Health Care

Court filing reveals inspection at heart of fight over Missouri’s last abortion clinic

Planned Parenthood advocates march in St. Louis, last abortion clinic in Missouri could close

Protesters opposed to Missouri's restrictive abortion law gathered at the St. Louis arch Thursday, May 30, 2019. Anti-abortion protesters maintain presence at the clinic.
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Protesters opposed to Missouri's restrictive abortion law gathered at the St. Louis arch Thursday, May 30, 2019. Anti-abortion protesters maintain presence at the clinic.

A court filing by the state of Missouri has made public for the first time the inspection results at the heart of a fight over whether the state’s last abortion provider will retain its license.

The May 2019 report, from the annual inspection by the Missouri Department of Health and Senior Services, centers on four patients who had failed abortions at the Planned Parenthood facility in St. Louis, including two who were hospitalized due to complications.

The inspectors wrote that:

One woman had a uterus that was tipped backwards and the positioning was not detected by a medical resident working at the clinic. After a surgical abortion and a medication abortion both failed to end the pregnancy, she needed a second surgical abortion.

Another woman had a surgical abortion at 10 weeks of pregnancy, then had to return to the clinic a month later for a second abortion — an incident previously hinted at in records related to a Columbia pathology lab that contracts with Planned Parenthood. Clinic staff told inspectors the woman was probably initially pregnant with twins, but the inspectors said an ultrasound before the first procedure showed no evidence of that. The inspectors wrote that the first abortion failed and two days after the second procedure the woman was hospitalized with a bloodstream infection.

A third woman had a surgical abortion for medical reasons at 21 weeks of pregnancy. According to inspectors, the procedure “resulted in massive uncontrolled bleeding and an emergency transfer of the patient to the hospital,” where it was determined she had lost two liters of blood. Doctors there performed a uterine artery embolization — a procedure for removing fibrous growths from the uterus or stopping bleeding.

Inspectors cited the Planned Parenthood facility for 30 deficiencies, but the most serious were related to those three patients and a fourth who also had to have a second surgical abortion about a month after the first.

What these cases say about the overall quality of care at the clinic is difficult to determine.

The Planned Parenthood facility performed 2,532 total abortions in 2018, according to spokesman Jesse Lawder. But information on the number performed May through September — the time frame examined by the inspectors — was not immediately available from Planned Parenthood or the state.

Without that number it’s impossible to determine the rate of complications during the period in question and how it compares to years past or to other facilities.

Abortions are statistically safer than many surgeries, but complications do happen. In 2017, the Missouri health department said it received 74 complication reports outlining 86 separate complications in about 3,900 abortions, a rate of 1.9%.

That’s roughly in line with the complication rates found in studies of other states, including California. Major complications, resulting in trips to the emergency room, are more rare, occurring in about 0.11% of all abortions nationally, according to a study published last year.

The state has said it can’t renew the facility’s license until it talks to all of the physicians who were involved in the incidents cited in the report. Planned Parenthood has sued to keep the state from pulling its license.

The organization has accused the state of “weaponizing” the inspection process for political reasons, noting Gov. Mike Parson’s strong support for a bill that, starting in August, will criminalize most abortions after eight weeks of pregnancy.

The state entered the inspection report into evidence Thursday in an attempt to get Judge Michael Stelzer to reconsider an injunction he granted that says the state must make a decision on the facility’s license by June 21, whether it has interviewed the doctors or not.

Lawder said that patient privacy laws limit what the organization can say about the incidents cited in the inspection report — and the state was no doubt aware of that when it entered the report into evidence, making it public before it usually would have been.

He said that Stelzer ordered the inspection records sealed on Monday — after several news organizations had already reported on their contents.

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Kansas City Star health reporter Andy Marso was part of a Pulitzer Prize-finalist team at The Star and previously won state and regional awards at the Topeka Capital-Journal and Kansas Health Institute News Service. He has written two books, including one about his near-fatal bout with meningitis.