Court Opinion

ID: 9578930
Source: CourtListenerOpinion
Date Created: 2023-08-21 21:49:43.445229+00
Date Added: 2024-06-11T13:33:38.857002
License: Public Domain

BROWN, C.J.
¶ 31. (dissenting). For me the question in this case is simply this: When there is widespread debate in the medical community about two distinct protocols for addressing a medical condition, must the treating physician inform the patient of the *205alternatives? In my view, that question is answered "yes" by Wis. Stat. § 448.30, which states that "[a]ny physician who treats a patient shall inform the patient about the availability of all alternate, viable medical modes of treatment and about the benefits and risks of these treatments." (emphasis added.)
¶ 32. But you do not have to take my word on the meaning of this statutory language: you can read, in Martin v. Richards, our supreme court's exegesis and application. In that case, the court restated the statute's standard as "what would a reasonable person in the patient's position want to know in order to make an intelligent decision with respect to the choices of treatment or diagnosis?" Martin v. Richards, 192 Wis. 2d 156, 176, 531 N.W.2d 70 (1995). The court also made clear that the statute is not about whether the doctor makes the right medical decision, but rather about whether the doctor provides the patient with the information that the patient needs to make a decision of his or her own:
It may well be a "medical decision" under these circumstances to decide not to do a CT scan, or to decide not to hospitalize the patient in a hospital that can treat an intracranial bleed if it should occur. The statute on its face says, however, that the patient has the right to know, with some exceptions, that there are alternatives available. The doctor might decide against the alternate treatments or care, he [or she] might try to persuade the patient against utilizing them, hut he [or she] must inform them when a reasonable person would want to know., Here, Mr. Martin could have decided to have a CT scan done or could have decided to take Ms. Martin to another hospital with a neurosurgeon.
Martin, 192 Wis. 2d at 181.
*206¶ 33. In this case, Dr. Brusky confronted a TIA and chose one course of action: sending Richard Bubb home with instructions for follow-up care. However, as Dr. Brusky's own expert testified, there was another, distinct course of action that is widely used in TIA cases— admission and immediate further testing for the potentially dangerous underlying causes. Dr. Brusky1 did not inform Richard of this course of action, as the statute requires. These facts, along with causation, make out an informed consent claim that should have gone to the jury, as Martin makes clear. The majority attempts to avoid Martin by drawing (in my view irrelevant) factual distinctions, and it focuses on the details of that case at the expense of ignoring both the language of the statute and Martin's central point: that the legislature, by the informed consent statute, has acted to protect the patient's right to know his or her options. See id. at 175. The majority would deprive the Bubbs of that right, apparently because it believes that Dr. Brusky's "medical decision" was the correct one, or at least reasonable under the circumstances. This is not the law. I dissent.
¶ 34. I will begin with the points on which the majority and I agree. The circuit court was required to submit the informed consent claim to the jury unless there was "no credible evidence" to sustain a verdict for the Bubbs. Majority, ¶¶ 15, 17. There was expert testimony (by Dr. Brusky's expert) that there are two established options for treating TLA patients: admit them immediately, or send them home and do further testing in the future. The expert further testified that treatment of TIA patients "varies widely, with some *207institutions admitting all patients and others proceeding with outpatient evaluation." Majority, ¶ 22. The majority brings this testimony up but does not comment on it; I assume, however, that the majority would concede that it constitutes credible evidence.
¶ 35. The next question is, evidence of what? I find unavoidable the conclusion that what the expert was describing was an "alternate, viable mode of treatment." The majority, however, does manage to avoid this conclusion, by drawing a series of distinctions from Martin. The majority first states that the diagnosis in this case was "correct and it was complete." Majority, ¶ 26. It is true that in Martin, the supreme court talked about diagnoses: it rejected a doctor's argument that only "affirmative, invasive treatments" could be considered alternate, viable modes of treatment under the statute. Martin, 192 Wis. 2d at 169, 176. It also rejected the doctor's factual claim that he had not diagnosed intracranial bleeding and therefore could not be required to give information about treatments or tests for it. Id. at 180-81. It did not say that misdiagnosis, or lack of a diagnosis, was a requirement for an informed consent case. Again, the issue in an informed consent case is not whether the doctor made a "correct" decision, but whether the doctor failed to tell the patient what a reasonable person would want to know in order to make his or her own decision. Id. at 181. The majority's latching on to the "correct," "complete" diagnosis here betrays its misdirected focus: it is treating this claim like an ordinary malpractice claim and evaluating Dr. Brusky's treatment, rather than applying the informed consent statute and addressing whether he properly informed Richard of his options.
¶ 36. The majority also appears to conclude that there was not really a choice between "alternate" modes *208of treatment here, stating that the "Bubbs1 complaint is about a lack of urgency rather than a lack of information" and that "[u]nlike the patient in Martin, Richard left the hospital knowing that his condition required further tests and treatment with a specialist." Majority, ¶¶ 28-29. Apparently the majority believes that being sent home and told to schedule an appointment with a specialist is the same thing as being admitted and given an ultrasound examination as soon as possible. As a matter of logic, this strikes me as highly suspect: obviously the two courses of action differ significantly, as the outcome in this case suggests. But again, you do not have to take my word for it: you could ask Dr. Brusky's own expert, who testified to the debate within the medical community over the two alternate treatment protocols. And, of course, because of this testimony, the trial court should have asked the jury, who are the proper finders of such facts.
¶ 37. If there was credible evidence, as I believe there was, that an "alternate" mode of treatment existed, the next question is whether this "alternate" course of action was "viable." The supreme court in Martin defined "viable" in this statutory context: "Presumably the use of the word 'viable' in the statute was intended to require disclosure to the extent mandated in Scari a [v. St. Paul Fire & Marine Ins. Co., 68 Wis. 2d 1, 227 N.W.2d 647 (1975)]: disclosure only of information reasonably necessary for a patient to intelligently exercise his or her choice regarding medical treatment." Martin, 192 Wis. 2d at 174-75. It follows that a doctor need not give information about a treatment that is of negligible potential worth or is for some reason not available to the patient.
¶ 38. The majority concludes that admission and further diagnostic testing was not a "viable" course of *209treatment because Dr. Brusky was an ER physician treating Richard on an emergency basis and did not have admitting privileges at St. Agnes, and also because no technician was on call for the emergency department that evening. Majority, ¶¶ 26-27. But the informed consent law does not require a physician only to inform a patient about procedures that that particular physician can perform at that very moment. Rather, the law requires a doctor to inform a patient of "all alternate, viable medical modes of treatment." The fact that another physician would perform the test does not mean that the test is not viable.
¶ 39. And once again, I am not speaking on my own authority here, but simply reading Martin. In that case, the defendant doctor was also an ER physician, also treating the patient on an emergency basis, and also did not have admitting privileges. Martin, 192 Wis. 2d at 163, 165. So, just like Dr. Brusky, he needed the cooperation of other doctors to treat the patient at issue.
¶ 40. Even more significantly, one of the "alternate modes of treatment" noted by the supreme court in Martin was that the father of the patient there may have wished to go to another hospital, one with a neurosurgeon. Id. at 181. Obviously the defendant ER doctor would have had nothing to do with this course of action except informing the father that it was an option. This simply confirms what I have already said: the informed consent law is not about what the doctor should have done, but what he should have told the patient. Maybe Richard would never, under any circumstances, have been admitted to St. Agnes or had the ultrasound performed there. But as Martin makes clear, this fact does not mean that he did not have the right to know about his options, even if he had to go somewhere else to exercise them.
*210¶ 41. The majority finally observes that the Bubbs must show causation: that Richard's injuries (that is, his stroke forty-eight hours later) were in some part caused by Dr. Brusky's failure to inform him of the alternate treatment. Majority, ¶ 28. Of course, this would not be the case if Richard would have elected to leave the hospital and come in for follow-up, even had he been informed of the alternative. Few questions are more clearly factual, and thus for the jury, than questions about what a particular person might have done under different circumstances. The majority nevertheless musters a few facts to suggest what Richard might have done had he been informed that he had options. I will only observe that the fact that Richard wanted to go home when he did not know that he might be better off staying is extraordinarily weak evidence about what he would have done had he been so informed.

 I agree with the majority's conclusion with respect to Dr. Gu.