A Planned Parenthood clinic is seen Tuesday, June 4, 2019, in St. Louis. On Monday, June 10, 2019, a judge in St. Louis issued another order allowing Missouri's only abortion clinic to continue operating. Circuit Judge Michael Stelzer granted Planned Parenthood's request for a preliminary injunction, which extends his temporary restraining order prohibiting Missouri from allowing the clinic's license to lapse. (AP Photo/Jeff Roberson)

JEFFERSON CITY, Mo. (AP) — Missouri's case for not renewing the license of its lone remaining abortion clinic includes a claim that three "failed abortions" there required additional surgeries and another led to life-threatening complications for the mother, according to a now-sealed court filing that Planned Parenthood alleges state officials made public in violation of patient privacy laws.

The documents, a letter and statement of deficiencies the Department of Health and Senior Services sent Friday to the St. Louis Planned Parenthood clinic provide the most specific details to date about a state investigation that triggered a licensing dispute now playing out in court.

Should the St. Louis facility be closed, Missouri would be the first state without a functioning abortion clinic since 1974, the year after the landmark Roe vs. Wade decision that legalized abortion nationwide, according to Planned Parenthood.

State attorneys filed the records in court after the organization sued last month in an attempt to continue providing abortion, despite the health department's refusal to renew its license amid an ongoing investigation.

Anti-abortion group Operation Rescue put the health department records on its website before St. Louis Circuit Judge Michael Stelzer sealed them Monday per a request by Planned Parenthood to shield confidential health information. A spokesman for Republican Gov. Mike Parson verified the accuracy of those documents to The Associated Press.

Jesse Lawder, a spokesman for Planned Parenthood of the St. Louis Region and Southwest Missouri, said the state violated patient-privacy laws by releasing the records. He didn't immediately comment further.

According to the documents, three patients remained pregnant after surgical or medical abortions and required follow-up surgical abortions, a health standards and licensure official wrote Friday to Planned Parenthood. One of those patients developed sepsis after the second surgical abortion, according to the letter from agency official William Koebel.

Koebel wrote that a fourth patient was hospitalized with life-threatening complications following an abortion at 21 weeks of pregnancy.

Medical residents performed some of the abortions at issue and have refused interviews with the health department, according to the agency. Part of the agency's concern, Koebel wrote, is that the residents were not properly supervised.

Planned Parenthood has said that the residents and several other physicians are not staffers and some no longer practice there, so the organization can't force them to cooperate. Two on-staff doctors agreed to speak with investigators.

But Koebel warned that it's "imperative" that Planned Parenthood address the agency's concerns about interviews with the other physicians.

"Refusal of health care providers to cooperate in the Department's investigations thwarts the Department's ability to conduct meaningful review of troubling instances of patient care, and obstructs the Department's ability to ensure that problems will not be repeated," Koebel wrote.

The judge has set a Friday deadline for the health department to decide whether to renew the clinic's license, which was set to expire May 31. Stelzer has allowed the clinic to continue providing abortions as the legal challenge plays out in court.

The fight over the clinic's license comes as lawmakers in many conservative states, including Missouri, are passing new restrictions that take aim at Roe. Abortion opponents, emboldened by new conservative justices on the Supreme Court, hope federal courts will uphold laws that prohibit abortions before a fetus is viable outside the womb, the dividing line the high court set in Roe.

Parson signed legislation on May 24 to ban abortions at or beyond eight weeks of pregnancy, with exceptions for medical emergencies but not for rape or incest. Efforts to put the new law to a public vote are tied up in court .