As U.S. nursesincreasinglyemploy AI in their day-to-day tasks, the American Nurses Association isadvocatingfor more nurse-led guardrails amid concerns of bias, unclear accountability and a decline in professional judgement.
On April 22, the ANA hosted an invitation-only “AI in Nursing Practice Think Tank” for nursing leaders to discuss how AI is affecting the profession and what safety protocols should be implemented.
According to a consensus summary, nursing leaders identified five areas of concern:
Erosion of professional judgement and critical thinking: “Poorly designed or rapidly deployed tools may diminish nurses’ ability to see the whole patient, question outputs and exercise professional reasoning.” They also voiced worries about overreliance and automation bias.
Unclear accountability and liability: Nursing leaders are concerned about responsibility when AI tools influence care decisions. A common concern was fear of licensure exposure.
Bias that worsens equity and trust: Patient safety could be at risk if AI tools have algorithmic bias or incorrect data, leaders said.
Cognitive burden and workflow harm: Even if an AI is designed to alleviate workload, a poor rollout can negatively affect cognitive burden.
Lack of nursing-specific governance and standards: Most AI frameworks do not specify nursing and are not applicable to practices at the bedside, in education or decision-making.
In its May 5 report, the ANA — which represents more than 5 million U.S. nurses — recommended five action items to address these concerns:
AmSurg’s history is unlike the other major ASC chains, shaped by a series of massive ownership transformations reshaping its identity and risk profile.
Starting as the pioneer of the physician-partnership ASC model, it stretched into physician services via Sheridan, merged into a $10 billion diversified company with Envision, became buried under PE debt, survived Envision’s bankruptcy as a standalone entity and is now landing under a nonprofit health system for what its leaders call its next chapter.
Here’s a breakdown of AmSurg’s last 30 years:
Origins and early dominance
AmSurg’s roots trace to a consulting firm. Co-founders David Manning and Rodney Lunn began as ASC consultants in 1986, eventually forming AmSurg in 1992 with backing from Nashville-area investors. The company went public in 1997, and by 2002, AmSurg had reached 100 ASCs and briefly claimed the title of largest ASC provider in the U.S.
AmSurg’s ownership model distinguished it from the outset. The company held 51% of each center while physicians retained 49%, a structure that aligned incentives and became a defining competitive feature.
2014-2015: The Sheridan acquisition — from ASC operator to physician services company
In 2014, AmSurg acquired Sheridan Healthcare in a $2.35 billion deal funded with $615 million of equity and the remainder in debt, adding more than 4,600 physician relationships in 38 states and expanding its footprint into anesthesiology, radiology and emergency medicine.
Financially, AmSurg’s net revenues increased 53% from 2014 to $1.62 billion in 2015, primarily due to Sheridan’s financial results, and the company continued acquiring anesthesia and radiology groups throughout the year.
2016: The Envision mega-merger
In 2016, AmSurg merged with Envision Healthcare in a $10 billion all-stock deal, creating a combined healthcare services company spanning ASCs and physician services.The resulting entity, operating under the Envision Healthcare name, was heavily weighted toward physician services.
After the merger, physician services accounted for 81% of Envision’s core revenues, with the company acquiring nine physician practices in the first half of 2016 alone for $440.8 million.
2018: KKR’s $9.9 billion acquisition
Two years after the Envision merger, the combined company was taken private. KKR completed its $9.9 billion acquisition of Envision Healthcare, making Envision a wholly-owned subsidiary. Following the acquisition, the combined Envision/AmSurg entity had about 300 ASCs in its portfolio.
Notably, Envision rejected two of KKR’s offers before accepting the final $9.9 billion bid, which underscores how contested the valuation was at the time. The deal was financed with more than $7 billion in debt, a structure that would become increasingly difficult to sustain as interest rates and labor costs rose.
2019-2022: Debt pressure
The KKR years were defined by the financial strain of the leveraged buyout. While AmSurg’s ASC operations continued steadily — the number of AmSurg ASCs grew 17% since 2011, reaching approximately 250 centers across 34 states with about 2,000 physicians — the parent company Envision was faltering under its debt load and deteriorating relationships with insurers. The pandemic added further pressure on volumes, and rising interest rates made the debt structure increasingly untenable.
2023: Envision bankruptcy & AmSurg’s split
In May 2023, Envision filed for Chapter 11 bankruptcy protection, citing pressures including rising interest rates, labor costs and payment disputes with insurers.
AmSurg split from Envision in October 2023 and purchased all of the ASCs held by Envision, emerging as a separate and independent entity with 250 surgery centers across 34 states. Pacific Investment Management Co., a creditor, became AmSurg’s new majority owner following the restructuring.
With Jeff Snodgrass installed as CEO, the company began rebuilding as a standalone operation and quickly resumed acquisition activity — picking up centers in Oregon, Las Vegas, Maryland and California in the months following the split.
2024-2025: Rebuilding the platform
Post-independence, AmSurg’s strategy centered on broadening what had always been a relatively GI- and ophthalmology-heavy portfolio. AmSurg focused on diversifying its portfolio mix, broadening service lines, expanding health system partnerships, reinforcing its commitment to independent physician practices and enhancing its management company value proposition to optimize surgery center performance for patients, partners and payers.
The company leaned into a “collaborative model” that distinguished it from more acquisitive peers. AmSurg controls roughly 3.9% of the ASC market with 250-plus ASCs across 34 states and partners with about 2,000 physicians. New joint ventures with health systems like LifeBridge Health and Palomar Health illustrated growth through partnership rather than pure acquisition.
2025-2026: Pending Ascension acquisition
AmSurg’s next chapter came in mid-2025 when another major ownership change arrived — this time to Ascension rather than a PE firm. The transaction, valued at about $3.9 billion and expected to close in late 2025 or early 2026, would expand Ascension’s ASC footprint from 58 to more than 300 centers across 34 states.
Ascension CEO Joe Impicciche positioned the acquisition as mission-aligned, expanding access to affordable, localized care while enhancing capacity for procedures rapidly shifting out of hospitals, such as orthopedics and cardiology.AmSurg’s leadership framed the deal as an accelerant, not a disruption. Mr. Snodgrass told Becker’s the company had invested heavily in its team and culture and described the organization as “very mission focused,” adding that the Ascension acquisition would “only advance and accelerate” those objectives.
Pennsylvania has sued the artificial intelligence company behind Character.AI to stop its chatbot from posing as doctors.
Governor Josh Shapiro on Tuesday called the lawsuit against Character Technologies the first of its kind by a U.S. governor.
It followed the creation in February of a state AI task force to stop chatbots from impersonating licensed medical professionals.
In a complaint filed in the Commonwealth Court of Pennsylvania, the state said it found chatbots on Character.AI that claimed to practice medicine.
One character, "Emilie," allegedly told a male investigator posing as a patient with depression that she was licensed to practice psychiatry in Pennsylvania, as well as in the United Kingdom, and provided a bogus license number.
When the investigator asked Emilie if she could prescribe medication, she allegedly answered: "Well technically, I could. It's within my remit as a Doctor."
In a statement, a Character.AI spokesperson declined to discuss the lawsuit.
"Our highest priority is the safety and well-being of our users," the spokesperson said. "User-created characters on our site are fictional and intended for entertainment and role playing. We have taken robust steps to make that clear."
Pennsylvania wants an injunction to stop Silicon Valley-based Character.AI from violating a state law against the unauthorized practice of medicine.
"Pennsylvanians deserve to know who-- or what -- they are interacting with online, especially when it comes to their health," Shapiro said in a statement.
Character.AI has faced lawsuits over child safety, including in January, when Kentucky said its platform exposed children to sexual conduct and substance abuse, and encouraged self-harm.
The same month, Character.AI and Google settled a wrongful death lawsuit by a Florida woman who claimed a chatbot pushed her 14-year-old son to suicide.
Character.AI said it has taken "innovative and decisive steps" concerning AI safety and teenagers, including by preventing open-ended chats.
As a primary care provider, you can help patients set short-term goals to help their day-to-day lives. To begin, use patient-centered language, as this approach encourages patients to feel empowered and engaged in their own care, said Scott Isaacs, MD, president of the American Association of Clinical Endocrinology, and an adjunct assistant professor of medicine, Emory University in Atlanta.
This philosophy is especially practical if older patients in your practice have diabetes.
“Seniors with diabetes can experience symptoms and chronic conditions that can impact their daily lives. Practical strategies can make a meaningful difference in patient well-being,” he said.
An Overview of Conditions to Assist Patients
Foot pain. While you’re speaking to an older patient with diabetes, address concerns of foot pain, as when unaddressed it can lead to decreased levels of physical activity, mobility, and quality of life, Isaacs said. Patients may report tingling, numbness, burning sensations, or pain in their feet.
Scott Isaacs, MD
“These symptoms can be signs of arthritis, neuropathy, or poor circulation. It is important to acknowledge the patient’s discomfort and perform a thorough foot exam,” said Isaacs. “Recommend wearing comfortable, well-fitting shoes, keeping feet clean and dry, and advise against walking barefoot.”
Consider referrals to neurology, vascular surgery, or podiatry when appropriate.
Swollen limbs. Swelling in the legs or feet may indicate fluid retention, poor circulation, venous insufficiency, hypothyroidism, or heart or kidney problems, Isaacs said. For venous insufficiency, suggest to the patient to elevate their legs when possible. Encourage gentle movement throughout the day to promote circulation. And if swelling is new or worsening, consider further evaluation for underlying causes.
Excessive thirst. This can be a sign of elevated blood sugar levels. Evaluate glucose control and rule out diabetic ketoacidosis for patients who complain of polyuria, polydipsia, and/or blurred vision, Isaacs said.
Fatigue. True, it’s a common symptom, and while it is normal to feel tired at times, such as after exertion or insufficient rest, persistent or unexplained fatigue deserves a medical evaluation. When evaluating fatigue in older adults, reassure patients that occasional tiredness is normal, but ongoing or severe fatigue is not normal, Isaacs said.
Of note, sleep disturbances, such as poor sleep quality, insomnia, or sleep apnea, are common in older adults and can significantly impact energy levels. Also, your patient’s medication side effects should be considered, as many medications can potentially cause fatigue, he said.
Blood sugar fluctuations. Seniors with diabetes may experience symptoms of both high and low blood sugar, such as shakiness, confusion, sweating, or headaches. Educate patients about the signs of blood sugar changes. For those at risk for hypoglycemia (ie, those on insulin) recommend carrying snacks to address low blood sugar if it occurs, Isaacs recommends.
Vision changes. The American Diabetes Association recommends that all people with diabetes should have a yearly eye examination. It’s an important to make sure patients understand, said Osagie Ebekozien, MD, MPH, CPHQ, chief quality officer at the American Diabetes Association in Boston. “Blurry vision can signal blood glucose changes or eye complications. Let’s schedule an eye exam. In the short term, avoid driving if vision is poor, and keep your blood sugar in the target range.”
Why Encouraging Attainable Goals Is Effective
A primary care doctor is a valuable partner in helping older adults set short-term goals because older adults may have diverse health statuses, comorbidities, and functional abilities, Ebekozien said. Patient goal setting ensures care aligns with the patient’s unique needs.
“Doctors can also help ensure goals are realistic and safe, especially for those at risk of hypoglycemia, falls, or medication side effects,” he said. “This means addressing not only glycemic targets, but also the integration of diabetes technology, the frequency of clinical visits, and the use of relevant laboratory monitoring to optimize outcomes and quality of life.”
Encourage Patients to Self-Monitor Progress
Helping older adults with diabetes set and track their short-term health goals is a helpful way to engage and empower patients to be actively involved in their health. However, self-monitoring is not limited to blood glucose checks.
Osagie Ebekozien, MD, MPH, CPHQ
“It encompasses a range of strategies that can be tailored to each patient’s needs, abilities, and treatment plan,” Isaacs said. “Not all seniors with diabetes require daily blood glucose checks, especially those not on insulin.”
To chart progress, suggest that patients keep a simple record of meals and snacks, noting portion sizes and timing, as well as activity logs can include steps walked, minutes of exercise, or types of movement, he said.
“These records help patients have a better understanding of how their lifestyle habits impact their health,” Isaacs added.
Another self-monitoring tip is to ask patients to record blood pressure (BP) results in a notebook or digital app, even if the monitor stores the BP readings. Finally, at follow-up visits, review self-monitoring records together.
“Celebrate progress and adjust goals as needed to maintain motivation,” Isaacs said. Once you understand your patient’s daily life and priorities, you can work together to set meaningful goals that fit their situation, he said.
“Encourage patients to choose goals that feel achievable and reassure them that you are there to support them every step of the way,” he said.
Since the COVID pandemic landed on American shores in early 2020, virologists and allied science writers have engaged in a vociferous propaganda campaign to deny the dangers of virus experiments. When Nature Magazine published a 2021 article minimizing a Wuhan lab accident as the pandemic’s cause, science writer Amy Maxmen quoted Vincent Munster, a virologist at the Rocky Mountain Laboratories, a division of the National Institutes of Health (NIH), in Montana.
Munster told Nature’s Maxmen that there was nothing suspicious about a novel coronavirus popping up in the same city as the Wuhan Institute of Virology which was studying coronaviruses. Labs tend to specialize in the specific viruses found around them, Munster explained, and the Wuhan Institute of Virology focuses on coronaviruses because many circulate in China and neighboring countries.
“Nine out of ten times, when there’s a new outbreak, you’ll find a lab that will be working on these kinds of viruses nearby,” Munster told Nature.
Well, kind of. Sort of. But really not.
In fact, virologists regularly collect viruses from far away countries and bring them back to their own cities to study. And according to emails I have seen that are now circulating inside the Department of Health and Human Services (HHS), one of those virologists is the NIH’s Vincent Munster.
“We are unable to comment as this is under investigation,” wrote HHS spokesperson, Andrew Nixon in an email. “So we will refer you to the FBI.”
When contacted about their investigation into Munster and his NIH researcher, the FBI press office replied by email, “We decline to comment.”
While on a trip back from the Democratic Republic of Congo earlier this year, Munster and a scientist in his NIH lab were pulled aside for an airport security inspection. Inside their luggage, one of the two had a hard-shelled protective case used to transport sensitive property such as electronics and firearms. When the protective case was opened, it was found to contain pathogen samples collected from patients.
However, the human pathogens, which included monkeypox virus, may have been inactivated by reagents and rendered no longer infectious.
Munster and his NIH research fellow Claude Kwe Yinda published a February study in a Lancet journal that cited monkeypox as a global threat. Without any hint of irony, they warned about “multiple travel-associated cases reported since 2024, including seven in the USA.” The Democratic Republic of Congo has been considered the global epicenter of monkeypox virus, with over 100,000 cases as of October last year.
Munster and his lab scientist did not have paperwork required by law to transport deadly pathogens from Africa to his NIH lab in Montana. Both NIH scientists were placed on leave. Contact information for both Vincent Munster and Claude Kwe Yinda have been removed from the HHS employment directory.
Last year, the Department of Justice charged two Chinese nationals with criminal conspiracy for smuggling a dangerous plant fungus through a Detroit airport so they could study it in a lab at the University of Michigan.
Rocky Mountain Labs is an integral part of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), the institute once led by Tony Fauci. The Montana facility has a BSL-4 lab where virologists study the world’s most deadly viruses including Ebola, Marburg, and Lassa Fever.
Andrea Marzi, the Acting Chief of Virology at Rocky Mountain Labs, did not return emails asking if the monkeypox and other possible viruses Munster was transporting had been inactivated or were still infectious. Nor did she reply to requests asking if Munster’s lab had been secured.
Senator Rand Paul sent the NIAID director a letter two years ago regarding Munster, who was listed as a partner for a project called DEFUSE that was submitted in 2018 to the Defense Advanced Research Projects Agency (DARPA). As part of DEFUSE proposal to DARPA, virologists planned to engineer novel viruses by taking the backbone of a bat virus and inserting a spike protein with a furin cleavage site. A furin cleavage site allows viruses to infect the cells of human lungs.
DARPA denied funding for DEFUSE, but the following year, a novel bat virus with a furin cleavage site began infecting humans in Wuhan. No other virus closely related to the COVID virus has this furin cleavage site.
Shortly after the COVID virus began infecting Americans, Columbia University virologist Vincent Racaniello sent Munster an alarming February 2020 email, saying he had heard that the new COVID virus had a furin cleavage site “that might have been engineered.”
“If true this is very bad for all of virology research,” Racaniell wrote to Munster.
“And the fun begins,” replied Munster.
The news about Munster hits during an especially hard media cycle for virologists. I reported last week for RealClearInvestigations that the federal government had quietly removed University of North Carolina virologist Ralph Baric from all his NIH grants; UNC also placed Baric on leave. A senior HHS official, who reviewed the government’s classified material, told me that UNC is terrified the public will learn that they were complicit in starting the COVID pandemic.
“Baric designed the gun,” he said. “But the Chinese built it, and then they pulled the trigger.”
That same day, the Department of Justice indicted Tony Fauci’s senior advisor, David Morens, for concealing federal records concerning funding for virus research during the COVID pandemic. The indictment listed Peter Daszak of EcoHealth Alliance as “CO-CONSPIRATOR 1” and Boston University virologist Gerald Keusch as “CO-CONSPIRATOR 2.”
Last month, I reported on newly unearthed emails that show Morens, Daszak, and Keusch plotted against me for writing a 2021 investigation for the BMJ that concluded virologists had conspired in a misinformation campaign to cover up a possible Wuhan lab accident as the COVID pandemic’s cause.
In emails discussing me and my 2021 article, Keusch asked Morens and Daszak if they knew how to get in contact with former BMJ editor Peter Smith to complain. Daszak emailed back that contacting the BMJ about me was “a really good move” as my reporting was “pretty offensive stuff.”
Iran’s Revolutionary Guards Navy warned vessels intending to transit the Strait of Hormuz to use only a designated corridor announced by Iran, after a US-led Joint Maritime Information Center advised ships to cross the strait in Oman's waters, saying it set up an "enhanced security area."
“We warn all vessels intending to transit the Strait that the only safe route for passage through the Strait of Hormuz is the corridor previously announced by the Islamic Republic of Iran,” the IRGC Navy said in a statement on Tuesday.
“Any deviation by vessels to other routes is unsafe and will face decisive action by the Revolutionary Guards Navy,” it added.
The head of Iran’s Football Federation demanded on Tuesday that the United States provide official guarantees that the country’s military, including the Islamic Revolutionary Guard Corps (IRGC), will not be insulted during the 2026 FIFA World Cup, warning that Iran could withdraw from the tournament if the condition is not met, Iranian media reported.
"Americans, if they guarantee not to insult our military institutions and the IRGC, we'll go - If they give such a guarantee that an incident like Canada doesn't happen and they definitely assure it, we'll go; we have no business with America at all," Mehdi Taj, president of the Football Federation of the Islamic Republic of Iran, said.
The “Canada incident” refers to Mehdi Taj and members of Iran’s football delegation being stopped and questioned by Canadian border officials in Toronto over admissibility concerns linked to Canada’s designation of the IRGC; after facing prolonged inspection and uncertainty over entry, the delegation was not allowed to proceed with their planned visit and left Canada, missing the FIFA Congress in Vancouver.
