Planned Parenthood of Greater Tex. Surgical Health Servs. v. Abbott

• Citation: 734 F.3d 406
• Decision Date: 31 October 2013
• Docket Number: No. 13–51008.,13–51008.
• Parties: PLANNED PARENTHOOD OF GREATER TEXAS SURGICAL HEALTH SERVICES; Planned Parenthood Center for Choice; Planned Parenthood Sexual Healthcare Services; Planned Parenthood Women's Health Center; Whole Woman's Health; Austin Women's Health Center; Killeen Women's Health Center; Southwestern Women's Surgery Center; West Side Clinic, Incorporated; Routh Street Women's Clinic; Houston Women's Clinic, each on behalf of itself, its patients and physicians; Alan Braid, M.D.; Lamar Robinson, M.D.; Pamela J. Richter, D.O., each on behalf of themselves and their patients, Plaintiffs–Appellees, v. Gregory ABBOTT, Attorney General of Texas; David Lakey, M.D., Commissioner of the Texas Department of State Health Services; Mari Robinson, Executive Director of the Texas Medical Board, Defendants–Appellants.
• Court: United States Courts of Appeals. United States Court of Appeals (5th Circuit)

734 F.3d 406

PLANNED PARENTHOOD OF GREATER TEXAS SURGICAL HEALTH SERVICES; Planned Parenthood Center for Choice; Planned Parenthood Sexual Healthcare Services; Planned Parenthood Women's Health Center; Whole Woman's Health; Austin Women's Health Center; Killeen Women's Health Center; Southwestern Women's Surgery Center; West Side Clinic, Incorporated; Routh Street Women's Clinic; Houston Women's Clinic, each on behalf of itself, its patients and physicians; Alan Braid, M.D.; Lamar Robinson, M.D.; Pamela J. Richter, D.O., each on behalf of themselves and their patients, Plaintiffs–Appellees,

v.Gregory ABBOTT, Attorney General of Texas; David Lakey, M.D., Commissioner of the Texas Department of State Health Services; Mari Robinson, Executive Director of the Texas Medical Board, Defendants–Appellants.

No. 13–51008.

United States Court of Appeals,

Fifth Circuit.

Oct. 31, 2013.

Negative Treatment Vacated

Tex. Health & Safety Code §§ 171.0031, 171.063Helene T. Krasnoff, Alice Clapman, Planned Parenthood Federation of America, Washington, DC, Elizabeth Rose von Kreisler, George Brothers Kincaid & Horton, L.L.P., Austin, TX, Janet Crepps, Simpsonville, SC, Esha Bhandari, New York, NY, Elizabeth Rose von Kreisler, Brigitte Adrienne Amiri, for Plaintiffs–Appellees.

Jonathan F. Mitchell, Solicitor General, Office of the Solicitor General, Arthur Cleveland D'Andrea, Andrew S. Oldham, Deputy Solicitor General, Office of the Attorney General, Office of the Solicitor General, Austin, TX, for Defendants–Appellants.

Appeal from the United States District Court for the Western District of Texas.

Before OWEN, ELROD, and HAYNES, Circuit Judges.

PRISCILLA R. OWEN, Circuit Judge:

Planned Parenthood of Greater Texas Surgical Health Services and other plaintiffs brought suit seeking a permanent injunction against the enforcement of two amendments to the laws of Texas pertaining to the performance of abortions (2013 Texas House Bill No. 2 (“H.B.2”)). At the conclusion of a bench trial, the district court held that parts of the legislation were unconstitutional and granted, in large measure, the requested injunctive relief. The Appellants, to whom we will refer as “the State,” have appealed and have filed an emergency motion to stay the district court's permanent injunction pending the resolution of their appeal. We grant, in part, the motion for a stay pending appeal.

I

On July 12, 2013, the Texas Legislature passed H.B. 2.¹ Two of its provisions are at issue. The first requires that a physician performing or inducing an abortion have admitting privileges, on the date of the procedure, at a hospital no more than thirty miles from the location at which the abortion is performed or induced.² The second limits the use of abortion-inducing drugs to a protocol authorized by the United States Food and Drug Administration (FDA), with limited exceptions.³ Abortions induced by drugs, as distinguished from surgical abortions, are denominated by the parties as “medication abortions,” and we use that terminology here.

The provisions of H.B. 2 under consideration were scheduled to take effect October 29, 2013.⁴ On September 26, Planned Parenthood and others ⁵ brought an action challenging their constitutionality. With regard to the requirement of hospital admitting privileges, Planned Parenthood asserted that patients have rights to liberty and privacy guaranteed by the Due Process Clause of the 14th Amendment that would be violated, the procedural due process rights of physicians and their patients would be violated, the provision is void for vagueness, and the provision is invalid because it unlawfully delegates control over the exercise of constitutional rights to private parties. The medication abortions restriction, Planned Parenthood contended, would violate liberty and privacy rights and is void for vagueness.

On October 28, following a three-day bench trial, the district court issued an opinion holding that the hospital-admitting-privileges requirement of H.B. 2 was unconstitutional because it was “without a rational basis and places a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus.” ⁶ The district court upheld the medication abortions restriction as constitutional, “except when a physician finds such an abortion necessary, in appropriate medical judgment, for the preservation of the life or health of the mother.” ⁷ The district court entered a final judgment declaring H.B. 2 unconstitutional in part and enjoining its enforcement with respect to the hospital-admitting-privileges provision in its entirety. ⁸ The final judgment enjoined the medication abortions provision to a greater extent than the court had indicated it would in its Memorandum Opinion Incorporating Findings of Fact and Conclusions of Law.

The State appealed the district court's decision the same day the final judgment was entered. The only issue before this panel is the disposition of the State's motion to stay the district court's permanent injunction pending the outcome of the appeal on the merits.

II

We consider four factors in deciding whether to grant a stay pending appeal: “ ‘(1) whether the stay applicant has made a strong showing that he is likely to succeed on the merits; (2) whether the applicant will be irreparably injured absent a stay; (3) whether issuance of the stay will substantially injure the other parties interested in the proceeding; and (4) where the public interest lies.’ ” ⁹ A stay “is not a matter of right, even if irreparable injury might otherwise result to the appellant.” ¹⁰

Although the State did not seek a stay in the district court, as it would ordinarily be required to do,¹¹ a motion for a stay pending appeal can first be made in this court if moving in the district court initially would be impracticable.¹² Planned Parenthood does not contend that the State should have sought relief in the district court before proceeding here, and we note that H.B. 2 was to have taken effect on October 29, 2013, the day after the district court issued its opinion and final judgment.

III

We first consider the hospital-admitting-privileges provision of H.B. 2 and whether the State has made a strong showing that it is likely to succeed on the merits. We conclude that it has.

A

Planned Parenthood contends, and the district court concluded, that the hospital-admitting-privileges requirement has no rational basis. ¹³ The district court focused primarily on emergency room treatment of women experiencing complications following an abortion.¹⁴ This overlooks substantial interests of the State in regulating the medical profession ¹⁵ and the State's interest in “ ‘protecting the integrity and ethics of the medical profession.’ ” ¹⁶ As the Supreme Court has noted, “the State has ‘legitimate concern for maintaining high standards of professional conduct’ in the practice of medicine.' ” ¹⁷ The Supreme Court has also consistently recognized that “[r]egulations designed to foster the health of a woman seeking an abortion are valid if they do not constitute an undue burden.” ¹⁸

The State offered more than a “conceivable state of facts that could provide a rational basis” ¹⁹ for requiring abortion physicians to have hospital admission privileges. The State offered evidence that such a requirement fosters a woman's ability to seek consultation and treatment for complications directly from her physician, not from an emergency room provider. There was evidence that such a requirement would assist in preventing patient abandonment by the physician who performed the abortion and then left the patient to her own devices to obtain care if complications developed. The district court's finding to the contrary is not supported by the evidence, and in any event, “a legislative choice is not subject to courtroom factfinding and may be based on rational speculation unsupported by evidence or empirical data.” ²⁰

The requirement that physicians performing abortions must have hospital admitting privileges helps to ensure that credentialing of physicians beyond initial licensing and periodic license renewal occurs. Dr. James Anderson stated that “[h]ospital staff privileges are dependent on [the credentialing] review,” and that such credentialing reviews “help[ ] maintain a quality medical staff and quality patient care.” Dr. John Thorp explained that the hospital-admitting-privileges requirement would ensure that only physicians “credentialed and board certified to perform procedures generally recognized within the scope of their medical training and competencies” would provide abortions. He noted that due to the “unique nature of an elective pregnancy termination and its likely underreported morbidity and mortality, it is appropriate and necessary to provide increased provider safeguards through hospital credentialing and privileging.” Dr. Anderson echoed this sentiment, noting that “hospital credentialing acts as another layer of protection for patient safety.”

The district court's conclusion that a State has no rational basis for requiring physicians who perform abortions to have admitting privileges at a hospital is but one step removed from repudiating the longstanding recognition by the Supreme Court that a State may constitutionally require that only a physician may perform an abortion.²¹ In Mazurek v. Armstrong,²² the state of Montana enacted a statute restricting the performance of an abortion to licensed physicians.²³ A physician-assistant and physicians challenged the law; the district court denied their request to preliminarily enjoin the law's effect; and the Ninth Circuit Court of Appeals vacated that denial, concluding that those challenging the restriction “had shown a ‘fair chance of success on the merits.’ ” ²⁴ The Supreme Court reversed, reasoning that in earlier decisions, it had “emphasized that ‘[o]ur cases reflect the fact that the Constitution gives the States broad latitude to decide that particular functions may...