SFALP Helps Block “Conscience Rule” Nationwide

With help from students in the San Francisco Affirmative Litigation Clinic (SFALP), San Francisco was the first city in the country to take the Trump administration to court over the so-called “conscience rule” that would have denied critical medical care to patients. On November 19, 2019, a federal court issued a summary judgment order invalidating the rule nationwide.

Yale Law School students helped draft the complaint the city filed just hours after the rule was announced in May 2019. “The SFALP students who worked on this case were exceptional,” said Deputy City Attorney Jaime Huling Delaye, who argued the case in the District Court. “From summary judgment briefing to oral argument preparation, they were full members of our team who played an instrumental role in this success that will protect access to healthcare nationwide.”

“This case demonstrates what is best about SFALP,” said Mailyn Fidler ’20, who has been in the Clinic for four semesters. “The attorneys included us in every stage.”

The rule would have allowed health care professionals to refuse to provide service to patients based on the staffer’s personal beliefs, threatening medical access for women; lesbian, gay, bisexual, and transgender people; and other medically or socially vulnerable populations. Nurses across the country, including at San Francisco’s level one trauma center, would have been able to refuse to provide treatment to women experiencing life-threatening, pregnancy-related complications — even if no other personnel were available to step in. Call operators would have been able to refuse to direct patients and potential patients to the correct departments to access contraception, abortions or gender transition-related services. Staff at all levels would have been emboldened to discriminate against LGBTQ patients or other vulnerable groups.

The lawsuit, filed in the U.S. District Court for the Northern District of California, asserts that the Department of Health and Human Services exceeded its statutory authority by creating the rule and violated the Administrative Procedure Act, the spending clause, separation of powers principles, and other provisions of the U.S. Constitution. The Judge held that all claims were ripe and all parties had standing, and then proceeded to vacate the rule nationwide on the basis that it violated the Administrative Procedure Act and was “not in accordance with law” because the definitions exceeded the scope of the underlying statutes.

“The government admitted that the rule would have allowed an ambulance driver to abandon a patient by the side of the road if he disagreed with the care she sought, even if that care would be lifesaving,” Fidler said. “This ruling ensures that patient health is not jeopardized by executive action that oversteps the considered decisions of the legislature.”