ST. LOUIS (AP) — The top doctor at Missouri's sole abortion clinic on Wednesday defended its handling of four patients who faced complications — women whose care has been cited by the state as it seeks to revoke the clinic's license.
The testimony from Dr. Colleen McNicholas at a hearing that could determine the St. Louis clinic's fate came as the state faced fallout over a revelation a day earlier from Missouri's top health official that he kept a spreadsheet that tracked the menstrual cycles of women who obtained abortions.
Missouri officials were staying mum, while Democrats and abortion-rights supporters decried what they called government overreach into women's private lives.
During testimony Tuesday, Missouri Department of Health and Senior Services Director Randall Williams said a spreadsheet was compiled at his request that included the dates of patients' last periods. He said the goal was to find women who had what the state calls "failed abortions," a complication in which a woman is still pregnant after an abortion and needs more than one procedure to complete it.
McNicholas told the administrative hearing that the Planned Parenthood clinic in St. Louis followed protocol in all of the instances cited by the state. She said that while a surgical abortion is safer than even a colonoscopy or tonsillectomy, complications do happen.
Yamelsie Rodriguez, president and CEO of Reproductive Health Services of Planned Parenthood of the St. Louis Region, told reporters that the organization learned of Williams' spreadsheet from his testimony on Tuesday. She did not know how many patients were listed on the spreadsheet.
"I think what is deeply disturbing about that is the fact that Director Randall Williams is using his position of authority and power to push a political agenda in order to try to end access to safe and legal abortion in the state of Missouri," Rodriguez said.
Williams declined interview requests. Several messages left with spokeswomen for Williams and Republican Gov. Mike Parson were not immediately returned. The Associated Press also submitted open records requests seeking additional information.
Williams testified that the spreadsheet contained information accessible by the state through its annual inspection, performed in March. It also included medication identification numbers, dates of medical procedures and the gestational ages of fetuses, the Kansas City Star reported. The spreadsheet did not include patients' names. The state has said it is concerned about patient care, and Williams called safety "the North Star" of the licensing process.
Missouri House Minority Leader Crystal Quade, a Democrat, called for an investigation to see if patient privacy was compromised or if laws were broken. State Auditor Nicole Galloway, who is running for governor in 2020, called the spreadsheet a "brazen violation of women's private health information" and called for Williams to be fired.
The spreadsheet was developed after an inspector raised concerns about an abortion that took five procedures to complete. That led to an investigation that found four overall instances where women underwent multiple procedures to complete their abortions. Among those cases, cited by Williams in testimony Tuesday, was one where the doctor missed that the patient was pregnant with twins, requiring two procedures five weeks apart.
Elizabeth Nash, a state policy analyst for the Guttmacher Institute, a national research group that supports abortion rights and tracks abortion legislation, told the AP she hasn't heard of another case where a state official has tracked menstruation as part of regulating a clinic.
Dr. Jennifer Conti, a San Francisco-area abortion provider, said in an interview that tracking periods is not a reliable way to determine when a pregnancy has ended and suggested that data was used to avoid having to obtain women's consent for access to addition information.
"It's very odd and it feels like an invasion of privacy," said Conti, who is a fellow with Physicians for Reproductive Health.
The state moved to revoke the clinic's license in June, prompting a court fight that was turned over to the Missouri Administrative Hearing Commission, which is conducting the hearing in St. Louis. A ruling isn't expected before February.
Missouri would become the first state since 1974, the year after the Supreme Court's Roe v. Wade decision, without a functioning abortion clinic if the license is revoked. Three clinics near Missouri offer the procedure. Two are in Illinois suburbs of St. Louis, and one is in Overland Park, Kansas, just across the state line from Kansas City.
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Associated Press reporters Heather Hollingsworth in Kansas City, Missouri, and John Hanna in Topeka, Kansas, contributed to this report.
DAY 2 | Oct. 29
The fight continues on day two as Planned Parenthood and Missouri’s Department of Health and Senior Services go head to head.
After the first day’s opening statements and hearing from the state’s first expert witness, we listen to more state witnesses on Tuesday. The state is thoroughly going through the four failed abortions and the investigation process.
The day started off with the state’s second witness, William Koebel. He’s been with the state’s health department for years. He conducted the investigation on Planned Parenthood. He notes there were standard of care issues, including that complication reports were not submitted and there weren’t accurate medical records. Koebel said under oath he found nothing unsafe at Planned Parenthood.
Through cross examination, Planned Parenthood said the 30 deficiencies found in the investigation, were mostly on the four patients presented by the state. Their argument points out that this is Koebel’s first time ever handling an abortion facility. Beyond that, Planned Parenthood’s defense says the four abortion failures presented in court, the state’s key examples, were not selected random. Koebel agreed they weren’t.
Issues preventing Missouri regulators from renewing the license for the state's only abortion clinic are "imminently fixable," the state's health director said Tuesday.
Missouri Department of Health and Senior Services Director Randall Williams testified during the second day of a state administrative hearing that will decide if the state can revoke Planned Parenthood's abortion license for its St. Louis clinic.
The state moved to revoke the license in June, citing concerns about a series of "failed abortions," and a lack of cooperation from some of the doctors involved in the procedures, who refused to talk to investigators.
Williams testified that two of the doctors have since relented and have now been deposed, and the information they provided was helpful in learning what happened with four instances where abortions went wrong.
"While these things are very concerning — they are grave — I think going forward they are imminently fixable," Williams said.
He believes there are solutions that both the state and Planned Parenthood would agree to that would allow for licensure.
The clinic remains open until the Administrative Hearing Commission ruling, which isn't expected until February at the earliest.
Wrangling over the license began when an investigator involved in a March inspection of the clinic found that a woman had undergone an abortion that took five attempts to complete. William Koebel, director of the section of the health department responsible for abortion clinic licensing, said Monday that the clinic failed to provide a "complication report" for that incident.
That failure led the health department to launch an investigation of other instances where women were required to undergo multiple procedures before an abortion was completed, Koebel said. They found four, including one where the physician apparently missed that the woman was pregnant with twins. As a result, the woman underwent two procedures five weeks apart.
Planned Parenthood officials have contended that the state "cherry-picked" a handful of difficult cases out of thousands of otherwise successful abortions. They've accused the state of using the licensing process as a tool to eliminate abortions in Missouri, saying the state is among several conservative-led states seeking to end abortion through tough new laws and tighter restrictions.
Missouri would become the first state since 1974, the year after the Supreme Court's Roe v. Wade decision, without a functioning abortion clinic if the license revocation is allowed.
Missouri is among several states to pass new restrictions on abortions in the hope that the increasingly conservative U.S. Supreme Court will eventually overturn Roe v. Wade. Republican Gov. Mike Parson signed legislation in May banning abortions at or beyond eight weeks of pregnancy, with exceptions for medical emergencies but not for rape or incest.
A federal judge in August temporarily blocked implementation of the law until the legal challenge plays out in court, which could take several months.
While the Missouri case unfolded, Planned Parenthood quietly built a new abortion clinic in Illinois, just across the Mississippi River from St. Louis. The 18,000-square-foot (1,700-square-meter) clinic in Fairview Heights, 12 miles (19 kilometers) east of St. Louis, opened Wednesday, in part to meet the demand for abortions from Missouri residents.
Missouri women have been increasingly getting abortions at the Hope Clinic for Women in Granite City, Illinois, another St. Louis suburb. Deputy Director Alison Dreith said 58% of the abortions performed at the Hope Clinic through August of this year involved Missouri women, compared with 37% involving Illinois women.
Another abortion clinic sits in Overland Park, Kansas, a Kansas City suburb. The clinic is 2 miles (3 kilometers) from the state line. Information from the state of Kansas shows about 3,300 of the 7,000 abortions performed there last year involved Missouri residents.
The hearing at a downtown St. Louis state office building is expected to last five days. Missouri officials have asked St. Louis police for heightened security since the licensing issue has generated protests from those on both sides of the debate
DAY 1 | Oct. 28
Patient safety at Missouri's only abortion clinic is the point of contention at a state administrative hearing that will decide if the clinic can remain open.
Opening statements and testimony began Monday before a commissioner with the Missouri Administrative Hearing Commission. At issue is the state health department's effort to revoke the license for Planned Parenthood's clinic in St. Louis.
Assistant Attorney General John Sauer outlined four cases of "failed abortions," including one where a woman had to have up to five procedures to complete the abortion, and another where the doctor failed to recognize that a patient was pregnant with twins, requiring a second procedure to remove the second fetus.
Planned Parenthood attorney Chuck Hatfield played a video deposition of a health department official indicating the clinic is not unsafe.
Hatfield says these four deficiencies are unique. They said out of 3,000 women they help, the state looked at these specific cases, not at random. According to their argument, if there was serious problem, they could've suspended the facility or limited the amount of patients.
Commissioner Sreenivasa Rao Dandamudi is presiding. A commission official said that in his role, Dandamudi "acts as an independent trial judge." A ruling isn't expected until February at the earliest.
Missouri would become the first state since 1974, the year after the Supreme Court's Roe v. Wade decision, without a functioning abortion clinic if the license revocation is allowed. The battle also comes as abortion rights supporters raise concerns that conservative-led states, including Missouri, are attempting to end abortion through tough new laws and tighter regulation.
Planned Parenthood has been battling the Missouri Department of Health and Senior Services for months to try to keep open its St. Louis clinic.
People who are with Planned Parenthood made their presence known Monday morning. They unfurled two large banners on a parking garage that's across the street from where the hearing is taking place.
One banner reads, 'Abortion is healthcare', while the other reads, 'Shame on Gov. Parson'.
The state said concerns arose from inspections in March. Among the problems health department investigators cited were three "failed abortions" requiring additional surgeries and another that led to life-threatening complications for the mother.
The health department has sought to interview physicians involved in those abortions, including medical residents who no longer work there. Planned Parenthood has said it can't force them to talk and that the state's concerns were addressed long ago. Attorneys for the health department wrote in legal filings to the commission that physicians' refusal to talk "presents the final, critical obstacle."
Missouri is among several states to pass new restrictions on abortions in the hope that the increasingly conservative U.S. Supreme Court will eventually overturn Roe v. Wade. Republican Gov. Mike Parson signed legislation in May banning abortions at or beyond eight weeks of pregnancy, with exceptions for medical emergencies but not for rape or incest.
A federal judge in August temporarily blocked implementation of the law until the legal challenge plays out in court, which could take several months.
While the Missouri case unfolded, Planned Parenthood quietly built a new abortion clinic in Illinois, just across the Mississippi River from St. Louis. The 18,000-square-foot (1,700-square-meter) clinic in Fairview Heights, 12 miles (19 kilometers) east of St. Louis, opened Wednesday, in part to meet the demand for abortions from Missouri residents.
Missouri women have been increasingly getting abortions at the Hope Clinic for Women in Granite City, Illinois, another St. Louis suburb. Deputy Director Alison Dreith said 58% of the abortions performed at the Hope Clinic through August of this year involved Missouri women, compared with 37% involving Illinois women.
Another abortion clinic sits in Overland Park, Kansas, a Kansas City suburb. The clinic is 2 miles (3 kilometers) from the state line. Information from the state of Kansas shows about 3,300 of the 7,000 abortions performed there last year involved Missouri residents.