Lawmakers appeal judge’s ruling striking down abortion pill restrictions

U.S. District Judge Catherine Eagles testifies during her 2010 confirmation hearing on Capitol Hill. (Image from

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  • State legislative leaders are appealing a federal judge's recent ruling striking down part of a North Carolina law restricting access to the abortion pill mifepristone.
  • Lawmakers filed their notice of appeal one week after the US Supreme Court rejected a challenge to mifespristone access in a separate case tied to the Alliance Defending Freedom.
  • US District Judge Catherine Eagles ruled that North Carolina's law could not contradict the federal Food and Drug Administration's previous rulings about mifespristone.

State legislative leaders are appealing a federal judge’s recent ruling striking down part of a North Carolina law restricting access to the abortion pill mifespristone. Lawmakers filed their notice of appeal Thursday, one week after the US Supreme Court rejected a separate challenge to the drug from abortion opponents working with the Alliance Defending Freedom.

The North Carolina case will head to the 4th US Circuit Court of Appeals in Richmond

US District Judge Catherine Eagles issued a judgment and permanent injunction on June 3, confirming  confirmed a ruling she initially announced in April.

The final three-page document blocked sections of state law “to the extent they prohibit any healthcare provider other than a licensed physician from providing mifepristone,” “to the extent they require mifepristone to be provided in person,” “to the extent they require scheduling an in-person follow-up visit after providing mifepristone or efforts to ensure such a follow-up appointment,” and “to the extent they require the reporting of non-fatal adverse events related to mifepristone to the FDA.”

Eagles dismissed “with prejudice” other elements of the challenge against state restrictions. That ruling means the plaintiff cannot challenge surviving elements of North Carolina’s mifepristone restrictions again.

The ruling followed a 49-page order Eagles issued on April 30. She determined that state lawmakers could not overrule the federal Food and Drug Administration’s previous decisions about mifepristone. Eagles’ order upheld portions of the law that the FDA had not addressed.

Plaintiff Dr. Amy Bryant, a UNC Health doctor, filed a lawsuit challenging the state’s restrictions. Bryant argued that state rules conflicted with FDA’s Risk Evaluation and Mitigation Strategy for mifepristone.

“This case thus raises the question of whether and when a state can impose additional requirements on the distribution of an FDA-approved drug,” Eagles wrote this spring. “While this case concerns the distribution of a drug used to terminate a pregnancy, a similar case could arise over any drug, from FDA-approved thyroid or diabetes medications, drugs for cancer treatment, vaccinations, contraceptives, or opioids for pain management.”

“The Court finds and concludes that to the extent North Carolina law imposes safety restrictions on the distribution of the drug that the FDA has implemented and then later affirmatively rejected and removed, those laws frustrate the congressional goal of establishing a comprehensive regulatory framework under which the FDA determines conditions for safe drug distribution that do not create unnecessary burdens on the health care system or patient access,” Eagles continued.

“The provisions of the North Carolina law that prohibit health care providers other than physicians from prescribing the drug, require in-person prescribing, dispensing, and administering, mandate the scheduling of an in-person follow-up appointment, and require non-fatal adverse event reporting to the FDA stand as obstacles to Congress’ purpose and are preempted,” the judge wrote.

“But to the extent North Carolina law imposes requirements that have not been expressly considered and rejected by the FDA or that focus more on the practice of medicine and a patient’s informed consent, these provisions do not interfere with Congress’ purpose and are not preempted,” Eagles explained. “This includes the state’s requirements for an in-person advance consultation, use of an ultrasound, an in-person examination, blood type testing, and adverse event reporting to state health authorities.”

Bryant named state Attorney General Josh Stein as lead defendant in her lawsuit. Stein, the Democratic nominee for governor, split with Republican legislative leaders over how to address Bryant’s complaints.

Stein and leading lawmakers offered Eagles opposing arguments in February court filings. Bryant also submitted her own brief.

“As part of its meticulous, statutorily mandated review of the Mifepristone REMS, FDA has rejected the very restrictions North Carolina imposes,” Bryant’s lawyers wrote. “Consistent with its duty under the REMS statute, FDA has sought to reduce burdens on patient access and the healthcare system — particularly for ‘patients who have difficulty accessing health care (such as patients in rural or medically underserved areas)’ — by facilitating access to mifepristone through telemedicine, including by certifying pharmacies to dispense mifepristone and eliminating in-person visits under the REMS. North Carolina’s requirements frustrate those objectives and conflict with FDA’s considered judgments.”

Stein submitted a brief supporting Bryant’s arguments.

“[T]he Attorney General respectfully requests that this Court grant summary judgment to Plaintiff and enjoin the enforcement of the challenged state-law restrictions on the provision of mifepristone because they are in conflict with, and therefore preempted by, federal law,” wrote lawyers with Stein’s state Justice Department.

“When the FDA approved mifepristone in 2000, the FDA imposed a number of conditions it deemed necessary to ensure safe use. Since that time, the FDA has regularly modified the drug’s REMS based on evidence that has been compiled across two decades of use,” Stein’s brief added. “As part of these modifications, the agency has rescinded a number of conditions that, in its expert scientific judgment, are no longer necessary to ensure the drug’s safetyand instead cause unnecessary burdens on access and delivery.”

“North Carolina law reimposes some of the very same restrictions on mifepristone that the FDA has withdrawn,” Stein argued. “Plaintiff challenges seven of those requirements. Under well-settled preemption principles, these requirements violate the Supremacy Clause because they frustrate the careful balance struck by the FDA pursuant to its express statutory authority. As a result, this Court should hold that the mifepristone REMS preempts the challenged North Carolina laws to the extent that those laws impose restrictions on mifepristone that the FDA previously required, but ultimately removed.”

Lawyers representing state Senate Leader Phil Berger, R-Rockingham, and House Speaker Tim Moore, R-Cleveland, intervened in the federal suit to defend North Carolina’s law.

“The States have long worked in tandem with the federal Food and Drug Administration to protect American consumers from dangerous drugs,” legislative lawyers wrote in February. “Mifepristone is a drug with known serious risks. For this reason, its FDA approval is subject to minimum safety requirements to ensure safe use.”

“North Carolina has chosen to protect the health and safety of its citizens by enacting additional safety measures above the federal floor set by the FDA,” lawmakers’ brief continued. “These requirements are consistent with Congress’s health and safety objectives.”

“Yet Plaintiff argues that North Carolina’s health and safety laws conflict with federal law. It is uncontested that no provision of federal law expressly preempts the challenged state laws and that nothing prevents Dr. Bryant from complying with both federal and state requirements,” legislators’ lawyers wrote. “She nevertheless argues that the state requirements somehow stand as an obstacle to Congress’s health and safety objective because the FDA has chosen not to adopt such requirements. Plaintiff can point to no federal statutory text supporting that argument and this Court should uphold the State’s health and safety requirements.”

Eagles took over the case on Dec. 21. It had been assigned to District Judge William Osteen.

During a January hearing, Eagles converted legislators’ motion to dismiss Bryant’s suit into a cross motion for summary judgment. That means both the plaintiff and legislative leaders sought a favorable ruling from Eagles without a trial.

Berger and Moore were not initially named as defendants in the lawsuit. Along with Stein, the list of defendants featured the state Health and Human Services secretary, Orange-Chatham district attorney, and members of the state Medical Board.

Eagles is also presiding over a separate lawsuit challenging portions of North Carolina’s 2023 abortion law. She granted an injunction in September blocking two pieces of that law from taking effect. A motions hearing in that case is scheduled Wednesday afternoon in Greensboro.

A trial in the lawsuit is scheduled for July 22, though Eagles could decide the case based on court filings and this week’s hearing.