KANSAS CITY — A longtime Missouri health regulator testified Thursday that abortion clinics were subjected to heightened scrutiny that had little to do with health or safety concerns, acknowledging under questioning that the extra attention was not tied to a greater risk of noncompliance.
John Langston has worked for the Missouri Department of Health and Senior Services for more than 30 years and appeared as a witness for the state Thursday in a trial over abortion regulations. His responsibilities have included managing regulatory compliance for health care clinics such as ambulatory surgery centers, clinical laboratories and rural health clinics.
When Langston was asked by attorneys for Planned Parenthood if the increased focus on abortion facilities was unrelated to their likelihood of noncompliance with health and safety standards, he paused for several moments, then replied: “I would say that’s true, yes.”
Abortion facilities used to fall under the category of ambulatory surgery centers until the Missouri Legislature voted to designate them as a separate entity for regulation in 2017. Langston was then responsible for inspecting the three Planned Parenthood clinics providing abortions under those new standards.
While approximately 120 ambulatory surgery centers in Missouri are scheduled for unannounced inspection every three to four years, the three abortion facilities were required to be inspected annually.
He testified on day 8 of a 10-day bench trial over Missouri’s Targeted Regulation of Abortion Providers, or TRAP, laws, one of which is the law that created those separate rules for abortion facilities. The state’s Planned Parenthood affiliates and the ACLU of Missouri sued to strike down the laws, claiming they are now unconstitutional under the state’s reproductive rights amendment approved by voters in 2024.
The licensing requirements law was temporarily blocked by a court order issued by Jackson County Judge Jerri Zhang, who is also presiding over the bench trial.
Langston said in a deposition that he asked the department to assign someone else to the abortion facilities regulation because it was taking up an “inordinate” amount of his time.
“It was a no-win situation from both sides,” Langston said.
Most of the complaints against the facilities were unsubstantiated, Langston said, and were often made by the same groups of protesters who frequently stood outside of the clinics and tried to talk to anyone going inside.
That included the inspectors. When the health department staff arrived at the facilities, he said, protesters would take pictures of the car and follow them, and tried to talk to the women especially, thinking they were patients at the clinic.
Dr. Randall Williams was the state health department director at the time, and had previously testified publicly that he was a “pro-life” OBGYN who had never performed an abortion. Langston and William Koebel, who took over the abortion facilities inspection responsibilities after Langston, both testified that Williams was heavily involved in any investigation of complaints and any deficiencies found at the clinics.
In 2019, the state threatened to shut down abortions at the St. Louis Planned Parenthood, the last to perform them before the U.S. Supreme Court’s Dobbs decision in 2022. The letter denying the clinic’s license renewal was signed by Koebel, who said several “deficiencies” forced the state’s hands.
Several of those deficiencies were related to the statutes requiring providers to inform a patient of their fetus’ gestational age before performing an abortion, and requiring fetal tissue to be submitted to a pathologist within 72 hours. Other deficiencies were related to dust and peeling laminate.
Since the law is blocked by court order, Koebel said they have not performed any abortion facility inspections since the ban was overturned. If the judge decides to permanently block it, he said the department will have no authority to investigate complaints of abortion facilities.
The clinic in St. Louis, as well as Columbia and Kansas City, resumed procedural abortions in 2025. Medication abortion remains unavailable.
Of 25 states with TRAP laws on the books, 14 have facility licensing requirements akin to surgical centers, and eight of those, including Missouri, have rules governing the size of hallways and rooms inside the clinic, according to the Guttmacher Institute. This means that the majority of states with abortion clinics do not have such requirements.
During the first week of the trial, President and CEO of Planned Parenthood Great Plains Emily Wales was asked if she believes any of the current regulations should stand. She replied: “What we want is for things abortion-specific to be regulated in the same way any non-abortion business would be.”
Many private OBGYN practices take patients who are insured by Medicaid and Medicare. In doing so, they are subject to oversight from the Centers for Medicare & Medicaid Services. In 2024, Missouri banned Planned Parenthood clinics from receiving any Medicaid reimbursements for low-income patients.
Any practicing OBGYNs in Missouri, including those who perform abortions, must be registered through the Missouri Board of Registration for the Healing Arts.
Koebel said abortion facilities would still be subject to regulations under the Bureau of Narcotics and Dangerous Drugs, as well as the Clinical Laboratory Improvement Amendments, the quality standards for lab testing on humans.
The trial is scheduled to resume Friday morning and conclude on Monday.