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The Dictatorship

I’m an emergency physician. The modern telehealth model should have all of us concerned.

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I’m an emergency physician. The modern telehealth model should have all of us concerned.

The recent lawsuit against Amazon’s telehealth clinic One Medical is a wake-up call about the pitfalls of prioritizing corporate growth over patient safety in health care. Last Christmas, The Washington Post reportedPhilip Tong, a 45-year-old man with diabetes, began coughing up blood and experiencing shortness of breath. His feet had turned blue. Seeking urgent care, he entered a video consultation with a clinician at Amazon One Medical and was advised to purchase an inhaler. Hours later, Tong collapsed and died in an Oakland emergency room. His family is now suing Amazon One Medical for malpractice, alleging that the virtual care provider failed to recognize the severity of his symptoms and neglected to direct him to emergency care.

This wrongful death claim underscores the risks inherent in a health care model that prioritizes scalability and efficiency over the nuances of medical decision-making.

The lawsuit accuses Amazon One Medical of employing inadequately trained staff and fostering an environment where patient care is “careless, reckless, and negligent.” In response, Amazon One Medical stated it is “prohibited by law from discussing patient records.” An Amazon One Medical spokesperson said“We care deeply about every patient we serve, and the quality and safety of our care are our highest priorities. We’re proud of our extensive quality and safety measures, and of the health outcomes we help our patients achieve. We take concerns about our care extremely seriously, and we’re committed to continuous improvement.”

Amazon acquired One Medical in February 2023 as part of its foray into health care, and the company has since aggressively expanded its telehealth services. This wrongful death claim underscores the risks inherent in a health care model that prioritizes scalability and efficiency over the nuances of medical decision-making.

In medicine, symptoms like shortness of breath and coughing up blood are classified as “red flags” — indicators of potentially life-threatening conditions. As an emergency physician, when I encounter a patient with these symptoms, I am immediately concerned about their need for advanced care. Telehealth, despite its conveniences, inherently limits a clinician’s ability to fully assess such high-risk cases. The subtle cues of how a patient is breathing, their sitting position and skin pallor simply can’t be assessed over video to the same extent as in person. This limitation becomes even more pronounced in models where clinicians are pressed for time and lack prior knowledge of the patient’s medical history, as can be the case with telehealth operations.

Telehealth can be broadly divided into two categories. The first involves consultations with a primary care provider (PCP) or specialist who has an established relationship with the patient. These providers know the patient’s medical history, baseline health, and even how they typically describe their symptoms. The second category involves first-time encounters between a patient and a clinician who must make high-stakes decisions with incomplete information. This second model, common in many corporate telehealth settings, is where the risks escalate.

The lawsuit against Amazon One Medical highlights broader concerns about the health care industry’s rapid embrace of tech-driven models. Unlike other industries, health care cannot prioritize speed and scalability without significant consequences. Telehealth companies often behave like tech startups, scaling aggressively to capture market share. This approach, although effective in tech, can be disastrous in health care, where lives are at stake.

For example, many telehealth companies are public or venture-backed entities worth billions of dollars. They often use advanced tools like data pixels to target advertisements and re-engage users who visit their websites. While this marketing sophistication has driven industry growth, it has also raised significant ethical and legal questions.

Data privacy is one such concern. Several telehealth companies have been found to share user data that includes identifiable information, a clear violation of HIPAA protections. Patients may be unaware that their personal health data is being used in ways that expose them to risks, such as targeted ads that exploit their medical conditions.

This rapid growth also necessitates a larger workforce, often achieved by relying heavily on nurse practitioners (NPs) and physician assistants (PAs). While these clinicians are integral to the health care system, their training is typically less extensive than that of physicians. Many new physicians are advised against working in telehealth immediately after residency due to the need to refine their ability to identify red-flag symptoms. Patients face more risk  when less-experienced providers like PAs and NPs are placed in high-pressure environments where they must make critical decisions without adequate supervision or support.

I’ve personally seen offers in telehealth that pay providers as little as $7 per consult, incentivizing volume over quality.

Moreover, corporate telehealth models often emphasize productivity metrics over patient outcomes. The platforms that I have participated with in the past have no guaranteed rate and pay is based on the number of patients a provider sees. I’ve personally seen offers in telehealth that pay providers as little as $7 per consult, incentivizing volume over quality. This creates a dangerous environment where providers may rush through visits, increasing the likelihood of missed diagnoses and poor patient outcomes.

Of course, telehealth is not inherently bad. On the contrary, it has the potential to address long-standing issues in health care by increasing access, reducing costs and improving convenience. But  the health care industry’s traditionally cautious approach to adopting new technologies exists for a reason. This deliberation ensures that innovations are safe, effective and beneficial for patients. The One Medical case serves as a reminder that we cannot afford to sacrifice patient safety for the sake of rapid innovation.

Amazon’s entry into health care exemplifies the tension between profit-driven motives and the ethical obligation to prioritize patient care. Leaked documents from earlier this year showed that One Medical’s call center staff, many of whom lacked medical training, placed more than a dozen patients at risk by failing to escalate cases appropriately. This pattern of behavior raises serious questions about the company’s commitment to patient safety.

It’s imperative that telehealth companies adopt a more measured approach to growth. This includes investing in better training for clinicians, ensuring adequate staffing levels, and prioritizing quality care over productivity metrics. Regulatory oversight must also keep pace with industry innovations to safeguard patient safety and privacy.

Telehealth holds immense promise, but its implementation must be deliberate and patient-centered. As clinicians, every decision we make, whether in an emergency room or a virtual consultation, is guided by the principle of doing what is best for the patient. It is time for corporate telehealth to embrace the same standard.

Dr. Owais Durrani

Dr. Owais Durrani is an emergency medicine physician in Houston, TX. Dr. Durrani has a background in Political Science and works to advocate for eliminating health inequities.

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The Dictatorship

Trump uses ambassadorship offer to narrow a closely watched GOP primary field

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Trump uses ambassadorship offer to narrow a closely watched GOP primary field

With Republican Sen. Mitch McConnell retiring in Kentucky, GOP officials are optimistic about holding on to the seat. The monthslong question, however, has been which of the party’s top contenders would get the nomination.

Much of the right had already rallied behind Rep. Andy Barr, whose candidacy is perhaps best known for a recent campaign ad in which he boasted“It’s not a sin to be white, it’s not against the law to be male, and it shouldn’t be disqualifying to be a Christian.” He nevertheless faced a primary against former state Attorney General Daniel Cameron and businessman Nate Morris, who enjoyed the backing of billionaire Republican megadonor Elon Musk, who invested $10 million in Morris’ candidacy.

Late last week, the GOP field narrowed from three candidates to two. The Associated Press reported:

President Donald Trump entered the fray of another Republican primary Friday by endorsing Kentucky congressman Andy Barr for the U.S. Senate seat being vacated by retiring Sen. Mitch McConnell, the former longtime Senate GOP leader. […]

In a Truth Social post just before his endorsement of Barr, Trump announced that he’d asked Morris to “step aside” from the race to join his administration as an ambassador.

The president didn’t elaborate on the specific office he would reward Morris with, writing“I’ve asked Nate to step aside from that Race to take a role in my Administration as an Ambassador. … We will be announcing Nate’s new role soon.”

As a practical matter, Barr is now very well positioned to succeed. Indeed, shortly after Trump endorsed him, Senate Republican leaders, including National Republican Senatorial Committee Chair Tim Scott, also threw their backing behind the congressman, leaving little doubt he’s the odds-on favorite ahead of primary day in Kentucky, which is just two weeks away.

But before the political world moves on, there are a couple of related dimensions to this to keep in mind.

First, to a degree without modern precedent, the White House keeps using ambassadorships as consolation prizesand the Morris example is just the latest in a broader pattern.

Second, remember Joe Sestak?

In 2010, the Democratic congressman from Pennsylvania made an offhand comment about being offered a job in the Obama administration if he agreed not to run against then-incumbent Sen. Arlen Specter, who had switched parties to become a Democrat a year earlier.

The remark didn’t seem especially provocative, but Republican Rep. Darrell Issa of California described it as a scandal comparable to Watergateand conservative commentator Jeffrey Kuhner similarly argued at the time, in reference to the Sestak matter, “The White House is facing a major scandal — one that threatens to bring down President Obama. It could be his Watergate.”

In hindsight, the claims were obviously quite silly, and the story (such as it was) quickly evaporated. But 16 years later, a Republican president has offered a candidate a job as part of a deal to get him out of a Senate race, and it’s hard not to notice the lack of hysteria from those who saw rumors of a Sestak offer as a meaningful controversy.

Steve Benen is a producer for “The Rachel Maddow Show,” the editor of MaddowBlog and an MS NOW political contributor. He’s also the bestselling author of “Ministry of Truth: Democracy, Reality, and the Republicans’ War on the Recent Past.”

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The Dictatorship

U.S. denies Iran struck a military vessel during new effort to reopen Strait of Hormuz

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U.S. denies Iran struck a military vessel during new effort to reopen Strait of Hormuz

DUBAI, United Arab Emirates (AP) — The U.S. military on Monday denied claims that Iran struck a U.S. Navy vessel as American forces are offering to guide commercial ships through the Strait of Hormuzwhere hundreds have been stuck since the Iran wasbegan. Over the past two months, Tehran has attacked some vessels and blocked others that don’t receive its authorization.

The U.S. military’s Central Command also said two American-flagged merchant ships have “successfully transited through the Strait of Hormuz” and that Navy guided-missile destroyers in the Persian Gulf are helping to restore commercial shipping traffic.

The statement on X said the destroyers transited the Strait of Hormuz “in support of Project Freedom” and that the merchant ships are ” safely headed on their journey.” It did not say when the Navy ships arrived or when the merchant vessels departed.

Iranian news agencies, including the semiofficial Fars and the Iranian Labour News Agency, had earlier claimed that Iran struck a U.S. vessel near an Iranian port southeast of the strait, accusing it of “violating maritime security and navigation norms.” The reports said the vessel was forced to turn back.

The U.S. Central Command said on social media that “no U.S. Navy ships have been struck.”

The U.S. military has said the new initiative, announced by President Donald Trumpon Sunday, might involve guided-missile destroyers, more than 100 aircraft and 15,000 service members but has not specified what kind of assistance it would provide. The U.S.-led Joint Maritime Information Center has advised ships to cross the strait in Oman’s waters, saying it set up an “enhanced security area.”

It was unclear whether any vessels were attempting to cross the strait, or whether shipping companies and their insurers would feel comfortable taking the risk given that Iran has fired on ships in the waterway and vowed to keep doing so.

Iran’s control of traffic through the crucial artery for the world’s oil and gas supplies has proved a major strategic advantage in its war with the U.S. and Israel, allowing Iran to inflict tremendous pain on the global economy despite being outgunned on the battlefield.

Trump warns of ‘forceful’ response if Iran interferes

The effort to revive traffic risks unraveling the fragile ceasefire that has held for more than three weeks.

U.S. President Donald Trump, in Sunday’s announcement that the U.S. would “guide” ships out of the strait, warned that Iranian efforts to block them “will, unfortunately, have to be dealt with forcefully.”

He described what he called “Project Freedom” in humanitarian terms, designed to aid stranded seafarers, many on oil tankers or cargo ships, who have been stuck in the Persian Gulf since the war began. Crews have described to The Associated Pressseeing intercepted drones and missiles explode over the waters as their vessels run low on drinking water, food and other supplies.

Iran’s state-run IRNA news agency called Trump’s “Project Freedom” part of his “delirium.”

Iran’s military command on Monday said ships passing must coordinate with them.

“We warn that any foreign military force — especially the aggressive U.S. military — that intends to approach or enter the Strait of Hormuz will be targeted,” Maj. Gen. Pilot Ali Abdollahi told state broadcaster IRIB.

The Joint Maritime Information Center said the U.S. has set up an “enhanced security area” near the Oman side of the strait. It urged mariners to coordinate closely with Omani authorities “due to anticipated high traffic volume.”

It warned that passing close to usual routes, known as the traffic separation scheme, “should be considered extremely hazardous due to the presence of mines that have not been fully surveyed and mitigated.”

Iran stands firm on its grip of the strait

The disruption of the waterway has squeezed countries in Europe and Asia that depend on Persian Gulf oil and gas, raising prices for gasoline, food and other items far beyond the region.

Trump has promised to bring down gas prices as he faces midterm elections this year.

Iran has called U.S. moves to dislodge its grip on the strait ceasefire violations.

The U.S. has warned shipping companies they could face sanctions for paying Iran for transit of the strait. It has enacted a naval blockade on Iranian ports since April 13, telling 49 commercial ships to turn back, U.S. Central Command said Sunday.

The blockade has deprived Tehran of oil revenue it needs to shore up its ailing economy.

U.S. officials hope the blockade forces Iran back to the negotiation table.

“We think that they’ve gotten less than $1.3 million in tolls, which is a pittance on their previous daily oil revenues,” U.S. Treasury Secretary Scott Bessent told Fox News on Sunday, adding that Iran’s oil storage is rapidly filling up and “they’re going to have to start shutting in wells, which we think could be in the next week.”

Iran’s 14-point proposal made public over the weekend calls for the U.S. to lift sanctions on Iran, end the U.S. naval blockade of Iranian ports, withdraw forces from the region, and cease all hostilities, including Israel’s operations in Lebanon, according to the semiofficial Nour News and Tasnim agencies, which have close ties to Iran’s security organizations.

Iranian officials said they received and were reviewing the U.S. response, though Foreign Ministry spokesperson Esmail Baghaei told reporters on Monday that changing demands, which he did not detail, made diplomacy difficult.

Iran has publicly claimed its proposal does not include issues related to its nuclear program and enriched uranium— long a driving force in tensions with the U.S.

Iran’s proposal wants other issues resolved within 30 days and aims to end the war rather than extend the ceasefire, according to Iran’s state-linked media. Trump on Saturday said he was reviewing the proposal but expressed doubt it would lead to a deal.

Iranian crew was taken off seized tanker

Pakistan said Monday it has facilitated the transfer of 22 crew members from an Iranian vessel seized earlier by the U.S., describing the move as a confidence-building measure as Islamabad attempts to revive talks between the two sides.

Pakistan’s Foreign Ministry said the crew members, who had been aboard the Iranian container ship MV Touska, were evacuated and flown to Pakistan overnight. They are expected to be handed over to Iranian authorities.

The vessel will be brought into Pakistani territorial waters for necessary repairs before being returned to its original owners, the ministry said, adding that the process is being coordinated with the support of Iran and the U.S.

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The Dictatorship

In key Southern red state, democracy suffers dramatic back-to-back setbacks

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In key Southern red state, democracy suffers dramatic back-to-back setbacks

After Republican-appointed Supreme Court justices further gutted the Voting Rights Act last week, it stood to reason that Louisiana Republicans would do what they’ve long wanted to do: redraw the state’s district map so that the state’s two Black congressmen would almost certainly lose. There was, however, a logistical problem.

The Pelican State’s electoral process, which included balloting in May, was already in motion, and by any reasonable measure, the high court’s ruling came too late in the year to accommodate partisan plans for the 2026 cycle.

Gov. Jeff Landry apparently didn’t care, and just one day after the Louisiana v. Callais ruling came down, the Republican governor suspended scheduled primary elections and directed the legislature to move forward with plans to approve a new district map.

The brazen and undemocratic move, executed two days before early voting began in Louisiana, led to chaotic conditions that were as predictable as they were unavoidable. The New York Times reported:

The signs were stark, in bold, capital letters at early voting sites in Louisiana on Saturday: “ATTENTION! NOTICE OF CANCELLATION.”

The normally scheduled House primaries had been scrapped, the bulletins said, and any votes cast for those races would not be counted. It was an unusual message directed at Louisianians who showed up for the first day of early voting, and a reflection of the dizzying scramble that is playing out after the Supreme Court struck down the state’s congressional map.

Under Landry’s plan, some of the state’s May 16 contests can proceed as planned, but congressional primaries have been suspended at his command. The result, the Times’ report added, was understandable “bewilderment” among local voters who weren’t altogether sure whether the state would count their ballots.

The governor’s gambit is now facing spirited legal challengesbut as it happens, this coincided with a different GOP effort in Louisiana that also undermined democracy.

A Louisiana man named Calvin Duncan was convicted of murder in 1981 and imprisoned for almost three decades before being fully exonerated in 2021, when a judge agreed that he had been unjustly convicted and vacated Duncan’s sentence. In the months and years that followed, he rebuilt his lifegraduated from law school at age 60 and even ran a successful campaign to become the Orleans Parish clerk of criminal court, vowing to help reform the justice system that had unjustly sent him to a maximum-security prison for a crime he did not commit.

That didn’t sit well with Landry and the GOP-controlled legislature, which, as my MS NOW colleague Jarvis DeBerry recently explainedscrambled to eliminate Duncan’s job before he could be sworn in on May 4.

They did exactly that. On the same day that the governor suspended the state’s congressional primary elections, Landry also signed into law a measure that folded the criminal clerk’s responsibilities into the city’s civil clerk’s office.

Duncan filed a federal lawsuit, which has fared well, at least so far: The Times-Picayune in New Orleans reported“A federal judge on Sunday blocked a state law that would have abolished the Orleans Parish criminal clerk of court position, clearing the way for Calvin Duncan, who was elected to the post last year, to assume office Monday. U.S. District Judge John deGravelles … declared Senate Bill 256 unconstitutional and enjoined Gov. Jeff Landry and Secretary of State Nancy Landry from enforcing it.”

The ruling was encouraging, but it doesn’t negate the fact that the GOP’s effort to eliminate Duncan’s position was emblematic of a larger truth: Democracy suffered some brutal blows in Louisiana last week.

UPDATE(May 4, 2026, 12:34 p.m. ET): Shortly after this piece was published, the U.S. Fifth Circuit Court of Appeals blocked the lower court ruling from taking effect and prevented Duncan from assuming the office to which he was elected to serve.

Steve Benen is a producer for “The Rachel Maddow Show,” the editor of MaddowBlog and an MS NOW political contributor. He’s also the bestselling author of “Ministry of Truth: Democracy, Reality, and the Republicans’ War on the Recent Past.”

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