273 F. Supp. 3d 1013
S.D. Ind.2017Background
- Plaintiff Planned Parenthood of Indiana and Kentucky (PPINK) challenged Indiana Code § 16-34-2-1.1(a)(5) (part of HEA 1337), which requires the mandatory fetal ultrasound to be performed and offered to be viewed at least 18 hours before an abortion and at the same time as statutorily mandated informed-consent counseling.
- Before HEA 1337, ultrasounds could be performed and (voluntarily) viewed on the day of the procedure; informed-consent counseling already required delivery of certain information at least 18 hours before the abortion.
- PPINK operates 17 Indiana health centers (4 provide abortions). After the law, PPINK consolidated informed-consent appointments (which must include the ultrasound) to six centers, forcing many patients—especially low-income patients living far from those centers—to make two long trips or overnight stays.
- PPINK presented evidence of burdens: increased travel costs and time, lost wages, childcare expenses, confidentiality risks for abused patients, appointment crowding/delays, and specific patient examples of inability to obtain abortions. Experts quantified the added costs and predicted some patients would be delayed past procedural time limits.
- The State asserted interests in promoting fetal life (persuading women to continue pregnancies) and protecting women’s psychological health, but offered little direct evidence that requiring the ultrasound at least 18 hours earlier (versus on the day of the procedure) materially advances those interests.
- The district court held that PPINK is likely to succeed on the merits, that irreparable harm would result without relief, and granted a preliminary injunction prohibiting enforcement of the 18-hour timing requirement pending litigation.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the undue-burden test requires weighing burdens vs. benefits here | Apply Casey/Whole Woman’s Health balancing; court must weigh burdens against asserted state benefits | State urged limiting Whole Woman’s Health balancing to health-based regulations; argued Casey alone controls | Court applied Casey as interpreted by Whole Woman’s Health: balance burdens against benefits regardless of asserted interest |
| Whether the 18-hour ultrasound-timing provision imposes an undue burden | Law forces two trips for many low-income, distant patients, causing financial, logistical, and procedural delays that block access for some | State said benefits (reflection time, persuasive effect of image, mental-health benefits) justify the requirement and PPINK could mitigate burdens by operational changes | Court found concrete evidence of significant burdens on a defined group (low-income women distant from centers) and near-absent evidence that timing advances state interests—law likely imposes an undue burden |
| Whether PPINK faces irreparable harm warranting injunctive relief | Denial would cause loss of constitutional rights for patients and concrete prevention of services; harm presumed for due-process violation | State argued PPINK could reallocate resources to avoid harm, so harm not irreparable | Court credited irreparable-harm showing; resource reallocation not a viable cure; constitutional injury presumed irreparable |
| Balance of equities and public interest for preliminary injunction | Public interest favors protecting constitutional rights and preventing ongoing access barriers; State will not be harmed by temporary preservation of status quo | State cited harm from enjoining a democratically enacted law and its interest in promoting fetal life | Court found the balance and public interest favor an injunction given weak evidence of state benefits and substantial harms to patients |
Key Cases Cited
- Planned Parenthood v. Casey, 505 U.S. 833 (1992) (establishes undue-burden framework for abortion regulations)
- Roe v. Wade, 410 U.S. 113 (1973) (constitutional liberty includes right to terminate pregnancy)
- Whole Woman’s Health v. Hellerstedt, 136 S. Ct. 2292 (2016) (courts must weigh burdens against benefits and evaluate evidence supporting asserted benefits)
- Planned Parenthood of Wisconsin, Inc. v. Schimel, 806 F.3d 908 (7th Cir. 2015) (weigh burdens against state justification; benefits must justify curtailment)
- Gonzales v. Carhart, 550 U.S. 124 (2007) (courts retain independent duty to review factual findings when constitutional rights are implicated)
- Winter v. Natural Resources Defense Council, Inc., 555 U.S. 7 (2008) (preliminary-injunction standard requires likelihood of success, irreparable harm, balance of hardships, and public interest)
- Van Hollen (Planned Parenthood of Wisconsin, Inc. v. Van Hollen), 738 F.3d 786 (7th Cir. 2013) (travel distances and increased burdens on low-income patients are significant in undue-burden analysis)
- Stuller, Inc. v. Steak N Shake Enters., 695 F.3d 676 (7th Cir. 2012) (sliding-scale balancing of harms relative to likelihood of success)