A conflict is brewing in New York that could become a turning point for the entire US healthcare system. The administration of the large Montefiore Medical Center in the Bronx has decided to fire 12 licensed nurses, replacing them with software based on artificial intelligence.
The parties to the conflict — the hospital administration and the industry union — have already moved on to legal battles. At the center of the dispute is not only the fate of specific employees, but also a fundamental question: is it permissible to completely delegate quality control functions to algorithms, and does this violate labor contracts?
What exactly robots replaced
It is important to clarify immediately: this is not about replacing doctors or nurses providing direct patient care. The administrative and analytical sector was subject to reduction. The fired specialists worked in the Utilization Review (UR) department.
Their work involved the painstaking analysis of medical records and negotiations with insurance companies. It was these specialists who ensured that prescribed procedures complied with protocols and that insurers did not refuse to pay for treatment. Now these functions have been transferred to a software solution from IT integrator Datavant.
Montefiore Vice President Joe Solmonese characterized the administration's move as the introduction of "non-clinical tools." According to the administration, algorithms are capable of extracting disease codes and generating reports faster, freeing people from routine work.
Contract violation and threat of strike
The New York State Nurses Association (NYSNA) called the administration's actions illegal. The union claims that the dismissal was carried out in violation of the terms of a three-year collective agreement, which was signed only after a massive 41-day strike by medical workers that ended in early 2026.
According to the terms of the agreement, the introduction of new technologies that could affect jobs should have been discussed with the union. However, the Montefiore administration acted unilaterally, limiting itself to notifying employees 45 days before dismissal.
Risks for patients and data security
In addition to legal aspects, the union raises the issue of patient safety. Shaidju Kalatil, a member of the NYSNA executive committee, warns: unlike experienced specialists, algorithms are not capable of taking into account the individual context of the course of the disease.
There is a real risk that the automated system will begin to refuse insurance payments more often, not seeing nuances that are obvious to a human. In addition, accusations of negligence regarding data are being made against the software vendor, Datavant. In 2024, the company already faced a data leak incident, which resulted in compensation payments of $900,000. Given Datavant's partnership ties with Palantir, information security issues in healthcare are becoming particularly acute.
Historical precedent
This conflict goes beyond a local dispute. Lawyers note that the Montefiore case could become the first precedent in the US where a court will decide on the direct replacement of licensed specialists by algorithmic systems. The verdict on this lawsuit could set new rules of the game for automation in American medicine.