healthcare worker sitting in hallway

When the coronavirus pandemic began in earnest in the United States in March, Sarah, who works as a nursing assistant at a hospital in St. Petersburg, Fla., noticed the uptick in workload right away. (Her name has been changed to protect her identity.)

“We’ve always had issues with staffing, but it got worse during the pandemic,” she said in an interview with ClearHealthCosts.

Sarah is a single parent, and her daughter has respiratory issues. Continually working on Covid units was “overwhelming, emotionally and mentally,” she said, and she was worried about getting her daughter sick. She asked her supervisor if other staff members were available to rotate so she could have some weeks off working with infected patients. “But I realized there’s not enough people [on staff] to rotate through the Covid unit,” she said.

Her daughter has stayed healthy throughout the summer, Sarah said. But she said conditions haven’t improved at her hospital. She’s still working nights in under-resourced Covid wards, scrambling to take care of dozens of patients at once with limited protective gear and not enough colleagues to help. “We’re always so short” on staff, she said. 

Sarah doesn’t work at a struggling system or under-resourced medical center. The hospital Sarah works at is owned by HCA Healthcare, one of the largest for-profit healthcare companies in the United States. And she’s not alone in saying she’s working in poor conditions. Across the country, workers at HCA hospitals have spent the summer protesting what they say are continued unsafe working conditions and inadequate pay as the pandemic drags on.

Meanwhile, HCA told investors in July in an earnings call that the company had had a profitable second quarter, with profits of $1.1 billion — 38 percent higher than the same quarter in 2019, thanks in large part to bailout money from the federal government.

Why are workers like Sarah still struggling with basic safety issues at work, like access to personal protective equipment like masks and gowns and understaffing, six months into the pandemic – and following an enormous handout from the federal government to their parent company?

What is HCA?

HCA Healthcare, founded as Hospital Corporation of America, owns 184 hospitals and around 2,000 surgery centers, emergency rooms, urgent care centers, clinics and other independent sites across the country (and some in the United Kingdom as well). HCA hospitals and clinics are located in 21 US states, and they employ more than 280,000 workers across their facilities. (ClearHealthCosts has reached out to HCA for comment on Sarah’s allegations and other facts reported in this article, and will update with any response.)

The company recorded big revenues last year pre-pandemic: $46.7 billion in 2019, up from $43.6 billion in 2018. CEO Samuel Hazen received $26.7 million in compensation in 2019 – a figure which, according to SEC filings, is 478 times the size of the median $56,012 salary for HCA workers.

In 2012, the New York Times profiled the company’s financial boom – and the benefits for its private-equity investors – during the Great Recession, when other healthcare companies struggled.

“Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care,” the paper reported.

How has the pandemic affected the company?

Like many healthcare companies, the onset of the pandemic threw HCA into new circumstances. Hazen said in a message to staff that he would donate his April and May salary to workers, and the executive team would take a 30 percent salary cut. Later reports revealed that admissions in HCA hospitals went down 30 percent in April, with steeper declines in surgery and emergency department visits.

“In April, our business was significantly limited by governmental policies that restricted elective procedures and required communities to shelter at home,” Hazen wrote in a July letter to staff.

Fortunately for HCA, the government also swooped in to help – in a big way. HCA has to date received more than $1.5 billion in federal bailout funds, part of a cohort of twenty large and well-funded hospital chains that, the New York Times reported in May, got more than $5 billion in government bailout money in the early stages of the pandemic.

In July, the company reported that its 2020 Q2 profit was around $1.1 billion. As Axios calculated, this figure marks a 38 percent increase from the company’s Q2 profit in 2019. Fifty-five percent of the company’s revenue in Q2, the company told its investors, was a result of taxpayer bailouts.

What are workers saying?

Throughout the summer, nurses at HCA-owned hospitals in multiple states throughout the country have staged public protests. For example, on Sept. 1, nurses at HCA hospitals in Kansas, Florida and Nevada protested what they said were inadequate staffing levels and said they were still being forced to reuse PPE. 

At Sarah’s hospital in Florida, she said workers used to be able to go to store rooms and get whatever protective gear they need. Now, she said, PPE is controlled by a “czar,” who operates a sign-out sheet for gowns, masks and other equipment. Sarah said the czars only allow workers to have a limited amount of PPE per shift, so she is constantly wiping down and reusing equipment between patients.

What’s more, the hospital is not allowing any workers who don’t work directly on Covid wards to access N95s – something that, Sarah says, doesn’t translate to the realities of helping patients with serious medical needs. 

“If you need an N95 you have to go to your supervisor, prove you’re going to a Covid unit, and sign one out,” she said.

She recalled how one Covid-positive patient she was treating tried to escape the hospital, cutting loose her breathing apparatus in the process and spraying infected particles into the air. Sarah was forced to call security for help. None of the security staff were equipped with N95s, she said, because they weren’t technically working in a Covid ward – and the hospital had rationed those masks.

Some workers are taking specific complaints to the government and to press. In August, staff at a Colorado HCA facility told The Denver Post that low staffing levels at the hospital led to a Covid patient death, while healthcare workers alleged in a lawsuit that an HCA hospital in California spread Covid by forcing sick staff to work, mandating staff reuse PPE, and ignoring staff complaints about unsafe conditions. A national nurses’ union filed an OSHA complaint at the end of August alleging HCA hospitals across the country required nurses sick with Covid to work during the pandemic.

“No one takes the health and safety of our workers more seriously than we do, and since day one, our top priority has been to protect them – to keep them safe and keep them employed – so they can best care for our patients,” a spokesperson for Riverside Community Hospital, which was named in the California lawsuit, told ClearHealthCosts in an email. “Any suggestion otherwise ignores the extensive work, planning and training we have done to ensure the delivery of high quality care during this pandemic. Our frontline caregivers have shown unwavering commitment, and our efforts to protect them have included the screening and testing of our colleagues, universal masking, contact tracing and notification, and other safeguards, in line with guidance from the CDC. We’re proud of our response and the significant resources we’ve deployed to help keep our colleagues safe. This lawsuit is an attempt for the union to gain publicity, and we will defend it vigorously.”

Past controversies

The company has seen multiple previous controversies. Some of the settlements and violations it has seen over the past decade include: 

  • In 2012, HCA paid $16.5 million to the federal and Tennessee governments to settle claims that it had provided financial incentives to a physician group, including paying rent for its office space, to convince the physician group to refer patients to local HCA hospitals. 
  • In 2013, the company settled with the federal government for more than $7 million for false spinal surgery claims it had submitted to Medicare.
  • In 2015, the company again paid $15.8 million to the federal government to settle claims that it, along with a group of other major hospital groups, had implanted cardiac devices into patients in violation of Medicare requirements.
  • In 2017, a nurse at one of HCA’s hospitals in San Jose, Calif., filed a whistleblower suit charging the company with submitting false claims to Medicare. 
  • In 2017, four HCA hospitals in Houston agreed to pay more than $8.5 million to settle allegations that they had bribed ambulance companies to deliver more lucrative Medicare and Medicaid patients. 
  • Earlier this year, the attorney general of North Carolina sent a letter to the company following “a surge in complaints about quality of care” demanding more information on, among other things, “billing issues” patients have faced at North Carolina HCA facilities.

What’s next?

If you ask a financial expert, the future looks rosy for the company. At the end of August, the company’s 2020 and 2021 profit estimates both moved up, with Zacks Equity Research calling HCA an “an investor’s favorite.” In September, analysts said HCA is outperforming 80% of healthcare companies on the stock market.

For workers like Sarah, seeing the company’s success is frustrating.

“They got all of this money from the government and they’re not using it for their employees,” she said. “They try to blame everything on Covid, but they made more money this past quarter than they did the year before when there wasn’t Covid.”

Molly Taft

Molly Taft is a  staff writer for Earther, Gizmodo's climate change blog. Her writing has appeared not only at ClearHealthCosts,...