When Group Health decided to kick tobacco’s butt
KP Washington Health Research Institute

Retired Group Health pulmonolgist James B. deMaine, MD, asked that I share these additional details regarding Group Health’s anti-tobacco initiative in the 1980s:

Dear Joan,

I enjoyed your history of Group Health’s activities in controlling smoking. I joined Group Health’s medical staff in 1971 as an internist pulmonologist and was very frustrated with smoking in the workplace and in the hospitals. I even saw our Cardiologists smoking on rounds at the nurses stations. I became chair of the Washington Lung Association’s Smoking Advisory Committee and in the late ‘70’s we surveyed Washington hospitals and found that none of them had a significant stop-smoking policy.

Also, I became frustrated by seeing a new patient with lung cancer almost weekly. The cases were often advanced with only a 5% five year survival. Emphysema and chronic bronchitis with tobacco addition were rampant problems. Medical personnel were no exception. Many doctors smoked as did several respiratory therapists and a majority of the ICU nurses. I began to give talks to groups about the perils of tobacco. Having watched consumer initiatives at work at GHC annual meetings, I decided that the initiative consumer voice might be the best way to get the ball rolling.

In the late 70’s I approached Dr. Tommy Thompson about bringing a petition to the GHC Board of Trustees to take a close look at GHC’s institutional smoking policies (or lack thereof). Tom was head of GHC’s Prevention Committee and brought it to his committee which endorsed the call for review. Prior to this several mid-level administrators and nurse managers had attempted to implement smoking control policies but there was always too much push back and GHC had no general policies on smoking controls. As one GHC Attorney said at the time, “I can’t tell my secretary that she can’t smoke at her desk!”

The petition to review and implement smoking policy at GHC was then taken from the Prevention Committee to the Medical Staff Executive Committee where it was enthusiastically endorsed. From there I submitted it to the GHC Board of Trustee’s Annual Meeting in 1982 where the consumers could have a voice, yea or nay. It read as follows: “Recommendation: The Board endorses the resolution to take a studied look at the broad issue of cigarette smoking in recognition of GHC’s responsibility to promote a healthy lifestyle.” (see View magazine Annual Meeting Edition 1982)

Fortunately, this seemed to empower upper levels of management to begin an innovative and effective process of change. After much internal debate and discussion, CEO Phil Nudleman announced that GHC would effectively become a smoke-free organization. The date set was about a year away. Initially exceptions were made for “smoking rooms” and outside areas. An organizational consultant was hired to talk to all the groups and to help them move forward. This was like starting a giant snowball. Within a few months some clinics had become non-smoking and within a year GHC became the first large healthcare organization in the country to become non-smoking. My colleague, the late Dr. Jerry Beekman, was a primary force in the guiding and implementing of the policies.

So I thought I’d add a little more history to your excellent story.

Best regards,

James B. deMaine, MD
Pulmonary/Critical Care — Retired Group Health
Emeritus Clinical Professor of Medicine UW School of Medicine