When Care Becomes Code

AI is spreading through American medicine. When the system is wrong, the burden often lands on those who never asked for a copilot in the first place

- HILKE SCHELLMANN

ADAM HART HAS BEEN A NURSE AT ST. ROSE Dominican Hospital in Henderson, Nev., for 14 years. A few years ago, while assigned to help out in the emergency department, he was listening to the ambulance report on a patient who'd just arrived-an elderly woman with dangerously low blood pressure-when a sepsis flag flashed in the hospital's electronic system.

Sepsis, a life-threatening response to infection, is a major cause of death in U.S. hospitals, and early treatment is critical. The flag prompted the charge nurse to instruct Hart to room the patient immediately, take her vitals and begin intravenous (IV) fluids. It was protocol; in an emergency room, that often means speed.

But when Hart examined the woman, he saw that she had a dialysis catheter below her collarbone. Her kidneys weren't keeping up. A routine flood of IV fluids, he warned, could overwhelm her system and end up in her lungs. The charge nurse told him to do it anyway because of the sepsis alert generated by the hospital's artificial-intelligence system. Hart refused.

Aphysician overheard the escalating conversation and stepped in. Instead of fluids, the doctor ordered dopamine to raise the patient's blood pressure without adding volume-averting what Hart believed could have led to a life-threatening complication.