Idaho Ass'n of Naturopathic Physicians, Inc. v. U.S. Food and Drug Administration

• Decision Date: 28 August 1978
• Docket Number: Nos. 77-1346,77-1908,77-2593 and 77-2594,s. 77-1346
• Parties: The IDAHO ASSOCIATION OF NATUROPATHIC PHYSICIANS, INC., a corporation, et al., Appellants, v. UNITED STATES FOOD AND DRUG ADMINISTRATION et al., Appellees. The IDAHO ASSOCIATION OF NATUROPATHIC PHYSICIANS, INC., a corporation, et al., Appellants, v. UNITED STATES FOOD AND DRUG ADMINISTRATION et al., Appellees. The IDAHO ASSOCIATION OF NATUROPATHIC PHYSICIANS, INC., a corporation, et al., Appellants, v. The STATE OF SOUTH CAROLINA, Lexington County, the State Board of Pharmaceutical Examiners, Board of Medical Examiners, Appellees, United States Food and Drug Administration et al., Defendants. The IDAHO ASSOCIATION OF NATUROPATHIC PHYSICIANS, INC., a corporation, et al., Appellants, v. The STATE OF WYOMING, the Wyoming State Board of Pharmacy, the Wyoming State Board of Medical Examiners, and the Department of Health and Social Services, Appellees, United States Food and Drug Administration, United States Department of Health, Education, and Welfare, Joseph A. Califano, in his capacity as Secretary of the Department of Health, Education and Welfare of the United States of America, Defendants.
• Court: U.S. Court of Appeals — Fourth Circuit

Page 849

582 F.2d 849

The IDAHO ASSOCIATION OF NATUROPATHIC PHYSICIANS, INC., a corporation, et al., Appellants, v. UNITED STATES FOOD AND DRUG ADMINISTRATION et al., Appellees.

The IDAHO ASSOCIATION OF NATUROPATHIC PHYSICIANS, INC., a corporation, et al., Appellants, v. UNITED STATES FOOD AND DRUG ADMINISTRATION et al., Appellees.

The IDAHO ASSOCIATION OF NATUROPATHIC PHYSICIANS, INC., a corporation, et al., Appellants, v. The STATE OF SOUTH CAROLINA, Lexington County, the State

Board of Pharmaceutical Examiners, Board of

Medical Examiners, Appellees,

United States Food and Drug Administration et al., Defendants.

The IDAHO ASSOCIATION OF NATUROPATHIC PHYSICIANS, INC., a corporation, et al., Appellants, v. The STATE OF WYOMING, the Wyoming State Board of Pharmacy,

the Wyoming State Board of Medical Examiners, and

the Department of Health and Social

Services, Appellees,

United States Food and Drug Administration, United States

Department of Health, Education, and Welfare, Joseph A.

Califano, in his capacity as Secretary of the Department of

Health, Education and Welfare of the United States of

America, Defendants.

Nos. 77-1346, 77-1908, 77-2593 and 77-2594.

United States Court of Appeals, Fourth Circuit.

Argued May 4, 1978.

Decided Aug. 28, 1978.

Stanley D. Crow, Boise, Idaho (James H. Toms, Hendersonville, N. C., on brief), for appellants.

Jack C. Tranter, Asst. Atty. Gen. of Md., Baltimore, Md., Corinne G. Russell, Asst. Atty. Gen. of S. C., Columbia, S. C., Kenneth Vines, Asst. Atty. Gen. of Wyo., Cheyenne, Wyo., Isaac T. Avery, III, Associate Atty. Gen., Raleigh, N. C. (Rufus L. Edmisten, Atty. Gen. of N. C., Raleigh, N. C., on brief), John H. Anderson, Raleigh, N. C. (Carl N. Patterson, Jr., Smith, Anderson, Blount & Mitchell, Raleigh, N. C., P. Eugene Price, Jr., Winston Salem, N. C., Edward Y. Brewer, Clemmons, N. C., Richard L. Goard, Winston Salem, N. C., W. Harley Stepp, Jr., Hendersonville, N. C., William R. Pope, Mooresville, N. C., on brief), for appellees.

Before WINTER, BUTZNER and HALL, Circuit Judges.

BUTZNER, Circuit Judge:

In these four substantially identical cases, practitioners and students of naturopathy, patients desiring naturopathic treatment, and associations promoting naturopathy (collectively referred to as naturopaths) seek broad declaratory and injunctive relief assuring the opportunity to study and practice naturopathy and to be treated according to its methods. ¹ The defendants are the Food and Drug Administration; the Secretary of Health, Education, and Welfare; the states of North Carolina, South Carolina, Maryland, and Wyoming and their agencies regulating medicine and pharmacy; and certain counties in North Carolina, South Carolina, and Maryland. The naturopaths appeal the dismissal of all county and state defendants from these actions. ² We affirm.

I

Each complaint seeks a declaratory judgment defining naturopathy as

. . . a separate and distinct healing art, science and philosophy of medicine, that is, the art, science and philosophy of natural healing, by application of the laws of nature to the human body for its care and to prevent disease by any means that will assist the self-healing processes of the body.

The naturopaths explain that this definition describes a broad range of practice illustrated by some 80 specialties such as cardio-vascular medicine, dermatology, and orthopedics. They also claim that they should be permitted to use and prescribe a variety of natural foods and medicine, including animal and vegetable substances, herbs, and non-narcotic prescription drugs. They request a declaratory judgment that the fifth and fourteenth amendments guarantee rights to practice, teach, and receive instruction in naturopathy. They also seek a judgment that every statute, regulation, and administrative practice or policy of the state and county defendants that restricts naturopathy more narrowly than the asserted definition is void and unenforceable as to all plaintiffs.

The naturopaths raise a number of constitutional issues. They allege violations of the due process and equal protection clauses because of the defendants' refusal to license practitioners of naturopathy notwithstanding the qualifications of the applicants. They assert that naturopathy is a healing art distinct from the orthodox practice of medicine. Consequently, they challenge the validity of state laws regulating medicine that sweep so broadly as to encompass naturopathy. They also allege that their rights to equal protection and due process are violated by state regulations that give medical doctors, who have a competing pecuniary interest, the power to establish licensing requirements for the separate discipline of naturopathy. They argue that ordinary doctors are not competent to judge the qualifications of a naturopath.

They assert that their freedom of academic inquiry under the first and fourteenth amendments is impaired by state regulation that creates a monopoly in favor of orthodox medicine. They voice similar complaints about regulations that make the practice of naturopathy unprofessional conduct warranting revocation of a medical license and that restrict the scope of research in health care to state-designated lines of inquiry.

Additionally, the naturopaths allege that statutes and regulations barring their profession abridge the rights of both patients and practitioners to unimpeded interstate travel secured by the privileges and immunities clauses of Article IV and the fourteenth amendment. Their patients, they claim, have a right to a reasonable choice of treatment arising from the right to privacy secured by the fifth, ninth, and fourteenth amendments. Finally, the naturopaths contend that naturopathy has advanced to such a degree that they should be allowed to present evidence that a state may no longer reasonably require a medical degree for its practice.

II

The Maryland district court, in No. 77-1908, ruled that while the allegations respecting the jurisdictional amount under § 1331(a) were sufficient, the naturopaths lacked standing and presented no "case or controversy." The court also ruled that even if it accepted jurisdiction, Hitchcock v. Collenberg, 140 F.Supp. 894 (D.Md.1956), Aff'd, 353 U.S. 919, 77 S.Ct. 679, 1 L.Ed.2d 718 (1957), established the constitutionality of Maryland's regulation of this matter.

The South Carolina district court, in No. 77-2593, ruled that the naturopaths had presented no substantial federal question with respect to the state and county defendants. The court considered itself bound by the results in two previous suits, Dantzler v. Callison, 230 S.C. 75, 94 S.E.2d 177, Appeal dismissed for want of a substantial federal question, 352 U.S. 939, 77 S.Ct. 263, 1 L.Ed.2d 235 (1956), and Beck v. McLeod, 240 F.Supp. 708 (D.S.C.1965), Aff'd, 382 U.S. 454, 86 S.Ct. 645, 15 L.Ed.2d 522 (1966).

The Wyoming district court ruled in No. 77-2594 that the state and its agencies were immune under the eleventh amendment.

In No. 77-1346, the North Carolina district court held that the county defendants lacked the power to deprive the naturopaths of their asserted rights. It ruled that although the naturopaths had satisfied the jurisdictional amount under § 1331(a), the eleventh amendment immunized the state defendants. Finally, it held that abstention was appropriate because the naturopaths had not shown that an adequate remedy was unavailable in the state courts.

Although we uphold the judgments of dismissal in all four cases, we find it necessary to address only the issue concerning the existence of a substantial federal question.

III

The Supreme Court has recently reiterated that a complaint must be dismissed when the federal question invoked as the basis for a district court's jurisdiction is "plainly unsubstantial . . . because 'its unsoundness so clearly results from the previous decisions of this court as to foreclose the subject and leave no room for the inference that the question sought to be raised can be the subject of controversy,' " Hagans v. Lavine, 415 U.S. 528, 537, 94 S.Ct. 1372, 1379, 39 L.Ed.2d 577 (1974). See 13 Wright, Miller, and Cooper, Federal Practice and Procedure § 3564, at 427-29 (1975). Even when the Court summarily affirms or dismisses an appeal, its judgment must be recognized by inferior courts as a decision on the merits of the issues presented. Mandel v. Bradley, 432 U.S. 173, 176, 97 S.Ct. 2238, 53 L.Ed.2d 199 (1977); Hicks v. Miranda, 422 U.S. 332, 343-45, 95 S.Ct. 2281, 45 L.Ed.2d 223 (1975). Since 1948, the Supreme Court has summarily affirmed or dismissed at least seven cases challenging state regulation of naturopathy. We must therefore examine the opinions and jurisdictional papers on which the Court based its dispositions. Mandel v. Bradley, 432 U.S. at 180, 97 S.Ct. 2238 (Brennan, J., concurring).

In Davis v. Beeler, 185 Tenn. 638, 207 S.W.2d 343 (1947), Appeal dismissed for want of a substantial federal question, 333 U.S. 859, 68 S.Ct. 745, 92 L.Ed. 1138 (1948), naturopaths claimed that they had been unconstitutionally deprived of liberty and property interests by a Tennessee law withdrawing recognition from naturopathy as a separate branch of medicine but allowing methods used by naturopaths to be used by other licensed practitioners. The Supreme Court of Tennessee rejected these arguments and sustained the legislature's power to require that practitioners of limited branches of the healing arts obtain a general practitioner's license. 207 S.W.2d at 345. The jurisdictional statement filed with the United States Supreme Court reveals that these due process and equal protection claims were directly presented on appeal.

In Taylor v. Oklahoma, 291 P.2d 1033 (1955), Appeal dismissed for want of a substantial federal question, 352 U.S. 805, 77 S.Ct. 33, 1 L.Ed.2d 38 (1956), the Supreme Court of Oklahoma affirmed an order restraining a naturopath from practicing. All of the issues raised in the...