Missouri Gov. Greitens signed law subjecting abortion clinics alone to annual unannounced inspections that other surgical centers escape

On July 26, 2017, Missouri Gov. Eric Greitens signed Senate Bill 5 into law in Jefferson City, a package of abortion regulations sponsored by state Sen. Andrew Koenig that the Missouri General Assembly passed 22-9 during a summer special session. The law pulled the state's abortion facilities out of the general "ambulatory surgical center" category defined in state statute and into a separate regulatory category with its own inspection schedule: annual, unannounced state inspections, versus every three to four years for the roughly 120 other ambulatory surgical centers statewide.

SB 5 also gave the Missouri attorney general authority to bring abortion prosecutions regardless of local prosecutors' decisions, required a physician rather than other clinic staff to conduct the pre-abortion consultation, mandated that all fetal tissue removed during a surgical abortion be sent to a pathologist, and exempted anti-abortion pregnancy resource centers from a St. Louis nondiscrimination ordinance. Then-DHSS director Dr. Randall Williams, a self-described "pro-life" OBGYN who said he had never performed an abortion, was personally and heavily involved in every complaint investigation and deficiency finding brought against the state's three abortion clinics under the new inspection regime, according to sworn testimony years later from the department regulators who worked under him.

The department used that authority in June 2019 to deny a license renewal to the St. Louis Planned Parenthood clinic -- then the only facility in Missouri still performing abortions -- over deficiencies that included a gestational-age-disclosure paperwork issue and dust and peeling laminate in the facility. Longtime department regulator John Langston, who oversaw the abortion-clinic inspections before his successor William Koebel signed the 2019 denial letter, testified that most complaints against the clinics were unsubstantiated and traced to anti-abortion protesters stationed outside.

Updates

2026-01-22 — Regulator testified inspection disparity was not safety-related [4]

Testifying on day eight of a 10-day Jackson County bench trial over Missouri's Targeted Regulation of Abortion Providers (TRAP) laws, longtime department regulator John Langston acknowledged under questioning from Planned Parenthood's attorneys that the heightened inspection scrutiny was "not tied to any greater risk of noncompliance" with health and safety standards -- an on-the-record admission, from the state's own witness, that the disparity SB 5 created was not a safety measure.

2026-06-18 — Judge struck down TRAP provisions as unconstitutional [5]

Jackson County Circuit Judge Jerri Zhang ruled most of the challenged TRAP provisions unconstitutional under Missouri's 2024 voter-approved reproductive-rights amendment, including the special abortion-facility licensing requirements SB 5 created. Missouri's attorney general said she would appeal the ruling to the Missouri Supreme Court.

2026-07-10 — Missouri appealed the ruling to the state Supreme Court [6][7]

Missouri Attorney General Catherine Hanaway, Gov. Mike Kehoe, and other state officials and agencies filed an appeal of Judge Zhang's ruling with the Missouri Supreme Court, contesting the trial court's decision and seeking reinstatement of the abortion regulations it struck down, including the special facility-licensing and inspection requirements SB 5 created.