On May 28, 2019, the County of Santa Clara, CA and various healthcare providers sued the U.S. Department of Health and Human Services (HHS) in the U.S. District Court for the Northern District of California for violating the Administrative Procedure Act (APA) and various constitutional clauses in a Final Rule published on May 21, 2019. The Rule, which plaintiffs called the “Denial-of-Care” Rule, changed the way healthcare institutions must protect and accommodate healthcare providers’ religious objections to providing certain medical services. Represented by Lambda Legal, the Center for Reproductive Rights, Americans United for Separation of Church and State, and Mayer Brown LLP, plaintiffs sought declaratory and injunctive relief to strike down the Rule as unlawful and unconstitutional, and enjoin Defendants from implementing and enforcing it. They also sought attorneys fees. This case was first assigned to Judge Nathanael M. Cousins and later reassigned to Judge William Alsup.
Plaintiffs included the County of Santa Clara (as an owner of healthcare facilities); five private healthcare facilities that provided reproductive-health services and healthcare services for LGBT individuals; four individual physicians and a licensed counselor who worked for these entities; three national associations of medical professionals; and two organizations that provided a wide range of services to the LGBT community. They alleged that the rule endangered patients’ health in the name of advancing the religious beliefs of those who are entrusted with caring for them, elevating religious objections over all other interests and values. They noted that the rule expanded the types of healthcare workers that can decline to serve patients based on religious objections, expanded the types of activities that may be objected to, and failed to reconcile the objections with the needs and rights of patients.
Their complaint contained ten separate causes of action, including three different APA violations (arbitrary and capricious, in excess of statutory authority, and not in accordance with other federal laws), as well as constitutional violations (Establishment Clause, Substantive Due Process/Right to Privacy and Personal Autonomy, Free Speech, and Equal Protection) brought by the non-County plaintiffs. Santa Clara County also alleged two violations independent from the other plaintiffs under the Spending Clause and Separation of Powers.
On June 11, 2019, plaintiffs filed a motion for a nationwide preliminary injunction to enjoin the Rule. On June 13, 2019, the court issued an order relating two other Ninth Circuit cases challenging the same HHS rule to this case; the plaintiffs in both of the related cases had also filed motions for preliminary relief. Because one or more of the parties in these cases declined to consent to have a magistrate judge hear their cases, all three were randomly reassigned to District Court Judge William Alsup.
On July 1, 2019, the court issued an order approving a stipulated request made by the parties. The order postponed the effective date of the Final Rule to November 22, 2019, and suspended the preliminary injunction motions. It also scheduled a summary judgment hearing for October 30, 2019. On July 8, the court issued an order granting all three cases’ parties’ Joint Administrative Motion for Relief from Automatic Referral to the Alternative Dispute Resolution Multi-Option Program, excusing them from mandatory participation.
On August 21, 2019, HSS filed a motion to dismiss or, in the alternative, motion for summary judgment. Following the hearing on October 30, 2019, the court granted the plaintiffs' motion of summary judgment and denied HHS's motion to dismiss on November 19, 2019. The court vacated the Rule for its discriminatory and unconstitutional scope. Specifically, the court found that some of the Rule's definitions extended the scope of its religious exemption beyond the text of underlying federal statutes that authorized conscience objections by healthcare workers. Final judgment was entered on January 8, 2020. 411 F.Supp. 3d 1001.
HHS appealed the decision on March 6, 2020. The appeal was assigned USCA Case Number 20-15399 and is ongoing.
Elise Coletta - 07/14/2019
Zofia Peach - 10/17/2020
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