St. Louis clinic starts offering some abortions, state rejects plan for others

More than four months after Missouri voters approved a measure that gave residents the right to an abortion, Planned Parenthood has begun offering the procedure at one of its St. Louis clinics.

Clinic officials announced Friday that staff this week have started offering patients procedural abortions, sometimes known as surgical abortions.

“Ever since Missourians declared their right to abortion in November, our medical and patient services teams have been working diligently to prepare to provide this essential health care,” said Planned Parenthood Great Rivers President and CEO Margot Riphagen. “We stand ready to welcome more patients to ensure they can get the care they need, when they need it.”

The clinic originally said it would start offering medication-assisted abortions, but Planned Parenthood Great Rivers Interim Chief Medical Officer Margaret Baum said Friday that regulators at Missouri’s Department of Health and Senior Services had rejected a state-required plan that outlined what the clinic would do in case a patient suffered complications due to medication-assisted abortions.

She said that providing medications for abortions is the only procedure that requires submitting a plan to the state.

“The state of Missouri has singled out medication abortion to require us to have a complication plan,” Baum said. “I will tell you, I do many things, including abortions, major surgeries, vasectomies…there’s nothing else I do that requires a written complication plan from the state of Missouri.”

The health department rejected Planned Parenthood’s plan for not being sufficiently detailed, Baum said, adding that what the clinic submitted in February was similar to plans it had given the state before.

Other clinics in Columbia and Kansas City have also resumed some abortion care.

Baum said Planned Parenthood's lawyers are considering what to do next. It’s unclear if the clinic can re-apply with an updated complication plan, she said.

“This is an artificial requirement that has been set up,” she said. “It does not protect folks, it really inhibits access.”

A long road

The availability of abortion in St. Louis comes months after voters in November approved Amendment 3, which placed the right to an abortion in the MIssouri constitution.

Clinics such as the one in the Central West End were not immediately able to provide the procedure until a judge ruled on the constitutionality of the state’s near-total ban.

Jackson County Judge Jerri Zhang in December ruled the ban violated the amendment, but left other restrictions in place, such as requirements that patients receive pelvic exams and rules that governed the design of clinics.

Zhang temporarily overturned those restrictions as well after Planned Parenthood clinics in MIssouri asked her to reconsider. A court date that could permanently overturn the ban is set for next year.

However, regulations that required clinics to submit a “complication plan” to prescribe medication abortions to patients remained on the books.

That meant clinics in Columbia and Kansas City resumed procedural abortions, in which a provider commonly uses suction to remove a pregnancy in-office. But abortions by medication, which are usually performed in a patient’s home, were still outlawed.

Challenges ahead

In the meantime, some Republican lawmakers and officials are battling to keep abortions limited in the state.

Legislators in Jefferson City have floated another constitutional amendment that would ban the procedure in all but some instances of rape or incest.

Earlier this month, Missouri’s Attorney General Andrew Bailey issued a cease-and-desist order to Planned Parenthood clinics saying that they were not to provide medication abortions since DHSS had not approved complication plans.

“Planned Parenthood has established an uncontroverted track record of violating the law in MIssouri in recent years,” the letter stated.

Officials from the organization called the letter harassment and said they were already complying with the law since they had not resumed offering medication abortions. (A representative for Bailey’s office said the letter provided a way to ensure the organization’s compliance with state statute.)

Complication Plans

Between the date Planned Parenthood Great Rivers submitted its complication plan in February and when the state rejected that plan this week, the Department of Health and Senior Services issued an emergency rule that provided lengthy requirements for what plans needed to include.

The rule, filed March 13, became effective on March 27, when the state notified the St. Louis clinic’s leaders that their plan had been rejected.

In the emergency rule, state officials wrote they wanted to “protect Missourians’ access to safe and reliable care.”

Citing the FDA labeling of mifepristone, one of the two medications used in medication-assisted abortions, the emergency rule stated that up to 4.6% of patients needed to visit the emergency room after inducing a medication abortion.

A spokesman from Bailey’s office did not respond to a request for comment. DHSS did not respond to questions asking for more details about why the state rejected the clinic’s complication plan.

Looking ahead

Amendment 3 has reinvigorated protests at the Central West End clinic, although few people were gathered there Friday morning.

Outside the clinic, Mary Kay Damazyn was one of a handful of protestors standing along Forest Park Avenue, carrying a rosary. She said she just learned of the clinic resuming abortions as she arrived that morning.

“We knew it was going to happen, she said. “It's just so sad. I just lost a grandson in December. He was stillborn, the most beautiful little baby you've never seen. So it's hitting me differently now than it ever has.”

Inside, Baum said the patients receiving the first abortions in Missouri in years were happy they could get the procedure in St. Louis.

“I will say the patients were very grateful,” she said. “These patients were from Missouri, one specifically from St. Louis, and one of the patients did say it was very meaningful to be able to get this care in her community where she lives, close to home.”

This story has been updated.

This story has been corrected to say Margaret Baum is interim chief medical officer at Planned Parenthood Great Rivers.