Anyone who wants a job next year at Anne Arundel Medical Center — whether as a surgeon or security guard — will have to prove they don't smoke or use tobacco.
The Annapolis hospital's new hiring policy might be controversial, but it is legal in Maryland and more than half of the United States. And it's a type of job screening that is gaining favor with employers — from hospitals to companies such as Alaska Airlines — trying to control rising health costs and cultivate a healthier, more productive workforce.
Anne Arundel Medical Center, like a growing number of health systems, universities and other businesses, will require a urine test for nicotine use for all applicants starting next July. The policy — which will not apply to current employees — is just one piece of the hospital's existing ban on tobacco use that was expanded July 1 to apply at all hospital buildings and surrounding public sidewalks, parking lots and garages. It covers not only cigarettes, but cigars, pipes, snuff and e-cigarettes.
Hospital representatives, who say their primary mission is "living healthier together," say the new rules grew out of two years of researching ways to prevent tobacco-related diseases — and hearing out those who questioned the policy's fairness and legality. The hospital hopes that health care costs will decrease over the long term, but that was not the primary driver, said Julie McGovern, the center's vice president of human resources.
"We're doing this to improve the health status of our community," McGovern said. "It's a serious obligation we have ... and one of the important steps we can take to be a role model."
But others say such policies set a dangerous precedent.
"These things are extremely intrusive," said George Koodray, assistant U.S. director of the Citizens Freedom Alliance, an organization that advocates for smokers' and property rights. "I think they really overstep. They really, in a lot of respects, defy so many principles that we believe in as Americans.
"What these folks are saying is they're going to deny a person's livelihood due to the fact that people are consuming a perfectly legal product that does not necessarily adversely affect their health," he said.
About 42.1 million people nationwide — about 18 percent of the population — smoke cigarettes, according to a February report from the Centers for Disease Control and Prevention. A 2013 survey by the U.S. Substance Abuse and Mental Health Administration found that 13.4 million people smoked cigars, 2.5 million smoked tobacco in pipes and about 9 million used smokeless or spit tobacco.
Some smokers say employers have no right to regulate employees' health-related choices outside the workplace.
Nickia Trafton, 40, takes smoke breaks from work as a phlebotomist at Mercy Medical Center to help relieve stress, adding that smoking is a personal choice she's made with full knowledge of the health risks.
"Everyone has an outlet," she said. "Cigarettes are sold over the counter — it's not illegal. ... My smoking doesn't interfere with my patients."
Her co-worker Pamela Schofield, also a phlebotomist, wondered who employers might target next.
"What about obese people, or if you weigh over a certain amount you are going to not be hired?" she said. "Smokers are not bad people."
Dajuan Robinson, a 25-year-old histology technician at Mercy has smoked for five years and is quitting now, largely because otherwise he'd be penalized with an added charge on his health insurance premium. But he believes employers with no-smoking policies in hiring have gone too far.
"I think it's a form of discrimination — you can't say someone can't come to work because they smoke," he said. "It's not fair. Smoking is legal at the end of the day."
Federal law does not protect tobacco users from discrimination. Smokers are protected from employment-based discrimination in at least two dozen states, but Maryland is not one of them.
"We're sure it's enforceable," McGovern said. "We think it's the right thing to do in trying to create a healthy population. That's our role."
Cigarette smoking, which causes more than 480,000 deaths a year nationwide, is the nation's leading preventable cause of death, according to the CDC.
"It contributes to more of the health burden than any other habit," said Cathy Brady-Copertino, executive director of the medical center's Geaton and JoAnn DeCesaris Cancer Institute. "We knew we had to take a different approach with tobacco and its awareness, intervention and policy."