Ketcham v. King County Medical Service Corp.

Finley, J.

(dissenting)—The majority has gone to great lengths apparently in an attempt to show that optometrists are less desirable than ophthalmologists as members of the healing arts; that, in comparison with opthalmologists, the inability of optometrists to deal with a variety of medical conditions renders them an almost inept faction of this state’s licensed practitioners. Indeed, following this descriptive essay on the comparative professionalism of the two groups, one wonders why the state chose to license optometrists. However, not only has the State of Washington licensed them, but thousands of people within this state *580rely upon their services. Hence, most of this discussion by the majority seems quite irrelevant.

Further,- the issue before this court is not. whether the legislative enactment under consideration “against their will compels the ophthalmologists ... to practice in a professional association with the optometrists,” as suggested by the majority. Nor is it one of “[cjompelling the opthalmologists to reimburse the patient for the costs of optometric refractions.” As it happens, neither allegation follows from the statute:

Whenever a health care service contractor has entered into an agreement with his subscribers' for vision care, and this service is performed by a licensee under chapter 18.53 RCW, who is neither a health care service contractor nor a participant, then reimbursement or indemnity shall be provided the persons paying for this service in the same amount as that given to a participant.

Laws of 1969, ch. 143, p. 504 (RCW 48.44.025). The issue squarely put, without dubious ad lib embellishments, is whether the State of Washington may, through the exercise of its police power, protect the health and welfare of the public by ensuring indemnification for optometric services to medical care program subscribers.

It is important to note at the outset that the real parties affected by this legislation are subscribers in need of the services of optometrists; in comparison, the interest of the opthalmologist, as a third-party beneficiary to the contract between the program administrators and subscribers,' is rather incidental to say the least. To determine whether the plaintiff-respondent ophthalmologists herein are justified in demanding that the immediate statute be stricken down as unconstitutional and that subscribers not be reimbursed by the program administrators for optometric services obtained by subscribers, it is the duty of this court to weigh the police power of the state to regulate health care service contracts against the limited interest of the opthalmologists in excluding optometrists from reimbursement by the program administrators. As the majority admits, the state’s *581power to regulate businesses and professions overrides contracts inconsistent therewith “[i]f a state of facts justifying the legislation in question can be conceived to exist;” the test is whether “a rational connection between the accomplishment of the purpose and the means employed” can be found. ¡Unfortunately, after setting out this test, the majority completely ignores it, failing to suggest any purpose behind the immediate legislation, and refusing to determine whether there exists a rational connection between the end and the means. It is Justice Hunter in dissent who cogently suggests that the legislative purpose is one of providing freedom of choice to subscribers for vision care as between optometrists and opthalmologists, as well as that of affording a greater opportunity for obtaining vision care. In providing that subscribers be reimbursed for amounts expended for necessary vision care by licensed optometrists, the legislature has reasonably achieved these ends. Lacking an assessment of legislative purpose and a reasoned application of the “rational connection” test which it sets up, the majority usurps the power and function of the legislature in declaring the statute void.

In Decker v. Decker, 52 Wn.2d 456, 464-65, 326 P.2d 332 (1958), this court established the relation of U.S. Const, art. 1, § 10, regarding impairment of contract obligations, to the police power of the state:

In Home Bldg. & Loan Ass’n v. Blaisdell (1934), 290 U. S. 398, 78 L. Ed. 413, 54 S. Ct. 231, 88 A. L. R. 1481, Chief Justice Hughes discussed the constitutional guarantee to freedom of contract. On page 347, he quoted from a previous United States supreme court case:
“ ‘It is the settled law of this court that the interdiction of statutes impairing the obligation of contracts does not prevent the State from exercising such powers as are vested in it for ,the promotion of the common weal, or are necessary for the general good of the public, though contracts previously entered into between individuals may thereby be affected. This power., which in its various ramifications is known as the police power, is an exercise of the sovereign right of the Government to protect the lives, health, morals, comfort and general welfare of. the *582people, and is paramount to any rights under contracts between individuals”

(Italics mine.) Accord, State v. Dexter, 32 Wn.2d 551, 202 P.2d 906, 13 A.L.R.2d 1081 (1949), aff’d, 338 U.S. 863, 94 L. Ed. 529, 70 S. Ct. 147 (1949). This police power extends as well to the economic needs of the people; thus, the guaranteed reimbursement aspect of the statute before this court (RCW 48.44.025) clearly takes precedence over the terms of the immediate medical service contracts, thereby amending them. Veix v. Sixth Ward Bldg. & Loan Ass’n, 310 U.S. 32, 84 L. Ed. 1061, 60 S. Ct. 792 (1940).

Noting, then, that the substantive area of this legislation falls directly within the police power of the state, the only remaining question for this court involves the extent of legislative discretion in exercising this power. In this regard, the United States Supreme Court stated the following in East New York Sav. Bank v. Hahn, 326 U.S. 230, 232-33, 90 L. Ed. 34, 66 S. Ct. 69, 160 A.L.R. 1279 (1945):

The formal mode of reasoning by means of which this “protective power of the State,” 290 U. S. at 440, is acknowledged is of little moment. It may be treated as an implied condition of every contract and, as such, as much part of the contract as though it were written into it, whereby the State’s exercise of its power enforces, and does not impair, a contract. . . . Once we are in this domain of the reserve power of a State we must respect the “wide discretion on the part of the legislature in determining what is and what is not necessary.”

(Italics mine.) Accord, Faitoute Iron & Steel Co. v. Asbury Park, 316 U.S. 502, 86 L. Ed. 1629, 62 S. Ct. 1129 (1942). Therefore, observing the wide discretion of the legislature in determining, as representatives of the public, what is necessary for the health, safety, and welfare of the people, and noting the reasonable means by which the ends of free choice in, and a greater opportunity for vision care have been achieved, it is evident that the terms of the existing medical service contracts must yield to and henceforth incorporate the provision of RCW 48.44.025 that pro*583gram subscribers—as the real parties in interest—be reimbursed out of the funds they have paid into their respective programs for vision care which they purchase from licensed optometrists.

Accordingly, the ruling of the trial court, declaring invalid Laws of 1969, ch. 143 (RCW 48.44.025), should, in my judgment, be reversed.