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Planned Parenthood's Chief Doctor Testifies Abortions At St. Louis Clinic Are Safe

Missouri Solicitor General John Sauer gives a statement before Administrative Hearing Commissioner Sreenivasa Rao Dandamudi. Dandamudi will decide if the state was justified in declining to renew the license of the last abortion provider left in Missouri.
Carolina Hidalgo | St. Louis Public Radio
Missouri Solicitor General John Sauer gives a statement before Administrative Hearing Commissioner Sreenivasa Rao Dandamudi. Dandamudi will decide if the state was justified in declining to renew the license of the last abortion provider left in Missouri.

The chief doctor at Planned Parenthood’s St. Louis clinic testified during a high-profile regulatory hearing on Wednesday that the abortions performed there are safe and that the facility has an above-average record of successful procedures.

State health officials earlier this year decided not to renew the license for Planned Parenthood’s abortion clinic, citing concerns about patient safety.

The four instances of patient care that caused state regulators alarmwere in line with acceptable legal and medical standards of care, said Dr. Colleen McNicholas, chief medical officer of Planned Parenthood Reproductive Health Services. The clinic performs thousands of procedures a year, she said. 

“There is no clarity about what they see as the problem,” McNicholas said. “I think we’ve repeatedly demonstrated that quality of care can’t be the problem because we continue to provide excellent care.” 

Data Review Sparks Outrage

Her testimony came a day after Dr. Randall Williams, director of the Missouri Department of Health and Senior Services, revealed the department had generated a spreadsheet that tracked certain patients’ medical information, including the date of their last menstrual cycle. 

That sparked outrage among elected representatives, among them St. Louis County Executive Sam Page and state Rep. Crystal Quade, both Democrats. Abortion-rights activists decried the practice as a gross violation of patients’ privacy that proved the state was trying to “cherry-pick” rare situations to prove the point the clinic was unsafe. 

“I think what is deeply disturbuing about that is that Director Randall Williams is using his position of authority and power to push a political agenda to try to end abortion access in Missouri,” said Yamelsie Rodriguez, president of Planned Parenthood of the St. Louis Region and Southwest Missouri.

Planned Parenthood representatives say there will likely be protests today to decry the state’s use of patients’ information. 

State officials said Wednesday that Williams had not seen the spreadsheet but that investigators were within their rights to keep such information.

They said the state's scrutiny of those records did not violate patients' privacy under the federal Health Insurance Portability and Accountability Act.

“HIPAA compliance was not a factor in this activity as no patient data has been released,” department officials said in a statement. “This information, in fact, was important in the investigative process in ensuring that facilities are safe for patients.”

A Clinic At Risk

The Department of Health and Senior Services had identified the four patients’ procedures as proof the clinic did not follow medical guidelines and put patients in danger. That led regulators to deny a license renewal for the clinic, the state’s last remaining abortion provider.

Sreenivasa Rao Dandamudi, a member of the state’s Administrative Hearing Commission,will determineif the state was justified in that decision. 

Throughout the hearing, state officials have insisted that the department denied Planned Parenthood a renewed license because state regulators were concerned the facility was not following state laws, such as one that requires the same physician who does a procedure to examine the patient at least three days earlier.

Williams has insisted throughout the proceedings the refusal was because state regulators were concerned that Planned Parenthood wasn’t following the law and people receiving care there could be hurt. 

McNicholas conceded that “doctors are allowed to make mistakes,” but she said the four patients who suffered complications at the clinic represented a tiny fraction of the thousands who receive care at the clinic each year.

Planned Parenthood officials contend Republican Gov. Mike Parson and his administration are holding the clinic to a much higher standard than similar abortion facilities. They argue the state is using Missouri’s increasingly stringent rules regarding abortion procedures as a way to close the clinic.

Differing Standards

State law requires regulators to inspect other ambulatory and outpatient facilities every year, but Missouri doesn’t have the staff or budget to inspect every facility, said William Koebel, a regulator with the state health department. Attorneys for Planned Parenthood say despite those restraints, Reproductive Health Services has been inspected every year for the past 20 years. 

Williams said Tuesday that because abortion procedures typically do not involve complications, state scrutiny is needed to ensure providers take precautions to ensure patient safety.

“And so, as the (American College of Obstetricians and Gynecologists) has rightfully recognized, in those settings, you have to be even more careful, because the risks are not as frequent than as cardiothoracic surgery or other issues,” Williams said. 

The investigation that uncovered the four patients who suffered complications was set in motion after a routine annual inspection by the department, which is in charge of licensing the clinic, he said. A nurse investigator identfied an instance of the clinic not following the state law that the same physician examine a patient 72 hours before performing an abortion.

After that, a review of the clinic’s medical records found the four patients. Three were still pregnant after undergoing abortion procedures and one was hospitalized during the procedure because of severe bleeding. 

Conflicting Interpretations

The testimony Wednesday involved hours of McNicholas dissecting medical terms and conditions, sometimes while using markers and an easel. 

The state's scrutiny of the clinic has been difficult for Planned Parenthood because regulators are interpreting some medical terms differently than doctors.

For example, state regulators criticized a medical report from Planned Parenthood doctors that stated McNicholas was “present” at the time of a failed abortion in one of the four patients. While state regulators understood the word to mean inside the same room, McNicholas said that she understands the word to mean “immediately available inside the building.”

In another instance, she answered a question by drawing pictures of uteri to illustrate the difficulty of a medical procedure.

Williams said proposed changes to Planned Parenthood policies, such as a clarification on what “present” means in medical reports, would solve many of the issues the department has with the facility. 

Williams said he thought it was important to work with Planned Parenthood to implement improvements. But McNicholas said state health officials had not contacted the clinic about such changes.

Follow Sarah on Twitter: @petit_smudge

Send questions and comments about this story to feedback@stlpublicradio.org

Sarah Fentem is the health reporter at St. Louis Public Radio.