Cynthia Herdrich, the plaintiff in Pegram, is an Illinois woman whose husband's employer provided health insurance through a local health maintenance organization (HMO) that was owned by a physicians' group, the Carle Clinic. Herdrich went to her physician at the clinic, Dr. Lori Pegram, complaining of abdominal pain, and no further workup was done. Six days later, after the pain had worsened, she returned. At that point Dr. Pegram discovered a six by eight centimeter inflamed mass in her lower abdomen. Dr. Pegram decided that an ultrasound examination was indicated, but rather than ordering one immediately at the local hospital, she scheduled one for eight days later at a facility 50 miles away that was staffed by Carle Clinic doctors. Before the ultrasound could be performed, the mass—Herdrich's inflamed appendix—ruptured, resulting in peritonitis and a prolonged hospital stay.