JEFFERSON CITY, Mo. (Reuters) - The fate of Missouri’s only abortion clinic was at stake on Monday, as a state arbiter heard arguments from Planned Parenthood and state officials who have threatened to close it and make Missouri the sole U.S. state without legal abortion services.

FILE PHOTO: A banner stating "STILL HERE" hangs on the side of the Planned Parenthood Building after a judge granted a temporary restraining order on the closing of Missouri's sole remaining Planned Parenthood clinic in St. Louis, Missouri, U.S. May 31, 2019. REUTERS/Lawrence Bryant/File Photo

Planned Parenthood, the women’s healthcare and abortion provider that operates the facility, sued the state health department in June for its refusal to renew the St. Louis clinic’s license. The state court judge presiding over the case referred the matter to the Administrative Hearing Commission, an independent arbiter.

The hearing, which is expected to last several days, began on Monday with opening statements from both sides and testimony from state witnesses including Donna Harrison, a doctor and director of the American Association of Pro-Life Obstetricians and Gynecologists.

Missouri Solicitor General John Sauer said in his opening statement that the state has “very serious concerns about the safety of patients” at the clinic after at least four patients had failed abortions there.

Planned Parenthood representatives said the state’s effort to shut down the clinic was politically motivated and that the clinic should remain open to guarantee the constitutional right of the 1 million women of child-bearing age in Missouri to receive an abortion.

“Our doors are open today, they’ll be open tomorrow, and we will continue to fight like hell for access to make sure that access to comprehensive sexual and reproductive health care continues to be a fundamental right for women here in Missouri,” Planned Parenthood of St. Louis President Yamelsie Rodriguez told reporters.

Missouri health officials earlier this year declined to renew the clinic’s license on the grounds that it failed to meet their standards, which included mandatory interviews with several physicians involved in what the health department said were multiple life-threatening abortions at the clinic.

Planned Parenthood officials have said they do not directly employ all the clinic’s staff and cannot force them to give interviews. The organization has said the state’s effort to close the clinic is politically motivated, which the state denies.

Abortion is one of the most divisive issues in the United States, with opponents citing religious beliefs to declare it immoral, while abortion-rights activists say the procedure is legally protected and that bans rob women of control over their bodies and futures.

Missouri is one of 12 states to pass laws restricting abortion access this year, some aimed at provoking a U.S. Supreme Court review of the landmark 1973 Roe v. Wade decision that recognized a woman’s constitutional right to terminate her pregnancy.

Last week, Planned Parenthood opened an abortion clinic just 13 miles (21 km) from the St. Louis clinic in Fairview Heights, Illinois, capable of treating up to 11,000 patients per year.

“While we continue the fight to maintain access in Missouri, we are excited to expand our abortion services in Illinois,” Colleen McNicholas, chief medical officer of Planned Parenthood’s southwest regional chapter, said in a statement.