EVADE: Evidence-Verified Agentic Diagnosis with Escape

Vision-language model safety benchmarks typically evaluate only final responses: whether a model refuses, warns, or complies. This outcome-level view cannot tell whether a model is safe for the right multimodal reason. Safelooking behavior may reflect keyword-triggered refusal, missed visual hazards, or over-refusal of benign-sensitive inputs. We introduce EviSafe, an evidence-grounded framework for VLM safety that jointly evaluates natural user-facing behavior, explicit grounding in textual and visual evidence, and behavioral sensitivity to counterfactual changes in safety-critical evidence. EviSafeBench instantiates the framework as a controlled benchmark with 1,181 gold image-text scenarios and 2,452 targeted counterfactual variants across eight safety domains and eight risk-source types. Each scenario includes a gold safety decision, evidence annotations, a safe-response policy, and counterfactual interventions. The three-probe protocol queries models with natural-response, evidencereporting, and counterfactual-response prompts, then scores them using an evidence-aware judge. Across eleven evaluated VLMs, natural severity accuracy ranges from 27.6% to 52.8%, relaxed diagnostic consistency from 6.1% to 29.3%, and unsafe-to-safe counterfactual transition success from 30.4% to 58.4%. These gaps show that the evaluated VLMs are not reliably safe for the right multimodal reason and motivate evaluation beyond refusal counts.

Many medical conditions require clinical assessment of symptoms, history, and functioning rather than judgments from appearance. We study whether vision-language models (VLMs) abstain from facial attribution of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). To support this study, we construct PARITY (Paired Assessment with Reused Identity), a demographically balanced dataset for testing whether changing facial expressions alters diagnostic judgments, while holding identity and other visual factors as constant as possible. Our comprehensive evaluation of 27 open- and closed-weight models reveals inconsistent abstention across expressions, conditions, and task formats. Models turn facial expressions into unsupported medical judgments: this behavior is widespread among open-weight VLMs and extends to safety-trained frontier models that abstain on individual portraits yet make diagnostic judgments when comparing portraits of the same identity. Safeguard checks reveal further gaps: clinical instructions do not consistently prevent these judgments, and a guardrail model rarely flags paired requests as unsafe. Semantic analysis further shows that most baseline open-model refusals fail to explain both the insufficiency of facial evidence and the need for clinical assessment. Unsupported judgments and seemingly authoritative explanations can cause distress, reinforce stigma, and offer false reassurance, underscoring the need for stronger safety measures in model training and deployment.

Vision-Language models (VLMs) reliability in medical diagnosis is challenged by trust-undermining hallucinations. Existing hallucination detection approaches mainly focus on identifying factual inconsistencies between generated text and reference data. While some studies analyze where models attend in images, they seldom verify whether such attention truly reflects the visual evidence supporting the generated text. To address this gap, we propose Co}unter-Evidence Verification (CoEV), a training-free plug-and-play framework that detects and corrects hallucinations through evidence-based factual consistency verification. CoEV performs bidirectional verification between textual assertions and visual evidence, testing whether each statement is supported by its corresponding evidence region, and assigns each statement into a four-quadrant diagnostic map capturing combinations of text factuality and visual grounding. CoEV detects hallucinated content and serves as a post hoc refinement tool, correcting hallucinations without retraining. Extensive experiments on four medical datasets show that CoEV combats hallucinations in VLMs.For hallucination detection, CoEV consistently outperforms existing methods, improving average PR-AUC and ROC-AUC by 3.0% and 3.9% absolute points respectively, with notable gains of up to 18.5% in specific VQA scenarios. For hallucination correction, it improves Micro-F1 by up to 12.5%, reduces hallucination rates by over 11.9% on medical report generation, and also boosts medical VQA accuracy. These results show that CoEV enables reliable detection and correction of hallucinations, providing clinicians with dependable, evidence-based cues for diagnosis. Code will be released upon acceptance.