The same day a federal appeals court overruled itself and voted to block two Missouri abortion restrictions, the state advised Missouri abortion providers that they will have to abide by a new restriction.
A memo dated Oct. 2 from the Missouri Department of Health and Senior Services (DHSS) says the agency will file emergency rules on Oct. 24 establishing standards for “complication plans” for medication-induced abortions.
The memo says the emergency rules will require doctors providing medical abortions to contract with an OB-GYN or group of OB-GYNs to treat complications arising from the procedure.
The memo says the rules are being enacted under Senate Bill 5, which was enacted during a special session called earlier this year by Gov. Eric Greitens. The law requires providers offering medical abortions to have complication plans approved by DHSS.
Medication-induced abortions are among the safest medical procedures, so it's not clear what the medical rationale for the rule is. A 2012 study of medical abortions performed at 317 Planned Parenthood clinics found that less than 1 percent of women experienced side effects or failed abortions. Another study showed that rates of infection requiring hospitalization were 0.01 percent and rates of transfusion were 0.03 percent.
The procedure typically involves a combination of two pills: mifepristone, better known as RU-486, which blocks the hormone necessary to maintain a pregnancy, and misoprostol, which works to empty the uterus.
Dr. Randall W. Williams, director of DHSS, could not immediately be reached for comment.
Aaron Samulcek, interim president and CEO of Planned Parenthood Great Plains, said the contracted-physician requirement was "unconstitutional" and "medically unnecessary."
"This is the state of Missouri, once again, attempting to circumvent well-established Supreme Court precedents in order to punish women in need of safe, legal abortion services," he said. "PPGP will not allow this new rule to get in the way of our efforts to expand abortion access in Missouri. We look forward to restoring abortion services at our Columbia Health Center in the coming days."
Samulcek was referring to Planned Parenthood's efforts to secure a license to perform surgical abortions at its clinic in Columbia, Missouri.
Arkansas imposed a similar contracted-physician requirement on abortion providers. Planned Parenthood challenged that restriction and a federal court blocked it from taking effect. Arkansas has appealed to the 8th U.S. Circuit Court of Appeals.
In court documents, Planned Parenthood said that the Arkansas requirement would provide no benefit but “would have a devastating effect on abortion access in Arkansas by eliminating medication abortion entirely, leaving only surgical abortion available at one health center, and requiring women to travel great distances to obtain an abortion.”
That’s because Planned Parenthood was unable to find a single physician in Arkansas willing to enter into the required agreement, Planned Parenthood asserted.
“As the district court further recognized, (Planned Parenthood) understandably had trouble locating a contracted physician because ‘physicians who provide abortions or associate with physicians who provide abortions risk being ostracized from their communities and face harassment and violence toward themselves, their family, and their private practices,’” Planned Parenthood said.
The DHSS memo was issued the same day the 8th U.S. Circuit Court of Appeals, after initially granting Missouri’s request to lift an injunction blocking other abortion restrictions, had a change of heart and left the injunction in place.
The injunction was issued by a federal judge in Kansas City after Planned Parenthood sued to block the restrictions. One restriction required abortion providers to have admitting privileges at nearby hospitals. The other required abortion clinics to meet the standards of surgical centers.
The U.S. Supreme Court last year ruled that similar restrictions enacted by Texas were unconstitutional.
Correction: An earlier version of this story referred to the Missouri Department of Health and Human Services. The agency's correct name is the Missouri Department of Health and Senior Services.
Dan Margolies is KCUR’s health editor. You can reach him on Twitter @DanMargolies.