The Case Against Carilion Clinic’s Embrace of AI

Or: Why “Cautious Governance” Isn’t Enough

Carilion Clinic frames its use of Artificial Intelligence (AI) as innovative and carefully regulated. But beneath the polished language and promising pilot projects lies a host of unresolved risks – risks that extend beyond slick marketing into real harms for patients, clinicians, and communities.

Administrative Burden vs. Structural Problems

Carilion promotes tools like AI scribes to reduce clinician documentation time. Yes, clinicians spend significant hours on notes instead of patients – but AI scribes aren’t a panacea.

Research shows that while ambient AI documentation tools can potentially ease workload, they also come with limitations such as hallucinations, inaccuracies, and variable quality that require sustained human oversight. This means the burden is transformed, not eliminated.

Source: Journal of Medical Systems – Limitations of Ambient Clinical Documentation

More importantly, the root causes of burnout – understaffing, productivity quotas, and billing-driven documentation – cannot be solved through software alone.

Predictive Analytics and Algorithmic Bias

Carilion cites predictive analytics tools designed to identify patient deterioration earlier. But real-world evidence shows that hospitals often do not adequately validate these models using their own patient populations.

Less than half of hospitals rigorously test AI tools for bias, raising serious concerns about reliability and equity.

Source: Health Affairs / Healthcare Dive – Hospitals Rarely Test AI for Bias

When models are trained on biased or incomplete data, they do not eliminate disparities – they scale them.

Source: arXiv – Algorithmic Bias in Healthcare AI

Operational Efficiency at the Expense of Humanity

AI-driven command centers promise smoother patient flow and optimized bed usage. But efficiency is not the same as quality care.

When algorithms influence transfer decisions, bed assignments, and discharge timing, patients risk becoming logistics problems rather than people. These systems optimize throughput – not dignity, continuity, or trust.

Imaging, Research, and the Consent Problem

AI-assisted imaging and clinical research tools rely on massive amounts of patient data. Yet patients rarely have meaningful control over how their data is reused, repurposed, or commercialized.

Ethical analyses warn that existing consent models are inadequate for AI-driven secondary data use.

Source: BMC Medical Ethics – AI, Data Use, and Informed Consent

Privacy and Re-identification Risks Are Real

Carilion emphasizes strict governance and data safeguards. However, research shows that advanced AI systems can sometimes re-identify individuals from supposedly anonymized datasets.

Source: Journal of Medical Internet Research – Re-identification Risks in Health AI

Public trust is fragile, and once patient data is compromised, it cannot be reclaimed.

The “Black Box” Problem

Many healthcare AI tools operate as opaque systems, offering little explanation for how they reach conclusions. This lack of transparency undermines clinician trust and complicates accountability.

Source: JMIR Formative Research – Explainability Challenges in Clinical AI

Deskilling and Erosion of Clinical Judgment

Researchers have raised concerns that reliance on AI tools – particularly large language models – could lead to deskilling, where clinicians increasingly defer to machine output rather than exercising independent judgment.

Source: arXiv – Deskilling Risks from Generative AI

Regulation Still Lags Behind Reality

The federal regulatory framework for healthcare AI remains incomplete. Hospitals are largely left to self-govern, creating uneven standards and weak accountability.

Source: Reuters – Calls for Equity-First AI Regulation in Medicine

AI Solves the Wrong Problems

Healthcare in Southwest Virginia does not suffer from a lack of algorithms. It suffers from staffing shortages, rural access barriers, poverty-driven health disparities, and burnout.

AI does not fix these problems. It distracts from them.

Conclusion

Carilion’s cautious rhetoric is better than blind adoption, but it still places patients and clinicians inside a live experiment.

Skepticism is not anti-technology. It is pro-patient, pro-clinician, and pro-trust.

Medicine should move at the speed of trust, not the speed of software.

Possible career paths in 2026:

Missing hiker

Vanished at sea

Weird thing in the woods

Forest goblin

Subject of local folklore

Libby’s AI feature, called “Inspire Me,” is a generative AI-driven, opt-in discovery tool designed to help users find books and audiobooks from their local library. It uses user-selected prompts (e.g., “fast-paced mystery”) or existing tags to suggest five titles, focusing on items that are available to borrow immediately.

Key features of the “Inspire Me” AI tool:
Contextual Recommendations: The AI analyzes your library’s digital collection to provide personalized suggestions, explaining why each title fits your chosen “inspiration”.

Instant Availability: The tool prioritizes titles that are ready to check out, helping users avoid long waitlists.

Privacy-Focused: The AI does not receive personal details, user data, or full tag descriptions; it only uses the titles within your tags to generate recommendations.

Optional Usage: The feature is optional, allowing users to choose whether to engage with the AI to find new reads.
This tool was introduced in late 2025 as a way to enhance discovery, aimed at supplementing, not replacing, the curated, human-selected collections of local libraries.

Tuesday morning. Car inspection. The sacred Virginia ritual where you hand over keys and wait to be judged by a man with a flashlight.

The waiting room is the usual. Burnt coffee. A rack of ancient magazines. Fox News murmuring from a TV mounted too high, like it isn’ttrying hard to be heard.

But it is part of the conversation.

What surprises me is not that Fox is on. It is that every Bubba in the shop is watching it. And not nodding. Not cheering. Not repeating the talking points like call and response at a tent revival.

They are talking about Greenland.

Greenland.

One guy says it is beyond stupid. Not “politically unwise” or “bad optics.” Just stupid. Another says Greenland is NATO. Says they helped us fight Nazis back in WWII by letting us put a base there. Says you do not threaten people who literally let you park planes on their island while the world was on fire.

Someone else laughs and says at least 47 could make up a drug excuse to go after Venezuela, but everyone knows that would be about oil anyway. They are not buying the right wing media story of righteous deposits and noble intentions. Not even a little.

One of them says this will not go unnoticed by China and Russia. Says it like he is talking about a cracked engine block that is about to grenade on the highway. Then another voice, from behind a rack of tires, says what the hell does that old idiot think he is doing?

A different guy, not quiet and not subtle, says he got caught diddling kids and now he is trying to get people talking about anything else. Anything else at all.

Nobody challenges him. Nobody cheers either. It just lands in the room like a dropped wrench.

These are white guys. Blue collar. Mechanics. Between 35 and 65. The kind of guys the news always talks about like they are a single organism. I have no idea who they voted for. I am not going to ask. That would be weird. Also rude.

But I do know this. They do not sound like men waiting for marching orders. They do not sound like people eager to vote for anyone carrying his endorsement next time around. They sound tired. Practical. Annoyed. Like people who can spot a bad idea because they fix the consequences of bad ideas for a living.

Fox keeps talking. The inspection continues. Somewhere, a printer spits out paperwork.

And in this little waiting room in Virginia, the narrative cracks just enough to let in some air.

Seed 561118013545

I heard that ICE was kicked out of Macado’s last night. If true, good on Macado’s!

Remember, Businesses generally have the right to refuse service to anyone to protect staff and patrons, such as for disruptive behavior or safety concerns.

I cannot think of a bigger disruption or safety concern right now than these thugs in our towns.

Please, refuse them any service. They do not deserve our food, drink, climate controlled rooms,  bathrooms or any hospitality. Let them sit in the cold, outside, off of *any* private property.

#abolishice #iceout

Applies to everyone selling a service! No haircuts, no beer, no groceries, no time at the gun range.

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Excavations in the Saltville Valley of southwestern Virginia have revealed rare, significant Late Pleistocene fossils of the giant short-faced bear (Arctodus simus), dating to approximately \(14,500\)–\(14,800\) years ago.

As the first carnivoran recorded there, these remains, including teeth and bones, demonstrate that this massive, top-tier predator scavenged on mammoths in the region, offering crucial evidence for the area’s paleoecology. 

Key Discovery: Researchers, including those from East Tennessee State University (ETSU), identified Arctodus simus remains in the Saltville Valley, a site known for its abundant Ice Age megafauna.

Evidence of Scavenging: The fossils, specifically dental and skeletal material, show that the short-faced bear fed on mammoth carcasses in the area. The find includes a mammoth heel bone, or calcaneus, with clear bite marks.

Significance: The Saltville Arctodus find is notable as one of the most eastern records for the species and provides a specific, direct radiocarbon date (approx. \(14,853\) BP) for their presence in the Appalachian Highlands.

The Predator: The giant short-faced bear was one of the largest terrestrial mammalian carnivores in North America, with a very powerful bite designed for bone-crushing and, likely, stealing carcasses from smaller predators.

Ongoing Research: The Saltville Valley continues to be a rich site for paleontological research, with the bear fossils contributing to a deeper understanding of the interactions between extinct species at the end of the Pleistocene epoch. 

The giant short-faced bear (Arctodus simus) went extinct around 11,000-12,500 years ago at the end of the Pleistocene epoch, likely due to a combination of factors including climate change, the disappearance of large prey animals like mammoths, increased competition with other bears (like brown bears), and potentially pressure from early humans, leading to an ecological collapse that their massive bodies couldn’t adapt to.

Palindromic day.

seed 561114074640

499,206 total hours

Day 20,800

I am rapidly approaching hour 500,000.

34.25 days from now, as of this writing.

Am I celebrating? I don’t know. Let’s see if I make it that long, first.

The idea of approaching 500,000 hours old lands differently than birthdays ever did. Years are abstract. Hours are intimate. Hours are what you actually live inside.

Five hundred thousand hours means there have been half a million chances to notice something or miss it entirely. Half a million opportunities to be kind, distracted, generous, petty, awake, asleep, or somewhere in between. It is a number large enough to feel mythic, but specific enough to feel accusatory.

Most of those hours were not dramatic. They were ordinary. Folding laundry. Waiting for software to update. Sitting in traffic, convinced you were late for something that now barely exists in memory. That is the uncomfortable truth of time: it is mostly made of beige moments. And yet those are the hours that add up. Those are the ones doing the real work.

Approaching 500,000 hours does not feel like running out of time so much as finally understanding the exchange rate. Hours turn into habits. Habits turn into days that feel familiar. Familiar days turn into a life that seems to have happened very quickly when you look back at it all at once.

There is a quiet relief in realizing how many hours survived you. The bad ones passed. The unbearable ones did not last forever. Even the best ones were temporary, which somehow makes them better instead of worse. Time takes everything, but it also carries you through things you could not have crossed on your own.

Five hundred thousand hours is not a trophy. It is not an achievement. It is evidence. Evidence that you stayed. That you endured boredom and heartbreak and repetition and still kept showing up for the next hour, and the next.

If there is anything to do with the hours ahead, it is probably this: notice them a little more often. Spend fewer of them pretending there will always be more. And forgive yourself for the ones you wasted, because wasting time is one of the most human ways to prove you were alive at all.

https://svonberg.org/wp-content/uploads/2026/01/time3.html

https://youtu.be/Nm0WhGHD8Lw?si=PjTfMG1Rv_Uy–Sp

Skunk, Mouse, mist and

https://en.wikipedia.org/wiki/Graupel

The Death of Renee Nicole Good: Why ICE is a Failed Experiment That Must End

The killing of Renee Nicole Good (often cited as Rose Nicole Good) on January 7, 2026, has become a flashpoint in the ongoing debate over the necessity and conduct of U.S. Immigration and Customs Enforcement (ICE). For critics, her death is not an isolated tragedy but a systemic symptom of an agency that has become hyper-militarized, unaccountable, and fundamentally flawed.

The Minneapolis Shooting: A Catalyst for Outcry

On a snowy Wednesday morning in Minneapolis, Renee Nicole Good—a 37-year-old U.S. citizen and mother of three—was shot and killed by an ICE agent. The Department of Homeland Security (DHS) quickly characterized the incident as an act of self-defense, alleging that Good “weaponized her vehicle” against agents.

However, eyewitness accounts and bystander videos paint a different picture: one of a legal observer and community member caught in the middle of a high-tension “surge” operation. Local leaders, including the Minneapolis Mayor, have described the shooting as reckless, noting that Good had no criminal record and was simply driving in her own neighborhood.

The immediate withdrawal of the Minnesota Bureau of Criminal Apprehension from the investigation—citing federal restrictions on access to evidence—has only deepened the perception that ICE operates within a vacuum of accountability.

A Pattern of Lethal Failure

The death of Renee Nicole Good is viewed by many as the “tip of the spear” of a broader institutional collapse. Critics argue that ICE’s current structure is inherently prone to tragedy for several reasons:

• The Deadliest Year on Record: The year 2025 was the deadliest for ICE since 2004, with 32 confirmed deaths in custody. This spike in mortality coincides with a “hyper-militarized” approach to enforcement and a massive surge in the detained population.
• Systematic Medical Neglect: Investigations by the U.S. Senate and human rights organizations have uncovered harrowing evidence of neglect. A 2024 report by the ACLU and Physicians for Human Rights found that 95% of deaths in ICE detention were preventable had adequate medical care been provided.
• Lack of Oversight and Impunity: ICE’s oversight mechanisms are often described as “internal and toothless.” By utilizing private, for-profit contractors for 90% of its detention capacity, the agency creates a layer of separation that complicates legal accountability.

Sources and Linkable Citations

The Minneapolis Incident (Jan 2026)

• CBS News: Renee Good, the driver shot and killed by an ICE agent in Minneapolis
• Fox News: Who was Renee Nicole Good, woman killed in Minneapolis ICE shooting?
• The Guardian: Minneapolis shooting is a brutal start to Trump’s ‘largest operation’

Systemic Neglect & Mortality Data

• ACLU: 95 Percent of Deaths in ICE Detention Could Likely Have Been Prevented
• Yale Global Health Review: A Silent Cry: Medical Negligence in ICE Detention
• PBS News: Senate report details medical neglect in federal immigration detention
• American Immigration Council: Mortality Statistics and Detainee Safety
• Freedom for Immigrants: Detention: A Death Sentence?

Legal & Policy Critiques

• National Immigrant Justice Center: Inhumane Conditions and Alarming Expansion
• Yale Law Journal: The Case for Abolishing ICE
• DHS Official Statement on Minneapolis Incident Context