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Op-Ed: Catholic Hospital's Refusal To Provide Tubal Ligation Marks 'Developing Crisis' in Health Care

January 13, 2016 — An ongoing lawsuit involving a Catholic hospital's refusal to provide sterilization services "underscores a developing crisis in American [health care], which is tied to the evolution of Catholic hospital chains into a major provider of medical services -- and the sole provider of some services in some communities," columnist Michael Hiltzik writes in an opinion piece for the Los Angeles Times.

According to Hiltzik, the lawsuit involves a California woman, Rebecca Chamorro, who requested that she receive a tubal ligation after her scheduled cesarean section on Jan. 28. The hospital, Mercy Medical Center in Redding, rejected her request, "[n]ot because its administrators thought the procedure was medically unwise, dangerous or illegal, but because it violates the Catholic religious principles to which the hospital's owner, Dignity Health, subscribes," Hiltzik writes. Chamorro now is seeking a preliminary injunction from a state judge to prohibit "Dignity Health from interfering with her doctor's judgment."

Hiltzik notes that there are 645 Catholic hospitals in the United States, "constituting the largest group of nonprofit [health care] providers in the country, according to the Catholic Health [Association] of the United States, caring for one in six patients." The increasing presence of Catholic health care systems "wouldn't be cause for concern if not for these hospitals' practice of placing non-medical concerns ahead of those of patients and their doctors," he writes, explaining that "[t]he Ethical and Religious Directives, or ERDs, bar Catholic hospitals from performing 'elective abortions' (a religious, not medical term), providing contraceptives or performing in vitro fertilization, tubal ligations or vasectomies if the latter are aimed at preventing pregnancies."

Hiltzik writes that "Catholic hospitals [typically] adhere to the ERDs through policies on which church prelates exercise a strong voice." Meanwhile, "Catholic [health care] systems receive billions of dollars in state and federal taxpayer funds and dominate some communities' health landscapes," he continues. Hiltzik cites Ruth Dawson -- an attorney with the American Civil Liberties Union, which is representing Chamorro -- who said these funds "should place a heavier responsibility on Catholic hospitals to comply with medical judgments." Dawson said, "We hope this case will lead to the precedent that organizations that accept public funds can't discriminate based on religious doctrine."

Hiltzik also points out that "nonsectarian hospitals merg[ing] with their Catholic brethren for financial reasons ... can get cornered into complying with some Catholic directives, shrinking [health care] options, especially for women of reproductive age." For example, Hiltzik writes that medical staff at Newport Beach's Hoag Hospital were surprised to learn that the hospital could no longer provide abortion care after it merged in 2013 with the Catholic St. Joseph Health System. Further, Hiltzik writes that another "problem with non-medical doctrines such as the ERDs is that they can lead to inconsistent and arbitrary decisions," as "appears to be happening" at Mercy Medical. Hiltzik notes that Chamorro's physician, Samuel Van Kirk, "has been unable to figure out the pattern" behind Mercy Medical's decisions to approve or reject his requests to perform tubal ligations. According to Hiltzik, Mercy Medical in 2015 approved a tubal ligation request for a woman, Rachel Miller, after initially denying it, "[b]ut the hospital hasn't explained how Miller's case differs from Chamorro's."

Hiltzik notes that while Dignity Health has stated that "Mercy Medical allows tubal ligations 'when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available,'" Van Kirk has said "tubal ligations are 'only ever ... performed to prevent future pregnancy.'" Meanwhile, Hiltzik writes, "ACLU says Dignity Health's approval of the tubal ligation for Miller and others while denying it to Chamorro opens it to the charge of violating California law, which forbids a hospital that allows any sterilizations for contraceptive purposes to impose non-medical conditions on anyone seeking them."

According to Hiltzik, the situation is "an example of hospital administrators and religious prelates stepping between a woman and her doctor, wielding rules and regulations that have nothing to do with medicine and may even compromise her health." He concludes, "If Rebecca Chamorro prevails in obtaining the care she seeks, she will have landed a powerful blow for driving religious doctrine out of the operating room" (Hiltzik, Los Angeles Times, 1/11).