Case Title: Hoem v. State

Citation: 

Docket Number: 87-41

State: wyoming

Court: Wyoming Supreme Court

Date: 1988-06-14T00:00:00Z

Document:
Hoem v. State1988 WY 83756 P.2d 780Case Number: 87-41Decided: 06/14/1988Supreme Court of Wyoming
SHERI I. HOEM, 
PLAINTIFF,

v.

THE STATE OF WYOMING AND 
THE UNIVERSITY OF WYOMING, ACTING BY AND THROUGH THE UNIVERSITY OF WYOMING 
STUDENT HEALTH SERVICE; T.E. CRONKLETON, M.D.; BERTRAND N. HONEA, M.D.; AND DOES 
I-X, INCLUSIVE; THE ATTORNEY GENERAL OF THE STATE OF WYOMING, OR HIS DESIGNEE, 
IN HIS CAPACITY AS DIRECTOR OF THE WYOMING MEDICAL REVIEW PANEL AND THE WYOMING 
MEDICAL REVIEW PANEL, DEFENDANTS.

John B. "Jack" 
Speight, Blair J. Trautwein and Michael Rosenthal of Hathaway, Speight, Kunz, 
Trautwein & Barrett, Cheyenne, for 
plaintiff.

Joseph B. Meyer, 
Atty. Gen., John W. Renneisen, Deputy Atty. Gen., and Karen A. Byrne, Asst. 
Atty. Gen., for State of Wyo., Atty. Gen. of State of Wyo., or his designee, in 
his capacity as Director of Wyoming Medical Review Panel and Wyoming Medical 
Review Panel, defendants.

Nicholas G. 
Kalokathis of Lathrop & Uchner, P.C., Cheyenne, for University of Wyoming, 
acting by and through the University of Wyoming Student Health Service and T.E. 
Cronkleton, M.D., defendants.

W.W. Reeves and 
M. Greg Carlson of Reeves & Murdock, Casper, for Bertrand N. Honea, M.D., defendant.

Robert W. 
Tiedeken of Terry W. Mackey, P.C., Cheyenne, for Wyoming Trial Lawyers Ass'n, amicus curiae.

John E. 
Stanfield of Smith, Stanfield & Scott, Laramie, for Ass'n of Trial Lawyers of America, 
amicus curiae.

Richard Rideout 
of Freudenthal, Salzburg, Bonds & Rideout, P.C., Cheyenne, for Wyoming 
Medical Soc., Inc., Wyoming Hosp. Ass'n, Inc., Wyoming Health Care Ass'n and 
Wyoming Dental Ass'n, amici 
curiae.

Before BROWN, C.J., and THOMAS, CARDINE, URBIGKIT and 
MACY, JJ.

MACY, 
Justice.

[¶1.]     This Court is asked to 
determine the constitutionality of the Wyoming Medical Review Panel Act, § 
9-2-1501 et seq., W.S. 1977. We hold that the act is unconstitutional because it 
violates the equal protection clause of the state 
constitution.

[¶2.]     The act was passed in 
1986 for the following purpose:

"[T]o prevent where 
possible the filing in court of actions against health care providers and their 
employees for professional liability in situations where the facts do not permit 
at least a reasonable inference of malpractice and to make possible the fair and 
equitable disposition of such claims against health care providers as are, or 
reasonably may be, well founded." Section 9-2-1502, W.S. 
1977.

The act creates 
the Wyoming 
medical review panel and provides that the attorney general or his designee 
shall serve as director of the panel and shall promulgate rules and regulations 
to implement the act. Section 9-2-1505, W.S. 1977. The act also provides that 
the panel shall consist of two health care providers, two lawyers, and one lay 
person. Section 9-2-1508, W.S. 1977. The panel is authorized to review all 
medical malpractice claims against health care providers. No complaint alleging 
medical malpractice can be filed in court unless a claim has been filed with the 
panel and a decision has been rendered. Section 9-2-1506, W.S. 1977. Under the 
act, claimants are required to submit a claim setting 
forth

"[a] statement in 
reasonable detail of the elements of the health care provider's conduct which 
are believed to constitute a malpractice claim, the dates the conduct occurred, 
and the names and addresses of all physicians, dentists and hospitals having 
contact with the claimant relevant to the claim and all witnesses[.]" Section 
9-2-1507(a)(i), W.S. 1977.

The claim also 
must include a statement signed by the claimant authorizing the panel to have 
access to all medical, dental, and hospital records pertaining to the claim. The 
act requires the health care provider to answer the claim within 30 days and to 
submit a statement authorizing the panel to inspect all medical records 
pertaining to the claim. A hearing must be held within 120 days after the 
director receives a claim unless the director or the panel finds good cause for 
delaying the hearing. Section 9-2-1509, W.S. 1977. The hearing is informal, and 
neither the Wyoming Rules of Evidence nor the Wyoming Administrative Procedure 
Act applies. The panel must determine whether there is

"(i) [s]ubstantial 
evidence that the acts complained of occurred and that they constitute 
malpractice; and

"(ii) [a] reasonable 
probability that the patient was injured as a result of the acts complained of." 
Section 9-2-1510(a), W.S. 1977.

Panel 
deliberations are confidential, and any records kept are to be used solely for 
compiling statistical data and facilitating ongoing studies of medical 
malpractice in Wyoming. Sections 9-2-1510 and 9-2-1511, W.S. 
1977. The panel's decision is not subject to review in court, it is not binding 
on either party, and it is not admissible at trial. Sections 9-2-1509, 9-2-1510, 
and 9-2-1511.

[¶3.]     Plaintiff sets forth 
the following constitutional challenges to the act:

"1. Does the Wyoming 
Medical Review Panel Act deny `equal protection' and, as such, violate Article 
1, Section 2; Article 1, Section 3; Article 1, Section 6; Article 1, Section 7; 
Article 1, Section 34 and Article 3, Section 27 of the Wyoming Constitution and 
the Fourteenth Amendment of the United States 
Constitution?

"2. Does the Wyoming 
Medical Review Panel Act unconstitutionally infringe upon the constitutional and 
inherent power of the Wyoming Supreme Court, in violation of Article 5, Section 
2 of the Wyoming Constitution?

"3. Does the Wyoming 
Medical Review Panel Act unconstitutionally impede free access to courts, in 
violation of Article 1, Section 6; Article 1, Section 8; Article 1, Section 9 
and Article 10, Section 4 of the Wyoming Constitution and the Fourteenth 
Amendment to the United States Constitution?

"4. Does the required 
confidentiality of the Panel proceedings and decision violate the First and 
Fourteenth Amendments to the Constitution of the United States of 
America and Article 1, Section 6; Article 1, 
Section 8 and Article 1, Section 20 of the Wyoming 
Constitution?"

[¶4.]     Because our holding as 
to plaintiff's equal protection claim is dispositive of this appeal, we decline 
to address the remaining issues set forth by plaintiff. The following 
constitutional provisions are relevant to plaintiff's equal protection 
challenge:

Article 1, § 2 of the 
Wyoming 
Constitution.

"In their inherent right 
to life, liberty and the pursuit of happiness, all members of the human race are 
equal."

Article 1, § 3 of the 
Wyoming 
Constitution.

"Since equality and the 
enjoyment of natural and civil rights is only made sure through political 
equality, the laws of this state affecting the political rights and privileges 
of its citizens shall be without distinction of race, color, sex, or any 
circumstance or condition whatsoever other than individual incompetency, or 
unworthiness duly ascertained by a court of competent 
jurisdiction."

Article 1, § 6 of the 
Wyoming 
Constitution.

"No person shall be 
deprived of life, liberty or property without due process of 
law."

Article 1, § 7 of the 
Wyoming 
Constitution.

"Absolute, arbitrary 
power over the lives, liberty and property of freemen exists nowhere in a 
republic, not even in the largest majority."

Article 1, § 8 of the 
Wyoming Constitution, in pertinent part.

"All courts shall be open 
and every person for an injury done to person, reputation or property shall have 
justice administered without sale, denial or delay."

Article 1, § 34 of the 
Wyoming 
Constitution.

"All laws of a general 
nature shall have a uniform operation."

Article 3, § 27 of the 
Wyoming Constitution, in pertinent part.

"The legislature shall 
not pass local or special laws in any of the following enumerated cases, that is 
to say: * * * for limitation of civil actions * * *."

[¶5.]     Relying upon these 
provisions, plaintiff claims that the act violates her equal protection rights 
in that, on the one hand, it singles out a limited class of health care 
providers for special protection while, on the other hand, it places an added 
burden on persons injured by health care providers. Plaintiff argues that the 
act treats medical malpractice victims differently than those injured by the 
tortious conduct of someone other than a health care provider in that only 
medical malpractice victims are prohibited from filing a claim for personal 
injury directly in court. Plaintiff argues that such a classification is 
arbitrary, unreasonable, and unrelated to the purpose for which the act was 
passed.

[¶6.]     When considering 
constitutional claims, this Court has applied the following 
standards:

"It is clear, according 
to the stance previously adopted by this court, that there must be some 
difference which furnishes a reasonable basis for different legislation as to 
different classes, and the differences must not be arbitrary and without just 
relation to the subject of the legislation. One who assails a classification 
must carry the burden of showing that it does not rest on a reasonable basis, 
but is essentially arbitrary." Mountain Fuel Supply Company v. Emerson, Wyo., 578 P.2d 1351, 1354-55 (1978) (citations 
omitted).

"[C]ourts * * * have 
proceeded upon the assumption that members of the legislature will investigate 
and determine for themselves whether or not a proposed law will violate the 
constitution, and accordingly, have adopted the rule that no law will be 
declared unconstitutional unless it is clearly so." Bell v. Gray, Wyo., 
377 P.2d 924, 925-26 (1963).

"If any state of facts 
can be reasonably conceived which sustain[s] the classification, such facts will 
be assumed." Mountain Fuel Supply Company v. Emerson, 578 P.2d  at 
1355.

"Although we have a duty 
to give great deference to legislative pronouncements and to uphold their 
constitutionality where possible, it is 
equally imperative that we declare them invalid when they transgress the 
Wyoming 
Constitution." Brenner v. City of 
Casper, Wyo., 723 P.2d 558, 560 (1986) (emphasis added).

[¶7.]     Applying these 
standards to the present case, we look first to the state interest intended to 
be furthered by the act. As demonstrated above, the act was intended to prevent 
the filing in court of claims against certain health care providers where the 
facts do not permit a reasonable inference of malpractice and to make possible 
the fair and equitable disposition of well-founded claims against health care 
providers. In attempting to reduce the number of claims filed in court against 
health care providers, the legislature was responding to the perceived medical 
malpractice insurance "crisis." The hope was that, by reducing the number of 
medical malpractice lawsuits, insurance rates would drop and coverage would 
become more available and affordable.

[¶8.]     Before proceeding 
further with our inquiry, we note the absence in the record of any evidence 
demonstrating the existence of such a crisis in Wyoming or elsewhere. More importantly, we 
note the absence in the record of any evidence that the "crisis," if in fact it 
exists, is in any way connected with medical malpractice claims. The statement 
of purpose contained in the act offers no explanation as to why the 
legislature's sole response to the insurance "crisis" was to attempt to change 
commonly recognized procedures and principles related to causes of action in 
tort. The act is silent as to other conceivable causes of the "crisis" such as 
poor management, bad underwriting, and bad investments by the insurance 
industry. Likewise, the act is silent as to other conceivable approaches to 
solving the alleged crisis such as regulation of the insurance industry. 
Apparently, tort reform was the only avenue explored by the legislature in its 
efforts to solve the "crisis." While it is true that "[t]he social wisdom of the 
legislature's policy choices is, of course, irrelevant to the question of 
constitutionality of the Act," it also is true that "[c]omplete disregard for 
other potential policy options is, however, of at least tangential relevance 
when considering whether a legislative * * * goal is a legitimate one." Waggoner 
v. Gibson, 647 F. Supp. 1102, 1104 n. 3 (N.D.Tex. 1986).

[¶9.]     Assuming, however, for 
the purposes of this opinion, that an insurance crisis does exist in Wyoming and that it is 
related to medical malpractice litigation, we must determine whether the 
legislation enacted is rationally related to its stated purpose. There is no 
question that the legislature has a legitimate interest in protecting the health 
of the citizens of Wyoming as well as the economic and social 
stability of the state. The question is whether the legislation at issue 
constitutes a reasonable and effective means of doing so. We maintain that it 
does not. It cannot seriously be contended that the extension of special 
benefits to the medical profession and the imposition of an additional hurdle in 
the path of medical malpractice victims relate to the protection of the public 
health. To the contrary,

"if the medical 
profession is less accountable than formerly because of the special treatment it 
is afforded by [medical review panel] laws, then a relaxation of medical 
standards may occur with the public as the victim. `[T]o find that the 
protection and special dispensation given to health delivery tortfeasors by the 
challenged legislation is in the best interest of public health is illogical to 
the point of irrationality.'" Boucher v. Sayeed, R.I., 459 A.2d 87, 94 (1983) 
(quoting from American Bank & Trust Co. v. Community Hospital of Los 
Gatos-Saratoga, Inc., 104 Cal. App. 3d 219, 163 Cal. Rptr. 513, 522 
(1980)).

[¶10.]  We have said previously that "[t]he 
continued availability and vitality of * * * causes of action [against health 
care providers] serve an important public policy - the preservation of quality 
health care for the citizens of this state." Greenwood v. Wierdsma, Wyo., 741 P.2d 1079, 1088 (1987). In light of 
this basic truth, we hold that the legislature's attempt to limit or reduce such 
causes of action is not rationally related to a legitimate state 
interest.

[¶11.]  Our holding that the act is not 
rationally related to protection of the public health or economic and social 
stability of the state would be sufficient alone to find the act 
unconstitutional. However, we also are persuaded by the principle 
that:

"[C]onstitutional 
protections are not suspended in time of even the most legitimate crisis. See 
Youngstown Sheet & Tube Co. v. Sawyer, 343 U.S. 579, 589, 
72 S. Ct. 863, 867, 96 L. Ed. 1153 (1952) (constitutional provisions exist `in 
good and bad times'); cf. Korematsu v. United 
States, 323 U.S. 214, 65 S. Ct. 193, 89 L. Ed. 194 
(1944) (since discredited-internment of Japanese descendants during war); 
Konigsberg v. State Bar [of California], 353 U.S. 252, 77 S. Ct. 722, 1 L. Ed. 2d 810 
(1957) (fear of communism). Constitutional protections exist for litigants 
regardless of market conditions for insurance companies and the medical 
industry; concerns about the latter cannot be allowed to overrun the former at 
the expense of those * * * injured by acts of malpractice." Waggoner v. Gibson, 
647 F. Supp.  at 1107.

Although the 
language quoted above concerns the question of the constitutionality of a limit 
on the amount recoverable by medical malpractice plaintiffs, it is persuasive in 
the present case. We cannot condone the legislature's use of the law to protect 
one class of people from financial difficulties while it dilutes the rights 
under the constitution of another class of people. Every profession confronts 
financial distress at some time, and that does not justify depriving others of 
the equal protection guaranteed by the constitution.

[¶12.]  In holding as we do that the act denies 
equal protection of the law in violation of the constitution, we are cognizant 
that the majority of states have upheld similar provisions. However, we find the 
following language to be convincing:

"Most state courts give 
considerable deference to the state legislatures' specific declarations in 
statutes that such a crisis does exist and that the substantive portions of the 
statute are intended to alleviate that crisis. A better approach for those 
courts that have yet to decide the issue would be, however, to take a more 
skeptical attitude toward the evidence presented by the medical profession and 
the insurance industry and toward the conclusion reached by the state 
legislature regarding the existence of a crisis.

"State courts that have 
swept aside the equal protection argument have seriously shirked their judicial 
responsibilities. Proper scrutiny of the 
constitutional validity of state legislation demands more than a perfunctory 
deferral to the legislature's conclusions regarding the existence of a health 
care crisis in the particular state." Comment, Constitutional Challenges to 
Medical Malpractice Review Boards, 46 Tenn.L. Rev. 607, 645 (1978) (emphasis 
added and footnote omitted).

[¶13.]  With this admonition in mind, we have no 
choice but to hold that the Medical Review Panel Act is 
unconstitutional.

THOMAS, J., filed a specially 
concurring opinion in which URBIGKIT, J., joined.

CARDINE, J., filed a dissenting 
opinion in which BROWN, C.J., 
joined.

THOMAS, Justice, specially 
concurring, with whom URBIGKIT, 
Justice, joins.

[¶14.]  It is fortunate that §§ 1, 2 and 3 of the 
Constitution of the State of Wyoming did not structure the Supreme Court as 
a debating society. It surely would have become one of the most grand and 
glorious of such bodies in all history if it had been permitted that 
role.

[¶15.]  The oath of office with which I am 
familiar encompasses fidelity to "the constitution of this state." It is that 
fidelity to the constitution which imparts efficacy to the separation of powers 
doctrine. I am satisfied that the Wyoming Medical Review Panel Act, §§ 9-2-1501 
through 9-2-1511, W.S. 1977 (June 1987 Repl.), must be declared 
unconstitutional. The other members of the majority assign primary significance 
to Art. 1, § 2 of the Constitution of the State of Wyoming, and justify 
declaring the statute to be unconstitutional on the ground that it invades the 
equal protection standard. The conclusion is that there is no rational basis for 
creating a class consisting of victims of medical malpractice. I do not disagree 
with that approach, but I also would declare the statute to be unconstitutional 
under Art. 1, § 8, and Art. 2, § 1 of the Constitution of the State of 
Wyoming.

[¶16.]  In further support of the conclusion that 
the statutory classification is unconstitutional, Farley v. Engelken, Kan., 740 P.2d 1058 (1987), is significant and 
persuasive. The case addressed a statutory exception to the collateral source 
rule in favor of medical malpractice actions. In a thoughtful and provacative 
opinion, the Kansas Supreme Court concluded that a "heightened scrutiny" test 
should be applied to victims of medical malpractice as a "quasi-suspect" class. 
The Wyoming Medical Review Panel Act, in requiring executive department review 
of claims submitted by victims of medical malpractice before they may file an 
action in the courts, parallels the Kansas statute creating an exception for the 
collateral source rule in medical malpractice cases.

[¶17.]  The Kansas court concluded that a Kansas citizen has a 
right, recognized and protected by its constitution, to a remedy for injury to 
person or property and that such a right justifies invoking the higher level of 
scrutiny. The "heightened scrutiny" standard, which it applied, eschews a 
presumption of constitutionality, which must be overcome by one who challenges 
the statute when the rational basis test is invoked and requires greater 
justification for the classification. At the other end of the spectrum, the 
standard also eschews the heavy burden of proof placed on the state to 
demonstrate a compelling state interest, which the "strict scrutiny" standard 
requires. Instead, as explained by the Kansas court, the "heightened scrutiny" 
standard requires "the statutory classification to substantially further a 
legitimate legislative purpose." In reaching this determination, the "heightened 
scrutiny" analysis requires that the interests of the burdened class be balanced 
against those of the benefited class, in the context of the legislative purpose. 
This standard peculiarly is applicable in an instance such as this, which does 
not involve any political question of importance to the state but essentially 
touches upon private interests. Utilization of the "heightened scrutiny" 
standard in this case seems eminently fair.

[¶18.]  Analysis of the Wyoming Medical Review 
Panel Act in this context leads to the conclusion that, while the burdened class 
(victims of medical malpractice) are required to wait at least an additional 
four months, and quite possibly much longer, in order to pursue their claims, 
the benefited class (the health care providers) really gain no advantage. The 
Wyoming Medical Review Panel Act serves only as an impediment to pursuing a 
claim for medical malpractice, providing no recourse to anyone. The ultimate 
product, which is not binding on any participant, is a decision reached in a 
proceeding, which is to be held in confidence. The process delays, for a minimum 
of 120 days, the right of the claimant to file a civil action, and there is no 
limit upon the period to which the proceeding may be extended for good 
cause.

[¶19.]  It almost seems that the Medical Review 
Panel Act process becomes an end in itself. Perhaps the real purpose simply was 
to spend state money to pursue such a review. The five panel members must be 
paid $40 per hour for the time spent in hearings and the time traveling to the 
hearings, as well as be reimbursed for their travel and per diem expenses. In 
lean times, the appropriation of some $200,000 for a process that produces no 
result certainly is suspect. Legislation that apparently furthers only an 
academic interest does not serve to accomplish any goal, never mind a legitimate 
state interest.

[¶20.]  I agree that this statute is 
unconstitutional under even a rational basis test, but it is quite clear that it 
cannot be sustained under the "heightened scrutiny" test. Setting apart victims 
of medical malpractice from victims of other tortious conduct as a separate 
class is patently unrelated to any reasonable or rational state purpose, nor can 
it be justified by any state of facts that reasonably might be conceived. Of a 
certainty, there is no legitimate legislative purpose for this classification 
that would survive the "heightened scrutiny" test.

[¶21.]  It may be that some of the events alluded 
to in the various newspaper articles and other documents in the dissenting 
opinion actually occurred. I recall arguments to the effect that legislation 
such as this was necessary in Wyoming to maintain medical services. The 
argument was, in substance, that medical care providers would cease practicing 
their profession because of the increasing cost of malpractice insurance. The 
record, however, does not teach us any of that. The fact of responsible 
jurisprudence is that the members of this court are called in every case, in 
accordance with their respective constitutional oaths, which are administered 
pursuant to Art. 6, § 10 of the Constitution of the State of Wyoming, to review 
the record before the court to test the constitutionality of any statute, in 
this instance, the Wyoming Medical Review Panel Act, §§ 9-2-1501 through 
9-2-1511, W.S. 1977 (June 1987 Repl.). The majority of the court must, under 
recognized principles, look only to the record to arrive at a 
decision.

[¶22.]  If one were to believe the manifestation 
of a crisis in this instance, one would have to recognize that the strange 
bedfellows in this political suite were (1) those who furnished medical care and 
services, who are seeking to maintain profits by reducing insurance premiums as 
much as possible, and (2) insurance carriers, who are seeking to maintain 
profits not necessarily by reducing insurance premiums but, hopefully, by 
inhibiting any victims of medical malpractice from being compensated out of the 
reserves funded by those premiums. However this bedfellowship may be described, 
there can be little question that these groups represent a politically powerful 
coalition. There is some apparent validity to the argument that it is necessary 
to maintain a profit posture for insurance carriers so that they will continue 
to write the coverage. The assumption, which has not necessarily been tested, is 
that unjust claims are being prosecuted successfully, and this assumption may be 
a fallacy. There is another assumption that medical care providers, particularly 
doctors, pursue their profession only because of economic motivations. In my 
judgment, that assumption is subject to challenge and well may be a fallacy. 
Even if these assumptions were conceded to be true, there is nothing in the 
Wyoming Medical Review Panel Act that would inhibit the prosecution of unjust 
claims or would necessarily reduce the insurance premiums paid by physicians. 
Fascinating as these arguments may be, they have no relevance to the resolution 
of the issues posed in this case.

[¶23.]  If it be taken as true that the medical 
practitioners and their insurance carriers orchestrated the events alluded to in 
the dissenting opinion, they must have been very frustrated because the 
legislature did not learn the tune, at least not well enough to play it back. 
While this court is encouraged to rely upon the public debate that occurred in 
Wyoming, and elsewhere, in order to decide this case, in terms of the record, we 
need examine only the articulation of the purpose found in § 9-2-1502, W.S. 1977 
(June 1982 Repl.), which states:

"The purpose of this act 
is to prevent where possible the filing in court of actions against health care 
providers and their employees for professional liability in situations where the 
facts do not permit at least a reasonable inference of malpractice and to make 
possible the fair and equitable disposition of such claims against health care 
providers as are, or reasonably may be, well founded."

This statement 
addresses private interests only. There is not a hint of any public interest to 
be served. Some say we cannot ignore the furor which claimed to articulate a 
public interest. If the legislature, however, chose to ignore that drama in its 
statement of the purpose for the legislation, the court must follow suit. 
Limiting the justification for the statute to the purpose stated by the 
legislature, which the record demands we do, it is clear that there is no 
legitimate legislative purpose nor any valid state interest, which is achieved 
or furthered by this legislation. It speaks to private interests 
only.

[¶24.]  While I am prepared to agree with the 
majority's conclusion that the Wyoming Medical Review Panel Act violates Art. 
1, § 2 of the Constitution of the State of Wyoming, my focus is upon Art. 1, § 8. It is 
interesting to compare the language of the articulated legislative purpose with 
the specific provisions of Art. 1, § 8, which reads:

"All courts shall be open 
and every person for an injury done to person, reputation or property shall have 
justice administered without sale, 
denial or delay." (Emphasis 
added.)

[¶25.]  The Supreme Court of Missouri declared a 
similar legislative scheme unconstitutional pursuant to a substantially 
identical article of that state's constitution. State ex rel. CardinalGlennonMemorialHospital for Children v. Gaertner, Mo., 583 S.W.2d 107 (1979). See also Jiron v. 
Mahlab, 99 N.M. 425, 659 P.2d 311 (1983) (declaring unconstitutional a New 
Mexico statute providing for a review panel, in light of a similar 
constitutional provision, as applied to the circumstances of the case); cf., 
People ex rel. Christiansen v. Connell, 2 Ill. 2d 332, 118 N.E.2d 262 (1954). The 
fact that there is no limit upon the duration of the Medical Review Panel Act 
proceedings is an additional reason to declare it unconstitutional pursuant to 
Art. 1, § 8 of the Constitution of the State of Wyoming. See Aldana v. Holub, Fla., 381 So. 2d 231 
(1980); Mattos v. Thompson, [491] Pa. [385], 421 A.2d 190 (1980). Because this 
legislation engenders delay in presenting claims in the judicial branch, without 
accomplishing any legislative purpose or serving any state interest on behalf of 
Wyoming 
citizens, I find it unconstitutional under Art. 1, § 8 of the Constitution of 
the State of Wyoming.

[¶26.]  In addition to being invalid under Art. 
1, §§ 2 and 8 of the Constitution of the State of Wyoming, I am satisfied that 
the effort to structure a review of a legal remedy by a panel created within the 
executive department of government, prior to pursuing the available remedy in 
the judicial department, runs afoul of Art. 2, § 1 of the Constitution of the 
State of Wyoming. I also would declare the Medical 
Review Panel Act unconstitutional under that article. There are times in which 
the significance of the separation of powers doctrine, found in Art. 2 of the 
Constitution of the State of Wyoming, is that the judicial branch of 
government must recognize the interests of the politically powerless and speak 
for those interests in order to defend the concept of justice. Future victims of 
potential medical malpractice fit within this principle.

CARDINE, Justice, dissenting, 
with whom BROWN, Chief Justice, 
joins.

[¶27.]  After reviewing the opinion of the court, 
the special concurrence and this dissent, I am left with the nagging feeling 
that if the supreme court is not a debating society, it will surely do until the 
real thing comes along. Debating society or not, there is not a single 
thoughtful or provocative opinion nor any scholarly authority that supports 
holding the Wyoming Medical Review Panel Act unconstitutional. Cases cited by 
the court to support its holding concern statutes that differ materially from 
the Wyoming 
act. Applying correct standards of review and constitutional determination, 
there cannot be the slightest doubt that the Wyoming Medical Review Panel Act is 
constitutional.

[¶28.]  The opinion of the court acknowledges 
that the party attacking a statute has the burden of demonstrating its 
unconstitutionality beyond a reasonable doubt. The party attacking the statute 
in this case is plaintiff Sheri I. Hoem. The state of Wyoming, represented by 
the attorney general, does not attack the statute but asserts its 
constitutionality. The court in its opinion states:

"`One who assails a 
classification must carry the burden of showing that it does not rest on a 
reasonable basis, but is essentially arbitrary.' Mountain Fuel Supply Company v. 
Emerson, Wyo., 578 P.2d 1351, 1354-55 
(1978)."

[¶29.]  After acknowledging that the burden is 
upon the party attacking the constitutionality of the statute (in this case 
plaintiff), the majority of this court states:

"[W]e note the absence in 
the record of any evidence that the `crisis,' if in fact it exists, is in any 
way connected with medical malpractice claims. The statement of purpose 
contained in the act offers no explanation as to why the legislature's sole 
response to the insurance `crisis' was to attempt to change commonly recognized 
procedures and principles related to causes of action in tort. The act is silent 
as to other conceivable causes of the `crisis' such as poor management, bad 
underwriting, and bad investments by the insurance industry. Likewise, the act 
is silent as to other conceivable approaches to solving the alleged crisis such 
as regulation of the insurance industry."

If the record is 
silent upon matters necessary to an attack upon the statute, then appellant 
should not prevail, for she has failed in her burden of presenting evidence that 
will demonstrate unconstitutionality beyond a reasonable doubt. Bell v. State, Wyo., 693 P.2d 769 (1985). In Meyer v. 
Kendig, Wyo., 641 P.2d 1235 (1982), we said that in 
determining the constitutionality of a statute, we were governed by the 
following standards:

"`Statutes are presumed 
to be constitutional unless affirmatively shown to be otherwise, and one who 
would deny the constitutionality of a statute has a heavy burden. The alleged 
unconstitutionality must be clearly and exactly shown beyond any reasonable 
doubt. One who assails a classification must carry the burden of showing that it 
does not rest on a reasonable basis, but is essentially arbitrary, and if any 
state of facts can be reasonably conceived which sustains the classification, 
such facts will be assumed.

"`Courts have a duty to 
uphold the constitutionality of statutes which the legislature has enacted if 
that is at all possible, and any doubt must be resolved in favor of 
constitutionality.'" (Citations omitted.) Id. at 1238-39 (quoting Washakie 
County School District Number One v. Herschler, Wyo., 606 P.2d 310, 319 (1980), 
reh. denied, cert. denied 449 U.S. 824, 101 S. Ct. 86, 66 L. Ed. 2d 28 
(1980)).

[¶30.]  And where a party assailing the 
constitutionality of a statute asserts that it is violative of equal protection 
because, in treating different persons differently, the classifications do not 
bear a rational relationship to a legitimate state objective, we have 
said:

"`One who assails the 
classification in such a law must carry the burden of showing that it does not 
rest upon any reasonable basis, but is essentially arbitrary.'" Baskin v. State 
ex rel. Worker's Compensation Division, Wyo., 722 P.2d 151, 155 (1986) (quoting 
In re Trent's Claim, 68 Wyo. 146, 231 P.2d 180 (1951), overruled Bowers v. 
Wyoming State Treasurer ex rel. Workmen's Compensation Division, Wyo., 593 P.2d 182 (1979)).

This court 
cannot lawfully hold this act to be unconstitutional upon a silent record. Nor 
can the court deny that appellant has failed to satisfy the heavy burden she has 
to establish unconstitutionality.

[¶31.]  Statutes dealing with the medical 
malpractice crisis have been enacted by more than 26 states. Twenty-three of 
these states and three federal circuits have rejected equal protection 
arguments. The following states with statutes that are similar or identical to 
Wyoming's 
medical review panel act have held their statutes constitutional. Reese v. 
Rankin Fite Memorial Hospital, Ala., 403 So. 2d 158, 160-62 (1981); Eastin v. 
Broomfield, 116 Ariz. 576, 570 P.2d 744, 750-51 (1977); Gay v. Rabon, 280 Ark. 
5, 652 S.W.2d 836, 837-38 (1983); Lacy v. Green, Del.Super., 428 A.2d 1171, 
1177-78 (1981); Pinillos v. Cedars of Lebanon Hospital Corporation, Fla., 403 So. 2d 365, 367-68 (1981); LePelley v. Grefenson, 101 Idaho 422, 614 P.2d 962, 
967-68 (1980); Anderson v. Wagner, 79 Ill. 2d 295, 37 Ill.Dec. 558, 402 N.E.2d 560, 570-71, appeal dismissed 449 U.S. 807, 101 S. Ct. 54, 66 L. Ed. 2d 11 (1979); 
Johnson v. St. Vincent Hospital, Inc., 273 Ind. 374, 404 N.E.2d 585, 600-01 
(1980); Rudolph v. Iowa Methodist Medical Center, Iowa, 293 N.W.2d 550, 557-59 
(1980); Stephens v. Snyder Clinic Association, 230 Kan. 115, 631 P.2d 222, 
233-36 (1981); Everett v. Goldman, La., 359 So. 2d 1256, 1265-67 (1978); Attorney 
General v. Johnson, 282 Md. 274, 385 A.2d 57, 76-80, appeal dismissed 439 U.S. 805, 99 S. Ct. 60, 58 L. Ed. 2d 97 (1978); Paro v. Longwood Hospital, 373 Mass. 
645, 369 N.E.2d 985, 987-89 (1977); Linder v. Smith, Mont., 629 P.2d 1187, 
1192-93 (1981); Prendergast v. Nelson, 199 Neb. 97, 256 N.W.2d 657, 667-69 
(1977); Perna v. Pirozzi, 92 N.J. 446, 457 A.2d 431, 437, 39 A.L.R.4th 1018 
(1983); Armijo v. Tandysh, 98 N.M. 181, 646 P.2d 1245, 1247 (1981); Comiskey v. 
Arlen, 55 A.D.2d 304, 390 N.Y.S.2d 122, 129-30 (1976); Roberts v. Durham County 
Hospital Corporation, 56 N.C. App. 533, 289 S.E.2d 875, 878-80 (1982), aff'd 307 
N.C. 465, 298 S.E.2d 384 (1983); Beatty v. Akron City Hospital, 67 Ohio St.2d 
483, 424 N.E.2d 586, 591-95 (1981); Allen v. Intermountain Health Care, Inc., 
Utah, 635 P.2d 30, 31-32 (1981); Duffy v. King Chiropractic Clinic, 17 Wn. App. 693, 565 P.2d 435, 437 (1977); State ex rel. Strykowski v. Wilkie, 81 Wis.2d 
491, 261 N.W.2d 434, 441-44 (1978); Woods v. Holy Cross Hospital, 591 F.2d 1164, 
1171-75 (5th Cir. 1979); DiAntonio v. Northampton-Accomack Memorial Hospital, 
628 F.2d 287, 291-92 (4th Cir. 1980); Fitz v. Dolyak, 712 F.2d 330, 332-33 (8th 
Cir. 1983). California, after construing parts of its 
statute pertaining to periodic payment of future damages, also held its statute 
constitutional. American Bank and Trust Company v. Community Hospital of Los 
Gatos-Saratoga, Inc., 36 Cal. 3d 359, 204 Cal. Rptr. 671, 683 P.2d 670, 677, 41 
A.L.R.4th 233 (1984).

[¶32.]  Three states found their legislation to 
be unconstitutional generally because of provisions not found in the Wyoming act. In Carson v. 
Maurer, 120 N.H. 925, 424 A.2d 825, 830-39, 12 A.L.R.4th 1 (1980), the statute 
was held unconstitutional because it provided for periodic payment, abolished 
the collateral source rule, and required that witnesses for plaintiff be expert 
in their field - provisions not found in the Wyoming statute. Arneson v. Olson, 
N.D., 270 N.W.2d 125, 131-36 (1978), held its statute unconstitutional because 
of provisions precluding joinder of parties and severely limiting the doctrine 
of res ipsa loquitur - provisions not found in the Wyoming statute. Boucher v. 
Sayeed, R.I., 459 A.2d 87, 93 (1983), held unconstitutional an act that 
provided, after the filing of a medical malpractice lawsuit, for a preliminary 
hearing which could result in the dismissal of plaintiff's lawsuit with 
prejudice - a provision not found in the Wyoming statute. New Mexico applied a 
strange holding in one case but declined to hold its statute unconstitutional, 
the dissent stating:

"If the majority feels 
that the statute is unconstitutional, the appropriate measure would be to say so 
and allow the Legislature to remedy the problem." Jiron v. Mahlab, 99 N.M. 425, 
659 P.2d 311, 314 (1983) (Stowers and Riordan, JJ., 
dissenting).

[¶33.]  The challenge to the constitutionality of 
the medical review panel act is before us in this case because a potential 
plaintiff structured a case by refusal to appear before the medical review 
panel. The Wyoming Trial Lawyers Association has filed an amicus brief. They 
attack this innocuous statute that imposes no perceptible burden on claimants, 
changes no law, affects no right to sue or recover, nor limits the amount of 
such recovery. Why they attack this statute, reopen old wounds, perpetuate this 
controversy and heated exchange with the medical profession and other citizens 
of this state is difficult to understand. It does seem, however, that if the 
participants fight hard enough and long enough, eventually they will succeed in 
causing some legislation to be produced that may drastically change the way 
persons injured by medical negligence are compensated. A committee of the 
legislature was meeting at the time this dissent was prepared to consider 
reforms and revisions in the existing medical review panel act. The matter is of 
great concern. Thus, on November 4, 1987, a newspaper, with state-wide 
circulation, in an editorial, stated:

"On July 1, St. Paul Fire 
and Marine Insurance Co., the major company writing malpractice insurance for 
Florida doctors, hiked rates 43 percent for doctors in Dade and Broward counties 
and announced it would stop insuring Florida doctors altogether at the end of 
1988.

"More than 1,000 doctors 
refused to continue working in the counties' emergency rooms * * *." Casper Star Tribune (Nov. 
4, 1987).

In the June 5, 
1988 Casper Star Tribune, Dr. Saunders of Sheridan, Wyoming, states in a letter 
to the editor:

"We do not believe that 
$58,000 a year for professional liability insurance for an 
obstetrician/gynecologist in this state is reasonable * * 
*."

"If I raise my rates, 
fewer people can afford my services and the quality of care will deteriorate 
because people will forsake prenatal care.

"We could be facing a 
situation like we were 15-20 years ago, where the perinatal mortality in this 
state was the highest in the nation! Then there will be victims of the system - 
more brain damaged babies - more prematures, etc."

 

To deny a public 
interest or the existence of a crisis is to be out of touch with reality. Thus 
it was said that

"[t]he recent medical 
malpractice crisis is the result of the increasing reluctance of insurance 
companies to write medical malpractice insurance policies and the dramatic rise 
in premiums demanded by those companies which continue to issue policies. The 
difficulties in obtaining insurance at reasonable rates have forced many health 
care providers to curtail or cease to render their services. Such a situation 
creates obvious dangers to the public welfare, and many state legislatures have 
attempted to take remedial action." (Footnote omitted.) Comment, An Analysis of 
the State Legislative Responses to the Medical Malpractice Crisis, 1975 Duke 
L.J. 1417 (1975).

"The current crisis in 
the provision of medical malpractice insurance has reached proportions of such 
magnitude that few commentators doubt its seriousness. Dramatic increases in 
medical malpractice insurance rates accompanied by the decreasing availability 
of malpractice insurance coverage are the most visible aspects of the crisis. 
Between 1960 and 1970, for example, insurance rates for surgeons rose 949.2 
percent; rates for non-surgical physicians increased 540.8 percent; and hospital 
premiums increased 262.7 percent. The situation has worsened considerably since 
1970. Premiums paid by physicians in some states rose more than 100 percent 
between 1974 and mid-1975 alone. One irony of the situation is that doctors 
faced with skyrocketing insurance rates may, in the not-too-distant future, be 
considered comparatively lucky; many doctors may be unable to obtain any 
insurance coverage at all." (Footnotes omitted.) Redish, Legislative Response to 
the Medical Malpractice Insurance Crisis: Constitutional Implications, 55 
Texas L.Rev. 
759-60 (1977).

[¶34.]  Against this background, Wyoming medical doctors traveled to Cheyenne and marched en 
masse to the state capitol. They testified before committees of the legislature, 
as did lawyers and other interested citizens. After lengthy debate over an 
extended period of time and drafting and redrafting of legislation, the 
legislature overwhelmingly (the House 63 to 1) enacted the "Wyoming Medical 
Review Panel Act," §§ 9-2-1501 through 9-2-1511, W.S. 1977. This court now, 
without any support in law, incorrectly holds the Wyoming Medical Review Panel 
Act unconstitutional.

[¶35.]  I do not say by this dissent that the act 
is a good one nor that it accomplishes its intended purpose. But that is not for 
the court to say. Constitutionality is for the courts, and I am convinced that 
according to all legal precepts and principles, this act is constitutional. I 
find nothing in my oath to "support, obey and defend * * * the constitution of 
this state," and "discharge the duties of my office with fidelity," Art. 6 § 20, 
Wyoming Constitution, that even suggests that this court declare legislation not 
to its liking unconstitutional. I do suggest that we recognize established law, 
honor the doctrine of stare decisis, and be true to our previous pronouncements 
that statutes are presumed to be constitutional; that unconstitutionality must 
be clearly and exactly shown beyond any reasonable doubt; that courts have a 
duty to uphold the constitutionality of statutes; that any doubt must be 
resolved in favor of constitutionality; that one who assails a statute has the 
burden of showing unconstitutionality, and in the absence of such showing any 
state of facts that will sustain the classification will be assumed. O'Brien v. 
State, Wyo., 711 P.2d 1144 (1986); White v. 
Fisher, Wyo., 689 P.2d 102 (1984); Armijo v. 
State, Wyo., 678 P.2d 864 (1984); Thomson v. 
Wyoming In-Stream Flow Committee, Wyo., 651 P.2d 778 (1982); Weiss v. State ex rel. Cardine, Wyo., 
455 P.2d 904 (1969), cert. denied 398 U.S. 927, 90 S. Ct. 1815, 26 L. Ed. 2d 89 
(1970). Applying these standards and tests, this statute is 
constitutional.

[¶36.]  But one cannot help but conclude from the 
overall tenor of the court's opinion that it simply does not like the statute 
adopted by the legislature. The likes or dislikes of individual justices have 
nothing to do with constitutionality of laws. Thus, it is said: "In reviewing 
legislative enactments, the court does not sit to judge the merits or wisdom of 
the act." Farley v. Engelken, 241 Kan. 663, 740 P.2d 1058, 1062 
(1987).

"`Though we may question 
the wisdom of a given enactment, as a matter of policy, that gives us no right 
to strike it down, if it violates no provision of the fundamental law.'" Otero 
v. Zouhar, 102 N.M. 493, 697 P.2d 493, 500 (1984) (quoting Village of Deming v. Hosdreg Company, Inc., 62 N.M. 
18, 303 P.2d 920 (1956)).

[¶37.]  A medical panel review act, similar to 
Wyoming's act, enacted by the Nebraska legislature was attacked as 
unconstitutional in Prendergast v. Nelson, supra 256 N.W.2d 657. The Nebraska 
Supreme Court said,

"`There are substantial 
reasons for legislative discrimination in regard to this field. We have seen in 
recent years the growth of malpractice litigation to the point where numerous 
insurance companies have withdrawn from this field. Insurance rates are 
practically prohibitive so that many professional people must either remain 
unprotected or pass the insurance charges along to their patients and clientele 
in the form of exorbitant fees and charges. This unduly burdens the public which 
requires professional services.' [Quoting from Taylor v. Karrer, 196 Neb. 581, 244 N.W.2d 201 
(1976).]

"* * * `"In the area of 
economics and social welfare, a State does not violate the Equal Protection 
Clause merely because the classifications made by its laws are imperfect. If the 
classification has some `reasonable basis,' it does not offend the Constitution 
simply because the classification `is not made with mathematical nicety or 
because in practice it results in some inequality. * * * The problems of 
government are practical ones and may justify, if they do not require, rough 
accommodations - illogical, it may be, and unscientific. * * * A statutory 
discrimination will not be set aside if any state of facts reasonably may be 
conceived to justify it.' * * * But the Equal Protection Clause does not require 
that a State must choose between attacking every aspect of a problem or not 
attacking the problem at all."' [Quoting from Botsch v. Reisdorff, 193 
Neb. 165, 226 N.W.2d 121 (1975).]

"* * * As we previously 
indicated, we have no reason to question the need for the legislation, and the 
defendant has failed to produce any evidence which would indicate 
otherwise.

* * * * * 
*

"At the time of the 
enactment of the act in question, there was an imminent danger that a drastic 
curtailment in the availability of health care services could occur in this 
state. No one can question the Legislature's power to deal with the problem. We 
affirm the right of the Legislature to exercise the police power to promote the 
general health and welfare of the citizens of this state." 256 N.W.2d  at 
668.

Montana is another of the 23 
states that have enacted this kind of legislation. Again the act was attacked as 
unconstitutional and the court stated:

"The burden is on the 
party challenging the legislation to show that the facts do not support the 
legislative enactment. We will presume a statute's validity, unless the 
constitutional violation is `clear and palpable.' We conclude here that the 
claimant did not sustain his burden of proof. Our previous discussion of the 
findings of the Master and of the evidence presented to the legislature 
convinces us that the legislature responded to a medical situation in a rational 
manner. We find that the classifications rest on distinctions between the groups 
of tort plaintiffs and tort defendants involved which have a fair and rational 
relationship to the object of the legislation." (Citations omitted.) Linder v. 
Smith, supra, 629 P.2d  at 1193.

[¶38.]  The court finally in its majority opinion 
holds that the legislature's attempt to limit or reduce such causes of action 
is

"not rationally related 
to protection of the public health or economic and social stability of the state 
[and] would be sufficient alone to find the act 
unconstitutional."

Answering this 
identical question, the New Mexico Supreme Court stated:

"The answer to the 
`rational relationship' argument, which asserts a violation of due process and 
equal protection, is that there is nothing in the record before us indicating an 
absence of a rational relationship between the legislative purpose and the 
accomplishment of that purpose." (Emphasis added.) Otero v. Zouhar, supra, 697 P.2d  at 500.

The court held 
the New Mexico 
act constitutional. It is utterly startling that this court in its majority 
opinion acknowledges that there is nothing in the record in this case to 
demonstrate absence of a rational basis for the classification and yet, without 
any legal authority, contrary to our prior holdings, finds the enactment of the 
medical review panel act by the Wyoming legislature 
unconstitutional.

[¶39.]  The specially concurring opinion is 
premised almost entirely upon a Kansas case, Farley v. Engelken, supra 740 P.2d 1058, which is not in point, for it considered not the issue presented to 
us, but "whether the equal protection clause of the Kansas Constitution is 
violated by the statutory abrogation of the collateral source rule in medical 
malpractice actions." Three dissenting Kansas Supreme Court justices thought the 
opinion of the court was not significant, persuasive, thoughtful or provocative. 
They thought it was clearly wrong. I agree. Thus, the "heightened scrutiny" test 
which the special concurrence finds so appealing was applied by the Kansas court 
after acknowledging that it had "previously applied a `rational basis' test to 
uphold the constitutionality of malpractice `crisis' legislation." Id. at 1065. The attempt 
by the Kansas 
court to distinguish the prior cases makes it clear that the "rational basis" is 
the proper test to be applied in the case before our court. This conclusion is 
supported by the fact that the rational basis test has been applied in 
thoughtful, persuasive opinions by the vast majority of courts in the cases 
heretofore cited in this dissent which consider the type of medical malpractice 
statute now before us.

[¶40.]  Some medical care providers have ceased 
practicing their profession because of the increasing cost of medical 
malpractice insurance. If the insurance premium is $50,000 (not unusual), the 
doctor must pay it from practicing medicine. The $50,000 must come either from 
fees charged patients or the doctor's own property. If it cannot come from 
either place, he will probably quit. Thus, last month KTWO Television reported 
that doctors have ceased obstetrical practice in Torrington, Lusk, and Douglas, Wyoming because of the cost of 
insurance.

[¶41.]  It is said "[t]here is not a hint of any 
public interest to be served." I cannot even comprehend such a suggestion in 
view of all that is before us; and it matters not that the legislature did not 
make specific reference, for it is implicit in the statute's statement of 
purpose and was explored in detail in the legislative 
hearings.

[¶42.]  Finally, out of thin air, without 
citation of authority, it is suggested the act runs afoul of the separation of 
powers doctrine by creating a panel to hear claims before they are filed in 
court. There is nothing new or novel about that procedure. Agencies, panels and 
boards are recognized, necessary, and essential to the business of government. 
We have never questioned the constitutionality of agencies created by the 
legislature that hold hearings, take evidence, and decide important 
controversies between citizens. Fosters, Inc. v. City of 
Laramie, Wyo., 718 P.2d 868 (1986); 
Rolfes v. State ex rel. Burt, Wyo., 464 P.2d 531 (1970); Bloomenthal, Administrative Law 
in Wyoming - An Introduction and Preliminary 
Report, 16 Wyo. L.J. 191, 194 (1961). Thus it has been 
said that

"practical men have been 
seeking practical answers to immediate problems, and their concern has been with 
how to get the * * * job done * * *. When the first Congress in 1789 wanted to 
provide benefits to the veterans of the Revolutionary War, it found high-paid 
judges and the trappings of a courtroom inappropriate for determining which 
individuals were entitled to benefits, and so the first Congress assigned the 
judicial task to an agency that could use a staff of low-paid clerks. Congress 
made similar down-to-earth, pragmatic, nontheoretical decisions when it created 
the Patent Office in 1790, the Office of Indian Affairs in 1796, and the General 
Land Office in 1812." K. Davis, Administrative Law § 2:1 at 60 
(1978).

[¶43.]  The legislature has created boards, 
commissions, administrative agencies, special hearing officers in worker's 
compensation, and professional licensing boards that all hear and decide claims 
and controversies that may or may not ultimately reach a court. Examples of some 
of these boards, panels and agencies are the Employment Security Commission, 
Parole Board, Parimutuel Commission, Oil and Gas Commission, Livestock Board, 
Game and Fish Commission, Real Estate Commission, Financial Institution Board, 
boards of examiners for law, medicine and accounting, and other licensing 
boards. I cannot understand even a suggestion that the acts creating all of 
these agencies and boards are unconstitutional as violating the separation of 
powers doctrine.

[¶44.]  The Wyoming Medical Review Panel Act 
requires a claimant, before filing suit, to file a claim with the board which 
will be set for hearing within 120 days of receipt of the claim. The hearing is 
informal before two medical practitioners, two attorneys, and one other person. 
The stated goal of the Wyoming Medical Review Panel Act 
is:

a) "to prevent where 
possible the filing in court of actions against health care providers and their 
employees for professional liability in situations where the facts do not permit 
at least a reasonable inference of malpractice,"

and

b) "to make possible the 
fair and equitable disposition of such claims against health care providers as 
are, or reasonably may be, well founded." Section 9-2-1502, W.S. 
1977.

The act provides 
that:

"(a) Upon consideration 
of all the relevant material, the panel shall determine whether there 
is:

"(i) Substantial evidence 
that the acts complained of occurred and that they constitute malpractice; 
and

"(ii) A reasonable 
probability that the patient was injured as a result of the acts complained of." 
Section 9-2-1510.

The act has a 
rational basis and is reasonably structured to accomplish its purpose. If the 
panel, comprised of medical doctors and lawyers, determines that the acts 
complained of did not constitute malpractice or that they did not cause injury, 
plaintiff would not likely pursue the claim because these types of claims are 
exceedingly costly, difficult and complicated. Several expert witnesses are 
always required. Weeks are consumed in trial. If the panel determined there was 
probably malpractice, plaintiff would feel more secure in incurring the expense 
of proceeding. The likelihood of settlement would be 
enhanced.

[¶45.]  The state of Arizona enacted a similar medical review panel act, and in 
Eastin v. Broomfield, supra 570 P.2d  at 751, the court 
stated:

"The panel provision was 
one of the several provisions enacted by the Arizona legislature in an effort to curb 
rising medical malpractice insurance premiums. At the time the Act was enacted, 
there was evidence that medical malpractice insurance costs, as well as hospital 
professional liability costs, were doubling every three years. (Arizona Medical 
Malpractice Insurance Study, Booz, Allen Consulting Actuaries, prepared for the 
Arizona Legislative Council.)

"By providing a system 
whereby the meritorious claims could be separated from the frivolous ones prior 
to trial and pretrial settlements would be encouraged, the Act promoted a 
legitimate legislative purpose. See Halpern v. Gozan, 85 Misc.2d 753, 381 N.Y.S.2d 744 (1976).

"We do not believe that 
the panel provisions violate the equal protection clause because the 
classification created by the Act has a rational basis."

[¶46.]  Under the Wyoming act, a copy of the panel's decision is 
provided the state licensing board and used by the state for the purpose of 
compiling statistical data in facilitating ongoing studies of medical 
malpractice in the state. There is nothing that requires that legislation be 
perfect. The legislative process provides for amendment and fine tuning of 
enactments to serve the needs of society. Thus we have said that "`reform may 
take one step at a time, addressing itself to the phase of the problem which 
seems most acute to the legislative mind.'" Bell 
v. State, supra, 693 P.2d  at 771 (quoting Williamson v. Lee Optical of 
Oklahoma, 348 U.S. 483, 75 S. Ct. 461, 99 L. Ed. 563 (1955)). It is appropriate that "[t]o attempt to meet a 
crisis, the Legislature is free to experiment and to innovate and to do so at 
will, or even `at the whim.' Munn v. Illinois, 
94 U.S. [4 Otto] 113, 24 L. Ed. 77." 
Prendergast v. Nelson, supra, 256 N.W.2d  at 668. The legislature will review 
this act at its next session. It should be free to review the compiled data, 
hold hearings, and modify the act as necessary to serve the needs of the 
citizens of this state.

[¶47.]  The requirements of the act are easily 
met. They are not onerous nor do they result in any significant delay nor 
prejudice to any of the parties. It is too early to tell at this time whether 
the act accomplishes its stated purposes. Whether it does or not, does not 
result in its being unconstitutional. Neither does it mean that the legislature, 
after studying the statistics that will become available, cannot correct any 
deficiencies, amend the act to alleviate the crisis in other ways, or do 
anything else that might be in the interest of citizens of this state who must 
have medical care at reasonable costs. The purpose of the medical panel review 
act is stated as:

"The purpose of this act 
is to prevent where possible the filing in court of actions against health care 
providers and their employees for professional liability in situations where the 
facts do not permit at least a reasonable inference of malpractice and to make 
possible the fair and equitable disposition of such claims against health care 
providers as are, or reasonably may be, well founded." Section 9-2-1502, W.S. 
1977.

From the record 
in this case before this court we cannot say that the act does not accomplish 
that purpose. Plaintiff has failed in her burden.

[¶48.]  I would hold the Wyoming Medical Review 
Panel Act constitutional.