Title: Jandre v. Physicians Ins. Co. of Wis.
Citation: 2012 WI 39
Docket Number: 2008AP001972
State: Wisconsin
Issuer: Wisconsin Supreme Court
Date: April 17, 2012

2012 WI 39 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2008AP1972 
COMPLETE TITLE: 
 
Thomas W. Jandre and Barbara J. Jandre, 
          Plaintiffs-Respondents, 
     v. 
Wisconsin Injured Patients and Families Compensation Fund, 
          Defendant-Co-Appellant, 
Physicians Insurance Company of Wisconsin and Therese J.  
Bullis, M.D., 
          Defendants-Appellants-Petitioners. 
 
------------------------------------------------------------ 
Thomas W. Jandre and Barbara J. Jandre, 
          Plaintiffs, 
     v. 
Wisconsin Injured Patients and Families Compensation Fund, 
          Defendant-Respondent, 
Physicians Insurance Company of Wisconsin and Therese J.  
Bullis, M.D., 
          Defendants-Appellants-Petitioners. 
 
 
 
 
REVIEW OF THE DECISION OF THE COURT OF APPEALS 
Reported at 330 Wis. 2d 50, 792 N.W.2d 558 
(Ct. App. 2010 - Published) 
 
 
OPINION FILED: 
April 17, 2012   
SUBMITTED ON 
BRIEFS: 
        
ORAL ARGUMENT: 
September 16, 2011 
 
 
SOURCE OF 
APPEAL: 
 
 COURT: 
CIRCUIT   
 COUNTY: 
FOND DU LAC 
 JUDGE: 
ROBERT J. WIRTZ 
  
 
JUSTICES: 
 
 CONCURRED: 
PROSSER, J., concurs (Opinion filed).  
     
 DISSENTED: 
ROGGENSACK, J., dissents (Opinion filed).  
ZIEGLER and GABLEMAN, J.J., join dissent.    
 NOT 
PARTICIPATING:    
  
 
ATTORNEYS: 
 
For the defendants-appellants-petitioners, there were 
briefs filed by Michael B. Van Sicklen and Krista J. Sterken, 
 
 
2
and Foley & Lardner, LLP, Madison, and oral argument by Michael 
B. Van Sicklen.   
 
For the plaintiffs-respondents there was a brief filed by 
Linda V. Meagher, Dana J. Weis, James M. Fergal, and Habush, 
Habush & Rottier, S.C., Waukesha, and oral argument by Dana J. 
Weis.  
 
An amicus curiae brief was filed by Lynn R. Laufenberg and 
Laufenberg, Stombaugh & Jassak, S.C., Milwaukee, and William C. 
Gleisner, III, Hartland, on behalf of the Wisconsin Association 
for Justice.   
 
 
Amicus curiae briefs were filed by Guy DuBeau, and Axley 
Brynelson, LLP, Madison, on behalf of the Wisconsin Medical 
Society, Inc., the Wisconsin Hospital Association, Inc. and the 
Wiconsin Chapter of the American College of Emergency 
Physicians, Inc.  
 
 
An amicus curiae brief was filed by William F. Bauer and 
Karen M. Gallagher, and Coyne, Schultz, Becker & Bauer, S.C., 
Madison, on behalf of Dean Health System, Inc., Marshfield 
Clinic and Gundersen Lutheran Health System, Inc.  
 
 
 
 
 
 
 
2012 WI 39
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.   2008AP1972 
(L.C. No. 
2004CV363) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
Thomas W. Jandre and Barbara J. Jandre, 
 
          Plaintiffs-Respondents, 
 
     v. 
 
Wisconsin Injured Patients and Families 
Compensation Fund, 
 
          Defendant-Co-Appellant, 
 
Physicians Insurance Company of Wisconsin and 
Therese J. Bullis, M.D., 
 
          Defendants-Appellants-Petitioners. 
 
----------------------------------------------- 
 
Thomas W. Jandre and Barbara J. Jandre, 
 
          Plaintiffs, 
 
     v. 
 
Wisconsin Injured Patients and Families 
Compensation Fund, 
 
          Defendant-Respondent, 
 
Physicians Insurance Company of Wisconsin and 
Therese J. Bullis, M.D., 
 
          Defendants-Appellants-Petitioners. 
 
FILED 
 
APR 17, 2012 
 
Diane M. Fremgen 
Clerk of Supreme Court 
 
 
 
 
No. 
2008AP1972   
 
2 
 
REVIEW of a decision of the Court of Appeals.  Affirmed.   
 
¶1 
SHIRLEY S. ABRAHAMSON, C.J.   This is a review of a 
published decision of the court of appeals in a medical 
malpractice case.1  The court of appeals affirmed a judgment of 
the Circuit Court for Fond du Lac County, Robert J. Wirtz, 
Judge, entered on a jury verdict in favor of Thomas W. Jandre 
(Jandre) and his wife, Barbara J. Jandre (collectively, the 
Jandres), against Dr. Therese J. Bullis and her insurer, 
Physicians Insurance Company of Wisconsin (collectively, PIC) 
and the Wisconsin Injured Patients and Families Compensation 
Fund (the Fund).  PIC seeks review, but the Fund does not. 
¶2 
We briefly put the issue presented and PIC's position 
in context.  The Jandres asserted two claims:  (1) Dr. Bullis 
negligently diagnosed Jandre with Bell's palsy; and (2) Dr. 
Bullis breached her duty to inform a patient under Wis. Stat. 
§ 448.30 (2007-08),2 by failing to inform Jandre of a diagnostic 
test (a carotid ultrasound) that was available to rule out the 
possibility of a stroke.  Stroke was one of several conditions 
                                                 
1 Jandre v. Physicians Ins. Co. of Wis., 2010 WI App 136, 
330 Wis. 2d 50, 792 N.W.2d 558. 
Justice Bradley and Justice Crooks join this opinion.  
Justice Prosser concurs in the decision to affirm the court of 
appeals and circuit court, but is unable to join this opinion.    
2 All subsequent references to the Wisconsin Statutes are to 
the 2007-08 version unless otherwise indicated. 
No. 
2008AP1972   
 
3 
 
that was included in Dr. Bullis's differential diagnosis3 but it 
was not in her final diagnosis.   
¶3 
The jury found that Dr. Bullis's diagnosis of Bell's 
palsy was not negligent and also found that Dr. Bullis was 
negligent with respect to her duty to inform the patient.4  The 
circuit court entered judgment on the verdict, and the court of 
appeals affirmed the judgment.  
¶4 
PIC presents the issue as follows: Is there a bright-
line rule that once a physician makes a non-negligent final 
diagnosis, there is no duty to inform the patient about 
diagnostic tests for conditions unrelated to the condition that 
was included in the final diagnosis?  Stating the issue in terms 
of the facts of the present case, PIC asks:  When a jury in a 
medical malpractice case finds that the emergency room physician 
was not negligent in the diagnosis of Bell's palsy, may a jury 
find a breach of the duty to inform when the physician fails to 
advise the patient about the availability of a non-invasive 
diagnostic tool (a carotid ultrasound) that might definitively 
                                                 
3 "Differential diagnosis" usually refers to a diagnostic 
process in which a physician begins by creating a list of 
diseases or ailments that he or she believes might possibly be 
causing the patient's symptoms.  In our discussion, we follow 
the parties' lead and use "differential diagnosis" to refer to 
the initial list of possible diseases, as opposed to "final 
diagnosis," which is the disease the physician determines is 
causing the patient's symptoms.      
4 The 
circuit 
court 
concluded 
that 
credible 
evidence 
supported the jury's findings and denied the defendants' motion 
to change the verdict.  PIC is no longer challenging the 
sufficiency of the evidence with respect to the informed consent 
verdict.  
No. 
2008AP1972   
 
4 
 
rule out a stroke (a condition that appeared in the differential 
diagnosis and is unrelated to the final diagnosis of Bell's 
palsy), when the physician ruled out a stroke by a less reliable 
diagnostic tool?      
¶5 
PIC answers these questions in the negative and urges 
us to adopt a bright-line rule.  PIC asserts that, as a matter 
of law, a physician has no duty to inform the patient about 
conditions 
unrelated 
to 
the 
condition 
identified 
in 
the 
physician's non-negligent diagnosis, and that the facts in the 
present case are so clear that as a matter of law the circuit 
court had to find Dr. Bullis not negligent on the claim of 
breach of duty to inform rather than let the jury decide the 
question.   
¶6 
PIC argues that the circuit court and court of appeals 
expanded a physician's duty to inform beyond what Wisconsin 
courts have previously recognized.  PIC asks the court to 
reverse the decision of the court of appeals, vacate the jury's 
verdict, and vacate the award of damages on the informed consent 
claim. 
¶7 
We affirm the decision of the court of appeals by 
applying the reasonable patient standard (sometimes referred to 
as 
the 
"prudent 
patient" 
standard), 
which 
Wisconsin 
has 
explicitly followed in informed consent cases since at least 
1975.5  The doctrine of stare decisis governs the present case.   
                                                 
5 See Scaria v. St. Paul Fire & Marine Ins. Co., 68 
Wis. 2d 1, 227 N.W.2d 647 (1975).  
No. 
2008AP1972   
 
5 
 
¶8 
Under the reasonable patient standard, "Wisconsin law 
'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.'"6  The reasonable 
patient standard requirement of disclosure "is rooted in the 
facts and circumstances of the particular case in which it 
arises."7  The bright-line rule PIC urges is incompatible with 
the reasonable patient standard adopted by the legislature in 
Wis. Stat. § 448.30 and explained in case law.      
¶9 
"[T]he 
informed 
consent 
standard . . . [i]s 
an 
objective standard based on negligence principles such as 
reasonableness . . . ."8  Thus, the physician's "duty to inform 
is not boundless."9   
¶10 Applying the reasonable patient standard to the facts 
and circumstances of the present case involving a non-negligent 
diagnosis of Bell's palsy, we conclude that the circuit court 
could not determine, as a matter of law, that the physician had 
no duty to inform the patient of the possibility that the cause 
of his symptoms might be a blocked artery, which posed imminent, 
                                                 
6 Kuklinski 
v. 
Rodriguez, 
203 
Wis. 2d 324, 
329, 
552 
N.W.2d 869 (Ct. App. 1996) (quoting Martin v. Richards, 192 
Wis. 2d 156, 175, 531 N.W.2d 70 (1995)).  See also Bubb v. 
Brusky, 2009 WI 91, ¶62, 321 Wis. 2d 1, 768 N.W.2d 903. 
7 Johnson v. Kokemoor, 199 Wis. 2d 615, 639, 545 N.W.2d 495 
(1996). 
8 Bubb, 321 Wis. 2d 1, ¶54 (citing Scaria, 68 Wis. 2d at 11, 
12-13). 
9 Id. (citing Scaria, 68 Wis. 2d at 11, 12-13).  
No. 
2008AP1972   
 
6 
 
life-threatening risks, and of the availability of alternative, 
non-invasive means of ruling out or confirming the source of his 
symptoms.   
¶11 PIC raises a fundamental legal question concerning the 
scope of a physician's duty to inform a patient.  We begin by 
recognizing that the instant case, like many cases this court 
decides, presents complicated questions about how a legal 
doctrine, here the reasonable patient standard in informed 
consent cases, unfolds in real life situations. 
I 
¶12 The practice of medicine is complex.  Circumstances 
differ from case to case.  Patients often lack the expertise of 
their physicians, and patients can become overwhelmed and 
confused by medical information.  Nonetheless, the court and the 
legislature have embraced the notion that although the physician 
is the expert, the patient should have the opportunity to 
understand what is happening to his or her body and autonomously 
and intelligently consent or refuse to consent to proposed 
medical care.10  Informed consent is fundamentally about each 
                                                 
10 See, e.g., Hannemann v. Boyson, 2005 WI 94, ¶34, 282 
Wis. 2d 664, 698 N.W.2d 714 (noting that the duty of informed 
consent is "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'" (quoting Trogun v. Fruchtman, 58 
Wis. 2d 569, 596, 207 N.W.2d 297 (1973))).  See generally Dr. 
Nili 
Karako-Eyal, 
Physicians' 
Duty 
of 
Disclosure: 
A 
Deontological and Consequential Analysis, 14 Quinnipiac Health 
L.J. 1, 6-9 (2010) (discussing the benefits and importance of 
patient autonomy). 
No. 
2008AP1972   
 
7 
 
person's right to decide "what shall be done with his [or her] 
own body."11     
¶13 Creating informed consent requirements that allow 
physicians to confidently perform their all-important work 
without fearing unfair and unpredictable liability, and that 
give patients a meaningful opportunity to intelligently exercise 
their right of self-determination, is the challenge.  A careful 
balance must be struck and clearly communicated to the concerned 
communities.12   
¶14 The court and the legislature have made this balance 
by adopting the reasonable patient approach to informed consent.   
A 
¶15 The formulation of the reasonable patient approach is 
stated in a variety of consistent ways in the case law.  The 
objective, negligence-based approach inherently limits the scope 
of the physician's duty to inform the patient.  A "physician's 
duty to inform is not boundless."13 
¶16 The physician's duty to inform does not mean the 
physician is "required to know every potential risk but only 
those known to a reasonably well qualified practitioner or 
                                                 
11 Martin, 192 Wis. 2d at 169 (quoted source omitted). 
12 See generally Mark A. Hall, A Theory of Economic Informed 
Consent, 31 Ga. L. Rev. 511, 545-56 (1997) (discussing the need 
to balance patient autonomy with the need to contain the costs 
of healthcare and to keep disclosures within limits manageable 
by both patients and physicians). 
13 Bubb, 321 Wis. 2d 1, ¶54 (citing Scaria, 68 Wis. 2d at 
11, 12-13).   
No. 
2008AP1972   
 
8 
 
specialist commensurate with his [or her] classification in the 
medical profession."14  Notably for the present case, in 2009 
this court refused to accept the argument that the reasonable 
patient standard would unduly burden emergency room physicians.15  
¶17 The physician must disclose only "what is material to 
the patient's decision, i.e., all of the viable alternatives and 
risks of the treatment proposed."16  This means that "Wisconsin 
law '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.'"17  There 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 
injury."18  
                                                 
14 Scaria, 68 Wis. 2d at 11, quoted with approval in Bubb, 
321 Wis. 2d 1, ¶54. 
15 The court determined that the express limitations in Wis. 
Stat. § 448.30 protected against emergency room physicians being 
held to an unrealistic standard given the nature of their work.  
Bubb, 321 Wis. 2d 1, ¶¶75-76. 
16 Martin, 192 Wis. 2d at 174, quoted with approval in Bubb, 
321 Wis. 2d 1, ¶62. 
17 Kuklinski, 203 Wis. 2d at 329 (quoting Martin, 192 
Wis. 2d at 175). 
18 Martin, 192 Wis. 2d at 176 (quoting John H. Derrick, 
Annotation, Medical 
Malpractice: Liability for Failure of 
Physician to Inform Patient of Alternative Modes of Diagnosis or 
Treatment, 38 A.L.R. 4th 900, 903 (1985)).  
No. 
2008AP1972   
 
9 
 
¶18 The 
court 
has observed that "[w]hat constitutes 
informed consent in a given case emanates from what a reasonable 
person in the patient's position would want to know."19  The 
court has rejected a proposed bright-line rule that would 
require physicians "to disclose only significant complications 
intrinsic to the contemplated procedure."20  The court has 
observed that "[t]he prudent patient standard adopted by 
Wisconsin in Scaria is incompatible with such a bright line 
rule."21    
¶19 The requirement of disclosure "is rooted in the facts 
and circumstances of the particular case in which it arises."22  
"The information that is reasonably necessary for a patient to 
make an informed decision regarding treatment will vary from 
case to case."23   
¶20 The physician is "to make such disclosures as appear 
reasonably necessary under circumstances then existing to enable 
a reasonable person under the same or similar circumstances 
confronting 
the 
patient 
at 
the 
time 
of 
disclosure 
to 
                                                 
19 Johnson, 199 Wis. 2d at 632. 
20 Id. at 637-38.  
21 Id. at 639. 
22 Id. 
23 Martin, 192 Wis. 2d at 175, quoted with approval in 
Johnson, 199 Wis. 2d at 634. 
No. 
2008AP1972   
 
10 
 
intelligently exercise his right to consent or to refuse the 
treatment or procedure proposed."24 
¶21 Even if it is determined that the information withheld 
is information "a reasonable person under the circumstances 
would want to know," the physician has no duty to inform the 
patient unless the physician "had sufficient knowledge about the 
patient's condition to trigger the physician's awareness that 
the 
information 
was 
reasonably 
necessary 
for 
the 
patient . . . to make an intelligent decision regarding the 
patient's care, or should have had that knowledge."25  
¶22 Thus, physicians are not held liable for failing to 
disclose information if they could not reasonably have known, 
based on circumstances then existing, that the information was 
potentially important.  The focus of an evaluation of whether a 
physician is negligent for failing to disclose available methods 
of diagnosis or treatment is on the circumstances existing when 
the information allegedly should have been given, not on 
circumstances arising thereafter.26 
¶23 In addition to these important limiting principles 
that are inherent in the objective, negligence-based reasonable 
patient standard, the court in Scaria v. St. Paul Fire & Marine 
Ins. Co., 68 Wis. 2d 1, 12-13, 227 N.W.2d 647 (1975), created 
                                                 
24 Scaria, 68 Wis. 2d at 13 (emphasis added), quoted with 
approval in Bubb, 321 Wis. 2d 1, ¶53.  
25 Kuklinski, 203 Wis. 2d at 330. 
26 Id. at 331. 
No. 
2008AP1972   
 
11 
 
several 
express 
limitations, 
which 
were 
adopted 
by 
the 
legislature and included in Wis. Stat. § 448.30.  The court in 
Bubb v. Brusky, 2009 WI 91, 321 Wis. 2d 1, 768 N.W.2d 903, later 
relied on these express limitations to assuage the concern that 
emergency room physicians were being held to an unattainable 
standard.27   
¶24 The Scaria court listed limitations to a physician's 
duty of disclosure as follows: 
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 
emergency or where the patient is a child, mentally 
incompetent or a person is emotionally distraught or 
susceptible to unreasonable fears.28   
 
¶25 Wisconsin 
Stat. 
§ 448.30 
lists 
the 
following 
limitations on liability: 
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. 
                                                 
27 Bubb, 321 Wis. 2d 1, ¶¶75-77.   
28 Scaria, 68 Wis. 2d at 12-13, quoted with approval in 
Bubb, 321 Wis. 2d 1, ¶54. 
No. 
2008AP1972   
 
12 
 
(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. 
¶26 It is clear that the objective, negligence-based 
approach and Wis. Stat. § 448.30 limit the scope of the 
physician's duty to inform the patient.  The physician's duty to 
inform is not boundless. 
B 
¶27 The liability imposed on Dr. Bullis and on other 
physicians in similar situations, springing from an objective, 
negligence-based reasonable patient standard, is decidedly not 
strict liability.  Physicians are liable only if the information 
they fail to disclose is "reasonably necessary for a reasonable 
person to make an intelligent decision with respect to the 
choices of treatment or diagnosis."29   
¶28 The argument that the rationale in the present case 
upholding 
the 
jury 
verdict 
against 
Dr. 
Bullis 
renders 
"physicians essentially strictly liable for bad results even 
though they were not negligent in the care and treatment of 
their patients"30 is unfounded.  It displays a misunderstanding 
of the reasonable patient standard.   
                                                 
29 Martin, 192 Wis. 2d at 174 (emphasis added). 
30 Jandre, 330 Wis. 2d 50, ¶44 (Fine, J., concurring).   
No. 
2008AP1972   
 
13 
 
¶29 A more subtle point, however, is that this strict 
liability argument rests on a mistrust of juries.  Because duty 
to inform cases ordinarily arise when a bad medical result has 
occurred, the fear is that juries will be influenced by 
"hindsight bias."  "Hindsight bias" is a well-documented 
phenomenon that causes people to overestimate, after the fact, 
how likely it was that an event would occur simply because the 
event did, in fact, occur.31      
¶30 Our 
system 
of 
law 
relies 
on 
juries 
to 
adhere 
faithfully to instructions on the law and to set aside any 
biases and sympathies.  If we cannot trust juries in the context 
of informed consent cases, we call into question the integrity 
of the jury system in all cases.   
¶31 One of the cases PIC relies on heavily actually 
presents a good example of a jury's faithfully applying the 
objective, 
negligence-based 
standard 
and 
finding 
that 
a 
physician was not liable for breach of the duty to inform, 
despite 
the 
fact 
that 
the 
patient 
suffered 
a 
medical 
catastrophe.  In Kuklinski v. Rodriguez, 203 Wis. 2d 324, 552 
N.W.2d 869 (Ct. App. 1996), the jury found that based on what 
the physician knew about the patient's condition at the time the 
patient 
contended 
disclosure 
should 
have 
been 
made, 
the 
                                                 
31 See, e.g., Robert P. Agans & Leigh S. Shaffer, The 
Hindsight Bias: The Role of the Availability Heuristic and 
Perceived Risk, 15 Basic & Applied Soc. Psych. 439 (1994). 
No. 
2008AP1972   
 
14 
 
physician was not negligent in failing to provide information to 
the patient.32   
¶32 Although, in hindsight, it was clear that severe harm 
to the patient might have been prevented had the physician 
informed the patient about the possibility of using a CT scan as 
a diagnostic tool, the jury understood that it was its duty to 
determine the physician's negligence on the basis of what the 
physician knew at the time the information allegedly should have 
been given, not what the physician came to know later.  
¶33 Based on the limitations that are inherent in the 
objective, negligence-based reasonable patient standard, the 
limitations that are expressly included in Wis. Stat. § 448.30, 
and our belief that juries are capable of faithfully applying 
the reasonable patient standard, we conclude that the reasonable 
patient standard imposed on physicians in cases like the instant 
one is not "essentially strict liability."  
C 
¶34 The doctrine of stare decisis governs the present 
case.  Both the majority opinion and the concurrence in the 
court of appeals' decision conclude, as do we, that the circuit 
court's judgment was based on "well-established precedent in 
Wisconsin."33   
¶35 As Judge Fine stated in his concurring opinion: "As 
seen from the [majority opinion's] cogent analysis of existing 
                                                 
32 Kuklinski, 203 Wis. 2d at 334.   
33 Jandre, 330 Wis. 2d 50, ¶¶3, 44 (Fine, J., concurring). 
No. 
2008AP1972   
 
15 
 
law 
in 
connection 
with 
the 
informed-consent 
issue, 
its 
conclusion that we must affirm is compelled by precedent."34   As 
we shall explain further, the present case is consistent with 
well-established precedent, including Martin v. Richards, 192 
Wis. 2d 156, 531 N.W.2d 70 (1995), Kuklinski v. Rodriguez, 203 
Wis. 2d 324, 552 N.W.2d 869 (Ct. App. 1996), and the court's 
recent decision in Bubb.  Furthermore, the facts of the present 
case are substantially similar to those in Martin and Bubb.35     
¶36 Fidelity to precedent is a fundamental concept in 
American law.  Under the doctrine of stare decisis, a court will 
adhere to a principle of law adopted after argument as binding 
precedent where the very point is again in controversy.  When 
                                                 
34 Id., ¶44 (Fine, J., concurring). 
35 The Martin case, the Bubb case, and the present case have 
the following factual similarities: 
(1) In all three cases, the treating physician was an 
emergency medicine physician. 
(2) In all three cases, the patient eventually 
suffered severe harm from an ailment or disease other 
than that which the physician included in the final 
diagnosis. 
(3) In all three cases, the physician failed to inform 
the patient of alternative diagnostic tools that could 
have been used to determine the cause of the ailment. 
(4) 
In 
all 
three 
cases, 
the 
patient's 
medical 
malpractice claim of negligent care and diagnosis was 
unsuccessful. 
(5) In all three cases, the supreme court concluded 
that a viable claim of breach of the physician's duty 
of informed consent was for the jury's determination.     
No. 
2008AP1972   
 
16 
 
existing law is open to recurring revision, the task of deciding 
cases becomes an exercise of judicial will, with arbitrary and 
unpredictable results.36  This court follows the doctrine of 
stare decisis because of our respect for the rule of law.37  
Departure 
from 
prior 
case 
precedent 
without 
good 
reason 
undermines confidence in the reliability of court decisions.   
¶37 Overruling 
prior case law requires a compelling 
justification.38   No such compelling justification exists in the 
present case.  The legislature has not changed Wis. Stat. 
§ 448.30 since its enactment.  The policy considerations raised 
by 
PIC in the present case to undermine precedent are 
substantially similar to those argued and rejected in prior 
cases.  Prior case law is sound as applied to the present case.  
Stare decisis compels us to reject PIC's interpretation of Wis. 
Stat. § 448.30, to adhere to prior case law, and to affirm the 
decision of the court of appeals that affirms the jury verdict.  
¶38 Applying the reasonable patient standard, we conclude 
that under the circumstances of the present case Dr. Bullis had 
a duty to inform Jandre on the night of June 13, 2003, of the 
availability of an alternative, viable means of determining 
                                                 
36 Schultz v. Natwick, 2002 WI 125, ¶37, 257 Wis. 2d 19, 653 
N.W.2d 266.   
37 Johnson Controls v. Employers Ins. of Wausau, 2003 WI 
108, ¶95, 264 Wis. 2d 60, 665 N.W.2d 257.  
38 State v. Outagamie County Bd. of Adjustment, 2001 WI 78, 
¶71, 244 Wis. 2d 613, 628 N.W.2d 376 (Crooks, J., concurring); 
State v. Stevens, 181 Wis. 2d 410, 442, 511 N.W.2d 591 (1994) 
(Abrahamson, J., concurring). 
No. 
2008AP1972   
 
17 
 
whether he had suffered an ischemic stroke event rather than an 
attack of Bell's palsy.  Dr. Bullis failed to discharge this 
duty, even though she knew that Bell's palsy was a diagnosis of 
exclusion (that is, there is no affirmative test for Bell's 
palsy) and that her chosen method of excluding an ischemic 
stroke event was, to quote Dr. Bullis,  "very, very poor."  A 
jury could have determined under the facts and circumstances of 
the present case that Dr. Bullis should have known that 
information about another available non-invasive diagnostic tool 
was information a reasonable patient in Jandre's position would 
have wanted in order to decide intelligently whether to follow 
Dr. Bullis's recommendations. 
II 
¶39 The relevant facts are not in dispute for purposes of 
our review.  On June 13, 2003, the coffee Jandre was drinking 
began coming out of his nose, and he began drooling and slurring 
his speech.  The left side of his face drooped.  He experienced 
about 20 minutes of dizziness and weakness in his legs.   
¶40 Jandre's co-workers took him to the emergency room, 
and the ER nurse noted these symptoms on Jandre's chart.  
¶41 Jandre was evaluated at the emergency room by Dr. 
Bullis, who read Jandre's chart, took Jandre's medical, social, 
and family history, and performed a physical examination.  Dr. 
Bullis testified that her differential diagnosis included 
"Bell's Palsy, stroke, TIA, all of those stroke syndromes 
including ischemic as well as hemorrhagic, tumors, syndromes 
like——things like Guillain-Barre, MS [multiple sclerosis], and 
No. 
2008AP1972   
 
18 
 
multiple other things like that."  She noted that it included 
"some of the more obscure disease processes."   
¶42 There are two types of strokes: hemorrhagic and 
ischemic.  Either type can cause death or permanent injury.   
¶43 Hemorrhagic strokes involve bleeding in the brain 
tissue.  After arriving at her differential diagnosis, Dr. 
Bullis ordered a CT scan, which could rule out a hemorrhagic 
stroke and brain tumors.  The results were normal.  A CT scan 
will not detect an ischemic stroke.   
¶44 Ischemic strokes are commonly caused by a blockage in 
the carotid artery in the neck that cuts off the brain's blood 
supply.  "Ischemic stroke event" is used here to refer to both a 
full-blown ischemic stroke and the less serious conditions 
called a "temporary ischemic attack" (TIA) and a "reversible 
ischemic neurological deficit" (RIND).  TIA and RIND are two 
types of "mini-strokes," which are warning signs of a full-blown 
stroke, but usually do not cause long-term damage. 
¶45 To determine whether Jandre had suffered an ischemic 
stroke event, Dr. Bullis listened to Jandre's carotid arteries 
with a stethoscope in an effort to detect the "whooshing sound" 
characteristic of turbulent blood flow caused by a blocked 
artery, known as a "bruit."  Dr. Bullis admitted at trial that 
listening to the carotid arteries for a bruit is a "very, very 
poor screening test for determining what shape the arteries are 
in."  Her testimony established that a bruit will not be heard 
if an artery is severely blocked and it will also not be heard 
if the artery is clear.  
No. 
2008AP1972   
 
19 
 
¶46 Dr. Bullis had the option of ordering a carotid 
ultrasound to assess the state of Jandre's carotid arteries, but 
she chose not to.  A carotid ultrasound is a non-invasive 
diagnostic technique that was available at the hospital and is 
more reliable than listening with a stethoscope for bruits.  
¶47 Also 
pertinent 
here 
is 
testimony 
that 
Jandre's 
symptoms were atypical of Bell's palsy.  Witnesses testified 
that Bell's palsy is a viral inflammation of the seventh cranial 
nerve, which enervates the face only.  Thus, in a classic case 
of Bell's palsy, the symptoms involve only facial paralysis.  
Jandre's additional symptoms of trouble swallowing (a process 
controlled by different nerves), dizziness, and weakness of the 
legs were all atypical of Bell's palsy.  Bell's palsy typically 
comes on slowly over a course of a few days; Jandre's symptoms 
came on quickly.  
¶48 Jandre's symptoms of slurred speech, dizziness, and 
weakness in the legs are associated with an ischemic stroke 
event.  
¶49 On the basis of the symptoms and the tests performed, 
Dr. Bullis ruled out an ischemic stroke event and came to a 
final diagnosis of a mild form of Bell's palsy.  Notably, Bell's 
palsy is a "diagnosis of exclusion," which means there is no 
affirmative test for Bell's palsy.  The only way to diagnose 
Bell's palsy is to rule out all other potential conditions.    
¶50 Dr. Bullis informed Jandre that she believed that he 
had Bell's palsy, prescribed medication, and sent him home with 
instructions to see a neurologist for follow-up care.   
No. 
2008AP1972   
 
20 
 
¶51 Dr. Bullis did not tell Jandre the following: (1) that 
he had an atypical presentation of Bell's palsy; (2) that his 
symptoms were also consistent with an ischemic stroke event; (3) 
that her method of eliminating an ischemic stroke event from the 
differential diagnosis was "very poor"; (4) that she could have 
ordered a carotid ultrasound to definitively rule out the 
possibility of an ischemic stroke event; and (5) that an event 
such as a TIA or a RIND is often a harbinger of a full-blown 
ischemic stroke. 
¶52 At trial, Dr. Bullis testified that she did not think 
she needed to tell Jandre about TIA or RIND because she 
considered both very unlikely and remote possibilities.    
¶53 Three days after seeing Dr. Bullis in the emergency 
room, Jandre saw a family medicine physician who noted that 
Jandre exhibited signs of resolving Bell's palsy. 
¶54 On the evening of June 24, 2003, Jandre suffered a 
full-blown stroke, which impaired his physical and cognitive 
abilities.  A carotid ultrasound performed at the hospital 
revealed that his right internal carotid artery was 95 percent 
blocked.  Two expert witnesses at trial testified that they 
would have ordered a carotid ultrasound for Jandre on June 13, 
2003; that Jandre had experienced a TIA or RIND on that day; 
that a carotid ultrasound would have revealed the blockage in 
Jandre's carotid artery; and that surgery could have been 
performed, reducing the likelihood that Jandre would suffer a 
stroke.  
No. 
2008AP1972   
 
21 
 
¶55 With 
regard 
to 
Jandre's 
claim 
of 
negligent 
misdiagnosis, one form of medical malpractice, the jury was 
given pattern jury instructions, Wis JI——Civil 1023, about the 
"reasonable doctor" standard of care.  The jury was told that 
the standard of negligence is whether Dr. Bullis "failed to use 
the degree of care, skill, and judgment which reasonable 
emergency room physicians would exercise given the state of 
medical knowledge on June 13, 2003."  Because there was evidence 
of two or more alternative methods of treatment or diagnosis 
recognized as reasonable, the jury was further instructed that 
Dr. Bullis was not negligent in diagnosing Bell's palsy if she 
chose one recognized diagnostic method rather than another and 
used reasonable care, skill, and judgment in administering the 
method.39   
¶56 Given the conflicting testimony by experts relating to 
the appropriate diagnosis and treatment, the jury could have 
reasonably concluded, and did conclude, that Dr. Bullis's 
diagnosis and treatment were reasonable under the circumstances.  
                                                 
39 The relevant part of the instruction is as follows:  
If you find from the evidence that more than one 
method of diagnosing . . . Thomas Jandre's condition 
was recognized as reasonable given the state of 
medical knowledge at that time, then Dr. Therese 
Bullis was at liberty to select any of the recognized 
methods.  Dr. Therese Bullis was not negligent because 
she chose to use one of these recognized diagnostic 
methods rather than another . . . recognized method if 
she used reasonable care, skill, and judgment in 
administering the method. 
No. 
2008AP1972   
 
22 
 
The Jandres do not seek review of the jury's verdict against 
them on their claim of negligent misdiagnosis.      
¶57 The standard governing informed consent, in contrast 
to the standard governing negligent misdiagnosis, is the 
reasonable patient standard.  Thus, the jury was instructed that 
a doctor must provide the patient with the information a 
reasonable person in the patient's position would regard as 
significant when deciding to accept or reject a diagnostic 
procedure.  The jury was also instructed that the physician's 
duty to inform does not require disclosure of "extremely remote 
possibilities that might falsely or detrimentally alarm the 
patient."40 
                                                 
40 In Martin, 192 Wis. 2d at 168, the court concluded as a 
matter of law that in light of the serious consequences of an 
intracranial bleed, a one to three percent chance is not remote: 
"[A]lthough the risk of complication may be small, such risk may 
be significant to a patient's decision in light of the 
potentially severe consequences" (citations omitted).  
The full jury instruction relating to question 3 is as 
follows: 
Question Number 3 on the verdict form asks:  Did Dr. 
Therese Bullis fail to disclose information about the 
alternative methods of diagnosis necessary for Thomas 
Jandre to make an informed decision?   
A doctor has the duty to provide her patient with 
information necessary to enable the patient to make an 
informed decision about a diagnostic procedure and 
alternative choices of diagnostic procedures.  If the 
doctor fails to perform this duty, she is negligent.   
To meet this duty to inform her patient, a doctor must 
provide her patient with the information a reasonable 
person in the patient's position would regard as 
significant when deciding to accept or reject a 
No. 
2008AP1972   
 
23 
 
¶58 The jury was asked to answer the following (pattern) 
special verdict questions:  
Question No. 3: Did defendant Dr. Therese J. Bullis 
fail to disclose to Thomas Jandre information about 
alternative medical diagnoses or treatments, which 
were [sic] necessary for Thomas Jandre to make an 
informed decision? 
The jury answered Yes. 
                                                                                                                                                             
diagnostic procedure.  In answering this question, you 
should determine what a reasonable person in the 
patient's position would want to know in consenting to 
or rejecting a diagnostic procedure.   
The 
doctor 
must 
inform 
the 
patient 
whether 
a 
diagnostic procedure is ordinarily performed in the 
circumstances 
confronting 
the 
patient, 
whether 
alternate 
procedures 
approved 
by 
the 
medical 
profession are available, what the outlook is for 
success or failure of each alternate procedure, and 
the benefits and risks inherent in each alternate 
procedure.   
However, the physician's duty to inform does not 
require disclosure of:  
Information beyond what a reasonably well-informed 
physician in a similar medical classification would 
know;  
Detailed technical information that in all probability 
the patient would not understand;  
The risks apparent or known to the patient;  
Extreme remote possibilities that might falsely or 
detrimentally alarm the patient.   
If Dr. Therese Bullis offers you an explanation to why 
she did not provide information to Thomas Jandre, and 
if this explanation satisfies you that a reasonable 
person in Thomas Jandre's position would not have 
wanted to know that information, then Dr. Therese 
Bullis was not negligent. 
No. 
2008AP1972   
 
24 
 
Question No. 4: If you answered question 3 "yes," then 
answer this question: If a reasonable person, placed 
in 
Thomas 
Jandre's 
position, 
had 
been 
provided 
necessary 
information 
about 
alternative 
medical 
diagnoses 
or 
treatments 
would 
that 
person 
have 
undertaken 
the 
alternative 
medical 
diagnoses 
or 
treatment? 
The jury answered Yes. 
Question No. 5: If you have answered both questions 3 
and 4 "yes," then answer this question: Was the 
failure by Dr. Therese Bullis to disclose information 
about alternative medical diagnoses or treatment a 
cause of Thomas Jandre's injuries?41 
The jury answered Yes. 
¶59 The jury awarded the Jandres damages of approximately 
$2,000,000.42  
III 
¶60 This case involves the interpretation and application 
of Wisconsin's informed consent statute, Wis. Stat. § 448.30.  
Interpreting and applying a statute to facts presents a question 
of law, which this court determines independently of the circuit 
court and court of appeals but benefiting from their analyses.43     
                                                 
41 The language of these special verdict questions closely 
tracks that found in Wis JI——Civil 1023.1.    
42 Before the court of appeals heard the case, PIC moved to 
consolidate it with Bubb on the belief that the cases "rais[ed] 
the same central issue."  Jandre, 330 Wis. 2d 50, ¶16.  The 
court of appeals instead stayed the present case until this 
court decided Bubb, and PIC now tries to distinguish this case 
from Bubb.  
43 Marder v. Bd. of Regents of the Univ. of Wis. Sys., 2005 
WI 159, ¶19, 286 Wis. 2d 252, 706 N.W.2d 110 (citing State v. 
Cole, 2003 WI 59, ¶12, 262 Wis. 2d 167, 663 N.W.2d 700). 
No. 
2008AP1972   
 
25 
 
¶61 This 
case 
also 
requires 
us 
to 
determine 
the 
applicability of prior cases, particularly Scaria, 68 Wis. 2d 1, 
Martin, 192 Wis. 2d 156, and Bubb, 321 Wis. 2d 1, to the facts 
in the instant case.  The interpretation and application of 
prior case law to a new set of facts presents another question 
of law, which this court decides independently of the circuit 
court and court of appeals but benefiting from their analyses.44   
IV 
¶62 PIC urges the court to hold that when a physician is 
not negligent in his or her final diagnosis and fully explains 
to the patient the risks and benefits of treatment alternatives 
for the condition diagnosed (here, Bell's palsy), the physician 
has no further obligation to disclose tests or treatments 
pertaining to other conditions that were included in the 
physician's differential diagnosis.  In other words, PIC wants 
this court to adopt a bright-line rule that a physician has no 
duty to inform a patient of alternative tests and treatments for 
conditions unrelated to the condition diagnosed.  
¶63 According to PIC's bright-line rule, Dr. Bullis had no 
duty to inform Jandre of the available alternative diagnostic 
tool to rule out a stroke, because a stroke is unrelated to 
Bell's palsy.  Although the two conditions, stroke and Bell's 
palsy, have overlapping but not identical symptoms, PIC contends 
                                                 
44 Acuity Mut. Ins. Co. v. Olivas, 2007 WI 12, ¶25, 298 Wis. 
2d 640, 726 N.W.2d 258. 
No. 
2008AP1972   
 
26 
 
that the two are unrelated because a diagnosis of Bell's palsy 
does not carry with it an increased risk of stroke.  
¶64 PIC asserts that the circuit court and court of 
appeals have expanded a physician's duty to inform beyond the 
statute and case law and that this court should adopt PIC's 
bright-line rule and hold as a matter of law, on the basis of 
this record, that the circuit court should have dismissed the 
informed consent claim without submitting it to the jury.     
¶65 It is well established, as we have stated previously, 
that a physician's duty to disclose information is governed by 
the informational needs of a reasonable patient.  Grounding this 
general articulation of the legal standard in the facts of the 
present case, the jury must determine whether upon hearing Dr. 
Bullis's diagnosis of Bell's palsy (a diagnosis that can be 
reached only by eliminating all other possibilities), Jandre 
could reasonably have wanted to know that a carotid ultrasound 
was available as a diagnostic tool for ischemic stroke and that 
it could more accurately eliminate the possibility of ischemic 
stroke than the physical examination Dr. Bullis performed.   
¶66 PIC asserts that under Wis. Stat. § 448.30 and the 
case law, a bright-line rule exists that a reasonable patient 
would never need to be informed about conditions that are 
unrelated to a non-negligent final diagnosis in order to make an 
intelligent, informed decision regarding medical care.       
¶67 PIC 
makes 
numerous 
arguments 
to 
support 
its 
interpretation of a physician's duty of informed consent.  We 
No. 
2008AP1972   
 
27 
 
shall discuss each of the following arguments raised by PIC in 
turn: 
A. The "plain language" of Wis. Stat. §  448.30 and 
the Scaria decision refer only to treatment, not diagnosis, 
and even if diagnostic techniques are within the scope of 
the duty to inform, the duty does not extend to alternative 
diagnostic tools for conditions unrelated to the condition 
diagnosed.  
B. The jury's verdict on Jandre's informed consent 
claim was inconsistent with its verdict of non-negligent 
diagnosis. 
C. Under Martin v. Richards, the physician does not 
have a duty to inform the patient about conditions 
unrelated to the condition diagnosed. 
D. Under Bubb v. Brusky, the physician does not have a 
duty to inform the patient about conditions unrelated to 
the condition diagnosed. 
E. Kuklinski v. Rodriguez holds that a physician's 
duty to inform does not attach until the physician reaches 
a final diagnosis.   
F. Failing to adopt PIC's view of the law of informed 
consent makes bad law and contravenes sound public policy.  
¶68 We do not agree with PIC that its position is 
supported by Scaria, or Wis. Stat. § 448.30, or any other cases.  
In order to adhere to the reasonable patient standard and 
principles of stare decisis, we reject the bright-line rule PIC 
No. 
2008AP1972   
 
28 
 
proposes.  No compelling reason has been set forth to overturn 
precedent. 
A 
(1) The Scaria Decision 
¶69 PIC argues that the "plain language" of Wis. Stat. 
§ 448.30 and the Scaria decision refer only to treatment, not 
diagnosis, and that even if diagnostic techniques are within the 
scope of a physician's duty to inform, the duty does not extend 
to alternative diagnostic tools for conditions unrelated to the 
condition diagnosed.  Under PIC's interpretation of the law of 
informed consent, Dr. Bullis had no duty to inform Jandre about 
the carotid ultrasound diagnostic tool because it relates to an 
ischemic stroke event, which is unrelated to Dr. Bullis's non-
negligent, final diagnosis of Bell's palsy.  
¶70 In Scaria, 68 Wis. 2d 1, the physician failed to 
disclose risks associated with an aortogram, which is a 
diagnostic procedure the physician asked the patient to undergo 
to determine the cause of high blood pressure.  After suffering 
severe harm from the procedure, the patient filed claims for 
both negligent care and treatment and breach of the duty to 
inform.45 
¶71 The issue before the court in Scaria involved the 
patient's challenge to the jury instruction adopting the 
"reasonable physician" approach to informed consent.   
                                                 
45 Scaria, 68 Wis. 2d at 20. 
No. 
2008AP1972   
 
29 
 
¶72 Under the reasonable physician approach, the scope of 
the physician's duty to inform is determined solely and 
exclusively by the generally accepted customs of the medical 
profession.  The trial court in Scaria gave the following jury 
instruction reciting the reasonable physician standard:  
[Y]ou are instructed that a physician and surgeon has 
a duty to make reasonable disclosure to his patient of 
all significant facts under the circumstances of the 
situation which are necessary to form the basis of an 
intelligent and informed consent by the patient to the 
proposed treatment or operation and the patient must 
have given such consent to the treatment or operation.  
This duty, however, is limited to those disclosures 
which physicians and surgeons of good standing would 
make under the same or similar circumstances, having 
due regard to the patient's physical, mental and 
emotional condition.46 
¶73 In Scaria, the supreme court took issue with the 
emphasized portion of the instructions, stating that "[t]he 
right to be recognized and protected is the right of the patient 
to consent or not to consent to a proposed medical treatment or 
procedure" and "[t]he need of a particular patient . . . should 
not necessarily be limited to a self-created custom of the 
profession."47   
¶74 In place of the reasonable physician approach to 
informed consent, the Scaria court relied considerably on its 
rationale 
in 
an 
earlier 
case, 
Trogun 
v. 
Fruchtman, 
58 
Wis. 2d 569, 207 N.W.2d 297 (1973), which in turn had relied 
                                                 
46 Id. at 10 (emphasis added). 
47 Id. at 12.  
No. 
2008AP1972   
 
30 
 
considerably on Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 
1972), for its articulation of what has come to be known as the 
"reasonable patient" (or the "prudent patient") standard in 
informed consent cases.48   
¶75 The Bubb court noted that Trogun endorsed the standard 
set forth in Canterbury, 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."49  The Trogun case (which Bubb recently 
endorsed) declared that disclosure was "to be judged by that 
conduct which is reasonable under the circumstances. . . . [T]he 
scope of the physician's disclosure must be measured by the 
patient's 'objective' need for information material to his 
decision . . . ."50   
¶76 In Scaria, the court adopted a refined articulation of 
the reasonable patient standard, holding:  
In short, the duty of the doctor is to make such 
disclosures 
as 
appear 
reasonably 
necessary 
under 
circumstances then existing to enable a reasonable 
person 
under 
the 
same 
or 
similar 
circumstances 
confronting the patient at the time of disclosure to 
                                                 
48 Id. at 13. 
49 Bubb, 321 Wis. 2d 1, ¶50 (internal quotation marks 
omitted). 
50 Trogun, 58 Wis. 2d at 600-01 (citing Canterbury, 464 F.2d 
at 785, 787), quoted with emphasis added in Bubb, 321 Wis. 2d 1, 
¶51.  Bubb also quoted 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.") 
No. 
2008AP1972   
 
31 
 
intelligently exercise his right to consent or to 
refuse the treatment or procedure proposed.51 
¶77 This standard has since been reaffirmed on many 
occasions.52 
¶78 Neither the facts nor the law in Scaria supports PIC's 
position. 
¶79 We turn our attention from Scaria to Wis. Stat. 
§ 448.30, which was enacted in 1982 to "codif[y] the common law 
set forth in Scaria."53   
(2) Wis. Stat. § 448.30 
¶80 The statute contains a general articulation of the 
scope of the duty of disclosure and provides six express 
limitations on a physician's duty of disclosure.  The statute 
reads as follows: 
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 
physicians duty to inform the patient under this 
section does not require disclosure of: 
                                                 
51 Scaria, 68 Wis. 2d at 13. 
52 See, e.g., Bubb, 321 Wis. 2d 1; Johnson, 199 Wis. 2d 615; 
Martin, 192 Wis. 2d 156. 
53 Johnson, 199 Wis. 2d at 629-30, quoted with emphasis in 
Bubb, 321 Wis. 2d 1, ¶57.  For other cases declaring that the 
statute was enacted to codify the common law standards for 
informed consent set forth in Scaria, see Hannemann, 282 
Wis. 2d 664, ¶48; Martin, 192 Wis. 2d at 174. 
The Legislative Reference Bureau Note to 1981 A.B. 941, 
which became Wis. Stat. § 448.30, states: "The bill places in 
the statutes the standard of care that physicians are required 
to meet under Scaria."  Martin, 192 Wis. 2d at 174. 
No. 
2008AP1972   
 
32 
 
(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. 
¶81 PIC argues that the plain words of the statute——
"medical modes of treatment" and "benefits and risks of these 
treatments"——and 
the 
language 
from 
Scaria——"consent 
to 
a 
proposed 
treatment 
or procedure"——necessarily mean that a 
physician's duty to inform the patient does not attach to a 
physician's diagnostic process but attaches only after a final 
diagnosis is made.  We rebuff PIC's narrow reading of the 
statute and Scaria, just as we have in prior cases.  
¶82 The court has "rejected the argument that Wis. Stat. 
§ 448.30 was limited by its plain language to disclosures 
intrinsic to a proposed treatment regimen."54  As we have 
explained, Wis. Stat. § 448.30 codified the reasonable patient 
approach from Scaria, so under the statute the scope of a 
physician's duty to inform "is driven" by "what is reasonably 
                                                 
54 Johnson v. Kokemoor, 199 Wis. 2d 615, 640, 545 N.W.2d 495 
(1996). 
No. 
2008AP1972   
 
33 
 
necessary for a reasonable person to make an intelligent 
decision 
with 
respect 
to 
the 
choices 
of 
treatment 
or 
diagnosis."55  The court has declared that it is the patient's 
"condition [symptoms], not the diagnosis, that drives the duty 
to inform" in a case.56   
(3) Subsequent Case Law 
¶83 The Martin court addressed the issue of diagnoses 
directly.  The court considered the statute's legislative 
history 
and 
adopted 
the 
following 
"reasonable 
person" 
interpretation of the statute and the Scaria case to include 
diagnosis:   
There can be no dispute that the language in Scaria, 
68 Wis. 2d at 13, 227 N.W.2d 647, 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 LRB 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 complications associated with 
an aortogram, a diagnostic procedure.  Id. at 4, 227 
N.W.2d 647.  The distinction between diagnostic and 
                                                 
55 Martin, 192 Wis. 2d at 174, quoted with approval and 
emphasis in Bubb, 321 Wis. 2d 1, ¶62.  
56 Martin, 192 Wis. 2d at 180-81, quoted with approval and 
emphasis in Bubb, 321 Wis. 2d 1, ¶65. 
No. 
2008AP1972   
 
34 
 
medical treatments is not in and of itself significant 
to an analysis of informed consent.57   
¶84 As support for this position, the Martin court relied 
on the following language from an ALR annotation: 
[I]t may safely be stated that, as part of the 
physician's duty to obtain a patient's informed 
consent to any medical procedure employed by the 
physician in dealing with the patient, there 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 injury.58 
¶85 Moreover, the Martin court declined to adopt the 
Seventh Circuit Court of Appeals' narrow interpretation of Wis. 
Stat. § 448.30.59  The federal court limited the doctrine of 
informed consent to apprising the patient of the risks that 
inhere in a proposed treatment and did not impose a duty to 
inform a patient of alternative, viable methods of diagnosis.60 
¶86 So too did the Bubb court directly address the issue 
of diagnoses under Wis. Stat. § 448.30.  The unanimous Bubb 
court61 concluded:  "Wis. Stat. § 448.30 requires any physician 
                                                 
57 Martin, 192 Wis. 2d at 175-76 (second emphasis added) 
(internal quotation marks omitted). 
58 John 
H. 
Derrick, 
Annotation, 
Medical 
Malpractice: 
Liability For Failure of Physician to Inform Patient of 
Alternative Modes of Diagnosis or Treatment, 38 A.L.R. 4th 900, 
903 (1985). 
59 Martin, 192 Wis. 2d at 176. 
60 McGeshick v. Choucair, 9 F.3d 1229, 1233-35 (7th Cir. 
1993). 
61 Justice Ziegler did not participate. 
No. 
2008AP1972   
 
35 
 
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."62  
¶87 Interpreting Wis. Stat. § 448.30 and Scaria to require 
disclosure about diagnostic techniques under certain facts and 
circumstances is sensible because diagnosis is an essential 
component of modes of treatment, and diagnostic tests are 
important to a patient's decision making.  In fact, Scaria 
itself involved disclosures regarding a diagnostic procedure, 
not treatment narrowly defined.    
¶88 In sum, neither Wis. Stat. § 448.30 nor the Scaria 
case (and subsequent case law) limits the physician's duty to 
inform the patient to modes of treatment only for the final 
diagnosis.   
¶89 We further conclude that the distinction between 
conditions "related" to the final diagnosis and conditions 
"unrelated" to the final diagnosis finds no support in the 
statute or case law.  PIC is correct that neither the statute 
nor Scaria expressly states that the duty to inform extends to 
conditions unrelated to the final diagnosis.  The reason for 
this silence is that the statute and Scaria present an 
objective, negligence-based reasonable patient standard.  It is 
inherent in the nature of the objective, negligence-based 
standard that the duty to inform depends on the facts and 
                                                 
62 Bubb, 321 Wis. 2d 1, ¶78 (emphasis added). 
No. 
2008AP1972   
 
36 
 
circumstances of the case and might, in some circumstances, 
reach conditions that are unrelated to the final diagnosis.  
¶90 For the reasons set forth, we reject PIC's two 
arguments based on the statute and Scaria: (1) that the statute 
and Scaria do not apply to diagnostic techniques at all; and (2) 
that the statute and Scaria do not apply to diagnostic 
techniques for conditions that are unrelated to the final 
diagnosis.  Wisconsin Stat. § 448.30 and Scaria declare that a 
physician's duty is to inform the patient about diagnostic 
procedures about which a reasonable patient would want to know 
to make an informed, voluntary decision about his or her medical 
care, 
even 
if 
those 
diagnostic 
procedures 
are 
aimed 
at 
conditions that are unrelated to the condition that was the 
final diagnosis.   
B 
¶91 PIC argues that the court of appeals' decision 
improperly conflates the issues of negligent care and diagnosis 
and informed consent.63  According to PIC, the jury's verdict on 
Jandre's informed consent claim was inconsistent with the jury's 
verdict that Dr. Bullis was not negligent because she chose one 
diagnostic method rather than another and was not negligent in 
the care and treatment of Jandre.   
¶92 PIC contends that the circuit court and court of 
appeals gave Jandre "two kicks" at his unsuccessful claim of 
                                                 
63 Judge Fine makes the same argument in his concurrence in 
the court of appeals.  See Jandre, 330 Wis. 2d 50, ¶48 (Fine, 
J., concurring). 
No. 
2008AP1972   
 
37 
 
misdiagnosis by enabling Jandre to fault the diagnosis a second 
time in the guise of the informed consent claim.  PIC's basic 
argument is that it is anomalous to impose liability for breach 
of the duty to inform the patient when, as in the present case, 
the physician was not negligent in her care and diagnosis of the 
patient.   
¶93 Under Wisconsin law, negligence in failing to abide by 
the professional standard of care and negligence in failing to 
obtain informed consent are two separate and distinct forms of 
malpractice, with two different standards of care.  "A failure 
to diagnose is one form of medical malpractice.  A failure to 
obtain informed consent is another discrete form of malpractice, 
requiring a consideration of additional and different factors."64  
There is nothing anomalous or inconsistent in holding that a 
reasonable 
patient 
may want information about alternative 
diagnostic techniques when the physician was not negligent in 
using one of multiple alternative, non-negligent techniques.  In 
fact, to hold otherwise would substantially undercut the 
reasonable patient standard.65       
                                                 
64 Hannemann, 282 Wis. 2d 664, ¶40 (quoting Finley v. 
Culligan, 201 Wis. 2d 611, 628, 548 N.W.2d 854 (Ct. App. 1996) 
(internal quotation marks omitted)).  
65 In concluding that the jury's verdicts were inconsistent, 
the dissent fails to grapple with the fact that there are two 
separate standards at play, one governing the claim of negligent 
care and treatment and another governing the informed consent 
claim. 
No. 
2008AP1972   
 
38 
 
¶94 In two of this court's prominent informed consent 
cases, we explained how juries can find that a physician was not 
negligent in care and treatment but could also find the 
physician negligent in discharging his or her duty to inform the 
patient.66  A jury can reach two different findings without the 
findings being anomalous or contradictory because the jury has 
applied different standards of care to the two claims.   
¶95 The 
standard 
of 
care 
for 
treatment, 
care, 
and 
misdiagnosis claims is a professional standard, a reasonable 
physician standard.  Physicians are held to the level of a 
hypothetical, reasonable physician in similar circumstances.  In 
the present case, testimony established that there was more than 
one method for diagnosing Jandre's condition.  The jury was free 
to conclude (and apparently did conclude) under the reasonable 
physician standard of care that Jandre's symptoms fit both 
Bell's palsy and TIA/RIND, and that Dr. Bullis' conduct in not 
ordering the carotid ultrasound before diagnosing Bell's palsy 
was reasonable professional care under the circumstances.   
¶96 In contrast, the standard governing informed consent 
is the reasonable patient standard.  Under this standard, the 
jury is asked, "[G]iven the circumstances of the case, what 
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?"67  Physicians may not rely on 
                                                 
66 See Bubb, 321 Wis. 2d 1, ¶¶75-78; Martin, 192 Wis. 2d at 
166-67. 
67 Martin, 192 Wis. 2d at 176 (emphasis added). 
No. 
2008AP1972   
 
39 
 
professional custom to determine the scope of informed consent 
in the way that they can rely on it with respect to treating, 
caring, and diagnosing.  Regardless of what disclosures might be 
customary in the medical profession, physicians must put 
themselves into the shoes of the patient and consider what 
information a reasonable patient would want to know. 
¶97 No test for Bell's palsy exists.  It is a diagnosis 
reached by excluding other possible ailments.  The jury was free 
to decide (and apparently did decide) under the reasonable 
patient standard that Dr. Bullis should have told Jandre that 
she could not conclusively exclude an ischemic stroke event from 
her differential diagnosis based on her physical examination and 
that a carotid ultrasound could be ordered to clarify her 
diagnosis of his condition. 
¶98 The duty to disclose in the instant case was triggered 
precisely because there was more than one reasonable diagnostic 
procedure available to diagnose Jandre's condition.  Although a 
physician is "at liberty to select any of the recognized 
methods"68 of diagnosis, the physician is not at liberty to fail 
to disclose the availability and prospects for success of 
recognized alternative procedures, especially where, as here, 
the alternative procedure is non-invasive and more importantly, 
is more conclusive than the alternative diagnostic tool actually 
selected by the physician.  To hold otherwise would be to deny 
                                                 
68 See Wis JI——Civil 1023. 
No. 
2008AP1972   
 
40 
 
patients the right to self-determination that the informed 
consent doctrine and Wis. Stat. § 448.30 are meant to protect.   
¶99 PIC's 
forceful 
argument 
to 
the 
contrary 
notwithstanding, we conclude that the issues of negligent 
diagnosis and informed consent are not conflated, contradictory, 
or anomalous in the present case.  It is PIC, not the circuit 
court or court of appeals, that is conflating a physician's duty 
of care with her or his duty to disclose information to the 
patient.   
¶100 The very same argument PIC makes in the present case 
was made by the physician-defendant in the Martin case.  The 
physician-defendant argued in Martin: 
If [the physician] was not negligent in failing to 
diagnose the epidermal hematoma, or in failing to 
conclusively rule out an epidermal hematoma, and/or in 
admitting 
[the 
patient] 
to 
a 
hospital 
with 
no 
neurosurgical capability, then as a matter of law [the 
physician] cannot be negligent for failing to discuss 
a diagnosis which he did not make, and treatments 
which [the physician] did not judge necessary.69 
¶101 The court rejected this argument in the Martin case in 
1995, and no compelling reasons have been brought forth for the 
court to reverse precedent and accept the argument now.   
C 
¶102 As we have noted, PIC urges the court to adopt a 
bright-line rule limiting a physician's duty to disclose to 
                                                 
69 Combined 
Cross-Petitioner's Brief, Response Brief & 
Appendix of Defendants-Third Party Plaintiff-Respondents-Cross-
Petitioners, Brief on Cross-Petition at 14-15, Martin v. 
Richards, 192 Wis. 2d 156, 531 N.W.2d 70 (1995) (No. 91-0016). 
No. 
2008AP1972   
 
41 
 
information about the final diagnosis and related conditions.  
Above, we rejected PIC's argument that Wis. Stat. § 448.30 and 
Scaria compel this limitation.   
¶103 PIC also argues that under Martin, the physician does 
not have a duty to inform the patient about conditions unrelated 
to the condition diagnosed.  We disagree with PIC's formulation 
of Martin's holding.  PIC creates a holding that fits the facts 
of Martin, but it is not the holding that the Martin court 
actually adopted. 
¶104 The facts of Martin are substantially similar to the 
facts of the present case, and the plain language of the holding 
in Martin applies in the present case.  Martin declared that 
Wis. Stat. § 448.30 and Scaria require that "a physician 
disclose information necessary for a reasonable person to make 
an intelligent decision with respect to the choices of treatment 
or diagnosis."70  Nothing in the Martin decision limits the scope 
of a physician's duty to inform a patient about diagnoses of 
conditions related to the final diagnosis.  PIC reads a limiting 
principle into Martin's holding that was not envisioned by the 
Martin court. 
¶105 In Martin, an emergency room physician came up with a 
differential diagnosis that included concussion, contusion, and 
intracranial bleeding.  After performing neurological tests, the 
ER physician ultimately diagnosed the patient as having a 
concussion.  The physician did not order an available, non-
                                                 
70 Martin, 192 Wis. 2d at 175 (emphasis added). 
No. 
2008AP1972   
 
42 
 
invasive diagnostic procedure (a CT scan), despite knowing that 
such a procedure would exclude or reveal a dangerous condition, 
namely an intracranial bleed.  The physician also failed to 
inform the patient that the hospital did not have a neurosurgeon 
who could be summoned should complications arise.  Sadly, 
neurological complications did develop.  The patient was 
transferred to another hospital where a CT scan revealed 
intracranial bleeding.  The patient survived two emergency 
surgeries but emerged from the ordeal with spastic quadriplegia.  
A lawsuit ensued. 
¶106 The Martin jury found that while the ER physician had 
not been negligent in diagnosing or treating the plaintiff-
patient, the physician had been negligent in failing to disclose 
to the plaintiff-patient the availability of a CT scan, a 
diagnostic technique that could have led to a more conclusive 
diagnosis.   
¶107 PIC asserts that Martin's holding is limited to 
requiring information about diagnostic procedures for conditions 
related to the physician's diagnosis.  According to PIC, the 
duty to inform extended to the availability of a CT scan because 
intracranial bleeding is related to the physician's final 
diagnosis of concussion.  According to PIC, the same cannot be 
said of an ischemic stroke event and Bell's palsy.  PIC's 
interpretation of Martin relies heavily on the distinction 
between final and differential diagnoses and between diagnostic 
procedures and medical treatment.  
No. 
2008AP1972   
 
43 
 
¶108 Applying its interpretation of Martin to the present 
case, PIC argues that the physician's duty does not extend to 
the availability of a carotid ultrasound because ischemic stroke 
events (which appeared in the differential diagnosis) are 
unrelated to the physician's final diagnosis of Bell's palsy. 
¶109 In the present case, however, without a carotid 
ultrasound, Dr. Bullis admittedly could not be sure of her 
diagnosis.  The uncertainty about the cause of Jandre's 
symptoms, the potentially grave and immediate risks of some of 
the possible causes, and the availability of a diagnostic tool 
that could lead to a more definitive diagnosis gave rise to a 
legitimate question for the jury regarding whether Dr. Bullis 
violated her duty of informed consent.  The essence of the 
Martin decision, Wisconsin's informed consent doctrine, and Wis. 
Stat. § 448.30 is that "[w]hen 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."71  
¶110 In both Martin and the present case, the availability 
of a more reliable, alternative diagnostic technique, coupled 
with the potentially severe consequences of an incorrect 
diagnosis, led the jury to find that a reasonable person in the 
patient-plaintiff's position would have wanted to know about the 
alternative diagnostic procedures. 
                                                 
71 Id. at 181. 
No. 
2008AP1972   
 
44 
 
¶111 PIC's attempt to limit the scope of a physician's duty 
to inform the patient about the final diagnosis and "related" 
conditions was not accepted in Martin.  The Martin court 
explicitly concluded that "it was [the] condition" of the 
patient, that is, the symptoms that the patient displayed, that 
"drives the duty to inform in this case," "not the diagnosis."72  
¶112 We apply the principle stated in Martin that it is 
Jandre's condition, not Dr. Bullis' diagnosis of Bell's palsy, 
that drives the scope of Dr. Bullis's duty to inform Jandre in 
the present case.  Jandre's symptoms indicated that he might be 
suffering from any number of conditions, of which a stroke 
seemed one of the most plausible and most capable of inflicting 
immediate, severe harm.  Dr. Bullis diagnosed Bell's palsy, but 
she knew or should have known that her chosen method for ruling 
out an ischemic stroke event was incapable of definitively doing 
so.   
¶113 In other words, a "known and non-remote" risk attached 
to Dr. Bullis's chosen method of diagnosis that she would not 
detect a significant occlusion of Jandre's carotid artery.  
Despite the chosen method of diagnosis being found by the jury 
to have been reasonable from the vantage of the physician, the 
jury found, and the evidence supports, that it was unreasonable, 
from the vantage of a patient in Jandre's position, that Dr. 
Bullis failed to disclose the availability of a more definitive, 
non-invasive diagnostic tool. 
                                                 
72 Id. at 180-81. 
No. 
2008AP1972   
 
45 
 
¶114 Again, according to Martin, the duty to disclose is 
not shaped by the physician's final diagnosis.  It is shaped by 
the patient's condition and what a reasonable patient would want 
to know.  Based on what the physician knows (or should know) 
about the patient's condition, the physician must determine what 
information a reasonable patient in that situation would want in 
order to make an intelligent, informed decision regarding 
treatment.73   
¶115 The Martin court concluded that "there 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 
injury."74  Nothing in the Martin decision explicitly or 
inferentially creates a rule that physicians are required to 
inform the patient only about the condition diagnosed and 
related conditions.   
¶116 Accordingly, we conclude that PIC tries to make Martin 
stand for something different than it truly does.  The Martin 
case did not hold that the scope of required disclosure is 
limited to information about the condition diagnosed and related 
conditions.  We acknowledge that such a holding could have been 
                                                 
73 Id. 
74 Id. at 176 (emphasis added) (quoting John H. Derrick, 
Annotation, Medical 
Malpractice: Liability for Failure of 
Physician to Inform Patient of Alternative Modes of Diagnosis or 
Treatment, 38 A.L.R. 4th 900, 903 (1985)).  
No. 
2008AP1972   
 
46 
 
reached from the facts of Martin, but the Martin court did not 
choose to adopt it.  PIC attempts to create this holding after 
the fact, by assuming that it must be what the court intended 
because it is plausible based on the facts of Martin.  We 
decline to read limitations into Martin's holding that do not 
exist in the Martin court's reasoning or the plain language of 
the decision and are inconsistent with the reasonable patient 
standard.  Martin's holding did not create any bright-line 
rules.  
¶117  For the reasons set forth, we conclude there is no 
basis for distinguishing the present case from Martin.  Martin 
stands as controlling precedent.  
D 
¶118 PIC also argues that this court's holding in Bubb v. 
Brusky supports its position that the physician does not have a 
duty to inform the patient about conditions or diagnostic 
techniques unrelated to the physician's final diagnosis.  We 
disagree with PIC's formulation of Bubb's holding.  PIC creates 
a holding that fits the facts of Bubb, but it is not the holding 
that the Bubb court actually adopted.  We conclude, as we did in 
our discussion of Martin, that PIC creates a holding for Bubb 
that the court did not adopt.  
¶119 PIC notes that in Bubb, the final diagnosis (TIA) 
included a well-acknowledged, significantly increased risk of 
ischemic stroke.  For PIC, this relationship between the two 
conditions 
is 
crucial.  PIC concludes that it was the 
relatedness of TIA and ischemic stroke that allowed the jury to 
No. 
2008AP1972   
 
47 
 
conclude that a physician had a duty to inform the patient about 
a test for ischemic stroke.   
¶120 In contrast, in the present case, according to PIC, 
the final diagnosis was Bell's palsy, and "a carotid ultrasound 
would have been of no use in diagnosing or treating [such a 
condition]."75  Therefore, PIC contends that, as a matter of law, 
Dr. Bullis should not have a duty to inform Jandre about the 
availability of the procedure.  PIC reasons that once Dr. Bullis 
provided 
Jandre 
with 
information 
about 
Bell's 
palsy 
and 
medication for Bell's palsy, she had satisfied her disclosure 
duties. 
¶121 PIC's interpretation of Bubb demonstrates a basic 
misunderstanding of our holding in Bubb (and prior case law) as 
having been premised on and limited to conditions associated 
with the final diagnosis.  Neither the Bubb court nor any other 
decision adopted such a ruling explicitly or implicitly.  
¶122 Rather, the Bubb court continued the prior case law, 
holding:  "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."76   
                                                 
75 Opening Brief & Appendix of Petitioners Physicians Ins. 
Co. of Wis. & Therese J. Bullis, M.D. at 28. 
76 Bubb, 321 Wis. 2d 1, ¶¶3, 78. 
No. 
2008AP1972   
 
48 
 
¶123 The facts in Bubb are substantially similar to those 
in the present case and Bubb's explicit holding governs the 
present case:  The reasonable patient standard applies.     
¶124 Bubb's wife took him to the emergency room because he 
was 
having 
trouble 
ingesting 
food 
and 
maintaining 
his 
equilibrium.   
¶125 The emergency room physician, Dr. Brusky, ordered 
several tests for Bubb including a CT scan, an EKG, and various 
blood tests.  Bubb's symptoms began to diminish and Dr. Brusky 
concluded that Bubb had a TIA.  Upon advice of Dr. Brusky and 
Dr. Gu, a neurologist, Bubb was discharged, and Dr. Gu agreed to 
provide follow-up 
treatment.  The after-care instructions 
advised Bubb that a TIA is a strong warning sign that a stroke 
could occur.77  The next day, Bubb called the specialist to 
schedule a follow-up appointment.  The day after that, Bubb 
suffered a significant stroke.  A carotid ultrasound revealed 
that his right carotid artery was 90 percent blocked.   
¶126 Bubb sued the physicians, alleging negligent medical 
care, and more important for the present case, alleging that the 
physicians failed to inform him of "'additional diagnostic tests 
or alternate treatment plans' in lieu of discharge from the 
hospital."78   
¶127 The circuit court in Bubb refused to give the jury the 
informed consent instructions and special verdict questions 
                                                 
77 Id., ¶9 n.3. 
78 Id., ¶12. 
No. 
2008AP1972   
 
49 
 
(substantially the same instructions and verdict questions given 
in the present case).  The circuit court reasoned that Dr. 
Brusky made a "specific diagnosis" of TIA that every expert 
agreed was correct; that Dr. Brusky told Bubb he was at risk for 
a stroke and should have a follow-up soon; and that Dr. Brusky 
knew that a carotid ultrasound could not be performed at the 
hospital until the following day.79  The jury returned a verdict 
of no negligence on the part of either Dr. Brusky or Dr. Gu in 
the standard of care they delivered to Bubb.    
¶128 Bubb appealed to the court of appeals and then sought 
review in this court, claiming that the circuit court improperly 
withheld the informed consent jury instructions and special 
verdict questions from the jury's consideration.   
¶129 The Bubb court traced the development of the law of 
informed consent and reaffirmed Martin's holding that the scope 
of a physician's duty to inform a patient "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."80  
¶130 Grounding its holding in the statutory language, the 
Bubb court also articulated the duty of informed consent as 
requiring "any physician who treats a patient to inform the 
                                                 
79 Id., ¶21. 
80 Id., ¶62 (quoting Martin, 192 Wis. 2d at 174) (emphasis 
added in Bubb). 
No. 
2008AP1972   
 
50 
 
patient about the availability of all alternate, viable medical 
modes of treatment, including diagnosis, as well as the benefits 
and risks of such treatments."81 
¶131 After deciding the applicable law, the Bubb court then 
stated that it would decide "whether there was any credible 
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'" for 
the patient's TIA.82  The Bubb court concluded that credible 
evidence existed to show that further diagnostic treatment was a 
reasonable alternative mode of treatment to the one prescribed, 
which was discharge from the hospital.83   
¶132 Having 
determined 
that 
an 
alternative 
mode 
of 
treatment existed, the court next asked, "[C]ould 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?"84  The answer, according to Bubb, 
hinges on what a reasonable person under the circumstances then 
existing would want to know.  
                                                 
81 Id., ¶78 (emphasis added). 
82 Id., ¶31. 
83 Id., ¶¶40, 70. 
84 Id., ¶71 (quoting Martin, 192 Wis. 2d at 174). 
No. 
2008AP1972   
 
51 
 
¶133 The Bubb court determined that "a reasonable jury 
could conclude that a reasonable person in [Bubb]'s condition 
would have wanted to know about the alternative of admission 
with further diagnostic testing."85  The conclusion was based on 
evidence that Bubb had an increased risk of stroke; that the 
consequences of a stroke are severe; and that a blocked artery, 
which could cause a stroke, was a possible cause of Bubb's 
condition.86  The Bubb court concluded that the circuit court 
erred in dismissing Bubb's claim of the physician's breach of 
the duty to inform.87 
¶134 Applying a similar analysis to the present case, we 
conclude that there was credible evidence in the record that 
would allow a reasonable jury to find Dr. Bullis negligent for 
failing to inform Jandre about an alternate, viable mode of 
treatment. 
 
There 
was 
testimony 
that 
using 
the 
carotid 
ultrasound was an accepted, alternative course of action that 
could have been employed in diagnosing Jandre's condition.  In 
fact, two experts testified that had they seen Jandre when he 
initially appeared at the emergency room, that is the course 
they would have taken. 
¶135 That other physicians would have pursued a different 
course does not compel a finding that the treating physician's 
care and diagnosis was negligent.  It simply highlights that a 
                                                 
85 Id., ¶72. 
86 Id. 
87 Id., ¶¶4, 28. 
No. 
2008AP1972   
 
52 
 
reasonable alternative course of treatment existed——ordering a 
carotid ultrasound to assess the state of Jandre's carotid 
arteries rather than, or in addition to, conducting a physical 
exam.88     
¶136 The jury concluded that a reasonable person in 
Jandre's circumstances would want to know that a carotid 
ultrasound was available, which could more accurately assess the 
state of the patient's carotid arteries and affirm or call into 
question the physician's diagnosis of Bell's palsy.   
¶137 The jury found that Jandre could not make an informed, 
intelligent decision to consent to Dr. Bullis's suggestion of 
discharge from the hospital with instructions to follow up with 
a physician without being informed that a carotid ultrasound 
could be ordered to eliminate the possibility of an ischemic 
stroke. 
¶138 PIC no longer challenges the sufficiency of the 
evidence, but examining the evidence in the present case and 
comparing it to the evidence in Bubb help to demonstrate that 
the two cases are similar in fact and law.   
                                                 
88 The Bubb court noted that "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."  Bubb, 321 Wis. 2d 1, ¶70.  The same 
alternative instruction was given to the jury in the present 
case. 
No. 
2008AP1972   
 
53 
 
¶139 Although the cases can be distinguished on the ground 
that the two conditions were "related" in Bubb, that distinction 
does not warrant a different outcome under the reasonable 
patient standard.   
¶140 In the present case, the jury's finding of a breach of 
the physician's duty to inform the patient is supported by 
several pieces of evidence, namely, (1) evidence that Jandre's 
symptoms were atypical of Bell's palsy and could also have been 
caused by an ischemic stroke event; (2) evidence of the severe 
consequences that can result from a stroke; (3) evidence that 
Dr. Bullis's method of ruling out ischemic stroke, while non-
negligent, did not definitively eliminate the possibility that 
Jandre's condition was caused by a blocked carotid artery; and 
(4) the availability of carotid ultrasound, a non-invasive 
diagnostic tool.  These facts demonstrate that it was reasonable 
for the jury to conclude that a reasonable person in Jandre's 
condition would have wanted to know about the alternative 
diagnostic tool of a carotid ultrasound. 
¶141 Notably, this analysis holds true despite the fact 
that Bell's palsy is "unrelated" to stroke.  As we have 
stressed, PIC's attempt to create a bright-line rule limiting 
the scope of required disclosure to the final diagnosis and 
related conditions is inconsistent with the reasonable patient 
standard, Wis. Stat. § 448.30, and case law.   
¶142 From the perspective of the patient, the materiality 
of a risk has nothing to do with whether that risk comes from a 
potential condition that is related to the final diagnosis, as 
No. 
2008AP1972   
 
54 
 
in Martin and Bubb, or from a potential condition that the 
physician has eliminated, though not unequivocally, as in the 
present case. 
¶143 In Martin, there was a one to three percent chance of 
intracranial 
bleeding. 
 
The 
court 
held 
that 
this 
was 
sufficiently non-remote to uphold the jury's finding that 
disclosure was required.89  Here, while neither party has 
attempted to assign percentages to the various risks, there was 
clearly a risk that Dr. Bullis's treatment, while reasonable, 
would fail to discover that Jandre's carotid artery was 
significantly blocked, and a risk that the undetected blockage 
might result in a stroke.  Nothing in the record suggests that 
the jury was unreasonable in finding that these risks were 
sufficiently non-remote that a reasonable person in Jandre's 
position would want to know about the availability of a carotid 
ultrasound. 
¶144 For these reasons, we reject PIC's proposed bright-
line rule and stress that Martin and Bubb did not hold that a 
physician had a duty to inform the patient only of information 
about the final diagnosis and related conditions, as PIC urges.  
We acknowledge that such a holding could plausibly have followed 
from the facts of Martin and Bubb, but it is clear that the 
court in those cases did not adopt such a holding.  Rather, the 
court 
embraced 
the 
reasonable 
patient 
standard 
that 
is 
                                                 
89 Martin, 192 Wis. 2d at 167-68. 
No. 
2008AP1972   
 
55 
 
articulated in Wis. Stat. § 448.30 and the case law.  We do the 
same. 
E 
¶145 PIC next points to the court of appeals' decision in 
Kuklinski v. Rodriguez, 203 Wis. 2d 324, 552 N.W.2d 869 (Ct. 
App. 1996), and proposes another, similar bright-line rule.  PIC 
argues that Kuklinski stands for the proposition that "the duty 
to inform should not attach until a diagnosis has been made."90  
The court of appeals observed that PIC "misrepresents the 
holding of Kuklinski."91 
¶146 We do not read Kuklinski as PIC does.  We read 
Kuklinski as standing for the important proposition that a 
physician's duty to provide information is necessarily limited 
by what the physician knows, or reasonably should know, at the 
time the patient contends a disclosure should have been made.92  
Thus, the court of appeals aptly held that "a physician is not 
negligent for failing to disclose unless he or she . . . had 
sufficient knowledge about the patient's condition to trigger 
the physician's awareness that the information was reasonably 
necessary for the patient . . . to make an intelligent decision 
regarding the patient's medical care . . . ."93 
                                                 
90 Opening Brief & Appendix of Petitioners Physicians Ins. 
Co. of Wis. & Therese J. Bullis, M.D. at 31. 
91 Jandre, 330 Wis. 2d 50, ¶32. 
92 Kuklinski, 203 Wis. 2d at 330. 
93 Id.  
No. 
2008AP1972   
 
56 
 
¶147 The physician in Kuklinski testified that his initial 
diagnosis was that Kuklinski did not suffer a head injury.  It 
was only when Kuklinski's symptoms changed that the physician 
thought of a head injury.   
¶148 According to the jury, Kuklinski's initial symptoms 
did not trigger the physician's awareness that the availability 
of a CT scan was something a reasonable patient would want to 
know.  Accordingly, the court of appeals ruled that there was 
sufficient evidence to support the Kuklinski jury's finding that 
the physician was not negligent, either with respect to care and 
treatment of the patient or in connection with the failure to 
inform the patient that a CT scan was an available diagnostic 
tool.94   
¶149 In the present case, unlike in Kuklinski, the jury 
evidently concluded that Dr. Bullis had sufficient information 
                                                 
94 "Given what the jury could reasonably conclude Dr. 
Rodriguez knew at the time that the Kuklinskis claim that he 
should have discussed with them the availability of a CT scan, 
the jury's finding that Dr. Rodriguez was not negligent on the 
informed-consent 
issue 
must 
be 
upheld." 
 
Kuklinski, 
203 
Wis. 2d at 334. 
The dissent misstates Kuklinski's holding by claiming the 
case "holds that there was no reason to inform the patient of 
the availability of a CT scan when the patient came into the 
emergency room because the physician's initial diagnosis of Mr. 
Kuklinski was that he had a 'minor head injury.'"  Dissent, ¶305 
(emphasis added).  Kuklinski's holding was not dictated by the 
physician's initial diagnosis; it was dictated by the patient's 
condition and what that condition should have (or should not 
have) triggered in the physician's mind.  See also Martin, 192 
Wis. 2d 
at 
180-81 
("It 
was 
this 
condition . . . not 
the 
diagnosis, that drives the duty to inform in this case.") 
(emphasis added). 
No. 
2008AP1972   
 
57 
 
to know that Jandre might have suffered an ischemic stroke event 
and that a reasonable patient would want to know about a carotid 
ultrasound that might have detected the event. 
¶150 The jury in the present case and the jury in Kuklinski 
reached different conclusions on different facts.  But the 
juries in the two cases applied the identical law: the 
reasonable patient standard, which is not constrained by the 
bright-line rules urged by PIC. 
¶151 Again, 
it 
is 
the 
patient's 
condition, 
not 
the 
physician's diagnosis, that drives the duty to disclose.  
Whether 
the 
physician 
had 
reached 
a 
final 
diagnosis 
is 
irrelevant to the question in Kuklinski, which was whether the 
physician had enough information at a given moment to know that 
a reasonable patient would want certain information disclosed. 
¶152 PIC does not persuade us that Kuklinski supports its 
position that the physician's duty to inform should not attach 
until a diagnosis has been made. 
F 
¶153 Having determined that well-established precedent in 
Wisconsin supports the judgment of the circuit court affirming 
the jury verdict and that the present case has not deviated from 
precedent or gone astray from the theoretical underpinnings of 
the reasonable patient standard of informed consent, we now turn 
to the public policy arguments advanced by PIC and several 
concerned amici.  Many of the policy arguments have been made in 
prior cases and are very familiar to the court.  None warrants 
No. 
2008AP1972   
 
58 
 
altering the reasonable patient standard in informed consent 
cases. 
(1) 
¶154 PIC and amicus assert, as Judge Fine asserted in his 
concurrence in the court of appeals, that the court of appeals' 
decision makes physicians essentially strictly liable when a bad 
result occurs.95  As we explained earlier, to the extent that PIC 
suggests informed consent liability is literally a form of 
strict liability, the argument is entirely unfounded.  It is 
clear from Wis. Stat. § 448.30 and the case law that the scope 
of the duty of informed consent is shaped by objective, 
negligence-based standards.96  The liability that physicians face 
in informed consent cases is not strict, in theory or in 
practice.97   
                                                 
95 See Amicus Curiae Brief of Dean Health Sys., Inc., 
Marshfield Clinic, & Gundersen Lutheran Health Sys., Inc. at 2.  
96 See, e.g., Bubb, 321 Wis. 2d 1, ¶54. 
97 The dissent repeatedly asserts that our holding results 
in strict liability for physicians, but does not explain the 
basis for that assertion. 
No. 
2008AP1972   
 
59 
 
¶155 If 
the 
suggestion 
is 
that 
the 
liability 
is 
"essentially" strict liability because juries' hindsight bias 
and sympathy for a seriously stricken patient inhibit jurors 
from faithfully applying the reasonable patient standard, we are 
still not persuaded that a deviation from established precedent 
is warranted.  The concern that juries will always find for the 
plaintiff if a bad result has come to fruition is not only 
overblown, but also demonstrates a mistrust of juries that 
cannot logically be limited to informed consent cases.  Cases 
like Kuklinski demonstrate that juries are capable of applying 
the objective standard fairly.    
¶156 Were we to alter our doctrine out of fear that juries 
could not be trusted to faithfully apply the law, we would need 
to reconsider the role of the jury in all negligence cases, and 
in our legal system as a whole. 
¶157 There 
are, 
as 
we 
have 
pointed 
out 
previously, 
limitations on physicians' liability inherent in the objective 
                                                                                                                                                             
The concurrence similarly questions whether this opinion 
will "serve to prevent strict liability in fact or perception."  
Concurrence, ¶235.  The concurrence also states, however, that 
"[i]t is hard to dispute that a reasonable person under the 
circumstances 
confronting 
Jandre 
would 
want 
to 
know 
the 
possibility that he had suffered some kind of stroke——and that a 
non-invasive diagnostic technique (a carotid ultrasound) was 
available 
at 
the 
hospital 
to 
confirm 
or 
eliminate 
that 
possibility."  Concurrence, ¶208 (emphasis added).  We could not 
agree more.  It is precisely because a reasonable person in 
Jandre's 
circumstances 
would 
have 
wanted 
the 
additional 
information that liability under the reasonable patient standard 
is appropriate and is not strict.  Had Jandre's desire for more 
information or more testing been unreasonable, liability would 
not follow.  
No. 
2008AP1972   
 
60 
 
reasonable patient standard and expressly included in Wis. Stat. 
§ 448.30 that protect physicians from unpredictable, unfair 
liability.   
¶158 Finally, 
it 
is 
noteworthy 
that 
in 
Martin, 
the 
physician-defendant made an essentially identical argument, 
which the court rejected.  The physicians in Martin argued that 
"if physicians can be sued under [Wis. Stat. § 448.30] for 
failing to inform a patient [of information relating to] a 
diagnosis considered but discarded as unlikely . . . the effect 
would be to make physicians guarantors of their conduct."98  This 
argument is no more persuasive today than it was in 1995 when 
the court decided the Martin case.  
(2) 
¶159 PIC next argues that the court of appeals' decision 
inappropriately shifts medical judgment from the physician to 
the patient, usurping the physician's role.  In other words, PIC 
contends that Dr. Bullis's decisions regarding diagnosis were 
"medical" decisions.   
¶160 This argument was squarely rejected in Martin and 
again in Bubb.  In Martin, the court reasoned as follows: 
[The doctor] further argues that these are medical 
decisions.  In essence he states, "Why should we 
inform the patient that we don't think we should do 
something?"  This misses the very point of the 
                                                 
98 Combined 
Cross-Petitioner's Brief, Response Brief & 
Appendix of Defendants-Third Party Plaintiff-Respondents-Cross-
Petitioners, Brief on Cross-Petition at 26, Martin v. Richards, 
192 Wis. 2d 156, 531 N.W.2d 70 (1995) (No. 91-0016). 
No. 
2008AP1972   
 
61 
 
statute.  When a reasonable person would want to know, 
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 . . . .  
The statute on its face says, however, that the 
patient has the right to know, with some exceptions, 
that there are alternatives available.99 
¶161 We were not persuaded then, and we are not persuaded 
now, that the physician's duty of informed consent allows 
patients 
to 
usurp 
the 
physician's 
role 
to 
make 
medical 
decisions.  This argument flies in the face of the patient's 
right to self-determination, which is at the heart of the 
informed 
consent 
doctrine, 
and 
is 
reminiscent 
of 
the 
paternalistic "doctor-knows-best" attitude that the court has 
long rejected.100 
(3) 
¶162 PIC asserts that affirming the jury verdict imposes an 
undue 
burden 
on 
physicians, 
particularly 
emergency 
room 
physicians.  PIC contends that "to avoid the risk of later being 
held liable Dr. Bullis would have had to provide information 
                                                 
99 Martin, 192 Wis. 2d at 181.  See also Bubb, 321 Wis. 2d 
1, ¶66 (quoting Martin's analysis of this argument). 
100 See, e.g., 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."); Scaria, 68 
Wis. 2d at 12 ("Because of the patient's lack of professional 
knowledge, he cannot make a rational reasonable judgment unless 
he has been reasonably informed by the doctor of the inherent 
and potential risks. . . . The need of a particular patient for 
competent expert information should not necessarily be limited 
to a self-created custom of the profession."). 
No. 
2008AP1972   
 
62 
 
about 
diagnostic 
options 
and 
treatments 
for 
all 
of 
the 
conditions 
in 
her 
differential 
diagnosis . . . ."101  
Accordingly, PIC contends that affirming the decision of the 
court of appeals will result in unduly burdening medical care 
and will cause skyrocketing costs.  PIC significantly misstates 
the ramifications of our decision.   
¶163 The limitations on the physician's duty to inform the 
patient that are imposed by the reasonable patient standard 
function to make the duty of informed consent manageable for 
emergency room physicians, like Dr. Bullis.  In Bubb, the court 
specifically addressed the argument that the duty of informed 
consent would hold emergency room physicians to an unattainable 
standard because it would force them "to have specialized 
knowledge in many areas of medicine in which they are not 
trained."102  The Bubb court pointed to the express limitations 
in the statute, particularly Wis. Stat. § 448.30(1), which 
provides that a physician is not liable for failing to disclose 
"[i]nformation beyond what a reasonably well-qualified physician 
in a similar medical classification would know" (emphasis 
added).103  Emergency room physicians are not asked to have 
specialized knowledge beyond their training.  This limitation 
protects emergency room physicians from being held to a level of 
specialized knowledge that is unrealistic. 
                                                 
101 Opening Brief & Appendix of Phys. Ins. Co. of Wis. & 
Therese J. Bullis, M.D. at 35. 
102 Bubb, 321 Wis. 2d 1, ¶75. 
103 Id., ¶77.  
No. 
2008AP1972   
 
63 
 
¶164 PIC also argues that emergency room physicians do not 
have time to provide the information required by the court of 
appeals' opinion to patients.  Emergency room physicians are not 
asked to discuss all options and possibilities with patients 
whom they see briefly.  Negligence-based standards that govern 
informed consent are capable of being applied fairly across 
different circumstances and contexts.   
¶165 We simply hold that there are circumstances in which a 
combination of facts may create a duty in an emergency room 
physician to inform the patient about a diagnostic option that 
addresses a condition that was eliminated on the way to reaching 
a non-negligent final diagnosis.   
¶166 The policy arguments PIC advances closely resemble 
those that the court considered and rejected in Martin.  In that 
case, the physician-defendant argued that the court of appeals' 
decision would force doctors to explain exhaustive lists of 
alternative diagnostic techniques and the alternative treatments 
associated with each.104  The Martin court rejected the argument. 
¶167 The reasonable patient standard does not require 
disclosure of all information, as PIC states.  The reasonable 
patient standard requires a physician to inform the patient of 
only the information that a reasonable patient would find 
necessary to make an intelligent, informed decision regarding 
                                                 
104 See Combined Cross-Petitioner's Brief, Response Brief & 
Appendix of Defendants-Third Party Plaintiff-Respondents-Cross-
Petitioners, Brief on Cross-Petition at 25-26, Martin v. 
Richards, 192 Wis. 2d 156 (1995) (No. 91-0016). 
No. 
2008AP1972   
 
64 
 
the physician's recommendations.  For example, PIC lists several 
diagnostic techniques for multiple sclerosis, another condition 
that appeared on Dr. Bullis's differential diagnosis along with 
stroke and Bell's palsy, and argues that if it turned out that 
Jandre had multiple sclerosis, Dr. Bullis would be liable for 
failing to discuss each of these tests.105   
¶168 PIC's argument misstates how the reasonable patient 
standard works to limit the physician's duty to inform the 
patient.   
¶169 It took a combination of unique facts in the present 
case to make the availability of a carotid ultrasound something 
that a reasonable patient would need to know about in order to 
make an intelligent decision about his health care:  The 
symptoms were indicative of a stroke; the risks posed by a 
potential ischemic stroke were imminent, sudden, and grave; the 
method Dr. Bullis chose to eliminate the possibility of an 
ischemic stroke led to uncertain results, despite the fact that 
it was accepted as a medically reasonable diagnostic tool; an 
alternative method of diagnosis (carotid ultrasound) was readily 
available and was non-invasive; Jandre's symptoms were atypical 
of Bell's palsy; and Dr. Bullis's final diagnosis, Bell's palsy, 
can be reached only by eliminating all other possibilities.   
¶170 We could go on.  The point is that the physician's 
duty 
to 
inform 
the 
patient 
depends 
on 
the 
facts 
and 
                                                 
105 The tests included a "spinal tap," "various imaging 
techniques," and more.  
No. 
2008AP1972   
 
65 
 
circumstances of each case.  The question of breach of the 
physician's duty to inform a patient is quintessentially a jury 
question.  If any of the facts in the present case had been 
different, the jury might have found that Dr. Bullis did not 
breach her duty of informed consent.   
¶171 The thrust of our holding is that the bright line 
rules PIC urges are inappropriate.  The specific facts of each 
case must be examined to determine the reasonable informational 
needs of the patient.    
¶172 For the reasons stated, which are as strong today as 
they were when the court decided Martin, we conclude that PIC's 
concerns are overstated.    
(4) 
¶173 PIC argues that our decision will cause health care 
costs in Wisconsin to skyrocket because patients will demand 
that physicians perform every conceivable diagnostic test and 
doctors will face increased liability.106   
One 
amicus 
argues 
                                                 
106 Judge Fine noted that the likely outcome is an increase 
in defensive procedures and "no ceiling to the already rocketing 
health-care costs because of the plethora of unnecessary tests 
and procedures . . . ."  Jandre, 330 Wis. 2d 50, ¶48 (Fine, J., 
concurring).   
No. 
2008AP1972   
 
66 
 
that "it will follow that some patients will want every 
conceivable test done whether reasonable or not."107  
¶174 These 
statements 
again 
betray 
a 
fundamental 
misconception 
about 
how 
the 
reasonable 
patient 
standard 
operates.  Physicians have no duty to provide information to 
patients about tests that would not be material to a reasonable 
patient.  The holding in the present case does not give patients 
leave to request all conceivable tests.  Nor do physicians have 
a duty to perform tests that are not medically reasonable.  
¶175 PIC and amici also worry that the duty to inform 
imposed in the present case will encourage the practice of 
defensive medicine.  With respect to this concern, one scholar 
notes: 
"Defensive medicine" has, indeed, . . . rarely [been] 
defined in any but the most vague and illusive terms.  
If, however, "positive defensive medicine" is taken to 
involve the subjection of the patient to procedures 
                                                                                                                                                             
Some 
commentators would likely predict more positive 
outcomes.  See, e.g., George D. Bussey, Keomaka v. Zakaib: The 
Physician’s Affirmative Duty to Protect Patient Autonomy Through 
the Process of Informed Consent, 14 U. Haw. L. Rev. 801, 824 
(1992) (discussing studies that showed that increased disclosure 
often led to patient selection of the least invasive, least 
expensive diagnostic procedure available with the same or 
similar chances of misdiagnosis); Jaime Staples King & Benjamin 
W. Moulton, Rethinking Informed Consent: The Case for Shared 
Medical Decision-Making, 32 Am. J.L. & Med. 429, 475-76 (2006) 
(suggesting that any increased expense as a result of more 
patient involvement in medical decision making could be offset 
by cost savings due to a reduction in frivolous claims brought 
by patients dissatisfied with physicians' poor communication). 
107 Brief Amicus Curiae on Behalf of the Wis. Med. Soc'y, 
Inc., the Wis. Hosp. Ass'n, Inc., & the Wis. Chapter of the Am. 
College of Emergency Physicians, Inc. at 9 (emphasis added). 
No. 
2008AP1972   
 
67 
 
which are not medically indicated, in order to 
forestall adverse legal action, then a clear-headed 
[understanding of the physician's duty of care] shows 
that the adoption of such practices is most ill-
advised from the doctor's point of view.  Since this 
type 
of 
defensive 
medicine 
is 
by 
definition 
superfluous to the patient's needs, the doctor far 
from discharging his legal duty of care is merely 
increasing the possibility of careless error and 
thereby the possibility of an action for medical 
negligence.  On the other hand, if the procedure is 
for the patient's benefit, it cannot be said to be 
superfluous and the doctor who undertakes it is merely 
complying with his legal obligation to exercise due 
care and skill in the treatment and diagnosis of his 
patients.  "Negative defensive medicine," which may be 
said to involve the omission of medically indicated 
procedures out of a similar sense of fear on the 
doctor's 
part, 
is 
equally 
foolhardy. 
 
In 
all 
jurisdictions it has been held that any deviation from 
the legal standard of care which results in damage or 
injury will lead to liability in negligence and a 
concomitant obligation to compensate the patient.108 
¶176 This opinion does not expand the duty of informed 
consent in Wisconsin.  It simply applies well-established, 
objective, negligence-based principles to a particular fact 
situation.  Patients are not entitled to more information or 
tests after this opinion than they were before.  Physicians are 
at no greater risk of liability after this opinion than they 
were before and therefore should feel no additional pressure to 
practice defensively.   
(5) 
¶177 PIC expresses a concern that if the jury verdict is 
affirmed in the present case, proper diagnostic techniques will 
                                                 
108 Dieter Giesen, Vindicating the Patient's Rights: A 
Comparative Perspective, 9 J. Contemp. Health L. & Pol'y 273, 
307 (1993) (emphasis added, footnotes omitted).  
No. 
2008AP1972   
 
68 
 
be discouraged and physicians will have the "perverse incentive" 
to 
abandon 
the 
differential 
diagnosis. 
 
Abandoning 
the 
differential diagnosis process would be misguided.  Like many of 
the policy arguments made, this one demonstrates a fundamental 
misunderstanding of the contours of the physician's duty of 
informed consent.   
¶178 The court held in Martin that it is the patient's 
condition, not the physician's diagnosis, that drives the scope 
of the physician's duty to disclose.109  In that case, the court 
determined that the diagnosis did not determine what information 
needed to be shared with the patient.  Similarly, we now make 
clear that a physician does not create disclosure duties by 
merely including a condition in a differential diagnosis.  Nor 
can a physician avoid disclosure duties by not conducting a 
differential diagnosis.  The patient's condition (i.e., the 
patient's symptoms), not the diagnosis, drives the duty to 
disclose. 
¶179 As the court of appeals aptly noted in Kuklinski, a 
physician is only liable for failing to disclose information if 
"he or she either had sufficient knowledge about the patient's 
condition 
to 
trigger 
the 
physician's 
awareness 
that 
the 
information was reasonably necessary for the patient . . . to 
make an intelligent decision regarding the patient's medical 
care, or should have had that knowledge."110  Combining the 
                                                 
109 Martin, 192 Wis. 2d at 180-81. 
110 Kuklinski, 203 Wis. 2d at 330.  
No. 
2008AP1972   
 
69 
 
teachings of Kuklinski and the teachings of Martin makes clear 
that an attempt to avoid liability by foregoing a differential 
diagnosis would fail.   
¶180 The scope of required disclosure is driven by (1) the 
patient's condition, not the physician's diagnosis; and (2) the 
awareness a physician has (or should have) based on the 
patient's condition that certain information needs to be 
disclosed.  Dr. Bullis was not negligent because the word 
"stroke" appeared in her differential diagnosis; she was 
negligent, according to the jury, because Jandre's condition 
should have triggered an awareness on her part that information 
about the availability of a carotid ultrasound would be 
important to the patient.  
¶181 Thus, 
were 
physicians 
to 
abandon 
differential 
diagnoses in an effort to avoid informed consent liability, not 
only would they jeopardize the quality of their work, but they 
would also fail to change their exposure to liability.  
(6) 
¶182 Both here and in Martin, the physicians argued that 
"extending" the informed consent duty to include alternate modes 
of diagnosis unrelated to a non-negligent final diagnosis would 
unnecessarily inundate patients with more information than they 
can possibly manage.  The physicians contend that in this way 
the very objective of the doctrine of informed consent will be 
undermined.   
¶183 We acknowledge that giving too much information to the 
patient has dangers, but as is the case with so many of the 
No. 
2008AP1972   
 
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policy arguments, the answer lies in the limitations inherent to 
the objective, negligence-based reasonable patient standard and 
the limitations expressly written into Wis. Stat. § 448.30.  
¶184 The second and fourth limitations provided in Wis. 
Stat. § 448.30 are particularly relevant to this concern: 
physicians need not disclose information if it is too technical 
to be understood by a layperson.  Nor must physicians disclose 
information relating to highly unlikely possibilities.  With 
these limitations in mind, we conclude that PIC's concern that 
physicians will have no choice but to inundate patients with 
highly technical information has no force. 
(7) 
¶185 Finally, PIC argues that the circuit court's judgment 
affirming the jury verdict and the court of appeals' decision 
affirming the judgment of the circuit court should be reversed 
because they create a physician's duty of informed consent in 
Wisconsin that is broader than that recognized in any other 
state.  Other states have concluded that non-negligent diagnosis 
does not give rise to a physician's duty to inform the patient 
about risks concerning conditions not diagnosed.  
¶186 This argument is unpersuasive for a number of reasons. 
¶187 First, even if Wisconsin's informed consent doctrine 
is clearly as unique as PIC contends, that would not, in itself, 
be a sufficient reason for the court to alter prior precedent 
and reconsider the doctrine.   
¶188 Second, informed consent is governed in each state by 
unique statutes and case law.  Informed consent in this state is 
No. 
2008AP1972   
 
71 
 
governed by Wis. Stat. § 448.30. Uniformity among the states is 
not required, nor is it even necessarily desirable.  
¶189 Third, this court was aware of variations in the law 
of the scope of informed consent from state to state when it 
decided Martin and again when it decided Bubb, even though cases 
from other jurisdictions are not explicitly cited in Martin or 
Bubb.  
¶190 The Martin court was apparently aware of the scope of 
the duty of informed consent in other states.111  In Martin, the 
court considered an A.L.R. annotation that summarized cases 
across the country that approached the issue of a physician's 
liability for failure to inform the patient of alternative modes 
of diagnosis.112       
¶191 In Bubb, the court confronted the law of other states 
even more directly.  A brief of a non-party was entirely devoted 
to the argument that "other courts have uniformly limited the 
                                                 
111 Several cases cited in the briefs in the present case 
were brought to the Martin court's attention for the proposition 
that 
requiring 
disclosure 
of 
reasonable 
and 
available 
alternative methods of diagnosis would make Wisconsin unique in 
terms of the scope of its law of informed consent.  See, e.g., 
Combined Cross-Petitioner's Brief, Response Brief & Appendix of 
Defendants-Third Party Plaintiff-Respondents-Cross-Petitioners, 
Brief on Cross-Petition at 25-26, Martin v. Richards, 192 
Wis. 2d 156 (1995) (No. 91-0016) (referring to Bays v. St. Lukes 
Hosp., 825 P.2d 319 (Wash. Ct. App. 1992); Pratt v. Univ. of 
Minn. Affiliated Hosps. & Clinics, 414 N.W.2d 399 (Minn. 1987)). 
112 See Martin, 192 Wis. 2d at 175-76 (citing John H. 
Derrick, Annotation, Medical Malpractice: Liability for Failure 
of Physician To Inform Patient of Alternative Modes of Diagnosis 
or Treatment, 38 A.L.R. 4th 900, 904-06 (1985)).  
No. 
2008AP1972   
 
72 
 
duty to provide informed consent to treatment and procedure 
options called for by the condition diagnosed."113   
¶192 The present case, as we have explained previously, 
does not mark an expansion of Wisconsin's informed consent 
doctrine.  The scope of a physician's duty of informed consent 
has long been determined, on a case-by-case basis, using the 
objective, negligence-based reasonable patient standard.114  The 
present case is simply an application of these pre-existing 
principles to a case with very similar facts.  Thus, the court 
today is no more persuaded by the charge that its holding 
deviates from holdings across the nation than it was 16 years 
ago when it decided Martin or two years ago when it decided 
Bubb. 
¶193 Fourth and finally, the law in other states does not 
appear to be as uniform or clear as PIC contends.  Some states, 
like Colorado, endorse a less robust concept of informed consent 
than Wisconsin.   
                                                 
113 Brief of Physicians Ins. Co. of Wis. as Amicus Curiae 
Supporting Respondents at 1, Bubb v. Brusky, 2009 WI 91, 321 
Wis. 2d 1, 768 N.W.2d 903 (No. 2007AP619).   
PIC's amicus brief in Bubb brought the following cases, 
also cited in its brief here, to the court's attention when it 
argued that reversal of the court of appeals' affirmance of the 
circuit court's dismissal of the informed consent claims in that 
case would make Wisconsin's informed consent law an "outlier"  
with respect to other states' law on the subject:  Hall v. 
Frankel, 190 P.3d 852 (Colo. Ct. App. 2008); Roukounakis v. 
Messer, 826 N.E.2d 777 (Mass. App. Ct. 2005); and Linquito v. 
Siegel, 850 A.2d 537 (N.J. Super. Ct. App. Div. 2004).  
114 See, e.g., Scaria, 68 Wis. 2d at 12-13. 
No. 
2008AP1972   
 
73 
 
¶194 In Hall v. Frankel, 190 P.3d 852 (Colo. App. 2008), 
the Colorado Court of Appeals described the pivotal question as 
"whether a physician can be held liable on an informed consent 
theory when the injury arises from the physician's misdiagnosis 
of the condition and failure to inform the patient that further 
diagnostic tests could be performed, which tests the physician 
has concluded are not medically indicated."115  The court 
concluded that "a physician does not have the duty to disclose 
the risk of an error in diagnosis or to disclose the 
availability of diagnostic and treatment procedures he or she 
has concluded are not medically indicated.  Errors of this sort 
are covered adequately by claims of negligence."116  
¶195 The Colorado court distinguished our Martin case, 
saying that the Wisconsin court was interpreting a statute that 
codified the state's informed consent doctrine as requiring that 
"'[a]ny 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.'"117  The Colorado court concluded that "Colorado 
statutes and law do not recognize such a duty".118  
¶196 Other state courts are not as clearly inconsistent 
with the present case as PIC wishes us to believe.  For example, 
                                                 
115 Hall v. Frankel, 190 P.3d 852, 864-65 (Colo. App. 2008). 
116 Id. at 865. 
117 Id. 
118 Id. 
No. 
2008AP1972   
 
74 
 
in Gates v. Jensen, 595 P.2d 919 (Wash. 1979), the physician 
diagnosed the problem as eye irritation from contact lenses but 
could not rule out glaucoma.  The physician never told the 
patient about the possibility of glaucoma or about additional 
inexpensive 
tests 
for 
glaucoma. 
 
Under 
those 
facts 
the 
Washington court allowed an informed consent suit to continue.119   
¶197 Our holding today does not depend on a detailed 
analysis of the law of other states.  A 50-state survey is not 
necessary.  Whether Wisconsin law represents a majority view or 
a minority view, we are satisfied that our informed consent 
doctrine is coherent and sound.  We are not persuaded to alter 
the reasonable patient standard by analysis of the law of other 
states. 
* * * * 
¶198 In conclusion, we affirm the decision of the court of 
appeals by applying the reasonable patient standard (sometimes 
referred to as the "prudent patient" standard), which Wisconsin 
has explicitly followed in informed consent cases since at least 
1975.120  The doctrine of stare decisis governs the present case.   
¶199 Under the reasonable patient standard, "Wisconsin law 
'requires that a physician disclose information necessary for a 
                                                 
119 The current state of informed consent law in Washington 
is not clear.  Gates v. Jensen, 595 P.2d 919 (Wash. 1979), has 
not be overturned.  But see, e.g., Keogan v. Holy Family Hosp., 
622 P.2d 1246 (Wash. 1980); Gustav v. Seattle Urological 
Assocs., 954 P.2d 319 (Wash. Ct. App. 1998).   
120 See Scaria v. St. Paul Fire & Marine Ins. Co., 68 
Wis. 2d 1, 227 N.W.2d 647 (1975).  
No. 
2008AP1972   
 
75 
 
reasonable person to make an intelligent decision with respect 
to the choices of treatment or diagnosis.'"121  The reasonable 
patient standard requirement of disclosure "is rooted in the 
facts and circumstances of the particular case in which it 
arises."122  The bright-line rule PIC urges is incompatible with 
the reasonable patient standard adopted by the legislature in 
Wis. Stat. § 448.30 and explained in case law.      
¶200 "[T]he 
informed 
consent 
standard . . . [i]s 
an 
objective standard based on negligence principles such as 
reasonableness . . . ."123  Thus, the physician's "duty to inform 
is not boundless."124   
¶201 Applying the reasonable patient standard to the facts 
and circumstances of the present case involving a non-negligent 
diagnosis of Bell's palsy, we conclude that the circuit court 
could not determine, as a matter of law, that the physician had 
no duty to inform the patient of the possibility that the cause 
of his symptoms might be a blocked artery, which posed imminent, 
life-threatening risks, and of the availability of alternative, 
non-invasive means of ruling out or confirming the source of his 
symptoms. 
                                                 
121 Kuklinski, 203 Wis. 2d at 329 (quoting Martin, 192 
Wis. 2d at 175).  See also Bubb, 321 Wis. 2d 1, ¶62. 
122 Johnson, 199 Wis. 2d at 639. 
123 Bubb, 321 Wis. 2d 1, ¶54 (citing Scaria, 68 Wis. 2d at 
11). 
124 Id., ¶54 (citing Scaria, 68 Wis. 2d at 11).  
No. 
2008AP1972   
 
76 
 
By the Court.—The decision of the court of appeals is 
affirmed.
No.  2008AP1972.dtp 
 
1 
 
¶202 DAVID T. PROSSER, J.   (concurring).  This case has 
important 
ramifications 
for 
the 
practice 
of 
medicine 
in 
Wisconsin.  The facts are not difficult to understand, but the 
"duties" that arise from those facts (and the way those duties 
are analyzed and stated) present critical policy questions for 
the court and society.  I concur in the decision to affirm the 
court of appeals and the circuit court, but I am unable to join 
the lead opinion. 
BACKGROUND 
¶203 On June 13, 2003, Thomas W. Jandre (Jandre), then 48, 
was 
working 
as 
a 
heavy 
equipment 
operator 
for 
a 
construction/excavation company.  On his way to a job site, he 
drank some coffee and it came out through his nose.  He began to 
drool, his speech was slurred, and the left side of his face was 
drooping.  He was unsteady, dizzy, and his legs felt weak.  Co-
workers transported Jandre to St. Joseph's Hospital in West Bend 
where he had trouble walking up the curb and needed help to get 
to the emergency room.  The observations of Jandre's co-workers 
and of an emergency room nurse were recorded in Jandre's chart. 
¶204 The emergency room physician was Dr. Therese Bullis.  
As carefully explained by the lead opinion, Dr. Bullis examined 
Jandre and took appropriate steps to come to a differential 
diagnosis 
including 
"Bell's Palsy, stroke, TIA [transient 
ischemic attack], all of those stroke syndromes including 
ischemic as well as hemorrhagic, tumors, syndromes like——things 
like Guillain-Barre, MS [multiple sclerosis], and multiple other 
things like that."  Lead op., ¶41. 
No.  2008AP1972.dtp 
 
2 
 
¶205 The lead opinion describes the different possible 
causes listed in the differential diagnosis and explains what 
Dr. Bullis did and did not do to reach a final diagnosis.  Lead 
op., ¶¶42-49. 
¶206 A parallel discussion is provided by the court of 
appeals: 
Dr. Bullis testified that she observed left-side 
facial weakness and mild slurred speech.  She made a 
differential diagnosis——which she testified was a 
"list" of what she was "evaluating the patient for"——
of some kind of stroke or Bell's palsy. 
 
The testimony at trial established that there are 
two types of stroke: (1) ischemic, during which the 
blood supply to the brain is cut off, most commonly 
due to blockage in the carotid artery in the neck, and 
(2) hemorrhagic, during which there is bleeding in the 
tissue of the brain.  There are also two types of 
temporary blockages, or "mini-strokes," a transient 
ischemic accident ("TIA") and a reversible ischemic 
neurological deficit ("RIND"), both of which are 
warning signs of a "full blown" stroke, which can 
cause death or permanent injury.  A TIA is temporary 
and does not usually result in long term damage.  A 
RIND is similar to a TIA but lasts more than twenty-
four hours.  Dr. Bullis ordered a CT scan for Jandre, 
which can determine whether a patient suffered from a 
hemorrhagic stroke, a brain bleed or a tumor.  The 
results of the CT scan were normal.  Dr. Bullis 
conceded that the CT scan would not detect an ischemic 
stroke.  Although there is a test to determine whether 
a patient suffered an ischemic stroke——a carotid 
ultrasound, which was available at St. Joseph's 
Hospital——Dr. Bullis did not order one. 
 
The trial testimony also established that Bell's 
palsy is an inflammation of the seventh cranial nerve, 
which is responsible for facial movement.  It is not 
life-threatening, and the majority of people who 
suffer from Bell's palsy recover after several weeks 
or months without any further symptoms.  There is no 
test for Bell's palsy.  It is diagnosed by ruling out 
everything else. 
No.  2008AP1972.dtp 
 
3 
 
Jandre v. Physicians Ins. Co. of Wis., 2010 WI App 136, ¶¶6-8, 
330 Wis. 2d 50, 792 N.W.2d 558. 
 
¶207 By 
ordering 
a 
CT 
scan, 
Dr. 
Bullis 
eliminated 
hemorrhagic stroke and brain tumor as possible causes of 
Jandre's distressed condition.  Lead op., ¶43.  By listening to 
Jandre's carotid arteries with a stethoscope, she may have 
reduced the odds that an ischemic stroke event should be her 
final diagnosis.  See id., ¶¶44-45.  However, neither of these 
procedures could establish that Jandre was suffering from Bell's 
palsy, or eliminate the possibility that he had suffered an 
ischemic stroke event.  Under the circumstances, in settling on 
Bell's palsy as her final diagnosis, the emergency room 
physician failed to eliminate a far more serious possible cause 
of Jandre's condition. 
¶208 It is hard to dispute that a reasonable person under 
the circumstances confronting Jandre would want to know the 
possibility that he had suffered some kind of stroke——and that a 
non-invasive diagnostic technique (a carotid ultrasound) was 
available 
at 
the 
hospital 
to 
confirm 
or 
eliminate 
that 
possibility.  It also is hard to imagine a physician providing 
this explanation to a patient and then not recommending the 
carotid ultrasound procedure. 
¶209 The informed consent statute reads in part: "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 those treatments."  
Wis. Stat. § 448.30.  The statute was interpreted by this court 
No.  2008AP1972.dtp 
 
4 
 
in Martin v. Richards, 192 Wis. 2d 156, 176, 531 N.W.2d 70 
(1995), as follows: 
 
The applicable statutory standard in informed 
consent cases in Wisconsin which is explicitly stated 
in Scaria [v. St. Paul Fire & Marine Ins. Co., 68 
Wis. 2d 1, 227 N.W.2d 647 (1975)] and subsequently 
codified in sec. 448.30, Stats., is this: given the 
circumstances of the case, what 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. (emphasis added). 
 
¶210 The Martin case repeatedly referred to diagnosis as 
well as treatment.  That is why this court in Bubb v. Brusky, 
2009 WI 91, ¶3, 321 Wis. 2d 1, 768 N.W.2d 903, concluded 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."  Id. (emphasis 
added). 
 
¶211 In 2001, long before Bubb was decided by this court, 
the Wisconsin Civil Jury Instructions Committee produced an 
instruction (Wis JI——Civil 1023.2, Professional Negligence: 
Medical: Informed Consent) which read in part: 
 
A doctor has the duty to provide (his) (her) 
patient with information necessary to enable the 
patient 
to 
make 
an 
informed 
decision 
about 
a 
(diagnostic) (treatment) (procedure) and alternative 
choices of (diagnostic) (treatments) (procedures).  If 
the doctor fails to perform this duty, (he) (she) is 
negligent. 
 
To meet this duty to inform (his) (her) patient, 
the doctor must provide (his) (her) patient with the 
information a reasonable person in the patient's 
No.  2008AP1972.dtp 
 
5 
 
position would regard as significant when deciding to 
accept or 
reject (a) (the) medical (diagnostic) 
(treatment) ( procedure).  In answering this question, 
you should determine what a reasonable person in the 
patient's position would want to know in consenting to 
or 
rejecting 
a 
medical 
(diagnostic) 
(treatment) 
(procedure). 
 
The doctor must inform the patient whether (a) 
(the) 
(diagnostic) 
(treatment) 
(procedure) 
is 
ordinarily performed in the circumstances confronting 
the 
patient, 
whether 
alternate 
(treatments) 
(procedures) approved by the medical profession are 
available, what the outlook is for success or failure 
of each alternate (treatment) (procedure), and the 
benefits 
and 
risks 
inherent 
in 
each 
alternate 
(treatment) (procedure). 
 
. . . .  
 
[If (doctor) offers to you an explanation as to 
why 
(he) 
(she) 
did 
not 
provide 
information 
to 
(plaintiff), and if this explanation satisfies you 
that a reasonable person in (plaintiff)'s position 
would not have wanted to know that information, then 
(doctor) was not negligent.] 
Wis 
JI——Civil 
1023.2 
clearly 
includes 
diagnosis 
in 
its 
formulation. 
 
¶212 The circuit court faithfully followed this instruction 
in the present case.  Thereafter, the jury returned a verdict in 
favor of the Jandres on the informed consent claim. 
DISCUSSION 
¶213 "Appellate courts in Wisconsin will sustain a jury 
verdict if there is any credible evidence to support it."  
Morden v. Cont'l AG, 2000 WI 51, ¶38, 235 Wis. 2d 325, 611 
N.W.2d 659.  "[I]f there is any credible evidence, under any 
reasonable view, that leads to an inference supporting the 
jury's finding, we will not overturn that finding."  Id.  We 
will "search the record for credible evidence that sustains the 
No.  2008AP1972.dtp 
 
6 
 
jury's verdict, not for evidence to support a verdict that the 
jury could have reached but did not."  Id., ¶39.  We will uphold 
the jury's verdict even though the evidence is contradicted and 
the contradictory evidence is stronger and more convincing to us 
than the evidence that supports the verdict.  Id.; Weiss v. 
United Fire & Cas. Co., 197 Wis. 2d 365, 390, 541 N.W.2d 753 
(1995). 
¶214 In this case, there is ample evidence to support the 
verdict.  To reverse the decision of the court of appeals would 
require us to overrule or withdraw language from past cases and 
change the law.  Such action is not warranted on the facts 
presented. 
¶215 Having determined that this court should affirm the 
decision of the court of appeals, I nonetheless acknowledge that 
I share some of the concerns articulated by Justice Roggensack 
in her dissent and by Judge Ralph Adam Fine in his concurring 
opinion in the court of appeals.  Jandre, 330 Wis. 2d 50, ¶¶44-
49 (Fine, J., concurring).  These concerns are that the law of 
informed consent is being expanded beyond its original scope and 
purpose, 
with 
profound 
consequences 
for 
the 
practice 
of 
medicine. 
A 
¶216 There has been a dramatic evolution in informed 
consent theory in the last half-century.  This history is 
briefly chronicled in Martin, 192 Wis. 2d at 169-76.  See also 
Bubb, 321 Wis. 2d 1, ¶¶47-56. 
No.  2008AP1972.dtp 
 
7 
 
¶217 Initially, "informed consent was based upon the tort 
of battery.  When a patient failed to authorize treatment or 
consented to one form of treatment and the physician performed a 
substantially different treatment, the patient had a cause of 
action for battery."  Martin, 192 Wis. 2d at 170. 
¶218 Over time, "the basis for liability in informed 
consent cases changed to a negligence theory of liability: a 
physician's failure to obtain a patient's informed consent is a 
breach of a professionally-defined duty to treat a patient with 
due care."  Id., at 171. 
¶219 There are several key words and phrases in the above-
quoted sentence: (1) "negligence," (2) "informed consent," (3) 
"professionally-defined duty," and (4) "treat."   
¶220 "Negligence" and "professionally-defined duty" are 
closely linked in the traditional medical malpractice case.  A 
physician is required to conform to the accepted standard of 
reasonable care.  The court has stated that a qualified medical 
practitioner, "be he a general practitioner or a specialist, 
should be subject to liability in an action for negligence if he 
fails to exercise that degree of care and skill which is 
exercised by the average practitioner in the class to which he 
belongs, acting in the same or similar circumstances."  Shier v. 
Freedman, 58 Wis. 2d 269, 283-84, 206 N.W.2d 166 (1973).  
¶221 Significantly, 
expert 
testimony 
is 
almost 
always 
needed to support a finding of negligence in a medical 
malpractice case.  Kuehnemann v. Boyd, 193 Wis. 588, 592, 214 
N.W. 326 (1927), overruled in part on other grounds by Fehrman 
No.  2008AP1972.dtp 
 
8 
 
v. Smirl, 20 Wis. 2d 1, 121 N.W.2d 251 (1963).  "Without such 
testimony the jury has no standard which enables it to determine 
whether the defendant failed to exercise the degree of care and 
skill required of him."  Id.; Francois v. Mokrohisky, 67 
Wis. 2d 196, 197-98, 226 N.W.2d 470 (1975); Zintek v. Perchik, 
163 Wis. 2d 439, 455, 471 N.W.2d 522 (Ct. App. 1991). 
¶222 The "negligence" standard in informed consent cases in 
Wisconsin is very different.  The physician's "duty" is not 
defined by professionals; it is defined by a jury determination 
of what a reasonable person in the patient's position would want 
to know.   The role of expert testimony in this exercise is not 
clear.1 
¶223 In the landmark case of Canterbury v. Spence, 464 F.2d 
772 (D.C. Cir. 1972), which has often been lauded by this court, 
the need for expert testimony in informed consent was addressed 
as follows: 
 
The 
guiding 
consideration 
our 
decisions 
distill, . . . is that medical facts are for medical 
experts and other facts are for any witnesses——expert 
or not——having sufficient knowledge and capacity to 
testify to them.  It is evident that many of the 
issues typically involved in nondisclosure cases do 
                                                 
1 In this case, the plaintiff's standard of care expert, Dr. 
Zun, testified regarding the alternate diagnostic procedures Dr. 
Bullis ought to have discussed with Jandre under Wisconsin's 
informed consent statute.  Even under the Canterbury decision, 
discussed infra, expert testimony would seem to be required in 
cases where an individual was injured because he or she was not 
informed of an alternate diagnostic procedure, which would have 
discovered the true illness that was affecting the patient.  The 
roles of alternate diagnostic procedures to assess a given 
condition 
would 
seem 
to 
be 
medical 
facts 
beyond 
the 
comprehension of lay jurors.  Canterbury v. Spence, 464 F.2d 772 
(D.C. Cir. 1972). 
No.  2008AP1972.dtp 
 
9 
 
not reside peculiarly within the medical domain.  Lay 
witness 
testimony 
can 
competently 
establish 
a 
physician's 
failure 
to 
disclose 
particular 
risk 
information, the patient's lack of knowledge of the 
risk, and the adverse consequences following the 
treatment.  Experts are unnecessary to a showing of 
the materiality of a risk to a patient's decision on 
treatment, or to the reasonably, expectable effect of 
risk disclosure on the decision.  These conspicuous 
examples of permissible uses of nonexpert testimony 
illustrate the relative freedom of broad areas of the 
legal problem of risk nondisclosure from the demands 
for expert testimony that shackle plaintiffs' other 
types of medical malpractice litigation. 
Id. at 792 (emphasis added) (footnotes omitted). 
¶224 The Martin case traces the history of moving away from 
a "professionally-defined duty."  The court said: "Courts are 
split on how to apply a negligence theory to informed consent 
cases . . . differing 
on 
what 
constitutes 
'sufficient 
information' for purposes of disclosure.  Many courts only 
require disclosure of information that the patient can prove is 
customarily disclosed by other medical professionals."  Martin, 
192 Wis. 2d at 171 (citation omitted). 
¶225 The court then noted that Canterbury took a different 
tack, concluding that a professional standard "was inconsistent 
with patients' rights to make their own health care decisions."  
Id. at 171.  "Therefore, a growing number of courts require 
physicians to disclose what a reasonable person in the patient's 
position would want to know."  Id. at 172. 
¶226 In Scaria, this court adopted "the standard expounded 
in Canterbury."  Martin, 192 Wis. 2d at 173.  The Scaria court 
rejected a trial court's instruction that limited a doctor's 
disclosures to "those disclosures which physicians and surgeons 
No.  2008AP1972.dtp 
 
10 
 
of 
good 
standing 
would make under the same or similar 
circumstances, having due regard to the patient's physical, 
mental and emotional condition."  Scaria, 68 Wis. 2d at 12 
(quotation marks omitted).  The Scaria court explained its 
decision as follows: 
We are not dealing primarily with the professional 
competence nor the quality of the services rendered by 
a doctor in his diagnosis or treatment.  The right to 
be recognized and protected is the right of the 
patient to consent or not to consent to a proposed 
medical treatment or procedure.  Because of the 
patient's lack of professional knowledge, he cannot 
make a rational reasonable judgment unless he has been 
reasonably informed by the doctor of the inherent and 
potential risks.  The right of the patient and the 
duty of the doctor are standards recognized and 
circumscribed 
by 
the 
law 
and 
are 
not 
entirely 
dependent upon the customs of a profession. . . .  
[T]he duty to disclose or inform cannot be summarily 
limited to a professional standard that may be 
nonexistent or inadequate to meet the informational 
needs of a patient. 
Id. (emphasis added). 
 
¶227 Scaria was not a unanimous opinion.  Justice Robert W. 
Hansen, joined by Justice Leo B. Hanley, dissented.  Justice 
Hansen observed that a physician's duty to make reasonable 
disclosure is "correctly stated . . . in terms of a duty on the 
part of the doctor, not a right or expectation on the part of 
the patient."  Scaria, 68 Wis. 2d at 22-23 (R. Hansen, J., 
dissenting).  Justice Hansen added: 
If the standards of the profession are adequate as to 
the duty of a brain surgeon in diagnosis, treatment 
and 
surgical 
procedures, 
they 
ought 
be 
equally 
adequate as to what ought be disclosed as to nature of 
the surgery and collateral risks involved. . . .  The 
writer has more confidence in the standards of the 
professional group involved than in court or jury 
No.  2008AP1972.dtp 
 
11 
 
deciding what disclosures need or ought be made to a 
patient facing the surgeon's scalpel.  Children play 
at the game of being a doctor, but judges and juries 
ought not. 
Id. at 23-24. 
¶228 Justice Hansen lost this battle, and Wisconsin law on 
informed 
consent 
has 
proceeded 
forward 
on 
an 
objective 
"reasonable person under the same or similar circumstances" 
standard ever since.   
¶229 The court's standard makes good sense to this writer 
in circumstances like the circumstances in which the standard 
was created.  For instance, in Canterbury, Dr. Spence, a 
neurosurgeon, performed a laminectomy on a 19-year-old boy 
without informing either the boy or his mother of the risk of 
paralysis incidental to the surgery.  Canterbury, 464 F.2d at 
776-77.  "[E]ven years later, [the plaintiff] hobbled about on 
crutches, a victim of paralysis of the bowels and urinary 
incontinence."  Id. at 776. 
¶230 In Scaria, the plaintiff became "a paraplegic as a 
result of a percutaneous femoral aortogram, a radiological 
procedure whereby a dye is injected into the aorta through a 
catheter inserted in the groin so that the arteries leading to 
the kidneys can be visualized by the use of X rays."  Scaria, 68 
Wis. 2d at 4.  There was "considerable dispute" between surgeon 
and patient about what the doctor told the patient about the 
"possible complications" of the procedure.  Id. at 6-7. 
¶231 These two cases are textbook examples to support the 
proposition that "[e]very human being of adult years and sound 
mind has a right to determine what shall be done with his own 
No.  2008AP1972.dtp 
 
12 
 
body."  Canterbury, 464 F.2d at 780 (quoting authorities).  They 
are very different from cases that do not involve any invasion 
of the body, either for treatment or for diagnosis.  As the 
scope and application of informed consent are extended to new 
realms, we ought to ask whether the reasonable patient standard—
—without any defined role for medical experts——is still always 
appropriate. 
¶232 This question is underscored by Wis. Stat. § 448.02, 
relating to the Medical Examining Board.  Subsection (3) of this 
statute reads in part: 
 
(3) Investigation; Hearing; Action. 
 
(a) The board shall investigate allegations of 
unprofessional conduct and negligence in treatment by 
persons holding a license . . . granted by the board.  
An 
allegation 
that 
a 
physician 
has 
violated 
s. . . . 448.30 . . . is 
an 
allegation 
of 
unprofessional conduct. 
Wis. Stat. § 448.02(3)(a) (emphasis added). 
 
¶233 Chapter 375, Laws of 1981, which created Wis. Stat. 
§ 448.30 (the informed consent statute), also amended § 448.02 
to add the important sentence: "An allegation that a physician 
has violated s. 448.30 is an allegation of unprofessional 
conduct." 
 
¶234 Today, then, a physician must worry not only about his 
or her patient's condition but also about tort liability and 
professional discipline, both of which may be grounded on a jury 
verdict that is not tied to a professionally defined standard of 
care.  This necessarily encourages the practice of defensive 
No.  2008AP1972.dtp 
 
13 
 
medicine.  Defensive medicine is a physician's natural response 
to the fear of strict liability. 
¶235 Under these circumstances, I believe it is fair to ask 
whether this court's opinions in informed consent cases serve to 
prevent strict liability in fact or perception, or whether they 
have the opposite effect at great cost to health care in 
Wisconsin. 
B 
¶236 Another of the key terms in the sentence quoted in 
¶17, supra, is the word "treat."   
¶237 "Treat" is not a defined term.  This undefined term 
appears six times in different forms in Wis. Stat. § 448.30. 
¶238 The title reads: "Information on alternate modes of 
treatment." 
¶239 The first sentence reads: "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."  Wis. Stat. § 448.30. 
¶240 Subsection (5), one of the exceptions to the general 
rule, reads: "Information in emergencies where failure to 
provide treatment would be more harmful to the patient than 
treatment."  Wis. Stat. § 448.30(5). 
¶241 The Bubb court concluded 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 
No.  2008AP1972.dtp 
 
14 
 
and risks of such treatments."  Bubb, 321 Wis. 2d 1, ¶78 
(emphasis added). 
¶242 The phrase "including diagnosis" was based on language 
in Martin.  Moreover, the aortogram described in Scaria was an 
invasive diagnostic procedure that was intended "to determine 
whether there was a narrowing of the arteries leading to the 
kidneys that might be causing the high blood pressure."  Scaria, 
68 Wis. 2d at 5. 
¶243 Especially in an emergency room, it would be difficult 
to draw a line between diagnostic procedures and treatment, and 
it would be illogical to distinguish among invasive procedures 
under the statute——including many but excluding others on the 
sole basis that they were diagnostic. 
¶244 President George W. Bush recently observed (in a much 
broader context) that: "You cannot solve a problem until you 
diagnose it."2  Most people who go to an emergency room expect 
health care providers to diagnose their problem so that they can 
proceed to address it.  The phrase "including diagnosis" in Bubb 
envisions "diagnosis" as a form of treatment. 
¶245 Nevertheless, 
the 
statute 
appears 
to 
distinguish 
treatment from diagnosis.3  Once diagnosis is determined to come 
                                                 
2 George W. Bush, Decision Points 274 (2010). 
3 Wisconsin Stat. § 448.30 is derived from 1981 Assembly 
Bill 941 introduced by Rep. Betty Jo Nelsen.  The analysis of 
the bill prepared by the Legislative Reference Bureau reads in 
part: 
 
In Scaria v. St. Paul Marine and Fire Insurance 
Co., 68 Wis. 2d 1 (1975), the Wisconsin supreme court 
has stated that a physician has a duty to make 
disclosures to 
a patient that appear reasonably 
No.  2008AP1972.dtp 
 
15 
 
within treatment, we are likely to be confronted with an endless 
variety of choices and options, some of which will entail no 
bodily invasion whatsoever.  Many states appear not to embrace 
diagnosis in their informed consent statutes or cases for this 
very reason. 
¶246 Inasmuch as the court has determined that "treatment" 
includes diagnosis, it becomes imperative for policy makers to 
fashion reasonable limits to that term and to the duty imposed 
by statute upon Wisconsin's physicians. 
C 
¶247 The other word in the sentence quoted in ¶218, supra, 
that deserves examination is "consent," which is contained in 
the phrase "informed consent." 
¶248 When it is used as a noun, "consent" has a well-
established meaning.  The American Heritage Dictionary of the 
English Language 401 (3d ed. 1992) defines the noun "consent" as 
"1. Acceptance or approval of what is planned or done by 
another; acquiescence.  See Synonyms at permission. 2. Agreement 
as to opinion or a course of action." 
                                                                                                                                                             
necessary under the existing circumstances to enable a 
reasonable person intelligently to exercise the right 
to consent or refuse treatment.  A physician can be 
guilty of malpractice if failure to make these 
disclosures is causally related to a patient's injury.  
The court stated that a causal relation exists if a 
prudent 
person 
would 
have 
decided 
against 
the 
treatment had the person been informed of the risks 
involved and alternatives available. 
Drafting file, 1981 A.B. 941, Legislative Reference Bureau, 
Madison, Wis. 
No.  2008AP1972.dtp 
 
16 
 
¶249 Neither "consent" nor "informed consent" is part of 
Wis. Stat. § 448.30.  However, informed consent to treatment is 
a central policy objective of the relevant cases and statutes.  
"The right to be recognized and protected is the right of the 
patient to consent or not to consent to a proposed medical 
treatment or procedure."  Scaria, 68 Wis. 2d at 12. 
¶250 Canterbury expanded this concept when it proclaimed 
the 
"patient's 
right 
of 
self-determination 
on 
particular 
therapy."  Canterbury, 464 F.2d at 784.  Martin, in turn, 
translated Canterbury to mean that "every human being has a 
right to make his or her own medical decisions."  Martin, 192 
Wis. 2d at 172. 
¶251 The case before us appears to represent an even 
greater expansion of a patient's rights: a patient shall be 
given sufficient information about the availability of all 
alternate, viable medical modes of treatment (or diagnosis) so 
that the patient may not only reject a recommended mode of 
treatment or diagnosis but also select a different one.  If this 
statement is correct, the right described goes well beyond any 
recognized definition of "consent." 
¶252 An amicus brief filed by the Wisconsin Medical 
Society, et al., complains that under the court of appeals' 
interpretation of the statute, which this court affirms: 
Physicians would effectively be required to tell their 
patients "I believe in my diagnosis but if my 
diagnosis is wrong, here are all the other things you 
should consider."  No other area of human interaction 
embraces the proposition that a professional must give 
a layperson the choice of usurping their professional 
No.  2008AP1972.dtp 
 
17 
 
judgment.  There is no practical guidance on how to 
meet this obligation. 
¶253 Another amicus, Dean Health System Inc., et al., 
asserts that Wis. Stat. § 448.30 "does not require——and should 
not be expanded to require——that the patient be allowed to 
select from an extensive list of procedures on demand." 
¶254 I have already stated that this court's informed 
consent jurisprudence may promote the practice of defensive 
medicine.  The abandonment of the limitations of "consent" has a 
corresponding impact on patients.  If a physician does not 
practice defensive medicine, his patient is empowered to make 
his or her own medical decisions, selecting modes of treatment 
or diagnosis pro se, potentially at great cost to the health 
care system. 
¶255 These concerns must be addressed and answered more 
effectively than anything written in this opinion. 
D 
¶256 The lead opinion provides a trenchant argument for 
affirmance and for the current direction of Wisconsin law.  I am 
unable to join the opinion because of the reservations I have 
about the direction we are going.   
¶257 Chapter 375, Laws of 1981, includes a provision 
requiring the Medical Examining Board to "adopt rules to 
implement s. 448.30."  That requirement is presently embodied in 
Wis. Stat. § 448.40(2)(a).   
¶258 The Board promulgated rules in 1983.  See Wis. Admin. 
Code ch. Med. 18 Alternative Modes of Treatment (Dec. 1999). 
No.  2008AP1972.dtp 
 
18 
 
¶259 Nearly three decades have passed since the adoption of 
Wis. Stat. § 448.30 and the rules implementing the statute.  
Much has changed in the intervening years.  Perhaps the time has 
come for a thorough review of the rules by a blue ribbon 
committee, including but not limited to medical professionals, 
so that physicians are given clear guidance as to their 
obligations under this statute. 
¶260 A blue ribbon committee would be better equipped to 
wrestle with the serious policy questions raised here than an 
individual justice. 
¶261 For the foregoing reasons, I respectfully concur. 
 
 
No.  2008AP1972.pdr 
 
1 
 
¶262 PATIENCE DRAKE ROGGENSACK, J. (dissenting).   I write 
in dissent because the lead opinion, when combined with Justice 
Prosser's 
concurrence 
that 
affirms 
the 
court 
of 
appeals 
decision, holds a physician strictly liable for a missed 
diagnosis, contrary to the legislative directive in Wis. Stat. 
§ 448.30 and our long-standing precedent.1  I also write in 
dissent to point out that if the lead opinion had garnered the 
vote of four justices for its reasoning, which it did not, the 
court would have imposed strict liability for missed diagnoses 
by expanding a patient's right of informed consent under 
§ 448.30 from a right to be informed about the risks and 
benefits of treatments and procedures that were recommended by 
the physician into a right to be informed about all treatments 
and procedures that were not recommended by the physician, but 
which may be relevant to whether the correct diagnosis was made.  
Stated otherwise, the lead opinion's attempted expansion of 
§ 448.30 would require that whenever there is a claim that the 
correct diagnosis of a patient's ailment was not made, a 
physician would be liable for failing to tell a patient about 
all potential diagnoses and all potential tests that could have 
been employed to evaluate whether different ailments were the 
source of the patient's symptoms.  This would be an entirely new 
                                                 
1 Justice Ann Walsh Bradley and Justice N. Patrick Crooks 
join Chief Justice Shirley S. Abrahamson's lead opinion.  
Justice David T. Prosser does not join the lead opinion, but he 
does affirm the court of appeals decision based on a theory 
different from that set out in the lead opinion.  Justice 
Annette Kingsland Ziegler and Justice Michael J. Gableman join 
Justice Patience Drake Roggensack's dissenting opinion. 
No.  2008AP1972.pdr 
 
2 
 
concept that the legislature did not codify when it enacted 
§ 448.30.  Accordingly, I conclude that § 448.30 is not 
implicated in this malpractice action because there was no 
failure to inform the patient about the risks and benefits of 
the treatment and procedures that the physician employed.   
¶263 I also conclude that under the circumstances presented 
the jury's finding that Dr. Bullis was not negligent in her care 
and treatment of Thomas Jandre is inconsistent with the jury's 
finding that Dr. Bullis was negligent in regard to her duty to 
obtain informed consent.  Accordingly, I would reverse the 
decision of the court of appeals, and due to the inconsistency 
in the jury's verdicts, I would remand for a new trial on 
whether Dr. Bullis was negligent in her care and treatment of 
Mr. Jandre.  Therefore, I respectfully dissent. 
I.  BACKGROUND 
¶264 On June 13, 2003, Mr. Jandre drank some coffee and it 
came out his nose.  He also began to drool, suffered from 
slurred speech and his face drooped on the left side.  He felt 
dizzy, unsteady and had weakness in both legs.  His co-workers 
took him to the St. Joseph's Hospital West Bend emergency room.  
Mr. Jandre related his symptoms to Dr. Bullis, who was on duty 
as the emergency room physician when he arrived.  Mr. Jandre's 
co-workers also explained to Dr. Bullis what they had seen.  Dr. 
Bullis made a differential diagnosis, which is a list of 
ailments from which the patient could be suffering in order of 
probability.  Her differential diagnosis included Bell's palsy, 
No.  2008AP1972.pdr 
 
3 
 
stroke, transient ischemic attack (TIA), tumor, Guillain-Barre 
and Multiple Sclerosis. 
¶265 Dr. Bullis pursued various diagnostic procedures to 
determine the ailment that was causing Mr. Jandre's symptoms.  
She examined Mr. Jandre's carotid arteries by listening for 
bruits, which develop when there is blockage in the carotid 
arteries.  Blockage of the carotid arteries may cause an 
ischemic stroke2 or a TIA.  She heard no bruits.  She ordered a 
CT (computerized tomography) scan to rule out hemorrhagic 
stroke.3  The CT scan was normal.  None of the procedures 
recommended by Dr. Bullis caused injury to Mr. Jandre.   
¶266 After all the tests were completed, Dr. Bullis 
determined that Mr. Jandre was suffering from a mild form of 
Bell's palsy.  She concluded that he had not experienced a 
hemorrhagic stroke, 
based on the CT scan, and had not 
experienced an ischemic stroke or a TIA, based on the lack of 
bruits in his carotid arteries.  Upon reaching her diagnosis of 
Bell's palsy, Dr. Bullis informed Mr. Jandre about what he might 
expect from Bell's palsy.  As treatment, she prescribed 
medications consistent with the diagnosis of Bell's palsy.  None 
of the medications prescribed by Dr. Bullis caused injury to Mr. 
Jandre.  She also told him to go to his family doctor for a 
                                                 
2 Ischemic stroke results from the brain receiving too 
little oxygen due to poor intracranial circulation. 
3 Hemorrhagic stroke results when there is an intracranial 
bleed. 
No.  2008AP1972.pdr 
 
4 
 
complete exam within a week, or sooner if other symptoms 
developed.   
¶267 Three days after being treated for Bell's palsy and 
sent home from the emergency room, Mr. Jandre saw Dr. Steele, a 
family medicine physician.  He confirmed Dr. Bullis's Bell's 
palsy diagnosis.  Unfortunately, eight days after Mr. Jandre's 
visit to Dr. Steele, he suffered a significant stroke.   
¶268 On June 14, 2004, Mr. and Mrs. Jandre filed suit 
against Dr. Bullis, alleging that she negligently diagnosed Mr. 
Jandre as having Bell's palsy, when he had initial symptoms of a 
stroke or a TIA.  The Jandres also alleged that Dr. Bullis 
negligently failed to inform Mr. Jandre about the possibility of 
having a carotid ultrasound to diagnose whether he had a blocked 
carotid artery that had caused a TIA or stroke.  
¶269 When the matter went to trial, Dr. Bullis objected to 
Mr. Jandre's informed consent claim and to the jury instructions 
that described an informed consent claim.  The jury found that 
Dr. Bullis was not negligent in her diagnosis of Mr. Jandre's 
ailment, but that she was negligent in fulfilling her duty to 
obtain informed consent.  Subsequent to the jury verdict, Dr. 
Bullis again objected to the informed consent claim, requesting 
a new trial because the verdict was contrary to Wisconsin's 
informed consent law.  All of her motions and objections in 
regard to informed consent were denied.  The court of appeals 
affirmed the decision of the circuit court.  Jandre v. 
Physicians Ins. Co. of Wis., 2010 WI App 136, ¶¶2-3, 330 Wis. 2d 
50, 792 N.W.2d 558.  
No.  2008AP1972.pdr 
 
5 
 
¶270 In affirming the court of appeals decision, the lead 
opinion attempts to significantly expand the obligations of 
physicians under Wis. Stat. § 448.30.  The lead opinion opines 
that "the circuit court could not determine, as a matter of law, 
that the physician had no duty to inform the patient of the 
possibility that the cause of his symptoms might be a blocked 
artery, which posed imminent, life-threatening risks, and of the 
availability of alternative, non-invasive means of ruling out or 
confirming the source of his symptoms."4  This reasoning would 
place a duty on a physician to inform his or her patients about 
medical treatments and procedures that the physician is not 
recommending solely because such treatments and procedures may 
be relevant to whether the physician's diagnosis was correct.  
II.  DISCUSSION 
A.  Standard of Review 
¶271 Statutory 
construction 
and 
application 
present 
questions of law for our independent review.  Richards v. Badger 
Mut. Ins. Co., 2008 WI 52, ¶14, 309 Wis. 2d 541, 749 N.W.2d 581.  
However, as we conduct our review, we benefit from prior 
analyses of the court of appeals and the circuit court.  Id.   
¶272 This case also requires us to consider the jury's 
verdicts on two separate claims based on the same factual 
occurrence.  On one of the claims, the jury found that Dr. 
Bullis was not negligent and on the other, the jury found she 
was negligent.  We examine the jury verdicts on the two separate 
claims to determine whether the jury's findings are inconsistent 
                                                 
4 Lead op., ¶10. 
No.  2008AP1972.pdr 
 
6 
 
as a matter of law.  Westfall v. Kottke, 110 Wis. 2d 86, 94, 328 
N.W.2d 481 (1983).   
B.  Informed Consent 
¶273 A physician's duty of informed consent is set forth in 
Wis. Stat. § 448.30. Section 448.30 provides: 
 
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. 
¶274 Statutory 
interpretation 
always 
"begins 
with 
the 
language of the statute."  Richards, 309 Wis. 2d 541, ¶20 
(internal quotation marks and citation omitted).  We assume that 
the meaning of the statute is expressed in the words that the 
legislature chose to use.  Id.  The context in which statutory 
terms are considered is helpful to our understanding.  Id.  When 
No.  2008AP1972.pdr 
 
7 
 
the statutory language is unambiguous, we apply the plain, clear 
meaning of the statute.  Id.   
¶275 Accordingly, I begin with the plain meaning of the 
words that the legislature chose, and then examine Scaria v. St. 
Paul Fire & Marine Insurance Co., 68 Wis. 2d 1, 227 N.W.2d 647 
(1975), because all parties agree that Wis. Stat. § 448.30 is 
the codification of our decision in Scaria.  See Johnson v. 
Kokemoor, 199 Wis. 2d 615, 629-30, 545 N.W.2d 495 (1996) 
(concluding that § 448.30 is the codification of Scaria).   
¶276 The plain language of Wis. Stat. § 448.30 speaks only 
to "modes of treatment" and the "benefits and risks of these 
treatments."  It requires the physician to provide the patient 
with enough information to permit the patient to choose whether 
to undergo a recommended treatment or not, if that choice is 
possible for the patient to make.  The entire focus of § 448.30 
is on something that a physician is recommending to be done to 
the patient.  Obtaining a patient's informed consent to 
treatment or procedures that the physician is not recommending 
as part of his diagnosis and treatment of the patient is not 
within the plain meaning of § 448.30.  Further, such an 
expansion of the duty of informed consent is not a concept found 
in Scaria, upon which the legislature based § 448.30.  
¶277 In Scaria, the medical malpractice action involved two 
claims:  a claim of negligent care and treatment and a claim of 
failure to obtain informed consent to a procedure that Mr. 
Scaria underwent based upon the recommendation of his physician.  
These medical claims both arose out of the same procedure that 
No.  2008AP1972.pdr 
 
8 
 
caused Mr. Scaria to become a paraplegic.  The procedure he 
underwent was a percutaneous femoral aortogram, recommended by 
the physician to determine why Mr. Scaria had elevated blood 
pressure.  The percutaneous femoral aortogram involved the 
injection of dye into Mr. Scaria's artery in order to study his 
kidneys.  Mr. Scaria had a severe reaction to the dye, which he 
alleged was a risk of the recommended procedure that was not 
explained to him.  Scaria, 68 Wis. 2d at 4.  At trial, the jury 
was asked to evaluate Mr. Scaria's informed consent claim under 
the following parameters:  
a physician and surgeon has a duty to make reasonable 
disclosure to his patient of all significant facts 
under the circumstances of the situation which are 
necessary to form the basis of an intelligent and 
informed consent by the patient to the proposed 
treatment or operation and the patient must have given 
such consent to the treatment or operation.  This 
duty, however, is limited to those disclosures which 
physicians and surgeons of good standing would make 
under the same or similar circumstances, having due 
regard to the patient's physical, mental and emotional 
condition. 
Id. at 10.  
¶278 Mr. 
Scaria 
objected 
to 
that 
part 
of 
the 
jury 
instruction that limited the physician's duty to only those 
disclosures that reasonable physicians would make under similar 
circumstances.  Id. at 10-11.  We agreed that Mr. Scaria was 
correct in that the limitation set out by the circuit court was 
not appropriate for an informed consent claim.  We stated "[t]he 
right to be recognized and protected is the right of the patient 
to consent or not to consent to a proposed medical treatment or 
procedure."  Id. at 12 (emphasis added). 
No.  2008AP1972.pdr 
 
9 
 
¶279 However, in Scaria, we also recognized that the 
obligation to provide information of the risks of a proposed 
medical treatment or procedure was not without limitation.  We 
explained: 
[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 
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 (footnote omitted).  We then summarized our holding 
as, "the duty of the doctor is to make such disclosures as 
appear reasonably necessary under circumstances then existing to 
enable 
a 
reasonable 
person 
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). 
¶280 Scaria's requirement that informed consent be obtained 
for any treatment or procedure that is recommended to be 
performed on a patient is supported by an earlier case, Trogun 
v. Fruchtman, 58 Wis. 2d 569, 207 N.W.2d 297 (1973).  In Trogun, 
we first explained a change in medical malpractice theory such 
that:  
where the alleged misconduct on the part of the 
physician amounts to a failure to disclose the 
ramifications 
of a pending course of treatment, 
therapy, or surgery . . . we conclude it is preferable 
to affirmatively recognize a legal duty, bottomed upon 
No.  2008AP1972.pdr 
 
10 
 
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.  
Id. at 598-600.   
¶281 Prior to Trogun, the law of medical malpractice had 
been grounded in assault and battery law, and Trogun was an 
early decision recognizing that informed consent claims do not 
readily fit within that parameter.  Therefore, Scaria, grounded 
in the reasoning of Trogun, focused on disclosing to the patient 
the risks of a course of treatment or a procedure, i.e., doing 
something to the patient that the physician recommended be done, 
so that the patient could make an informed decision about 
whether to consent to the recommended treatment or procedure.  
Nothing in Trogun or Scaria could be read as imposing a duty on 
a physician to obtain the patient's consent to a treatment or 
procedure that the physician had not recommended.   
¶282 We also addressed the duty of informed consent in 
Martin v. Richards, 192 Wis. 2d 156, 531 N.W.2d 70 (1995), where 
we interpreted a claim of failure to obtain informed consent to 
treatment that was recommended for a child.  In order to be 
understood, Martin must be considered in the circumstances under 
which it arose.  There, 14-year-old Cheryl Martin "ran into the 
back of a truck while riding her bicycle."  Id. at 163.  She was 
transported to the hospital emergency room at approximately 
10:40 p.m.  Id.   
¶283 Dr. Richards was on duty in the emergency room that 
evening.  He examined Ms. Martin when she came in and also an 
hour later.  Id.  He had been told that she was injured when she 
No.  2008AP1972.pdr 
 
11 
 
hit the back of a dump truck while riding her bicycle and that 
she had been unconscious at the scene for an undetermined period 
of time.  Id.  He was also told that she had vomited five or six 
times and some amnesia was observed.  Id. at 163-64.  There was 
swelling and bruising to the right zygomatic area of her head, 
an area where intracranial bleeding may occur if a cranial 
artery is torn.  Id. at 164.   
¶284 Dr. Richards' differential diagnosis was "concussion, 
contusion, and the possibility of intracranial bleeding."  Id. 
at 
164 
(internal 
quotation 
marks 
omitted). 
 
Given 
that 
diagnosis, Dr. Richards explained to her father that he could 
send her home for Mr. Martin to watch over or he could admit her 
to the hospital for observation.  Id.  Dr. Richards believed 
that Ms. Martin should remain at the hospital for continued 
observation, and he convinced her father to accept that 
treatment.  Id.  However, Dr. Richards did not advise Mr. Martin 
that if Ms. Martin were to incur subsequent intracranial 
bleeding, which was one of the risks Dr. Richards knew was 
present, that Ms. Martin could not be treated for that 
consequence of her head injury because the hospital had no 
neurosurgeon.  Id.   
¶285 Ms. Martin was admitted to the hospital and did incur 
a subsequent intracranial bleed, whereupon she was transferred 
to the University of Wisconsin Hospital.  Unfortunately, the 
necessary neurosurgery was not performed until 3:55 a.m. and she 
suffered severe and permanent injuries.  Id. at 165.  The 
Martins brought a malpractice action alleging that Dr. Richards 
No.  2008AP1972.pdr 
 
12 
 
was negligent in his treatment of Ms. Martin; that the care 
provided by the nursing staff was negligent in not observing Ms. 
Martin more closely; and that Dr. Richards did not inform Ms. 
Martin's father about the risks of his recommended treatment 
that she remain at the hospital when the hospital had no 
neurosurgeon to treat the known risk of an intracranial bleed.  
Id. at 165-66. 
¶286 The 
jury 
determined 
that 
Dr. 
Richards 
was 
not 
negligent in either his diagnosis or treatment of Ms. Martin.  
Id. at 166.  The jury did conclude that the nurses were 
negligent in failing to monitor Ms. Martin's condition more 
closely, but that their negligence was not a cause of Ms. 
Martin's injury.  Id.  The jury also found that Dr. Richards 
negligently failed to inform Mr. Martin of alternate forms of 
treatment for the head injury Ms. Martin had sustained.  Id.  
The alternate treatment would have involved moving Ms. Martin to 
a hospital that had a neurosurgeon to operate if intracranial 
bleeding occurred.  See id.  The circuit court dismissed the 
informed consent claim notwithstanding the verdict, and the 
court of appeals reversed.  Id.   
¶287 When we reviewed the claim brought by Ms. Martin under 
Wis. Stat. § 448.30, we concluded "that statute's operative 
language [was]:  '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. at 169.  We explained that the 
No.  2008AP1972.pdr 
 
13 
 
difficulty in interpreting the statute was determining "what is 
considered an alternate, viable mode of treatment."  Id.   
¶288 We determined the scope of the statute by examining 
the development of the doctrine of informed consent and the 
codification of informed consent set out in Wis. Stat. § 448.30.  
Id.  We opined that "[c]onsent to treatment is [meaningful] only 
if it is given by persons informed or knowledgeable about the 
various choices available and the risks attendant upon each."  
Id. at 169-70.  We reasoned that in Scaria, upon which § 448.30 
is based, the plaintiff's injuries resulted from complications 
associated with an aortogram, a diagnostic procedure.  Id. at 
175.  In so doing, we explained that when a physician recommends 
a treatment, "[t]he distinction between diagnostic and medical 
treatments is not in and of itself significant to an analysis of 
informed consent."  Id.  We continued to opine that: 
as part of the physician's duty to obtain a patient's 
informed consent to any medical procedure employed by 
the physician in dealing with the patient, there 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 injury.   
Id. at 175-76 (emphasis added) (citation omitted).  We further 
explained that, "[a] physician who proposes to treat a patient 
or [to] attempt to diagnose a medical problem must make such 
disclosures as will enable a reasonable person under the 
circumstances confronting the patient to exercise the patient's 
right to consent to, or to refuse the procedure proposed or to 
request an alternative treatment or method of diagnosis."  Id. 
No.  2008AP1972.pdr 
 
14 
 
at 176.  Contrary to the lead opinion, nothing in Martin 
suggested that a physician was required to disclose information 
to enable a patient to consent to a treatment or procedure that 
was not recommended by his physician.5  To do so, would be 
tantamount to requiring the physician to obtain the patient's 
informed consent not to institute a treatment or procedure that 
the 
physician 
has 
decided 
is 
not 
appropriate 
given 
the 
physician's diagnosis.   
¶289 In Martin, the recommended treatment for Ms. Martin's 
head trauma was to remain at Fort Atkinson Hospital for careful 
observation.  However, the risk of that treatment, i.e., a 
significant delay in surgery if it became necessary due to an 
intracranial bleed, was not explained.  Id. at 179.  We 
concluded that it was "not the diagnosis, that drives the duty 
to inform in this case," but the consequences associated with a 
concussion, which included a "delayed intracranial bleed."  Id. 
at 180-81.   
¶290 When we analyze the breadth of Wis. Stat. § 448.30 as 
construed in Martin, it is important to recognize that what was 
being determined in Martin was whether information existed that 
should have been provided about the risk of the recommended 
treatment, i.e., information about the risk of remaining in a 
hospital that had no neurosurgeon to operate on Ms. Martin if an 
intracranial bleed occurred.  That our discussion in Martin was 
driven by the recommended treatment is shown by the special 
verdict:  
                                                 
5 Lead op., e.g., ¶¶8, 10, 17, 27, 38, 81, 95.  
No.  2008AP1972.pdr 
 
15 
 
Question 3 . . .:  Would a reasonable person in Robert 
Martin's position have agreed to the alternate forms 
of care and treatment had he been informed of their 
availability?  (Yes or No).   
Id. at 184.   
¶291 In Martin, we did not decide that information about 
alternate diagnoses of the injury suffered by Ms. Martin was 
required by Wis. Stat. § 448.30.  But rather, in affirming the 
jury's verdict, we said: 
[Dr. Richards] knew that Ms. Martin's condition was 
more serious than a simple concussion.  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." 
Id. at 180-81 (emphasis added).   
¶292 Bubb v. Brusky, 2009 WI 91, 321 Wis. 2d 1, 768 N.W.2d 
903, is our most recent interpretation of informed consent under 
Wis. Stat. § 448.30.  As with Martin, it must be understood in 
light of the circumstances in which it arose.  Bubb arose out of 
Richard Bubb's initially having trouble ingesting his food and 
then falling out of his chair.  Id., ¶5.  He was transported to 
the hospital emergency room, where he was seen by Dr. Brusky.  
Id., 
¶¶5-6. 
 
Dr. 
Brusky 
ordered 
a 
CT 
scan, 
an 
EKG 
(electrocardiogram) and blood tests to evaluate Mr. Bubb.  Id., 
¶6.  Mr. Bubb began to feel better and the results of the tests 
caused Dr. Brusky to conclude that Mr. Bubb had suffered a TIA 
(transient ischemic attack), which manifested itself as stroke-
like symptoms.  Id., ¶7.  Dr. Brusky discharged Mr. Bubb with 
instructions to follow up with a neurologist, Dr. Gu.  Id., ¶¶8-
No.  2008AP1972.pdr 
 
16 
 
9.  Two days later, Mr. Bubb suffered a significant stroke.  
Id., ¶11.   
¶293 In his lawsuit, Mr. Bubb did not question the 
correctness 
of 
Dr. 
Brusky's 
TIA 
diagnosis. 
 
Rather, 
he 
questioned the completeness of the information given to him 
about viable treatments for his TIA.  See id., ¶70.  We agreed 
with Mr. Bubb's contention that the question presented was 
whether he made an informed decision when he consented to Dr. 
Brusky's suggested mode of treatment.  The recommended treatment 
for Mr. Bubb's TIA was discharge from the hospital with 
instructions for follow-up care.  The issue of informed consent 
arose because Mr. Bubb was not told of alternative treatment, 
which was admission to the hospital for further diagnostic 
testing, and the benefits and risks of both treatments.  Id., 
¶71.   
¶294 We concluded that there was credible evidence in the 
record from which a reasonable jury could conclude that Dr. 
Brusky did not obtain informed consent to the treatment he 
recommended, and therefore, the circuit court should have 
submitted Mr. Bubb's informed consent claim to the jury.  Id., 
¶73.  Contrary to the holding of the lead opinion, our decision 
in Bubb has nothing to do with a physician's obligation to 
obtain informed consent to procedures that the physician has not 
recommended and that are not consistent with the physician's 
diagnosis.6 
                                                 
6 Lead op., ¶121. 
No.  2008AP1972.pdr 
 
17 
 
¶295 Indeed, Wis. Stat. § 448.30, Scaria, Martin and Bubb 
are consistent in what they require.  Each requires the 
physician to obtain the patient's informed consent to a 
treatment or procedure that is being recommended to be done to 
the patient based on either the physician's diagnosis of the 
patient's ailment or in an attempt to diagnose the patient's 
ailment.  Informed consent to the proposed treatment or 
procedure is obtained when the patient is told of the benefits 
and the risks of following the physician's advice.  Scaria, 68 
Wis. 2d at 13; Martin, 192 Wis. 2d at 169-70; Bubb, 321 Wis. 2d 
1, ¶73.  
¶296 Hoven v. Kelble, 79 Wis. 2d 444, 256 N.W.2d 379 
(1977), also is an important medical malpractice case.  Hoven 
involved a claim for injuries sustained as a result of a lung 
biopsy.  Id. at 446.  During the lung biopsy, Mr. Hoven suffered 
a cardiac arrest, resulting in injury to his nervous system and 
brain tissue that caused extensive medical expenses, pain, 
suffering and disability.  Id. 
¶297 Mr. Hoven alleged ten separately stated causes of 
action, three of which were predicated on the theory of strict 
liability for allegedly defective medical services rendered by 
each of the defendants.  Our discussion of strict liability in 
Hoven begins by explaining that "[o]ur court has held members of 
the medical profession to a standard of reasonable care under 
the circumstances."  Id. at 456.  We stated that the proper 
standard is reasonable care under the circumstances because 
"'[a] physician is not an insurer of the results of his 
No.  2008AP1972.pdr 
 
18 
 
diagnosis or procedures.'"  Id. (internal quotation marks and 
citation omitted).  
¶298 We also explained that medicine is not an exact 
science and the very best physicians using a reasonable degree 
of care and skill could not be expected never to err in regard 
to a diagnosis or the performance of a procedure.  Id.  We 
concluded our discussion in Hoven by establishing that under the 
law, "[m]edical sciences are not exact.  A patient cannot 
consider a doctor's treatment to be defective simply because it 
does not cure his ailment. . . .  To hold medical professionals 
strictly liable under these circumstances would not promote any 
social benefit."  Id. at 465.  The rule of law set out in Hoven, 
that a physician's duty is not based on strict liability, but 
rather on negligence, would be overruled sub silento by the lead 
opinion if four justices had joined it.  This is so because the 
lead opinion attempts to expand a physician's duty to explain 
procedures that the physician did not recommend, but which may 
be relevant to whether the physician's diagnosis was correctly 
made. 
¶299 In the case at hand, Dr. Bullis did not contravene her 
duty to obtain informed consent from Mr. Jandre, as a matter of 
law.  The treatment she recommended for Mr. Jandre, which was to 
see his private physician within a week, or sooner if his 
symptoms recurred, was consistent with her diagnosis of Bell's 
palsy.  If her diagnosis had been correct, there were no 
undisclosed risks of the recommended treatment.   
No.  2008AP1972.pdr 
 
19 
 
¶300 The lead opinion attempts to hold Dr. Bullis strictly 
liable for a missed diagnosis by requiring that she obtain Mr. 
Jandre's informed consent to forgo a carotid ultrasound, whose 
only relevance was to show that Dr. Bullis' diagnosis of Bell's 
palsy was not correct.  That the lead opinion attempts to impose 
strict liability for a missed diagnosis becomes apparent when 
one examines what would have happened if the diagnosis of Bell's 
palsy had been correct.  If that were the circumstance, the lead 
opinion would not conclude that Dr. Bullis violated Wis. Stat. 
§ 448.30 for failing to tell Mr. Jandre that a carotid 
ultrasound could have been done to assist in ruling out a TIA or 
stroke.   
¶301 The reasoning of the lead opinion is a significant 
change in the law, and it is not supported either by Wis. Stat. 
§ 448.30 or Scaria, upon which § 448.30 is based.  Stated 
otherwise, § 448.30 is based on informing patients of the risks 
and benefits of procedures that the physician recommends be done 
to the patient.  Scaria, 68 Wis. 2d at 12 (concluding that 
"[t]he right to be recognized and protected is the right of the 
patient to consent or not to consent to a proposed medical 
treatment or procedure").  In sharp contrast, the lead opinion 
is based on requiring the physician to obtain informed consent 
to forgo procedures that the physician has not recommended be 
done to the patient, procedures that are not consistent with the 
diagnosis the physician made.  The potential scope of the 
reasoning underlying the lead opinion is breathtaking because a 
claim for the violation of the duty of informed consent would be 
No.  2008AP1972.pdr 
 
20 
 
limited only by an expert's theory on what might have been 
diagnosed. 
¶302 The lead opinion's attempted expansion of the law to 
require information about procedures that may show that the 
physician's diagnosis was not correct is not supported by any 
other Wisconsin case.  This is so because the doctrine of 
informed consent arises from the "notion that an adult has a 
right to determine what shall be done with his own body."  
Schreiber v. Physicians Ins. Co. of Wis., 223 Wis. 2d 417, 426, 
588 N.W.2d 26 (1999) (internal quotation marks and citation 
omitted).  If a physician has not recommended a treatment, or 
that a procedure be done, there is no invasion of the patient's 
right to bodily integrity that the physician recommended. 
¶303 I agree that a patient has the right to say what will 
be done with his or her body, and he or she cannot make an 
informed decision about that right unless the "benefits and 
risks" of the recommended procedures or treatments are explained 
to the patient.  However, there is no Wisconsin case that 
requires a physician to explain procedures to the patient that 
the physician is not recommending be done.  See Trogun, 58 
Wis. 2d at 599 (explaining that "a failure to disclose the 
ramifications of a pending course of treatment, therapy, or 
surgery" was the issue in an informed consent claim); Martin, 
192 Wis. 2d at 176 (concluding that "[a] physician who proposes 
to treat a patient or [to] attempt to diagnose a medical problem 
must make such disclosures as will enable a reasonable person 
under the circumstances confronting the patient to exercise the 
No.  2008AP1972.pdr 
 
21 
 
patient's right to consent to, or to refuse the procedure 
proposed"); Johnson, 199 Wis. 2d at 630 (concluding that the 
"concept of informed consent is based on the tenet that in order 
to make a rational and informed decision about undertaking a 
particular 
treatment 
or 
undergoing 
a 
particular 
surgical 
procedure, a patient has the right to know about significant 
potential risks involved in the proposed treatment or surgery"); 
Hannemann v. Boyson, 2005 WI 94, ¶44, 282 Wis. 2d 664, 698 
N.W.2d 714 (explaining that medical professionals "are obligated 
to disclose and discuss the material risks of any given 
procedure or treatment with their patients so that their 
patients may make informed decisions as to whether they want to 
consent to bodily intrusions and proceed with the recommended 
procedure or treatment"); Bubb, 321 Wis. 2d 1, ¶73 (concluding 
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").   
¶304 The lead opinion requires more than information about 
physician-recommended treatment or procedures and their benefits 
and risks.  The lead opinion attempts to change the duty to 
obtain informed consent for a physician-recommended treatment or 
procedure into a duty to obtain informed consent for a procedure 
that the physician has not recommended, solely because the 
procedure may show that the physician's diagnosis was not 
correct.  The lead opinion attempts to expand Wis. Stat. 
§ 448.30 to require the physician to inform the patient about 
the 
risks 
and benefits of a procedure, here a carotid 
No.  2008AP1972.pdr 
 
22 
 
ultrasound, that the physician did not recommend in regard to 
treating or diagnosing the ailment that the physician concluded 
the patient had.  Rather, a carotid ultrasound has relevance 
only to determining whether the diagnosis of Bell's palsy was 
correctly made.  Therefore, the lead opinion's holding, if it 
were adopted by four members of this court, would impose strict 
liability on the physician for his or her diagnosis, contrary to 
our holding in Hoven.  Hoven, 79 Wis. 2d at 456. 
¶305 The 
lead 
opinion 
attempts 
to 
clothe 
itself 
in 
precedent, as it takes statements from past cases and juxtaposes 
them with holdings that the statements and the cases cited do 
not support.  For example, the lead opinion says, "Wisconsin law 
'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.'"7  Although the words 
are accurately quoted from Kuklinski v. Rodriguez, 203 Wis. 2d 
324, 329, 552 N.W.2d 869 (Ct. App. 1996), Kuklinski did not 
require a physician to inform a patient of the availability of a 
CT scan at a time when the physician did not believe a CT scan 
was warranted.  To the contrary, Kuklinski holds that there was 
no reason to inform the patient of the availability of a CT scan 
when the patient came into the emergency room because the 
physician's initial diagnosis of Mr. Kuklinski was that he had a 
"minor head injury."  Id. at 333.  That the physician later 
                                                 
7 Lead op., ¶8, quoting Kuklinski v. Rodriguez, 203 Wis. 2d 
324, 329, 552 N.W.2d 869 (Ct. App. 1996) (quoting Martin v. 
Richards, 192 Wis. 2d 156, 175, 531 N.W.2d 70 (1995)); see also 
Bubb v. Brusky, 2009 WI 91, ¶62, 321 Wis. 2d 1, 768 N.W.2d 903. 
No.  2008AP1972.pdr 
 
23 
 
ordered a CT scan was due to a change in his diagnosis based on 
the patient's change in condition.  Id. at 332-33.  Neither 
Kuklinski nor any other case supports a claim that Dr. Bullis 
violated her duty to obtain Mr. Jandre's informed consent when 
she did not explain to him that a carotid ultrasound may show 
that her diagnosis of Bell's palsy was not correct. 
C.  Inconsistent Verdicts 
¶306 The jury found that Dr. Bullis was not negligent in 
her diagnosis of Bell's palsy even though she had not done a 
carotid ultrasound to rule out the diagnoses of TIA or stroke 
caused by blockage of the carotid arteries.  The jury also found 
that Dr. Bullis was negligent in performing her duty of 
obtaining informed consent because she did not tell Mr. Jandre 
that a carotid ultrasound could have determined whether he had 
suffered a TIA or small stroke rather than Bell's palsy.   
¶307 Jury verdicts are inconsistent when the facts that 
must have been found by the jury in regard to one verdict are 
repugnant to the facts that must have been found by the jury in 
order to return the second verdict.  See Westfall, 110 Wis. 2d 
at 92-95.  A verdict that is inconsistent, "if not timely 
remedied by reconsideration by the jury, must result in a new 
trial."  Id. at 98.8   
                                                 
8 The tripartite rule relative to inconsistent verdicts of 
Statz v. Pohl, 266 Wis. 23, 28-29, 62 N.W.2d 556 (1954), has 
been abrogated as well as the court's "expressions of the 
approval of such rationalization for preserving and reconciling 
such inconsistent verdicts."  Westfall v. Kottke, 110 Wis. 2d 
86, 100, 328 N.W.2d 481 (1983). 
No.  2008AP1972.pdr 
 
24 
 
¶308 In his action for negligent care and treatment, Mr. 
Jandre argued that Dr. Bullis negligently diagnosed Bell's palsy 
because she had not ordered a carotid ultrasound to rule out the 
possibility that blocked carotid arteries were causing Mr. 
Jandre's symptoms.  In regard to the claim of informed consent, 
Mr. Jandre argued that he should have been told that a carotid 
ultrasound was an available diagnostic tool to determine whether 
blocked carotid arties were causing his symptoms, rather than 
Bell's palsy.   
¶309 The jury instructions on informed consent also focused 
on the possibility that there was a more accurate diagnostic 
procedure than that used by Dr. Bullis to diagnose Mr. Jandre's 
ailment.  To focus on Mr. Jandre's claim that he should have 
been told about a carotid ultrasound, the circuit court 
instructed the jury as follows:   
A doctor has the duty to provide her patient with 
information necessary to enable the patient to make an 
informed decision about a diagnostic procedure and 
alternative choices of diagnostic procedures.  If the 
doctor fails to perform this duty, she is negligent. 
To meet this duty to inform her patient, a doctor 
must provide her patient with the information a 
reasonable person in the patient's position would 
regard as significant when deciding to accept or 
reject a diagnostic procedure.  In answering this 
question, you should determine what a reasonable 
person in the patient's position would want to know in 
consenting to or rejecting a diagnostic procedure. 
The doctor must inform the patient whether a 
diagnostic procedure is ordinarily performed in the 
circumstances 
confronting 
the 
patient, 
whether 
alternate 
procedures 
approved 
by 
the 
medical 
profession are available, what the outlook is for 
success or failure of each alternate procedure, and 
No.  2008AP1972.pdr 
 
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the benefits and risks inherent in each alternate 
procedure.  
¶310 The underlined language in the above-quoted jury 
instructions, under the facts of this case, is not consistent 
with the law of informed consent.  Even though the jury 
instruction may have been proper for the informed consent claim 
under other circumstances, given the facts of this case, it 
promoted the inconsistent verdicts the jury rendered.  This is 
so because the jury instruction required Dr. Bullis to obtain 
Mr. Jandre's consent to forgo a diagnostic procedure that she 
had not recommended be done, which procedure the jury also found 
was not required to meet Dr. Bullis' requisite standard of care.   
¶311 Mr. Jandre suffered no injury from any alternate 
diagnostic procedure that Dr. Bullis recommended and employed, 
yet liability for injury suffered from a recommended and 
employed procedure is the essence of an informed consent claim.  
Stated otherwise, informed consent requires that a physician 
give sufficient information to a patient so that the patient can 
make an informed decision about whether to permit a recommended 
procedure be done to him or her.  The right to give or refuse 
consent is grounded in a patient's right to control what will be 
done to his or her body.  Scaria, 68 Wis. 2d at 12; Martin, 192 
Wis. 2d at 169-70; Johnson, 199 Wis. 2d at 630; Schreiber, 223 
Wis. 2d at 426; Hannemann, 282 Wis. 2d 664, ¶44; Bubb, 321 
Wis. 2d 1, ¶69.   
¶312 Alternate diagnostic procedures become an issue on 
which to ground an informed consent claim when a physician 
recommends and employs a procedure and the patient suffers an 
No.  2008AP1972.pdr 
 
26 
 
injury that the physician did not disclose to the patient before 
the procedure was performed.  Hannemann, 282 Wis. 2d 664, ¶¶43-
44.  However, no violation of Wis. Stat. § 448.30 or the common 
law consistent with § 448.30 arises when a physician declines to 
employ an alternate diagnostic procedure, simply because that 
alternate diagnostic procedure may have been a more accurate 
diagnostic tool than the one chosen by the physician.   
¶313 One of the central issues at trial was whether Dr. 
Bullis's diagnosis of Bell's palsy was negligently made because 
she listened for bruits in Mr. Jandre's carotid arteries rather 
than doing a carotid ultrasound to evaluate his carotid 
arteries.  The jury found that Dr. Bullis's decision not to 
employ carotid ultrasound during her diagnosis of Mr. Jandre's 
ailment was not negligent.  However, in order to sustain the 
informed consent verdict, the jury must have found that Dr. 
Bullis had an obligation to tell Mr. Jandre that she could have 
used a carotid ultrasound in her diagnosis of his ailment even 
though she chose not to do so.  The jury instruction directs the 
jury to that conclusion when it instructs that "[a] doctor has 
the duty to provide her patient with information necessary to 
enable the patient to make an informed decision about a 
diagnostic 
procedure 
and 
alternate 
choices 
of 
diagnostic 
procedures.  If the doctor fails to perform this duty, she is 
negligent." 
¶314 The jury verdict places claims of informed consent in 
direct conflict with claims of negligent care and treatment when 
no injury results from the procedure employed.  This is so 
No.  2008AP1972.pdr 
 
27 
 
because so long as the diagnostic procedures that were employed 
for the patient were "reasonable given the state of medical 
knowledge at that time," no negligent care can be found,9 yet 
failing to advise about the use of other procedures that are not 
being recommended is a failure in the duty of informed consent, 
according to the jury verdict, given the facts of this case. 
¶315 The verdicts rest on inconsistent factual foundations, 
in that the claim of negligent care and treatment and the claim 
of informed consent turn on the use of a carotid ultrasound.  
The jury found that Dr. Bullis was not negligent when she did 
not employ carotid ultrasound in her diagnosis, but that she was 
negligent in failing to obtain Mr. Jandre's consent not to 
employ a carotid ultrasound in her diagnosis.  Therefore, under 
the facts of this case, the jury's verdicts required the jury to 
find inconsistent facts.  
¶316 There is no claim under law for failing to inform a 
patient of procedures that were not recommended, when the 
procedures employed do not cause injury.  Accordingly, the claim 
of informed consent should be dismissed.  In addition, because 
the verdicts for Mr. Jandre's two claims are inconsistent, 
pursuant to our directive in Westfall, I would order a new trial 
on the claim of negligent care and treatment.  
III.  CONCLUSION 
                                                 
9 The standard jury instruction employed here stated in 
relevant part, "If you find from the evidence that more than one 
method of . . . diagnosing Thomas Jandre's condition was 
recognized as reasonable given the state of medical knowledge at 
that time, then Dr. Therese Bullis was at liberty to select any 
of the recognized methods." 
No.  2008AP1972.pdr 
 
28 
 
¶317 The lead opinion, when combined with Justice Prosser's 
concurrence that affirms the court of appeals decision, holds 
one physician strictly liable for a missed diagnosis, contrary 
to the legislative directive in Wis. Stat. § 448.30 and our 
long-standing precedent.  I also write in dissent to point out 
that if the lead opinion had garnered the vote of four justices 
for its reasoning, which it did not, the court would have 
imposed strict liability for missed diagnoses by expanding a 
patient's right of informed consent under § 448.30 from a right 
to be informed about the risks and benefits of treatments and 
procedures that were recommended by the physician into a right 
to be informed about all treatments and procedures that were not 
recommended by the physician, but which may be relevant to 
whether the correct diagnosis was made.  Stated otherwise, the 
lead opinion's attempted expansion of § 448.30 would require 
that whenever there is a claim that the correct diagnosis of a 
patient's ailment was not made, a physician would be liable for 
failing to tell a patient about all potential diagnoses and all 
potential tests that could have been employed to evaluate 
whether different ailments were the source of the patient's 
symptoms.  This would be an entirely new concept that the 
legislature 
did 
not 
codify 
when 
it 
enacted 
§ 448.30.  
Accordingly, I conclude that § 448.30 is not implicated in this 
malpractice action because there was no failure to inform the 
patient about the risks and benefits of the treatment and 
procedures that the physician employed.   
No.  2008AP1972.pdr 
 
29 
 
¶318 I also conclude that under the circumstances presented 
the jury's finding that Dr. Bullis was not negligent in her care 
and treatment of Mr. Jandre is inconsistent with the jury's 
finding that Dr. Bullis was negligent in regard to her duty to 
obtain informed consent.  Accordingly, I would reverse the 
decision of the court of appeals, and due to the inconsistency 
in the jury's verdicts, I would remand for a new trial on 
whether Dr. Bullis was negligent in her care and treatment of 
Mr. Jandre.  Therefore, I respectfully dissent. 
¶319 I am authorized to state that Justices ANNETTE 
KINGSLAND ZIEGLER and MICHAEL J. GABLEMAN join in this dissent. 
No.  2008AP1972.pdr 
 
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