DeSalle v. Wright, 91-2050

• Decision Date: 16 July 1992
• Docket Number: No. 91-2050,91-2050
• Citation: 969 F.2d 273
• Parties: Louis DeSALLE, Plaintiff-Appellant, v. Kevin W. WRIGHT, Jere E. Fridheim, M.D., Arvid K. Goyal, M.D., Nikki M. Zollar, et al., Defendants-Appellees.
• Court: U.S. Court of Appeals — Seventh Circuit

Page 273

969 F.2d 273

23 Fed.R.Serv.3d 123

Louis DeSALLE, Plaintiff-Appellant, v. Kevin W. WRIGHT, Jere E. Fridheim, M.D., Arvid K. Goyal M.D., Nikki M. Zollar, et al., Defendants-Appellees.

No. 91-2050.

United States Court of Appeals Seventh Circuit.

Argued April 1, 1992.

Decided July 16, 1992.

Alan Rhine (argued), Terrance A. Norton, Augustine & Kern, Chicago, Ill., for plaintiff-appellant.

Jennifer A. Keller, Asst. Atty. Gen., Civ. Appeals Div., Chicago, Ill. (argued), for defendants-appellees.

Before CUMMINGS, CUDAHY and EASTERBROOK, Circuit Judges.

CUDAHY, Circuit Judge.

Louis DeSalle, an unsuccessful applicant for a temporary medical license, commenced this action under 42 U.S.C. § 1983 against Kevin Wright, ¹ the (former) Director of the Illinois Department of Professional Regulation, and certain members of the Illinois Medical Licensing Board alleging violations of his constitutional rights to equal protection and due process. We must decide whether DeSalle successfully stated a cause of action against the defendants.

I.

We review the grant of a motion to dismiss de novo, accepting as true all well-pleaded factual allegations and drawing inferences in favor of the plaintiff. Prince v. Rescorp Realty, 940 F.2d 1104, 1106 (7th Cir.1991). The allegations are straightforward.

Louis DeSalle attended the University of Illinois School of Medicine (the U of I) from September 1972 through December 1977. During those five years at the U of I, DeSalle successfully completed all of his course work, including his core clinical rotations, ² but he did not graduate. Later, DeSalle enrolled in Spartan Health Sciences University, an unaccredited, foreign medical school. ³ Spartan credited DeSalle for his studies at the U of I, and after requiring DeSalle to complete an additional forty-four weeks of clinical training, Spartan awarded DeSalle an M.D.

Intending to begin his postgraduate residency training at Cook County Hospital in Chicago, DeSalle applied to the Illinois Department of Professional Regulation (the Department) for a temporary medical license. Although DeSalle submitted an official transcript from the U of I with his application, the Department wrote to DeSalle requesting that he provide the Department with a detailed explanation of the courses he successfully completed at the U of I. The Department also requested that DeSalle attend an interview with the Illinois Medical Licensing Board (the Board) but did not inform him about the specific issues to be raised at the interview.

After interviewing DeSalle and reviewing his application the Board voted to recommend denial of DeSalle's application. Acting on the Board's recommendation, the Director rejected DeSalle's application for a temporary license.

DeSalle brought this action against the Department and the Board under 42 U.S.C. § 1983, alleging violations of his right to equal protection and due process. The district court dismissed the action under Fed.R.Civ.P. 12(b)(6) for failure to state a claim upon which relief can be granted. We affirm.

II.

A. Equal Protection

DeSalle challenges the constitutionality of the Illinois Medical Practice Act (the MPA or Act), Ill.Rev.Stat., ch. 111, p 4400-1 et seq. (1991), alleging that the Act arbitrarily discriminates against graduates of foreign medical schools. DeSalle specifically challenges the education requirements of the Act.

An applicant for a temporary medical license must satisfy the professional education requirements in Section 11 of the Act. p 4400-17(c) (referring to p 4400-11). Section 11 establishes minimum standards for three different classes of applicants: (1) graduates of unaccredited medical schools, p 4400-11(A)(2)(a)(i); (2) graduates of accredited medical schools, p 4400-11(A)(2)(a)(ii); and (3) applicants who have completed the requirements of a foreign medical school and who have then completed one year of clinical training at an accredited medical school, p 4400-11(A)(2)(b). Since Spartan is not an accredited medical school and DeSalle has not completed one year of additional training at an accredited school, DeSalle is in the first category. Applicants in this category, unlike graduates of accredited medical schools, must have completed their core clinical rotations at a clinical facility affiliated with the medical school from which they take their degree. p 4400-11(A)(2)(a)(i). DeSalle claims that this requirement is arbitrary and irrational and violates the equal protection clause.

The equal protection clause requires that all similarly situated persons be treated in a similar manner. Cleburne v. Cleburne Living Center, Inc., 473 U.S. 432, 439, 105 S.Ct. 3249, 3254, 87 L.Ed.2d 313 (1985). Unless the challenged statute involves a suspect classification or impinges upon a fundamental right, however, the statute need only rationally relate to a legitimate state interest. New Orleans v. Dukes, 427 U.S. 297, 303, 96 S.Ct. 2513, 2516-17, 49 L.Ed.2d 511 (1976); Illinois Health Care Ass'n v. Illinois Dept. of Public Health, 879 F.2d 286, 288 (7th Cir.1989). The classification at issue distinguishes between graduates of accredited medical schools and graduates of unaccredited medical schools for purposes of qualification for medical licenses. We have consistently deferred to legislative judgment in cases involving the regulation of licensed professions. Sutker v. Illinois State Dental Soc., 808 F.2d 632, 635 (7th Cir.1986); see also Maguire v. Thompson, 957 F.2d 374, 376 (7th Cir.1992) (medical licenses for practitioners of naprapathy). Consequently, the district court correctly evaluated the statute using a rational basis analysis.

Under the rational basis test, the court presumes that the classification is constitutional, and the plaintiff bears the burden of demonstrating that the classification at issue furthers no legitimate public interest. Minnesota v. Clover Leaf Creamery Co., 449 U.S. 456, 465-66, 101 S.Ct. 715, 724-25, 66 L.Ed.2d 659 (1981); Oriental Health Spa v. Fort Wayne, 864 F.2d 486, 490 (7th Cir.1988). There is no question that a legitimate state interest is at stake here: as we recently held in Maguire, the minimum education standards set out in the MPA are designed to protect the public from unqualified medical practitioners. 957 F.2d at 377.

While the state interest is plainly legitimate, the statute must, in order to satisfy the equal protection clause, rationally relate to the advancement of that interest. Oriental Health Spa, 864 F.2d at 491. DeSalle argues that the Act arbitrarily and irrationally discriminates against graduates of unaccredited medical schools by forcing them to complete their core clinical rotations at the schools from which they graduate. In response to the State's argument that the requirement furthers continuity of medical education, DeSalle asks why the same requirement is not imposed on graduates of accredited medical schools and why Illinois allows students at unaccredited medical schools to transfer credits for ordinary course work. Finally, DeSalle notes that had he done his clinical rotations at Spartan, he would have satisfied the statutory requirements for a temporary license. In effect, DeSalle has been penalized for doing his clinical rotations at an accredited school--a result that seems irrational.

At the outset, we note that the issue is not whether DeSalle himself is a competent physician. The fact that a statute works a hardship on a particular individual does not make it unconstitutional. Whitfield v. Illinois Board of Law Examiners, 504 F.2d 474, 476 (7th Cir.1974) (per curiam). Further, a statute "need not be in every respect logically consistent with its aims to be constitutional." Williamson v. Lee Optical of Oklahoma, Inc., 348 U.S. 483, 487-88, 75 S.Ct. 461, 464, 99 L.Ed. 563 (1955). This court will uphold the state regulatory scheme if it finds any conceivable or plausible basis for the distinction. United States Railroad Retirement Board v. Fritz, 449 U.S. 166, 179, 101 S.Ct. 453, 461-62, 66 L.Ed.2d 368 (1980); Vance v. Bradley, 440 U.S. 93, 111-12, 99 S.Ct. 939, 950, 59 L.Ed.2d 171 (1979). It is "constitutionally irrelevant" whether the hypothesized basis for the rule actually motivated the legislative action. Flemming v. Nestor, 363 U.S. 603, 612, 80 S.Ct. 1367, 1373, 4 L.Ed.2d 1435 (1960).

The central issue is whether there exists a difference between unaccredited schools and accredited schools that could be the basis for the classification made by the legislature. We think such a difference exists. The legislature could have concluded that the process of accreditation provides some guarantee that a school will provide a coherent course of medical education. A degree conferred by an unaccredited school carries no such guarantee. The legislature could have refused to issue medical licenses to any graduates of unaccredited schools, but it decided to impose additional educational requirements on them instead. Thus the legislature could have concluded that requiring clinical work to be done at the school conferring the degree is a reasonable proxy for the guarantee provided by the accreditation process. The further distinction the State has made between credits for clinical rotations and credits for ordinary course work may reflect the greater difficulty of evaluating clinical work. Course work is easy to evaluate from afar, since credits are based on written examinations; clinical work requires subjective evaluation by an observer. The legislature could reasonably trust unaccredited schools to make the first evaluation when transferring academic credits, but not the second.

DeSalle's last argument on this point is that the Act arbitrarily discriminates between graduates of Canadian medical schools and graduates of other foreign medical schools. But the Act does not distinguish between foreign and domestic medical schools, rather the distinction is between accredited and unaccredited schools....