Title: The Unborn Child Amendment Comm. v. Ward

State: arkansas

Issuer: Arkansas Supreme Court

Document:

The UNBORN CHILD AMENDMENT COMMITTEE v. Dr.
Harry WARD

93-1149                                            ___ S.W.2d ___

                    Supreme Court of Arkansas
                  Opinion delivered May 5, 1997


1.   Constitutional law -- Ark. Const. amend. 68 must give way to Hyde
     Amendment to Title XIX of Social Security Act so long as Arkansas
     participates in Medicaid program. -- Whatever construction the
     supreme court gives to Amendment 68 to the Arkansas
     Constitution with regard to Medicaid patients in situations
     involving rape or incest, the amendment must give way to the
     Hyde Amendment to Title XIX so long as Arkansas participates
     in the Medicaid program and the current version of the Hyde
     Amendment remains in effect.

2.   Appeal & error -- supreme court reached merits of case as appeal from
     trial court's order and permanent injunction. -- Although the supreme
     court does not review the denial of a motion for summary
     judgment, it nonetheless reached the merits of appellant's
     case as an appeal from the trial court's order and permanent
     injunction.

3.   Constitutional law -- Ark. Const. amend 68, 2 -- mere expression of
     public policy -- did not prohibit injunction imposed by chancellor on UAMS.
     -- The supreme court reiterated its holding that Ark. Const.
     amend. 68,  2, was a mere expression of Arkansas's public
     policy and, not providing any means by which the policy was to
     be effectuated, could not be considered a self-executing
     provision; accordingly, the court declined to construe Section
     2 as prohibiting the injunction imposed by the chancellor on
     UAMS, which allowed a patient to pay in advance for an
     abortion procedure or to furnish guarantee of payment by a
     third-party provider.

4.   Constitutional law -- construction of provisions -- words given obvious and
     natural meaning. -- The fundamental rule in construing a
     constitutional provision is that the words of the constitution
     or statute should ordinarily be given their obvious and
     natural meaning; if the language used in a constitutional
     provision is plain and unambiguous, the supreme court should
     not seek other aides of interpretation in determining the
     intent of the framers and voters.

5.   Constitutional law -- Ark. Const. amend. 68,  1 -- proof required of
     violation of. -- For any entity to be in violation of Ark. Const.
     amend. 68,  1, the challenging party must provide the
     following proof: (1) that abortions were performed at the
     entity that were paid for with public funds; or (2) that the
     entity paid for, with public funds, abortions that were
     performed elsewhere.

6.   Constitutional law -- Ark. Const. amend 68,  1 -- does not prohibit use
     of public funds to pay for any activity that might further or advance
     performance of abortions -- "pay" defined. -- Amendment 68, section
     1, does not prohibit the use of public funds to pay for any
     activity that might further or advance the performance of
     abortions; instead, it prohibits the use of public funds to
     "pay for" abortions, except where necessary to save the life
     of the mother; the verb "pay" has been defined in part as
     "[t]o compensate for goods, services or labor" and "to make
     due return to for services rendered" or "to give in return for
     goods or service"; thus, the phrase "pay for" plainly
     implicates an exchange in return for services.

7.   Constitutional law -- Ark. Const. amend 68 -- use of public funds must go
     to pay for abortion for prohibition to apply -- use of things paid for by
     public funds not prohibited. -- Appellant's assertion that
     Amendment 68 generally prohibits the use of public buildings
     or the use of publicly paid employees to perform abortions
     ignored the plain language of the amendment; the use of public
     funds must go to "pay for" an abortion in order for the
     prohibition to apply; Amendment 68 does not prohibit the use
     of things paid for by public funds, but it does plainly
     prohibit payment for abortions with public funds.

8.   Constitutional law -- Ark. Const. amend. 68 -- does not prohibit
     performance of abortions at public facilities and by public employees --
     does not prohibit UAMS from performing abortions for patients who pay or
     secure payment from third-party provider. -- Giving the phrase "pay
     for" its plain and ordinary meaning, i.e., compensation for a
     service, the supreme court concluded that Amendment 68 did not
     erect a per se bar to abortions at UAMS other than those to
     save the life of the mother where patients pay for the cost in
     advance or furnish guarantee of payment by a third-party
     provider; if a patient or third-party provider paid for the
     cost of an abortion under the chancellor's order and permanent
     injunction, it could not be said that public funds were being
     used to pay for that abortion; there is no per se Amendment 68
     violation when such an abortion is performed in a public
     hospital or by a public employee; the supreme court affirmed
     the chancellor's ruling that Amendment 68 does not prohibit
     the performance of abortions at public facilities and by
     public employees and does not prohibit UAMS from performing
     abortions for patients who either pay for their abortions or
     secure payment from a third-party provider. 
9.   Appeal & error -- appellant's burden to prove that UAMS could not
     determine cost of abortion or that amount charged did not cover actual
     cost. -- Appellant, as the challenger in the case, had the
     burden of proving that UAMS could not determine the cost of an
     abortion or that the amount UAMS charged did not cover the
     actual cost of the procedure.

10.  Constitutional law -- Ark. Const. amend 68,  1 -- appellant failed to
     meet its burden -- trial court did not err in finding that direct and
     indirect costs of abortion could be reasonably calculated and in ordering
     UAMS to see that its charge covers calculated costs. -- Reciting
     evidence presented at trial, the supreme court held that
     appellant failed to meet its burden of proving that UAMS could
     not accurately determine the cost of an abortion; the weight
     of the evidence suggested that UAMS attempted to cover all of
     its direct and indirect costs in arriving at a charge for a
     procedure, both on the hospital and physician side of billing;
     it appeared that the charges billed by UAMS far exceeded costs
     because full-pay patients covered the costs of those patients
     who did not pay; to the extent that UAMS may not have included
     all of its direct and indirect costs in calculating its charge
     to a particular patient in the past, the supreme court
     directed that it must do so under the express terms of the
     trial court's order and injunction; the supreme court could
     not say that the trial court erred in finding that the direct
     and indirect costs of an abortion could be reasonably
     calculated and in ordering UAMS to take all steps reasonably
     necessary to ensure that its charge covers those calculated
     costs.      

11.  Appeal & error -- appellant failed to obtain ruling on violation of
     preliminary injunction in matter of unpaid charges -- supreme court
     declined to reverse. -- Where appellant failed to obtain a
     specific ruling from the trial court on whether UAMS had
     violated the preliminary injunction in the matter of unpaid
     charges, the supreme court, noting that the facts on the
     record before it were simply unknown, declined to reverse the
     chancellor's order and injunction on that ground.


     Appeal from Pulaski Chancery Court; Robin L. Mays, Chancellor;
affirmed.
     Rutherford Institute of Arkansas, Inc., by: Lavenski R. Smith
and David G. Nixon, for appellants.
     Fred Harrison, General Counsel, University of Arkansas, and
Winston Bryant, Att'y Gen., by:  Jeffrey A. Bell, Deputy Att'y
Gen., for appellees.

     Annabelle Clinton Imber, Justice.
     Amendment 68 to the Arkansas Constitution prohibits the use of
public funds to pay for abortions, except to save the mother's
life.  The appellants allege that the performance of abortions at
UAMS, other than for the purpose of saving the mother's life,
violates Amendment 68.  The chancery court enjoined UAMS from
performing abortions, other than those to save the mother's life,
unless the patient paid for the abortion in advance, or furnished
sufficient guarantee of payment by a third-party provider.  We
affirm.  
     In the 1988 general election, the Arkansas electorate adopted
Amendment 68 to the Arkansas Constitution by a vote of 398,107 for
and 368,117 against.  In its entirety, the amendment provides as
follows:
 1.  Public funding.
  
  No public funds will be used to pay for any abortion,
except to save the mother's life.

 2.  Public policy.

  The policy of Arkansas is to protect the life of every
unborn child from conception until birth, to the extent
permitted by the Federal Constitution.

 3.  Effect of amendment.

  This amendment will not affect contraceptives or
require an appropriation of public funds.

     On August 8, 1991, the Unborn Child Amendment Committee, Jerry
Cox, the Family Council, Larry Page, and the Christian Civic
Foundation filed a complaint in Pulaski County chancery court
seeking declaratory relief against the University of Arkansas for
Medical Sciences.  The Committee alleged that abortions were
performed at UAMS, some of which were not for the purpose of saving
the mother's life, in violation of Amendment 68.  The complaint
specifically alleged that these abortions were in violation of
Sections 1 and 2 of Amendment 68, and stated that such abortions
constituted an illegal exaction.  Among other things, the Committee
requested that the chancellor declare as "public funds" all funds
received or expended by UAMS, a declaration that all abortions
performed at UAMS necessarily involve the expenditure of "public
funds," and a declaration that all abortions performed at UAMS not
necessary to save the life of the mother were in violation of
Sections 1 and 2 of Amendment 68.  The Committee also sought
injunctive relief against UAMS prohibiting all abortions except
those to save the mother's life.  
     In July of 1991, the chancellor entered a preliminary
injunction that prohibited UAMS from performing abortions other
than those to save the mother's life, unless the patient paid in
advance for the cost of the abortion, or furnished sufficient
guarantee of payment by a third-party provider.  The case was
eventually consolidated with two substantially similar cases
against UAMS, brought by plaintiffs Ralph Forbes and Melissa
Knowlton.  Both the Committee and UAMS moved for summary judgment. 
After a hearing on the matter, the chancellor rendered her order on
June 30, 1993, which denied both motions for summary judgment, but
issued an order and permanent injunction that substantially
reflected the preliminary injunction.
     The chancellor found that funds appropriated to UAMS, as well
as revenues received from patients, were "public funds" as that
term was used in Amendment 68.  Accordingly, UAMS's use of funds
from full-paying patients to cover the cost of abortions for those
patients who did not pay in full was prohibited by the amendment. 
However, the chancellor ruled that the amendment did not prohibit
the performance of abortions at public facilities or by public
employees, nor did it prohibit UAMS from performing abortions for
patients who either paid for their abortions or who secured payment
from a third-party provider.  Accordingly, the chancellor enjoined
UAMS from performing abortions, other than those to save the life
of the mother, unless the patient paid for the cost of the abortion
in advance or sufficiently guaranteed payment by a third-party
provider.  UAMS was also directed to take all steps reasonably
necessary to ensure that all those paying for abortions do in fact
pay for the direct and indirect costs of the abortion procedure. 
To that end, the trial court ordered UAMS to maintain cost figures
based on all usual and customary calculations that would be made by
a prudent individual making such a cost assessment.  The trial
court also declined to hold that Article 68, section 2, was
anything more than a statement of public policy which was not a
self-executing provision.  On June 30, 1993, the Committee filed
its notice of appeal from this order and permanent injunction.
     Subsequently, a lawsuit was filed challenging Amendment 68 in
the United States District Court, Eastern District of Arkansas,
Little Rock Division, styled Little Rock Family Planning Servs.,
P.A. v. Dalton, No. LR-C-93-803.  At issue in that case was whether
Amendment 68 conflicted with the fiscal-year 1994 version of the
Hyde Amendment, The Department of Labor, Health & Human Services,
& Education, & Related Agencies Appropriations Act of 1994,  509,
Pub. L. No. 103-112, 107 Stat. 1082, 1113 (1993).  This version of
the Hyde Amendment amended Title XIX of the Social Security Act of
1965 (commonly referred to as the Medicaid program) to prohibit
federal reimbursements to participating states for an abortion
unless "such procedure is necessary to save the life of the mother
or that the pregnancy is the result of an act of rape or incest." 
Id.
     On July 25, 1994, the district court held that under the
Supremacy Clause, the Hyde Amendment preempted Amendment 68. 
Little Rock Family Planning Servs., P.A. v. Dalton,