Missouri’s sole abortion provider, a Planned Parenthood clinic in St. Louis, has announced it will refuse to perform a pelvic exam on patients at least three days before an abortion, a regulation mandated by the state’s health department.
Instead, it will continue its previous practice of performing the exam on the same day as the procedure.
“We believe continuing to force an additional invasive and uncomfortable vaginal exam on patients at least 3 days before her abortion procedure, when it is not medically indicated, and when she will have the identical exam on the day of the abortion procedure, is not patient-centered,” Dr. Colleen McNicholas, a physician who practices at the clinic, said in a statement. “It is disrespectful and dehumanizing.”
The mandate from the Missouri Department of Health and Senior Services (DHSS) has received national attention as Missouri is on the verge of becoming the only state in the country without an abortion provider. The clinic has gone to court to compel the state to renew its license.
DHSS first raised concern that Planned Parenthood was not performing the two required pelvic exams in its statement of deficiencies after an annual inspection in March.
The state began requiring pelvic exams before abortions, whether it be a medication or surgical abortion, in 2017. Since then, Planned Parenthood has stopped offering medication abortions in Missouri, saying performing invasive vaginal exams for patients that take an abortfacient orally to be unethical. It has instead directed patients to its clinic across the border in St. Clair County, Ill.
Though Planned Parenthood argued that DHSS was shifting its interpretation of the regulation, it reluctantly agreed to comply in the face of losing its license May 31. It submitted two plans of correction in the last week of May that addressed the “deficiencies.”
Planned Parenthood has only performed two pelvic exams per patient since the last week of May, according to Planned Parenthood spokesperson Jesse Lawder. The number of abortions it has performed since then was not immediately available.
The decision to reverse course was announced in the clinic’s fourth plan of correction it submitted to the Missouri Department of Health and Senior Services Tuesday, and was first reported by CBS News.
“Patients have confirmed for us what we already knew — that the additional medically unnecessary forced pelvic exam newly interpreted by the state is deeply traumatizing and inhumane,” McNicholas said, in a statement.
Request for comment to DHSS was not immediately returned.
Dr. Randall Williams, DHSS director and an OBGYN, has stated that the initial pelvic exam is necessary for guiding physician decisions and that DHSS has not changed how it has interpreted the regulation. Planned Parenthood was not cited for violating the requirement in its 2018 inspection.
Though the clinic’s license lapsed May 31, a preliminary injunction issued by a St. Louis judge has allowed the it to remain open. Judge Michael Stelzer has ordered DHSS to formally deny or accept the clinic’s license renewal application by Friday and has denied DHSS’s request to reconsider.
In asking the court to reconsider, attorneys for DHSS unveiled the clinic’s inspection records through court documents, listing about 30 deficiencies. The most serious incidents were centered around four patients with failed abortions.
In the cover letter prefacing the clinic’s fourth correction plan, Kawanna Shannon, director of surgical services, said many of the deficiencies cited in DHSS’s 62-page report were “vague, unsupportable, and baseless claims” that made it “impossible” for the clinic to respond.
“The statement of deficiencies, moreover, exaggerates a handful of known complications from abortion to suggest a widespread problem at Planned Parenthood when, in fact, Planned Parenthood’s low complication rate is well within published rates,” Shannon wrote.
Shannon did not list the complication rate. The Planned Parenthood facility performed 2,532 total abortions in 2018.
As of Thursday afternoon, Planned Parenthood had not received word as to whether their license application was denied or accepted.
A court hearing on the license has been scheduled for Friday at 10 a.m.