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Document 003111699584 - Supplemental Brief on behalf of Appellees Milagros Collazo, Governor of New Jersey, Paul Jordan, Eric T. Kanefsky and J. Michael Walker
Document 003111699584 - Supplemental Brief on behalf of Appellees Milagros Collazo, Governor of New Jersey, Paul Jordan, Eric T. Kanefsky and J. Michael Walker
Document 003111699584 - Supplemental Brief on behalf of Appellees Milagros Collazo, Governor of New Jersey, Paul Jordan, Eric T. Kanefsky and J. Michael Walker
ON APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW JERSEY CIVIL ACTION NO. 13-5038
SUPPLEMENTAL BRIEF ON BEHALF OF DEFENDANTS-APPELLEES AS REQUESTED BY THE COURT
JOHN J. HOFFMAN ACTING ATTORNEY GENERAL OF NEW JERSEY R.J. Hughes Justice Complex 25 Market Street, P.O. Box 112 Trenton, New Jersey 08625-112 609-292-8150 (Phone) SUSAN.SCOTT@DOL.LPS.STATE.NJ.US Attorney for Defendants-Appellees
Melissa H. Raksa Assistant Attorney General Of Counsel
Eric S. Pasternack Susan M. Scott Deputy Attorneys General On the Brief Case: 13-4429 Document: 003111699584 Page: 1 Date Filed: 08/05/2014 i
POINT I ................................................................................................. 2
SEXUAL ORIENTATION CHANGE EFFORTS PRACTICED BY STATE-LICENSED MENTAL HEALTH PROVIDERS FALL SQUARELY WITHIN THE PROFESSIONAL SPEECH DOCTRINE. .................................. 2
POINT II ................................................................................................ 3
PROFESSIONAL SPEECH THAT IS INCIDENTAL TO THE PROVISION OF PROFESSIONAL SERVICES IS SUBJECT ONLY TO RATIONAL BASIS REVIEW. ........................ 3
Garrison v. Louisiana, 379 U.S. 64 (1964) ................................................................................................. 6
Greater Balt. Ctr. for Pregnancy Concerns, Inc. v. Mayor & Council of Balt., 683 F.3d 539 (4th Cir. 2012), ...............................................................................10
Lowe v. S.E.C., 472 U.S. 181 (1985) ..................................................................................... passim
Moore-King v. County of Chesterfield, 708 F.3d 560 (4th Cir. 2013) ........................................................................ passim
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New York Times Co. v. Sullivan, 376 U.S. 254 (1964) ............................................................................................... 5
Ohralik v. Ohio State Bar Assn, 436 U.S. 447 (1978) .........................................................................................9, 12
Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833 (1992) .............................................................................. 2, 7, 10, 12
Prince v. Massachusetts, 321 U.S. 158 (1944) .............................................................................................12
Riley v. Natl Fedn of the Blind of N.C., Inc., 487 U.S. 781 (1988) ............................................................................................... 4
Semler v. Oregon State Bd. of Dental Examrs, 294 U.S. 608 (1935) .............................................................................................12
Stuart v. Loomis, 2014 U.S. Dist. LEXIS 6194 (M.D.N.C. 2014) ..................................................... 4
Thomas v. Collins, 323 U.S. 516 (1945) ...........................................................................................2, 6
Thornburg v. American College of Obstetricians & Gynecologists, 476 U.S. 747 (1968) .............................................................................................11
Watson v. Maryland, 218 U.S. 173 (1910) ............................................................................................... 4
Wollschlaeger v. Governor of Fla., __ F.3d __, __, 2014 U.S. App. LEXIS 14192 (11th Cir. 2014) .......... 5, 8, 10, 11
Wooley v. Maynard, 430 U.S. 705 (1977) ............................................................................................... 7
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Zahl v. Harper, 282 F.3d 204 (3d Cir. 2002) ................................................................................... 4
Statutes
N.J. Stat. Ann. 45:1-54, -55 ............................................................... 3, 11, 12, 13 Case: 13-4429 Document: 003111699584 Page: 5 Date Filed: 08/05/2014 1
QUESTIONS PRESENTED
What role does the doctrine of professional speech play in this case? If A3371 regulates speech and not merely conduct, how much protection does this speech receive under the First Amendment? Are Plaintiffs free speech rights diminished when they are speaking as licensed professionals in the course of treating clients? SUMMARY OF THE ARGUMENT Without conceding that sexual orientation change efforts (SOCE) are speech, rather than conduct, for the purposes of this supplemental brief, the State will address the Courts question of whether if SOCE counseling is speech is it professional speech subject to lesser First Amendment protection? Under the Courts inquiry, SOCE is professional speech that is incidental to the provision of professional services and afforded no First Amendment protection. Therefore, whether SOCE is considered conduct or professional speech incidental to treatment, the result is the same: SOCE is not entitled to any First Amendment protection, and any regulation thereof is subject only to rational basis review, which New Jerseys statute readily survives.
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ARGUMENT POINT I
SEXUAL ORIENTATION CHANGE EFFORTS PRACTICED BY STATE-LICENSED MENTAL HEALTH PROVIDERS FALL SQUARELY WITHIN THE PROFESSIONAL SPEECH DOCTRINE.
As early as 1945, Justice Jackson observed that the states have an interest in shielding the public against the untrustworthy, the incompetent, or the irresponsible [professional]. Thomas v. Collins, 323 U.S. 516, 545 (1945) (Jackson, J., concurring). Then in Lowe v. S.E.C., Justice White explained that one is engaged in professional speech where he or she takes the affairs of a client personally in hand and purports to exercise judgment on behalf of the client in the light of the clients individualized needs and circumstances . . . . Lowe v. S.E.C., 472 U.S. 181, 228 (1985) (White, J., concurring). In such instances a professionals speech is incidental to the conduct of the profession. Id. at 232. Put another way, in those instances the speech rights of physicians are, for example, implicated, but only as part of the practice of medicine. Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833, 884 (1992) (plurality opinion of OConnor, Kennedy and Souter, JJ.) (internal citations omitted). Therefore, the professional speech doctrine applies when the speaker is providing personalized advice [i.e., the professional service provided] in a private setting to a paying client . . . . Moore-King v. County of Chesterfield, 708 F.3d 560, 569 (4th Cir. 2013). Case: 13-4429 Document: 003111699584 Page: 7 Date Filed: 08/05/2014 3
Here, SOCE therapy falls squarely within the principles underlying the doctrine of professional speech because the state-licensed mental health providers speech is incidental to the professional service provided, i.e., mental health treatment. Appellants give information and advice and counsel [to their clients] to help the [clients] reach their ultimate goal and objectives, (T14:24-15:1), based upon the clients individual needs and objectives. Therefore, Appellants take their clients affairs personally in hand and exercise their professional judgment on behalf of the client in the interest of the clients individual needs and circumstances. Lowe, 472 U.S. at 228 (White, J., concurring). Accordingly, because SOCE therapy falls within the professional speech doctrine, N.J. Stat. Ann. 45:1-54, -55 is a permissible regulation of the mental health profession and does not violate the First Amendment. POINT II PROFESSIONAL SPEECH THAT IS INCIDENTAL TO THE PROVISION OF PROFESSIONAL SERVICES IS SUBJECT ONLY TO RATIONAL BASIS REVIEW.
The First Amendment does not require that all speech by professionals be subject to strict scrutiny review. Rather, the level of First Amendment protection afforded depends upon the context in which the professional speech is uttered. To that end, it is useful to view a professionals speech as falling along a continuum: (1) where the professionals speech falls outside the confines of a professional Case: 13-4429 Document: 003111699584 Page: 8 Date Filed: 08/05/2014 4
relationship, it is subject to traditional First Amendment analysis; (2) where the professionals speech occurs within the confines of a professional relationship, but is not incidental to the services provided by the professional, it receives diminished First Amendment protection; and (3) where the professionals speech both falls within the confines of a professional relationship and is incidental to the professionals services, it is subject only to rational basis review. In determining what level of First Amendment scrutiny is to be applied to regulations impacting professional speech within the confines of a professional relationship, courts take into account the regulatory context, the nature of the professional relationship, the degree of intrusion into the relationship, the reasons and evidentiary support for the intrusion, and the connection between the [regulation] and the governments interests. Stuart v. Loomis, 2014 U.S. Dist. LEXIS 6194, *36-37 (M.D.N.C. 2014) (citing Riley v. Natl Fedn of the Blind of N.C., Inc., 487 U.S. 781, 796 (1988); Pickup v. Brown, 728 F.3d 1042, 1053-55 (9th Cir. 2013); Centro Tepeyac v. Montgomery Cnty., 722 F.3d 184, 193 (4th Cir. 2013) (Wilkinson, J., concurring)). It is well-settled that the State has broad police powers in regulating the medical profession. Barsky v. Bd. of Regents, 347 U.S. 442, 449 (1954); Watson v. Maryland, 218 U.S. 173, 176 (1910); Zahl v. Harper, 282 F.3d 204, 211 (3d Cir. 2002) (citing Brodie v. State Bd. of Med. Examrs, 427 A.2d 104, 108 (N.J. Super. Ct. App. Div. 1981). [A] states legitimate concern for maintaining high standards of professional Case: 13-4429 Document: 003111699584 Page: 9 Date Filed: 08/05/2014 5
conduct extends beyond initial licensing. Barsky, 347 U.S. at 451. Under the professional speech doctrine, the government can license and regulate those who would provide services to their clients for compensation without running afoul of the First Amendment. Moore-King, 708 F.3d at 569. As recognized by the Supreme Court in Lowe, [t]he power of the government to regulate the professions is not lost whenever the practice of a profession entails speech. Lowe, 472 U.S. at 228 (White, J., concurring). As such, the regulation of professionals speech necessarily involves the collision between the power of government to license and regulate those who would pursue a profession or vocation and the rights of freedom of speech . . . guaranteed by the First Amendment. Lowe, 472 U.S. at 228 (White, J., concurring). Confronted by this tension, courts have evaluated this collision along a continuum to locate the point at which a measure is no longer a regulation of a profession but a regulation of speech or of the press. Accountants Socy of Va. v. Bowman, 860 F.2d 602, 604 (4th Cir. 1988) (quoting Lowe, 472 U.S. at 230 (White, J., concurring)); see also Wollschlaeger v. Governor of Fla., __ F.3d __, __, 2014 U.S. App. LEXIS 14192, *51-52 (11th Cir. 2014); Pickup v. Brown, 740 F.3d 1208, 1227-30 (9th Cir. 2014). When a professional speaks to the public on matters of public concern, the First Amendments protections are at their apex. Wollschlaeger, 2014 U.S. App. LEXIS 14192, at *51. See also New York Times Co. v. Sullivan, 376 U.S. 254, 270 (1964) (the Case: 13-4429 Document: 003111699584 Page: 10 Date Filed: 08/05/2014 6
First Amendment embodies a profound national commitment to the principle that debate on public issues should be uninhibited, robust, and wide-open.); Garrison v. Louisiana, 379 U.S. 64, 74-75 (1964) (speech concerning public affairs is more than self-expression; it is the essence of self-government.). As Justice White explained in Lowe, 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 [a] regulation of speaking or publishing. . . . Lowe, 472 U.S. at 232. Justice Jackson, similarly observed in Thomas, that while a state may forbid one without its license to practice law as a vocation, . . . it could not stop an unlicensed person from making a speech about the rights of man or the rights of labor, or any other kind of right, including recommending that his hearers organize to support his views. Thomas, 323 U.S. at 544-45 (Jackson, J., concurring). Thus, outside the doctor-patient relationship, doctors are constitutionally equivalent to soapbox orators and pamphleteers, and their speech receives robust protection under the First Amendment. Pickup, 740 F.3d at 1227-28. When speech by a professional is not incidental to the provision of the professionals services, or a course of treatment, but occurs within the confines of the professional relationship, the First Amendments protections are diminished and Case: 13-4429 Document: 003111699584 Page: 11 Date Filed: 08/05/2014 7
legislation here is reviewed for reasonableness, at most. 1 Id. at 1228. At this point on the continuum, the First Amendment tolerates a substantial amount of speech regulation within the professional-client relationship that it would not tolerate outside of it. Pickup, 740 F.3d at 1228. This is reasonable because [w]hen professionals, by means of their state-issued licenses, form relationships with clients, the purpose of those relationships is to advance the welfare of the clients, rather than to contribute to public debate. Id. In Casey, the Plurality observed that an informed consent requirement implicated the physicians First Amendment rights only as part of the practice of medicine, subject to reasonable licensing and regulation by the State. Casey, 505 U.S. at 884 (plurality opinion of OConnor, Kennedy and Souter, JJ.). Such a requirement would, as the Plurality observed, almost certainly be deemed impermissible compelled speech if it were outside the context of a professional relationship. Id. (citing Wooley v. Maynard, 430 U.S. 705 (1977)). While, at first blush, it appears that the Ninth Circuits holding in Conant v. Walters, is inconsistent with Casey, a closer review reveals that the Ninth Circuit applied heightened scrutiny due to the federal governments lack of police power to regulate the medical profession and because the restriction on speech interfered with
1 This is not to say that this category of professional speech falls directly at a midpoint on the continuum between the two ends, or that it is somehow entitled to heightened First Amendment scrutiny, but merely to note that the professional speech uttered here varies by its nature from the ends of the continuum. Case: 13-4429 Document: 003111699584 Page: 12 Date Filed: 08/05/2014 8
the states interest in ensuring the provision of medically competent care. Conant v. Walters, 309 F.3d 629, 638-39 (9th Cir. 2002); Wollschlaeger, 2014 U.S. App. LEXIS 14192, at *72. There, the Ninth Circuit enjoined a federal policy that prohibited doctors from merely recommending marijuana to patients. Conant, 309 F.3d at 638- 39. Having observed that the states [are] the primary regulators of professional conduct[,] the Ninth Circuit found that the application of heightened First Amendment scrutiny was consistent with the principles of federalism. Id. The Ninth Circuits decision, thus, rested on an interpretation of the federal governments regulatory interests, which as the court observed, differ from the broad police powers that the states enjoy to regulate the medical profession. Id.; see also Barsky, 347 U.S. at 449. Indeed, because of this distinction between the regulatory interests of the federal and state governments, Conant does not compel heightened scrutiny where a state exercises its broad police powers to regulate the medical profession to protect public health and safety, Wollschlaeger, 2014 U.S. App. LEXIS 14192, at *72, and Caseys reasonableness test controls. When speech occurs within the confines of a professional relationship and is incidental to the services provided by the professional, rational basis review governs the analysis of regulations falling at this point on the continuum. Lowe, 472 U.S. at 232; Pickup, 740 F.3d at 1228-29; Moore-King, 708 F.3d at 567-70; Bowman, 860 F.2d at 604. As the Supreme Court has emphasized, it has never been deemed an Case: 13-4429 Document: 003111699584 Page: 13 Date Filed: 08/05/2014 9
abridgement of freedom of speech or press to make a course of conduct illegal merely because the conduct was in part imitated, evidenced, or carried out by means of language, either spoken, written, or printed. Ohralik v. Ohio State Bar Assn, 436 U.S. 447, 456 (1978); see also Coggeshall v. Mass. Bd. of Registration of Psychologists, 604 F.3d 658, 667 (1st Cir. 2010) (Simply because speech occurs does not exempt those who practice a profession from state regulation[.]). Thus, a regulation of speech by professionals is not invalid, nor is it subject to [F]irst [A]mendment strict scrutiny, merely because it restricts some kinds of speech. Bowman, 860 F.2d at 604 (citing Ohralik, 436 U.S. at 456-57). A statute regulating a profession is constitutional so long as any inhibition of that right is merely the incidental effect of observing an otherwise legitimate regulation. Id. (quoting Underhill Assoc. v. Bradshaw, 674 F.2d 293, 296 (4th Cir. 1982)). Moreover, doctors are routinely held liable for giving negligent medical advice to their patients, without serious suggestion that the First Amendment protects their right to give advice that is not consistent with the accepted standard of care. Pickup, 740 F.3d at 1228. Indeed, most, if not all, medical and mental health treatments require speech, but that fact does not give rise to a First Amendment claim when the state bans a particular treatment. Id. at 1229 As such, the First Amendment does not permit a physician to speak the words necessary to provide or administer [a] banned drug or counsel a patient to rely on quack medicine. Id. at 1228-29. Case: 13-4429 Document: 003111699584 Page: 14 Date Filed: 08/05/2014 10
Relying on Lowe and the principles underlying the professional speech doctrine, courts have applied rational basis review to regulations that govern professional speech incidental to the professionals services, such as regulations that prohibit a form of medical treatment, Pickup, 740 F.3d at 1228-29; govern counseling activities, Moore-King, 708 F.3d at 567-70; and restrict the use of certain terms in the work product of unlicensed accountants, Bowman, 860 F.2d at 604. Most recently, in Wollschlaeger, the Eleventh Circuit applied rational basis scrutiny to uphold a regulation restricting irrelevant inquiry and record-keeping by physicians regarding firearms as a legitimate regulation of professional conduct that had only an incidental effect on physicians speech. 2 Wollschlaeger, 2014 U.S. App. LEXIS 14192, at *5. In doing so, the Eleventh Circuit stated that the First Amendments protections are at their nadir . . . when the professional speaks privately, in the course of exercising his or her professional judgment, to a person receiving the professionals
2 Based on its reading of Casey, the Dissent in Wollschlaeger argues that intermediate scrutiny applies. 2014 U.S. App. LEXIS 14192, *132. However, the Casey Plurality used none of the language commonly understood to impart intermediate scrutiny analysis. Casey, 505 U.S. at 884; see, e.g., Clark v. Jeter, 486 U.S. 456, 461 (1988) (to satisfy intermediate scrutiny, a regulation must be substantially related to an important governmental objective). On the contrary, as the Eleventh Circuit explained, the language the Dissent cites to support this reading is . . . directed at others issues and is set forth in the opinion before the Court turned to its discussion of the First Amendment[.] Wollschlaeger, 2014 U.S. App. LEXIS 14192, *64 n. 16; but see Greater Balt. Ctr. for Pregnancy Concerns, Inc. v. Mayor & Council of Balt., 683 F.3d 539, 554 (4th Cir. 2012), vacated on rehg en banc on other grounds, 721 F.3d 264 (4th Cir. 2013) (assuming without analysis that Casey employed intermediate scrutiny).
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services. Wollschlaeger, 2014 U.S. App. LEXIS 14192, at *51-52; see also Thornburg v. American College of Obstetricians & Gynecologists, 476 U.S. 747, 802 (1968) (Burger, J., dissenting) (explaining that regulations governing how physician practices profession or dialogues physician engages in while treating patients subject rational basis review). While the Wollschaelger Dissent expressed a concern that the Majority lumped all professional speech into one, unprotected category, Wollschlaeger, 2014 U.S. App. LEXIS 14192, at *141 (Wilson, U.S.C.J., dissenting), it is unnecessary for this Court to consider whether the Eleventh Circuits formulation is too broad. Even the Wollschlaeger Dissent acknowledges the regulation in Pickup, which is virtually identical to the regulation here, left only a narrow category of speech unprotected by the First Amendment, consistent with the principles underlying the professional speech doctrine. Id. In accordance with the Eleventh Circuits reasoning, N.J. Stat. Ann. 45:1-54, -55 should be subject to rational basis review as it regulates only speech that is the functional equivalent of providing a drug, like in Pickup. Wollschlaeger, 2014 U.S. App. LEXIS 14192, at *141-42 (Wilson, U.S.C.J., dissenting). Therefore, the regulation at issue here, more surely than the one in Wollschlaeger, falls within the principles underlying the professional speech doctrine because it does not prohibit any speech other than that which is necessary and incidental to the provision of SOCE therapy. Case: 13-4429 Document: 003111699584 Page: 16 Date Filed: 08/05/2014 12
In sum, the State has a legitimate interest and concern in protecting the welfare of its citizens, and especially minors, from dangerous and unsound medical practices that extend beyond initial licensing requirements. Barsky, 347 U.S. at 449; Prince v. Massachusetts, 321 U.S. 158, 166 (1944); Semler v. Oregon State Bd. of Dental Examrs, 294 U.S. 608, 611 (1935). Due to this regulatory interest, the First Amendments protection of professional speech is diminished where that speech occurs within the professional relationship. Casey, 505 U.S. at 884; Pickup, 740 F.3d at 1227-28. Therefore, when professional speech is merely incidental to the provision of the professionals services, such as when medical treatment is carried out through speech, the First Amendment requires only rational basis review. Ohralik, 436 U.S. at 456; Pickup, 740 F.3d at 1228-29; Moore-King, 708 F.3d at 567-70; Bowman, 860 F.2d at 604; see also Busch v. Marple Newtown Sch. Dist., 567 F.3d 89, 99 n.11 (3d Cir. 2009) (holding that rational basis review is appropriate where First Amendment rights not burdened). Guided by these principles, this Court should find that N.J. Stat. Ann. 45:1- 54, -55 is subject only to rational basis review. With the enactment of the statute, the State sought to fulfill its obligation to the protect the welfare of minors by defining the acceptable standard of mental health care as it pertains to SOCE in New Jersey. The statute was narrowly drawn to accomplish this end by prohibiting only the provision of a particular mental health therapy that the State has deemed harmful to minors Case: 13-4429 Document: 003111699584 Page: 17 Date Filed: 08/05/2014 13
based upon an expansive legislative inquiry. The statute does not limit state-licensed mental health providers from engaging in the public dialogue or even prohibit them from discussing or recommending SOCE. N.J. Stat. Ann. 45:1-54, -55. The statute, thus, prohibits speech by professionals that is merely incidental to the valid regulation of a medical practice. The statute, therefore, is more akin to those seen in Pickup, Moore-King, and Bowman, and should be subject to rational basis review, which it easily passes as explained in the Appellees principle brief. CONCLUSION For the foregoing reasons, this Court should affirm the District Courts Order granting summary judgment to Defendants-Appellees. Respectfully submitted, JOHN J. HOFFMAN ACTING ATTORNEY GENERAL OF NEW JERSEY
By: s/ Susan M. Scott Susan M. Scott Deputy Attorney General R.J. Hughes Justice Complex P.O. Box 112, 25 Market Street Trenton, New Jersey 08625-0112 (609) 292-8150 NJ Bar #02897-2004
Date: August 4, 2014
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CERTIFICATION OF BAR MEMBERSHIP
I certify that I am an attorney in good standing of the bar of the Third Circuit. Dated: August 4, 2014 s/Susan M. Scott Susan M. Scott Deputy Attorney General R.J. Hughes Justice Complex P.O. Box 112, 25 Market Street Trenton, New Jersey 08625-0112 (609) 292-8150 NJ Bar #02897-2004
CERTIFICATION OF COMPLIANCE WITH RULE 32(a)
I certify that this brief complies with the typeface requirements of Fed. R. App. P. 32(a)(5) and the type style requirements of Fed. R. App. P. 32(a)(6) because this brief has been prepared in a monospaced typeface using Microsoft Word 2010 with 12 characters per inch in Times New Roman. I further certify that this brief complies with the page limitation of the Court and Fed. R. App. P. 32(a)(7)(A) because this brief does not exceed 15 pages. Dated: August 4, 2014 s/Susan M. Scott Susan M. Scott Deputy Attorney General R.J. Hughes Justice Complex P.O. Box 112, 25 Market Street Trenton, New Jersey 08625-0112 (609) 292-8150 NJ Bar #02897-2004
Case: 13-4429 Document: 003111699584 Page: 19 Date Filed: 08/05/2014 15
CERTIFICATION OF COMPLIANCE WITH LOCAL RULE 31.1(c)
I certify that the text of the paper copies of this brief and the text of the PDF version of this brief filed electronically with the Court today are identical. I further certify that prior to electronically filing this brief with the Court today it was scanned by McAfee VirusScan Enterprise 8.7.0i, a virus detection software, and found to be free from computer viruses. Dated: August 4, 2014 s/Susan M. Scott Susan M. Scott Deputy Attorney General R.J. Hughes Justice Complex P.O. Box 112, 25 Market Street Trenton, New Jersey 08625-0112 (609) 292-8150 NJ Bar #02897-2004 Case: 13-4429 Document: 003111699584 Page: 20 Date Filed: 08/05/2014