Cleveland Clinic: New hires must be nonsmokers

Smoke-free policy extends to home

At the Cleveland Clinic, smoke-free means more than clearing the air in the hospital. The hospital doesn't want employees smoking anywhere — even in their own homes. Smokers need not bother applying for a job, unless they intend to quit.

The health system is testing all new hires for cotinine, a metabolite of nicotine. Anyone who tests positive has 90 days to quit. The job will be held open and prospective employees will be retested. If they fail to have two weeks of negative urine tests, the offer is withdrawn.

The rule, which went into effect Sept. 1, 2007, applies equally to a top-ranked cardiac surgeon or an environmental services worker or an employee of the vendor who stocks the snack machines.

The no-smoking policy is part of the Cleveland Clinic's commitment to health among its employees as well as its patients, says Michael Roizen, MD, chief wellness officer. An internist and anesthesiologist, Roizen is author of several best- selling books, including YOU: The Owner's Manual with co-author Mehmet Oz (Collins, 2008).

"As a health care organization, we believe we need to stand for health," says Roizen. He notes that smoking is a major contributor to chronic disease and skyrocketing health care costs in the United States. "We felt we had to get rid of toxins and set an example."

In the first eight months of the health system's policy, only two applicants tested positive at the Cleveland Clinic's main campus, says Roizen.

It may seem like an audacious policy to have in the midst of a nursing shortage. But Roizen asserts that the positive response has outweighed the negative. Among employees, the e-mails ran 17-1 in favor of the health care system's smoke-free policies. Current employees who smoke outside of work do not face sanctions.

"We've had an increase in applications, not a decrease," he says. "We don't think it's disadvantaged us and it may have advantaged us."

Although the no-smokers policy is unusual, it is not unique. In 2003, Weyco Inc., a medical benefits administrator based in Okemos, MI, announced that it would not hire smokers and gave current employees 15 months to quit. The company offered a variety of smoking cessation techniques and began giving breath tests. Smokers who were not enrolled in smoking cessation were fined $50 a month, and at the end of the transition period, they were expected to have quit smoking. Four employees chose not to be tested and lost their jobs.

"We are saying people can smoke if they choose to smoke. That's their choice. But they just can't work for us," Gary Climes, Weyco's chief financial officer, told The Detroit News.

It is legal in most states for employers to refuse to hire smokers, says Jeremy Gruber, JD, legal director of the National Work Rights Institute in Princeton, NJ.

But Gruber considers it a dangerous trend. "This is only one example of many across the country where employers are refusing to hire smokers or trying to push smokers out of their current employment ranks," he says. "Employers are legitimately faced with the rising cost of health care, but unfortunately a growing number are starting to try to save money on the backs of their employees.

"I think employees should be judged on their ability to do their job," he says.

Beyond the smoke-free hospital

The Cleveland Clinic wants to make a statement against smoking that goes beyond signs that declare the hospital "smoke-free."

The smoke-free policies began in 2005, the year after Toby Cosgrove, MD, a cardiothoracic surgeon, became CEO. He offered smoking cessation classes — and not just to employees. Anyone in the community who came to the Cleveland Clinic could get free nicotine therapy.

"Smash the Ash" was meant to be a catchy slogan for a campaign to eliminate smoking. But some smokers saw it as "anti-smoker" as well as "anti-smoking," says Roizen. That was not the intent, he says. But the no-smoking policy did have a punitive edge. Employees caught smoking on hospital grounds receive a reprimand for the first offense and can be terminated after a second offense, says Roizen.

Overall, the no-smoking efforts were successful, as almost 1,700 employees and 1,000 family members ultimately quit smoking, Roizen says.

In 2006, the Cleveland Clinic entered a more public battle over smoking as it became a prominent player in ballot initiatives. The health system helped sponsor a massive ad campaign in support of a ballot initiative that would ban smoking in bars, restaurants, and other public places. At the same time, the health system opposed another ballot measure that would create a constitutional amendment to preserve the right to smoke in restaurants, bars, bowling alleys and bingo halls.

The smoking ban ultimately passed — and the constitutional amendment failed. "The Cleveland Clinic is credited in Ohio with turning the tide and getting that ban passed," says Roizen.

While critics such as Gruber question whether employers such as the Cleveland Clinic will begin policing other unhealthy lifestyle choices, Roizen says the health system has no intention to expand its no-smokers policy. Current employees may continue to smoke — and, in fact, if a new hire passes the no-nicotine test but then begins to smoke again after getting the job, she won't face any repercussions, he says.

Meanwhile, other leading hospitals have visited the Cleveland Clinic to learn about its smoke-free policies. "We believe we have made a difference," he says.