Title: Richard Bubb v. William Brusky, MD
Citation: 2009 WI 91
Docket Number: 2007AP000619
State: Wisconsin
Issuer: Wisconsin Supreme Court
Date: July 24, 2009

2009 WI 91 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2007AP619 
COMPLETE TITLE: 
 
 
Richard Bubb and Marjorie Bubb, 
          Plaintiffs-Appellants-Petitioners, 
     v. 
William Brusky, MD, Saint Agnes Hospital, Xian 
Feng Gu, MD, Lakeside Neurocare Limited and 
Medical Protective Co., 
          Defendants-Respondents, 
West Bend Company, 
          Subrogated Defendant. 
 
 
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
2008 WI App 104 
Reported at: 313 Wis. 2d 187, 756 N.W.2d 584 
(Ct. App. 2008-Published) 
 
 
OPINION FILED: 
July 24, 2009   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
March 5, 2009   
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit   
 
COUNTY: 
Fond du Lac   
 
JUDGE: 
Robert J. Wirtz   
 
 
 
JUSTICES: 
 
 
CONCURRED: 
        
 
DISSENTED: 
        
 
NOT PARTICIPATING: ZIEGLER, J., did not participate.   
 
 
 
ATTORNEYS: 
 
For the plaintiffs-appellants-petitioners there were briefs 
by John L. Cates, Heath P. Straka, Susan M. Kurien, and Gingras, 
Cates & Luebke, S.C., Madison, and oral argument by Heath P. 
Straka. 
 
For the defendants-respondents, William Brusky, M.D. and 
Medical Protective Company, by Paul H. Grimstad, Ryan R. Graff, 
and Nash, Spindler, Grimstad & McCracken, Manitowoc, and oral 
argument by Paul H. Grimstad. 
 
An amicus curiae brief was filed by Michael B. Van Sicklen, 
Bree Grossi Wilde, and Foley & Lardner LLP, Madison, on behalf 
of Physicians Insurance Company of Wisconsin, Inc. 
 
 
 
2 
An amicus curiae brief was filed by Lynn R. Laufenberg and 
Laufenberg & Hoefle, S.C., Milwaukee, on behalf of the Wisconsin 
Association for Justice. 
 
 
 
 
2009 WI 91
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.  2007AP619   
(L.C. No. 
2003CV487) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
Richard Bubb and Marjorie Bubb, 
 
          Plaintiffs-Appellants-Petitioners, 
 
     v. 
 
William Brusky, MD, Saint Agnes Hospital, Xian 
Feng Gu, MD, Lakeside Neurocare Limited and 
Medical Protective Co., 
 
          Defendants-Respondents, 
 
West Bend Co., 
 
          Subrogated Defendant. 
 
 
 
FILED 
 
JUL 24, 2009 
 
David R. Schanker 
Clerk of Supreme Court 
 
 
 
 
 
REVIEW of a decision of the Court of Appeals.  Reversed and 
cause remanded.   
 
¶1 
DAVID T. PROSSER, J.   This is a review of a published 
decision of the court of appeals, Bubb v. Brusky, 2008 WI App 
104, 313 Wis. 2d 187, 756 N.W.2d 584, which affirmed the 
decision of the Fond du Lac County Circuit Court, Robert J. 
No. 
  2007AP619 
 
2 
 
Wirtz, Judge, to dismiss Richard and Marjorie Bubb's informed 
consent claim under Wis. Stat. § 448.30 (2007-08).1 
¶2 
The respondents state the issue as follows: "Did the 
evidence presented at trial establish an informed consent claim 
[under 
Wis. 
Stat. 
§ 448.30] 
against 
Dr. 
Brusky?" 
 
The 
petitioners ask whether "the trial court commit[ted] reversible 
error by precluding the jury from considering [their] informed 
consent claim?" 
¶3 
We conclude that Wis. Stat. § 448.30 requires any 
physician who treats a patient to inform the patient about the 
availability 
of 
all 
alternate, 
viable 
medical 
modes 
of 
treatment, including diagnosis, as well as the benefits and 
risks of such treatments.  The statute contains several 
reasonable exceptions to this requirement that limit the 
treating physician's duty to inform under the statute.  In this 
medical malpractice action, the plaintiffs filed a separate and 
distinct claim grounded in the requirements of § 448.30.  They 
presented sufficient evidence at trial to support such a claim.  
None of the statutory exceptions apply.  Hence, the circuit 
court's dismissal of the claim at the conclusion of trial 
evidence was error. 
¶4 
We reverse the decision of the court of appeals and 
remand the case to the circuit court for further proceedings 
consistent with this opinion. 
                                                 
1 All subsequent references to the Wisconsin Statutes are to 
the 2007-08 version unless otherwise indicated. 
No. 
  2007AP619 
 
3 
 
I. FACTS AND PROCEDURAL HISTORY 
¶5 
On October 24, 2001, Marjorie and Richard Bubb were 
eating dinner together when Marjorie noticed that Richard was 
having difficulty ingesting his food.  "I asked him what was 
wrong, if he was okay," Marjorie said, "and he said he was."  
But he wasn't.  When Richard fell out of his chair, Marjorie 
suspected that Richard was having a stroke.  She immediately 
called for help from a neighbor and then called an ambulance, 
which transported Richard to the emergency department of St. 
Agnes Hospital in Fond du Lac. 
¶6 
After arriving at St. Agnes, Richard was examined by 
Dr. William Brusky, an emergency medicine physician.2  Dr. Brusky 
ordered several tests for Richard, including a CT (computerized 
tomography) scan, an EKG (electrocardiogram), and various blood 
tests, to evaluate Richard's condition.  While Richard was at 
St. Agnes, his symptoms began to diminish, and he told both his 
wife and Dr. Brusky that he was feeling better and wanted to go 
home. 
¶7 
Based on Richard's test results and his improving 
condition, Dr. Brusky concluded that Richard had suffered a 
transient ischemic attack, otherwise known as a TIA.  A TIA 
occurs when a portion of the brain fails to receive enough 
oxygen, resulting in stroke-like symptoms.  According to one of 
                                                 
2 As an emergency medicine physician, Dr. Brusky did not 
have admitting privileges at St. Agnes Hospital.  To admit a 
patient to the hospital, Dr. Brusky would need to contact a 
consultant 
with 
admitting 
privileges. 
 
According 
to 
his 
testimony, "almost every consultant" has admitting privileges. 
No. 
  2007AP619 
 
4 
 
the Bubbs' experts, a TIA is an "atherosclerotic disease, 
[caused by] a build-up of cholesterol plaque, often called 
'hardening of the arteries,' that can diminish the heart's 
capacity to provide blood to the brain."  Unlike a stroke, where 
symptoms 
are 
permanent, 
TIA 
symptoms 
frequently 
resolve 
themselves within 24 hours.   
¶8 
Once Dr. Brusky had diagnosed Richard's condition, he 
telephoned Dr. Xian Feng Gu, a neurologist.  Dr. Gu was in a 
position to provide a more specialized assessment of Richard's 
condition and admit him to the hospital or provide follow-up 
treatment.  Dr. Brusky reviewed Richard's condition with Dr. Gu, 
who agreed to see Richard as a patient.  Following this 
conversation, Dr. Brusky instructed Richard to take some Aspirin 
and contact Dr. Gu the next morning for follow-up treatment.   
¶9 
Dr. Brusky then discharged Richard from the hospital 
with specific "Aftercare Instructions" for a person who has been 
diagnosed with TIA.3  Dr. Gu concurred with Dr. Brusky's decision 
to discharge Richard, with future treatment on an outpatient 
basis.    
                                                 
3 The "Aftercare Instructions" advised that a TIA "is a 
strong warning sign that a stroke could occur.  A stroke occurs 
in about 1/3 of those people who have had a TIA.  The TIA you 
had today shows that you are at risk for a stroke."  The 
instructions also directed Richard to contact Dr. Gu "as soon as 
possible to make an appointment."  Finally, the form instructed 
Richard to not smoke, take 325 mgs of Aspirin each morning, and 
call the doctor or go to the hospital if symptoms of a stroke 
should reoccur.  
No. 
  2007AP619 
 
5 
 
¶10 The following morning, October 25, Marjorie called Dr. 
Gu's office and scheduled the earliest available appointment——
November 5, 2001, which was 12 days after the October 24 
incident. 
¶11 On October 26, 2001, Marjorie returned home from work 
and found Richard on the bedroom floor pleading for help.  
Marjorie called for an ambulance, and Richard was taken to St. 
Joseph's Community Hospital in West Bend.  At St. Joseph's, 
doctors determined that Richard had suffered a large-scale 
stroke, affecting the right side of his brain.  The doctors at 
St. Joseph's discovered that Richard's right carotid artery, the 
blood vessel in his neck leading to the afflicted area of his 
brain, showed a 90-percent blockage.  The stroke debilitated 
Richard to an extent that he presently has no use of his left 
arm and cannot walk without using a cane.   
¶12 On September 3, 2003, the Bubbs filed a complaint 
against Drs. Brusky and Gu, alleging negligence in their care of 
Richard.  Specifically, the complaint alleged that Dr. Brusky 
negligently failed to comply with prevailing standards of 
medical care by not appropriately diagnosing and treating 
Richard's condition before it escalated into a stroke.  The 
Bubbs also alleged that Dr. Gu was negligent in failing to 
instruct his office staff that Richard's appointment should be 
prioritized, depriving Richard of timely treatment.  Finally, 
the Bubbs alleged that Dr. Brusky was liable for failing to 
properly inform Richard of "additional diagnostic tests or 
No. 
  2007AP619 
 
6 
 
alternate treatment plans" in lieu of discharge from the 
hospital.  
¶13 At trial, several experts provided testimony regarding 
the treatment Richard received at St. Agnes Hospital, the 
alternative courses of action that could be employed when a 
physician is presented with a TIA, and the role of an emergency 
room physician.  For example, the Bubbs presented evidence 
indicating that Dr. Brusky should have informed Richard that one 
alternative to discharge was admission to the hospital for 
further diagnostic testing to determine the cause of the TIA.  
According to one of the Bubbs' experts, Dr. Burton Bentley II, a 
Doppler ultrasound is a testing protocol that helps determine 
carotid artery blockage and helps doctors determine whether a 
patient is at imminent risk of a stroke.  Dr. Bentley testified 
that conducting a Doppler ultrasound is part of the standard of 
care for TIA patients in order for the treating physician to 
know whether the patient requires immediate additional treatment 
to prevent the TIA from becoming a large-scale stroke.   
¶14 Dr. Brusky agreed during his testimony that admitting 
the patient and performing additional diagnostics, like the 
Doppler ultrasound, was a reasonable alternative course of 
treatment: 
Q 
[Judith E. Tintinalli et al., Emergency Medicine: 
A Comprehensive Study Guide (5th ed. 2000)] says, 
"Patients with new onset TIAs should be admitted 
for evaluation of possible cardiac sources of 
TIAs 
or 
high-grade stenosis in the carotid 
arteries.  The incidence of stroke after" the 
"TIA may be as high as 20 to 25 percent in the 
No. 
  2007AP619 
 
7 
 
first year, with the highest incidence in the 
first month.  Because of proven efficacy of 
carotid 
endarterectomy, 
patients 
should 
be 
admitted 
unless 
high-grade 
stenosis 
of 
the 
carotid artery can be ruled out."  Did I read 
that correctly? 
A 
That is correct. 
. . . . 
Q 
[According to Tintinalli, supra], "Patients with 
new-onset TIAs should be evaluated for possible 
cardiac sources of TIAs or high-grade stenosis in 
the carotid arteries."  Correct? 
A 
Yes. 
Q 
And that the highest incidence of stroke is 
within the first month, correct? 
A 
Yes. 
Q 
Now, you certainly would agree that it is 
reasonable medicine to admit a patient and order 
Doppler ultrasound, correct? 
A 
No.  It's——it's reasonable, I agree, but it's not 
necessarily what's done. 
Q 
I'm not saying that you don't——you testified that 
you don't do it, sir.  But you would agree that 
there are many reasonable physicians that do? 
A 
There are many ways of treating TIAs and this is 
one of the reasonable ways of doing it. 
¶15 In response to the Bubbs' claims, Dr. Brusky presented 
evidence showing that there is an "ongoing debate in the medical 
community about how to address suspected TIA episodes after the 
initial evaluation."  For example, Dr. Robert Stuart testified 
that "some medical institutions admit all TIA patients while 
others discharge them with a referral to a neurologist."  Dr. 
Robert Powers testified that there is considerable debate and 
No. 
  2007AP619 
 
8 
 
varied practice within the medical community over whether to use 
carotid Doppler ultrasounds in evaluating TIAs or whether to 
discharge a TIA patient with instructions for subsequent follow-
up care with a specialist.   
¶16 Furthermore, Dr. Powers noted that "an emergency 
department 
physician 
must 
make 
a 
general 
assessment 
and 
stabilize the patient, create a differential diagnosis and make 
an additional disposition or referral for additional care."  Dr. 
Powers opined that Dr. Brusky performed the essential duties of 
an emergency room physician by diagnosing and stabilizing 
Richard and then referring him to a specialist whose expertise 
is better suited for long-term treatment.  Dr. Powers also 
testified that, unless they have some additional specialty, 
emergency room physicians generally should not admit TIA 
patients because they lack neurological expertise.   
¶17 At the close of evidence, the Bubbs submitted their 
proposed jury instructions, which included Wis JI——Civil 1023.2 
(2009),4 the instruction for informed consent claims under Wis. 
Stat. § 448.30.  The Bubbs also submitted the special verdict 
questions for informed consent,5 which are contained in Wis JI——
Civil 1023.1 (2006).6 
                                                 
4 All subsequent references to Wis JI——Civil 1023.2 (2009) 
are to the 2009 version unless otherwise indicated. 
5 The record before this court does not include the Bubbs' 
proposed special verdict questions.  It appears as though those 
questions were attached to some submission of the Bubbs.  We do 
not know. 
No. 
  2007AP619 
 
9 
 
¶18 On December 19, 2006, Judge Wirtz conducted off-the-
record discussions with the parties regarding jury instructions 
and the special verdict form related to the Bubbs' informed 
consent claim against Dr. Brusky.  After those discussions 
concluded, Judge Wirtz stated on the record that he and the 
parties "had a rather lengthy discussion in this case about 
whether 
[Wis 
JI——Civil] 
1023.2, 
the 
informed 
consent 
instruction, [would] be given" and that he had decided not to 
give the instruction to the jury.  Following his statement, 
Judge Wirtz gave both parties the opportunity to summarize their 
arguments on the record, pursuant to State v. Munoz, 200 
Wis. 2d 391, 403, 546 N.W.2d 570 (Ct. App. 1996) (stating that 
"it is essential that the subsequent on-the-record comments 
repeat or summarize the arguments and confirm exactly what was 
presented to the trial court at the time of its ruling").   
¶19 The Bubbs' attorney took the opportunity, and he 
summarized his arguments as follows: 
The legislature passed a statute, 448.30, and 
basically created a standard of care for doctors to 
inform 
patients 
about 
the 
availability 
of 
all 
alternative viable medical modes of treatment and 
about 
the 
benefits 
and 
risks 
of 
those 
treatments. . . . 
                                                                                                                                                             
However, the late Paul H. Grimstad, attorney for Dr. 
Brusky, forthrightly acknowledged at oral argument that the 
special verdict questions contained in Wis JI——Civil 1023.1 
(2006) were submitted by opposing counsel.  We appreciate 
Attorney Grimstad's honesty and integrity in this matter.  
6 All subsequent references to Wis JI——Civil 1023.1 (2006) 
are to the 2006 version unless otherwise indicated. 
No. 
  2007AP619 
 
10 
 
 
Now, I have elicited from every one of the 
defense experts that having a Doppler evaluation in a 
speedy manner that night or the following morning was 
a well-recognized form of treatment and, furthermore, 
the 
doctors 
all 
agree 
that 
a 
patient 
who 
is 
[discharged 
from] 
the 
hospital 
without 
proper 
evaluation has . . . as much as a 5 percent chance of 
having a stroke within 48 hours.  The informed consent 
statute clearly talks to this.  It says . . . a doctor 
has 
the 
duty 
to 
provide 
his 
patient 
with 
the 
information necessary to enable the patient to make an 
informed decision about diagnostic treatment or a 
procedure 
and 
alternative 
choices 
of 
diagnostic 
treatments and procedures.  If the doctor fails to do 
that, he's negligent. 
 
. . . . 
 
There 
is 
no 
question 
that . . . Dr. 
Brusky 
admitted that the advice given by Tintinalli[, supra,] 
and 
the 
other 
people 
in 
the 
textbooks 
was 
an 
alternative form of treatment, whether he provided it 
or got someone else to provide it. . . .  
 
There's no question in this case that everybody 
agrees that a highly stenosed carotid artery puts 
[Richard] at higher risk for having an early stroke.  
Is that information that can be told to him?  Yes.  
[Are] there diagnostic tests that can be done to rule 
that out?  Yes. . . .  And then the [c]ourt in Martin 
[v. Richards, 192 Wis. 2d 156, 176, 531 N.W.2d 70 
(1995),] says, "[T]here is a duty imposed on the 
physician to disclose to the patient the existence of 
any methods of diagnosis or treatment that would serve 
as feasible alternatives to the method initially 
selected by the physician to diagnose or treat the 
patient's illness or injur[y]."  Well, what was Dr. 
Brusky's initial method?  His initial method was to do 
the tests that he did in the ER room and send him 
home.  What were the alternatives?  The alternatives 
were to tell him about the other diagnostic tests that 
can be done, and how quickly they can be done, and 
what the purpose of those things can be.  That is, 
clearly, what the [Martin] case is talking about. 
 
And when you look at the informed consent 
instruction, it says that you have to tell him about 
alternative choices.  It says, "The doctor must inform 
No. 
  2007AP619 
 
11 
 
the 
patient 
whether 
a 
diagnostic 
procedure 
is 
ordinarily performed in the circumstances confronting 
the patient, whether alternative procedures approved 
by the medical profession are available," and "what 
the outlook is for success or failure of each 
alternative procedure." . . .   
 
. . .  Every single physician that I questioned 
agreed that the alternative reasonable treatment would 
be to hospitalize [Richard] and do a Doppler that 
night.  They could have done a Doppler, they could 
have hospitalized him or, at least, inform him of the 
risks of not doing that procedure and the fact that 
they could get it done first thing in the morning, if 
necessary. 
 
. . . . 
 
In . . . the Martin case, the [s]upreme [c]ourt 
basically says, when it starts out, "This requires us 
to determine whether there was any credible evidence 
for the jury to determine whether Dr. Richards was 
negligent in failing to inform."  Any credible 
evidence.  There is so much credible evidence in this 
record, it's spilling out of the courtroom.  Every 
single person talked about the alternative method of 
treatment.  Every single person.  And every single 
person said yes, that would be a fine thing if you 
wanted to do that. . . .  
 
. . . . 
 
You have to tell [the patients] about the test.  
You have to tell them about it and——if you [have it] 
available, and you have to tell them about the 
significance of it and why it's important, and if it's 
not available immediately tonight, we can do it in the 
morning.  You have to tell them about these things so 
that they can make a decision, so that the man doesn't 
leave the hospital blindly, not knowing anything about 
what could happen to him, not knowing that this 
condition could be ruled out and, boom, he has a 
stroke.  That's the whole purpose.  The duty is to 
inform the . . . patient. 
¶20 Dr. Brusky's attorney declined the invitation to 
summarize his off-the-record arguments: 
No. 
  2007AP619 
 
12 
 
 
Well, my understanding is the [c]ourt's ruled and 
read the Martin case.  We had a long debate about this 
earlier this afternoon.  I disagree with counsel.  I 
don't think the Martin case is applicable.  I could go 
through the whole litany, if you want me to, of why, 
as far as Dr. Brusky is concerned, this is not an 
informed consent case, but the [c]ourt's heard it and 
the [c]ourt's ruled. 
 
THE COURT:  You wish to make a record about what 
you said earlier? 
 
[Dr. Brusky's Attorney]:  No, I don't think I 
have to.  You're ruling that you're not going to give 
informed consent and that's good enough for me. 
¶21 After allowing the parties the opportunity to make a 
record of their arguments, Judge Wirtz summarized his reasoning 
for not giving the informed consent jury instructions and 
special verdict questions.  Distinguishing Martin, Judge Wirtz 
stated that, in Martin, the doctor "had no diagnosis and had a 
test 
that 
he 
could 
run 
in 
order 
to 
specifically 
rule 
out . . . what he was wondering about."  According to Judge 
Wirtz, Dr. Brusky made a "specific diagnosis" of TIA that every 
expert agreed was correct, and "[Richard] was then told this 
[TIA] puts you at risk for stroke[,] [y]ou should have follow-up 
soon[,] and a consultation was made to do that follow-up."  
Therefore, Judge Wirtz concluded, "[T]he facts between this case 
and Martin are quite different."  Judge Wirtz also found 
significant that the carotid Doppler ultrasound would not have 
been performed until the next day, which he said raised "serious 
causation questions" for the informed consent claim.  Finally, 
Judge Wirtz distinguished the informed consent claims against 
Dr. Brusky and Dr. Gu because, as the consulting physician 
No. 
  2007AP619 
 
13 
 
rather than the treating physician, Dr. Gu had no duty to inform 
Richard of the diagnostic alternatives.    
¶22 Following Judge Wirtz's decision not to give the 
informed 
consent 
jury 
instructions 
and 
special 
verdict 
questions, the jury returned a verdict of no negligence on the 
part of either Drs. Brusky or Gu in the standard of care they 
delivered to Richard. 
¶23 The Bubbs brought a motion after the verdict for a new 
trial, pursuant to Wis. Stat. § 805.15(1), arguing that the 
jury's verdict was contrary to law and there were reversible 
errors in the trial.  Specifically, the Bubbs claimed that Judge 
Wirtz improperly withheld the informed consent jury instructions 
and special verdict questions from the jury's consideration.  
Judge Wirtz dismissed the Bubbs' motion for a new trial and 
entered judgment against them and their insurer, The West Bend 
Company, "for their respective statutory costs, disbursements, 
and attorney's fees, according to the law."7  The Bubbs appealed. 
¶24 The Bubbs' principal argument in the court of appeals 
was that the jury "should have been properly instructed on an 
informed consent question and given the opportunity to resolve 
it."  Bubb, 313 Wis. 2d 187, ¶14.  The majority opinion affirmed 
the 
circuit 
court's 
decision 
that 
Dr. 
Gu, 
a 
consulting 
physician, had no duty to provide information to a patient he 
was not treating.  Id., ¶21.  Accordingly, the court of appeals 
                                                 
7 The court's judgment awarded Dr. Brusky and his insurer, 
Medical Protective Company, $9,689.88; the judgment awarded Dr. 
Gu and his insurer, Lakeside Neurocare, LMPC, $7,169.12. 
No. 
  2007AP619 
 
14 
 
held that Dr. Gu could not be liable for failing to properly 
inform Richard.  Id.   
¶25 The court of appeals also discussed Wis. Stat. 
§ 448.30 in some detail.  "The informed consent statute requires 
that the patient be informed of alternatives that are available 
and viable."  Id., ¶22.  The court continued with the following: 
Dr. Brusky did not have admitting privileges at St. 
Agnes Hospital and, therefore, hospitalizing Richard 
was not a viable option. . . .  Dr. Brusky testified 
that . . . he 
did 
not 
know 
of 
any 
ultrasound 
technician on call for the emergency department that 
night. . . .  [T]he Bubbs' evidence did not establish 
that a carotid Doppler ultrasound was a viable 
alternative treatment for Richard's properly diagnosed 
TIA.   
Id., ¶¶26-27.   
¶26 Additionally, 
the 
court 
of 
appeals 
dedicated 
significant time to addressing the Bubbs' arguments in regards 
to Martin.  The court noted that the doctor in Martin failed to 
inform the patient on two important issues: (1) that a CT scan 
was available and could detect intracranial bleeding; and (2) 
that the hospital was not equipped to treat intracranial 
bleeding if it should occur or be found.  See id., ¶24.  Because 
Dr. Brusky correctly diagnosed Richard's condition, and because 
there was no apparent consensus in the medical community 
mandating that physicians perform carotid Doppler ultrasounds to 
detect artery blockage in patients suffering a TIA, the court of 
appeals affirmed the circuit court's decision.  See id., ¶26. 
¶27 Judge Brown wrote a dissenting opinion, the thrust of 
which is as follows:  
No. 
  2007AP619 
 
15 
 
For me the question in this case is simply this: When 
there is widespread debate in the medical community 
about two distinct protocols for addressing a medical 
condition, must the treating physician inform the 
patient of the alternatives?  In my view, that 
question is answered "yes" by W[is]. S[tat]. § 448.30, 
which states that "any physician who treats a patient 
shall inform the patient about the availability of all 
alternate, viable medical modes of treatment and about 
the benefits and risks of these treatments."   
Id., ¶31.  Judge Brown characterized the language in Martin as 
properly framing the inquiry: "'[W]hat would a reasonable person 
in the patient's position want to know in order to make an 
intelligent decision with respect to the choices of treatment or 
diagnosis?'"  Id., ¶32 (quoting Martin, 192 Wis. 2d at 176).  
Further, Judge Brown reasoned that "the statute is not about 
whether the doctor makes the right medical decision, but rather 
about 
whether 
the 
doctor 
provides 
the 
patient 
with 
the 
information that the patient needs to make a decision of his or 
her own."  Id.  Because Dr. Brusky proceeded down one course of 
action——no admission with instructions for follow-up care——
without informing Richard of the alternative course of action——
admission with further diagnostic testing——Judge Brown would 
have held that Dr. Brusky failed to properly inform Richard of 
available and viable alternatives, as required by the statute.  
See id., ¶33.   
¶28 Following the decision of the court of appeals, the 
Bubbs petitioned this court for review, arguing for a new trial 
against Dr. Brusky on the issue of informed consent.  We granted 
the petition for review on September 11, 2008. 
No. 
  2007AP619 
 
16 
 
 
II. STANDARD OF REVIEW 
¶29 In this case, the Bubbs' informed consent claim 
against Dr. Brusky was pleaded in the complaint, argued at 
trial, and dismissed at the close of evidence before going to 
the jury.  The procedural mechanism used by the circuit court to 
dismiss the claim is not clear because Dr. Brusky did not file a 
motion to dismiss, and the record does not reveal the authority 
the circuit court used in making its decision.  However, we note 
that a party may move to dismiss a claim at the close of 
evidence under Wis. Stat. § 805.14(4), before the case goes to 
the jury.   
¶30 A motion under Wis. Stat. § 805.14(4) challenges the 
sufficiency of the evidence presented and allows a claim to be 
dismissed, as a matter of law, if the circuit court "is 
satisfied that, considering all credible evidence and reasonable 
inferences therefrom in the light most favorable to the party 
against whom the motion is made, there is no credible evidence 
to sustain a finding in favor of such party."  Wis. Stat. 
§ 805.14(1), (4) (emphasis added).  Although there was no motion 
submitted in this case, we treat the circuit court's dismissal 
of the informed consent claim against Dr. Brusky as if a motion 
had been made under Wis. Stat. § 805.14(4). 
¶31 To determine whether the circuit court erred when it 
decided, as a matter of law, that the Bubbs did not present a 
claim against Dr. Brusky under Wis. Stat. § 448.30, we review 
the court's decision to resolve whether there was any credible 
No. 
  2007AP619 
 
17 
 
evidence in the record for the jury to determine that Dr. Brusky 
was negligent in failing to adequately inform the Bubbs 
regarding "alternate, viable medical modes of treatment"8 for 
Richard's TIA.9  Wis. Stat. § 805.14(1), (4); Martin, 192 
Wis. 2d at 167; see also Christianson v. Downs, 90 Wis. 2d 332, 
334-35, 279 N.W.2d 918 (1979) 
A motion for dismissal for insufficiency of the 
evidence should not be granted unless there is no 
credible evidence to support a finding in favor of the 
plaintiff when all credible evidence and reasonable 
inferences therefrom are considered in the light most 
favorable to the plaintiff.  This test serves the 
purpose of preserving a litigant's right to a jury 
determination of factual disputes.   
¶32 This case also involves the interpretation of Wis. 
Stat. § 448.30.  Statutory interpretation presents a question of 
law that this court reviews de novo.  Rechsteiner v. Hazelden, 
2008 WI 97, ¶26, 313 Wis. 2d 542, 753 N.W.2d 496. 
                                                 
8 Wisconsin Stat. § 448.30. 
9 Dr. Brusky argues that we should review the circuit 
court's decision under the erroneous exercise of discretion 
standard because the circuit court is allowed discretion in 
choosing how to instruct the jury.  Indeed, the circuit court 
has broad discretion in fashioning the form of the jury 
instructions and special verdict questions submitted to the 
jury.  See State v. Lenarchick, 74 Wis. 2d 425, 455, 247 
N.W.2d 80 (1976).  However, as the court of appeals stated, 
"This is not a situation where the court rejected certain 
wording or companion instructions relevant to a particular 
claim; rather, the court rejected a distinct cause of action."  
Bubb v. Brusky, 2008 WI App 104, ¶17, 313 Wis. 2d 187, 756 
N.W.2d 584.  Because the circuit court completely disposed of 
the Bubbs' distinct claim for informed consent under Wis. Stat. 
§ 448.30, we do not review its decision as an exercise of 
discretion.  See id.  
No. 
  2007AP619 
 
18 
 
III. DISCUSSSION 
¶33 The Bubbs contend that the circuit court committed 
reversible error by improperly dismissing their informed consent 
claim.  They assert that an informed consent claim under Wis. 
Stat. 
§ 448.30 
is 
"separate 
and 
distinct" 
from 
medical 
negligence claims alleging breaches of the standard of care.   
¶34 After establishing that their informed consent claim 
is separate and distinct from any other claim, the Bubbs focus 
attention on this court's decision in Martin, suggesting that 
their case is indistinguishable from Martin.  The Bubbs point to 
the following similarities:  
(A) In both cases, the treating physician was an emergency 
medicine physician without admitting privileges.  
(B) In both cases, there was a firm diagnosis.  In Martin, 
the patient was diagnosed with a concussion; in this 
case, the patient was diagnosed with a TIA. 
(C) In both cases, there was a failure to inform the 
patient of alternative diagnostic tests that could 
have been performed.  In Martin, there was a failure 
to inform the patient about the availability of a CT 
scan; in this case, there was a failure to inform the 
Bubbs 
about the alternative course of admitting 
Richard to the hospital and performing a Doppler 
ultrasound. 
(D) In both cases, the plaintiffs' standard of care claims 
were unsuccessful. 
No. 
  2007AP619 
 
19 
 
(E) In both cases, the plaintiffs' informed consent claims 
were dismissed by the circuit court judge.  In Martin, 
the claim was dismissed pursuant to a motion after the 
jury's verdict; in this case, the claim was dismissed 
without a motion before going to the jury. 
¶35 The Bubbs argue that because this court affirmed the 
court of appeals' reversal of the circuit court's decision in 
Martin dismissing the informed consent claim, it should conclude 
here that the Bubbs presented a prima facie case under Wis. 
Stat. § 448.30 that should have been resolved by a jury. 
¶36 Although the Bubbs admit that the decisions of whether 
to admit Richard and to perform additional diagnostic testing, 
such 
as 
the 
carotid 
Doppler 
ultrasound, 
were 
"medical 
decision[s] left to the judgment of the physicians," they assert 
that, under Martin, Richard "had an absolute right to know about 
the[] alternatives and choose for himself."  For support, the 
Bubbs quote the following statement from Martin: 
It may well be a "medical decision" under these 
circumstances to decide not to do a CT scan, or to 
decide not to hospitalize the patient in a hospital 
that can treat an intracranial bleed if it should 
occur.  The statute on its face says, however, that 
the 
patient 
has 
the 
right 
to 
know, 
with 
some 
exceptions, that there are alternatives available.  
The 
doctor might decide against the alternative 
treatments or care, he might try to persuade the 
patient against utilizing them, but he must inform 
them when a reasonable person would want to know.  
Here, Mr. Martin could have decided to have a CT scan 
done or could have decided to take Ms. Martin to 
another hospital with a neurosurgeon. 
Martin, 192 Wis. 2d at 181. 
No. 
  2007AP619 
 
20 
 
¶37 The Bubbs' argument is that, "[w]hile Dr. Brusky made 
the medical decision not to admit [Richard] and perform a 
carotid Doppler ultrasound, the analysis does not end" there 
because Richard, like the Martins, had a right to know all 
viable alternatives to the treatment he received. 
¶38 The Bubbs also take issue with the procedure used by 
the circuit court to dismiss their informed consent claim.  The 
Bubbs argue that the circuit court dismissed their claim without 
a motion pending before it.  Consequently, they assert that the 
circuit court's "decision was improper as a matter of law."   
¶39 The Bubbs state that the only authority that allows a 
circuit court to dismiss a properly pleaded claim is found in 
Wis. Stat. § 805.14(3), governing a motion to dismiss at the 
close of the plaintiff's case, and Wis. Stat. § 805.14(4), 
governing a motion for a directed verdict at the close of all 
evidence.  According to the Bubbs, neither subsection is 
appropriate unless "there is no credible evidence to sustain a 
finding in favor of the plaintiff's claim."  The Bubbs contend 
that it was inappropriate for the circuit court to invoke either 
subsection of Wis. Stat. § 805.14 in eliminating their informed 
consent claim because "it is undisputed that" Dr. Brusky did not 
move the court to make such a determination and "the Bubbs 
presented more than enough evidence" to send their informed 
consent claim to the jury. 
¶40 For example, the Bubbs reason that evidence presented 
by the defense and Dr. Brusky's own testimony established that 
admission to the hospital for further diagnostic testing using 
No. 
  2007AP619 
 
21 
 
the carotid Doppler ultrasound was a well-accepted, alternative 
course of action that could have been employed in treating 
Richard's TIA.   
¶41 The Bubbs also contend that the circuit court must 
have concluded there was sufficient evidence establishing the 
availability of alternative courses of action in treating 
Richard's condition.  Otherwise, they claim, the court would not 
have included the optional paragraph in the standard medical 
negligence jury instruction——a paragraph that is to be used, as 
it expressly states, "only if there is evidence of two or more 
alternative methods of treatment or diagnosis recognized as 
reasonable."  Wis JI——Civil 1023 (2009).10 
¶42 Finally, the Bubbs conclude their argument by stating 
that, if a carotid Doppler ultrasound had been performed on 
Richard either that night or the next day at the hospital, then 
Richard's 90-percent stenosed carotid artery would have been 
diagnosed prior to his stroke.  The Bubbs reason that, because 
Richard 
was 
sent 
home 
without 
having 
a 
carotid 
Doppler 
ultrasound performed and he developed a stroke before receiving 
follow-up treatment, the failure to inform Richard of the 
alternative courses of action available was a cause of the 
debilitating injuries he suffered following the stroke. 
¶43 In response, Dr. Brusky presents four arguments to 
rebut the Bubbs' contention that their informed consent claim 
                                                 
10 All subsequent references to Wis JI——Civil 1023 (2009) 
are to the 2009 version unless otherwise indicated. 
No. 
  2007AP619 
 
22 
 
was improperly dismissed.  First, Dr. Brusky asserts that he 
treated Richard on an emergency basis only and he satisfied all 
his duties as an emergency medicine physician.  He contends he 
never proposed to treat Richard for his underlying neurological 
condition——the stenosed carotid artery——and therefore, "he had 
no duty to inform [Richard] about tests that a neurologist might 
recommend in follow-up."  Dr. Brusky argues that requiring more 
from an emergency medicine physician would "impose upon [such an 
emergency physician] a duty to be, in effect, a specialist in 
numerous medical specialties." 
¶44 Second, Dr. Brusky maintains that this case was a 
standard of care case, not an informed consent case.  He claims 
"[t]he mere fact that there is a dispute on how patients should 
be managed does not necessarily trigger an informed consent 
claim" because the doctor may reasonably employ any one of the 
available options without breaching his standard of care.  
Ultimately, Dr. Brusky argues that "choosing between two 
recognized 
methods 
[of 
treatment 
or 
diagnosis] 
doesn't 
necessarily mean that the physician must instruct the patient on 
the other recognized method." 
¶45 Third, Dr. Brusky disputes the Bubbs' argument that 
this case is analogous to Martin.  He agrees with the circuit 
court and the court of appeals that the two cases are 
distinguishable.  Specifically, Dr. Brusky notes that both lower 
courts found it significant that he made a correct diagnosis of 
Richard's condition, whereas the doctor in Martin did not make 
the correct diagnosis.  Therefore, Dr. Brusky argues that the 
No. 
  2007AP619 
 
23 
 
diagnostic tests in question in Martin and this case differ 
significantly in that the test in Martin would have been used to 
make the correct diagnosis.  Here, Dr. Brusky claims he made the 
correct diagnosis from the beginning, and the carotid Doppler 
ultrasound "was part of the follow-up for the underlying 
condition."    
¶46 Finally, Dr. Brusky takes the position that the 
circuit court properly withheld the Bubbs' informed consent 
claim from the jury because it failed to establish causation.  
His reasoning is twofold: (1) it is "speculative at best" as to 
whether all the necessary preconditions for getting Richard to 
surgery would have been completed before his stroke; and (2) it 
is questionable as to whether a carotid Doppler ultrasound 
"could have been completed on" the night Richard presented to 
the emergency room at St. Agnes.  Essentially, Dr. Brusky argues 
that, 
even if Richard would have been informed of the 
alternative course of treatment of admission and further 
testing, it is debatable whether anything could have been done 
to save Richard from having a stroke. 
A. 
Wisconsin's Common Law Informed Consent Doctrine 
¶47 Wisconsin courts developed a common law doctrine of 
informed consent before 1982, the year in which Wis. Stat. 
§ 448.30 was adopted.11  See, e.g., Scaria v. St. Paul Fire & 
Marine Ins. Co., 68 Wis. 2d 1, 11, 227 N.W.2d 647 (1975); Trogun 
v. Fruchtman, 58 Wis. 2d 569, 596, 207 N.W.2d 297 (1973).  The 
                                                 
11 See § 2, ch. 375, Laws of 1981 (effective May 7, 1982).  
No. 
  2007AP619 
 
24 
 
doctrine originally developed as a tort claim for intentional 
battery in recognition of "the fundamental notion of the right 
to bodily integrity."  Johnson v. Kokemoor, 199 Wis. 2d 615, 
628, 545 N.W.2d 495 (1996); see also Hannemann v. Boyson, 2005 
WI 94, ¶34, 282 Wis. 2d 664, 698 N.W.2d 714 (citing Trogun, 58 
Wis. 2d at 596); Martin, 192 Wis. 2d at 170.12   
¶48 In the classic situation giving rise to a common law 
informed consent claim, a patient would "consent[] to a certain 
type of operation but, in the course of that operation, [would 
be] subjected to other, unauthorized operative procedures."  
Johnson, 199 Wis. 2d at 628-29 (citing as examples Paulsen v. 
Gundersen, 218 Wis. 578, 584, 260 N.W. 448 (1935) and Throne v. 
Wandell, 176 Wis. 97, 186 N.W. 146 (1922)).  Common law informed 
consent claims also included cases "where the patient had not 
received [adequate] information about the risks associated with 
the medical procedure."  Martin, 192 Wis. 2d at 170.   
¶49 This latter category of informed consent cases, where 
the doctor simply failed to disclose risks associated with a 
certain treatment, "fit uncomfortably, or not at all, within the 
intentional, antisocial nature of battery."  Id. at 171; see 
also Trogun, 58 Wis. 2d at 598-600.  Consequently, in 1973, the 
                                                 
12 In other words, "[t]he [common law] obligation to secure 
informed consent before performing a procedure was premised on 
the notion that 'a person of sound mind has a right to 
determine, even as against his physician, what is to be done to 
his body.'"  Hannemann v. Boyson, 2005 WI 94, ¶34, 282 
Wis. 2d 664, 698 N.W.2d 714 (quoting Trogun v. Fruchtman, 58 
Wis. 2d 569, 596, 207 N.W.2d 297 (1973)).   
No. 
  2007AP619 
 
25 
 
Wisconsin Supreme Court changed course and held that "it is 
preferable to affirmatively recognize a legal duty, bottomed 
upon a negligence theory of liability, in cases wherein it is 
alleged the patient-plaintiff was not informed adequately of the 
ramifications of a course of treatment."13  Trogun, 58 Wis. 2d at 
600 (emphasis added).14   
                                                 
13 In Trogun, this court set forth the following reasons as 
to why a treating physician's failure to disclose information 
regarding a course of medical treatment should not be considered 
akin to battery: (1) "physicians are invariably acting in good 
faith and for the benefit of the patient," unlike the typical 
battery situation where the defendant unlawfully makes physical 
contact with another; (2) failure to provide information is not 
likely an intentional act on the part of the physician; (3) "the 
act complained of in informed consent cases is not within the 
traditional idea of 'contact' or 'touching'" contemplated by 
battery; (4) "a valid question exists with respect to whether a 
physician's malpractice insurance covers liability for an 
arguably 'criminal' act——battery"; and (5) failing to provide 
adequate disclosure "do[es] not fit the traditional mold of 
situations[, such as battery,] wherein punitive damages can be 
awarded."  Trogun, 58 Wis. 2d at 598-600.   
Additionally, 
Dean 
William 
L. 
Prosser 
gives 
a 
contemporaneous account of the development in the law of 
informed consent as a whole: 
A considerable number of late cases have involved the 
doctrine of "informed consent," which concerns the 
duty of the physician or surgeon to inform the patient 
of the risk which may be involved in treatment or 
surgery.  The earliest cases treated this as a matter 
of vitiating the consent, so that there was liability 
for battery.  Beginning with a decision in Kansas in 
1960, it began to be recognized that this was really a 
matter of the standard of professional conduct, since 
there will be some patients to whom disclosure may be 
undesirable or even dangerous for success of the 
treatment or the patient's own welfare; and that what 
should be done is a matter for professional judgment 
in the light of the applicable medical standards.  
Accordingly, the prevailing view now is that the 
No. 
  2007AP619 
 
26 
 
¶50 Trogun stated that, in general, "[t]he negligence 
theory of liability has taken many shapes, although common to 
all is the existence of the duty to disclose or warn on the part 
of a physician and exposure to negligence liability when such 
duty is not properly discharged."  Id. at 598 (emphasis added).  
In particular, the court endorsed the standard set forth by the 
U.S. Court of Appeals in Canterbury v. Spence, 464 F.2d 772, 781 
(D.C. Cir. 1972), which stated that for a physician to fully 
satisfy the standard of due care, she must inform the patient 
"of any risks to his well-being which contemplated therapy may 
involve."  See Trogun, 58 Wis. 2d at 600.   
¶51 Trogun also recognized that the standard for adequate 
disclosure 
was 
"not 
'dependent 
upon 
the 
existence 
and 
nonperformance 
of 
a 
relevant 
professional 
tradition,' 
                                                                                                                                                             
action, regardless of its form, is in reality one for 
negligence in failing to conform to the proper 
standard, to be determined on the basis of expert 
testimony as to what disclosure should be made. 
William L. Prosser, Handbook of the Law of Torts § 32 at 165 
(4th ed. 1971) (internal footnotes omitted). 
14 See also Hannemann, 282 Wis. 2d 664, ¶35 ("In Trogun, 
this court determined that it was no longer appropriate to treat 
the failure to obtain informed consent as an assault and battery 
and instead 'recognized a legal duty, bottomed upon a negligence 
theory of liability . . . .'" (quoting Trogun, 58 Wis. 2d at 
600)); Johnson v. Kokemoor, 199 Wis. 2d 615, 629, 545 N.W.2d 495 
(1996) ("The court further developed the doctrine of informed 
consent in Trogun[], stating for the first time that a 
plaintiff-patient could bring an informed consent action based 
on negligence rather than as an intentional tort."); Martin v. 
Richards, 192 Wis. 2d 156, 171, 531 N.W.2d 70 (1995) ("[T]he 
basis for liability in informed consent cases changed to a 
negligence theory of liability."). 
No. 
  2007AP619 
 
27 
 
[Canterbury, 464 F.2d at 783,] and [was] to be judged by that 
conduct which is reasonable under the circumstances," Trogun, 58 
Wis. 2d at 600 (citing Canterbury, 464 F.2d at 785) (internal 
footnotes omitted).  What is reasonable under the circumstances, 
Trogun observed, "must be measured by the patient's 'objective' 
need for information material to his decision."  Id. at 601 
(citing Canterbury, 464 F.2d at 787) (emphasis added); see also 
Cobbs v. Grant, 502 P.2d 1, 11 (Cal. 1972) ("[T]he patient's 
right of self-decision is the measure of the physician's duty to 
reveal.").   
¶52 Moreover, according to Trogun, if the failure to 
inform could be established by a plaintiff using the above 
standard, then liability would attach if the plaintiff could 
demonstrate "a causal connection between the physician's failure 
to disclose and the injury to the patient."  Trogun, 58 
Wis. 2d at 602 (citing Cobbs, 502 P.2d at 11).  The Trogun court 
explained that the test for whether there is a causal connection 
"is not one of hindsight but an objective standard: what would 
the average prudent person in the patient's position have 
decided if informed of the perils."  Id. at 603 (emphasis 
added). 
¶53 Two years after Trogun, in 1975, this court took up 
Scaria, another informed consent case, and reaffirmed the 
reasonable patient standard adopted in Trogun.  See Scaria, 68 
Wis. 2d at 11, 13.  The Scaria court stated that a physician has 
a duty "to make such disclosures as appear reasonably necessary 
under circumstances then existing to enable a reasonable person 
No. 
  2007AP619 
 
28 
 
under the same or similar circumstances confronting the patient 
at the time of disclosure to intelligently exercise his right to 
consent or to refuse the treatment or procedure proposed."  
Id. at 13 (emphasis added).  The court made clear that a 
physician's duty of disclosure is measured objectively under the 
reasonableness standard by noting that the "community standard" 
(based on what the average doctor in the community would 
disclose to the patient) is "certainly relevant and material" 
but not determinative in evaluating whether the physician 
satisfied her duty of disclosure.  Id. at 12.     
¶54 The court also made clear that, because the informed 
consent standard adopted in Trogun was an objective standard 
based on negligence principles such as reasonableness, the 
physician's duty to inform is not boundless.  See id. at 11, 12-
13.  The court noted that the physician's duty to inform does 
not mean he is "required to know every potential risk but only 
those known to a reasonably well-qualified practitioner or 
specialist commensurate with his classification in the medical 
profession."  Id. at 11.  Moreover, the court listed the 
following additional limitations to a physician's duty of 
disclosure: 
A doctor should not be required to give a detailed 
technical medical explanation that in all probability 
the patient would not understand.  He should not be 
required to discuss risks that are apparent or known 
to the patient.  Nor should he be required to disclose 
extremely remote possibilities that at least in some 
instances might only serve to falsely or detrimentally 
alarm the particular patient.  Likewise, a doctor's 
duty to inform is further limited in cases of 
No. 
  2007AP619 
 
29 
 
emergency or where the patient is a child, mentally 
incompetent or a person is emotionally distraught or 
susceptible to unreasonable fears. 
Id. at 12-13 (internal footnote omitted). 
¶55 Finally, Scaria discussed the importance of utilizing 
the reasonableness standard for determining cause in informed 
consent claims.  Id. at 13-15.  Without an objective standard, 
the court contended, the cause determination would come down to 
an assessment of the patient's credibility in testifying as to 
what she would have done had she been fully informed.  Id. at 
15.  This, the court thought, was unsatisfactory: 
[W]hen causality is explored at a post[-]injury trial 
with a professedly uninformed patient, the question 
whether he actually would have turned the treatment 
down if he had known the risks is purely hypothetical: 
"Viewed from the point at which he had to decide, 
would the patient have decided differently had he 
known something he did not know?"  And the answer 
which the patient supplies hardly represents more than 
a guess, perhaps tinged by the circumstance that the 
uncommunicated hazard has in fact materialized. 
 
In our view, this method of dealing with the 
issue on causation comes in second-best.  It places 
the physician in jeopardy of the patient's hindsight 
and bitterness.  It places the fact[-]finder in the 
position of deciding whether a speculative answer to a 
hypothetical question is to be credited.  It calls for 
a subjective determination solely on testimony of a 
patient-witness shadowed by the occurrence of the 
undisclosed risk. 
 
Better 
it 
is, 
we 
believe, 
to 
resolve 
the 
causality issue on an objective basis: in terms of 
what a prudent person in the patient's position would 
have decided if suitably informed of all perils 
bearing significance.  If adequate disclosure could 
reasonably be expected to have caused that person to 
decline the treatment because of the revelation of the 
No. 
  2007AP619 
 
30 
 
kind of risk or danger that resulted in harm, 
causation is shown, but otherwise not. 
Id. at 14 (quoting Canterbury, 464 F.2d at 790-91) (internal 
quotations omitted). 
¶56 Ultimately, the objective standards set forth in 
Trogun and reaffirmed in Scaria governed common law informed 
consent claims in Wisconsin and were the impetus for the 
legislature's decision to create Wis. Stat. § 448.30, the 
informed consent statute. 
B. 
Wisconsin Stat. § 448.30 
¶57 Wisconsin Stat. § 448.30 reads, in its entirety, as 
follows: 
448.30 
 
Information 
on 
alternate 
modes 
of 
treatment.  Any physician who treats a patient shall 
inform the patient about the availability of all 
alternate, viable medical modes of treatment and about 
the benefits and risks of these treatments.  The 
physician's duty to inform the patient under this 
section does not require disclosure of: 
 
(1) Information beyond what a reasonably well-
qualified 
physician 
in 
a 
similar 
medical 
classification would know. 
 
(2) Detailed technical information that in all 
probability a patient would not understand. 
 
(3) Risks apparent or known to the patient. 
 
(4) Extremely remote possibilities that might 
falsely or detrimentally alarm the patient. 
 
(5) Information in emergencies where failure to 
provide treatment would be more harmful to the patient 
than treatment. 
 
(6) Information in cases where the patient is 
incapable of consenting. 
No. 
  2007AP619 
 
31 
 
The language of the statute "codifies the common law set forth 
in Scaria."  Johnson, 199 Wis. 2d at 629-30 (emphasis added); 
Hannemann, 282 Wis. 2d 664, ¶48 ("[Section] 448.30 was enacted 
in order to codify the common-law standards for informed consent 
set forth in Scaria."); Martin, 192 Wis. 2d at 174 ("[T]he 
Wisconsin legislature codified the standard articulated in 
Scaria in sec. 448.30, Stats.").  In fact, the Legislative 
Reference Bureau Note to 1981 A.B. 941, the bill that became 
Wis. Stat. § 448.30, includes the following statement: "The bill 
places in the statutes the standard of care that physicians are 
required to meet under Scaria."  See Martin, 192 Wis. 2d at 174.  
The informed consent statute was enacted in 1982 and remains in 
its original form today.  See § 2, ch. 375, Laws of 1981.  
Consequently, the standards set forth in Trogun and Scaria are 
implicated in the interpretation of Wis. Stat. § 448.30. 
¶58 For example, in Martin, the supreme court relied 
heavily upon Trogun and Scaria for its interpretation of Wis. 
Stat. § 448.30.  Martin involved a 14-year old girl who rode her 
bicycle into the back of a dump truck, causing her injuries that 
required emergency care at Fort Atkinson Memorial Hospital 
(FAMH).  Martin, 192 Wis. 2d at 162.  The emergency physician 
who 
treated 
the 
girl 
made 
a 
differential 
diagnosis 
of 
concussion, contusion, and possible intracranial bleeding based 
No. 
  2007AP619 
 
32 
 
on her symptoms.15  Id. at 164.  Then, "[i]n an attempt to 
determine which diagnosis was correct, he performed several 
neurological tests as well as skull x-rays.  Based upon the 
results of these tests, [the emergency physician] ultimately 
diagnosed [the girl] as having a concussion."  Id.   
¶59 The emergency physician explained his diagnosis to the 
girl's father and advised him that there were two appropriate 
alternatives available for treating the girl's condition: (1) 
"send [her] home under the care of a responsible adult, or" (2) 
"admit [her] to the hospital for observation."  Id.  The 
emergency physician did not inform the girl's father that a CT 
scan could be performed at the hospital to further diagnose the 
girl's head injuries.  Id.  In addition, the physician did not 
inform the girl's father that if a neurological complication 
would be detected or would arise while the girl was at FAMH, 
"she would have to be transferred to a different hospital 
because FAMH did not have a neurosurgeon."  Id.  The girl's 
father decided to have her admitted to the hospital that 
evening.  Id. 
¶60 Very early the next morning, the girl's condition 
deteriorated to the point that she had to be transferred by 
helicopter to the University of Wisconsin (UW) Hospital in 
                                                 
15 The Martin court stated that "differential diagnosis" 
means "'[t]he determination of which of two or more diseases 
with similar symptoms is the one from which the patient is 
suffering, by a systematic comparison and contrasting of the 
clinical findings.'"  Martin, 192 Wis. 2d at 164 n.2 (quoting 
Stedman's Medical Dictionary 428 (25th ed. 1990)).  
No. 
  2007AP619 
 
33 
 
Madison.  Id. at 165.  CT scans were performed at the UW 
Hospital and intracranial bleeding was discovered.  Id.  The 
girl required two emergency surgeries to relieve the bleeding.  
Id.  The surgeries were only partially successful, leaving the 
girl a partial spastic quadriplegic.  Id. 
¶61 As part of a larger malpractice action, the girl and 
her family filed an informed consent claim against the emergency 
physician for his failure to disclose "the existence of 
alternate forms of care and treatment."  Id. at 166.  The jury 
found the physician liable on this claim alone and awarded the 
girl and her family "almost 5 million dollars in damages."16  Id.  
However, following the verdict, the circuit court granted the 
emergency physician's motion to dismiss the informed consent 
claim because "[t]he court believed that under sec. 448.30, 
Stats., the doctors had no duty to inform [the girl's father] 
about diagnostic or treatment alternatives with respect to what 
it characterized as the 'extremely remote' possibility that [the 
girl] would develop an intracranial bleed."  Id.  The court of 
appeals reversed, disagreeing with the circuit court that a one 
to three percent chance of the girl developing an intracranial 
bleed was "extremely remote" given the serious consequences that 
can result from such a condition.  Id. at 166-67.  The issue was 
then presented to this court for review. 
                                                 
16 The jury found no liability for the emergency physician 
or the consulting physician in relation to the standard of care 
rendered.  Id. at 166.   
No. 
  2007AP619 
 
34 
 
¶62 Initially, this court observed that the language of 
Wis. Stat. § 448.30 "appears clear in its directive.  The 
difficulty in applying the statute, however, is in determining 
how far the duty to disclose extends, i.e., what is considered 
an alternate, viable mode of treatment."  Id. at 169.  In making 
this 
determination, 
the 
court 
referenced 
Scaria 
and 
re-
emphasized "that the standard for informed consent cannot be 
defined by the medical profession" because the decision of what 
mode of treatment to proceed with "is not a medical decision."  
Id. at 174; see also Hannemann, 282 Wis. 2d 664, ¶¶35-36, 38-39, 
40, 46; Johnson, 199 Wis. 2d at 633-34, 649; Scaria, 68 
Wis. 2d at 12.  Instead, the court stated, "[t]he decision must 
be made by the patient, and a patient cannot make an informed, 
intelligent decision to consent to a physician's suggested 
treatment unless the physician discloses what is material to the 
patient's decision, i.e., all of the viable alternatives and 
risks of the treatment proposed."  Martin, 192 Wis. 2d at 174; 
see also Hannemann, 282 Wis. 2d 664, ¶¶35-36, 46; Johnson, 199 
Wis. 2d at 630-31, 640, 645; Scaria, 68 Wis. 2d at 13; Trogun, 
58 Wis. 2d at 600-02.  The extent of this disclosure, the court 
concluded, "is driven . . . by what a reasonable person under 
the circumstances then existing would want to know, i.e., what 
is reasonably necessary for a reasonable person to make an 
intelligent decision with respect to the choices of treatment or 
diagnosis."17  Martin, 192 Wis. 2d at 174 (emphasis added); see 
                                                 
17 The court, citing Canterbury v. Spence, 464 F.2d 772, 788 
(D.C. Cir. 1972), stated "that whenever the determination of 
No. 
  2007AP619 
 
35 
 
also Johnson, 199 Wis. 2d at 631, 637-40; Scaria, 68 Wis. 2d at 
11, 13; Trogun, 58 Wis. 2d at 600-02.  The court presumed that 
this standard is embodied in Wis. Stat. § 448.30 by "the use of 
the word 'viable.'"  Martin, 192 Wis. 2d at 174-75. 
¶63 In addition, the Martin court made clear that the 
physician's duty of disclosure "under the statute is not limited 
to affirmative violations of bodily integrity."  Id. at 175 
(emphasis added).  The court explained as follows: 
There can be no dispute that the language in Scaria, 
68 Wis. 2d at 13, requires that a physician disclose 
information necessary for a reasonable person to make 
an intelligent decision with respect to the choices of 
treatment or diagnosis.  Because this standard was 
adopted by the legislature, as indicated by the 
[Legislative 
Reference 
Bureau] 
notes, 
the 
phrase 
"modes of treatment" in sec. 448.30, Stats., should 
not be construed so as to unduly limit the physician's 
duty 
to 
provide information which is reasonably 
necessary under the circumstances.  Such a reading 
would be contrary to Scaria.  Certainly, procedures 
which are purely diagnostic in nature are not excluded 
from sec 448.30's reach.  In Scaria, itself, the 
plaintiff's injuries resulted from . . . a diagnostic 
procedure.  Id. at 4.  The distinction between 
diagnostic and medical treatments is not in and of 
itself significant to an analysis of informed consent. 
Martin, 192 Wis. 2d at 175 (emphasis added). 
¶64 Applying 
Wis. 
Stat. 
§ 448.30 
in 
line 
with 
the 
principles set forth in Trogun and Scaria, the Martin court 
reinstated the jury's finding of liability against the emergency 
physician on informed consent.  Id. at 182.  The court reasoned 
                                                                                                                                                             
what a reasonable person would want to know is open to debate by 
reasonable people, the issue is one for the jury."  Martin, 192 
Wis. 2d at 172-73. 
No. 
  2007AP619 
 
36 
 
that "there was credible evidence for the jury to determine that 
in order to make an intelligent decision regarding the choices 
of treatment or diagnosis, a reasonable person, under the 
circumstances then existing, would have wanted to know" the 
following information: (1) that a CT scanner was available and 
would have detected any neurological complications resulting 
from the girl's injuries; and (2) that if the girl would have 
developed neurological complications, she would have needed to 
be transferred to a hospital with a neurosurgeon for further 
treatment.18  Id.   
¶65 In making its decision, the Martin court dismissed two 
arguments made by the emergency physician.  First, the court 
rejected the argument that Wis. Stat. § 448.30 does not impose a 
duty on physicians "to inform patients of alternate treatments 
for a condition not diagnosed or not being treated by the 
physician."  Id. at 180.  The court rejected this argument 
because it "ignore[d] the facts" of the case: 
[The emergency physician] believed [the girl] had a 
concussion.  He did not believe she was bleeding at 
the time he diagnosed concussion.  But given the 
circumstances of this case, that does not end the 
inquiry.  [The emergency physician] knew that delayed 
intracranial 
bleeding 
was 
a 
condition 
of 
his 
diagnosis.  He could not rule it out.  He knew there 
was a distinct possibility that intracranial bleeding 
might occur.  In sum, he knew that [the girl's] 
condition was more serious than a simple concussion.  
                                                 
18 The supreme court also affirmed the court of appeals' 
determination that a one to three percent chance of developing 
an 
intracranial 
bleed 
was 
not 
remote 
given 
the 
serious 
consequences that may result.  Id. at 167. 
No. 
  2007AP619 
 
37 
 
He knew that associated with this concussion was the 
possibility of a delayed intracranial bleed.  It was 
this condition (the excessive vomiting, the amnesia, 
the unconsciousness of an undetermined time, the 
injury to the head) not the diagnosis, that drives the 
duty to inform in this case.  The statute speaks to 
information about alternate modes of treatment; it is 
not limited in title or in text to "Information on 
alternate modes of treatment for diagnosis." 
Id. at 180-81 (second and third emphasis added).   
¶66 The court also rejected as clearly mistaken the 
emergency 
physician's 
argument 
that 
these 
were 
medical 
decisions, thus relieving him of the duty to disclose adequate 
information:  
When a reasonable person would want to know about an 
alternative treatment or method of diagnosis such as a 
CT scan or hospitalization in a facility with a 
neurosurgeon, the decision is not the doctor's alone 
to make.  
It may well be a "medical decision" under these 
circumstances to decide not to do a CT scan, or to 
decide not to hospitalize the patient in a hospital 
that can treat an intracranial bleed if it should 
occur.  The statute on its face says, however, that 
the 
patient 
has 
the 
right 
to 
know, 
with 
some 
exceptions, that there are alternatives available.  
The 
doctor 
might 
decide 
against 
the 
alternate 
treatments or care, he might try to persuade the 
patient against utilizing them, but he must inform 
them when a reasonable person would want to know.  
Here, [the girl's father] could have decided to have a 
CT scan done or could have decided to take [the girl] 
to another hospital with a neurosurgeon.  In fact, the 
jury found that [the father] would have agreed to the 
alternate forms of care and treatment had he been 
informed of their availability. 
Id. at 181 (emphasis added). 
¶67 Martin was decided in 1995.  A year later, this court 
further clarified its interpretation of Wis. Stat. § 448.30 in 
No. 
  2007AP619 
 
38 
 
Johnson.  In Johnson, the court rejected the defendant's 
proposed "'bright-line' rule requiring physicians to disclose 
only significant complications intrinsic to the contemplated 
procedure."  Johnson, 199 Wis. 2d at 637-39.  Instead, the court 
reiterated, with reference to Trogun and Scaria, that "Wis[.] 
Stat. § 448.30 explicitly requires disclosure of more than just 
treatment complications associated with a particular procedure.  
Physicians must, the statute declares, disclose the availability 
of all alternate, viable medical modes of treatment in addition 
to the benefits and risks of these treatments."  Id. at 640 
(internal quotations omitted) (emphasis added).19    
¶68 The 
preceding 
discussion 
illustrates 
that 
the 
standards set forth in Trogun and Scaria continue to guide our 
interpretation of Wis. Stat. § 448.30, and we see no reason to 
depart from these standards in interpreting the statute in the 
present case.  
¶69 With these standards in mind, we conclude that there 
is credible evidence in the record from which a reasonable jury 
could find that Dr. Brusky failed, in violation of Wis. Stat. 
§ 448.30, to adequately inform the Bubbs "of all alternate, 
                                                 
19 The Johnson court also reaffirmed that the cause element 
under Wis. Stat. § 448.30 was to be judged objectively by the 
jury asking "whether a reasonable person in the patient's 
position would have arrived at a different decision about the 
treatment . . . had he or she been fully informed."  Johnson, 
199 Wis. 2d at 651; see also Scaria, 68 Wis. 2d at 14-15; 
Trogun, 58 Wis. 2d at 603-04. 
No. 
  2007AP619 
 
39 
 
viable medical modes of treatment and about the benefits and 
risks of th[o]se treatments."  See Wis. Stat. § 448.30. 
¶70 First, there is credible evidence in the record from 
which 
a 
reasonable 
jury 
could 
conclude 
that 
there 
were 
reasonable alternatives available for treating Richard's TIA.  
Most pertinently, Dr. Brusky's own testimony establishes that 
admitting Richard to the hospital20 and ordering a carotid 
Doppler ultrasound was "one of the reasonable ways of" treating 
a TIA.  Second, expert testimony elicited during the trial 
demonstrates that there is considerable debate in the medical 
community over whether to admit patients immediately after a TIA 
episode or to discharge them with instructions and a referral to 
a neurologist.  The fact this debate exists presents credible 
evidence for the jury to believe that there were reasonable 
                                                 
20 On appeal, Dr. Brusky makes an argument that admission to 
the hospital was not an alternate mode of treatment available 
for Richard because Dr. Brusky did not have admitting privileges 
at St. Agnes Hospital.  The fact that Dr. Brusky did not have 
admitting privileges is irrelevant for two reasons.  First, the 
physician's duty under Wis. Stat. § 448.30 is to inform the 
patient of the availability of all viable alternatives and allow 
the patient to make a decision, but the physician is not 
necessarily required to do what the patient desires.  See 
Martin, 192 Wis. 2d at 181 ("The doctor might decide against the 
alternate treatments or care, he might try to persuade the 
patient against utilizing them, but he must inform them when a 
reasonable person would want to know.").  Second, emergency 
physicians often do not have admitting privileges at the 
hospitals where they work; however, that does not mean that 
patients treated by emergency physicians cannot be admitted.  
They can be, as evidenced by Martin, where the emergency 
physician did not have admitting privileges, but he recommended 
to the girl and her father that she be admitted, which was done 
with assistance from a physician with admitting privileges.  Id. 
at 165. 
No. 
  2007AP619 
 
40 
 
alternative treatments available for Richard.  Third, the 
circuit court's decision to include the alternative paragraph to 
the standard medical negligence jury instruction, which is to be 
used "only if there is evidence of two or more alternative 
methods of treatment or diagnosis recognized as reasonable," 
demonstrates that credible evidence was presented to show that a 
reasonable alternative mode of treatment existed.  See Wis JI——
Civil 1023. 
¶71 Because there is credible evidence for the jury to 
conclude that admission to the hospital and further diagnostic 
testing was a reasonable alternative mode of treatment available 
for Richard's condition, the question is whether there is 
credible evidence in the record to support the notion that this 
alternative was viable.  See Martin, 192 Wis. 2d at 174-75.  In 
other 
words, 
could 
the 
Bubbs 
have 
"ma[d]e 
an 
informed, 
intelligent decision to consent" to Dr. Brusky's suggested mode 
of treatment——discharge from the hospital with instructions for 
follow-up care——without being informed of the alternative——
admission to the hospital with further diagnostic testing?  
Id. at 174; see also Hannemann, 282 Wis. 2d 664, ¶¶35-36, 46; 
Johnson, 199 Wis. 2d at 630-31, 640, 645; Scaria, 68 Wis. 2d at 
13; Trogun, 58 Wis. 2d at 600-02.  This answer is dictated "by 
what a reasonable person under the circumstances then existing 
would want to know."  Martin, 192 Wis. 2d at 174; see also 
Johnson, 199 Wis. 2d at 631, 637-40; Scaria, 68 Wis. 2d at 11, 
13; Trogun, 58 Wis. 2d at 600-02.   
No. 
  2007AP619 
 
41 
 
¶72 Credible evidence in the record, including statistics 
related to the increased risk of stroke following a TIA, the 
severe consequences that can result from a stroke, and the fact 
that a stenosed carotid artery is a possible cause of a TIA, 
demonstrates that a reasonable jury could conclude that a 
reasonable person in Richard's condition would have wanted to 
know about the alternative of admission with further diagnostic 
testing.21  See Johnson, 199 Wis. 2d at 631, 637-40; Martin, 192 
                                                 
21 Richard testified at trial as follows: 
Q 
Did anybody, when you left, as you were leaving 
St. Agnes that night, tell you that you could 
possibly have the option of staying overnight in 
the hospital? 
A 
I don't believe so.  No. 
Q 
Did anybody say anything to you about the fact 
that there -- that another test could be done to 
look at your carotid arteries? 
A 
No, no one mentioned that at all. 
Q 
Did anybody tell you that if you had a blockage 
in your carotid artery, that you could -- were at 
high risk for stroke? 
A 
I don't believe so. 
Q 
Did anybody tell you that this carotid artery 
could tell you whether you were at risk for 
stroke? 
A 
No. 
Q 
Would that information have been interesting to 
you or significant? 
A 
Of course it would have been. 
No. 
  2007AP619 
 
42 
 
Wis. 2d at 174; Scaria, 68 Wis. 2d at 11, 13; Trogun, 58 
Wis. 2d at 600-02. 
¶73 Finally, there is credible evidence in the record from 
which a reasonable jury could conclude that Dr. Brusky's failure 
to adequately inform the Bubbs of the alternative mode of 
treatment available was a cause of Richard's injuries that 
resulted from his stroke.  The same evidence bearing on whether 
a reasonable patient in Richard's position would have wanted to 
know about the reasonable alternative mode of treatment that was 
available, see supra, ¶72, is also credible evidence for the 
jury to determine whether a reasonable patient in Richard's 
condition would have refused Dr. Brusky's recommended mode of 
treatment if the patient had been informed of the alternative, 
see Johnson, 199 Wis. 2d at 651, Scaria, 68 Wis. 2d at 14-15, 
Trogun, 58 Wis. 2d at 603-04.   
¶74 Furthermore, the record contains testimony indicating 
that if the carotid Doppler ultrasound was performed either that 
night or the next day, Richard's stenosed carotid artery would 
have been detected, and he would have been immediately medicated 
                                                                                                                                                             
This testimony would not be helpful if it were inconsistent with 
what a reasonable person under the circumstances would want to 
know.  However, we cannot say on the facts here that this 
testimony should be disregarded. 
No. 
  2007AP619 
 
43 
 
and prepared for emergency surgery.22  Therefore, we can say 
there is credible evidence in the record from which a reasonable 
jury could conclude that Dr. Brusky's failure to adequately 
inform the Bubbs of the reasonable alternate mode of treatment 
available was a cause of his injuries that resulted from his 
stroke.  See Wis JI——Civil 1023.1.  Ultimately, causation is a 
question for the jury.23 
¶75 In conclusion, we note that one of Dr. Brusky's 
arguments in defending against the Bubbs' informed consent claim 
is that he properly discharged his duties as an emergency 
physician, and to require more would create undue hardship on 
emergency physicians because they would be forced to have 
specialized knowledge in many areas of medicine in which they 
are not trained.  This concern, which is legitimate, is greatly 
alleviated by the express language of the statute, placing 
limits on the physician's duty of disclosure.  See Wis. Stat. 
§ 448.30(1)-(6).24   
                                                 
22 Dr. Gu specifically testified that a Doppler ultrasound 
would have been available either that night or the next day and 
that the results of the Doppler ultrasound probably would have 
detected Richard's 90-percent stenosed carotid artery.  If the 
stenosed artery was diagnosed, then Dr. Gu testified that he 
would have contacted a neurosurgeon so that preparations for 
surgery could begin.  He also stated that if a neurosurgeon was 
not available at St. Agnes, then Richard would have been 
transferred to a different hospital.  
23 "[W]henever the determination of what a reasonable person 
would want to know is open to debate by reasonable people, the 
issue is one for the jury."  Id. at 172-73. 
24 The physician's duty to inform the patient under 
this section does not require disclosure of: 
No. 
  2007AP619 
 
44 
 
¶76 In 
particular, 
Wis. 
Stat. 
§ 448.30(1) 
limits 
a 
physician's duty of disclosure to information that "a reasonably 
well-qualified physician in a similar medical classification 
would know."  See Scaria, 68 Wis. 2d at 11.  Therefore, Dr. 
Brusky's concern that he and other emergency physicians will be 
required to provide patients with information outside their 
field of knowledge should be minimal given the statutory 
language.  See Wis. Stat. § 448.30(1); Scaria, 68 Wis. 2d at 11.  
For instance, Dr. Brusky is not being asked to provide 
information outside his field of knowledge; he acknowledged in 
his testimony that admission and further diagnostic testing was 
a reasonable alternative course of action in treating patients 
after a TIA.  The jury determined he was not negligent in his 
standard of care for failing to employ this alternative when 
                                                                                                                                                             
(1) Information beyond what a reasonably well-
qualified 
physician 
in 
a 
similar 
medical 
classification would know. 
 
(2) Detailed technical information that in all 
probability a patient would not understand. 
 
(3) Risks apparent or known to the patient. 
 
(4) Extremely remote possibilities that might 
falsely or detrimentally alarm the patient. 
 
(5) Information in emergencies where failure to 
provide treatment would be more harmful to the patient 
than treatment. 
 
(6) Information in cases where the patient is 
incapable of consenting. 
Wis. Stat. § 448.30. 
No. 
  2007AP619 
 
45 
 
treating Richard, but that did not relieve Dr. Brusky of his 
duty to inform the Bubbs "about the availability of all 
alternate, viable medical modes of treatment."  Wis. Stat. 
§ 448.30.  
¶77 Another way the statute limits Dr. Brusky's duty in 
this case is that he does not necessarily have a duty to inform 
Richard of which particular diagnostic tests should be employed 
or the details of those tests.  This would likely be either 
"[i]nformation beyond what a reasonably well-qualified physician 
in a similar medical classification would know," Wis. Stat. 
§ 448.30(1), or "[d]etailed technical information that in all 
probability 
a 
patient 
would 
not 
understand," 
Wis. 
Stat. 
§ 448.30(2).  The Bubbs' complaint bears this out in that it 
alleges that Dr. Brusky "failed to inform Plaintiff Richard Bubb 
of additional diagnostic tests or alternate treatment plans." 
IV. CONCLUSION 
¶78 We conclude that Wis. Stat. § 448.30 requires any 
physician who treats a patient to inform the patient about the 
availability 
of 
all 
alternate, 
viable 
medical 
modes 
of 
treatment, including diagnosis, as well as the benefits and 
risks of such treatments.  The statute contains several 
reasonable exceptions to this requirement that limit the 
treating physician's duty to inform under the statute.  In this 
medical malpractice action, the plaintiffs filed a separate and 
distinct claim grounded in the requirements of § 448.30.  They 
presented sufficient evidence at trial to support such a claim.  
None of the statutory exceptions apply.  Hence, the circuit 
No. 
  2007AP619 
 
46 
 
court's dismissal of the claim at the conclusion of trial 
evidence was error. 
By the Court.—The decision of the court of appeals is 
reversed and the cause is remanded to the circuit court for 
further proceedings consistent with this opinion. 
¶79 ANNETTE KINGSLAND ZIEGLER, J., did not participate. 
 
 
 
 
No. 
2007AP619 
 
 
 
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