Academic journal article
By Castagna, Nicole
American Journal of Law & Medicine , Vol. 27, No. 1
Medical Malpractice: The Evidentiary Link Between Medical Care and Managed Care Plans-Shea v. Esensten. I-The Minnesota Court of Appeals held that the appellant failed to establish a sufficient link between the care her husband received and the managed care contract regarding specialist referrals to allow evidence of financial incentives in the plan to be introduced as evidence of medical malpractice.2 The appellant's husband ("Shea") died of a heart attack in 1993. The appellant filed a medical malpractice suit in 1994 against Shea's treating physicians, Drs. Esensten and Arenson, the Family Medical Clinic where the doctors were employed, and Shea's insurer, Medica.
Drs. Esensten and Arenson had treated Shea for more than a decade before his death. The appellant claims that Shea was suffering from chest pains as early as 1991, but there is no evidence that the pain was reported to the doctors at this time. Shea saw his doctors multiple times during 1992, complaining primarily of abdominal problems. Drs. Arenson and Esensten treated Shea's symptoms and referred him to a gastroenterologist. Tests conducted by the gastroenterologist showed nothing out of the ordinary, and the doctors concluded that Shea's symptoms were anxiety-related. Shea visited Dr. Arenson on February 1, 1993, complaining of shortness of breath and dizziness. The electrocardiogram administered at that time by Dr. Arenson was returned analyzed as normal. Shea subsequently suffered a heart attack and died on March 5, 1993.
The case was tried by a jury in October 1999. Prior to the trial, the case was removed to federal court. The Eighth Circuit reversed the district court's finding that state tort law claims against Medica for negligent misrepresentation were preempted by ERISA.3 The Eighth Circuit found no reference to an ERISA plan in this case, and held that the state law of negligent misrepresentation was generally applicable.4 The case was remanded to state courts At trial, the appellant sought to introduce evidence that Shea's doctors had a financial disincentive for specialist referrals, which was the result of a capitation contract between the clinic and Medica. The appellant contended that this arrangement was the reason Shea was not referred to a cardiologist. …