Federal Trial Court Won’t Block Missouri Admitting Privileges Requirement Pending Further Litigation

A federal district court has denied a motion by abortion providers to temporarily block a health and safety law in Missouri.

The case is Comprehensive Health of Planned Parenthood Great Plains v. Randall Williams, No. 2:16-cv-04313 in the U.S. District Court for the Western District of Missouri. The case is on remand following a September 2018 ruling from the U.S. Court of Appeals for the Eighth Circuit.

As summarized by the district court, the Missouri law “requires a physician performing or attempting to perform an abortion at a facility to maintain clinical privileges with a hospital that offers obstetrical or gynecological services within thirty miles of the facility offering abortion services.”

Plaintiffs had sought a preliminary injunction against the law. To obtain a preliminary injunction, plaintiffs needed to persuade the court that they were “likely to succeed” on the merits of their claim.

The district court concluded that “Plaintiffs have not demonstrated a likelihood of success on the merits with respect to their claim that the Privileges Requirement violates substantive due process as applied to the Columbia Facility.”

This ruling does not end the case. It means only that plaintiffs have failed to obtain a preliminary injunction. After full litigation, and with the introduction of further evidence, the court could still reach the conclusion that the law should fall under relevant legal standards. For now, though, the law stands, pending further litigation.

The plaintiffs in the case are Comprehensive Health of Planned Parenthood Great Plains (“Comprehensive Health”), Reproductive Health Services of Planned Parenthood of St. Louis Region (“RHS”), and Dr. Ronald Yeomans.

The preliminary injunction motion and the ruling denying it focus only on application of Missouri’s admitting privileges requirement to a facility operated by Comprehensive Health in Columbia, Missouri. According to plaintiffs’ motion, “The licensing process is now complete, and the only remaining impediment to the Department of Health and Senior Services (‘DHSS’) issuing an abortion facility license to the Columbia health center is the privileges requirement.”

The district court construed the challenge as an “as applied” challenge instead of a “facial challenge.” At the same time, the court applied the “large fraction test” to evaluate the impact of the admitting privileges law on abortion access at the Columbia facility.

As the district court writes, quoting Eighth Circuit precedent, “The ‘large fraction test,’ is a ‘different standard’ specifically used in ‘challenges to abortion regulations . . . .’” Under this test, the district court explains, “a plaintiff can prevail by demonstrating that in a large fraction of the cases in which the law is relevant, it will operate as a substantial obstacle to a woman’s choice to undergo an abortion.” (I’ve omitted internal quotation marks.)

Having adopted the “large fraction test,” the district court then turns to the test used to determine whether a law imposes an “undue burden” on abortion access and thus fails constitutional scrutiny.

• “To show a likelihood of success on the merits of their substantive due process claim, Plaintiffs must demonstrate that the Privileges Requirement imposes an ‘undue burden on abortion access’” (quoting the Supreme Court’s 2016 opinion in Whole Women’s Health v. Hellerstedt).

• “‘A finding of an undue burden is a shorthand for the conclusion that a state regulation has the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus’” (quoting from section IV, joined only by three justices, of the opinion in the 1992 Planned Parenthood v. Casey Supreme Court case).

• “In assessing whether such circumstances are present with respect to the challenged law, courts are required to ‘consider the burdens a law imposes on abortion access together with the benefits those laws confer’” (quoting Hellerstedt).

The district court then combines the “large fraction test” and the “undue burden test.”

• “An abortion regulation is considered to be a substantial obstacle in the path of a woman seeking an abortion (and thus an undue burden) only if the law being challenged can be said to operate as a substantial obstacle to a woman’s choice to undergo an abortion in a large fraction of the cases in which the regulation is relevant . . . .” (I’ve omitted internal quotation marks.)

• “Thus,” the district court writes, “Plaintiffs can demonstrate a likelihood of success on the merits by demonstrating that in a large fraction of the cases in which it is relevant, the Privileges Requirement will operate as a substantial obstacle to a woman’s choice to undergo an abortion.” (I’ve omitted internal quotation marks.)

In the light of these legal standards, “[t]he dispositive issue, then, is the number of cases in which the Privileges Requirement is relevant.”

Not surprisingly, Plaintiffs and Defendants disagreed on that issue. But the court concluded it didn’t matter because “Plaintiffs have not established a likelihood of success on the merits, even if the Court considers the large fraction test pursuant to the denominator Plaintiffs suggest.”

Having reached this conclusion, the district court then turns to the Hellerstedt part of the analysis.

“In the context of undue burden analysis,” the district court writes, “the court is required to ‘consider the burdens a law imposes on abortion access together with the benefits those laws confer’” (quoting Hellerstedt). “In striking down a Texas law similar to the Privileges Requirement here, the Supreme Court found in Hellerstedt that the following burdens are proper considerations in analyzing whether a statute imposes an undue burden:”

• “whether the abortion provider has attempted to or has identified local physicians with hospital privileges willing to provide abortions in the particular community;”

• “whether a significant number of clinics face closure, leading to fewer doctors, longer wait times, and increased crowding;”

• “and whether a significant number of women faced increased travel distances.”

“In this case,” the district court concluded, “the current record does not provide a sufficient basis for the Court to conclude that Plaintiffs are likely to succeed on their claim that the burdens associated with the Privileges Requirement as applied to the Columbia Facility, outweigh the benefits conferred by the Privileges Requirement as applied to the Columbia Facility.”

Accordingly, the court denied Plaintiffs’ motion for preliminary injunction and ordered the parties to meet and confer regarding a proposed litigation schedule.

Thomas M. Messner, J.D. is a senior fellow in legal policy at the Charlotte Lozier Institute.