American Academy of Pediatrics v. James Uthmeier
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Opinion
In the
United States Court of Appeals For the Seventh Circuit ____________________ No. 26-2238 AMERICAN ACADEMY OF PEDIATRICS, Plaintiff-Appellee,
v.
JAMES UTHMEIER, Attorney General of the State of Florida, Defendant-Appellant. ____________________
Appeal from the United States District Court for the Northern District of Illinois, Eastern Division. No.1:26-cv-02401— Matthew F. Kennelly, Judge. ____________________
DECIDED JUNE 22, 2026 ____________________
Before HAMILTON, SCUDDER, and JACKSON-AKIWUMI, Cir- cuit Judges. PER CURIAM. In December 2025, James Uthmeier, the At- torney General of the State of Florida, sued the American Academy of Pediatrics, the World Professional Association for Transgender Health, and the Endocrine Society in Florida state court. General Uthmeier alleged and announced pub- licly that through their policy statements and legal filings sup- porting access to gender-affirming care, the organizations 2 No. 26-2238
violated the Florida Deceptive and Unfair Trade Practices Act, Florida’s Racketeer Influenced and Corrupt Organizations (RICO) Act, and, later, Florida antitrust law. Three months later, General Uthmeier had not yet even served the organiza- tions with process, but the pending case was hanging over those defendants. The American Academy of Pediatrics (AAP), an Illinois non-profit, then sued General Uthmeier in federal court in Illinois. AAP sued under 42 U.S.C. § 1983. It contends that the Florida enforcement action was brought in bad faith in violation of the First Amendment to retaliate against AAP’s advocacy for gender-affirming care. The district court granted AAP’s motion for a preliminary injunction, enjoining General Uthmeier from pursuing his state court action against AAP. General Uthmeier has ap- pealed and moved for a stay of the preliminary injunction pending our full and expedited consideration of his appeal of the preliminary injunction. See Fed. R. App. P. 8. The issue before us is narrow. We do not decide the merits of the preliminary injunction. We consider only whether we should stay the district court’s injunction pending our expe- dited consideration of the appeal. We deny the requested stay pending appeal. We recognize that an injunction against a pending state enforcement action like this raises serious fed- eralism concerns that are the foundation of Younger absten- tion. See Younger v. Harris, 401 U.S. 37 (1971) (reversing injunc- tion against criminal proceeding brought in good faith). The Younger abstention doctrine, however, has always included an exception for proceedings brought in bad faith. Id. at 46–50, citing Dombrowski v. Pfister, 380 U.S. 479 (1965) (reversing de- nial of injunction against criminal proceedings brought in bad faith). In this case, the district court made detailed findings No. 26-2238 3
indicating the Florida proceeding has been brought in bad faith, so that Younger abstention should not apply. The district court also explained why personal jurisdiction and venue in Illinois are supported by law. The district court’s decision finds strong support from de- cisions by both the Fifth Circuit and the D.C. Circuit, decisions with which neither General Uthmeier nor our dissenting col- league engages. See Defense Distributed v. Grewal, 971 F.3d 485 (5th Cir. 2020) (holding that Texas district court should have enjoined bad-faith enforcement action brought in New Jersey by state a orney general); Media Ma ers for America v. Paxton, 138 F.4th 563 (D.C. Cir. 2025) (affirming D.C. injunction against bad-faith investigation by a orney general in Texas). In light of those cases providing legal support for the injunc- tion here, as well as AAP’s factual showings, General Uth- meier has not made the required “strong showings” that he is likely to succeed on the merits of the appeal or that the injunc- tion will cause him irreparable harm while we consider his appeal on an expedited basis. See Nken v. Holder, 556 U.S. 418, 434 (2009). I A The American Academy of Pediatrics is a non-partisan, non-profit organization incorporated and headquartered in Illinois. Founded in 1930, AAP contributes to the develop- ment of pediatric medicine through conducting research, providing educational materials, hosting events for medical professionals, and publishing Pediatrics, a peer-reviewed sci- entific journal. AAP also files amicus briefs, submits 4 No. 26-2238
comments in response to agency rulemaking, and issues pol- icy statements on issues affecting pediatric health. In 2018, AAP published a policy statement titled “Ensur- ing Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents” in the Pediatrics journal. According to its abstract, the policy statement re- views concepts and challenges in the field of gender-affirming care, providing suggestions for pediatric providers that are “focused on promoting the health and positive development” of transgender youth. The policy statement contains an im- portant disclaimer: “The guidance in this statement does not indicate an exclusive course of treatment or serve as a stand- ard of medical care. Variations, taking into account individual circumstances, may be appropriate.” The policy statement provides an overview of various forms of gender-affirming care with an overall supportive tone. It notes that suppression of puberty comes with risks, noting that some research suggests it may have long-term ef- fects on bone metabolism and fertility and observing that the current research is “limited and provides varied results.” The statement favorably summarizes social affirmation, including adapting one’s hairstyle, clothing, and pronouns. The state- ment also describes different types of surgical approaches. It observes that these changes are irreversible and typically are reserved for adults, but that surgery is “occasionally pursued during adolescence on a case-by-case basis.” AAP’s policy statement concludes with several recom- mendations, four of which the district court highlighted as particularly relevant to this case: (1) “that youth who identify as [transgender] have access to comprehensive, gender-af- firming, and developmentally appropriate health care that is No. 26-2238 5
provided in a safe and inclusive space”; (2) “that insurance plans offer coverage for health care that is specific to the needs of youth who identify as [transgender], including coverage for medical, psychological, and, when indicated, surgical gen- der-affirming interventions”; (3) “that pediatricians have a role in advocating for policies and laws that protect youth who identify as [transgender] from discrimination and vio- lence”; and (4) “that the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for youth who identify as [transgender].” AAP affirmed this policy statement in 2023. The statement is freely accessible online. In early December 2025, General Uthmeier filed a lawsuit in a state court in Florida against AAP, the World Professional Association for Transgender Health (WPATH), and the Endo- crine Society. His initial complaint alleged that AAP and its co-defendants violated the Florida Deceptive and Unfair Trade Practices Act by making “immoral, unethical, oppres- sive, and unscrupulous” representations, misleading con- sumers about the safety and reversibility of “sex intervention” treatments in order to advertise memberships, goods, and ser- vices.
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In the
United States Court of Appeals For the Seventh Circuit ____________________ No. 26-2238 AMERICAN ACADEMY OF PEDIATRICS, Plaintiff-Appellee,
v.
JAMES UTHMEIER, Attorney General of the State of Florida, Defendant-Appellant. ____________________
Appeal from the United States District Court for the Northern District of Illinois, Eastern Division. No.1:26-cv-02401— Matthew F. Kennelly, Judge. ____________________
DECIDED JUNE 22, 2026 ____________________
Before HAMILTON, SCUDDER, and JACKSON-AKIWUMI, Cir- cuit Judges. PER CURIAM. In December 2025, James Uthmeier, the At- torney General of the State of Florida, sued the American Academy of Pediatrics, the World Professional Association for Transgender Health, and the Endocrine Society in Florida state court. General Uthmeier alleged and announced pub- licly that through their policy statements and legal filings sup- porting access to gender-affirming care, the organizations 2 No. 26-2238
violated the Florida Deceptive and Unfair Trade Practices Act, Florida’s Racketeer Influenced and Corrupt Organizations (RICO) Act, and, later, Florida antitrust law. Three months later, General Uthmeier had not yet even served the organiza- tions with process, but the pending case was hanging over those defendants. The American Academy of Pediatrics (AAP), an Illinois non-profit, then sued General Uthmeier in federal court in Illinois. AAP sued under 42 U.S.C. § 1983. It contends that the Florida enforcement action was brought in bad faith in violation of the First Amendment to retaliate against AAP’s advocacy for gender-affirming care. The district court granted AAP’s motion for a preliminary injunction, enjoining General Uthmeier from pursuing his state court action against AAP. General Uthmeier has ap- pealed and moved for a stay of the preliminary injunction pending our full and expedited consideration of his appeal of the preliminary injunction. See Fed. R. App. P. 8. The issue before us is narrow. We do not decide the merits of the preliminary injunction. We consider only whether we should stay the district court’s injunction pending our expe- dited consideration of the appeal. We deny the requested stay pending appeal. We recognize that an injunction against a pending state enforcement action like this raises serious fed- eralism concerns that are the foundation of Younger absten- tion. See Younger v. Harris, 401 U.S. 37 (1971) (reversing injunc- tion against criminal proceeding brought in good faith). The Younger abstention doctrine, however, has always included an exception for proceedings brought in bad faith. Id. at 46–50, citing Dombrowski v. Pfister, 380 U.S. 479 (1965) (reversing de- nial of injunction against criminal proceedings brought in bad faith). In this case, the district court made detailed findings No. 26-2238 3
indicating the Florida proceeding has been brought in bad faith, so that Younger abstention should not apply. The district court also explained why personal jurisdiction and venue in Illinois are supported by law. The district court’s decision finds strong support from de- cisions by both the Fifth Circuit and the D.C. Circuit, decisions with which neither General Uthmeier nor our dissenting col- league engages. See Defense Distributed v. Grewal, 971 F.3d 485 (5th Cir. 2020) (holding that Texas district court should have enjoined bad-faith enforcement action brought in New Jersey by state a orney general); Media Ma ers for America v. Paxton, 138 F.4th 563 (D.C. Cir. 2025) (affirming D.C. injunction against bad-faith investigation by a orney general in Texas). In light of those cases providing legal support for the injunc- tion here, as well as AAP’s factual showings, General Uth- meier has not made the required “strong showings” that he is likely to succeed on the merits of the appeal or that the injunc- tion will cause him irreparable harm while we consider his appeal on an expedited basis. See Nken v. Holder, 556 U.S. 418, 434 (2009). I A The American Academy of Pediatrics is a non-partisan, non-profit organization incorporated and headquartered in Illinois. Founded in 1930, AAP contributes to the develop- ment of pediatric medicine through conducting research, providing educational materials, hosting events for medical professionals, and publishing Pediatrics, a peer-reviewed sci- entific journal. AAP also files amicus briefs, submits 4 No. 26-2238
comments in response to agency rulemaking, and issues pol- icy statements on issues affecting pediatric health. In 2018, AAP published a policy statement titled “Ensur- ing Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents” in the Pediatrics journal. According to its abstract, the policy statement re- views concepts and challenges in the field of gender-affirming care, providing suggestions for pediatric providers that are “focused on promoting the health and positive development” of transgender youth. The policy statement contains an im- portant disclaimer: “The guidance in this statement does not indicate an exclusive course of treatment or serve as a stand- ard of medical care. Variations, taking into account individual circumstances, may be appropriate.” The policy statement provides an overview of various forms of gender-affirming care with an overall supportive tone. It notes that suppression of puberty comes with risks, noting that some research suggests it may have long-term ef- fects on bone metabolism and fertility and observing that the current research is “limited and provides varied results.” The statement favorably summarizes social affirmation, including adapting one’s hairstyle, clothing, and pronouns. The state- ment also describes different types of surgical approaches. It observes that these changes are irreversible and typically are reserved for adults, but that surgery is “occasionally pursued during adolescence on a case-by-case basis.” AAP’s policy statement concludes with several recom- mendations, four of which the district court highlighted as particularly relevant to this case: (1) “that youth who identify as [transgender] have access to comprehensive, gender-af- firming, and developmentally appropriate health care that is No. 26-2238 5
provided in a safe and inclusive space”; (2) “that insurance plans offer coverage for health care that is specific to the needs of youth who identify as [transgender], including coverage for medical, psychological, and, when indicated, surgical gen- der-affirming interventions”; (3) “that pediatricians have a role in advocating for policies and laws that protect youth who identify as [transgender] from discrimination and vio- lence”; and (4) “that the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for youth who identify as [transgender].” AAP affirmed this policy statement in 2023. The statement is freely accessible online. In early December 2025, General Uthmeier filed a lawsuit in a state court in Florida against AAP, the World Professional Association for Transgender Health (WPATH), and the Endo- crine Society. His initial complaint alleged that AAP and its co-defendants violated the Florida Deceptive and Unfair Trade Practices Act by making “immoral, unethical, oppres- sive, and unscrupulous” representations, misleading con- sumers about the safety and reversibility of “sex intervention” treatments in order to advertise memberships, goods, and ser- vices. The Florida complaint also alleged that the defendants vi- olated Florida’s RICO Act. The criminal enterprise purport- edly began when defendant WPATH issued a publication in 1998 that did not specify an age minimum for puberty-block- ing hormones, allegedly with no credible supporting evi- dence. Defendant Endocrine Society allegedly joined the criminal enterprise in 2009 by publishing a guideline adopt- ing most of WPATH’s recommendations, stating falsely that puberty blockers were “fully reversible.” 6 No. 26-2238
General Uthmeier alleged that AAP joined the supposed criminal enterprise with its 2018 policy statement, described above, which adopted and cited elements of the WPATH and Endocrine Society reports. General Uthmeier alleged that the three organizations furthered their supposed criminal enter- prise by submi ing comments opposing a rule proposed by the Florida Agency for Health Care Administration that would exclude gender-affirming treatments from Medicaid coverage. Their later amicus briefs challenging the scientific basis for the rule, General Uthmeier alleged, were further ev- idence of their criminal enterprise based on a “formula” of “co-signing amicus briefs that cite each other’s guidelines.” General Uthmeier sought declaratory and injunctive relief, as well as statutory penalties of $1 million against each de- fendant and an additional $10,000 for each allegedly false rep- resentation. Important for our analysis of personal jurisdic- tion and venue, he also asked the Florida state court to grant additional relief including “imposing reasonable restrictions upon Defendants’ future activities,” “[o]rdering the dissolu- tion or reorganization of Defendants’ enterprise,” and “[o]rdering the forfeiture of Defendants’ charters.” The day General Uthmeier filed the state complaint, he an- nounced the enforcement action on X, formerly known as Twi er: “In 2023, @GovRonDeSantis signed legislation to ban so-called 'gender-affirming care' for kids. Now it's time for ac- countability! Today, my office sued @wpath, @AmerAcadPeds, and @TheEndoSociety for mutilating kids and misleading families.” AAP alleges that two days later, General Uthmeier was a guest on a podcast where he dis- cussed the enforcement action and said: “we want to hurt [AAP and its co-defendants] in their wallet,” “we want them No. 26-2238 7
to cough up millions,” and that his lawsuit would “end” gen- der-affirming care “for once and for all.” B Despite the publicity about the filing, General Uthmeier did not serve AAP and its co-defendants in the state enforce- ment action for more than three months after filing the com- plaint. He did so only after AAP filed this lawsuit in the Northern District of Illinois alleging that General Uthmeier had filed the state enforcement action to retaliate against AAP for its advocacy in favor of gender-affirming care and to sup- press its speech in violation of the First Amendment. AAP sought injunctive relief under 42 U.S.C. § 1983 and Ex parte Young, 209 U.S. 123 (1908). See generally Chiles v. Salazar, 607 U.S. —, 146 S. Ct. 1010 (2026) (First Amendment protects speech on issues of gender-affirming care and prevents state from requiring therapists to adopt state’s favored viewpoint). AAP moved for a preliminary injunction. General Uth- meier moved to dismiss the federal lawsuit for lack of per- sonal jurisdiction, improper venue, Younger abstention, and failure to state a claim. On the same day he filed his motion to dismiss, General Uthmeier filed an amended complaint in the Florida court. The amended complaint added an antitrust claim, alleging that the three defendants restrained trade or commerce by “employing biased standards-se ing proce- dures designed to promote their members’ ‘gender-affirming’ model of care.” The amended complaint seeks an additional $1 million penalty for each alleged antitrust violation. After holding a hearing and assessing the record, the dis- trict court denied General Uthmeier’s motion to dismiss, granted AAP’s motion for a preliminary injunction against 8 No. 26-2238
General Uthmeier’s pursuing the Florida enforcement action against AAP pending further proceedings. The court acknowledged General Uthmeier’s argument that his service of process on AAP in Illinois was likely insufficient on its own to establish personal jurisdiction. The district court concluded that the combination of service in Illinois, the chilling effect on AAP in Illinois, and General Uthmeier’s stated intent to halt AAP’s operations in Illinois and nationwide, including dissolving AAP and forfeiting its charter, was likely sufficient to establish personal jurisdiction in Illinois. The district court found that venue, too, was likely proper because the chilling effect of the enforcement action, as well as AAP’s conduct and publications giving rise to the state enforcement action, oc- curred in the Northern District of Illinois. The district court also found at this preliminary stage that AAP’s suit appears likely to meet the Younger exception al- lowing injunctions against bad-faith litigation. Based on the facts before it, the court found that General Uthmeier ap- peared to have filed the enforcement action with no reasona- ble expectation of success. All three state-law claims require General Uthmeier to prove that AAP’s activities are commer- cial. AAP is a nonprofit scientific organization that does not sell or provide gender-affirming care. In addition, the court found, several other factors supported an inference of bad faith: General Uthmeier’s delay in prosecuting the enforce- ment action, the Florida complaint’s inaccurate portrayal of AAP’s stance on age limits and side effects of gender-affirm- ing care, and General Uthmeier’s inflammatory public com- ments. The district court further found that AAP was likely to suc- ceed on the merits of its First Amendment retaliation claim. No. 26-2238 9
General Uthmeier had offered no arguments to rebut AAP’s position that its scientific publications about gender-affirming care were protected by the First Amendment. Also, there was li le doubt that AAP’s protected speech was the impetus for the Florida enforcement action. The monetary and injunctive penalties threatened by the suit also appeared to be severe enough to deter future First Amendment activity. Irreparable harm is presumed in First Amendment violations. The district court also credited AAP’s evidence that the enforcement ac- tion was chilling scientific discourse, undermining security and a endance at AAP’s events, and burdening AAP employ- ees with threats to their safety. Consistent with the reasoning in Younger, the court found that raising a First Amendment defense in state court would likely not provide an adequate remedy for AAP because the right it sought to protect was the right not to be subjected to a bad-faith prosecution in the first place. See Younger, 401 U.S. at 48–49 (injunction would be justified where “defense of the State’s criminal prosecution will not assure adequate vindica- tion of constitutional rights,” and “substantial loss of or im- pairment of freedoms of expression will occur if appellants must await the state court’s disposition and ultimate review in this Court of any adverse determination”), quoting Dom- browski, 380 U.S. at 485–86 (reversing denial of injunction against bad-faith prosecution); Netflix, Inc. v. Babin, 88 F.4th 1080, 1097 n.51 (5th Cir. 2023) (affirming injunction against state-court prosecution for actions protected by First Amend- ment because criminal defendant sought to protect federal right not to be subjected to bad-faith prosecution, and that right could not be vindicated by undergoing prosecution). 10 No. 26-2238
General Uthmeier appealed the injunction. He moved for a stay pending appeal and an immediate administrative stay as to the district court’s order to file a prompt status report detailing his compliance with the preliminary injunction. This court denied the motion for an immediate administrative stay. General Uthmeier then filed his status report in the dis- trict court showing that he had notified the Florida state court of the preliminary injunction. He described the injunction as “lawless” and “illicit” and told the state court that “[t]he in- junction does not bind [it] in any way.” II When considering whether to stay an injunction pending appeal, this court applies a standard parallel to the prelimi- nary injunction standard while keeping in mind “the district court’s exercise of equitable discretion.” Illinois v. Trump, 155 F.4th 929, 936 (7th Cir. 2025), quoting Camelot Banquet Rooms, Inc. v. U.S. Small Bus. Admin., 14 F.4th 624, 628 (7th Cir. 2021). We take a “fresh look at the legal issues but review the district court’s factual findings for clear error.” Id. at 936–37. To justify a stay, the moving party must make a “strong show- ing that he is likely to succeed on the merits,” and that he will be “irreparably injured” absent a stay. Nken v. Holder, 556 U.S. 418, 434 (2009). If he makes such a “strong showing,” then this court considers the balance of harms and the public interest. The party requesting a stay bears the burden of showing it is justified. Id. at 433–34. General Uthmeier argues he is likely to succeed on the merits for three reasons: the district court lacks personal No. 26-2238 11
jurisdiction, venue is improper, and Younger v. Harris de- mands abstention. We address each in turn. A. Personal Jurisdiction First, General Uthmeier argues that he is likely to succeed on the merits because the Illinois district court lacks personal jurisdiction over him. He argues that the effects of the state enforcement action felt by AAP in Illinois are not contacts be- tween himself and Illinois and that the fact that he served pro- cess on AAP in Illinois does not establish sufficient minimum contacts with the state. General Uthmeier has not made the required strong show- ing that the district court lacks personal jurisdiction. Illinois’s long-arm statute permits personal jurisdiction coextensive with the Due Process Clause of the Fourteenth Amendment. Mobile Anesthesiologists Chi., LLC v. Anesthesia Assocs. of Hou. Metroplex, P.A., 623 F.3d 440, 443 (7th Cir. 2010). Thus, General Uthmeier is subject to personal jurisdiction in Illinois if he has “certain minimum contacts” with Illinois such that this law- suit “does not offend ‘traditional notions of fair play and sub- stantial justice.’” Id., quoting International Shoe Co. v. Washing- ton, 326 U.S. 310, 316 (1945). The simple fact of injury in the forum is not enough by itself to establish jurisdiction, but it can be sufficient when a defendant’s intentional conduct in a foreign state is “calcu- lated to cause injury” to the plaintiff in the forum state. Calder v. Jones, 465 U.S. 783, 791 (1984). Under Calder, personal juris- diction based on the location of a plaintiff’s injury is appro- priate when a defendant “expressly aims its actions at the state with the knowledge that they would cause harm to the plaintiff there.” Mobile Anesthesiologists, 623 F.3d at 445. 12 No. 26-2238
“Express aiming” requires some “evidence beyond the plain- tiff’s mere residence in the forum state.” Id. at 447. General Uthmeier maintains that exercising personal juris- diction over an out-of-state a orney general is unprecedented overreach. But the Fifth and D.C. Circuits have each affirmed findings of personal jurisdiction over out-of-state a orneys general in analogous circumstances. General Uthmeier does not engage with those cases and identifies no contrary author- ity. As the district court noted, Defense Distributed v. Grewal, 971 F.3d 485 (5th Cir. 2020), is particularly instructive. De- fense Distributed, a Texas company that promotes popular ac- cess to firearms, produced and made accessible online infor- mation related to the 3D printing of firearms. Id. at 488. New Jersey A orney General Grewal sent a cease-and-desist le er to Defense Distributed in Texas threatening legal action if it published its files online, and he brought a civil lawsuit against Defense Distributed in New Jersey. Defense Distrib- uted filed suit in federal court in Texas alleging the a orney general’s actions violated the First Amendment. Id. at 489. The Fifth Circuit determined that the a orney general had suffi- cient minimum contacts with Texas to subject him to the juris- diction of Texas courts. Notably, the Fifth Circuit reasoned that General Grewal purposefully directed conduct at Texas because, rather than “cabin his request by commanding the plaintiffs to stop pub- lishing materials to New Jersey residents; he instead demands that the plaintiffs cease publication of their materials gener- ally.” Id. at 492. The Fifth Circuit also noted that General Grewal’s conduct beyond sending the cease-and-desist le er confirmed his intent to “crush Defense Distributed’s No. 26-2238 13
operations and not simply limit the dissemination of digital files in New Jersey,” citing his public comments threatening to “come after” “anyone who is contemplating making a printable gun.” Id. Those facts closely track the situation here. General Uthmeier seeks to block AAP’s speech nationwide and to dissolve it and cause its operations to cease. The District of Columbia Circuit found personal jurisdic- tion in another similar action in Media Ma ers for America v. Paxton, 138 F.4th 563 (D.C. Cir. 2025), where a district court in the District of Columbia enjoined the Texas a orney general from pursuing an investigation of a reporter and a nonprofit media watchdog organization. They had published an article asserting that the owner of X.com was endorsing an antise- mitic conspiracy theory on its internet platform. Id. at 571. The D.C. Circuit rejected the Texas a orney general’s a ack on personal jurisdiction: “The point is that the censorship-based effects of the allegedly retaliatory investigation [have] con- nected [Texas A orney General] Paxton to the District [of Co- lumbia], rather than to just Appellees.” Id. at 578, citing De- fense Distributed, 971 F.3d at 495–96. As the circuit courts did in Defense Distributed and Media Ma ers, the district court here reasonably found that General Uthmeier’s actions appear calculated to cause injury to AAP in Illinois. General Uthmeier has asked the Florida state court to impose “restrictions upon [AAP’s] future activities” and even to order “the forfeiture of [AAP’s] charter” in Illinois. Further, his amended state complaint identifies the “relevant market” of AAP’s allegedly misleading advertisements as “the treatment of children and adolescents experiencing gen- der dysphoria in the United States” and notes that AAP and its co-defendants “have thousands of members across the 14 No. 26-2238
country and wield considerable power in the Relevant Mar- ket.” This evidence, beyond AAP’s presence in Illinois, sup- ports the conclusion that General Uthmeier intends to “crush” AAP’s operations in Illinois and to chill its speech there rather than simply to limit the dissemination of AAP policy reports in Florida. See Defense Distributed, 971 F.3d at 493. General Uthmeier has not shown a strong likelihood that these find- ings were clearly erroneous. See Illinois v. Trump, 155 F.4th at 936–37. And he does not otherwise distinguish the authority of the Fifth and D.C. Circuits in Defense Distributed and Media Ma ers, let alone show a strong likelihood of success on his challenge to personal jurisdiction at this preliminary stage. B. Venue General Uthmeier next argues that venue is improper be- cause AAP cannot show a substantial part of the events giving rise to its First Amendment claim occurred in the Northern District of Illinois. He has also failed to show a strong likeli- hood of success on this defense. For venue to be proper, a “substantial” part of the events giving rise to the claim needs to occur in the venue, but not all parts. See 28 U.S.C. § 1391(b)(2). The location of the plaintiff’s harm is not irrelevant in the venue analysis. Other circuits have considered the locus of injury a relevant factor in venue for tort actions. See, e.g., Myers v. Benne Law Offices, 238 F.3d 1068, 1076 (9th Cir. 2001). The fact that the allegedly retaliatory enforcement action is in a Florida state court is not the only event giving rise to the First Amendment claim. General Uthmeier served AAP in the Northern District of Illinois, but even more important, the intended “ensuing adverse effects” occurred there. See Media No. 26-2238 15
Ma ers, 138 F.4th at 583 (venue proper in District of Columbia to enjoin bad-faith investigation in Texas). Further, the en- forcement action is based on allegations concerning the devel- opment and strategy behind AAP’s policy statement and legal filings, including accusing AAP of publishing policy reports to mislead consumers about the efficacy of gender-affirming treatments despite supposedly knowing that its recommen- dations were not backed by medical evidence. These allega- tions address discussions, knowledge, and publications based in the Northern District of Illinois. In sum, then, General Uth- meier has failed to make a strong showing that venue in Illi- nois is improper in this case. C. Younger Abstention It is a well se led principle that federal courts have a “vir- tually unflagging obligation” to hear and decide cases within their jurisdiction. Colorado River Water Conservation Dist. v. United States, 424 U.S. 800, 817 (1976). The Younger abstention doctrine established an important exception to this principle. Younger v. Harris 401 U.S. 37, 43 (1971). Under the Younger doc- trine, federal courts refrain from issuing injunctions that would keep state courts from hearing state criminal cases, as well as civil proceedings akin to criminal cases and other civil cases that implicate a state’s interest in enforcing the orders and judgments of its courts. Sprint Commc’ns, Inc. v. Jacobs, 571 U.S. 69, 72–73 (2013). Younger abstention is grounded in concerns of federalism and comity. In our federal system of dual sovereigns, federal courts must respect the balance between state and federal ju- diciaries. We pay due respect to the legitimate interests that state governments have in enforcing their law in their own 16 No. 26-2238
institutions and in allowing their own courts to apply federal law. Younger, 401 U.S. at 43–45. Younger itself recognized, however, that its limits on fed- eral jurisdiction are not absolute. Younger abstention does not prevent a federal court from honoring its obligation to hear and decide cases when the pending state case involves “bad faith and harassment.” Id. at 49; accord, Huffman v. Pursue, Ltd., 420 U.S. 592, 611 (1975) (“Younger, and its civil counter- part which we apply today, do of course allow intervention in those cases where the District Court properly finds that the state proceeding is motivated by a desire to harass or is con- ducted in bad faith …”). The Supreme Court did not find bad faith in Younger itself, but the Court described the exception in terms of its decision in Dombrowski v. Pfister, 380 U.S. 479 (1965); see generally 17A Moore’s Federal Practice § 122.73[2] (2026) (describing bad- faith exception and Younger’s reliance on Dombrowski). The plaintiffs in Dombrowski were civil rights activists in Louisi- ana. They had been facing prosecution in state court for vio- lating the Louisiana Subversive Activities and Communist Control Law and the Communist Propaganda Control Law. They sued in federal court to challenge the constitutionality of those statutes and to enjoin state officials from continuing to prosecute or threatening to prosecute them. 380 U.S. at 481– 82. A three-judge district court had dismissed the complaint, concluding that it should abstain from intervening in the state criminal proceedings. Id. at 482–83. The Supreme Court No. 26-2238 17
reversed and held that an injunction was appropriate, with its precise terms to be determined on remand. Id. at 497–98. Dombrowski’s logic, as described in Younger, had not devi- ated from “se led doctrines that have always confined very narrowly the availability of injunctive relief against state criminal prosecutions.” Younger, 401 U.S. at 53. Unlike in ear- lier cases, the Dombrowski plaintiffs made “substantial allega- tions” and offered to prove several instances of bad faith and harassment. See id. at 47–48. They had been subject to raids and had their files and records seized pursuant to warrants later vacated for lack of probable cause. Id. at 48. Further, de- spite a state judge “quashing the warrants and suppressing the evidence seized,” the prosecutor threatened to continue prosecution and held “public hearings” where “copies of the illegally seized documents were being used.” Id.1 The bad-faith exception in Younger provides a critical safety valve for protecting federal rights while also respecting states and their courts. We have explained that “[t]he harm posed by bad faith prosecution is both immediate and great.” Collins v. Kendall County, 807 F.2d 95, 98 (7th Cir. 1986). When state officials bring suits in bad faith or to harass, comity con- cerns are at their weakest. A state “does not have any legiti- mate interest in pursuing a bad faith prosecution brought to retaliate for or to deter the exercise of constitutionally pro- tected rights. Perhaps the most important comity rationale
1 Younger was careful to note that Dombrowski did not imply that “the
federal courts may give equitable relief, without regard to any showing of bad faith or harassment, whenever a state statute is found … in violation of the First Amendment.” Younger, 401 U.S. at 50. A “chilling effect” on First Amendment–protected speech is not enough on its own to justify en- joining a state proceeding. See id. at 51–52. 18 No. 26-2238
of Younger deference—that of respect for the State’s legitimate pursuit of its substantive interests…—is therefore inapplica- ble.” Id. at 98 n.5, quoting Wilson v. Thompson, 593 F.2d 1375, 1382–83 (5th Cir. 1979) (reversing denial of injunction; plain- tiffs showed bad faith, so Younger abstention did not apply); accord, e.g., Netflix, Inc., 88 F.4th at 1091 (“While states cer- tainly have a legitimate interest in the enforcement of their criminal laws, they have no such interest when the enforce- ment of those laws is carried out in bad faith. … Comity … gives way once good faith does.”). Federal courts do not apply the bad-faith exception to Younger lightly, or often. A plaintiff must allege and ulti- mately prove specific facts to support an inference of bad faith. See Collins, 807 F.2d at 98. But the exception is a critical feature of the federalism balance struck in Younger doctrine. The Supreme Court has framed the exception in both sub- jective and objective terms. In Perez v. Ledesma, the Court noted that the bad-faith exception is implicated when harass- ment or prosecution is undertaken “without hope of obtain- ing a valid conviction.” 401 U.S. 82, 85 (1971). Several years later, in Kugler v. Helfant, the Court defined the exception in more objective terms, explaining that bad faith requires that state officials undertook a prosecution “without a reasonable expectation of obtaining a valid conviction.” 421 U.S. 117, 126 n.6 (1975), citing Perez, 401 U.S. at 85. This court has described bad faith as the use of prosecutions “as instrumentalities for the suppression of speech” or prosecutions brought “with no expectation of convictions.” Collins, 807 F.2d at 101, quoting No. 26-2238 19
first Sheridan v. Garrison, 415 F.2d 699, 706 (5th Cir. 1969), then Cameron v. Johnson, 390 U.S. 611, 621 (1968). The district court in this case discussed factors relevant to both subjective and objective bad faith on the part of General Uthmeier. Based on extensive factual findings, the court con- cluded that together the facts at this preliminary injunction stage of the case support an inference of bad faith. See Collins, 807 F.2d at 98. General Uthmeier argues in his motion to stay, as he did in the district court, that the bad-faith exception applies only in circumstances of repeated prosecutions. He has not identi- fied any substantial authority imposing such a multiple-pros- ecution requirement. Younger itself did not impose such a re- quirement. The Court wrote that the exception did not apply in Younger because the plaintiff did not suggest the prosecu- tion was “brought in bad faith or [was] only one of a series of repeated prosecutions.” 401 U.S. at 49 (emphasis added); see also Fi gerald v. Peek, 636 F.2d 943, 944 (5th Cir. 1981) (“[T]he threat of multiple or repeated prosecutions is not necessary to establish bad faith prosecution.”); Wilson, 593 F.2d at 1381 (“Nearly every Supreme Court case addressing the bad faith exception has described it in terms which indicate that it is not limited to situations of repeated or multiple prosecutions.”). General Uthmeier also argues that the district court was wrong to consider the merits of the Florida enforcement ac- tion’s claims in its bad-faith analysis. He asserts that, regard- less, he has a reasonable expectation of obtaining a judgment on his claims under the FDUTPA, Florida RICO Act, and Flor- ida antitrust laws. We disagree. 20 No. 26-2238
The objective framing of the bad-faith inquiry in Kugler at least invites and probably requires some consideration of the likelihood of success on the underlying state claims. See 421 U.S. at 126 n.6. Even a purely subjective test would invite con- sideration of the merits as circumstantial evidence of the state actor’s good or bad faith. Consideration of the merits features prominently in many cases addressing the exception. E.g., Netflix, Inc., 88 F.4th at 1094–95 (affirming preliminary injunc- tion against state prosecution, and concluding that bad-faith exception applied in part because “presumably,” as to the merits, “there are none”); Nobby Lobby, Inc. v. City of Dallas, 970 F.2d 82, 83–84, 88 (5th Cir. 1992) (affirming preliminary injunction; bad-faith exception applied, in part because city seized video and computer equipment even though all offi- cials “were fully aware” of recent court decision narrowing relevant statute’s construction); see also Collins, 807 F.2d at 101 (holding that district court did not err in applying Younger abstention when defendants had “successfully prosecuted the plaintiffs on three obscenity charges”). But see Fi gerald, 636 F.2d at 945 (a prosecution “brought for the purposes of har- assment and retaliation … will justify an injunction regardless of whether valid convictions conceivably could be obtained”). At this preliminary stage, the merits of the Florida claims against AAP appear weak. The district court found that Gen- eral Uthmeier’s theory—that AAP’s policy statements were commercial in nature, a prerequisite for all three state claims—lacked any merit because AAP is a nonprofit that does not sell or provide any gender-affirming care, and be- cause its policy statement resembled “scientific and medical advocacy, not a money-making scheme.” No. 26-2238 21
General Uthmeier now counters that the state claims are meritorious because, despite its nonprofit status, AAP is a “standards-se ing” association that derives benefits from its standards, including influence and memberships. In doing so, he relies on Wilk v. American Medical Ass’n, 895 F.2d 352, 357– 58 (7th Cir. 1990), where this court explained that the AMA’s “standards-se ing” speech implicated antitrust laws based on its labeling of chiropractors as an “unscientific cult” and instruction to its members that it was unethical for medical practitioners to associate with chiropractors. Id. at 356. This speech prevented physicians from referring patients to chiro- practors and therefore imposed higher costs on chiropractors by forcing them to pay for their own x-ray equipment and preventing medical physicians from teaching chiropractors. Id. at 360. AAP’s policy statement in Pediatrics, surveying the field of gender-affirming care, and its comments and amicus briefs opposing regulation of gender-affirming care, do not appear to have a similar boyco ing effect that implicates an- titrust principles. At the very least, General Uthmeier has not made a strong showing that the district court erred in its as- sessment, which is what would be required to obtain a stay pending appeal. General Uthmeier asserts that AAP’s statements are “false.” He argues they were published in the conduct of “trade or commerce” because AAP intends to induce pur- chase of puberty blockers, surgeries, and “social transition- ing” services from its members. This argument does not re- fute the district court’s findings that the AAP does not sell gender-affirming care and that its policy statements appear to discuss scientific research and advocacy debate, “not a money-making scheme.” Accord, Endocrine Soc’y v. Federal Trade Comm’n, No. 26-512, 2026 WL 1257289 (D.D.C. May 7, 22 No. 26-2238
2026) (granting preliminary injunction against FTC’s civil in- vestigative demands on First Amendment grounds; “clinical guidance, education, and policy advocacy clearly fall on the ‘ideas’ rather than ‘products’ side of the line”); accord, Chiles v. Salazar, 607 U.S. —, 146 S. Ct. 1010, 1029 (2026) (state may not censor speech on gender-affirming care based on view- point). Moreover, the alleged intended commercial induce- ment of gender-affirming care would not even materialize in the state of Florida. Since May 2023, it has been a crime to pro- vide gender-affirming care to minors in Florida. The district court found that other facts also contributed to the finding of bad faith at this preliminary stage. The court observed that General Uthmeier’s complaint in state court made misleading allegations, including that AAP knew scien- tific evidence did not support lowering age minimums for gender-affirming surgery yet deliberately provided no age minimum in its policy statement. On the contrary, the district court found, the evidence instead showed that AAP had not omi ed a specific age minimum to encourage surgery for mi- nors. AAP had instead tried to avoid broadly approving of sur- geries for minors. AAP had noted that surgery is generally ac- ceptable only for adults and should be available to minors only on a case-by-case basis. The district court found that General Uthmeier’s three- month delay in pursuing the state enforcement action, despite his public statements about the lawsuit in the interim, also contributed to a finding of bad faith. So, too, did General Uth- meier’s public comments opposing gender-affirming care and vowing to hold AAP accountable for “mutilating children.” The district court acted within its discretion in drawing “un- favorable inference[s]” based on this conduct, and we see no No. 26-2238 23
clear error in its factual findings. See Netflix, Inc., 88 F.4th at 1092 (relying on similar delay to support application of bad- faith exception to Younger). The bad-faith exception to Younger is difficult to establish, but as noted, it provides an important safety valve for protect- ing federal rights. Other circuits have applied it in circum- stances comparable to this case. See, e.g., Netflix, Inc., 88 F.4th 1080, 1095–96; Nobby Lobby, 970 F.2d 82, 88; Lewellen v. Raff, 843 F.2d 1103, 1112–13 (8th Cir. 1988); Krahm v. Graham, 461 F.2d 703, 707–08 (9th Cir. 1972); Rowe v. Griffin, 676 F.2d 524, 529 (11th Cir. 1982). The federalism and comity foundations of Younger call for restraint, not a wholesale prohibition on federal protection of federal rights. See 401 U.S. at 44 (“The concept [of federalism] does not mean blind deference to ‘States’ Rights’ any more than it means centralization of control over every important issue in our National Government and its courts. … What the concept does represent is a system in which there is sensitivity to the legitimate interests of both State and National Govern- ments.”). Federal courts are permi ed and even required to intervene when a state official wields state power out of bad faith or a desire to harass—when federalism and comity con- cerns are at their low ebb. See Younger, 401 U.S. at 48–49, quot- ing Dombrowski, 380 U.S. at 485–86; Collins, 807 F.2d at 101 (ac- knowledging that bad-faith exception could have applied if there had been evidence of a “concerted publicity campaign aimed at pu ing the plaintiffs out of business for exercising their first amendment rights”). Based on the available record at this preliminary stage of this case, the district court did not clearly err in finding that AAP has presented a rare case of a state official acting in bad 24 No. 26-2238
faith to use his powers to silence protected speech. General Uthmeier has not made a strong showing that the district court erred in applying the bad-faith exception to Younger. D. Equitable Factors To justify a stay of the preliminary injunction pending ap- peal, General Uthmeier would also need to show that he would face irreparable harm while this appeal is pending. He has not met this burden. He asserts: “Any time a State is en- joined by a court from effectuating statutes enacted by repre- sentatives of its people, it suffers a form of irreparable injury,” quoting Maryland v. King, 567 U.S. 1301, 1303 (2012) (Roberts, C.J., in chambers). We do not disagree with the general point, but it is not enough to carry the day here, given both the facts of General Uthmeier’s Florida action and the evidence of more concrete harm to AAP’s First Amendment rights. First, assuming the purpose of the Florida enforcement ac- tion is to prevent AAP from advertising the provision of gen- der-affirming care to Florida pediatricians and families, it will have no immediate effect in Florida. Florida law has made it a crime to provide gender-affirming care to minors since May 2023. General Uthmeier asserts an interest in holding AAP ac- countable for earlier alleged violations of the FDUTPA, Flor- ida antitrust law, and the Florida RICO Act, before passage of the criminal ban. We do no irreparable harm to that retrospec- tive interest by leaving the preliminary injunction in place while we consider this appeal on an expedited basis. General Uthmeier’s own delay in prosecuting the state en- forcement action further undercuts any argument that he would suffer irreparable harm absent a stay. He did not serve AAP and its co-defendants in the state enforcement action No. 26-2238 25
until after AAP filed this federal lawsuit, about three months after he filed his complaint and publicly announced the state enforcement action. He points out that such a delay was per- missible under the Florida Rules of Civil Procedure. We as- sume that’s correct, but the months’-long delay shows a lack of urgency that is inconsistent with the current claim of irrep- arable harm. That reasoning applies generally when a party seeks emergency injunctive relief. See Ty, Inc. v. Jones Group, Inc., 237 F.3d 891, 903 (7th Cir. 2001) (noting that a “delay in pursuing” an action “may raise questions regarding the plain- tiff’s claim that he or she will face irreparable harm.”) Because General Uthmeier has not made a strong showing of either a reasonable likelihood of success on the merits or irreparable harm, we touch only briefly on the balance of eq- uities and public interest. At this stage, the balance of harms favors AAP. The harm General Uthmeier may experience from a delay in pursuing the state enforcement action does not outweigh the First Amendment harm to AAP if the alleg- edly unconstitutional enforcement action is allowed to pro- ceed while we consider this appeal. AAP has, at this prelimi- nary stage, made a convincing showing that Uthmeier’s en- forcement action is retaliation for exercise of its First Amend- ment rights. See Chiles, 607 U.S. at —, 146 S. Ct. at 1024–25 (First Amendment does not permit state to ban free expres- sion, including on subjects of sexual orientation and gender identity, under guise of regulating medicine). AAP has a strong interest in not being subjected to retaliatory enforce- ment actions from state officials who disagree with its re- search and advocacy. The public interest—the interests of those not before the court—also does not require a stay pend- ing this appeal. We see no harm to third parties from staying 26 No. 26-2238
Florida’s prosecution of its case against AAP in Florida while we consider this appeal. III We emphasize that our conclusions are preliminary and based on our review of the record before the district court. Our conclusions on these issues may differ after full briefing and argument. But at this stage, General Uthmeier has not made the required “strong showing” of likelihood of success on the merits and irreparable harm. See Nken v. Holder, 556 U.S. 418, 434 (2009). We therefore DENY the motion for a stay pending appeal. An expedited briefing schedule will is- sue separately. No. 26-2238 27
SCUDDER, Circuit Judge, dissenting. Today’s decision in- flicts a grievous blow to federalism. The Younger abstention doctrine generally requires federal courts to refrain from ex- ercising jurisdiction when doing so would interfere with a state court proceeding. But the majority today invokes a nar- row exception—not applied by the Supreme Court since 1965—to permit a federal court in Illinois to enjoin the Florida Attorney General from enforcing Florida law in a Florida state court. The decision licenses federal intrusion and casts a vote of no confidence in the Florida judiciary. In my respectful view, we should grant the motion to stay the injunction pend- ing appeal. I A This story begins in state court. In December 2025, Florida Attorney General James Uthmeier sued the American Acad- emy of Pediatrics and two other medical organizations in a Florida circuit court, alleging that they “initiated a coordi- nated campaign to develop ‘clinical guidelines’ recommend- ing sex intervention for pediatric gender dysphoria” to “con- vince patients, insurance companies, regulators, and judges” that there is “credible evidence that sex interventions alleviate pediatric gender dysphoria.” According to Uthmeier, gender- affirming “drugs and surgeries are extremely profitable for [the defendants] and their members.” The Academy pub- lished its relevant guidelines in 2018, stating among other things that certain puberty blockers have been used since the 1980s and are “reversible.” This seemed to contradict the Flor- ida Department of Health’s later guidance that puberty block- ers may cause “long-term, irreversible effects.” 28 No. 26-2238
Uthmeier claimed that the Academy and its co-defendants violated Florida law in two ways. First, he claimed that they engaged in “unfair or deceptive acts or practices in the con- duct of any trade or commerce,” in violation of the Florida Deceptive and Unfair Trade Practices Act. See Fla. Stat. § 501.204(1); see also PNR, Inc. v. Beacon Prop. Mgmt., Inc., 842 So. 2d 773, 777 (Fla. 2003) (suggesting that “deception occurs if there is a representation, omission, or practice that is likely to mislead the consumer acting reasonably in the circum- stances, to the consumer’s detriment” (cleaned up)). Second, he claimed that the defendants participated in an “enterprise through a pattern of racketeering activity,” or at least con- spired to do so, in violation of the Florida RICO Act. See Fla. Stat. § 895.03(3)–(4). In his view, their allegedly misleading advertisements constituted racketeering activity. See id. § 895.02(8)(a)(36) (defining “[r]acketeering activity” to in- clude crimes listed in Chapter 817 of the Florida Statutes); id. § 817.41(1) (prohibiting misleading advertisements). B The Academy turned to federal court for relief. On March 4, 2026, it sued Uthmeier in the Northern District of Illinois, alleging that he brought the state court case to retaliate against its protected speech, in violation of the First Amend- ment. It also moved for a preliminary injunction, asking the district court to order Uthmeier to stop pursuing his enforce- ment action in Florida. As the federal court considered the motion, the state court proceedings continued. On March 16, 2026, Uthmeier amended his complaint in Florida to add a third claim. Build- ing on his initial complaint, he alleged that the Academy and its co-defendants “contracted, combined, and conspired in No. 26-2238 29
restraint of trade or commerce,” in violation of the Florida An- titrust Act. See Fla. Stat. § 542.18. More specifically, he claimed that their guidelines were “the result of panel stack- ing, failure to manage conflicts of interest, and other proce- dural biases designed to promote the sex interventions of- fered by [the defendants’] members and to ignore evidence supporting” contrary views. In May 2026, the Academy moved to dismiss the amended state court complaint, raising the same First Amendment re- taliation defense. That motion remains pending before the Florida court. A month later, in June 2026, the district court in Illinois granted the Academy’s motion for a preliminary injunction. It issued an order preventing Uthmeier “from pursuing [his] Enforcement Action against” the Academy and “from taking further unlawful action interfering with or retaliating against [the Academy’s] exercise of its First Amendment rights, such as pursuing a substantially similar enforcement action in vio- lation of [the Academy’s] First Amendment rights.” Uthmeier now asks us to stay the preliminary injunction pending appeal. II A “In deciding whether to stay an injunction pending ap- peal, we apply a standard that parallels the preliminary in- junction standard but also keeps in mind the district court’s exercise of equitable discretion.” Illinois v. Trump, 155 F.4th 929, 936 (7th Cir. 2025) (cleaned up). “Thus, a party seeking a stay must show (1) a likelihood of success on the merits, and (2) a threat of irreparable harm absent a stay.” Id. “If the 30 No. 26-2238
moving party makes such a showing, this court must consider (3) the balance of harms, primarily in terms of the balance of risks of irreparable harm in case of a judicial error, as well as (4) the public interest.” Id. (cleaned up) (citing Nken v. Holder, 556 U.S. 418, 434 (2009)). B Attorney General Uthmeier is likely to succeed on appeal because of insurmountable jurisdictional barriers. He con- tends that the district court lacked personal jurisdiction, that venue was improper, and that the district court should have abstained from exercising its jurisdiction under Younger v. Harris, 401 U.S. 37 (1971). The first two issues present substan- tial questions worthy of further consideration. But the Younger issue is open and shut in his favor. Cf. Sinochem Int’l Co. v. Malay. Int’l Shipping Corp., 549 U.S. 422, 431, 436 (2007) (identifying Younger abstention as one of several “threshold grounds” warranting dismissal even before a district court determines it has “subject-matter or personal jurisdiction”). Younger abstention roots itself “in the traditional princi- ples of equity, comity, and federalism.” SKS & Assocs. v. Dart, 619 F.3d 674, 678 (7th Cir. 2010). The doctrine “ordinarily re- quires federal courts to refrain from exercising jurisdiction over federal constitutional claims that seek to interfere with or interrupt ongoing state proceedings.” Courthouse News Serv. v. Brown, 908 F.3d 1063, 1071 (7th Cir. 2018). It is “de- signed to allow the State an opportunity to ‘set its own house in order’ when the federal issue is already before a state tri- bunal.” Ohio Bureau of Emp. Servs. v. Hodory, 431 U.S. 471, 479– 80 (1977). The Supreme Court has described the doctrine as giving effect to the principle of “Our Federalism” at the No. 26-2238 31
cornerstone of our constitutional structure. Younger, 401 U.S. at 44. But Younger abstention is not absolute. The Supreme Court has recognized a “narrow” exception when “the state proceeding is motivated by a desire to harass or is conducted in bad faith.” Huffman v. Pursue, Ltd., 420 U.S. 592, 611 (1975); see also Younger, 401 U.S. at 49–50 (similar). “‘[B]ad faith’ in this context generally means that a prosecution has been brought without a reasonable expectation of obtaining a valid conviction.” Kugler v. Helfant, 421 U.S. 117, 126 n.6 (1975). Indeed, the bad-faith exception is so narrow that “[t]here is no case since Younger was decided in which the [Supreme] Court has” applied it. 17B Charles Alan Wright & Arthur R. Miller, Federal Practice and Procedure § 4255 (3d ed. 2026). Younger itself described the exception by reference to Dom- browski v. Pfister, 380 U.S. 479 (1965), where federal plaintiffs claimed that police raided their offices and seized their files pursuant to warrants “that were later summarily vacated by a state judge for lack of probable cause,” only for state officials to continue threatening prosecution despite “the state court order quashing the warrants and suppressing the evidence seized.” Younger, 401 U.S. at 48. Dombrowski “held that an in- junction against the enforcement of certain state criminal stat- utes could properly issue under the circumstances presented in that case.” Younger, 401 U.S. at 47. Today’s majority opinion incorrectly extends the bad-faith exception to the Academy’s lawsuit. Like the district court, the majority concludes that Attorney General Uthmeier can- not reasonably expect to prevail in a Florida court because his state law claims are very weak on the merits. But very weak claims are not uncommon. Younger’s exception requires much 32 No. 26-2238
more: the Attorney General’s claims must be “so facially mer- itless as to connote bad faith.” Yelp Inc. v. Paxton, 137 F.4th 944, 953 (9th Cir. 2025); see also Netflix, Inc. v. Babin, 88 F.4th 1080, 1095 (5th Cir. 2023) (“[T]here was never any remote chance of Babin obtaining a valid child-pornography convic- tion against Netflix for a scene involving an adult.”). Uthmeier’s claims are not so plainly lacking merit that we should infer bad faith. According to the majority, all three claims require proving that the Academy’s 2018 guidelines are somehow commercial in nature, which it sees as a tall or- der given the Academy is a nonprofit. But the Florida Decep- tive and Unfair Trade Practices Act expressly applies to non- profits. See Fla. Stat. § 501.203(8) (“‘Trade or commerce’ shall include the conduct of any trade or commerce, however de- nominated, including any nonprofit or not-for-profit person or activity.”). The Florida Antitrust Act likewise seems to ap- ply to nonprofits. See id. § 542.16 (instructing that Florida Stat- ute § 542.18 should “be liberally construed” to “complement the body of federal law prohibiting restraints of trade or com- merce in order to foster effective competition”); Am. Soc’y of Mech. Eng’rs, Inc. v. Hydrolevel Corp., 456 U.S. 556, 576 (1982) (“[I]t is beyond debate that nonprofit organizations can be held liable under the antitrust laws.”). As the district court recounted, Uthmeier provides two theories for why the 2018 guidelines may be commercial. He first contends that the Academy issued the guidelines to make more people want to join its organization, thereby increasing its income from membership dues. He also alleges that the Academy published the guidelines recommending gender-af- firming care so that its members who provide that type of care, including the authors of the guidelines, could make No. 26-2238 33
more money because of increased demand. Cf. Am. Soc’y of Mech. Eng’rs, 456 U.S. at 573–74 (“ASME contends that it should not be held liable unless its agents act with an intent to benefit the Society …. [But] whether they act in part to ben- efit ASME or solely to benefit themselves or their employers, ASME’s agents can have the same anticompetitive effects on the marketplace.”). The majority views these theories as so implausible and beyond the pale that they must reflect bad faith on the part of the Florida Attorney General. The district court thought the same thing, reaching that conclusion without a single citation to Florida case law. But these are just the sort of allegations routinely evaluated in ordinary motion-to-dismiss practice or ultimately proved through discovery. The majority also points to Uthmeier’s litigation conduct as evidence of bad faith. It highlights that he waited three months to serve process. The district court also observed that he amended his complaint to add the state antitrust claim only after the Academy filed its federal lawsuit. No doubt “a burst of prosecutorial alacrity” after a state defendant asserts its First Amendment rights may cut in favor of finding bad faith. Netflix, Inc., 88 F.4th at 1092. But that is not enough on its own, especially where, as here, the state official’s behavior falls within the bounds of the state’s procedural rules. The majority additionally highlights Uthmeier’s incendi- ary public statements. With respect to gender-affirming care, for example, he promised to “aggressively fight this radical ideology anytime it threatens women, kids, and our Florida way of life.” And when he announced his enforcement action, he accused the Academy of “mutilating kids and misleading families.” The majority blesses the district court’s finding that 34 No. 26-2238
these statements reveal that Uthmeier’s personal convictions drove his enforcement action. But that does not mean that he sued the Academy “without a reasonable expectation of ob- taining” a favorable judgment. Kugler, 421 U.S. at 126 n.6. The Florida Constitution establishes the Florida Attorney General as the state’s chief legal officer. See Fla. Const. art. IV, § 4(b); see also Fla. Stat. § 16.01 (outlining the duties of the office). A federal court finding he has enforced Florida law in bad faith is very serious constitutional business. Finally, the majority suggests that we must engage with Defense Distributed v. Grewal, 971 F.3d 485 (5th Cir. 2020), and Media Matters for America v. Paxton, 138 F.4th 563 (D.C. Cir. 2025). But those cases do not purport to apply Younger’s bad- faith exception. Indeed, neither decision even mentions Younger. Perhaps that is why the majority similarly says noth- ing about these two decisions in the Younger portion of its own opinion. C The remaining stay factors favor Uthmeier as well. “Any time a State is enjoined by a court from effectuating statutes enacted by representatives of its people, it suffers a form of irreparable injury.” Maryland v. King, 567 U.S. 1301, 1303 (2012) (Roberts, C.J., in chambers) (cleaned up). The balance of harms and the public interest tell the same story. If we stay the district court’s injunction, the Academy will still be able to vindicate its First Amendment rights in Florida court. But if we decline to stay the injunction, the Attorney General will be unable to pursue his state law claims against the Academy in Florida state court all because a federal court in Illinois found the merits of his claims unpersuasive, threatening en- trenched principles of federalism and comity. No. 26-2238 35
III “The Framers split the atom of sovereignty.” Saenz v. Roe, 526 U.S. 489, 504 n.17 (1999). “It was the genius of their idea that our citizens would have two political capacities, one state and one federal, each protected from incursion by the other.” Id. Younger gives effect to this principle. But today’s decision expands an eye-of-the-needle doctrinal exception into a broad license for federal court intrusion into matters pending—and belonging—in state court. The Florida courts are fully capable of ruling on the Academy’s pending motion to dismiss and swiftly resolving the Attorney General’s claims. Make no mistake about the legal magnitude of what is at stake here. A federal court in Illinois has enjoined a state’s chief legal officer from proceeding in state court, all because it doubts the merits of his state law claims. The implications are grave. It is hard to see why future state defendants will not turn to federal court whenever they think a state com- plaint warrants dismissal and a public comment suggests “bad faith.” This decision expands the narrowest of excep- tions into a gap in “Our Federalism” that invites abuse. Younger, 401 U.S. at 44. We are a long way from the quashed warrants and threats of repeated prosecutions in Dom- browski—the one and only time the Supreme Court has ever found bad faith. Cf. Erwin Chemerinsky, Federal Jurisdiction § 13.5 (7th ed. 2016) (explaining that “commentators have ob- served that the universe of bad-faith harassment claims that can be established is virtually empty” and concluding that “the bad-faith prosecutions exception appears limited to facts such as those present in Dombrowski” (cleaned up)). To be sure, maybe the Florida Attorney General’s enforce- ment action lacks merit. Perhaps it even violates the First 36 No. 26-2238
Amendment. But those decisions belong to the Florida courts. Even if the Academy is right, that would not permit a federal court to enjoin the Florida state court proceeding. See Yelp Inc., 137 F.4th at 954 (unanimous opinion by Bress, J.) (“Simply because a state court defendant may advance a re- taliation-based defense to a state court lawsuit does not mean it has established bad faith sufficient for a federal court to en- join a state court action.”). The Academy has raised its First Amendment defense in state court. And “[m]inimal respect for the state processes … precludes any presumption that the state courts will not safeguard federal constitutional rights.” Middlesex County Ethics Comm. v. Garden State Bar Ass’n, 457 U.S. 423, 431 (1982) (cleaned up). We have no basis whatso- ever to doubt that the Academy would get a fair hearing in the Florida courts. I respectfully dissent.
Related
Cite This Page — Counsel Stack
American Academy of Pediatrics v. James Uthmeier, Counsel Stack Legal Research, https://law.counselstack.com/opinion/american-academy-of-pediatrics-v-james-uthmeier-ca7-2026.