Beth Laurine’s viral Facebook post about “dirty illegals” mooching off “free healthcare” prompted enough outrage for the nurse’s employer—the San Jose Regional Medical Center—to publicly distance itself from her latest of many anti-immigrant diatribes.

“Thank you for bringing this to our attention,” the hospital’s marketing team wrote in an Aug. 21 tweet about the emergency department director’s inflammatory remarks. “We are handling this internally. Please note, the views expressed do not represent the hospital or the care we provide.”

“Handling this internally” apparently meant sending Laurine to another facility owned by the Hospital Corporation of America (HCA), San Jose Regional’s multi-national parent company. But word about the nursing manager’s xenophobic rant traveled fast enough to waylay her relocation.

“Via email she was announced as one of our new agency managers in Lansing, Michigan,” a nurse wrote on Twitter a day after San Jose Inside broke a story about Laurine’s racially charged comments. “We were outraged at her views and notified our union. Now she will no longer be coming to our [emergency department].”

It’s unclear at this point where Laurine will end up. Or if the hospital will take seriously her claim that somebody hacked her Facebook, where she repeatedly railed against non-citizens, welfare recipients and black people protesting police brutality. The traveling nurse who hails from a Pennsylvania suburb has evaded media inquiries, deactivated her LinkedIn profile and set her Facebook account to private. HCA, for its part, has stayed mum, referring reporters to its social media pages for updates—the last of which was posted late last week.

But the controversy is far from over.

The community’s trust in HCA’s ability to equitably serve the culturally and socioeconomically diverse East Side is badly shaken. Vice Mayor Magdalena Carrasco, who represents the largely blue-collar Latino district where San Jose Regional lies, has demanded answers from HCA, to no avail. Meanwhile, employees who worked under Laurine say her divisive rant is no isolated outburst, but the symptom of an abusive corporate culture and toxic work environment that endangers staff and patients alike.

Before Laurine made headlines last week with her ill-advised hot-take, a group of concerned staffers penned a letter they planned to send to local journalists alert them to what they call “illegal and unsafe healthcare practices.” That is, according to its authors, assigning nurses to work despite not meeting state-mandated staff-to-patient ratios; placing new graduates into critical care without adequate training; ordering employees to falsify medical records by claiming that patients waiting in urgent care were already assigned to an upstairs hospital bed.

“Over the past several years, the nursing staff of [the Regional Medical Center]’s emergency department have had to endure numerous shifts from safe and standardized nursing practice by order from their constantly rotating management team and corporate leadership,” the nurses wrote. “More recently, these illegal and unethical practices have found themselves seeping over to other patient care units like the Intensive Care Unit. Time and time again, reports are filed with multiple state agencies ... however, these reports yield no significant progress, as investigational interviews are often times conducted with management, the individuals who promote said illegal and unsafe practices. As a result, no changes have been made to the unsafe work environment, which place our patients and staff at risk.”

The letter was never sent, but its authors say the situation remains just as dire. “It’s extremely demoralizing, but it’s also compromising the quality of care,” said a nurse who asked to withhold his name for fear of reprisal.

According to the California Department of Public Health, San Jose Regional has been the subject of 46 substantiated complaints since 2012 for administrative, patient care and safety violations. And the 264-bed hospital has been hit with $161,700 in fines for failing to report, among other things, information breaches, improper use of medical equipment and patients coming down with serious ulcers after admission. HCA-owned Good Samaritan Hospital, in comparison—with 140 more beds than San Jose Regional— accounted for 56 sustained claims since 2012 and $131,100 in fines since 2008.

To HCA—a company that in 2000 survived a $1.7 billion fine for its role in one of the biggest Medicare fraud cases in history under then-CEO, now-Florida Gov. Rick Scott—that’s a small price to pay. When HCA founder Tommy Frist Jr. launched the hospital chain a half-century ago, he modeled it after Kentucky Fried Chicken by consolidating branches throughout the U.S. under a single corporate administration. The plan worked. HCA grew out of its base in Tennessee into a multibillion-dollar healthcare behemoth with hospitals around the world and two in San Jose.

“They’re putting profits before patients,” said another veteran urgent care nurse who asked to remain anonymous. Then, employees say, there are the labor violations such retaliation, intimidation, racial discrimination and preventing nurses from bringing union reps to meetings with managers. “They’re creating this hostile workplace and finding any way they can to get rid of the most experienced nurses to bring in the lower-paid recent grads,” the same nurse added.

More than a dozen other current and former staffers who spoke to San Jose Inside in recent days on condition of anonymity echoed those concerns. All expressed fear of retribution, saying HCA’s subcontracted management team—hired through Tennessee-based subsidiary HealthTrust Workforce Solutions—punishes people for speaking out.

San Jose Regional spokeswoman Jessica Menchaca did not respond to requests for comment by press time Tuesday. However, a leaked email sent earlier this summer by management hints at an us-vs.-them posture. In the email, HealthTrust Vice President of Interim Leadership and Physicians Brandi Vines talks about the need for battle-ready supervisors to deal with the “union environment” at San Jose Regional.

“Must be willing to get punched in the face,” Vines wrote facetiously. “Not literally … but they will be fielding the issues. Evaluating schedules, adjusting schedules, meeting with union reps, write-ups if necessary. … Basically be the police in the ER.”

Employees who intercepted the correspondence balked at the idea of being treated as suspects. “Any reasonable individual would have to ask themselves, ‘What kind of work environment are you in where management feels the need to ‘police’ your practice?’” the group of nurses asked in their never-sent letter to the media. By openly recruiting adversarial supervisors, HCA and HealthTrust were basically asking for someone like Laurine, another employee added.

The out-of-state department head arrived last fall as part of a “cleaning crew” to purge outspoken employees and replace them with younger, cheaper recruits. She reportedly had no qualms about reminding subordinates that she was there to “clean house,” which seemed to mean writing up, suspending or firing employees who talked back.

“It’s obvious retaliation for these nurses making a stand for patient safety and doing what we are supposed to do: report violations,” an intensive care unit employee lamented.

Since June, the urgent care source said, nine nurses have been suspended and six have been terminated. Four are suing, he said, in addition to filing grievances through the union. “Of course you want a hospital to investigate all members of the care team if there are questions,” the staffer said, “but these nurses have clean records, great reputations and are highly regarded as clinical leaders in the department.”

Laurine’s combative management style and off-color remarks, unsurprisingly, put her at odds with the 60-or-so employees under her watch in San Jose—but also with people she worked with at hospitals in other states where she served as interim department head. In addition to routinely lambasting non-citizens on social media, as evidenced by multiple screenshots shared with San Jose Inside, Laurine alarmed people at the San Jose Regional ER by making sexual comments about a male traveling nurse, speaking down to a lesbian colleague and glibly disparaging a whole host of marginalized groups.

During a meeting at another hospital in another state to discuss hiring someone to process sexual assault kits, multiple sources say Laurine downplayed the problem by exclaiming that “most rapes are fake anyway.” At least one person in the room was a rape survivor herself. And one filed an internal complaint about the incident.

“That’s traumatizing,” a female nurse who overheard the exchange said. “How can you be expected to treat patients with dignity if you look down on them like that?”

Another longtime San Jose Regional nurse said she’s looking for work elsewhere because she wants no part of an institution that tolerates such disrespect. “The focus has been lost,” she said. “My job is to take care of people no matter what country they’re from, no matter what language they speak, no matter what insurance they have.”