Missouri’s top health official testified Tuesday that he kept a spreadsheet tracking the menstrual periods of women who visitedPlanned Parenthoodin St. Louis — a revelation that has drawn scrutiny and raised questions about whether it was a violation of patient privacy.
The spreadsheet — which Missouri Department of Health and Senior Services Director Dr. Randall Williams said was created to identify patients who had undergone failedabortions— included patients’ medical identification numbers, dates of medical procedures, gestational ages of fetuses, and the date of the patients’ last menstrual period, theKansas CityStarreported.
Williams’s testimony on Tuesday was part of a hearing over whether Planned Parenthood will retain its license to perform abortions in the state— the latest step in a battle over abortion access in Missouri. The St. Louis clinic is the only health care provider in the state that currently performs abortions.
The document was reportedly created at Williams’s request by a state health inspector who had access to medical records during the state’s annual inspection of the clinic. The state says it ultimately found four patients who returned to Planned Parenthood more than once to have a surgical abortion, causing concerns about safety standards at the clinic, theStarreported.
The time period during which those four patients received care was not clear. But Planned Parenthood claimed state health officials “cherry-picked” those cases,theStarreported. Planned Parenthood’s St. Louis clinic provided abortion care to 4,782 patients in 2016-17 and served more than 30,000 patients in total that year,according to its annual report.
A DHHS spokesperson did not immediately respond to TIME’s request for comment Wednesday.
In May, Missouri Gov. Mike Parson, a Republican, signed a law banning abortion after the eighth week of pregnancy with no exceptions for cases of rape and incest — one of severalrestrictive anti-abortion lawspassed this year, with an eye towardoverturningRoe v. Wade, the 1973 case that effectively legalized abortion across the country. A federal judge blocked the state from enforcing the state law in August, as litigation continues.
Meanwhile, state officials have refused to renew the license for Missouri’slast remaining abortion clinic. If it closed, Missouri would become the first state in decades to lack an abortion provider. Missouri is currently one of six states with only one abortion clinic, according to the Guttmacher Institute, a research and policy organization that advocates for abortion rights.
Throughout the licensing dispute, Planned Parenthood has defended its medical care as a safe and necessary resource for patients.
“Missouri politicians have gone too far. This is government overreach at its worst,” Yamelsie Rodríguez, president and CEO of Planned Parenthood of the St. Louis region, said in astatementabout DHHS tracking menstrual cycles. “This is outrageous and disgusting. Planned Parenthood will always do what’s best for patients and that will guide any decisions we make about how we continue fighting for abortion access.”
State Rep. Crystal Quade, the Democratic minority leader of the Missouri House, called the revelation “deeply disturbing” and also called for an investigation.
“State law requires the health department director to be ‘of recognized character and integrity.’ This unsettling behavior calls into question whether Doctor Williams meets that high standard,” Quade said in a statement on Tuesday, calling on Parson to “immediately investigate whether patient privacy was compromised or laws broken and determine if this is a person who Missourians can be comfortable having in a position of public trust.”
Write toKatie Reilly atKatie.Reilly@time.com.