Opinion ID: 2819793
Heading Depth: 4
Heading Rank: 1

Heading: Substantial Underinclusion

Text: A law is not generally applicable if its prohibitions substantially underinclude non-religiously motivated 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.7 Id. 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 STORMANS, INC. V. WIESMAN 27 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 pharmacy lacks 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 religiously motivated conduct would. Id. Prohibiting Santeria animal sacrifices may have advanced the government’s interests, but so would have prohibiting several types of secular 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. 28 STORMANS, INC. V. WIESMAN 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, 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.