F I L E D

United States Court of Appeals

Tenth Circuit

PUBLISH

APR 17 2002

UNITED STATES COURT OF APPEALS

PATRICK FISHER

TENTH CIRCUIT

PLANNED PARENTHOOD OF THE

ROCKY MOUNTAINS SERVICES
CORPORATION; PETER A. VARGAS,
M.D.; BOULDER ABORTION CLINIC,
P.C.; WARREN M. HERN, M.D.; JAMES
A. MCGREGOR, M.D.; MICHAEL D.
RUDNICK, M.D.; ARIS M. SOPHOCLES,
JR., M.D.; and WOMEN'S CHOICE OF
BOULDER VALLEY, INC.,
Plaintiffs - Appellees,
v.
WILLIAM OWENS, in his official
capacity as Governor of the State of
Colorado; DAVID J. THOMAS, in his
official capacity as District Attorney for
the First Judicial District, State of
Colorado; A. WILLIAM RITTER, JR., in
his official capacity as District Attorney
for the Second Judicial District, State of
Colorado; GLENN DAVIS, in his official
capacity as District Attorney for the Third
Judicial District, State of Colorado;
JEANNE MARIE SMITH, in her official
capacity as District Attorney for the Fourth
Judicial District, State of Colorado;
MICHAEL GOODBEE, in his official
capacity as District Attorney for the Fifth
Judicial District, State of Colorado;
SARAH LAW, in her official capacity

No. 00-1385

Clerk

as District Attorney for the Sixth Judicial

District, State of Colorado; WYATT
ANGELO, in his official capacity as
District Attorney for the Seventh Judicial
District, State of Colorado; STUART A.
VAN MEVEREN, in his official capacity
as District Attorney for the Eighth
Judicial District, State of Colorado; MARK
MCLUCAS MYERS, in his official
capacity as District Attorney for the Ninth
Judicial District, State of Colorado; GUS
SANSTROM, in his official capacity as
District Attorney for the Tenth Judicial
District, State of Colorado; EDWARD J.
RODGERS, III, in his official capacity as
District Attorney for the Eleventh Judicial
District, State of Colorado; ROBERT
PASTORE, in his official capacity as
District Attorney for the Twelfth Judicial
District, State of Colorado; MARK
ADAMS, in his official capacity as District
Attorney for the Thirteenth Judicial
District, State of Colorado; PAUL R.
MCLIMANS, in his official capacity as
District Attorney for the Fourteenth
Judicial District, State of Colorado;
RONALD F. FOSTER, in his official
capacity as District Attorney for the
Fifteenth Judicial District, State of
Colorado; GARY STORK, in his official
capacity as District Attorney for the
Sixteenth Judicial District, State of
Colorado; ROBERT S. GRANT, in his
official capacity as District Attorney for
the Seventeenth Judicial District, State of
Colorado; JAMES PETERS, in his official
capacity as District Attorney for the
Eighteenth Judicial District, State of

-2-

Colorado; AL DOMINGUEZ, in his

official capacity as District Attorney for
the Nineteenth Judicial District, State of
Colorado; ALEXANDER M. HUNTER, in
his official capacity as District Attorney
for the Twentieth Judicial District, State of
Colorado; FRANK J. DANIELS, in his
official capacity as District Attorney for
the Twenty-First Judicial District, State of
Colorado; and MICHAEL F. GREEN, in
his official capacity as District Attorney
for the Twenty-Second Judicial District,
State of Colorado,
Defendants - Appellants,
------------------------COLORADO PRO LIFE ALLIANCE,
INC.; UNITED FAMILIES
INTERNATIONAL, INC.; SOCIETY FOR
ADOLESCENT MEDICINE; COLORADO
CHAPTER OF THE AMERICAN
ACADEMY OF PEDIATRICS;
AMERICAN MEDICAL WOMEN'S
ASSOCIATION; and AMERICAN
PUBLIC HEALTH ASSOCIATION,
Amici Curiae.
Appeal from the United States District Court
for the District of Colorado
(D.C. No. 99-WM-60)
Maurice G. Knaizer, Deputy Attorney General (Ken Salazar, Attorney General,
John S. Sackett, Assistant Attorney General, State of Colorado, Denver, Colorado;
A. William Ritter, Jr., District Attorney, Henry R. Reeve, Deputy District
-3-

Attorney, Second Judicial District, Denver, Colorado; and Jeanne M. Smith,

District Attorney, Fourth Judicial District, Colorado Springs, Colorado, with him
on the briefs), for Defendants-Appellants.
Jennifer Ellen Dalven, American Civil Liberties Union Foundation Reproductive
Freedom Project, New York, New York (Louise Melling, American Civil
Liberties Union Foundation Reproductive Freedom Project, New York, New
York, Edward T. Ramey, Isaacson, Rosenbaum, Woods & Levy, P.C., Denver,
Colorado, Tim Atkeson and Keri Howe, Arnold & Porter, Denver, Colorado,
Mark Silverstein, American Civil Liberties Union Foundation of Colorado,
Denver, Colorado, Kevin C. Paul, Planned Parenthood of the Rocky Mountains,
Inc., Denver, Colorado, with her on the brief), for Plaintiffs-Appellees.
Paul Benjamin Linton, Northbrook, Illinois, filed an amici curiae brief on behalf
of the Colorado Pro Life Alliance, Inc., and United Families International, Inc., in
support of Defendants-Appellants.
A. Stephen Hut, Jr., Kimberly A. Parker, and Julie M. Riewe, Wilmer, Cutler &
Pickering, Washington, D.C., filed an amici curiae brief on behalf of the Society
for Adolescent Medicine, the Colorado Chapter of the American Academy of
Pediatrics, the American Medical Womens Association, and the American Public
Health Association, in support of Plaintiffs-Appellees.
Before BRISCOE, BALDOCK, and LUCERO, Circuit Judges.
LUCERO, Circuit Judge.

Plaintiffs filed suit seeking to have a Colorado statute regulating abortion

declared unconstitutional and to have enforcement of that statute enjoined. The
district court granted summary judgment for plaintiffs, holding that the lack of a
health exception for the parental notification requirement of the statute rendered

-4-

it unconstitutional. We have jurisdiction pursuant to 28 U.S.C. 1291 and affirm.

I
The Colorado Parental Notification Act (PNA) was adopted as an
initiative in Colorados general election of November 3, 1998. 1 It generally
requires that minors in the state of Colorado provide notice to at least one of their
parents before obtaining an abortion. The legislative declaration of the act states:
The people of the state of Colorado . . . declare that family life and
the preservation of the traditional family unit are of vital importance
to the continuation of an orderly society; that the rights of parents to
rear and nurture their children during their formative years and to be
involved in all decisions of importance affecting such minor children
should be protected and encouraged, especially as such parental
involvement relates to the pregnancy of an unemancipated minor,
recognizing that the decision by any such minor to submit to an
abortion may have adverse long-term consequences for her.
Colo. Rev. Stat. 12-37.5-102.
Performance of an abortion on an unemancipated minor is specifically
prohibited until at least forty-eight hours after written notice is delivered to the
minors parent, guardian, or foster parent. Id. 12-37.5-103(2), -104(1).
Violation of the PNA is a class one misdemeanor and creates liability for civil
damages. Id. 12-37.5-106(1). 2
1

The full text of the PNA is set out in the Appendix to this Opinion.

The statute also provides that [a]ny person who counsels, advises,
encourages or conspires to induce or persuade any pregnant minor to furnish any
physician with false information . . . concerning the minors age, marital status or
(continued...)
2

-5-

There are two exceptions to the PNAs notice requirement. First, the notice
requirement does not apply if the persons entitled to notice certify in writing that
they have already been notified. Id. 12-37.5-105(a). Second, the notice
requirement does not apply if the minor declares that she is a victim of child
abuse or neglect by the persons entitled to notice, and the physician reports this
fact in accordance with Colorado law. 12-37.5-105(b). Two affirmative
defenses to liability also exist. First, the physician is absolved from liability if he
shows that he reasonably relied upon representations by the minor indicating
compliance with the PNA. Id. 12-37.5-106(2)(a). Second, the physician can
show that the abortion was necessary to prevent the imminent death of the minor
and that there was insufficient time to provide the required notice. 12-37.5106(2)(b).
Plaintiffs filed suit challenging the constitutionality of the PNA on
December 22, 1998. 3 Named defendants originally were the governor of Colorado
and one local district attorney; the suit was later expanded to include all local

(...continued)
any other fact or circumstance to induce . . . the physician to perform an abortion
without written notice can be found guilty of a class five felony. Colo. Rev. Stat.
12-37.5-106(3).
2

The suit was originally filed in Colorado state court but was removed to
federal court by defendants. Planned Parenthood of the Rocky Mountains Servs.
Corp. v. Owens, 107 F. Supp. 2d 1271, 127475 (D. Colo. 2000).
3

-6-

district attorneys in Colorado. 4 One of plaintiffs claims was that the PNA was
facially unconstitutional because it lacked an exception permitting a physician to
perform an abortion without notice or a waiting period even when necessary to
protect the health of the pregnant minor. 5 Planned Parenthood of the Rocky
Mountains Servs. Corp. v. Owens, 107 F. Supp. 2d 1271, 1275 (D. Colo. 2000).
The district court granted summary judgment for plaintiffs on this claim. Id. at
1276.
We review the district courts grant of summary judgment de novo. Simms
v. Oklahoma ex rel. Dept of Mental Health & Substance Abuse Servs., 165 F.3d
1321, 1326 (10th Cir. 1999). Summary judgment is appropriate if the pleadings,
depositions, answers to interrogatories, and admissions on file, together with the
affidavits, if any, show that there is no genuine issue as to any material fact and
4

Hereinafter, we refer to defendants collectively as the State.

Plaintiffs other claims were (1) that the PNA violates the federal
constitution by failing to provide a judicial bypass for the parental notification
provision for mature, abused, or best interest children; (2) that the existing
judicial bypass provision in the PNA does not adequately protect federal
constitutional rights; (3) that the PNA violates state due process rights; (4) that
the PNA violates state separation of powers; and (5) that the PNAs definition of
abortion violates the federal constitution by requiring parental notification for the
use of contraception by minors. Planned Parenthood, 107 F. Supp. 2d at 1275.
Plaintiffs contraception claim was dismissed after the district court granted
the States motion for partial summary judgment pursaunt to a joint motion by the
parties. Id. at 1276. Because relief was granted to plaintiffs on the health
exception claim, the district court did not address the other federal constitutional
claims. The state constitutional claims were dismissed without prejudice by the
district court. Id.
5

-7-

that the moving party is entitled to a judgment as a matter of law. Fed. R. Civ.
P. 56(c). When applying this standard, we view the evidence and draw reasonable
inferences therefrom in the light most favorable to the nonmovant. Simms, 165
F.3d at 1326. The mere existence of a scintilla of evidence in support of the
nonmovants position is insufficient to create a dispute of fact that is genuine;
an issue of material fact is genuine only if the nonmovant presents facts such that
a reasonable jury could find in favor of the nonmovant. Id. (quotation omitted).
In the absence of a genuine issue of material fact, we determine whether the
district court correctly applied the substantive law. Id.
II
Key to resolution of this case is our answer to this question: Does the
United States Constitution, as interpreted by the Supreme Court, require that state
abortion regulations provide a health exception where such an exception is
necessary to ensure that those regulations do not threaten the health of a pregnant
woman? If the answer is yes, then a subsidiary and related question that we must
also answer is: What is the appropriate standard of review to apply when a
lawsuit challenges an abortion statute for failing to provide a health exception?
A
Three cases are essential to answering the first question: Roe v. Wade, 410
U.S. 113 (1973), which established the current constitutional principles regarding
-8-

abortion; Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833 (1992),
which reaffirmed and refined the holdings of Roe; and Stenberg v. Carhart, 530
U.S. 914 (2000), which is the most recent holding by the Supreme Court on the
constitutional requirements for a health exception for abortion regulations.
Roe established the importance of protecting the health of pregnant women
in the context of abortion regulation. One of the three central holdings of Roe is
that for the stage of pregnancy subsequent to viability, a state may regulate and
even proscribe abortion, except, where it is necessary, in appropriate medical
judgment, for the preservation of the life or health of the mother. Roe, 410 U.S.
at 165.
This holding was reaffirmed in Casey, where the Court stated in the clearest
possible terms that abortion regulations cannot interfere with a womans ability to
protect her own health. The Casey Court emphasized that the essential holding
of Roe forbids a State from interfering with a womans choice to undergo an
abortion procedure if continuing her pregnancy would constitute a threat to her
health. Casey, 505 U.S. at 880. In upholding Pennsylvanias abortion
regulations, the Court found it crucial that the statute had a medical emergency
exception to the application of the state regulations, and that the exception was
broad enough to assure that compliance with [the States] abortion regulations

-9-

would not in any way pose a significant threat to the life or health of a woman.
Id. (quotation omitted).
Roe and Casey directly address only state regulation of post-viability
abortions, Roe, 410 U.S. at 16465; Casey, 505 U.S. at 879 (joint opinion of
OConnor, Kennedy, and Souter, JJ.), a context in which the Court has held that a
state has a compelling interest in protecting potential life, Roe, 410 U.S. at 163.
This means that pre-viability, where the states interest in regulation of abortion
is weaker, the state would likewise have no constitutional power to infringe on
the right of the pregnant woman to protect her health. In other words, at no time
during the period of pregnancy may the state regulate abortion in a manner that
infringes on the ability of a pregnant woman to protect her health. In Stenberg,
the Court confirmed this deduction. Since the law requires a health exception in
order to validate even a postviability abortion regulation, it at a minimum requires
the same in respect to previability regulation. 530 U.S. at 930.
Stenberg also confirmed that the lack of a health exception is a sufficient
ground for invalidating a state abortion statute. Id. (announcing two independent
reasons for invalidating the state abortion law in question, one of which was that
the law lack[ed] any exception for the preservation of the . . . health of the
mother (quotation omitted)); see also id. at 947 (OConnor, J., concurring)
([T]he Nebraska statute is inconsistent with Casey because it lacks an exception
- 10 -

for those instances when the banned procedure is necessary to preserve the health
of the mother.). Even the dissent in Stenberg agreed that Casey and Roe require
state abortion regulations to have health exceptions for those situations in which
continuing a pregnancy would threaten the health of the mother. Id. at 1009
(Thomas, J., dissenting). The point of departure for the dissent regarded
application of the foregoing standard to the facts in Stenberg. Id. (contending
that Roe and Casey were inapplicable to the presented facts because they say
nothing at all about cases in which a physician considers one prohibited method
of abortion to be preferable to permissible methods.). 6

Even before the Supreme Court affirmed the existence of the healthexception requirement in Casey and Stenberg, the Court was filling in the
substance of that requirement in a series of cases. See Thornburgh v. Am. Coll.
of Obstetricians & Gynecologists, 476 U.S. 747, 76871 (1986) (invalidating a
requirement that a second physician be present for all abortions where viability is
possible because there was no health exception to the requirement), overruled in
part on other grounds by Planned Parenthood of Southeastern Pa. v. Casey, 505
U.S. 833, 88283 (1992); Planned Parenthood Assn of Kan. City v. Ashcroft, 462
U.S. 476, 485 n.8 (1983) (upholding a Missouri statute requiring two physicians
to be present for third-trimester abortions because the statute could be interpreted
to create a health exception to that requirement); see also Harris v. McRae, 448
U.S. 297, 316 (1980) ([I]t could be argued that the freedom of a woman to
decide whether to terminate her pregnancy for health reasons does in fact lie at
the core of the constitutional liberty identified in [Roe].).
Although Casey overrules in part Thornburgh, Thornburghs essential
holding regarding the health exception requirement was reaffirmed by Casey. See
Jane L. v. Bangerter, 102 F.3d 1112, 1118 n.7 (10th Cir. 1996).
6

- 11 -

That the PNA regulates abortion performed for minors does not alter the
constitutional requirements or mandates laid down by the Court regarding the
necessity of a health exception. Constitutional rights do not mature and come
into being magically only when one attains the state-defined age of majority.
Minors, as well as adults, are protected by the Constitution and possess
constitutional rights. Planned Parenthood of Cent. Mo. v. Danforth, 428 U.S.
52, 74 (1976). The State does not urgeand the Court has never ruledthat a
state may constitutionally infringe on a minors ability to protect her health
through an abortion, or that the health exception requirement either does not
apply or applies differently to minors.
Thus, the current state of the law is that state abortion regulations must
provide an exception for the protection of the health of pregnant women where
those regulations might otherwise infringe on their ability to protect their health
through an abortion. 7
The State argues that the analysis of whether a health exception is
required for a particular state abortion regulation must proceed using the undue
burden test laid out in Casey, a test that generally applies to state regulation of
pre-viability abortion. Casey, 505 U.S. at 87677 (joint opinion of OConnor,
Kennedy, and Souter, JJ.). However, the Stenberg Court implicitly concluded that
the undue burden test does not apply to the determination of whether a health
exception is required, and that the lack of a health exception is a separate,
independent ground upon which a state abortion regulation may be invalidated.
Stenberg, 530 U.S. at 930 (holding that the Nebraska statute is unconstitutional
for at least two independent reasons, the lack of a health exception and the
(continued...)
7

- 12 -

B
Although facial challenges to statutes generally require the plaintiff to
show that there are no circumstances under which the law could be valid, see
United States v. Salerno, 481 U.S. 739, 745 (1987), the standard of review for
facial challenges to abortion statutes is quite different.
We have followed the majority of other circuits in holding that Casey
altered the Salerno standard in the context of abortion cases, with the Casey
undue burden test replacing the Salerno no set of circumstances test. See
Jane L. v. Bangerter, 102 F.3d 1112, 1116 (10th Cir. 1996). Review of state previability abortion regulations generally proceeds under Casey, which prescribes a
showing that the state abortion regulation operates, in a large fraction of the
cases . . . as a substantial obstacle to a womans choice to undergo an abortion.
Casey, 505 U.S. at 895. The State concedes that the Salerno standard is
inapplicable and assumes that our review should proceed under the Casey
standard.
However, in Stenberg the Supreme Court departed in yet another manner
from Salerno, relying on neither the Salerno no set of circumstances test nor the
(...continued)
imposition of an undue burden (emphasis added)). The proper analysis is thus to
determine whether a health exception is necessary given the restrictions imposed
by the PNA. See id. at 931. Our analysis, based on the facts conceded by the
State and contained in the record, shows that a health exception is necessary.
7

- 13 -

Casey undue burden test in striking down Nebraskas partial birth abortion
ban for lack of a health exception. See Stenberg, 530 U.S. at 938; see also id. at
1019 (Thomas, J., dissenting) (arguing that under the no set of circumstances
test the Nebraska statute should not be declared facially unconstitutional).
Without overruling or even citing Salerno, the Court instead held that in the
absence of evidence that a health exception would never [be] necessary to
preserve the health of women, the statute must be declared unconstitutional.
Stenberg, 530 U.S. at 93738 (quotation omitted). The district court in this case
implicitly reached this conclusion as well. See Planned Parenthood, 107 F. Supp.
2d at 1280 (concluding without discussing Salerno that Stenberg established a per
se rule requiring a health exception). We will follow what the Supreme Court
actually didrather than what it failed to sayand apply the standard for
reviewing abortion statutes laid out in Stenberg. Planned Parenthood v. Miller,
63 F.3d 1452, 1458 (8th Cir. 1995).
Applying that standard, if we conclude that the record shows that there is
no genuine issue as to the material fact that the PNA will infringe on the ability
of any pregnant woman to protect her health, we must hold the statute
unconstitutional. Plaintiffs need not show that all, or even most, pregnant women
who will be covered by the provisions of the PNA would have the right to protect
their health infringed unconstitutionally by the PNA. See Womens Med. Profl
- 14 -

Corp. v. Voinovich, 130 F.3d 187, 196 (6th Cir. 1997) ([A] post-viability
abortion regulation which threatens the life or health of even a few pregnant
women should be deemed unconstitutional.).
With these preliminary matters resolved, we address whether the Colorado
statute meets the appropriate constitutional requirements.
III
We first conclude that the evidence presented by the parties before the
district court mandates that the PNA contain a health exception. We then reject
the States argument that the PNA may be interpreted to contain a constitutionally
adequate health exception by reading into it a provision from Colorados
Childrens Code. That rejection is compelled because (1) Colorados principles
of statutory interpretation do not allow us to consider such an interpretation; and
(2) even if the PNA and the Childrens Code arguably conflict, those principles of
statutory interpretation would not allow us to read the Childrens Code as
superseding the PNA.
A
Both parties agree that there are circumstances in which complications of a
pregnancy may pose major health risks to the patient, including a threat to the
patients life. Planned Parenthood, 107 F. Supp. 2d at 1277. (9 App. at 2481,
2588; Appellants Br. at 9.) The parties also agree that these medical
- 15 -

complications may require medical treatment during the mandatory forty-eighthour waiting period of the PNA, and that treatment may necessitate an abortion as
defined in the PNA. Planned Parenthood, 107 F. Supp. 2d at 1277. (9 App. at
248183; 12 id. at 3297; Appellants Br. at 9.) Medical experts deposed on
behalf of both defendants and plaintiffs stated that delays required by the PNA for
the provision of an abortion to treat medical complications could result in
significant harm to the health of a pregnant woman and that these medical
complications could often arise in circumstances short of imminent death.
Planned Parenthood, 107 F. Supp. 2d at 1277 & n.9. (1 App. at 203208; 4 id. at
10471067, 1120-21; 5 id. at 124853; 6 id. at 147779, 1485, 160103,
160809; 9 id. at 262426.) Consequently, the PNAs affirmative defense for
imminent death would not be available to treating physicians in such situations.
Stated more formalistically, the evidence before the district court at the
time of plaintiffs summary judgment motion showed (1) that there are
circumstances in which pregnant minor women may be diagnosed by a physician
with a pregnancy complication that could seriously threaten their health; (2) that
such threatened harm may fall short of imminent death; and (3) that the fortyeight-hour delay required by the PNA would interfere with the medically

- 16 -

appropriate treatmentan abortionfor these women. 8 Having carefully

reviewed the record, we agree with the district court that there is no genuine issue
as to the material fact that the PNA infringes on the ability of pregnant women to
protect their health. We thus conclude that a health exception to Colorados
Parental Notification Act is constitutionally required.
B
Although the State admits that [w]ithin its four corners, the Act contains
no express exception when an abortion is necessary for the minors health, 9 it
The State disputes whether a form of pregnancy complicationectopic
pregnancy, where the fertilized egg is located somewhere other than the
uteruswould be covered by the PNA, and whether termination of an ectopic
pregnancy would be an abortion for purposes of the PNA. As the district court
noted, however, there are a number of other pregnancy complications the parties
agree could pose major risks to the health of the pregnant minor, treatment for
which may require an abortion as defined by the PNA and for which the fortyeight-hour waiting period of the PNA (or any delay at all) could endanger the
health of the pregnant minor. Planned Parenthood, 107 F. Supp. 2d at 1277 n.7.
Thus, we need not address the ectopic pregnancy issue to resolve this case.
8

The following state laws which require parental notice or consent for a
minor to obtain an abortion also provide a medical exception where the minors
life or health is at risk. See Ala. Code 26-21-5 (requirements do not apply
where medical emergency exists); Ariz. Rev. Stat. 36-2152 (requirements do not
apply where physician certifies immediate abortion necessary to avert death or
serious risk of substantial and irreversible impairment of major bodily function of
minor); Cal. Health & Safety Code 123450 (consent not required if medical
emergency exists); Del. Code Ann. tit. 24, 1787 (requirements do not apply
when medical emergency exists); Fla. Stat. ch. 390.01115 (notice not required
when medical emergency exists and immediate abortion necessary to avert death
or serious risk of substantial and irreversible impairment of major bodily function
of minor); Ga. Code Ann. 15-11-116 (requirements do not apply where medical
(continued...)
9

- 17 -

contends that such an exception should be imported from other provisions of

(...continued)
emergency exists); Idaho Code 18-609A (consent not required where medical
emergency exists); 750 Ill. Comp. Stat. 70/20 (notice not required where medical
emergency exists); Ind. Code 16-34-2-4 (requirements do not apply where
continuation of pregnancy provides immediate threat and grave risk to life or
health of minor); Iowa Code 135L.3 (requirements do not apply where physician
determines medical emergency exists); Kan. Stat. Ann. 65-6705 (notice not
required where emergency exists that threatens health, safety, or well-being of
minor); Ky. Rev. Stat. 311.732 (requirements do not apply when medical
emergency exists); La. Rev. Stat. Ann. 40:1299.35.12 (provisions do not apply
where medical emergency exists and continuation of pregnancy poses immediate
threat and grave risk to life or permanent physical health of minor); Md. Code
Ann., Health-Gen. I 20-102 (minor has same capacity as adult to consent if
physician determines life or health of minor would be affected adversely by
delay); Mich. Comp. Laws 722.905 (requirements do not apply if abortion
performed pursuant to medical emergency); Miss. Code Ann. 41-41-57
(requirements do not apply when physician determines medical emergency exists);
Mont. Code Ann. 50-20-208 (notice not required if physician certifies medical
emergency exists); Neb. Rev. Stat. 71-6906 (notice not required if physician
certifies immediate threat and grave risk to life or health of minor); Nev. Rev.
Stat. 442.255 (notice not required if life or health of minor is in immediate
danger); N.C. Gen. Stat. 90-21.9 (requirements do not apply when physician
determines medical emergency exists); 18 Pa. Cons. Stat. 3206 (consent not
required in case of medical emergency); R.I. Gen. Laws 23-4.7-4 (requirements
waived where emergency exists); S.C. Code Ann. 44-41-30 (consent waived
where physician determines medical emergency exists involving life of or grave
physical injury to minor); S.D. Codified Laws 20-9-4.2 (consent not required
where delay would threaten minors life or health); Tenn. Code Ann. 37-10-305
(requirements do not apply when physician determines medical emergency exists);
Tex. Fam. Code Ann. 33.002 (notice not required when physician determines
immediate abortion necessary to avert minors death or avoid serious risk of
substantial and irreversible impairment of major bodily function of minor); W.
Va. Code 16-2F-5 (requirements do not apply where emergency exists which
constitutes immediate threat and grave risk to life or health of minor); Wis. Stat.
48.375 (requirements do not apply where physician determines medical
emergency exists).
9

- 18 -

Colorado law. (Appellants Br. at 12.) In particular, the State points to 19-1104(3) of the Colorado Revised Statutespart of the Colorado Childrens
Codewhich allows a state juvenile court to grant authorization for emergency
medical treatment for a minor when reasonable effort is not sufficient to notify
the minors parents. This provision of Colorado law, the State claims, effectively
creates a health exception to the PNA that satisfies constitutional requirements. 10

The State also argues that a physician is relieved of the waiting

requirements of the Act by notifying the parent and either receiving permission to
proceed or by reporting the child as neglected. (Appellants Br. at 20.)
However, the plain language of the PNA excludes the first optioneven if
a parent is notified and provides permission, the forty-eight-hour delay is only
waived if the permission is provided in writing. Colo. Rev. Stat. 12-37.5105(1). The writing requirement could create substantial delay that might harm a
pregnant womans health in a medical emergency situation. Moreover, this
exception is only operative if the parent can be contacted at the time of the
medical emergency.
The second optionreporting a parent as abusive or neglectfulwould
seem to be an unwarranted response to a medical emergency where the difficulty
of obtaining parental consent is due not to the refusal of a parent to consent, but
rather to an inability to contact the parent during the minutes or hours within
which a doctor must respond to a medical emergency. Such a situation does not
appear to be what the Colorado legislature had in mind when it defined child
abuse or neglect in the Childrens Code to include physical violence, id. 19-1103(1)(a)(I), sexual assault or molestation, 19-1-103(1)(a)(II), failure to provide
the care that a prudent parent would provide, 19-1-103(1)(a)(III), emotional
abuse, 19-1-103(1)(a)(IV), or abandonment, 19-1-103(1)(a)(V). It also does
not appear to be what the legislature had in mind when it established a
requirement that all reports of abuse or neglect be forwarded to appropriate
government or law enforcement authorities, id. 19-3-307(1), and that those
authorities undertake an assessment of the situation, id. 19-3-308(1)(a), with the
possibility of criminal charges or removal of the child from home, id. 19-3307(4)(b).
10

- 19 -

In analyzing the States argument, we rely on Colorados principles and laws of

statutory construction to interpret the PNA and other Colorado statutes as the
Colorado state courts would interpret them. Phelps v. Hamilton, 59 F.3d 1058,
1071 (10th Cir. 1995). 11
We agree with the district court that the language of the PNA is clear and
unambiguous. No abortion shall be performed without written notice and the
forty-eight-hour delay. Colo. Rev. Stat. 12-37.5-104(1) (emphasis added). As
noted earlier, the statute provides two, and only two, exceptions to the notice and
waiting period requirements: No notice is required if the parent or parents certify
in writing that they have been notified, id. 12-37.5-105(a), and no notice is
required if the pregnant minor declaresand the attending physician reportsthat
she is a victim of abuse or neglect, 12-37.5-105(b). In addition, the PNA
provides for two, and only two, affirmative defenses to prosecutions under the
Act: The physician reasonably relied on the representations of the pregnant minor
regarding information necessary to comply with the PNA, id. 12-37.5-106(2)(a),
or an abortion was necessary to prevent the imminent death of the minor child

The fact that the PNA was adopted by initiative, rather than by the
Colorado legislature, does not alter the approach to statutory interpretation relied
upon by Colorado courts. See Common Sense Alliance v. Davidson, 995 P.2d
748, 754 (Colo. 2000) (en banc) (citing Bickel v. City of Boulder, 885 P.2d 215,
228 n.10 (Colo. 1994) (en banc), for the proposition that the general rules of
statutory construction apply when interpreting citizen-initiated measures).
11

- 20 -

and there was insufficient time to provide the required notice, 12-37.5106(2)(b). 12 Thus, the PNA provides for a near-absolute rule that abortions are
not to be performed on minor children unless notice is provided and the fortyeight-hour waiting period has expired.
We further agree with the district court that where a statute is clear and
unambiguous, the Colorado Supreme Court refuses to apply any rules of statutory
construction. See, e.g., Nicholas v. People, 973 P.2d 1213, 1216 (Colo. 1999) (en
banc) (Where the language is clear and unambiguous, we need not resort to rules
of statutory construction. (quotation omitted)). Thus, the States argument that
we should use the doctrine of in pari materia, a rule of statutory construction, to
interpret the Childrens Code provision as providing a health exception to the
PNA is unavailing. 13
The State urges us to apply the maxim that whenever possible statutes
should be construed to avoid serious doubts as to their constitutionality. See, e.g.,
Communications Workers of Am. v. Beck, 487 U.S. 735, 762 (1988) (discussing
The State does not argue that the imminent death provision provides
an adequate health exception for the PNA. We independently conclude that this
provision is not an adequate health exception, as the Supreme Court has held that
exceptions solely to protect the life of the mother are not constitutionally
sufficient. See Roe, 410 U.S. at 16364.
12

Under the doctrine of in pari materia, a court will interpret a statute by

examining other statutes dealing with the same subject as the statute being
construed. 2B Norman J. Singer, Statutes and Statutory Construction 51.01 (6th
ed. 2000).
13

- 21 -

federal statutes); Colo. Ground Water Commn v. Eagle Peak Farms, Ltd., 919
P.2d 212, 221 (Colo. 1996) (en banc) (discussing Colorado statutes). If we chose
to interpret the Childrens Code judicial approval provision as remaining in effect
with respect to abortion, and if the Childrens Code provision met the
constitutional requirements for a health exception, then this interpretation would
save the PNA from unconstitutionality. However, as the Supreme Court of
Colorado has noted, [W]e must give full effect to the language used by the
General Assembly even if to do so results in a determination that the statute
violates constitutional criteria. People v. Thomas, 867 P.2d 880, 883 (Colo.
1994) (en banc); see also Phelps, 59 F.3d at 1070 (The federal courts do not have
the power to narrow a state law by disregarding plain language in the statute just
to preserve it from constitutional attack.). The language of the PNA is clear that
there is no health exception; therefore, the maxim does not apply.
C
We perceive only one way that would allow us to consider the States
Childrens Code argument in light of the plain language of the PNAif we first
concluded that the Childrens Code judicial approval provision and the PNA were
in conflict. In such a circumstance, we would be required to attempt to reconcile
the two statutes. Scholz v. Metro. Pathologists, P.C., 851 P.2d 901, 911 (Colo.
1993) (en banc) ([W]hen two statutes apparently conflict, a court will strive to
- 22 -

read them harmoniously so as to give effect to both.). However, following

Colorados principles of statutory interpretation, we nonetheless conclude that,
even if a conflict exists, the PNA has superseded the conflicting provisions of the
Childrens Code.
Arguably, the PNA and the Childrens Code conflict. The PNA by its terms
requires compliance with its notice requirements and with its forty-eight-hour
waiting period except for specified exceptions and affirmative defenses. In
contrast, the Childrens Code authorizes judicial approval of emergency medical
caresuch as an abortionwhen the parents cannot be contacted. A conflict
exists when one provision authorizes what the other forbids or forbids what the
other authorizes. Bickel v. City of Boulder, 885 P.2d 215, 22829 (Colo. 1994)
(en banc); 14 Ray v. City & County of Denver, 121 P.2d 886, 888 (Colo. 1942) (en
banc).
In the case of a conflict, we look to see how the courts of Colorado would
construe the PNA and the Childrens Code judicial approval provision in order to
reconcile them. As discussed above, the PNA has a clear and unambiguous

Bickel dealt with a potential conflict between a statute and a

constitutional provision. See Bickel, 885 P.2d at 220. However, in Colorado
rules of constitutional interpretation may be utilized in developing rules of
statutory interpretation. See Common Sense Alliance, 995 P.2d at 75354 (citing
previous Colorado constitutional interpretation cases for interpretation principles
to be applied in the statutory context).
14

- 23 -

prohibition against the performance of abortions on minors absent compliance

with the notice and forty-eight-hour waiting period requirements, subject to
specified exceptions and affirmative defenses. Moreover, the PNA is specific in
its notification requirements, laying out precisely who may deliver the notice,
Colo. Rev. Stat. 12-37.5-104(a), the manner of delivery of the notice (including
the language to be placed on the envelope containing the notice), 12-37.5104(b), and how to maintain the records for the written return of service of the
notice, 12-37.5-104(d).
In contrast, the Childrens Code broadly authorizes the provision of
medical services on an emergency basis, as required only by the best interest of
the child, upon authorization by a judge. Id. 19-1-104(3)(a). Notice to parents
is necessary only if reasonable effort allows such notice in an emergency
situation. 19-1-104(3)(b). There are no procedural requirements for the
provision of notice.
The parties in this case have, explicitly or implicitly, suggested to us only
two options for reconciling the PNA and the Childrens Code. First, we could
read the judicial approval provision of the Childrens Code as remaining in force
with respect to abortions, effectively carving out an additional exception from the
PNA. This exception would theoretically apply whenever a doctor obtains
permission from the juvenile court to provide a minor with an abortion when there
- 24 -

is a medical emergency and when notice (without the procedural requirements of

the PNA) cannot reasonably be provided to the parent. This is the alternative that
the State urges upon us. Second, we could read the PNA as carving an exception
from the Childrens Codein essence requiring parental consent for all abortions,
irrespective of the judicial approval provision of 19-1-104(3). In other words,
for all medical procedures except abortion the judicial approval provision would
remain, but for abortion the new and more stringent parental notice requirements
of the PNA would apply. This is the interpretation implicitly supported by
plaintiffs.
Our options are thus limited to choosing which statute overrides the other,
because regardless of which provision we conclude the legislature intended to
effectuate, the result will by necessity abrogate the other statute in part. If we
hold that the PNA carves an exception from the Childrens Code, then we have
recognized a narrow exception to a statute of broad applicability. For almost all
medical services, the provisions of the Childrens Code will continue to apply, but
for abortions only, there will be a specific rule with more stringent parental notice
requirements. On the other hand, if we hold that the Childrens Code was not
superseded by the PNA and therefore remains effective in the abortion context,
then we have recognized an additional exception to a statute of narrow
applicability. The PNAs parental notice requirements will not apply any time a
- 25 -

medical emergency requires provision of an abortion to a minor where parental

notice cannot be made with reasonable effort. Instead of only the four specific
and enumerated exceptions and affirmative defenses to the PNA, there would also
be a fifth.
We, of course, have no desire or authority to draft legislationit is simply
not our constitutional prerogative to do so. We therefore choose the option that
best gives effect to both the PNA and the Childrens Code, and we hold that the
PNA has superseded the Childrens Code. Under this interpretation the strict
parental notice requirements of the PNA would stand and not infringe on the
Childrens Code provisions in the vast majority of medical emergencies. Cf.
Zaner v. City of Brighton, 899 P.2d 263, 267 (Colo. Ct. App. 1995) (adopting an
interpretation of a constitutional amendment because it allows the amendment to
be effective while preserving [other conflicting] constitutional provisions to the
greatest degree possible), affd, 917 P.2d 280 (Colo. 1996). The result of this
conclusion, of course, is that the PNA must be held unconstitutional because it
lacks a health exception.
This conclusion is consistent with Colorado statutory construction
principles, which dictate that if two statutes irreconcilably conflict, then the later,
more specific statute prevails. See Colo. Rev. Stat. 2-4-205, -206; see also
Martin v. People, 27 P.3d 846, 852 (Colo. 2001) (en banc). The PNA is more
- 26 -

specific than the Childrens Code provisions because it addresses the specific
issue of parental notification for abortions by minors rather than the larger issue
of childrens medical emergencies in general. The PNA was also enacted well
after the relevant provisions of the Childrens Code. Thus, if there is a conflict,
because these statutes are irreconcilable we conclude that the provisions of the
PNA supersede 19-1-104(3) with regard to the provision of notice to parents
about abortions. 15
Other general principles of Colorado statutory construction support this
conclusion. 16 First, as a general rule of statutory construction, [the] enumeration
While it is true that repeals by implication are not favored in Colorado,
if there is a manifest inconsistency between a later and an earlier statute . . . a
repeal by implication [will] be held to have occurred. People v. James, 497 P.2d
1256, 1257 (Colo. 1972) (en banc). We are not faced with a case where a general
statute is being interpreted to repeal by implication a specific statutea situation
in which Colorado courts have required a showing of clear and unmistakable
intent, Martin, 27 P.3d at 863 (Colo. 2001) (en banc); see also People v. Smith,
971 P.2d 1056, 1058 (Colo. 1999) (en banc). Instead, this is a case where a
specific statute, the PNA, is interpreted to have established an exception to a
general statute, the Childrens Code judicial approval provision. Moreover,
Colorado does not require that the later statute expressly state that it is repealing
the previous statute. State v. Beckman, 368 P.2d 793, 797 (Colo. 1961) (en banc)
([A] specific legislative declaration that a later law repeals any provisions of an
earlier law in conflict with the later law is superfluous since a later law
automatically repeals an earlier law which conflicts with it.).
15

The State urges that we to give deference to its interpretation of the

statute because it is the construction provided by the Colorado Attorney General,
the chief officer in charge of enforcing the statute. However, as noted by the
Supreme Court in Stenberg, such an interpretation is not to be taken as
authoritative or to have controlling weight when the interpretation does not bind
(continued...)
16

- 27 -

of exclusions from the operation of a statute indicates that the statute should
apply to all cases not specifically excluded. Nicholas, 973 P.2d at 1217
(quotation omitted). Following the States argument would result in recognizing
a new exception to a statute that contains a list of specific exceptions; this is a
form of statutory interpretation that the Colorado courts have avoided. See id. at
121617 (holding that a good-faith exception cannot be read into a statute
requiring the presence of a parent when a juvenile is interrogated by the police
because the statute already has enumerated exceptions).
Moreover, the drafters of the PNA were aware of the potential for
interaction with the Childrens Code and cited relevant provisions where
necessary. See Colo. Rev. Stat. 12-37.5-105(1)(b) (referring to the provisions
of the Childrens Code for abuse or neglect in order to explicate the exception
to the notice requirement in the PNA). Clearly, the drafters knew how to
reference the Childrens Code where the PNA was intended to be coordinated
(...continued)
the state courts or local law enforcement authorities. Stenberg, 530 U.S. at
94041 (quotation omitted). The State has given no indication that the Attorney
Generals opinion might have controlling weight either with local law
enforcement or in state court, other than a citation to 18-1-504(2)(c) of the
Colorado Revised Statutes. This provision provides an affirmative defense to
criminal liability where there has been reliance on an official written
interpretation of the statute. Colo. Rev. Stat. 18-1-504(2)(c). The State has
provided us with no official written interpretation of the statute provided by the
Attorney General respecting the PNA, and therefore, 18-1-504(2)(c) is
inapplicable.
16

- 28 -

with these provisions; if the medical emergency procedures of 19-1-104(3) were

intended to have been preserved by the PNA, it would have been a simple matter
to refer to them in the Act. See Common Sense Alliance, 995 P.2d at 754 (The
electorate, as well as the legislature, must be presumed to know the existing law
at the time they amend or clarify that law.). 17
The State argues that the PNAs legislative declaration indicates a desire
to promote the best interests of children, such that the PNA must be interpreted to
incorporate implicitly the Childrens Code provision. Even assuming that the
references in the legislative declaration to the adverse long-term consequences
that attend abortion by minor children, Colo. Rev. Stat. 12-37.5-102(1), means
that the voters of Colorado intended the statute to promote the best interests of
children, this reference must be read in the context of the other goals expressed in
the legislative declaration, including the rights of parents . . . to be involved in
all decisions of importance affecting . . . minor children. Id. There are multiple
goals expressed in the legislative declaration, including providing for the best
interests of children and requiring that parents be notified of any abortions by
their minor children. Given the multiple goals expressed in the legislative
declaration, we cannot conclude that the adverse long-term consequences
language cited by the State is enough to trump principles of Colorado statutory
interpretation and the clear structure of the PNA.
Similarly, the State relies on another part of the legislative declaration,
which states, The people of the state of Colorado, being mindful of the
limitations imposed upon them at the present time by the federal judiciary in the
preservation of the parent-child relationship, hereby enact into law the following
provisions. 12-37.5-102(2). According to the State, the PNA clearly states
the intention to adhere to constitutional requirements. (Appellants Br. at 14.)
Again, given the multiple goals expressed in the legislative declaration, we cannot
take this individual sentence in the legislative declaration as sufficiently
demonstrative of a legislative intent to override established principles of Colorado
statutory interpretation and the structure of the PNA. See Common Sense
Alliance, 995 P.2d at 753 (quoting In re Great Outdoors Colo. Trust Fund, 913
P.2d 533, 540 (Colo. 1996) (en banc), for the proposition that when courts
construe an initiative, any intent of the proponents that is not adequately
(continued...)
17

- 29 -

Nor does the States argument that statutes should be construed whenever
possible to avoid serious doubts as to their constitutionality alter our conclusion.
Again, the language of the PNA is clear that there is no health exception, and the
States proposed interpretation of the PNA and the Childrens Code would require
us to ignore other equally relevant Colorado statutory interpretation principles.
We are only to consider interpretations of statutes that are fairly possible,
Communications Workers of Am., 487 U.S. at 762, and the States suggested
interpretation is not fairly possible.
IV
We conclude that the PNA is unconstitutional because it fails to provide a
health exception as required by the Constitution of the United States. 18 The
(...continued)
expressed in the language of the measure will not govern the courts construction
of the amendment).
17

In its reply brief, the State argues that 18-1-703(1)(e) of the Colorado
Revised Statutes also provides a health exception to the PNA. Because this issue
was raised for the first time in the States reply brief, we do not address it here.
See Stump v. Gates, 211 F.3d 527, 533 (10th Cir. 2000).
The dissent suggests that our opinion side steps this argument, and that
even though we ordinarily do not address such late-blooming arguments, in the
present case we should nonetheless address the issue. (Dissent at 7.) However,
in the present case there are good reasons for invoking the rule against
consideration of arguments first raised in a reply brief. First, to allow an
appellant to raise new arguments at this juncture would be manifestly unfair to
the appellee who, under our rules, has no opportunity for a written response.
Headrick v. Rockwell Intl Corp., 24 F.3d 1272, 1278 (10th Cir. 1994) (quoting
Herbert v. Natl Acad. of Scis., 974 F.2d 192, 196 (D.C. Cir. 1992)). Second,
(continued...)
18

- 30 -

(...continued)
it would also be unfair to the court itself, which, without the benefit
of a response from appellee to an appellants late-blooming
argument, would run the risk of an improvident or ill-advised
opinion, given our dependence as an Article III court on the
adversarial process for sharpening the issues for decision.

18

Id. (quotation omitted). These considerations apply with special force in this
case, where the State has developed a wholly new theory as to why the PNA
contains a constitutionally adequate health exception.
We add that the State also failed to raise its argument in the trial court
below. As we have explained,
Where a litigant changes to a new theory on appeal that falls under
the same general category as an argument presented at trial . . . the
theory will not be considered on appeal. . . . Furthermore,
[appellants] new argument gives rise to a host of new issues, and
[appellee] had no opportunity to present evidence it may have
thought relevant to these issues. Fear of such an unjust occurrence is
one of the primary rationales underlying the rule that appellate courts
do not hear issues not previously raised.
Bancamerica Commercial Corp v. Mosher Steel of Kan., Inc., 100 F.3d 792, 798
(10th Cir. 1996) (quotation omitted); see also Tele-Communications, Inc. v.
Commr of Internal Revenue, 104 F.3d 1229, 1232 (10th Cir. 1997) (This rule is
particularly apt when dealing with an appeal from a grant of summary
judgment . . . . Propounding new arguments on appeal in an attempt to prompt us
to reverse the trial court undermines important judicial values. (citation
omitted)). In the present case, plaintiffs were deprived of the opportunity to
challenge the argument in the district court and to develop facts as to whether
18-1-703(1)(e) would supply a constitutionally adequate health exception. Both
parties had such an opportunity with respect to the States Childrens Code
argument and took full advantage of that opportunity, spending significant
portions of their discovery investigating the scope and nature of the Childrens
Code and the impact that the Code has had on physicians who provide abortion
and other pregnancy services to minors. It would be unfair to rule on the States
argument based on 18-1-703 without providing plaintiffs with a similar
(continued...)
- 31 -

judgment of the district court is therefore AFFIRMED. 19

(...continued)
opportunity with respect to that issue as well. Thus, the State has doubly waived
the issue.
Moreover, the exceptions to the rule in Headrick are exceedingly narrow,
and are limited to issues such as jurisdiction and plain error by the lower courts.
See Herbert, 974 F.2d at 196; accord Headrick, 24 F.3d at 1278. We do not see
the fact that the district court did not address the States unraised argument
regarding 18-1-703(1)(e) as providing an example of plain error, or indeed
any error at all. To the extent that the PNA and 18-1-703(1)(e) conflict, we
conclude that the two statutes irreconcilably conflict and that the PNA supersedes
18-1-703(1)(e). See Section III.C, supra. In particular, we note that the PNA
contains specific procedures for obtaining parental consent, while 18-1703(1)(e) provides an affirmative defense for any medical treatment the physician
reasonably believes to be adapted to promoting the physical or mental health of
the patient. Section 18-1-703(1)(e) is also a more general statuteas it applies
to all medical proceduresand was enacted prior to the PNA. Thus, the rule in
Colorado that the more specific and later statute trumps the more general and
earlier statute would apply. See Colo. Rev. Stat. 2-4-205, -206; see also
Martin, 27 P.3d at 852. Furthermore, the States proposed interpretation would
create a new exception to the PNA where the statute already has specific,
enumerated exceptionsa result that the Colorado courts disfavor. See Nicholas,
973 P.2d at 1217. Finally, the States proposed interpretation, by creating a new
affirmative defense for when the physician reasonably believes that there is no
time to obtain consent in the context of a medical emergency, would essentially
render the PNAs affirmative defense for situations threatening imminent death
superfluous, see Colo. Rev. Stat. 12-37.5-106(2)(b), contrary to an important
principle of statutory interpretation in Colorado. See People v. Hoinville, 553
P.2d 777, 781 (Colo. 1976) (en banc); see also Colo. Rev. Stat. 2-4-201(b)
(establishing the presumption that the entirety of a statute was intended to be
effective).
18

The dissent argues that we should certify this case to the Colorado
Supreme Court in order to obtain a definitive interpretation of the PNA. (Dissent
at 46.) It asserts that the Colorado Supreme Court could render a reasonable
limiting construction of the [PNA] to preserve it consistent with its intended
applications. (Id. at 89.) However, as Part III of this Opinion shows, no such
construction is fairly possible. As a result, we decline to certify or abstain
(continued...)
19

- 32 -

(...continued)
because the statute is not fairly susceptible to a narrowing construction.
Stenberg, 530 U.S. at 945 (quotation omitted).
We are especially skeptical of certifying this case not only because the
parties expressly rejected the district courts suggestion of certification, Planned
Parenthood, 107 F. Supp. 2d at 1275 (Upon my inquiry, all parties recommended
against certification of the issues to the Colorado Supreme Court . . . . Both sides
in essence urged that the issues of this case, including any necessary statutory
interpretation of state law, were inextricably tied to issues of federal
constitutional law and should be decided in federal court.), but also because the
Statethe party that is allegedly being harmed by our failure to certifyis the
party that removed this case from state court to federal court in the first place, id.
(characterizing the States rejection of certification to state court as consistent
with the [States] decision to remove this case to federal court).
19

- 33 -

APPENDIX
12-37.5-101. Short title. This article shall be known and may be
cited as the Colorado Parental Notification Act.
12-37.5-102. Legislative declaration. (1) The people of the state
of Colorado, pursuant to the powers reserved to them in Article V of
the Constitution of the state of Colorado, declare that family life and
the preservation of the traditional family unit are of vital importance
to the continuation of an orderly society; that the rights of parents to
rear and nurture their children during their formative years and to be
involved in all decisions of importance affecting such minor children
should be protected and encouraged, especially as such parental
involvement relates to the pregnancy of an unemancipated minor,
recognizing that the decision by any such minor to submit to an
abortion may have adverse long-term consequences for her.
(2) The people of the state of Colorado, being mindful of the
limitations imposed upon them at the present time by the federal
judiciary in the preservation of the parent-child relationship, hereby
enact into law the following provisions.
12-37.5-103. Definitions. As used in this article, unless the
context otherwise requires:
(1) Minor means a person under eighteen years of age.
(2) Parent means the natural or adoptive mother and father
of the minor who is pregnant, if they are both living; one parent of
the minor if only one is living, or if the other parent cannot be served
with notice, as hereinafter provided; or the court-appointed guardian
of such minor if she has one or any foster parent to whom the care
and custody of such minor shall have been assigned by any agency of
the state or county making such placement.
(3) Abortion for purposes of this article means the use of any
means to terminate the pregnancy of a minor with knowledge that the
termination by those means will, with reasonable likelihood, cause
the death of that persons unborn offspring at any time after
fertilization.
12-37.5-104. Notification concerning abortion. (1) No abortion
shall be performed upon an unemancipated minor until at least 48
- 34 -

hours after written notice of the pending abortion has been delivered
in the following manner:
(a) The notice shall be addressed to the parent at the dwelling
house or usual place of abode of the parent. Such notice shall be
delivered to the parent by:
(I) The attending physician or member of the physicians
immediate staff who is over the age of eighteen; or
(II) By the sheriff of the county where the service of notice is
made, or by his deputy; or
(III) By any other person over the age of eighteen years who is
not related to the minor.
(b) Notice delivered by any person other than the attending
physician shall be furnished to and delivered by such person in a
sealed envelope marked Personal and Confidential and its content
shall not in any manner be revealed to the person making such
delivery.
(c) Whenever the parent of the minor includes two persons to
be notified as provided in this article and such persons reside at the
same dwelling house or place of abode, delivery to one such person
shall constitute delivery to both, and the 48-hour period shall
commence when delivery is made. Should such persons not reside
together and delivery of notice can be made to each of them, notice
shall be delivered to both parents, unless the minor shall request that
only one parent be notified, which request shall be honored and shall
be noted by the physician in the minors medical record. Whenever
the parties are separately served with notice, the 48-hour period shall
commence upon delivery of the first notice.
(d) The person delivering such notice, if other than the
physician, shall provide to the physician a written return of service at
the earliest practical time, as follows:
(I) If served by the sheriff or his deputy, by his certificate with
a statement as to date, place, and manner of service and the time such
delivery was made.
(II) If by any other person, by his affidavit thereof with the
same statement.
(III) Return of service shall be maintained by the physician.
(e)(I) In lieu of personal delivery of the notice, the same may
be sent by postpaid certified mail, addressed to the parent at the usual
place of abode of the parent, with return receipt requested and
delivery restricted to the addressee. Delivery shall be conclusively
- 35 -

presumed to occur and the 48-hour time period as provided in this

article shall commence to run at 12:00 oclock noon on the next day
on which regular mail delivery takes place.
(II) Whenever the parent of the minor includes two persons to
be notified as provided in this article and such persons reside at the
same dwelling house or place of abode, notice addressed to one
parent and mailed as provided in the foregoing subparagraph shall be
deemed to be delivery of notice to both such persons. Should such
persons not reside together and notice can be mailed to each of them,
such notice shall be separately mailed to both parents unless the
minor shall request that only one parent shall be notified, which
request shall be honored and shall be noted by the physician in the
minors medical record.
(III) Proof of mailing and the delivery or attempted delivery
shall be maintained by the physician.
12-37.5-105. No notice requiredwhen. (1) No notice shall be
required pursuant to this article if:
(a) The person or persons who are entitled to notice certify in
writing that they have been notified;
(b) The pregnant minor declares that she is a victim of child
abuse or neglect by the acts or omissions of the person who would be
entitled to notice, as such acts or omissions are defined in The Child
Protection Act of 1987, as set forth in title 19, article 3, of the
Colorado Revised Statutes, and any amendments thereto, and the
attending physician has reported such child abuse or neglect as
required by the said act.
12-37.5-106. Penaltiesdamagesdefenses. (1) Any person who
performs or attempts to perform an abortion in willful violation of
this article:
(a) Commits a class 1 misdemeanor and shall be punished as
provided in section 18-1-106 C.R.S.; and
(b) Shall be liable for damages proximately caused thereby.
(2) It shall be an affirmative defense to any criminal or civil
proceedings if the person establishes that:
(a) The person relied upon facts or information sufficient to
convince a reasonable, careful and prudent person that the
representations of the pregnant minor regarding information
necessary to comply with this article were bona fide and true; or
- 36 -

(b) The abortion was performed to prevent the imminent death

of the minor child and there was insufficient time to provide the
required notice.
(3) Any person who counsels, advises, encourages or conspires
to induce or persuade any pregnant minor to furnish any physician
with false information, whether oral or written, concerning the
minors age, marital status, or any other fact or circumstance to
induce or attempt to induce the physician to perform an abortion
upon such minor without providing written notice as required by this
article commits a Class 5 felony and shall be punished as provided in
section 18-1-105, C.R.S.
12-37.5-107. Judicial bypasswhen operative. (1) If section 1237.5-104 of this article is ever temporarily, preliminarily or
permanently restrained or enjoined due to the absence of a judicial
bypass provision, the said section shall be enforced as though the
following provisions were incorporated as subsection (2) of section
104, provided however that if any such restraining order or
injunction is stayed, dissolved or otherwise ceases to have effect,
section 104 shall have full force and effect without the addition of
the following subsection (2):
(2)(a) If any pregnant minor elects not to allow the notification
of any parent, any judge of a court of competent jurisdiction may,
upon petition filed by or on behalf of such minor enter an order
dispensing with the notice requirements of this article if the Judge
determines that the giving of such notice will not be in the best
interest of the minor, or if the court finds, by clear and convincing
evidence, that the minor is sufficiently mature to decide whether to
have an abortion. Any such order shall include specific factual
findings and legal conclusions in support thereof and a certified copy
of such order shall be provided to the attending physician of said
minor and the provisions of section 12-37.5-104(1) and section 1237.5-106 of this article shall not apply to the physician with respect
to such minor.
(b) The court, in its discretion, may appoint a guardian ad
litem for the minor and also an attorney if said minor is not
represented by counsel.
(c) All court proceedings herein shall be confidential and shall
be given preference over other pending matters, so that the court may
reach a decision without undue delay.
- 37 -

(d) An expedited confidential appeal shall be available to any

such minor for whom the court denies an order dispensing with
notification as required by this article. Upon the minors
representation as contained in her petition, or otherwise, that no
funds are available to her for payment of filing fees, no filing fees
shall be required in either the trial court or appellate court.
12-37.5-108. Limitations. (1) This article shall in no way be
construed so as to:
(a) Require any minor to submit to an abortion; or
(b) Prevent any minor from withdrawing her consent
previously given to have an abortion; or
(c) Permit anything less than fully informed consent before
submitting to an abortion.
(2) This article shall in no way be construed as either ratifying,
granting or otherwise establishing an abortion right for minors
independently of any other regulation, statute or court decision which
may now or hereafter limit or abridge access to abortion by minors.

- 38 -

No. 00-1385, Planned Parenthood v. Owens

Baldock, Circuit Judge, dissenting.
As of this writing, a womans fundamental constitutional right to abort
a fetus previabilitywithout undue interference from the stateis settled.
See Stenberg v. Carhart, 530 U.S. 914, 946 (2000) (Stevens, J., concurring)
([D]uring the past 27 years, the central holding of Roe v. Wade, 410 U.S. 113
(1973), has been endorsed by all but 4 of the 17 justices who have addressed
the issue.). At the same time, Supreme Court Justices remain divided over
state regulation of abortion, including regulation pertaining to minors. See H.L.
v. Matheson, 450 U.S. 398, 413-14 (1981) (Powell, J., concurring) (noting the
divisive nature of questions over state statutes intended to encourage parental
involvement in a minors decision to have an abortion). In a stream of opinions
over the past three decades, the Justices have struggled to articulate meaningful
standards for lower courts to apply. See e.g., Planned Parenthood v. Casey, 505
U.S. 833, 950 (1992) (Rehnquist, C.J., dissenting in part) ([W]hen confronted
with state regulation . . . [of abortion], the Court has become increasingly more
divided[.]) (citing cases). Justice White accurately predicted the future a quarter
century ago: In Roe v. Wade . . . this Court recognized a right to an abortion
free from state prohibition. The task of policing this limitation on state police
power is and will be a difficult and continuing venture in substantive due
process. Planned Parenthood v. Danforth, 428 U.S. 52, 92 (1976) (White, J.,

dissenting in part). True to Justice Whites words, state lawmakers continue

to test the limits of Roe and courts continue to police those limits with no
foreseeable end to the struggle.
Given Supreme Court precedent, I have little quarrel with the legal
proposition that a state may not infringe on a womans ability, regardless of
her age, to obtain an abortion in a timely manner where medically necessary to
proscribe a serious health risk. See Courts Op. at 8-12; Stenberg, 530 U.S. at
930-31 (state may promote but not endanger a womans health when regulating
abortion). 1 I do not agree, however, with the Courts conclusion that the voter
initiated and approved Colorado Parental Notification Act, Colo. Rev. Stat.
In Casey, Justice Stevens explained the existing legal rationale for why
the States obligation to protect the health of the mother must take precedence
over any duty to the unborn. (emphasis in original).
1

The Court in Roe carefully considered, and rejected, the States

argument that a fetus is a person within the language and meaning
of the Fourteenth Amendment. . . . In short, the unborn have
never been recognized in the law as persons in the whole sense.
Accordingly, an abortion is not the termination of life entitled to
Fourteenth Amendment protection. From this holding, there was no
dissent. Indeed, no Member of the Court has ever questioned this
fundamental proposition. Thus, as a matter of federal constitutional
law, a developing organism that is not yet a person does not have
what is sometimes described as a right to life. This has been and,
by the Courts holding today, remains a fundamental premise of our
constitutional law governing reproductive freedom.
Casey, 505 U.S. at 912-14 (Stevens, J., concurring in part) (internal quotations,
citations, and footnote omitted).
-2-

 12-37.5-101 thru 108 (2001) (CPNA), when construed under Colorado state
law, necessarily infringes on the ability of pregnant women to protect their
health. 2 Courts Op. at 17. Nor do I agree with the Courts conclusion that
the CPNA is unconstitutional in its entirety simply because it may infringe on
the ability of any pregnant woman to protect her health. Courts Op. at 14
(emphasis in original). In my opinion, the Court is much too eager to apply its
view of Colorado state statutory interpretation to strike on its face, not a single
prohibitory statute like that at issue in Stenberg, but a multi-section act directly
approved by the voters of Colorado. See Courts Op. at 17-30. The Court
declares the CPNA unconstitutional because it fails to address the availability
of emergency medical procedures in the rare instance where a pregnant minors
health (but not life) is threatened and that minor cannot or does not wish to
notify an unknowing parent. 3
Colorado voters reportedly approved the CPNA at a general election
held on November 3, 1998, by a vote of 708,689 to 582,102, or 55% to 45%.
2

Section 12-37.5-106(2)(b) of the CPNA provides an affirmative defense

to a criminal charge under the CPNA if [t]he abortion was performed to prevent
the imminent death of the minor child and there was insufficient time to provide
the required notice. The district court briefly took issue with subsection (2)(b),
asserting an affirmative defense is significantly different from an exception to
the reach of a criminal statute. Planned Parenthood v. Owens, 107 F. Supp. 2d
at 1271, 1283 (D. Colo. 2000). Aside from the case where an exception to a penal
statute constitutes an element of the offense, however, an exception operates the
same as an affirmative defense. See United States v. Prentiss, 256 F.3d 971,
978-80 (10th Cir. 2001) (en banc); id. at 986-89 (Baldock, J., dissenting in part).
3

-3-

Resolution of the narrow issue in this case, and the possible validity of
the CPNA, unquestionably turns on the Courts application of Colorado state
law. 4 Granted the Courts application of that law might be correct in whole or
in part. But the CPNA, in my view, is susceptible of a construction by the
state judiciary which might avoid in whole or in part the necessity for federal
constitutional adjudication, or at least materially change the nature of
the problem. Bellotti v. Baird, 428 U.S. 132, 147 (1976) (internal quotations
omitted). Consequently, the Colorado Supreme Court, which has had no
occasion to consider application of the CPNA, seems better suited than a
federal court for that application in the first instance. Accordingly, I believe
the preferable approach at this stage is to abstain from deciding the CPNAs
constitutionality and to certify to the Colorado Supreme Court, pursuant to

Given Supreme Court precedent discussing the constitutional demands

for parental notification laws, Plaintiffs remaining arguments as to why the
CPNA is unconstitutional in whole or in part, see Courts Op. at 7 n.5, at least
initially do not appear nearly as forceful as the health exception argument we
address today. Indeed, the district court recognized that parental notification
statutes . . . have generally passed constitutional muster. Owens, 107 F. Supp.
2d at 1279; see also Lambert v. Wicklund, 520 U.S. 292 (1997) (per curiam)
(collecting cases); Hodgson v. Minnesota, 497 U.S. 417, 448 (1990) (opinion
of Stevens, J.) (We think it clear that a requirement that a minor wait 48 hours
after notifying a single parent of her intention to get an abortion would reasonably
further the legitimate state interest in ensuring that the minors decision is
knowing and intelligent.).
4

-4-

the certification procedure outlined in Colo. Sup. Ct. R. 21.1., questions of

Colorado state law which may be determinative of this cause. 5
In Bellotti, a three-judge district court held a Massachusetts parental
consent statute unconstitutional. Because the statutes constitutionality turned
on questions of state law, a unanimous Supreme Court vacated the district courts
judgment and directed the court to certify to the states highest court appropriate
questions concerning the meaning of [the statute] and the procedure it imposes.
Bellotti, 428 U.S. at 151. In abstaining, the Court explained:
It is sufficient that the statute is susceptible of the interpretation
offered by [the State], and we so find, and that such an interpretation
would avoid or substantially modify the federal constitutional
challenge to the statute, as it clearly would. Indeed, in the absence
of an authoritative construction, it is impossible to define precisely
the constitutional question presented.
Id. at 148; see also Akron v. Akron Center for Reproductive Health, 462 U.S.
416, 468-69 (1983) (OConnor, J., dissenting) (arguing that despite the absence
of a certification procedure, the Court should have abstained from declaring
a parental consent provision of a municipal ordinance unconstitutional); but see
Stenberg, 530 U.S. at 945 (declining to employ a state certification procedure

Colo. Sup. Ct. R. 21.1 provides that a federal court, upon its own motion,
may certify questions of state law which may be determinative of the cause then
pending in the certifying court and as to which to the certifying court there is
no controlling precedent in the decisions of the [Colorado] Supreme Court.
5

-5-

where a Nebraska statute banning partial birth abortion outright was not
fairly susceptible to a narrowing construction). 6
We must assume that the Colorado Supreme Court, if given its rightful
opportunity, would seek to construe the CPNA consistent with constitutional
requirements. Where fairly possible, courts should construe a statute to avoid
a danger of unconstitutionality. Ohio v. Akron Center for Reproductive Health,
497 U.S. 502, 514 (1990) (internal quotations omitted). The Colorado Supreme
Court abides by this rule. In construing a statute chilling the fundamental right
of speech, the court recently stated: If a limiting construction or partial
invalidation that confines the statute to sufficiently narrow applications
can be applied, the court should construe the statute in light of that limiting
construction. People v. Hickman, 988 P.2d 628, 636 (Colo. 1999). This is
especially true where a statutes constitutionality is in question: A court
has a responsibility to apply a limiting construction or partial invalidation
if doing so will preserve the statutes constitutionality. Id.
In this case, the district court inquired into the possibility of certifying
state law questions to the Colorado Supreme Court under Colo. Sup. Ct. R.
21.1, but the parties were unreceptive. See Owens, 107 F. Supp. 2d at 1275.
Nevertheless, where appropriate, a federal court may consider abstention sua
sponte. See Bellotti, 428 U.S. at 143-44 n.10; Colo. Sup. Ct. R 21.1(b). Citing
the equitable nature of abstention, the Court in Bellotti noted the fact that the
full arguments in favor of abstention may not have been asserted in the District
Court does not bar this Courts consideration of the issue. Bellotti, 428 U.S.
143 n.10.
6

-6-

Despite this responsibility, the Court side steps the States

belated but perhaps most forceful argument, namely that Colo. Rev. Stat.
18-1-703(1)(e)(II) (2001), a part of the Colorado Criminal Code, provides the
necessary health exception to the CPNA. See Courts Op. at 30-32 n.18. That
section, which applies to criminal offenses generally, exempts from criminal
responsibility medical personnel performing emergency procedures on minors:
(1) The use of physical force upon another person which would
otherwise constitute an offense is justifiable and not criminal under
any of the following circumstances:
...
(e) A duly licensed physician, or a person acting under his
direction, may use reasonable and appropriate physical force for
the purpose of administering a recognized form of treatment which
he reasonably believes to be adapted to promoting the physical or
mental health of the patient if:
...
(II) The treatment is administered in an emergency when the
physician reasonably believes that no one competent to consent
can be consulted and that a reasonable person, wishing to safeguard
the welfare of the patient, would consent.
Given the Courts insistence to decide the CPNAs constitutionality, I
cannot understand the Courts decision, based largely on procedural grounds,
to shirk its responsibility to come to grips with 18-1-703(1)(e)(II). To be sure,
this Court does not ordinarily review issues raised for the first time in a reply
brief. Stump v. Gates, 211 F.3d 527, 533 (10th Cir. 2000) (emphasis added).
But the ordinary rule is subject to exception, and this is no ordinary case.
Headrick v. Rockwell Intl Corp., 24 F.3d 1272, 1278 (10th Cir. 1994)
-7-

(citing Herbert v. National Academy of Sciences, 974 F.2d 192, 196 (D.C.
Cir. 1992) ([T]here do exist circumstances in which a court may consider,
or even raise sua sponte, arguments ignored or left undeveloped in the first
round of briefing.)). A federal courts decision to declare a state legislative
act unconstitutional on its face is most invasive of state sovereignty. Because
such a decision extends far beyond the immediate parties, a federal court, in
my opinion, should reach such a decision only after the utmost consideration.
This seems especially true where the court bases its decision solely upon an
arguably erroneous application of state law principles.
The Court states that [i]t would be unfair to rule on the States argument
based on 18-1-703 without providing Plaintiffs an opportunity to respond.
Courts Op. at 31 n.18. Of course, certifying the appropriate state law questions
to the Colorado Supreme Court would give Plaintiffs ample opportunity to answer
all the States arguments. Moreover, because the State has agreed to refrain
from enforcing the [CPNA] until entry of a final non-appealable judgment,
Planned Parenthood v. Owens, 107 F. Supp. 2d 1271, 1275 (D. Colo. 2000),
Plaintiffs stand to suffer no discernible injury if we employ Colorados
certification procedure.
Without unduly analyzing each of the acceptable possibilities, I believe
the Colorado Supreme Court could render a reasonable limiting construction
-8-

of the CPNA to preserve it consistent with its intended applications. As the

district court noted, nothing in the record suggests that Colorado voters in
supporting the CPNA initiative intend[ed] to place a pregnant minors health
at risk contrary to the minors best interests. 7 See Owens, 107 F. Supp. 2d
at 1283 n.21; compare Thornburgh v. American College of Obstetricians and
Gynecologists, 476 U.S. 747, 771 (1986) (We necessarily conclude that the
[Pennsylvania] legislatures failure to provide a medical-emergency exception
. . . was intentional.), overruled in part on other grounds by Casey, 505 U.S.
at 870, 882 (opinion of OConnor, J.).
In the end, the Court concludes that a saving construction of the CPNA
is not fairly possible. Courts Op. at 30. I disagree. I am not convinced
that, if called upon to construe the voter initiated and approved CPNA, the
Colorado Supreme Court would refuse to narrow its application and construe
it in a constitutional manner. Compare Matheson, 450 U.S. at 406-07 & n.14
(parental notification law which did not explicitly exempt pregnant minors with
emergency health care needs did not give the Court any reason to assume that a
The Court recognizes that the Colorado Childrens Code, specifically
Colo. Rev. Stat. 19-1-104(3) (2001) (CCC), broadly authorizes the provision of
medical services on an emergency basis, as required only by the best interest of
the child upon authorization by a judge. Courts Op. at 24. The Court, however,
rejects the possibility that the CPNA may be construed in pari materia with the
CCC despite the fact that reflected in both the CPNA and CCC is the judgment
of the Colorado electorate that these laws are in the best interest of their youth.
7

-9-

minor in need of emergency treatment will be treated in any way different from a
similarly situated adult); Rust v. Sullivan, 500 U.S. 173, 195 (1991) (rejecting
a facial challenge to federal regulations barring a federal project from referring
women to abortion providers where the regulations did not explicitly exempt
cases of imminent peril to the mothers life).
Today, the Court prematurely and perhaps unjustifiably thwarts the will
of the Colorado electorate. Due to the lack of reasonable certainty as to how
the CPNA will operate in its application or how the CPNA interacts with other
Colorado laws, legislative or judicial, our scrupulous regard for the rightful
independence of state governments counsels against unnecessary [and premature]
interference by the federal courts with proper and validly administered state
concerns, a course so essential to the balanced working of our federal system.
Akron, 462 U.S. at 470 (OConnor, dissenting).
Accordingly, I dissent.

- 10 -