Dr. Bernd Wollschlaeger v. Governor of the State of Florida
760 F.3d 1195 (2014)
Rule of Law:
A state law regulating professional conduct that only incidentally affects speech within the physician-patient relationship is a valid exercise of the state's power to police the boundaries of good medical practice and does not facially violate the First Amendment.
Facts:
- Florida legislators received complaints from constituents that physicians were asking unwelcome questions about firearm ownership.
- Some constituents reported feeling harassed or discriminated against due to their firearm ownership or their refusal to answer such questions.
- Specific incidents reported included a pediatrician terminating a physician-patient relationship after a mother refused to answer firearm questions, and another physician refusing care to a child over the issue.
- In response, the Florida legislature passed the Firearm Owners Privacy Act ('the Act').
- The Act restricts physicians from inquiring about or recording information on patient firearm ownership unless they believe in good faith it is relevant to medical care or safety.
- The Act also prohibits physicians from discriminating against or unnecessarily harassing patients based on their firearm ownership status.
- Violation of the Act could subject a physician to disciplinary measures by the Florida Board of Medicine, including fines and license suspension or revocation.
- After the Act's passage, a group of physicians (Plaintiffs) curtailed their practice of routinely asking all patients about firearms as part of preventative counseling, fearing disciplinary action.
Procedural Posture:
- A group of physicians and physician advocacy groups (Plaintiffs) filed a 42 U.S.C. § 1983 action against Florida officials (the State) in the U.S. District Court for the Southern District of Florida.
- Plaintiffs sought declaratory and injunctive relief, alleging the Act facially violated the First and Fourteenth Amendments.
- The District Court granted a preliminary injunction against the enforcement of the Act's key provisions.
- On cross-motions for summary judgment, the District Court granted summary judgment in favor of the Plaintiffs.
- The District Court permanently enjoined the State from enforcing the Act's record-keeping, inquiry, harassment, and discrimination provisions, holding they violated the First Amendment and were void for vagueness.
- The State of Florida (appellant) appealed the District Court's judgment to the U.S. Court of Appeals for the Eleventh Circuit.
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Issue:
Does Florida's Firearm Owners Privacy Act, which restricts physicians from inquiring about or recording information regarding patient firearm ownership unless it is relevant to medical care or safety, facially violate the First Amendment's guarantee of free speech?
Opinions:
Majority - Tjoflat, Circuit Judge
No. The Florida Firearm Owners Privacy Act does not facially violate the First Amendment because it is a valid regulation of professional conduct that has only an incidental effect on physicians' speech. The court reasoned that states have long-established authority to regulate the medical profession and define the standards of good practice. The Act does not regulate public speech but instead governs speech within the private, one-on-one physician-patient relationship, where the 'personal nexus' is strongest and First Amendment protections are at their nadir. Citing Justice White's concurrence in Lowe v. S.E.C., the court held that any burden the Act places on speech is merely incidental to its legitimate purpose of protecting patient privacy and ensuring good medical care, which does not require irrelevant inquiries into sensitive, private matters. The court also rejected the vagueness challenge, finding that terms like 'relevant' and 'unnecessarily harassing' have common-sense meanings within the context of professional medical judgment.
Dissenting - Wilson, Circuit Judge
Yes. The Florida Firearm Owners Privacy Act facially violates the First Amendment's guarantee of free speech. The dissent argued that the Act is a content-based, speaker-based, and viewpoint-based 'gag order' that directly targets and chills doctors' speech on a matter of public health. As such, it should be subject to at least intermediate scrutiny, which it cannot survive because the state failed to provide evidence that its asserted interests were under threat or that the Act would materially advance them. The dissent contended that the majority's reliance on cases like Lowe v. S.E.C. is misplaced, as those involved content-neutral licensing schemes, not direct prohibitions on speech by licensed professionals. The dissent warned that the majority's decision creates a new, unprotected category of speech for professionals, allowing states to censor any topic within the doctor's office by simply labeling it 'bad medicine'.
Analysis:
This decision significantly strengthens a state's power to regulate the content of conversations within the physician-patient relationship by classifying such regulations as pertaining to professional conduct rather than speech. It establishes a precedent that as long as a law is framed as defining 'good medical practice' and is confined to the private professional context, it can survive First Amendment scrutiny even if it directly targets speech on a specific topic. This ruling provides a roadmap for states wishing to restrict professional speech on other controversial subjects. The dissent argues this creates a dangerous exception to the First Amendment, allowing the government to silence disfavored viewpoints under the guise of professional regulation.
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