Court Opinion

ID: 9384579
Source: CourtListenerOpinion
Date Created: 2023-04-04 13:10:29.719247+00
Date Added: 2024-06-11T17:17:54.416194
License: Public Domain

2023 WI 25

                  SUPREME COURT             OF        WISCONSIN
CASE NO.:              2020AP1582

COMPLETE TITLE:        Beatriz Banuelos,
                                  Plaintiff-Appellant,
                            v.
                       University of Wisconsin Hospitals and Clinics
                       Authority,
                                  Defendant-Respondent-Petitioner.

                           REVIEW OF DECISION OF THE COURT OF APPEALS
                           Reported at 399 Wis. 2d 568, 966 N.W.2d 78
                               PDC No: 2021 WI App 70 - Published

OPINION FILED:         April 4, 2023
SUBMITTED ON BRIEFS:
ORAL ARGUMENT:         November 1, 2022

SOURCE OF APPEAL:
   COURT:              Circuit
   COUNTY:             Dane
   JUDGE:              Juan B. Colas

JUSTICES:
ANN WALSH BRADLEY, J., delivered the majority opinion of the
Court, in which DALLET, HAGEDORN, and KAROFSKY, JJ., joined.
ROGGENSACK, J., filed a dissenting opinion. REBECCA GRASSL
BRADLEY, J., filed a dissenting opinion, in which ZIEGLER, C.J.,
and ROGGENSACK, J., joined.

NOT PARTICIPATING:

ATTORNEYS:

       For the defendant-respondent-petitioner, there were briefs
filed        by   Daniel   A.   Manna,    Jay    P.    Lefkowitz,   P.C.,   Gilad
Bendheim,         Kelsey   Davis,   and   Gass   Turek    LLC,   Milwaukee,   and
Kirkland & Ellis LLP, New York City. There was an oral argument
by Jay P. Lefkowitz, P.C.
      For the plaintiff-appellant, there was a brief filed by
Jesse B. Blocher, Peter M. Young, Corey G. Lorenz, and Habush,
Habush, & Rottier, S.C., Waukesha. There was an oral argument by
Jesse B. Blocher.

      An    amicus       curiae     brief    was    filed    by    Daniel     E.    Conley,
Matthew J. Splitek, Alexandra W. Shortridge, and Quarles & Brady
LLP, Milwaukee, for Aurora Health Care, Inc.

      An amicus curiae brief was filed by Scott E. Rosenow and
WMC Litigation Center, Madison, for the Wisconsin Civil Justice
Council, Inc.

      An amicus curiae brief was filed by                          Brett A. Eckstein,
Edward E.         Robinson, Brian D. Anderson,               and Cannon & Dunphy,
S.C., Brookfield, and Everson, Whitney, Everson & Brehm, S.C.,
Green      Bay,    for    the     Wisconsin        Association       for     Justice    and
Wisconsin Defense Counsel.

      An amicus curiae brief was filed by                          Sara J. MacCarthy,
Stephane P. Fabus, Heather D. Mogden, and Hall, Render, Killian,
Heath   &     Lyman,      P.C.,     Milwaukee,       for    the    Wisconsin       Hospital
Association,        Inc.,     the    Wisconsin       Medical      Society,     Inc.,    the
Wisconsin Dental Association, Inc., LeadingAge Wisconsin, Inc.,
the   Rural       Wisconsin     Health      Cooperative,       the    Wisconsin      Health
Care Association/Wisconsin Center for Assisted Living, and the
Wisconsin Health Information Management Association, Inc.

      An    amicus       curiae     brief    was     filed    by     Susan    E.    Lovern,
Christopher        E.    Avallone,       and       von   Briesen      &    Roper,      S.C.,
Milwaukee, for the Association of Health Information Outsourcing
Services.

                                               2
                                                                  2023 WI 25
                                                          NOTICE
                                            This opinion is subject to further
                                            editing and modification.   The final
                                            version will appear in the bound
                                            volume of the official reports.
No.    2020AP1582
(L.C. No.   2020CV903)

STATE OF WISCONSIN                      :            IN SUPREME COURT

Beatriz Banuelos,

            Plaintiff-Appellant,
                                                               FILED
      v.
                                                           APR 4, 2023
University of Wisconsin Hospitals and Clinics
Authority,                                                   Sheila T. Reiff
                                                          Clerk of Supreme Court
            Defendant-Respondent-Petitioner.

ANN WALSH BRADLEY, J., delivered the majority opinion of the
Court, in which DALLET, HAGEDORN, and KAROFSKY, JJ., joined.
ROGGENSACK, J., filed a dissenting opinion. REBECCA GRASSL
BRADLEY, J., filed a dissenting opinion, in which ZIEGLER, C.J.,
and ROGGENSACK, J., joined.

      REVIEW of a decision of the Court of Appeals.          Affirmed.

      ¶1    ANN WALSH BRADLEY, J.    The petitioner, University of

Wisconsin Hospitals and Clinics Authority (UW Hospitals), seeks

review of a published court of appeals opinion reversing and

remanding the circuit court's dismissal of Beatriz Banuelos's
                                                                            No.     2020AP1582

complaint for failure to state a claim upon which relief can be

granted.1        Banuelos contends that she was unlawfully charged per

page fees for copies of her medical records which were provided

in   an     electronic       format.          The   court      of    appeals      agreed   and

determined        that    Wis.      Stat.      § 146.83(3f)         (2017-18)2     does    not

permit      a    health     care    provider        to   charge      fees   for    providing

copies of patient health care records in an electronic format.

       ¶2        UW Hospitals argues, in essence, that the court of

appeals erred because Wis. Stat. § 146.83(3f) is silent as to

fees       for   electronic        copies     of    patient     health      care    records.

Accordingly,         it     does    not       prohibit     a    health      care    provider

charging fees for providing such copies.                            And thus, Banuelos's

complaint alleging unlawful and excess charges fails to state a

claim upon which relief can be granted.3

       ¶3        Banuelos    offers       a    different       interpretation        of    the

statute's silence.            She asserts that because fees for electronic

copies are not enumerated in the statutory list of permissible

fees that a health care provider may charge, the fees charged
here       are   unlawful     under    state        law.       As    a   result,    Banuelos

maintains that her complaint survives the motion to dismiss.

       Banuelos v. Univ. of Wis. Hosps. and Clinics Auth., 2021
       1

WI App 70, 399 Wis. 2d 568, 966 N.W.2d 78 (reversing and
remanding the order of the circuit court for Dane County, Juan
Colas, Judge).

       All subsequent references to the Wisconsin Statutes are to
       2

the 2017-18 version unless otherwise indicated.
       3   See Wis. Stat. § 802.06(2)(a)6.

                                                2
                                                                            No.    2020AP1582

     ¶4     We     conclude      that    although         Wis.     Stat.     § 146.83(3f)

provides    for       the   imposition       of    fees      for   copies     of    medical

records    in    certain     formats,        it   does    not      permit    health       care

providers to charge fees for patient records in an electronic

format.         Therefore,      we    determine        that     Banuelos's         complaint

states a claim upon which relief can be granted.

     ¶5     Accordingly, we affirm the decision of the court of

appeals.

                                              I

     ¶6     The essential facts set forth below are taken from

Banuelos's      complaint.           Because      we   are    reviewing      the     circuit

court's determination of a motion to dismiss for failure to

state a claim, we must assume that these facts are true.                               Yacht

Club at Sister Bay Condo. Ass'n, Inc. v. Village of Sister Bay,

2019 WI 4, ¶4, 385 Wis. 2d 158, 922 N.W.2d 95.

     ¶7     Banuelos        signed      and       submitted        a   request       to     UW

Hospitals       for    copies    of    her     medical       records    in        electronic

format.4    The request directed and authorized that the records be
transmitted to her attorneys.

     4 Banuelos   requested   that  her   records   be    provided
electronically pursuant to the Health Information Technology for
Economic   and   Clinical   Health  (HITECH)   Act,    42   U.S.C.
§ 17935(e)(1) and 45 C.F.R. § 164.524(c).

                                                                              (continued)
                                              3
                                                                No.    2020AP1582

    ¶8     UW   Hospitals   complied     with   the   request    through     its

service   provider,   Ciox,   and   transmitted       copies   of     Banuelos's

patient   health   care   records   electronically       to    her    attorneys,

along with an invoice for $109.96.5             The requested payment for

     As described by UW Hospitals, "[t]hat federal statutory
regime authorizes (in certain circumstances) a patient to
request that copies of electronic health records be provided in
an electronic format to the patient, or to a designated third
party, such as her personal injury attorney."    "[I]n the case
that a covered entity uses or maintains an electronic health
record . . . the individual shall have a right to obtain from
such covered entity a copy of such information in an electronic
format and . . . to direct the covered entity to transmit such
copy directly to an entity or person designated by the
individual," 42 U.S.C. § 17935(e)(1), which is mandatory "if it
is readily producible in such form and format."       45 C.F.R.
§ 164.524(c).

     There is no issue of federal law that has been presented to
this court to address.
    5  Justice Roggensack's dissent assumes the role of an
advocate by deciding this case on an argument it raises sua
sponte, and then, based on that never-before-raised argument, it
attempts to transform the motion in this case from a motion to
dismiss (which it is) into a motion for summary judgment (which
it is not).

     In this motion to dismiss, we accept the facts alleged in
Banuelos's complaint as true.        UW Hospitals is the sole
defendant here and the complaint avers wrongdoing against it
alone.   Nevertheless, the dissent attempts to read into the
complaint wrongdoing by Ciox, thereby creating factual issues
regarding who did what, and whose acts caused the harm.

                                                                     (continued)
                                     4
                                                   No.   2020AP1582

copies included "per page" charges of $1.14 for the first 25

pages, $0.86 for the next 25 pages, $0.56 for the next 50 pages,

and $0.34 for an additional 94 pages, which is consistent with

     Justice Roggensack's dissent's "read in" is accomplished
only by omitting an essential part of the complaint's averments.
Citing to paragraphs 16 and 17 and Exhibit C of the complaint,
the dissent describes     Banuelos's complaint, stating "her
Complaint alleges that Ciox Health, LLC (Ciox), who is not a
health care provider, supplied the health care records and
charged $109.96." Dissent, ¶47. What the dissent omits is that
the complaint actually alleges that the supplying of the records
and the charges incurred were done at the instance of UW
Hospitals, with Ciox as a conduit.

     Paragraph 16 avers that "Defendant, through its business
associate, Ciox, complied with the request and transmitted the
medical records electronically to Habush Habush & Rottier S.C."
Paragraph 17 avers, "The response from defendant, through its
business associate, Ciox, included an invoice requesting payment
of $109.96."

     Thus, all the complaint alleges with respect to Banuelos's
specific case is that UW Hospitals "through its business
associate, Ciox, complied with the request and transmitted the
medical records electronically . . . [and] included an invoice
requesting payment of $109.96."

     In   order   to   reach   Justice   Roggensack's   dissent's
conclusion, further factual development would be necessary to
establish Ciox's role, which typically would be the subject of a
summary judgment motion, not a motion to dismiss.     For summary
judgment methodology see Wis. Stat. § 802.08.

     Perhaps the most devastating response to the dissent is
that UW Hospitals, in its reply brief, specially discarded the
dissent's newly embraced argument, deeming it "irrelevant." See
infra, ¶18 n.8.

                                5
                                                                       No.    2020AP1582

the maximum rate for paper copies of patient health care records

permitted under Wis. Stat. § 146.83(3f).6

       ¶9      Banuelos      filed        suit,      seeking      declaratory         and

injunctive relief, as well as damages.                      Her complaint alleged

that       because   the    copies    of    electronic       patient    health       care

records she requested do not fall into one of the enumerated

categories contained within Wis. Stat. § 146.83(3f), none of the

charges permitted under § 146.83(3f) applies to her electronic

records request.            Accordingly, she argued that UW Hospital's

charge of $109.96 was in violation of state law.

       ¶10     In response, UW Hospitals filed a motion to dismiss,

alleging in its supporting brief that Banuelos's claims were

"fundamentally        flawed"      with    respect    to    her   interpretation       of

Wis. Stat. § 146.83(3f).7             The circuit court granted the motion.

It   concluded       that   "the     legislature      has    failed    to    cover    the

situation where records are requested in electronic form and

provided in electronic form.               And therefore, the charge that was

made or demanded is not a violation."                  It reasoned that because
the fee UW Hospitals charged was not a violation of Wisconsin

       These numbers deviate from those listed in Wis. Stat. §
       6

146.83(3f)(b)1. due to the operation of § 146.83(3f)(c)2., which
provides for adjustments in the amounts specified based on
changes in the consumer price index.

       In its motion to
       7                            dismiss, UW Hospitals did not specify
under which paragraph              of Wis. Stat. § 802.06(2) it sought
dismissal.  The circuit            court construed the motion as a motion
to dismiss for failure             to state a claim, and we will do the
same.

                                            6
                                                            No.     2020AP1582

law, Banuelos could not prevail in this case and dismissal of

the complaint was warranted.

    ¶11     Banuelos appealed, and the court of appeals reversed

the circuit court's order.      Banuelos v. Univ. of Wis. Hosps. and

Clinics Auth., 2021 WI App 70, 399 Wis. 2d 568, 966 N.W.2d 78.

The court of appeals conducted a plain meaning analysis of Wis.

Stat. § 146.83(3f) and determined that the statute plainly and

unambiguously permits a health care provider to charge fees for

the formats enumerated in the statute and only those formats.

Because fees for copies of records in an electronic format are

not enumerated, the court of appeals concluded that such fees

cannot lawfully be charged.           UW Hospitals petitioned for this

court's review.

                                      II

    ¶12     We are called upon to review the court of appeals'

decision reversing and remanding the circuit court's dismissal

of Banuelos's complaint for failure to state a claim.               In order

to withstand a motion to dismiss for failure to state a claim,
the complaint must plead facts, which if true, would entitle the

plaintiff   to   relief.    Wis.      Stat.   §   802.02(1)(a);   Data    Key

Partners v. Permira Advisers LLC, 2014 WI 86, ¶21, 356 Wis. 2d

665, 849 N.W.2d 693.       Whether a complaint states a claim upon

which relief can be granted is a question of law this court

reviews   independently    of   the    determinations    rendered    by   the

circuit court and court of appeals.           Hinrichs v. DOW Chem. Co.,

2020 WI 2, ¶23, 389 Wis. 2d 669, 937 N.W.2d 37.

                                      7
                                                                                No.      2020AP1582

      ¶13    Our     review       also      requires        us     to    interpret          several

Wisconsin        statutes.        Statutory           interpretation           is    likewise     a

question      of     law       that      we      review          independently           of      the

determinations of the circuit court and court of appeals.                                        Sw.

Airlines    Co.     v.     DOR,   2021      WI       54,   ¶16,    397    Wis. 2d 431,           960

N.W.2d 384.

                                               III

      ¶14    The sufficiency of the claims alleged in Banuelos's

complaint        depends      upon    our     interpretation             of    Wis.      Stat.     §

146.83(3f).        Interestingly, both parties embrace a plain meaning

interpretation           of    the       statute,          but     arrive           at   opposite

conclusions.

      ¶15    In     resolving         the     inquiry        of     whether          Wis.     Stat.

§ 146.83(3f) permits a fee to be charged for copies of health

care records in electronic format, we are aided by some familiar

tools of statutory interpretation.                          With those interpretative

tools in hand, we examine first the text of § 146.83(3f).                                     Next,

we   look    to     § 146.83(3f)'s            statutory          history.           Finally,      we
address     UW    Hospitals'         arguments        advancing         that    the      scope    of

§ 146.83(3f) does not include electronic records.

                                                 A

      ¶16    The familiar tools of statutory interpretation provide

guiding principles for our inquiry.                        "[T]he purpose of statutory

interpretation is to determine what the statute means so that it

may be given its full, proper, and intended effect."                                     State ex

rel. Kalal v. Cir. Ct. for Dane Cnty., 2004 WI 58, ¶44, 271
Wis. 2d 633, 681 N.W.2d 110.                   "We assume that the legislature's
                                                 8
                                                                           No.       2020AP1582

intent    is    expressed      in     the    statutory       language."          Id.       "In

construing or interpreting a statute the court is not at liberty

to disregard the plain, clear words of the statute."                                 Id., ¶46.

If the text of the statute is plain and unambiguous, our inquiry

stops there.       Id., ¶45.

       ¶17     Statutory language is given its "common, ordinary, and

accepted       meaning,    except      that        technical      or    specially-defined

words    or      phrases       are     given        their    technical          or     special

definitional meaning."               Id.     We interpret statutory language in

context, "as part of a whole; in relation to the language of

surrounding       or   closely-related             statutes;      and     reasonably,       to

avoid absurd or unreasonable results."                       Id., ¶46.          Language is

also    interpreted       to   avoid       surplusage       and    to    give    reasonable

effect to every word.                Id.     A review of statutory history is

part of a plain meaning analysis.                    Richards v. Badger Mut. Ins.

Co., 2008 WI 52, ¶22, 309 Wis. 2d 541, 749 N.W.2d 581.

                                               B

       ¶18     In applying these principles, we look first to the
text of Wis. Stat. § 146.83(3f).                       It contains two provisions

important to our analysis.                 Paragraph (a) states:

       Except as provided in sub. (1f) or s. 51.30 or
       146.82(2), if a person requests copies of a patient's
       health care records, provides informed consent, and
       pays the applicable fees under par. (b), the health
       care provider shall provide the person making the
       request copies of the requested records.

                                               9
                                                                 No.   2020AP1582

§ 146.83(3f)(a).8

      ¶19   This      provision       unambiguously       outlines        three

requirements that a person requesting a copy of patient health

care records must fulfill:            (1) request copies, (2) provide

informed consent, and (3) pay the applicable fee set forth in

paragraph   (b).       Id.     Once    a   person   has   met     those   three

requirements, a health care provider "shall provide" the person

with the requested copies.        Id.; Heritage Farms, Inc. v. Markel

Ins. Co. (Heritage Farms II), 2012 WI 26, ¶32, 339 Wis. 2d 125,

810   N.W.2d    465   ("[W]e   presume      that    the   word     'shall'    is

mandatory.").

      ¶20   The second provision important to our discussion is

paragraph (b), which provides:

      8As referenced above in footnote 5, Justice Roggensack's
dissent produces a new argument on behalf of UW Hospitals,
arguing that because Ciox is not a health care provider, it is
not   constrained   by   Wis.  Stat.   § 146.83(3f).    Justice
Roggensack's Dissent, ¶66.       Neither party developed this
argument in its brief, nor did this argument arise during oral
arguments in this case.       UW Hospitals, in fact, actually
eschewed this argument in its reply brief, calling it
"irrelevant" to this case:

      First, Banuelos's mud-slinging in relation to Ciox
      cannot have any bearing on this case.       This court
      recently    held  that   the    fee   restrictions  in
      § 146.83(3f)(b) apply only to health care providers,
      not their vendors.   See [Townsend v. ChartSwap, LLC,
      2021 WI 86, ¶¶16—17, 399 Wis. 2d 599, 967 N.W.2d 21].
      Accordingly, the statute is, and always has been,
      directed at Wisconsin health care providers, and
      whether or not a health care provider may choose to
      outsource    its records    collection   processes  is
      irrelevant.

                                      10
                                                             No.    2020AP1582

       Except as provided in sub. (1f), a health care
       provider may charge no more than the total of all of
       the following that apply for providing the copies
       requested under par. (a):

       1. For paper copies: $1 per page for the first 25
       pages; 75 cents per page for pages 26 to 50; 50 cents
       per page for pages 51 to 100; and 30 cents per page
       for pages 101 and above.

       2. For microfiche or microfilm copies, $1.50 per page.

       3. For a print of an X-ray, $10 per image.

       4. If the requester is not the patient or a person
       authorized by the patient, for certification of
       copies, a single $8 charge.

       5. If the requester is not the patient or a person
       authorized by the patient, a single retrieval fee of
       $20 for all copies requested.

       6. Actual shipping costs and any applicable taxes.
Wis. Stat. § 146.83(3f)(b).

       ¶21    Paragraph (b) sets out the parameters of the third

requirement,     delineating   maximum    allowable   fees   that    may   be

charged for patient health care records.         Listed in the statute

are three formats in which records can be provided and fees

charged, and only three formats.         For paper copies, the fee is a

per page charge of $1 for the first 25 pages; 75 cents for pages

26-50; 50 cents for pages 51-100; and 30 cents for pages above

100.    Id.     Additionally, a health care provider is allowed to

charge no more than $1.50 per page for microfiche or microfilm

copies and $10 per image for x-ray prints.            Id.    Conspicuously

missing is any reference to copies of "electronic records" or

any substantially similar term.

                                   11
                                                                                No.     2020AP1582

       ¶22     The text of the statute sets forth that health care

providers "may charge no more than the total of all of the

following that apply for providing the copies requested."                                      Id.

That is, a health care provider may charge up to the rates

prescribed       in    the     statute    for       furnishing            copies       of    paper

records, microfiche or microfilm records, or x-rays.                                  We observe

that there is no provision in the text permitting the charge of

fees for copies in formats for which the legislature did not

expressly authorize a fee.

       ¶23     The court of appeals relied on a similar observation

in   reaching     its    conclusion       that      no    fee       may    be       charged    for

providing copies of patient health care records in an electronic

format.       Banuelos, 399 Wis. 2d 568, ¶15.                       It initially focused

on the introductory language of paragraph (b), that a health

care provider may "charge no more than the total of all of the

following,"       to    conclude       that    "para.         (b)    defines          the    total

universe of fees that a provider may collect from a requester

for the service of fulfilling a request for patient health care
records under para. (a)."                Id.        "This means that the fees a

health care provider is permitted to charge must be equal to or

less    than    the    total    of    whichever,         if    any,       of    the    six    fees

enumerated in subds. (b)1.-6. that apply . . . ."                              Id.

       ¶24     We agree with the court of appeals that the plain text

of     Wis.    Stat.     § 146.83(3f)         indicates         that           if     the    three

requirements laid out in paragraph (a) are met, the healthcare

provider       must    provide       copies    of    the      patient's             health    care
records.       We further agree with the court of appeals that the
                                              12
                                                                           No.    2020AP1582

statute does not permit charges for copies of electronic records

because the statute does not enumerate electronic formats as one

of the three formats for which a health care provider may charge

a fee.

                                                C

     ¶25        A    review   of       the    statutory       history     of    Wis.    Stat.

§ 146.83(3f) yields a similar result.                         Statutory history refers

to   previously         enacted        versions       of    the   statute       which   have

subsequently been amended by the legislature.9                            Heritage Farms,

Inc. v. Markel Ins. Co. (Heritage Farms I), 2009 WI 27, ¶15

n.10,     316       Wis. 2d 47,    762       N.W.2d    652.       Prior   versions      of   a

statute were enacted law and constitute an intrinsic source,

part and parcel of a plain meaning interpretation.                                Richards,

309 Wis. 2d 541, ¶22.

     ¶26        Prior to 2009, the relevant statutes did not mention

electronic           copies       of     medical           records.            Wis.     Stat.

§ 146.83(3m)(a) (2007-08).10                  At the time, the statute governing

     9 Statutory history is distinct from legislative history,
which "is extrinsic evidence of a law's meaning and becomes
relevant only to confirm plain meaning or when a statute remains
ambiguous even after 'the primary intrinsic analysis has been
exhausted[.]'" Brey v. State Farm Mut. Auto. Ins. Co., 2022 WI
7, ¶21, 400 Wis. 2d 417, 970 N.W.2d 1.
     10   Wis. Stat. § 146.83(3m)(a)(2007-08) states:

     The department shall, by rule, prescribe fees that are
     based on an approximation of actual costs. The fees,
     plus applicable tax, are the maximum amount that a
     health care provider may charge under sub. (1)(b) for
     duplicate patient health care records and under sub.
     (1)(c) for duplicate X−ray reports or the referral of
                                                     (continued)
                                               13
                                                            No.    2020AP1582

access to patient health care records merely provided that the

Wisconsin Department of Health Services (DHS) shall prescribe

fees, based on actual costs, which constitute the maximum amount

a health care provider may charge.      Id.

    ¶27     In   2009,   the   legislature    took   away    DHS's    broad

authority to prescribe fees and instead set permissible fees by

statute.    See 2009 Wis. Act 28, § 2433d.       The new statute, Wis.

Stat.   §    146.83(1f)(c)3m.    (2009-10),     referenced        electronic

copies, providing that "a health care provider may charge no

more than the total of all of the following that apply for

providing copies requested . . . For providing copies in digital

or electronic format, a charge for all copies requested."               This

language was mirrored in § 146.83(1h) (2009-10), which addressed

    X−rays to another health care provider of the
    patient's choice.    The rule shall also permit the
    health care provider to charge for actual postage or
    other actual delivery costs.      In determining the
    approximation of actual costs for the purposes of this
    subsection, the department may consider all of the
    following factors:

    1. Operating expenses, such as wages, rent, utilities,
    and duplication equipment and supplies.

    2. The varying cost of retrieval of records, based on
    the   different media   on  which  the   records  are
    maintained.

    3. The cost of separating requested patient               health
    care records from those that are not requested.

    4. The cost of duplicating requested patient health
    care records.

    5. The impact on costs of advances in technology.

                                   14
                                                                No.    2020AP1582

fees for a patient health care record request made by someone

other than the patient themselves.                 A new provision was also

created, stating:

       Upon the request of the person requesting copies of
       patient health care records under sub. (1f) or (1h),
       the health care provider shall provide the copies in a
       digital or electronic format unless the health care
       provider's record system does not provide for the
       creation or transmission of records in a digital or
       electronic format, in which case the health care
       provider   shall   provide   the  person   a   written
       explanation for why the copies cannot be provided in a
       digital or electronic format.
2009 Wis. Act 28, § 2433h (creating § 146.83(1k)).

       ¶28   In 2011, subsequent to a change in federal law,11 the

Wisconsin Legislature repealed § 146.83(1f) and (1h) (2009-10)

and created Wis. Stat. § 146.83(3f) as it is today, without

specific reference to electronic records.                 2011 Wis. Act 32,

§§ 2649x-2663m.        Two key changes regarding what was formerly

Wis.    Stat.    § 146.83(1f)     took   place.      First,   the    legislature

deleted two charges that were previously permissible.                  One now-

deleted provision was § 146.83(1f)(c)3m. (2009-10), which as set

forth above provided an allowable "charge" for the provision of

electronic records.          The other deleted provision authorized a

surcharge       contingent   on    the    timing    of   requested    delivery.

       As part of the American Recovery and Reinvestment Act of
       11

2009, federal law was enacted encouraging health care providers
to adopt electronic health records, mandating that individuals
may receive electronic copies and setting a fee limitation on
such copies.   American Recovery and Reinvestment Act of 2009,
H.R. 1, 111th Cong. § 13001(a) H.R. 1-112 (2009) (enacted).

                                         15
                                                                                   No.    2020AP1582

§ 146.83(1f)(c)5. (2009-10).                    Second, the legislature added two

permissible charges.                Those charges, which still exist today,

create    an    additional          surcharge         for        a    third-party        requester,

i.e., a requester who is not the patient or a person authorized

by the patient.         § 146.83(3f)(b)4-5.

       ¶29     Although       Wisconsin          statutes            previously     permitted       a

charge for the provision of electronic copies of patient health

care   records,        that       language       has     since         been     repealed.         The

legislature's chosen actions resulted in the comprehensive list

of permitted fees a health care provider may charge for copies

of   patient        health       care     records.               We    cannot     interpret       the

subsequently amended statute to permit a charge for copies of

electronic       records,          as    doing      so      would       require     us     to    read

language back into the statute that is no longer there.                                    This we

cannot do.          See Milwaukee J. Sentinel v. City of Milwaukee, 2012

WI 65, ¶37, 341 Wis. 2d 607, 815 N.W.2d 367.
                                                  D

       ¶30     UW      Hospitals           challenges                 this       plain      meaning
interpretation of the text of Wis. Stat. § 146.83(3f) and its

statutory           history        by      citing           to        surrounding         statutes.

Specifically,          it     looks       to     Wis.       Stat.       § 146.836,         entitled

"Applicability,"            and     Wis.       Stat.        § 146.81(4),          which     defines

"patient       health       care    records,"          to    argue        that    the     scope   of

§ 146.83(3f) does not cover electronic records.

       ¶31     It    argues       that    a    determination            of    whether      the    fee
provision      in     paragraph          (b)   of     Wis.        Stat.      § 146.83(3f)        even

applies      depends        on     whether        the       records          request      initially
                                                 16
                                                                          No.    2020AP1582

qualifies as a request pursuant to paragraph (a).                          UW Hospitals

observes that nothing in paragraph (a) indicates that a request

for patient health care records includes electronic records.                             It

advances that such an omission was intentional because a nearby

statute, Wis. Stat. § 146.836, unambiguously provides that only

four        statutory         provisions        apply       to   electronic       records.

Section 146.836 states:

       Sections 146.815, 146.82, 146.83(4) and 146.835[12]
       apply to all patient health care records, including
       those on which written, drawn, printed, spoken,
       visual, electromagnetic or digital information is
       recorded or preserved, regardless of physical form or
       characteristics.

According to UW Hospital, because § 146.83(3f) is not one of the

four statutory provisions applicable to electronic records, the

scope       of   paragraph        (a)   clearly       does    not    include    electronic

records.

       ¶32       Next, UW Hospitals looks to the definition of "patient

health      care       records"    found    in       Wis.    Stat.   § 146.81(4)    in   an

effort to further rebut the court of appeals' plain meaning

interpretation           of    Wis.     Stat.    § 146.83(3f).          The     definition

contained         in     § 146.81(4)       in        relevant    part    provides     that

        The sections referred to in this statute all relate to
       12

the content and confidentiality of records. The titles in order
of appearance in Wis. Stat. § 146.836 are as follows: "Contents
of certain patient health care records;" "Confidentiality of
patient health care records;" "Access to patient health care
records" (specifying prohibited actions relating to records);
and "Parents denied physical placement rights."      Wis. Stat.
§§ 146.815; 146.82; 146.83(4); 146.835.

                                                17
                                                                                    No.     2020AP1582

"'[p]atient health care records' means all records related to

the health of a patient prepared by or under the supervision of

a health care provider . . . ."                      § 146.81(4).                  Relying on the

statutory       definition,             the    court       of    appeals       determined          that

"'[p]atient health care records' means all records related to

the health of a patient prepared by or under the supervision of

a    health    care    provider,"             and    that       "all"    records          "means    all

records,"       including             electronic         records.            See    Banuelos,       399

Wis. 2d 568, ¶12 n.4.

       ¶33     UW Hospitals argues that an examination of the plain

text of the statutory definition reveals that it addresses the

substance of the records and not their format.                                 It explains that

the records must "relate to the health of the patient" and be

"prepared       by    or     under       the     supervision            of    the    health        care

provider," which are matters of substance.                                    UW Hospitals thus

reasons      that     the    definition          does      not    contemplate             records    in

electronic format.

       ¶34     Additionally, according to UW Hospitals, to interpret
the    definition           as        applying      to     all      formats         would     render

superfluous the "Applicability" statute, Wis. Stat. § 146.836,

given that it limits the applicability of electronic records

formats to only four enumerated provisions.                                  To explain briefly

in    the     words    of        UW    Hospitals,         "[i]f     'patient         health        care

records' included electronic records whenever that term appears,

then there was no need for the legislature to specify" in the
"Applicability" section that the definition of "patient health

                                                    18
                                                                   No.    2020AP1582

care records" in the four listed provisions also applies to

electronic records.
    ¶35     We are unpersuaded and address each argument in turn.

To start, we conclude that Banuelos's request for electronic

records was a request under Wis. Stat. § 146.83(3f)(a).                          This

conclusion is informed by the definition of "patient health care

records."        In turning to the statutory definition of "patient

health    care    record"    in   Wis.    Stat.    § 146.81(4)     we     make    two

important    observations.        Initially,       we   observe    the    threshold

language in § 146.81 indicates that the definitions listed in

§ 146.81 apply to "ss. 146.81 to 146.84."                 § 146.81.      This range

includes the statute at the center of our analysis, Wis. Stat. §

146.83.     We observe next that the legislature used the inclusive

term, "all" in the definition of "patient health care record."

Indeed, it is evident that "all records" means "all records."

See Pfister v. Milwaukee Econ. Dev. Corp., 216 Wis. 2d 243, 270,

576 N.W.2d 554 (Ct. App. 1998) (concluding that "'all' means

'all'").
    ¶36     Thus     under   this   definition,         "patient      health     care

record"     means    "all    records,"        including    electronic      records.

Because paragraph (a) regulates access to "patient health care

records," Wis. Stat. § 146.83(3f)(a) encompasses requests for

electronic records as well.              We resolve UW Hospitals' argument

that paragraph (a) does not apply to electronic records due to

the "Applicability" statute, Wis. Stat. § 146.836, in the same

manner as its related argument that to interpret "patient health
care records" as "all records," renders superfluous § 146.836.
                                         19
                                                                         No.   2020AP1582

      ¶37     These arguments fail for several reasons.                    First, they

ignore the fact that Wis. Stat. § 146.83(3f) regulates access to

"copies" of patient health care records, not the actual records.

The    text    of     Wis.      Stat.   § 146.836      "does    not       address    the

significance        of    the    distinction      between      the       reference    to

'electronic records' in § 146.836 and the reference to 'copies

of a patient's health care records' in Wis. Stat. § 146.83(3f)."

Banuelos, 399 Wis. 2d 568, ¶39.                 UW Hospitals is not able to

articulate any language in the "Applicability" section limiting

"copies" to a particular format.

      ¶38     Second,      UW    Hospitals'      interpretation           of   "patient

health care record" as excluding electronic records for purposes

of all but four statutory sections is unavailing because of the

impact     such     an   interpretation     would      have    on    other     statutes

discussing "patient health care records."                   For example, we look

to    Wis.    Stat.      § 146.819(1),13       which   governs       a    health     care

      13   Wis. Stat. § 146.819(1) states:

      Except as provided in sub. (4), any health care
      provider who ceases practice or business as a health
      care provider or the personal representative of a
      deceased health care provider who was an independent
      practitioner shall do one of the following for all
      patient health care records in the possession of the
      health care provider when the health care provider
      ceased business or practice or died:

      (a) Provide for the maintenance of the patient health
      care records by a person who states, in writing, that
      the records will be maintained in compliance with ss.
      146.81 to 146.835.

                                                                           (continued)
                                          20
                                                                        No.   2020AP1582

provider's responsibility upon ceasing practice, including that

such a provider must maintain, delete, or destroy patient health

care records in their possession.                   UW Hospitals' interpretation

suggests that § 146.819(1) requires that a former health care

provider must maintain or destroy only physical patient health

care records, as records in electronic format would be excluded

from this statute's purview.                 Given the ubiquity of electronic

record keeping, excluding electronic records from this statutory

mandate because of an amorphous link to Wis. Stat. § 146.836

makes no sense.        See also Wis. Stat. § 146.84 (excluding records

in   electronic   format         from   a    section      imposing   violations     for

actions taken in relation to handling related to "patient health

care records" would likewise make no sense).

      ¶39   Third, the text of Wis. Stat. § 146.836 limits its

applicability     to    four      enumerated         statutes,   and     ensures    the

confidentiality of "written, drawn, printed, spoken, visual" and

electronic information.            The enumerated statutes are Wis. Stat.

§ 146.815    (content       of   hospital         records);   Wis.   Stat.    § 146.82
(confidentiality       of    records        and    informed   consent    to   access);

Wis. Stat.    § 146.83(4) (prohibiting certain actions regarding

patient     records);       and     Wis.          Stat.   § 146.835      (maintaining

      (b) Provide for the deletion or destruction of the
      patient health care records.

      (c) Provide for the maintenance of some of the patient
      health care records, as specified in par. (a), and for
      the deletion or destruction of some of the records, as
      specified in par. (b).

                                             21
                                                                       No.    2020AP1582

confidentiality from parents that are denied physical placement

of a child).        Nothing in the text of § 146.836 changes the

definition of "patient health care records" as applied to Wis.

Stat. § 146.83(3f), nor any other statute.                       If § 146.836 was

intended    to   have    the   far   reaching      effect    as    espoused      by    UW

Hospitals, one would expect it to be clearly reflected in the

text.

    ¶40     Finally, we turn to UW Hospitals' remaining argument

that the definition of "patient health care record" is one of

substance    and   not    format.       This    curious      argument         does    not

support the conclusion UW Hospitals would have us draw from it

to exclude electronic records from the definition.                           Regardless

of whether it relates to the "substance" of the record or its

"format," the legislature chose to define "patient health care

records" as "all records."           State ex rel. Girouard v. Cir. Ct.

for Jackson Cnty., 155 Wis. 2d 148, 156, 454 N.W.2d 792 (1990)

("When a word used in a statute is defined in the statutes, that

definition is controlling.").
    ¶41     Thus we conclude that Wis. Stat. § 146.836 does not

serve as an omnibus statute, intending to supersede in scope all

statutes that reference health care records.                      Rather, the four

enumerated        statutes      cover        matters        of         content        and

confidentiality, and there is nothing in the text to indicate

that its circumference was intended to expand beyond that narrow

field.       It     neither      limits      the     scope        of     Wis.     Stat.

§ 146.83(3f)(a) nor is it rendered superfluous by the definition
of "patient health care records" in Wis. Stat. § 146.81(4).                            We
                                        22
                                                                            No.    2020AP1582

instead remain wedded to the statutory definition of "patient

health care records," determining that "all" indeed does mean

"all."

       ¶42    At times it appears as though UW Hospitals' arguments

endeavor to place this court in the very midst of an important

policy decision.            It frames the essence of our inquiry as:                         "At

bottom, this case asks who should bear the cost of supporting

these commercial entities' profit making:                       the Wisconsin health

care   system      (and     ultimately,      all    Wisconsin       patients)           or    the

commercial entities themselves."

       ¶43    It restates the question before the court as relating

to how the court should apportion the costs involved:                                        "The

question      here . . . relates            to     how    the     cost      of     providing

electronic records access should be apportioned as between the

health    care     provider       and    commercial       third   parties . . .               who

choose,      for   their      own       business    reasons,      to     obtain      records

directly      from     health       care    providers       rather       than     from       the

patients who are their customers."
       ¶44    We disagree.          At bottom, our inquiry is neither about

"who     should      bear    the     cost    of    supporting        these        commercial

entities' profit making" nor is the question before us "how the

cost   of    providing       electronic      records"       should     be     apportioned.

Rather,      our   task      is    to    discern    the    meaning       of      Wis.    Stat.

§ 146.83(3f), and this we have done in the discussion above.

"It goes without saying, of course, that the legislature may

amend the fee provisions.                   Policy decisions are left to the
legislature."        Milwaukee J. Sentinel, 341 Wis. 2d 607, ¶37.
                                             23
                                                              No.     2020AP1582

    ¶45     In sum, we conclude that Wis. Stat. § 146.83(3f) does

not permit health care providers to charge fees for electronic

records.     Therefore, Banuelos's complaint states a claim upon

which relief can be granted that UW Hospital's charge of $109.96

was a violation of Wisconsin law.             Accordingly, we affirm the

decision of the court of appeals.

    By     the   Court.—The   decision   of    the   court   of     appeals   is

affirmed.

                                    24
                                                          No.    2020AP1582.pdr

     ¶46     PATIENCE   DRAKE    ROGGENSACK,      J.   (dissenting).        We

review a motion to dismiss.         According to the majority opinion,

we are asked to determine whether Wis. Stat. § 146.83(3f)(b)'s

permission to health care providers to charge for copies of

health care records that are provided in paper, microfilm and X-

ray formats is also a prohibition against health care providers

charging for copies of health care records in electronic format.1

     ¶47     I conclude that Beatriz Banuelos's Complaint fails to

state    a   claim   against    University   of   Wisconsin     Hospital   and

Clinics Authority ("UW Hospital") because her Complaint alleges

that Ciox Health, LLC (Ciox), who is not a health care provider,

supplied the health care records and charged $109.96 for them,

payable to Ciox.2       Wisconsin Stat. § 146.83(3f)(b), invoked and

relied on by the majority opinion, does not regulate persons who

are not health care providers.         Townsend v. ChartSwap, LLC, 2021

WI 86, ¶14, 399 Wis. 2d 599, 967 N.W.2d 21 (explaining that

"[b]y the terms of the statute itself, these restrictions apply
only to health care providers"); Smith v. RecordQuest, LLC, 380

F. Supp. 3d 838, 842 (E.D. Wis. 2019) (explaining that "[t]he

statute does not impose liability on a person who is not a

health care provider but who responds to records requests on

behalf of a health care provider").3

     1   Majority op., ¶4.
     2 Complaint, ¶¶16, 17; Banuelos – Exhibit 3 (attached to the
Complaint and to this dissent).
     3   The Seventh Circuit reversed Smith v. RecordQuest, LLC,
                                                      (continued)
                                 1
                                                                      No.    2020AP1582.pdr

       ¶48   Permitting      a    claim    against       UW    Hospital      for   charges

made by Ciox for the provision of health care records is not

addressed in Wis. Stat. § 146.83(3f)(b).4                       Whether to permit a

claim against a health care provider for charges made by a third

party for the provision of health care records, whether                                 the

third party is denominated a "conduit," a "business associate"

or    something     else,    is    a     policy       choice   better       left   to   the

legislature.      The charges the Complaint alleges Ciox made here

are    not   contrary       to    the    plain    meaning       of    § 146.83(3f)(b);

therefore,    the    Complaint          fails    to    state    a    claim    against   UW

Hospital and must be dismissed.

       ¶49   The majority opinion ignores material facts that are

alleged in Banuelos's Complaint and the effect of Townsend on

380 F. Supp 3d 838 (E.D. Wis. 2019) in Smith v. RecordQuest,
LLC, 989 F.3d 513 (7th Cir. 2021).    However, in reversing the
Eastern District of Wisconsin to determine that Wis. Stat.
§ 146.83(3f)(b) applied to a "health care records company," the
Seventh Circuit relied on Townsend v. ChartSwap, LLC, 2020 WI
App 79, 395 Wis. 2d 229, 952 N.W.2d 831. Just months after the
Seventh Circuit's decision, this court reversed the Wisconsin
Court of Appeals in Townsend v. ChartSwap, LLC, 2021 WI 86, 399
Wis. 2 599, 967 N.W.2d 21.    Effectively, the Eastern District
of Wisconsin's determinations in Smith are consistent with
Wisconsin law. See also id., 399 Wis. 2d 599, ¶¶9 n.6, 32.

       The majority alleges that Ciox is a "conduit" and a
       4

"business associate" of UW Hospital.       Majority op., ¶8 n.5.
That may be true, but that does not make Ciox a health care
provider according to the definition of health care provider in
Wis. Stat. § 146.81(1).     And, only health care providers are
restricted   by  Wis.   Stat.   § 146.83(3f)(b).     Townsend  v.
ChartSwap, LLC, 2021 WI 86, ¶14, 399 Wis. 2d 599, 967 N.W.2d 21.

                                            2
                                                             No.    2020AP1582.pdr

the pending motion to dismiss, given those facts.                  Accordingly,

I respectfully dissent.5

                              I.     BACKGROUND

     ¶50   Wisconsin Stat. § 146.83(3f) is central to our review.

It was enacted in 2011 Wis. Act 32 § 9321(4), effective July 1,

2011.

     ¶51   Banuelos alleges she requested her health care records

be sent to her attorneys in electronic format.           She alleges that

the records were provided, but that she was charged fees in

excess of that permitted by Wis. Stat. § 146.83(3f)(b).                        UW

Hospital   moved    to    dismiss.      The   circuit   court       granted    UW

Hospital's motion because charges for electronic documents are

not mentioned in § 146.83(3f)(b) and therefore, the charge for

electronic copies was not regulated by subsec. (3f)(b).

     ¶52   The court of appeals reversed, concluding that it is

"self-evident" that because there is no listing of "applicable

fees under par. (b)" for electronic copies, the records must

still be provided.       However, no fees may be charged.6
     ¶53   Rather    than    reviewing     facts   alleged     in    Banuelos's

complaint, as a motion to dismiss requires, the majority opinion

slides over that obligation.          Instead, it interprets Wis. Stat.

§ 146.83(3f)(b)'s silence in regard to electronic records as a

     5 When on a motion to dismiss a majority opinion ignores the
facts alleged in the complaint, it invites a motion for
reconsideration.
     6 Banuelos v. Univ. of Wis. Hosps. and Clinics Auth., 2021
WI App 70, ¶¶13, 14, 399 Wis. 2d 568, 966 N.W.2d 78.

                                       3
                                                                         No.   2020AP1582.pdr

prohibition on charging for those records, notwithstanding that

UW Hospital charged Banuelos's lawyers nothing for health care

records that Ciox provided.7

                                       II.   DISCUSSION

                                  A.    Standard of Review

     ¶54       The dispute before us presents as a motion to dismiss.

Whether facts alleged in a complaint are sufficient to state a

claim    for    relief       is    a    question      of    law    for   our   independent

review.        Townsend, 399 Wis. 2d 599, ¶10.                       This dispute also

requires       us     to   interpret         and    apply       statutes.       These    are

additional          questions      of    law       that    we     independently     decide.

Marder v. Bd. of Regents of Univ. of Wis. Sys., 2005 WI 159,

¶19, 286 Wis. 2d 252, 706 N.W.2d 110.

                                  B.    Motion to Dismiss

                                  1.    Legal Principles

     ¶55       A motion to dismiss tests the legal sufficiency of the

complaint.          Townsend, 399 Wis. 2d 599, ¶10.                 In order to survive

a motion to dismiss, a complaint must allege facts, which if
true, would entitle the pleader to relief.                         Data Key Partners v.

Permira Advisers LLC, 2014 WI 86, ¶21, 356 Wis. 2d 665, 849

N.W.2d 693.           Although for purposes of the pending motion, we

accept as true all facts well-pleaded and reasonable inferences

therefrom, we cannot add facts to a complaint.                              Townsend, 399

Wis. 2d    599,       ¶10.        In    addition,     we    give    no   deference      to   a

     7   Majority op., ¶1.

                                               4
                                                                         No.   2020AP1582.pdr

complaint's legal conclusions.                      Id.     Accordingly, I begin with

the factual allegations stated in Banuelos's Complaint.

                               2.    Banuelos's Complaint

                  a.    Facts Found in Banuelos's Complaint

       ¶56     Her   Complaint         alleges:          "From    2016   to    January    23,

2020, all major institutional health care providers, like UW

Health in Wisconsin and their business associates, like Ciox,

were complying with the DHHS guidance and charging a cost-based

fee, $6.50 in the vast majority of cases, upon receipt of a

HITECH[8] electronic medical records request from the patient

with the patient's lawyers designated to receive the records."9

       ¶57     "On January 23, 2020, a Federal District Court on the

D.C. Circuit issued a Memorandum Opinion in [Ciox Health, LLC v.

Azar, 435 F. Supp. 3d 30 (D.D.C. Jan. 2020)], indicating that

the 2016 DHHS guidance document entitling patients to the cost-

based fee when the medical records were directed to be received

by a third party, like a law firm, was unenforceable."10                                After

this       federal     court        decision,       UW     Hospital      and   Ciox     began
informing       patients       who    had   requested            electronic    health    care

records under HITECH and designated receipt by a third-party

that their requests would be fulfilled according to allowable

       HITECH is the acronym for Health Information Technology
       8

for Economic and Clinical Health Act.
       9    Complaint, ¶9.
       10   Id., ¶10.

                                                5
                                                                No.    2020AP1582.pdr

state     costs,   not   the    earlier       mandate    in   the    DHHS    guidance

document.11

     ¶58     On February 27, 2020, Banuelos requested copies of her

health care records in electronic format.12                   She directed that

the copies be sent to her lawyers.13                    Ciox sent the requested

health care records electronically to Banuelos's lawyers.14                       Ciox

also included its invoice requesting payment of $109.96 to Ciox

at   "P.O.    Box     409740,     Atlanta,       Georgia      30384-9740,"        with

questions by email directed to "collections@cioxhealth.com."15

                          b.    The Applicable Law

     ¶59     Banuelos relies on Wis. Stat. § 146.83(3f)(b) for her

claim against UW Hospital that she was charged excessive fees.16

Section 146.83(3f)(b) provides in relevant part:

          (b) Except as provided in sub (1f), a health
     care provider may charge no more than the total of all
     of the following that apply for providing the copies
     requested under par. (a) . . . .
     ¶60     We have interpreted Wis. Stat. § 146.83(3f)(b) in a

prior     decision.       Townsend,       399     Wis. 2d     599,     ¶2.        Past

interpretations of a statute become part of our understanding of

     11   Id., ¶12.
     12   Id., ¶14.
     13   Id., ¶15.
     14   Id., ¶16.
     15Id., ¶17; "Banuelos – Exhibit                     3"   (attached      to    the
Complaint and attached to this dissent).
     16   Id., ¶22.

                                          6
                                                                 No.   2020AP1582.pdr

the meaning of the statute.             Adams v. Northland Equip. Co.,

Inc., 2014 WI 79, ¶30, 356 Wis. 2d 529, 850 N.W.2d 272; State v.

Soto, 2012 WI 93, ¶20, 343 Wis. 2d 43, 817 N.W.2d 848.

       ¶61    In Townsend, we had a claim similar to that set out in

Banuelos's complaint, where ChartSwap provided and charged for

medical records that had been requested from the health care

provider, Milwaukee Radiologists.              Townsend, 399 Wis. 2d 599,

¶4.     Here, Banuelos's Complaint requested health care records

from UW Hospital and Ciox provided the records and billed for

payment of $109.96, directing that payment be made to Ciox.17

       ¶62    In Townsend, we concluded that under a plain meaning

interpretation of Wis. Stat. § 146.81(1), "ChartSwap is not a

health care provider."           Id., ¶2.     We also concluded that Wis.

Stat. § 146.83(3f)(b) regulates only health care providers.                      Id.

Therefore, because ChartSwap was not a health care provider and

§ 146.83(3f)(b)        regulated       only      health         care    providers,

§ 146.83(3f)(b) did not regulate ChartSwap.               Id.

       ¶63    In parallel with Townsend, Ciox is not a health care
provider because it meets none of the identifications provided

by Wis. Stat. § 146.81(1)(a)–(s).             Because Ciox is not a health

care    provider,     it    is   not   subject     to     fee     regulations     in

§ 146.83(3f)(b).           Id.     Therefore,      the     payment      Banuelos's

attorneys made to Ciox does not come within subsec. (3f)(b).

Smith confirms this conclusion as it explains:

       17   Id., ¶¶14, 16, 17.

                                        7
                                                                   No.    2020AP1582.pdr

       [P]laintiff's argument finds no support in the text of
       the statute. The statute does not impose liability on
       a person who is not a health care provider but who
       responds to records requests on behalf of a health
       care provider.
Smith, 380 F. Supp. 3d at 842.

       ¶64    This case differs from Townsend and Smith in that the

health care provider, UW Hospital, was named as the defendant,

rather than naming the entity that provided the records and

charged      for    their     provision.        However,    Banuelos's            Complaint

bases its alleged statutory violation on the Ciox bill and the

payment      to     Ciox.      The   Complaint      does    not    make       a    factual

allegation        that   UW   Hospital     billed    or    collected      anything      in

regard to the provision of Banuelos's health care records.

       ¶65    Banuelos's Complaint tries to avoid this problem by

alleging      "charges        submitted    by    defendant,       UW     Hospital      and

Clinics Authority, through its business associate, Ciox, to the

plaintiff,         Beatriz    Banuelos,    are    not     permitted      by   Wisconsin

Statutes § 146.83(3f)."18            However, Banuelos cites no statutory

language in § 146.83(3f) to support this legal conclusion.

       ¶66    Wisconsin Stat. § 146.83(3f)(b) regulates health care

providers.         It does not regulate business associates of health

care providers.          If the legislature chooses to cause health care

providers to incur liability for acts of a business associate,

that is a policy choice the legislature can make by amending the

statute.       However, as the statute is now written, it regulates

only    health       care     providers    for      charges    that      health       care

       18   Id., ¶25.

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                                                               No.   2020AP1582.pdr

providers impose.       Townsend firmly sets aside Banuelos's claim

because Ciox is not a health care provider and, as her Complaint

alleges, Ciox charged and collected for the records.19                   Townsend,

399 Wis. 2d 599, ¶2; Smith, 380 F. Supp. 3d at 842.

      ¶67    The majority opinion never quotes or analyzes facts

alleged in Banuelos's Complaint.               Instead, it sets out facts

that it creates to enable it to get to where it wants to go.

For   example,    Banuelos's       Complaint    does    not     state    that    UW

Hospital "transmitted . . . an invoice for $109.96" or made a

"charge of $109.96" as the majority opinion states.20                     Instead,

her   Complaint    alleges   that     Ciox     made    that    charge,    and    it

attaches the invoice from Ciox showing payment is due to Ciox,

not to UW Hospital.      See invoice copy attached to dissent.

      ¶68    Accordingly,    because    Banuelos's       Complaint       fails   to

state a claim against UW Hospital that comes within the plain

meaning of Wis. Stat. § 146.83(3f)(b), her Complaint must be

dismissed.      Because the majority opinion does not review facts

actually      alleged   in   the     Complaint,       and     instead    rewrites
§ 146.83(3f)(b) to make a policy choice that belongs to the

legislature, I respectfully dissent.

                             III.     CONCLUSION

       A health care provider is defined in Wis. Stat.
      19

§ 146.81(1).   Ciox does not fit within any of those persons
listed in subsec. (1)(a)-(s), even when described as a "business
associate" of a health care provider.
      20   Majority op., ¶¶8, 9.

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                                                                        No.    2020AP1582.pdr

       ¶69     I conclude that Banuelos's Complaint fails to state a

claim against UW Hospital because it alleges that Ciox, who is

not a health care provider, supplied the health care records and

charged $109.96 for them, payable to Ciox.21                            Wisconsin Stat.

§ 146.83(3f)(b), invoked and relied on by the majority opinion,

does not regulate persons who are not health care providers.

Townsend, 399 Wis. 2d 599, ¶14; Smith, 380 F. Supp. 3d at 842.

       ¶70     Permitting       a    claim     against     UW    Hospital      for    charges

made by Ciox for the provision of health care records is not

addressed in Wis. Stat. § 146.83(3f)(b).                          Whether to permit a

claim against a health care provider for charges made by a third

party for the provision of health care                           records, whether the

third party is denominated a "conduit," a "business associate"

or    something        else,    is    a    policy       choice   better       left    to   the

legislature.       The charges Banuelos's Complaint alleges Ciox made

here     are     not     contrary         to   § 146.83(3f)(b);          therefore,        the

Complaint fails to state a claim against UW Hospital and must be

dismissed.
       ¶71     The majority opinion ignores material facts that are

alleged in Banuelos's Complaint and the effect of Townsend on

the pending motion to dismiss, given those facts.                             Accordingly,

I respectfully dissent.

       ¶72     Although I conclude the Complaint should be dismissed

for    the     reasons    stated      above,        I   agree    with   Justice       Rebecca

Grassl       Bradley’s         statutory       interpretation           of     Wis.     Stat.

       Id., ¶¶16, 17; Banuelos – Exhibit 3 (attached to the
       21

Complaint).

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                                               No.    2020AP1582.pdr

§ 146.83(3f) as applied to "health care providers."     Therefore,

I join her dissent.

                              11
     No.   2020AP1582.pdr

12
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     ¶73    REBECCA       GRASSL       BRADLEY,   J.      (dissenting).             Beatriz

Banuelos    requested       electronic       health       care    records         from    her

health    care    provider,       University      of   Wisconsin        Hospitals        and

Clinics    Authority       (UW     Health),       which    provided         the    records

through    Ciox    Health,       LLC    (Ciox),    a   service        provider.          Ciox

charged Banuelos $109.96 for providing the requested records.

Banuelos sued UW Health, alleging it had no statutory authority

under    Wis.     Stat.   § 146.83(3f)          (2021–22)1       to   charge       for    the

provision of electronic records.                  Misinterpreting the statutory

text, the majority agrees with Banuelos and concludes Wis. Stat.

§ 146.83(3f) prohibits such charges.                      The majority is wrong.

Wisconsin Stat. § 146.83(3f) is silent as to the amount health

care providers may charge for the provision of electronic health

care records.       The absence of any state regulation of such fees

means providers retain the freedom to charge them, subject only

to federal law.

                            I.     The Statutory Text

     [T]he construction must be made upon the entire
     instrument, and not merely upon disjointed parts of
     it.
Herbert Broom, A Selection of Legal Maxims 440 (Joseph Gerald

Pease & Herbert Chitty eds., 8th ed. 1911).

     ¶74    The majority misconstrues Wis. Stat. § 146.83(3f) as

an authorization of private economic activity, namely, charging

for the provision of health care records.                         Like the court of

     1 All subsequent references to the Wisconsin Statutes are to
the 2021–22 version unless otherwise indicated.

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appeals, the majority concludes:            "[§ 146.83(3f)] does not permit

charges for copies of electronic records because the statute

does   not   enumerate     electronic       formats    as   one   of     the     three

formats for which a health care provider may charge a fee," and

"there is no provision in the text permitting the charge of fees

for    copies     in   formats    for   which    the    legislature        did     not

expressly authorize a fee."             Majority op. ¶¶24, 22.                 In the

absence of constitutionally legitimate regulation, people do not

require the State's permission to engage in economic activity.

Because the applicable statute does not impose a statutory cap

on charges for providing electronic health records, the provider

may charge whatever it chooses——subject to federal law, which

does impose a limit.       42 U.S.C. § 17935(e)(3) (2012).

       ¶75   Wisconsin    Stat.    § 146.83(3f)        requires     health        care

providers to provide health care records upon request.                           Wis.

Stat. § 146.83(3f)(a).           The statute imposes caps on the fees

providers may charge for providing records in particular forms

including    paper,     microfiche,     and   x-ray    prints.         Wis.      Stat.
§ 146.83(3f)(b).       For reference, the statute provides:

       (a)   [I]f a person requests copies of a patient's
             health care records, provides informed consent,
             and pays the applicable fees under par. (b), the
             health care provider shall provide the person
             making the request copies of the requested
             records.

       (b)   [A] health care provider may charge no more than
             the total of all of the following that apply for
             providing the copies requested under par. (a):

             1.    For paper copies: $1 per page for the first
                   25 pages; 75 cents per page for pages 26 to
                   50; 50 cents per page for pages 51 to 100;

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                    and 30    cents   per     page    for     pages      101    and
                    above.

            2.      For microfiche      or    microfilm       copies,      $1.50
                    per page.

            3.      For a print of an X-ray, $10 per image.

            4.      If the requester is not the patient or a
                    person   authorized  by   the  patient,   for
                    certification of copies, a single $8 charge.

            5.      If the requester is not the patient or a
                    person authorized by the patient, a single
                    retrieval  fee   of  $20  for  all  copies
                    requested.

            6.      Actual   shipping    costs        and    any   applicable
                    taxes.
Paragraphs (a) and (b) must be read as a whole, and in the

context of surrounding statutes.              State ex rel. Kalal v. Circuit

Court for Dane Cnty., 2004 WI 58, ¶46, 271 Wis. 2d 633, 681

N.W.2d 110.

      ¶76   Under    paragraph    (a),       health    care    providers         "shall"

provide copies of a patient's health care records to each person

who requests them, with the patient's informed consent.                               The

word "shall" is mandatory.            Heritage Farms, Inc. v. Markel 8

Ins. Co. (Heritage Farms II), 2012 WI 26, ¶32, 339 Wis. 2d 125,
810   N.W.2d 465      ("[W]e     presume       that    the     word       'shall'     is

mandatory"); Antonin Scalia & Bryan A. Garner, Reading Law: The

Interpretation of Legal Texts 112 (2012) (Mandatory/Permissive

Canon) ("The traditional, commonly repeated rule is that shall

is mandatory and          may is permissive").              Compliance with this

provision necessarily imposes costs on the provider.                            In 2011,

for   instance,     the    average    request        for    health       care    records
"total[ed] 61 pages in length" and cost providers "an average"

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of $62.22 in "direct processing."                              Legislative Fiscal Bureau,

Joint Fin. Cmte., Paper #367 (May 18, 2011) at 6.                                   The statute

requires health care providers to shoulder a substantial cost;

the total fee that can be charged under paragraph (b) for an

average      request      of    61     pages       equals       only    $36.35.       Id.       The

statutory scheme reflects a legislative balancing of patients'

interest in guaranteed and affordable access to their health

care    records         and     the       health       care      provider's         interest     in

recouping the costs of providing them.

       ¶77    Nothing          in     paragraph           (a)       requires      health       care

providers         to    give        requesters         any      health    care      records     in

electronic form.              The statutory limits on fees under paragraph

(b) apply only to requests for the form of records expressly

listed in paragraph (b)(1–6).                      Health care records in electronic

form   are    not       listed       in    paragraph         (b);     therefore,      electronic

health care records are not subject to any cap on fees the

provider      may       charge.           Requests        for    electronic         health     care

records fall beyond the scope of § 146.83(3f) altogether because
records      in    electronic         form       are     not    mentioned      at    all.      The

majority      converts         the     legislature's            silence     with      regard     to

electronic health care records into a mandate that health care

providers provide them at no charge.                           Had the legislature wished

to impose such an obligation on health care providers, it would

have done so explicitly.                   "[T]he legislature knows how to write

a   statute       accomplishing            the     work"        the    majority      would     have

§ 146.83(3f)           perform.           Teigen    v.    Wisconsin       Elections      Comm'n,

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2022 WI 64, ¶49, 403 Wis. 2d 607, 976 N.W.2d 519 (citing State

v. Yakich, 2022 WI 8, ¶26, 400 Wis. 2d 549, 970 N.W.2d 12).

       ¶78   Although the majority claims both paragraphs (a) and

(b) are "important" to its analysis and purports to read those

paragraphs     in   their   proper   context,     the    majority       does    not

consider Wis. Stat. § 146.83(3f) as a whole text.                   Majority op.,

¶¶17, 18.      The majority commits an interpretive fault perhaps

"more common" than any other.         Scalia & Garner, Reading Law 167.

As we have stated in countless cases, statutory text may not be

read   in    isolation.      See,    e.g.,    State     ex   rel.     Zignego    v.

Wisconsin Elections Comm'n, 2021 WI 32, ¶12, 396 Wis. 2d 391,

957 N.W.2d 208 ("When interpreting statutes, we focus primarily

on the language of the statute, looking as well to its statutory

context and structure"); see also Stroede v. Soc'y Ins. & R.R.

Station, LLC, 2021 WI 43, ¶11, 397 Wis. 2d 17, 959 N.W.2d 305

("[Statutory] language is 'interpreted in the context in which

it is used, not in isolation but as part of a whole.'") (quoting

Kalal, 271 Wis. 2d 633, ¶46); Piper v. Jones Dairy Farm, 2020 WI
28, ¶27, 390 Wis. 2d 762, 940 N.W.2d 701 ("As with statutory

interpretation, we interpret the language of a regulation in the

context in which it is used, 'not in isolation but as part of a

whole; in relation to the language of surrounding or closely-

related [regulations]'") (citing             Williams v. Integrated Cmty.

Servs., Inc., 2007 WI App 159, ¶12, 303 Wis. 2d 697, 736 N.W.2d

                                       5
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226)       (quoting    Kalal,      271   Wis. 2d 633,         ¶46).2         The   majority

opinion represents another failure to apply the whole-text canon

correctly.         See, e.g., Zignego, 2021 WI 32, ¶52 (Rebecca Grassl

Bradley, J., dissenting).

       ¶79     The    majority      fails   to    read        paragraph      (b)   in    the

context      of    paragraph     (a).       It    misconstrues         the     portion   of

paragraph (b) under which health care providers "may charge no

more than the total of all of the following that apply for

providing the copies requested."                       Majority op., ¶22 (quoting

Wis.       Stat.     § 146.83(3f)(b)).           The    majority       translates       this

language to mean "a health care provider may charge up to the

rates prescribed in the statute for furnishing copies of paper

records,      microfiche      or    microfilm      records,       or    x-rays."         Id.

Because the majority "observe[s] that there is no provision in

the text permitting the charge of fees for copies in formats for

which the legislature did not expressly authorize a fee," it

concludes Wis. Stat. § 146.83(3f) "does not permit charges for

copies of electronic records[.]"                       Id., ¶24 (emphasis added).
The majority badly misreads the statute.

       ¶80     Interpreting         Wis.        Stat.         § 146.83(3f)         as     an

authorization          of   certain      charges,       the     majority      incorrectly

concludes paragraph (b) applies to all requests for health care

       The United States Supreme Court has espoused the same
       2

principle.   See Panama Ref. Co. v. Ryan, 293 U.S. 388, 439
(1935) (Cardozo, J., dissenting) ("[T]he meaning of a statute is
to be looked for, not in any single section, but in all the
parts together and in their relation to the end in view"); Davis
v. Michigan Dep't of Treasury, 489 U.S. 803, 809 (1989)
("[S]tatutory language cannot be construed in a vacuum").

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records, whatever the form.                  As explained above, § 146.83(3f)

does not authorize any activity; rather, it limits the amounts

health    care     providers        may    charge     for   delivering      only     those

records requested in the particular forms listed in paragraph

(b).     Paragraph (b) regulates economic activity by capping fees

for    records     requested        in    particular     formats,     and    electronic

records are not among them.                Because this statute does not apply

to electronic health care records, the fees charged by health

care     providers       for    their       provision       have    no     limit     under

§ 146.83(3f).

       ¶81     Because    the       majority       "observe[s]     that    there    is    no

provision in the text permitting the charge of fees for copies

in formats for which the legislature did not expressly authorize

a fee," it concludes Wis. Stat. § 146.83(3f) "does not permit

charges      for   copies      of    electronic       records[.]"         Majority    op.,

¶¶22,    24.       The   majority         converts     statutory     silence       into   a

statutory prohibition, at the expense of fundamental freedom.

As amicus Wisconsin Civil Justice Council, Inc. put it, "[i]n a
free society, private behavior is allowed unless prohibited by

law.     Free people do not need the government's permission before

engaging in private conduct."               Wis. Civ. Just. Council Br. at 6.

                                    II.    First Principles

       ¶82 Liberty is not provided by government; liberty
       preexists government. It is not a gift from the
       sovereign; it is our natural birthright. Fixed.
       Innate. Unalienable.
Patel v. Texas Dep't of Licensing & Regul., 469 S.W.3d 69, 92–93
(Tex. 2015) (Willet, J., concurring).                       The Founders fought a

                                               7
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revolution to reclaim the people's liberty, and established our

republican form of government to secure this birthright freedom:

    We hold these truths to be self-evident, that all Men
    are created equal, that they are endowed by their
    Creator with certain unalienable Rights, that among
    these are Life, Liberty, and the Pursuit of Happiness—
    That   to   secure  these    Rights, Governments   are
    instituted among Men, deriving their just Powers from
    the Consent of the Governed.
The Declaration of Independence para. 2 (U.S. 1776) (emphasis

added).       The Wisconsin Constitution enshrines liberty in its

very first provision:

    All people are born equally free and independent, and
    have certain inherent rights; among these are life,
    liberty and the pursuit of happiness; to secure these
    rights, governments are instituted, deriving their
    just powers from the consent of the governed.
Wis. Const. art. I, § 1 (emphasis added).                 "Too much dignity

cannot well be given to that declaration."              State v. Redmon, 134

Wis. 89, 101, 114 N.W. 137 (1907). "An inherent right to liberty

means   all    people   are   born   with   it;   the   government   does   not

bestow it upon us and it may not infringe it."              Porter v. State,

2018 WI 79, ¶52, 382 Wis. 2d 697, 913 N.W.2d 842 (Rebecca Grassl
Bradley & Kelly, JJ., dissenting).

    ¶83       John Locke, whose works influenced the Framers, built

his theories of government on the immutable principle that all

"are born free," and therefore, "[a]ll government is limited in

its powers and exists only by the consent of the governed."

Robert A. Goldwin, John Locke in History of Political Philosophy

476 (Leo Strauss & Joseph Cropsey, eds., 3d ed. 1987).

    The power a man has in the state of nature "of doing
    whatsoever he thought fit for the preservation of
                                       8
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    himself and the rest of mankind, he gives up," to a
    significant extent, "to be regulated by laws made by
    the society."
McDonald v. City of Chicago, Ill., 561 U.S. 742, 892 (2010)

(Stevens, J., dissenting) (quoting John Locke, Second Treatise

of Civil Government § 129, 64 (J. Gough ed., 1947)) (emphasis

added).      "Once a government is formed, however, it cannot be

given   'a   power        to    destroy      that     which          every    one     designs   to

secure'; it cannot legitimately 'endeavour to take away, and

destroy the property of the people,' or exercise 'an absolute

power over [their] lives, liberties, and estates.'"                                     Carpenter

v. United States, 585 U.S. __, 138 S. Ct. 2206, 2239 (2018)

(Thomas,     J.,    dissenting)            (quoting        Second       Treatise        of    Civil

Government § 222           (1690)).          If the legislature                    will restrict

liberty,     it     must       do    so    expressly,           in    written       laws.       The

government        possesses         no    authority        to    bind        the    people    with

silence.

    ¶84      The majority flips this first principle on its head,

equating     silence           with       prohibition,           and     implying        we     are

restrained        until    made          free.       The    majority's              extraordinary

misunderstanding of basic founding principles is anathema to our

republican form of government, under which the people consent to

be governed by written law, not haunted by specters:

    The liberty of man, in society, is to be under no
    other legislative power, but that established, by
    consent, in the commonwealth; nor under the dominion
    of any will, or restraint of any law, but what that
    legislative shall enact, according to the trust put in
    it.
John Locke, Two Treatises on Government 205 (J. Bumpus ed. 1821)

(emphasis added).
                                                 9
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    [A] system of laws, is alone calculated to maintain
    civil liberty, which leaves the subject entire master
    of his own conduct, except in those points wherein the
    public good requires some direction or restraint.
1 W. Blackstone, Commentaries on the Laws of England, 121–122

(1769) (emphasis added).       American liberty means the people may

order their lives as they wish, subject only to the restraints

imposed by written law enacted with the consent of the governed—

—through their elected legislative representatives:

    By liberty we mean the power, which a man has to act
    as he thinks fit, where no law restrains him; it may
    therefore be called a mans right over his own actions.
1 T. Rutherforth, Institutes of Natural Law 146 (1754) (emphasis

added).    The people consent to be governed by written law, but

beyond those restraints they retain absolute freedom:

    [I]n Society, every Man parts with a Small Share of
    his natural Liberty, or lodges it in the publick
    Stock, that he may possess the Remainder without
    Controul.
Boston Gazette and Country Journal, No. 58, May 10, 1756, p. 1

(emphasis added).

    ¶85     The majority transforms legislative silence into an

unwritten, omnipresent restraint.       The logical extension of this

remarkable misconception of democracy consigns the people into

the servitude of their master——government——a regime overthrown

in America nearly 250 years ago.           According to the majority,

unless the master expressly gives the people permission to do

something, they may not act.       This turns democracy upside down.

It is tyranny.

    ¶86     To the extent the legislature is silent, the people
retain    their   inherent,   unfettered   freedom.   Wisconsin    Stat.

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§ 146.83(3f) says nothing about charges for the provision of

electronic        health      care    records.        In    the    absence     of    state

regulation        of   such    fees,     health      care     providers      retain    the

freedom to charge whatever they see fit, subject to any limits

imposed by federal law.

                               III.    Statutory History

      ¶87    The history of Wis. Stat. § 146.83(3f) reinforces this

plain    meaning       analysis.        "Statutory         history,    which      involves

comparing the statute with its prior versions, may also be used

as part of plain meaning analysis."                        Brey v. State Farm Mut.

Auto. Ins. Co., 2022 WI 7, ¶20, 400 Wis. 2d 417, 970 N.W.2d 1

(internal quotation marks omitted) (quoting James v. Heinrich,

2021 WI 58, ¶26, 397 Wis. 2d 516, 960 N.W.2d 350).                                  As the

majority notes, the revisions made to § 146.83 (2009–10) in 2011

are most relevant to resolving this dispute.                          These revisions

must be interpreted in light of the changes to federal law that

occurred shortly before § 146.83 was amended.

      ¶88    In    2009,      two     years    before      the    legislature       revised
§ 146.83,      the      United        States       Congress      passed     the     Health

Information Technology for Economic and Clinical Health (HITECH)

Act as part of the American Recovery and Reinvestment Act of

2009 (ARRA), an omnibus stimulus bill ostensibly passed to allay

the     nation's       financial        crisis.            American       Recovery      and

Reinvestment Act of 2009, PL 11-5, 123 Stat. 115, 226 (Feb. 17,

2009).      Taking effect in February 2010, the HITECH Act sought to

promote       a        "nationwide        health           information        technology

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infrastructure" allowing "for the electronic use and exchange of

information[.]"           Id. at 230.

         ¶89    Prior to the passage of the HITECH Act "many technical

barriers still exist[ed]" preventing the widespread adoption of

electronic health record systems.                      Kalle Deyette, Hitech Act:

Building an Infrastructure for Health Information Organizations

and A New Health Care Delivery System, 8 St. Louis U.J. Health

L.   &    Pol'y    375,     386    (2015).          Such    systems      were       especially

uncommon "within small practices" because no software "trusted

by providers" and capable of "meeting [small practices'] needs"

existed.         Id.      By and large, designers of electronic record

systems "focused on the needs of large provider systems and did

not address the needs of small, office-based practices."                                Id. at

387.      "In fact, some of the larger [electronic health records]

systems, such as EPIC, [would] not license to small community

hospitals,        claiming       these     hospitals       may    not    [have       had]   the

resources to run the system properly."                           Id.     This left small

hospitals        with     only    one      option:         "contracting        with     larger
hospitals to sublicense and facilitate its [electronic health

record]        system."      Id.         The    problems      extended         beyond    small

practices.         Id.     Medium practices also "implemented expensive

[electronic        health        records       systems]      that       did    not    perform

critical        functions         of     their      practice, such             as     clinical

management, and did not address their patients' diverse needs,

such as mental health issues."                      Id.      Throughout the country,

there was "an overall lack of knowledge, choice, and product
variation in [electronic health records] systems, which [] left

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providers with expensive systems that [were] resource-intensive"

and frequently incapable of fulfilling "the actual objectives of

[electronic health records systems]."                Id.

      ¶90   The     HITECH     Act     allocated     hundreds      of    millions   of

dollars     "to     support      regional       or   sub-national        efforts    to

implement" electronic "health information exchanges."                          Id. at

405 (2015).       The HITECH Act's ultimate goal was to enable "each

person in the United States" to obtain accurate, private, and

secure electronic health records.               123 Stat. 115 at 231.

      ¶91   To effectuate that goal, Congress enacted mechanisms

for   individuals        to   obtain    and     review     their   health     records

directly.      123 Stat. 115 at 266, 268.            The HITECH Act provides:

      (e)   ACCESS TO CERTAIN INFORMATION IN ELECTRONIC
            FORMAT.—In applying section 164.524 of title 45,
            Code of Federal Regulations, in the case that a
            covered entity uses or maintains an electronic
            health record with respect to protected health
            information of an individual[.]

      (1)   [T]he individual shall have a right to obtain
            from   such  covered  entity  a  copy   of  such
            information in an electronic format and, if the
            individual chooses, to direct the covered entity
            to transmit such copy directly to an entity or
            person designated by the individual, provided
            that any such choice is clear, conspicuous, and
            specific[.]
42 U.S.C. § 17935(e)(1) (2012).                In addition to establishing the

right to review an individual's health records, Congress capped

allowable charges.            123 Stat 115, 268 (Feb. 17, 2009).                 Under

the   HITECH      Act,   a    health   care     provider    may,    when    asked   to

provide electronic records, charge no more than its "labor costs
in responding to the request":

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       (3)   [A]ny fee that the covered entity may impose for
             providing such individual with a copy of such
             information (or a summary or explanation of such
             information)   if  such  copy  (or   summary  or
             explanation) is in an electronic form shall not
             be greater than the entity's labor costs in
             responding to the request for the copy (or
             summary or explanation).
42 U.S.C. § 17935(e)(3) (2012).

       ¶92   Against   this   backdrop,    the   Wisconsin   legislature

revised Wis. Stat. § 146.83 in 2011.         For reference, below is a

side-by-side comparison of the relevant provisions of § 146.83
as they appeared both prior to and after the 2011 amendments.3

On the left side is the (2009–10) version of the statute, and on

the right are the changes the legislature made.               The struck

through portions signify legislative deletions.          The underlined

portions signify legislative additions.          All revisions made in

2011 remain in effect.

     Wis. Stat. § 146.83(1h)(b)           Wis. Stat. § 146.83(3f)(b)

             (2009–10)                            (2021–22)
(b)     . . . [A]    health    care (b)      . . . [A]    health    care
       provider   may   charge   no         provider   may   charge   no
       more than the total of all           more than the total of all
       of   the   following    that         of   the   following    that
       apply for providing copies           apply for providing copies
       requested under par. (a):            requested under par. (a):

1.     For paper copies, 35 cents    1.     For paper copies, 35 cents
       per page.                            per page.: $1 per page for

       The court of appeals provided a similar side-by-side
       3

representation of these changes, but its chart, at least as it
appears on Westlaw, is inaccurate.   The statutory headings are
flipped, but the statutory text is not, causing the table to
show the (2019-20) version under the (2009–10) version, and
vice-versa.

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                                        the first 25 pages; 75
                                        cents per page for pages
                                        26 to 50; 50 cents per
                                        page for pages 51 to 100;
                                        and 30 cents per page for
                                        pages 101 and above.

2.    For      microfiche       or 2.   For      microfiche         or
      microfilm   copies,    $1.25      microfilm   copies,      $1.25
      per page.                         $1.50 per page.

3.    For a print of an X-ray, 3.       For a print of an X-ray,
      $10 per image.                    $10 per image.

3m.   For providing copies in 3m.       For providing copies in
      digital    or    electronic       digital    or    electronic
      format, a charge for all          format, a charge for all
      copies requested.                 copies requested.

4.    For    certification     of 4.    For    certification        of
      copies, $5.                       copies, $5.

5.    For     processing      and 5.    For     processing      and
      handling,   a  single   $15       handling,   a  single   $15
      charge   for  all    copies       charge   for  all    copies
      requested.                        requested.

                                   4.   If the requester is not
                                        the patient or a person
                                        authorized by the patient,
                                        for     certification   of
                                        copies,    a    single  $8
                                        charge.

                                   5.   If the requester is not
                                        the patient or a person
                                        authorized by the patient,
                                        a single retrieval fee of
                                        $20    for   all    copies
                                        requested.

6.    Actual shipping costs.       6.   Actual shipping costs.

7.    If the requester requests 7.      If the requester requests
      delivery  of   the  copies        delivery  of   the  copies
      within 7 or fewer days            within 7 or fewer days
      after making a request for        after making a request for
                                        copies,  and   the  health
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       copies,  and   the  health                        care provider delivers the
       care provider delivers the                        copies within that time, a
       copies within that time, a                        fee equal to 10 percent of
       fee equal to 10 percent of                        the total fees that may be
       the total fees that may be                        charged under subds. 1. to
       charged under subds. 1. to                        6.
       6.
       ¶93    The    2009–10 version of Wis. Stat. § 146.83 specified

no   cap     on    fees   health    care       providers     could    charge    for   the

provision of electronic records.                     Originally, the legislature

imposed a $5 cap on such charges in § 146.83(1h)(b)3m. (2009–

10).    Governor Jim Doyle, Veto Message § D.11, at 37 (June 29,

2009) (responding to Assembly Bill 75 (2009)).                        Using his line-

item veto power, then-Governor Doyle removed that cap from the

statute.      Id.    The enacted law required health care providers to

provide electronic records upon request but without any limit on

the fees they could charge.

       ¶94    As    shown    above,      the    legislature     eventually       removed

subsection 3m. from Wis. Stat. § 146.83. Currently, the statute

contains      no     reference      to     electronic        health     care     records

whatsoever.         The HITECH Act overrode Wisconsin's limitless fee

provision, obviating the need to address charges for electronic

health care records.             Removing the language regarding charges

for such records from the statute eliminated any tension between

Wisconsin law and federal law by conforming state statutes to

the federal fee cap.               From this, the majority reads into the

statute      an    implicit    prohibition          on    charging    for    electronic

health care records at all.

       ¶95    Conspicuously missing from the majority opinion, as
well    as    the    court    of     appeals        opinion,    is    any    meaningful

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discussion      of    the     context   in    which     the    2011     legislative

amendments occurred.           The majority scarcely mentions the HITECH

Act at all.4        The majority's entire analysis rests on the absence

of legislative "permission" for health care providers to charge

for the provision of electronic health records.                      Of course, the

legislature       hasn't    given    lawyers,    plumbers,      or     electricians

permission     to    charge    for   their    services    either,       despite   the

existence of laws governing those trades.                It would be absurd to

suggest any provider of services or goods must provide them for

free,    but   the    majority      doesn't   explain    why    it     decrees    that

health care providers must do so.

                                 IV.    Conclusion

         ¶96 Our system of ordered liberty under the rule of law

has been analogized to the Sears Tower:5                      although inside it

people move freely, their movement is necessarily restrained by

the building's structure——its walls, its floors, its elevators.

See Randy Barnett, The Structure of Liberty: Justice and the

Rule of Law 1–3 (1998).             The majority fills a statute's silence
with a prohibition, surrounding economic actors——in this case,

health     care      providers——with     invisible       restraints       on     their

freedom.       The majority establishes a dangerous precedent that

violates first principles and imperils liberty.                  People who live

     4   See Majority op., ¶28 n.11.
     5 "Sears Tower" refers to the 110 story skyscraper in
Chicago now named Willis Tower. The Making of an American Icon,
Willis Tower, https://www.willistower.com/about (last visited
March 11, 2023).

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in freedom may not be transformed into mimes bound by invisible

chains.     In the absence of written law, we are free.              Because

the fee caps imposed in Wis. Stat. § 146.83(3f) do not encompass

electronic health care records, health care providers are free

to charge whatever they choose, subject only to federal law.                I

respectfully dissent.

    ¶97     I am authorized to state that Chief Justice ANNETTE

KINGSLAND   ZIEGLER   and   Justice    PATIENCE   DRAKE   ROGGENSACK     join

this dissent.

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