FICTION
Pegram v. Herdrich
530 U.S. 211 (2000) · 2000
Her appendix ruptured during an eight-day wait. The Court held the decision to make her wait was not the kind of decision the law supervises.
“We hold that mixed eligibility decisions by HMO physicians are not fiduciary decisions under ERISA.”
The Ruling
9–0: Mixed eligibility and treatment decisions made by HMO physicians are not fiduciary decisions under ERISA — even where the physician shares in the savings produced by withholding care.
The Personhood Argument Not Made
The law recognises two roles here — the doctor who owes a duty to a patient, and the administrator who owes a duty to a plan. The HMO physician is both at once, and the Court declined to say which one was acting. The patient's interest survives in principle and attaches to neither role in practice. Personhood dissolves not by denial but by division of the office that was supposed to be obliged to her.
The Execution Gap Created
A patient retains every right to competent care and to a loyal fiduciary. The moment the same person holds both hats, the fiduciary duty is assigned to the hat that was not worn. The duty exists. It is owed by nobody in the room.
Primary sources & research
Related cases
Part of The Personhood Prism, the companion to The Execution Gap by Thomas William Hornig. See all personhood cases →