US Hospitals Rely On Exploited Volunteer Staff, Potentially Violating Labor Laws

Mount Nice, S.C. — A lot of the 30 volunteers who work on the 130-bed, for-profit East Cooper Medical Middle spend their days aiding surgical sufferers — the scope of their duties extending far past these of sweet stripers, child cuddlers, and reward store clerks.

In reality, one-third of the volunteers on the Tenet Healthcare-owned hospital are retired nurses who examine individuals in for surgical procedure or escort sufferers to a preoperative room, stated Jan Ledbetter, president of the hospital’s nonprofit Volunteer Companies Group. Others relay necessary info from hospital staffers to expectant households. “They’re saved extraordinarily busy,” Ledbetter stated. “We have to have 4 of these volunteers a day.”

At hospitals throughout the U.S., volunteers play an integral position. A lot in order that when volunteers had been barred from East Cooper in the beginning of the COVID-19 pandemic, workers nurses assumed the volunteers’ duties within the surgical ready room. Like paid workers, hospital volunteers usually face necessary vaccine necessities, background checks, and affected person privateness coaching. And their duties usually entail working in common shifts.

At HCA Healthcare, the world’s largest for-profit hospital system, volunteers embrace aspiring medical providers who work in affected person rooms, in labs, and in wound care items, in line with the corporate’s journal.

Over centuries, leaning on volunteers in medication has turn into so embedded in hospital tradition that research present they yield meaningful cost savings and may enhance affected person satisfaction — seemingly a win-win for hospital programs and the general public.

Besides, there’s a catch.

The U.S. well being system advantages from doubtlessly greater than $5 billion in free volunteer labor yearly, a KHN evaluation of information from the Bureau of Labor Statistics and the Independent Sector discovered. But some labor specialists argue that utilizing hospital volunteers, significantly at for-profit establishments, gives a possibility for amenities to run afoul of federal guidelines, create exploitative preparations, and deprive workers of paid work amid a bigger combat for honest wages.

The federal authorities instructs that any particular person performing a job of “consequential economic benefit” for a for-profit entity is entitled to wages and additional time pay. Which means profit-generating companies, like banks and grocery shops, should pay for labor. A Chick-fil-A franchise in North Carolina was lately discovered responsible of violating minimal wage legal guidelines after paying individuals in meal vouchers as a substitute of wages to direct visitors, in line with a Department of Labor citation.

Nonetheless, volunteer labor at for-profit hospitals is commonplace and unchecked.

“The foundations are fairly clear, and but it occurs on a regular basis,” stated Marcia McCormick, a lawyer who co-directs the Wefel Middle for Employment Regulation at Saint Louis College. “It’s a complicated state of affairs.”

In a press release, HCA spokesperson Harlow Sumerford stated coordinators oversee hospital volunteers to make sure they’re collaborating in acceptable actions, reminiscent of greeting and aiding guests. Tenet Well being spokesperson Valerie Burrow didn’t reply to a query about how the corporate ensures that its volunteer actions adjust to federal labor legal guidelines.

Ben Teicher, a spokesperson for the American Hospital Affiliation, whose members embrace greater than 6,000 nonprofit, for-profit, and authorities hospitals, didn’t reply to a query about whether or not the group affords steerage to hospitals relating to the authorized makes use of of volunteers.

In the meantime, the pandemic made the significance of hospital volunteers extra obvious. In March 2020, volunteer packages nationwide had been largely disbanded, and the volunteers’ roles had been crammed by workers members — or left unfilled — when hospitals closed their doorways to everybody besides workers, sufferers, and some guests. Volunteers had been welcomed again as soon as vaccines turned extensively accessible, however many didn’t return.

“We’ve misplaced so many volunteers,” stated Ledbetter, who runs the volunteer group at East Cooper Medical Middle. “They discovered one thing else to do.”

On South Carolina’s Hilton Head Island, Vicki Gorbett, president of the island’s hospital auxiliary, estimated 60% of the group’s volunteers who left throughout the pandemic haven’t returned. A lot bigger hospital programs, a few of which boast tons of or hundreds of volunteers, have been affected, too.

“We’re constructing again from absolutely the backside,” stated Kelly Hedges, who manages volunteers on the Medical College of South Carolina.

Hedges was furloughed for the higher a part of six months when hospital volunteers had been despatched house in March 2020. She estimates there are about 600 volunteers at MUSC’s hospital campus in Charleston now, down from 700 earlier than the pandemic.

“Throughout a labor disaster, it is a division you need in operation,” she stated.

Whereas hospital volunteer packages reboot throughout the nation, labor specialists say utilizing volunteers might expose some medical amenities to legal responsibility.

The Truthful Labor Requirements Act prohibits “workers” — outlined broadly as individuals an employer “requires or permits” to work — from volunteering their time to for-profit non-public employers. The identical legislation additionally requires these workers to be paid a minimum of the federal minimal wage.

These laws make it “very, very troublesome” for a volunteer to donate time to a for-profit hospital, defined Jenna Bedsole, an employment lawyer in Birmingham, Alabama.

The suitable to be paid isn’t waivable, McCormick stated, which means that even these volunteers who don’t contemplate themselves employed could also be entitled to compensation. Nonetheless, the U.S. Division of Labor is “stretched fairly skinny” and doesn’t implement the principles that apply to for-profit firms, besides in excessive circumstances, she stated.

She cited a court ruling in 2017 that discovered individuals who volunteered at consignment occasions for Rhea Lana — a for-profit firm that organizes the resale of kids’s clothes — had been workers who ought to be paid.

However typically, McCormick stated, it’s troublesome to find out the end result of enforcement actions towards for-profit firms.

“The Division of Labor sends a letter to the putative employer warning them that it thinks the FLSA is being violated,” she stated, “and it could not take some other motion. And it solely points information releases for large circumstances.”

Corporations usually tend to be focused for the inappropriate use of unpaid interns, she stated.

However this isn’t to say that, in some circumstances, people can’t donate their time in a for-profit setting. In a for-profit nursing house, the federal government has said, individuals might volunteer with out pay in the event that they’re attending “to the consolation of nursing house residents in a way not in any other case offered by the power.” Which may embrace studying to a resident, for instance.

One-off charitable alternatives are additionally potential. A choir group may host a live performance in a hospital foyer with out violating the legislation, or a neighborhood group may serve hospital staffers an appreciation lunch.

Past that, for-profit “hospitals doubtlessly expose themselves to threat of civil legal responsibility,” Bedsole stated, which may add up by way of again pay attributable to workers, fines, and authorized charges. If hospital volunteers present important providers, there’s a hazard they might be held liable, she stated.

Nonprofit hospitals should observe federal labor legal guidelines, too.

On the small, nonprofit Baptist Memorial Hospital-Leake in Carthage, Mississippi, the coordinator of volunteers, Michelle McCann, can’t use a volunteer in any position that matches an worker’s job description. She stated she’s additionally prohibited from asking a hospital worker who’s off the clock to volunteer their time for a job much like their very own.

“We’d need to pay them for the hours,” stated McCann, nationwide president of the Society of Healthcare Volunteer Leaders.

Nonprofit hospitals are required to provide a benefit to their communities, reminiscent of providing charity care, in alternate for his or her particular tax standing. However relating to creating wealth, the variations between for-profit and nonprofit hospitals are sometimes negligible to the informal observer, stated Femida Useful, a professor of social coverage on the College of Pennsylvania.

“Once you go to the hospital, do you ask for the tax standing?” she requested.

Sam Fankuchen, CEO of Golden, an organization that develops software program used to prepare volunteer labor, stated the pandemic hastened a change in public opinion. “Simply because a corporation is nonprofit, it doesn’t essentially imply they’re 100% devoted to the higher good,” he stated. “Some nonprofits are higher run than others.”

Most volunteers are merely making an attempt to determine how and the place they will help in the absolute best manner, he stated.

“The consideration concerning the tax construction is secondary,” stated Fankuchen, whose software program is utilized by hospitals and different companies. “The large image is that hospitals exist to ship care. I believe it’s cheap that they’ve volunteer packages.”

Jay Johnson, assist providers supervisor at Trident Medical Middle in North Charleston, South Carolina, coordinates roughly 50 volunteers who contribute an estimated 133,000 hours yearly to the for-profit hospital, which is owned by HCA Healthcare.

Trident’s volunteers are extensively beloved by the workers, he stated.

“We really had a ceremony for them once they got here again” when restrictions loosened, Johnson stated. Past that, volunteers profit from premium parking areas and free lunches “to actually make certain they’re appreciated,” he stated.

Trident volunteers are required to be vaccinated and endure a background examine. Then, they’re assigned to the areas that greatest match their pursuits.

Breast most cancers survivor Pat LoPresti for instance, volunteers in Trident’s Breast Care Middle. Volunteering gives a way of function and a possibility to socialize, stated LoPresti, a retiree who met her husband, one other volunteer, whereas volunteering on the hospital.

“I began volunteering there as a result of they might use me,” LoPresti stated. “It’s such a privilege to assist individuals in a time once they want it.”

KHN (Kaiser Well being Information) is a nationwide newsroom that produces in-depth journalism about well being points. Along with Coverage Evaluation and Polling, KHN is likely one of the three main working packages at KFF (Kaiser Household Basis). KFF is an endowed nonprofit group offering info on well being points to the nation.

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