## Facts

- A pregnant Missouri inmate, suing for herself and a certified class of incarcerated women seeking elective, non-therapeutic abortions, challenged a Missouri Department of Corrections (MDC) policy governing off-site transportation (“outcounts”) for abortions.
- Before September 5, 2005, MDC provided transportation outcounts for inmates who sought to terminate pregnancies.
- On September 5, 2005, MDC changed its policy to authorize transport only when an abortion was indicated due to a threat to the mother’s life or health and approved by senior medical officials; the policy stated outcounts for elective abortions would no longer be authorized.
- MDC cited security concerns and cost savings as reasons for the policy change.
- Under other MDC medical policies, some care labeled “elective” could still be approved if an attending physician deemed it medically necessary; the abortion policy did not provide a comparable override for elective abortions.
- The named plaintiff requested transportation for an elective abortion; MDC denied the request under the new policy.
- The district court granted preliminary injunctive relief requiring MDC to transport the plaintiff and later, on cross-motions for summary judgment, entered class-wide relief enjoining enforcement of the policy, finding violations of the Fourteenth and Eighth Amendments.
- MDC officials appealed.

## Issues

1. Whether a prison policy categorically denying transportation for elective, non-therapeutic abortions (except for threats to life or health) is reasonably related to legitimate penological interests under Turner v. Safley and thus consistent with the Fourteenth Amendment.
2. Whether denying transportation for an elective, non-therapeutic abortion constitutes deliberate indifference to a serious medical need in violation of the Eighth Amendment.

## Decision

- The court of appeals affirmed the injunction against the policy on Fourteenth Amendment grounds, applying Turner v. Safley.
- The court held the district court erred in part of its Turner analysis by treating the absence of past security incidents as making the policy irrational under Turner’s first factor.
- Despite that error, the court concluded the policy could not withstand Turner scrutiny and was not reasonably related to legitimate penological interests.
- The court rejected the district court’s Eighth Amendment rationale, holding that an elective, non-therapeutic abortion is not a “serious medical need” for Eighth Amendment purposes.
- The judgment was affirmed on modified grounds: relief sustained under the Fourteenth Amendment, not the Eighth Amendment.

## Legal Principles

- Prison regulations that impinge on constitutional rights are evaluated under Turner v. Safley’s reasonableness framework, even when the underlying right is constitutionally protected outside prison.
- Under Turner, the regulation must be reasonably related to legitimate penological interests, assessed through factors including a rational connection to asserted interests, alternative means, the impact of accommodation, and the existence of ready alternatives.
- Prison officials may rely on prospective security concerns; a lack of past security problems does not, by itself, make a restriction irrational under Turner’s first factor.
- A categorical restriction that effectively blocks access to a constitutionally protected choice, without adequate support under Turner, violates the Fourteenth Amendment in the prison setting.
- An Eighth Amendment medical-care claim requires deliberate indifference to a serious medical need; an elective, non-therapeutic abortion does not qualify as a serious medical need under this decision.

## Conclusion

The court enjoined Missouri’s categorical denial of transportation for elective, non-therapeutic abortions because the restriction failed Turner’s reasonableness test under the Fourteenth Amendment, while holding that the denial did not constitute an Eighth Amendment violation because such abortions are not a serious medical need for deliberate-indifference analysis.


Roe v. Crawford, 514 F.3d 789 (8th Cir. 2008)