Cynthia Herdrich felt a sharp, persistent pain in her abdomen. She went to see her doctor, a physician who was a member of her health maintenance organization, but Dr. Lori Pegram sent her home. Herdrich returned six days later. This time, the doctor found an inflamed six-byeight centimeter mass in her abdomen. Instead of sending Herdrich immediately to an emergency ultrasound, the doctor scheduled the test eight days later. By the time Herdrich had her ultrasound, her appendix had ruptured and she was suffering from peritonitis, a potentially fatal internal infection. She required emergency surgery and a lengthy hospital stay.

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