ST. LOUIS — A judge is deciding whether to ensure Missouri’s only abortion clinic can keep its license past Friday, the latest development in a decadeslong push by abortion opponents to get states to enact strict rules on the procedure.
Like many states, Missouri over the years enacted a series of regulations, ranging from waiting periods before women can receive abortions to rules on the width of clinic doors. Abortion-rights supporters say the rules are arbitrary and are intended to shutter abortion clinics, while abortion opponents say they’re aimed at protecting women and ensuring proper patient care.
It’s not a “pro-life issue at all,” Missouri Republican Gov. Mike Parson said in defending the state’s reluctance to renew Planned Parenthood’s license to perform abortions at a St. Louis clinic. “This is about a standard of care for women in Missouri. Whether it’s this clinic or any other clinic or any other hospital, they should have to meet the same standard.”
Parson recently signed a bill that bans abortions on or beyond the eighth week of pregnancy, with exceptions for medical emergencies but not for rape or incest. But even before that law takes effect Aug. 28, strict regulations in Missouri have limited access to the procedure, according to abortion-rights supporters.
Planned Parenthood says a Missouri law requiring physicians who provide abortions to partner with a nearby hospital, which many hospitals have been unwilling to do, resulted in a Columbia clinic losing its license to perform abortions in 2018. That left the St. Louis clinic as the only one providing the procedure.
If the St. Louis clinic’s license is not renewed before it expires at midnight Friday, Planned Parenthood officials said Missouri would become the first state without a functioning abortion clinic since the 1973 Roe v. Wade Supreme Court decision legalizing abortion.
Circuit Judge Michael Stelzer heard an hour of arguments Thursday on Planned Parenthood’s request for a temporary restraining order that would prohibit the state from allowing the license to lapse. It isn’t clear when Stelzer will rule.
The hearing happened as abortion-rights supporters rallied elsewhere in downtown St. Louis.
The Department of Health & Senior Services said March inspections at the clinic uncovered deficiencies. The agency cited “at least one incident in which patient safety was gravely compromised.” It also cited what it called “failed surgical abortions in which women remained pregnant” and an alleged failure to obtain “informed consent.”
The nearest clinics performing abortions are in a Kansas suburb of Kansas City and in Granite City, Illinois, just across the Mississippi River from St. Louis.
The number of abortions performed in Missouri has declined every year for the past decade, reaching a low of 2,910 last year. State figures show a handful of Missouri hospitals also perform abortions, but those are rare.
Missouri women also seek abortions in other states. In Kansas, about 3,300 of the 7,000 abortions performed in 2018 were for Missouri residents, according to the state’s health department. Illinois does not track the home states of women seeking abortions.
When women first meet with physicians about abortion, Missouri law mandates that they are given a 22-page booklet with information about fetal development, alternatives to abortion and a statement that “abortion will terminate the life of a separate, unique, living human being.” After that initial consultation, women must wait at least 72 hours before they can receive an abortion.
Missouri regulations also require pelvic exams before abortions. Planned Parenthood’s lawsuit alleges that the health department recently interpreted the longstanding rule to apply to medication-induced abortions, not just surgical ones.
Doctors at the St. Louis clinic refused to perform pelvic exams on women before medication abortions, so the facility now offers only surgical abortions.
Pelvic exams also were a sticking point in the clinic’s latest attempt to renew its license. Planned Parenthood says it performed the exams right before surgical abortions. The health department says those must occur 72 hours prior. The agency says Planned Parenthood last week agreed to change its policy.
National Abortion Federation Interim President and CEO Katherine Ragsdale said other regulations on abortion facilities “tend to be things like the size of the janitorial closet or the height of the water fountains.”
“It’s clearly just a tool to try to make abortion unavailable,” she said.
Taylor Surprenant, 11, began receiving music therapy at Giving Song in Columbia when he was 5 years old.
His grandparents, Randy and Johnna Carrender, noticed his response to music at home and thought it could be a motivational tool to address his developmental skills.
“It seems like every goal we’ve tried to accomplish with Taylor we’ve tied it to music,” Johnna said. “It’s just the center of his world.”
Giving Song provides musical therapy to a variety of people, from unborn babies to those at the end of life. The company began in 2010 with Giving Song’s owner, Kristin Veteto, treating six children at the Delmar Cobble School for the Severely Disabled. It has since expanded to include a team of five therapists serving a 100-mile radius around Columbia.
Therapists serve in patient homes, in the Giving Song clinic on Towne Drive, during after-school programs and in public schools. Because music therapists work with such a diverse group, they are trained to assist in a wide range of treatments, including speech, language, physical, motor and cognitive skills across the lifespan.
Giving Song treats primarily children with developmental disabilities like Taylor’s.
He has lived with his grandparents in Jefferson City since he was about 7 months old, after he was injured by a family member and diagnosed with Shaken Baby Syndrome.
Initially, doctors believed Taylor wouldn’t survive his injury. He was in the hospital for two months struggling with seizures and extreme sensitivity to light and noise.
His nurses discouraged Taylor’s family from touching him, so Johnna found CDs that played quiet, soothing music and kept it playing for most of his hospital stay. The music seemed to relax him.
It was trial and error for the Carrenders to find things Taylor enjoyed once he got home, but what pacified him and brought him joy had to do with music in one form or another. When Taylor got a little older, his grandparents turned to music therapy, which proved to be a useful teaching tool.
Music therapy can be a productive treatment because of the way music is processed in the brain, Veteto said. When melody and rhythm are present during the learning process, the information essentially attaches itself to the music and the brain processes it more efficiently.
That’s why memories that are connected in some way to music are the last to be forgotten, even among patients with Alzheimer’s disease.When treating patients with developmental disabilities like Taylor, music therapists tend to work within treatment teams to reach a set of goals. According to a study published by The New York Academy of Sciences, music is beneficial for learning and understanding actions, as well as predicting the actions of others.
Taylor has cortical blindness because of his injury, meaning his eyes work, but the area of the brain that interprets what his eyes are seeing has been damaged. It’s common for those who have visual impairments to let their head fall to one side rather than sitting straight.
Taylor’s therapist, Holly Pering, has used music to teach Taylor to keep his head up by reinforcing the action with celebratory music.
When his head hangs to the side, Pering waits in silence. Taylor then lifts his head and is rewarded with music for as long as he can hold it up. The goal of the exercise is to eventually strengthen Taylor’s neck so he can keep his head upright for an extended period of time until the posture becomes natural for him.
Music has also taught Taylor how to take turns. When he started therapy at Giving Song, if an instrument was taken away from him, he would throw a fit and cry. Now he understands that if something is taken away from him, it can come back later.
Since Taylor is unable to speak intelligibly, he and his grandparents tend to communicate with each other in song.
According to an article published by the American Music Therapy Association, musical interactions create new methods of communication for people with disabilities and develop social closeness with their loved ones. The Carrenders’ home is almost always filled with some sort of music, and it has created a bond between Taylor and his grandparents.
When Randy walks into the room, Taylor begins to sing a song he associates with his “Papa.” He sings different songs for Johnna.
“Singing back and forth is kind of how we learned to interact with each other since we can’t really carry on what you’d call a meaningful conversation,” Johnna said.
Before Taylor came into her life, she wouldn’t have sung in front of anyone.
“But not anymore. It’s all about Taylor,” she said.
“So the rest of you are just going to have to get over it because even my terrible singing is music to Taylor’s ears.”
Supervising editor is Katherine Reed
Almost three years after voters passed a medical marijuana amendment in Arkansas, the state was able to finally open its first dispensary this month.
Although regulators approved the first medical marijuana dispensary, the drug’s distribution is still uncertain, according to the Arkansas Democrat-Gazette. Medical marijuana may have become available, but enough is unlikely to be produced anytime soon to supply the 11,000 residents or so who are able to purchase it.
Only three of five licensed growers have started cultivating plants, and just one has harvested them. Legal and bureaucratic setbacks have also delayed the program, according to the Democrat-Gazette. The process of evaluating dispensary applications took longer than expected, and the cultivation permit process has been challenged in court.
“We didn’t have our cultivation facilities graded independently; they were graded by this commission themselves, and it was a mess,” said David Couch, the lawyer who drafted Arkansas’ medical marijuana amendment.
In Missouri, the regulations for its own medical marijuana rollout were finalized last week.
The Department of Health & Senior Services has been tasked with overseeing the regulation and operation of the state’s medical marijuana program.
Patient and business applications are now available, DHSS will accept patient applications starting July 4, and business applications starting Aug. 3. The department will score applications until Dec. 31, before licenses are distributed in 2020.
The initiative to legalize marijuana for medical purposes passed in November, making Missouri the 33rd state to join the club. Being late to the game, Missouri could benefit from the experience of its neighbors when implementing its own medical marijuana law.
Arkansas approved a constitutional amendment legalizing medical marijuana in 2016.
The reason Arkansas was so late in opening dispensaries, according to Couch, is because there was no mechanism to speed up the application process. Dispensaries that were finally approved are taking longer than anticipated to be operable.
“They mucked this up bad,” Couch said about the commission responsible for setting up the program. Though he says Arkansas is close to having medical marijuana available, he laments that there should have been a “hammer” in the amendment that could’ve gotten medical marijuana out in Arkansas sooner.
“Whatever system you guys have to award the actual licenses and stuff, it just needs to be open and transparent and independent of politicians,” he said about lessons Missouri could learn from the process. “That’s what really screwed this thing up in Arkansas.”
In Illinois, the medical marijuana law has morphed several times since it was passed as a pilot program by the General Assembly in 2013.
Originally, medical marijuana was restricted to those 18 years or older, but this was later changed to allow children under the age of 18 to use medical marijuana as long as they have the consent of their parents.
Additional illnesses had to be added to the list of qualifying conditions for medical marijuana, according to Conny Moody, a representative of the Illinois Department of Health. Additions included post-traumatic stress disorder, terminal illnesses and other debilitating conditions.
The pilot program was set to expire in 2018, effectively making it illegal, but in 2016 it was extended to 2020.
In other changes, Illinois eliminated the need to fingerprint patients, which allows convicted felons to participate, and the state allowed caregivers to administer cannabis oil to students on school grounds.
Currently, Illinois has introduced a program to reduce reliance on opioids by using medical marijuana as an alternative, Moody said.
The Illinois Department of Public Health states that the program “allows access to medical cannabis for individuals who have or could receive a prescription for opioids as certified by a physician licensed in Illinois.”
Missouri has 10 debilitating conditions listed on its draft rules, though it allows a licensed physician to identify other chronic, debilitating or medical conditions that could qualify.
Comparatively, Illinois lists 41 conditions and Arkansas has 19 with the ability to add more. Illinois has a laundry list of qualifying conditions, while Arkansas allows for any condition that is approved by the Department of Health.
Other issues worrying Missourians, such as keeping the money from medical marijuana in the state, have already been addressed in states like Arkansas, as well as Missouri.
Couch said the Arkansas amendment ensures that 60 percent of the ownership of any medical marijuana entity has to belong to Arkansas residents. Similarly, Missouri also has a provision ensuring that 51 percent of ownership remains in the hands of Missourians.
Another important consideration is supply and demand when it comes to medical marijuana. Often, as in Arkansas right now, the demand is expected to exceed the initial supply.
According to Paul Armentano, a member of NORML, shortages are often caused when “only a limited number of operators are initially licensed in a staggered manner, or in jurisdictions where the total number of operators are arbitrarily capped.” Initial demand is often greater than the available supply, and regulatory fees can lead to inflated prices.
When deciding how many cultivation facilities were needed, Couch said Arkansas anticipated around 70,000 patients for medical marijuana based on a population of 3 million people, half that of Missouri. They allowed for a maximum of eight cultivation facilities and 40 dispensaries. The dispensaries are also able to grow their own plants and buy and trade among themselves based on a limited number of plants, according to Couch.
He said he looked at New Mexico’s medicinal marijuana program when it came to deciding how many facilities they would need.
In contrast, Missouri’s amendment will allow for a maximum of 60 cultivation facilities and 192 dispensaries, according to current draft rules for medical marijuana in Missouri, though according to a study by University of Missouri, the state may have overestimated the number of patients who would be eligible for medical marijuana.
The original amendment assumed that there would be 100,000 qualifying patients by 2022, but the study by MU says it may be as low as 26,000.
A new summer rate scale for water use by Columbia residents takes effect Saturday and lasts through August.
The changes are intended to encourage residents to conserve water, said Ryan Williams, assistant director of utilities at Columbia Water & Light.
The restructuring will mostly affect customers who use a lot of water during the summer. The changes create a three-tier system for residential water customers in the summer and will charge customers higher rates if they exceed a certain amount.
During June, July and August, residents will be billed depending upon how much they use.
Residents who fall under the first tier will pay $2.86 per 100 cubic feet of water used each month, the standard rate for water use in the non-summer months. Tier 2 will increase the charge to $4.01, and the third tier will cost $6.02 per 100 cubic feet of water.
The three-tier rate system is based on the residents’ average winter use for the quarter that includes January, February and March. Average winter use is 400 cubic feet of water each month, Williams said. One-hundred cubic feet is equal to about 748 gallons, according to Columbia’s water utility website.
• Customers will remain in the first tier ($2.86 per 100 cubic feet of water) until they reach 70 percent of their winter average.
• If water use per month exceeds 70 percent and up to 170 percent of the winter average, they fall into the second tier ($4.01 per 100 cubic feet of water).
• The rate for the third tier ($6.02) will be imposed if the monthly water use is above 170 percent of the winter average.
Water used for lawn irrigation will also be charged differently in the summer. The summer water use rate will increase to $6.02 from the non-summer rate of $2.86 per 100 cubic feet of water used, according to a city ordinance.
Williams said a customer’s bill could increase substantially based on average winter use.
“It just depends on what your summer habits are like,” Williams said. “If you utilize the same amount all year around, you won’t get into the third tier.”
Columbia Water & Light identifies that about 60 percent of summer water use is from outdoor landscaping. Officials suggest multiple tips on water conservation: