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[Preprint]. 2026 Aug 12:rs.3.rs-10464629. [Version 1] doi: 10.21203/rs.3.rs-10464629/v1

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Figure 1: — Sentinel architecture and dual-mode verdict routing. (a) Pipeline flow from clinical scenario through five sequential gates to a four-way verdict (allow, repair, block, escalate), with a repair loop (max 2 iterations). (b) Dual-mode routing of each verdict under the handoff-on and handoff-off protocols. Under handoff-on, blocked and escalated outputs are replaced by a deferral to a clinician; under handoff-off, no substitution is applied and the original output is scored directly. (c) All 15 safety invariants by gate, severity, and failure action. The only block-level invariant is INV-TOOL-04 (wrong-patient 3 tool call); INV-LOOP-05 converts to escalate when repair is exhausted; all remaining violations trigger repair or flag for review. Full definitions are in the Supplementary Information.