Legal Eagle Eye Newsletter for the Nursing Profession(4)3 Dec 95

   Quick Summary: The court accepted medical testimony that there are sound treatment-related reasons for not attempting to ban smoking outright by psychiatric patients in the throes of acute psychotic symptoms. The needs of patients are paramount.  

  Even if the plaintiff filing this suit alleging disability discrimination had proven that the defendant psychiatric facility had failed to accommodate her asthmatic condition by not banning smoking in designated patient-smoking areas in the facility, the defendant facility exonerated itself from fault by producing convincing evidence that completely banning its acutely psychotic patients from smoking at the facility would pose an undue hardship upon them.

      In different circumstances, an outright ban on smoking in a healthcare facility might be an appropriate accommodation to employees’ respiratory conditions.

   Admittedly there are very few situations where patients’ medical needs are served by permitting them to smoke.  COURT OF APPEALS OF MICHIGAN, 1995.

   An asthmatic mental health worker was expected to go into all areas of the psychiatric facility where she worked, including the designated patient-smoking areas. Intensive care patients were required to have their cigarettes lighted by a nurse at the nursing station, then walk to a designated area to smoke.

   The Michigan Court of Appeals threw out a suit against the facility which was filed under state disability-discrimination laws, because the accommodation sought in the suit would have imposed an undue hardship upon the employer, and would have gone beyond the employer’s obligation to make reasonable accommodation to an employee’s disability.

   The court agreed that asthma is a disability which would normally require accommodation to the employee’s need to be free from exposure to second-hand tobacco smoke. This employee in particular had documentation from her physician that exposure to tobacco smoke was aggravating her respiratory problems, and this was communicated to the nursing administrator of the facility.

   To ban smoking altogether in this psychiatric facility, however, or to give this employee a position where she was never exposed to second-hand smoke, was not a reasonable accommodation, but would impose an undue hardship upon the employer under this unique factual scenario, the court ruled.

   According to medical testimony offered by the facility in defense of its claim of undue hardship, acutely psychotic patients addicted to tobacco can experience increased assaultive behavior, acute withdrawal and profound depression if their access to nicotine is abruptly halted, which is detrimental to treatment strategy. Management of acute psychotic symptoms must be achieved before the issue of nicotine addiction can be addressed. Hall vs. Hackley Hospital, 532 N.W. 2d 893 (Mich. App., 1995).

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