To the Editor: In a recent article in THE JOURNAL,1 Mr Pomfret and I described the structure of the
Federal Employee Retirement Income Security Act (ERISA) and how ERISA litigation
reduces physician autonomy. In a subsequent development, the Supreme Court
recently decided Pegram v Herdrich, 530 US_ (2000),
a case that further addresses these issues.
Herdrich argued that she was not provided with an ultrasound diagnosis
in a timely manner because her managed care plan's financial incentives encouraged
her physician to delay the procedure. During the delay, her appendix ruptured,
causing peritonitis. After being awarded $35,000 in state court, she sued
under ERISA, arguing that the plan's financial incentives breached a fiduciary
duty to act in the patient's best interests.