In the wake of a scandal involving fabricated sources found in the province’s Education Accord, The Independent has confirmed another major government-commissioned policy report contains false citations like generated by artificial intelligence, calling into question the credibility of policy papers involving the use of AI.

Authored by global consulting firm Deloitte and published by the Department of Health and Community Services in May, Newfoundland and Labrador’s Health Human Resources Plan contains at least four citations which do not, or appear not to, exist.

The report cost the province nearly $1.6 million, according to documents obtained through an access to information request and published on blogger Matt Barter’s website.

The Health Human Resources Plan was commissioned by the previous Liberal government as part of its efforts to develop an effective human resource strategy for the province’s healthcare sector, which has been plagued by nurse and doctor staffing shortages.

The research papers cited in the 526-page document are used to support claims related to recruitment strategies, monetary recruitment and retention incentives, virtual care, and impacts of the COVID-19 pandemic on healthcare workers.

In one case, the report cites a team of researchers and their work to support the claim that monetary and recruitment incentives “have inherent cost savings benefits as it will cost less than recruiting and training new employees in the medium- and long-term.”

Martha MacLeod, a professor emerita in the University of Northern British Columbia’s School of Nursing and one of the co-authors of the article cited in that claim—“The cost-effectiveness of a rural retention program for registered nurses in Canada”—told The Independent the citation is “false” and “potentially AI-generated”.

“Our team certainly has done rural and remote nursing research,” she said in an email. “But we never did do a cost-effectiveness analysis, nor did we ever have the financial data to do it.”

In another case, a team of researchers is cited to back the claim that, “Local recruitment is typically the most cost-effective strategy, as it eliminates the need for costly relocation packages, reduces likelihood of turnover, and can reduce recruitment and training costs.”

One of the authors of that paper—which according to the report is titled “The cost-effectiveness of local recruitment and retention strategies for health workers in Canada”—told The Independent that while she and some of the researchers named in the citation have worked on the economics of recruitment and retention strategies, the paper itself “ does not exist.” Gail Tomblin Murphy, an adjunct professor in the School of Nursing at Dalhousie University and former vice-president of research, innovation and discovery with Nova Scotia’s health authority, said she has only worked with three of the six other authors named in the citation.

“It sounds like if you’re coming up with things like this, they may be pretty heavily using AI to generate work,” Tomblin Murphy said. “And I definitely think that there’s many challenges with that. We have to be very careful to make sure that the evidence that’s informing reports [is] the best evidence, that it’s validated evidence. And that, at the end of the day, these reports—not just because they cost governments and they cost the public—[are] accurate and evidence-informed and helpful to move things forward.”

A third citation is used to support the uncontroversial claim that registered respiratory therapists “working in acute care settings reported increased workload and stress levels due to the pandemic.” The Deloitte report claims a group of researchers “found” this to be the case in an article titled “The impact of COVID-19 on respiratory therapist workload and stress levels in Canada,” published in the Canadian Journal of Respiratory Therapy.

The report includes a hyperlink to an article on the Canadian Journal of Respiratory Therapy website that does not deal with registered respiratory therapists workload and stress levels due to the pandemic. The Independent has not been able to confirm the article’s existence as it doesn’t appear in academic search engines or on the Canadian Journal of Respiratory Therapy’s website.

Not a first for Deloitte

Last month Deloitte made international headlines after its firm in Australia produced a report for the Australian government that contained “apparent AI-generated errors, including a fabricated quote from a federal court judgment and references to nonexistent academic research papers,” according to the Associated Press.

The firm reportedly agreed to partially refund the government US$290,000, but Deloitte did not answer questions from AP about the potential involvement of AI. The firm told the AP the “matter has been resolved directly with the client.”

The report was removed from the Australian government’s website then later reappeared, this time with a disclosure in its appendix that a generative AI system called Azure OpenAI was used in part of the report; the company didn’t specifically link the errors to the AI program.

According to media reports, the company said the use of AI had no impact on the report’s “substantive content, findings or recommendations.”

Deloitte itself encourages the use of AI technologies, both within its company and with its clients. A statement from Deloitte Canada CEO Anthony Viel on the firm’s website notes that Deloitte is “helping and inspiring Canadian organizations to unlock all the possibilities, equipping them with the necessary industry knowledge, infrastructure and cloud services so that they can develop, train, and deploy generative AI models safely, ethically and impactfully, which serve us all in the age of digital transformation.”

In the N.L. Health Human Resources Plan, Deloitte recommends the use of generative AI “to support healthcare providers in clinical decision-making and inform the development of personalized treatment plans.” The report also suggests AI can “help analyse hospital data (e.g., electronic health records, medical claims data, etc.) and analyse patterns and trends to inform resource allocation.”

In a report published on its website earlier this year, Deloitte Canada says “growing confidence [in generative AI] underscores a critical responsibility for Canadian enterprises: to ensure that trust is not taken for granted but actively nurtured through transparency and collaboration.

“It is essential that all parties are engaged, and that governance is embedded into the design, development, and implementation of AI solutions,” the report says, adding “it is crucial to establish guardrails for the responsible deployment of Generative AI solutions while prioritizing upskilling to ensure that people understand the technology and know how to use it effectively.”

Deloitte did not respond to questions from The Independent by the time of publication.

Wakeham, PCs silent so far

In the wake of the Education Accord scandal, then Premier-designate Tony Wakeham told the Newfoundland and Labrador Teachers’ Association it was “embarrassing” the report contained the errors, as reported by CBC/Radio-Canada, and that the PC’s “first step will be to review the Education Accord in detail and speak directly with the writers about the content [to] determine what is factual and what is not.”

The Independent recently asked the premier if his government would be reviewing its policies around Artificial Intelligence, but a spokesperson from Wakeham’s office said it was “not prioritizing” one.

In light of a second major government-commissioned report found to contain errors likely generated by AI, The Independent asked Wakeham and the province’s Department of Health and Community Services what the government will do in response to the situation, how it will verify the veracity of claims made in the report, whether it will be requesting a refund from Deloitte, and whether it will be considering a policy around the use of AI in third-party reports.

The government had more than two days to respond but did not by the time of publication.

NDP Leader Jim Dinn says he’s “disgusted” by the revelation, especially given how recent the Education Accord scandal unfolded. “You’re playing with people’s lives,” he said Friday. “We already have enough reports in the media that are undermining confidence in the healthcare system as it is, and people are desperate. So this doesn’t do anything to inspire confidence in the fact that they’re trying to fix the problem.”

Dinn said to whatever extent AI was used in both reports, “it undermines confidence in the reports and in the decisions” that will come.

In June Deloitte was chosen by the provincial government to conduct a core staffing review of nursing resources in the province, which is expected in the spring.

As of Nov. 22, the Health Human Resources Plan remained on the Government of Newfoundland and Labrador’s website with no disclosure of AI use.

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