The Missouri health department issued a license to the state's only abortion clinic Thursday. Its license had been revoked a year ago over regulators' concerns about health and safety problems at the clinic.

The state's Administrative Hearing Commission had ruled last month that the Missouri Department of Health and Senior Services was wrong not to renew Reproductive Health Services of Planned Parenthood of the St. Louis Region's license to perform abortions.

The health department inspected the clinic in St. Louis before granting the license June 25. If it should want to appeal the ruling from the Administrative Hearing Commission, the health department must do so by June 29.

The license had been revoked in June 2019, but the administrative commission and a state judge both granted a temporary stay of the health department’s decision, allowing the clinic to remain open while the case was reviewed.

The health department has 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,” identifying four instances of failed abortion procedures at the clinic; among these, one of the mothers developed sepsis, and another was hospitalized with life threatening complications.

According to the health department, 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.

A 2016 report on an inspection of the clinic by the health department shows that the clinic at that time was in violation of multiple state standards involving the sterilization and storing of equipment, and the proper documentation of medication and procedures.

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

In October 2019 Planned Parenthood opened a new clinic in Fairview Heights, Ill., just 15 miles east of St. Louis.

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.

Earlier this month a federal appellate court dismissed a lawsuit filed by a member of the Satanic Temple against Missouri’s informed consent abortion law, rejecting the argument that the law established Catholic religious belief by stating that life begins at conception.

“Any theory of when life begins necessarily aligns with some religious beliefs and not others,” said U.S. Circuit Judge David R. Stras in a June 9 decision from the U.S. 8th Circuit Court of Appeals. Under the plaintiff’s theory, the decision said, “Missouri’s only option would be to avoid legislating in this area altogether.”

State law requires abortion providers to distribute a booklet from the Missouri Department of Health and Senior Services which includes the statement: “The life of each human being begins at conception. Abortion will terminate the life of a separate, unique, living human being.”

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. In August 2019 a federal judge struck down all of the bans related to the stages of pregnancy, but left intact the disability, race, and sex-selective abortion bans.