Anne Arundel Medical Center decision raises legal, ethical questions of tobacco-free hiring

Smoking is prohibited inside every workplace in Maryland, thanks to the Clean Indoor Air Act . In some workplaces, the policy is expanded to include the entire campus. Now, one hospital will become the first in Maryland to take its policy even further -- it won't hire tobacco-users period.
Anne Arundel Medical Center has banned smoking since 2007. But starting just last month, the use of any tobacco products, including e-cigarettes, is now prohibited throughout the entire campus. This time next year, the policy will include tobacco-free hiring. Though law experts say the policy is legal, it's not without controversy.
"It's a big part of the mission of the hospital of course, to maintain the health of the employees, but also the well-being of the environment and the health of the community and so that's really where all this is coming from," said Dr. Stephen Cattaneo, medical director of thoracic oncology at AAMC.
Cigarettes, cigars, e-cigarettes and chewing tobacco are all prohibited. Come July 1, 2015, using these products will also be grounds for rejecting job applicants.
"New applicants for employment will have a nicotine test essentially to see if there's any nicotine by-products in their urine, prior to be accepted for employment," Dr. Cattaneo said.
The medical center is following in the footsteps of a handful of hospitals nationwide that have adopted smoker-free hiring policies, though AAMC is the first to do so in Maryland. 
"We're fairly confident that under that case law, Maryland being an at-will employment state, that there is not a legal impediment to imposing such a policy," said Kathi Hoke, director of the Legal Resource Center for Public Health Policy at the University of Maryland Carey School of Law.
The center helps businesses, government agencies and advocacy groups develop sound and effective policies to reduce tobacco use. 
"The issues that one has to look at is, are there any kind of legal protections for smokers that might come into play here?" Hoke said. "One might look at the Americans with Disabilities Act to determine whether tobacco addiction would be considered a disability. And it is not and we've kind of cleared that hurdle of it not being considered a disability."
Twenty nine states and the District of Columbia have laws that prevent employers from discriminating against tobacco users. Maryland does not. Though the policy is legal, Hoke said there are other questions to consider. 
"Folks in lower socioeconomic groupings tend to smoke at higher rates, and so will this policy result in, if it were expanded beyond Anne Arundel Medical Center frankly, will it result in less employment opportunity for the least among us?" she said.
Cathy Reisenwitz, an editor at D.C. based Young Voices , said it can also be viewed as a business decision. People who use tobacco products cost more for their employers to insure.
"Smokers, the obese, people who like to eat fast food a lot, whatever it is, I think they should be really concerned about de-linking health insurance from employment," she said. "I really think that this would help disincentivize or remove that incentive to discriminate against them in employment."
Dr. Cattaneo said the ultimate goal is to promote wellness and prevent disease. As part of the policy, the hospital is expanding its free tobacco cessation programs, by increasing the number of treatment specialists and the availability of classes and counseling.
"Smoking has huge implications," Dr. Cattaneo. "It's the single biggest preventable cause of death and disease that we know of worldwide, and has major implications for heart health, lung health, vascular health and so forth."
Hoke said it's unlikely that other types of employers will follow suit.
"I don't see this particular shtick is something we're going to be seeing a lot of in Maryland," she said. "Again, maybe in other hospital systems, maybe in other health facilities. But I don't suspect it'll take off among private employers." 
Current employees who use tobacco do not have to worry about losing their jobs. The no-tobacco hiring policy will only affect new applicants starting July 1 next year.
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