Gateway Health Network Inc. is a corporation that operates a network of independent professional and institutional healthcare providers. It does not own or employ the providers in its network, and it is not an insurance company or a health plan. Rather, it is merely a network of doctors and hospitals. Gateway is large, with more than 2000 physician members and 5 affiliated hospitals. Gateway enters into agreements with health plans to be the provider network for those plans.

Gateway is an ACO. It earns financial bonuses from the private health plans it serves when (a) care given by Gateway's providers to plan beneficiaries during a plan year costs less than the financial benchmarks agreed to by Gateway and each plan, and (b) Gateway's providers meet certain quality indicators. As part of Gateway's contracts with its affiliated providers, Gateway promises to pay the affiliated provider half of all shared savings and quality bonuses Gateway receives from health plans for care provided to patients who receive care from the affiliated provider.

Laclede Internists, P.C. is a professional corporation that operates the primary care medical practice of twelve internal medicine physicians. Laclede has a contract with Gateway to be part of its provider network. Dr. Leroy Levinson is an internist who practices at Laclede.

Amy Abelman receives her primary care from Dr. Levinson. In keeping with Gateway policies, Dr. Levinson created a plan of care for Amy at the start of their treatment relationship. As part of the plan, Dr. Levinson would do a standard pelvic examination as part of Amy's annual physical and, because Amy is 29 years old. Dr. Levinson would also do a pap smear to test once every three years. In further compliance with Gateways policies, Dr. Levinson also identified a Gateway-affiliated OB/GYN specialist willing to provide specialty care to Amy in the future if needed. Dr. Levinson identified Dr. Donna Decker. Dr. Decker is an OB/GYN specialist employed at River City OB/GYN, P.C., which also has an affiliation agreement with Gateway.

Dr. Levinson confirmed that Dr. Decker would accept Amy as a patient when and if needed. Additionally, as required by Gateway policy, Dr. Decker agreed to Dr. Levinson's care plan for Amy which included his completing an annual pelvic exam and a pap smear once every three years. Finally, Drs. Levinson and Decker agreed that Dr. Levinson would refer Amy to Dr. Decker only if complications arose requiring an OB/GYN specialist.

A pap smear is a test of sample cells taken from a woman's cervix or vagina. It is used to look for cellular changes that show cancer or conditions that may develop into cancer. If detected early, cervical cancer often can be cured. Pap smears often detect cellular abnormalities even when cancer is not present, and these abnormalities often clear by themselves without treatment.

Gateway adopted a clinical guideline stating that affiliated primary care providers should not refer a female patient aged 21-65 to Gateway OB/GYN for a biopsy unless and until the patient has a total of 4 abnormal pap smear tests over 6 months. This guideline falls within the parameters of guidelines published by the American Society of Obstetricians and Gynecologists.

Following 4 abnormal pap smears over 6 months, Dr. Levinson referred Amy to Dr. Decker for a cervical biopsy. It showed that Amy had a rare and aggressive form of cervical cancer that was very serious. Despite all of Dr. Decker's best efforts over the next year, it was determined that Amy would not likely survive the cancer.

Assuming that Amy's odds of surviving her cancer would have significantly improved had it been diagnosed just two months earlier than it was, can she sustain an action against Gateway for her damages, and, if so, under what theories?