140 Nev., Advance Opinion cg 

IN THE SUPREME COURT OF THE STATE OF NEVADA 

No. 87681 

FILED 

NEVADANS FOR REPRODUCTIVE 

FREEDOM, A POLITICAL ACTION 

COMMITTEE, 

Appellant, 

vs. 

DONNA WASHINGTON, AN 

INDIVIDUAL; COALITION FOR 

PARENTS AND CHILDREN, A 

POLITICAL ACTION COMMITTEE; 

AND FRANCISCO V. AGUILAR, IN HIS 

OFFICIAL CAPACITY AS THE 

NEVADA SECRETARY OF STATE, 

Respondents. 

URT 

iEF DEPUTY CLERK 

Appeal from a district court order granting injunctive relief 

preventing the Secretary of State from placing an initiative petition on the 

ballot. First Judicial District Court, Carson City; James Todd Russell, 

Judge. 

Reversed. 

Elias Law Group LLP and David R. Fox, Elisabeth C. Frost, and Daniel J. 

Cohen, Washington, D.C.; Bravo Schrager, LLP, and Bradley S. Schrager 

and Daniel Bravo, Las Vegas, 

for Appellant. 

Aaron D. Ford, Attorney General, and Laena St-Jules, Senior Deputy 

Attorney General, Carson City, 

for Respondent Francisco V. Aguilar, Secretary of State. 

Guinasso Law, Ltd., and Jason D. Guinasso, Reno. 

for Respondents Donna Washington and Coalition for Parents and 

Children. 

2 8.4- 13 

SUPREME COURT 

OF 

NEVADA 

(0) 1947A atiail. 

%.* • .n?",••• 
Stranch, Jennings, & Garvey, PLLC, and Nathan R. Ring, Las Vegas; 

Sandler Reiff Lamb Rosenstein & Birkenstock, P.C., and Joseph Sandler, 

Washington, D.C., 

for Amicus Curiae Ballot Initiative Strategy Center Foundation. 

BEFORE THE SUPREME COURT, EN BANC.' 

OPINION 

By the Court, STIGLICH, J.: 

Appellant Nevadans for Reproductive Freedom (NRF) intends 

to place an initiative petition on the ballot that would establish a 

constitutional right to reproductive freedom. The initiative petition would 

grant every individual a right to make their own decisions regarding all 

matters related to a pregnancy, including prenatal care, childbirth, 

postpartum care, birth control, vasectomy, tubal ligation, abortion, abortion 

care, management of a miscarriage, and infertility care. Respondents 

Donna Washington and Coalition for Parents and Children (collectively 

Washington) filed a complaint in district court challenging the petition. 

They alleged that the petition failed to meet statutory and constitutional 

requirements and sought to enjoin respondent the Secretary of State from 

placing the initiative on the ballot. Specifically, Washington asserted that 

the initiative petition violated the single-subject requirement because it 

considered multiple medical procedures, instead of being limited to only 

1The Honorable Patricia Lee, Justice, voluntarily recused herself from 

participation in the decision of this matter. 

SUPREME COURT 

OF 

NEVADA 

(0) I947A alem 

2 
pregnancy or abortion. The district court granted the injunction, finding 

the initiative petition invalid for three reasons: (1) it does not contain a 

single subject, (2) its description of effect is misleading, and (3) it requires 

an expenditure of money without raising the necessary revenue. 

We conclude the district court erred. First, all the medical 

procedures considered in the initiative petition concern reproduction. To 

assert that they could not all be addressed together because they are 

separate procedures is improper. Each medical procedure relates to human 

reproduction, and they are germane to each other and the initiative's single 

subject of establishing a right to reproductive freedom. We further conclude 

that the description of effect was legally sufficient and the initiative petition 

does not require an expenditure of funds. Accordingly, we reverse. 

FACTS AND PROCEDURAL HISTORY 

In September 2023, NRF filed its notice of intent to circulate an 

initiative petition that proposes adding a section to Article 1 of the Nevada 

Constitution recognizing a person's right to reproductive freedom. 

Subsection 1 of the initiative describes the right to reproductive freedom as 

follows: 

Every individual has a fundamental right to 

reproductive freedom, which entails the right to 

make and effectuate decisions about all matters 

relating to pregnancy, including, without 

limitation, prenatal care, childbirth, postpartum 

care, birth control, vasectomy, tubal ligation, 

abortion, abortion care, management of a 

miscarriage and infertility care. The right of an 

individual to reproductive freedom shall not be 

denied, burdened or infringed upon unless justified 

by a compelling State interest that is achieved by 

the least restrictive means available. 

SUPREME COURT 

OF 

NEVADA 

(0) I947A 

3 
Subsection 2 permits the State to regulate abortions after fetal viability but 

prohibits such regulation when, in the professional judgment of an 

attending provider of health care, an abortion would protect the pregnant 

individual. Subsections 3 and 5 prohibit the State from penalizing or 

prosecuting a pregnant individual based on the outcome of a pregnancy or 

penalizing or prosecuting an individual or entity who assists another person 

in exercising their right to reproductive freedom. Subsection 4 provides 

similar protections to health care providers: 

The State shall not penalize, prosecute or otherwise 

take adverse action against a provider of health 

care, who is licensed by the State, for acting 

consistent with the applicable scope of practice and 

standard of care for performing an abortion upon, 

providing abortion care to, or providing 

reproductive care services to an individual who has 

granted their voluntary consent. 

Additionally, subsection 6 states that nothing in the initiative "limits the 

rights to equality and equal protection." 

The initiative includes two definitions. It defines a "compelling 

state interest" as "an interest which is limited exclusively to the State's 

interest in protecting the health of an individual who is seeking 

reproductive health care that is consistent with accepted clinical standards 

of practice." It also defines "fetal viability" as the point when, in the 

professional judgment of an attending provider of health care, there is a 

"significant likelihood" that a fetus could survive outside of the uterus 

without extraordinary medical measures. 

NRF included the following description of effect on the 

signature pages for the petition: 

If enacted, this initiative would add a new section 

to Article 1 of the Nevada Constitution establishing 

a fundamental right to reproductive freedom. This 

SUPREME COURT 

OF 

NEVADA 

(0) I947A 440ip 

4 
initiative enables individuals to make and carry out 

decisions about matters relating to their 

pregnancies, including prenatal care, childbirth, 

postpartum care, birth control, vasectomies and 

tubal ligations, abortion and abortion care, and 

care for miscarriages and infertility. 

If this measure is enacted, the State still may 

regulate provision of abortion care after fetal 

viability, except where medically indicated to 

protect the life or physical or mental health of the 

pregnant individual. 

Under this measure, the State may not penalize, 

prosecute, or take adverse action against any 

individual based on the outcome of a pregnancy of 

the individual, or against any licensed health care 

provider who acts consistent with the applicable 

scope and practice of providing reproductive health 

care services to an individual who has granted their 

voluntary consent. Neither may the State penalize, 

prosecute, or take adverse action against any 

individual or entity for aiding or assisting another 

individual in the exercise of the rights established 

by this initiative. 

Washington filed the underlying complaint seeking to enjoin 

the Secretary of State from placing the initiative on the 2024 election ballot. 

Washington challenged the initiative on three grounds: (1) it violates 

Nevada's single-subject requirement, (2) the description of effect is 

misleading and fails to provide essential information, and (3) the initiative 

requires the expenditure of money but does not provide the necessary 

funding.2

2The Secretary of State was listed as a defendant but did not file an 

answer and took no position on the matter at the hearing. Likewise, the 

Secretary has filed an answering brief on appeal that takes no position. 

SUPREME COURT 

OF 

NEVADA 

(0) 1947A eat. 

5 
After a hearing, the district court granted Washington's request 

for declaratory and injunctive relief, barring the Secretary of State from 

placing the initiative on the ballot. The court concluded that the initiative 

embraces a multitude of subjects that are covered under various chapters 

of the Nevada Revised Statutes. The court also concluded that the 

description of effect was misleading and omitted important effects of the 

initiative petition. Lastly, the court concluded that the initiative requires 

the State to create a board to determine whether a provider of health care 

acted within the standard of care in providing reproductive care, that 

creating such a board would require the expenditure of money, and that the 

initiative does not provide a revenue source for that expenditure. This 

appeal followed. 

DISCUS SION 

The Nevada Constitution gives the people the authority to place 

an initiative on the ballot to make law directly by proposing legislation and 

constitutional amendments. That power is broad but subject to some 

limitations. In particular, an initiative petition must be limited to a single 

subject, include a legally sufficient description of effect, and provide a 

revenue source for any required expenditure of funds. When considering 

whether an initiative petition complies with those requirements, a 

reviewing court must ensure the people's right to the initiative process is 

not quelled. See Educ. Initiative PAC v. Comm. to Protect Nev. Jobs, 129 

Nev. 35, 37-38, 293 P.3d 874, 876 (2013) (explaining that a court must 

construe an initiative petition's compliance with the description of effect 

requirement in such a way that does not "obstruct, rather than facilitate, 

the people's right to the initiative process"). Thus, the party challenging an 

initiative petition bears the burden of demonstrating the initiative is clearly 

invalid or does not comply with these requirements. See Las Vegas 

SUPREME COURT 

OF 

NEVADA 

(0) 1947A 

6 
Taxpayer Accountability Comm. v. City Council of Las Vegas (LVTAC), 125 

Nev, 165, 176, 208 P.3d 429, 436 (2009) (holding that the party challenging 

ballot measures "beads] the burden of demonstrating that the measures are 

clearly invalid"). Our review is de novo given that the district court resolved 

the challenge to the underlying initiative petition without any factual 

disputes. Helton v. Nev. Voters First PAC, 138 Nev., Adv. Op. 45, 512 P.3d 

309, 313 (2022). 

The initiative petition complies with the single-subject requirement 

NRF asserts that because the initiative contains a single 

subject, "creating and defining a fundamental right to reproductive 

freedom," the district court erred when it concluded that the initiative 

petition violated Nevada's single-subject requirement. We agree. 

Under Nevada law, "[e]ach petition for initiative or referendum 

must ... [e]mbrace but one subject and matters necessarily connected 

therewith and pertaining thereto." NRS 295.009(1). A petition meets this 

single-subject requirement if its provisions "are functionally related and 

germane to each other in a way that provides sufficient notice of the general 

subject of, and of the interests likely to be affected by, the proposed 

initiative." NRS 295.009(2). 

Applying these provisions, we have stated that the "preliminary 

inquiry. .. is whether the initiative's parts are 'functionally related' and 

'germane' to each other." Nevadans for the Prot. of Prop. Rights, Inc. v. 

Heller (NPPRI), 122 Nev. 894, 907, 141 P.3d 1235, 1243 (2006). To answer 

that question, the court must first determine the initiative's overarching 

purpose or subject and then determine if each provision is functionally 

related and germane to that purpose or subject. See id. at 907-09, 141 P.3d 

at 1244-45; LVTAC, 125 Nev. at 180, 208 P.3d at 439. In determining an 

SUPREME COURT 

OF 

NEVADA 

(0) MTh ,-(Far ,

7 
initiative's purpose or subject, we look to the initiative's textual language 

and the proponents' arguments. LVTAC, 125 Nev. at 180, 208 P.3d at 439. 

We recently applied this analysis in Helton. 138 Nev., Adv. Op. 

45, 512 P.3d 309. That case concerned an initiative petition seeking to 

implement open primary elections and ranked-choice general elections for 

specified officeholders. Id. at 312-13. We first identified that the initiative's 

purpose was "the framework by which specified officeholders are presented 

to voters and elected."3 Id. at 314 (emphasis omitted). We then analyzed 

the changes proposed—an open primary and ranked-choice general 

election—and concluded that even though the two changes concerned 

different steps in the election process, they were functionally related and 

germane to each other and the initiative's purpose. Id. at 314-15. Thus, we 

concluded the initiative complied with the single-subject requirement. Id. 

at 315. 

The initiative petition here has the single subject of 

establishing a fundamental right to reproductive freedom. All the 

initiative's provisions functionally relate and are germane to that subject 

arid each other. Subsection 1 establishes and describes the right to 

reproductive freedom. Subsections 2 through 5 ensure that the right 

established in subsection 1 cannot be violated by the State. Subsection 6 

clarifies that the initiative does not narrow or limit equal protection rights. 

Lastly, subsection 7 defines terms used within the initiative. Thus, 

3To the extent Washington argues that Helton created a new singlesubject compliance criteria by requiring an initiative to include a framework 

concerning the subject, instead of addressing the mechanics of a subject, we 

reject this contention. Our discussion of those terms in Helton was to help 

explain why the initiative there did not violate the single-subject 

requirement. 

SUPREME COURT 

OF 

NEVADA 

OD) 1947A 

8 
subsections 2 through 7 all functionally relate to subsection 1 and the 

creation of a right to reproductive freedom. 

The inclusion of enforcement provisions that ensure the State 

does not violate the newly established reproductive freedom right does not 

violate the single-subject requirement. We acknowledge that some of the 

proposed prohibitions against penalties and regulatory allowances 

contained in subsections 2 through 5 could have been proposed in separate 

initiative petitions. Nevertheless, that possibility does not preclude a single 

initiative that presents them together when they are all germane to the 

creation of a right to reproductive freedom. In Helton, we recognized that 

an initiative petition can propose more than one change and still comply 

with the single-subject requirement as long as the changes are functionally 

related and germane to each other and the overall subject of the initiative. 

512 P.3d at 315. This is true here, as all the initiative's sections relate to 

reproduction. Further, even though the medical treatments or conditions 

discussed in the initiative may be addressed by various NRS chapters, they 

each concern the subject of reproduction and can be addressed together in a 

petition addressing that subject. 

Washington takes issue with this view of the petition's subject, 

arguing that characterizing the broad idea of "reproductive freedom" as the 

petition's single subject results in "logrolling." The term "logrolling" was 

used by the concurring and dissenting justices in NPPRI to describe what 

the single-subject requirement is intended to prevent. 122 Nev. at 918, 141 

P.3d at 1251 (Maupin, J., concurring and dissenting); id. at 922, 141 P.3d 

at 1254 (Hardesty, J., concurring and dissenting). As Justice Hardesty 

explained, "logrolling" occurs "when two or more completely separate 

provisions are combined in a petition, one or both of which would not obtain 

SUPREME COURT 

OF 

NEVADA 

(0) (947A Alitto 

9 
enough votes to pass without the other." Id. at 922, 141 P.3d at 1254 

(Hardesty, J., concurring and dissenting). In that scenario, an unpopular 

provision typically is buried in the text of an initiative addressing a more 

popular provision that the proponent expects will easily be approved by the 

voters. Id. The single-subject requirement thus aims to prevent logrolling 

by ensuring that the voters' attention is focused on the one subject being 

advanced, "without creating confusion over what that subject is, and 

without making them choose between competing policy goals." Id. at 923, 

141 P.3d at 1254. This court expanded upon that discussion of logrolling in 

LVTAC, stating that logrolling may also occur when an unpopular provision 

is concealed in a lengthy, complex initiative. 125 Nev. at 176-77, 208 P.3d 

at 436-37. 

We are not convinced this initiative petition involves logrolling. 

The petition itself is rather short and limited to protecting reproductive 

rights. Additionally, the initiative petition does not tie a highly attractive 

proposal to one that may struggle to get votes. Notably, Washington does 

not identify a popular provision that NRF is using to hide a less popular 

provision. In fact, the most contentious provision in the petition, abortion, 

is prominent and clearly identified both in the petition and in the 

description of effect. We cannot say that NRF is hiding an unpopular 

provision in a lengthy, complex petition or attaching an unpopular provision 

to a popular one. Thus, logrolling has not occurred here. 

This initiative petition's single subject is the creation of a 

fundamental right to reproductive freedom. All the petition's provisions are 

fundamentally related or germane to that single subject. There is no 

logrolling. We therefore conclude that the district court erred by 

SUPREME COURT 

OF 

NEVADA 

(0) 1947A 

10 

• 
determining that the initiative petition did not comply with the singlesubject requirement. 

The description of effect is legally sufficient 

Next, NRF challenges the district court's conclusion that the 

initiative petition's description of effect is defective. NRF asserts that the 

description of effect is a straightforward, succinct, and nonargumentative 

summary of the initiative's effect. Thus, NRF argues the description of 

effect complies with NRS 295.009(1)(b). 

NRS 295.009(1)(b) requires each initiative petition to Is]et 

forth, in not more than 200 words, a description of the effect of the 

initiative . . . if the initiative . . . is approved by the voters." Because the 

description of effect is statutorily required to be no more than 200 words, it 

41cannot constitutionally be required to delineate every effect that an 

initiative will have; to conclude otherwise could obstruct, rather than 

facilitate, the people's right to the initiative process." Educ. Initiative, 129 

Nev. at 38, 293 P.3d at 876. In sum, the description of effect "must be a 

straightforward, succinct, and nonargumentative summary of what the 

initiative is designed to achieve and how it intends to reach those goals." 

Helton, 138 Nev., Adv. Op. 45, 512 P.3d at 316 (quoting Educ. Initiative, 129 

Nev. at 37, 293 P.3d at 876). 

The district court concluded that the description of effect is 

legally insufficient. In doing so, the court concluded that the description of 

effect is "misleading because it fails to mention that the law will bar the 

State from prosecuting, fining, or regulating any rniscarriage or stillbirth"; 

fails to clarify what provider of health care would make a decision that an 

abortion is necessary; and does not define the term "medically indicated," 

which "misleads voters into believing that there is a specific set of criteria 

to determine when the mother's physical or mental health requires an 

SUPREME COURT 

OF 

NEVADA 

(0) 1947A cleliD 

11 
abortion." The district court was also concerned that the description of 

effect does not address the equal protection section. 

We disagree with the district court. The description of effect 

addresses the initiative's goals: to recognize and protect a fundamental 

right to reproductive freedom. The description of effect also addresses how 

the initiative intends to reach those goals: by defining what is included in 

the right to reproductive freedom and limiting the State's regulation and 

prosecution of reproductive decisions. Although Washington and the 

district court express concern with the failure to address specific effects of 

the petition, we reiterate that a description of effect cannot be required to 

address all possible ramifications of an initiative in the limited 200-word 

summary. See Helton, 138 Nev., Adv. Op. 45, 512 P.3d at 317 ("With so few 

words in which to explain the effect of an initiative petition, a challenger 

will always be able to find some ramification of or provision in an initiative 

petition that the challenger feels is not adequately addressed in the 

description of effect."). Most of the omitted effects identified by Washington 

and the district court do not concern the initiative's primary goal. Instead, 

the identified omissions involve how the initiative may apply in a variety of 

hypothetical situations, such as whether a prosecution may be permitted 

after a miscarriage or stillbirth. The court cannot, after the fact, conclude 

that the description of effect must discuss certain potential issues when the 

proponents do not allege that the primary goal of the initiative petition was 

to address those potential issues. See id. at 317 (explaining that the 

sufficiency of the description of effect does not depend "on whether someone 

else could have written it better"). Because the description of effect for this 

initiative petition is "a straightforward, succinct, and nonargumentative 

summary of what the initiative is designed to achieve and how it intends to 

SUPREME COURT 

OF 

NEVADA 

(0) I917A 

12 
reach those goals," we conclude the description of effect is legally sufficient. 

Id. at 317-18 (internal quotation marks omitted). 

The initiative petition does not require an expenditure of money 

Lastly, NRF argues that the district court erred when it 

concluded that the initiative violates the Nevada Constitution because it 

requires an expenditure of money but does not provide a source of revenue. 

We agree that the initiative does not require an expenditure of money. 

Article 19, Section 2 of the Nevada Constitution generally 

guarantees the people the power to legislate and to amend the Nevada 

Constitution by initiative petition. That power is limited by Article 19, 

Section 6, which precludes "the proposal of any statute or statutory 

amendment which makes an appropriation or otherwise requires the 

expenditure of money, unless such statute or amendment also imposes a 

sufficient tax, not prohibited by the Constitution, or otherwise 

constitutionally provides for raising the necessary revenue." See also Nev. 

Const. art. 19, § 2(1) (stating that the people's power to legislate by initiative 

petition is "subject to the limitations of Section 6 of this Article"); Educ. 

Freedorn PAC v. Reid, 138 Nev., Adv. Op. 47, 512 P.3d 296, 302-03 (2022) 

(holding that Article 19, Section 6's limitation on the initiative power 

applies to petitions that propose constitutional changes). Thus, "an 

initiative that makes an appropriation or requires an expenditure of money 

is void if it does not also provide for the necessary revenue." Educ. Freedom, 

138 Nev., Adv. Op. 47, 512 P.3d at 303 (internal quotation marks omitted). 

The district court concluded that the initiative requires an 

expenditure of money to create a board to determine if abortions are 

performed within the standard of care. In particular, the district court 

focused on subsection 4 of the initiative, which provides the State cannot 

:`penalize, prosecute or otherwise take adverse action against a provider of 

SUPREME COURT 

OF 

NEVADA 

(0) 1947A 

13 
health care, who is licensed by the State, for acting consistent with the 

applicable scope of practice and standard of care for performing an abortion 

upon, providing abortion care to, or providing reproductive care services to 

an individual." The district court reasoned that only a provider of health 

care can testify as to the standard of care and thus a panel or board would 

need to be created to evaluate whether an abortion had been provided 

within the standard of care. 

The district court reads too much into subsection 4. The 

provision limits the State's ability to prosecute a health care provider for 

providing abortion services or reproductive care that a party has consented 

to receive. It does not require that such providers be prosecuted if their care 

falls below the standard of care. Nor does the provision clearly contemplate 

a new State entity to determine the standard of care or to evaluate whether 

a provider performed within the standard of care. As the district court's 

order seemingly recognizes, if a health care provider were prosecuted or 

sued for substandard care, appropriate expert testimony could be presented 

to address the applicable standard of care. If a provider's care fell below the 

standard of care, current laws and procedures for penalizing or prosecuting 

a health care provider could address such a situation. See, e.g., NRS 

Chapter 41A (permitting an action for professional negligence when a 

health care provider's treatment falls below the standard of care, causing 

damages); NRS Chapter 630 (governing licenses of health care providers 

and providing procedures for discipline). Further, to the extent the district 

court construed the initiative as requiring a standard of care to be set as a 

matter of law, the state government already includes entities that the 

Legislature could task with adopting such regulations. See, e.g., NRS 

442.007(1) (providing that "Mlle State Board of Health shall adopt 

SUPREME COURT 

OF 

NEVADA 

(0) 1947A 4044 

14 
regulations establishing standards for perinatal care provided by any 

provider of health care"); NRS 442.260(1) (providing that the Division of 

Public and Behavioral Health "shall adopt and enforce regulations 

governing the conditions under and the methods by which abortions may be 

performed"). Accordingly, it is not a foregone conclusion that the initiative 

requires an expenditure of money to create a board to make those 

determinations. The idea that the initiative requires such an expenditure 

is speculative, at best. 

Washington failed to meet her burden of demonstrating that 

the initiative petition includes an appropriation or requires the expenditure 

of money. Washington provided no relevant evidence below, and the fiscal 

report did not indicate that the initiative petition would require an 

expenditure of funds. Even at oral argument before this court, Washington 

acknowledged that any appropriation or expenditure of funds would be 

merely speculative at this point. Accordingly, we conclude the initiative 

petition does not violate Article 19, Section 6 of the Nevada Constitution. 

CONCLUSION 

The district court erred when it credited Washington's 

challenge to the initiative petition and enjoined the Secretary of State from 

placing the measure on the ballot. The initiative petition has a single 

subject: the establishment of a fundamental right to reproductive freedom. 

All the provisions of the initiative petition are germane or functionally 

related to that subject. Additionally, the description of effect is legally 

sufficient, as it is a straightforward, succinct, and nonargurnentative 

summary of the initiative's goals and how it intends to achieve those goals. 

Lastly, Washington did not meet her burden of demonstrating that the 

initiative petition requires an expenditure of money. Accordingly, we 

SUPREME COURT 

OF 

NEVADA 

(0) 1947A 

15 
Parraguirre 

reverse the district court's order enjoining the Secretary of State from 

placing the initiative petition on the 2024 ballot. 

Al;„%y,*"..P 

Stiglich 

J. 

We concur: 

, C.J. 

Cadish 

Pickering Herndon 

SUPREME COURT 

OF 

NEVAOA 

16 

10) I947A