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The use of artificial intelligence in healthcare could create a legally complex blame game when it comes to establishing liability for medical failings, experts have warned.

The development of AI for clinical use has boomed, with researchers creating a host of tools, from algorithms to help interpret scans to systems that can aid with diagnoses. AI is also being developed to help manage hospitals, from optimising bed capacity to tackling supply chains.

But while experts say the technology could bring myriad benefits for healthcare, they say there is also cause for concern, from a lack of testing of the effectiveness of AI tools to questions over who is responsible should a patient have a negative outcome.

Prof Derek Angus, of the University of Pittsburgh, said: “There’s definitely going to be instances where there’s the perception that something went wrong and people will look around to blame someone.”

The Jama summit on Artificial Intelligence, hosted last year by the Journal of the American Medical Association, brought together a panoply of experts including clinicians, technology companies, regulatory bodies, insurers, ethicists, lawyers and economists.

The resulting report, of which Angus is first author, not only looks at the nature of AI tools and the areas of healthcare where they are being used, but also examines the challenges they present, including legal concerns.

Prof Glenn Cohen from Harvard law school, a co-author of the report, said patients could face difficulties showing fault in the use or design of an artificial intelligence product. There could be barriers to gaining information about its inner workings, while it could also be challenging to propose a reasonable alternative design for the product or prove a poor outcome was caused by the AI system.

He said: “The interplay between the parties may also present challenges for bringing a lawsuit – they may point to one another as the party at fault, and they may have existing agreement contractually reallocating liability or have indemnification lawsuits.”

Prof Michelle Mello, another author of the report, from Stanford law school, said courts were well equipped to resolve legal issues. “The problem is that it takes time and will involve inconsistencies in the early days, and this uncertainty elevates costs for everyone in the AI innovation and adoption ecosystem,” she said.

The report also raises concerns about how AI tools are evaluated, noting many are outside the oversight of regulators such as the US Food and Drug Administration (FDA).

Angus said: “For clinicians, effectiveness usually means improved health outcomes, but there’s no guarantee that the regulatory authority will require proof [of that]. Then once it’s out, AI tools can be deployed in so many unpredictable ways in different clinical settings, with different kinds of patients, by users who are of different levels of skills. There is very little guarantee that what seems to be a good idea in the pre-approval package is actually what you get in practice.”

The report outlines that at present there are many barriers to evaluating AI tools including that they often need to be in clinical use to be fully assessed, while current approaches to assessment are expensive and cumbersome.

Angus said it was important that funding was made available for the performance of AI tools in healthcare to be properly assessed, with investment in digital infrastructure a key area. “One of the things that came up during the summit was [that] the tools that are best evaluated have been least adopted. The tools that are most adopted have been least evaluated.”

Greenpeace is threatening to sue King Charles’s property management company, accusing it of exploiting its monopoly ownership of the seabed.

The environmental lobby group alleges the crown estate has driven up costs for wind power developers and boosted its own profits, as well as the royal household’s income, due to the “aggressive” way it auctions seabed rights.

The crown estate, as the legal owner of the seabed around England, Wales and Northern Ireland, is responsible for auctioning offshore wind rights. It has benefited from the huge growth in the industry, commanding hefty option fees from renewable energy developers to secure areas of the seabed to build their windfarms.

It made a £1.1bn profit in its financial year ended in March, double its level just two years ago.

Will McCallum, co-executive director at Greenpeace UK, said the estate should be “managing the seabed in the interest of the nation and the common good, not as an asset to be milked for profit and outrageous bonuses”.

“We should leave no stone unturned in looking for solutions to lower energy bills that are causing misery to millions of households,” he said.

“Given how crucial affordable bills and clean energy are to the government’s agenda, the chancellor should use her powers of direction to ask for an independent review of how these auctions are run. If the problem isn’t fixed before the next round, we may need to let a court decide whether or not what’s happening is lawful.”

Greenpeace argues the crown estate has a legal duty not to exploit its monopoly position as owner of the seabed around England, Wales and Northern Ireland, but that it is now in breach of this.

The lobby group said it was concerned the crown estate was rationing supply of the seabed to protect high prices, and argued this could harm the development of offshore wind power in the UK.

The crown estate has reportedly rejected Greenpeace’s claims, arguing the lobby group has misinterpreted the estate’s legal duties.

About 12% of crown estate profits flow to the monarchy through the sovereign grant to fund its work. This was lowered from 25% in 2023 to offset the rise in profits from offshore wind projects.

The UK’s wind industry is at a critical juncture as the government plans to double onshore wind and quadruple offshore wind power capacity by the end of the decade.

The crown estate, which also includes a portfolio of London properties and rural real estate, is worth £15bn. The property assets in London, which is concentrated around Regent Street and St James’s, are valued at £7.1bn.

A spokesperson for the crown estate said: “Greenpeace has misunderstood the crown estate’s legal duties and leasing processes. Option fees are not fixed by the crown estate. They are set by the developers through open, competitive auctions and reflect market appetite at the time. As our net revenue is returned to the Treasury, option fees help to ensure that taxpayers benefit from the requisite value from the development of our scarce and precious seabed resource.

“The crown estate is accelerating offshore wind in line with government policy to move forward the energy transition at pace and improve energy security.”

A Treasury spokesperson said the crown estate “operates independently and makes its own commercial decisions”, adding that “every penny of profit [that] goes to the Treasury … [helps] pay for vital public services like schools and hospitals”.