Document ID: ./input/supremecourt_opinions/opinions/19pdf/18-1323_c07d.pdf
Page Number: 26

Cite as:  591 U. S. ____ (2020) 

21 

Opinion of BREYER, J. 

App. 1310, 1435–1436.  It also compiled circumstantial evi-
dence that explains why other applications were denied and 
explains why, given the costs of applying and the reputa-
tional risks that accompany rejection, some providers could 
have chosen in good faith not to apply to every qualifying 
hospital.  Id., at 1135, 1311 (discussing the costs associated 
with  unsuccessful  applications).    That  circumstantial  evi-
dence includes documents and testimony that described the
processes Louisiana hospitals follow when considering ap-
plications for admitting privileges, including requirements 
like  the  ones  we  cited  in  Whole  Woman’s  Health  that  are 
unrelated  to  a  doctor’s  competency  to  perform  abortions.
See generally Brief for Medical Staff Professionals as Amici 
Curiae 11–30 (reviewing the hospital bylaws in the record).
The  evidence  shows,  among  other  things,  that  the  fact 
that hospital admissions for abortion are vanishingly rare
means that, unless they also maintain active OB/GYN prac-
tices, abortion providers in Louisiana are unlikely to have
any recent in-hospital experience.  250 F. Supp. 3d, at 49.
Yet such experience can well be a precondition to obtaining 
privileges.  Doe 2, a board-certified OB/GYN with nearly 40
years’  experience,  testified  that  he  had  not  “done  any  in-
hospital work in ten years” and that just two of his patients
in the preceding 5 years had required hospitalization.  App.
387,  400.  As  a  result,  he  was  unable  to  comply  with  one 
hospital’s demand that he produce data on “patient admis-
sions and management, consultations and procedures per-
formed”  in-hospital  before  his  application  could  be  “pro-
cessed.”  Id., at 1435; see id., at 437–438.  Doe 1, a board-
certified family doctor with over 10 years’ experience, was
similarly unable to “submit documentation of hospital ad-
missions and management of patients.”  Id., at 1436. 

The  evidence  also  shows  that  many  providers,  even  if 
they  could  initially  obtain  admitting  privileges,  would  be
unable to keep them.  That is because, unless they have a 
practice  that  requires  regular  in-hospital  care,  they  will