Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca9-15-16598/USCOURTS-ca9-15-16598-1/pdf.json

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

---

FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

DONALD WELCH; ANTHONY DUK;

AARON BITZER,

Plaintiffs-Appellants,

v.

EDMUND G. BROWN, JR., Governor

of the State of California, in his

official capacity; DENISE BROWN,

Case Manager, Director of

Consumer Affairs, in her official

capacity; HARRY DOUGLAS; JULIA

JOHNSON; SARITA KOHLI; RENEE

LONNER; KAREN PINES; CHRISTINA

WONG, in their official capacities as

members of the California Board of

Behavioral Sciences; SHARON

LEVINE; MICHAEL BISHOP;

REGINALD LOW; DENISE PINES;

SILVIA DIEGO; DEV GNANADEV;

JANET SALOMONSON; GERRIE

SCHIPSKE; DAVID SERRANO SEWELL;

BARBARA YAROSLAVSKY; ANNA M.

CABALLERO; CHRISTINE

WIETLISBACH; PATRICIA LOCKDAWSON; SAMARA ASHLEY, in their

official capacities as members of

The Medical Board of California,

Defendants-Appellees.

No. 15-16598

D.C. No.

2:12-cv-02484-

WBS-KJN

ORDER AND

AMENDED

OPINION

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 1 of 14
2 WELCH V. BROWN

Appeal from the United States District Court

for the Eastern District of California

William B. Shubb, District Judge, Presiding

Argued and Submitted June 22, 2016

San Francisco, California

Filed August 23, 2016

Amended October 3, 2016

Before: Alex Kozinski, Susan P. Graber,

and Morgan B. Christen, Circuit Judges.

Order;

Opinion by Judge Graber

SUMMARY*

Civil Rights

The panel amended the opinion filed on August 23, 2016;

affirmed the district court’s judgment on the pleadings,

entered in favor of the State of California, on remand from a

preliminary injunction appeal, in an action challenging

California’s Senate Bill 1172, which prohibits state-licensed

mental health providers from engaging in “sexual orientation

change efforts” with minor patients; denied the petition for

panel rehearing; and denied on behalf of the court the petition

for panel rehearing en banc.

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

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

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 2 of 14
WELCH V. BROWN 3

The panel held that plaintiffs’ claims under the Free

Exercise and Establishment Clauses of the First Amendment

failed. The panel rejected plaintiffs’ Establishment Clause

claim that Senate Bill 1172 excessively entangled the State

with religion. The panel held that the scope of the law

regulates conduct only within the confines of the counselorclient relationship. 

The panel rejected plaintiffs’ assertion that Senate Bill

1172 has the principal or primary effect of advancing or

inhibiting religion because some minors who seek sexual

orientation change efforts have religious motivations. The

panel held that the prohibition against sexual change efforts

applies without regard to the nature of the minor’s motivation

for seeking treatment. The panel concluded that the operative

provisions of SB 1172 were fully consistent with the secular

purpose of preventing harm to minors and the evidence fell

far short of demonstrating that the primary intended effect of

SB 1172 was to inhibit religion. The panel further concluded

that although the evidence considered by the legislature noted

that some persons seek sexual orientation change efforts for

religious reasons, the documents also stressed that persons

seek change efforts for many secular reasons. The panel held

that an informed and reasonable observer would conclude that

the primary effect of SB 1172 is not the inhibition (or

endorsement) of religion. For substantially the same reasons,

the panel rejected plaintiffs’ argument that under the Free

Exercise Clause, SB 1172 was not neutral.

Finally, the panel held that plaintiffs’ privacy claim was

foreclosed by Pickup v. Brown, 740 F.3d 1208 (9th Cir.

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 3 of 14
4 WELCH V. BROWN

2014), which held that substantive due process rights do not

extend to the choice of type of treatment or of a particular

health care provider.

COUNSEL

Kevin T. Snider (argued), Michael J. Peffer, and Matthew B.

McReynolds, Pacific Justice Institute, Sacramento,

California, for Plaintiffs-Appellants.

Alexandra Robert Gordon (argued), Deputy Attorney

General; Tamar Pachter, Supervising Deputy Attorney

General; Douglas J. Woods, Senior Assistant Attorney

General; Kamala D. Harris, Attorney General; Office of the

Attorney General, San Francisco, California; for DefendantsAppellees.

William D. Temko, Katherine M. Forster, and Thomas Paul

Clancy, Munger, Tolles & Olson LLP, Los Angeles,

California; Shannon P. Minter and Christopher F. Stoll,

National Center for Lesbian Rights, San Francisco,

California; for Amicus Curiae Equality California.

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 4 of 14
WELCH V. BROWN 5

ORDER

The opinion filed August 23, 2016, and published at 2016

WL 4437617, is amended by the opinion filed concurrently

with this order.

With this amendment, the panel has voted to deny

Appellants’ petition for panel rehearing and petition for

rehearing en banc.

The full court has been advised of the petition for

rehearing en banc, and no judge of the court has requested a

vote on it.

Appellants’ petition for panel rehearing and petition for

rehearing en banc are DENIED. No further petitions for

panel rehearing or petitions for rehearing en banc may be

filed.

OPINION

GRABER, Circuit Judge:

Once again, we consider facial constitutional challenges

to California’s law prohibiting state-licensed mental health

providers from engaging in “sexual orientation change

efforts’ (“SOCE”) with minor patients. The law is known as

Senate Bill 1172, or SB 1172, and is codified in California’s

Business and Professions Code sections 865, 865.1, and

865.2. Plaintiffs are two state-licensed mental health

providers and one aspiring state-licensed mental health

provider who seek to engage in SOCE with minor patients. 

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 5 of 14
6 WELCH V. BROWN

Defendants are the Governor of California and other state

officials, to whom we refer collectively as “the State.”

Our earlier opinion in Pickup v. Brown, 740 F.3d 1208

(9th Cir. 2014), contains further background information. In

that appeal, we undertook plenary review of the claims raised

at the preliminary injunction stage. We held that “SB 1172,

as a regulation of professional conduct, does not violate the

free speech rights of SOCE practitioners or minor patients, is

neither vague nor overbroad, and does not violate parents’

fundamental rights”; and we remanded for further

proceedings on any additional claims. Id. at 1222. On

remand, Plaintiffs claimed that SB 1172 violates the Free

Exercise and Establishment Clauses of the First Amendment

and that SB 1172 violates the privacy rights of their minor

clients. The district court granted judgment on the pleadings

to the State. Reviewing de novo, Lyon v. Chase Bank USA,

N.A., 656 F.3d 877, 883 (9th Cir. 2011), we affirm.

Plaintiffs’ claims under the Religion Clauses1fail. We

earlier held that SB 1172 survives rational basis review

because “SB 1172 is rationally related to the legitimate

government interest of protecting the well-being of minors.” 

Pickup, 740 F.3d at 1232. But Plaintiffs argue that, under the

Religion Clauses, we must apply strict scrutiny. We are not

persuaded.

1

“The First Amendment provides in pertinent part that ‘Congress shall

make no law respecting an establishment of religion, or prohibiting the

free exercise thereof.’ The Free Exercise andEstablishment Clauses apply

to the States through the Due Process Clause of the Fourteenth

Amendment.” California v. Grace Brethren Church, 457 U.S. 393, 396

n.1 (1982).

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 6 of 14
WELCH V. BROWN 7

Plaintiffs first argue that, under the Establishment Clause,

SB 1172 excessively entangles the State with religion. Their

argument rests on a misconception of the scope of SB 1172. 

For example, Plaintiffs assert that Dr. Welch may not “offer

certain prayers or quote certain Scriptures to young people”

even “while working as a minister for Skyline Church” within

“the four walls of the church . . ., while engaging in those

religious activities.” The premise of this Establishment

Clause argument is mistaken, and the argument fails, because

SB 1172 regulates conduct only within the confines of the

counselor-client relationship.

We held as much in our earlier opinion: “As we have

explained, SB 1172 regulates only (1) therapeutic treatment,

not expressive speech, by (2) licensed mental health

professionals acting within the confines of the counselorclient relationship.” Id. at 1229–30 (emphasis added). That

conclusion flows primarily from the text of the law. For

example, SB 1172 prohibits SOCE “with a patient under 18

years of age.” Cal. Bus. & Prof. Code § 865.1 (emphasis

added). Legislative history, too, strongly suggests that the

law was aimed at practices that occur in the course of acting

as a licensed professional.2 Finally, the doctrine of

constitutional avoidance requires us not to interpret SB 1172

as applying in the manner suggested by Plaintiffs. See, e.g.,

Edward J. DeBartolo Corp. v. Fla. Gulf Coast Bldg. &

2 The record contains legislative reports submitted by Plaintiffs. Those

reports note repeatedly that “the intent of this bill is to limit deceptive

therapies that are harmful to minors by mental health providers.” 

(Emphasis added.) Similarly, some reports describe the “[p]urpose of this

bill” as “protections for youths [from] dangerous so-called therapies that

aim to change a person’s sexual orientation.” (Emphasis added.) Nothing

in the legislative history suggests that SB 1172 aimed to regulate ordinary

religious conduct.

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 7 of 14
8 WELCH V. BROWN

Constr. Trades Council, 485 U.S. 568, 575 (1988) (“[W]here

an otherwise acceptable construction of a statute would raise

serious constitutional problems, the Court will construe the

statute to avoid such problems unless such construction is

plainly contrary to the intent of [the legislature].”).

Notably, Plaintiffs are in no practical danger of

enforcement outside the confines of the counselor-client

relationship. The State repeatedly and expressly has

disavowed Plaintiffs’ expansive interpretation of the law. For

example, in its brief to this court, the State asserts that “SB

1172 does not apply to members of the clergy who are acting

in their roles as clergy or pastoral counselors and providing

religious counseling to congregants.” At oral argument, the

State’s lawyer reiterated that the law “does not actually apply

to members of the clergy or religious counselors who are

acting in their pastoral or religious capacity.” Oral Argument

at 15:12–15:22, available at http://www.ca9.uscourts.gov/

media/view_video.php?pk_vid=0000009871. Similarly, the

State’s lawyer emphasized that the law “exempts pastoral

counselors, clergy, etc., as long as they don’t hold themselves

out as operating pursuant to their license.” Id. at

15:32–15:41. In sum, because SB 1172 does not regulate

conduct outside the scope of the counselor-client relationship,

the law does not excessively entangle the State with religion.

Plaintiffs next argue that, under the Establishment Clause,

SB 1172 “has the principal or primary effect of advancing or

inhibiting religion.” Am. Family Ass’n, Inc. v. City of San

Francisco, 277 F.3d 1114, 1122 (9th Cir. 2002). “We

conduct this inquiry from the perspective of a ‘reasonable

observer’ who is both informed and reasonable.” Id. (quoting

Kreisner v. City of San Diego, 1 F.3d 775, 784 (9th Cir.

1993)).

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 8 of 14
WELCH V. BROWN 9

“The legislature’s stated purpose in enacting SB1172 was

to ‘protect the physical and psychological well-being of

minors, including lesbian, gay, bisexual, and transgender

youth, and to protect its minors against exposure to serious

harms caused by sexual orientation change efforts.’ 2012

Cal. Legis. Serv. ch. 835, § 1(n).” Pickup, 740 F.3d at 1223

(brackets omitted). The operative provisions of SB 1172 are

fully consistent with that secular purpose. The law regulates

the conduct of state-licensed mental health providers only; the

conduct of all other persons, such as religious leaders not

acting as state-licensed mental health providers, is unaffected. 

As explained in detail above, even the conduct of statelicensed mental health providers is regulated only within the

confines of the counselor-client relationship; in all other areas

of life, such as religious practices, the law simply does not

apply.

The prohibition against SOCE applies without regard to

the nature of the minor’s motivations for seeking treatment. 

That is, whether or not the minor has a religious motivation,

SB 1172 prohibits SOCE by state-licensed mental health

providers. And, of course, the law leaves open many

alternative paths. Minors who seek to change their sexual

orientation—for religious or secular reasons—are free to do

so on their own and with the help of friends, family, and

religious leaders. If they prefer to obtain such assistance

from a state-licensed mental health provider acting within the

confines of a counselor-client relationship, they can do so

when they turn 18.

Plaintiffs nevertheless argue that SB 1172 has the effect

of inhibiting religion because some minors who seek SOCE

have religious motivations. We acknowledge that a law

aimed only at persons with religious motivations may raise

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 9 of 14
10 WELCH V. BROWN

constitutional concerns. See, e.g., Church of Lukumi Babalu

Aye, Inc. v. City of Hialeah, 508 U.S. 520 (1993)

(invalidating under the Free Exercise Clause the prohibition

of ritual animal slaughter, tailored to reach only religiously

motivated conduct); Cent. Rabbinical Congress of U.S. &

Can. v. N.Y. City Dep’t of Health & Mental Hygiene,

763 F.3d 183 (2d Cir. 2014) (holding that strict scrutiny

applies under the Free Exercise Clause to health regulations

targeting metzitzah b’peh, an Orthodox Jewish ritual during

circumcision). But SB 1172 falls well outside that category.

The bill’s text and its legislative history make clear that

the legislature understood the problem of SOCE to

encompass not only those who seek SOCE for religious

reasons, but also those who do so for secular reasons of social

stigma, family rejection, and societal intolerance for sexual

minorities. For example, in its express legislative findings,

the legislature quoted a policy statement that found that

“[s]ocial stigmatization of lesbian, gay and bisexual people

is widespread and is a primary motivating factor in leading

some people to seek sexual orientation changes.” 2012 Cal.

Legis. Serv. ch. 835, § 1(h) (emphasis added); see also id.

§ 1(m) (“Minors who experience family rejection based on

their sexual orientation face especially serious health risks.”

(emphasis added)). The documents in the legislative history

recognized that religion is a motivating factor for some

persons who seek to change their sexual orientation; but it

also repeatedly listed “social stigmatization,” “unfavorable

and intolerant attitudes of the society,” and “family rejection”

as common causes of distress that might motivate people to

seek counseling.

The legislative findings of SB 1172 cited a 2009 report

from a Task Force convened by the American Psychological

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 10 of 14
WELCH V. BROWN 11

Association (“APA”). 2012 Cal. Legis. Serv. ch. 835, § 1(b). 

Plaintiffs note that the APA Task Force’s report concluded

that “the population that undergoes SOCE tends to have

strongly conservative religious views that lead them to seek

to change their sexual orientation.” Extrapolating from that

statement, Plaintiffs characterize the report as focusing

exclusively on persons who seek SOCE for religious reasons. 

Plaintiffs further conclude that the legislature, too, focused

exclusively on persons who seek SOCE for religious reasons.

We disagree. The evidence falls far short of

demonstrating that the primary intended effect of SB 1172

was to inhibit religion. The legislative findings cite—in

addition to the APA Task Force report—many other sources,

including a 2009 resolution by the APA; a 2000 position

statement bytheAmerican Psychiatric Association; a position

statement by the American School Counselor Association; a

1993 article by the American Academy of Pediatrics; a 1994

report by the American Medical Association Council on

Scientific Affairs; a 1997 policy statement by the National

Association of Social Workers; a 1999 position statement by

the American Counseling Association Governing Council; a

2012 position statement by the American Psychoanalytic

Association; a 2012 article by the American Academy of

Child and Adolescent Psychiatry; and a 2012 statement by the

Pan American Health Organization. 2012 Cal. Legis. Serv.

ch. 835, § 1(c)–(l). Those additional sources do not

characterize the main motivation of persons seeking SOCE as

being religious.

Even viewing the APA Task Force’s report in isolation

does not support a conclusion that only those with religious

views sought SOCE. Although the report concluded that

those who seek SOCE “tend” to have strong religious views,

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 11 of 14
12 WELCH V. BROWN

the report is replete with references to non-religious

motivations, such as social stigma and the desire to live in

accordance with “personal” values. The report noted that

“sexual stigma, manifested as prejudice and discrimination

directed at non-heterosexual sexual orientations and

identities, is a major source of stress for sexual minorities,”

which the report termed “minority stress.” “Homosexuality

and bisexuality are stigmatized, and this stigma can have a

variety of negative consequences (e.g., minority stress)

throughout the life span.” “Some individuals choose to live

their lives in accordance with personal or religious values

. . . .” (Emphasis added.) The following illustrates the

report’s general approach:

[E]xperiences of felt stigma—such as selfstigma, shame, isolation and rejection from

relationships and valued communities, lack of

emotional support and accurate information,

and conflicts between multiple identities and

between values and attractions—played a role

in creating distress in individuals. Many

religious individuals desired to live their lives

in a manner consistent with their values . . . .

That passage first identifies many non-religious sources of

distress that might cause a person to seek counseling and only

then notes that, for many religious individuals, an additional

source of distress may be present.

In sum, although the scientific evidence considered by the

legislature noted that some persons seek SOCE for religious

reasons, the documents also stressed that persons seek SOCE

for many secular reasons. Accordingly, an informed and

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 12 of 14
WELCH V. BROWN 13

reasonable observer would conclude that the “primary effect”

of SB 1172 is not the inhibition (or endorsement) of religion.

Plaintiffs next argue that, under the Free Exercise Clause,

SB 1172 is not “neutral.” Church of Lukumi, 508 U.S. at 531. 

This argument fails for substantially the same reasons as

discussed above. See also King v. Governor of N.J.,

767 F.3d 216, 241–43 (3d Cir. 2014) (rejecting the plaintiffs’

free exercise challenge to New Jersey’s law prohibiting statelicensed counselors from engaging in SOCE with minors),

cert. denied, 135 S. Ct. 2048 (2015).

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

practices because of their religious motivation, the law is not

neutral . . . .” Church of Lukumi, 508 U.S. at 533. The object

of SB 1172 is the prevention of harm to minors, regardless of

the motivations for seeking SOCE. As we have explained,

many persons seek SOCE for secular reasons. Moreover,

even if we assume that persons with certain religious beliefs

are more likely to seek SOCE, 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 by members 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).

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 13 of 14
14 WELCH V. BROWN

Stormans, Inc. v. Wiesman, 794 F.3d 1064, 1077 (9th Cir.

2015), cert. denied, 136 S. Ct. 2433 (2016).

Finally, Plaintiffs’ privacy claim fails. Plaintiffs

characterize their claim as relying on the principles found in

cases such as Lawrence v. Texas, 539 U.S. 558 (2003). 

Lawrence rests on a substantive due process analysis. Id. at

564. Accordingly, we understand Plaintiffs to be asserting

that their clients have a substantive due process right to

receive a particular form of treatment—SOCE—from a

particular class of persons—mental health providers licensed

by the State of California. See Washington v. Glucksberg,

521 U.S. 702, 721 (1997) (“[W]e have required in

substantive-due-process cases a ‘careful description’ of the

asserted fundamental liberty interest.” (quoting Reno v.

Flores, 507 U.S. 292, 302 (1993))). Our previous opinion

forecloses that argument. See Pickup, 740 F.3d at 1235–36

(“[W]e have held that ‘substantive due process rights do not

extend to the choice of type of treatment or of a particular

health care provider.’” (quoting Nat’l Ass’n for Advancement

of Psychoanalysis v. Cal. Bd. of Psychology, 228 F.3d 1043,

1050 (9th Cir. 2000))).

AFFIRMED.

 Case: 15-16598, 10/03/2016, ID: 10145006, DktEntry: 33, Page 14 of 14