Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_09-cv-01909/USCOURTS-azd-2_09-cv-01909-1/pdf.json

Nature of Suit Code: 950
Nature of Suit: Constitutionality of State Statutes
Cause of Action: 42:1983 Civil Rights Act

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Tucson Women’s Center; Family

Planning Associates; William

Richardson, M.D.; Paul A. Isaacson,

M.D.; and Frank Laudonio, M.D., 

Plaintiffs, 

vs.

Arizona Medical Board; Lisa Wynn, in

her official capacity as Executive

Director of the Arizona Medical Board;

and Terry Goddard, in his official

capacity as Attorney General of Arizona, 

Defendants. 

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No. CV-09-1909-PHX-DGC

ORDER CERTIFYING QUESTION TO

THE ARIZONA SUPREME COURT

Arizona House Bill 2564 (“the Act”) amends Arizona law relating to abortions. The

Act was passed by the Arizona Legislature and signed by the Governor in July 2009, and

becomes effective today. Among other things, the Act adds A.R.S. § 36-2153.

Section 36-2153(A) prohibits, except in the case of a medical emergency, the

performance of an abortion unless, at least 24 hours before the abortion, the patient gives

consent after having received certain statutorily-prescribed information. Section 36-2153(D)

then provides:

A person shall not write or communicate a prescription for a drug or drugs to

induce an abortion or require or obtain payment for a service provided to a

patient who has inquired about an abortion or scheduled an abortion until the

expiration of the twenty-four hour reflection period required by subsection A.

A.R.S. § 36-2153(D).

Case 2:09-cv-01909-DGC Document 71 Filed 09/30/09 Page 1 of 26
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Plaintiffs challenge the payment provision of section 36-2153(D) as unconstitutionally

vague. Dkt. #1 ¶¶ 70-76, 81-82. No Arizona appellate court has interpreted section

36-2153(D). The meaning of that provision presents a question of state law that may be

determinative of a claim in this action. Pursuant to A.R.S. § 12-1861 and Rule 27 of the

Rules of the Arizona Supreme Court, the Court certifies the following question to the

Arizona Supreme Court:

Whether the payment provision of A.R.S. § 36-2153(D) applies only when the

informed consent and 24-hour waiting period of A.R.S. § 36-2153(A) is

triggered by the actual providing or inducing of an abortion, or whether it

applies outside the abortion context whenever an inquiry about abortion is

made to a health care provider.

Because the certified question is one of law, the Court will not provide a statement of

facts. See Ariz. R. Sup. Ct. 27(3)(B). The Court addressed the interpretation of A.R.S. § 36-

2153(D) in an order dated September 29, 2009, a copy of which is attached to this order. The

following is a list of counsel appearing in this matter. See Ariz. R. Sup. Ct. 27(3)(C).

Counsel for Plaintiffs:

Suzzane Novak and Jordan Goldberg, Center for Reproductive Rights, 120 Wall

Street, 14th Floor, New York, NY 10005, (917) 637-3600.

Aimee Goldstein, James Gamble, and Jayma Meyer, Simpson Thacher & Bartlett

LLP, 425 Lexington Avenue, New York, NY 10017, (212) 455-2000.

Christopher LaVoy, Lavoy & Chernoff PC, 201 North Central Avenue, Suite 3300,

Phoenix, AZ 85004, (602) 253-3330.

Counsel for Defendants:

Paula Bickett, Carrie Brennan, Gregory Honig, and Mary O’Grady, Office of the

Attorney General, 1275 West Washington Street, Phoenix, AZ 85007, (602) 542-3333.

IT IS ORDERED:

1. The following question is certified to the Arizona Supreme Court pursuant to

A.R.S. § 12-1861 and Rule 27 of the Rules of the Arizona Supreme Court:

Whether the payment provision of A.R.S. § 36-2153(D) applies only when the

informed consent and 24-hour waiting period of A.R.S. § 36-2153(A) is

Case 2:09-cv-01909-DGC Document 71 Filed 09/30/09 Page 2 of 26
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triggered by the actual providing or inducing of an abortion, or whether it

applies outside the abortion context whenever an inquiry about abortion is

made to a health care provider.

2. The Clerk is directed to file with the Arizona Supreme Court the original and

six copies of this certification order. The Clerk shall transmit to the Arizona

Supreme Court the original or copies of such other portions of the Court’s

record as the Arizona Supreme Court may deem necessary to a determination

of the certified question.

DATED this 30th day of September, 2009.

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Case 2:09-cv-01909-DGC Document 65 Filed 09/29/09 Page 1 of 23 

WO
 

IN THE UNITED STATES DISTRICT COURT
 

FOR THE DISTRICT OF ARIZONA
 

Tucson Women's Center; Family ) No. CV-09-1909-PHX-DGC 

Planning Associates; William 

Richardson, M.D.; Paul A. Isaacson, ORDER 

M.D.; and Frank Laudonio, M.D., j 

Plaintiffs, 

vs. j 

Arizona Medical Board; Lisa Wynn, in »
 

her official capacity as Executive
 

Director of the Arizona Medical Board; )
 

and Terry Goddard, in his official )
 

capacity as Attorney General of Arizona, )
 

____D_e_fe_n_d_a_nt_s_.------l 

Arizona House Bill 2564, which will be referred to in this order as "the Act," amends 

Arizona law relating to abortions. The Act was passed by the Arizona Legislature and signed 

by the Governor in July of2009, and becomes effective tomorrow. Among other things, the 

Act prohibits an abortion unless the patient has received certain statutorily-prescribed 

information, has then waited 24 hours before receiving an abortion, and has consented to the 

abortion in writing. A.R.S. § 36-2153(A). The 24-hour waiting period does not apply in 

cases ofmedical emergency as defined in the Act. Id.; A.R.S. § 36-2151(5). The Act also 

states that a person who provides services to a patient who has inquired about or scheduled 

an abortion may not obtain payment for those services until after the 24-hour waiting period 

has expired. A.R.S. § 36-2153(D). 

Plaintiffs claim that the 24-hour provision unconstitutionally burdens a woman's right 

to an abortion and that the payment provision is unconstitutionally vague. Plaintiffs ask the 

Case 2:09-cv-01909-DGC Document 71 Filed 09/30/09 Page 4 of 26
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Case 2:09-cv-01909-DGC Document 65 Filed 09/29/09 Page 2 of 23 

Court to enter a preliminary injunction prohibiting enforcement of these provisions. For 

reasons set forth below, the Court concludes that Plaintiffs have failed to show that they are 

likely to prevail on the merits ofthese constitutional claims. The Court therefore will deny 

Plaintiffs' request for a preliminary injunction. The Court will certify to the Arizona 

Supreme Court a question concerning the proper construction of the payment provision. 

I. Parties and Proceedings. 

Plaintiff Tucson Women's Center is a medical facility that offers a variety of 

reproductive healthcare services, including abortions. Plaintiff William Richardson, M.D., 

operates the center and is a physician licensed to practice medicine in Arizona. Plaintiff 

Family Planning Associates is a reproductive healthcare facility located in Phoenix. Plaintiff 

Paul Isaacson, M.D., a licensed physician, is a co-owner of the facility. Plaintiff Frank 

Laudonio, M.D., is a licensed physician certified in obstetrics and gynecology who provides 

referrals for abortions, but does not perfonn them himself. 

On September 14,2009, Plaintiffs filed a complaint challenging the constitutionality 

ofvarious provisions ofthe Act including, among others, the 24-hour waiting period and the 

payment provision. Dkt. # 1. Plaintiffs bring the complaint under 42 U.S.C. § 1983 and the 

United States Constitution. Id., 2. All Plaintiffs except Dr. Laudonio sue on their own 

behalf and on behalf of their respective patients. Id." 14-18. 

Defendants are the Arizona Medical Board, Lisa Wynn in her official capacity as the 

Executive Director ofthe Board, and Arizona Attorney General Terry Goddard. The Arizona 

Medical Board is responsible for enforcing the Act. 

Certain other individuals and groups have sought to intervene in this case as 

defendants. They include the American Association of Pro-Life Obstetricians and 

Gynecologists, Catholic Medical Association, Christian Medical and Dental Associations, 

Christian Phannacists Fellowship International, Ave Maria Phannacy, PLLC, Arizona 

Catholic Conference, Crisis Pregnancy Centers ofGreater Phoenix, Senator Linda Gray, and 

Representative Nancy Barto. Because time did not pennit the briefing and consideration of 

their request to intervene before the preliminary injunction motion must be resolved, the 

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Case 2:09-cv-01909-DGC Document 65 Filed 09/29/09 Page 3 of 23 

Court pennitted these groups to file a memorandum as amicus curiae. Dkt. #44. 

Plaintiffs filed their motion for preliminary injunction on September 14, 2009, and 

seek a ruling before the Act's effective date ofSeptember 30,2009. Dkt. ##5-6. Defendants 

have filed a response in opposition to the motion (Dkt. #51), the proposed intervenors have 

filed an opposing memorandum (Dkt. #52), and Plaintiffs have filed a reply (Dkt. #56). The 

Court held oral argument on September 29,2009. 

II. Preliminary Injunction Standard. 

Plaintiffs bear the burden of establishing their right to a preliminary injunction. 

Plaintiffs must show that (1) they are likely to succeed on the merits, (2) they are likely to 

suffer irreparable hann in the absence ofpreliminary relief, (3) the balance of equities tips 

in their favor, and (4) an injunction is in the public interest. See Winter v. NRDC, Inc., --­

U.S. ---, 129 S. Ct. 365, 374 (2008); Am. Trucking Ass 'ns, Inc. v. City ofLos Angeles, 559 

F.3d 1046, 1052 (9th Cir. 2009). 

III. Twenty-Four Hour Informed Consent Period. 

The Act provides that "[a]n abortion shall not be perfonned or induced without the 

voluntary and infonned consent ofthe [patient]." A.R.S. § 36-2153(A). Except in the case 

of a medical emergency, consent to an abortion is infonned only iftwo conditions are met. 

The conditions can be summarized as follows: 

1. At least twenty-four hours before the abortion, the physician who is to 

perfonn the abortion or the referring physician must infonn the woman of(a) 

the name ofthe physician who will perfonn the abortion, (b) the nature ofthe 

proposed procedure, (c) the immediate and long-tenn medical risks associated 

with the procedure, (d) alternatives to the procedure, (e) the probable 

gestationa age of the unborn child, (f) the probable anatomIcal and 

physiological characteristics of the unborn child, and (g) the medical risks 

associated with carrying the child to tenn. 

2. At least twenty-four hours before the abortion, the physician who is to 

perfonn the abortion, the referring physician, or a delegated medical 

professional, must infonn the woman that (a) medical assistance benefits may 

be available for llrenatal care, childbirth, and neonatal care, (b) the father of 

the unborn child IS liable to assist in child support even ifhe has offered to pay 

for the abortion, (c) agencies and services are available to assist the woman 

during her pregnancy and after giving birth, (d) it is unlawful for any person 

to coerce a woman to undergo an abortion, and (e) the woman is free to 

withhold or withdraw her consent at any time without affecting her right to 

future care and without loss of any state or federal benefits. 

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Case 2:09-cv-01909-DGC Document 65 Filed 09/29/09 Page 4 of 23 

See A.R.S. § 36-2153(A)(1)-(2). This information must be provided to the woman 

individually and in private, § 36-2153(A)(3), and the woman must certify in writing that she 

has received the information, § 36-2153(A)(4).1 Reflecting their respective views, Plaintiffs 

refer to this section as the "two trip/biased counseling" provision; Defendants call it the 

"informed consent/24 hour waiting period." The Court will refer to it simply as the "24-hour 

provision." 

Plaintiffs contend that the 24-hour provision violates a woman's constitutional right 

to an abortion as recognized in Roe v. Wade, 410 U.S. 113 (1973). Plaintiffs specifically rely 

on the analysis established by the Supreme Court in Planned Parenthood of Southeast 

Pennsylvania v. Casey, 505 U.S. 833 (1992).2 

Casey concerned a Pennsylvania abortion statute that established a 24-hour waiting 

period like the one in this case, required married women to inform their husbands of an 

abortion, required minors to obtain their parents' consent to an abortion, and imposed other 

record keeping and reporting requirements on abortion providers. The constitutionality of 

the Pennsylvania statute was challenged by five abortion clinics and a class of physicians. 

At issue was whether the Supreme Court would adhere to the constitutional right recognized 

in Roe and, if so, how far States could go in regulating abortions. 

The Supreme Court confirmed the constitutional right to an abortion. Casey held that 

"it is a constitutional liberty ofthe woman to have some freedom to terminate her pregnancy. 

We conclude that the basic decision in Roe was based on a constitutional analysis which we 

cannot now repudiate." Id. at 869. Casey also held, however, that "[t]he woman's liberty 

1 The disclosure that the father is liable to provide child support need not be provided 

in the case of rape or incest. A.R.S. § 36-2153(A)(2)(B). 

2Casey included a number of opinions from Supreme Court justices. Plaintiffs and 

Defendants cite the plurality opinion of Justices O'Connor, Kennedy, and Souter. Because 

the undue burden analysis adopted in the plurality opinion was "the narrowest ground for the 

Court's holding" in Casey, "it is as binding on the lower courts as would be a majority 

opinion." Planned Parenthood ofIdaho, Inc. v. Wasden, 376 F.3d 908,921 n.11 (9th Cir. 

2004). The Court will cite to the plurality opinion throughout this decision, referring to it 

simply as the Casey decision. 

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Case 2:09-cv-01909-DGC Document 65 Filed 09/29/09 Page 5 of 23 

is not so unlimited ... that from the outset the State cannot show its concern for the life of 

the unborn[.]" Id. Seeking to protect the woman's right to an abortion while leaving room 

for States to pursue their interest in the life of the fetus, Casey adopted an "undue burden" 

test, holding that State restrictions on abortion are legal so long as they do not place an undue 

burden on women seeking abortions. Id. at 878. "An undue burden exists, and therefore a 

provision oflaw is invalid," Casey held, ifthe "purpose or effect" ofthe law "is to place a 

substantial obstacle in the path of a woman seeking an abortion before the fetus attains 

viability." Id. Applying the undue burden test, Casey identified the group of women on 

whom the law would have an effect and then considered whether the law imposed a 

"substantial obstacle" to obtaining an abortion on a "large fraction" ofthose women. Ifso, 

Casey held, the statute would impose an undue burden on the right to an abortion and is 

therefore invalid. Id. at 894-95. 

Plaintiffs contend that the 24-hour provision places an undue burden on women 

seeking abortions in Arizona. To obtain a preliminary injunction, Plaintiffs must show that 

they are likely to prevail on this claim. Using the Casey analysis, the Court will define the 

relevant group and then determine whether Plaintiffs are likely to prevail in their assertion 

that the 24-hour provision places a substantial obstacle in the path of a large fraction ofthe 

women in that group.3 

A. The Relevant Group. 

Plaintiffs provide the Court with declarations from 92 Arizona abortion patients 

concerning possible effects ofthe 24-hour provision. Plaintiffs note that 80 ofthe 92 women 

report that the 24-hour period will have some negative effect on their right to an abortion. 

Plaintiffs contend, therefore, that the relevant group consists of 80 women. 

Defendants contend that the relevant group consists not ofwomen on whom the law 

will have a negative effect, but of women on whom it will have any effect. Defendants 

contend that the relevant group is therefore all 92 women who provided declarations. 

3Plaintiffs state that they are bringing both facial and as-applied challenges to the Act. 

Dkt. #6 at 6. At oral argument, Plaintiffs agreed that the Casey analysis governs both. 

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Case 2:09-cv-01909-DGC Document 65 Filed 09/29/09 Page 6 of 23 

Defendants are correct. Casey did not define the relevant group as women on whom 

the abortion regulation has a "negative impact" as Plaintiffs contend. See Dkt. #56 at 8.4 

Casey identified the relevant group as women on whom the law would have some effect: 

Legislation is measured for consistency with the Constitution by its impact on 

those whose conduct it affects. ... The proper focus of constitutional mquiry 

is the group for whom the law is a restriction, not the group for whom the law 

is irrelevant. ... [The statute] must be judged by reference to those for whom 

it is an actual rather than an irrelevant restriction. 

505 U.S. at 894-95 (emphasis added). The Ninth Circuit likewise defines the relevant group 

as "those upon whom a challenged law would have some actual effect." PlannedParenthood 

ofIdaho, Inc. v. Wasden, 376 F.3d 908,921 (9th Cir. 2004). 

Casey found that the spouse-notification requirement of the Pennsylvania statute 

would affect only the one percent of married women who would not otherwise notifY their 

spouses of an abortion. 505 U.S. at 894-95. The law would have no effect on women who 

already intended to notifY their spouses - they would give the notice regardless ofthe statute. 

In this case, the 24-hour provision has an effect on all women who would not 

otherwise wait 24 hours to have an abortion. The provision requires these women to wait 24 

hours they would not otherwise wait. The provision also constitutes a restriction on these 

women - absent a medical emergency, itrestricts their right to have an abortion immediately. 

Because none ofthe women who submitted declarations stated that they would have waited 

24 hours for their abortion in the absence ofthe statute, all ofthem are affected by the statute 

and included in the relevant group. 

B. Substantial Obstacle. 

In Casey, the Supreme Court held that a 24-hour waiting period substantially identical 

to the Arizona provision did not impose an undue burden on the right to obtain an abortion. 

In doing so, the Court shed light on the meaning ofthe substantial obstacle requirement. 

Casey held that States may require that women be fully informed of the nature and 

consequences oftheir abortions, and may even advocate for childbirth over abortion: "To 

4 Citations to page numbers will be to the numbers assigned by the Court's electronic 

docket (at the top ofthe page), not to page numbers in the documents themselves. 

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Case 2:09-cv-01909-DGC Document 65 Filed 09/29/09 Page 7 of 23 

promote the State's profound interest in potential life, throughout pregnancy the State may 

take measures to ensure that the woman's choice is informed, and measures designed to 

advance this interest will not be invalidated as long as their purpose is to persuade the woman 

to choose childbirth over abortion." Id. at 878. Casey made clear that the State's pursuit of 

this interest may not impose an undue burden on a woman's right to an abortion, id., but held 

that requiring informed consent does not itself constitute such a burden: 

[W]e permit a State to further its legitimate goal of protecting the life of the 

unborn by enacting legislation aimed at ensuring a decision that is mature and 

informed, even when in so doing the State expresses a preference for childbirth 

over abortion. In short, requiring that the woman be informed of the 

availability of information relating to fetal development and the assistance 

available should she decide to carry the pregnancy to full term is a reasonable 

measure to ensure an informed choice, one which might cause the woman to 

choose childbirth over abortion. This requirement cannot be considered a 

substantial obstacle to obtaining an abortion, and, it follows, there is no undue 

burden. 

Id. at 883. 

Casey also shed light on the level ofhardship necessary for a "substantial obstacle." 

Casey accepted the district court's finding that Pennsylvania's 24-hour waiting period would 

result in greater inconvenience and expense for women seeking abortions, even to the point 

ofbeing "particularly burdensome," but held that this did not constitute a substantial obstacle 

sufficient to invalidate the statute: 

The findings offact by the District Court indicate that because ofthe distances 

many women must travel to reach an abortion provider, the practical effect will 

often be a delay ofmuch more than a day because the waitmg period requires 

that a woman seeking an abortion make at least two visits to the doctor. The 

District Court also found that in many instances this will increase the exposure 

of women seeking abortions to the harassment and hostility of anti-abortion 

protestors demonstrating outside a clinic. As a result, the District Court found 

that for those women who have the fewest financial resources, those who must 

travel long distances, and those who have difficulty explaining their 

whereabouts to husbands, employers, or others, the 24-hour waitmg penod will 

be "particularly burdensome." 

These findings are troubling in some respects, butthey do not demonstrate that 

the waiting period constitutes an undue burden. 

Id. at 885-86 (quotation marks and citations omitted). 

Casey thus makes clear that the substantial obstacle test is, as the name suggests, 

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substantial. It requires more than State-sponsored informed consent and State-sponsored 

advocacy for childbirth. It requires more than delay and inconvenience. Indeed, even when 

the restriction in question is "particularly burdensome" for women with few financial 

resources, women who must travel long distances, and women who may have difficulty 

explaining their whereabouts to husbands, employers, or others, the Supreme Court held that 

the burden does not rise to the level of a substantial obstacle that invalidates the statute.5 

Perhaps because of the substantial nature of the Casey test, every federal court that 

has considered a 24-hour informed consent requirement since Casey has upheld the 

requirement. See Cincinnati Women's Servs., Inc. v. Taft, 468 F.3d 361(6th Cir. 2006); A 

Woman's Choice-East Side Women's Clinic v. Newman, 305 F.3d 684 (7th Cir. 2002); 

Eubanks v. Schmidt, 126 F. Supp. 2d 451 (W.D. Ky. 2000); Karlin v. Foust, 188 F.3d 446 

(7th Cir. 1999); Utah Women's Clinic v. Leavitt, 844 F. Supp. 1482 (D. Utah 1994), rev'd 

in part and dismissing appeal in part, 75 F.3d 564 (lOth Cir. 1995); Planned Parenthood, 

Sioux Falls Clinic v. Miller, 860 F. Supp. 1409 (D.S.D. 1994); Fargo Women's Health Org. 

v. Schafer, 18 F.3d 526 (8th Cir. 1994); Barnes v. Moore, 970 F.2d 12 (5th Cir. 1992). 

Plaintiffs note, however, that Casey was based on the factual record before the 

Supreme Court. See 505 U.S. at 887 ("[O]n the record before us, and in the context of this 

facial challenge, we are not convinced that the 24-hour waiting period constitutes an undue 

burden."); see also Tucson Woman's Clinic v. Eden, 379 F.3d 531,541 (9th Cir. 2004) 

("Casey made clear that the'substantial obstacle' standard for determining when a law poses 

an undue burden on the right to obtain an abortion is record-dependent."). Plaintiffs assert 

5 The parties disagree on the proper definition of"substantial obstacle" under Casey. 

Defendants assert that a substantial obstacle exists only when the statute is "likely to prevent" 

a woman from obtaining an abortion, or when the woman is "likely to be deterred." Casey, 

505 U.S. at 893-94; see also Karlin v. Foust, 188 F.3d 446, 482 (7th Cir. 1999) ("[T]o 

constitute an undue burden, a challenged state regulation must have a strong likelihood of 

preventing women from obtaining abortions rather than merely making abortions more 

difficult to obtain." (emphasis in original)). Plaintiffs contend that something less than the 

prevention or deterrence may constitute a substantial obstacle. The Court need not resolve 

this issue now. The Court concludes that Plaintiffs have failed to show a likelihood of 

success on the undue burden test even if prevention and deterrence are not required. 

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that the evidence presented with their motion establishes an undue burden that was not 

revealed by the record in Casey, and that the result in Casey therefore does not control the 

result in this case. The Court agrees that Casey left the door open for a fact-specific showing 

that a 24-hour provision imposes an undue burden. The question to be decided on this 

motion, then, is whether Plaintiffs have shown that they are likely to establish at trial that 

Arizona's 24-hour provision imposes an undue burden. 

Plaintiffs identify four categories of women for whom they contend the 24-hour 

provision presents a substantial obstacle: those for whom it would (1) make an abortion 

impossible, (2) impose a delay ofone week or more and thereby increase the health risks of 

the abortion, (3) force disclosure of the abortion to a person from whom the woman 

otherwise would keep the abortion secret, and (4) cause significant physical or psychological 

harm. Dkt. #6 at 26-27. Plaintiffs' 92 declarations were obtained from abortion patients at 

Tucson Women's Center and Family Planning Associates between August 25 and September 

4, 2009. Dkt. #7-1. Each declaration is in the form of a questionnaire that asks questions 

regarding the patient's pregnancy, personal circumstances, and abortion.6 Plaintiffs also 

provide declarations from two doctors who regularly perform abortions (Dkt. ##5-1,5-2,56­

2, 56-3), two clinical psychologists who specialize in violence against women, rape, and 

incest (Dkt. ##5-4, 5-5), and a Ph.D. abortion expert (Dkt. #5-6). The Court will address the 

effect ofthis evidence with respect to the four categories ofwomen identified by Plaintiffs.7 

1. Women for Whom Abortions Would Become Impossible. 

Of the 92 women who provided declarations, 14 state that the 24-hour provision 

6 Amicus curiae attack the reliability of the declarations, noting that they are signed 

with pseudonyms and appear to be in the handwriting of only a few people. Dkt. #52 at 5. 

Plaintiffs respond with a declaration of attorney Rebecca Hart explaining how she assisted 

in collecting some of the declarations. Dkt. #56-1. Because the Court concludes that 

Plaintiffs' motion should be denied even if all ofthe declarations are considered, it will not 

address the admissibility ofthe declarations at this time. 

7 In discussing whether Plaintiffs are likely to satisfy the substantial obstacle test, the 

Court does not intend to identify firm categories of"substantial obstacles" for trial. The final 

definition and assessment of substantial obstacles are best left to a more complete record. 

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would have made their abortions impossible. Dkt. #7-1. The Court has examined the 

declarations individually and finds that six ofthese 14 women - Tiffany Collins, Carly Doe, 

Sara Gilmore, Amber Jones, Amanda Perez, and Stacy Smith - provide reasonably concrete 

and credible reasons for their assertions that an abortion would have been impossible under 

the 24-hour provision. These include a combination ofloss ofjobs or school; a substantial 

inability to arrange child care, accommodations, or travel; fear of retaliation; and, 

significantly, the advanced stages of their pregnancies, which leave little or no time for an 

abortion if delay occurs. Dkt. #7-1 at 29-31,45-47,73-75,105-07,204-06,364-66.8 

The other eight declarations also state that the abortions would have been impossible, 

but the reasons they provide are less concrete and credible. Some assert that child care, 

work, and transportation issues would have made a second trip impossible, but their abortions 

occurred relatively early in their pregnancies and they live relatively close to the clinic. Id. 

at 49-51, 133-35, 153-55,224-26,244-46,264-66,308-10. Two state thatthe emotional toll 

would have been too great, but provide no explanation. Id. at 190,309. Another states that 

she wanted to keep the abortion secret from her parents, but she too obtained her abortion 

early and does not explain why a 24-hour delay would have resulted in her parents learning 

ofthe procedure, particularly when her boyfriend drove her to the clinic. Id. at 226. 

The Court's task in ruling on Plaintiffs' preliminary inj unction motion is to determine 

a future likelihood - whether Plaintiffs are likely to succeed in establishing the merits oftheir 

claim at trial. Given the lack of concrete explanations in these eight declarations, the Court 

cannot conclude that Plaintiffs are likely to succeed in showing that abortions would have 

been impossible for these eight women. Under Casey, Plaintiffs must show more than that 

the 24-hour provision is "particularly burdensome." 505 U.S. at 885-86. The Court therefore 

concludes that Plaintiffs are likely to succeed in showing that the 24-hour provision would 

have made abortions impossible for six women, but the Court cannot reach the same 

8 The Court understands that the names of these women are pseudonyms, and 

therefore perceives no risk to the women by identifYing them in this order. The Court notes 

that the women are identified by these names in declarations placed in the public record by 

Plaintiffs. Dkt. #7-1. 

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conclusion with respect to the eight women who fail to provide concrete reasons for their 

assertions. Plaintiffs do not claim that any other women in this first category satisfy the 

substantial obstacle requirement.9 

2. Women for Whom Delay Would Result in Increased Health Risks. 

Plaintiffs note that 45 ofthe women who completed declarations state that the 24-hour 

provision would have caused them to delay their abortions for at least one week. Dkt. ##6 

at 28, 56 at 14. 10 Plaintiffs assert that this delay will expose the women to significantly 

greater health risks. Plaintiffs assert that the risk of death from abortion increases 38% for 

each week the abortion is delayed beyond eight weeks. Dkt. #6 at 10. For two reasons, the 

Court concludes that Plaintiffs have not shown they are likely to succeed in establishing an 

undue burden based on such health risks. 

First, the 24-hour waiting period does not apply "in the case ofa medical emergency." 

A.R.S. § 36-2153(A). '''Medical emergency' means a condition that, on the basis of the 

physician's good faith clinicaljudgment, so complicates the medical condition ofa pregnant 

woman as to necessitate the immediate abortion of her pregnancy to avert her death or for 

which a delay will create serious risk of substantial and irreversible impairment of a major 

9 The Court does not mean to minimize the concerns of the women who completed 

declarations or the challenges they face. Nor in later sections of this order is the Court 

insensitive to the health risks faced by some women obtaining abortions. But Plaintiffs 

mount a broad attack on the statute and ask the Court to enjoin it state-wide. Plaintiffs do 

not base their claim on the specific circumstance of any particular woman, but instead ask 

the Court to conclude that the Act will impose an undue burden on a large fraction of the 

women to whom it applies. Dkt. ##6, 56. Plaintiffs count numbers, asserting that 63% of 

the relevant group will encounter a substantial obstacle. Dkt.#6 at 22-23. Because Plaintiffs 

have chosen to attack the 24-hour provision generally, the Court must consider the evidence 

generally, asking whether itshows an undue burden on a large fraction ofthe relevant group. 

The inquiry necessarily considers numbers, but the Court is mindful that real lives underlie 

the data. 

10 Plaintiffs' motion states that 45 of patients averred the 24-hour provision would 

cause them to wait one week. Dkt. #6 at 14-15. Elsewhere in that motion, Plaintiffs say 41 

women made the assertion. Id. at 28. Plaintiffs' reply also says 41. Dkt. #56 at 14. The 

Court counts 45 patients who made the assertion. 

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bodily function." A.R.S. § 36-2151(5). 

The Pennsylvania statute at issue in Casey contained an identical medical emergency 

provision. See 505 U.S. at 879. At least 25 other states have adopted essentially the same 

definition. See Wasden, 376 F.3d at 926. In Casey, the court of appeals construed the 

Pennsylvania provision to mean that compliance with the 24-hour waiting period "would not 

in any way pose a significant threat to the life or health of a woman." 505 U.S. at 880 

(quotation omitted). The Supreme Court deferred to this construction by the lower court and 

held that the emergency provision, so construed, eliminated any undue burden that might 

otherwise have been imposed by the statutory delay: "In light ofthe construction given the 

statute's definition ofmedical emergency by the Court ofAppeals, and the District Court's 

findings, we cannot say that the waiting period imposes a real health risk." Id. at 886. 

This Court reaches the same conclusion. The Arizona statute provides that the 24­

hour provision does not apply if, in the physician's good faith judgment, an immediate 

abortion is required by the woman's medical condition in order to avoid death, or when delay 

will create a serious risk of substantial and irreversible impairment of a major bodily 

function. 

Plaintiffs argue that the medical emergency exception is too narrow - that it protects 

women only from death or serious risks ofpermanent impairment to major bodily functions. 

Plaintiffs contend that some women whose abortions are delayed by the 24-hour provision 

will face serious health risks that do not fall within this definition, and that those women will 

face a substantial obstacle not alleviated by the medical emergency exception. But Plaintiffs 

provide no statistics concerning the number of women in this category. Plaintiffs thus 

provide no basis for the Court to conclude that a large fraction of the relevant group will 

experience increased health risks. 

Plaintiffs cite to the declarations ofDrs. Richardson, Isaacson, and Henshaw, but these 

declarations state only that the 24-hour delay will increase the risk of health problems for 

some patients. They do not assert that the problems will fall outside the statutory definition 

of medical emergency, nor do they describe the nature, severity, or statistical frequency of 

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the conditions to which they are referring. See Dkt. ##5-1, 16; 5-2, 19; 5-6, ~~ 5-6. Dr. 

Henshaw does assert that each week's delay beyond eight weeks ofpregnancy will increase 

the risk of death by 38% - a statistic that will be discussed below - but he does not address 

which cases would fall outside the medical emergency exception so as to create this risk. 

Plaintiffs attach new declarations from Drs. Richardson and Isaacson to their reply 

memoranda. Dkt. #56-2, 56-3. The Court normally does not consider evidence submitted 

for the first time with a reply because the other side has not had a fair opportunity to respond. 

In this case, however, Defendants had an opportunity to address the supplemental 

declarations at oral argument. Both doctors note that they often perform abortions for 

women referred by other doctors because ofparticular health issues. Both doctors typically 

try to complete the procedure on the day of the referral or the next day, often coordinating 

the procedure with the availability ofthe referring physician. Dr. Richardson asserts that it 

is difficult to say "with certainty," and Dr. Isaacson says it is difficult to "be certain," that the 

risk posed by delaying these abortions would cause a "serious risk of substantial and 

irreversible impairment of a major bodily function" as required by the medical emergency 

exception in the statute. Dkt. ##56-2 at 4, 56-3 at 2-3. Plaintiffs rely on these declarations 

to assert that the exception does not alleviate the health risks confronting abortion patients. 

The Court first notes, however, that the medical emergency exception does not require 

certainty as the doctors suggest. It calls only for a physician's "good faith clinical 

judgment." A.R.S. § 36-2151 (5). More importantly for purposes of this motion, Drs. 

Richardson and Isaacson provide no information about the frequency ofthese cases or the 

number of abortions in which they arise. Plaintiffs therefore fail to show that health issues 

not covered by the medical emergency exception will arise in a "large fraction" of the 

relevant group. I I 

II When the Court questioned Plaintiffs' counsel about this gap in the evidence during 

oral argument, counsel said that the doctors were in the courtroom and could provide 

additional information. But she made no proffer ofwhat they would say and did not request 

to call them as witnesses. Moreover, presenting live testimony on such an issue at oral 

argument and only hours before the statute is to become effective would not have afforded 

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Second, even if the medical emergency exception is disregarded, the evidence 

submitted by Plaintiffs does not show that the 24-hour provision will create a substantial 

obstacle for a large fraction ofthe relevant group. The parties disagree on the level ofhealth 

risk required to reach a substantial obstacle. But surely not every increase in risk would 

suffice. Inconsequential increases could not be characterized as substantial obstacles to an 

abortion. Casey did not identify the level of health risk that will constitute a substantial 

obstacle, but did make reference to an "appreciable health risk" and a "real health risk." 505 

U.S. at 885,886. Other cases also speak of "appreciable" health risks. See, e.g., Richmond 

Med. Ctr. for Women v. Gilmore, 11 F. Supp. 2d 795, 827 (E.D. Va. 1998); Carhart v. 

Stenberg, 972 F. Supp. 507, 524-525 (D. Neb. 1997). The Court need not attempt to 

determine the precise level of risk required for a substantial obstacle, however, because 

Plaintiffs have not shown a real or appreciable health risk under any reasonable definition. 

Of the 92 women who provided declarations, 45 indicate that the 24-hour provision 

would have delayed their abortion by at least one week. Dkt. #7-1. Plaintiffs assert that each 

week of delay after eight weeks ofpregnancy increases the risk of death by 38%. Dkt. #6 

at 10. They do not specify the increase that occurs before eight weeks. From this evidence, 

and general assertions by the doctors that delays increase the risk of abortion procedures, 

Plaintiffs contend that the delay caused by the 24-hour provision will significantly increase 

health risks ofthe 45 women who provided declarations. 

The Court cannot agree. Plaintiffs cite a 38% increase in risk, but 38% ofa very small 

number is still a very small number. Plaintiffs' own expert, Dr. Henshaw, avers that 

"[a]bortion at any stage is considered to be one ofthe safest surgical procedures." Dkt. #5-6, 

5 (emphasis added). Plaintiffs' physician experts likewise aver that "abortion is a very safe 

the State a fair opportunity to respond. With respect to the definition ofmedical emergency, 

the court of appeals in Casey construed an identical medical emergency provision to mean 

that the 24-hour waiting period "would not in any way pose a significant threat to the life or 

health ofa woman." 505 U.S. at 880 (quotation omitted). The Court need not decide at this 

time whether the Arizona exception should be construed in the same way. Even in the 

absence ofsuch a construction, Plaintiffs have not shown that the 24-hour provision creates 

a risk ofserious medical complications for a large fraction ofthe relevant group. 

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procedure and the risk of complication from abortion is very low[.]" Dkt. #5-1, 16; #5-2, 

19; see also L. Bartlett et aI., Risk Factors for Legal Induced Abortion-Related Mortality 

in the United States, 103 J. Obstetrics & Gynecology 729 (2004), available at http://www. 

acog.org/from_home/publications/greenjoumal/2004/vl03n4p729.pdf. 

The risk of death from an abortion performed at eight weeks or earlier is 0.1 per 

100,000, or one in 1,000,000. Id. at 733, Tbl. 2. Given this very low risk, the Court cannot 

conclude that delays in abortions before eight weeks would constitute a real or appreciable 

health risk. The risk does increase after eight weeks, but it still appears to be small. Id. At 

nine to ten weeks the risk is 0.2 per 100,000; at eleven to twelve weeks it is 0.4 per 100,000; 

at thirteen to fifteen weeks it is 1.7 per 100,000; at sixteen to twenty weeks it is 3.4 per 

100,000; and at twenty-one weeks or more it is 8.9 per 100,000. Id. 

With the exception of childbirth, Plaintiffs provide no information from which the 

Court can assess the seriousness of these risks as compared to other medical procedures or 

daily activities that people routinely accept. Dr. Henshaw does note that the risk of death in 

childbirth is 12.4 times higher than the risk ofdeath in abortions. Dkt. #5-6, 5. Taking Dr. 

Henshaw at his word - that abortion "at any stage" is considered one of the safest surgical 

procedures (id.) - the Court cannot conclude that one-week increases in abortion risks 

represent such real or appreciable health risks as to constitute a substantial obstacle to an 

abortion. The Court likely will have a greater ability to evaluate the increased risks at trial, 

particularly if the parties provide comparative risks for other routinely accepted medical 

procedures, but on this record Plaintiffs have not shown that they are likely to succeed in 

proving that a one-week delay will constitute a substantial obstacle to abortion. 12 

12 Among the 45 women who state that the 24-hour provision would have delayed 

their abortions, most say it would have delayed the abortion one week. Dkt. #7-1. This 

generally comports with a study cited by Dr. Henshaw which shows that 24-hour waiting 

periods cause delays of 4.7 days for low-income women who live in counties with no 

abortion providers. Dkt. #5-6, ~~ 12, 13. Thus, it appears that the delays caused by the 24­

hour provision will usually be about one week. The increase in risk caused by the provision, 

therefore, will be the difference between the risk when the woman elected to schedule her 

abortion and the risk one week later. 

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3. The Risk of Unwanted Disclosures. 

Plaintiffs note that 14 of the women submitting declarations state that the 24-hour 

provision would prevent them from keeping their abortions confidential from family 

members, friends, or coworkers. Dkt. #6 at 15. These women, however, provide no details 

concerning the consequences ofsuch disclosure. Dkt. #7-1 at 16,63, 75, 119, 191,226,262, 

274,286,290,310,334,358,374. Six other women, not mentioned by Plaintiffs in this 

category, say they were keeping their abortions secret from someone whom they feared 

would pose a danger to them. Id. at 4, 12, 55, 131, 187, 206. 

Responding to the 14 women identified by Plaintiffs, Defendants contend that courts 

have viewed the likely disclosure of an abortion to be a substantial obstacle only when 

women are in abusive relationships or the disclosure would be to the government in a publicrecords format. Dkt. #51 at 14-15. Plaintiffs disagree, citing cases where concerns about 

disclosures have been recognized. Dkt. #56 at 13. 13 

Rather than attempting to resolve this disagreement now, the Court will credit the 

declarations of all six women who fear danger if their abortions are revealed. Because one 

ofthem - Amanda Perez - was counted in Plaintiffs' first category, the Court will not count 

her again for purposes of the "large fraction" determination. Dkt. #7-1 at 204-06. For 

purposes ofthis motion, however, the Court will assume that Plaintiffs are likely to succeed 

in establishing that the other five women face a substantial obstacle. 

The Court cannot reach the same conclusion with respect to the 14 women who fail 

to provide any detail as to the consequences of unwanted disclosures. The Court cannot 

conclude, for example, that disclosures to coworkers or some family members would always 

rise to the level of a substantial obstacle to abortion. The district court in Casey found that 

the 24-hour waiting period would create difficulty for women required to explain "their 

whereabouts to husbands, employers, or others," and even characterized this difficulty as 

"particularly burdensome." 505 U.S. at 886. Casey held, however, that these difficulties "do 

13 Plaintiffs cite Casey's reference to disclosures "to family and friends," but this 

reference appears in the context of abusive relationships. See 505 U.S. at 893. 

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not demonstrate that the waiting period constitutes an undue burden." Id. On the record 

provided by Plaintiffs, the Court cannot conclude that the 14 women will face substantial 

obstacles sufficient to create the undue burden necessary to invalidate the law. 

4. Increased Physical or Psychological Harm. 

Plaintiffs describe this category as women who have been victims ofrape or incest. 

Plaintiffs contend that these women will be traumatized by the statute's required disclosures 

and the added waiting time, but they do not identify the number ofwomen in their group of 

92 who will be so affected. Dkt. #6 at 16-17. Plaintiffs' declarations ofabortion patients did 

not make the inquiry. Dkt. #7-1. Plaintiffs thus provide no evidence from which the Court 

can determine what portion ofthe relevant group would face this problem. 

5. Conclusion. 

Plaintiffs have shown that they are likely to succeed in establishing that 11 womensix from their first category and five from their third - will face a substantial obstacle from 

the 24-hour provision. The Court cannot say that 11 out of92 constitutes a "large fraction" 

ofthe relevant group. This would be true even ifthe Court adopted Plaintiffs' relevant group 

of80. Under the analysis mandated by Casey, therefore, Plaintiffs have failed to show that 

they are likely to succeed in their claim that the 24-hour provision imposes an undue burden 

on the right ofArizona women to an abortion. 14 

14 At oral argument, Plaintiffs asserted that Casey's "large fraction" test is conceptual, 

not mathematical. They argued that a large fraction can exist in a qualitative sense even if 

the numerical fraction is relatively small. Thus, they would contend, even 11 women out of 

92 constitute a large fraction given the level ofdifficulties faced by the 11 women under the 

Arizona statute. The Court cannot agree. Casey, in a very carefully worded opinion, chose 

the phrase "large fraction" to describe the extent ofthe substantial obstacles that must exist 

before a statute can be said to impose an undue burden on the right to an abortion. The 

choice was clearly deliberate. The "large fraction" requirement was discussed at some length 

in other Casey opinions. See 505 U.S. at 925,926,938 n. 9, 942 (Blackmun, J., concurring), 

965,973 n. 2, (Rehnquist, C.J., concurring in part and dissenting in part). The Court cannot 

conclude that the use ofthe rather mathematical phrase was inadvertent or imprecise. Had 

Casey intended to establish a test that looked at the severity of the hardship suffered by 

women under the statute rather than the number of women who would encounter a 

substantial obstacle, it could have imposed a "significant hardship" test or similar words. It 

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Because Plaintiffs have failed to satisfy the first requirement for a preliminary 

injunction, the Court need not address the remaining requirements. See Freecycle Network, 

Inc. v. Dey, 505 F.3d 898,906 n.l5 (9th Cir. 2007). The Court will deny Plaintiffs' request 

for a preliminary injunction on the 24-hour provision. 

IV. Payment Provision. 

The payment provision states that a person shall not "require or obtain payment for 

a service provided to a patient who has inquired about an abortion or scheduled an abortion 

until the expiration of the twenty-four hour reflection period required by subsection A [of 

section36-2153]." A.R.S. § 36-2153(D). A physician who knowingly violates this provision 

"commits an act of unprofessional conduct and is subject to license suspension or 

revocation[.]" A.R.S. § 36-2153(F). 

Plaintiffs' vagueness argument focuses on the words "has inquired about." Plaintiffs 

concede that the payment provision is clear as it applies to abortion doctors. The patients of 

such doctors must be afforded the informed consent and 24-hour waiting period prescribed 

by subsection (A), and the payment provision makes clear that such doctors may charge for 

their services only after the waiting period has expired. Dkt. #6 at 29. Plaintiffs contend that 

the provision is unconstitutionally vague, however, when it comes to doctors who do not 

perform abortions. Such doctors may well have patients who "inquire[] about an abortion" 

within the meaning of the statute, but who take no steps to obtain one. Once triggered by 

such an inquiry, Plaintiffs contend, the payment provision would prohibit such physicians 

from charging for their services even ifthe patients never seek an abortion. Plaintiffs assert 

that the payment provision gives no guidance to physicians in this position, forcing them to 

guess at when or how they can charge for non-abortion services without risking suspension 

or revocation of their licenses. Id.; see Dkt. #56 at 21 n.20. Plaintiffs also argue that such 

did not. In fact, Casey rejected the district court's "particularly burdensome" finding as a 

sufficient basis for constitutional invalidity. The Court concludes that "large fraction" must 

be taken at face value. Courts must consider the proportion ofwomen in the relevant group 

who will encounter a substantial obstacle, and should strike down statutes as unconstitutional 

only if a large fraction ofthe women in the group face such an obstacle. 

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a vague provision lends itselfto arbitrary enforcement. Dkt. #6 at 29. 

Defendants say the purpose ofthe payment provision is to prevent abortion providers 

from creating a financial incentive for a woman to have an abortion by requiring her to pay 

for the procedure before the 24-hour waiting period. Dkt. #51 at 23. Plaintiffs' concerns 

about non-abortion doctors are unwarranted, Defendants argue, because the provision applies 

only when a patient must be provided informed consent under subsection (A), and that occurs 

only when the patient seeks an abortion. Dkt. #51 at 22. The payment restriction does not 

apply to patients who merely inquire about an abortion because those patients need not give 

the informed consent under subsection (A). Id. at 22-23. 

The proposed intervenors make a similar argument. They assert that the 24-hour 

reflection period is triggered under subsection (A) only when an abortion is to be "performed 

or induced," and thus healthcare professionals who do not intend to perform or induce an 

abortion have no reason to be concerned about liability under the payment provision. 

Dkt. #52 at 10. They further assert that the other provision of subsection (D) prohibiting a 

person from prescribing a drug to induce an abortion until the reflection period has expired 

makes clear that the payment provision is directed at abortion providers, not other doctors. 

Id. 

A. The Vagueness Doctrine. 

"The Fourteenth Amendment is violated by laws so vague that persons' of common 

intelligence must necessarily guess at their meaning and differ as to their application. ", 

Tucson Woman's Clinic, 379 F.3d at 554 (quotingPlannedParenthoodv. Arizona, 718 F.2d 

938, 947 (9th Cir. 1983». "A law is unconstitutionally vague if it fails to provide a 

reasonable opportunity to know what conduct is prohibited, or is so indefinite as to allow 

arbitrary and discriminatory enforcement." Id. (internal citations omitted). Courts also 

recognize, however, that "[s]tatutes need not be written with 'mathematical' precision, nor 

can they be thus written." Forbes v. Napolitano, 236 F.3d 1009, 1011 (9th Cir. 2000) 

(quoting Graynedv. City a/Rockford, 408 U.S. 104, 108-09 (1972». 

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B. Arizona Law and the Meaning of the Payment Provision. 

The Court's role is to interpret the provision as would the Arizona Supreme Court. 

See Wasden, 376 F.3d at 925. Under Arizona law, a court's primary goal in interpreting a 

statute is '''to fulfill the intent ofthe legislature that wrote it.'" Bilke v. Arizona, 80 P.3d 269, 

271 (Ariz. 2003)(en bane) (quoting State v. Williams, 854 P.2d 131, 133 (Ariz. 1993)). The 

court must seek "to give effect to the entire statutory scheme." Backus v. State, 203 P.3d 

499,502 (Ariz. 2009) (en bane); see Zamora v. Reinstein, 915 P.2d 1227,1230 (Ariz. 1996) 

(en bane) (stating that statutes should be interpreted '''to achieve the general legislative goals 

that can be adduced from the body oflegislation in question''') (citation omitted). Courts 

interpreting Arizona statutes must apply'" fundamental principles ofstatutory construction, 

the cornerstone of which is the rule that the best and most reliable index of a statute's 

meaning is its language and, when language is clear and unequivocal, it is determinative of 

the statute's construction.'" Deer Valley Unified Sch. Dist. No. 97 v. Houser, 152 P.3d 490, 

493 (Ariz. 2007) (en bane) (quoting Janson ex rei. Janson v. Christensen, 808 P.2d 1222, 

1223 (Ariz. 1991)). 

The Court finds the payment provision to be ambiguous. Defendants assert that the 

provision would not apply if a patient requests general information about abortion, but the 

language of the statute appears to prohibit pre-waiting-period collection of fees from any 

"patient who has inquired about an abortion[.]" A.R.S. § 36-2153(D). Such inquiries may 

well arise outside the abortion context. Patients may ask their doctors about abortions 

without ever intending to obtain one. Doctors who never perform abortions, such as those 

practicing obstetrics and gynecology, might well be asked about abortions by their patients. 

Dr. Laudonia confirms that this occurs in his practice. Dkt. #5-3, 7. The statute could be 

read to suggest that such inquiries trigger the payment provision and prohibit the doctors 

from billing for their services until the 24-hour provision has been satisfied - something that 

will never occur in many of these inquiries. 

The fact that a statute is ambiguous, however, does not mean that it is invalid. 

Arizona courts seek to "determine legislative intent by reading the statute as a whole, giving 

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meaningful operation to all ofits provisions, and by considering factors such as the statute's 

context, subject matter, historical background, effects and consequences, and spirit and 

purpose." Zamora, 915 P.2d at 1230; see Ariz. Newspapers Ass 'n, Inc. v. Super. Ct., 694 

P.2d 1174, 1176 (Ariz. 1985) (en banc). Applying these principles, the Court concludes that 

Defendants' interpretation of the statute is probably correct. 

The Act regulates abortion and nothing more. Section 36-2152 deals with parental 

notification andjudicial bypass requirements for minors seeking abortions. Section 36-2153 

includes the 24-hour provision and established civil remedies for women who have received 

an abortion and for fathers and maternal grandparents ofthe aborted fetus. Section 36-2154 

concerns the right of healthcare professionals to refuse to participate in abortions. Section 

36-2151 defines terms used in these other sections. "[R]eading the statute as a whole, giving 

meaningful operation to all ofits provisions," and giving effect to its context, subject matter, 

consequences, and purpose, Zamora, 915 P.2d at 1230, the Court concludes that the Arizona 

legislature sought to regulate abortions. No other kind of health care is regulated. is 

The payment provision also appears to focus on abortion. The first part of the 

provision concerns persons who "write or communicate a prescription for a drug or drugs to 

induce an abortion[.]" A.R.S. § 36-2153(D). The last part concerns "services provided to 

a patient who has ... scheduled an abortion[.]" Id. Only the middle phrase, concerning 

patients who have "inquired about an abortion," is not firmly tied to the act of providing 

abortions. Id. The context ofthe ambiguous language thus suggests that it is concerned with 

abortions, not with other health services that may occasionally involve inquiries about 

abortions. 

Given the singular focus ofthe statute and the context ofthe ambiguous phrase, the 

is The sparse legislative history confirms this focus. The Arizona House of 

Representatives' summary explains that "HB 2564 makes a variety of changes to statutes 

related to abortion[.]" See http://www.azleg.gov/DocumentsForBill.asp?Bill Number= 

HB2564 (follow "Show Summaries/Fact Sheets" link). Hearing minutes from the 

House Committee on Health and Human Services also demonstrate that the focus of the 

Act was abortion. See http://www.azleg.gov/Committeelnfo.asp?Committee_ID=23 (follow 

"Minutes Document" link for 2/25/09). 

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Court concludes that the payment provision was intended to regulate only abortion providers. 

Nothing in the Act suggests that other health care services were targeted. The Court 

concludes that the payment provision most reasonably can be read as applying only in those 

consultations and services attached to the performing or inducing of abortions. Inquiries 

outside of this context, such as inquiries made to a doctor practicing obstetrics and 

gynecology, are not covered by the provision. So construed, the payment provision is not 

unconstitutionally vague. 

This interpretation squares with another important principle of Arizona law - that 

courts should construe statutes "to avoid rendering them unconstitutional." Hayes v. Cant'I 

Ins. Co., 872 P.2d 668,676-77 (Ariz. 1994); see Zamora, 915 P.2d at 1232 ("We will not 

'declare invalid for vagueness every statute which we believe could have been drafted with 

greater precision."') (quoting State v. Tasca, 750 P.2d 874, 877-78 (Ariz. 1988)); State Bd. 

a/Tech. Registration v. McDaniel, 326 P.2d 348,357 (Ariz. 1958) (an "Act will be given a 

construction consistent with validity if at all possible") (citation omitted); Adams v. Bolin, 

247 P.2d 617, 626 (Ariz. 1952) ("all presumptions and intendments are in favor of the 

validity and constitutionality of legislative acts"); see also Gonzales v. Carhart, 550 U.S. 

124, 153 (2007) ("[T]he elementary rule is that every reasonable construction must be 

resorted to, in order to save a statute from unconstitutionality.") (quotations omitted); 

Wasden, 376 F.3d at 925 (courts must "presume the legislature both intended to and did in 

fact act constitutionally" and must "indulge in any reasonable construction that can save the 

statute from invalidity"). 

C. Certification to the Arizona Supreme Court and Denial of Motion. 

The Court recognizes that the construction ofArizona statutes is a matter for Arizona 

state courts to decide, that Arizona law generally requires a construing court to "give effect 

to each word of the statute," Bilke, 80 P.3d at 271, and that the construction of section 36­

2153(D) adopted in this order could be viewed as rendering the words "inquired about" 

superfluous. The Court therefore will certify the proper interpretation of the payment 

provision to the Arizona Supreme Court. See A.R.S. § 12-1861; Ariz. Sup. Ct. R. 27. In the 

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meantime, because the Court finds a constitutional reading of the statute to be most 

reasonable, the Court concludes that Plaintiffs have not shown they are likely to prevail on 

the merits of this claim. Plaintiffs' motion for a preliminary injunction on the payment 

provision will therefore be denied. The Court need not address the additional requirements 

for a preliminary injunction. See Freecycle Network, 505 F.3d at 906 n.15. 

IT IS ORDERED: 

1.	 Plaintiffs' motion for preliminary injunction and expedited briefing schedule 

(Dkt. #5) is granted with respect to the expedited briefing schedule, but 

denied with respect to the preliminary injunction. 

2.	 By separate order, the Court will certify the following question to the Arizona 

Supreme Court: Whether the payment provision of A.R.S. § 36-2153(D) 

applies only when the informed consent and 24-hour waiting period ofA.R.S. 

§ 36-2153(A) is triggered by the actual providing or inducing ofan abortion, 

or whether it applies outside the abortion context whenever an inquiry about 

abortion is made to a health care provider. 

3.	 The motions for leave to file excess pages (Dkt. ##53, 57) are granted. 

4.	 The Court will set a Rule 16 scheduling conference after it has ruled on the 

pending motion to intervene.
 

DATED this 29th day of September, 2009.
 

David G. Campbell
 United States District Judge
 

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