Public Citizen, Health Research Group v. Commission on Medical Discipline of Maryland, 76-1944

• Decision Date: 29 March 1978
• Docket Number: No. 76-1944,76-1944
• Citation: 573 F.2d 863
• Parties: PUBLIC CITIZEN, HEALTH RESEARCH GROUP and Maryland Public Interest Research Group, Appellants, v. COMMISSION ON MEDICAL DISCIPLINE OF MARYLAND, Elmer G. Einhardt, Charles Bagley, Jerome Coller, Eli Lippman, Carl F. Meck, Members, Commission on Medical Discipline of Maryland, Medical and Chirurgical Faculty of the State of Maryland, William Carl Ebeling, President, Medical and Chirurgical Faculty of the State of Maryland, Prince George's County Medical Society, and John T. Lynn, President, Prince George's County Medical Society, John M. Dennis, John E. Adams, and William G. Speed, III, Appellees.
• Court: U.S. Court of Appeals — Fourth Circuit

Page 863

573 F.2d 863

PUBLIC CITIZEN, HEALTH RESEARCH GROUP and Maryland Public

Interest Research Group, Appellants, v. COMMISSION ON MEDICAL DISCIPLINE OF MARYLAND, Elmer G.

Einhardt, Charles Bagley, Jerome Coller, Eli Lippman, Carl

F. Meck, Members, Commission on Medical Discipline of

Maryland, Medical and Chirurgical Faculty of the State of

Maryland, William Carl Ebeling, President, Medical and

Chirurgical Faculty of the State of Maryland, Prince

George's County Medical Society, and John T. Lynn,

President, Prince George's County Medical Society, John M.

Dennis, John E. Adams, and William G. Speed, III, Appellees.

No. 76-1944.

United States Court of Appeals, Fourth Circuit.

Argued Nov. 8, 1977.

Decided March 29, 1978.

Girardeau A. Spann, Washington, D. C. (Alan B. Morrison, Washington, D. C., on brief), for appellants.

E. Dale Adkins, III, Baltimore, Md. (John F. King, Baltimore, Md., on brief), for appellees William Ebeling and The Medical & Chirurgical Faculty of Maryland.

Stephen J. Sfekas, Asst. Atty. Gen., Baltimore, Md. (Francis B. Burch, Atty. Gen. of Maryland, and Paul Walter, Asst. Atty. Gen., Baltimore, Md., on brief), for appellees, Commission on Medical Discipline of Maryland.

Before BUTZNER, WIDENER and HALL, Circuit Judges.

PER CURIAM:

Article 43, § 129 of the Annotated Code of Maryland, provides that "No physician shall advertise except as provided by regulations of the Board (of Medical Examiners)." Regulation F of the Board, promulgated pursuant to § 129, ¹ permits advertising in certain areas. Neither § 129 nor Regulation F, however, defines the term "advertise."

Plaintiffs, various "public interest" organizations, sought to publish a medical directory containing information about physicians practicing in Prince George's County, Maryland. To gather information for the proposed directory, the plaintiffs prepared a telephone questionnaire that was used to obtain the particulars of each physician's office hours, fees for office visits and laboratory tests, educational background, foreign language availability, availability to treat Medicare or Medicaid patients, and other items of information the plaintiffs thought would assist consumers of medical services. The plaintiffs advised the physicians "that this is a consumer effort and that their refusal to cooperate will be made public when the directory is published." The response by county doctors was less than desired, however. The directory as published, according to plaintiffs, contains no information about three-quarters of the county physicians; nine pages of the directory list the names of doctors characterized as "non-responding and uncooperative doctors."

The plaintiffs' efforts to compile the directory came to the attention of the defendants Prince George's County Medical Society, and Medical and Chirurgical Faculty of the State of Maryland. These defendants indicated that participation in the directory as conceived by plaintiffs might involve questions of ethics and advertising illegal under § 129. Defendant Commission on Medical Discipline is charged under Maryland law, Md.Code Ann. Art. 43, § 130, with regulating the medical profession, including the discipline of physicians and advertising by physicians.

Alleging that the actions of the defendants State Faculty and County Society caused the inadequate participation of county physicians in the directory, the plaintiffs brought suit under 28 U.S.C. §§ 1331 & 1343(3), requesting the convening of a three-judge district court which they asked to declare that § 129 and Regulation F violated their rights under 42 U.S.C. § 1983 and the First Amendment, and they prayed for injunctive relief enjoining all defendants from enforcing § 129 and Regulation F "insofar as they prohibit any physician from supplying plaintiffs the answers to questions contained in (the questionnaire) for publication in the directory."

The three-judge court which was convened noted that Maryland law, Md.Code Ann., Article 41, § 250, provides for the issuance of declaratory rulings by state agencies "with respect to the applicability to any person . . . of any rule or statute enforceable by it . . . ," and that the primary issue presented by plaintiffs was "whether the Directory is an advertisement of the character inhibited by the Maryland law." It abstained from deciding the merits of the suit and dismissed the cause without prejudice in an unreported opinion. Plaintiffs' complaint that abstention would lead to unjustifiable delay was rebutted, in the district court's view, by plaintiffs' choice of the federal forum over the readily available state remedy contained in § 250.

We hold that the district court did not err in abstaining. This case presents an example for abstention under the doctrine of Railroad Comm'n v. Pullman Co., 312 U.S. 496, 61 S.Ct. 643, 85 L.Ed. 971 (1941). Decision on the constitutionality of the challenged statute and regulation "may be rendered unnecessary by decision" of the Maryland courts "as a matter of state law," Carey v. Sugar, 425 U.S. 73, 78, 96 S.Ct. 1208, 1211, 47 L.Ed.2d 587 (1976). If the Maryland courts hold that the directory does not constitute advertising as prohibited by § 129, the need for federal adjudication will disappear. The Maryland courts have not yet construed the sweep of § 129 and Regulation F, and we think we should not provide a "tentative answer which may be displaced tomorrow by a state adjudication." Railroad Comm'n v. Pullman Co., 312 U.S. at 500, 61 S.Ct. at 645. ²

We realize that First Amendment claims do require special attention from a federal court that is considering whether to order abstention, Zwickler v. Koota, 389 U.S. 241, 249-52, 88 S.Ct. 391, 19 L.Ed.2d 444 (1967), and abstention is not in order "simply to give state courts the first opportunity to vindicate the federal claim," Zwickler at 251, 88 S.Ct. at 397, but abstention is not always precluded by a claim of First Amendment privilege. Harrison v. NAACP, 360 U.S. 167, 79 S.Ct. 1025, 3 L.Ed.2d 1152 (1959). The decision to abstain "involves a discretionary exercise of a court's equity powers," Baggett v. Bullitt, 377 U.S. 360, 375, 84 S.Ct. 1316, 1324, 12 L.Ed.2d 377 (1964), and we are not persuaded that the three-judge court abused its discretion. Certainly, this is not a case like Griffin v. School Board, 377 U.S. 218, 229, 84 S.Ct. 1226, 1232, 12 L.Ed.2d 256 (1964), with a long history of "resistance at the state and county level, by legislation, and by lawsuits" to well-settled constitutional rights. Indeed, the sole area of disagreement between the parties, and now awaiting decision in the Maryland courts, is the very question reserved in Bates v. State Bar of Arizona, 433 U.S. 350, 97 S.Ct. 2691, 53 L.Ed.2d 810 (1977): ". . . we need not...