Court Opinion

ID: 9391577
Source: CourtListenerOpinion
Date Created: 2023-05-02 17:11:58.06562+00
Date Added: 2024-06-11T17:18:42.328847
License: Public Domain

2023 WI 35

                  SUPREME COURT           OF   WISCONSIN
CASE NO.:              2021AP1787-FT

COMPLETE TITLE:        Allen Gahl Attorney in fact, on behalf of his
                       principal, John J. Zingsheim,
                                 Petitioner-Respondent-Petitioner,
                            v.
                       Aurora Health Care, Inc. d/b/a Aurora Medical
                       Center - Summit,
                                 Respondent-Appellant.

                         REVIEW OF DECISION OF THE COURT OF APPEALS
                         Reported at 403 Wis. 2d 539, 977 N.W.2d 756
                             PDC No: 2022 WI App 29 - Published

OPINION FILED:         May 2, 2023
SUBMITTED ON BRIEFS:
ORAL ARGUMENT:         January 17, 2023

SOURCE OF APPEAL:
   COURT:              Circuit
   COUNTY:             Waukesha
   JUDGE:              Lloyd Carter

JUSTICES:
ANN WALSH BRADLEY, J., delivered the majority opinion of the
Court, in which ZIEGLER, C.J., ROGGENSACK, DALLET, HAGEDORN, and
KAROFSKY, JJ., joined. REBECCA GRASSL BRADLEY, J., filed a
dissenting opinion.
NOT PARTICIPATING:

ATTORNEYS:

       For the petitioner-respondent-petitioner, there were briefs
filed by Karen L. Mueller and Amos Center for Justice & Liberty,
Chippewa Falls. There was an oral argument by Karen L. Mueller.

       For the respondent-appellant, there was a brief filed by
Michael L. Johnson, Jason J. Franckowiak, Randall R. Guse, and
Otjen Law Firm, S.C., Waukesha. There was an oral argument by
Jason J. Franckowiak.
       An    amicus   curiae    brief    was   filed     by   Ben   Seel,     Maher
Mahmood,      Patricia   Epstein        Putney,   Melita      M.    Mullen,     and
Democracy Forward Foundation, Washington D.C., and Bell, Moore &
Richter, S.C., Madison, for the American Medical Association and
Wisconsin Medical Society.

       An amicus curiae brief was filed by Joseph W. Voiland and
Veterans Liberty Law, Cedarburg, for the Front Line COVID-19
Critical Care Alliance.

       An amicus curiae brief was filed by Andrew L. Schlafly,
Rory    E.    O’Sullivan,      and   Rodli,    Beskar,     Neuhaus,    Murray    &
Pletcher, S.C., River Falls, for the Association of American
Physicians and Surgeons.

                                         2
                                                                         2023 WI 35
                                                                 NOTICE
                                                   This opinion is subject to further
                                                   editing and modification.   The final
                                                   version will appear in the bound
                                                   volume of the official reports.
No.    2021AP1787-FT
(L.C. No.   2021CV1469)

STATE OF WISCONSIN                             :            IN SUPREME COURT

Allen Gahl Attorney in fact, on behalf of his
principal, John J. Zingsheim,

            Petitioner-Respondent-Petitioner,
                                                                      FILED
      v.
                                                                  MAY 2, 2023
Aurora Health Care, Inc. d/b/a Aurora Medical
Center - Summit,                                                    Sheila T. Reiff
                                                                 Clerk of Supreme Court
            Respondent-Appellant.

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

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

      ¶1    ANN WALSH BRADLEY, J.         The petitioner, Allen Gahl,

who holds power of attorney for his uncle, John Zingsheim, seeks

review of a published decision of the court of appeals reversing

the circuit court's issuance of an injunction.                   That injunction
compelled    Aurora   Health   Care,   Inc.,       to   administer       a   certain
                                                                           No.    2021AP1787-FT

medical treatment to Zingsheim.1                    The court of appeals determined

that Gahl's claim must fail because he did not identify a source

of law that (1) would give a patient or a patient's agent the

right to force a health care provider to administer a treatment

the health care provider concludes is below the standard of

care, or (2) could compel Aurora to put an outside provider that

would provide such care through its credentialing process.

      ¶2     Gahl       contends       that   the     court        of    appeals     erred   in

reversing the circuit court's order.                         Specifically, he asserts

that the circuit court has the authority to issue an injunction

in   the    present       circumstances,            and    that     the     injunction       the

circuit court issued was a proper exercise of its discretion.

      ¶3     Aurora disagrees.            It argues that neither Gahl nor the

circuit court identified a source of law that gives the circuit

court      the    authority       to    compel        a    health       care     provider    to

administer a treatment that it believes is below the standard of

care, or to compel a hospital to put a doctor that will do so

through its credentialing process, such that Gahl would have a
reasonable probability of success on the merits of his claim.

      ¶4     We        conclude    that       the         circuit       court     erroneously

exercised        its    discretion       by     issuing       an        injunction    without

referencing any basis demonstrating that Gahl had a reasonable

probability       of    success    on     the       merits    of    some    type     of   legal

      1Gahl ex rel. Zingsheim v. Aurora Health Care, Inc., 2022
WI App 29, 403 Wis. 2d 539, 977 N.W.2d 756 (reversing order of
the circuit court for Waukesha County, Lloyd V. Carter, Judge).

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                                                              No.     2021AP1787-FT

claim.     Accordingly, we affirm the decision of the court of

appeals.

                                      I

      ¶5   Gahl   holds     health   care    power     of    attorney    for    his

uncle, Zingsheim.     At the time this case was filed, on October

7, 2021, Zingsheim was a patient in Aurora's care after testing

positive for COVID-19.2

      ¶6   Through personal research, Gahl became aware of a drug

called Ivermectin, which had been used as a purported treatment

for COVID-19.      He received a prescription for Ivermectin from

Dr. Edward Hagen, a retired OB/GYN, who asserted that he "wrote

the   prescription    based     on    a     detailed    discussion        of   Mr.

Zingsheim's     condition    with    Mr.    Gahl,"     but    never     met    with

Zingsheim.

      ¶7   Aurora declined to effectuate Dr. Hagen's prescription

for   several   reasons.       According      to   Aurora's     Chief     Medical

Officer, Ivermectin is "primarily used as an anti-parasitic in

farm animals or administered to humans for treatment of certain
parasites and scabies" and is not approved by the Food and Drug

Administration as a treatment for COVID-19.                  The Chief Medical

Officer further averred that a high dose of Ivermectin, such as

      2According to the briefing, Zingsheim has recovered from
his COVID-19 infection and was discharged by Aurora.   No party
makes any argument regarding mootness, and we will not develop
any such argument for the parties. See Serv. Emps. Int'l Union,
Loc. 1 v. Vos, 2020 WI 67, ¶24, 393 Wis. 2d 38, 946 N.W.2d 35
(explaining that "[w]e do not step out of our neutral role to
develop or construct arguments for parties; it is up to them to
make their case").

                                      3
                                                                  No.     2021AP1787-FT

that prescribed by Dr. Hagen, "can be dangerous to humans and

cause hypotension, ataxia, seizures, coma, and even death," and

that accordingly "the use of ivermectin in the treatment of John

Zingsheim's COVID-19 symptoms does not meet the standard of care

for treatment."

    ¶8      Gahl    subsequently       filed      a   complaint   in     the    circuit

court, seeking declaratory and injunctive relief.                       Specifically,

he sought an order requiring Aurora to administer Ivermectin to

Zingsheim    as    prescribed    by     Dr.       Hagen.    Aurora       opposed    the

requested relief.

    ¶9      The circuit court held an initial hearing on Gahl's

petition on October 12, 2021.                    It heard arguments from both

parties,    but    did   not   reach    a       decision.   Instead,       it   sought

additional information, stating:

    I feel that I do need more information[.] . . . This
    is not a decision that a Court makes based on emotion.
    That's   not   appropriate.    So  I   need   evidence,
    and . . . want more evidence from the treating doctors
    as to what is Mr. Zingsheim's current medical
    situation,   what   is   his prognosis, . . . what   is
    proposed to move forward. Is there something proposed
    to move forward, or is this a wait-and-see situation
    with no other alternatives?

    And I'd like some more information . . . to create
    that connection between this Dr. Hagen prescription
    and Mr. Zingsheim, because what I'm seeing here is
    just – there's a prescription written by somebody who
    really   has  very   limited   information  about  Mr.
    Zingsheim. . . . Other than Mr. Gahl, averring that he
    has communicated what the hospital has told him,
    again, there's no details of that. . . . It's Mr.
    Gahl's interpretation of what the hospital told him.
    And I don't know where that information comes from, so
    I don't know the viability of that information.

                                            4
                                                          No.    2021AP1787-FT

      But, you know, the ask here is for this Court to give
      a directive to some treating licensed medical doctors
      that they are telling me is contravening their
      responsibility to their patient.        I mean, the
      divergent positions here couldn't be more extreme.
      And the consequences of action and nonaction are
      significant as well.
Accordingly, the circuit court gave the parties the opportunity

to supplement the record.

      ¶10    Gahl and Aurora each submitted supplemental materials.

Those filed by Gahl consisted of affidavits from Gahl himself,

Dr.   Hagen,   and     Dr.   Pierre   Kory.3   Dr.   Kory's    affidavit   was

accompanied by a document indicating that it was Dr. Kory's

testimony before the Homeland Security Committee regarding early

treatment approaches to COVID-19.

      ¶11    Aurora filed a supplemental affidavit from its Chief

Medical     Officer.         This   supplemental   affidavit    updated    the

circuit court on Zingsheim's medical condition and the plan for

his care and treatment.

      ¶12    Based on the supplemental information submitted, the

circuit court acted quickly, and later in the day on October 12,

signed an order to show cause Gahl had drafted and submitted.

The order compelled Aurora to "immediately enforce Dr. Hagen's[]

order and prescription to administer Ivermectin to their mutual

patient, Mr. Zingsheim, and thereafter as further ordered by Mr.

Gahl."      There was no statutory basis or other legal foundation

for the order set forth in its text.

      3   Dr. Kory's affidavit was neither dated nor notarized.

                                        5
                                                               No.   2021AP1787-FT

      ¶13    Almost    immediately   after      the    order   issued,    Aurora

objected.      Aurora    referred    to   the   circuit    court's     order   as

"extremely     problematic."         Specifically,        it     observed      the

following alleged shortcomings:

      I am not aware of any orders written by Dr. Hagen, but
      am aware of a prescription written by Dr. Hagen for
      Ivermectin 66mg to be taken once daily.            The
      prescription   does  not   indicate  from   where  the
      Ivermectin is to be obtained or how the tablets are to
      be administered to a patient who is intubated and
      sedated.   Finally, the Order provides that Aurora is
      to administer Ivermectin "as further ordered by Mr.
      Gahl." Mr. Gahl is not a healthcare provider.

      For the reasons above, it is my position as counsel
      for Aurora that my client is unable to comply with the
      terms of the Order as drafted.
      ¶14    The next day, on October 13, 2021, Aurora filed a

petition for leave to appeal a nonfinal order with the court of

appeals.4      Additionally on that date, the circuit court held

another     hearing.     At   this   hearing,     the    discussion     revolved

largely around Zingsheim's medical condition and the advantages

and disadvantages of Ivermectin.          After hearing from both sides,
the circuit court maintained, but modified its previous order of

the   day    before    such   that   rather     than    ordering     Aurora    to

administer the treatment, Gahl could identify a physician who

could then be credentialed by Aurora:

      As it stands right now, this Court entered an order
      that is subject to a petition for leave to appeal to

      4   See Wis. Stat. § 808.03(2) (2019-20).

     All subsequent references to the Wisconsin Statutes are to
the 2019-20 version unless otherwise indicated.

                                      6
                                                          No.    2021AP1787-FT

     the Court of Appeals, who have not weighed in on it.
     My intention is to maintain that order, but I am not
     going   to  engage   in  directing   the  hospital   or
     individuals at the hospital . . . to administer this
     medication to Mr. Zingsheim.    I think it's incumbent
     on the petitioner to supply a medical professional
     that's approved by the hospital for purposes of
     assisting this patient.      But I don't think it's
     appropriate for this Court to engage in further orders
     to the hospital as to how this drug is administered.

     They have, they being the hospital, have their rules
     of whom they admit to practice medicine there and how
     they do it, and I don't think – The Court is taking a
     significant step in this case by the order that's been
     entered. I think it's the petitioner's responsibility
     for not only supplying the prescription but supplying
     an individual that meets the approval of the hospital
     for administration. If Dr. Hagen doesn't pass muster,
     then the petitioner has to find somebody else. But I
     don't think this Court – This Court does not feel
     comfortable in making any further directives or orders
     to the hospital as to how that's to occur.     I think
     that's a responsibility of the petitioner here and
     it's – That's how the Court views it.
Accordingly, the circuit court indicated its intent to clarify

its previous order, agreeing that Gahl "is to supply or identify

a physician that Aurora can then review and pass through its

credentialing     process.            And   once     credentialed,       that
physician . . . will have permission to enter upon the premises

and administer the Ivermection as ordered by Dr. Hagen[.]"

     ¶15   The   day   after   this    hearing,    the   court   of   appeals

granted Aurora's petition for leave to appeal a nonfinal order.

It additionally stayed the circuit court's order and all circuit

court proceedings pending appeal.           Gahl sought to bypass the

court of appeals, which this court denied.5

     5 Gahl v. Aurora Health Care, Inc., No.                2021AP1787-FT,
unpublished order (Wis. S. Ct. Oct. 25, 2021).

                                       7
                                                                       No.       2021AP1787-FT

    ¶16        In a published opinion, the court of appeals reversed

the circuit court's order.                    Gahl ex rel. Zingsheim v. Aurora

Health       Care,    Inc.,     2022     WI     App     29,    403    Wis. 2d 539,        977

N.W.2d 756.          It determined that "[Gahl] has failed to identify

any source of Wisconsin law that gives a patient or a patient's

agent    the    right    to     force    a     private    health      care    provider     to

administer a particular treatment that the health care provider

concludes       is      below     the     standard        of     care."           Id.,    ¶1.

Accordingly, "[b]ecause Gahl has failed to identify any law,

claim, or recognized cause of action under Wisconsin law by

which    a     patient    may     compel       a     health    care    professional        to

administer       a    course     of     treatment       contrary      to     that     medical

professional's         judgment,        the    court     erroneously       exercised      its

discretion in granting Gahl injunctive relief."                            Id.    The court

of appeals further concluded that the circuit court "had no

legal    authority       to     compel        Aurora    to     credential        an   outside

provider to provide care that is below the standard of care."

Id., ¶64.       Gahl petitioned for this court's review.
                                               II

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

determination that the circuit court erroneously exercised its

discretion in the issuance of a temporary injunction.                              A circuit

court may issue a temporary injunction if four criteria are

fulfilled:       (1) the movant is likely to suffer irreparable harm

if an injunction is not issued, (2) the movant has no other

adequate       remedy    at     law,    (3)     an     injunction     is     necessary     to
preserve the status quo, and (4) the movant has a reasonable
                                                8
                                                                   No.     2021AP1787-FT

probability of success on the merits.                   Serv. Emps. Int'l Union,

Loc. 1 v. Vos, 2020 WI 67, ¶93, 393 Wis. 2d 38, 946 N.W.2d 35.

      ¶18   The issuance of a temporary injunction is reviewed for

an erroneous exercise of discretion.                    Id.      We will sustain a

discretionary decision as long as the circuit court examines the

relevant facts, applies a proper standard of law, and, using a

demonstrated      rational    process,         reaches    a    conclusion        that    a

reasonable judge could reach.                  Indus. Roofing Servs., Inc. v.

Marquardt, 2007 WI 19, ¶41, 299 Wis. 2d 81, 726 N.W.2d 898.

                                       III

      ¶19   We begin by observing the limited nature of our review

and   emphasize     that    this    case   is     not    about    the     efficacy      of

Ivermectin as a treatment for COVID-19.                       Rather, it is about

whether the circuit court erroneously exercised its discretion

by issuing the subject temporary injunction.

      ¶20   Gahl    raises    three    arguments         in    this      court   in     an

attempt to demonstrate that the court of appeals erred and that

in fact the circuit court had the authority to issue a temporary
injunction.        First,    he    contends      that    the   power      of   attorney

statute, Wis. Stat. § 155.30(1), provides authority to issue the

subject injunction.         Second, Gahl asserts that the circuit court

has inherent authority to issue such an injunction.                       Finally, he

advances that the circuit court may issue the injunction in

question under a theory of implied contract between Zingsheim

and Aurora.    Aurora disputes each of these bases.

      ¶21   We need not address in depth any of Gahl's arguments
because we do not know on what basis the circuit court issued
                                           9
                                                               No.   2021AP1787-FT

the injunction.6         The circuit court cited no law in either its

written    order   or    its   oral   ruling,    as   Gahl   conceded   at   oral

argument    before      this   court.7    This   in   itself    constitutes    an

erroneous exercise of discretion.

     ¶22    "Discretion is not synonymous with decision-making."

McCleary v. State, 49 Wis. 2d 263, 277, 182 N.W.2d 512 (1971).

Instead, "[d]iscretion contemplates a process of reasoning with

     6 We additionally observe that Gahl did not clearly raise
these three arguments before the circuit court.    Because we do
not reach the merits of these arguments, we need not determine
whether they are forfeited.    See State v. Wilson, 2017 WI 63,
¶51 n.7, 376 Wis. 2d 92, 896 N.W.2d 682 (explaining that
"[g]enerally, issues not raised or considered by the circuit
court will not be considered for the first time on appeal"). At
oral argument before this court, Gahl's counsel asserted the
belief that the circuit court based its order on its inherent
authority, but there is nothing in the record to support such an
assertion, and no inherent authority argument was clearly
articulated before the circuit court.
     7 At oral argument before this court, Gahl's counsel engaged
in the following colloquy with the court:

     THE COURT: One of the requirements in order to issue
     a temporary injunction needs to be a reasonable
     likelihood of success on the merits.     The merits has
     to be some legal authority for a court to intervene
     and issue an order mandating some action.     The trial
     court, in my reading, did not cite any actual law to
     support its order. . . . The court of appeals rested
     its decision largely on that grounds.         Even the
     dissent didn't point to any actual law that was
     cited . . . or at least relied upon to show why there
     is a reasonable likelihood of success on the merits.
     So just on the reasonable likelihood of success on the
     merits, what law was cited by the trial court to give
     it authority for it to issue this order?

     COUNSEL:      The trial court did not identify a specific
     law.

                                         10
                                                                           No.       2021AP1787-FT

a rational and explainable basis."                          State ex rel. Payton v.

Kolb, 135 Wis. 2d 202, 205-06, 400 N.W.2d 285 (Ct. App. 1986).

It is "more than a choice between alternatives without giving

the    rationale       or    reason       behind     the    choice."             Reidinger      v.

Optometry      Examining         Bd.,    81   Wis. 2d 292,       297,       260       N.W.2d 270

(1977).       "This process must depend on facts that are of record

or that are reasonably derived by inference from the record and

a conclusion based on a logical rationale founded upon proper

legal standards."           McCleary, 49 Wis. 2d at 277.

       ¶23    A circuit court erroneously exercises its discretion

in    the    context    of    a    temporary        injunction       when       it    "fails   to

consider      and    make    a     record     of    the     factors       relevant       to    its

determination."         Sch. Dist. of Slinger v. Wis. Interscholastic

Athletic Ass'n, 210 Wis. 2d 365, 370, 563 N.W.2d 585 (Ct. App.

1997).       Further, whether the party seeking an injunction has a

reasonable probability of success on the merits in part turns on

whether the moving party has stated a claim entitling it to

relief.      Id. at 374; see Wis. Stat. § 813.02(1)(a).
       ¶24    Although       the     circuit        court     acknowledged            the     four

factors      that    must     be        fulfilled     in     order        for    a     temporary

injunction to be granted, it did not engage in any analysis of

those factors.          We base our determination here on its lack of

analysis      of    Gahl's    reasonable           probability       of    success       on    the

merits.      Indeed, from a review of the circuit court's order, we

do not know upon what legal basis it premised its authority to

issue the injunction in the first instance.                          In other words, we
do not know what viable legal claim the circuit court thought
                                              11
                                                                         No.    2021AP1787-FT

Gahl had presented.               Without identifying the legal basis it

accepted, the circuit court cannot support the conclusion that

Gahl has demonstrated a reasonable probability of success on the

merits.

    ¶25     The circuit court's written order granting Gahl relief

does not cite any statute, case, or other source of law as a

foundation    allowing       for    its    issuance.              Although     the     circuit

court later clarified its intent in oral comments, those oral

comments likewise did not identify any law on which the order

was premised.        Absent any citation to law establishing a legal

basis for the order, we cannot determine that the circuit court

employed the reasoning process our precedent demands.

    ¶26     In     exercising       its    discretion,           there    are    no    "magic

words" the circuit court must utter or any precise level of

specificity that is required.                But the record must make clear

that the circuit court examined the relevant facts, applied a

proper    standard    of     law,    and,       using       a    demonstrated         rational

process,    reached    a   conclusion        that       a       reasonable     judge     could
reach.     See Indus. Roofing Servs., 299 Wis. 2d 81, ¶41.                               Here,

the record is lacking in this respect.

    ¶27     The    circuit    court        heard    legal         argument      and    at   one

point     stated    that     is     "has    a      significant           respect      for    an

individual's right to choose their treatment."                           However, such a

stray    reference    does    not     equate       to   a       legal    analysis      of   the

probability of success on the merits of Gahl's legal claim.                                 The

circuit court did not tie such "respect" to any legal analysis

                                            12
                                                               No.   2021AP1787-FT

or indicate how it could serve as a basis for the declaratory

and injunctive relief Gahl sought.

    ¶28     We    therefore    conclude         that   the      circuit     court

erroneously exercised its discretion by issuing an injunction

without   referencing   any   basis    demonstrating         that    Gahl   had   a

reasonable probability of success on the merits of some type of

legal claim.      Accordingly, we affirm the decision of the court

of appeals.

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

affirmed.

                                      13
                                                                No.   2021AP1787-FT.rgb

       ¶29   REBECCA GRASSL BRADLEY, J.               (dissenting).

       The right of liberty is a natural right and it resides
       in the person, because he is a person.      It is his
       self-determination with regard to fulfilling his
       natural final goal without interference. . . .      It
       follows then that for the fulfillment of his destiny,
       man must be free and it is the duty of the State to
       secure and protect that freedom to enable the person
       to achieve his destiny.
Thomas J. Brogan, The Natural Law and the Right to Liberty, in 4

University of Notre Dame Natural Law Institute Proceedings 23,
29 (1951).

       ¶30   The    first     operative       provision        of     the     Wisconsin

Constitution recognizes "[a]ll people" have certain "inherent

rights" and the State of Wisconsin was founded by the people for

the sole purpose of securing these rights.                 See Wis. Const. art.

I, § 1.      See generally Porter v. State, 2018 WI 79, ¶52, 382

Wis. 2d 697,       913   N.W.2d 842     (Rebecca      Grassl     Bradley      &   Kelly,

JJ., dissenting) (explaining "[t]oo much dignity cannot well be

given" to this provision (quoting State v. Redmon, 134 Wis. 89,

101, 114 N.W.2d 137 (1907))).            Under the Wisconsin Constitution,

the "just powers" of the government derive "from the consent of

the governed," a consent explicitly premised on the State using

these powers to secure the people's rights.                 Wis. Const. art. I,

§ 1.     The Wisconsin Constitution exists not only to protect the

people    from     an    overreaching    government       but       to   empower     the

people's     government     to    protect     their    individual        freedom     from

non-state     actors.            See   generally       Jacobs       v.      Major,    139

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                                                                No.   2021AP1787-FT.rgb

Wis. 2d 492,       535,     407       N.W.2d 832       (1987)     (Abrahamson,       J.,

concurring/dissenting).

      ¶31    In this case, the circuit court used its equitable

power to craft a narrow remedy, ensuring a non-state actor could

not override the decision-making autonomy of a Wisconsin citizen

to whom the non-state actor owed a duty of care.1                         See Immanuel

Kant,     Groundwork      for   the    Metaphysics      of   Morals     34   (Jonathan

Bennett     ed.,    amend.      2008)      (1785)      (calling       decision-making

autonomy "the basis for the dignity of human nature").                              John

Zingsheim     contracted          COVID-19——a         serious     virus      that    has

threatened the world.2          He became so sick that he lay comatose in

a   privately-owned        hospital,      Aurora      Medical     Center-Summit——his

life sustained by a feeding tube and ventilator.                      In a sense, he

was a prisoner of circumstance:                 unable to be safely moved, he

had no practical ability to exercise his natural right to seek

treatment     elsewhere.          See,   e.g.,     Martin    ex    rel.    Scoptur    v.

Richards,    192   Wis. 2d 156,          172,   531    N.W.2d 70      (1995)   (noting

"every human being has a right to make his . . . own medical
decisions"); 1 T. Rutherforth, Institutes of Natural Law 146

(1754) ("By liberty we mean the power, which a man has to act as

      1The Honorable Lloyd V. Carter, Waukesha County Circuit
Court, presided.
      2As of mid-April 2023, the Wisconsin Department of Health
Services has confirmed 16,523 people in this state have died
while sick or probably sick with COVID-19. COVID-19: Wisconsin
Deaths, Wis. Dep't Health Servs. (last updated Apr. 14, 2023),
https://dhs.wisconsin.gov/covid-19/deaths.htm#number%20deaths.
The World Health Organization (WHO) estimates nearly 7 million
people have died of COVID-19.        WHO Coronavirus (COVID-19)
Dashboard,    WHO     (last    updated     Apr.    12,     2023),
https://covid19.who.int/.

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                                                             No.   2021AP1787-FT.rgb

he thinks fit, where no law restrains him; it may therefore be

called a man[']s right over his own actions.").                       Rather than

allow     Aurora    to    dictate     Zingsheim's       treatment,        the   court

temporarily enjoined Aurora.

      ¶32   The     circuit     court    was    cautious      in     crafting     its

temporary injunction not to favor Zingsheim's natural right at

Aurora's expense.            The court merely ordered that Gahl could

propose a doctor and that Aurora had to put this doctor through

its   credentialing       process     without       undue   delay.        The    court

clarified the proposed doctor was not entitled to any special

treatment.       If the proposed doctor satisfied Aurora's standard

criteria, Aurora was required to credential him but only for the

limited purpose of administering ivermectin to Zingsheim.                         The

court also required Gahl to sign a hold-harmless agreement to

limit Aurora's exposure to liability.                   With this remedy, the

court ensured no one would have to violate the dictates of his

conscience.        See generally City of Milwaukee v. Burnette, 2001

WI App 258, ¶10, 248 Wis. 2d 820, 637 N.W.2d 447 ("An injunction
may be no more broad than is 'equitably necessary.'"                        (quoting

State v. Seigel, 163 Wis. 2d 871, 890, 472 N.W.2d 584 (Ct. App.

1991))).

      ¶33   On     review,    this    court    is    presented     with    a    single

issue:       Whether      the      circuit    court properly       exercised      its

discretion in entering an order granting temporary injunctive

relief.     See Gahl ex rel. Zingsheim v. Aurora Health Care, Inc.,

2022 WI App 29, ¶66, 403 Wis. 2d 539, 977 N.W.2d 756 (Grogan,
J., dissenting).         It did.

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                                                               No.   2021AP1787-FT.rgb

    ¶34    The    resolution       of    this    issue   is     governed       by    the

"highly deferential" standard of review.                  See Prince Corp. v.

Vandenberg,     2016   WI 49,     ¶16,   369     Wis. 2d 387,        882     N.W.2d 371

(quoting     Klawitter     v.    Klawitter,      2001    WI     App 16,       ¶8,    240

Wis. 2d 685,     623     N.W.2d 169).           The   circuit        court    properly

exercised its discretion by considering the relevant facts and

applying   the    correct       legal    standard,      ultimately         reaching    a

reasonable conclusion.           Gahl, 403 Wis. 2d 539, ¶90.                  Although

the court's analysis could have been more meticulous, this court

has never required the detailed explanation the majority now

demands.         Additionally,      "[r]egardless         of     the        extent    of

the . . . [circuit] court's reasoning, [a reviewing court] will

uphold a discretionary decision if there are facts in the record

which   would    support    the . . . court's         decision        had     it    fully

exercised its discretion."              State v. Hurley, 2015 WI 35, ¶29,

361 Wis. 2d 529, 861 N.W.2d 174 (quoting State v. Hunt, 2003

WI 81, ¶52, 263 Wis. 2d 1, 666 N.W.2d 771) (third modification

in the original).
    ¶35    As three justices in the majority lamented in a case

last term:

    Could the circuit court have more clearly articulated
    its factual findings and legal conclusions?      Sure.
    However, when we review discretionary decisions, we do
    not require a perfectly polished transcript or magic
    words.    Rather we "look for reasons to sustain
    the . . . [circuit] court's discretionary decision,"
    reversing "if and only if the record does not reflect
    a reasonable basis for the determination or a
    statement of the relevant facts or reasons motivating
    the determination is not carefully delineated in the
    record."

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                                                                   No.    2021AP1787-FT.rgb

State v. X.S., 2022 WI 49, ¶91, 402 Wis. 2d 481, 976 N.W.2d 425

(Hagedorn,         J.,    dissenting)        (quoting      J.A.L.        v.    State,     162

Wis. 2d 940, 961, 471 N.W.2d 493 (1991)).

       ¶36    If    the    majority        applied       the   correct         standard    of

review,      it    would    be     forced     to    uphold     the     circuit        court's

decision.         As Judge Shelley A. Grogan, who was on the panel at

the     court      of     appeals,        wrote    in     dissent,       "it     is     clear

the . . . decision          was    reasoned        and   based    on     the    record    and

applicable law."           Gahl, 403 Wis. 2d 539, ¶83 (citing Diamondback

Funding, LLC v. Chili's of Wis., Inc., 2004 WI App 161, ¶6, 276

Wis. 2d 81, 687 N.W.2d 89).                  Because the majority raises the

review standard and now deems the expression of the substance of

law insufficient to sustain a discretionary decision, I dissent.

                                     I.    BACKGROUND

       ¶37    The majority opinion provides a scant statement of the

facts, which misleads through omission.                          For that reason, I

provide a thorough overview of the case.                         See generally Becker

v. Dane County, 2022 WI 63, ¶89, 403 Wis. 2d 424, 977 N.W.2d 390
(Rebecca Grassl Bradley, J., dissenting) ("It is . . . customary

for any judicial opinion to relay the facts of the case[.]"),

recons. mot. filed.

       ¶38    This tragedy started when Zingsheim contracted COVID-

19    in   September       2021.      His     condition        deteriorated        rapidly.

Zingsheim began receiving treatment at an Aurora hospital where

his condition worsened.               He was placed in the intensive care

unit.      He was then transferred to Aurora Summit and was on "full
intubation ventilation," which the petition for relief describes

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                                                             No.    2021AP1787-FT.rgb

as     "ventilation      treatment   that     requires       full    sedation    and

restraints and which involves an extreme risk of decline and

death."       While such ventilation can be life-sustaining, it can

also damage the lungs.           In fact, counsel for Zingsheim's adult

nephew, Allen Gahl, who held the health care power of attorney

(HCPOA),       informed    the    circuit     court    the     "pressure"       that

ventilation places on the lungs is "unnatural[.]"                         The high

pressure setting on which Zingsheim was placed could cause semi-

permanent       damage    by     "blow[ing]    holes     in . . . lungs"         and

"scar[ring] the tissues[.]"           While at Aurora Summit, Zingsheim

developed       "perforated      lungs,"     which,    according        to   Gahl's

counsel, caused bleeding.            According to Aurora, Zingsheim had

"[a]cute respiratory failure with hypoxia" among other sobering

health concerns at that point.             In summary, Zingsheim, a sixty-

year-old man, was on death's doorstep.

       ¶39    Aurora administered to Zingsheim a cocktail of drugs

including steroids, blood thinners, antibiotics, and sedatives,

none of which improved his condition.                 Remdesivir was the only
drug       Aurora   provided     Zingsheim    that     was    specifically       for

treating COVID-19, as opposed to his symptoms.                      Remdesivir was

approved by the Food & Drug Administration (FDA) for treating

COVID-19, but its use was controversial.3                    After two days on

       Gahl argued before the circuit court that WHO "recommends
       3

against the use of [r]emdesivir because it has severe
effect[s]. . . . It has severe effect[s] on people's kidneys."
Expanding on this point, an amicus curiae notes that WHO had
issued   a  conditional   recommendation   against   the  use   of
remdesivir.   WHO Recommends Against the Use of Remdesivir in
COVID-19      Patients,       WHO      (Nov.       20,      2020),
https://www.who.int/news-room/feature-stories/detail/who-
recommends-against-the-use-of-remdesivir-in-covid-19-patients#:-
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                                                                    No.    2021AP1787-FT.rgb

remdesivir,           Zingsheim's        family           demanded         Aurora      stop

administering         it,    worried    it     may    cause    severe      side    effects.

Aurora responded that only palliative care was available.                                 As

the circuit court seemed to characterize the situation, Aurora

adopted    a    "wait-and-see"         approach——wait         and    see    if    Zingsheim

died or got better.

    ¶40        Gahl       became    "fear[ful]"       that    Zingsheim       would    "not

survive."            He   averred,     "[i]t       is . . . now      common       knowledge

that . . . [COVID-19]              patients    on     full    ventilation        and   under

heavy sedation and restraints have a poor prognosis"——a point

the medical community later acknowledged to be true.

    ¶41        Gahl's fear caused him to begin researching COVID-19

treatments and specifically a drug called ivermectin.                             A summary

of ivermectin clinical trials, attached as an exhibit to the

petition       for    relief,      explains        that   ivermectin       "inhibits    the

replication of many viruses, including . . . [COVID-19]," much

like remdesivir.            A report in the record also notes ivermectin

"protects against organ damage in animal models," having "potent
anti-inflammatory              and       immune-modulating                 properties[.]"

According to Gahl's counsel, before Zingsheim became comatose,

:text=WHO%20has%20issued%20a%20conditional.    The recommendation
was stated in quite strong terms: WHO recommended "against the
use of remdesivir in hospitalized patients, regardless of
disease   severity,  as   there   [wa]s . . . no   evidence  that
remdesivir improve[d] survival and other outcomes in these
patients."   Id.  In April 2022, well after the circuit court's
decision, WHO began to "suggest[] the use of remdesivir in mild
or moderate COVID-19 patients who are at high risk of
hospitalization." Id.

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                                                        No.   2021AP1787-FT.rgb

he "told his two children and his nephew, . . . Gahl, that he

wanted to take [ivermectin] so that he could live."

     ¶42      Like   remdesivir,   ivermectin   is   controversial.        See

generally Gahl v. Aurora Health Care, Inc., No. 2021AP1787-FT,

unpublished order, at 2–3 (Wis. Oct. 25, 2022, as amended Oct.

28, 2022) (Roggensack, J., dissenting) ("I have concerns that

Gahl is being treated differently because underlying the current

motion   is    his   effort   to   obtain   treatment   with    [i]vermectin

for . . . Zingsheim[.]").4         Exactly why is unclear and beyond the

scope of this writing.         Ivermectin is approved by the FDA to

treat humans suffering from parasitic infections.               Some doctors

have also prescribed it to treat COVID-19, although the FDA has

not approved it for that specific purpose.           In medical parlance,

these doctors are prescribing ivermectin for an "off-label" use.

The FDA explains "off-label" as follows:

     Unapproved use of an approved drug is often called
     "off-label" use. This term can mean that the drug is:

              • Used for a disease or medical condition that it
                is not approved to treat, such as when a
                chemotherapy is approved to treat one type of
                cancer, but healthcare providers use it to
                treat a different type of cancer.

              • Given in a different way, such as when a drug
                is approved as a capsule, but it is given
                instead in an oral solution.

              • Given in a different dose, such as when a drug
                is approved at a dose of one tablet every day,
                but a patient is told by their healthcare
                provider to take two tablets every day.

     4 Four unpublished orders of this court are cited in this
writing.   For transparency, a copy of each is provided in the
appendix.

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                                                     No.   2021AP1787-FT.rgb

     If you and your healthcare provider decide to use an
     approved drug for an unapproved use to treat your
     disease or medical condition, remember that FDA has
     not determined that the drug is safe and effective for
     the unapproved use.
FDA, Understanding Unapproved Use Of Approved Drugs "Off Label"

(Feb.      5,    2018),    https://www.fda.gov/patients/learn-about-

expanded-access-and-other-treatment-options/understanding-

unapproved-use-approved-drugs-label#:~:text=Unapproved%20use%

20of%20an%20approved,a%20different%20type%20of%20cancer.               Off-

label use might sound scary, but it is actually quite common.

As Gahl explains in his opening brief, "[t]housands of 'off-

label' prescription drugs are prescribed every day for use that

the FDA has not 'approved' of in the United States."           One amicus

brief notes about 20 percent of all prescriptions are for an

off-label use.    The majority omits this context from its opinion

while emphasizing ivermectin is "not approved by the . . . [FDA]

as a treatment for COVID-19."       Majority op., ¶7.      Apparently for

dramatic    rhetorical    effect,   the   majority   even     notes    that

ivermectin, which, to reiterate, is approved for humans, is also

used to treat animals.5     Id.

     ¶43    Gahl's research led him to conclude ivermectin could

be an effective treatment for COVID-19.         Various studies Gahl

     5 Even more absurdly, the court of appeals majority equated
Gahl's concession that treating COVID-19 with ivermectin is an
"off-label" use with an admission that ivermectin is below the
standard of care. Gahl ex rel. Zingsheim v. Aurora Health Care,
Inc., 2022 WI App 29, ¶33, 403 Wis. 2d 539, 977 N.W.2d 756
("[T]hroughout his brief, Gahl effectively acknowledges that the
proposed treatment is not within the accepted standard of care
for COVID-19.   He admits that using the proposed treatment for
COVID-19 is not approved by the FDA, as it is an 'off-label use
of the drug.'").

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                                                                 No.   2021AP1787-FT.rgb

read strongly indicated ivermectin could help his uncle.                            For

example, one study presented to the circuit court found COVID-19

patients in severe condition had a substantially lower chance of

dying when treated with ivermectin.

    ¶44     In an effort to save his uncle, Gahl sought medical

advice from a doctor unaffiliated with Aurora, Dr. Edward Hagen,

M.D.,     who     had    experience      with    ivermectin.            According    to

Dr. Hagen, he spoke with Gahl who conveyed to him                            "detailed

information       about his       [u]ncle's     condition."            Dr. Hagen    also

averred    he     reviewed     Zingsheim's       eight-page       medical     history,

which was in the record before the circuit court.                            Dr. Hagen

then prescribed Zingsheim ivermectin.

    ¶45     Gahl requested that Aurora administer ivermectin as

Dr. Hagen       had     prescribed,      but    Aurora     refused.         Curiously,

Dr. James       Holmberg,      M.D.,     Aurora's      Chief      Medical     Officer,

averred,        "[i]vermectin      was    requested        by    family"     but    not

administered          "per   system    policy."          Gahl    alleges     corporate

executives——not          doctors——were     making        broad    policies     without
knowledge about individual patients.

    ¶46     Gahl averred he could not "give up" on his uncle even

if Aurora had.          As Gahl explained, "[a]t this point, there [wa]s

nothing . . . [Aurora could] do, or [was] will[ing to] do, for

my uncle that [wa]s likely to improve his condition."                        Gahl sued

Aurora on Zingsheim's behalf.

    ¶47     Gahl        posited    a   number     of     legal    theories     in   the

petition for relief.              Most pertinently, Gahl emphasized, "the
hospital . . . has sole custody of the patient due to his poor

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                                                       No.   2021AP1787-FT.rgb

medical     condition[.]"      Consequently,     Aurora's      conduct    was

depriving Gahl of his "undisputed right under well-established

law to make reasonable and lawful medical decisions" because he

could not go elsewhere to receive treatment.             As noted in the

petition:     "[W]hat dramatically changes the normal analysis of

patient choice is that fact that the patient is essentially in

hospital 'prison' due to his poor medical condition.              He cannot

go out into the medical marketplace to fulfill his preferences

which is otherwise his right under state law[.]"

     ¶48    Gahl cited Zingsheim's "right to self-determination"

under, among other legal sources, Article I, Section 1 of the

Wisconsin Constitution, the informed consent statute, and the

common    law.6    Among    other   theories,   Gahl   also    argued    that

withholding ivermectin violated the patient-physician contract,

the Hippocratic Oath, and Gahl's statutory right as the holder

of the HCPOA.      Gahl also argued that administering ivermectin

was within the standard of care, noting, "the evidence in favor

of . . . [ivermectin] is considerable, and the counterarguments
against its use and efficacy are weak."

     6 Gahl cited the wrong informed consent statute, Wis. Stat.
§ 51.61(1)(fm) (2019–20).    His point still stands.       Compare
§ 51.61(1)(fm) (explaining a "patient," which is defined as a
person receiving certain mental health or substance abuse
treatment, has "the right to be informed of his . . . treatment
and   care    and    to  participate    in    the   planning    of
his . . . treatment and care"), with Wis. Stat. § 448.30 ("Any
physician who treats a patient shall inform the patient about
the availability of reasonable alternate medical modes of
treatment   and   about  the   benefits   and   risks   of   these
treatments.").

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                                                                       No.    2021AP1787-FT.rgb

      ¶49     The       majority      inaccurately            suggests       Gahl   may     have

forfeited several legal arguments by not advancing them before

the circuit court.              Specifically, the majority claims Gahl did

not   argue      a    contract        theory      or    a    HCPOA     theory,      but   these

assertions        are     untrue——even           the    court     of     appeals     majority

acknowledged these arguments were made.                          Compare id., ¶21 n.6,

with Gahl, 403 Wis. 2d 539, ¶¶36–37 (majority op.) (noting Gahl

did   not   forfeit          his     argument      that      Aurora     had    violated     "an

implied contractual duty based on the Hippocratic Oath" or his

argument that Aurora violated the "statute concerning HCPOAs"),

and ¶35 n.22 ("We have carefully scrutinized the petition [for

relief]     to    discern       Gahl's      probable         arguments       supporting     his

claim that the court has authority to act in this case.                                      The

arguments        Gahl    set       forth    in    his       original     petition     are    as

follows:         (1) failure         to    provide      the    treatment       violated     the

'Hippocratic Oath'; . . . (3) withholding treatment violates the

HCPOA held by Gahl[.]").                   The court of appeals majority also

seemed to conclude that Gahl did not forfeit his argument that
the   circuit        court     had    "legal      and   equitable        authority"——which

that majority labeled as "inherent power"——to impose the relief

it did.     Gahl, 403 Wis. 2d 539, ¶¶36–37, 47–48.

      ¶50     The majority suggests Gahl "sought an order requiring

Aurora to administer [i]vermectin," which is partly true, but

ultimately Gahl simply wanted ivermectin administered; he did

not care by whom.               See Majority op., ¶8.                  Gahl noted in the

petition for relief that if the circuit court was not willing to

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                                                                         No.    2021AP1787-FT.rgb

order    Aurora      to   administer          the      drug,     "other"        or   "different"

relief would be acceptable.

      ¶51     Gahl explained in the petition for relief that he was

willing to sign a hold-harmless agreement.                               The majority omits

this fact among many others that do not fit its narrative.                                        The

court    of   appeals         majority       speculated         an    agreement        might      not

"shield Aurora and its health care professionals from liability"

in "future litigation."               Gahl, 403 Wis. 2d 539, ¶58.                     Strangely,

the court of appeals majority also complained that an agreement

in this case would not resolve how other disputes, involving

different      patients,        might        be     handled.          Id.      ("Although         the

plaintiff had offered to sign a release, 'the potential harm to

defendants      is    broader         than    this       one     case,      because      a    court

directive in this matter could open the door for a flood of

similar suits from other patients with COVID-19, not to mention

other    conditions,          suing    to     obtain          care   that      is    contrary      to

hospital      policies.'"         (quoting             Frey    v.    Trinity        Health-Mich.,

No. 359446, unpublished slip op., 2021 WL 5871744 at *5 (Mich.
Ct. App. Dec. 10, 2021) (per curiam))).

      ¶52     The circuit court initially rejected the petition for

relief out-of-hand because it was filed without the exhibits

mentioned in the petition.                    The court explained, "I think it

highly      inappropriate         for        this       [c]ourt       to       set    aside       its

obligations under the law and act in a vacuum without proper

basis or knowledge."              After the missing materials were filed,

the   court     held      a    hearing       on     what       its   characterized           as    an
"emergency      medical        injunctive           relief       petition."           The     court

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                                                               No.    2021AP1787-FT.rgb

emphasized    the      urgency    presented   by    Gahl's      assertions.         It

considered the situation "dire" and "felt it incumbent on the

[c]ourt . . . to get this in as soon as possible to address [the

issue.]"     Nonetheless, the court recognized "there ha[d] to be a

legal basis" for its decision, stating that it would "not [be]

appropriate"      to    base     its   decision    "on    emotion"       instead    of

evidence.     The court also recognized it was a "layperson" in

relation     to   medicine       and   accordingly       was    "relying      on   the

record . . . generated . . . to make the evaluation and exercise

the [c]ourt's discretion on the request."                  At the hearing, the

circuit court heard lengthy arguments involving many exhibits.

The transcript of the hearing spans 70 pages.

    ¶53     On the one hand, Gahl's counsel contended ivermectin

was a viable treatment that could improve Zingsheim's condition.

Although the circuit court was receptive to Gahl's arguments, it

noted   skepticism       at    times.       For    example,          Gahl's   counsel

referenced various cases across the nation in which courts had

ordered health care providers to administer ivermectin.                       Some of
these decisions were provided as exhibits.                 The court questioned

whether these decisions were factually on point.                       Specifically,

the court told Gahl's counsel:

    The specific cases that you referenced by way of
    example, and you submitted some documents regarding
    those, my review, at least of the ones that were
    identified specifically, you referenced the 80-year-
    old woman, the Rochester, New York, situation.      My
    understanding from what I reviewed was that there had
    already been administration of [i]vermectin, and those
    cases were for either reinstitute [sic] it or
    continuing it after a medical doctor who had a
    relationship with the patient had made a decision to
    prescribe it and then the hospital, for whatever
                              14
                                                            No.    2021AP1787-FT.rgb

      reason, decided to either not continue it or to
      terminate it. But those cases involved the situation
      where a licensed medical doctor with a patient –– a
      patient-doctor relationship with the individual had
      already made a prescription decision, and it seems
      facially different from what we have here.
The court ultimately viewed these cases as "anecdotal[.]"

      ¶54    On the other hand, Aurora argued that administering

ivermectin would fall below the standard of care.                      Repeatedly

during    the     hearing,   Aurora   analogized      the    administration         of

ivermectin to the administration of bleach; however, the court

rejected the analogy:         "we're not talking about putting bleach

in   somebody's     veins    here."     The   court    also       pushed    back    on

Aurora's argument that Gahl was trying to change the "status

quo":

      I have to interject a question here . . . .       [W]e
      don't have –– And that's what's missing in the two
      doctors' affidavits.    What is the ongoing medical
      protocol and treatment that's being pursued. I mean,
      if, in fact, . . . they're at the end of the line of
      their available treatments for . . . Zingsheim and
      they're saying, well, we put him on a ventilator and
      we're just going to, you know, see if he can fight
      this off without any further intervention, then the
      status quo is then, well, we'll just cross our fingers
      and hope for the best.   And I don't mean to diminish
      their medical opinions, but I don't have anything in
      the record that says, well, what are we doing to treat
      this gentleman other than put him on a ventilator and
      hope for the best.
      ¶55    Toward the close of the hearing, the circuit court

recited     the    correct   legal    standard;    the      majority       does    not

dispute this.       Specifically, the circuit court stated:

      The parties have touched on the elements that are
      before the [c]ourt on what amounts to a legal decision
      when considering a temporary injunction/restraining
      order.   And it requires the moving party here, the
      petitioner, demonstrate that the movant is likely to
                                15
                                                                     No.    2021AP1787-FT.rgb

      suffer irreparable harm if the temporary injunctive
      relief is not issued; also, secondly, that the movant
      has no other adequate remedy at law; thirdly, a
      temporary injunction is necessary to preserve at
      status quo; and, finally, the movant has a reasonable
      probability of success on the merits. That issue with
      those elements is put before the [c]ourt as a matter
      of exercising its discretion. . . .    So that's the
      basis and the background legally that the [c]ourt has
      to utilize as a framework and in assessing the
      circumstances of this case.
This court has applied the same standard in numerous cases.                                  See

e.g., Waste Mgmt., Inc. v. Wis. Solid Waste Recycling Auth., 84

Wis. 2d 462, 465, 267 N.W.2d 659 (1978) (quoting Werner v. A. L.
Grootemaat & Sons, Inc., 80 Wis. 2d 513, 519–20, 259 N.W.2d 310

(1977)).

      ¶56      After       articulating     the     correct     legal       standard,        the

circuit      court        explained     various     factual    considerations.                It

mentioned       Zingsheim's         serious        condition        and     the    competing

evidence regarding whether ivermectin would be effective.                                     It

was   also      concerned        with   preserving     Zingsheim's          life,      noting,

"the petitioner has asserted that if this [c]ourt doesn't act,

act     now,     act        today, . . . Zingsheim            is      going       to     die."

Critically,       it      also    expressed    "a    significant           respect     for    an

individual's right to choose and choose their treatment."                                Even

still, the court understood this right is not absolute——very few

rights are.

      ¶57      The     circuit     court    then     found     it    lacked       sufficient

information          to    determine       whether     the     temporary          injunction

requirements had been satisfied.                      It wanted more information

about     how     Dr. Hagen        had     made     his   decision           to   prescribe
ivermectin.          More generally, it recognized that both Zingsheim's

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                                                                     No.   2021AP1787-FT.rgb

condition and the viability of ivermectin as a treatment for

COVID-19      were    key       considerations.          As    the    court      explained,

without      additional         information      on    these     matters,        "it's    very

difficult . . . to          assess       what,   in     fact,    we're       dealing     with

other than relying on anecdotal representations today that [are]

otherwise     unsupported          by    competent      medical       expertise."          The

court ordered supplemental material be filed later that day.

       ¶58    While the circuit court was indicating it needed more

information, Gahl's counsel tried to pass the burden of proof

onto      Aurora,           arguing        "respondents           need           to      prove

that . . . [i]vermectin is dangerous and does not work.                                   And

they can't do that."              The court rejected such burden shifting,

making clear it viewed this case as a neutral arbiter should.

While Gahl had submitted some evidence, the court noted Aurora

had submitted:

       two affidavits from treating physicians and doctors
       licensed in the State of Wisconsin that assert to this
       [c]ourt that . . . [ivermectin] is dangerous.   That's
       the problem. . . . I've read the other materials that
       you submitted in support of the petition . . . . And
       that's great, but now I have two other doctors
       involved . . . say[ing] . . . Judge this is dangerous
       and we believe . . . that the use of [i]vermectin is
       more dangerous than efficacious.
The court continued, "we're in a court of law here today and

there   has    to     be    a    legal   basis    for     this    [c]ourt        to   make   a

determination."

       ¶59    The circuit court received dueling affidavits.                              Gahl

filed an affidavit by Dr. Hagen, who averred he had discussed
Zingsheim's condition with Gahl and reviewed Zinghseim's medical

history.             He     opined       that         "based     on        the    patient's
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history, . . . the administration of [i]vermectin at the dosage

indicated . . . [would give] the patient a realistic chance for

improvement while presenting a low risk of side effects."                                      He

also       attested,      "I    have    prescribed       [i]vermectin          in    about    300

other       cases      with    generally    favorable          results       and    no   serious

cases of side effects from the drug."7                        Aurora filed an affidavit

from       Dr. Holmberg——his            second     in    the     case——which          described

Zingsheim's treatment plan.

       ¶60       The    majority's        misuse        of    affidavits           reveals    its

misunderstanding regarding the standard of review.                                 The majority

opinion largely ignores Dr. Hagen's affidavit and instead relies

heavily on Dr. Holmberg's first even though the circuit court

obviously gave Dr. Hagen's more weight——which, as the trier of

fact, it had the discretion to do.                       See Majority op., ¶7.                The

majority         also    takes     a     not-so-subtle         shot     at     Dr. Hagen       by

referring to him as a retired OB/GYN.                         Id., ¶6.        Similarly, the

court       of    appeals        majority        mentioned       that        Dr.    Hagen    was

sanctioned about a decade ago by the Wisconsin Medical Examining
Board for prescribing medication to an individual who was not

his patient.            Gahl, 403 Wis. 2d 539, ¶8.               The circuit court was

aware       of    these        facts.      The        court    could     have        used    this

information to discount the information provided by Dr. Hagen,

but it did not do so.              Under the proper standard of review, this

       Gahl also filed an unnotarized affidavit of another
       7

doctor, which cannot be considered.    Wis. Hosp. Ass'n v. Nat.
Res. Bd., 156 Wis. 2d 688, 723 n.13, 457 N.W.2d 879 (Ct. App.
1990); see also Wis. Stat. § 887.01 (2019-20).

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court is not the trier of fact and must defer to the circuit

court's credibility determinations.

      ¶61    After     reviewing          the     supplemental             materials,       the

circuit     court     ordered       Aurora       to    administer           ivermectin      to

Zingsheim as prescribed.             Instead of complying with the circuit

court's order, Aurora instead wrote a letter to the court in

which it claimed it was "unable to comply with the terms of the

[o]rder     as    drafted"    and    asked       the       court    for     clarification.

Aurora also filed a petition for leave to appeal the nonfinal

order.      Aurora did not seek relief pending appeal in the court

of appeals.

      ¶62    The next day, the circuit court held a second hearing

to   consider      Aurora's     concerns.             At    this     hearing,       Aurora's

counsel told the circuit court that Zingsheim tested negative

for COVID-19 and asked whether that changed anything from the

court's perspective.          Gahl's counsel represented that ivermectin

was "not solely for the issue of COVID.                       It's for COVID and the

damages     that    come   about     as    a    result      of     COVID."        The   court
accepted the representation of Gahl's counsel.                             It then orally

modified its prior order.

      ¶63    The     modified       order       required         Aurora      to     allow     a

physician        identified     by    Gahl,        who      met     Aurora's        standard

credentialing        criteria,       to        have    access        to      Zingsheim      to

administer       ivermectin.8        The       modified      order     did    not    require

      8As one amicus curiae points out, the concern about
Dr. Hagen having prescribed a medicine without an in-person
examination is unwarranted given that a doctor willing to
administer the drug would have to come to Zingsheim in person.

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Aurora's      medical   staff    to   administer,        or   even     to   provide,

ivermectin.

      ¶64     Contrary to the insinuation of the court of appeals

majority, the circuit court did not require Aurora to credential

any particular doctor.           See id., ¶64.           As the circuit court

explained:

      I am not going to engage in directing the hospital or
      individuals at the hospital . . . to administer this
      medication to . . . Zingsheim. I think it's incumbent
      on the petitioner to supply a medical professional
      that's approved by the hospital for purposes of
      assisting this patient.      But I don't think it's
      appropriate for this [c]ourt to engage in further
      orders to the hospital as to how this drug is
      administered.

      They have, they being the hospital, have their rules
      of whom they admit to practice medicine there and how
      they do it, and I don't think –– The [c]ourt is taking
      a significant step in this case by the order that's
      been   entered.     I  think   it's  the  petitioner's
      responsibility for not only supplying the prescription
      but supplying an individual that meets the approval of
      the hospital for administration.
The court stated it was "not going to step on . . . [Aurora's]

toes" and it was giving "due deference" to Aurora's procedures.

The   court    specifically      declared     it   was   "not       going   to   start

dictating to the hospital and start to change their policies of

how they make their determination of who's appropriate to come

into their facility and administer medication," considering such

action "an overreach."

      ¶65     In   particular,     the   circuit     court      emphasized       that

Aurora need not credential Dr. Hagen, noting:

      If Dr. Hagen doesn't pass muster, then the petitioner
      has to find somebody else.    But I don't think this

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      [c]ourt –– This [c]ourt does not feel comfortable in
      making any further directives or orders to the
      hospital as to how that's to occur. I think that's a
      responsibility of the petitioner here and it's ––
      That's how the [c]ourt views.
While Aurora was required to not "engage in undue delay" in the

credentialing process, it was not required to give the proposed

doctor any special treatment.

      ¶66   Additionally,        the     circuit      court's        modified     order

required Gahl to sign a hold-harmless agreement, at Aurora's

request and in light of Gahl stating in the petition for relief

he would be willing to sign one.                 Despite these facts, the court

of appeals majority actually relied on the existence of the

agreement      as   support    for    its    erroneous      holding:       "That    the

parties and the circuit court discussed a release of liability

is   further    evidence      that    Gahl's      requested   relief      would    have

forced Aurora to act outside the boundaries of the law and that

his request was not grounded in any legal authority."                         Id., ¶58

n.34.

      ¶67   After     the    circuit    court      orally   modified      its    order,

Gahl and Aurora began to negotiate.                  According to the court of

appeals majority, Aurora was "on the cusp of providing temporary

credentials     to   an     outside    provider,      subject    to    Gahl     signing

releases."      Id., ¶26 n.19.         The day after the oral modification,

while negotiations were ongoing, the court of appeals granted

Aurora's petition for leave to appeal a nonfinal order——before

even receiving a response from Gahl.                 Worse still, the court of

appeals, on its own motion and without any explanation, stayed
the circuit court's oral ruling, even though it apparently did

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not know the exact contents of that ruling.          See Gahl v. Aurora

Health Care, Inc., No. 2021AP1787, unpublished order, at 3 (Wis.

Oct. 21, 2021) (Rebecca Grassl Bradley, J., dissenting).                 The

court of appeals acted so hastily that the oral ruling had not

been reduced to a signed written order.        Gahl filed an emergency

petition to bypass the court of appeals.            In a 4-3 decision,

this court denied that petition, leaving the stay entered by the

court of appeals undisturbed.

       ¶68    Following the bypass denial, the court of appeals took

seven months to decide this case despite its emergency nature.

While the appeal was initiated on October 12, 2021, the court of

appeals did not issue its opinion until May 25, 2022——225 days

later.       Gahl, 403 Wis. 2d 539, ¶72 n.4 (Grogan, J., dissenting).

If the court of appeals decides to take a case with life or

death consequences, it has a moral, if not legal, duty to decide

it in a timely manner.         Gahl, No. 2021AP1787, at 4 (Oct. 21,

2021) ("While appellate courts have all the luxury of time to

ponder     the   law, . . . Zingsheim,   fighting   for    his   life,   does
not.       Circuit courts are best equipped to make these sorts of

frontline decisions, in which time is of the essence.").

       ¶69    The court of appeals majority reversed the modified

order of the circuit court over the well-reasoned dissent of

Judge Grogan, which this court's majority completely ignores.9

The court of appeals majority held the circuit court erroneously

       The court of appeals understood itself to be reviewing the
       9

circuit   court's  order   as   orally  modified.     Gahl,   403
Wis. 2d 539, ¶25 n.18. This court likewise reviews the modified
order.

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exercised its discretion because, in its view, Gahl, not the

circuit court, "failed to identify any law, claim, or recognized

cause    of   action   under    Wisconsin    law    by    which    a   patient    may

compel a health care professional to administer a course of

treatment     contrary    to    that   medical     professional's       judgment."

Gahl, 403 Wis. 2d 539, ¶1 (majority op.).                    It "further [held]

the [circuit] court had no legal authority to compel Aurora to

credential an outside provider to provide care that is below the

standard of care."        Id., ¶64.

    ¶70       This holding presupposes that the administration of

ivermectin actually falls below the standard of care.                        As Judge

Grogan explained:

    By redefining "standard of care" to mean what the
    treating physician believes it to be, the majority
    effectively requires all courts going forward to
    simply accept the health care provider's belief as to
    the standard of care where a patient seeks an
    injunction based on a disagreement with the provider's
    course of action in providing care.
Id., ¶85 n.11 (Grogan, J., dissenting).                  Judge Grogan's dissent

documented the existence of "legal authority to issue injunctive
relief    under   these    circumstances"        and     concluded     the    circuit

court properly exercised its discretion.                  Id., ¶¶88, 90.         Gahl

petitioned this court for review, which this court granted.

                          II.    STANDARD OF REVIEW

    ¶71       Whether to grant a temporary injunction is within the

circuit court's discretion.            Milwaukee Deputy Sheriffs' Ass'n v.

Milwaukee County, 2016 WI App 56, ¶20, 370 Wis. 2d 644, 883

N.W.2d 154 (citing State v. C. Spielvogel & Sons Excavating,

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Inc., 193 Wis. 2d 464, 479, 535 N.W.2d 28 (Ct. App. 1995)).                     As

already explained, the standard of review is highly deferential:

         An appellate court "may not substitute its discretion for
          that of the circuit court." State v. Rhodes, 2011 WI 73,
          ¶26, 336 Wis. 2d 64, 799 N.W.2d 850 (citing State v.
          McCall, 202 Wis. 2d 29, 42, 549 N.W.2d 418 (1996)).

         An "appellate court[] should 'look for reasons to sustain
          a . . . [circuit]   court's   discretionary   decision.'"
          State v. Gutierrez, 2020 WI 52, ¶27, 391 Wis. 2d 799, 943
          N.W.2d 870 (quoting State v. Wiskerchen, 2019 WI 1, ¶18,
          385 Wis. 2d 120, 921 N.W.2d 730).
An appellate court must uphold a circuit court's discretionary

decision if the circuit court applied the correct legal standard

to the relevant facts and reached a reasonable conclusion.                     See

Seigel,    163    Wis. 2d at    889   (citing     Hartung    v.    Hartung,    102

Wis. 2d 58, 66, 306 N.W.2d 16 (1981)).

    ¶72     In      fact,      "[r]egardless       of       the     extent      of

the . . . [circuit] court's reasoning, [a reviewing court] will

uphold a discretionary decision if there are facts in the record

which would support the trial court's decision had it                         fully

exercised    its     discretion."       Hurley,      361     Wis. 2d 529,      ¶29
(quoting Hunt, 263 Wis. 2d 1, ¶52) (third modification in the

original).       If the appellate court is unsure whether the record

can be so read, the proper remedy is to remand to the circuit

court so that the circuit court can "articulate reasoning[.]"

See X.S., 402 Wis. 2d 481, ¶58 n.1 (Ziegler, C.J., concurring)

(citing     Paschong    v.     Hollenbeck,   16     Wis. 2d 284,       286,    114

N.W.2d 438 (1962)).

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      ¶73   A circuit court may issue a temporary injunction if

the   requirements        of   Wis.    Stat.    § 813.02(1)(a)     (2019–20)     are

satisfied.       Section 813.02(1)(a) states:

      When it appears from a party's pleading that the party
      is entitled to judgment and any part thereof consists
      in restraining some act, the commission or continuance
      of which during the litigation would injure the party,
      or when during the litigation it shall appear that a
      party is doing or threatens or is about to do, or is
      procuring or suffering some act to be done in
      violation of the rights of another party and tending
      to render the judgment ineffectual, a temporary
      injunction may be granted to restrain such act.
This court has generally required four elements:

         The party requesting relief is likely to suffer
          irreparable harm if a temporary injunction is not issued;

         A temporary injunction is necessary to maintain                        the
          status quo, thereby preventing the irreparable harm;

         The moving party has no other adequate remedy; and

         The party has a reasonable probability of success on the
          merits.
Waste     Mgmt.,    Inc.,      84   Wis. 2d at     465   (quoting      Werner,    80

Wis. 2d at 519).

                                    III.   ANALYSIS

      ¶74   In this case, the circuit court properly exercised its

discretion.        The majority seems to take issue with the circuit

court's analysis regarding only one of the four prerequisites

for injunctive relief:              the reasonable probability of success.

The majority, however, also states, "[the circuit court] did not

engage in any analysis" of any requirement.                  Majority op., ¶24.

Similarly,    the    court     of     appeals   majority    opinion,    which    the
majority    of     this   court     affirms,    seriously    misunderstood       the
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elements.            A    majority     of     this     court     leaves        these    errors

uncorrected, and therefore they are likely to feature in future

cases.     Although the majority seems to affirm the decision on a

narrow basis, it does not expressly——or even impliedly——signal

the opinion below loses its precedential value.                                Consequently,

the court of appeals will understand itself to be bound by that

opinion.        See State v. Schmidt, 2016 WI App 45, ¶48 n.11, 370

Wis. 2d 139, 884 N.W.2d 510 (citing                      Blum v. 1st Auto & Cas.

Ins., 2010 WI 78, ¶44, 326 Wis. 2d 729, 786 N.W.2d 78).                                      See

generally       Wis.       Mfrs.   &    Com.    v.     Evers,    2023        WI 5,     ¶2,   405

Wis. 2d 478, 984 N.W.2d 402 (per curiam) (noting that while this

court has not addressed the issue directly, when this                                    court

affirms     a    published         opinion      of     the     court     of     appeals,     on

different grounds but without suggesting the rationale of the

court of appeals was incorrect, the court of appeals opinion may

remain binding precedent).                  Accordingly, a brief overview of the

circuit court's analysis regarding the other requirements is in

order first.
                              A.   The Other Requirements

    ¶75     Judge           Grogan's     dissent        accurately           describes       the

circuit    court's          analysis    of     the    requirements:            "The    circuit

court . . . recognized that Zingsheim's medical condition, which

undoubtedly relates to multiple injunction factors, created an

urgent, if not dire, situation."                       Gahl, 403 Wis. 2d 539, ¶83.

Zingsheim's          "precarious         medical         condition"           unquestionably

pertained       to       "irreparable    harm        (death)"    and     the    "status      quo

                                               26
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(life)[.]"          Id.        "Additionally,          given . . . the       finality    of

death, there was no other adequate remedy at law[.]"                          Id.

       ¶76    The court of appeals' discussion of irreparable harm

in   the     majority      opinion      focused      on    the    wrong    party.     That

majority discussed "several concerns" raised by Aurora about the

"irreparable harm" Aurora could experience from the temporary

injunction.          Id.,       ¶¶57–59    (majority        op.).         Aurora    claimed

providing treatment below what it perceived to be the standard

of care could impact the licensing of its doctors and nurses and

expose     Aurora     to       civil    liability       despite     the     hold-harmless

agreement.          Id.        Analyzing the potential harm to Aurora was

improper.      Wisconsin Stat. § 813.02(1)(a) provides, in relevant,

part:      "When it appears from a party's pleading that the party

is   entitled       to     judgment      and     any    part     thereof    consists    in

restraining some act, the commission or continuance of which

during the litigation would injure the party . . . ."                           (Emphasis

added.)       As indicated by the plain language of § 813.02(1)(a),

the irreparable harm requirement concerns injury to "the party
asking for relief."               See 43A C.J.S. Injunctions § 68 (updated

Mar. 2023).         Accordingly, the court of appeals majority should

have     evaluated        whether       Aurora's       conduct      would    "violate    a

right . . . and injure [Zingsheim]" in a way that Zingsheim's

injury would be "irreparable."                   Pure Milk Prods. Co-op. v. Nat'l

Farmers      Org.,        90    Wis. 2d 781,        800,    280     N.W.2d 691      (1979)

(citations omitted).

       ¶77    The    court       of    appeals      majority     mischaracterized       the
modified order.            The modified order did not compel Aurora to

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administer          the      drug,       so      Aurora's      licensing      concerns     are

unfounded.          Similarly, the standard of review does not permit

the court of appeals to speculate the hold-harmless agreement

might be found invalid.                   The circuit court at least implicitly

found the agreement sufficient to protect Aurora, and the court

of appeals majority lacked competence to question that finding.

       ¶78        The    court      of    appeals       majority      also    suggested    the

circuit court did not understand the status quo, a claim belied

by    the    full       record.          Gahl,    403    Wis. 2d 539,        ¶¶60–61.     That

majority asserted:

       Here, . . . the circuit court's order changed the
       status quo by ordering Aurora to begin providing the
       proposed treatment to the patient. . . .

       The circuit court did not address this factor
       directly, but it is of paramount importance given the
       concerns Aurora provided to the court and the
       affirmative relief ordered. The status quo before the
       litigation was that Aurora was able to exercise its
       medical judgment as to patients in the hospital within
       the bounds of its standard of care.
Id.         The    court     of     appeals       again     misdirected       its   analysis,

erroneously focusing on the status quo from Aurora's perspective
rather than the party seeking injunctive relief.

       ¶79        Under      this        court's        precedent,      the     status     quo

requirement             is   closely          related     to    the     irreparable       harm

requirement.            As this court explained more than a century ago:

       Just where the truth lies cannot be told till a trial
       of the case on the merits, hence the necessity of a
       power   to   preserve  the   status  quo  pending the
       litigation, if that be necessary to make the final
       decree    effective   to   do   justice  between  the
       parties. . . . [I]t is . . . within the discretionary
       power of the court, by a temporary injunction, to
       preserve the status quo between the parties pending
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                                                                      No.    2021AP1787-FT.rgb

    the final decree, if that be necessary in order to
    make such decree effective or to save the person
    claiming relief from irreparable injury by the conduct
    of his adversary pending the litigation.
Valley Iron Works Mfg. Co. v. Goodrick, 103 Wis. 436, 444, 78

N.W. 1066 (1899) (emphasis added); see also De Pauw v. Oxley,

122 Wis. 656, 659, 100 N.W. 1028 (1904) ("[I]t is well-nigh an

imperative      duty     of    the       court    to   preserve    the       status     quo    by

temporary    injunction,            if    its     disturbance     pendente          lite    will

render futile in considerable degree the judgment sought[.]").

More recently, this court has explained, "[i]njunctions are not

to be issued without a showing of . . . irreparable harm, but at

the temporary injunction stage the requirement of irreparable

injury is met by a showing that, without it to preserve the

status quo [during litigation] . . . , the permanent injunction

sought   would     be     rendered          futile."       Waste        Mgmt.,      Inc.,      84

Wis. 2d at 465 (quoting Werner, 80 Wis. 2d at 519).

    ¶80     In the context of this case, during which Zingsheim's

survival hung in the balance, the preservation of the status quo

reasonably      meant         the    preservation        of     the     opportunity           for
Zingsheim to obtain his ultimate requested relief:                                  access to

ivermectin.        The    status          quo    was   life.      Had       Zingsheim      died,

obviously access to ivermectin would have been rendered futile.

Notably, not all of this court's cases on temporary injunctive

relief   even     impose       a    status       quo   requirement.           See    James     v.

Heinrich,    Nos.       2020AP1419-OA,             2020AP1420-OA        &    2020AP1446-OA,

unpublished order, at 2 (Wis. Sept. 10, 2020).

    ¶81     The    circuit          court        demonstrated     it     understood         both
perspectives on the status quo, and, unlike the court of appeals

                                                 29
                                                              No.   2021AP1787-FT.rgb

majority,    viewed    the    preservation        of   the   status       quo    as    the

preservation of Zingsheim's right to self-determination.                              When

Aurora's counsel tried to argue Gahl was changing the "status

quo" the circuit court posed the following question:

       I have to interject a question here . . . .       [W]e
       don't have –– And that's what's missing in the two
       doctors' affidavits.    What is the ongoing medical
       protocol and treatment that's being pursued. I mean,
       if, in fact, . . . they're at the end of the line of
       their available treatments for . . . Zingsheim and
       they're saying, well, we put him on a ventilator and
       we’re just going to, you know, see if he can fight
       this off without any further intervention, then the
       status quo is then, well, we'll just cross our fingers
       and hope for the best.   And I don't mean to diminish
       their medical opinions, but I don't have anything in
       the record that says, well, what are we doing to treat
       this gentleman other than put him on a ventilator and
       hope for the best.
Quite    clearly,    the     circuit    court     viewed     the    status       quo    as

maintaining Zingsheim's life and well-being, not Aurora's denial

of ivermectin.       The court's framing of the issue comported with

this    court's    precedent.       The    circuit      court      also    repeatedly

voiced    its     concerns    for   the    "dire"      situation.          The    court
considered and rejected the view later maintained by the court

of appeals majority regarding the status quo——no ivermectin——

which it was entitled (if not required) to do.

       ¶82   No member of this court or the court of appeals has

suggested that Zingsheim had a different and adequate remedy

available    at    law.      "[G]iven     Zingsheim's        condition,"         no    one

suggests "a transfer to another hospital or checking out of

Aurora" were plausible options.                Gahl, 403 Wis. 2d 539, ¶83 n.10
(Grogan, J., dissenting).           Death is irreversible.                There is no

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remedy at law or otherwise.                     "It is hard to have patience with

people who say, 'There is no death' or 'Death doesn't matter.'

There is death.             And whatever is matters.                   And whatever happens

has     consequences,             and     it    and      they        are     irrevocable            and

irreversible."                    Gahl     v.      Aurora         Health           Care,         Inc.,

No. 2021AP1787-FT, unpublished order, at 3 (Wis. Oct. 25, 2021)

(Rebecca Grassl Bradley, J., dissenting) (quoting C.S. Lewis, A

Grief     Observed          15     (HarperCollins             Paperback          1st    ed.      1994)

(1961)).

                     B.     Reasonable Probability of Success

       ¶83     Most of the majority opinion focuses on the reasonable

probability of success.                  At points, the majority criticizes Gahl

for, in its view, not stating a claim upon which relief could be

granted.        Majority op., ¶23.                     At other points, the majority

acknowledges         the     circuit      court        grounded      its     decision          in   its

"respect       for     an     individual's         right        to     choose          their     [sic]

treatment,"      but        the    majority       proclaims       in       conclusory          fashion

that something more was required.                         Id., ¶27.              The majority is
wrong.

                                  1.    Gahl Stated a Claim.

       ¶84     As a preliminary matter, the majority seems to adopt

the    court    of    appeals          majority's       insupportable            assertion          that

"Gahl's claim must fail because he did not identify a source of

law[.]"         Id.,        ¶1;    see     also        id.,    ¶16     (quoting          Gahl,      403

Wis. 2d 539,         ¶1     (majority          op.)).          Based       on     this     mistaken

premise, the majority holds Gahl failed to state a claim.                                           Id.,
¶23.     At no point does the majority examine Article I, Section 1

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of the Wisconsin Constitution, the informed consent statute, or

the    common       law    even    though       all        were   referenced       in    Gahl's

petition for relief (among other legal authorities).

       ¶85    As a matter of natural law, people have a right "to

make    their       own    health        care    decisions."           See     Martin,        192

Wis. 2d at 171.            This right to self-determination is protected

by Article I, Section 1 of the Wisconsin Constitution, which

this court has held protects an "independent right to liberty

includ[ing] an individual's choice of whether or not to accept

medical treatment."             Lenz v. L.E. Phillips Career Dev. Ctr., 167

Wis. 2d 53,         69,      482     N.W.2d 60             (1992).         But       for     his

incapacitation, in a free market Zingsheim could have exercised

this right by leaving the hospital; his condition precluded that

option.

       ¶86    The right to self-determination is also protected by

the informed consent statute.                   "The doctrine of informed consent

comes from the common law and stems from the fundamental notion

of the right to bodily integrity:                      '[e]very human being of adult
years and sound mind has a right to determine what shall be done

with his own body[.]'"                   Martin, 192 Wis. 2d at 169 (quoting

Schloendorff v. Soc'y of N.Y. Hosp., 105 N.E. 92, 93 (1914),

overruled      on    other      grounds     by       Bing    v.   Thunig,     143       N.E.2d 3

(1957);      citing       Lenz,    167    Wis. 2d at         68).      Interpreting          this

court's precedent, the court of appeals explained in a different

decision,       "the      deference . . . [this               precedent]      pays      to   the

patient's         right    to     choose . . . his            treatment       is     important
because      it     demonstrates         that        the    informed    consent         statute

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protects     more    than    merely      the    patient's     right        to     obtain

information."       Schreiber v. Physicians Ins. Co. of Wis., 217

Wis. 2d 94,    105,    579      N.W.2d 730     (Ct.    App.   1998),       aff'd,    223

Wis. 2d 417, 588 N.W.2d 26 (1999).               A right to informed consent

presupposes    a    doctor      cannot     wholly     "ignor[e]      the    patient's

ultimate choice."         Id.      Particularly if the patient is trapped

in a hospital, unable to leave, the informed consent statute

would mean very little if it mandated only the provision of

information by a doctor.             See id.          The court of appeals has

therefore held "in addition to protecting the patient's right to

obtain information, the informed consent statute must protect

the patient's right to choose a medically viable treatment and

have that choice respected by . . . his doctor."                    Id.

    ¶87     This court also recognizes the "common law right to

self determination[.]"           Lenz, 167 Wis. 2d at 67.            This court has

explained:     "No right is held more sacred, or is more carefully

guarded by the common law, than the right of every individual to

the possession and control of his own person, free from all
restraint     or    interference      of     others,     unless      by    clear    and

unquestionable authority of law."              Id. at 68 (quoting Union Pac.

Ry. v. Botsford, 141 U.S. 250, 251 (1891)).                    Zingsheim's self-

determination       was      not     constrained         by    any        clear      and

unquestionable authority of law.                 It was constrained by his

inability to leave the hospital.

    ¶88     Gahl also argued ivermectin fell within the standard

of care.     As the court of appeals has previously held:

    Where there are two or more medically acceptable
    treatment approaches to a particular medical problem,
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      the informed consent doctrine, medical ethics, and the
      standard of care all provide that a competent patient
      has the absolute right to select from among these
      treatment options after being informed of the relative
      risks and benefits of each approach.
Schreiber, 217 Wis. 2d at 103.                        On appeal, this court affirmed

on narrower grounds, emphasizing "this opinion should not be

interpreted as requiring physicians to perform procedures they

do not consider medically viable, procedures for which they lack

the   appropriate       expertise,            or    procedures      to     which    they      are

morally opposed."          Schreiber, 223 Wis. 2d 417, ¶15.                       This court,

however, did not withdraw language from the court of appeals

decision      and    did     not    express           disagreement       with     it.         More

importantly, the modified order in this case did not require any

doctor to do anything.                    The circuit court received evidence

sufficient      to    reasonably          find      that   ivermectin        was    a     viable

medical treatment; Dr. Hagen's affidavit alone was a sufficient

basis    on   which     to     make       this        finding.       The    circuit          court

therefore      had     authority         to    ensure      Zingsheim       had     access       to

ivermectin.         Schreiber, 217 Wis. 2d at 103.

      ¶89     Gahl identified multiple legal sources in his petition

for   relief;       regardless,          black-letter       law     does    not    require       a

specific citation to state a claim.                        "[L]egal theories need not

be    fully    developed,          or     even        expressly     identified,         at    the

pleading      stage."          Kohlbeck            v.   Reliance     Const.        Co.,       2002

WI App 142,     ¶12     n.3,       256    Wis. 2d 235,        647    N.W.2d 277         (citing

Murray   v.     City    of     Milwaukee,           2002   WI App 62,        ¶12    n.6,       252

Wis. 2d 613, 642 N.W.2d 541).                      In Murray v. City of Milwaukee,
the court of appeals explained:

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    The City contends that we should not address Murray's
    contention that the City erroneously exercised its
    discretion under Wis. Stat. § 895.35 because that was
    not alleged in the complaint, and Murray did not make
    that argument until his brief in opposition to the
    City's motion to dismiss.     However, a complaint need
    not expressly identify a legal theory, but only the
    facts   necessary    to   recover   under    that   legal
    theory. . . .     Because   the   City    has   had   the
    opportunity, both in the trial court and in this
    court, to respond to Murray's legal theory . . . it is
    proper to decide the merits of this legal theory.
252 Wis. 2d 613, ¶12 n.6 (citing Nw. Nat. Cas. Co. v. State

Auto. & Cas. Underwriters, 35 Wis. 2d 237, 241, 151 N.W.2d 104

(1967); Wis. Stat. § 802.02(1)).                     The decisions of the United

States Supreme Court are in accord.                          See Johnson v. City of

Shelby, 574 U.S. 10, 12 (2014) (per curiam) ("The federal rules

effectively          abolish        the   restrictive         theory      of      pleadings

doctrine, making it clear that it is unnecessary to set out a

legal theory for the plaintiff's claim for relief."                              (quoting 5

Charles    Alan       Wright    &    Arthur    R.    Miller,     Federal       Practice    &

Procedure § 1219 (3d ed. 2004))).                       That Court has reversed,

without controversy, decisions of lower federal courts imposing

a specific citation requirement to state a claim.                         Id. at 11-12.

    2.     The Circuit Court Correctly Analyzed the Reasonable
                 Probability of Success Requirement.
    ¶90        The     majority's         analysis      of    the     circuit       court's

reasoning       on    Gahl's    reasonable         probability      of    success    is   as

wrong     as    it     is     confusing.           On   one     hand,      the     majority

acknowledges "there are no 'magic words' the circuit court must

utter or any precise level of specificity that is required."

Majority       op.,    ¶26.     Undoubtedly,         this     statement     is     correct.
This court has rejected a so-called magic words requirement on

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many occasions.           Marathon County v. D.K., 2020 WI 8, ¶66, 390

Wis. 2d 50,       937      N.W.2d 901        (Rebecca        Grassl     Bradley,     J.,

concurring) ("We do not impose a 'magic words' requirement in

the     law     and     this    court       has    repeatedly       rejected      them."

(collecting cases)).

       ¶91    Contradicting its rejection of a magic words standard,

the majority repeatedly faults the circuit court for not citing

a specific source of law.               See, e.g., majority op., ¶12 ("There

was no statutory basis or other legal foundation for the order

set     forth     in     its      text.");        id.,   ¶21      n.7     ("The    trial

court . . . did not cite any actual law to support its order.");

id.,    ¶25     ("The    circuit    court's        written     order    granting    Gahl

relief does not cite any statute, case, or other source of law

as a foundation allowing for its issuance."); id. ("Absent any

citation to law establishing a legal basis for the order, we

cannot determine that the circuit court employed the reasoning

process our precedent demands.").                  It then holds "[w]e need not

address in depth any of Gahl's arguments because we do not know
on     what     basis     the     circuit     court      issued     the    [temporary]

injunction."          Id., ¶21.

       ¶92    The majority continues, "[t]he circuit court cited no

law either in its written order or in its oral ruling," which

the majority declares is "in itself" a reversible error.                             Id.

Ironically, the majority does not cite any authority obligating

the circuit court to provide a specific citation, wading into

"the native land of the hypocrite."                  Oscar Wilde, The Picture of
Dorian Grey 129 (Canterbury Classics 2013) (1891).                        No effort is

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made by the majority to "determine . . . [whether] the circuit

court   employed        the    reasoning      process       our    precedent       demands"

because, the majority claims, this inquiry is impossible without

a specific citation by the circuit court.                       Majority op., ¶25.

      ¶93   Although          the   circuit        court     did    not       recite     case

precedent     or        statutory       law,        it      explicitly         espoused     a

"significant respect for an individual's right to choose and

choose their treatment" clearly grounded in both.                              In light of

the   petition     for        relief    and    the       record    as     a   whole,     this

statement should be sufficient.                    After all, magic words are not

required.         The    majority       nevertheless         claims       "such    a   stray

reference" is insufficient.                   Id., ¶27.           It cites nothing to

support this conclusion.

      ¶94   No general rule requiring the circuit court to cite a

specific    law    exists,       and    in    fact,      this   court     has     crafted   a

special rule requiring a specific statutory citation in just one

context.     See Langlade County v. D.J.W., 2020 WI 41, ¶3, 391

Wis. 2d 231, 942 N.W.2d 277.                 The creation of this special rule
proves the general one.                 In Langlade County v. D.J.W., this

court held that "going forward circuit courts in recommitment

proceedings are to make specific factual findings with reference

to the subdivision paragraph of Wis. Stat. § 51.20(1)(a)2. on

which the recommitment is based."                     Id.    The rule in D.J.W. was

adopted,    in    part,       because    circuit         courts    left       unstated    the

statutory basis of recommitments.                    D.J.W. facilitated appellate

review by imposing a rule of judicial administration.                             Id., ¶40.
D.J.W. is an anomaly in this court's jurisprudence.                             If it were

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otherwise, this court would not have needed to make a ruling

specific to recommitment cases.                      As D.J.W. shows, this court

does not require circuit courts to cite specific legal authority

as a basis for its decision.

       ¶95    The majority pretends the circuit court's reasoning

was so bad that the majority cannot make heads or tails of it,

but    the    reasoning       is    easily    discernable.            As     Judge     Grogan

explained:

       What is clear from the record . . . is that the
       circuit court understood that likelihood of success on
       the merits was a required factor, that it was honed in
       on the competing medical opinions presented by
       Aurora's and Gahl's supporting physicians as to what
       treatment would or would not be appropriate for
       Zingsheim under the circumstances, and that the
       medical   information   from   the   parties'  various
       physicians was central to its determination.
Gahl,        403      Wis. 2d 539,         ¶84       (Grogan,        J.,         dissenting).

Critically,         "[b]ased   on    the     information        in    the     record,"      the

circuit       court      concluded     Gahl        had   established         a    reasonable

probability         of     success     either       under    a       "right       to   choose

ivermectin" theory or because the "standard of care" required

it.     Id.        Under the latter theory, the court did not have to

conclude ivermectin was actually effective——merely that if the

case were to continue, the trier of fact might so find.                                    "The

fact    that       the    circuit    court         was   presented         with    differing

opinions about what treatment is proper for Zingsheim suggests

the    jury    is     still    'out'    as    to     whether     there       is     only    one

particular and established 'standard of care' in treating this
novel virus."            Id., ¶89.     "Time will eventually reveal what the

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standard    of    care   or    reasonable      alternative          treatment     is   for

people in Zingsheim's position."              Id.

    ¶96     The     majority      errs   in      treating           this      politically

controversial      case       differently      than       other       cases     involving

similar     decisions.              "Regardless           of        the      extent     of

the . . . [circuit] court's reasoning, [a reviewing court] will

uphold a discretionary decision if there are facts in the record

which would support the trial court's decision had it                                 fully

exercised its discretion."           Hurley, 361 Wis. 2d 529, ¶29 (quoted

source     omitted)       (second     modification             in     the      original).

Arguably, the majority must search the record for reasons to

support the circuit court's decision.                     Altogether absent from

the majority opinion is any attempt to read the record in a

light favorable to the circuit court's discretionary decision.

See State v. Johnson, 2021 WI 61,                   ¶34, 397 Wis. 2d 633, 961

N.W.2d 18        (quoting       Gutierrez,          391        Wis. 2d 799,           ¶27).

Alternatively, the majority could remand the case to the circuit

court to better explain its decision.                     X.S., 402 Wis. 2d 481,
¶58 n.1.     When "there [is] room in the facts which d[o] not

confine the [circuit] court to one result," remand is often the

proper remedy.      Id. (quoting Paschong, 16 Wis. 2d at 286) (first

modification in the original).                Outright reversal is a drastic

remedy, not normally imposed unless the record is totally devoid

of evidence supporting the circuit court's decision.                             See id.,

¶56 (majority op.).

    ¶97     On a final note, the majority fails to appreciate the
circumstances the circuit court faced when it made its decision.

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"Wisconsin          judges      are        rarely       asked    to     make       life-or-death

decisions.               This     case          present[ed]          one     of        those     rare

circumstances [to the circuit court].                           The circuit court made a

decision on the side of life."                          Gahl, No. 2021AP1787-FT, at 3

(Oct. 25, 2021).                 Zingsheim had COVID-19, and Aurora placed

Zingsheim on a ventilator.                       Death was a realistic possibility.

Time was of the essence.                    As the circuit court recognized, the

situation      was       "dire."           The    circuit       court,       which      was    not   a

medical       professional,           was       presented       with       "polar      opposite[]"

information         as    to    whether          ivermectin      was       likely      to     improve

Zingsheim's         condition.              Under       such     fast-paced,           high-stakes

circumstances,           the     majority         commits       an    especially         egregious

error    by    demanding         a    "polished         transcript"         from       the    circuit

court.         See       X.S.,       402     Wis.       2d   481,      ¶91       (Hagedorn,       J.,

dissenting).

                                          IV.    CONCLUSION

    ¶98        The circuit court considered the relevant facts and

applied       the    correct         legal       standard       to     reach       a    reasonable
decision in light of the life-or-death circumstances presented.

Like the majority of the court of appeals, a majority of this

court fails to look for reasons to sustain the circuit court's

discretionary decision as the law requires.                                  Under our highly

deferential         standard         of     review,      the     circuit         court       properly

exercised its discretion in entering an order granting temporary

injunctive relief to a man near death.                          I dissent.

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                  APPENDIX:     Unpublished Orders

Gahl v. Aurora Health Care, Inc., No. 2021AP1787-FT, unpublished

order (Wis. Oct. 25, 2022, as amended Oct. 28, 2022).

Gahl v. Aurora Health Care, Inc., No. 2021AP1787-FT, unpublished

order (Wis. Oct. 25, 2021).

Gahl v. Aurora Health Care, Inc., No. 2021AP1787, unpublished

order (Wis. Oct. 21, 2021).

James   v.   Heinrich,   Nos.     2020AP1419-OA,     2020AP1420-OA      &

2020AP1446-OA, unpublished order (Wis. Sept. 10, 2020).

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