An administrator at Planned Parenthood’s St. Louis clinic testified Thursday that recent Missouri inspections became much more combative after the involvement of the inspectors’ supervisor, who eventually opened an investigation into the clinic of his own volition.
“The dynamic completely changed,” Kawanna Shannon, director of surgical services, said.
Shannon’s testimony, which at times became emotional, came on the fourth and final day of a state administrative commission hearing that will help decide whether the clinic can retain its license to perform abortions.
The state decided not to renew the clinic’s license in June after it could not complete an investigation of “failed” abortions of four patients because the physicians involved, who were medical residents or fellows in training, would not submit to interviews.
Under a stay from Commissioner Sreenivasa Dandamudi, the clinic can still perform abortions.
Shannon, who had worked at Planned Parenthood for more than a decade and was the state’s “point person” on licensure for three years, said inspections by the state were usually collaborative and that inspectors would offer on-the-spot suggestions that would prevent citations.
She described the former longtime inspector for Planned Parenthood, John Langston, as “very respectful.” Langston stopped inspecting Planned Parenthood after 2018.
However, Shannon noticed a difference in 2018 when William Koebel, the licensing supervisor, shadowed the team of his employees during their annual inspection, according to Shannon.
“They started asking questions as if they didn’t understand how to do an inspection,” Shannon said.
Shannon said Koebel often interrupted with questions in an “accusatory demeanor.” Langston had to become a “mediator” and at one point, had to tell Koebel to “calm down,” she said.
“We had been doing the same things we had always done, the things we always do,” Shannon said.
Koebel later testified he had never personally inspected a medical facility before and had no medical training. Most of the state inspectors assigned to Planned Parenthood have nursing backgrounds.
Inspectors came to Planned Parenthood in person five times this year. In years past, they would visit once and often request records through encrypted email, according to Shannon.
The state’s attorney, Solicitor General John Sauer, said that Langston, Planned Parenthood’s longtime inspector, opted out of the inspection process this year because “it became so contentious.” Koebel came last year because inspectors felt they needed “supervisory support,” Sauer added.
An attorney from Planned Parenthood played a video clip from Langston’s deposition to give context to Sauer’s assertion.
“The amount of scrutiny and questions we might get asked, that seemed to start with the legislator, the hardcore pro-life folks who were protesting,” Langston said in the video.
During the March annual inspection, Shannon said Thursday it immediately became clear “tensions were high.”
“(One of the inspectors) was asking us questions as if she had never been there before,” Shannon said.
Planned Parenthood staff ‘distraught’
Inspectors brought up the requirement to perform two pelvic exams prior to a surgical abortion, one three days in advance, when the patient receives state-mandated information and gives consent to the procedure.
Shannon said she and Planned Parenthood staff were “distraught” that the inspectors were citing them for what she claimed to be a new requirement. In years past, including in 2018, Planned Parenthood physicians performed a single pelvic exam immediately before the procedure.
Shannon said one of the inspectors told her they “had bosses, too.”
Sauer said Thursday that when asked during her deposition if the inspector remembered that conversation with Shannon, the inspector said she did not recall it.
When Koebel and another investigator returned in April for medical records, Shannon said they wouldn’t tell her why they were at the clinic. Since Koebel referred to a patient hypothetically, she said she mistakenly assumed any complaint being investigated was lodged by a patient.
Koebel had previously admitted to helping create a spreadsheet that helped find “failed” abortions.
Shannon said after receiving a “statement of deficiencies,” or a record of violations, within 10 days of the March inspection, the clinic received another list later in the year. It was the first time they had been given two such statements in one year, she said.
Planned Parenthood submitted four plans of correction to the state over the next months.
During his testimony Tuesday, the state health department director Dr. Randall Williams gave suggestions as to how to improve record-keeping and communication. He said Planned Parenthood’s issues were “imminently fixable.”
It was the first time Planned Parenthood had heard from the department this year as to how they could improve, according to its chief medical officer, Dr. Colleen McNicholas.
She said Wednesday she would consider all “reasonable” suggestions.
‘I don’t know who cried the most that day’
Shannon became emotional, her voice breaking, when describing one of the only days when Planned Parenthood decided to comply with the state’s request to perform a pelvic exam days before an abortion.
“It was one of the most horrible experiences ever,” she said.
Pelvic exams were performed on patients who had to strip down and consent to having “fingers and instruments” in their vaginas, according to Shannon. Patients were “violated” and women who had more than one abortion questioned why the exam was suddenly necessary, Shannon said.
“I don’t know who cried the most that day,” Shannon said Thursday, referring to patients and staff.
The hearing commissioner called for a break while Shannon collected herself. The Planned Parenthood attorney who questioned Shannon wiped away tears herself, and hugged her during the break.
Planned Parenthood is no longer is required to perform two pelvic exams before surgical abortions.
After a national uproar, Williams announced that he would change the rule so that physicians could opt out of the initial pelvic exam as long as they recorded their decision to do so.
Planned Parenthood still must perform a pelvic exam before medication abortions, so it no longer offers the service at its St. Louis clinic. Instead, it refers its patients to its clinic across the border in Illinois, where there is no such requirement.
Though the hearing is complete, Dandamudi is expected to make his decision on the licensing dispute only after post-hearing briefs are filed in February.