Title: State v. Kozel
Citation: N/A
Docket Number: 2015AP000656-CR
State: Wisconsin
Issuer: Wisconsin Supreme Court
Date: January 12, 2017

2017 WI 3 
 
 
Supreme Court of Wisconsin
 
 
 
CASE NO.: 
2015AP656-CR 
COMPLETE TITLE: 
State of Wisconsin, 
          Plaintiff-Respondent-Petitioner, 
     v. 
Patrick K. Kozel, 
          Defendant-Appellant. 
 
 
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
 
 
OPINION FILED: 
January 12, 2017 
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
October 18, 2016 
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit 
 
COUNTY: 
Sauk 
 
JUDGE: 
Guy D. Reynolds 
 
 
 
JUSTICES: 
 
 
CONCURRED: 
      
 
DISSENTED: 
BRADLEY, A. W., J. dissents, joined by 
ABRAHAMSON, J. (Opinion filed).  
 
 
NOT PARTICIPATING:          
 
 
 
ATTORNEYS: 
 
 
For 
the 
plaintiff-respondent-petitioner 
the 
cause 
was 
argued by Michael C. Sanders, assistant attorney general, with 
whom on the brief was Brad D. Schimel, attorney general. 
 
For the defendant-appellant, there was a brief by Tracey A. 
Wood, Sarah Schmeiser and Tracey Wood and Associates, Madison, 
and 
oral 
argument 
by 
Tracey 
A. 
Wood.
 
 
2017 WI 3
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.   2015AP656-CR 
(L.C. No. 
2013CT499) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
State of Wisconsin, 
 
          Plaintiff-Respondent-Petitioner, 
 
     v. 
 
Patrick K. Kozel, 
 
          Defendant-Appellant. 
FILED 
 
JAN 12, 2017 
 
Diane M. Fremgen 
Clerk of Supreme Court 
 
 
 
 
REVIEW of a decision of the Court of Appeals.  Reversed.   
 
¶1 
ANNETTE KINGSLAND ZIEGLER, J.   This is a review of an 
unpublished decision of the court of appeals, State v. Kozel, 
No. 2015AP656-CR, unpublished slip op. (Wis. Ct. App. Nov. 12, 
2015), which reversed the Sauk County circuit court's1 judgment 
of conviction of defendant Patrick K. Kozel ("Kozel") and 
remanded the case to the circuit court to suppress evidence of 
drunk driving obtained from a sample of Kozel's blood.  Kozel, 
unpublished slip op., ¶1. 
                                                 
1 The Honorable Guy D. Reynolds presided. 
No. 
2015AP656-CR   
 
2 
 
¶2 
After being arrested for drunk driving, Kozel was 
taken to the Sauk County jail where he agreed to have his blood 
drawn.  In a clean room at the jail, an emergency medical 
technician ("EMT") trained in drawing blood and acting at the 
request of law enforcement used a new blood draw kit containing 
a sterile needle to take samples of Kozel's blood.  The EMT was 
authorized in writing by a physician to draw blood when asked to 
do so by law enforcement.  Kozel argues that the results of 
testing of his blood must be suppressed because the EMT who drew 
Kozel's blood was not a "person acting under the direction of a 
physician" as required by statute, Wis. Stat. § 343.305(5)(b) 
(2011-12),2 
and 
because 
the 
blood 
draw 
was 
taken 
in 
a 
constitutionally unreasonable manner under the Fourth Amendment 
to the United States Constitution and Article I, Section 11 of 
the Wisconsin Constitution. 
¶3 
We conclude that the EMT who drew Kozel's blood was a 
"person acting under the direction of a physician," Wis. Stat. 
§ 343.305(5)(b), 
and 
that 
Kozel's 
blood 
was 
drawn 
in 
a 
constitutionally reasonable manner.  Accordingly, we reverse the 
decision of the court of appeals. 
I.  FACTUAL BACKGROUND 
¶4 
On August 20, 2013, at about 2:10 a.m., while "sitting 
stationary" at the Greenfield Town Hall in Sauk County, 
Wisconsin, Deputy Brian Slough ("Deputy Schlough") of the Sauk 
                                                 
2 All subsequent references to the Wisconsin Statutes are to 
the 2011-12 version unless otherwise indicated. 
No. 
2015AP656-CR   
 
3 
 
County sheriff's department allegedly observed a vehicle make a 
wide right turn onto Bluff Road.  Deputy Schlough began 
following the vehicle.  Bluff Road is a relatively "narrow," 
"hilly" roadway "with several curves," and there are no lane 
markers on the road.  According to Deputy Schlough, the ditches 
on either side of the road are "very steep" at certain locations 
and "a creek . . . runs along the road" at various points, so 
the road is somewhat dangerous.  According to Deputy Schlough's 
testimony, the vehicle Deputy Schlough was following drove 
across the road and almost into the ditch on the east side of 
the road, and more than once the vehicle drove into the ditch on 
the west side of the road.  After following the vehicle for 
about half of a mile, Deputy Schlough stopped the vehicle and 
spoke with its driver, Kozel. 
¶5 
Kozel "had difficulty retrieving" his driver's license 
from his wallet, and Deputy Schlough eventually obtained the 
license for him.  Deputy Schlough noticed that Kozel had 
"bloodshot, glassy" eyes and the deputy smelled "a strong odor 
of intoxicants coming from the vehicle."  Kozel's speech was 
slurred.  Upon questioning, Kozel informed Deputy Schlough that 
he was traveling from Black River Falls and that he had consumed 
two beers.  Deputy Schlough returned to his vehicle whereupon he 
learned that Kozel had a prior conviction for operating while 
intoxicated.  Deputy Schlough decided to have Kozel perform 
field sobriety tests and went back to Kozel's vehicle.  
¶6 
Deputy Schlough asked Kozel to exit his vehicle and 
once again asked him "how much he had to drink and where he was 
No. 
2015AP656-CR   
 
4 
 
coming from."  This time, Kozel replied that "he was coming from 
a friend's house in Baraboo and that he had three 12-ounce cans 
of Budweiser."  Deputy Schlough asked Kozel if he had any 
physical or medical problems, and Kozel stated that he did not.  
Kozel did not perform well on the field sobriety tests.  Deputy 
Schlough then administered a preliminary breath test; Kozel blew 
a 0.17, that is, the preliminary breath test results were well 
in excess of the 0.08 legal limit.  See Wis. Stat. § 340.01(46m) 
(2013-14).  Deputy Schlough placed Kozel in handcuffs and under 
arrest.  Kozel was then taken to the Sauk County jail. 
¶7 
At the jail, Kozel agreed to have his blood drawn.  At 
3:20 a.m., Matthew Goethel ("Goethel"), an EMT employed by 
Baraboo District Ambulance Service ("BDAS"), conducted the blood 
draw, 
obtaining 
two 
specimens. 
 
Testing 
by 
the 
Medical 
Toxicology Section of the Wisconsin State Laboratory of Hygiene 
showed a blood ethanol level of 0.196, again, well in excess of 
the legal limit of 0.08.  See Wis. Stat. § 340.01(46m) (2013-
14). 
II.  PROCEDURAL BACKGROUND 
¶8 
On October 7, 2013, a criminal complaint was filed 
against Kozel in Sauk County circuit court charging him with one 
count of operating a motor vehicle while intoxicated, contrary 
to Wis. Stat. § 346.63(1)(a) (2013-14), second offense, see Wis. 
Stat. § 346.65(2)(am)2. (2013-14), and one count of operating 
with a prohibited alcohol concentration, contrary to Wis. Stat. 
§ 346.63(1)(b) 
(2013-14), 
second 
offense, 
see 
Wis. 
Stat. 
§ 346.65(2)(am)2. (2013-14).  On November 5, 2013, Kozel filed 
No. 
2015AP656-CR   
 
5 
 
motions to suppress evidence obtained as a consequence of Deputy 
Schlough's stop and detention of Kozel and to suppress the 
results of the analysis of Kozel's blood.   
¶9 
On June 23, 2014, a hearing was held on the 
suppression motion pertaining to the traffic stop initiated by 
Deputy Schlough.  The circuit court orally denied the motion.  
On June 27, 2014, the court entered an order to the same effect.  
¶10 On September 26, 2014, a hearing was held on the 
suppression motion pertaining to the draw of Kozel's blood.  
Kozel made two primary arguments relevant to this appeal: (1) 
his blood was not taken by a person statutorily authorized to do 
so, namely a "person acting under the direction of a physician," 
Wis. Stat. § 343.305(5)(b); and (2) his blood was taken in a 
constitutionally unreasonable manner, see U.S. Const. amend. IV 
("The right of the people to be secure in their persons, houses, 
papers, and effects, against unreasonable searches and seizures, 
shall not be violated . . . ."). 
¶11 In order to meet these claims, the State called 
Goethel, the EMT who had drawn Kozel's blood, to testify at the 
hearing.  Questioning of Goethel provided the following relevant 
pieces of information. 
¶12 Goethel testified that he had been employed as an EMT 
intermediate technician by BDAS since September of 2005.  This 
position is "a level of licensure set forth by the Wisconsin 
[Department of Health Services] that allows [Goethel] to, upon 
completion of appropriate and successful training, . . . provide 
certain skills and perform various procedures."  Goethel was 
No. 
2015AP656-CR   
 
6 
 
"certified 
in 
[cardiopulmonary 
resuscitation] 
through 
the 
American Heart Association" and had taken "three certification 
classes to allow [him] to [reach his] current level of 
licensure," as well as "additional trainings as they are 
required and/or available."  He was "certified by the National 
Registry of Emergency Medical Technicians as an advanced EMT." 
¶13 When asked "[w]hat kind of things . . . [he] do[es]" 
in his work for BDAS, Goethel replied that he "[r]espond[s] to 
911 calls, interfacility transfers, perform[s] legal blood 
draws, PR events, general education and training."  He takes 
care of people "who are sick and in an emergency setting."  
Goethel "can perform splinting for possible fractures, spinal 
immobilization, medical and trauma assessments, establishment of 
intravenous lines, the administration of several different 
medications by various routes and . . . also mak[e] transport 
decisions."   
¶14 As of August of 2013, Goethel was both licensed and 
certified by the State of Wisconsin to "perform legal blood 
draws" and had drawn blood between 100 and 150 times, not 
including practice draws he had performed.  Goethel had been 
performing legal blood draws since June of 2009 under the 
supervision of Dr. Manuel Mendoza ("Dr. Mendoza"), a physician 
licensed in the State of Wisconsin who is the "medical director" 
of BDAS.  Dr. Mendoza had been serving in that position since 
before Goethel joined BDAS.  Goethel explained that as medical 
director, Dr. Mendoza "signs off on not only our licenses, which 
No. 
2015AP656-CR   
 
7 
 
allow us to practice medicine, but also any of the additional 
training and/or procedures that require approval."  
¶15 The State introduced into evidence, in the words of 
Goethel, "[A] letter from Dr. Mendoza to our staff, our 
administration stating that the authorized EMT paramedics and 
intermediate 
technicians 
may 
perform 
legal 
blood 
draws."3  
According to Goethel, the letter was "current" and "was issued 
to [Goethel] via [his] training director [at BDAS] at the time."  
The letter states as follows (typographical errors have not been 
corrected): 
August 21, 2009 
To Whom It May Concern: 
As Medical Director for Baraboo District Ambulance 
Service, I have authorized a standing order for the 
EMT-Paramedics 
and 
approved 
EMT-Intermediate 
Technicians authority to draw legal blood draws at the 
request of the law enforcement officers. 
The Baraboo District Ambulance Service EMT-Paramedics 
and EMT-Intermediate Technicians are acting under the 
direction of my physician license. 
They have all completed extensive training regarding 
the procedures and legalities of obtaining blood 
draws. If you have any questions regarding this 
manner, please do not hesitate to contact me. 
Best regards, 
[signature] 
Manuel Mendoza, M.D. 
Medical Control for Baraboo District Ambulance Service 
                                                 
3 Kozel's attorney objected to introduction of the letter. 
The circuit court overruled the objection. 
No. 
2015AP656-CR   
 
8 
 
St. Clare Hospital 
[address] 
Baraboo, WI, 53913 
[phone number] 
¶16 Goethel was "personally familiar" with Dr. Mendoza, 
and Dr. Mendoza occasionally appeared at Goethel's place of 
work.  Goethel agreed that Dr. Mendoza "give[s] trainings and 
just in general ways supervise[s]" him.  Goethel was certified 
but not trained by Dr. Mendoza.  Dr. Mendoza did not "test 
[Goethel] or have [him] do [any] procedures for him"; "he simply 
reviewed [Goethel's] certification."  Dr. Mendoza had never 
observed Goethel performing a blood draw at the jail.  Although 
Dr. Mendoza had never "personally told [Goethel] that [it] is 
okay for [Goethel] to draw blood at the jail," Goethel testified 
that Dr. Mendoza "is aware" that blood draws occur at the jail.  
"All of the legal blood draws [Goethel] [had] performed ha[d] 
been at the Sauk County Jail." 
¶17 Goethel agreed with the defense that it is "possible 
for a person to have medical issues that would affect a blood 
draw," and that there is "the potential" for "some medical 
issues [to] have a serious effect."  But during a blood draw, 
Goethel could contact Dr. Mendoza "[i]mmediately via cell 
phone," and if Dr. Mendoza "were not available" Goethel could 
contact "the on-duty physician at the St. Clare Hospital 
emergency department."  According to Goethel, there is always an 
emergency doctor on call there.  On cross-examination, Goethel 
clarified that his "first point of contact would be the 
emergency room doctor."  In the event of an emergency, 
No. 
2015AP656-CR   
 
9 
 
Dr. Mendoza could be contacted by telephone for assistance, and 
emergency room doctors were also available. 
¶18 Goethel is regularly in contact with the emergency 
department, "providing basic information on why [BDAS] had 
contact with the patient and what interventions and procedures 
[BDAS] performed," asking "any questions," and speaking with 
them 
if 
BDAS 
"needed 
additional 
approval 
to 
do 
certain 
interventions or provide certain medications."  "[I]f somebody 
had to be transported to the hospital," it could "be done 
quickly."  If Goethel ever were "in over [his] head," he 
"could . . . call someone."  Finally, if someone "experienc[ed] 
a heart problem," Goethel himself could "be of assistance to 
them" because he "ha[s] training in that."  On cross-examination 
Goethel granted that "[p]ossibly" a person experiencing such an 
issue would "receive faster treatment if [the parties] were at 
the emergency room already."  Likewise, Goethel conceded that 
"in some circumstances . . . there are specific interventions 
that can occur at the emergency room that cannot occur at the 
jail." 
¶19 Goethel testified that he performed blood draws at the 
Sauk County jail in Baraboo in "a small room" he "refer[s] to as 
the prebooking area" which is "approximately eight feet by 12 
feet."  Goethel uses the room "at least once or twice a month." 
When asked about the room's contents, Goethel explained:  
On one side is a chair that's equipped with 
armrests, very typical of what you would see at a 
medical clinic or a hospital.  There is a Breathalyzer 
machine, which I have no use for.   
No. 
2015AP656-CR   
 
10 
 
There 
are 
various 
shelves 
and 
stacks 
of 
paperwork.  Additionally this is the location where 
the unused and new legal blood draw kits are stored. 
The room "appears clean" and "well-lit."  Goethel knew that the 
room was cleaned "regularly" because there is "a sign or chart 
on the wall indicating when jail staff have come through to 
perform janitorial duties."  Goethel had never "noticed [the] 
room to be dirty" before drawing an individual's blood in it, 
and the room has never "looked any dirtier than an emergency 
room" to Goethel.  The floor "look[s] comparable to what 
[Goethel] would see in an emergency room."  The chair in the 
room is "designed for drawing blood," and its armrests "are 
specific for drawing blood."  The chair is either "the type of 
chair [one] might find in the emergency room" or "very close by 
[sic]"; it "look[s] similar to the chair in the emergency room." 
Goethel has never "noticed [the] chair to be dirty."  
¶20 If Goethel ever "noticed anything that was dirty about 
the room," he could "contact the jail" and they would "fix it" 
"immediately."  Goethel testified that although the room was not 
sterile, neither are emergency rooms.  He had never heard of 
anyone from whom he had drawn blood in the jail acquiring an 
infection due to the blood draw.  When asked whether Dr. Mendoza 
had "ever inspected the blood draw location at the jail," 
Goethel stated, "Not to my knowledge." 
¶21 The blood draw kits in the room are also clean.  The 
kits contain a "butterfly needle" that is sterile "[w]hile it is 
still in the package."  The needle "comes packaged" and "no one 
else has had [the] needle in them."  When the package is opened, 
No. 
2015AP656-CR   
 
11 
 
that "let[s] air in and that means it's no longer sterile," but 
"that would be true in the emergency room as well."  
¶22 Goethel agreed with the State that he had "been doing 
continual training on how to draw blood" and explained that he 
had been trained to draw blood by "several . . . individuals," 
including 
[D.C.] from then known as the Madison Area 
Technical College, former captain [J.H.] who was our 
former training director. Additionally [D.P.], who is 
a former critical care paramedic on our staff, and 
then my appropriate training via the Madison Area 
Technical College, to which I'm licensed as an 
intermediate technician, and then also my training as 
an advanced EMT. 
Goethel testified that all of the classes are certified.  
¶23 Goethel set forth the procedures for drawing blood 
which he had been trained to follow in some detail: 
Initially I start -- within the blood draw kit 
itself there are a couple of glass, we call them 
Vacutainer tubes, it's a vacuum-charged glass tube, 
those are held off to the side until we're completely 
ready to draw. 
I will have affixed a tourniquet usually above 
what's known as the antecubital space where you think 
of the inside of your elbow.  That's tightened down.  
The space, the antecubital space, will be cleansed 
with an alcohol-free swab in what's known as an 
aseptic technique. 
Once I have found a suitable location to make the 
venipuncture with a 21-gauge butterfly needle, it's 
placed into the vein.  I receive confirmation that it 
is in the vein by a small amount of blood in what's 
known as a flash chamber. 
Once I have that confirmation, I apply the vacuum 
tube to the back end of the needle and tubing 
assembly, allow them to fill as much as they can with 
No. 
2015AP656-CR   
 
12 
 
the blood.  I then invert them upright and upside down 
several times to mix the powder that's within the 
tube. 
Once that has been completed, I generally hold 
onto the tubes, remove the tourniquet, and then place 
a cotton ball or piece of gauze over the site of the 
venipuncture, remove the needle and tape the dressing 
down. 
Following that the tubes are generally sealed 
with a two-sticker seal and I then turn over custody 
of them to the arresting officer. 
This is "the same type of procedure[] they use to draw blood in 
the emergency room."  Indeed, Goethel agreed that "the emergency 
room technicians [are] trained at some of the same places 
[Goethel] is," at least "to [his] knowledge."  The defense asked 
Goethel, "Other than the letter that has been introduced, are 
there other instructions or protocols from Dr. Mendoza that you 
follow?"  Goethel's response was, "Regarding the blood draw, I 
would have to check.  I believe there are."  
¶24 Goethel was asked whether he "ever had anyone have any 
difficulties while [he] [was] drawing their blood in the blood 
draw room at the jail."  Goethel replied "[y]es" and explained 
that "[A]fter my initial attempt on one occasion, I was 
preparing for a second venipuncture, [and] the subject, a male 
subject, lost consciousness and myself and one or two jail 
deputies assisted him to the floor.  I immediately requested the 
jail staff page for an ambulance."  The individual recovered 
and, as far as Goethel was aware, did so without any 
difficulties. 
No. 
2015AP656-CR   
 
13 
 
¶25 The State questioned Goethel about the specific blood 
draw that had occurred in this case.  Goethel talked to Deputy 
Schlough prior to drawing Kozel's blood.  Deputy Schlough 
explained that Kozel "had been read the Informing the Accused 
and that [Goethel] could proceed with the blood draw."  Goethel 
typically received this confirmation before performing a blood 
draw.  Kozel was cooperative, and Goethel's report did not 
"indicate anything out of the ordinary."  Before drawing the 
blood, Goethel did not "speak with [Kozel] about any health 
issues that [Kozel] ha[d]" and did not ask Kozel "if he was on 
any medication."  Goethel "didn't verify [Kozel's] medical 
status at all."  Goethel drew the blood according to the 
procedures explained above.  Goethel did not "have any problems 
with [Kozel's] blood draw."  When asked if Kozel had any 
problems, Goethel replied, "Not that I recall."  Goethel had not 
heard that the defendant had had "any issues concerning 
infection or anything."  
¶26 After hearing all of this testimony, the circuit court 
orally denied Kozel's motion pertaining to the blood draw that 
occurred.  
¶27 On January 9, 2015, Kozel pleaded no contest to one 
count of operating a motor vehicle while intoxicated, contrary 
to Wis. Stat. § 346.63(1)(a) (2013-14), second offense, see Wis. 
Stat. § 346.65(2)(am)2. (2013-14).  The court sentenced Kozel to 
17 days in the Sauk County jail with Huber privileges, assessed 
a fine and costs, ordered Kozel's driving privilege revoked for 
No. 
2015AP656-CR   
 
14 
 
15 months, and specified requirements for reinstatement of that 
privilege. 
¶28 On March 30, 2015, Kozel filed a notice of appeal.  On 
November 12, 2015, the court of appeals reversed the circuit 
court's judgment of conviction and remanded the case to the 
circuit court to suppress the evidence obtained from Kozel's 
blood.  Kozel, unpublished slip op., ¶1.  The court of appeals 
concluded that "the evidence was insufficient to establish that 
the EMT [who drew Kozel's blood] was operating under the 
direction of a physician."  Id., ¶14.  Given that conclusion, 
the court of appeals found it unnecessary to analyze whether the 
blood draw was constitutionally reasonable and thus did not do 
so.  Id. (citing Gross v. Hoffman, 227 Wis. 296, 300, 277 N.W. 
663 (1938)). 
¶29 On December 11, 2015, the State filed a petition for 
review in this court.  On March 7, 2016, this court granted the 
petition. 
III.  STANDARD OF REVIEW 
¶30 In cases involving review of decisions on motions to 
suppress evidence, this court "review[s] the circuit court's 
findings of historical fact under a deferential standard, 
upholding 
them 
unless 
they 
are 
clearly 
erroneous," 
then 
"independently appl[ies] constitutional principles to those 
facts."  State v. Tullberg, 2014 WI 134, ¶27, 359 Wis. 2d 421, 
857 N.W.2d 120 (quoting State v. Robinson, 2010 WI 80, ¶22, 327 
Wis. 2d 302, 786 N.W.2d 463). 
No. 
2015AP656-CR   
 
15 
 
¶31 This 
case 
also 
necessitates 
"interpretation 
and 
application" of a statute, matters "present[ing] questions of 
law that we review de novo while benefiting from the analyses of 
the court of appeals and circuit court."  Journal Times v. 
Racine Bd. of Police & Fire Comm'rs, 2015 WI 56, ¶42, 362 
Wis. 2d 577, 866 N.W.2d 563 (quoting 118th St. Kenosha, LLC v. 
DOT, 2014 WI 125, ¶19, 359 Wis. 2d 30, 856 N.W.2d 486).  
IV.  ANALYSIS 
¶32 We need address only two issues in this case: (1) 
whether Goethel was a "person acting under the direction of a 
physician" 
when 
he 
drew 
Kozel's 
blood, 
Wis. 
Stat. 
§ 343.305(5)(b); and (2) whether Kozel's blood was drawn in a 
constitutionally 
reasonable 
manner. 
We 
now 
analyze 
these 
questions.4  
 
A. Whether Goethel Was a Person Acting Under the  
Direction of a Physician When He Drew Kozel's Blood 
¶33 Wisconsin Stat. § 343.305, "known as the implied 
consent law," Village of Elm Grove v. Brefka, 2013 WI 54, ¶19, 
348 Wis. 2d 282, 832 N.W.2d 121, amended by 2013 WI 86, 350 
                                                 
4 The State argues that suppression is not required even if 
Goethel did not comply with Wis. Stat. § 343.305(5)(b), as long 
as the blood draw that occurred was constitutionally reasonable.  
We need not resolve that issue in light of our conclusions 
today.  See Walworth State Bank v. Abbey Springs Condo. Ass'n, 
Inc., 2016 WI 30, ¶13 n.7, 368 Wis. 2d 72, 878 N.W.2d 170 
("Typically, an appellate court should decide cases on the 
narrowest possible grounds." (quoting Maryland Arms Ltd. P'ship 
v. Connell, 2010 WI 64, ¶48, 326 Wis. 2d 300, 786 N.W.2d 15)). 
This opinion should not be read to address the issue. 
No. 
2015AP656-CR   
 
16 
 
Wis. 2d 724, 838 N.W.2d 87, governs the testing of a motorist's 
"breath, blood or urine, for the purpose of determining the 
presence or quantity in his or her blood or breath, of alcohol, 
controlled substances, controlled substance analogs or other 
drugs, or any combination of alcohol, controlled substances, 
controlled substance analogs and other drugs." Wis. Stat. 
§ 343.305(2).  We examine a "single, narrow aspect of the 
procedures set forth in the implied consent law," Brefka, 348 
Wis. 2d 282, ¶19, namely the set of individuals authorized to 
draw blood under the statute. 
¶34 Section 343.305(5)(b) provides in relevant part: 
Blood may be withdrawn . . . to determine the 
presence 
or 
quantity 
of 
alcohol, 
a 
controlled 
substance, a controlled substance analog or any other 
drug, or any combination of alcohol, controlled 
substance, controlled substance analog and any other 
drug in the blood only by a physician, registered 
nurse, medical technologist, physician assistant or 
person acting under the direction of a physician.  
Wis. Stat. § 343.305(5)(b) (emphasis added).5  The State argues 
that this requirement is fulfilled because Goethel drew blood 
                                                 
5 The legislature recently amended the language at issue in 
this case.  See 2013 Wis. Act. 224, § 3.  The statute now reads, 
in relevant part:  
Blood may be withdrawn . . . to determine the 
presence 
or 
quantity 
of 
alcohol, 
a 
controlled 
substance, a controlled substance analog, or any other 
drug, or any combination of alcohol, controlled 
substance, controlled substance analog, and any other 
drug in the blood only by a physician, registered 
nurse, 
medical 
technologist, 
physician 
assistant, 
phlebotomist, or other medical professional who is 
(continued) 
No. 
2015AP656-CR   
 
17 
 
under the direction of Dr. Mendoza.  Kozel contends that the 
evidence introduced by the State was insufficient to establish 
compliance with the statute.  There appears to be no dispute, 
nor any reason to dispute, that Goethel is a "person" and that 
Dr. Mendoza 
is 
a 
"physician" 
within 
the 
meaning 
of 
§ 343.305(5)(b).  Thus, the only question is whether Goethel was 
"acting under the direction" of Dr. Mendoza when he drew Kozel's 
blood.  We conclude that the evidence is sufficient to show that 
Goethel was a "person acting under the direction of a 
physician."  Id. 
¶35 "[W]e 
have 
repeatedly 
held 
that 
statutory 
interpretation 'begins with the language of the statute.  If the 
meaning of the statute is plain, we ordinarily stop the 
inquiry.'  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."  State ex rel. Kalal v. Circuit Court for 
Dane Cty., 2004 WI 58, ¶45, 271 Wis. 2d 633, 681 N.W.2d 110 
(citations omitted) (quoting Seider v. O'Connell, 2000 WI 76, 
¶43, 236 Wis. 2d 211, 612 N.W.2d 659).  The court of appeals 
below relied on a definition of "direction" taken from Webster's 
Third New International Dictionary: "guidance or supervision of 
action, conduct, or operation."  Kozel, unpublished slip op., 
                                                                                                                                                             
authorized to draw blood, or person acting under the 
direction of a physician. 
Wis. Stat. § 343.305(5)(b) (2013-14) (emphasis added). 
No. 
2015AP656-CR   
 
18 
 
¶13 (quoting Direction, Webster's Third New International 
Dictionary 640 (1993)).  This definition is adequate for our 
purposes. 
¶36 The evidence below showed that Dr. Mendoza, the 
medical "director" of BDAS of at least seven years, specifically 
"authorized 
a 
standing 
order" 
for 
BDAS 
EMT 
intermediate 
technicians such as Kozel to perform blood draws when requested 
to do so by law enforcement.  A "standing order" is "an 
instruction or prescribed procedure in force permanently or 
until specifically changed or canceled."  Standing order, 
Webster's Third New International Dictionary 2224 (1993).  
Dr. Mendoza's authorization was formalized in a writing which 
also contained his confirmation that the EMTs had "completed 
extensive training regarding the procedures and legalities of 
obtaining blood draws."  Finally, Goethel was able to contact 
Dr. Mendoza if necessary when performing a blood draw.  
¶37 This evidence demonstrates that BDAS EMTs are acting 
under Dr. Mendoza's direction.  The concept of "direction" 
reasonably contemplates varying degrees of proximity between a 
director and the person whose actions he or she guides rather 
than a single, set relationship applicable in all cases.  Had 
the legislature envisioned only one manner of "direction," it 
would have spelled out the specific procedures that a physician 
and the person he or she directs must follow to meet that 
requirement.  See State v. Penzkofer, 184 Wis. 2d 262, 266, 516 
N.W.2d 774 (Ct. App. 1994) ("[T]he legislature could have chosen 
to require the test to be taken by or taken in the presence of a 
No. 
2015AP656-CR   
 
19 
 
physician, but it did not."); cf., e.g., Longview Fibre Co. v. 
Rasmussen, 980 F.2d 1307, 1314 (9th Cir. 1992) (dismissing 
petition for review) ("Had Congress intended a more general 
meaning, it would have used more general words.").  
¶38 If Dr. Mendoza had trained the BDAS EMTs himself, 
ordered each blood draw on a case-by-case basis, and personally 
observed each individual blood draw, there would likely be no 
dispute that the EMTs were acting under Dr. Mendoza's direction.  
But blood draws are "routine" affairs, Schmerber v. California, 
384 U.S. 757, 771 n.13 (1966) (quoting Breithaupt v. Abram, 352 
U.S. 432, 436 (1957)), and nothing in Wis. Stat. § 343.305(5)(b) 
prevents a physician from supervising such standard procedures 
in a more streamlined fashion.  Thus, instead of training the 
EMTs on his own, Dr. Mendoza satisfied himself that the EMTs had 
"completed extensive training regarding the procedures and 
legalities of obtaining blood draws" and made that fact known to 
others in his writing.  Instead of ordering each blood draw on a 
case-by-case 
basis, 
Dr. 
Mendoza 
issued 
a 
standing 
order 
authorizing EMTs to draw blood when requested to do so by law 
enforcement. 
 
And 
instead 
of 
personally 
observing 
each 
individual blood draw, Dr. Mendoza allowed EMTs to perform blood 
draws on their own, but made himself accessible by telephone 
should any problems arise.  
¶39 The testimony below leaves no doubt that it is 
Dr. Mendoza who is in charge of blood-drawing activities 
conducted by BDAS EMTs.  To require more evidence than what the 
State provided below to establish that Goethel was acting under 
No. 
2015AP656-CR   
 
20 
 
the direction of Dr. Mendoza would be to require a specific type 
or degree of direction where the statute at issue does not so 
specify.  "We will not read into the statute a limitation the 
plain language does not evidence."  Cty. of Dane v. LIRC, 2009 
WI 9, ¶33, 315 Wis. 2d 293, 759 N.W.2d 571.  The court of 
appeals erred in concluding otherwise.  
 
B.  Whether Kozel's Blood Was Drawn in a Constitutionally 
Reasonable Manner 
¶40 The 
Fourth 
Amendment 
to 
the 
United 
States 
Constitution, applicable to the states though the Fourteenth 
Amendment, e.g., State v. Kramer, 2009 WI 14, ¶18, 315 
Wis. 2d 414, 759  N.W.2d 598 (citing Mapp v. Ohio, 367 U.S. 643 
(1961)), provides: 
The right of the people to be secure in their 
persons, 
houses, 
papers, 
and 
effects, 
against 
unreasonable searches and seizures, shall not be 
violated, and no Warrants shall issue, but upon 
probable cause, supported by Oath or affirmation, and 
particularly describing the place to be searched, and 
the persons or things to be seized. 
U.S. Const. amend. IV.6  "Virtually any 'intrusio[n] into the 
human body' will work an invasion of '"cherished personal 
security" 
that 
is 
subject 
to 
constitutional 
scrutiny.'"  
Maryland v. King, 569 U.S. ___, 133 S. Ct. 1958, 1969 (2013) 
                                                 
6 "We 
have 
historically 
interpreted 
the 
Wisconsin 
Constitution's [Article I, § 11] protections in this area 
identically to the protections under the Fourth Amendment as 
defined by the United States Supreme Court."  State v. Dearborn, 
2010 WI 84, ¶14, 327 Wis. 2d 252, 786 N.W.2d 97 (citing State v. 
Kramer, 2009 WI 14, ¶18, 315 Wis. 2d 414, 759 N.W.2d 598).  We 
will reference only the Fourth Amendment in this opinion. 
No. 
2015AP656-CR   
 
21 
 
(alteration in original) (citation omitted) (quoting Schmerber, 
384 U.S. at 770; then quoting Cupp v. Murphy, 412 U.S. 291, 295 
(1973)).  Consistent with this principle, "the taking of a blood 
sample . . . is 
a 
search" 
under 
the 
Fourth 
Amendment.  
Birchfield v. North Dakota, 579 U.S. ___, 136 S. Ct. 2160, 2173 
(2016).  
¶41 Nevertheless, 
"[t]he 
Fourth 
Amendment's 
proper 
function is to constrain, not against all intrusions as such, 
but 
against 
intrusions 
which 
are 
not 
justified 
in 
the 
circumstances, or which are made in an improper manner."  King, 
133 S. Ct. at 1969 (quoting Schmerber, 384 U.S. at 768). 
¶42 In 
Schmerber 
the 
Supreme 
Court 
assessed 
the 
constitutional reasonableness of a blood draw of a drunk driver, 
characterizing the applicable issues as "whether the police were 
justified in requiring petitioner to submit to the blood test, 
and whether the means and procedures employed in taking his 
blood 
respected 
relevant 
Fourth 
Amendment 
standards 
of 
reasonableness."  Schmerber, 384 U.S. at 758-59, 768.  After 
concluding that a warrant was not required in that case, id. at 
768-71, the Supreme Court briefly examined the State's "means of 
testing" the defendant's blood-alcohol content and "manner" in 
which "the test was performed."  Id. at 771-72.  With regard to 
the State's "means of testing," the Supreme Court explained:  
Extraction of blood samples for testing is a highly 
effective means of determining the degree to which a 
person is under the influence of alcohol.  Such tests 
are a commonplace in these days of periodic physical 
examination and experience with them teaches that the 
quantity of blood extracted is minimal, and that for 
No. 
2015AP656-CR   
 
22 
 
most people the procedure involves virtually no risk, 
trauma, or pain.  
Id. at 771 (citation omitted).  In a footnote, the court 
remarked: 
The blood test procedure has become routine in 
our everyday life.  It is a ritual for those going 
into the military service as well as those applying 
for marriage licenses.  Many colleges require such 
tests 
before 
permitting 
entrance 
and 
literally 
millions of us have voluntarily gone through the same, 
though a longer, routine in becoming blood donors. 
Id. at 771 n.13 (quoting Breithaupt, 352 U.S. at 436).  With 
regard to the "manner" in which "the test was performed," the 
Court concluded:  
[T]he record shows that the test was performed in a 
reasonable manner.  Petitioner's blood was taken by a 
physician in a hospital environment according to 
accepted medical practices.  We are thus not presented 
with the serious questions which would arise if a 
search involving use of a medical technique, even of 
the most rudimentary sort, were made by other than 
medical 
personnel 
or 
in 
other 
than 
a 
medical 
environment——for example, if it were administered by 
police in the privacy of the stationhouse.  To 
tolerate searches under these conditions might be to 
invite an unjustified element of personal risk of 
infection and pain. 
Id. at 771-72.  
¶43 Kozel argues that certain material differences between 
the blood draw that occurred in this case and the blood draw 
that occurred in Schmerber require suppression of evidence.  
Specifically, Kozel simply maintains that the State failed to 
establish that the manner in which the State drew his blood——by 
an EMT in a jail rather than "by a physician in a hospital 
No. 
2015AP656-CR   
 
23 
 
environment according to accepted medical practices," id. at 
771——was constitutionally reasonable.  We reject this argument.7 
¶44 First, it was not unreasonable for an EMT, as opposed 
to a physician, to draw Kozel's blood.  We need not resolve the 
parties' dispute over whether Goethel technically qualifies as a 
"medical professional" or a "paraprofessional."  The important 
point 
for 
constitutional 
purposes 
is 
that 
the 
evidence 
demonstrated that Goethel was thoroughly trained and experienced 
in properly drawing blood.  Additionally, if any medical issues 
arose for which Goethel was not equipped, Goethel had access to 
physicians who could assist.  The Schmerber Court explained with 
regard to blood testing that "for most people the procedure 
involves virtually no risk, trauma, or pain."  Id. at 771.  Its 
concern——though it did not decide the issue——was that procedures 
"made by other than medical personnel . . . might . . . invite 
an unjustified element of personal risk of infection and pain."  
Id. at 772.  We fail to see how performance of such an everyday 
                                                 
7 Kozel does not argue that other differences between the 
circumstances in Schmerber and those in this case require 
suppression, and we do not comment on them.  See generally 
Winston v. Lee, 470 U.S. 753, 760-63 (2013) (discussing the list 
of items considered by the Supreme Court in Schmerber v. 
California, 
384 
U.S. 
757 
(1966), 
as 
relevant 
to 
the 
constitutionality of the blood test that occurred in that case, 
including "the ordinary requirements of the Fourth Amendment," 
"the extent to which the procedure may threaten the safety or 
health of the individual," "the extent of intrusion upon the 
individual's dignitary interests in personal privacy and bodily 
integrity," 
and 
"the 
community's 
interest 
in 
fairly 
and 
accurately determining guilt or innocence"). 
No. 
2015AP656-CR   
 
24 
 
procedure by a licensed, certified EMT unjustifiably increases 
such a risk.  The evidence presented showed the opposite.  Nor 
do we conclude that the State's failure to introduce specific 
protocols for drawing blood mandates a different result, where 
Goethel testified as to his training in drawing blood, the 
specific procedures he was taught to follow, and the fact that 
he followed those procedures in this case.  The circuit court's 
finding that Kozel's blood was drawn "in accordance with 
medically accepted procedures" is not clearly erroneous. 
¶45 Second, it was not unreasonable for the blood draw to 
occur in the non-medical setting of the jail.  As the trial 
court explained, the evidence indicated that the room in which 
Kozel's blood was drawn "was clean and as clean as a hospital 
emergency room."  Further, Goethel used a new blood draw kit 
containing a sterile needle.  While some non-medical settings——
indeed, some jails——might "invite an unjustified element of 
personal risk of infection and pain," Schmerber, 384 U.S. at 
772, the evidence presented by the State dispelled any such 
fears as to the particular room in the particular jail at issue.  
See State v. Daggett, 2002 WI App 32, ¶14, 250 Wis. 2d 112, 640 
N.W.2d 546 ("[W]e reject Daggett's assertion that blood draws 
must take place in a hospital setting in order to be 
constitutionally reasonable.  Although Schmerber urged caution, 
it did not categorically reject the possibility that a blood 
draw could take place in a non-medical setting." (citation 
omitted)). 
No. 
2015AP656-CR   
 
25 
 
¶46 Finally, we would be remiss if we failed to mention 
the lack of evidence that Kozel ever objected to the particular 
circumstances of the blood draw.  See Schmerber, 384 U.S. at 771 
("Petitioner is not one of the few who on grounds of fear, 
concern for health, or religious scruple might prefer some other 
means of testing . . . ."); cf. Tullberg, 359 Wis. 2d 421, ¶31 
("A warrantless, nonconsensual blood draw of a suspected drunken 
driver complies with the Fourth Amendment if: . . . (4) the 
suspect did not reasonably object to the blood draw.").  
¶47 In sum, the blood draw that occurred in this case was 
constitutionally reasonable.  See, e.g., State v. Johnston, 336 
S.W.3d 649, 651-53, 655, 664 (Tex. Crim. App. 2011) (blood draw 
in "blood-draw room" at police station by police officer 
certified as an intermediate EMT assisted by police officer 
certified as a basic EMT held constitutionally reasonable), 
cert. denied, 132 S. Ct. 212 (2011).   
V.  CONCLUSION 
¶48 We conclude that the EMT who drew Kozel's blood was a 
"person acting under the direction of a physician," Wis. Stat. 
§ 343.305(5)(b), 
and 
that 
Kozel's 
blood 
was 
drawn 
in 
a 
constitutionally reasonable manner.  Accordingly, we reverse the 
decision of the court of appeals. 
 
By the Court.-The decision of the court of appeals is 
reversed. 
 
 
No. 2015AP656-CR.awb 
 
1 
 
¶49 ANN WALSH BRADLEY, J.   (dissenting).  As the State 
has acknowledged, this case in essence presents a question of 
sufficiency of evidence. 
¶50 Because 
we 
are 
a 
law 
developing 
court 
setting 
precedent for the entire state, we generally do not accept for 
review sufficiency of evidence cases because they often are tied 
to the unique facts of a particular case and thus have very 
limited precedential value. 
¶51 Likewise, we generally eschew cases of statutory 
interpretation where the statute has subsequently changed 
because 
of 
the 
limited 
application 
of 
the 
decision.  
Nevertheless, 
in 
this 
case 
the 
majority 
tackles 
both 
circumstances and reverses the unpublished decision of the court 
of appeals. 
¶52 The petitioner, State of Wisconsin, asserts that the 
court of appeals erred when it determined that the State failed 
to present sufficient evidence to show that the EMT was a 
"person acting under the direction of a physician" as required 
by statute.1  It further contends that under the facts presented 
it has demonstrated that the blood draw was constitutionally 
reasonable under the Fourth Amendment of the United States 
Constitution. 
¶53 The majority agrees with the State.  Majority op., 
¶¶34, 48.  However, it missteps in its analysis when construing 
                                                 
1 Wis. Stat. § 343.305(5)(b) (2011-12).  All subsequent 
references to the Wisconsin Statutes are to the 2011-12 version 
unless otherwise indicated. 
No. 2015AP656-CR.awb 
 
2 
 
the former statute by conflating the terms "direction" and 
"authorization," thereby sub silencio writing into the statute a 
word not used or intended by the legislature. 
¶54 In determining that Kozel's blood draw satisfied 
statutory requirements and was constitutionally reasonable, the 
majority also errs when it excuses the failure of the State to 
present evidence sufficient to demonstrate that the EMT in this 
case was acting under the direction of a physician. 
¶55 Contrary to the majority, I conclude that there is 
insufficient evidence to determine that the EMT-Intermediate 
technician who drew Kozel's blood was a "person acting under the 
direction 
of 
a 
physician" 
as 
required 
by 
Wis. 
Stat. 
§ 343.305(5)(b).  Likewise, I determine that Kozel's blood draw 
was not constitutionally reasonable based upon the facts of 
record. 
¶56 I would affirm the court of appeals and remand to the 
circuit 
court 
for 
further 
proceedings. 
 
Accordingly, 
I 
respectfully dissent. 
I 
 
¶57 Wisconsin's implied consent statute authorizes legal 
blood draws in order to obtain evidence of intoxication.  
Section § 343.305(5)(b) provides in relevant part that "[b]lood 
may be withdrawn . . . to determine the presence or quantity of 
alcohol . . . only by a physician, registered nurse, medical 
technologist, physician assistant or person acting under the 
direction of a physician."  In this case, Kozel's blood was 
No. 2015AP656-CR.awb 
 
3 
 
drawn by an EMT-Intermediate Technician ("the EMT") in a pre-
booking room in the Sauk County Jail. 
¶58 The State asserts that there was sufficient evidence 
to support the requirement that the EMT was a "person acting 
under the direction of a physician" pursuant to Wis. Stat. 
§ 343.305(5)(b).  The majority embraces the State's position. 
¶59 In interpreting the statute, the majority relies on a 
plain meaning analysis of the term "direction."  Majority op., 
¶35.  Initially it follows the court of appeals approach, 
adopting the dictionary definition which requires "guidance or 
supervision of action, conduct or operation."  Id.  However, it 
rejects 
the 
court 
of 
appeals 
conclusion 
that 
there 
is 
insufficient evidence in this record to show that the EMT was a 
"person acting under the direction of a physician."  Majority 
op., 
¶¶35-39 
(citing 
Webster's 
Third 
New 
International 
Dictionary 640 (1993)). 
¶60 The 
majority 
reasons 
that 
"[t]he 
concept 
of 
'direction' reasonably contemplates varying degrees of proximity 
between a director and the person whose actions he or she guides 
rather than a single, set relationship applicable in all cases."  
Majority op., ¶37.  I agree. 
¶61 However, it proceeds next to set up a strawman only to 
subsequently knock it down when it concludes that "[h]ad the 
legislature envisioned only one manner of 'direction,' it would 
have spelled out the specific procedures that a physician and 
the person he or she directs must follow to meet that 
requirement."  Id.  According to the majority, "[w]e will not 
No. 2015AP656-CR.awb 
 
4 
 
read into the statute a limitation the plain language does not 
evidence."  Majority op., ¶39 (quoting Cty. of Dane v. LIRC, 
2009 WI 9, ¶33, 315 Wis. 2d 293, 759 N.W.2d 571). 
¶62 No one even attempts to advance an argument that the 
statute should be read in such a limited fashion.  Not the 
defendant, not the court of appeals and certainly not this 
dissent. 
¶63 Rather, what needs to be done, and what the majority 
skirts by setting up the fabricated argument, is an examination 
of whether the evidence presented here demonstrates that the EMT 
was acting under the physician’s direction, that is, under the 
"guidance or supervision of action, conduct or operation." 
¶64 Although this court often resorts to using dictionary 
definitions when engaging in statutory construction, we also 
often find guidance by looking at how other courts have defined 
the same statutory language.  In People v. Gregg, the Illinois 
court of appeals interpreted the statutory phrase "acting under 
the direction of a physician" in a similar context to this case.2  
526 N.E.2d 537, 539 (Ill. App. Ct. 1988). 
¶65 The Illinois court of appeals defined "acting under 
the direction"  of a physician to mean that: 
                                                 
2 77 Ill. Adm. Code 510.110(a)(2) (1985) provides in 
relevant part: 
The blood sample shall be collected per venipuncture 
by a physician licensed to practice medicine by a 
registered nurse or by a trained phlebotomist acting 
under the direction of a licensed physician (emphasis 
added). 
No. 2015AP656-CR.awb 
 
5 
 
[W]ork is performed under the guidance and direction 
of a supervisor who is responsible for the work, who 
plans work and methods, who is available on short 
notice to answer questions and deal with problems that 
are not strictly routine, who regularly reviews the 
work performed, and who is accountable for the 
results. 
Id. (citing 77 Ill. Am. Code 300.330, 330.330, 350.330, 370.240, 
390.330 (1985)). 
¶66 The physician in Gregg was not present when a trained 
phlebotomist performed a blood draw, but was "responsible for 
supervising emergency room procedures."  Id. at 538.  Thus, 
Gregg concluded that "[i]n light of the complex and extensive 
procedures already required in performing a blood analysis," a 
trained phlebotomist acting under a physician's supervision 
sufficiently ensured the accuracy and uniformity of blood 
analysis.  Id. at 539. 
¶67 Armed with the dictionary definition of "direction" 
and further informed by Gregg's interpretation of the statutory 
phrase, I normally would turn next to an examination of whether 
the evidence here is sufficient to meet the statutory directive. 
¶68 Yet, I would be remiss to ignore an additional 
impediment in the majority’s statutory analysis.  It missteps 
when it conflates the statutory term "direction" with a 
distinctly different term "authorization." 
¶69 As set forth more fully above, "direction" requires 
guidance and supervision.  The plain meaning of "authorize" is 
defined as "to give permission for (something); sanction."3  
                                                 
3 The 
majority 
does 
not 
include 
the 
definition 
of 
"authorize" in its opinion. 
No. 2015AP656-CR.awb 
 
6 
 
American Heritage Dictionary of the English Language 120 (5th 
ed. 2011).  Despite this distinction between "direction" and 
"authorization," in determining that the EMT was acting under 
the direction of a physician, the majority relies almost 
entirely on the fact that he was authorized by Dr. Mendoza to 
draw blood.  See e.g., majority op., ¶36 ("The evidence below 
showed that Dr. Mendoza, the medical 'director' of BDAS of at 
least seven years, specifically 'authorized a standing order' 
for BDAS EMT intermediate technicians such as Kozel to perform 
blood 
draws 
when 
requested 
to 
do 
so 
by 
law 
enforcement. . . . Dr. Mendoza's authorization was formalized in 
writing . . . .") (emphasis added); see also majority op., ¶¶2, 
15, 38.4 
¶70 The majority relies upon an August 21, 2009 letter 
written by Dr. Mendoza, the Medical Director for the Baraboo 
District Ambulance Service, which authorized the EMT to perform 
the 
blood 
draws 
at 
the 
request 
of 
law 
enforcement.  
Specifically, Dr. Mendoza's letter "authorized a standing order 
for the EMT-Paramedics and approved EMT-Intermediate Technicians 
authority to draw legal blood draws at the request of law 
                                                 
4 Majority op., ¶2 ("The EMT was authorized in writing by a 
physician 
to 
draw 
blood 
when 
asked 
to 
do 
so 
by 
law 
enforcement."); majority op., ¶15 ("The State introduced into 
evidence . . . '[A] letter from Dr. Mendoza to our staff, our 
administration stating that the authorized EMT paramedics and 
intermediate technicians may perform legal blood draws.'"); 
majority op., ¶38 (" . . . Dr. Mendoza issued a standing order 
authorizing EMTs to draw blood when requested to do so by law 
enforcement."). 
No. 2015AP656-CR.awb 
 
7 
 
enforcement officers."  It further states that "[t]he Baraboo 
District Ambulance Services EMT-Paramedics and EMT-Intermediate 
Technicians are acting under the direction of my physician 
license." 
¶71 As the court of appeals in this case explained, 
evidence that an EMT was authorized to act under a physician's 
license is not evidence that the EMT was acting under the 
physician's direction.  State v. Kozel, No. 2015AP656-CR, 
unpublished slip op., ¶13 (Wis. Ct. App. Nov. 12, 2015).  Dr. 
Mendoza's letter authorizes EMTs to conduct blood draws because 
it grants them the authority to do so at the request of law 
enforcement.  However, it tells us nothing about the physician’s 
guidance or supervision of the EMT's actions when conducting a 
blood draw. 
¶72 The distinction between "directed" and "authorized" is 
further supported by recent changes to the statutory provision 
at issue here.  Pursuant to 2013 WI Act 224, the legislature 
amended section 343.305(5)(b) to include medical professionals 
who are authorized to draw blood as a distinct category from a 
"person acting under the direction of a physician."  Under the 
amended statute, a blood draw may now be performed by authorized 
medical professionals: 
Blood may be withdrawn . . . to determine the presence 
or quantity of alcohol . . . only by a physician, 
registered 
nurse, 
medical 
technologist, 
physician 
assistant, phlebotomist, or other medical professional 
who is authorized to draw blood, or person acting 
under the direction of a physician. 
Wis. Stat. § 343.305(5)(b) (2013-14) (emphasis added). 
No. 2015AP656-CR.awb 
 
8 
 
¶73 According to the Wisconsin Legislative Council Act 
Memorandum for 2013 Wis. Act 224, the 2011-2012 version of the 
statute at issue in this case provided that only individuals 
"acting under the direction of a physician could draw blood."  
Conversely, the amended statute now allows a phlebotomist or 
other medical professional who is authorized to draw blood, in 
addition to the other health care providers listed under prior 
law: 
Under prior law, only a physician, registered nurse, 
medical technologist, physician assistant, or personal 
acting under the direction of a physician could draw 
blood for alcohol or controlled substance testing. 
 
Act 224 allows a phlebotomist or other medical 
professional who is authorized to draw blood, in 
addition to the other health care providers listed 
under prior law, to draw blood for alcohol or 
controlled substance testing. 
Wisconsin Legislative Council Act Memorandum for 2013 Wis. Act 
224 
(April 
14, 
2014), 
available 
at 
http://docs.legis.wisconsin.gov/2013/related/lcactmemo/act224. 
¶74 This statutory change suggests that the EMT in this 
case, who was formerly not permitted to draw blood under the 
statute unless "acting under the direction of a physician," now 
may be permitted to draw blood under the statute if he qualifies 
as an other medical professional who is authorized to draw 
blood. 
¶75 Unlike the newly amended statute, the 2011-12 version 
of the statute that is the subject of our analysis here uses the 
term "direction" but not the term "authorize."  In conflating 
the two terms in its analysis, the majority is sub silencio 
No. 2015AP656-CR.awb 
 
9 
 
writing into the prior statute terms not then used or intended 
by the legislature. 
II 
¶76 Perhaps because the majority conflates "direction" 
with "authorization," it incorrectly concludes that there was 
sufficient evidence that the EMT was acting under the direction 
of a physician as required by Wis. Stat. § 343.305(5)(b).  This 
misstep allows the majority to disregard the lack of evidence 
presented in this case in contrast to evidence deemed sufficient 
in other similar cases. 
¶77 In State v. Penzkofer, 184 Wis. 2d 262, 265, 516 
N.W.2d 774 (Ct. App. 1994), a certified laboratory technician 
performed a blood draw in a hospital, but without a physician 
present in the room at the time of the blood draw.  However, the 
hospital pathologist testified that the technician performed 
laboratory 
functions 
under 
his 
general 
supervision 
and 
direction.  Id. 
¶78 Significantly, the physician identified a written 
hospital protocol setting forth the detailed procedures that 
guided a technician performing a blood draw.  Id.  These 
procedures were reviewed and revised, and the protocol was dated 
and signed by the physician.  Id.  The physician testified that 
he did not "stand over [the technician's] shoulder" because 
"[t]hen I might as well draw it myself . . . or I'm busy with 
other work . . . so I couldn't be two places at one time."  Id. 
¶79 Considering the evidence of written procedures and 
protocols that were reviewed in a hospital setting by a 
physician, the Penzkofer court concluded that "the procedure 
No. 2015AP656-CR.awb 
 
10 
 
used here meets the legislature's concern for testing in such a 
manner as to yield reliable and accurate results.  Id. at 266.  
It explained that "[h]ospital laboratories are subject to 
detailed and stringent standards in almost every aspect of their 
facilities and services."  Id. (citing Wis. Admin. Code § HSS 
124.17).  Penzkofer reasoned further that "[t]he certified lab 
assistant followed a written protocol approved and kept current 
by the pathologist."  Id. (emphasis added). 
¶80 The court of appeals concluded that "Penzkofer's 
concern for safety and accuracy are addressed by those standards 
as well as the procedures in place here."  Id.  Conversely, the 
majority opinion neglects to consider how the lack of protocols 
setting forth detailed procedures for performing a blood draw, 
as well as the lack of detailed sanitation standards governing 
blood draws at the jail, might undermine confidence in the 
safety and accuracy of Kozel's blood drawn. 
¶81 Additionally, unlike here, in another unpublished case 
involving a blood draw performed by an EMT at the Sauk County 
jail, the State presented evidence of written protocols and 
procedures that guided the technician.  In State v. Heath, No. 
2014AP2466-CR, unpublished slip op., ¶5 (Wis. Ct. App. Sept. 15, 
2016), the State introduced a letter from the paramedic program 
coordinator for the Department of Health Services ("DHS") that 
"approved the Baraboo District Ambulance Service's revised and 
updated protocol for legal blood draws, and which authorized the 
ambulance service to implement the protocol." 
No. 2015AP656-CR.awb 
 
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¶82 Even in cases where written protocols setting forth 
detailed procedures were not introduced, the State presented 
significantly more evidence of direction by a physician than was 
introduced here.  As explained above, "direction" requires 
"guidance or supervision of action."  See also Gregg, 526 N.E.2d 
at 539 (concluding that there was sufficient evidence of 
direction when a supervising physician planed work and methods, 
was available on short notice, regularly reviewed the work 
performed, and was accountable for the results). 
¶83 For example, in State v. Osborne, No. 2012AP2540-CR, 
unpublished slip op., ¶19 (Wis. Ct. App. June 27, 2013), the EMT 
testified that he was "operating under the supervision of a 
physician, that a physician 'signed off' on the performance of 
the EMT's duties, that the EMT was in at least monthly contact 
with that physician, and that the EMT could be in contact with 
that physician at any time if the need arose."  Accordingly, the 
blood draw was performed under the direction of a physician 
because he regularly reviewed the work performed and was 
accountable for the results. 
¶84 Contrary to Penzkofer and other unpublished cases such 
as Heath and Osbourne, the facts in the record here demonstrate 
an absence of direction by a physician, including an absence of 
written protocols setting forth the detailed procedures that the 
EMT must follow when performing a blood draw.  Here, the only 
evidence introduced was the testimony of the EMT and Dr. 
Mendoza's letter.  When asked about whether there were written 
protocols setting forth procedures for performing a blood draw, 
No. 2015AP656-CR.awb 
 
12 
 
the EMT equivocated and could not identify any.  He responded 
"[r]egarding the blood draw, I would have to check." 
¶85 In other cases, even where detailed procedures were 
not introduced, there was testimony that the EMT had regular 
contact with the supervising physician who took responsibility 
for the EMT's work.  See, e.g., Osborne, No. 2012AP2540-CR, 
unpublished slip op., ¶19.  The EMT in Osbourne testified that 
he was in at least monthly contact with the supervising 
physician.  Id.  Unlike Osbourne where the EMT testified that 
the supervising physician signed off on the performance of his 
duties, the EMT in this case testified that he had never spoken 
to Dr. Mendoza about the letter authorizing him to conduct blood 
draws.  Rather, the EMT testified only that Dr. Mendoza 
"occasionally show[ed] up" at his place of work.  Absent from 
the record is any indication that when Dr. Mendoza occasionally 
appeared that the EMT had any contact whatsoever with the 
physician——let alone any supervision or guidance from him. 
¶86 Contrary to the majority's assertion, the facts in the 
record demonstrate a total absence of guidance and supervision 
necessary to support a determination that the EMT here was 
acting under the direction of a physician: 
 The State did not introduce into evidence any protocols or 
procedures guiding blood draws by an EMT. 
 There are no protocols to ensure that the jail's blood 
draw room is sterile or meets the appropriate standard. 
 Dr. Mendoza did not train the EMT. 
No. 2015AP656-CR.awb 
 
13 
 
 Dr. Mendoza had never been to the jail nor inspected the 
room where blood is drawn at the jail. 
 Dr. Mendoza never witnessed the EMT perform any blood 
draws. 
 There is no evidence that Dr. Mendoza approved or 
supervised the EMT's blood draw techniques on a regular or 
even irregular basis. 
 There is no evidence that the EMT had regular or even 
irregular contact with Dr. Mendoza. 
¶87 In short, no evidence was presented of any supervision 
of this EMT by Dr. Mendoza, whether it be general or direct.  
Additionally, there is a dearth of evidence demonstrating any 
guidance by Dr. Mendoza.  Thus, contrary to the majority, I 
conclude that there is insufficient evidence to determine that 
the EMT-Intermediate who drew Kozel's blood was a "person acting 
under 
the 
direction 
of 
a 
physician." 
 
Wis. 
Stat. 
§ 343.305(5)(b). 
III 
¶88 Given the state of the evidentiary record, I turn next 
to examine whether the blood draw here was constitutionally 
reasonable under the Fourth Amendment of the United States 
Constitution, which provides that "[t]he right of the people to 
be secure in their persons, houses, papers, and effects, against 
unreasonable 
searches 
and 
seizures 
shall 
not 
be 
violated . . . ." 
¶89 In the context of a blood draw, the United States 
Supreme Court has explained that "[t]he integrity of an 
No. 2015AP656-CR.awb 
 
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individual's person is a cherished value of our society."  
Schmerber v. California, 384 U.S. 757, 772 (1966).  Accordingly, 
the "overriding function of the Fourth Amendment is to protect 
personal privacy and dignity against unwarranted intrusion by 
the State."  Id. at 767. 
¶90 The Fourth Amendment does not prohibit all intrusions, 
however, but only those which are not justified under the 
circumstances or are made in an improper manner.  Id. at 768.  
Thus, the question in Schmerber, as in this case, was whether 
"the means and procedures employed in taking [] blood respected 
relevant Fourth Amendment standards of reasonableness."  Id. 
¶91 Relying on Schmerber, the majority contends that 
"[t]he blood test procedure has become routine in our everyday 
life" and "that for most people the procedure involves virtually 
no risk, trauma or pain."  Majority op., ¶42 (citing 384 U.S. at 
771).  The majority does not acknowledge, however, that the 
United States Supreme Court has recently emphasized the serious 
nature of a blood test. 
¶92 In Birchfield v. North Dakota, 136 S. Ct. 2160, 2178 
(2016), the Supreme Court explained that "[b]lood tests are a 
different matter [from breath tests].  They 'require piercing 
the skin' and extract a part of the subject's body." (citations 
omitted).  As Birchfield reasoned, although many people submit 
to blood draws, "the process is not one they relish."  Id.  
Additionally, the Birchfield court noted that blood samples "can 
be preserved and from which it is possible to extract 
information beyond a simple BAC reading."  Id. 
No. 2015AP656-CR.awb 
 
15 
 
¶93 Ignoring the serious and intrusive nature of a blood 
draw, the majority asserts that "[t]he important point for 
constitutional purposes is that the evidence demonstrated that 
[the EMT] was thoroughly trained and experienced in properly 
drawing blood."  Majority op., ¶44.  Schmerber was explicit, 
however, that "we reach this judgment only on the facts of the 
present record."  384 U.S. at 772.  Thus, it warned that in 
other circumstances, such as a blood draw administered at a 
jail, may not be constitutionally reasonable: 
Petitioner's blood was taken by a physician in a 
hospital environment according to accepted medical 
practices.  We are thus not presented with the serious 
questions which would arise if a search . . . were 
made by other than medical personnel or in other than 
a 
medical 
environment——for 
example, 
if 
it 
were 
administered 
by 
police 
in 
the 
privacy 
of 
the 
stationhouse.  To tolerate searches under these 
conditions might invite an unjustified element of 
personal risk of infection and pain. 
Id. at 771-72. 
¶94 In State v. Daggett, 2002 WI App 32, ¶¶8-15, 250 
Wis. 2d 112, 640 N.W.2d 546, the Wisconsin court of appeals 
addressed whether under Schmerber, a warrantless blood draw 
performed by a doctor in a police booking room was reasonable 
under the Fourth Amendment.  The majority parses Daggett, citing 
it only once for the proposition that a constitutionally 
reasonable blood draw can take place in a non-medical setting.  
Majority op., ¶45.  It does not, however, analyze where this 
case falls on the spectrum of reasonableness set forth in 
Daggett. 
No. 2015AP656-CR.awb 
 
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¶95 Daggett moved to suppress the results of the blood 
test on the grounds that the blood draw was unlawful because it 
took place in the county jail booking room, rather than in a 
hospital.  Daggett, 250 Wis. 2d 112, ¶5.  The Daggett court 
concluded that "the method used to take the blood sample was a 
reasonable one and was performed in a reasonable manner."  Id., 
¶14. 
¶96 According 
to 
the 
Daggett 
court, 
"[r]ather 
than 
establishing a bright-line rule, Schmerber recognized a spectrum 
of reasonableness."  Id., ¶15.  It explained that a blood draw 
by a medical professional in a medical setting is generally 
reasonable, but blood withdrawn by a non-medical professional in 
a non-medical setting would raise "serious questions" of 
reasonableness.  Id. (citation omitted).  Thus, under Daggett, a 
blood draw "in a jail setting may be unreasonable if it 'invites 
an unjustified element of personal risk of infection and pain.'"  
Id., ¶16 (citing Schmerber, 384 U.S. at 772). 
¶97 Under Daggett's spectrum of reasonableness, the blood 
draw here falls below the standard of anything that has 
previously been determined to be reasonable.  In Schmerber, the 
blood draw was performed by a physician in a hospital.  384 U.S. 
at 758.  The blood draw in Daggett took place in a jail, but was 
performed by a physician.  250 Wis. 2d 112, ¶4.  In this case, 
Kozel's blood draw was performed by an EMT-Intermediate in a 
jail. 
¶98 As such, this case represents the latter end of the 
Daggett spectrum of reasonableness.  Although a blood draw by an 
No. 2015AP656-CR.awb 
 
17 
 
EMT in a jail may not be per se unreasonable, it is unreasonable 
under the facts of this case.  As set forth above, there is no 
evidence of any written protocols or procedures in the record.  
Dr. Mendoza did not train the EMT, had never witnessed him 
perform a blood draw, nor had he ever approved of his blood draw 
techniques. 
¶99 Additionally, there are no protocols to ensure that 
the jail's blood draw room is sterile.  Admittedly, the EMT 
testified that the pre-booking room looked clean.  However, the 
pre-booking room where the blood draw was administered was also 
used to perform breathalyzer tests on those arrested for drunk 
driving and for miscellaneous storage.  According to the 
evidence, Dr. Mendoza had never been to the jail let alone 
inspected the pre-booking room where blood is drawn. 
¶100 Other than testimony regarding the fact that jail 
staff have a schedule for cleaning, which is initialed by the 
cleaner and posted on the wall, there is no other evidence that 
the pre-booking room in the jail meets the high sanitary 
standards of a hospital.  To the contrary, such an initialed and 
posted cleaning schedule is akin to those found in many 
department or convenience store restrooms. 
¶101 For 
example, 
the 
Wisconsin 
Administrative 
Code 
requires that hospitals maintain a sanitary environment, that 
sterilizing services be available at all times, and that a 
committee be established at each hospital to implement measures 
to make sure infections do not spread.  Wis. Admin. Code DHS 
§ 124.08(2), (4)(b) and (e).  The rules for jails are less 
No. 2015AP656-CR.awb 
 
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stringent, requiring only monthly sanitation inspections.  Wis. 
Admin. Code DOC § 350.12(13). 
¶102 It is a well-established principle that "[i]t is the 
duty of courts to be watchful for the constitutional rights of 
the citizen, and against stealthy encroachments thereon."  
Schneckloth v. Bustamonte, 412 U.S. 218, 229 (1973) (citation 
omitted).  Permitting blood draws in a jail without written 
protocols 
and 
procedures 
could 
erode 
Fourth 
Amendment 
protections beyond what was contemplated in Schmerber and 
Daggett. 
¶103 Given the absence of written protocols and procedures, 
the record here lacks the same evidence of safety and accuracy 
present in cases in which a blood draw has been determined to be 
constitutionally reasonable.  Thus, I determine that the 
evidentiary record is insufficient to conclude that the blood 
draw administered here was performed in a constitutionally 
reasonable manner. 
¶104 For the reasons set forth above, I respectfully 
dissent. 
¶105 I am authorized to state that Justice SHIRLEY S. 
ABRAHAMSON joins this dissent. 
 
No. 2015AP656-CR.awb 
 
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