Anna Spoerre, Missouri Independent

Missouri’s trigger law banning nearly all abortions remains in place. But at 12:01 a.m. Friday, Amendment 3 will go into effect.

The constitutional amendment, which received 51.6% of the nearly 3 million votes cast, prohibits the legislature from regulating abortion prior to the point of fetal viability — generally seen as the point at which a fetus can likely survive outside the womb without extraordinary measures.

Planned Parenthood officials said they have providers and staff prepared to start seeing patients for walk-in medication abortion appointments at three clinics — in Kansas City, St. Louis and Columbia — beginning Friday, followed later by scheduled surgical abortions.

But whether that happens depends on the outcome of a lawsuit that had its first hearing before a Jackson County judge Wednesday morning.

“What we don’t have are the abilities to overcome state restrictions and hurdles that were intended to deny care,” Emily Wales, President and CEO with Planned Parenthood Great Plains, said Wednesday evening.

Less than 24 hours after voters narrowly approved Amendment 3, the ACLU of Missouri, Planned Parenthood Great Plains and Planned Parenthood Great Rivers filed a lawsuit seeking to take down decades worth of overlapping restrictions and bans on abortion on the books in Missouri.

There was no disagreement between Planned Parenthood and the Missouri Attorney General’s office that Amendment 3 makes unconstitutional the trigger law that went into effect in June 2022 when the U.S. Supreme Court overturned the right to abortion.

The disagreement instead revolves around more than a dozen “targeted regulation of abortion providers” laws, also known as TRAP laws, that previously made abortions all but inaccessible in Missouri prior to the total ban taking effect.

Planned Parenthood is asking a Jackson County judge to grant a preliminary injunction which would immediately declare the current ban and the TRAP laws unconstitutional.

“Every single day that Missourians cannot access their constitutional rights, they’re being denied critical care,” Wales said.

Solicitor General Josh Divine, who argued Wednesday’s hearing on behalf of the state, characterized the lawsuit as “unusually aggressive,” saying it would be more appropriate for the plaintiffs to challenge each TRAP law individually rather than all together “on a very short fuse.”

He added that preliminary injunctions should only be granted in “drastic, extraordinary circumstances.” The lawsuit at hand, he contended, does not apply because Missourians are still able to access abortion in Illinois to the east and Kansas to the west.

“Nobody’s actually going to be materially affected by what this court does,” Divine added.

A decade ago, more than 5,000 abortions were performed in Missouri, according to data from the Missouri Department of Health and Senior Services.

By 2020, two years before the abortion ban went into effect, that number dropped to 167 as a result of the TRAP laws.

Anti-abortion lawmakers, activists call on Missouri court to rule against Planned Parenthood

Sam Lee, a longtime Missouri anti-abortion activist and lobbyist, said he’s been pleased by the attorney general’s defense of Missouri’s anti-abortion laws.

If the TRAP laws remain in effect, as Lee is hoping, “it may severely affect Planned Parenthood’s ability to do abortions, because they weren’t doing abortions when those laws were in effect some years ago.”

Judge Jerri Zhang, who is overseeing the case, did not immediately rule on the injunction when the hearing concluded late Wednesday evening.

She did, however, deny the state’s request to remove Jackson County Prosecutor Jean Peters Baker as a defendant and move the case to Cole County. Earlier this year, a Cole County judge struck Amendment 3 from the ballot, a decision that was quickly overridden by the Missouri Court of Appeals.

The attorney general’s office said they plan to appeal Zhang’s decisions, arguing that Peters Baker does not appropriately represent all statewide prosecutors because of her previous statements in support of abortion rights.

The Missouri Attorney General’s Office also posed a court challenge to the Planned Parenthood suit. This latest lawsuit, filed last week in Cole County, questions Planned Parenthood Great Plains’ ability to sue the state, claiming a 2010 settlement agreement prevents them from doing so.

Missouri’s TRAP laws

For decades, Missouri legislators have passed laws restricting abortion access and regulating the procedure.

“The voters have now changed all of that,” Eleanor Spottswood, an attorney with Planned Parenthood, argued before the court Wednesday.

Amendment 3 states, in part, that “the right to reproductive freedom shall not be denied, interfered with, delayed, or otherwise restricted unless the government demonstrates that such action is justifiable by a compelling governmental interest achieved by the least restrictive means.”

The litigation challenges numerous current laws, including a mandatory 72-hour waiting period between an initial appointment and the abortion procedure; requirements that abortion clinics must have admitting privileges at a hospital roughly 15 minutes away; and a requirement that the same physician who initially saw the patient also perform the abortion.

The lawsuit is also challenging the current law criminalizing physicians who perform abortions.

Spottswood argued that a failure to immediately strike down the TRAP laws would cause “irreparable harm” to Missourians because “patients and providers have to do twice the work to access abortion.”

Meanwhile, the attorney general’s office argued that striking down such laws would cause more harm.

Divine on multiple occasions cited an FDA label for mifepristone, one of two medications used to induce a medication abortion, that shows that according to two U.S. studies of about 1,00 women, up to 5% of women who took mifepristone ended up in the emergency room. It did not specify if the emergency room visits were necessary.

The same FDA label says that across three studies of more than 14,000 women who took mifepristone, fewer than 0.6% were admitted to the hospital as a result of the medication.

Divine also noted that no individual women seeking abortions were named as plaintiffs in the lawsuit, arguing that’s because women don’t actually want abortions once given more information. He said this is why the state’s requirements that those seeking abortions first be given the state’s informed consent booklet should remain.

“It’s against their moral beliefs,” Divine said. “But they’re being pressured, often by an abusive partner, by parents, things of that nature, so what we’re trying to do is we’re trying to create a situation where those women can in fact make the choice that they want to do, and we know most of the time that’s childbirth.”

About one in four women in the United States have an abortion before the age of 45, according to 2020 data. In 2021, around 94% of abortions occurred before 14 weeks gestation. Abortions later than 20 weeks account for fewer than 1% of all abortions in the United States, according to the Centers for Disease Control and Prevention.

Divine, in his final arguments Wednesday, characterized the state’s TRAP laws as incidental, much like speeding laws or road construction that could delay someone getting to an abortion. But he said the TRAP laws don’t fall under the strict scrutiny requirement and therefore don’t require an immediate ruling.

Solicitor General Josh Divine called Planned Parenthood’s lawsuit seeking to unravel Missouri’s abortion restrictions “unusually aggressive” while speaking to media Wednesday, Dec. 4, 2024, outside the Jackson County Courthouse (Anna Spoerre/Missouri Independent).

Zhang asked if delaying an abortion through the required 72-hour waiting period would infringe on a patient’s autonomy, especially if the patient was a day or two shy of 10 weeks gestation, when procedures switch from medication to surgical abortions.

Divine responded that the attorney general’s office believes Amendment 3 gives Missourians the right to an abortion, but doesn’t give them the right to a certain abortion procedure.

He also noted that Amendment 3 doesn’t specifically mention the legalization of mifepristone, alluding to future attempts by the incoming GOP administration to enforce the Comstock Act, an 1873 law that bans mailing obscene material, including for the use of abortion.

Missouri’s attorney general has renewed a push to restrict access to the abortion pill mifepristone, arguing in a lawsuit filed this month that its availability hurt the state by decreasing teenage pregnancy.

The revised lawsuit was filed by Missouri Attorney General Andrew Bailey, alongside GOP attorneys general in Kansas and Idaho. It asks a judge in Texas to order the Federal Drug Administration to reinstate restrictions on mifepristone, one of two medications prescribed to induce chemical abortions.

The trio of attorneys general were forced to refile the litigation after the U.S. Supreme Court rejected the original lawsuit after concluding the original plaintiffs — a group of anti-abortion doctors and medical organizations — did not have standing to sue because they couldn’t show they had been harmed.

In making the case that the states have standing this time, the attorneys general contend access to mifepristone has lowered “birth rates for teenaged mothers,” arguing it contributes to causing a population loss for the states along with “diminishment of political representation and loss of federal funds.”

“Younger women are more likely to navigate online abortion finders or websites ordering mail-order medication to self-manage abortions,” the filing argues.

Missouri’s teen pregnancy birth rate has steadily declined over the past several years, according to the Centers for Disease Control and Prevention, though it still remains among the highest in the country.

The family business that owns the Kansas City Chiefs is one of the biggest funders of a political action committee opposing a proposed amendment to overturn Missouri’s abortion ban.

Unity Hunt, the business that controls the assets of the late Lamar Hunt, including the Chiefs, in late September donated $300,000 to the Leadership for America PAC. It is currently running ads on several conservative radio stations across the state opposing the abortion-rights amendment, which will appear on the November ballot as Amendment 3.

Leadership for America is an independent spending PAC created in January. Prior to receiving the donation from Unity Hunt, the PAC had $31,159 on hand.

Along with paying directly for radio ads, Leadership for America has donated $100,000 to Vote “No” on 3, the main opposition group in the Amendment 3 campaign. And on Oct. 3, the PAC donated $100,000 to a PAC called Missouri Leadership Fund, which gave $100,000 to Vote “No” on 3 six days later.

Neither Unity Hunt nor the Kansas City Chiefs responded to requests for comment.

No one from Leadership for America could be reached for comment. The telephone number given to the Missouri Ethics Commission for treasurer John Royal has been disconnected.

The ads, which began airing across the state on Monday, call Amendment 3 “cleverly-worded to convince you that it only allows abortions until fetal viability.”

“But it has loopholes that allow for abortions through all nine months of pregnancy,” the ad continues. “Abortion proponents used to say ‘safe, legal and rare.’ But now they want abortion as common as the morning after pill.”

Supporters of the amendment say claims of abortions in the third trimester are misleading, since the legal freedoms around abortion would only apply until fetal viability, which is generally considered to be around 24 weeks, according to the American College of Obstetricians and Gynecologists.

The amendment text would allow the Missouri legislature to regulate abortion after fetal viability with exceptions only to “protect the life, or physical or mental health of the pregnant person.”

Abortion is illegal from the moment of conception in Missouri, with limited exceptions for medical emergencies. There are no exceptions for victims of rape or incest.

Failed GOP attempt to keep abortion off Missouri ballot could foreshadow fight to come

Leadership for America has spent a little more than $32,000 on the radio ads, which are set to run through Nov. 4. There are no other broadcast ads opposing the amendment.

Organized efforts against Amendment 3 have been hugely outspent by Missourians for Constitutional Freedom, the committee backing the amendment. The campaign reported spending $7.3 million through June 30 and has purchased more than $8.7 million in television ads since the start of September.

Vote “No” on 3 has not filed a full disclosure report but has amassed $870,000 in donations greater than $5,000 since Aug. 30.

While the content of the Leadership for America ad aligns with most other opposition talking points, the original source of the money behind the ad drew some attention.

“It is incredibly disappointing to see Unity Hunt spend resources on this campaign to spread lies and continue the fear-mongering surrounding Amendment 3,” said state Rep. Maggie Nurrenbern, a Democrat from Kansas City.

Nurrenbern, who is running for the 17th Senate District in Clay County, said she was particularly alarmed by the size of the donation from a family she said “has done so much good for Kansas City and the Kansas City area.”

State Rep. Ashley Aune, also a Democrat from Kansas City, said she wasn’t surprised to see the Hunt family backing an effort to stop abortion.

“But also, it’s disappointing because when you have such a big platform,” Aune said. “Using that platform to sow misinformation is a really irresponsible way to use it.”

In 2020, Lamar Hunt Jr. served as the master of ceremonies at the Kansans for Life annual Valentine’s Day banquet.

Hunt, an owner of the Chiefs, told the crowd: “I do not think it is a cliché to say we are in a life and death battle for the truth and authentic dignity of the human person.”

Hunt six years earlier published a blog post to his website contemplating what he observed as cultural shifts away from the “pro-choice” movement, comparing the momentum in the “pro-life” community to the San Francisco 49ers comeback and near-win in the final seconds of the 2013 Super Bowl.

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com. Follow Missouri Independent on Facebook and X.

The decision to keep a constitutional amendment legalizing abortion on the November statewide ballot was decided by a narrowly-divided Missouri Supreme Court, according to opinions released Friday.

The majority opinion was written by Judge Paul Wilson, with Chief Justice Mary Russell, Judge Robin Ranson and Judge Brent Powell concurring.

The dissent was authored by Judge Kelly Broniec, with Judge Zel Fisher and Judge Ginger Gooch concurring in the dissent.

Amendment 3, if approved by a simple majority, would legalize abortion up until the point of fetal viability and protect other reproductive rights, including birth control. Abortion is illegal in Missouri with limited exceptions for medical emergencies. There are no exceptions for victims or rape or incest.

The Supreme Court, while divided, made one point clear in both the majority and dissenting opinions: “this case is not about abortion.”

“It concerns only what information the constitution requires proponents to include on any initiative petition,” Wilson wrote in the majority opinion. “It is about form and procedure, not substance.”

Wilson was appointed to the court by then-Democratic Gov. Jay Nixon. Russell was appointed by former Democratic Gov. Robert Holden. Powell was appointed by former Republican Gov. Eric Greitens, and Ranson was appointed by current Republican Gov. Mike Parson

Broniec and Gooch were appointed by Parson, and Fisher was appointed by Republican Gov. Matt Blunt.

Both Gooch and Broniec are up for retention elections this year.

The initial case stemmed from a lawsuit filed in late August by a group of anti-abortion lawmakers and activists claiming the initiative petition that was later certified and approved as an amendment, failed to follow a number of laws.

This includes a section of state law requiring initiative petitions “include all sections of existing law or of the constitution which would be repealed by the measure.”

The plaintiffs — state Sen. Mary Elizabeth Coleman, state Rep. Hannah Kelly, anti-abortion activist Kathy Forck and shelter operator Marguerite Forrest — sued Secretary of State Jay Ashcroft arguing the initiative petition failed to state any laws that would be repealed if it passed.

Attorneys for Missourians for Constitutional Freedom, the campaign behind the ballot measure, have said the amendment would not repeal the state’s current abortion law or take it off the books. Instead, they told the courts, it would create a new law that would supersede much of the existing one because not every element of the current law would be rendered moot, including laws protecting women who get abortions from prosecution.

They also argued anything that falls under the scope of the amendment would be left to the judicial system to interpret and not truly repealed just in the amendment’s passing.

More than 800 Missouri medical professionals sign letter in support of abortion amendment

A majority of the Supreme Court ruled that interpreting the law to require listing every possible provision that could be impacted by an amendment would have “absurd effects.”

“It seems reasonable to expect that few – if any – initiative petitions could survive under such a statute,” Wilson wrote.

He added that to interpret the statute as such would be unconstitutional because it would impede citizens’ right to the initiative petition process.

“In fact,” Wilson wrote, “it is hard to imagine how a statute could impair and impede the initiative process more.”

Broniec, in her dissent, took a broader interpretation of the word “repeal,” saying that it is also defined as the ability to “effectively render invalid.”

She called the majority opinion “an absurd result contrary to the plain language” of the state constitution.

If Amendment 3 passes, Broniec wrote, Missouri’s current abortion ban cannot continue to stand. She noted a handful of other current laws that could be in conflict with the amendment, including parental consent for minors and the mandatory 72-hour waiting period between meeting with a doctor and receiving an abortion.

“Today’s opinion from the Missouri Supreme Court was a complete rejection of the anti-abortion politicians’ arguments and attempts to subvert our constitutional right to vote to protect reproductive freedom,” Tori Schafer, an attorney with the ACLU of Missouri, said in a statement Friday. “Including access to abortion, birth control and miscarriage care.”

Coleman, one of the plaintiffs, wrote on social media Friday that she agreed the issue at hand wasn’t abortion.

“It is about abrogating the will of the general assembly,” Coleman wrote. “By using absurd arguments to reach their desired result.”

Mary Catherine Martin, an attorney with the Thomas More Society who represented the plaintiffs, said in a statement Friday that she still believes the crafters of the initiative petition violated state laws.

“It should not require courage to clearly apply the law, but it does when powerful political forces oppose a just outcome,” Martin said. “We applaud the courage of these three dissenting judges.”

The Supreme Court published its decision on Aug. 10, a few hours after oral arguments were completed and less than three hours before the constitutional deadline to remove a question from the ballot.

In their decision, the majority reversed a lower court ruling made just four days earlier by Cole County Circuit Judge Christopher Limbaugh, who recommended the measure be stripped from the Nov. 5 ballot.

As part of its decision, the Supreme Court ordered that Ashcroft “certify to local election authorities that Amendment 3 be placed on the Nov. 5, 2024, general election ballot and shall take all steps necessary to ensure that it is on said ballot.”

A day earlier, Ashcroft, in an unprecedented move, attempted to decertify the ballot measure based on the lower court’s ruling, and temporarily removed Amendment 3 from the Secretary of State’s website.

Correction: This story was updated at 4:10 p.m. to clarify that Chief Justice Mary Russell was appointed by former Democratic Gov. Robert Holden.

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com. Follow Missouri Independent on Facebook and X.

The Missouri Supreme Court will decide whether an abortion-rights will end up on the Nov. 5 ballot after a Cole County judge ruled the proposed amendment violated state law.

The case bypassed the court of appeals over the weekend and headed straight to the state’s highest court, which scheduled oral arguments for 8:30 a.m. Tuesday — the same day ballots are supposed to be printed for those voting absentee.

Sunday afternoon, attorneys representing the campaign behind the amendment, which would appear on the ballot as Amendment 3, filed an emergency motion asking the court to allow it to proceed to the ballot while the case plays out. Doing so, they argued, would “preserve the status quo and prevent irreparable harm to intervenors-appellants, election officials throughout the state and Missouri voters themselves.”

Amendment 3 would establish the constitutional right to an abortion up until fetal viability and grant constitutional protections to other reproductive health care, including in-vitro fertilization and birth control. It would also protect those who assist in an abortion from prosecution.

Abortion is illegal in Missouri, with limited exceptions for the life and health of the mother.

2 years after Missouri banned abortion, navigating access still involves fear, confusion

In late August, a group of anti-abortion lawmakers and activists sued Missouri Secretary of State Jay Ashcroft, accusing him of wrongly certifying the citizen-led ballot initiative for the Nov. 5 ballot nine days earlier.

Late Friday evening, Cole County Circuit Judge Christopher Limbaugh ruled in favor of the plaintiffs, saying the text of the initiative petition failed to list what existing laws would be repealed if it passed, as he said is required by state law.

He suggested the amendment be withheld from the ballot, but also left the door open for an appeal to a higher court, saying he recognized “the gravity of the unique issues involved in this case, and the lack of direct precedent on point.”

Limbaugh was appointed to the newly-created judicial position in the 19th circuit on Aug. 2 by Missouri Gov. Mike Parson, for whom he previously served as general counsel.

He was previously a potential candidate to replace Eric Schmitt as Missouri Attorney General after he was elected to the U.S. Senate. His father was a federal court judge and his cousin was the late Rush Limbaugh, a conservative radio host who was awarded the Presidential Medal of Freedom by former President Donald Trump.

Missourians for Constitutional Freedom, the campaign behind the amendment, quickly appealed his decision.

Tori Schafer, an attorney with the ACLU of Missouri, speaks to media following a trial over Amendment 3 on Friday outside the Cole County Courthouse (Anna Spoerre/Missouri Independent).

“Judges come from their own experience and background, and they’re not imperfect,” Emily Wales, president and CEO of Planned Parenthood Great Plains Votes, a member of the Missourians for Constitutional Freedom coalition, said Sunday, later adding: “What we’re asking is that the Supreme Court hold us to the same standard everyone else has had.”

Missouri law requires that initiative petitions “include all sections of existing law or of the constitution which would be repealed by the measure.”

Loretta Haggard, an attorney representing the campaign said during a hearingFriday that the amendment would not literally repeal the state’s current abortion law and take it off the books, but rather would create a new law that would supersede much of the existing one.

She said this is because not every element of the current law would be rendered moot: the two texts overlap in that both protect women who get abortions from prosecution and both restrict abortion after fetal viability, generally seen as the point at which a fetus can outside the womb, generally around 24 weeks pregnancy.

Anything else that falls under the scope of the amendment would be left to the judicial system to interpret, Haggard said.

During the trial, Mary Catherine Martin, an attorney with the Thomas More Society representing the plaintiffs, also argued the initiative petition illegally included more than one subject, pointing to language protecting “a person’s fundamental right to reproductive freedom” and saying such a phrase encompasses “infinite subjects.”

Mary Catherine Martin, an attorney with the Thomas Moore Society, represented a group of Missouri anti-abortion lawmakers and activists Friday during a trial at the Cole County Courthouse (Anna Spoerre/Missouri Independent).

Haggard contended that the single subject was clear: “reproductive freedom.”

While Limbaugh ruled the initiative petition did not meet the sufficiency requirement through a “failure to include any statute or provision that will be repealed, especially when many of these statutes are apparent,” he did not address the single subject claims in his decision.

The plaintiffs — state Sen. Mary Elizabeth Coleman, state Rep. Hannah Kelly, anti-abortion activist Kathy Forck and shelter operator Marguerite Forrest — said in a statement Friday evening that the amendment’s scope is about more than just abortion and could be interpreted to also include gender-affirming care and human cloning, though neither are mentioned by name in the amendment.

“There is no way to know if the proponents of this radical amendment would have gathered enough signatures to place this on the ballot if the truth about the staggering scope of laws Amendment 3 invalidates had been disclosed,” they said in a statement.

Wales said the campaign behind Amendment 3 remains undeterred despite the ruling.

“We are right on the law. The history of how initiative petitions have worked in this state has meant that they’re able to vote on their rights,” Wales said. “The constitution creates a process for citizens to engage in democracy, not one that’s intended to trip them up or hinder them from participating in democracy. We think the court is going to see that.”

In May, the campaign turned in signatures from more than 380,000 Missourians across the state who supported the issue landing on the ballot. If Amendment 3 is ultimately voted on in November and wins by a simple majority, Missouri could be the first state to overturn an abortion ban by citizen-vote.

“These ballot initiatives just go through shenanigans, often at the eleventh hour, and what it does again every time is fire people up,” Wales said. “We expect to win, and we’re going to take all the energy and use it to galvanize folks to win in November.”

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com. Follow Missouri Independent on Facebook and X.

Two years ago, Mylissa Farmer was denied an emergency abortion at hospitals in Missouri and Kansas while experiencing a miscarriage.

On Tuesday, she filed a lawsuit against one of the hospitals — The University of Kansas Health System — accusing the hospital of sex discrimination and saying it violated a federal law meant to ensure doctors treat patients who come into the emergency room.

A spokesperson with the health system did not immediately respond to a request for comment.

“While Ms. Farmer was clearly in the midst of a complicated and dangerous miscarriage — and there was no chance her fetus could survive — the care she needed was an abortion because fetal cardiac activity was still detectable,” states the lawsuit filed in Kansas federal court. “Ms. Farmer was entitled to this emergency abortion care under state and federal law.”

Farmer was living in southwest Missouri when she miscarried. Several weeks earlier, Missouri banned abortion in the wake of the U.S. Supreme Court overturning the constitutional right to the procedure.

The day she went to an emergency room — cramping and bleeding at 18 weeks pregnant — Kansas voters were heading to the polls to vote in favor of keeping abortion legal in that state.

Farmer went to the emergency room at Freeman Health’s emergency department in Joplin at her OB-GYN’s urging. There, medical staff determined the pregnancy was no longer viable, but because the fetus had a heartbeat, and because Farmer’s condition wasn’t immediately life-threatening, she was turned away.

Hospitals in Joplin, KCK cited for denying emergency abortion to Missouri woman

According to the lawsuit, doctors told Farmer that she was at risk of infection, severe blood loss, the loss of her uterus and death. But they would not help her because of Missouri’s abortion ban, which had only been in place for several weeks, outlawing all abortions except for in cases where the mother’s life is at risk.

Farmer then traveled three hours across the border to a hospital in Kansas, where abortion is limited after 22 weeks gestation. However, doctors at the University of Kansas Health System also refused to perform an abortion. Kansas law bans abortions at any facilities run by the University of Kansas Hospital Authority, with exceptions only for the life of the mother.

“Ms. Farmer arrived at (the University of Kansas Health) heartbroken, in pain and terrified for her life,” the lawsuit reads.

The doctor who saw Farmer initially told her the hospital would induce labor so Farmer could then hold her daughter and say goodbye, according to the lawsuit. But the doctor later said her decision had been overridden by others at the hospital, and that she could no longer induce labor because it would be too “risky” in Kansas’ “heated” political environment to do so when the fetus still had a heartbeat.

Instead, according to the suit, the hospital refused to even perform routine checks such as taking her temperature and assessing her pain. She was turned away without so much as Tylenol or antibiotics to ward off potential infection despite Farmer being at high risk for infection and experiencing heavy bleeding, mental fog and acute pain.

She returned to the Joplin hospital the next day, was kept overnight and then released without additional treatment.

Farmer eventually traveled several hours to Hope Clinic in Granite City, Illinois, for an abortion on Aug. 5. On the drive there, according to the suit, she was in excruciating pain, by then several days into her miscarriage and almost fully dilated.

Back home after the abortion, Farmer’s OB-GYN diagnosed her with an infection and prescribed her antibiotics.

The damage to Farmer’s health and wellbeing was long-term, the lawsuit argues. She was hospitalized several times after the miscarriage, and was unable to work for months. She eventually lost her home and moved out of Missouri.

What Farmer experienced at the Kansas hospital “compounded the trauma of her pregnancy loss and denied her the ability to mourn that loss on her own terms,” the suit reads.

Farmer, who has a history of polycystic ovary syndrome, had feared she and her husband would not be able to get pregnant prior to the summer of 2022, the lawsuit reads.

Her story caused national outrage as women and providers in states with abortion bans and restrictions navigated new and often vague laws. Under Missouri’s new ban, health care providers who perform abortions deemed not necessary to save a woman’s life can be charged with a class B felony. If convicted, they would face up to 15 years in prison and their medical license could also be suspended or revoked.

In a letter to the hospitals several months later, U.S. Secretary of Health and Human Services Xavier Becerra warned that both locations had to provide all necessary care required by federal law. A report by the Centers for Medicare and Medicaid Services found both hospitals had violated the Emergency Medical Treatment and Labor Act.

This act, known as EMTALA, requires that hospitals treat patients with emergency conditions despite their ability to pay.

“Although her doctors advised her that her condition could rapidly deteriorate, they also advised that they could not provide her with the care that would prevent infection, hemorrhage, and potentially death because, they said, the hospital policies prohibited treatment that could be considered an abortion,” Becerra wrote in May 2023. “This was a violation of the EMTALA protections that were designed to protect patients like her.”

The federal lawsuit comes in the wake of an Idaho EMTALA case recently argued before the U.S. Supreme Court. While awaiting the decision, thousands of doctors, including dozens across Missouri, asked the court to uphold EMTALA.

Emergency care for pregnant women at stake in Supreme Court case, Missouri doctor warns

The nation’s highest court sent the case back down to the court of appeals, lifting an injunction that temporarily blocked enforcement of EMTALA in Idaho. Earlier this year, several women with high-risk pregnancies were airlifted to other states in order for emergency physicians to avoid performing emergency abortions in a state with a ban on the procedure.

Unlike the Idaho case, which was brought by the government, Farmer’s is the first high profile EMTALA lawsuit brought by an individual denied their federal rights while pregnant, said Kenna Titus, a legal fellow with the National Women’s Law Center, the organization representing Farmer.

“In the post-Dobbs world, we know that these protections that are provided by EMTALA for pregnant people are more important than they’ve ever been,” Titus said. “A clear decision in this case will make it clear for people across the country that are dealing with this that this is not a gray area. Federal law requires abortion care in emergency situations like this.”

As of Wednesday, no lawsuit had been filed in federal court against the Joplin hospital.

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com. Follow Missouri Independent on Facebook and X.

A lawsuit filed by Missouri Attorney General Andrew Bailey accusing Planned Parenthood of transporting minors out of state for abortions will move forward, a judge ruled Tuesday evening.

The lawsuit is based on conversations between Planned Parenthood staff and a man with Project Veritas who secretly filmed the staff while inquiring about an abortion for his fake 13-year-old niece.

Planned Parenthood Great Plains, which runs the Kansas City area clinic where the video was taken, asked that the judge dismiss the lawsuit shortly after it was filed.

“We’re reviewing all our options and will continue to vigorously defend this case based on hypotheticals and fictitious patients,” Erin Thompson, general counsel with Planned Parenthood Great Plain, said in a statement Wednesday.

At a hearing in early June, John Andrew Hirth, an attorney for Planned Parenthood, said there was no proof the Kansas City area clinic broke the law.

“There’s no allegation that any abortion has been performed either in Missouri or outside of Missouri, with or without parental consent here,” Hirth said. “The whole conversation is hypothetical.”

But Boone County Judge Brouck Jacobs found merit for moving forward with the case. He did not issue an opinion along with his ruling explaining his reasoning.

“This is the beginning of the end for Planned Parenthood in the State of Missouri,” Bailey said in a statement Tuesday following the ruling.

Missouri Planned Parenthood clinics remain ‘open to all’ despite new Medicaid restrictions

The video, captured in December, was posted on social media by Project Veritas, a self-proclaimed right wing news organization that often conducts undercover stings.

The man filming in the clinic told staff that the made-up girl’s parents couldn’t know about the abortion. Staff then directed him to their affiliate clinics in Kansas where they said he could “bypass” parental consent. When the man asked how often girls go out of state for abortions, the Planned Parenthood employee said it happens “every day.”

Kathryn Monroe, who represented the attorney general’s office at the hearing, said while the man’s questions were hypothetical, the employee at Planned Parenthood thought the situation was real.

“There was admitted conduct about what they would do in this actual situation,” she said.

The attorney general’s office in its arguments before the court pointed to Missouri law which states: “No one shall intentionally cause aid or assist a minor to obtain an abortion.”

That law was written before the state’s trigger law went into place in June 2022, effectively making all abortions — with the exception of life-threatening situations — illegal.

Missouri doesn’t have explicit laws requiring parental consent for minors getting abortions in other states, nor does it prohibit minors from going to other states to get abortions.

Kansas law requires physicians to either obtain parental consent or to go through the judicial bypass process where a judge can authorize a minor to get an abortion without parental consent.

A spokesperson for Planned Parenthood Great Plains said in February that they do not provide any form of transportation directly to any patients, regardless of age or where they live.

With the state budget finally out of the way, Missouri Republicans are ready to turn their attention to a priority they’ve pursued since day one of legislative session: making it harder to amend the state constitution through an initiative petition.

Senate Majority Leader Cindy O’Laughlin told reporters Thursday that Republicans intend to bring the initiative petition bill to the floor at noon Monday, five days before the end of session.

State Sen. Andrew Koenig of Manchester, a member of the Missouri Freedom Caucus, said Republicans plan to put changes to the initiative petition process before voters this year, even if it means invoking a rarely-used process to quash a Democratic filibuster.

The proposal would require constitutional amendments placed on the ballot through the initiative petition process to pass by both a simple majority of votes statewide and a majority of votes in at least a majority of the votes in Missouri’s congressional districts.

State Sen. Rick Brattin, a Harrsonville Republican and Freedom Caucus member, said Republicans are ready to use “any means necessary” to pass the initiative petition bill.

Republicans have argued that Missouri’s constitution is too easy to change, and that passing this amendment would give more voice to rural voters. Fueling their concerns this year is a proposed initiative petition seeking to get on the November ballot that would enshrine abortion rights into the constitution.

Democrats counter that the change is a direct assault on the concept of “one person, one vote” making it practically impossible for citizen-led ballot measures — which are already costly endeavors — to ever be victorious.

Initiative petitions campaigns currently require signatures from 8% of voters in six of the state’s eight congressional districts to qualify for the ballot. To pass once on the ballot, a statewide vote of 50% plus one is required — a simple majority vote.

An analysis by The Independent found that under the concurrent majority standard being proposed by Republicans, as few as 23% of voters could defeat a ballot measure. This was done by looking at the majority in the four districts with the fewest number of voters in 2020 and 2022.

Senate Minority Leader John Rizzo, an Independence Democrat, said Thursday that his party has worked in good faith on plenty of bills they opposed this session. And they are ready to sit down and let the initiative petition bill pass and be placed on the August ballot if Republicans remove the “ballot candy,” referring to provisions added that are unrelated to initiative petitions but included to make the proposal more appealing to conservative voters.

Alongside the initiative petition changes, the GOP-backed bill would ask Missourians to change the constitution to define legal voters as citizens of the United States as well as whether they want to prohibit foreign entities from sponsoring initiative petitions.

“They know if they have a straight-up fight over this issue, they lose,” Rizzo said. “Which is why they have to contort themselves into all these different shapes and sizes in order to fool people into voting for something that will take rights away from them.”

Koenig said there are three paths forward for Republicans: session ends without a vote on the bill, Democrats relent and allow a vote with ballot candy, or Republicans break the Democratic filibuster and force a vote.

In the Missouri Senate, with a long tradition of unlimited debate, moving to kill a filibuster is rare and typically results in a quick end to the legislative session.

The bill got initial approval from the Senate in February following a 21-hour-long filibuster by Democrats who only agreed to sit down once the “ballot candy” was removed.

A day later while sitting before the House Committee on Elections and Elected Officials, state Sen. Mary Elizabeth Coleman, the bill’s sponsor, asked the House to reinstate the ballot candy, adding that Senate Republicans would be willing to kill a filibuster in order to defeat another filibuster by Democrats down the road.

Democrats cried foul, saying Coleman’s push represented a double cross after a deal was struck in the Senate. Nevertheless, the House ultimately obliged Coleman, passing the measure with ballot candy attached back to the Senate.

Missouri Senate avoids impasse over budget to make constitutional deadline

On Thursday, after the passage of the state budget, Coleman brought her bill to the floor for final passage. But after about 20 minutes of debate, she withdrew the bill for the day.

Brattin said his caucus colleagues agreed to end their 41-hour filibuster last week as part of an agreement to get both the budget and initiative petition changes across the finish line.

Republicans, Brattin said, are ready to use “any means necessary” to pass the initiative petition bill.

Speaking to reporters Thursday, O’Laughlin gave no indication about whether she was considering a move to cut off debate and force a vote on the bill.

Rizzo acknowledged that Senate Democrats will be “throwing caution to the wind” if they take up a filibuster, but said they’ve been left with no other option to try and protect citizens’ voices.

In the past two election cycles, two ballot measures stemming from initiative petitions – Medicaid expansion and recreational marijuana legalization – have passed despite opposition from the GOP majority in the statehouse. Meanwhile, hundreds of other initiative petition campaigns failed to land on the ballot in the first place.

Just last week, four initiative petition campaigns turned in signatures to the Missouri Secretary of State’s office hoping to land a spot on the ballot. Perhaps chief among these is a measure that would legalize abortion up to the point of fetal viability in Missouri, where nearly all abortions are illegal.

Republican leaders since last year have said that if the initiative petition process doesn’t change, abortion would likely become legal again in Missouri.

“Instead of the legislature being happy they don’t have to deal with the issue,” Rizzo said Thursday. “They’re offended that the people would have the audacity to go around them.”

The Independent’s Rudi Keller contributed.

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com. Follow Missouri Independent on Facebook and Twitter.