Court Opinion

ID: 9644808
Source: CourtListenerOpinion
Date Created: 2023-08-22 21:05:24.971967+00
Date Added: 2024-06-11T13:07:11.654881
License: Public Domain

OPINION
LEWIS, Chief Judge.
In this class action we consider the legality under federal law of state regulations that prohibit the Utah Planned Parenthood Association (UPPA) from providing minors with family planning assistance absent parental consent. Under 42 U.S.C. § 1983 the plaintiff seeks a declaratory order to the effect that these regulations violate her rights under federal statutes and the United States Constitution, and she seeks an injunction against their continued enforcement. A three-judge court was duly empaneled to hear her case. Our jurisdiction, *876which is not disputed, arises from 28 U.S.C. § 1343(3) and (4).
Pursuant to plans approved by the Department of Health, Education and Welfare (HEW), the State of Utah administers Aid to Families with Dependent Children (AFDC) and Medicaid, both of which programs are subsidized by federal funds and regulated under the Social Security Act of 1935, as amended, 42 U.S.C. § 601 et seq.; 42 U.S.C. § 1396 et seq. Federal law requires states participating in these programs to provide family planning assistance to those program recipients, including sexually active minors, who desire such assistance. 42 U.S.C. § 602(a)(15); 42 U.S.C. §§ 1396a(a)(8), 1396d(a)(4)(C). The state contracted with the UPPA for the latter to provide family planning services and supplies to AFDC and Medicaid recipients. Regulations FPX 120, FPC 120, and 3.7(c), which were adopted by the defendant state administrators and approved by HEW as part of the state’s AFDC and Medicaid plans, provide that family planning services to minors may be furnished only with written consent of the minor’s parents.
At the time this action was filed, the plaintiff was fifteen years old. She is a member of a family receiving AFDC and Medicaid. She has sought family planning information, counseling, services, and supplies from the UPPA, but because she refuses to obtain permission of her parents the UPPA has, pursuant to regulations FPX 120, FPC 120, and 3.7(c), denied her assistance. She therefore challenges the state’s regulations on the grounds that they violate her rights to family planning assistance under the Social Security Act and her right of privacy under the fourteenth amendment. In this action plaintiff T_H-represents herself and all other minors in the state who receive or who are eligible to receive either AFDC or Medicaid or both, and who seek family planning assistance from the UPPA.
In Doe v. Planned Parenthood Ass’n, 29 Utah 2d 356, 510 P.2d 75, the Utah Supreme Court held that the state’s parental consent requirements do not violate the rights of minors under either the ninth amendment or the equal protection clause of the fourteenth amendment. In a summary order and without citation of authority, the United States Supreme Court dismissed Doe’s appeal for want of jurisdiction. 414 U.S. 805, 94 S.Ct. 138, 38 L.Ed.2d 42. The defendants in the present action argue that the high court’s summary dismissal in Doe v. Planned Parenthood Ass’n forecloses our examination of the issues raised by plaintiff T_ H_Our reading of Doe, however, leads us to conclude that the Utah court did not rule on the validity of defendants’ parental consent regulations with respect to the constitutional right of privacy or the federal statutory restrictions that are the subject of this case. Accordingly the law of the case has not been established by the United States Supreme Court’s summary dismissal of the appeal from that case.
We hold first that the state’s regulations impermissibly engraft upon AFDC and Medicaid eligibility requirements a condition in conflict with the provisions of the Social Security Act. Second we hold that the state’s regulations infringe upon the plaintiff’s right to privacy unjustified by any compelling state interest in regulation.
I.
As a preliminary matter, the defendants request the appointment of a guardian ad litem to represent the plaintiff T- H_ in this litigation in accordance with Fed.R.Civ.P. 17(c). The pertinent portion of that Rule is as follows:
The court shall appoint a guardian ad litem for an infant or incompetent person not otherwise represented in an action or shall make such other order as it deems proper for the protection of the infant or incompetent person.
Neither the appointment of a guardian ad litem nor a protective order in lieu of such appointment is mandatory so long as we determine that the plaintiff is adequately protected in this litigation without a guardian. Jacobs v. Board of School Comm’rs, 7 Cir., 490 F.2d 601, 604, vacated as moot, 420 *877U.S. 128, 95 S.Ct. 848, 43 L.Ed.2d 74 (1975); Roberts v. Ohio Cas. Ins. Co., 5 Cir., 256 F.2d 35, 39; Rotzenburg v. Neenah Joint School Dist., E.D.Wis., 62 F.R.D. 340. We have considered the following facts in making that determination. First, the plaintiff in this action asserts her own statutory and constitutional rights independent of her parents, who are her guardians under Utah law. Second, the plaintiff does not seek monetary relief but raises statutory and constitutional claims aimed at declaratory and injunctive relief. Third, the plaintiff is represented by able and experienced counsel. These circumstances, we believe, eliminate the need for appointment of a guardian ad litem or other protective order. Jacobs v. Board of School Comm’rs, supra, 490 F.2d at 604; Rotzenburg v. Neenah School Dist., supra. We therefore refuse defendants’ request.
II.
States that desire to take advantage of the substantial federal assistance funds from the AFDC and Medicaid programs are required under 42 U.S.C. §§ 601 and 1396 to submit plans for approval of the Secretary of HEW. These plans must conform with the requirements of the Social Security Act and with relevant regulations promulgated by HEW. 42 U.S.C. §§ 602,1396a; King v. Smith, 392 U.S. 309, 88 S.Ct. 2128, 20 L.Ed.2d 1118. Although the states have considerable latitude in shaping these assistance programs, they may not depart from pertinent federal statutory and administrative guidelines. Thus the Supreme Court has repeatedly held that state AFDC eligibility standards that exclude persons eligible for assistance under federal AFDC guidelines violate the Social Security Act, 42 U.S.C. § 602(a)(10), and are therefore invalid under the supremacy clause of the Constitution. Carleson v. Remillard, 406 U.S. 598, 92 S.Ct. 1932, 32 L.Ed.2d 352; Townsend v. Swank, 404 U.S. 282, 92 S.Ct. 502, 30 L.Ed.2d 448; King v. Smith, 392 U.S. 309, 88 S.Ct. 2128, 20 L.Ed.2d 1118. Most recently the Supreme Court has held in a per curiam opinion that state regulations may not, consistent with this line of cases, engraft upon AFDC eligibility requirements a condition in conflict with 42 U.S.C. § 602(a), which sets forth standards for state AFDC plans. Lascaris v. Shirley, 420 U.S. 730, 95 S.Ct. 1190, 43 L.Ed.2d 583 (1975). Although none of these cases deals directly with the validity of state limitations on the provision of federally-funded family planning services through AFDC or Medicaid, we believe that the principle of review is the same: to the extent that the states impose conditions on the provision of these services in conflict with federal standards, the latter must prevail.
We turn now to the specific federal standards claimed by plaintiff to conflict with the state’s regulations FPX 120, FPC 120, and 3.7(c). 42 U.S.C. § 602(a)(15) provides in part that state plans for the administration of AFDC must provide
for the development of a program, for each appropriate relative and dependent child receiving aid under the plan . . . for preventing or reducing the incidence of births out of wedlock and otherwise strengthening family life, and for implementing such program by assuring that in all appropriate cases (including minors who can be considered to be sexually active) family planning services are offered to them and are provided promptly . to all individuals voluntarily requesting such services .
We observe two salient features of this provision, which were among the 1972 amendments to Title IV A of the Social Security Act. First, the purpose behind Congress’ requiring the states to provide family planning assistance is the prevention of births out of wedlock and, thereby, the strengthening of family ties. Second, the sole expressed precondition to the state’s obligation to provide such services to sexually active minors is that such persons voluntarily request family planning assistance. These observations find support in HEW regulations promulgated under Title IV A, as amended. In particular we note that those regulations require participating states to offer and provide family planning services to
*878those individuals wishing such services, specifically including medical contraceptive services (diagnosis, treatment, supplies, and followup) . . . . Such services must be available without regard to marital status, age, or parenthood. Individuals must be assured choice of method and there must be arrangements with varied medical resources so that individuals can be assured choice of source of service. ... 45 CFR § 220.21. (Emphasis added.)1
The 1972 amendments to the Medicaid provisions of the Social Security Act (Title XIX) similarly appear to limit the state’s power to impose conditions upon eligibility for family planning assistance. 42 U.S.C. § 1396a(a)(8) requires participating states to provide “medical assistance” to all “eligible individuals.” The term “medical assistance” is defined in section 1396d(a)(4)(C) as
payment of part or all of the cost of
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family planning services and supplies furnished ... to individuals of childbearing age (including minors who can be considered to be sexually active) who are eligible under the State plan and who desire such services and supplies . . ..
Standards of Medicaid eligibility are set forth in section 1396a(a)(10). Part (A) of section 1396a(a)(10) denominates the recipients of various Social Security Act assistance programs as eligible individuals; included are AFDC recipients under Title IV A of the Act. Section 1396a(a)(13)(B) further requires state plans to provide family planning services, as defined by section 1396d(a)(4)(C), to recipients of AFDC benefits, making the provision of other medical services optional with respect to AFDC recipients.
Thus, we read the 1972 Medicaid amendments to establish two preconditions to the state’s obligation to provide family planning assistance to sexually active minors. First, such persons must be eligible under the standards of section 1396a(a)(10); second, such persons must voluntarily request assistance.2 HEW regulations promulgated under Title XIX permit states further to limit family planning services and supplies “to individuals of child-bearing age (including minors who can be considered to be sexually active) who desire such services”; but family planning services must otherwise be “made available to-any categorically needy individual included under the plan.” 45 CFR § 249.10(a)(6)(vi).
Our reading of the 1972 amendments to the Social Security Act leads us to conclude that the challenged Utah regulations, which require parental consent before minors may receive family planning assistance under the AFDC and Medicaid programs, are’ in conflict with these federal standards. The state’s regulations impermissibly engraft upon the federal scheme a condition for eligibility where Congress has undertaken fully to define the class of persons who may receive family planning assistance. The legislative history of the 1972 amendments bears out Congress’ concern that AFDC and Medicaid family planning services be provided to sexually active minors who desire them on a confidential basis; in this way Congress has sought to stem the rising number of births out of wedlock and the consequent increase in numbers of welfare recipients.3 Utah’s reg*879ulations, although undoubtedly motivated by the state’s concern for the integrity of the family, nevertheless run afoul of the policies of confidentiality and comprehensive assistance to sexually active minors embodied in the 1972 amendments.
The State of Utah argues, however, that noncompliance with federal family planning assistance standards merely provides grounds for cutbacks in federal funds after review by the Secretary consistent with 42 U.S.C. § 604, but does not provide a basis for injunctive relief against offending state regulations. The Supreme Court rejected this argument in Rosado v. Wyman, 397 U.S. 397, 90 S.Ct. 1207, 25 L.Ed.2d 442. The Court stated, “We are most reluctant to assume Congress has closed the avenue of effective judicial review to those individuals most directly affected by the administration of its program." Id. at 420, 90 S.Ct. at 1222. Although King v. Smith, supra, did not specif - ically advert to the remedial problem, the Rosado Court continued, the unarticulated premise of that case was that “the State had alternative choices of assuming the additional cost of paying benefits to families [not eligible under challenged state regulations] or not using federal funds to pay welfare benefits according to a plan that was inconsistent with federal requirements.” Id. at 420-21, 90 S.Ct. at 1222. In these cases and others the Court has consistently acknowledged the right of recipients of federal assistance to challenge the validity of state restrictions affecting the scope of and conditions placed upon their receiving federal assistance.
The state also argues that HEW’s approval of its plan — including its express approval of the challenged regulations — must be considered in determining the validity of the plan under federal standards.4 We agree. But the principle that accords substantial weight to the interpre*880tation of a statute by the department entrusted with its administration does not apply where the department’s approval is so clearly inconsistent with federal statutory language and legislative policy. See Townsend v. Swank, 404 U.S. 282, 286, 92 S.Ct. 502, 30 L.Ed.2d 448. Indeed, it appears that HEW sometimes approves state plans that it concedes to be in conflict with its own regulations, perhaps on the premise that the state departures from federal standards are not substantial enough to justify disapproval by the Secretary. See, e. g., Carleson v. Remillard, 406 U.S. 598, 602 & n. 3, 92 S.Ct. 1932, 32 L.Ed.2d 352; King v. Smith, 392 U.S. 309, 334-35, 88 S.Ct. 2128, 20 L.Ed.2d 1118 (Douglas, J., concurring). We are convinced, however, that the conflict between Utah’s parental consent regulations and federal requirements constitutes an important disagreement affecting the scope and effect of federal family planning assistance. Under such circumstances, federal law must control.
III.
We turn now to plaintiff’s claim that Utah’s parental consent regulations imper-missibly burden her constitutional right to privacy and are for that reason invalid. We proceed by determining first whether the constitutional privacy doctrine prevents the state generally from imposing restrictions upon access to family planning services and contraceptive supplies; second, whether the right to privacy — if inclusive of freedom from state interference in matters of family planning and use of contraceptives — extends to minors; and third, whether the state has shown a compelling interest that justifies its parental consent regulations.
The Supreme Court has never determined whether the constitutional right of privacy developed in Griswold v. Connecticut, 381 U.S. 479, 85 S.Ct. 1678, 14 L.Ed.2d 510, and succeeding cases includes the right to obtain family planning services and materials free from unjustified government interference. In Eisenstadt v. Baird, 405 U.S. 438, 92 S.Ct. 1029, 31 L.Ed.2d 349, the Court expressly refused to decide whether individuals have a right of access to contraceptives. The Court nevertheless stated,
If the right of privacy means anything, it is the right of the individual, married or single, to be free from unwarranted governmental intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child. Id. at 453, 92 S.Ct. at 1038.
In Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147, in which the Texas criminal abortion statute was held to violate a woman’s fundamental right to decide whether she would bear a child, the Court further acknowledged that the same right to privacy “has some extension to activities relating to . contraception.” Id. at 152, 93 S.Ct. at 726. If, as Roe teaches, the fourteenth amendment protects a woman’s right to decide whether she will terminate her pregnancy, it must also, we believe, protect her right to take measures to guard against pregnancy. In either instance the woman’s interest is the same, that is, to make fundamental personal decisions about sexual conduct and procreation free from state interference. We are convinced, therefore, that the right to privacy underlying the Supreme Court’s decision in Roe v. Wade prevents the state from intruding, without justification, into the decision of adults whether to obtain and use contraceptive devices and whether to seek out counseling in family planning matters.
A more difficult question is whether the right to privacy as we have described it extends to minors such as the plaintiff in the present action. The Supreme Court has consistently recognized as a general principle that the Bill of Rights and the fourteenth amendment protect children as well as adults from unjustified state action. See, e. g., Breed v. Jones, 421 U.S. 519, 95 S.Ct. 1779, 44 L.Ed.2d 346 (1975); Tinker v. Des Moines Ind. Community School Dist., 393 U.S. 503, 506, 89 S.Ct. 733, 21 L.Ed.2d 731; In re Gault, 387 U.S. 1, 13, 87 S.Ct. 1428, 18 L.Ed.2d 527; Prince v. Massachusetts, 321 U.S. 158, 165-66, 64 *881S.Ct. 438, 88 L.Ed. 645. The Court has nevertheless recognized that the state may legitimately curtail the rights of children where it acts to protect children from their own incapacity to fend for themselves. See Prince v. Massachusetts, supra, 321 U.S. at 168—70, 64 S.Ct. 438. In the present case, however, the state can assert no such interest in protecting sexually active minors from dangers that may be entailed in the use of contraceptives. The UPPA employs social workers, licensed physicians and other trained personnel to examine and counsel minors seeking contraceptives. These circumstances, we believe, afford adequate protection to minors from physical harms associated with birth control.
More importantly, we perceive no developmental differences between minors and adults that may affect the gravity of the right asserted by sexually active minors to family planning services and materials. The interest of minors in access to contraceptives is one of fundamental importance. The financial, psychological and social problems arising from teenage pregnancy and motherhood argue for our recognition of the right of minors to privacy as being equal to that of adults. This is not to say that the state may not regulate that right in pursuit of some compelling interest of its own; rather, we hold that the fundamental nature of minors’ right to privacy must be considered in assessing the constitutionality of state-imposed restrictions on access to contraceptives. In Doe v. Rampton, D.Utah, 366 F.Supp. 189, this court implicitly recognized that the constitutional right to privacy extended to minors. There we held that Utah law impermissibly required parental or spousal consent before minors could receive abortions during the first trimester of pregnancy. Other courts have similarly recognized that the fourteenth amendment guarantees to minors as well as adults the freedom to make basic decisions about sexual conduct and procreation without unjustified interference from the state. Foe v. Vanderhoof, D.Col., 389 F.Supp. 947 (Colo.1975); Coe v. Gerstein, S.D.Fla., 376 F.Supp. 695; State v. Koome, 84 Wash.2d 901, 530 P.2d 260.
With respect to both minors and adults, the right to personal privacy is not absolute but must be considered against important state interests in regulation. Roe v. Wade, supra, 410 U.S. at 154, 93 S.Ct. 705. The state may regulate plaintiff’s access to contraceptives with measures narrowly drawn to achieve some compelling state interest. Id. at 155, 93 S.Ct. 705. The question for us becomes whether Utah’s challenged parental consent regulations are supported by any such interest.
The state argues in this respect that it has a “substantial” interest in protecting minor females “from the evil effects and unsuspected harm of actions which go against the mores of society” and in enforcing the right of parents to control the family. For a number of reasons we must hold that neither of these justifications is so compelling as to override the plaintiff's constitutional right to privacy. First, we note that Utah law does not prohibit minors more affluent than plaintiff from obtaining contraceptive materials from their personal physicians even absent parental consent; the challenged regulations, in effect, burden the fundamental rights of indigent minors only.5 Thus, even if we were to sus*882tain the state’s regulations in their effect upon plaintiff’s privacy, they would nevertheless be subject to attack on equal protection grounds. See Griswold v. Connecticut, 381 U.S. 479, 485, 85 S.Ct. 1678, 14 L.Ed.2d 5Í0; Eisenstadt v. Baird, 405 U.S. 438, 453, 92 S.Ct. 1029, 31 L.Ed.2d 349. More importantly in the present context, the failure of the state legislature to enact restrictions upon the- access of minors — rich and poor— to contraceptives seriously undercuts the state’s claim that its family planning regulations embody compelling public interests.
Second, although parental prerogatives are entitled to considerable legal deference, they frequently must yield to valid interests of the state, for example, in enforcing compulsory education, in regulating child labor, in preventing parental neglect and in providing for the general health. See Prince v. Massachusetts, 321 U.S. 158, 166, 64 S.Ct. 438, 88 L.Ed. 645. See also Utah Code Ann. §§ 55-16-1 et seq. (child abuse), 55-10-77 (parental neglect), 34-22-1 (child labor), 53-24-1 et seq. (compulsory education), 26-6-39.1 (treatment of venereal disease). Likewise, we believe that, in appropriate cases, the state’s interest in enforcing parental prerogatives must yield to the fundamental rights of minors. See Rowan v. Post Office Dept., 397 U.S. 728, 741, 90 S.Ct. 1484, 25 L.Ed.2d 736. (Brennan, J., concurring).
To the extent that the plaintiff and her class must consult with a physician before receiving prescription contraceptives and avail themselves of the UPPA’s family planning counseling, these youths will be aided by the mature judgment of trained adults before making important decisions regarding sexual conduct. Unlike the abortion decision, a youth’s decision to use contraceptives is not irrevocable. Nor does our insistence upon the right to privacy of minors preclude continuing guidance of parents and family in the personal lives of minors. Rather we hold that the state may not enforce the choice of parents in conflict with a minor’s constitutional right of free access to birth control information and services. This is not to say, of course, that the state may not require notification to parents or guardians before minors receive such services. See Roe v. Rampton, D.Utah, 394 F.Supp. 677 (1975). Such a requirement, however, must be applied non-discriminatorily to all youths, and not merely those too poor to seek out family planning services on their own.
Accordingly, it is hereby determined that Regulations FPX 120, FPC 120, and 3.7(c) of the Utah State Division of Family Services are unconstitutional and in violation of federal statute insofar as they require consent of a parent or guardian before a minor may obtain family planning services, counseling, and supplies from the UPPA. Enforcement of these regulations must be enjoined.

.With respect to the purpose behind requiring provision of family planning for appropriate AFDC recipients, 45 CFR § 220.20 provides:
There must be a program to prevent or reduce the incidence of births out-of-wedlock and to otherwise strengthen family life. Services to prevent and reduce births out-of-wedlock must be extended progressively to all appropriate adults and youths, with initial priority for youths living in conditions immediately conducive to births out-of-wedlock.

. 45 CFR § 249.10(a)(9) provides that Title XIX plans must ensure, with respect to family planning services,
that there shall be freedom from coercion or pressure of mind and conscience, and freedom of choice of method, so that such individuals can choose in accordance with the dictates of their consciences.

. Commenting on section 299E of the Senate bill amending Titles IV A and XIX of the Social Security Act, the Senate Finance Committee reported:
*879The committee amendment would authorize States to make available on a voluntary and confidential basis family planning counseling, services, and supplies, directly and/or on a contract basis with family planning organizations (such as Planned Parenthood clinics and Neighborhood Health Centers) throughout the State, to present, former, or potential recipients including any eligible medically needy individuals who are of childbearing age and who desire such services.
* * * * * *
The Secretary would be required to work with the States to assure that particular effort is made in the provision of family planning services to minors (and non-minors) who have never had children but who can be considered to be sexually active; for example, persons who have contracted venereal diseases, etc.
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Because of the difficulties of enforcing or monitoring the mandatory provision of family planning services to former or potential recipients, the penalty provision will be limited to the offering and provision of services to present adult recipients of AFDC and workfare. However, family planning services must be offered and made available on an optional basis to former and potential recipients of child-bearing age.
It is envisioned that individuals of childbearing age applying for or receiving AFDC would formally acknowledge that they have been informed that they are eligible to receive family planning services on a voluntary and confidential basis. If they desire family planning services, an appointment would be set up at that time and a copy of the form would be sent to the clinic or physician providing necessary services and supplies. This would not preclude “walk-in” requests for family planning assistance by present and former recipients or those likely to become recipients in the absence of such services. S.Rep. No. 92-1230, 92d Cong. (1972).

. In response to an inquiry by defendant Evan E. Jones, Jr., Director of Utah’s Division of Family Services, to HEW’s Regional Office, Associate Regional Commissioner Ray Myrick, Jr., responded on September 20, 1974 as follows:
Under 45 CFR 220.21 family planning services must be offered and provided to those individuals requesting such services. Such services must be available without regard to marital status, age, or parenthood. However, where State law stipulates a specific age of consent, such services may not be provided any more than any medically related service, without parental consent.
We are unable to find any state law that requires the consent of parents before minors may obtain family planning services or supplies. See Doe v. Planned Parenthood Ass’n, 29 Utah 2d 356, 360, 510 P.2d 75, 77 (Tuckett, J., dissenting).

. Except for the regulations challenged in this action, which apply only to indigent minors seeking family planning services from the UPPA, Utah law does not apparently prohibit or restrict physicians from prescribing contraceptives for minors. The defendants argue that various state statutes must be read as implying that all minors must obtain parental consent before obtaining contraceptive devices. The defendants point primarily to Utah Code Ann. §§ 15-2-1 et seq., which specify the age of majority and provide for rescission of contracts made by minors, and to Utah Code Ann. § 26-6-39.1, which permits treatment of minors for venereal disease without parental consent. These statutes, in our view, cannot be read either to restrict physicians in prescribing contraceptives or to create a legal disability in minors seeking contraceptives. The defendants also note that Utah Code Ann. § 58-19-9 prohibits licensed retailers from selling “prophylactics” to persons eighteen years of age or under. We note that the term “prophylactic” is defined as “[a]ny device, appliance or medi*882cal agent used in the prevention of venereal disease.” Id. § 58-19-l(f). The statute thus has doubtful application to contraceptive devices used by women. We also observe that § 58-19-2 excepts physicians from the restrictions on sale imposed by § 58-19-9.
In his dissenting opinion in Doe v. Planned Parenthood Ass’n, 29 Utah 2d 356, 360, 510 P.2d 75, 77, Justice Tuckett observed that the Utah legislature has never restricted minors from obtaining contraceptives. The court’s majority was apparently of the same view. 510 P.2d at 77 n. 6.