Title: Banuelos v. University of Wisconsin Hospitals and Clinics Authority

State: wisconsin

Issuer: Wisconsin Supreme Court

Document:

2023 WI 25 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2020AP1582 
 
 
 
COMPLETE TITLE: 
Beatriz Banuelos, 
          Plaintiff-Appellant, 
     v. 
University of Wisconsin Hospitals and Clinics 
Authority, 
          Defendant-Respondent-Petitioner. 
 
 
 
 
 
REVIEW OF DECISION OF THE COURT OF APPEALS  
Reported at 399 Wis. 2d 568, 966 N.W.2d 78 
PDC No: 2021 WI App 70 - Published  
 
 
OPINION FILED: 
April 4, 2023   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
November 1, 2022   
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit   
 
COUNTY: 
Dane   
 
JUDGE: 
Juan B. Colas   
 
 
 
JUSTICES: 
ANN WALSH BRADLEY, J., delivered the majority opinion of the 
Court, in which DALLET, HAGEDORN, and KAROFSKY, JJ., joined.  
ROGGENSACK, J., filed a dissenting opinion.  REBECCA GRASSL 
BRADLEY, J., filed a dissenting opinion, in which ZIEGLER, C.J., 
and ROGGENSACK, J., joined. 
 
NOT PARTICIPATING: 
        
 
 
 
ATTORNEYS: 
 
 
For the defendant-respondent-petitioner, there were briefs 
filed by Daniel A. Manna, Jay P. Lefkowitz, P.C., Gilad 
Bendheim, Kelsey Davis, and Gass Turek LLC, Milwaukee, and 
Kirkland & Ellis LLP, New York City. There was an oral argument 
by Jay P. Lefkowitz, P.C. 
 
 
 
2 
For the plaintiff-appellant, there was a brief filed by 
Jesse B. Blocher, Peter M. Young, Corey G. Lorenz, and Habush, 
Habush, & Rottier, S.C., Waukesha. There was an oral argument by 
Jesse B. Blocher.  
 
An amicus curiae brief was filed by Daniel E. Conley, 
Matthew J. Splitek, Alexandra W. Shortridge, and Quarles & Brady 
LLP, Milwaukee, for Aurora Health Care, Inc.  
 
An amicus curiae brief was filed by Scott E. Rosenow and 
WMC Litigation Center, Madison, for the Wisconsin Civil Justice 
Council, Inc.  
 
An amicus curiae brief was filed by Brett A. Eckstein, 
Edward E. Robinson, Brian D. Anderson, and Cannon & Dunphy, 
S.C., Brookfield, and Everson, Whitney, Everson & Brehm, S.C., 
Green Bay, for the Wisconsin Association for Justice and 
Wisconsin Defense Counsel.  
 
An amicus curiae brief was filed by Sara J. MacCarthy, 
Stephane P. Fabus, Heather D. Mogden, and Hall, Render, Killian, 
Heath & Lyman, P.C., Milwaukee, for the Wisconsin Hospital 
Association, Inc., the Wisconsin Medical Society, Inc., the 
Wisconsin Dental Association, Inc., LeadingAge Wisconsin, Inc., 
the Rural Wisconsin Health Cooperative, the Wisconsin Health 
Care Association/Wisconsin Center for Assisted Living, and the 
Wisconsin Health Information Management Association, Inc.  
 
An amicus curiae brief was filed by Susan E. Lovern, 
Christopher E. Avallone, and von Briesen & Roper, S.C., 
Milwaukee, for the Association of Health Information Outsourcing 
Services.  
 
 
 
 
2023 WI 25 
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.   2020AP1582 
(L.C. No. 
2020CV903) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
Beatriz Banuelos, 
 
          Plaintiff-Appellant, 
 
     v. 
 
University of Wisconsin Hospitals and Clinics 
Authority, 
 
          Defendant-Respondent-Petitioner. 
 
 
FILED 
 
APR 4, 2023 
 
Sheila T. Reiff 
Clerk of Supreme Court 
 
 
 
 
ANN WALSH BRADLEY, J., delivered the majority opinion of the 
Court, in which DALLET, HAGEDORN, and KAROFSKY, JJ., joined.  
ROGGENSACK, J., filed a dissenting opinion.  REBECCA GRASSL 
BRADLEY, J., filed a dissenting opinion, in which ZIEGLER, C.J., 
and ROGGENSACK, J., joined. 
 
 
 
REVIEW of a decision of the Court of Appeals.  Affirmed.   
 
¶1 
ANN WALSH BRADLEY, J.   The petitioner, University of 
Wisconsin Hospitals and Clinics Authority (UW Hospitals), seeks 
review of a published court of appeals opinion reversing and 
remanding the circuit court's dismissal of Beatriz Banuelos's 
No. 
2020AP1582   
 
2 
 
complaint for failure to state a claim upon which relief can be 
granted.1  Banuelos contends that she was unlawfully charged per 
page fees for copies of her medical records which were provided 
in an electronic format.  The court of appeals agreed and 
determined that Wis. Stat. § 146.83(3f) (2017-18)2 does not 
permit a health care provider to charge fees for providing 
copies of patient health care records in an electronic format.   
¶2 
UW Hospitals argues, in essence, that the court of 
appeals erred because Wis. Stat. § 146.83(3f) is silent as to 
fees for electronic copies of patient health care records.  
Accordingly, it does not prohibit a health care provider 
charging fees for providing such copies.  And thus, Banuelos's 
complaint alleging unlawful and excess charges fails to state a 
claim upon which relief can be granted.3   
¶3 
Banuelos offers a different interpretation of the 
statute's silence.  She asserts that because fees for electronic 
copies are not enumerated in the statutory list of permissible 
fees that a health care provider may charge, the fees charged 
here are unlawful under state law.  As a result, Banuelos 
maintains that her complaint survives the motion to dismiss. 
                                                 
1 Banuelos v. Univ. of Wis. Hosps. and Clinics Auth., 2021 
WI App 70, 399 Wis. 2d 568, 966 N.W.2d 78 (reversing and 
remanding the order of the circuit court for Dane County, Juan 
Colas, Judge).   
2 All subsequent references to the Wisconsin Statutes are to 
the 2017-18 version unless otherwise indicated. 
3 See Wis. Stat. § 802.06(2)(a)6. 
No. 
2020AP1582   
 
3 
 
¶4 
We conclude that although Wis. Stat. § 146.83(3f) 
provides for the imposition of fees for copies of medical 
records in certain formats, it does not permit health care 
providers to charge fees for patient records in an electronic 
format.  Therefore, we determine that Banuelos's complaint 
states a claim upon which relief can be granted. 
¶5 
Accordingly, we affirm the decision of the court of 
appeals. 
I 
¶6 
The essential facts set forth below are taken from 
Banuelos's complaint.  Because we are reviewing the circuit 
court's determination of a motion to dismiss for failure to 
state a claim, we must assume that these facts are true.  Yacht 
Club at Sister Bay Condo. Ass'n, Inc. v. Village of Sister Bay, 
2019 WI 4, ¶4, 385 Wis. 2d 158, 922 N.W.2d 95.  
¶7 
Banuelos 
signed 
and 
submitted 
a 
request 
to 
UW 
Hospitals for copies of her medical records in electronic 
format.4  The request directed and authorized that the records be 
transmitted to her attorneys. 
                                                 
4 Banuelos 
requested 
that 
her 
records 
be 
provided 
electronically pursuant to the Health Information Technology for 
Economic 
and 
Clinical 
Health 
(HITECH) 
Act, 
42 
U.S.C. 
§ 17935(e)(1) and 45 C.F.R. § 164.524(c).  
(continued) 
No. 
2020AP1582   
 
4 
 
¶8 
UW Hospitals complied with the request through its 
service provider, Ciox, and transmitted copies of Banuelos's 
patient health care records electronically to her attorneys, 
along with an invoice for $109.96.5  The requested payment for 
                                                                                                                                                             
As described by UW Hospitals, "[t]hat federal statutory 
regime authorizes (in certain circumstances) a patient to 
request that copies of electronic health records be provided in 
an electronic format to the patient, or to a designated third 
party, such as her personal injury attorney."  "[I]n the case 
that a covered entity uses or maintains an electronic health 
record . . . the individual shall have a right to obtain from 
such covered entity a copy of such information in an electronic 
format and . . . to direct the covered entity to transmit such 
copy directly to an entity or person designated by the 
individual," 42 U.S.C. § 17935(e)(1), which is mandatory "if it 
is readily producible in such form and format."  45 C.F.R. 
§ 164.524(c). 
There is no issue of federal law that has been presented to 
this court to address. 
5 Justice Roggensack's dissent assumes the role of an 
advocate by deciding this case on an argument it raises sua 
sponte, and then, based on that never-before-raised argument, it 
attempts to transform the motion in this case from a motion to 
dismiss (which it is) into a motion for summary judgment (which 
it is not). 
In this motion to dismiss, we accept the facts alleged in 
Banuelos's complaint as true.  UW Hospitals is the sole 
defendant here and the complaint avers wrongdoing against it 
alone.  Nevertheless, the dissent attempts to read into the 
complaint wrongdoing by Ciox, thereby creating factual issues 
regarding who did what, and whose acts caused the harm. 
(continued) 
No. 
2020AP1582   
 
5 
 
copies included "per page" charges of $1.14 for the first 25 
pages, $0.86 for the next 25 pages, $0.56 for the next 50 pages, 
and $0.34 for an additional 94 pages, which is consistent with 
                                                                                                                                                             
Justice Roggensack's dissent's "read in" is accomplished 
only by omitting an essential part of the complaint's averments.  
Citing to paragraphs 16 and 17 and Exhibit C of the complaint, 
the 
dissent 
describes 
Banuelos's 
complaint, 
stating 
"her 
Complaint alleges that Ciox Health, LLC (Ciox), who is not a 
health care provider, supplied the health care records and 
charged $109.96."  Dissent, ¶47.  What the dissent omits is that 
the complaint actually alleges that the supplying of the records 
and the charges incurred were done at the instance of UW 
Hospitals, with Ciox as a conduit. 
Paragraph 16 avers that "Defendant, through its business 
associate, Ciox, complied with the request and transmitted the 
medical records electronically to Habush Habush & Rottier S.C."  
Paragraph 17 avers, "The response from defendant, through its 
business associate, Ciox, included an invoice requesting payment 
of $109.96."  
Thus, all the complaint alleges with respect to Banuelos's 
specific case is that UW Hospitals "through its business 
associate, Ciox, complied with the request and transmitted the 
medical records electronically . . . [and] included an invoice 
requesting payment of $109.96."    
In 
order 
to 
reach 
Justice 
Roggensack's 
dissent's 
conclusion, further factual development would be necessary to 
establish Ciox's role, which typically would be the subject of a 
summary judgment motion, not a motion to dismiss.  For summary 
judgment methodology see Wis. Stat. § 802.08.  
Perhaps the most devastating response to the dissent is 
that UW Hospitals, in its reply brief, specially discarded the 
dissent's newly embraced argument, deeming it "irrelevant."  See 
infra, ¶18 n.8.  
No. 
2020AP1582   
 
6 
 
the maximum rate for paper copies of patient health care records 
permitted under Wis. Stat. § 146.83(3f).6 
¶9 
Banuelos 
filed 
suit, 
seeking 
declaratory 
and 
injunctive relief, as well as damages.  Her complaint alleged 
that because the copies of electronic patient health care 
records she requested do not fall into one of the enumerated 
categories contained within Wis. Stat. § 146.83(3f), none of the 
charges permitted under § 146.83(3f) applies to her electronic 
records request.  Accordingly, she argued that UW Hospital's 
charge of $109.96 was in violation of state law. 
¶10 In response, UW Hospitals filed a motion to dismiss, 
alleging in its supporting brief that Banuelos's claims were 
"fundamentally flawed" with respect to her interpretation of 
Wis. Stat. § 146.83(3f).7  The circuit court granted the motion.  
It concluded that "the legislature has failed to cover the 
situation where records are requested in electronic form and 
provided in electronic form.  And therefore, the charge that was 
made or demanded is not a violation."  It reasoned that because 
the fee UW Hospitals charged was not a violation of Wisconsin 
                                                 
6 These numbers deviate from those listed in Wis. Stat. § 
146.83(3f)(b)1. due to the operation of § 146.83(3f)(c)2., which 
provides for adjustments in the amounts specified based on 
changes in the consumer price index. 
7 In its motion to dismiss, UW Hospitals did not specify 
under which paragraph of Wis. Stat. § 802.06(2) it sought 
dismissal.  The circuit court construed the motion as a motion 
to dismiss for failure to state a claim, and we will do the 
same. 
No. 
2020AP1582   
 
7 
 
law, Banuelos could not prevail in this case and dismissal of 
the complaint was warranted.   
¶11 Banuelos appealed, and the court of appeals reversed 
the circuit court's order.  Banuelos v. Univ. of Wis. Hosps. and 
Clinics Auth., 2021 WI App 70, 399 Wis. 2d 568, 966 N.W.2d 78.  
The court of appeals conducted a plain meaning analysis of Wis. 
Stat. § 146.83(3f) and determined that the statute plainly and 
unambiguously permits a health care provider to charge fees for 
the formats enumerated in the statute and only those formats.  
Because fees for copies of records in an electronic format are 
not enumerated, the court of appeals concluded that such fees 
cannot lawfully be charged.  UW Hospitals petitioned for this 
court's review. 
II 
¶12 We are called upon to review the court of appeals' 
decision reversing and remanding the circuit court's dismissal 
of Banuelos's complaint for failure to state a claim.  In order 
to withstand a motion to dismiss for failure to state a claim, 
the complaint must plead facts, which if true, would entitle the 
plaintiff to relief.  Wis. Stat. § 802.02(1)(a); Data Key 
Partners v. Permira Advisers LLC, 2014 WI 86, ¶21, 356 Wis. 2d 
665, 849 N.W.2d 693.  Whether a complaint states a claim upon 
which relief can be granted is a question of law this court 
reviews independently of the determinations rendered by the 
circuit court and court of appeals.  Hinrichs v. DOW Chem. Co., 
2020 WI 2, ¶23, 389 Wis. 2d 669, 937 N.W.2d 37.   
No. 
2020AP1582   
 
8 
 
¶13 Our review also requires us to interpret several 
Wisconsin statutes.  Statutory interpretation is likewise a 
question 
of 
law 
that 
we 
review 
independently 
of 
the 
determinations of the circuit court and court of appeals.  Sw. 
Airlines Co. v. DOR, 2021 WI 54, ¶16, 397 Wis. 2d 431, 960 
N.W.2d 384. 
III 
¶14 The sufficiency of the claims alleged in Banuelos's 
complaint depends upon our interpretation of Wis. Stat. § 
146.83(3f).  Interestingly, both parties embrace a plain meaning 
interpretation 
of 
the 
statute, 
but 
arrive 
at 
opposite 
conclusions. 
¶15 In resolving the inquiry of whether Wis. Stat. 
§ 146.83(3f) permits a fee to be charged for copies of health 
care records in electronic format, we are aided by some familiar 
tools of statutory interpretation.  With those interpretative 
tools in hand, we examine first the text of § 146.83(3f).  Next, 
we look to § 146.83(3f)'s statutory history.  Finally, we 
address UW Hospitals' arguments advancing that the scope of 
§ 146.83(3f) does not include electronic records.    
A 
¶16 The familiar tools of statutory interpretation provide 
guiding principles for our inquiry.  "[T]he purpose of statutory 
interpretation is to determine what the statute means so that it 
may be given its full, proper, and intended effect."  State ex 
rel. Kalal v. Cir. Ct. for Dane Cnty., 2004 WI 58, ¶44, 271 
Wis. 2d 633, 681 N.W.2d 110.  "We assume that the legislature's 
No. 
2020AP1582   
 
9 
 
intent is expressed in the statutory language."  Id.  "In 
construing or interpreting a statute the court is not at liberty 
to disregard the plain, clear words of the statute."  Id., ¶46.  
If the text of the statute is plain and unambiguous, our inquiry 
stops there.  Id., ¶45. 
¶17 Statutory language is given its "common, ordinary, and 
accepted meaning, except that technical or specially-defined 
words 
or 
phrases 
are 
given 
their 
technical 
or 
special 
definitional meaning."  Id.  We interpret statutory language in 
context, "as part of a whole; in relation to the language of 
surrounding or closely-related statutes; and reasonably, to 
avoid absurd or unreasonable results."  Id., ¶46.  Language is 
also interpreted to avoid surplusage and to give reasonable 
effect to every word.  Id.  A review of statutory history is 
part of a plain meaning analysis.  Richards v. Badger Mut. Ins. 
Co., 2008 WI 52, ¶22, 309 Wis. 2d 541, 749 N.W.2d 581. 
B 
¶18 In applying these principles, we look first to the 
text of Wis. Stat. § 146.83(3f).  It contains two provisions 
important to our analysis.  Paragraph (a) states:  
Except as provided in sub. (1f) or s. 51.30 or 
146.82(2), if a person requests copies of a patient's 
health care records, provides informed consent, and 
pays the applicable fees under par. (b), the health 
care provider shall provide the person making the 
request copies of the requested records.   
No. 
2020AP1582   
 
10 
 
§ 146.83(3f)(a).8 
¶19 This 
provision 
unambiguously 
outlines 
three 
requirements that a person requesting a copy of patient health 
care records must fulfill:  (1) request copies, (2) provide 
informed consent, and (3) pay the applicable fee set forth in 
paragraph (b).  Id.  Once a person has met those three 
requirements, a health care provider "shall provide" the person 
with the requested copies.  Id.; Heritage Farms, Inc. v. Markel 
Ins. Co. (Heritage Farms II), 2012 WI 26, ¶32, 339 Wis. 2d 125, 
810 N.W.2d 465 ("[W]e presume that the word 'shall' is 
mandatory."). 
¶20 The second provision important to our discussion is 
paragraph (b), which provides: 
                                                 
8 As referenced above in footnote 5, Justice Roggensack's 
dissent produces a new argument on behalf of UW Hospitals, 
arguing that because Ciox is not a health care provider, it is 
not 
constrained 
by 
Wis. 
Stat. 
§ 146.83(3f). 
 
Justice 
Roggensack's Dissent, ¶66.  Neither party developed this 
argument in its brief, nor did this argument arise during oral 
arguments in this case.  UW Hospitals, in fact, actually 
eschewed 
this 
argument 
in 
its 
reply 
brief, 
calling 
it 
"irrelevant" to this case:  
First, Banuelos's mud-slinging in relation to Ciox 
cannot have any bearing on this case.  This court 
recently 
held 
that 
the 
fee 
restrictions 
in 
§ 146.83(3f)(b) apply only to health care providers, 
not their vendors.  See [Townsend v. ChartSwap, LLC, 
2021 WI 86, ¶¶16—17, 399 Wis. 2d 599, 967 N.W.2d 21].  
Accordingly, the statute is, and always has been, 
directed at Wisconsin health care providers, and 
whether or not a health care provider may choose to 
outsource 
its 
records 
collection 
processes 
is 
irrelevant. 
No. 
2020AP1582   
 
11 
 
Except as provided in sub. (1f), a health care 
provider may charge no more than the total of all of 
the following that apply for providing the copies 
requested under par. (a):  
1. For paper copies: $1 per page for the first 25 
pages; 75 cents per page for pages 26 to 50; 50 cents 
per page for pages 51 to 100; and 30 cents per page 
for pages 101 and above. 
2. For microfiche or microfilm copies, $1.50 per page. 
3. For a print of an X-ray, $10 per image. 
4. If the requester is not the patient or a person 
authorized by the patient, for certification 
of 
copies, a single $8 charge. 
5. If the requester is not the patient or a person 
authorized by the patient, a single retrieval fee of 
$20 for all copies requested. 
6. Actual shipping costs and any applicable taxes. 
Wis. Stat. § 146.83(3f)(b). 
¶21 Paragraph (b) sets out the parameters of the third 
requirement, delineating maximum allowable fees that may be 
charged for patient health care records.  Listed in the statute 
are three formats in which records can be provided and fees 
charged, and only three formats.  For paper copies, the fee is a 
per page charge of $1 for the first 25 pages; 75 cents for pages 
26-50; 50 cents for pages 51-100; and 30 cents for pages above 
100.  Id.  Additionally, a health care provider is allowed to 
charge no more than $1.50 per page for microfiche or microfilm 
copies and $10 per image for x-ray prints.  Id.  Conspicuously 
missing is any reference to copies of "electronic records" or 
any substantially similar term. 
No. 
2020AP1582   
 
12 
 
¶22 The text of the statute sets forth that health care 
providers "may charge no more than the total of all of the 
following that apply for providing the copies requested."  Id.  
That is, a health care provider may charge up to the rates 
prescribed in the statute for furnishing copies of paper 
records, microfiche or microfilm records, or x-rays.  We observe 
that there is no provision in the text permitting the charge of 
fees for copies in formats for which the legislature did not 
expressly authorize a fee. 
¶23 The court of appeals relied on a similar observation 
in reaching its conclusion that no fee may be charged for 
providing copies of patient health care records in an electronic 
format.  Banuelos, 399 Wis. 2d 568, ¶15.  It initially focused 
on the introductory language of paragraph (b), that a health 
care provider may "charge no more than the total of all of the 
following," to conclude that "para. (b) defines the total 
universe of fees that a provider may collect from a requester 
for the service of fulfilling a request for patient health care 
records under para. (a)."  Id.  "This means that the fees a 
health care provider is permitted to charge must be equal to or 
less than the total of whichever, if any, of the six fees 
enumerated in subds. (b)1.-6. that apply . . . ."  Id.   
¶24 We agree with the court of appeals that the plain text 
of 
Wis. 
Stat. 
§ 146.83(3f) 
indicates 
that 
if 
the 
three 
requirements laid out in paragraph (a) are met, the healthcare 
provider must provide copies of the patient's health care 
records.  We further agree with the court of appeals that the 
No. 
2020AP1582   
 
13 
 
statute does not permit charges for copies of electronic records 
because the statute does not enumerate electronic formats as one 
of the three formats for which a health care provider may charge 
a fee. 
C 
¶25 A review of the statutory history of Wis. Stat. 
§ 146.83(3f) yields a similar result.  Statutory history refers 
to previously enacted versions of the statute which have 
subsequently been amended by the legislature.9  Heritage Farms, 
Inc. v. Markel Ins. Co. (Heritage Farms I), 2009 WI 27, ¶15 
n.10, 316 Wis. 2d 47, 762 N.W.2d 652.  Prior versions of a 
statute were enacted law and constitute an intrinsic source, 
part and parcel of a plain meaning interpretation.  Richards, 
309 Wis. 2d 541, ¶22. 
¶26 Prior to 2009, the relevant statutes did not mention 
electronic 
copies 
of 
medical 
records. 
 
Wis. 
Stat. 
§ 146.83(3m)(a) (2007-08).10  At the time, the statute governing 
                                                 
9 Statutory history is distinct from legislative history, 
which "is extrinsic evidence of a law's meaning and becomes 
relevant only to confirm plain meaning or when a statute remains 
ambiguous even after 'the primary intrinsic analysis has been 
exhausted[.]'"  Brey v. State Farm Mut. Auto. Ins. Co., 2022 WI 
7, ¶21, 400 Wis. 2d 417, 970 N.W.2d 1.   
10 Wis. Stat. § 146.83(3m)(a)(2007-08) states:  
The department shall, by rule, prescribe fees that are 
based on an approximation of actual costs.  The fees, 
plus applicable tax, are the maximum amount that a 
health care provider may charge under sub. (1)(b) for 
duplicate patient health care records and under sub. 
(1)(c) for duplicate X−ray reports or the referral of 
(continued) 
No. 
2020AP1582   
 
14 
 
access to patient health care records merely provided that the 
Wisconsin Department of Health Services (DHS) shall prescribe 
fees, based on actual costs, which constitute the maximum amount 
a health care provider may charge.  Id. 
¶27 In 2009, the legislature took away DHS's broad 
authority to prescribe fees and instead set permissible fees by 
statute.  See 2009 Wis. Act 28, § 2433d.  The new statute, Wis. 
Stat. 
§ 
146.83(1f)(c)3m. 
(2009-10), 
referenced 
electronic 
copies, providing that "a health care provider may charge no 
more than the total of all of the following that apply for 
providing copies requested . . . For providing copies in digital 
or electronic format, a charge for all copies requested."  This 
language was mirrored in § 146.83(1h) (2009-10), which addressed 
                                                                                                                                                             
X−rays 
to 
another 
health 
care 
provider 
of 
the 
patient's choice.  The rule shall also permit the 
health care provider to charge for actual postage or 
other actual delivery costs.  In determining the 
approximation of actual costs for the purposes of this 
subsection, the department may consider all of the 
following factors: 
1. Operating expenses, such as wages, rent, utilities, 
and duplication equipment and supplies. 
2. The varying cost of retrieval of records, based on 
the 
different 
media 
on 
which 
the 
records 
are 
maintained. 
3. The cost of separating requested patient health 
care records from those that are not requested. 
4. The cost of duplicating requested patient health 
care records. 
5. The impact on costs of advances in technology. 
No. 
2020AP1582   
 
15 
 
fees for a patient health care record request made by someone 
other than the patient themselves.  A new provision was also 
created, stating:  
Upon the request of the person requesting copies of 
patient health care records under sub. (1f) or (1h), 
the health care provider shall provide the copies in a 
digital or electronic format unless the health care 
provider's record system does not provide for the 
creation or transmission of records in a digital or 
electronic format, in which case the health care 
provider 
shall 
provide 
the 
person 
a 
written 
explanation for why the copies cannot be provided in a 
digital or electronic format. 
2009 Wis. Act 28, § 2433h (creating § 146.83(1k)).   
  
¶28 In 2011, subsequent to a change in federal law,11 the 
Wisconsin Legislature repealed § 146.83(1f) and (1h) (2009-10) 
and created Wis. Stat. § 146.83(3f) as it is today, without 
specific reference to electronic records.  2011 Wis. Act 32, 
§§ 2649x-2663m.  Two key changes regarding what was formerly 
Wis. Stat. § 146.83(1f) took place.  First, the legislature 
deleted two charges that were previously permissible.  One now-
deleted provision was § 146.83(1f)(c)3m. (2009-10), which as set 
forth above provided an allowable "charge" for the provision of 
electronic records.  The other deleted provision authorized a 
surcharge contingent on the timing of requested delivery.  
                                                 
11 As part of the American Recovery and Reinvestment Act of 
2009, federal law was enacted encouraging health care providers 
to adopt electronic health records, mandating that individuals 
may receive electronic copies and setting a fee limitation on 
such copies.  American Recovery and Reinvestment Act of 2009, 
H.R. 1, 111th Cong. § 13001(a) H.R. 1-112 (2009) (enacted).   
No. 
2020AP1582   
 
16 
 
§ 146.83(1f)(c)5. (2009-10).  Second, the legislature added two 
permissible charges.  Those charges, which still exist today, 
create an additional surcharge for a third-party requester, 
i.e., a requester who is not the patient or a person authorized 
by the patient.  § 146.83(3f)(b)4-5. 
¶29 Although Wisconsin statutes previously permitted a 
charge for the provision of electronic copies of patient health 
care records, that language has since been repealed.  The 
legislature's chosen actions resulted in the comprehensive list 
of permitted fees a health care provider may charge for copies 
of patient health care records.  We cannot interpret the 
subsequently amended statute to permit a charge for copies of 
electronic records, as doing so would require us to read 
language back into the statute that is no longer there.  This we 
cannot do.  See Milwaukee J. Sentinel v. City of Milwaukee, 2012 
WI 65, ¶37, 341 Wis. 2d 607, 815 N.W.2d 367. 
D 
¶30 UW 
Hospitals 
challenges 
this 
plain 
meaning 
interpretation of the text of Wis. Stat. § 146.83(3f) and its 
statutory 
history 
by 
citing 
to 
surrounding 
statutes.  
Specifically, it looks to Wis. Stat. § 146.836, entitled 
"Applicability," and Wis. Stat. § 146.81(4), which defines 
"patient health care records," to argue that the scope of 
§ 146.83(3f) does not cover electronic records.  
¶31 It argues that a determination of whether the fee 
provision in paragraph (b) of Wis. Stat. § 146.83(3f) even 
applies depends on whether the records request initially 
No. 
2020AP1582   
 
17 
 
qualifies as a request pursuant to paragraph (a).  UW Hospitals 
observes that nothing in paragraph (a) indicates that a request 
for patient health care records includes electronic records.  It 
advances that such an omission was intentional because a nearby 
statute, Wis. Stat. § 146.836, unambiguously provides that only 
four 
statutory 
provisions 
apply 
to 
electronic 
records.  
Section 146.836 states: 
 
Sections 146.815, 146.82, 146.83(4) and 146.835[12] 
apply to all patient health care records, including 
those on which written, drawn, printed, spoken, 
visual, electromagnetic or digital information is 
recorded or preserved, regardless of physical form or 
characteristics.  
According to UW Hospital, because § 146.83(3f) is not one of the 
four statutory provisions applicable to electronic records, the 
scope of paragraph (a) clearly does not include electronic 
records. 
¶32 Next, UW Hospitals looks to the definition of "patient 
health care records" found in Wis. Stat. § 146.81(4) in an 
effort to further rebut the court of appeals' plain meaning 
interpretation of Wis. Stat. § 146.83(3f).  The definition 
contained 
in 
§ 146.81(4) 
in 
relevant 
part 
provides 
that 
                                                 
12 The sections referred to in this statute all relate to 
the content and confidentiality of records.  The titles in order 
of appearance in Wis. Stat. § 146.836 are as follows:  "Contents 
of certain patient health care records;" "Confidentiality of 
patient health care records;" "Access to patient health care 
records" (specifying prohibited actions relating to records); 
and "Parents denied physical placement rights."  Wis. Stat. 
§§ 146.815; 146.82; 146.83(4); 146.835. 
No. 
2020AP1582   
 
18 
 
"'[p]atient health care records' means all records related to 
the health of a patient prepared by or under the supervision of 
a health care provider . . . ."  § 146.81(4). 
Relying on the 
statutory definition, the court of appeals determined that 
"'[p]atient health care records' means all records related to 
the health of a patient prepared by or under the supervision of 
a health care provider," and that "all" records "means all 
records," including electronic records.  See Banuelos, 399 
Wis. 2d 568, ¶12 n.4.    
¶33 UW Hospitals argues that an examination of the plain 
text of the statutory definition reveals that it addresses the 
substance of the records and not their format.  It explains that 
the records must "relate to the health of the patient" and be 
"prepared by or under the supervision of the health care 
provider," which are matters of substance.  UW Hospitals thus 
reasons that the definition does not contemplate records in 
electronic format. 
¶34 Additionally, according to UW Hospitals, to interpret 
the 
definition 
as 
applying 
to 
all 
formats 
would 
render 
superfluous the "Applicability" statute, Wis. Stat. § 146.836, 
given that it limits the applicability of electronic records 
formats to only four enumerated provisions.  To explain briefly 
in the words of UW Hospitals, "[i]f 'patient health care 
records' included electronic records whenever that term appears, 
then there was no need for the legislature to specify" in the 
"Applicability" section that the definition of "patient health 
No. 
2020AP1582   
 
19 
 
care records" in the four listed provisions also applies to 
electronic records. 
¶35 We are unpersuaded and address each argument in turn.  
To start, we conclude that Banuelos's request for electronic 
records was a request under Wis. Stat. § 146.83(3f)(a).  This 
conclusion is informed by the definition of "patient health care 
records."  In turning to the statutory definition of "patient 
health care record" in Wis. Stat. § 146.81(4) we make two 
important observations.  Initially, we observe the threshold 
language in § 146.81 indicates that the definitions listed in 
§ 146.81 apply to "ss. 146.81 to 146.84."  § 146.81.  This range 
includes the statute at the center of our analysis, Wis. Stat. § 
146.83.  We observe next that the legislature used the inclusive 
term, "all" in the definition of "patient health care record."  
Indeed, it is evident that "all records" means "all records."  
See Pfister v. Milwaukee Econ. Dev. Corp., 216 Wis. 2d 243, 270, 
576 N.W.2d 554 (Ct. App. 1998) (concluding that "'all' means 
'all'"). 
¶36 Thus under this definition, "patient health care 
record" means "all records," including electronic records.  
Because paragraph (a) regulates access to "patient health care 
records," Wis. Stat. § 146.83(3f)(a) encompasses requests for 
electronic records as well.  We resolve UW Hospitals' argument 
that paragraph (a) does not apply to electronic records due to  
the "Applicability" statute, Wis. Stat. § 146.836, in the same 
manner as its related argument that to interpret "patient health 
care records" as "all records," renders superfluous § 146.836.  
No. 
2020AP1582   
 
20 
 
¶37 These arguments fail for several reasons.  First, they 
ignore the fact that Wis. Stat. § 146.83(3f) regulates access to 
"copies" of patient health care records, not the actual records.  
The text of Wis. Stat. § 146.836 "does not address the 
significance of the distinction between the reference to 
'electronic records' in § 146.836 and the reference to 'copies 
of a patient's health care records' in Wis. Stat. § 146.83(3f)."  
Banuelos, 399 Wis. 2d 568, ¶39.  UW Hospitals is not able to 
articulate any language in the "Applicability" section limiting 
"copies" to a particular format. 
¶38 Second, 
UW 
Hospitals' 
interpretation 
of 
"patient 
health care record" as excluding electronic records for purposes 
of all but four statutory sections is unavailing because of the 
impact such an interpretation would have on other statutes 
discussing "patient health care records."  For example, we look 
to Wis. Stat. § 146.819(1),13 which governs a health care 
                                                 
13 Wis. Stat. § 146.819(1) states: 
Except as provided in sub. (4), any health care 
provider who ceases practice or business as a health 
care provider or the personal representative of a 
deceased health care provider who was an independent 
practitioner shall do one of the following for all 
patient health care records in the possession of the 
health care provider when the health care provider 
ceased business or practice or died:  
(a) Provide for the maintenance of the patient health 
care records by a person who states, in writing, that 
the records will be maintained in compliance with ss. 
146.81 to 146.835.  
(continued) 
No. 
2020AP1582   
 
21 
 
provider's responsibility upon ceasing practice, including that 
such a provider must maintain, delete, or destroy patient health 
care records in their possession.  UW Hospitals' interpretation 
suggests that § 146.819(1) requires that a former health care 
provider must maintain or destroy only physical patient health 
care records, as records in electronic format would be excluded 
from this statute's purview.  Given the ubiquity of electronic 
record keeping, excluding electronic records from this statutory 
mandate because of an amorphous link to Wis. Stat. § 146.836 
makes no sense.  See also Wis. Stat. § 146.84 (excluding records 
in electronic format from a section imposing violations for 
actions taken in relation to handling related to "patient health 
care records" would likewise make no sense).  
¶39 Third, the text of Wis. Stat. § 146.836 limits its 
applicability to four enumerated statutes, and ensures the 
confidentiality of "written, drawn, printed, spoken, visual" and 
electronic information.  The enumerated statutes are Wis. Stat. 
§ 146.815 (content of hospital records); Wis. Stat. § 146.82 
(confidentiality of records and informed consent to access); 
Wis. Stat. § 146.83(4) (prohibiting certain actions regarding 
patient 
records); 
and 
Wis. 
Stat. 
§ 146.835 
(maintaining 
                                                                                                                                                             
(b) Provide for the deletion or destruction of the 
patient health care records.  
(c) Provide for the maintenance of some of the patient 
health care records, as specified in par. (a), and for 
the deletion or destruction of some of the records, as 
specified in par. (b). 
No. 
2020AP1582   
 
22 
 
confidentiality from parents that are denied physical placement 
of a child).  Nothing in the text of § 146.836 changes the 
definition of "patient health care records" as applied to Wis. 
Stat. § 146.83(3f), nor any other statute.  If § 146.836 was 
intended to have the far reaching effect as espoused by UW 
Hospitals, one would expect it to be clearly reflected in the 
text. 
¶40 Finally, we turn to UW Hospitals' remaining argument 
that the definition of "patient health care record" is one of 
substance and not format.  This curious argument does not 
support the conclusion UW Hospitals would have us draw from it 
to exclude electronic records from the definition.  Regardless 
of whether it relates to the "substance" of the record or its 
"format," the legislature chose to define "patient health care 
records" as "all records."  State ex rel. Girouard v. Cir. Ct. 
for Jackson Cnty., 155 Wis. 2d 148, 156, 454 N.W.2d 792 (1990) 
("When a word used in a statute is defined in the statutes, that 
definition is controlling."). 
¶41 Thus we conclude that Wis. Stat. § 146.836 does not 
serve as an omnibus statute, intending to supersede in scope all 
statutes that reference health care records.  Rather, the four 
enumerated 
statutes 
cover 
matters 
of 
content 
and 
confidentiality, and there is nothing in the text to indicate 
that its circumference was intended to expand beyond that narrow 
field. 
 
It 
neither 
limits 
the 
scope 
of 
Wis. 
Stat. 
§ 146.83(3f)(a) nor is it rendered superfluous by the definition 
of "patient health care records" in Wis. Stat. § 146.81(4).  We 
No. 
2020AP1582   
 
23 
 
instead remain wedded to the statutory definition of "patient 
health care records," determining that "all" indeed does mean 
"all." 
¶42 At times it appears as though UW Hospitals' arguments 
endeavor to place this court in the very midst of an important 
policy decision.  It frames the essence of our inquiry as:  "At 
bottom, this case asks who should bear the cost of supporting 
these commercial entities' profit making:  the Wisconsin health 
care system (and ultimately, all Wisconsin patients) or the 
commercial entities themselves."  
¶43 It restates the question before the court as relating 
to how the court should apportion the costs involved:  "The 
question here . . . relates to how the cost of providing 
electronic records access should be apportioned as between the 
health care provider and commercial third parties . . .  who 
choose, for their own business reasons, to obtain records 
directly from health care providers rather than from the 
patients who are their customers." 
¶44 We disagree.  At bottom, our inquiry is neither about 
"who should bear the cost of supporting these commercial 
entities' profit making" nor is the question before us "how the 
cost of providing electronic records" should be apportioned.  
Rather, our task is to discern the meaning of Wis. Stat. 
§ 146.83(3f), and this we have done in the discussion above.  
"It goes without saying, of course, that the legislature may 
amend the fee provisions.  Policy decisions are left to the 
legislature."  Milwaukee J. Sentinel, 341 Wis. 2d 607, ¶37. 
No. 
2020AP1582   
 
24 
 
¶45 In sum, we conclude that Wis. Stat. § 146.83(3f) does 
not permit health care providers to charge fees for electronic 
records.  Therefore, Banuelos's complaint states a claim upon 
which relief can be granted that UW Hospital's charge of $109.96 
was a violation of Wisconsin law.  Accordingly, we affirm the 
decision of the court of appeals. 
By the Court.—The decision of the court of appeals is 
affirmed. 
No.  2020AP1582.pdr 
 
1 
 
 
¶46 PATIENCE DRAKE ROGGENSACK, J.   (dissenting).  We 
review a motion to dismiss.  According to the majority opinion, 
we are asked to determine whether Wis. Stat. § 146.83(3f)(b)'s 
permission to health care providers to charge for copies of 
health care records that are provided in paper, microfilm and X-
ray formats is also a prohibition against health care providers 
charging for copies of health care records in electronic format.1   
¶47 I conclude that Beatriz Banuelos's Complaint fails to 
state a claim against University of Wisconsin Hospital and 
Clinics Authority ("UW Hospital") because her Complaint alleges 
that Ciox Health, LLC (Ciox), who is not a health care provider, 
supplied the health care records and charged $109.96 for them, 
payable to Ciox.2  Wisconsin Stat. § 146.83(3f)(b), invoked and 
relied on by the majority opinion, does not regulate persons who 
are not health care providers.  Townsend v. ChartSwap, LLC, 2021 
WI 86, ¶14, 399 Wis. 2d 599, 967 N.W.2d 21 (explaining that 
"[b]y the terms of the statute itself, these restrictions apply 
only to health care providers"); Smith v. RecordQuest, LLC, 380 
F. Supp. 3d 838, 842 (E.D. Wis. 2019) (explaining that "[t]he 
statute does not impose liability on a person who is not a 
health care provider but who responds to records requests on 
behalf of a health care provider").3  
                                                 
1 Majority op., ¶4.   
2 Complaint, ¶¶16, 17; Banuelos – Exhibit 3 (attached to the 
Complaint and to this dissent). 
3 The Seventh Circuit reversed Smith v. RecordQuest, LLC, 
(continued) 
No.  2020AP1582.pdr 
 
2 
 
¶48 Permitting a claim against UW Hospital for charges 
made by Ciox for the provision of health care records is not 
addressed in Wis. Stat. § 146.83(3f)(b).4  Whether to permit a 
claim against a health care provider for charges made by a third 
party for the provision of health care records, whether the 
third party is denominated a "conduit," a "business associate" 
or something else, is a policy choice better left to the 
legislature.  The charges the Complaint alleges Ciox made here 
are not contrary to the plain meaning of § 146.83(3f)(b); 
therefore, the Complaint fails to state a claim against UW 
Hospital and must be dismissed.  
¶49 The majority opinion ignores material facts that are 
alleged in Banuelos's Complaint and the effect of Townsend on 
                                                                                                                                                             
380 F. Supp 3d 838 (E.D. Wis. 2019) in Smith v. RecordQuest, 
LLC, 989 F.3d 513 (7th Cir. 2021).  However, in reversing the 
Eastern District of Wisconsin to determine that Wis. Stat. 
§ 146.83(3f)(b) applied to a "health care records company," the 
Seventh Circuit relied on Townsend v. ChartSwap, LLC, 2020 WI 
App 79, 395 Wis. 2d 229, 952 N.W.2d 831.  Just months after the 
Seventh Circuit's decision, this court reversed the Wisconsin 
Court of Appeals in Townsend v. ChartSwap, LLC, 2021 WI 86, 399 
Wis. 2  599, 967 N.W.2d 21.  Effectively, the Eastern District 
of Wisconsin's determinations in Smith are consistent with 
Wisconsin law.  See also id., 399 Wis. 2d 599, ¶¶9 n.6, 32. 
4 The majority alleges that Ciox is a "conduit" and a 
"business associate" of UW Hospital.  Majority op., ¶8 n.5.  
That may be true, but that does not make Ciox a health care 
provider according to the definition of health care provider in 
Wis. Stat. § 146.81(1).  And, only health care providers are 
restricted 
by 
Wis. 
Stat. 
§ 146.83(3f)(b). 
 
Townsend 
v. 
ChartSwap, LLC, 2021 WI 86, ¶14, 399 Wis. 2d 599, 967 N.W.2d 21.   
No.  2020AP1582.pdr 
 
3 
 
the pending motion to dismiss, given those facts.  Accordingly, 
I respectfully dissent.5  
I.  BACKGROUND 
¶50 Wisconsin Stat. § 146.83(3f) is central to our review.  
It was enacted in 2011 Wis. Act 32 § 9321(4), effective July 1, 
2011.   
¶51 Banuelos alleges she requested her health care records 
be sent to her attorneys in electronic format.  She alleges that 
the records were provided, but that she was charged fees in 
excess of that permitted by Wis. Stat. § 146.83(3f)(b).  UW 
Hospital moved to dismiss.  The circuit court granted UW 
Hospital's motion because charges for electronic documents are 
not mentioned in § 146.83(3f)(b) and therefore, the charge for 
electronic copies was not regulated by subsec. (3f)(b).   
¶52 The court of appeals reversed, concluding that it is 
"self-evident" that because there is no listing of "applicable 
fees under par. (b)" for electronic copies, the records must 
still be provided.  However, no fees may be charged.6   
¶53 Rather than reviewing facts alleged in Banuelos's 
complaint, as a motion to dismiss requires, the majority opinion 
slides over that obligation.  Instead, it interprets Wis. Stat. 
§ 146.83(3f)(b)'s silence in regard to electronic records as a 
                                                 
5 When on a motion to dismiss a majority opinion ignores the 
facts alleged in the complaint, it invites a motion for 
reconsideration.   
6 Banuelos v. Univ. of Wis. Hosps. and Clinics Auth., 2021 
WI App 70, ¶¶13, 14, 399 Wis. 2d 568, 966 N.W.2d 78. 
No.  2020AP1582.pdr 
 
4 
 
prohibition on charging for those records, notwithstanding that 
UW Hospital charged Banuelos's lawyers nothing for health care 
records that Ciox provided.7   
II.  DISCUSSION 
A.  Standard of Review 
¶54 The dispute before us presents as a motion to dismiss.  
Whether facts alleged in a complaint are sufficient to state a 
claim for relief is a question of law for our independent 
review.  Townsend, 399 Wis. 2d 599, ¶10.  This dispute also 
requires us to interpret and apply statutes.  These are 
additional questions of law that we independently decide.  
Marder v. Bd. of Regents of Univ. of Wis. Sys., 2005 WI 159, 
¶19, 286 Wis. 2d 252, 706 N.W.2d 110.   
B.  Motion to Dismiss 
1.  Legal Principles 
¶55 A motion to dismiss tests the legal sufficiency of the 
complaint.  Townsend, 399 Wis. 2d 599, ¶10.  In order to survive 
a motion to dismiss, a complaint must allege facts, which if 
true, would entitle the pleader to relief.  Data Key Partners v. 
Permira Advisers LLC, 2014 WI 86, ¶21, 356 Wis. 2d 665, 849 
N.W.2d 693.  Although for purposes of the pending motion, we 
accept as true all facts well-pleaded and reasonable inferences 
therefrom, we cannot add facts to a complaint.  Townsend, 399 
Wis. 2d 599, ¶10.  In addition, we give no deference to a 
                                                 
7 Majority op., ¶1.  
No.  2020AP1582.pdr 
 
5 
 
complaint's legal conclusions.  Id.  Accordingly, I begin with 
the factual allegations stated in Banuelos's Complaint.   
2.  Banuelos's Complaint 
a.  Facts Found in Banuelos's Complaint 
¶56 Her Complaint alleges:  "From 2016 to January 23, 
2020, all major institutional health care providers, like UW 
Health in Wisconsin and their business associates, like Ciox, 
were complying with the DHHS guidance and charging a cost-based 
fee, $6.50 in the vast majority of cases, upon receipt of a 
HITECH[8] electronic medical records request from the patient 
with the patient's lawyers designated to receive the records."9 
¶57 "On January 23, 2020, a Federal District Court on the 
D.C. Circuit issued a Memorandum Opinion in [Ciox Health, LLC v. 
Azar, 435 F. Supp. 3d 30 (D.D.C. Jan. 2020)], indicating that 
the 2016 DHHS guidance document entitling patients to the cost-
based fee when the medical records were directed to be received 
by a third party, like a law firm, was unenforceable."10  After 
this federal court decision, UW Hospital and Ciox began 
informing patients who had requested electronic health care 
records under HITECH and designated receipt by a third-party 
that their requests would be fulfilled according to allowable 
                                                 
8 HITECH is the acronym for Health Information Technology 
for Economic and Clinical Health Act. 
9 Complaint, ¶9.   
10 Id., ¶10.   
No.  2020AP1582.pdr 
 
6 
 
state costs, not the earlier mandate in the DHHS guidance 
document.11 
¶58 On February 27, 2020, Banuelos requested copies of her 
health care records in electronic format.12  She directed that 
the copies be sent to her lawyers.13  Ciox sent the requested 
health care records electronically to Banuelos's lawyers.14  Ciox 
also included its invoice requesting payment of $109.96 to Ciox 
at 
"P.O. 
Box 
409740, 
Atlanta, 
Georgia 
30384-9740," 
with 
questions by email directed to "collections@cioxhealth.com."15  
b.  The Applicable Law 
¶59 Banuelos relies on Wis. Stat. § 146.83(3f)(b) for her 
claim against UW Hospital that she was charged excessive fees.16  
Section 146.83(3f)(b) provides in relevant part:   
(b)  Except as provided in sub (1f), a health 
care provider may charge no more than the total of all 
of the following that apply for providing the copies 
requested under par. (a) . . . .   
¶60 We have interpreted Wis. Stat. § 146.83(3f)(b) in a 
prior decision.  
Townsend, 399 Wis. 2d 599, 
¶2.  Past 
interpretations of a statute become part of our understanding of 
                                                 
11 Id., ¶12.   
12 Id., ¶14.   
13 Id., ¶15.   
14 Id., ¶16.   
15 Id., ¶17; "Banuelos – Exhibit 3" (attached to the 
Complaint and attached to this dissent).   
16 Id., ¶22. 
No.  2020AP1582.pdr 
 
7 
 
the meaning of the statute.  Adams v. Northland Equip. Co., 
Inc., 2014 WI 79, ¶30, 356 Wis. 2d 529, 850 N.W.2d 272; State v. 
Soto, 2012 WI 93, ¶20, 343 Wis. 2d 43, 817 N.W.2d 848.   
¶61 In Townsend, we had a claim similar to that set out in 
Banuelos's complaint, where ChartSwap provided and charged for 
medical records that had been requested from the health care 
provider, Milwaukee Radiologists.  Townsend, 399 Wis. 2d 599, 
¶4.  Here, Banuelos's Complaint requested health care records 
from UW Hospital and Ciox provided the records and billed for 
payment of $109.96, directing that payment be made to Ciox.17  
¶62 In Townsend, we concluded that under a plain meaning 
interpretation of Wis. Stat. § 146.81(1), "ChartSwap is not a 
health care provider."  Id., ¶2.  We also concluded that Wis. 
Stat. § 146.83(3f)(b) regulates only health care providers.  Id. 
Therefore, because ChartSwap was not a health care provider and 
§ 146.83(3f)(b) 
regulated 
only 
health 
care 
providers, 
§ 146.83(3f)(b) did not regulate ChartSwap.  Id.   
¶63 In parallel with Townsend, Ciox is not a health care 
provider because it meets none of the identifications provided 
by Wis. Stat. § 146.81(1)(a)–(s).  Because Ciox is not a health 
care provider, it is not subject to fee regulations in 
§ 146.83(3f)(b).  Id.  Therefore, the payment Banuelos's 
attorneys made to Ciox does not come within subsec. (3f)(b).  
Smith confirms this conclusion as it explains: 
                                                 
17 Id., ¶¶14, 16, 17.   
No.  2020AP1582.pdr 
 
8 
 
[P]laintiff's argument finds no support in the text of 
the statute.  The statute does not impose liability on 
a person who is not a health care provider but who 
responds to records requests on behalf of a health 
care provider.   
Smith, 380 F. Supp. 3d at 842. 
¶64 This case differs from Townsend and Smith in that the 
health care provider, UW Hospital, was named as the defendant, 
rather than naming the entity that provided the records and 
charged for their provision.  However, Banuelos's Complaint 
bases its alleged statutory violation on the Ciox bill and the 
payment to Ciox.  The Complaint does not make a factual 
allegation that UW Hospital billed or collected anything in 
regard to the provision of Banuelos's health care records.   
¶65 Banuelos's Complaint tries to avoid this problem by 
alleging "charges submitted by defendant, UW Hospital and 
Clinics Authority, through its business associate, Ciox, to the 
plaintiff, Beatriz Banuelos, are not permitted by Wisconsin 
Statutes § 146.83(3f)."18  However, Banuelos cites no statutory 
language in § 146.83(3f) to support this legal conclusion.   
¶66 Wisconsin Stat. § 146.83(3f)(b) regulates health care 
providers.  It does not regulate business associates of health 
care providers.  If the legislature chooses to cause health care 
providers to incur liability for acts of a business associate, 
that is a policy choice the legislature can make by amending the 
statute.  However, as the statute is now written, it regulates 
only health care providers for charges that health care 
                                                 
18 Id., ¶25.   
No.  2020AP1582.pdr 
 
9 
 
providers impose.  Townsend firmly sets aside Banuelos's claim 
because Ciox is not a health care provider and, as her Complaint 
alleges, Ciox charged and collected for the records.19  Townsend, 
399 Wis. 2d 599, ¶2; Smith, 380 F. Supp. 3d at 842.  
¶67 The majority opinion never quotes or analyzes facts 
alleged in Banuelos's Complaint.  Instead, it sets out facts 
that it creates to enable it to get to where it wants to go.  
For example, Banuelos's Complaint does not state that UW 
Hospital "transmitted . . . an invoice for $109.96" or made a 
"charge of $109.96" as the majority opinion states.20  Instead, 
her Complaint alleges that Ciox made that charge, and it 
attaches the invoice from Ciox showing payment is due to Ciox, 
not to UW Hospital.  See invoice copy attached to dissent.   
¶68 Accordingly, because Banuelos's Complaint fails to 
state a claim against UW Hospital that comes within the plain 
meaning of Wis. Stat. § 146.83(3f)(b), her Complaint must be 
dismissed.  Because the majority opinion does not review facts 
actually 
alleged 
in 
the 
Complaint, 
and 
instead 
rewrites 
§ 146.83(3f)(b) to make a policy choice that belongs to the 
legislature, I respectfully dissent.   
III.  CONCLUSION 
                                                 
19 A health care provider is defined in Wis. Stat. 
§ 146.81(1).  Ciox does not fit within any of those persons 
listed in subsec. (1)(a)-(s), even when described as a "business 
associate" of a health care provider.   
20 Majority op., ¶¶8, 9.   
No.  2020AP1582.pdr 
 
10 
 
¶69 I conclude that Banuelos's Complaint fails to state a 
claim against UW Hospital because it alleges that Ciox, who is 
not a health care provider, supplied the health care records and 
charged $109.96 for them, payable to Ciox.21  Wisconsin Stat. 
§ 146.83(3f)(b), invoked and relied on by the majority opinion, 
does not regulate persons who are not health care providers.  
Townsend, 399 Wis. 2d 599, ¶14; Smith, 380 F. Supp. 3d at 842.  
¶70 Permitting a claim against UW Hospital for charges 
made by Ciox for the provision of health care records is not 
addressed in Wis. Stat. § 146.83(3f)(b).  Whether to permit a 
claim against a health care provider for charges made by a third 
party for the provision of health care records, whether the 
third party is denominated a "conduit," a "business associate" 
or something else, is a policy choice better left to the 
legislature.  The charges Banuelos's Complaint alleges Ciox made 
here are not contrary to § 146.83(3f)(b); therefore, the 
Complaint fails to state a claim against UW Hospital and must be 
dismissed.    
¶71 The majority opinion ignores material facts that are 
alleged in Banuelos's Complaint and the effect of Townsend on 
the pending motion to dismiss, given those facts.  Accordingly, 
I respectfully dissent.   
¶72 Although I conclude the Complaint should be dismissed 
for the reasons stated above, I agree with Justice Rebecca 
Grassl 
Bradley’s 
statutory 
interpretation 
of 
Wis. 
Stat. 
                                                 
21 Id., ¶¶16, 17; Banuelos – Exhibit 3 (attached to the 
Complaint). 
No.  2020AP1582.pdr 
 
11 
 
§ 146.83(3f) as applied to "health care providers."  Therefore, 
I join her dissent. 
  
No.  2020AP1582.pdr 
 
12 
 
 
No.  2020AP1582.rgb 
 
1 
 
 
¶73 REBECCA GRASSL BRADLEY, J.   (dissenting).  Beatriz 
Banuelos requested electronic health care records from her 
health care provider, University of Wisconsin Hospitals and 
Clinics Authority (UW Health), which provided the records 
through Ciox Health, LLC (Ciox), a service provider.  Ciox 
charged Banuelos $109.96 for providing the requested records.  
Banuelos sued UW Health, alleging it had no statutory authority 
under Wis. Stat. § 146.83(3f) (2021–22)1 to charge for the 
provision of electronic records.  Misinterpreting the statutory 
text, the majority agrees with Banuelos and concludes Wis. Stat. 
§ 146.83(3f) prohibits such charges.  The majority is wrong.  
Wisconsin Stat. § 146.83(3f) is silent as to the amount health 
care providers may charge for the provision of electronic health 
care records.  The absence of any state regulation of such fees 
means providers retain the freedom to charge them, subject only 
to federal law. 
I.  The Statutory Text 
[T]he construction must be made upon the entire 
instrument, and not merely upon disjointed parts of 
it. 
Herbert Broom, A Selection of Legal Maxims 440 (Joseph Gerald 
Pease & Herbert Chitty eds., 8th ed. 1911). 
 
¶74 The majority misconstrues Wis. Stat. § 146.83(3f) as 
an authorization of private economic activity, namely, charging 
for the provision of health care records.  Like the court of 
                                                 
1 All subsequent references to the Wisconsin Statutes are to 
the 2021–22 version unless otherwise indicated. 
No.  2020AP1582.rgb 
 
2 
 
appeals, the majority concludes:  "[§ 146.83(3f)] does not permit 
charges for copies of electronic records because the statute 
does not enumerate electronic formats as one of the three 
formats for which a health care provider may charge a fee," and 
"there is no provision in the text permitting the charge of fees 
for copies in formats for which the legislature did not 
expressly authorize a fee."  Majority op. ¶¶24, 22.  In the 
absence of constitutionally legitimate regulation, people do not 
require the State's permission to engage in economic activity.  
Because the applicable statute does not impose a statutory cap 
on charges for providing electronic health records, the provider 
may charge whatever it chooses——subject to federal law, which 
does impose a limit.  42 U.S.C. § 17935(e)(3) (2012).   
¶75 Wisconsin Stat. § 146.83(3f) requires health care 
providers to provide health care records upon request.  Wis. 
Stat. § 146.83(3f)(a).  The statute imposes caps on the fees 
providers may charge for providing records in particular forms 
including paper, microfiche, and x-ray prints.  Wis. Stat. 
§ 146.83(3f)(b).  For reference, the statute provides:  
(a) 
[I]f a person requests copies of a patient's 
health care records, provides informed consent, 
and pays the applicable fees under par. (b), the 
health care provider shall provide the person 
making the request copies of the requested 
records.  
(b) 
[A] health care provider may charge no more than 
the total of all of the following that apply for 
providing the copies requested under par. (a): 
1. 
For paper copies: $1 per page for the first 
25 pages; 75 cents per page for pages 26 to 
50; 50 cents per page for pages 51 to 100; 
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3 
 
and 30 cents per page for pages 101 and 
above. 
2. 
For microfiche or microfilm copies, $1.50 
per page. 
3. 
For a print of an X-ray, $10 per image. 
4. 
If the requester is not the patient or a 
person 
authorized 
by 
the 
patient, 
for 
certification of copies, a single $8 charge. 
5. 
If the requester is not the patient or a 
person authorized by the patient, a single 
retrieval 
fee 
of 
$20 
for 
all 
copies 
requested. 
6. 
Actual shipping costs and any applicable 
taxes. 
Paragraphs (a) and (b) must be read as a whole, and in the 
context of surrounding statutes.  State ex rel. Kalal v. Circuit 
Court for Dane Cnty., 2004 WI 58, ¶46, 271 Wis. 2d 633, 681 
N.W.2d 110.   
¶76 Under paragraph (a), health care providers "shall" 
provide copies of a patient's health care records to each person 
who requests them, with the patient's informed consent.  The 
word "shall" is mandatory.  Heritage Farms, Inc. v. Markel 8 
Ins. Co. (Heritage Farms II), 2012 WI 26, ¶32, 339 Wis. 2d 125, 
810 
N.W.2d 465 
("[W]e 
presume 
that 
the 
word 
'shall' 
is 
mandatory"); Antonin Scalia & Bryan A. Garner, Reading Law: The 
Interpretation of Legal Texts 112 (2012) (Mandatory/Permissive 
Canon) ("The traditional, commonly repeated rule is that shall 
is mandatory and may is permissive").  Compliance with this 
provision necessarily imposes costs on the provider.  In 2011, 
for instance, the average request for health care records 
"total[ed] 61 pages in length" and cost providers "an average" 
No.  2020AP1582.rgb 
 
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of $62.22 in "direct processing."  Legislative Fiscal Bureau, 
Joint Fin. Cmte., Paper #367 (May 18, 2011) at 6.  The statute 
requires health care providers to shoulder a substantial cost; 
the total fee that can be charged under paragraph (b) for an 
average request of 61 pages equals only $36.35.  Id.  The 
statutory scheme reflects a legislative balancing of patients' 
interest in guaranteed and affordable access to their health 
care records and the health care provider's interest in 
recouping the costs of providing them.   
¶77 Nothing 
in 
paragraph 
(a) 
requires 
health 
care 
providers to give requesters any health care records in 
electronic form.  The statutory limits on fees under paragraph 
(b) apply only to requests for the form of records expressly 
listed in paragraph (b)(1–6).  Health care records in electronic 
form are not listed in paragraph (b); therefore, electronic 
health care records are not subject to any cap on fees the 
provider may charge.  Requests for electronic health care 
records fall beyond the scope of § 146.83(3f) altogether because 
records in electronic form are not mentioned at all.  The 
majority converts the legislature's silence with regard to 
electronic health care records into a mandate that health care 
providers provide them at no charge.  Had the legislature wished 
to impose such an obligation on health care providers, it would 
have done so explicitly.  "[T]he legislature knows how to write 
a statute accomplishing the work" the majority would have 
§ 146.83(3f) perform.  Teigen v. Wisconsin Elections Comm'n, 
No.  2020AP1582.rgb 
 
5 
 
2022 WI 64, ¶49, 403 Wis. 2d 607, 976 N.W.2d 519 (citing State 
v. Yakich, 2022 WI 8, ¶26, 400 Wis. 2d 549, 970 N.W.2d 12). 
¶78 Although the majority claims both paragraphs (a) and 
(b) are "important" to its analysis and purports to read those 
paragraphs in their proper context, the majority does not 
consider Wis. Stat. § 146.83(3f) as a whole text.  Majority op., 
¶¶17, 18.  The majority commits an interpretive fault perhaps 
"more common" than any other.  Scalia & Garner, Reading Law 167.  
As we have stated in countless cases, statutory text may not be 
read in isolation.  See, e.g., State ex rel. Zignego v. 
Wisconsin Elections Comm'n, 2021 WI 32, ¶12, 396 Wis. 2d 391, 
957 N.W.2d 208 ("When interpreting statutes, we focus primarily 
on the language of the statute, looking as well to its statutory 
context and structure"); see also Stroede v. Soc'y Ins. & R.R. 
Station, LLC, 2021 WI 43, ¶11, 397 Wis. 2d 17, 959 N.W.2d 305 
("[Statutory] language is 'interpreted in the context in which 
it is used, not in isolation but as part of a whole.'") (quoting 
Kalal, 271 Wis. 2d 633, ¶46); Piper v. Jones Dairy Farm, 2020 WI 
28, ¶27, 390 Wis. 2d 762, 940 N.W.2d 701 ("As with statutory 
interpretation, we interpret the language of a regulation in the 
context in which it is used, 'not in isolation but as part of a 
whole; in relation to the language of surrounding or closely-
related [regulations]'") (citing Williams v. Integrated Cmty. 
Servs., Inc., 2007 WI App 159, ¶12, 303 Wis. 2d 697, 736 N.W.2d 
No.  2020AP1582.rgb 
 
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226) (quoting Kalal, 271 Wis. 2d 633, ¶46).2  The majority 
opinion represents another failure to apply the whole-text canon 
correctly.  See, e.g., Zignego, 2021 WI 32, ¶52 (Rebecca Grassl 
Bradley, J., dissenting). 
¶79 The majority fails to read paragraph (b) in the 
context of paragraph (a).  It misconstrues the portion of 
paragraph (b) under which health care providers "may charge no 
more than the total of all of the following that apply for 
providing the copies requested."  Majority op., ¶22 (quoting 
Wis. Stat. § 146.83(3f)(b)).  The majority translates this 
language to mean "a health care provider may charge up to the 
rates prescribed in the statute for furnishing copies of paper 
records, microfiche or microfilm records, or x-rays."  Id.  
Because the majority "observe[s] that there is no provision in 
the text permitting the charge of fees for copies in formats for 
which the legislature did not expressly authorize a fee," it 
concludes Wis. Stat. § 146.83(3f) "does not permit charges for 
copies of electronic records[.]"  Id., ¶24 (emphasis added).  
The majority badly misreads the statute. 
¶80 Interpreting 
Wis. 
Stat. 
§ 146.83(3f) 
as 
an 
authorization of certain charges, the majority incorrectly 
concludes paragraph (b) applies to all requests for health care 
                                                 
2 The United States Supreme Court has espoused the same 
principle.  See Panama Ref. Co. v. Ryan, 293 U.S. 388, 439 
(1935) (Cardozo, J., dissenting) ("[T]he meaning of a statute is 
to be looked for, not in any single section, but in all the 
parts together and in their relation to the end in view"); Davis 
v. Michigan Dep't of Treasury, 489 U.S. 803, 809 (1989) 
("[S]tatutory language cannot be construed in a vacuum"). 
No.  2020AP1582.rgb 
 
7 
 
records, whatever the form.  As explained above, § 146.83(3f) 
does not authorize any activity; rather, it limits the amounts 
health care providers may charge for delivering only those 
records requested in the particular forms listed in paragraph 
(b).  Paragraph (b) regulates economic activity by capping fees 
for records requested in particular formats, and electronic 
records are not among them.  Because this statute does not apply 
to electronic health care records, the fees charged by health 
care 
providers 
for 
their 
provision 
have 
no 
limit 
under 
§ 146.83(3f).     
¶81 Because the majority "observe[s] that there is no 
provision in the text permitting the charge of fees for copies 
in formats for which the legislature did not expressly authorize 
a fee," it concludes Wis. Stat. § 146.83(3f) "does not permit 
charges for copies of electronic records[.]"  Majority op., 
¶¶22, 24.  The majority converts statutory silence into a 
statutory prohibition, at the expense of fundamental freedom.  
As amicus Wisconsin Civil Justice Council, Inc. put it, "[i]n a 
free society, private behavior is allowed unless prohibited by 
law.  Free people do not need the government's permission before 
engaging in private conduct."  Wis. Civ. Just. Council Br. at 6.   
II.  First Principles 
¶82 Liberty is not provided by government; liberty 
preexists government.  It is not a gift from the 
sovereign; it is our natural birthright. Fixed. 
Innate. Unalienable. 
Patel v. Texas Dep't of Licensing & Regul., 469 S.W.3d 69, 92–93 
(Tex. 2015) (Willet, J., concurring).  The Founders fought a 
No.  2020AP1582.rgb 
 
8 
 
revolution to reclaim the people's liberty, and established our 
republican form of government to secure this birthright freedom: 
We hold these truths to be self-evident, that all Men 
are created equal, that they are endowed by their 
Creator with certain unalienable Rights, that among 
these are Life, Liberty, and the Pursuit of Happiness—
That 
to 
secure 
these 
Rights, 
Governments 
are 
instituted among Men, deriving their just Powers from 
the Consent of the Governed. 
The Declaration of Independence para. 2 (U.S. 1776) (emphasis 
added).  The Wisconsin Constitution enshrines liberty in its 
very first provision:   
All people are born equally free and independent, and 
have certain inherent rights; among these are life, 
liberty and the pursuit of happiness; to secure these 
rights, governments are instituted, deriving their 
just powers from the consent of the governed. 
Wis. Const. art. I, § 1 (emphasis added).  "Too much dignity 
cannot well be given to that declaration."  State v. Redmon, 134 
Wis. 89, 101, 114 N.W. 137 (1907). "An inherent right to liberty 
means all people are born with it; the government does not 
bestow it upon us and it may not infringe it."  Porter v. State, 
2018 WI 79, ¶52, 382 Wis. 2d 697, 913 N.W.2d 842 (Rebecca Grassl 
Bradley & Kelly, JJ., dissenting). 
¶83 John Locke, whose works influenced the Framers, built 
his theories of government on the immutable principle that all 
"are born free," and therefore, "[a]ll government is limited in 
its powers and exists only by the consent of the governed."  
Robert A. Goldwin, John Locke in History of Political Philosophy 
476 (Leo Strauss & Joseph Cropsey, eds., 3d ed. 1987).  
The power a man has in the state of nature "of doing 
whatsoever he thought fit for the preservation of 
No.  2020AP1582.rgb 
 
9 
 
himself and the rest of mankind, he gives up," to a 
significant extent, "to be regulated by laws made by 
the society."   
McDonald v. City of Chicago, Ill., 561 U.S. 742, 892 (2010) 
(Stevens, J., dissenting) (quoting John Locke, Second Treatise 
of Civil Government § 129, 64 (J. Gough ed., 1947)) (emphasis 
added).  "Once a government is formed, however, it cannot be 
given 'a power to destroy that which every one designs to 
secure'; it cannot legitimately 'endeavour to take away, and 
destroy the property of the people,' or exercise 'an absolute 
power over [their] lives, liberties, and estates.'"  Carpenter 
v. United States, 585 U.S. __, 138 S. Ct. 2206, 2239 (2018) 
(Thomas, J., dissenting) (quoting Second Treatise of Civil 
Government § 222 (1690)).  If the legislature will restrict 
liberty, it must do so expressly, in written laws.  The 
government possesses no authority to bind the people with 
silence. 
¶84 The majority flips this first principle on its head, 
equating 
silence 
with 
prohibition, 
and 
implying 
we 
are 
restrained until made free.  The majority's extraordinary 
misunderstanding of basic founding principles is anathema to our 
republican form of government, under which the people consent to 
be governed by written law, not haunted by specters: 
The liberty of man, in society, is to be under no 
other legislative power, but that established, by 
consent, in the commonwealth; nor under the dominion 
of any will, or restraint of any law, but what that 
legislative shall enact, according to the trust put in 
it.  
John Locke, Two Treatises on Government 205 (J. Bumpus ed. 1821) 
(emphasis added). 
No.  2020AP1582.rgb 
 
10 
 
[A] system of laws, is alone calculated to maintain 
civil liberty, which leaves the subject entire master 
of his own conduct, except in those points wherein the 
public good requires some direction or restraint. 
1 W. Blackstone, Commentaries on the Laws of England, 121–122 
(1769) (emphasis added).  American liberty means the people may 
order their lives as they wish, subject only to the restraints 
imposed by written law enacted with the consent of the governed—
—through their elected legislative representatives: 
By liberty we mean the power, which a man has to act 
as he thinks fit, where no law restrains him; it may 
therefore be called a mans right over his own actions. 
1 T. Rutherforth, Institutes of Natural Law 146 (1754) (emphasis 
added).  The people consent to be governed by written law, but 
beyond those restraints they retain absolute freedom:   
[I]n Society, every Man parts with a Small Share of 
his natural Liberty, or lodges it in the publick 
Stock, that he may possess the Remainder without 
Controul. 
Boston Gazette and Country Journal, No. 58, May 10, 1756, p. 1 
(emphasis added). 
¶85 The majority transforms legislative silence into an 
unwritten, omnipresent restraint.  The logical extension of this 
remarkable misconception of democracy consigns the people into 
the servitude of their master——government——a regime overthrown 
in America nearly 250 years ago.  According to the majority, 
unless the master expressly gives the people permission to do 
something, they may not act.  This turns democracy upside down.  
It is tyranny.  
 
¶86 To the extent the legislature is silent, the people 
retain their inherent, unfettered freedom.  Wisconsin Stat. 
No.  2020AP1582.rgb 
 
11 
 
§ 146.83(3f) says nothing about charges for the provision of 
electronic health care records.  In the absence of state 
regulation of such fees, health care providers retain the 
freedom to charge whatever they see fit, subject to any limits 
imposed by federal law. 
III.  Statutory History 
¶87 The history of Wis. Stat. § 146.83(3f) reinforces this 
plain meaning analysis.  "Statutory history, which involves 
comparing the statute with its prior versions, may also be used 
as part of plain meaning analysis."  Brey v. State Farm Mut. 
Auto. Ins. Co., 2022 WI 7, ¶20, 400 Wis. 2d 417, 970 N.W.2d 1 
(internal quotation marks omitted) (quoting James v. Heinrich, 
2021 WI 58, ¶26, 397 Wis. 2d 516, 960 N.W.2d 350).  As the 
majority notes, the revisions made to § 146.83 (2009–10) in 2011 
are most relevant to resolving this dispute.  These revisions 
must be interpreted in light of the changes to federal law that 
occurred shortly before § 146.83 was amended.   
¶88 In 2009, two years before the legislature revised 
§ 146.83, 
the 
United 
States 
Congress 
passed 
the 
Health 
Information Technology for Economic and Clinical Health (HITECH) 
Act as part of the American Recovery and Reinvestment Act of 
2009 (ARRA), an omnibus stimulus bill ostensibly passed to allay 
the 
nation's 
financial 
crisis. 
 
American 
Recovery 
and 
Reinvestment Act of 2009, PL 11-5, 123 Stat. 115, 226 (Feb. 17, 
2009).  Taking effect in February 2010, the HITECH Act sought to 
promote 
a 
"nationwide 
health 
information 
technology 
No.  2020AP1582.rgb 
 
12 
 
infrastructure" allowing "for the electronic use and exchange of 
information[.]"  Id. at 230.   
¶89 Prior to the passage of the HITECH Act "many technical 
barriers still exist[ed]" preventing the widespread adoption of 
electronic health record systems.  Kalle Deyette, Hitech Act: 
Building an Infrastructure for Health Information Organizations 
and A New Health Care Delivery System, 8 St. Louis U.J. Health 
L. & Pol'y 375, 386 (2015).  Such systems were especially 
uncommon "within small practices" because no software "trusted 
by providers" and capable of "meeting [small practices'] needs" 
existed.  Id.  By and large, designers of electronic record 
systems "focused on the needs of large provider systems and did 
not address the needs of small, office-based practices."  Id. at 
387.  "In fact, some of the larger [electronic health records] 
systems, such as EPIC, [would] not license to small community 
hospitals, claiming these hospitals may not [have had] the 
resources to run the system properly."  Id.  This left small 
hospitals with only one option:  "contracting with larger 
hospitals to sublicense and facilitate its [electronic health 
record] system."  Id.  The problems extended beyond small 
practices.  Id.  Medium practices also "implemented expensive 
[electronic health records systems] that did not perform 
critical 
functions 
of 
their 
practice, such 
as 
clinical 
management, and did not address their patients' diverse needs, 
such as mental health issues."  Id.  Throughout the country, 
there was "an overall lack of knowledge, choice, and product 
variation in [electronic health records] systems, which [] left 
No.  2020AP1582.rgb 
 
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providers with expensive systems that [were] resource-intensive" 
and frequently incapable of fulfilling "the actual objectives of 
[electronic health records systems]."  Id. 
¶90 The HITECH Act allocated hundreds of millions of 
dollars 
"to 
support 
regional 
or 
sub-national 
efforts 
to 
implement" electronic "health information exchanges."  Id. at 
405 (2015).  The HITECH Act's ultimate goal was to enable "each 
person in the United States" to obtain accurate, private, and 
secure electronic health records.  123 Stat. 115 at 231.   
¶91 To effectuate that goal, Congress enacted mechanisms 
for individuals to obtain and review their health records 
directly.  123 Stat. 115 at 266, 268.  The HITECH Act provides: 
(e) 
ACCESS 
TO 
CERTAIN 
INFORMATION 
IN 
ELECTRONIC 
FORMAT.—In applying section 164.524 of title 45, 
Code of Federal Regulations, in the case that a 
covered entity uses or maintains an electronic 
health record with respect to protected health 
information of an individual[.] 
(1) 
[T]he individual shall have a right to obtain 
from 
such 
covered 
entity 
a 
copy 
of 
such 
information in an electronic format and, if the 
individual chooses, to direct the covered entity 
to transmit such copy directly to an entity or 
person designated by the individual, provided 
that any such choice is clear, conspicuous, and 
specific[.] 
42 U.S.C. § 17935(e)(1) (2012).  In addition to establishing the 
right to review an individual's health records, Congress capped 
allowable charges.  123 Stat 115, 268 (Feb. 17, 2009).  Under 
the HITECH Act, a health care provider may, when asked to 
provide electronic records, charge no more than its "labor costs 
in responding to the request":   
No.  2020AP1582.rgb 
 
14 
 
(3) 
[A]ny fee that the covered entity may impose for 
providing such individual with a copy of such 
information (or a summary or explanation of such 
information) 
if 
such 
copy 
(or 
summary 
or 
explanation) is in an electronic form shall not 
be greater than the entity's labor costs in 
responding to the request for the copy (or 
summary or explanation). 
42 U.S.C. § 17935(e)(3) (2012). 
¶92 Against 
this 
backdrop, 
the 
Wisconsin 
legislature 
revised Wis. Stat. § 146.83 in 2011.  For reference, below is a 
side-by-side comparison of the relevant provisions of § 146.83 
as they appeared both prior to and after the 2011 amendments.3  
On the left side is the (2009–10) version of the statute, and on 
the right are the changes the legislature made.  The struck 
through portions signify legislative deletions.  The underlined 
portions signify legislative additions.  All revisions made in 
2011 remain in effect.  
 
Wis. Stat. § 146.83(1h)(b)  
(2009–10) 
Wis. Stat. § 146.83(3f)(b) 
(2021–22) 
(b) 
 . . . [A] 
health 
care 
provider 
may 
charge 
no 
more than the total of all 
of 
the 
following 
that 
apply for providing copies 
requested under par. (a): 
 
1. 
For paper copies, 35 cents 
per page. 
(b) 
 . . . [A] 
health 
care 
provider 
may 
charge 
no 
more than the total of all 
of 
the 
following 
that 
apply for providing copies 
requested under par. (a):
 
 
1. 
For paper copies, 35 cents 
per page.: $1 per page for 
                                                 
3 The court of appeals provided a similar side-by-side 
representation of these changes, but its chart, at least as it 
appears on Westlaw, is inaccurate.  The statutory headings are 
flipped, but the statutory text is not, causing the table to 
show the (2019-20) version under the (2009–10) version, and 
vice-versa.  
No.  2020AP1582.rgb 
 
15 
 
 
 
 
 
 
 
 
 
2. 
For 
microfiche 
or 
microfilm 
copies, 
$1.25 
per page. 
 
3. 
For a print of an X-ray, 
$10 per image.  
 
3m. 
For providing copies in 
digital 
or 
electronic 
format, a charge for all 
copies requested. 
 
4. 
For 
certification 
of 
copies, $5. 
 
5. 
For 
processing 
and 
handling, 
a 
single 
$15 
charge 
for 
all 
copies 
requested. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
6. 
Actual shipping costs. 
 
7. 
If the requester requests 
delivery 
of 
the 
copies 
within 7 or fewer days 
after making a request for 
the first 25 pages; 75 
cents per page for pages 
26 to 50; 50 cents per 
page for pages 51 to 100; 
and 30 cents per page for 
pages 101 and above. 
 
 
2. 
For 
microfiche 
or 
microfilm 
copies, 
$1.25 
$1.50 per page. 
 
3. 
For a print of an X-ray, 
$10 per image.  
 
3m. 
For providing copies in 
digital 
or 
electronic 
format, a charge for all 
copies requested. 
 
4. 
For 
certification 
of 
copies, $5. 
 
5. 
For 
processing 
and 
handling, 
a 
single 
$15 
charge 
for 
all 
copies 
requested. 
 
4. 
If the requester is not 
the patient or a person 
authorized by the patient, 
for 
certification 
of 
copies, 
a 
single 
$8 
charge. 
 
5. 
If the requester is not 
the patient or a person 
authorized by the patient, 
a single retrieval fee of 
$20 
for 
all 
copies 
requested. 
 
6. 
Actual shipping costs. 
 
7. 
If the requester requests 
delivery 
of 
the 
copies 
within 7 or fewer days 
after making a request for 
copies, 
and 
the 
health 
No.  2020AP1582.rgb 
 
16 
 
copies, 
and 
the 
health 
care provider delivers the 
copies within that time, a 
fee equal to 10 percent of 
the total fees that may be 
charged under subds. 1. to 
6. 
 
care provider delivers the 
copies within that time, a 
fee equal to 10 percent of 
the total fees that may be 
charged under subds. 1. to 
6. 
¶93 The 2009–10 version of Wis. Stat. § 146.83 specified 
no cap on fees health care providers could charge for the 
provision of electronic records.  Originally, the legislature 
imposed a $5 cap on such charges in § 146.83(1h)(b)3m. (2009–
10).  Governor Jim Doyle, Veto Message § D.11, at 37 (June 29, 
2009) (responding to Assembly Bill 75 (2009)).  Using his line-
item veto power, then-Governor Doyle removed that cap from the 
statute.  Id.  The enacted law required health care providers to 
provide electronic records upon request but without any limit on 
the fees they could charge. 
¶94 As shown above, the legislature eventually removed 
subsection 3m. from Wis. Stat. § 146.83. Currently, the statute 
contains 
no 
reference 
to 
electronic 
health 
care 
records 
whatsoever.  The HITECH Act overrode Wisconsin's limitless fee 
provision, obviating the need to address charges for electronic 
health care records.  Removing the language regarding charges 
for such records from the statute eliminated any tension between 
Wisconsin law and federal law by conforming state statutes to 
the federal fee cap.  From this, the majority reads into the 
statute an implicit prohibition on charging for electronic 
health care records at all. 
¶95 Conspicuously missing from the majority opinion, as 
well as the court of appeals opinion, is any meaningful 
No.  2020AP1582.rgb 
 
17 
 
discussion of the context in which the 2011 legislative 
amendments occurred.  The majority scarcely mentions the HITECH 
Act at all.4  The majority's entire analysis rests on the absence 
of legislative "permission" for health care providers to charge 
for the provision of electronic health records.  Of course, the 
legislature hasn't given lawyers, plumbers, or electricians 
permission to charge for their services either, despite the 
existence of laws governing those trades.  It would be absurd to 
suggest any provider of services or goods must provide them for 
free, but the majority doesn't explain why it decrees that 
health care providers must do so.   
IV.  Conclusion 
 
 ¶96 Our system of ordered liberty under the rule of law 
has been analogized to the Sears Tower:5  although inside it 
people move freely, their movement is necessarily restrained by 
the building's structure——its walls, its floors, its elevators. 
See Randy Barnett, The Structure of Liberty: Justice and the 
Rule of Law 1–3 (1998).  The majority fills a statute's silence 
with a prohibition, surrounding economic actors——in this case, 
health care 
providers——with invisible restraints on their 
freedom.  The majority establishes a dangerous precedent that 
violates first principles and imperils liberty.  People who live 
                                                 
4 See Majority op., ¶28 n.11. 
5 "Sears Tower" refers to the 110 story skyscraper in 
Chicago now named Willis Tower.  The Making of an American Icon, 
Willis Tower, https://www.willistower.com/about (last visited 
March 11, 2023). 
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in freedom may not be transformed into mimes bound by invisible 
chains.  In the absence of written law, we are free.  Because 
the fee caps imposed in Wis. Stat. § 146.83(3f) do not encompass 
electronic health care records, health care providers are free 
to charge whatever they choose, subject only to federal law.  I 
respectfully dissent. 
 
¶97 I am authorized to state that Chief Justice ANNETTE 
KINGSLAND ZIEGLER and Justice PATIENCE DRAKE ROGGENSACK join 
this dissent. 
 
 
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