Title: Bonnie Pierce v. Physicians Insurance Company of Wisconsin, Inc.
Citation: 2005 WI 14
Docket Number: 2001AP002710
State: Wisconsin
Issuer: Wisconsin Supreme Court
Date: February 17, 2005

2005 WI 14 
 
 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
01-2710 
COMPLETE TITLE: 
 
 
Bonnie Pierce,  
          Plaintiff-Appellant-Petitioner, 
 
     v. 
 
Physicians Insurance Company of  
Wisconsin, Inc., Frederick J. Bartizal,  
Jr., M.D., OHIC Insurance Company, and  
Theda Clark Regional Medical Center,  
Wisconsin Patients Compensation Fund,  
          Defendants-Respondents. 
 
 
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
Reported at:  268 Wis. 2d 843, 673 N.W.2d 410 
(Ct. App. 2003-Unpublished) 
 
 
OPINION FILED: 
February 17, 2005 
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
April 28, 2004 and November 3, 2004 
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit   
 
COUNTY: 
Outagamie   
 
JUDGE: 
James T. Bayorgeon 
 
 
 
JUSTICES: 
 
 
CONCURRED: 
PROSSER, J., concurs (opinion filed). 
WILCOX, J., joins concurrence.   
 
DISSENTED: 
 
 
NOT PARTICIPATING: BUTLER, J., did not participate. 
 
 
 
ATTORNEYS: 
 
For the plaintiff-appellant-petitioner there were briefs by 
Jolene D. Schneider and Peterson, Berk & Cross, S.C., Appleton, 
and oral argument by Jolene D. Schneider and Avram D. Berk. 
 
For the defendants-respondents Physicians Insurance Company 
of Wisconsin, Inc. and Frederick J. Bartizal, M.D., there were 
briefs by Michael B. VanSicklen, John C. Schaak, Naikang Tsao 
and Foley & Lardner LLP, Madison, and oral argument by Michael 
B. VanSicklen. 
 
 
 
 
2
 
For the defendants-respondents Theda Clark Regional Medical 
Center and OHIC Insurance Company there were briefs by Todd M. 
Weir, Milwaukee, Patricia Sommer, Madison, and Otjen, Van Ert, 
Lieb & Weir, S.C., and oral argument by Patricia Sommer. 
 
For 
the 
defendant-respondent 
Wisconsin 
Patients 
Compensation Fund there were briefs by R. George Burnett and 
Liebmann, Conway, Olejniczak & Jerry, S.C., Green Bay, and oral 
argument by R. George Burnett. 
 
 
Amicus curiae briefs were filed by Charles J. Crueger, 
Julie M. Rusczek and Michael Best & Friedrich LLP, Milwaukee, on 
behalf of Wisconsin Medical Society and Wisconsin Hospital 
Association, Inc. 
 
 
Amicus curiae briefs were filed by Martha H. Heidt and 
Doar, Drill & Skow, S.C., Baldwin, on behalf of the Wisconsin 
Academy of Trial Lawyers. 
 
 
2005 WI 14 
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.  01-2710  
(L.C. No. 
99 CV 971) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
Bonnie Pierce,  
 
          Plaintiff-Appellant-Petitioner, 
 
     v. 
 
Physicians Insurance Company of  
Wisconsin, Inc., Frederick J. Bartizal,  
Jr., M.D., OHIC Insurance Company, and  
Theda Clark Regional Medical Center,  
Wisconsin Patients Compensation Fund,  
 
          Defendants-Respondents. 
 
FILED 
 
FEB 17, 2005 
 
Cornelia G. Clark 
Clerk of Supreme Court 
 
 
 
 
 
REVIEW of a decision of the Court of Appeals.  Reversed and 
cause remanded.   
 
¶1 
N. 
PATRICK 
CROOKS, 
J.   Petitioner 
Bonnie 
Pierce 
(Pierce) seeks review of an unpublished per curiam decision of 
the court of appeals, which affirmed the circuit court's grant 
of summary judgment.  This case presents the narrow issue of 
whether a mother who suffers the stillbirth of her infant as a 
result of medical malpractice has a personal injury claim 
involving negligent infliction of emotional distress, which 
No. 
01-2710   
 
2 
 
includes the distress arising from the injuries and stillbirth 
of her daughter, in addition to her derivative claim for 
wrongful death of the infant.  In these unusual circumstances, 
we conclude that the mother may recover as a parent, for the 
wrongful death of the stillborn infant; and as a patient, for 
her personal injuries including the negligent infliction of 
emotional distress.  We also conclude the stipulation of the 
parties did not waive this claim.  Accordingly, we reverse the 
decision of the court of appeals that affirmed the circuit 
court's order, which dismissed that portion of the mother's 
personal injury claim for negligent infliction of emotional 
distress arising from the injuries and stillbirth of her 
daughter.  
I 
¶2 
The relevant facts of this case are undisputed.   
Bonnie Pierce was nearly 35 weeks pregnant when she arrived for 
an appointment with her obstetrician, Dr. Frederick Bartizal, 
Jr., (Bartizal) on November 18, 1996.  Bartizal examined Pierce 
and determined that she was four centimeters dilated.  She was 
subsequently admitted to Theda Clark Regional Medical Center 
(Theda Clark) for care. 
 
¶3 
Later that day, while at Theda Clark, Pierce noticed 
her fetal monitor flashing.  A nurse explained to Pierce that 
her baby's heart rate was declining because the umbilical cord 
No. 
01-2710   
 
3 
 
was wrapped around the baby's neck.  The nurse repositioned 
Pierce, apparently believing that the problem would be solved.  
At 6:00 p.m., Bartizal visited Pierce to examine her and the 
fetal monitor readings.  Bartizal examined Pierce for about 10 
to 15 minutes and informed her that she was five centimeters 
dilated.  He explained to her that if she did not go into labor 
that night, he would induce labor the next morning.   
 
¶4 
Pierce fell asleep at approximately 12:45 a.m. without 
going into labor.  At 1:30 a.m., she awoke as a nurse searched 
for the baby's heartbeat.  After the first nurse was unable to 
find a heartbeat, a second nurse attempted to do so.  The second 
nurse was also unable to detect a fetal heartbeat.  In 
Bartizal's absence, the nurses called on Dr. Darr, who examined 
Pierce and performed an ultrasound.  Doctor Darr informed Pierce 
that he was not able to detect the baby's heartbeat or any fetal 
activity.  Shortly thereafter, Bartizal returned to the hospital 
to inform Pierce that her baby would be stillborn.  Pierce was 
treated with an epidural and IV fluids before her baby, named 
Brianna, was delivered vaginally by vacuum extraction.  Pierce 
kept Brianna with her for approximately 10 hours while she and 
family members had photographs taken with Brianna.  
¶5 
On November 16, 1999, Pierce filed a claim in the 
Outagamie County Circuit Court alleging that Bartizal, Theda 
Clark, and their respective insurers were liable for wrongful 
No. 
01-2710   
 
4 
 
death and the negligent infliction of emotional distress.  On 
the wrongful death claim, the defendants stipulated to their 
causal negligence and settled the claim.  The other claim, 
negligent infliction of emotional distress, alleged that the 
defendants negligently caused Brianna's death and stillbirth, 
and that experiencing the baby's stillbirth caused Pierce 
physical injury and severe emotional distress.   
¶6 
The defendants filed a motion for summary judgment on 
Pierce's claim for negligent infliction of emotional distress.  
The circuit court, Judge James T. Bayorgeon presiding, granted 
the 
motion 
in 
part. 
 
Judge 
Bayorgeon 
relied 
on 
both 
Wis. Stat. ch. 655 and Wis. Stat. § 893.55,1 as well as Kwaterski 
                                                 
1 All references to the Wisconsin Statutes are to the 2001-
02 version unless otherwise indicated.   
Wisconsin Stat. § 893.55 states, in relevant part:  
(4)(a) In this subsection, "noneconomic damages" 
means moneys intended to compensate for pain and 
suffering; humiliation; embarrassment; worry; mental 
distress; noneconomic effects of disability including 
loss of enjoyment of the normal activities, benefits 
and pleasures of life and loss of mental or physical 
health, well-being or 
bodily 
functions; 
loss of 
consortium, society and companionship; or loss of love 
and affection. 
(b) The total noneconomic damages recoverable for 
bodily injury or death, including any action or 
proceeding based on contribution or indemnification, 
may not exceed the limit under par. (d) for each 
occurrence on or after May 25, 1995, from all health 
care providers and all employees of health care 
providers acting within the scope of their employment 
No. 
01-2710   
 
5 
 
v. State Farm Mutual Automobile Insurance Co., 34 Wis. 2d 14, 
148 N.W.2d 107 (1967), to dismiss that portion of Pierce's claim 
for the negligent infliction of emotional distress arising from 
the injuries and stillbirth of her daughter.  The court held 
that the plaintiff could only recover for the emotional pain and 
suffering 
damages 
that 
resulted 
from 
her 
own 
injuries.  
Subsequently, the parties agreed to a stipulation that Bartizal 
and Theda Clark were negligent in the management of labor, and 
that such negligence caused the death of Brianna.  The 
stipulation provided that the defendants would pay damages for 
loss of society and companionship and for funeral expenses.  
Based on a second stipulation, the other claims were dismissed, 
with the exception of the claims that were dismissed by the 
court pursuant to the court's order of August 20, 2001, which 
claims were before the court on the motion for partial summary 
judgment.  
¶7 
On October 11, 2003, the court of appeals affirmed the 
circuit court's grant of summary judgment.  The court of appeals 
                                                                                                                                                             
and providing health care services who are found 
negligent and from the patients compensation fund.  
 . . . . 
(d) The limit on total noneconomic damages for 
each occurrence under par. (b) on or after May 25, 
1995, shall be $350,000 and shall be adjusted by the 
director of state courts. . . . 
 
No. 
01-2710   
 
6 
 
relied on Finnegan v. Patients Compensation Fund, 2003 WI 98, 
263 Wis. 2d 574, 666 N.W.2d 797, and Bowen v. Lumbermens Mutual 
Casualty Co., 183 Wis. 2d 627, 517 N.W.2d 432 (1994), to 
determine that Pierce did not satisfy the legal standard for 
recovery of emotional damages related to Brianna's stillbirth.  
The court of appeals concluded that Pierce did not satisfy the 
three-prong test of Bowen, which had recently been applied to 
plaintiffs' claim in Finnegan.2  Specifically, the court held 
that while Pierce observed her daughter suffering, she did not 
witness the extraordinary event that caused her daughter's 
suffering——the umbilical cord wrapped around Brianna's neck.  
Additionally, the court noted that while Pierce's physician may 
have been negligent in waiting to induce labor, he did not cause 
the umbilical cord to wrap around the baby's neck.  In response, 
Pierce filed a motion for reconsideration that the court denied 
on December 4, 2003. 
¶8 
This court granted Pierce's petition for review.  Oral 
arguments were held on April 28, 2004.  On June 16, 2004, we 
                                                 
2 The court in Bowen v. Lumbermens Mutual Casualty Co., 183 
Wis. 2d 627, 633, 517 N.W.2d 432 (1994), established a three-
prong test to determine whether a "bystander's" claim for 
negligent infliction of emotional distress can be maintained.  
The test is as follows: (1) the injury suffered by the victim 
must have been fatal or severe; (2) the victim and the plaintiff 
must be related as spouses, parent-child, grandparent-grandchild 
or 
siblings; 
(3) 
the 
plaintiff 
must 
have 
observed 
an 
extraordinary event, namely the incident and injury or the scene 
soon after the incident with the injured victim at the scene.   
No. 
01-2710   
 
7 
 
ordered the parties to file supplemental briefs addressing the 
following issues:  
1. Was the Circuit Court mistaken in its reliance on 
the case of Kwaterski v. State Farm Mut. Auto. Ins. 
Co., 34 Wis. 2d 14, 148 N.W.2d 107 (1967) for its 
conclusion that: "A mother's injuries do not include 
the injury to or death of a child as part of her own 
injuries?"   
2. Is it appropriate, under relevant case law, to 
separate or compartmentalize Bonnie Pierce's claimed 
emotional injury into what is related to her own pain 
and suffering (including emotional distress) resulting 
directly from the physical discomfort of child birth, 
as against her pain and suffering (including emotional 
distress) resulting from the medical malpractice that 
caused the death and stillbirth of her child, Briana 
Lynn Marcks? 
3. Did the Stipulation which resulted in the Circuit 
Court's Order of October 3, 2001, in effect waive 
either claim referenced in question number 2 that 
Bonnie Pierce had for her own pain and suffering, 
including her own claimed emotional injury? 
 
¶9 
Additional oral arguments were heard on November 3, 
2004.     
II 
¶10 The focus of this case is on whether Pierce may bring 
a claim which includes the negligent infliction of emotional 
distress arising from the injuries and stillbirth of her 
daughter, under the undisputed factual circumstances.  This is a 
question of law that we review de novo, independently of the 
reasoning of the circuit court and the court of appeals, but 
benefiting from their analyses.  See, e.g., Beloit Liquidating 
No. 
01-2710   
 
8 
 
Trust v. Grade, 2004 WI 39, ¶17, 270 Wis. 2d 356, 677 N.W.2d 298 
(question of law whether complaint states a claim); see also 
State v. Lombard, 2004 WI 95, ¶17, 273 Wis. 2d  538, 684 
N.W.2d 103 (statutory interpretation is a question of law, 
subject to de novo appellate review). 
¶11 Wisconsin Stat. ch. 655 governs claims in the event of 
medical malpractice.  According to Wis. Stat. § 655.007, "any 
patient or . . . any . . . parent . . . of the patient having a 
derivative claim for injury or death on account of malpractice 
is subject to this chapter."  Wisconsin Stat. § 655.0173 limits 
the noneconomic damages recoverable to those individuals listed 
in 
Wis. Stat. § 893.55(4). 
 
Section 
893.55(4)(a) 
caps 
noneconomic damages, defined in part as "pain and suffering; 
 . . . mental distress. . . ."  "Notwithstanding the limits on 
noneconomic damages under this section, damages recoverable 
against health care providers . . . for wrongful death are 
subject to the limit under s. 895.04(4)."  Section 893.55(4)(f).  
                                                 
3 Wisconsin Stat. § 655.017 states:  
The amount of noneconomic damages recoverable by a 
claimant or plaintiff under this chapter for acts or 
omissions of a health care provider if the act or 
omission occurs on or after May 25, 1995, and for acts 
or omissions of an employee of a health care provider, 
acting within the scope of his or her employment and 
providing health care services, for acts or omissions 
occurring on or after May 25, 1995, is subject to the 
limits under s. 893.55(4)(d) and (f).   
No. 
01-2710   
 
9 
 
Wisconsin Stat. § 895.04(4), in turn, separately caps damages 
"in the case of a deceased minor . . . for loss of society and 
companionship (which) may be awarded to the . . . parents of the 
deceased. . . ."  
¶12 Here, we have the unique situation where the patient, 
Bonnie Pierce, was also the parent of the patient, Brianna Lynn 
Marcks.  There is no dispute that Pierce has the derivative 
claim of a parent for the wrongful death of Brianna under 
Wis. Stat. § 655.007.4  It is Pierce's direct claim for emotional 
distress that is at issue. 
¶13 The court of appeals characterized Pierce's direct 
claim for negligent infliction of emotional distress as a 
bystander claim.  That is, that Pierce was merely a witness to 
the stillbirth of her daughter Brianna and could recover only if 
she met the test we set forth in Bowen and Finnegan.  We 
conclude differently.  Because of the unusual position of 
Pierce, as a mother in labor, the result of which was a 
stillbirth, she clearly was not a witness to the "gruesome 
aftermath" of an automobile accident that eventually resulted in 
the death of her child, as was the case in Bowen, 183 Wis. 2d at 
                                                 
4 Wisconsin Stat. § 655.007 states, in relevant part: "On 
and after 
July 24, 1975, 
any patient or 
the 
patient's 
representative having a claim or any spouse, parent, minor 
sibling or child of the patient having a derivative claim for 
injury or death on account of malpractice is subject to this 
chapter."   
No. 
01-2710   
 
10 
 
634-35. 
 
Nor 
was 
Pierce 
the 
witness 
of 
"the 
physical 
deterioration and death" of her child, as was the case in 
Finnegan, 263 Wis. 2d 574, ¶20.  Rather, she was a participant, 
and a victim of the actionable conduct——medical malpractice——
that gave rise to her claim.  Accordingly, Bowen and Finnegan 
are inapposite. 
¶14 We find that the circumstances here are strikingly 
similar to those in Westcott v. Mikkelson, 148 Wis. 2d 239, 434 
N.W.2d 822 (Ct. App. 1988).  There, the mother, Karla Westcott, 
brought a claim of negligent infliction of emotional distress 
against an attending physician for injuries related to the 
delivery of her son, who was asphyxiated by the umbilical cord 
that had wrapped around his neck, resulting in stillbirth.  The 
court of appeals concluded that Westcott was not a witness or 
observer of the cause of the emotional distress, but instead a 
participant.  The court said that in determining whether 
Westcott "is an observer or a participant, it is difficult to 
imagine a more clear-cut example of the latter than a mother 
giving birth to a child in distress."  Id. at 242.   
¶15 The same conclusion applies here.  It is difficult to 
imagine 
that 
Bonnie 
Pierce 
was 
anything 
other 
than 
a 
participant, directly involved in the tortious activity that 
resulted in the stillbirth of Brianna.  Accordingly, she can 
maintain a direct claim for injuries that resulted from that 
No. 
01-2710   
 
11 
 
activity.  Wisconsin Stat. § 655.007 contemplates such a result, 
namely, that a patient who has suffered medical malpractice can 
bring a direct claim.  The fact that the same patient may also 
have a derivative claim for wrongful death is unusual, and 
likely to arise only in the unique circumstances presented in 
cases like this where the patient is also a victim/participant 
in the events at issue.5  
¶16 The court of appeals concluded that Bowen effectively 
overruled Westcott.  Pierce v. Physicians Ins. Co. of Wis., 
Inc., No. 01-2710, unpublished slip op., ¶24 n.6 (Wis. Ct. App. 
Nov. 11, 2003).  We disagree.  Westcott followed Garrett v. City 
of New Berlin, 122 Wis. 2d 223, 362 N.W.2d 137 (1985), where 
Connie Garrett pursued a claim for emotional distress based upon 
a police officer running over her brother with a police car.  
The officer had been pursuing a group of children, including the 
two of them, at an outdoor theater.  We concluded that "Connie 
Garrett was not merely an observer who was not directly involved 
in the tortious activity.  She was an object of the police 
officer's activities since she was a member of the group of 
children he was pursuing."  Id. at 232.  In Garrett, we also 
distinguished the circumstances there from the situation in 
                                                 
5 It is noteworthy that the damages caps in Wis. Stats. §§  
893.55(4) and 895.04(4) also segregate damages recoverable 
directly and derivatively.   
No. 
01-2710   
 
12 
 
Waube v. Warrington, 216 Wis. 603, 258 N.W. 497 (1935), where 
the court refused to recognize a claim for negligent infliction 
of emotional distress for a mother who witnessed the automobile 
accident that killed her child.  The mother was not in peril 
herself.  See Westcott, 148 Wis. 2d at 241. 
¶17 Consequently, when Bowen rejected Waube's "zone of 
danger" rule, it did not, as the court of appeals concluded, 
undermine Westcott.  We continue to recognize a claim for 
negligent infliction of emotional distress where the claimant is 
directly involved in the tortious activity.  Bowen did nothing 
to change this.  
¶18 Other courts have adopted a similar approach where the 
tortious activity results in the stillbirth of a child and have 
allowed both a derivative claim for wrongful death and a direct 
claim for negligent infliction of emotional distress.  For 
example, in Vaillancourt v. Medical Center Hospital of Vermont, 
Inc., 425 A.2d 92 (Vt. 1980), the Vermont Supreme Court allowed 
recovery for both the wrongful death of the viable fetus and the 
emotional distress of the mother.  Id. at 143.  In Johnson v. 
Ruark Obstetrics and Gynecology Associates, 395 S.E.2d 85 (N.C. 
1990), the North Carolina Supreme Court also recognized a claim 
for negligent infliction of emotional distress related to the 
inadequate prenatal care, which allegedly caused the stillbirth 
No. 
01-2710   
 
13 
 
of a child, in addition to allowing recovery for a wrongful 
death claim.   
¶19 Here, the circuit court erred in determining that 
Bonnie Pierce "may not seek relief for the emotional distress 
associated with the injuries and death of her stillborn infant," 
but could only "seek relief for emotional distress connected to 
her own injuries."  The circuit court came to that conclusion 
based upon an interpretation of our decision in Kwaterski, that 
a "mother's injuries do not include the injury to or death of a 
child as part of her own injuries."     
¶20 Just as Bowen and Finnegan are not applicable, neither 
is Kwaterski.  Kwaterski presented the "narrow issue" of 
"whether an eighth-month, viable unborn child, whose later 
stillbirth is caused by the wrongful act of another, is 'a 
person' within the meaning" of the wrongful death statute (then 
Wis. Stat. § 331.03; now Wis. Stat. § 895.03).  Kwaterski, 34 
Wis. 2d at 15.  At the time this court decided Kwaterski, in 
1967, only a handful of states allowed wrongful death recovery 
for a stillborn infant.  Id. at 18-19.  Twenty-eight years 
later:   
The overwhelming majority of states now permit some 
form of recovery for the loss of a fetus.  For 
example, approximately ten states and the District of 
Columbia recognize a common law cause of action for 
mental anguish suffered as a result of the loss of a 
fetus.  In addition, approximately thirty-six states 
No. 
01-2710   
 
14 
 
and the District of Columbia recognize a wrongful 
death cause of action for the loss of a viable fetus.  
Most of these states characterize a viable fetus as a 
"person" or "minor child" under their wrongful death 
statutes.   
 
Krishnan v. Sepulveda, 916 S.W.2d 478, 480-81 (Tex. 1995) 
(footnotes omitted).   
¶21 The passage in Kwaterski that the circuit court relied 
upon, that "we know of no court that has permitted a plaintiff 
mother to include injury to or death of a child as part of her 
injuries," was the explanation for this court's rejection of 
other courts' reasoning denying wrongful death recovery for a 
stillborn infant on the basis that "[s]ince the child is part of 
the mother, the wrong will be remedied if the mother sues and 
recovers for her injuries."  Kwaterski, 34 Wis. 2d at 22.  It 
did not, contrary to the circuit court's conclusion, foreclose a 
claim for emotional injuries sustained by the mother as a result 
of the stillbirth.  Moreover, as noted above, a number of states 
since Kwaterski have allowed the plaintiff mother to recover, 
including 
recovery 
for 
negligent 
infliction 
of 
emotional 
distress.  See, e.g., Vaillancourt, 425 A.2d 92; Johnson, 395 
S.E.2d 85; see also Krishnan, 916 S.W.2d at 480 n.2. 
¶22 Instead of restricting the remedy for a stillbirth to 
the mother's claim for her own injuries, we concluded in 
No. 
01-2710   
 
15 
 
Kwaterski that a wrongful death remedy would ameliorate likely 
"incongruous results":   
If no right of action is allowed, there is a wrong 
inflicted for which there is no remedy.  Denying a 
right of action for negligent acts which produce a 
stillbirth leads to some very incongruous results.  
For example, a doctor or a midwife whose negligent 
acts in delivering a baby produced the baby's death 
would be legally immune from a lawsuit.  However, if 
they badly injured the child they would be exposed to 
liability.  Such a legal rule would produce the absurd 
result that an unborn child who was badly injured by 
the tortious acts of another, but who was born alive, 
could recover while an unborn child, who was more 
severely injured and died as the result of the 
tortious acts of another, could recover nothing.   
 
Kwaterski, 34 Wis. 2d at 20.  
¶23 It would be equally incongruous here to do the 
reverse——deny recovery to the injured mother because of a 
stillbirth merely because there is recovery via a wrongful death 
claim.  The wrongful death claim does not and cannot compensate 
the mother for the pain and anguish that she suffered associated 
with the stillbirth of her child, resulting from the conceded 
medical malpractice.  The wrongful death claim is intended to 
compensate the surviving parent for funeral expenses and 
especially for the loss of society and companionship caused by 
the child's death.  "It does not include . . . the grief and 
mental suffering caused by the child's death."  Wis JI——Civil 
1895 (2001).    
No. 
01-2710   
 
16 
 
¶24 Kwaterski settled the issue of whether Wisconsin would 
follow the nascent national trend of allowing a wrongful death 
claim for a stillborn infant.  It provides no guidance as to 
whether the mother is entitled to recover for her emotional 
distress as a result of medical malpractice that caused the 
stillbirth.  The circuit court erred in relying on Kwaterski to 
dismiss Pierce's emotional distress claim related to the 
stillborn child, and the court of appeals erred in applying 
Bowen and Finnegan.   
III 
¶25 The circuit court's reliance on Kwaterski to segregate 
Bonnie Pierce's "own injuries" from those "arising from the 
injuries and stillbirth of her daughter . . . " (see circuit 
court's August 20, 2001 Order), led this court to ask the 
parties to brief and argue, in addition to the appropriateness 
of that court's reliance on Kwaterski, the appropriateness of 
compartmentalizing the suffering, including emotional distress, 
here.   
¶26 We are satisfied that, as we reiterated recently in 
Mullen v. Walczak, 2003 WI 75, 262 Wis. 2d 708, 664 N.W.2d 76, 
in discussing Redepenning v. Dore, 56 Wis. 2d 129, 143, 201 
N.W.2d 580 (1972), it may be impossible to segregate injuries 
for emotional distress that stem from different sources:  
No. 
01-2710   
 
17 
 
In Redepenning, a mother sought recovery for injuries 
she sustained in an automobile accident.  Her daughter 
died in the accident, and the mother's claims included 
one for emotional distress.  In upholding a jury's 
damage 
award, 
we 
determined 
that 
the 
mother's 
emotional distress was caused both by her own physical 
injuries as well as witnessing her daughter's death.  
Ultimately, we concluded that it was impossible to 
adequately separate the two.  
 
Mullen, 262 Wis. 2d 708, ¶23 (emphasis in original)(citation 
omitted).    
 
¶27 Similarly, we cannot separate the damages Pierce 
suffered into what could be described as "her own" from those 
she suffered in experiencing the stillbirth of her daughter.  
She experienced labor, the death of an infant inside of her, and 
the vacuum extraction of her dead child.  To segregate her 
emotional injuries would be an even more Herculean task than in 
Redepenning.  Pierce was not a witness, but rather a participant 
as a patient.  The inextricable nature of Pierce's position as 
participant/patient relates to the source of her emotional 
injuries, so that it is indeed impossible for them to be 
compartmentalized.  Accordingly, we conclude that the circuit 
court erred in separating Pierce's negligent infliction of 
emotional distress claim, and dismissing that part of her claim 
"arising from the injuries and stillbirth of her daughter . . ." 
while allowing Pierce to proceed on "her claim for damages for 
emotional distress due to her own injuries."   
No. 
01-2710   
 
18 
 
¶28 The fact that the sources of Pierce's emotional 
injuries cannot be segregated does not mean that we have here a 
single claim of medical malpractice subject to the single cap 
for noneconomic damages we discussed last term in Maurin v. 
Hall, 2004 WI 100, 274 Wis. 2d 28, 682 N.W.2d 866.  In Maurin, 
there was a single victim of medical malpractice, the child.  
Id., ¶¶9-13.  Here, in contrast, there are two patients and two 
victims, Pierce and her stillborn daughter, Brianna.  To apply a 
single cap here would effectively excuse the medical malpractice 
inflicted on one of the patient/participant/victims.     
IV 
¶29 Finally, we asked the parties to brief and argue 
whether the stipulation they entered into concerning dismissal 
of claims resulted in Pierce's waiver of her claim for negligent 
infliction of emotional distress.  We find that there is no such 
waiver. 
¶30 The parties entered into a stipulation which provided 
that all causes of action set forth in the plaintiff's amended 
complaint may be dismissed "with the exception of the cause of 
action which was dismissed by the court by order dated August 
20, 2001 . . . with prejudice and without costs to any party 
based upon the Stipulation attached hereto as Exhibit A."  This 
resulted in a dismissal order of the circuit court, dated 
October 3, 2001, which excepted the claims or "causes of action 
No. 
01-2710   
 
19 
 
that were dismissed by the court pursuant to the court's order 
of August 20, 2001. . . ."  Exhibit A is the stipulation 
agreeing to liability and settling the wrongful death claim 
involving loss of society and companionship and funeral expenses 
and gravesite marker.   
¶31 Stipulations are contractual in nature.  Duhame v. 
Duhame, 154 Wis. 2d 258, 264, 453 N.W.2d 149 (Ct. App. 1989).  
We have held that interpretation of a stipulation must, above 
all, give effect to the intention of the parties.  D'Angelo v. 
Cornell 
Paperboard 
Prods. 
Co., 
33 
Wis. 2d 218, 
227, 
147 
N.W.2d 321 (1967).  In Milwaukee & Suburban Transport Corp. v. 
Milwaukee County, 82 Wis. 2d 420, 263 N.W.2d 503 (1978), this 
court held:  
Stipulations should be construed consistent with the 
apparent intention of the parties, the spirit of 
justice, and the furtherance of fair trials upon the 
merits, and should not be construed technically so as 
to defeat the purposes for which they were made.  In 
seeking the intent of the parties, the language of the 
stipulation should not be construed so as to effect 
the waiver of a right not plainly intended to be 
relinquished. 
 
Id. at 442 (citations omitted).   
¶32 The modifying language that the dismissal is "based 
upon the Stipulation attached hereto as Exhibit A" strongly 
suggests that the dismissal of claims was based upon the 
settling of the wrongful death claim, and that the parties 
No. 
01-2710   
 
20 
 
intended the dismissal of only that claim.  While the parties' 
intent of what, if anything, was to be dismissed, in addition to 
the wrongful death claim, and what causes of action were to be 
preserved, 
is 
not 
entirely 
clear 
from the 
face of the 
stipulation, it becomes much clearer when the procedural 
circumstances are reviewed. 
¶33 As we concluded above, the circuit court erred in 
compartmentalizing Pierce's negligent infliction of emotional 
distress claim and separating it into two claims, one for 
"her . . . own injuries," and another "arising from the injuries 
and stillbirth" of Brianna.  Pierce did not agree that the 
circuit court correctly characterized her personal injury claim 
that encompassed her emotional distress claim, and appealed that 
decision to the court of appeals.  Her appeal of the circuit 
court decision and order leads us to conclude that she did not 
intend to stipulate to dismiss the entire claim that was the 
basis of that appeal——her claim which involved the negligent 
infliction of emotional distress.  We are satisfied that Pierce 
did not, by entering into the stipulation for dismissal, waive 
her emotional distress claim, or any portion thereof.  That 
stipulation clearly was intended to preserve the claim dismissed 
by the circuit court order of August 20, 2001. 
V 
No. 
01-2710   
 
21 
 
¶34 For the reasons set forth, Bonnie Pierce may pursue 
her entire claim for the negligent infliction of emotional 
distress, including that portion arising from the injuries and 
stillbirth 
of 
her 
daughter, 
Brianna. 
 
In 
these 
unusual 
circumstances, we conclude that the mother may recover as a 
parent, for the wrongful death of the stillborn infant; and as a 
patient, for her personal injuries including the negligent 
infliction of emotional distress.  We also conclude the 
stipulation 
of 
the 
parties 
did 
not 
waive 
this 
claim.  
Accordingly, we reverse the decision of the court of appeals 
that affirmed the circuit court's order, which dismissed that 
portion of the mother's personal injury claim for negligent 
infliction of emotional distress arising from the injuries and 
stillbirth of her daughter.  
By the Court.—The decision of the court of appeals is 
reversed, and the cause remanded.   
¶35 LOUIS B. BUTLER, JR., J., did not participate. 
 
No. 01-2710.dtp 
 
1 
 
 
¶36 DAVID T. PROSSER, J.   (concurring).   In Wisconsin, 
medical malpractice is a distinct area of tort law whose 
principles are dictated, in large part, by detailed provisions 
of the Wisconsin Statutes.  One of the most critical of these 
statutes is Wis. Stat. § 655.007 entitled "Patients' claims."  
It provides: "On and after July 24, 1975, any patient or the 
patient's representative having a claim or any spouse, parent, 
minor sibling or child of the patient having a derivative claim 
for injury or death on account of malpractice is subject to this 
chapter."  (Emphasis added.)   
¶37 This statute governs claims "for injury or death on 
account of malpractice," including direct claims by a patient or 
a patient's representative and derivative claims by specified 
family members. 
¶38 The 
facts 
in 
this 
case 
are 
different 
and 
distinguishable from the facts in Maurin v. Hall, 2004 WI 100, 
274 Wis. 2d 28, 682 N.W.2d 866, and Finnegan v. Wisconsin 
Patients Compensation Fund, 2003 WI 98, 263 Wis. 2d 574, 666 
N.W.2d 797, because the family members in Maurin and Finnegan 
had only derivative claims.  All three cases involve medical 
malpractice and the death of a minor child.  All three cases 
involve a legitimate wrongful death claim.  But only this case 
involves direct medical malpractice against two patients, a 
mother and a child.  The mother's claim for negligent infliction 
of emotional distress must be rationalized and analyzed as a 
No. 01-2710.dtp 
 
2 
 
direct claim, not a derivative claim, in order to be separate 
and to comply with Wis. Stat. § 655.007. 
¶39 Insofar as the wrongful death claim is concerned, this 
court ruled in 1967 that an eighth-month, viable unborn child 
whose later stillbirth is caused by the wrongful act of another 
is a "person" within the meaning of the wrongful death statute.  
Kwaterski v. State Farm Mut. Automobile Ins. Co., 34 Wis. 2d 14, 
148 N.W.2d 107 (1967).  This rule, that a viable unborn child is 
a "person" under the wrongful death statute, is not here in 
dispute.6   
¶40 That a mother may bring a claim for negligent 
infliction of emotional injuries sustained during the delivery 
of her child, in addition to a claim for wrongful death, was 
decided 
in 
Westcott 
v. 
Mikkelson, 
148 
Wis. 2d 239, 
434 
N.W.2d 822 (Ct. App. 1988). 
¶41 One puzzle in this case is whether this court's 
subsequent decision in the case of Bowen v. Lumbermens Mutual 
Casualty Co., 183 Wis. 2d 627, 517 N.W.2d 432 (1994), limited 
claims for the negligent infliction of emotional distress to 
"bystander" claims.  Clearly, the answer is "no."  Sharon Bowen 
was a "bystander," a plaintiff who alleged emotional distress 
from viewing the immediate aftermath of a tortfeasor's negligent 
infliction of physical harm on a third person, her son.  Id. at 
631-32.  In upholding her claim, the court did not repudiate 
                                                 
6 The principle that an unborn child is a separate entity 
whose interests are protected is reflected in a number of 
Wisconsin 
statutes. 
 
See 
the 
statutes 
listed 
in 
Wis. Stat. § 939.75(3). 
No. 01-2710.dtp 
 
3 
 
Westcott.  In fact, it stated that a bystander situation was not 
the only circumstance that could give rise to a claim for 
negligent infliction of emotional distress.  Id. at 631, 632-33.  
¶42 The majority opinion determines that Bonnie Pierce has 
a separate direct claim for negligent infliction of emotional 
distress, but it does not delineate what she must prove, as a 
matter of law, to recover on this claim.  The court has not said 
before and the court does not say now what elements must be 
present for the tort of "negligent infliction of emotional 
distress" when the claim is not a bystander claim.  In 
addressing this question, the central problem is "the difficulty 
in setting limits on recovery for this common, but intangible, 
category of harm."  Terrence F. Kiely, Modern Tort Liability: 
Recovery in the '90s 109 (1990). 
¶43 Wisconsin Jury Instruction——Civil 2725 sets out the 
elements of Intentional Infliction of Emotional Distress.  The 
instruction reads in part: 
 
A person may recover damages for the intentional 
infliction of severe emotional distress upon him or 
her by another. 
 
A person who by extreme and outrageous conduct 
intentionally causes emotional distress to another is 
liable to that person if the resulting emotional 
distress is severe. 
 
Four factors must be established for an injured 
person to recover: 
 
1. 
That the conduct was intended to cause 
emotional distress, 
 
2. 
That the conduct was extreme and outrageous, 
No. 01-2710.dtp 
 
4 
 
 
3. 
That the conduct was a cause of the person's 
emotional distress, and 
 
4. 
That the emotional distress was extreme and 
disabling. 
 
. . . .  
 
For a person's emotional response to be extreme 
and disabling, you must find that the person was 
unable to function in other relationships because of 
the 
emotional 
distress 
caused 
by 
the 
conduct.  
Temporary discomfort is not extreme and disabling and 
cannot be the basis of recovery. 
Wis JI——Civil 2725. 
 
¶44 It goes without saying that this case does not involve 
"extreme and outrageous" conduct or an "intention" to cause 
emotional distress.  However, the plaintiff did allege in her 
complaint that she "suffered severe emotional distress and 
injury" and that she "sustained physical injury."  She did not 
allege that she "was unable to function in other relationships 
because of the intentional distress caused by the" defendant's 
medical negligence. 
 
¶45 Wisconsin Jury Instruction——Civil 1510 sets out the 
elements of Negligent Infliction of Severe Emotional Distress 
(Bystander Claim).  This instruction is based on Bowen's 
explicit delineation of elements: 
First, the injury suffered by the victim must have 
been fatal or severe.  Second, the victim and the 
plaintiff must be related as spouses, parent-child, 
grandparent-grandchild 
or 
siblings. 
 
Third, 
the 
plaintiff must have observed an extraordinary event, 
namely the incident and injury or the scene soon after 
the incident with the injured victim at the scene. 
Bowen, 183 Wis. 2d at 633. 
No. 01-2710.dtp 
 
5 
 
 
¶46 The Bowen court also stated that "borrowing concepts 
from the tort of intentional infliction of emotional distress," 
a plaintiff must prove "severe emotional distress; but the 
plaintiff 
need 
not 
prove 
physical 
manifestation 
of 
that 
distress."  Id. at 632.  The resulting jury instruction 
explains: 
Emotional distress may arise from the natural 
shock and grief of directly observing an (incident) 
which 
results 
in 
the 
(death) 
to 
a 
family 
member . . . .  Emotional distress includes mental 
suffering, anguish, and shock.  It can include fright, 
horror, grief, and worry.  It need not include 
physical manifestations of injury, although these may 
also be present.   
In order for (plaintiff) to recover, however, 
(her) emotional distress must be severe.  This means 
it must be more than temporary discomfort or a minor 
psychic or emotional shock.  It must be an extreme 
emotional response. 
Wis JI——Civil 1510. 
 
¶47 The Bowen court opined that claimants and courts: 
need a framework for evaluating a bystander's claims 
of negligent infliction of emotional distress. . . . 
We conclude that the traditional elements of a 
tort 
action 
in 
negligence——negligent 
conduct, 
causation and injury (here severe emotional distress)—
—should serve as the framework for evaluating a 
bystander's claim of negligent infliction of emotional 
distress. 
Bowen, 183 Wis. 2d at 652-53.   
 
¶48 If this same framework is also applied to direct 
claims such as the present case, we have a formula of: (1) 
negligent conduct (namely, medical malpractice); (2) causation; 
and (3) injury (severe emotional distress), without any need for 
No. 01-2710.dtp 
 
6 
 
either physical injury or "physical manifestations" of emotional 
injury.  Such a formulation requires comment. 
¶49 First, 
the 
plain 
truth 
is 
that 
"the 
physical 
manifestations" of emotional injury were viewed as an "essential 
requirement of this type of claim" in Westcott.  148 Wis. 2d at 
242 n.2.7  In presenting the case to the court of appeals, Karla 
Westcott's attorney, Jerome Maeder, stated in his brief: 
 
What Karla Westcott observed during the last 
minutes of the birthing process and the shock of then 
observing and feeling the issuance of her dead child 
caused her mental illness. 
 
. . . .  
 
Karla Westcott was in prior good physical and 
mental 
health 
before 
this 
but 
as 
a 
result 
of 
witnessing her own child's strangulation she has been 
severely psychiatrically damaged.  She now goes from 
one major depression to another and has had over 200 
contacts with the Health Care Center since the birth 
of 
her 
child, 
frequently 
attempting 
suicide 
or 
idealizing such thoughts.  She has been on various 
medications, 
has 
experienced 
insomnia, 
and 
then 
episodes where she has not been able to get up out of 
her sleep.  Her personality has changed and today she 
still 
periodically 
experiences 
a 
frightening 
and 
overwhelming episode 
of 
having her unborn 
child 
kicking her inside so that she actually feels the 
child kicking within her. 
                                                 
7 Other jurisdictions are divided on the question of whether 
the plaintiff must suffer some physical injury or physical 
manifestation of an emotional injury to successfully prosecute 
tort claims for emotional injuries.  Compare, e.g., St. Charles 
v. Kender, 646 N.E.2d 411, 414 (Mass. App. Ct. 1995) (physical 
injury required) and Sceusa v. Mastor, 525 N.Y.S.2d 101, 102 
(N.Y. App. Div. 1988) (same) with Giardina v. Bennett, 545 A.2d 
139, 140, 142-43 (N.J. 1988) (physical injury not required) and 
Johnson v. Ruark Obstetrics & Gynecology Assoc., P.A., 395 
S.E.2d 85, 97 (N.C. 1990) (same). 
No. 01-2710.dtp 
 
7 
 
 
She has been treated at the Health Care Center as 
an inpatient and has seen other psychiatrists.  She 
was evaluated by Dr. Bruce Rhoades, the clinical head 
of the North Central Health Institute, and his 
affidavit has been filed with this court.  This 
affidavit and the affidavit of Karla Westcott shows 
that she has many physical manifestations of her 
psychiatric problem and that the diagnosis is not one 
of "grief" as is implied by the respondents but is an 
illness 
readily 
perceived 
and 
categorized 
by 
psychiatry and directly resulting from the negligent 
conduct of the defendant doctor. 
 
She 
has 
a "post 
traumatic 
stress 
disorder" 
together 
with 
"major 
depressive 
disorder" 
and 
"dysthymic 
disorder" 
(Diagnostic 
and 
Statistical 
Manual of Mental Disorders III and IIIR).  (Emphasis 
added). 
 
¶50 This powerful representation was paralleled in Bowen, 
where the court stated: "The complaint asserts that these 
experiences caused Sharon Bowen extreme emotional and psychic 
injuries with accompanying physical symptoms including hysteria, 
insomnia, 
nausea 
and 
the 
disruption 
of 
work 
and 
family 
relationships."  Bowen, 183 Wis. 2d at 635 (emphasis added). 
¶51 Thus, in a very real sense, the presence of physical 
symptoms of emotional distress in Bowen's claim meant that the 
court's blunt disavowal of any requirement for physical injury 
or 
physical 
manifestation 
of 
emotional 
distress 
was 
not 
necessary to its decision.   
¶52 If there is no requirement of physical manifestation 
of emotional distress, the concerns expressed by Justice Wilcox 
in Bowen about assuring the validity of claims for emotional 
distress become more urgent.  See Bowen, 183 Wis. 2d at 663 
(Wilcox, J., concurring).  He asserted that claimants should be 
No. 01-2710.dtp 
 
8 
 
required to produce "some extrinsic, verifiable evidence to 
support their claims."  Id. at 664.  
¶53 At the very least, a fact-finder reviewing the merits 
of a claim for negligent infliction of emotional distress should 
be permitted to consider the presence or absence of physical 
injury or physical manifestations of distress.8  In a legitimate 
claim, the absence of any physical manifestations of distress 
may be explained by expert testimony, which would be helpful, in 
any event, in describing and categorizing the patient's mental 
health. 
¶54 Second, there should be little dispute that the 
stillbirth of a child as a result of medical negligence will be 
deeply hurtful to the mother, producing extraordinary grief and 
anguish.  Nonetheless, I do not understand the court's decision 
to approve a claim for negligent infliction of emotional 
distress in every such case.  A claimant will necessarily be 
required to meet some threshold of proof for emotional injury, 
and I do not see why the burden of proving severe emotional 
distress should be less in a negligence case than in an 
intentional tort. 
¶55 Third, severe emotional distress should not, at least 
in this case, encompass the mother's loss of society and 
                                                 
8 Other courts have struggled to find tests to discern the 
legitimacy of a plaintiff's claim for emotional distress in the 
absence of physical injury.  The Nebraska Supreme Court requires 
the plaintiff to show that the emotional distress was "medically 
diagnosable 
and 
. . . of 
sufficient 
severity 
that 
it 
is 
medically significant."  Hamilton v. Nestor, 659 N.W.2d 321, 329 
(Neb. 2003). 
No. 01-2710.dtp 
 
9 
 
companionship of her child.  Loss of "companionship, society and 
the like . . . are usually viewed as something distinct from 
anguish or grief."  Dan B. Dobbs, 2 The Law of Torts 812 (2001).  
Wisconsin's present wrongful death statute authorizes up to 
$500,000 for "loss of society and companionship," for the death 
of a child from medical malpractice or other tortious causes.  
Wis. Stat. § 895.04(4).  A mother seeking damages for negligent 
infliction of emotional distress from medical malpractice is 
making 
a 
separate 
claim 
governed 
by 
the 
cap 
under 
Wis. Stat. § 893.55(4)(d).  The two claims may be stacked but 
they must not be permitted to overlap.  Courts "can and should 
preclude double recovery by an individual."  EEOC v. Waffle 
House, 534 U.S. 279, 297 (2002).9  Here the plaintiff has already 
settled for an award under the wrongful death statute.  The 
specific injury compensated under the wrongful death statute may 
not be compensated again through a tort claim for negligent 
infliction of emotional distress. 
                                                 
9 As another court summarized the difficulty, 
The 
major 
issue 
with 
which 
[courts 
considering 
emotional distress arising from a miscarriage or 
stillbirth] have wrestled is defining the kinds of 
damages that are allowable in the mother's action so 
as neither to duplicate damages afforded in a wrongful 
death action nor to permit damages that, under the 
State's law, clearly are not allowed, even in a 
wrongful death action.  The demarcation lines drawn by 
the courts are not always consistent and they are not 
always clearly articulated. 
Smith v. Borello, 804 A.2d 1151, 1159 (Md. 2002). 
No. 01-2710.dtp 
 
10 
 
¶56 These observations about the requisite elements for 
negligent infliction of emotional distress are not exhaustive.  
Circuit courts may develop other criteria for claims and may in 
some 
cases 
invoke 
familiar 
public 
policy 
limitations 
on 
liability.  See, e.g., Smaxwell v. Bayard, 2004 WI 101, ¶¶33, 
40, 274 Wis. 2d 278, 682 N.W.2d 923. 
¶57 For the foregoing reasons, I respectfully concur. 
¶58 I am authorized to state that Justice JON P. WILCOX 
joins this concurrence. 
 
 
 
 
 
No. 01-2710.dtp 
 
 
 
1