England v. Louisiana State Board of Medical Examiners

• Decision Date: 09 November 1965
• Docket Number: Civ. A. No. 9292-A.
• Citation: 246 F. Supp. 993
• Parties: Jerry R. ENGLAND et al., Plaintiffs, v. LOUISIANA STATE BOARD OF MEDICAL EXAMINERS et al., Defendants.
• Court: U.S. District Court — Eastern District of Louisiana

246 F. Supp. 993

Jerry R. ENGLAND et al., Plaintiffs, v. LOUISIANA STATE BOARD OF MEDICAL EXAMINERS et al., Defendants.

Civ. A. No. 9292-A.

United States District Court E. D. Louisiana, New Orleans Division.

November 9, 1965.

Simon, Trice & Mouton, J. Minos Simon, Lafayette, La., Reed, Reed, Reed & Garvey, Floyd J. Reed, New Orleans, La., for plaintiffs.

Adams & Reese, W. Ford Reese, Robert F. LeCorgne, Jr., Joel L. Borrello, Thomas Wyllie, New Orleans, La., for defendants.

Phelps, Dunbar, Marks, Claverie & Sims, Ashton Phelps, Blake West, New Orleans, La., for intervenor, Louisiana State Medical Soc.

Before JONES and WRIGHT^*, Circuit Judges, and CHRISTENBERRY, District Judge.

J. SKELLY WRIGHT, Circuit Judge.

Plaintiffs are chiropractors practicing their profession in the State of Louisiana. In this litigation¹ they seek an injunction prohibiting the Louisiana State Board of Medical Examiners from enforcing the licensing provisions of the Louisiana Medical Practice Act² against them. After a full trial on the merits, we conclude that the application for injunction must be denied and this case dismissed.

The Louisiana Medical Practice Act has a general licensing provision applicable broadly to practitioners of the healing arts. It first defines "the practice of medicine, surgery, or midwifery" as "the holding out of one's self to the public as being engaged in the business of diagnosing, treating, curing, or relieving any bodily or mental disease, condition, infirmity, deformity, defect, ailment, or injury in any human being other than himself whether by the use of any drug, instrument or force, whether physical or psychic, or of what other nature, or any other agency or means; or the examining, either gratuitously or for compensation, of any person or material from any person for such purpose whether such drug, instrument, force, or other agency or means is applied or used by the patient or by another person * * *." La.R.S. 37:1261.

After thus defining its coverage, the Louisiana Medical Practice Act then prohibits any person from practicing medicine unless he possesses a certificate issued under the Act. Qualifications for obtaining a certificate, in addition to being a citizen of the United States, of good moral character and 21 years of age or over, are that the applicant must present to the Louisiana State Board of Medical Examiners, defendant herein, a diploma "from a college in good standing of any sect teaching medicine or the healing art" and "pass an examination before the Board upon the following: Anatomy, Physiology, Chemistry, Physical Diagnosis, Pathology and Bacteriology, Hygiene, Surgery, Theory & Practice of Medicine, Materia Medica, Obstetrics, and Gynecology." La.R.S. 37:1271 (1964).

In addition to the Medical Practice Act, the Legislature of Louisiana has passed special statutes outlining qualifications and licensing procedures for the practice of certain specialities related to medicine such as dentistry,³ optometry,⁴ pharmacy,⁵ osteopathy,⁶ podiatry,⁷ homeopathy,⁸ and nursing.⁹ Persons qualifying under one of these special acts are exempted from the requirements of the Medical Practice Act. Thus any person practicing a healing art in Louisiana must qualify and be licensed under one of the special statutes or under the general licensing provisions of the Medical Practice Act.

There is no special statute covering chiropractic. As interpreted by the Board, persons desiring to practice chiropractic in the State of Louisiana must qualify under the provisions of the Medical Practice Act, including the provision requiring a diploma from a medical school and a test before the Board in, among other things, materia medica and surgery. It is the position of the plaintiffs that, as chiropractors, they have no concern with materia medica and surgery and, consequently, should not be required, in order to practice their profession, to graduate from an approved medical school and be proficient in materia medica and surgery. Chiropractic, according to the plaintiffs, is an independent, complete, drugless healing art, basically unrelated to medicine, and to require them to qualify under the Medical Practice Act when other healing arts are relieved of this responsibility is to work an invidious discrimination against them in violation of the Equal Protection and Due Process Clauses of the Fourteenth Amendment.

As broadly defined by its proponents, chiropractic is a healing art designed to relieve human ailments by manipulation and adjustment of the spine. It is chiropractic doctrine that most, if not all, human ailments result from a slight misalignment, or subluxation, of contiguous vertebrae. This subluxation tends to impinge on nerves emanating from the spinal cord through apertures in the vertebrae. As a result of the impingement, the innervation to the parts of the body served by the impinged nerve is abnormally altered, and such parts become diseased or predisposed to disease. The realignment of these subluxated vertebrae through manipulation of the spine by the chiropractor removes the impingement and restores the nerve function to the diseased parts of the body.¹⁰ Chiropractic science postulates that the commonly accepted causes of disease, such as viruses and germs, are merely secondary factors acting on parts of the body already predisposed to disease by nerve impingement. Thus disease results from a lack of resistance to the viruses and germs which are always present in the body.¹¹

There seem to be two schools of chiropractic. The members of the International Chiropractic Association apparently believe that there is one cause of disease — subluxation of the vertebrae — and one cure — manipulation of the spine to relieve the subluxation. The American Chiropractic Association, while not as absolute in its approach to the problem of disease, nevertheless feels that chiropractic is a complete and independent healing art which not only can prevent disease, but can cure disease if the manipulation of the spine begins in time.

With one possible exception,¹² all of the legal issues presented in this case were decided adversely to plaintiffs in Louisiana State Board of Medical Examiners v. Fife, 162 La. 681, 111 So. 58, 54 A.L.R. 594 (1926), affirmed, 274 U.S. 720, 47 S.Ct. 590, 71 L.Ed. 1324 (1927). It was there decided, under the very Act in suit, that chiropractors are covered by the Medical Practice Act and that the materia medica and surgery requirement as applied to them is constitutionally unassailable. Fife also held that the fact that other Louisiana statutes exempted certain medical specialities from compliance with the general licensing requirements of the Medical Practice Act did not violate the Equal Protection Clause.

This court originally dismissed this case on the authority of Fife. The Fifth Circuit Court of Appeals, however, in reversing that ruling, stated that in the 30-odd years since Fife, enormous progress has been made in the healing arts, and that it was unable to say, without a full evidentiary hearing on the merits, whether chiropractic is "no more entitled to recognition today than it was thirty odd years ago." England v. Louisiana State Board of Medical Examiners, supra Note 1, 259 F.2d at 627. The court pointed out that chiropractic had been legalized as such in 44 (now 46) states and the District of Columbia, and that such requirements as a diploma from a college approved by the American Medical Association may at this time be an unconstitutional imposition on the rights of chiropractors. In remanding for a trial on the merits, the court recognized that "the burden upon the plaintiffs is great, if not insurmountable. They must show that the Act as administered `has no rational relation' to the regulation of chiropractic and `therefore is beyond constitutional bounds.'" England v. Louisiana State Board of Medical Examiners, supra Note 1, 263 F.2d at 661.

Our mandate then, after hearing the evidence, is to determine whether in 1965 it is irrational and unreasonable for the Louisiana Legislature still to require chiropractors to comply with the licensing provisions of the Medical Practice Act before being allowed to practice their profession in Louisiana. We approach resolution of this problem fully cognizant of "the principle that the State is primarily the judge of regulations required in the interest of public safety and welfare, and its police statutes may only be declared unconstitutional where they are arbitrary or unreasonable attempts to exercise the authority vested in it in the public interest." Graves v. State of Minnesota, supra Note 10, 272 U.S. at 428, 47 S.Ct. at 123.

At the outset it should be noted that the laws of the State of Louisiana do not prohibit the practice of chiropractic. As a matter of fact, as this record shows, one chiropractor complied with the provisions of the Medical Practice Act and subsequently practiced chiropractic in the state. The question here is: May Louisiana require a chiropractor to obtain what is in effect a medical education from an approved medical school before he may practice his profession in the state?

It is clear that the Louisiana Legislature is fully cognizant of the problems which confront the chiropractor with reference to compliance with the Medical Practice Act. Time and again efforts have been made by the chiropractors to have a special statute passed which would provide a licensing procedure for them similar to those provided for other specialties in the healing arts. What has been the motivation of the Legislature in refusing to pass such legislation is, of course, a matter of conjecture. Plaintiffs suggest it is that the lobby of the Louisiana Medical Association is more powerful and effective than theirs. This may be true. It may also be true that, since...