Whole Woman's Health v. Hellerstedt

Claim preclusion bars successive litigation of the same claim, but the Abbott litigation was based on predictions made before the admitting-privileges requirement was enforced. This suit rested on concrete later developments, including actual clinic closures and physicians' inability to obtain privileges. Those changed facts transformed a previously uncertain constitutional injury into a distinct claim.

The Court emphasized that, where important constitutional interests are involved, later experience may demonstrate that a harm once regarded as speculative is real. Abbott itself had recognized that later as-applied litigation could address concrete constitutional problems arising after the law took effect.

Although petitioners principally sought as-applied relief for the McAllen and El Paso clinics, they also requested further equitable relief. Under Federal Rule of Civil Procedure 54(c), a court may grant the relief to which a party is entitled even if the pleadings did not specifically demand it. Because the evidence established that the requirement was unconstitutional across the board, a statewide injunction was proper.

The two provisions imposed separate and independent regulatory requirements, served different operational functions, and had different effective dates. Courts ordinarily treat challenges to distinct regulatory requirements as separate claims, even when those requirements are enacted as part of a broader regulatory scheme.

At the time Abbott was filed, Texas had not yet promulgated the regulations implementing the surgical-center requirement. Providers could reasonably have awaited those rules, including the possibility that they would grandfather existing facilities or grant waivers, as Texas had done for many non-abortion surgical centers.

Treating every provision in a single statute as one transaction for claim-preclusion purposes would force litigants to bring sweeping, kitchen-sink challenges to preserve possible claims. The Court rejected that approach as inefficient and inconsistent with ordinary preclusion principles.

Casey holds that an unnecessary health regulation imposes an undue burden when its purpose or effect places a substantial obstacle in the path of a woman seeking a previability abortion. That inquiry requires attention to both sides of the equation: the obstacles imposed and the health benefits supplied.

The Fifth Circuit erred by treating a law as constitutional so long as it was rationally related to a legitimate state interest and did not independently amount to a substantial obstacle. That formulation improperly substituted the deferential review used for ordinary economic legislation for the constitutional inquiry required by Casey.

Courts may consider trial evidence, including expert testimony, when evaluating a law's asserted medical justification. Gonzales v. Carhart did not require courts to defer blindly to legislative judgments in the face of contrary evidence; courts retain an independent duty to review facts bearing on constitutional rights.

Texas asserted that admitting privileges would ensure prompt hospital care for complications. But the trial record showed that serious abortion complications were rare, that immediate hospital transfers were rarer still, and that complications generally occurred after patients had left the clinic. Texas identified no evidence that the new requirement improved care compared with the prior rule requiring a working arrangement with a doctor holding admitting privileges.

The requirement did not meaningfully screen for provider competence. Hospitals commonly condition privileges on factors unrelated to clinical ability, such as a minimum number of hospital admissions, residency requirements, or faculty status. Because abortion is so safe, abortion providers often could not satisfy admission-volume requirements.

The evidence supported the District Court's finding that the requirement caused approximately half of Texas's abortion facilities to close. Those closures meant fewer doctors, longer waiting periods, greater crowding, and sharply increased travel distances for many women. Travel alone is not invariably an undue burden, but these burdens, combined with the near absence of health benefits, supported the undue-burden conclusion.

Before H. B. 2, Texas already imposed extensive licensing, safety, recordkeeping, staffing, inspection, and enforcement requirements on abortion facilities. The record showed that abortions were extremely safe in those facilities and that requiring compliance with every ambulatory-surgical-center standard did not improve outcomes.

Many surgical-center requirements had little connection to abortion care. Detailed rules concerning operating-room dimensions, one-way patient traffic, ventilation, construction, and protections for deeply sedated patients were often irrelevant because abortions commonly involve medication or procedures through a natural bodily opening and do not use general anesthesia or deep sedation.

Texas did not apply the standards consistently to similarly situated medical care. Procedures with greater risks, including childbirth, colonoscopy, and some treatment following miscarriage, were not subject to equivalent requirements. Texas also grandfathered or waived requirements for about two-thirds of other surgical centers but afforded no comparable relief to abortion facilities.

The District Court reasonably found that only seven or eight clinics would remain if the requirement took effect and that they could not absorb the demand for 60,000 to 72,000 annual abortions. Expert testimony, the scale of the projected increase in demand, common sense, and the high costs of converting or building compliant facilities supported that finding.

A severability clause expresses a legislature's preference for preserving valid portions of a statute, but it is an aid to construction rather than an inexorable command. It cannot require courts to undertake endless application-by-application litigation when a statutory provision itself has been shown facially unconstitutional.

The surgical-center provision required abortion facilities to satisfy an integrated set of ambulatory-surgical-center standards, not merely an unidentified subset of them. Judicially selecting particular regulations to retain would entail legislative line-drawing and risk incoherent administration of interconnected requirements.

Permitting a broadly drafted severability clause to insulate a law from facial review would let legislatures shift a fundamentally legislative task to courts. The Court therefore declined Texas's invitation to preserve the provisions through piecemeal judicial rewriting.

Casey uses the phrase 'large fraction' to refer to a large fraction of the cases in which a restriction is relevant. The proper denominator therefore consists of women seeking abortions for whom the requirements operate as an actual restriction, rather than all women generally or all women of reproductive age.

Simopoulos upheld a surgical-center rule as applied to second-trimester abortions under the former trimester framework. H. B. 2 applied to all abortions, most of which occurred in the first trimester, and Casey later displaced the trimester framework with the viability rule. Moreover, the petitioner in Simopoulos had not argued that the regulation lacked a meaningful health benefit.