Missouri is down to one abortion clinic after a court decision Wednesday.

A federal district court declined Planned Parenthood’s request to block a requirement that doctors who perform abortions have admitting privileges at nearby hospitals.

The organization’s Columbia clinic hasn’t had such a doctor since medical staff at the University of Missouri voted to stop offering those privileges in 2015 during an abortion probe by Republican state lawmakers.

Last month, a federal appeals court overturned a 2017 decision that blocked enforcement of Missouri laws that require admitting privileges and that abortion clinics to be licensed as outpatient surgical centers.

That decision didn’t take effect while Planned Parenthood considered whether to seek review of the case by the full appeals court (the 8th Circuit Court of Appeals).  But Wednesday’s ruling will prevent the Columbia facility from offering abortions.

The procedure is now only available in Missouri at Planned Parenthood’s St. Louis facility.

In addition, the license of the Columbia health center expired Tuesday.  Planned Parenthood says it’ll once again ask the court that declined its request Wednesday to block the admitting privileges requirement once the Columbia facility’s license is renewed.

In November 2016, Planned Parenthood’s two operators in Missouri filed a lawsuit in federal court challenging the two restrictions. The litigation came after the U.S. Supreme Court determined earlier that year that Texas restrictions almost identical to Missouri’s were unconstitutional.

After the 2017 decision by a federal district court, Planned Parenthood announced intentions to expand its abortion services in Missouri. At the time, the procedure was only available at its St. Louis facility. Plans included offering either surgical or medication abortions in Kansas City, Columbia, Springfield, and Joplin.

The Kansas City operation lost its abortion facility license in August. The clinic said it sought timely renewal of its license, but the state Department of Health and Senior Services delayed the license after saying the agency was unable to conduct a complete inspection of the facility in June.

The clinic did not have an abortion doctor at the time and had stopped offering the procedure in late March when the provider left. The Kansas City center has since arranged for a new provider and continues to push for its license.

A planned expansion of services to Springfield and Joplin had initially been delayed by Missouri passing further restrictions in 2017.  Planned Parenthood the Wednesday decision requiring admitting privileges could further complicate plans for its facilities in Kansas City, Springfield, and Columbia.