JEFFERSON CITY, Mo. (AP) -- Missouri House members on Tuesday passed legislation to tighten state abortion regulations, including provisions to require annual inspections of clinics and give the state attorney general new authority to prosecute violations of abortion laws.
The legislation now heads back to the Senate because of changes made in the House to create more stringent restrictions. Republican Rep. Diane Franklin said the Senate bill "did not really specifically meet the governor's call" for a special session, and said additions in House would "help to provide for the health and safety of women."
Republican Gov. Eric Greitens has said he called the special session on abortion in reaction to the St. Louis ordinance banning discrimination in employment and housing based on "reproductive health decisions" and a federal judge's ruling that struck down some Missouri abortion restrictions passed in previous legislative sessions.
The ruling, which the state is appealing, tossed out requirements that doctors who perform abortions have admitting privileges at nearby hospitals, and that clinics meet hospital-like standards for outpatient surgery. Greitens wants lawmakers to enact other restrictions on clinics in place of those that were struck down.
Planned Parenthood raised questions about the constitutionality of the bill passed by the House. Enacting the legislation would put "medically unnecessary restrictions on abortion providers," Planned Parenthood Advocates of Missouri policy and organizing director M'Evie Mead said in a statement.
House members also voted 98-43 against a broader ban on abortion, with exceptions for medical emergencies or those needed to save the lives of pregnant women. Anti-abortion Republican Rep. Mike Moon's proposal also said that "due process of law shall be required" before abortions. The measure met bipartisan opposition.
Here's a breakdown of what lawmakers' latest proposal would do:
AMBULANCES
It would be a misdemeanor offense for abortion clinic staff to ask that ambulances responding to medical emergencies at the facilities not use sirens or flashing lights. Violating that would be punishable by up to a year in prison or a $1,000 fine. Mary Kogut, president and CEO of Reproductive Health Services of Planned Parenthood of the St. Louis Region, previously told The Associated Press that Planned Parenthood has dropped such policies but acknowledged "there are times where we may have asked that the siren wasn't on so that it didn't alarm other people."
ANNUAL INSPECTIONS
The bill would require annual, unannounced inspections of abortion clinics by the Department of Health and Senior Services, which now chooses how often to inspect. Kogut has said the St. Louis clinic already is inspected at least once a year. The St. Louis clinic is the only licensed abortion facility in the state.
ATTORNEY GENERAL
The latest version of the legislation would give the state attorney general, now Republican abortion-opponent Josh Hawley, authority to supersede local prosecutors to enforce the state's abortion laws.
COMPLICATIONS
If the bill is enacted, doctors providing medication-induced abortions would first need to have a plan approved by the Department of Health and Senior Services for dealing with potential complications.
CONSENT
Under the latest version, doctors performing abortions would be required to meet with women at least 72 hours in advance and review potential risks of the procedure. Currently nurses, physician assistants, counselors and others could also provide that information.
FETAL TISSUE
House members voted in favor of requiring all tissue from abortions -- with exceptions for tissue used to identify potential medical problems, needed by law enforcement officials or used for a paternity test -- to be submitted to a pathologist in five days for further review. Pathologists would have 72 hours to review the tissue and issue a report to the health department, which would need to compare tissue and abortion reports. If the tissue reports and abortion reports don't match, that would trigger an unannounced inspection.
Some Republican lawmakers have been trying to pass more stringent laws overseeing fetal tissue from abortions since the 2015 release of undercover videos by anti-abortion activists, who said the videos showed Planned Parenthood officials discussing the sale of tissue, which is illegal. Planned Parenthood officials have said clinics in the state do not participate in fetal-tissue donation programs. Investigations by at least 13 states, including Missouri, into those videos have concluded without criminal charges, and the leader of an anti-abortion group that released videos is facing felony charges in California accusing him of recording people without their permission in violation of state law.
ST. LOUIS ORDINANCE
Both the Senate and House versions of the legislation would undo the St. Louis ordinance that bans discrimination in housing and employment based on "reproductive health decisions," such as pregnancies or abortions.
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EARLIER COVERAGE
JEFFERSON CITY, Mo. (AP) -- Missouri House members meeting during a special session to consider new abortion restrictions sought Monday to restore some of the most divisive proposals that senators stripped from a bill to increase its chances of becoming law.
The House Children and Families Committee advanced many of the provisions sought by GOP Gov. Eric Greitens, but not before making some significant changes. The bill, which already cleared the full Senate, will have to go back there should the House pass the amended version -- a step expected as early as Tuesday.
One of the proposals the House panel revived would ban abortion clinic staff from asking that ambulances responding to medical emergencies at the facilities not use sirens or flashing lights during the calls. Violating that would be a misdemeanor offense punishable by up to a year in prison or a $1,000 fine.
Mary Kogut, president and CEO of Reproductive Health Services of Planned Parenthood of the St. Louis Region, previously told The Associated Press that Planned Parenthood has dropped such policies but acknowledged "there are times where we may have asked that the siren wasn't on so that it didn't alarm other people." Greitens asked for an outright ban.
Other changes added to the House bill would give the state attorney general new authority to prosecute violations of state abortion laws without first notifying local prosecutors, which the Senate version had required.
If passed, abortion clinics also would face losing their licenses for at least a year if they don't comply with requirements for submitting all fetal tissue from abortions, with some exceptions, to pathologists for review within 72 hours.
Republican Committee Chairwoman Diane Franklin said the Senate version "did not meet the muster that we felt like was important to go forward for the state."
Proponents said the bill would mean historic changes to abortion law in the state.
Lawmakers in 1986 passed legislation that included a requirement that physicians performing abortions have surgical privileges at a hospital that offers obstetrical or gynecological care, as well as a ban on using taxpayer money for "encouraging or counseling" women to have abortions.
"If this passes, it would be the biggest change in Missouri's abortion laws in at least 10 years and possibly since 1986," said Samuel Lee, director of Campaign Life Missouri, said of the House version of the bill.
A federal judge this year struck down requirements on hospital privileges, along with another state law that had required clinics to meet hospital-like standards for outpatient surgery. Greitens said the ruling in part motivated him to call the special session, during which he wants lawmakers to enact other restrictions on clinics in place of those that were struck down.
Missouri is among the most restrictive states on abortion. For example, Missouri is one of only five states that requires women to wait 72 hours after receiving counseling before getting an abortion, which according to the Guttmacher Institute is the nation's longest waiting period. The institute is a national organization that supports abortion rights.
Missouri also already bans abortion after 20 weeks of pregnancy, with some exceptions, one of 17 states with that limit.