Petition for Writ of Certiorari — Sally Priester, Petitioner v. Puerto Rico Department of Health, et al.

NO. 25-_____

In the

Supreme Court of the United States

SALLY PRIESTER, M.D.,

Petitioner,

v.

PUERTO RICO DEPARTMENT OF HEALTH, ET AL.,

Respondents.

__________________________

On Petition for a Writ of Certiorari to the

United States Court of Appeals for the First Circuit

PETITION FOR A WRIT OF CERTIORARI

Ana Luisa Toledo, Esq.

Counsel of Record

P.O. Box 15990

Houston, TX 77220-1590

(832) 247-3046

ana@anatoledo.com

July 23, 2025

SUPREME COURT PRESS

Counsel for Petitioner

♦

(888) 958-5705

♦

BOSTON, MASSACHUSETTS

i

QUESTIONS PRESENTED

Since the onset of the COVID-19 pandemic in

March 2020, Dr. Priester, M.D., exerted her rights

under the Free Speech, Freedom of Association, and

Free Exercise clauses of the First Amendment by speaking in public meetings, churches, and the media about

topics ranging from the unscientific, draconian measures

imposed by the government to the mRNA vaccine

ingredients that included cells of aborted fetuses.

In April, 2021, Respondent Puerto Rico Department

of Health issued Resolution 2021-04 ordering Dr.

Priester to: “CEASE AND DESIST from making, expressing,

communicating, disseminating, . . . and/or endorsing,

by any means of communication or in person, messages

. . . against the health efforts . . . with respect to . . . the

Coronavirus Pandemic . . . , as well as any of its variants”

apprising her that “[f]ailure to comply with this Order

may entail severe monetary and disciplinary penalties

and/or even judicial contempt.” The district court denied

Petitioner’s motion for preliminary injunction challenging the gag order on Younger abstention grounds. After

staying Petitioner’s interlocutory appeal for almost two

years, the court of appeals entered an order dismissing

the case as moot. The Questions Presented Are:

1. Whether, a physician has a First Amendment

right to publicly speak on healthcare matters in the

public square without government interference or

disciplinary actions by licensing boards.

2. Whether the First Circuit decision should be

reversed, as this case meets the exceptions to mootness

that this Court articulated in Friends of the Earth, Inc.

v. Laidlaw Envtl. Servs. (TOC), Inc., 528 U.S. 167 (2000)

and FBI v. Fikre, 601 U.S. 234 (2024).

ii

PARTIES TO THE PROCEEDINGS

Petitioner and Plaintiff-Appellant below

●

Sally Priester, M.D.

Respondents and Defendants-Appellees below

●

Puerto Rico Department of Health

●

Victor Ramos

●

Colegio de Médicos-Cirujanos de Puerto Rico

●

John Doe

●

Richard Roe

●

John Smith

●

Peter Poe

●

Freddie Roman-Aviles

●

Veronica Rodriguez-de la Cruz

iii

LIST OF PROCEEDINGS

U.S. Court of Appeals for the First Circuit

No. 22-1694

Sally Priester, Plaintiff-Appellant v. Puerto Rico

Department of Health et al., Defendants-Appellees

Judgment: April 24, 2025 (App.1a)

_________________

United States Supreme Court:

No. 24-1041

In re Sally Priester

Voluntary dismissal pursuant to Sup. Ct. R. 46:

June 6, 2025.

_________________

U.S. District Court for the District of Puerto Rico

No. 22-1035

Sally Priester, Plaintiff v.

Puerto Rico Department of Health et al., Defendants

Omnibus Opinion: August 10, 2022 (App.5a)

_________________

Department of Health Legal Counseling Office, the

Medical Discipline and Licensing Board of Puerto Rico

No. QF-JLDM-2020-270

The Medical Discipline and Licensing Board of

Puerto Rico, Plaintiff, v. Dr. Sally Priester, Lic. No.

16480, Defendant.

Agency Decision (Resolution): July 10, 2024

iv

TABLE OF CONTENTS

Page

QUESTIONS PRESENTED ........................................ i

PARTIES TO THE PROCEEDINGS ......................... ii

LIST OF PROCEEDINGS ......................................... iii

TABLE OF AUTHORITIES ..................................... vii

PETITION FOR A WRIT OF CERTIORARI ............. 1

OPINIONS BELOW ................................................... 1

JURISDICTION.......................................................... 1

CONSTITUTIONAL PROVISIONS INVOLVED...... 2

STATEMENT OF THE CASE .................................... 2

REASONS FOR GRANTING THE PETITION ....... 12

I.

This Court Should Grant This Petition

Because This Case Presents Questions of

Great and Increasing Societal Importance

Worthy of This Court’s Review, Such as the

Need to Set the National Standard Required

to Protect Physicians’ First Amendment

Rights, Shielding Them from State Action

Seeking to Suppress Public Speech on

Matters of Public Concern and Divergent

Viewpoints in Violation of the First and

Fourteenth Amendments of the U.S.

Constitution.................................................... 12

A. Protected Public Speech by a

Professional ............................................... 12

B. A Medical Licensing Board’s Authority

Is Subject to Strict Scrutiny ..................... 16

C. The Need for a National Standard ........... 19

v

TABLE OF CONTENTS – Continued

Page

II. This Court Should Grant This Petition to

Reverse the First Circuit Court of Appeals’

Erroneous Dismissal of the Case on

Inapplicable Mootness Grounds, Deviating

from This Court’s Precedent .......................... 21

CONCLUSION.......................................................... 25

vi

TABLE OF CONTENTS – Continued

Page

APPENDIX TABLE OF CONTENTS

OPINIONS AND ORDERS

Judgment, U.S. Court of Appeals for the First

Circuit (April 24, 2025) ...................................... 1a

Omnibus Opinion and Order, U.S. District Court

for the District of Puerto Rico

(August 10, 2022) ............................................... 5a

Agency Decision: Resolution, Medical Discipline

and Licensing Board of Puerto Rico [Certified

Translation] (July 10, 2024) ............................. 24a

REHEARING ORDERS

Order Denying Petition for Rehearing,

U.S. Court of Appeals for the First Circuit

(June 9, 2025) .................................................... 42a

vii

TABLE OF AUTHORITIES

Page

TABLE OF AUTHORITIES

CASES

303 Creative LLC v. Elenis,

600 U.S. 570 (2023) ........................................... 13

ACLU of Mass. v. U.S. Conf. of Cath. Bishops,

705 F.3d 44 (1st Cir. 2013) ................................ 21

Ashcroft v. ACLU,

542 U.S. 656 (2004) ........................................... 18

Church of Lukumi Babalu Aye, Inc. v. Hialeah,

508 U.S. 520 (1993) ........................................... 18

Colorado River Water Conservation Dist. v.

United States, 424 U.S. 800 (1976) ................... 21

Delucca Jimenez v. Colegio de MédicosCirujanos, 2023 TSPR 119,

213 DPR ___ (2023) ............................................. 3

Elrod v. Burns,

427 U.S. 347 (1976) ........................................... 12

FBI v. Fikre,

601 U.S. 234 (2024) ....................................... ii, 22

Friends of the Earth, Inc. v. Laidlaw Envtl.

Servs. (TOC), Inc., 528 U.S. 167 (2000) .. ii, 21, 22

Harris v. Univ. of Mass. Lowell,

43 F. 4th 187 (1st Cir. 2022) ............................. 23

Hustler Magazine, Inc. v. Falwell,

485 U.S. 46 (1988) ............................................. 15

Ibanez v. Florida Dep’t of Bus. & Professional

Regulation, Bd. of Accountancy,

512 U.S. 136 (1994) ........................................... 17

viii

TABLE OF AUTHORITIES – Continued

Page

In re R.M.J.,

455 U.S. 191 (1982) ........................................... 17

Lowe v. SEC,

472 U.S. 181 (1985) ............................... 14, 17, 20

Middlesex Cnty. Ethics Comm. v. Garden State

Bar Ass’n, 457 U.S. 423 (1982) ........................... 9

NAACP v. Button,

371 U.S. 415 (1963) ........................................... 18

Nat’l Inst. of Fam. & Life Advocs. v. Becerra,

585 U.S. 755 (2018) ......................... 13, 17, 18, 20

Packingham v. North Carolina,

582 U.S. 98 (2017) ............................................. 13

Posadas de Puerto Rico Assocs. v. Tourism Co.,

478 U.S. 328 (1986) ........................................... 12

R.A.V. v. City of St. Paul,

505 U.S. 377 (1992) ........................................... 15

Riley v. National Federation of Blind of N. C.,

Inc., 487 U.S. 781 (1988) ................................... 18

Roman Catholic Diocese of Brooklyn v. Cuomo,

592 U.S. 14 (2014) ....................................... 15, 20

Roman Catholic Diocese v. Cuomo,

592 U.S. 14 (2020) ....................................... 12, 13

Rosenberger v. Rector & Visitors of Univ. of

Va., 515 U.S. 819 (1995) .................................... 15

Snyder v. Phelps,

562 U.S. 443 (2011) ........................................... 13

South Bay Pentecostal Church v. Newsom,

141 S.Ct. 716 (2021) .......................................... 19

ix

TABLE OF AUTHORITIES – Continued

Page

Thomas v. Collins,

323 U.S. 516 (1945) ........................................... 16

United States v. Stevens,

559 U.S. 460 (2010) ........................................... 17

Va. State Bd. of Pharmacy v. Va. Citizens

Consumer Council, 425 U.S. 748 (1976) ........... 13

Whitmore v. Arkansas,

495 U.S. 149 (1990) ........................................... 22

Winter v. Natural Res. Def. Council, Inc.,

555 U.S. 7 (2008) ............................................... 21

Younger v. Harris,

401 U.S. 37 (1971) ............................................ i, 8

CONSTITUTIONAL PROVISIONS

U.S. Const. amend. I ....................... i, 2, 8, 9, 12-21, 23

U.S. Const. amend. V ................................................ 12

U.S. Const. amend. XIV, § 1 ................................. 2, 12

STATUTES

28 U.S.C. § 1254(1) ..................................................... 1

42 U.S.C. § 1983 .......................................................... 8

P.R. Laws Ann. tit. 20 § 73(g)..................................... 3

JUDICIAL RULES

Fed. R. Civ. P. 65 ........................................................ 8

x

TABLE OF AUTHORITIES – Continued

Page

OTHER AUTHORITIES

American Hospital Association,

Digging into the Reasons for Puerto Rico’s

Successful COVID-19 Response, July 22,

2022, found in https://www.aha.org/news/

blog/2022-07-22-digging-reasons-puertoricos-successful-covid-19-response,

archived in http://archive.today/WETBz,

last accessed on July 18, 2025 .......................... 10

Robert Post,

Informed Consent to Abortion: A First

Amendment Analysis of Compelled

Physician Speech,

2007 U. ILL. L. REV. 939 (2007) ......................... 14

Select Subcommittee on the Coronavirus

Pandemic, After Action Review of the

COVID-19 Pandemic: The Lessons

Learned and a Path Forward,

U.S. House of Representatives (December

4, 2024) found in https://oversight.house.

gov/wp-content/uploads/2024/12/2024.12.

04-SSCP-FINAL-REPORT-ANS.pdf, last

accessed on July 18, 2025 ........................... 10, 19

1

PETITION FOR A WRIT OF CERTIORARI

Petitioner Sally Priester, M.D., (“Dr. Priester”)

respectfully petitions for a writ of certiorari to review

the judgment of the United States Court of Appeals

for the First Circuit.

OPINIONS BELOW

The court of appeals for the First Circuit’s Order

dismissing Petitioner’s appeal was entered on April 24,

2025 (unpublished), and reprinted in the Appendix

(“App.”) at 1a. The Omnibus Memorandum and Order

of the district court (unpublished) is found at 2022

U.S. Dist. LEXIS 144023 and reprinted at App.5a.

JURISDICTION

The First Circuit entered its opinion on April 24,

2025. App.1a. This Court has jurisdiction under 28

U.S.C. § 1254(1).

2

CONSTITUTIONAL PROVISIONS INVOLVED

U.S. Const. Amend. I

Congress shall make no law respecting an

establishment of religion, or prohibiting the free

exercise thereof; or abridging the freedom of

speech, or of the press; or the right of the people

peaceably to assemble, and to petition the Government for a redress of grievances.

U.S. Const. Amend XIV, sec. 1

All persons born or naturalized in the United

States, and subject to the jurisdiction thereof, are

citizens of the United States and of the State

wherein they reside. No State shall make or

enforce any law which shall abridge the privileges

or immunities of citizens of the United States; nor

shall any State deprive any person of life, liberty,

or property, without due process of law; nor deny

to any person within its jurisdiction the equal

protection of the laws.

STATEMENT OF THE CASE

Petitioner Dr. Sally Priester is a medical doctor

and scientist with more than 20 years of clinical

experience in disaster medicine and public health. She

has published ten peer-reviewed abstract, book

chapter, or medical journal manuscript publications.

She has a license to practice medicine in Puerto Rico

3

and, by operation of law, is required to be a member

of the Association to practice medicine in Puerto Rico.1

Since the early days of the COVID-19 health emergency began in Puerto Rico in March 2020, Petitioner

became a staunch critic of Respondent PRDH’s management of the situation. During the nine months prior

to her silencing by Respondent PRDH, Dr. Priester

raised reasonable concerns regarding mask mandates,

forced lockdowns, and the government’s unsatisfactory

response to the COVID-19 emergency.

A few days prior to the December 2020 announcement of the Emergency Use Authorization of the Pfizer

COVID-19 vaccine, Respondent Ramos,2 acting under

color of state law as the President of Respondent

Colegio de Médicos-Cirujanos3 and in violation of the

organization’s regulations,4 sent Respondent PRDH’s

licensing board a complaint letter against Petitioner.

App.26a. Ramos requested that Respondent PRDH

carry out an investigation of, and issue a gag order

1 P.R. Laws Ann. tit. 20 § 73(g).

2 On March 31, 2025 Ramos was confirmed as Respondent

PRDH’s Secretary of Health. He now has the authority to order

any proceeding, persecution, and/or sanctioning of Petitioner,

including the deprivation of her license to practice medicine.

Ramos continues to be a defendant in his individual capacity in

the case before the district court.

3 The College of Physicians and Surgeons is the statutory entity

created to group the medical professionals in Puerto Rico pursuant

to P.R. Laws Ann. tit. 20 § 73(g). The Puerto Rico Supreme Court

eliminated the mandatory membership to this College in Delucca

Jimenez v. Colegio de Médicos-Cirujanos, 2023 TSPR 119, 213

DPR ___ (2023).

4 See paragraphs 36-47 of Amended Complaint, Dist. P.R. Dkt. 76.

4

against, Dr. Priester to prevent her from speaking in

public and in the media about anything relating to

the COVID-19 issue. Respondent Ramos specifically

requested that Respondent PRDH’s Medical Licensing

Board issue an order against Petitioner to:

[C]ease and desist immediately from promoting and distributing information with no

scientific basis regarding the pandemic, the

SARS-CoV-2 virus, the COVID-19 illness,

and that jeopardizes the health of the People

and the fiduciary relationships between

doctors and patients of the entire medical

class of this country. This order must be

decreed as soon as the investigation commences, as a preventive action to avoid greater

harm to the population and deviations from

safety measures.

1st Cir. Doc. 00117987018 at p. 7.

Respondent Ramos’ complaint was based on Petitioner’s public expressions made in public spaces before

crowds of people that were interested to hear what Dr.

Priester had to say on matters of public concern such

as public health. Respondent Ramos denounced the

following public expressions made by Dr. Priester on

a November 29, 2020, rally:

To refer to the pandemic as the ‘plandemic’

. . . [H]ow dare they launch a terror and impotence campaign . . .

It is a lack of respect from us in the medical

community and that doctors are lending

themselves for this kind of things, let’s put

an end to this sham . . .

5

I can’t understand why health centers like

CDTs are closed and thus force patients to

turn to just emergency rooms for receiving

healthcare. It is incredible to know that they

cannot communicate with primary care physicians. Don’t let them scare you anymore

because there will come the time when those

14 days of incubation do NOT exist and the

Department of Health will have to explain,

on trial, from where it has taken so much

data that has not been scientifically proven

worldwide.

We do not have to wait for any vaccine . . .

No child will get vaccinated . . .

App.27a.

Respondent PRDH readily complied with Ramos’

request, even though the complaint did not stem from

Petitioner’s professional conduct.

The minutes of Respondent PRDH’s Licensing

Board’s meetings evaluating the complaint illustrate

what Dr. Priester was up against. Some of its members

set their opinions for the record as follows:

Specifically, a member of the Licensing Board

said that “because Dr. Priester is a licensed

physician, her freedom of speech is irrelevant,

and therefore, if at any point she intends to

question the establishment publicly, she must

submit proof to partake on such challenge.

Otherwise, she should not be allowed to challenge the establishment.”5 Another member

5 These expressions were made by PRDH Licensing Board member

Carlos Portocarrero Blanco, and they are particularly troubling

6

pointed out that Dr. Priester did not offer

expert testimony to rebut the experts who

declared on behalf of the Association,

although she was never made aware of the

“expert testimony” that she was required to

rebut. And that the same member said that

“he wanted to make clear that while a

physician has freedom of speech, a medical

doctor cannot speak against the recommendations of the CDC, FDA, and accrediting

colleges during a pandemic.” Then, a third

member intimated that Dr. Priester had to

submit evidence that she was capable of publicly expressing her opinion regarding Covid-19

and that, because she was unsuccessful in a

challenge to the investigative proceedings in

state court, the Licensing Board could censor

Dr. Priester’s speech without repercussions.

A fourth member said that “because Dr.

Priester is a medical physician, she must face

the consequences of providing opinions

contrary to the standards of care promulgated

by the FDA, AMA, infectious disease experts,

the CDC, and the whole world.” The last

member said that Dr. Priester did not show

that she had knowledge on how to manage

Covid and that she could not demonstrate

that she did not violate the Code of Ethics.

1st Cir. Doc. 00117987021 at pages 249-251. (Emphasis

ours.)

because, unlike the rest of the Licensing Board Members, Dr.

Portocarrero is the only licensed attorney among them. PR

Supreme Court License number 17,870.

7

Without granting a full hearing observing due

process guarantees, on April 21, 2021, Respondent

PRDH issued Resolution and Order 2021-04 prohibiting Dr. Priester from speaking out against the

efforts of the Government of Puerto Rico and other

private entities with respect to the COVID-19 pandemic. The document specifically ordered Dr. Priester

to:

. . . CEASE AND DESIST from making,

expressing, communicating, disseminating,

publishing, sharing, and/or endorsing, by

any means of communication or in person,

messages without any legitimate scientific

basis against the health efforts being carried

out by government or private authorities

recognized and respected by the scientific

and medical community to alert and protect

the society with respect to the spread and

propagation of the SARS-CoV-2 virus, the

Coronavirus Pandemic and/or Covid-19, as

well as any of its variants.

Resolution 2024-04 further apprised Dr. Priester that:

[F]ailure to comply with this Order may entail

severe monetary and disciplinary penalties

and/or even judicial contempt . . .

Dist. P.R. Dkt. 1-1 at page 26.

Since then, Respondent PRDH has acknowledged

that the gag order and subsequent investigation

stemmed from Petitioner’s “disparaging declarations

concerning the policies and efforts undertaken by the

PRDH and the Commonwealth . . . ” (Emphasis ours.)

1st Cir. Doc. 00118222835 at 1-2.

8

Petitioner requested the dismissal of the complaint

based on her First Amendment rights of freedom of

speech and assembly. App.26a.

After having filed two prior lawsuits seeking

redress, on January 19, 2022, Petitioner filed a third

lawsuit6 before the district court seeking injunctive

and declaratory relief under 42 U.S.C. 1983. Dist. P.R.

Dkt. 1. Dr. Priester also filed a petition for preliminary

injunction under F. Civ. Proc. R. 65 seeking to have the

Resolution 2021-04’s gag order declared an unconstitutional prior restraint on her freedom of expression,

viewpoint discrimination, and an imminent threat of

retaliation. Dist. P.R. Dkt. 4.

Without holding an evidentiary hearing, on August

10, 2022, the district court disregarded Dr. Priester’s

First Amendment claims and those regarding the

prejudice and bias of the administrative forum, dismissing the motion for preliminary injunction on Younger

v. Harris, 401 U.S. 37 (1971) abstention grounds.

App.5a. Despite the statements by Respondent PRDH’s

Licensing Board Members alleged in the complaint as

reproduced above, the district court concluded that:

6 This case is Petitioner’s third lawsuit seeking redress. As early

as February 10, 2021, Dr. Priester filed her first lawsuit in what

has become a judicial via cruxis to vindicate her constitutional

rights. Prior to the case that gave rise to this Petition, Petitioner

had unsuccessfully sought redress three times from the Commonwealth Courts (SJ2021CV00832 (filed February 10, 2021), Sally

Priester v. Colegio de Médicos et al; Sally Priester v. Colegio de

Médicos et al., KLAN202100203 (P.R. Court of Appeals); and once

from the United States District Court for the District of Puerto Rico

(3:21-cv-01313-ADC) voluntarily dismissed on PROMESA

grounds.

9

Dr. Priester has not identified any type of

bias or intent to harass in the second phase

of the ongoing administrative proceedings and

she will be afforded numerous procedural

safeguards there, the Board is capable of

remaining impartial and moving forward

with the administrative proceedings.

App.20a-21a.

Despite the undisputed bias by the Licensing

Board members against Dr. Priester set forth above,

the district court found that all the factors set forth in

Middlesex Cnty. Ethics Comm. v. Garden State Bar

Ass’n, 457 U.S. 423, 432 (1982) were present to justify

the denial of the preliminary injunction. App.16a. This,

despite the district court’s acknowledgment that:

“ . . . at first glance, the statements attributed to certain

Board members regarding Dr. Priester’s First

Amendment rights that were included in the Amended

Complaint may be concerning.” App.19a. (Emphasis

ours). The district court did not take a second glance

to protect Petitioner.

Petitioner filed an interlocutory appeal for the

review of the dismissal of the preliminary injunction.

Dist. P.R. Dkt. 111. Respondents requested that the

court of appeals summarily affirm the judgment without

further briefing and stay the case until its decision. 1st

Cir. Doc. 00118011062 and Doc. 00118011072. Petitioner opposed these requests. 1st Cir. Doc. 00118027117.

Despite the momentous constitutional and public

interest issues that Dr. Priester’s appeal raised, the court

of appeals acquiesced to Respondents’ requests. As of

June 8, 2023, it had unreasonably stayed the appeal

for twenty-three months, exempting Respondents from

replying thereto. 1st Cir. Doc. 00118018886.

10

Since then, the court of appeals’ actions reflected

its position that Petitioner was not entitled to due

process or the protection of her constitutional rights

because of her beliefs and convictions.

While the case lingered in the courts, Petitioner’s

speech was entirely chilled, enabling the most successful COVID-19 vaccination campaign in the nation

to unravel in Puerto Rico.7

Eleven months after the court of appeals had

stayed the case, on July 10, 2024, Dr. Priester was

notified of Respondent PRDH’s Resolution 2024-22

that had been issued four months before. Like the first

one, devoid of regulatory authority or due process, and

with the aim of publicly discrediting Petitioner,

Respondent PRDH notified the document to thirteen

state and federal agencies and insurance companies

outside of the licensing process. App.38a-40a.

In this new order, Respondent PRDH dismissed

Resolution 2021-04 without finding that Petitioner

had violated the ethical provisions that govern the

7 By July 2022, 95% of the population in Puerto Rico had been

injected with at least one dose of the product compared to the

national average of 81.3% as of July 2025, and 84% were “fully

vaccinated” as of the same date of July 2022, compared to the

national average of 70% in 2025. American Hospital Association,

Digging into the Reasons for Puerto Rico’s Successful COVID-19

Response, July 22, 2022, found in https://www.aha.org/news/blog/

2022-07-22-digging-reasons-puerto-ricos-successful-covid-19response, archived in http://archive.today/WETBz, last accessed

on July 18, 2025, and the House of Representatives Select

Subcommittee on the Coronavirus Pandemic, After Action

Review of the COVID-19 Pandemic: The Lessons Learned and a

Path Forward found in https://oversight.house.gov/wp-content/

uploads/2024/12/2024.12.04-SSCP-FINAL-REPORT-ANS.pdf, last

accessed on July 18, 2025.

11

medical profession. App.24a. However, it imposed a

new, all-encompassing, permanent warning and gag

order that states:

. . . The Board understands and forewarns

Dr. Sally Priester that should there be any

national crisis or emergency similar to that

caused by the COVID-19 pandemic in the

future, she should abide by the safety measures that the organizations in charge of

healthcare should then recommend and adopt

for the benefit of the citizenship as a whole.

App.35a.

On November 22, 2024, the court of appeals sua

sponte issued an order instructing the parties to show

cause as to why the case should not be dismissed as

moot. 1st Cir. Doc. No. 00118218075. Petitioner replied,

setting forth specific reasons why Resolution 2024-22

did not turn the appeal moot (1st Cir. Doc. 00118223300

at pages 6-8).

On March 28, 2025, Petitioner filed a Writ of

Mandamus with this Court, case 24-1041, to compel

the court of appeals to proceed with the adjudication

of the case. After two years of having stayed the appeal,

and six days short of the deadline for Respondents to

file their reply with this Court, the court of appeals

entered an order dismissing the case as moot. App.1a.

The court of appeals’ order is conspicuously silent

regarding Respondent PRDH’s new, all-encompassing,

forward-looking gag order against Petitioner contained

in Resolution 2024-04.

12

REASONS FOR GRANTING THE PETITION

I.

This Court Should Grant This Petition

Because This Case Presents Questions of

Great and Increasing Societal Importance

Worthy of This Court’s Review, Such as the

Need to Set the National Standard Required

to Protect Physicians’ First Amendment

Rights, Shielding Them from State Action

Seeking to Suppress Public Speech on

Matters of Public Concern and Divergent

Viewpoints in Violation of the First and

Fourteenth Amendments of the U.S.

Constitution.

A. Protected Public Speech by a Professional

The First Amendment is extensive to Puerto Rico

through the Due Process Clause of either the Fifth or

Fourteenth Amendments. Posadas de Puerto Rico

Assocs. v. Tourism Co., 478 U.S. 328, 330 n.1 (1986).

The loss of First Amendment freedoms, for even

minimal periods of time, unquestionably constitutes

irreparable injury’ for purposes of the issuance of a

preliminary injunction. Elrod v. Burns, 427 U.S. 347,

373 (1976). The COVID-19 pandemic prompted our

“first freedom [to fall] on deaf ears.” Roman Catholic

Diocese v. Cuomo, 592 U.S. 14, 23 (2020) (Per Curiam)

(Gorsuch, concurring). “Judicial deference in an

emergency or a crisis does not mean wholesale judicial

abdication, especially when important questions of

. . . free speech . . . are raised.” Id. “Even in a [real]

13

pandemic, the Constitution cannot be put away and

forgotten.” Id., 592 U.S. at 19.

“A fundamental principle of the First Amendment is that all persons have access to places where

they can speak and listen, and then, after reflection,

speak and listen once more.” Packingham v. North

Carolina, 582 U.S. 98, 104 (2017). “[W]here a speaker

exists . . . , the protection afforded is to the communication, to its source and to its recipients both.” Va.

State Bd. of Pharmacy v. Va. Citizens Consumer

Council, 425 U.S. 748, 756 (1976).

The First Amendment protects an individual’s

right to speak his mind regardless of whether the

government considers his speech sensible and well

intentioned or deeply “misguided.” Snyder v. Phelps,

562 U.S. 443, 571-572 (2011). Likewise, the government

cannot compel a person to speak its own preferred

messages. 303 Creative LLC v. Elenis, 600 U.S. 570,

571-72 (2023).

The right of people to freely communicate publicly

on matters of public concern lies at the core of First

Amendment values. “Speech on public issues occupies

the highest rung of the hierarchy of First Amendment

values and is entitled to special protection.” Snyder v.

Phelps, 562 U.S. at 451-452 (The First Amendment

precludes viewpoint discrimination, an “egregious form

of content discrimination” and is therefore “presumptively unconstitutional.”) The prohibition on viewpoint

discrimination reflects the fundamental principle that

governments have “no power to restrict expression

because of its message, its ideas, its subject matter, or

its content.” Nat’l Inst. of Fam. & Life Advocs. v.

Becerra, 585 U.S. 755, 766 (2018) (“NIFLA”).

14

This Court has made the unequivocal distinction

that the regulation of a profession does not extend to

the licensing of public speech. “The principle that the

government may restrict entry into professions and

vocations through licensing schemes has never been

extended to encompass the licensing of speech per

se . . . ” Lowe v. SEC, 472 U.S. 181, 229 (1985).

Justice White’s concurrence in Lowe is particularly enlightening here:

Where the personal nexus between professional and client does not exist, and a speaker

does not purport to be exercising judgment on

behalf of any particular individual with whose

circumstances he is directly acquainted,

government regulation ceases to function as

legitimate regulation of professional practice

with only incidental impact on speech; it

becomes regulation of speaking or publishing

as such, subject to the First Amendment‘s

command that “Congress shall make no law

. . . abridging the freedom of speech, or of the

press.”

Lowe v. SEC, 472 U.S. at 232 (White, J., concurring).

In the specific context of physicians, “[w]hen a

physician speaks to the public, his opinions cannot be

censored and suppressed, even if they are at odds with

preponderant

opinion

within

the

medical

establishment.”8 There should be no labeling of

“misinformation” on a medical doctor’s public speech

8 Robert Post, Informed Consent to Abortion: A First Amendment

Analysis of Compelled Physician Speech, 2007 U. ILL. L. REV.

939, 949 (2007).

15

because “the First Amendment recognizes no such

thing as a ‘false idea.’” Hustler Magazine, Inc. v.

Falwell, 485 U.S. 46, 51 (1988). The “point of the First

Amendment is that majority preferences must be

expressed in some fashion other than silencing speech

on the basis of its content.” R.A.V. v. City of St. Paul,

505 U.S. 377, 392 (1992). “Discrimination against

speech because of its message is presumed to be

unconstitutional,” Rosenberger v. Rector & Visitors of

Univ. of Va., 515 U.S. 819, 828 whereas “viewpoint

discrimination . . . is presumed impermissible.” Id., 515

U.S. at 830.

Regardless of the mass hysteria and genuine

concerns that the COVID-19 emergency presented,

“even in a pandemic, the Constitution cannot be put

away and forgotten.” Roman Catholic Diocese of

Brooklyn v. Cuomo, 592 U.S. 14, 19 (2014). “Judicial

deference in an emergency or a crisis does not mean

wholesale judicial abdication, especially when important questions of religious discrimination, racial

discrimination, free speech, or the like are raised.” 592

U.S. at 30 (Kavanaugh, J., concurring).

In short, constitutional rights do not vanish in a

pandemic.

Respondent PRDH’s undisputed gag order chilling

Petitioner’s right to speak in public on matters of

public concern is repugnant to the constitution. It is

dangerously susceptible to unbridled repetition against

Petitioner and physicians across the nation if this

Court does not rein in its illegality.

16

B. A Medical Licensing Board’s Authority Is

Subject to Strict Scrutiny

Eighty years ago, Justice Jackson’s concurring

opinion in Thomas v. Collins, 323 U.S. 516 (1945),

first articulated the bedrock constitutional principle

that a professional’s public speech is essentially offlimits to government regulation and control. Although

Justice Jackson recognized the right of the state to

regulate the practice of a profession, he stated that the

state does not have right to protect against “false

doctrine.”

[I]t is not the right, of the state to protect the

public against false doctrine. The very

purpose of the First Amendment is to foreclose

public authority from assuming a guardianship of the public mind through regulating

the press, speech, and religion. In this field

every person must be his own watchman for

truth, because the forefathers did not trust

any government to separate the true from

the false for us. Nor would I. Very many are

the interests which the state may protect

against the practice of an occupation, very

few are those it may assume to protect

against the practice of propagandizing by

speech or press. These are thereby left great

range of freedom.

...

This liberty was protected because they

knew of no other way by which free men

could conduct representative democracy.

323 U.S. at 545-46 (Jackson, J., concurring) (Citations

omitted.)

17

Hence, even when a medical licensing board has

the authority to regulate the medical profession within

each state, such authority cannot be used to curtail

protected speech. “Where a professional is engaged in

a public dialogue, First Amendment protection is at

its greatest. Thus, for example, a doctor who publicly

advocates a treatment that the medical establishment

considers outside the mainstream, or even dangerous,

is entitled to robust protection under the First Amendment—just as any person is—even though the state

has the power to regulate medicine.” See Lowe, 472

U.S. at 232.

This Court has recognized that “a State may not,

under the guise of prohibiting professional misconduct,

ignore constitutional rights” and the line is “‘long

familiar the bar,’” United States v. Stevens, 559 U.S.

460, 468 (2010). Moreover, its “precedents require

disclosures to remedy a harm that is ‘potentially real,

not purely hypothetical’” Ibanez v. Florida Dep’t of

Bus. & Professional Regulation, Bd. of Accountancy,

512 U.S. 136, 146 (1994), and to extend “no broader

than reasonably necessary,” In re R.M.J., 455 U.S.

191, 203 (1982).

In NIFLA, this Court held that content-based

regulations “target speech based on its communicative

content.” NIFLA, 585 U.S. at 765. As a general matter,

such laws “are presumptively unconstitutional and

may be justified only if the government proves that

they are narrowly tailored to serve compelling state

interests. Id.

This stringent standard reflects the fundamental

principle that governments have “‘no power to restrict

expression because of its message, its ideas, ‘alte[r]

the content of [their] speech, its subject matter, or its

18

content.’” Riley v. National Federation of Blind of N.

C., Inc., 487 U.S. 781, 795 (1988). This is a high bar,

particularly because of the danger of content-based

regulations “in the fields of medicine and public health,

where information can save lives.” NIFLA. 585 U.S at

756.

“Broad prophylactic rules in the area of free

expression are suspect. Precision of regulation must

be the touchstone in an area so closely touching our

most precious freedoms.” NAACP v. Button, 371 U.S.

415, 438 (1963).

From the above it is axiomatic that a medical

licensing board’s regulation of a physician’s speech is

subject to the highest degree of strict scrutiny that

requires that the government provide evidence that

other alternatives that do not involve restricting

protected speech would not have been effective to

achieve the compelling state interest. Ashcroft v.

ACLU, 542 U.S. 656, 666 (2004).

This Court should hold Respondent PRDH’s

Resolutions 2021-4 and 2024-22 to be subject to strict

scrutiny since they target Petitioner’s viewpoint and

public speech. “Robust” First Amendment protection

requires nothing less. The Resolutions issued against

Petitioner are not “neutral” and of “general applicability,” they must satisfy “strict scrutiny,” and this

means that they must be “narrowly tailored” to serve

a “compelling” state interest. Church of Lukumi Babalu

Aye, Inc. v. Hialeah, 508 U.S. 520, 546 (1993).

Strict scrutiny means that Respondents must

prove a compelling state interest to have chilled Dr.

Priester’s speech, and they also must prove that the

means chosen were narrowly tailored such that the

19

least restrictive means possible were used. South Bay

Pentecostal Church v. Newsom, 141 S.Ct. 716, 718-19

(2021).

Respondent PRDH never provided for such alternatives to Petitioner, revealing its clear intent of

silencing any diverging viewpoints from its narratives,

most of which Congress in its “House of Representatives

Select Subcommittee on the Coronavirus Pandemic,

After Action Review of the COVID-19 Pandemic: The

Lessons Learned and a Path Forward”9 concluded were

“unscientific” and “caused more harm than good.”

C. The Need for a National Standard

The egregiously unconstitutional nature of the

original and most recent gag orders that Respondent

PRDH has imposed on Petitioner provides an ideal

setting for this Court to set the record straight and

establish clear constitutional limits that medical

licensing boards must adhere to with respect to

physicians’ First Amendment rights to speak freely

about matters of public concern whose suppression

can cause irreparable harm.

From there that this case presents this Court with

the unique opportunity to set a uniform guidance for

the equal protection of physicians’ First Amendment

rights, including a medical licensing board’s lack of

authority to chill the speech of a medical doctor

speaking on matters of public health.

The facts of this case are not speculative. They

occurred, remain undisputed, and are ominously

susceptible of occurring again. Thus, they provide an

9 See n. 7.

20

actionable framework for this Court to set the record

straight when it comes to the highest degree of

constitutional protection that physicians are entitled

to when publicly speaking on matters of public concern.

Respondent PRDH eliminated the possibility

that its unconstitutional behavior would not recur.

Under the latest gag order issued against Dr. Priester,

she is again under the threat of facing yet another

unfounded prosecutorial process and risking the loss

of her license to practice medicine if she publicly speaks

to the mostly Spanish-speaking population of Puerto

Rico about matters of public concern exposed in the

mainland regarding the public health that are in

contravention of PRDH’s unscientific policies. For

example: publicly speaking about recent discoveries

linking myocarditis and autism to vaccines could be

used by Respondent PRDH to initiate new proceedings

against Dr. Priester since the current “safety measures

that the organizations in charge of healthcare should

then recommend and adopt for the benefit of the

citizenship as a whole” adopted by Respondent PRDH

include mandatory COVID vaccination in children

under the age of 16, including babies, mandating it as

a requirement to allow children, adolescents, and even

university students to enroll in school.

This petition should be granted because it presents

a unique opportunity to adjudicate an actual case and

controversy and provide sensible guidance on the

constitutional parameters that medical licensing

boards must adhere to in the protection of physicians’

rights of freedom of expression and association under

the First Amendment.

Based on Lowe, NIFLA, and Roman Catholic

Diocese of Brooklyn, this Court should conclude that

21

Respondent PRDH’s gag orders violated the First

Amendment clauses on freedom of speech and association, satisfying the likelihood of success on the merits

under Winter v. Natural Res. Def. Council, Inc., 555

U.S. 7 (2008) test. Consequently, this Court should

reverse the court of appeals’ dismissal and remand it

with instructions accordingly.

II. This Court Should Grant This Petition to

Reverse the First Circuit Court of Appeals’

Erroneous Dismissal of the Case on

Inapplicable Mootness Grounds, Deviating

from This Court’s Precedent.

A court with jurisdiction has a “virtually

unflagging obligation” to hear and resolve questions

properly before it. Colorado River Water Conservation

Dist. v. United States, 424 U.S. 800, 817 (1976).

After staying its decision for almost two years,

only to hastily dismiss the appeal six days short of

Respondents’ deadline to reply to Dr. Priester’s petition

in this Court’s case 24-1041, the court of appeals

disregarded its longstanding mootness criteria to

conclude that Dr. Priester’s appeal was moot.

This Court’s and the First Circuit’s precedent

provide that a case is not moot if the plaintiff can

provide “demonstrated probability” that the situation

is “capable of repetition, yet evading review.” Friends

of the Earth, Inc. v. Laidlaw Envtl. Servs. (TOC), Inc.,

528 U.S. 167 (2000); ACLU of Mass. v. U.S. Conf. of

Cath. Bishops, 705 F.3d 44, 57 (1st Cir. 2013). If a court

concludes that “unchecked by the litigation,

respondents’ wrongful behavior will likely occur or

continue and that the threatened injury to Petitioner

22

is certainly impending” it cannot conclude the case is

moot. Whitmore v. Arkansas, 495 U.S. 149, 158 (1990).

Regarding the voluntary cessation exception, this

Court expressed in FBI v. Fikre, 601 U.S. 234, 240

(2024) that a defendant does not “automatically moot

a case” by the simple expedient of suspending its

challenged conduct after it is sued. Instead, this

Court’s precedents hold that a defendant’s “‘voluntary

cessation of a challenged practice’” will moot a case

only if the defendant can show the “formidable burden”

that the practice cannot “‘reasonably be expected to

recur.’” Friends of the Earth, Inc., 528 U.S. at 189-190.

The “voluntary cessation” doctrine presents a

“formidable burden” because “‘[t]he Constitution deals

with substance, not strategies.” Id. “Were the rule more

forgiving, a defendant might suspend its challenged

conduct after being sued, win dismissal, and later pick

up where it left off; it might even repeat ‘this cycle’ as

necessary until it achieves all of its allegedly

‘unlawful ends.’” Id. (Citations omitted).

In this context, Respondent PRDH failed to meet

the formidable burden of proving that it was highly

unlikely that it would not persecute Petitioner again

for exerting her right to public speech on matters of

public concern. With Resolution 2024-22, it confirmed

it would.

It is revealing that after Respondent PRDH issued

Resolution 2024-22 on March 21, 2024, it did not

readily appear before the court of appeals to argue

that the appeal had turned moot. Instead, it waited

for the court of appeals that had indefinitely stayed

the case, to sua sponte issue an order expressing its

inclination to dismiss the appeal relying on the a

23

clearly distinguishable situation discussed in Harris

v. Univ. of Mass. Lowell, 43 F. 4th 187 (1st Cir. 2022).

In response to the court of appeal’s intent of

dismissing the case, Petitioner asserted that her claims

were “capable of repetition,” as long as she was a

licensed doctor subject to Respondent PRDH’s

authority. As a Puerto Rico licensed physician subject

to Respondent PRDH’s regulatory power, Dr. Priester

has a reasonable expectation that as soon as she again

engages in public speech, she will be subjected to the

arbitrary, capricious, and unconstitutional restrictions

and threats by Respondent’s Licensing Board.

Furthermore, Petitioner argued to the court that

by enacting Resolution 2024-22, Respondent PRDH

confirmed that not only was it capable of repetition,

but that it had repeated itself. Resolution 2024-04

unequivocally imposed on Dr. Priester an ambiguous,

all-encompassing, future, and permanent prohibition

on her public speech. Through its own undisputed

conduct, Respondent PRDH proved to the court of

appeals that as long as any court with jurisdiction

doesn’t order otherwise, it was not willing to let go of

the hijacking of Dr. Priester’s right to speak in public

on matters of public concern. Respondent PRDH

removed the speculation out of the “reasonable expectation” and turned it into an uncontroverted fact.

The court of appeals’ order dismissing the case

made no mention of this fact.

The court of appeals’ unjustified prolonged stay,

treatment, and dismissal of Dr. Priester’s interlocutory appeal requesting the protection of her First

Amendment rights leaves a lot to be desired. Regardless of the ideology of the individual members of that

24

court, they should not have allowed it to interfere with

their responsibility towards a litigant properly before

the court.

Respondents’ collusion to suppress Dr. Priester’s

public speech on matters of public concern has

caused—and continues to cause—irreparable harm on

Petitioner as well as the thousands of victims that

were prevented from hearing what she had to say to

decide for themselves whether the government was

being forthcoming or not regarding its campaigns

associated with the COVID-19 emergency, most of

which have been debunked.

This harmful and egregiously unconstitutional

conduct cannot be allowed to happen again within a

jurisdiction of the United States.

Petitioner urges this Court to grant this petition,

that will incidentally provide the necessary guidance

to state medical boards throughout the United States

to prevent physicians’ civil rights violations under the

guise of a future pandemic.

This Court should reverse the court of appeals’

order dismissing the appeal and remand the case for

its full adjudication according to the Court’s precedents

set forth above and the guidance that this Court

should provide.

25

CONCLUSION

For the reasons set forth above, this Petition for

a Writ of Certiorari to the First Circuit Court of

Appeals should be granted as to Questions 1 and 2.

Respectfully submitted,

Ana Luisa Toledo, Esq.

Counsel of Record

P.O. Box 15990

Houston, TX 77220-1590

(832) 247-3046

ana@anatoledo.com

Counsel for Petitioner

July 23, 2025