Title: Gahl v. Aurora Health Care, Inc.
Citation: N/A
Docket Number: 2021AP001787-FT
State: Wisconsin
Issuer: Wisconsin Supreme Court
Date: May 2, 2023

2023 WI 35 
 
SUPREME COURT OF WISCONSIN 
 
 
 
CASE NO.: 
2021AP1787-FT 
 
 
 
COMPLETE TITLE: 
Allen Gahl Attorney in fact, on behalf of his 
principal, John J. Zingsheim, 
          Petitioner-Respondent-Petitioner, 
     v. 
Aurora Health Care, Inc. d/b/a Aurora Medical 
Center - Summit, 
          Respondent-Appellant. 
 
 
 
REVIEW OF DECISION OF THE COURT OF APPEALS  
Reported at 403 Wis. 2d 539, 977 N.W.2d 756 
PDC No: 2022 WI App 29 - Published  
 
 
OPINION FILED: 
May 2, 2023   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
January 17, 2023   
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit   
 
COUNTY: 
Waukesha   
 
JUDGE: 
Lloyd Carter    
 
 
 
JUSTICES: 
ANN WALSH BRADLEY, J., delivered the majority opinion of the 
Court, in which ZIEGLER, C.J., ROGGENSACK, DALLET, HAGEDORN, and 
KAROFSKY, JJ., joined. REBECCA GRASSL BRADLEY, J., filed a 
dissenting opinion. 
NOT PARTICIPATING: 
        
 
 
 
ATTORNEYS: 
 
 
For the petitioner-respondent-petitioner, there were briefs 
filed by Karen L. Mueller and Amos Center for Justice & Liberty, 
Chippewa Falls. There was an oral argument by Karen L. Mueller. 
 
For the respondent-appellant, there was a brief filed by 
Michael L. Johnson, Jason J. Franckowiak, Randall R. Guse, and 
Otjen Law Firm, S.C., Waukesha. There was an oral argument by 
Jason J. Franckowiak. 
 
 
2 
An amicus curiae brief was filed by Ben Seel, Maher 
Mahmood, 
Patricia 
Epstein 
Putney, 
Melita 
M. 
Mullen, 
and 
Democracy Forward Foundation, Washington D.C., and Bell, Moore & 
Richter, S.C., Madison, for the American Medical Association and 
Wisconsin Medical Society.  
 
An amicus curiae brief was filed by Joseph W. Voiland and 
Veterans Liberty Law, Cedarburg, for the Front Line COVID-19 
Critical Care Alliance.  
 
An amicus curiae brief was filed by Andrew L. Schlafly, 
Rory E. O’Sullivan, and Rodli, Beskar, Neuhaus, Murray & 
Pletcher, S.C., River Falls, for the Association of American 
Physicians and Surgeons.  
 
 
 
 
2023 WI 35 
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.   2021AP1787-FT 
(L.C. No. 
2021CV1469) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
Allen Gahl Attorney in fact, on behalf of his 
principal, John J. Zingsheim, 
 
          Petitioner-Respondent-Petitioner, 
 
     v. 
 
Aurora Health Care, Inc. d/b/a Aurora Medical 
Center - Summit, 
 
          Respondent-Appellant. 
 
 
 
FILED 
 
MAY 2, 2023 
 
Sheila T. Reiff 
Clerk of Supreme Court 
 
 
 
 
ANN WALSH BRADLEY, J., delivered the majority opinion of the 
Court, in which ZIEGLER, C.J., ROGGENSACK, DALLET, HAGEDORN, and 
KAROFSKY, JJ., joined. REBECCA GRASSL BRADLEY, J., filed a 
dissenting opinion. 
 
 
 
REVIEW of a decision of the Court of Appeals.  Affirmed.   
 
¶1 
ANN WALSH BRADLEY, J.   The petitioner, Allen Gahl, 
who holds power of attorney for his uncle, John Zingsheim, seeks 
review of a published decision of the court of appeals reversing 
the circuit court's issuance of an injunction.  That injunction 
compelled Aurora Health Care, Inc., to administer a certain 
No. 
2021AP1787-FT   
 
2 
 
medical treatment to Zingsheim.1  The court of appeals determined 
that Gahl's claim must fail because he did not identify a source 
of law that (1) would give a patient or a patient's agent the 
right to force a health care provider to administer a treatment 
the health care provider concludes is below the standard of 
care, or (2) could compel Aurora to put an outside provider that 
would provide such care through its credentialing process. 
¶2 
Gahl contends that the court of appeals erred in 
reversing the circuit court's order.  Specifically, he asserts 
that the circuit court has the authority to issue an injunction 
in the present circumstances, and that the injunction the 
circuit court issued was a proper exercise of its discretion. 
¶3 
Aurora disagrees.  It argues that neither Gahl nor the 
circuit court identified a source of law that gives the circuit 
court the authority to compel a health care provider to 
administer a treatment that it believes is below the standard of 
care, or to compel a hospital to put a doctor that will do so 
through its credentialing process, such that Gahl would have a 
reasonable probability of success on the merits of his claim. 
¶4 
We 
conclude 
that 
the 
circuit 
court 
erroneously 
exercised its discretion by issuing an injunction without 
referencing any basis demonstrating that Gahl had a reasonable 
probability of success on the merits of some type of legal 
                                                 
1 Gahl ex rel. Zingsheim v. Aurora Health Care, Inc., 2022 
WI App 29, 403 Wis. 2d 539, 977 N.W.2d 756 (reversing order of 
the circuit court for Waukesha County, Lloyd V. Carter, Judge). 
No. 
2021AP1787-FT   
 
3 
 
claim.  Accordingly, we affirm the decision of the court of 
appeals. 
I 
¶5 
Gahl holds health care power of attorney for his 
uncle, Zingsheim.  At the time this case was filed, on October 
7, 2021, Zingsheim was a patient in Aurora's care after testing 
positive for COVID-19.2  
¶6 
Through personal research, Gahl became aware of a drug 
called Ivermectin, which had been used as a purported treatment 
for COVID-19.  He received a prescription for Ivermectin from 
Dr. Edward Hagen, a retired OB/GYN, who asserted that he "wrote 
the 
prescription 
based 
on 
a 
detailed 
discussion 
of 
Mr. 
Zingsheim's condition with Mr. Gahl," but never met with 
Zingsheim. 
¶7 
Aurora declined to effectuate Dr. Hagen's prescription 
for several reasons.  According to Aurora's Chief Medical 
Officer, Ivermectin is "primarily used as an anti-parasitic in 
farm animals or administered to humans for treatment of certain 
parasites and scabies" and is not approved by the Food and Drug 
Administration as a treatment for COVID-19.  The Chief Medical 
Officer further averred that a high dose of Ivermectin, such as 
                                                 
2 According to the briefing, Zingsheim has recovered from 
his COVID-19 infection and was discharged by Aurora.  No party 
makes any argument regarding mootness, and we will not develop 
any such argument for the parties.  See Serv. Emps. Int'l Union, 
Loc. 1 v. Vos, 2020 WI 67, ¶24, 393 Wis. 2d 38, 946 N.W.2d 35 
(explaining that "[w]e do not step out of our neutral role to 
develop or construct arguments for parties; it is up to them to 
make their case"). 
No. 
2021AP1787-FT   
 
4 
 
that prescribed by Dr. Hagen, "can be dangerous to humans and 
cause hypotension, ataxia, seizures, coma, and even death," and 
that accordingly "the use of ivermectin in the treatment of John 
Zingsheim's COVID-19 symptoms does not meet the standard of care 
for treatment." 
¶8 
Gahl subsequently filed a complaint in the circuit 
court, seeking declaratory and injunctive relief.  Specifically, 
he sought an order requiring Aurora to administer Ivermectin to 
Zingsheim as prescribed by Dr. Hagen.  Aurora opposed the 
requested relief. 
¶9 
The circuit court held an initial hearing on Gahl's 
petition on October 12, 2021.  It heard arguments from both 
parties, but did not reach a decision.  Instead, it sought 
additional information, stating: 
I feel that I do need more information[.] . . . This 
is not a decision that a Court makes based on emotion.  
That's 
not 
appropriate. 
 
So 
I 
need 
evidence, 
and . . . want more evidence from the treating doctors 
as 
to 
what 
is 
Mr. 
Zingsheim's 
current 
medical 
situation, 
what 
is 
his 
prognosis, . . . what 
is 
proposed to move forward.  Is there something proposed 
to move forward, or is this a wait-and-see situation 
with no other alternatives? 
And I'd like some more information . . . to create 
that connection between this Dr. Hagen prescription 
and Mr. Zingsheim, because what I'm seeing here is 
just – there's a prescription written by somebody who 
really 
has 
very 
limited 
information 
about 
Mr. 
Zingsheim. . . . Other than Mr. Gahl, averring that he 
has communicated what the hospital has told him, 
again, there's no details of that. . . . It's Mr. 
Gahl's interpretation of what the hospital told him.  
And I don't know where that information comes from, so 
I don't know the viability of that information. 
No. 
2021AP1787-FT   
 
5 
 
But, you know, the ask here is for this Court to give 
a directive to some treating licensed medical doctors 
that they are telling me is contravening their 
responsibility 
to 
their 
patient. 
 
I 
mean, 
the 
divergent positions here couldn't be more extreme.  
And the consequences of action and nonaction are 
significant as well. 
Accordingly, the circuit court gave the parties the opportunity 
to supplement the record. 
¶10 Gahl and Aurora each submitted supplemental materials.  
Those filed by Gahl consisted of affidavits from Gahl himself, 
Dr. Hagen, and Dr. Pierre Kory.3  Dr. Kory's affidavit was 
accompanied by a document indicating that it was Dr. Kory's 
testimony before the Homeland Security Committee regarding early 
treatment approaches to COVID-19. 
¶11 Aurora filed a supplemental affidavit from its Chief 
Medical Officer.  This supplemental affidavit updated the 
circuit court on Zingsheim's medical condition and the plan for 
his care and treatment. 
¶12 Based on the supplemental information submitted, the 
circuit court acted quickly, and later in the day on October 12, 
signed an order to show cause Gahl had drafted and submitted.  
The order compelled Aurora to "immediately enforce Dr. Hagen's[] 
order and prescription to administer Ivermectin to their mutual 
patient, Mr. Zingsheim, and thereafter as further ordered by Mr. 
Gahl."  There was no statutory basis or other legal foundation 
for the order set forth in its text.   
                                                 
3 Dr. Kory's affidavit was neither dated nor notarized. 
No. 
2021AP1787-FT   
 
6 
 
¶13 Almost immediately after the order issued, Aurora 
objected.  Aurora referred to the circuit court's order as 
"extremely 
problematic." 
Specifically, 
it 
observed 
the 
following alleged shortcomings: 
I am not aware of any orders written by Dr. Hagen, but 
am aware of a prescription written by Dr. Hagen for 
Ivermectin 
66mg 
to 
be 
taken 
once 
daily. 
 
The 
prescription 
does 
not 
indicate 
from 
where 
the 
Ivermectin is to be obtained or how the tablets are to 
be administered to a patient who is intubated and 
sedated.  Finally, the Order provides that Aurora is 
to administer Ivermectin "as further ordered by Mr. 
Gahl."  Mr. Gahl is not a healthcare provider. 
For the reasons above, it is my position as counsel 
for Aurora that my client is unable to comply with the 
terms of the Order as drafted. 
¶14 The next day, on October 13, 2021, Aurora filed a 
petition for leave to appeal a nonfinal order with the court of 
appeals.4  Additionally on that date, the circuit court held 
another hearing.  At this hearing, the discussion revolved 
largely around Zingsheim's medical condition and the advantages 
and disadvantages of Ivermectin.  After hearing from both sides, 
the circuit court maintained, but modified its previous order of 
the day before such that rather than ordering Aurora to 
administer the treatment, Gahl could identify a physician who 
could then be credentialed by Aurora: 
As it stands right now, this Court entered an order 
that is subject to a petition for leave to appeal to 
                                                 
4 See Wis. Stat. § 808.03(2) (2019-20). 
All subsequent references to the Wisconsin Statutes are to 
the 2019-20 version unless otherwise indicated. 
No. 
2021AP1787-FT   
 
7 
 
the Court of Appeals, who have not weighed in on it.  
My intention is to maintain that order, but I am not 
going 
to 
engage 
in 
directing 
the 
hospital 
or 
individuals at the hospital . . . to administer this 
medication to Mr. Zingsheim.  I think it's incumbent 
on the petitioner to supply a medical professional 
that's approved by the hospital for purposes of 
assisting this patient.  But I don't think it's 
appropriate for this Court to engage in further orders 
to the hospital as to how this drug is administered. 
They have, they being the hospital, have their rules 
of whom they admit to practice medicine there and how 
they do it, and I don't think – The Court is taking a 
significant step in this case by the order that's been 
entered.  I think it's the petitioner's responsibility 
for not only supplying the prescription but supplying 
an individual that meets the approval of the hospital 
for administration.  If Dr. Hagen doesn't pass muster, 
then the petitioner has to find somebody else.  But I 
don't think this Court – This Court does not feel 
comfortable in making any further directives or orders 
to the hospital as to how that's to occur.  I think 
that's a responsibility of the petitioner here and 
it's – That's how the Court views it. 
Accordingly, the circuit court indicated its intent to clarify 
its previous order, agreeing that Gahl "is to supply or identify 
a physician that Aurora can then review and pass through its 
credentialing 
process. 
 
And 
once 
credentialed, 
that 
physician . . . will have permission to enter upon the premises 
and administer the Ivermection as ordered by Dr. Hagen[.]" 
¶15 The day after this hearing, the court of appeals 
granted Aurora's petition for leave to appeal a nonfinal order.  
It additionally stayed the circuit court's order and all circuit 
court proceedings pending appeal.  Gahl sought to bypass the 
court of appeals, which this court denied.5 
                                                 
5 Gahl v. Aurora Health Care, Inc., No. 2021AP1787-FT, 
unpublished order (Wis. S. Ct. Oct. 25, 2021). 
No. 
2021AP1787-FT   
 
8 
 
¶16 In a published opinion, the court of appeals reversed 
the circuit court's order.  Gahl ex rel. Zingsheim v. Aurora 
Health Care, Inc., 2022 WI App 29, 403 Wis. 2d 539, 977 
N.W.2d 756.  It determined that "[Gahl] has failed to identify 
any source of Wisconsin law that gives a patient or a patient's 
agent the right to force a private health care provider to 
administer a particular treatment that the health care provider 
concludes 
is 
below 
the 
standard 
of 
care." 
 
Id., 
¶1.  
Accordingly, "[b]ecause Gahl has failed to identify any law, 
claim, or recognized cause of action under Wisconsin law by 
which a patient may compel a health care professional to 
administer a course of treatment contrary to that medical 
professional's judgment, the court erroneously exercised its 
discretion in granting Gahl injunctive relief."  Id.  The court 
of appeals further concluded that the circuit court "had no 
legal authority to compel Aurora to credential an outside 
provider to provide care that is below the standard of care."  
Id., ¶64.  Gahl petitioned for this court's review.  
II 
¶17 We are called upon to review the court of appeals' 
determination that the circuit court erroneously exercised its 
discretion in the issuance of a temporary injunction.  A circuit 
court may issue a temporary injunction if four criteria are 
fulfilled:  (1) the movant is likely to suffer irreparable harm 
if an injunction is not issued, (2) the movant has no other 
adequate remedy at law, (3) an injunction is necessary to 
preserve the status quo, and (4) the movant has a reasonable 
No. 
2021AP1787-FT   
 
9 
 
probability of success on the merits.  Serv. Emps. Int'l Union, 
Loc. 1 v. Vos, 2020 WI 67, ¶93, 393 Wis. 2d 38, 946 N.W.2d 35. 
¶18 The issuance of a temporary injunction is reviewed for 
an erroneous exercise of discretion.  Id.  We will sustain a 
discretionary decision as long as the circuit court examines the 
relevant facts, applies a proper standard of law, and, using a 
demonstrated rational process, reaches a conclusion that a 
reasonable judge could reach.  Indus. Roofing Servs., Inc. v. 
Marquardt, 2007 WI 19, ¶41, 299 Wis. 2d 81, 726 N.W.2d 898. 
III 
¶19 We begin by observing the limited nature of our review 
and emphasize that this case is not about the efficacy of 
Ivermectin as a treatment for COVID-19.  Rather, it is about 
whether the circuit court erroneously exercised its discretion 
by issuing the subject temporary injunction. 
¶20 Gahl raises three arguments in this court in an 
attempt to demonstrate that the court of appeals erred and that 
in fact the circuit court had the authority to issue a temporary 
injunction.  First, he contends that the power of attorney 
statute, Wis. Stat. § 155.30(1), provides authority to issue the 
subject injunction.  Second, Gahl asserts that the circuit court 
has inherent authority to issue such an injunction.  Finally, he 
advances that the circuit court may issue the injunction in 
question under a theory of implied contract between Zingsheim 
and Aurora.  Aurora disputes each of these bases. 
¶21 We need not address in depth any of Gahl's arguments 
because we do not know on what basis the circuit court issued 
No. 
2021AP1787-FT   
 
10 
 
the injunction.6  The circuit court cited no law in either its 
written order or its oral ruling, as Gahl conceded at oral 
argument before this court.7  This in itself constitutes an 
erroneous exercise of discretion.   
¶22 "Discretion is not synonymous with decision-making."  
McCleary v. State, 49 Wis. 2d 263, 277, 182 N.W.2d 512 (1971).  
Instead, "[d]iscretion contemplates a process of reasoning with 
                                                 
6 We additionally observe that Gahl did not clearly raise 
these three arguments before the circuit court.  Because we do 
not reach the merits of these arguments, we need not determine 
whether they are forfeited.  See State v. Wilson, 2017 WI 63, 
¶51 n.7, 376 Wis. 2d 92, 896 N.W.2d 682 (explaining that 
"[g]enerally, issues not raised or considered by the circuit 
court will not be considered for the first time on appeal").  At 
oral argument before this court, Gahl's counsel asserted the 
belief that the circuit court based its order on its inherent 
authority, but there is nothing in the record to support such an 
assertion, and no inherent authority argument was clearly 
articulated before the circuit court. 
7 At oral argument before this court, Gahl's counsel engaged 
in the following colloquy with the court: 
THE COURT:  One of the requirements in order to issue 
a temporary injunction needs to be a reasonable 
likelihood of success on the merits.  The merits has 
to be some legal authority for a court to intervene 
and issue an order mandating some action.  The trial 
court, in my reading, did not cite any actual law to 
support its order. . . . The court of appeals rested 
its decision largely on that grounds.  Even the 
dissent didn't point to any actual law that was 
cited . . . or at least relied upon to show why there 
is a reasonable likelihood of success on the merits.  
So just on the reasonable likelihood of success on the 
merits, what law was cited by the trial court to give 
it authority for it to issue this order? 
COUNSEL:  The trial court did not identify a specific 
law. 
No. 
2021AP1787-FT   
 
11 
 
a rational and explainable basis."  State ex rel. Payton v. 
Kolb, 135 Wis. 2d 202, 205-06, 400 N.W.2d 285 (Ct. App. 1986).  
It is "more than a choice between alternatives without giving 
the rationale or reason behind the choice."  Reidinger v. 
Optometry Examining Bd., 81 Wis. 2d 292, 297, 260 N.W.2d 270 
(1977).  "This process must depend on facts that are of record 
or that are reasonably derived by inference from the record and 
a conclusion based on a logical rationale founded upon proper 
legal standards."  McCleary, 49 Wis. 2d at 277. 
¶23 A circuit court erroneously exercises its discretion 
in the context of a temporary injunction when it "fails to 
consider and make a record of the factors relevant to its 
determination."  Sch. Dist. of Slinger v. Wis. Interscholastic 
Athletic Ass'n, 210 Wis. 2d 365, 370, 563 N.W.2d 585 (Ct. App. 
1997).  Further, whether the party seeking an injunction has a 
reasonable probability of success on the merits in part turns on 
whether the moving party has stated a claim entitling it to 
relief.  Id. at 374; see Wis. Stat. § 813.02(1)(a). 
¶24 Although the circuit court acknowledged the four 
factors that must be fulfilled in order for a temporary 
injunction to be granted, it did not engage in any analysis of 
those factors.  We base our determination here on its lack of 
analysis of Gahl's reasonable probability of success on the 
merits.  Indeed, from a review of the circuit court's order, we 
do not know upon what legal basis it premised its authority to 
issue the injunction in the first instance.  In other words, we 
do not know what viable legal claim the circuit court thought 
No. 
2021AP1787-FT   
 
12 
 
Gahl had presented.  Without identifying the legal basis it 
accepted, the circuit court cannot support the conclusion that 
Gahl has demonstrated a reasonable probability of success on the 
merits. 
¶25 The circuit court's written order granting Gahl relief 
does not cite any statute, case, or other source of law as a 
foundation allowing for its issuance.  Although the circuit 
court later clarified its intent in oral comments, those oral 
comments likewise did not identify any law on which the order 
was premised.  Absent any citation to law establishing a legal 
basis for the order, we cannot determine that the circuit court 
employed the reasoning process our precedent demands. 
¶26 In exercising its discretion, there are no "magic 
words" the circuit court must utter or any precise level of 
specificity that is required.  But the record must make clear 
that the circuit court examined the relevant facts, applied a 
proper standard of law, and, using a demonstrated rational 
process, reached a conclusion that a reasonable judge could 
reach.  See Indus. Roofing Servs., 299 Wis. 2d 81, ¶41.  Here, 
the record is lacking in this respect. 
¶27 The circuit court heard legal argument and at one 
point stated that is "has a significant respect for an 
individual's right to choose their treatment."  However, such a 
stray reference does not equate to a legal analysis of the 
probability of success on the merits of Gahl's legal claim.  The 
circuit court did not tie such "respect" to any legal analysis 
No. 
2021AP1787-FT   
 
13 
 
or indicate how it could serve as a basis for the declaratory 
and injunctive relief Gahl sought. 
¶28 We 
therefore 
conclude 
that 
the 
circuit 
court 
erroneously exercised its discretion by issuing an injunction 
without referencing any basis demonstrating that Gahl had a 
reasonable probability of success on the merits of some type of 
legal claim.  Accordingly, we affirm the decision of the court 
of appeals. 
By the Court.—The decision of the court of appeals is 
affirmed. 
 
No.  2021AP1787-FT.rgb 
 
1 
 
 
¶29 REBECCA GRASSL BRADLEY, J.   (dissenting).   
The right of liberty is a natural right and it resides 
in the person, because he is a person.  It is his 
self-determination 
with 
regard 
to 
fulfilling 
his 
natural final goal without interference. . . .  It 
follows then that for the fulfillment of his destiny, 
man must be free and it is the duty of the State to 
secure and protect that freedom to enable the person 
to achieve his destiny. 
Thomas J. Brogan, The Natural Law and the Right to Liberty, in 4 
University of Notre Dame Natural Law Institute Proceedings 23, 
29 (1951). 
 
¶30 The 
first 
operative 
provision 
of 
the 
Wisconsin 
Constitution recognizes "[a]ll people" have certain "inherent 
rights" and the State of Wisconsin was founded by the people for 
the sole purpose of securing these rights.  See Wis. Const. art. 
I, § 1.  See generally Porter v. State, 2018 WI 79, ¶52, 382 
Wis. 2d 697, 913 N.W.2d 842 (Rebecca Grassl Bradley & Kelly, 
JJ., dissenting) (explaining "[t]oo much dignity cannot well be 
given" to this provision (quoting State v. Redmon, 134 Wis. 89, 
101, 114 N.W.2d 137 (1907))).  Under the Wisconsin Constitution, 
the "just powers" of the government derive "from the consent of 
the governed," a consent explicitly premised on the State using 
these powers to secure the people's rights.  Wis. Const. art. I, 
§ 1.  The Wisconsin Constitution exists not only to protect the 
people from an overreaching government but to empower the 
people's government to protect their individual freedom from 
non-state 
actors. 
 
See 
generally 
Jacobs 
v. 
Major, 
139 
No.  2021AP1787-FT.rgb 
 
2 
 
Wis. 2d 492, 
535, 
407 
N.W.2d 832 
(1987) 
(Abrahamson, 
J., 
concurring/dissenting).  
 
¶31 In this case, the circuit court used its equitable 
power to craft a narrow remedy, ensuring a non-state actor could 
not override the decision-making autonomy of a Wisconsin citizen 
to whom the non-state actor owed a duty of care.1  See Immanuel 
Kant, Groundwork for the Metaphysics of Morals 34 (Jonathan 
Bennett ed., amend. 2008) (1785) (calling decision-making 
autonomy "the basis for the dignity of human nature").  John 
Zingsheim 
contracted 
COVID-19——a 
serious 
virus 
that 
has 
threatened the world.2  He became so sick that he lay comatose in 
a privately-owned hospital, Aurora Medical Center-Summit——his 
life sustained by a feeding tube and ventilator.  In a sense, he 
was a prisoner of circumstance:  unable to be safely moved, he 
had no practical ability to exercise his natural right to seek 
treatment elsewhere.  See, e.g., Martin ex rel. Scoptur v. 
Richards, 192 Wis. 2d 156, 172, 531 N.W.2d 70 (1995) (noting 
"every human being has a right to make his . . . own medical 
decisions"); 1 T. Rutherforth, Institutes of Natural Law 146 
(1754) ("By liberty we mean the power, which a man has to act as 
                                                 
1 The Honorable Lloyd V. Carter, Waukesha County Circuit 
Court, presided. 
2 As of mid-April 2023, the Wisconsin Department of Health 
Services has confirmed 16,523 people in this state have died 
while sick or probably sick with COVID-19.  COVID-19:  Wisconsin 
Deaths, Wis. Dep't Health Servs. (last updated Apr. 14, 2023), 
https://dhs.wisconsin.gov/covid-19/deaths.htm#number%20deaths.  
The World Health Organization (WHO) estimates nearly 7 million 
people have died of COVID-19.  WHO Coronavirus (COVID-19) 
Dashboard, 
WHO 
(last 
updated 
Apr. 
12, 
2023), 
https://covid19.who.int/. 
No.  2021AP1787-FT.rgb 
 
3 
 
he thinks fit, where no law restrains him; it may therefore be 
called a man[']s right over his own actions.").  Rather than 
allow Aurora to dictate Zingsheim's treatment, the court 
temporarily enjoined Aurora.   
 
¶32 The circuit court was cautious in crafting its 
temporary injunction not to favor Zingsheim's natural right at 
Aurora's expense.  The court merely ordered that Gahl could 
propose a doctor and that Aurora had to put this doctor through 
its credentialing process without undue delay.  The court 
clarified the proposed doctor was not entitled to any special 
treatment.  If the proposed doctor satisfied Aurora's standard 
criteria, Aurora was required to credential him but only for the 
limited purpose of administering ivermectin to Zingsheim.  The 
court also required Gahl to sign a hold-harmless agreement to 
limit Aurora's exposure to liability.  With this remedy, the 
court ensured no one would have to violate the dictates of his 
conscience.  See generally City of Milwaukee v. Burnette, 2001 
WI App 258, ¶10, 248 Wis. 2d 820, 637 N.W.2d 447 ("An injunction 
may be no more broad than is 'equitably necessary.'"  (quoting 
State v. Seigel, 163 Wis. 2d 871, 890, 472 N.W.2d 584 (Ct. App. 
1991))). 
¶33 On review, this court is presented with a single 
issue:  Whether the circuit court properly exercised its 
discretion in entering an order granting temporary injunctive 
relief.  See Gahl ex rel. Zingsheim v. Aurora Health Care, Inc., 
2022 WI App 29, ¶66, 403 Wis. 2d 539, 977 N.W.2d 756 (Grogan, 
J., dissenting).  It did.   
 
No.  2021AP1787-FT.rgb 
 
4 
 
¶34 The resolution of this issue is governed by the 
"highly deferential" standard of review.  See Prince Corp. v. 
Vandenberg, 2016 WI 49, ¶16, 369 Wis. 2d 387, 882 N.W.2d 371 
(quoting Klawitter v. Klawitter, 2001 WI App 16, ¶8, 240 
Wis. 2d 685, 623 N.W.2d 169).  The circuit court properly 
exercised its discretion by considering the relevant facts and 
applying the correct legal standard, ultimately reaching a 
reasonable conclusion.  Gahl, 403 Wis. 2d 539, ¶90.  Although 
the court's analysis could have been more meticulous, this court 
has never required the detailed explanation the majority now 
demands. 
 
Additionally, 
"[r]egardless 
of 
the 
extent 
of 
the . . . [circuit] court's reasoning, [a reviewing court] will 
uphold a discretionary decision if there are facts in the record 
which would support the . . . court's decision had it fully 
exercised its discretion."  State v. Hurley, 2015 WI 35, ¶29, 
361 Wis. 2d 529, 861 N.W.2d 174 (quoting State v. Hunt, 2003 
WI 81, ¶52, 263 Wis. 2d 1, 666 N.W.2d 771) (third modification 
in the original). 
¶35 As three justices in the majority lamented in a case 
last term: 
Could the circuit court have more clearly articulated 
its factual findings and legal conclusions?  Sure.  
However, when we review discretionary decisions, we do 
not require a perfectly polished transcript or magic 
words.  Rather we "look for reasons to sustain 
the . . . [circuit] court's discretionary decision," 
reversing "if and only if the record does not reflect 
a 
reasonable 
basis 
for 
the 
determination 
or 
a 
statement of the relevant facts or reasons motivating 
the determination is not carefully delineated in the 
record." 
No.  2021AP1787-FT.rgb 
 
5 
 
State v. X.S., 2022 WI 49, ¶91, 402 Wis. 2d 481, 976 N.W.2d 425 
(Hagedorn, J., dissenting) (quoting J.A.L. v. State, 162 
Wis. 2d 940, 961, 471 N.W.2d 493 (1991)). 
¶36 If the majority applied the correct standard of 
review, it would be forced to uphold the circuit court's 
decision.  As Judge Shelley A. Grogan, who was on the panel at 
the 
court 
of 
appeals, 
wrote 
in 
dissent, 
"it 
is 
clear 
the . . . decision was reasoned and based on the record and 
applicable law."  Gahl, 403 Wis. 2d 539, ¶83 (citing Diamondback 
Funding, LLC v. Chili's of Wis., Inc., 2004 WI App 161, ¶6, 276 
Wis. 2d 81, 687 N.W.2d 89).  Because the majority raises the 
review standard and now deems the expression of the substance of 
law insufficient to sustain a discretionary decision, I dissent. 
I.  BACKGROUND 
¶37 The majority opinion provides a scant statement of the 
facts, which misleads through omission.  For that reason, I 
provide a thorough overview of the case.  See generally Becker 
v. Dane County, 2022 WI 63, ¶89, 403 Wis. 2d 424, 977 N.W.2d 390 
(Rebecca Grassl Bradley, J., dissenting) ("It is . . . customary 
for any judicial opinion to relay the facts of the case[.]"), 
recons. mot. filed. 
¶38 This tragedy started when Zingsheim contracted COVID-
19 in September 2021.  His condition deteriorated rapidly.  
Zingsheim began receiving treatment at an Aurora hospital where 
his condition worsened.  He was placed in the intensive care 
unit.  He was then transferred to Aurora Summit and was on "full 
intubation ventilation," which the petition for relief describes 
No.  2021AP1787-FT.rgb 
 
6 
 
as "ventilation treatment that requires full sedation and 
restraints and which involves an extreme risk of decline and 
death."  While such ventilation can be life-sustaining, it can 
also damage the lungs.  In fact, counsel for Zingsheim's adult 
nephew, Allen Gahl, who held the health care power of attorney 
(HCPOA), 
informed 
the 
circuit 
court 
the 
"pressure" 
that 
ventilation places on the lungs is "unnatural[.]"  The high 
pressure setting on which Zingsheim was placed could cause semi-
permanent 
damage 
by 
"blow[ing] 
holes 
in . . . lungs" 
and 
"scar[ring] the tissues[.]"  While at Aurora Summit, Zingsheim 
developed 
"perforated 
lungs," 
which, 
according 
to 
Gahl's 
counsel, caused bleeding.  According to Aurora, Zingsheim had 
"[a]cute respiratory failure with hypoxia" among other sobering 
health concerns at that point.  In summary, Zingsheim, a sixty-
year-old man, was on death's doorstep. 
¶39 Aurora administered to Zingsheim a cocktail of drugs 
including steroids, blood thinners, antibiotics, and sedatives, 
none of which improved his condition.  Remdesivir was the only 
drug Aurora provided Zingsheim that was specifically for 
treating COVID-19, as opposed to his symptoms.  Remdesivir was 
approved by the Food & Drug Administration (FDA) for treating 
COVID-19, but its use was controversial.3  After two days on 
                                                 
3 Gahl argued before the circuit court that WHO "recommends 
against 
the 
use 
of 
[r]emdesivir 
because 
it 
has 
severe 
effect[s]. . . .  It has severe effect[s] on people's kidneys."  
Expanding on this point, an amicus curiae notes that WHO had 
issued 
a 
conditional 
recommendation 
against 
the 
use 
of 
remdesivir.  WHO Recommends Against the Use of Remdesivir in 
COVID-19 
Patients, 
WHO 
(Nov. 
20, 
2020), 
https://www.who.int/news-room/feature-stories/detail/who-
recommends-against-the-use-of-remdesivir-in-covid-19-patients#:-
No.  2021AP1787-FT.rgb 
 
7 
 
remdesivir, 
Zingsheim's 
family 
demanded 
Aurora 
stop 
administering it, worried it may cause severe side effects.  
Aurora responded that only palliative care was available.  As 
the circuit court seemed to characterize the situation, Aurora 
adopted a "wait-and-see" approach——wait and see if Zingsheim 
died or got better.  
¶40 Gahl became "fear[ful]" that Zingsheim would "not 
survive."  He averred, "[i]t is . . . now common knowledge 
that . . . [COVID-19] patients on full ventilation and under 
heavy sedation and restraints have a poor prognosis"——a point 
the medical community later acknowledged to be true. 
¶41 Gahl's fear caused him to begin researching COVID-19 
treatments and specifically a drug called ivermectin.  A summary 
of ivermectin clinical trials, attached as an exhibit to the 
petition for relief, explains that ivermectin "inhibits the 
replication of many viruses, including . . . [COVID-19]," much 
like remdesivir.  A report in the record also notes ivermectin 
"protects against organ damage in animal models," having "potent 
anti-inflammatory 
and 
immune-modulating 
properties[.]"  
According to Gahl's counsel, before Zingsheim became comatose, 
                                                                                                                                                             
:text=WHO%20has%20issued%20a%20conditional.  The recommendation 
was stated in quite strong terms:  WHO recommended "against the 
use of remdesivir in hospitalized patients, regardless of 
disease 
severity, 
as 
there 
[wa]s . . . no 
evidence 
that 
remdesivir improve[d] survival and other outcomes in these 
patients."  Id.  In April 2022, well after the circuit court's 
decision, WHO began to "suggest[] the use of remdesivir in mild 
or moderate COVID-19 patients who are at high risk of 
hospitalization."  Id. 
No.  2021AP1787-FT.rgb 
 
8 
 
he "told his two children and his nephew, . . . Gahl, that he 
wanted to take [ivermectin] so that he could live."   
¶42 Like remdesivir, ivermectin is controversial.  See 
generally Gahl v. Aurora Health Care, Inc., No. 2021AP1787-FT, 
unpublished order, at 2–3 (Wis. Oct. 25, 2022, as amended Oct. 
28, 2022) (Roggensack, J., dissenting) ("I have concerns that 
Gahl is being treated differently because underlying the current 
motion is his effort to obtain treatment with [i]vermectin 
for . . . Zingsheim[.]").4  Exactly why is unclear and beyond the 
scope of this writing.  Ivermectin is approved by the FDA to 
treat humans suffering from parasitic infections.  Some doctors 
have also prescribed it to treat COVID-19, although the FDA has 
not approved it for that specific purpose.  In medical parlance, 
these doctors are prescribing ivermectin for an "off-label" use.  
The FDA explains "off-label" as follows: 
Unapproved use of an approved drug is often called 
"off-label" use.  This term can mean that the drug is: 
• Used for a disease or medical condition that it 
is not approved to treat, such as when a 
chemotherapy is approved to treat one type of 
cancer, but healthcare providers use it to 
treat a different type of cancer. 
• Given in a different way, such as when a drug 
is approved as a capsule, but it is given 
instead in an oral solution. 
• Given in a different dose, such as when a drug 
is approved at a dose of one tablet every day, 
but a patient is told by their healthcare 
provider to take two tablets every day. 
                                                 
4 Four unpublished orders of this court are cited in this 
writing.  For transparency, a copy of each is provided in the 
appendix. 
No.  2021AP1787-FT.rgb 
 
9 
 
If you and your healthcare provider decide to use an 
approved drug for an unapproved use to treat your 
disease or medical condition, remember that FDA has 
not determined that the drug is safe and effective for 
the unapproved use. 
FDA, Understanding Unapproved Use Of Approved Drugs "Off Label" 
(Feb. 
5, 
2018), 
https://www.fda.gov/patients/learn-about-
expanded-access-and-other-treatment-options/understanding-
unapproved-use-approved-drugs-label#:~:text=Unapproved%20use% 
20of%20an%20approved,a%20different%20type%20of%20cancer. 
 
Off-
label use might sound scary, but it is actually quite common.  
As Gahl explains in his opening brief, "[t]housands of 'off-
label' prescription drugs are prescribed every day for use that 
the FDA has not 'approved' of in the United States."  One amicus 
brief notes about 20 percent of all prescriptions are for an 
off-label use.  The majority omits this context from its opinion 
while emphasizing ivermectin is "not approved by the . . . [FDA] 
as a treatment for COVID-19."  Majority op., ¶7.  Apparently for 
dramatic rhetorical effect, the majority even notes that 
ivermectin, which, to reiterate, is approved for humans, is also 
used to treat animals.5  Id. 
¶43 Gahl's research led him to conclude ivermectin could 
be an effective treatment for COVID-19.  Various studies Gahl 
                                                 
5 Even more absurdly, the court of appeals majority equated 
Gahl's concession that treating COVID-19 with ivermectin is an 
"off-label" use with an admission that ivermectin is below the 
standard of care.  Gahl ex rel. Zingsheim v. Aurora Health Care, 
Inc., 2022 WI App 29, ¶33, 403 Wis. 2d 539, 977 N.W.2d 756 
("[T]hroughout his brief, Gahl effectively acknowledges that the 
proposed treatment is not within the accepted standard of care 
for COVID-19.  He admits that using the proposed treatment for 
COVID-19 is not approved by the FDA, as it is an 'off-label use 
of the drug.'"). 
No.  2021AP1787-FT.rgb 
 
10 
 
read strongly indicated ivermectin could help his uncle.  For 
example, one study presented to the circuit court found COVID-19 
patients in severe condition had a substantially lower chance of 
dying when treated with ivermectin. 
¶44 In an effort to save his uncle, Gahl sought medical 
advice from a doctor unaffiliated with Aurora, Dr. Edward Hagen, 
M.D., who had experience with ivermectin.  According to 
Dr. Hagen, he spoke with Gahl who conveyed to him "detailed 
information about his [u]ncle's condition."  Dr. Hagen also 
averred he reviewed Zingsheim's eight-page medical history, 
which was in the record before the circuit court.  Dr. Hagen 
then prescribed Zingsheim ivermectin.   
¶45 Gahl requested that Aurora administer ivermectin as 
Dr. Hagen had prescribed, but Aurora refused.  Curiously, 
Dr. James Holmberg, M.D., Aurora's Chief Medical Officer, 
averred, 
"[i]vermectin 
was 
requested 
by 
family" 
but 
not 
administered "per system policy."  Gahl alleges corporate 
executives——not doctors——were making broad policies without 
knowledge about individual patients.   
¶46 Gahl averred he could not "give up" on his uncle even 
if Aurora had.  As Gahl explained, "[a]t this point, there [wa]s 
nothing . . . [Aurora could] do, or [was] will[ing to] do, for 
my uncle that [wa]s likely to improve his condition."  Gahl sued 
Aurora on Zingsheim's behalf.   
¶47 Gahl posited a number of legal theories in the 
petition for relief.  Most pertinently, Gahl emphasized, "the 
hospital . . . has sole custody of the patient due to his poor 
No.  2021AP1787-FT.rgb 
 
11 
 
medical condition[.]"  Consequently, Aurora's conduct was 
depriving Gahl of his "undisputed right under well-established 
law to make reasonable and lawful medical decisions" because he 
could not go elsewhere to receive treatment.  As noted in the 
petition:  "[W]hat dramatically changes the normal analysis of 
patient choice is that fact that the patient is essentially in 
hospital 'prison' due to his poor medical condition.  He cannot 
go out into the medical marketplace to fulfill his preferences 
which is otherwise his right under state law[.]" 
¶48 Gahl cited Zingsheim's "right to self-determination" 
under, among other legal sources, Article I, Section 1 of the 
Wisconsin Constitution, the informed consent statute, and the 
common law.6  Among other theories, Gahl also argued that 
withholding ivermectin violated the patient-physician contract, 
the Hippocratic Oath, and Gahl's statutory right as the holder 
of the HCPOA.  Gahl also argued that administering ivermectin 
was within the standard of care, noting, "the evidence in favor 
of . . . [ivermectin] is considerable, and the counterarguments 
against its use and efficacy are weak."   
                                                 
6 Gahl cited the wrong informed consent statute, Wis. Stat. 
§ 51.61(1)(fm) (2019–20).  His point still stands.  Compare 
§ 51.61(1)(fm) (explaining a "patient," which is defined as a 
person receiving certain mental health or substance abuse 
treatment, has "the right to be informed of his . . . treatment 
and 
care 
and 
to 
participate 
in 
the 
planning 
of 
his . . . treatment and care"), with Wis. Stat. § 448.30 ("Any 
physician who treats a patient shall inform the patient about 
the availability of reasonable alternate medical modes of 
treatment 
and 
about 
the 
benefits 
and 
risks 
of 
these 
treatments."). 
No.  2021AP1787-FT.rgb 
 
12 
 
¶49 The majority inaccurately suggests Gahl may have 
forfeited several legal arguments by not advancing them before 
the circuit court.  Specifically, the majority claims Gahl did 
not argue a contract theory or a HCPOA theory, but these 
assertions are untrue——even the court of appeals majority 
acknowledged these arguments were made.  Compare id., ¶21 n.6, 
with Gahl, 403 Wis. 2d 539, ¶¶36–37 (majority op.) (noting Gahl 
did not forfeit his argument that Aurora had violated "an 
implied contractual duty based on the Hippocratic Oath" or his 
argument that Aurora violated the "statute concerning HCPOAs"), 
and ¶35 n.22 ("We have carefully scrutinized the petition [for 
relief] to discern Gahl's probable arguments supporting his 
claim that the court has authority to act in this case.  The 
arguments Gahl set forth in his original petition are as 
follows:  (1) failure to provide the treatment violated the 
'Hippocratic Oath'; . . . (3) withholding treatment violates the 
HCPOA held by Gahl[.]").  The court of appeals majority also 
seemed to conclude that Gahl did not forfeit his argument that 
the circuit court had "legal and equitable authority"——which 
that majority labeled as "inherent power"——to impose the relief 
it did.  Gahl, 403 Wis. 2d 539, ¶¶36–37, 47–48.   
¶50 The majority suggests Gahl "sought an order requiring 
Aurora to administer [i]vermectin," which is partly true, but 
ultimately Gahl simply wanted ivermectin administered; he did 
not care by whom.  See Majority op., ¶8.  Gahl noted in the 
petition for relief that if the circuit court was not willing to 
No.  2021AP1787-FT.rgb 
 
13 
 
order Aurora to administer the drug, "other" or "different" 
relief would be acceptable. 
¶51 Gahl explained in the petition for relief that he was 
willing to sign a hold-harmless agreement.  The majority omits 
this fact among many others that do not fit its narrative.  The 
court of appeals majority speculated an agreement might not 
"shield Aurora and its health care professionals from liability" 
in "future litigation."  Gahl, 403 Wis. 2d 539, ¶58.  Strangely, 
the court of appeals majority also complained that an agreement 
in this case would not resolve how other disputes, involving 
different patients, might be handled.  Id. ("Although the 
plaintiff had offered to sign a release, 'the potential harm to 
defendants is broader than this one case, because a court 
directive in this matter could open the door for a flood of 
similar suits from other patients with COVID-19, not to mention 
other conditions, suing to obtain care that is contrary to 
hospital policies.'"  (quoting Frey v. Trinity Health-Mich., 
No. 359446, unpublished slip op., 2021 WL 5871744 at *5 (Mich. 
Ct. App. Dec. 10, 2021) (per curiam))). 
¶52 The circuit court initially rejected the petition for 
relief out-of-hand because it was filed without the exhibits 
mentioned in the petition.  The court explained, "I think it 
highly 
inappropriate 
for 
this 
[c]ourt 
to 
set 
aside 
its 
obligations under the law and act in a vacuum without proper 
basis or knowledge."  After the missing materials were filed, 
the court held a hearing on what its characterized as an 
"emergency medical injunctive relief petition."  The court 
No.  2021AP1787-FT.rgb 
 
14 
 
emphasized the urgency presented by Gahl's assertions.  It 
considered the situation "dire" and "felt it incumbent on the 
[c]ourt . . . to get this in as soon as possible to address [the 
issue.]"  Nonetheless, the court recognized "there ha[d] to be a 
legal basis" for its decision, stating that it would "not [be] 
appropriate" to base its decision "on emotion" instead of 
evidence.  The court also recognized it was a "layperson" in 
relation to medicine and accordingly was "relying on the 
record . . . generated . . . to make the evaluation and exercise 
the [c]ourt's discretion on the request."  At the hearing, the 
circuit court heard lengthy arguments involving many exhibits.  
The transcript of the hearing spans 70 pages.   
¶53 On the one hand, Gahl's counsel contended ivermectin 
was a viable treatment that could improve Zingsheim's condition.  
Although the circuit court was receptive to Gahl's arguments, it 
noted skepticism at times.  For example, Gahl's counsel 
referenced various cases across the nation in which courts had 
ordered health care providers to administer ivermectin.  Some of 
these decisions were provided as exhibits.  The court questioned 
whether these decisions were factually on point.  Specifically, 
the court told Gahl's counsel: 
The specific cases that you referenced by way of 
example, and you submitted some documents regarding 
those, my review, at least of the ones that were 
identified specifically, you referenced the 80-year-
old woman, the Rochester, New York, situation.  My 
understanding from what I reviewed was that there had 
already been administration of [i]vermectin, and those 
cases 
were 
for 
either 
reinstitute 
[sic] 
it 
or 
continuing it after a medical doctor who had a 
relationship with the patient had made a decision to 
prescribe it and then the hospital, for whatever 
No.  2021AP1787-FT.rgb 
 
15 
 
reason, decided to either not continue it or to 
terminate it.  But those cases involved the situation 
where a licensed medical doctor with a patient –– a 
patient-doctor relationship with the individual had 
already made a prescription decision, and it seems 
facially different from what we have here. 
The court ultimately viewed these cases as "anecdotal[.]" 
 
¶54 On the other hand, Aurora argued that administering 
ivermectin would fall below the standard of care.  Repeatedly 
during the hearing, Aurora analogized the administration of 
ivermectin to the administration of bleach; however, the court 
rejected the analogy:  "we're not talking about putting bleach 
in somebody's veins here."  The court also pushed back on 
Aurora's argument that Gahl was trying to change the "status 
quo": 
I have to interject a question here . . . .  [W]e 
don't have –– And that's what's missing in the two 
doctors' affidavits.  What is the ongoing medical 
protocol and treatment that's being pursued.  I mean, 
if, in fact, . . . they're at the end of the line of 
their available treatments for . . . Zingsheim and 
they're saying, well, we put him on a ventilator and 
we're just going to, you know, see if he can fight 
this off without any further intervention, then the 
status quo is then, well, we'll just cross our fingers 
and hope for the best.  And I don't mean to diminish 
their medical opinions, but I don't have anything in 
the record that says, well, what are we doing to treat 
this gentleman other than put him on a ventilator and 
hope for the best. 
¶55 Toward the close of the hearing, the circuit court 
recited the correct legal standard; the majority does not 
dispute this.  Specifically, the circuit court stated: 
The parties have touched on the elements that are 
before the [c]ourt on what amounts to a legal decision 
when considering a temporary injunction/restraining 
order.  And it requires the moving party here, the 
petitioner, demonstrate that the movant is likely to 
No.  2021AP1787-FT.rgb 
 
16 
 
suffer irreparable harm if the temporary injunctive 
relief is not issued; also, secondly, that the movant 
has no other adequate remedy at law; thirdly, a 
temporary injunction is necessary to preserve at 
status quo; and, finally, the movant has a reasonable 
probability of success on the merits.  That issue with 
those elements is put before the [c]ourt as a matter 
of exercising its discretion. . . .  So that's the 
basis and the background legally that the [c]ourt has 
to utilize as a framework and in assessing the 
circumstances of this case. 
This court has applied the same standard in numerous cases.  See 
e.g., Waste Mgmt., Inc. v. Wis. Solid Waste Recycling Auth., 84 
Wis. 2d 462, 465, 267 N.W.2d 659 (1978) (quoting Werner v. A. L. 
Grootemaat & Sons, Inc., 80 Wis. 2d 513, 519–20, 259 N.W.2d 310 
(1977)). 
¶56 After articulating the correct legal standard, the 
circuit court explained various factual considerations.  It 
mentioned Zingsheim's serious condition and the competing 
evidence regarding whether ivermectin would be effective.  It 
was also concerned with preserving Zingsheim's life, noting, 
"the petitioner has asserted that if this [c]ourt doesn't act, 
act 
now, 
act 
today, . . . Zingsheim 
is 
going 
to 
die."  
Critically, it also expressed "a significant respect for an 
individual's right to choose and choose their treatment."  Even 
still, the court understood this right is not absolute——very few 
rights are.   
¶57 The circuit court then found it lacked sufficient 
information to determine whether the temporary injunction 
requirements had been satisfied.  It wanted more information 
about 
how 
Dr. Hagen 
had 
made 
his 
decision 
to 
prescribe 
ivermectin.  More generally, it recognized that both Zingsheim's 
No.  2021AP1787-FT.rgb 
 
17 
 
condition and the viability of ivermectin as a treatment for 
COVID-19 were key considerations.  As the court explained, 
without additional information on these matters, "it's very 
difficult . . . to assess what, in fact, we're dealing with 
other than relying on anecdotal representations today that [are] 
otherwise unsupported by competent medical expertise."  The 
court ordered supplemental material be filed later that day. 
¶58 While the circuit court was indicating it needed more 
information, Gahl's counsel tried to pass the burden of proof 
onto 
Aurora, 
arguing 
"respondents 
need 
to 
prove 
that . . . [i]vermectin is dangerous and does not work.  And 
they can't do that."  The court rejected such burden shifting, 
making clear it viewed this case as a neutral arbiter should.  
While Gahl had submitted some evidence, the court noted Aurora 
had submitted:  
two affidavits from treating physicians and doctors 
licensed in the State of Wisconsin that assert to this 
[c]ourt that . . . [ivermectin] is dangerous.  That's 
the problem. . . .  I've read the other materials that 
you submitted in support of the petition . . . .  And 
that's great, but now I have two other doctors 
involved . . . say[ing] . . . Judge this is dangerous 
and we believe . . . that the use of [i]vermectin is 
more dangerous than efficacious. 
The court continued, "we're in a court of law here today and 
there has to be a legal basis for this [c]ourt to make a 
determination." 
¶59 The circuit court received dueling affidavits.  Gahl 
filed an affidavit by Dr. Hagen, who averred he had discussed 
Zingsheim's condition with Gahl and reviewed Zinghseim's medical 
history. 
 
He 
opined 
that 
"based 
on 
the 
patient's 
No.  2021AP1787-FT.rgb 
 
18 
 
history, . . . the administration of [i]vermectin at the dosage 
indicated . . . [would give] the patient a realistic chance for 
improvement while presenting a low risk of side effects."  He 
also attested, "I have prescribed [i]vermectin in about 300 
other cases with generally favorable results and no serious 
cases of side effects from the drug."7  Aurora filed an affidavit 
from Dr. Holmberg——his second in the case——which described 
Zingsheim's treatment plan.   
¶60 The majority's misuse of affidavits reveals its 
misunderstanding regarding the standard of review.  The majority 
opinion largely ignores Dr. Hagen's affidavit and instead relies 
heavily on Dr. Holmberg's first even though the circuit court 
obviously gave Dr. Hagen's more weight——which, as the trier of 
fact, it had the discretion to do.  See Majority op., ¶7.  The 
majority also takes a not-so-subtle shot at Dr. Hagen by 
referring to him as a retired OB/GYN.  Id., ¶6.  Similarly, the 
court 
of 
appeals 
majority 
mentioned 
that 
Dr. 
Hagen 
was 
sanctioned about a decade ago by the Wisconsin Medical Examining 
Board for prescribing medication to an individual who was not 
his patient.  Gahl, 403 Wis. 2d 539, ¶8.  The circuit court was 
aware of these facts.  The court could have used this 
information to discount the information provided by Dr. Hagen, 
but it did not do so.  Under the proper standard of review, this 
                                                 
7 Gahl also filed an unnotarized affidavit of another 
doctor, which cannot be considered.  Wis. Hosp. Ass'n v. Nat. 
Res. Bd., 156 Wis. 2d 688, 723 n.13, 457 N.W.2d 879 (Ct. App. 
1990); see also Wis. Stat. § 887.01 (2019-20). 
No.  2021AP1787-FT.rgb 
 
19 
 
court is not the trier of fact and must defer to the circuit 
court's credibility determinations. 
¶61 After 
reviewing 
the 
supplemental 
materials, 
the 
circuit court ordered Aurora to administer ivermectin to 
Zingsheim as prescribed.  Instead of complying with the circuit 
court's order, Aurora instead wrote a letter to the court in 
which it claimed it was "unable to comply with the terms of the 
[o]rder as drafted" and asked the court for clarification.  
Aurora also filed a petition for leave to appeal the nonfinal 
order.  Aurora did not seek relief pending appeal in the court 
of appeals. 
¶62 The next day, the circuit court held a second hearing 
to consider Aurora's concerns.  At this hearing, Aurora's 
counsel told the circuit court that Zingsheim tested negative 
for COVID-19 and asked whether that changed anything from the 
court's perspective.  Gahl's counsel represented that ivermectin 
was "not solely for the issue of COVID.  It's for COVID and the 
damages that come about as a result of COVID."  The court 
accepted the representation of Gahl's counsel.  It then orally 
modified its prior order. 
¶63 The 
modified 
order 
required 
Aurora 
to 
allow 
a 
physician 
identified 
by 
Gahl, 
who 
met 
Aurora's 
standard 
credentialing 
criteria, 
to 
have 
access 
to 
Zingsheim 
to 
administer ivermectin.8  The modified order did not require 
                                                 
8 As one amicus curiae points out, the concern about 
Dr. Hagen having prescribed a medicine without an in-person 
examination is unwarranted given that a doctor willing to 
administer the drug would have to come to Zingsheim in person. 
No.  2021AP1787-FT.rgb 
 
20 
 
Aurora's medical staff to administer, or even to provide, 
ivermectin.   
¶64 Contrary to the insinuation of the court of appeals 
majority, the circuit court did not require Aurora to credential 
any particular doctor.  See id., ¶64.  As the circuit court 
explained: 
I am not going to engage in directing the hospital or 
individuals at the hospital . . . to administer this 
medication to . . . Zingsheim.  I think it's incumbent 
on the petitioner to supply a medical professional 
that's approved by the hospital for purposes of 
assisting this patient.  But I don't think it's 
appropriate for this [c]ourt to engage in further 
orders to the hospital as to how this drug is 
administered. 
They have, they being the hospital, have their rules 
of whom they admit to practice medicine there and how 
they do it, and I don't think –– The [c]ourt is taking 
a significant step in this case by the order that's 
been 
entered. 
 
I 
think 
it's 
the 
petitioner's 
responsibility for not only supplying the prescription 
but supplying an individual that meets the approval of 
the hospital for administration. 
The court stated it was "not going to step on . . . [Aurora's] 
toes" and it was giving "due deference" to Aurora's procedures.  
The court specifically declared it was "not going to start 
dictating to the hospital and start to change their policies of 
how they make their determination of who's appropriate to come 
into their facility and administer medication," considering such 
action "an overreach." 
¶65 In particular, the circuit court emphasized that 
Aurora need not credential Dr. Hagen, noting: 
If Dr. Hagen doesn't pass muster, then the petitioner 
has to find somebody else.  But I don't think this 
No.  2021AP1787-FT.rgb 
 
21 
 
[c]ourt –– This [c]ourt does not feel comfortable in 
making any further directives or orders to the 
hospital as to how that's to occur.  I think that's a 
responsibility of the petitioner here and it's –– 
That's how the [c]ourt views. 
While Aurora was required to not "engage in undue delay" in the 
credentialing process, it was not required to give the proposed 
doctor any special treatment. 
¶66 Additionally, 
the 
circuit 
court's 
modified 
order 
required Gahl to sign a hold-harmless agreement, at Aurora's 
request and in light of Gahl stating in the petition for relief 
he would be willing to sign one.  Despite these facts, the court 
of appeals majority actually relied on the existence of the 
agreement as support for its erroneous holding:  "That the 
parties and the circuit court discussed a release of liability 
is further evidence that Gahl's requested relief would have 
forced Aurora to act outside the boundaries of the law and that 
his request was not grounded in any legal authority."  Id., ¶58 
n.34. 
¶67 After the circuit court orally modified its order, 
Gahl and Aurora began to negotiate.  According to the court of 
appeals majority, Aurora was "on the cusp of providing temporary 
credentials to an outside provider, subject to Gahl signing 
releases."  Id., ¶26 n.19.  The day after the oral modification, 
while negotiations were ongoing, the court of appeals granted 
Aurora's petition for leave to appeal a nonfinal order——before 
even receiving a response from Gahl.  Worse still, the court of 
appeals, on its own motion and without any explanation, stayed 
the circuit court's oral ruling, even though it apparently did 
No.  2021AP1787-FT.rgb 
 
22 
 
not know the exact contents of that ruling.  See Gahl v. Aurora 
Health Care, Inc., No. 2021AP1787, unpublished order, at 3 (Wis. 
Oct. 21, 2021) (Rebecca Grassl Bradley, J., dissenting).  The 
court of appeals acted so hastily that the oral ruling had not 
been reduced to a signed written order.  Gahl filed an emergency 
petition to bypass the court of appeals.  In a 4-3 decision, 
this court denied that petition, leaving the stay entered by the 
court of appeals undisturbed.   
¶68 Following the bypass denial, the court of appeals took 
seven months to decide this case despite its emergency nature.  
While the appeal was initiated on October 12, 2021, the court of 
appeals did not issue its opinion until May 25, 2022——225 days 
later.  Gahl, 403 Wis. 2d 539, ¶72 n.4 (Grogan, J., dissenting).  
If the court of appeals decides to take a case with life or 
death consequences, it has a moral, if not legal, duty to decide 
it in a timely manner.  Gahl, No. 2021AP1787, at 4 (Oct. 21, 
2021) ("While appellate courts have all the luxury of time to 
ponder the law, . . . Zingsheim, fighting for his life, does 
not.  Circuit courts are best equipped to make these sorts of 
frontline decisions, in which time is of the essence."). 
¶69 The court of appeals majority reversed the modified 
order of the circuit court over the well-reasoned dissent of 
Judge Grogan, which this court's majority completely ignores.9  
The court of appeals majority held the circuit court erroneously 
                                                 
9 The court of appeals understood itself to be reviewing the 
circuit 
court's 
order 
as 
orally 
modified. 
 
Gahl, 
403 
Wis. 2d 539, ¶25 n.18.  This court likewise reviews the modified 
order. 
No.  2021AP1787-FT.rgb 
 
23 
 
exercised its discretion because, in its view, Gahl, not the 
circuit court, "failed to identify any law, claim, or recognized 
cause of action under Wisconsin law by which a patient may 
compel a health care professional to administer a course of 
treatment contrary to that medical professional's judgment."  
Gahl, 403 Wis. 2d 539, ¶1 (majority op.).  It "further [held] 
the [circuit] court had no legal authority to compel Aurora to 
credential an outside provider to provide care that is below the 
standard of care."  Id., ¶64.   
¶70 This holding presupposes that the administration of 
ivermectin actually falls below the standard of care.  As Judge 
Grogan explained: 
By redefining "standard of care" to mean what the 
treating physician believes it to be, the majority 
effectively requires all courts going forward to 
simply accept the health care provider's belief as to 
the standard of care where a patient seeks an 
injunction based on a disagreement with the provider's 
course of action in providing care.  
Id., ¶85 n.11 (Grogan, J., dissenting).  Judge Grogan's dissent 
documented the existence of "legal authority to issue injunctive 
relief under these circumstances" and concluded the circuit 
court properly exercised its discretion.  Id., ¶¶88, 90.  Gahl 
petitioned this court for review, which this court granted. 
II.  STANDARD OF REVIEW 
 
¶71 Whether to grant a temporary injunction is within the 
circuit court's discretion.  Milwaukee Deputy Sheriffs' Ass'n v. 
Milwaukee County, 2016 WI App 56, ¶20, 370 Wis. 2d 644, 883 
N.W.2d 154 (citing State v. C. Spielvogel & Sons Excavating, 
No.  2021AP1787-FT.rgb 
 
24 
 
Inc., 193 Wis. 2d 464, 479, 535 N.W.2d 28 (Ct. App. 1995)).  As 
already explained, the standard of review is highly deferential: 
 An appellate court "may not substitute its discretion for 
that of the circuit court."  State v. Rhodes, 2011 WI 73, 
¶26, 336 Wis. 2d 64, 799 N.W.2d 850 (citing State v. 
McCall, 202 Wis. 2d 29, 42, 549 N.W.2d 418 (1996)). 
 An "appellate court[] should 'look for reasons to sustain 
a . . . [circuit] 
court's 
discretionary 
decision.'"  
State v. Gutierrez, 2020 WI 52, ¶27, 391 Wis. 2d 799, 943 
N.W.2d 870 (quoting State v. Wiskerchen, 2019 WI 1, ¶18, 
385 Wis. 2d 120, 921 N.W.2d 730). 
An appellate court must uphold a circuit court's discretionary 
decision if the circuit court applied the correct legal standard 
to the relevant facts and reached a reasonable conclusion.  See 
Seigel, 163 Wis. 2d at 889 (citing Hartung v. Hartung, 102 
Wis. 2d 58, 66, 306 N.W.2d 16 (1981)).   
 
¶72 In 
fact, 
"[r]egardless 
of 
the 
extent 
of 
the . . . [circuit] court's reasoning, [a reviewing court] will 
uphold a discretionary decision if there are facts in the record 
which would support the trial court's decision had it fully 
exercised its discretion."  Hurley, 361 Wis. 2d 529, ¶29 
(quoting Hunt, 263 Wis. 2d 1, ¶52) (third modification in the 
original).  If the appellate court is unsure whether the record 
can be so read, the proper remedy is to remand to the circuit 
court so that the circuit court can "articulate reasoning[.]"  
See X.S., 402 Wis. 2d 481, ¶58 n.1 (Ziegler, C.J., concurring) 
(citing Paschong v. Hollenbeck, 16 Wis. 2d 284, 286, 114 
N.W.2d 438 (1962)). 
No.  2021AP1787-FT.rgb 
 
25 
 
 
¶73 A circuit court may issue a temporary injunction if 
the requirements of Wis. Stat. § 813.02(1)(a) (2019–20) are 
satisfied.  Section 813.02(1)(a) states: 
When it appears from a party's pleading that the party 
is entitled to judgment and any part thereof consists 
in restraining some act, the commission or continuance 
of which during the litigation would injure the party, 
or when during the litigation it shall appear that a 
party is doing or threatens or is about to do, or is 
procuring or suffering some act to be done in 
violation of the rights of another party and tending 
to render the judgment ineffectual, a temporary 
injunction may be granted to restrain such act. 
This court has generally required four elements: 
 The 
party 
requesting 
relief 
is 
likely 
to 
suffer 
irreparable harm if a temporary injunction is not issued; 
 A temporary injunction is necessary to maintain the 
status quo, thereby preventing the irreparable harm;  
 The moving party has no other adequate remedy; and 
 The party has a reasonable probability of success on the 
merits. 
Waste Mgmt., Inc., 84 Wis. 2d at 465 (quoting Werner, 80 
Wis. 2d at 519). 
 
III.  ANALYSIS 
 
¶74 In this case, the circuit court properly exercised its 
discretion.  The majority seems to take issue with the circuit 
court's analysis regarding only one of the four prerequisites 
for injunctive relief:  the reasonable probability of success.  
The majority, however, also states, "[the circuit court] did not 
engage in any analysis" of any requirement.  Majority op., ¶24.  
Similarly, the court of appeals majority opinion, which the 
majority of this court affirms, seriously misunderstood the 
No.  2021AP1787-FT.rgb 
 
26 
 
elements.  A majority of this court leaves these errors 
uncorrected, and therefore they are likely to feature in future 
cases.  Although the majority seems to affirm the decision on a 
narrow basis, it does not expressly——or even impliedly——signal 
the opinion below loses its precedential value.  Consequently, 
the court of appeals will understand itself to be bound by that 
opinion.  See State v. Schmidt, 2016 WI App 45, ¶48 n.11, 370 
Wis. 2d 139, 884 N.W.2d 510 (citing Blum v. 1st Auto & Cas. 
Ins., 2010 WI 78, ¶44, 326 Wis. 2d 729, 786 N.W.2d 78).  See 
generally Wis. Mfrs. & Com. v. Evers, 2023 WI 5, ¶2, 405 
Wis. 2d 478, 984 N.W.2d 402 (per curiam) (noting that while this 
court has not addressed the issue directly, when this court 
affirms a published opinion of the court of appeals, on 
different grounds but without suggesting the rationale of the 
court of appeals was incorrect, the court of appeals opinion may 
remain binding precedent).  Accordingly, a brief overview of the 
circuit court's analysis regarding the other requirements is in 
order first. 
A.  The Other Requirements 
 
¶75 Judge 
Grogan's 
dissent 
accurately 
describes 
the 
circuit court's analysis of the requirements:  "The circuit 
court . . . recognized that Zingsheim's medical condition, which 
undoubtedly relates to multiple injunction factors, created an 
urgent, if not dire, situation."  Gahl, 403 Wis. 2d 539, ¶83.  
Zingsheim's 
"precarious 
medical 
condition" 
unquestionably 
pertained to "irreparable harm (death)" and the "status quo 
No.  2021AP1787-FT.rgb 
 
27 
 
(life)[.]"  Id.  "Additionally, given . . . the finality of 
death, there was no other adequate remedy at law[.]"  Id. 
 
¶76 The court of appeals' discussion of irreparable harm 
in the majority opinion focused on the wrong party.  That 
majority discussed "several concerns" raised by Aurora about the 
"irreparable harm" Aurora could experience from the temporary 
injunction.  Id., ¶¶57–59 (majority op.).  Aurora claimed 
providing treatment below what it perceived to be the standard 
of care could impact the licensing of its doctors and nurses and 
expose Aurora to civil liability despite the hold-harmless 
agreement.  Id.  Analyzing the potential harm to Aurora was 
improper.  Wisconsin Stat. § 813.02(1)(a) provides, in relevant, 
part:  "When it appears from a party's pleading that the party 
is entitled to judgment and any part thereof consists in 
restraining some act, the commission or continuance of which 
during the litigation would injure the party . . . ."  (Emphasis 
added.)  As indicated by the plain language of § 813.02(1)(a), 
the irreparable harm requirement concerns injury to "the party 
asking for relief."  See 43A C.J.S. Injunctions § 68 (updated 
Mar. 2023).  Accordingly, the court of appeals majority should 
have evaluated whether Aurora's conduct would "violate a 
right . . . and injure [Zingsheim]" in a way that Zingsheim's 
injury would be "irreparable."  Pure Milk Prods. Co-op. v. Nat'l 
Farmers Org., 90 Wis. 2d 781, 800, 280 N.W.2d 691 (1979) 
(citations omitted). 
 
¶77 The court of appeals majority mischaracterized the 
modified order.  The modified order did not compel Aurora to 
No.  2021AP1787-FT.rgb 
 
28 
 
administer 
the 
drug, 
so 
Aurora's 
licensing 
concerns 
are 
unfounded.  Similarly, the standard of review does not permit 
the court of appeals to speculate the hold-harmless agreement 
might be found invalid.  The circuit court at least implicitly 
found the agreement sufficient to protect Aurora, and the court 
of appeals majority lacked competence to question that finding. 
 
¶78 The court of appeals majority also suggested the 
circuit court did not understand the status quo, a claim belied 
by the full record.  Gahl, 403 Wis. 2d 539, ¶¶60–61.  That 
majority asserted: 
Here, . . . the circuit court's order changed the 
status quo by ordering Aurora to begin providing the 
proposed treatment to the patient. . . .   
The 
circuit 
court 
did 
not 
address 
this 
factor 
directly, but it is of paramount importance given the 
concerns 
Aurora 
provided 
to 
the 
court 
and 
the 
affirmative relief ordered.  The status quo before the 
litigation was that Aurora was able to exercise its 
medical judgment as to patients in the hospital within 
the bounds of its standard of care. 
Id.  The court of appeals again misdirected its analysis, 
erroneously focusing on the status quo from Aurora's perspective 
rather than the party seeking injunctive relief.   
 
¶79 Under 
this 
court's 
precedent, 
the 
status 
quo 
requirement 
is 
closely 
related 
to 
the 
irreparable 
harm 
requirement.  As this court explained more than a century ago: 
Just where the truth lies cannot be told till a trial 
of the case on the merits, hence the necessity of a 
power 
to 
preserve 
the 
status 
quo 
pending 
the 
litigation, if that be necessary to make the final 
decree 
effective 
to 
do 
justice 
between 
the 
parties. . . .  [I]t is . . . within the discretionary 
power of the court, by a temporary injunction, to 
preserve the status quo between the parties pending 
No.  2021AP1787-FT.rgb 
 
29 
 
the final decree, if that be necessary in order to 
make such decree effective or to save the person 
claiming relief from irreparable injury by the conduct 
of his adversary pending the litigation. 
Valley Iron Works Mfg. Co. v. Goodrick, 103 Wis. 436, 444, 78 
N.W. 1066 (1899) (emphasis added); see also De Pauw v. Oxley, 
122 Wis. 656, 659, 100 N.W. 1028 (1904) ("[I]t is well-nigh an 
imperative duty of the court to preserve the status quo by 
temporary injunction, if its disturbance pendente lite will 
render futile in considerable degree the judgment sought[.]").  
More recently, this court has explained, "[i]njunctions are not 
to be issued without a showing of . . . irreparable harm, but at 
the temporary injunction stage the requirement of irreparable 
injury is met by a showing that, without it to preserve the 
status quo [during litigation] . . . , the permanent injunction 
sought would be rendered futile."  Waste Mgmt., Inc., 84 
Wis. 2d at 465 (quoting Werner, 80 Wis. 2d at 519).   
 
¶80 In the context of this case, during which Zingsheim's 
survival hung in the balance, the preservation of the status quo 
reasonably meant the preservation of the opportunity for 
Zingsheim to obtain his ultimate requested relief:  access to 
ivermectin.  The status quo was life.  Had Zingsheim died, 
obviously access to ivermectin would have been rendered futile.  
Notably, not all of this court's cases on temporary injunctive 
relief even impose a status quo requirement.  See James v. 
Heinrich, Nos. 2020AP1419-OA, 2020AP1420-OA & 2020AP1446-OA, 
unpublished order, at 2 (Wis. Sept. 10, 2020). 
 
¶81 The circuit court demonstrated it understood both 
perspectives on the status quo, and, unlike the court of appeals 
No.  2021AP1787-FT.rgb 
 
30 
 
majority, viewed the preservation of the status quo as the 
preservation of Zingsheim's right to self-determination.  When 
Aurora's counsel tried to argue Gahl was changing the "status 
quo" the circuit court posed the following question: 
I have to interject a question here . . . .  [W]e 
don't have –– And that's what's missing in the two 
doctors' affidavits.  What is the ongoing medical 
protocol and treatment that's being pursued.  I mean, 
if, in fact, . . . they're at the end of the line of 
their available treatments for . . . Zingsheim and 
they're saying, well, we put him on a ventilator and 
we’re just going to, you know, see if he can fight 
this off without any further intervention, then the 
status quo is then, well, we'll just cross our fingers 
and hope for the best.  And I don't mean to diminish 
their medical opinions, but I don't have anything in 
the record that says, well, what are we doing to treat 
this gentleman other than put him on a ventilator and 
hope for the best. 
Quite clearly, the circuit court viewed the status quo as 
maintaining Zingsheim's life and well-being, not Aurora's denial 
of ivermectin.  The court's framing of the issue comported with 
this court's precedent.  The circuit court also repeatedly 
voiced its concerns for the "dire" situation.  The court 
considered and rejected the view later maintained by the court 
of appeals majority regarding the status quo——no ivermectin——
which it was entitled (if not required) to do. 
 
¶82 No member of this court or the court of appeals has 
suggested that Zingsheim had a different and adequate remedy 
available at law.  "[G]iven Zingsheim's condition," no one 
suggests "a transfer to another hospital or checking out of 
Aurora" were plausible options.  Gahl, 403 Wis. 2d 539, ¶83 n.10 
(Grogan, J., dissenting).  Death is irreversible.  There is no 
No.  2021AP1787-FT.rgb 
 
31 
 
remedy at law or otherwise.  "It is hard to have patience with 
people who say, 'There is no death' or 'Death doesn't matter.'  
There is death.  And whatever is matters.  And whatever happens 
has 
consequences, 
and 
it 
and 
they 
are 
irrevocable 
and 
irreversible." 
 
Gahl 
v. 
Aurora 
Health 
Care, 
Inc., 
No. 2021AP1787-FT, unpublished order, at 3 (Wis. Oct. 25, 2021) 
(Rebecca Grassl Bradley, J., dissenting) (quoting C.S. Lewis, A 
Grief Observed 15 (HarperCollins Paperback 1st ed. 1994) 
(1961)).    
B.  Reasonable Probability of Success 
 
¶83 Most of the majority opinion focuses on the reasonable 
probability of success.  At points, the majority criticizes Gahl 
for, in its view, not stating a claim upon which relief could be 
granted.  Majority op., ¶23.  At other points, the majority 
acknowledges the circuit court grounded its decision in its 
"respect for an individual's right to choose their [sic] 
treatment," but the majority proclaims in conclusory fashion 
that something more was required.  Id., ¶27.  The majority is 
wrong.   
1.  Gahl Stated a Claim. 
 
¶84 As a preliminary matter, the majority seems to adopt 
the court of appeals majority's insupportable assertion that 
"Gahl's claim must fail because he did not identify a source of 
law[.]"  Id., ¶1; see also id., ¶16 (quoting Gahl, 403 
Wis. 2d 539, ¶1 (majority op.)).  Based on this mistaken 
premise, the majority holds Gahl failed to state a claim.  Id., 
¶23.  At no point does the majority examine Article I, Section 1 
No.  2021AP1787-FT.rgb 
 
32 
 
of the Wisconsin Constitution, the informed consent statute, or 
the common law even though all were referenced in Gahl's 
petition for relief (among other legal authorities).   
¶85 As a matter of natural law, people have a right "to 
make their own health care decisions."  See Martin, 192 
Wis. 2d at 171.  This right to self-determination is protected 
by Article I, Section 1 of the Wisconsin Constitution, which 
this court has held protects an "independent right to liberty 
includ[ing] an individual's choice of whether or not to accept 
medical treatment."  Lenz v. L.E. Phillips Career Dev. Ctr., 167 
Wis. 2d 53, 
69, 
482 
N.W.2d 60 
(1992). 
 
But 
for 
his 
incapacitation, in a free market Zingsheim could have exercised 
this right by leaving the hospital; his condition precluded that 
option. 
 
¶86 The right to self-determination is also protected by 
the informed consent statute.  "The doctrine of informed consent 
comes from the common law and stems from the fundamental notion 
of the right to bodily integrity:  '[e]very human being of adult 
years and sound mind has a right to determine what shall be done 
with his own body[.]'"  Martin, 192 Wis. 2d at 169 (quoting 
Schloendorff v. Soc'y of N.Y. Hosp., 105 N.E. 92, 93 (1914), 
overruled on other grounds by Bing v. Thunig, 143 N.E.2d 3 
(1957); citing Lenz, 167 Wis. 2d at 68).  Interpreting this 
court's precedent, the court of appeals explained in a different 
decision, "the deference . . . [this precedent] pays to the 
patient's right to choose . . . his treatment is important 
because it demonstrates that the informed consent statute 
No.  2021AP1787-FT.rgb 
 
33 
 
protects more than merely the patient's right to obtain 
information."  Schreiber v. Physicians Ins. Co. of Wis., 217 
Wis. 2d 94, 105, 579 N.W.2d 730 (Ct. App. 1998), aff'd, 223 
Wis. 2d 417, 588 N.W.2d 26 (1999).  A right to informed consent 
presupposes a doctor cannot wholly "ignor[e] the patient's 
ultimate choice."  Id.  Particularly if the patient is trapped 
in a hospital, unable to leave, the informed consent statute 
would mean very little if it mandated only the provision of 
information by a doctor.  See id.  The court of appeals has 
therefore held "in addition to protecting the patient's right to 
obtain information, the informed consent statute must protect 
the patient's right to choose a medically viable treatment and 
have that choice respected by . . . his doctor."  Id.   
 
¶87 This court also recognizes the "common law right to 
self determination[.]"  Lenz, 167 Wis. 2d at 67.  This court has 
explained:  "No right is held more sacred, or is more carefully 
guarded by the common law, than the right of every individual to 
the possession and control of his own person, free from all 
restraint or interference of others, unless by clear and 
unquestionable authority of law."  Id. at 68 (quoting Union Pac. 
Ry. v. Botsford, 141 U.S. 250, 251 (1891)).  Zingsheim's self-
determination 
was 
not 
constrained 
by 
any 
clear 
and 
unquestionable authority of law.  It was constrained by his 
inability to leave the hospital. 
 
¶88 Gahl also argued ivermectin fell within the standard 
of care.  As the court of appeals has previously held: 
Where there are two or more medically acceptable 
treatment approaches to a particular medical problem, 
No.  2021AP1787-FT.rgb 
 
34 
 
the informed consent doctrine, medical ethics, and the 
standard of care all provide that a competent patient 
has the absolute right to select from among these 
treatment options after being informed of the relative 
risks and benefits of each approach. 
Schreiber, 217 Wis. 2d at 103.  On appeal, this court affirmed 
on narrower grounds, emphasizing "this opinion should not be 
interpreted as requiring physicians to perform procedures they 
do not consider medically viable, procedures for which they lack 
the appropriate expertise, or procedures to which they are 
morally opposed."  Schreiber, 223 Wis. 2d 417, ¶15.  This court, 
however, did not withdraw language from the court of appeals 
decision and did not express disagreement with it.  More 
importantly, the modified order in this case did not require any 
doctor to do anything.  The circuit court received evidence 
sufficient to reasonably find that ivermectin was a viable 
medical treatment; Dr. Hagen's affidavit alone was a sufficient 
basis on which to make this finding.  The circuit court 
therefore had authority to ensure Zingsheim had access to 
ivermectin.  Schreiber, 217 Wis. 2d at 103. 
 
¶89 Gahl identified multiple legal sources in his petition 
for relief; regardless, black-letter law does not require a 
specific citation to state a claim.  "[L]egal theories need not 
be fully developed, or even expressly identified, at the 
pleading stage."  Kohlbeck v. Reliance Const. Co., 2002 
WI App 142, ¶12 n.3, 256 Wis. 2d 235, 647 N.W.2d 277 (citing 
Murray v. City of Milwaukee, 2002 WI App 62, ¶12 n.6, 252 
Wis. 2d 613, 642 N.W.2d 541).  In Murray v. City of Milwaukee, 
the court of appeals explained: 
No.  2021AP1787-FT.rgb 
 
35 
 
The City contends that we should not address Murray's 
contention that the City erroneously exercised its 
discretion under Wis. Stat. § 895.35 because that was 
not alleged in the complaint, and Murray did not make 
that argument until his brief in opposition to the 
City's motion to dismiss.  However, a complaint need 
not expressly identify a legal theory, but only the 
facts 
necessary 
to 
recover 
under 
that 
legal 
theory. . . .  
Because 
the 
City 
has 
had 
the 
opportunity, both in the trial court and in this 
court, to respond to Murray's legal theory . . . it is 
proper to decide the merits of this legal theory.   
252 Wis. 2d 613, ¶12 n.6 (citing Nw. Nat. Cas. Co. v. State 
Auto. & Cas. Underwriters, 35 Wis. 2d 237, 241, 151 N.W.2d 104 
(1967); Wis. Stat. § 802.02(1)).  The decisions of the United 
States Supreme Court are in accord.  See Johnson v. City of 
Shelby, 574 U.S. 10, 12 (2014) (per curiam) ("The federal rules 
effectively 
abolish 
the 
restrictive 
theory 
of 
pleadings 
doctrine, making it clear that it is unnecessary to set out a 
legal theory for the plaintiff's claim for relief."  (quoting 5 
Charles Alan Wright & Arthur R. Miller, Federal Practice & 
Procedure § 1219 (3d ed. 2004))).  That Court has reversed, 
without controversy, decisions of lower federal courts imposing 
a specific citation requirement to state a claim.  Id. at 11-12.  
2.  The Circuit Court Correctly Analyzed the Reasonable 
Probability of Success Requirement. 
 
¶90 The 
majority's 
analysis 
of 
the 
circuit 
court's 
reasoning on Gahl's reasonable probability of success is as 
wrong as it is confusing.  On one hand, the majority 
acknowledges "there are no 'magic words' the circuit court must 
utter or any precise level of specificity that is required."  
Majority op., ¶26.  Undoubtedly, this statement is correct.  
This court has rejected a so-called magic words requirement on 
No.  2021AP1787-FT.rgb 
 
36 
 
many occasions.  Marathon County v. D.K., 2020 WI 8, ¶66, 390 
Wis. 2d 50, 
937 
N.W.2d 901 
(Rebecca 
Grassl 
Bradley, 
J., 
concurring) ("We do not impose a 'magic words' requirement in 
the 
law 
and 
this 
court 
has 
repeatedly 
rejected 
them."  
(collecting cases)). 
 
¶91 Contradicting its rejection of a magic words standard, 
the majority repeatedly faults the circuit court for not citing 
a specific source of law.  See, e.g., majority op., ¶12 ("There 
was no statutory basis or other legal foundation for the order 
set 
forth 
in 
its 
text."); 
id., 
¶21 
n.7 
("The 
trial 
court . . . did not cite any actual law to support its order."); 
id., ¶25 ("The circuit court's written order granting Gahl 
relief does not cite any statute, case, or other source of law 
as a foundation allowing for its issuance."); id. ("Absent any 
citation to law establishing a legal basis for the order, we 
cannot determine that the circuit court employed the reasoning 
process our precedent demands.").  It then holds "[w]e need not 
address in depth any of Gahl's arguments because we do not know 
on 
what 
basis 
the 
circuit 
court 
issued 
the 
[temporary] 
injunction."  Id., ¶21.   
 
¶92 The majority continues, "[t]he circuit court cited no 
law either in its written order or in its oral ruling," which 
the majority declares is "in itself" a reversible error.  Id.  
Ironically, the majority does not cite any authority obligating 
the circuit court to provide a specific citation, wading into 
"the native land of the hypocrite."  Oscar Wilde, The Picture of 
Dorian Grey 129 (Canterbury Classics 2013) (1891).  No effort is 
No.  2021AP1787-FT.rgb 
 
37 
 
made by the majority to "determine . . . [whether] the circuit 
court employed the reasoning process our precedent demands" 
because, the majority claims, this inquiry is impossible without 
a specific citation by the circuit court.  Majority op., ¶25.   
 
¶93 Although the circuit court did not recite case 
precedent 
or 
statutory 
law, 
it 
explicitly 
espoused 
a 
"significant respect for an individual's right to choose and 
choose their treatment" clearly grounded in both.  In light of 
the petition for relief and the record as a whole, this 
statement should be sufficient.  After all, magic words are not 
required.  The majority nevertheless claims "such a stray 
reference" is insufficient.  Id., ¶27.  It cites nothing to 
support this conclusion. 
 
¶94 No general rule requiring the circuit court to cite a 
specific law exists, and in fact, this court has crafted a 
special rule requiring a specific statutory citation in just one 
context.  See Langlade County v. D.J.W., 2020 WI 41, ¶3, 391 
Wis. 2d 231, 942 N.W.2d 277.  The creation of this special rule 
proves the general one.  In Langlade County v. D.J.W., this 
court held that "going forward circuit courts in recommitment 
proceedings are to make specific factual findings with reference 
to the subdivision paragraph of Wis. Stat. § 51.20(1)(a)2. on 
which the recommitment is based."  Id.  The rule in D.J.W. was 
adopted, in part, because circuit courts left unstated the 
statutory basis of recommitments.  D.J.W. facilitated appellate 
review by imposing a rule of judicial administration.  Id., ¶40.  
D.J.W. is an anomaly in this court's jurisprudence.  If it were 
No.  2021AP1787-FT.rgb 
 
38 
 
otherwise, this court would not have needed to make a ruling 
specific to recommitment cases.  As D.J.W. shows, this court 
does not require circuit courts to cite specific legal authority 
as a basis for its decision. 
 
¶95 The majority pretends the circuit court's reasoning 
was so bad that the majority cannot make heads or tails of it, 
but the reasoning is easily discernable.  As Judge Grogan 
explained: 
What is clear from the record . . . is that the 
circuit court understood that likelihood of success on 
the merits was a required factor, that it was honed in 
on 
the 
competing 
medical 
opinions 
presented 
by 
Aurora's and Gahl's supporting physicians as to what 
treatment would or would not be appropriate for 
Zingsheim under the circumstances, and that the 
medical 
information 
from 
the 
parties' 
various 
physicians was central to its determination.  
Gahl, 
403 
Wis. 2d 539, 
¶84 
(Grogan, 
J., 
dissenting).  
Critically, "[b]ased on the information in the record," the 
circuit court concluded Gahl had established a reasonable 
probability 
of 
success 
either 
under 
a 
"right 
to 
choose 
ivermectin" theory or because the "standard of care" required 
it.  Id.  Under the latter theory, the court did not have to 
conclude ivermectin was actually effective——merely that if the 
case were to continue, the trier of fact might so find.  "The 
fact that the circuit court was presented with differing 
opinions about what treatment is proper for Zingsheim suggests 
the jury is still 'out' as to whether there is only one 
particular and established 'standard of care' in treating this 
novel virus."  Id., ¶89.  "Time will eventually reveal what the 
No.  2021AP1787-FT.rgb 
 
39 
 
standard of care or reasonable alternative treatment is for 
people in Zingsheim's position."  Id.   
 
¶96 The 
majority 
errs 
in 
treating 
this 
politically 
controversial case differently than other cases involving 
similar 
decisions. 
 
"Regardless 
of 
the 
extent 
of 
the . . . [circuit] court's reasoning, [a reviewing court] will 
uphold a discretionary decision if there are facts in the record 
which would support the trial court's decision had it fully 
exercised its discretion."  Hurley, 361 Wis. 2d 529, ¶29 (quoted 
source 
omitted) 
(second 
modification 
in 
the 
original).  
Arguably, the majority must search the record for reasons to 
support the circuit court's decision.  Altogether absent from 
the majority opinion is any attempt to read the record in a 
light favorable to the circuit court's discretionary decision.  
See State v. Johnson, 2021 WI 61, ¶34, 397 Wis. 2d 633, 961 
N.W.2d 18 
(quoting 
Gutierrez, 
391 
Wis. 2d 799, 
¶27).  
Alternatively, the majority could remand the case to the circuit 
court to better explain its decision.  X.S., 402 Wis. 2d 481, 
¶58 n.1.  When "there [is] room in the facts which d[o] not 
confine the [circuit] court to one result," remand is often the 
proper remedy.  Id. (quoting Paschong, 16 Wis. 2d at 286) (first 
modification in the original).  Outright reversal is a drastic 
remedy, not normally imposed unless the record is totally devoid 
of evidence supporting the circuit court's decision.  See id., 
¶56 (majority op.). 
 
¶97 On a final note, the majority fails to appreciate the 
circumstances the circuit court faced when it made its decision.  
No.  2021AP1787-FT.rgb 
 
40 
 
"Wisconsin judges are rarely asked to make life-or-death 
decisions. 
 
This 
case 
present[ed] 
one 
of 
those 
rare 
circumstances [to the circuit court].  The circuit court made a 
decision on the side of life."   Gahl, No. 2021AP1787-FT, at 3 
(Oct. 25, 2021).  Zingsheim had COVID-19, and Aurora placed 
Zingsheim on a ventilator.  Death was a realistic possibility.  
Time was of the essence.  As the circuit court recognized, the 
situation was "dire."  The circuit court, which was not a 
medical professional, was presented with "polar opposite[]" 
information as to whether ivermectin was likely to improve 
Zingsheim's condition.  Under such fast-paced, high-stakes 
circumstances, the majority commits an especially egregious 
error by demanding a "polished transcript" from the circuit 
court.  See X.S., 402 Wis. 2d 481, ¶91 (Hagedorn, J., 
dissenting). 
IV.  CONCLUSION 
 
¶98 The circuit court considered the relevant facts and 
applied the correct legal standard to reach a reasonable 
decision in light of the life-or-death circumstances presented.  
Like the majority of the court of appeals, a majority of this 
court fails to look for reasons to sustain the circuit court's 
discretionary decision as the law requires.  Under our highly 
deferential standard of review, the circuit court properly 
exercised its discretion in entering an order granting temporary 
injunctive relief to a man near death.  I dissent.  
 
No.  2021AP1787-FT.rgb 
 
41 
 
APPENDIX:  Unpublished Orders 
Gahl v. Aurora Health Care, Inc., No. 2021AP1787-FT, unpublished 
order (Wis. Oct. 25, 2022, as amended Oct. 28, 2022). 
 
Gahl v. Aurora Health Care, Inc., No. 2021AP1787-FT, unpublished 
order (Wis. Oct. 25, 2021). 
 
Gahl v. Aurora Health Care, Inc., No. 2021AP1787, unpublished 
order (Wis. Oct. 21, 2021). 
 
James 
v. 
Heinrich, 
Nos. 
2020AP1419-OA, 
2020AP1420-OA 
& 
2020AP1446-OA, unpublished order (Wis. Sept. 10, 2020). 
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