12 Nurses Say They Are Being Replaced by AI

 Montefiore Medical Center in the Bronx, New York, fired 12 nurses and plans to replace them with artificial intelligence (AI) software, said nurses and city and state officials during a call with reporters on Wednesday.

The change comes on the heels of a February agreement between the nurses' union and the Montefiore hospital system that ended a nearly month-long strike. Nurses say the terminations directly violate that agreement, and the New York State Nurses Association (NYSNA) has filed a class action grievance. A spokesperson for Montefiore Health System says the claims are "inaccurate and misleading."

In late May, Ajita Mathew, RN, who has been a nurse for 36 years and is a member of Montefiore's utilization review team, received a letter from the manager of Labor and Employee Relations stating that her position would be eliminated in 45 days.

"During this time, the Medical Center will work closely with you to determine whether there are suitable positions that [are] in accordance with the collective bargaining agreement," the letter stated. "Montefiore recognizes the commitment you have made to its patients and will work hard to make this transition easier for you."

All 12 nurses on the utilization review team received a similar letter, NYSNA said.

Marilyn Shuler, RN, who has worked at Montefiore for 39 years, said nurses had been told that "someone" would be sending necessary clinical information from patients' charts to payers, but no one made clear whether that task would fall to a nurse or a machine.

Utilization review nurses have a "vast knowledge" based on years of experience, Shuler said during the Wednesday call. "So much of what we do cannot be reduced ... to a click."

New York City Council member Shirley Aldebol, who advocated for Montefiore to stop its "45-day displacement clock," said she's worried replacing "complicated clinical judgment by real nurses" with AI will lead to dropped cases, missed diagnoses, unapproved surgeries, and other patient services being denied.

Judy Sheridan-Gonzalez, RN, an emergency department nurse at Montefiore and former NYSNA president, said utilization review teams exist because insurers want to save money and not pay for prolonged visits if they can avoid it.

"The patients require a human being to advocate for [them] to see if the visit is necessary," she noted.

If a patient's situation improves but they're not well enough to go home, an algorithm can't make those calls, she pointed out.

"These algorithms just take very raw data and make a conclusion ... without taking into account the patient's gender, race, ethnicity, cultural needs, physical needs, and clinical needs, because they can't do that analysis," Sheridan-Gonzalez said. Unlike an algorithm, nurses reviewing charts have access to people and can say, "There's something missing here. Let me go find out what that is."

"This is all about human beings, about their outcomes," she added. "It's about ... what's going to happen while they're in the hospital, what kind of teaching needs do they have, what learning needs do they have, what kind of support do they have at home? How will they survive when they go home?"

It's about "other complex conditions that come into play here, which require a different type of assessment. Only a human being can do that," she argued.

Sheridan-Gonzalez also pointed out that the changes violate the most recent union agreement, which states "that any use of AI really has to be discussed with the union to ensure that our patients are protected."

"Montefiore is denying that AI has anything to do with this, which we know is not true," she noted.

In a statement to Gothamist, Joe Solomonese, a spokesperson for Montefiore Health System, blasted the nurses' claims.

"As is often the case, the claims by NYSNA are inaccurate and misleading," Solomonese said. "What is true is that we are always investing in new technology to ensure the best care and outcomes for our patients and will continue to do so for the betterment of the people we serve."

The nurses said Montefiore changed its utilization review process earlier this year, using AI-powered software from Datavant, a private equity-backed health IT company. In May, Datavant settled a class action lawsuit following a data breach that impacted 320,702 individuals.

Sheridan-Gonzalez said that this move is the "tip of the iceberg."

They started with nurses doing documentation, "but who's to say that in the future they won't replace ... other nurses who actually touch patients, work with patients in the hospital, have that intimate relationship ... with something else, whether it's a machine or a robot or some kind of algorithm," she pointed out.

"Nurses are not against technology," said Shaiju Kalathil, RN, an NYSNA executive committee member at Montefiore. "The problem is when hospitals roll out new technologies without evidence that these technologies will improve the lives of patients and working people, and worse, with evidence that patient care may suffer, and jobs will be long lost."

Shuler stressed that "what we want is simple: to stop layoffs, the hospital to keep a licensed nurse to complete the utilization review and sit down with the nurses who do this work, [and] discuss how AI can support us instead of replacing us."

https://www.medpagetoday.com/nursing/nursing/122039