Smoking Ban a Case Study in Unintended Consequences

John Commins, for HealthLeaders Media, September 15, 2008

Aspinwall, PA, the leafy, affluent borough northeast of Pittsburgh, was formed more than 125 years ago as a neighborhood for wealthy families looking to escape the sooty smokestacks of the Steel City. Now, the tiny borough of 3,000 souls has a new problem with unwanted smoke, and the source of that problem is the University of Pittsburgh Medical Center Saint Margaret.

Thanks to a year-old, campus-wide ban on tobacco, Saint Margaret patients, visitors, and employees troop down the 200 yards from the main door to the residential side streets at all hours of the day to light up, leaving the manicured lawns of nearby residents looking like ashtrays.

"It's causing a very bad problem," Aspinwall borough manager Ed Warchol says. "These are nice houses and the homeowners are coming home and finding three or four people on their front lawn smoking cigarettes. They're telling people not to toss their cigarette butts down and they're getting rude responses.

"They've got people over there smoking in wheelchairs and hospital gowns with IV poles. We saw a guy out there smoking who had a quarantine outfit going from his neck down. A doctor told me that that light-brown suit means that guy's body is rejecting every antibiotic for the disease he has, and he's out there smoking!"

The borough last week asked Saint Margaret to create a designated smoking area on its campus. The hospital said no.

Doug Harrison, the hospital's executive of operations, told the Pittsburgh Post-Gazette that Saint Margaret wouldn't budge on the ban. "We are a health center, and we are here to promote health for all people," Harrison said. "Being smoke-free is extremely important."

Harrison told the newspaper that Saint Margaret would spend the next month looking for a solution but he didn't provide details.

In the meantime, the neighbors around the hospital are making noises. They've made videotapes of the cigarette smokers, and they've collected plastic bags full butts, empty lighters, empty cigarette packages, and other discarded smoking paraphernalia to show to the hospital, the town, and the media. They've posted large signs on their front lawns stating "UPMC Hear This! Aspinwall is not your ashtray! Stop exporting your habitual smokers." They even have a Web site that details their problems with litterers and loiterers and their efforts to pick up after them.

The neighbors considered filing a public nuisance suit against the hospital, but that effort stalled because the four attorneys they've attempted to hire-including the borough solicitor-declined because they already represent Saint Margaret in some capacity.

Warchol says he thought about sending the police down to ticket the smokers, but decided the idea was too expensive and time-consuming. "I'd have to send them down there five or six times a day." Besides, he said, it would penalize the smokers for obeying the hospital's policies. As a snuff dipper himself, Warchol says he sympathizes with his fellow nicotine slaves.

Nobody thought much about it last year when UPMC banned smoking on all campuses of its 20 hospitals. After all, UPMC was just doing what scores of other hospital systems were in the midst of doing, and what most other industries had done years before.

It turns out, however, that UPMC's system-wide smoking ban has become a case study in the law of unintended consequences. In most respects, the health system's stand against smoking is commendable. Cigarettes have killed more people than Stalin. But by foisting its smoking problem on others, Saint Margaret is presenting itself as intransigent, selfish, and uncaring in its refusal to provide relief for nearby homeowners, who are not unreasonably asking the hospital to be a good neighbor.

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at
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