Court Opinion

ID: 9700845
Source: CourtListenerOpinion
Date Created: 2023-08-25 21:51:07.719962+00
Date Added: 2024-06-11T18:21:15.181491
License: Public Domain

*544Dissenting Opinion by
Judge Mencer:
I respectfully dissent. In Gambone v. Commonwealth, 375 Pa. 547, 550-52, 101 A.2d 634, 636-37 (1954), former Chief Justice Stern succinctly stated:
Probably the most important function of government is the exercise of the police power for the purpose of preserving the public health, safety and morals, and it is true that, to accomplish that purpose, the legislature may limit the enjoyment of personal liberty and property. It is also true, as stated in Commonwealth v. Zasloff, 338 Pa. 457, 460, 13 A.2d 67, 69, that the police power has been juridically extended to many fields of social and economic welfare. But, as likewise there stated, the power is not unrestricted; its exercise, like that of all other governmental powers, is subject to eonstitutional limitations and judicial review. By a host of authorities, Federal and State alike, it has been held that a law which purports to be an exercise of the police power must not be unreasonable, unduly oppressive or patently beyond the necessities of the case, and the means which it employs must have a real and substantial relation to the objects sought to be attained. Under the guise ’of protecting the public interests the legislature may not arbitrarily interfere with private business or impose unusual and unnecessary restrictions upon lawful occupations. The question whether any particular statutory provision is so related to the public good and so reasonable in the means it prescribes as to justify the exercise of the police power, is one for the judgment, in the first instance, of the law-making branch of the government, but its final determination is for the courts. (Footnotes omitted.)
*545Testing the provision of the Health Care Services Malpractice Act (Act) here in question1 which requires, inter alia, a physician to insure his professional liability or provide proof of self-insurance, I cannot but conclude that such a requirement, in view of the proclaimed purposes of the Act, is unreasonable and arbitrary and bears no rational relation to public health, safety, morals, or welfare.
Unquestionably, the right to pursue the occupation of one’s own choosing may not be curtailed without due process of law. The interest in a profession, being akin to a proper [ty] right, may not be removed arbitrarily.
Pirillo v. Takiff, 462 Pa. 511, 521, 341 A.2d 896, 900 (1975), reinstated, 466 Pa. 187, 352 A.2d 11 (1976), cert. denied, 423 U.S. 1083 (1976).
If the Legislature meant what it said about the purposes of the Act, and if the anticipated results were in fact more insurance at less cost, then, indeed, compulsory insurance was an unnecessary restriction upon the practice of medicine.
Section 102 of the Act, 40 P.S. §1301.102, sets forth the purposes to be attained by the Act:
It is the purpose of this act to make available professional liability insurance at a reasonable cost, and to establish a system through which a person who has sustained injury or death as a result of tort or breach of contract by a health care provider can obtain a prompt determination and adjudication of his claim and *546the determination of fair and reasonable compensation.
The requirement that those health care providers covered by the Act carry private malpractice insurance or be self-insured under regulations adopted by the Insurance Commissioner has no legislative relationship to the purpose section of the Act. Nowhere is there a legislative finding that judgments against health care providers had been going unsatisfied, or that valid suits had not been brought because the defendants had neither insurance coverage nor sufficient assets. I agree with the following portions of the amicus curiae brief filed by The Keystone Podiatry Society of Pennsylvania:
Contradictorily, the Legislature requires every health care provider to obtain a liability insurance policy while it specifically recognizes that such insurance is so expensive and so difficult or impossible to obtain that the Act itself is necessary.
Quite simply, the objectives to be met are stated unequivocally in Section 102 of the Act. The Legislature meant to create a stable insurance market with reasonable rates so that health care providers could obtain insurance coverage at an affordable price. The Legislature also meant to hasten and simplify the adjudicatory process of medical malpractice claims, and to strengthen the regulatory effectiveness of the appropriate Boards.
The Statutory Construction Act of 1972, Act of December 6, 1972, P.L. 1339, No. 290, 1 Pa. C.S. §1501 et seq., is clear on how legislative intent is to be determined. Section 1924 thereof provides in pertinent part: ‘The title and preamble of a statute may be considered in the construction thereof.’ (Preambles are now usu*547ally placed in a ‘policy’ or ‘purpose’ section such as Section 102 of the Act.)
Furthermore, Section 1921(b) thereof states, ‘When the words of a statute are clear and free from all ambiguity, the letter of it is not to be disregarded under the pretext of pursuing its spirit.’ (Emphasis added.) A strong choice of words indeed from one governmental branch to another!
Then, in the very next subsection, the Legislature gave its imprimatur to judicial pursuits of legislative spirit only ‘[w]hen the words of a statute are not explicit. . . .’ (Emphasis added.) Section 1921(c) continues with a list of matters which may not be considered if the words of the statute are clear and free from all ambiguity.
A careful reading of Section 102 of the Act, which is clear, unambiguous, and explicit, reveals that there is no discernable intent on the part of the Legislature to deal with any problem which compulsory insurance could remedy. The problem was getting the insurance, not not getting it. . . .
In summary, the compulsory insurance requirement of Section 701(a) bears no reasonable relationship to the objectives sought to be attained by the Malpractice Act.
In other words, it was not necessary to guarantee the insurance companies a market for their product in order to keep them in Pennsylvania. The companies did not need, nor were they interested in, such a boon. In fact they were not interested in the Pennsylvania mar*548ket at all. The tash was to get them to stay despite their belief that the risk was no longer insurable.
Given this state of affairs, it is obvious that it would serve no useful purpose to try to persuade insurance companies to stay in Pennsylvania by guaranteeing them customers — most companies wanted no part of the market in any event. Health care providers just would not be willing to pay high enough premiums to justify the risk.
Again, would compulsory insurance have halted the exodus of insurers? Plainly, no. The following descriptions of the situation facing the Legislature in 1975 condemns the requirement as a superfluity:
‘It was clear both to doctors’ representatives and to insurance carriers that the recent history of claim payments would compel any prudent insurer to insist upon very large premium increases. Probably it was also foreseen that any increase that the carriers would consider as even minimally adequate would be unacceptable to the doctors. But whatever the anticipation, medical spokesmen wasted little time haggling over the details of premiums and proceeded directly to the heart of the matter, the liability rules responsible for the insurers’ losses.
‘Legislators soon found that under existing liability rules there was no chance of finding premium rates acceptable to both doctors and insurers. A legislature had to choose between a protracted struggle with doctors and insurance companies to keep *549health care available, under continuing threat of job actions by doctors and withdrawal of malpractice coverage by the insurers, and changing the legal arrangements governing malpractice litigation.’ Reder, ‘Medical Malpractice: An Economist’s View,’ Amer. Bar Foun. Res. J. 511, 515 (1976) (Emphasis added).
‘It was clear that the problem involved more than the charging of exorbitant rates to produce excessive profits. If the medical malpractice insurance business were a profit-making one, companies would be entering, rather than abandoning, the field. Pennsylvania’s legislature was not alone in its consideration of why malpractice insurance, unlike other types, is not a profitable business.
‘The answer to this question is that medical malpractice was an uninsurable risk with which private companies had become unable to deal. The legislature, thus, faced the task of either coping with the risk as such or attempting to make it an insurable one.’ Note, ‘Medical Malpractice — A Question of Insurability,’ [80 Dick. L.R. 594, 595 (1976)].
A cursory glance of the Act’s Table of Contents reveals that the Legislature made the risk an insurable one by means of fundamental changes in malpractice litigation and by limiting an individual insurer’s liability.
So, one must conclude that the Legislature either misconceived the problem (it didn’t), or simply overkilled it. The latter in fact occurred —coercion (compulsory insurance) backed by *550a threat (suspension or revocation of license in Section 701(f)) was utilized when only economic persuasion and changes in litigation methods were necessary.
This of course is not a phenomenon of democracy, but only a natural and quite unwitting violation by a harried body of individuals •anxiously seeking to remedy one of many problems.
Nevertheless, ‘a governmental purpose to control or prevent activities constitutionally subject to state regulation may not be achieved by means which sweep unnecessarily broadly and thereby invade the area of protected freedoms.’ NAACP v. Alabama, 377 U.S. 288, 307 (1969). (Emphasis in original.)
We need to keep in mind that protection to patients who may be harmed as a result of medical malpractice is not the problem this kind of legislation is intended to solve. Likewise, we need to ask ourselves just how a scarce commodity (malpractice insurance) is to be rendered any less scarce by requiring every eligible party to buy it. See McGuffey v. Hall, 557 S.W. 2d 401 (Ky. 1977). In McGuffey, in an opinion reaching a conclusion that a Kentucky statute similar to the one here under consideration was constitutionally defective, we find the following-language which is pertinent to testing the constitutionality of our Act by the principles of constitutional law enunciated, at the outset of this opinion, by former Chief Justice Stern:
§1 of the Act states in substance that its purpose is to promote the health and general welfare of the general citizenry through adopting reforms in medical malpractice claims, establishing the Fund so as to increase the availability and lower the cost of medical malprac*551tice insurance, and assuring that medical malpractice judgments and settlements will be satisfied. Conceding, therefore, that the payment of malpractice claims is within the stated purposes of the Act, still it does hot appear to have any reasonable relationship to the problem stated in the preamble or to any other problem or threatened problem shown to exist. Is there, for example, any problem or threatened problem in the form of unsatisfied claims against doctors and hospitals? Not to our knowledge. If not, and especially when the legislature has not suggested that there is, must its existence be presumed from the bare circumstance that the legislature has acted on the subject? We do not think so. The police power does have limits.
‘It is fundamental that such [an] extraordinary power is not without limitation, for it may not operate unreasonably beyond the occasion or necessity of the ease. It may not unreasonably invade private rights and thus violate those rights guaranteed under either the Federal or the State Constitution. . . . The exercise of the power must have a substantial basis and cannot be made a mere pretext for actions that do not come within its scope. To state it another way, the action of the government may not arbitrarily invade liberty or property rights under the guise of police regulation.’ Bond Bros. v. Louisville & Jefferson County Met. S. Dist., 307 Ky. 689, 211 S.W. 2d 867, 872 (1948).
‘It is true that legislative bodies possess what the opinions designate as “the primary authority” to determine whether or not the particular enactment is justified under authority conferred by the Police Power. Therefore, *552when the law-making department has so determined the rule is, that the courts should hesitate to declare otherwise.
‘But the power of the courts to so declare is not thereby denied or taken away. In determining such questions judicial knowledge may be consulted and relied on, and if from that knowledge, or any other source, it appears that the grounds upon which the legislature based its action are arbitrary and unfounded in fact it is not only the right but the duty of courts to say so and declare the consequences.’ City of Louisville v. Kuhn, 284 Ky. 684, 145 S.W. 2d 851, 854 (1940).
‘The rule is that, in order to sustain legislative interference with the business of the citizen, by virtue of the police power, the act or ordinance must have some reasonable relation to the subjects included in such power. If it is claimed that the statute or ordinance is referable to the police power, the court must be able to see that it tends in some degree towards the prevention of offenses, or the preservation of the public health, morals, safety, or welfare.
It must be apparent that some such end is the one actually intended, and that there is some connection between the provisions of the law and such purpose. If it is manifest that the statute or ordinance has no such object, but, under the guise of the police regulation, is an invasion of the property rights of the citizen, it is the duty of the court to declare it void.’ Tolliver v. Blizzard, 143 Ky. 773, 137 S.W. 509, 510-511, 34 L.R.A. (NS) 890 (1911).
‘Moreover, the law must tend toward the accomplishment or promotion of the enumerated objects in a degree that is perceptible and *553clear.’ Schoo v. Rose, Ky., 270 S.W. 2d 940, 941 (1954).
Id. at 412-13.
I am certain that the majority and I are in agreement that the practice of medicine is a lawful, honorable, and necessary profession which is properly subject to state regulation. Yet I find it totally unreasonable to impose upon this class of health care providers the responsibility for curing the ills recognized in the purpose section of the Act, without an attendant finding of responsibility for such ills.
I would hearken to Dr. McCoy’s clarion protestation that, absent a showing that physicians or other health care providers are financially irresponsible or unwilling to satisfy claims made against them, the requirement of maintenance of insurance upon penalty of loss of license is unreasonable and violative of the due process clause of the Fourteenth Amendment to the United States Constitution and Article I, Section 1 of the Pennsylvania Constitution.2
Judge Crumlish, Jr., joins in this dissent.

 Section 701(a) of the Act of October 15, 1975, P.L. 390, as amended. 40 P.S. §1301.701 (a). Section 701(a) provides:
(a) Every health care provider as defined in this act, practicing medicine or podiatry or otherwise providing health care services in the Commonwealth shall insure his professional liability or provide proof of self-insurance in accordance with this section.

 Article I, Section 1 of the Pennsylvania Constitution reads:
All men are born equally free and independent, and have certain inherent and indefeasible rights, among which are those of enjoying and defending life and liberty, of acquiring, possessing and protecting property and reputation, and of pursuing their own happiness.