Opinion ID: 2633430
Heading Depth: 3
Heading Rank: 3

Heading: The Strength of the Public Interest in Professional Discipline

Text: The third prong of Mathews, the public interest in professional discipline, including the government's added fiscal and administrative burdens in having a heightened standard of proof in professional disciplinary hearings, is critical here. Under the plain reading of Mathews, the cost to the government is only one component of the government's interest. See, e.g., Morris v. Blaker, 118 Wash.2d 133, 145, 821 P.2d 482 (1992) (noting the government's interest in being able to quickly remove dangerous weapons from those who present a danger to the public weighs against a prerevocation notice and hearing procedure); In re Harris, 98 Wash.2d 276, 286, 654 P.2d 109 (1982) (under Mathews balancing test, because State's interest in statutory summons procedure was not emergent, due process requires a finding of probable dangerousness before a summons may issue). The Mathews Court itself said, Financial cost alone is not a controlling weight in determining whether due process requires a particular procedural safeguard prior to some administrative decision. Mathews, 424 U.S. at 348, 96 S.Ct. 893. The United States Supreme Court demonstrated how the balance is to be drawn: The individual should not be asked to share equally with society the risk of error when the possible injury to the individual is significantly greater than any possible harm to the state. Addington, 441 U.S. at 427, 99 S.Ct. 1804. Santosky, in evaluating the third prong of the Mathews test, is particularly illustrative of the use of factors other than just fiscal and administrative costs: Two state interests are at stake in parental rights termination proceedingsa parens patriae interest in preserving and promoting the welfare of the child and a fiscal and administrative interest in reducing the cost and burden of such proceedings. Santosky, 455 U.S. at 766, 102 S.Ct. 1388. The public interest in professional discipline encompasses both the government's interest in efficiently processing professional disciplinary complaints and the public's interest in competent, honest health care practitioners. In Washington, the latter interest weighs heavily against a heightened standard of proof in medical discipline cases. Washington law on health care professional discipline indicates a strong remedial policy to protect the public from incompetent or unscrupulous practitioners. This remedial policy emanates from the constitutional authority of the Legislature over the practice of medicine. Article XX, section 2 of our state constitution provides: The legislature shall enact laws to regulate the practice of medicine and surgery, and the sale of drugs and medicines. See also Seeley v. State, 132 Wash.2d 776, 789, 940 P.2d 604 (1997). We have held the legislative power over the practice of the healing arts is virtually plenary. In Ellestad v. Swayze, 15 Wash.2d 281, 291, 130 P.2d 349 (1942), we stated: The authorities are uniform to the effect that the legislature may adopt such regulations and restrictions of the healing arts as it may consider necessary for the public good, and the courts will not question the wisdom or desirability of such legislative requirements, so long as there is any reasonable basis upon which the legislative determination can rest. See also State v. Wilson, 11 Wash.App. 916, 528 P.2d 279 (1974). The use of the phrase any reasonable basis is indicative of our early determination to apply only the most relaxed standard of review to legislative enactments with respect to the practice of medicine. We have also noted the significance of the public's interest in the regulation of the medical profession: The daily practice of medicine concerns life and death consequences to members of the public. They have an understandable interest in the maintenance of sound standards of conduct by medical practitioners. The public has a right to expect the highest degree of trustworthiness of the members of the medical profession. Kindschi, 52 Wash.2d at 12, 319 P.2d 824. To carry out the constitutional mandate to regulate the practice of medicine and surgery, the Legislature created the Commission, the purpose of which is set forth in detail in RCW 18.71.003: (1) In the exercise of the police power of the state to protect public health, to promote the welfare of the state, and to provide an adequate public agency to act as a disciplinary body for the members of the medical profession licensed to practice medicine and surgery in this state; (2) Because the health and well-being of the people of this state are of paramount importance; (3) Because the conduct of the members of the medical profession licensed to practice medicine and surgery in this state plays a vital role in preserving the health and well-being of the people of the state; and (4) Because the agency which now exists to handle disciplinary proceedings for members of the medical profession licensed to practice medicine and surgery in this state is ineffective and very infrequently employed, and consequently there is no effective means of handling such disciplinary proceedings when they are necessary for the protection of the public health. The Legislature articulated a similar concern about protection of the public when it enacted the Act. RCW 18.130.010 indicates the purpose of the Act is to assure the public of the adequacy of professional competence and conduct in the healing arts. We have also expressed similar purposes for professional discipline. In Haley, 117 Wash.2d at 727, 818 P.2d 1062, we stated: The Legislature enacted the Medical Disciplinary Board Act (Act), the statute creating the Board, in 1955. RCW 18.72. The Act was passed in the exercise of the State's police power to promote the public welfare and to create an administrative agency mandated to act as a disciplinary body for medical professionals. RCW 18.72.010(1). The Act also provides that it was passed because of the paramount importance of the health and well-being of Washington citizens, the role of medical professionals in preserving this health and well-being, and the ineffectiveness of the disciplinary agency that had existed previously. RCW 18.72.010(2)-(4). We interpret the stated purposes of the Act as giving the Board a legislative mandate to pursue vigorously its disciplinary task. (Emphasis added.) See also Heinmiller, 127 Wash.2d at 602-03, 903 P.2d 433 (The goal of the Uniform Disciplinary Act, of which RCW 18.130.180 is a part, is to protect the public from the hazards of health care professional incompetence and misconduct.). Plainly, the central focus of professional discipline in health care is to protect the public and ensure that only competent practitioners provide health care: The power of the State to provide for the general welfare of its people authorizes it to prescribe all such regulations as, in its judgment, will secure or tend to secure them against the consequences of ignorance and incapacity as well as of deception and fraud. As one means to this end it has been the practice of different States, from time immemorial, to exact in many pursuits a certain degree of skill and learning upon which the community may confidently rely.... Dent, 129 U.S. at 122, 9 S.Ct. 231. The sine qua non of professional licensure and discipline is protection of the public employing professional services. Gandhi v. State Med. Examining Bd., 168 Wis.2d 299, 483 N.W.2d 295, 305 (1992). The wrongdoing of a physician can be threatening to life and limb. As the United States Supreme Court noted: We recognize that the States have a compelling interest in the practice of professions within their boundaries, and that as part of their power to protect the public health, safety, and other valid interests they have broad power to establish standards for licensing practitioners and regulating the practice of professions. Goldfarb v. Va. State Bar, 421 U.S. 773, 792, 95 S.Ct. 2004, 44 L.Ed.2d 572 (1975) (emphasis added). The people of Washington certainly have a compelling interest in disciplining doctors who fail to meet standards of professional competence, who misprescribe medications, and who sexually abuse their patients. The State's interest in regulating the practice of medicine and protecting the public from incompetent or unscrupulous practitioners is of vital significance to the State and its citizens. In conclusion, examining and balancing the three Mathews factors for due process, we cannot say the Legislature in its plenary authority over medical discipline violated Dr. Nguyen's right to due process by authorizing the Commission to utilize a preponderance of the evidence burden of proof. Under Mathews, a professional license is a significant property interest with overtones of a liberty interest where the professional's reputation is at stake, but the risk of an erroneous deprivation of such an interest in the Commission context is limited given the procedures afforded a physician before discipline may occur. The paramount interest in professional discipline, however, is the public interest in competent health care practitioners. Due process principles do not compel the clear, cogent, and convincing standard of proof in health care professional discipline cases under the APA. [10]