G en. 279] 279 H E AL T H O CCUPATI ONS

) D ENTI STS

) A D VE R T I S I N G OF S PE CI AL T Y S ERVICES

N ovember 10, 1994

Melvi n J. Sl an, D

. D

. S. Secr etar y- Tre as ur er Maryl an d S t ate Bo ard o f D entalE

xam i ners Y ou have r eques t ed ouropi ni on conce r ni ng the auth o r i t yof the B oard of D ental E xam i ners t o take act i on against l i censees w ho l i st t hemsel ves i n di r ect or i es orot herw i s e adve r t i s e as per for m i ng cert ai n s peci al t y serv ic es w i t houtm eet i ng t he cr i t er i a for id e n tif ic a tio n a s a s p e c ia lis t. F or t he reasons st at ed b el ow , w e con cl ud e as foll ow s: 1

. If a d e n tist is no t id e n tifie d b y th e B o a rd a s a sp e c ialist in a fi el d of dent i s t r ydes i gnat ed by l aw as a s peci al t y , t he B oar d m ay t ake di s ci pl i nary act i on agai ns tt he dent i s tforadvert i s i ng t hathe or s h e is s u c h a s p e c ia lis t. 2

. E v e n if

a d e n tist is n o t id e n tifie d a s a sp e c ialist in a f ield of dent i stry , t he B oar d m aynott ake di s ci pl i naryact i on agai ns tt he dent i s tfort rut hful l yadvert i s i ng t hathe or sh e p er for m s t hat p a rt ic u la r d e n ta l s e rv ic e . 3

. T h e B o ard m ayad o p t a reg u lat ion that w o u ld req u ir e cert ai n aff

i r m at i ve di s cl os ur es i n conj unct i on w i t h an adv erti s i ng cl ai m aboutt he per for m ance of par t i cul ar dent al s er vi ces and, aft er ado pti on of the reg u lati on , cou l d take di sci pli naryact i on against d e n tis ts w h o f

a il to p ro v id e th e re q u ir e d d is c lo s u re .

I Speci al i zat i on T h e D e n tistryA c t p ro h ib its a d e n tist f ro m “ re p re se n t[ in g ] to t he publ i c thatt he l i cens ee i s a spec i al i s t i n any fi el d of s peci al i zed dent al pr act i ce unl es s i dent i fi ed as a s peci al i s ti n that fi el d byt he B oar d. ” H O §4- 504 (a) of the H eal t h O ccupa t i ons ( “H O ”) A r t i cl e,280 [7 9 O p . A tt ’y

The B oard ha s no t approve d any new spe cialty

. SeeCOMAR 1 10.44.14.03. The de finit i o ni n cl u d es , fo r e x amp l e, “any i ntra o ra ld ent al service 2 ....” HO §4- 101(m)(2) (empha sis added). M a ryla n d C o d e . See a l

so H O §4- 503( b) ( 1) ( i i )

. T he A ctdes i gnat es th e f o llo w in g “ sp e c ialtie s” :

(1 ) E n d o d o n tics ; ( 2 ) O r a l p a t h o l o g y; (3 ) O ra l su rg e ry ; (4) O rtho do nti cs; ( 5 ) P e d i a t r i c d e n t i s t r y; (6 ) P e rio d o n tics ; (7 ) P ro sth o d o n tics ; ( 8) Publ i c hea l t h; and ( 9) A nyot herfi el d of s peci al i zed de nt al p ra c tice th a t th e B o a rd a p p ro v e s u n d e r th is s ect i on. H O §4 -504(c). T he “requ i red qu al i fi cat i on s for i den t i fi cat i on as a 1 s peci al i s t ” ar e t o be s etouti n a r egul at ion

. H O §4- 504( d)

. T he B o a rd h a s d o n e s o in C O M A R 1 0 .4 4 .1 4 .0 4

. N e ith e r th e D e n tistry A c t n o r th e re g u latio n p u rp o rt s to lim it the p rac ti ce o f a n yli ce n sed d en ti st, h o w ev er. U n d er H O § 4 -30 8 (a),

“ [ a ] g e n e ra l li c e n se to p ra c tice d e n tistry

.. . a u th o riz e s the lice n se e to pr act i ce de nt i s t r yw hi l e the l i cens e i s eff ect i ve. ” The t er m “pr act i ce dent i s t r y ” i s defi ned i n br oad t er m s and encom pas s es al l of the s p e c ia lty f

ie ld s . See H O § 4 -10 1 (m ). 2 T hus , anyl i cens ed dent i s ti s fr ee t o per for m s er vi ces i n anyof t he des i gnat ed s peci al t yfi el ds

. I n t hi s r es p ec t, d en t i s t r yi s l i ke m e d ic in e : A lth o u g h p h y sici an s ten d to sp ec ial ize a n d to ac q u ir eG en. 279] 281

c re d e n tials th a t u n d e r li e th e e x p e rtise a ss o c iate d w ith a sp e c ialist, anyphy s i ci an i s fr ee t o per for m anyactw i t hi n t he s cope of pr act i ce o f m e d i c i n e . P u ttin g to o n e s id e th e is s u e o f m a lp ra c tic e , a d e r m a t o l o g i s t , f

o re x a m p l e , i s l e g a l l y f

r e e t o p r a c t i c e b r a i n s u r g e r y. So anyl i cens ed dent i s ti s fr ee t o pr act i ce a ny o f t he dent al s p e c ia ltie s . T h e c o n c e r n o f t h e Den t a l Boa r d i s t h a t t h e p u b l i c mi g h tbe m i s l ed bya non-s peci al i s t dent i s t ’ s advert i s i ng cl ai m t hat he or s he per for m s a part i cul ar s er vi ce. A dent i s tw ho advert i s es t he s er vi ce of or t hodont i cs , for ex am pl e, m i ghtbe thoughtt o i m pl yt hatt he dent i s ti s a s peci al i s ti n t hatfi el d. If the d ent i s thas notm ett he B o a rd ’s re q u ire m e n ts f

o r sp e c ialtyid e n tific a tio n , the im p lied c laim w oul d be fal s e. T he B oar d w oul d l i ke t o be abl e t o actagai ns ts uch advert i s i ng under H O §4- 503( a) ( 4) , w hi ch pr ohi bi t s advert i s i ng t hat “t ends t o dece i ve and mi s l ead the publ i c. ” II Fi r s t A m e ndm e nt C ons i de r at i ons A s t he D ent al B oar d i s aw ar e fr om a pr i orexhaus t i ve opi ni on on t he s ubj ect , t he Fi r s tA m endment t o t he U ni t ed St at es C ons t i tut i on i m pos es l i m i t at i ons on t he author i t yof the B oar d t o act a g a in s t a d v e rt is in g b yd e n tis ts

. See 70 O pi ni ons of

the At t or ney G ener al4 3 (1 9 8 5 ). O ne pr i nci pl e of the comm er ci al s peec h doctr i ne, as devel oped i n t he s ever al cas es of t he Supr eme Court , i s t hata r egul at or ybody m aypr ohi bi tadvert isi ng t hati s actual l yori nher ent l yfal s e, m is le a d in g , o r d e c e p tiv e . Ibanez v. F l ori da D ep’t

. of Bu si ness & P r of

. R egulat i on , 1 1 4 S . C t. 20 8 4 , 2 0 8 8 (1 9 9 4 ); Zauder erv. O f f i ce of D is ci pl i nar y C ouns el , 4 7 1 U .S . 6 2 6 , 6 3 8 (1 9 8 5 ). In o u r v iew , this p rin c ip le a llo w s th e D e n tal B o a rd to p ro h ib it a d e n tist w h o is n o t a s peci al i s tfr om s el f- l abel i ng t hatfal s el yi m pl i es t he s peci al i s ts t atus of t he dent i s t

. For exampl e, a dent i s tw ho has not at t ai ned i dent i fi ed s peci al t ys t atus i n or t hodont i cs m aynotl ay clai m t o bei ng an o rth o d o n tist. T h e u se o f th a t lab e l f

o r th e d e n tist in e sc a p a b ly convey s t he i m pr es s i on of a s peci al t ys t atus t hatt he dent i s t does not h av e. T h u s, H O § § 4 -50 3 (b)(1 )(i i) an d 4 -50 4 (a)

)w hi ch, as w e have c o n stru e d th e m , ap p lyo n lyto f a lse c laim s tha t o n e is a s p e c ialist

) a re c o n s titu tio n a l. See 70 O p inions of

the At t or ney G ener alat64- 6 6

. S e e a l

s o Th e Fl o r i da Ba rv . Her r i ck , 5 7 1 So. 2d 1303, 1307 (F la . 1 9 9 0 ), cer t

. deni ed , 111 S. C t

. 2798 ( 1991) ( uphol di ng ban on282 [7 9 O p . A tt ’y

us e of t er m “s peci al i s t ” by l aw y er w ho i s not offi ci al l y des i gnat ed or c e rtifie d in th a t ar e a o f

p ra c tice ); P ar m l ey v . Mis s our i D entalB d. , 719 S. W

. 2d 745, 752- 53 ( M o . 1986) ( uphol di ng ban on nonsp ec ial ist s’ ad v erti sing as sp ec ial ist s o r l im it ed p rac ti ti o n ers). B yc on t r a s t , a n a dv e r t i s i ng c l a i m t ha ta no n- s pe c i a l i s tde nti st s i m pl y per for m s a par t i cul ars ervi ce ) or t hodont i cs , forexampl e ) i s not actual l y ori nher ent l yfal s e, m i s l eadi ng, ordece pt i ve. I ndeed, t he s t at ement i s t rue: T he dent i s t does per for m or t hodont i cs , as he o r s h e is le g a l l ya u th o ri z e d to d o . See The Fl or i da B arv. Her r i ck , 571 So. 2d at 1307 ( not i ng t hat l aw y er pr ohi bi t ed fr om advert i s i ng a s a sp e c ialist “ is n o t p re v e n ted f ro m a d v e rtisin g th a t h e p ra c tice s in th e [ s p e c ia lty] a re a ...” ). T o be sure, such an ad vert i si ng cl ai m i s p o ten tia lly m i s l eadi ng. Som e w ho encount ert he adve r t i s i ng m i g h ta s s u me, err oneous l y , t hat t he dent i s tm us tbe a s peci al i s ti f he ors he a d ver t i s es t he s er vi ce. B u t th e F irst A m e n d m e n t d o e s n o t allo w c o m m e rc ial s p e e c h th a t is m e re ly p o te n tia lly m is le a d in g to b e b a n n e d a lto g e th e r. S e e , e .g ., P eel v. A t t or ney Regis tr at i on & D is ci pl i nar y C om m ’ n, 496 U

. S. 91, 1 1 0 (1 9 9 0 ); B at es v. St at e Bar of A r iz ona, 4 3 3 U

. S

. 3 5 0 , 3 7 5 (19 7 7 ). A s t he Supr eme Court hel d i n another cas e, “the St at es m ay not p lac e a n a b so lu te p ro h ib iti o n o n c e rta in typ e s o f p o te n ti a lly m is le a d in g in f

o rm a tio n , e .g ., a l i s t i ng of ar eas of p rac ti ce, i f the in f o rm a tio n a ls o m a yb e p re s e n te d i n a w a y th a t is n o t d e c e p tiv e .” I n r e R. M

. J. , 4 5 5 U .S . 1 9 1 , 2 0 3 (1 9 8 2 ). T hes e pr i nci pl es have be en appl i ed i n exac t l yt he ar ea of y our i nqui r ybya fe der al appel l at e court

. I n P ar ker v. C om m onw eal th of Kentucky, B oa rd of D entistry , 818 F. 2d 50 4 (6th C i r . 1987) , t he K entuckyr egul atorys cheme w as m uch l i ke M ary l and’ s . T hr ough s peci al l i cens ur e, a dent i s tcould at t ai n a s peci al t ydes i gnat i on and a d v e r t i s e a s a s p e c i a l i s ti n t h a t p a r t i c u l a rf i e l d o f d e n t i s t r y. N e v e rth e les s, a n ylice n se d d e n tist in K e n tu c k yw a s a llo w e d to per for m s er vi ces i n anyoral l of the fi el ds of dent ist ry for w hi ch s peci al t ydes i gnat i on w as avai l abl e. Par ker , a gene r al pr act i ce de nt i s t , w as nota desi g n at ed sp e c ialist in o rth o d o n tics

. N e v e rth e les s, h e p e rf o rm e d o rth o d o n tic proc ed u res as a s i gni fi cantpar tof hi s pr act i ce. I n t el ephone di r ect or yadvert i s i ng, Par kerl i s t ed or t hodont i cs a s one of the s er vi ces t hathe off

er ed. T he K ent u ck y B oar d t hen br ought d is c ip lin a ry a c tio n a g a in s t h im . 8 1 8 F .2 d a t 5 0 6

.G en. 279] 283 T he fe deral cou rtrej ect ed the argum ent that the d e n t i st ’s use of t he t er m “or t hodont i cs ” w as i nher ent l ym i s l eadi ng:

Such t er m s ar e not fal s e, butactual l ydes cr i be proced ures w hich a gen eral pract i ci ng den t i st i s p e r mi t t e d t o p e r f

o r m u n d e r s t a t e l a w. I f a sta te p e rm its a d e n tist to p e rf o rm o rth o d o n tic pr ocedur es , w e do notbel i ev e a st at e ca n j us t i fyan outr i ght ban on t he us e of par t i cul ar te rm s relati n g to o rth o d o n ti cs o n the th eo ry t hats uch t er m s i nher ent l ym i s l ead the publ i c. T o t he contr ary , bys uppr es s i ng s uch s peec h, th e pu bli c w i l l po ssi blybe m i sl ed into b eli ev ing that o n lyo rth o d o n ti sts can p erf o rm o rth o d o n tic p rocedu res . S in c e th is i nfor m at i on i s t rut hful and r el at es t o a l aw ful act i vi t y , i ti s ent i t l ed t o Fi r st A m endment pr ot ect i on. 8 1 8 F .2 d a t 5 1 0

. T h e c o u r t w e n t o n to o b se rv e “ th a t ev e n a ss u m in g th is inf o rm ati o n co u ld b e c lassifi ed as p o tential ly m isl ea d ing , the s tat e’s o u tr ig h t p ro h ib itio n o n th e u s e o f th e s e te rm s c a n n o t b e ju s tif ie d .” Id

. T he courtr ecogni zed the s t at e’ s “s ubs t ant i al i nt er es ti n enabl i ng t he publ i c t o di s t i ngui s h betw een ge ner al pr act i t i oner s and s peci al i s t s or i n ens ur i ng t he pr ofes s i onal conductof dent i s t s . Such interest i n this co n text, h o w ev er, ca n b e f u rth ere d b yreq u ir ing m o re di s cl os ur e; an outr i ght b an on t he us e of s peci fi c, nonm i s l eadi ng te rm s is s im p ly n o t n a rr o w ly ta ilo re d to m e e t th e s ta te ’s c o n c e rn .” 8 1 8 F .2 d a t 5 1 0 -1 1

. T h e c o u rtp o inted o u t th at i n fo rm ati o n ab o u t a n o n -spe ciali st’ s s cope of pr act i ce “ can be pr es ent ed i n a w ay w hi ch does notm i s l ead t he p ub l i c i nto bel i eving t hat a general pract i ci ng den t i sti s a denti st w i t h an or t hodont i a s peci al t yl i cens e. A di s cl ai m ert o s uch an e ffe ct w o u ld a d e q u a te ly ad d re s s th e s ta te ’s c o n c e rn .” 8 1 8 F .2 d a t 5 1 0

. I n ourvi ew , t hi s an al y s i s corr ect l yappl i es Fi r s tA m endment pr i nci pl es t o a non- s peci al i s tdent i s t ’ s advert i s i ng of ar eas of p ra c tice th a t ar e d e sig n a ted sp e c ialtie s. T h e D e n tal B o a rd is cons t i tut i onal l yper m i t t ed t o adopta r egul at i on r equi r i ng aff i r m at i ve dis cl osures ) for exampl e, a r equi r ement t hat advert i s i ng of a sp e c ialtyse rv ice b ya n o n -sp e c ialist c o n tain a d isc laim e r o f sp e c ialty s ta tu s . S e e P a r m le

y v . Mis s o u r i D e n ta l B d ., 7 1 9 S

. W

. 2d at752284 [7 9 O p . A tt ’y

A non-spec ialist who advertises that or thodontics is part of his or 3 her practicecould be require d, for e x ample, to state in any adver tising “not a spec ialist in orthodonti cs” or some oth er phrase de signe d to aver t any misimpression about the dentist’s status as a specialist. Although such an a ff ir mativ edis c los urere qu ir e me nt c an c a ll fo r dis c laimers of thi s kin d to be done i n a way

that consumers w ill noti ce thedisclaimer, the requirem en tmay

not be so burdensomeas to eff ectively chill the adver tising that is entitled to F irst Amendment protec tion. See Zaudere r v. Office of Disc iplinary Counsel , 471 U.S. at 651. (upho l ding dis cl ai m er r equ i rem ent fo r non-speci al i stden t i stw ho se a d v e rt is in g c o n ta in s “ te rm s d e n o tin g re c o g n iz e d s p e c ia ltie s ” ). See gener al l y Zauder erv. O

f f i ce of D is ci p li n a r y C ouns el , 471 U

. S. at 651. I ti s notcons t i tut i onal l yper m i t t ed t o pr ohi bi tt hatki nd of 3 a d v e rt is in g , h o w e v e r.

III C oncl usi on I n s umma r y , i ti s o u ro p i n i o n th a t , a l t h o u g h t h e Boa r d of D ent al E xami ner s m ay p rohi bi ta dent i s tw ho i s notan i dent i fi ed sp ec ial ist fro m ad v erti sing that the de n ti st is a spe ciali st, the B o ard m ay not pr ohi bi t a t rut hful advert i s i ng cl ai m by a non- s peci al i s tt hat h e o r sh e p e rf

o rm s a s p e c ia ltyse rv ice . T h e B o a rd m a ya d o p t a r egul at i on, how ever , t o req u i r e appr opr i at e af fi r m at i ve di s cl os ur es in c o n ju n c tio n w ith s u c h a c la im

.
J. Jo sep h C u rran , Jr. A t t or ney G ener al Ja c k S c h w a rtz C hi ef C ouns el O pi ni ons & Advi ce E ditor ’s N

ote: Si nce the i s s uance of thi s opi ni on, t he G ener al A s s embl yhas r epe aled t he l i s tof s peci al i t i es i n H O §4- 504( c) and s ubs t i tut ed an a u th o riz a tio n f

o r th e B o a rd to “ a p p r o v e a n ya re a o f sp e c iality r ecogni zed byt he C om m i s s i on on D e nt al A ccr edi t at i on . . . . ” C hapt er 376, L aw s of M ary l and 1999.