Court Opinion

ID: 9851796
Source: CourtListenerOpinion
Date Created: 2023-09-24 05:19:49.609193+00
Date Added: 2024-06-11T09:22:15.434196
License: Public Domain

Chief Justice TOAL
dissenting:
I respectfully dissent. Like the majority, I believe the statute does not infringe upon a physician’s statutory right to practice medicine and that there has been no violation of the appellants’ procedural due process rights. However, in my view, the plain language of S.C.Code Ann. § 40-45-110(A)(l) (2001) does not prohibit all employee-employer relationships between a physician and a physical therapist. Additionally, in my view, the South Carolina Board of Physical Therapy Examiners (Board) failed to comply with the Administrative Procedures Act (APA) in adopting the attorney general’s opinion, thereby promulgating an invalid regulation. Further, in my opinion, the majority’s interpretation of the statute would result in a violation of the plaintiffs’ rights to equal protection and substantive due process. Accordingly, I would reverse the remainder of the issues on appeal.
I. Interpretation of Section 40-45-110(A)(l)
The cardinal rule of statutory interpretation is to ascertain and effectuate the intention of the Legislature. Hodges v. Rainey, 341 S.C. 79, 85, 533 S.E.2d 578, 581 (2000). In ascertaining the intent of the Legislature, a court should not focus on any single section or provision but should consider the language of the statute as a whole. Mid-State Auto Auction of Lexington, Inc. v. Altman, 324 S.C. 65, 69, 476 S.E.2d 690, 692 (1996). When a statute’s terms are clear and unambiguous on their face, there is no room for statutory *487construction and courts are required to apply them according to their literal meaning. Carolina Power & Light Co. v. City of Bennettsville, 314 S.C. 137, 139, 442 S.E.2d 177, 179 (1994).
Where the plain and ordinary meaning of the words used in a statute would lead to a result so plainly absurd that it could not possibly have been intended by the legislature or would defeat the plain legislative intention, the courts will reject the literal import of those words. Kiriakides v. United Artists Commc’n, Inc., 312, S.C. 271, 275, 312 S.C. 271, 440 S.E.2d 364, 366 (1994) (internal citations omitted). If possible, the court will construe the statute so as to escape the absurdity and carry the intention into effect. Id. Further, where the statute contains an ambiguity, the court may look to other statutes dealing with the same subject matter, or in pari material, and construed them together, if possible, to produce a single harmonious result. Joiner v. Rivas, 342 S.C. 102, 536 S.E.2d 372 (2000).
Pursuant to the statute, the Board may take adverse action against any physical therapist who
requests, receives, participates, or engages directly or indirectly in the dividing, transferring, assigning, rebating, or refunding of fees received for professional services or profits by means of a credit or other valuable consideration including, but not limited to, wages, an unearned commission, discount, or gratuity with a person who referred a patient, or with a relative or business associate of the referring person.
S.C.Code Ann. § 40-45-110(A)(1). In my view, the majority misinterprets § 40-45-110(A)(l) to prohibit all employer-employee relationships between physicians and physical therapists. The majority finds that the legislature intended to prohibit physician-physical therapist employment relationships in order to prevent conflicts of interests and misuse of government-sponsored health care plans. However, this result would be absurd when viewed in relation to the other legislation related to this same purpose. Additionally, it is illogical that the legislature would intend to prohibit these relationships, while placing no restrictions on employment relationships between physicians and other health care providers. In my opinion, the more accurate interpretation of the statute would only prohibit a referral-for-pay situation. I believe the statute *488can be interpreted in a way which would give effect to all words of the statute and avoid the result proposed by the majority.
First, assuming that the meaning of the statute turns on the definition of “wage”, in my opinion, the majority extends the plain meaning of the word. The majority would find that the use of the word “wages” clearly demonstrates that the legislature intended to prohibit all employer-employee relationships between physicians and physical therapists. However, in my view, the use of this term, in its plain and ordinary use, would not prohibit all types of employment relationships.
The term “wage” is defined as “a pledge or payment of usually monetary remuneration by an employer especially for labor or services usually according to contract and on an hourly, daily, or piecework basis.” Webster’s Third New International Dictionary, 2568-69 (2002). In my opinion, the legislature’s use of the word “wages” is indicative of their desire to prohibit only those payments received directly for work done on specific patients referred to the physical therapist; in other words, a referral-for-pay arrangement. In my view, this interpretation of the statute comports with the legislative purpose of protecting consumers as well as government-sponsored health care programs from conflicts of interest and potential misuse of medical services. Additionally, in my opinion, when the term “wages” is read in conjunction with the other listed descriptors of valuable consideration — unearned commission, discount, or gratuity10 — the statute reflects the legislative intention to ban only those types of payments which occur on a piecemeal or individual referral basis.11
*489Additionally, in my opinion, the statute itself is indicative of the legislative intention to regulate the ethical practices of physical therapists rather than prohibit specific employment arrangements. Within subsection A of the statute, a physical therapist may also be subject to adverse actions by the Board if the physical therapist practices any service other than physical therapy, treats a patient without the requisite referral from a physician, assists another in the unauthorized practice of physical therapy, or changes patient care instructions. S.C.Code Ann. § 40-45-110(A). In my view, considering the other provisions of the statute, subsection (A)(1) was enacted to prohibit the unethical behavior of receiving or giving illegal kickbacks and participating in referral-for-pay arrangements.
Further, in my view, the statute is at least susceptible to two reasonable interpretations, making the statute ambiguous.12 Accordingly, in my opinion, the majority inappropriately dismisses the importance of the other existing statutes enacted to prevent abuse and misuse of health care services and government-sponsored health care plans in its analysis. In looking at the other pertinent statutes, the Provider Self-Referral Act, federal Anti-Kickback statutes, and the federal Stark laws are all instructive of the legislative intention in enacting § 40-45-110(A)(l).
The Provider Self-Referral Act provides that the prohibitions on referrals are inapplicable to “an investment interest where the healthcare professional directly provides the health care services within the entity or will be personally involved in the provision, supervision, or direction of care to the referred patient.” S.C.Code Ann. § 44-113-30(A)(l) (2002). The federal Anti-Kickback statutes provide both criminal and civil *490penalties for misusing federal health care programs by making false claims and illegal kickbacks. 42 U.S.C.A. §§ 1320a-7a to 7d (2003 & Supp.2005). Moreover, the Anti-Kickback statutes exempt bona fide employment relationships from the types of remuneration prohibited by the statutes. 42 C.F.R. § 1001.952(i) (2005). Further, the federal Stark laws create an exception to the self-referral statute for payments made by an employer to a physician in a bona fide employment relationship. 42 U.S.C.A. § 1395nn(e)(2) (Supp.2005).
In my view, these statutes were enacted to prevent health care providers from profiting on the basis of referrals, which is exactly the same reason the majority proposes for the enactment of § 40-45-110(A)(l). Viewing § 40-45-110(A)(1) in conjunction with these statutes, in my view, the more reasonable interpretation of the statute would prohibit only “sham” employment relationships where the physician and physical therapist are participating in a referral-for-pay arrangement.
Finally, in my opinion, had the legislature intended to prohibit employment relationships between physicians and physical therapists, they could have easily stated that intention in clear explicit terms. See Broadhurst v. City of Myrtle Beach Election Comm’n, 342 S.C. 373, 385, 537 S.E.2d 543, 549 (2000); Williams v. Williams, 335 S.C. 386, 390, 517 S.E.2d 689, 691 (1999); Ray Bell Const. Co., Inc. v. School Dist. Of Greenville County, 331 S.C. 19, 30, 501 S.E.2d 725, 731 (1998). Several statutes throughout the Code contain employment prohibitions. See S.C.Code Ann. § 38-46-60(B) (2002); and S.C.Code Ann. § 41-29-90 (2002). I find the legislature’s failure to explicitly prohibit these relationships particularly instructive, especially in light of the fact that the Code contains no other employment restrictions regarding health care providers.
Accordingly, I would reverse the lower court’s finding that § 40-45-110(A)(1) prohibits all employer-employee relationships between physical therapists and physicians. Instead, I would give the statute the more reasonable and logical reading and hold that the statute prohibits all arrangements in which the physical therapist participates in a referral-for pay situation.
*491II. Board’s Failure to Comply with the APA
In my view, the Board violated the APA by adopting the attorney general’s opinion without promulgating it as a regulation. Whether an agency proceeding creates a regulation or simply announces a general policy statement depends on whether the agency action establishes a “binding norm.” Home Health Serv., Inc. v. South Carolina Tax Comm’n, 312 S.C. 324, 328, 440 S.E.2d 375, 378 (1994).
The key inquiry, therefore, is the extent to which the challenged policy leaves the agency free to exercise its discretion to follow or not to follow that general policy in an individual case, or on the other hand, whether the policy so fills out the statutory scheme that upon application one need only determine whether a given case is within the rule’s criterion. As long as the agency remains free to consider the individual facts in the various cases that arise, then the agency action in question has not established a binding norm.
Ryder Truck Lines, Inc. v. United States, 716 F.2d 1369, 1377 (11th Cir.1983) (internal citations omitted). If the agency action is a binding norm, the action must be promulgated as a regulation under the rule-making provisions of the APA. Home Health Serv., Inc., 312 S.C. at 329, 440 S.E.2d at 378. “When there is a close question whether a pronouncement is a policy statement or regulation, the [agency] should promulgate the ruling as a regulation in compliance with the APA.” Id.
In my opinion, the Board promulgated an invalid regulation because they failed to comply with the rule-making provisions of the APA in adopting the attorney general’s opinion. Unlike the majority, I would find that the Board’s actions constitute a binding norm, or at the very least constitute a close question which should have been promulgated as a regulation.
The majority finds that by endorsing the attorney general’s opinion, the Board did not enact a binding norm because “[t]he opinion merely sets forth the legal reasoning and authority ... used to interpret the statute.” However, in my view, the majority overlooks the fact that the statute is only permissive, while the Board’s statement adopts a mandatory stance on the issue. Under the attorney general’s opinion, the Board will have no discretion as to when discipline is appropriate. Addi*492tionally, the attorney general’s opinion details the type of relationship which should be considered an employment relationship subject to the statute. Before the adoption of the attorney general’s opinion, the Board was free to determine what situations qualified as an impermissible transfer or sharing of fees in the form of wages. After the adoption of the opinion, the Board must now presume any employment relationship in which the employer physician refers patients to the employee physical therapist is one that is prohibited by the statute, regardless of whether or not the physical therapist actually shares any portion of the fee charged to the patient. In my view, the agency is not “free to exercise its discretion to follow or not to follow that general policy in an individual case,” but instead has created a situation in which “one need only determine whether a given case is within the rule’s criterion.” This is the very definition of a binding norm. Accordingly, in my opinion, the Board should have complied with the rulemaking provisions of the APA.
For that reason, I would reverse the lower court and find the Board’s actions constitute an invalid regulation that is null and void for failure to comply with the rule-making provisions of the APA.
III. Equal Protection
Additionally, in my view, the majority’s interpretation of § 40^15-110(A)(1) would lead to an equal protect violation. The requirements of equal protection are met if: (1) the classification bears a reasonable relationship to the legislative purpose sought to be effected; (2) the members of the class are treated alike under similar circumstances; and (3) the classification rests on a reasonable basis. Hanvey v. Oconee Mem’l Hosp., 308 S.C. 1, 5, 416 S.E.2d 623, 625 (1992). “While the General Assembly has the power in passing legislation to make a classification of its citizens, the constitutional guaranty of equal protection of the law requires that all members of a class be treated alike under similar circumstances and conditions, and that any classification cannot be arbitrary but must bear a reasonable relation to the legislative purpose sought to be effected.” Broome v. Truluck, 270 S.C. 227, 230, 241 S.E.2d 789 (1978).
*493The majority concludes that it would be inappropriate to hold that the legislature must treat all health care providers and allied health professionals as similarly situated for purposes of self-referral issues. I disagree. In my view, this is precisely the type of situation in which the legislature should treat all health care providers and allied health professionals as similarly situated. Unlike the majority, I would find that the classification has no reasonable relation to the types of variations and nuances of the medical profession which would necessitate a distinction between physical therapist and all other health care professionals. Although I would agree that the separate classification of physical therapists may be appropriate in other situations, I find it difficult to envision any aspect of physical therapy which is so different from other health care services that it warrants separate classification for self-referral purposes.
In my opinion, there is no reasonable relationship between the legislative purpose and the separate classification of physical therapists apart from other health providers in this case. In my view, although it is reasonable that the legislature enacted this statute to protect consumers as well as government-sponsored health care programs from conflicts of interest and potential misuse of medical services, neither the Respondents nor the majority articulate any plausible reason why physical therapists are being specifically singled out for disparate treatment for self-referral purposes. Although it is possible for physicians to overuse physical therapy services, physicians could just as easily overuse the services of all other health care providers. Accordingly, in my view, the statute treats physical therapists differently than other health care providers who are similarly situated for purposes of this statute; and therefore, the statute’s classification is arbitrary and violative of the equal protection rights of physical therapists. See Hanvey, 308 S.C. at 5, 416 S.E.2d at 625-26 (holding that there is no rational basis for distinguishing between charitable hospitals and other medical providers of goods and services, such as the Red Cross, for the purpose of limiting the liability of health care providers under S.C.Code Ann. § 44-7-50 (1976)); and Broome, 270 S.C. at 230, 241 S.E.2d at 740 (finding that no rational basis appears for making a distinction between architects, engineers, and con*494tractors, on one hand, and owners and manufacturers, on the other, for the purpose of establishing a statute of limitations to recover damages for any deficiency in design of an improvement to realty under S.C.Code Ann. § 15-3-670 (1976)).
IY. Substantive Due Process
Finally, I believe the statute, as interpreted by the majority, violates the substantive due process rights of the physical therapists. Substantive due process protects a person from being deprived of life, liberty, or property for arbitrary reasons. Worsley Co., Inc. v. Town of Mount Pleasant, 339 S.C. 51, 56, 528 S.E.2d 657, 660 (2000). In order to claim a denial of substantive due process, a plaintiff must show that he was arbitrarily and capriciously deprived of a cognizable property interest rooted in state law. Id.
Given the majority’s interpretation, I believe § 40-45-110(A)(1) acts as an arbitrary prohibition of physical therapists’ employment relationships with physicians. It is well established that the practice of medicine or other professions by a properly licensed person is a cognizable property interest. See Dantzler v. Callison, 230 S.C. 75, 92, 94 S.E.2d 177, 186 (1956). While the State has a right to regulate the profession, “the State cannot abridge this right except as a reasonable exercise of its police powers when it is clearly found that abridgement is necessary for the preservation of the health, safety, and welfare of the public.” See S.C.Code Ann. § 40-1-10 (2001). Although the legislature may have a legitimate interest in protecting consumers as well as government-sponsored health care programs from conflicts of interest and potential misuse of medical services, in my opinion, § 40-45-110(A)(l) imposes an arbitrary employment restriction upon physical therapists while preserving those employment relationships for all other health care providers and allied health professionals.
For the foregoing reasons, I respectfully dissent.
Acting Justice ROGER M. YOUNG, concurs.

. "Commission” is defined as "a fee paid to an agent or employee for transacting a piece of business or performing a service; especially a percentage of the money received from a total paid to the agent responsible for the business.” Webster's Third New International Dictionary, 457 (2002). "Discount” means "an abatement or reduction made from the gross amount or value of anything.” Id. at 646. "Gratuity” is defined as a tip or "something given voluntarily or over and above what is due usually in return for or in anticipation of some service.” Id. at 992. In my view, these words describe payments which are made for individual transactions or services.

. Conversely, the term "salary” is defined as "fixed compensation paid regularly (as by the year, quarter, month, or week) for services ...— *489often distinguished from wage.” Id. at 2003. In my view, this term more accurately describes the dynamics of a bona fide employment relationship between a physician and a physical therapist in which the physical therapist receives a fixed salary unrelated to the number of patients who receive services. In my opinion, the legislature did not intend to prohibit these types of relationships, where compensation is unrelated to the referral.

. Because the term "wages” is not defined, it is, at a minimum, ambiguous as demonstrated by the two different views advanced by the majority opinion and my dissent.