A hidden system of exploitation underpins US hospitals’ employment of overseas nurses

This sequence was produced in partnership with the nonprofit newsroom Sort Investigations, with assist from the Gertrude Blumenthal Kasbekar Fund, the Puffin Basis, and the Pulitzer Middle.

TALLAHASSEE, Florida — When Rachel began her job as a nurse within the inside medication unit at Tallahassee Memorial HealthCare final yr, it felt like the belief of a dream that was years within the making.


A slight, soft-spoken Filipino girl, Rachel, 31, had spent her profession working in hospitals throughout the Philippines, struggling to look after sufferers within the nation’s under-resourced healthcare system. Within the US, against this, she would have entry to important medicines, MRI machines—all the newest remedies and applied sciences fashionable medication has to supply. She would additionally obtain a coveted US inexperienced card, and be paid way over she might make at house.

“I used to be excited,” Rachel mentioned of the weeks earlier than she boarded her flight to Tallahassee in August 2022. “It’s the US. It’s probably the most glamorous place.”

At Tallahassee Memorial, that was true sufficient. The hospital, gleaming and fashionable, is rated among the many high healthcare amenities within the area. The one useful resource lacking? Time. Rachel, who was an emergency room nurse within the Philippines, was assigned to the interior medication unit at Tallahassee Memorial, the place she needed to rapidly be taught the brand new specialization. She and her colleagues would commonly juggle as many as 5 sufferers at one time, straining them to their limits. Generally they needed to look after as many as seven sufferers every.

Sliding a needle into an aged affected person’s papery vein might take as much as half an hour, Rachel mentioned. One other affected person may turn into combative, lunging to hit her, and it could take much more time to calm him down. In the meantime, different duties would pile up: wounds to scrub, feeding tubes to exchange, diapers to vary, to not point out all of the paperwork for admissions, transfers, and discharges. With three sufferers, Rachel was assured she might present the care they wanted. With 5 or extra she was scrambling to maintain up.


Quickly, Rachel discovered herself spinning by the cycle of tension, burnout, and guilt a couple of job swiftly completed that has plagued nurses throughout the US and accelerated in the course of the covid-19 pandemic. Based on analysis by the Nationwide Council of State Boards of Nursing, 45 % of nurses surveyed in 2022 reported experiencing burnout, and almost one-fifth of the present workforce plans to go away the occupation by 2027. An American nurse who began at Tallahassee Memorial similtaneously Rachel give up two months into the job. “The work is simply horrible,” a colleague of Rachel’s remembered him saying.

However Rachel couldn’t give up so simply. Her employment contract with Tallahassee Memorial dedicated her to working for the hospital for no less than three years and barred her from altering departments for no less than one yr.

Furthermore, Rachel had additionally signed a contract with a Florida-based recruitment company, Professionals to USA (PTU), that had organized the job on the hospital and dealt with her immigration paperwork. The company had charged her a $2,500 payment as a part of the appliance course of, she mentioned, and she or he needed to shoulder hundreds of {dollars} in further prices, corresponding to a job supply letter and a medical clearance examination. Rachel additionally mentioned her PTU contract included a $30,000 breach payment, a typical apply amongst companies that recruit nurses to work in the USA.

Quartz and Sort Investigations reviewed a PTU contract signed by one other Filipino nurse who began working for Tallahassee Memorial across the similar time as Rachel. It specified that if the nurse violated the phrases of the contract, she would wish to pay the company $30,000 in damages, ostensibly to cowl the reputational hurt PTU mentioned it could undergo if the nurse left her job early or in any other case breached the contract. The company’s CEO additionally instructed in social media posts that he would report nurses who didn’t fulfill their contracts to immigration authorities.


Rachel, who requested to be referred to by a pseudonym as a result of she feared retaliation from Tallahassee Memorial and Professionals to USA, is one in every of hundreds of nurses who immigrate to the USA annually, nearly all of whom come from the Philippines. In the course of the early days of the covid-19 pandemic, from February to April 2020, the US healthcare sector shed greater than 1.5 million jobs, in accordance with the US Bureau of Labor Statistics — almost 10% of the overall healthcare workforce — contributing to a important scarcity within the nursing occupation. For the USA, together with the UK and different European nations, hiring nurses from abroad has turn into an important technique to fill the hole.

For a lot of overseas nurses, working within the US can present alternatives for training, profession development, and better pay. However a year-long investigation by Quartz and Sort Investigations, with funding from the Pulitzer Middle, discovered that some nurses from the Philippines have been subjected to exploitative labor contracts that may entice them of their jobs and intimidate them into silence.

Quartz and its companions spoke with migrant nurses in Florida and different states, together with 9 nurses who have been recruited to work at Tallahassee Memorial by Professionals to USA. To maintain them in line, many of those nurses mentioned, PTU or its CEO threatened to sue nurses for tens of hundreds of {dollars} in contract breach charges or report them to immigration authorities in the event that they left their jobs early. The sort of remedy is pervasive within the worldwide nurse recruitment business, in accordance with lawsuits towards different companies and interviews with nurses and advocates.

In some instances, excessive contract breach charges and threatening disobedient staff with deportation could violate legal guidelines towards human trafficking and compelled labor. However the work of recruitment and staffing companies typically falls right into a regulatory grey space. Though some state and federal companies are starting to attempt to handle these points, enforcement is inconsistent, contributing to exploitative practices within the worldwide nurse recruitment business. Entities just like the US State Division, the Division of Labor, the Justice Division, and state attorneys normal might do extra to assist staff, consultants say.


Such practices can affect not simply nurses, however sufferers as nicely. Rachel mentioned she feared that understaffing in her unit at Tallahassee Memorial put her prone to making a critical error. She felt anxious earlier than her shifts, and anxious after them. She barely ate and had bother sleeping. She spent her days off struggling to manage, mendacity in mattress, toggling between numbing TikTok movies of cute puppies and job openings her contract prevented her from pursuing.

In a press release to Quartz and Sort Investigations, PTU’s founder and CEO Raymund Raval denied threatening to report nurses to immigration authorities and defended the company’s inclusion of breach charges in its contracts. “A few of our contracts do embrace a ‘liquidated damages’ quantity. That’s not a ‘breach payment’ and isn’t unlawful within the case of everlasting visa immigrants,” Raval mentioned. “The liquidated damages provision shouldn’t be supposed as a penalty, however is a standard means of agreeing to damages within the case of breach when damages can’t be moderately calculated.”

A spokesperson for Tallahassee Memorial mentioned in a press release that its precedence is “creating an surroundings of engagement and assist for everybody who comes by our doorways,” and that every one staff are handled with dignity and respect. “For a few years, TMH has recruited nurses and different medical professionals from the Philippines,” the spokesperson mentioned. “These colleagues are valued members of our TMH household, and lots of have been with us for years and are leaders in our group.”


Confronted with the $30,000 breach payment and the specter of being deported, nonetheless, Rachel mentioned felt she had no selection however to stay within the job, even because it eroded her psychological well being. The expertise made her query the choices that had led her to Florida and drained her want to proceed within the occupation she’d as soon as liked.

“I got here right here for a greater life,” Rachel mentioned. “But it surely’s solely turn into tougher.”

The company

When Raymund Raval appeared at a recruitment occasion on the luxurious Shangri-La resort in Manila in January 2020, one nurse mentioned she felt “starstruck.”

Raval got here throughout as dapper and charismatic, dressed neatly in designer garments. He was Filipino and spoke flawless English, peppered warmly with Tagalog, the first language of the Philippines. His pitch was engaging: You possibly can work in your unit of specialization, he informed the assembled nurses. They’d be employed straight by Tallahassee Memorial, and PTU wouldn’t skim cash from their paychecks like different recruitment companies have been identified to do, he mentioned.


“We don’t get something from this,” the nurse, who requested to not be named for worry of retaliation from PTU, remembered Raval saying. “Not one peso.”

They’d be paid $30 an hour, possibly extra, PTU informed the nurses, in comparison with the few hundred {dollars} a month most nurses might anticipate to make within the Philippines. All they needed to do was pay a number of thousand {dollars} to PTU to course of their paperwork. A consultant from Tallahassee Memorial was additionally on the occasion, prepared to fulfill any nurses who have been concerned with relocating.

For the nurses in attendance, it felt like the primary style of the luxurious that awaited them in the USA. “If you wish to go to the US,” one other nurse thought to himself as he walked into the glowing Shangri-La, “that is it.” He requested to stay nameless for worry of retaliation from the company.

Raval has been within the worldwide nurse recruitment enterprise for greater than twenty years. Primarily based in Gainesville, Florida, his firm was based in 2000 as Nurses to USA earlier than altering its identify to Professionals to USA in 2010. As a distinguished recruiter, Raval is well known within the Philippines. In 2019, a Philippine TV information community referred to him as a “International Pinoy Idol,” utilizing the Tagalog slang phrase for Filipino.


In its first 23 years of enterprise, Raval has mentioned, the company has organized for greater than 2,200 nurses from the Philippines to work in American healthcare amenities. Along with offering worldwide employees to Tallahassee Memorial, PTU’s web site says it additionally recruits nurses for College of Florida hospitals in Gainesville, Leesburg, and the Villages, the sprawling retirement group exterior Orlando.

Because the begin of the pandemic, PTU says it has additionally expanded its enterprise past Florida, bringing on new shoppers together with Stormont Vail Well being in Topeka, Kansas, and Archbold Medical Middle in Thomasville, Georgia. On his Fb web page, Raval mentioned that PTU was accepting functions not simply from Filipino nurses, but in addition from nurses from Ghana, South Korea, and Japan. The corporate positioned 252 nurses in US hospitals between December 2021 and July 2022, Raval introduced on his Fb web page. By December 2022, he was congratulating himself on Fb: “We SOLVED the Nursing Scarcity in Tallahassee !”

Raval’s Fb web page is a continuous scroll of motivational ideas and smiling nurses simply arrived on American soil. However amid the uplifting messages concerning the good life that awaits nurses in America, posts on PTU’s and Raval’s private Fb pages additionally leveled what appeared to nurses like thinly veiled threats.

“Kindly HONOR your 3-year dedication to the HOSPITAL which filed on your US IMMIGRANT VISA,” he scolded nurses in an August 2022 Fb put up, after no less than one Tallahassee Memorial nurse’s employment was terminated. “We’re within the enterprise of Recruiting and Bringing you to America to have a greater life. We’re NOT within the enterprise of submitting a lawsuit.”


In a video he posted on Fb that month, Raval filmed himself strolling by the Atlanta airport, an American flag hanging from the rafters above him. He had simply spoken with an immigration officer, he mentioned with a frown, who informed him that he might report nurses who didn’t end their contracts to US authorities. “So he gave me the knowledge, who to report them and provides them their Social Safety numbers and names. They’ll’t simply come into the nation and make the most of the immigrant visa and go away, with out fulfilling their dedication,” Raval mentioned. “I’m sorry, however I’ve to report. I do need to report you all.”

Within the caption, Raval instructed that nurses who didn’t end their contracts might have bother coming into the US once more. “The following time you go to AMERICA, your names and passport copies would most likely be forwarded to the port of entry,” he wrote in a mix of English and Tagalog. “It’s not a scare tactic, it’s what the Border Patrol from Atlanta informed us earlier.”

In a press release, Raval mentioned his warnings have been merely supposed to dissuade nurses from utilizing his firm to acquire inexperienced playing cards in the event that they didn’t intend to stay of their jobs. “Now we have by no means threatened to report nurses to USCIS,” he informed Quartz and Sort Investigations. “Now we have had communications with USCIS when the information point out that the nurse utilized for immigration with fraudulent intent, and we do warn all candidates to not file with us if their intent is fraudulent. It’s uncommon, however now and again a nurse merely doesn’t present up for work on the hospital who sponsored them.”

International nurses usually enter the USA on EB-3 visas, which grant them everlasting residency. These staff can change jobs with out risking their inexperienced playing cards so long as they got here to the US with the intention of working indefinitely for the employer that sponsored their visas. A spokesperson for the US Citizenship and Immigration Companies mentioned employment agreements “are exterior the scope of USCIS.” The Division of Labor mentioned in an electronic mail that the company “doesn’t have a task in imposing the contracts of EB-3 visa holders.” US Customs and Border Safety, whose officers assessment passports and immigration paperwork at airports and different factors of entry into the nation, didn’t reply to a number of requests for remark.


Even so, Raval’s video performed on nurses’ fears about what might occur to them in the event that they give up their jobs. Raval had helped give them the chance to return to America. And in the event that they didn’t behave, they believed, he might take it away.

Funds and hidden paperwork

For Rachel and different nurses, the price of securing a job by Professionals to USA was excessive.

Along with what Rachel paid to PTU, she additionally shelled out for airplane tickets within the Philippines to take her licensure exams, then others to the US as soon as she obtained her visa. She additionally paid for the associated prices of journey, like resorts. All informed, she mentioned, she spent almost $8,000 to return to America for the job at Tallahassee Memorial.

Requiring staff to pay cash to take a job abroad violates internationally agreed-upon honest recruitment practices, in accordance with the Worldwide Labour Group, the UN company that units labor requirements and works to stop human trafficking and compelled labor. Based on the ILO, potential employers ought to bear the prices of hiring, and staff shouldn’t be charged charges associated to their recruitment, straight or not directly. Such charges, as outlined by the ILO, embrace recruitment and placement charges, the prices of verifying expertise and {qualifications} like nursing board certifications and English language proficiency, journey and lodging prices, and prices related to functions and authorized illustration.


The US authorities is conscious that the method of bringing in staff from abroad can result in exploitation.

“Practices that result in human trafficking typically happen within the recruitment course of earlier than employment begins, whether or not by misrepresentation of contract phrases, the imposition of recruitment charges, the confiscation of identification paperwork, or a mix of those,” a State Division spokesperson informed Quartz and its companions in an electronic mail. “The involvement of intermediaries (for instance, labor brokers, middlemen, employment companies, or recruiters) creates further layers within the provide chain and positions these people to both help or exploit.”

CGFNS Worldwide, a Philadelphia-based group that screens worldwide nursing credentials for visa functions, has cited recruitment charges as a main pink flag that worldwide nurses ought to be careful for. “No recruiter ought to cost you a recruitment payment for his or her providers,” the group wrote in a 2022 weblog put up.

In December 2022, PTU filed a lawsuit towards a nurse alleging that he had violated his PTU contract by leaving his job at Tallahassee Memorial earlier than the tip of his three-year dedication interval, and looking for $40,000 in damages. In a authorized submitting, the nurse denied PTU’s claims and alleged that the company’s excessive breach payment and threats of deportation and lawsuits violated federal anti-trafficking legal guidelines. The case is ongoing.


In a press release to Quartz and Sort Investigations, Raval mentioned PTU doesn’t at the moment cost nurses a recruitment payment. “Our contracts have advanced over time in response to altering legal guidelines, norms and financial realities,” Raval mentioned. “In our present contract with nurses, the nurses don’t pay us something. Typically, we do require our nurses to pay the USCIS a ‘premium processing’ payment. The hospitals that we recruit for reimburse this payment to the nurses or pay them a relocation bonus or allowance that exceeds that quantity.”

A PTU contract for a nurse positioned at Tallahassee Memorial, which was reviewed by Quartz and Sort Investigations, stipulates that the hospital will reimburse nurses for each the USCIS premium processing payment and relocation bills. However nurses mentioned Tallahassee Memorial lined solely relocation bills.

Tallahassee Memorial mentioned it’s at the moment reassessing its recruitment practices. “We’re conscious of the litigation involving Professionals to USA, Inc,” the Tallahassee Memorial spokesperson mentioned. “Whereas TMH shouldn’t be a celebration to this litigation, we take issues like this very severely. We’re utilizing this as a possibility to assessment our recruitment relationships to make sure all colleagues really feel revered and valued at TMH.”

The hospital didn’t reply to questions concerning the extent to which it reimbursed nurses for bills.


Within the paperwork US employers file to rent a overseas employee for a everlasting place, the employer should specify whether or not they acquired any fee as a part of the appliance course of. Such funds is usually a signal to US officers of an exploitative relationship, and might violate federal laws that prohibit the shopping for and promoting of everlasting labor certifications.

International employers who wish to rent staff from the Philippines should additionally apply for accreditation with the federal government. The Division of Migrant Employees won’t accredit an employer if its employment contract features a liquidated damages provision, just like the $30,000 breach payment within the PTU contract. The division didn’t reply questions on whether or not it had accredited PTU or reviewed its contracts. Raval mentioned PTU companions with native licensed recruitment companies, though Philippine officers say employers have to be accredited straight.

And the relationships between staff and recruitment companies may be simple to hide. The counter declare towards PTU filed earlier this yr alleged that the US State Division started refusing nurses’ visa functions attributable to PTU’s recruitment charges and the excessive breach payment in its contracts. After that, a number of Filipino nurses mentioned PTU discouraged them from disclosing their contracts with the recruitment company to US officers or mentioning recruitment charges throughout consular interviews. In the event that they talked about the contracts, Raval implied, their visas may be denied.

When Rachel visited the US Consulate in Manila in 2022, she introduced her official job supply from Tallahassee Memorial, which US officers reviewed earlier than issuing her a visa. However Rachel didn’t present US officers her contract with Professionals to USA, following directions she mentioned Raval had given nurses in Zoom conferences.


When requested about instances during which contracts are hid from the authorities, Saul De Vries, the Philippine embassy’s labor attaché in Washington, D.C., mentioned that such companies “are actually hiding one thing.”

Raval, nonetheless, denied telling nurses to hide their PTU contracts from US officers. “PTU has instructed nurses to offer all paperwork that the embassy asks for, together with their contract with PTU,” he mentioned.

PTU’s contract wasn’t the one settlement that positioned restrictions on nurses. As soon as Rachel and one other nurse arrived in the USA, they mentioned Tallahassee Memorial added onerous phrases to their hospital contracts. Rachel’s unique settlement with Tallahassee Memorial, which Quartz and Sort Investigations reviewed, didn’t specify what number of years she would wish to work for the hospital. However after she arrived in Florida, the hospital made her signal a brand new contract, which specifies the time dedication of no less than three years.

Rachel and the opposite Filipino nurse mentioned the hospital’s human assets division had them signal the brand new contracts throughout a bunch orientation, telling them they couldn’t begin work till they did so. The nurses felt they’d no selection however to signal, Rachel mentioned.


A spokesperson for Tallahassee Memorial didn’t handle the allegations of their assertion.

A “excessive wave” of contract breaches

Recruitment and staffing companies have filed main lawsuits towards nurses lately, looking for tens of hundreds of {dollars} in breach charges and damages — and sending a message to the remainder of the workforce. “They attempt to acquire [from] one nurse, and the nurses discuss,” mentioned Carmen Comsti, lead regulatory coverage specialist on the California affiliate of Nationwide Nurses United, the biggest union representing registered nurses within the US. “That’s all it takes to suppress the nurses’ voices.”

In 2019, the staffing company Well being Carousel collected a $20,000 payment from a nurse in Pennsylvania for leaving their job earlier than the tip of their contract. Sentosa Companies, a Brooklyn-based staffing company, sued three nurses in 2016 for $25,000 every for breaching their contracts, plus lots of of hundreds of {dollars} in damages. And in 2022, Superior Care Staffing, one other Brooklyn company, initiated arbitration proceedings towards a nurse who give up his job. The corporate informed the nurse that it could search damages of “no less than $20,000,” plus attorneys’ charges and extra prices related to the arbitration course of, which the nurse’s attorneys mentioned might add as much as tens of hundreds of {dollars}. CommuniCare, one other worldwide recruitment company, sued nurses in 2022 for $100,000 for breaching their contracts.

Excessive breach charges could run afoul of federal anti-human trafficking legal guidelines, in accordance with consultants, as a result of they’ll act as threats of significant hurt that coerce staff into remaining of their jobs. Some instances can also violate minimal wage or shopper safety legal guidelines. Prolonged dedication durations, just like the three or extra years specified within the contracts reviewed by Quartz and Sort Investigations, undermine the free motion of labor and deny staff one in every of their strongest bargaining chips: the flexibility to give up their jobs if the situations of employment don’t go well with them.


In March 2023, the Division of Labor filed a lawsuit towards Superior Care Staffing to cease the company from forcing nurses to work for 3 years or pay the corporate for projected future earnings, attorneys’ charges, and the price of arbitration, alleging that the apply is a violation of the Truthful Labor Requirements Act as a result of it brings staff’ wages under federal minimums. “Employers can’t use staff as insurance coverage insurance policies to unconditionally assure future revenue streams,” Solicitor of Labor Seema Nanda mentioned within the division’s announcement.

David Seligman, a labor lawyer and govt director of In direction of Justice, a nonprofit that has filed lawsuits on behalf of worldwide nurses, together with towards Superior Care Staffing, mentioned the criticism is a significant step towards higher authorities enforcement on this space, which might go away corporations “on the hook for fairly large publicity.”

A lawyer for Superior Care Staffing mentioned in March that the corporate was “deeply troubled” by the Division of Labor’s allegations, which it mentioned have been “unsupported by both the information or the legislation.” The case is ongoing.

For now, nonetheless, no single US company is accountable for regulating the nurse recruitment business, and enforcement is scattershot. “There is no such thing as a systematic mechanism for detecting compelled labor within the healthcare subject,” Nationwide Nurses United wrote in a July 2022 assertion to the Division of Well being and Human Companies. Examples of coercive laborpractices the union mentioned solely surfaced “in an advert hoc method — by litigation, short-term analysis tasks, or discussions amongst nurses.”


Nurses have filed quite a few class-action lawsuits lately — and have gained some vital victories. In 2019, a federal decide in New York dominated that Sentosa Companies’s threats to implement its $25,000 contract termination penalty violated federal human trafficking legal guidelines. Greater than 100 Filipino nurses have been awarded a complete of $2.5 million. In 2021, the New York legal professional normal discovered {that a} native hospital, Albany Medical, had illegally charged Filipino nurses for quitting or being fired, and ordered the power to pay $90,000 to seven nurses.

However restrictive contract provisions don’t have to face as much as authorized scrutiny as a way to preserve nurses in line. “Fairly often, employers and different companies will put unenforceable phrases within the nice print of contracts,” Seligman mentioned. “As a result of enforcement is difficult. And since fairly often, individuals are scared by that time period. Even when no court docket would ever implement it, folks discover it scary.”

Mukul Bakhshi, chief world affairs officer at CGFNS Worldwide, mentioned the nursing business is at the moment experiencing a “excessive wave of breaches.” Because the pandemic-induced staffing disaster has elevated demand for nurses, small companies have popped up throughout the nation, contributing to a Wild West of worldwide nurse recruitment with companies utilizing more and more aggressive ways to maintain staff from leaving their jobs. In some contracts, extra time and coaching hours don’t depend towards a nurse’s whole time dedication, including months of labor. Analysis printed in 2007 discovered that nurses reported contract breach charges starting from $8,000 to $50,000. However over time, these charges have crept up. Some companies attempt to cost nurses as a lot as $100,000 for leaving their jobs, in accordance with court docket information and interviews with nurses and advocacy teams.

“Since 2020, every little thing’s form of exploded,” Bakhshi mentioned concerning the practices employed by some companies in response to the nursing scarcity.


“They’ll simply exhaust you till you’re demoralized”

Within the absence of extra thorough authorities oversight, nurses have banded collectively to guard themselves and push again towards abusive working situations.

At a fancy of grey, low-rise buildings a couple of minutes drive from Tallahassee Memorial, Rachel and some of her colleagues gathered at one in every of their flats for a lunch of Filipino oxtail stew, served alongside a tidy stack of crisp spring rolls. The nurses, most of whom lived within the advanced, supported one another as they navigated their new lives. They loved nights out collectively at native bars and eating places, went on street journeys to the seaside, and tried to make sense of the quirks of American tradition and the methods it could possibly be so completely different from what they have been used to again house. That afternoon in October, nonetheless, the main focus of their dialog was Ray Raval.

Ten days earlier than, an nameless put up appeared on Lefora Filipino Nurses to US, a non-public Fb group that at the moment has greater than 200,000 members, the place nurses share ideas, have fun success tales, and sometimes warn colleagues of exploitative conditions. The put up mentioned an unnamed recruitment company had been mistreating nurses by charging them hundreds of {dollars} for job placement, locking them into their positions with $30,000 breach charges, breaking guarantees concerning the pay they’d obtain, assigning them to jobs exterior their areas of specialization — or, worse, not putting them in jobs for months after arriving within the US, leaving them with out earnings whereas stress and payments piled up.

“That is so irritating,” the put up learn. “Hopefully nobody else will probably be victimized by this company.”


When US employers rent overseas staff for everlasting jobs, they’re required to attest to the federal government that they’ll place the workers on payroll by the point the employees enter the nation. Tallahassee Memorial didn’t reply to a request for remark concerning the allegations that some nurses waited for months earlier than the hospital gave them assignments.

The Lefora put up generated an enormous response among the many group, and members demanded to know the company’s identify. Whereas the unique put up prevented figuring out the company, a number of members of the group named Raval or Professionals to USA within the feedback.

Three days later, on October 22, Raval issued a press release on Fb addressed to the Lefora group. “Anybody on this board or elsewhere who says that we ‘double dip’ or are dishonest is mendacity,” he mentioned.


Raval additionally spoke concerning the Lefora put up throughout a public Zoom assembly. “And then you definately can’t even discuss in entrance of fucking Lefora? That is bullshit,” he mentioned in a mixture of Tagalog and English to the nurses in attendance, in accordance with a recording of the assembly obtained by Quartz and Sort Investigations. “Who is that this individual? I carry three weapons, as a result of these Filipinos will stab me. They higher make it possible for in the event that they stab me within the again I’m now not respiration, as a result of I’d simply shoot them within the head.”

Per week and a half after the put up within the Lefora group, Raval posted photographs on his Fb web page exhibiting three handguns, hid in metallic instances designed to seem like books. “Convey your e book/s with you at all times :-),” he wrote within the caption.

If such posts appeared designed to discourage nurses from talking critically of him, Victoria, a Filipina nurse in her 20s, had determined to not stay silent. “It means he’s getting actually scared,” she mentioned after scrolling by Raval’s Fb feed, whereas sitting in her condominium in Tallahassee. Victoria had come to Tallahassee Memorial by means of PTU, and Raval’s remedy of her and different nurses had begun to rankle. Because the writer of the nameless put up on Lefora Filipino Nurses to US, she requested to be referred to by a pseudonym, for worry of retaliation by Raval and Professionals to USA.


Nervous as she was, the concept that Raval may be intimidated by her additionally struck Victoria as humorous. If solely he knew who he was fearful of, she mentioned, her fuzzy slippers kicked off on the foot of the couch. “And if he noticed me, I’m simply right here laying round,” she mentioned. “And a lady at that.”

In a press release, Raval mentioned he was not conscious of the Lefora Fb put up that criticized PTU and denied threatening his critics. He introduced up his weapons, he mentioned, throughout a dialogue about anti-Asian hate crimes within the US. “In response to some questions on what I do for my private safety, I did say that I’ve a Florida hid weapons license and carried a gun,” Raval mentioned. “That’s 100% regular in Florida and we do encourage all nurses who’re to acquire coaching and licensure of their house state.”

“As a Filipino-American who immigrated to this nation, I take the anti-Asian hate crime assaults very severely and don’t wish to ever have one in every of our nurses unable to defend themselves,” he mentioned. “As to what you have got been informed, I’ve by no means threatened anybody and positively not with weapons.”

Victoria had hoped that her put up would stop different nurses from being exploited. By way of an administrator of the Lefora Fb group, she introduced Raval’s threats and the nurses’ complaints to the eye of the Philippine Nurses’ Affiliation of America (PNAA), the principle skilled group representing Filipino nurses within the US.


After the submission of the criticism, nonetheless, she was listening to one in every of Raval’s Zoom conferences, a rant that careneed from the conflict in Ukraine to an anti-abortion screed to criticism of whoring actors on TV, when he acquired a message from a person who recognized himself as a consultant of PNAA in Florida. The message mentioned that somebody had filed a criticism a couple of hospital in Tallahassee. The decision alarmed Victo ria, who frightened that she may need been uncovered.

However Victoria stored going. She mentioned she filed a criticism towards PTU with the Inner Income Service, however by no means acquired a response. She thought of contacting the FBI, but it surely was troublesome for her to work out methods to navigate the system for submitting complaints. She even despatched an electronic mail anonymously to the Philippine embassy’s abroad labor workplace, which she mentioned additionally didn’t reply. There was no clear means for worldwide nurses to hunt accountability, she felt. And regardless of the legal guidelines and ethics may be, nothing would occur if nobody enforced them. She spoke to a lawyer, which gave her some hope, but it surely was clear that any potential authorized case would take a very long time to resolve.

“They’ll simply exhaust you till you’re demoralized,” Victoria mentioned of the shortage of response she acquired from PNAA and the authorities. “They haven’t any enamel. That’s why companies aren’t afraid to do sketchy contracts.”

The Philippine Nurses’ Affiliation of America didn’t reply to a number of requests for remark.


In April 2023, Victoria and her colleagues acquired a reminder of what they have been up towards. A screenshot started circulating among the many nurses who had signed contracts with Professionals to USA. It was a summons from a Florida circuit court docket to a former Tallahassee Memorial nurse: If he didn’t reply inside 20 days, “you could lose the case, and your wages, cash and property could thereafter be taken with out additional warning from the court docket,” it learn. “You might wish to name an legal professional immediately.” Courtroom information present that PTU is suing the nurse for $40,000, plus attorneys’ charges, for breaching his contract.

Concern radiated by the group of Filipino nurses in Tallahassee. Victoria heard that nurses who have been planning to go away Tallahassee Memorial have been reconsidering, and a few who had left the hospital have been now considering of returning. For Victoria, too, the psychological prices of opposing Raval have been excessive. She began taking anti-anxiety treatment to assist address the stress. She understands why different nurses could also be afraid to talk out.

Even so, she’s gladshe wrote the Fb put up — that she mentioned one thing in order that different nurses may be capable to keep away from the same scenario. “This is the reason that is taking place,” Victoria mentioned. “Nobody tried to right it up to now, and nobody warned us. So it simply retains going and going.”


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