throbber

`(Slip Opinion)
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` OCTOBER TERM, 2019
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`Syllabus
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`1
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` NOTE: Where it is feasible, a syllabus (headnote) will be released, as is
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`
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` being done in connection with this case, at the time the opinion is issued.
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`
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` The syllabus constitutes no part of the opinion of the Court but has been
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` prepared by the Reporter of Decisions for the convenience of the reader.
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` See United States v. Detroit Timber & Lumber Co., 200 U. S. 321, 337.
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`SUPREME COURT OF THE UNITED STATES
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`
`
` Syllabus
`
` JUNE MEDICAL SERVICES L. L. C. ET AL. v. RUSSO,
`
`INTERIM SECRETARY, LOUISIANA DEPARTMENT
`
`
`OF HEALTH AND HOSPITALS
`CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR
`
`THE FIFTH CIRCUIT
`No. 18–1323. Argued March 4, 2020—Decided June 29, 2020*
`
`Louisiana’s Act 620, which is almost word-for-word identical to the Texas
`“admitting privileges” law at issue in Whole Woman’s Health v. Heller-
`
`stedt, 579 U. S. ___, requires any doctor who performs abortions to hold
`“active admitting privileges at a hospital . . . located not further than
`thirty miles from the location at which the abortion is performed or
`induced,” and defines “active admitting privileges” as being “a member
`
`in good standing” of the hospital’s “medical staff . . . with the ability to
`admit a patient and to provide diagnostic and surgical services to such
`
`patient.”
`
`
`In these consolidated cases, five abortion clinics and four abortion
`
`providers challenged Act 620 before it was to take effect, alleging that
`
`it was unconstitutional because (among other things) it imposed an
`
`
`undue burden on the right of their patients to obtain an abortion. (The
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`plaintiff providers and two additional doctors are referred to as Does 1
`through 6.) The plaintiffs asked for a temporary restraining order
`(TRO), followed by a preliminary injunction to prevent the law from
`
`taking effect. The defendant (State) opposed the TRO request but also
`
`
`urged the court not to delay ruling on the preliminary injunction mo-
`
`tion, asserting that there was no doubt about the physicians’ standing.
`Rather than staying the Act’s effective date, the District Court provi-
`
`sionally forbade the State to enforce the Act’s penalties, while directing
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`
`
`——————
`*Together with No. 18–1460, Russo, Interim Secretary, Louisiana De-
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`partment of Health and Hospitals v. June Medical Services L. L. C. et al.,
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`also on certiorari to the same court.
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`2
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`JUNE MEDICAL SERVICES L. L. C. v. RUSSO
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`Syllabus
`the plaintiff doctors to continue to seek privileges and to keep the court
`
`apprised of their progress. Several months later, after a 6-day bench
`
`trial, the District Court declared Act 620 unconstitutional on its face
`and preliminarily enjoined its enforcement. On remand in light of
`
`Whole Woman’s Health, the District Court ruled favorably on the plain-
`
`tiffs’ request for a permanent injunction on the basis of the record pre-
`viously developed, finding, among other things, that the law offers no
`significant health benefit; that conditions on admitting privileges com-
`mon to hospitals throughout the State have made and will continue to
`make it impossible for abortion providers to obtain conforming privi-
`leges for reasons that have nothing to do with the State’s asserted in-
`
`terests in promoting women’s health and safety; and that this inability
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`places a substantial obstacle in the path of women seeking an abortion.
`
`The court concluded that the law imposes an undue burden and is thus
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`unconstitutional. The Fifth Circuit reversed, agreeing with the Dis-
`trict Court’s interpretation of the standards that apply to abortion reg-
`ulations, but disagreeing with nearly every one of the District Court’s
`factual findings.
`Held: The judgment is reversed.
`905 F. 3d 787, reversed.
`JUSTICE BREYER, joined by JUSTICE GINSBURG, JUSTICE SOTOMAYOR,
`
`and JUSTICE KAGAN, concluded:
`
`1. The State’s unmistakable concession of standing as part of its ef-
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`fort to obtain a quick decision from the District Court on the merits of
`the plaintiffs’ undue-burden claims and a long line of well-established
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`precedents foreclose its belated challenge to the plaintiffs’ standing in
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`this Court. Pp. 11–16.
`
`
`2. Given the District Court’s factual findings and precedents, partic-
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`ularly Whole Woman’s Health, Act 620 violates the Constitution.
`Pp. 16–40.
`
`
`(a) Under the applicable constitutional standards set forth in the
`Court’s earlier abortion-related
`cases, particularly Planned
`
`Parenthood of Southeastern Pa. v. Casey, 505 U. S. 833, and Whole
`Woman’s Health, “ ‘[u]nnecessary health regulations that have the
`
`purpose or effect of presenting a substantial obstacle to a woman seek-
`ing an abortion impose an undue burden on the right’ ” and are there-
`
`fore “constitutionally invalid,” Whole Woman’s Health, 579 U. S., at
`___. This standard requires courts independently to review the legis-
`lative findings upon which an abortion-related statute rests and to
`
`weigh the law’s “asserted benefits against the burdens” it imposes on
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`abortion access. Id., at ___. The District Court here, like the trial court
`in Whole Woman’s Health, faithfully applied these standards. The
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`

`3
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`Cite as: 591 U. S. ____ (2020)
`
`
`Syllabus
`Fifth Circuit disagreed with the District Court, not so much in respect
`to the legal standards, but in respect to the factual findings on which
`
`the District Court relied in assessing both the burdens that Act 620
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`imposes and the health-related benefits it might bring.
`
`
`Under well-established legal standards, a district court’s findings of
`fact “must not be set aside unless clearly erroneous, and the reviewing
`court must give due regard to the trial court’s opportunity to judge the
`witnesses’ credibility.” Fed. Rule. Civ. Proc. 52(a)(6). When the dis-
`trict court is “sitting without a jury,” the appellate court “is not to de-
`
`
`
`cide factual issues de novo,” Anderson v. Bessemer City, 470 U. S. 564,
`
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`573. Provided “the district court’s account of the evidence is plausible
`
`
`
`in light of the record viewed in its entirety, the court of appeals may
`not reverse it even though convinced that had it been sitting as the
`trier of fact, it would have weighed the evidence differently.” Id., at
`573–574. Viewed in light of this standard, the testimony and other
`evidence contained in the extensive record developed over the 6-day
`
`trial support the District Court’s conclusion on Act 620’s constitution-
`
`ality. Pp. 16–19.
`
`
`
`(b) Taken together, the District Court’s findings and the evidence
`underlying them are sufficient to support its conclusion that enforcing
`the admitting-privileges requirement would drastically reduce the
`number and geographic distribution of abortion providers, making it
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`impossible for many women to obtain a safe, legal abortion in the State
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`and imposing substantial obstacles on those who could. Pp. 19–35.
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`
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`(1) The evidence supporting the court’s findings in respect to
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`Act 620’s impact on abortion providers is stronger and more detailed
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`than that in Whole Woman’s Health. The District Court supervised
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`
`
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`Does 1, 2, 5, and 6 for more than 18 months as they tried, and largely
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`failed, to obtain conforming privileges from 13 relevant hospitals; it
`relied on a combination of direct evidence that some of the doctors’ ap-
`plications were denied for reasons having nothing to do with their abil-
`ity to perform abortions safely, and circumstantial evidence—includ-
`ing hospital bylaws with requirements like those considered in Whole
`
`Woman’s Health and evidence that showed the role that opposition to
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`abortion plays in some hospitals’ decisions—that explained why other
`applications were denied despite the doctors’ good-faith efforts. Just
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`as in Whole Woman’s Health, that evidence supported the District
`
`
`Court’s factual finding that Louisiana’s admitting-privileges require-
`ment serves no “relevant credentialing function.” 579 U. S., at ___.
`
`The Fifth Circuit's conclusion that Does 2, 5, and 6 acted in bad faith
`cannot be squared with the clear-error standard of review that applies
`to the District Court’s contrary findings. Pp. 19–31.
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`
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`(2) The District Court also drew from the record evidence sev-
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`4
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`JUNE MEDICAL SERVICES L. L. C. v. RUSSO
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`Syllabus
`eral conclusions in respect to the burden that Act 620 is likely to im-
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`pose upon women’s ability to access an abortion in Louisiana. It found
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`that enforcing that requirement would prevent Does 1, 2, and 6 from
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`providing abortions altogether. Doe 3 gave uncontradicted, in-court
`testimony that he would stop performing abortions if he was the last
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`provider in northern Louisiana, so the departure of Does 1 and 2 would
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`also eliminate Doe 3. And Doe 5’s inability to obtain privileges in the
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`Baton Rouge area would leave Louisiana with just one clinic with one
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`provider to serve the 10,000 women annually who seek abortions in
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`the State. Those women not altogether prevented from obtaining an
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`abortion would face “longer waiting times, and increased crowding.”
`Whole Woman’s Health, 579 U. S., at ___. Delays in obtaining an abor-
`tion might increase the risk that a woman will experience complica-
`
`tions from the procedure and may make it impossible for her to choose
`
`
`a non-invasive medication abortion. Both expert and lay witnesses
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`testified that the burdens of increased travel to distant clinics would
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`fall disproportionately on poor women, who are least able to absorb
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`them. Pp. 31–35.
`
`
`
`(c) An examination of the record also shows that the District
`
`
`Court’s findings regarding the law’s asserted benefits are not “clearly
`erroneous.” The court found that the admitting-privileges require-
`
`ment serves no “relevant credentialing function.” 250 F. Supp. 3d 27,
`
`87. Hospitals can, and do, deny admitting privileges for reasons unre-
`lated to a doctor’s ability safely to perform abortions, focusing primar-
`ily upon a doctor’s ability to perform the inpatient, hospital-based pro-
`
`cedures for which the doctor seeks privileges—not outpatient
`abortions. And nothing in the record indicates that the vetting of ap-
`
`plicants for privileges adds significantly to the vetting already pro-
`vided by the State Board of Medical Examiners. The court’s finding
`that the admitting-privileges requirement “does not conform to pre-
`vailing medical standards and will not improve the safety of abortion
`
`in Louisiana,” ibid., is supported by expert and lay trial testimony.
`And, as in Whole Woman’s Health, the State introduced no evidence
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`“showing that patients have better outcomes when their physicians
`
`
`have admitting privileges” or “of any instance in which an admitting
`privileges requirement would have helped even one woman obtain bet-
`
`ter treatment,” 250 F. Supp. 3d., at 64. Pp. 35–38.
`
`
`(d) In light of the record, the District Court’s significant factual
`findings—both as to burdens and as to benefits—have ample eviden-
`
`tiary support and are not “clearly erroneous.” Thus, the court’s related
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`factual and legal determinations and its ultimate conclusion that Act
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`620 is unconstitutional are proper. P. 38.
`THE CHIEF JUSTICE agreed that abortion providers in this case have
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`5
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`Cite as: 591 U. S. ____ (2020)
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`Syllabus
`standing to assert the constitutional rights of their patients and con-
`
`cluded that because Louisiana’s Act 620 imposes a burden on access to
`
`abortion just as severe as that imposed by the nearly identical Texas
`law invalidated four years ago in Whole Woman’s Health v. Hellerstedt,
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`579 U. S. ___, it cannot stand under principles of stare decisis. Pp. 1–
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`16.
` BREYER, J., announced the judgment of the Court and delivered an
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`opinion, in which GINSBURG, SOTOMAYOR, and KAGAN, JJ., joined. ROB-
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`ERTS, C. J., filed an opinion concurring in the judgment. THOMAS, J., filed
`a dissenting opinion. ALITO, J., filed a dissenting opinion, in which GOR-
`
`SUCH, J., joined, in which THOMAS, J., joined except as to Parts III–C and
`IV–F, and in which KAVANAUGH, J., joined as to Parts I, II, and III. GOR-
`
`SUCH, J., and KAVANAUGH, J., filed dissenting opinions.
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`

`

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` Cite as: 591 U. S. ____ (2020)
`
`Opinion of the Court
`Opinion of BREYER, J.
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`1
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` NOTICE: This opinion is subject to formal revision before publication in the
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` preliminary print of the United States Reports. Readers are requested to
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` notify the Reporter of Decisions, Supreme Court of the United States, Wash-
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` ington, D. C. 20543, of any typographical or other formal errors, in order that
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` corrections may be made before the preliminary print goes to press.
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`SUPREME COURT OF THE UNITED STATES
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`
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`
`
`_________________
` Nos. 18–1323 and 18–1460
`_________________
` JUNE MEDICAL SERVICES L. L. C., ET AL.,
`
`
`PETITIONERS
`
`18–1323
`v.
`STEPHEN RUSSO, INTERIM SECRETARY,
`
`
`LOUISIANA DEPARTMENT OF HEALTH
`AND HOSPITALS
`
`
`
`STEPHEN RUSSO, INTERIM SECRETARY,
`LOUISIANA DEPARTMENT OF HEALTH
`
`
`AND HOSPITALS, PETITIONER
`
`18–1460
`
`v.
`
` JUNE MEDICAL SERVICES L. L. C., ET AL.
`
`
`ON WRITS OF CERTIORARI TO THE UNITED STATES COURT OF
`
`APPEALS FOR THE FIFTH CIRCUIT
`[June 29, 2020]
` JUSTICE BREYER announced the judgment of the Court
`and delivered an opinion, in which JUSTICE GINSBURG,
`
`
`
`JUSTICE SOTOMAYOR, and JUSTICE KAGAN join.
`
`
`In Whole Woman’s Health v. Hellerstedt, 579 U. S. ___
`
`(2016), we held that “‘[u]nnecessary health regulations that
`
`have the purpose or effect of presenting a substantial obsta-
`cle to a woman seeking an abortion impose an undue bur-
`den on the right’ ” and are therefore “constitutionally inva-
`lid.” Id., at ___ (slip op., at 1) (quoting Planned Parenthood
`
`of Southeastern Pa. v. Casey, 505 U. S. 833, 878 (1992) (plu-
`rality opinion); alteration in original). We explained that
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`

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` JUNE MEDICAL SERVICES L. L. C. v. RUSSO
`
`Opinion of BREYER, J.
` this standard requires courts independently to review the
`
`legislative findings upon which an abortion-related statute
`rests and to weigh the law’s “asserted benefits against the
`
`burdens” it imposes on abortion access. 579 U. S., at ___
`
`(slip op., at 21) (citing Gonzales v. Carhart, 550 U. S. 124,
`
`
`165 (2007)).
`The Texas statute at issue in Whole Woman’s Health re-
`
`
`quired abortion providers to hold “‘active admitting privi-
`leges at a hospital’” within 30 miles of the place where they
`perform abortions. 579 U. S., at ___ (slip op., at 1) (quoting
`Tex. Health & Safety Ann. Code §171.0031(a) (West Cum.
`Supp. 2015)). Reviewing the record for ourselves, we found
`
`ample evidence to support the District Court’s finding that
`
`the statute did not further the State’s asserted interest in
`protecting women’s health. The evidence showed, moreo-
`ver, that conditions on admitting privileges that served no
`“relevant credentialing function,” 579 U. S., at ___ (slip op.,
`
`at 25), “help[ed] to explain” the closure of half of Texas’
`abortion clinics, id., at ___ (slip op., at 24). Those closures
`
`placed a substantial obstacle in the path of Texas women
`seeking an abortion. Ibid. And that obstacle, “when viewed
`in light of the virtual absence of any health benefit,” im-
`
`posed an “undue burden” on abortion access in violation of
`the Federal Constitution. Id., at ___ (slip op., at 26); see
`
`Casey, 505 U. S., at 878 (plurality opinion).
`
`
`In this case, we consider the constitutionality of a Louisi-
`
`ana statute, Act 620, that is almost word-for-word identical
`
`to Texas’ admitting-privileges law. See La. Rev. Stat. Ann.
`§40:1061.10(A)(2)(a) (West 2020). As in Whole Woman’s
`
`Health, the District Court found that the statute offers no
`significant health benefit. It found that conditions on ad-
`mitting privileges common to hospitals throughout the
`State have made and will continue to make it impossible for
`abortion providers to obtain conforming privileges for rea-
`sons that have nothing to do with the State’s asserted in-
`terests in promoting women’s health and safety. And it
`
`2
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`

`

`3
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` Cite as: 591 U. S. ____ (2020)
`
`Opinion of BREYER, J.
`found that this inability places a substantial obstacle in the
`path of women seeking an abortion. As in Whole Woman’s
`
`Health, the substantial obstacle the Act imposes, and the
`
`absence of any health-related benefit, led the District Court
`to conclude that the law imposes an undue burden and is
`therefore unconstitutional. See U. S. Const., Amdt. 14, §1.
`
`The Court of Appeals agreed with the District Court’s in-
`terpretation of the standards we have said apply to regula-
`
`tions on abortion. It thought, however, that the District
`
`Court was mistaken on the facts. We disagree. We have
`examined the extensive record carefully and conclude that
`
`it supports the District Court’s findings of fact. Those find-
`ings mirror those made in Whole Woman’s Health in every
`
`relevant respect and require the same result. We conse-
`
`quently hold that the Louisiana statute is unconstitutional.
`I
`A
`
`In March 2014, five months after Texas’ admitting-privi-
`
`leges requirement forced the closure of half of that State’s
`abortion clinics, Louisiana’s Legislature began to hold hear-
`ings to consider a substantially identical proposal. Com-
`
`pare Whole Woman’s Health, 579 U. S., at ___ – ___ (slip op.,
`
`at 1–2), with June Medical Services LLC v. Kliebert, 250
`F. Supp. 3d 27, 53 (MD La. 2017); Record 11220. The pro-
`
`posal became law in mid-June 2014. 2014 La. Acts p. 2330.
`
`As was true in Texas, Louisiana law already required
`abortion providers either to possess local hospital admitting
`
`privileges or to have a patient “transfer” arrangement with
`a physician who had such privileges. Compare Whole
`
`Woman’s Health, 579 U. S., at ___ (slip op., at 2) (citing Tex.
`Admin. Code, tit. 25, §139.56 (2009)), with former La. Ad-
`
`min. Code, tit. 48, pt. I, §4407(A)(3) (2003), 29 La. Reg. 706–
`707 (2003). The new law eliminated that flexibility. Act
`620 requires any doctor who performs abortions to hold “ac-
`tive admitting privileges at a hospital that is located not
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`

`

`4
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` JUNE MEDICAL SERVICES L. L. C. v. RUSSO
`
`Opinion of BREYER, J.
`further than thirty miles from the location at which the
`abortion is performed or induced and that provides obstet-
`rical or gynecological health care services.” La. Rev. Stat.
`Ann. §40:1061.10(A)(2)(a).
`
`The statute defines “active admitting privileges” to mean
`
`that the doctor must be “a member in good standing” of the
`hospital’s “medical staff . . . with the ability to admit a pa-
`tient and to provide diagnostic and surgical services to such
`patient.” Ibid.; La. Admin. Code, tit. 48, pt. I, §4401. Fail-
`
`ure to comply may lead to fines of up to $4,000 per violation,
`
`license revocation, and civil liability. See ibid.; La. Rev.
`
`Stat. Ann. §40:1061.29.
`
`
`
`B
`
`A few weeks before Act 620 was to take effect in Septem-
`ber 2014, three abortion clinics and two abortion providers
`
`filed a lawsuit in Federal District Court. They alleged that
`Act 620 was unconstitutional because (among other things)
`
`it imposed an undue burden on the right of their patients to
`obtain an abortion. App. 24. The court later consolidated
`their lawsuit with a similar, separate action brought by two
`other clinics and two other abortion providers. (Like the
`
`courts below, we shall refer to the two doctors in the first
`
`case as Doe 1 and Doe 2; we shall refer to the two doctors in
`
`the second case as Doe 5 and Doe 6; and we shall refer to
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`two other doctors then practicing in Louisiana as Doe 3 and
`Doe 4.)
`
`The plaintiffs immediately asked the District Court to is-
`sue a temporary restraining order (TRO), followed by a pre-
`liminary injunction that would prevent the law from taking
`effect. June Medical Services LLC v. Caldwell, No. 14–cv–
`
`00525 (MD La., Aug. 22, 2014), Doc. No. 5.
`
`The State of Louisiana, appearing for the defendant Sec-
`
`retary of the Department of Health and Hospitals, filed a
`response that opposed the plaintiffs’ TRO request. App. 32–
`
`39. But the State went on to say that, if the court granted
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`

`5
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` Cite as: 591 U. S. ____ (2020)
`
`Opinion of BREYER, J.
`the TRO or if the parties reached an agreement that would
`allow the plaintiffs time to obtain privileges without a TRO,
`the court should hold a hearing on the preliminary injunc-
`tion request as soon as possible. Id., at 43. The State ar-
`
`gued that there was no reason to delay a ruling on the mer-
`its of the plaintiffs’ undue-burden claims. Id., at 43–44. It
`
`
`asserted that there was “no question that the physicians
`
`had standing to contest the law.” Id., at 44. And, in light
`of the State’s “overriding interest in vindicating the consti-
`tutionality of its admitting-privileges law,” the plaintiffs’
`suit was “the proper vehicle” to “remov[e] any cloud upon”
`
`Act 620’s “validity.” Id., at 45.
`The District Court declined to stay the Act’s effective
`
`date. Instead, it provisionally forbade the State to enforce
`
`the Act’s penalties, while directing the plaintiff doctors to
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`continue to seek conforming privileges and to keep the court
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`apprised of their progress. See TRO in No. 14–cv–00525,
`Doc. No. 31, pp. 2–3; see, e.g., App. 48–55, 64–82. These
`
`updates continued through the date of the District Court’s
`decision. 250 F. Supp. 3d, at 77.
`C
`
`
`In June 2015, the District Court held a 6-day bench trial
`
`on the plaintiffs’ request for a preliminary injunction. It
`heard live testimony from a dozen witnesses, including
`three Louisiana abortion providers, June Medical’s admin-
`istrator, the Secretary (along with a senior official) of the
`State’s Department of Health and Hygiene, and three ex-
`perts each for the plaintiffs and the State. Id., at 33–34. It
`also heard from several other witnesses via deposition.
`Ibid. Based on this evidentiary record, the court issued a
`decision in January 2016 declaring Act 620 unconstitu-
`tional on its face and preliminarily enjoining its enforce-
`
`ment. June Medical Services LLC v. Kliebert, 158 F. Supp.
`3d 473 (MD La.).
`
`The State immediately asked the Court of Appeals for the
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`

`

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` JUNE MEDICAL SERVICES L. L. C. v. RUSSO
`
`Opinion of BREYER, J.
`Fifth Circuit to stay the District Court’s injunction. The
`Court of Appeals granted that stay. But we then issued our
`own stay at the plaintiffs’ request, thereby leaving the Dis-
`trict Court’s preliminary injunction (at least temporarily)
`
`in effect. See June Medical Services, L.L.C. v. Gee, 814
`
`F. 3d 319 (CA5), vacated, 577 U. S. ___ (2016).
`
`
`
`Approximately two months later, in June 2016, we issued
`
`our decision in Whole Woman’s Health, reversing the Fifth
`
`Circuit’s judgment in that case. We remanded this case for
`reconsideration, and the Fifth Circuit in turn remanded the
`case to the District Court permitting it to engage in further
`
`factfinding. See June Medical Services, L.L.C. v. Gee, 2016
`
`WL 11494731 (CA5, Aug. 24, 2016) (per curiam). All the
`parties agreed that the District Court could rule on the
`plaintiffs’ request for a permanent injunction on the basis
`
`of the record it had already developed. Minute Entry in No.
`
`14–cv–00525, Doc. No. 253. The court proceeded to do so.
`D
`
`
`Because the issues before us in this case primarily focus
`upon the factual findings (and fact-related determinations)
`
`of the District Court, we set forth only the essential findings
`
`here, giving greater detail in the analysis that follows.
`
`With respect to the Act’s asserted benefits, the District
`Court found that:
` “[A]bortion in Louisiana has been extremely safe,
`
`
`with particularly low rates of serious complications.”
`250 F. Supp. 3d, at 65. The “testimony of clinic staff
`and physicians demonstrated” that it “rarely . . . is
`necessary to transfer patients to a hospital: far less
`than once a year, or less than one per several thou-
`sand patients.” Id., at 63. And “[w]hether or not a
`
`patient’s treating physician has admitting privileges
`is not relevant to the patient’s care.” Id., at 64.
` There was accordingly “‘no significant health-related
`
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`
`
`
`
`
`6
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`7
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`
`
`
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` Cite as: 591 U. S. ____ (2020)
`
`Opinion of BREYER, J.
`problem that the new law helped to cure.’ The rec-
`
`ord does not contain any evidence that complications
`from abortion were being treated improperly, nor
`any evidence that any negative outcomes could have
`been avoided if the abortion provider had admitting
`privileges at a local hospital.” Id., at 86. (quoting
`Whole Woman’s Health, 579 U. S., at ___ (slip op., at
`22)); see also 250 F. Supp. 3d, at 86–87 (summariz-
`
`ing conclusions).
`
` There was also “no credible evidence in the record
`
`
`that Act 620 would further the State’s interest in
`women’s health beyond that which is already in-
`sured under existing Louisiana law.” Id., at 65.
`
`Turning to Act 620’s impact on women’s access to abor-
`tion, the District Court found that:
` Approximately 10,000 women obtain abortions in
`
`Louisiana each year. Id., at 39. At the outset of this
`
`litigation, those women were served by six doctors at
`
`five abortion clinics. Id., at 40, 41–44. By the time
`the court rendered its decision, two of those clinics
`had closed, and one of the doctors (Doe 4) had re-
`
`tired, leaving only Does 1, 2, 3, 5, and 6. Ibid.
` “[N]otwithstanding the good faith efforts of Does 1,
`
`
`2, 4, 5 and 6 to comply with the Act by getting active
`
`admitting privileges at a hospital within 30 miles of
`where they perform abortions, they have had very
`
`limited success for reasons related to Act 620 and
`not related to their competence.” Id., at 78.
` These doctors’ inability to secure privileges was
`
`“caused by Act 620 working in concert with existing
`laws and practices,” including hospital bylaws and
`criteria that “preclude or, at least greatly discour-
`age, the granting of privileges to abortion providers.”
`Id., at 50.
`
`
`
`
`
`

`

`
`
`
`
`
`
` JUNE MEDICAL SERVICES L. L. C. v. RUSSO
`
`Opinion of BREYER, J.
` These requirements establish that admitting privi-
`
`leges serve no “‘relevant credentialing function’” be-
`cause physicians may be denied privileges “for rea-
`sons unrelated to competency.” Id., at 87 (quoting
`Whole Woman’s Health, 579 U. S., at ___ (slip. op.,
`at 25)).
` They also make it “unlikely that the [a]ffected clinics
`
`
`will be able to comply with the Act by recruiting new
`physicians who have or can obtain admitting privi-
`leges.” 250 F. Supp. 3d, at 82.
` Doe 3 testified credibly “that, as a result of his fears,
`
`and the demands of his private OB/GYN practice, if
`he is the last physician performing abortion in either
`the entire state or in the northern part of the state,
`he will not continue to perform abortions.” Id., at
`79; see also id., at 78–79 (summarizing that testi-
`mony).
` Enforcing the admitting-privileges requirement
`
`would therefore “result in a drastic reduction in the
`
`number and geographic distribution of abortion pro-
`viders, reducing the number of clinics to one, or at
`most two, and leaving only one, or at most two, phy-
`sicians providing abortions in the entire state,” Does
`3 and 5, who would only be allowed to practice in
`Shreveport and New Orleans. Id., at 87. Depending
`
`
`on whether Doe 3 stopped practicing, or whether his
`retirement was treated as legally relevant, the im-
`pact would be a 55%–70% reduction in capacity. Id.,
`
`at 81.
` “The result of these burdens on women and provid-
`
`ers, taken together and in context, is that many
`women seeking a safe, legal abortion in Louisiana
`will be unable to obtain one. Those who can will face
`substantial obstacles in exercising their constitu-
`tional right to choose abortion due to the dramatic
`
`
`8
`
`
`
`
`

`

`
`
`9
`
`
`
`
`
` Cite as: 591 U. S. ____ (2020)
`
`Opinion of BREYER, J.
` reduction in abortion services.” Id., at 88; see id., at
`79, 82, 87–88.
` In sum, “Act 620 does not advance Louisiana’s legit-
`
` imate interest in protecting the health of women
`
`seeking abortions. Instead, Act 620 would increase
`the risk of harm to women’s health by dramatically
`reducing the availability of safe abortion in Louisi-
`ana.” Id., at 87; see also id., at 65–66.
`
`The District Court added that
`“there is no legally significant distinction between this
`
`case and [Whole Woman’s Health]: Act 620 was mod-
`eled after the Texas admitting privileges requirement,
`and it functions in the same manner, imposing signifi-
`cant obstacles to abortion access with no countervailing
`benefits.” Id., at 88.
`On the basis of these findings, the court held that Act 620
`
`
`and its implementing regulations are unconstitutional. It
`entered an injunction permanently forbidding their en-
`forcement.
`
`E
`The State appealed. A divided panel of the Court of Ap-
`
`
`peals reversed the District Court’s judgment. The panel
`majority concluded that Act 620’s impact was “dramatically
`less” than that of the Texas law invalidated in Whole
`
`Woman’s Health. June Medical Services L.L.C. v. Gee, 905
`F. 3d 787, 791 (CA5 2018). “Despite its diligent effort to
`
`apply [Whole Woman’s Health] faithfully,” the majority
`thought that the District Court had “clearly erred in con-
`cluding otherwise.” Id., at 815.
`
`
`With respect to the Act’s asserted benefits, the majority
`thought that, “[u]nlike Texas, Louisiana presents some ev-
`idence of a minimal benefit.” Id., at 805. Rejecting the Dis-
`trict Court’s contrary finding, it concluded that the admit-
`ting-privileges
`requirement
`“performs a
`real, and
`
`
`
`
`
`
`
`

`

`
`
`
`
`
`
`
` JUNE MEDICAL SERVICES L. L. C. v. RUSSO
`
`Opinion of BREYER, J.
`previously unaddressed, credentialing function that pro-
`
`motes the wellbeing of women seeking abortion.” Id., at
`806. The majority believed that the process of obtaining
`privileges would help to “verify an applicant’s surgical abil-
`ity, training, education, experience, practice record, and
`criminal history.” Id., at 805, and n. 53. And it accepted
`the State’s argument that the law “brings the requirements
`regarding outpatient abortion clinics into conformity with
`the preexisting requirement that physicians at ambulatory
`surgical centers (‘ASCs’) must have privileges at a hospital
`
`within the community.” Id., at 805.
`
`
`Moving on to Act 620’s burdens, the appeals court wrote
`that “everything turns on whether the privileges require-
`
`ment actually would prevent doctors from practicing in
`Louisiana.” Id., at 807. Although the State challenged the
`
`District Court’s findings only with respect to Does 2 and 3,
`
`the Court of Appeals went further. It disagreed with nearly
`
`every one of the District Court’s findings, concluding that
`
`“the district court erred in finding that only Doe 5 would be
`
`able to obtain privileges and that the application process
`creates particular hardships and obstacles for abortion pro-
`viders in Louisiana.” Id., at 810. The court noted that “[a]t
`least three hospitals have proven willing to extend privi-
`leges.” Ibid. It thought that “only Doe 1 has put forth a
`
`good-faith effort to get admitting privileges,” while “Doe 2,
`
`Doe 5, and Doe 6 could likely obtain privileges,” ibid., and
`“Doe 3’s personal choice to stop practicing cannot be legally
`
`attributed to Act 620,” id., at 811.
`
`
`Having rejected the District Court’s findings with respect
`to all but one of the physicians, the Court of Appeals con-
`cluded that “there is no evidence that Louisiana facilities
`will close from Act 620.” Id., at 810. The appeals court al-
`lowed that the Baton Rouge clinic where Doe 5 had not ob-
`tained privileges would close. But it reasoned that
`“[b]ecause obtaining privileges is not overly burdensome,
`
`10
`
`
`
`
`

`

`
`
` 11
`
`
`
`
`
` Cite as: 591 U. S. ____ (2020)
`
`Opinion of BREYER, J.
`. . . the fact that one clinic would have to close is not a sub-
`
`stantial burden that can currently be attributed to Act 620
`
`as distinguished from Doe 5’s failure to put forth a good
`
`faith effort.” Ibid. The Court of Appeals added that the
`
`additional work that Doe 2 and Doe 3 would have to do to
`
`compensate for Doe 1’s inability to perform abortions “does
`not begin to approach the capacity problem in” Whole
`
`Woman’s Health. 905 F. 3d, at 812. It estimated that Act
`620 would “resul[t] in a potential increase” in waiting times
`“of 54 minutes at one of the state’s clinics for at most 30%
`
`

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