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P.S.C. v. Meier

United States District Court, W.D. Kentucky, Louisville Division

May 10, 2019



          Joseph H. McKinley Jr., District Judge

         This matter came before the court for a bench trial that commended on November 13, 2018 and concluded on November 19, 2018. The court has reviewed the parties' post-trial briefs and the evidence at trial, and its findings of facts and conclusions of law are set forth below.

         I. BACKGROUND

         A. Procedural History

         Plaintiffs, a Kentucky abortion facility and its two board-certified obstetrician-gynecologists (“OB-GYN”) Drs. Ashlee Bergin and Tanya Franklin, challenge the constitutionality of a recently enacted Kentucky abortion law. The law at issue regulates second-trimester abortion procedures and is included in House Bill 454 (“H.B. 454” or “the Act”). Plaintiffs allege that the Act's requirement that Kentucky physicians perform a fetal-demise procedure prior to performing the evacuation phase of a standard Dilation and Evacuation (“D&E”) abortion-the principal second-trimester abortion method nationally-is a substantial obstacle to a woman's right to choose a lawful pre-viability second-trimester abortion. As such, Plaintiffs argue H.B. 454 is unconstitutional. More specifically, the individual Plaintiffs assert that, if the Act goes into effect, they will stop performing standard D&E abortions altogether due to ethical and legal concerns regarding compliance with the law, thereby rendering abortions unavailable in the Commonwealth of Kentucky starting at 15.0 weeks from the date of a woman's last menstrual period (“LMP”).[1] Defendants respond that the Act has neither the purpose nor the effect of placing an undue burden on a woman seeking a second-trimester abortion. Rather, the Defendants contend that H.B. 454 appropriately advances the Commonwealth's interests while leaving open alternative means of obtaining an abortion-specifically, by receiving an additional medical procedure to cause fetal-demise prior to the evacuation phase of a standard D&E. The proposed alternative methods for physicians to induce fetal-demise are threefold: (1) digoxin injection; (2) potassium chloride injection; and (3) umbilical cord transection. The Commonwealth maintains that these procedures are safe, available, and reliable methods for causing fetal-demise. Thus, the Commonwealth claims that H.B. 454 does not operate as an undue burden on a woman's right to a second-trimester pre-viability abortion and is thus a constitutional abortion regulation.

         On the day the Act was signed, Plaintiffs filed this lawsuit challenging it as a violation of Plaintiffs' patients' Fourteenth Amendment rights to privacy and bodily integrity. [DN 1 ¶¶ 46- 49]. Thereafter, Plaintiffs filed a Motion for a Temporary Restraining Order and Preliminary Injunction and the Court convened a telephonic hearing on the Motion. [DN 6]. During the telephonic hearing, the parties agreed to the entry of a consent order suspending enforcement of the Act until the Court ruled on Plaintiffs' motion for preliminary injunctive relief. [DN 24]. The Court later issued an order requiring the parties to continue abiding by the terms of the consent order until the trial on the merits. [DN 56].

         B. The Act

         H.B. 454 states in relevant part:

No person shall intentionally perform or . . . attempt to perform . . . an abortion on a pregnant woman that will result in the bodily dismemberment, crushing, or human vivisection of the unborn child when the probable post-fertilization age of the unborn child is eleven (11) weeks or greater, except in the case of a medical emergency.

         Act, § 1(2)(a)-(b). “Bodily dismemberment, crushing, or human vivisection” is further defined by H.B.454 as any

procedure in which a person, with the purpose of causing the death of an unborn child, dismembers the living unborn child and extracts portions, pieces, or limbs of the unborn child from the uterus through the use of clamps, grasping forceps, tongs, scissors, or a similar instrument that . . . slices, crushes, or grasps . . . any portion, piece, or limb of the unborn child's body to cut or separate the portion, piece, or limb from the body.

Id. § 2(18). A “medical emergency” exception is provided for under this framework. Such an emergency is defined as a condition that “so complicates the medical condition of a pregnant female as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible impairment of a major bodily function[.]” K.R.S. § 311.720(9); see Act § 1(1)(b). A physician found to be in violation of the Act commits a Class D felony, subjecting him or her to punishment of up to five years' imprisonment, KRS § 532.060(2)(d), and can also expose clinics and physicians to adverse licensing and disciplinary action. See KRS § 311.565; KRS § 311.606.

         The parties do not dispute that after approximately 15 weeks of pregnancy and before a fetus is viable, the most common second-trimester abortion procedure nationwide is a standard D&E without first inducing fetal-demise. It is also undisputed that the Act prohibits the standard D&E abortion unless fetal-demise occurs before any fetal tissue is removed from the woman.


         Plaintiffs seek a permanent injunction of H.B. 454. In determining whether a permanent injunction should issue, four considerations are relevant: (1) whether plaintiff showed actual success on the merits; (2) whether the movant will suffer irreparable injury unless the injunction issues; (3) whether issuance of the injunction would cause substantial harm to others; and (4) whether the public interest would be served by issuance of the injunction. Jolivette v. Husted, 694 F.3d 760, 765 (6th Cir. 2012) (outlining the permanent injunction factors). The plaintiff bears the burden of persuasion as to each of these four showings. The court will address each showing but first addresses a justiciability question raised by the Commonwealth.

         A. Standing

         As a preliminary matter, the Commonwealth asserts that EMW lacks standing to challenge the constitutionality of H.B. 454. Ordinarily, a party cannot claim standing to vindicate constitutional rights of some third party, in this case the patients of EMW. Singleton v. Wulff, 428 U.S. 106, 114 (1976). However, this general rule has exceptions. Without engaging in a lengthy analysis about the relationship between EMW and its patients, it is enough to state that it is well-established that it is “appropriate to allow a physician to assert the rights of women patients as against governmental interference with the abortion decision . . . .” Id. at 118; see also Planned Parenthood Ass'n of Cincinnati, Inc. v. City of Cincinnati, 822 F.2d 1390, 1396 (6th Cir. 1987) (holding that Planned Parenthood and its Medical Director had standing to assert the third-party rights of their patients because the patients' rights are “inextricably bound up with the activity the . . . clinic desires to pursue and seemingly would not be asserted as effectively by the third parties who actually possess those rights”) (internal quotation marks omitted); Northland Family Planning Clinic, Inc. v. Cox, 487 F.3d 323, 328 (6th Cir. 2007) (adjudicating physicians' and clinics' claims on behalf of their abortion patients); Women's Med. Prof. Corp. v. Voinovich, 130 F.3d 187, 191-92 n.3 (6th Cir. 1997) (same).

         B. Permanent Injunction - Success on the Merits

         To be entitled to permanent injunctive relief, Plaintiffs must first show they succeeded on the merits of their constitutional challenge to the Act.

         1. Legal Framework

         a. The Undue Burden

         Test In the nearly half century since Roe v. Wade recognized the Fourteenth Amendment right to decide whether or not to terminate a pregnancy, the Supreme Court has addressed abortion regulations on several occasions. This court's decision is controlled by the precepts articulated in those opinions. Specifically, three basic principles arising from Planned Parenthood of Southeastern Pa. v. Casey guide this court. 505 U.S. 833 (1992). In that case, the Supreme Court affirmed the essential holding of Roe. Id. at 846.

First is a recognition of the right of the woman to choose to have an abortion before viability and to obtain it without undue interference from the State. Before viability, the State's interests are not strong enough to support a prohibition of abortion or the imposition of a substantial obstacle to the woman's effective right to elect the procedure. Second is a confirmation of the State's power to restrict abortions after fetal viability, if the law contains exceptions for pregnancies which endanger the woman's life or health. And third is the principle that the State has legitimate interests from the outset of the pregnancy in protecting the health of the woman and the life of the fetus that may become a child.

Id. In this case the Court turns its focus to the first and third principles.

         According to this framework, before viability, a state may not forbid elective abortion entirely. See Gonzales v. Carhart, 550 U.S. 124, 146 (2007) (quoting Casey, 505 U.S. at 879); see also Stenberg v. Carhart, 530 U.S. 914, 921 (2000). Further, a state “may not impose upon this right an undue burden, which exists if a regulation's ‘purpose or effect is to place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability.'” Gonzales, 550 U.S. at 146 (quoting Casey, 505 U.S. at 878). But a state is not left with no power to regulate. Rather, “[r]egulations which do no more than create a structural mechanism by which the State . .. may express profound respect for the life of the unborn are permitted, if they are not a substantial obstacle to the woman's exercise of the right to choose.” Id. (quoting Casey, 505 U.S. at 877) (internal quotation marks omitted).

         In 2016 the Supreme Court elaborated on pre-viability regulations. See Whole Woman's Health v. Hellerstedt, 136 S.Ct. 2292 (2016). The Court reiterated that “a statute which, while furthering [a] valid state interest, has the effect of placing a substantial obstacle in the path of a woman's choice cannot be considered a permissible means of serving its legitimate ends.” Id. at 2309 (quoting Casey, 505 U.S. 877) (internal quotation marks omitted). Specifically, Casey “requires that courts consider the burdens a law imposes on abortion access together with the benefits those laws confer.” Id. The determination of whether a state regulation is a substantial obstacle-and therefore an undue burden-must be assessed in relation to the benefits that the regulation provides. Id. Where a regulation's burdens exceed its benefits, the regulation constitutes a substantial obstacle to a woman's choice and cannot withstand constitutional challenge. Id.

         b. Second-Trimester Abortion Jurisprudence

         Plaintiffs rely heavily on two Supreme Court cases in which the Court reviewed laws intended to ban Dilation and Extraction (“D&X”) abortions, otherwise known as partial-birth abortions. See Stenberg v. Carhart, 530 U.S. 914 (2000); Gonzales v. Carhart, 550 U.S. 124 (2007). Both cases are instructive. Nebraska's statute in Stenberg was found to be unconstitutional because the language of the law was such that it prohibited not only D&X abortions, but also could be read to ban the standard D&E abortion. See Stenberg, 530 U.S. at 930 (“[I]t ‘imposes an undue burden on a woman's ability' to choose a D&E abortion, thereby unduly burdening the right to choose abortion itself.”) (quoting Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833, 874 (1992)). In striking down the Nebraska law, the Court elaborated that using the challenged law,

some present prosecutors and future Attorneys General may choose to pursue physicians who use [the standard] D&E procedures, the most commonly used method for performing previability second trimester abortions. All those who perform abortion procedures using that method must fear prosecution, conviction, and imprisonment. The result ...

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