State of Texas, et.al. v. Xavier Becerra, et. al.

Statue:

Notable Items:

Issue(s) Before the Court:

• whether the Guidance is a final agency action subject to the court's review,
• whether the Guidance is consistent with EMTALA,
• whether the district court erred in concluding that the Guidance was required to undergo notice and comment under the Medicare Act, and
• whether the injunction is overbroad.

Appellant's Claim(s):

Appellee's Claim(s):

Holding(s) and Disposition:

• Legal consequences flow from the Guidance, and it determines rights and obligations. The Guidance therefore constitutes final agency action.
• The question before the court is whether EMTALA, according to HHS's Guidance, mandates physicians to provide abortions when that is the necessary stabilizing treatment for an emergency medical condition. It does not.
• Thus, because the Guidance "establishes or changes a substantive legal standard,", HHS was required to subject the Guidance to notice and comment.
• The district court was correct in tailoring the injunction based on the parties, issues, and evidence before it.

Material Facts:

• A full recounting of the facts is available below

Procedural History:

• Appeal from the United States District Court for the Northern District of Texas USDC No. 5:22-CV-185
• The pertinent language from the permanent injunction for the purpose of this appeal is:
  1. The defendants may not enforce the Guidance and Letter's interpretation that Texas abortion laws are preempted by EMTALA; and
  2. The defendants may not enforce the Guidance and Letter's interpretation of EMTALA--both as to when an abortion is required and EMTALA's effect on state laws governing abortion--within the State of Texas or against AAPLOG's members and CMDA's members.

Rationale

Majority Opinion (xxx)

• A full description of the rationale is available below

?? Concurrance in part, dissent in part (??) (xxx)

?? Dissent (??) (xxx)

Full Recounting of Facts

• A list of the material facts is available above

Majority Full Argument

• See Material Facts
• See Procedural History
• III A whether the Guidance is a final agency action subject to the court's review
• The APA provides for judicial review of a "final agency action." Two conditions must be met for agency action to be "final."
• First, the action must mark the 'consummation' of the agency's decisionmaking process. Bennett v. Spear, 520 U.S. 154, 177-78 (1997)
• And second, the action must be one by which 'rights or obligations have been determined,' or from which 'legal consequences will flow.'
• Courts have consistently held that 'an agency's guidance documents binding it and its staff to a legal position produce legal consequences or determine rights and obligations, thus meeting the second prong of Bennett.
• In this case, the mandatory language of the Guidance renders it binding.
• Put simply, the Guidance sets out HHS's legal position--for the first time--regarding how EMTALA operates post-Dobbs.
• The Guidance is new policy; it does not "merely restate" EMTALA's requirements. Legal consequences flow from the Guidance, and it determines rights and obligations. The Guidance therefore constitutes final agency action.
• III B whether the Guidance is consistent with EMTALA
• The district court applied Chevron, finding that the Guidance exceeds HHS's statutory authority and is not a permissible construction of EMTALA.
• In HHS's view, EMTALA mandates whatever a medical provider concludes is medically necessary to stabilize whatever condition is present.
• Employing the traditional tools of statutory interpretation, we hold that HHS's Guidance exceeds the statutory language.
• EMTALA does not specify stabilizing treatments in general, except one: delivery of the unborn child and the placenta.
• The inclusion of one stabilizing treatment indicates the others are not mandated. (the expressio unius est exclusio alterius canon)
• The Texas plaintiffs' argument that medical treatment is historically subject to police power of the States, not to be superseded unless that was the clear and manifest purpose of Congress, is convincing. [Congress cannot rely upon the Supremacy Clause unless it is specifically invoked] [Allows Texas to exclude standard medical care procedures from the set available to patients elsewhere. Idaho's claim in Moyle v. United States (2024) ]
• HHS's argument that 'any' type of treatment should be provided is outside EMTALA's purview.
• EMTALA states: "The provisions of this section do not preempt any State or local law requirement, except to the extent that the requirement directly conflicts with a requirement of this section."
• Under the conflicts-preemption test, a state statute directly conflicts with federal law where
  1. it is impossible for a person to comply with both the state law and EMTALA, or
  2. where the state law "stands as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress." Crosby v. Nat'l Foreign Trade Council, 530 U.S. 363, 372–73 (2000)
• The question before the court is whether EMTALA, according to HHS's Guidance, mandates physicians to provide abortions when that is the necessary stabilizing treatment for an emergency medical condition. It does not.
• III C whether the district court erred in concluding that the Guidance was required to undergo notice and comment under the Medicare Act, and
• ... statements of policy that establish or change a legal standard are subject to notice and comment under the Medicare Act. Azar v. Allina Health Servs., 139 S. Ct. 1804, 1808 (2019)
• The Guidance, at a minimum, falls under Azar's definition of a "state- ment of policy" because it lets the public know of HHS's "adjudicatory approach" concerning the application of EMTALA with respect to abortion and state abortion laws.
• As discussed at length infra, the Guidance goes beyond EMTALA by mandating abortion. Thus, because the Guidance "establishes or changes a substantive legal standard,", HHS was required to subject the Guidance to notice and comment.
• III D
• Federal Rule of Civil Procedure 65(d)(1)(B) and (C) requires every injunction must "state its terms specifically; and ... describe in reasonable detail--and not by referring to the complaint or other document--the act or acts restrained or required."
• The injunction squarely enjoins HHS from enforcing the Guidance and Letter regarding these two issues within the State of Texas and against the plaintiff organizations.
• The district court was correct in tailoring the injunction based on the parties, issues, and evidence before it.
• The core of the rationale is available above