Bristol Reg'l Women's Ctr., P.C. v. Slatery

• Decision Date: 05 August 2021
• Docket Number: No. 20-6267,20-6267
• Court: U.S. Court of Appeals — Sixth Circuit
• Parties: BRISTOL REGIONAL WOMEN'S CENTER, P.C. ; Memphis Center for Reproductive Health, on behalf of itself and its patients, Knoxville Center for Reproductive Health ; Planned Parenthood of Tennessee and North Mississippi, formerly known as Planned Parenthood of Middle and East Tennessee, and Dr. Kimberly Looney, Plaintiffs-Appellees, v. Herbert H. SLATERY, III, Attorney General of Tennessee, Glenn R. Funk, District Attorney General of Nashville, Tennessee, Amy P. Weirich, District Attorney General of Shelby County, Tennessee; Barry P. Staubus, District Attorney General of Sullivan County, Tennessee, Charme P. Allen, Lisa Piercey, Commissioner of the Tennessee Department of Health, and W. Reeves Johnson, Jr., M.D., President of the Tennessee Board of Medical Examiners, in their official capacities, Defendants-Appellants.

7 F.4th 478

BRISTOL REGIONAL WOMEN'S CENTER, P.C. ; Memphis Center for Reproductive Health, on behalf of itself and its patients, Knoxville Center for Reproductive Health ; Planned Parenthood of Tennessee and North Mississippi, formerly known as Planned Parenthood of Middle and East Tennessee, and Dr. Kimberly Looney, Plaintiffs-Appellees,

v.Herbert H. SLATERY, III, Attorney General of Tennessee, Glenn R. Funk, District Attorney General of Nashville, Tennessee, Amy P. Weirich, District Attorney General of Shelby County, Tennessee; Barry P. Staubus, District Attorney General of Sullivan County, Tennessee, Charme P. Allen, Lisa Piercey, Commissioner of the Tennessee Department of Health, and W. Reeves Johnson, Jr., M.D., President of the Tennessee Board of Medical Examiners, in their official capacities, Defendants-Appellants.

No. 20-6267

United States Court of Appeals, Sixth Circuit.

Argued En Banc: June 2, 2021

Decided and Filed: August 5, 2021

ARGUED EN BANC: Sarah K. Campbell, OFFICE OF THE TENNESSEE ATTORNEY GENERAL, Nashville, Tennessee, for Appellants. Autumn Katz, CENTER FOR REPRODUCTIVE RIGHTS, New York, New York, for Appellees. ON BRIEF AND SUPPLEMENTAL BRIEF: Sarah K. Campbell, Mark Alexander Carver, OFFICE OF THE TENNESSEE ATTORNEY GENERAL, Nashville, Tennessee, for Appellants. Autumn Katz, Michelle Moriarty, Rabia Muqaddam, CENTER FOR REPRODUCTIVE RIGHTS, New York, New York, Maithreyi Ratakonda, PLANNED PARENTHOOD FEDERATION OF AMERICA, New York, New York, Scott Tift, BARRETT JOHNSTON MARTIN & GARRISON, LLC, Nashville, Tennessee, Michael J. Dell, Jason M. Moff, KRAMER LEVIN NAFTALIS & FRANKEL LLP, New York, New York for Appellees. ON AMICUS BRIEF: Elizabeth B. Murrill, OFFICE OF THE LOUISIANA ATTORNEY GENERAL, Baton Rouge, Louisiana, Kevin H. Theriot, ALLIANCE DEFENDING FREEDOM, Scottsdale, Arizona, Matthew F. Kuhn, OFFICE OF THE KENTUCKY ATTORNEY GENERAL, Frankfort, Kentucky, Sarah A. Hunger, OFFICE OF THE ILLINOIS ATTORNEY GENERAL, Chicago, Illinois, Jessica L. Ellsworth, HOGAN LOVELLS US LLP, Washington, D.C., Kimberly A. Parker, WILMER CUTLER PICKERING HALE AND DORR LLP, Washington, D.C., Andrew M. Leblanc, MILBANK LLP, Washington, D.C., Michael L. Rosenthal, COVINGTON & BURLING LLP, Washington, D.C., Sarah Mac Dougall, COVINGTON & BURLING LLP, New York, New York, Jonathan F. Mitchell, MITCHELL LAW PLLC, Austin, Texas for Amici Curiae.

Before: SUTTON, Chief Judge; MOORE, COLE, CLAY, GIBBONS, GRIFFIN, KETHLEDGE, WHITE, STRANCH, DONALD, THAPAR, BUSH, LARSEN, NALBANDIAN, READLER, and MURPHY, Circuit Judges.

THAPAR, J., delivered the opinion of the court in which SUTTON, C.J., GRIFFIN, KETHLEDGE, BUSH, LARSEN, NALBANDIAN, READLER, and MURPHY, JJ., joined. BUSH, J. (pp. 489–91 – ––––), delivered a separate concurring opinion in which GRIFFIN, J., joined. MOORE, J. (pp. 491–520 – ––––), delivered a separate dissenting opinion in which COLE, CLAY, GIBBONS, WHITE, STRANCH, and DONALD, JJ., joined. GIBBONS, J. (pg. 520), delivered a separate dissenting opinion.

THAPAR, Circuit Judge.

Before making life's big decisions, it is often wise to take time to reflect. The people of Tennessee believed that having an abortion was one of those decisions. So they passed a law requiring a waiting period of 48 hours. Although the Supreme Court upheld a similar 24-hour waiting period in Planned Parenthood v. Casey , the district court said that Tennessee's waiting period violates a woman's right to have an abortion. We disagree and reverse.

I.

Tennessee's waiting-period law resulted from a decades-long democratic process. In 1978, Tennessee enacted a 48-hour waiting period for abortions. 1978 Tenn. Pub. Acts, ch. 847, § 1. But a federal district court enjoined the law based on precedent that predated Casey . See Planned Parenthood of Memphis v. Alexander , No. 78-2310, 1981 U.S. Dist. LEXIS 18617, at *28–29 (W.D. Tenn. Mar. 23, 1981). Then, after Casey was decided, the Tennessee Supreme Court held that the waiting period violated Tennessee's constitution, even if it did not violate the Federal Constitution. Planned Parenthood of Middle Tenn. v. Sundquist , 38 S.W.3d 1, 25 (Tenn. 2000). In response, Tennessee voters amended the State's constitution to clarify that it does not protect the right to an abortion. Tenn. Const. art. I, § 36 ; see also George v. Hargett , 879 F.3d 711, 714 (6th Cir. 2018).

After approving this constitutional amendment, the Tennessee legislature enacted a law restoring the 48-hour waiting period. That law requires doctors to provide women with certain information at least 48 hours before performing an abortion (except in cases of medical emergency). Tenn. Code Ann. § 39-15-202(a) – (h) (2019). This information includes the age of the unborn child, the alternatives to abortion, and the medical risks of abortion and pregnancy. Id. The law also provides that a 24-hour waiting period will take effect if a court enjoins the 48-hour waiting period. Id. § (d)(2).

A group of abortion providers then sued. The providers alleged that Tennessee's waiting period burdened access to abortion and was facially unconstitutional. Yet they did not seek a preliminary injunction, and the law went into effect in July 2015. For five years, the law remained in force. And for five years, women continued to obtain abortions in Tennessee: Abortion rates remained above 10,000 per year both before and after passage of the law.

Four years after the providers filed their suit, the district court held a bench trial. It heard testimony from witnesses, reviewed exhibits, and issued a published opinion. In that opinion, the district court balanced the law's benefits against its alleged burdens and concluded that the law was unconstitutional because it unduly burdened access to abortion. Adams & Boyle, P.C. v. Slatery , 494 F. Supp. 3d 488, 565, 570 (M.D. Tenn. 2020).

Tennessee sought a stay pending appeal from the district court. It pointed out that the district court's decision conflicted with Supreme Court and Sixth Circuit precedent governing waiting periods. Planned Parenthood of Se. Pa. v. Casey , 505 U.S. 833, 871–76, 112 S.Ct. 2791, 120 L.Ed.2d 674 (1992) (joint opinion); Cincinnati Women's Servs., Inc. v. Taft , 468 F.3d 361, 366, 372–74 (6th Cir. 2006). Tennessee also noted that the Sixth Circuit had recently held that a benefits-burden test does not apply in the abortion context. EMW Women's Surgical Ctr., P.S.C. v. Friedlander , 978 F.3d 418, 437–39 (6th Cir. 2020). But the district court refused to issue a stay pending appeal, and a panel of our court did too. Bristol Reg'l Women's Ctr., P.C. v. Slatery , 988 F.3d 329 (6th Cir. 2021) ; see also id. at 344 (Thapar, J., dissenting).

Tennessee next moved for initial hearing en banc and sought a stay pending appeal from the en banc court. We granted both motions and now reverse on the merits.

II.

We start by explaining the relevant legal standard. A law regulating abortion is facially valid if it meets two requirements: (1) the law is "reasonably related to a legitimate state interest," and (2) the law does not place a "substantial obstacle" in the path of a large fraction of women "seeking an abortion of a nonviable fetus."

Preterm-Cleveland v. McCloud , 994 F.3d 512, 525 (6th Cir. 2021) (en banc) (quoting EMW , 978 F.3d at 433–34 ).¹

The first requirement is met whenever the state has a rational basis to act. Gonzales v. Carhart , 550 U.S. 124, 158, 127 S.Ct. 1610, 167 L.Ed.2d 480 (2007). Under the rational basis test, "legislative choice is not subject to courtroom fact-finding and may be based on rational speculation unsupported by evidence or empirical data." FCC v. Beach Commc'ns, Inc. , 508 U.S. 307, 315, 113 S.Ct. 2096, 124 L.Ed.2d 211 (1993). Courts may not second-guess a state's "medical and scientific judgments." Preterm-Cleveland , 994 F.3d at 525 (citation omitted). And they must defer to a state's judgment that there is a problem that merits correction. Indeed, the government has "no obligation" to produce evidence supporting the rationality of its actions. TriHealth, Inc. v. Bd. of Comm'rs, Hamilton Cnty. , 430 F.3d 783, 790 (6th Cir. 2005).

If this standard appears "highly deferential," that's because it is. EMW , 978 F.3d at 438. The rule is designed to respect the constitutional prerogatives of democratically accountable legislatures and executives. So under rational basis scrutiny, an act remains constitutional even if—to the judge's eye—it seems to offer "little if any benefit." June Medical Servs. v. Russo , ––– U.S. ––––, 140 S. Ct. 2103, 2137, 207 L.Ed.2d 566 (2020) (Roberts, C.J., concurring in judgment). All that matters is whether the state conceivably had a rational basis to enact the regulation at issue, judged under the standards of "traditional rational-basis review." EMW , 978 F.3d at 439–40.

When there is a rational basis for the law, courts must ask the second question: Does the law place a "substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus"? Preterm-Cleveland , 994 F.3d at 525 (citation omitted); see also June Medical Servs. , 140 S. Ct. at 2136–37 (Roberts, C.J., concurring in judgment). And for a facial challenge like this one, the standard is higher still. "Even if a law regulating abortion is unconstitutional in some applications, the law remains facially valid so long as it does not impose an undue burden in a large fraction of the cases in which the regulation is relevant." Preterm-Cleveland , 994 F.3d at 525 (citation omitted); see also Casey , 505 U.S. at 894–95, 112 S.Ct. 2791 (joint opinion). Thus, a law regulating abortion is facially constitutional unless it places a substantial obstacle in the path of a large fraction of women seeking previability abortions.

III.

Having set forth the law, we now turn to the central issue in this case, which is whether Tennessee's 48-hour waiting period is facially constitutional. We answer that question by applying the two-step framework discussed above: (1)...