Opinion ID: 2804418
Heading Depth: 4
Heading Rank: 3

Heading: Prosecuting Attorney Herzog continues to

Text: assert that the provisions are not unconstitutional. Moreover, the district court determined that “[t]here is a significant public interest in settling the legality of these provisions, and the existence of this interest ‘militates against a mootness conclusion.’” (citing Olagues v. Russoniello, 770 F.2d 791, 794–95 (9th Cir. 1985)). McCormack argues that her claims are not moot because they fall under three exceptions to the mootness doctrine: (a) “voluntary cessation,” (b) “collateral legal consequences,” and (c) “capable of repetition, yet evading review.” (a) McCormack is correct that this case falls within the “voluntary cessation” exception. Herzog acknowledges that under the “voluntary cessation” exception, it is well-settled that “a defendant claiming that its voluntary compliance moots a case bears the formidable burden of showing that it is absolutely clear the allegedly wrongful behavior could not reasonably be expected to recur.” Friends of the Earth, 12 MCCORMACK V. HERZOG 528 U.S. at 190. Yet Herzog argues that the court should presume that the government is acting in good faith, that the Bannock County Prosecuting Attorney office’s decision against re-filing criminal charges was made in “the interests of justice,” and that the office’s sparse history of bringing criminal charges under § 18-606 demonstrates a lack of “biased calculus.” A presumption of good faith, however, cannot overcome a court’s wariness of applying mootness under “protestations of repentance and reform, especially when abandonment seems timed to anticipate suit, and there is probability of resumption.” United States v. W.T. Grant Co., 345 U.S. 629, 632 n.5 (1953) (quoting United States v. Oregon State Medical Society, 343 U.S. 326, 333 (1952)). Furthermore, while a statutory change “is usually enough to render a case moot,” an executive action that is not governed by any clear or codified procedures cannot moot a claim. Bell v. City of Boise, 709 F.3d 890, 898–900 (9th Cir. 2013) (quoting Chem. Prod. And Distrib. Ass’n v. Helliker, 463 F.3d 871, 878 (9th Cir. 2006)). “Even assuming Defendants have no intention to alter or abandon the [offer of transactional immunity], the ease with which the [Prosecuting Attorney] could do so counsels against a finding of mootness.” Id. at 900. The discretionary decision to not refile criminal charges against McCormack is neither “entrenched” nor “permanent.” Id. In addition to the suspicious timing of the offer of transactional immunity, the district court noted that Herzog has “never repudiated the statute as unconstitutional, and he did not cease McCormack’s prosecution because he believed the prosecution was unlawful.” Instead, Herzog’s office first determined that it had insufficient evidence to re-file criminal charges against McCormack. Then, Herzog’s office offered MCCORMACK V. HERZOG 13 McCormack transactional immunity from prosecution after our court affirmed the district court’s decision that the Idaho statutes imposed an undue burden on a woman’s ability to terminate her pregnancy. The offer of immunity does not by itself make it “absolutely clear” that the prosecution of McCormack would never recur. Friends of the Earth, 528 U.S. at 170; see also Olagues, 770 F.2d at 795 (finding a continuing case or controversy where the government “did not voluntarily cease the challenged activity because [it] felt that the investigation was improper[, but, r]ather, [the government] terminated the investigation solely because it failed to produce evidence supporting any further investigative activities.”). (b) The “collateral legal consequences” exception also applies. “[A]lthough the primary injury may have passed”—Herzog has offered transactional immunity to McCormack—there still exists “‘a substantial controversy, between parties having adverse legal interests, of sufficient immediacy and reality to warrant the issuance of a declaratory judgment.’” E.E.O.C. v. Fed. Exp. Corp., 558 F.3d 842, 847 (9th Cir. 2008) (quoting In re Burrell, 415 F.3d 994, 999 (9th Cir. 2005)). Herzog continues to maintain the constitutionality of § 18-606, and declaratory relief remains available and unaffected. (c) Finally, as the district court determined, McCormack would also be eligible for the “capable of repetition, yet evading review” exception to the mootness doctrine. Like any other woman challenging a potentially applicable abortion law, McCormack may become pregnant again, and her term of pregnancy is of limited duration. Herzog counters that McCormack lacks standing to challenge § 18-606 on the basis of future pregnancies. Yet Herzog is conflating the 14 MCCORMACK V. HERZOG mootness of McCormack’s claim with her standing to bring the claim. As elaborated below, McCormack may not have standing to challenge the provision on the basis of future pregnancies, but that does not moot her current action. See Friends of the Earth, 528 U.S. at 191 (explaining that a postcomplaint resolution will not moot an action, “despite the fact that [the plaintiff] would have lacked initial standing had she filed the complaint after the [resolution]”). Thus, the district court correctly held that McCormack’s claim is not moot. 3. McCormack has standing based on a lingering risk of prosecution under § 18-606. Prosecuting Attorney Herzog asserts that McCormack lacks standing to challenge § 18-606 on the basis of future pregnancies. Article III standing requires that McCormack establish (1) that she personally has suffered an “actual or imminent, not conjectural or hypothetical” injury as a result of the allegedly illegal conduct; (2) a causal link between her injury and the challenged action; and (3) that the injury must likely be “redressed by a favorable decision” of a federal court. Lujan v. Defenders of Wildlife, 504 U.S. 555, 560–61 (1992) (internal quotation marks and citations omitted). “A plaintiff who challenges a statute must demonstrate a realistic danger of sustaining a direct injury as a result of the statute’s operation or enforcement.” Babbitt v. United Farm Workers Nat’l Union, 442 U.S. 289, 298 (1979) (citing O’Shea v. Littleton, 414 U.S. 488, 494 (1974)). MCCORMACK V. HERZOG 15 In McCormack I, we held that McCormack does not have standing to challenge PUCPA “based on a possible future pregnancy” because “in McCormack’s case there are too many ‘possibilities that may not take place and all may not combine.’” 694 F.3d at 1025 (quoting Roe v. Wade, 410 U.S. 113, 128 (1973)). And McCormack conceded that Roe and other related cases have held that the possibility of future pregnancy “may be too speculative and conjectural for standing.”9 Nevertheless, McCormack continues to have standing based on the ongoing risk of prosecution for the termination of her past pregnancy. The district court properly noted that “[a]t the outset of this litigation, McCormack had standing to challenge the constitutionality of section 18-606 in conjunction with both section 18-608(1) and section 18608(2) . . . because she faced prosecution and continued to be threatened with prosecution.” And McCormack presently has standing to challenge §§ 18-606 and 18-608 because, as discussed in section A.2 above, the Prosecuting Attorney’s offer of immunity does not guarantee that the prosecution of McCormack would never recur. Because McCormack 9 Indeed, “there are circumstances in which the prospect that a [party] will engage in (or resume) [its] conduct may be too speculative to support standing, but not too speculative to overcome mootness.” Friends of the Earth, 528 U.S. at 190. Therefore, even if McCormack may not have standing to challenge § 18-606 on the basis of future pregnancies, that does not moot her initial claim that she asserted when she properly had standing. Id. (“Standing doctrine functions to ensure, among other things, that the scarce resources of the federal courts are devoted to disputes in which the parties have a concrete stake. In contrast, by the time mootness is an issue, the case has been brought and litigated, often . . . for years. To abandon the case at an advanced stage may prove more wasteful than frugal.”). 16 MCCORMACK V. HERZOG currently has standing based on a lingering risk of prosecution under § 18-606, her injury is not conjectural or hypothetical. Lastly, the risk of continued enforcement of § 18-606 against McCormack is still redressable by declaratory relief. Accordingly, McCormack has standing to challenge the enforcement of § 18-606 against her for her past alleged abortion. B. Dr. Hearn has standing to challenge §§ 18-505 and 18608. The district court properly found that Dr. Hearn, as an Idaho licensed physician intending to provide pre-viability medical abortions, has standing to challenge §§ 18-505 and 18-608. We review the district court’s standing decision de novo. Gospel Missions of America v. City of Los Angeles, 328 F.3d 548, 553 (9th Cir. 2003). To determine whether a physician has third-party standing to assert the rights of patients in the abortion context, the panel must determine: (1) whether the physician alleges “injury in fact” to himself or herself; and (2) whether the physician is a proper proponent of the legal rights on which he or she bases the suit. Singleton v. Wulff, 428 U.S. 106, 112 (1976). Herzog concedes that we have held that a physician possesses standing on his own behalf and on that of his patients to challenge the validity of another Idaho abortion statute. Planned Parenthood of Idaho, Inc. v. Wasden, 376 F.3d 908, 917 (9th Cir. 2004) (“[P]hysicians and clinics performing abortions are routinely recognized as having standing to bring broad facial challenges to abortion statutes.”). The Supreme Court has also repeatedly held that MCCORMACK V. HERZOG 17 a physician may “assert the rights of women patients as against governmental interference” in the abortion context. Singleton, 428 U.S. at 118 (recognizing that “there seems little loss in terms of effective advocacy from allowing [an assertion of a woman’s right to an abortion] by a physician”); see also Planned Parenthood of Se. Pa. v. Casey, 505 U.S. 833, 845 (1992) (allowing abortion providers to challenge a state statute on behalf of third-party women who seek abortion services); Griswold v. Connecticut, 381 U.S. 479, 481 (1965) (holding that physicians have standing to assert the constitutional rights of patients to whom they prescribed contraceptive devices). Prosecuting Attorney Herzog attempts to distinguish Dr. Hearn from other physicians who have been recognized as having standing. Herzog asserts that Dr. Hearn cannot challenge the validity of §§ 18-505 and 18-608 because he has not established that he can provide abortions in a “medically appropriate manner.” Herzog claims that Dr. Hearn seeks to provide access to abortifacients, i.e., medication to induce abortions, under a regime that has negative health and potentially life-threatening consequences and a finding of standing cannot be “squarely adverse to the interests of the patient.” First, Dr. Hearn has stated his clear intention to “prescribe FDA approved medications to women in Bannock County, Idaho such as Plaintiff McCormack who . . . seek to medically terminate their pregnancies in violation of the restrictions contained in Idaho Code Title 18, Chapters 5 and 6 . . . prior to fetal viability.” Furthermore, Dr. Hearn intends to perform medical abortions outside a clinical or hospital setting through the second trimester. We have recognized that a physician’s statement of intent is sufficient to establish 18 MCCORMACK V. HERZOG standing, when the physician is at risk of criminal prosecution under the relevant statutes. Wasden, 376 F.3d at 916–17 (“by stat[ing] his clear intent[] to continue to perform abortions . . . [a physician] has alleged a sufficiently concrete and imminent injury—possible prosecution and imprisonment—to challenge the provisions that ban abortion providers from [providing medical abortions to women prior to fetal viability.]”). Further, Dr. Hearn need not even claim a “specific intent to violate the statute.” Id. at 917 (noting that a plaintiff need only “reasonable fear a statute would be enforced against it if it engaged in certain conduct”) (citation omitted). Second, Dr. Hearn’s intent to provide FDA-approved medication to women to terminate their pregnancies prior to fetal viability does not need to be supported by a demonstration of the “medical appropriateness” of his ability to provide medical abortions. Whether Dr. Hearn can provide medical abortions in “an appropriate clinical setting” is irrelevant to whether he, as an Idaho licensed physician, can effectively represent the constitutional right to terminate a pregnancy before viability. The Supreme Court has looked to the professional relationship between a physician and a patient, Griswold, 381 U.S. at 481, the economic harm on abortion providers, Singleton, 428 U.S. at 112–13, and a physician’s “direct stake” in the abortion process, Diamond v. Charles, 476 U.S. 54, 67 (1986), when determining standing. But an inquiry into the “medical appropriateness” of an abortion provider’s practice is not only unprecedented, but is also too ambiguous, and thus unwarranted. Since 1997, Dr. Hearn has continuously been registered with the Federal Drug Enforcement Agency and the Idaho State Board of Pharmacy. And his ability to legally prescribe MCCORMACK V. HERZOG 19 FDA-approved abortion medication in Bannock County is sufficient to demonstrate an “actual and imminent” injury—the risk of criminal prosecution for prescribing abortion pills prior to viability. Accordingly, the district court properly determined that Dr. Hearn has standing to assert his patients’ rights in cases challenging abortion restrictions, and we will consider Dr. Hearn’s claims. C. The statutes pose an undue burden on a woman’s ability to obtain an abortion, and the criminal sanctions for abortion providers are unconstitutionally vague. A woman has a Fourteenth Amendment right to terminate a pre-viability pregnancy, “and to obtain it without undue interference from the State.” Casey, 505 U.S. at 846. However, this right is not absolute, and the state may express its interest in potential life by regulating abortions, so long as the regulations do not pose an “undue burden” on a woman’s ability to seek an abortion before the fetus attains viability. Id. at 874. Although the state may ensure that the woman’s choice is informed, and protect the health and safety of a woman seeking an abortion, the state may not prohibit a woman from making the “ultimate decision” to undergo an abortion. Id. at 878–79. 1. Standard of Review We review de novo a district court’s grant of summary judgment. Nunez v. City of San Diego, 114 F.3d 935, 940 (9th Cir. 1997). “[A] facial challenge to an abortion statute will succeed where, in a large fraction of the cases in which 20 MCCORMACK V. HERZOG the statute is relevant, it will operate as a substantial obstacle to a woman’s choice to undergo an abortion.” Wasden, 376 F.3d at 921 (internal quotation marks, brackets, and citation omitted). And the “large fraction” is computed by focusing on “those upon whom a challenged law would have some actual effect, rather than all women . . . seeking an abortion.” Id. There is also a heightened need for definiteness “when the ordinance imposes criminal penalties on individual behavior or implicates constitutionally protected rights.” Nunez, 114 F.3d at 940. 2. Section 18-505 is facially unconstitutional because it categorically bans some abortions before viability. Section 18-505 prohibits abortions of fetuses of twenty or more weeks postfertilization. The twenty-week ban applies regardless of whether the fetus has attained viability. The Supreme Court reaffirmed in Casey that an undue burden exists if the purpose or effect of a provision of law places a substantial obstacle in the path of a woman seeking an abortion before the fetus obtains viability. Casey, 505 U.S. at 846. In Planned Parenthood of Cent. Mo. v. Danforth, 428 U.S. 52, 64 (1976), the Court further explained that “it is not the proper function of the legislature or the courts to place viability, which essentially is a medical concept, at a specific point in the gestation period.” Because § 18-505 places an arbitrary time limit on when women can obtain abortions, the statute is unconstitutional. We also recently held unconstitutional an Arizona law banning abortions after the twenty week gestational age because the law operated as a ban on a woman’s constitutional right a to pre-viability abortion. Isaacson v. Horne, 716 F.3d 1213, 1225–1227 (9th Cir. 2013). MCCORMACK V. HERZOG 21 Prosecuting Attorney Herzog concedes that “[n]o dispute exists that medical induction abortions can occur between the twentieth week of pregnancy and fetal viability.” Yet Herzog attempts to reframe the issue as whether the statute imposes an undue burden on Dr. Hearn’s proposed plan to provide medical abortions in the patient’s home after the twentieth week of pregnancy. Although Dr. Hearn’s proposed plan would be detrimentally affected by the enforcement of § 18505, the broader effect of the statute is a categorical ban on all abortions between twenty weeks gestational age and viability. This is directly contrary to the Court’s central holding in Casey that a woman has the right to “choose to have an abortion before viability and to obtain it without undue interference from the State.” Casey, 505 U.S. at 846 (emphasis added). Thus, the district court did not err in finding § 18-505 facially unconstitutional. 3. Section 18-608(2) is facially unconstitutional because it requires hospitalizations for all second-trimester abortions. Section 18-608(2) requires that all second-trimester abortions occur in a hospital. If the licensed medical provider fails to abide by § 18-608(2), he or she will be subject to civil and criminal penalties, as outlined in §18-605. The Supreme Court has twice invalidated requirements that physicians perform all second-trimester abortions in hospitals. See Planned Parenthood Ass’n of Kansas City, Mo., Inc. v. Ashcroft, 462 U.S. 476 (1983); City of Akron v. Akron Center for Reproductive Health, Inc., 462 U.S. 416 (1983) (overturned on other grounds). “[S]uch a requirement 22 MCCORMACK V. HERZOG unreasonably infringes upon a woman’s constitutional right to obtain an abortion.” Planned Parenthood Ass’n of Kansas City, Mo., Inc., 462 U.S. at 482 (internal quotation marks omitted). Prosecuting Attorney Herzog attempts to distinguish the present case from this controlling Supreme Court precedent by arguing that both the absolute and percentage terms of second trimester abortions in Idaho are “quite small.” Between 2007 and 2011, about 1.2 percent of abortions in Idaho were performed during or after the fourteenth week of pregnancy and only about 21.5 percent of those abortions were non-surgical. But Herzog draws the court’s attention to irrelevant figures. The percentage of non-surgical second trimester abortions is certainly small, but for “a large fraction of the cases in which [the statute] is relevant,” required hospitalization will operate as a substantial obstacle. Casey, 505 U.S. at 895. Herzog also asserts that Dr. Hearn is not “competent professionally” to provide medical abortions outside of a hospital setting. However, we think that an inquiry into the “medical appropriateness” of Dr. Hearn’s proposed prescriptions of abortion pills is not properly part of our analysis, especially given the vagueness of that phrase. Therefore, the district court did not err in finding § 18608(2) facially unconstitutional. 4. Section 18-608(1) in conjunction with § 18-605 is unconstitutionally vague. Section 18-608 outlines where certain abortions are permitted. Specifically, §18-608(1) requires abortions during MCCORMACK V. HERZOG 23 the first trimester to take place in a hospital, physician’s office, or clinic that is: properly staffed and equipped for the performance of such procedures and respecting which the responsible physician or physicians have made satisfactory arrangements with one or more acute care hospitals within reasonable proximity thereof providing for the prompt availability of hospital care as may be required due to complications or emergencies that might arise. Idaho Code Ann. § 18-608(1) (emphasis added). Section 18-605 establishes civil and criminal penalties for persons who perform abortions other than as permitted by the remainder of Title 18, Chapter 6 of the Idaho Code. In particular, § 18-605(3) states that the licensed or certified health care provider must “knowingly” violate the statute to be guilty of a felony. Herzog contests the district court’s determination that § 18-608(1) is unconstitutionally vague, arguing that: (1) whether a medical office is “properly staffed” and whether “satisfactory arrangements” with a hospital have been made “connote objectively determinable facts,” and (2) the § 18-605 enforcement provisions require the alleged violation to be performed “knowingly.” We are not persuaded. “To avoid unconstitutional vagueness, an ordinance must (1) define the offense with sufficient definiteness that 24 MCCORMACK V. HERZOG ordinary people can understand what conduct is prohibited; and (2) establish standards to permit police to enforce the law in a non-arbitrary, non-discriminatory manner.” Nunez, 114 F.3d at 940. If a statute subjects violators to criminal penalties, the need for clear definitions “is even more exacting.” Forbes v. Napolitano, 236 F.3d 1009, 1011 (9th Cir. 2000). The Supreme Court has held that “a criminal statute that fails to give a person of ordinary intelligence fair notice that his contemplated conduct is forbidden by the statute or is so indefinite that it encourages arbitrary and erratic arrests and convictions is void for vagueness.” Colautti v. Franklin, 439 U.S. 379, 390 (1979) (internal quotation marks and citations omitted). “[W]here the uncertainty induced by the statute threatens to inhibit the exercise of constitutionally protected rights[,]” the law is even more likely to be found unconstitutionally vague. Id. at 391. In Gonzales v. Carhart, 550 U.S. 124, 147–48 (2007), the Supreme Court considered whether the Partial-Birth Abortion Ban Act of 2003, 18 U.S.C. § 1531 (2000 ed., Supp. IV), was unconstitutionally vague. The Act defines the unlawful abortion in explicit terms and includes very specific “anatomical landmarks” to put abortion providers on notice as to what type of abortions are prohibited. Gonzales, 550 U.S. at 147–48. The Court found that the Act sets forth “relatively clear guidelines as to prohibited conduct and provides objective criteria to evaluate whether a doctor has performed a prohibited procedure[,] . . . [u]nlike the statutory language in Stenberg [v. Carhart, 530 U.S. 914 (2000)] that prohibited the delivery of a substantial portion of the fetus.” Id. at 149 (internal quotation marks omitted). MCCORMACK V. HERZOG 25 Unlike the terms in the Act at issue in Gonzales, the terms “properly” and “satisfactory,” as used in § 18-608(1), lack precise definition, and “subject[] physicians to sanctions based not on their own objective behavior, but on the subjective viewpoints of others.” Tucson Woman’s Clinic v. Eden, 379 F.3d 531, 555 (9th Cir. 2004) (internal quotation marks omitted). Neither term is defined in the statute, nor are they terms of art with specific definitions in the medical context. We have found a statute unconstitutionally vague that required that patients “be treated with consideration, respect, and full recognition of the patient’s dignity and individuality” because “understandings of what ‘consideration,’ ‘respect,’ ‘dignity,’ and ‘individuality’ mean are widely variable, . . . [making the statute too] vague and subjective for providers to know how they should behave in order to comply, as well as too vague to limit arbitrary enforcement.” Id. at 554–55 (internal quotation marks omitted). Here, the terms “properly” and “satisfactory” are similarly subjective and open to multiple interpretations. The district court noted that the dictionary definitions of the terms also are unhelpful in curing the statute’s vagueness. “Properly” means “suitably, fitly, rightly, correctly.” WEBSTER’S THIRD INT’L DICTIONARY 1818 (3d ed. 1976)). “Satisfactory” means “sufficient to meet a condition or obligation.” Id. at 2017. Instead of providing clarity, the definitions raise the same questions as the terms themselves: proper, satisfactory, fit, right, or sufficient according to whom or what standard? Unlike the specific “anatomical landmarks” in the statute at issue in Gonzales, § 18-608(1) fails to provide a specific 26 MCCORMACK V. HERZOG standard to measure or determine what is “proper” or “satisfactory.” The district court correctly recognized the “trap” of these imprecise terms: they “could well impose criminal liability on activity that offends some people’s sense of what is ‘properly staffed and equipped’ or what arrangements are ‘satisfactory,’ but may appear to others as more than adequate.” Moreover, the scienter requirement in § 18-605(3) (a medical provider must “knowingly violate[] the provision[]” to be guilty of a felony), does not make the widely variable definitions of “properly” and “satisfactory” any less vague. Because the enforcement of the statute relies on “wholly subjective judgments without statutory definitions,” a physician could argue that he believed he complied with § 18608(1). United States v. Williams, 553 U.S. 285, 306 (2008). Additionally, “this lack of clarity may operate to inhibit [a physician’s provision of legal abortion services] because individuals will not know whether the ordinance allows their conduct, and may choose not to exercise their rights for fear of being criminally punished.” Hunt v. City of Los Angeles, 638 F.3d 703, 713 (9th Cir. 2011). Herzog also attempts to import the “reasonable physician” standard from Idaho’s medical practice liability statute (which is not being challenged in this case) to argue that a standard of objective reasonableness for physicians generally applies to all instances of civil liability—including § 18-608. However, violators of § 18-608 are not just subject to civil penalties, but also to criminal prosecution under § 18-605. And whereas the legislature definitively outlined a reasonable physician standard in the medical malpractice statute, it failed to do so in the abortion statute. Without clear language that gives physicians adequate notice of how to comply with the MCCORMACK V. HERZOG 27 statute, § 18-608(1), as interpreted with § 18-605, is unconstitutionally vague. See Colautti, 439 U.S. at 391 (finding a statute void for vagueness “where the uncertainty induced by the statute threatens to inhibit the exercise of constitutionally protected rights,” even where the law could have some constitutional applications). Lastly, Herzog argues that if our court finds § 18-608(1) impermissibly vague, we should sever the unconstitutional words from the statute pursuant to § 18-616, the law’s severability clause. The Idaho Supreme Court has held that “when the unconstitutional portion of a statute is not integral or indispensable, it will recognize and give effect to a severability clause.” Simpson v. Cenarrusa, 944 P.2d 1372, 1377 (Idaho 1997). Assuming the terms “properly” and “satisfactory” are severable, striking these words from the statute would not remedy the constitutional infirmities of the statute. Removing the ambiguous terms would result in the following language: Abortions permitted by this subsection shall only be lawful if and when performed in a hospital or in a physician’s regular office or a clinic which office or clinic is ______ staffed and equipped for the performance of such procedures and respecting which the responsible physician or physicians have made ______ arrangements with one or more acute care hospitals within reasonable proximity thereof providing for the prompt availability of hospital care as may be required due to complications or emergencies that might arise. 28 MCCORMACK V. HERZOG The appropriate amount of staff and equipment for an abortion remains unclear, as there may be differing opinions about what is sufficient. It also is unclear what types of arrangements must be made with acute care hospitals to comply with the statute. “Given the potential for harassment of abortion providers, it is particularly important that enforcement of any unconstitutionally vague provisions of the scheme be enjoined.” Tucson Woman’s Clinic, 379 F.3d at 554. Thus, the lack of definitive standards for performing legal first trimester abortions causes § 18-608(1) to remain unconstitutionally vague.