injuries, alcoholics and people infected from sexual contact be exempt? Especially in the context of the NHS paying for non-life threatening services such as tattoo removal, boob jobs and IVF.
In addition, is this not a contravention of the Hippocratic Oath?
The NHS has a lot of explaining to do.

NICE ? No, just plain horrible people.
29 November 2013
So we now have the people who purport to act on behalf of NICE (National Institute for Health and Clinical Excellenc) deciding what hospital policy/ies should be with regard to smoking. Since when have they been a legislative body I ask?
These are the people who decide whether cancer sufferers live or die – acording to cost etc. If the life extending drugs seem to cost 'too much' then they refuse to supply the necessary drugs and the patient dies earlier than would probably have been. It's easy to see where the medical world have coined the phrase "premature death" from isn't it-they've created the situation! So, in effect, the horrible people at NICE are Godlike in deciding who lives & who dies.
It seems that horrible, horrible NICE have now decided that all smoking on hospoital grounds be banned, patients no longer allowed outside for a NICE relaxing cigarette, staff no longer allowed to smoke on their breaks and, worst of all, this is all to be policed by staff who have to supposedly run around after smokers to inform them to stop smoking. I thought medical staff were medical staff, trained to treat people that were ill – not bullyboy style doormen/women that harrassed others because of a lifestyle chosen by them! This is one step too far. Far from helping this smoking situation NICE are simply going to cause more hospital admissions as nurses (m/f) are assaulted by smokers who are fed up of being harrassed by illegal 'doormen'/smoke wardens. Yet the answer is so simple! CHOICE.
Read More.

Royal Bolton Hospital rebuilds smoking shelters
19 June 2013

Smoking shelters are to be rebuilt at the Royal Bolton Hospital, after an online poll and postal vote from patients, staff and local people.

Those who wanted them won with 1,629 votes – just 49 more than those against the proposals.

Work on three new shelters starts soon, costing around £1,200 each. Six shelters were taken down in 2009.

Public health charity ASH (Action on Smoking and Health) described the decision as "the lesser of two evils".

Stephen Tyldesley, associate director for estates and facilities at the Royal Bolton. said: "It's been very contentious and we have had lots of complaints about people smoking round the entrance areas and we get those complaints from other patients, visitors and our staff.

"We found it difficult to manage by moving the patients on but they would come back later in the day."

Mr Tyldesley said it was not legally enforceable to ban smoking on the site.

A spokeswoman for ASH said: "This is a tricky one as having shelters might seem like condoning smoking, but if they don't there are people smoking everywhere in the grounds.

"This is the lesser of two evils really."

Hospital cigarette ban has gone up in smoke

May 8, 2013
By Mark Taylor

HEALTH officials have admitted a ban on smoking at Oxfordshire’s hospitals has failed to stub out the problem.

They are reviewing the situation as a “matter of urgency” after receiving complaints about staff and other people lighting up, despite the habit being outlawed at all four of their sites.

Carterton resident Andrew Whitehead took a picture of what appears to be a member of staff smoking in grounds of the John Radcliffe Hospital in Oxford when he went in for a check-up recently. He said: “If they say it is a no- smoking site, then they have to enforce it.

“Parking is prohibited in any part of the hospital, except the designated areas, and the hospital ensures this is adhered to.

“There are areas where the public are prohibited and the hospital ensures the public stay out. Why would the hospital not ensure another of its rules is adhered to?”

In March the Oxford University Hospitals NHS Trust (OUHT) relaunched its no smoking policy on National No Smoking Day.

The aim was to stop smoking at the JR, the Nuffield Orthopaedic Centre an the Churchill Hospital in Oxford, and at The Horton Hospital in Banbury.

A health bus visited the sites to promote the policy and offer support and advice to patients, visitors and staff.

The trust said it there had been problems enforcing a total ban.

Director of workforce Sue Donaldson said: “Smoking is currently prohibited on our four hospital sites and there are no designated areas for staff, patients and visitors.

“However, it has not been possible to enforce the current policy in all areas and we are now reviewing it to consider what other measures can be put in place.

“We would hope that everyone would respect our efforts to deter smoking on our sites.”

It is not known how long the review will take.

Mr Whitehead, 62, wrote to the chief executive of the OUHT, Sir Jonathan Michael, about the problem.

Sir Jonathan wrote back to say the trust realised it had to do more and that the policy needed proper enforcement.

Smoking was banned outright at the hospitals on January 1, 2007.

The trust said there had been four formal complaints between April last year and March this year over smoking at its hospitals.

Recently, larger ‘No Smoking’ signs have been placed at the main entrances of all four hospitals. A spokesman for anti-smoking campaign Ash said: “Many hospitals have found it difficult to eradicate smoking from their grounds, despite bans. It is disappointing, as clearly smoking and tobacco have no place near a hospital.

“Mr Whitehead’s interjection is timely, given the National Institute for Health and Care Excellence (Nice) is consulting on this particular issue and advising on what action hospitals must take to create smoke-free environments.”

Nice is an independent body but answers to the Department of Health.

It says there should be better management of hospital sites and better attitudes to confronting smokers about their habit, whether they are staff, patients or visitors.

University Hospital of North Staffordshire ditches ban on smoking
October 11, 2012
A SMOKING ban is being dropped at Staffordshire's biggest hospital because it is being flouted by so many patients and visitors.
Four shelters for people to light up will now be provided at the University Hospital of North Staffordshire.
They include one outside its cancer centre, where people being treated for the disease continue smoking.
Another is planned for the maternity unit after heavily pregnant women were spotted with cigarettes by the front door.
Officials are seeking planning consent to build the shelters, which are designed to move smokers from around hospital doorways.
Health watchdogs said they were disappointed with the move but understood why it had to be made.
Hospital managers, who introduced the ban four years ago, said the change 'in no way condones smoking' and added that staff who light up will continue to risk disciplinary action.
But the opening of its £400million superhospital in March has slashed the number of entrances meaning more smokers are huddled round the remaining ones.
That led to rising complaints from non-smoking patients left to walk through clouds of smoke and past bins overflowing with cigarette butts.
Chief nurse Liz Rix said: "The beautiful main entrance is a particular problem with such a large number of smokers congregating at times it has been difficult to keep it clean."
National anti-smoking charity ASH praised the hospital for having tried the 'gold standard' of a total ban.
A spokesman said: "We are extremely sympathetic with the trust in having to alter its policy as we too find it astonishing that people smoke in the doorways of cancer and maternity units.
"But large numbers still do smoke and it is sensible to use shelters to move them from entrances."
Newcastle Mayor David Becket, a member of the borough council health scrutiny committee, said: "I am disappointed they have had to do this particularly as so many people are in hospital from smoking-related illnesses. But if people insist, it is better to move them away from the doorway.
"I now hope anti-smoking posters will be plastered over the shelters to be read by captive audience."

GPs agree ban on operations for smokers and obese patients

19 Jul 2011
GPs have signed off a series of sweeping referral restrictions by NHS managers that will bar smokers and overweight patients from being referred for surgery, as PCTs across the country bring in new cost-saving restrictions.

Both LMCs and GP consortium leaders have backed moves by NHS Hertfordshire to block any patient with a BMI over 30 from being referred for routine joint replacement surgery without first being referred to a weight management scheme. GPs will also be prevented from referring smokers for any orthopaedic surgery until they have been referred for smoking cessation.

GPC leaders are seeking legal advice on the controversial plans and are warning that a number of trusts across England have suggested they may follow suit. Locally, the move has driven a wedge between GPs – with consortium leaders divided over the ethics of the restrictions and Hertfordshire LMC backing the plans by just one vote.

Meanwhile, a Pulse investigation covering 41 PCTs has found two-thirds have added new procedures to ‘low clinical priority' lists since April, as trusts struggle to cut costs.

Procedures subject to new restrictions include the treatment of ganglions in Hampshire and DEXA scanning in primary prevention of osteoporotic fractures in men and women over 50 in Bristol. NHS Warrington has added 13 restrictions, including the treatment of obstructive sleep apnoea.

But it is the restrictions on treatment for smokers and obese patients that have prompted fiercest debate.

Dr Tony Kostick, joint chair of NHS Hertfordshire's clinical executive committee and chair of East & North Herts GP Commissioning Consortium, insisted the move was based on ‘sound' clinical evidence.

He said: ‘It's divisive in the sense some GPs don't want to confront the rationing debate. We spend fortunes on treatments of limited clinical value.'

A spokesperson for NHS Hertfordshire said the changes had been legally approved, and were necessary to ‘make absolutely the best use of NHS resources'.

But Dr Mike Ingram, chair of the single-practice Red House Consortium and a member of Hertfordshire LMC, said: ‘Patients' access to services should be based on the care they require and not on a discriminatory policy. I'm very worried about denying people care on the basis they are fat.'

Dr Nigel Watson, chief executive of Wessex LMCs and chair of the GPC's commissioning and service development subcommittee, said he was discussing the restrictions with the BMA's legal department.

‘My understanding is you cannot discriminate against patients on the basis of lifestyle choices,' he said.

Clinical procedures being added to low-priority lists
•Acne scarring treatment
•Cataracts
•DEXA scanning in primary prevention of osteoporotic fragility fractures in women and men over 50 years
•Dose-dense temozolomide in recurrent glioblastoma multiforme
•Hip replacement
•Knee replacement
•Treatment of ganglions
•Treatment of obstructive sleep apnoea
•Ultrasound to promote bone fracture healing
Source: Pulse survey of 41 PCTs

Raigmore Hospital's no smoking ban ignored
5 August 2010
NHS Highland banned smoking at all its sites two years ago
Patients and visitors are ignoring no smoking rules at the biggest hospital in the Highlands.
Concerns have been raised by Raigmore Hospital management about policing the ban at the site in Inverness.
NHS Highland banned smoking at all its sites in 2008, but said implementing the restriction was challenging.
The health board said allowances were made in some circumstances, such as relatives who were distressed about a loved one.
Chief operating officer Elaine Mead said there were discussions about the sensitivity of the ban in some cases, but she added that "the spirit of the policy" was not being adhered to.
She said: "We will be providing advice to staff about directing patients appropriately and plan to continue to challenge individuals smoking on site, out with the exceptional circumstances.
"We will also be able to provide smoking cessation advice and guidance.
"Patients and staff tell us repeatedly that they no longer wish to have to walk through a smoky atmosphere to enter the hospital, or accept cigarette ends at our doorways.
"They also find it disturbing to see patients in night wear smoking at entrances to the hospital."
Ms Mead said as a health provider NHS Highland believed it was important to set an example.
Earlier this week, a decision on whether to ban smoking from all of NHS Grampian's premises by 2012 was delayed amid concerns over enforcing the measures.
The board deferred the decision for six months after agreeing more discussion was needed with staff, patients, the public and other health authorities.
Proposals included disciplinary procedures for staff and the possible withdrawal of care from patients.
But some members expressed reservations that a total ban was unenforceable.

Anger as visitors flout St Richard's Hospital smoking ban at hospital

09 September 2009

A woman who was regularly visiting her sick grandmother at St Richard's Hospital said she is disgusted by visitors and patients smoking outside the reception doors.

Diana Hutchings of East Wittering said people were smoking just two metres away from the entrance doors, allowing smoke to waft through into the hospital, close to the accident and emergency department.

She said people were ignoring the smoking ban put in place by the Western Sussex Hospitals NHS Trust and leaving cigarette butts to litter the hospital grounds.

"I am furious. My grandmother has been in St Richard's Hospital for a month," said Mrs Hutchings.

"Every day I visit her, there are people literally outside the hospital entrance smoking. I was under the impression that it was illegal to smoke anywhere on hospital grounds.

"It is not just the visitors, people are sat outside in wheelchairs smoking. I have complained several times to the reception staff, sitting literally two metres away from the smokers, who have informed me they are aware of the problem but there is nothing they will do about it."

Members of the hospital trust met this week to discuss the ongoing problem with smoking on the hospital grounds. In 2006 a no-smoking policy was put in place to encourage visitors and patients not to smoke.

Mrs Hutchings added: "Smokers are standing underneath the banner which says no smoking. I think if people smoke they should be fined or asked to leave the premises and patients should be monitored by a member of staff.

"There are cigarette butts everywhere because there is nowhere to put them in. I appreciate people have the right to smoke, but not where it's illegal."

Spokeswoman for the hospital trust Sue Hines said: "It is an ongoing issue to try to prevent people and we strongly discourage everyone from smoking on the hospital grounds. It is a national NHS policy and smoking on trust property is strictly forbidden in staff contracts. We do challenge and constantly remind people not to do so and have again set up a management group to try to address the issue.

"We would ask all members of the public either visiting or being treated in hospital to respect the hospital's no-smoking policy and refrain from smoking anywhere on the hospital site."

Freedom To Choose (Scotland) Petition Gains International Support

April 10, 2009

The e-petition raised by Freedom To Choose (Scotland) calling on the Scottish Parliament to request the Scottish Government to review the consultation ‘Achieving Smoke-free Mental Health Services in Scotland’ has gained international support.1

Signatures have been received from all parts of the UK, other EU countries including Austria, France, Germany, Malta, Spain, the Irish Republic and Denmark, and also from Switzerland, Canada and the USA.

The petition calls for a full review of the consultation, and will be collecting signatures until the closing date of Friday 17 April. It was put forward in response to factual inaccuracies in the consultation document that make the process fatally flawed.

Freedom To Choose (Scotland) are confident that the Scottish Parliament will agree that a consultation should be based on accurate information and solid, scientific data.

Reference:
http://epetitions.scottish.parliament.uk/view_petition.asp?PetitionID=310

Freedom To Choose (Scotland) 0845 643 9552
Spokesperson: Eddie Douthwaite: 0131 331 3607

Request To Terminate Mental Health Consultation: The Truth Is A Lie?

19/03/09
A comprehensive petition has been submitted by Freedom to Choose (Scotland) asking for the nullification of the consultation ‘Achieving Smoke-free Mental Health Services’.

Eddie Douthwaite, spokesperson for the pro-choice group, has cited various flaws in the consultation document, which is open for replies until Monday, 6 April. 1

“The document itself contains various claims that are extremely questionable, and it is entirely unreferenced,” states Eddie Douthwaite. “No bibliography has been provided and it relies on claims that are already under dispute.”

Freedom to Choose are still awaiting replies to unanswered letters dating back to early February 2009 from the First Minister in relation to this consultation. They have also alerted individual MSPs to the misleading information that is contained within it.

“The Tobacco Control division have already confirmed that the reduction in heart attacks in 2007 (the year after the ban was implemented) was just over 6%”, continues Eddie Douthwaite. “I would like to know why this document contains the figure of a 17% reduction, when the official data from the ISD Scotland show otherwise. Other similarly contentious claims, some very tenuous, are stated as fact without any attempt to support them with evidence.”

"I am also concerned that one of the questions in the consultation refers to bans being extended into hospital grounds, a move that goes beyond the provisions of existing legislation."

Freedom to Choose will be placing an e-petition on the Holyrood official website requesting the termination of this consultation, and are still awaiting responses from their unanswered correspondence.

1. Achieving smoke-free mental health services in Scotland: a consultation
http://www.scotland.gov.uk/Resource/Doc/255862/0075839.pdf
Spokesperson: Eddie Douthwaite: 0131 331 3607

When I reported the Royal Oldham story Tuesday, I was wondering whether any anti-smoking groups would join me in condemning the policy. Even then, it never occurred to me that a major anti-smoking group would actually come out and support such a policy and encourage the widespread extension of that policy.
Major National Anti-Smoking Group Supports Bans on Smokers in Certain Public Places and Workplaces

Smokers Not Allowed in Maternity Waiting Room of Royal Oldham Hospital

March 24, 2009
By Michael Siegel

In what may be the first policy of its kind, the Royal Oldham Hospital has prohibited smokers from entering a public area of the hospital — the maternity waiting room — according to the Freedom to Choose web site. Dick Puddlecote's blog captured a picture of the sign outside the waiting room, which states: "In the interests of others, smokers are not allowed in this room."

The Rest of the Story

If you're straining to accept the credulity of the above, you did indeed read it correctly. The sign doesn't say: "smoking is not allowed in this room," it says "smokers are not allowed in this room."

To the best of my knowledge, this is the first policy ever in which smokers have been prohibited from entering a public place. All other smoke-free policies of which I'm aware have prohibited the act of smoking in various public places. I'm aware of no other policy that has banned smokers from entering a particular place.

Presumably, the "justification" for this policy is that smokers emit thirdhand smoke which could be harmful to patients in the waiting room.

Although there is no scientific evidence that thirdhand smoke — such as the very minute levels of residual smoke constituents remaining in the breath of smokers or on their clothing — poses any threat to health, let's go with this rationale for a minute and stipulate that the "claim" being implied by the Royal Oldham Hospital is accurate.

This raises two questions.

First, why would smokers be allowed in any areas of the hospital? After all, it is not just pregnant women who would be at risk from the toxins emitted by smokers. Even more at risk would be patients with respiratory disease. So you certainly wouldn't want to allow smokers on the respiratory floor. Nor would you want to allow smokers in the intensive care units. You certainly wouldn't want to allow smokers in the emergency room or emergency waiting room. In fact, if thirdhand smoke is really so much of a health risk that smokers cannot be allowed in the maternity waiting room, then they really shouldn't be allowed anywhere in the hospital.

Second, why would passive smokers be allowed in the maternity waiting room? If smoke particles that settle on the hair or clothing of a smoker pose a threat to women in the maternity waiting room, then wouldn't smoke that settles on the hair or clothing of a nonsmoker also pose a similar risk? So if a nonsmoker lives with a smoker, that individual's clothing is also going to be contaminated with residual smoke particles. Shouldn't these individuals also be prohibited from entering the waiting room? Shouldn't the sign say: "In the interests of others, active and passive smokers are not allowed in this room," or "In the interests of others, anyone who smokes or has been exposed to secondhand smoke is not allowed in this room."

This raises another interesting question. What if the pregnant woman who is waiting to deliver a baby is herself a smoker? Does this mean she cannot enter her own waiting room? Is there some secret, backdoor passageway into the delivery rooms that smokers must take? Are they asked to wait outside the hospital until their water breaks and then quickly and quietly ushered through hidden passages to get to the delivery room without going near anyone else?

To be consistent, why are only pregnant women afforded the protection of not having to be near smokers. Shouldn't we afford that same protection to infants after they are born? Perhaps the Oldham City Council should consider banning smokers from going within 20 feet of any infant. Of course, that would mean that smokers must not be allowed to enter the day care profession.

And why stop with infants. Children are also very susceptible to the effects of tobacco smoke. So Oldham should also prohibit smokers from being teachers, guidance counselors, or librarians, or from working in or entering a school.

You might ask: what would parents who are smokers do on teacher-parent night? This is not a problem. With advanced video technology, teachers could record a message about each student whose parent smokes and those parents could simply view the video without having to enter the school or classroom.

Astute readers might ask: what about smoking parents who want to pick up their infants from day care? Again, not a problem. Every smoking parent would be paired up with a nonsmoking parent. The nonsmoking parent would be in charge of going into the day care facility and picking up the infants of the smoking parents. The smoking parents would wait comfortably outside while their children are picked up by the nonsmokers. The risk of mixing up or losing a child would be minimal under this system.

Now the really insightful among you will ask the natural question: what about smokers who need to be admitted to the hospital? You can ban smokers from entering the hospital, but what if they are sick or injured and in need of medical attention.

Not a problem, I say. Simply set up a two-tiered system of medical care. You would have separate hospitals for smokers and nonsmokers. That way, the two would never cross paths.

Aha, you might say. What if a nonsmoker has a close family member who smokes, such as her husband? Does this mean that the husband cannot visit the wife while she is in the hospital? Well yes, but again, with advanced video technology, we could set up "virtual" visits with family members over the computer.

Another huge problem is what to do about infants or children whose parents smoke. Those infants and children are going to have clothing that is contaminated with smoke particles and they will therefore be a source of thirdhand smoke. What to do about those kids? Certainly, they cannot be allowed in day care centers or schools. The solution is to set up a two-tiered day care and education system, where there are separate day cares and schools for nonsmoking and passive smoking infants and children.

We already have peanut-free schools. I don't see why we cannot have "thirdhand smoke-free" schools. We already have smoke-free hospitals. I don't see why we cannot have thirdhand smoke-free hospitals.

Of course, there are a large percentage of nurses who smoke. This would not be a problem under my two-tiered system, because they could simply be assigned to work in the thirdhand smoke-laden hospitals. Similarly, teachers who smoke would be assigned to work in the thirdhand smoke-laden schools. The same is true for maintenance staff, administrative staff, and physicians themselves.

Under my policy, anti-smoking advocates should be happy, because it truly addresses the fact that, as reported in a recent Scientific American article: "Smokers themselves are also contaminated…smokers actually emit toxins [from clothing and hair]." Everybody is happy, and we can all peacefully co-exist.