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 reported, Philip 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.
