Case Title: Bruce Martindale v. Bruce A. Ripp

Citation: 2001 WI 113

Docket Number: 1999AP000649

State: wisconsin

Court: Wisconsin Supreme Court

Date: 2001-07-12T00:00:00Z

Document:
2001 WI 113 
 
SUPREME COURT OF WISCONSIN 
 
 
Case No.: 
99-0649 
 
 
Complete Title 
of Case: 
 
Bruce Martindale,  
 
Plaintiff-Appellant-Petitioner, 
 
v. 
Bruce A. Ripp, City of Beloit, Pekin Insurance 
Company, and Cities and Villages Mutual 
Insurance Company,  
 
Defendants-Respondents.  
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
Reported at:  231 Wis. 2d 239, 604 N.W.2d 305 
 
 
(Ct. App. 1999-Unpublished) 
 
 
Opinion Filed: 
July 12, 2001 
Submitted on Briefs: 
      
Oral Argument: 
November 1, 2000 
 
 
Source of APPEAL 
 
COURT: 
Circuit 
 
COUNTY: 
Rock 
 
JUDGE: 
Edwin C. Dahlberg 
 
 
JUSTICES: 
 
Concurred: 
ABRAHAMSON, C.J., concurs (opinion filed). 
 
Dissented: 
WILCOX, J., dissents (opinion filed). 
 
 
CROOKS, J., joins dissent. 
 
 
CROOKS, J., dissents (opinion filed). 
 
 
WILCOX, J., joins dissent. 
 
Not Participating:       
 
 
ATTORNEYS: 
For the plaintiff-appellant-petitioner there were 
briefs by Edward E. Grutzner and Grutzner, Holland & Vollmer, 
S.C., Beloit, and oral argument by Edward E. Grutzner. 
 
 
For the defendants-respondents there was a brief 
by Ted Waskowski, Laura Skilton Verhoff and Stafford Rosenbaum, 
 
2 
LLP, Madison, and oral argument by Ted Waskowski. 
 
2001 WI 113 
 
NOTICE 
This opinion is subject to further editing and 
modification.  The final version will appear 
in the bound volume of the official reports. 
 
 
No. 99-0649  
 
STATE OF WISCONSIN                    :  
  IN SUPREME COURT 
 
 
Bruce Martindale,  
 
          Plaintiff-Appellant-Petitioner, 
 
     v. 
 
Bruce A. Ripp, City of Beloit, Pekin  
Insurance Company, and Cities and  
Villages Mutual Insurance Company,  
 
          Defendants-Respondents. 
 
 
REVIEW of a decision of the Court of Appeals.  Reversed and 
cause remanded. 
 
¶1 
DAVID T. PROSSER, J.   Bruce Martindale seeks review 
of an unpublished decision of the court of appeals that affirmed 
certain rulings to exclude evidence by the Circuit Court for 
Rock County, Edwin C. Dahlberg, Judge.1  These evidentiary 
rulings are the focus of this appeal. 
¶2 
In 
this 
personal 
injury 
case, 
the 
first 
issue 
presented is whether an oral surgeon who has testified that, in 
his opinion, an injury to plaintiff's temporomandibular joints 
                     
1 Martindale v. Ripp, No. 99-0649, unpublished slip op. 
(Wis. Ct. App. Oct. 28, 1999). 
FILED 
 
JUL 12, 2001 
 
Cornelia G. Clark 
Clerk of Supreme Court 
Madison, WI 
 
 
 
 
 
No. 99-0649  
 
 
2 
(TMJs) was caused by the whiplash motion of the plaintiff's head 
and neck after plaintiff's car was struck from behind by a 
garbage truck, may be prohibited from explaining and describing 
to the jury the manner in which he thought the whiplash caused 
injury to the TMJs.  The surgeon's excluded testimony was 
intended as part of the plaintiff's evidence establishing a 
causal link between the accident-related whiplash and the TMJ 
condition.  The jury ultimately decided that the accident did 
not cause the TMJ condition. 
¶3 
The 
second 
issue 
presented 
is 
whether 
certain 
testimony about the plaintiff's fears about the possible 
complications of possible future surgery on his TMJs should have 
been excluded.  This evidence was intended to support the 
plaintiff's claim for past, present, and future damages for 
mental distress. 
¶4 
After examining the record, we conclude that the 
circuit court erroneously exercised its discretion in excluding 
the testimony explaining the probable manner in which the 
plaintiff was injured.  After conducting a harmless error 
analysis of this erroneous exercise of discretion, we conclude 
that the substantial rights of the plaintiff have been affected. 
 Accordingly, we reverse and remand the case to the circuit 
court for a new trial. 
 
I 
 
No. 99-0649  
 
 
3 
¶5 
The facts surrounding the automobile accident in this 
case are not in dispute.  On the morning of September 14, 1993, 
Martindale was driving his 1992 Pontiac Bonneville in the City 
of Janesville.  Martindale was in his early 50s.  He stood six 
feet seven inches tall.  He was such a tall man that the 
headrest in his vehicle "[sat] too low in any position." 
¶6 
Martindale was driving in the left lane on Highway 51. 
 He came to a complete stop at an intersection just north of the 
Rock River, behind a car that was waiting to turn left.  He 
later testified that he stopped his car approximately 20 to 25 
feet behind the car ahead of him.  As he waited for the car to 
turn, Martindale looked into his rear view mirror and saw a 
garbage truck "bearing down on [him]."  He said he knew the 
truck was going to hit him.  Hoping to avoid the collision, he 
pulled forward slightly from his dead stop and tried to go 
around the right side of the car in front of him, but his 
maneuver was blocked by the traffic in the right lane. 
¶7 
Martindale testified that the fully loaded garbage 
truck, which was owned by the City of Beloit (the City) and 
driven by Bruce Ripp, was traveling at an estimated speed of 20 
to 25 miles per hour before it slammed into his car.  Martindale 
estimated the speed from the observation he made in his rear 
view mirror and the impact of the collision.  The force of the 
garbage truck drove Martindale's car into the vehicle ahead of 
him.  His Bonneville finally stopped between 100 and 150 feet 
from its original position.  The car suffered more than $9000 in 
damages. 
No. 99-0649  
 
 
4 
¶8 
Martindale testified that his head "whipped" backwards 
when the garbage truck collided with his car.  His teeth 
"clashed" together when his head came forward.  He chipped at 
least one tooth. 
¶9 
Martindale testified he initially had numbness from 
the accident, but after he "shook" the numbness he had 
"immediate pain" in his jaw and neck.  He also had pain in his 
teeth.  After talking with police, Martindale went to the 
emergency room of a local hospital for pain.  He testified that 
he had a severe headache, a very sore neck, and pain in his 
teeth. 
¶10 At trial, Martindale described the movement of his 
head and neck at the time of the collision.  He said he thought 
his height and the type of headrest in the car contributed to 
his injuries.  The "headrest was down" at the time of the crash, 
he said, facilitating the snapping back of his head as well as 
the clashing and chipping of his teeth.  He claimed the whiplash 
movement of his head and jaw caused permanent injury to his 
TMJs——the joints connecting both sides of his jaw to his skull. 
¶11 In the years after the accident, Martindale allegedly 
experienced a variety of health problems, primarily related to 
pain and discomfort in his TMJs.  He sought treatment for his 
injuries from a number of doctors, but his primary caregivers 
were Dr. Harry Clark, his general dentist, and Dr. Doran E. 
Ryan, an oral and maxillofacial surgeon and professor at the 
Medical College of Wisconsin, to whom Martindale was referred by 
Dr. Clark. 
No. 99-0649  
 
 
5 
¶12 The City admitted that Ripp was negligent in operating 
the garbage truck and that Ripp was acting on behalf of the City 
at the time of the accident.  The City was at fault.  However, 
the City disputed Martindale's claim that the accident had 
caused his alleged TMJ problem, and it challenged the extent of 
his injury claims. 
 
II 
 
¶13 Martindale filed suit against the City on April 30, 
1996.  His alleged damages included "severe personal injuries 
consisting primarily of permanent injury to his teeth," past and 
future hospital and medical expenses, loss of earnings and 
future earning capacity, and $9000 in damage to his car.  By the 
time of trial, Martindale's claims for damages centered on the 
alleged injuries he suffered to his TMJs as a result of the 
accident.  In addition, Martindale sought to recover for the 
alleged mental distress he had over potential future surgery on 
his jaw and the complications that might arise from the surgery. 
 Martindale 
claimed 
all 
these 
damages 
resulted 
from 
the 
negligence of Ripp in causing the accident. 
¶14 The gist of Martindale's case was that his TMJ 
injuries occurred as a result of (1) his head snapping back over 
his car's headrest in whiplash fashion when the garbage truck 
struck his car from behind, and (2) his head moving rapidly 
forward after his car struck the car in front of him. 
No. 99-0649  
 
 
6 
¶15 The circuit court set a trial date for the spring of 
1998, but the jury trial was not actually held until the fall.  
In May, the City filed a motion in limine to exclude certain 
testimony from Dr. Ryan's deposition.  The circuit court 
entertained the motion at a hearing in June and ruled in large 
part in the City's favor.  Later, Martindale moved the circuit 
court to reconsider its rulings.  In September, the circuit 
court affirmed its earlier determinations. 
¶16 Counsel for Martindale planned to present videotaped 
deposition testimony of the two doctors at trial.  This 
videotaped testimony was reduced to a written transcript, and 
the parties debated the admissibility of the testimony, in some 
instances on a line-by-line basis.  The parties planned to edit 
the videotape after the circuit court's rulings to eliminate any 
inadmissible testimony for trial. 
¶17 The City argued that Dr. Ryan should not be able to 
testify about the "mechanism" by which Martindale sustained 
injuries.  Although the City conceded that Dr. Ryan was 
qualified to treat and assess Martindale's jaw injuries, it 
claimed he was not qualified to give an opinion about how the 
garbage truck hitting Martindale's car specifically caused 
Martindale's head and jaw to react.  At the September hearing, 
the City characterized Martindale's efforts with Dr. Ryan's 
testimony as an inappropriate attempt to use Dr. Ryan as an 
"auto reconstruction accident expert." 
¶18 The circuit court agreed with the City that certain 
portions of Dr. Ryan's deposition should not be admitted.  The 
No. 99-0649  
 
 
7 
court excluded statements of Dr. Ryan's opinion concerning the 
"mechanism" that caused Martindale's TMJ injuries and his 
opinion regarding possible complications from possible future 
TMJ surgery.  In addition, the court ruled Martindale could not 
present three exhibits to the jury, all of which related to the 
excluded testimony. 
¶19 The circuit court excluded several pages of testimony 
by Dr. Ryan relating to the "mechanism" by which Martindale was 
injured.  Initially, the circuit court did not provide reasoning 
for its decision that approximately four pages of deposition 
testimony would be excluded.  Later in the hearing, when the 
City sought to clarify which exhibits had been excluded, counsel 
for Martindale, Edward Grutzner, expressed surprise that the 
court had ruled earlier in the hearing to exclude the testimony 
concerning the "mechanism" or manner of injury.  When the 
circuit court stated it had excluded that testimony, counsel 
said to the circuit court: "I didn't understand you to do so."  
The following exchange then occurred: 
 
The Court:  [T]here is no foundation for the doctor's 
expertise in this particular thing, and he is not 
giving his opinion in this testimony to a reasonable 
standard of reasonable probability.  What they are 
trying to do is to tie the issue in with some type of 
whiplash injury.  I have thrown that out, and having 
thrown that out, [the diagram exhibit related to this 
testimony] is not admissible.  We have resolved that. 
 
Mr. Grutzner:  You say he doesn't have sufficient 
expertise in this area?  Is that -- because I filed 
his curriculum vitae, which is 20 pages long. 
 
No. 99-0649  
 
 
8 
The Court:  I sustained . . . the objection to the 
testimony on that . . . there is a lack of foundation 
on the witness's qualifications that his opinions are 
not being given to a standard of a reasonable 
probability, and that there is -- what it is is an 
attempt to try to tie the problem the defendant has 
with some whiplash mechanism.  And I don't think this 
witness is competent to do it, and you have exception 
to the Court's ruling.  That takes care of that one. 
 
Mr. Grutzner:  So your reasoning is the competency of 
the witness to testify as to the manner in which the -
- 
 
The Court:  The qualifications that he is not 
qualified to give an opinion in this field to a 
reasonable degree of professional probability.  And 
that's my ruling.  You are stuck with it, Counsel.  
Even an angel could give you no more.  We have got 
that all covered then, now, as I understand it, 
gentlemen. 
¶20 In September, when the court affirmed its ruling on 
Martindale's motion to reconsider, it said: 
 
There is no foundation on the witness's qualifications 
to give his expert opinion as to how the accident 
occurred and the testimony that's in the deposition.  
The witness is not giving his opinion to a standard of 
reasonable probability -- what you are trying to do is 
tie the defendant's injury to some whiplash problem, 
but --  and it may well be that a whiplash-type of 
thing caused it -- but the testimony, in the judgment 
of the Court, doesn't meet the standard necessary in 
order to allow it.  So I will reaffirm my prior 
ruling, and you again have exception.  I can give you 
no more, Counsel. 
¶21 The City did not object to some testimony by Dr. Ryan 
concerning the cause of the injury to Martindale.  In the 
videotaped deposition, Dr. Ryan testified briefly about the 
cause of Martindale's injury when he verbally reviewed the 
medical and dental records he had examined and then stated that 
No. 99-0649  
 
 
9 
his "impression would be that the accident is what caused the 
displacement of the discs in his [temporomandibular] joint."  
This testimony was not excluded. 
¶22 On the other issue, the circuit court excluded most of 
the contested testimony relating to fear of future surgery.  
Over objection from the City, however, the circuit court 
permitted Dr. Ryan to testify about the likelihood of success of 
TMJ surgery for Martindale.  In doing so, the circuit court told 
Martindale's counsel: "You can get in the possibility of 
success, but not impossible complications if surgery is had."  
Thus, Dr. Ryan could not testify about complications that might 
result if Martindale had surgery.  The circuit court also 
excluded two exhibits about the potential complications of TMJ 
surgery. 
¶23 A two-day jury trial in the case began September 16, 
1998, about five years after the accident.  Martindale and his 
wife, Sandra Lee Martindale, testified on Martindale's behalf.  
Martindale also presented the videotaped deposition testimony of 
the two doctors.  The City did not present any witnesses but it 
read into evidence a portion of Dr. Ryan's deposition. 
¶24 The trial did not concentrate on the underlying auto 
accident because the City had admitted its negligence.  Instead, 
the trial testimony centered on Martindale's alleged symptoms 
and injuries from the accident, as well as Martindale's 
subsequent interaction with Drs. Ryan and Clark.  Martindale 
testified about visiting numerous other doctors but they were 
identified only by surname. 
No. 99-0649  
 
 
10
¶25 The City's defense was that Martindale had not 
suffered serious injury from the accident, and to the extent he 
had dental or skeletal injuries, the injuries were caused in 
part by a pre-existing bruxism condition.2 
¶26 On a special verdict form the jury answered "no" to 
the question of whether Ripp's negligence caused Martindale's 
alleged injuries.  The jury did find, however, that $6100 would 
compensate Martindale for his past and future pain, suffering, 
and disability.  Nevertheless, the circuit court granted the 
City's motion for judgment on the verdict and dismissed 
Martindale's case. 
¶27 To sum up, as a result of evidentiary rulings before 
trial, the circuit court excluded portions of the videotaped 
deposition testimony by Dr. Ryan regarding the "mechanism" or 
manner of Martindale's injury and possible complications from 
possible future surgery.  Then, during trial, the circuit court 
excluded testimony by Martindale about his fear of possible 
complications from possible future TMJ surgery.  After trial, 
Martindale appealed all these exclusions of evidence. 
 
III 
 
A. Standard of Review of Evidentiary Decisions  
                     
2 Bruxism is "a clenching of the teeth, associated with 
forceful lateral or protrusive jaw movements, resulting in 
rubbing, gritting, or grinding together of the teeth, usually 
during sleep; sometimes a pathologic condition."  Stedman's 
Medical Dictionary 216 (25th ed. 1990). 
No. 99-0649  
 
 
11
 
¶28 We review a circuit court's decision to admit or 
exclude evidence under an erroneous exercise of discretion 
standard.  Morden v. Continental AG, 2000 WI 51, ¶81, 235 Wis. 
2d 325, 611 N.W.2d 659; State v. Pharr, 115 Wis. 2d 334, 342, 
340 N.W.2d 498 (1983).  In making evidentiary rulings, the 
circuit court has broad discretion.  State v. Oberlander, 149 
Wis. 2d 132, 140, 438 N.W.2d 580 (1989).  This discretion 
includes whether a witness is qualified as an expert to offer 
opinion testimony pursuant to Wis. Stat. § 907.02 (1997-98).3  
State v. Watson, 227 Wis. 2d 167, 186, 595 N.W.2d 403 (1999); 
Farrell v. John Deere Co., 151 Wis. 2d 45, 70, 443 N.W.2d 50 
(Ct. App. 1989), cited in 7 Daniel D. Blinka, Wisconsin 
Practice: Evidence § 702.4, at 487 (2001).  As with other 
discretionary determinations, this court will uphold a decision 
to admit or exclude evidence if the circuit court examined the 
relevant facts, applied a proper legal standard, and, using a 
demonstrated rational process, reached a reasonable conclusion. 
 Glassey v. Cont'l Ins. Co., 176 Wis. 2d 587, 608, 500 N.W.2d 
295 (1993); Loy v. Bunderson, 107 Wis. 2d 400, 414-15, 320 
N.W.2d 175  (1982). 
¶29 Our inquiry into whether a circuit court properly 
exercised its discretion in making an evidentiary ruling is 
highly deferential:   
 
                     
3 All subsequent statutory references are to the 1997-98 
volumes unless noted otherwise. 
No. 99-0649  
 
 
12
The question on appeal is not whether this court, 
ruling initially on the admissibility of the evidence, 
would have permitted it to come in, but whether the 
trial court exercised its discretion in accordance 
with accepted legal standards and in accordance with 
the facts of record.  McCleary v. State, 49 Wis.2d 
263, 182 N.W.2d 512 (1971).  The test is not whether 
this court agrees with the ruling of the trial court, 
but 
whether 
appropriate 
discretion 
was 
in 
fact 
exercised. 
State v. Wollman, 86 Wis. 2d 459, 464, 273 N.W.2d 225 (1979), 
quoted with approval in Pharr, 115 Wis. 2d at 342; see also 
Morden, 235 Wis. 2d 325, ¶81.  We will not find an erroneous 
exercise of discretion if there is a rational basis for a 
circuit court's decision.  State v. Hammer, 2000 WI 92, ¶43, 236 
Wis. 2d 686, 613 N.W.2d 629 (citing Boodry v. Byrne, 22 Wis. 2d 
585, 589, 126 N.W.2d 503 (1964)).  For a discretionary decision 
of this nature to be upheld, however, the basis for the court's 
decision should be set forth.  Pharr, 115 Wis. 2d at 342.  If 
the circuit court fails to provide reasoning for its evidentiary 
decision, this court independently reviews the record to 
determine whether the circuit court properly exercised its 
discretion.  Id. at 343. 
 
B. Harmless Error Analysis of Evidentiary Decisions 
 
¶30 An erroneous exercise of discretion in admitting or 
excluding evidence does not necessarily lead to a new trial.  
The appellate court must conduct a harmless error analysis to 
determine whether the error "affected the substantial rights of 
No. 99-0649  
 
 
13
the party."  If the error did not affect the substantial rights 
of the party, the error is considered harmless. 
¶31 Two 
statutes 
govern 
this 
situation, 
Wis. 
Stat. 
§ 901.03 (Rulings on evidence) and Wis. Stat. § 805.18(2) 
(Mistakes and Omissions; Harmless Error).  Section 901.03 
provides that error may not be predicated on a ruling that 
admits or excludes evidence "unless a substantial right of the 
party is affected."  This statute must be read together with 
§ 805.18(2), which provides that a new trial shall not be 
granted for an error unless the error has affected the 
substantial rights of the party.  This latter provision, which 
dates back to the early years of Wisconsin statehood,4 applies to 
both civil and criminal cases.5  Martindale contends he deserves 
a new trial pursuant to this rule. 
¶32 For an error "to affect the substantial rights" of a 
party, there must be a reasonable possibility that the error 
contributed to the outcome of the action or proceeding at issue. 
 State v. Dyess, 124 Wis. 2d 525, 543, 547, 370 N.W.2d 222 
(1985); see also Town of Geneva v. Tills, 129 Wis. 2d 167, 184-
85, 384 N.W.2d 701 (1986) (noting that the standard set forth in 
                     
4 The prohibition against reversal for procedural error that 
does not affect "substantial rights" has existed since § 84, ch. 
120, Laws of 1856, and is embodied in Wis. Stat. § 805.18(2).  
City of La Crosse v. Jiracek Cos., Inc., 108 Wis. 2d 684, 690, 
329 N.W.2d 441 (Ct. App. 1982). 
5 State v. Armstrong, 223 Wis. 2d 331, 368 n.36, 588 N.W.2d 
606 (1999), mot. for recons. denied, State v. Armstrong, 225 
Wis. 2d 121, 591 N.W.2d 604 (1999) (clarifying harmless error 
analysis).  
No. 99-0649  
 
 
14
Dyess applies in civil cases as well as criminal cases).  A 
reasonable possibility of a different outcome is a possibility 
sufficient to "undermine confidence in the outcome."  Dyess, 124 
Wis. 2d at 544-45 (quotation omitted).  Where the erroneously 
admitted or excluded evidence affects constitutional rights or 
where the outcome of the action or proceeding is weakly 
supported by the record, a reviewing court's confidence in the 
outcome may be more easily undermined than where the erroneously 
admitted or excluded evidence was peripheral or the outcome was 
strongly supported by evidence untainted by error.  Id. at 545. 
 
IV 
 
¶33 In a negligence case, the plaintiff must prove four 
elements: "(1) [a] duty of care on the part of the defendant; 
(2) a breach of that duty; (3) a causal connection between the 
conduct and the injury; and (4) an actual loss or damage as a 
result of the injury."  Rockweit v. Senecal, 197 Wis. 2d 409, 
418, 541 N.W.2d 742 (1995). 
¶34 The pivotal issue in this case relates to causation.  
In the pretrial motion hearing, Martindale's attorney told the 
court that Martindale had suffered a "rather unusual injury.  I 
never have seen one before, and I have not heard of a 
temporomandibular joint injury arising out of a whiplash 
occurrence." 
¶35 The jury decided the case on causation.  At the 
conclusion of the trial, the jury was asked: "Was the negligence 
No. 99-0649  
 
 
15
of Bruce E. Ripp on September 14, 1993, a cause of injury to 
Bruce Martindale?"  Its answer was "No."  Thus, Martindale's 
suit was dismissed and Martindale recovered nothing for his 
alleged personal injuries. 
¶36 This is the context in which Martindale contends that 
the circuit court erred in excluding certain expert opinion 
testimony and an exhibit explaining the mechanism of whiplash-
related TMJ injury. 
¶37 The 
expert 
witness 
was 
Dr. 
Ryan, 
an 
associate 
professor of oral and maxillofacial surgery and past chairman of 
the Department of Oral and Maxillofacial Surgery at the Medical 
College of Wisconsin.  Dr. Ryan had served at the Medical 
College since 1981.  He was board certified by the American 
Board of Oral and Maxillofacial Surgery in 1976 and had received 
advanced surgical training.  He testified that at least half of 
his 34 publications dealt with TMJs.  Dr. Ryan had an active 
practice in this specialized field.  He examined Martindale 
twice (March 1997 and November 1997); he corresponded with 
Martindale's personal dentist, Dr. Clark; and he studied 
Martindale's medical and dental records,6 including the records 
of Dr. Clark made shortly after Martindale's accident.  Dr. Ryan 
diagnosed 
Martindale's 
TMJ 
condition 
and 
discussed 
the 
                     
6  Dr. Ryan testified in cross-examination that he had to 
see Martindale's medical records before he testified.  Dr. Ryan 
said that Martindale had asked him whether he thought the 
accident caused the TMJ injury and Dr. Ryan said: "I can't tell 
without knowing whether he had a problem before." 
No. 99-0649  
 
 
16
possibility of performing surgery.  He observed a worsening of 
Martindale's condition between the two examinations. 
¶38 During their first meeting, Dr. Ryan took Martindale's 
medical history and discussed the accident.  He was told that 
Martindale had been driving a Pontiac Bonneville, that he had 
been hit by a fully loaded garbage truck from behind, that he 
was six foot seven inches tall, and that the headrest in his car 
was not high enough to brace the back of Martindale's head.  He 
was told by Martindale that Martindale experienced whiplash in 
the accident and that the clicking in his jaw and the pain in 
his teeth and neck resulted from the accident. 
¶39 In the deposition, Martindale's attorney asked:   
 
Mr. Grutzner:  Did you form an -- do you have an 
opinion to a reasonable degree of probability in the 
field of oral and maxillofacial surgery as to the 
cause of this condition of his temporomandibular 
joint? 
 
Dr. Ryan:  In this particular case, going by the 
history that I had from Mr. Martindale, he had been 
involved in a automobile accident in which he was hit 
from behind by, I think, a garbage truck and at that 
point he had a whiplash injury and not long after that 
he noted -- noticed a clicking in his jaw.  And I've 
reviewed some of the records or at least the ones that 
were sent to me from his dentist, who has been his 
dentist for a long time, and he said he didn’t have 
that problem before.  And I've looked at some of the 
medical records and there doesn't seem to be any 
indication 
that 
he 
had 
problems 
with 
his 
temporomandibular joint discs before the accident.  So 
for that reason, I would -- my -- my impression would 
be that the accident is what caused the displacement 
of the discs in his joint. 
No. 99-0649  
 
 
17
¶40 This answer from Dr. Ryan was admitted into evidence 
and is part of the record.7  Dr. Ryan also testified that from 
what he understood, Martindale had never complained of pain in 
the temporomandibular joint, or had his teeth hurt when eating, 
or had any difficulty moving his jaw during the many years he 
was a patient of Dr. Clark——until immediately after the 
accident. 
¶41 This was the background leading up to the excluded 
testimony.  In the middle of Dr. Ryan's deposition, Martindale's 
attorney produced a large diagram of a head in three different 
positions, purporting to depict the movement of the head and jaw 
during a whiplash injury.  The following exchange and the 
exhibit were excluded by the court: 
 
Mr. Grutzner:  Doctor [Ryan], I'm showing you what's 
been marked as Exhibit Number 11 and ask you if you 
have reviewed a −− this drawing before it was made so 
big? 
 
Dr. Ryan:  Yes, I have. 
 
Mr. Grutzner:  And did you review it to −− for accuracy 
to see whether or not it accurately reflected the 
mechanism of whiplash-related internal disc injury 
regarding Bruce Martindale? 
 
Dr. Ryan:  Yes. 
 
Mr. Grutzner:  And my first question is, in your 
opinion, is this an accurate representation of the 
mechanism of whiplash-related internal disc injury? 
 
Dr. Ryan:  Yes, it is. 
                     
7  The court of appeals was mistaken when it wrote that this 
testimony was excluded. 
No. 99-0649  
 
 
18
 
Mr. Waskowski:  I object to the extent that the 
witness is talking about this particular case.  I 
don't think there's any foundation that the witness 
has any idea how this [accident] occurred. 
 
Mr. Grutzner:  Well, you've already testified, have 
you 
not, 
Doctor, 
that 
you 
understood 
that 
Mr. 
Martindale was in his automobile when he was struck 
behind by a garbage truck owned by the City of Beloit? 
 
Dr. Ryan:  Yes. 
 
Mr. Grutzner:  And that he sustained a whiplash injury 
as a result of that collision? 
 
Dr. Ryan:  Yes. 
 
Mr. Grutzner:  And that he's a man of about six feet 
seven inches tall, is that correct? 
 
Mr. Waskowski:  I -- I'm going to object to leading 
the witness and telling the witness what perhaps he 
should know, but he −− he -- this -- we -- we both 
realize that this witness knows nothing about the 
vehicle that Mr. Martindale was driving and on that 
basis alone there is no possibility that this witness 
or any other similarly situated witness could possibly 
testify that the chart that you are showing him is an 
accurate representation of what occurred in this 
accident. 
 
Mr. Grutzner:  You may answer, Doctor. 
 
Dr. Ryan:  Well, I do know which kind of automobile he 
was in.  He was in a Bonneville.  And I also know that 
he testified that his -- his headrest was too low for 
his head and that this would depict what could happen 
in a whiplash injury and I have no other reason to 
believe that he had an injury to his jaw other than 
the whiplash injury in this accident.  And since I've 
already testified that I think the accident caused 
this problem, this is the mechanism of -- I believe -- 
causes internal joint derangement. 
 
Mr. Grutzner:  All right. 
 
No. 99-0649  
 
 
19
Mr. Waskowski:  Excuse me.  I object based on the 
witness' answer and move to strike. 
 
Mr. Grutzner:  Doctor, the middle picture shows what's 
depicted there as normal.  And what does that show, 
Doctor? 
 
Dr. Ryan:  That shows the disc -- the disc sitting in 
between the jaw bones like it's supposed to be. 
 
Mr. Grutzner:  All right.  And -- 
 
Dr. Ryan:  With it −− and at that point the patient's 
teeth are together. 
 
Mr. 
Grutzner: 
 
The 
-- 
on 
the 
right 
it 
says 
hyperextension, what does that mean? 
 
Dr. Ryan:  That means the jaw is -- is swung forward 
and it moves out of where it normally is and it's 
slung forward and it's done very rapidly so that you 
get a separation of the disc from the lower jaw bone. 
 
Mr. Grutzner:  First -- and do -- do you have an 
opinion as to whether or not that is what occurred in 
the injury that Bruce Martindale sustained? 
 
Dr. Ryan:  I think it did, yes. 
 
. . . .  
 
Mr. Grutzner:  Over on the left side it says 
hyperflexion.  What does that mean, Doctor? 
 
Dr. Ryan:  That means he's gone -- his head has gone 
forward this way. 
 
. . . .  
 
Dr. Ryan:  And what happens then, the -- the lower jaw 
is thrown back at this point and it gets caught back 
in behind the disc.  As we can see here, the disc is 
trapped in front.  We now have stretching of this 
ligament or tearing of this ligament and that -- 
that's the mechanism you end up with a disc being 
displaced. 
 
No. 99-0649  
 
 
20
Mr. Grutzner:  And do you have an opinion as to 
whether or not that occurred to Bruce Martindale at 
the time of the -- when the garbage truck struck him 
from the rear? 
 
Dr. Ryan:  I think it is, yes. 
 
¶42 Martindale 
complains 
that 
the 
circuit 
court's 
exclusion of this evidence disrupted his ability to prove 
causation of injury——the one decisive issue in his suit.  In 
particular, Martindale contends the circuit court "committed an 
error of law" when it excluded this testimony by Dr. Ryan after 
having earlier admitted testimony by the doctor regarding 
causation. 
¶43 The circuit court agreed with the City that Dr. Ryan 
was not qualified as an expert to give an opinion about 
Martindale's head and jaw movement as a result of the garbage 
truck striking his car from behind.  The court of appeals 
summarized the circuit court's position as "believing that there 
was no evidence that Ryan had any knowledge as to what happened 
to Martindale in the collision——no knowledge of the 'mechanics' 
of the accident or his actual injury, or that the impact in fact 
caused a 'whiplash.'"  Martindale v. Ripp, No. 99-0649, 
unpublished slip op. at 5 (Wis. Ct. App. Oct. 28, 1999).  The 
court 
of 
appeals 
noted 
that 
Dr. 
Ryan 
never 
inspected 
Martindale's car (or a similar model) "and knew nothing about 
Martindale's movements or what happened to him or the car at and 
after the moment of impact."  Id. 
¶44 Wisconsin Stat. § 907.02 authorizes experts to give 
opinion testimony.  Section 907.02 provides: 
 
No. 99-0649  
 
 
21
If 
scientific, 
technical, 
or 
other 
specialized 
knowledge will assist the trier of fact to understand 
the evidence or to determine a fact in issue, a 
witness qualified as an expert by knowledge, skill, 
experience, 
training, 
or 
education, 
may 
testify 
thereto in the form of an opinion or otherwise. 
The general rule in Wisconsin is that expert testimony is 
properly admitted into evidence if, after the circuit court 
finds a witness is qualified to answer a particular question, 
the testimony might "assist the trier of fact."  Wis. Stat. 
§ 907.02; see also 7 Blinka, supra, §§ 702.1-702.202, at 472-78 
(2001). 
¶45 The qualification of an expert witness to testify on 
an issue is a preliminary question of fact for the circuit court 
to decide under Wis. Stat. § 901.04(1).  7 Blinka, supra, 
§ 702.4, 
at 
487. 
 
The 
determination 
of 
a 
witness's 
qualifications to offer an expert opinion is normally a decision 
left to the discretion of the circuit court.  Watson, 227 
Wis. 2d at 186; Simpsen v. Madison Gen. Hosp. Ass'n, 48 Wis. 2d 
498, 509, 180 N.W.2d 586 (1970); Farrell, 151 Wis. 2d at 70, 
cited in 7 Blinka, supra, § 702.4, at 487.  The circuit court's 
discretion in this determination is unquestionably entitled to 
substantial deference, and we will uphold a decision to admit or 
exclude evidence if the circuit court examined the relevant 
facts, 
applied 
a 
proper 
legal 
standard, 
and, 
using 
a 
demonstrated rational process, reached a reasonable conclusion. 
 Nonetheless, 
our 
decisions 
speak 
of 
"sound 
discretion," 
Simpsen, 48 Wis. 2d at 509, "a reasonable conclusion," Farrell, 
151 Wis. 2d at 70; and "the essential demands of fairness."  
No. 99-0649  
 
 
22
State v. Koch, 144 Wis. 2d 838, 847, 426 N.W.2d 586 (1988), 
signifying that even evidentiary rulings may be held to account. 
¶46 Here the circuit court erred for several reasons.  
First, the circuit court excluded expert testimony that would 
have assisted the trier of fact in understanding the evidence 
and determining the issue of causation.  After recognizing Dr. 
Ryan's credentials, permitting him to testify as an expert, and 
allowing him to give his opinion as to the cause of Martindale's 
medical condition, the court denied the expert the ability to 
explain 
the 
"mechanism" 
that 
prompted 
him 
to 
reach 
his 
conclusion.  As a result, the trier of fact never received an 
explanation of how whiplash could lead to the stretching and 
tearing of ligament and the displacement of the discs that are 
part of the TMJs.  In excluding this explanation, the circuit 
court deprived the jury of expert testimony that could have 
assisted it in sifting through the evidence and reaching its own 
conclusion.  7 Blinka, supra, § 702.2, at 473.  It also 
seriously undermined the credibility of the expert's opinion. 
¶47 Second, at least three times the court stated that Dr. 
Ryan was attempting to tie the TMJ problem in "with some kind of 
whiplash injury," but that "there is no foundation for the 
doctor's expertise in that particular thing."  Dr. Ryan was not 
"competent" to describe "some whiplash mechanism" that would tie 
whiplash to "the problem the defendant has," the court declared. 
¶48 Dr. Ryan was certainly an expert in matters concerning 
temporomandibular joints.  Consequently, he should have been 
allowed to explain how he thought Martindale's TMJ condition was 
No. 99-0649  
 
 
23
created if he had a reasonable foundation for Martindale's 
whiplash. 
¶49 Dr. Ryan's opinion was not the source of the fact that 
Martindale suffered whiplash.  Martindale was the source of that 
fact.  He told Dr. Ryan and others that he had experienced 
whiplash in the accident, and whiplash was also reflected in 
Martindale's medical records.  Martindale said his whiplash 
occurred when his head "whipped" backward, over the lowered 
headrest, when his car was hit from behind; then his head 
snapped forward and his teeth clashed together, when his car was 
propelled into the vehicle in front of him.  The City did not 
present any evidence that Martindale's whiplash was caused by 
anything other than a backward and forward movement.  Dr. Ryan 
relied on this information in forming his opinion about the 
cause of the TMJ condition. 
¶50 The facts upon which an expert bases an opinion or 
inference may be those perceived by or made known to the expert 
before the hearing.  Wis. Stat. § 907.03.  Both Dr. Ryan's 
admitted testimony and his excluded testimony were consistent 
with this rule.  Because Dr. Ryan was basing his opinion on 
information 
he 
had 
received 
from 
Martindale, 
plus 
other 
information, he had a good foundation for offering the opinion, 
and the circuit court erred in denying it to the jury. 
¶51 Third, the circuit court appears to have accepted the 
City's argument that Dr. Ryan was attempting to testify as an 
automobile accident reconstruction expert, giving opinions on 
matters beyond his competence.  The court said bluntly: "There 
No. 99-0649  
 
 
24
is no foundation on the witness's qualifications to give his 
expert opinion as to how the accident occurred." 
¶52 A witness must be qualified to answer the question put 
to him.  As Professor Blinka explains it, "a witness eminently 
capable on one subject may not be sufficiently qualified to give 
helpful testimony on another, albeit related, issue in the 
case."  7 Blinka, supra, § 702.4, at 489 (citing Lemberger v. 
Koehring Co., 63 Wis. 2d 210, 216 N.W.2d 542 (1974)).  "No 
expert has carte blanche."  Id. at 490. 
¶53 The Lemberger case, 63 Wis. 2d 210, is instructive of 
the principle at issue.  Lemberger was a construction worker who 
suffered a depressed skull fracture when a 16-pound block of 
wood, supposedly secured to a crane, fell 70 to 80 feet from the 
crane and hit him on the head.  Lemberger was not wearing a 
"hard hat" when the injury occurred.  Lemberger sued the 
manufacturer of the crane.  At trial, the manufacturer was found 
40 percent negligent and Lemberger was found 60 percent 
negligent.  During the course of the trial, the manufacturer 
presented testimony from a neurologist, Dr. Millen, who gave his 
opinion that if Lemberger had been wearing a hard hat, serious 
injury would have been prevented.  Id. at 218.  Lemberger 
appealed the admission of this testimony. 
¶54 This court ruled the neurologist's testimony exceeded 
his expertise: 
 
[W]e see no basis for the admission of Dr. Millen's 
deposed testimony.  Dr. Millen is a neurologist, who 
specializes in psychology and the physical disorders 
of the nervous system.  He may well be an expert on 
No. 99-0649  
 
 
25
personal injuries, and it was agreed that he had some 
knowledge of the basic laws of physics involving the 
forces asserted by falling objects.  He was permitted, 
however, to express the opinion that, had Lemberger 
been wearing a hard hat, serious injury would have 
been prevented.  That opinion was not within the field 
of Dr. Millen's expertise.  The only knowledge he had 
in that field was the very meager information that he 
had gleaned from the fact that his father-in-law ran a 
construction company, that his son had worked for that 
construction company, and that hard hats were used in 
the work.  He had no expertise or special knowledge on 
the capacity of a hard hat to withstand impact and to 
prevent a skull injury.  To the extent that Dr. Millen 
was 
permitted 
to 
testify 
as 
an 
expert 
on 
the 
protective capacity of the hard hat, his opinion was 
beyond 
his 
qualifications 
and 
should 
have 
been 
excluded by the trial judge.  He did not have "'such 
skill, knowledge or experience in that field or 
calling as to make it appear that his opinion or 
inference will probably aid the trier in his search 
for truth.'" 
Id. at 217-18 (citation omitted).  Nevertheless, the court ruled 
such an admission of testimony did not, standing alone, require 
a reversal of the verdict for the defendant, based on the 
cumulative nature of the evidence.8  Id. at 218. 
¶55 The result in Lemberger is inapposite here because Dr. 
Ryan did not testify beyond his expertise.  He did not present 
himself as an accident expert.  The jury knew that he did not 
examine Martindale until more than three years after the 
accident, and he did not try to describe exactly what happened 
inside Martindale's car.  Instead, he was given certain facts 
about the accident: a Pontiac Bonneville was hit from behind by 
                     
8 This court did reverse and remand in Lemberger v. Koehring 
Co., 63 Wis. 2d 210, 227, 216 N.W.2d 542 (1974), but did so on 
other grounds. 
No. 99-0649  
 
 
26
a fully loaded garbage truck, forcing the vehicle into the car 
ahead.  The driver of the car was six feet seven inches tall.  
The headrest in his car was "too low for his head."  The driver 
suffered a whiplash injury in the accident.  Having and 
accepting this information, as well as the results of his own 
examinations, 
and 
having 
no 
plausible 
alternative 
for 
Martindale's TMJ condition, Dr. Ryan attempted to explain "what 
could happen in a whiplash injury."  His testimony and the 
accompanying exhibit were intended to explain to the jury how 
Dr. 
Ryan 
believed 
Martindale's 
whiplash-related 
injuries 
occurred. 
¶56 Dr. Ryan testified that the whiplash injury caused the 
TMJ problem, not that the accident had caused the whiplash 
injury.  The fact that Martindale had suffered a whiplash injury 
was not contested.  Thus, Dr. Ryan, unlike Dr. Millen, did not 
stray outside his field of expertise.  If Dr. Ryan had tried to 
testify about the speed of the garbage truck, the distances 
required to brake a garbage truck at a particular speed, the 
physics of Martindale pulling his car forward when he noticed 
the garbage truck bearing down on him, the significance of the 
garbage truck being fully loaded, the importance of a particular 
No. 99-0649  
 
 
27
angle of collision, or how fast Martindale's head snapped 
backward and then forward, the issue would be different.9 
¶57 In the past, courts have permitted medical experts to 
testify when the testimony helped the trier of fact to analyze 
the causal link between an injury and negligent conduct.  For 
instance, in Liles v. Employers Mutual Insurance of Wausau, 126 
Wis. 2d 492, 497-99, 377 N.W.2d 214 (Ct. App. 1985), a woman was 
injured in an automobile accident.  Her orthopedic surgeon later 
discovered a degenerative disc disease that required surgical 
treatment.  At trial, Dr. Hagens testified that the cause of the 
disc 
disease 
was 
the 
automobile 
accident. 
 
"Dr. 
Hagens 
testified . . . that there was a causal relationship between the 
accident and the dis[c] disease."  Id. at 499.  The court upheld 
this testimony. 
¶58 Pucci v. Rausch, 51 Wis. 2d 513, 187 N.W.2d 138 
(1971), was another automobile accident case.  Dr. Peterson 
testified that "in his opinion Mrs. Pucci had a previously 
existing back condition which was aggravated by the automobile 
accident."  Id. at 518.  His testimony, which would have been 
                     
9 The dissent's citation to Simpsen v. Madison General 
Hospital, 48 Wis. 2d 498, 510-11, 180 N.W.2d 586 (1970), is 
inapposite.  Justice Wilcox’s dissent at ¶111.  Simpsen involved 
the question whether a podiatrist——as opposed to a surgeon who 
was involved in the case——was qualified to testify concerning 
the cause of post-operative complications.  This court affirmed 
the circuit court's exclusion of the podiatrist's testimony.  
Simpsen, however, involved what type of medical witness was 
qualified to speak concerning causation, not whether a medical 
witness of some type could testify about a matter, as is the 
case here. 
No. 99-0649  
 
 
28
sufficient to sustain causation, was stricken by the circuit 
court.  We reversed, concluding that "the trial court acted 
hastily in striking the doctor's testimony and it was error to 
do so."  Id. at 520. 
¶59 The Pucci court made the important observation that 
medical testimony is not always based upon absolute certitude.  
It is sometimes based upon "empirical knowledge and experience 
in the area of cause and effect.  The term 'medical probability' 
more accurately expresses the standard.  The standard requires a 
conviction of the mind or that degree of positiveness that the 
doctor has in his opinion, which is based upon his knowledge of 
medicine and the case facts."  Id. at 518-19. 
¶60 Dr. Ryan's testimony would have assisted the jury on 
the element of causation.  In attempting to describe and explain 
the manner in which he thought the injuries probably occurred, 
Dr. Ryan did not go beyond his competence as an expert. 
¶61 Fourth, in effect the circuit court ruled that Dr. 
Ryan's expertise in oral and maxillofacial surgery did not 
qualify him to give his opinion about what is known as the 
"occupant kinematics" of the accident. 
¶62 Kinematics is "[t]he branch of mechanics that studies 
the motion of a body or a system of bodies without consideration 
given to its mass or the forces acting on it."  The American 
No. 99-0649  
 
 
29
Heritage Dictionary of the English Language 992 (3d ed. 1992).10 
In simpler terms, the term "occupant kinematics" relates to the 
movement of an occupant's body in a situation.  In this case, 
the occupant kinematics of this accident concern Martindale's 
body movementparticularly his head, neck, and jaw motionas a 
result of this accident. 
¶63 The dilemma herethat is, the permissible extent of 
physician testimony about the physical effects of an automobile 
accident on the bodyhas arisen in cases elsewhere.  See Gorman 
v. Hunt, 19 S.W.3d 662, 670 (Ky. 2000) (ruling that trial court 
properly exercised its discretion in admitting testimony by 
physician concerning physical position of pedestrian plaintiff 
struck by a vehicle); see also Lind v. Slowinski, 450 N.W.2d 
353, 358-59 (Minn. Ct. App. 1990) (affirming decision by trial 
court to exclude testimony by physician regarding positioning of 
automobile 
occupant 
on 
another 
occupant's 
lap 
during 
a 
collision).  Occupant kinematics is commonly a major issue in 
"second collision" or "crashworthiness" cases.11  Sumnicht v. 
                     
10 This court has previously defined this term as "'a branch 
of dynamics that deals with aspects of motion (as acceleration 
and velocity) apart from considerations of mass and force.'"  
Sumnicht v. Toyota Motor Sales, 121 Wis. 2d 338, 364, 360 N.W.2d 
2 (1984) (quoting Webster's Third New International Dictionary 
1243 (1967)). 
11 "The crashworthiness doctrine imposes liability upon a 
manufacturer in a vehicular collision case for design defects 
which do not cause the initial accident but which cause 
additional or more severe injuries when the driver or passenger 
subsequently impacts with the defective interior or exterior of 
the vehicle."  Sumnicht, 121 Wis. 2d at 348-49.  Most courts use 
the terms "crashworthy" and "second collision" interchangeably. 
 Id. at 348 n.4. 
No. 99-0649  
 
 
30
Toyota Motor Sales, 121 Wis. 2d 338, 364, 360 N.W.2d 2 (1984); 
William Petrus, Injury Causation Experts Prevent Cases From 
Crashing, Trial, Aug. 2000, at 54. 
¶64 The court of appeals appeared to extend the circuit 
court's determination, implying that a plaintiff must employ an 
expert in occupant kinematics in what is arguably a simple 
accident case that has not given rise to a "crashworthiness" 
claim.  We disagree.   
¶65 An accident reconstruction expert or an expert in 
kinematics is not required for an elementary discussion of 
whiplash, which is the abrupt jerking motion of the head, either 
backward or forward.  Expert testimony on kinematics is not 
necessary to confirm the potential for whiplash when a fully 
loaded garbage truck smashes into a barely moving or stopped 
automobile, pushing it into another vehicle, sending it 100 to 
150 feet from the point of origin, and causing $9000 in damages 
to the vehicle.  Requiring specialized expert testimony beyond a 
medical 
expert 
in 
relatively 
simple 
automobile 
accident 
situations would escalate the cost of presenting personal injury 
cases without adequate justification.  In short, it would 
present a serious issue in the administration of the legal 
system. 
¶66 Testimony concerning the cause of an injury by a 
medical expert with experience in treating a particular injury 
can be vital for parties who suffer bodily injury.  We recognize 
that certain accidents or certain causes of action, e.g., 
crashworthiness claims, may present facts that require expert 
No. 99-0649  
 
 
31
testimony by a witness such as an engineer or an accident 
reconstruction expert.  However, this simple case is not one of 
those, based on our analysis of the proffered testimony. 
¶67 Finally, the circuit court stated that Dr. Ryan was 
"not giving his opinion in this testimony to a reasonable 
standard of reasonable probability."  Although neither party 
discussed this issue on appeal, we note that early in his 
testimony, Dr. Ryan was asked to give his opinion "to a 
reasonable degree of probability in the field of oral and 
maxillofacial surgery as to the cause of this condition of 
[Martindale's] temporomandibular joint."  Much of the subsequent 
testimony excluded by the court was merely an explanation of the 
mechanism of whiplash and how Dr. Ryan thought that applied to 
Martindale.  A fair reading of his testimony shows that Dr. Ryan 
was not giving his opinion on mere conjecture. 
¶68 The standard in this state for the admission of expert 
testimony is not stringent.  This court "has repeatedly 
emphasized that 'assistance,' 'aid,' and 'helpfulness' to the 
trier of facts are the touchstones of admissibility."  7 Blinka, 
supra § 702.202, at 478.  In light of Dr. Ryan's extensive 
qualifications in treating TMJ injuries, we conclude that his 
testimony would have assisted the jury in analyzing whether the 
whiplash from the collision caused the alleged injuries. 
¶69 Notwithstanding our conclusion that the circuit court 
erroneously exercised its discretion, we will not disturb the 
judgment entered on the jury's verdict unless "substantial 
rights" 
of 
Martindale 
have 
been 
affected. 
 
Wis. 
Stat. 
No. 99-0649  
 
 
32
§ 805.18(2).  We must therefore determine whether the error was 
harmless. 
¶70 In a special verdict the jury found the impact from 
the City's garbage truck did not cause Martindale's injuries.  
The jury did find, however, that $6100 would compensate 
Martindale "for past and future pain, suffering, and disability 
sustained as a result of the accident."  The circuit court 
entered judgment on the jury's verdict and Martindale did not 
recover any damages. 
¶71 The standard for harmless error is whether there is a 
"reasonable possibility" that the error contributed to the 
outcome of the action or proceeding at issue.  Dyess, 124 Wis. 
2d at 543.  A "reasonable possibility" of a different outcome is 
a possibility sufficient to undermine confidence in the outcome. 
 Dyess, 124 Wis. 2d at 545. 
¶72 We conclude that the erroneous exclusion of Dr. Ryan's 
testimony created a reasonable possibility that if the evidence 
had been admitted the verdict would have been different.  Our 
decision is based upon several factors.  In his cross-
examination of Dr. Ryan, the City's attorney, Ted Waskowski, was 
very 
effective 
in 
suggesting 
an 
alternative 
cause 
for 
Martindale's TMJ condition, namely, that Martindale had been "a 
tooth grinder and a teeth clencher" before the accident.  In 
short, there was evidence of bruxism that predated the accident. 
 In his cross-examination, which was played to the jury, 
Waskowski skillfully used Dr. Ryan to imply that Martindale had 
No. 99-0649  
 
 
33
embellished his injury and misrepresented its source.  The City 
built on this theory in closing argument: 
 
Let me just say a couple things more about whether 
this [the jaw injury] was caused by the accident.  I 
really don’t know.  It seems to me that if I had to 
guess, Mr. Martindale has a minor problem that 
probably has been nagging him a bit off and on for 
years.  And this accident really has nothing to do 
with it.  But based on this evidence, I am guessing 
and we would all have to guess.  The judge will 
instruct you if you have to guess what the answer will 
be, if you have to guess, then Mr. Martindale has not 
met his burden of proof.  And under that circumstance 
he would be -- you would find that he has no damages 
because he hasn't proved any if you have to guess 
(emphasis added).  
¶73 Then Waskowski delivered the coup de grace, by 
stressing the absence of causation evidence from Martindale's 
expert witnesses: 
 
Was this caused by the accident?  One very interesting 
thing to me is we have a highly qualified doctor and 
we have a good, honest dentist, Dr. Clark.  And 
neither of them made any attempt at all to describe 
how it is that this jaw problem resulted from the 
accident.  How?  I mean not, yes, he started 
complaining right after the accident and see it must 
be somehow but [nobody] tried to even explain to you 
how.  Nobody tried to prove that.  How?  He had a 
slight chip on one tooth.  But it's the bottom part of 
your jaw that moves.  Not the top.  The top is part of 
your head.  Nobody even bothered to explain here what 
happened. . . . Here is what happened.  What happened? 
 How did getting hit from behind cause this accident? 
 We could get -- we could say, well, maybe it was 
this, maybe it was that.  But there is no evidence.  
You gotta guess.  And I think since you have to guess, 
the answer to the first question that's gonna be put 
to you is . . . what injury was caused by Mr. Ripp to 
Mr. Martindale.  The answer is, you don't know.  And 
if you don't know, if you have to guess, the answer is 
no.  And I think truthfully, if you truthfully 
No. 99-0649  
 
 
34
consider the evidence, that is the answer that you 
would have to give (emphasis added). 
This argument coupled with the prior exclusion of Dr. Ryan's 
deposition testimony explaining causation, has undermined our 
confidence in the outcome of the trial.  The testimony by Dr. 
Ryan, as well as the accompanying exhibit, would have assisted 
the trier of fact to such a degree in understanding the cause of 
Martindale's alleged injuriesthe issue in the trialthat we 
conclude the error clouds the validity of the jury's verdict 
sufficiently to meet the "reasonable possibility" standard 
described above.  Accordingly, we reverse the judgment and 
remand for a new trial. 
 
V 
 
¶74 We turn now to Martindale's other claim, that the 
circuit court erroneously exercised its discretion in excluding 
testimony relating to Martindale's fear of possible future 
surgery.  The circuit court excluded testimony by Martindale and 
Dr. Ryan regarding the specific possible complications that may 
arise from TMJ surgery.  The circuit court did allow some 
testimony by Martindale expressing fear of surgery and testimony 
by Dr. 
Ryan 
rating the 
chances 
of 
surgical 
success on 
Martindale's jaw. 
 
A. Dr. Ryan's Testimony 
 
No. 99-0649  
 
 
35
¶75 Mental distress damages caused by an accident in which 
the plaintiff suffers physical injury are compensable.  Rennick 
v. Fruehauf Corp., 82 Wis. 2d 793, 804-05, 264 N.W.2d 264 
(1978).  Damages for a specific species of mental distress, fear 
of possible future surgery, are compensable.  Brantner v. 
Jenson, 121 Wis. 2d 658, 360 N.W.2d 529 (1985).  Brantner is the 
leading case on this subject.  In Brantner, the defendant 
contended that the circuit court should not have allowed the 
plaintiff and his surgeon to testify regarding possible future 
back surgery because the plaintiff did not prove to a reasonable 
degree of medical probability that his injury would require 
surgery.  Id. at 665. 
¶76 In Brantner, the plaintiff suffered a back injury as a 
result of an automobile accident.  Id. at 661.  The plaintiff's 
physician prescribed back exercises and a back brace to minimize 
pain.  Id.  The physician also advised the plaintiff his injury 
might require surgery if these techniques did not relieve the 
pain and keep him working.  Id. at 661-62.  At subsequent visits 
with the physician the plaintiff continued to report pain; the 
physician advised the plaintiff that if pain continued and 
interrupted his ability to work or live comfortably, surgery 
might be required.  Id. at 662. 
¶77 At trial, the jury awarded the plaintiff damages for 
past, present, and future mental distress relating to possible 
future back surgery.  Id. at 660.  The plaintiff's surgeon 
testified he had discussed "the operation, recovery time, risks, 
chances of success and possible subsequent disability" with the 
No. 99-0649  
 
 
36
plaintiff on numerous occasions.  Id. at 662.  The plaintiff 
testified as to these conversations, as well as a conversation 
he had with his father concerning back surgery.  Id. at 660.  
The defendant argued, however, that neither the physician nor 
the plaintiff properly testified because the plaintiff did not 
"prove to a reasonable degree of medical probability that he 
will require the back surgery in the future."  Id. at 665. 
¶78 This court affirmed the decision of the court of 
appeals favoring the plaintiff, Brantner.  The court stated: 
 
We 
conclude 
that 
fear 
of 
surgery 
may 
be 
reasonably certain, even though there is no certainty 
that surgery will occur and even though the physician 
cannot testify to a reasonable degree of medical 
probability 
that 
the 
consequence 
feared 
will 
occur. . . . A doctor's realistic prediction as to the 
possibility of future surgery, illness or disability 
may give rise to reasonable fear and anxiety in the 
victim concerning his or her future health and well-
being. 
 
 . . . . 
 
 . . . Although the surgeon was not able to 
testify that back surgery was reasonably probable in 
the 
future, 
the 
disclosure 
of 
the 
realistic 
possibility of back surgery as a natural consequence 
of the injuries under the facts of this case is 
sufficient to enable a jury to find to a reasonable 
certainty that the plaintiff has sustained, and will 
sustain, 
mental 
distress 
as 
a 
result 
of 
the 
defendant's negligent conduct. 
Id. at 666-67 (footnote omitted).  The Brantner court discussed 
a two-part test employed by the court of appeals in that 
litigation, but it did not explicitly adopt the test.  Id. at 
No. 99-0649  
 
 
37
668-69 (analyzing Brantner v. Jenson, 120 Wis. 2d 63, 66-67, 352 
N.W.2d 671 (Ct. App. 1984)). 
¶79 The Brantner court qualified its recognition of the 
relevance of a plaintiff's evidence regarding possible future 
consequences, however.  That is, 
 
fear of future surgery is not reasonably certain and a 
defendant would not be liable for damages for mental 
distress when a medical witness describes to the 
victim 
or 
to 
the 
jury 
remotely 
conceivable 
complications which may develop from the physical 
injury caused by the defendant's negligence.  Anxiety 
about a fictitious or imagined or highly unlikely 
consequence is not a recoverable element. Howard v. 
Mt. Sinai Hospital, Inc., 63 Wis. 2d 515, 217 N.W.2d 
383 (1974).  Liability ceases at a point dictated by 
public policy and common sense.  Wilson v. Continental 
Ins. Co., 87 Wis. 2d 310, 325, 274 N.W.2d 679 (1979) 
(quoting Justice Hansen's concurrence in Howard v. Mt. 
Sinai Hospital, Inc.). 
Id. at 666-67.  Applying the Brantner test here, if the evidence 
proffered 
by 
Martindale 
describes 
"remotely 
conceivable 
complications" from the possible surgery that he faced, he 
cannot recover for fear of those complications. 
¶80 The circuit court allowed testimony by Dr. Ryan about 
the option of TMJ surgery on Martindale.  Dr. Ryan first rated 
the chances of success at 85% for repair to the discs in his 
TMJ's and 75% for disc removal.  In addition, moments after this 
assessment, Dr. Ryan rated the chances of success at 85% for 
Martindale's right side and 75% for his left side, although he 
did not indicate the procedure about which he was talking.  The 
circuit court permitted this evidence over objections from the 
City based on Brantner. 
No. 99-0649  
 
 
38
¶81 Martindale, however, complains of the exclusion of 
testimony and exhibits relating to his alleged fear of possible 
future surgery that the circuit court did exclude.  The 
exclusions by the circuit court included testimony by Dr. Ryan 
that he "probably" discussed all the potential complications of 
TMJ surgery with Martindale.  The circuit court also excluded 
two exhibits that Dr. Ryan discussed during his deposition 
testimony.  The first exhibit was entitled "Post-Operative 
Complications."  The second exhibit also related to post-
operative complications. 
¶82 At trial, the circuit court also ruled that Martindale 
himself could not testify regarding the possible complications 
of TMJ surgery.  Martindale's counsel sought to elicit testimony 
from Martindale about the risks of surgery that he heard from 
Dr. Ryan and the risks of complications that he learned from the 
internet. 
¶83 In Brantner, this court considered whether a plaintiff 
has to prove to a reasonable certainty that his or her injury 
would require surgery in the future.  This court answered that 
inquiry negatively, indicating that a plaintiff must prove to a 
reasonable certainty that he or she has a fear of surgery; a 
plaintiff need not prove to a reasonable certainty that he or 
she will need surgery.  The plaintiff must do two things, 
however, in order to advance a claim for fear of future surgery: 
(1) The plaintiff must establish a reasonable fear of the 
possibility of future surgery, which according to Brantner may 
be accomplished with a doctor's realistic prediction as to the 
No. 99-0649  
 
 
39
possibility of future surgery; and (2) the plaintiff may not 
present evidence of fear of future surgery if the evidence 
relates to "remotely conceivable complications" or "a fictitious 
or imagined or highly unlikely consequence."  Brantner, 121 
Wis. 2d at 666-67. 
¶84 This case requires an additional analytical step.  The 
dispute here requires us to decide if, after a circuit court 
decides that a plaintiff may testify concerning his or her fear 
of surgery, the court may thereafter exclude testimony by the 
plaintiff and a medical witness about the specific possible 
complications of surgery. 
¶85 Despite this extra analytical step, Brantner provides 
all the guidance this court needs in analyzing whether the 
circuit court made a sustainable use of discretion.  Brantner 
said that a plaintiff cannot recover for "damages for mental 
distress when a medical witness describes to the victim or to 
the jury remotely conceivable complications which may develop 
from the physical injury caused by the defendant's negligence." 
 Brantner, 121 Wis. 2d at 666-67 (emphasis added). 
¶86 We must be mindful that our inquiry does not rest on 
what we would have done in the circuit court's position, but 
instead on whether a reasonable judge could make the same 
decision.  Wollman, 86 Wis. 2d at 464.  When the circuit court 
ruled that Dr. Ryan could not testify regarding potential 
complications, it stated that Martindale could "get in the 
possibility 
of 
success 
[of 
surgery], 
but 
not 
impossible 
complications if surgery is had."  We read this statement by the 
No. 99-0649  
 
 
40
circuit court to mean the plaintiff had not offered sufficient 
evidence to show such complications were more than remotely 
conceivable, if conceivable at all.  This reading of the record 
is supported by the numerous references the circuit court made 
to the possibility of complications from the surgery. 
¶87 Martindale, however, takes issue with the circuit 
court's seemingly interchangeable use of words to describe the 
standard 
required 
of 
Dr. 
Ryan's 
testimony 
about 
the 
complications of surgery.  The circuit court used the words 
"reasonable 
probability," 
"reasonable 
possibility," 
"what 
complications might occur," "complications that might result," 
and "impossible complications," when it ruled that Dr. Ryan 
could not testify about the complications of potential future 
surgery. 
¶88 Notwithstanding the inconsistent terminology used by 
the circuit court, it is apparent based on our reading of the 
record that the circuit court determined Martindale had not 
shown that the potential complications were anything more than 
remotely conceivable.  We conclude the circuit court had a 
reasonable basis to make this decision because the record is 
devoid of any evidence from any qualified witness about the 
likelihood of any complications if surgery did occur.  Dr. 
Ryan's statement in which he rated the chances of success of 
surgery is insufficient by itself to show that complications 
were not just remotely conceivable.  Certainly, the surgery 
could be deemed a success, but also entail complications. 
No. 99-0649  
 
 
41
¶89 Had 
Martindale 
presented 
Dr. 
Ryan's 
"realistic 
prediction as to the possibility of future surgery," and 
evidence that complications were more than remotely conceivable, 
we would be compelled to find the circuit court erroneously 
exercised its discretion.  Brantner, 121 Wis. 2d at 666.  This 
simply did not occur. 
¶90 The circuit court properly exercised its discretion in 
excluding the testimony of the doctor on potential complications 
on the basis that remotely conceivable complications do not give 
rise 
to 
damages 
for 
fear 
of 
possible 
future 
surgery.  
Accordingly, we also conclude the circuit court properly 
exercised its discretion in excluding the exhibits relating to 
post-operative complications and this excluded testimony. 
 
B. Martindale's Testimony 
 
¶91 We also find the circuit court properly exercised its 
discretion in excluding testimony by Martindale that revealed he 
had learned additional information on the possible complications 
of TMJ surgery from internet sources.  The circuit court 
initially overruled objection by the City during the direct 
examination of Martindale concerning what he had learned from 
the internet.  Based on our reading of the record, the circuit 
court anticipated the plaintiff might testify as to accounts or 
stories of persons who suffered complications from TMJ surgery. 
 Apparently, 
the 
circuit 
court 
would 
have 
allowed 
such 
testimony.  The City asked for argument outside the presence of 
No. 99-0649  
 
 
42
the jury. When the plaintiff began testifying during an offer of 
proof about the very specific medical effects of TMJ surgery, 
however, the circuit court sustained further objection by the 
City. 
¶92 During the offer of proof, Martindale stated: 
 
[I] have learned that there are a lot of risks.  That 
I can end up with some severe problems if the surgery 
does not go as planned.  I could become -- I could 
have problems with degeneration of the bones, the jaw 
bones, 
and 
have 
to 
face 
the 
possibility 
of 
reconstructive surgery, and loss of motion -- those 
kinds of things. 
  
[W]hat I have really learned is that everything that I 
have, basically, that Dr. Ryan −− it's all been 
confirmed. 
 
That 
reading 
documentaries, 
case 
histories, studies, they are all medical records, 
medical papers, and basically, they are confirming 
everything that I have already heard. 
 
Basically, what has been confirmed by these papers 
that I have read is that I have a high risk of -- or a 
risk of degenerated bone disease, arthritic bone 
disease, which would mean they would have to do 
plastic reconstruction of the joint, a very dangerous 
and very high risk operation, something I don't want 
to get into.  I have also learned that I can get 
scarring of the joints through surgery, and I can end 
up with loss of motion, and so forth (questions of 
counsel omitted). 
We agree with the circuit court's exclusion of this evidence. 
¶93 Martindale did not establish that the complications of 
which he spoke were anything more than "remotely conceivable."  
Brantner, 121 Wis. 2d at 666.  This was especially problematic 
because his expert witness did not establish whether any 
complications 
were 
more 
than remotely 
conceivable either.  
No. 99-0649  
 
 
43
Accordingly, we conclude the circuit court did not erroneously 
exercise its discretion in excluding this testimony. 
 
VI 
 
¶94 We 
conclude 
that 
the 
circuit 
court 
erroneously 
exercised its discretion when it excluded the testimony of an 
oral surgeon, testifying as an expert, explaining and describing 
the probable manner in which the whiplash motion of the 
plaintiff's head and neck caused injury to the plaintiff's 
temporomandibular joints (TMJs).  This exclusion was critical to 
the plaintiff's proof of causation and occurred after the 
circuit 
court 
admitted 
testimony 
by 
the 
expert 
witness 
indicating that the TMJ injuries were caused by whiplash 
suffered when the plaintiff's car was struck from behind by a 
garbage truck.  On the facts of this case, the witness was not 
testifying beyond his expertise, and the evidence concerning the 
probable manner of injury should not have been excluded.  
Because the excluded testimony was critical to plaintiff's proof 
of causation and because the defendant stressed plaintiff's 
failure to establish causation, the exclusion of this evidence 
was not harmless error.  Although we affirm the circuit court's 
exclusion of proffered testimony about remotely conceivable 
complications of possible future surgery to plaintiff's TMJs, we 
reverse the decision of the court of appeals and remand the 
cause for a new trial. 
No. 99-0649  
 
 
44
By the Court.—The decision of the court of appeals is 
reversed and the cause is remanded. 
 
 
 
 
No. 99-0649.ssa 
 
1 
¶95 SHIRLEY S. ABRAHAMSON, CHIEF JUSTICE (concurring).  I 
join the majority opinion.  I wrote a concurrence on the issue 
of harmless error in In re the Termination of Parental Rights to 
Jayton S.: Evelyn C.R. v. Tykila S., 2001 WI 110 ¶¶37-42, ___ 
Wis. 2d ___, ___ N.W.2d ___ (Abrahamson, C.J. concurring).  My 
views on harmless error expressed in that concurrence apply to 
the present case as well.  Rather than repeat the concurrence 
verbatim in the present case, I refer the reader to the Evelyn 
C.R. case. 
 
 
 
No. 99-0649.jpw 
 
1 
¶96 JON P. WILCOX, J. (dissenting).  While I agree with 
the majority that the circuit court properly excluded the 
proffered 
testimony 
regarding 
the 
remotely 
conceivable 
complications that could occur if Martindale opted to undergo 
TMJ surgery, I do not join the majority's conclusion that the 
circuit court erroneously exercised its discretion by excluding 
Dr. Ryan's proffered testimony and diagram regarding the 
"mechanism" 
by 
which 
Martindale 
allegedly 
was 
injured.  
Accordingly, I dissent. 
I 
¶97 As the majority explains, the question of whether a 
witness is qualified under Wis. Stat. § 907.02 (1997-98)12 to 
provide an expert opinion is a matter left to the sound 
discretion of the circuit court.  Majority op. at ¶¶44-45; see 
also State v. Watson, 227 Wis. 2d 167, 186, 595 N.W.2d 403 
(1999).  When reviewing a circuit court's decision on a 
discretionary matter, this court should not examine whether we 
would have reached the same conclusion as the circuit court.  
State v. Wollman, 86 Wis. 2d 459, 464, 273 N.W.2d 225 (1979); 
see also majority op. at ¶86.  Rather, the appropriate scope of 
our review is much more limited:  "We review a discretionary 
decision only to determine whether the [circuit] court examined 
the facts of record, applied a proper legal standard, and, using 
a rational process, reached a reasonable conclusion.  This court 
                     
12 All subsequent references to the Wisconsin Statutes are 
to the 1997-98 version unless otherwise indicated.  
No. 99-0649.jpw 
 
2 
will not reverse unless the circuit court's use of discretion is 
wholly unreasonable."  Watson, 227 Wis. 2d at 186 (quotation and 
citation omitted); see also majority op. at ¶28.  Indeed, we 
generally look for reasons to sustain a circuit court's 
determination on discretionary matters.  Schauer v. DeNeveu 
Homeowners Ass'n, 194 Wis. 2d 62, 71, 533 N.W.2d 470 (1995). 
¶98 Although the majority in this case professes to adhere 
to this standard of review, it nonetheless fails to explain on 
what legal basis the circuit court erred in excluding Dr. Ryan's 
proffered testimony.  Instead, the majority simply reexamines 
the facts in the record and substitutes its own judgment for the 
sound discretion of the circuit court.   
¶99 Had the majority reviewed this case in light of the 
standard of review that it ostensibly applies, it properly would 
have concluded that the circuit court reasonably exercised its 
discretion in excluding Dr. Ryan's proffered evidence regarding 
the possible "mechanism" by which Martindale may have been 
injured.  The circuit court provided two bases for its decision, 
both of which are legally sound and either of which should have 
provided grounds for this court to uphold the circuit court's 
ruling. 
A 
 
¶100 First, the circuit court ruled that Dr. Ryan's 
testimony lacked foundation.  As this court previously has 
explained, a judge may insist that an expert opinion be 
supported by some foundation in the record.  Rabata v. Dohner, 
45 Wis. 2d 111, 134-35, 172 N.W.2d 409 (1969); see also Wis. 
No. 99-0649.jpw 
 
3 
Stat. § 904.03 ("Although relevant, evidence may be excluded if 
its probative value is substantially outweighed by the danger 
of . . . misleading the jury . . . .").   
¶101 In 
the 
present 
case, 
Martindale 
attempted 
to 
introduce:  (1) a diagram allegedly depicting how his head and 
jaw moved during his accident; and (2) Dr. Ryan's testimony 
explaining the diagram.  Although Dr. Ryan stated that he 
believed that the diagram accurately depicted Martindale's head 
and jaw movement, his factual foundation for his belief was 
extremely limited.  As he testified: 
 
Well, I do know which kind of automobile [Martindale] 
was in.  He was in a Bonneville.  And I also know that 
he testified that his——his headrest was too low for 
his head and that this would depict what could happen 
in a whiplash injury and I have no other reason to 
believe that he had an injury to his jaw other than 
the whiplash injury in this accident.  And since I've 
already testified that I think the accident caused 
this problem, this is the mechanism of——I believe——
causes internal joint derangement. 
Thus, in his own words, Dr. Ryan's belief was based on his 
opinion that the accident caused Martindale's TMJ injury and 
Martindale's statements regarding his automobile and whiplash 
injury. 
 
¶102 Dr. Ryan's opinion about the cause of Martindale's TMJ 
injury does not provide an evidentiary basis for his hypothesis 
regarding how Martindale's head and jaw moved during the 
accident.  To be sure, Dr. Ryan testified without objection that 
in his opinion, the accident caused Martindale's TMJ injury.  
This opinion, however, was not based on Dr. Ryan's firsthand 
No. 99-0649.jpw 
 
4 
knowledge of the accident or Dr. Ryan's understanding of 
kinematics, physics, or accident reconstruction.  Rather, it was 
simply a matter of common sense deduction based on the facts 
available to Dr. Ryan.  As his testimony indicates, Dr. Ryan 
began with the factual premises that Martindale had a TMJ injury 
and was involved in an accident; he then ruled out possible 
causes 
for 
the 
injury 
other 
than 
Martindale's 
accident.  
Syllogistically, Dr. Ryan's reasoning was as follows: 
 
(1) Martindale had a TMJ injury. 
 
(2) Martindale was in an accident that caused a 
whiplash injury. 
 
(3) Whiplash injuries are caused by head movement. 
 
(4) Head movement can cause TMJ injuries. 
 
(5) Thus, the head movement in the accident could 
have caused Martindale's TMJ injury. 
 
(6) Dr. Ryan knew of no other possible cause for 
Martindale's TMJ injury. 
 
(7) Therefore, Dr. Ryan opined that the head movement 
in the accident caused Martindale's TMJ injury. 
At best, this reasoning indicates that Dr. Ryan knew that 
Martindale's head moved in the accident.  But none of this 
reasoning indicates that Dr. Ryan knew how Martindale's head and 
jaw moved in the accident. 
 
¶103 Further, 
Dr. 
Ryan's 
knowledge 
of 
Martindale's 
testimony does not support a conclusion that Dr. Ryan knew how 
Martindale's head and jaw moved in the accident.  Martindale 
testified about the type of car he was driving and the general 
No. 99-0649.jpw 
 
5 
facts surrounding his whiplash injury, but he did not explain 
how his head and jaw moved in the accident with enough precision 
to allow Dr. Ryan to create a diagram and use it to depict the 
exact head and jaw movements. 
 
¶104 Because Dr. Ryan did not provide any other basis for 
his opinion, the circuit court reasonably concluded that his 
diagram and testimony allegedly explaining the exact nature of 
Martindale's 
head 
and 
jaw 
movements 
lacked 
foundation.  
Accordingly, the circuit court did not erroneously exercise its 
discretion in excluding this proffered evidence. 
B 
 
¶105 Second, the circuit court ruled that Dr. Ryan's 
testimony was not given to a reasonable degree of medical 
probability.  Medical opinions must be based on a reasonable 
degree of probability, not upon mere possibility, conjecture, or 
speculation.  Pucci v. Rausch, 51 Wis. 2d 513, 518-19, 187 
N.W.2d 138 (1971).  Although there are "[n]o particular words of 
art" that a medical expert must employ in relating his or her 
opinion, Drexler v. All American Life & Cas. Co., 72 Wis. 2d 
420, 432, 241 N.W.2d 401 (1976), this court has made it clear 
that "'might' or 'could' is not sufficient and does not reach 
the certitude required."  Pucci, 51 Wis. 2d at 519.   
 
¶106 In the case at hand, Dr. Ryan expressed his opinion 
regarding Martindale's head and jaw movements in terms of mere 
possibility, conjecture, or speculation:  "[T]his would depict 
what could happen in a whiplash injury."  (Emphasis added.)  Dr. 
Ryan did not explain whether there are other types of whiplash 
No. 99-0649.jpw 
 
6 
injuries that involve different head and/or jaw movements, and, 
if so, whether those types of whiplash injuries can cause TMJ 
injuries.  Nor did he attempt to explain with what frequency the 
type of movement depicted in his diagram actually causes TMJ 
injury.  Rather, Dr. Ryan merely asserted in uncertain terms 
that the movements shown in his diagram could have occurred in 
the accident at issue and, if so, Martindale's TMJ injury could 
have resulted.  This does not reach the required level of 
certitude necessary to form an admissible opinion.  
 
¶107 The majority attempts to make an end-run around this 
shortcoming by scouring Dr. Ryan's deposition transcript for 
testimony that did reach the requisite degree of certitude.  As 
a result of its efforts, the majority does manage to find such 
testimony:  twenty-six pages and seventy-five questions earlier 
in the transcript, Dr. Ryan testified "to a reasonable degree of 
probability" that in his opinion, Martindale's accident had 
caused the TMJ injury.  See majority op. at ¶67 (quotation 
omitted).  As explained above, this testimony is not disputed.  
But as also explained above, it does not follow from this 
testimony that Dr. Ryan had knowledge about how Martindale's 
head and jaw allegedly moved during the accident sufficient to 
warrant introducing Dr. Ryan's "mechanism" diagram and testimony 
to the jury.   
¶108 The fact remains that with regard to the testimony and 
diagram at issue (not another question at another point in Dr. 
Ryan's testimony), Dr. Ryan failed to testify with the requisite 
degree of certainty.  He provided the opinion at issue only in 
No. 99-0649.jpw 
 
7 
terms of possibility, conjecture, and speculation——as what could 
have happened.  As such, the circuit court reasonably concluded 
that Dr. Ryan's diagram and testimony should be excluded.  
Accordingly, as with the foundation ruling discussed above, the 
circuit court did not erroneously exercise its discretion. 
II 
 
¶109 Seemingly driven by a desired outcome rather than its 
professed adherence to the appropriate standard of review, the 
majority ignores the circuit court's reasoning and, instead, 
engages in legal gymnastics.  First, rather than initially 
finding that the circuit court's ruling was in error, the 
majority begins its analysis with a harmless error standard.  As 
the 
majority 
explains, 
"[a]fter 
recognizing 
Dr. 
Ryan's 
credentials, permitting him to testify as an expert, and 
allowing him to give his opinion as to the cause of Martindale's 
medical condition, the court denied [Dr. Ryan] the ability to 
explain 
the 
'mechanism' 
that 
prompted 
him 
to 
reach 
his 
conclusion."  Majority op. at ¶46.  In light of these facts, the 
majority suggests that Martindale was prejudiced because the 
jury never received an explanation of how a whiplash injury can 
relate to a TMJ injury.  Id.  Thus, the majority suggests that 
the circuit court ruling affected the substantial rights of 
Martindale without first finding that the ruling was incorrect. 
¶110 The majority's analysis is flawed.  Not only does the 
majority's analysis beg the questions of whether Dr. Ryan's 
"mechanism" diagram and testimony lacked foundation and/or the 
requisite degree of certainty, but it is based on circular 
No. 99-0649.jpw 
 
8 
logic.  In effect, the majority's logic is that the circuit 
court's ruling was in error because it was not harmless error 
(i.e., it affected Martindale's substantial rights).  Pursuant 
to this prejudice-first analysis, even if the majority had 
concluded that the circuit court ruling was correct and was the 
only reasonable ruling in this case, so long as the ruling could 
cause Martindale to be prejudiced, the majority would be 
compelled to reverse.  This is not our law. 
¶111 There is no doubt that Dr. Ryan was an expert.  But an 
expert qualified to testify on one subject is not necessarily 
qualified to testify on another——even a closely related——
subject.  See Lemberger v. Koehring Co., 63 Wis. 2d 210, 217-18, 
216 N.W.2d 542 (1974).  Simply because the circuit court ruled 
that Dr. Ryan was qualified to provide an opinion regarding the 
cause of Martindale's TMJ injury, it does not necessarily follow 
that the circuit court was in error when it concluded that Dr. 
Ryan was not qualified to opine about the physical mechanics 
surrounding Martindale's alleged head and jaw movement during 
the accident.  As explained above, based on the facts in the 
record, the circuit court reasonably excluded this latter 
proffered evidence.  Accord Simpsen v. Madison Gen. Hosp., 48 
Wis. 2d 498, 510-11, 180 N.W.2d 586 (1970) (affirming the 
circuit court's decision to allow a doctor to testify about 
No. 99-0649.jpw 
 
9 
injuries, but not about the possible causes of those injuries).13 
 Consequently, the circuit court's ruling was not in error and 
                     
13 In an attempt to undermine the precedential value of 
Simpsen v. Madison Gen. Hosp., 48 Wis. 2d 498, 180 N.W.2d 586 
(1970), the majority asserts that Simpsen is inapposite to the 
present case because Simpsen involved a podiatrist while the 
present case involves an oral surgeon.  See majority op. at ¶56 
n.9.  I cannot discern that this negligible factual distinction 
undermines the precedential value of Simpsen.  Simpsen, like the 
present case, involved a licensed, well-seasoned doctor who had 
experience in diagnosing and treating the type of injury at 
issue, who had treated the plaintiff after (and before) she was 
injured, and who had consulted with another doctor who had 
treated 
the 
plaintiff. 
 
Simpsen, 
48 
Wis. 2d 
at 
509-10.  
Nevertheless, the circuit court in Simpsen, like the circuit 
court in the present case, ruled that although the doctor was 
qualified to testify as an expert regarding some aspects of the 
plaintiff's injuries, he was not qualified to testify about all 
aspects of the plaintiff's injuries.  Id. at 509.  As this court 
should have done with regard to the circuit court's ruling in 
the present case, this court affirmed the circuit court's sound 
discretionary decision in Simpsen.  Id. at 511.    
As noted above, the mere fact that a witness is qualified 
to testify as an expert on one issue does not mean that the 
witness is qualified to testify as an expert on another——even a 
closely related——issue.  Lemberger v. Koehring Co., 63 Wis. 2d 
210, 217-18, 216 N.W.2d 542 (1974).  The circuit court in the 
present case, like the circuit court in Simpsen, recognized this 
rule of law.  
No. 99-0649.jpw 
 
10
the majority should not have reached the harmless error 
analysis.14 
¶112 And second, the majority puts an irrational spin on 
the facts of this case.  According to the majority, Dr. Ryan 
"did 
not 
try 
to 
describe 
exactly 
what 
happened 
inside 
Martindale's car. . . .  His testimony and the accompanying 
exhibit were intended to explain to the jury how Dr. Ryan 
believed Martindale's [alleged] injuries occurred."  Majority 
op. at ¶55.   
¶113 I cannot discern how the majority harmonizes these 
"facts."  On one hand, the majority suggests that Dr. Ryan did 
not intend to explain how Martindale's head and jaw moved during 
the accident.  On the other hand, it suggests that Dr. Ryan 
intended to explain how he believed Martindale's injuries 
occurred——i.e., how Martindale's head and jaw moved during the 
accident.  I fail to understand this reasoning.  To explain how 
                     
14 As the court of appeals noted, Martindale knew well in 
advance of the trial that the evidence at issue was not 
admissible.  Martindale v. Ripp, No. 99-0649, unpublished slip 
op. at ¶8 (Wis. Ct. App. Oct. 28, 1999).  The circuit court made 
its ruling on June 8, 1998, approximately three months prior to 
the September 11, 1998, commencement of the trial.  With such 
advance notice that Dr. Ryan's diagram and deposition testimony 
would be partially excluded, Martindale could have sought to 
have Dr. Ryan testify at trial in order to bolster his opinion 
or asked the circuit court to permit another qualified expert to 
testify.  Martindale did not pursue either option.  Rather, he 
chose to try the case without the evidence that he now claims to 
have needed.  In light of these facts and the facts discussed 
above, I would conclude that it was Martindale's inaction——not 
the circuit court's ruling——that hurt Martindale's case. 
  
No. 99-0649.jpw 
 
11
Martindale's injury occurred by means of anything more than a 
generic statement that the accident caused Martindale's injury, 
Dr. Ryan necessarily would have to explain precisely how 
Martindale's head and jaw moved during the accident.  He is not 
qualified to do so. 
¶114 For these reasons, I not only am troubled by the fact 
that the majority has reversed a reasonable discretionary 
decision by the circuit court, but I also am troubled that the 
majority 
has 
replaced 
the 
circuit 
court's 
reasonable 
discretionary decision with specious logic and irreconcilable 
statements of "fact."    
III 
¶115 The majority in this case has overstepped the bounds 
of the appropriate standard of review.  This court does not and 
cannot conclude that the circuit court's ruling was "wholly 
unreasonable."  See Watson, 227 Wis. 2d at 186 (quotation and 
citation omitted).  Rather, at best, the majority simply 
concludes that the circuit court could have made another 
"reasonable"——albeit less reasonable——ruling.  Thus, in the 
place of the circuit court's sound discretionary decision, the 
majority has injected as a matter of law its determination of 
how, were it the circuit court, it would have decided the 
question of whether to admit Dr. Ryan's testimony.   
¶116 I will not join the majority's usurpation of the 
circuit court's discretionary authority.  For this reason, I 
respectfully dissent.  
No. 99-0649.jpw 
 
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¶117 I am authorized to state that Justice N. PATRICK 
CROOKS joins this dissent.   
 
 
 
 
No.99-0649.npc 
 
1 
¶118 
N. PATRICK CROOKS, J.    (dissenting).  While I join 
Justice Jon P. Wilcox's dissent, I write separately to express 
my concerns about the majority's standard for harmless error.  
See majority op. at ¶32.  The majority's standard is whether 
there is "a reasonable possibility that the error contributed to 
the outcome," and that a "reasonable possibility" is one 
"sufficient to 'undermine confidence in the outcome.'"  Id. 
(quoting State v. Dyess, 124 Wis. 2d 525, 544-45, 370 N.W.2d 222 
(1985)).  Since the standard for harmless error is the same for 
civil, as well as criminal, cases (Town of Geneva v. Tills, 129 
Wis. 2d 167, 184-85, 384 N.W.2d 701 (1986)), it is imperative 
that the standard be accurately conveyed.  
¶119 For at least the past 35 years, this court has 
wrestled with formulating a standard for harmless error.  See, 
e.g., Pulaski v. State, 24 Wis. 2d 450, 456-57, 129 N.W.2d 204 
(1964); State v. Spring, 48 Wis. 2d 333, 339-40, 179 N.W.2d 841 
(1970); Wold v. State, 57 Wis. 2d 344, 356-57, 204 N.W.2d 482 
(1973); State v. Grant, 139 Wis. 2d 45, 406 N.W.2d 744 (1987).  
In an attempt to formulate a single, uniform test for harmless 
error, Dyess "conclude[d] that the test of prejudice as 
formulated in Strickland subsumes the various statements of the 
harmless error test that this court has used over the years."  
No.99-0649.npc 
 
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Dyess, 124 Wis. 2d at 545.15  The Strickland case referred to is 
Strickland v. Washington, 466 U.S. 668, 693 (1984), and the test 
is whether "there is a reasonable probability" that "but for" 
the error, "the result of the proceeding would have been 
different.  A reasonable probability is a probability sufficient 
to undermine confidence in the outcome."  466 U.S. at 694 
(emphasis added).   Dyess obviously adopted that test, but 
incorrectly assumed that there was no real difference between 
using 
"reasonable 
possibility" 
instead 
of 
"reasonable 
probability." 124 Wis. 2d at 544.  Granted, Dyess applied its 
test by stating that "[i]n the present case, the probability to 
be weighed is whether the defendant would have been acquitted." 
 Id. at 546 (emphasis added).  However, as evident in the 
majority's opinion here today,16 Wisconsin courts have frequently 
                     
15 Dyess' single test for harmless error standard has not 
been without controversy.  State v. Dyess, 124 Wis. 2d 525, 370 
N.W.2d 222 (1985).  In addition to the majority opinion's 
discussion of Dyess' harmless error standard, authored by 
Justice Day, in State v. Grant, 139 Wis. 2d 45, 406 N.W.2d 744 
(1987), 
Chief 
Justice 
Heffernan, 
Justice 
Day, 
Justice 
Abrahamson, and Justice Callow separately concurred on the Dyess 
issue.  The controversy has continued.  See State v. Dodson, 219 
Wis. 2d 
65, 
92-98, 
580 
N.W.2d 
181 
(1998) 
(Crooks, 
J., 
concurring, joined by Justice Steinmetz and Justice Wilcox).    
16 See also Green v. Smith & Nephew AHP, Inc., 2001 WI 109, 
 ___ Wis. 2d ___, ___ N.W.2d ___; Koffman v. Leichtfuss, 2001 WI 
111, ___ Wis. 2d ___, ___ N.W.2d ___; Evelyn C.R. v. Tykila S., 
2001 WI 110, ___ Wis. 2d ___, ___ N.W.2d ___; and Nommensen v. 
American Cont’l Ins. Co., 2001 WI 112, ___ Wis. 2d ___, ___ 
N.W.2d ___.  (I have written dissents or concurrences in these 
cases.)  But see State v. Lindell, 2001 WI 81, ___ Wis. 2d ___, 
___ N.W.2d ___ (Strickland's probability sufficient to undermine 
the confidence in the outcome test used to determine ineffective 
assistance of counsel claim).   
No.99-0649.npc 
 
3 
used the term "reasonable possibility," and have not indicated 
that, in the context of a harmless error standard, possibility 
means probability.17   
¶120 There can be no doubt that there is a significant 
difference between what is reasonably probable and what is 
reasonably possible.  "A possibility test is the next thing to 
automatic reversal."  Wold v. State, 57 Wis. 2d 344, 356-57, 204 
N.W.2d 482 (1973).18  While I agree that the focus should be "on 
whether the error 'undermine[s] confidence in the outcome,'" 
(Dyess, 124 Wis. 2d at 545 (quoting Strickland, 466 U.S. at 
694)), if that error need only possibly undermine the confidence 
in the outcome, rather than probably, appellate courts, and 
circuit courts considering motions after verdict and post-
convictions motions, will find themselves invading the purview 
of the jury.  A cornerstone of the common law is deference to 
the jury, which is diluted by determining whether the alleged 
error possibly, and only possibly, may have affected the jury's 
decision.  
                     
17 According to my research, on few occasions since Dyess 
has this court, in a majority opinion, noted that reasonable 
possibility 
means 
reasonable 
probability. 
 
See 
State 
v. 
Armstrong, 223 Wis. 2d 331, 372 n.40, 588 N.W.2d 606 (1999); see 
also State v. Huntington, 216 Wis. 2d 671, 695-96, 575 N.W.2d 
268 (1998).  However, several court of appeals opinions have 
applied the Dyess harmless error test using the correct 
"reasonable probability" standard.  See, e.g., State v. A.H., 
211 Wis. 2d 561, 569, 566 N.W.2d 858 (Ct. App. 1997); State v. 
Joseph P., 200 Wis. 2d 227, 237, 546 N.W.2d 494 (Ct. App. 1996). 
18 Wold's "reasonable probability" test for harmless error 
was replaced by Dyess' "reasonable possibility" test.  
No.99-0649.npc 
 
4 
¶121 I do not take issue with the term "reasonable 
possibility," so long as it is made clear that this term means 
reasonable probability, and probability is the standard to be 
applied.  Accordingly, I offer the following test for harmless 
error, which makes clear that Dyess' use of the term "reasonable 
possibility" is intended to require "reasonable probability": 
 
Wisconsin Stat. § 805.18(2) provides that an error 
requires reversal only where it has "affected the 
substantial rights of the party" claiming error.  We 
have long recognized that the focus of a court's 
analysis under this statute is whether, in light of 
the 
applicable 
burden 
of 
proof, 
the 
error 
is 
significant enough to "undermine confidence in the 
outcome" of the trial.  Dyess, 124 Wis. 2d at 544-45. 
 An 
error 
is 
significant 
enough 
to 
undermine 
confidence in the outcome if there is a reasonable 
probability of a different outcome without the error. 
 Dyess 
made 
it 
clear 
that 
"probability" 
is 
substantially 
the 
same 
as 
"possibility" 
under 
Wisconsin law.  Id. at 544. 
¶122 That Wisconsin courts have often used "reasonable 
possibility" rather than "reasonable probability" should not 
dissuade the court from correcting such missteps today.  See, 
e.g., State v. Sullivan 216 Wis. 2d 768, 792, 576 N.W.2d 30 
(1998); State v. Alexander, 214 Wis. 2d 628, 653, 571 N.W.2d 662 
(1997).  There is no time like the present——dum fervet opus19——
when the court has before it five cases wherein it discusses the 
harmless error standard, to clarify Dyess.   
¶123 For the reasons stated herein, I respectfully dissent. 
                     
19 "While the action is fresh; in the heat of action."  
Black's Law Dictionary 518 (7th ed. 1999).  
No.99-0649.npc 
 
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¶124 I am authorized to state that Justice JON P. WILCOX 
joins this opinion. 
 
 
 
No.99-0649.npc 
 
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