The Wisconsin Supreme Court chambers. (Henry Redman/Wisconsin Examiner)

In February 2018 Melissa Hubbard underwent surgery to remove part of her colon. What she didn’t know until afterward was that her ovaries were removed as well.

Removing Hubbard’s ovaries had been recommended to Hubbard’s surgeon by her gynecologist to treat another painful condition that Hubbard was dealing with. But while the gynecologist had previously discussed the ovary surgery with her, Hubbard wasn’t ready to go forward with that procedure. She was unaware that the gynecologist had suggested it to the surgeon who was operating on her colon.

On Tuesday, the Wisconsin Supreme Court will hear oral arguments in a lawsuit that Hubbard has filed against the gynecologist, Dr. Carol Neuman. The lawsuit argues that Neuman’s recommendation to the surgeon without Hubbard’s knowledge was an act of medical negligence.

The lawsuit Hubbard filed against Neuman hasn’t gone to trial yet. The Ob/Gyn doctor, through her attorneys, argues that the lawsuit should be dismissed for failing to state a claim.

The lawsuit — and the doctor’s argument to throw it out — revolve around Wisconsin’s law that requires informed consent from patients for medical treatment.

Neuman’s lawyers argue that the doctor had no legal responsibility for Hubbard’s surgery under that law and no duty to tell Hubbard about what was merely Neuman’s recommendation to the surgeon, since Neuman didn’t perform the surgery herself.

A Rock County circuit judge disagreed with the doctor’s lawyers and rejected the summary judgment motion. The 4th District Wisconsin Court of Appeals upheld the circuit court’s refusal to dismiss the case. Now Neuman’s lawyers have asked the state Supreme Court to reverse those decisions.

Writing for a three-judge District 4 appeals court panel in March 2024, Judge Chris Taylor found that “the duty to inform a patient about ‘the availability of reasonable alternative medical modes of treatment and about the benefits and risks of these treatments’ applies to any physician who treats a patient, regardless of whether that physician actually performs the disclosed treatment options.”

According to the appeals court’s summary of the case, in 2018 Hubbard was in Neuman’s care for treatment of endometriosis — a condition in which the same sort of tissue that lines the inside of the uterus also grows outside the uterus. Endometriosis can cause pain as well as infertility, according to the Mayo Clinic.

In a medical note quoted in the original lawsuit, Neuman wrote that she told Hubbard she should consider having at least her left uterus tube and ovary removed, or both tubes and ovaries.

Those procedures would leave Hubbard unable to conceive a child, but Neuman wrote in her clinical note, “I believe her endometriosis is so severe she may need reproductive specialists to help her. She does not want to see them because her insurance does not cover this option.”

Hubbard did not agree to the removal of her reproductive organs, according to the lawsuit.

Neuman also referred Hubbard to a surgeon for a separate procedure: the removal of part of her colon due to a concern about cancer, according to Hubbard’s lawyer, Guy Fish of Milton.

Before the colon surgery, the doctor made a recommendation to the surgeon that he could remove Hubbard’s ovaries at the same time.

“Hubbard, prior to her surgery on February 13, 2018, at no time advised Neuman that she opted to have an ovary or ovaries be surgically removed” during the operation, however, according to Hubbard’s lawsuit.

Neuman and the surgeon, Dr. Michael McGauley, “engaged in pre-surgery discussions and planning … without including or briefing Hubbard,” the lawsuit states. At one point in their discussions, the plan was for Neuman to remove Hubbard’s tubes, ovaries and uterus, with McGauley performing the colon surgery in the same procedure.

Hubbard was not informed of those conversations, the lawsuit states. On the day that the surgery took place, McGauley performed the colon surgery and also removed Hubbard’s ovaries himself.

“Had Hubbard been apprised of Neuman’s pre-surgery recommendations to McGauley . . . Hubbard would have immediately cancelled the scheduled surgery for February 13, 2018 in order to consider all her options,” the lawsuit states.

Defending the motion to dismiss the case, Neuman’s lawyers have argued that a doctor’s recommendation to another doctor shouldn’t be subject to the state’s informed consent law.

“A recommendation is not an order or a prescription,” wrote Neuman’s legal team, from the Corneille Law Group in Madison, in a Supreme Court brief. The lawyers argued that not disclosing to Hubbard the recommendation Neuman made to the surgeon should not be treated as a violation of the state’s informed consent law.

“Treating physicians who discuss the patients’ care must be able to freely exchange their thoughts, opinions, advice and counsel without concern that they may each be liable for failing to disclose the content of those communications to the patient,” the brief for Neuman argues.

The brief asks the Supreme Court to send the case back to the Rock County circuit court with an order to dismiss the lawsuit.

But Hubbard’s lawyer argues that it’s in the interest of patients to encourage disclosure, including of communications among doctors.

“Doesn’t a treating physician more fully fulfill his/her duty by disclosing more pertinent medical information to the patient?” Fish asked in a brief to the high court. 

The lower court also rejected the assertion that holding the gynecologist responsible for providing informed consent for her recommendation to the surgeon would squelch doctors from freely consulting one another.

In making their ruling, the appeals court judges focused on whether the state law would not apply to Neuman even assuming all of the factual allegations in the lawsuit were true.

The effect of Neuman’s recommendation — the loss of Hubbard’s ovaries without her knowledge ahead of time — was instrumental enough to consider Neuman a “treating physician,” even though she didn’t perform the surgery, the lower court judges wrote.

In making the recommendation to the surgeon, they wrote, Neuman arguably had a responsibility to disclose to the patient the risks of the procedure, the probabilities of success and any alternative treatments that might be available.

In short, they ruled, Neuman failed to make the case for dismissing the case outright.