Specialist language models are usually understood through endpoint gains: the generalist scores lower, the specialist scores higher, and the difference is treated as evidence of specialization. This leaves the released update itself largely unexamined. We propose a paired weight-delta path audit and apply it to two public, aligned generalist-to-medical-specialist checkpoint pairs: Gemma-3-4B-IT → MedGemma-4B-IT and Qwen2.5-7B-Instruct → HuatuoGPT-o1-7B. In both pairs, the full decoder-side update strongly reconstructs measured medical benchmark movement (0.974 and 1.183 endpoint-normalized retention), making each decoder delta an appropriate substrate for the audit. Yet the movement is not cleanly localized. MLP is the strongest broad component family in both pairs, but mixed off-domain movements, 10-seed matched controls, and endpoint-anchored rollbacks prevent a unique coarse-family explanation. The audit therefore separates update-level reconstruction from component-level explanation. Its claims concern text-only multiple-choice benchmark movement, not clinical validation, repair, or circuit-level mechanism.

Ensuring clinical data privacy while preserving utility is critical for AI-driven healthcare and data analytics. Existing de-identification (De-ID) methods, including rule-based techniques, deep learning models, and large language models (LLMs), often suffer from recall errors, limited generalization, and inefficiencies, limiting their real-world applicability. We propose a fully automated, multi-modal framework, RedactOR for de-identifying structured and unstructured electronic health records, including clinical audio records. Our framework employs cost-efficient De-ID strategies, including intelligent routing, hybrid rule and LLM based approaches, and a two-step audio redaction approach. We present a retrieval-based entity relexicalization approach to ensure consistent substitutions of protected entities, thereby enhancing data coherence for downstream applications. We discuss key design desiderata, de-identification and relexicalization methodology, and modular architecture of RedactOR and its integration with Oracle Health Clinical AI system. Evaluated on the i2b2 2014 De-ID dataset using standard metrics with strict recall, our approach achieves competitive performance while optimizing token usage to reduce LLM costs. Finally, we discuss key lessons and insights from deployment in real-world AI-driven healthcare data pipelines.