Opinion ID: 1749734
Heading Depth: 1
Heading Rank: 1

Heading: was the delegation of legislative authority to the medical examining board invalid?

Text: In this review, we are concerned with the Board's power to revoke a physician's license to practice medicine in the state of Wisconsin, for violation of the standards of conduct set out in sec. 448.18(1)(g), Stats., and sec. Med. 16.02(1)(g), Wis. Admin. Code. Section 448.03(1), provides that one must possess such a license to practice medicine in order to represent himself or herself as a doctor. The relevant portion of sec. 448.18, entitled Revocation, reads as follows: (1) `Immoral or unprofessional conduct' as used in this section mean: ... (g) engaging in conduct unbecoming a person licensed to practice or detrimental to the best interests of the public. Section Med. 16.02, Wis. Admin. Code, reads as follows: (1) The terms `practices that are inimical to the public health,' `conduct unbecoming a person licensed to practice or detrimental to the best interest of the public,' `unprofessional conduct,' and `unprofessional acts' are defined to mean and include but not be limited to the following, or aiding or abetting the same: ... (g) Any practice or conduct under license or certificate granted by the examining board which tends to constitute a danger to the health, welfare, or safety of the patient or public. . . . At the court of appeals level, Gilbert argued that while the term unprofessional conduct has been held to be sufficiently definite to meet constitutional standards because of recent case law construing the term, there was no evidence in the record to support the Board's finding that Gilbert had indeed engaged in unprofessional conduct. However, apparently in response to the court of appeals decision that both the statute and regulation are invalid as unreasonable, Gilbert has now argued that the palpable ambiguity of the regulatory and statutory language rendered it so subject to the wildest misinterpretation ... that they violated the rule of reason limiting the delegation of legislative authority to administrative bodies. It appears that Gilbert has taken the position that the statute empowers the Medical Examining Board to exercise essentially standardless discretion is disciplining physicians. This involves a challenge to the standard set out in the statute, similar to the attack in Westring v. James, 71 Wis. 2d 462, 467, 238 N.W.2d 695 (1976). Gilbert's challenge centers around the delegation of legislative power to the Medical Examining Boardthat the statutory delegation is not circumscribed with a definite standard that characterizes the legislative duties to be exercised by the Board. Article IV, sec. 1 of the Wisconsin Constitution provides that, The legislative power shall be vested in a senate and assembly. Taken literally, this provision would bar any delegation of legislative power to administrative agencies. However, this court has long recognized that the delegation of the power to make rules and effectively administer a given policy is a necessary ingredient of an efficiently functioning government. See, In Matter of Guardianship of Klisurich, 98 Wis. 2d 274, 279-80, 296 N.W.2d 742 (1980); Schmidt v. Local Affairs & Development Dept., 39 Wis. 2d 46, 58, 158 N.W.2d 306 (1968); and State ex rel. Wis. Inspection Bureau v. Whitman, 196 Wis. 472, 505-06, 220 N.W. 929 (1928). Originally, this court focused upon the nature of the power delegated. The power to declare whether or not there shall be a law; to determine the general purpose or policy to be achieved by the law; to fix the limits within which the law shall operate,is a power which is vested by our constitutions in the legislature and may not be delegated. When, however, the legislature has laid down these fundamentals of a law, it may delegate to administrative agencies the authority to exercise such legislative power as is necessary to carry into effect the general legislative purpose, in the language of Chief Justice Marshall `to fill up the details;' in the language of Chief Justice Taft `to make public regulations interpreting the statute and directing the details of its execution.' It is legislative power of the latter kind which is oftentimes called the rule-making power of boards, bureaus, and commissions. It only leads to confusion and error to say that the power to fill up the details and promulgate rules and regulations is not legislative power. State ex rel. Wis. Inspection Bureau v. Whitman, 196 Wis. at 505-06. Since 1928, however, the doctrine of the delegation of legislative power has shifted the focus away from the nature of the power delegated through scrutiny of the delegating standard's language and more toward the safeguards surrounding the delegated power. Professor Davis, in discussing the doctrine of delegation to administrative agencies, has suggested the following: The focus should not be exclusively on standards; it should be on the totality of protections against arbitrariness, including both safeguards and standards. He concludes that the judiciary should shift its focus away from the requirement of meaningful statutory standards and should instead require protections against unnecessary and uncontrolled discretionary power by the agency. See, 1 Davis, Administrative Law Treatise, sec. 3:15 at 206-07 (2d ed. 1978). This court has recognized this shift toward the requirement of adequate procedural safeguards. In Schmidt v. Local Affairs & Development Department, 39 Wis. 2d 46, this court observed that it may take a more liberal attitude toward delegations of legislative authority to an administrative agency than it may toward delegations to the judiciary. The Schmidt court utilized the following reasons to explain this more liberal approach: The legislative [sic] agency or director is, in fact, an arm or agent of the legislature itself. The very existence of the administrative agency or director is dependent upon the will of the legislature; its or his powers, duties and scope of authority are fixed and circumscribed by the legislature and subject to legislative change.... An administrative agency is subject to more rigid control by the legislature and judicial review of its legislative authority and the manner in which that authority is exercised. Id. at 56-57. The Schmidt court concluded that the existence of safeguards is an appropriate consideration when addressing a question of legislative delegation. Id. at 57, citing State ex rel. Wis. Inspection Bureau v. Whitman, 196 Wis. at 507-08. Subsequently, in Westring v. James, 71 Wis. 2d 462, this court utilized the following language concerning statutes which delegate legislative power to administrative agencies: `A delegation of legislative power to a subordinate agency will be upheld if the purpose of the delegating statute is ascertainable and there are procedural safeguards to insure that the board or agency acts within that legislative purpose.' Id. at 468, citing Watchmaking Examining Bd. v. Husar, 49 Wis. 2d 526, 536, 182 N.W.2d 257 (1971). Therefore, consistent with this evolution of the delegation of legislative power, we will first turn our attention to the purpose behind the delegating statutes. The statute which delegates general power to the Medical Examining Board is sec. 15.08, Stats. 1973, entitled Examining boards. The pertinent section provides, (5) GENERAL POWERS. Each examining board may compel the attendance of witnesses, administer oaths, take testimony and receive proof concerning all matters within its jurisdiction. It shall formulate rules for its own guidance and for the guidance of the trade or profession to which it pertains, and define and enforce professional conduct and unethical practices not inconsistent with the law relating to the particular trade or profession. The Board's powers are set out more specifically in ch. 448, which deals with the licensing of physicians and contains the above-quoted standard for the revocation of licenses in sec. 448.18(1)(g). Section 448.02, 1975 deals with the Board's authority to grant licenses, and sec. 448.05, 1975, dealing with qualifications for licensure, contains the following language: (1) GENERAL REQUIREMENTS. To be qualified for the grant of any license or certificate by the board, an applicant must: (a) Supply evidence satisfactory to the board that the applicant is of good professional character. (b) Meet the specific requirements as set out in this section for that class of license or certificate for which applying. (c) Achieve a passing grade in the examinations required in this section. (d) Be found qualified by three-fourths of the members of the board, except that an applicant for a temporary license under s. 448.04(1) (b) 1 and 3, (d) and (e) must be found qualified by 2 officers of the board. [5] This court has acknowledged that the purpose of licensing statutes is not to benefit those persons licensed to practice under the statutes, but rather to protect the public by the requirement of a license as a condition precedent to practicing in a given profession. The granting of a license pursuant to such a statute has been characterized as a privilege. Strigenz v. Department of Regulation, 103 Wis. 2d 281, 286, 307 N.W.2d 664 (1981). Such statutes are grounded in the state's police power to protect the public welfare through safeguarding the life, health, and property of its citizens. State ex rel. Wis. R. Bd. of A. & P.E. v. T.V. Eng., 30 Wis. 2d 434, 438-39, 141 N.W.2d 235 (1966). Occupational licensing requirements follow a legislative determination that the public's health and safety require protection from incompetent practitioners. Laufenberg v. Cosmetology Examining Board, 87 Wis. 2d 175, 184, 274 N.W.2d 618 (1979), citing Watchmaking Examining Bd. v. Husar, 49 Wis. 2d at 533. See also, State ex rel. Green v. Clark, 235 Wis. 628, 631, 294 N.W. 25 (1940). As this court noted in Strigenz, 103 Wis. 2d at 287, which dealt with licensing of dentists, When the professional license is issued to a dentist, the state assures the public of the competence of that person. As long as that person holds the dentistry license, the state of Wisconsin continues to assure the public of his or her competence as a dentist. The state does not rank nor rate the competence of the dentist but at the very least, the state does assure the public that the licensed dentist is competent to perform at a minimal standard as determined by others in the profession. The purpose behind the delegating statutes, generally sec. 15.08(5) and, more specifically, ch. 448, is readily discernible. The purpose is to protect the public by insuring that those licensed to practice medicine in the State of Wisconsin are competent to do so under standards which have become accepted in the profession. This is apparent from the qualifications set forth in sec. 448.05, which must be met before the Board grants such a license. The purpose behind sec. 448.18(1) (g), addressing the grounds for revocation by the Board, is also readily discernible. Unprofessional conduct is clearly defined as detrimental to the best interests of the public. It is obvious that detrimental to the best interests of the public refers to the fact that the physician found to be engaging in unprofessional conduct no longer meets the purpose behind the requirement of licensing. In other words, the Board can no longer assure the public that based upon its findings, the holder of the license is competent to practice medicine. Consequently, revocation of the privilege to practice medicine is the remedy permitted the Board. We acknowledge that this is a broad grant of legislative power, since by its terms the Board is authorized to define and enforce professional conduct and unethical practices not inconsistent with the law concerning the practice of medicine. Section 15.08, Stats. See also, sec. 448.40, which empowers the Board to adopt rules under ch. 227 in order to effectuate the purpose of ch. 448. Defining and enforcing professional conduct necessarily entails disciplining those who do not meet these standards. This court, however, has emphasized that broad grants of legislative powers will be permitted where there are procedural and judicial safeguards against arbitrary, unreasonable or oppressive conduct of the agency. State (Dept. of Admin.) v. ILHR Dept., 77 Wis. 2d 126, 135, 252 N.W.2d 353 (1977). Therefore, we must now direct our attention to the procedural and judicial safeguards surrounding this grant of power to the Medical Examining Board. We note that under sec. 448.02(3), Stats. 1975, the Board is empowered to investigate allegations of unprofessional conduct. This statute is hedged about with procedural safeguards. Westring v. James, 71 Wis. 2d at 468. Initially, there are intrinsic safeguards within the procedure the Board itself must follow upon receiving an allegation of unprofessional conduct. The Board must first investigate the allegation and, upon a finding of probable cause to believe that a person is guilty of such conduct, conduct a hearing before the Board prior to any action which may be taken concerning reprimand, suspension, etc. Thus, due process requirements are met. See, Withrow v. Larkin, 421 US 35 (1975). Further, the Board is empowered to adopt rules concerning the procedures it will follow for such investigations and hearings pursuant to ch. 227, Stats. This court has already noted that a delegation of rule-making authority which is attended by the safeguards under ch. 227, Stats., requiring public hearings and the opportunity for the challenge of its rules in court, is a sufficient procedural safeguard. State v. ILHR Dept., 77 Wis. 2d at 135. Further, we find that sec. 448.09(2), Stats. 1975, provides that a party aggrieved by any Board action taken under ch. 448 may apply for judicial review as provided for in ch. 227. We cannot imagine any more stringent judicial safeguard against the exercise of arbitrary, unreasonable or oppressive conduct by the Board than such a provision allowing judicial review. Consequently, we find that the legislature has adequately stated the purpose of ch. 448 and sec. 15.08(5) and that the legislature's delegation of power is valid, because of the procedural safeguards and opportunity for court review as set forth in the chapter. We also note that even under the earlier practice of focusing upon the language of the standard set forth in the statute, this court has approved similar statutes providing for the discipline of professionals. In Strigenz v. Department of Regulation, 103 Wis. 2d 281, this court addressed the authority of the Dentistry Examining Board as set forth under sec. 447.07(3), Stats. Section 447.07(5) allowed the Board to investigate and conduct hearings in response to allegations of conduct unbecoming a professional person. This court held that such language referred to the fact that a dentist must perform professionally in a minimally competent manner for his conduct to be becoming a professional person. Id. at 287. The court reached this conclusion by observing that because of the very nature of a licensing statute, it is not necessary to specifically enunciate in a written rule that a professional must practice in a minimally competent manner. Id. at 286-87. This court, therefore, concluded that it was unnecessary that the Dental Examining Board utilize its statutory rule-making powers to promulgate further rules interpreting this statutory term of conduct unbecoming a professional person. Id. at 285-86. See also, secs. 15.08(5) (b), 227.014, and 447.07, Stats. 1981-82. We also approved a similar standard in Vivian v. Examining Board of Architects, 61 Wis. 2d 627, 642, 213 N.W.2d 359 (1974), finding that misconduct is synonymous with unprofessional conduct and denotes conduct which through professional experience has become the standard of the profession. In the instant case, the Medical Examining Board has promulgated a rule further interpreting the terms unprofessional conduct and detrimental to the public interest as utilized in sec. 448.18(1) (g), Stats. This was set forth above in sec. Med. 16.02(1)(g), Wis. Admin. Code. [6] The Board has further interpreted these terms to mean conduct which tends to pose a danger to the health, welfare, or safety of the patient.... Section Med. 16.02(1)(g), Wis. Admin. Code. Both the terms danger as utilized in the regulation and detrimental as utilized in the statute are derived from the standard of minimal competence which arises from the very nature of a licensing requirement. We may take judicial notice of the fact that many medical procedures involve associated risks and negative results. Therefore, we disagree with the court of appeals' conclusion that each time a doctor undertakes to prescribe a treatment, he or she is guilty of conduct which tends to pose a danger to the health of the patient. This is because even though such risks and negative results are inherent in the nature of the practice of medicine, professionals within the field are aware of and accept these risks. See, sec. 448.30, Stats. 1981-82, which requires that a physician treating a patient must inform the patient of the availability of alternative methods of treatment and the benefits or risks of such alternative methods. The terms danger and detrimental refer to those risks and negative results which are unacceptable to other physicians and, therefore, demonstrate incompetence when measured against the standards which have become established in the medical profession. [7] Accordingly, we hold that the standard utilized by the legislature in sec. 448.18(1) (g), Stats., and further interpreted by the Board in sec. Med. 16.02(1) (g), Wis. Admin. Code, provides a standard for revocation sufficiently definite so that physicians should have no difficulty providing a standard of care which meets the requirement of professional conduct.