By Sandra Basu
WASHINGTON — If a new law is passed, veterans living in facilities such as VA nursing homes would have only 90 days to phase out smoking in their rooms, according to veteran service organizations expressing concern about the proposal.
Lawmakers were considering legislation last month that would ban smoking in all VHA facilities almost immediately and outside thosefacilities within five years.
The bill would apply to all VHA medical centers, nursing homes, domiciliary facilities, outpatient clinics and centers that provide readjustment counseling.
“As a doctor and as a veteran, I feel strongly that we cannot continue to allow practices as toxic and damaging as smoking to continue taking place on VA medical facility campuses,” explained Rep. Brad Wenstrup (R-OH), DPM, who introduced the bill.
Currently VHA provides 971 outdoor designated smoking areas and 15 indoor designated smoking areas, as required by the Veterans Health Care Act of 1992. Wenstrup pointed out that most private sector hospitals and clinics “adopted 100% smoke-free policies for their facilities, grounds and buildings many years ago.”
“I recognize that some veterans and VA employees are smokers and that quitting can be a challenging uphill battle,” he said. “That’s why H.R. 1662 would allow smoking outside of VHA facilities to be phased out over a five-year period, rather than right away.”
Wenstrup also said he hoped that those veterans who are struggling to quit smoking would take advantage of VA’s “programs and interventions to support those who are trying to kick their smoking habit.”
The bill was voted favorably out of a House Committee on Veterans’ Subcommittee last month and was awaiting consideration by the full House Committee on Veterans’ Affairs as of last month.
At an earlier legislative hearing where the bill was discussed, VHA Deputy Under Secretary for Health and Policy Services Jennifer Lee, MD, told the subcommittee that VA “strongly supports” the bill. According to VA, approximately 20% of veterans enrolled in VA healthcare are smokers.
“VA has proposed legislation for many years to reverse the requirement for smoking areas at VHA facilities … we believe that veterans and employees should be protected from second-hand smoke exposure at VA healthcare facilities as they would be in thousands of other hospitals currently smoke free across the country,” Lee said.
VA estimates that it would see no savings in FY 2018 from the proposed changes but estimates it would save approximately $8.2 million in FY 2023.
Meanwhile, veteran advocacy groups expressed some concerns with the bill.
Disabled American Veterans Assistant National Legislative Director Shurhonda Love suggested in a written statement that, if the bill is enacted that the measure should “require VA to conduct a comprehensive tobacco cessation outreach program targeting all veteran patients that smoke to raise awareness about options for quitting.”
“The policy must recognize that nicotine dependence is a chronic, relapsing disorder; with most tobacco users in the general population requiring multiple attempts before they are finally able to quit for good,” she explained.
Veterans of Foreign Wars National Legislative Service Legislative Associate Kayda Keleher wrote in a statement that her organization had no position on the bill but expressed concern that the legislation would require VA to prohibit indoor smoking within 90 days of enactment. She asked that, if the bill advances, that lawmakers consider extending the effective date to allow veterans more time to make the adjustment.
“Veterans who reside in the 120 VA nursing homes with co-located smoking areas, most of which are ventilated indoor smoking rooms, would only be given three months to adjust to a smoke-free environment,” Keleher wrote. “Approximately 9,225 veterans currently reside in VA community living centers.”
She also explained that, if VA medical facilities are to become smoke-free campuses, “VA must strengthen and expand its smoking cessation programs.”
“This includes nicotine replacement therapy for veterans residing in VA nursing homes who tend to be older with severe service-connected disabilities, and who may not be able to easily travel off campus to smoke, as well as veterans using VA rehabilitation therapies for substance abuse of illicit drugs and alcohol,” she wrote.
The American Legion wrote in a statement that it “is unable to determine whether this bill seeks to provide a safe patient environment by protecting staff and patients from second hand smoke, is a proposed law to eliminate a perceived nuisance or an overreach by government to legislate personal choices.”
“The American Legion is holding this bill for further review before we offer any recommendation,” the association explained.
Accounting for nearly a third of all cancer diagnoses, prostate cancer is the most frequently diagnosed cancer in the VHA, where past research has suggested that the malignancy is caught earlier than in other healthcare systems.
While many other cancers have seen dramatic improvement in outcomes in the past 20 years, pancreatic cancer remains one of the deadliest malignancies, regardless of stage at diagnosis, with an overall five-year survival rate of only 8%, according to the American Cancer Society.