Hoem v. State , 1988 Wyo. LEXIS 88 ( 1988 )

MACY, Justice.

This Court is asked to determine the constitutionality of the Wyoming Medical Review Panel Act, § 9-2-1501 et seq., W.S. 1977. We hold that the act is unconstitutional because it violates the equal protection clause of the state constitution.

The act was passed in 1986 for the following purpose:

“[T]o prevent where possible the filing in court of actions against health care providers and their employees for professional liability in situations where the facts do not permit at least a reasonable inference of malpractice and to make possible the fair and equitable disposition of such claims against health care providers as are, or reasonably may be, well founded.” Section 9-2-1502, W.S.1977.

The act creates the Wyoming medical review panel and provides that the attorney general or his designee shall serve as director of the panel and shall promulgate rules and regulations to implement the act. Section 9-2-1505, W.S.1977. The act also provides that the panel shall consist of two health care providers, two lawyers, and one lay person. Section 9-2-1508, W.S.1977. The panel is authorized to review all medical malpractice claims against health care providers. No complaint alleging medical malpractice can be filed in court unless a claim has been filed with the panel and a decision has been rendered. Section 9-2-1506, W.S.1977.' Under the act, claimants are required to submit a claim setting forth

“[a] statement in reasonable detail of the elements of the health care provider’s conduct which are believed to constitute a malpractice claim, the dates the conduct occurred, and the names and addresses of all physicians, dentists and hospitals having contact with the claimant relevant to the claim and all witnesses[.]” Section 9-2-1507(a)(i), W.S.1977.

The claim also must include a statement signed by the claimant authorizing the panel to have access to all medical, dental, and hospital records pertaining to the claim. The act requires the health care provider to answer the claim within 30 days and to submit a statement authorizing the panel to inspect all medical records pertaining to the claim. A hearing must be held within 120 days after the director receives a claim unless the director or the panel finds good cause for delaying the hearing. Section 9-2-1509, W.S.1977. The hearing is informal, and neither the Wyoming Rules of Evidence nor the Wyoming Administrative Procedure Act applies. The panel must determine whether there is

“(i) [substantial evidence that the acts complained of occurred and that they constitute malpractice; and

“(ii) [a] reasonable probability that the patient was injured as a result of the acts complained of.” Section 9-2-1510(a), W.S.1977.

Panel deliberations are confidential, and any records kept are to be used solely for compiling statistical data and facilitating ongoing studies of medical malpractice in Wyoming. Sections 9-2-1510 and 9-2-1511, W.S.1977. The panel’s decision is not subject to review in court, it is not binding on either party, and it is not admissible at trial. Sections 9-2-1509, 9-2-1510, and 9-2-1511.

Plaintiff sets forth the following constitutional challenges to the act:

“1. Does the Wyoming Medical Review Panel Act deny ‘equal protection’ and, as such, violate Article 1, Section 2; Article 1, Section 3; Article 1, Section 6; Article 1, Section 7; Article 1, Section 34 and Article 3, Section 27 of the Wyoming Constitution and the Fourteenth Amendment of the United States Constitution?

“2. Does the Wyoming Medical Review Panel Act unconstitutionally infringe upon the constitutional and inherent power of the Wyoming Supreme Court, in violation of Article 5, Section 2 of the Wyoming Constitution?

“3. Does the Wyoming Medical Review Panel Act unconstitutionally impede free access to courts, in violation of Article 1, Section 6; Article 1, Section 8; Article 1, Section 9 and Article 10, Section 4 of the Wyoming Constitution and the Fourteenth Amendment to the United States Constitution?

“4. Does the required confidentiality of the Panel proceedings and decision violate the First and Fourteenth Amendments to the Constitution of the United States of America and Article 1, Section 6; Article 1, Section 8 and Article 1, Section 20 of the Wyoming Constitution?”

Because our holding as to plaintiff’s equal protection claim is dispositive of this appeal, we decline to address the remaining issues set forth by plaintiff. The following constitutional provisions are relevant to plaintiff’s equal protection challenge:

Article 1, § 2 of the Wyoming Constitution.

“In their inherent right to life, liberty and the pursuit of happiness, all members of the human race are equal.” Article 1, § 3 of the Wyoming Constitution.

“Since equality and the enjoyment of natural and civil rights is only made sure through political equality, the laws of this state affecting the political rights and privileges of its citizens shall be without distinction of race, color, sex, or any circumstance or condition whatsoever other than individual incompetency, or unworthiness duly ascertained by a court of competent jurisdiction.”

Article 1, § 6 of the Wyoming Constitution.

“No person shall be deprived of life, liberty or property without due process of law.”

Article 1, § 7 of the Wyoming Constitution.

“Absolute, arbitrary power over the lives, liberty and property of freemen exists nowhere in a republic, not even in the largest majority.”

Article 1, § 8 of the Wyoming Constitution, in pertinent part.

“All courts shall be open and every person for an injury done to person, reputation or property shall have justice administered without sale, denial or delay.” Article 1, § 34 of the Wyoming Constitution.

“All laws of a general nature shall have a uniform operation.”

Article 3, § 27 of the Wyoming Constitution, in pertinent part.

“The legislature shall not pass local or special laws in any of the following enumerated cases, that is to say: * * * for limitation of civil actions * *

Relying upon these provisions, plaintiff claims that the act violates her equal protection rights in that, on the one hand, it singles out a limited class of health care providers for special protection while, on the other hand, it places an added burden on persons injured by health care providers. Plaintiff argues that the act treats medical malpractice victims differently than those injured by the tortious conduct of someone other than a health care provider in that only medical malpractice victims are prohibited from filing a claim for personal injury directly in court. Plaintiff argues that such a classification is arbitrary, unreasonable, and unrelated to the purpose for which the act was passed.

When considering constitutional claims, this Court has applied the following standards:

“It is clear, according to the stance previously adopted by this court, that there must be some difference which furnishes a reasonable basis for different legislation as to different classes, and the differences must not be arbitrary and without just relation to the subject of the legislation. One who assails a classification must carry the burden of showing that it does not rest on a reasonable basis, but is essentially arbitrary.” Mountain Fuel Supply Company v. Emerson, Wyo., 578 P.2d 1351, 1354-55 (1978) (citations omitted).

“[CJourts * * * have proceeded upon the assumption that members of the legislature will investigate and determine for themselves whether or not a proposed law will violate the constitution, and accordingly, have adopted the rule that no law will be declared unconstitutional unless it is clearly so.” Bell v. Gray, Wyo., 377 P.2d 924, 925-26 (1963).

“If any state of facts can be reasonably conceived which sustain[s] the classification, such facts will be assumed.” Mountain Fuel Supply Company v. Emerson, 578 P.2d at 1355.

“Although we have a duty to give great deference to legislative pronouncements and to uphold their constitutionality where possible, it is equally imperative that we declare them invalid when they transgress the Wyoming Constitution.” Brenner v. City of Casper, Wyo., 723 P.2d 558, 560 (1986) (emphasis added).

Applying these standards to the present case, we look first to the state interest intended to be furthered by the act. As demonstrated above, the act was intended to prevent the filing in court of claims against certain health care providers where the facts do not permit a reasonable inference of malpractice and to make possible the fair and equitable disposition of well-founded claims against health care providers. In attempting to reduce the number of claims filed in court against health care providers, the legislature was responding to the perceived medical malpractice insurance “crisis.” The hope was that, by reducing the number of medical malpractice lawsuits, insurance rates would drop and coverage would become more available and affordable.

Before proceeding further with our inquiry, we note the absence in the record of any evidence demonstrating the existence of such a crisis in Wyoming or elsewhere. More importantly, we note the absence in the record of any evidence that the “crisis,” if in fact it exists, is in any way connected with medical malpractice claims. The statement of purpose contained in the act offers no explanation as to why the legislature’s sole response to the insurance “crisis” was to attempt to change commonly recognized procedures and principles related to causes of action in tort. The act is silent as to other conceivable causes of the “crisis” such as poor management, bad underwriting, and bad investments by the insurance industry. Likewise, the act is silent as to other conceivable approaches to solving the alleged crisis such as regulation of the insurance industry. Apparently, tort reform was the only avenue explored by the legislature in its efforts to solve the “crisis.” While it is true that “[t]he social wisdom of the legislature’s policy choices is, of course, irrelevant to the question of constitutionality of the Act,” it also is true that “[c]omplete disregard for other potential policy options is, however, of at least tangential relevance when considering whether a legislative * * * goal is a legitimate one.” Waggoner v. Gibson, 647 F.Supp. 1102, 1104 n. 3 (N.D.Tex.1986).

Assuming, however, for the purposes of this opinion, that an insurance crisis does exist in Wyoming and that it is related to medical malpractice litigation, we must determine whether the legislation enacted is rationally related to its stated purpose. There is no question that the legislature has a legitimate interest in protecting the health of the citizens of Wyoming as well as the economic and social stability of the state. The question is whether the legislation at issue constitutes a reasonable and effective means of doing so. We maintain that it does not. It cannot seriously be contended that the extension of special benefits to the medical profession and the imposition of an additional hurdle in the path of medical malpractice victims relate to the protection of the public health. To the contrary,

“if the medical profession is less accountable than formerly because of the special treatment it is afforded by [medical review panel] laws, then a relaxation of medical standards may occur with the public as the victim. ‘[T]o find that the protection and special dispensation given to health delivery tortfeasors by the challenged legislation is in the best interest of public health is illogical to the point of irrationality.’ ” Boucher v. Sayeed, R.I., 459 A.2d 87, 94 (1983) (quoting from American Bank & Trust Co. v. Community Hospital of Los Gatos-Saratoga, Inc., 104 Cal.App.3d 219, 163 Cal.Rptr. 513, 522 (1980)).

We have said previously that “[t]he continued availability and vitality of * * * causes of action [against health care providers] serve an important public policy— the preservation of quality health care for the citizens of this state.” Greenwood v. Wierdsma, Wyo., 741 P.2d 1079, 1088 (1987). In light of this basic truth, we hold that the legislature’s attempt to limit or reduce such causes of action is not rationally related to a legitimate state interest.

Our holding that the act is not rationally related to protection of the public health or economic and social stability of the state would be sufficient alone to find the act unconstitutional. However, we also are persuaded by the principle that:

“[Constitutional protections are not suspended in time of even the most legitimate crisis. See Youngstown Sheet & Tube Co. v. Sawyer, 343 U.S. 579, 589, 72 S.Ct. 863, 867, 96 L.Ed. 1153 (1952) (constitutional provisions exist ‘in good and bad times’); cf. Korematsu v. United States, 323 U.S. 214, 65 S.Ct. 193, 89 L.Ed. 194 (1944) (since discredited-intemment of Japanese descendants during war); Konigsberg v. State Bar [of California], 353 U.S. 252, 77 S.Ct. 722, 1 L.Ed.2d 810 (1957) (fear of communism).

Constitutional protections exist for litigants regardless of market conditions for insurance companies and the medical industry; concerns about the latter cannot be allowed to overrun the former at the expense of those * * * injured by acts of malpractice.” Waggoner v. Gibson, 647 F.Supp. at 1107.

Although the language quoted above concerns the question of the constitutionality of a limit on the amount recoverable by medical malpractice plaintiffs, it is persuasive in the present case. We cannot condone the legislature’s use of the law to protect one class of people from financial difficulties while it dilutes the rights under the constitution of another class of people. Every profession confronts financial distress at some time, and that does not justify depriving others of the equal protection guaranteed by the constitution.

In holding as we do that the act denies equal protection of the law in violation of the constitution, we are cognizant that the majority of states have upheld similar provisions. However, we find the following language to be convincing:

“Most state courts give considerable deference to the state legislatures’ specific declarations in statutes that such a crisis does exist and that the substantive portions of the statute are intended to alleviate that crisis. A better approach for those courts that have yet to decide the issue would be, however, to take a more skeptical attitude toward the evidence presented by the medical profession and the insurance industry and toward the conclusion reached by the state legislature regarding the existence of a crisis.

“State courts that have swept aside the equal protection argument have seriously shirked their judicial responsibilities. Proper scrutiny of the constitutional validity of state legislation demands more than a perfunctory deferral to the legislature’s conclusions regarding the existence of a health care crisis in the particular state.” Comment, Constitutional Challenges to Medical Malpractice Review Boards, 46 Tenn.L. Rev. 607, 645 (1978) (emphasis added and footnote omitted).

With this admonition in mind, we have no choice but to hold that the Medical Review Panel Act is unconstitutional.

THOMAS, J., filed a specially concurring opinion in which URBIGKIT, J., joined.

CARDINE, J., filed a dissenting opinion in which BROWN, C.J., joined.