ST. LOUIS _ Missouri has rejected the license application of the Planned Parenthood clinic in St. Louis, the state's sole abortion provider, but the facility will remain open under court order for the time being.
The decision by the Missouri Department of Health and Senior Services was announced just prior to a hearing Friday in St. Louis City Circuit Court. It has no immediate impact, however, because a preliminary injunction keeping the clinic open remains in place.
But the agency's formal denial of the license clears the way for the next phase of the legal dispute, which is likely to be Planned Parenthood's appeal of the decision to the Administrative Hearing Commission, a body that resolves disputes between state agencies and individuals or businesses.
DHSS director Randall Williams said during a news conference Friday that the licensing decision came after a March inspection turned up complications in four surgical abortions. Two of them left patients still pregnant (requiring another procedure), one resulted in an infection and one ended with the patient being rushed to the hospital, bleeding heavily.
"None of us would hope that for anybody," Williams said.
Under normal circumstances, Williams said, inspectors would work with the health facility to identify what went wrong and form a plan to fix any systematic problems. But in the case of the St. Louis clinic, the doctors involved (who are residents and fellows and not technically employed by the clinic), have refused to be interviewed.
"It makes a very difficult job for our regulators _ in fact unprecedented _ to investigate the quality of care if the people who took care of the patient won't talk to them," Williams said.
Williams said the agency was doing its routine regulatory work and that no political pressure was exerted over whether to pull the clinic's license.
Planned Parenthood said that the court fight will not prevent the clinic from serving women.
"While Gov. (Mike) Parson and his political cronies are on the wrong side of history, nothing changes right now for patients who need access to abortion at Planned Parenthood," Dr. Colleen McNicholas, a physician with the clinic, said in a statement. "We will continue providing abortion care for as long as the court protects our ability to do so."
Williams also announced that it would eliminate a requirement that the clinic perform pelvic exams on patients three days in advance of an abortion and then again on the day of the procedure.
He said the agency would issue an emergency rule allowing pelvic exams closer to the time of the abortion if the clinic believes that it is best for the patient.
The state's reversal comes after Planned Parenthood informed regulators earlier this week that it would not do the exam three days in advance, a practice McNicholas called "disrespectful and dehumanizing."
During a brief court hearing that began at 10 a.m., Planned Parenthood attorney Jamie Boyer told Judge Michael Stelzer that the clinic received the letter announcing license denial about 30 minutes earlier.
DHSS had allowed the clinic's license to lapse May 31 without acting on the renewal application. Planned Parenthood preemptively sued the week before the license expired and court orders have allowed its clinic to continue to provide abortions.
Up until Friday, DHSS withheld its decision on the application, saying it needed to first interview seven physicians who practiced at the clinic about the specific cases flagged in a review of medical records during the clinic's March annual inspection.
But Stelzer ordered DHSS to formally approve or reject the application by Friday. A request to reconsider _ which Stelzer denied _ included the clinic's inspection records, which showed that DHSS was investigating four failed abortions.
Planned Parenthood submitted a fourth plan of correction to DHSS Tuesday, in response to a state filing with the court that listed included the 30 deficiencies at the clinic. In the plan, it announced it would defy a health department mandate to perform pelvic exams at least 72 hours prior to an abortion procedure, saying doing so was medically unnecessary and "inhumane."
During the hearing, Stelzer remarked that he would make an additional order to determine the case's next step.
"The state in its denial letter today stated that it didn't want any more conversations so it really is in the court's hands," M'Evie Mead, Planned Parenthood Advocates in Missouri spokeswoman, told reporters on the courthouse steps.
DHSS has asked to dismiss the case. In a previous order, Stelzer agreed with DHSS that the appropriate venue for the Planned Parenthood to challenge the state on licensing matters was in front an Administrative Hearing Commission.
The formal denial by DHSS will allow the clinic to appeal the decision to the AHC.
The four commissioners _ three of whom were appointed by former Democratic Gov. Jay Nixon _ hear cases individually and their decisions can be subject to judicial review.
The newest commissioner, Philip Prewitt, was appointed by Republican Gov. Mike Parson earlier in the month. In a bid for the state house, he received support from Missouri Right to Life, and as a Macon County associate circuit judge, he was reprimanded by the Missouri Supreme Court for urging support of a teen pregnancy resource center, according to The Associated Press.
Cases are assigned to commissioners on a rotating basis. Prewitt has said he would consider recusing himself if the Planned Parenthood case were to come before him.
Mead did not answer a question when asked if Planned Parenthood could get an apolitical decision from the commission.
