Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca9-12-35221/USCOURTS-ca9-12-35221-0/pdf.json

Nature of Suit Code: 442
Nature of Suit: Civil Rights Employment
Cause of Action: 

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FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

STORMANS, INC., doing business as

Ralph’s Thriftway; RHONDA

MESLER; and MARGO THELEN,

Plaintiffs-Appellees,

v.

JOHN WIESMAN, Secretary of the

Washington State Department of

Health; DAN RUBIN; ELIZABETH

JENSEN; EMMA ZAVALA-SUAREZ;

SEPI SOLEIMANPOUR, Members of

the Washington Pharmacy Quality

Assurance Commission; MARK

BRENMAN, Executive Director of the

Washington Human Rights

Commission; MARTIN MUELLER,

Assistant Secretary of the

Washington State Department of

Health, Health Services Quality

Assurance; CHRISTOPHER BARRY;

NANCY HECOX; TIM LYNCH; STEVEN

ANDERSON; ALBERT LINGGI;

MAUREEN SIMMONS SPARKS;

MAURA C. LITTLE; KRISTINA

LOGSDON, Members of the

Washington Pharmacy Quality

Assurance Commission,

Defendants-Appellants,

No. 12-35221

D.C. No.

3:07-cv-05374-

RBL

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2 STORMANS, INC. V. WIESMAN

and

JUDITH BILLINGS; RHIANNON

ANDREINI;JEFFREY SCHOUTEN;

MOLLY HARMON; CATHERINE

ROSMAN; TAMI GARRARD,

Defendant-Intervenors.

STORMANS, INC., doing business as

Ralph’s Thriftway; RHONDA

MESLER; MARGO THELEN,

Plaintiffs-Appellees,

v.

JOHN WIESMAN, Secretary of the

Washington State Department of

Health; DAN RUBIN; ELIZABETH

JENSEN; EMMA ZAVALA-SUAREZ;

SEPI SOLEIMANPOUR, Members of

the Washington Pharmacy Quality

Assurance Commission; MARK

BRENMAN, Executive Director of the

Washington Human Rights

Commission; MARTIN MUELLER,

Assistant Secretary of the

Washington State Department of

Health, Health Services Quality

Assurance; CHRISTOPHER BARRY;

NANCY HECOX; TIM LYNCH; STEVEN

ANDERSON; ALBERT LINGGI;

MAUREEN SIMMONS SPARKS;

No. 12-35223

D.C. No.

3:07-cv-05374-

RBL

OPINION

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STORMANS, INC. V. WIESMAN 3

MAURA C. LITTLE; KRISTINA

LOGSDON, Members of the

Washington Pharmacy Quality

Assurance Commission,

Defendants,

and

JUDITH BILLINGS; RHIANNON

ANDREINI;JEFFREY SCHOUTEN;

MOLLY HARMON; CATHERINE

ROSMAN; TAMI GARRARD,

Defendant-Intervenors–Appellants.

Appeals from the United States District Court

for the Western District of Washington

Ronald B. Leighton, District Judge, Presiding

Argued and Submitted

November 20, 2014—Portland, Oregon

Filed July 23, 2015

Before: Susan P. Graber, Richard R. Clifton,

and Mary H. Murguia, Circuit Judges.

Opinion by Judge Graber

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4 STORMANS, INC. V. WIESMAN

SUMMARY*

Civil Rights

The panel reversed the district court’s judgment, entered

following a bench trial, in an action brought by the owner of

a pharmacy and two pharmacists who have religious

objections to delivering emergency contraceptives, and who

challenged Washington state rules requiring the timely

delivery of all prescription medications by licensed

pharmacies. 

The rules permit pharmacies to deny delivery for certain

business reasons, such as fraudulent prescriptions or a

customer’s inability to pay. The rules also permit a

religiously objecting individual pharmacist to deny delivery,

so long as another pharmacist working for the pharmacy

provides timely delivery.

Addressing plaintiffs’ free exercise claim, the panel held

that the rules, promulgated by the Washington Pharmacy

Quality Assurance Commission, were facially neutral. The

panel also held that the rules operated neutrally because they

prescribed and proscribed the same conduct for all, regardless

of motivation. The panel further held that the rules were

generally applicable and that according to the evidence

produced at trial, the rules (1) were not substantially

underinclusive in their prohibition of religious objections but

allowance of certain secular exemptions; (2) did not create a

regime of unfettered discretion through the individualized

* 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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STORMANS, INC. V. WIESMAN 5

exemptions that would permit discriminatory treatment of

religion or religiously motivated conduct; and (3) were not

selectively enforced. 

Because the rules were neutral and generally applicable,

rational basis review applied. The panel held that the rules

were rationally related to Washington’s legitimate interest in

ensuring that its citizens have safe and timely access to their

lawful and lawfully prescribed medications. The panel

rejected plaintiffs’ equal protection claim on the same basis

as the free exercise claim.

Addressing plaintiffs’ due process claim, the panel

declined to recognize a new fundamental right. The panel

held that it was unconvinced that the right to own, operate, or

work at a licensed professional business free from regulations

requiring the business to engage in activities that one

sincerely believes lead to the taking of human life was so

rooted in conscience and the Nation’s tradition as to be

ranked as fundamental. 

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6 STORMANS, INC. V. WIESMAN

COUNSEL

Thomas L. Boeder (argued), Andrew L. Greene, Katherine D.

Bennett, and Noah Guzzo Purcell, Perkins Coie LLP, Seattle,

Washington; Lisa M. Stone, Molly Terwilliger, and Janet

Chung, Legal Voice, Seattle, Washington; Laura Einstein,

Planned Parenthood of the Great Northwest, Seattle,

Washington, for Defendant-Intervenors–Appellants.

Alan D. Copsey (argued), Deputy Solicitor General, Robert

M. McKenna, Attorney General, Rene Tomisser, Senior

Counsel, Joyce A. Roper, Senior Assistant Attorney General,

Olympia, Washington, for Defendants-Appellants.

Kristen K. Waggoner (argued) and Steven T. O’Ban, Ellis, Li

& McKinstry PLLC, Seattle, Washington; Michael W.

McConnell, Stanford, California; Luke W. Goodrich, The

Becket Fund for Religious Liberty, Washington, D.C.; Steven

H. Aden, Alliance Defending Freedom, Scottsdale, Arizona,

for Plaintiffs-Appellees.

Sara L. Ainsworth, University of Washington School of Law,

Seattle, Washington; Michael S. Wampold, Peterson

Wampold Rosato Luna Knopp, Seattle, Washington, for

Amici Curiae Organizations andExperts Dedicated to Ending

Rape and Intimate Partner Violence.

Mary Re Knack and Sarah Joye, Williams, Kastner & Gibbs

PLLC, Seattle, Washington, for Amici Curiae Public Health

and Human Rights Organizations, et al.

Alex J. Luchenitser, Ayesha N. Khan, and Benjamin N.

Hazelwood, Americans United for Separation of Church and

State, Washington, D.C., as Amicus Curiae.

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STORMANS, INC. V. WIESMAN 7

Shannon P. Minter, Christopher F. Stoll, Angela Perone, Asaf

Orr, and Ashland Johnson, National Center for Lesbian

Rights, San Francisco, California, for Amici Curiae AIDS

United, et al.

Stephanie Toti, Senior Staff Attorney, New York, New York,

as Amici Curiae Center for Reproductive Rights and for

National Women’s Law Center.

Jessica A. Skelton and Kymberly K. Evanson, Pacifica Law

Group LLP, Seattle, Washington, for Amici Curiae Religious

and Religiously-Affiliated Organizations and Individual

Clergy.

Denise M. Burke and Mailee R. Smith, Americans United for

Life, Washington, D.C., for Amici Curiae Members of the

United States Congress.

Jason A. Levine and Eric A. White, Vinson & Elkins LLP,

Washington, D.C., for Amici Curiae American Pharmacists

Association, et al.

Mark E. Chopko, Marissa Parker, and Zeenat A. Iqbal,

Stradley Ronon Stevens & Young, LLP, Washington, D.C.,

for Amici Curiae The Muslim Public Affairs Council, et al.

Christian J. Ward, Scott A. Keller, J. Campbell, and April L.

Farris, Yetter Coleman LLP, Austin, Texas; Douglas

Laycock, University of Virginia Law School, Charlottesville,

Virginia, for Amici Curiae Constitutional Law Professors.

Dorinda C. Bordlee and Nikolas T. Nikas, Bioethics Defense

Fund, Scottsdale, Arizona;Kimberlee Wood Colby,Christian

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8 STORMANS, INC. V. WIESMAN

Legal Society, Springfield, Virginia, for Amici Curiae

Christian Medical Association, et al.

Kevin Marshall and Richard M. Re, Jones Day, Washington,

D.C., for Amici Curiae The Church of the Lukumi Babalu

Aye, Inc., et al.

Alexander Dushku and Justin W. Starr, Kirton/McConkie,

Salt Lake City, Utah, for Amici Curiae Washington State

Catholic Conference, et al.

Carrie L. Severino and Ammon Simon, Judicial Education

Project, Washington, D.C., for Amici Curiae Agudath Israel

of America, et al.

Sean D. Jordan, Kent C. Sullivan, Danica L. Milios, Travis

Mock, and Peter Hansen, Sutherland Asbill & Brennan LLP,

Austin, Texas; Jeffrey C. Mateer and Justin E. Butterfield,

Liberty Institute, Plano, Texas, for Amicus Curiae Liberty

Institute.

Matthew T. Nelson and Elinor Jordan, Warner Norcross &

Judd LLP, Grand Rapids, Michigan, for Amicus Curiae The

Bruderhof and Hopewell Mennonite Church.

Sandra Payne Hagood, La Jolla, California; Thomas C. Berg,

University of St. Thomas Law School, Minneapolis,

Minnesota, for Amici Curiae Individual Physicians,

Obstetricians, and Health Care Practitioners Licensed in the

State of Washington.

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STORMANS, INC. V. WIESMAN 9

OPINION

GRABER, Circuit Judge:

In order to promote patient safety in the state of

Washington, the Washington Pharmacy Quality Assurance

Commission (“Commission”) promulgated rulesrequiring the

timely delivery of all prescription medications by licensed

pharmacies. The rules permit pharmacies to deny delivery for

certain business reasons, such as fraudulent prescriptions or

a customer’s inability to pay. The rules also permit a

religiously objecting individual pharmacist to deny delivery,

so long as another pharmacist working for the pharmacy

provides timely delivery. But, unless an enumerated

exemption applies, the rules require a pharmacy to deliver all

prescription medications, even if the owner of the pharmacy

has a religious objection.

Plaintiffs are the owner of a pharmacy and two individual

pharmacists who have religious objections to delivering

emergency contraceptives such as Plan B and ella. They

challenge the rules on free exercise and other constitutional

grounds. After a bench trial, the district court held that the

rules violate the Free Exercise and Equal Protection Clauses,

and the court permanently enjoined enforcement of the rules. 

Because we conclude that the rules are neutral and generally

applicable and that the rules rationally further the State’s

interest in patient safety, we reverse.

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10 STORMANS, INC. V. WIESMAN

BACKGROUND

A. History of the Rules

The Commission regulates the practice of pharmacyin the

state of Washington. Wash. Rev. Code § 18.64.001. A

comprehensive regulatory scheme tasks the Commission to,

among other duties, “[r]egulate the practice of pharmacy and

enforce all laws placed under its jurisdiction”; “[e]stablish the

qualifications for licensure of pharmacists or pharmacy

interns”; conduct and manage disciplinaryproceedings; assist

in the enforcement of the pharmacy laws and regulations; and

“[p]romulgate rules for the dispensing, distribution,

wholesaling, and manufacturing of drugs and devices and the

practice of pharmacy for the protection and promotion of the

public health, safety, and welfare.” Id. § 18.64.005(1),

(3)–(7).

To “practice pharmacy or to institute or operate any

pharmacy,” a person must obtain a license. Id. § 18.64.020. 

A “pharmacist” is defined as “a person duly licensed by the

commission to engage in the practice of pharmacy,” id.

§ 18.64.011(20), and a “pharmacy” is defined as “every place

properly licensed by the commission where the practice of

pharmacy is conducted,” id. § 18.64.011(21). The “practice

of pharmacy” includes “[i]nterpreting prescription orders; the

compounding, dispensing, labeling, administering, and

distributing of drugs and devices; . . . [and] the proper and

safe storing and distributing of drugs and devices and

maintenance of proper records thereof.” Id. § 18.64.011(23). 

Under what is known as the “Stocking Rule,” promulgated in

1967, a pharmacy “must maintain at all times a representative

assortment of drugs” approved by the Food and Drug

Administration (“FDA”) “in order to meet the pharmaceutical

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STORMANS, INC. V. WIESMAN 11

needs of its patients.” Wash. Admin. Code § 246-869-150(1). 

Violation of an administrative rule “shall constitute grounds

for refusal, suspension, or revocation of licenses or any other

authority to practice issued by the commission.” Wash. Rev.

Code § 18.64.005(7).

In 2007, the Commission unanimously and formally

adopted two new administrative rules. The first rule, known

as the “Pharmacist Responsibility Rule,” amends a section

titled “Pharmacist’s professional responsibilities,” and it

applies to the conduct of individual pharmacists. Wash.

Admin. Code § 246-863-095. Under that rule, “[i]t is

considered unprofessional conduct” for a pharmacist to: 

“(a) Destroy unfilled lawful prescription[s]; (b) Refuse to

return unfilled lawful prescriptions; (c) Violate a patient’s

privacy; (d) Discriminate against patients or their agent in a

manner prohibited by state or federal laws; and (e) Intimidate

or harass a patient.” Id. § 246-863-095(4). Importantly, the

parties agree that the foregoing rule does not require an

individual pharmacist to dispense medication if the

pharmacist has a religious, moral, philosophical, or personal

objection to delivery. Stormans, Inc. v. Selecky (“Stormans

I”), 586 F.3d 1109, 1116 (9th Cir. 2009). A pharmacy may

“accommodate” an objecting pharmacist in any way the

pharmacy deems suitable, including having another

pharmacist available in person or by telephone. Id.

The second rule, known as the “Delivery Rule,” is titled

“Pharmacies’ responsibilities” and applies to pharmacies. 

Wash. Admin. Code § 246-869-010. That rule requires

pharmacies to “deliver lawfully prescribed drugs or devices

to patients and to distribute drugs and devices approved by

the [FDA] for restricted distribution by pharmacies, or

provide a therapeutically equivalent drug or device in a

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12 STORMANS, INC. V. WIESMAN

timely manner consistent with reasonable expectations for

filling the prescription.” Id. § 246-869-010(1). The Delivery

Rule also prohibits pharmacies from destroying or refusing to

return an unfilled lawful prescription; violating a patient’s

privacy; or unlawfullydiscriminating against, intimidating, or

harassing a patient. Id. § 246-869-010(4). By contrast to the

Pharmacist Responsibility Rule, the Delivery Rule contains

no exemption for pharmacies whose owners object to delivery

on religious, moral, philosophical, or personal grounds. An

objecting pharmacy must deliver the drug or device and may

not refer a patient to another pharmacy.

Under the Delivery Rule’s enumerated exemptions, a

pharmacy need not deliver a drug or device

[in] the following or substantially similar

circumstances:

(a) Prescriptions containing an obvious or

known error, inadequacies in the instructions,

known contraindications, or incompatible

prescriptions, or prescriptions requiring action

in accordance with WAC 246-875-040[;]

(b) National or state emergencies or

guidelines affecting availability, usage or

supplies of drugs or devices;

(c) Lack of specialized equipment or

expertise needed to safely produce, store, or

dispense drugs or devices, such as certain

drug compounding or storage for nuclear

medicine;

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STORMANS, INC. V. WIESMAN 13

(d) Potentially fraudulent prescriptions; or

(e) Unavailability of drug or device

despite good faith compliance with [the

Stocking Rule].

Id. § 246-869-010(1). The Delivery Rule also provides that

pharmacies are not required to deliver a drug or device

“without payment of their usual and customary or contracted

charge.” Id. § 246-869-010(2).

The Delivery Rule and the amended Pharmacist

Responsibility Rule took effect on July 26, 2007.

B. Procedural History

Plaintiffs filed this action on July 25, 2007, the day before

the rules were to take effect. Plaintiffs include Stormans,

Inc., a family business that operates Ralph’s Thriftway

(“Ralph’s”), a grocery store and pharmacy located in

Olympia, Washington. Stormans, Inc., declines to stock

Ralph’s with the emergency contraceptive drugs Plan B or

ella because the pharmacy’s owners have religious objections

to their use.1 Since 2006, twenty-four complaints have been

1 Plan B is an emergency contraceptive containing levonorgestrel, a

synthetic hormone similar to progesterone. Tummino v. Hamburg, 936

F. Supp. 2d 162, 164–65 (E.D.N.Y. 2013). At the time of the bench trial,

Plan B was available for “behind-the-counter,” non-prescription

distribution for women at least 17 years old and via prescription for

women under 17. Id. ella is an emergency contraceptive containing the

chemical compound ulipristal acetate. Approved by the FDA in 2010, ella

is currently available only with a prescription. Id. Plaintiffs amended

their complaint to include ella within their requests for relief. Plaintiffs

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14 STORMANS, INC. V. WIESMAN

filed with the Commission against Ralph’s in connection with

this policy. Twenty-one of the complaints have been

dismissed for procedural reasons, but three remain pending.

The other two Plaintiffs are Rhonda Mesler and Margo

Thelen, Washington-based pharmacists who are unwilling to

dispense Plan B or ella for religious reasons. Before 2007,

Mesler and Thelen referred customers who were seeking Plan

B to another pharmacy. After the regulations took effect,

Thelen was transferred to a different pharmacy because her

employer could not accommodate her religious objection. 

Mesler alleges that she will be forced to move out-of-state if

the regulations are upheld.

Defendants include the Commission’s members and the

Secretary of the Washington State Department of Health. 

The district court also permitted several Washington residents

to intervene to defend the rules. Intervenors Rhiannon

Andreini and Molly Harmon had negative experiences after

being denied or delayed access to Plan B. Intervenor Dr.

Jeffrey Schouten is HIV-positive, and Intervenor Judith

Billings has AIDS; both fear being denied timely access to

their prescription medications.

Plaintiffs seek declaratory and injunctive relief under the

Free Exercise Clause, the Due Process Clause, the Equal

Protection Clause, and the SupremacyClause. Plaintiffs limit

their claims to the Pharmacist Responsibility Rule and the

Delivery Rule; they do not challenge the Stocking Rule. 

Stormans I, 586 F.3d at 1118.

believe that dispensing these drugs “constitutes direct participation in the

destruction of human life.”

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STORMANS, INC. V. WIESMAN 15

In 2007, the district court issued a preliminary injunction

prohibiting enforcement of the rules. The district court held

that Plaintiffs were likely to succeed on the merits of their

free exercise claim because the rules were neither neutral nor

generally applicable, and the rules could not survive strict

scrutiny. The court preliminarily enjoined Defendants from

enforcing the rules against any pharmacy or pharmacist who

declined to dispense Plan B.

In 2009, we vacated the preliminary injunction and

remanded for further proceedings. Stormans I, 586 F.3d

1109. We held that, on the record presented, the rules were

both neutral and generally applicable. Id. at 1127–37. We

declined to conduct rational basis review in the first instance

and instead remanded for the district court to apply that

standard in assessing whether Plaintiffs were likely to

succeed on the merits. Id. at 1137–38, 1142. We further held

that the district court had erred in its analysis of the remaining

preliminary injunction factors and that it had abused its

discretion in enjoining enforcement of the rules as to all

pharmacies and pharmacists, rather than limiting the relief to

the named Plaintiffs. Id. at 1138–40. Also in 2009, the

district court stayed enforcement of the two rules in dispute.

In 2010, the Commission commenced a new rule-making

process to consider whether to amend the rules to allow for

facilitated referrals in the face of a conscientious objection to

a prescription medication. Because such an amendment

would have mooted Plaintiffs’ claims, the parties agreed to

delay trial until the rule-making process was complete. Over

Intervenors’ objections, Defendants stipulated that

“facilitated referrals are often in the best interest of patients,

pharmacies, and pharmacists; that facilitated referrals do not

pose a threat to timely access to lawfully prescribed

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16 STORMANS, INC. V. WIESMAN

medications[;] and that facilitated referrals help assure timely

access to lawfully prescribed medications.” The stipulation

also provided that the district court’s 2009 stay order would

remain in effect. In late 2010, after receiving public

comments and conducting additional hearings, the

Commission voted not to amend the rules.

After a twelve-day bench trial, the district court ruled in

Plaintiffs’ favor, issuing an opinion accompanied by

extensive findings of fact and conclusions of law. Stormans,

Inc. v. Selecky, 854 F. Supp. 2d 925 (W.D. Wash. 2012). The

court again held that the rules were neither neutral nor

generally applicable and that they did not survive strict

scrutiny. Id. at 967–90. Accordingly, the district court held

that Plaintiffs were entitled to relief on their free exercise

claim. Id. at 992. Because Plaintiffs’ equal protection claim

was coextensive with their free exercise claim, the court

ruled, in an unpublished supplemental order, that Plaintiffs

also had established an equal protection violation. Although

the court implied that Plaintiffs had a meritorious due process

claim, premised on the right “to refrain from taking human

life,” the court ultimately rejected that claim. Id. at 990–91. 

Finally, the district court rejected Plaintiffs’ contention that

the rules are preempted by federal law under the Supremacy

Clause. Id. at 991.

The court entered a final judgment (1) declaring the

Delivery Rule, the Pharmacist Responsibility Rule, and the

Stocking Rule2unconstitutional under the Free Exercise

Clause; (2) declaring those rules unconstitutional under the

Equal Protection Clause; (3) enjoining Defendants from

2 The district court held the Stocking Rule unconstitutional even though

Plaintiffs did not challenge it.

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STORMANS, INC. V. WIESMAN 17

enforcing those rules against Plaintiffs; and (4) retaining

jurisdiction to enforce the judgment. Defendants and

Intervenors timely appeal.

STANDARD OF REVIEW

We review de novo a district court’s conclusions of law

following a bench trial. Navajo Nation v. U.S. Forest Serv.,

535 F.3d 1058, 1067 (9th Cir. 2008) (en banc). We review

for clear error the court’s findings of fact.

3 Lentini v. Cal.

Ctr. for the Arts, Escondido, 370 F.3d 837, 843 (9th Cir.

2004).

DISCUSSION

A. Free Exercise Claim

The First Amendment’s Free Exercise Clause, which

applies to the states via the Fourteenth Amendment, Cantwell

v. Connecticut, 310 U.S. 296, 303 (1940), provides that

3 The parties dispute this standard of review. Defendants and

Intervenors contend that we should review de novo the district court’s

findings because they pertain to “mixed questions of law and fact that

implicate constitutional rights.” Berger v. City of Seattle, 569 F.3d 1029,

1035 (9th Cir. 2009) (en banc). Moreover, Defendants and Intervenors

note that we review a district court’s findings of fact “‘with special

scrutiny’” when a district court “‘engage[s] in the regrettable practice of

adopting the findings drafted by the prevailing party wholesale.’” Silver

v. Exec. Car Leasing Long-Term Disability Plan, 466 F.3d 727, 733 (9th

Cir. 2006) (alteration in original) (quoting Sealy, Inc. v. Easy Living, Inc.,

743 F.2d 1378, 1385 (9th Cir. 1984)). Plaintiffs, on the other hand, argue

that the district court’s factual findings are reviewed for clear error. 

Because we would reach the same conclusion under either a “clear error”

or “de novo” standard, we apply the standard of review that Plaintiffs

seek, and we need not resolve the parties’ dispute.

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18 STORMANS, INC. V. WIESMAN

“Congress shall make no law . . . prohibiting the free exercise

[of religion].” U.S. Const. amend. I. The right to exercise

one’s religion freely, however, “does not relieve an individual

of the obligation to comply with a valid and neutral law of

general applicability on the ground that the law proscribes (or

prescribes) conduct that his religion prescribes (or

proscribes).” Emp’t Div. v. Smith, 494 U.S. 872, 879 (1990)

(internal quotation marks omitted); see also United States v.

Lee, 455 U.S. 252, 261 (1982) (“When followers of a

particular sect enter into commercial activity as a matter of

choice, the limits they accept on their own conduct as a

matter of conscience and faith are not to be superimposed on

the statutory schemes which are binding on others in that

activity.”).

Under the rule announced in Smith and affirmed in

Church of Lukumi Babalu Aye, Inc. v. City of Hialeah

(“Lukumi”), 508 U.S. 520, 531 (1993), a neutral law of

general application need not be supported by a compelling

government interest even when “the law has the incidental

effect of burdening a particular religious practice.”4 Such

laws need only survive rational basis review. Miller v. Reed,

4 Last year, the Supreme Court addressed the statutory protections

afforded by the Religious Freedom Restoration Act of 1993 (“RFRA”). 

Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751 (2014). RFRA,

which applies only to federal laws, provides protections to religious

practices above and beyond those afforded by the Constitution;

specifically, the statute prevents the federal government from

“substantially burden[ing] a person’s exercise of religion even if the

burden results from a rule of general applicability.” 42 U.S.C. § 2000bb1(a). The Court expressly limited its holding to that statutory context. 

Hobby Lobby, 134 S. Ct. at 2785. Here, Plaintiffs have not asserted

claims under RFRA; nor could they, because they challenge only state

laws and regulations, to which RFRA does not apply.

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STORMANS, INC. V. WIESMAN 19

176 F.3d 1202, 1206 (9th Cir. 1999). For laws that are not

neutral or not generally applicable, strict scrutiny applies. 

See Lukumi, 508 U.S. at 531–32 (“A law failing to satisfy

these requirements must be justified by a compelling

governmental interest and must be narrowly tailored to

advance that interest.”).

The tests for “[n]eutrality and general applicability are

interrelated, and . . . failure to satisfy one requirement is a

likely indication that the other has not been satisfied.” Id. at

531. Nevertheless, we must consider each criterion

separately so as to evaluate the text of the challenged law as

well as the “effect . . . in its real operation.” Id. at 535. 

Accordingly, we assess whether the rules are neutral and

generally applicable.5

1. Neutrality

“[I]f the object of a law is to infringe upon or restrict

practices because of their religious motivation, the law is not

neutral . . . .” Id. at 533. “A law lacks facial neutrality if it

 

5

 Defendants argue that Stormans I, 586 F.3d 1109, which vacated the

district court’s grant of a preliminary injunction, constitutes the law of the

case. We disagree. The “general rule” is that our decisions “at the

preliminary injunction phase do not constitute the law of the case.” 

Ranchers Cattlemen Action Legal Fund United Stockgrowers of Am. v.

Dep’t of Agric., 499 F.3d 1108, 1114 (9th Cir. 2007) (internal quotation

marks omitted). Although there is an exception to the general rule for

“conclusions on pure issues of law,” id., the exception does not apply here

because we are analyzing a mixed question of law and fact, Alpha Delta

Chi-Delta Chapter v. Reed, 648 F.3d 790, 804–05 (9th Cir. 2011). But

Stormans I is “law of the circuit” and, therefore, is relevant. Gonzalez v.

Arizona, 677 F.3d 383, 389 n.4 (9th Cir. 2012) (en banc) (internal

quotation marks omitted), aff’d, Arizona v. Inter Tribal Council of Ariz.,

Inc., 133 S. Ct. 2247 (2013).

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20 STORMANS, INC. V. WIESMAN

refers to a religious practice without a secular meaning

discernable from the language or context.” Id. Because the

rules at issue here make no reference to any religious

practice, conduct, belief, or motivation, they are facially

neutral.

The more challenging question is whether the rules are

operationally neutral. In Lukumi, practitioners of the Santeria

religion, which prescribes ritual animal sacrifice as a

principal form of devotion, challenged city ordinances

restricting the slaughter of animals. Id. at 524–25. One of

the challenged ordinances flatly prohibited the sacrifice of

animals, but the definition of “sacrifice” excluded “almost all

killings of animals except for religious sacrifice” and

provided an additional exemption for kosher slaughter. Id. at

535–36. The net result of this definition, the Court ruled, was

that “few if any killings of animals are prohibited other than

Santeria sacrifice.” Id. at 536. Thus, because of the way the

ordinance operated in practice, it (and two others) actually

prohibited only Santeria sacrifice. Id. In this way, the

challenged ordinances accomplished a “religious

gerrymander,” an impermissible attempt to target religious

practices through careful legislative drafting. Id. at 535–37

(internal quotation marks omitted).

Unlike the ordinances at issue in Lukumi, the rules here

operate neutrally. As an initial matter, we note that, as they

pertain to pharmacists, the rules specifically protect

religiously motivated conduct. The Commission created a

right of refusal for pharmacists by allowing pharmacies to

“accommodate” individual pharmacists who have religious,

moral, philosophical, or personal objections to the delivery of

particular prescription drugs. The rules do not require

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STORMANS, INC. V. WIESMAN 21

pharmacists to dispense a prescription medication to which

they object.

As they pertain to pharmacies, the rules’ delivery

requirement applies to all objections to delivery that do not

fall within an exemption, regardless of the motivation behind

those objections. See Stormans I, 586 F.3d at 1131 (“[A]side

from the exemptions, any refusal to dispense a medication

violates the rules, and this is so regardless of whether the

refusal is motivated by religion, morals, conscience, ethics,

discriminatoryprejudices, or personal distaste for a patient.”). 

By prohibiting all refusals that are not specifically exempted,

the rules establish a practical means to ensure the safe and

timely delivery of all lawful and lawfully prescribed

medications to the patients who need them. See id. (“[T]he

object of the rules was to ensure safe and timely patient

access to lawful and lawfully prescribed medications.”); see

also Wash. Rev. Code § 18.64.005 (assigning to the

Commission the responsibility of regulating the practice of

pharmacy so as to protect and promote the public health,

safety, and welfare).

The delivery requirement also applies to all prescription

products—not just Plan B, ella, or other emergency

contraceptives. In both trial testimonyand official documents

accompanying the final regulations, Commission members

expressed their expectation that the Delivery Rule’s effect

would extend beyond Plan B, for example, by guaranteeing

access to medications for HIV patients. Evidence before the

Commission and at trial demonstrated that pharmacists and

pharmacies had refused to fill prescriptions for several kinds

of medications other than emergencycontraceptives. Specific

examples included refusals, for a varietyof reasons, to deliver

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diabetic syringes, insulin, HIV-related medications, and

Valium.

The possibility that pharmacies whose owners object to

the distribution of emergency contraception for religious

reasons may be burdened disproportionately does not

undermine the rules’ neutrality. The Free Exercise Clause is

not violated even if a particular group, motivated by religion,

may be more likely to engage in the proscribed conduct. See

Reynolds v. United States, 98 U.S. 145, 166–67 (1878)

(upholding a ban on polygamy despite the fact that polygamy

was practiced primarily bymembers of the Mormon Church);

cf. United States v. O’Brien, 391 U.S. 367, 378–86 (1968)

(rejecting a First Amendment challenge to a statutory

prohibition of the destruction of draft cards even though most

violators likely would be opponents of war). In American

Life League, Inc. v. Reno, 47 F.3d 642, 646, 656 (4th Cir.

1995), the Fourth Circuit upheld the Federal Freedom of

Access to Clinic Entrances Act of 1984 (“Access Act”),

which prohibited conduct intended to injure, intimidate, or

interfere with persons seeking to obtain or provide

reproductive health services. Even after acknowledging that

Congress passed the law in response to religiously motivated

protests at reproductive health clinics, the court found no free

exercise violation. Id. at 654 (“[T]he Access Act punishes

conduct for the harm it causes, not because the conduct is

religiously motivated.”). Although the Access Act may have

the effect of disproportionately punishing religiously

motivated violators, it makes no difference whether a violator

acts because of religious convictions or for other reasons, for

“[t]he same conduct is outlawed for all.” Id.

Here, similarly, the rules prescribe and proscribe the same

conduct for all, regardless of motivation. The rules require,

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subject to specific exemptions, that all pharmacies deliver all

lawfully prescribed drugs. And the rules allow the

Commission to sanction conduct (refusal to deliver a lawfully

prescribed drug) because of the harm that it causes—patients’

being denied safe and timely access to their lawfully

prescribed medications—not because the conduct is

religiously motivated. Id. Neutrality is not destroyed by the

supposition that pharmacies whose owners have religious

objections to emergency contraception will be burdened

disproportionately, or by the speculation that pharmacists

with religious objections to Plan B disproportionately will

require accommodation from their pharmacy-employers. 

Stormans I, 586 F.3d at 1131.

Plaintiffs counter that the Commission’s decision not to

allow facilitated referrals demonstrates discriminatory intent,

which undercuts the rules’ neutrality. According to Plaintiffs,

facilitated referrals are a reasonable accommodation for

objecting pharmacies because facilitated referrals do not

jeopardize the timely delivery of prescription medication. 

Plaintiffs assert that the Commission’s decision could have

no purpose other than to discriminate against religiously

motivated refusals to deliver. We disagree.

When a drug is unavailable at a particular pharmacy,

facilitated referrals help the customer receive the prescribed

drug by traveling to another pharmacy where it is available. 

But the immediate delivery of a drug is always a faster

method of delivery than requiring a customer to travel

elsewhere. Speed is particularly important considering the

time-sensitive nature of emergency contraception and of

many other medications. The time taken to travel to another

pharmacy, especially in rural areas where pharmacies are

sparse, may reduce the efficacy of those drugs. Additionally,

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24 STORMANS, INC. V. WIESMAN

testimony at trial demonstrated how facilitated referrals could

lead to feelings of shame in the patient that could dissuade

her from obtaining emergency contraception altogether. In

our view, the Commission’s decision not to allow facilitated

referrals falls within its stated goal of ensuring timely and

safe delivery of prescription medications and, accordingly,

does not demonstrate discriminatory intent.

As a matter of logic, we reject Plaintiffs’ argument that

Defendants’ 2010 mid-litigation stipulation regarding

facilitated referrals is evidence of discriminatory intent by the

Commission when it adopted the rules in 2007. Moreover,

the existence of other means that might achieve the

Commission’s purpose does not necessarilydestroy the rules’

neutrality.

Nor does the legislative and administrative history behind

the rules undermine their neutrality. Whether a court may

examine legislative history in this context remains an open

question. Id. at 1131–32. Even if we should analyze that

history, it does not reveal improper intent. As we explained

in Stormans I, the administrative history “hardly reveals a

single design to burden religious practice; rather, it is a

patchwork quilt of concerns, ideas, and motivations.” Id. at

1133. “The collective will of the [Commission] cannot be

known, except as it is expressed in the text and associated

notes and comments of the final rules.” Id.

To the extent that the record reveals anything about the

Commission’s motivation in adopting the rules, it shows that

the Commission approached the problem from the point of

view of ensuring patients’ timely access to prescription

medications. The Commission did not act solely in response

to religious objections to dispensing emergency

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STORMANS, INC. V. WIESMAN 25

contraception. It was also concerned with the safe and timely

delivery of many other drugs, which may or may not

engender religious objections. See id. at 1114 (noting that

public testimony “addressed the availability of a variety of

prescription medicines and devices, such as syringes, prenatal

vitamins, oral contraceptives, and AIDS medications”). For

example, the Commission had heard testimony that patients

“were not getting access to” prescription medications and

devices used to treat diabetes and HIV. Similarly, the district

court noted that “since 1997 there have been at least nine

complaints to the [Commission] regarding a pharmacy’s

refusal (or failure) to dispense drugs other than Plan B.” 

Accordingly, the Commission was “motivated by concerns

about the potential deleterious effect on public health that

would result from allowing pharmacists to refuse to dispense

lawfully prescribed medications based on personal, moral

objections (of which religious objections are a subset).”6Id.

at 1133. Nothing in the record developed since Stormans I

alters that conclusion. Therefore, the district court clearly

erred in finding discriminatory intent.

6 Even if the Commission had drafted and adopted the rules solely in

response to incidents of refusal to deliver Plan B, that fact would not

necessarily mean that the rules were drafted with the intent of

discriminating against religiously motivated conduct. See Stormans I,

586 F.3d at 1131; Am. Life League, 47 F.3d at 654;see also Vision Church

v. Vill. of Long Grove, 468 F.3d 975, 999 (7th Cir. 2006) (finding no free

exercise violation even if a zoning ordinance targeted a proposed plan for

a new church, because the commission was concerned about the nonreligious effect of the church on the community); Knights of Columbus,

Council No. 94 v. Town of Lexington, 272 F.3d 25, 35 (1st Cir. 2001)

(finding no free exercise violation although a regulation limiting displays

on the town green was adopted in response to a flood of requests from

religious groups seeking to erect displays).

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For the foregoing reasons, we hold that the rules operate

neutrally.

2. General Applicability

We next must consider whether the rules are generally

applicable. Lukumi, 508 U.S. at 542; Smith, 494 U.S. at

879–81. A law is not generally applicable if it, “in a selective

manner[,] impose[s] burdens only on conduct motivated by

religious belief.” Lukumi, 508 U.S. at 543. Plaintiffs argue

that the rules are not generally applicable because (a) they are

substantially underinclusive in their prohibition of religious

objections but allowance of certain secular exemptions;

(b) they contain vague, open-ended wording that affords

individualized discretion that could rest on discriminatory

animus; and (c) the Commission has selectively enforced the

rules against, and only against, Plaintiffs.

a. Substantial Underinclusion

A law is not generally applicable if its prohibitions

substantiallyunderinclude non-religiouslymotivated conduct

that might endanger the same governmental interest that the

law is designed to protect. Id. at 542–46. In other words, if

a law pursues the government’s interest “only against conduct

motivated by religious belief” but fails to include in its

prohibitions substantial, comparable secular conduct that

would similarly threaten the government’s interest, then the

law is not generally applicable.7Id. at 545.

7 For example, in Lukumi, the city claimed that the ordinances at issue

advanced two interests: protecting the public health and preventing cruelty

to animals. 508 U.S. at 543. The ordinances failed to prohibit secular

conduct that would nevertheless endanger these interests in the same way

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The rules require pharmacies to deliver prescription

medications, but they also carve out several enumerated

exemptions. See Wash. Admin. Code § 246-869-010(1), (2)

(exempting pharmacies from the duty to deliver when the

prescription cannot be filled due to lack of payment; because

the prescription may be fraudulent, erroneous, or incomplete;

because of declared emergencies; because the pharmacylacks

specialized equipment or expertise; or when a drug or device

is unavailable despite good faith compliance with the

Stocking Rule). Plaintiffs assert that those exemptions

threaten the State’s interest in patient safety to the same

degree as would a religious exemption. In Plaintiffs’ view,

the rules are substantially underinclusive because of the

secular exemptions. We disagree.

As we held in Stormans I, the enumerated exemptions are

“necessary reasons for failing to fill a prescription” in that

they allow pharmacies to operate in the normal course of

business. 586 F.3d at 1134. Indeed, we reassert the

following:

that religiouslymotivated conduct would. Id. Prohibiting Santeria animal

sacrifices may have advanced the government’s interests, but so would

have prohibiting several types ofsecular killings. See id. (“Many types of

animal deaths or kills for nonreligious reasons are either not prohibited or

approved by express provision.”); id. at 544 (“The health risks posed by

the improper disposal of animal carcasses are the same whether

[prohibited] Santeria sacrifice or some [non-prohibited] nonreligious

killing preceded it.”). The ordinances’ failure to prohibit non-religious

conduct endangered the government interest “in a similar or greater

degree” than the religiously motivated conduct. Id. at 543. It was this

substantial underinclusion that led the Court to conclude that the

ordinances were not generally applicable. Id.

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Nobody could seriously question a refusal to

fill a prescription because the customer did

not pay for it, the pharmacist had a legitimate

belief that it was fraudulent, or supplies were

exhausted or subject to controls in times of

declared emergencies. Nor can every single

pharmacy be required to stock every single

medication that might possibly be prescribed,

or to maintain specialized equipment that

might be necessary to prepare and dispense

every one of the most recently developed

drugs. Instead of increasing safe and legal

access to medications, the absence of these

exemptions would likely drive pharmacies out

of business or, even more absurdly, mandate

unsafe practices. Therefore, the exemptions

actually increase access to medications by

making it possible for pharmacies to comply

with the rules, further patient safety, and

maintain their business.

Id. at 1135 (emphasis added). In that way, the exemptions

further the rules’ stated goal of ensuring timely and safe

patient access to medications. Evidence presented at trial

does not alter the quoted conclusions that we reached in

Stormans I.

But the district court found that there are several

unwritten exemptions to the Delivery Rule’s delivery

requirement. Stormans, 854 F. Supp. 2d at 970–72. These

are scenarios, the district court explained, in which a

pharmacy’s refusal to deliver medication was “permitted in

practice” despite the lack of an enumerated exemption in the

text of the rules. Id. The court asserted that, for instance,

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STORMANS, INC. V. WIESMAN 29

some pharmacies would “not deliver the drug over the

counter because it requires extra recordkeeping (e.g.,

Sudafed),” “not stock the drug because it is an expensive

drug,” or “not stock the drug because it would attract crime

(e.g., Oxycontin).” Id. at 970. The court found that, in other

instances, pharmacies refused to perform “simple

compounding” or “unit dosing” packaging and refused to

carry and dispense specific drugs that require the monitoring

of patient dosages. Id.

The district court’s findings that those practices had

occurred are not clearly erroneous, but the court clearly erred

by concluding that the Commission permitted those practices

or exempted them from enforcement. Trial testimony shows

that, if complaints were filed about those practices, the

Commission would follow its normal procedure in deciding

whether to investigate and to initiate an enforcement action. 

It has not received such complaints. The fact that no one has

filed a complaint with the Commission, to trigger its action,

does not make the practices permissible under the rules. The

Commission has never issued an official interpretation of the

rules suggesting that those practices are permitted. An

individual Commission member’s view about how the

Commission might act if it received a complaint has no

bearing on the Commission’s collective interpretation of the

rules. Accordingly, the evidence produced at trial did not

demonstrate that the rules are substantially underinclusive.

b. Individualized Exemptions

Plaintiffs also contend that the rules are not generally

applicable because they contain discretionary text that allows

those who enforce the rules to discriminate against religion. 

The “individualized exemptions” doctrine, which Plaintiffs

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thus invoke, was developed in a series of cases involving

unemployment benefits programs under which persons were

ineligible for benefits if they failed to accept available

employment “without good cause.” See Thomas v. Review

Bd. of Ind. Emp’t Sec. Div., 450 U.S. 707, 717–18 (1981)

(finding unconstitutionalthe denial of unemployment benefits

when the state determined that the claimant’s religiously

motivated voluntary termination of his employment in the

production of armaments was “without good cause”);

Sherbert v. Verner, 374 U.S. 398, 402–10 (1963) (finding

unconstitutional a state’s denial of unemployment benefits

when the state determined that the claimant’s religiously

motivated refusal to work on Saturday was “without good

cause”); see also Hobbie v. Unemp’t Appeals Comm’n,

480 U.S. 136, 140–46 (1987) (finding unconstitutional a

state’s denial of benefits to a claimant whose employment

was terminated because she refused to work on Saturday, as

was required by her religion). The Court opined that an openended, purely discretionary standard like “without good

cause” easily could allow discrimination against religious

practices or beliefs. Sherbert, 374 U.S. at 406; see also

Lukumi, 508 U.S. at 537–38 (holding that the city’s

determination that Santeria animal sacrifice was

“unnecessary”—and thus in violation of the ordinance at

issue—“devalue[d] religious reasons for killing by judging

them to be of lesser import than nonreligious reasons,”

meaning that “religious practice [was] being singled out for

discriminatory treatment”).

But the Court has limited that doctrine. In Smith, the

Court refused to extend that reasoning to a criminal

prohibition on the use of peyote that could disqualify a

violator from receiving state unemployment benefits. 

494 U.S. at 882–85; see id. at 884 (noting that the reasoning

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of Sherbert, Thomas, and Hobbie had “nothing to do with an

across-the-board criminal prohibition on a particular form of

conduct”). The Court explained that the individual

exemption test was “developed in a context that lent itself to

individualized governmental assessment ofthe reasons for the

relevant conduct.” Id. at 884.

Here, Plaintiffs point to two phrases in support of their

argument that the Delivery Rule contains discretionary text: 

“substantially similar” (located in the Delivery Rule’s

introduction) and “good faith compliance” (located in the

Delivery Rule’s fifth exemption). We conclude, however,

that the rules do not afford unfettered discretion that could

lead to religious discrimination because the provisions are

tied to particularized, objective criteria.

The introduction to the list in the Delivery Rule allows

exemptions in circumstances that are “substantially similar”

to those in the five enumerated exemptions in section 246-

869-010(1) of the Washington Administrative Code. Thus,

the introductory text is tethered directly to those five

business-related exemption categories.

The fifth exemption is broader than the other four in that

it requires “good faith compliance” with the Stocking Rule. 

Wash. Admin. Code § 246-869-010(1)(e). Similarly, though,

that exemption ties directly to the objective standard of

meeting patients’ needs by providing a representative

assortment of drugs, as is required by the Stocking Rule. 

And, again, we note that Plaintiffs do not challenge the

Stocking Rule.

As mentioned previously, Plaintiffs’ reliance on evidence

of individual Commission members’ opinions does not

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support the conclusion that the exemptions will be interpreted

broadly to permit discriminatory treatment of religion or

religiouslymotivated conduct. The Commission collectively

has never issued commentary supporting such a broad

interpretation. To the extent that the Commission has made

official comments, those comments contradict Plaintiffs’

assertion that the Commission would allow exemptions

except for religious reasons; for instance, the Commission has

stated that pharmacies may not object to delivering drugs

because the drugs are too expensive.

The mere existence of an exemption that affords some

minimal governmental discretion does not destroy a law’s

general applicability. See Grace United Methodist Church v.

City of Cheyenne, 451 F.3d 643, 651 (10th Cir. 2006)

(“Consistent with the majority of our sister circuits, . . . we

have already refused to interpret Smith as standing for the

proposition that a secular exemption automatically creates a

claim for a religious exemption.”). As the Third Circuit

explained in Lighthouse Institute for Evangelism, Inc. v. City

of Long Branch:

What makes a system of individualized

exemptions suspicious is the possibility that

certain violations may be condoned when they

occur for secular reasons but not when they

occur for religious reasons. In Blackhawk[ v.

Pennsylvania, 381 F.3d 202, 211 (3d Cir.

2004)], it was not the mere existence of an

exemption procedure that gave us pause but

rather the fact that the Commonwealth could

not coherently explain what, other than the

religious motivation of [the prohibited]

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conduct, justified the unavailability of an

exemption.

510 F.3d 253, 276 (3d Cir. 2007); cf. Grace United Methodist

Church, 451 F.3d at 651 (“Indeed, in the land use context, the

Sixth, Seventh, Eighth, and Eleventh Circuits have rejected

a per se approach and instead apply a fact-specific inquiry to

determine whether the regulation at issue was motivated by

discriminatory animus, or whether the facts support an

argument that the challenged rule is applied in a

discriminatory fashion that disadvantages religious groups or

organizations.”). In summary, because the exemptions at

issue are tied directly to limited, particularized, businessrelated, objective criteria, they do not create a regime of

unfettered discretion that would permit discriminatory

treatment of religion or religiously motivated conduct.8

c. Selective Enforcement

Plaintiffs also argue that the Commission has enforced the

rules selectively in two ways: by enforcing them against

Ralph’s pharmacy but not against Catholic-affiliated

hospitals; and by enforcing them against religiously

8 Although the challenged rules on their face, and the official

commentary, demonstrate that the discretionary text in the exemptions is

tied to specific, objective criteria, we note that the Commission has the

power to change its interpretation of its rules. If the Commission were to

adopt an interpretation that penalizes religious conduct while permitting

a broad range of similar secular conduct, our holdings today would not

prevent a future as-applied challenge. See Monahan v. N.Y. City Dep’t of

Corr., 214 F.3d 275, 290 (2d Cir. 2000) (noting that a previous lawsuit

challenging the constitutionality of a government policy would not bar

subsequent as-applied challenges to the same policy, should the execution

or interpretation of the policy change).

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motivated violations but not against secularly motivated

violations.

The Commission enforces the Delivery Rule and section

(1) of the Stocking Rule through a complaint-driven process.9

Although the Commission may have different enforcement

mechanisms for rules not at issue in this litigation, the record

shows that the Commission has adopted a passive

enforcement process with respect to the rules listed above;

that is, it takes action only when a consumer files a complaint

of a violation.10 Plaintiffs assert that Catholic-affiliated

pharmacies also refuse to stock or deliver Plan B or ella. But

the record contains no evidence that any complaints have

been filed against Catholic-affiliated pharmacies. The

Commission did not investigate alleged non-compliance

among Catholic pharmacies for the simple reason that the

Commission received no complaints against those

9 Although the district court found that the Commission actively

enforced sections (2) through (6) of the Stocking Rule by means of, inter

alia, inspections, test-shopping, newsletters, and Commission-initiated

complaints, the Commission is not required to use the same mechanisms

to enforce every rule. Accordingly, we disagree with the district court’s

conclusion that the Commission’s methods of enforcing other rules

demonstrates selective enforcement with respect to the Delivery Rule and

section (1) of the Stocking Rule.

 

10 Although the district court found that the Commission itself initiated

a complaint under the Stocking Rule against Ralph’s, the Commission’s

enforcement process remained consumer-driven. The Commission filed

a complaint for procedural reasons; the original genesis was a consumer

complaint that had been filed against a pharmacist employed at Ralph’s. 

The Commission terminated the complaint against the pharmacist and

filed the complaint against Ralph’s because the individual pharmacist

would have dispensed Plan B if Ralph’s had carried it. Accordingly, the

Commission’s action was in reality initiated by a consumer’s complaint.

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pharmacies. The record does not show that the Commission

has made religiously based distinctions in its complaintdriven enforcement of the rules. The record, similarly,

contains no evidence that the Commission responded

differentlyto complaints about Catholic-affiliated pharmacies

than it did to complaints about Ralph’s. Nor does the

evidence at trial show that consumers filed complaints about

similarly situated, secularly motivated refusals to deliver

prescription drugs.11 What the record does show is that

consumers filed many complaints against Ralph’s in

connection with the store’s policy of declining to stock and

deliver Plan B and ella. In short, selective enforcement

cannot be inferred from the fact that Ralph’s has been

implicated in a disproportionate percentage of investigations,

because the Commission responds only to the complaints that

it receives.

That there may be other means by which the Commission

could enforce the rules does not weaken this conclusion. The

executive branch has an array of enforcement options, and it

is not our role to second-guess how the executive branch

exercises its discretion to enforce administrative regulations. 

Wayte v. United States, 470 U.S. 598, 607–08 (1985). The

Commission quite reasonably could have decided that a

“passive enforcement” system—one that relies on reports of

non-compliance—is the most efficient and cost-effective

11 Although three complaints were filed against entities other than

Ralph’s for failing to dispense Plan B, those entities were not similarly

situated to Ralph’s. The record shows that the Commission did not need

to take further action because the other pharmacies reassured the

Commission that they would re-stock the medication; the original failure

to dispense Plan B occurred simply because the pharmacies were

temporarily out ofstock. By contrast, Plaintiffs refuse to stock Plan B and

ella at all times.

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means of enforcement.12See id. at 612–13. That is especially

true in the present context, because those who file

complaints—customers of pharmacies—are the rules’

intended beneficiaries. Plaintiffs’ suggestion that the

Commission adopted the complaint system with the specific

intent to disadvantage religious objectors to emergency

contraception lacks any foundation in the record. The

Commission has utilized the complaint-driven system to

enforce the Stocking Rule since its enactment in 1967,

decades before Plan B or ella came on the market.

In short, no evidence supports the district court’s finding

that the Commission’s enforcement of the rules is other than

complaint-driven. Because no complaints have been filed

against Catholic-affiliated pharmacies or against other

pharmacies for non-religious refusals, other pharmacies are

12 Wayte concerned a passive enforcement system used to prosecute

persons who failed to register for the draft. The Court described some of

the benefits of this system:

[B]y relying on reports of nonregistration, the

Government was able to identify and prosecute

violators without further delay. Although it still was

necessary to investigate those reported to make sure

that they were required to register and had not, the

Government did not have to search actively for the

names of these likely violators. Such a search would

have been difficult and costly at that time. Indeed, it

would be a costly step in any “active” prosecution

system involving thousands of nonregistrants. The

passive enforcement program thus promoted

prosecutorial efficiency.

470 U.S. at 612. Those sentiments apply equally here.

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STORMANS, INC. V. WIESMAN 37

not “similarly situated” to Ralph’s.13 Therefore, they provide

no evidence of selective enforcement.

3. Application of Rational Basis Review

Because the rules at issue are neutral and generally

applicable, we review them for a rational basis. Guam v.

Guerrero, 290 F.3d 1210, 1215 (9th Cir. 2002); Miller,

176 F.3d at 1206. Under rational basis review, we must

uphold the rules if they are rationally related to a legitimate

governmental purpose. Gadda v. State Bar of Cal., 511 F.3d

933, 938 (9th Cir. 2007). Plaintiffs “have the burden to

negat[e] every conceivable basis which might support [the

rules],” FCC v. Beach Commc’ns, Inc., 508 U.S. 307, 315

(1993) (internal quotation marks omitted), a burden that they

have failed to meet. The rules are rationally related to

Washington’s legitimate interest in ensuring that its citizens

have safe and timely access to their lawful and lawfully

prescribed medications.

Defendants’ stipulation regarding “facilitated referrals”

does not change our conclusion. Whether facilitated referrals

also further patients’ access to medication is irrelevant. On

rational basis review, Plaintiffs still have the burden to negate

the Commission’s chosen method for achieving that goal. Id.

Because Plaintiffs have failed to meet that burden, the rules

survive rational basis review.

In sum, Plaintiffs’ free exercise claim fails.

 

13 As noted previously, the three complaints filed against entities other

than Ralph’s are not comparable secular refusals because those entities

experienced a temporary shortage and agreed to re-stock the medication.

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38 STORMANS, INC. V. WIESMAN

B. Equal Protection Claim

The district court also held that the rules at issue violated

Plaintiffs’ equal protection rights under the Fourteenth

Amendment. The court reasoned that Plaintiffs’ equal

protection claim is coextensive with their free exercise claim. 

On appeal, Plaintiffs do not advance any equal protection

arguments independent of their arguments concerning the

Free Exercise Clause. Because we reject Plaintiffs’ free

exercise claim, their equal protection claim, as they have

framed it, also fails.

C. Due Process Claim

Plaintiffs also argue that the rules violate their due

process rights under the Fourteenth Amendment. The district

court rejected the argument and declined to enter a judgment

that the rules violate the Due Process Clause. Defendants

urge us not to reach this issue on appeal because Plaintiffs

failed to cross-appeal. See Greenlaw v. United States,

554 U.S. 237, 244 (2008) (holding that, under the “crossappeal rule, . . . an appellate court may not alter a judgment

to benefit a nonappealing party”); El Paso Natural Gas Co.

v. Neztsosie, 526 U.S. 473, 479 (1999) (“Absent a

cross-appeal, an appellee may urge in support of a decree any

matter appearing in the record, although his argument may

involve an attack upon the reasoning of the lower court, but

may not attack the decree with a view either to enlarging his

own rights thereunder or of lessening the rights of his

adversary.” (internal quotation marks omitted)). We reject

Defendants’ suggestion.

Although “there is no bright-line test” for determining

whether an argument on appeal falls within the scope of the

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STORMANS, INC. V. WIESMAN 39

cross-appeal rule, Lee v. Burlington N. Santa Fe Ry. Co.,

245 F.3d 1102, 1107 (9th Cir. 2001), we need not explore that

issue in depth here. “Because the cross-appeal requirement

is a rule of practice and not a jurisdictional bar, an appellate

court has broad power to make such dispositions as justice

requires.” Id. (internal quotation marks omitted). Even

assuming that Plaintiffs’ due process argument is an attempt

to enlarge their own rights or lessen Defendants’ rights, in the

absence of prejudice to Defendants and in the interest of

fairness to Plaintiffs, we exercise our discretion to reach the

issue.

Plaintiffs assert that the rules infringe a fundamentalright,

which they characterize as the “right to refrain from taking

human life.” Laws that infringe a “fundamental” right

protected by the Due Process Clause are constitutional only

if “the infringement is narrowly tailored to serve a compelling

state interest.” Reno v. Flores, 507 U.S. 292, 302 (1993). 

Laws that do not infringe a fundamental right survive

substantive-due-process scrutiny so long as they are

“rationally related to legitimate government interests.” 

Washington v. Glucksberg, 521 U.S. 702, 728 (1997).

TheSupremeCourt “require[s] in substantive-due-process

cases a ‘careful description’ of the asserted fundamental

liberty interest.” Id. at 721. Accordingly, we must formulate

the asserted right by carefully consulting both the scope of the

challenged regulation and the nature of Plaintiffs’ allegations. 

See, e.g., id. at 723–24 (consulting the text of the challenged

state statute in reformulating the asserted right); Collins v.

City of Harker Heights, 503 U.S. 115, 125 (1992) (“It is

important, therefore, to focus on the allegations in the

complaint to determine how petitioner describes the

constitutional right at stake . . . .”).

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40 STORMANS, INC. V. WIESMAN

For example, in Flores, 507 U.S. at 297, a class of

juvenile detainees challenged a regulation that permitted their

release to a parent, close relative, or legal guardian generally

but permitted their release to others only in certain

circumstances. The Supreme Court rejected the plaintiffs’

characterization of the right to “freedom from physical

restraint” as too broad and concluded that “the right at issue

is the alleged right of a child who has no available parent,

close relative, or legal guardian, and for whom the

government is responsible, to be placed in the custody of a

willing-and-able private custodian rather than of a

government-operated or government-selected child-care

institution.” Id. at 302; see also Glucksberg, 521 U.S. at

722–23 (rejecting the plaintiffs’ characterization of “the

liberty to shape death” and, consulting the text of the

challenged state statute, reformulating the right as “a right to

commit suicide which itself includes a right to assistance in

doing so”); Cruzan ex rel. Cruzan v. Dir., Mo. Dep’t of

Health, 497 U.S. 261, 277–79 (1990) (referring to the right at

issue as the “constitutionally protected right to refuse

lifesaving hydration and nutrition” instead of the more

generic “right to die”); Raich v. Gonzales, 500 F.3d 850, 864

(9th Cir. 2007) (generally accepting Raich’s “careful

statement” of the right as the “right to make life-shaping

medical decisions that are necessary to preserve the integrity

of her body, avoid intolerable physical pain, and preserve her

life” but only after adding “the centerpiece—the use of

marijuana—to Raich’s proposed right” (brackets and internal

quotation marks omitted)). “This degree of specificity is

required.” Raich, 500 F.3d at 864 n.12. “[T]he right must be

carefully stated and narrowly identified before the ensuing

analysis can proceed.” Id. at 864.

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STORMANS, INC. V. WIESMAN 41

Here, Plaintiffs characterize the fundamental liberty

interest at stake as the “right to refrain from taking human

life.” That formulation is too broad in two important

respects. We must be “more precise.” Glucksberg, 521 U.S.

at 723.

First, Plaintiffs have not attempted to establish that Plan

B and ella objectively cause the taking of human life. As the

district court noted, “the parties do not agree that a life is at

stake. There is no doubt about the consequences of assisted

suicide; here, there is doubt.” In response, Plaintiffs have

neither argued nor presented evidence to establish that the

drugs objectively cause the taking of human life. Instead,

Plaintiffs have emphasized that their “religious beliefs form

the foundation” of their due process claim. They seek to

prove a violation of their due process rights by establishing

that: “Plaintiffs believe that human life begins at the point of

union of the female ovum and male sperm, or fertilization”;

they “believe Plan B may prevent implantation of a fertilized

ovum”;14and their “religious beliefs are sincere.” 

Accordingly, we must refine the asserted fundamental liberty

interest to account for the subjectivity of Plaintiffs’

allegations.

A second refinement is also necessary. The disputed rules

do not apply generally to the population as a whole. See, e.g.,

Glucksberg, 521 U.S. at 707 (noting that the criminal

14 We doubt that courts are equipped to make a factual finding

concerning whether life begins at fertilization. Roe v. Wade, 410 U.S.

113, 159 (1973). Whether the drugs at issue prevent implantation of a

fertilized ovum, however, strikes us as a proper subject for a finding of

fact. Nevertheless, Plaintiffs declined to introduce evidence on that point,

so we address Plaintiffs’ claim as presented—which rests on their “belief”

that the drugs prevent implantation.

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42 STORMANS, INC. V. WIESMAN

prohibition against assisting suicide applies to all persons). 

Instead, like the challenged regulations in Flores, 507 U.S. at

297, the rules here apply only to persons in specific

circumstances. In particular, the rules require the delivery of

medication only by pharmacies, which are professional

businesses subject to licensing and regulatory requirements.15

Accordingly, as the Court did in Flores, 507 U.S. at 302, we

must refine the asserted right to account for the particularized

scope of the challenged law.

Taking into account those two refinements, the proper

formulation of the asserted liberty interest at stake is the right

to own, operate, or work at a licensed professional business

free from regulations requiring the business to engage in

activities that one sincerely believes lead to the taking of

human life. With that “careful description” in mind,

Glucksberg, 521 U.S. at 724, we turn to whether the asserted

right is, “objectively, deeply rooted in this Nation’s history

and tradition and implicit in the concept of ordered liberty,

such that neither liberty nor justice would exist if they were

sacrificed,” id. at 720–21 (citations and internal quotation

marks omitted). We must be “reluctant to expand the concept

of substantive due process” and must “exercise the utmost

care whenever we are asked to break new ground in this

field.” Id. at 720 (internal quotation marks omitted).

We conclude that Plaintiffs have not established the

fundamental nature of the asserted right. Plaintiffs cite a law

review article that offers historical evidence concerning,

among other things, legal protections for those wishing not to

participate in military service, capital punishment, and

15 As discussed above, the rules do not require delivery of the

medications by individual pharmacists.

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STORMANS, INC. V. WIESMAN 43

assisted suicide. Mark L. Rienzi, The Constitutional Right

Not to Kill, 62 Emory L.J. 121, 130–47 (2012). Those topics

concern non-participation in events that objectively cause the

taking of human life. Accordingly, they have little, if any,

probative weight on the topic whether our Nation has a deep

tradition of protecting the non-participation of persons who

subjectively believe that an event leads to the taking of human

life. See id. at 147 (noting that, with respect to military

service, capital punishment, and assisted suicide, “there is

essentially no room for debate that each of these contexts

involves the killing of other human beings” and that the

“context of abortion, of course, is different”). Even if we

assume that society generally protects personal nonparticipation in contexts that indisputably cause death, it does

not follow that society is equally concerned with protecting

non-participation in every context that an individual might

believe leads to death. Cf. Glucksberg, 521 U.S. at 727

(“That many of the rights and liberties protected by the Due

Process Clause sound in personal autonomy does not warrant

the sweeping conclusion that any and all important, intimate,

and personal decisions are so protected . . . .”). Moreover,

very few of the legal sources presented by Plaintiffs concern

a right of non-participation by businesses.

We recognize that there is a “trend of protecting

conscientious objectors to abortions,” Rienzi, 62 Emory L.J.

at 148, and that most—but not all—states do not require

pharmacies to deliver prescriptions, such as Plan B and ella,

in a timely manner. On balance, however, we are

unconvinced that the right to own, operate, or work at a

licensed professional business free from regulations requiring

the business to engage in activities that one sincerely believes

leads to the taking of human life is “so rooted in the traditions

and conscience of our people as to be ranked as

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44 STORMANS, INC. V. WIESMAN

fundamental.” Snyder v. Massachusetts, 291 U.S. 97, 105

(1934). Accordingly, we decline to recognize a new

fundamental right.

Because the rules do not infringe a fundamental right,

they need only be “rationally related to legitimate

government interests.” Glucksberg, 521 U.S. at 728. As

explained above, in Part A-3 of our discussion, p. 37, the

rules meet that test.

REVERSED.

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