Targeted Regulation of Abortion Providers (TRAP)
Missouri imposes extra restrictions on abortion providers, despite the fact that all health-care providers already must comply with a variety of federal and state regulations governing health, safety, building and fire codes, and zoning requirements.
Restrictions on Where Abortion Services May Be Provided
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). All abortion providers must have staff privileges at a hospital within 15 minutes' travel time or maintain a working arrangement with a hospital within such a distance. Nothing requires the hospital to grant providers such an arrangement. Mo. Code Regs. Ann. tit. 19, §§ 30-30.060(1)(C)(4).
Missouri regulations require each provider to be licensed as an "abortion facility" if 51 percent or more of its patients receive abortion care, or if 51 percent or more of its 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 medically unnecessary 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 10 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 enacted 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." 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 forced to leave 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). The state district court denied Planned Parenthood's motion for summary judgment on the matter, citing the suit's redundancy with the ongoing federal case. In 2009, a Missouri court of appeals affirmed the lower court's judgment that Planned Parenthood could not seek relief in the state courts while its federal suit was ongoing. Planned Parenthood of Kansas and Mid-Missouri Inc. v. Jane Drummond, Jeremiah W. Nixon, and James F. Kanatzar, No. 0716-CV30805 (Mo. Cir. Ct. May 9, 2008), aff'd sub nom. Planned Parenthood of Kansas and Mid-Missouri Inc. v. Donnelly 2009 WL 2341890 (Mo. App. W.D. July 31, 2009).
Missouri has an unconstitutional and unenforceable statute that requires all abortion services after 16 weeks be provided 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 abortion services after the 12th week also was declared unconstitutional. Planned Parenthood Ass'n of Kansas City v. Ashcroft, 462 U.S. 476 (1983).
Restrictions on Who May Provide Abortion ServicesMissouri prohibits certain qualified health-care professionals from providing abortion services.
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 provide abortion services. 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); Mo. Ann. Stat. § 334.245(1) (Enacted 2010).
A court held that the provision requiring physicians providing abortion services 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).
A physician's assistant may not provide abortion services. Mo. Ann. Stat. § 334.735(10) (Original Statute Enacted 1989; Relevant Provision Enacted 1998).