Missouri Department of Health and Senior Services vs. Reproductive Health Services of Planned Parenthood of the St. Louis Region

Missouri Court of Appeals·Decided September 16, 2025·No. WD87223·Published

Opinion

IN THE MISSOURI COURT OF APPEALS WESTERN DISTRICT

MISSOURI DEPARTMENT OF ) HEALTH AND SENIOR SERVICES, )

)

Appellant, )

)

v. ) WD87223 )

REPRODUCTIVE HEALTH ) Opinion filed: September 16, 2025 SERVICES OF PLANNED ) PARENTHOOD OF THE ST. LOUIS ) REGION, )

)

Respondent. )

APPEAL FROM THE CIRCUIT COURT OF COLE COUNTY, MISSOURI HONORABLE JON E. BEETEM, JUDGE

Division Two: Lisa White Hardwick, Presiding Judge, Edward R. Ardini, Jr., Judge and W. Douglas Thomson, Judge

This appeal is about attorney’s fees and expenses under section 536.087, RSMo, 1 the statutory provision allowing a party to recover fees and expenses when prevailing in agency proceedings against the state. This statute permits a prevailing party to recover the reasonable fees and expenses incurred, unless the state’s position was substantially justified or special circumstances make an award of fees and expenses unjust.

1 All references to the Revised Statutes of Missouri are to the 2016 edition, unless otherwise noted.

In 2019, the Missouri Department of Health and Senior Services (“the Department”)

denied the application of Reproductive Health Services of Planned Parenthood of the St. Louis Region (“RHS”) to renew its abortion facility license. RHS appealed the decision by filing a complaint with the Administrative Hearing Commission (“the AHC”). After a four- day hearing, the AHC issued a ninety-seven-page decision reversing the Department, finding that RHS was entitled to renewal of its license. The Department did not appeal.

RHS filed a complaint with the AHC, seeking attorney’s fees and expenses pursuant to section 536.087. The AHC determined that RHS was entitled to attorney’s fees and expenses under the statute, however RHS could not recover all expenses requested. Both RHS and the Department appealed to the Circuit Court of Cole County (“the trial court”). The trial court found in favor of RHS, concluding RHS qualified for fees and expenses under the statute and the AHC erred in determining that RHS could not recover certain expenses. The trial court remanded the action to the AHC to decide whether the expenses claimed by RHS were reasonable, and on remand, the AHC found that they were. The Department appealed to the trial court, and the trial court affirmed the AHC’s decision.

The Department appeals—which is the present appeal—asserting RHS was not entitled to attorney’s fees and expenses under section 536.087 because RHS was not a “party” as that term is defined by statute, RHS did not incur fees and expenses, the Department’s position was substantially justified, and special circumstances existed that made the award unjust. For the reasons stated below, we affirm the trial court’s judgment affirming the decision of the AHC awarding RHS attorney’s fees and expenses. We also

remand this matter to the trial court with directions to remand to the AHC to determine the proper amount of fees and expenses to be awarded to RHS in defending this appeal.

Factual and Procedural Background

The underlying action involving RHS’s license renewal (“the merits action”)

In 2019, RHS operated an abortion facility in St. Louis; it was the only abortion facility in Missouri. An abortion facility must have a license from the Department to operate, and licenses are renewed annually. RHS’s annual license expired on May 31 of each year.

As relevant here, the Department may deny renewal of an abortion facility license if it finds a “substantial failure” to comply with the requirements of sections 197.200 through 197.240. See § 197.220, RSMo Supp. 2017. To determine a facility’s eligibility for renewal, the Department conducts licensure inspections. The term “inspection” refers to the annual process where a survey team from the Department goes to a facility to determine compliance. An “investigation” refers to a limited review of a particular area of concern identified with a facility; it also involves a visit from Department surveyors to determine compliance.

Within ten business days after an inspection or investigation, the Department delivers a “statement of deficiencies” to the facility. The facility then must submit a “plan of correction” addressing the Department’s concerns. The facility must respond to each identified deficiency with details of how the facility plans to correct it. The Department

either accepts or rejects the plan. If the plan is rejected, the facility has an opportunity to revise it. This process may repeat several times.

In January and February of 2019, the Department initiated two “internal complaint investigations” of RHS—meaning the complaints were made by someone in the Department—and conducted on-site inspections. Both investigations revealed no wrongdoing.

On March 11, 2019, five Department surveyors arrived at RHS to conduct its annual licensure inspection. The inspection lasted three days. The surveyors reviewed records and conducted interviews. Later that month, the Department submitted to RHS its first statement of deficiencies. In preparing this statement, the Department identified an issue relating to RHS’s treatment of Patient 1. However, the Department did not cite RHS for this deficiency, and instead opened an internal complaint investigation.

In its investigation into the issue with Patient 1, the Department requested physicians’ personal phone numbers and demanded they be interviewed in a specific order. The Department refused to provide any context for the investigation. Two physicians and a nurse agreed to be interviewed; the Department refused the offers because they were not in the desired order. The other physicians refused the interview requests on the advice of legal counsel.

Meanwhile, RHS submitted its plan of correction for the statement of deficiencies.

The Department denied RHS’s plan of correction and warned that the Department could not complete its investigation without physician interviews. RHS submitted a revised plan of correction. The Department accepted RHS’s plan for correction of certain deficiencies,

but not others. The Department again repeated its demand to conduct physician interviews in a particular order. Ultimately, the Department relented and agreed to interview the physicians who had offered to be interviewed.

As previously noted, RHS’s annual license expired on May 31 of each year. On May 28, 2019, RHS filed a lawsuit in circuit court to maintain its license. The circuit court issued a temporary restraining order preventing RHS’s license from expiring.

On June 13, 2019, the Department sent a letter to RHS attaching the Department’s final statement of deficiencies. The Department identified what it claimed were “at least 30 deficient practices,” and, in its letter, “highlight[ed] several” of what it contended were “the most serious deficiencies” that “rais[ed] particular concerns.” Five days later, RHS submitted a plan of correction. On June 21, 2019, the Department delivered a letter to RHS denying its renewal application. The Department accepted RHS’s plan of correction for certain deficiencies, but considered the remaining deficiencies unresolved.

On June 24, 2019, RHS filed a complaint with the AHC, appealing the Department’s denial of its renewal application. 2 In October 2019, the AHC conducted a four-day hearing, at which the parties presented numerous exhibits and the testimony of five expert witnesses.

Thereafter, the AHC issued its decision reversing the Department’s denial of RHS’s application for license renewal. The decision was ninety-seven pages long; it contained

2 RHS’s license remained in effect pending the AHC’s decision by virtue of a stay order issued by the AHC.

three hundred findings of fact and credibility determinations, and extensive legal analysis. The AHC summarized its decision as follows:

Our review of the record reflects only two instances where [RHS]

failed to comply with the requirements of §§ 197.200 to 197.240. [RHS]

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Missouri Department of Health and Senior Services vs. Reproductive Health Services of Planned Parenthood of the St. Louis Region, (Mo. Ct. App. 2025).

Missouri Department of Health and Senior Services vs. Reproductive Health Services of Planned Parenthood of the St. Louis Region (Missouri Department of Health and Senior Services vs. Reproductive Health Services of Planned Parenthood of the St. Louis Region) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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