Government & Politics

Missouri backs off on rule requiring women get pelvic exam three days before abortion

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.

The state health department will no longer require Missouri’s sole abortion provider to perform pelvic exams on patients at least three days prior to receiving an abortion, it announced Friday.

The practice has drawn major backlash nationally and been called “dehumanizing” by the clinic’s operator, Planned Parenthood clinic of St. Louis. The clinic has always performed a pelvic the same day a patient receives a surgical abortion, and the requirement means two invasive vaginal exams per patient days apart. The clinic told the state Tuesday it would not comply.

Missouri Department of Health and Senior Services (DHSS) Director Dr. Randall Williams told reporters Friday that the agency would issue an emergency rule to relieve Planned Parenthood of the requirement.

“In looking at what they are doing and the fact that they think that causes a burden for patients to do (the pelvic exam) twice...as a clinician who practiced for 30 years, I’m sensitive to that,” Williams said.

Williams said the rule would allow physicians to conduct pelvic exams the same day of a surgical abortion.

Physicians could also forgo the exam if it is deemed not “medically indicated,” according to a letter sent to Planned Parenthood Friday morning notifying it that the agency would deny its license renewal application.

Planned Parenthood is in the midst of fighting DHSS in St. Louis Circuit Court after the agency allowed the clinic’s license to lapse May 31. Judge Michael Stelzer ordered the agency to officially act on the application by Friday.

Even though Planned Parenthood has officially denied the license, the clinic can still offer abortions because of a preliminary injunction issued by Stelzer. He is deliberating on what will happen next in the case and has promised to issue an order in the coming weeks.

The issue of pelvic exams first arose after the clinic’s annual inspection in March. DHSS cited the clinic for not performing a pelvic during the informed consent portion of the process, which comes at least 72 hours prior to the procedure.

During informed consent, physicians are required to discuss, or counsel, patients on the complications of abortion and read state-mandated literature.

DHSS has maintained that pelvic exams guide doctors in choosing the correct procedure so that it can be discussed with the patient during the informed consent period.

In the denial letter, DHSS said Planned Parenthood choosing to not perform the exam during informed consent is a “conflict with current law.”

“Nevertheless, the Department believes that this issue may be resolved in a manner that promotes the Department’s goals of quality patient care and safety,” the letter stated.

Planned Parenthood held that the violation was a new interpretation by DHSS of a regulation to perform a pelvic exam prior to an abortion. In the last week of May, it reluctantly agreed to comply in the face of losing its license and has only performed two pelvic exams per patient since then, according to Planned Parenthood spokesperson Jesse Lawder.

Dr. Colleen McNicholas, a physician with the clinic, called for Gov. Mike Parson to remove Williams from office over the flip-flop.

“Williams abused his authority as a doctor and a health department director and traumatized over 100 women who were forced to undergo this exam,” McNicholas, a physician with the clinic, said in a statement.

Pelvic exams will still be required for medication abortions, because they provide information needed by physicians to make medical decisions, Williams said.

Planned Parenthood has stopped offering medication abortions in Missouri, saying that performing pelvic exams for patients who take an abortfacient orally to be unethical. It has instead directed patients to its clinic across the border in St. Clair County, Ill.

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Crystal Thomas covers Missouri politics for The Kansas City Star. An Illinois native and a graduate of the Missouri School of Journalism, she has experience covering state and local government.
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