The Brief

Social media apps have long been accused of being harmful to children. Now those claims will come before a jury for the first time in a trial kicking off Tuesday in a Los Angeles courtroom.

A key question will be whether tech companies deliberately built their platforms to hook young users, contributing to a youth mental health crisis. The jury's decision could have big consequences for the tech industry and how children use social media.

Meta, the owner of Instagram and Facebook, and Google's YouTube will stand trial in California state court after TikTok settled the lawsuit on the eve of the trial. Terms of the settlement were confidential, said Matthew Bergman of the Social Media Victims Law Center, who represents the plaintiff. Tiktok didn't respond to a request for comment about the settlement on Tuesday. Snapchat was also named as a defendant in the lawsuit but reached its own undisclosed settlement with the plaintiff last week.

The LA case is the first of a wave of lawsuits headed for trial this year that have been brought against social media companies by more than 1,000 individual plaintiffs, hundreds of school districts and dozens of state attorneys general. It's drawing comparisons to the legal campaign against Big Tobacco in the 1990s, which accused cigarette makers of covering up what they knew about the harms of their products.

The suits accuse Instagram, Facebook, YouTube, TikTok and Snapchat of engineering features that make their apps nearly impossible for kids to put down, like infinite scroll, auto-play videos, frequent notifications and recommendation algorithms, leading in some cases to depression, eating disorders, self-harm and even suicide. (Snapchat and TikTok remain defendants in the other lawsuits.)

The plaintiffs are seeking monetary damages as well as changes to the way social media apps are designed.

The trial starting on Tuesday in LA will give a rare look inside how the most popular and powerful social media platforms operate. Jurors will be presented with thousands of pages of internal documents, including research on children conducted by the companies; expert witnesses; and the testimony of the teenage plaintiff, identified as K.G.M., who says her excessive use of social media led to mental health problems.

Meta CEO Mark Zuckerberg and Adam Mosseri, the head of Instagram, are also set to take the stand in the trial, which is expected to last several weeks.

Meta CEO Mark Zuckerberg, seen here in 2025, is expected to testify in the upcoming trial about social media addiction.

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"The public is going to know for the first time what social media companies have done to prioritize their profits over the safety of our kids," said Bergman, who represents K.G.M. and other plaintiffs.

The tech companies argue that there's no clinical diagnosis of addiction to social media and that no direct link between using social media and mental health problems has been proved. They say they've rolled out safety features for kids in recent years, including parental controls, guardrails on who can contact teen accounts and time limits.

They also cite the First Amendment, saying that just as people's speech is protected from government censorship, the decisions that social media companies make about content are also a type of "protected speech" — an argument the Supreme Court has affirmed.

Both Meta and YouTube parent Google said in statements that the allegations in the lawsuits are baseless.

"These lawsuits misportray our company and the work we do every day to provide young people with safe, valuable experiences online," Meta said in a statement. "Despite the snippets of conversations or cherry-picked quotes that plaintiffs' counsel may use to paint an intentionally misleading picture of the company, we're proud of the progress we've made, we stand by our record of putting teen safety first, and we'll keep making improvements."

The YouTube logo is displayed on a sign outside the company's corporate headquarters in San Bruno, Calif., in 2025.

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"The allegations in these complaints are simply not true," said Google spokesperson José Castañeda. He added that YouTube works with experts to provide "age-appropriate experiences" and "robust" parental controls.

YouTube will also argue that its video platform works differently from apps such as Instagram, Facebook and TikTok.

TikTok declined to comment on its approach to the trial.

Eric Goldman, a professor at Santa Clara University School of Law who studies internet law, is skeptical of the plaintiffs' argument that the companies should be held liable for the features they've designed.

"Essentially what the plaintiffs are trying to do is argue that social media is the virtual equivalent to a soda bottle, like a Coca-Cola bottle, that explodes and sends shards of glass to anyone in the nearby area," he said. "And if that doesn't make any sense to you, it doesn't make any sense to me either. The entire premise of treating publications as products is itself architecturally flawed."

"A compulsion to engage"

The cases are on two tracks: some in state court and others in federal court. In each, a handful of "bellwether" cases head to trial first. The outcome of those cases could affect how the rest play out and could open the door for wide-ranging settlement talks.

Jury selection in the first bellwether case starts Tuesday in Los Angeles County Superior Court. The plaintiff K.G.M, now 19 years old, says her use of Instagram, Snapchat and TikTok led to depression, anxiety and body dysmorphia.

K.G.M. began using social media at age 10, despite her mother's efforts to block her from the apps, according to the complaint. She "developed a compulsion to engage with those products nonstop" as a result of their "addictive design" and "constant notifications."

"The more K.G.M. accessed Defendants' products, the worse her mental health became," the complaint says.

"She is going to be able to explain in a very real sense what social media did to her over the course of her life and how, in so many ways, it robbed her of her childhood and her adolescence," Bergman told reporters at a briefing last week. "She is very typical of so many children in the United States, the harms that they've sustained and the way their lives have been altered by the deliberate design decisions of the social media companies."

Last week, Snap, the parent company of Snapchat, settled with K.G.M., meaning it will not be involved in the first trial. No details about the settlement were publicly released. Still, the company remains a defendant in the other cases in both the state and federal consolidated proceedings.

"The Parties are pleased to have been able to resolve this matter in an amicable manner," Snap said in a statement. The company has previously disputed the allegations in the lawsuits. "Snapchat was designed differently from traditional social media; it opens to the camera, allowing Snapchatters to connect with family and friends in an environment that prioritizes their safety and privacy," its lawyers told Bloomberg News in November.

"The internet is on trial"

It has been an uphill battle for the plaintiffs to bring their claims at all, because online platforms are broadly protected by a controversial legal shield known as Section 230 of the Communications Decency Act of 1996.

The plaintiffs hope to get around the immunity usually afforded to tech companies by focusing on features they say are designed to keep kids coming back to social media apps rather than on the specific posts or videos that users encounter.

"We are not talking about third-party content. We are talking about the reckless design of these platforms that are designed not to show kids what they want to see, but what they can't look away from," Bergman said.

Los Angeles Superior Court Judge Carolyn Kuhl, who is overseeing the consolidated state cases, including K.G.M.'s, has struck some plaintiffs' claims on the grounds they were about third-party content and therefore covered by Section 230. But she said the question of whether features like infinite scrolling could contribute to harming users is something a jury should decide.

Goldman, the Santa Clara University law professor, said the potential damages should the plaintiffs win pose "an existential threat" to the social media companies and beyond — not just in terms of financial impact but also if tech companies were forced to change how their products work.

"The internet is on trial in these cases," he said. "If the plaintiffs win, the internet will almost certainly look different than it does today. And probably it will be a far less conversational one that we have today."

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Copyright 2026 NPR

The Los Angeles City Council decided Tuesday to delay voting on proposed reforms to the city’s embattled “mansion tax.”

The tax has staunch defenders, but a number of economic studies have found that it’s slowing housing development at a time when L.A. is grappling with a severe housing shortage.

Instead of sending Measure ULA back to voters with proposed changes, the council decided to refer the idea to their Housing and Homelessness Committee for further debate.

Councilmember Nithya Raman, chair of the committee, introduced a motion last week that sought to put a reform measure on the June ballot. Her proposal would have asked voters to cancel the tax on apartment buildings constructed within the last 15 years, exempt Palisades Fire victims from the tax and change financing terms in city-funded affordable housing projects.

“Voters were sold a mansion tax,” Raman said during Tuesday’s council meeting. “Ignoring the very real impacts on apartment construction — apartments that people want and need and want to move into — doesn’t protect Measure ULA. It weakens it.”

How the ‘mansion tax’ works

Measure ULA was approved by nearly 58% of L.A. voters in 2022. It levies a 4% tax on real estate sales over $5.3 million and a 5.5% tax on properties selling for more than $10.6 million.

The city uses tax revenue to fund tenant aid programs, such as eviction defense and rent relief. And it subsidizes the construction of affordable housing, though most of the funds raised for that purpose have not yet been spent.

Supporters rallied outside City Hall before the Tuesday vote, urging City Council members not to send Measure ULA back to the voters with proposed changes.

“We believe it's working,” said Carla De Paz, a steering committee member of the United to House L.A. coalition. “Every day we hear the stories of the tenants who are staying housed, who are not being evicted, who are getting the services they need.”

De Paz said putting Measure ULA back on the ballot would detract from efforts to better the city’s implementation of affordable housing and tenant aid programs.

“The harm is that we're spending a lot of time trying to amend something that doesn't need fixing,” she said.

Reform would reduce revenues by around 8%

Housing policy researchers contend that the measure does need fixing. They point to a number of studies showing that because the “mansion tax” also applies to new apartment complexes selling for more than $5.3 million, housing development has slowed in the city relative to other parts of L.A. County.

One UCLA and RAND study found that L.A. would likely have more affordable housing units — like those bundled in with many market-rate projects — if the tax did not apply to new apartments. That study also estimated that canceling the tax during the first 15 years of an apartment building’s life would reduce total revenues by 8% because most sales happen in older properties.

Scott Epstein, policy director with Abundant Housing L.A., said he supports keeping ULA in place, but with the proposed reforms.

Epstein said he wants the city to “continue to provide the important revenue that we need for tenant protection, homeless prevention and affordable housing production, while not dissuading needed multi-family housing production from the private sector.”

What happens now? 

Because the L.A. City Council decided not to take action Tuesday, the proposed reform measure will not be ready for the June ballot. If the council approves sending it to voters later on, it could go head-to-head with a separate ballot initiative currently gathering signatures for a November measure to repeal not just Measure ULA, but all such taxes across the state.

Before failing to convince her colleagues to vote on the reform measure Tuesday, Raman said the other ballot initiative, plus the possibility of intervention of state lawmakers, should inspire city leaders to act fast.

“We can head off donors and supporters and promoters of other efforts if we do it the right way and if we do it locally,” she said. “Fixing unintended consequences is how we keep this policy aligned with what voters expected and what the city needs.”

The proposed changes are proving hard to advance for reformers. State lawmakers pursued similar tweaks in a bill that failed to move forward at the end of last year’s legislative session in Sacramento.

One year into President Donald Trump’s second term, Californians who voted for him are mostly happy with how his policies have played out so far.

Trump’s support among California Republicans has slipped to 79%, down from 84% near the start of his term, according to a Public Policy Institute of California poll released last month.

The survey found that Californians name the cost of living and the economy as the most important issues facing the state today. Those concerns also dominated follow-up conversations KQED had with voters first interviewed 100 days into Trump’s second administration. From Southern California and the Central Valley to the North Coast, seven voters offer a mixed review of Trump’s performance.

They weigh in on a range of issues, including sweeping tariffs, immigration raids, National Guard deployments and a redistricting battle. While there is general support for his “America First” platform, they are divided on whether the president’s actions fulfill that mandate. Several also criticized Trump’s rhetoric and tone.

Emerson Green, 26, El Dorado County

Of all of his expectations for Trump’s second term, Emerson Green had been most optimistic that the president would improve the economy. Instead, he said he’s deeply disappointed and believes Trump let him down.

“I wish I never voted for him,” Green said. “It’s not that he lied or he didn’t hold up his promise. It is that he did the exact opposite, with intent, of what he promised he was going to do.”

Since Trump returned to the White House, Green got engaged and is expecting a baby in May. The 26-year-old now works at O’Reilly Auto Parts after changing jobs twice last year. He said he’s noticed the cost of some car parts rising because of tariffs, though not as dramatically as he expected when Trump announced his “Liberation Day” tariffs last April.

Emerson Green sits during a hike in Adams Canyon, Utah, on May 4, 2025.

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He’s also noticed everyday expenses like groceries and medication becoming more expensive and has begun to see home ownership as nearly unattainable.

“The idea of owning a house at this point in my life seems like something that is, if I even do it, it might be 30 years out at this point,” Green said. “It’s probably as bleak as it gets for young people these days … and [Trump] has done nothing to improve that.”

Last year, Green’s mom received an offer letter for a job with the Internal Revenue Service, but when Trump issued a government hiring freeze, her offer was rescinded. It took her a couple of months to find another job, and she now works in funeral insurance sales.

“She is really struggling to make ends meet,” Green said.

Beyond his dissatisfaction with the economy, Green is most critical of Trump’s military intervention in Venezuela, which he sees as veering away from the president’s pledge to prioritize America first. On Jan. 3, Trump ordered U.S. forces to seize President Nicolás Maduro in a stunning extraction that resulted in Venezuela’s leader facing federal charges in New York.

“I can’t see a strategic benefit to it at all,” Green said. “I do think he did it as, like, a stunt to boost his approval ratings.”

Green also faults Trump for repeatedly delaying the release of the Epstein files, then issuing heavily redacted documents despite vows on the campaign trail to declassify them.

“You may as well have red hands,” he said.

Ben Pino, 56, Los Angeles County

Following the fatal shooting of 37-year-old Alex Pretti by federal immigration agents in Minneapolis over the weekend, Ben Pino still stands behind the administration’s immigration tactics. The shooting marks the second killing this month of a Minneapolis resident during an operation after 37-year-old Renee Good was fatally shot in her car by a U.S. Immigration and Customs Enforcement officer earlier in January.

Pino believes Pretti and Good were “antagonizing the feds,” echoing statements made by Secretary of Homeland Security Kristi Noem, who said Pretti approached U.S. Border Patrol officers with a 9 mm semiautomatic handgun and claimed, without evidence, that he attacked officers with intent to harm them.

Ben Pino in his neighborhood in Los Angeles County on May 7, 2025.

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Video footage shows Pretti holding a phone, with his concealed gun removed from his waistband by an agent, before he was shot.

“I think the loss of life is tragic. I think that those young people used poor judgment and got themselves killed,” Pino said. “I don’t understand the outrage, to be quite honest with you.”

Pino lives in the Diamond District in Los Angeles and works in Carson. He supported Trump’s decision to deploy thousands of California National Guard troops to Southern California, without the governor’s approval, to quell anti-ICE protests last summer.

“If you ask me, ICE needed some kind of protection because people were going nuts,” he said.

In December, the U.S. Supreme Court upheld a lower-court ruling barring Trump from deploying National Guard troops to Chicago without Illinois Gov. JB Pritzker’s permission.

“I’m a little bit surprised that they can take that kind of power away from the president of the United States. He is the ultimate leader of our country,” Pino said.

While he bristled at limits on the president’s authority at home, Pino praised Trump for exercising that power abroad by ordering a military incursion into Venezuela.

“I’ve never seen a president take an action like going into a foreign country, grabbing its Communist criminal leader and bringing them back to face trial,” Pino said. “It’s one of the most spectacular foreign policy events that I’ve seen any American president make in my lifetime.”

Pino, whose parents immigrated to the U.S. from Cuba, hopes Trump will intervene there, too.

“As a Cuban American, I feel that direct U.S. intervention should happen if you want to protect something that’s that close to your shores,” he said.

One year in, Pino remains fully on board with the administration.

“I approve of everything he’s done so far,” he said. “I’m a bigger fan now than you found me last year.”

Kim Durham, 68, Sacramento County

Kim Durham is thankful to have Trump in office, but wants to see him temper his rhetoric.

“I think he shoots himself in the foot by saying things he doesn’t need to say,” she said. “Decorum could be utilized a little bit in public speaking.”

Immigration ranks among Durham’s top policy concerns, and she supports Trump’s rapid push to secure the southern border as well as his aggressive approach to deportations. Her daughter is a police officer, and Durham believes national media coverage has fueled hostility toward ICE that has spilled over to local law enforcement.

Kim Durham sits outside of an apartment she rents outside of Sacramento on May 6, 2025. 

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“It’s just infuriating to watch just regular people in uniforms … have to fight through angry mobs of cars,” she said.

In response to the killing of Pretti, Durham repeated Noem’s rhetoric, blaming Minnesota Gov. Tim Walz and Minneapolis Mayor Jacob Frey for not coordinating with ICE.

“If they’ve let ICE do the job that they’ve been called to do, this wouldn’t be happening,” she said.

Durham would not condemn the individual officers involved, saying that a final judgment should come from the courts.

“There’s no guarantee that individually every ICE agent is gonna act perfect,” she said. “So, I don’t believe as a whole ICE is wrong. Or even necessarily overreaching.”

Durham also backs Trump’s decision to deploy the National Guard in Los Angeles, and said she wishes state leaders would cooperate with the president.

“There are some that say he’s a dictator. Well, no, he’s not a dictator — we voted him in,” she said. “I think it would all be a lot better if we didn’t resist the federal government and instead just got together and said, ‘Hey, I’m with you … Let’s sit down, work together and clean it up instead of fight it.’”

On health care, Durham said she’s glad to see the administration target Medicaid fraud. In July, Trump signed into law his sweeping policy bill, including an estimated $1 trillion in Medicaid cuts. Much of that reduction would come from new work requirements and additional paperwork demands that would shrink enrollment.

“I honestly believe if all the fraud could be cut out of Medicaid and Medicare, we would be in a surplus of money,” she said.

Durham also praised Health Secretary Robert F. Kennedy Jr.’s Make America Healthy Again initiatives, especially efforts to remove synthetic dyes from the food supply and curb ultra-processed foods, raising concerns about what her grandchild eats. She’s also in favor of his updated childhood vaccine schedule, calling the previous standard “ridiculous” and saying families need choices.

Cindy Cremona, 66, formerly San Diego County

When Cindy Cremona heard about Proposition 50, the November 2025 ballot measure approved by voters that redraws California’s congressional maps, she felt Republicans would never have a voice in the state.

“I think for many, people just felt that it was going to lock in California as a blue state forever and ever,” she said.

In September, Cremona moved from Encinitas, a coastal city in northern San Diego County, to Wellington, Florida. She had been considering the move since Gov. Gavin Newsom took office in 2019 and was even more compelled to leave during the pandemic, when she felt the state went too far with vaccine and mask mandates and lockdowns.

Cindy Cremona and her 12-year-old Andalusian horse, Durango, in San Marcos, California, on May 8, 2025. 

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Last year, she reached her breaking point and decided to move, citing “the politics, the taxes, the over-regulation, the traffic, the overdevelopment.”

Cremona finds Florida’s housing costs and policies preferable to California’s. For instance, she took issue with last year’s passing of SB 79, which makes it easier to build apartment buildings near major public transit stops.

She’s optimistic about Trump’s housing proposals, including a recent pledge to target institutional investors who buy up single-family homes. Newsom echoed a similar stance toward corporate landlords in his State of the State address, a rare instance of political overlap between the Democratic governor and the president.

Looking ahead, Cremona expressed confidence in the president’s ability to deliver on other economic promises, like lower food and energy costs.

“I think 2026 is the year where we’ll see some of those policies borne out,” she said.

Debbie Pope, 60, Long Beach

Debbie Pope is deeply disillusioned with Trump’s first year back in office. At the beginning of 2025, she welcomed what she described as Trump’s “guns-a-blazing” return. But her view shifted in the second half of the year, following the assassination of conservative activist Charlie Kirk and repeated delays in releasing the Epstein files.

“I saw a whole different view of Trump after that for some reason,” she said. “The biggest disappointment is the Epstein files. It’s just like, Trump, you’re in them. You’re in it.”

Debbie Pope in her Long Beach home on May 10, 2024.

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Pope voted for Trump in 2016, 2020 and 2024, but before that, she was a Democrat and voted for Barack Obama in 2008 and 2012. Her party switch was driven by a distaste for Hillary Clinton and Trump’s hardline stance on immigration, one of her top policy concerns.

The daughter of a Nicaraguan immigrant, Pope supports stricter border enforcement — and thinks Trump has failed to deliver on promises of mass deportations.

She wants to see the president focus on domestic issues, like ramping up deportations even more, rather than foreign military interventions in Venezuela and Iran.

“He’s veered off the America First train, I think,” she said. “So yeah, I’m a little disappointed in him.”

These days, Pope sees Trump as prioritizing the interests of billionaires over those of his constituents. She also points to his massive ballroom renovations and putting his name on the Kennedy Center as diversions from America First.

“Dude, we know you’re a narcissist, but really, you’re getting carried away,” she said.

Ron Dawson, 68, Eureka

Ron Dawson said he would give Trump’s performance in 2025 a B+. He feels his cost of living has improved since Trump took office, noting lower grocery and fuel prices. He still wants to see the president lower the federal deficit.

Dawson voted for Trump in 2024, but his preferred presidential candidate was Nikki Haley. He still favors the president over Kamala Harris.

Once a Democrat like his parents, Dawson said the last time he voted blue was for Bill Clinton in 1996. Since then, he’s felt like the Democratic Party has become elitist, prioritizing identity politics and social justice issues, which he said have “nothing to do with running a country.”

Before settling in Eureka six years ago, Dawson spent almost five decades in Southern California. He recalls working as a machinist in 1980 and losing the job to an immigrant.

“He could work cheaper than I would accept,” he said. “I have a problem with the system. The system I recognized way back then is really broken.”

Today, Dawson approves of Trump’s secure border platform.

Now living in far Northern California, Dawson is critical of Proposition 50 and the newly redrawn 2nd Congressional District. Previously stretching from Marin County to the Oregon border, the new boundaries push further inland to the Nevada border, pulling in Siskiyou, Modoc and Shasta counties.

“Our congressional representative, Jared Huffman — he already has a very, very large district and a lot of people say, like, you never see him, never hear from him,” Dawson said. “They didn’t stop and think, how does this one guy represent such a large area?”

Those concerns deepened following the recent death of Rep. Doug LaMalfa, a Republican who represented rural Northern California for more than a decade.

Mari Barke, Orange County

Mari Barke, president of the Orange County Board of Education, has mostly positive things to say about the president.

“He puts our country first, which to me is critically important of somebody who is president,” she said.

Mari Barke, photographed at the California Policy Center in Irvine in 2024. 

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Above all, she aligns with Trump’s education agenda, like his executive order banning transgender athletes from participating in girls’ and women’s sports and his push to eliminate diversity, equity and inclusion programs. The administration has threatened to withhold federal funding from schools with DEI initiatives.

“I think it’s important to get rid of all the biases and just let people enter higher education based on merit,” Barke said, arguing that merit incentivizes students to work hard and reduces the likelihood of academic failure.

Barke is a staunch advocate for parental notification policies, which require school teachers and staff to notify parents if their child identifies as a gender other than what they were assigned at birth.

“I never think it’s a good idea to teach children to lie to their parents,” she said. “I think if a child is going through something like that, nothing is more important than having your parents’ love. I have a gay son who has a husband, and I love him to death, no matter who he is or what he decides.”

Despite her alignment with the administration, Barke occasionally finds fault with Trump’s delivery, suggesting he could behave “more presidential” so as not to offend people.

As AI expands into every facet of society, a California company is testing whether the technology can help improve the health of people living on the streets.

Akido Labs, a Los Angeles-based health care technology company that runs clinics and street medicine teams in California, plans to start using its AI model on homeless and housing insecure patients in the Bay Area next month. The program generates questions for outreach workers to ask patients and then suggests diagnoses, medical tests and even medication, which a human doctor then signs off on remotely. The idea is to save doctors time and allow them to see more patients.

The new model, called Scope AI, is addressing a very real problem: There aren’t nearly enough doctors visiting encampments and shelters. At the same time, homeless Californians are in much poorer health and are dying earlier than the general population.

“There are individuals who haven’t seen doctors for years. There are individuals who haven’t seen a dentist ever,” said Steve Good, president and CEO of Five Keys, which is partnering with Akido to launch the AI technology in its San Francisco homeless shelters. “There just aren’t enough resources to go in there and find out the needs these individuals have.”

Experts who research AI told CalMatters that if done right, the technology has the power to increase access to care for homeless and other marginalized communities. But while many health care providers already are using AI for administrative duties, such as transcribing patient visits, using it to help diagnose people is still a relatively new field. It brings up concerns around data privacy, biases and patient outcomes, which are particularly pressing when the technology is being used on homeless patients and other vulnerable groups.

“We don’t have perfect solutions to a lot of these challenges yet,” said Angel Hsing-Chi Hwang, an assistant professor at USC who researches human-AI interaction.

How Scope uses AI to diagnose homeless patients

Scope AI essentially allows non-medically trained outreach workers to start the intake and diagnosis process before a patient sees a doctor.

An outreach worker goes out into the field with Scope on their tablet or laptop. As they start interviewing a patient, Scope suggests questions the outreach worker should ask. Scope listens to, records and transcribes the interview, and as the interaction progresses, it suggests new questions based on what the patient says.

When it has enough information, Scope suggests diagnoses, prescriptions and follow-up tests. That information is then sent to a human doctor, who reviews it (usually the same day) and either signs off on the prescriptions, makes changes, or, if it’s a more complex case, arranges to see the patient to get additional information. The medical care is paid for by Medi-Cal through its CalAIM expansion into social services.

Dr. Rishi Patel from the Akido street medicine team checks on an unhoused man living in a vineyard in Arvin on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments.

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Dr. Rishi Patel from the Akido street medicine team checks on an unhoused man living in a vineyard in Arvin on May 28, 2024. Street medicine teams throughout California are increasingly using long-acting injectable antipsychotic medication to stabilize the mental health of people living in homeless encampments. Photo by Larry Valenzuela, CalMatters/CatchLight Local In demonstrating the technology to CalMatters, using an imaginary 56-year-old female patient who complained of trouble breathing, Scope asked several follow-up questions to drill down on her symptoms. Then, it made suggestions that included: a diagnosis of COPD or chronic bronchitis, a chest x-ray and spirometry breathing test, and a prescription of an albuterol inhaler.

The Scope AI technology is already being used in a few target areas. Akido’s street medicine teams began using it in homeless encampments in Los Angeles County in 2023, where it has since seen more than 5,000 patients. Akido also uses AI in encampments in Kern County, clinics in California and Rhode Island, and to treat ride-share workers in New York.

Scope lands on the correct diagnoses within its top three suggestions 99% of the time, according to Akido.

Other studies have called into question the reliability of diagnoses made by artificial intelligence. A 2024 study, for example, found that AI was significantly more likely to misdiagnose breast cancer in Black women than in white women.

The infiltration of AI into homeless services has sparked concern from some critics who argue homeless patients, because of their increased vulnerability, need a human health care provider.

“We should not experiment on patients who are unhoused or have low incomes for an AI rollout,” Leah Goodridge, a tenants rights attorney and housing policy expert, and Dr. Oni Blackstock, a physician and executive director of Health Justice, wrote in a recent opinion piece for the Guardian.

Brett Feldman, director of USC Street Medicine, agrees. When someone is homeless, much of their health status is dependent on their living environment, he told CalMatters. For example, he recently treated a patient with scabies. Typically, he would prescribe a shampoo or body wash, but this patient had no access to a shower — a key detail that AI might not know to ask.

Instead, he prescribed an oral medication. The patient needed one dose right away, and another dose in a week. He had to decide whether to give the patient the second dose now and trust that it wouldn’t get lost or stolen, ask the patient to travel to a pharmacy to pick up the second dose, or try to find the patient again in a week to deliver the dose. AI couldn’t make that complex calculation, and neither could a doctor who hadn’t met the patient and seen their living situation, Feldman said.

And any missteps the AI makes could have outsized consequences when a patient is homeless, Feldman said. If the patient has an issue with the medication prescribed, they likely don’t have an easy way to contact the doctor or have a follow-up appointment.

“I would say, in general, that this would not work for this population,” Feldman said.

Akido argues the benefit of AI is clear: better efficiency and improved access to health care.

Before introducing AI, each of Akido’s street medicine doctors in LA and Kern counties could carry a case load of about 200 homeless patients at a time, said Karthik Murali, head of safety net programs for the company. Now, it’s closer to 350 patients per doctor, he said, because doctors spend less time asking routine questions and filling out paperwork.

That means more patients get access to care and medication more quickly, Murali said.

Nearly a quarter of homeless Californians surveyed by the UCSF Benioff Homelessness and Housing Initiative reported needing medical care that they couldn’t get in the six months prior to the study. Only 39% said they had a primary care provider. Nearly half of homeless Californians surveyed reported their health as poor or fair — a rate about four times higher than the general U.S. population.

Good, of Five Keys, hopes the technology also will let clinicians build trust and deeper relationships with their clients. An outreach worker using Scope will have time to form a bond with the patient and better respond to their individual needs, as opposed to a doctor who is rushing through the visit to get to the next patient, he said.

His organization hopes to roll out the technology in some of its San Francisco homeless shelters next month.

Partnerships and access

Akido also plans to work with Reimagine Freedom and the Young Women’s Freedom Center to use the AI technology at four centers — in San Francisco, Oakland, Richmond and San Jose — that serve women and girls who are or have been incarcerated. The clients they serve often had poor access to health care while in jail or prison, or had their medical concerns ignored, said Reimagine Freedom President Jessica Nowlan. Many have no trust in the medical system.

Currently, the centers offer health education. This new AI technology will allow them to provide actual medical care, Nowlan said.

“Our guess is we will see a huge increase in women being able to access health and care for themselves,” she said.

Reimagine Freedom started testing Scope AI at its Los Angeles clinic in November. So far, “it’s going really well,” Nowlan said.

Akido plans to partner with additional homeless service providers who can help it roll out its AI technology in more places throughout the Bay Area. That partnership is being spearheaded by the Future Communities Institute, which is also developing metrics to judge the effectiveness of Akido's program.

If providers who serve vulnerable patients are left out of the AI race, any benefits in the technology will go to wealthy communities instead — further widening the gap between the haves and have-nots, said Stella Tran, who researches AI companies for a California Health Care Foundation investment fund. That’s why social service providers need to be involved in testing this technology and developing the ground rules and safety checks, she said.

But that doesn’t mean Tran doesn’t have concerns. For example, AI works differently on different communities. An algorithm that produced accurate diagnoses for patients in Los Angeles might not work as well in the Bay Area, she said. And while AI has the potential to be less racially biased than human doctors, it all depends on how the algorithm is constructed.

“I think there is a potential to increase access if we do it right,” Tran said, “with the right set of guardrails and being thoughtful about safety, transparency to patients, consent, all of that.”

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.