The decision of the state court that an offense under a statute
did not depend on conditions as to notice contained in another
statute is conclusive on this Court, and one convicted in a state
court is not denied due process of law by reason of such
construction.
The police power of the state particularly extends to regulating
trades and callings concerning public health, and practitioners of
medicine are properly subject to police regulation, the details of
which are primarily with the legislature and are not to be
interfered with by the federal courts so long as fundamental
constitutional rights are not violated.
Dent v. West
Virginia, 129 U. S. 114.
Classification will not render a state police statute
unconstitutional as denying equal protection of the law so long as
there is a reasonable basis for such classification; nor will
exceptions of specified classes render the law unconstitutional
unless there is no fair reason for the law that would not equally
require its extension to the excepted class.
Williams v.
Arkansas, 217 U. S. 79.
The medical registration law of Maryland (art. 43, § 83, Code of
1904) is not unconstitutional as denying equal protection of the
law because its provisions do not apply to those who practiced
prior to a specified date and treated at least twelve persons
within a year prior thereto, or because it does not apply to
gratuitous services, or to physicians in hospitals, none of the
exceptions being unreasonable.
105 Md. 650 affirmed.
The facts, which involve the constitutionality of the statute of
Maryland relative to registration of medical practitioners in that
state, are stated in the opinion.
Page 218 U. S. 174
MR. JUSTICE DAY delivered the opinion of the Court.
The plaintiff in error was convicted in the Circuit Court of
Allegany County, Maryland, for a violation of § 99 of article 43 of
the Maryland Code of 1904, for the offense of practicing medicine
in the State of Maryland without being registered in accordance
with the provisions of §§ 83 and 89 of the same article. The
Maryland act in question, requiring registration of physicians,
provides a comprehensive system for the regulation of the practice
of medicine and surgery, and, concerning the necessity of
registration, enacts (Art. 43, § 83):
"All persons, except physicians who were practicing medicine in
this state prior to the first day of January, 1898, who are now
practicing medicine or surgery, and can prove by affidavit that
within one year of said date said physician had treated in his
professional capacity at least twelve persons, who shall commence
the practice of medicine or surgery in any of their branches after
the eleventh day of April, 1902, shall make a written application
for license to the president of either board of medical
examiners,"
etc.
The statute requires proof of good moral character, certain
school education, and makes provision as to the effect of diplomas
from certain medical colleges, and as to other and various details
required of an applicant for the practice of medicine or
surgery.
The judgment of conviction was affirmed by the Court of Appeals
of Maryland (105 Md. 650), and the case is brought here to review
that judgment, because of alleged violation of certain rights
secured to the plaintiff in error by the federal Constitution. The
first of these grounds concerns § 80 of the same act, which
provides for the sending of notice to physicians practicing in the
state without being legally registered, and further providing that
those physicians being entitled to register, and yet
Page 218 U. S. 175
have failed to comply at the expiration of four months from the
election of the secretary-treasurer of the board, shall be
prosecuted, and that no one after the eleventh day of April, 1902,
shall be allowed to practice medicine or surgery without being duly
registered according to the provision of the subtitle.
The contention of the plaintiff in error is that there being no
charge in the indictment, nor proof in the case, that he was
furnished with this notice, his conviction was without due process
of law. But the Court of Appeals of Maryland, examining this
question, determined that § 99, under which the indictment was
prosecuted, making it a misdemeanor to attempt to practice medicine
in the State of Maryland without registration, was not subject to
the limitations of § 80, relating to the sending of the notice,
etc.
The offense, the Court of Appeals held, was created solely by §
99 in broad and general language, without exceptions or
qualification, and that, for conviction under that section, it was
not essential to prove the sending of the notice required by § 80.
This construction of the Maryland statute is conclusive upon us.
The accused had a trial before a court and jury under the statutes
of Maryland, was proceeded against under the forms provided for by
the laws of that state, and under a statute which the highest court
of the state has held completely defined the offense without
resorting to the necessity of notifying unregistered physicians
before they became liable for the penalties of the act for
practicing without registration. The contention that the conviction
in this aspect was without due process of law under the federal
Constitution cannot be sustained.
It is next contended that § 83 violates the federal
Constitution, in the Fourteenth Amendment thereof, in denying to
the plaintiff in error the equal protection of the laws, in that it
makes unreasonable and arbitrary
Page 218 U. S. 176
distinction in its classification of physicians, including some
and excluding others, and in making unreasonable omissions of
certain classes from the requirements of the act, as shown in the
exemption of certain classes from its requirements. It is contended
that to except from the provisions of the act the physicians who
were practicing medicine in the state prior to the first day of
January, 1898, who at the time of the passage of the act, were
practicing medicine or surgery, and who could prove by affidavit
that within one year of said date they had treated at least twelve
persons in their professional capacity, is an unreasonable and
arbitrary classification, resulting in the exclusion from the
exception of physicians of equal merit and like qualifications with
those who are within its terms.
It is too well settled to require discussion at this day that
the police power of the states extends to the regulation of certain
trades and callings, particularly those which closely concern the
public health. There is perhaps no profession more properly open to
such regulation than that which embraces the practitioners of
medicine. Dealing, as its followers do, with the lives and health
of the people, and requiring for its successful practice general
education and technical skill, as well as good character, it is
obviously one of those vocations where the power of the state may
be exerted to see that only properly qualified persons shall
undertake its responsible and difficult duties. To this end, many
of the states of the Union have enacted statutes which require the
practitioner of medicine to submit to an examination by a competent
board of physicians and surgeons, and to receive duly authenticated
certificates showing that they are deemed to possess the necessary
qualifications of learning, skill, and character essential to their
calling. In
Dent v. West Virginia, 129 U.
S. 114, the subject is elaborately considered, and this
view affirmed by Mr. Justice Field, speaking for the Court.
Page 218 U. S. 177
In such statutes there are often found exceptions in favor of
those who have practiced their calling for a period of years. In
the
Dent case,
supra, an exception was made in
favor of practitioners of medicine who had continuously practiced
their profession for ten years prior to a date shortly before the
enactment of the law. Such exception proceeds upon the theory that
those who have acceptably followed the profession in the community
for a period of years may be assumed to have the qualifications
which others are required to manifest as a result of an examination
before a board of medical experts. In the statute under
consideration, the excepted class were those who had practiced
before the first day of January, 1898, being more than four years
before the passage of the law, and who could show, presumably with
a view to establishing that they were actively practicing at that
time, that they had treated at least twelve persons within one year
of that date.
Conceding the power of the legislature to make regulations of
this character, and to exempt the experienced and accepted
physicians from the requirements of an examination and certificate,
the details of such legislation rest primarily within the
discretion of the state legislature. It is the lawmaking body, and
the federal courts can only interfere when fundamental rights
guaranteed by the federal Constitution are violated in the
enactment of such statutes.
This subject has been so frequently and recently before this
Court as not to require an extended consideration. The right to
regulate occupations was considered by this Court at the present
term in the case of
Williams v. Arkansas, 217 U. S.
79, in which it was held that a state statute which
prohibited a certain class of drumming or soliciting of business on
trains did not amount to a denial of the equal protection of the
law. In that case, the recent cases in this Court were reviewed
and
Page 218 U. S. 178
followed. It was therein held that regulations of a particular
trade or business essential to the public health and safety were
within the legislative capacity of the state in the exercise of its
police power, and that, unless such regulations are so unreasonable
and extravagant as to interfere with property and personal rights
of citizens unnecessarily and arbitrarily, they are within the
power of the state, and that the classification of the subjects of
such legislation, so long as such classification has a reasonable
basis, and is not merely arbitrary selection without real
difference between the subjects included and those omitted from the
law, does not deny to the citizen the equal protection of the laws.
Applying these tests, we see nothing arbitrary or oppressive in the
classification of physicians subject to the provisions of this
statute, which excludes from its requirements those who have
practiced prior to January 1, 1898, and were able to show that they
had treated at least twelve persons in a professional way within a
year of that date.
But it is insisted that undue discrimination is shown and equal
protection of the law denied in the exceptions of the statute
provided for in Art. 43, § 101, of the Code. These exceptions are
contained in the following portions of that section:
". . . but nothing herein contained shall be construed to apply
to gratuitous services, nor to any resident or assistant resident
physicians or students at hospitals, in the discharge of their
hospital or dispensary duties, or in the office of physicians, or
to any physician or surgeon from another state, territory, or
district in which he resides, when in actual consultation with a
legal practitioner of this state, or to commissioned surgeons of
the United States Army or Navy or Marine Hospital Service, or to
chiropodists, or to midwives, or to masseurs or other manual
manipulators, who use no other means; nor shall the provisions of
this subtitle apply to physicians or surgeons
Page 218 U. S. 179
residing on the borders of a neighboring state, and duly
authorized under the laws thereof to practice medicine or surgery
therein, whose practice extends into the limits of this state:
Provided, that such practitioners shall not open an office
or appoint places to meet their patients or receive calls within
the limits of this state without complying with the provisions of
this subtitle:
Provided, that the same privileges be
accorded to licensed physicians of this state:
Provided,
further, that nothing in this subtitle shall annul any of the
provisions of article 32, title 'Dentistry,' nor shall apply to any
registered graduate of dental surgery now practicing in the said
State of Maryland, with the sign titles Dentist, surgeon dentist,
dental surgeon, or stomatologist."
The Court of Appeals of Maryland contented itself on this branch
of the case with a reference to its former decisions as to certain
of the exceptions, and, as to the others, with the expression of
the opinion that all of them came within the discretion vested in
the legislature, in the exercise of the police power, to make
regulations for the public health and safety. We shall not take
occasion to consider each of these exceptions. A reading of them
makes it manifest that they are not without reason. Before a law of
this kind can be declared violative of the Fourteenth Amendment as
an unreasonable classification of the subjects of such legislation
because of the omission of certain classes, the court must be able
to say that there is "no fair reason for the law that would not
require with equal force its extension to others whom it leaves
untouched." Such was the expression of this Court in
Missouri,
Kansas & Texas R. Co. v. May, 194
U. S. 269, quoted with approval in
Williams v.
Arkansas, supra.
The stress of the argument for the plaintiff in error as to
these exceptions is put upon the exemption of resident physicians,
or assistant physicians at hospitals, and students on hospital and
dispensary duties. The selection
Page 218 U. S. 180
of the exempted classes was within the legislative power,
subject only to the restriction that it be not arbitrary or
oppressive, and apply equally to all persons similarly situated. We
cannot say that these exceptions nullify the law. The reason for
them may be that hospitals are very often the subject of state or
municipal regulation and control, and employment in them may be by
boards responsible to public authority under state law or municipal
ordinance. Certainly the conduct of such institutions may be
regulated by such laws or municipal regulations as might not reach
the general practitioner of medicine. In any event, we cannot say
that these exceptions are so wholly arbitrary and have such slight
relation to the objects to be attained by the law as to require the
courts to strike them down as a denial of the equal protection of
the law within the meaning of the federal Constitution.
Other questions are made in the record, but they do not present
alleged denials of rights of a federal character, reviewable here.
We find no error in the judgment of the Court of Appeals of
Maryland, and the same is affirmed.
Affirmed.