Hospitals 'tip-toe' into nicotine-free workforces with new hiring policies

Matt Volpini Fran Meringolo, director of human resources at Marlborough Hospital, said a new nicotine-free hiring policy may be controversial but for a health care organization, it's the "right thing to do."

Write a Comment

By Emily Micucci

Clearly, tobacco use and good health are mutually exclusive. But how far should health care providers go to get that point across?

Some hospital administrators believe excluding tobacco users from employment opportunities is a reasonable means for discouraging smoking and other tobacco-related activities, including those running a handful of Central Massachusetts hospitals.

In October, Marlborough Hospital became the latest to implement a nicotine-free hiring policy, which involves testing job applicants for nicotine use and eliminating those who test positive from the hiring process. Applicants who test positive are invited to reapply after 90 days, and those who are hired are not testing on an ongoing basis for nicotine use, nor are employees who were hired before the policy was implemented.

Smoke-free hospital campuses are now the norm, but nicotine-free hiring policies, which essentially exclude people from work because they engage in a legal, if unhealthy, activity in their free time, are still somewhat novel. Saint Vincent Hospital in Worcester implemented such a policy in 2012, while HealthAlliance Hospital, which, like Marlborough, is part of the UMass Memorial Health Care system, launched its nicotine-free hiring policy in January.

Fran Meringolo, director of human resources at Marlborough Hospital, acknowledged that a nicotine-free hiring policy may rub some people the wrong way.

“It is controversial and there are people who say it’s discriminatory,” Meringolo said in a recent interview, about a month after the new policy was implemented.

But is it really discriminatory to refuse to hire nicotine users? In one important sense, it’s not. Meringolo noted that the hospital felt comfortable adopting the policy because smokers are not a protected class under federal anti-discrimination law. That’s reassurance that, should an applicant challenge the policy, Marlborough Hospital would not face recourse. That doesn’t mean the policy can’t be challenged in court, but it’s worth the potential risk, Meringolo said.

“It’s been proven that it has such a relationship with … preventable disease. As a healthcare organization, we think it’s the right thing to do,” Meringolo said.

A closer look at Marlborough Hospital’s policy, which is similar to those held by other area hospitals, also indicates that the hospital has taken a relatively relaxed approach to ensuring employees are nicotine free. The test is only performed during the job application process, and there’s no follow-up testing, so people could potentially resume or begin using nicotine products after they’re hired. The hospital also would not retaliate against an employee found to be using nicotine products, unless they were doing so on the hospital campus, Meringolo said.

Healthcare lobby may guard against challenges

That may be a reason that Marlborough Hospital has received little pushback related to the new policy. Bob Kilroy, chair of the Labor and Employment group at Worcester law firm Mirick O’Connell, said the policy is a relatively safe approach for hospitals to take toward fostering smoke-free environments. So far, there have been no legal impediments in Massachusetts to such a policy. Similar policies have been challenged in other states, and some now have laws protecting workers from discrimination for smoking and other lifestyle choices, Kilroy said. But he doubts such legislation could pass muster in the Bay State.

“You’ve got a very strong healthcare practice and lobbying arm here in Massachusetts,” Kilroy said.

Nicotine-free hiring policies have mostly been practiced by healthcare organizations so far. But that could change. Kilroy cited some major companies, like Alaska Airlines, Union Pacific Railroad and Turner Broadcasting, that have employed smoke-free hiring policies.

On the other hand, employers need to be careful. By excluding those who smoke, or use other nicotine products, from the pool of candidates, companies may be limiting their labor pools. Companies that employ a large-number of low-wage workers might be particularly challenged, because those workers tend to have a higher rate of nicotine use, Kilroy said.

A separate issue is that of health insurance coverage for employees who use nicotine products. Some companies provide plans with higher premiums for smokers, and that’s allowed under the Affordable Care Act, though the federal healthcare law and the Health Insurance Portability and Accountability Act (HIPAA) do limit premiums for smokers, Kilroy said.

Is insurance cost a factor?

The fact that smokers tend to have more health problems, and therefore higher health insurance claims, than non-smokers begs the question: Are companies motivated to hire nicotine-free employees mostly because it saves money on insurance claims?

Local hospital officials say that it will be interesting to see how nicotine-free hiring impacts claims, but that’s not the main driver. According to Dr. Daniel O’Leary, chief medical officer at HealthAlliance Hospital in Leominster, said hiring nicotine-free employees is part of the hospital’s larger campaign to encourage smoking cessation in the North Central Massachusetts area it serves.

HealthAlliance began offering a low-radiation CT scan to smokers and those who have quit in the last 15 years about two years ago. Physicians use the lung cancer screening scan as an opportunity to discuss smoking cessation to those who choose to undergo it. Rolling out the nicotine-free hiring policy on Jan. 1 is showing the community HealthAlliance employees walk the walk, O’Leary said.

“We’re tip-toeing into it,” O’Leary said. Like Marlborough Hospital, HealthAlliance does not regularly test employees for nicotine use. Also like Marlborough, HealthAlliance invites applicants who test positive for nicotine to reapply in 90 days.

“The reason we didn’t get a lot of push back is, honestly, it’s a very small step,” O’Leary said.

Regarding saving on health insurance claims for employees, O’Leary said the hospital isn’t yet following that data.

“Our goal is to help our employees not smoke cigarettes,” O’Leary said.

Follow-up testing a logistical feat

For now, follow-up testing of established employees isn’t on the agenda for HealthAlliance and doing that would likely be challenging, said Jan Peters, chief human resource officer at Saint Vincent Hospital. Peters, who championed a nicotine-free hiring policy that was adopted in 2012.

“Operationally, trying to stay on top of it is a pretty difficult proposition,” Peters said.

That doesn’t mean testing upon hire isn’t an effective way to reduce nicotine use among the workforce. Though existing employees were grandfathered, and exempt from testing when the policy was put into place, some ended up quitting anyway, said Peters, herself a former smoker.

Today’s culture around nicotine use by employees has certainly come a long way since Peters joined Saint Vincent 25 years ago. She recalled a time, years ago, when there were smoking platforms on the campus. Eventually, Peters led the push to convert to a smoke-free campus in 2009.

Of the changes, Peters said, “It was much smoother than even I expected it to be.”