## Facts

- Anthony Robert Neade, age 37, had multiple cardiac risk factors, including family history, hypertension, high cholesterol, heavy smoking, and obesity.
- In 1990, he reported symptoms consistent with coronary artery disease, including chest pain radiating to his arm and shortness of breath.
- Dr. Steven Portes hospitalized him (Aug. 10–13, 1990), and he received a thallium stress test and EKG that were interpreted as normal; he was diagnosed with gastrointestinal conditions.
- After discharge, Neade repeatedly returned to Portes and the clinic with continued and worsening chest pain.
- Two clinic associates recommended an angiogram, but Portes did not order it, relying on the earlier test interpretations.
- Neade later suffered a massive myocardial infarction due to coronary blockage and died.
- The estate alleged Portes’s HMO contract created financial incentives to limit referrals and testing, and that Portes failed to disclose these incentives and allowed them to affect his decision not to order an angiogram.

## Issues

1. Whether Illinois recognizes a separate cause of action for breach of fiduciary duty against a physician for failing to disclose HMO financial incentives that allegedly discouraged referrals and diagnostic testing, when the complaint also alleges medical negligence based on the same medical decisions and injury.

## Decision

- The Illinois Supreme Court reversed the appellate court and reinstated the trial court’s dismissal of the fiduciary-duty count.
- The court held that a patient may not bring an independent breach-of-fiduciary-duty claim against a physician under these circumstances.
- The medical negligence claim was not resolved in this appeal and remained available under ordinary malpractice principles.

## Legal Principles

- When the complained-of conduct and alleged injury are fully addressed by medical negligence doctrine, Illinois will not recognize a duplicative, standalone tort claim labeled as breach of fiduciary duty.
- Allegations that financial incentives influenced a physician’s medical judgment are actionable, if at all, through malpractice standards governing the adequacy of care and decision-making.
- A physician–patient relationship may have fiduciary aspects, but the existence of that relationship does not require recognition of a separate fiduciary-duty cause of action where established tort remedies provide an adequate framework and a separate claim risks duplicative recovery and unclear disclosure duties.

## Conclusion

Illinois does not permit a separate fiduciary-duty action against a physician for nondisclosure of HMO incentive arrangements when the alleged misconduct and harm are coextensive with a medical malpractice claim; the proper vehicle is negligence law.


Neade v. Portes, 739 N.E.2d 496 (Ill. 2000)