MAYOR OF BALTIMORE v. AZAR

No. 19-1614, No. 20-1215.

973 F.3d 258 (2020)

MAYOR and City Council OF BALTIMORE, Plaintiff-Appellee, v. Alex M. AZAR, II, in his official capacity as the Secretary of Health and Human Services; Diane Foley, M.D., in her official capacity as the Deputy Assistant Secretary, Office of Population Affairs; United States Department of Health & Human Services; Office of Population Affairs, Defendants-Appellants. Ohio; Alabama; Arkansas; Indiana; Kansas; Louisiana; Nebraska; Oklahoma; South Carolina; South Dakota; Tennessee; Texas; Utah; West Virginia, Amici Supporting Appellants, New York, New York City Health + Hospitals and 10 Local Governments; National Health Law Program; Advocates for Youth; American Medical Student Association; American Society for Reproductive Medicine; Community Catalyst; The Endocrine Society; Families USA; in Our Own Voice: National Black Women's Reproductive Justice Agenda; Juvenile Law Center; The Leadership Conference on Civil and Human Rights; National Council of Jewish Women; NARAL Pro-Choice America; National Abortion Federation; National Immigration Law Center; National Institute for Reproductive Health; National Latina Institute for Reproductive Health; National Partnership for Women & Families; National Women's Health Network; National Women's Law Center; Northwest Health Law Advocates; Positive Women's Network-USA; Power to Decide; Union for Reform Judaism; Central Conference of American Rabbis; Women of Reform Judaism; Men of Reform Judaism; Unite for Reproductive & Gender Equity; Whitman-Walker Health; WomenHeart; YWCA of the USA; National Center for Lesbian Rights; GLMA: Health Professionals Advancing LGBT Equality; The LGBT Movement Advancement Project; National LGBTQ Task Force; Equality Federation; Sexuality Information and Education Council of the United States; Family Equality Council; The National Center for Transgender Equality; HIV Medicine Association; GLBTQ Legal Advocates & Defenders; Lambda Legal Defense and Education Fund, Incorporated; The Human Rights Campaign; Transgender Law Center; Bay Area Lawyers for Individual Freedom; The Institute for Policy Integrity at New York University School of Law; National Center for Youth Law; American Academy of Pediatrics; American College of Obstetricians and Gynecologists; American College of Physicians; American Medical Association; Society for Adolescent Health and Medicine; Society for Maternal-Fetal Medicine; Zachary D. Clopton; Amanda Frost; Suzette Malveaux; Mila Sohoni; Alan Trammell; California; Nevada; Colorado; Connecticut; Delaware; Hawaii; Illinois; Maine; Maryland; Massachusetts; Michigan; Minnesota; New Jersey; New Mexico; New York; North Carolina; Oregon; Pennsylvania; Rhode Island; Vermont; Virginia; Washington; District of Columbia, Amici Supporting Appellee. Mayor and City Council of Baltimore, Plaintiff-Appellee, v. Alex M. Azar, II, in his official capacity as the Secretary of Health and Human Services; Diane Foley, M.D., in her official capacity as the Deputy Assistant Secretary, Office of Population Affairs; United States Department of Health & Human Services; Office of Population Affairs, Defendants-Appellants. Kentucky; Alabama; Arkansas; Indiana; Louisiana; Nebraska; Ohio; Oklahoma; South Carolina; South Dakota; Tennessee; Texas; Utah; West Virginia, Amici Supporting Appellants. American Medical Association; Zachary D. Clopton; Amanda Frost; Suzette Malveaux; Mila Sohoni; Alan Trammell; California; Nevada; Colorado; Connecticut; Delaware; District of Columbia; Hawaii; Illinois; Maine; Maryland; Massachusetts; Michigan; Minnesota; New Jersey; New York; North Carolina; Oregon; Pennsylvania; Rhode Island; Vermont; Virginia; Washington; New Mexico, Amici Supporting Appellee.

United States Court of Appeals, Fourth Circuit.

Decided: September 3, 2020.


Attorney(s) appearing for the Case

ARGUED: Jaynie Lilley , UNITED STATES DEPARTMENT OF JUSTICE, Washington, D.C., for Appellants. Andrew Tutt , ARNOLD & PORTER KAYE SCHOLER LLP, Washington, D.C., for Appellee. ON BRIEF: Joseph H. Hunt , Assistant Attorney General, Hashim M. Mooppan , Deputy Assistant Attorney General, Brinton Lucas , Senior Counsel, Michael S. Raab , Joshua Dos Santos , Civil Division, UNITED STATES DEPARTMENT OF JUSTICE, Washington, D.C., for Appellants. Andre M. Davis , City Solicitor, Dana Petersen Moore , Acting City Solicitor, Suzanne Sangree , Senior Counsel for Public Safety & Director of Affirmative Litigation, CITY OF BALTIMORE DEPARTMENT OF LAW, Baltimore, Maryland; Drew A. Harker , ARNOLD & PORTER KAYE SCHOLER LLP, Washington, D.C.; Stephanie Toti , LAWYERING PROJECT, New York, New York; Priscilla J. Smith , Brooklyn, New York, Faren M. Tang , REPRODUCTIVE RIGHTS & JUSTICE PROJECT AT YALE LAW SCHOOL, New Haven, Connecticut, for Appellee. Dave Yost , Attorney General, Benjamin M. Flowers , Solicitor General, Stephen P. Carney , Deputy Solicitor General, Jason D. Manion , Deputy Solicitor General, Shams H. Hirji , Deputy Solicitor General, OFFICE OF THE ATTORNEY GENERAL OF OHIO, Columbus, Ohio, for Amicus State of Ohio. Steve Marshall , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF ALABAMA, Montgomery, Alabama, for Amicus State of Alabama. Leslie Rutledge , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF ARKANSAS, Little Rock, Arkansas, for Amicus State of Arkansas. Curtis T. Hill, Jr. , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF INDIANA, Indianapolis, Indiana, for Amicus State of Indiana. Derek Schmidt , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF KANSAS, Topeka, Kansas, for Amicus State of Kansas. Jeff Landry , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF LOUISIANA, Baton Rouge, Louisiana, for Amicus State of Louisiana. Doug Peterson , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF NEBRASKA, Lincoln, Nebraska, for Amicus State of Nebraska. Mike Hunter , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF OKLAHOMA, Oklahoma City, Oklahoma, for Amicus State of Oklahoma. Alan Wilson , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF SOUTH CAROLINA, Columbia, South Carolina, for Amicus State of South Carolina. Jason Ravnsborg , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF SOUTH DAKOTA, Pierre, South Dakota, for Amicus State of South Dakota. Herbert H. Slatery III , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF TENNESSEE, Nashville, Tennessee, for Amicus State of Tennessee. Ken Paxton , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF TEXAS, Austin, Texas, for Amicus State of Texas. Sean Reyes , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF UTAH, Salt Lake City, Utah, for Amicus State of Utah. Patrick Morrisey , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF WEST VIRGINIA, Charleston, West Virginia, for Amicus State of West Virginia. Zachary W. Carter , Corporation Counsel, Richard Dearing , Claude S. Platton , Jamison Davies , Melanie C.T. Ash , MacKenzie Fillow , THE CITY OF NEW YORK, New York, New York; Mark A. Flessner , Corporation Counsel, Benna Ruth Solomon , Deputy Corporation Counsel, CITY OF CHICAGO, Chicago, Illinois; Michael N. Feuer , City Attorney, Danielle L. Goldstein , Deputy City Attorney, CITY OF LOS ANGELES, Los Angeles, California; Philippa M. Guthrie , Corporation Counsel, Legal Department, CITY OF BLOOMINGTON, Bloomington, Indiana; Angela Wheeler , City Attorney, FLINT CITY ATTORNEY'S OFFICE, Flint, Michigan; Zack Klein , City Attorney, CITY OF COLUMBUS, Columbus, Ohio; Dennis J. Herrera , City Attorney, CITY AND COUNTY OF SAN FRANCISCO, San Francisco, California; Ronald C. Lewis , City Attorney, Judith L. Ramsey , Chief, General Litigation Section, Collyn Peddie , Senior Assistant City Attorney, CITY OF HOUSTON, Houston, Texas; James R. Williams , County Counsel, COUNTY OF SANTA CLARA, San Jose, California; Barbara J. Parker , City Attorney, CITY OF OAKLAND, Oakland, California; Peter S. Holmes , City Attorney, CITY OF SEATTLE, Seattle, Washington, for Amici The City of New York, New York City Health + Hospitals, and 10 Local Governments. Aaron D. Ford , Attorney General, Heidi Parry Stern, Solicitor General, Jeffrey M. Conner , Deputy Solicitor General, OFFICE OF THE ATTORNEY GENERAL OF NEVADA, Las Vegas, Nevada, for Amicus State of Nevada. Xavier Becerra , Attorney General, Renu R. George , Senior Assistant Attorney General, Kathleen Boergers , Supervising Deputy Attorney General, Ketakee Kane , Deputy Attorney General, Karli Eisenberg , Deputy Attorney General, CALIFORNIA DEPARTMENT OF JUSTICE, Oakland, California, for Amicus State of California. Phil Weiser , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF COLORADO, Denver, Colorado, for Amicus State of Colorado. William Tong , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF CONNECTICUT, Hartford, Connecticut, for Amicus State of Connecticut. Kathleen Jennings , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF DELAWARE, Wilmington, Delaware, for Amicus State of Delaware. Karl A. Racine , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF THE DISTRICT OF COLUMBIA, Washington, D.C., for Amicus District of Columbia. Clare E. Connors , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF HAWAII, Honolulu, Hawaii, for Amicus State of Hawaii. Kwame Raoul , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF ILLINOIS, Chicago, Illinois, for Amicus State of Illinois. Aaron M. Frey , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF MAINE, Augusta, Maine, for Amicus State of Maine. Brian E. Frosh , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF MARYLAND, Baltimore, Maryland, for Amicus State of Maryland. Maura Healey , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF MASSACHUSETTS, Boston, Massachusetts, for Amicus Commonwealth of Massachusetts. Dana Nessel , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF MICHIGAN, Lansing, Michigan, for Amicus State of Michigan. Keith Ellison , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF MINNESOTA, St. Paul, Minnesota, for Amicus State of Minnesota. Gurbir S. Grewal , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF NEW JERSEY, Trenton, New Jersey, for Amicus State of New Jersey. Hector Balderas , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF NEW MEXICO, Santa Fe, New Mexico, for Amicus State of New Mexico. Letitia James , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF NEW YORK, Albany, New York, for Amicus State of New York. Joshua H. Stein , Attorney General, NORTH CAROLINA DEPARTMENT OF JUSTICE, Raleigh, North Carolina, for Amicus State of North Carolina. Ellen F. Rosenblum , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF OREGON, Salem, Oregon, for Amicus State of Oregon. Josh Shapiro , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF PENNSYLVANIA, Harrisonburg, Pennsylvania, for Amicus Commonwealth of Pennsylvania. Peter F. Neronha , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF RHODE ISLAND, Providence, Rhode Island, for Amicus State of Rhode Island. Thomas J. Donovan, Jr. , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF VERMONT, Montpelier, Vermont, for Amicus State of Vermont. Mark R. Herring , Attorney General, OFFICE OF THE ATTORNEY GENERAL OF VIRGINIA, Richmond, Virginia, for Amicus Commonwealth of Virginia. Robert W. Ferguson, Attorney General, OFFICE OF THE ATTORNEY GENERAL OF WASHINGTON, Olympia, Washington, for Amicus State of Washington. Martha Jane Perkins , NATIONAL HEALTH LAW PROGRAM, Carrboro, North Carolina, for Amici National Health Law Program, Advocates for Youth, American Medical Student Association, American Society for Reproductive Medicine, Community Catalyst, The Endocrine Society, Families USA, In Our Own Voice: National Black Women's Reproductive Justice Agenda, Juvenile Law Center, The Leadership Conference on Civil and Human Rights, National Council of Jewish Women, NARAL Pro-Choice America, National Abortion Federation, National Immigration Law Center, National Institute for Reproductive Health, National Latina Institute for Reproductive Health, National Partnership for Women & Families, National Women's Health Network, National Women's Law Center, Northwest Health Law Advocates, Positive Women's Network—USA, Power to Decide, Union for Reform Judaism, Central Conference of American Rabbis, Women of Reform Judaism, Men of Reform Judaism, Unite for Reproductive & Gender Equality, Whitman-Walker Health, WomenHeart, and YWCA USA. Shannon Minter , Julianna Gonen , Amy Whelan , Julie Wilensky , NATIONAL CENTER FOR LESBIAN RIGHTS, San Francisco, California; James E. Hough , New York, New York, Andre Fontana , MORRISON & FOERSTER LLP, San Francisco, California, for Amici National Center for Lesbian Rights, Bay Area Lawyers for Individual Freedom, Equality Federation, Family Equality Council, GLMA: Health Professionals Advancing LGBTQ Equality, The HIV Medicine Association, The National Center for Transgender Equality, The National LGBTQ Task Force, The Sexuality Information and Education Council of the United States (SIECUS), THE LGBT Movement Advancement Project, Lambda Legal Defense and Education Fund, Inc., GLBTQ Legal Advocates & Defenders, The Human Rights Campaign, and Transgender Law Center. Madison Condon , Bethany A. Davis Noll , Richard L. Revesz , Jason Schwartz , Institute for Policy Integrity, NEW YORK UNIVERSITY SCHOOL OF LAW, New York, New York, for Amicus Institute for Policy Integrity at New York University School of Law. Bina G. Patel , David D. Doak , QUINN EMANUEL URQUHART & SULLIVAN, LLP, San Francisco, California, for Amicus National Center for Youth Law. Thomas N. Bulleit , Andrew J. Sutton , Washington, D.C., Lisa H. Bebchick , Catherine J. Djang , Amy W. Malone , New York, New York, Daniel W. Richards , East Palo Alto, California, Haley Eagon , ROPES & GRAY LLP, Boston, Massachusetts for Amici American College of Obstetricians and Gynecologists, American Academy of Pediatrics, American College of Physicians, Society for Adolescent Health and Medicine, and Society for Maternal-Fetal Medicine. Ruth E. Harlow , Jennesa Calvo-Friedman , Hillary Ledwell , Brigitte Amiri , AMERICAN CIVIL LIBERTIES UNION FOUNDATION, New York, New York, for Amicus National Family Planning & Reproductive Health Association. James R. Sigel , MORRISON & FOERSTER LLP, San Francisco, California, for Amici Professors Zachary Clopton, Amanda Frost, Suzette Malveaux, Mila Sohoni, and Alan Trammell. Leonard A. Nelson , Kyle A. Palazzolo , AMERICAN MEDICAL ASSOCIATION, Chicago, Illinois, for Amicus American Medical Association.

19-1614 dismissed, and 20-1215 affirmed by published opinion. Judge Thacker wrote the opinion, in which Chief Judge Gregory and Judges Motz, King, Keenan, Wynn, Floyd, and Harris joined. Judge Diaz filed a separate opinion concurring in the judgments. Judge Wilkinson wrote a separate dissenting opinion. Judge Richardson wrote a dissenting opinion, in which Judges Wilkinson, Niemeyer, Agee, Quattlebaum, and Rushing joined.


ON REHEARING EN BANC

In these consolidated appeals, we address the propriety of the district court's preliminary and permanent injunctions. These injunctions halt implementation of a Health and Human Services ("HHS") rule that, inter alia, prohibits physicians and other providers in Title...

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