Missouri has narrowly avoided a return to a time before Roe v. Wade after an independent arbiter ruled that its last operating abortion clinic can continue offering the procedure.

After a year-long legal battle that pitted allegations of grave violations against accusations of regulatory overreach, the Planned Parenthood in St. Louis won a rare victory in a state that has become increasingly hostile to abortion rights.

The dispute between the state and its sole clinic began last May, when Missouri’s Department of Health and Senior Services announced that it wouldn’t renew Planned Parenthood’s license. The clinic sued, accusing the agency of shifting the goal posts of its oversight and carrying out an antiabortion political agenda. But health officials said they uncovered “serious and extensive” problems during the clinic’s annual inspection.

In a 96-page decision issued Friday, Missouri’s Administrative Hearing Commission said the clinic’s operations were overwhelmingly safe and that the state health department wrongfully withheld its license. The ruling means the clinic’s license is renewed through May 2021.

“Planned Parenthood has demonstrated that it provides safe and legal abortion care,” wrote commissioner Sreenivasa Rao Dandamudi. “In over 4,000 abortions provided since 2018, the Department has only identified two causes to deny its license.”

The national organization, which in the last two years has battled a barrage of antiabortion legislation across the country, cheered the ruling but said access to abortion remains limited — and has been threatened further during the coronavirus pandemic as some states have sought to ban the procedure as part of their sweeping emergency orders.

“Today’s decision is a hard-fought victory for Planned Parenthood patients — and for people across Missouri," Planned Parenthood acting president Alexis McGill Johnson said in a statement. “This is how we fight for our patients: case by case, day by day, to ensure abortion remains safe and legal across the country. The data shows that many have already paid the price, with the vast majority of Missouri patients forced to cross state lines to get the care they need. This is what it looks like when abortion is a right in name only.”

A spokesperson for the state health department declined to comment.

The clinic was nearly forced to shut its doors in June, after the health department denied its permit renewal application, citing concerns over multiple “failed abortions,” which required additional procedures, and a patient who suffered life-threatening complications. But Planned Parenthood contended that the state’s argument was “cherry-picked,” and Circuit Judge Michael Stelzer allowed its physicians to continue performing abortions while he adjudicated the case.

The two sides sparred in court until Stelzer ordered Planned Parenthood to take its appeal to the Administrative Hearing Commission, the independent state agency that handles disputes between the public and private sectors.

The judge wrote that he “has no authority to intercede in this matter until there has been a final decision by the AHC,” and he granted a preliminary injunction keeping the clinic running until the body handed down its decision. This announcement flipped the clinic’s hourglass — it gave the health center more time, yet its leaders couldn’t shake the feeling that they were down to their last grains of sand.

“The terrifying reality is that access is hanging on by a thread,” Colleen McNicholas, an OB/GYN at the clinic, said in June.

The state’s health director, Randall Williams, drew widespread condemnation when he said at an administrative hearing in October that his agency tracked the menstrual cycles of the clinic’s patients, with the aim of identifying those who had failed abortions. Williams said he attempted to use that data to determine whether women who went in for follow-up appointments after abortions suffered complications. He said his goal was protecting patient safety. But critics called it an invasion of women’s privacy and demanded his resignation and an investigation by the governor.

Since 2019, the legal and political battle over abortion has intensified in Missouri, just as it has in other Republican-led states, which have pushed increasingly strict bans on the procedure.

Like many other states, Missouri already had restrictive laws on its books. Last year, Gov. Mike Parson (R) signed into law a measure that bans abortions after eight weeks of pregnancy. It provides no exceptions for victims of rape or incest, only for medical emergencies. He said on Twitter that the bill would make Missouri “the most Pro-Life state in the country!” Three months later, a federal judge blocked the law from taking effect.

Antiabortion advocates have applauded Parson’s policies and derided Dandamudi’s decision, claiming the clinic has unfairly dodged state oversight.

“It is a sad day when the health and safety of women is sacrificed in the name of abortion access," Jeanne Mancini, president of March for Life, said in a statement. "Planned Parenthood of St. Louis, the last abortion business in Missouri, demonstrated consistently that they value profits above the health and safety of women. Their numerous deficiencies, which Planned Parenthood refused to correct when given the opportunity, merited closure. The women of Missouri deserve better.”

The loss of its last abortion clinic would have made Missouri the first state since 1974 left without a licensed facility, and a testament to the struggle stands newly constructed across the Mississippi River: a Planned Parenthood in Fairview Heights, Ill., opened in October to meet the demand from out-of-state patients.

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