# NHS 111 - Misclassification of Medical Emergencies
UK, 2020-2022 | Severity: N2

## What Happened
Between 2020 and 2022, the UK's National Health Service (NHS) used an algorithmic decision-support tool (the NHS Pathways system used by NHS 111 call handlers) to assess and triage calls from the public. Investigations revealed that the system frequently misclassified critical medical emergencies—such as sepsis, strokes, or cardiac events—as lower-risk conditions, advising callers to wait or seek routine care instead of directing them to immediate emergency departments. In several cases, patients suffered severe medical complications or died due to delays in receiving urgent care because the algorithm's decision paths deprioritized their symptoms based on rigid, flawed logic.

## How MEG 1 acted
The medical triage system failed the Index of Safety and Responsibility (ISR) audit due to its high failure rate in detecting life-threatening emergencies, violating the core principle of medical safety and non-harm.

## MEG 2 Analysis - Legal Framework
* **Agent level:** N2 (management) - algorithmic decision-support system used by a public authority to make critical medical triage and resource allocation decisions directly affecting human life.
* **Cause (6.1):**
  * **(a) system defect** - design flaws and rigid decision paths in the triage algorithm that systematically failed to recognize critical emergency symptoms (design defect), attributable to the manufacturer.
  * **(b) autonomous decision error** - the automated decision to classify life-threatening conditions as low-risk without clinician override.
* **Attachment of liability:** The public operator (NHS) is liable for deploying an unsafe clinical triage tool; the developer is liable for the system defects (6.1a) regarding medical safety and accuracy.

## Procedural Mechanism
* **6.2 (architectural human confirmation):** Algorithmic triage decisions must require active, architectural human confirmation. The AI must act as a suggestion tool; any decision to deny or delay emergency transport (such as an ambulance) must require clinical verification by a human nurse or doctor.
* **7.1 (independent forensics):** The call transcript, the specific symptoms entered into the algorithm, and the system's decision path must be securely logged in an unalterable ledger for medical and legal audits.
* **9.4 (least privilege):** The algorithm was granted primary authority to guide emergency routing without redundant medical validation layers, violating safe clinical boundaries.