Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_05-cv-00328/USCOURTS-cand-3_05-cv-00328-26/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 28:1331 Fed. Question

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United States District Court

For the Northern District of California

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

STATE OF CALIFORNIA, et al.

Plaintiffs,

 v.

UNITED STATES OF AMERICA, et al.

Defendants. /

No. C 05-00328 JSW

ORDER RE CROSS-MOTIONS

FOR SUMMARY JUDGMENT

Now before the Court is the motion for summary judgment filed by plaintiffs the State

of California (“California”), ex rel Bill Lockyer, in his official capacity as Attorney General of

the State and Jack O’Connell, in his official capacity as the State Superintendent of Public

Instruction (collectively, “Plaintiffs”), and the cross-motions for summary judgment filed by

defendants United States of America, United States Department of Labor, Elaine Chao, in her

official capacity as Secretary of Labor, United States Department of Health and Human

Services, Tommy G. Thompson, in his official capacity as Secretary of Department of Health

and Human Services, United States Department of Education, and Margaret Spellings, in her

official capacity as Secretary of Education (collectively, “Defendants”), defendant-intervenor

Alliance of Catholic Health Care (“Alliance”), and defendant-intervenors Christian Medical

Association, American Association of Pro-Life Obstetricians and Gynecologists, and

Fellowship of Christian Physician Assistants (collectively, “Medical Groups”). Having

carefully reviewed the parties’ papers, the brief filed by amicus curiae California Medical

Association and Planned Parenthood Affiliates of California, the relevant legal authority, and

having had the benefit of oral argument, the Court denies Plaintiffs’ motion for summary

Case 3:05-cv-00328-JSW Document 128 Filed 03/18/08 Page 1 of 9
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For the Northern District of California

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 The Court GRANTS the motions filed by the Alliance and Medical Groups for leave

to file statements of recent decisions.

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judgment and grants the cross-motions for summary judgment filed by Defendants, the

Alliance, and Medical Groups.1

BACKGROUND

Plaintiffs challenge the constitutionality of section 508(d) of the Departments of Labor,

Health and Human Services, and Education, and Related Agencies Appropriations Act, 2005

(the “Weldon Amendment”). Consolidated Appropriations Act, 2005, Pub. L. No. 108-447,

118 Stat. 2809, 3163. The Weldon Amendment prohibits any federal funds from being made

available to a state or local government “if such ... government subjects any institutional or

individual health care entity to discrimination on the basis that the health care entity does not

provide, pay for, provide coverage of, or refer for abortions.” Id. The Weldon Amendment was

reenacted in subsequent appropriations bills and remains in effect. Consolidated Appropriations

Act, 2008, Pub. L. No. 110-161, 121 Stat. 1844. 

California has a statutory scheme that requires health care facilities that provide

emergency services to provide medically necessary emergency abortions. Plaintiffs contend

that because the Weldon Amendment does not contain an explicit exception for situations in

which an emergency abortion is needed to protect the health or life of a woman, there is a

conflict between federal and state law, and that this conflict negatively impacts California’s

sovereign interests. Plaintiffs move for summary judgment as to whether the Weldon

Amendment violates the Spending Clause and a woman’s constitutional right of access to

abortions. (Plaintiffs’ Mot. at 1-2.) Defendants cross-move for summary judgment as to the

constitutionality of the Weldon Amendment, but also contend this action should be dismissed

for lack of standing and ripeness. (Defendants’ Mot. at 1-2.) The Alliance and Medical Groups

similarly move for summary judgment on the issues of standing and ripeness and the

constitutionality of the Weldon Amendment, in addition to other issues. The Court shall

address additional facts as necessary to its analysis in the remainder of this Order.

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Although the Court recognizes the importance of the issues before it, and the serious

potential consequences if a woman were to be denied necessary medical services in an

emergency, as currently presented the Court cannot reach the merits of this matter.

ANALYSIS

A. Legal Standards Applicable to Standing and Ripeness.

Federal courts’ jurisdiction “is circumscribed by the ‘case or controversy’ requirement

of Article III standing and by prudential considerations, such as ripeness.” Scott v. Pasadena

Unified Schl. Dist., 306 F.3d 646, 654 (9th Cir. 2002). “Article III of the Constitution requires

that a plaintiff have standing before a case may be adjudicated.” Covington v. Idaho, 358 F.3d

626, 637 (9th Cir. 2004). To satisfy the Constitution’s standing requirements, a plaintiff must

show (1) an “injury in fact” that is (a) concrete and particularized and (b) actual or imminent,

not conjectural or hypothetical; (2) the injury must be fairly traceable to the challenged action

of the defendant; and (3) it must be likely, as opposed to merely speculative, that the injury will

be redressed by a favorable decision. Lujan v. Defenders of Wildlife, 504 U.S. 555, 560-61

(1992); see also Covington v. Jefferson County, 358 F.3d 626, 637-38 (9th Cir. 2004). A

plaintiff, as the party invoking federal jurisdiction, bears the burden of establishing these

elements. Lujan, 504 U.S. at 561. Although, “[a]t the pleading stage, general factual

allegations of injury resulting from the defendant’s conduct may suffice” to demonstrate

standing, “[i]n response to a summary judgment motion, ... the plaintiff can no longer rest on

such mere allegations, but must set forth by affidavit or other evidence specific facts... .” Id.

(internal cite and quotations omitted). While the Supreme Court has “always insisted on strict

compliance with this jurisdictional standing requirement,” the standing inquiry must be

“especially rigorous when reaching the merits of the dispute would force [a court] to decide

whether [a statute is] unconstitutional.” Raines v. Byrd, 521 U.S. 811, 819-820 (1997).

The “ripeness doctrine is drawn both from Article III limitations on judicial power and

from prudential reasons for refusing to exercise jurisdiction.” Reno v. Catholic Soc. Servs., Inc.,

509 U.S. 43, 57 n.18 (1993). As a prudential matter, a claim is not ripe for judicial resolution

“if it rests upon contingent future events that may not occur as anticipated, or indeed may not

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occur at all.” Texas v. United States, 523 U.S. 296, 300 (1998) (internal quotes and citation

omitted). “The basic rationale of the ripeness doctrine is to prevent courts, through avoidance

of premature adjudication, from entangling themselves in abstract disagreements.” Scott, 306

F.3d at 662 (internal quotes and citation omitted). As with standing, “[t]he prudential

considerations of ripeness are amplified where constitutional issues are concerned.” Id. To

determine when a claim is ripe, courts consider “both the fitness of the issues for judicial

decision and the hardship to the parties of withholding court consideration.” Id. (quoting Abbott

Labs. v. Gardner, 387 U.S. 136, 149 (1967)).

B. Plaintiffs Fail to Demonstrate An Injury In Fact.

The parties contest whether Plaintiffs have sufficiently shown an injury in fact to

demonstrate standing. Defendants argue that Plaintiffs will not suffer an injury until a woman

needs but is refused a medically necessary emergency abortion, California then attempts to

enforce its law requiring the provision of such services, and the federal government denies

California federal funds as a result. Thus, according to Defendants, this action is merely a “preenforcement” action and any injury is too remote at this time for standing purposes. Plaintiffs

counter that their unique position as a state with sovereign interests distinguishes this case from

those relied on by Defendants in which private citizens or entities challenged statutes as

unconstitutional. 

The Supreme Court has recognized that a state has standing to sue when it alleges an

interest in preserving its sovereignty and its sovereign interests have been interfered with or

diminished. See Bowen v. Public Agencies Opposed to Social Sec. Entrapment, 477 U.S. 41, 51

n.17 (1986) (affirming district court’s finding that state had standing based on alleged

diminishment of its sovereignty). A state’s sovereign interest includes the power to create and

enforce a legal code. Alfred L. Snapp & Son, Inc. v. Puerto Rico, ex rel. Barez, 458 U.S. 592,

601 (1982). Courts have held that states have standing when they assert an injury to their

sovereign interests in the continued enforceability of their own statutes. Alaska v. U.S.

Department of Transportation, 868 F.2d 441, 443 (D.C. Cir. 1989); see also Oregon v.

Ashcroft, 192 F. Supp. 2d 1077, 1087 (D. Or. 2002), aff’d on other grounds, 368 F.3d 1118 (9th

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Cir. 2004), aff’d on merits, Gonzalez v. Oregon, 546 U.S. 243 (2006). However, Plaintiffs have

not demonstrated that their ability to enforce their own statutes has been interfered with or

diminished.

In Alaska, the Department of Transportation (“DOT”) issued orders regarding the

regulation of unfair and deceptive advertising under the Federal Aviation Act and exempting

international and domestically imposed surcharges. The National Association of Attorneys

General adopted guidelines providing that separate advertising of air travel surcharges was

deceptive under various states’ consumer protection laws, and several states informed airlines

that they intended to enforce these laws. In response, the DOT warned the states that the

federal government preempted this aspect of state advertising regulation and that if the states

attempted to enforce them, the DOT would consider taking formal legal action. Alaska, 868

F.2d at 442-43. The state plaintiffs alleged that, based DOT’s assertion of preemption, the

states suffered an injury to their sovereign power to enforce state law. Id. at 443. The court

concluded that the state’s sovereign interest in law enforcement was sufficient to support

standing. Id. at 443.

In Oregon, there was a conflict between the Oregon Death with Dignity Act and a

directive issued by the then Attorney General, John Ashcroft (the “Ashcroft Directive”). The

Oregon Death with Dignity Act provided a detailed procedure by which a mentally competent,

terminally ill patient could make a written request for medication to end his or her life. 

Physicians and pharmacists were immune from civil and criminal liability, or from any adverse

disciplinary action for prescribing medication under the Oregon Act. Oregon, 192 F. Supp. 2d

at 1081-82. The Ashcroft Directive declared that controlled substances could not be dispensed

to assist suicide, that prescribing or administering federal controlled substances to assist suicide

violated the Controlled Substances Act, and that physicians who prescribed or administered

federally controlled substances were subject to suspension or revocation of their registration. 

Id. at 1079. Moreover, the Attorney General directed the Drug Enforcement Agency to enforce

and apply the Ashcroft Directive. Id. at 1083. Thus, court found that the Ashcroft Directive

essentially nullified the Oregon Act. Id. at 1079. The court concluded that Oregon met the

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constitutional requirements for standing by alleging a sufficient injury to its sovereignty and

legitimate interest in the continued enforceability of its own statutes. Id. at 1087.

In both Alaska and Oregon, there was a clear conflict between state and federal law and

an express statement from a federal official or agency affirmatively finding such a conflict. In

contrast here, is it not evident that federal and state law conflicts. The Weldon Amendment

prohibits any federal funds from being made available to a state or local government “if such ...

government subjects any institutional or individual health care entity to discrimination on the

basis that the health care entity does not provide, pay for, provide coverage of, or refer for

abortions.” Title V, § 508(d) of Division G, 121 Stat. 2209. The Emergency Medical

Treatment and Active Labor Act (“EMTALA”) requires hospitals that have a medicare provider

agreement and an emergency room or department to provide to anyone requesting treatment an

appropriate medical screening to determine whether an emergency medical condition exists, and

to stabilize the condition or, if medically warranted, to transfer the person to another facility. 

See 42 U.S.C. § 1395dd(a)-(c). Analogous to the EMTALA, California Health and Safety Code

§ 1317 (“Section 1317”) requires that: “Emergency services and care shall be provided to any

person requesting the services or care, or for whom services or care is requested, for any

condition in which the person is in danger of loss of life, or serious injury or illness, at any

health facility licensed under this chapter that maintains and operates an emergency department

to provide emergency services to the public when the health facility has appropriate facilities

and qualified personnel to provide the services or care.” Cal. Health & Safety Code § 1317(a);

see Brooker v. Desert Hosp. Corp., 947 F.2d 412, 415 (9th Cir. 1991) (describing Section 1317

as “California’s version of [the EMTALA]”). California Health and Safety Code § 123420

exempts medical personnel and facilities from participating in performing abortions if they

object to abortions on moral, ethical, or religious grounds, except in medical emergency

situations and spontaneous abortions. Cal. Health & Safety Code § 123420. 

There is no clear indication, either from the express language of the Weldon

Amendment or from a federal official or agency, that enforcing Section 1317 or the EMTALA

to require medical treatment for emergency medical conditions would be considered

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“discrimination” under the Weldon Amendment if the required medical treatment was abortionrelated services. 

In fact, the Weldon Amendment is completely silent on this issue. The Alliance argues that the

Weldon Amendment must be read in light of the EMTALA, which requires hospitals to provide

medical services to stabilize an emergency medical condition or, if medically warranted, to

transfer the patient to another facility. See 42 U.S.C. § 1395dd. The Ninth Circuit has made

clear that “to the extent that statutes can be harmonized, they should be” and that “Congress

must be presumed to have known of its former legislation and to have passed new laws in view

of the provisions of the legislation already enacted.” United States v. Trident Seafoods Corp.,

92 F.3d 855, 862 (9th Cir. 1996). In light of this standard, it is far from clear whether the

Weldon Amendment would prohibit California from enforcing its own version of the EMTALA

in medical emergencies.

Moreover, the facts currently before the Court undermine Plaintiffs’ position that the

Weldon Amendment infringes upon the State’s ability to enforce Section 1317. In September

2005, and then again in February 2006 by the same complainant, the State received complaints

that a pregnant woman needing emergency abortion-related services was denied such services at

a California hospital emergency room. (Declaration of James J. Gilligan, ¶¶ 3, 4.) On May 2,

2006, the California Attorney General’s Office referred these complaints to the California

Department of Health Services to conduct an investigation of the allegations. (Declaration of

Brenda Klutz, ¶¶ 3, 4.) Based on its findings from the investigation, California determined that

the incident did not constitute a “denial of emergency services” within the meaning of Section

1317. (Declaration of Stephen R. McCutcheon, Ex. 1.) The evidence before the Court indicates

that California fully investigated these complaints, but determined that no violation had

occurred. Thus, it does not appear that California refrained from taking action out of concern

that it risked losing billions of dollars in federal funding. It is not clear what the State would

have done, or how the federal government would have reacted, if the State had determined

Section 1317 was violated and sought to enforce this statute. 

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In the absence of express statutory language or an express statement from a federal

official or agency indicating a present conflict between state and federal law, the Court finds

that Plaintiffs have not met their burden to demonstrate an injury in fact to their sovereign

interest.

C. Plaintiffs’ Claims Are Not Ripe.

Even if the Court could find that Plaintiffs had sufficiently demonstrated standing, the

Court finds that their claims should be dismissed based on the prudential considerations of the

ripeness doctrine. To determine when a claim is ripe, courts consider “both the fitness of the

issues for judicial decision and the hardship to the parties of withholding court consideration.”

Scott, 306 F.3d at 662 (internal quotes and citation omitted). The Court finds that Plaintiffs’

claims are not fit for judicial review because whether California will risk losing federal funds

pursuant to the Weldon Amendment if it seeks to enforce Section 1317 is contingent upon a

series of future events that may not ever occur. See Texas, 523 U.S. at 300 (“A claim is not ripe

for judicial resolution if it rests upon contingent future events that may not occur as anticipated,

or indeed may not occur at all.”) (internal quotes and citation omitted). Here, Plaintiffs’ claims

will not be ripe until a woman needs but is refused emergency abortion-related services,

California then attempts to enforce its law requiring the provision of such services, and the

federal government denies or threatens to deny California federal funds as a result. Notably,

Plaintiffs could not identify any violations of Section 1317 in the twenty years since the statute

was enacted. (Declaration of Elbert Lin, ¶ 2, Ex. A.) 

 Moreover, the Court finds that Plaintiffs will not be harmed by the Court refraining

from adjudicating this matter at this time. To the extent a violation of Section 1317 does occur

in the future, as the evidence before the Court demonstrates, Plaintiffs are not powerless to take

action. As California has already done after the Weldon Amendment was enacted, California

could investigate any complaints that Section 1317 was violated. If California determines that a

violation did occur, it could then seek a determination from the federal government as to

whether taking enforcement action pursuant to Section 1317 would be considered

“discrimination” under the Weldon Amendment. If the federal government answers in the

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affirmative, or refuses to provide an answer, thus leaving California in a difficult position of

putting at risk billions of dollars in federal funds if it enforces its own statute, the case then

would be ripe for a court to determine this matter. At that point, the record would be fully

developed. However, until then, and because it is not clear that such an unfortunate situation

would ever occur, this matter is not yet ripe.

CONCLUSION

For the foregoing reasons, Plaintiffs’ motion for summary judgment is DENIED and the

cross-motions for summary judgment filed by Defendants, the Alliance and Medical Groups are

GRANTED.

IT IS SO ORDERED.

Dated: March 18, 2008 

JEFFREY S. WHITE

UNITED STATES DISTRICT JUDGE

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