California Appeals Court Voids Medical Center's Abortion Clinic Ban As 'Unconstitutional Government Action'

The Tulare Medical Center Property Owners Association sued to enforce covenants, codes, and restrictions (CC&Rs) that ban abortion clinics from operating within the development, seeking to stop Family Planning Associates Medical Group from leasing space from property owners Leopoldo and Jennifer Valdivia. FPA provides comprehensive women's health services including abortion care at 24 locations statewide, and announced plans to begin seeing patients at the North Cherry Street property in October 2024.

Writing for the panel, Justice Peña concluded the abortion clinic prohibition was unenforceable on two independent grounds. First, because the CC&Rs were originally adopted in 1991 by the Tulare Local Hospital District—a public entity—their enforcement constitutes government action that interferes with fundamental reproductive rights. 'When a statutory provision intrudes or impinges upon this most intimate and fundamental constitutional right, the California Supreme Court has concluded the intrusion or impingement must be evaluated under the compelling interest standard,' Peña wrote, applying the same standard to land use restrictions.

The court delivered its sharpest rebuke when addressing the Association's failure to justify the restriction under constitutional scrutiny. As Justice Peña noted, 'the Association's papers requesting a preliminary injunction incorrectly treated the land use restriction as solely a private contractual matter and made no attempt to identify a compelling interest that justified the Tulare Local Hospital District's impingement of an interest fundamental to personal autonomy.'

The case reached the appeals court after Tulare County Superior Court Judge Bret D. Hillman denied the Association's request for a preliminary injunction in December 2024. Judge Hillman had stated from the bench that 'this is a case where I think we need some appellate guidance,' acknowledging the tension between 'a fairly clear contractual issue' and 'a lot of countervailing public policy issues.' The lower court found it was 'an open question' whether abortion clinic restrictions violated the Unruh Civil Rights Act.

The Association had argued that the CC&Rs were purely private contractual arrangements, but the appeals court rejected this characterization entirely. Justice Peña explained that the hospital district's foundational role in creating the restrictions established 'such a close nexus between the state and the challenged action that seemingly private behavior may be fairly treated as action of the state itself.' The court noted that without the public entity's actions, 'there would be no prohibition for the Association to enforce.'

The court also broke new ground by ruling that Civil Code section 531 renders abortion clinic prohibitions void as discriminatory restrictions. Justice Peña determined that an individual's decision to have an abortion constitutes a protected characteristic under the Unruh Civil Rights Act, writing that the choice 'is clearly among the most intimate and fundamental of all constitutional rights' and represents a 'choice[] fundamental to a person's identity, beliefs and self-definition.'

For practitioners, the decision establishes that land use restrictions adopted by public entities face the same constitutional scrutiny as statutes when they impinge on reproductive rights. The ruling also expands Unruh Act protections to cover abortion-related discrimination in property restrictions, potentially affecting CC&Rs and similar documents statewide that contain similar prohibitions.