Missouri authorities could soon rule on whether the state’s only remaining abortion clinic will remain open despite failures to meet basic patient care standards, and abortion advocates are already publicizing high abortion numbers at the new multi-million-dollar Planned Parenthood clinic built in secret just across the Illinois state line.

In June 2019, the Missouri Department of Health and Senior Services refused to renew the license of the clinic, Reproductive Health Services of Planned Parenthood of the St. Louis Region, to perform abortions.

A Missouri judge and the Missouri Administration Hearing Commission both granted a temporary stay of the health department’s decision, allowing the clinic to remain open while the case was reviewed.

March 16 marked the deadline for written briefs to be filed with the Missouri Administrative Hearing Commission. The state health department had requested an extension to the original Feb. 28 deadline.

A decision is now “imminent,” advocates in the case told the U.K. newspaper The Guardian.

Before Missouri’s health department refused to renew the license, it submitted to court a “Statement of Deficiencies.” It cited an “unprecedented lack of cooperation” on the part of the St. Louis clinic, as well as a “failure to meet basic standards of patient care.” The statement also identified four instances of failed abortion procedures at the clinic.

Planned Parenthood’s attorneys argued that the state “cherry-picked” a “handful of difficult cases” out of an estimated 3,000 abortions performed at the facility. Its defenders have said that state inspectors did not find an unsafe environment.

Planned Parenthood has provided an analysis to National Public Radio reporting that only three abortions were performed at its St. Louis clinic in February 2020, compared to 174 abortions the previous year. However, 323 abortions were performed at the new Planned Parenthood clinic in nearby Fairview Heights, Ill.

Yamelsie Rodriguez, CEO of Planned Parenthood of the St. Louis Region and Southwest Missouri, said that women are seeking abortions in Illinois due to more permissive abortion laws. Missouri also has a 72-hour waiting period for abortion.

“When they are weighing their options, the majority of patients are clearly seeing that abortion access is so unmanageable that they're choosing to cross state lines,” Rodriguez told NPR.

The new clinic, which opened in October 2019, has space of 18,000 square feet and cost about $7 million to build.

Mary Kate Knorr, Illinois Right to Life Executive Director, in October said the facility is a “money-making venture.”

“Make no mistake – this new mega-facility is not a response to an increased demand, nor is it a gesture of care for women. This facility was created to fill the gaping hole they’re seeing in their bottom line,” Knorr said.

“The construction of this new facility was a strategic business move – certainly not a defense of women.”

Planned Parenthood constructed its new abortion clinic in secret just 13 miles from the St. Louis clinic. It used a shell company to hide that the facility would become one of the nation’s largest abortion clinics.

Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri, told CBS News in October that abortion facilities in other areas had faced public outcry and protest during their construction, hence their decision to build the clinic in secret.

Missouri authorities, however, could have final say over the St. Louis Planned Parenthood clinic.

According to the Missouri health department's “Statement of Deficiencies,” Planned Parenthood went back on its agreement to perform pelvic examinations as a “preoperative health requirement.” Several doctors at the clinic refused requests to provide interviews with the health department, and the clinic would not have been prepared for a case of a woman who suffered “severe hemorrhaging” at a hospital before being referred to Planned Parenthood.

For its part, Planned Parenthood has accused the state of weaponizing the regulatory process and claimed the state has admitted the pelvic exams are “medically unnecessary.”

Some states have seen strong trends in favor of restricting abortion and providing legal protections to the unborn, expecting possible changes in U.S. Supreme Court precedent.

Missouri enacted a comprehensive abortion ban in 2019, which Republican Gov. Mike Parson signed into law. The legislation was supported by Archbishop Robert Carlson of St. Louis.

Missouri’s law set up a multi-tier ban on abortions after eight weeks, 14 weeks, 18 weeks and 20 weeks, as well as bans on abortions conducted solely because of the baby’s race, sex, or Down syndrome diagnosis.

The law was crafted to be able to survive in the courts, but a federal judge in August 2019 struck down all of the bans related to the stages of pregnancy. At present the court left intact the disability, race, and sex-selective abortion bans.

In contrast to Missouri, Illinois law has moved further in a pro-abortion rights direction. In June Democratic Gov. J.B. Pritzker of Illinois signed legislation to expand vastly access to abortion in that state.

The Reproductive Rights Act ended a ban on dilation and evacuation abortion, removed regulations for abortion clinics, and ended required waiting periods to obtain an abortion. It also lifted criminal penalties for performing abortions, required all private health insurance plans to cover elective abortions, and eliminated abortion reporting requirements, as well as regulations requiring the investigation of maternal deaths due to abortion.

The legislation was strongly opposed by Illinois’ Catholic bishops.