Planned Parenthood will not be allowed to provide medication-induced abortions in Columbia or Springfield because it has been unable to prove that enough women will be denied the ability to terminate their pregnancy under state regulations imposed last year, U.S. District Judge Beth Phillips ruled on Monday.
Phillips denied a request from Planned Parenthood Great Plains and Planned Parenthood of the St. Louis Region and Southwest Missouri for a preliminary injunction blocking enforcement of the regulations. In her ruling, Phillips wrote that while the regulations have “virtually no benefit,” the burden they impose is not enough to be unconstitutional.
Columbia’s Planned Parenthood clinic offers surgical abortions and there is no barrier to obtaining a license for the same services in Springfield, Phillips wrote. Evidence produced in the case shows that the “vast majority” of women who cannot travel to Kansas City or St. Louis, where medication-induced abortions are available, will obtain a surgical abortion.
Phillips noted that Planned Parenthood argued that women prefer medication abortions.
“The court does not doubt this fact; however, for purposes of the constitution, women are not necessarily entitled access to the procedure that they prefer,” Phillips wrote.
The challenged regulations require continuous availability of an obstetrician-gynecologist with hospital admitting privileges to provide care in the case of complications. A medication abortion is induced with doses of two medications, one administered at the clinic and the second taken by the woman 24 to 48 hours later, usually at home.
The ruling is the second to go against Planned Parenthood in the lawsuit filed after lawmakers enacted new restrictions in a 2017 special session. In November, Phillips denied a request for a temporary restraining order to block the regulations. The ruling Monday did not end the case but showed Phillips doubts Planned Parenthood will succeed if it goes to trial.
The lawsuit was filed against the state Department of Health and Senior Services, which licenses clinics, and county prosecutors who would enforce criminal penalties in the law. Attorney General Josh Hawley’s office praised the decision in a statement from press secretary Mary Compton.
“We are pleased that the district court denied Planned Parenthood’s motion for preliminary injunction.” Compton wrote in an email. “The Attorney General’s Office will continue to vigorously defend commonsense regulations that protect the health of Missouri women.”
In a joint statement, from Brandon Hill, president of Planned Parenthood Great Plains, and Mary Kogut, president of of Planned Parenthood of the St. Louis Region, said the ruling was upsetting because Phillips found that the regulation was intentionally written to be difficult to meet.
“It is extremely troubling that the court would allow a regulation, that it found ‘has virtually no benefit,’ to deny women access to safe, legal abortion,” Hill and Kogut said.
The law approved last year grew out of abortion opponents’ response to the U.S. Supreme Court ruling on a Texas law requiring abortion providers to have hospital admitting privileges and for clinics to meet regulations for ambulatory surgical centers. The law closed most abortion clinics in Texas and the court ruled that the regulations created an “undue burden” on women.
Missouri had similar regulations. From November 2015 until August 2017, Missouri had only one abortion clinic in St. Louis, operated by Reproductive Health Services, an affiliate of Planned Parenthood of St. Louis and Southwest Missouri. After U.S. District Judge Howard Sachs ruled that Missouri’s regulations were unenforceable under the high court ruling in the Texas case, Planned Parenthood prepared to seek licenses for clinics Kansas City, Columbia, Springfield and Joplin.
Gov. Eric Greitens called lawmakers into special session to pass the new restrictions and the regulations took effect as the Kansas City and Columbia license applications were under review. The U.S. Supreme Court in late May refused to hear a case from Arkansas over a similar law, leaving an Eighth Circuit Court of Appeals ruling in place upholding the restrictions.
In her ruling, Phillips noted in a footnote that she was upholding a regulation tied to medical abortions that is unenforceable for surgical abortions. Sachs’ ruling is being appealed to the Eighth Circuit Court of Appeals and oral arguments were held in March. That makes a decision likely this summer.
“The court further notes that Defendants are seeking to overturn that injunction; if they succeed, and if the Columbia and Springfield clinics are precluded from performing surgical abortions, the court’s analysis in this case may need to be revisited,” she wrote.
In the lawsuit, Planned Parenthood argued that the regulations are unconstitutional because women seeking medication abortions must travel to Kansas City or St. Louis. The complication plan submitted to obtain the Kansas City license, as approved by the department, allows for consultation by phone for women experiencing complications who live outside the Kansas City area and for Planned Parenthood to direct a woman to seek emergency room care for major complications.
Planned Parenthood has not been able to hire a doctor in Columbia who would provide the continuous coverage. The regulations have been interpreted to also require a second doctor to be available in case of illness or travel by the primary doctor.
In her ruling, Phillips wrote that the state argued that the regulations insure that a doctor is available to complete the abortion surgically if necessary.
“However, the regulation goes further than is necessary to achieve this benefit; the objective can be achieved simply by requiring the prescribing doctor to have a relationship with another doctor or facility capable of performing a vacuum aspiration,” she wrote.
Hill and Kogut focused on those findings and that the regulations were written so it is unlikely they can be met.
“Politicians and state regulators, ignoring medical evidence, continue to impose arbitrary restrictions that harm the women they purportedly serve,” they said.
Phillips, however, based her ruling on Planned Parenthood’s inability to show that large numbers of women are prevented from obtaining an abortion of any kind.
“Therefore, despite the regulation’s minimal benefits, the court cannot conclude that plaintiffs have demonstrated that the regulation is a substantial obstacle to a large fraction of women’s right to obtain an abortion, so plaintiffs have not demonstrated that they are likely to succeed on the merits,” she wrote.