ST. LOUIS (CN) – Planned Parenthood took its fight to keep Missouri’s lone abortion clinic open to state administrators on Monday, arguing that an investigation into failed abortions did not uncover any safety issues.

Attorneys from both sides began the hearing before the Missouri Administrative Hearing Commission by briefly outlining their cases in opening statements.

Missouri Solicitor General D. John Sauer stated that the clinic in St. Louis failed to address concerns about several failed abortions and did not make those physicians directly involved available to investigators.

Charles Hatfield, an attorney with the firm Stinson LLP representing Planned Parenthood, showed a video deposition of a state investigator stating that he didn’t find anything unsafe during the investigation of the clinic and argued that the state could have chosen other alternatives such as limiting patient admission rather than denying the clinic’s license outright.

After opening arguments, the state called its first witness, Dr. Donna Harrison of the American Association of Pro-Life Obstetricians & Gynecologists. Sauer asked her about the four failed abortions in question on patients identified only as Patients 1, 2, 3 and 12.

Harrison testified that Patient 1 suffered a perforated cervix as a result of a misdiagnosis of the size of her uterus. She said the medical record showed that the uterus shrunk between exams, which should have automatically raised red flags.

“There’s no reason during the course of a normal pregnancy for a uterus to shrink in size,” Harrison said. “At this point, a more experienced physician would have stepped back and say, ‘let’s do an ultrasound.’”

Patient 2, according to court records, first presented to Planned Parenthood seeking to find out if she was carrying twins. The ultrasound showed the fetus at nine weeks and four days.

Harrison said by that time, it should be easy to tell if there were multiple fetuses, but the Planned Parenthood doctor allegedly only found one. Patient 2 returned five weeks later after it was determined that there was indeed another fetus.

The state argued Planned Parenthood did not get informed consent by not telling the patient about abortion risks a second time, as the second fetus was in the second trimester and a different procedure would have to be used.

“It is the obligation of the surgeon to make sure the uterus is empty before the patient leaves the room,” Harrison testified.

Patient 2 was treated for a uterine infection immediately following the second abortion. Patient 3 allegedly had another failed surgical abortion, with all three episodes involving the patients happening with a two-month time frame, according to the state. Harrison said she found no evidence on the record of a quality assurance review.

“You have an unexpected outcome … one should at least ask, is there something wrong?” Harrison said.

Patient 12 reportedly presented with a high risk of a complication called placenta accreta, which could cause life-threatening hemorrhaging during an abortion.

Harrison testified that the patient lost two liters of blood, or roughly one-third of her total blood.

During cross-examination, Planned Parenthood attorneys attempted to shed doubt on the placenta accrete diagnosis.

“I can’t make a confirmed diagnosis but I can say that the clinical picture is consistent with patients we see with placenta accreta,” Harrison said.

Planned Parenthood attorneys questioned Harrison’s experience with electronic medical records, noting that the last time she practiced was in 2000. They also attacked her use of terms describing uterus positioning.

Attorneys clarified that Harrison had only performed one abortion and asked if she was sued at least three times for medical malpractice.

“I believe I was named in a suit twice and I was a resident in another suit,” she said.

Planned Parenthood asked Harrison about previous anti-abortion comments she allegedly made to various news outlets, including the New York Times. Harrison answered that she was misquoted and called it “creative journalism.”

The clinic ended its cross by asking Harrison about two other cases in other states where judges threw out her testimony.

The hearing is expected to last until late Friday afternoon and a decision isn’t expected until February at the earliest.

Planned Parenthood sued the Missouri Department of Health and Senior Services, its director Randall Williams and Republican Governor Mike Parson in May, seeking injunctive relief with its license set to expire. It claims the state has illegally refused to renew the St. Louis clinic’s abortion license until officials complete an investigation into unspecified patient complaints.

After several rounds of legal wrangling, St. Louis Circuit Judge Michael Stelzer ruled that the Administrative Hearing Commission was the proper venue for Planned Parenthood’s petition since it involved state licensing. AHC Commissioner Sreenivasa Rao Dandamudi, who is overseeing the hearing, kept a preliminary injunction in place in June, keeping abortion services available at the clinic until a decision could be made.

If the license denial is ultimately allowed, Missouri would become the first state without any abortion providers since the U.S. Supreme Court’s 1973 landmark decision Roe v. Wade, which legalized abortion up until 22 to 24 weeks of pregnancy.