## Facts

- Puerto Rico’s Board of Medical Examiners issued a 2005 regulation limiting the practice of cosmetic medicine to physicians with specified specialty board certifications (e.g., dermatology or plastic surgery).
- Dr. Efraín González-Droz, licensed in Puerto Rico and board-certified in obstetrics and gynecology, shifted his practice toward cosmetic medicine but lacked the certifications required by the regulation.
- In December 2006, the Board preliminarily suspended his medical license for practicing cosmetic medicine without the required specialty certification and notified him that a hearing would follow.
- After an administrative hearing, the Board imposed a five-year suspension of his license.
- Dr. González-Droz filed a federal civil rights action under 42 U.S.C. § 1983 challenging both the regulation and the suspension, alleging equal protection, substantive due process, procedural due process, vagueness, and First Amendment retaliation.
- The district court granted summary judgment for defendants largely on immunity grounds; Dr. González-Droz appealed.

## Issues

1. Whether the specialty-certification restriction on cosmetic medicine violated substantive due process or equal protection under rational basis review.
2. Whether the regulation was unconstitutionally vague as to what conduct and qualifications it required.
3. Whether the five-year suspension constituted conscience-shocking executive action in violation of substantive due process.
4. Whether preliminary suspension without a pre-deprivation evidentiary hearing, and the overall administrative process, violated procedural due process.
5. Whether the Board suspended the license in retaliation for protected speech or litigation activity in violation of the First Amendment.

## Decision

- The First Circuit affirmed summary judgment for the defendants.
- The court held the cosmetic-medicine restriction was rationally related to public health and safety and therefore did not violate equal protection or substantive due process.
- The court rejected the vagueness challenge, finding the regulation provided sufficient notice and enforceable standards for a licensed physician.
- The court held the five-year suspension was within regulatory discretion and did not meet the “shocks the conscience” threshold for substantive due process.
- The court held the procedures satisfied due process because the Board provided notice and a meaningful post-suspension hearing; a temporary pre-hearing suspension was not per se unconstitutional.
- The court rejected the First Amendment retaliation claim for lack of evidence that protected activity was a substantial or motivating factor in the suspension.
- Although the district court relied on immunity, the First Circuit affirmed on the merits because it found no constitutional violation.

## Legal Principles

- Professional licensing regulations affecting non-fundamental interests are generally reviewed under rational basis; a classification stands if rationally related to a legitimate governmental interest such as public health and safety.
- A regulation is void for vagueness only if persons of ordinary intelligence must guess at its meaning or it authorizes arbitrary enforcement; regulated professionals’ sophistication may bear on notice.
- Substantive due process challenges to administrative enforcement require conduct so egregious as to “shock the conscience”; ordinary regulatory enforcement and sanctions typically do not qualify.
- Procedural due process is assessed under the Mathews v. Eldridge balancing test; temporary suspension without a full pre-deprivation hearing may be permissible when prompt, adequate post-deprivation process is provided.
- First Amendment retaliation requires proof that protected activity was a substantial or motivating factor for adverse action; independent, legitimate regulatory grounds defeat causation.

## Conclusion

The First Circuit upheld Puerto Rico’s specialty-based limitation on cosmetic medicine and the physician’s suspension, concluding the regulation was rational and sufficiently clear, the enforcement did not violate substantive or procedural due process, and the record did not support retaliation.


González-Droz v. González-Colón, 660 F.3d 1 (1st Cir. 2011)