A new industry position highlights a growing disconnect in AI use across clinical trials: sponsors and CROs push algorithmic tools to sites, while sites often lack governance, transparency, and escalation pathways. The Society for Clinical Research Sites (SCRS) says trial centers are being scored and ranked by AI systems they cannot see or appeal. The report argues that responsible AI adoption requires site-level guidance, including details on inputs, weighting logic, validation standards, and recourse when AI-driven decisions affect operations. SCRS frames the problem as structural, not a matter of individual trial staff “carelessness.” For biotech and trial stakeholders, the message is that AI-driven oversight can introduce compliance and operational risk if governance frameworks are not aligned with how sites are assessed and managed.