ST. LOUIS (AP) — Patient safety takes priority over access to abortion, Missouri's health department director said Wednesday after a court hearing on an effort by the state's only abortion clinic to keep operating.

Missouri Department of Health and Senior Services Director Randall Williams spoke to reporters after a court hearing on Planned Parenthood's request for a preliminary injunction that would retain its license to perform abortions at its St. Louis clinic. Circuit Judge Michael Stelzer did not indicate when he would rule.

The health department last week declined to renew the clinic's license to perform abortions, saying March inspections at the clinic uncovered deficiencies. The agency cited "at least one incident in which patient safety was gravely compromised." It also cited what it called "failed surgical abortions in which women remained pregnant," and an alleged failure to obtain "informed consent." Clinic leaders say the allegations are part of an effort by an anti-abortion administration to eliminate the procedure in the state.

Stelzer issued an order on Friday that allows the clinic to continue performing abortions while he considers Planned Parenthood's request.

Williams told reporters that reviews of records raised concerns about patient care. He declined to elaborate.

M'Evie Mead, director of policy and organizing for Planned Parenthood Advocates in Missouri, said the state is playing a "political game," and that Planned Parenthood has not been advised by the health department of any issues related to patient safety.

"The department, if they have any concerns about health and safety, especially grave concerns, they are obligated to outline them in clear words and say, 'This is a deficiency and it's at this level.' They have not done that," Mead said after the court hearing.

If the abortion clinic closes, Missouri would become the first state without a functioning abortion clinic since 1974, the year after the U.S. Supreme Court's Roe v. Wade ruling that legalized abortion nationwide.

"We can never sacrifice safety for access," Williams said. "We have to have both."

Wednesday's hourlong court hearing focused on technical legal matters. Planned Parenthood attorney Jamie Boyer argued that the health department regulations that relate to licensing abortion clinics exceed the authority provided by state law.

John Sauer of the Missouri attorney general's office disagreed. He also argued that an administrative hearing, not a court, is the proper venue for Planned Parenthood's effort to keep its license.

Stelzer ruled Tuesday that four former doctors in training who worked briefly at the clinic are not required to testify at the hearing. The refusal of those four doctors and a fifth to cooperate with the state investigation was at the core of the health department's decision not to renew the license.

Lawmakers in Missouri and many other conservative states have recently passed new restrictions taking 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.

The number of abortions performed in Missouri has declined every year for the past decade, reaching a low of 2,910 last year.

The closest abortion clinic to the St. Louis facility is just across the Mississippi River in Granite City, Illinois, less than 10 miles (16 kilometers) away. Planned Parenthood's abortion clinic in the Kansas City area is in Overland Park, Kansas, just 2 miles (3 kilometers) from the state line.