Helena, Montana – Montana Attorney General Austin Knudsen is leading a coalition of attorneys general from 14 states in asking the U.S. Supreme Court to review and overturn a federal appeals court decision that they argue threatens the free speech rights of medical professionals.
The coalition recently filed an amicus brief in the case Azadeh Khatini, MD; Do No Harm, Inc. v. Randy Hawkins, urging the nation’s highest court to reverse a ruling issued by the Ninth Circuit Court of Appeals. The dispute centers on California’s Continuing Medical Education requirements and whether the state can require physicians to receive training that includes specific diversity, equity, and inclusion, or DEI, viewpoints.
According to the attorneys general, the issue extends beyond medical education and raises broader constitutional questions involving the First Amendment and the government’s ability to compel speech.
States Argue Physicians Are Being Forced To Adopt Government Views
Continuing Medical Education, commonly referred to as CME, is required by states across the country for physicians who wish to maintain their medical licenses and remain in good standing.
The coalition argues that California’s current requirements go beyond ordinary professional education by requiring physicians and instructors to promote state-approved viewpoints related to DEI and implicit bias.
Attorney General Knudsen and the other states contend that such requirements amount to compelled speech because medical professionals must complete the training as a condition of keeping their licenses.
“If California’s statute passes Constitutional muster, the prior limitations on the government-speech doctrine fall away, leaving only questions about just how far this power reaches,” Attorney General Knudsen wrote in the brief.
The filing argues that government officials should not be permitted to force private citizens to communicate specific viewpoints simply because they work in a licensed profession.
According to the coalition, California’s approach differs significantly from historical practices, when the state exercised little direct control over the specific content of CME coursework.
Debate Centers On DEI And Implicit Bias Training
Under California’s more recent requirements, CME instructors must provide educational content that addresses implicit bias and its potential impact on medical treatment and patient outcomes.
The curriculum includes discussions about how bias may affect healthcare decisions involving patients from different racial, ethnic, age, gender identity, and sexual orientation groups. It also includes strategies intended to help medical professionals recognize and address such bias.
The attorneys general challenging the policy argue that these topics remain the subject of ongoing national debate and should not be mandated as government-approved viewpoints.
Their brief cites the case Chiles v. Salazar, arguing that courts have previously recognized protections for the speech rights of professionals. The coalition maintains that if the government cannot prohibit professionals from expressing viewpoints contrary to official positions, it should likewise be unable to require them to promote government-approved viewpoints.
The brief warns that allowing California’s policy to stand could create a precedent extending beyond healthcare.
According to the filing, the government could potentially compel speech in other licensed professions if courts permit the current requirements to remain in place.
“Into this maelstrom of national debate over DEI, including implicit bias training, and other deeply controversial issues, California has thrust petitioners and anyone else who engages in CME instruction,” the brief states. “In doing so, it has forced these private actors to serve as the mouthpiece of the California government, endorsing one viewpoint in the controversy while implicitly rejecting the other. And it has done so despite having other viable avenues for expressing California’s position on implicit bias in medicine.”
Multistate Coalition Joins Supreme Court Effort
The legal challenge has attracted support from a broad coalition of states.
Alongside Montana and Iowa, attorneys general from Alabama, Alaska, Georgia, Idaho, Indiana, Kansas, Louisiana, Nebraska, Oklahoma, South Carolina, Texas, and West Virginia joined the brief.
The coalition is asking the Supreme Court to review the Ninth Circuit’s ruling and determine whether California’s CME requirements violate constitutional free speech protections.
The case now places the debate over professional licensing, DEI education, and the limits of government authority before the nation’s highest court. A decision by the Supreme Court could have significant implications not only for physicians and medical educators but also for how states regulate speech within licensed professions across the country.
