Justice for Sentosa Nurses Campaign Turns 1 Year!

Filipino Nurses, Healers in Trouble

Filipino Nurses, Healers in Trouble

By JOSEPH BERGER

Published: January 27, 2008

THEY are recruited in their homeland with perks like free airfare. Some have been offered thousands of dollars in bonuses to relocate. And in the process, they have become a mainstay of the New York area’s hospitals and nursing homes.

Joyce Dopkeen/The New York Times

Juliet Anilao and Claudine Gamiao, right, two of the nurses.

Joyce Dopkeen/The New York Times

Avalon Gardens Rehabilitation and Health Care Center in Smithtown, N.Y., where nurses are accused of resigning without sufficient notice.

Joyce Dopkeen/The New York Times

Avalon Gardens Rehabilitation and Health Care Center in Smithtown.

Joyce Dopkeen/The New York Times

Sharon Bannon, reading to her disabled daughter Jodie, a patient in the center’s pediatric unit.

Joyce Dopkeen/The New York Times

Meeting at an office in Garden City, N.Y., are Felix Vinluan standing between Claudine Gamiao, left, and Juliet Anilao, nurses.

They are nurses from the Philippines, and they are highly prized here because they speak English, are trained in American-caliber medicine and enjoy a reputation for tender care — the legacy of a society in which families tend to their own sick and aging relatives.

“We’re honest, industrious and don’t complain a lot,” explained Elmer Jacinto, 32, a registered nurse.

His voice, however, carried a palpable note of sarcasm. He and nine other Filipino nurses on Long Island did complain, and now they find themselves caught in what he called “a nightmare” — a disturbing new chapter in the upbeat story of one of this nation’s most successful immigrations.

The 10 nurses are under indictment in Suffolk County on charges of endangering the welfare of five chronically ill children and one terminally ill man. They are accused of walking off their jobs at the Avalon Gardens Rehabilitation and Health Care Center in Smithtown in April 2006 without providing sufficient notice for the nursing home to replace them on coming shifts.

Although their resignations were prompted by a seemingly commonplace dispute with their employers over what the nurses say were broken promises and shabby working conditions involving a total of 26 Filipino nurses and a physical therapist, the 10 defendants could each be sentenced to a year in jail and lose their nursing licenses. Their trial was scheduled to start Monday, but it appears that it will be put off until March.

The district attorney’s office conceded that the patients suffered no harm, and acknowledged that it could not recall a similar prosecution against nurses in the state. But it said the nurses’ crime was serious: four of the children they left behind were on ventilators that demand round-the-clock monitoring.

“They walked off their jobs, and the critical care patients didn’t have the health professionals to attend to their needs,” said Robert Clifford, a spokesman for Thomas J. Spota, the Suffolk district attorney.

The case has drawn wide attention and outrage in the Philippines, where legislators have held hearings into how the nurses were treated by the company that recruited them. Filipinos there and in the United States have rallied to support the nurses, joined by the American Nurses Association, which has said in a statement that “the real patient endangerment lies in the deplorable conditions that led the nurses to leave.”

The pushback has even taken on a political tinge. Commentators in both countries, citing an investigation by Newsday, have questioned whether favoritism was shown the nursing home owners because of their political influence and campaign contributions, and because of letters written to the Philippine president and other officials by Senator Charles E. Schumer. The senator and the owners have denied exerting any unusual pressure.

But what no one denies is that the case is a startling anomaly in what has been a remarkably successful migration of people seeking to work in a single occupation. More than half of American nurses trained abroad are from the Philippines, and they alleviate a perennial shortage of nurses in this country.

Of the New York area’s 215,000 Filipinos, 3 out of 10 work as nurses or other health-care practitioners, according to an analysis of Census Bureau data by Susan Weber-Stoger, a Queens College demographer. Many of the rest are their spouses, children or aging parents. That migration explains the large colonies of Filipinos in places like Jersey City and Bergenfield, N.J., a middle-class suburb, where Robert C. Rivas, mayor from 1999 to 2003, claimed to be the only Filipino mayor in the Northeast.

The indicted nurses pose a strange counterpoint to that success: the image of highly educated legal immigrants complaining about being exploited as green, overly trusting newcomers.

“You were treated like dirt,” said Juliet Anilao, 36, a mother of two and another of the nurses indicted. “All we wanted to do was work and send money home.”

MR. Jacinto, a soft-spoken native of a small Philippines island, saw medicine as his ticket out of poverty. He not only received a nursing degree, but also graduated from medical school in the Philippines in 2004 with stellar board scores.

Deciding to leave one’s homeland is always wrenching, but American salaries were a large incentive. “You can earn here $3,000 a month in America while a doctor in the Philippines earns $400 a month and a nurse $200,” Mr. Jacinto said.

He came to New York in November 2005 with 21 other nurses who had been recruited by a Filipino agency that works mainly for SentosaCare, a network of 16 nursing homes with headquarters in Woodmere, N.Y., and operated by Benjamin Landa of Brooklyn and Bent Philipson of Monsey, N.Y. Mr. Landa owns eight other homes independently, and together with SentosaCare, the network of 24 homes has more than 5,000 patients and 5,000 employees. The 22 nurses who came over here in November 2005 say they were promised they would earn the same pay as American nurses and would quickly receive green cards giving them the status of permanent residents.

But Mr. Jacinto says he soon got some surprises: for two months, he was paid as a clerk, at a salary far below that of a nurse. It took more than half a year to get the green card. And he was not assigned to the SentosaCare-affiliated home in Queens that had sponsored his entry, but to Avalon, 40 miles east.

For weeks, he said, he slept on a couch in a frigid living room of a nurses’ staff house in Smithtown where the only toilet was frequently clogged. When he finally received nurses’ pay, he said, it was $24 an hour instead of the $34 that federal law requires immigrant nurses be paid to prevent undercutting of American workers’ salaries. He did not receive the same health insurance and workers’ compensation benefits as other nurses, he said, and was not paid for sick days or holidays.

Ms. Anilao said Avalon employed so few aides on the night shift that she regularly had to change soiled diapers and sheets and cart them away. The nurses complained that raises they were promised were wiped out by a reduction in work hours from 37.5 per week to 35.

Howard Fensterman, SentosaCare’s lawyer, denied that the nurses were mistreated or shortchanged, and rejected complaints that staffing was inadequate. SentosaCare, he said, had successfully employed 350 nurses from the Philippines over the years and had never experienced a wave of resignations.

The nurses say that when their complaints went unaddressed, they turned to the Philippines consulate in New York, which put them in touch with an immigration lawyer, Felix Vinluan. Mr. Vinluan concluded that their contract had been breached and on April 6, 2006, he filed a discrimination complaint with immigration officials in Washington. He also advised the nurses that one option was to resign.

On April 6 and 7, 14 nurses in four SentosaCare homes other than Avalon submitted their resignations, and late on the afternoon of April 7, 10 Avalon nurses followed suit. They say they offered so little notice because they were worried that SentosaCare might drum up charges against them that could jeopardize their licenses.

Still, the nurses say, they left confident that the elderly and the patients in a pediatric unit would be taken care of because they knew of nurses waiting for assignment in two other SentosaCare staff houses. According to the nurses and their lawyers, only one of the 10 indicted Avalon nurses was working at the time the resignations were handed in and only two were scheduled for 7 a.m. shifts 12 hours away. Some had as many as four days off before resuming work.

“No patient was ever placed in jeopardy,” Ms. Anilao said. “Not a single shift was unattended.”

Susan O’Connor, Avalon’s administrator, has said, associates say, that she had only 12 hours to rustle up replacements for five nurses who had resigned and were scheduled to start the 7 a.m. shift. In her 30-year career — enduring snowstorms, fires and strikes — the walkout created the single scariest night of her professional life, she has said. Ms. O’Connor is a major witness in the criminal case and has been advised by SentosaCare lawyers not to comment publicly.

Mr. Fensterman has argued that finding substitutes was especially difficult because the replacements had to be experienced in monitoring ventilators for sick children. “If they vomit into the tubes and the tubes are not cleared, they can asphyxiate themselves,” Mr. Fensterman said.

Sharon Bannon of Farmingdale, whose severely brain-damaged daughter Jodie, 24, is a patient in the pediatric unit and requires a breathing apparatus, said she was upset that the nurses resigned abruptly.

“They left my child unattended and it could have been a potential hazard,” she said in a telephone interview. “Jodie is critical and she can’t be left. Luckily, the home was able to handle it.”

THE case escalated. SentosaCare filed a civil suit charging the nurses with breach of contract and lodged a complaint with the State Department of Education. The nurses filed complaints against SentosaCare’s recruiting arm in the Philippines, and the government effectively suspended the company’s recruiting privileges.

But in June 2006, the suspension was lifted, and last September Newsday reported that Senator Schumer had written four letters over two months to officials in the Philippines — including one to the president — to get the suspension reviewed. In the two months after the suspension was revoked, the newspaper reported, the Democratic Senatorial Campaign Committee, whose chairman is Mr. Schumer, received nearly $75,000 from investors, vendors and lawyers associated with SentosaCare.

Josh Vlasto, a spokesman for Mr. Schumer, said all the senator asked for was due process, not “any outcome in any direction.” Mr. Schumer, he added, writes letters for many constituents and SentosaCare “was a major employer on Long Island and operates in an industry Schumer is active on.”

Newsday also reported that the SentosaCare partners, allied investors and their lawyer, Mr. Fensterman, have donated $750,000 to Democratic and Republican campaign funds, though Mr. Fensterman said that the amounts lumped together the contributions from his associates in other industries. In 2003, Mr. Fensterman contributed $1,500 to the campaign of Mr. Spota, the district attorney prosecuting the nurses, the newspaper said.

Mr. Fensterman is chairman of the Nassau County Industrial Development Agency, which awards leases and tax incentives, and is Mr. Schumer’s campaign finance chairman for Long Island. Mr. Landa was, during the governorship of George E. Pataki, a member of the state’s Public Health Council, which reviews proposals for new health care institutions like nursing homes.

Mr. Fensterman and spokesmen for Mr. Schumer and the district attorney’s office deny that campaign contributions played any role in the prosecution of the nurses or the Philippine government’s actions.

“Because I made a $1,500 contribution to Tom Spota four years before, does that mean that I’m disenfranchised from seeking the help of an elected official?” Mr. Fensterman asked.

In September 2006, after two hearings, the New York State Education Department, which licenses nurses, rejected SentosaCare’s charge that the nurses had abandoned patients. (That finding has been buttressed by the results of a New York State Department of Health review, announced on Jan. 16. “The shifts were covered,” said a department spokesman, Jeffrey Hammond, “and the patients were not placed in jeopardy.”)

But last March, the district attorney, who had met 10 months earlier with Mr. Fensterman, Mr. Landa and Mr. Philipson, secured the grand jury indictment, which also charged the nurses’ lawyer, Mr. Vinluan, with conspiring in the resignations.

James O. Druker, a lawyer for the nurses, argues that the case should never have been brought. Mr. Vinluan, he said, was “indicted for giving the nurses legally correct advice” and his clients “were indicted for following his advice.”

It took months for some of the nurses to find other jobs, they say, because every time they applied employers would Google their names and up would pop articles about the indictment. Mr. Jacinto and Ms. Anilao now work at a hospital in Queens.

Something of a mystery still lingers: Why were matters allowed to reach such a state? Why would nurses who forsook their homeland to seek well-paying work risk those jobs? And why would SentosaCare’s owners risk their successful recruitment of Filipinos by seeking prosecution?

Company officials say they sought to keep nurses from imperiling fragile patients.

“A message needs to be sent,” Mr. Fensterman said, “that if nurses can simply walk out on patients with impunity, that is a danger for all Americans, whether in nursing homes or hospitals.”

One nurse, Ms. Anilao, said some things were more important than a salary.

“I wasn’t raised by my parents to bow down,” she said, “ and take all those things just for the money.”

Global Networking : Myths of Sentosa/Avalon

http://services.inquirer.net/print/print.php?article_id=20080124-114546

GLOBAL NETWORKING Global Networking : Myths of Sentosa/Avalon

By Rodel Rodis INQUIRER.net

Posted date: January 24, 2008

There are myths about the American legal system that Filipinos blindly subscribe to. The most common is that it's generally free of the kind of corruption and political manipulation its Philippine counterpart is subject to. The Filipino nurses recruited by the Sentosa Recruitment Agency (SRA) to work at the Avalon Garden nursing home facility in New York entertain no such illusions. Their trial on trumped-up criminal charges is set to begin next week on January 28. Their problems all began when they signed up with the SRA in the Philippines in 2004. They chose SRA over other nurse recruiters from the US because SRA offered to provide them with green cards to work at nursing home facilities, which individually petitioned them, upon their arrival in New York. As an added enticement, they were offered two months of free housing and reimbursement of all their travel expenses. Among the Filipino nurses who signed up with SRA was Elmer Jacinto, the physician-nurse who topped the Philippine medical board exams in 2004 but opted to work as a nurse in the US rather than as a doctor in the Philippines. Jacinto was recruited by SRA to work for the Franklin Center nursing home which signed up as his immigration sponsor. The owner of the Philippine-based SRA, Francris Luyun, facilitated all the immigration paperwork for the nurses and even flew to New York to greet them when they arrived and escort them to their staffing house. A few days after their arrival, however, the nurses were informed by Luyun that they could not work for the nursing home facilities that petitioned them because they had no work permits (SRA forgot to submit them). Luyun mentioned that he could provide them temporary work through Sentosa Services where, it turned out, he was the recruitment contractor. Because the nurses had no other choice, they accepted Sentosa’s offer. Jacinto and nine other nurses were given work at the Avalon Gardens nursing home while other nurses were doled out to around a dozen different nursing homes. It turned out that all of them were owned and operated by Sentosa Care, LLC, whose CEO was Bent Philipson, the man who signed all the employment contracts with the Filipino nurses on behalf of the various New York nursing homes which had petitioned them. They were not employees of the nursing homes where they worked but “agency nurses” employed by Sentosa Services to work as independent contractors at their assigned locations. They were paid below the prevailing wage of the Department of Labor and not paid for the overtime they were compelled to put in. Felix Vinluan, the lawyer consulted by the nurses, reported that they were provided substandard living accommodations upon their arrival. “Some had to sleep on the cold floor; some had to alternate in using the beds; and most of them complained that their staff house was not properly heated. In fact, two of them who had to sleep on makeshift beds in the garage, because there was no more space for them inside the house,” Vinluan said. The nurses complained to both Luyun and Philipson about their working conditions and about patient safety as they were each tasked with taking care of 40 to 60 patients. Their complaints were ignored, prompting them to seek lawyer Vinluan’s counsel. Approximately 27 Filipino nurses signed up with Vinluan; he advised them all to file discrimination charges against their respective sponsoring or contracting employers with the US Department of Justice's Office of Special Counsel for Immigration-Related Unfair Employment Practices. Because they were employed by Sentosa Services and not the nursing homes they were assigned to, and because they never signed employment contracts with Sentosa Services, Vinluan advised them that they were “at-will” employees who could resign anytime, the same way their employer could fire them anytime. On April 6, 2006, the Filipino nurses at one Sentosa facility resigned at the end of their shifts, followed the next day by Filipinos working at four other Sentosa facilities, including ten nurses at Avalon. In response, Philipson and Sentosa Care, LLC filed a civil suit for “breach of contract” against the Filipino nurses and a “tortuous interference with contractual relations” cause of action against their lawyer, Vinluan. The nurses filed a cross-complaint against Sentosa for breach of contract. Sentosa then filed complaints against individual nurses with the New York Office of Professional Discipline (OPD), causing the licenses and permits of the nurses to be placed on hold. The Filipino nurses filed administrative cases against the SRA in Manila for violations of Philippine recruitment rules and regulations before the Philippine Overseas Employment Administration (POEA). On March 24, 2006, the POEA administrator issued a preventive suspension order against the SRA. After US Sen. Charles Schumer contacted the POEA on behalf of Bent Philipson, a campaign contributor, the POEA lifted its suspension order just two weeks after it was issued. Presidential Chief of Staff Michael Defensor also reportedly intervened to prompt the POEA to lift the suspension order. On September 13, 2006, the New York Office of Professional Discipline (OPD) informed Vinluan that the administrative cases against the Filipino nurses were closed, and that there was “no finding of patient abandonment and that there was no good moral character issue that would prohibit the nurse-permittees from securing their limited permits or nursing licenses.” After failing to secure a preliminary injunction against the Filipino nurses, Sentosa’s lawyer next sought a meeting with the District Attorney of Suffolk County to discuss their complaints against the Filipino nurses and Vinluan. Because Sentosa's lawyer was a heavy campaign contributor to the DA, he could call in some chips. On March 22, 2007, the District Attorney secured a Suffolk County Grand Jury indictment against the 10 nurses working at Avalon Gardens, including Elmer Jacinto, as well as their attorney, Felix Vinluan, for “endangering the welfare of pediatric patients” at a Suffolk County nursing home. The nurse-defendants and their attorney have become known as the "Avalon 11". Last week, the New York Department of Health released the results of its investigation, finding that the pediatric residents of Avalon Gardens "were not placed in jeopardy" by the mass resignation of 10 nurses in 2006. This report was released less than two weeks before the immigrant nurses were scheduled for a January 28 jury trial in Suffolk County, New York, on charges of conspiracy and endangering patients in a pediatric ventilation unit at the Avalon Gardens Rehabilitation and Health Care Center. Despite this exculpatory report, the Avalon 11 defendants are still concerned about their case because of the political connections of Sentosa’s lawyer with the Suffolk County District Attorney. They have launched a campaign to convince New York Gov. Elliot Spitzer to appoint a Special Prosecutor to take over the case from the Suffolk County D.A. Members of the Filipino community are encouraged to send letters to Gov. Spitzer at the State Capitol, Albany, NY 12224 or by faxing him at 518-474-1513. Will justice be a myth at the Avalon 11 trial? Send comments to Rodel50@aol.com or log on to www.rodel50.blogspot.com/) or send your letter to the Law Offices of Rodel Rodis at 2429 Ocean Avenue, San Francisco, CA 94127 or call (415) 334-7800.

Federal civil suit vs. Sentosa, district attorney

http://globalnation.inquirer.net/news/breakingnews/view/20100110-246526/Federal-civil-suit-vs-Sentosa-district-attorney
INQUIRER.netFirst Posted 10:42:00 01/10/2010

MANILA, Philippines—Ten Filipino nurses recruited and brought to the United States by Sentosa Care, as well as their lawyer, filed a Federal civil rights lawsuit against the company, its owner and officials, and the Suffolk County district attorney and other officers of the court.

The nurses were among the more than 27 who have been charged for allegedly abandoning and endangering their pediatric and geriatric patients when they resigned en masse in 2006.

In an e-mail to INQUIRER.net, lawyer Felix Vinluan said the lawsuit, which was filed on January 6, 2010, in the Federal District Court in Central Islip New York, seeks unspecified monetary damages. The case followed a decision by a state appellate court dismissing the misdemeanor charge.

Respondents in the case include Sentosa Care; its principle owner Bent Phillipson; Suffolk County District Attorney Thomas Spota; Assistant District Attorney Leonard Lato; Avalon Gardens; Prompt Nursing Employment Agency; Berish Rubinstein; Francris Luyun; and Avalon’s Susan O’Connor and Nancy Fitzgerald.

Separate civil cases brought by Sentosa Care against the so-called Sentosa 27++ nurses and Vinluan are still pending before Justice Stephen Bucaria in Nassau Supreme Court, Vinluan said..

The story attracted headlines in Manila and New York, as Filipino nurses generally look to finding work in the US. Congressional hearings were held in the Philippines in 2007.

Broken Promises from Manila to Mineola; Filipino Nurses Say Company Exploited Them

Michael Amon and Ridgely Ochs
Sept. 24, 2007, p. A6, Part 2 of series
Elmer Jacinto arrived from Manila at Kennedy Airport in November 2005 to pursue a nursing career, a symbol of the Philippines’ best and brightest.

The top scorer on the Philippines’ national medical exam, Jacinto had prompted an agonized national discussion in his country when he, like thousands of other skilled Filipino workers, decided to leave his homeland to make more money.

But by March of this year, when Jacinto and nine other registered nurses were criminally indicted for endangering their patients at a Smithtown nursing home – apparently the first such indictment in the state – he and the others had become symbols in the Philippines of something else: shattered expectations of life in America.

And for Benjamin Landa and Bent Philipson, owners of the nursing home, the situation marked the only time their relationship with Filipino nurses had resulted in something approaching disaster.

The clash between the nurses and their bosses began as an ordinary employer-employee dispute. But it has reverberated far beyond Long Island as the nurses’ legal troubles have been intensely chronicled in the Philippine press. The events leading up to their indictment also shed light on the difficulties that U.S health care companies face as they struggle to secure sources of qualified staff amid a persistent shortage of nurses. And they highlight the gambles that foreign nurses such as Jacinto take as they uproot their lives for a chance to make more money for themselves and their families back home.

“We should have been very proud. Instead we are becoming criminals,” said Jacinto, who is now working as a nurse at Bellevue Hospital Center in Manhattan. He is actually one of the lucky ones: Of the 10 indicted nurses from the Smithtown nursing home, six remain unemployed. Jacinto and the other nurses face a year in jail and possible deportation if convicted. No trial date has been set. In addition, the nurses are being sued for breach of contract by SentosaCare.

Resigning their posts

On April 7, 2006, Jacinto and nine other Filipino nurses and a physical therapist at Avalon Gardens Rehabilitation and Health Care Center in Smithtown quit their jobs – without notice. They resigned over pay, hours and other work disputes after they had complained repeatedly to their supervisors and had met with senior executives, including Philipson. In days before and after, another 16 Filipino nurses at affiliated nursing homes joined them. The Smithtown facility is part of the SentosaCare nursing home network – based in Woodmere and owned by Philipson and Landa. It is the state’s largest for-profit nursing home group with annual revenue of about $450 million.

Almost a year after they quit, a Suffolk County grand jury handed up a misdemeanor indictment against the 10 Avalon nurses, charging conspiracy and endangering the welfare of children and the physically disabled. The indictment focuses on an unusual pediatric unit with 10 chronically ill children on ventilators. It charged that by resigning together without notice, the nurses were leaving the nursing home pediatric unit, the only one licensed on Long Island, with inadequate nursing coverage.

The nurses’ immigration lawyer, Felix Vinluan of Westbury, is also charged with criminal solicitation and conspiracy for encouraging the nurses to resign. Such charges against attorneys are rare, legal experts said.

Different players in the nurses’ story offer dramatically different views of the impact of their actions that day. The Avalon nurses contend that they never put the children at risk because other nurses were available. None of the nurses left during their shifts; the only nurse working the day they quit completed her shift, then worked four hours overtime.

Marlene Fazio, a former nursing supervisor who said she was never interviewed by the district attorney’s office, was in charge of the nursing staff on the 3-11 p.m. shift the Friday the nurses resigned. Administrators had to fill one shift that night and eight over the next four days, according to the nurses’ affidavits.

“It didn’t seem that chaotic,” she said. Although she said there was a “scramble” to find replacements, her shift was unremarkable and she believed no residents were ever at risk. “They had people in place,” Fazio said.

The state Education Department, which regulates nurses, investigated them last year and cleared them in October.

Philipson and Landa’s attorney criticized the Education Department’s probe as superficial and painted a starkly different picture from Fazio.

“At the end of the day, the nursing home was confronted with the following: They had a group of nurses that they were relying upon to care for these children, these fragile children, and the fragile elderly people in the nursing home, and they left. They just left,” said Howard Fensterman of Hewlett Harbor.

An ‘error in judgment’

Assistant District Attorney Leonard Lato said the nurses seemed to be “good, hard-working people,” but that as medical professionals they made “a severe error in judgment.

“They’re trying to transform this into a civil case about the working conditions,” said Lato, who conducted the investigation. “The working conditions don’t matter to me. They didn’t develop overnight – even if you believe them. Why didn’t they say a couple of days earlier, ‘If our demands are not met, we’re just resigning?’ Just give some notice to allow the nursing home to find skilled replacement workers.”

The nurses have suffered two recent legal setbacks. Last month, an office in the U.S. Justice Department decided not to bring a discrimination lawsuit on their behalf before an administrative immigration court. The nurses now plan to file the suit with the court on their own. That strategy keeps the case alive, but reduces the damages the nurses could win.

And this month, the Philippines Overseas Employment Administration, which regulates Filipinos who work in foreign countries, dismissed an action brought by 26 nurses and a physical therapist against SentosaCare and its affiliated Philippine-based recruiter, Sentosa Recruitment Agency. The nurses are appealing. They charge fraud and misrepresentation in SentosaCare’s sending them to nursing homes other than those with which they had contracts.

Cecilia Rebong, the Philippines consul general in New York, described her government’s decision as “legalistic. It might not be what I wanted. … My personal want is maybe different from the official position of a government agency.

“My fervent hope is that our nurses will get justice,” she said.

The son of teachers who grew up on Basilan, a rebel-torn island in the southern Philippines, Jacinto got his nursing degree in 1996. He then went on a full scholarship to medical school in Manila where he graduated first in the class of 2002.

In 2004, Jacinto finished top among about 1,800 aspiring doctors taking the Philippine national medical exam. In 2005, he decided to work as a nurse in the U.S. His decision was widely covered in the Philippines, where a “brain drain” of skilled workers is a major national issue.

With 70 percent or more of its nursing graduates working abroad, the Philippines is the biggest supplier of nurses worldwide. The reason is money: The average starting salary for a registered nurse in the Philippines is between $100 and $200 a month, according to Dovelyn Agunias, associate policy analyst at the Migration Policy Institute in Washington, D.C. Doctors make $300 to $800 a month. By contrast, the average nurse in New York state earns between $4,000 and $5,000 a month, Agunias said.

“I heard good stories about how you can upgrade yourself,” Jacinto said.

For Philipson and Landa – who with their wives own controlling interests in 25 nursing homes in New York City, Westchester and Long Island – bringing Filipino nurses to work in their facilities also made sense. New York is expected to have a shortfall of 30,858 nurses by the end of the year, according to the state Education Department.

Quickly turning sour

Landa and Philipson established a relationship with Sentosa Recruitment Agency in metropolitan Manila to take care of their own shortage. Although the similar-sounding companies have no corporate connection, Fensterman said, SentosaCare has first rights to the nurses recruited in the Philippines by Sentosa Recruitment Agency. Owned by Filipino Francis Luyun, the agency has sent 364 nurses to Landa-Philipson homes since the agency opened in 2002, Fensterman said. About a quarter of SentosaCare’s nursing services directors are Filipino, he said. “These nurses are RNs. One of the objectives of Ben Landa and Bent Philipson originally was to try to ensure that they were maintaining the quality of care in their facilities,” Fensterman said.

The seeds of the disagreement between SentosaCare and the Filipino nurses were planted hours after Jacinto and a dozen or so other nurses landed in New York.

Jacinto liked what he saw in Sentosa Recruitment Agency materials: salaries at $21 to $35 an hour, medical and dental coverage, relocation and housing allowances, free malpractice insurance, paid vacation days, paid sick days, free airfare from Manila to New York, reimbursement of fees for processing certifications, night shift differentials, comprehensive training, and free housing for new nurses. The three-year contract had a $25,000 penalty if a nurse left early.

Virtually all of the subsequent disagreements resulted from the nurses’ feeling that promises were not kept by Sentosa Recruitment Agency in the Philippines and by SentosaCare on Long Island. In general, the issues are typical of those in employee-employer disputes, but for the Sentosa nurses, already feeling insecure and far away from home, they apparently took on even more significance.

For example, Jacinto believed Sentosa Recruitment Agency was a direct-hire agency, as it is described on the agency’s Web site. To Jacinto and the other nurses, that meant that a specific facility would be each nurse’s “petitioner” to the U.S. to help them secure a green card, which makes the bearer a legal permanent resident. For nurses, the distinction is important because many prefer to work for an institution, not an agency that can switch their assignments. The nurses each signed contracts with their petitioning nursing homes.

But it turned out that almost all the Filipino nurses who eventually resigned were placed in nursing homes that did not petition them. While Philipson in an affidavit said the nurses asked for re-assignments, the nurses deny this. However, this arcane point of immigration law eventually became the nurses’ legal rationale for their resignations: They claim they had no contract because they never worked for their petitioner.

Nothing illegal?

Shawn Saucier, an immigration services spokesman, said Philipson and Landa had done nothing illegal in transferring the nurses to other homes. The nurses’ contract states that “employer has the right at its sole discretion to transfer this agreement to any of its affiliated facilities. “

There were other problems, the nurses said. Their housing for the first several months was free, but Jacinto said the house he lived in was so crowded he had to bunk on a couch. They said another was in an unsafe neighborhood and had a faulty heating system. Many found they had to work as clerks for weeks or months because essential documents – including their state nursing licenses – were not ready for them. As clerks, they made $12 an hour, instead of $21 an hour as a nurse.

Sarah Lichtenstein, a lawyer in Fensterman’s office, said the delay in getting the necessary documents was not unusual.

“Our people did them a favor by employing them, giving them some employment even at a clerk level, so they had some income while they were waiting for their permits to be issued,” she said.

The nurses at Avalon also had complaints about working conditions, ranging from inadequate training, inadequate staff on the units, paychecks they say did not reflect their hours worked and reductions in their work week from 37.5 hours to 35 hours.

Avalon’s nursing-patient ratios are above average, federal statistics show. Federal regulators look at health care staffing ratios by calculating how much nursing time each patient gets. In 2006, Avalon residents on average got 40 minutes a day of care from a registered nurse, compared with the state average of 36 minutes and a national average of 30 minutes. That number rose to 55 minutes this year.

Nevertheless, the nurses who quit said they often felt they didn’t have enough staff to help them. Ma Theresa Ramos, who worked on the pediatric ventilator unit, said attempts to get more staff went unheeded.

“We kept telling them that these were children with different needs than other residents,” she said. “We felt we cannot give the care they need.”

Susan O’Connor, Avalon’s administrator, said staffing for the unit is “based on patient census and needs. For ventilator patients, we have a nurse for every four to six patients. In addition, we have 24/7 respiratory technician coverage.”

The nurses also were upset when their hours were cut. The nurses at the beginning of 2006 had their hourly wages raised from $21 to $24 an hour to comply with the U.S. Department of Labor’s prevailing wage rate – a minimum wage for foreign workers to protect American workers from being undercut by lower-paid foreigners. But on Jan. 3 a memo informed the nurses they would no longer work 37.5 hours but 35 hours a week, in effect reducing their pay raise.

Their unhappiness was noticed by other staff members. Fazio said the nurses often seemed miserable – even though she praised them as “excellent, cooperative, hard-working and respectful.”

Attorney’s involvement

In late March, Jacinto and another nurse, Alipio Esguerra, went to the Manhattan office of immigration attorney Felix Vinluan to see what their rights under the contract were. Two days later, Vinluan said, he got a call from the Philippine consulate about Eileen Magnaye and Noralyn Ortega, nurses at Bayview Nursing and Rehabilitation Center in Island Park, who had similar complaints. The consulate asked him to help the nurses.

Vinluan called a meeting the next week at which 15 or so nurses showed up. The lawyer charged each nurse a one-time fee of $100. He said he advised them that because they were not working for the nursing homes that petitioned them, the contracts they had signed had already been breached and thus they could resign if they chose to without penalty.

Fensterman charged that Vinluan told them to quit: “My view is that there were a few malcontents who ran into an attorney … who himself has his own employment agency in the Philippines. And he, in my view, conspired with these nurses and worked with them.”

But Vinluan denied – as did the 10 nurses – that he told them to quit or orchestrated their resignations. He also said he has no “employment agency anywhere else in the world.”

The nurses’ resignations occurred over several days.

On April 6, 10 Filipino nurses from Brookhaven Rehabilitation & Health Care Center in Far Rockaway quit without notice.

The next day, Jacinto said he and the other Avalon nurses debated all day whether they should quit and whether they should give notice. Their contracts did not require them to give notice unless they had worked for the nursing home for five years. Jacinto said they were afraid of reprisals if they stayed after giving notice.

By 5:15 p.m. on April 7, the nurses said, they had handed in or faxed their resignations. SentosaCare says the nurses did not quit until 7 p.m.

Also that day, two Filipino nurses at Bayview and two at Split Rock Rehabilitation & Health Care Center in the Bronx also quit.

Only two of the Avalon nurses were scheduled to work April 7, according to their affidavits: Rizza Maulion and Ma Theresa Ramos. Maulion said she had been scheduled to work the 7 a.m. to 7 p.m. shift.

“When I showed up for work, the nursing director sent me home, telling me to work the evening shift. … This was an extreme inconvenience and, in fact, was the final straw leading to my resignation,” she said in her affidavit.

Ramos worked her 7 a.m. to 7 p.m. shift in the pediatric ventilator unit and also worked an extra four hours – six hours after her resignation, she said in her affidavit.

As for worrying about whether the residents would be taken care of if they resigned, Jacinto – like the other nurses – said he felt there were sufficient numbers of nurses available to cover their shifts.

Fazio, the nursing supervisor from 3 to 11 p.m. that day, said that although “the tension was very thick” after the 10 submitted their resignations, other nurses from within Avalon and other facilities were brought in. “Basically, I didn’t sense there was any real danger or real jeopardy,” she said.

Fensterman disagreed. “If you contemplate … the fact that we are dealing with an acute nursing shortage … where are you supposed to get the nurses from to replace the nurses that walked off the job?”

Lato said it “would have been a different story” if the nurses had quit at 9 a.m. He contends that the nurses quit in the evening so that Sentosa would not be able to bring a restraining order against the nurses.

The indictment, which came almost a year after the nurses left, took all the nurses by surprise. Jacinto, who was working at St. Vincent’s Midtown Hospital until it closed at the end of August, is worried whether he and the other nurses will prevail in court.

As for his time in the United States, Jacinto is polite but noncommittal. “The land of milk and honey – I do not know,” he said, his voice trailing off into silence.