HCA Accused Of Putting Profits Before Patients: A staffing paper from Service Employees International Union (SEIU), the nation’s largest union of healthcare workers, entitled “Care Crisis How Low Staffing Contributes to Patient Care Failures at HCA Hospitals” states: HCA Healthcare is the largest hospital company in America and is widely regarded as an industry leader, with more than 180 hospitals in some 20 states and more than 280,000 total employees.
HCA routinely engages in practices that maximize profits at the expense of patient care, working conditions, and responsible corporate behavior. HCA staffs its hospitals at very low levels, typically about 30% below the national
average, according to analysis of Medicare cost report data. This trend of low staffing at HCA hospitals reflects an intentional corporate strategy that long predates the COVID pandemic. In particular, Medicare cost report data shows staffing levels routinely and precipitously drop after HCA acquires a hospital.
Short staffing saves HCA billions each year. These billions are costs borne by patients, as lower staffing levels are associated with inferior patient care … HCA safety and quality failures include examples of outright inadequate staffing, such as low staffing in telemetry units leading to patient deaths.
The costs from short staffing are also borne by people working in HCA hospitals, who are overstretched and often in dangerous situations because of HCA’s low staffing levels. According to a January 2022 survey of over 1,500 frontline nurses and healthcare workers at HCA hospitals, nearly 80 percent reported witnessing patient care being jeopardized due to low staffing.
Many hospitals—especially smaller, independent rural hospitals—find themselves needing to cut staffing in order to remain solvent. This is not HCA’s story. HCA is the largest hospital system in the country, with nearly $60 billion in annual revenue. The company has been consistently profitable since its most recent public offering in 2011. HCA,
founded in 1968, has gone through periods of being both publicly traded and privately held. The most recent public offering was in 2011, following a mammoth leveraged buyout in 2006.
Rather than invest in its workforce, HCA uses its profits to line the pockets of investors through share buybacks. In 2021, HCA earned close to $7 billion in profits, its highest profits since the 2011 IPO. HCA chose in 2021 to repurchase $8 billion worth of the company’s stock from their shareholders. This is a regular theme for HCA: Since the company’s IPO in March 2011, HCA has paid to its investors more than $4.9 billion in dividends and $26.9 billion in share repurchases, a total of over $32.2 billion in payouts.
While share repurchases are common in many industries, HCA stands out for having the highest share repurchases in the healthcare industry and the 17th highest among all publicly traded companies in the U.S. in 2021. This volume of share repurchases is even more concerning given that roughly 40% of HCA’s revenue ($24 billion in 2021) comes from the taxpayer-funded Medicare and Medicaid programs—a staggering use of public funding to facilitate the transfer of wealth to private shareholders.
HCA could use these billions of dollars to invest in its workforce rather than reward shareholders. Instead, HCA has trotted out what it calls “new models of care,” which include sending nurses to the bedside without adequate training (such as being asked to insert a feeding tube into a patient without training on that specific task) and requiring nurses and other employees to perform out-of-scope duties (for example, security guards being expected to serve as patient sitters, or EMTs performing the duties of ER staff).
Moreover, when HCA’s own employees express concern about the safety of staffing levels, they often experience retaliation. In one notable example, a nurse expressed concern that ICU nurses were being assigned more patients than the monitoring equipment could handle. She was fired, and she reported in an online blog that at least two patients from her hospital died in the ICU because of unsafe staffing and insufficient monitoring.
The staffing crisis in HCA’s hospitals has also long predated the COVID-19 pandemic. COVID made the situation even worse, as HCA refused to provide adequate PPE. One hospital in California was fined by the state OSHA department for withholding N95 masks. Yet, rather than prioritizing the needs of its employees in dealing with an unprecedented, highly transmissible disease, HCA focused on returning to business as usual with elective surgeries as quickly as possible. It should come as no surprise that HCA has been highly profitable through the pandemic—$3.8 billion in profits in 2020, and close to $7.0 billion in 2021. HCA even returned $6 billion in federal CARES Act funding in October 2020 because the company did not need it. These profits could have been used by HCA to invest in its frontline workforce and address its ongoing staffing crisis, rather than to reward company shareholders.
A thorough examination of a wide variety of data on quality of care—from hospital inspection reports, CMS’s Care Compare website, and countless lawsuits—reveal strong evidence of staffing-related quality breakdowns in HCA hospitals. This includes higher death rates from pneumonia, higher readmission rates for certain conditions such as
heart failure and pneumonia, and very troubling evidence concerning bedsores suggesting that HCA may be avoiding Medicare financial penalties by engaging in practices that discourage employees from documenting the most severe hospital-acquired bedsores.
It also includes multiple concerns about staffing levels in HCA’s telemetry units, where monitor techs are routinely required to be responsible for dangerously high numbers of patients. Additionally, this report documents patterns of avoidable patient care failures and patient harm linked to low staffing levels such as missed nursing assessments, delays in patient treatment, patient falls, and other instances of the endangerment of patients.
Given these facts, HCA hospital workers across the country are calling on the company to put patients ahead of profits and address its staffing crisis:
■ Raise staffing to safe levels. HCA’s facilities need safe staffing—inclusive of all care and services jobs.
■ Pay living wages for all workers. Tens of thousands of HCA’s workers make poverty wages, and rising inflation has squeezed the budgets of households across the country. All HCA workers deserve wages that allow them to provide for their families and get ahead.
■ Provide safe workplaces. Policies must prioritize protecting health workers from workplace violence and ensure that they have sufficient personal protective equipment.
■ Not retaliate for expressing safety concerns. All healthcare workers need to be able to advocate for staffing levels and other conditions that are safe for patients and workers. Workers should not be retaliated against when they advocate for their patients and themselves.
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