News From Terre Haute, Indiana

February 6, 2011

MARK BENNETT: Lawmakers should question smoking-law exemptions, including those for nursing homes

Mark Bennett
The Tribune-Star

TERRE HAUTE — The amendments inside House Bill 1018 pretty much say it all about Indiana’s relationship with smoking.

We realize scientists with the Centers for Disease Control and Prevention, the Environmental Protection Agency and the Office of the Surgeon General all have concluded that smoking is harmful not only to the smoker, but also to other people inside the same building. We understand that 30 other states have enacted comprehensive laws to provide smokefree indoor workplaces. We know we lead the nation in adult smoking (1 in 4 Hoosiers do so). We’ve heard state statistics that medical costs related to smoking by Hoosiers total $2 billion a year, including a $487-million tab for publicly funded Medicaid cases.

And we don’t want to change, too much.

That’s essentially the sentiment behind all of the amendments members of the Indiana House of Representatives tacked onto a proposed statewide indoor smoking law. Those amendments would allow smoking in casinos, bars, private clubs and nursing homes.

The exception for nursing homes was unusual enough for the leader of the upper house of the Indiana Legislature — Senate President Pro Tem David Long, R-Fort Wayne — to tell The Associated Press, “We’re interested to see why it’s there. On its face, it draws questions.”

The proposal, House Bill 1018, is headed for review by Long and his fellow senators. It started in the Indiana House as a comprehensive ban to assure public indoor places would be smokefree. As usual, it was sponsored by Rep. Charlie Brown, D-Gary. For the fourth straight year, Brown’s smoking bill passed the House, this time by a 68-31 margin. Each time in the past, his bills passed the House but never survived long enough in the Senate to get a full vote. This year, such a vote might actually occur. That’s because Republican Gov. Mitch Daniels said he’s ready and willing to sign a smoking law, and because House members softened it with all of those exemptions.

Still, it appears the Senate intends to scrutinize the House’s exceptions to the bill, which is wise. The nursing home exemption would permit smoking only in separate, designated room. Nonetheless, the health of some folks in nursing homes is fragile, and exposure to secondhand smoke exacerbates existing health problems, especially respiratory ailments such as emphysema and COPD, according to studies by the EPA and others cited by the Center for Social Gerontology in Ann Arbor, Mich.

The nursing home exemption also would contradict trends around the nation. Since 2002, states such as Montana, New Jersey, South Dakota, Washington, Michigan and North Carolina (ironically, the top tobacco producer in the United States) have enacted statewide indoor smoking laws that include nursing homes, according to the Americans for Nonsmokers’ Rights. On a local level, Vigo County did the same thing in 2006, when the county commissioners — prompted by a brave, determined, landmark effort by the Vigo County Board of Health office — passed an ordinance that prohibited smoking in most indoor public places. Thus, Vigo County nursing homes have been smokefree since that ordinance took effect in 2007.

“The amendment to the Indiana [smoking] legislation would clearly run counter to that” trend, said Jim Bergman, co-director of the Center for Social Gerontology, a nonprofit research and social policy agency funded by the U.S. Administration on Aging, the state of Michigan and private donors.

“These days, it’s more and more unusual to see nursing homes that allow smoking,” Bergman added.

Don Lehe, a Republican state representative from Brookston, introduced the nursing home exemption to the proposed statewide smoking ban. He’d visited the nearby Indiana Veterans Home, and saw the facility’s smoking lounge, with a TV and recreation area. Lehe, who voted against the bill, emphasized his primary motivation for the amendment was, understandably, out of respect for aging veterans. Lehe said he wanted to preserve separate, designated smoking areas for vets at that home and in other senior care facilities.

His amendment would include any nursing home; it allows an exemption for “a health facility licensed under [Indiana Code] 16-28, including the Indiana Veterans Home, if the health facility chooses to provide a separate, designated smoking area.” Persons under 18 would not be allowed in those areas.

In 2006, the U.S. Surgeon General concluded that separately ventilated smoking rooms don’t eliminate the health risks of secondhand smoke exposure to others.

Though Lehe acknowledged that employees of nursing homes, who would need to accompany some smokers in those rooms for fire safety reasons, could encounter the irritation and smell associated with cigarettes, he questions the claims of health risks related to secondhand smoke exposure. Lehe found studies indicating the dangers of secondhand smoke have been overstated.

“There’s no significant correlation to lung cancer, there’s no significant correlation to death from being around secondhand smoke,” Lehe said by telephone Wednesday.

The Surgeon General’s report of 2006 says otherwise. It reads: “Secondhand smoke has been designated as a known human carcinogen (cancer-causing agent) by the U.S. Environmental Protection Agency, National Toxicology Program and the International Agency for Research on Cancer. The National Institute for Occupational Safety and Health has concluded that secondhand smoke is an occupational carcinogen.”

The Indiana Senate should take a reasonable, but proactive stance on exceptions to the smoking law. The Center for Social Gerontology offers a reasonable variety of “models” for states and municipalities to implement smokefree laws, including an option for a “grandfather clause” that would allow current nursing home residents to continue smoking in designated areas. Beyond that, nursing homes would become smokefree, just like they already are in Vigo County.

The Senate needs to strongly question the reasoning behind every exemption to the proposed smoking law, from casinos to bars, private clubs and nursing homes. If the proposed law purports to give Hoosiers the right to a safe environment in workplaces and public indoor spaces, then it should do so for all Hoosiers.

Mark Bennett can be reached at (812) 231-4377 or