well your argument this morning case fifteen to seventy four whole women's health versus heller step mr chief justice and may it please the court the texas requirements undermine the careful balance  states legitimate interests in regulating abortion and women's fundamental liberty to make personal decisions about their pregnancies they are unnecessary health regulations that create substantial obstacles to abortion access which totally material facts relevant to the claim developed subsequent to entry of judgment in the abbott case but you could have amanda you could have asked for supplemental briefing i mean the new action is filed six days after  in the trial record in rendering its decision and it held that the evidence in the trial record was speculative that there wasn't a sufficient basis to conclude that any doctor would be unable to obtain admitting privileges or that any clinic would be forced to close as a result of the admitting privileges requirement which you are you made allegations concerning those same claims i mean is your argument that you have allegations on the facial challenge fishel challenge is resolved against you and all you have to do is come up with new evidence and then you can start over again no your honor the evidence must be material and it must be newly developed so newly discovered evidence wouldn't be sufficient if it was evidence that was a valuable at the time of the first suit but the plaintiffs merely hadn't discovered the evidence or didn't bring it forward that wouldn't provide the basis for a subsequent suit but evidence that developed after judgment in the first suit that is material to the cleans does provide sufficient challenge it was before the law took effect in the court concluded that there is not sufficient evidence that any doctor would actually be unable to obtain admitting privileges or the at any clinic with actually a person very little specific evidence in the record in this case with respect to why any particular clinic closed basically your argument is that the law took effect and after that point there was a decrease in the number of clinics so suppose you win here and the state then examines what happened in each of these clinics and comes up with evidence showing that in quite a few instances the closure was due to other factors and so then they would then could they take the position well the decision of this core holding that the law is facially unconstitutional is not binding on us by and so you would have to see them again and they would be able to make the same argument you're making now is that correct no your honor and what's the difference well first of all the state had an opportunity to bring forward evidence in this case about the reasons why was it that was that their burden no your honor not in the first instance but the plaintiffs came forward with evidence and the state did not offer anything to rebut the evidence which was more than sufficient to support the district court stable in any given year there may have been a one to two clinic variance following the enactment of h b two more than twenty clinics closed within a very short period of time the timing of the closures would loan i'm sorry acquirement weren't right at the time that the abbott case was filed because the final implementing regulations for that statutory requirement hadn't yet been adopted well certainly in the federal system so many states as well making were clear in the statute anyway i would disagree that the extent of the burden that the law would impose was clear on the face of the statute intil those implementing regulations were adopted in the statu provided a deadline for the adoption of those regulations until they were adopted the plaintiffs couldn't have known whether waivers or grandfathering would have been permitted and if waivers or grandfathering were permitted as they have been in every you can separately challenge the admitting privilege provision and the provision yes your honor because those so if you can separately challenge them if you challenge just the admitting privileges provision how would you factor in presumably would have to assume that the a and c provision was not under challenge so in assessing the burden you would look at just the admission privilege and vice versa if you're challenging just being a c separately you'd have to assume you discussed the burden soley caused by that provision it seems to me the separation of the two provisions makes you would make your case much harder and i would disagree with that your honor because each of these requirements is extremely burdensome on its own the admitting privileges requirement which is partially in a fact has been responsible for the closure of nearly half of all the abortion facilities in texas to date and the aesir acquirement if it took a fact the respondents have stipulated that it would close any remaining licensed abortion facility that was able to comply with the admitting privileges requirement so independently into effect there will be one facility left in austin two in dallas one in fort worth two in houston and either one of the two in san antonio and before that he said that the enforcement of the  appointment with the privileges the privileges of admission would reduce the number from twenty down to about from forty down to about twenty i think the question was what evidence did those findings rest upon as you've heard the other side i think say there is no such evidence or the court of appeals said there is no such evidence so he's can you give a brief account or page numbers that will show that those findings the diminishment of the number from about forty to about eight which is what the district court rested upon some evidence what knowing that the clinic would not be able to continue operating once their parents took a fact and as a result of that either they needed to move resources to remaining clinics to ensure that some clinics would continue to operate in the state what they say could you give us any record references later on rebuttal yet as to how many of the total that you claim closed do you have direct evidence about the reason for the closure well eleven of them your honor closed on the  approximately twelve your honor direct because if if you go through this no we're not talking about a huge number of facilities i really don't understand why you could not have put in evidence about each particular clinic and to show why the clinic closed and as to some of them there is there is information that they close for reasons that have nothing to do with this law now maybe when you take out all of those there still would be substantial number and enough to make your case but i don't understand why you didn't put in direct evidence i mean i could give you examples planned parenthood center for choice brian texas is that one of the ones you're talking about  there's a news report planned parenthood and huff and the huffington post reported that this was caused as a result of the two thousand and eleven texas women's health program bill which cut funding for family planning services it's not the law that we're talking about here well your honor that evidence is not in the record i understand that and you put quite a bit of evidence that's not in the record in your brief but my point is why is there not direct evidence about particular clinic's you facilities shut their doors and then when that was stated when that was lifted they reopened again immediately is that right that is correct your honor and then almost like a perfect controlled experiment as to the effect of  it's like you put the law into fact twelve planets closed you take the law out of a path they reopen that's absolutely correct and as the state had stipulated that's exactly what the seat stipulated would would happen and that that stipulation is certainly direct evidence of the impact of the s c requirement that the state i think is going to talk about the capacity of the remaining clinics would it be a proper and be helpful for this court to remain and for further findings clinic capacity i don't think that's necessary your honor i think there's sufficient evidence in the record that we have to support the district court's finding that the remaining clinics which would number fewer than ten don't have capacity to meet the statewide demand that there have been some changes like of a major clinic i don't quite know that if they used ford in san antonio there suppose there were evidence that there was a capacity and the capability to to build these kinds of clinics would that be in of imports and then it would show that this law has in effect and the beneficial effects of part of the legislation is concerned if the court had any doubts about the capacity of the remaining clinics to remain and would certainly provide the petitioners with the opportunity to supplement the evidence already in the record but the evidence in the record shows that supports the district court's finding that because the assyria choir meant the costs of it are so prohibitive it will deter new effect the year how since this law has taken a fact three new in military surgery centers have opened and there is evidence about that at the trial in the trial court knew that that was going to happen that the trial court took that into account in its finding but nevertheless there was substantial evidence including texas experience in two thousand and three following anathem end of the ating a case like this and wheezing out and in that case the plaintiffs were able to put in evidence about the exact number of abortions that were performed in all of the facilities why could that not have been done here  america when it why don't you take an extra five minutes and will be sure to afford you rebuttal time after that thank you mr chief justice so fundamentally these laws impose heavy burdens on abortion access that are not medically justified and for that reason they impose an undue burden on the right to abortion do you think there's a rational basis for the log based on the benefits that the legislature saw i do because the law actually undermines the state's interest in health rather than advancing it by causing an increase in later abortions and self induced abortion we wouldn't can see that it's rationally related to the state's interest in health but our group said even if the test is undue burden that rational basis that that's correct your honor and in order to determine whether a law imposes an undue burden on the abortion rights we must first consider the magnitude of the burden that it imposes and then compare that burden to what the law is intended to achieve to the i don't understand how is that illogical i mean the question is whether there's an undue burden or substantial obstacle what what difference does it make what the purpose behind the law is in assessing whether the burden is substantial or were undue it seems once you get past the  the law has a rational basis and you have a challenge that then you look at the burden of the obstacle and the purpose that the law is directed to i would think doesn't make a difference it's either a substantial obstacle or an undue burden or it's not in order to determine whether a burden is on your honor we have to consider what the burden is in relation to in casey for them in upholding the informed consent requirements of the court first look to the state interest that was being served by those requirements in that case if the state interests of potential life and concluded that the requirements are reasonably believed designed to serve that purpose by making the abortion decision more informed and i thought the undue burden and substantial obstacle went to whether it was on do in light of the woman's right to exercise her right to an abortion not with respect to the state interest that's asserted well your honor if if it's book he thought to balance the steet legitimate interest in regulating abortion with the woman's fundamental right with her heard liberty to access the procedure and it it concluded that the state couldn't impose unwarranted burdens so where the state had a good reason to impose a restriction and that restriction didn't impose burdens that were undue then the restriction could stand but where restriction is on reasonable or in the language of he seem medically unnecessary and it's going to impose burdens on access to abortion then then that restriction cannot be sustained under the fourteenth amendment i walked through the a moment there's two types of early abortions are at play here the medical abortion that doesn't involve any hospital procedure a doctor prescribes two pills and the women take the pills at home correct under texas law she must take them at the facility but but that is otherwise correct i'm sorry she has to come back two separate days to take them that's correct yes or so now from when she could take it home it's now she has to travel two hundred miles or pay for a hotel to get those two days of treatment that's correct around let me ask you something about that two day wait ok or that travel time how many other states and how many other recognized medical people have testified or shown that there is any benefit from taking pills at the facilit benefit to having a medication abortion at a multimillion dollar surgical facility the american medical association and every other mainstream leading medical association to consider these requirements as has concluded that they are not medically justified for a variety of reasons including that they impose these onerous burdens on medical abortion which is the earliest form of abortion and that these burdens are also and in imposed on early surgical abortions procedures prior to sixteen weeks and as a result women are going to be delayed later in pregnancy and there's evidence in the record that following implementation of the admitting privileges requirement in the six month period following there is an increase in both the number and the proportion of abortions being performed in the second trimester so by delaying women's access to abortion these requirements are actually of other conditions besides abortion is there any evidence in the record that shows that there's any medical difference in the two rec'd in the in the procedures that would necessitate an abortion being in an a c s or not are orphans more risky than the regular d n c no your honor the evidence in the record shows that the procedures are virtually identical particularly when c is performed to complete a spontaneous miscarriage so when a woman miscarries and then follows up with her doctor the doctor will typically perform a dean fee and that's that it's virtually identical to an abortion but they are not subject to the requirements of h b to you so your point that from taking is that the two main health reasons show that this law was targeted at abortion only the that's absolutely correct yes him so is there any other medical condition like taking the pills that are required to be done in hospital not as a prelude to a procedure in hospital but an independent  you know i know their cancer treatments by pills now how many of those are required to be done in front of the doctor none your honor there are no other medication requirements and no other  outpatient procedures that are required by law to be performed in any thank you counsel mr chief justice inmate please the court the effects of the texas law at issue in this case are much more extreme than those of any abortion law that this court has considered since casey this law closes most abortion facilities in the state puts extreme stress on the few facilities that remain open and exponentially increases the obstacles confronting women who seek abortions in the state and it does all of that on the basis of a medical justification that cannot withstand any meaningful scrutiny that the american medalists medical association has told you was groundless and that the district court found will actually operate in practice to increase health risks to women and not the is this true of every provision of the the a s c law no i don't think it is true about every provision in the regulations justice alito on the not the regulations and yes in the regulations every single provision then why was the whole thing held to be all constitutional so i agree with the premise of your honest question there are some parts of the regulation that i think operating alone wouldn't have the substantial logical fact in fact some parts of the regulation actually re state and we authorized regulations that were already on the compare the abortion the prior abortion clinic licensing laws against you you see requirements but there somewhere there's an increase in what's required it seems pretty reasonable under the under the the old law there had to be a nurse but not necessarily at a registered nurse under the new law there has to be a registered nurse who has a c p r certificate so you think that some reasonable to say that there has to be a registered nurse who knows how to do c p r so are i don't wan state an opinion one way or the other about that but i do want to but i think getting to the point of your honor's question i think the problem the district or confronted here and i think the reason the district court acted reasonably despite the presence of the severability clause of the subcommittee clause provides an instruction that  that every provision every clause every word every application every individual should be severed and the problem is a problem of the kind that the court noted i think in the i r case for a court trying to apply that the court's got to go in and decide which collection of the many many requirements there want to stand in which shouldn't and it's going to be in the store know how it's worked but maybe the district court should have done that work i mean i read through this and i was surprised i read through these regulations i was surprised by how many are completely innocuous and many of them have nothing to do they have to do with basic safety they don't even have anything to do particular with abortion so the entrances to the clinic have to be a grade level you have a rematch is appropriate for the for the remedy to be more carefully tailored in the way that the court did in the eye at case we think that would be appropriate but we do think that the basic point remains that this is a substantial obstacle and i would like to address two points that rose during petitioner's argument were first closures and then capacity with respect to closures here's what i think the record will show you taking the a s c requirement first the thirteen there's a stipulation j one during the period in which the law was and stayed there is evidence in the record with respect to the seven clinics that are operated by whole women's health that they that it was physically impossible to meet the a s c construction requirements because they couldn't fit on the real estate footprint that they had couldn't meet them there's expert testimony in the record from dr lane for our the economist that the cost of retrofitting these clinics to meet the requirements would be between one point six and two point three million dollars which would be prohibitive that the cost of building a new facility would be at least three point five million dollars which would be prohibitive and that the additional operating cost of an a s c would be between six hundred thousand a million dollars a year more so i think with respect to those there's ample evidence with respect to the with respect to the admitting privileges requirement we know that eleven of the twenty clinics that closed between the date when the law was enacted in the effective date of the meeting pillages requirement both on the date that that requirement became effective seems to me the only reasonable inference you can draw with respect to those eleven is that the law caused the closure with respect to the others i don't think there's evidence with respect to each one but with respect to several there is evidence that they in advance of the effective date because they were otherwise going to have to pay a licensing fee to stay open for another year which they knew they were not and they knew they weren't going to be able to open i didn't want to flush the money away so i think there's ample evidence in the record was that the causation i would expect that capacity i really think this is key because i do think this is the locus of the substantial obstacle problem here was a spectacle pasadena before this law took  look affect are approximately sixty five to seventy thousand abortions a year annually the a s e clinics that will be able to remain open a f c facilities will be able to remain open performed about fourteen thousand a year that's what the record tells you is dr gross expert testimony it's in the j a from pages two twenty five to two fifty nine about twenty percent twenty percent so they'd have to increase for five fold in a very short period of time with the against the backdrop of having to meet the problems that the admitting privileges requirement causes and i understand that the fifth circuit said that was if he dixit but with all due respect that's not binding on you and it's just wrong and if you look at the expert testimony that j pages identified you'll see that what dr grossman said first was something that is just common sense that these clinics aren't going to these facilities are going to be able to increase by four or five times and second he didn't just rely on common sense he looked at the period of time between when the meeting procedures requirement result in the closure of twenty clinics you look at that period of time and he studied the number of abortions that occurred at the remaining a s c facilities during that period of time and one would expect given that half the facilities and stay close that there be substantial did not resist her or would have had discretion   apologize just as kenny i haven't given that question thought and i'm loath to opine on that without without having to give thought but i do think i mean that district judges often think they can do anything right and but but i do think as i significant creases in the overall number of abortions particularly the parts of the state that were far away from the major cities and nor there is no home evidence there's no evidence of the actual capacity of these clinics and why was that not put in particularly since if we look at the we can see that it's very possible to put it in and some of the some of the numbers there are quite quite amazing that one doctor there performed three thousand abortions in a year so we don't really know what the capacity of these of these went down by four point four percent and there was an increased demand for abortions but there's no statistics showing that there actually was an increased demand for abortion in texas the grossman affidavit which i have a grant you it's going on the breeze but it said it table apa david page nine table two says that there could be the number of abortions that are on average a performed annually at the remaining clinics is two thousand so let's multiply by two and you get by three you get twenty four there were seventy thousand approximately women who needed these procedures so i take that is that accurate yes ok in the short time i have remaining i'd like to finish with one point if i could i think ultimately the question before you is whether the right here is going to retain real substance and where the balance whether the balance struck in casey still holds if that right still does retain real substance in this law cannot stand the burdens and imposes the obstacles are far beyond anything that this court is countenanced and the justification for it is far weaker than anything that this court has owner stand while you're arguing the opposite i think whether it's a obstacle or a burden would exist without regard to the strength of the state interest and the strength of the state interest it would seem to me is evaluated on whatever test there is with respect to that legislation and then you look at what the impact was i think it's actually in the interest of government to look at the way that we're suggesting it ought to be looked at in iraq and i you know at my church they committed to explain why and i think mr chief justice that is because you know it is one thing to say that you're going to impose a requirement that does work as much as to be the kind of obstacle that this requirement that these requirements do when you have a justification it's frankly flimsy american medical association told you it's grounds but if if the government were able to come in if it were us or if it were state we're able community we're actually this requirement is going to make a difference in saving hundreds of lives that might be a burden that you would think would be acceptable given the medical benefit that's why we think that this is the test that makes sense the best understanding i want to burden the understanding that when we were in the works best for the government is the one we're suggesting but i think whichever way you look at that when you look at it our way whether you look at it as two separate  inquiries this law each b two can't pass it for the reasons i said i think therefore that if you do find of this law is upheld what you will be saying is that this right really only exists in theory and not in fact going forward  that the commitments that this court made in casey will not have been kept thank you  abortion safety and planned parenthood provides this increased standard of care and has opened new a f c s abortion is legal and accessible in texas all the texas metropolitan areas that have abortion clinics today will have open clinics if the  obviously can't tell new mexico how to regulate the substantial obstacle inquiry exams whether there is the ability to make the ultimate decision reflect the procedure and when the clinics will hear the evidence and the records show that this particular clinic was one mile across the border that was still in the opacity metroplex and women in el paso often use that facility to obtain abortions so that would go into the can textual analysis of this particular as applied challenge this doesn't go to the facial challenge but as applied challenge and whether women in el paso do have access to abortion in any event over ninety percent of texas women of reproductive age lived within one hundred fifty miles of an open clinic as another day the the statistics that i gleaned from the record were that nine hundred thousand women live further than one hundred fifty miles from a provider seven hundred fifty thousand three quarters a million further than two hundred miles now that's as compared million live in more than two hundred miles away we're just taking first of all i believe the statistics at j two forty two which is their expert testimony would not account for macallan or a paso but in looking at the fraction of women affected and that would be the facial challenge standard that at a minimum a large fraction of cases there would have to be invalid even if there wasn't a burden the travel distance of even k c the district court found over forty percent of pennsylvania women were going to have to travel at least one hour sometimes over three hours and there was a twenty four hour waiting period texas reduces that waiting period to two hours travelling over one hundred miles in k c that was not official substantial obstacle here that relevant fraction is is lower in under casey than the facial challenge would not succeed and pitches yours have a heavy burden and they haven't shown any capacity evidence when there's a need meaning where each taking into account in the und burden analysis the value of the need being imposed meaning even if i grant you that in some circumstances the travel time is necessary sport what what's the need you you seeing your brief seem to be telling us that there's no role for the court to judge whether there is really a health benefits of what you're doing or there would be three elements of the doctrine there's rational basis test not talking about the doctrine i'm talking about the question i asked which is according to you the slightest health improvement isn't enough to impose on hundreds of thousands of women even assuming i accept your argument which i don't necessarily because it's being challenged but the slightest benefit isn't enough to burden the lives of a million women that's your  point what casey said is the substantial obstacle test examines access to abortion now if a law had no health benefits presumably it would be irrational but even their expert in this is a j two fifty six and two fifty eight acknowledged that some doctors different part of the bill that was in petitions first lawsuit and i have not raised any challenge that in this lawsuit in any event in sanaa i'm not talking about the prior author of i'm talking about this lawsuit you need to have access to a hospital within thirty miles thirty miles of what thirty miles of the surgical center when the woman lives at a much greater distance and he's going to go to any hospital it will be in her local benefit of having a woman take that was in an ambulatory surgical center when there was no surgery and there would be surgery and a complication all abortion clinics in texas perform surgical abortions and that's arises after the woman is back at home and then the nearest hospital has nothing to do with the surgical center although when the significant majority of women are living within fifty miles of the clinic in abortions as distinct from medical abortions and that that is within the state's authority to do because my reading indicated that medical abortions are a nationwide but down significantly in texas it would certainly be permissible to regulate both surgical and and drug induced abortions and in drug induced abortion since there are greater complications in the first lawsuit fifth circuit noted expert testimony there was a six percent rate when i saw an underlying theme or at least underline the factual demonstration is that this law has really increased the number of surgical procedures as opposed to medical procedures and that this may not be medically w challenged that particular part of the district court's holding that gave them as applied relief on the drug induced abortion part in the fifth circuit they haven't raised that what they're trying to do on the effects of song is say that the remaining clinics will ask a pacifist circuit correctly noted that actually performed more abortions and so the inference that they were at capacity cannot be drawn what evidence would you have put in on the capacity issue if you had been afforded that opportunity what evidence  statistically significant showing on the other side out capacity and also the circumstantial evidence about the timing of the closures while this is not in the record but in petitions first lawsuit k two their application to vacate the state in this court in the first lawsuit they have litigation they went clinic by clinic in a chart excuse me and they tried to estimate the number of abortions that could be performed in those facilities a district court did you make a fact finding there but the houston planned parenthood a s c they estimate it could perform nine thousand abortions annually nine thousand that's one hundred seventy five a week is what their charts before the before the well yes yes because the houston plan planned parenthood operates five of the nine seats planned parenthood it is not in this lawsuit they were in the first lawsuit they have complied with the law they have doctors are there many privileges and they have facilities in each of the five most populous texas cities and so if one e s c can perform nine thousand abortions annually and they're going to be at least eight other a a season texas plus the tenth facility of the caliphate still it obtained as applied relief it does not stretch credulity to believe that those remaining facilities would suffice to meet demand for what was not in this evidence and then the court said no we will not let you put in the evidence we didn't put in the evidence because petitioners bore the burden i think if you do ask to put in the sevens no thank you very much ok i'd like to go back to the question that justice ginsburg was asking which is about what is the benefit of this procedure there are two laws i'm focusing on the first the first law says that a doctor at the abortion clinic must have admitting privileges in a hospital thirty miles within that nearby right correct ok to know go back in time to the period before the new law was passed we are in the record will i find evidence of women who had complications who could not get to a hospital even though there was a working arrangement for admission but now they couldn't get to a hospital because the doctor himself asked to have admitting privileges which were the women on what page does it tell me their names what the complications w only one arguable example of such a thing and he's not certain that even that one is correct so what is the benefit to the woman of a procedure is going to cure a problem of which there is not one single instance in the nation though perhaps there is one but not in texas just as for the national abortion federation please previously recommended that women use abortion i didn't ask and i'm sure there are people who have all kinds of reasons that would like to have this and so forth and i'm not i'm just asking you where we have a judicial to say whether this is undue burden upon the woman who wants the abortion there are two parts is she burdened and what is the benefit and now on the first one i've asked you to give an single exam instance where there was a benefit and you say i think quite honestly there is no such court so let's turn to the second the second one according to the a mike is briefs here which i guess i could validate that even without the surgical center leave it out there are risks quite correct those risks are roughly the same as the risk that you have a dentist office when you have some surgery where you don't have an m d or a surgical center they are twenty eight times less than a risk of a colonoscopy or you don't have ambulatory surgical  this ambulatory surgical center when the risk is minuscule compared to common procedures that women run every day in other areas anything general i mean if the legislature says we have a health really related abortion regulation here we've looked around the country and we think that there are ten great hospitals in the country you know massachusetts general rhythm and women's and we're going to make all our abortion facilities conform to the standards of those obstacles and that will you know that will increase medical care now it's true we don't make anybody else doing any kind other kind of procedure conform to those standards and we think it will increase health and that's if abortion facilities conform to them would that be all right under this court's precedent abortion can be treated differently minimum disputed in here their experts have conceded that doctors believe this is precisely where there's a medical disagreement even if you don't accept our medical testimony although it was admitted into the record i'm sure that there's medical evidence that if every hospital if every facility was as good as massachusetts general they would be better facilities i'm sure that you could find doctors to say that because m p h it's a great hospital but that would be ok even though it's not applied to any other kind of facility doing any other kind of procedure increase the standard of care as high as it wants so long as there's not an undue burden on the women seeking abortions so you know if they could if they could increase the standard of care up to the very highest anywhere in the country and it wouldn't be a burden on the women well that would be a benefit to them with their be anything unconstitutional about that no provided that women do you are able to make the ultimate decision to elective procedure but doesn't that show th undue burden test is weighed against what the state's interest is just as committed are they are they are these two completely discreet and with equal categories undue burden we don't look at things interest what casey no it was at the under burton test is there a purpose or an effect of substantial obstacle to access and that's a question about access as to whether what the state's interest would be that would be going to a rational basis review or maybe a purpose based analysis but you need the clearest proof under the court's general doctrine about unconstitutional purpose to infer that there is an unconstitutional purpose when there is a legitimate interest in promoting patient health which is what texas did here even roe versus wade said th to childbirth many many months we see a procedure is that not well the american center for law and justice and former portion providers amica sprees dispute that but regardless there is evidence if there really why reporting is important is there's evidence in the record here that abortion complications are under reported that's a j eight forty four and eight seventy to seventy two in fact petition i'm holding myself under reported most of the complications you're talking about were reported at hospitals correct but yes there is some evidence of not reporting other things outside the hospital but you know the number of hostile hospitals are accurately reporting small and the statistic a j to sixty six is that it is lower than one percent however when there are two to three women they don't mean to negate that one should try to avoid injury to anyone and don't take my question is that but there are people who die from complications from mass maybe and the usual but this is certain percentage that do that yet we don't require that people take aspirin legislature have an invalid purpose and if you don't you think that you can read from the fact that there are so many other medical treatments whose complication rates are so disproportionately high and the legislature is only targeting abortion when there is nothing about the figures before it that show a risk question their purpose i don't question the purpose good thank you just read it but the what their purpose is that they're worried about these complications and they want to make life safer for the women are let's take that as the purpose you said there aren't very many complications now would you so if you reduce the number of clinics as has been argued it isn't exactly that  and you you suddenly have at least ten thousand maybe a few less and maybe a few more women who have to travel one hundred fifty miles to get their abortion maybe more maybe stay overnight maybe try to scrape together the money you understand the argument are there are going to be more women or fewer women who die of complications due to an effort to create an abortion i mean you read the briefs and you read the same articles i have and of course the argument is if you leap to self induced abortion you will find many more women dying so if the concern is this tiny risk of dying through a complication in a clinic is this a remedy that will in fact  legislature's health saving purpose just described about self induced abortion the evidence in the record on that were two points of testimony both from macallan where petitioners prevailed as applied challenges can be brought in areas for instance if there could be shown a substantial obstacle based on travel distance the four clinics the close in west texas between a pass and san antonio all those close before the meeting privileges requirements of the fact they were all planned parenthood facilities in petitioners reopen the lubbock facility though which is one of the facilities in west texas in petitions first lawsuit they told this court in their application and that clinic was going to close regardless of seven of the eight clinics that closed before the admitting privileges requirement effect and went from forty one to thirty three seven of those eight were planned parenthood clinics planned parenthood is complying with the law in providing that increase standard of care and also the eleven clinics that closed the day that the reading privileges requirements of a fact went from thirty three to twenty two i don't believe six of those clinics can be deemed to have ceased performing abortions because of that requirement the lubbock facility was going to close anyway there with the stipulation that is no parent is licensed abortion facility meets the am soon requirements each will be prohibited from performing abortions after the day the law goes into dallas to at fort worth one in austin is j one thirty one seven fifteen eleven eleven fourteen thirty six two of those were a c's now when it comes to the count of a ses there are nine a f c s performing abortion building it seems to me that they must have been plans for a while and if they were it was because there was a need independent of the number of abortions what other words is fortuitous that they've come into existence but it was in the their need was not there was independent of the reduced number of facilities elsewhere and legislature provided thirteen months to come into compliance in addition you could be spaced texas has over four hundred thirty there are four hundred thirty three generally a season texas at the time most of them don't choose to provide a portion that's correct of course space could be leased and so what you don't know is what do you have enough resources to open up in a s c if you're going to do abortion doctors had a check from that spot had asked for admitting privileges on the fifth circuit serenity only provided for one doctor dr lynn who's past retirement age to be the only doctor performing abortions in that clinic now if the clinic had why i don't know how many it had but it had at least four people for it seems rather callous to say as a remedy that we're going to make that one doctor do the work of four or maybe more doctors who can get admitting privileges why is even the fifth circuit's remedy reasonable because justice sotomayor that was the only name pla does it require a name plaintive to relieve that clinic of the obligation of going without admitting privileges well that was the only one of the four doctors to join this lawsuit because most of the doctors and clinics in but just lifted the requirement because you know that it's the only clinic in the area so if any doctor who's licensed appropriately can get that meeting privileges they should be permitted to work in that clin g you you said that as the law is now under your interpretation of it texas is allowed to set much much higher medical standards whether it has to do with personnel or procedures or the facilities  themselves higher medical standards including much higher medical standards for abortion facilities than for facilities the do any other kind of medical work even much more risky medical work and you said that that was your understanding of the law am i right of the question and i think you haven't challenge this assumption is that there are many procedures that are much higher risk colonoscopies lip assumptions we could go on and on and and you're saying that's ok we get to see much higher standards for abortion and i just want to know why that is justice kagan this bill was passed in the wake of the kermit gosnell scandal that prompted texas and many other states to re examine their abortion regulations of course the i mean actually have made abortion facilities such that that can never happen because you have continual inspections i mean to your credit so that was really not a problem in texas having a kind of rogue outfit there texas has taken actions to prevent that so again i just sort of i'm left wondering given this baseline of regulation that prevents rogue outfits like that why it is th texas would make this choice and you say you're allowed to make this choice and we can argue about that i just want to know why texas would make it i think the amica spree for the hundred twenty one texas legislators the canvas is the medical evidence of camus's statements confirms facilities which justice kagan just mention one of the amicus briefs cites instance after instance where our old woman's facilities have been cited for really appalling violations when they were inspected holes in the floor where or where rats could come in and the lack of any equipment to adequately store allies instruments is that not the case stories similar to that are also raised anyone from the state in sixteen years but texas can go into any one of these clinics and the mean immediately spots a violation that says you can't operate in some other species so texas had head as just taken point it up its own mechanism for preventing that kind of thing from happening texas did have existing regulations but increasing the standard of care is valid particularly not only in light of and only in that not this clinic has not been inspected for fifteen years has a doctor was fabricating his reports that could happen almost in any city anyone who intends to break the law is going to break the law or whatever of the regulatory rules are you going to have doctors as happens read our laws who were forming abortions without permission in their offices or without licenses and i don't want to suggest that we should presume that's going to happen but it will be the constitutional standard for whether the state can make abortion safe or can't be there can we prevent the gazan l situation well mary that raised the cell like situation in texas that made legislature so concerned after so many years about taking care of this greater risk in abortions as justice pryor just correct me twenty eight percent higher but legislatures react to topics that are of public concern indians all as the court noted that after dr haskell's procedure for partial birth abortion became more of an issue my concern states reacted when the legislature sees that there's a problem and maybe that there wouldn't rise to the same level of gaza no problem but the legislature can still act to make abortion safer which is precisely what texas that here if i can address applied challenge in paso and did not prevail in the clean clinic did not seek as applied relief indeed if there are any future concerns as applied challenges can be raised for instance the wide swath of area in west texas is does not have an abortion clinic today there was no as applied relief sought in this case and if there were it would turn out that there were going to be an issue in that area a future as applied challenge could address that concern that the problem once it could clinic close and you  later so and as applied challenge could allow a clinic if an undue burden if a substantial obstacle were shown because of driving distances or capacity in the future in that discrete instance but war in this facial challenge posture the tissues bear the heavy it certainly is a large use isaac actually isn't itself evidence if you have a law that says you can only be an a c s provider and who's going to come in and say i can't be an a c s provider but it's an undue burden on me an undue burden that self evident on the women in that area what the right is possessed by the women the clinics and doctors actually answering why don't we just take this lawsuit as those women saying just that because there was no one time along that more marginal if any medical benefit the upon i should this procedure anywhere where there's an undue burden on people on women planned parenthood and for clinics in west texas they all closed before any part of h b two was actually put into a fact they could have brought in as applied challenge they didn't planned parenthood did not join this lawsuit they were part of the first lawsuit and indeed the facial challenge this year barred by russia to cut in their significant record gaps ma means to travel that those women will have access to abortion anyway so that in texas so out of texas so casey was quite precise  it's talking about husbands and notification you don't look into all the women who are getting abortions you look only to the intent to the women for whom this is a problem and so the only women we would be looking at is not all the women who would who live in austin or in dallas but the women who have the problem who don't live near that isn't that a clear message of casey and the husband notification when a law is one of laws regulating women as it would in this present spousal notification provision that might be different but when we're talking about doctrine clinic regulations when the law is going to have a relevant effect is going to be for every doctor in every clinic which is precisely why the fifth circuit noted that that was the proper denominator all women of texas reproductive age and petitioners have not challenged that to nominate or holding in there oh but there is about what it's about is that a woman has a fundamental right to make this choice for herself that's what we start with the starting premise and then this is certainly about that's the case casey made that plain that the focus is on the woman and it has to be on the segment of women who are affected in the right held by women to make that ultimate decision is not burdened in a minimal large fraction of cases in texas one huge metropolitan area will still have a clinic even after the law goes into effect in future as applied to knowledge could address any possible concerns about west texas or otherwise thank you counsel thank you mr chief justice mr toady you have five minutes remaining thank you a few brief and that testimony is at j three thirty nine seven fifteen seven twenty two and seven thirty one respondent stipulated at j one eighty three and one eighty four that the is c requirement would cause any licensed abortion facilities still operating on the date took a fact to close plaintiff's exhibit twenty eight at peach two which is not in the joint appendix but was admitted in the record at twenty eight zero eight zero nine demonstrates that for the five years prior to the anatomy of each b two the number of abortion clinics in texas remained fairly constant in finally j eighteen twenty nine and fourteen thirty there is at two twenty nine testimony from dr gross page two thirty two he said i am not your offering any opinion on the cause of the decline in the number of abortion facilities that's correct dr grossman did not offer an opinion on that but his testimony supplies the fact which the district court threw the inference that levon clinics closed on the day that the the first enforce the admitting privileges requirement the district court referred from that back that in force meant was the cause of the closure and respondents offered no the and the admitting privileges had nothing to do with the closures in the western area of work so well that the two clinics in el paso which is in western regions of katz's that would be forced to close as a result of these requirements are not operated by planned parenthood planned parenthood doesn't have any clinics and in texas the plaintiff in this case and another independent provider operate those clinics i'm asked so that the clinics where there is direct evidence to the direct evidence show whether the cause was the admitting so with respect to whether abortion can be regulated differently than other medical procedures abortion can certainly be treated differently if there is a reason to treat it differently but texas may not impose unnecessary medical regulations that burden women's access to abortion in some marvelous the court found that the regulations of second trimester procedures at issue in that case were consistent with prevailing medical standards at the time and that was critical to the court's decision that is not the case here there is extensive testimony in the record that these requirements are not medically justified they are not consistent with prevailing medical standards and there are meekest briefs from leading medical associations including the a m a and confirming that do you think that that federal district judges or this court is well qualified to determine whether there's a competent to determine the credibility and the reliability of expert testimony that something that's within the core competence of a trial port and the trial court in this case determined that there was no credible or reliable evidence supporting texas's contentions about the medical justification for these laws and further had texas truly believe that these laws provided some important benefit for outpatient surgery it would have made them generally a political  outpatient surgical providers would have to have admitting privileges or practice in an a s c but that's not the keith texas law expressly authorizes other surgical procedures including those performed under general anesthesia which early abortion is not to be performed in the physician's office and even other physicians that operate at an a s c aren't required to have admitting privileges the facility is merely required to have a transfer agreement so these regulations