VA Hospitals Ban Smoking, But Employee Union Objects

Nick Mulcahy

September 13, 2019

Starting on October 1, the Department of Veterans Affairs (VA) will ban smoking at its hospitals and other healthcare facilities, joining thousands of other tobacco-free medical organizations in the United States, announced VA Secretary Robert Wilkie in a press statement this summer.

The ban includes cigarettes, cigars, pipes, and vaping with e-cigarettes.

But the policy, called "commonsense" by the VA, has since met with legal opposition from a major union of VA employees and emotional opposition from some veterans and their families who say that the military promoted tobacco use among soldiers and that it is cruel to take it away, especially among disabled men.

Due to roll out through January 2020, the ban is "unlawful," said the American Federation of Government Employees (AFGE), which has 260,000 members who work for VA healthcare in white- and blue-collar jobs.

Union employees are allowed to smoke outdoors in designated areas provided by the VA, per the union's 2008 contract with the agency.

According to the military publication Stars and Stripes, there are currently about 1000 outdoor smoking areas at VA hospitals, clinics, and nursing homes nationwide.

Last month, the AFGE union filed a grievance with VA's labor-management office, objecting to the new smoking ban and calling it "unilaterally" imposed.

Furthermore, Tim Kaufmann, AFGE spokesperson, told Medscape Medical News that the smoking ban is "not part of the current renegotiations on a new contract," suggesting that the policy is not being discussed by the two parties.

The VA is moving forward with the ban, said VA spokesperson Susan Carter.

"Three other national unions have already agreed to abide by this new policy, which is being implemented regardless of AFGE's cooperation," Carter said in an email to Medscape Medical News.

"I hope that the union has their members' interests — in terms of their long-term health — at heart," said Amanda Holm, MPH, project manager, tobacco treatment service, Henry Ford Health System, Detroit, Michigan.

"Policies like this can be subject to union contract negotiations," added Holm, who has worked for 20-plus years in the field and helped implement the 2007 smoking ban at Henry Ford facilities and campuses.

"Tobacco use is a social justice issue. It's been promoted to people in difficult situations," she also told Medscape Medical News.

In the past, those targets of promotion have included US soldiers, said Connie Fischer, an Illinois resident and wife of a Vietnam War veteran, in a tweet protesting the VA's impending ban.

"Shame on you!! You sent these people to war with cigarettes to boot and now you're taking away what they have left to make them feel mentally normal??" she (@connajean) tweeted last month after the VA announcement.

Fisher told Medscape Medical News that the US military provided free and very low-cost ($.10 - $.15 a pack) cigarettes to soldiers in Vietnam. Furthermore, currently, US Army bases "STILL sell cigarettes discounted (No taxes)," she said in an email.

Fisher's husband is an incomplete quadriplegic whom Fisher cares for "at home 24/7." He "can no longer feed himself but he can smoke thanks to a way I devised it for him," she said.

Fisher is not an advocate for smoking in general, however.

"Don't get me wrong, I know that smoking is bad for a person — as do the veterans who smoke. I just think that it's sad that they take away the last thing (at least for my husband) that makes them 'feel' normal," she said. "My beef is for the vets who go to the VA frequently and the ones who live in VA facilities."

The US military has a "culture of tobacco use," according the truthinitiative.org, the largest US nonprofit devoted to smoking cessation. For example, some military newspapers still carry tobacco advertisements; only the Air Force has banned the ads from its publications.

A 2016 Department of Defense (DoD) study found that 38% of current smokers in the military began smoking after joining. Also, combat exposure was tied to an increased risk of starting smoking, according to other DoD research.

Fisher echoed that finding about combat experience: "I've seen many vets with PTSD all hanging around together at the St Louis [Missouri] VA, smoking."

Henry Ford's Holm had words of encouragement for VA employees and veterans.

People are going to "experience some hardships" complying with the policy, she predicted, adding that there will hopefully be "plenty of resources for their employees to be tobacco free."

Professionals in the field of tobacco treatment "very much want to support people in making that transition," Holm added.

Employees Were Exempt at First

In June, the VA first announced that the new policy banned smoking by patients, visitors, volunteers, contractors, and vendors at all of its healthcare facilities.

Notably missing from that list was employees.

The exemption of employees was the subject of immediate criticism. In July, US Congress members led by Brad Wenstrup (R-Ohio) responded by introducing a bill in the House of Representatives that banned smoking at VA facilities, including for employees.

The bill would also void the portion of the Veterans Health Care Act of 1992 that mandates the designated smoking areas.

In mid-August, the VA said the policy now included employees, but allowed them to comply by January 2020, instead of by the October 1 deadline for the other affected groups

At the same time, AFGE filed its grievance citing a 2008 memorandum of understanding, which dates from the Obama administration and allows for outdoor smoking.

"The right of AFGE bargaining-unit employees to smoke on VA property, as well as the responsibilities of the agency to provide designated smoking areas, are subjects explicitly covered by an existing agreement," states the grievance, signed by Thomas Dargon Jr, staff counsel, AFGE.

Nonetheless, a no-smoking policy has been so appealing to some VA facilities that they enacted the ban ahead of schedule.

The AFGE charged that the Roseburg (Oregon) VA Health Care System, the Chillicothe (Ohio) VA Medical Center, and the Milwaukee (Wisconsin) VA Medical Center had already implemented the ban. But the VA said that the accusation was not accurate, except in the case of the Chillicothe VA, which subsequently ceased to enforce it ahead of the official start of October 1.

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