OFFICES AND OFFICERS ‑- STATE ‑- UNIVERSITY OF WASHINGTON ‑- CONSTITUTIONALITY OF PROPOSED MEDICAL SCHOOL ADMISSION PROGRAM

OFFICES AND OFFICERS ‑- STATE ‑- UNIVERSITY OF WASHINGTON ‑- CONSTITUTIONALITY OF PROPOSED MEDICAL SCHOOL ADMISSION PROGRAM

Legislation requiring the establishment of a program at the University of Washington Medical School giving preferential treatment to Washington residents who are attending or have attended medical schools in certain foreign countries by providing for special admission, transfer, accreditation or clinical training for such students would, if enacted, be constitutionally defensible.

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                                                                    April 5, 1977

Honorable A. N. Shinpoch
Chairman, House Appropriations Committee
435 House Office Building
Olympia, Washington 98504                                                                                                               Cite as:  AGLO 1977 No. 14

Dear Sir:

            By letter previously acknowledged you have requested our opinion with regard to the constitutionality of certain legislative proposals pertaining to admission or transfer policies at the University of Washington Medical School.  Your basic question may be paraphrased as follows:

            May the legislature consitutionally require the establishment of a program at the University of Washington Medical School giving preferential treatment to Washington residents who are attending or have attended medical schools in certain foreign countries by providing for special admission, transfer, accreditation or clinical training for such students?

            It is our opinion, for the reasons set forth below, that such legislative action would be constitutionally defensible.

                                                                     ANALYSIS

            Although you have indicated, in your letter, that your opinion request is related to the pendency of House Bill No. 271 before the legislature we note, at the outset, that  [[Orig. Op. Page 2]] you have not specifically asked us to pass upon the constitutionality of that particular bill.  Instead, your question is somewhat more general although it does, most certainly, pertain to the basic concept of the bill; i.e., a legislatively mandated "special" program at the University of Washington Medical School for Washington residents who are students or graduates of foreign medical schools.1/

             By way of background it is, of course, a well known fact that competition among qualified candidates for admission to medical schools in this country has become increasingly severe in recent years.  The medical schools, including, most certainly, our own University of Washington School of Medicine, have only limited human and financial resources with which they may educate candidates for the MD degree, thus creating a need to screen in a sophisticated manner in order to select candidates deemed to be the most qualified by the schools to fulfill their educational and social missions.  As a consequence, however an increasing number of Washington residents, finding themselves unable to obtain admission to what is the only medical school now in existence in their own state, have had to look elsewhere for the medical training which they desire.  In some cases, obviously, they have simply gone to medical schools (both private and public) in other parts of our own country but in other instances they have gone (in reportedly significant numbers), instead, to foreign medical schools such as, for example, the University of Guadalajara in Mexico.

            At the same time, however, as these pressures for admission to medical school have developed there has continued to exist, on the outside, a shortage of qualified practitioners ‑ particularly in the smaller and more rural communities of our state.  As stated in the legislative finding which is contained in § 1 of House Bill No. 271 itself,supra,

            ". . . there is a serious shortage and maldistribution of primary health care practitioners in the state of Washington, . . ."

            Therefore, a proposal has surfaced in the legislature during its current session to attempt to rectify the situation to some extent by seeking to bring those students who have gone  [[Orig. Op. Page 3]] to foreign medical schools back to Washington to complete their studies here.  Accord, the following additional legislative finding from House Bill No. 271:

            ". . . qualified Washington state residents who have completed or who are in the process of completing formal academic requirements for graduation from a foreign medical school constitute a valuable resource to the state if such residents are granted the opportunity to transfer to the school of medicine for the third year of training; or if such residents, upon graduation from a foreign medical school, are provided with one year of additional clinical training sponsored by the school of medicine, thereby producing quality physicians for the state with a minimum of state funds."

            Yet, obviously, by thus singling out for special treatment only those Washington residents who have gone to "foreign medical schools"2/ the proposal distinguishes between such residents and those who have merely gone, instead, to medical schools in other states of our own country or in Canada.  Therefore, it has been suggested by some that the proposal may be unconstitutionally discriminatory against the latter and, accordingly, your present request for an attorney general's opinion has been submitted.

            Clearly, the legislature has plenary power over the University of Washington and its medical school.  State ex rel. Holcomb V. Armstrong, 39 Wn.2d 860, 239 P.2d 545 (1952).  Thus, within constitutional limitations, the legislature may require the establishment of whatever admissions standards or programs it desires at the university as it also may in the case of any of our various state institutions of higher education.  Moreover, the wisdom of any such legislatively mandated programs is purely a policy question and not a constitutional one.

            Because state action would obviously be present at both the legislative and administrative levels, however, there is also a significant constitutional question raised by the proposal.  Under what is commonly referred to as the equal protection clause of Amendment 14 to the United States Constitution, ". . .  No state shall . . . deny to any person  [[Orig. Op. Page 4]] within its jurisdiction the equal protection of the laws."  And similarly, Article I, § 12 of our own state constitution provides:

            "No law shall be passed granting to any citizen, class of citizens, or corporation other than municipal, privileges or immunities which upon the same terms shall not equally belong to all citizens, or corporations."

            These two constitutional provisions, although somewhat differently worded, have consistently been construed to have the same basic meaning.  See, e.g.,Markham Advertising Co. v. State, 73 Wn.2d 405, 439 P.2d 248 (1968).  The result, however, is not a constitutional prohibition against all laws which discriminate ‑ for all law classifies and all law discriminates.  The constitutional ban, instead, is only against those laws which classify or discriminateinvidiously.  In short, neither the state nor the federal constitution requires identical treatment for all without recognition of the differences in relevant circumstances.  City of Everett v. Fire Fighters' Local No. 350, 87 Wn.2d 572, 555 P.2d 418 (1976);Aetna Life v. Washington Life, 83 Wn.2d 523, 520 P.2d 162 (1974).

            Two alternative tests have developed, over the years, for determining whether a given law is invidiously discriminatory and, hence, unconstitutional.  If the legislation in question either infringes upon a "fundamental constitutional right" (e.g., freedom of expression or the right to travel freely between the states) or creates a "suspect classification" (e.g., race) then the state, in order to justify the legislation, must demonstrate that its enactment was necessary for the furtherance of some "compelling state interest."Dunn v. Blumsteen, 405 U.S. 330, 31 L.ed.2d [[L.Ed.2d]]274, 92 S.Ct. 995 (1972); Kramer v. Union Free School Dist., 395 U.S. 621, 23 L.ed.2d [[L.Ed.2d]]583, 89 S.Ct. 1886 (1969); Shapiro v. Thompson, 394 U.S. 618, 22 L.ed.2d [[L.Ed.2d]]600, 89 S.Ct. 1322 (1969).  In all other instances, on the other hand, discriminatory legislation may be constitutionally justified simply by showing a rational basis for the particular classification in question.  In such cases, moreover, the legislature is to be given

            ". . . a wide scope of discretion in enacting laws which affect some groups of citizens differently from others. . . ."  Haddenham v. State, 87 Wn.2d 145, 150, 550 P.2d 9 (1976).

             [[Orig. Op. Page 5]]

            Thus, in those cases to which this rule is applicable the constitutional guarantee of equal protection is violated only if a classification rests on grounds wholly irrelevant to the state's objective, McGowan v. Maryland, 366 U.S. 420, 6 L.ed.2d [[L.Ed.2d]]393, 81 S.Ct. 1101 (1961), and a party challenging the constitutionality of such a statute must overcome a presumption that the questioned classification rests upon a reasonable basis.  State v. Perrigoue, 81 Wn.2d 640, 503 P.2d 1063 (1972).  Also, if in such a case it is possible to conceive of any state of facts which would justify a classification, the existence of those facts will be assumed to be the basis for the classification.  Oregon v. Mitchell, 400 U.S. 112, 27 L.ed.2d [[L.Ed.2d]]272, 91 S.Ct. 260 (1970).  And finally, as we have previously said, a mere challenge to the wisdom or expediency of a statute is not sufficient to overcome the presumption regarding its constitutionality and rationality.  Brewer v. Copeland, 86 Wn.2d 58, 542 P.2d 445 (1975).

            Applying the foregoing constitutional principles to the legislative proposal which has given rise to your opinion request, we come to the conclusion that such legislation would be constitutionally defensible.  A medical school education does not, under any decided cases, involve any fundamental constitutional right.  In fact, the Supreme Court of the United States has only recently refused to hold that education, generally, is a fundamental right implicitly guaranteed by the United States Constitution so as to require application of the alternative, strict scrutiny, test, when a classification is challenged as a denial of equal protection.  San Antonio Independent School District v. Rodriguez, 411 U.S. 1, 36 L.ed.2d [[L.Ed.2d]]16, 93 S.Ct. 1278 (1973).  And by the same token whatever else it may be a classification of state residents based merely upon where they may be attending school cannot be said to constitute a "suspect classification" for constitutional purposes.  Therefore, all that need be shown in order to sustain the validity of a bill such as House Bill No. 271, is that it has some rational basis; i.e., whether or not there is a reasonable basis for placing state residents who are or have been in attendance at foreign medical schools in a preferential position over other state residents who are otherwise similarly situated.3/

             [[Orig. Op. Page 6]]

            Clearly, the legislature has not only the power but also the duty to safeguard the public health and welfare of Washington citizens and this includes a paramount duty to regulate the medical profession.  See, e.g.,Reagles v. Simpson, 72 Wn.2d 577, 434 P.2d 559 (1967); and Williamson v. Grant Cy. Pub. Hosp. Dist., 65 Wn.2d 245, 396 P.2d 879 (1964).  Among the consequences of that duty, obviously, is a responsibility to take action designed to insure that adequate medical services are available to all of the citizens of our state no matter where therein they may reside.  We believe it entirely conceivable that a special program for admission to the University of Washington Medical School (i.e., on a priority basis) of students who have already received some training in a foreign medical school would serve that purpose.  Moreover, it is even conceivable that discriminating in favor of such foreign transferees and against Washington residents who are enrolled in other domestic medical schools would, likewise, promote the public health and welfare by increasing the total pool of medical doctors who might eventually be practicing medicine in this state.