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An underwhelming first quarter at the country’s biggest hospital chain shows the pandemic’s stranglehold on labor costs is proving to be more stubborn than many had expected.

Investor-owned HCA Healthcare knocked down its full-year revenue and profit expectations on Friday, a move that sent shares tumbling and triggered a flurry of questions from analysts about its travel nurse spending. The Nashville-based hospital chain is a stock market darling that tends to dwarf its peers profit-wise, so its results don’t bode well for the rest of the sector.

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