St. Louis, Missouri — The last remaining abortion clinic in Missouri says it expects to be shut down this week, effectively ending legal abortion in the state.
In a statement Tuesday, Planned Parenthood said Missouri's health department is "refusing to renew" its annual license to provide abortion in the state. If the license is not renewed by May 31, Missouri would become the first state without a functioning abortion clinic since 1973 when Roe v. Wade was decided.
Planned Parenthood filed a lawsuit requesting a restraining order against the state, hoping to restore the license and avoid service disruption. A circuit court judge will hear arguments on Wednesday.
Planned Parenthood would still be able to provide non-abortion health services for women in Missouri.
Planned Parenthood said it plans to sue the state "in order to try to keep serving Missouri women."
"This is not a drill. This is not a warning. This is a real public health crisis," said Dr. Leana Wen, president and CEO of the Planned Parenthood Federation of America.
Lisa Cox, a spokesperson for The Missouri Department of Health and Senior Services, told CBS News on Tuesday morning via email that Planned Parenthood's license was "under review," and did not respond to additional questions.
Representatives for Planned Parenthood told CBS News that the upcoming deadline follows weeks of back-and-forth with state health officials.
On May 20, the Missouri Department of Health and Senior Services notified Planned Parenthood of three issues that could impact license renewal, according to documents reviewed by CBS News and provided by Planned Parenthood.
On May 22, Planned Parenthood said it would address two of them: adjusting who at the clinic provided the state-mandated counseling and adding an additional pelvic exam for abortion patients.
But it said a third request was out of its control. According to Planned Parenthood, the health department said it was investigating "deficient practices," and needed to interview seven physicians who provide care at the clinic. Planned Parenthood said it could offer interviews only with two who are its employees. The other five physicians working at the facility are residents in training and not employed by Planned Parenthood, a spokesperson for the clinic said via email on Tuesday. The state has indicated that the result of those interviews could be "board review" in addition to "criminal proceedings," the spokesperson said. The medical residents declined to be interviewed for the state's investigation.
In its letter, the Department of Health wrote that it could not "complete our investigation until it interviews the physicians involved in the care provided in the potential deficient practices," and that "the investigation needs to be completed and any deficiencies resolved before the expiration of [the clinic's] license on May 31, 2019."
Dr. Colleen McNicholas, a Planned Parenthood physician in St. Louis, said the agency hasn't shared details of the investigation or the potential concerns. She expected to be interviewed by the health agency Tuesday afternoon, an apparent compromise from the state, which had initially requested that interviews be conducted in a specific order with other physicians going first.
"We are 100 percent committed to the best care that we can provide for patients. So certainly if there is an issue with the care we're providing we want to know about it," she said. "We want to be able to address that. But we can't do that when we're being attacked."
In 2019, six states — including Missouri — have passed laws banning virtually all abortions. In each case, the laws have not yet been enacted and face court challenges.
But now it appears Missouri would be losing its last clinic as a result of state regulations, not a new law.
Clinics that can't comply with the regulations may be forced to shut their doors, something that happened to several clinics in Missouri when the state began requiring pelvic exams for medical abortions, a method administered by pill, according to McNicholas.
Although Planned Parenthood, in this year's negotiations with the state, agreed to administer an extra pelvic exam for surgical abortions, the group wouldn't budge on pill-administered ones.
"When I say an unnecessary pelvic exam what I mean is that the state is forcing me to put my fingers in somebody's vagina when it is totally medically irrelevant," McNicholas said. "That is really bordering on harassment... I am really proud of our clinicians for taking a stand and saying you know we just won't do that to patients."
In 2008, Missouri had 5 abortion clinics.
"This a chilling warning for all of us that we are in a public health crisis," said Dr. Wen in an email to CBS News.
"Today it's Missouri, tomorrow it could be all of America."