Government & Politics

State zeroes in on care of 4 patients in Planned Parenthood abortion licensing dispute

“Grave concerns” about patient care at Planned Parenthood’s St. Louis clinic prompted state regulators to deny renewal of a license to perform abortions at the facility, the Missouri solicitor general said Monday at the opening of a closely watched hearing.

The case before the state’s administrative hearing commission could decide whether Missouri becomes the sole state without an abortion clinic.

The state health department decided in June not to renew the license that allows the clinic to perform abortions, an action Planned Parenthood appealed to the state’s administrative hearing commission, which weighs in on regulatory disputes.

A state judge has ordered the clinic’s license to remain in force until the case is resolved.

On the first day of what could be a week-long hearing, the state zeroed in on complications experienced by four Planned Parenthood patients who had to return to the clinic to successfully terminate their pregnancies.

“Patient safety is the lodestar -- it’s the touchstone of the entire process,” Solicitor General John Sauer told administrative hearing commissioner Sreenivasa Rao Dandamudi.

Meanwhile, Planned Parenthood claimed that the state health department “cherry-picked” the four cases from about 4,000 abortions the clinic performs annually for an investigation opened after the it didn’t file a complication report.

As part of his opening statement, the abortion provider’s lead attorney, Chuck Hatfield, played a clip from the deposition of the state’s main investigator, William Koebel.

“Your investigation did not identify an unsafe environment?” Hatfield asked Koebel in the video.

“Not that I recall,” Koebel said.

Hatfield alleged that the state health department used rare complications and first-time, minor deficiencies to rationalize yanking Planned Parenthood’s license, instead of working with the health care provider on solutions, as is the usual procedure in medical facility inspections.

The true reason investigators chose to revoke the license was because physicians who had performed abortions at the St. Louis clinic, some of whom were medical fellows and residents, initially refused to be interviewed, Hatfield alleged. That reasoning is not a valid under Missouri licensing law, he added.

“The investigators described the issues here as small issues,” Hatfield said, in his opening statement. “The investigators described the issues here as easily resolved.”

Koebel later said on the stand that he, too, was concerned for patient safety. In questioning, Hatfield revealed Koebel, unlike most ambulatory facility inspectors, didn’t have medical training and that this year was the first time Koebel had personally conducted an investigation of a medical facility.

Emotions running high

The hearing is only the latest front in a long fight between Gov. Mike Parson’s administration and Planned Parenthood over access to abortion in the state. If Planned Parenthood were to lose, Missouri would become the first state prior to Roe v. Wade Supreme Court ruling to not have a single abortion provider.

Dandamudi is not expected to make a decision until next year, after each side submits post-hearing briefs in February. The losing side most likely will appeal to Missouri state court.

Still, advocates on both sides of the issue see the hearing as a pivotal moment.

On Sunday, anti-abortion activists picketed the central West End clinic, which was covered in a blue banner that said “Still Here” in stark white letters.

An hour before the hearing at the Wainwright Building downtown, Planned Parenthood supporters unfurled two 10-foot banners on a nearby parking garage. “Abortion is health care,” said one.

A red banner said, “Shame on Gov. Parson,” a cry abortion activists have taken up as the governor has appeared at events around the state, including at his own 2020 election announcement.

While emotions leading up to the hearing were high, the atmosphere inside was calm. Early on, a uniformed police officer stood guard over attorneys, press and the more than 70 pink-clad Planned Parenthood supporters.

Supporters filtered out of the room as the hearing came bogged down with medical terminology.

With the precision similar to trying a medical malpractice case, Sauer worked through the circumstances of each of the four patients with the state’s first expert witness, Dr. Donna Harrison.

Harrison, the executive director of the American Association of Pro-Life Obstetricians and Gynecologists, painstakingly detailed the patient’s medical records, sometimes page by page.

The 20-year OBGYN used her hands at one point to illustrate the shape of an “anteverted” —or tilted—uterus, which could have caused a complication in one of the patients.

“The concern was the uterus was not appropriately evaluated prior to the surgery,” Harrison said, of one patient.

Sauer noted that Planned Parenthood failed to file complication reports with the state. He asserted that poor supervision of medical training fellows led to inappropriate decisions and contributed to the four patients having to return to the clinic.

Dr. Colleen McNichols, the clinic’s chief medical officer, who is responsible for supervising many of the procedures, sat in the row behind Planned Parenthood’s attorneys. In a filing, she detailed how the state’s conclusions were misguided.

Following Harrison’s testimony, Planned Parenthood dismissed Harrison as an anti-abortion activist, noting her leadership position with an anti-abortion group.

“To me, this appears to be an attempt to fear-monger in advance of the state’s ultimate goal to ban abortion,” Dr. David Eisenberg, an abortion provider at the clinic, told reporters.

Planned Parenthood has also challenged in federal court the new Missouri law criminalizing abortion after 8 weeks of pregnancy. The law, parts of which were effective upon Parson’s signature in May, was stayed in September by a federal judge and will be considered by the Eighth Circuit Court of Appeals.

Even if the Planned Parenthood were to regain its license, the new state law—if upheld by the courts—would great reduce the clinic’s ability to offer abortions, especially as it only offers surgical abortions.

Recently, Planned Parenthood built a 18,000-square foot clinic in secret across the Illinois border, about 13 miles from its embattled St. Louis facility.

The second day of the hearing is slated to begin 9 a.m. Tuesday. Koebel is expected to resume testimony and the state is expected to call on Dr. Randall Williams, the state health department director and an OBGYN, as an expert witness.

This story has been updated.

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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.