DDS v. Bd. of Dental Examiners of Ala.
382 F. Supp. 3d 1214
N.D. Ala.2019Background
- SmileDirectClub operates a teledentistry platform; nondentist employees at Alabama "SmileShops" use an iTero intraoral scanner to create digital dental images, which Alabama-licensed dentists (e.g., Dr. Leeds) review remotely and may prescribe clear aligners.
- Alabama Board of Dental Examiners sent a cease-and-desist in Sept. 2018, treating iTero use as "digital imaging" constituting the practice of dentistry unless performed under dentist supervision (Board regulation requires dentist physically present for intraoral procedures).
- Plaintiffs (SmileDirect and Dr. Leeds) sued Board and members (official and individual capacities) asserting Sherman Act, Dormant Commerce Clause, Equal Protection, Due Process, and state-law claims; Defendants moved to dismiss under Rules 12(b)(1) and 12(b)(6).
- Court held the Board (entity) is protected by Eleventh Amendment sovereign immunity (Versiglio) and dismissed claims against the Board; Ex parte Young permits Plaintiffs’ federal claims to proceed against Board members in their official capacities.
- Court allowed Sherman Act and Dormant Commerce Clause claims to proceed against Board members (official capacities), denied Parker-immunity dismissal at motion-to-dismiss stage (factual development needed), but dismissed Plaintiffs’ Equal Protection and Substantive Due Process claims (rational-basis review) and all state-law claims against Board members (Pennhurst).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Eleventh Amendment immunity for the Board | Versus Board: suit valid; seek injunctive/declaratory relief | Board: Board is arm of the State entitled to sovereign immunity | Board (entity) immune; claims against Board dismissed (Versiglio controls) |
| Ex parte Young statutory/federal claims vs. Board members (official capacities) | Federal claims seek prospective relief to stop enforcement of state law violating federal law | Board argues Eleventh Amendment bars suit against state officials | Ex parte Young permits prospective federal claims against Board members in official capacities to proceed |
| Sherman Act (antitrust) — Parker/state-action immunity | Plaintiffs: Board’s actions are protectionist and lack active state supervision; anticompetitive | Board: enforcing express state statute/regulation; Parker immunity applies | Sherman Act claims survive 12(b)(6); Parker immunity defense premature — factual record required to test Midcal elements (clear articulation; active supervision) |
| Dormant Commerce Clause | Plaintiffs: physical-presence rule burdens interstate commerce and favors in-state dentists without legitimate local benefit | Board: rule advances public health/safety (sterilization, emergencies, diagnosis, imaging accuracy) | Dormant Commerce Clause claim survives 12(b)(6); factual development required for Pike balancing |
| Equal Protection & Substantive Due Process | Plaintiffs: rule irrationally discriminates against out-of-state practice and teledentistry platform | Board: rational basis exists (health/safety), right to practice profession not fundamental | Claims dismissed — rational-basis review applies and statute/regulation survives that deferential standard |
| State-law claims (Alabama Constitution; exceed authority) against Board members | Plaintiffs: Board exceeded authority under state law; seek declaratory relief | Board: Eleventh Amendment bars state-law claims vs. state officials | State-law claims dismissed for lack of jurisdiction under Pennhurst (decl. relief against state law enforcement barred) |
Key Cases Cited
- Parker v. Brown, 317 U.S. 341 (state-action immunity doctrine)
- California Retail Liquor Dealers Ass'n v. Midcal Aluminum, Inc., 445 U.S. 97 (two‑part test for private/state-delegated conduct to obtain Parker immunity)
- North Carolina State Bd. of Dental Examiners v. FTC, 135 S. Ct. 1101 (Supreme Court: boards controlled by active market participants must show clear articulation and active supervision)
- Versiglio v. Bd. of Dental Examiners of Alabama, 686 F.3d 1290 (11th Cir. — Alabama Dental Board is an arm of the State for Eleventh Amendment purposes)
- Ex parte Young, 209 U.S. 123 (exception permitting prospective relief against state officials for federal-law violations)
- Pennhurst State Sch. & Hosp. v. Halderman, 465 U.S. 89 (Eleventh Amendment bars federal-court suits against state officials on the basis of state law)
- Pike v. Bruce Church, Inc., 397 U.S. 137 (Pike balancing test for Dormant Commerce Clause)