Hospitals’ use of volunteer staff risks circumventing labor laws, experts say

MOUNT PLEAANT, South Carolina. Most of the 30 volunteers who work at the 130-bed commercial East Cooper Medical Center spend their days helping surgical patients. shop sellers.

In fact, a third of the volunteers at the Tenet Healthcare-owned hospital are retired nurses who register people for surgery or escort patients to the pre-op room, said Ian Ledbetter, president of the hospital’s non-profit Volunteer Services. Others pass on important information from hospital staff to future families. “They are very busy,” Ledbetter said. “We need to have four of these volunteers a 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, full-time nurses took over as volunteers in the surgical waiting room. Like paid employees, hospital volunteers typically face mandatory vaccination requirements, background checks, and patient privacy training. And their duties often involve working regular shifts.

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

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

Except for one snag.

The U.S. healthcare system benefits more than $5 billion in free volunteer labor annually, according to a KHN analysis of data from Bureau of Labor Statistics and Independent sector found. However, some labor experts argue that the use of volunteers in hospitals, especially in commercial establishments, provides an opportunity for establishments to violate federal regulations, create exploitative mechanisms, and deprive employees of paid work amid a broader fight for fair wages.

The federal government specifies that any person performing a task “subsequent economic benefit” for a commercial organization is entitled to wages and overtime pay. This means that profitable businesses, such as banks and grocery stores, must pay wages. AND Chick-fil-A franchise in North Carolina was recently found guilty of violating minimum wage laws after paying people food vouchers instead of wages for direct traffic, according to Department of Labor Quote.

However, volunteer work in commercial hospitals is common and not controlled.

“The rules are pretty clear, and yet it happens all the time,” said Marcia McCormick, an attorney who co-directs the Wefel Labor Law Center at St. Louis University. “It’s a confusing state of affairs.”

In a statement, HCA spokesman Harlow Summerford said coordinators are monitoring hospital volunteers to make sure they participate in appropriate activities such as welcoming and assisting visitors. Tenet Health spokeswoman Valerie Burrow did not respond to a question about how the company ensures its volunteer activities comply with federal labor laws.

Ben Teicher, a spokesman for the American Hospital Association, which has over 6,000 nonprofit, for-profit and public hospitals, did not respond to a question about whether the organization advises hospitals on the legitimate use of volunteers.

Meanwhile, the pandemic has made the importance of hospital volunteers more evident. In March 2020, volunteer programs across the country were largely dissolved, with volunteer roles filled by staff — or left unfilled — as hospitals closed their doors to all but staff, patients, and a few visitors. When vaccines became widely available, volunteers were welcomed again, but many never returned.

“We have lost so many volunteers,” said Ledbetter, a volunteer team leader at East Cooper Medical Center. “They found something to do.”

On Hilton Head Island in South Carolina, Vicki Gorbett, president of the island’s satellite hospital, estimated that 60% of the group’s volunteers who left during the pandemic have not returned. Much larger hospital systems have also been affected, some of which boast hundreds or thousands of volunteers.

“We are rising from absolute bottom,” said Kelly Hedges, who leads volunteers at the Medical University of South Carolina.

Hedges was fired for the better part of six months when hospital volunteers were sent home in March 2020. She estimates there are about 600 volunteers on MUSC’s hospital campus in Charleston now, up from 700 before the pandemic.

“During a labor crisis, this is the department you need,” she said.

While volunteer programs at hospitals are being restarted across the country, labor experts say the use of volunteers could lead to some medical institutions being held accountable.

The Fair Labor Standards Act prohibits “employees” – broadly defined as people who are “required or permitted” by an employer to work – from voluntarily giving their time to for-profit private employers. The same law also requires these employees to receive wages no lower than the federal minimum wage.

According to Jenna Bedsoul, an employment lawyer in Birmingham, Alabama, these rules make it “very, very difficult” for a volunteer to donate time to a commercial hospital.

McCormick said the right to pay cannot be waived, meaning that even those volunteers who don’t consider themselves working may be eligible for compensation. However, the US Department of Labor is “pretty stretched” and does not enforce the rules that apply to commercial companies except in extraordinary circumstances, she said.

She quoted court decision in 2017 found that the people who volunteered for consignment activities for Rhea Lana, a commercial company that organizes the resale of children’s clothing, were employees who needed to be paid.

But in most cases, according to McCormick, it is difficult to determine the outcome of enforcement actions against commercial companies.

“The Department of Labor sends a letter to the prospective employer, warning them that they believe the FLSA is being violated,” she said, “and cannot take any other action. And he only issues press releases on big cases.”

Companies are more likely to fall victim to the misuse of unpaid interns, she said.

But this does not mean that in some cases people cannot donate their time for commercial purposes. In a commercial nursing home the federal government said, people can volunteer for free if they serve the “comfort of nursing home residents in a manner not mandated by the institution.” For example, it could be reading for a local resident.

One-time charitable actions are also possible. A choir group can put on a concert in a hospital lobby without breaking the law, or a community organization can treat hospital staff to a dinner as a token of appreciation.

In addition, for-profit “hospitals are potentially exposing themselves to civil liability risk,” Bedsole said, which can add up in terms of non-payment of employee salaries, fines and legal fees. If hospital volunteers provide the necessary services, she said, there is a danger that they could be held accountable.

Nonprofit hospitals must also comply with federal labor laws.

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

“We would have to pay them for the watch,” said McCann, national president of the Society for Health Volunteer Leaders.

Non-profit hospitals benefit must be provided to their communities, for example by offering charitable assistance in exchange for their special tax status. But when it comes to making money, the differences between for-profit and non-profit hospitals are often invisible to the casual observer, says Themis Handy, professor of social policy at the University of Pennsylvania.

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

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

Most volunteers are just trying to figure out how and where they can best help, he says.

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

Jay Johnson, Support Services Manager at Trident Medical Center in North Charleston, South Carolina, coordinates approximately 50 volunteers who work approximately 133,000 hours annually at a commercial hospital owned by HCA Healthcare.

Trident volunteers are well liked by the staff, he says.

“We actually had a ceremony for them when they got back,” Johnson said. In addition, volunteers receive premium parking spaces and free meals “to make sure they are truly appreciated,” he said.

Trident volunteers must be vaccinated and pass a background check. They are then assigned to areas that best suit their interests.

For example, Pat LoPresti, a breast cancer survivor, volunteers at the Trident Breast Care Center. Volunteering provides a sense of purpose and an opportunity to connect, says LoPresti, a retiree who met her husband, another volunteer, while volunteering at a hospital.

“I started volunteering there because they could be useful to me,” LoPresti said. “It’s such a privilege to help people at a time when they need it.”