invalidate a law the court in this case failed to acknowledge that the facts in this case were different the regulatory scheme is different and that the law should have been applied differently you mean different from texas so i would yes different from texas because the texas case in the first place the whole woman's health was brought as after it had already been through the gauntlet here on facial invalidity it was  brought to the supreme court on an as applied challenge to the two clinics and then a challenge to the tory surgery centers of likeability across the state so it fundamentally came up differently to the united states supreme court but the facts were very very different to i mean if you would that i think that we go to great lengths in our brief to talk about the difference in the the impact in texas when you look at what happened there and the clinics that were closed here but the we start i think with facial and validity and facial and validity requires the plaintiff to meet a very high standard of proof and there's a reason for that the reason is because the state goes through a democratic process to enact those laws and the burden is high to invalidate them here the court really failed to even mention the standard for facially invalidating the law you went straight to whole woman's health and he applied a fairly reflexive application of whole woman's hell after going through a number of legal errors and factual errors to get to that result so attributed private party conduct to the state and several instances he could tributed state hostility to abortion also to the state just general hostility to abortion by quoting  laws that are valid state laws that were passed and up held as constitutional and then he also violated penn herbst by adopting an interpretation of state law of the contrary to the secretary department of health interpretation of state law in order to disqualify doe to use privileges so i mean at an at least three instances the court made legal errors in order to force the facts to fit what he believed to be the result that was compelled by whole woman's health and so we will submit to you that the legal heirs create enough o basis for us to river for you to reverse this judgment but we would also point to a number of different factual problems he he exaggerated the burdens he minimized the benefits and  in doing so he he basically undercut the entirety of the validity of the state law and there's one i think there's one very compelling factor that that i would like to point your attention to and that is the fact that these are two of the donors were able to obtain privileges during the course of this litigation one of the days already had them he had them at willis night many had them at christus which is the catholic hospital not only you speak of the donors give them number sho ok so dr joe three had privileges at the outset he had privileges at willis knighton and he had privileges at christus which is a catholic hospital operated under the umbrella of the of catholic hospitals dr joe chu was able to obtain courtesy privileges during the course of the litigation which the district court judge rejected saying that they they didn't comply this was the dough whose privileges he said conflicted with the language of the law and in fact the secretary of health submitted an affidavit a declaration stating that she had looked at those privileges and they did of they did comply and he rejected her declaration and interpreted the law differently and in fact interpreted it so narrowly that it would render the privileges in a political so that he didn't have to count them and then that subsequently resulted in a lower number of doctors available to perform abortions in the state how would you articulate that so to interests your honor one i think would that the state continues to have an interest in maximizing women's health but but the second interest in this was testified in committee and it was also part of the record is that it is part of our it is a a rational part of our regulatory structure unlike texas on like mississippi tennessee in arkansas we do not impose all of the ambulatory surgery climate yes you're on that testimony came from dr joe thore who testified that he in fact used his admitting privileges after he perforated a woman's uterus and he was able to admit her immediately to the hospital and repair the uterus he also was able to use his own admitting privileges when joe dr joe won and perforated a woman's uterus and she then was used he admitted her patient and fixed it so i think there was clear evidence by the doctor doe's themselves the plaintiffs that it did in fact have some medical reasonableness that was that was a political in this state to these doctors wrong that was a very significant factor to justice briar in that case that that texas had presented no evidence whatsoever that it would help a single woman and we we did have that evidence and it came from the  themselves there is contrary evidence that the contrary evidence is not on and only a fraction tiny fraction of one percent are there such incidents that this particular need that these incidents that do occur and so the doctors and i think none of the doctors dispute that there are a whole range of potential complications and that most of the time if you have a competent doctor they're there they're not going to have a problem but  did not over will or modify the substantial obstacle test there's that the burden is still to prove that if there is a burning that it creates a substantial obstacle so so i think that that goes back to what their burden of proof is that it's there i think the plaintiffs argue that this is now simply a pure balancing test and i would submit to you that that is not correct that whole woman's health did not erase casey and it also begins it begins with the premise that the state is permitted to regulate in a manner that maximizes women's health and it begins with that premise and so i don't think that it has changed the level at which states can regulate and it hasn't changed that the the fact that that still has to prove that the law creates a substantial obstacle we're not in a pure balancing environment i mean there is some balancing her women's health mention the word order to facially invalidate the law or to create an undue burden at all even balancing the benefits versus the burdens in louisiana are going to have a very different situation than that the court was confronted with in texas you absolutely do and i think that if you look at the statistics in texas for example texas is five times the state of louisiana has five times the population louisiana we had an contradicted testimony which which was also discussed by the motions panel when the stay was issued and and i think that that that those findings of fact that the district court relied on at that time never changed our evidence was an contradicted that women would have to travel all women that are within reproductive age would have to travel away to a distance of eighty two miles that was on contradicted evidence and if you look at even the joes who had privileges if you count dr too and you look at the two clinics in shrink porn and in new orleans the only people who are really left out of a hundred mile radius are a very small corner of women who had to travel anyway especially in lake charles if you look at lake charles those women were having to travel to baton rouge or new orleans are they were having to travel to shreveport for an hour or more so in our more maybe a half an hour or more depending i mean it's just it wasn't that the burden was not substantial and so not only did they not prove that they couldn't get privileges because they in fact showed that they could get privileges and that fact should have been beneficial to the state if we're talking about facial invalidity and we're talking about interpret in a law in a manner that renders it constitutional rather than unconstitutional because that is the presumption that should apply then the factors that these doctors could get privileges and did get privileges should have been favorable to the state and in fact it was flatly ignored and with regard to courtesy privileges it was just it was i think legal error so the facts of the facts were very different i think it also factored into the judge's ultimate conclusions on undue burden when he factored in private parties conduct and what he referred to the climate of louisiana being hostile to abortion and i submit that those were not end poverty to me he also relied on poverty as a factor and and i know that that was something that was discussed and in whole woman self in terms of affecting the burden but those are not factors that were created by the act the act did not impose those burdens and i think that it was legal error for him to attribute those to the act itself of which of the two clinics that had had closed what those were not a result of the act were of a they were not and the district court judge and i want to i would like to to quote him because i think that the language that he uses in the judgment is is troubling he specifically says he draws no imprints with regard to the closers in that closures and there was no evidence that these closures were in any way related to the act but he says and i quote it further supports the court's findings regarding the impact statement if there's no inference there's no inference and you cannot attribute those closures to the  katz related to the effect of poverty and some of the other factors that may be attributable to some of the population in louisiana but there was no testimony whatsoever about any specific women that would have to  travel any extended differences that was substantially different than what they would have to travel before and in the jag lee case which was an eighth circuit case that was issued after whole woman's health it was another attempt to facially invalidate a law in arkansas law and in that case the court referred to the fact that amorphous groups of women is insufficient to support facially invalidating the law and i submit that that's what what you had here the plaintiffs presented proof of an amorphous group of women who may have to travel farther or may have additional burdens and they presented no specific evidence that any woods and  on contradicted that the vast majority of women would be able to travel and would not have a substantial burden and that those within one hundred fifty miles would all be covered if they had brought in as the plug challenge they still would have been successful your honor i think that i think that they would not have been successful on the on the facts simply with and have one cabbie out to that because i think that there are some significant problems of proof on their declarations that there's this th this sequence of of of hearsay that they used to weave together their inability to get privileges and some of them and i can give you a couple of specific examples  dr doe two for example i'm sorry doctor dr joe five obtained privileges it charo and then was not denied at women's hospital and acknowledged in her deposition that she did not think that women's hospital could deny her privileges and she didn't follow up at the other hospitals for her purse or personal reason so and then there was other testimony that they just didn't think they would get approved so inconsistent testimony with that with the actual record for example christus one doctor to three had privileges at christus and yet two of the other doctors said well we don't think christus will give us privileges because chrysis is a catholic hospital doctor does three had privileges at christus and christus this policy which is in the record that it says that they simply don't allow abortions at their hospital so there's nothing in the record that suggests that they couldn't get privileges and unsub but but delta potentially would have closed if you assume if you assume the facts in the record that doctor that the that the doctor did know who worked at delta and i could tell you which one that that is and then it does get kind of confusing but delta was dr joe five dr joe five was able to obtain privileges that to row but had not yet been able to obtain them in baton rouge and that potentially would have resulted in the delta clinic closing  obtained an answer from women's hospital and had not applied to the others because her personal preference or was to was to to go to women so i mean she had she had reasons or in the deposition the doctor testified that she had personal reasons for not go in forward with those until the first hospital responded personal reasons i mean that's not a result of the act and there's no evidence that that the doctor was denied privileges at all  in fact none of them are absolutely denied any privileges and the presumption should have been based on the fact that two of them obtained them and one already had them that it was possible in this less than stellar effort to obtain privileges had something to do with hoping that their facial or car could be successful i believe so i do believe so i think that i think that the proper burden of would hold them to a higher standard and and that they would have to actually go through the process and show a meaningful effort to obtain and be denied privileges and that that that just making up your own mind that it is not worth your effort is not sufficient i want to talk a little bit about our regulatory scheme the because i think that that is also a very important factor in this case louisiana has a requirement for office privileges that to surgery center standards where the doctors are required to have both a transfer agreement and admitting privileges commensurate with their surgical specialties or whatever they do at the dettori surgery center what the testimony was in the record in this case at the legislature and testified to by a doctor who testified in the legislature and at the trial was that this provision that acts six twenty three hold a loophole in the law that it was an intermediate choice a reasonable intermediate choice that the legislature made to to require the abortion doctors to have admitting privileges that were that were active in the sense that they were not dormant and that they essentially be commensurate with whatever their licensing was which which ties back to the licensing law they have to be commensurate their with their whether they are o b g y n or whether they are family practice doctor so it's it is not imposing the standard upon them that texas mississippi arkansas or tennessee imposed by imposing all of the stimulatory surgery center requirements on the clinic didn't do that took a very intermittent step and said you just need to have admitting privileges and we have evidence that it helps and that it also helps because it serves a credentialing function and we presented that evidence to none of the doctors not even the defendants the plaintiffs doctors and their experts disputed that these kinds of privileges do serve a credentialing function their testimony was that it's simply not necessary it's not necessary but that's not what the case the standard is casey permits us to regulate at the maximum level too pretty to protect women's health as long as it doesn't create a substantial obstacle and so if you look at our law it was a reasonable middle ground it did not impose the a military surgery cent requirements on these clinics which had a very significant impact in texas if you look at whole women's health half the clinics closed when employed when the admitting privileges law so you went from forty to twenty and then when the able to tori surgery center law took effect you went to eight that didn't happen here the only two clinics that closed were not related to the act and the other three remain open and have doctors who have privileges so i think that again it we end up in a a loop where the court refuses to acknowledge the privileges that were obtained ridged it ignores the impact of those that did in terms of how that should be treated as a matter of law and then ultimately comes to the conclusion that these clinics are all going to close except for one but even if you look at one you still don't have the kind of distances that you had in texas and if you look at the facts in texas some of those women were i think that when you looked at the two hundred mile mark it was something like two thousand percent increase and it was found zones tens of thousands of women who were being impacted and ultimately there was another effect by the the restriction of all the clinics because you had so many women i think texas had somewhere close to seventy thousand women of reproductive age that were the relevant population seeking abortions in louisiana there's ten thousand abortions on average per  year substantially different numbers substantially different capacities of the doctors and i think that the capacity information was also he exaggerated the  perceived a lack of capacity and then exaggerated the geographical impact exaggerated the difficulty to obtain privileges and all to mentally then was able to centrally manufacture clinic closures so i would i would say this case is different and it does not compel the same result because we did produce evidence of medical reasonable mess we did produce evidence the court my name is mark here and i represent the beliefs the district court correctly applied the supreme court's holding and whole women's health and held at louisiana admitting privileges law creates an undue burden on women seeking an abortion the court found that if x six twenty goes into effect most clinics in louisiana will close and the state only mention capacity at the very tail end of the argument but that that capacity your honour's seventy percent of women in louisiana will be completely denied access to abortion that is the very definition of a substantial upside evidence supports that broader the only clinically just report found that said it is because that because opposing counsel is trying to rely on facts factual findings that is is trying to overcome factual findings that are supported by clear of them as i'm happy to walk through you have it's undisputed that doe one and the state's argument focuses on doe two and doe three and i'm happy to walk through but i think it's important to realize there are ten thousand abortions performed in louisiana every year this state has no theory under which all ten thousand abortions under which there is capacity to provide all ten thousand abortions and we see in it if even if you accept the state's argument that doe two and doe three would continue to have privileges and i and i and i a why you should not accept an argument there would still be only about half of the capacity remaining in the state for abortions to be provided so regardless of that's the state's  arguments there is no theory that the state has under which ten thousand abortions would continue to be provided louisiana and so on i'm happy to discuss two three and zero two three does have admitting privileges  t the state found sorry the just report found two independent reasons why joe three would stop providing abortions one is that joe three has said if he is the only remaining provider northern louisiana will stop providing abortions but i it in louisiana thing and north of here you said north of here he joe three testified that if he's the only remaining provider in northern louisiana that he would stop providing abortions because he would be the only and provides backup support to joe does one in three in shreveport the only reason he's able to do that right now is because the admitting privileges requirement is in joint if the admitting privileges requirement goes into effect doe one will stop being sufficient which they're not which i'll explain and to doe to who lives and practices in bowser city will suddenly start working full time in in new orleans at a because the whole rationale for do to use privileges so start when we back up the privileges the doe to cause are the privileges to admit patients but not to provide services to those patients not to provide diagnostic or surgical services to those patients at the hospital what at six twenty requires is that a doctor not only be able to admit patients but also provide diagnostic and surgical services to the patient at the hospital diagnostic can bear simple as sending the chart or making a phone call right i am i don't know that that's correct but there is no all of the only privileges the dough to has is the ability to admit patients not to provide it then then after he admits patients said that the requirement to provide diagnostic and surgical services only applies to the hospital not to the doctor that doesn't make any sense because the whole purpose for the the requirement is continuity of care the purpose purpose of the state has put forward is that the provider should be the one who can also provide the services at the hospital to ensure continuity of care and if the in if if the privileges that if it were specialty of the position if you're just doing abortions in your patient's suddenly having a massive heart attack does it make sense that you would be required to provide the service if surgery is needed are some things specific to alleviate the heart problem well i think that's that's a reason why the admitting privileges requirement doesn't make sense it doesn't dance in the medical objective but i think if you also look at the actual text of the statute that's the text of the statute says that because the physician is a must be a member in good standing of the medical stuff and this is in the back of the bed brief in our agenda of the medical staff of a hospital that is currently licensed by the department up with the ability to admit a patient and and to provide diagnostic and surgical services to such patients so that the interpretation is that with the ability to admit a patient applies to the physician but then in to provide diagnostic and surgical services applies to the hospital it doesn't make any sense it's just with with the ability to admit a patient and revive diagnostic and surgical services if they both if one applies to the position that they both would apply to the physician i think your honor that the reason to three is it is it has privileges that at that hospital is because he is an o b g y n practice and delivers has hospital not going to do anything for me so if you but he hasn't the fact i don't three is there i'd say a known abortion provider and has privileges of a hospital it seems to me that it's unreasonable or sort of lack their privileges in new orleans was sufficient under the act ok course you do you have the burden of proof is there any is there any factual support in the record for the finding that you just referred to right and the state never challenged it so as as this case is presented before this court this court should accept that the actual finding because the state is not challenging and the district court signed it we normally don't accept factual findings where it's the plaintiffs burden and there's nothing in the record to support the finding were underground and no obligation to accept that short of finding so so your honor regardless of that even if you thought that there was a clearly erroneous it doesn't it doesn't get the state the state still can't win because due to only provides four hundred it's around five hundred abortions a year in that in that area and there still is no way that the state can get to the number of the where it's providing ten thousand abortions where there's enough capacity remaining even if you think that due to could get admitting privileges in the in the bowser city area the state cannot get enough remaining as he is the only one who provides services in baton rouge and doe five does not have admitting privileges there the other so with respect to doe three providing abortions because the clinic where do three works which is the hope clinic in treif work will close and that supported by the record because this is definitely not clearly erroneous and the reason is that doe one is the primary provider  lose the clinic where he provides access season where he provides abortions but i don't know if three does have a separate port from the one you just made but those three does currently have privileges to hospitals with him thirty miles of hope clinic isn't that right that's right but the reason is because doe three only provides abortions one and a half days a week his primary practice is as an o b g y n and joe three only provides about twelve hundred abortions a year so even if again this is the just report made factual findings that even if you accept the state's argument that doeth three five will continue providing abortions that will only come up to about forty five hundred abortions a year capacity that is fifty five percent of the women in the state will continue will be completely denied access to abortion even if you accept the state's arguments and that that i think it's important to note that that's not simply just that just that number of that you've calculated whether it's accurate or not we can check but does that assume that no doctor will will increase his or her number of abortions that he or she is willing to perform if it does it does a soon that it be it's based on the current the current number of of abortions that are provided but the the it's important to know that in whole women's health the supreme court rejected the state's argument that the state could just count on providers providing more abortions the state has well but in texas i mean the numbers were so dramatically different i mean there were several that get greater order of magnitude of the number of abortions that that would have to be in increased by the by the remaining providers of the remaining clammy shot i don't quite understand how that spills over into this case i don't think that's actually correct and the state says that but but in in texas the record was that sixty to seventy thousand abortions provided a year in texas and the remaining clinics would have to essentially quadruple but here there would be under the disappoints primary factual findings there would be one provider left only in louisiana that one provider cannot provide ten thousand abortions a year in louisiana even if you accept there is no five and zero three even if you accept that don't three doubles his the number of abortions that he provides you still have about five thousand abortions  lack of capacity of five thousand orphans and in fact during the whole women's health argument justice alito remarks that the they could you have it's of capacity in this case because at that time this exact same record was before the supreme court supreme court looking at this exact same record vacated that stay and there was only one dissent from the denial from that they cation of that stay that the standard is that this court's ruling was demonstra wrong so that's what the supreme court had to find to vacate that this is the same record in fact justice alito remarked during oral argument that woman's health that the evidence of capacity in this case is better than the evidence the of capacity that was in the texas case so i i think there is no way your honor that two to reverse the district court here would be completely inconsistent with the supreme court's decision and whole woman's health  record here is substantially the same there is no medical benefit the district court made that finding it's consistent with the just with the supreme court's findings there is no and i'm happy to discuss the evidence of benefits but i just i think it's important that there is no n n terms of capacity there is no way that the state can get to the number of abortions to ten thousand horses here and if women are different and are denied capacity or are denied access to their abortions because the it will take longer to get a clinic that will push abortions from the first trimester into the second trimester as the district court found here where the complication rate although still very low is much higher in the second trimester than it is in the first trimester and so for those reasons the district court actually found that this state this law does not promote women's health but it actually harms women's health it would it would delay women women would be delayed to the point that they would not be eligible any longer for medication abortions they would have to have surgical abortions so so there's there's a whole other their whole you know legitimate one one of the things that that we should focus on whole women's health focused first on the lack of capacity and then it said that the driving distances were an additional burden on women and it didn't focus exclusively or even primarily on driving distances but here even if you accept the state's argument that doe three and zero five will continue to provide abortions there would be in northern louisiana one provider who provides abortions one and a half days a week would you please i'm going to push shift just for a minute would you address the the district court's weighing of the fact that in the district judges view and we cna is a state that's hostile to abortions i i have a hard time seeing how that should be weighted all in a facial challenge his suggestion if i understand it and if i misunderstand it you can clarify is that if this same law were passed and say new jersey or oregon that the result might be different if there's a perceived a less hostility in either of those states to to abortion generally so i don't think that's what the district court was saying there there were a couple of pages in the district court's opinion that simply discussed and laid out what the what louisiana's regulations of abortion are that the district court did not then make any large differences it just discussed and the state doesn't dispute any of those things the discourse states are true does that mean does would be in louisiana so women for example in what we started would be in new orleans so women in northern louisiana for example would have to travel to new orleans which i understand louisiana is not has as large a state of tech as texas but it's still a three hundred twenty five mile drive drive five hour drive or more from shreveport to new orleans and because of the twenty four hour waiting period women would have to spend two days and it was essentially come once for the consultation and then either make a second trip or remain in that provide that it's the it's the the the confluence of the two requirements that that exacerbates the burden that's what that's that's how it's relevant  abortion action to the state that's not at all but the district court did but you know that's relevant to the just reports factual finding that doe three will stop providing abortions if the law does go into effect but again even if you don't accept it you don't have to accept the district court's finding that don't three will stop providing abortions because even if you does the court found that only that fifty five percent of louisiana women will still be completely denied access to initial finding was the doe five will be the only remaining provider if joe five is the only remaining provider to five four three thousand abortions a year out of the ten thousand abortions in the state so seventy percent of women will be done access as a as an alternative finding that the district court found that even if they don't three continues to provide abortions that because of three provides about twelve hundred abortions a year that would only add up to about forty five hundred abortions a year out of the ten thousand so there will that the evidence before the district where the districts factual findings were that there that the complication rates are extremely low and that's the same findings it's essentially the same evidence that was before the supreme court and whole women's health the admitting privileges requirement made a difference in terms of providing better health to a woman and i would submit the same is true here because joe three those two so all that dough three testified is there were two instances where there were perforated abortions because i had a meeting privileges i performed at the surgery at the hospital doeth three never said that in there was no evidence that as a result of doing three is having a privileges those women received better care by don't three than they would have received had they been treated by a different position at the hospital the state of the district court discussed transfer agreements abortion clinics are required under current l admitting privileges requirement to have transfer agreements so that women will receive continuity of care and those transfer agreements in fact the states this states there's deposition testimony from the states the head of the losing a part of medical examiners and from former and current employees of the d h h that there's never been that they're unaware of any incidents where simply having a transfer agreement provided that there were women who were did not receive proper treatment as a result of just having a transfer agreement in place but the point is that the standard of care as recognized by the district court is recognized by the american medical association is that if there is a complication that arises the patient will be transferred to the hospital and will be treated by the attending physician of the hospital there is no evidence in this record including those two incidents of the  that women receive better care as a result of having the abortion provider provide that surgical services in the hospital than they would receive if there were a different position of the hospital providing those same services and in fact i think it's really important to note that the vast majority of complications that occur happen at home after the abortion has already taken place with where it's extremely rare in fact to just report found that it's one out of only a few thousand instances of complications where a woman where there's actual transfer from the clinic itself to the hospital the vast majority of complications occur after the woman has already gone home in the standard of care for that woman is if she does need to to receive a mercy treatment at a hospital she would go to the nearest hospital trademark wouldn't would be a better doctor provide better care like what is your position on the fact that these physicians having to qualify for admitting privileges that that would be a significant like a credentialing situation a credential function where ok if they satisfy the requirements of the hospital then they're trained better or more qualified or something i mean do you think that that's total and significant so the just report made factual findings that the need for clear error that these doctors were denied admitting privileges for reasons completely unrelated to their competency or to credentialing the hospitals there is no requirement in louisiana for example that louis that that the hospital has to provide imaging privileges to any any doctor who to qualify and you have to qualify but then the state has it within the hospitals can deny it many privileges for a multitude of reasons completely unrelated to competency completely unrelated to potentially for example the vast majority financial sense for the hospital to grant admitting privileges to that doctor but the complication rate of abortions is so low that abortion providers don't expect that they'll be and that there will be any they will meet the minimum no credentialing function and so again it can't be clear error ronnie's for this report to on this same essentially the same factual record to make that finding as well but we'll see  your honest i'd like to hit on a couple of factual points and i want to walk through real quickly just walk through the dr dos and just sort of to bring home the point of who had privileges and what they did to sabotage their own their own applications basically dr joe won board certified in family medicine and addiction medicine applied it meant in hospital was was not given privileges there and submitted an application to willis night for addiction medicine not family medicine and so why she didn't submit an application for family medicine which is her board certification in which she had actual proof that she had performed on a residency and the record record doesn't say  two obtained privileges at tulane worked as an assistant clinical professor of medicine at all she medical school for eighteen years and had admitting privileges at various hospitals when he had a general o b g y n practice told willis night and that they would have to come to the clinic to look at the documentation that they requested for his application said you know well you're just going to come to my clinic to find that stuff if that's what you want if you want to look at that i mean that's you know that another evidence of sabotage doe three had living meeting privileges at willis knighton and at christus and had had those since the ninety's and at christus while he was performing abortions and it willis knighton since ninety seven or ninety eight clear evidence that both of those hospitals would in fact give privileges to someone even if they were performing abortions because he had been dope for ceased practicing at color after causeway closed and was eighty two years old when he retired nope no inference to be drawn from that joe five has privileges in new orleans but not in b r obtained privileges at touro testimony of doe five did not call to check up on line and batteries general being that i felt my best chances for privileges would have been at women's they cannot deny my privileges from what i'm told i meet all of the qualifications and as long as i meet those they cannot deny it will stay pending until i find someone to cover me in batteries general one of the requirements for that hospitals that you have to take what's called city call whether your by the hospital terms whether your courtesy you have to take city call and that's something i really don't want to have to be subjected to so personal reasons joe six s to three testified and in the case he testified that the uterus was perforated and it was unsafe to continue with the abortion so we transferred to the patient to elicit and since i was on the staff i went ahead and accompanied her and then i taught the residents how to do what to do in that situation we did a laparoscopic germination of the pregnancy at that point to be able to confirm that we had not damaged any organs and any of her vital organs inside and she did well we went home the next day clear evidence that there was medical reasonable limits in this particular requirement absent in texas present in louisiana and so i just want to kind of bring this back full circle to the burden of and validate a law there's a higher burden for facial invalidity because it towards the democratic process that's very important to the states these are not the only this is not the only case we've got a lot more in the pipeline as does the state regulatory scheme is different it we did not hold abortion providers to the same standard as able atory surgery centers or the doctors who work there we chose a reasonable intermediate position that reflects the level of anesthesia that is used in these procedures because it's not simply always a local a cogged a cut guidelines actually say don't single out abortion providers we didn't we didn't and  our law has been held to be facially invalidated the facts are different it is not the same record it is not even close to the same record as texas we show proof of medical reasonable mous which is a significant problem that the supreme court i honestly i'm not sure i can specifically recall exactly what justice alito said i think that justice brier commented that there was evidence in this case there was that you know justice prior was very focused on the fact that there was no evidence of medical reasonable and it's brought by the state to back up the claim that it was medically reasonable as a justification for the law and we have both so i think that right now you've asked our question thank you and your case is under