Chris Simopoulos, M.D. v. Virginia State Board of Medicine, Marshall Coleman, Fairfax Hospital Association, Potomac Hospital

BUTZNER, Circuit Judge,

concurring and dissenting:

I agree with much of Judge Russell’s scholarly opinion. Specifically, I concur in the affirmance of the part of the district court’s judgment that dismissed on the basis of abstention Dr. Simopoulos’s claim that certain Virginia abortion statutes are unconstitutional. For reasons adequately explained in the majority opinion, Younger v. Harris, 401 U.S. 37, 91 S.Ct. 746, 27 L.Ed.2d 669 (1971), and its related cases provide controlling authority for abstention on this issue.

I dissent from the part of the majority opinion that holds abstention is also required with respect to the doctor’s claim that his license was revoked without affording him procedural due process of law.

I

In determining whether abstention is required, the Supreme Court has distinguished claims of the denial of substantive constitutional rights unaccompanied by denial of procedural due process of law from claims that are based on the complainant’s inability to have his substantive federal rights decided by a state forum in accordance with procedural due process. Compare Gibson v. Berryhill, 411 U.S. 564, 93 S.Ct. 1689, 36 L.Ed.2d 488 (1973), with Juidice v. Vail, 430 U.S. 327, 97 S.Ct. 1211, 51 L.Ed.2d 376 (1977). The Court clarified the significance of this distinction in Gibson, 411 U.S. at 577, 93 S.Ct. at 1697, where, referring to a denial of procedural due process, it said:

Younger v. Harris contemplates the outright dismissal of the federal suit, and the presentation of all claims, both state and federal, to the state courts. Such a course naturally presupposes the opportunity to raise and have timely decided by a competent state tribunal the federal issues involved. Here the predicate for a Younger v. Harris dismissal was lacking, for the appellees alleged, and the District Court concluded, that the State Board of Optometry was incompetent by reason of bias to adjudicate the issues pending before it. If the District Court’s conclusion was correct in this regard, it was also correct that it need not defer to the Board. Nor, in these circumstances, would a different result be required simply because judicial review, de novo or otherwise, would be forthcoming at the conclusion of the administrative proceedings.

The Court has consistently recognized this predicate of Younger. See, e. g., Moore v. Sims, 442 U.S. 415, 430, 99 S.Ct. 2371, 2381, 60 L.Ed.2d 994 (1979); Trainor v. Hernandez, 431 U.S. 434, 441, 97 S.Ct. 1911, 1916, 52 L.Ed.2d 486 (1977); Juidice v. Vail, 430 U.S. 327, 337, 97 S.Ct. 1211, 1218, 51 L.Ed.2d 376 (1977); Huffman v. Pursue, 420 U.S. 592, 594, 95 S.Ct. 1200, 1204, 43 L.Ed.2d 482 (1975).

The facts disclosed by this record establish that the essential predicate for abstention explained in Gibson is lacking with respect to the doctor’s claim that he was deprived of his license without procedural *332due process of law. Time and again the Supreme Court has reiterated that due process encompasses “the opportunity to be heard ... ‘at a meaningful time and in a meaningful manner.’ ” See Barry v. Barchi, 443 U.S. 55, 66, 99 S.Ct. 2642, 2650, 61 L.Ed.2d 365 (1979). Parts III and IV of my dissent demonstrate that the state administrative hearing after the summary revocation of the doctor’s license lacked these fundamental attributes of procedural due process. But first it is necessary to recount pertinent aspects of the state criminal and administrative proceedings.

II

The doctor was convicted of violating Virginia statutes that proscribe as felonies second trimester abortions unless they are performed in a licensed hospital. Va.Code §§ 18.2-71 and 73. His principal defense was that these statutes are unconstitutional facially and as applied to the circumstances .of his case.1 Relying on Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 747 (1973), the doctor insisted that the statutes requiring hospitalization were not reasonably related to the health of his patient. In support, he presented as witnesses the chairman of the department of obstetrics and gynecology at the Albert Einstein College of Medicine, an associate clinical professor in obstetrics and gynecology at George Washington University, and a Virginia physician who specializes in obstetrics and gynecology. These witnesses testified that the procedure followed by the doctor is acceptable medical practice in an outpatient facility, and they stated that the doctor’s clinic was well equipped for such practice. One of the witnesses added that even when treatments to induce a second trimester abortion are administered at a Virginia hospital, where he had served as chairman of the department of obstetrics and gynecology, the patients are frequently allowed to leave the hospital before they abort. The state presented no witness to contradict this testimony.

Although not precisely on point, Doe v. Bolton, 410 U.S. 179, 93 S.Ct. 739, 35 L.Ed.2d 201 (1973), is instructive. There the Court held unconstitutional a statute requiring that abortions be performed only in hospitals accredited by the Joint Commission on Accreditation of Hospitals. At 410 U.S. 194-95, 93 S.Ct. 748-49, the Court explained the criteria that should govern the determination of the constitutionality of statutes that require the performance of abortions in hospitals:

This is not to say that Georgia may not or should not, from and after the end of the first trimester, adopt standards for licensing all facilities where abortions may be performed so long as those standards are legitimately related to the objective the State seeks to accomplish. The appellants [who challenged the constitutionality of the statute] contend that such a relationship would be lacking even in a lesser requirement that an abortion be performed in a licensed hospital, as opposed to a facility, such as a clinic, that may be required by the State to possess all the staffing and services necessary to perform an abortion safely (including those adequate to handle serious complications or other emergency, or arrangements with a nearby hospital to provide such services). Appellants and various amici have presented us with a mass of data purporting to demonstrate that some facilities other than hospitals are entirely adequate to perform abortions if they possess these qualifications. The State, on the other hand, has not presented persuasive data to show that only hospitals meet its acknowledged interest in insuring the quality of the operation and *333the full protection of the patient. We feel compelled to agree with appellants that the State must show more than it has in order to prove that only the full resources of a licensed hospital, rather than those of some other appropriately licensed institution, satisfy these health interests.

Notwithstanding the Supreme Court’s explication of the appropriate criteria for determining the constitutionality of the Virginia statute, the state trial court summarily denied the doctor’s defense. The judge said: “I am certainly not going to go further than the Supreme Court, than I believe the Supreme Court has gone at this point.” The judge then observed that one hospital in the community permitted second trimester abortions. The evidence, however, disclosed that this hospital imposed an absolute requirement for a minor’s parental consent. The judge made no reference to this evidence and did not rule on the claim that this requirement administered in conjunction with the statute raised a question of the statute’s constitutionality. See, e. g., Planned Parenthood Ass’n of Kansas City v. Ashcroft, 483 F.Supp. 679, 687 (W.D.Mo.1980).

The judge added: “Furthermore, from the evidence I have heard, I frankly believe that the regulations that the Virginia Legislature has imposed on second trimester abortions are reasonably related to maternal health and are not unconstitutional in any way.” Just before he sentenced the doctor, the judge commented, “I look at your case as really one where you were doing that which you had a legal right to do, but you weren’t following what I consider legitimate regulations handed down by the legislature of Virginia.”

In reaching his conclusion that the Virginia statutes are constitutional, the judge did not advert to any of the evidence. He made no findings about the factual criteria prescribed by the Supreme Court in Bolton.

After the doctor was found guilty, his license was revoked without a hearing pursuant to Va.Code § 54r-321.2, which mandates revocation or suspension when a physician is convicted of any felony. As allowed by this statute, the doctor applied to the State Board of Medicine for a hearing and reinstatement of his license pending appeal.

The Board granted the doctor a hearing 56 days after his license was revoked. Again the doctor presented evidence from expert witnesses in support of his claim that the procedures he followed in his clinic were acceptable medical practice and that hospitalization was unnecessary to safeguard the patient’s health. The doctor gave assurances that pending his appeal he would not undertake the procedures for which he was convicted.

The Board retired to executive session, and upon its return to public session took a recorded vote. Nine members of the Board voted to reinstate the doctor’s license; four voted against. Because reinstatement requires a vote of three-fourths of the members in attendance, it failed to carry by a fraction of one vote.

Although the statute requires the Board to consider the likelihood of irreparable harm to the physician, the risk of injury to patients or the public, and the seriousness of the offense, the Board made no findings on these issues either orally or in writing. Furthermore, it made no findings with respect to the relative safety of abortions performed in a hospital and those performed in the doctor’s outpatient clinic. Instead, the Secretary of the Board simply notified the doctor that after consideration of the evidence “it was the decision of the Board that your request for termination of revocation of your license to practice medicine in Virginia, pending appeals, be denied.” No reasons for this decision were disclosed.

While this federal appeal was pending, the doctor filed a timely petition for review of the Board’s action in the appropriate state court.

Ill

The due process clause protects a physician’s property interest in his professional *334license. See Barry v. Barchi, 443 U.S. 55, 64, 99 S.Ct. 2642, 2649 (1979); Gibson v. Berryhill, 411 U.S. 564, 93 S.Ct. 1689, 36 L.Ed.2d 488 (1973). I agree with the majority opinion that the doctor’s right to due process was not offended because his license was initially revoked without a hearing. Barry v. Barchi, 443 U.S. at 64-65, 99 S.Ct. at 2648-49; Mackey v. Montrym, 443 U.S. 1. 99 S.Ct. 2612, 61 L.Ed.2d 321 (1979); accord Christhilf v. Annapolis Emergency Hospital Ass’n., 496 F.2d 174, 180 (4th Cir. 1974).

Barry, however, couples its approval of prehearing revocation with the admonition that the state must furnish the licensee with a “prompt judicial or administrative hearing that would definitely determine the issues.... ” 443 U.S. at 64, 99 S.Ct. at 2649. In the absence of an explanation by the state that compelling reasons caused the delay, I would hold that a lapse of 56 days between summary revocation and a hearing does not satisfy the due process clause’s requirement for a prompt postrevo-cation hearing when a physician’s license is at stake. I find it unnecessary, however, to base my dissent solely on the application of the revocation statutes to the doctor’s situation. Barry indicates that the denial of procedural due process is more deeply rooted.

In Barry the statute providing for an administrative postrevocation hearing made no provision for a prompt hearing. The district court declined to abstain to await state interpretation of the statute and granted relief. The Supreme Court affirmed part of the district court’s order, holding that the licensee’s suspension was unconstitutional “for lack of assurance of a prompt postsuspension hearing.” 443 U.S. at 68, 99 S.Ct. at 2651.

Conversely, in Mackey v. Montrym, 443 U.S. 1 (1979), a statute mandating prehear-ing suspension of a driver’s license was held to be constitutional because it afforded the licensee a prompt — indeed an immediate— postsuspension hearing.

Here, as in Barry, and unlike the situation in Mackey, a Virginia physician has no assurance of a prompt postrevocation hearing. The statute provides that a physician whose license has been summarily revoked “shall be entitled to a hearing not later than the regular meeting of the Board next following the expiration of ten days from the receipt of such application....” Va. Code § 54-321.2. The statute governing meetings of the Board requires “not less than one regular meeting a year.”2

We have been told that the Board customarily meets three times a year. But this custom affords no assurance to a physician that he will receive a prompt postrevocation hearing for it lacks the mandate of the statute.3 Moreover, by the express provision of § 54-321.2, a physician whose license is summarily revoked nine days before a regular meeting must await 100 days for his mandatory postrevocation hearing.

Therefore, applying the principles explained in Barry and Mackey, I conclude that the lack of assurance of a prompt postrevocation hearing, as well as the actual lapse of 56 days, deprived the doctor of his property interest in his license without procedural due process of law.

*335IV

The doctor’s right to procedural due process of law was abridged for an independent reason. The due process clause requires an administrative agency to state the findings that undergird its order and the reasons for its decision. Vitek v. Jones, 445 U.S. 480, 495-96, 100 S.Ct. 1254, 1264-65, 63 L.Ed.2d 552 (1980); Panama Refining Co. v. Ryan, 293 U.S. 388, 432, 55 S.Ct. 241, 253, 79 L.Ed. 446 (1935). In Wolff v. McDonnell, 418 U.S. 539, 564, 94 S.Ct. 2963, 2978, 41 L.Ed.2d 935 (1974), the Court held that “there must be a ‘written statement by the factfinders as to the evidence relied on and reasons’ for the disciplinary action” meted out to a prisoner. We recently emphasized this principle in Franklin v. Shields, 569 F.2d 784, 801 (4th Cir. 1977), where speaking of parole hearings we said: “[A]t the present time the only explicit constitutional requisite is that the Board furnish to the prisoner a statement of its reasons for denial of parole.”

The Board did not adhere to this elemental precept of procedural due process. One would not expect the Board to issue an opinion on the constitutionality of the abortion statutes. But because of the expertise of some of its members, it is admirably fitted to make factual findings about the inquiries the Virginia statute requires it to consider.4 In the context of this case, these findings would also encompass the factual criteria that the Supreme Court has said are essential for determining the constitutionality of an abortion statute. As pointed out in Part II of this opinion, the Board made no findings whatsoever and issued no opinion. Without furnishing any reasons, the Board simply announced that it would not terminate the summary revocation of the doctor’s license.

In most instances, the Board could probably rely on the judgment of the state trial court when a physician has been convicted of a felony, and it could incorporate by reference the record of the state criminal trial in its decision. Here the Board did not even do that. Moreover, as pointed out in Part II, the record of the criminal trial is deficient, for the state court made none of the evidentiary findings essential to determine whether the abortion statutes are constitutional.

The doctor’s challenge of the constitutionality of the Virginia abortion statutes is not frivolous.5 Nevertheless, his license has been revoked despite the fact that no state tribunal, either judicial or administrative, has made the factual findings essential for deciding whether the statutes he violated are constitutional. Furthermore, the Board gave no reasons for its action.

Accordingly, I conclude that the doctor’s license has been revoked without any state tribunal according him the procedural due process of law required by Vitek v. Jones, 445 U.S. 480, 495-96, 100 S.Ct. 1254, 1264-65, 63 L.Ed.2d 552 (1980); Wolff v. McDonnell, 418 U.S. 539, 564-65, 94 S.Ct. 2963, 2978-79, 41 L.Ed.2d 935 (1974); Panama Refining Co. v. Ryan, 293 U.S. 388, 432, 55 S.Ct. 241, 253, 79 L.Ed. 446 (1935), and Franklin v. Shields, 569 F.2d 784, 801 (4th Cir. 1977).

V

The state also contends that abstention is required because review of the Board’s action by a state court will satisfy the requirements of the due process clause. I cannot accept this argument.

The doctor has exhausted his administrative remedies. Because of the lack of assurance of a prompt postrevocation hearing and the failure of the Board to state any *336reasons for its action, these remedies have not afforded the doctor procedural due process. Under these circumstances, I believe the principles explained in Gibson v. Berryhill, 411 U.S. 564, 577, 93 S.Ct. 1689, 1697, 36 L.Ed.2d 488 (1973), are applicable. Although the facts of that case differ from those before us, its rationale cannot be put aside. Gibson teaches that when a licensee is denied procedural due process by an administrative agency, abstention is not required simply because the licensee can seek judicial review of the administrative action, de novo or otherwise.6 I think Gibson is dispositive, but because the point is pressed, I add the following observations.

If the doctor is relegated to the state reviewing court for a determination of the reasons why his license should, or should not, be restored, it is apparent that this forum would afford the only significant postrevocation hearing provided by the state. But such review cannot be sought until after the administrative hearing. The inordinate lapse of time between summary revocation and completion of review would not satisfy the requirements of Barry v. Barchi, 443 U.S. 55, 99 S.Ct. 2642, 61 L.Ed.2d 365 (1979), and Mackey v. Montrym, 443 U.S. 1, 99 S.Ct. 2612, 61 L.Ed.2d 321 (1979), for a prompt postrevocation hearing.

Furthermore, the total absence of findings and statement of reasons for the Board’s action render doubtful the utility of reviewing the administrative proceedings. Cf. S.E.C. v. Chenery Corp., 318 U.S. 80, 92-95, 63 S.Ct. 454, 461-62, 87 L.Ed. 626 (1943). A remand by the reviewing court to the Board to correct these deficiencies would not comport with the requirement of a prompt postrevocation hearing.

Huffman v. Pursue, 420 U.S. 592, 95 S.Ct. 1200, 43 L.Ed.2d 482 (1975), and Scruggs v. Campbell, 630 F.2d 237 (4th Cir. 1980), do not support the state’s position. Neither of these cases require abstention with respect to the doctor’s procedural due process claims. The complainant in Huffman had litigated a substantive challenge to the constitutionality of a state statute in a state court. Dissatisfied, he sought to relitigate the same substantive question in federal court. The case did not involve, as here, proof that the state remedies were procedurally defective. Huffman is pertinent to that portion of. the doctor’s complaint that sought a judgment declaring the abortion statutes unconstitutional — an aspect of this case in which I agree that abstention is proper. It did not involve, however, any claim that the state proceedings deprived the claimant of his property without affording him procedural due process of law.

Scruggs also misses the mark. There a federal statute allowed the party aggrieved by an administrative decision to seek review in either state or federal court. Applying this statute when the aggrieved party had petitioned the state court, we held that the other party could not bifurcate review or forestall state review by commencing a federal suit before the administrative proceedings were completed. By the terms of the statute, one judicial forum was sufficient. 630 F.2d at 238-39.

Rucker v. Wilson, 475 F.Supp. 1164 (E.D.Mich.1979), is also distinguishable. In Rucker the doctor’s license had not been summarily revoked without a hearing. The question before the medical board was whether his license should be revoked. The delay in the board’s proceedings did not deprive him of a property interest because, pending resolution by the board of the complaints against him, he was entitled to practice his profession. The absence of a prehearing revocation in Rucker is the critical factual distinction between that case and the one we are considering. If in Rucker, as here, the doctor’s license had been summarily revoked and he was not assured a prompt postrevocation hearing before the board, the principles explained in Barry v. Barchi, 443 U.S. 55, 99 S.Ct. 2642, 61 L.Ed.2d 365 (1979), would have afforded him relief in a federal court because he had been deprived of his property interest in his license without procedural due process of law.

*337VI

Finally, in addition to the legal issues involved in this ease, there remain equitable considerations concerning the relief which the doctor seeks. These involve weighing the interests of the state in protecting and vindicating the public interest against the harm that a physician suffers by revocation of his professional license. Although the harm to the doctor is substantial, the principal factor to be considered is the likelihood of endangering the public if he is permitted to practice pending his appeal to the Supreme Court of Virginia.

The record discloses the following facts. The doctor is a Diplómate of the American Board of Obstetrics and Gynecology and a Fellow of the American College of Obstetricians and Gynecologists. He has given assurances that pending appeal of his conviction he will not undertake the outpatient procedures for which he was prosecuted. At the conclusion of the state trial, the prosecutor described the doctor’s violation of the abortion statutes as “victimless activity” and recommended a suspended sentence with community service. The judge, who also was aware of the nature of the doctor’s culpability, stated that while he had no control over the license and took no position concerning it, “If they determine that you should keep your license, that would be fine with me.”7 The two hospitals where the doctor practiced filed answers in this action stating that his staff privileges would be reinstated if his license were restored. Nine of the fourteen members of the Board voted to reinstate his license.

These facts persuade me that there is no showing of likelihood of danger to the public if the doctor is permitted to practice pending his appeal. Accordingly, I would remand this case to the district court with directions to grant an injunction restraining revocation of the doctor’s license pending appeal of his conviction to the Supreme Court of Virginia, conditioned on his compliance with the Virginia statutes pertaining to abortions,

. The application of the statute was asserted to be unconstitutional because it was administered in conjunction with hospital rules that required parental consent for a minor’s abortion. See Planned Parenthood Ass’n of Kansas City v. Ashcroft, 483 F.Supp. 679, 687 (W.D.Mo.1980). Cf. Bellotti v. Baird, 443 U.S. 622, 651, 99 S.Ct. 3035, 3052, 61 L.Ed.2d 797 (1979); Planned Parenthood of Missouri v. Danforth, 428 U.S. 52, 74, 96 S.Ct. 2831, 2843, 49 L.Ed.2d 788 (1976) (statutes unqualifiedly imposing provisions for parental consent are unconstitutional).

. Va.Code § 54.290 provides:

Regular meetings of the Board shall be held at such times and places as the Board shall prescribe, and special meetings may be held upon the call of the president and any eight members, but there shall be not less than one regular meeting each year. Nine members of the Board shall constitute a quorum.

. The statute makes no provision for a mandatory expedited hearing, although in its discretion the Board can convene a special meeting upon the call of the president and eight members. Va.Code §§ 54-321.2 and 54-290. The Board was polled in mid-June, but a quorum was not obtained for a special meeting. The district court found that the doctor had not made formal application for a hearing, but that as a result of a telephone call from the doctor’s counsel, the Board scheduled a hearing on July 18. This was the date of the next regular meeting of the Board. The doctor’s brief states that this call was made in April and the Board declined to schedule an earlier hearing. Because the district court made no findings about the date of the telephone call and its contents, I believe it would be improper to rely on this incident as a basis of decision.

. Most of the members of the Board are medical doctors. Serving with them are an osteopath, a podiatrist, a chiropractor, and a clinical psychologist. Va.Code § 54 — 284.

. The constitutional question, which the doctor raised, has not yet been definitively resolved. Two federal courts have held that state statutes requiring hospitalization for second trimester abortions are unconstitutional. Margaret S. v. Edwards, 488 F.Supp. 181, 191-96 (E.D.La.1980); Planned Parenthood Ass’n of Kansas City v. Ashcroft, 483 F.Supp. 679, 685-87 (W.D.Mo.1980); contra, Wynn v. Scott, 449 F.Supp. 1302, 1317, 1318 (N.D.Ill.1978), appeal dismissed, 439 U.S. 8, 99 S.Ct. 49, 58 L.Ed.2d 7, aff'd 599 F.2d 193 (7th Cir. 1979).

. The pertinent text of Gibson is quoted, supra, in Part I.

. The punishment imposed by the judge would not have prevented the doctor from continuing his practice. The court suspended a two-year sentence, ordered him confined to the county jail for 30 days to be served on weekends, and placed him on inactive probation for two years. Execution of the sentence was suspended pending appeal.