Summary Of The Shea Vs. Esensten Case

In the Shea v. Esensten case, there was a lot of information that was compared to different laws. “Mr. Shea's doctor persuaded Mr. Shea, who was then forty years old, that he was too young and did not have enough symptoms to justify a visit to a cardiologist. A few months later, Mr. Shea died of heart failure” (Shea v. Esensten, 1997). The given information brought into question, why would the doctor not make a referral for Mr. Shea? “Mr. Shea had been an employee of Seagate Technologies, Inc. (Seagate) for many years. Seagate provided health care benefits to its employees by contracting with a health maintenance organization (HMO) known as Medica” (Shea v. Esensten, 1997). Although Mr. Shea needed a referral to a cardiologist, there was a specific reason for his physician not giving him the referral he needed. “Specifically, the primary care doctors were rewarded for not making covered referrals to specialists, and were docked a portion of their fees if they made too many” (Shea v. Esensten, 1997). Mrs. Shea clearly states that if her husband would have known the following circumstances, he would sought a cardiologist on his own and still be alive.

Shea alleged Medica's fraudulent nondisclosure and misrepresentation about its doctor incentive programs limited Mr. Shea's ability to make an informed choice about his life-saving health care” (Shea v. Esensten, 1997). However, Medica removed the case to federal court, claiming that Mrs. Shea’s statement was preempted by the Employee Retirement Income Security Act (ERISA) (Shea v. Esensten, 1997). “Believing ERISA does not require an HMO to disclose its doctor compensation arrangements because they are not "material facts affecting a beneficiary's interests," the district court dismissed Mrs. Shea's amended complaint for failing to state a claim” (Shea v. Esensten, 1997). The case was long a drawn out because of the integrating of common laws brought into the