The affidavit submitted by Mary Roe is also persuasive evidence of the deterrent effects of the regulations. Mary Roe is a sixteen year old unemancipated minor who states that she has visited a family planning clinic in order to obtain prescription contraceptives. She stated, "I absolutely do not want my mother to know about my sexual activity because I am sure that she would have a strong and painful reaction if she found out." Affi. Roe para. 5. Mary Roe also stated that if the notification requirements were in effect, "I would have to give up using contraceptives and risk becoming pregnant." Affi. Roe para. 5.
Despite the Secretary's contention that the plaintiffs' injuries are speculative, this court considers indisputable the fact that Mary Roe, and the class she represents, will suffer an increased risk of pregnancy as a result of these regulations. The affidavits submitted by the minor plaintiffs clearly indicate that the injuries threatened are both real and immediate, and are sufficient to meet the injury in fact requirement for standing. O'Shea v. Littleton, 414 U.S. 488, 494, 38 L. Ed. 2d 674, 94 S. Ct. 669 (1974).
The court also concludes that the Planned Parenthood Federation, Inc., and NFPRHA may serve as representatives for a class of member affiliate family planning clinics. Such clinics are direct and indirect recipients of Title X funds and have standing to maintain this suit. The Secretary disputes the standing of the clinics, repeatedly characterizing the objections of these entities as "philosophical objections" which cannot substitute for the requirement of "injury in fact" required for standing. This court finds the Secretary's argument singularly unconvincing. The court does not read any of plaintiffs' claims of injury as rooted in moral, religious, or philosophical principles. The clinics do not argue that the regulations will erode their notion of what is right, or proper. The clinics indicate, quite simply, that the regulations will cause serious and systematic injury to the operations of the clinic.
First, the clinics note that, as beneficiaries of Title X funds, they have standing to object to conditions on their receipt of funds which threaten the statutory framework under which they operate. The Secretary maintains that the clinics are not injured by the new regulations because as voluntary Title X grantees they have chosen to participate in the grant program and are bound to accept the conditions HHS places on their receipt of federal subsidiaries. According to the Secretary, objecting Title X grantees may withdraw from the program and provide contraceptive services without parental notification, or they may accept the funds without protest. They may not, according to the Secretary, challenge the regulations of the agency under which they operate.
Defendant's reasoning would, if endorsed by this court, prevent the plaintiffs from objecting to any grant regulation, however unreasonable or unconstitutional, because a grantee may refuse to participate in an objectionable federal program. Contrary to defendant's assertion, the law does not permit the government to present such a restricted set of opinions. Although plaintiffs have no right to a government contract, they are entitled to have grants dispensed lawfully. To the extent that funds are dispensed with unconditional or unlawful conditions attached, the plaintiffs are injured and have standing to object. Scanwell Laboratories, Inc. v. Shaffer, 137 U.S. App. D.C. 371, 424 F.2d 859 (D.C. Cir. 1970); Planned Parenthood Ass'n-Chicago Area v. Kempiners, 531 F. Supp. 320, 323-24 (N.D. Ill. 1981).
The clinics are not injured only through the alleged failure of HHS to promulgate regulations that are consistent with Title X and the congressional purposes embodied in that Act, but they will suffer professional and economic injury as a result of the regulations. The clinics have presented persuasive evidence demonstrating that the notification requirement will cause them to breach a guarantee of confidentiality that is frequently codified in state law, or established pursuant to clinic policy. The professional reputations of the clinics, and that of the professional health employees of the clinics, would be compromised if they were forced to reveal sensitive physician-patient information. The clinics therefore may assert their own rights to consult and treat their clients confidentially, and to protect confidential services from infringement. See Planned Parenthood Ass'n v. Kempiners, supra at 324 n.3.
Conversely, if the clinics are forced to forfeit Title X funds in order to protect their medical judgments concerning patient confidentiality, the clinics will be injured. The clinics embraced by the classes represented by Planned Parenthood and NFPRHA are Title X beneficiaries. If they are forced to reject federal funds because of conditions they believe to be unlawful, they will be forced to curtail their operations substantially. This will result in a serious erosion in the availability of family planning services nationwide, to the detriment of the clinics and their clients.
Additionally, this court finds that the second requirement for standing, that plaintiffs be within the zone of interest sought to be protected by Title X, is met in this case. There can be no question that each of the classes of plaintiffs are intended beneficiaries of Title X funding. The purpose of Title X is to make family planning services available to all persons. Program participants, including unemancipated minors, are the ultimate beneficiaries of family planning services. Clinics are funded, and physicians hired, to deliver necessary confidential contraceptive services to participants. Title X grantees are relied upon by Congress to effectuate the intent of Title X, and it is clear that both the clinics and the unemancipated minor participants are within the zone of interests to be protected by the statute. See Constructores Civiles de Centroamerica, S.A. v. Hannah, 148 U.S. App. D.C. 159, 459 F.2d 1183, 1189 (D.C. Cir. 1972).
The final element of standing, "causation" or "redressability", presents no problems for these plaintiffs. The injury threatened each plaintiff is directly traceable to the challenged regulations. The regulations directly increase the risk of pregnancy for minors, and present the clinics with the choice of abridging physician-patient confidentiality, or sacrificing needed Title X funds. In addition, each plaintiff alleges that the regulations do direct violence to the statutory framework of Title X. Certainly, if this court grants plaintiffs the relief sought, these threatened injuries will be prevented.
Plaintiffs seek, at this stage, preliminary relief preserving the status quo until this court can rule on the parties' motions for summary judgment. In this Circuit, a plaintiff's entitlement to a preliminary injunction depends upon the following:
(1) Has the petitioner made a strong showing that it is likely to prevail on the merits of its appeal . . . (2) Has the petitioner shown that without such relief, it will be irreparably injured? . . . (3) Would the issuance of a stay substantially harm other parties interested in the proceedings? . . . (4) Where lies the public interest?