Document: 462 U.S. 506 103 S.Ct. 2532 76 L.Ed.2d 755 Chris SIMOPOULOS, Appellant,v.VIRGINIA. No. 81-185. Argued Nov. 30, 1982. Decided June 15, 1983. Syllabus Appellant, an obstetrician-gynecologist, was convicted after a Virginia state-court trial for violating statutory provisions that make it unlawful to perform abortion during the second trimester of pregnancy outside licensed hospital. "Hospital" is defined include outpatient hospitals, and State Department Health regulations define "outpatient hospital" as including institutions primarily furnish facilities performance surgical procedures on outpatients. The also provide second-trimester abortions may be performed in clinic "hospital" by State. evidence at appellant's established, inter alia, he unmarried minor injection saline solution his unlicensed clinic; understood appellant agree her plan deliver fetus motel did not recall being advised go hospital when labor began, although such advice included instruction sheet provided appellant; minor, alone motel, aborted 48 hours injection. Virg nia Supreme Court affirmed conviction. Held: 1. statute unconstitutionally applied asserted ground failed allege indictment prove lack medical necessity abortion. Under authoritative construction Court, prosecution obligated beyond reasonable doubt until invoked defense. Placing upon defendant burden going forward with affirmative defense normally permissible. And contention acts fact caused fetus' death meritless, view undisputed facts proved trial. P.510. 2. Virginia's requirement clinics unreasonable means furthering State's important legitimate interest protecting woman's health, which becomes "compelling" approximately end first trimester. In Akron v. Center Reproductive Health, Inc., --- ----, 2481, 75 Planned Parenthood Assn. Kansas City Ashcroft, 2517, constitutional challenges were upheld regard requirements mandating all "general, acute-care facilities." contrast, statutes do require exclusively full-service but permit their clincs. Thus, decisions Ashcroft are controlling here. Although discretion determining standards licensing does adopt depart from accepted practice, face compatible governing abortions. Pp. 510-519. 221 Va. 1059, 277 S.E.2d 194, affirmed. Roy Lucas, Washington, D.C., appellant. William G. Broaddus, Chief Deputy Atty. Gen., Richmond, Va., appellee. Justice POWELL delivered opinion Court. 1 We have considered today mandatory hospitalization City, Mo., Inc. ----. principal issue here whether constitutional. 2 * Appellant practicing obstetrician-gynecologist certified American Board Obstetrics Gynecology. November, 1979, practiced office Woodbridge, Virginia, four local Falls Church, Virginia. Church has operating room resuscitation emergency treatment cardiac/respiratory arrest. Replacement stabilization fluids hand. customarily performs first-trimester clinic. During time relevant this case, licensed, nor had sought any license it. 3 P.M. 17-year old high-school student she went November 8, 1979. She unmarried, told 22 weeks pregnant. requested want parents know. Examination confirmed five months pregnant, well into testified encouraged confer discussed alternative continuing term. return home, never decision. 4 Two days later, returned boy friend. solution. planned him course. gave prescription analgesic "Post-Injection Information" stated undergone "a procedure" warned "wide range normal reactions." App. 199. call physician if "heavy" bleeding began. sheet. Id., 200. 5 motel. Alone, bathroom left fetus, follow-up instructions, pain medication wastebasket Her friend took home. Police found later day began investigation.1 6 indicted2 unlawfully performing Circuit Fairfax County sitting without jury. unanimously Simopoulos Commonwealth, 194 (1981). This appeal followed. noted probable jurisdiction, 456 988, 102 3479, 73 1364, now affirm. II 7 raises two issues extended treatment. He contends Va.Code § 18.2-71 him, because alleged indictment, addressed prosecution's or mentioned trier fact. failure renders conviction unconstitutional reasons: (i) meet its alleging required United States Vuitch, 402 62, 91 1294, 28 601 (1971); (ii) persuasion, Patterson New York, 432 197, 97 2319, 53 281 (1977). 8 makes clear that, least respect necessity, See 1069, S.E.2d, Appellant's reliance Vuitch thus misplaced: District olumbia construed allegation. U.S., 70, S.Ct., 1298. Engle Isaac, 107, 120-121, n. 20, 1558, 1567-1568, 20 (1982); Mullaney Wilbur, 421 684, 701-703, nn. 28, 31, 95 1881, 1890-1892, 44 508 (1975). 9 fetus. trial, summarized above, meritless. 1069-1070, 200-201. III 10 consistently recognized reaffirm "important health mother" " 'compelling' . trimester." Roe Wade, 410 113, 163, 93 705, 731, 35 147 (1973). Akron, supra, 2492. embraces circumstances performed. id., 150, 725. argues, however, prohibits non-hospital imposes right privacy. we challenge there. argues differs significantly reasonably promotes interests. A. 11 furtherance compelling maternal enacted As general proposition, physicians' offices regulated under law.3 law not, practice medicine surgery unless "such procedure Health." 18.2-73 (1982). itself term "hospital." definition 32.1-123.1,4 defines hospitals."5 Section 20.2.11 Health's Rules Regulations Licensure Outpatient Hospitals (1977) ("regulations")6 pertinent part "[i]nstitutions outpatients"7 provides these clinics.8 law, facility been 12 applicable hospitals are, few exceptions, same grouped purposes discussion three main categories. grouping relates organization, management, policies, procedures, staffing. These personnel "necessary patient program needs." Va.Regs. (Outpatient Hospitals) 40.3; see 40.1. They policy manual, 43.2, administrative officer, 40.6, who must supervise clinical services 42.1, registered nurse duty times while use, 42.2. category outlines clinics, "deviations prescribed herein approved determined minimum fulfilled," 50.2.1. There set forth public areas, laboratory radiology services, §§ 52.1, 52.2, 52.3, building, 50.6.1, 50.7.1, 50.8.1, 52.4. final group care services. Most various offer, anesthesia, 43.1, laboratory, 43.6.1, 64.1.3, 64.1.4, pathology, 43.6.3, 64.2.4. Some relate sanitation, laundry, physical plant. 43.10, 43.11, 43.12.6. guidelines records, 43.7, pre-operative admission, 43.8, post-operative recovery, 43.9. Finally, mandate some evacuation planning. 43.4.1, 43.5. B 13 It readily apparent those 2493, ---- - 2520. cases, "at early trimester[,] D & E safely hospital." 2496. issue, mandated "all general, hospitals. requirement, qualify "hospitals" lawfully our 14 citizens, necessarily considerable facilities. regulating ing 15 On face, appear generally Public Association (APHA), recognizing "that greater use dilatation make[s] possible vast majority prior 16th [w]eek last menstrual period," still "[u]rges endorsement provision free-standing qualified state certification." APHA, Right Second Trimester Abortion 1, (1979). profession thought need relaxed merely abortions: "Ambulatory providing should recommended other physician's hospital-based ambulatory setting." College Obstetricians Gynecologists (ACOG), Standards Obstetric-Gynecologic Services 54 (5th ed. 1982). 52 ("Free-standing conform federal legislation."). Indeed, profession's stringent: "Such maintain surgical, anesthetic, hospitals." Ibid. 16 consider every particular. Despite personal knowledge attacked them insufficiently related health.9 His throughout litigation appears limited assertion cannot essence, argued no different substance reviewed cases.10 At time, position—both before courts Court—that would constitutional.11 can only assume petitioner either views unspecified way exist Yet, reply brief elect criticize apart broadside attack entire requirement. 17 Given plain language history adoption, 6, reason adequately equipped could, proper application, obtain permitting conclude "protecting own safety." Roe, 725.12 emphasized "[t]he seeing abortion, like procedure, insure maximum safety patient." Unlike hospitalized inpatient full-service, Rather, comport leaves method timing precisely where they belong—with patient. IV 18 judgment 19 Affirmed. O'CONNOR, whom WHITE REHNQUIST join, concurring judgment. 21 I Court's arguments based (1971) Accordingly, join parts opinion. concur insofar affirms For reasons my dissent 81-746, 81-1172, validity contingent imposed. believe case undue decision undergo 23 STEVENS, dissenting. 24 Prior (1973), felony except accredited Joint Committee Accreditation approval hospital's Review (a committee physicians).* 1975, Code amended authorize additional abortions, abor ion "in control Mental Retardation." 25 might interpreted ways. read prohibit facility. Or accord subsequently adopted Health. chooses latter interpretation. ante, 512-514. 26 think wrong. enacted, there identifying "hospitals." structure 1975 amendment suggests General Assembly change than believed necessary comply constitutionally acceptable. Moreover, below suggest incorporate clinics. testimony pertaining Hospital. Juris. Statement 16a. "two Northern located elsewhere 1977," 19a, again referring refers "clinics" once, statement concerning variety licenses regulates; even there, list distinct 18a. 27 hand, correct interpretation statute. word could reference institution 32.1-123.1 implementing regulations. role, interpret law. rest endorsed court whose reviewing. written assumption Commonwealth Our proves incorrect. disposition therefore vacate remand reconsider holding light Akron. respectfully dissent. Except permitted statute, persons guilty Class subject revocation. 18.2-71, 54-316(3), 54-317(1), 54-321.2 A punishable sentence ten years prison. 18.2-10(d). alleges violation provides: "Except sections article, person administer to, cause taken woman, drug thing, means, intent destroy unborn child, produce miscarriage, thereby shall felony." sets exceptions statute: criminal liability within trimester, 18.2-72; 18.2-73; (iii) third certain circumstances, 18.2-74; (iv) save life, 18.2-74.1. expressly negated 18.2-72. rebut defenses. explicitly excluded used principally surgery. 32.1-124(5). "Surgery" defined. question resolved, uncertain notes certificate need, 32.1-102.3, informed Office Attorney "clinic-office "if you wish perf rm type must, build it." Reply Brief 3a, 4a. seek here, argue broadly attacks irrelevant us complied 32.1-123.1. made court's title 32.1 Code, contains many laws: "The empowered regulate home agencies, facilities, generally, Title fix enforce decided employed Based record, preserving health." 1075, 204. basis assuming differently 32.1, specifically 5, infra. 'Hospital' primary function diagnosis, treatment, nursing nonsurgical, more nonrelated individuals, known varying nomenclature designation sanatoriums, sanitariums acute, short-term, long-term, maternity effect similar. 32.298(2) (1973) (repealed 1979 Acts, c. 711). "out-patient (which one physicians surgeons surgery)." promulgated pursuant authority rules prescribing permits "classify accordance character care, service rendered offered, prescribe each class conformity chapter, guiding principles expressed implied herein, due hygiene, established specialists matters safety, having availability physicians, surgeons, nurses assistants, cost expense resulting costs patients." 32-301 711) (similar rulemaking currently granted 32.1-12 32.1-127 (1979)). draft differed considerably finally approved. Draft I, (October 27, 1976). most difference Part performed, regardless preliminary proposed December 1976, hearing held January 26, 1977. Dr. R. Hill, member Board, presided hearing, staff present doctors Director Bureau Medical Nursing Facilities Services. Witnesses Associate Executive Hospital Association; representative State; representatives Richmond Hillcrest Clinic; professor Eastern School representing Southside Tidewater OBGYN Society; Ambulatory Surgical Leigh Memorial Hospital; Administrator Society Human Life; Center. Hearing Re: Proposed (January 1977). "[i]n good support." 4. concerned, about imposition then acknowledged "the [abortion] 7. But "propose[d] Virginia." 26. 28. Hospital, concerned high State, agreed "compromise" strict needed order 30. Following added III, apply doing 12, discrete periods. approval, became effective prosecuted 10, later. note new similar supersede prosecuted. pt. 32.1-12, 32.1-127, 32.1-125 "No establish, conduct, maintain, operate article." 30.1 hospitals). several II, i.e., 43.6.2, 43.7.3(c), 43.8.4, 43.8.5, 43.9.5, refer supra. counsel oral argument represented legally Tr. Oral Arg. 33. uses cl nics" meeting Hospitals), p. i. pregnancy. 62.1.2 ("Any terminate [in clinic] (12th week amenorrhea)."). 3, supra; Record 55-56 (appellant acknowledging existence license; stating seeking denying knew performed). regulations, individually specific grounds, instead making facial broadest conclusory terms: record silent applicability facility; show whether, exist, allow abortions; reasonableness regulations; opportunity defend against trial; license, granted; obtaining arduous process; construe "licensing regulations"; cover simply others irrelevant, none raised below. 196a, 214a; 801107 (Va.S.Ct.), 35; 16; 32, 43 75, 46. covering requires equipment II. fact, detailed See, e.g., 63.1.1(b), 63.3, 64.2.5(a)-(m). given extensive technological support restrict acute-care, us, An in-hospital (a) protect life mother, (b) product rape incest, (c) substantial likelihood child born irremediable incapacitating mental defect. 1970 Va.Acts, ch. 508.

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