Total extinguishment; More hospitals remove areas where people can smoke.

Byline: George Barnes

In making its campus smoke-free Sept. 4, Athol Memorial Hospital saw some walls come falling down, both literally and figuratively.

"The Butt Hut has been demolished," announced hospital spokeswoman Marcia M. Flynn.

The Butt Hut was built by the hospital to allow staff and visitors shelter when the hospital banned smoking in buildings in the early 1990s. It became symbolic of the hospital's decision to make the main campus smoke-free, including outside areas such as parking lots and entryways.

After Labor Day, the hospital followed the lead of many hospitals around the country that have eliminated exposure to secondhand smoke on their campuses by going smoke-free. The ban includes areas around its main hospital and Medical Arts Building, both part of the main campus.

For many, having a medical facility go smoke-free might not seem remarkable, but certain factors caused hospital administrators and staff to look at the issue thoroughly before deciding on the change. At Athol Memorial, the policy takes into consideration patients who say they absolutely need a smoke.

"If a patient is in need of a cigarette, we have protocols to allow that to happen," said Steve Penka, Athol Hospital president.

On rare occasions, when a person is absolutely unable to go without a cigarette, the hospital will allow that person to go out and smoke, Mr. Penka said.

But while finding ways for the patient to smoke, he said, the hospital will also supply information and encouragement to help the patient quit smoking. The hospital also offers support groups and smoking cessation classes to the public and staff.

Outside Athol Memorial, Pat Cardillo of Petersham was waiting for a ride home after visiting a patient. A smoker for 40 years, Mrs. Cardillo acknowledged she has grown used to rules prohibiting smoking in many places, but is unhappy when a place where she has always smoked tells her she can't.

"It makes you feel like a criminal," she said.

Mrs. Cardillo said she was hospitalized in Boston for four days and could not smoke.

"They got me the patch and a pill and I got through pretty well," she said.

Mrs. Cardillo said she considered quitting then, but went back to smoking. She said she may have another hospital stay coming up in the near future and she is considering trying to quit again.

The decision by Athol Memorial to go smoke-free was in part following the lead of other hospitals and in part because Mr. Penka learned The L.S. Starrett Co., Athol's biggest company, was smoke-free. Mr. Penka said the next step is to make the hospital's West River Medical Center in Orange smoke-free. The difficulty there is that the hospital does not rent the entire building and needs to iron out any smoking issues with the other tenants.

Several Central Massachusetts hospitals have gone smoke-free in the past few years. Heywood Hospital in Gardner did so in 2003. Milford Regional Medical Center and Marlboro Hospital also went smoke-free in 2005, as did Wing Memorial Hospital in Palmer and its associated medical centers in Belchertown, Ludlow, Monson, Palmer and Wilbraham in June 2006.

Wing Memorial backed off from its plan a few months after it went smoke-free when construction of a new building made it dangerous for employees and visitors to go off campus to smoke. When the work is done, it plans to return to entirely smoke-free. During the past year, a place outside on campus has been provided for smokers, said spokesman Bill Rousseau-Apple.

UMass Memorial Medical Center and the University of Massachusetts Medical School in Worcester are also looking into going smoke-free campus-wide, but are taking a measured approach.

"Right now we have a campus where there is no smoking anywhere except in three designated areas," said Mark L. Shelton, associate vice chancellor for university relations. For the past 18 months, the center and school have been evaluating a plan to make the campus become entirely smoke-free. The effort has been delayed somewhat by construction that made managing pedestrian flow, let alone monitoring smokers, challenging.

"Both the medical school and the hospital are committed to the philosophy of going smoke-free as much for health and a healthy environment as the message it sends," he said.

Mr. Shelton said the committee working on the policy recognizes that even a small amount of secondhand smoke is harmful, but also that being in or visiting a hospital is a stressful situation where people are more likely to want to smoke.

St. Vincent Hospital in Worcester also faces challenges in operating a smoke-free campus. Hospital spokesman Dennis L. Irish said the policy limits smoking to designated areas outside hospital buildings, and employees may be punished if they smoke outside of designated areas. But the hospital is part of Worcester Medical Center, which houses many other businesses, making achieving a smoke-free campus more difficult.

Milford Regional Medical Center was one of the first hospitals in the state to go smoke-free, but scaled back its plan a few months after it started. Hospital spokeswoman Terri L. McDonald said construction at the hospital made it difficult to manage pedestrians as well as smokers. A few months later, when the work was completed, the medical center returned to smoke-free.

Ms. McDonald said one of the more difficult problems the hospital dealt with was the public seeing large numbers of staff standing on the sidewalk and smoking next to the hospital's campus. The second time around, the medical center told employees they were not allowed to smoke at all during their eight-hour shift.

Dr. Joseph Difranza, a professor of family medicine and community health at UMass Medical School, has been at the forefront of smoking cessation efforts since 1984. He was the leader in the successful effort to end the Joe Camel advertising targeting teen smokers, and continues to work on smoking research, especially focused on smoking and children. He said he supports the idea of hospital campuses going fully smoke-free, and does not believe hospitals need to find ways to allow patients to smoke. He said there are medications available to temporarily eliminate the craving for a cigarette.

"There is no reason to have to go out and smoke," he said.

Dr. Difranza also said medicine is available for reducing withdrawal symptoms, although a desire to quit is still key to success.

The Massachusetts Nurses Association fully supports hospital efforts to rid campuses of smoking. David J. Schildmeier, a spokesman for the association, said he is not aware of any union issues involving nurses that have arisen in the state over hospitals going smoke-free.

"We are totally in support of all efforts to make smoke-free hospitals," he said. "We all know the dangers of secondhand smoke, and people going in and out of the hospitals may have serious respiratory issues."

Contact reporter George Barnes by e-mail at [e-mail].

Smoking in Massachusetts

In July 2004, the Massachusetts Smoke-Free Workplace Law, then the sixth in the nation, went into effect, banning smoking in workplaces, including private offices, taxis, restaurants and bars.

Workplaces may allow smoking in outdoor spaces if physically separated from the enclosed workspace, open to the air at all times and smoke does not migrate back into the workspace.

Percentage of adult smokers: 1986, 28%; 2005, 18.1%

Yearly deaths from smoking: More than 9,000; Tobacco use is the leading cause of preventable death and illness in Mass.

Yearly costs from smoking illnesses: $4.2 billion in health care and lost productivity

Yearly deaths from secondhand smoke: 1,000 or more estimated adults and child victims

Questions? Complaints?

[phone]

The Smoke-Free Workplace Law complaint and information line

Source: Massachusetts Tobacco Control Program

ART: PHOTOS

CUTLINE: (1) A smoker stands under the front entrance awning of Worcester Medical Center, which houses St. Vincent Hospital and other businesses. (1) Dr. Joseph Difranza, a professor at the University of Massachusetts Medical School in Worcester, is a nationally recognized expert on the health consequences of tobacco. (3) Signs at Athol Memorial Hospital announce that smoking is not permitted anywhere on the main campus.

PHOTOG: (1, 2) T&G Staff/PAUL KAPTEYN (3) GEORGE BARNES