Health commissioner becomes focal point of smoking debate

Monday, April 15th 2002, 12:00 am

By: News On 6

OKLAHOMA CITY (AP) _ The state Board of Health's failed attempt to ban smoking in public places is the first skirmish in a larger battle to improve the overall health of Oklahomans, says Health Commissioner Dr. Leslie M. Beitsch.

Smoking-related illnesses are the leading cause of preventable death in Oklahoma and the state's death rate from chronic illnesses related to tobacco use, including heart disease, cancer, stroke and chronic obstructive pulmonary disease, is among the nation's highest.

``Tobacco was directly responsible for three of the top four leading causes of death in the state,'' said Beitsch. ``Why not tackle that thing that is really at the root of the issue?''

About 6,000 Oklahomans die prematurely each year due to the effects of nicotine addiction, he said. Obesity and insufficient access to medical care also hurt the health of Oklahomans.

A United Health Care survey ranked Oklahoma 41st in the nation on health care issues in 2001, compared to 33rd in 1990.

``Every state, with some exceptions, became healthier. Oklahoma became less healthy,'' Beitsch said. ``We're really concerned about the health of Oklahoma.''

Beitsch, 46, discussed the smoking debate and his goals for improving the health of Oklahomans in an interview with The Associated Press.

Beitsch, who took over the state's top health job on June 1, became the focal point in the debate over smoking and the effects of secondhand smoke when the Board of Health adopted rules that would have banned smoking in most public places, including restaurants, shopping malls and bars.

Beitsch, former deputy secretary and assistant state health officer for the Florida Department of Health, said the Board of Health passed the rules only after legislation that would have imposed a similar ban failed to make it through the state Senate.

``Rule making was only done by the board as a last resort,'' Beitsch said.

Beitsch, who earned his medical degree at Georgetown University and his law degree at Harvard, defended the rules at legislative hearings where lawmakers chastised him and the board.

Lawmakers accused the health officials of usurping a legislative function and acting outside their authority.

``Some people think I'm a health Nazi. Some people think I'm brusque. They may be right,'' Beitsch said.

But as commissioner of health, Beitsch said his role is to be frank about the state's overall health in the same way a doctor must break bad news to a patient.

``If you have a medical problem, you expect them to tell you about it,'' he said. ``I'm obligated to share with you what that situation is. I am accountable.''

The rules were disapproved by a legislative committee and Gov. Frank Keating, who said they conflict with state law.

But Keating said there is popular support for eliminating secondhand smoke in public places. The governor vowed to work with the Board of Health to draft new rules that would meet legal muster.

``The governor really threw down the gauntlet,'' Beitsch said. ``There is popular support for everything we have proposed. We're very well tuned into what a silent majority wants.''

Rep. Charles Gray, D-Oklahoma City, chairman of the committee that rejected the rules, said he admires Beitsch's passion about health issues.

``That's his job,'' Gray said. ``I think we're fortunate to have Dr. Beitsch. I have high regard for him.''

The smoking rules were drafted to limit the exposure of nonsmokers, who comprise more than 75 percent of Oklahomans, from secondhand smoke, which studies have shown contain more than 40 cancer-causing compounds.

The Department of Health said that 89 percent of Oklahoma adults questioned for a 1999 poll believed secondhand smoke was harmful. Seventy-five percent said secondhand smoke bothers them.

``At some point you need to say, we're going to take a more aggressive approach,'' Beitsch said. ``If we're going to move our state forward, we've got to take action.''

Beitsch rejected arguments by some that scientific findings on the affects of secondhand smoke are soft ``pseudoscience.''

``This science is not soft. The heads of people who make those statements are soft,'' Beitsch said.

The debate over secondhand smoke helped pass legislation that bans smoking in the state Capitol and other state government buildings. Keating is expected to sign it.

But Beitsch said passing strict rules on smoking in other public places will be more difficult because of a shaky relationship with state lawmakers and a powerful tobacco lobby, which he said had an ``enormous impact'' in rejecting the board's smoking rules.

``Narrow business interests trumped the public interest,'' he said. ``The tobacco lobby loves Oklahoma _ and they ought to.''

Beitsch said the tobacco industry is working to preserve its $1.2 billion annual revenue stream from Oklahoma. He said the industry sold 360 million packs of cigarettes in Oklahoma in 2000 at a cost of about $3 a pack.

Oklahoma ranks fifth nationally in the per capita purchase of cigarettes and cigarette use costs the state $1.2 billion a year in health care costs and lost productivity.

Beitsch said he was disheartened at the lack of support the smoking rules received among state lawmakers, with whom Beitsch has had a sometimes stormy relationship.

``A positive working relationship with the Legislature is crucial. We got off on the wrong foot,'' he said.

In February, Beitsch was subpoenaed to appear before a House committee that had invited the health commissioner to discuss some proposed health Department rules regarding health care reporting by hospitals and surgery centers.

Beitsch was at a different meeting and unable to attend. The subpoena was later withdrawn.

Beitsch said at the time he believed the Health Department was being punished by lawmakers for aggressively working to change the state's high prevalence of smoking and other tobacco use.

``I don't want to commit my efforts and my hard work and misery if there's not going to be support,'' he said. ``You only get one maiden voyage. Mine was tainted from the beginning.''