913 F.3d 573
5th Cir.2019Background
- Louisiana enacted Act 620 (2014), requiring abortion providers to have active hospital admitting privileges within 30 miles of the abortion site.
- Plaintiffs (abortion clinics and doctors) challenged Act 620 as facially unconstitutional; the district court found the law provided no health benefit and would drastically reduce abortion access, enjoining enforcement.
- District-court findings: admitting-privileges decisions often reflect nonmedical factors; several doctors were denied privileges for reasons related to abortion; only one physician likely would remain, leaving many women without timely access and shifting burdens heavily onto poor and rural women.
- While this case was pending, the Supreme Court decided Whole Woman’s Health v. Hellerstedt, instructing courts to weigh a law’s burdens against its benefits under Casey’s undue-burden standard and striking down a near-identical Texas admitting-privileges law.
- A Fifth Circuit panel nevertheless reversed the district court (majority) by conducting de novo factual review, finding some doctors could likely obtain privileges and concluding Act 620 did not impose a substantial burden on a large fraction of women.
- Multiple judges (Dennis, Higginbotham, Graves, Higginson) dissented from denial of rehearing en banc, arguing the panel misread WWH/Casey, failed to apply clear-error review to factual findings, and improperly raised plaintiffs’ causation burden.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Act 620 imposes an undue burden under Casey/WWH | Act 620 confers no medical benefit and imposes substantial obstacles (clinic closures, reduced capacity, delays, disproportionate impact on poor/rural women) | Act 620 provides at least minimal credentialing benefits and does not impose a substantial burden on a large fraction of women | Panel majority: No undue burden (reversed district court). Dissent: Panel misapplied WWH/Casey and should have affirmed district court. |
| Proper legal test: Must courts weigh benefits against burdens per WWH? | Yes—courts must balance benefits and burdens; absence of benefit + substantial burdens = undue | Argues WWH allows focus on substantial obstacles and minimal burdens need not trigger full balancing | Dissent: Panel misread WWH by allowing minimal-burden findings to avoid weighing benefits; WWH requires balancing. |
| Standard of review for district-court factual findings | District court’s credibility-based findings are entitled to clear-error deference | Appellate court may reassess each provider’s efforts and hospital bylaws to determine causation | Panel majority applied de novo factual review; dissenters argue this violated clear-error review and improperly retried facts. |
| Causation standard to show law caused access burdens | Timing, clinic closures, and record-wide inferences suffice (as in WWH) | Plaintiffs must show individualized, good-faith efforts by each doctor to obtain privileges | Panel required more individualized proof than WWH; dissent contends this heightens causation beyond Supreme Court precedent. |
Key Cases Cited
- Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016) (Supreme Court: courts must weigh benefits and burdens under Casey and invalidated Texas admitting-privileges law)
- Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833 (1992) (established undue-burden standard for abortion regulations)
- Roe v. Wade, 410 U.S. 113 (1973) (recognized state interest in safety of abortion but affirmed constitutional right to choose)
- Anderson v. City of Bessemer City, N.C., 470 U.S. 564 (1985) (clear-error standard requires meaningful deference to trial-court factual findings)