ROBERT L VAZZO and SOLI DEO GLORIA INTERNATONAL, INC. d/b/a NEW HEARTS OUTREACH TAMPA BAY, Plaintiffs, v. CITY OF TAMPA, Defendant.
No. 8:17-cv-2896-T-02AAS
UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF FLORIDA TAMPA DIVISION
October 4, 2019
Document 213 Filed 10/04/19
This matter comes to the Court on Motions for Summary Judgment filed by Plaintiffs Robert Vazzo and New Hearts Outreach Tampa Bay, Dkt. 194, and Defendant, City of Tampa, Dkt. 189. With the benefit of full briefing and able argument by both sides at a hearing, the Court grants Plaintiffs’ motion for summary judgment as to Count VI of the Amended Complaint, Dkt. 78, pursuant to
INTRODUCTION
This case involves a challenge to the City of Tampa’s municipal ordinance prohibiting sexual orientation change efforts (“SOCE”) on minors during licensed psychotherapy and counseling. The Eleventh Circuit follows “the longstanding principle that federal courts should avoid reaching constitutional questions if there are other grounds upon which a case can be decided.” BellSouth Telecomms., Inc. v. Town of Palm Beach, 252 F.3d 1169, 1176 (11th Cir. 2001). The Supreme Court has long endorsed this “sound general policy.” District of Columbia v. Little, 339 U.S. 1, 3–4 (1950). Following this policy, the Court turns first to Count VI, a preemption Count based upon Florida law. According to the City, the Ordinance regulates medical professionals and “part of the practice of medicine” within the City limits. Dkt. 189 at 17. The City is unaware of any child ever receiving proscribed SOCE in the City.1 The City
PROCEDURAL BACKGROUND
The Ordinance: The City of Tampa passed Ordinance 2017-47 (attached here as an appendix) on April 6, 2017. It was signed into law by Mayor Bob Buckhorn four days later.2 Broadly stated, the Ordinance bars therapy within the City by medical doctors and mental health professionals that seeks to assist a minor patient in a goal to change gender expression or to change sexual orientation/attraction. These two subjects are separate and distinct, but related. The cases have generically referred to these two subjects as “SOCE” or sexual orientation change efforts. The Ordinance uses the term “conversion therapy.” Neither term is entirely accurate, but the Court will use the term “SOCE” for these two subjects as that seems more prevalent in the case law and literature and that term was preferred by the City’s expert.3 The Tampa Ordinance prohibiting SOCE on minors is very similar to one present in other lawsuits now pending.4
Specifically, the Ordinance contains a lengthy preamble, citing a number of psychological and medical studies offering criticism of SOCE.
The Ordinance states that the City Council found “overwhelming research demonstrating that sexual oriеntation and gender identity change efforts can pose critical health risks to lesbian, gay, bisexual, transgender or questioning persons, and that being lesbian, gay, bisexual, transgender or questioning is not a mental disease, mental disorder, mental illness, deficiency, or shortcoming.”
Sec. 14-310.–Intent.
The Intent of this Ordinance is to protect the physical and psychological well-being of minors, including but not limited to lesbian, gay, bisexual, transgender
and/or questioning youth, from exposure to the serious harms and risks caused by conversion therapy or reparative therapy by licensed providers, including but not limited to licensed therapists. These provisions are exercises of police power of the City for the public safety, health, and welfare; and its provisions shall be liberally construed to accomplish that purpose. Sec. 14-311.–Definitions.
Conversion therapy or reparative therapy means, interchangeably, any counseling, practice or treatment performed with the goal of changing an individual’s sexual orientation or gender identity, including, but not limited to, efforts to change behaviors, gender identity, or gender expression, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender or sex. Conversion therapy does not include counseling that provides support and assistance to a person undergoing gender transition or counseling that provides acceptance, support, and understanding of a person or facilitates a person’s coping, social support, and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices, as long as such counseling does not seek to change sexual orientation or gender identity.
Minor means any person less than 18 years of age.
Provider means any person who is licensed by the State of Florida to provide professional counseling, or who performs counseling as part of his or her professional training under chapters 456, 458, 459, 490 or 491 of the Florida Statutes, as such chapters may be amended, including but not limited to, medical practitioners, osteopathic practitioners, psychologists, psychotherapists, social workers, marriage and family therapists, and licensed counselors. A Provider does not include members of the clergy who are acting in their roles as clergy or pastoral counselors and providing religious counseling to congregants, as long as they do not hold themselves out as operating pursuant to any of the aforementioned Florida Statutes licenses.
Sec. 14-312.–Conversion Therapy Prohibited.
It shall be unlawful for any Provider to practice conversion therapy efforts on any individual who is a minor regardless of whether the Provider receives monetary compensation in exchange for such services.
The Ordinance provides for a $1000 fine for the first offense and a $5000 fine for subsequent offenses.
If contested, the City would employ a “special magistrate” to adjudicate the alleged
The Ordinance does not preclude providers from speaking about SOCE to any persons including patients and in any setting, other than as part of therapy with minor patients. The Ordinance applies only to licensed practitioners while giving mental health therapy to minors within City limits, and applies to no other persons such as ministers, lay providers, parents, unlicensed persons, etc.
The Plaintiffs: Plaintiff Vazzo is a marriage and family therapist licensed in Florida and other states. Dkt. 78 ¶ 14. His practice includes providing SOCE counsel to minors. Id. ¶ 102. According to Vazzo, SOCE cоunseling may help clients including minors “reduce or eliminate same-sex sexual attractions, behaviors, or identity.” Id. ¶¶ 60, 88, 116. Vazzo employs no coercive or aversive techniques. Id. ¶ 61. During SOCE counseling, Vazzo uses speech to help clients “understand and identify their anxiety or confusion regarding their attractions, or identity and then help the client formulate the method of counseling that will most benefit that particular client.” Id. ¶ 65.
Vazzo states that clients initiate SOCE counseling by giving informed consent. Id. ¶ 8. Some clients request SOCE counseling to “address the conflicts between their sincerely held religious beliefs and goals to reduce or eliminate their unwanted same-sex attractions, behaviors, or identity.” Id. ¶ 9.
Plaintiff New Hearts Outreach is a Christian ministry in Tampa. Id. ¶¶ 16, 126. Part of its ministry is to refer individuals, including minors, “struggling with unwanted same-sex attractions, behaviors, and identity” to mental health professionals to receive SOCE counseling. Id. ¶¶ 132–34.
Vazzo cannot provide SOCE counseling to minors in Tampa under Ordinance 2017-47. Id. ¶ 112. Nor can New Hearts Outreach refer minors to Vazzo for SOCE counseling in Tampa. Id. ¶ 135.
Plaintiffs sue the City and allege Ordinance 2017-47 violates their federal and state constitutional rights. Dkt. 78. The Plaintiffs allege Ordinance 2017-47 violates their right to freedom of speech under the First Amendment (Count I), a claim to which the parties have devoted great attention. Id. ¶¶ 177–96; see Dkt. 189 at 5–17; Dkt. 194 at 2–20.
Among their other claims, Plaintiffs allege in Count VI that the Florida legislature preempted the field of regulating mental health professionals. Id. ¶¶ 262–75. Because this Court grants summary judgment on the preemption claim in Count VI, the other counts in the Amended Complaint are not discussed.6
SUMMARY JUDGMENT STANDARD
Furthermore, “[t]he mere existence of a scintilla of evidence in support of the plaintiff‘s position will be insufficient; there must be evidence on which the jury could reasonably find for the plaintiff. The judge‘s inquiry, therefore, unavoidably asks whether reasonable jurors could find by a preponderance of the evidence that the plaintiff is entitled to a verdict—‘whether there is [evidence] upon which a jury can properly proceed to find a verdict for the party producing it, upon whom the onus of proof is imposed.’” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 252 (1986) (quoting Schuylkill and Dauphin Imp. Co. v. Munson, 81 U.S. 442, 448 (U.S. 1871)).
FLORIDA’S LAW OF IMPLIED PREEMPTION
The Supreme Court of Florida most recently addressed the implied preemptiоn doctrine in D’Agastino v. City of Miami, 220 So. 3d 410 (2017) (finding portion of Miami ordinance impliedly preempted). The Court noted that, “in Florida, the power of a municipal government to legislate is derived from both constitutional provisions and statute. Generally speaking, the Florida Constitution authorizes and empowers municipalities to exist and conduct municipal powers except as otherwise provided by law.” Id. at 420. Concerning municipal powers, the Florida Constitution states:
(b) POWERS. Municipalities shall have governmental, corporate and proprietary powers to enable them to conduct municipal government, perform municipal functions and render municipal services, and may exercise any power for municipal purposes except as otherwise provided by law. Each municipal legislative body shall be elective.
Acting on its constitutional authority to address municipal powers, the Legislature clarified the powers of municipal government by enacting the Municipal Home Rule Powers Act, which is now codified in
166.021 Powers.–
(1) As provided in s. 2(b), Art. VIII of the State Constitution, municipalities shall have the governmental, corporate, and proprietary powers to enable them to conduct municipal government, perform municipal functions, and render municipal services, and may exercise any power for municipal purposes, except when expressly prohibited by law.
However, these powers are subject to limitations; among others, municipalities may not enact legislаtion concerning subjects expressly preempted to the state by general law:
“(3) The Legislature recognizes that pursuant to the grant of power set forth in s. 2(b), Art. VIII of the State Constitution, the legislative body of each municipality has the power to enact legislation concerning any subject matter upon which the state Legislature may act, except:
(a) The subjects of annexation, merger, and exercise of extraterritorial power, which require general or special law pursuant to s. 2(c), Art. VIII of the State Constitution;
(b) Any subject expressly prohibited by the constitution;
(c) Any subject expressly preempted to state or county government by the constitution or by general law; and
(d) Any subject preempted to a county pursuant to a county charter adopted under the authority of ss. 1(g), 3, and 6(e), Art. VIII of the State Constitution.”
220 So. 3d at 420 (quoting
Against this backdrop, the D’Agastino court observed that “a local government enactment may be inconsistent with state law where the Legislature has preempted a particular subject area.” Id. at 420–21 (quoting Sarasota All. for Fair Elections, Inc. v. Browning, 28 So. 3d 880, 886 (Fla. 2010)). The Florida Supreme Court noted that Florida law recognizes both express preemption and implied preemption. Id. at 421.
Unlike the explicit nature of express preemption, “implied preemption occurs when the state legislative scheme is pervasive and the local legislation would present a danger of conflict with that pervasive scheme.” Id. Put another way, “preemption is implied when the legislative scheme is so pervasive as to virtually evidence an intent to preempt the particulаr area or field of operation, and where strong public policy reasons exist for finding such an area or field to be preempted by the Legislature.” Id. Thus, explicit words are not required for preemption “so long as it is clear from the language utilized that the Legislature has clearly preempted local regulation of the subject.” Id. (citing to Barragan v. City of Miami, 545 So. 2d 252, 254 (Fla. 1989)). The D’Agastino Court held that the test for implied preemption requires that the courts look “to the provisions of the whole law, and to its object and policy.” Id. (citing Browning, 28 So. 3d at 886); see also State v. Harden, 938 So. 2d 480, 486 (Fla. 2006). Additionally, “[t]he nature of the power exerted by the Legislature, the object sought to be attained by the statute at issue, and the character of the obligations imposed by the statute” are all vital in this analysis. Id.
D’Agastino cautioned judges to “be careful and mindful in attempting to impute intent to the Legislature to preclude a local elected governing body from exercising its home rule powers.” Id. (citing Tallahassee Mem’l Reg’l Med. Ctr., Inc. v. Tallahassee Med. Ctr., Inc., 681 So. 2d 826, 831 (Fla. 1st DCA 1996)). Despite this caveat the Florida Supreme Court went on to explain:
Nevertheless, as we reemphasized in City of Palm Bay, because the Legislature is ultimately superior to local government under the Florida Constitution, preemption can arise even where there is no specifically preclusive language. 114 So. 3d at 928 (“But we have never interpreted either the constitutional or statutory provisions relating to the legislative preemption of municipal home rule powers to require that the Legislature specifically state that the exercise of municipal powеr on a particular subject is precluded.”). We further reaffirmed in City of Palm Bay that the language “except as otherwise provided by law” contained in the constitutional provision “establishes the constitutional superiority of the Legislature’s power over municipal power.”
“Although implied preemption involving a municipality’s home rule powers may be disfavored, [courts] must carefully consider the intent of the Legislature with regard to the preemptive operation even though it may not be expressly stated.” D’Agastino, 220 So. 3d at 423. The D’Agastino court found that a portion of municipal disciplinary proceedings for local police officers was impliedly preempted by an extensive state statutory and regulatory scheme set up for police disciplinary matters. Id. at 423–24. The Court found it readily apparent that the field of police disciplinary investigations was regulated by multiple Florida statutes. Id. at 424. The municipal creation of a local subpoena power over police officers, as part of police discipline and police conduct investigations, was impliedly preempted. Id. at 427.
The test is simple: “implied preemption is found when the state legislative scheme of regulation is pervasive and the local legislation would present the danger of conflict with that pervasive regulatory scheme.” Classy Cycles, Inc. v. Bay Cty. Fla., 201 So. 3d 779, 788 (Fla. 1st DCA 2016) (citing to Browning, 28 So. 3d at 886). The state legislative scheme should be “so pervasive as to evidence an intent to preempt the particular area, and [] strong public policy reasоns exist for finding such an area to be preempted by the Legislature.” Phantom of Clearwater, Inc. v. Pinellas Cty., 894 So. 2d 1011, 1019 (Fla. 2d DCA 2005) (citing Tallahassee Mem’l, 681 So. 2d at 831). “[T]he preempted field is usually a narrowly defined field, ‘limited to the specific area where the Legislature has expressed their will to be the sole regulator.’” Id. (citing St. Johns Cty. v. N.E. Fla. Builders Ass‘n, 583 So. 2d 635, 642 (Fla. 1991)).
Examples of these principles in action can be seen in D’Agastino where a survey of the relevant state statutes relating to police disciplinary investigations showed a legislative intent to cover the entire spectrum of subpoenaed police testimony. 220 So. 3d at 420–26. There was no room for municipal intrusion into subpoenaing police officers concerning discipline. That the city’s police subpoenas conflicted somewhat with the State’s showed that the State occupied the field exclusively. Likewise, in Classy Cycles, the municipality imposed insurance requirements for motor vehicle usage (tourist-style scooters). 201 So. 3d at 782–83. In finding implied preemption, the appellate court stated:
[T]he Legislature has created a pervasive scheme of regulation, coverage requirements, and limitation of liability, including specific requirements for coverage necessary to operate various motor vehicles in Florida. Thus, the ordinances are an attempt to regulate in an
area well-covered by existing statutes. The local governments’ ordinances attempting to mandate insurance are therefore impliedly preempted.
Id. at 788 (emphasis added).
Some courts have found no implied preemption when the state regulatory scheme was brief, or only a few pages in the law books. See, e.g., Phantom of Clearwater, Inc., 894 So. 2d at 1019 (noting the state statute at issue was only 3 pages long); Bloom v. Miami-Dade Cty., No. 09-51205 CA 13, 2009 Fla. Cir. LEXIS 4303 at *4–6 (Fla. Cir. Ct. Sept. 6, 2009), aff’d sub nom. Exile v. Miami-Dade Cty., 35 So. 3d 118 (Fla. 3d DCA 2010). As discussed below, this is manifestly not the case here with Florida health regulations.
Other courts have found no implied preemption when the municipal ordinance is local in nature, or tied to a situation unique to the locale. For example, in Exile v. Miami-Dade Cty., 35 So. 3d 118 (Fla. 3d DCA 2010), the District Court of Appeal found that an ordinance prohibiting convicted sex offenders from living within 2500 feet of a school was not preempted by a state statute with a 1000 feet prohibition. In the trial court opinion, which the Third District Court of Appeal appeared to rely upon, the court noted there was no need for statewide uniformity because the most effective buffer zone would depend upon local conditions and local property boundaries, varying across municipalities. Bloom, 2009 Fla. Cir. LEXIS 4303 at *8–10.
But in Classy Cycles, the county argued its local conditions, involving untrained and unruly tourists driving scooters and motorcycles in the beach area, showed a need for its local insurance requirements and local safety regulations for motor vehicle traffic. 201 So. 3d at 789. The court rejected this, noting that 1) no grant from the Legislature to localities existed regarding vehicle insurance; and 2) rowdy tourists are not a local phenomena in Florida to permit differing laws in Bay County, when the Legislature’s broad program of regulation occupied the field. Id. at 788–89.
Classy Cycles is apt here. There is no grant of authority by the Florida Legislature to municipalities to substantively regulate healthcare treatment and discipline. The State, not localities, occupies this field. Just as in Classy Cycles, hеre there is nothing local or unique to Tampa about SOCE that would suggest the statewide, uniform medical regulation regime should vary because of Tampa’s peculiarities, and should vary across the State, from town to town and from county to county. The matter legislated against—SOCE—is statewide, not Tampa-specific. And, a uniform and statewide system of healthcare treatment and practitioner discipline already exists, for sound reasons. Implied preemption is a disfavored remedy because cities have broad powers to address municipal concerns. But substantive regulation of psychotherapy is a State, not a municipal concern.
Additional cases considering implied preemption have considered whether the Florida Legislature via statute has delegated some enforcement or regulation to local government. Thus, in Sarasota Alliance for Fair Elections, Inc. v. Browning, 28 So. 3d 880, 887–88 (Fla. 2010) the court found implied preemption to be improper, in part because Florida election law specifically delegated certain responsibilities and powers to local authorities concerning voting systems. Similar cases finding delegation to local authorities include Phantom of Clearwater, 894 So. 2d at 1011 (finding no implied preemption on local fireworks legislation; the State statutory scheme expressly delegated enforcement to local government, with municipalities to regulate displays and set and require bonds for
FLORIDA’S BROAD AND EXCLUSIVE REGULATION OF HEALTHCARE MODALITIES AND DISCIPLINE
The City of Tampa’s Ordinance instructs medical doctors, osteopathic doctors, psychologists, and licensed mental health counselors as to what they may and may not say within patient therapy. Tampa has never regulated healthcare substantively in any other way before Ordinance 2017-47.7 Nor does Tampa substantively regulate services similar in nature to healthcare such as massage therapy, acupuncture, optometry, tattoos, piercings, hearing aids, medical labs, or funeral services.
This contrasts with the State of Florida’s pervasive and all-encompassing regulation in this field. To say that the State of Florida’s regime of healthcare regulations is vast is an understatement. There seems nothing more regulated and addressed by the Florida legislative and administrative body than healthcare, and a material part of this is mental health related. In addition to its breadth and depth, this Florida regulatory scheme is uniform across each of the 400 plus municipalities in the State. In contrast, the Tampa Ordinance covers only the 114 square miles of city limits, leaving the substantive mental health therapy rules to vary depending which of the 400 plus Florida municipalities one is in, or even where one is within Hillsborough County.8
A. Five State-Mandated Areas the Ordinance Encroaches Upon:
Before the Court surveys specific Florida regulations conсerning the practice types Tampa wishes to regulate, it is important to note five areas of Florida healthcare law that the Tampa Ordinance seeks to occupy or partly alter. Because State law and policy already reside in these areas broadly, there is “danger of conflict with that pervasive regulatory scheme.” Classy Cycles, 201 So. 3d at 788 (citing Sarasota Alliance, 28 So. 3d at 886.).
1. Florida’s Broad Right of Privacy:
Nothing is more intimate, more private, and more sensitive, than a growing young man or woman talking to a mental health therapist about sex, gender, preferences, and conflicting feelings. The Ordinance inserts the City’s code enforcers into the middle of this sensitive, intense and private moment. But this moment is already governed by Florida’s very broad rights of privacy, something the Ordinance ignores.
Article I, Section 23 of the Florida Constitution states in pertinent part: “Right of Privacy.– Every natural person has the right to be let alone and free from governmental intrusion into the person’s private life except as otherwise provided herein.”
The Florida Constitution’s privacy right has been implicated in a wide variety of cases.9 “The drafters of the amendment rejected the use of the words ‘unreasonable’ or ‘unwarranted’ before the phrase ‘governmental intrusion’ in order to make the privacy right as strong as possible.” Winfield v. Div. of Pari-Mutual Wagering, 477 So. 2d 544, 548 (Fla. 1985). The Florida Constitution’s privacy amendment suggests that government should stay out of the therapy room. The Tampa Ordinance does not address this constitutional issue, and in doing so
the City attempts to occupy a very private space, contrary to a strong statewide policy.
2. Parental Choice in Healthcare:
The law in Florida is that, with very few exceptions,10 parents are responsible for selecting the manner of medical treatment received by their children, and this continues until age 18. See
3. Florida Patient’s Bill of Rights:
Besides impacting Florida privacy rights and rights to parental choice in healthcare, the Ordinance alters within the City a patient’s rights under the Florida Patient’s Bill of Rights and Responsibilities. This section of the Public Health Chapter, Chapter 381 of the Florida Statutes, states in part:
A patient has the right to access any mode of treatment that is, in his or her own judgment and the judgment of his or her health care practitioner, in the best interests оf the patient, including
complementary or alternative health care treatments, in accordance with the provisions of s. 456.41.
4. Florida’s Endorsement of Alternative Healthcare Options:
The Ordinance also encroaches upon, without mention or consideration, a provision in Chapter 456 of the Florida Statutes, which is titled “Health Professions and Occupations: General Provisions.” In this chapter, the Legislature stated its intent for health professions:
Legislative Intent.–It is the intent of the Legislature that citizens be able to make informed choices for any type of health care they deem to be an effective option for treating human disease, pain, injury, deformity, or other physical or mental condition. It is the intent of the Legislature that citizens be able to choose from all health care options, including the prevailing or conventional treatment methods as well as other treatments designed to complement or substitute for the prevailing or conventional treatment methods. It is the intent of the Legislature that health care practitioners be able to offer complementary or аlternative health care treatments, with the same requirements, provisions, and liabilities as those associated with the prevailing or conventional treatment methods.
Although the City outlaws the practice, the Florida statute goes on to read:
(c) The health care practitioner may, in his or her discretion and without restriction, recommend any mode or treatment that is, in his or her judgment, in the best interest of the patient . . . in accordance with the provisions of his or her license.
. . . .
(5) EFFECT.–This section does not modify or change the scope of practice of any licensees of the department, nor does it alter in any way the provisions of the individual practice acts for those licensees, which require the licensees to practice within their respective standards of care and which prohibit fraud or exploitation of patients.
This very plain statement of legislative intent in
The Ordinance appears to impact the well-traveled Florida statutory doctrine of informed consent. For SOCE there will be no informed consent in Tampa although the Florida Legislature has set up a complete and developed scheme of informed consent. E.g.,
This informed consent concept notes that some medical procedures have “substantial risks and hazards inherent in the proposed treatment or procedures[.]”
Informed consent is a bedrock principle of healthcare in a free society. The concept vindicates the individual’s right to make his or her own informed decision as to what health treatment he or she will undergo. When the patient is denied the ability to exercise or even consider informed consent, the patient’s personal liberty suffers.
According to the Florida Supreme Court, in Florida “[t]he doctrine of informed consent is well recognized, has a long history, and is grounded in the common law and based in the concepts of bodily integrity and patient autonomy.” State v. Presidential Women’s Ctr., 937 So. 2d 114, 116 (Fla. 2006). The Florida Supreme Court adopted the “general rule on this subject as follows: The patient must be the final arbiter as to whether he will take his chances with the operation, or take his chances living without it.” Id. at 117. The court further noted, “[N]o right is held more sacred, or is more carefully guarded, by the common law, than
the right of every individual to the possession and control of his own person, free from all restraint or interference of others, unless by clear and unquestionable authority of law.” Id. (citing Cruzan v. Dir., Mo. Dep’t of Health, 497 U.S. 261, 269 (1990)).
The Tampa Ordinance simply ignores this well-known and broad Florida concept of informed consent. The City Council has determined that SOCE is too dangerous for even a patient fully informed of all risks, who desires to proceed.
All of these toрics such as constitutional privacy rights, parental choice, patient choice as to treatment, and the availability of non-conventional or alternative treatments show that the Legislature has occupied entirely the very wide healthcare swath, whether it is called “informed consent” or “patient’s rights.” No room exists in this pervasive and uniform statewide program for the more than four-hundred Florida municipalities to regulate where legislative intent resides so broadly.
B. Legislative Regulation of the Practice Areas:
The Ordinance outlaws some therapeutic speech in the fields of medicine, osteopathic
The Legislature created the Department of Health by
The first source to consult in assessing Florida’s regulation in this area is Florida Statutes Chapter 456, entitled “Health Professions and Occupations: General Provisions.” Spanning 50 pages of the statute book, this Chapter sets forth the elaborate administrative governing rules for healthcare practice in Florida, placing the State Department of Health as overseer. All relevant persons practicing healthcare and healing arts in Floridа are included under this Department’s supervision. All practice types regulated by Tampa’s Ordinance are included in Chapter 456’s program of regulation. Chapter 456 states that “The Legislature . . . believes that such professions shall be regulated only for the preservation of health, safety, and welfare of the public under the police powers of the state. Such professions shall be regulated when . . . [t]he public is not effectively protected by other means, including, but not limited to, other state statutes, local ordinance, or federal legislation.”
open the possibility that the State could set aside areas for local regulation, no such local regulation exists historically and the State has provided no grants to localities prospectively. Neither Chapter 456 nor other statutes or State regulations provide any opening or suggestion that municipal regulation should supplement the State’s comprehensive healthcare coverage.
In fact, the healthcare regulatory scheme created in Chapter 456 provides for an exhaustive disciplinary regime, leaving no set-aside areas for localities to regulate. Chapter 456 enables the establishment of regulatory boards, based in Tallahassee, for governance and discipline of the various medical professions.
Section 456.072 is entitled “Grounds for discipline; penalties; enforcement.” The final provision of that section states: “The purpose of this section is to facilitate uniform discipline for those actions made punishable under this section and, to this end, a reference to this section constitutes a general reference under the doctrine of incorporation by reference.”
The text makes clear the Legislature intended for uniform discipline to apply throughout the State when it comes to healthcare providers. But Tampa’s Ordinance creates a different and encroaching process in this area.
For disciplinary proceedings brought pursuant to Florida statute, the State must prove the allegations against a medical professional by “clear and convincing” evidencе, subject to investigation at several levels and final review by a peer-review board, trained in the field.14
only requires that a violation be proven by “the greater weight of the evidence” before a code enforcement magistrate. Tampa, Fla., Code of Ordinances § 9-108(1). The Florida Administrative Procedure Act prohibits this lesser “greater weight of the evidence standard” in licensure disciplinary proceedings.
The practitioners’ appellate remedies are also greatly lessened by Tampa. A practitioner disciplined under the Tampa Ordinance would have an appeal right to the Circuit Court and review would be limited to the record below, not de novo.
As to professional discipline, the Ordinance occupies the same field as the Legislature but differs greatly from the statewide model adopted by the Legislature. The reason for this difference is clear. Under Florida law,
“professional disciplinary statutes are penal in nature.”15 The Ordinance alters Florida law and makes professional disсiplinary action not penal, but civil in nature.
The Legislative requirement for “uniform discipline” exists because health care modalities are highly complex and dynamic, but they do not vary across the state. With due respect for the citizen legislators on the Tampa City Council, none
are skilled in mental health issues,16 nor are any of the City’s code enforcement personnel. In contrast the Florida Department of Health, with its skilled adjudicatory bodies, is equipped to address this dynamic area of psychotherapy.
And dynamic it is, indeed. Although the City expresses confident certitude, the City’s experts, one or both, exрressly agreed with the following points:
- Minors can be gender fluid and may change or revert gender identity. Dkt. 192-2 at 38–40.
- Gender dysphoria during childhood does not inevitably continue into adulthood. Dkt. 192-2 at 85–87.
- Formal epidemiologic studies on gender dysphoria in children, adolescents, and adults are lacking. Dkt. 192-2 at 92.
- One Tampa expert testified there is not a consensus regarding the best practices with prepubertal gender nonconforming children. Dkt. 192-2 at 120–21.
- A second Tampa expert testified consensus does not exist regarding best practices with prepubertal gender nonconforming children, but a trend toward a consensus exists. Dkt. 192-1 at 159.
- Emphasizing to parents the importance of allowing their child the freedom to return to a gender identity that aligns with sex assigned at birth or another gender identity at any point cannot be overstated. Dkt. 192-2 at 123.
- One cannot quantify or put a percentage on the increased risk from conversion therapy, as compared to other therapy. Dkts. 192-2 at 131; 192-1 at 198–99.
- Scientific estimates of the efficacy of conversion therapy are essentially nonexistent because of the difficulties of obtaining samples following individuals after they exit therapy, defining success, and obtaining objective reassessment. Dkt. 192-1 at 136–37.
- Based on a comprehensive review of this work, the American Psychological
Association 2009 SOCE Task Force concluded that no study to date has demonstrated adequate scientific rigor to provide a clear picture of the prevalence or frеquency of either beneficial or harmful SOCE outcomes.
- More recent studies claiming benefits and/or harm have done little to ameliorate this concern. Dkt. 192-1 at 148.
- No known study to date [looking at 2014 article Dkt. 192-6 at 2] has drawn from a representative sample of sufficient size to draw conclusions about the experience of those who have attempted SOCE. Dkt. 192-1 at 149.
- No known study [looking at same 2014 article] has provided a comprehensive assessment of basic demographic information, psychosocial wellbeing, and religiosity, which would be required to understand the effectiveness, benefits and/or harm caused by SOCE. Dkt. 192-1 at 150.
- Although research on adult populations has documented harmful effects of SOCE, no scientific research studies have examined SOCE among adolescents. Dkt. 192-1 at 153.
- With extraordinarily well-trained counseling “in a hypothetically perfect world” it may be an appropriate course of action for a counselor to aid a gender-dysphoric child who wants to return to biological gender of birth. Dkt. 192-1 at 171–72.
- There is a lack of published research on efforts to change gender identity among childhood and adolescents. Dkt. 192-1 at 177.
- As of October 2015 no research demonstrating the harms of conversion therapy with gender minority youth has been published. Dkt. 192-1 at 180–81. In 2018 an article was published on youth but causal claims could not be made from that 2018 report. Dkt. 192-1 at 181.
As the citations above show, the City’s highly-credentialed experts, one or both, expressly agreed with the above bullet points. This illustrates the complex and dynamic subject matter of human gender and sexual preference. This shows the wisdom of the Legislature’s program of uniform statewide governance and defining and disciplining the field statewide by medical experts. The field of gender expression is especially complex. Tampa’s lay attempt at psychotherapy regulation crowds into this very complex, evolving area.
1. Specific Regulations for Medical Doctors (M.Ds.):
After the lengthy set-up of the Florida Department of Health in Chapters 20 and 456, the Legislature then set forth practitioner-specific statutes. M.Ds. are more specifically regulated by Chapter 458—spanning 37 pages in the statute book.
Chapter 458 restricts certain dangerous psychiatric procedures such as electroconvulsive and psychosurgical procedures,
This far into the Court’s survey of Florida law it is apparent that the Florida statutes already provide the City with its desired protection against SOCE. The City and its experts adamantly assert that even non-aversive SOCE violates the
prevailing treatment standard of care, and constitutes psychiatric, psychological, and counseling malpractice.18 This is the essence of the Ordinance. The present Florida legislative scheme already outlaws such professional behavior, and it is subject to statewide discipline.
All the City, the City’s Neighborhood Enhancement director, or the Assistant City Attorney need do if the SOCE they describe is detected within Tampa limits is file a complaint with the Department of Health. As the Board of Medicine notes, “Who can file a complaint? Anyone can file a complaint.” Board of Medicine, Complaints Process FAQs, https://flboardofmedicine.gov/complaints-process-faqs/ (last accessed Oct. 3, 2019).
The Florida regulatory scheme punishes and bars all mental health therapy that is beneath the prevailing standard of care. See
Department of Health had no records regarding complaints against medical providers regarding SOCE.” Otto, 353 F. Supp. 3d at 1264.
To complete the Cоurt’s review of Chapter 458, it is noteworthy that Section 458.331 lists “grounds for disciplinary action” of M.Ds. Like Chapter 456, the Legislature in the final subsection notes “The purpose of this section is to facilitate uniform discipline . . . .”
The Florida regulatory scheme for medical doctors then goes beyond the statute book, to the Florida Administrative Code. Starting at Chapter 64B8-1.001, the administrative code stretches some 143 pages of regulations concerning how medical doctors must run their practices, their assistants, and how they must treat patients. The administrative code supplements and expands the disciplinary functions set forth in the statute book. Fla. Admin. Code 64B8-8.001. Practicing below the general standard of care is punishable by fines and sanctions ranging from one year probation and a $1000 fine to a $10,000 fine and permanent license revocation.
2. Specific Regulations for Osteopaths (D.Os.)
The Tampa Ordinance applies to Osteopathic Medicine. The Florida Legislature regulates D.Os. through Chapter 459, Florida Statutes, entitled
“Osteopathic Medicine.” The 29 pages of this Chapter set forth the regulatory framework for osteopaths. The Chapter creates a gubernatorial appointed and senate-approved 7-member “Board of Osteopathic Medicine”
Discipline for osteopathic physicians is set forth in
Florida’s regulation of osteopathic medicine is supplemented by the Florida Administrative Code, with separate and lengthy administrative code provisions albeit along the same lines as those administrative regulations appertaining to medical doctors. See Fla. Admin. Code 64B15. The administrative regulations for osteopathic physicians say nothing about local ordinances supplementing or contradicting the State rules.
3. Specific Regulations for Psychologists
The Tampa’s Ordinance also seeks to regulate licensed psychologists. Psychologists are subject to 21 pages of statutory regulation by Florida Statutes Chapter 490, entitled “Psychological Services.”
As with the other practitioners, Florida goes beyond the statute book and provides 31 pages of regulations in the Florida Administrative Code for psychologists. Fla. Admin. Code 64B19. The regulations cover licensure, limited licensure, discipline, consent for treatment for minors, special rules for treating juvenile sex offenders, etc. The regulations do not refer to local rules.
4. Specific Regulations for Licensed Counselors:
Plaintiff Vazzo is a Florida-licensed marriage and family therapy counselor, and the Ordinance applies to him. Vazzo and his fellow practitioners are regulated under Chapter 491, Florida Statutes, entitled “Clinical, Counseling, and
Psychotherapy Services.”
The disciplinary provisions of Chapter 491 make sanctionable any counseling practice that fails to meet the minimum standard of care “when measured against generally prevailing peer performance[.]”
64B4. These 45 pages of administrative regulations control the qualifications, licensing, practice, and discipline in the entire licensed counselor area. No delegation to cities can be found.
Among the disciplinary sanctions for counseling beneath the prevailing standard of care are a $5000 fine and permanent license revocation.
The regulations add additional license requirements for Vazzo’s specialty of marriage and family therapy.
sociology, gender, anthropology or culture and ethnicity in counseling offer psychosocial awareness.”
For the reasons noted above, the Court concludes that Florida‘s substantive regulation of healthcare practices, modalities, and discipline is so pervasive that it occupies the entire field. The City‘s Ordinance creates a danger of conflict with the Legislature‘s broad program for the healing arts in Florida. The strong policy reasons for a statewide, uniform system of substantive healthcare regulation and discipline are clear, as is the Legislature‘s intent for same.
CONCLUSION
Accordingly, the Court grants Plaintiffs’ motion for summary judgment, Dkt. 194, on Count VI.
DONE AND ORDERED, at Tampa, Florida, on October 4, 2019.
/s/ William F. Jung
WILLIAM F. JUNG
UNITED STATES DISTRICT JUDGE
COPIES FURNISHED TO:
Counsel of Record
Appendix
STATE OF FLORIDA)
) CITY OF TAMPA
COUNTY OF HILLSBOROUGH)
CLERK‘S CERTIFICATE
I, Shirley Foxx-Knowles, the duly appointed and qualified City Clerk of the City of Tampa, Florida. do hereby certify to
WITNESS, My hand and the Official Seal of the City of Tampa, Florida on this the 15th day of December, 2017.
Shirley Foxx-Knowles
City Clerk
(SEAL OF THE CITY OF TAMPA)
ORDINANCE NO. 2017-47
AN ORDINANCE OF THE CITY OF TAMPA, FLORIDA, RELATING TO CONVERSION THERAPY ON PATIENTS WHO ARE MINORS, MAKING REVISIONS TO CITY OF TAMPA CODE OF ORDINANCES, CHAPTER 14 (OFFENSES); CREATING ARTICLE X, SECTIONS 14-310 – 14-313; AMENDING CHAPTER 19 (PROPERTY MAINTENANCE AND STRUCTURAL STANDARDS); AMENDING SECTION 19-4(a)(2), DEPARTMENT OF CODE ENFORCEMENT; DUTIES AND SCOPE OF AUTHORITY OF THE DIRECTOR; REPEALING ALL ORDINANCES OR PARTS OF ORDINANCES IN CONFLICT THEREWITH; PROVIDING FOR SEVERABILITY; PROVIDING AN EFFECTIVE DATE.
WHEREAS, as recognized by major professional associations of mental health practitioners and researchers in the United States and elsewhere for nearly 40 years, being lesbian, gay, bisexual, transgender or gender nonconforming, or questioning (LGBT or LGBTQ) is not a mental disease, disorder or illness, deficiency or shortcoming; and
WHEREAS, the American Academy of Pediatrics in 1993 published an article in its Journal, stating: “Therapy directed at specifically changing sexual orientation is contraindicated, since it can provoke guilt and anxiety while having little or no potential for achieving changes in orientation;”1 and
WHEREAS, the American Psychiatric Association in December 1998 published its opposition to any psychiatric treatment, including reparative or conversion therapy, which therapy regime is based upon the assumption that homosexuality is a mental disorder per se or that a patient should change his or her homosexual orientation;2 and
WHEREAS, the American Psychological Association‘s Task Force on Appropriate Therapeutic Responses to Sexual Orientation (“APA Task Force“) conducted a systematic review of peer-reviewed journal literature on Sexual Orientation Change Efforts (“SOCE“), and issued its report in 2009, citing research that sexual orientation change efforts can pose critical health risks to lesbian, gay, and bisexual people, including confusion, depression, guilt, helplessness, hopelessness, shame, social withdrawal, suicidality, substance abuse, stress, disappointment, self-blame, decreased self-esteem and authenticity to others, increased self-hatred, hostility and blame toward parents, feelings of anger and betrayal, loss of friends and potential romantic partners, problems in sexual and emotional intimacy, sexual dysfunction, high-risk sexual behaviors, a feeling of being dehumanized and untrue to self, a loss of faith, and a sense of having wasted time and resources;3 and
WHEREAS, following the report issued by the APA Task Force, the American Psychological Association in 2009 issued a resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts, advising parents, guardians, young people, and their families
WHEREAS, the American Psychoanalytic Association in June 2012 issued a position statement on conversion therapy efforts, articulating that “As with any societal prejudice, bias against individuals based on actual or perceived sexual orientation, gender identity or gender expression negatively affects mental health, contributing to an enduring sense of stigma and pervasive self-criticism through the internalization of such prejudice” and that psychoanalytic technique “does not encompass purposeful attempts to ‘convert,’ ‘repair,’ change or shift an individual‘s sexual orientation, gender identity or gender expression,” such efforts being inapposite to “fundamental principles of psychoanalytic treatment and often result in substantial psychological pain by reinforcing damaging internalized attitudes;”5 and
WHEREAS, the American Academy of Child & Adolescent Psychiatry in 2012 published an article in its Journal stating that clinicians should be aware that there is “no evidence that sexual orientation can be altered through therapy and that attempts to do so may be harmful;” that there is “no medically valid basis for attempting to prevent homosexuality, which is not an illness;” and that such efforts may encourage family rejection and undermine self-esteem, connectedness and caring, important protective faсtors against suicidal ideation and attempts; and that, for similar reasons cumulatively stated above, carrying the risk of significant harm, SOCE is contraindicated;6 and
WHEREAS, the Pan American Health Organization, a regional office of the World Health Organization, issued a statement in 2012 stating: “These supposed conversion therapies constitute a violation of the ethical principles of health care and violate human rights that are protected by international and regional agreements.” The organization also noted that conversion therapies “lack medical justification and represent a serious threat to the health and well-being of affected people;”7 and
WHEREAS, in 2014 the American School Counselor Association issued a position statement that states: “It is not the role of the professional school counselor to attempt to change a student‘s sexual orientation or gender identity. Professional school counselors do not support efforts by licensed mental health professionals to change a student‘s sexual orientation or gender as these practices have been proven ineffective and harmful;”8 and
WHEREAS, a 2015 report of the Substance Abuse and Mental Health Services Administration, a division of the U.S. Department of Health and Human Services, “Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth” further reiterates based on scientific literature that conversion therapy efforts to change an individual‘s sexual orientation, gender identity, or gendеr expression is a practice not supported by credible evidence and has been disavowed by behavioral health experts and associations, perpetuates outdated views of gender roles and identities, negative stereotypes, stating, importantly, that such therapy may put young people at risk of serious harm, and recognizing that, same-gender sexual orientation (including identity, behavior, and attraction) is part of the normal spectrum of human diversity and does not constitute a mental disorder;
WHEREAS, the American College of Physicians wrote a position paper in 2015 opposing the use of “conversion,” “reorientation,” or “reparative” therapy for the treatment of LGBT persons, stating that “[a]vailable research does not support the use of reparative therapy as an effective method in the treatment of LGBT persons. Evidence shows that the practice may actually cause emotional or physical harm to LGBT individuals, particularly adolescents or young persons;”10 and
WHEREAS, in 2016, the American Medical Association issued policy statement H-160.991, which expressly opposed the use of “reparative” or “conversion” therapy for sexual orientation or gender identity;11 and
WHEREAS, the World Psychiatric Association issued a policy statement in March, 2016 on Gender Identity and Same-Sex Orientation, which stated, “There is no sound scientific evidence that innate sexual orientation can be changed. Furthermore, so-called treаtments of homosexuality can create a setting in which prejudice and discrimination flourish, and they can be potentially harmful. The provision of any intervention purporting to ‘treat’ something that is not a disorder is wholly unethical;”12 and
WHEREAS, The National Association of Social Workers (“NASW“) issued a policy statement stating that “No data demonstrates that reparative or conversion therapies are effective, and in fact they may be harmful.” The NASW went further and stated that “conversion and reparative therapies are an infringement to the guiding principles inherent to social worker ethics and values;”13 and
WHEREAS, The Agency for Healthcare Research and Quality issued a clinician‘s guideline for practitioners who work with children and adolescents based on research provided by the American Academy of Child and Adolescent Psychiatry. It stated that “There is no empirical evidence that adult homosexuality can be prevented if gender nonconforming children are influenced to be more gender conforming. Indeed, there is no medically valid basis for attempting to prevent homosexuality, which is not an illness. On the contrary, such efforts may encourage family rejection and undermine self-esteem, connectedness, and caring, which are important protective factors against suicidal ideation and attempts;”14 and
WHEREAS, At least two federal circuit courts of appeal have upheld bans on conversion therapy.15 Both courts found that bans on conversion therаpy did not violate free speech rights; nor did such bans run afoul of the Free Exercise Clause; nor were such bans vague or impermissibly overbroad. Further the courts found that counseling is professional speech, subject to a lower level of judicial scrutiny because the government has a substantial interest in protecting citizens from ineffective or harmful professional practices; and
WHEREAS, the City does not intend to prevent mental health providers from speaking to the public about SOCE; expressing their views to patients; recommending SOCE to patients; administering SOCE to any person who is 18 years of age or older; or referring minors to unlicensed counselors, such as religious leaders. This ordinance does not prevent unlicensed providers, such as religious leaders, from administering SOCE to children or adults; nor does it prevent minors from seeking SOCE from mental health providers in other political subdivisions or states outside of the City of Tampa, Florida; and
WHEREAS, City of Tampa has a compelling interest in protecting the physical and psychological well-being of
WHEREAS, the City Council hereby finds the overwhelming research demonstrating that sexual orientation and gender identity change efforts can pose critical health risks to lesbian, gay, bisexual, transgender or questioning persons, and that being lesbian, gay, bisexual, trаnsgender or questioning is not a mental disease, mental disorder, mental illness, deficiency, or shortcoming; and
WHEREAS, the City Council finds minors receiving treatment from licensed therapists in the City of Tampa, Florida who may be subject to conversion or reparative therapy are not effectively protected by other means, including, but not limited to, other state statutes, local ordinances, or federal legislation; and
WHEREAS, the City Council desires to prohibit, within the geographic boundaries of the City, the practice of sexual orientation or gender identity change efforts on minors by licensed therapists only, including reparative and/or conversion therapy, which have been demonstrated to be harmful to the physical and psychological well-being of lesbian, gay, bisexual, transgender and questioning persons.
NOW, THEREFORE,
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF TAMPA, FLORIDA,
Section 1. That the Whereas Clauses are adopted as if set forth fully herein.
Section 2. That “Chapter 14, Article X” is created as follows:
”CHAPTER 14, ARTICLE X, CONVERSION THERAPY”
Section 3. That “Sec. 14-310. – Intent.” is hereby created by adding the underlined language as follows:
”Sec. 14-310. – Intent.
The Intent of this Ordinance is to protect the physical and psychological well-being of minors, including but not limited to lesbian, gay, bisexual, transgender and/or questioning youth, from exposure to the serious harms and risks caused by conversion therapy or reparative therapy by licensed providers, including but not limited to licensed therapists. These provisions are exercises of police power of the City for the public safety, health, and welfare; and its provisions shall be liberally construed to accomplish that purpose.”
Section 4. That “Sec. 14-311. – Definitions.” is hereby created by adding the underlined language as follows:
”Sec. 14-311. – Definitions.
(a) Conversion therapy or reparative therapy means, interchangeably, any counseling, practice or treatment performed with the goal of changing an individual‘s sexual orientation or gender identity, including, but not limited to, efforts to change behaviors, gender identity, or gender expression, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender or sex. Conversion therapy does not include counseling that provides support and assistance to a person undergoing gender transition or counseling that provides acceptance, support, and understanding of a person or facilitates a person‘s coping, social support, and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices, as long as such counseling does not seek to change sexual orientation or gender identity.
(b) Minor means any person less than 18 years of age.
Section 5. That “Sec. 14-312. – Conversion Therapy Prohibited.” is hereby created by adding the underlined language as follows:
”Sec. 14-312. – Conversion Therapy Prohibited.
It shall be unlawful for any Provider to practice conversion therapy efforts on any individual who is a minor regardless of whether the Provider receives monetary compensation in exchange for such services.”
Section 6. That “Sec. 14-313. – Enforcement and Civil Penalties.” is hereby created by adding the underlined language as follows:
”Sec. 14-313. – Enforcement and Civil Penalties.
(a) This article may be enforced pursuant to Chapter 9, Article II of this Code.
(b) The violation of Sec. 14-312 of this Division is deemed an irreparable or irreversible violation.
(c) Each separate incident of a violation of Sec. 14-312 shall constitute a separate violation for enforcement purposes.
(d) The fine for a first violation of Sec. 14-312 is $1000.00. The fine for a second and subsequent violation(s) of Sec. 14-312 is $5000.00.
(e) These penalties shall not preclude any other remedies available at law or in equity, including, injunctive relief in the circuit court.”
Section 7. That “Sec. 19-4(a)(2). – Department of Code Enforcement; duties and scope of authority of the director” is hereby amended by adding the underline language as follows:
”Sec. 19-4(a)(2). – Department of Code Enforcement; duties and scope of authority of the director
(a)The director shall have all powers, duties and responsibilities to administer and enforce the following City Code chapters or sections: The director shall be deemed to be an officer for the purpose of enforcing the provisions of this chapter under authority provided in section 1-14 of this Code.
(1)Section 5-105;
(2)Chapter 14, articles III, IV, and X;
(3)Chapter 19;
(4)Chapter 21, articles I, II, III and V;
(5)Chapter 22, articles I and III;
(6)Chapter 25, article I;
(7)Chapter 27.”
Section 8. All ordinances or parts of ordinances in conflict herewith are hereby repealed.
Section 9. Should any section or provision of this Ordinance or any portion, paragraph, sentence, or word be declared invalid by a court of competent jurisdiction, such decision shall not affect the validity of the remainder of this Ordinance.
Section 10. Authority is hereby granted to codify the text amendment set forth in Section 1 of this Ordinance.
Section 11. That this Ordinance shall take effect immediately upon its adoption.
PASSED AND ORDAINED BY THE CITY COUNCIL OF THE CITY OF TAMPA, FLORIDA, ON APR 0 6 2017
/s/ Yvonne Yolie Capin
CHAIRMAN/CHAIRMAN PRO-TEM,
CITY COUNCIL
ATTEST:
/s/ Shirley Foxx-Knowles
SHIRLEY FOXX-KNOWLES, CITY CLERK
APPROVED BY ME ON APR 1 0 2017
/s/ Bob Buckhorn
BOB BUCKHORN, MAYOR
Approved As to Legal Sufficiency:
E/S
Ernest Mueller, Senior Assistant City Attorney