Koop Calls On Hospitals to Ban Smoking : May Try to Force Curbs on Institutions Participating in Medicare

Top federal health officials Friday called on the nation’s 7,000 Medicare-participating hospitals to ban smoking in their facilities and said that they are considering making a smoke-free environment a “formal condition” for participation in the program.

“The evidence is now clear regarding the hazards to patients of exposure to involuntary smoking,” said Surgeon General C. Everett Koop and Dr. William L. Roper, administrator of the Health Care Financing Administration, which runs the federal Medicare and Medicaid programs, in a letter to hospital administrators.

Swift Action Urged

“We believe that hospitals, as leaders in the health care field, should take swift and concerted action to protect patients from these hazards, and to serve as an example to their communities by creating a safe environment,” they wrote.

Two weeks ago, Koop issued his annual report on smoking, which focused on the addictive properties of nicotine. He termed nicotine as addictive as cocaine and heroin and recommended that laws restricting the sale of tobacco products to minors be strengthened and expanded--including requiring establishments where tobacco is sold to have a license. In addition, he urged that health labels on cigarettes include warnings about addiction.

Koop’s 1986 report concentrated on the dangers of “involuntary smoking” and declared that exposure to environmental smoke is a cause of disease in nonsmokers and that separation of smokers from nonsmokers within the same air space reduces, but does not eliminate, nonsmokers’ exposure to smoke.

Patient Susceptibility Noted

Citing the 1986 report in their letter, Koop and Roper wrote: “We are especially concerned about smoking in health care facilities. Patients in these facilities are probably more susceptible than the general population to the ill effects of passive smoking, particularly children and those with lung or heart conditions. Many are less mobile (or immobile), and thus less able (or unable) to avoid exposure to tobacco smoke.”

In February, 1987, smoking was banned in general office space in all federal buildings, although designated smoking areas were permitted. However, Koop and Roper have asked hospitals to establish total smoke-free environments.

The latest volley in the war against cigarettes, predictably, was praised by health and anti-smoking groups and attacked by the tobacco industry.

“Certainly, there are areas in a hospital where smoking can be allowed,” said Gary Miller, assistant to the president of the Tobacco Institute. “There’s no necessity for an all-out ban. We’d be opposed to anything like that. This type of government intrusion is unwarranted. It causes more disruption among employees than good.”

Matthew Myers, speaking for the anti-smoking Coalition on Smoking OR Health, noted that many hospitals have already instituted smoking bans, adding: “Health care facilities have a special role both in protecting their patients and as serving as role models for the rest of society. We hope this serves as a catalyst for those hospitals which have not yet acted to do so.”

A spokesman for Roper said the agency has the authority to propose a regulation that would require hospitals to establish smoke-free facilities as a condition for participating in the federal aid programs but first wanted “to give hospitals an opportunity to do so voluntarily.”

Endorsements Cited

The Health Care Financing Administration said that major medical and health care organizations, including the American Medical Assn., the American College of Physicians, the American Heart Assn. and the American Academy of Pediatrics, already have endorsed the goal of smoke-free hospitals.

Further, the agency said, officers of the country’s leading hospital industry groups, including the American Hospital Assn., the Federation of American Health Systems and the American Osteopathic Hospital Assn., “are informing their memberships and encouraging them to pay special attention” to the Koop-Roper letter.