Booth v. Bowser
| Decision Date | 18 March 2022 |
| Docket Number | 21-cv-01782 (TNM),21-cv-01857 (TNM) |
| Court | U.S. District Court — District of Columbia |
| Parties | VICTOR M. BOOTH, individually and as next of friend of L.B., a minor child, et al., Plaintiffs, v. MURIEL BOWSER, in her official capacity as Mayor of the District of Columbia, et al., Defendants. and JOSHUA A. MAZER, individually and on behalf of his minor child, Plaintiff |
In late 2020, the D.C. Council approved a law allowing children as young as eleven to get vaccinated without parental consent or knowledge. Parents who object to childhood vaccinations filed complaints and sought preliminary injunctions in two separate cases, but they bring nearly identical claims. They argue that federal law preempts the District's law and that it violates their constitutional and statutory rights. The District opposes the imposition of preliminary injunctions and moves to dismiss. It argues that the parents lack standing, that they have not justified preliminary injunctive relief, and that they failed to state a claim.
The Court holds that all the parents have standing for their preemption claims and have shown a likelihood of success on the merits for those claims. Federal law preempts the District's law because the laws place contradictory duties on healthcare providers. The Court also holds that some of the parents have standing for their Free Exercise claim and that they have shown they are likely to succeed on the merits because the District's law requires providers to hide children's vaccination status from parents who invoke their religious exemption rights but not from other parents. For both the preemption and Free Exercise claims, the parents have shown that they face irreparable harm and that the balance of the equities and public interest supports granting an injunction.
Because the parents are entitled to preliminary injunctions for these two theories, the Court need not evaluate their other theories. The Court therefore will grant the motions for preliminary relief and will deny the District's motions to dismiss for all the parents as to their preemption claims and for some of the parents as to their Free Exercise claim. The Court will separately address the remaining claims.
Both the federal government and the District regulate the administration of childhood vaccines. The federal government's regulatory power stems from the National Childhood Vaccine Injury Act of 1986 (NCVIA). 42 U.S.C §§ 300aa-1, et seq. Congress passed the NCVIA on the heels of “a massive increase in vaccine-related tort litigation” in the mid-1980s. Bruesewitz v. Wyeth LLC, 562 U.S. 223, 227 (2011). As a result, several vaccine manufacturers left the market even as many plaintiffs claimed that obtaining compensation for vaccine-related injuries was costly and difficult. Id. Vaccination rates among children began to fall and public health officials sounded the alarm. Id.
The NCVIA contains a two-pronged solution. First, it grants “significant tort-liability protections [to] vaccine manufacturers.” Id. at 229. It accomplishes this by prohibiting state law to the contrary. See 42 U.S.C. § 300aa-22(e).
Second, in a “quid pro quo, ” it created the National Vaccine Injury Compensation Program. Bruesewitz, 562 U.S. at 228-29. A key component of the Program is the Vaccine Injury Table, which lists covered vaccines and associated injuries. Id. If an injury manifests soon after administration of a vaccine, “then the vaccine is presumed to have caused the injury and the child is entitled to compensation, unless [the U.S. Department of Health and Human Services (HHS)] can prove an alternative cause of injury.” Booth Ver. Am. Compl. (Booth Compl.) ¶ 306, ECF No. 31. This is called a “table injury.” Id. But if the injury manifests later, then the petitioner must prove causation. These so-called “non-table injuries” account for more than 90% of all vaccine injury claims. Id. A minor cannot be a petitioner. 42 U.S.C. § 300aa-11(b)(1)(A). Instead, the minor's legal representative must petition on the minor's behalf. Id.
Because of time limits set by the NCVIA, petitioners must quickly identify vaccine-related injuries to qualify for the Program. To assist petitioners, Congress mandated that HHS produce vaccine information statements (VIS) for distribution to vaccine recipients. Id. § 300aa-26(a). A VIS must include “(1) a concise description of the benefits of the vaccine, (2) a concise description of the risks associated with the vaccine, (3) a statement of the availability of the [Program], and (4) such other relevant information as may be determined by [HHS].” Id. § 300aa-26(c). Every time a healthcare provider administers a vaccine listed on the Vaccine Injury Table, he must provide a VIS “to the legal representatives of any child or to any other individual to whom such provider intends to administer such vaccine.” Id. § 300aa-26(d).
The District requires certain vaccinations for all children attending a D.C.-area school- whether public, private, or parochial. See D.C. Code §§ 38-501, et seq. The District bars schools from admitting a student “unless the school has certification of immunization for that student, or unless the student is exempted pursuant to § 38-506.” Id. § 38-502(a). Section 38-506 exempts students from the certification requirement if the “responsible person” for the student “objects in good faith and in writing . . . that the immunization would violate his or her religious beliefs.” Id. § 38-506(1). The law also exempts students “[f]or whom the school has a written certification by a private physician . . . or the public health authorities that immunization is medically inadvisable.” Id. § 38-506(2). Absent one of these exemptions, students certify their immunizations on part 3 of the District's Universal Health Certificate (Certificate). See Id. § 38-602(a)(1); see also Booth Ex. 1, ECF No. 31-1 (copy of the Certificate).
In 2020, the District passed the Minor Consent for Vaccinations Act Amendment of 2020 (MCA). The MCA allows some children to receive a vaccine without parental consent:
A minor, 11 years of age or older, may consent to receive a vaccine if the minor is capable of meeting the informed consent standard, the vaccine is recommended by the United States Advisory Committee on Immunization Practices (“ACIP”), and will be provided in accordance with ACIP's recommended immunization schedule.
D.C. Law 23-193 § 2(a). The MCA states that a minor meets the informed consent standard “if the minor is able to comprehend the need for, the nature of, and any significant risks ordinarily inherent in the medical care.” Id. § 2(b).
Several key features of the MCA are relevant here. First, to help minors make an informed decision, the MCA instructs the D.C. Department of Health to “produce one or more age-appropriate alternative vaccine information sheets” that explain the risks and benefits of vaccines. Id. § 2(c). Second, the MCA tells medical providers to seek reimbursement for vaccinations “without parental consent, directly from the insurer.” Id. § 2(d)(1). The provider must tell the insurer that he gave the vaccine under the MCA. Id. Insurers may not send an Explanation of Benefits for services provided under the authority of the MCA. Id. § 2(d)(2). Third, a minor who receives a vaccine under the MCA may access his immunization records without parental consent. Id. § 2(e).
Fourth, the MCA changes the guidelines for providers filling out the Certificate. See Id. § 3(b)(2) (codified at D.C. Code § 38-602(a)(2)). If a minor's parent has filed a religious exemption for the child and the child elects to get a vaccine anyway, a healthcare provider must leave blank part 3 of the Certificate. Id. Part 3 is the child's immunization record. This serves to obfuscate the child's vaccination from his parents. But the MCA does not require providers to leave blank part 3 of the Certificate for students whose parents filed a medical exemption. This part of the MCA applies only to students whose parents filed a religious exemption to vaccinations under § 38-506(1). For the students with a religious exemption, the provider must send the immunization record directly to the school. Id. The MCA directs the school to keep the record confidential. Id. Confidential from the religious parents, that is, because the school may share it with D.C.'s Department of Health or the school-based health center. Id.
Plaintiffs in Booth (Booth Parents) are four parents who object on religious grounds to vaccinating their minor children. See Booth Compl. ¶¶ 1-4, 143, 211, 239, 269. Collectively, the Booth Parents have six children who range from 4 to 15 years old. Id. ¶¶ 1-4. Joshua Mazer also objects on religious grounds to vaccinating J.D., his minor child. Mazer Am. Ver. Compl. (Mazer Compl.) ¶ 49, ECF No. 24. J.D. is 16 years old. Id. ¶ 7. All Plaintiffs bring their claims under 42 U.S.C. § 1983, which grants a right of action against the District for deprivations of statutory and constitutional rights.
The Booth Parents argue that (1) federal law preempts the MCA, (2) the MCA violates the Religious Freedom and Restoration Act of 1993 (RFRA), (3) the MCA conflicts with the U.S. Constitution's Free Exercise Clause, and (4) the MCA violates their fundamental right to parent. See Booth Compl. ¶¶ 370-410. Mazer brings similar claims and also contends that the MCA violates both his procedural due process rights and his fundamental right to make medical decisions for J.D. See Mazer Compl. ¶¶ 84-122.
All Plaintiffs filed motions for a preliminary injunction. The District opposes the motions and moves to dismiss both complaints. Those motions are now ripe. Because the cases involve nearly...
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