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

This collection was produced in partnership with the nonprofit newsroom Kind Investigations, with help 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 conclusion 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 most recent remedies and applied sciences trendy medication has to supply. She would additionally obtain a coveted US inexperienced card, and be paid excess of she may make at house.

“I used to be excited,” Rachel stated 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 trendy, is rated among the many prime 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 study the brand new specialization. She and her colleagues would often juggle as many as 5 sufferers at one time, straining them to their limits. Typically they needed to look after as many as seven sufferers every.

Sliding a needle into an aged affected person’s papery vein may take as much as half an hour, Rachel stated. One other affected person may turn out to be 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 wash, 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 may present the care they wanted. With 5 or extra she was scrambling to maintain up.


Quickly, Rachel discovered herself spinning via the cycle of tension, burnout, and guilt a few job unexpectedly performed that has plagued nurses throughout the US and accelerated throughout the covid-19 pandemic. In keeping with analysis by the Nationwide Council of State Boards of Nursing, 45 % of nurses surveyed in 2022 reported experiencing burnout, and practically one-fifth of the present workforce plans to go away the career by 2027. An American nurse who began at Tallahassee Memorial concurrently 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 price as a part of the appliance course of, she stated, and she or he needed to shoulder 1000’s of {dollars} in extra prices, corresponding to a job supply letter and a medical clearance examination. Rachel additionally stated her PTU contract included a $30,000 breach price, a typical follow amongst businesses that recruit nurses to work in the USA.

Quartz and Kind Investigations reviewed a PTU contract signed by one other Filipino nurse who began working for Tallahassee Memorial across the identical 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 stated it could undergo if the nurse left her job early or in any other case breached the contract. The company’s CEO additionally advised 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 all 1000’s of nurses who immigrate to the USA annually, the vast majority 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 — practically 10% of the full healthcare workforce — contributing to a crucial scarcity within the nursing career. For the USA, together with the UK and different European nations, hiring nurses from abroad has turn out to be a necessary solution 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 Kind 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 had been recruited to work at Tallahassee Memorial via Professionals to USA. To maintain them in line, many of those nurses stated, PTU or its CEO threatened to sue nurses for tens of 1000’s 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 trade, in accordance with lawsuits towards different businesses and interviews with nurses and advocates.

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


Such practices can influence not simply nurses, however sufferers as effectively. Rachel stated she feared that understaffing in her unit at Tallahassee Memorial put her liable to making a critical error. She felt anxious earlier than her shifts, and anxious after them. She barely ate and had hassle 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 Kind 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 embody a ‘liquidated damages’ quantity. That’s not a ‘breach price’ and isn’t unlawful within the case of everlasting visa immigrants,” Raval stated. “The liquidated damages provision just isn’t meant as a penalty, however is a standard manner of agreeing to damages within the case of breach when damages can’t be moderately calculated.”

A spokesperson for Tallahassee Memorial stated in a press release that its precedence is “creating an setting of engagement and help for everybody who comes via our doorways,” and that each 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 stated. “These colleagues are valued members of our TMH household, and plenty of have been with us for years and are leaders in our group.”


Confronted with the $30,000 breach price and the specter of being deported, nonetheless, Rachel stated felt she had no alternative 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 need to proceed within the career she’d as soon as cherished.

“I got here right here for a greater life,” Rachel stated. “Nevertheless it’s solely turn out to be more durable.”

The company

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

Raval got here throughout as dapper and charismatic, dressed well 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 may work in your unit of specialization, he advised the assembled nurses. They’d be employed instantly by Tallahassee Memorial, and PTU wouldn’t skim cash from their paychecks like different recruitment businesses have been identified to do, he stated.


“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 advised the nurses, in comparison with the few hundred {dollars} a month most nurses may count on to make within the Philippines. All they needed to do was pay just a few 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 had been involved in 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 20 years. Based mostly in Gainesville, Florida, his firm was based in 2000 as Nurses to USA earlier than altering its title to Professionals to USA in 2010. As a distinguished recruiter, Raval is widely known within the Philippines. In 2019, a Philippine TV information community referred to him as a “World Pinoy Idol,” utilizing the Tagalog slang phrase for Filipino.


In its first 23 years of enterprise, Raval has stated, the company has organized for greater than 2,200 nurses from the Philippines to work in American healthcare amenities. Along with offering worldwide workers 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 outdoors 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 stated 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 suggestions and smiling nurses simply arrived on American soil. However amid the uplifting messages in regards to 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 in your US IMMIGRANT VISA,” he scolded nurses in an August 2022 Fb publish, 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 via the Atlanta airport, an American flag hanging from the rafters above him. He had simply spoken with an immigration officer, he stated with a frown, who advised him that he may 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 will’t simply come into the nation and make the most of the immigrant visa and go away, with out fulfilling their dedication,” Raval stated. “I’m sorry, however I’ve to report. I do need to report you all.”

Within the caption, Raval advised that nurses who didn’t end their contracts may have hassle getting into the US once more. “The subsequent time you go to AMERICA, your names and passport copies would in all probability 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 advised us earlier.”

In a press release, Raval stated his warnings had been merely meant 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. “We now have by no means threatened to report nurses to USCIS,” he advised Quartz and Kind Investigations. “We now have had communications with USCIS when the info 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 every now and then a nurse merely doesn’t present up for work on the hospital who sponsored them.”

Overseas nurses sometimes enter the USA on EB-3 visas, which grant them everlasting residency. These employees 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 Providers stated employment agreements “are outdoors the scope of USCIS.” The Division of Labor stated in an electronic mail that the company “doesn’t have a job in implementing 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 may 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 may take it away.

Funds and hidden paperwork

For Rachel and different nurses, the price of securing a job via 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 inns. All advised, she stated, she spent practically $8,000 to return to America for the job at Tallahassee Memorial.

Requiring employees to pay cash to take a job abroad violates internationally agreed-upon truthful recruitment practices, in accordance with the Worldwide Labour Group, the UN company that units labor requirements and works to forestall human trafficking and compelled labor. In keeping with the ILO, potential employers ought to bear the prices of hiring, and employees shouldn’t be charged charges associated to their recruitment, instantly or not directly. Such charges, as outlined by the ILO, embody 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 employees 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 via misrepresentation of contract phrases, the imposition of recruitment charges, the confiscation of identification paperwork, or a mix of those,” a State Division spokesperson advised Quartz and its companions in an electronic mail. “The involvement of intermediaries (for instance, labor brokers, middlemen, employment businesses, or recruiters) creates extra 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 major pink flag that worldwide nurses ought to be careful for. “No recruiter ought to cost you a recruitment price for his or her providers,” the group wrote in a 2022 weblog publish.

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 price and threats of deportation and lawsuits violated federal anti-trafficking legal guidelines. The case is ongoing.


In a press release to Quartz and Kind Investigations, Raval stated PTU doesn’t presently cost nurses a recruitment price. “Our contracts have developed over time in response to altering legal guidelines, norms and financial realities,” Raval stated. “In our present contract with nurses, the nurses don’t pay us something. Most often, we do require our nurses to pay the USCIS a ‘premium processing’ price. The hospitals that we recruit for reimburse this price 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 Kind Investigations, stipulates that the hospital will reimburse nurses for each the USCIS premium processing price and relocation bills. However nurses stated Tallahassee Memorial coated solely relocation bills.

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

The hospital didn’t reply to questions in regards to 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 cost as a part of the appliance course of. Such funds could be a signal to US officers of an exploitative relationship, and might violate federal rules that prohibit the shopping for and promoting of everlasting labor certifications.

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

And the relationships between employees and recruitment businesses could be straightforward to hide. The counter declare towards PTU filed earlier this yr alleged that the US State Division started refusing nurses’ visa functions resulting from PTU’s recruitment charges and the excessive breach price in its contracts. After that, a number of Filipino nurses stated 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 is likely to 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 stated Raval had given nurses in Zoom conferences.


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

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

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 stated Tallahassee Memorial added onerous phrases to their hospital contracts. Rachel’s authentic settlement with Tallahassee Memorial, which Quartz and Kind 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 stated the hospital’s human sources division had them signal the brand new contracts throughout a gaggle orientation, telling them they couldn’t begin work till they did so. The nurses felt that they had no alternative however to signal, Rachel stated.


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

A “excessive wave” of contract breaches

Recruitment and staffing businesses have filed main lawsuits towards nurses lately, looking for tens of 1000’s 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,” stated Carmen Comsti, lead regulatory coverage specialist on the California affiliate of Nationwide Nurses United, the most important 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 price from a nurse in Pennsylvania for leaving their job earlier than the tip of their contract. Sentosa Providers, a Brooklyn-based staffing company, sued three nurses in 2016 for $25,000 every for breaching their contracts, plus a whole lot of 1000’s 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 advised 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 stated may add as much as tens of 1000’s 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 will act as threats of great hurt that coerce employees into remaining of their jobs. Some circumstances might 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 Kind Investigations, undermine the free motion of labor and deny employees one in all their strongest bargaining chips: the power to give up their jobs if the situations of employment don’t swimsuit 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 follow is a violation of the Honest Labor Requirements Act as a result of it brings employees’ wages under federal minimums. “Employers can’t use employees as insurance coverage insurance policies to unconditionally assure future revenue streams,” Solicitor of Labor Seema Nanda stated within the division’s announcement.

David Seligman, a labor lawyer and government director of In the direction of Justice, a nonprofit that has filed lawsuits on behalf of worldwide nurses, together with towards Superior Care Staffing, stated the grievance is a serious step towards larger authorities enforcement on this space, which may go away firms “on the hook for fairly large publicity.”

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

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


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

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

Mukul Bakhshi, chief international affairs officer at CGFNS Worldwide, stated the nursing trade is presently experiencing a “excessive wave of breaches.” Because the pandemic-induced staffing disaster has elevated demand for nurses, small businesses have popped up throughout the nation, contributing to a Wild West of worldwide nurse recruitment with businesses utilizing more and more aggressive ways to maintain employees from leaving their jobs. In some contracts, time beyond regulation and coaching hours don’t depend towards a nurse’s complete time dedication, including months of labor. Analysis revealed 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 businesses attempt to cost nurses as a lot as $100,000 for leaving their jobs, in accordance with courtroom data and interviews with nurses and advocacy teams.

“Since 2020, every part’s type of exploded,” Bakhshi stated in regards to the practices employed by some businesses 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 posh of grey, low-rise buildings a couple of minutes drive from Tallahassee Memorial, Rachel and some of her colleagues gathered at one in all their residences 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 highway journeys to the seashore, and tried to make sense of the quirks of American tradition and the methods it might be so completely different from what they had been used to again house. That afternoon in October, nonetheless, the main target of their dialog was Ray Raval.

Ten days earlier than, an nameless publish appeared on Lefora Filipino Nurses to US, a non-public Fb group that presently has greater than 200,000 members, the place nurses share suggestions, rejoice success tales, and infrequently warn colleagues of exploitative conditions. The publish stated an unnamed recruitment company had been mistreating nurses by charging them 1000’s of {dollars} for job placement, locking them into their positions with $30,000 breach charges, breaking guarantees in regards to the pay they’d obtain, assigning them to jobs outdoors their areas of specialization — or, worse, not inserting 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 publish learn. “Hopefully nobody else might be victimized by this company.”


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

The Lefora publish generated an enormous response among the many group, and members demanded to know the company’s title. Whereas the unique publish averted 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 stated.


Raval additionally spoke in regards to the Lefora publish throughout a public Zoom assembly. “And then you definately can’t even discuss in entrance of fucking Lefora? That is bullshit,” he stated in a mixture of Tagalog and English to the nurses in attendance, in accordance with a recording of the assembly obtained by Quartz and Kind Investigations. “Who is that this particular person? I carry three weapons, as a result of these Filipinos will stab me. They higher ensure that in the event that they stab me within the again I’m now not respiratory, as a result of I’d simply shoot them within the head.”

Per week and a half after the publish within the Lefora group, Raval posted photographs on his Fb web page displaying three handguns, hid in steel circumstances designed to appear to be 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 stated after scrolling via Raval’s Fb feed, whereas sitting in her condominium in Tallahassee. Victoria had come to Tallahassee Memorial by the use of PTU, and Raval’s remedy of her and different nurses had begun to rankle. Because the creator of the nameless publish 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 Raval is likely to be intimidated by her additionally struck Victoria as humorous. If solely he knew who he was terrified of, she stated, her fuzzy slippers kicked off on the foot of the couch. “And if he noticed me, I’m simply right here laying round,” she stated. “And a lady at that.”

In a press release, Raval stated he was not conscious of the Lefora Fb publish that criticized PTU and denied threatening his critics. He introduced up his weapons, he stated, 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 stated. “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 significantly and don’t wish to ever have one in all our nurses unable to defend themselves,” he stated. “As to what you may have been advised, I’ve by no means threatened anybody and definitely not with weapons.”

Victoria had hoped that her publish would stop different nurses from being exploited. Via 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 primary skilled group representing Filipino nurses within the US.


After the submission of the grievance, nonetheless, she was listening to one in all 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 stated that somebody had filed a grievance a few hospital in Tallahassee. The decision alarmed Victo ria, who apprehensive that she may need been uncovered.

However Victoria stored going. She stated she filed a grievance towards PTU with the Inside Income Service, however by no means acquired a response. She thought-about contacting the FBI, nevertheless it was tough for her to work out find out how to navigate the system for submitting complaints. She even despatched an electronic mail anonymously to the Philippine embassy’s abroad labor workplace, which she stated additionally didn’t reply. There was no clear manner for worldwide nurses to hunt accountability, she felt. And regardless of the legal guidelines and ethics is likely to be, nothing would occur if nobody enforced them. She spoke to a lawyer, which gave her some hope, nevertheless it 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 stated of the dearth of response she acquired from PNAA and the authorities. “They don’t have any enamel. That’s why businesses 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 had 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 courtroom to a former Tallahassee Memorial nurse: If he didn’t reply inside 20 days, “it’s possible you’ll lose the case, and your wages, cash and property could thereafter be taken with out additional warning from the courtroom,” it learn. “Chances are you’ll wish to name an lawyer instantly.” Court docket data present that PTU is suing the nurse for $40,000, plus attorneys’ charges, for breaching his contract.

Concern radiated via the group of Filipino nurses in Tallahassee. Victoria heard that nurses who had been planning to go away Tallahassee Memorial had been reconsidering, and a few who had left the hospital had 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 deal with the stress. She understands why different nurses could also be afraid to talk out.

Even so, she’s gladshe wrote the Fb publish — that she stated one thing in order that different nurses may be capable of keep away from the same state of affairs. “That is why that is taking place,” Victoria stated. “Nobody tried to right it previously, and nobody warned us. So it simply retains going and going.”


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