The louisiana law at issue here, act 620, is identical to the texas law and was expressly modeled on it. After a trial, the District Court ruled act 620 unconstitutional, finding no material differences between this case and whole Womans Health. On burdens, it found that act 620 would leave louisiana with just one clinic and one doctor providing abortions. At the same time, it found that act 620 would do nothing for womens health. In reversing the District Courts decision, the fifth circuit committed two fundamental errors. First, it usurped the role of the District Court and disregarded nearly all of its factual findings. Second, the fifth circuit accepted legal arguments that this court rejected four years ago. Nothing, however, has changed that would justify such a legal aboutface. In fact, even more medical organizations have joined the ama and acog to say that admitting privileges impose barriers to abortion with no benefit to patients and that this impact is not state dependent. Finally, the states eleventhhour objection to thirdparty standing runs up against still more binding precedent. The court squarely held in craig versus boren that such objections are waiveable, and the state deliberately and strategically waived the issue in the District Court. And even if the state could get past waiver, denying standing here would contradict decades of this courts precedent in numerous areas of the law. In short, petitioners have thirdparty standing, especially because act 620 restricts abortion by regulating them, rather than their patients. Justice ginsburg would you have done anything different if it had been if the thirdparty standing have been timely raised . Ms. Rikelman your honor, we certainly could have submitted additional evidence in the court, but we believe that the evidence that is already there is sufficient to find thirdparty standing. This court has squarely found thirdparty standing in at least four abortion cases that are on point, as well as a number of other cases such as meyer, craig, carey, and the courts cases have been consistent in saying that a plaintiff who is directly regulated by a law has thirdparty standing. Justice alito would you agree with the general proposition that a party should not be able to sue ostensibly to protect the rights of other people, if there is a real conflict of interest between the party who is suing and those whose rights the party claims to be attempting to defend . Ms. Rikelman no, your honor, not if that party is directly regulated by the law in question. And, in fact, this court has allowed thirdparty standing in cases where the state argued that the third parties were protected by the law and in a sense protected from the plaintiffs. Justice alito really . Thats amazing. You think that if the plaintiff actually has interests that are directly contrary to those of the those individuals on whose behalf the plaintiff is claiming to sue, nevertheless that plaintiff can have standing . Ms. Rikelman if the plaintiff is directly regulated by the law. This court has allowed an attorney to bring thirdparty claims against a statute that capped attorneys fees in favor of clients. Justice alito well, thats amazing. Lets i mean i i suppose i know you think that the admitting privileges requirement serves no safety purpose, but suppose that the regulation that was being challenged was one that a lot of people might think really did serve a safety purpose. Lets say were in a state where physicians assistants can perform abortions, and a an Abortion Clinic wants to challenge the training requirements for physicians assistants. It just thinks those are too onerous and theres no justification for them. Now, if theyre wrong about that, it implicates the interests of the women who may want to get an abortion, but you would say the clinic nevertheless can sue on behalf of those women . Ms. Rikelman this court has squarely held in many cases that a plaintiff directly regulated by the law can sue, and those cases make sense for at least two reasons, your honor. First, because a plaintiff should not be subject to severe penalties under an unconstitutional rule. And, second, if the plaintiff is the one directly regulated, then theyre it makes sense that they are the appropriate plaintiff. Justice ginsburg and that sounds like a direct standing, not thirdparty standing. Is there anything like the conflict that Justice Alito had mentioned . Is there a conflict . Ms. Rikelman no, your honor, there is not even a plausible conflict in this case because this court already held that admitting privileges served no medical benefit, and the District Court here, after a trial, specifically found that this law would serve no benefit and, in fact, would harm the health of women in louisiana. Justice alito but, you know, your argument is using the merits to defeat to to support standing. Theres a serious problem with that. Ms. Rikelman no, your honor. I believe its the state thats collapsing standing and merits. And, again, this court has allowed thirdparty standing in cases where one could argue that the state law in question was protecting third parties from the plaintiffs. In addition to triplett, that was the issue in craig versus boren. The law there was a state law in oklahoma, and the state claimed that it was designed to protect young men from buying beer in order to make sure that they were safe and didnt get into traffic accidents. Justice sotomayor counsel, is this i im just wondering, are these doctors in any different position than potential plaintiffs, women, who feel burdened by this law . Ms. Rikelman no, your honor. And, in fact, the state has not pointed to a single thing that would have been different if one woman had been joined in this lawsuit. To the contrary, the issues that the state says are the key issues in this case, whether this law serves health and safety benefits and how difficult it is for physicians to obtain privileges, are issues that the physicians are particularly well suited to litigate. And, again, this is a law Justice Sotomayor so the point is you have standing on behalf of those women who feel burdened . Ms. Rikelman yes, your honor. Justice sotomayor to the extent that other women may not have brought a suit, thats irrelevant to the fact that there are some, those burdened, who could have and would have, if situations had permitted them to . Ms. Rikelman thats absolutely right, your honor. Justice alito well, then why cant why shouldnt they be the ones to bring suit . Ms. Rikelman your honor, this is a law that restricts abortion by regulating the physicians, rather than their patients. And so its appropriate for them to be the plaintiffs here. Again, the Justice Alito well, but ms. Rikelman state has pointed to Justice Alito the the constitutional right at issue is not a constitutional right of Abortion Clinics, is it . Its the right of women. Ms. Rikelman thats correct, your honor, but in order for women to access their right to abortion, they need to be able to access those services. Justice alito do do you think a party can have thirdparty there can be thirdparty standing if there is no hindrance whatsoever to the bringing of suit by the people whose rights are at stake . Ms. Rikelman this court has allowed thirdparty standing in cases where the law directly regulates the plaintiff without a showing of hindrance. For instance, in craig versus boren, there was clearly no hindrance. But i would also say that the court doesnt need to reach these issues here because the state strategically and deliberately waived thirdparty standing. Justice alito well, i think thats highly debatable that they waived it. They certainly didnt raise it in the District Court, but whether they they affirmatively waived it is quite debatable. Ms. Rikelman your honor at ja 45, the state explicitly conceded thirdparty standing and urged the District Court to reach the undue burden claim, saying that it had a keen interest in removing any cloud upon the validity of its law, that this case was the proper vehicle for doing so. Justice alito its a its a highly debatable interpretation of that passage, which ive read numerous times. What the state was saying was that the while the temp if a temporary restraining order was issued, the lawsuit should continue to go forward. And they said there wouldnt be an impediment to the lawsuit going forward, because the doctors would have standing. And what i think they may have been saying in that instance is that they would have standing under the law that was applicable at that time. We and we could debate what was actually said, but i think its quite a stretch of the record for you to say there was an affirmative waiver. Ms. Rikelman your honor, at ja 45 there was a deliberate waiver. And the and the state did it strategically because it was attempting to take advantage of favorable fifth circuit precedent at the time because the fifth circuit had just upheld the texas admitting privileges law. Again, the state specifically urged the District Court to decide the undue burden claim, saying that this case was the proper proper vehicle for resolving the constitutional issues and that any delay wouldnt serve judicial efficiency. Justice ginsburg it wasnt raised in in the District Court or in the court of appeals. It was it cropped up in a wasnt it a crosspetition for cert . Ms. Rikelman thats correct, your honor. Justice ginsburg and might you have, if you had a timely notice, just as insurance, joined a patient or two . Ms. Rikelman yes, your honor. And, in fact, it would be profoundly unfair to allow the state to raise the objection for the first time five years into this litigation after it urged the District Court to decide the undue burden claim and then pursued the undue burden claim through multiple rounds of appeals. It didnt even raise the issue when this case came before the court in 2016 on the stay. The first time that it raised an objection was when it filed its crosspetition for cert. And, again, at ja 45, it deliberately and strategically waived this issue. Justice breyer how many abortion cases has has the court either expressly or silently allowed the doctors to sue on behalf of the women . I i counted eight, but maybe thats overstating it. How many abortion cases in this court . Ms. Rikelman at least eight, your honor. And i believe at least four of them squarely allowed standing in precisely these circumstances. Justice breyer so if we didnt in this case, it would require either directly or indirectly overruling eight cases of this court . Ms. Rikelman thats correct. And, in fact, in danforth and akron the same type of law was at issue. It was a law that the state claimed was designed to protect the health and safety of women but the Court Allowed the physicians to bring the claim and to show that, in fact, the law didnt further health and safety. Justice alito in how many of those cases did the court discuss the issue of conflict of interest . Ms. Rikelman the court in danforth specifically said that the plaintiffs had standing. It wasnt discussed in terms of the words conflict, your honor, but, again, the same types of arguments were in front of the court Justice Alito was it ms. Rikelman because the state Justice Alito was it a footnote in danforth . Ms. Rikelman i dont believe so, your honor. I believe it was a foot footnote in akron but in danforth it was Justice Alito yeah. Justice ginsburg you made a point about craig versus boren, that the ostensible purpose of the law was to save the vulnerable young men from the evils of 3. 2 beer . Ms. Rikelman thats correct, your honor, and the Court Allowed the saloon keeper to bring the thirdparty standing claim. Again, in triplet the Court Allowed an attorney to challenge a law designed to cap attorney fees. And in carey the Court Allowed a mail order contraceptive company to challenge a law that was designed to limit the prescription of contraceptives to pharmacists, again, claiming that that was about protecting the health and safety of people. So the court has allowed thirdparty standing in many cases that are squarely on point. Chief Justice Roberts counsel, do you agree that the inquiry under hellerstedt is a factual one that has to proceed statebystate . Ms. Rikelman your honor, i think that facts may vary, but what we know is that the District Court held a trial here and found that there were no material differences between this case and chief Justice Roberts no, no, i know, but if if the issue, the statutes are on the books in other states, and if the issues are raised there, is the same inquiry required in each case . You have to have the District Court examine the availability of specific clinics and the admitting privileges of doctors so that the litigation could be the results could be different in different states . Ms. Rikelman two points, if i may, your honor. This court held in whole Womans Health that the texas admitting privileges law was medically unnecessary and its burdens were undue. That holding should clearly apply to louisianas identical law, and certainly the courts reasoning is applicable in louisiana. Now, the burdens of a law may vary, but a law that has no benefits and doesnt serve any valid state interest is much more likely to impose an undue burden. And Justice Kavanaugh if a if a state passed an admitting privileges law therefor, and suppose a state had 10 clinics and two doctors for each clinic, but all 20 doctors could easily get the admitting privileges, so that there would be no effect on the clinics, no effect on the doctors who perform abortions, and therefore no effect on the women who obtain abortions, would a law be constitutional in that state . Ms. Rikelman that law may still be unconstitutional if its restricting access because of the 30mile limit, your honor, but thats very different from the situation here where the District Court concluded Justice Kavanaugh if it didnt im sorry to interrupt if it didnt, though, put aside the 30 miles, assume all the doctors who currently perform abortions can obtain admitting privileges, could you say that the law still imposes an undue burden, even if there were no effect . Ms. Rikelman that law would have no benefit, your honor, and it may pose a much harder question than this case. But in this case the District Court after a trial explicitly found that the burdens of this law would be severe, and it would leave only one physician to serve 10,000 people per year in the entire state. And the Justice Alito well, the fifth circuit went through what the District Court had said about the various doctors. And it was proper for the fifth circuit to review the District Courts findings for clear error, was it not . Ms. Rikelman yes, your honor. Clear error is the standard. And we believe that the District Courts findings are more than plausible under the standard here. Justice alito well, lets take one example. Lets take doe number 2. Doe number 2 is a plaintiff in this case, right . Ms. Rikelman yes, your honor. Justice alito so he had he didnt have it would be counter to his own interests for him to make a super effort to get admitting privileges, wouldnt it, because hed be defeating his own claim . Ms. Rikelman no, your honor. Doe 2 brought this lawsuit to protect the rights of his patients. And the District Court found that he was competent and qualified and that he made good faith efforts to obtain Justice Alito all right. So if all right. We can argue about whether he had a conflict of interest or not. He previously had admitting privileges at a hospital in the shreveport area, did he not . Ms. Rikelman yes, your honor. Justice alito a predecessor of Christus Schumpert . Ms. Rikelman yes, your honor. Justice alito he testified that he didnt apply for admitting privileges there because its a catholic hospital, isnt that right . Ms. Rikelman that was part of the testimony. But in addition, the bylaws of in that hospital showed that there would be admissions requirements that doe 2 couldnt meet. Justice alito all right. Well, he testified directly, i did not apply there because its a catholic hospital. Is that not correct . Ms. Rikelman thats correct, your honor. Justice alito all right. Doe number 3 performs abortions, does he not . Ms. Rikelman yes. Justice alito doe number 3 has admitting privileges there . Ms. Rikelman he has admitting privileges that require 50 admissions per year which he is able to satisfy because he has an obstetrics practice. And thats why he was the only physician with privileges. The states own credentialing expert in this case conceded that outpatient physicians like these who never intend to treat patients in the hospital will not be able to get privileges, and the hospital bylaws included many criteria that these physicians could never satisfy, including residency Justice Alito when doe number 2 explained why he didnt apply to this hospital, he said, in part, because its not a place where i would feel comfortable. Didnt he say that . Ms. Rikelman he did, your honor. Doe 2 focused his efforts on hospitals where he thought he had the best chance of obtaining privileges. He had had privileges at lsu and wasnt even able to get privileges there. Justice alito did the District Court mention any of these facts . Ms. Rikelman yes, your honor. The District Courts opinion was very careful, and its its decision and finding that these physicians would not be able to get privileges was based on at least four points.