Planned Parenthood Southwest Ohio Region v. Yost, 375 F. Supp. 3d 848

Background

Ohio enacted S.B. 145 (Ohio Rev. Code § 2919.15), effective March 22, 2019, criminalizing "dismemberment abortions" (defined to describe D & E) unless fetal demise is first induced or a narrow medical exception applies. Violations carry felony penalties and civil liability.
Plaintiffs (Ohio abortion providers and physicians) challenged the statute pre-enforcement, seeking a preliminary injunction arguing the implicit fetal‑demise requirement effectively bans common, safe pre‑viability second‑trimester D & E procedures without feasible alternatives.
The State defended by proposing three methods to induce fetal demise (digoxin, potassium chloride (KCl), or umbilical cord transection (UCT)) and invoking interests in protecting fetal life, preventing fetal pain, and regulating the medical profession.
The court held an expedited evidentiary hearing with expert testimony about D & E, risks and practicability of digoxin/KCl/UCT, complication rates, training/equipment limits, and uncertainty about fetal pain; it made preliminary factual findings favoring Plaintiffs on feasibility/safety limits of the State’s alternatives.
The court found Plaintiffs likely to prevail on a facial undue‑burden challenge: the statute burdens a "large fraction" of women seeking pre‑viability, second‑trimester abortions (especially ~15–18 weeks) because alternatives are unsafe, impracticable, or unstudied, and the statutory medical exception is too narrow/vague.
The court granted a partial preliminary injunction (no bond) narrowly enjoining prosecutions in four categories: D & E before 18 weeks LMP; accidental removal of fetal parts when complying with demise requirements; D & E after a failed attempted demise; and D & E when a physician reasonably determines the patient is not a candidate for demise.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether §2919.15 is facially unconstitutional under the undue‑burden/"large fraction" test	The implicit fetal‑demise mandate leaves no feasible, safe option for many pre‑viability second‑trimester patients and thus imposes a substantial obstacle in a large fraction of relevant cases	The law furthers legitimate interests (respect for life, medical dignity, preventing fetal pain); alternatives (digoxin, KCl, UCT) make compliance feasible and court should defer to state factfinding	Court: Plaintiffs likely to succeed; statute burdens a large fraction of women seeking pre‑viability second‑trimester abortions given infeasibility/risks of State’s alternatives and narrow medical exception
Adequacy and scope of State‑proposed alternatives (digoxin, KCl, UCT)	Alternatives are medically risky, not universally available, require specialized training/equipment, have nontrivial failure rates, and in some gestational ranges are unstudied	Alternatives are viable means to avoid criminal liability and can be performed safely by clinicians	Court: Digoxin is not safe/feasible for all (failure up to ~10%, contraindications, unstudied <19 weeks); KCl needs MFM specialists and high‑end equipment; UCT risks accidental dismemberment and other harms—so alternatives do not cure the burden
Sufficiency of statutory medical exception ("reasonable medical judgment" for serious risk of substantial and irreversible impairment)	Exception is too narrow and vague to protect physicians who face immediate, complex clinical decisions after a failed demise attempt; doctors will be chilled or forced to abandon D & E	Exception permits life/health necessity determinations by physicians; mitigates burden	Court: Medical exception is inadequate and potentially vague; it does not remove the untenable choices doctors face after failed demise attempts
Appropriate preliminary relief/remedy	Plaintiffs sought complete injunction; alternatively limited relief to avoid irreparable harm and preserve access	State urged narrower relief or preservation of statute	Court: Granted partial preliminary injunction tailored to four specific categories (see Background). Court declined a total statewide enjoinment pending full merits.

Key Cases Cited

Roe v. Wade, 410 U.S. 113 (1973) (established constitutional right to abortion prior to viability)
Planned Parenthood v. Casey, 505 U.S. 833 (1992) (undue‑burden standard governs pre‑viability abortion regulations)
Gonzales v. Carhart, 550 U.S. 124 (2007) (upheld federal partial‑birth abortion ban; discussed state interests in regulating abortion methods)
Stenberg v. Carhart, 530 U.S. 914 (2000) (invalidated a prior partial‑birth ban that lacked adequate health exception)
Whole Woman's Health v. Hellerstedt, 579 U.S. 582 (2016) (courts must assess both benefits and burdens of abortion regulations)
Ayotte v. Planned Parenthood, 546 U.S. 320 (2006) (remedy principles favor partial invalidation/narrowing when possible)
Williamson v. Secretary, 900 F.3d 1310 (11th Cir. 2018) (invalidated statute similar to Ohio’s; persuasive on feasibility analysis)
Planned Parenthood of Greater Ohio v. Hodges, 917 F.3d 908 (6th Cir. 2019) (standing principles for abortion providers to litigate on behalf of patients)
Cincinnati Women's Servs. v. Taft, 468 F.3d 361 (6th Cir. 2006) (facial undue‑burden/large‑fraction discussion)
Northland Family Planning Clinic, Inc. v. Cox, 487 F.3d 323 (6th Cir. 2007) (Ayotte's remedial approach applied in abortion context)