905 F.3d 787
5th Cir.2018Background
- Louisiana enacted Act 620 requiring physicians who perform abortions to have "active admitting privileges" at a hospital within 30 miles; violation carries fines.
- Plaintiffs (several clinics and doctors, "June Medical") brought a facial undue-burden challenge under Casey and Whole Woman’s Health (WWH); district court enjoined the law; this appeal followed after remand to consider WWH.
- At enactment there were few providers in Louisiana (five clinics, six doctors) and limited admitting privileges; some clinics later closed for reasons the record ties to neither Act 620 nor enforcement.
- The district court found minimal benefits and substantial burdens (predicting closures and decreased access) and permanently enjoined Act 620; the Fifth Circuit majority reviewed facts in light of WWH and reversed, rendering dismissal.
- Majority: unlike Texas (WWH), Louisiana’s record shows few hospitals impose minimum-admission bars, only limited provider inaction in pursuing privileges, no expected increase in driving distances or statewide capacity collapse, and at most a potential small increase in wait time affecting up to 30% of patients — not a substantial burden on a large fraction.
- Dissent: criticizes the majority for reweighing factual findings the district court made (credibility, good-faith application efforts), argues Act 620 confers little medical benefit and would substantially restrict access (potentially up to 70% of women), and would therefore impose an undue burden.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Proper standard for facial challenge to abortion regulation | Salerno is inapplicable; under WWH plaintiffs may show facial invalidity if the law places a substantial obstacle for a "large fraction" of relevant cases | State urges Salerno (no set of circumstances) and says district court applied wrong test | Court applied WWH/Casey large-fraction undue-burden framework (rejecting Salerno in this context) and evaluated facts under WWH |
| How to apply undue-burden balancing (benefits v. burdens) | WWH requires balancing; plaintiffs assert burdens outweigh benefits here | State contends WWH did not change Casey; benefits (credentialing, continuity of care) exist | Court recognized and applied a balancing test per Casey/WWH but concluded benefits minimal and burdens not substantial when properly weighed in Louisiana record |
| Causation: did hospitals' bylaws and provider efforts lead to inability to obtain privileges (and closures)? | Plaintiffs: doctors made good-faith efforts but could not get privileges; closures and capacity loss caused by Act 620 | State: many doctors did not make full, good-faith efforts; hospitals generally do not impose minimum-admission bars like Texas; causation broken by provider inaction | Court found district court clearly erred on good-faith findings for most doctors; majority concluded causation not established and that Act 620 would not likely force clinic closures |
| Large-fraction / substantial-burden numeric question | Plaintiffs: Act 620 would substantially burden a large fraction of Louisiana women seeking abortions (district court found up to ~70%) | State: even if one doctor stopped, impact at most 30% and burdens would not be substantial or would be absorbed by other providers | Court held Act 620 does not impose a substantial burden on a large fraction of women; facial challenge fails (dissent would affirm injunction) |
Key Cases Cited
- Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016) (establishes fact-intensive undue-burden balancing and "large fraction" approach in admitting-privileges context)
- Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833 (1992) (defines "undue burden" standard; balancing benefits and burdens of abortion regulations)
- United States v. Salerno, 481 U.S. 739 (1987) (facial challenge standard argued by state; "no set of circumstances" test)
- Planned Parenthood of Greater Tex. Surgical Health Servs. v. Abbott, 748 F.3d 583 (5th Cir. 2014) (Fifth Circuit precedent addressing abortion regulation review prior to WWH)
- Planned Parenthood of Ark. & E. Okla. v. Jegley, 864 F.3d 953 (8th Cir. 2017) (applies WWH and discusses limiting denominator to those for whom the provision is actually relevant)