Title: Barney v. Mickelson

State: wisconsin

Issuer: Wisconsin Supreme Court

Document:

2020 WI 40 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2017AP1616 
 
 
 
COMPLETE TITLE: 
London Scott Barney, a minor, by David P. Lowe, 
his guardian ad litem and Raquel Barney, 
          Plaintiffs-Appellants, 
State of Wisconsin Department of Health and 
Family Services, 
          Involuntary-Plaintiff, 
United Health Care of Wisconsin, Inc., 
          Intervenor, 
     v. 
Julie Mickelson, MD, Columbia St. Mary's 
Hospital Milwaukee, Inc. and Injured Patients 
and Families Compensation Fund, 
          Defendants-Respondents-Petitioners. 
 
 
 
 
 
REVIEW OF DECISION OF THE COURT OF APPEALS 
Reported at 387 Wis. 2d 684,928 N.W.2d 799 
(2019 – unpublished) 
 
 
OPINION FILED: 
April 24, 2020   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
January 13, 2020   
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit    
 
COUNTY: 
Milwaukee   
 
JUDGE: 
Timothy M. Witkowiak   
 
 
 
JUSTICES: 
 
DALLET, J., delivered the majority opinion for a unanimous 
Court. 
NOT PARTICIPATING: 
        
 
 
 
ATTORNEYS: 
 
 
For the defendants-respondents-petitioners Julie Mickelson, 
M.D. and Columbia St. Mary’s Hospital Milwaukee, Inc., there were 
briefs filed by James R. Gutglass, Bradley S. Foley, Jason M. 
Prekop and Gutglass, Erickson, Larson & Schneider, S.C., 
Milwaukee. There was an oral argument by James R. Gutglass. 
 
 
2 
 
For the defendant-respondent-petitioner Injured Patients and 
Families Compensation Fund, there were briefs filed by Todd M. 
Weir, Jason J. Franckowiak and Otjen Law Firm, S.C., Waukesha. 
There was an oral argument by Todd M. Weir. 
 
For the plaintiffs-appellants London Scott Barney and Raquel 
Barney, there was a brief filed by Kent A. Tess-Mattner, Amy 
Hetzner and Schmidt, Rupke, Tess-Mattner & Fox, S.C., Brookfield.  
There was an oral argument by Jeffrey M. Goldberg. 
 
 
 
 
2020 WI 40 
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.   2017AP1616 
(L.C. No. 
15CV3042) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
London Scott Barney, a minor, by David P. Lowe, 
his guardian ad litem and Raquel Barney, 
 
          Plaintiffs-Appellants, 
  
State of Wisconsin Department of Health and 
Family Services, 
 
          Involuntary-Plaintiff, 
 
United Health Care of Wisconsin, Inc., 
 
          Intervenor, 
 
     v. 
 
Julie Mickelson, MD, Columbia St. Mary's 
Hospital Milwaukee, Inc. and Injured Patients 
and Families Compensation Fund, 
 
          Defendants-Respondents-Petitioners. 
FILED 
 
APR 24, 2020 
 
Sheila T. Reiff 
Clerk of Supreme Court 
 
 
 
 
DALLET, J., delivered the majority opinion for a unanimous Court. 
 
 
REVIEW of a decision of the Court of Appeals.  Reversed.   
 
¶1 
REBECCA FRANK DALLET, J.   This case centers on whether, 
based on the evidence introduced at trial, a circuit court properly 
No. 
2017AP1616   
 
2 
 
instructed a jury on the "alternative methods" paragraph of Wis 
JI——Civil 1023 (2019) (the "alternative methods instruction"). 
¶2 
London Barney was born with severe and permanent 
neurologic injuries.  London and his mother, Raquel Barney, filed 
a medical malpractice action alleging that Dr. Julie Mickelson, 
M.D., was negligent for failing to accurately trace London's fetal 
heart rate during Mrs. Barney's labor.  The Barneys alleged that 
without an accurate tracing of London's heart rate, Dr. Mickelson 
did not recognize signs that London's oxygenation status was 
depleting. 
¶3 
Over the Barneys' objection, the circuit court read the 
jury the alternative methods instruction.  This instruction 
generally informed the jury that Dr. Mickelson was not negligent 
if she used reasonable care, skill, and judgment in administering 
any one of the recognized reasonable treatment methods for 
monitoring London's heart rate.  The jury found Dr. Mickelson not 
negligent in her care and treatment of the Barneys.1  The court of 
appeals reversed the judgment dismissing the Barneys' medical 
malpractice action and remanded the case for a new trial.2 
¶4 
We conclude that based on all of the expert testimony 
introduced at trial, the jury was properly given the alternative 
methods instruction in this case.  Therefore, we reverse the court 
of appeals and uphold the jury verdict. 
                                                 
1 The Honorable Timothy Witkowiak of the Milwaukee County 
Circuit Court presided. 
2 Barney v. Mickelson, No. 2017AP1616, unpublished slip op., 
¶18 (Wis. Ct. App. Apr. 16, 2019). 
No. 
2017AP1616   
 
3 
 
I.  FACTUAL BACKGROUND AND PROCEDURAL POSTURE 
¶5 
Mrs. Barney was admitted to Columbia St. Mary's Hospital 
in Milwaukee on February 15, 2012, to induce labor and deliver her 
son, London.  Throughout Mrs. Barney's labor, Dr. Mickelson and 
the care team utilized an external monitor, attached to Mrs. 
Barney's abdomen, to record and report London's heart rate.3  Dr. 
Mickelson delivered London on February 16, 2012.  London was born 
blue, nonresponsive, and exhibited limited muscle movements.  
London was resuscitated, but sustained permanent and severe 
neurologic injuries. 
¶6 
The Barneys filed a medical malpractice suit against Dr. 
Mickelson, Columbia St. Mary's Hospital, and the Injured Patients 
and Families Compensation Fund (collectively, the Defendants), 
alleging that Dr. Mickelson and her staff failed to recognize and 
properly respond to signs of fetal oxygen deprivation, and that 
this failure caused London to suffer severe and permanent 
neurologic injuries.  The case proceeded to a three-week jury trial 
that included the testimony of 16 expert witnesses. 
                                                 
3 There is no dispute about what an external monitor does.  
However, we provide some background for the benefit of the reader.  
An external monitor is a device to listen to and record a fetal 
heart 
rate 
through 
the 
mother's 
abdomen. 
 
See 
https://www.hopkinsmedicine.org/health/treatment-tests-and-
therapies/fetal-heart-monitoring.  The rate and pattern of the 
baby's heart rate is shown on a screen and printed on paper on 
"external monitor strips."  Id. 
No. 
2017AP1616   
 
4 
 
¶7 
As relevant to this appeal,4 the Barneys maintained that 
90 minutes prior to delivery, at the critical pushing stage, Dr. 
Mickelson was negligent in failing to switch to a more accurate 
method of monitoring London's heart rate, which would have revealed 
London's lack of adequate oxygenation.5  The Barneys' standard of 
care expert, Dr. Bruce Bryan, testified that the external monitor 
was not accurately tracing London's heart rate 90 minutes prior to 
delivery, and therefore Dr. Mickelson should have switched to a 
pulse oximeter or a fetal scalp electrode to trace the fetal heart 
rate.6 
¶8 
Dr. Mickelson testified that she believed that the 
external monitor was accurately tracing London's heart rate.  Dr. 
Mickelson's two standard of care experts, Dr. Dennis Worthington 
and Dr. Sean Blackwell, opined that the external monitor was 
                                                 
4 Although a total of 16 experts testified at trial, the issue 
raised in this appeal involves the testimony of the three standard 
of care experts and Dr. Mickelson. 
5 The parties do not dispute that information about the rate 
and pattern of the fetal heart rate during labor helps the care 
team to assess fetal well-being and oxygenation levels. 
6 As background for the reader:  a pulse oximeter is "[a] 
clip-like device called a probe [that] is placed on a body part, 
such as a finger or ear lobe.  The probe uses light to measure how 
much 
oxygen 
is 
in 
the 
blood."  
https://www.hopkinsmedicine.org/health/treatment-tests-and-
therapies/pulse-oximetry. 
A fetal scalp electrode is a "wire electrode [that] is 
attached to the fetal scalp or other body part through the cervical 
opening 
and 
is 
connected 
to 
[a] 
monitor."  
https://www.urmc.rochester.edu/encyclopedia/content.aspx?content
typeid=92&contentid=P07776. 
No. 
2017AP1616   
 
5 
 
accurately monitoring London's heart rate, and that it was 
reasonable for Dr. Mickelson to continue using the external monitor 
throughout the delivery, rather than switching to a pulse oximeter 
or fetal scalp electrode. 
¶9 
Prior to trial, and again at the jury instruction 
conference, the Defendants requested that the circuit court give 
the alternative methods instruction, which reads: 
If you find from the evidence that more than one method 
of (treatment for) (diagnosing) (plaintiff)'s (injuries) 
(condition) was recognized as reasonable given the state 
of medical knowledge at that time, then (doctor) was at 
liberty to select any of the recognized methods.  
(Doctor) was not negligent because (he) (she) chose to 
use one of these recognized (treatment) (diagnostic) 
methods rather than another recognized method if (he) 
(she) used reasonable care, skill, and judgment in 
administering the method. 
Wis JI——Civil 1023.7  The Defendants argued that the instruction 
was warranted based on testimony that the continued use of the 
external monitor was recognized as a reasonable method of 
treatment.  The Barneys objected to the instruction, arguing that 
Dr. Mickelson's continued reliance on the external monitor, as 
opposed to switching to the pulse oximeter or fetal scalp 
electrode, was effectively "doing nothing," which was not an 
alternative method. 
¶10 The circuit court agreed with the Defendants and gave 
the jury the following alternative methods instruction: 
                                                 
7 The alternative 
methods instruction is an optional 
paragraph 
contained in the medical malpractice jury instruction, Wis JI——
Civil 1023. 
No. 
2017AP1616   
 
6 
 
If you find from the evidence that more than one method 
of 
treatment 
for 
Raquel 
Barney's 
condition 
was 
recognized as reasonable in the state of medical 
knowledge at the time, then Dr. Mickelson was at liberty 
to select any of the recognized methods.  Dr. Mickelson 
was not negligent because she chose to use one of these 
recognized 
treatment 
methods 
rather 
than 
another 
recognized treatment method if she used reasonable care, 
skill, and judgment in administering the method. 
The jury, with two jurors dissenting, found Dr. Mickelson not 
negligent in her care and treatment of the Barneys.8 
¶11 The Barneys filed a motion after verdict for a new trial 
pursuant to Wis. Stat. § 805.15(1) (2017-18)9 on the basis that 
the circuit court erroneously gave the alternative methods 
instruction.  The Barneys asserted that the instruction misled the 
jury because Dr. Mickelson did not actually employ one of the 
alternative methods of treatment.  The circuit court denied the 
motion. 
¶12 The court of appeals, relying on Miller v. Kim, 191 
Wis. 2d 187, 528 N.W.2d 72 (Ct. App. 1995), concluded that 
Dr. Mickelson's continued reliance on the external monitor was 
"not an acceptable 'alternative diagnostic technique'" and her 
failure to switch to a pulse oximeter or fetal scalp electrode 
was, instead, a decision to "do nothing."  Barney v. Mickelson, 
No. 2017AP1616, unpublished slip op., ¶19 (Wis. Ct. App. Apr. 16, 
2019).  Since the alternative methods instruction "likely misled 
                                                 
8 The jury also found that Dr. Mickelson was not negligent 
with respect to her informed consent obligations.  That issue is 
not before us on appeal. 
9 All subsequent references to the Wisconsin Statutes are to 
the 2017-18 version unless otherwise indicated. 
No. 
2017AP1616   
 
7 
 
the jury," the court of appeals remanded the case for a new trial.  
Id., ¶¶19-20. 
¶13 The Defendants petitioned this court for review, which 
we granted. 
II.  STANDARD OF REVIEW 
¶14 It is well established that a circuit court has broad 
discretion when instructing a jury.  See, e.g., White v. Leeder, 
149 Wis. 2d 948, 954, 440 N.W.2d 557 (1989).  We review the jury 
instructions to determine whether, as a whole, they adequately and 
properly communicated to the jury a correct statement of the law.  
See Nowatske v. Osterloh, 198 Wis. 2d 419, 428-29, 543 N.W.2d 265 
(1996), abrogated on other grounds by Nommensen v. Am. Cont'l Ins. 
Co., 2001 WI 112, 246 Wis. 2d 132, 629 N.W.2d 301.  If a jury 
instruction is determined to be erroneous, we reverse and remand 
for a new trial only if the error was prejudicial.  See Kochanski 
v. Speedway SuperAmerica, LLC, 2014 WI 72, ¶11, 356 Wis. 2d 1, 850 
N.W.2d 160.  "An error is prejudicial when it probably misled the 
jury."  Id. 
III.  ANALYSIS 
¶15 This court has upheld substantially the same alternative 
methods instruction as a correct statement of the law.  Nowatske, 
198 Wis. 2d at 446-49.  The opening sentence of the instruction 
"insures that it is for the jury, exercising its role as fact-
finder, to determine whether there is more than one method of 
treatment as well as whether the treatment method chosen is among 
No. 
2017AP1616   
 
8 
 
those methods recognized as acceptable."  Id. at 447.10  The 
instruction is optional and to be given "only when the evidence 
allows the jury to find that more than one method of diagnosis or 
treatment 
of 
the 
patient 
is 
recognized 
by 
the 
average 
practitioner."  Finley v. Culligan, 201 Wis. 2d 611, 622, 548 
N.W.2d 854 (Ct. App. 1996) (citing Miller, 191 Wis. 2d at 198). 
¶16 In Miller, the court of appeals recognized that the 
alternative methods instruction is inappropriate in cases where 
the alleged negligence "lies in failing to do something, not in 
negligently choosing between courses of action."  191 Wis. 2d at 
198 n.5.  Our task is to determine whether the alternative methods 
instruction was erroneously given to the jury based on the record 
in this case and in light of Miller. 
¶17 We first review the trial testimony of Dr. Mickelson and 
the parties' standard of care experts——Dr. Bryan, Dr. Worthington, 
                                                 
10 Nowatske v. Osterloh, 198 Wis. 2d 419, 543 N.W.2d 265 
(1996), abrogated on other grounds by Nommensen v. American 
Continental Insurance Co., 2001 WI 112, 246 Wis. 2d 132, 629 
N.W.2d 301, primarily dealt with the final sentence of the 
alternative methods instruction, which was subsequently removed.  
The Nowatske court reasoned that the instruction would be clearer 
if: 
its final sentence were eliminated or if the paragraph 
stated explicitly that the jury alone determines which 
methods of treatment are "recognized" on the basis of 
the expert testimony in evidence.  But these suggested 
revisions do not alter our conclusion that the third 
paragraph adequately instructed the jury regarding its 
prerogative to assess and weigh the evidence before it 
in reaching a verdict. 
Id. at 448-49. 
No. 
2017AP1616   
 
9 
 
and Dr. Blackwell——to ascertain the reasonable methods of 
treatment available to monitor London's heart rate.  We then 
consider whether the court of appeals correctly relied upon Miller 
to conclude that Dr. Mickelson in fact "did nothing," rendering 
the alternative methods instruction inappropriate. 
A. The Contested Expert Testimony at Trial 
¶18 The Barneys' case depends upon the conclusion that 
Dr. Mickelson's continued use of an external monitor was not among 
the reasonable alternative methods of treatment to continuously 
and accurately measure London's heart rate.  A review of the record 
shows that the parties' experts disputed whether the external 
monitor was continuously and accurately measuring London's heart 
rate in the last 90 minutes of labor and, consequently, whether 
Dr. Mickelson's use of the external monitor continued to be a 
reasonable alternative method. 
¶19 The experts disputed the extent to which, in the last 90 
minutes of labor, the external monitor missed London's heart rate 
or traced Mrs. Barney's heart rate instead.  Dr. Blackwell, one of 
Dr. Mickelson's experts, testified that "[m]y interpretation is 
the bulk of the continuous tracing is fetal," meaning the external 
monitor was predominantly monitoring London's heart rate.  While 
Dr. Blackwell admitted that "it is a known phenomenon that a 
monitor can misinterpret a fetal heart and a maternal heart 
sometimes," he testified: 
I don't believe that it happened here.  As I continuously 
watch the tracing, as we saw, we've seen hours and hours 
of tracing, a baby's heart rate like our heart rate 
changes quite a bit based on what's going on.  I just 
No. 
2017AP1616   
 
10 
 
don't see those - - I don't over-interpret some of those 
isolated findings.  You have to look at the overall 
continuous pattern. 
¶20 Additionally, in responding to the contention that for 
substantial periods of time the fetal heart rate was being missed 
and instead the maternal heart rate was being traced, Dr. Blackwell 
said the following: 
[Defense 
counsel]: 
 
Was 
there 
any 
reasonable 
possibility, in your opinion, that for substantial 
periods of time the real fetal tracing was being missed 
and maternal was being traced, and you were missing the 
status of this fetus during this labor? 
[Dr. Blackwell]:  Other than the period of the epidural, 
I'd say no.[11] 
In Dr. Blackwell's view, when all of the external monitor strips 
were read together, and in context, there was nothing to suggest 
that London's heart rate was being missed. 
¶21 Dr. Worthington, another one of Dr. Mickelson's experts, 
testified that it was fairly easy to distinguish the fetal heart 
rate from the maternal heart rate on the external monitor strips.12  
Dr. Mickelson herself testified that she "could rule out that the 
entire tracing was the maternal" and that she was "confident that 
                                                 
11 The epidural was given to Mrs. Barney 12 hours prior to 
London's delivery. 
12 The Barneys assert that Dr. Worthington's deposition 
testimony was different than his trial testimony in regard to 
whether the tracings on the external monitor were fetal or 
maternal.  However, this inconsistency was raised at trial and we 
defer to a jury's credibility determinations.  See Meurer v. ITT 
Gen. Controls, 90 Wis. 2d 438, 450, 280 N.W.2d 156 (1979) ("The 
credibility of witnesses and the weight given to their testimony 
are left to the judgment of the jury . . . ."). 
No. 
2017AP1616   
 
11 
 
the majority of the tracing except for a few small spots was the 
baby . . . ." 
¶22 The Barneys' expert, Dr. Bryan, was the only expert to 
testify that there was a concerning "discontinuity" in the tracings 
by the external monitor and indications that the monitor was 
tracing the maternal heart rate rather than the fetal heart rate, 
which should have prompted action by Dr. Mickelson.13  Dr. Bryan 
testified that, starting in the morning on February 16th, there 
was discontinuity in the external monitor readings, which meant 
that Dr. Mickelson could not accurately assess fetal well-being.  
However, he admitted that the failure to switch to an alternative 
earlier in the day did not cause London any harm and that the 
previous fetal tracings had been "decent."14  He ultimately opined 
                                                 
13 It was undisputed at trial that there were periods of time 
where the external monitor showed discontinuity.  All of the 
experts agreed that this was not automatically concerning, as it 
was common to see this discontinuity or "drop out" during maternal 
movement or repositioning.  Dr. Bryan testified as follows: 
[Defense counsel]:  So you agree that every time there's a 
difficult read or a sketchy tracing, the standard of care 
does not require putting in an internal scalp electrode, true? 
[Dr. Bryan]:  That's correct. 
14 Dr. Bryan was asked the following questions: 
[Defense counsel]:  The fact that there was no fetal 
scalp electrode on through 17:21, 5:21 for us civilians, 
did not cause any harm, true? 
[Dr. Bryan]:  True. 
[Defense counsel]:  And we even extended it further at 
your deposition, did we not? 
[Dr. Bryan]:  Yes. 
No. 
2017AP1616   
 
12 
 
that, at the very least, Dr. Mickelson missed signs of fetal 
distress by not having an accurate fetal heart rate reading in the 
90 minutes prior to London's delivery. 
¶23 The experts further disputed whether, in the last 90 
minutes of labor, Dr. Mickelson's continued use of the external 
monitor to measure London's heart rate was a reasonable alternative 
method to the use of a pulse oximeter or fetal scalp electrode to 
monitor fetal heart rate.  Dr. Bryan was the only expert to testify 
that since the external monitor was not accurately tracing London's 
heart rate, Dr. Mickelson had to switch to one of two methods to 
more accurately monitor the fetal heart rate and fetal well-being:  
a pulse oximeter or a fetal scalp electrode. 
¶24 Dr. Mickelson's experts did not dispute that the pulse 
oximeter and fetal scalp electrode were reasonable alternatives to 
monitor fetal heart rate.15  However, they testified that those 
alternatives were not necessary in this case because continuing 
                                                 
[Defense counsel]:  You said that the baby was fine, and 
you've said that today through 18:10 or 6:10 . . . . 
[Dr. Bryan]:  I remember that.  That's what I said. 
[Defense counsel]:  Okay.  So as of 18:10 or 6:10, the 
fact that a fetal scalp electrode had not been placed 
did not cause any harm, true? 
[Dr. Bryan]:  True. 
 
15 Dr. Blackwell and Dr. Mickelson both voiced concern that 
Mrs. Barney's infection could have spread to London if a fetal 
scalp electrode had been attached. 
No. 
2017AP1616   
 
13 
 
with an external monitor was a reasonable alternative that fell 
within the standard of care.  Dr. Worthington testified: 
[Defense counsel]:  Let me ask you this, if you have 
brief switches from fetal to maternal or drop-out due to 
position change, is it required by the standard of care 
to switch your monitoring of an infected mother to the 
invasive scalp electrode from what had been working with 
the external monitor? 
[Dr. Worthington]:  I think if you feel comfortable with 
your recording and can interpret the fetal heart rate, 
there's no reason to switch. 
¶25 Dr. Blackwell similarly testified that "the most common 
and the most reasonable thing, if your tracings have been good 
before then, is to continue to watch the tracing" and that it was 
"very reasonable to continue to follow and watch" in this case.  
He further testified on this point: 
[Plaintiff's counsel]:  Am I correct, Doctor, that all 
they had to do to confirm whether they were really 
watching London or watching [Mrs. Barney] was take [Mrs. 
Barney's] pulse during a contraction and see how that 
compared to the rate -- the rate that's being traced.  
That is one way, correct? 
[Dr. Blackwell]:  That is one way.  There are other ways.  
That is one way. 
[Plaintiff's counsel]:  And the other way is to put on 
a pulse oximeter? 
[Dr. Blackwell]:  That is another way, and another way 
is to watch the continuous fetal heart rate tracing. 
[Plaintiff's counsel]:  No, Doctor.  Watching it 
continuously may not tell you whether you're really 
watching mom or watching baby, correct? 
No. 
2017AP1616   
 
14 
 
[Dr. Blackwell]:  I believe that it did, and I believe 
it can, and I believe it's within the standard of 
care.[16] 
¶26 Dr. Worthington also answered a question that precisely 
tracked the language in the alternative methods instruction: 
[Defense counsel]:  One final question.  Was utilizing 
an external monitor a recognized alternative method to 
monitor this fetus? 
[Dr. Worthington]:  Yes. 
[Defense counsel]:  And in administrating and applying 
that method of the external monitor, did Dr. Mickelson 
use 
reasonable 
care, 
skill, 
and 
judgment 
in 
administering that method? 
[Dr. Worthington]:  Yes. 
¶27 The trial testimony demonstrates that the experts 
disputed whether the external monitor was continuously and 
accurately tracing London's heart rate.  Further, there was a 
dispute about whether continuing with the external monitor in the 
last 90 minutes of Mrs. Barney's labor was a reasonable alternative 
to a pulse oximeter or a fetal scalp electrode.  Since there was 
substantial testimony that Dr. Mickelson's continued use of the 
external monitor was a reasonable method to continue to assess 
London's heart rate and was within the standard of care, the 
alternative methods instruction was properly given by the circuit 
court in this case. 
B. Miller v. Kim  
                                                 
16 In addition, Dr. Blackwell testified that the placement of 
a scalp electrode, the Barneys' other proffered alternative, was 
not necessary in order to meet the standard of care. 
No. 
2017AP1616   
 
15 
 
¶28 Both the court of appeals and the Barneys maintain that 
Dr. Mickelson's decision to continue with the external monitor was 
a decision to "do nothing" that rendered the alternative methods 
instruction improper, pursuant to the court of appeals' decision 
in Miller.  In Miller, a jury found that a doctor was not negligent 
in his failure to perform a spinal tap on an infant who 
subsequently suffered permanent brain damage from undiagnosed 
meningitis.  191 Wis. 2d 187.  The Millers contended that the 
circuit court committed prejudicial error when it gave the 
alternative methods instruction because all of the experts 
testified that a spinal tap is the only reasonable method of 
diagnosis for a young child with symptoms of spinal meningitis.  
Id. at 191. 
¶29 The court of appeals concluded that the circuit court 
erred when it gave the alternative methods instruction because the 
doctor's 
claim 
that 
"individualized 
observation" 
was 
"an 
alternative diagnostic technique" did not conform with the 
unanimous expert testimony presented at trial.  Id.  The court 
reasoned: 
[t]he "alternative method" instruction is optional and 
is only to be given by the trial court when the evidence 
allows the jury to find that more than one method of 
treatment of the patient is recognized by the average 
practitioner.  The trial court's amendment of the 
pattern instruction would have been appropriate had 
there been medical expert testimony that there were 
available to the average practitioner alternative 
methods of diagnosing [the child's] spinal meningitis. 
No. 
2017AP1616   
 
16 
 
Id. at 198.  Because the alternative methods instruction probably 
misled the jury, the court remanded the case for a new trial.  Id. 
at 190. 
¶30 To fit this case into the Miller framework, the court of 
appeals ignored the testimony of Dr. Mickelson's experts as to 
alternative methods.17  The court focused solely on Dr. Bryan's 
testimony and reasoned that since "there were signs that the 
external fetal monitor may not have been reliably tracing the fetal 
heart beat," Dr. Mickelson's "continued reliance on the external 
fetal monitor, was not an acceptable 'alternative diagnostic 
technique.'"  Barney, No. 2017AP1616, ¶19 (quoted source omitted). 
¶31 However, as discussed above, the experts in this case 
disputed whether the external monitor failed to accurately monitor 
London's heart rate in the last 90 minutes of labor.  Unlike 
Miller, where the experts were unanimous that only one diagnostic 
method existed, this record contained substantial expert testimony 
                                                 
17 Dr. Mickelson asks us to overrule Miller v. Kim, 191 
Wis. 2d 187, 528 N.W.2d 72 (Ct. App. 1995), because "its analysis 
and reasoning allows Courts to engage in critical fact finding 
that should be left to the jury."  On several occasions, Wisconsin 
courts have reviewed the applicability of the alternative methods 
instruction and a plaintiff's assertion that their case was akin 
to Miller.  See, e.g., Weborg v. Jenny, No. 2010AP258, unpublished 
slip op., ¶20 ("However, here, unlike Miller, there was evidence 
of alternatives."); Finley v. Culligan, 201 Wis. 2d 611, 625-26, 
548 N.W.2d 854 (Ct. App. 1996) ("Thus, this case is not like Miller 
because this is not a case where all of the experts, including the 
defense experts, testified at some point that performing a biopsy 
was the only way to definitively diagnose a solid tumor as being 
cancerous."). 
 
Similarly, 
the 
facts 
in 
this 
case 
are 
distinguishable from Miller and therefore, overruling Miller is 
unwarranted and unnecessary. 
No. 
2017AP1616   
 
17 
 
on which the jury could find that Dr. Mickelson's choice to 
continue with the external monitor was a reasonable alternative 
method of monitoring London's heart rate and was not analogous to 
"doing nothing."  Therefore, we conclude that there is ample 
evidence in this record to support the circuit court's decision to 
give the alternative methods instruction.  See Lutz v. Shelby Mut. 
Ins. Co., 70 Wis. 2d 743, 750, 235 N.W.2d 426 (1975) ("It is error 
for a court [] to refuse to instruct on an issue which is raised 
by the evidence . . . ."); see also Aetna Cas. & Sur. Co. v. 
Osborne-McMillan Elevator Co., 26 Wis. 2d 292, 305, 132 N.W.2d 51 
(1965) ("Where there is a conflict in the evidence and inconsistent 
theories on the cause of the event are advanced, we believe 
instructions encompassing both theories should be given."). 
¶32 It is important to remember that "[i]t is the function 
of the trier of fact, and not of an appellate court, to fairly 
resolve conflicts in the testimony, to weigh the evidence, and to 
draw reasonable inferences from basic facts to ultimate facts."  
State v. Poellinger, 153 Wis. 2d 493, 506, 451 N.W.2d 752 (1990) 
(citing Jackson v. Virginia, 443 U.S. 307, 319 (1979)).  Any 
dispute in testimony regarding the complex medical issues in this 
case was for the jury, not the court of appeals or this court, to 
weigh and ultimately resolve.  Based on all of the expert testimony 
presented at trial, the circuit court properly gave the jury the 
alternative methods instruction. 
IV.  CONCLUSION 
¶33 We conclude that the jury was properly given the 
alternative methods instruction in this case based on the expert 
No. 
2017AP1616   
 
18 
 
testimony introduced at trial.  Therefore, we reverse the court of 
appeals decision and reinstate the judgment dismissing the 
Barneys' claim against the Defendants. 
By the Court.— The decision of the court of appeals is 
reversed. 
 
No. 
2017AP1616   
 
 
 
1