Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca9-23-35518/USCOURTS-ca9-23-35518-0/pdf.json

Nature of Suit Code: 440
Nature of Suit: Other Civil Rights
Cause of Action: 

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FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

PLANNED PARENTHOOD GREAT 

NORTHWEST, HAWAII, ALASKA, 

INDIANA, KENTUCKY, On Behalf 

of Itself, Its Staff, Physicians and 

Patients; CAITLIN GUSTAFSON, On 

Behalf of Herself and Her Patients; 

DARIN WEYHRICH, On Behalf of 

Himself and His Patients, 

Plaintiffs-Appellees, 

 v. 

RAUL R. LABRADOR, In His 

Official Capacity as Attorney General 

of the State of Idaho, 

Defendant-Appellant, 

and 

MEMBERS OF THE IDAHO STATE 

BOARD OF MEDICINE; IDAHO 

STATE BOARD OF NURSING, In 

Their Official Capacities; COUNTY 

PROSECUTING ATTORNEYS, In 

Their Official Capacities; CODY 

BROWER, Oneida County Prosecutor; 

No. 23-35518

D.C. No.

1:23-cv-00142-

BLW 

OPINION

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2 PLANNED PARENTHOOD V. LABRADOR

STEVE STEPHENS, Butte County 

Prosecutor; JAN BENNETTS, Ada 

County Prosecutor; CHRIS BOYD, 

Adams County Prosecutor; ALEX 

GROSS, Boise County Prosecutor; 

ANDRAKAY PLUID, Boundary 

County Prosecutor; JIM THOMAS, 

Camas County Prosecutor; MCCORD 

LARSEN, Cassia County Prosecutor; 

E. CLAYNE TYLER, Clearwater 

County Prosecutor; TREVOR 

MISSELDINE, Gooding County 

Prosecutor; MARK TAYLOR, 

Jefferson County Prosecutor; ROB 

WOOD, Madison County Prosecutor; 

LANCE STEVENSON, Minidoka 

County Prosecutor; BENJAMIN 

ALLEN, Shoshone County Prosecutor; 

GRANT LOEBS, Twin Falls County 

Prosecutor; BRIAN NAUGLE, Valley 

County Prosecutor; LOUIS E. 

MARSHALL, Bonner County; 

RICHARD TALBOT ROATS; 

ADAM STRONG; BRYAN 

TAYLOR; ADAM MCKENZIE, Bear 

Lake County Prosecutor; S. DOUG 

WOOD, Caribou County Prosecutor; 

JUSTIN COLEMAN, Nez Perce 

County Prosecutor; PAUL WITHERS; 

JASON MACKRILL, Power County 

Prosecutor; JUSTIN OLESON; 

MARIAH DUNHAM, Benewah 

County Prosecutor; PAUL ROGERS, 

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PLANNED PARENTHOOD V. LABRADOR 3

Bingham County Prosecutor; SHONDI 

LOTT, Elmore County Prosecutor; 

LINDSEY BLAKE, Fremont County 

Prosecutor; BRAD CALBO, Jerome 

County Prosecutor; STANLEY 

MORTENSEN, Kootenai County 

Prosecutor; BILL THOMPSON, Latah 

County Prosecutor; BRUCE 

WITHERS, Lemhi County 

Prosecutors; ZACHARY PALL, 

Lewis County; CHRISTOPHER 

TOPMILLER, Owyhee County 

Prosecutor; MIKE DUKE, Payette 

County Prosecutor; DELTON 

WALKER, Washington County 

Prosecutor; STEPHEN F. HERZOG, 

Bannock County Prosecutor; RANDY 

NEAL, Bonneville County Prosecutor; 

KIRK ANGUS MACGREGOR, Idaho 

County Prosecutor; JANNA BIRCH, 

Clark County Prosecuting Attorney; 

MATT FREDBACK, Blaine County 

Prosecutor; VIC PEARSON, Franklin 

County Prosecutor; ERICK 

THOMSON, Gem County Prosecutor; 

BAILEY SMITH, Teton Valley 

Prosecutor, 

Defendants.

Appeal from the United States District Court

for the District of Idaho

B. Lynn Winmill, Chief District Judge, Presiding

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4 PLANNED PARENTHOOD V. LABRADOR

Argued and Submitted March 27, 2024 

Seattle, Washington

Filed December 4, 2024 

Before: Kim McLane Wardlaw, William A. Fletcher, and 

Eric D. Miller, Circuit Judges.

Opinion by Judge W. Fletcher; 

Partial Concurrence by Judge Miller

SUMMARY*

First Amendment/Abortion

The panel affirmed the district court’s order 

preliminarily enjoining on First Amendment grounds the 

Idaho Attorney General from enforcing his interpretation of 

a provision of Idaho’s criminal abortion statute, Idaho Code 

§ 18-622(1), as prohibiting medical providers from referring 

a patient across state lines to an abortion provider. 

Idaho Code § 18-622 criminalizes performing or 

attempting to perform an abortion as a felony punishable by 

two to five years in prison. Subparagraph 1 of § 18-622 

imposes professional licensing penalties on any health care 

professional who “assists in performing or attempting to 

perform an abortion.” Idaho Code § 18-622(1). In their 

lawsuit, Planned Parenthood and two physicians allege that 

* This summary constitutes no part of the opinion of the court. It has 

been prepared by court staff for the convenience of the reader.

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PLANNED PARENTHOOD V. LABRADOR 5

§ 18-622(1), as interpreted by the Attorney General in an 

opinion letter to a state legislator (“Opinion Letter”), 

violates, among other things, their right to free speech 

because it prevents medical providers in Idaho from 

providing patients with information about abortion services 

in other states. 

The panel first held that the physician plaintiffs, who 

prior to the Opinion Letter, had provided their patients with 

information or referrals to abortion providers outside of 

Idaho, had established Article III standing. The panel next 

held that the case was ripe and not moot despite the Attorney 

General’s subsequent withdrawal of the Opinion Letter as 

void on procedural grounds. The withdrawal did not 

disavow the Attorney General’s interpretation of § 18-

622(1), and the Attorney General remained free to enforce 

the interpretation. Finally, because the Attorney General 

was authorized to assist in the enforcement of §18-622(1), 

the Eleventh Amendment did not bar the suit, and he was 

properly named a defendant under Ex parte Young. 

Addressing the merits, the panel agreed with the district 

court that the plaintiffs established a likelihood of success on 

the merits of their First Amendment claim. The Attorney 

General’s interpretation of § 18-622(1) in the Opinion Letter 

was a content-based restriction on speech because it silences 

healthcare providers on the specific topic of abortion. The 

interpretation forbids the expression of a particular 

viewpoint—that abortion services in another state would 

likely help a patient. Because the physician plaintiffs made 

out a colorable First Amendment claim, they demonstrated 

that they likely would suffer irreparable harm absent an 

injunction. The panel affirmed the district court’s order 

granting the preliminary injunction and denied the Attorney 

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6 PLANNED PARENTHOOD V. LABRADOR

General’s request to assign this case to a different district 

judge. 

Concurring in part and concurring in the judgment, 

Judge Miller noted that in this preliminary injunction appeal, 

the Idaho Attorney General challenged only the jurisdiction 

of the district court and expressly disclaimed any challenge 

to the merits of the injunction. Judge Miller agreed with the 

majority that the Attorney General’s jurisdictional argument 

failed, but did not join the portion of the opinion in which 

the court went on to address the merits because the court 

should confine itself to the issues presented by the parties 

and refrain from opining on constitutional questions that 

have not been briefed and that are unnecessary to the 

resolution of this appeal. 

COUNSEL

Peter G. Neiman (argued), Alan E. Schoenfeld, Michelle N. 

Diamond, and Rachel E. Craft, Wilmer Cutler Pickering 

Hale and Dorr LLP, New York, New York; Katherine 

Mackey, Wilmer Cutler Pickering Hale and Dorr LLP, 

Boston, Massachusetts; Jennifer R. Sandman and Catherine 

P. Humphreville, Planned Parenthood Federation of 

America, New York, New York; Emily M. Croston and Paul 

C. Southwick, American Civil Liberties Union of Idaho 

Foundation, Boise, Idaho; Andrew D. Beck, Meagan 

Burrows, Scarlet Kim, and Ryan Mendias, American Civil 

Liberties Union Foundation, Washington, D.C.; Colleen R. 

Smith, Stris & Maher LLP, Washington, D.C.; for PlaintiffsAppellees.

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PLANNED PARENTHOOD V. LABRADOR 7 

Alan M. Hurst (argued) and Brian V. Church, Deputy 

Attorneys General; Lincoln D. Wilson, Chief, Civil 

Litigation and Constitutional Defense; Joshua N. Turner, 

Deputy Solicitor General; Theodore J. Wold, Solicitor 

General; Raul R. Labrador, Idaho Attorney General; Office 

of the Idaho Attorney General, Boise, Idaho; for DefendantAppellant. 

OPINION

W. FLETCHER, Circuit Judge: 

Idaho Code § 18-622 criminalizes performing or 

attempting to perform an abortion as a felony punishable by 

two to five years in prison. A subparagraph of § 18-622 

imposes professional licensing penalties on any health care 

professional who “assists in performing or attempting to 

perform an abortion.” Idaho Code § 18-622(1). 

In March 2023, Idaho Attorney General Raúl Labrador 

wrote a letter on his official stationery to a state legislator 

stating that he interpreted the word “assists” in § 18-622(1) 

as prohibiting medical providers from “refer[ring]” a patient 

“across state lines to an abortion provider.” Soon thereafter, 

the letter was published on the public website of a third-party 

organization. Planned Parenthood and two physicians sued, 

alleging that § 18-622(1) as interpreted by the Attorney 

General violated the First Amendment, the Due Process 

Clause of the Fourteenth Amendment, and the Commerce 

Clause. Based on the First Amendment, the district court 

preliminarily enjoined the Attorney General from enforcing 

§ 18-622(1) under the Attorney General’s interpretation as 

set forth in that letter. 

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8 PLANNED PARENTHOOD V. LABRADOR

On appeal, the Attorney General contends that plaintiffs 

have not suffered an injury sufficient for Article III standing 

and that their claims are simultaneously unripe and moot. 

The Attorney General also contends that he is not a proper 

defendant under the Eleventh Amendment. We disagree and 

affirm the district court’s grant of a preliminary injunction. 

We deny the Attorney General’s request for reassignment to 

a different district judge. 

I. Factual and Procedural Background

A. Idaho Code § 18-622

The Idaho legislature passed Idaho Code § 18-622 in 

2020. The statute went into effect shortly after the Supreme 

Court decided Dobbs v. Jackson Women’s Health 

Organization, 597 U.S. 215 (2022). 

With exceptions not relevant here, § 18-622 criminalizes 

performing or attempting to perform an abortion as a felony 

punishable by two to five years in prison. Section 18-622(1) 

imposes professional licensing penalties on “any health care 

professional who performs or attempts to perform an 

abortion or who assists in performing or attempting to 

perform an abortion in violation of this subsection.” Section 

18-622(1) mandates that the provider’s license be suspended 

for at least six months upon the first offense and permanently 

revoked upon the second.

B. The Opinion Letter

On March 27, 2023, Attorney General Labrador sent a 

letter to Idaho Representative Brent Crane (the “Opinion 

Letter”). Representative Crane had requested the Attorney 

General’s opinion on whether § 18-622 prohibits referral of 

women across state lines to obtain abortion services. In 

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PLANNED PARENTHOOD V. LABRADOR 9

response to Representative Crane’s request, the Attorney 

General wrote:

Idaho law prohibits an Idaho medical 

provider from either referring a woman 

across state lines to access abortion services 

or prescribing abortion pills for the woman to 

pick up across state lines. Idaho law requires 

the suspension of a health care professional’s 

license when he or she “assists in performing 

or attempting to perform an abortion.” Idaho 

Code § 18-622(2)1 (emphasis added). The 

plain meaning of assist is to give support or 

aid. An Idaho health care professional who 

refers a woman across state lines to an 

abortion provider or who prescribes abortion 

pills for the woman across state lines has 

given support or aid to the woman in 

performing or attempting to perform an 

abortion and has thus violated the statute. 

(emphasis in original). 

The Opinion Letter was signed by the Attorney General 

and printed on his official letterhead. In his brief to us, the 

Attorney General writes that the Opinion Letter was 

intended to be a communication only to Representative 

1 A prior version of Idaho Code § 18-622 was in effect when the Attorney 

General issued the Opinion Letter. The relevant language remains 

unchanged. However, the language that now appears in subparagraph 

622(1) of the statute was in subparagraph 622(2) at the time of the 

Opinion Letter. Compare Idaho Code § 18-622 (effective July 1, 2023) 

with Idaho Code § 18-622 (effective July 1, 2020). We will consistently 

refer to subparagraph 622(1) in our opinion. 

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10 PLANNED PARENTHOOD V. LABRADOR

Crane. However, the letter was soon published on the public 

website of a third-party organization. 

C. The Lawsuit

On April 5, 2023, after the Opinion Letter was made 

public, Planned Parenthood Great Northwest and two 

physicians, Dr. Caitlin Gustafson and Dr. Darin Weyhrich, 

(collectively, “plaintiffs”), sued the Attorney General, all 

Idaho county prosecutors, and individual members of the 

Idaho State Boards of Medicine and Nursing. Plaintiffs 

alleged that § 18-622(1), as interpreted by the Attorney 

General in the Opinion Letter, violated their First 

Amendment right to free speech because it prevented 

medical providers in Idaho from providing patients with 

information about abortion services in other states. Plaintiffs 

also alleged that the Attorney General’s interpretation of the 

statute violated the Due Process Clause and the Commerce 

Clause because it criminalized abortions performed outside 

of Idaho. They sought a temporary restraining order and a 

preliminary injunction to enjoin enforcement of § 18-622(1) 

as interpreted in the Opinion Letter.

The Attorney General and some of the county prosecutor 

defendants filed a motion to dismiss and an opposition to the 

plaintiffs’ motion for a preliminary injunction. They 

maintained that the case should be dismissed as nonjusticiable and as barred by the Eleventh Amendment. They 

did not defend the constitutionality of § 18-622(1) as 

interpreted in the Opinion Letter; nor did they address the 

merits of plaintiffs’ request for a preliminary injunction. 

D. Post-Filing Developments

On April 7, two days after plaintiffs filed suit, the 

Attorney General sent a second letter to Representative 

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PLANNED PARENTHOOD V. LABRADOR 11

Crane, withdrawing his Opinion Letter and characterizing it 

as void (the “Withdrawal Letter”). The Attorney General 

provided the Withdrawal Letter to the district court on the 

same day. The Attorney General wrote to Representative 

Crane in the Withdrawal Letter: 

On March 27, 2023, I provided you with a 

letter analysis of several questions prepared 

by my Associate Attorney General. Since 

then, the letter analysis has been 

mischaracterized as law enforcement 

guidance sent out publicly to local 

prosecutors and others. It was not a guidance 

document, nor was it ever published by the 

Office of the Attorney General. 

Due to subsequent events in the legislative 

process and my determination that your 

request was not one I was required to provide 

under Idaho law, that analysis is now void. 

Accordingly, I hereby withdraw it. 

The Withdrawal Letter characterized the Opinion Letter 

as void on the ground that Representative Crane’s request 

for an opinion was procedurally improper under Idaho Code 

§ 67-1401(6). The Withdrawal Letter declared that the 

Opinion Letter did not “represent the views of the Attorney 

General on any question of Idaho law,” but the Withdrawal 

Letter did not disavow or disclaim the legal reasoning or 

conclusions in the Opinion Letter. Nor did it offer an 

alternative interpretation of § 18-622(1).

On April 24, the district court held a hearing on the 

motion to dismiss and the motion for a preliminary 

injunction. The court asked counsel for the Attorney 

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12 PLANNED PARENTHOOD V. LABRADOR

General whether “there [was] still no disavowal of the legal 

analysis or conclusions drawn in [the Opinion Letter].” 

Counsel for the Attorney General answered, “[T]hat is . . . 

correct, but it’s not the right framing of the issue. And that’s 

because if there is no properly presented context for us to 

have an opinion on this issue, then we don’t have an opinion 

on this issue. Nothing has called on us to do so.” 

On April 27, the Attorney General issued Opinion No. 

23-1, an official opinion regarding the Attorney General’s 

statutory authority to enforce § 18-622. Opinion No. 23-1 

reviewed Idaho statutory authority and case law and 

concluded that “under Idaho law, the Attorney General has 

prosecutorial authority only if specifically conferred by the 

Legislature or if requested by county prosecutors and 

approved by a state district judge.” The opinion concluded 

that, because the Idaho legislature has not specifically 

authorized the Attorney General to prosecute violations of 

§ 18-622, the “Attorney General may not bring or assist in a 

prosecution under Idaho Code § 18-622 unless a county 

prosecutor specifically so requests and an appointment is 

made by the district court under Idaho Code § 31-2603.”

That same day, the Attorney General asked permission 

to file a supplemental brief to address the effect of Opinion 

No. 23-1 on the justiciability of plaintiffs’ claims. He also 

asked permission to submit supplemental briefing to address 

whether plaintiffs’ intended conduct of counselling and 

referring patients to out-of-state abortion providers was 

protected speech under the First Amendment. The district 

court denied both requests, writing that the Attorney General 

“could have issued the new opinion or made the protected 

speech argument on the original briefing schedule. Plaintiffs 

have waited several weeks for urgent relief—due in part to 

the Court’s calendar—and the Court will not impose further 

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PLANNED PARENTHOOD V. LABRADOR 13

delay for matters that could and should have been brought 

sooner.” 

E. The Preliminary Injunction

On July 31, the district court denied the motion to 

dismiss and granted plaintiffs’ motion to preliminarily 

enjoin the Attorney General from enforcing § 18-622(1) as 

interpreted in the Opinion Letter.2 The court held that the 

physician plaintiffs have Article III standing to bring a preenforcement First Amendment challenge, that the First 

Amendment claim was ripe and not moot, and that the 

Attorney General is subject to suit for prospective relief 

under Ex parte Young, 209 U.S. 123 (1908). The district 

court granted a preliminary injunction, holding that plaintiffs 

have shown a likelihood of success on the merits of their 

First Amendment claim and a likelihood of irreparable harm 

absent an injunction. The Attorney General timely appealed. 

II. Standard of Review

“We review the district court’s decision to grant or deny 

a preliminary injunction for abuse of discretion.” Sw. Voter 

Registration Educ. Project v. Shelley, 344 F.3d 914, 918 (9th 

Cir. 2003) (en banc) (per curiam). We review de novo the 

district court’s interpretation of underlying legal principles. 

Id. “[A] district court abuses its discretion when it makes an 

error of law.” Id. 

2 The district court declined to issue an injunction against the members 

of the Idaho State Boards of Medicine and Nursing because plaintiffs did 

not address standing for their claims against those defendants. The court 

deferred ruling on the county prosecutors’ jurisdictional objections. 

Accordingly, the members of the State Boards and the county 

prosecutors are not subject to the preliminary injunction and are not 

parties to this appeal. 

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14 PLANNED PARENTHOOD V. LABRADOR

III. Discussion

A. Justiciability

1. Article III Standing

The “irreducible constitutional minimum” of Article III 

standing has “three elements.” Lujan v. Defs. of Wildlife, 

504 U.S. 555, 560 (1992). Article III “requires a plaintiff to 

have [1] suffered an injury in fact, [2] caused by the 

defendant’s conduct, that [3] can be redressed by a favorable 

result.” Tingley v. Ferguson, 47 F.4th 1055, 1066 (9th Cir. 

2022) (citing Lujan, 504 U.S. at 560–61) (bracketed 

numbers added). Where, as here, plaintiffs bring a preenforcement challenge under the First Amendment, “‘unique 

standing considerations’ . . . ‘tilt dramatically toward a 

finding of standing.’” Id. at 1066–67 (quoting Lopez v. 

Candaele, 630 F.3d 775, 781 (9th Cir. 2010)). That is 

because “a chilling of the exercise of First Amendment 

rights is, itself, a constitutionally sufficient injury.” 

Libertarian Party of L.A. Cnty. v. Bowen, 709 F.3d 867, 870 

(9th Cir. 2013). 

On appeal, the Attorney General argues that the two 

physician plaintiffs have not established an Article III injury 

with respect to their First Amendment claims. Specifically, 

he argues the Opinion Letter does not convey “a credible 

threat of prosecution.” Susan B. Anthony List v. Driehaus, 

573 U.S. 149, 159 (2014) (quoting Babbitt v. United Farm 

Workers Nat’l Union, 442 U.S. 289, 298 (1979)); “Preenforcement injury is a special subset of injury-in-fact,” 

where “the injury is the anticipated enforcement of the 

challenged statute in the future.” Peace Ranch, LLC v. 

Bonta, 93 F.4th 482, 487 (9th Cir. 2024). However, “neither 

the mere existence of a proscriptive statute nor a generalized 

threat of prosecution” satisfies the injury requirement. 

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PLANNED PARENTHOOD V. LABRADOR 15

Thomas v. Anchorage Equal Rts. Comm’n, 220 F.3d 1134, 

1139 (9th Cir. 2000) (en banc). “Rather, there must be a 

‘genuine threat of imminent prosecution.’” Id. (quoting San 

Diego Cnty. Gun Rts. Comm’n v. Reno, 98 F.3d 1121, 1126 

(9th Cir. 1996)). 

In Thomas, our circuit articulated a three-prong 

framework for “evaluating the genuineness of a claimed 

threat of prosecution.” Id. 

The Supreme Court has articulated the framework for 

evaluating pre-enforcement injury in a slightly different 

way, “albeit incorporating part of the essence of the Ninth 

Circuit test.” Peace Ranch, 93 F.4th at 487. Under 

Driehaus, a plaintiff demonstrates injury-in-fact by showing 

“[1] an intention to engage in a course of conduct arguably 

affected with a constitutional interest, but [2] proscribed by 

a statute, and [3] there exists a credible threat of prosecution 

thereunder.” Driehaus, 573 U.S. at 159 (quoting Babbitt, 

442 U.S. at 298) (bracketed numbers added). 

Though our circuit “has toggled between” the Thomas 

and Driehaus formulations, we have “adopt[ed] the Supreme 

Court’s framework” in Driehaus. Peace Ranch, 93 F.4th at 

487 (adopting Driehaus and citing Arizona v. Yellen, 34 

F.4th 841, 849 (9th Cir. 2022) (applying Driehaus), and 

Clark v. City of Seattle, 899 F.3d 802, 813 (9th Cir. 2018) 

(applying Thomas)). The parties’ briefing and the district 

court’s order analyzed standing under Thomas. Shortly 

before oral argument, the parties filed Rule 28(j) letters that 

raised arguments under Driehaus in light of our decision in 

Peace Ranch.

The Attorney General does not challenge the Article III 

standing of Planned Parenthood in this appeal. If the 

physician plaintiffs have standing, we need not address the 

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16 PLANNED PARENTHOOD V. LABRADOR

standing of Planned Parenthood. “Where the legal issues on 

appeal are fairly raised by ‘one plaintiff [who] had standing 

to bring the suit, the court need not consider the standing of 

the other plaintiffs.’” Planned Parenthood of Idaho, Inc. v.

Wasden, 376 F.3d 908, 918 (9th Cir. 2004) (quoting Laub v. 

U.S. Dep’t of the Interior, 342 F.3d 1080, 1086 (9th Cir. 

2003)). We are satisfied that the physician plaintiffs have 

established injury sufficient for Article III standing under 

Driehaus. 

We address the three Driehaus criteria in turn. 

a. Intended Course of Conduct Affected with a 

Constitutional Interest

It is clear that plaintiffs have shown that they had an 

intended course of conduct affected with a constitutional 

interest. “[A] plaintiff need not plan to break the law” to 

show an “intention to engage in a course of conduct” under 

Driehaus. Peace Ranch, 93 F.4th at 488. Rather, we “must 

ask whether the plaintiff would have the intention to engage 

in the proscribed conduct, were it not proscribed.” Id.

The physician plaintiffs testified that prior to the 

Attorney General’s Opinion Letter they referred or planned 

to refer patients to out-of-state abortion services. They 

stopped providing such referrals after the Opinion Letter 

became public because they feared enforcement. See 

Tingley, 47 F.4th at 1068 (“[W]e do not require plaintiffs to 

specify ‘when, to whom, where, or under what 

circumstances’ they plan to violate the law when they have 

already violated the law in the past.”) (quoting Thomas, 220 

F.3d at 1139).

Dr. Gustafson stated in a sworn declaration that, after 

§ 18-622 went into effect but before the Opinion Letter 

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PLANNED PARENTHOOD V. LABRADOR 17

became public, she provided “options counseling” for 

pregnant patients. That counseling “involve[d] an openended conversation with the patient that would cover giving 

birth, adoption, and abortion.” If the patient were 

considering abortion, Dr. Gustafson provided details about 

different abortion options and explained that such services 

are unavailable in Idaho. She informed patients about 

“where abortion services remain legal and advise[d] them on 

their out-of-state options for abortion care.” She also

directed patients with medical complications to facilities that 

could provide appropriate care. For example, she told “a 

patient who was 20 weeks pregnant and with a medically 

complicated pregnancy that her best out-of-state option for 

abortion care was in Portland or Seattle, because many other 

hospitals and clinics cannot provide appropriate care for 

such patients.” 

Before the Opinion Letter became public, Dr. Gustafson 

also referred patients to abortion providers outside of Idaho. 

The referral process involved conversations with patients 

and with “out-of-state providers to help facilitate continuity 

of care and provide medically pertinent information to the 

receiving physician.” If, for example, a patient presented 

with a medical complication or a complex mental health or 

social history and needed abortion care, Dr. Gustafson 

contacted out-of-state abortion providers to communicate 

the patient’s medical history.

After the Opinion Letter became public, Dr. Gustafson 

stopped providing patients with information and 

recommendations about out-of-state abortion services 

because she feared her statements violated § 18-622(1) as 

interpreted by the Attorney General. She also stopped 

referring patients to abortion providers in other states. She 

explained in her declaration that the licensing penalties she 

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18 PLANNED PARENTHOOD V. LABRADOR

could face under § 18-622(1) would jeopardize her 

livelihood and ability to practice medicine. 

Dr. Weyhrich stated in a sworn declaration that, even 

after § 18-622 came into effect, he continued to treat patients 

who would choose to seek abortion care. For example, some 

of Dr. Weyhrich’s patients who were considering prenatal 

screening asked whether he could refer them to out-of-state 

abortion providers if the screening showed severe fetal 

anomalies. Although Dr. Weyhrich has not yet needed to 

make any such referrals, he explained that, before the 

Opinion Letter became public, he typically would have 

discussed the patients’ “options for abortion care in other 

states” and “recommend[ed] or refer[red] them to abortion 

providers in other states.” If necessary, he also would have 

called abortion providers in other states to facilitate 

continuity of care. After the Opinion Letter became public, 

Dr. Weyhrich decided he could no longer provide 

information or refer patients to abortion providers outside of 

Idaho due to the risk of serious licensing penalties. 

b. Conduct Arguably Proscribed by the Statute

It is equally clear that plaintiff’s intended conduct was 

arguably proscribed by the statute. The Attorney General’s 

Opinion Letter states that § 18-622(1) prohibits “referring” 

a patient “across state lines to access abortion services.”

That is precisely what the physician plaintiffs did or intended 

to do before the Opinion Letter was made public. 

c. Substantial Threat of Enforcement

Finally, plaintiffs have shown a substantial threat of 

enforcement. The ability to satisfy this prong “often rises or 

falls with the enforcing authority’s willingness to disavow 

enforcement.” Peace Ranch, 93 F.4th at 490. In Peace 

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PLANNED PARENTHOOD V. LABRADOR 19

Ranch, for example, the Attorney General had “stop[ped] 

short of stating its intention to enforce” the challenged law 

against the plaintiff, “and his briefing diligently avoid[ed] 

taking a stance.” Id. But there was no question that the 

challenged law targeted the plaintiff, and at oral argument 

the Attorney General’s counsel refused to “commit” to not 

enforcing the law against the plaintiff. Id. We held that the 

“clear targeting” of the plaintiff and the Attorney General’s 

failure to disavow enforcement were “enough to substantiate 

the threat and satisfy the final Driehaus prong.” Id. 

The same is true here. Far from a general warning of 

enforcement, the Opinion Letter singled out “Idaho health 

care professional[s]” who perform the specific act of 

“referring” patients to abortion providers “across state 

lines.” Both physician plaintiffs testified that they referred 

or intended to refer patients to abortion providers outside 

Idaho but have self-censored after the Opinion Letter 

became public. 

The Attorney General has refused to disavow his 

interpretation of § 18-622(1) contained in the Opinion 

Letter. See Tingley, 47 F.4th at 1068 (“We have, however, 

interpreted the government’s failure to disavow enforcement 

of the law as weighing in favor of standing.”); see also Cal. 

Trucking Ass’n v. Bonta, 996 F.3d 644, 653 (9th Cir. 2021) 

(“Here, the state’s refusal to disavow enforcement . . . is 

strong evidence that the state intends to enforce the law and 

that [plaintiffs] face a credible threat.”). And the Attorney 

General has not offered an alternative interpretation of the 

scope of § 18-622(1). 

The Attorney General argues there is no threat of 

enforcement based on the Opinion Letter because he lacks 

authority to enforce § 18-622(1) directly. Several county 

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20 PLANNED PARENTHOOD V. LABRADOR

prosecutors submitted declarations in opposition to the 

preliminary injunction motion stating that they do not view 

the Opinion Letter as “guidance or directive.” But it is 

important to note that a substantial number of county 

prosecutors did not submit such declarations. Further, we 

note that the Governor can direct the Attorney General to 

assist a prosecutor. Idaho Code § 67-802(7).

On the record before us, we conclude that there is a 

significant likelihood that a county prosecutor will enforce 

§ 18-622(1) and will rely on the Opinion Letter’s 

interpretation to support such enforcement. There is also 

some likelihood that a county prosecutor will request the 

Attorney General’s assistance in the enforcement, and some 

likelihood that the Governor will direct the Attorney General 

to assist a prosecutor. To the extent the Attorney General 

suggests causation is lacking, our precedent makes clear that 

the Attorney General’s authority to assist county prosecutors 

in the enforcement of penal statutes like § 18-622(1) 

“demonstrates the requisite causal connection for standing 

purposes.” See Wasden, 376 F.3d at 920. 

The Attorney General also argues that the Opinion Letter 

cannot be construed as a threat of enforcement because it 

was intended as a private communication. However, the 

Opinion Letter is no ordinary private communication. It was 

signed by the Attorney General in his official capacity, 

written on the Attorney General’s official letterhead, and 

delivered to an Idaho lawmaker in response to that 

lawmaker’s request for the Attorney General’s interpretation 

of the statute. As the district court noted, the Opinion Letter 

remains the Attorney General’s only public written 

interpretation of § 18-622(1). On this record, the physician 

plaintiffs reasonably viewed the Opinion Letter as 

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PLANNED PARENTHOOD V. LABRADOR 21

“communicat[ing] a specific warning or threat to initiate 

proceedings” against them. Thomas, 220 F.3d at 1139.

2. Ripeness

“The ripeness doctrine is ‘drawn from both Article III 

limitations on judicial power and from prudential reasons for 

refusing to exercise jurisdiction.’” Nat’l Park Hosp. Ass’n 

v. Dep’t of Interior, 538 U.S. 803, 808 (2003) (quoting Reno 

v. Cath. Soc. Servs, Inc., 509 U.S. 43, 57 n.18 (1993)). The 

doctrine is intended to prevent “premature adjudication” and 

judicial entanglement in “abstract disagreements.” Portman 

v. County of Santa Clara, 995 F.2d 898, 902 (9th Cir. 1993) 

(quoting Abbott Lab’ys v. Gardner, 387 U.S. 136, 148 

(1967), overruled on other grounds by Califano v. Sanders, 

430 U.S. 99 (1977)). Ripeness, like standing, is evaluated 

“less stringently in the context of First Amendment claims.” 

Twitter, Inc. v. Paxton, 56 F.4th 1170, 1173–74 (9th Cir. 

2022) (quoting Wolfson v. Brammer, 616 F.3d 1045, 1058 

(9th Cir. 2010). But ripeness, unlike standing, takes into 

account events that have occurred after the filing of the 

complaint. Blanchette v. Conn. Gen. Ins. Corps., 419 U.S. 

102, 140 (1974) (“[S]ince ripeness is peculiarly a question 

of timing, it is the situation now rather than the situation at 

the time of the District Court’s decision that must govern.”). 

a. Constitutional Ripeness

“For a suit to be ripe within the meaning of Article III, it 

must present ‘concrete legal issues, presented in actual cases, 

not abstractions.’” Colwell v. Dep’t of Health & Hum. 

Servs., 558 F.3d 1112, 1123 (9th Cir. 2009) (quoting United 

Pub. Workers v. Mitchell, 330 U.S. 75, 89 (1947)). In many 

cases, the constitutional component of ripeness “is 

synonymous with the injury-in-fact prong of the standing 

inquiry.” Twitter, 56 F.4th at 1173 (quoting Cal. Pro-Life 

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22 PLANNED PARENTHOOD V. LABRADOR

Council, Inc. v. Getman, 328 F.3d 1088, 1094 n.2 (9th Cir. 

2003)). But “[w]hile standing is primarily concerned with 

who is a proper party to litigate a particular matter, ripeness 

addresses when that litigation may occur.” Lee v. Oregon, 

107 F.3d 1382, 1387 (9th Cir. 1997).

The Attorney General argues this case is constitutionally 

unripe for the same reasons he contends the physician 

plaintiffs lack injury-in-fact. But as is apparent from our 

discussion above, the physician plaintiffs’ First Amendment 

claim is a concrete rather than abstract challenge to the 

Attorney General’s interpretation of § 18-622(1) in the 

Opinion Letter. The ripeness requirement of Article III is 

therefore satisfied.

b. Prudential Ripeness

Unlike Article III standing and ripeness, “[p]rudential 

considerations of ripeness are discretionary.” Thomas, 220 

F.3d at 1142. The Supreme Court has stated that the 

prudential ripeness doctrine is “in some tension” with “the 

principle that ‘a federal court’s obligation to hear and 

decide’ cases within its jurisdiction ‘is virtually 

unflagging.’” Driehaus, 573 U.S. at 167 (quoting Lexmark 

Int’l, Inc. v. Static Control Components, Inc., 572 U.S. 118, 

126 (2014)). However, we need not address this tension 

because both prongs of the prudential ripeness test—“the 

fitness of the issues for judicial decision and the hardship to 

the parties of withholding court consideration”—are easily 

satisfied here. Thomas, 220 F.3d at 1141 (quoting Abbott 

Lab’ys, 387 U.S. at 149). 

With regard to the fitness of the issues for judicial 

decision, “pure legal questions that require little factual 

development are more likely to be ripe.” San Diego County, 

98 F.3d at 1132. The Attorney General argues that plaintiffs’ 

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First Amendment claims are not ripe and are “riddled with 

contingencies and speculation that impede judicial review” 

because they depend on a county prosecutor relying on the 

interpretation of § 18-622(1) in the Opinion Letter, 

prosecuting one of the plaintiffs, and requesting the 

assistance of the Attorney General in the prosecution. We 

disagree with the Attorney General’s conclusion. The First 

Amendment claim is primarily legal. The Opinion Letter 

specifies the conduct that the physician plaintiffs reasonably 

fear prosecution for doing; and the declarations of Drs. 

Gustafson and Weyrich “provide enough of a specific factual 

context” because they describe in detail how the Opinion 

Letter has impaired their ability to treat patients. See 

Tingley, 47 F.4th at 1070. The Letter effectively compelled 

the physician plaintiffs to self-censor, and it had a “direct 

and immediate effect” on their ability to provide information 

and referrals to patients in need of abortion services. Id. 

(quoting Stormans, Inc. v. Selecky, 586 F.3d 1109, 1126 (9th 

Cir. 2009)). 

The hardship prong of prudential ripeness “dovetails, in 

part, with the constitutional consideration of injury.” 

Thomas, 220 F.3d at 1142. It “requires looking at whether 

the challenged law ‘requires an immediate and significant 

change in the plaintiffs’ conduct of their affairs with serious 

penalties attached to noncompliance.’” Tingley, 47 F.4th at 

1070–71 (quoting Stormans, Inc., 586 F.3d at 1126). Section 

18-622(1) requires exactly that. The physician plaintiffs 

described in detail how the publication of the Opinion Letter 

forced them to choose between “refraining from desired 

speech or engaging in that speech and risking costly 

sanctions.” Id. at 1071. As noted above, there are serious 

professional licensing penalties for noncompliance with 

§ 18-622(1). 

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24 PLANNED PARENTHOOD V. LABRADOR

The Attorney General also contends this case is 

prudentially unripe due to the issuance of the Withdrawal 

Letter, which characterized the Opinion Letter as void on 

procedural grounds. However, the Withdrawal Letter said 

nothing to disavow the Attorney General’s interpretation of 

§ 18-622(1), which is the source of the physician plaintiffs’ 

constitutional injury. 

3. Mootness

“A case becomes moot—and therefore no longer a 

‘Case’ or ‘Controversy’ for purposes of Article III—‘when 

the issues presented are no longer live or the parties lack a 

legally cognizable interest in the outcome.’” Already, LLC 

v. Nike, Inc., 568 U.S. 85, 91 (2013) (quoting Murphy v. 

Hunt, 455 U.S. 478, 481 (1982)) (some internal quotation 

marks omitted). In evaluating mootness, we may “look to 

changing circumstances that arise after the complaint is 

filed.” ACLU of Nev. v. Lomax, 471 F.3d 1010, 1016 (9th 

Cir. 2006) (quoting Clark v. City of Lakewood, 259 F.3d 996, 

1006 (9th Cir. 2001)).

“[A] defendant’s ‘voluntary cessation of a challenged 

practice’ will moot a case only if the defendant can show that 

the practice cannot ‘reasonably be expected to recur.’” 

F.B.I. v. Fikre, 601 U.S. 234, 241 (2024) (quoting Friends 

of the Earth, Inc. v. Laidlaw Env’t Servs. (TOC), Inc., 528 

U.S. 167, 189 (2000)). This is a “formidable burden.” Id. 

(quoting Friends of the Earth, 428 U.S. at 190). “Were the 

rule more forgiving, a defendant might suspend its 

challenged conduct after being sued, win dismissal, and later 

pick up where it left off.” Id. Accordingly, “[t]o show that 

a case is truly moot, a defendant must prove ‘no reasonable 

expectation’ remains that it will ‘return to [its] old ways.’” 

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Id. (some internal quotation marks omitted) (quoting United 

States v. W.T. Grant Co., 345 U.S. 629, 632–33 (1953)). 

The voluntary cessation rule “holds for governmental 

defendants no less than for private ones.” Id. The 

government is entitled to a presumption of good faith when 

it asserts mootness, but it “must still demonstrate that the 

change in its behavior is ‘entrenched’ or ‘permanent.’” 

Fikre v. F.B.I., 904 F.3d 1033, 1037 (9th Cir. 2018) (quoting 

McCormack v. Herzog, 788 F.3d 1017, 1025 (9th Cir. 

2015)). “[A] voluntary change in official stance or behavior 

moots an action only when it is ‘absolutely clear’ to the 

court, considering the ‘procedural safeguards’ insulating the 

new state of affairs from arbitrary reversal and the 

government’s rationale for its changed practice(s), that the 

activity complained of will not reoccur.” Id. at 1039 (first 

quoting McCormack, 788 F.3d at 1025, then quoting 

Rosebrock v. Mathis, 745 F.3d 963, 974 (9th Cir. 2014)). 

Thus, “an executive action that is not governed by any clear 

or codified procedure cannot moot a claim.” McCormack, 

788 F.3d at 1025; see also Rosebrock, 745 F.3d at 971 (“[A] 

policy change not reflected in statutory changes or even in 

changes in ordinances or regulations will not necessarily 

render a case moot.”). 

This case is not moot despite the Attorney General’s 

efforts to make it so. While plaintiffs’ motion for a 

preliminary injunction was pending, the Attorney General 

withdrew the Opinion Letter and characterized it as void 

solely on procedural grounds. He also repeatedly disclaimed 

any authority to enforce § 18-622(1) directly. But the 

Attorney General still has not repudiated his conclusion that 

§ 18-622(1) prohibits referring patients to out-of-state 

abortion providers. Nor has he provided an alternative 

interpretation of § 18-622(1) that would ease plaintiffs’ fears 

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of enforcement. The Withdrawal Letter, Opinion No. 23-1, 

and the Attorney General’s statements during the pendency 

of the litigation do not change the fact that absent an 

injunction the Attorney General remains “free to return to 

his old ways” and enforce § 18-622(1) as he interpreted it in 

his Opinion Letter. W.T. Grant Co., 345 U.S. at 632.

B. Eleventh Amendment

Absent abrogation, the Eleventh Amendment prohibits 

federal and state courts from entertaining suits against 

unconsenting states and their instrumentalities. However, 

suits seeking prospective relief under federal law may 

ordinarily proceed against state officials sued in their official 

capacities. See Ex parte Young, 209 U.S. 123 (1908); see 

also Mecinas v. Hobbs, 30 F.4th 890, 903–04 (9th Cir. 

2022). To be the proper subject of judicially ordered 

prospective relief, a state official must have “some 

connection with the enforcement” of the challenged act. Ex 

parte Young, 209 U.S. at 157. The connection requirement 

is “modest.” Mecinas, 30 F.4th at 904. It “demands merely 

that the implicated state official have a relevant role that goes 

beyond ‘a generalized duty to enforce state laws or general 

supervisory power over the persons responsible for 

enforcing the challenged provision.’” Id. at 903–04 (quoting

Wasden, 376 F.3d at 919). 

The Attorney General contends he is not a proper 

defendant under Ex parte Young because he does not have 

authority to enforce § 18-622(1) directly. Idaho law grants 

county prosecutors the “primary duty” to enforce the state’s 

penal statutes. Idaho Code § 31-2227; see also id. § 31-2604 

(listing the duties of county prosecutors). Absent a specific 

grant of authority by the Idaho legislature, the Attorney 

General has the duty to “assist” county prosecutors “in the 

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PLANNED PARENTHOOD V. LABRADOR 27

discharge of duties” “[w]hen required by the public service,” 

id. § 67-1401(7), or when ordered by the governor of Idaho, 

id. § 67-802(7).

Idaho law sets out at least three avenues through which 

the Attorney General may assist county prosecutors. First, a 

county prosecutor may move for the trial court to appoint the 

Attorney General as a special prosecutor with “all the 

powers of the prosecuting attorney.” Id. § 31-2603(a). 

Second, a county prosecutor may ask the trial court to 

appoint a special assistant Attorney General to prosecute or 

assist in prosecuting a criminal case. Id. § 31-2603(b). 

Third, the Governor may direct the Attorney General to 

assist a prosecutor. Id. § 67-802(7). The Idaho Supreme 

Court has held that when rendering assistance the Attorney 

General may “do every act that the county attorney can 

perform.” Newman v. Lance, 922 P.2d 395, 399 (Idaho 

1996) (per curiam). 

The Attorney General argues that his authority to assist 

in the enforcement of § 18-622 is insufficient to subject him 

to suit under Ex parte Young. The district court 

appropriately concluded that our decision in Wasden 

forecloses the Attorney General’s argument. See Wasden, 

376 F.3d at 919. The plaintiffs in Wasden sought to enjoin 

the Idaho Attorney General and the Ada County prosecutor 

from enforcing an Idaho statute that governed minors’ access 

to abortion services. The Attorney General argued he was

not a proper defendant under the Eleventh Amendment 

because he lacked authority to enforce the challenged statute 

directly because under Idaho law he could only assist county 

prosecutors in the discharge of their duties. We held that 

there was a sufficient enforcement connection to subject the 

Attorney General to suit because “unless the county 

prosecutor objects, ‘[t]he attorney general may, in his 

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assistance, do every act that the county attorney can 

perform.’” Wasden, 376 F.3d at 920 (quoting Newman, 922 

P.2d at 399) (emphasis in Wasden). “That is, the attorney 

general may in effect deputize himself (or be deputized by 

the governor) to stand in the role of a county prosecutor, and 

in that role exercise the same power to enforce the statute the 

prosecutor would have.” Id. We held “[t]hat power 

demonstrates the requisite causal connection” for standing 

and Ex parte Young purposes. Id. 

The same is true here. The Attorney General’s authority 

to assist in the enforcement of § 18-622(1) is essentially the 

same as the authority at issue in Wasden. Opinion No. 23-1, 

the official opinion the Attorney General issued after the 

preliminary injunction hearing, does not alter the analysis. 

Opinion No. 23-1 asserts that the analysis in Wasden “is 

immaterial” to the Attorney General’s authority to enforce 

penal laws. It also states that the Idaho Governor may not 

require the Attorney General to render assistance over the 

objections of a county prosecutor. However, Opinion No. 

23-1 ultimately concludes that the Attorney General has 

authority to enforce § 18-622 only “if specifically requested 

by a county prosecutor pursuant to an appointment made by 

a district court under Idaho Code § 31-2603.” That 

describes essentially the same assistance authority that 

Wasden held satisfied Ex parte Young. See Wasden, 376 

F.3d at 919–20.

The Attorney General’s attempts to distinguish Wasden 

on other grounds are unpersuasive. He points out that in 

Wasden there was no dispute that the Ada County prosecutor 

was “a proper defendant with regard to those provisions 

creating the potential for prosecution.” Id. at 919. Here, 

however, the district court has not yet determined whether it 

has jurisdiction over the county prosecutor defendants 

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PLANNED PARENTHOOD V. LABRADOR 29

because it deferred ruling on their jurisdictional objections.

Even if the district court were to conclude that it does not 

have jurisdiction over the county prosecutors (a question we 

do not reach), it unquestionably has jurisdiction over the 

Attorney General. 

The Attorney General also asserts there can be no 

enforcement connection for Ex parte Young purposes until 

there is a “live claim” against a county prosecutor and the 

prosecutor requests the assistance of the Attorney General in 

enforcing § 18-622(1). The Attorney General misreads 

Wasden. In Wasden, as in the case before us, the county 

prosecutor defendant had not initiated a prosecution against 

the plaintiff or requested the Attorney General’s assistance 

to enforce the challenged statute. 

The Attorney General is thus a properly named 

defendant under Ex parte Young. 

C. The Preliminary Injunction

Having determined that the physician plaintiffs’ First 

Amendment claim is justiciable and that the Eleventh 

Amendment poses no bar, we now turn to the preliminary 

injunction itself. 

The district court granted the preliminary injunction on 

the merits. In its briefing to us, Planned Parenthood did not 

argue this point, but it asked this Court to affirm on the 

merits, urging us to “affirm the order of the district court 

granting . . . preliminary injunctive relief.”

Despite ample opportunity to do so, the Attorney 

General has not contested in our court the merits of the 

preliminary injunction. On appeal, he has relied only on the 

jurisdictional challenges discussed above. We take the 

failure to object on the merits to the district court’s 

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30 PLANNED PARENTHOOD V. LABRADOR

preliminary injunction as a concession by the Attorney 

General that the district court was correct in granting the 

injunction. But we will not permit the Attorney General, 

through the tactic of failing to argue the merits of his appeal 

of the preliminary injunction, to avoid our addressing those 

merits in the course of affirming the district court. 

“A plaintiff seeking a preliminary injunction must 

establish that he is likely to succeed on the merits, that he is 

likely to suffer irreparable harm in the absence of 

preliminary relief, that the balance of equities tips in his 

favor, and that an injunction is in the public interest.” All. 

for the Wild Rockies v. Cottrell, 632 F.3d 1127, 1131 (9th 

Cir. 2011) (quoting Winter v. Nat. Res. Def. Council, Inc., 

555 U.S. 7, 20 (2008)). “A preliminary injunction is an 

extraordinary remedy never awarded as of right.” Id. 

(quoting Winter, 555 U.S. at 24). Alternatively, a 

preliminary injunction may issue where “serious questions 

going to the merits were raised and the balance of hardships 

tips sharply in plaintiff’s favor” if the plaintiff “also shows 

that there is a likelihood of irreparable injury and that the 

injunction is in the public interest.” Id. at 1135. This reflects 

our circuit’s “sliding scale” approach, in which “the 

elements of the preliminary injunction test are balanced, so 

that a stronger showing of one element may offset a weaker 

showing of another.” Id. at 1131. 

We agree with the district court that plaintiffs established 

a likelihood of success on their First Amendment claim. The 

professional medical speech at issue here is entitled to at 

least as much First Amendment protection as other speech. 

Nat’l Inst. of Fam. & Life Advocs. v. Becerra, 585 U.S. 755, 

767–68 (2018) (“Speech is not unprotected merely because 

it is uttered by ‘professionals.’”). The exception for 

“regulations of professional conduct that incidentally burden 

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PLANNED PARENTHOOD V. LABRADOR 31

speech” does not apply here. Id. at 769. Section 18-622(1), 

as interpreted by the Attorney General in the Opinion Letter, 

is not merely an incidental burden. It directly prohibits 

medical professionals from “referring” a patient “across 

state lines to access abortion services.” That is, it prohibits 

speech that is distinct from the actual provision of treatment. 

See Tingley, 47 F.4th at 1073 (listing the recommendation of 

treatment “from out-of-state providers” as an example of 

speech distinct from professional conduct). 

The Attorney General’s interpretation of § 18-622(1) in 

the Opinion Letter is a content-based restriction on speech 

because it silences healthcare providers on the specific topic 

of abortion. The interpretation forbids expression of a 

particular viewpoint—that abortion services in another state 

would likely help a patient. See Conant v. Walters, 309 F.3d 

629, 637 (9th Cir. 2002) (holding that a statute that imposed 

licensing penalties on physicians who recommended 

medical marijuana to patients was content- and viewpointdiscriminatory). 

Because the physician plaintiffs have made out “a 

colorable First Amendment Claim, they have demonstrated 

that they likely will suffer irreparable harm” absent an 

injunction, Am. Bev. Ass’n v. City & County of San 

Francisco, 916 F.3d 749, 758 (9th Cir. 2019) (en banc), and 

that the balance of equities and public interest tip “sharply” 

in their favor, Fellowship of Christian Athletes v. San Jose 

Unified Sch. Dist. Bd. of Educ., 82 F.4th 664, 695 (9th Cir. 

2023). We therefore affirm the district court’s order granting 

the preliminary injunction. 

D. Reassignment

The Attorney General has asked that we assign this case 

to a different district judge. “We reassign only in ‘rare and 

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32 PLANNED PARENTHOOD V. LABRADOR

extraordinary circumstances.’” Nat’l Council of La Raza v. 

Cegavske, 800 F.3d 1032, 1045 (9th Cir. 2015) (quoting 

Krechman v. Cnty. of Riverside, 723 F.3d 1104, 1112 (9th 

Cir. 2013)). We may reassign when the judge “‘has 

exhibited personal bias,’ or when ‘reassignment is advisable 

to maintain the appearance of justice.’” Id. (citations 

omitted) (quoting In re Ellis, 356 F.3d 1198, 1211 (9th Cir. 

2004) (en banc) and United States v. Kyle, 734 F.3d 956, 967 

(9th Cir. 2013)). The Attorney General has not come close 

to meeting that standard. 

No “reasonable outside observer” could conclude that 

the district judge harbors personal bias against the 

defendants or that reassignment is warranted to preserve the 

appearance of justice. See id. at 1046. The Attorney General 

charges that the district judge ignored relevant materials, 

mischaracterized the record, and unfairly denied 

supplemental briefing. This charge is patently false. The 

thorough preliminary injunction order shows that the district 

judge carefully considered the record, the Attorney

General’s arguments, and the parties’ timely filings. The 

compressed briefing schedule reflects the emergency nature 

of the relief plaintiffs requested. The decisions to deny 

supplemental briefing and reject untimely filings were well 

within the district judge’s broad discretion to manage his 

docket. 

Conclusion

We affirm the grant of a preliminary injunction and deny 

the request for reassignment. 

AFFIRMED. 

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PLANNED PARENTHOOD V. LABRADOR 33

MILLER, Circuit Judge, concurring in part and concurring 

in the judgment:

In this preliminary-injunction appeal, the Idaho Attorney 

General challenges the jurisdiction of the district court, but 

he expressly disclaims any challenge to the merits of the 

injunction. I agree that the Attorney General’s jurisdictional 

arguments fail, so I join most of the court’s opinion.

I do not join Section III.C, however, in which the court 

goes on to address the merits. In my view, we should confine 

ourselves to the issues presented by the parties and refrain 

from opining on constitutional questions that have not been 

briefed and that are unnecessary to the resolution of this 

appeal. See United States v. Sineneng-Smith, 590 U.S. 371 

(2020); Ashwander v. TVA, 297 U.S. 288, 347 (1936) 

(Brandeis, J., concurring).

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