Targeted Regulation of Abortion Providers (TRAP)
Missouri imposes a variety of burdensome requirements on abortion providers that are not imposed on other health care providers, including:
Restrictions on Where Abortions May Be Performed
Among the most common TRAP regulations are those restricting the performance of abortions to hospitals or other specialized facilities, which place medically unnecessary and costly requirements on doctors and can decrease the availability of abortion care for women. Missouri has such regulations, including:
Abortion providers must be located within 30 miles of a hospital, or face criminal penalties. No exception is provided for rural areas. Mo. Stat. Ann. § 188.080 (Original Statute Enacted 1974; Relevant Provision Enacted 2005). A court issued a temporary restraining order prohibiting the state from enforcing this provision, but this order was dissolved after the clinic bringing suit shut down. Springfield Healthcare Center v. Nixon, No. 05-4296-CV-C-NKL (W.D. Mo. Sept. 16, 2005) (issuing temporary restraining order), Springfield Healthcare Center v. Nixon, No. 05-4296-CV-C-NKL (W.D. Mo. Oct. 25, 2005) (dissolving temporary restraining order).
Missouri regulations require all providers to be licensed as an "abortion facility" if 51% or more of their patients receive abortions, or if 51% or more of their revenues are "from abortions or procedures related to abortions." Mo. Code Regs. Ann. tit. 19, §30-30.050(1)(A), (B), .050(2)(A). Facilities that were built after the rule was put into effect in 1987 must comply with dozens of administrative, professional qualification, patient and employee testing, and physical plant requirements. Mo. Ann. Stat. §§ 188.060 (Enacted 1974; Last Amended 1979), 188.080 (Enacted 1974; Last Amended 2005); Mo. Code Regs. Ann. tit. 19, §§ 30-30.060, 30-30.070. These include particularly costly and onerous construction and design requirements, such as that procedure rooms must be at least 12 feet long and wide with ceilings at least nine feet high and doors at least 44 inches wide, corridors must be at least six feet wide, and separate counseling rooms are required and must be at least ten feet long and wide. Mo. Code Regs. Ann. tit. 19, §§ 30-30.070(2)(B), .070(2)(C), .070(2)(M), .070(2)(Z). Facilities that existed at the time the regulations were passed had to comply with other physical requirements that were slightly less cumbersome than those for facilities built after 1987. Mo. Code Regs. Ann. tit. 19, § 30-30.070(3).
Recently, Missouri passed another law that would require most, if not all, health care facilities that provide abortion care in Missouri to become licensed "ambulatory surgical centers," regardless of how long the facility has been operating. Mo. Ann. Stat. § 197.200. Becoming an ambulatory surgical center is a highly burdensome and unnecessary process that would force providers to make even more expensive and time consuming changes to their facilities than are already required. This would likely result in abortion providers being shut down and patients being forced to travel out of the state to receive abortion care. On September 24, 2007, a court granted a preliminary injunction to stop the state of Missouri from immediately enforcing the law. Planned Parenthood of Kansas and Mid-Missouri Inc. v. Jane Drummond, Jay Nixon, Daniel Knight, and James Kanatzar, No. 07-4164-CV-C-ODS (W.D. Mo. filed Sept. 24, 2007) (issuing preliminary injunction). The court ordered abortion providers and the state to work together to modify the clinic regulations and return to the court in the event of an impasse. Subsequently, a lawsuit was filed in a Missouri state court asking to exclude providers from the law who only prescribe the medical abortion pill (commonly known as RU 486 or mifepristone). Planned Parenthood of Kansas and Mid-Missouri Inc. v. Jane Drummond, Jeremiah W. Nixon, and James F. Kanatzar, No. 0716-CV30805 (Mo. Cir. Ct. filed Oct. 22, 2007). A decision has not been rendered in that case.
Missouri has an unconstitutional and unenforceable statute that requires all abortions after 16 weeks of pregnancy or later be performed in a hospital. Mo. Ann. Stat. § 188.025 (Enacted 1974; Last Amended 1986). The statute was declared unconstitutional in Reprod. Health Servs. v. Webster, 851 F.2d 1071 (8th Cir. 1988), aff'd in part and rev'd in part on other grounds, 492 U.S. 490 (1989).
An earlier version of the requirement mandating hospitalization for all abortions after the 12th week of pregnancy was also declared unconstitutional. Planned Parenthood Ass'n of Kansas City v. Ashcroft, 462 U.S. 476 (1983).
Restrictions on Who May Perform Abortions
Missouri prohibits certain qualified health care professionals from performing abortions.
Only a physician licensed by the state to practice medicine in the state and having surgical privileges at a hospital that offers obstetrical or gynecological care may perform an abortion. Mo. Ann. Stat. § 188.015(5) (Enacted 1974), Mo. Ann. Stat. § 188.020 (Enacted 1974; Last Amended 1979), Mo. Ann. Stat. § 188.080 (Enacted 1974; Last Amended 2005).
A physician's assistant may not perform an abortion. Mo. Ann. Stat. § 334.735(10) (Original Statute Enacted 1989; Relevant Provision Enacted 1998).
A court held that the provision requiring physicians performing abortions to have surgical privileges at specified hospitals is constitutional. Women's Health Ctr. of West County, Inc. v. Webster, 871 F.2d 1377 (8th Cir. 1989).
