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Judge Denies Preliminary Injunction Against Catholic Hospital That Refuses To Provide Tubal Ligation

January 15, 2016 — In a ruling Thursday, San Francisco Superior Court Judge Ernest Goldsmith finalized his decision allowing a Catholic hospital in California to deny a woman's request for a tubal ligation, the AP/San Jose Mercury Newsreports (Thanawala, AP/San Jose Mercury News, 1/14).

Background

Sterilization is the second most common birth control method in the United States. Ob-gyns often perform tubal ligations in conjunction with cesarean sections so women do not require a second surgery for the sterilization. In the past, some Catholic hospitals provided sterilizations if they were medically indicated, such as when a woman was undergoing a C-section and another pregnancy would present a health risk.

However, the Vatican in the early 2000s sought stricter enforcement of the Ethical and Religious Directives for Catholic Health Care Services, which ban Catholic facilities from performing sterilizations, abortions and certain other procedures. Meanwhile, the number of Catholic hospitals in the United States increased by 16% between 2001 and 2011.

In October 2015, Mercy Medical Center, which is owned by Dignity Health of San Francisco, reversed its decision and decided to perform a tubal ligation on a patient, Rachel Miller, following notice of a possible sex-discrimination lawsuit from the American Civil Liberties Union. Dignity Health is the largest private health care system in California. More than half of its 32 hospitals in the state are affiliated with the Catholic Church.

The hospital, which had cited the directives in its original decision against providing the procedure, said it reconsidered after Miller's physician provided additional information. However, Mercy Medical Center recently rejected requests from two other women -- Rebecca Chamorro and Lynsie Brushett -- seeking to undergo tubal ligation procedures immediately after giving birth.

Earlier this month, ACLU filed a lawsuit against the hospital on behalf of Chamorro and Physicians for Reproductive Health. Chamorro's physician, Samuel Van Kirk, is a member of PRH, and he said he has received at least two other tubal ligation requests. Goldsmith last week refused ACLU's request for an emergency order that would have blocked Mercy Medical Center from denying Chamorro a tubal ligation after delivery (Women's Health Policy Report, 1/8).

Hearing Details During the hearing on Thursday, Goldsmith heard arguments from Elizabeth Gill, an attorney for ACLU, and Barry Landsberg, representing Dignity Health.

Gill argued that Mercy Medical Center does not have a "free-exercise right here to impose those religious views" on others. She also pointed out that Chamorro would have to travel more than 70 miles to reach the next-closest hospital, which could endanger her health. In addition, Gill said the hospital's policy on sterilization violates a California law, under which the definition of discrimination based on sex includes the refusal to provide pregnancy-related care. She also disputed the hospital's claim that it would provide sterilization services to address serious health issues as long as they are not related to contraception, noting that tubal ligation is inherently about contraception. As a result, she said, the hospital is breaking a state law that bars the denial of contraception care based on nonmedical reasons (Egelko, San Francisco Chronicle, 1/14).

Meanwhile, Dignity Health claimed that Chamorro's tubal ligation was not medically necessary and that being forced to provide the service would violate the hospital's right to freedom of religion (AP/San Jose Mercury News, 1/14). Latest Ruling

In his ruling, Goldsmith said the right to freedom of religion permits Mercy Medical Center to adhere to the religious directives (San Francisco Chronicle, 1/14).

Goldsmith said it was not about sex discrimination because the hospital's ban on sterilization applies to male and female patients. He also said Chamorro could opt to deliver at a different hospital, and he ruled that there was not enough evidence to show that Mercy Medical Center provided other women tubal ligations for only the purpose of contraception (Cohen, The Guardian, 1/14).

Comments

Gill said unless Goldsmith's decision is overruled by a higher court, Chamorro likely will have to deliver at Mercy Medical Center and then have a second surgery for the tubal ligation or use a different type of contraception. However, she said ACLU would pursue a ruling from the state courts on the issue even if Chamorro does not receive a decision in her favor before she delivers (San Francisco Chronicle, 1/14).

"We disagree with the court about what California law requires," Gill said, adding, "This is a real issue about women's health" (AP/San Jose Mercury News, 1/14). She continued, "Catholic hospitals have been aggressively expanding over the past 15 years, and as our client is experiencing, they're the only option for care in a lot of cases," she said.

Separately, Chamorro in an email wrote, "It's unbelievable that the hospital where my doctor has admitting privileges is denying him the ability to provide a safe, legal and common procedure, especially considering that Mercy is my only real option."

Miller also criticized the hospital's decision, noting that her tubal ligation was not more medically necessary than Chamorro's. "I think it is totally wrong that a hospital is using religion to deny standard medical care for an entire community," she said (The Guardian, 1/14).