Thursday, January 24, 2013
The history of smoking restrictions

By Dr. Anthony Policastro
Recently, Beebe Hospital made an announcement about smoking and employment. Columnist Frank Calio commented on the announcement. One of the things in question is related to whether the idea of not hiring smokers is reasonable or not. In order to answer this question, we need to spend some time looking at the history of cigarette smoking and hospitals. There was a time when smoking was not thought to be that bad. In those days, there were few restrictions on smoking. At that time about half the population smoked. There was not much evidence of issues from secondhand smoke. Over time we learned about the dangers of smoking. Even after we knew about the dangers, not many changes were made to smoking restrictions. That changed over time. In 1985, I was assigned to an Air Force hospital in England. One of the physicians asked the hospital commander to ban smoking for patients in the hospital. The commander (a smoker) did not want to do that. I told the physician that all he needed to do was tell his patients that they could not smoke while they were in the hospital. He objected because he did not want his patients to get angry at him. He wanted to be able to blame the restriction on the commanding officer. A year later in 1986 I was the hospital commander at an Air Force hospital in South Carolina. I made a decision that inpatients in my hospital would not be allowed to smoke. At the time, that was something that was just not done. We had the first smoke free hospital in the entire Air Force. My logic was that patients in our hospital were putting their health care in our hands. Part of our responsibility was to keep them from doing unhealthy things while in the hospital. In order to protect my physicians from complaints, I made it a requirement that anyone who wanted an exception to the rule had to get that from me personally. That gave me the chance to explain that I was using this opportunity to look out for their health. As expected, many patients were unhappy. I was able to enforce the rules relatively easily. An active duty individual that violated the rules would face possible court martial for failing to obey a direct order to discontinue smoking while in the hospital. A dependent would be faced with a transfer to a civilian hospital where they would be responsible for 20% of that hospital's bill. They paid nothing in the military hospital. Those seemed to be good deterrents. When I moved to be the commanding officer of another Air Force hospital in Virginia in 1989, I again made the hospital non-smoking. This time it was not such a big thing. Other military hospitals had now started doing the same thing. However, I did make one additional change at the new hospital. Smokers frequently got smoke breaks. I continued to allow that, however, I made it a requirement that all individuals in the hospital got equal break time. Thus, if a smoker got four smoking breaks per day, the supervisor had to give everyone in the office four breaks per day. Most supervisors could not afford that amount of lost time. Thus, they limited the number of smoke breaks. This was now another idea whose time had come. Over the subsequent years we learned more about secondhand smoke. The immediate result was separate smoking areas. Then there were bans on smoking in public places. Both of these would not have been possible in earlier years. Further steps over time included changes in health insurance premiums for smokers. Over time the number of smokers has decreased over 50%. Therefore, changes that would have affected over half the population in the mid 20th century now only affect less than one quarter of the population. While it would be good if the number eventually drops to zero, that is not likely to happen. That leads us to the question about an employer making a decision to not hire smokers. At this present point in time, that is clearly ahead of the curve in terms of what is expected. In the future that might not be the case. It may prove to be similar to what I did in 1986 when I banned smoking by my hospital patients. It may prove to be a move that is ultimately judged to be unfair to smokers. However, it is more likely that time will tell how this decision will ultimately be judged.

Flu outbreak dangerous for seniors This flu season is shaping up to be one of the worst in decades - with the Centers for Disease Control already reporting widespread outbreaks in many states. While anyone can get the flu, seniors are especially susceptible to the virus and are at greater risk for serious flu-related complications that can lead to hospitalization and even death. Ninety percent of flu-related deaths and more than half of flu-related hospitalizations occur in people age 65 and older. "The flu can be very dangerous for seniors, so we are concerned about this recent outbreak," said Jeff Huber, president of Home Instead, Inc., franchisor of the Home Instead Senior Care franchise network. "We encourage seniors and their families to take extra precautions to protect themselves from the virus." To fight the flu, senior care experts recommend the following: Get a flu shot: Experts strongly encourage all seniors and those in frequent contact with seniors to get vaccinated if they haven't already done so. Medicare covers one vaccine per flu season. Practice good hand washing: Wash hands with soap frequently, especially after coughing or sneezing. If soap and water aren't available, use an alcohol-based hand sanitizer. Cover coughs and sneezes: Droplets from a sneeze or a cough can travel up to six feet. Cover coughs and sneezes with a tissue and dispose of the tissue immediately. If a tissue is not available, cough or sneeze into the elbow, not the hands. Stay in to stay well: If there's an outbreak in the area, avoid trips to crowded shopping centers or community events. Avoid contact: Those with flu-like symptoms, especially school-aged children, should avoid contact with senior loved ones. Enlist the help of friends, neighbors or professional Home Instead caregivers to take over caregiving responsibilities, if necessary. Rest well, eat well: Get plenty of sleep, drink plenty of fluids and eat healthy foods. Experts also recommend a diet rich in Vitamins C and D and plenty of exercise. If senior loved ones begin to show symptoms of the flu, contact their health care provider immediately. Antiviral medications (like Tamiflu) are available to help make symptoms less severe. For more information about senior and caregiver well-being, visit

Cholesterol, glucose screening Nanticoke Memorial Hospital will offer cholesterol and glucose screenings at the Seaford Senior Center on Thursday, Feb. 21, from 7 to 10 a.m. Screenings are free with a $10 donation appreciated. Free blood pressure checks will also be offered. For more information, call 629-6611, ext. 8948. Pre-registration is not required.

Free flu clinic at Beebe Even with the flu outbreak in full swing in Delaware, it is not too late to get a flu vaccination. Beebe Medical Center is holding an additional free Flu Clinic, Saturday, Jan. 26, from noon to 4 p.m., at the Bookhammer Outpatient Center at the Beebe Health Campus, 18941 John J. Williams Highway in Rehoboth Beach.

Pre-registration is not required. The vaccinations are available for those 18 and older. More information about the flu can be found on the CDC website, For more information, contact Beebe's Population Health Department at 645-3337.

Beebe receives Healthgrades award For the fourth year in a row, Beebe Medical Center has received the Distinguished Hospital Award for Clinical Excellence from Healthgrades, a leading provider of comprehensive information about physicians and hospitals. This distinction places Beebe Medical Center among the top five percent of more than 4,500 hospitals nationwide for clinical performance. The Centers for Medicare and Medicaid Services (CMS) has recognized Beebe Medical Center in its "Hospital Value Based Purchasing" rating system. Beebe Medical Center received a 73.3 rating, which put it 32 percent higher than the national average and 53 percent higher than the Delaware hospital average. A 2012 Medicare (CMS) report shows that Beebe Medical Center also stands out as a hospital that provides high quality patient care at an efficient cost. Becker's Hospital Review, a respected industry publication, in 2012 also named Beebe Medical Center among the 100 Great Community Hospitals in the nation. Healthgrades over the past year has recognized Beebe Medical Center for its quality care in orthopaedic surgery, cardiology, vascular surgery, and pulmonary care. The 2013 performance outcomes are now available free to the public at

Bayhealth pioneers surgery Rahul Singh, MD, and Wendy Newell, MD, of Wolf Creek Surgeons, performed Delaware's first single-site cholecystectomy using the da Vinci robotic surgery system at Kent General Hospital, Dover. Neither robotic surgery nor single-incision surgery is new, but combining the two to remove the gallbladder allows surgeons to apply the procedure to a wider range of patients. In addition, the da Vinci system provides a 3D view of the patient's internal organs. This perspective enables meticulous dissection of the diseased gallbladder and reduces the risk of damage to nearby organs. Controls below the console's screen allow them to manipulate the instrument's arms and camera inside the patient's body as if they were their own fingers. Bayhealth is currently the only facility in Delaware to offer thoracic and colorectal robotic surgeries. Various types of robotic-assisted surgeries are also available at Kent General Hospital. Bayhealth also offers a wide range of minimally invasive conventional laparoscopic surgeries. To learn more about robotic and other minimally invasive surgeries at Bayhealth, visit

Walk for Autism is April 20 As a statewide agency whose mission is to create better lives for people with autism, Autism Delaware is expanding to provide the range of services needed by all Delawareans living with autism spectrum disorders over their lifespans. To this end, the nonprofit agency relies on volunteers, donations, and fundraising. "Our next big fundraiser in southern Delaware is Walk for Autism on April 20 at Cape Henlopen State Park," says Lisa Albany, the committee chair. "Our goal is to raise as much as possible to provide services through Autism Delaware that benefit individuals with autism spectrum disorders. We need volunteers to help run the event plus business and corporate leaders to sponsor it." "The need for autism services and support is rising rapidly," adds Autism Delaware Executive Director Teresa Avery. "The CDC now says that one in 88 children is identified with an autism spectrum disorder. In 1991, the Delaware Department of Education reported 152 public school students with autism – and 982 in 2010. That's a 546 percent increase over 19 years. For more information, visit

CPR classes offered Nanticoke Memorial Hospital will offer community CPR classes to anyone interested in learning CPR at the Nanticoke Training Center located on Water Street in Seaford. Participants will learn how to perform the basic skills of CPR on adults, children, and infants and how to help an adult, child, or infant who is choking and use of the AED. This classroom-based, video, and instructor-led CPR course offers families, friends, and community members the opportunity to learn CPR and receive a course completion card. Classes are open to participants ages 12 and up. The target audience is those who have a duty to respond to a cardiac emergency because of job responsibilities or regulatory requirements. Cost is $45. Payment and registration is required by no later than five business days prior to the class. Late registrations may be accepted if seating is available. To register and obtain a listing of class dates/times, contact the Nanticoke Memorial Hospital's Training Center office at 629-6611, ext. 8919. Pre-registration is required.

Parkinson's support group meeting The Nanticoke Parkinson's Education and Support Group will hold its regularly scheduled monthly meeting on the third Monday of each month, from 10 to 11:30 a.m in the ballroom at the Nanticoke Senior Center. The public is welcome to attend the meeting and stay for lunch and a social time after the meeting.

Diabetes education program Nanticoke Memorial Hospital will offer a free educational program to share diabetes self-management and lifestyle strategies at 5 p.m. on Monday, Jan. 28. Roger Baird, a member of the A1C Champions¨ Program and supported by Sanofi, a patient-led approach to diabetes education, will present the program which is based on his extensive training and his personal experience living with diabetes. If you or someone you know is struggling with diabetes or has an A1C that is 7% or above, the A1C Champions¨ can provide motivation to take those first steps to better blood glucose control. Diabetes patients need to know they are not alone and there are people like Roger who can help them along their journey with diabetes. Call 629-6611, ext. 2446, to reserve space for this free event.

Go Red for Women 2013 The Southern Delaware Go Red For Women will be held on Friday, Feb. 8. Tickets, which are $35 each, include extensive health screenings, $10 gift card from Macy's, guest gift bag and lunch, entertainment that includes fashion show and silent auction. Table sponsorships are $1,000 and exhibitor sponsorships are $1,500. The event begins at 10 a.m. with lunch and the program starting at noon. For more information, visit

HIV/AIDS Support Group A new support group for HIV/AIDS will meet every other Wednesday, at 7 p.m., in the Branford Lounge at Epworth UMC at 19285 Holland Glade Rd., Rehoboth Beach. The group is sponsored by Epworth UMC, CAMP Rehoboth, the AIDs Delaware and Delaware HIV Consortium. For more information, contact David at