Singleton v. Wulff

Decision Date01 July 1976
Docket NumberNo. 74-1393,74-1393
PartiesThomas E. SINGLETON, etc., Petitioner, v. George J. L. WULFF, Jr., et al
CourtU.S. Supreme Court

Respondents, two Missouri-licensed physicians, brought this action for injunctive relief and a declaration of the unconstitutionality of a Missouri statute that excludes abortions that are not "medically indicated" from the purposes for which Medicaid benefits are available to needy persons. In response to petitioner's preanswer motion to dismiss, each respondent averred that he had provided, and anticipated providing, abortions to needy patients, and that petitioner, the responsible state official, acting in reliance on the challenged statute, had refused all Medicaid applications filed in connection with such abortions. A three-judge District Court dismissed the relevant count of the complaint for lack of standing, having concluded that no logical nexus existed between the status asserted by respondents and the claim that they sought to have adjudicated. The Court of Appeals reversed, finding that respondents had alleged sufficient "injury in fact" and also an interest "arguably within the zone of interests to be protected . . . by the . . . constitutional guarantees in question." That court then considered the case on the merits and found that the challenged statute clearly violated the Equal Protection Clause. Held : The judgment is reversed and the case is remanded. Pp. 112-121; 121-122; 122.

508 F.2d 1211, reversed and remanded.

Mr. Justice BLACKMUN delivered the opinion of the Court with respect to Parts I, II-A, and III, finding that:

1. Respondents had standing to maintain this suit. Respondents alleged "injury in fact," I. e., A sufficiently concrete interest in the outcome of their suit to make it a case or controversy subject to the District Court's Art. III jurisdiction. If respondent physicians prevail in their suit to remove the statutory limitation on reimbursable abortions, they will benefit by receiving payment for the abortions and the State will be out of pocket by the amount of the payments. P. 1112-113.

2. The Court of Appeals should not have proceeded to resolve the merits of this case, since petitioner, who has not filed an answer or other pleading addressed to the merits, has not had the opportunity to present evidence or legal arguments in defense of the statute. Pp. 119-121.

Mr. Justice BLACKMUN, joined by Mr. Justice BRENNAN, Mr. Justice WHITE, and Mr. Justice MARSHALL, concluded, in Part II-B, that as a prudential matter, respondents are proper proponents of the particular rights on which they base their suit. Though "(o)rdinarily, one may not claim standing . . . to vindicate the constitutional rights of some third party," Barrows v. Jackson, 346 U.S. 249, 255, 73 S.Ct. 1031, 1034, 97 L.Ed. 1586, here the underlying justification for that rule is absent. A woman cannot safely secure an abortion without a physician's aid, and an impecunious woman cannot easily secure an abortion without the physician's being paid by the State. Aside from the woman herself, the physician is uniquely qualified, by virtue of his confidential, professional relationship with her, to litigate the constitutionality of the State's interference with, or discrimination against, the abortion decision. Moreover, there are obstacles to the woman's assertion of her own rights, in that the desire to protect her privacy may deter her from herself bringing suit, and her claim will soon become at least technically moot if her indigency forces her to forgo the abortion. Pp. 113-118.

Michael L. Boicourt, Jefferson City, Mo., for practitioner.

Frank Susman, St. Louis, Mo., for respondents.

Mr. stice BLACKMUN delivered the opinion of the Court (Parts I, II-A, and III) together with an opinion (Part II-B), in which Mr. Justice BRENNAN, Mr. Justice WHITE, and Mr. Justice MARSHALL joined.

Like its companions,1 this case involves a claim of a State's unconstitutional interference with the decision to terminate pregnancy. The particular object of the challenge is a Missouri statute excluding abortions that are not "medically indicated" from the purposes for which Medicaid benefits are available to needy persons. In its present posture, however, the case presents two issues not going to the merits of this dispute. The first is whether the plaintiff-appellees, as physicians who perform nonmedically indicated abortions, have standing to maintain the suit, to which we answer that they do. The second is whether the Court of Appeals, exercising jurisdiction because the suit had been dismissed in the District Court for lack of standing, properly proceeded to a determination of the merits, to which we answer that it did not.


Missouri participates in the so-called Medicaid program, under which the Federal Government partially underwrites qualifying state plans for medical assistance to the needy. See 42 U.S.C. § 1396 Et seq. (1970 ed. and Supp. IV). Missouri's plan, which is set out in Mo.Rev.Stat. §§ 208.151-208.158 (Supp.1975), includes, in § 208.152, a list of 12 categories of medical services that are eligible for Medicaid funding. The last is:

"(12) Family planning services as defined by federal rules and regulations; provided, however, that such family planning services shall not in- clude abortions unless such abortions are medically indicated."

This provision is the subject of the litigation before us.2

The suit was filed in the United States District Court for the Eastern District of Missouri by two Missouri-licensed physicians. Each plaintiff avers, in an affidavit filed in opposition to a motion to dismiss, that he "has provided, and anticipates providing abortions to welfare patients who are eligible for Medicaid payments." App. 32, 36.3 The plaintiffs further allege in their affidavits that all Medicaid applications filed in connection with abortions performed by them have been refused by the defendant, who is the responsible state official,4 in reliance on the challenged § 208.152(12). App. 32, 36. It is not entirely clear who has filed these applications. One affiant states that "he and (his) patients have been refused," Id., at 32; the other refers to "those who have submitted applications for such payments on his behalf" and states that such "payments have been refused." Id., at 36. Indeed, it is not entirely clear to whom the payments would go if they were made. We assume, however, from the statute's several references to payments "on behalf of" eligible persons, see §§ 208.151 and 208.152, that the provider of the services himself seeks reimbursement from the State. In any event, each plaintiff states that he anticipates further refusals by the defendant to fund nonmedically indicated abortions. Each avers that such refusals "deter (him) from the practice of medicine in the manner he considers to be mosexpertise (Sic ) and beneficial for said patients . . . and chill and thwart the ordinary and customary functioning of the doctor-patient relationship." App. 32, 36.

The complaint sought a declaration of the statute's invalidity and an injunction against its enforcement. A number of grounds were stated, among them that the statute, "on its face and as applied," is unconstitutionally vague, "(d)eprives plaintiffs of their right to practice medicine according to the highest standards of medical practice"; "(d)eprives plaintiffs' patients of the fundamental right of a woman to determine for herself whether to bear children"; "(i)nfringes upon plaintiffs' right to render and their patients' right to receive safe and adequate medical advice and treatment"; and "(d) eprives plaintiffs and their patients, each in their own classification, of the equal protection of the laws." Id., at 16, 12-13.

The defendant's sole pleading in District Court was a pre-answer motion to dismiss. Dismissal was sought upon several alternative grounds: that there was no case or controversy; that the plaintiffs lacked "standing to litigate the constitutional issues raised"; that injunctive relief "cannot be granted" because of absence of "irreparable harm" to the plaintiffs; that the plaintiffs "personally could suffer no harm"; and that in any case they "cannot litigate the alleged deprivation or infringement of the civil rights of their welfare patients." Id., at 24-25.

The plaintiffs having responded to this motion with a memorandum and also with the affidavits described above, the three-judge panel that had been convened to hear the case dismissed the count now before us "forack of standing." The court saw no "logical nexus between the status asserted by the plaintiffs and the claim they seek to have adjudicated." Wulff v. State Bd. of Registration for Healing Arts, 380 F.Supp. 1137, 1144 (1974).

The United States Court of Appeals for the Eighth Circuit reversed. 508 F.2d 1211 (1974). It reasoned that Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147 (1973), and Doe v. Bolton, 410 U.S. 179, 93 S.Ct. 739, 35 L.Ed.2d 201 (1973), as interpreted in several of its own earlier decisions, had " 'paved the way for physicians to assert their constitutional rights to practice medicine,' " citing Nyberg v. City of Virginia, 495 F.2d 1342, 1344 (CA8), appeal dismissed and cert. denied, 419 U.S. 891, 95 S.Ct. 169, 42 L.Ed.2d 136 (1974). Those rights were said to include " 'the right to advise and perform abortions,' " and furthermore to be " 'inextricably bound up with the privacy rights of women who seek abortions.' " 508 F.2d at 1213. Clearly, the restriction of Medicaid benefits affected the plaintiff physicians "both professionally and monetarily." Id., at 1214. The result, in the Court of Appeals' view, was that they had alleged sufficient " 'injury in fact,' " and also an interest " 'arguably within the zone of interests to be protected . . . by the . . . constitutional guarantee in question,' " Ibid., quoting Data Processing Service v....

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