MOUNT PLEASANT, S.C. \u2014 Most of the 30 volunteers who work at the 130-bed, for-profit East Cooper Medical Center spend their days assisting surgical patients \u2014 the scope of their duties extending far beyond those of candy stripers, baby cuddlers, and gift shop clerks.<\/p>\n

In fact, one-third of the volunteers at the Tenet Healthcare-owned hospital are retired nurses who check people in for surgery or escort patients to a preoperative room, said Jan Ledbetter, president of the hospital\u2019s nonprofit Volunteer Services Organization. Others relay important information from hospital staffers to expectant families. \u201cThey\u2019re kept extremely busy,\u201d Ledbetter said. \u201cWe need to have four of those volunteers a day.\u201d<\/p>\n

At hospitals across the U.S., volunteers play an integral role. So much so that when volunteers were barred from East Cooper at the beginning of the covid-19 pandemic, staff nurses assumed the volunteers\u2019 duties in the surgical waiting room. Like paid employees, hospital volunteers typically face mandatory vaccine requirements, background checks, and patient privacy training. And their duties often entail working in regular shifts.<\/p>\n

At HCA Healthcare, the world\u2019s largest for-profit hospital system, volunteers include <\/a>aspiring medical providers<\/a> who work in patient rooms, in labs, and in wound care units, according to the company\u2019s magazine.<\/p>\n

Over centuries, leaning on volunteers in medicine has become so embedded in hospital culture that studies show they yield meaningful cost savings<\/a> and can improve patient satisfaction \u2014 seemingly a win-win for hospital systems and the public.<\/p>\n

Except, there\u2019s a catch.<\/p>\n

The U.S. health system benefits from potentially more than $5 billion in free volunteer labor annually, a KHN analysis of data from the Bureau of Labor Statistics<\/a> and the Independent Sector<\/a> found. Yet some labor experts argue that using hospital volunteers, particularly at for-profit institutions, provides an opportunity for facilities to run afoul of federal rules, create exploitative arrangements, and deprive employees of paid work amid a larger fight for fair wages.<\/p>\n

The federal government instructs that any person performing a task of \u201c consequential economic benefit<\/a>\u201d for a for-profit entity is entitled to wages and overtime pay. That means profit-generating businesses, like banks and grocery stores, must pay for labor. A Chick-fil-A franchise<\/a> in North Carolina was recently found guilty of violating minimum wage laws after paying people in meal vouchers instead of wages to direct traffic, according to a Department of Labor citation<\/a>.<\/p>\n

Still, volunteer labor at for-profit hospitals is commonplace and unchecked.<\/p>\n

\u201cThe rules are pretty clear, and yet it happens all the time,\u201d said Marcia McCormick, a lawyer who co-directs the Wefel Center for Employment Law at Saint Louis University. \u201cIt\u2019s a confusing state of affairs.\u201d<\/p>\n

In a statement, HCA spokesperson Harlow Sumerford said coordinators oversee hospital volunteers to ensure they are participating in appropriate activities, such as greeting and assisting visitors. Tenet Health spokesperson Valerie Burrow did not respond to a question about how the company ensures that its volunteer activities comply with federal labor laws.<\/p>\n

Ben Teicher, a spokesperson for the American Hospital Association, whose members include more than 6,000 nonprofit, for-profit, and government hospitals, did not respond to a question about whether the organization offers guidance to hospitals regarding the legal uses of volunteers.<\/p>\n

Meanwhile, the pandemic made the importance of hospital volunteers more apparent. In March 2020, volunteer programs nationwide were largely disbanded, and the volunteers\u2019 roles were filled by staff members \u2014 or left unfilled \u2014 when hospitals closed their doors to everyone except employees, patients, and a few visitors. Volunteers were welcomed back once vaccines became widely available, but many didn\u2019t return.<\/p>\n

\u201cWe\u2019ve lost so many volunteers,\u201d said Ledbetter, who runs the volunteer group at East Cooper Medical Center. \u201cThey found something else to do.\u201d<\/p>\n

On South Carolina\u2019s Hilton Head Island, Vicki Gorbett, president of the island\u2019s hospital auxiliary, estimated 60% of the group\u2019s volunteers who left during the pandemic haven\u2019t returned. Much larger hospital systems, some of which boast hundreds or thousands of volunteers, have been affected, too.<\/p>\n