New Directive Abolishes Designated Smoking Zones

WASHINGTON—Starting in October, all VA healthcare facilities will be official no-smoking zones.

While VA now permits smoking in designated areas, the department has issued a new policy restricting smoking by patients, visitors, volunteers, contractors and vendors at its healthcare facilities by October.

The reason, according to VA officials, is the “growing evidence that smoking and exposure to secondhand and thirdhand smoke creates significant medical risks, and risks to safety and direct patient care that are inconsistent with medical requirements and limitations. Accordingly, VA’s Veterans Health Administration (VHA) has collaborated with key stakeholders to update and recertify the policy to be consistent with the department’s commitment to Veterans and the community.”

The decision was based partly on a recent VA survey indicating that about 85% of VAMC leaders support smoke-free campuses.

“We are not alone in recognizing the importance of creating a smoke-free campus,” pointed out VA Secretary Robert Wilkie. “As of 2014, 4,000 health care facilities and four national health care systems in the U.S. have implemented smoke-free grounds. This policy change coincides with additional VHA efforts to help us become the provider of choice for veterans and the reason why veterans will ChooseVA.”

The new directive applies to cigarettes, cigars, pipes, any other combustion of tobacco and non-Federal Drug Administration approved electronic nicotine delivery systems, including but not limited to electronic or e-cigarettes, vape pens or e-cigars.

All VA medical facilities have had a smoke-free policy since 1991, with smoking allowed only in designated areas. In 1992, Congress passed the Veterans Health Care Act of 1992, calling for each VA medical center, nursing home or domiciliary care facility is required, consistent with medical requirements and limitations, to establish and maintain a suitable indoor smoking area for patients or residents and provide access to such area for patients or residents of the facility who are receiving care or services and who desire to smoke tobacco products.

In 1997, meanwhile, President Bill Clinton signed Executive Order 13058 Protecting Federal Employees and the Public from Exposure to Tobacco Smoke in the Federal Workplace, which mandated a smoke-free environment for federal employees and members of the public visiting or using Federal facilities. VHA Directive 1085, Smoke-Free Policy for VA Health Care Facilities, issued in 2017, restricted smoking to designated smoking areas. b. Smoking Cessation Policy.

The updated directive issues in March detailed scientific evidence that cigarette smoking is the No. 1 preventable cause of morbidity and premature mortality worldwide. It emphasizes that the harmful effects of smoking are not confined solely to the tobacco user but often extend to co-workers and members of the public who are exposed to secondhand smoke. In fact, it notes that studies have shown that there is no risk-free level of exposure to secondhand smoke and that the newest research suggests risks from thirdhand smoke, which is defined as particulate matter or residue left behind or carried around on materials with which smokers come into contact and that might be deposited in areas where there is no smoking activity.

Fire Hazards

In addition to the medical issues associated with smoking, which the VA is addressing by providing access to treatment and consultation for tobacco use cessation in the clinical setting, the agency has expressed concern about fire and safety hazards.

“There are numerous reports in VA issue briefs and The Joint Commission citations of fire and safety hazards caused by smoking,” according to the recent directive. “VHA seeks to reduce all fire and safety hazards associated with smoking as documented in issue briefs and citations on fire and safety hazards related to smoking on VA property.”

That new evidence helps explain why the agency has opted to abolish designated smoking areas.

“As there is currently overwhelming evidence that smoking and exposure to secondhand smoke creates significant medical risks, and a growing body of evidence that exposure to thirdhand smoke creates additional risks to safety and direct patient care, VHA is unable to establish suitable indoor smoking areas that are consistent with medical requirements and limitations as required by Pub L. 102-585 Section 526. Accordingly, VHA must eliminate all designated smoking areas for patients at VHA health care facilities in order to be consistent with medical requirements and limitations, and to prevent the creation of hazards to persons on VA property, as required by 38 CFR 1.218(a)(3),” the document explained.

The VA suggested it won’t be playing around when it comes to enforcement. The directive stated that appropriate staff, such as its Police Service, will be assigned to verbally remind individuals who are not complying with the smoke-free signage. If that doesn’t work, a courtesy violation warning can be issued by VA Police. “Ultimately, failure to comply with the signage can result in the issuance of a Federal citation in accordance with 38 CFR 1.218(b)(6),” it adds.