Goe v. Zucker, 43 F.4th 19

Background

New York historically required schoolchildren to be immunized; until 2019 the statute allowed both religious (non-medical) and medical exemptions.
After a 2018–19 measles outbreak centered in NY, the legislature repealed non-medical exemptions and the Health Department adopted regulations (Aug. emergency; Dec. final 2019) narrowing medical exemptions to contraindications/precautions consistent with ACIP guidance or other nationally recognized evidence‑based standards and requiring a detailed physician‑signed form.
Plaintiffs (a children’s‑advocacy org and parents of medically fragile children) sued after many submitted medical‑exemption requests were denied, alleging violations of substantive due process and Section 504 of the Rehabilitation Act; most denials were by school officials relying on district physicians or Health Dept. reviewers.
The district court dismissed the First Amended Complaint for failure to state a claim; plaintiffs appealed.
The Second Circuit reviewed de novo, upheld the district court’s use of certain extrinsic materials as judicially noticed or incorporated, and affirmed dismissal.
The court held the regulations survive rational‑basis review as reasonably related to the State’s legitimate public‑health interest and rejected plaintiffs’ Rehabilitation Act and as‑applied substantive due process claims.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Procedural: Use of extrinsic documents at 12(b)(6) stage	District court improperly relied on exhibits outside the FAC that contradict plaintiffs’ allegations	Court may judicially notice legislative and administrative materials and consider documents incorporated by reference	Affirmed: judicial notice and incorporation by reference were proper; court did not resolve disputed facts but used materials to explain state decisionmaking
Facial substantive‑due‑process challenge / fundamental‑right question	Plaintiffs: they have a fundamental right to a medical exemption based on a treating physician’s certification, so strict scrutiny applies	State: no fundamental right implicated; regs regulate access to exemption consistent with public‑health standards	Affirmed: no fundamental right; rational‑basis review applies; regs reasonably relate to protecting public health
As‑applied substantive‑due‑process challenge to school officials	Plaintiffs: officials’ denials infringed rights (parental liberty, informed consent, access to education) and shocked the conscience	Defendants: officials applied regs within delegated discretion; denials were not arbitrary or conscience‑shocking	Affirmed: pleadings failed to show conscience‑shocking conduct or deprivation of a protected right; municipal liability dismissed
Rehabilitation Act (§ 504) claims	Plaintiffs: narrowing exemptions discriminates against children with disabilities who cannot safely be vaccinated	Defendants: regs apply to all students; disabled children can obtain medical exemptions if consistent with evidence‑based standards; appeal and state judicial review available	Affirmed: FAC failed to plausibly allege exclusion "solely by reason of" disability; § 504 claims dismissed

Key Cases Cited

Jacobson v. Massachusetts, 197 U.S. 11 (1905) (states may limit medical exemptions to cases where harm from vaccination is reasonably certain)
Zucht v. King, 260 U.S. 174 (1922) (local authorities may have broad discretion to enforce school health laws)
Phillips v. City of New York, 775 F.3d 538 (2d Cir. 2015) (New York school immunization law does not compel vaccination and is subject to ordinary review)
Leebaert v. Harrington, 332 F.3d 134 (2d Cir. 2003) (framework for identifying fundamental rights in substantive due process analysis)
Immediato v. Rye Neck Sch. Dist., 73 F.3d 454 (2d Cir. 1996) (parental liberty interest not necessarily fundamental when challenged by state regulation)
Plyler v. Doe, 457 U.S. 202 (1982) (education is important but not a fundamental right for strict scrutiny purposes)
Ashcroft v. Iqbal, 556 U.S. 662 (2009) (plausibility standard for pleadings)
Bell Atlantic Corp. v. Twombly, 550 U.S. 544 (2007) (pleading must be plausible, not merely possible)
B.C. v. Mount Vernon Sch. Dist., 837 F.3d 152 (2d Cir. 2016) (discussing § 504 discrimination forms and limits)
Segal v. City of New York, 459 F.3d 207 (2d Cir. 2006) (no municipal liability where no underlying constitutional violation)
Garcia v. S.U.N.Y. Health Scis. Ctr. of Brooklyn, 280 F.3d 98 (2d Cir. 2001) (no individual capacity liability under § 504)
All. for Open Soc'y Int'l, Inc. v. U.S. Agency for Int'l Dev., 651 F.3d 218 (2d Cir. 2011) (unconstitutional‑conditions doctrine overview)
Agency for Int'l Dev. v. All. for Open Soc'y Int'l, Inc., 570 U.S. 205 (2013) (unconstitutional‑conditions doctrine affirmed)