# Opinion

> District Court, N.D. California · August 7, 2026

URL: https://www.frixlaw.com/law-library/cases/11427647

## Case

- **Full name:** California Primary Care Association, et al. v. Shirley N Weber, PH.D., et al.
- **Court:** District Court, N.D. California
- **Decided:** August 7, 2026
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

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## Opinion text

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF CALIFORNIA

CALIFORNIA PRIMARY CARE ASSO- Case No. 26-cv-03837-AGT
CIATION, et al.,

Plaintiffs, ORDER ON MOTIONS TO DISMISS
AND FOR PRELIMINARY
v. INJUNCTION

SHIRLEY N WEBER, PH.D., et al., Re: Dkt. Nos. 28, 32, 33
Defendants.

Plaintiffs California Primary Care Association (CPCA) and Open Door Community
Health Centers (Open Door) (together, Plaintiffs) move to enjoin defendant California Sec-
retary of State Shirley N. Weber from placing an initiative on the November 2026 ballot.
Dkt. 1 (complaint); dkt. 28 (motion for preliminary injunction).1 Weber moves to dismiss.
Dkts. 31-1 & 33.
Plaintiffs additionally named as defendants the real-parties-in-interest: Service Em-
ployees International Union – United Healthcare Workers West, Shawna Brown, and Sean
Fleming (collectively, Proponent Defendants). Dkt. 1. Proponent Defendants also move to
dismiss. Dkt. 32.
After hearing oral argument on July 31, 2026, the Court now grants the motions to

1 The California Hospital Association filed an amicus curiae brief in support of the motion
for a preliminary injunction. Dkt. 36. The California Medical Association, California Acad-
emy of Family Physicians, and the California Chapter of the American College of Emer-
gency Physicians jointly filed an amicus curiae brief, also in support of the motion. Dkt. 37.
dismiss and denies the motion for a preliminary injunction.2
I. Background
Initiative No. 25-0008 (the Initiative) is also known as the “Clinic Funding Account-
ability and Transparency Act.” Dkt. 1 ¶ 74. See also dkt. 28-1 at 7–14 (text of Initiative).3 It
requires that clinics, which include community health centers, annually report a mission

spend ratio to the California Registry of Charities and Fundraisers. Dkt. 1 ¶ 74; dkt. 28-1 at
8.4
The mission spend ratio is “the total amount a health center spends on activities that
accomplish each center’s exempt purpose,” divided by the clinic’s total revenue. Dkt. 1 ¶ 75;
dkt. 28-1 at 8. The California Attorney General may issue guidance regarding how to report
the total amount spent on exempt purpose activities and total revenue. Dkt. 28-1 at 9.
Clinics must spend 90% of their revenue on activities that accomplish their purpose.
Dkt. 1 ¶ 76; dkt. 28-1 at 11. If a clinic does not spend 90%, then the California Department
of Public Health (DPH) shall levy a penalty “equal to the difference between the amount the

clinic spent on mission-directed expenses and 90 percent of the clinic’s total revenue.” Dkt.
28-1 at 11; see also dkt. 1 ¶ 76;
Under certain circumstances, DPH may issue a waiver “providing a temporary pause
of the 90 percent requirement or for an alternative mission spend ratio requirement . . . .”

2 Citations to argument in this order refer to time stamps from the audio recording of the
Court’s July 31, 2026, hearing. Upon request, the Court can provide access to the recording.
Any such requests should be filed on the Court’s docket.
3 Plaintiffs ask the Court to judicially notice the Initiative, filed at dkt. 28-1. The Court takes
judicial notice of the text as it “can be accurately and readily determined from [a] source[ ]
whose accuracy cannot reasonably be questioned.” Fed. R. Evid. 201(b)(2). Plaintiffs’ re-
quests for judicial notice at dkt. 28-1 and dkt. 40-1 are otherwise denied; the Court didn’t
rely on those materials.
4 References to page numbers correspond to the ECF page number at the top of each dock-
eted page.
Dkt. 28-1 at 11. The issuance of the waiver is “solely and exclusively within the authority
of [DPH].” Id.
II. Legal Standard
Dismissal under Federal Rule of Civil Procedure 12(b)(1) is appropriate where a
court lacks subject matter jurisdiction, for example, where a plaintiff lacks standing or brings

unripe claims. See Chandler v. State Farm Mut. Auto. Ins. Co., 598 F.3d 1115, 1121–22 (9th
Cir. 2010). An Eleventh Amendment defense “‘is quasi-jurisdictional’ in nature and may be
raised in either a Rule 12(b)(1) or 12(b)(6) motion.” Sato v. Orange Cty. Dep’t of Educ., 861
F.3d 923, 927 n.2 (9th Cir. 2017).
III. The Eleventh Amendment Immunizes Secretary Weber
Weber moves under Rule 12(b)(1), contending that she is entitled to Eleventh
Amendment immunity. Dkt. 31-1. Plaintiffs disagree, arguing that this action is not barred
pursuant to Ex parte Young. Dkt. 40. The Court now finds that Weber is immune from suit.
“The Eleventh Amendment erects a general bar against federal lawsuits brought

against a state,” but “does not bar actions for prospective declaratory or injunctive relief
against state officers in their official capacities for alleged violations of federal law.” Coal.
to Defend Affirmative Action v. Brown, 674 F.3d 1128, 1133–34 (9th Cir. 2012). The latter
are permitted under Ex parte Young. See Papasan v. Allain, 478 U.S. 265, 276–77 (1986).
To determine whether Ex parte Young applies, a court “need only conduct a straight-
forward inquiry into whether the complaint alleges an ongoing violation of federal law and
seeks relief properly characterized as prospective.” Verizon Maryland, Inc. v. Public Service
Comm’n of Maryland, 535 U.S. 635, 645 (2002) (cleaned up). The official sued must have
some connection to the enforcement of the allegedly unconstitutional act. Coal. to Defend
Affirmative Action, 674 F.3d at 1134.
A. Ongoing Violations
Weber argues that Plaintiffs fail to allege that Weber has engaged in any ongoing
violation of federal law, indeed, that no violation of federal law is alleged. Dkt. 31-1 at 11.
Without that allegation, Plaintiffs cannot overcome the Eleventh Amendment. Id.

Plaintiffs respond that Weber has statutory duties to advance the Initiative through
California’s initiative process. Dkt. 40 at 17. Because Weber qualified the Initiative for the
ballot, she is mandated to prepare statewide ballot materials. Id. Plaintiffs argue that the
Initiative is unconstitutional, and therefore the exercise of Weber’s duties here constitutes
an ongoing exercise of state authority enabling the enactment of an unconstitutional state
initiative. Id.
Plaintiffs aren’t arguing that the ballot qualification procedures violate federal law.
See id. Instead, Plaintiffs argue that the Initiative itself is violative and that, by following the
ballot initiative statutes (which are not accused), Weber is subject to suit. Such a suit can’t

properly proceed under Ex parte Young. See Papasan, 478 U.S. at 277 (“Young applies only
where the underlying authorization upon which the named official acts is asserted to be ille-
gal.”); Mecinas v. Hobbs, 30 F.4th 890 (9th Cir. 2022) (finding that Ex parte Young didn’t
bar suit against Arizona Secretary of State when plaintiffs challenged the Ballot Order Stat-
ute, which gave the Secretary statutory authority to prescribe ballot rules).
Furthermore, Plaintiffs cite to no authority in support of their position. See dkt. 40 at
17. Plaintiffs concede Weber has no duty (statutory or otherwise) to review ballot initiatives
for their constitutionality. Finally, as Weber argues in reply, Plaintiffs’ argument would al-
low any party to invoke federal jurisdiction to enjoin Weber’s duties based on an argument
of infirmity. Dkt. 41 at 3. In sum, Plaintiffs fail to show an ongoing violation of federal law.
B. Sufficient Connection
Even if Plaintiffs had shown an ongoing violation, Weber argues that Plaintiffs can-
not show that she has taken any action to enforce a state law that violates a federal law. Dkt.
31-1 at 12. Plaintiffs respond that they challenge specific official conduct (creation of ballot

materials) which only Weber has the authority to perform. Dkt. 40 at 18. An injunction
against Weber would prevent the Initiative from appearing on the ballot. Id.
As noted above, the official sued must have some connection to the enforcement of
the allegedly unconstitutional act. Coalition to Defend Affirmative Action, 674 F.3d at 1134.
That connection “must be fairly direct; a generalized duty to enforce state law or general
supervisory power over the persons responsible for enforcing the challenged provision will
not subject an official to suit.” Id.
Plaintiffs don’t allege that Weber has any connection with enacting the Initiative,
beyond listing it on ballot materials. As summarized in Plaintiffs’ complaint, DPH would

levy any fines, not Weber. See dkt. 1 ¶¶ 74–76. Weber therefore doesn’t enforce or admin-
ister the Initiative and lacks the requisite direct connection. Cf. Coalition to Defend Affirm-
ative Action, 674 F.3d at 1134–35 (permitting suit challenging admissions criteria of a uni-
versity and naming as defendant the university president, reasoning that the president was
“duty-bound to ensure that his employees follow [the challenged provision] and refrain from
using race as a criterion in admission decisions”); Mecinas, 30 F.4th at 903–04 (finding
sufficient connection where plaintiffs sued Arizona Secretary of State over Election Proce-
dures Manual that she promulgated).
Without an ongoing violation of federal law or a sufficient connection to such, this
suit against Weber isn’t permitted by Ex parte Young. Weber is therefore immune from suit
under the Eleventh Amendment.
IV. Plaintiffs’ Claims against Proponent Defendants Are Unripe
Pursuant to Rule 12(b)(1), Proponent Defendants argue that Plaintiffs lack standing
and their claims are not ripe. Dkt. 32 at 13. Plaintiffs disagree on both counts. Dkt. 40.

Regarding ripeness, the gravamens of the parties’ arguments go to whether discretion
left to the Attorney General renders this case unripe and whether California allows pre-elec-
tion review in a case such as this.5 The Court now finds that this claim is not ripe or permitted
by California’s pre-election review doctrines.
A. Attorney General’s Role
Proponent Defendants first argue that this claim is unripe because the Initiative com-
mits some discretion to the Attorney General. Dkt. 32 at 18. Because the Attorney General
has not spoken, any constitutional conflict is speculative. Id. Plaintiffs respond that this ar-
gument is a red herring because Plaintiffs’ arguments arise from the text of the Initiative.

Dkt 40 at 15. The Initiative as drafted is unconstitutional. Id.
First, as Proponent Defendants reply, dkt. 42 at 7, the Initiative hasn’t passed. It
might not pass in November. That renders this matter unripe for review because Plaintiffs’
claims are “dependent on contingent future events that may not occur as anticipated, or in-
deed may not occur at all.” Trump v. New York, 592 U.S. 125, 131 (2020) (per curiam)
(cleaned up).
Second, the Initiative empowers the Attorney General to issue guidance on how to

5 Proponent Defendants argue also that no California state court has yet weighed in, coun-
seling against a federal court’s intervention, and that Plaintiffs ask this Court to forecast.
Dkt. 32 at 18. Plaintiffs don’t counter.
report “total sums spent on a clinic’s exempt purpose” and total revenue. Dkt. 28-1 at 8–9.
Those figures are then used to calculate the mission spend ratio; they are the only two com-
ponents of the ratio. Id. DPH is tasked with assessing penalties on clinics with mission spend
ratios of below 90% and is permitted to issue waivers to violating clinics. See id. at 11.
Depending on what guidance is issued by the Attorney General, the constitutional

issues cited by Plaintiffs may not occur here (even assuming the Initiative passes). So, the
Court can’t be certain whether or when sanctions might issue, if at all, and that outcome
renders this case unripe. See Texas v. United States, 523 U.S. 296, 300 (1998) (finding a case
unripe, noting that a claim was contingent upon a number of factors and the Supreme Court
had “no idea whether or when” a sanction would be ordered).6
These claims are not ripe for decision: they are dependent on a passage that may not
happen and on guidance from the Attorney General that has yet to issue.7
B. California Pre-Election Review
Plaintiffs understand that this Initiative has not passed, but they argue that the pre-

election review doctrine in California provides a path to bring suit now. Dkt. 40 at 14–15.
Proponent Defendants argue that it is more appropriate to review constitutional challenges
to ballot provisions after an election. Dkt. 32 at 20–21. Proponent Defendants have the better
argument.

6 Additionally, as discussed at the July 31, 2026, hearing, DPH is empowered to issue waiv-
ers to clinics falling below the 90% threshold. Oral Argument at 39:00–40:16. This renders
enforcement speculative.
7 Ripeness requires the Court to consider the fitness of the issues for judicial determination.
Texas, 523 U.S. at 300–01. Here, like in Texas, even if the Court assumes greater certainty
regarding implementation, the claims aren’t ripe. As the Supreme Court noted, there is no
pending enforcement action, rendering this case abstract and remote. See id. “The operation
of the statute is better grasped when viewed in light of a particular application,” especially
when the provision has yet to be interpreted by the state courts. Id.
In California, “it is usually more appropriate to review constitutional and other chal-
lenges to ballot propositions or initiative measures after an election[,] . . . in the absence of
some clear showing of invalidity.” Brosnahan v. Eu, 641 P.2d 200, 201 (Cal. 1982). “[T]his
general rule applies primarily when a challenge rests upon the alleged unconstitutionality of
the substance of the proposed initiative,” and “does not preclude preelection review when

the challenge is based upon a claim, for example, that the proposed measure may not
properly be submitted to the voters because the measure is not legislative in character or
because it amounts to a constitutional revision rather an amendment.” Senate of State of Cal.
v. Jones, 988 P.2d 1089, 1095–96 (Cal. 1999).
Even where “the strong presumption against preelection review does not apply,” a
court should “keep in mind” that where a challenge “generally will not become moot if the
initiative is approved by the voters at the election” “there is good reason for a court to be
even more cautious . . . before deciding that it is appropriate to resolve such a claim prior to
an election rather than wait until after the election.” Indep. Energy Producers Ass’n. v.

McPherson, 136 P.3d 178, 183–85 (Cal. 2006).
Plaintiffs bring a substantive challenge to the Initiative, arguing that the Initiative is
unconstitutional both on its face and as it will be applied. See dkt. 1; Oral Argument at 2:25–
6:13. This renders the case distinguishable from recent California Supreme Court decisions
allowing pre-election review. In Costa v. Superior Court, for example, a challenge based on
“several differences between the version of the measure that was submitted to the Attorney
General prior to the circulation of the initiative petition, and the version printed on the peti-
tion that subsequently was circulated for signature” was permitted. 128 P.3d 675, 676 (Cal.
2006). This isn’t that case. At the hearing, Plaintiffs confirmed that no such procedural claim
is brought. Oral Argument at 6:49–7:40.
In Independent Energy Producers Association v. McPherson, the California Supreme
Court permitted a challenge based “on the contention that the measure in question is not the
type of measure that may be adopted through the initiative process.” 136 P.3d at 180–81. See
also Legislature of State of California v. Weber, 549 P.3d 884, 909 (Cal. 2024) (permitting

a preelection challenge and finding that a “measure exceed[ed] the scope of the power to
amend the Constitution via citizen initiative”). The McPherson court repeatedly distin-
guished its case from one in which “a challenge rests upon the alleged unconstitutionality of
the substance of the proposed initiative.” 136 P.3d at 184. A claim of the latter variety, the
court noted, is usually more appropriate for post-election review. See id. at 183–84. And it’s
a claim of the latter variety that Plaintiffs bring here. They don’t argue that this type of
initiative is not proper; instead, they argue that the Initiative as written and as will be applied
is not proper. Oral Argument at 2:25–6:13.8
Even assuming that “the strong presumption against preelection review does not ap-

ply,” see McPherson, 136 P.3d at 184, Plaintiffs’ challenge to the text of the Initiative won’t
become moot. They don’t argue that it will be, only that pre-election review is preferable.
See dkt. 40 at 16. But because they could also bring this challenge after the election, the
Court should be even “more cautious” before diving in now. See McPherson, 136 P.3d at
184–85.

8 Plaintiffs frame the Initiative as beyond the power of the people to enact. Dkt. 40 at 14–15;
Oral Argument at 6:30–7:00. The challenge in McPherson alleged that the California Con-
stitution precluded a proposed initiative, such that the initiative was not one which the people
could enact via initiative. See 136 P.3d at 193. But the Court finds that Plaintiffs’ constitu-
tional challenge here more properly goes to the substance, not type, of the Initiative. Cf. City
& Cnty. of San Francisco v. Patterson, 248 Cal. Rptr. 290, 293 (Cal. Ct. App. 1988) (per-
mitting “challenge . . . directed to the power of the electorate to adopt the proposed initia-
tive”).
Finally, Proponent Defendants argue that withholding pre-election review doesn’t
cause any hardship because “even if the measure passes, no obligation attaches until a full
fiscal year beginning at least six months after passage has run.” Dkt. 32 at 21. In arguing
harm, Plaintiffs make only abstract and generic arguments about harm to voters, initiative
proponents, and the electoral process. See dkt. 40 at 16. These generalized hardships are not

unduly burdensome. See McPherson, 136 P.3d at 184–85 (“because this type of challenge is
one that can be raised and resolved after an election, deferring judicial resolution until after
the election—when there will be more time for full briefing and deliberation—often will be
the wiser course”).9
Plaintiffs’ claims don’t fall within an exception to the general rule against pre-elec-
tion review. As such, they can be more properly reviewed after the election, if needed.
V. Plaintiffs Lack Standing
Standing is comprised of three required elements. Lujan v. Defenders of Wildlife, 504
U.S. 555, 560–61 (1992). Relevant here, a plaintiff must prove that she suffered an “injury

in fact.” Id. An injury in fact is “an invasion of a legally protected interest which is (a) con-
crete and particularized, and (b) “actual or imminent, not ‘conjectural’ or ‘hypothetical.’”
Id. (cleaned up). The Court finds that Plaintiffs have failed to allege an injury in fact.
A. CPCA’s Injuries
CPCA claims it has organizational standing. The Initiative forces CPCA to “divert
substantial money, time, and resources away from its mission work.” Dkt. 1 ¶ 19. If the

9 Additionally, under the federal ripeness analysis, the Court must consider “the hardship to
the parties of withholding court consideration.” Texas, 523 U.S. at 301. Here, as the Supreme
Court found in Texas, abstract and remote events are “inadequate to support suit.” Id. at 301–
02.
Initiative makes the ballot, CPCA will need to continue to “divert additional time, resources,
and money towards education, advocacy, voter engagement and campaigning, analysis, and
other activities that divert resources and attention” away from CPCA’s mission. Id. As Pro-
ponent Defendants argue, dkt. 32 at 15, these expenditures do not constitute a cognizable
injury in fact. See FDA v. All. for Hippocratic Med., 602 U.S. 367, 394–95 (2024) (“an

organization that has not suffered a concrete injury caused by a defendant’s action cannot
spend its way into standing simply by expending money to gather information and advocate
against the defendant’s action”).
Plaintiffs’ reliance upon Havens Realty Corporation v. Coleman for organizational
standing is misplaced. 455 U.S. 363 (1982). In Havens, a housing counseling organization
had standing to bring a Fair Housing Act claim against the owner and operator of apartment
complexes. Id. at 367–68 & 382. That owner-operator provided the plaintiff organization’s
Black employees with false information regarding apartment availability, which impaired
the plaintiff’s ability to provide counseling and referral services for low-income apartment

hunters. Id. at 368–69 & 379. Here, though the Initiative might impact CPCA’s counseling
agenda, CPCA’s ability to provide counseling hasn’t been impaired by the provision of false
information, or otherwise. See AZ All. for Retired Americans v. Mayes, No. 22-16490, at 21
(9th Cir. Aug. 7, 2026) (en banc) (finding that where an organization could not allege harm
to its core activities, expenditures to better inform its members and the public did not estab-
lish injury). Furthermore, the Supreme Court recently counseled that “Havens was an unu-
sual case, and this Court has been careful not to extend the Havens holding beyond its con-
text.” All. for Hippocratic Med., 602 U.S. at 396.10

10 Plaintiffs’ other cited authority, Immigrant Defenders Law Center v. Noem, is
If the Initiative passes, CPCA claims that it would need to “divert additional time,
resources, and money to assist its members to understand and respond to the requirements
in the Initiative.” Dkt. 1 ¶ 19. Because the election has not yet occurred, the Initiative has
not passed.11 Harms linked to its passage are not imminent or assured. Additionally, as ad-
dressed above, even if the Initiative passes, the Attorney General and DPH are allotted some

discretion to issue guidance and waivers. So, the harms alleged are further rendered only
speculative, not impending. Cf. All. for Hippocratic Med., 602 U.S. at 381 (“injury must be
actual or imminent, not speculative—meaning that the injury must have already occurred or
be likely to occur soon”).
CPCA lacks organizational standing.
B. Open Door’s Injuries
Open Door is a CPCA member. Dkt. 1 ¶ 21. It claims that it has “diverted money and
human resources to analyze the Initiative; educate staff, patients, or other stakeholders; con-
sider and modify capital expenditure and other spending plans; consider and modify fund-

raising goals and plans; and consider and modify proposals and applications for federal
grants and other nonfederal revenues. Open Door also has contributed money to support the

distinguishable because that organizational plaintiff challenged a policy which was other-
wise in force and would impact their operations. 145 F.4th 972 (9th Cir. 2025). So, the de-
cision doesn’t provide support for an organization spending money to advocate against the
passage of a ballot initiative. See id. at 988 “[Plaintiff organization] is not ‘assert[ing] stand-
ing simply because [it] object[s] to [the government’s] actions’ or is gathering information
and advocating against [the policy].”). Furthermore, Immigrant Defenders is overruled to
the extent that it relied upon East Bay Sanctuary Covenant v. Biden, 993 F.3d 640 (9th Cir.
2021), for its organizational standing analysis. AZ All. for Retired Americans, No. 22-16490,
at 19 n.2.
11 This also renders causation wanting here. See All. for Hippocratic Med., 602 U.S. at 383
(“The causation requirement precludes speculative links—that is, where it is not sufficiently
predictable how third parties would react to government action or cause downstream injury
to plaintiffs.”). Plaintiffs don’t argue that the electorate would react predictably.
campaign against the Initiative.” Id. ¶ 22.
As argued by Proponent Defendants, dkt. 32 at 15–16, these actions are voluntary
and self-imposed. Plaintiffs’ response, that Open Door had to act “to avoid or mitigate the
Initiative’s impending penalties,” dkt. 40 at 10, ignores that the Initiative has not passed and
may never pass. The Initiative imposes no requirements upon Open Door to engage (or dis-

engage) in any actions; indeed, it can’t.
In opposition, Plaintiffs describe in detail the risks posed to community health cen-
ters by the Initiative. Dkt. 40 at 9–11. Because the Initiative is only a proposal, these harms
are not imminent or actual.12
Open Door lacks standing.13
VI. Conclusion
Secretary of State Weber is shielded from suit by the Eleventh Amendment; her mo-
tion to dismiss, dkts. 31-1 & 33, is granted. Plaintiffs’ claims against Proponent Defendants
are not ripe and Plaintiffs lack standing to pursue them. So that motion to dismiss, dkt. 32,

is also granted. Plaintiffs’ complaint is dismissed under Rule 12(b)(1) without prejudice.
Leave to amend would be futile.
/ / /
/ / /
/ / /

12 This also renders Plaintiffs’ pre-enforcement authorities distinguishable. See, e.g., Susan
B. Anthony List v. Driehaus, 573 U.S. 149 (2014) (statute already enacted, enforcement
threatened); Valle del Sol Inc. v. Whiting, 732 F.3d 1006 (9th Cir. 2013) (statute already
enacted, plaintiff alleged credible threat of prosecution); Mendia v. Garcia, 768 F.3d 1009
(9th Cir. 2014) (causation sufficiently alleged where plaintiff spent years in detention after
failure to post bail, when bail bondspersons refused bail because of immigration detainer).
13 CPCA also claims associational standing on behalf of members such as Open Door. Dkt.
1 ¶ 20. This standing fails for the reasons stated here.
In light of this order, Plaintiffs’ motion for a preliminary injunction, dkt. 28, is de-
nied.
IT IS SO ORDERED.
Dated: August 7, 2026
Alex G. Tse
United States Magistrate Judge

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/11427647. Public record. Not legal advice.