Lori Pegram, et al. v. Cynthia Herdrich (530 U.S. 211)
U.S. Supreme Court · decided June 12, 2000 · Supreme Court Database (Spaeth)
- Citation
- 530 U.S. 211 · 120 S. Ct. 2143
- Decided
- June 12, 2000
- Term
- October Term 1999
- Vote
- 9–0
- Majority author
- Justice Souter
- Issue area
- Economic Activity
- Disposition
- Reversed
- Outcome
- Petitioning party won
- Ideological direction
- Conservative
Opinion excerpt
Justice Souter delivered the opinion of the Court. The question in this ease is whether treatment decisions made by a health maintenance organization, acting through its physician employees, are fiduciary acts within the meaning of the Employee Retirement Income Security Act of 1974 (ERISA), 88 Stat. 832, as amended, 29 U. S. C. § 1001 et seq. (1994 ed. and Supp. III). We hold that they are not. r-f Petitioners, Carle Clinic Association, P. C., Health Alliance Medical Plans, Inc., and Carle Health Insurance Management Co., Inc. (collectively Carle), function as a health maintenance organization (HMO) organized for profit. Its owners are physicians providing prepaid medical services to participants whose employers contract with Carle to provide such coverage. Respondent, Cynthia Herdrich, was covered by Carle through her husband’s employer, State Farm Insurance Company. The events in question began when a Carle physician, petitioner Lori Pegram, examined Herdrich, who was experiencing pain in the midline area of her groin. Six days later, Dr. Pegram discovered a six by eight centimeter inflamed mass in Herdrich’s abdomen. Despite the noticeable inflammation, Dr. Pegram did not order an ultrasound diagnostic procedure at a local hospital, but decided that Herdrich would have to wait eight more days for an ultrasound, to be performed at a facility staffed by Carle more than 50…
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