With a toddler and a new baby on the way, Rachel Miller and her husband felt their family was complete. Miller, with her doctor’s recommendation, asked to have her tubes tied as a permanent form of birth control, a procedure used by millions of women in recent decades.
But she was denied the option at Redding’s Mercy Medical Center, which cited Catholic Church principles opposing abortion and sterilization. Only after the American Civil Liberties Union threatened a lawsuit did the Dignity Health-affiliated hospital relent and allow the contraceptive procedure. That was in late September, immediately after Miller gave birth to her second daughter.
This week, the ACLU is threatening to sue on behalf of two more Redding women who have been denied requests to have tubal ligations immediately after their C-sections, which are scheduled at the same Dignity Health hospital early next year.
Rebecca Chamorro’s due date is Feb. 4, and Lynsie Brushett’s baby is due March 26. Like Miller, both had decided, in consultation with their Redding obstetrician, that a tubal ligation immediately after delivery would be the best solution for their families. Both were turned down.
Brushett, 30, had a difficult first pregnancy. Her son was born 12 weeks prematurely, and she developed severe pre-eclampsia. She said having a second child is all she can safely afford.
“It was worth the risk, but I know my body can’t handle any more pregnancies.” she said. “We decided a tubal ligation was the best option to prevent any future unintended pregnancies, for my health and my family.”
In its Dec. 2 letter to Dignity Health’s president and CEO in San Francisco and to local officials at Mercy Medical Center in Redding, the ACLU demands that the hospital reverse its denials and allow the two women’s procedures.
“Refusing to allow doctors to perform postpartum tubal ligations denies patients pregnancy-related care, and, as such, constitutes sexual discrimination,” the letter states. The ACLU is threatening to sue if the hospital doesn’t act by Wednesday.
“The problem continues to be a conflict between the best interest of patients and the directives of the Catholic hospital system,” said Elizabeth Gill, senior staff attorney with ACLU of Northern California. “This is not an anomaly in Redding. We’re seeing a wide range of instances (nationwide) in which women’s health is being put at risk by hospitals invoking the (Catholic church’s) ethical and religious directives.”
In a statement, Dignity Health officials said they could not comment on individual patient care or the ACLU’s letter. But the statement confirmed that tubal ligations and other sterilization procedures are not performed in Catholic hospitals unless necessary to alleviate “a present and serious pathology and (when) a simpler treatment is not available.”
When Dignity Health does not offer a requested medical service, it noted, “the patient’s physician makes arrangements for the care of his/her patient at a facility that does provide the needed service.”
The skirmish marks the latest battle between religious-affiliated health care systems, such as Dignity Health, and patients or employees seeking reproductive services, such as birth control. Last month the U.S. Supreme Court agreed to take up seven cases involving nonprofit religious-based institutions that seek an exception to providing contraceptive coverage to their employees.
The issue has become more heated as Catholic health care organizations have expanded their network of hospitals nationwide. Most abide by religious directives spelling out which medical procedures violate church doctrine. A 2009 directive issued by the U.S. Conference of Catholic Bishops says Catholic health care organizations are not permitted to engage in actions that are “intrinsically immoral,” including direct sterilization for men or women.
In a footnote, the guidelines state, “While there are many acts of varying moral gravity that can be identified as intrinsically evil, in the context of contemporary health care the most pressing concerns are currently abortion, euthanasia, assisted suicide and direct sterilization.”
With 645 hospitals and 116,415 beds, Catholic hospitals treat 1 in 6 of all U.S. patients, according to a January 2015 report by the Catholic Health Association of the United States. Dignity Health, ranked as the fifth-largest nonprofit hospital system in the country in 2015, has 39 hospitals in three states, including California. In the greater Sacramento area, it has six acute care hospitals, including Mercy General, Methodist and Woodland Memorial.
In many smaller communities, the ACLU argues, physicians and patients may not have access to more than one hospital. Miller and Brushett, for example, said that if they wanted to be covered by their insurance plans, their only option – outside of Mercy Medical Center – was to travel more than two hours to Sacramento for a combined C-section and tubal ligation.
“It really wasn’t an option,” said Brushett, an administrative assistant for a medical supply company. “The thought of not having my husband, son and the rest of our family within minutes away, I just couldn’t do it.”
She and Miller said they wanted their tubal ligations done in the hospital immediately after their C-sections to save the time, cost and potential trauma of a second surgery. In a tubal ligation, a woman’s fallopian tubes are cut or clamped, preventing her eggs from reaching the uterus. It’s considered more cost-effective to do the procedure after a C-section, when a woman’s abdomen is open.
All three women have the same obstetrician-gynecologist, Dr. Samuel Van Kirk, who’s been practicing in Redding since 2010. A receptionist at his office said Van Kirk had no comment on his patients’ cases and referred callers to the ACLU.
Physicians for Reproductive Health, a national group supporting women’s access to contraception and other services, is supporting the ACLU’s efforts. The group includes 1,200 doctors who practice in California, some at Dignity Health hospitals.
“The directives prohibiting direct sterilization ignore recommended medical practice,” Dr. Pratima Gupta, a Bay Area OB-GYN who represents Physicians for Reproductive Health, said in an emailed statement. “Unfortunately, these cases are neither surprising nor unique given the growth of the Catholic hospital system, which has left many women with very few places to turn for reproductive health care.”
Gupta said postpartum tubal ligations are “an incredibly common and safe method of contraception – especially for women who are already scheduled for a C-section.” She said the procedures are performed in nearly 10 percent of all hospital deliveries and are the contraception choice for more than 30 percent of U.S. married women of reproductive age.
Under the federal Affordable Care Act, most forms of birth control are covered by insurance at no cost to the patient. That includes birth control pills and patches; IUDs and diaphragms; emergency contraceptives (“morning after” pills); and permanent contraception, such as tubal ligations.
Companies and nonprofits that don’t want to offer contraceptive coverage to employees for religious reasons can apply for an “accommodation,” meaning they don’t have to provide contraceptives but their employees can receive them through the insurance provider. In the cases to be heard before the U.S. Supreme Court in March, some groups, including several Catholic organizations, are seeking an “exception” to the ACA requirement, meaning there would be no contraceptive coverage for their employees. That status currently is granted only to houses of worship, such as churches, synagogues or mosques.
“It is a very challenging problem, because Catholic hospitals are governed by Catholic Church policies that ... are completely unrelated to medical standards of care,” said Susan Berke Fogel, director of reproductive health for the National Health Law Program, based in Los Angeles. “They are refusing to provide the standard of care that everyone expects.”
Fogel said it’s becoming a bigger problem as hospitals consolidate and consumers may be unaware that certain procedures are unavailable to them. “For someone who is in an insurance plan where all the hospitals are Catholic, which definitely happens in some areas, she could find herself not able to get these services in-network. If she has to go to a hospital that is out-of-network and get a sterilization, she may have enormous costs.”
In Rachel Miller’s case, Mercy Medical Center relented after the ACLU sent a letter threatening legal action. But even after the hospital changed course, there were stumbling blocks, Miller said. Arriving at Mercy General at 5 a.m. for her scheduled C-section on Sept. 29, Miller said she was told the tubal ligation paperwork had been lost, so the procedure could not be done. But Miller had brought her own copy of the authorization form, which was handed over, allowing her doctor to proceed.
Nearly two months later, Miller, 32, said she’s 100 percent sure that getting her fallopian tubes tied was the right decision for her family. Shortly after her delivery and tubal ligation, she developed postpartum pre-eclampsia, her blood pressure skyrocketed and she was hospitalized. “Even if my husband and I had a completely different path and were planning for 20 kids, there’s just no way we would be having any more given the medical complications I had.”
For Chamorro and Brushett, the clock is ticking. Brushett, about 5 1/2 months pregnant, is especially anxious for an answer because she’s worried that she won’t be able to go full term with her second baby.
“Mercy or anyone else shouldn’t be allowed to deny women access to health care,” said Brushett, home this week with her 18-month-old son. “It’s not a good feeling when something you made a decision on, with your family and doctor ... that they can just tell you ‘no.’ ”