The Carroll Hospital Center campus has been a no-smoking zone since 1998, but in a decision announced on Thursday, the organization has taken its anti-smoking efforts to a new level: The hospital will no longer hire anyone who uses nicotine in any form — including e-cigarettes, nicotine patches and gums — making the controversial claim that the use of such products is as hazardous as smoking.

"We expected a lot of attention with this: We understand that it's a bold move," said Leslie Simmons, president and CEO of Carroll Hospital Center. "Back in 1998, when we made the decision to go smoke free, that was a bold move then. ... Going nicotine free is just the logical next step."

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Beginning Jan. 1, applicants for positions with Carroll Hospital Center will be tested for nicotine along with the usual pre-employment drug screen, according to Simmons. Those who fail will be offered a free 90-day supply of smoking cessation products, their choice of nicotine patches, gums or other products.

"It is $750, for a 90-day supply, and we would provide that for free," Simmons said. "We would encourage them to reapply and retest in 90 days. We are not trying to make this punitive; we are really trying to help people."

Current hospital employees have been eligible for the free smoking cessation products for the past two years, according to Simmons, with voluntary nicotine testing.

"Last year, we made the nicotine testing mandatory if you had our insurance. If you tested positive, we again offered cessation products," she said. "This year, if you decided you didn't want to quit, then a smoking surcharge was added biweekly for any associate covered under our insurance."

Current employees will be grandfathered in when it comes to the new zero-tolerance policy toward nicotine, however, Simmons said. No current employees will be fired for their use of tobacco or nicotine products.

There is no legal protection for smokers or nicotine users, whether they are new applicants or existing employees.

"I know there have been some questions about the legality, and of course, we would never do anything like this without having it thoroughly vetted," Simmons said. "The federal government ... classifies smoking as an activity, not an issue that is protected under the Americans with Disabilities Act, so we are perfectly within our rights to do that."

It's not just the Americans with Disabilities Act that applies to employment discrimination, according to the website of the U.S. Equal Employment Opportunity Commission. There is the Civil Rights Act, which protects against discrimination on the basis of race, religion, sex or country of birth; and the Genetic Information Nondiscrimination Act, which prohibits discrimination on the basis of genetic profile, as well as other regulations, but none of them prevent a company from excluding employees on the basis of a behavior like using nicotine.

Even if perfectly legal, the hospital's goal of controlling the behavior of employees at home and outside the workplace is troubling to some, including Carroll County Commissioner Richard Rothschild, R-District 4. While he acknowledges the right of the hospital to ban nicotine use on its own property, he bristles at the notion of a company controlling the behavior of individuals once they leave the hospital campus.

"This breaches a firewall that is very dangerous. If we can prevent people from working because they smoke, there is nothing to stop them from preventing them from working because they are obese or because they drink alcohol," Rothschild said. "Where do you draw the line?"

If the goal is protecting health and lowering insurance costs, Rothschild said, why not ban high-risk activities like skiing as well?

There is a major difference between skiing or even drinking and nicotine use, according to Simmons, however. Nicotine, she said, is the leading cause of death in the community and in the nation.

According to the hospital news release that announced the policy change, "Nicotine use causes a wide range of health problems, including heart disease and cancer, and is the leading cause of preventable deaths in the United States."

According to the Centers for Disease Control and Prevention, tobacco use kills 480,000 Americans annually.

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However, that figure pertains to the use of tobacco, and not tobacco-free nicotine products such as gums, patches and e-cigarettes. Nevertheless, that distinction is not recognized by the hospital.

"We look at them together. There is nicotine in tobacco," Simmons said. "I am not suggesting you won't find something out there that [will] differ, but our experts believe that nicotine is just as dangerous and causes just as much harm and needs to be dealt with."

Dissenting opinions on the risk associated with the use of nontobacco nicotine products is easy to find. According to a CDC spokesman, who in accordance with CDC policy would not give his name, while nicotine alone can have negative effects on the developing, adolescent brain, and is implicated in high blood pressure and heart problems, it is not a carcinogen, and the assertion that the use of nicotine gum, e-cigarettes or other nicotine products that do not contain tobacco are as dangerous as smoking has little scientific basis.

The CDC's website does provide information on the growing number of e-cigarette calls to poison control centers across the nation — 2,405 between September 2010 and February 2014, which are mostly due to children tampering with e-cigarette liquids. The number of poison control center calls related to traditional, tobacco cigarettes for this same time period was 16,248.

Carroll Hospital Center did provide links to Web pages that Simmons said support its view that nicotine products are as equally dangerous as tobacco, a National Institutes of Health Web page that discusses the effects of nicotine and tobacco and a CDC Web page that discusses quitting smoking. The addictive powers of nicotine are discussed in both, but the relative harms of tobacco-less nicotine products compared with tobacco products is not discussed in either.

It is the addictive power of nicotine and its relation to tobacco that concerns the hospital, Simmons said. Controversial or not, she said the decision is an important step toward reducing deaths from tobacco smoke.

"We have been working with the Partnership for a Healthier Carroll County, and we have a countywide goal to reduce the number of smokers in Carroll County by 2020. This is our best attempt," she said. "Again, we are not trying to do this punitively. ... We just really believe it is the right move for the health of our employees."

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Reach staff writer Jon Kelvey at 410-857-3317 or jon.kelvey@carrollcountytimes.com.

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