CINCINNATI -- Cincinnati would be the largest metropolitan area in the country without access to surgical abortion if a Planned Parenthood clinic in the city's Mount Auburn neighborhood is forced to discontinue the procedure.

Although the state health department notified the clinic and the Women’s Med Center in Kettering on Friday that their licenses to perform surgical procedures would be revoked, the president of Planned Parenthood of Southwest Ohio sees a way the Cincinnati facility could continue offering them.

If the facilities' licenses are revoked, they would be prohibited from performing abortions and other surgical procedures, but could continue offering other general healthcare services and screenings. General health services offered by Planned Parenthood include anemia testing, cholesterol screening, and physical exams.

Ohio law requires surgical clinics to have a patient-transfer agreement with a private -- not public -- hospital in order to receive a license to perform abortions. The requirement, passed by Republican lawmakers in 2013, does allow for exceptions, or "variances."

And a new regulation, taking effect Tuesday, adds an extra hurdle –- variances will be automatically denied if a state health director fails to respond to them within 60 days. This means that a clinic can lose its license if state officials simply ignore its request.

Neither facility has a patient-transfer agreement, according to state officials, but they had requested variances -- as they must do annually -- so they could continue operating.

The Planned Parenthood clinic in Mount Auburn requested its variance in May; Friday's notice was the state's formal denial of that request, which would, in effect, force the clinic to close.

Jerry Lawson, president of Planned Parenthood of Southwest Ohio, said he was surprised the state opted to deny the variance before the new regulation took effect -- meaning the 60-day countdown clock won't start running.

The state's denial, he said, also seemed to spell out what the clinic needs to do to remain open: Though it doesn't have a patient-transfer agreement, the Mount Auburn clinic does have agreements with local doctors who have admitting privileges at hospitals here.

"They want us to have one additional back-up physician, and we think that is something we'll be able to do," he said.

Both Planned Parenthood and Women's Med Center, which are the last remaining clinics that perform abortions in Cincinnati and Dayton, have 30 days to appeal the decision in a hearing. The facilities currently perform a total of about 5,800 abortions each year.

According to a lawsuit filed by the clinics earlier this month, it's difficult for them to meet the state requirements because of "hospitals' religious and political opposition to abortion" and "because of hospitals' fear of the harassment and intimidation they and their doctors would face if they were to enter into a [patient-transfer agreement] with an abortion clinic."

Those requirements, along with other state laws, “do nothing to increase patient safety or health and are not medically necessary,” according to the clinics' lawsuit. They are seeking to have a judge declare the rules unconstitutional.

U.S. District Judge Michael Barrett set a hearing Monday in Cincinnati to decide if the two clinics can stay open while the case moves toward trial, which could take a year.

Mary Clark, an abortion opponent, was part of a group that spent Friday praying outside the Mount Auburn clinic, hoping it would close.

"We think there are other ways for women who think that they need to have an abortion to take care of their situation," she said.

"Our presence out here, even in small numbers, kind of reminds them that there is a tremendous support here and the U.S. for life and all of life for every stage of development," the Rev. Dale Peterka said.

The case being heard Monday is the second time that Planned Parenthood here has sued the state in less than a year: The group filed a federal lawsuit in November 2014 after waiting 14 months for the state health department to approve a variance and renew the operating license for its Mount Auburn clinic. The state health department finally gave its approval to the clinic days after that lawsuit was filed.

