Missouri Has One Abortion Clinic. Its Fate Rests on a Judge’s Decision.

ST. LOUIS — A judge is expected to decide Friday whether to give Missouri’s last abortion clinic more time to resolve a dispute with the state’s health department over an audit of the clinic’s practices. If the judge rules against the clinic, Missouri would become the first state without any abortion services in nearly 50 years.

Gov. Mike Parson has said that the clinic, Reproductive Health Services of Planned Parenthood of the St. Louis Region, needs to clear up what he described as “a number of serious health concerns” before the audit would end, and the clinic’s license could be renewed. Leaders of the clinic say the state is making unreasonable requests and is bent on closing the clinic for political reasons. They filed suit this week arguing that the state was abusing its regulatory authority.

Lawyers for the clinic presented their case before Judge Michael F. Stelzer of Missouri Circuit Court in St. Louis on Thursday.

Mr. Parson, a Republican, has warned the court to stay out of it.

“It would be reckless for any judge to grant a temporary restraining order ruling before the state has taken action on a license renewal,” the governor said during a news conference on Wednesday.

The clinic’s license is due to expire at midnight on Friday, and without intervention from the judge, the clinic would be forced to stop providing abortions, its leaders have said.

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Louisiana joined several others states in effectively prohibiting abortions after six weeks of pregnancy.

That would make Missouri the first state in the United States without access to abortion services since 1974, the year after the Supreme Court extended federal protections for the procedure in its landmark Roe v. Wade decision.

The disagreement comes toward the end of a busy legislative season, in which states across the country, including Missouri, have passed some of the strictest abortion laws the country has ever seen. Earlier this month, Alabama passed a law that would ban abortion at any stage of pregnancy. On Wednesday, Louisiana lawmakers voted to ban abortion as early as six weeks into a woman’s pregnancy.

The strict new laws are expected to be tied up in court. Even so, their passage is having an effect. On Wednesday, Disney’s chief executive, Bob Iger, said it would be “very difficult” for the company to continue filming in Georgia if that state’s new, restrictive abortion law is implemented. Other media companies — including WarnerMedia and Netflix — have said they would also reconsider working in the state.

Abortion politics have changed dramatically since the election of President Trump. His two new appointments on the Supreme Court have shifted the math in favor of conservatives on the issue, and activists on both sides are holding their breath — in excitement and in fear — for what might come next.

So far, the court has held back. On Tuesday, it sidestepped part of a case that could have tested the constitutional right to abortion established in Roe v. Wade, turning down an appeal to reinstate a strict Indiana abortion law.

Missouri has been on the front line of the abortion wars, with increasingly stringent laws leaving the state with one clinic. But the conflict that flared this week seemed to have little to do with legislation.

It began with the audit, a type of annual inspection, which started in early March. The state found what it said were deficiencies and the clinic submitted its plan for correcting them on April 9.

In a news conference on Wednesday, Governor Parson said the audit uncovered “a number of serious health concerns.” He said there was “significant medical evidence showing three failed surgical abortions,” including one in which the patient had to be taken to a hospital for surgery.

He said the health department was asking to interview seven of the clinic’s doctors, including fellows and residents, but that only two doctors agreed — Dr. David Eisenberg and Dr. Colleen McNicholas, the clinic’s senior doctors. They talked to health officials on Tuesday.

Helene Krasnoff, head of litigation at Planned Parenthood Federation of America, said the doctors work for a local hospital and have separate legal representation. She said the state has not given details on the scope of what it wants to ask, nor has it offered any assurances that there would not be legal — or even criminal — consequences.

“At this point, we have reached an impasse,” Ms. Krasnoff said in a phone call with journalists on Tuesday.

A Planned Parenthood spokeswoman said on Wednesday that the group could not comment publicly on individual patient histories. But Dr. Leana Wen, the organization’s president, said in a statement: “We do everything to ensure our patients get the best medical care available. When we find anything that does not meet our high standards of care, we take swift action.”

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