The American Medical Association says developers, health systems and physicians should each answer for the risks they can control. An ASC leader explains what that means for surgery centers.
When an AI-assisted navigation system or robotic platform fails during a procedure, who is responsible: the surgeon, the manufacturer or the facility that bought it? Under today’s liability rules, the answer often isn’t clear.
The American Medical Association (AMA) Center for Digital Health and AI is pushing for a new framework that would tie liability to each party’s authority and ability to prevent or reduce harm. The AMA says existing liability frameworks weren’t designed for technologies in which physicians, developers and healthcare organizations each exercise different levels of control. As a result, physicians may be held liable for risks they can’t reasonably prevent, while patients may struggle to find a remedy when AI causes harm.
“Patients must have meaningful avenues for recourse when clinical AI causes harm, and physicians must be able to use these technologies with confidence that responsibility reflects what they can reasonably know and control,” said AMA President Willie Underwood III, MD, MSc, MPH. “As AI assumes more clinical functions, developers, healthcare organizations and physicians each have important responsibilities. We need clear expectations that protect patients, support sound clinical judgment and ensure accountability remains with those best positioned to prevent harm.”
Four sets of responsibilities
The AMA framework calls for well-defined, complementary responsibilities across the clinical AI life cycle:
- Developers and manufacturers should demonstrate and maintain the safety and effectiveness of their products and address risks within their control.
- Healthcare organizations and other deployers should be accountable for how AI systems are selected, implemented, governed and monitored in real-world settings.
- Physicians should be responsible for the clinical judgment they can meaningfully exercise, based on a system’s intended use, known limitations and the information available at the point of care.
- Patients must keep meaningful ways to seek accountability and appropriate remedies when harm results from defective AI systems or other actionable failures.
The framework recognizes that more than one party may share liability when something goes wrong. It also stresses that physician oversight can’t make up for inadequate evidence, poor system design or conditions that keep clinical review from being meaningful.
What it means for surgery centers
Mandy Hawkins, BSN, RN, CAIP, CASC, chair of the Ambulatory Surgery Center Association’s (ASCA) AI working group, said the framework gives ambulatory surgery centers (ASCs), especially those with limited resources, a clearer foundation for adopting AI responsibly. Hawkins, a former ASCA board president, is CEO of Three Hawks Advisors in Mount Pleasant, South Carolina.
She said that alongside accreditation standards and established safety oversight, the framework can help ASCs strengthen operations and clarify accountability as AI becomes more integrated into surgical care.
“AI-assisted navigation and robotic platforms can enhance surgical capabilities, but their safe use depends on appropriate patient selection, clinical expertise, staff training and effective oversight,” Hawkins said. “Strong governance and standardization help establish a consistent approach to incorporate these technologies into quality surgical care.”
The framework’s division of responsibility maps closely onto the surgical setting, she said.
“Surgeons remain responsible for clinical judgment and the appropriate use of technology. Manufacturers should be accountable for defects and risks within their control, while organizations should be accountable for how systems are selected, implemented and monitored,” Hawkins said. “A surgeon should not automatically bear sole responsibility for an internal system failure that could not reasonably be detected or prevented. Meaningful clinical oversight requires access to relevant information and a practical opportunity to assess and act on it.”
More than a purchase
Hawkins said adopting AI is an ongoing commitment for ASCs that goes well beyond buying equipment or a software platform. Responsible integration, she said, should include:
- Formal governance
- Vendor due diligence
- Verification of performance accuracy
- Training for surgeons and staff
- Risk assessments
- Quality and safety monitoring
- A clear process for reporting and acting on incidents
To help members keep up, ASCA has launched an AI working group. Its top priority is helping surgery centers understand the legal and risk implications of adopting AI tools so they can protect themselves and their patients and avoid unintended consequences, Hawkins said.
The association plans a webinar series beginning later this year and continuing into 2027 on AI’s impact on clinical operations, governance, billing and customer service. ASCA also plans to launch a webpage dedicated to AI resources.
“The goal is to help ASCs make informed decisions about using these tools while minimizing potential risks,” Hawkins said.
