140 S. Ct. 2103 (2020)
In March 2014, five months after Texas' admitting-privileges requirement forced the closure of half of that State's abortion clinics, Louisiana's Legislature began to hold hearings to consider a substantially identical proposal.1 The proposal became law in mid-June 2014.2
Act 620 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.3 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 patient and to provide diagnostic and surgical services.4
Several weeks before the law's September 2014 effective date, three abortion clinics and two providers filed suit in the United States District Court for the Middle District of Louisiana.5 The suit was later consolidated with a similar action brought by two additional clinics and two additional providers.6 The plaintiffs alleged that the law imposed an undue burden on their patients' right to obtain an abortion and immediately sought a temporary restraining order followed by a preliminary injunction.7
The State opposed the temporary restraining order request but urged the court to decide the preliminary injunction motion as soon as possible.8 It asserted that there was no question the physicians had standing and that the suit was the proper vehicle to remove any cloud on the law's validity.9 Rather than staying the Act's effective date, the District Court provisionally forbade the State to enforce the Act's penalties. It directed the plaintiff doctors to continue seeking conforming privileges and to keep the court apprised of their progress.10 These updates continued for more than eighteen months.11
In June 2015 the District Court held a six-day bench trial on the request for a preliminary injunction.12 It heard live testimony from a dozen witnesses, including three Louisiana abortion providers, June Medical's administrator, the Secretary of the Department of Health and Hospitals, and three experts each for the plaintiffs and the State.13 It also heard from several other witnesses via deposition.14 In January 2016 the District Court declared Act 620 unconstitutional on its face and issued a preliminary injunction.15 The Fifth Circuit stayed the injunction, but the Supreme Court reinstated it.16
After the decision in Whole Woman's Health v. Hellerstedt, the case was remanded.17 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.18 The District Court found that the admitting-privileges requirement would prevent Does 1, 2, and 6 from providing abortions altogether and would bar Doe 5 from practicing in Baton Rouge, leaving only Doe 3 and Doe 5 and resulting in a 55 to 70 percent reduction in capacity.19 It further found that the requirement served no relevant credentialing function because hospitals often deny privileges for reasons unrelated to competence.20 The Fifth Circuit reversed, concluding that the District Court had clearly erred in nearly all of its factual findings and that the law would impose no substantial burden.21 The Supreme Court granted certiorari on the plaintiffs' petition challenging that reversal and on the State's cross-petition contesting the providers' standing.22
Whether the State waived its objection to the abortion providers' standing to assert the constitutional rights of their patients?23
A party may forfeit or waive a prudential objection to third-party standing by failing to raise it in a timely manner during the litigation, particularly when the party has affirmatively conceded standing to obtain a prompt merits decision, as established in precedents such as Craig v. Boren and Wood v. Milyard.24
Yes. The State expressly conceded that the physicians had standing in its memorandum opposing the temporary restraining order.25 It urged the District Court to decide the undue-burden claims quickly.26 It asserted that the suit was the proper vehicle to remove any cloud on Act 620's validity.27
This concession occurred more than five years before the State raised its standing challenge for the first time in its cross-petition for certiorari.28 The State's strategic waiver, combined with the long line of precedents permitting abortion providers to assert patients' rights, forecloses consideration of the belated objection.29
The State's waiver bars its standing challenge, allowing the Court to proceed to the merits of the providers' claims.30
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Chief Justice Roberts concurred in the judgment. He agreed that the abortion providers have standing to assert the constitutional rights of their patients.31 Roberts emphasized that the State's concession of standing was strategic, made as part of an effort to obtain a quick decision from the District Court on the merits of the undue-burden claims.32
He stressed fidelity to precedent under principles of stare decisis. 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 in Whole Woman's Health, it cannot stand.33 Roberts noted his prior dissent in Whole Woman's Health but concluded that adherence to that precedent required the same result here.34
Justice Thomas dissented on standing.35 He argued that under a proper understanding of Article III the providers lack standing because they assert no private rights of their own.36 They seek only to vindicate the putative rights of third parties whose interests may conflict.37
Thomas maintained that the traditional rule against third-party standing is constitutional rather than prudential.38 The providers' financial incentive to challenge safety regulations creates an inherent conflict with the women the law aims to protect.39 He would have dismissed the case for lack of jurisdiction.40
Whether the District Court's factual findings that Act 620 would drastically reduce the number of abortion providers and impose substantial obstacles on women seeking abortions are clearly erroneous?41
Under Federal Rule of Civil Procedure 52(a)(6), a district court's findings of fact must not be set aside unless clearly erroneous.42 The reviewing court must give due regard to the trial court's opportunity to judge witness credibility.43 An appellate court may not reverse even if it would have weighed the evidence differently so long as the district court's account is plausible in light of the entire record.44
No. The District Court supervised the doctors' efforts for more than eighteen months.4546 It conducted a six-day bench trial with live testimony from multiple witnesses.47 It made detailed findings supported by direct evidence of application denials for reasons unrelated to competence.48 It also relied on circumstantial evidence of hospital bylaws and opposition to abortion.49
These findings mirror those in Whole Woman's Health and are not clearly erroneous under the deferential standard.50 The Fifth Circuit misapplied that standard by substituting its own view of the evidence.51
The District Court's factual findings are not clearly erroneous and must be upheld.52
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Joined by Justice Gorsuch
Justice Alito dissented.53 He contended that the District Court applied the wrong legal standard by using a good-faith test that ignored the doctors' incentives to make only perfunctory efforts because they stood to lose if the law took effect.54 Alito argued that the evidence showed the doctors did not pursue privileges with the diligence expected if their ability to practice depended on success.55
The record failed to demonstrate that any clinic would close.56 He would have remanded for a new trial under the correct standard requiring proof that the doctors made efforts equal to those they would expend if personally affected.57
Justice Gorsuch dissented on the ground that the plurality and the District Court failed to apply the proper standard of review to factual findings.58 He maintained that the court improperly treated legal questions as factual ones subject only to clear-error review.59 Gorsuch argued that the record does not support the prediction of clinic closures because it assumes no market response such as new providers entering or hospitals changing policies.60
The decision rests on speculative assumptions rather than the required showing that irreparable injury is likely.61
Whether Act 620 imposes an undue burden on women's access to abortion in Louisiana?62
Under the standards set forth in Planned Parenthood of Southeastern Pa. v. Casey and Whole Woman's Health v. Hellerstedt, unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden and are constitutionally invalid.63 Courts must independently review legislative findings and weigh asserted benefits against the burdens imposed on abortion access.64
Yes. The District Court's findings establish that enforcing Act 620 would prevent Does 1, 2, and 6 from providing abortions altogether.65 Doe 3 testified credibly that he would stop performing abortions if he became the last provider in northern Louisiana.66 The law would leave only one clinic with one provider, resulting in a 55 to 70 percent reduction in capacity.67
These burdens, combined with the absence of any significant health benefit because the requirement serves no relevant credentialing function and complications are rare, impose a substantial obstacle on a large fraction of women seeking abortions in Louisiana.68
Act 620 imposes an undue burden and is unconstitutional.69
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Justice Kavanaugh dissented.70 He agreed that the Whole Woman's Health cost-benefit standard should be rejected.71 He concluded that additional factfinding is necessary before determining whether Act 620 would have the same effect as the Texas law.72
Kavanaugh noted that the record does not adequately demonstrate that the three relevant doctors cannot obtain admitting privileges or that any clinic would close.73 He would remand for a new trial under the appropriate legal standards.74 He emphasized that the factual record at this stage of the facial pre-enforcement challenge was incomplete.75
The State had identified additional evidence supporting the law's benefits that had not yet been considered by the lower courts.76