Experts say the use of volunteer staff by hospitals risks violating labor laws

MOUNT PLEASANT, SC — Most of the 30 volunteers working at the 130-bed, for-profit East Cooper Medical Center, spend their days assisting surgical patients — the scope of our mission. They go beyond the duties of candy stripper, baby carrier and store employee gift.

In fact, one-third of the volunteers at the Tenet Healthcare-owned hospital are retired nurses who examine patients for surgery or escort patients to the pre-operative room, says Jan Ledbetter, owner president of the hospital’s nonprofit Volunteer Service Organization. Others pass important information from hospital staff to prospective families. “They are extremely busy,” Ledbetter said. “We need four of these volunteers every day.”

In hospitals across the United States, volunteers play an integral role. So much so that when volunteers were banned from East Cooper at the start of the covid-19 pandemic, staff nurses took over the duties of volunteers in the surgical waiting room. Like paid staff, hospital volunteers often face mandatory requirements for vaccines, background checks, and patient privacy training. And their duties often require working in regular shifts.

At HCA Healthcare, the world’s largest for-profit hospital system, volunteers include aspiring medical service provider people who work in patient rooms, in laboratories and in wound care units, according to the company’s magazine.

Over the centuries, the reliance on medical volunteers has become so ingrained in hospital culture that studies show they Meaningful cost savings and can improve patient satisfaction — seemingly a win-win solution for the hospital system and the public.

Except, there is a catch.

The US health system benefits from more than $5 billion in potential free volunteer labor annually, a KHN analysis of data from Bureau of Labor Statistics and Independent area Find. However, some labor experts argue that the hospital’s use of volunteers, especially at for-profit organizations, creates an opportunity for facilities to violate federal rules, creating exploitative agreements and depriving employees of paid work amid a larger fight for fair wages.

The federal government instructs that any person performing the duties “consequential economic benefits” for a for-profit organization entitled to wages and overtime pay. That means profit-making businesses, like banks and grocery stores, have to pay for labor. One Chick-fil-A . franchise in North Carolina was recently found guilty of violating the minimum wage law after paying people with meal vouchers instead of wages to direct traffic, according to a Quote from the Ministry of Labor.

However, volunteer labor in for-profit hospitals is widespread and unregulated.

“The rules are pretty clear, but it happens all the time,” said Marcia McCormick, a lawyer co-director of the Wefel Center for Employment Law at Saint Louis University. “It’s a confusing situation.”

In a statement, HCA spokesman Harlow Sumerford said coordinators monitor hospital volunteers to ensure they are engaging in appropriate activities, such as welcome and support. visiting guests. Tenet Health spokeswoman Valerie Burrow did not respond to a question about how the company ensures that its volunteering activities comply with federal labor laws.

Ben Teicher, a spokesman for the American Hospital Association, whose membership includes more than 6,000 nonprofit, for-profit and government hospitals, did not respond to a question about whether the organization would provide guidance. to hospitals about the legal use of volunteers.

Meanwhile, the pandemic has made the importance of hospital volunteers even more apparent. In March 2020, volunteer programs across the country were largely disbanded and the role of volunteers was taken over by staff — or left empty — as hospitals closed. everyone, except staff, patients, and some visitors. Volunteers were welcomed back after the vaccine became widely available, but many did not return.

“We have lost a lot of volunteers,” said Ledbetter, who runs the volunteer group at East Cooper Medical Center. “They found something else to do.”

On South Carolina’s Hilton Head Island, Vicki Gorbett, the island’s hospital adjunct president, estimates that 60% of the group’s volunteers who left during the pandemic have not returned. Much larger hospital systems, some with hundreds or thousands of volunteers, were also affected.

“We are rebuilding from the absolute bottom,” said Kelly Hedges, volunteer manager at the University of South Carolina School of Medicine.

Hedges was put on leave for the better of six months when hospital volunteers were sent home in March 2020. She estimates there are around 600 volunteers on MUSC’s hospital campus now. in Charleston, down from 700 pre-pandemic.

“In a time of labor crisis, this is the department you want to operate in,” she said.

As hospital volunteer programs restart across the country, labor experts say the use of volunteers could subject some medical facilities to legal liability.

The Fair Labor Standards Act prohibits “employees” — broadly defined as those for whom an employer “requires or permits” work — from volunteering their time to private employers. for profit. The same law also requires these employees to be paid no less than the federal minimum wage.

“These regulations make it ‘very, very difficult’ for a volunteer to donate time to a for-profit hospital,” explains Jenna Bedsole, an employment attorney in Birmingham, Alabama.

McCormick says the right to be paid is inalienable, meaning that even volunteers who don’t consider themselves employed can get paid. However, the US Labor Department is “quite thin” and does not enforce the rules that apply to for-profit companies, except in extreme cases, she said.

She quotes a 2017 court ruling found volunteers at consignment events for Rhea Lana – a for-profit company that organizes the resale of children’s clothing – as employees who should be paid.

But in most cases, McCormick said, it is difficult to determine the outcome of coercive actions against for-profit companies.

“The Department of Labor sends a letter to the hypothetical employer warning them that they believe the FLSA is being violated,” she said, “and that they may not take any other action. And it only issues bulletins for major cases.”

“Companies are more likely to become targets of inappropriate use of unpaid interns,” she said.

But this does not mean that in some cases individuals cannot donate their time to a for-profit organization. In a for-profit nursing home, the federal government said, people can volunteer unpaid if they are participating “for the comfort of nursing home residents in a way that the facility does not provide.” For example, that might include reading to a resident.

One-time charity opportunities are also possible. A choir group can hold a concert in a hospital lobby without breaking the law, or a community organization can serve hospital staff a gratitude lunch.

Additionally, “for-profit hospitals have the potential to expose themselves to civil liability,” says Bedsole, which can add up to employee reimbursements, fines and fees. juridical. If hospital volunteers provide essential services, she said, they risk being held liable.

Not-for-profit hospitals are also subject to federal labor laws.

At the small, nonprofit Baptist Memorial Hospital-Leake in Carthage, Mississippi, the volunteer coordinator, Michelle McCann, cannot employ volunteers in any role that fits the employee’s job description. pellets. She said she was also prohibited from asking a hospital employee who was working full-time to volunteer their time for a job similar to their own.

“We have to pay them by the hour,” said McCann, national president of the Association of Healthcare Volunteers Leaders.

Non-profit hospitals are necessary to provide a benefit to their community, such as providing charity care, in exchange for their special tax status. Femida Handy, a professor of social policy at the University of Pennsylvania, said that when it comes to making money, the difference between for-profit and nonprofit hospitals is often insignificant to the casual observer.

“When you went to the hospital, did you ask for the tax status?” she asked.

Sam Fankuchen, CEO of Golden, a company that develops software used to organize volunteer workers, said the pandemic has accelerated a shift in public opinion. “Just because an organization is non-profit, it doesn’t necessarily mean they are 100% dedicated to the greater good,” he said. “Some nonprofits perform better than others.”

Most volunteers, he said, are simply trying to figure out how and where they can help in the best way possible.

Fankuchen, whose software is used by hospitals and other businesses, said: “The tax structure consideration is secondary. “The big picture is that hospitals exist to provide care. I think it makes sense that they have volunteer programs.”

Jay Johnson, director of support services at Trident Medical Center in North Charleston, South Carolina, coordinates approximately 50 volunteers who contribute an estimated 133,000 hours annually to the for-profit, HCA Healthcare-owned hospital. .

“Trident volunteers are widely loved by staff,” he said.

“We actually held a ceremony for them when they come back,” Johnson said when restrictions were eased. Additionally, volunteers benefit from premium parking and free lunches “to really make sure they’re appreciated,” he said.

Trident volunteers are required to have vaccinations and background checks. They are then assigned to the fields that best match their interests.

Pat LoPresti, a breast cancer survivor, for example, volunteers at Trident’s Breast Care Center. LoPresti, a retiree who met her husband, another volunteer, while volunteering at the hospital, said volunteering provides a sense of purpose and an opportunity to socialize.

“I started volunteering there because they could use me,” says LoPresti. “It is a privilege to help people in their time of need.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Exploration, KHN is one of the three main activities in Vietnam KFF (Kaiser Family Foundation). KFF is a funded non-profit organization that provides information on health issues to the nation.


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