Title: Vuagniaux v. Department of Professional Regulation
Citation: N/A
Docket Number: 94073
State: Illinois
Issuer: Illinois Supreme Court
Date: November 20, 2003

Docket No. 94073-Agenda 8-May 2003.
THAD VUAGNIAUX, Appellee, v. THE DEPARTMENT OF 							PROFESSIONAL REGULATION et al., Appellants.
Opinion filed November 20, 2003.
	JUSTICE RARICK delivered the opinion of the court:
	Dr. Thad Vuagniaux, a licensed chiropractic physician, was
reprimanded by the Department of Professional Regulation (the
Department) and fined the sum of $2,500 for violating the advertising
provisions set forth in section 26 of the Medical Practice Act of 1987
(225 ILCS 60/26 (West 1998)). On administrative review of the
Department's decision, the circuit court of Madison County reversed.
In so doing, it found various sections of the Medical Practice Act,
including section 26's advertising restrictions, to be unconstitutional
and void. The Department appealed. Because the circuit court's
judgment held statutes of the State of Illinois to be invalid, the appeal
was taken directly to our court. 134 Ill. 2d R. 302(a). For the reasons
that follow, we affirm in part, reverse in part and remand for further
proceedings.
	Although the record in this case is voluminous, the facts
necessary to the disposition are straightforward. Thad Vuagniaux
graduated from Logan Chiropractic College in 1993 and was licensed
as a chiropractor by the State of Illinois in 1994. At all relevant times,
Vuagniaux has maintained a practice in Madison County, Illinois,
located in the St. Louis, Missouri, metropolitan area.
	Two years after receiving his license, Vuagniaux published a
series of advertisements for his practice in the St. Louis Post-Dispatch. The advertisements, which ran throughout 1996, appeared
in editions of the paper circulated in Illinois. Each ad addressed a
different ailment. The ailments discussed were migraine headaches,
asthma, fibromylagia, carpal tunnel syndrome, Crohn's
Disease/irritable bowel syndrome, learning disorders, "TMJ
Dysfunction," whiplash and vertebral subluxations, and Meniere's
Disease/vertigo.
	Vuagniaux's ads described the causes and symptoms of the
foregoing conditions and linked each of them to interference with the
brain stem. The ads stated that a procedure termed "Specific
Chiropractic" corrects or removes interference to the brain stem,
enabling sufferers to recover normal function and achieve their "fullest
health potential without the use of drugs or surgery."
	Vuagniaux's ads publicized that he employed "Specific
Chiropractic" in his practice. In fact, the first two ads represented that
he was one of only two "Certified Brain Stem Specialists" in the St.
Louis metropolitan area. Those ads included, under his photo, the
notation that he is a "Kale Certified Brain Stem Specialist" and an
officer of the "Kale International Research Council." Vuagniaux's
third ad deleted the references to his being certified or a specialist and
indicated simply that he was one of only two "Specific Chiropractors"
in the St. Louis area. The same claim appeared in the fourth ad, but
was deleted from the fifth and all subsequent ads.
	Publication of Vuagniaux's ads elicited complaints from other
chiropractors. After investigating the matter, the Department initiated
disciplinary proceedings against Vuagniaux pursuant to section 22 of
the Medical Practice Act of 1987 (225 ILCS 60/22 (West 1998)). The
Department's complaint, which contained three counts, asked that
Vuagniaux's license be suspended, revoked, or otherwise disciplined
on the grounds that his ads violated the provisions of the Medical
Practice Act governing advertising.
	Advertising by persons licensed under the Medical Malpractice
Act is subject to section 26 of the statute (225 ILCS 60/26 (West
1998)). Section 26 permits licensees to advertise the availability of
their professional services in the public media or on the premises
where the services are rendered. The statute provides, however, that
any such advertising is limited to certain types of information.
Information that may be published under the statute includes the
licensee's "name, title, office hours, address and telephone number"
(225 ILCS 60/26(a) (West 1998)); his "usual and customary fees for
routine professional services" (225 ILCS 60/26(c) (West 1998)); his
"areas of specialization, including appropriate board certification or
limitation of professional practice" (225 ILCS 60/26(b) (West 1998));
announcement of the "opening of, change of, absence from, or return
to business" (225 ILCS 60/26(d) (West 1998)); announcement of
changes in professional licensed staff (225 ILCS 60/26(e) (West
1998)); and issuance of business or appointment cards (225 ILCS
60/26(f) (West 1998)).
	Counts I and III of the Department's complaint both charged
violations of the foregoing provisions. Count III made a general
allegation that Vuagniaux's ads all contravened the Medical Practice
Act because they are "not limited in the information provided to the
information permitted in [section 26]." Count I focused specifically on
the ads representing Vuagniaux as a "Certified Brain Stem Specialist"
and a "Kale Certified Brain Stem Specialist." According to the
Department, those ads violated the Act because the specialties
identified in the ad were not legitimate. In the words of the complaint,
"[t]here is no appropriate board certification as a Certified Brain Stem
Specialist or a Kale Certified Brain Stem Specialist in Chiropractic
medicine."
	In addition to limiting the types of information a licensee may
include in his advertising, section 26 of the Medical Practice Act also
forbids a licensee from using statements in his advertising that contain
"false, fraudulent, deceptive or misleading material or *** statements
which play upon the vanity or fears of the public." 225 ILCS 60/26
(West 1998). Count II of the Department's complaint was premised
on that prohibition. It alleged that Vuagniaux's claims that
chiropractic treatment of the brain stem will treat asthma, Meniere's
disease, learning disorders and the other conditions mentioned in the
various ads "are deceptive or misleading and play upon the fears of the
public."
	After the Department served Vuagniaux with its administrative
complaint, Vuagniaux sought declaratory and injunctive relief from
the circuit court of Madison County to prevent the disciplinary
proceedings against him from going forward. Vuagniaux's complaint,
as amended, raised a variety of issues regarding the fairness and
constitutionality of the process by which chiropractors in Illinois are
subject to discipline and the standards by which their conduct is
judged. Among the claims he made were (1) that subjecting
chiropractors to regulation by the Department's Medical Disciplinary
Board, which by statute includes but a single chiropractor among its
seven voting members, denies chiropractors their rights to due process
and equal protection, (2) that the advertising provisions in section 26
of the Medical Practice Act are uncertain and vague, and the
Department has failed to enact standards for assessing whether those
provisions have been violated, (3) that the Department has failed to
adopt meaningful rules of discovery, and (4) that the Department
should not be allowed to limit the location of evidentiary hearings in
disciplinary matters to Chicago and Springfield.
	At the same time he pursued this civil action, Vuagniaux
vigorously contested various developments in the Department's
disciplinary action against him. Among the actions he took was to
move for exclusion of Dr. Lacy Cook, the sole chiropractic member
of the Medical Disciplinary Board, from further participation in his
case. Vuagniaux based that motion on claims that Cook would be
prejudiced against him and the chiropractic theories he followed.
Although the administrative law judge assigned to the case found no
actual prejudice by Cook, the administrative law judge granted
Vuagniaux's motion and excluded Cook to avoid the appearance of
prejudice.
	Once Cook was excluded from the case, the Department moved
for appointment of a "Special Chiropractor" to the Medical
Disciplinary Board so that the Board would include a chiropractic
member when it considered Vuagniaux's case. The administrative law
judge referred the motion to the Board for its consideration. The
Board granted the motion and named Dr. Roger Pope, a doctor of
chiropractic, to serve in Cook's place on the Board for the purposes
of these proceedings.
	Vuagniaux raised objections to Pope's appointment in both the
disciplinary proceeding and the civil action. The principle basis for
Vuagniaux's objection was that the Board's appointment violated the
Medical Practice Act, which specifies that members of the Medical
Disciplinary Board are "to be appointed by the Governor by and with
the advice and consent of the Senate." 225 ILCS 60/7(A) (West
1998). Vuagniaux further claimed that the appointment would infringe
on his right to confront and cross-examine witnesses.
	Vuagniaux's objection to Pope's inclusion on the Board went
unheeded. A motion he filed in the administrative proceeding for
judgment on the pleadings or, in the alternative, to dismiss, was
denied. Vuagniaux then moved for a preliminary injunction in his civil
action. When that motion was also denied, an administrative hearing
on the Department's disciplinary complaint was convened. The
hearing took place over a series of dates during the summer of 1998.
In the course of the hearing, the administrative law judge allowed the
Department to delete from count II of its complaint the allegations
pertaining to whiplash and vertebral subluxations. Experts witnesses
were called by both sides, and Vuagniaux testified on his own behalf.
	Following the hearing, the administrative law judge issued her
findings and recommendations in accordance with section 35 of the
Medical Practice Act (225 ILCS 60/35 (West 1998)). The
administrative law judge concluded that the Department had proved
all three counts of its complaint by clear and convincing evidence and
recommended to the Medical Disciplinary Board that Vuagniaux be
fined the sum of $2,500. The Medical Disciplinary Board adopted the
administrative law judge's findings of fact and conclusions of law. It
also agreed with the administrative law judge's recommendation that
Vuagniaux be fined $2,500. Unlike the administrative law judge,
however, the Board believed that the sanctions imposed on Vuagniaux
should also include a reprimand. The Board's recommendation, made
with the concurrence of five members, including the specially
appointed chiropractor, Pope, was adopted by the Department's
director. In an order signed by the director and dated December 16,
1998, the Department reprimanded Vuagniaux's license and ordered
him to pay a $2,500 fine.
	Vuagniaux sought administrative review of the Department's
decision pursuant to article III of the Code of Civil Procedure (the
Administrative Review Law) (735 ILCS 5/3-101 et seq. (West 1998))
in the circuit court of Madison County. On Vuagniaux's motion, the
circuit court subsequently consolidated that action with Vuagniaux's
suit for declaratory and injunctive relief and allowed Vuagniaux to
make various amendments to his complaint for declaratory and
injunctive relief. Following those amendments, the Department moved
for summary judgment against Vuagniaux on his suit for a declaratory
judgment and injunction. As grounds for its motion, the Department
argued that where, as here, the Administrative Review Law is
applicable and provides a remedy, the circuit court may not redress a
party's grievance through any other type of action. The circuit court
found this argument to be meritorious, granted the Department's
motion for summary judgment, and dismissed Vuagniaux's complaint
for declaratory and injunctive relief with prejudice.
	The proceedings for administrative review remained pending.
Vuagniaux was allowed to amend his complaint for administrative
review to include a number of different claims, including claims he had
previously asserted in his action for declaratory and injunctive relief.
Following a hearing, the circuit court entered an order setting aside
the Department's decision and dismissing the Department's complaint
against Vuagniaux. The court gave numerous reasons for reaching
that decision. Among these were that appointment of Dr. Pope to
replace Dr. Cook on the Medical Disciplinary Board was not
authorized by law and was unconstitutional, that the statutory
composition of the Board violates due process and equal protection,
that the Department's administrative complaint was defective, that the
Department had failed to properly prove its case against Vuagniaux,
and that the provisions of the Medical Practice Act regulating
advertising are unconstitutionally vague and violate "Vuagniaux's
right to engage in free commercial and educational speech." This
appeal by the Department followed.
	The Department took its appeal directly to us based on the circuit
court's determination that provisions of the Medical Practice Act were
invalid. See 134 Ill. 2d R. 302(a). Although the constitutionality of
those provisions has been the focus of the parties' arguments in our
court, a fundamental principle of judicial decisionmaking is that
questions regarding the constitutionality of statutes should be
considered "only where essential to the disposition of a case, i.e.,
where the case cannot be determined on other grounds." Bonaguro v.
County Officers Electoral Board, 158 Ill. 2d 391, 396 (1994). Having
reviewed the record and the applicable law, we have concluded that
the disciplinary action undertaken by the Department in this case
suffered from a basic flaw which rendered its decision invalid for
reasons wholly unrelated to the constitutionality of the Medical
Practice Act.
	The problem with the proceedings is that the Medical Disciplinary
Board, the administrative body charged with enforcing the provisions
of the Act pertaining to discipline, was not properly constituted when
it considered Vuagniaux's case on the merits and recommended that
his license be disciplined. It was improperly constituted because it
included Pope, the chiropractor appointed by the Board to replace
Cook after Cook was excluded from further participation in the case
by the administrative law judge. As Vuagniaux has consistently
argued, and as the circuit court correctly determined, Pope's
appointment was impermissible because the Board had no statutory or
constitutional authority to make it.
	The Medical Practice Act plainly provides that all members of the
Medical Disciplinary Board are "to be appointed by the Governor by
and with the advice and consent of the Senate." 225 ILCS 60/7(A)
(West 1998). There is no situation under the Act where anyone other
than the Governor, by and with the advice and consent of the Senate,
may appoint a person to be a member of the Board. Upon expiration
of the Board members' terms, their successors must be appointed by
the Governor by and with the consent of the Senate. If a vacancy
occurs before the expiration of a Board member's term, it is the
Governor, by and with the advice and consent of the Senate, who is
authorized to fill the vacancy. 225 ILCS 60/7(B) (West 1998).
	There are two circumstances in which the Governor can take
action with regard to Board members without involving the Senate.
The first is where the Board has recommended that a member be
removed for misfeasance, malfeasance, or wilful neglect of duty. In
such a case, the Governor may remove the offending member on his
own, after notice and a public hearing, unless the member expressly
waives the right to such notice and hearing in writing. 225 ILCS
60/7(B) (West 1998). The second is where a vacancy occurs while the
Senate is in recess. There, the basic constitutional provisions
governing recess appointments apply and the Governor is authorized
to "make a temporary appointment until the next meeting of the
Senate, when he shall make a nomination to fill such office." Ill.
Const. 1970, art. V, §9.
	While participation by the Senate is unnecessary in the foregoing
situations, participation by the Governor is always required. Neither
the Medical Practice Act nor the Illinois Constitution of 1970 permit
appointment or involuntary removal of Board members without
gubernatorial action. As an administrative agency, the Medical
Disciplinary Board is and was constrained by these limitations. It has
no general or common law authority. The only powers it possesses are
those granted to it by the legislature, and any action it takes must be
authorized by statute. Business &amp; Professional People for the Public
Interest v. Illinois Commerce Comm'n, 136 Ill. 2d 192, 243-44
(1989).
	Because the Board had no authority to appoint Pope, it was not
lawfully constituted at the time it recommended that Vuagniaux be
reprimanded and fined. The Department's decision, which was based
on the Board's recommendation, is therefore invalid and cannot be
given effect. See Gilchrist v. Human Rights Comm'n, 312 Ill. App. 3d
597, 603 (2000).
	Unlike the administrative body whose decision was challenged in
Daniels v. Industrial Comm'n, 201 Ill. 2d 160 (2002), the Department
makes no claim that its decision can be legitimized on the grounds that
Pope was a de facto officer. Under the de facto officer doctrine, a
person actually performing the duties of an office under color of title
is a considered to be an officer de facto, and his acts as such an officer
are valid so far as the public or third parties who have an interest in
them are concerned. People ex rel. Chillicothe Township v. Board of
Review, 19 Ill. 2d 424, 426 (1960). Pursuant to the doctrine, litigants
may not assert collateral challenges to the officer's qualifications to
hold office as a means of a contesting the legality of the officer's acts.
Daniels v. Industrial Comm'n, 201 Ill. 2d  at 174 (McMorrow, J.,
specially concurring, joined by Freeman, J.).
	The case before us does not involve the effects of an officer's
acts on a member of the public or a third party, and the officer's
qualifications to act are not being contested in a collateral proceeding.
The challenge to Pope's authority to act as a member of the Board
was raised in the proceeding in which Pope was appointed, at the time
the appointment was made, by a doctor whose case was directly
affected by the appointment, to the tribunal responsible for
considering the disciplinary charges against the doctor, and before the
tribunal considered the doctor's case on the merits or made its
recommendations. The de facto officer doctrine is therefore
inapplicable.
	In attempting to justify Pope's appointment, the Department does
not dispute that the Medical Practice Act contains no provisions
authorizing its actions. It argues, however, that the Board has implicit
authority to make temporary appointments for a particular case where
a permanent Board member is excluded from participating or
voluntarily recuses himself. This argument is untenable. As discussed
earlier in this opinion, administrative bodies such as the Board are
creatures of statute and possess no general or common law powers.
Any power or authority claimed by an administrative agency must find
its source within the provisions of the statute by which the agency was
created. The agency's authority must either arise from the express
language of the statute or "devolve by fair implication and intendment
from the express provisions of the [statute] as an incident to achieving
the objectives for which the [agency] was created." Schalz v.
McHenry County Sheriff's Department Merit Comm'n, 113 Ill. 2d 198, 202-03 (1986).
	There being no explicit statutory authorization for the Board to
appoint replacement members when one of its existing members
cannot hear a case, the appointment of Pope can be upheld under the
foregoing standard only if authority for such an appointment can fairly
be implied from the express provisions of the Medical Practice Act as
an incident to achieving the objectives for which the Board was
created. In our view, no such implication can be made.
	By statute, only four of the Board's seven voting members are
needed for a quorum, and vacancies in the membership of the Board
"shall not impair the right of a quorum to exercise all the rights and
perform all the duties of the *** Board." 225 ILCS 60/7(E) (West
1998). If the Board may continue to conduct its work with a vacancy,
it may surely continue its work where, as here, a particular Board
member is for some reason unable to participate in a particular matter.
Its power to function is no more impeded than ours is when one of
our members is unable to take part in the consideration and disposition
of a case. Just as the absence of one of our members due to
disqualification or recusal does not entitle us to bypass the normal
judicial selection mechanism and invite another judge from another
court to join us temporarily, the removal of a Board member from
participation in a specific disciplinary action does not empower the
remaining Board members to sidestep the statutory nomination and
confirmation process and invite another doctor to join them as a
substitute. We therefore do not believe that the power to appoint
temporary Board members can fairly be implied from the Medical
Practice Act as an incident to achieving the Board's statutory
purposes.
	Having concluded that Pope's appointment exceeded the Board's
statutory and constitutional authority and that the decision of the
Department based on the recommendation of the improperly
constituted Board cannot stand, we agree with the circuit court that
the Department's decision to fine Vuagniaux and reprimand his license
must be set aside. Unlike the circuit court, however, we believe that
the appropriate remedy in this case is to remand the matter to the
Department for reconsideration by a legally constituted Board. See
Daniels v. Industrial Comm'n, 201 Ill. 2d 160 (2002); Gilchrist v.
Human Rights Comm'n, 312 Ill. App. 3d 597 (2000) (causes
remanded to administrative agencies for new hearings when original
agency decisions were found to have been made by or with the
participation of public officers whose appointments were not
authorized by statute).
	In ordering a remand for further proceedings by the Department,
we hasten to add that the unauthorized appointment of Pope does not
render the entire disciplinary proceeding a nullity. It merely invalidates
the actions taken by the Department following Pope's appointment to
the Board. Because the Board's initial decision to pursue charges
against Vuagniaux preceded Pope's participation on the Board, it is
unaffected. Because the evidentiary hearings regarding those charges
followed Pope's appointment, however, they are invalid and are to be
disregarded. If the Department still wishes to pursue disciplinary
charges against Vuagniaux, it must afford him the opportunity for a
new set of hearings.
	Our decision to afford Vuagniaux such relief eliminates the need
for us to address issues regarding the sufficiency of the evidence
presented by the Department in the original proceedings or the
procedural rulings made there. It also renders premature consideration
of whether the advertising provisions of the Medical Practice Act
violate rights to free speech guaranteed by the first amendment to the
United States Constitution (U.S. Const., amend. I) and corresponding
protections under the Constitution of Illinois.
	Whether governmental restrictions on advertising by medical
professionals contravene the first amendment is judged by the
standards governing commercial speech. See Desnick v. Department
of Professional Regulation, 171 Ill. 2d 510 (1996); Snell v.
Department of Professional Regulation, 318 Ill. App. 3d 972 (2001).
Restrictions on commercial speech are analyzed under the test set
forth in Central Hudson Gas &amp; Electric Corp. v. Public Service
Comm'n, 447 U.S. 557, 566, 65 L. Ed. 2d 341, 351, 100 S. Ct. 2343,
2351 (1980). A court first asks whether the commercial speech
concerns unlawful activity or is misleading. If the answer to that
question is in the affirmative, the speech is not protected by the first
amendment. If the answer is in the negative, that is, if the speech
concerns lawful activity and is not misleading, the court next asks
whether the asserted governmental interest in regulating the speech is
substantial. If the interest is substantial, the court must determine
whether the regulation directly advances the governmental interest
asserted. The court must also assess whether the regulation is more
extensive than necessary to serve the governmental interest.
Thompson v. Western States Medical Center, 535 U.S. ___, ___, 152 L. Ed. 2d 563, 573, 122 S. Ct. 1497, 1504 (2002).
	When analyzing challenges to a regulation's constitutionality
based on the first amendment, courts differentiate between an
as-applied challenge and an overbreadth challenge. An as-applied
challenge asserts that the particular acts which gave rise to the
litigation fall outside what a properly drawn regulation could cover.
An overbreadth challenge, on the other hand, attacks a regulation's
facial validity, enabling persons to whom a statute may constitutionally
be applied to challenge the statute on the ground that it may
conceivably be applied unconstitutionally to others in situations not
before the court. Desnick v. Department of Professional Regulation,
171 Ill. 2d  at 519-20.
	The overbreadth is not available to plaintiffs contesting the
validity of a statute regulating commercial speech. Board of Trustees
of the State University of New York v. Fox, 492 U.S. 469, 106 L. Ed. 2d 388, 109 S. Ct. 3028 (1989). That is so because commercial
speech is considered "more hardy, less likely to be 'chilled,' and not
in need of surrogate litigators." Board of Trustees of the State
University of New York, 492 U.S.  at 481, 106 L. Ed. 2d  at 404, 109 S. Ct.  at 3035. Accordingly, any party challenging the constitutionality
of a restriction on commercial speech must normally demonstrate his
standing by first showing that his particular conduct is protected under
the first amendment. Desnick v. Department of Professional
Regulation, 171 Ill. 2d  at 520.
	Such a showing necessarily requires a developed factual record.
No such record can be said to exist here. Having been generated
following the Board's unlawful appointment of Pope, the present
record and findings of fact are a nullity. Before the Department can
discipline Vuagniaux, new hearings must conducted, and the matter
must be taken up again, this time by a lawfully constituted Board.
Until that occurs and valid findings of fact are issued, we have no
basis for evaluating whether enforcement of the advertising provisions
against Vuagniaux would violate his rights to free speech.
	In addition to challenging the advertising provisions under the
first amendment, Vuagniaux asserts that they are unconstitutionally
vague. The vagueness arguments Vuagniaux raises appear to turn, in
large part, on the particular facts of this case. To that extent, their
resolution must await new hearings on remand, just as with his first
amendment challenges. We note, however, that Vuagniaux also
purports to advance a facial challenge to the advertising provisions.
	Statutes regulating commercial speech are subject to attack on
the grounds that they are unconstitutional on their face, not simply as
applied, where the constitutional challenge is based on vagueness.
Jacobs v. Florida Bar, 50 F.3d 901, 907 (11th Cir. 1995); see, e.g.,
Posadas de Puerto Rico Associates v. Tourism Co. of Puerto Rico,
478 U.S. 328, 92 L. Ed. 2d 266, 106 S. Ct. 2968 (1986). The
vagueness doctrine is founded on considerations of due process. As
a matter of due process, a law is void if it is so vague that persons
" 'of common intelligence must necessarily guess at its meaning and
differ as to its application.'" Ardt v. Illinois Department of
Professional Regulation, 154 Ill. 2d 138, 157 (1992), quoting
Connally v. General Construction Co., 269 U.S. 385, 391, 70 L. Ed. 322, 328, 46 S. Ct. 126, 127 (1926).
	In Ardt v. Illinois Department of Professional Regulation, 154 Ill. 2d 138, this court considered the void for vagueness doctrine in a
disciplinary action brought against a dentist for violation of the
advertising provisions of the Dental Practice Act. We held there that
a statute does not violate the due process clauses of the United States
or Illinois Constitution on grounds of vagueness if it is explicit enough
to serve as a guide to those who must comply with it. Because we
concluded that the advertising provisions at issue in the case and the
regulations promulgated in connection with them provided dentists
sufficient guidance to enable them to avoid advertising prohibited
information, we found that the challenged provisions were not
unconstitutionally vague. Ardt v. Illinois Department of Professional
Regulation, 154 Ill. 2d  at 157.
	The portion of the advertising provisions attacked by Vuagniaux
as facially invalid under the void-for-vagueness doctrine in this case
is section 26(b) of the Medical Practice Act, which permits doctors to
include in their advertising information pertaining to his "areas of
specialization, including appropriate board certification or limitation
of professional practice." 225 ILCS 60/26(b) (West 1998). Vuagniaux
takes issue with this statute because it does not define the phrase
"appropriate board certification" or include a list of certifications
considered to be appropriate. Although the circuit court was
persuaded by Vuagniaux's argument, its decision enjoys no deference
on appeal. We consider de novo whether a statute is constitutional. In
undertaking our review, we presume that statutory enactments are
constitutional. The burden is on the party challenging the statute to
clearly establish any constitutional invalidity. The burden is a
formidable one, and this court will uphold a statute's validity
whenever it is reasonably possible to do so. People ex rel. Lumpkin v.
Cassidy, 184 Ill. 2d 117, 123 (1998).
	Due process does not mandate absolute standards or
mathematical precision in the formulation of statutory enactments.
Although it does require that a regulation not be vague, indefinite or
uncertain, the doctrine recognizes that different situations require
different levels of specificity. A regulation need not be more specific
than is possible under the circumstances. People v. Izzo, 195 Ill. 2d 109, 114 (2001).
	Section 26(b) of the Medical Practice Act, the provision
challenged by Vuagniaux as vague, pertains to physicians. "Board
certification" is a standard and widely used term in the practice of
medicine. For a physician to be "board certified" is commonly
understood to mean that he has passed an examination administered
by a medical specialty board, has fulfilled all requirements of that
board for certification as a specialist, and has been certified by the
board as a specialist. See 1 Schmidt, Attorneys' Dictionary of
Medicine 12 (Cum. Supp. 2002). Section 26(b)'s use of the word
"appropriate" in connection with "board certification" doe not add any
ambiguity to the term. Section 26(b) pertains to advertising of the
physician's area of specialization. When the statute says that a
physician may include "appropriate board certification" in his ads, it
means simply that he may make mention of whatever board
certification he has received that is relevant to the particular area of
specialization he is advertising.
	The Medical Practice Act governs different types of physicians
engaged in a spectrum of specialties whose standards are administered
by a variety of different medical boards. The statute's generic
reference to board certifications without specifying each particular
board or each particular type of certification is a reflection of this
situation. Enumeration of every possible board certification would be
cumbersome. It could also prove unduly restrictive, preventing
doctors in new or emerging specialties from advertising legitimate
board certifications that had not yet made it onto the officially
prescribed list.
	We note, moreover, that there is nothing to indicate that the
present statutory and regulatory scheme is proving difficult to follow
or administer. To our knowledge, the only physician to have run afoul
of the advertising provision on "board certification" is Vuagniaux.
Considering that the "brain stem specialist" certification Vuagniaux
claimed in his ads was not bestowed by any medical board, but came
instead from the educational institution where Vuagniaux learned the
technique, it is difficult for us to see how he could reasonably have
been misled into the thinking that his certification qualified as an
"appropriate board certification" under the statute. A definitive
answer as to whether the provision was vague as applied to him must,
of course, await the new proceedings following remand. At this point,
however, it is clear that Vuagniaux cannot meet his burden of showing
that the statute is void for vagueness on its face.
	The circuit court's judgment presents two additional questions
whose resolution remains necessary in light of our decision to remand
for further proceedings. The first concerns disposition of a motion to
dismiss filed by Vuagniaux during the disciplinary action. The circuit
court concluded that counts II and III of the Department's complaint
were insufficient as a matter of law and that Vuagniaux's motion for
judgment on the pleadings or to dismiss should have been granted at
the administrative level because those counts "did not set forth facts
informing [Vuagniaux] wherein his ads violated the applicable law."
	We cannot sustain that ruling. Administrative complaints are not
required to state the charges with the same precision, refinements, or
subtleties as pleadings in a judicial proceeding. Abrahamson v. Illinois
Department of Professional Regulation, 153 Ill. 2d 76, 93 (1992).
Section 10-25(a)(4) of the Illinois Administrative Procedure Act (5
ILCS 100/10-25(a)(4) (West 1998)), which is adopted by and
incorporated into the Medical Practice Act (225 ILCS 60/47 (West
1998)), provides that "[e]xcept where a more detailed statement is
otherwise provided for by law," the notice served on a party in a
contested case shall include "a short and plain statement of the matters
asserted, the consequences of a failure to respond, and the official file
or other reference number." 5 ILCS 100/10-25(a)(4) (West 1998).
No additional specificity is mandated by the Medical Practice Act
itself. It requires simply that the Department notify the accused doctor
in writing of the charges made and the time and place where the
hearing on the charges will be conducted, that it direct the doctor to
file his written answer to the charges under oath within a specified
time, and that it advise the doctor that if he fails to file such an
answer, a default will be taken against him and his license will be
subject to such disciplinary action as the Department may deem
proper. 225 ILCS 60/36 (West 1998).
	In applying these provisions, the courts have held that charges
filed before an administrative agency "need only be drawn sufficiently
so that the alleged wrongdoer is reasonably apprised of the case
against him to intelligently prepare his defense." See Siddiqui v.
Department of Professional Regulation, 307 Ill. App. 3d 753, 757
(1999). The complaint filed against Vuagniaux met that standard. It
specifically identified the allegedly improper advertisements, identified
where and when they were published, set forth the statutory
provisions they were alleged to have violated, and described why they
were claimed to be in violation of the law. These allegations provided
Vuagniaux with ample notice of the nature of the charges against him.
If Vuagniaux was in any way impaired in his ability to defend himself,
it is not apparent in the materials we have before us. The complaint is
therefore not subject to dismissal on the pleadings.
	The final aspect of the circuit court's judgment we must address
before the matter is remanded is its determination that the disciplinary
mechanism established by the Medical Practice Act violates
constitutional rights to due process and equal protection because it
subjects physicians who are chiropractors to discipline by physicians
who are not chiropractors. According to Vuagniaux, only
chiropractors should be permitted to stand in judgment of other
chiropractors. Because the Medical Practice Act calls for the
Disciplinary Board to include only one chiropractor among its seven
voting members (see 225 ILCS 60/7(A) (West 1998)), Vuagniaux
contends that the law is inherently flawed and that the Board, as
constituted under the law, should not be permitted to take disciplinary
action against him.
	In challenging the statutory composition of the Disciplinary
Board, Vuagniaux asserts no first amendment claims. The
infringement claimed is on his ability to pursue his profession, not his
freedom of speech. Legislation infringing on the right to pursue a
profession is examined under the rational basis test. Potts v. Illinois
Department of Registration &amp; Education, 128 Ill. 2d 322, 330 (1989).
	Rational basis review is limited and " 'highly deferential.'"
Arangold Corp. v. Zehnder, 204 Ill. 2d 142, 147 (2003), quoting
Committee for Educational Rights v. Edgar, 174 Ill. 2d 1, 33 (1996).
Under the rational basis test, a statute will be upheld if it bears a
rational relationship to a legitimate legislative purpose and is neither
arbitrary nor discriminatory. Potts v. Illinois Department of
Registration &amp; Education, 128 Ill. 2d  at 330.
	Vuagniaux assails the composition of the Disciplinary Board on
the grounds that it prevents chiropractors from being judged by their
peers and subjects them to discipline by doctors who do not
understand their work and are prejudiced against them. We disagree.
While chiropractors may once have been ostracized by certain
segments of the medical community, the Medical Practice Act treats
them as full and equal members of the medical profession. Under the
law, those holding the degree of doctor of chiropractic possess
precisely the same professional stature as those holding degrees as
doctors of medicine or doctors of osteopathy. All are regarded as
physicians. Although more of the physicians on the Disciplinary Board
are doctors of medicine, the record in this case indicates that the
apportionment of membership on the Disciplinary Board was intended
to reflect the relative number of each type of physician practicing in
the state. Medical doctors outnumber chiropractors on the Board
simply because medical doctors outnumber chiropractors in the
profession. It is a matter of proportional representation, not
antichiropractic prejudice.
	The physicians on the Disciplinary Board who are doctors of
medicine may not be conversant with the methods and practices
employed by physicians who are doctors of chiropractic. Likewise,
physicians who are chiropractors will not normally be knowledgeable
about the methods and practices employed by physicians who are
doctors of medicine. The law understands this, just as it understands
that practitioners in one speciality of medicine or chiropractic may
know little of the work of practitioners in another specialty. That is
why it does not restrict members of the Disciplinary Board to reliance
on their personal training and experience in judging fellow physicians.
Under the Medical Practice Act and the regulations enacted in
accordance with that Act, provision is made for full hearings in
contested cases where experts in the relevant field can testify, as they
were called to testify in this case. Through relevant expert testimony,
Board members can obtain the specialized knowledge needed to
assess a particular case, just as jurors are educated and guided by
expert testimony in complex civil and criminal matters.
	Under these circumstances, we believe that the legislature had a
rational basis for structuring the Disciplinary Board the way it did and
that the composition of the Board is neither arbitrary nor
discriminatory. While Vuagniaux asserts that the disciplinary system
would work better and achieve superior results if only medical doctors
could consider charges against medical doctors and only chiropractors
could consider charges against chiropractors, his arguments are purely
theoretical. They also present their own set of problems. For example,
if disciplinary action against a physician could only be conducted by
other physicians with his same training and background, as Vuagniaux
urges, one might be required to similarly conclude that specialists
within each of the basic physician groups could only be subject to
discipline by physicians who practiced the same specialty. If that were
so, numerous additional disciplinary boards would be necessary to
accommodate all the different specialties. Bureaucracy would
proliferate.
	Regardless of the relative merits of the system proposed by
Vuagniaux, however, such considerations are of no consequence in
evaluating the law in its present form. The legislature is presumed to
have investigated the question and ascertained what is best for the
good of the medical profession and for the good of the people among
whom medical professionals practice. Whether the course chosen by
the legislature is wise or whether it is the best means to achieve the
desired result is not a proper subject of judicial inquiry. It is for the
legislature, and not the courts, to balance the advantages and
disadvantages of the law's requirements. Potts v. Illinois Department
of Registration &amp; Education, 128 Ill. 2d  at 333.
	For the foregoing reasons, the judgment of the circuit court is
affirmed in part and reversed in part, and the cause is remanded to the
Department for further proceedings consistent with this opinion.
Affirmed in part and reversed in part;
cause remanded.
	CHIEF JUSTICE McMORROW, dissenting:
	Although neither party has raised the issue, this court has an
obligation to consider, sua sponte, its jurisdiction over the present
appeal. See, e.g., People v. Fuller, 187 Ill. 2d 1, 7 (1999). Because I
conclude that we do not have jurisdiction under Trent v. Winningham,
172 Ill. 2d 420 (1996), and Hearne v. Illinois State Board of
Education, 185 Ill. 2d 443 (1999), I respectfully dissent.
	In Trent, the plaintiff, Barbara Trent, sought retroactive child
support from the father of her child under section 14(b) of the Illinois
Parentage Act of 1984 (750 ILCS 45/14(b) (West 1992)). The trial
court denied Trent's claim for support, holding that she was not
entitled to the support, that the claim was time-barred and, in the
alternative, that section 14(b) was unconstitutional. Trent, 172 Ill. 2d 
at 422. Trent appealed to this court, asserting that a direct appeal was
appropriate under Supreme Court Rule 302(a) (134 Ill. 2d R. 302(a))
because section 14(b) had been held unconstitutional.
	This court did not reach the merits of Trent's claim for support.
Instead, after examining our jurisdiction sua sponte, we concluded
that the circuit court's constitutional ruling could not serve as a basis
for direct review under Rule 302(a) because the circuit court had also
denied the plaintiff relief on alternative, nonconstitutional grounds. In
so holding, we noted that when a judgment of the circuit court is
based upon a finding that legislation is unconstitutional, Rule 302(a)
mandates the parties to bypass the normal appellate process and
proceed directly to this court. We explained that this direct review
process becomes problematic when the judgment of the circuit court
contains alternative, nonconstitutional grounds, as this court is then
compelled to consider issues it might otherwise decline to address "in
deference to our appellate court where the issues would have been
reviewable as a matter of right." Trent, 172 Ill. 2d  at 426. We also
noted that when a circuit court holds legislation unconstitutional, the
stability of the legal system is undermined. We admonished courts
"not to compromise that stability in the first place by declaring
legislation unconstitutional when the particular case does not require
it," i.e., when alternative, nonconstitutional grounds can resolve the
case. Trent, 172 Ill. 2d  at 425.
	Because the circuit court in Trent had denied plaintiff relief on
two, nonconstitutional grounds, the constitutional holding was not
necessary for the resolution of the case. Based on the concerns noted
above, we concluded that Rule 302(a) jurisdiction was improper.
Trent, 172 Ill. 2d  at 426. We vacated the circuit court's order and
remanded the cause to the circuit court with instructions to enter a
new, modified order, without the holding that section 14(b) was
unconstitutional. Trent, 172 Ill. 2d  at 427.
	Our decision in Trent was reaffirmed in Hearne. In Hearne, a
Chicago school teacher who had been dismissed by the board of
education filed suit in the circuit court contesting his dismissal. Upon
administrative review, the circuit court set aside the dismissal, finding
that the weight of the evidence supported reinstatement. Hearne, 185 Ill. 2d  at 451. However, the court also held a portion of the Illinois
School Code unconstitutional and ordered the teacher reinstated on
this alternative basis as well. Hearne, 185 Ill. 2d  at 451-52. The
school board filed a motion to reconsider in which it argued that,
under Trent, the circuit court should not have reached the
constitutional claim. Hearne, 185 Ill. 2d  at 452. The circuit court
denied the motion, stating that it was appropriate to reach the
constitutional question in order to correct a "fundamentally unfair"
process created by the legislation and to relieve other courts from the
burden of having to interpret a "vague and ambiguous statute."
Hearne, 185 Ill. 2d  at 452. Based on the finding of unconstitutionality,
direct appeal was sought in this court under Rule 302(a).
	Applying our holding in Trent, we concluded that the circuit
court's constitutional ruling did not provide a proper basis for direct
review. We expressly rejected the circuit court's rationale for reaching
the constitutional issue, noting that the circuit court's constitutional
ruling granted the teacher "additional and alternative relief" which was
"not necessary to resolve plaintiff's claim for administrative review."
Hearne, 185 Ill. 2d  at 456. As in Trent, we remanded the cause to the
circuit court with instructions to vacate its order. We further
instructed the circuit court to reenter a modified order which excluded
the holding that a portion of the School Code was unconstitutional.
Hearne, 185 Ill. 2d  at 457. See also McLean v. Department of
Revenue, 184 Ill. 2d 341, 351 (1998) (the rationale of Trent did not
apply where the finding of statutory unconstitutionality was not an
alternative basis for granting or denying relief).
	The present case is controlled by Trent and Hearne. Here, the
circuit court granted complete relief to Vuagniaux on several
nonconstitutional grounds. The circuit court held that the decision of
the Department had to be set aside because, among other reasons, the
appointment of Dr. Pope to replace Dr. Cook on the Medical
Disciplinary Board was not authorized by the Medical Practice Act
(225 ILCS 60/7 (West 1998)), the Department's administrative
complaint was defective, and the Department had failed to prove its
case by clear and convincing evidence. However, the circuit court also
held, in the alternative, that the decision of the Department had to be
set aside because sections 22(A)(13) and (A)(26) of the Medical
Practice Act (225 ILCS 60/22(A)(13), (A)(26) (West 1998)) were
unconstitutionally vague and violated Vuagniaux's right to engage in
"free commercial and educational speech," and because section 7 of
the Medical Practice Act (225 ILCS 60/7 (West 1998)), which sets
forth the composition of the Medical Disciplinary Board, violated
Vuagniaux's rights to due process and equal protection.
	As in Hearne, the circuit court in this case granted Vuagniaux
"alternative relief" (Hearne, 185 Ill. 2d at 456) based on its holdings
that provisions of the Medical Practice Act were unconstitutional,
even though none of these holdings were necessary for the circuit
court's disposition of the case. Accordingly, under Hearne and Trent,
the proper resolution of this case is to vacate the circuit court's order
and to remand the cause to the circuit court with instructions to enter
a new order which excludes the holdings of unconstitutionality. See
Hearne, 185 Ill. 2d  at 457; Trent, 172 Ill. 2d  at 427.
	I believe that Hearne and Trent are relevant to the present case.
Because the majority does not acknowledge either decision or explain
why the principles set forth in those decisions are inapplicable, I
respectfully dissent.