Planned Parenthood Gulf Coast, Inc. v. Phillips, No. 18-30699 (5th Cir. 2021)

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Justia Opinion Summary

Two Planned Parenthood entities and three Jane Does filed a 42 U.S.C. 1983 action alleging that the Louisiana Department of Health is unlawfully declining to act on Planned Parenthood's application for a license to provide abortion services in Louisiana. The district court denied the Department's motion to dismiss under Federal Rule of Civil Procedure 12(b)(1).

The Fifth Circuit held that it has jurisdiction over the Department's interlocutory appeal because the Department asserted sovereign immunity in the district court. The court held that plaintiffs' second requested injunction—directing the Department to "promptly rule" on their application "in accordance with all applicable constitutional requirements"—is not barred by Pennhurst State Sch. & Hosp. v. Halderman, 465 U.S. 89, 106 (1984), because plaintiffs allege a potential violation of their procedural-due-process rights pursuant to Ex parte Young and because requiring the Department to make a decision on the application and comply with the federal Constitution does not infringe the state's sovereign immunity.

The court also held that the first and third of plaintiffs' requested injunctions—directing the Department to "not withhold approval" of their application or "grant" them a license—are barred by Pennhurst because there is no free-standing federal right to receive an abortion-clinic license. The court declined to exercise its pendant jurisdiction to consider other issues raised by the Department. Accordingly, the court denied the motion to dismiss, affirmed in part and reversed in part, and remanded for further proceedings.

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Case: 18-30699 Document: 00515940047 Page: 1 Date Filed: 07/15/2021 United States Court of Appeals for the Fifth Circuit United States Court of Appeals Fifth Circuit FILED July 15, 2021 No. 18-30699 Lyle W. Cayce Clerk Planned Parenthood Gulf Coast, Incorporated; Planned Parenthood Center for Choice; Jane Doe #1; Jane Doe #2; Jane Doe #3, Plaintiffs—Appellees, versus Courtney N. Phillips, in her official capacity as Secretary of the Louisiana Department of Health, Defendant—Appellant. Appeal from the United States District Court for the Middle District of Louisiana USDC No. 3:18-CV-176 Before Higginbotham, Elrod, and Ho, Circuit Judges. Jennifer Walker Elrod, Circuit Judge: Two Planned Parenthood entities and three Jane Does brought this lawsuit under 42 U.S.C. § 1983 alleging that the Louisiana Department of Health is unlawfully declining to act on Planned Parenthood Center for Choice’s application for a license to provide abortion services in Louisiana. The Department moved to dismiss under Federal Rule of Civil Procedure Case: 18-30699 Document: 00515940047 Page: 2 Date Filed: 07/15/2021 No. 18-30699 12(b)(1) on several bases, including sovereign immunity. 1 The district court denied the motion without prejudice, and the Department filed this interlocutory appeal. The plaintiffs moved to dismiss this interlocutory appeal, arguing that we lack appellate jurisdiction. Because the Department asserted sovereign immunity in the district court, we DENY the motion to dismiss the appeal. At least one of the plaintiffs’ requested forms of relief is a valid invocation of federal jurisdiction under Ex parte Young. The judgment of the district court is AFFIRMED in part and REVERSED in part. The case is REMANDED for further proceedings consistent with this opinion. I. Plaintiff Planned Parenthood Gulf Coast provides non-abortion healthcare services at its clinics in Texas and Louisiana. Gulf Coast also participates in Texas’s and Louisiana’s Medicaid programs. The three Jane Doe plaintiffs are Gulf Coast patients. Plaintiff Planned Parenthood Center for Choice, a Texas Corporation, has a facilities and services agreement with Gulf Coast to provide abortion services at Gulf Coast clinics and provides abortions services at Gulf Coast’s clinics in Texas. Currently, however, Planned Parenthood is not licensed to provide abortions anywhere in Louisiana. In September 2016, Planned Parenthood applied for a license to operate an abortion clinic at a Gulf Coast clinic in New Orleans, Louisiana. About six weeks later, the Department notified Planned Parenthood that its application was incomplete and missing information, which triggered a 90-day deadline for Planned Parenthood to 1 The nominal defendant is Dr. Courtney Phillips, Secretary of the Louisiana Department of Health, who is substituted for former Secretary Dr. Rebekah Gee pursuant to Federal Rule of Appellate Procedure 43(c)(2). Phillips is sued only in her official capacity. 2 Case: 18-30699 Document: 00515940047 Page: 3 Date Filed: 07/15/2021 No. 18-30699 respond. 2 Planned Parenthood did not respond until five months later, in April 2017, allegedly with the Department’s permission to postpone the response deadline. The Department continued its review of the application, including inspecting Gulf Coast’s New Orleans clinic in May 2017. Meanwhile, in December 2016, a Select Investigative Panel of the United States House of Representatives began investigating Planned Parenthood’s handling of fetal remains. The investigation was spurred in part by videos recorded at Gulf Coast’s headquarters in Texas that “depict[ed] two individuals posing as representatives from a fetal tissue procurement company discussing the possibility of a research partnership with PP Gulf Coast.” Planned Parenthood of Greater Tex. Fam. Plan. & Preventative Health Servs., Inc. v. Kauffman, 981 F.3d 347, 351 (5th Cir. 2020) (en banc). 3 Among other findings, the Select Committee’s Final Report related evidence that Gulf Coast had illegally received or sought financial compensation in exchange for transferring fetal body parts to academic institutions in Texas. 4 In December 2016, the Select Committee referred several of those violations to the Texas Attorney General for investigation and released a 450-page report documenting its findings. The Department decided to withhold action on Planned Parenthood’s application to let the Texas investigation run its course. In June 2017, the Department sent Planned Parenthood a letter communicating its decision to defer resolution of the application. The letter explained that, under 2 See La. Admin. Code tit. 48, pt. I, § 4405(E) (Jan. 2021) (giving an applicant “90 calendar days from receipt of the notification to submit the additional requested information”). 3 The videos, in their entirety, are publicly available. Kauffman, 981 F.3d at 382 n.10 (Elrod, J., concurring) (linking to videos). 4 See 42 U.S.C. § 289g-2; Tex. Penal Code Ann. § 48.02. 3 Case: 18-30699 Document: 00515940047 Page: 4 Date Filed: 07/15/2021 No. 18-30699 Louisiana law, “the Department may deny a license if an investigation or survey determines that the applicant is in violation of any federal or state law or regulation.” 5 Referencing the Select Committee’s “criminal and regulatory referral to the Texas Attorney General related to the operations of Planned Parenthood Gulf Coast,” the letter explained that the Department needed to “conduct[] an investigation to determine if Planned Parenthood Center for Choice, either in its own name or through the actions of Planned Parenthood Gulf Coast, is in violation of any federal or state law or regulation.” The letter concluded by saying that the Department “is neither approving nor denying [Planned Parenthood’s] application,” but that “[a]fter the conclusion of this investigation, [the Department] will be in a position to make a determination on [Planned Parenthood’s] license application.” Then, in January 2018, Louisiana received a confidential complaint regarding activity by Gulf Coast in Louisiana. The Louisiana Attorney General is currently investigating that complaint for potential action by the state. Because Planned Parenthood has a facilities and services agreement with Gulf Coast to use Gulf Coast’s space, services, and staff, the Department views the investigation as necessarily implicating Planned Parenthood. In February 2018, the plaintiffs sued the Department, asserting two sets of claims. 6 The first set—the licensing claims—challenge the 5 See La. Stat. Ann. § 40:2175.6(G) (stating that the Department may deny a license “if an investigation or survey determines that the applicant or licensee is in violation of any provision of this Part, in violation of the licensing rules promulgated by the department, or in violation of any other federal or state law or regulation”). 6 The plaintiffs’ claims, as set out by the district court, are as follows: Claim I alleges that the [constructive] denial and [Louisiana’s House Bill 4 Case: 18-30699 Document: 00515940047 Page: 5 Date Filed: 07/15/2021 No. 18-30699 Department’s handling of their application for a license to provide abortion services in Louisiana. The plaintiffs allege that the Department’s letter and decision to await more information constituted a “constructive denial” of Planned Parenthood’s application and that the Department’s licensing process is a “sham” intended to prevent Planned Parenthood from performing abortions. The plaintiffs assert that this alleged denial violates their rights to substantive due process, procedural due process, and equal protection. They do not challenge the underlying statutes or regulations that govern abortion-clinic licensing; they challenge only the Department’s handling of this particular application. On their licensing claims, the plaintiffs seek a declaratory judgment that the “denial” of their license violates the Due Process and Equal Protection Clauses of the Fourteenth Amendment and “is therefore void and of no effect.” They also seek three injunctions on their licensing claims: (1) an injunction preventing the Department from “withholding approval” of its application; (2) an injunction ordering the Department to “promptly 606 (“HB 606”)] violate [Planned Parenthood’s] patients’ due process rights to liberty and privacy as guaranteed by the Fourteenth Amendment because they have the unlawful purpose or effect of imposing an undue burden on women’s exercise of their right to an abortion. Claim II alleges that the denial and HB 606 “single out” [Gulf Coast], [Planned Parenthood], and their patients for unfavorable treatment without justification in violation of the Equal Protection Clause. Claim III alleges that HB 606 violates 42 U.S.C. § 1396a(a)(23) by denying [Gulf Coast’s] Louisiana Medicaid patients the right to choose any willing, qualified provider. Claim IV alleges that HB 606 violates the First Amendment and the Due Process Clause of the Fourteenth Amendment by placing an unconstitutional condition on [Gulf Coast’s] eligibility to participate in Medicaid based on the Plaintiffs’ exercise of constitutionally protected activity. Finally, Claim V alleges that the denial violates [Planned Parenthood’s] right to procedural due process by denying [Planned Parenthood] a license without adequate procedural protections. 5 Case: 18-30699 Document: 00515940047 Page: 6 Date Filed: 07/15/2021 No. 18-30699 rule” on the application “in accordance with all applicable constitutional requirements”; and (3) an injunction ordering the Department to grant the application and issue an abortion-clinic license to Planned Parenthood. The plaintiffs’ second set of claims—their funding claims— challenges Louisiana’s House Bill 606 (“HB 606”), which prohibits giving taxpayer funds, including Medicaid funds, to abortion providers and their affiliates. 7 The plaintiffs assert that, in the event that Planned Parenthood is eventually granted a license, HB 606 would require Louisiana to cease providing Gulf Coast with Medicaid funding. The plaintiffs claim that HB 606 violates their due process, equal protection, and First Amendment rights, as well as a provision of the federal Medicaid Act. 8 They seek both declaratory and injunctive relief on the funding claims. The Department moved to dismiss the complaint for lack of subjectmatter jurisdiction under Federal Rule of Civil Procedure 12(b)(1). The Department asserted sovereign immunity from the licensing claims because, in the Department’s view, those claims call on the district court to “supervise an ongoing State-law licensing process—the very kind of situation” that deprives a federal court of jurisdiction under Pennhurst. Pennhurst State Sch. & Hosp. v. Halderman, 465 U.S. 89, 106 (1984) (holding that sovereign immunity prohibits federal courts from “instruct[ing] state officials on how to conform their conduct to state law”). Likewise, the Department argued that granting the plaintiffs’ requested relief on their licensing claims would violate Pennhurst because they “demand a change in the Department’s interpretation of State law.” It also urged that the licensing claims involve the kinds of state-law 7 See La. Stat. Ann. §§ 36:21(B), 40:1061.6(A)(2), 40:2175.4(B). 8 42 U.S.C. § 1396a(a)(23). 6 Case: 18-30699 Document: 00515940047 Page: 7 Date Filed: 07/15/2021 No. 18-30699 entanglements that require the district court to abstain and dismiss under Burford. Burford v. Sun Oil Co., 319 U.S. 315, 318, 332 (1943) (holding that a federal court may abstain from exercising its equity jurisdiction where doing so would “be prejudicial to the public interest” or would “so clearly involve[] basic problems of [State] policy” (quoting United States ex rel. Greathouse v. Dern, 289 U.S. 352, 360 (1933))). Finally, the Department urged dismissal because the plaintiffs’ funding claims are contingent on the barred licensing claims, are not ripe, and are therefore not justiciable. The plaintiffs responded, arguing that the claims are ripe because the Department’s actions up to this point have been “pretextual” and that the Department “will continue to stall until this Court orders it to act.” They also countered that Burford did not require the district court to abstain because it is “unclear” whether state-court relief is available, and that Pennhurst does not foreclose jurisdiction because their licensing claims are about federal rights. The district court denied the Department’s motion to dismiss without prejudice to the renewal of the Department’s jurisdictional arguments once the case returns to the district court after this interlocutory appeal. The Department appealed. Thereafter, the plaintiffs filed a motion to dismiss this appeal for lack of jurisdiction, which was carried with the case. II. First, we must decide whether we have jurisdiction over this interlocutory appeal. Normally, our jurisdiction reaches only appeals from “final decisions.” 28 U.S.C. § 1291. 9 Because an order denying a motion to dismiss is not a final decision, it “ordinarily does not constitute an 9 The Department does not argue that this appeal satisfies any of the exceptions to this rule set out in 28 U.S.C. § 1292. 7 Case: 18-30699 Document: 00515940047 Page: 8 Date Filed: 07/15/2021 No. 18-30699 immediately appealable order.” Thomas ex rel. D.M.T. v. Sch. Bd. St. Martin Par., 756 F.3d 380, 383 (5th Cir. 2014). Nevertheless, beginning with Cohen v. Beneficial Industrial Loan Corp., the Supreme Court has recognized narrow exceptions to this rule under what is now termed the collateral-order doctrine. 337 U.S. 541, 545–47 (1949). The collateral-order doctrine permits appellate courts to hear appeals of interlocutory orders that “[1] conclusively determine the disputed question, [2] resolve an important issue completely separate from the merits of the action, and [3] [are] effectively unreviewable on appeal from a final judgment.” Coopers & Lybrand v. Livesay, 437 U.S. 463, 468 (1978); accord Microsoft Corp. v. Baker, 137 S. Ct. 1702, 1708 n.3 (2017). In Puerto Rico Aqueduct & Sewer Authority v. Metcalf & Eddy, Inc., the Supreme Court concluded that the collateral-order doctrine permits appeal of a district court’s order denying a state “immunity from suit.” 506 U.S. 139, 141, 145 (1993). Because “[d]enials of States’ and state entities’ claims to [sovereign] immunity purport to be conclusive determinations that they have no right not to be sued in federal court,” the Supreme Court held that the “elements of the Cohen collateral order doctrine” were satisfied and therefore expanded the doctrine to appeals of denials of sovereign immunity. Id. at 144–45. The Department argues that we have appellate jurisdiction under Metcalf & Eddy because, it says, it has always asserted “immunity from suit.” Id. at 145. The Department says that it has consistently argued that sovereign immunity bars the plaintiffs’ “entire suit.” McCarthy ex rel. Travis v. Hawkins, 381 F.3d 407, 411 (5th Cir. 2004) (exercising jurisdiction over appeal of a denial of a motion to dismiss “asserting [sovereign] immunity from the entire suit”). In its motion to dismiss, the Department stated that the district court lacked jurisdiction over the entire case. Specifically, it 8 Case: 18-30699 Document: 00515940047 Page: 9 Date Filed: 07/15/2021 No. 18-30699 urged that the plaintiffs’ licensing claims were barred by sovereign immunity and Pennhurst, 10 that all of the requested forms of relief on the licensing claims were barred by sovereign immunity and Pennhurst, 11 that the funding claims were enveloped by and contingent on the licensing claims, 12 and that the funding claims were unripe anyway. Thus, the Department argues that it asserted immunity from this suit and that we have jurisdiction. The plaintiffs argue that we do not have jurisdiction because, they contend, the Department asserted sovereign immunity from only certain forms of relief, and not others. This argument is without merit. As the Department explained in its motion, “Pennhurst covers all the licensing claims, and all the relief Plaintiffs request on those claims, because all demand a change in the Department’s interpretation of State law.” 10 The Department’s reply in support of its motion to dismiss states that “Pennhurst covers all the licensing claims.” 11 The Department’s reply in support of its motion to dismiss states that “Pennhurst covers all the licensing claims, and all the relief Plaintiffs request on those claims, because all demand a change in the Department’s interpretation of State law.” The Department’s motion to dismiss states that “the relief Plaintiffs demand on their license claim—including an injunction requiring issuance of a license to Planned Parenthood— would require this Court to override the Department’s interpretation of State law. This Court has no authority to issue such relief.” The motion to dismiss also states that, “even if it were appropriate for this Court to review the State’s ongoing licensing processes, Plaintiffs are not entitled to the relief they seek from their licensing claim. . . . Plaintiffs demand a declaration . . . and an injunction.” 12 The Department’s motion to dismiss states: Plaintiff[s’] [funding] claim is premised on the theory that if [Planned Parenthood] receives a license, then [Planned Parenthood’s] State Medicaid funding would be threatened. Plaintiffs’ challenge to HB 606 is therefore not even arguably ripe until [Planned Parenthood] receives an abortion clinic license. But [Planned Parenthood] does not have a license. Plaintiffs’ [funding] claims are nonjusticiable until a concrete case or controversy arises. 9 Case: 18-30699 Document: 00515940047 Page: 10 Date Filed: 07/15/2021 No. 18-30699 Alternatively, the plaintiffs argue that the Department asserted sovereign immunity only on the licensing claims and only a ripeness challenge on the funding claims. Because the Department did not assert sovereign immunity from the funding claims independent of the licensing claims, the plaintiffs contend that we do not have jurisdiction under Metcalf & Eddy. But Metcalf & Eddy is not as limited as the plaintiffs say that it is. The jurisdictional inquiry is not overly technical; it is straightforward. Under Metcalf & Eddy, we ask: Did the state assert sovereign immunity from suit? See Metcalf & Eddy, 506 U.S. at 144 (“This withdrawal of jurisdiction effectively confers an immunity from suit.”); see also id. (“Once it is established that a State . . . [is] immune from suit . . . .”). As we characterized it in McCarthy, a proper invocation of sovereign immunity will be from the “entire suit.” McCarthy, 381 F.3d at 411. Metcalf & Eddy’s straightforward, entire-suit standard fulfills the purpose of jurisdiction over interlocutory appeals in this context, which is to ensure that a state has not been deprived of this “fundamental constitutional protection” before a lawsuit proceeds to trial. Metcalf & Eddy, 506 U.S. at 143–45. “[T]he value to the States of their [sovereign] immunity . . . is for the most part lost as litigation proceeds past motion practice.” Id. at 145. The potential injury is being wrongly “haled into court” and the only way to truly protect that right is to ask simply whether the state asserted immunity from the lawsuit. Va. Off. for Prot. & Advoc. v. Stewart, 563 U.S. 247, 258 (2011). Here, we hold that we have jurisdiction because the Department asserted sovereign immunity from this entire lawsuit. Simply put, the Department has always argued that a proper application of sovereign 10 Case: 18-30699 Document: 00515940047 Page: 11 Date Filed: 07/15/2021 No. 18-30699 immunity would remove it from this litigation and require dismissal of all claims. We therefore have jurisdiction over this interlocutory appeal. 13 In rejecting the plaintiffs’ argument that we should undertake a hypertechnical inquiry to exercise jurisdiction, we find ourselves in good company. The Supreme Court rejected a similar argument in Metcalf & Eddy. There, the respondent argued “that a distinction should be drawn between cases in which the determination of a State[’s] . . . claim to [sovereign] immunity is bound up with factual complexities whose resolution requires trial and cases in which it is not.” Metcalf & Eddy, 506 U.S. at 147. Just as the Supreme Court saw “little basis for drawing such a line” and rejected that argument, we reject the plaintiffs’ argument here. Id. We have jurisdiction. III. We next examine whether the district court erred in denying the Department’s motion to dismiss. As discussed above, the Department first and foremost argues that sovereign immunity mandates dismissal of this entire case. The states’ sovereign immunity is derived from the principle of federalism woven throughout our constitutional framework. Federalism recognizes our dual sovereignties—the states and the federal government— 13 This is not the first time that we have exercised jurisdiction over an interlocutory appeal where the state asserted absolute immunity from only some, and not all, of a plaintiff’s claims in the district court. In BancPass, Inc. v. Highway Toll Administration, L.L.C., we held that we had jurisdiction over the interlocutory appeal even though the state agency asserted immunity from a defamation claim, but not from a tortious interference with contract claim. 863 F.3d 391, 396, 398 (5th Cir. 2017). Indeed, this appeal presents an even stronger case for finding jurisdiction than the situation in Bancpass did because the state agency in Bancpass asserted immunity from only one claim—never arguing that a sovereign-immunity win on that claim would dispose of the entire lawsuit—whereas here the Department has always argued that a win on the sovereign-immunity issue would protect it from the entire lawsuit. 11 Case: 18-30699 Document: 00515940047 Page: 12 Date Filed: 07/15/2021 No. 18-30699 and “secures to citizens the liberties that derive from the diffusion of sovereign power.” Shelby Cnty. v. Holder, 570 U.S. 529, 543 (2013) (quoting Bond v. United States, 564 U.S. 211, 221 (2011)). Under the Eleventh Amendment, federal courts cannot tell state officials “how to conform their conduct to state law”—for one can hardly imagine “a greater intrusion on state sovereignty.” Pennhurst, 465 U.S. at 106. Letting a federal court tell state officials how to act under state law would “conflict[] directly with the principles of federalism that underlie the Eleventh Amendment.” Id. Hence, the Eleventh Amendment generally deprives federal courts of jurisdiction to hear “suits by individuals against nonconsenting states” and suits “against state officials in their official capacities.” McCarthy, 381 F.3d at 412; id. at 418 (Garza, J., concurring in part and dissenting in part). Importantly, however, sovereign immunity is not boundless and one of its limits is the Ex parte Young doctrine. 209 U.S. 123 (1908). The doctrine grants a federal court jurisdiction over a lawsuit against a “state official in his official capacity if the suit seeks prospective relief to redress an ongoing violation of federal law.” Williams ex rel. J.E. v. Reeves, 954 F.3d 729, 736 (5th Cir. 2020), stay denied, No. 20A126, 2021 WL 1306942 (Apr. 8, 2021). For Ex parte Young to apply, “three criteria must be satisfied: (1) A ‘plaintiff must name individual state officials as defendants in their official capacities’; (2) the plaintiff must ‘allege[] an ongoing violation of federal law’; and (3) the relief sought must be ‘properly characterized as prospective.’” Green Valley Special Util. Dist. v. City of Schertz, 969 F.3d 460, 471 (5th Cir. 2020) (en banc) (internal citations omitted) (first quoting Raj v. La. State Univ., 714 12 Case: 18-30699 Document: 00515940047 Page: 13 Date Filed: 07/15/2021 No. 18-30699 F.3d 322, 328 (5th Cir. 2013); then quoting Verizon Md., Inc. v. Pub. Serv. Comm’n of Md., 535 U.S. 635, 645 (2002)). Ex parte Young is a “necessary exception” to sovereign immunity, preventing state officials from using their state’s sovereignty as a shield to avoid compliance with federal law. Metcalf & Eddy, 506 U.S. at 146. The “premise” of the doctrine, which applies to state officials but not to the states themselves, is that a “state official is ‘not the State for sovereign-immunity purposes’ when ‘a federal court commands [her] to do nothing more than refrain from violating federal law.’” Williams, 954 F.3d at 736 (quoting Va. Off. for Prot. & Advoc., 563 U.S. at 255). The inquiry requires us to give “careful consideration [to] the sovereign interests of the State as well as the obligations of state officials to respect the supremacy of federal law.” Verizon, 535 U.S. at 649 (Kennedy, J., concurring). Ex parte Young’s purpose is to “give[] life to the Supremacy Clause” and prevent violations of federal rights. Green v. Mansour, 474 U.S. 64, 68 (1985). Accordingly, the exception does not apply when plaintiffs seek to vindicate state-law rights, because there is no “greater intrusion on state sovereignty” than when a federal court instructs a state official on how to conform her conduct to state law. Pennhurst, 465 U.S. at 106. “[I]f there are no federal rights for the plaintiff to vindicate then the justification for the Young exception is not present in the case and the state’s right to [sovereign] immunity should be honored.” McCarthy, 381 F.3d at 419 (Garza, J., concurring in part and dissenting in part). “In determining whether the doctrine of Ex parte Young” applies, “a court need only conduct a ‘straightforward inquiry into whether [the] complaint alleges an ongoing violation of federal law and seeks relief properly characterized as prospective.’” Verizon, 535 U.S. at 645 (alteration in original) (quoting Idaho v. Coeur d’Alene Tribe of Idaho, 521 U.S. 261, 296 13 Case: 18-30699 Document: 00515940047 Page: 14 Date Filed: 07/15/2021 No. 18-30699 (1997) (O’Connor, J., concurring in part and concurring in the judgment)). “[T]he inquiry into whether suit lies under Ex parte Young does not include an analysis of the merits of the claim.” Id. at 646. A. Here, the first and third criteria of Ex parte Young are satisfied, because the state official is sued in her official capacity and the plaintiffs seek prospective relief. See Green Valley, 969 F.3d at 471. Consequently, our task is to decide whether Ex parte Young’s second criterion has been satisfied: Do the plaintiffs allege violations of federal law such that the Ex parte Young exception to sovereign immunity allows this lawsuit to proceed in federal court, or do the plaintiffs allege only violations of state law such that sovereign immunity requires dismissal of the entire lawsuit? See id. On their licensing claims, the plaintiffs allege that the Department has “constructively denied” their application and that the investigations purportedly preventing the Department from officially ruling on the application are in fact “shams.” The plaintiffs assert that the Department’s actions violate their federal constitutional rights to equal protection, substantive due process, and procedural due process. They seek injunctions directing the Department: (1) to “not withhold approval” of the license; (2) to “promptly rule” on the application “in accordance with all applicable constitutional requirements”; or (3) to “grant” the license. In response, the Department argues that the complaint asserts only state-law claims disguised as federal claims. It says that the plaintiffs’ real complaint is that the Department has incorrectly interpreted the Louisiana statute that forbids granting abortion-clinic licenses to applicants in violation 14 Case: 18-30699 Document: 00515940047 Page: 15 Date Filed: 07/15/2021 No. 18-30699 of “federal or state law.” 14 Specifically, one way to read the plaintiffs’ complaint is that it says that the state statute is confined to actual violations of federal or Louisiana law—not potential violations of other states’ laws, as the Department reads the statute. 15 If that is the real thrust of the complaint, the Department says, then the plaintiffs are asking a federal court to order a state official “to conform [her] conduct to [the plaintiffs’ interpretation of] state law,” which the Department says that Pennhurst forbids. Pennhurst, 465 U.S. at 106. The Department also argues that all forms of relief sought by the plaintiffs on their licensing claims are barred by Pennhurst. The district court rejected the Department’s argument. It held that the licensing claims were supported by “extensive allegations spanning many years that, when taken in the light most favorable to [the plaintiffs], suggest that [the Department’s] current proffered interpretation of state law is the latest in a series of largely pretextual decisions made to indefinitely prevent [the plaintiffs] from providing abortions.” The district court held that “while [the Department] is correct that ‘particular abortion providers do not have a federal constitutional right to a license,’ . . . to parse the federal constitutional right a[t] issue as simply the right to ‘a license’ under state law reads the issue too narrowly at least at this early stage.” We hold that the plaintiffs have established federal jurisdiction on their requested injunction to “promptly rule.” Specifically, under Rule 12(b)(1)’s straightforward inquiry, plaintiffs’ procedural due process and equal protection claims seeking an injunction directing the Department to rule on their license application satisfy Ex parte Young. 14 Plaintiffs’ See La. Stat. Ann. § 40:2175.6(G). 15 But see Doe I v. Landry, 909 F.3d 99, 112 (5th Cir. 2018) (“When the state official charged with implementing a statute has provided an interpretation of how to enforce it, we will defer unless that explanation is inconsistent with the statutory language.”). 15 Case: 18-30699 Document: 00515940047 Page: 16 Date Filed: 07/15/2021 No. 18-30699 complaint alleges that Planned Parenthood is entitled to a license under Louisiana law and that the Department’s “constructive denial” of their license application occurred “without sufficient procedural protections.” It also alleges that throughout the licensing process Planned Parenthood was treated differently than other similarly situated applicants. An injunction ordering the Department to provide the procedural protections guaranteed by the federal Due Process Clause and heed the requirements of the Equal Protection Clause does not order the Department to conform to state law in violation of Pennhurst. See Brown v. Ga. Dep’t of Revenue, 881 F.2d 1018, 1023 (11th Cir. 1989) (“Under Pennhurst, however, the determinative question is not the relief ordered, but whether the relief was ordered pursuant to state or federal law.”). We emphasize that the Rule 12(b)(1) inquiry “does not include an analysis of the merits of the claim,” and accordingly do not comment on whether plaintiffs can survive a Rule 12(b)(6) motion to dismiss. Verizon, 535 U.S. at 646; see also McCarthy, 381 F.3d at 416 (“[T]he Court [in Verizon] made clear that analyzing the applicability of the Ex parte Young exception should generally be a simple matter, which excludes questions regarding the validity of the plaintiff’s cause of action.”). We note, however, that to survive a such a motion, plaintiffs’ complaint must identify which procedural protections guaranteed by the Due Process Clause are lacking. Allegations that the Department is not following Louisiana law or is applying that law incorrectly are insufficient because “[t]he constitutional procedural standards of the due process clause are . . . wholly and exclusively federal in nature.” Stern v. Tarrant Cnty. Hosp. Dist., 778 F.2d 1052, 1059 (5th Cir. 1985) (en banc). “[A] violation of state law is neither a necessary nor a sufficient condition for a finding of a due process violation.” Id.; see also Snowden v. Hughes, 321 U.S. 1, 11 (1944) (“Mere violation of a state statute 16 Case: 18-30699 Document: 00515940047 Page: 17 Date Filed: 07/15/2021 No. 18-30699 does not infringe the federal Constitution.”). 16 Similarly, to state a valid equal protection claim, plaintiffs must point to other similarly situated applicants who were treated differently. See, e.g., Priester v. Lowndes Cnty., 354 F.3d 414, 424 (5th Cir. 2004). B. The plaintiffs alternatively request two other injunctions commanding the Department to “grant” them a license or “not withhold approval” of their license application. 17 These injunctions are fundamentally different from the “promptly rule” injunction. They would share the same result, which is that the plaintiffs would receive the license. They also share the same fatal flaw, which is that the plaintiffs have no free-standing “federal right” to an abortion-clinic license. Va. Off. for Prot. & Advoc., 563 U.S. at 260. Conducting our “straightforward inquiry,” it is clear that these injunctions ask a federal court to tell a state official to grant an abortion-clinic license—the right to which arises entirely under state law. Coeur d’Alene Tribe of Idaho, 521 U.S. at 296 (O’Connor, J., concurring in part and concurring in the judgment). Under Pennhurst, a federal court can do no such thing. Abortion-clinic licensing is a creature of state law. See, e.g., Planned Parenthood of Se. Penn. v. Casey, 505 U.S. 833, 884 (1992) (abortion services are “part of the practice of medicine, subject to reasonable licensing and regulation by the State”); Hillsborough Cnty. v. Automated Med. Lab’ys, Inc., 471 U.S. 707, 719 (1985) (holding local health ordinance not preempted 16 The district court should address in the first instance how the plaintiffs can reconcile their concession that there are no constitutional issues with Louisiana’s licensing statute or regulation with their burden to show a violation of the Constitution. 17 The district court did not explicitly discuss the “grant” and “not withhold approval” requested injunctions. 17 Case: 18-30699 Document: 00515940047 Page: 18 Date Filed: 07/15/2021 No. 18-30699 because “the regulation of health and safety matters is primarily, and historically, a matter of local concern”); Women’s Med. Ctr. of Nw. Hous. v. Bell, 248 F.3d 411, 419 (5th Cir. 2001) (noting that “without violating the Constitution, the State could have required all abortion providers to be licensed”); Tex. Med. Providers Performing Abortion Servs. v. Lakey, 667 F.3d 570, 579 n.8 (5th Cir. 2012) (“[W]hat [abortion providers] think is medically necessary does not cabin, under the state’s legitimate power, the regulation of medicine, as Casey holds.”). 18 Because abortion-clinic-licensing is quintessentially a matter of state law, there is no free-standing federal right to receive an abortion-clinic license. Just as there is no free-standing federal right to receive a medical license. Or a law license. A federal court cannot tell a state official, absent a violation of federal law, to deny or approve a license application—the potential right to which arises entirely from state law. And plaintiffs cannot circumvent the doctrine of sovereign immunity by suing a state official and adding magic words like “federal law” and “constitution” to their complaint. Unlike the plaintiffs’ “promptly rule” injunction demanding a decision on their application, the “grant” and “not withhold approval” 18 See also United States v. Bird, 124 F.3d 667, 688 (5th Cir. 1997) (DeMoss, J., concurring in part and dissenting in part) (“There is no national regulatory scheme regarding the provision of abortion services. The federal government does not license abortion clinics, does not approve the training of abortion providers, and does not regulate the delivery of abortion services to ensure that any minimum health standards are met. The federal government has not created any administrative agency nor designated any department of the federal government to regulate the abortion industry in order to stabilize the supply of abortion services or encourage the demand for such services.”). 18 Case: 18-30699 Document: 00515940047 Page: 19 Date Filed: 07/15/2021 No. 18-30699 injunctions have no underlying federal right and no basis outside of state law. These forms of relief are therefore barred by sovereign immunity. C. The plaintiffs also request a declaratory judgment “that the denial of [the] license violates the Due Process Clause and Equal Protection Clause of the Fourteenth Amendment and is therefore void and of no effect.” It is unclear what exactly the plaintiffs seek with this form of relief. To the extent that this declaratory judgment would allow the district court to tell the Department to grant or deny the license, this requested form of relief is also barred by Pennhurst for the same reasons that the “grant” and “not withhold approval” injunctions are barred. And, to the extent that this is some sort of place-holder claim to evaluate an anticipated, formal denial of the plaintiffs’ application, we express no opinion on that here. D. In sum, we hold that the plaintiffs’ second requested injunction— directing the Department to “promptly rule” on their application “in accordance with all applicable constitutional requirements”—is not barred by Pennhurst because the plaintiffs allege a potential violation of their procedural-due-process rights pursuant to Ex parte Young and because requiring the Department to make a decision on the application and comply with the federal Constitution does not infringe the state’s sovereign immunity. We also hold that the first and third of the plaintiffs’ requested injunctions—directing the Department to “not withhold approval” of their 19 Case: 18-30699 Document: 00515940047 Page: 20 Date Filed: 07/15/2021 No. 18-30699 application or “grant” them a license—are barred by Pennhurst because there is no free-standing federal right to receive an abortion-clinic license. IV. The Department raised other issues in the district court that it argues we could exercise our pendant jurisdiction to decide on appeal. For example, the Department urges us to consider its ripeness and standing challenges to the plaintiffs’ funding claims. Although we have the discretion to exercise our pendant jurisdiction to consider these issues, we decline to do so. See Hosp. House, Inc. v. Gilbert, 298 F.3d 424, 429 (5th Cir. 2002) (holding that when a court has “interlocutory appellate jurisdiction to review a district court’s denial of [sovereign] immunity, [it] may first determine whether there is federal subject matter jurisdiction over the underlying case”). At oral argument, the plaintiffs conceded that on remand the Department will be able to bring a Rule 12(b)(6) motion to dismiss, raising ripeness, standing, and other jurisdictional objections. 19 Oral Argument at 24:33–25:20. The district court should carefully consider the Department’s jurisdictional challenges before proceeding to the merits. Regarding ripeness, the plaintiffs allege that HB 606 will disqualify Gulf Coast from receiving Medicaid funds once Planned Parenthood “begins providing . . . abortions at the New Orleans Health Center,” i.e., if and when it receives a license. For a claim to be ripe, there must be a “hardship to the parties of withholding court consideration.” Choice Inc. of Tex. v. Greenstein, 691 F.3d 710, 715 (5th Cir. 2012) (quoting New Orleans Pub. Serv., Inc. v. Council of City of New Orleans, 833 F.2d 583, 586 (5th Cir. 1987)). Given that 19 Prior to this appeal, the district court permitted the Department to file only a Rule 12(b)(1) motion to dismiss. See Oral Argument at 24:47–24:58 (“The only motion that [the Department was] permitted to bring was a 12(b)(1) motion and make the immunity argument. . . . The district court was sequencing things.”). 20 Case: 18-30699 Document: 00515940047 Page: 21 Date Filed: 07/15/2021 No. 18-30699 it is unclear if and when Planned Parenthood will receive a license, it is difficult to see how the absence of a judicial decision on the hypothetical future impact of HB 606 causes the plaintiffs any harm in the present. 20 Relatedly, the Department argued in the district court that the plaintiffs do not have standing because they have not suffered an injury. The bulk of the district court’s jurisdictional analysis was not conducted plaintiffby-plaintiff, despite the fact that the various plaintiffs occupy very different positions with respect to Louisiana’s licensing scheme. But “standing is not dispensed in gross.” Lewis v. Casey, 518 U.S. 343, 358 n.6 (1996). And even if Planned Parenthood has standing to challenge the alleged constructive denial of its license application, it is unclear how such a constructive denial directly injures Gulf Coast or the Jane Does, who are patients of Gulf Coast’s. See Lujan v. Defenders of Wildlife, 504 U.S. 555, 562 (1992) (describing the closer inquiry demanded when “a plaintiff’s asserted injury arises from the government’s allegedly unlawful regulation (or lack of regulation) of someone else”). The Jane Does do not appear to allege that they wish to receive abortion services at all—much less with the type of specificity that Lujan requires. 21 See id. at 564 (holding that plaintiffs failed to demonstrate an actual or imminent injury because they presented merely “‘some day’ 20 The district court noted that purely legal questions are often ripe. But “even where an issue presents purely legal questions, the plaintiff must show some hardship in order to establish ripeness.” Choice Inc., 691 F.3d at 715 (quoting Cent. & S. W. Servs., Inc. v. EPA, 220 F.3d 683, 690 (5th Cir. 2000)). 21 The district court also stated that it is “well established that third parties may sometimes sue to protect the abortion rights of others.” However, the district court’s analysis on this point was perfunctory. It cited only a case in which this court held that physician-plaintiffs had a sufficiently “‘close’ relationship” with their patients such that they could assert the patients’ rights. Planned Parenthood of Greater Tex. Surgical Health Servs. v. Abbott, 748 F.3d 583, 589 (5th Cir. 2014) (quoting Kowalski v. Tesmer, 543 U.S. 125, 130 (2004)). But there are no physician-plaintiffs in this case. The plaintiffs here are two Planned Parenthood entities and three patients. 21 Case: 18-30699 Document: 00515940047 Page: 22 Date Filed: 07/15/2021 No. 18-30699 intentions—without any description of concrete plans, or indeed even any specification of when the some day will be”). Moreover, our en banc court has held that Medicaid patients do not have an individual right to contest a State’s determination that a particular provider is not qualified under Medicaid. Kauffman, 981 F.3d at 368; see also id. at 376 (Elrod, J., concurring). The Department also argued that the district should abstain under Burford, 319 U.S. at 333–34. The district court rejected that argument because the availability of a special state forum for resolution of licensing disputes was “unclear.” Yet the Department notes that applicants allegedly injured by its licensing decisions may seek intra-Department review under state law, 22 and it admitted at oral argument that this review is available now to the plaintiffs. Oral Argument at 14:44–14:59. The Department estimated the length of that review process to be only “a matter of weeks.” Oral Argument at 15:43. The Department further notes that a party dissatisfied with the result of intra-Department review may seek review in the appropriate parish district court under another state-law provision. 23 The plaintiffs have not pursued these remedies. Indeed, when pressed to explain how they could maintain a procedural-due-process claim at all without having taken advantage of these state-law procedures—given the Department’s concession that they are available—the plaintiffs only pointed out that they “don’t just have a procedural-due-process claim, [they] also have an equal-protection claim and an undue-burden claim.” Oral Argument at 21:46. 22 See La. Admin. Code, tit. 48, pt. I, § 4415(E). 23 See La. Stat. Ann. § 49:964(B). 22 Case: 18-30699 Document: 00515940047 Page: 23 Date Filed: 07/15/2021 No. 18-30699 We expect the district court to carefully consider each jurisdictional challenge—including whether and how they impact each of the plaintiffs and each of the claims—before proceeding to the merits. See In re Gee, 941 F.3d 153, 159 (5th Cir. 2019) (“A district court’s obligation to consider a challenge to its jurisdiction is non-discretionary.”); see also Ramming v. United States, 281 F.3d 158, 161 (5th Cir. 2001) (“[T]he plaintiff constantly bears the burden of proof that jurisdiction does in fact exist.”). * * * The motion to dismiss the appeal is DENIED. The judgment of the district court is AFFIRMED in part and REVERSED in part. The case is REMANDED for further proceedings consistent with this opinion. The district court shall either strike from the complaint the barred forms of relief or allow the plaintiffs to re-plead and delete those barred forms of relief in accordance with this opinion’s holdings. 23
Primary Holding
Plaintiffs' second requested injunction—directing the Department to "promptly rule" on their application for a license to provide abortion services in Louisiana "in accordance with all applicable constitutional requirements"—is not barred by Pennhurst State Sch. & Hosp. v. Halderman, pursuant to Ex parte Young and does not infringe the state's sovereign immunity.

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