Title: Seifert v. Balink

State: wisconsin

Issuer: Wisconsin Supreme Court

Document:

2017 WI 2 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2014AP195 
COMPLETE TITLE: 
Braylon Seifert, by his Guardian ad litem, Paul 
J. 
Scoptur, Kimberly Seifert and David Seifert, 
Plaintiffs-Respondents, 
Dean Health Insurance and BadgerCare Plus, 
Involuntary-Plaintiffs, 
v. 
Kay M. Balink, M.D. and Proassurance Wisconsin 
Insurance 
Company, 
Defendants-Appellants-Petitioners. 
 
 
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
 
 
OPINION FILED: 
      
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
September 6, 2016 
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit Court 
 
COUNTY: 
Grant 
 
JUDGE: 
Craig R. Day 
 
 
 
JUSTICES: 
 
 
CONCURRED: 
ZIEGLER, J. and GABLEMAN, J. concurs, joined by 
ROGGENSACK, C. J., J. 
 (Opinion filed). 
 
DISSENTED: 
KELLY, J. joined by BRADLEY, R. G., J. dissent 
(Opinion Filed). 
 
NOT PARTICIPATING:          
 
 
 
ATTORNEYS: 
 
For 
the 
defendants-appellants-petitioners, 
there 
were 
briefs by Samuel J. Leib, Brent A. Simerson, and Leib, Knott, 
Gaynor, LLC, Milwaukee, WI, and oral argument by Samuel J. Leib.  
 
For the plaintiffs-respondents, there was a brief by 
Kenneth M. Levine, (pro hac vice), and Kenneth M. Levine & 
Associates, LLC, Brookline, MA, and Paul J. Scoptur and Aiken & 
Scoptur, S.C., Milwaukee. Oral argument by Kenneth M. Levine.   
 
 
2017 WI 2
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.   2014AP195 
(L.C. No. 
2011CV588) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
Braylon Seifert, by his Guardian ad litem, Paul 
J. Scoptur, Kimberly Seifert and David Seifert, 
 
          Plaintiffs-Respondents, 
 
Dean Health Insurance and BadgerCare Plus, 
 
          Involuntary-Plaintiffs, 
 
     v. 
 
Kay M. Balink, M.D. and Proassurance Wisconsin 
Insurance Company, 
 
          Defendants-Appellants-Petitioners. 
 
FILED 
 
JAN 6, 2017 
 
Diane M. Fremgen 
Clerk of Supreme Court 
 
 
 
 
REVIEW of a decision of the Court of Appeals.  Affirmed.   
 
¶1 
SHIRLEY S. ABRAHAMSON, J.   This is a review of a 
published decision of the court of appeals.1  The court of 
appeals affirmed a judgment and an order of the Circuit Court 
for Grant County, Craig R. Day, Judge, in favor of the 
plaintiff, Braylon Seifert (by his guardian ad litem, Paul 
                                                 
1 Seifert ex rel. Scoptur v. Balink, 2015 WI App 59, 364 
Wis. 2d 692, 869 N.W.2d 493. 
No. 
2014AP195   
 
2 
 
Scoptur, and his parents, Kimberly Seifert and David Seifert) 
and against the defendants, Dr. Kim Balink (the defendant 
doctor) and Proassurance Wisconsin Insurance Company. 
¶2 
This medical malpractice case is based on the claim 
that the defendant doctor was negligent in the prenatal care of 
Braylon Seifert's mother and in Braylon's delivery in May 2009.  
¶3 
Complications arose during Braylon's delivery.  Almost 
immediately after Braylon's head appeared, the head retracted, 
indicating a shoulder dystocia, that is, indicating that the 
shoulder was stuck, prohibiting the body from being delivered.  
The defendant doctor undertook a series of steps to resolve the 
dystocia and delivered the baby.  Braylon's shoulder was 
injured, however, and the growth and function of Braylon's left 
arm are permanently and severely limited.    
¶4 
Braylon claims that the defendant doctor's care during 
delivery fell below the standard of reasonable care and caused 
him to have a permanent brachial plexus injury, that is, to have 
a permanent injury to the nerves that animate his left arm.  
¶5 
Braylon's obstetrical expert witness, Dr. Jeffrey 
Wener, testified that he was familiar with the standard of care 
for family practitioners practicing obstetrics with regard to 
prenatal care, labor, and delivery.  Dr. Wener explained the 
reasonable care to be used in a case like the instant one and 
opined that the care provided and the procedures used by the 
defendant doctor fell below the standard of reasonable care.    
¶6 
The defendants challenged Dr. Wener's testimony in the 
circuit court, in the court of appeals, and in this court as 
No. 
2014AP195   
 
3 
 
inadmissible under the recently amended Wis. Stat. § 907.02(1) 
(2013-14).2  This amended statute governing the admissibility of 
expert evidence was enacted in 2011.   It adopted the federal 
evidentiary standard codified in Federal Rule of Evidence 702 
(2000), 
which 
in 
turn 
adopted 
the 
reliability 
standard 
explicated in Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 
U.S. 579 (1993).  
¶7 
The new Daubert aspect of Wis. Stat. § 907.02(1) 
became effective February 1, 2011, and applies in the instant 
case.3  It requires that expert testimony be based on sufficient 
facts or data and that the expert testimony be the product of 
reliable principles and methods.4  The expert witness must apply 
                                                 
2 All references to the Wisconsin Statutes are to the 2013-
14 version unless otherwise indicated. 
3 Wisconsin Stat. § 907.02(1) provides as follows, with 
emphasis added to show the new language added in 2011: 
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, if the 
testimony is based upon sufficient facts or data, the 
testimony is the product of reliable principles and 
methods, and the witness has applied the principles 
and methods reliably to the facts of the case.  
4 The case law uses the words "methodology" and "methods" 
interchangeably.  See, e.g., Fuesting v. Zimmer, Inc., 421 
F.3d 528, 535 (7th Cir. 2005), opinion vacated on other grounds 
on reh'g, 448 F.3d 936 (7th Cir. 2006) ("The district court must 
also, in keeping with its gatekeeper's duty, assess the 
reliability of the methodology the expert has employed in 
arriving at his opinion.").   
No. 
2014AP195   
 
4 
 
the principles and methods reliably to the facts of the case.5  
These three aspects of the Daubert standard are often referred 
to as the "reliability standard." 
¶8 
Both the circuit court and the court of appeals 
concluded in the instant case that Dr. Wener's testimony was 
admissible under § 907.02(1).       
¶9 
The jury's special verdict found that the defendant 
doctor was negligent in the delivery of Braylon and in the 
prenatal care of his mother and that this negligence was a cause 
of injury to Braylon.  The jury further found that Braylon 
should be awarded $100,000 for past pain, suffering, disability, 
and disfigurement and $1,650,000 for future pain, suffering, 
disability, and disfigurement.   
¶10 The jury did not award any damages to Braylon's 
parents.  The jury did not find that the defendant doctor 
violated informed consent.  These two rulings are not at issue 
in this review. 
¶11 The circuit court entered judgment for Braylon for 
$135,000 in medical expenses and $750,000 in pain and suffering, 
"as reduced pursuant to Wisconsin Statute, plus interest thereon 
provided by law."6   
                                                 
5 See Daniel D. Blinka, The Daubert Standard in Wisconsin:  
A Primer, Wis. Lawyer, Mar. 2011, at 61 ("Only when the witness 
identifies her principles and methods is the trial court in a 
position to assess their reliability").   
6 See Wis. Stat. § 893.55, which caps noneconomic damages at 
$750,000 in medical malpractice cases. 
No. 
2014AP195   
 
5 
 
¶12 On three occasions, the circuit court carefully and 
extensively 
considered 
the 
defendants' 
challenges 
to 
the 
admissibility 
of 
Dr. 
Wener's 
testimony 
under 
Wis. 
Stat. 
§ 907.02(1):  at a "Daubert" hearing before trial, on a 
challenge to Dr. Wener's testimony at trial, and on motions 
after verdict.  The circuit court ruled in favor of admitting 
Dr. Wener's testimony at each of these junctures.  
¶13 Seeking a new trial, the defendants raise three issues 
in this court:  
I. 
Did the circuit court err in admitting the testimony 
of Dr. Jeffrey Wener, Braylon's medical expert?  The 
defendants claim that because Dr. Wener's testimony 
was experience-based, his method was unreliable and 
inadmissible under Wis. Stat. § 907.02(1). 
II. Did several remarks of Braylon's counsel during 
closing argument violate the circuit court's orders in 
limine, prejudice the jury, and warrant a new trial?  
III. Should this court grant a new trial in the interests 
of justice pursuant to Wis. Stat. § 751.06? 
¶14 The court of appeals affirmed the judgment of the 
circuit court, concluding that a new trial was not warranted.   
¶15 For the reasons set forth, we affirm the decision of 
the court of appeals affirming the circuit court's judgment and 
order that a new trial was not warranted.  We conclude:  
I. 
The circuit court did not err in applying Wis. Stat. 
§ 907.02(1) and admitting as reliable Dr. Wener's 
No. 
2014AP195   
 
6 
 
expert medical testimony on the standard of reasonable 
care based on his personal experiences. 
II. The circuit court did not err in concluding that 
Braylon's counsel's remarks during closing argument 
did not constitute prejudicial error justifying a new 
trial. 
III. A new trial should not be granted pursuant to Wis. 
Stat. § 751.06 in the interests of justice.  
¶16 We shall address each issue in turn.  The facts and 
law relevant to each issue are stated in the discussion of that 
issue. 
I 
¶17 The first issue entails the defendants' challenge to 
the testimony of Braylon's medical expert, Dr. Jeffrey Wener, as 
unreliable and inadmissible under Wis. Stat. § 907.02(1).  Dr. 
Wener testified about the standard of reasonable care in the 
instant case and how the defendant doctor breached the standard.   
¶18 We review the circuit court's admission of Dr. Wener's 
testimony for compliance with the Daubert reliability standard 
codified in Wis. Stat. § 907.02(1).  The defendants' challenge 
was that Dr. Wener's experience-based testimony is not the 
product of a reliable method.  We conclude that Dr. Wener's 
testimony was reliable and admissible under § 907.02(1).  Our 
reasoning in reaching the conclusion that the circuit court did 
not erroneously exercise its discretion in admitting Dr. Wener's 
testimony proceeds as follows: 
No. 
2014AP195   
 
7 
 
A. 
We set forth the facts of the defendant doctor's 
prenatal care of Braylon's mother and conduct during 
Braylon's delivery.  See ¶¶19-28, infra. 
B. 
We examine undisputed facets of the case, including 
aspects of Dr. Wener's testimony and the standard of 
reasonable care applicable to the defendant doctor in 
the instant case.  See ¶¶29-37, infra. 
C. 
We summarize Dr. Wener's testimony about the standard 
of reasonable care of a family practice doctor 
practicing obstetrics.  Dr. Wener's testimony was 
based on his personal experiences; his opinion was 
that the defendant doctor breached that standard.  See 
¶¶38-49, infra. 
D. 
We discuss the reliability standard set forth in Wis. 
Stat. § 907.02(1) that governs admission of expert 
evidence.  We pay special attention to assessing the 
method used by a medical expert based on the expert's 
personal experiences.  See ¶¶50-93, infra. 
E. 
We set forth the standard for reviewing a circuit 
court's determination that medical expert testimony is 
admissible under the reliability standard incorporated 
in Wis. Stat. § 907.02(1).  See ¶¶94-100, infra. 
F. 
Against this backdrop of the teachings about the 
reliability of the methodology of medical expert 
opinion testimony based on personal experiences and 
the 
standards 
for 
reviewing 
a 
circuit 
court's 
determination of reliability and admissibility, we 
No. 
2014AP195   
 
8 
 
review the circuit court's ruling and conclude, as did 
the court of appeals, that the circuit court did not 
erroneously exercise its discretion in admitting Dr. 
Wener's expert medical testimony on the standard of 
reasonable care based on his personal experiences.  
Accordingly, we affirm the decision of the court of 
appeals affirming the circuit court's admission of Dr. 
Wener's testimony.  See ¶¶101-146, infra. 
A 
¶19 The defendant doctor, a family practitioner, provided 
prenatal care to Braylon's mother during regular prenatal visits 
and also delivered Braylon.   
¶20 During the regular prenatal visits, as relevant here, 
the defendant doctor measured the mother's weight, tested the 
mother for gestational diabetes, and performed fundal height 
measurements.  Obstetricians use the results of these tests to 
estimate the baby's birth size.  An obese or diabetic mother and 
a large fundal height indicate macrosomia (a large baby).  The 
baby's expected weight influences decisions made leading up to 
and during the delivery.   
¶21 Braylon's mother weighed 269 pounds at the start of 
her pregnancy, and she gained approximately 36 pounds during the 
pregnancy.   
¶22 The defendant doctor used a one-hour glucose screening 
test to determine whether the mother had gestational diabetes.  
The test result was 131 mg/dL.  A three-hour glucose screening 
test diagnoses gestational diabetes more accurately.     
No. 
2014AP195   
 
9 
 
¶23 The defendant doctor also performed fundal height 
measurements, which, according to Dr. Wener, involves "literally 
putting a tape measure on mom's pubic bone and then extending 
the tape to the top of the fundus, which is the top of the mom's 
uterus."  
¶24 Obstetricians may also perform an ultrasound near the 
date of delivery to get a more accurate estimate of the baby's 
size.  The defendant doctor did not perform an ultrasound.   
¶25 The defendant doctor estimated that Braylon would 
weigh eight pounds, eight ounces at birth.  Braylon's actual 
birth weight was nine pounds, twelve ounces. 
¶26 Braylon's mother arrived at the hospital on May 28, 
2009 for inducement of labor.  Initially, things went well.  The 
mother was completely dilated and ready to push by 11:00 p.m.  
After an hour, the baby had started descending but Braylon's 
mother had grown tired.   
¶27 The defendant doctor then decided to use a vacuum 
device to assist in the delivery.  This device is essentially a 
suction cup that attaches to the baby's head and is used to aid 
the mother's efforts.  Thirteen minutes and four contractions 
later, the baby's head delivered.   
¶28 Right after the baby's head emerged, it retracted into 
the mother (the "turtle sign") and the defendant doctor was 
faced with a shoulder dystocia.  A shoulder dystocia occurs when 
one or both of the baby's shoulders become stuck inside the 
mother's body and prevent delivery.  The defendant doctor then 
performed a series of well-known obstetrical maneuvers (physical 
No. 
2014AP195   
 
10 
 
manipulations to mother and baby) to resolve the dystocia.  The 
baby was delivered approximately three minutes after the 
diagnosis of shoulder dystocia.   
B 
¶29 Before we delve into the substance of Dr. Wener's 
challenged testimony, we turn to undisputed facets of the case, 
including aspects of Dr. Wener's testimony and the standard of 
reasonable 
care 
for 
a 
family 
practice 
doctor 
practicing 
obstetrics. 
¶30 The parties do not dispute that the applicable 
standard of care under Wisconsin law is reasonable care for a 
family practice doctor practicing obstetrics and that a family 
practice doctor may be liable for injury caused by breach of 
that standard of care.   
¶31 Nor do the parties dispute that the jury in the 
instant case was properly instructed on this standard of 
reasonable care.  The circuit court presented the standard of 
reasonable care, as set forth in Wisconsin Jury Instruction 
Civil 1023, to the jury as follows: 
In 
treating 
and 
diagnosing 
Kimberly 
Seifert's 
pregnancy, labor, and delivery, Dr. Kay Balink was 
required to use the degree of care, skill, and 
judgment which reasonable family practice doctors 
practicing obstetrics would exercise in the same or 
similar circumstances, having due regard for the state 
of medical science at the time of the pregnancy, 
labor, and delivery.  A doctor who fails to conform to 
this standard is negligent. 
The burden is on the plaintiffs to prove that Dr. Kay 
Balink was negligent.  A doctor is not negligent; 
[sic] however, for failing to use the highest degree 
No. 
2014AP195   
 
11 
 
of care, skill, and judgment, or solely because a bad 
result may have followed her care, and treatment 
and/or diagnosis.  
The standard you must apply in determining if Dr. Kay 
Balink is negligent is whether Dr. Kay Balink failed 
to use the degree of care, skill, and judgment which 
reasonable 
family 
practice 
doctors 
practicing 
obstetrics would exercise given the state of medical 
knowledge at the time of the treatment and diagnosis 
in issue.  (Emphasis added.)   
¶32 The parties do not dispute that Braylon was required 
to introduce expert testimony to describe the care that 
satisfies the standard of reasonable care in the instant case 
and to detail the defendant doctor's failure to furnish care 
that met this standard. 
¶33 Braylon offered Dr. Wener's testimony to establish the 
standard of reasonable care for a family practice doctor 
practicing obstetrics.  The parties do not dispute that Dr. 
Wener is a qualified expert; that Dr. Wener has "scientific, 
technical, or other specialized knowledge" that could assist the 
trier of fact; and that if admissible, his testimony would be 
relevant and helpful to the trier of fact.  Wis. Stat. 
§ 907.02(1). 
¶34 The parties also do not dispute: 
• Braylon suffered a shoulder dystocia.  
• Immediately after the delivery, Braylon's left upper 
arm was not functioning, and within a few days after 
birth he was diagnosed with a permanent brachial 
plexus injury.   
No. 
2014AP195   
 
12 
 
• Braylon's brachial plexus injury limits the growth and 
function of the arm, required surgery, and will 
require continued therapy to ameliorate the injury. 
• An 
obese 
mother, 
gestational 
diabetes, 
and 
a 
macrosomic 
baby 
increase 
the 
risk 
of 
shoulder 
dystocia.        
¶35 The circuit court stated that the parties do not 
seriously question that the application of excessive traction 
beyond what the fetus can withstand may be a cause of severe 
brachial plexus injuries during childbirth, although the circuit 
court acknowledged that there were contentions that other causes 
may have been present in the instant case.  Relatedly, the 
parties do not dispute that the use of a vacuum during delivery 
may increase the risk of a brachial plexus injury.   
¶36 Collectively, these shoulder dystocia risk factors——
obese mother, gestational diabetes, macrosomic baby, excessive 
traction, and vacuum-assisted delivery——are undisputed; these 
are the principles that guide Dr. Wener's testimony.   
¶37 The defendants' challenge to Dr. Wener's testimony is 
that his testimony is not the product of reliable methods, that 
is, the defendants contend that Dr. Wener's methodology is 
unreliable.  Specifically, the defendants argue that Dr. Wener's 
testimony is not the product of reliable methods under Wis. 
Stat. § 907.02(1) because the testimony was based on Dr. Wener's 
personal experiences.  In evaluating the defendants' challenge, 
we begin by reviewing the substance of Dr. Wener's testimony.  
C 
No. 
2014AP195   
 
13 
 
¶38 Dr. Wener testified at length about the standard of 
reasonable care in the instant case and opined that the 
defendant doctor breached that standard of reasonable care.  Dr. 
Wener's lengthy expert medical testimony was based on his 
personal experiences, and he was subjected to extensive cross-
examination. 
¶39 Dr. Wener described his extensive qualifications.  He 
stated that he is a board certified obstetrician-gynecologist 
(OB-GYN) who practices in a suburb outside of Chicago.  An OB-
GYN provides medical care to women.  The obstetric portion of 
the practice relates to pregnancy; the gynecological portion of 
the practice relates to female patients who are not pregnant. 
¶40 As to his obstetrics practice, Dr. Wener estimated 
that he has delivered between 7,500 and 8,000 babies and has 
encountered between 37 and 40 instances of shoulder dystocia in 
his 36-year career.     
¶41 In addition to private practice, Dr. Wener has taught 
medical 
students 
and 
residents 
and 
was 
chairman 
of 
the 
obstetrics-gynecology department at a hospital for about 20 
years.  As chairman, he was responsible for the quality of care 
provided by physicians practicing in his department, and he sat 
on the medical executive committee of the hospital.  He further 
testified that he examines medical records for both plaintiff 
and defense attorneys.  Dr. Wener is a member of the American 
College of Obstetricians and Gynecologists.   
¶42 Dr. Wener did not preface each of his statements with 
the words "a reasonable family doctor practicing obstetrics."  
No. 
2014AP195   
 
14 
 
The clear inference from Dr. Wener's testimony, taken as a 
whole, is that he was setting forth and applying a standard of 
reasonable care for prenatal care and delivery applicable to a 
family practitioner practicing obstetrics.  Furthermore, the 
jury instructions declared that the burden was on Braylon to 
prove that the defendant doctor was negligent and that the 
defendant doctor had to conform to the standard of care "which 
reasonable family practice doctors practicing obstetrics would 
exercise in the same or similar circumstances."  See ¶31, supra.    
¶43 Dr. Wener's experience and testimony demonstrate that 
he is familiar with the standard of reasonable care for family 
practice doctors practicing obstetrics. 
¶44 Dr. Wener concluded that the defendant doctor in the 
instant case breached the standard of reasonable care in several 
respects. He testified that several risk factors should have 
alerted the defendant doctor to the risk of shoulder dystocia, 
such as the pre-pregnancy weight of the mother and the weight 
she gained during pregnancy, the risk of gestational diabetes, 
and the risk of a large baby.     
¶45 In Dr. Wener's opinion, these three interrelated risk 
factors were important because, added together, they increased 
the risk of shoulder dystocia.  Dr. Wener explained, "A doctor 
has to take care of every patient individually.  And in doing so 
there are risk factors that every patient has.  And you have to 
look at the patient as a whole and look at all of the risk 
factors as they are applicable to the patient."  Dr. Wener 
opined to a reasonable degree of medical certainty that, based 
No. 
2014AP195   
 
15 
 
on his education, training, experience, and the facts of the 
instant case, it was more likely than not that the mother was a 
gestational diabetic because of her weight and a one-hour 
glucose test result of 131 mg/dL.  
¶46 Dr. Wener asserted that the defendant doctor fell 
below the standard of reasonable care for a family practice 
doctor practicing obstetrics by failing to order a three-hour 
glucose test for Braylon's mother.  Dr. Wener concluded that the 
standard of reasonable care required a three-hour test when the 
result from the one-hour test was over 130 mg/dL and the mother 
was obese.  The three-hour glucose test would have been more 
likely to diagnose gestational diabetes, a condition associated 
with increased risk of shoulder dystocia. 
¶47 Dr. Wener also gave his opinion to a reasonable degree 
of medical certainty that, in view of the mother's size and the 
one-hour test result, the defendant doctor breached the standard 
of reasonable care for a family practice doctor practicing 
obstetrics by failing to perform an ultrasound on Braylon's 
mother immediately prior to delivery.  An ultrasound, in Dr. 
Wener's opinion, would have given the defendant doctor a better 
estimate of Braylon's fetal weight and whether Braylon was 
macrosomic (that is, a large baby), a condition that Dr. Wener 
associated with a greater risk of shoulder dystocia. 
¶48 In addition, Dr. Wener testified that the defendant 
doctor's use of vacuum assistance during the birthing process 
breached the standard of reasonable care by increasing the risk 
of shoulder dystocia.  Explaining that it is risky to use the 
No. 
2014AP195   
 
16 
 
vacuum on a patient exhibiting the risk factors that Braylon's 
mother exhibited, Dr. Wener opined——to a reasonable degree of 
medical certainty——that a vacuum should not have been applied at 
all in the instant case.  
¶49 Dr. Wener also testified to a reasonable degree of 
medical certainty that the defendant doctor breached the 
standard of reasonable care for a family practice doctor 
practicing obstetrics by applying excessive traction beyond what 
the fetus could withstand in attempting to resolve the shoulder 
dystocia and that this excessive traction (not the mother's 
pushing) had a causative effect on Braylon's brachial plexus 
injury.    
D 
¶50 With the substance of Dr. Wener's testimony in mind, 
we turn to the reliability standard governing the admission of 
expert evidence set forth in the 2011 amendment to Wis. Stat. 
§ 907.02(1).  The following emphasized language in Wis. Stat. 
§ 907.02(1) adopting the reliability standard was added in 2011.  
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, if the 
testimony is based upon sufficient facts or data, the 
testimony is the product of reliable principles and 
methods, and the witness has applied the principles 
and methods reliably to the facts of the case. 
¶51 The 2011 amendment to Wis. Stat. § 907.02(1) changed 
the law to mirror Federal Rule of Evidence 702, which codifies 
No. 
2014AP195   
 
17 
 
Daubert v. Merrell Dow Pharmaceuticals Inc., 509 U.S. 579 
(1993), and its progeny.7  
¶52 Before 2011, when the legislature adopted the Daubert 
reliability 
standard 
in 
amended 
Wis. 
Stat. 
§ 907.02(1), 
Wisconsin case law applied the "relevancy test" to the admission 
of expert evidence:  Expert evidence was admissible if the 
witness was qualified, the evidence assisted the trier of fact, 
and the evidence was relevant.8 
¶53 Wisconsin case law had rejected both Frye's "general 
acceptance test"9 and the federal Daubert reliability standard.10   
                                                 
7 See 2011 WI Act 2, WI S. Amend. Memo, 2011 Jan. Spec. 
Sess. S.B. 1 ("This language [in Wis. Stat. § 907.02(1)] is 
identical to the language of Rule 702 of the Federal Rules of 
Evidence."); State v. Giese, 2014 WI App 92, ¶17, 356 
Wis. 2d 796; 854 N.W.2d 687 ("In January 2011, the legislature 
amended § 907.02 to make Wisconsin law on the admissibility of 
expert testimony consistent with 
'the Daubert reliability 
standard embodied in Federal Rule of Evidence 702.'") (quoting 
State v. Kandutsch, 2011 WI 78, ¶26 n.7, 336 Wis. 2d 478, 799 
N.W.2d 865). 
8 For discussion of pre-Daubert Wisconsin case law, see 
Daniel D. Blinka, Expert Testimony and the Relevancy Rule in the 
Age of Daubert, 90 Marq. L. Rev. 173 (2006). 
9 Frye v. United States, 293 F. 1013, 1014 (D.C. Cir. 1923), 
stated the rule as follows: 
The rule is that the opinions of experts or skilled 
witnesses are admissible in evidence in those cases in 
which the matter of inquiry is such that inexperienced 
persons are unlikely to prove capable of forming a 
correct judgment upon it . . . . 
 
. . . . 
[W]hile courts will go a long way in admitting expert 
testimony deduced from a well-recognized scientific 
(continued) 
No. 
2014AP195   
 
18 
 
¶54 Professor 
Daniel 
Blinka 
concludes 
that 
Daubert 
"created a reliability standard that is less a bright-line test, 
as it is often assumed to be, and more an evidentiary 
porridge."11  
¶55 The instant case is this court's first occasion to 
apply amended Wis. Stat. § 907.02(1).  We do not write on a 
blank slate.  Wisconsin Stat. § 907.02(1) mirrors Federal Rule 
of Evidence 702 as amended in 2000,12 and we may look for 
                                                                                                                                                             
principle or discovery, the thing from which the 
deduction is made must be sufficiently established to 
have gained general acceptance in the particular field 
in which it belongs. 
10 A law student commentator concluded that the Wisconsin 
Supreme Court nudged the relevancy standard closer to Daubert to 
the point that the relevancy standard became "Daubert lite," 
citing State v. Hibl, 2006 WI 52, ¶52, 290 Wis. 2d 595, 714 
N.W.2d 194 (explaining that circuit courts have a limited 
gatekeeping function because the relevancy test requires a 
showing that the expert's opinion was "reliable enough to be 
probative").  Kristen Irgens, Wisconsin Is Open for Business or 
Business Just as Usual?  The Practical Effects and Implications 
of 2011 Wisconsin Act 2, 2012 Wis. L. Rev. 1245, 1256-57. 
11 Blinka, supra note 5, at 19 ("[The Daubert reliability 
standard] is purportedly more liberal than the once-dominant 
general acceptance test ('too cold') yet more demanding than the 
relevancy standard ('too hot')."). 
The post-Daubert case law indicates that rejecting expert 
testimony is "the exception rather than the rule."  See Federal 
Rule Evidence 702 Advisory Committee Note (2000). 
12 In 2000, the following underlined language was added to 
Federal Rule of Evidence 702 to reflect Daubert:  
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, 
(continued) 
No. 
2014AP195   
 
19 
 
guidance and assistance in interpreting and applying § 907.02(1) 
to the Daubert case and its progeny, to the Advisory Committee 
                                                                                                                                                             
experience, 
training, 
or 
education, 
may 
testify 
thereto in the form of an opinion or otherwise., if 
(1) the testimony is based on sufficient facts or 
data, (2) the testimony is the product of reliable 
principles and methods, and (3) the witness has 
applied the principles and methods reliably to the 
facts of the case.  
Federal Rule of Evidence 702 was also amended in 2011 "as 
part of the restyling of the Evidence Rules to make them more 
easily understood and to make style and terminology consistent 
throughout the rules," but no substantive changes were intended.  
Federal Rule of Evidence 702 Committee Notes (2011).  
Federal Rule of Evidence 702 now provides:   
A witness who is qualified as an expert by knowledge, 
skill, experience, training, or education may testify 
in the form of an opinion or otherwise if: 
(a) the expert's scientific, technical, or other 
specialized knowledge will help the trier of fact to 
understand the evidence or to determine a fact in 
issue; 
(b) the testimony is based on sufficient facts or 
data; 
(c) 
the 
testimony 
is 
the 
product 
of 
reliable 
principles and methods; and 
(d) the expert has reliably applied the principles and 
methods to the facts of the case. 
No. 
2014AP195   
 
20 
 
Notes to Federal Rule of Evidence 702,13 and to federal and state 
cases interpreting the text of Rule 702 or an analogous state 
law.  The federal or state interpretations, however, are not 
necessarily dispositive.14   
¶56 As we have previously noted, the federal reliability 
standard for the admissibility of expert evidence is explained 
in Daubert.  After Daubert, the United States Supreme Court 
decided General Electric Co. v. Joiner, 522 U.S. 136 (1997), and 
Kumho Tire Co., Ltd. v. Carmichael, 526 U.S. 137 (1999).  This 
trilogy of cases delineated the contours of the reliability 
standard.   
¶57 In 
Daubert——a 
products 
liability 
case——the 
Court 
rejected Frye's general acceptance test and concluded that 
Federal Rule of Evidence 702 contemplates that trial courts have 
a 
gatekeeping 
obligation. 
 
This 
gatekeeping 
obligation 
                                                 
13 Under the Rules Enabling Act, 28 U.S.C. § 2072, the 
United States Supreme Court is authorized to promulgate rules of 
practice and procedure for the federal courts.  This authority 
is exercised by the Judicial Conference of the United States.  
The Conference promulgates and changes rules of practice and 
procedure in the federal courts subject to oversight by the 
Court. 
For 
the 
Federal 
Rules 
of 
Evidence, 
the 
Judicial 
Conference is aided in its rule-making powers by the Evidence 
Advisory Committee; the members of and reporter to this 
Committee are appointed by the Chief Justice of the United 
States Supreme Court.  Paul R. Rice and Neals-Erik William 
Delker, Federal Rules of Evidence Advisory Committee: A Short 
History of Too Little Consequence, 191 F.R.D. 678, 679 (2000). 
14 State v. Poly-America, Inc., 164 Wis. 2d 238, 246, 474 
N.W.2d 770 (1991) ("When a state statute is modeled after a 
federal rule, we look to the federal interpretation of that rule 
for guidance and assistance."). 
No. 
2014AP195   
 
21 
 
"assign[s] to the trial court the task of ensuring that a 
scientific expert is qualified" and that his or her "testimony 
both rests on a reliable foundation and is relevant to the task 
at hand."  Daubert, 509 U.S. at 597.   
¶58 In the instant case, the parties challenge the 
reliability of Dr. Wener's expert medical testimony.15 We 
therefore focus our discussion on the reliability prong of Wis. 
Stat. § 907.02(1), specifically the reliability of the methods 
used by Dr. Wener.16  The trial court must be satisfied that the 
testimony is reliable by a preponderance of the evidence.  
Daubert, 509 U.S. at 593; Wis. Stat. § 901.04.   
                                                 
15 The parties do not dispute that Dr. Wener was qualified 
as an expert and that his opinion was relevant in the instant 
case. 
16 Wisconsin Stat. § 907.02(1) states that testimony must be 
based on "reliable principles and methods."  Only Dr. Wener's 
"method" is challenged in the instant case.  For an illustration 
of the difference between principles and methods, the Federal 
Rule of Evidence 702 Advisory Committee Note (2000) gives the 
following illustration:  
For example, when a law enforcement agent testifies 
regarding the use of code words in a drug transaction, 
the principle used by the agent is that participants 
in such transactions regularly use code words to 
conceal the nature of their activities. The method 
used by the agent is the application of extensive 
experience 
to 
analyze 
the 
meaning 
of 
the 
conversations. So long as the principles and methods 
are reliable and applied reliably to the facts of the 
case, this type of testimony should be admitted. 
Several cases tend to collapse principles and methods into 
a singular "reliability" analysis.   
No. 
2014AP195   
 
22 
 
¶59 Daubert makes the trial court a gatekeeper, not a fact 
finder.  When credible, qualified experts disagree, a litigant 
is entitled to have the jury, not the trial court, decide which 
expert to believe.  Dorn v. Burlington N. Santa Fe R.R. Co., 397 
F.3d 1183, 1196 (9th Cir. 2005).17   
¶60 Although the Daubert Court focused its discussion on 
scientific testimony, the Supreme Court later clarified that  
Daubert's inquiry applies not just to scientific evidence, but 
to 
all 
expert 
opinions, 
"whether 
the 
testimony 
reflects 
scientific, technical, or other specialized knowledge."  Kumho 
Tire, 526 U.S. at 149. 
¶61 The 
reliability 
standard 
"entails 
a 
preliminary 
assessment 
of 
whether 
the 
reasoning 
or 
methodology 
is 
scientifically 
valid." 
 
Daubert, 
509 
U.S. 
at 
592-93.  
Reliability depends "solely on principles and methodology, not 
                                                 
17 "Experts often disagree.  A trial court's determination 
that the proffered testimony of one expert witness is reliable 
and helpful does not necessarily mean that the contradictory 
testimony of another witness, concerning the same subject matter 
by using a different methodology, is not also reliable and 
helpful."  4 Jack B. Weinstein, Weinstein's Federal Evidence 
§ 702.05[3] (2d ed. 2011), citing Federal Rule of Evidence 702 
Committee Note (2000). 
"Since its inception, the courts have sought to apply Rule 
702 in a manner that preserves the jury's traditional power to 
weigh evidence and determine witness credibility."  29 Charles 
Alan Wright & Victor Gold, Federal Practice and Procedure: 
Evidence, § 6268.2 (2d ed. 2016), citing DiCarlo v. Keller 
Ladders, Inc., 211 F.3d 465, 468 (8th Cir. 2000).   
No. 
2014AP195   
 
23 
 
on the conclusions that they generate."  Daubert, 509 U.S. at 
595.   
¶62 To guide the reliability analysis, the Daubert court 
provided a nonexhaustive18 list of factors that make scientific 
evidence sufficiently reliable for admission:  "(1) whether the 
methodology can and has been tested; (2) whether the technique 
has been subjected to peer review and publication; (3) the known 
or potential rate of error of the methodology; and (4) whether 
the technique has been generally accepted in the scientific 
community."  Heller v. Shaw Indus., Inc., 167 F.3d 146, 152 (3d 
Cir. 1999), citing Daubert, 509 U.S. at 592-93.  
¶63 The Federal Rules Advisory Committee added five 
factors to those stated in Daubert to guide decisions about 
reliability:   
(1) Whether experts are "proposing to testify about 
matters growing naturally and directly out of research 
they have conducted independent of the litigation, or 
whether they have developed their opinions expressly 
for purposes of testifying.  Daubert v. Merrell Dow 
Pharmaceuticals, Inc., 43 F.3d 1311, 1317 (9th Cir. 
1995). 
(2) Whether the expert has unjustifiably extrapolated 
from an accepted premise to an unfounded conclusion.  
See General Elec. Co. v. Joiner, 522 U.S. 136, 146 
(1997) (noting that in some cases a trial court "may 
conclude that there is simply too great an analytical 
gap between the data and the opinion proffered"). 
                                                 
18 "Many factors will bear on the inquiry, and we do not 
presume to set out a definitive checklist or test."  Daubert, 
509 U.S. at 593. 
No. 
2014AP195   
 
24 
 
(3) Whether the expert has adequately accounted for 
obvious alternative explanations.  
See Claar v. 
Burlington 
N.R.R., 
29 
F.3d 499 
(9th 
Cir. 
1994) 
(testimony 
excluded 
where 
the 
expert 
failed 
to 
consider other obvious causes for the plaintiff's 
condition).  Compare Ambrosini v. Labarraque, 101 
F.3d 129 (D.C. Cir. 1996) (the possibility of some 
uneliminated causes presents a question of weight, so 
long as the most obvious causes have been considered 
and reasonably ruled out by the expert). 
(4) Whether the expert "is being as careful as he 
would be in his regular professional work outside his 
paid litigation consulting."  Sheehan v. Daily Racing 
Form, Inc., 104 F.3d 940, 942 (7th Cir. 1997).  See 
Kumho Tire Co. v. Carmichael, 119 S. Ct. 1167, 1176 
(1999) (Daubert requires the trial court to assure 
itself that the expert "employs in the courtroom the 
same level of intellectual rigor that characterizes 
the practice of an expert in the relevant field"). 
(5) Whether the field of expertise claimed by the 
expert is known to reach reliable results for the type 
of opinion the expert would give.  See Kumho Tire Co. 
v. Carmichael, 119 S. Ct. 1167, 1175 (1999) (Daubert's 
general acceptance factor does not "help show that an 
expert's testimony is reliable where the discipline 
itself lacks reliability, as for example, do theories 
grounded 
in 
any 
so-called 
generally 
accepted 
principles of astrology or necromancy."); Moore v. 
Ashland Chemical, Inc., 151 F.3d 269 (5th Cir. 1998) 
(en banc) (clinical doctor was properly precluded from 
testifying 
to 
the 
toxicological 
cause 
of 
the 
plaintiff's respiratory problem, where the opinion was 
not sufficiently grounded in scientific methodology); 
Sterling v. Velsicol Chem. Corp., 855 F.2d 1188 (6th 
Cir. 1988) (rejecting testimony based on "clinical 
ecology" as unfounded and unreliable)."19 
¶64 Considering the broad range of cases in which expert 
evidence arises, courts have not been constrained by the listed 
                                                 
19 See commentary following the 2000 amendment to Federal 
Rule of Evidence 702.  See also Blinka, supra note 5, at 19.  
No. 
2014AP195   
 
25 
 
factors.  How courts apply these factors necessarily varies case 
by case, expert by expert.  "Too much depends upon the 
particular circumstances of the particular case at issue" to 
impose hard and fast rules.  Kumho Tire, 526 U.S. at 150.   A 
trial 
court 
conducts 
its 
reliability 
analysis 
with 
wide 
latitude.20  Kumho Tire emphasized that the application of the 
Daubert factors is a flexible inquiry:  "[T]he law grants a 
district court the same broad latitude when it decides how to 
determine reliability as it enjoys in respect to its ultimate 
reliability determination."  Kumho Tire, 526 U.S. at 142. 
¶65 Thus, the trial court may consider some, all, or none 
of the factors listed to determine whether the expert evidence 
is reliable.  Federal Rule of Evidence 702 Advisory Committee's 
Note (2000).  
¶66 Because the instant case involves expert medical 
testimony based on a witness's personal experiences, we discuss 
the reliability of expert medical opinion based on the expert's 
personal experiences.  
                                                 
20 "[W]e 
conclude 
that 
the 
trial 
judge 
must 
have 
considerable leeway in deciding in a particular case how to go 
about 
determining 
whether 
particular 
expert 
testimony 
is 
reliable.  That is to say, a trial court should consider the 
specific factors identified in Daubert where they are reasonable 
measures of the reliability of expert testimony."  Kumho Tire 
Co., Ltd. v. Carmichael, 526 U.S. 137, 152 (1999) (emphasis 
added).  "[W]hether Daubert's specific factors are, or are not, 
reasonable measures of reliability in a particular case is a 
matter that the law grants the trial judge broad latitude to 
determine."  Kumho Tire, 526 U.S. at 153.   
No. 
2014AP195   
 
26 
 
¶67 Daubert affirms that experience-based expert evidence 
may pass muster as a method under the reliability requirement.  
Though the Daubert Court stated that "[p]roposed testimony must 
be supported by appropriate validation——i.e., 'good grounds,' 
based on what is known," the Court also stated that the very 
structure of the rules of evidence suggest that experience can 
be "good grounds."  Daubert, 509 U.S. at 590. 
¶68 Daubert's reference to the structure of the rules of 
evidence was a reference to the evidentiary rule that all 
witnesses except experts generally must have firsthand knowledge 
of the events to which they testify.21  The Daubert court 
inferred that this "relaxation of the usual requirement of 
firsthand knowledge . . . is premised on an assumption that the 
expert's opinion will have a reliable basis in the knowledge and 
experience of this discipline."  Daubert, 509 U.S. at 592.  
¶69 Likewise, the Kumho Tire Court explicitly recognized 
that in some cases, "the relevant reliability concerns will 
focus upon personal knowledge or experience."  Kumho Tire, 526 
U.S. at 150.   
¶70 In Kumho Tire, the United States Supreme Court 
specifically 
addressed 
the 
application 
of 
the 
Daubert 
reliability analysis to experience-based, non-scientific expert 
testimony.  The Court required a witness relying on experience 
                                                 
21 Compare Federal Rule of Evidence 701 (firsthand knowledge 
requirement for witnesses) with Federal Rule of Evidence 703 (no 
firsthand knowledge requirement for experts). 
No. 
2014AP195   
 
27 
 
to offer some articulated rationale supporting his or her 
opinion.  This Kumho Tire requirement is not "impossibly 
demanding."22   
¶71 The Kumho Tire Court recognized that "there are many 
different kinds of experts, and many different kinds of 
expertise," Kumho Tire, 526 U.S. at 150, so the factors set 
forth in Daubert and Kumho Tire "may or may not be pertinent in 
assessing reliability, depending on the nature of the issue, the 
expert's 
particular 
expertise, 
and 
the 
subject 
of 
his 
testimony."  Kumho Tire, 526 U.S. at 150.   
¶72 The Kumho Tire Court emphasized that in the case of a 
non-scientific expert, "the relevant reliability concerns may 
focus upon personal knowledge or experience." Kumho Tire, 536 
U.S. at 150.  The point, according to Kumho Tire, is to ensure 
that an expert, "whether basing testimony upon professional 
studies or personal experience, employs in the courtroom the 
same level of intellectual rigor that characterizes the practice 
of an expert in the relevant field."  Kumho Tire, 526 U.S. at 
152.23  
                                                 
22 Blinka, supra note 5, at 61 
23 See also Rosen v. Ciba-Geigy Corp., 78 F.3d 316, 318 (7th 
Cir. 1996) (The purpose of the rule announced in Daubert "was to 
make sure that when scientists testify in court they adhere to 
the same standards of intellectual rigor that are demanded in 
their professional work.").  
(continued) 
No. 
2014AP195   
 
28 
 
¶73 The Federal Advisory Committee Note to the 2000 
Amendment to Rule 702 also recognizes that expert evidence based 
on personal experiences can meet the reliability test and offers 
the following general guidance for evaluating experience-based 
testimony: 
If the witness is relying solely or primarily on 
experience, then the witness must explain how that 
experience leads to the conclusion reached, why that 
experience is a sufficient basis for the opinion, and 
how that experience is reliably applied to the facts.24  
 
¶74 The trial court's gatekeeping function in regard to 
experience-based testimony, however, "requires more than simply 
'taking the expert's word for it.'"25   
¶75 An expert cannot establish that a fact is generally 
accepted merely by saying so.26  Trial courts do not have "to 
admit opinion evidence that is connected to existing data only 
by the ipse dixit of the expert."  Such an application is 
                                                                                                                                                             
"Kumho at least made it clear that, in addition to gauging 
reliability in light of factors specific to the area of 
expertise involved, a trial court also may consider whether the 
expert's testimony holds together based on logic and common 
sense."  29 Wright & Gold, supra note 17, § 6267.  
24 Federal Rule of Evidence 702 Advisory Committee Note 
(2000). 
25 Federal Rule of Evidence 702 Advisory Committee Note 
(2000). 
26 "A supremely qualified expert cannot waltz into the 
courtroom and render opinions unless those opinions are based 
upon some recognized scientific method and are reliable and 
relevant under the test set forth by the Supreme Court in 
Daubert."  Clark v. Takata Corp., 192 F.3d 750, 759 n.5 (7th 
Cir. 1999). 
No. 
2014AP195   
 
29 
 
unreliable because "there is simply too great an analytical gap 
between the data and the opinion offered."  Gen. Elec. Co. v. 
Joiner, 522  U.S. 136, 146 (1997).  
¶76 Thus, for example, a federal district court excluded 
proffered expert testimony because the witness's experience was 
not extensive enough to indicate reliability for testimony based 
on personal experience.  The expert's "sample size" (himself 
alone) was too small:    
Essentially, his proposed testimony boils down to the 
conclusion that because he has been able to perform 
police work successfully despite his monocular vision, 
then the Plaintiff will likewise be successful.  This 
is a leap of faith that the Court is unwilling to 
make, 
as 
there 
is 
nothing 
inherent 
about 
[the 
witness's] own personal experience as a monocular 
visioned person which logically or scientifically 
leads to a supportable conclusion that other persons 
with monocular vision necessarily, or even probably, 
would have the same abilities that he has.   
Trevino 
v. 
City 
of 
Rock 
Island 
Police 
Dep't, 
91 
F. Supp. 2d 1204, 1207 (C.D. Ill. 2000).27   
¶77 Case 
law 
demonstrates, 
nonetheless, 
that 
courts 
frequently admit experience-based testimony, especially when 
                                                 
27 Even when expert testimony relies on adequate principles, 
trial 
courts 
may 
still 
exclude 
the 
testimony 
when 
the 
methodology used to reach a conclusion based on those principles 
is unsupported.  McGovern ex rel. McGovern v. Brigham & Women's 
Hosp., 584 F. Supp. 2d 418, 425-26 (D. Mass. 2008) (excluding 
expert's "opinion [that was] was connected to existing data 
about the risk of stroke after vacuum extraction only by his own 
ipse dixit.").  The reliability standard requires an explanation 
of how the methodology used by the expert is derived from the 
witness's 
experience 
and 
led 
to 
the 
conclusion 
reached. 
McGovern, 384 F. Supp. 2d at 426. 
No. 
2014AP195   
 
30 
 
expert medical evidence is offered.  Expert medical opinion 
based on experience alone, "or experience in conjunction with 
other knowledge, skill, training or education" may constitute a 
reliable basis.28  "In certain fields, experience is the 
predominant, if not sole, basis for a great deal of reliable 
expert testimony."29   
¶78 Medicine is an example of such a field because 
medicine 
"is 
based 
on 
specialized 
as 
distinguished 
from 
scientific 
knowledge."30 
 
When 
evaluating 
specialized 
or 
technical expert opinion testimony, "the relevant reliability 
concerns may focus upon personal knowledge or experience."  
Kumho Tire, 526 U.S. at 150.   
¶79 The classic medical school texts explain that medicine 
is scientific but not entirely a science.31  "Medicine is not a 
science but a learned profession, deeply rooted in a number of 
sciences and charged with the obligation to apply them for man's 
benefit."32  Much of medical decision-making relies on judgment 
                                                 
28 Blinka, supra note 5, at 60 (quoting Federal Rule of 
Evidence 702 Advisory Committee Note (2000)). 
29 Federal Rule of Evidence 702 Advisory Committee Note 
(2000). 
30 Sullivan v. U.S. Dep't of the Navy, 365 F.3d 827, 834 
(9th Cir. 2004). 
31 Primiano v. Cook, 598 F.3d 558, 565 (9th Cir. 2010). 
32 Primiano v. Cook, 598 F.3d at 565 (quoting the "classic 
medical school text" Cecil Textbook of Medicine 1 (James B. 
Wyngaarden & Lloyd H. Smith Jr. eds., 17th ed. 1985)). 
No. 
2014AP195   
 
31 
 
and is difficult to quantify or even to assess qualitatively.  
In medicine, "knowledge is often uncertain," "[t]he human body 
is complex," and "etiology is often uncertain."33  Furthermore, 
practical and ethical concerns prevent "studies calculated to 
establish statistical proof."34  Physicians must use their 
knowledge and experience as a basis for weighing known factors 
along with "inevitable uncertainties" to "mak[e] a sound 
judgment."35 
¶80 That Daubert lends its analysis more favorably to more 
objective sciences does not bar the testimony of physicians 
applying their experience and clinical methods.36  That the 
knowledge is uncertain "does not preclude the introduction of 
                                                 
33 United States v. Sandoval-Mendoza, 472 F.3d 645, 655 (9th 
Cir. 2006). 
34 Sandoval-Mendoza, 472 F.3d at 655. 
35 Primiano, 598 F.3d at 565 (quoting the "classic medical 
school text" Harrison's Principles of Internal Medicine 3 
(Dennis L. Kasper et al. eds., 16th ed. 2005)). 
36 See, e.g., 29 Wright & Gold, supra note 17, § 6269.8 
(medical expert "opinion[s] also may be based on extensive 
personal observations, professional experience, education, and 
training even where the medical expert has not conducted an 
epidemiological study and even where the expert's opinion is not 
generally 
accepted 
and 
is 
unsupported 
by 
peer 
review"); 
Sandoval-Mendoza, 472 F.3d at 656 (a well qualified physician 
with 
sufficient 
expertise 
could 
reliably 
testify 
about 
defendant's brain tumor to establish an entrapment defense); 
Primiano, 598 F.3d at 568 (abuse of discretion to exclude 
doctor's testimony in products liability case based on his 
experiences alone, but noting that medical literature had not 
addressed a similar situation). 
No. 
2014AP195   
 
32 
 
medical expert opinion testimony when medical knowledge permits 
the assertion of a reasonable opinion."37   
¶81 "A trial court should admit medical expert testimony 
if physicians would accept it as useful and reliable."38  In 
other words, expert medical opinion testimony is reliable if the 
knowledge underlying it "has a reliable basis in the knowledge 
and experience of the [relevant] discipline."39  
¶82 In Schneider ex rel. Estate of Schneider v. Fried, 320 
F.3d 396, 406 (3d Cir. 2003), the federal Third Circuit Court of 
Appeals explained that a physician's "experience render[ed] his 
testimony reliable [and] demonstrate[d] that his testimony [was] 
based on 'good grounds.'"  In light of his considerable 
professional experience, the physician's testimony on the 
standard of care was reliable, even if the content of the 
literature cited was irrelevant.  The federal court of appeals 
                                                 
37 Sandoval-Mendoza, 472 F.3d at 655 (internal quotation 
marks & quoted source omitted). 
38 Sandoval-Mendoza, 472 F.3d at 655. 
39 Sandoval-Mendoza, 472 F.3d at 655 (quoting Kumho Tire, 
526 U.S. at 149 (quoting Daubert, 509 U.S. 579, 592)); Zuchowicz 
v. United States, 140 F.3d 381 (2d Cir. 1998) (district court 
had discretion to admit opinions of clinical medical experts 
about cause of plaintiff's disease because they were based on 
methods reasonably relied on by clinical physicians, even though 
the drug had not been previously linked to that disease).   
"In a non-scientific context, the reliability of an 
expert's methodology often will be a function of accepted 
practice in the area of expertise in question."  29 Wright & 
Gold, supra note 17, § 6268.1.       
No. 
2014AP195   
 
33 
 
concluded that the magistrate judge abused his discretion by 
excluding the expert testimony.40   
¶83 The Schneider court stated that expert testimony does 
not have to be subject to peer review to be admitted under Rule 
702; the physician's experience renders his or her testimony 
reliable and demonstrates that the testimony is based on good 
grounds.41  The court recognized, however, that the degree to 
which the medical expert is qualified implicates the reliability 
of the testimony.  Schneider, 320 F.3d at 406.  
¶84 Similarly, the federal Sixth Circuit Court of Appeals 
held that a district court abused its discretion by excluding a 
physician's testimony based on extensive, relevant experience 
when the physician had not cited medical literature supporting 
                                                 
40 Schneider ex rel. Estate of Schneider v. Fried, 320 
F.3d 396 (3rd Cir. 2003), involved a claim that a decedent 
received cardiac care that fell below the standard of care.  The 
court provided the following discussion in regard to this 
expert:   
The 
record 
establishes 
that 
as 
an 
invasive 
cardiologist, who normally diagnoses heart conditions, 
Dr. Semigran was routinely present during surgical 
procedures 
and 
regularly 
advised 
interventional 
cardiologists during the course of those procedures.  
Dr. Semigran also testified that he would consult with 
interventional cardiologists about which drugs should 
or 
should 
not 
be 
given 
to 
patients 
undergoing 
angioplasties.   
Schneider, 320 F.3d at 406. 
41 Daubert, 509 U.S. at 590 ("Proposed testimony must be 
supported 
by 
appropriate 
validation——i.e., 
good 
grounds . . . ."). 
No. 
2014AP195   
 
34 
 
his view.  Dickenson v. Cardiac & Thoracic Surgery of E. Tenn., 
388 F.3d, 976, 980 (6th Cir. 2004).  Requiring an expert to 
demonstrate a familiarity with accepted medical literature or 
published standards in order for the testimony to be reliable in 
the sense contemplated by Federal Rule of Evidence 702 is an 
erroneous statement of the law.  Dickenson, 388 F.3d at 980-81  
(citing Federal Rule of Evidence 702, Advisory Committee Note 
expressly contemplating that an expert may testify on the basis 
of experience).42 
                                                 
42 Kumho Tire, 526 U.S. 137, 156 ("[N]o one denies that an 
expert might draw a conclusion from a set of observations based 
on extensive and specialized experience."); Feliciano-Hill v. 
Principi, 439 F.3d 18, 24-25 (1st Cir. 2006) (physician's expert 
testimony met Daubert/Rule 702 standards even though he failed 
to 
support 
his 
diagnosis 
with 
citations 
to 
published 
authorities; physician offered a "routine diagnosis" on patient 
he had examined, related to common condition well within his 
expertise); Bonner v. ISP Techs., Inc., 259 F.3d 924, 929 (8th 
Cir. 2001) ("There is no requirement that a medical expert must 
always cite published studies on general causation in order to 
reliably conclude that a particular object caused a particular 
illness." (internal quotation marks & quoted source omitted)). 
(continued) 
No. 
2014AP195   
 
35 
 
¶85 The case law teaches that Daubert's role of ensuring 
that the courtroom door remains closed to junk science is not 
served by excluding medical expert testimony that is supported 
by extensive relevant medical experience.43  Such exclusion is 
rarely justified in cases involving medical experts.  Dickenson, 
388 F.3d at 981.  See also Daniel W. Shuman, Expertise in Law, 
Medicine, and Health Care, 27 J. Health Pol., Pol'y & L. 267 
                                                                                                                                                             
The defendants cite several cases for the proposition that 
to offer reliable testimony, Dr. Wener should have based his 
testimony on medical literature.  The cases are distinguishable 
from the instant case.  For example, although the court noted in 
Berk 
v. 
St. 
Vincent's 
Hospital 
& 
Medical 
Center, 
380 
F. Supp. 2d 334 (S.D.N.Y. 2005), that the excluded expert cited 
"no germane medical literature," the expert's report was 
excluded for other reasons:  the expert's report was unsworn, 
was based on incorrect factual assumptions, and offered no 
methodology 
other 
than 
the 
expert's 
say-so. 
 
Berk, 
380 
F. Supp. 2d at 354-56.  In contrast, Dr. Wener's testimony was 
given under oath; Dr. Wener relied on Braylon's and his mother's 
medical reports; Dr. Wener offered a clinical methodology that 
applied accepted risk factors to the facts of the instant case; 
and the defendants' experts offered testimony that actually 
supported Dr. Wener's testimony.  
43 The phrase "junk science" is ordinarily used as an 
epithet to refer to research or information that is not 
credible.  See Kumho Tire, 526 U.S. at 159 (Scalia, J., 
concurring) (Kumho makes clear that the discretion it endorses 
is "discretion to choose among reasonable means of excluding 
expertise that is fausse and science that is junky.").    
No. 
2014AP195   
 
36 
 
(2001) (characterizing the effect of Daubert and Kumho cases on 
claims of medical expertise as "much ado about little").44    
¶86 Instead 
of 
exclusion, 
the 
appropriate 
means 
of 
attacking "shaky but admissible" experience-based medical expert 
testimony is by "[v]igorous cross-examination, presentation of 
contrary evidence, and careful instruction on the burden of 
proof . . . ."  Daubert, 509 U.S. at 597.  
                                                 
44 The Wisconsin Medical Society and American Medical 
Association filed an amicus brief urging that this court 
"recognize that medical opinions supported by unsystematic 
clinical 
observations 
have 
reliability 
limited 
to 
those 
situations where physicians would not be expected to produce 
extrinsic support for their contentions but presumptively fail 
to cross the Daubert reliability threshold when tendered to 
establish the standard of care in a medical negligence claim." 
See Brief of Amicus Curiae Wisconsin Medical Society & American 
Medical Association at 9-10.     
This argument is not supported in the case law.  Expecting 
on-point medical literature to define a physician's standard of 
care in the penumbra of clinical situations is unreasonable.  
See Michelle M. Mello, Using Statistical Evidence to Prove the 
Malpractice Standard of Care: Bridging Legal, Clinical, and 
Statistical Thinking, 37 Wake Forest L. Rev. 821, 857 (2002).  
The author states:   
For clinical scenarios involving a high degree of 
independent judgment and careful attention to the 
individual characteristics of each patient, expert 
opinion testimony tailored to the particular situation 
at issue in the malpractice case truly does have an 
advantage over reliance on practice guidelines or 
other standards formulated ex ante[,] . . . derived 
from a population of patients that may not resemble 
the plaintiff . . . . 
Id. at 846. 
No. 
2014AP195   
 
37 
 
Once evaluated and deemed sufficiently reliable for 
admission, that expert opinion [based on personal 
experience] is submitted to the "capabilities of the 
jury and of the adversary system generally." 
Lapsley v. Xtek, Inc., 689 F.3d 802, 810 (7th Cir. 2012) (citing 
Daubert, 509 U.S. at 596).45   
E 
 
¶87 Our next task is to determine the standard for 
reviewing the circuit court's gatekeeping determination under 
Wis. Stat. § 907.02(1).  We refer to federal law to guide our 
analysis of the standard for review. 
¶88 We 
examine 
the 
circuit 
court's 
rulings 
both 
independently as a question of law and also under the erroneous 
exercise of discretion standard.       
¶89 The interpretation and application of a statute 
presents 
a 
question 
of 
law 
that 
this 
court 
decides  
independently of the circuit court and court of appeals but 
benefiting from their analyses.  State v. Steffes, 2013 WI 53, 
¶15, 347 Wis. 2d 683, 832 N.W.2d 101.  It follows that this 
court decides whether the circuit court applied the proper legal 
standard under Wis. Stat. § 907.02(1) in the first instance 
independently of the circuit court and the court of appeals but 
benefiting from their analyses.  Lees v. Carthage College, 714 
F.3d 516, 520 (7th Cir. 2013) ("[w]hether the district court 
                                                 
45 "Shaky but admissible evidence is to be attacked by cross 
examination, contrary evidence, and attention to burden of 
proof, not exclusion."  Primiano, 598 F.3d at 564 (citing 
Daubert, 509 U.S. at 596). 
No. 
2014AP195   
 
38 
 
applied the appropriate legal framework for evaluating expert 
testimony is reviewed de novo"); Lewis v. CITGO Petroleum Corp., 
561 F.3d 698, 705 (2009) ("we review de novo whether the court 
employed 
the 
correct 
legal 
standard 
in 
reaching 
its 
admissibility decision").  
¶90 Once satisfied that the circuit court applied the 
appropriate legal framework, an appellate court reviews whether 
the 
circuit 
court 
properly 
exercised 
its 
discretion 
in 
determining which factors should be considered in assessing 
reliability,46 and in applying the reliability standard to 
determine whether to admit or exclude evidence under Wis. Stat. 
§ 907.02(1).  Gen. Elec. Co. v. Joiner, 522 U.S. 136, 141 
(1997).47  
¶91 Once the circuit court selects the factors to be 
considered in assessing reliability, the circuit court measures 
the expert evidence against these factors.  The circuit court 
also determines whether the witness faithfully and properly 
applied the reliability principles and methodology to the facts 
of the case.48     
                                                 
46 Blinka, supra note 5, at 19 (citing Kumho Tire, 526 U.S. 
at 152). 
47 "[T]he law grants the district court great discretion 
regarding the manner in which it conducts that evaluation" of 
the admissibility of expert testimony.  "[W]e have not required 
that the Daubert inquiry take any specific form . . . ."  Lewis 
v. CITGO Petroleum Corp., 561 F.3d 698, 704 (2009). 
48 Blinka, supra note 5, at 19, 60 (citing Federal Rule 
Evidence 702 Advisory Committee Note (2000)).   
No. 
2014AP195   
 
39 
 
¶92 In other words, a circuit court has discretion in 
determining the reliability of the expert's principles, methods, 
and the application of the principles and methods to the facts 
of the case.49 
¶93 A trial court's decision on admissibility or exclusion 
of expert evidence is an erroneous exercise of discretion when a 
decision rests upon a clearly erroneous finding of fact, an 
erroneous conclusion of law, or an improper application of law 
to fact.50   
                                                 
49 In Kumho Tire, the Supreme Court held that trial courts 
have great latitude in determining the methods by which they 
test the reliability of expert testimony.  Indeed the federal 
abuse of discretion standard "applies as much to the trial 
court's decisions about how to determine reliability as to its 
ultimate conclusion."  United States v. Charley, 189 F.3d 1251, 
1261 n.11 (10th Cir. 1999) (quoting Kumho Tire, 526 U.S. at 
152).  "[T]he law grants a district court the same broad 
latitude when it decides how to determine reliability as it 
enjoys in respect to its ultimate reliability determination."  
Kumho Tire, 526 U.S. at 142.  See also Gen. Elec. Co. v. Joiner, 
522 U.S. 136, 146 (1997) ("abuse of discretion is the proper 
standard by which to review a district court's order to admit or 
exclude scientific evidence."). 
"Our case law has recognized that experts in various fields 
may rely properly on a wide variety of sources and may employ a 
similarly wide choice of methodologies in developing an expert 
opinion."  Cooper v. Carl A. Nelson & Co., 211 F.3d 1008, 1020 
(7th Cir. 2000).  
50 The federal cases state:  "An abuse of discretion may 
occur as a result of an errant conclusion of law, an improper 
application of law to fact, or a clearly erroneous finding of 
fact."  McDowell v. Philadelphia Housing Auth., 423 F.3d 233, 
238 (3d Cir. 2005).  
(continued) 
No. 
2014AP195   
 
40 
 
F 
¶94 Against this backdrop of the teachings about the 
reliability of expert medical testimony based on personal 
experiences and the standards for appellate review of a circuit 
court's determination of reliability, we decide whether the 
circuit court erred in admitting Dr. Wener's testimony.  We 
conclude, as did the court of appeals, that the circuit court 
did not erroneously exercise its discretion in admitting Dr. 
Wener's testimony as reliable under Wis. Stat. § 907.02(1).  
¶95 In the first instance, we note, as a matter of law, 
that the circuit court applied the proper reliability standard 
under Wis. Stat. § 907.02(1).  
                                                                                                                                                             
In Wisconsin, the cases use the phrase "erroneous exercise 
of discretion" in place of the phrase "abuse of discretion."  
The two phrases are equivalent.  We did not change the standard 
of review, just the locution.  We concluded that the term "abuse 
of discretion" carries unjustified negative connotations.  City 
of 
Brookfield 
v. 
Milwaukee 
Metro. 
Sewerage 
Dist., 
171 
Wis. 2d 400, 423, 491 N.W.2d 484, 493 (1992).  See King v. King, 
224 Wis. 2d 235, 248, 590 N.W.2d 480 (1999) ("A circuit court 
erroneously exercises its discretion if it makes an error of law 
or neglects to base its decision upon facts in the record."); 
Hartung v. Hartung, 102 Wis. 2d 58, 66, 306 N.W.2d 16 (1981): 
A discretionary determination . . . must demonstrably 
be made and based upon the facts appearing in the 
record[,] 
in 
reliance 
on 
the 
appropriate 
and 
applicable 
law[,] . . . and 
most 
importantly, 
a 
discretionary determination must be the product of a 
rational mental process by which the facts of record 
and law relied upon are stated and are considered 
together for the purpose of achieving a reasoned and 
reasonable determination. 
No. 
2014AP195   
 
41 
 
¶96 Because the circuit court applied the correct Daubert 
reliability standard, our review of the circuit court's decision 
to admit Dr. Wener's testimony is limited to reviewing whether 
the circuit court erroneously exercised its discretion.  See 
Cipollone v. Yale Indus. Prods., Inc., 202 F.3d 376, 380 (1st 
Cir. 2000).     
¶97 The circuit court made a good, clear record.  Based on 
the circuit court's extensive oral rulings on the admissibility 
of Dr. Wener's testimony as reliable, it is apparent that the 
circuit court examined federal and state case law applying the 
Daubert 
standard 
to 
medical 
expert 
testimony 
and 
fairly 
considered the defendants' challenges to the admissibility of 
Dr. Wener's testimony.   
¶98 Because the circuit court was careful in exploring the 
applicable law and in setting out its reasoning, we can more 
easily review the circuit court's rulings to determine whether 
the circuit court erroneously exercised its discretion.  We 
commend the circuit court's efforts and conclude that the 
circuit court's rulings establishing that Dr. Wener's personal 
clinical experiences satisfy the reliability requirement, are 
well reasoned, and are not an erroneous exercise of discretion. 
¶99 The defendants make the following three principal 
arguments supporting their position that Dr. Wener's testimony 
was unreliable under Wis. Stat. § 907.02(1) and was not applied 
reliably: 
(1) Dr. Wener's testimony was unreliable under Wis. Stat. 
§ 907.02(1) because Dr. Wener did not apply a sound 
No. 
2014AP195   
 
42 
 
methodology: Dr. Wener's testimony rested on his 
qualifications and "personal preferences."     
(2) Dr. Wener's testimony was unreliable under Wis. Stat. 
§ 907.02(1) because Dr. Wener did not rely on medical 
literature or other recognized sources of reliability. 
(3) Dr. Wener's application of his opinions to the facts 
of the case was flawed because Dr. Wener's testimony 
was internally inconsistent.  
¶100 We address each of the defendants' arguments in turn. 
(1) 
¶101 To use defendants' counsel's words, the defendants' 
challenge to Dr. Wener's testimony is based on "method, method, 
method."   
¶102 The circuit court ruled that Dr. Wener's testimony 
satisfied the Wis. Stat. 
§ 907.02(1) reliability standard 
because his methodology was reliable:  Dr. Wener's methodology 
is a "classic medical methodology," looking at recognized 
medical indicators.  
¶103 The 
circuit 
court 
explained 
that 
Dr. 
Wener's 
testimony, taken as a whole, demonstrated that Dr. Wener 
formulated an opinion about the standard of reasonable care of 
family practice doctors practicing obstetrics on the basis of 
his 
experiences, 
as 
opposed 
to 
simply 
his 
own 
personal 
preference.  Thus, Dr. Wener had a reliable basis for rendering 
an opinion.  
¶104 In contrast, the defendants contend that Dr. Wener was 
really just opining based on his "personal preferences."  The 
No. 
2014AP195   
 
43 
 
defendants assert that an expert cannot establish that a fact is 
generally accepted merely by saying so.  They argue that Dr. 
Wener's testimony had to be based on the methods and procedures 
of science rather than on his subjective belief or unsupported 
speculation.  According to the defendants, Dr. Wener's opinion 
about the standard of reasonable care was connected to existing 
data only by his own ipse dixit.  
¶105 The circuit court regarded Dr. Wener's methods as the 
ordinary methodology of medicine: conscientious use of the 
thousands of instances in which he had delivered babies and made 
decisions about the care of individual patients and his teaching 
and hospital experiences relating to obstetrics.  Echoing case 
law, the circuit court declared that medicine is "not a science, 
but a learned profession deeply rooted in a number of sciences."  
¶106 The circuit court viewed Dr. Wener's methodology as 
essentially 
a 
comparison 
of 
the 
instant 
case 
to 
other 
deliveries, reasoning that the Daubert factors were not helpful 
in evaluating this methodology because a medical expert's 
personal 
clinical 
experience 
is 
not 
subject 
to 
precise 
measurements.  "[B]ecause the standard of care is determined by 
the care customarily provided by other physicians, it need not 
be 
scientifically 
tested 
or 
proven 
effective . . . ."  
Palandjian v. Foster, 842 N.E.2d 916, 921 (Mass. 2006). 
¶107 Dr. Wener gave ample testimony about what a family 
practice doctor practicing obstetrics should have known and how 
a family practice doctor practicing obstetrics should have acted 
in the instant case.  Dr. Wener's testimony about the standard 
No. 
2014AP195   
 
44 
 
of reasonable care of family practice doctors practicing 
obstetrics was based on his knowledge of family practice doctors 
practicing obstetrics gained through education, his decades of 
delivering thousands of babies, his repeated observations in 
decades of clinical experiences, and his numerous teaching and 
supervisory experiences in important positions in the field of 
obstetrics and gynecology.  He used his many experiences to 
arrive at an opinion in the instant case that is sufficiently 
similar to his vast array of clinical experiences over decades 
of practice. 
¶108 Dr. Wener demonstrated to the circuit court that he 
had formed an opinion about the standard of reasonable care of a 
family practice doctor practicing obstetrics and that the 
opinion had a reliable basis.  
¶109 The circuit court concluded on the basis of the record 
and case law that it had adequate grounds to view Dr. Wener's 
testimony as not subjective belief, unsupported conjecture, or 
ipse dixit.  The circuit court ruled that Dr. Wener's 
methodology was reliable based on Dr. Wener's extensive personal 
experiences.  In other words, Dr. Wener's testimony was based on 
"good grounds."  Daubert, 509 U.S. at 590. 
¶110 Characterizing its pretrial decision as "a close 
call," and looking at the vagaries of medical treatment and 
diagnosis, 
the 
circuit 
court 
concluded 
that 
Dr. 
Wener's 
testimony was "reliably based on a reliable medical methodology 
looking at recognized factors of the standard of care."  
No. 
2014AP195   
 
45 
 
¶111 The circuit court declared that Dr. Wener looked at 
recognized risk factors and, using his own varied experiences, 
concluded that the defendant doctor breached the standard of 
reasonable care by failing to weigh these risk factors.  
According to the circuit court, Dr. Wener used his knowledge and 
experience as a basis for weighing known factors along with the 
inevitable uncertainties to make a sound judgment.  Dr. Wener's 
testimony was not based on his personal preference, ruled the 
circuit court; it was based on clinical experience, a reliable 
methodology.  
¶112 The circuit court determined that the way in which Dr. 
Wener "adds [the factors up] is debatable, but that's not the 
same as saying the way that Dr. Wener adds them up is not 
reliable."  According to the circuit court, Dr. Wener explained 
the bases for his opinions in sufficient detail to permit the 
jury to evaluate his conclusions. 
¶113 The circuit court obviously relied on Daubert case law 
in making its determination of reliability and used the language 
and reasoning set forth in the case law to rule on the 
reliability and admissibility of Dr. Wener's expert medical 
testimony based on personal experiences.   
¶114 The circuit court regarded the defendants' contention 
that Dr. Wener's opinions are unreliable because they are 
untestable as failing from the outset.  According to Daubert, 
testability is not a prerequisite to admission.  Testability, 
like all of the Daubert factors, is a suggested way to assess 
methodology, not a required way to assess methodology.   
No. 
2014AP195   
 
46 
 
¶115 The circuit court ruled that Dr. Wener's testimony was 
testable and met the Wis. Stat. § 907.02(1) standard.  The 
circuit court reasoned that "the testable principles[ ] are the 
biological and physiological and anatomical principles that 
inform the conclusions that arise."  
¶116 The circuit court also explained that the defendants 
could (and did) test Dr. Wener's testimony through cross 
examination, further explaining that although "medicine is a 
science, it is not a quantified science.  It is not a 
measurement, in many respects.  It is not engineering."        
¶117 The 
circuit 
court 
further 
compared 
Dr. 
Wener's 
testimony with the testimony of defense experts, including Dr. 
Michelle Grimm, a defense expert on medical engineering, and Dr. 
Dwight Jonathan Rouse, an obstetrician with additional training 
in maternal fetal medicine.       
¶118 According to the circuit court, some defense expert 
testimony actually supported Dr. Wener's testimony.  For 
example, both Dr. Wener and the defense expert witnesses 
testified that applying excessive traction beyond what the fetus 
can withstand during childbirth violates the standard of 
reasonable care.   
¶119 Accordingly, the circuit court declared that the 
context of the entire case supported admitting Dr. Wener's 
testimony as reliable:  
[A]fter the trial there is a lot more context within 
which to analyze the issues in respect to Dr. Wener's 
testimony. 
No. 
2014AP195   
 
47 
 
. . . .  
And I still believe that Dr. Wener's testimony met the 
Daubert 
standards 
as 
that 
applies 
to 
medical 
testimony. 
. . . . 
And after trial, Dr. Werner's position looked every 
bit as good, and better, than it did pretrial when the 
context of the other experts, Grimm and Rouse, 
particularly, was taken into account. And so I stand 
on my prior rulings as to Dr. Wener as supplemented 
here today with what we know after trial.  His 
testimony was properly admitted, to the extent it was 
admitted. 
¶120 In sum, the circuit court ruled that Dr. Wener's 
principles 
and 
methods 
were 
sufficiently 
reliable 
to 
be 
admitted, emphasizing that Dr. Wener's testimony, although 
shaky, is not junk science and that Dr. Wener is not a junk 
scientist:  
Dr. 
Wener's 
opinions 
are 
shaky 
due 
to 
their 
generality, but I conclude that they are sufficiently 
reliable to be admitted.  The methodology employed is 
what I will call, I guess, holistic.  The defense 
motion parses out the various factors and how they 
don't match a body of opinion about that particular 
factor. . . . [T]he essence of Dr. Wener's opinion [is 
that] these elements converge and then the sum is 
greater than the total of the parts, essentially.  
It's not something that's been peer reviewed or 
published because it's an individualized determination 
based upon the facts of this case, and in using known 
factors. 
¶121 We conclude, as did the court of appeals, that the 
circuit court did not erroneously exercise its discretion when 
it concluded that the Daubert factors were not helpful and that 
Dr. Wener's clinical methodology rendered his expert medical 
No. 
2014AP195   
 
48 
 
testimony on the standard of reasonable care based on his 
personal experiences reliable under Wis. Stat. § 907.02(1). 
¶122 Dr. Wener's opinion based on his personal experiences 
satisfied the reliability standard.  He identified established 
risk factors (principles).  He then used classic, ordinary 
medical methods to establish the standard of care of a family 
practice doctor practicing obstetrics and to opine that the 
defendant doctor breached this standard.   
¶123 In the instant case, the reliability standard entails 
the circuit court's assessment of methodology.  In expert 
medical evidence, the methodology often relies on judgment based 
on the witness's knowledge and experience.  Accordingly, 
reliability concerns may focus on the personal knowledge and 
experience of the medical expert witness.  Dr. Wener's testimony 
was based on his knowledge of and experience with obstetrics and 
family practice doctors practicing obstetrics.  He gained his 
knowledge through education, his decades of delivering thousands 
of babies, his repeated observations during decades of clinical 
experiences, 
and 
his 
numerous 
teaching 
and 
supervisory 
experiences in the fields of obstetrics and gynecology.  Because 
Dr. Wener applied an accepted medical method relied upon by 
physicians and had extensive personal experiences and knowledge 
pertaining to the standard of reasonable care, the circuit court 
did not erroneously exercise its discretion in admitting his 
testimony.       
(2) 
No. 
2014AP195   
 
49 
 
¶124 The defendants argue that Dr. Wener's testimony was 
mere speculation because it was not supported by even one peer 
reviewed publication or medical text.  The defendants correctly 
contend, as we stated previously, that an expert cannot 
establish that a fact is generally accepted merely by saying so.   
¶125 With respect to the defendants' arguments that Dr. 
Wener's testimony was not reliable because he did not rely on 
medical literature, the circuit court concluded that Dr. Wener's 
approach is "not something that's been peer reviewed or 
published because it's an individualized determination based 
upon the facts of this case, and in using known factors" such as 
estimated maternal weight, fetal weight, and glucose levels.   
¶126 Indeed, on cross-examination Dr. Wener said he was 
aware of the medical literature but that there was a wide range 
of statistics in the literature so that the publications were 
not helpful and did not directly contradict his testimony. 
¶127 For example, Dr. Wener concluded that, considering all 
of the risk factors in totality, the defendant doctor breached 
the standard of reasonable care by failing to order a three-hour 
glucose test after the one-hour test's result exceeded 130 
mg/dL.  The defendants, citing American College of Obstetricians 
and 
Gynecologists, 
Clinical 
Management 
Guidelines 
for 
Obstetrician-Gynecologists No. 30 (Sept. 2001) (reaffirmed 2008) 
[hereinafter Guidelines], argued that Dr. Wener's opinion was 
erroneous because the Guidelines suggest that the reasonable 
standard of care requires a three-hour test when the mother's 
one-hour test result exceeds 140 mg/dL.  The publication notes, 
No. 
2014AP195   
 
50 
 
however, that either the 130 or 140 mg/dL "threshold is 
acceptable."  Guidelines at 762.  Furthermore, the publication 
expressly states that it does not prescribe a standard of care:  
"These guidelines should not be construed as dictating an 
exclusive course of treatment or procedure.  Variations in 
practice may be warranted based on the needs of the individual 
patient, resources, and limitations unique to the institution or 
type of practice."  Guidelines at 759.  Dr. Wener's testimony 
did not directly contradict the guidelines.  
¶128 The circuit court did not bar Dr. Wener's testimony on 
the ground that Dr. Wener did not cite to any publications as 
support, reasoning that peer-reviewed literature would not be 
all that useful in the experience-specific methodology that Dr. 
Wener applied in the instant case.   
¶129 The circuit court's conclusion was not an erroneous 
exercise of discretion.  Dr. Wener's failure to rely on 
literature is no bar to admissibility.  Daubert supports the 
circuit court in the instant case:  "Publication (which is but 
one element of peer review) is not a sine qua non of 
admissibility; 
it 
does 
not 
necessarily 
correlate 
with 
reliability."  Daubert, 509 U.S. at 593. 
(3) 
¶130 Reliable application, or "fit," is the final step in 
the Daubert analysis.  The defendants argue that Dr. Wener 
failed to reliably apply his methodology to the facts.   
¶131 The defendants argue that Dr. Wener's "holistic" 
methodology was unreliable.  We have already discussed Dr. 
No. 
2014AP195   
 
51 
 
Wener's methodology (as part of our analysis of the defendants' 
objections to Dr. Wener's testimony) and concluded that the 
circuit court did not err in declaring that Dr. Wener's use of a 
constellation of factors is reliable, as doctors usually apply 
this method when treating patients.   
¶132 The defendants also contend that Dr. Wener improperly 
applied his method to the instant case because his testimony was 
riddled with inconsistencies.  The circuit court correctly 
concluded that inconsistencies do not necessarily render expert 
testimony unreliable; they go to the weight of the testimony:  
"Vigorous cross-examination, presentation of contrary evidence, 
and careful instruction on the burden of proof are the 
traditional and appropriate means of attacking shaky but 
admissible evidence."  Daubert, 509 U.S. at 596.   
¶133 The defendants argue in this court that Dr. Wener's 
experience-based 
testimony 
was 
not 
reliably 
applied, 
specifically objecting to three of Dr. Wener's opinions related 
to prenatal care and the delivery of Braylon.  The defendants 
objected to Dr. Wener's statements that the defendant doctor 
breached the standard of care by failing to order a three-hour 
glucose test; that the defendant doctor breached the standard of 
care by failing to perform an ultrasound immediately prior to 
delivery; and that the defendant doctor breached the standard of 
care by doing a vacuum-assisted delivery.  The defendants again 
argue that these opinions are personal preferences and that 
personal preference is not a permissible basis for an expert 
opinion.   
No. 
2014AP195   
 
52 
 
¶134 The circuit court reviewed Dr. Wener's discussion of 
the generally accepted risk factors of shoulder dystocia——
elevated 
birth 
weight, 
maternal 
obesity, 
and 
gestational 
diabetes——and 
his 
application 
of 
these 
risk 
factors, 
in 
totality, to the facts of the instant case.  The circuit court 
acknowledged that just as clinical medical practice entails 
evaluating a specific patient and applying known risk factors or 
variables, Dr. Wener's testimony analyzed Braylon's mother's 
prenatal care and the delivery of Braylon with respect to the 
three risk factors that he adduced at trial.  The circuit court 
did not view Dr. Wener's testimony as stating a personal 
preference, but as based on reliable medical methods. 
¶135 Furthermore, Dr. Wener's testimony regarding threshold 
glucose levels for gestational diabetes and macrosomia did not 
necessarily contradict the defendants' experts:  Each offered a 
spectrum of ranges under which the risks warranted special care, 
and their spectrums overlapped.  Any disagreement, ruled the 
circuit court, goes to the weight of Dr. Wener's testimony, not 
its admissibility.  
¶136 For the reasons set forth by the circuit court, we 
conclude that the circuit court did not erroneously exercise its 
discretion in admitting Dr. Wener's testimony as reliable based 
on personal experiences and that Dr. Wener reliably applied his 
methodology to the facts.  The circuit court kept the gate open 
No. 
2014AP195   
 
53 
 
to the opinion of Dr. Wener, a qualified OB-GYN.  "[T]rial 
judges are gatekeepers, not armed guards."51   
II 
¶137 The second issue we must address is whether three 
remarks separately or together made by Braylon's counsel during 
his closing arguments prejudiced the defendants, justifying a 
new trial.  We will set out each of the remarks and address each 
of the defendants' arguments for a new trial.  Ultimately, we 
agree with the court of appeals that the circuit court properly 
exercised its discretion by rejecting the defendants' motion for 
a new trial.   
¶138 We begin by noting that although the defendants 
contemporaneously objected to Braylon's counsel's remarks, the 
defendants erred by failing to move for a mistrial.  Generally, 
an offended party must object and then move for a mistrial to 
preserve a challenge to prejudicial remarks.  Hansen v. State, 
64 Wis. 2d 541, 551-52, 219 N.W.2d 246 (1974).  The court of 
appeals nonetheless addressed this issue by exercising its 
discretionary authority.  Seifert ex rel. Scoptur v. Balink, 
                                                 
51 29 Wright & Gold, supra note 17, § 6268.2 (citing Ruiz-
Troche v. Pepsi Cola of Puerto Rico Bottling Co., 161 F.3d 77, 
86 (1st Cir. 1998)). 
See Guild v. Gen. Motors Corp., 53 F. Supp. 2d 363 
(W.D.N.Y. 1999) ("[T]rial judges acting as gatekeepers under 
Daubert must not assume 'the role of St. Peter at the gates of 
heaven, performing a searching inquiry into the depth of an 
expert witness's soul' and thereby usurp 'the ageless role of 
the jury' in evaluating witness credibility and weight of the 
evidence." (quoted source omitted)).  
No. 
2014AP195   
 
54 
 
2015 WI App 59, ¶36 n.10, 364 Wis. 2d 692, 869 N.W.2d 493 
(citing Pophal v. Siverhus, 168 Wis. 2d 533, 545, 484 N.W.2d 555 
(Ct. App. 1992)).  We do the same.  
¶139 We review a circuit court's decision to deny a motion 
for a new trial under an erroneous exercise of discretion 
standard.52  An order for a new trial based on improper 
statements of counsel is appropriate if it "'affirmatively 
appear[s]' that the remarks prejudiced the complaining party."  
Wausau Underwriters Ins. Co. v. Dane Cty., 142 Wis. 2d 315, 329-
30, 417 N.W.2d 914 (Ct. App. 1987) (quoting Roeske v. Schmitt, 
266 Wis. 557, 572, 64 N.W.2d 394 (1954)).  This standard is 
satisfied when the circuit court is convinced that "the verdict 
reflects a result which in all probability would have been more 
favorable to the complaining party but for the improper 
argument."53  Related to our review of a circuit court's decision 
to deny the defendants' motion for a new trial is the assumption 
that "a properly given admonitory instruction is followed" and 
that "the jury acted according to law."  State v. Pitsch, 124 
Wis. 2d 628, 645 n.8, 369 N.W.2d 711 (1985) (citations omitted). 
(1) 
¶140 The defendants assert that Braylon's counsel made an 
impermissible and prejudicial reference to the rules of the road  
                                                 
52 Wagner v. Am. Family Mut. Ins. Co., 65 Wis. 2d 243, 249, 
222 N.W.2d 652 (1974). 
53 Wagner, 65 Wis. 2d at 249.  
No. 
2014AP195   
 
55 
 
during his closing argument.54  The following is Braylon's 
counsel's reference to the rules of the road during closing 
argument:  
Thank you.  Okay, well, on a nice, beautiful sunny 
day, clear skies, 65 miles an hour is probably fine.  
But there may be factors that you have to consider 
that would make that not fine.  That would make you 
question whether that's the speed you should be going. 
Let's say it's pouring rain, let's say it's snowing.  
You're not going to look at that number the same.  And 
Dr. Wener, who I'll talk about in a moment, explained 
that to you.  And this is the issue in this case about 
gestational diabetes. 
No one is denying that they're throwing these two 
numbers out; 130 and 140.  But what he tried to 
explain to you was when you have a big mom, who has an 
increased risk of gestational diabetes because of her 
weight, and an increased risk of a big baby because of 
her weight, you've got to consider which of these 
numbers you're going to use. 
His point was what's safe at one speed might not be at 
another.  And that you have to consider those issues. 
¶141 The 
defendants 
made 
timely 
objections 
to 
these 
statements, which the circuit court overruled.  The defendants 
also challenged these statements in their motion after the 
verdict.  They argued that these statements violated the circuit 
court's order in limine and that the statements prejudicially 
confused the jury in regard to the applicable standard of 
reasonable care.  The defendants asserted that as a result of 
                                                 
54 The circuit court granted a motion in limine to prohibit 
Braylon's counsel from analogizing medical negligence to the 
failure of a driver to follow the rules of the road.  
No. 
2014AP195   
 
56 
 
Braylon's counsel's statements, "the jury was left with the 
impression that Dr. Wener's opinions regarding standards of care 
could be equated to speed limits and weather hazards on the 
roadway."  
¶142 The circuit court rejected this argument.  The circuit 
court decided that Braylon's counsel's analogy to driving a car 
in various weather conditions did not violate the order in 
limine.  Instead, the circuit court interpreted Braylon's 
counsel's statement as "an attempt to analogize and to put into 
context Dr. Wener's theory of these additive elements as they 
pile up with the total being more than the sum of its parts," 
not as an analogy to ordinary negligence.   
¶143 Further, in regard to the defendants' concern that the 
jury was confused as to the applicable standard of reasonable 
care, the circuit court concluded that the jury was not confused 
about the standard of care to apply:55  The jurors were 
instructed to "find a standard of care for medical negligence."  
Jurors are assumed to follow jury instructions.  Accordingly, 
the circuit court concluded that "there is no reason to believe" 
Braylon's counsel's statements were prejudicial or could be 
interpreted by the jury in a way that would violate the in 
limine order.  
                                                 
55 The circuit court also noted, "We have to remember that 
the juror's [sic] don't even know what regular negligence is, 
probably. 
 
They 
weren't 
instructed 
on 
regular 
negligence. . . . They were given one instruction."  
No. 
2014AP195   
 
57 
 
¶144 The court of appeals agreed with the circuit court and 
concluded that Braylon's counsel did not violate the circuit 
court's order in limine and that counsel's analogy to drivers 
did not prejudice the defendants.  The court of appeals reasoned 
that instead of comparing ordinary negligence and medical 
negligence, "the analogy illustrated the interplay of the 
alleged risk factors present in this case through a comparison 
to the interplay of various weather conditions that might affect 
a driver's decision-making process."56   
¶145 Further, the court of appeals concluded that there was 
no indication that the absence of the analogy would have 
resulted in a different verdict.  The analogy pertained to 
gestational diabetes testing thresholds, which was just one 
aspect of the evidence presented to the jury on the issue of the  
standard of reasonable care.  The circuit court instructed the 
jury that its decision must be based only on the evidence 
presented to the jury and nothing else, including the statements 
of counsel.   
¶146 We agree with the reasoning and conclusion of the court 
of appeals.   
(2) 
¶147 Turning to another remark of Braylon's counsel, the 
defendants assert that they were prejudiced because Braylon's 
counsel 
made 
an 
impermissible 
"Golden 
Rule" 
argument 
in 
                                                 
56 Seifert, 364 Wis. 2d 692, ¶40.   
No. 
2014AP195   
 
58 
 
violation of an order in limine.  "Golden Rule" arguments arise 
when counsel asks "the jurors to place themselves in the 
position of someone claiming injury or damage and ask[s] the 
jurors what they would want as compensation."  State v. DeLain, 
2004 WI App 79, ¶23, 272 Wis. 2d 356, 679 N.W.2d 562.   
¶148 An order in limine prohibited Braylon's counsel from 
making statements that might suggest that the jury determine 
whether medical negligence occurred based on the jurors' own 
knowledge, experience, common sense, or what they would want or 
deserve.  
¶149 The defendants assert that Braylon's counsel violated 
the order in limine when he stated:    
Now, you heard some testimony from the defense 
experts, and I'll talk about them as I go along in 
this case as well and their bias, where they're coming 
from.  You heard somebody actually get up on the 
witness stand and say——Dr. Rouse, I think it was——if 
it was 139, I wouldn't have done anything.  Really?  
If it was 139, I would have done nothing different.  
Is that reasonable to you?  Is that reasonable 
medicine to you?  Is that how you want your doctor to 
care? 
 
. . . . 
Is that what you want?  You want a doctor to treat 
you, or you want a doctor to say, well, you're at 139.  
You're not at 140.  No test for you.  Or do you want a 
doctor to think about you?   
¶150 The defendants' counsel objected to these remarks at 
trial, and Braylon's counsel withdrew the first remark. The 
circuit court sustained the defendants' objection to the second 
remark.  The circuit court, however, did not strike either 
statement, opting instead to give a "curative" instruction.  
No. 
2014AP195   
 
59 
 
¶151 The curative instruction followed counsel's remarking:  
"How do you want to be with your healthcare?  Do you want to be 
a participant in your healthcare?"  The curative instruction 
stated:  "There aren't a lot of rules about what can and can't 
be argued, but one of them is that a lawyer may not ask a juror 
to place themselves in the position of the injured person or the 
doctor for that matter.  Not sure that's what was going on, but 
if you got that idea, disregard it."   
¶152 The defendants argued in their motion after the 
verdict 
that 
these 
"Golden 
Rule"-type 
statements 
were 
prejudicial and warranted a new trial.  They argued that 
arguments involving what a juror would want from his or her 
doctor are irrelevant and appeal to the jurors' emotions.  They 
further argued that involving jurors' personal feelings about 
the standard of care caused the jury to consider a standard of 
care inconsistent with the reasonable physician standard.  They 
also argued that these statements violated the circuit court's 
order in limine.   
¶153 The circuit court refused to order a new trial on 
"Golden Rule" grounds.  The circuit court explained that 
Braylon's counsel's statements were "not [] classic "golden 
rule" violations, where the jurors were explicitly asked to 
place themselves in the position of the plaintiff."  The circuit 
court noted that its curative instruction obviated any prejudice 
which may have resulted from Braylon's counsel's remarks.  The 
circuit court denied the defendants' request for a new trial.  
No. 
2014AP195   
 
60 
 
¶154 The circuit court is in the best position to evaluate 
"Golden Rule" statements and should look at a variety of factors 
such as "the nature of the case, the emphasis upon the improper 
measuring stick, the reference in relation to the entire 
argument, [and] the likely impact or effect upon the jury."  
Rodriguez v. Slattery, 54 Wis. 2d 165, 170, 194 N.W.2d 817 
(1972).  
¶155 The court of appeals concluded that the circuit court 
did not erroneously exercise its discretion for the following 
reasons:   
• These were not pure "Golden Rule" violations because 
the jurors were not asked to place themselves in the 
victim's shoes.   
• Even if these remarks were "Golden Rule" violations, 
the circuit court gave the curative instruction stated 
above. 
• The remarks, in light of the entire argument presented 
to the jury, did not affirmatively prejudice the 
defendants.57  
¶156 We agree with the court of appeals' analysis that 
these remarks did not violate the order in limine.   
¶157 In sum, because the circuit court properly considered 
objections to Braylon's counsel's statements during trial and 
after the verdict and provided a curative instruction, we 
                                                 
57 Seifert, 364 Wis. 2d 692, ¶46.   
No. 
2014AP195   
 
61 
 
conclude that the circuit court did not erroneously exercise its 
discretion by denying the defendants' motion for a new trial on 
the basis of these remarks.   
(3) 
¶158 Turning to their final challenge, the defendants argue 
that they were prejudiced by Braylon's counsel's remarks (1) 
disparaging the defendants' attorney and (2) suggesting to the 
jurors that the jurors were experts.   
¶159 The defendants refer to the following remarks:   
• I spoke to you in my closing argument and I 
addressed issues.  I didn't tell you what to do.  
I didn't tell you you're not experts.  I didn't 
tell you you're not that smart.  I didn't tell 
you don't know the law.  Apparently I have a 
little more respect for you than Mr. Leib does.  
• I've got a little more faith in you than he does, 
because he spent the last hour and a half telling 
you what to do, telling you what you can't do, 
telling you what you don't know and that you're 
not going to be experts——you're not going to know 
the information.  I disagree.  
• These are the kind of arguments you make to 
juries if you think they're not too smart.  Fool 
you, scare you, you know?  You people are from 
Lancaster.  How smart could you be, right?  I 
think you're pretty smart.  I think you get it.  
I think you see through all this nonsense.  I 
think you should be respected, not told what to 
do or fooled.  You should be talked to like 
adults, make you own decisions about this case.  
Not be told what to do.  
• This shell game, you know, this game that they're 
trying to play with you.  You know, it's that 
game, you know, when you go to the fair?  Where's 
the ball?  Whoa, whoa, whoa, where's the ball?  
That's what they tried to do to you.  It's a 
matter of respect.  I don't do it to you.  I'm 
No. 
2014AP195   
 
62 
 
giving you the information, you'll figure it out.  
I'm not telling you what to do.  You're smart.  
• So when Mr. Leib comes before you and makes his 
big grandstand move.  Where's this one, where's 
that one?  Where's this one?  Well, you know, 
it's just not true.  It's a matter, again, of 
respect.  It's a matter of respecting you as a 
group and trying to fool you.  You're not going 
to get fooled.  You're pretty damn smart.  You're 
not going to get fooled.  I don't think you'll 
get fooled.  
• You have common sense and you can analyze the 
expert testimony and you're smart enough to do 
it.  I'm like, again, I'm like Mr. Leib.  I have 
a lot of faith in your smarts.  I think you are 
experts in a sense.  I think you've learned quite 
a bit and I think you can make good decisions.  I 
don't have to tell you what to do or how to do 
it.  I'm not going to do that.  But think it 
through, ladies and gentlemen.  
• Unlike Mr. Leib, I think you're smart people and 
I think you've learned the medicine and I think 
you are experts in a sense.  
¶160 The circuit court concluded that, in context, these 
statements (and others of a similar vein) were not prejudicial or 
improper.  The circuit court explained that these were rebuttal 
statements made in response to the defendants' "strenuous 
argument" and were meant to empower the jury to weigh the 
conflicting expert testimony and make the required credibility 
determinations.   
¶161 The circuit court also explained that in a complex 
medical malpractice case filled with days of expert medical 
testimony, jurors have to make a finding based on medical 
evidence, so they do "in a sense become expert."  The circuit 
court concluded there was nothing wrong with telling jurors that 
No. 
2014AP195   
 
63 
 
they are smart while simultaneously characterizing defense 
counsel's view of the jurors as that they are "dumb."   
¶162 Considering the context in which these remarks arose, 
we conclude that the circuit court did not erroneously exercise 
its discretion in ruling in favor of Braylon.  Braylon's 
counsel's remarks were used to empower the jury to perform its 
essential role of weighing conflicting testimony and making 
credibility determinations.   
¶163 The remarks at issue did not cause the jury to reach a 
decision that it would not have reached otherwise.  Accordingly, 
we affirm the court of appeals' decision that the circuit court 
did not erroneously exercise its discretion in concluding that 
Braylon's counsel's remarks during closing argument did not 
constitute prejudicial error justifying a new trial.   
III 
¶164 Lastly, the defendants argue that this court should 
grant their motion for a new trial in the interests of justice 
under Wis. Stat. § 751.06.58  They claim that justice was not 
                                                 
58 Wisconsin Stat. § 751.06 provides: 
Discretionary reversal. In an appeal in the supreme 
court, if it appears from the record that the real 
controversy has not been fully tried, or that it is 
probable that justice has for any reason miscarried, 
the court may reverse the judgment or order appealed 
from, regardless of whether the proper motion or 
objection appears in the record, and may direct the 
entry of the proper judgment or remit the case to the 
trial court for the entry of the proper judgment or 
for a new trial, and direct the making of such 
amendments in the pleadings and the adoption of such 
(continued) 
No. 
2014AP195   
 
64 
 
served because the circuit court admitted Dr. Wener's unreliable 
testimony and did not order a new trial in response to Braylon's 
counsel's prejudicial remarks.   
¶165 We have already concluded that the circuit court did 
not erroneously exercise its discretion by admitting Dr. Wener's 
testimony or by failing to grant a new trial on the basis of 
Braylon's counsel's remarks.  Nevertheless, we will elaborate 
further on Wis. Stat. § 751.06.     
¶166 Under 
this 
court's 
interpretations, 
Wis. 
Stat. 
§ 751.06 rarely calls for a new trial.  This court has often 
expressed its "reluctan[ce] to grant a new trial in the interest 
of justice" and has stated that it "exercises its discretionary 
power only in exceptional cases."  State v. Cuyler, 110 
Wis. 2d 133, 141, 327 N.W.2d 662 (1983) (ordering new trial 
where 
trial 
court 
misread 
evidentiary 
statute 
and 
thus 
prohibited 
material 
witnesses 
from 
testifying). 
 
Such 
"exceptional" cases occur in two situations:  (1) "when the real 
controversy has not been fully tried" and (2) "when it is 
probable that justice has for any reason been miscarried."  
Vollmer v. Luety, 156 Wis. 2d 1, 7, 456 N.W.2d 797 (1990).   
                                                                                                                                                             
procedure 
in 
that 
court, 
not 
inconsistent 
with 
statutes or rules, as are necessary to accomplish the 
ends of justice. 
No. 
2014AP195   
 
65 
 
¶167 The real controversy was fully tried in the instant 
case and there is no "substantial degree of probability that a 
different result was likely to be produced on retrial.59 
¶168 For the reasons set forth, we affirm the decision of 
the court of appeals. 
By the Court.—The decision of the court of appeals is 
affirmed. 
 
                                                 
59 Discretionary reversals based on a miscarriage of justice 
are appropriate when this court "determine[s] to a substantial 
degree of probability that a different result was likely to be 
produced on retrial."  State v. Wyss, 124 Wis. 2d 681, 741, 370 
N.W.2d 745 (1985).   
No.  2014AP195.akz 
 
1 
 
¶169 ANNETTE 
KINGSLAND 
ZIEGLER, 
J.   (concurring). 
 
I 
concur only in the court's conclusion to affirm the decision of 
the court of appeals.  I do not join the lead opinion for two 
reasons.  First, the lead opinion does not sufficiently address 
the legislature's 2011 changes to Wis. Stat. § 907.02 (2009-10), 
which had significant effect on the admissibility of expert 
opinion testimony in Wisconsin.  The legislature has now 
tightened the applicable standard.  Second, the lengthy lead 
opinion does not adequately guide trial courts with regard to 
how they should apply Wis. Stat. § 907.02 (2013-14).1  I write to 
clarify that § 907.02 has now changed the gatekeeping function 
of the trial court concerning the admissibility of expert 
testimony. Simply stated, the trial court now must adhere to and 
apply the heightened Daubert-Wis. Stat. § 907.02 standard.  In 
my view, a best practice for trial courts and counsel is to 
create a detailed, complete record regarding why any particular 
expert's testimony meets the heightened scrutiny due under 
§ 907.02.  The trial court's determinations here are upheld 
under the facts of this case because the trial court did not 
erroneously exercise its discretion in admitting the testimony 
of Dr. Wener. 
¶170 While I agree that this court should uphold the 
circuit court's decision to admit Dr. Wener's expert testimony 
at trial, I reach this conclusion in spite of the fact that the 
legislature tightened the standard of admissibility of expert 
                                                 
1 All subsequent references to the Wisconsin Statutes are to 
the 2013-14 version unless otherwise indicated. 
No.  2014AP195.akz 
 
2 
 
opinion testimony when it amended Wis. Stat. § 907.02 (2009-10).  
The circuit court did not "appl[y] an improper legal standard or 
make[] a decision not reasonably supported by the facts of 
record" in admitting Dr. Wener's testimony, 118th St. Kenosha, 
LLC v. DOT, 2014 WI 125, ¶18, 359 Wis. 2d 30, 856 N.W.2d 486 
(quoting  260 North 12th St., LLC v. DOT, 2011 WI 103, ¶38, 338 
Wis. 2d 34, 808 N.W.2d 372), and its decision should be upheld.  
See id.  I view the record below, however, as a "close call" 
which might not survive appellate review had this been a 
different case type. 
I  
¶171 We have recognized that the legislature amended Wis. 
Stat. § 907.02 (2009-10) in 2011 Wisconsin Act 2 in order "to 
adopt the Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 
579 (1993), reliability standard as stated in Federal Rule of 
Evidence 702."  260 North 12th St., 338 Wis. 2d 34, ¶55 n.10.  
Allow me to provide background concerning the federal adoption 
of Daubert.  Unlike in Wisconsin, where the Daubert standard 
heightened the level of scrutiny to apply to expert witnesses, 
in the federal system, Daubert loosened the standard for 
admission of expert testimony.  
¶172 To begin with, while the federal rule, Rule 702, may 
"embod[y] a liberal standard of admissibility for expert 
opinions," Nimely v. City of New York, 414 F.3d 381, 395 (2d 
Cir. 2005), it is liberal as compared to the standard it 
"superseded," namely the so-called Frye "'general acceptance' 
test," Daubert, 509 U.S. at 585-87 (named for Frye v. United 
No.  2014AP195.akz 
 
3 
 
States, 293 F. 1013 (D.C. Cir. 1923)).  See Nimely, 414 F.3d at 
395-96.  It is not liberal as compared to Wisconsin's prior test 
for admitting expert testimony.  
¶173 Frye's "austere standard" "made 'general acceptance' 
[of the matter upon which expert scientific testimony is based] 
the exclusive test for admitting expert scientific testimony."  
Daubert, 509 U.S. at 585-86, 589.  Daubert recognized that the 
Federal Rules of Evidence, on the other hand, did not mandate 
general acceptance, consistent with the Rules' "general approach 
of relaxing the traditional barriers to 'opinion' testimony."  
Id. at 588-89 (quoting Beech Aircraft Corp. v. Rainey, 488 U.S. 
153, 169 (1988)). 
¶174 In Wisconsin, however, there is no "traditional 
barrier[]" à la Frye for the legislature's adoption of Rule 702 
to "relax[]."  See State v. Walstad, 119 Wis. 2d 483, 516, 351 
N.W.2d 469 (1984) ("The Frye concept is alien to the Wisconsin 
law of evidence.").  Wisconsin's prior standard of admissibility 
of expert evidence was considerably more accommodating than 
either the Frye test or Rule 702's standard.  As stated, Frye's 
yardstick is "general acceptance."  Rule 702 mandates, inter 
alia, that expert testimony be "based on sufficient facts or 
data" and "the product of reliable principles and methods" and 
that the expert testifying "reliably appl[y] the principles and 
methods to the facts of the case."  Fed. R. Evid. 702(b)-(d).  
In contrast, under the previous Wisconsin standard "questions of 
the weight and reliability of relevant evidence [were] matters 
for the trier of fact."  State v. Fischer, 2010 WI 6, ¶7, 322 
No.  2014AP195.akz 
 
4 
 
Wis. 2d 265, 
778 
N.W.2d 629. 
 
"[E]xpert 
testimony 
[was] 
generally admissible in the circuit court's discretion if the 
witness [was] qualified to testify and the testimony would help 
the trier of fact understand the evidence or determine a fact at 
issue."  State v. Kandutsch, 2011 WI 78, ¶26, 336 Wis. 2d 478, 
799 N.W.2d 865.  This was a "low threshold."  State v. Shomberg, 
2006 WI 9, ¶67, 288 Wis. 2d 1, 709 N.W.2d 310 (Butler, J., 
dissenting) (citing State v. St. George, 2002 WI 50, ¶39, 252 
Wis. 2d 499, 643 N.W.2d 777). 
¶175 The fact that the legislature has added three new 
prerequisites to the admission of expert testimony in Wisconsin 
means that it now requires more of a showing and further trial 
court analysis before expert testimony may be introduced.  That 
the legislature now requires——in addition to its earlier 
mandates 
of 
a 
qualified 
expert 
and 
sufficiently 
helpful 
testimony, Kandutsch, 336 Wis. 2d 478, ¶26——testimony "based 
upon sufficient facts or data," testimony which is "the product 
of reliable principles and methods" and a witness who has 
"applied the principles and methods reliably to the facts of the 
case," Wis. Stat. § 907.02(1), suggests that trial courts must 
now be much more piercing in their evaluation of proffered 
expert testimony.  The days of relatively easy admission of 
expert testimony into Wisconsin courtrooms are over.  The trial 
courts' gatekeeping function has changed in light of § 907.02. 
¶176 The Wisconsin legislature's adoption of the Daubert 
standard was part of a larger seemingly legislative reaction to 
Wisconsin Supreme Court decisions; one observer argues that "Act 
No.  2014AP195.akz 
 
5 
 
2 generated the most significant changes in at least sixteen 
years to Wisconsin's civil litigation system by limiting the 
applicability of 'risk contribution' theory, capping punitive 
damages, and mandating damages for frivolous claims," "most 
drastically chang[ing] the areas of strict products liability 
and 
expert 
opinion 
testimony." 
Kristen 
Irgens, 
Comment, 
Wisconsin Is Open for Business or Business Just As Usual? The 
Practical Effects and Implications of 2011 Wisconsin Act 2, 2012 
Wis. L. Rev. 1245, 1247 (2012) (footnotes omitted); see 
Honorable Diane S. Sykes, Reflections on the Wisconsin Supreme 
Court, 89 Marq. L. Rev. 723, 737-38 (2006) (arguing that certain 
"cases from the last term reflect a court quite willing to 
aggressively assert itself to implement the statewide public 
policies it deems to be most desirable," and that "[t]he court 
is loosening the usual constraints on the use of its power, 
freeing itself to move the law essentially as a legislature 
would, except that its decisions are for the most part not 
susceptible of political correction as the legislature's would 
be").2  
¶177 Previously this court has rejected the invitation to 
follow the Daubert approach taken in the federal courts with 
                                                 
2 Compare, e.g., Thomas ex rel. Gramling v. Mallett, 2005 WI 
129, ¶¶178-79, 285 Wis. 2d 236, 701 N.W.2d 523 (Wilcox, J., 
dissenting) (contending that the court's "expansion" of risk-
contribution theory "amounts to an unwarranted and unprecedented 
relaxation of the traditional rules governing tort liability, 
and raises serious concerns of fundamental fairness"), with 14 
Jay E. Grenig, Wisconsin Practice Series: Elements of an Action 
§ 14:5, at 765 (2015-2016 ed.) (arguing that Act 2 "limits the 
holding of Thomas"). 
No.  2014AP195.akz 
 
6 
 
regard to expert testimony.  See Fischer, 322 Wis. 2d 265, ¶7 
("[T]here is no reason for us to revisit [in this case] 
Wisconsin's well-established role for the circuit court where 
expert testimony is proffered.  The law in Wisconsin continues 
to be that questions of the weight and reliability of relevant 
evidence are matters for the trier of fact. . . . We, therefore, 
decline to adopt a Daubert-like approach to expert testimony 
that would make the judge the gatekeeper.").  Act 2 negates this 
decision, transforming Wisconsin law so that it now adheres to 
Federal Rule 702's heightened standard.  To minimize the 
significance of this change, as the lead opinion might be read 
to do, contravenes the requirement of Wisconsin's Act 2, which 
clearly contemplates a more substantial burden on litigants who 
seek to have expert testimony admitted in Wisconsin courts. 
¶178 Importantly, even after Daubert, trial courts retain 
substantial discretion in deciding whether to admit expert 
testimony.  See, e.g., Kumho Tire Co. v. Carmichael, 526 U.S. 
137, 141–42 (1999) ("[T]he test of reliability is 'flexible,' 
and Daubert's list of specific factors[3] neither necessarily nor 
                                                 
3 In 
Daubert 
the 
Supreme 
Court 
"discussed 
certain . . . factors . . . some or all of which might prove 
helpful 
in 
determining 
the 
reliability 
of 
a 
particular 
scientific 'theory or technique.'" Kumho Tire Co. v. Carmichael, 
526 U.S. 137, 141 (1999) (quoting Daubert v. Merrell Dow 
Pharmaceuticals, Inc., 509 U.S. 579, 593-94 (1993)). The Daubert 
Court pointed to "whether [a theory or technique] can be (and 
has been) tested," "whether the theory or technique has been 
subjected to peer review and publication," "the known or 
potential rate of error," and whether there is "general 
acceptance" of the matter within the "relevant scientific 
community." Daubert, 509 U.S. at 593-94 (quoting United States 
v. Downing, 753 F.2d 1224, 1238 (3d Cir. 1985)). 
No.  2014AP195.akz 
 
7 
 
exclusively applies to all experts or in every case.  Rather, 
the law grants a district court the same broad latitude when it 
decides how to determine reliability as it enjoys in respect to 
its ultimate reliability determination." (quoting Daubert, 509 
U.S. at 594)).  Moreover, the question before this court in 
reviewing the circuit court's evidentiary decision below "is not 
whether this court agrees with the ruling of the trial court, 
but whether appropriate discretion was in fact exercised."  
Martindale v. Ripp, 2001 WI 113, ¶29, 246 Wis. 2d 67, 629 
N.W.2d 698 (quoting State v. Wollman, 86 Wis. 2d 459, 464, 273 
N.W.2d 225 (1979)).  
¶179 Given the foregoing, the facts of this current case 
might stand as a poor example to clearly illustrate the 
heightened standard of Wis. Stat. § 907.02.  This court today 
decides that the court below did not erroneously exercise its 
discretion but does little to advise courts how to apply the new 
heightened standard to other cases involving different expert 
testimony.  I note that, had the circuit court below decided to 
exclude Dr. Wener's testimony, we would analyze that exclusion 
of evidence in light of the standard espoused in Daubert and the 
fact that we owe the circuit court erroneous-exercise-of-
discretion deference.  In this case, under these facts, 
involving this doctor's testimony, that deference due tips the 
scales in favor of the circuit court's detailed determination 
below. 
II 
No.  2014AP195.akz 
 
8 
 
¶180 In this medical malpractice case, the defense seeks to 
exclude the testimony of a medical doctor who is board certified 
in obstetrics and gynecology, who has delivered thousands of 
babies over three decades and confronted dozens of instances of 
shoulder dystocia, who taught medical students and residents in 
a clinical capacity for four years at the University of 
California, San Diego, and who served as chairman of the OB/GYN 
department at a hospital for 20 years, arguing that this expert 
cannot meet the Daubert standard as set forth in Wis. Stat. 
§ 907.02.  The above expertise is directly on point with the 
claim made here. 
¶181 Wisconsin 
Stat. 
§ 907.02(1) 
requires, 
for 
the 
admission of expert testimony: (1) that "scientific, technical, 
or other specialized knowledge will assist the trier of fact to 
understand the evidence or to determine a fact in issue"; (2) 
that the expert witness "testify[ing] thereto in the form of an 
opinion or otherwise" is "qualified as an expert by knowledge, 
skill, experience, training, or education"; (3) that the expert 
testimony is "based upon sufficient facts or data"; (4) that the 
expert testimony is "the product of reliable principles and 
methods"; and (5) that the expert witness "has applied the 
principles and methods reliably to the facts of the case."  
§ 907.02(1). 
¶182 Digging deeper into the facts specific to this case, 
Dr. Balink argues that Dr. Wener's testimony is not the product 
of reliable principles and methods, and that Dr. Wener did not 
apply the principles and methods he used reliably to the facts 
No.  2014AP195.akz 
 
9 
 
of the case.  Dr. Balink contends that Dr. Wener's opinions are 
simply based on his own personal preferences rather than, for 
instance, on medical literature; criticizes Dr. Wener's so-
called 
"holistic" 
approach; 
and 
points 
out 
supposedly 
contradictory or confusing aspects of Dr. Wener's testimony.  
All of these arguments could be well-developed in cross-
examination. 
Argument 
could 
be 
made 
that 
such 
personal 
preference does not meet the legal definition of medical 
malpractice.  The circuit court did not erroneously exercise its 
discretion in declining to exclude Dr. Wener's testimony. The 
trial court concluded that Dr. Wener's opinion was "reliably 
based on a reliable medical methodology looking at recognized 
factors of the standard of care." 
¶183 Wisconsin Stat. § 907.02 uses, for example, two key 
terms relevant to this case: "method[]" and "principle[]."  See 
Wis. Stat. § 907.02(1).  A "method" is a "mode of organizing, 
operating, or performing something, esp. to achieve a goal."  
Method, Black's Law Dictionary 1141 (10th ed. 2014).  A 
"principle" is a "basic rule, law, or doctrine; esp., one of the 
fundamental tenets of a system."  Principle, id. at 1386.  
Generally speaking, Dr. Wener's method in providing the disputed 
expert testimony was, to quote the plaintiffs-respondents' 
brief, to "review the [relevant medical] records and provide an 
opinion based upon his education, training, and 36 years of 
experience" as to whether the steps taken and not taken by Dr. 
Balink in her care of Braylon and Kimberly Seifert met the 
applicable standard of care.  More specifically, Dr. Wener's 
No.  2014AP195.akz 
 
10 
 
application of his education, training, and experience to the 
facts of the Seiferts' case included consideration of a specific 
set of medical "principles," namely the various "risk factors" 
for shoulder dystocia present in the Seiferts' case.  These 
principles suggested that "maternal obesity, excessive weight 
gain [in the mother], gestational diabetes [suspected through 
the result of blood glucose testing,] . . . a large baby[,]" and 
use of a vacuum during delivery all increase the likelihood that 
shoulder dystocia will occur during delivery.  
¶184 Moreover, the Wisconsin Jury Instructions state the 
standard used in a case involving alleged medical negligence 
like this one in part as follows:  
In 
(treating) 
(diagnosing) 
(plaintiff)'s 
(injuries) (condition), (doctor) was required to use 
the 
degree 
of 
care, 
skill, 
and 
judgment 
which 
reasonable (doctors who are in general practice) 
(specialists who practice the specialty which (doctor) 
practices) would exercise in the same or similar 
circumstances, having due regard for the state of 
medical science at the time (plaintiff) was (treated) 
(diagnosed).  A doctor who fails to conform to this 
standard is negligent. The burden is on (plaintiff) to 
prove that (doctor) was negligent. 
A doctor is not negligent, however, for failing 
to use the highest degree of care, skill and judgment 
or solely because a bad result may have followed (his) 
(her) 
(care 
and 
treatment) 
(surgical 
procedure) 
(diagnosis). 
The 
standard 
you 
must 
apply 
in 
determining if (doctor) was negligent is whether 
(doctor) failed to use the degree of care, skill, and 
judgment 
which 
reasonable 
(general 
practitioners) 
(specialists) would exercise given the state of 
medical knowledge at the time of the (treatment) 
(diagnosis) in issue. 
Wis JICivil 1023 at 1.  Dr. Wener's conclusion was essentially 
that, given the presence of the risk factors discussed as 
No.  2014AP195.akz 
 
11 
 
evidenced by the facts of the case and the medical records he 
studied, certain of Dr. Balink's actions and omissions——failure 
to perform additional glucose testing, for example——constituted 
unreasonable care because of the unjustified risk of shoulder 
dystocia.  Clearly, cross-examination and argument could dispel 
the notion that Dr. Wener's conclusions are but one, and not a 
conclusive, reasonable standard of care.  
¶185 The 
circuit 
court 
below 
indeed 
assessed 
the 
reliability of Dr. Wener's testimony as required by Wis. Stat. 
§ 907.02(1).  The circuit court explained, citing McGovern ex 
rel. McGovern v. Brigham & Women's Hosp., 584 F. Supp. 2d 418 
(D. Mass. 2008), that obstetrics "is a recognized field of 
expertise" as opposed to "junk science."  See McGovern, 584 
F. Supp. 2d at 424.  The circuit court characterized Dr. Wener's 
method as "holistic" "clinical medical methodology," relying 
partly on Cooper v. Carl A. Nelson & Co., 211 F.3d 1008 (7th 
Cir. 2000), in which the Seventh Circuit——applying Daubert——
noted the apparent agreement of the party seeking to exclude the 
expert testimony of three physicians that "in clinical medicine, 
the methodology of physical examination and self-reported 
medical history employed by [one of the experts] is generally 
appropriate."  Cooper, 211 F.3d at 1020; see also, e.g., 
Reference Manual on Sci. Evid. 703 (3d ed.) ("A patient-
physician encounter typically consists of four components: (1) 
patient 
history, 
(2) 
physical 
examination, 
(3) 
medical 
decisionmaking, and (4) counseling.").  This approach was 
analogous to the one taken by Dr. Wener (although Dr. Wener's 
No.  2014AP195.akz 
 
12 
 
review was also retroactive).  The circuit court observed that 
Dr. Wener's opinion was "based upon the facts of this case," and 
on "recognized factors subject to cross[-]examination" such as 
Braylon's estimated size, Kimberly's weight gain, and the 
results of Kimberly's glucose tests.  Consequently, the court 
concluded that Dr. Wener's opinion was "reliably based on a 
reliable medical methodology looking at recognized factors of 
the standard of care."  
¶186 The court tempered its conclusions by exploring 
various weaknesses in Dr. Wener's approach, stating, for 
instance, "[A] lot of things in medicine can't be tested because 
you can't repeat the exact same factors because every human body 
is different.  And maybe that makes the defense's case 
ultimately."  The court also acknowledged that there was some 
level of extrapolation in Dr. Wener's analysis.  But there was a 
common thread running through the court's remarks: that although 
Dr. Wener's testimony was not perfect, it was "sufficiently 
reliable to be admitted."  
¶187 Remaining in our required position in review of the 
record makes plain that the circuit court "applie[d] [the] 
[]proper legal standard [and] ma[de] a decision . . . reasonably 
supported by the facts of record."  118th St. Kenosha,, 359 
Wis. 2d 30, ¶18 (quoting 260 North 12th St., 338 Wis. 2d 34, 
¶38).  Dr. Wener's conclusions certainly could have been better 
supported.  In particular, he could have done a better job of 
attempting to quantify the point at which a tolerable level of 
risk of shoulder dystocia becomes intolerable.  In addition, 
No.  2014AP195.akz 
 
13 
 
Dr. Balink points to alleged errors and inconsistencies in 
Dr. Wener's testimony.  But all of these deficiencies were able 
to be tested on cross-examination; they did not mandate 
exclusion 
of 
the 
entire 
expert 
opinion. 
 
The 
record 
substantiates a conclusion that Dr. Wener "adhere[d] to the same 
standards of intellectual rigor that are demanded in [his] 
professional work."  Cooper, 211 F.3d at 1020 (quoting Rosen v. 
Ciba-Geigy Corp., 78 F.3d 316, 318 (7th Cir. 1996)).4  
¶188 Ultimately, and as suggested by the circuit court, 
this case does not involve "junk science," a "junk scientist," 
                                                 
4 In an amicus brief, the American Medical Association and 
the Wisconsin Medical Society set forth their concern that: 
If left uncorrected, the decisions of the lower courts 
would place an unreasonable burden on physicians, 
[because] . . . [i]n making decisions about how to 
treat 
their 
patients, . . . physicians . . . would 
have 
to 
account 
for 
the 
possibility 
that 
the 
preferences 
of 
a 
physician 
they 
have 
never 
met . . . could serve as the basis by which their 
conduct will be judged. 
But this argument ignores the fact that the standard against 
which a physician's conduct is judged is the conduct of a 
similarly-situated reasonable physician.  Wis JI——Civil 1023 at 
1.  And arguably "for any set of clinical facts, however unique, 
there are decisions or actions that virtually no doctor would 
find acceptable."  Mark A. Hall, Mary Anne Bobinski & David 
Orentlicher Health Care Law and Ethics 321 (8th ed. 2013) 
(presenting idea without necessarily endorsing it).  Physicians 
need only ensure that their conduct matches the conduct of a 
similarly-situated reasonable physician.  Assuming that a judge 
finds that expert testimony passes the requirements of Wis. 
Stat. § 907.02, the party against whom the testimony is offered 
may dispute it by cross-examination and by presenting contrary 
expert testimony suggesting that the party's conduct was 
reasonable.  It is then up to the jury to decide which set of 
testimony is more believable.  
No.  2014AP195.akz 
 
14 
 
or a "junk opinion."  McGovern, 584 F. Supp. 2d at 424.  This 
was testimony in a "recognized field of expertise" as to the 
standard 
of 
care 
required, 
provided 
by 
a 
well-qualified 
physician who had delivered thousands of babies.  Dr. Wener used 
his own education, training, and experience to review the 
relevant medical records and to reach a conclusion as to whether 
the applicable standard of care was followed.  The circuit court 
did not err in admitting this testimony.5 
III 
¶189 Thus, I concur only in the court's conclusion to 
affirm the decision of the court of appeals.  I do not join the 
lead opinion for two reasons.  First, the lead opinion does not 
sufficiently address the legislature's 2011 changes to Wis. 
Stat. § 907.02 (2009-10), which had significant effect on the 
admissibility of expert opinion testimony in Wisconsin.  The 
                                                 
5 I reject Dr. Balink's remaining arguments for reversal.  
Without opining on whether, or the extent to which, the 
Seiferts' attorney violated various pretrial orders, and without 
opining on the possibility that Dr. Balink has waived this 
argument, I conclude that the record does not establish that, 
because of comments made by the Seiferts' attorney during 
closing arguments following this week-long jury trial, "the 
verdict reflects a result which in all probability would have 
been more favorable to the complaining party but for the 
improper argument."  Wagner v. Am. Family Mut. Ins. Co., 65 
Wis. 2d 243, 250, 222 N.W.2d 652 (1974) (citing Klein v. State 
Farm Mut. Auto. Ins. Co., 19 Wis. 2d 507, 510 n.1, 120 
N.W.2d 885 (1963)).  The circuit court did not erroneously 
exercise its discretion in declining to grant a new trial.  See 
id. at 249-50. 
Further, given the conclusions set forth in this writing, 
discretionary reversal is not warranted.  See Wis. Stat. 
§ 751.06. 
No.  2014AP195.akz 
 
15 
 
legislature has now tightened the applicable standard.  Second, 
the lengthy lead opinion does not adequately guide trial courts 
with regard to how they should apply Wis. Stat. § 907.02.  I 
write to clarify that § 907.02 has now changed the gatekeeping 
function of the trial court concerning the admissibility of 
expert testimony.  Simply stated, the trial court now must 
adhere to and apply the heightened Daubert-Wis. Stat. § 907.02 
standard.  In my view, a best practice for trial courts and 
counsel is to create a detailed, complete record regarding why 
any particular expert's testimony meets the heightened scrutiny 
due under § 907.02.  The trial court's determinations here are 
upheld under the facts of this case because the trial court did 
not erroneously exercise its discretion in admitting the 
testimony of Dr. Wener. 
¶190 While I agree that this court should uphold the 
circuit court's decision to admit Dr. Wener's expert testimony 
at trial, I reach this conclusion in spite of the fact that the 
legislature tightened the standard of admissibility of expert 
opinion testimony when it amended Wis. Stat. § 907.02 (2009-10).  
The circuit court did not "appl[y] an improper legal standard or 
make[] a decision not reasonably supported by the facts of 
record" in admitting Dr. Wener's testimony, 118th St. Kenosha, 
359 Wis. 2d 30, 
¶18 (quoting 
 
260 North 12th St., 338 
Wis. 2d 34, ¶38), and its decision should be upheld.  See id.  I 
view the record below, however, as a "close call" which might 
not survive appellate review had this been a different case 
type. 
No.  2014AP195.akz 
 
16 
 
¶191 For the foregoing reasons, I respectfully concur. 
 
No.  2014AP195.mjg 
 
1 
 
¶192 MICHAEL 
J. 
GABLEMAN, 
J.   (concurring 
in 
the 
judgment).  This is a review of a published decision of the 
court of appeals that affirmed the Grant County circuit court's1 
order denying Dr. Kay M. Balink's ("Dr. Balink") postverdict 
motion for a new trial.  Seifert ex rel. Scoptur v. Balink, 2015 
WI App 59, 364 Wis. 2d 692, 869 N.W.2d 493.  Dr. Balink 
requested a new trial because (1) the circuit court erred by 
admitting the medical standard-of-care expert testimony of Dr. 
Jeffrey Wener ("Dr. Wener"); (2) counsel's statements during 
closing arguments unfairly prejudiced the verdict; and (3) the 
interests of justice require a new trial because the issues have 
not been fully tried. 
¶193 This case requires us to interpret how the Daubert2 
standard as adopted in Wis. Stat. § 907.02(1) (2013-14)3 applies 
to a standard-of-care expert in a medical malpractice case where 
the expert relies on his experience to show that his principles 
and methods, and the application thereof, are reliable. 
¶194 I conclude that experience is sufficient to satisfy 
Daubert's reliability requirement provided the expert shows how 
his 
experience 
makes 
his 
opinion 
reliable. 
 
No 
medical 
literature is required provided this is done.  Thus, Dr. Wener's 
opinion is admissible in this case because he showed how his 
                                                 
1 The Honorable Craig R. Day presided. 
2 Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579 (1993). 
3 All subsequent references to the Wisconsin Statutes are to 
the 2013-14 version unless otherwise indicated. 
No.  2014AP195.mjg 
 
2 
 
experience made his opinion reliable, and the circuit court did 
not err when it admitted his testimony at trial.  Consequently, 
the circuit court did not err when it denied Dr. Balink's motion 
for a new trial based on her argument that the circuit court 
erroneously admitted Dr. Wener's testimony. 
¶195 Further, I conclude the circuit court did not err when 
it denied Dr. Balink's request for a new trial based on the 
effect of counsel's statements during closing argument. 
¶196 I do not reach Dr. Balink's request for a new trial in 
the interests of justice as Dr. Balink bases the request on the 
inadmissibility of Dr. Wener's testimony and the effect of 
counsel's statements during closing arguments.  I consider it 
unnecessary to reach her request because I conclude that the 
circuit court properly admitted Dr. Wener's testimony and the 
verdict was not unfairly prejudiced by counsel's statements. 
¶197 Accordingly, I would affirm the decision of the court 
of appeals, and I concur in the court's judgment.  I write 
separately, however, to express how I reach this result. 
I.  FACTUAL BACKGROUND AND PROCEDURAL HISTORY 
A.  Ms. Seifert's Prenatal Care 
¶198 Beginning on December 5, 2008, Dr. Balink assumed Ms. 
Seifert's prenatal care.  As part of this prenatal care, Dr. 
Balink tracked Ms. Seifert's weight.  Ms. Seifert weighed 269 
pounds at the beginning of the pregnancy, which meant Ms. 
Seifert was obese.  Over the course of her pregnancy, Ms. 
Seifert gained an additional 36 pounds, and by the time of 
delivery, she weighed 305 pounds.  
No.  2014AP195.mjg 
 
3 
 
¶199 Dr. Balink took regular fundal measurements in order 
to measure the baby's growth and to estimate its size.  On 
occasion, Dr. Balink used ultrasounds, but typically, Dr. Balink 
used 
fundal 
measurements. 
 
When 
performing 
these 
fundal 
measurements, Dr. Balink placed a tape measure on Ms. Seifert's 
stomach and measured the distance from her pubic bone to the top 
of the fundus, the fundus being the top of her uterus.  
¶200 As another aspect of Ms. Seifert's prenatal care, Dr. 
Balink monitored Ms. Seifert's glucose level.  Here Dr. Balink 
used a one-hour glucose tolerance test in order to determine if 
Ms. Seifert's glucose level rose above a 140 mg/dL threshold.  
If Ms. Seifert's glucose level rose above the 140 mg/dL 
threshold, Dr. Balink would have performed a three-hour glucose 
tolerance test to determine if Ms. Seifert had gestational 
diabetes.  Because Ms. Seifert's glucose level was 131 mg/dL, 
Dr. Balink considered Ms. Seifert's glucose level safe and never 
ran the diagnostic test to determine if in fact Ms. Seifert had 
gestational diabetes. 
B.  Braylon Seifert's Delivery 
¶201 On May 26, 2009, Dr. Balink ordered Ms. Seifert's 
labor be induced.  In the induction order, Dr. Balink noted that 
Ms. Seifert's baby was "expected LGA," meaning large for 
gestational age.  Again using a fundal height measurement, Dr. 
Balink estimated the baby's weight at eight pounds, eight 
ounces.  Dr. Balink did not order an ultrasound, a more accurate 
method of measuring the baby's size, despite her awareness of 
No.  2014AP195.mjg 
 
4 
 
the complicating factors of Ms. Seifert's obesity and the 
possibility of the LGA child.  
¶202 Ms. Seifert arrived at the hospital for induction of 
labor on May 28, 2009.  After she had been pushing for one hour 
without making progress in delivering her baby, Ms. Seifert 
tired, and Dr. Balink decided to use a vacuum device on the 
baby's head for assistance.  Braylon Seifert's ("Braylon") head 
emerged when Dr. Balink used the vacuum, but shortly thereafter, 
it retracted.  This type of retraction, known as the "turtle 
sign," indicates shoulder dystocia, which essentially means the 
baby's shoulder is caught on the mother's pubic bone.  Thus, 
after 
seeing 
Braylon's 
head 
retract, 
Dr. 
Balink 
quickly 
diagnosed Braylon with shoulder dystocia. 
¶203 Shoulder dystocia can be a life-threatening emergency 
if not swiftly resolved.  This is so because a baby experiencing 
such a condition cannot breathe properly.  In an effort to 
resolve the situation as quickly as possible, Dr. Balink 
attempted a variety of maneuvers to safely deliver Braylon.  
Eventually she succeeded by using traction to dislodge Braylon's 
shoulder and pull him out.  At 12:24 a.m. on May 29, 2009, 
Braylon was born.  He weighed nine pounds, twelve ounces.  Only 
a few minutes had elapsed from the time Dr. Balink diagnosed the 
shoulder dystocia to the time she delivered Braylon, and it 
appeared that the situation had been successfully resolved with 
no permanent harm to the baby.  However, Braylon was diagnosed 
just days later with a permanent brachial plexus injury in his 
left arm that inhibits its growth and use.  Braylon has since 
No.  2014AP195.mjg 
 
5 
 
undergone surgery to improve the use of his left arm, but even 
with surgery and therapy, he will never have full use of his 
arm. 
C.  Dr. Balink's Trial for Medical Malpractice 
¶204 After discovering Braylon's permanent brachial plexus 
injury, Braylon's parents (David and Kimberly) and his guardian 
ad litem (Paul J. Scoptur) sued Dr. Balink and Proassurance 
Wisconsin Insurance Co. on Braylon's behalf alleging that Dr. 
Balink was (1) negligent in providing Ms. Seifert's prenatal 
care; (2) negligent in delivering Braylon; and (3) failed to 
obtain Ms. Seifert's informed consent before using the vacuum to 
assist with the delivery. 
1.  Dr. Wener's Opinion on the Standard of Care 
¶205 Braylon's parents and guardian ad litem hired Dr. 
Wener, a board certified obstetrician-gynecologist, to testify 
as to the standard of care required of Dr. Balink as a family 
practitioner and Dr. Balink's breach of that standard of care.  
According to Dr. Wener, Dr. Balink fell below the standard of 
care because (1) she did not use an ultrasound to estimate 
Braylon's weight prior to delivery despite Ms. Seifert's obesity 
and Braylon's suspected LGA status; (2) she never ordered the 
three-hour glucose tolerance test to determine if Ms. Seifert 
did in fact have gestational diabetes even though Ms. Seifert 
was obese and had gained more weight than would be expected over 
the course of her pregnancy; and (3) she used a vacuum to assist 
No.  2014AP195.mjg 
 
6 
 
in the delivery in spite of the presence of an increased risk 
for shoulder dystocia.4   
¶206 To form both his opinion of the applicable standard of 
care as well as his opinion that Dr. Balink had breached that 
standard of care, Dr. Wener considered the following factors:  
(1) Ms. Seifert's prepregnancy weight of 269 pounds; (2) Ms. 
Seifert's 36-pound weight gain over the course of her pregnancy; 
(3) the 131 mg/dL result from the 1-hour glucose tolerance test; 
and (4) Braylon's estimated fetal weight of 8 pounds, 8 ounces.  
Dr. Wener opined that, as a result of the confluence of these 
factors, Braylon was at an increased risk for shoulder dystocia.  
Furthermore, Dr. Wener testified that Dr. Balink fell below the 
applicable standard of care because her conduct did not account 
for the increased risk created by the factors presented by Ms. 
Seifert and her unborn child.  
¶207 Dr. 
Wener 
testified 
that 
a 
family 
practitioner 
practicing obstetrics in accordance with the applicable standard 
of care in 2009 would have recognized that Ms. Seifert's obesity 
and above-average weight gain would have rendered a fundal 
measurement too inaccurate for the situation and would have 
instead ordered an ultrasound in order to estimate the baby's 
size.  Obtaining a more accurate measurement would, in turn, 
have indicated to Dr. Balink that the vacuum device should not 
                                                 
4 Dr. Wener also opined that Dr. Balink fell below the 
standard of care by applying excessive traction when resolving 
the shoulder dystocia, but this part of Dr. Wener's opinion is 
unchallenged. 
No.  2014AP195.mjg 
 
7 
 
be used on a baby of Braylon's size because of the risk of 
shoulder dystocia.  In addition, Dr. Wener opined that a family 
practitioner practicing obstetrics in 2009 should have used a 
lower threshold than Dr. Balink used——130 mg/dL as opposed to 
140 mg/dL——when performing the 1-hour glucose tolerance test 
because of Ms. Seifert's weight, which increased the risk of 
gestational diabetes.  Finally, Dr. Wener opined that, to meet 
the 
applicable 
standard 
of 
care, 
a 
family 
practitioner 
practicing obstetrics in 2009 would avoid use of a vacuum device 
during the delivery because of the increased risk of shoulder 
dystocia resulting from Ms. Seifert's weight and Braylon's 
suspected status as a large baby. 
2.  Dr. Balink's Challenge to Dr. Wener's Opinion on the 
Standard of Care 
¶208 Before trial, Dr. Balink challenged the admissibility 
of Dr. Wener's opinion, arguing that his opinion was unreliable 
because it was based not on science and medical literature but 
rather was based solely on Dr. Wener's personal preferences.  At 
a pretrial hearing to address, inter alia, the admissibility of 
Dr. Wener's opinion, the circuit court determined Dr. Wener used 
a "holistic" method whereby Dr. Wener looked at the patient as a 
whole using recognized factors in order to come to a conclusion 
about the standard of care required.  In support of its decision 
to admit Dr. Wener's opinion, the circuit court pointed to "the 
vagaries of medical treatment and diagnosis" and emphasized that 
Dr. Wener does not represent the junk science Daubert was 
intended to exclude.  Thus, the circuit court ruled that Dr. 
No.  2014AP195.mjg 
 
8 
 
Wener's opinion testimony was admissible, and the case proceeded 
to trial. 
3.  Closing Arguments 
¶209 At trial, Kenneth M. Levine ("Atty. Levine"), the 
Seiferts' counsel, made a series of statements during closing 
arguments that Dr. Balink argues require a new trial because the 
statements were improper and unfairly prejudiced the verdict.  
First, Dr. Balink says Atty. Levine compared Dr. Wener's opinion 
about the standard of care required of Dr. Balink as a family 
practitioner to the standard of care required of an ordinary 
person while driving.  Dr. Balink's counsel objected to these 
statements as a violation of the "rules of the road prohibition" 
put in place by the circuit court in a ruling on a motion in 
limine.  The circuit court's ruling stated that Atty. Levine 
could not compare medical negligence to ordinary negligence.  
Second, Atty. Levine asked the jurors on three occasions how 
they would like their doctors to care for them, and in so doing, 
Dr. Balink argues Atty. Levine violated the "golden rule 
prohibition."  At the time of the first violation, Atty. Levine 
withdrew his statement in response to the objection made by Dr. 
Balink's counsel; at the time of the second violation, the 
circuit court gave a brief curative instruction; and at the time 
of the third violation, the circuit court sustained the 
objection made by Dr. Balink's counsel.  Third, in his rebuttal 
argument, Atty. Levine made a statement that he thought more 
highly of the jurors than Dr. Balink's counsel and another 
No.  2014AP195.mjg 
 
9 
 
statement that he thought the jurors were well equipped to 
decide the case and were experts in their own right. 
4.  Dr. Balink's Motion for a New Trial 
¶210 Following the verdict, Dr. Balink moved the circuit 
court for a new trial based on three arguments.  First, Dr. 
Balink argued the circuit court erred when it admitted Dr. 
Wener's testimony.  Second, the cumulative effects of Atty. 
Levine's statements during closing arguments unfairly prejudiced 
the verdict.  Third, the interests of justice required a new 
trial because the issues were not fully tried due to the 
erroneous admission of Dr. Wener's testimony and the effect of 
Atty. Levine's improper statements during closing arguments.  
¶211 At the hearing to address Dr. Balink's motion for a 
new trial, the circuit court again determined that Dr. Wener's 
opinion was admissible.5  The circuit court noted Dr. Wener's 
method was grounded in science and further that his method can 
be tested.  In regard to the nature of Dr. Wener's testimony, 
the circuit court observed, "[I]t is not in the nature of 
engineering or other more hard sciences.  It is not a 
mathematical calculation wherein one plus one plus one always 
yields three.  Sometimes it yields 3.2 and sometimes it yields 
2.8."  Further, in light of the expert testimony Dr. Balink 
introduced at trial, it was more firmly assured of the 
                                                 
5 In total, the circuit court considered the admissibility 
of Dr. Wener's testimony three times:  first at the pretrial 
hearing, second at trial pursuant to an objection to Dr. Wener's 
testimony, and third at the hearing on Dr. Balink's motion for a 
new trial. 
No.  2014AP195.mjg 
 
10 
 
admissibility of Dr. Wener's testimony because there were points 
on which Dr. Balink's experts agreed with Dr. Wener. 
¶212 The circuit court also found that neither Atty. 
Levine's statements, nor their cumulative effect, required an 
order for a new trial.  The circuit court determined that the 
first set of statements did not violate the motion in limine, 
even though it was close.  In reaching its conclusion, the 
circuit court noted that the jury was instructed on medical 
negligence, not ordinary negligence; therefore, the jury was 
unlikely to see the comparison between the two types of 
negligence given that the jury had not been instructed on 
ordinary negligence.  For the second set of statements, the 
circuit court found that the sustained objection of Dr. Balink's 
counsel and curative instruction given by the court were 
sufficient to eliminate any unfair prejudice.  Finally, for the 
third set of statements, the circuit court found the context——
rebuttal argument——important because Atty. Levine's statements 
were made in response to statements made by Dr. Balink's counsel 
during closing arguments.  In addition, the circuit court 
determined that Atty. Levine employed an argument technique 
meant to empower the jury and give it confidence to decide the 
case.  Therefore, these statements were not improper.  Thus, the 
effect of Atty. Levine's statements did not require a new trial. 
¶213 The circuit court then denied Dr. Balink's request for 
a new trial. 
5.  Dr. Balink's Appeal 
No.  2014AP195.mjg 
 
11 
 
¶214 Dr. Balink appealed, and the court of appeals affirmed 
the circuit court determining that it did not err when it denied 
Dr. Balink's request for a new trial.  Seifert, 364 Wis. 2d 692, 
¶3.  Relying heavily on the discretion afforded to circuit 
courts in the Daubert analysis, the court of appeals determined 
the circuit court properly exercised its discretion in admitting 
Dr. Wener's opinion.  Id., ¶¶23-27, 34.  Then, pointing out that 
Dr. Balink failed to move for a mistrial before the verdict, the 
court of appeals determined that the circuit court did not err 
when it denied Dr. Balink's request for a new trial based on the 
effect of Atty. Levine's statements during closing arguments.  
Id., ¶¶36 n.10, 37.  The court of appeals next addressed Dr. 
Balink's request for a new trial in the interests of justice 
stating that the issues were fully tried and no new trial was 
needed.  Id., ¶49 n.12. 
¶215 Dr. Balink then petitioned this court for review, and 
because we have yet to address the adoption of the Daubert 
standard in Wisconsin, we granted review to take the opportunity 
to define the reliability analysis for a standard-of-care expert 
in a medical malpractice case. 
II.  STANDARD OF REVIEW 
¶216 Before discussing the standard of review it is 
important to note that while Daubert has imposed change in some 
areas of the law concerning expert testimony, it has not changed 
the standard of review in such cases.  Gen. Elec. Co. v. Joiner, 
522 U.S. 136, 141-43 (1997).  Thus, review of a circuit court's 
decision to admit or exclude expert testimony follows the same 
No.  2014AP195.mjg 
 
12 
 
standards previously used before the legislature adopted the 
Daubert standard in 2011.  
¶217 This court reviews a circuit court's decision to admit 
or exclude expert testimony for an erroneous exercise of 
discretion.  
State v. Kandutsch, 2011 WI 78, 
¶23, 336 
Wis. 2d 478, 799 N.W.2d 865.  "The circuit court has 'broad 
discretion to admit or exclude evidence,'" and this court 
upholds the circuit court's decision unless it failed to apply 
the proper legal standard or the record lacks reasonable support 
for its decision.  Id. (quoting State v. Nelis, 2007 WI 58, ¶26, 
300 Wis. 2d 415, 733 N.W.2d 619; Martindale v. Ripp, 2001 WI 
113, ¶28, 246 Wis. 2d 67, 629 N.W.2d 698). 
¶218 In order to determine whether the circuit court 
erroneously exercised its discretion, this court must first 
interpret the Daubert standard as adopted by the legislature in 
Wis. Stat. § 907.02(1) and determine if the circuit court used 
the 
proper 
legal 
standard 
when 
it 
analyzed 
Dr. 
Wener's 
testimony.  Statutory interpretation is a question of law this 
court reviews de novo.  State v. Hemp, 2014 WI 129, ¶12, 359 
Wis. 2d 320, 856 N.W.2d 811.  Should this court interpret 
§ 907.02(1) and conclude that the circuit court used the proper 
legal standard, "the [circuit] court's choice of relevant 
factors 
within 
[the 
Daubert] 
framework 
and 
its 
ultimate 
conclusion as to admissibility" is reviewed for an erroneous 
exercise of discretion.  Lees v. Carthage Coll., 714 F.3d 516, 
520 (7th Cir. 2013). 
No.  2014AP195.mjg 
 
13 
 
¶219 As with evidentiary rulings, this court reviews a 
circuit court's ruling on a motion for a new trial for an 
erroneous exercise of discretion.  Wagner v. Am. Family Mut. 
Ins., 65 Wis. 2d 243, 249-50, 222 N.W.2d 652 (1974). 
III.  DISCUSSION 
¶220 First, I consider the admissibility of Dr. Wener's 
opinion and conclude that the circuit court properly exercised 
its discretion when it admitted Dr. Wener's opinion.  In so 
concluding, I further conclude the circuit court properly 
exercised its discretion in denying Dr. Balink's request for a 
new trial.  Second, I consider the effect of Atty. Levine's 
statements during closing arguments and conclude the circuit 
court properly exercised its discretion when it found the effect 
of the statements did not require a new trial.  As noted above, 
I do not reach Dr. Balink's argument for a new trial in the 
interests of justice because the circuit court properly admitted 
Dr. Wener's testimony and Atty. Levine's statements do not 
require a new trial.  Thus, the issues were fully tried, and 
there is no reason to grant a new trial in the interests of 
justice under Wis. Stat. § 751.06. 
A.  The Admissibility of Dr. Wener's Testimony 
1.  The Governing Statute 
¶221 The admissibility of expert testimony is governed by 
Wis. Stat. § 907.02(1): 
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 
No.  2014AP195.mjg 
 
14 
 
thereto in the form of an opinion or otherwise, if the 
testimony is based upon sufficient facts or data, the 
testimony is the product of reliable principles and 
methods, and the witness has applied the principles 
and methods reliably to the facts of the case. 
(Emphasis added).  This last part of the statute, emphasized 
above, was added by the legislature in 2011, see 2011 Wis. Act 
2, § 34m, and it is this addition that I address today. 
¶222 In addressing the addition to § 907.02(1), I first 
look at the standard previously followed in Wisconsin and then 
look to federal law for guidance on how Federal Rule 702 ("Rule 
702") and Daubert have been interpreted and applied in the 
federal courts.  Next, I evaluate Dr. Wener's testimony and the 
circuit court's analysis of his testimony in order to determine 
whether the circuit court erred in determining that Dr. Wener's 
principles and methods meet the reliability standards set forth.  
After concluding that Dr. Wener's principles and methods are 
reliable, I then evaluate if his principles and methods were 
reliably applied.  
2.  The Relevancy Standard and Wisconsin's Adoption of the 
Daubert Standard 
¶223 Traditionally, 
Wisconsin 
followed 
the 
relevancy 
standard as articulated in State v. Walstad, 119 Wis. 2d 483, 
515-16, 351 N.W.2d 469 (1984), to determine the admissibility of 
expert testimony.  Under this standard, the expert needed only 
to be qualified, helpful, and relevant in order to be permitted 
to testify.  Id. at 516.  Reliability was considered a 
credibility determination left for the jury.  State v. Fischer, 
2010 WI 6, ¶2, 322 Wis. 2d 265, 778 N.W.2d 629.  When confronted 
No.  2014AP195.mjg 
 
15 
 
with the opportunity to replace the relevancy standard with the 
Daubert 
standard 
followed 
in 
federal 
courts, 
this 
court 
confirmed adherence to the relevancy standard.  E.g., Fischer, 
322 Wis. 2d 265, ¶7.  Not until the legislature amended the 
statute governing expert testimony in 2011 to add the language 
emphasized above did Wisconsin adopt the Daubert standard 
followed in federal courts.  See 2011 Wis. Act 2, § 34m.  Thus, 
because our statute governing the admissibility of expert 
testimony now mirrors Rule 702, compare Wis. Stat. § 907.02(1), 
with Fed. R. Evid. 702, we may look to federal law interpreting 
the Daubert standard for guidance concerning how we should apply 
the 
standard 
in 
Wisconsin, 
State 
v. 
Gudenschwager, 
191 
Wis. 2d 431, 439, 529 N.W.2d 225 (1995). 
3.  Federal Rule of Evidence 702 and the Daubert Standard 
¶224 Rule 702 contains five inquiries for a district court 
to make before admitting expert testimony.  Fed. R. Evid. 702.  
All of these inquiries must be met by a preponderance of the 
evidence.  Id. advisory committee notes (2000 amend.).  First, 
the witness must be qualified.  Lees, 714 F.3d at 521.  
Essentially this means that the witness must possess specialized 
knowledge, which is something Wisconsin has required for expert 
testimony before the legislature amended Wis. Stat. § 907.02(1).  
Second, the witness's testimony must be helpful, meaning it must 
assist the trier of fact.  Lees, 714 F.3d at 521.  This element 
closely relates to the relevance requirement previously followed 
in Wisconsin.  Third, the witness's testimony must be based on 
sufficient facts and data.  Id.  Fourth, the witness must have 
No.  2014AP195.mjg 
 
16 
 
reliable principles and methods, and fifth, those principles and 
methods must be reliably applied to the facts of the case.  Id. 
at 521-22.  I address the fourth and fifth elements today 
because these elements are new to Wisconsin law with the 
legislature's adoption of the Daubert standard and are the 
elements at issue in this case. 
4.  The Reliability Analysis 
¶225 In order to assist with the reliability analysis 
required by the fourth and fifth elements (reliable principles 
and methods reliably applied to the facts of the case), the 
United 
States 
Supreme 
Court 
in 
Daubert 
v. 
Merrell 
Dow 
Pharmaceuticals, Inc., 509 U.S. 579, 593-94 (1993), articulated 
four non-exhaustive factors courts could use to analyze the 
reliability of expert testimony:  (1) whether the method has 
been or will be tested; (2) whether the method "has been 
subjected to peer review and publication"; (3) "the known or 
potential rate of error"; and (4) whether the method has been 
generally accepted.  In articulating these factors, the Court 
emphasized the factors are flexible and do not represent all the 
factors a court could possibly consider.  Id. at 594.  In fact,  
a trial court may consider one or more of the more 
specific factors that Daubert mentioned when doing so 
will help determine that testimony's reliability.  
But, as the Court stated in Daubert, the test of 
reliability is "flexible," and Daubert's list of 
specific factors neither necessarily nor exclusively 
applies to all experts or in every case.  Rather, the 
law grants a district court the same broad latitude 
when it decides how to determine reliability as it 
enjoys 
in 
respect 
to 
its 
ultimate 
reliability 
determination.  
No.  2014AP195.mjg 
 
17 
 
Kumho Tire Co. v. Carmichael, 526 U.S. 137, 141-42 (1999).  
"[T]here are many different kinds of experts and many different 
kinds of expertise, including experts in drug terminology, 
handwriting analysis, land valuation, agricultural practices, 
railroad procedures, and so forth."  United States v. Brumley, 
217 F.3d 905, 911 (7th Cir. 2000).  Therefore, the reliability 
analysis must be flexible enough to allow the circuit court to 
assess the type of expert being evaluated. 
¶226 As a result of the different kinds of experts, courts 
developed additional factors——many of which are listed in the 
Advisory 
Committee 
Notes 
of 
Rule 
702——for 
analyzing 
the 
reliability of an expert's opinion as the situation required.  
In some of these situations, particularly those involving 
specialized knowledge, courts used an expert's experience to 
determine reliability.  See Kumho Tire, 526 U.S. at 150.  Rule 
702 expressly allows for the use of an expert's experience, and 
the Advisory Committee Notes say: 
Nothing in this amendment is intended to suggest that 
experience alone——or experience in conjunction with 
other knowledge, skill, training or education——may not 
provide a sufficient foundation for expert testimony. 
To the contrary, the text of Rule 702 expressly 
contemplates that an expert may be qualified on the 
basis of experience. 
Fed. R. Evid. 702 advisory committee notes (2000 amend.) 
(emphasis added).  In fact, "[i]n certain fields, experience is 
the predominant, if not sole, basis for a great deal of reliable 
expert testimony."  Id.  Therefore, when assessing reliability, 
a circuit court should have flexibility to use different 
reliability factors, including the expert's experience, to 
No.  2014AP195.mjg 
 
18 
 
analyze whether the expert's opinion is reliable.  As the Court 
pointed out in Kumho Tire, 
[e]xperts of all kinds tie observations to conclusions 
through the use of what Judge Learned Hand called 
"general 
truths 
derived 
from . . . specialized 
experience." 
 
And 
whether 
the 
specific 
expert 
testimony focuses upon specialized observations, the 
specialized translation of those observations into 
theory, 
a 
specialized 
theory 
itself, 
or 
the 
application of such a theory in a particular case, the 
expert's testimony often will rest "upon an experience 
confessedly foreign in kind to [the jury's] own." 
526 U.S. at 148-49 (alteration in original) (emphasis added) 
(citation 
omitted) 
(quoting 
Learned 
Hand, 
Historical 
and 
Practical Considerations Regarding Expert Testimony, 15 Harv. L. 
Rev. 40, 54 (1901)). 
¶227 In general, when assessing reliability, a circuit 
court is looking for "good grounds" for the expert's opinion to 
show that it is "more than subjective belief or unsupported 
speculation" and demonstrates "a reliable basis in the knowledge 
and experience of his discipline."  Daubert, 509 U.S. at 590, 
592.  Therefore, whatever factors a court uses to assess an 
expert's reliability, the factors, and the court's analysis, 
must ensure the expert has good grounds for his or her opinion.  
In addition, "[t]he focus, of course, must be solely on 
principles and methodology, not on the conclusions that they 
generate."  Id. at 595.  Thus, if a circuit court finds that an 
expert has good grounds for his opinion, it is for the jury to 
decide between competing conclusions. 
5.  The Reliability Analysis in the Medical Standard-of-Care 
Context 
No.  2014AP195.mjg 
 
19 
 
¶228 When assessing a medical standard-of-care expert, 
other jurisdictions have found good grounds for the expert's 
opinion when the expert had experience that demonstrated 
familiarity with the type of medicine at issue and the standard 
of care for that type of medicine.  For example, the Third 
Circuit concluded a doctor's testimony was based on good grounds 
and the district court abused its discretion in excluding the 
doctor's standard-of-care testimony because the doctor no longer 
practiced as an interventional cardiologist and now practiced as 
an invasive cardiologist.  Schneider ex rel. Estate of Schneider 
v. Fried, 320 F.3d 396, 399-400 (3d Cir. 2003).  As an invasive 
cardiologist, the doctor still interacted with, and even 
advised, interventional cardiologists, which, along with his 
past experience as an invasive cardiologist, was sufficient to 
satisfy Daubert.  Id. at 406-07.  Therefore, the Third Circuit 
concluded the expert was sufficiently familiar with the type of 
medicine involved in the case such that he could reliably 
testify to the standard of care.  
¶229 The Sixth Circuit reached a similar conclusion in 
Dickenson v. Cardiac & Thoracic Surgery of Eastern Tennessee, 
P.C., 388 F.3d 976, 978-82 (6th Cir. 2004), when it concluded 
the district court abused its discretion in excluding a cardio-
thoracic surgeon's testimony regarding the standard of care 
required for a pulmonologist.  There, the court concluded the 
district court abused its discretion by not allowing the doctor 
to testify as to the standard of care based on the doctor's 
No.  2014AP195.mjg 
 
20 
 
extensive experience and familiarity with the pulmonology issue 
involved in the case.  Id. at 980-82. 
¶230 As Hippocrates, the father of medicine, noted in his 
writing On the Art of Medicine, clinical medicine is an art that 
requires 
good 
judgment 
developed 
over 
time 
and 
through 
experience.  Put another way, "medicine is scientific, but not 
entirely a science."  Primiano v. Cook, 598 F.3d 558, 565 (9th 
Cir. 2010).  As the Sixth Circuit noted, 
Daubert's role of "ensur[ing] that the courtroom door 
remains closed to junk science," is not served by 
excluding testimony such as [the doctor's] that is 
supported by extensive relevant experience.  Such 
exclusion is rarely justified in cases involving 
medical experts as opposed to supposed experts in the 
area of product liability.  
Dickenson, 388 F.3d at 982 (alteration in original) (citation 
omitted) (quoting Amorgianos v. Nat'l R.R. Passenger Corp., 303 
F.3d 256, 267 (2d Cir. 2002)).   
6.  Determining the Reliability of Dr. Wener's Principles and 
Methods 
¶231 With the foregoing in mind, we now turn to the 
question of whether Dr. Wener's principles and methods are 
reliable such that he can testify about the standard of care 
applicable to Dr. Balink.   
i.  Identifying Dr. Wener's Principles and Methods 
¶232 In order to answer the question before us, namely 
whether Dr. Wener's testimony is admissible under Daubert, the 
first step is to identify the principles and methods Dr. Wener 
employed.  The circuit court found Dr. Wener used a "holistic," 
or comprehensive, method of determining the standard of care 
No.  2014AP195.mjg 
 
21 
 
applicable to Ms. Seifert.  Essentially, this comprehensive 
method amounts to an expert physician examining the patient as a 
whole, determining what, if any, of the risk factors recognized 
by the medical community are present within the patient, and 
then using that expert physician's experience to interpret the 
risk factors and arrive at the standard of care required.  It 
is, as it must be, a case-by-case method to determine what type 
of care is appropriate for a particular patient.  
¶233 Here, Dr. Wener identified the following risk factors 
recognized by the medical community:  (1) Ms. Seifert's 
prepregnancy weight of 269 pounds; (2) Ms. Seifert's 36-pound 
weight gain over the course of her pregnancy; (3) the 131 mg/dL 
result from the one-hour glucose tolerance test; and (4) 
Braylon's estimated fetal weight.  As his method, Dr. Wener used 
his experience to determine that these factors indicated that 
Ms. Seifert's baby was at an increased risk for shoulder 
dystocia and that Dr. Balink fell below the standard of care 
because she did not account for this increased risk. 
ii.  Assessing Reliability 
¶234 Now that we have identified Dr. Wener's principles and 
methods, we must determine if they are reliable and reliably 
applied.  In this case, I conclude that the circuit court did 
not err when it found Dr. Wener's principles and methods are 
sufficiently reliable and reliably applied.  Dr. Wener showed 
how 
his 
experience 
made 
his 
methodology 
reliable 
and 
demonstrated, through his experience, an understanding of the 
applicable standard of care in a way that he can reliably opine 
No.  2014AP195.mjg 
 
22 
 
about the standard of care required.  Dr. Wener testified that 
he delivered 7,500 to 8,000 babies, encountered shoulder 
dystocia, and even brachial plexus injuries, which shows that 
Dr. Wener is experienced with the type of medical practice at 
issue in this case.  This experience in turn makes his 
comprehensive methodology reliable because Dr. Wener has used 
his factors and his methods in treating his own patients.  Dr. 
Wener also testified that he has experience as Chairman of the 
Department of Obstetrics and Gynecology at Saint Alexius Medical 
Center.  Part of his responsibilities as Chairman required 
reviewing the work of other doctors and setting the quality of 
care for the hospital.  In addition, Dr. Wener testified that he 
taught medical students at the University of California San 
Diego, and he was named "One of Chicago's Top Doctors" by his 
peers.  This testimony demonstrates an understanding of the 
applicable standard of care by showing Dr. Wener is familiar 
with the medical community and more than just his own practice.  
When tailoring the reliability analysis to a medical standard-
of-care expert, good grounds may come from the expert's own 
experience provided that experience has made him or her familiar 
with the type of medicine at issue.  Dr. Wener shows that here, 
and therefore the circuit court did not err when it found his 
testimony reliable. 
¶235 Further, the circuit court undertook a thoughtful 
analysis of the admissibility of Dr. Wener's testimony that 
shows it considered the reliability factors in order to 
determine good grounds for Dr. Wener's opinion.  It noted that 
No.  2014AP195.mjg 
 
23 
 
Dr. Wener is not the kind of junk scientist Daubert sought to 
exclude and Dr. Wener's decision not to use medical literature 
was 
acceptable 
because 
the 
individualized 
nature 
of 
a 
determination made when caring for a particular patient is not 
something that can be published or peer reviewed.  Also, the 
circuit court correctly found that Dr. Wener's method had an 
aspect of testability to it because the factors he relied on 
were, indeed, capable of being tested.  Although it prudently 
and accurately observed that the nature of the case was "not in 
the nature of engineering or other more hard sciences," the 
circuit court properly admitted Dr. Wener's opinion based on Dr. 
Wener's experience. 
¶236 Indeed, I emphasize that the circuit court does have 
and must have discretion to apply the Daubert analysis so as to 
fit the facts of each particular case, as the circuit court did 
here.  See Kumho Tire, 526 U.S. at 150 ("Our emphasis on the 
word 'may' thus reflects Daubert's description of the Rule 702 
inquiry as 'a flexible one.'  Daubert makes clear that the 
factors it mentions do not constitute a 'definitive checklist or 
test.'  And Daubert adds that the gatekeeping inquiry must be 
'tied to the facts' of a particular 'case.'" (citations omitted) 
(quoting Daubert, 509 U.S. at 591, 593-94)).  However, this 
discretion does not allow the circuit court to abdicate its role 
as gatekeeper in performing the reliability analysis.  Id. at 
158-59 (Scalia, J., concurring) ("[T]he discretion [the Court] 
endorses——trial-court discretion in choosing the manner of 
testing expert reliability——is not discretion to abandon the 
No.  2014AP195.mjg 
 
24 
 
gatekeeping function. . . . Rather, it is discretion to choose 
among reasonable means of excluding expertise that is fausse and 
science that is junky.").   
¶237 As is evident by the circuit court's discussion of the 
Daubert factors, it did not abdicate its role as gatekeeper when 
admitting Dr. Wener's testimony; instead, the analysis indicates 
the circuit court thoughtfully and carefully considered the 
Daubert factors before turning to other considerations.  The 
circuit court used its discretion to tailor its analysis to the 
type of expert we have here, namely a medical standard-of-care 
expert, and it looked to Dr. Wener's experience in order to 
determine reliability.  In so doing, it noted that Dr. Wener 
used factors recognized by the medical community that he then 
"added up" based on his own experience with delivering babies, 
dealing with shoulder dystocia, and setting the quality of care 
at his hospital to reach a conclusion as to the standard of care 
required here.  This, the circuit court said, made Dr. Wener's 
opinion reliable, and I see no error in this conclusion. 
7.  Dr. Balink's Arguments 
¶238 Dr. Balink makes two main arguments as to the 
unreliability of Dr. Wener's opinion.  First, she argues that 
Dr. Wener's testimony is based on nothing but his personal 
preferences, and second, she argues that Dr. Wener's failure to 
ground his testimony in any published medical literature makes 
his testimony unreliable.  I address each argument in turn. 
i.  Dr. Wener's Opinion Is More than Personal Preference 
No.  2014AP195.mjg 
 
25 
 
¶239 First, Dr. Balink argues Dr. Wener has nothing but his 
personal preferences to support his conclusion as to the 
standard of care and Dr. Balink's breach of that standard of 
care.  Thus, his opinion is unreliable because it reflects only 
what Dr. Wener would do and not what the reasonable family 
practitioner practicing obstetrics in 2009 would do.  While it 
may be true that Dr. Wener practices medicine in the manner he 
set forth as the applicable standard of care, that fact, 
standing alone, does not transform his opinion into a statement 
of personal preference.  Dr. Wener assisted in setting the 
quality of care required at Saint Alexius Medical Center while 
he served there as Chairman of the Department of Obstetrics and 
Gynecology.  Furthermore, Dr. Wener taught medical students and 
was named "One of Chicago's Top Doctors" by his peers.  At least 
one other court has reached a similar conclusion when presented 
with the question of how to determine if a medical standard-of-
care expert's testimony is reliable based on his experience.  In 
Ellison v. United States, 753 F. Supp. 2d 468, 480-81 (E.D. Pa. 
2010), the court dismissed the United States' argument that the 
standard-of-care expert based his opinion on his personal 
preferences because, "[t]aken as a whole, Dr. Super's testimony 
is that he has formulated an opinion as to the general——as 
opposed to simply his own, personal——standard of care and that, 
based on his experience, he had a reliable basis for doing so."  
ii.  There Is No Medical Literature Requirement 
¶240 Second, Dr. Balink argues that Dr. Wener's failure to 
rely 
on 
published 
medical 
literature 
makes 
his 
opinion 
No.  2014AP195.mjg 
 
26 
 
unreliable.  However, as the Third Circuit noted when it 
addressed medical literature in the context of differential 
diagnosis, 
[i]n the actual practice of medicine, physicians do 
not wait for conclusive, or even published and peer-
reviewed, studies to make diagnoses to a reasonable 
degree of medical certainty.  Such studies of course 
help them to make various diagnoses or to rule out 
prior diagnoses that the studies call into question.  
However, 
experience 
with 
hundreds 
of 
patients, 
discussions with peers, attendance at conferences and 
seminars, detailed review of a patient's family, 
personal, and medical histories, and thorough physical 
examinations are the tools of the trade, and should 
suffice for the making of a differential diagnosis 
even in those cases in which peer-reviewed studies do 
not exist to confirm the diagnosis of the physician. 
Heller v. Shaw Indus., Inc., 167 F.3d 146, 155 (3d Cir. 1999); 
see also Dickenson, 388 F.3d at 980 (calling the district 
court's imposition of a medical literature requirement for a 
medical expert "an erroneous statement of the law"); Schneider, 
320 F.3d at 406 ("Where there are other factors that demonstrate 
the reliability of the expert's methodology, an expert opinion 
should not be excluded simply because there is no literature on 
point."); Kudabeck v. Kroger Co., 338 F.3d 856, 862 (8th Cir. 
2003) 
("[P]ublication 
is 
not 
a 
prerequisite 
for 
admissibility.").  The Court itself noted in Daubert that 
"[p]ublication . . . is not a sine qua non of admissibility."  
Daubert, 509 U.S. at 593.  Thus, there simply is no medical 
literature requirement of the kind Dr. Balink suggests, and an 
expert's decision not to rely on literature does not render his 
opinion unreliable provided the expert has something else, like 
his experience, to make his opinion reliable.  Thus, because 
No.  2014AP195.mjg 
 
27 
 
there is no requirement that an expert physician's testimony be 
based in whole or in part on medical literature and Dr. Wener 
showed how his experience makes his opinion reliable, the 
circuit court did not err when it admitted Dr. Wener's 
testimony. 
¶241 It is true that Dr. Balink produced medical literature 
in this case that seemingly contradicted Dr. Wener's opinion, 
particularly regarding the threshold to use for the one-hour 
glucose tolerance test; however, Dr. Wener was able to meet that 
literature and provide an explanation for why, based on his 
experience, he did not agree with it.  Thus, the presence of 
this literature does not render Dr. Wener's testimony unreliable 
as a matter of law, as Dr. Balink argues.  Such a conflict of 
evidence boils down to an issue of credibility, requiring 
determination by the trier of fact.  "Daubert makes the 
[circuit] court a gatekeeper, not a fact finder."  United States 
v. Sandoval-Mendoza, 472 F.3d 645, 654 (9th Cir. 2006). 
8.  Determining the Reliable Application of Dr. Wener's 
Principles and Methods 
¶242 Last in the Daubert analysis, I determine that Dr. 
Wener reliably applied his comprehensive method to the facts of 
this case.   
¶243 Under the Daubert analysis, we are to look for 
reliable principles and methods and a conclusion that logically 
follows from those reliable principles and methods.  See Joiner, 
522 U.S. at 144-46.  If the expert's conclusion logically 
follows 
from 
reliable 
principles 
and 
methods, 
any 
No.  2014AP195.mjg 
 
28 
 
inconsistencies,6 or flaws, go to the weight, or credibility, of 
the expert's testimony as opposed to its admissibility.  See 
Lees, 714 F.3d at 525. 
¶244 Such is the case here.  As detailed above, Dr. Wener 
had a reliable method of determining the standard of care 
applicable to this case because of his experience.  His 
conclusion that Dr. Balink breached that standard of care 
logically follows from that method.  Thus, the inconsistencies 
Dr. Balink points to in her brief as examples of an unreliable 
application go to the weight to be given to Dr. Wener's 
testimony and not to the question of its admissibility.  When 
assessing expert testimony, we are looking for good grounds, not 
flawless grounds.  "Vigorous cross-examination, presentation of 
contrary evidence, and careful instruction on the burden of 
proof are the traditional and appropriate means of attacking 
shaky but admissible evidence."  Daubert, 509 U.S. at 596. 
¶245 "[W]hen an expert purports to apply principles and 
methods in accordance with professional standards, and yet 
reaches a conclusion that other experts in the field would not 
reach, 
the 
[circuit] 
court 
may 
fairly 
suspect 
that 
the 
principles and methods have not been faithfully applied."  Fed. 
                                                 
6 Dr. Balink complains of inconsistencies in Dr. Wener's 
testimony.  As one example, Dr. Balink points to Dr. Wener's 
testimony that he would not use a vacuum for a baby with an 
estimated fetal weight greater than 4,500 grams by ultrasound 
and that babies with an estimated fetal weight of greater than 
4,500 grams are associated with an increased risk of shoulder 
dystocia.  Dr. Balink argues that Dr. Wener's testimony is 
inconsistent for the facts of this case because Braylon's actual 
birth weight was only 4,370 grams. 
No.  2014AP195.mjg 
 
29 
 
R. Evid. 702 advisory committee notes (2000 amend.).  This is 
not the case here, and Dr. Wener's testimony may not be excluded 
because, as the circuit court noted in the postverdict motion 
hearing, Dr. Balink's experts agreed with Dr. Wener in some 
respects.  Thus, the circuit court did not have reason to 
exclude Dr. Wener's testimony because the record discloses no 
reason to suspect that Dr. Wener's application of his principles 
and methods to the facts of this case was unreliable. 
¶246 In some cases the expert's conclusion bears on the 
reliability analysis because "conclusions and methodology are 
not entirely distinct from one another."  Joiner, 522 U.S. at 
146.  For example, "[a] court may conclude that there is simply 
too great an analytical gap between the data and the opinion 
proffered."  Id.  However, provided the conclusions of the 
respective expert physicians logically follow from their methods 
and there is no analytical gap between the two, a court is not 
to choose between the differing conclusions of two experts; such 
a determination is left for the jury.  See id.  But this is not 
the case with Dr. Wener's testimony despite the fact that Dr. 
Balink presented contradictory medical literature and comes to a 
different conclusion.  Thus, Dr. Wener's conclusion does not 
render his testimony inadmissible because it differs from Dr. 
Balink's conclusion. 
¶247 In sum, I conclude that Dr. Wener's opinion is 
admissible.  His comprehensive method is reliable and reliably 
applied.  This is a result of his extensive experience that 
supports his opinion, and the circuit court did not err when it 
No.  2014AP195.mjg 
 
30 
 
found Dr. Wener's testimony admissible.  Thus, Dr. Balink's 
request for a new trial based on the erroneous admission of Dr. 
Wener's testimony was properly denied. 
B.  Counsel's Statements During Closing Arguments 
¶248 Dr. 
Balink 
next 
argues 
that 
the 
circuit 
court 
erroneously denied her motion for a new trial because the effect 
of Atty. Levine's improper statements during closing arguments 
unfairly prejudiced the verdict. 
¶249 Before addressing this argument, I first note that I 
conclude that Dr. Balink waived this argument by failing to move 
for a mistrial.  See Wagner, 65 Wis. 2d at 249.  However, like 
the court of appeals, I choose to address this argument under 
the court's discretionary jurisdiction. 
¶250 A motion for a new trial based on unfairly prejudicial 
statements by counsel "is addressed to the discretion of the 
trial court."  Id. at 249-50; see also Rodriguez v. Slattery, 54 
Wis. 2d 165, 170-71, 194 N.W.2d 817 (1972) ("The trial court is 
in a particularly good 'on-the-spot' position to evaluate these 
factors.").  Thus, we are bound to uphold the circuit court's 
decision unless the circuit court erroneously exercised its 
discretion.  See Klein v. State Farm Mut. Auto. Ins., 19 
Wis. 2d 507, 511, 120 N.W.2d 885 (1963). 
¶251 Here, the circuit court gave an account of its 
reasoning.  I see no reason to say the circuit court erroneously 
exercised its discretion by denying Dr. Balink's motion for a 
new trial.   
IV.  CONCLUSION 
No.  2014AP195.mjg 
 
31 
 
¶252 In this instance, I conclude that experience is 
sufficient to satisfy Daubert's reliability requirement provided 
the expert shows how his experience makes his opinion reliable.  
No medical literature is required provided this is done.  Thus, 
Dr. Wener's opinion is admissible in this case because he showed 
how his experience made his opinion reliable, and the circuit 
court did not err when it admitted his testimony at trial.  
Consequently, the circuit court did not err when it denied Dr. 
Balink's motion for a new trial based on her argument that the 
circuit court erroneously admitted Dr. Wener's testimony. 
¶253 Further, I conclude the circuit court did not err when 
it denied Dr. Balink's request for a new trial based on the 
effect of counsel's statements during closing argument. 
¶254 I do not reach Dr. Balink's request for a new trial in 
the interests of justice as Dr. Balink bases the request on the 
inadmissibility of Dr. Wener's testimony and the effect of 
counsel's statements during closing arguments.  I consider it 
unnecessary to reach her request because I conclude that the 
circuit court properly admitted Dr. Wener's testimony and the 
verdict was not unfairly prejudiced by opposing counsel's 
statements. 
¶255 Accordingly, I would affirm the decision of the court 
of appeals, and I concur in the court's judgment.  I write 
separately, however, to express how I reach this result. 
¶256 For the foregoing reasons I concur. 
¶257 I am authorized to state that Chief Justice PATIENCE 
DRAKE 
ROGGENSACK 
joins 
this 
concurrence.
No.  2014AP195.dk 
 
1 
 
¶258 DANIEL 
KELLY, 
J.   (dissenting). 
 
I 
dissent, 
respectfully, because we missed an opportunity to clarify the 
standards for admission of expert testimony.  This lack of 
clarity caused us to affirm the admission of testimony that does 
not satisfy the requirements of Wis. Stat. § 907.02 (2013–14).1 
¶259 I agree with the lead opinion that an expert's 
personal experience can qualify him as an expert under Wis. 
Stat. § 907.02, making his testimony sufficiently "reliable" for 
admission to the jury.  But that just begs the question:  In 
light of that personal experience, to what is the admitted 
expert qualified to testify?  Here, Dr. Wener's task was to 
identify and describe the standard of medical care against which 
to measure Dr. Balink's performance of her duties.  His 
testimony failed to satisfy Wis. Stat. § 907.02 because there 
was 
no 
apparent 
match 
between 
this 
objective 
and 
his 
qualification 
as 
an 
undeniably 
accomplished 
obstetrician/gynecologist.  As it turns out, we focused so 
narrowly on Dr. Wener's sterling professional credentials that 
we let him become the thing about which he was supposed to 
testify.  That is, instead of determining whether Dr. Wener was 
qualified to discover and describe the proper standard of 
medical care, we found that he is the standard of medical care. 
I 
¶260 The primary question this case presents is whether the 
plaintiffs identified a proper standard of medical care against 
                                                 
1 All subsequent references to the Wisconsin Statutes are to 
the 2013-14 version unless otherwise indicated. 
No.  2014AP195.dk 
 
2 
 
which a jury could measure Dr. Balink's performance in the 
delivery of Braylon Seifert.2  Even though this case progressed 
through a jury trial, an appeal, and review by this court, I 
find that I still do not know what that standard might be, or 
whether Dr. Wener was qualified to describe it. 
¶261 Here is what we do know.  We know young Seifert 
suffered a grievous injury at birth.  We know the injury was 
caused by the manner in which he was delivered.  We know he 
could have been delivered differently.  We know that Dr. Wener 
says that if young Seifert had been delivered according to the 
practices and procedures he described, the injury very likely 
would not have occurred.  And I believe he is right. 
¶262 What I do not know is whether young Seifert's delivery 
was done negligently.  The reason I do not know this is because 
no one described what care we should expect from the reasonably 
qualified family practitioner in the circumstances revealed by 
this case.  That is, the jury never received a proper measuring 
stick against which to compare Dr. Balink's performance of her 
obligations. 
                                                 
2 Dr. Balink phrased the issue as whether "an expert 
witness' qualifications and personal preferences [are] alone 
sufficient to meet Wis. Stat. § 907.02(1)'s new reliability 
standard?"  Although this framing conflates the statute's 
subjective and objective criteria (as I discuss below), and so 
obscures the gravamen of her concern, there is no doubt her 
central complaint is that the plaintiffs' expert witness did not 
identify a proper standard of medical care. 
No.  2014AP195.dk 
 
3 
 
¶263 As we sketch out the contours of Wis. Stat. § 907.02,3 
I think we should use a sharper pencil.  As it is, we have not 
made the necessary distinction between the thing about which an 
expert is to testify, on the one hand, and on the other, the 
qualification to so testify.  Because we did not make that 
distinction, 
it 
almost 
necessarily 
followed 
that 
our 
"qualification" inquiry focused on the wrong question. 
¶264 The Seiferts tasked Dr. Wener with demonstrating that 
Dr. Balink delivered young Seifert negligently.  That task 
comprises two separate responsibilities.  First, Dr. Wener 
needed to identify the proper standard of medical care under the 
circumstances of this case.  Francois v. Mokrohisky, 67 
Wis. 2d 196, 200–01, 226 N.W.2d 470 (1975).  And second, he had 
to opine on whether Dr. Balink's performance fell short of that 
standard.  Christianson v. Downs, 90 Wis. 2d 332, 338, 279 
N.W.2d 918 (1979) ("Unless the situation is one where the common 
knowledge of laymen affords a basis for finding negligence, 
expert medical testimony is required to establish the degree of 
care and skill required of a physician.").  Competence in one of 
these subjects does not automatically conclude competence in the 
other.  The proper standard of medical care and the failure to 
meet that standard are distinct subjects and should receive 
                                                 
3 The 
standard 
described 
in 
this 
statute 
was 
first 
enunciated in Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579 
(1993), and later formalized as Federal Rule of Evidence 702 (as 
amended in 2000).  Because § 907.02(1)'s wording mirrors that of 
the Federal Rule, and other states have followed suit, I will 
follow the lead opinion's example in consulting relevant cases 
from other jurisdictions. 
No.  2014AP195.dk 
 
4 
 
distinct treatment.  This means the proffered expert must 
satisfy the court he has the necessary qualifications to speak 
on each one. 
¶265 We did not, however, require this of Dr. Wener.  That 
is, we allowed the Seiferts to graft Dr. Wener's competence to 
testify with respect to the second inquiry (performance in 
relation to the standard) onto the first (identification of the 
standard).  Perhaps he can authoritatively speak on both 
subjects, but we do not know because no one asked.  And he was 
not asked because there was insufficient appreciation of the 
need to conceptually separate the two inquiries.  Here is what I 
mean. 
A 
¶266 I assume Dr. Wener is a very talented obstetrician.  
Indeed, for the sake of illustration, I will assume he is the 
gold standard when it comes to delivering babies under the 
circumstances this case presents.  To what, then, shall we have 
him testify?  Shall we learn from him the optimal means of 
delivering babies in those circumstances?  Or should he teach us 
how the reasonably qualified family practitioner delivers babies 
in such circumstances?  There are potentially leagues of 
difference between the answers to these questions.  If we select 
the first, we will hear about the best possible practices that 
could have been followed in young Seifert's delivery.  If we 
select 
the 
second, 
however, 
we 
will 
hear 
what 
we 
may 
legitimately expect from any given family practitioner.  Put 
another way, the first option informs us of the care we all 
No.  2014AP195.dk 
 
5 
 
want, while the second describes the standard of medical care to 
which we may hold all family practitioners accountable. 
¶267 Qualifying 
under 
the 
first 
option 
is 
pretty 
straightforward.  Having established himself as the gold 
standard, 
it 
necessarily 
follows 
that 
Dr. 
Wener 
may 
authoritatively opine on how he would deliver a baby when 
confronted with patients like the Seiferts.  Thus would he 
establish the standard of medical care for the case, a reference 
point we might usefully call the "What Would Wener Do" standard 
("WWWD").  This is a narrowly vertical inquiry——we explore the 
depth, and precision, of his knowledge, experience, and practice 
in relation to the circumstances at hand. 
¶268 As I will explain at greater length below, qualifying 
under the second option calls for something different.  It is a 
broadly horizontal inquiry.  It requires that the testifying 
doctor have more than just knowledge of the best method of 
delivering a baby in such circumstances.  In light of the 
natural variability inherent in the practice of medicine, it 
requires that he be familiar with what is generally expected of 
reasonably qualified practitioners under similar circumstances.4  
He must have a source of knowledge that informs him of what 
other doctors do under similar circumstances, or describes what 
                                                 
4 Francois v. Mokrohisky, 67 Wis. 2d 196, 201–02, 226 
N.W.2d 470 (1975) ("The standard to which [physicians] must 
conform . . . is determined by the practices of neither the very 
best nor the worst of the class. Like automobile drivers, 
engineers, common laborers, and lawyers, they are obliged to 
conform to reasonable care in the circumstances."). 
No.  2014AP195.dk 
 
6 
 
they ought to do, or what they must do.  His knowledge of such 
things must be extensive enough that he can distill from it 
certain practices and procedures of sufficiently widespread 
implementation that one may conclude that they represent a 
standard known to reasonably qualified doctors in the relevant 
field of practice. 
¶269 If he cannot do this, and yet he testifies, then we 
allow him to collapse the medical field into himself, and we 
appoint him the reference point against which we measure all 
doctors who deliver babies.  For the following reasons, I 
believe this is untenable, and it is not what Wis. Stat. 
§ 907.02 either requires or authorizes. 
1 
¶270 I will begin by describing the nature of the standard 
applicable to this case.  That is, I will explain why I believe 
it is essential that the standard be external to the testifying 
expert.  Afterwards, I will address Dr. Wener's qualification to 
testify regarding that standard. 
¶271 The Seiferts bore the burden of establishing the 
standard of medical care to which they wished to hold Dr. Balink 
accountable.  Carney-Hayes v. Nw. Wis. Home Care, Inc., 2005 WI 
118, ¶37, 284 Wis. 2d 56, 699 N.W.2d 524.  Generally speaking, 
expert testimony is necessary to meet that burden:  "Unless the 
situation is one where the common knowledge of laymen affords a 
basis for finding negligence, expert medical testimony is 
required to establish the degree of care and skill required of a 
physician."  Christianson, 90 Wis. 2d at 338.  Negligence, in 
No.  2014AP195.dk 
 
7 
 
this case, turns (at least in part) on recognizing circumstances 
that call for a three-hour glucose diagnostic test (rather than 
a one-hour screening test), when it is necessary to perform an 
ultrasound examination of the baby immediately before delivery, 
and when a vacuum assistance device may or may not be used to 
assist the baby in making his exit from the birth canal.  These 
are not subjects on which laypeople would commonly find 
themselves knowledgeable. 
¶272 The expert's first task, therefore, is to identify the 
relevant standard of medical care, which must "be established by 
a determination of what it is reasonable to expect of a 
professional given the state of medical knowledge at the time of 
the treatment in issue."  Nowatske v. Osterloh, 198 Wis. 2d 419, 
438-39, 543 N.W.2d 265 (1996), abrogated on other grounds by 
Nommensen v. Am. Cont. Ins. Co., 2001 WI 112, 246 Wis. 2d 132, 
629 N.W.2d 301.  This means one may not establish a standard 
with reference to what one doctor, or a non-representative 
sampling of doctors, would do under the circumstances.  A 
"standard" is not the same thing as the existence of alternative 
procedures or more accomplished practitioners. 
¶273 A standard is, instead, normative.  It is a reference 
point external to the testifying doctor, something commonly 
accessible by those practicing in the relevant field: 
True, there was evidence that other physicians might 
have acted differently and that there were alternate 
procedures available, but no physician testified that 
what was done did not comport with approved medical 
practice under the circumstances. As we said in Trogun 
v. Fruchtman, 58 Wis. 2d 569, 584, 207 N.W.2d 297 
(1973): 
No.  2014AP195.dk 
 
8 
 
'(A) plaintiff must prove the defendant failed to 
give him, not the highest degree of care, but 
merely the reasonable care and skill usually 
possessed 
by 
physicians 
of 
the 
same 
school . . . .' 
Francois, 67 Wis. 2d at 201 (emphasis added).  A physician 
answers to this normalized reference point, not to the WWWD 
standard of medical care:  "He is obliged to conform to the 
accepted standard of reasonable care, but he is not liable for 
failing to exercise an extraordinary degree of care."  Id. 
(emphasis added). 
¶274 Other courts reject self-referential standards of 
medical care, too.  Massachusetts says that "[b]ecause the 
standard of care is based on the care that the average qualified 
physician would provide in similar circumstances, the actions 
that a particular physician, no matter how skilled, would have 
taken are not determinative."  Palandjian v. Foster, 842 
N.E.2d 916, 920-21 (Mass. 2006).  The Michigan Supreme Court 
recently addressed this issue in Elher v. Misra, 878 N.W.2d 790 
(Mich. 2016) (per curiam).  It rejected the proffered expert's 
testimony because "his opinion was based on his own beliefs, 
there was no evidence that his opinion was generally accepted 
within the relevant expert community, there was no peer-reviewed 
medical literature supporting his opinion, plaintiff failed to 
provide any other support for [the expert's] opinion, and 
defendants submitted contradictory peer-reviewed literature."  
Id. at 798 (emphasis added).  California has long recognized 
that "the fact that another physician or surgeon might have 
elected to treat the case differently or use methods other than 
No.  2014AP195.dk 
 
9 
 
those employed by defendant does not of itself establish 
negligence."  Lawless v. Calaway, 147 P.2d 604, 607 (Cal. 1944).  
The District of Columbia says that "[t]he personal opinion of 
the testifying expert as to what he or she would do in a 
particular case, without reference to a standard of care, is 
insufficient to prove the applicable standard of care."  Travers 
v. District of Columbia, 672 A.2d 566, 568 (D.C. 1996).  South 
Carolina's court of appeals has similarly stated that if an 
expert "merely testifies as to his own personal standard of 
care, rather than the generally recognized and accepted standard 
of care, such testimony is insufficient to survive summary 
judgment."  Melton v. Medtronic, Inc., 698 S.E.2d 886, 893 (S.C. 
Ct. App. 2010).  In Wallbank v. Rothenberg, 74 P.3d 413, 416 
(Colo. Ct. App. 2003), the Colorado Court of Appeals said that 
"a standard of care may not be established by the testimony of 
the personal practices of expert witnesses."  Georgia also 
follows this rule:  A party "may not establish the applicable 
standard of care with evidence of an expert witness's personal 
practices, or evidence about the course of conduct the expert 
would have followed under similar circumstances."  Dendy v. 
Wells, 718 S.E.2d 140, 144 (Ga. Ct. App. 2011).  Arizona's court 
of appeals recognizes that testimony regarding a physician's 
personal practices can be useful to the jury, but only after the 
standard of care is established.  See Smethers v. Campion, 108 
P.3d 946 (Ariz. Ct. App. 2005).5 
                                                 
5 Treatises reflect the same principles.  See, e.g., 29 
Charles Alan Wright & Victor Gold, Federal Practice & Procedure: 
(continued) 
No.  2014AP195.dk 
 
10 
 
¶275 Nor may physicians smuggle their own practices or 
preferences past the Daubert gatekeeper by box-checking expected 
phrases.  Missouri's court of appeals provided the only logical 
response to such an effort.  It reasoned that "[i]n articulating 
the appropriate legal standard of care, it is insufficient for 
an expert merely to use the terms 'accepted medical standards' 
or 'standards of care.'"  Sheffler v. Arana, 950 S.W.2d 259, 267 
(Mo. Ct. App. 1997).  Instead, the court said "an expert should 
be properly oriented with the meaning of negligence in a health 
care provider context and, in fact, employ the legal standards 
in offering his opinion."  Id.  The court recognized that "[t]he 
purpose of these requirements is to prevent experts from relying 
upon their own views of acceptable practice rather than applying 
the objective legal standards."  Id. 
¶276 Our cases, and those across the country, teach us that 
a proper standard of medical care is one that is "approved," 
"generally recognized," "customary," "generally accepted," or 
"objective," and that describes skills "usually possessed" by a 
physician in the relevant field of practice.  However one 
chooses to synthesize this into a single descriptor, the 
manifest import is that a standard of medical care exists 
                                                                                                                                                             
Evidence § 6268.1 (2d ed. 2016) ("In a non-scientific context, 
the reliability of an expert's methodology often will be a 
function of accepted practice in the area of expertise in 
question."); 5 D.W. Louisell & H. Williams, Medical Malpractice 
§ 29.01, at 29–7 (2005) ("The standard is measured against what 
a reasonably prudent practitioner in the defendant's position 
would do, not what any individual physician or physicians might 
do."). 
No.  2014AP195.dk 
 
11 
 
separately 
and 
apart 
from 
the 
testifying 
expert, 
it 
is 
widespread within the relevant medical community, it has gained 
at least some acceptance, and it is legitimate to charge a 
reasonably qualified physician with its knowledge. 
2 
¶277 Doctor Wener did not identify such a standard.  One of 
the consequences of not requiring the expert to focus on an 
external, 
generally-known 
standard 
is 
that 
the 
resulting 
testimony resolves into a self-portrait.  As the circuit court 
and the lead opinion's characterization of his testimony 
demonstrate, that is largely what happened here: 
• 
"Dr. Wener formulated an opinion about the 
standard of reasonable care of family practice doctors 
practicing 
obstetrics 
on 
the 
basis 
of 
his 
experiences. . . ."  Lead op., at ¶103. 
• 
Dr. 
Wener's 
methodology 
consisted 
of 
the 
"conscientious use of the thousands of instances in 
which he had delivered babies and made decisions about 
the care of individual patients and his teaching and 
hospital experiences relating to obstetrics."  Lead 
op., at ¶105. 
• 
"[E]ssentially a comparison of the instant case 
to other deliveries . . . ."  Lead op., at ¶106. 
• 
"He used his many experiences to arrive at an 
opinion in the instant case that is sufficiently 
similar to his vast array of clinical experiences over 
decades of practice."  Lead op., at ¶107. 
• 
"The 
circuit 
court 
ruled 
that 
Dr. 
Wener's 
methodology 
was 
reliable 
based 
on 
Dr. 
Wener's 
extensive personal experiences."  Lead op., at ¶109. 
¶278 A review of the transcript confirms the accuracy of 
these characterizations.  Here, for example, is the closest Dr. 
Wener came to establishing any standard of medical care with 
No.  2014AP195.dk 
 
12 
 
respect to use of a vacuum to assist in the delivery of young 
Seifert: 
My opinion is that the standard of care required that 
a vacuum not be applied on this child at all.  Because 
of the risk factors already established for shoulder 
dystocia, and knowing that the vacuum is the largest 
of the risk factors, you're adding a major risk factor 
on top of that.  And in my opinion that's why the baby 
had a severe brachial plexus injury. 
That may or may not be a proper standard of medical care, but 
because he never described how he goes about discovering such 
standards, this ends up as the type of ipse dixit that Sheffler 
properly rejected. 
¶279 With respect to whether Dr. Balink should have 
performed an ultrasound immediately before young Seifert's 
birth, Dr. Wener said:  "I would have known that an ultrasound——
assuming it's done within the standard of care——would have been 
within 10 to 15 percent off.  And [with] a baby that's 9 pounds 
12 ounces, [an] ultrasound would have shown a macrosomic 
infant."  This is two steps removed from establishing a standard 
of medical care.  First, he is simply describing what he knows.  
And second, he says nothing about whether this knowledge 
necessarily 
means 
an 
ultrasound 
should 
have 
been 
done 
immediately before birth to meet the applicable standard of 
medical care.  And if he believes this is what is required to 
meet the standard, he has offered nothing to establish how he 
knows this is, in fact, the standard. 
¶280 Dr. Wener's testimony reveals he is impressively 
qualified along the vertical axis; his experience and knowledge 
are deep, deep.  Surely this is the physician one would want in 
No.  2014AP195.dk 
 
13 
 
attendance when faced with the Seiferts' situation.  But his 
testimony along the horizontal axis was almost non-existent.  
What he described was what he would have done had he been the 
attending physician.  That is, he testified that the relevant 
standard of medical care was WWWD; he told us little about what 
a reasonably qualified family practitioner ought to have done 
for the Seiferts.  Consequently, the jury received the case 
without knowing the proper standard against which to compare Dr. 
Balink's performance.  And that is why we still do not know 
whether Dr. Balink negligently delivered young Seifert. 
B 
¶281 So now I arrive at the subject that gave rise to our 
consideration of this case:  Dr. Wener's qualification under 
Wis. Stat. § 907.02 to testify about his opinions.  This statute 
contains both subjective and objective criteria, both of which 
he must satisfy before giving his thoughts to the jury:6 
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, if the 
testimony is based upon sufficient facts or data, the 
testimony is the product of reliable principles and 
methods, and the witness has applied the principles 
and methods reliably to the facts of the case. 
                                                 
6 I use the terms "subjective" and "objective" in their 
grammatical sense.  These terms separate the one testifying (the 
subject) from the thing about which the subject is testifying 
(the object). So the subjective element of Wis. Stat. § 907.02 
inquires into Dr. Wener's qualifications, while the objective 
element concentrates on the thing about which he testifies (the 
standard of medical care). 
No.  2014AP195.dk 
 
14 
 
Wis. Stat. § 907.02(1). 
¶282 On the objective criterion, Dr. Wener may testify if 
his opinions are "based upon sufficient facts or data, the 
testimony is the product of reliable principles and methods, and 
the witness has applied the principles and methods reliably to 
the facts of the case."  Id.  With respect to the subjective 
criterion, he must be "qualified as an expert by knowledge, 
skill, experience, training, or education."  Id. 
1 
¶283 I have already addressed the objective criterion——it 
is the standard of medical care.  In the context of this case, 
"facts or data" are situations like the Seiferts' and how 
reasonably qualified family practitioners respond to them.  The 
"reliable principles and methods" are the means by which a 
qualified expert informs himself of those facts and data.  As 
described above, Dr. Wener offered no such testimony.  He did 
not offer testimony about the skills usually possessed by family 
practitioners who deliver babies.  He did not tell us what the 
"generally accepted" practices might be, what is "approved," or 
"generally recognized," or "customary."  Nor did he say anything 
about the "principles and methods" he used to discover that 
information.  Instead, he offered himself——a supremely qualified 
obstetrician——as the standard of medical care.  The result was a 
conflation of the objective and subjective criteria. 
¶284 This was a mistake for two reasons.  First, by 
allowing Dr. Wener to become the standard against which to 
measure Dr. Balink's performance, we eliminate the concept of a 
No.  2014AP195.dk 
 
15 
 
consistent and knowable standard against which to measure a 
physician's performance.  It's WWWD this time.  But the 
plaintiffs in the next malpractice case might employ a different 
expert witness, thereby establishing a new standard.  So as a 
practical matter, no one will know the "standard" of medical 
care until the plaintiffs reveal their expert witness. 
¶285 Second, even if it is appropriate to pick a specific 
doctor and make his practices the touchstone, as opposed to an 
objectively-verifiable standard external to the expert, we 
allowed the plaintiffs in this case to pick the wrong doctor.  
Dr. Wener is an obstetrician.  Dr. Balink is a family 
practitioner.  The standard of medical care expected of each are 
not the same.  We must assess a physician's conduct in the 
context of the field in which she practices.  Phelps v. 
Physicians Ins. Co. of Wis., Inc., 2005 WI 85, ¶40, 282 
Wis. 2d 69, 698 N.W.2d 643.  This is such an embedded principle 
in 
our 
law 
that 
it 
even 
appears 
in 
our 
pattern 
jury 
instructions: 
In (treating) (diagnosing) (plaintiff)'s (injuries) 
(condition), (doctor) was required to use the degree 
of care, skill, and judgment which reasonable (doctors 
who are in the general practice) [or] (specialists who 
practice the specialty which (doctor) practices) would 
exercise in the same or similar circumstances, having 
due regard for the state of medical science at the 
time (plaintiff) was (treated) (diagnosed).  A doctor 
who fails to conform to this standard is negligent. 
The burden is on (plaintiff) to prove that (doctor) 
was negligent. 
No.  2014AP195.dk 
 
16 
 
Wis. JI——Civil 1023 (emphasis added).  So if the expert himself 
is to be the standard, we should at least require that he is 
from the same field of practice.7 
¶286 Dr. Wener's testimony neither identified a standard 
external to himself, nor did it describe what we should expect 
of a family practitioner, as opposed to an obstetrician.  His 
testimony should have been excluded because it did not satisfy 
the objective criterion of Wis. Stat. § 907.02.  Not because he 
was unqualified to testify about what he would have done had he 
been the attending physician (no one is better qualified to 
offer that testimony), but because in the main he did not 
describe what we may expect of reasonably qualified family 
practitioners, and so failed to satisfy the objective criterion. 
2 
¶287 I say Dr. Wener did not describe the required standard 
"in the main" because there were a few pieces of testimony that 
contained the seed of such a standard.  For example, with 
respect to when a three-hour glucose test should be conducted 
based on the results of the one-hour glucose screening, Dr. 
Wener said the following: 
Q: You're also aware that some, as you mentioned some 
people use a 140? 
                                                 
7 If the expert offers proper testimony——that is, a standard 
of medical care external to himself——then it is not necessary 
that he come from the same field of medical practice as the 
physician in question.  Thus, if Dr. Wener can demonstrate he 
has the requisite knowledge to identify and describe the 
standard of medical care applicable to family physicians in 
these circumstances, there is no reason he could not qualify as 
an expert. 
No.  2014AP195.dk 
 
17 
 
A: Yes. 
Q: [O]f what significance was it that the glucose 
tolerance one hour testing revealed to be 131? 
A: Well 131 is abnormal.  By 2009, those providing 
obstetrical care were using 130.  For many, many years 
prior to that it had been 140.  And then probably 
around the turn of the century . . . changed to 130.  
And by 2009 most everyone was using 130. . . .  And to 
use 140 as a cut off is not the right number. 
This, of course, is just one piece of information that goes into 
describing what a reasonably qualified doctor would do for the 
Seiferts (although whether it describes the "cut-off" family 
practitioners, as opposed to obstetricians, were using as of 
2009 cannot be determined from the testimony). 
¶288 If this seed had matured into a fully-formed objective 
standard applicable to family practitioners, we would ask 
whether Dr. Wener satisfied the subjective criterion of Wis. 
Stat. § 907.02.  We do so by looking to his "knowledge, skill, 
experience, training, or education."  Id. 
¶289 But we would not look at those qualities in a vacuum——
we would be interested in them insofar as they bear on the 
objective criterion (the standard of medical care). That is, we 
must allow the standard of medical care to focus our attention 
on the type of background we should require of the proffered 
expert witness.  In this case, we would ask not whether Dr. 
Wener is a well-qualified obstetrician (he is).  We would 
instead ask whether he has the knowledge, experience, training, 
or education necessary to search out and describe the standard 
of medical care we may reasonably expect a family practitioner 
to meet. 
No.  2014AP195.dk 
 
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¶290 The background required by the subjective criterion 
may not be as obvious as it might appear.  As much as we wish 
the practice of medicine to be a scientific endeavor, it 
inescapably encompasses a substantial amount of art.  And to the 
extent it is a science, it is nonetheless constantly developing 
and evolving.  All physicians learn the practice of medicine in 
(presumably) the same general sense——they attend medical school.  
But the United States has 147 medical schools,8 and it is 
reasonable to expect that each will offer instruction that 
varies in technique, emphasis, expertise, and extent.  The 
current result of those natural variations is over 900,000 
practicing physicians9 spread amongst 5,600 hospitals10 and many 
additional smaller clinics and offices. 
¶291 Theoretically, those initial variations could amplify 
once the physician begins his practice and encounters new 
methods, analyses, equipment, or experiences.  Or, conversely, 
they could dampen as the hospitals and other centers of practice 
                                                 
8 About the AAMC, Assoc. of Am. Med. Colleges (last visited 
Jan. 3, 2017), https://www.aamc.org/about. 
9 Total Professionally Active Physicians, The Henry J. 
Kaiser 
Family 
Found. 
(last 
accessed 
Jan. 
3, 
2017), 
http://kff.org/other/state-indicator/total-active-
physicians/?currentTimeframe=0&selectedRows=%7B%22nested%22:%7B%
22all%22:%7B%7D%7D,%22wrapups%22:%7B%22united-
states%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%
22sort%22:%22asc%22%7D (stating that in September 2016 there 
were 926,119 practicing physicians in the United States). 
10 Fast Facts on US Hospitals, Am. Hosp. Ass'n (Jan. 2016), 
http://www.aha.org/research/rc/stat-studies/fast-facts.shtml 
(stating that in January 2016 there were 5,627 U.S. hospitals 
registered with the American Hospital Association). 
No.  2014AP195.dk 
 
19 
 
impose some measure of uniformity on practitioners.  Whichever 
it is, the result is the same——there is no obvious playbook to 
which we, or a practitioner, may readily resort to determine 
what "ought" to be done in every given circumstance.  The 
"ought" is out there, but courts and juries are not equipped to 
identify it on their own.  That is why we need experts to sift 
through all the different ways in which physicians treat their 
patients, the extant literature on the subject at hand (if any), 
and information from any other potentially instructive source, 
to identify the common threads with which to stitch together a 
standard of medical care. 
¶292 The background required to do a competent job of such 
sifting and identifying is not necessarily the same as the 
background that leads to successful, injury-free deliveries of 
babies like young Seifert.  This case calls for an expert who is 
familiar with the type of training and experience typical of 
family practitioners (not obstetricians), the type of equipment 
available to them, the tests and diagnostic procedures they 
commonly employ, and their practical responses to situations 
like that of the Seiferts.  This is a background that reflects a 
broadly horizontal outward focus——what do others know, and 
experience, and do?  It may be that Dr. Wener has that kind of 
background and knowledge, but he did not speak of it in this 
case. 
¶293 This 
division 
between 
subjective 
and 
objective 
criteria is essential to the rule of law as it relates to 
negligence, especially in the context of medical malpractice.  
No.  2014AP195.dk 
 
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When the Seiferts asserted their cause of action against Dr. 
Balink, the import of their claim was that there existed a 
knowable standard of medical care and that she failed to conform 
to that standard when she delivered young Seifert.  Dr. Balink 
did not know that a court, sometime in the future, would decide 
that the standard governing her conduct would be WWWD.  And 
there is no apparent reason why she should have known that. 
¶294 To the extent the lead opinion concludes that a 
person's personal experience can qualify him as an expert 
witness for the purpose of testifying about a standard of 
medical care, I have no dispute.  But because our pencil was not 
sharp enough in answering that question, the holding we announce 
today is that an individual doctor's personal experience can be 
the standard of medical care. 
¶295 And for that reason, I respectfully dissent. 
¶296 I am authorized to state that Justice REBECCA GRASSL 
BRADLEY joins this dissent. 
 
 
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