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All Rebecca Chamorro wanted was to get her tubes tied.
The 33-year-old mother of two from Redding, California was pregnant with her third baby, and she and her husband decided they didn't want any more kids. So she consulted with her doctor, who offered to do a "tubal ligation"—a routine procedure that involves sealing off the fallopian tubes to prevent fertilization—immediately following her cesarean section scheduled for January 2016.
Then the hospital stepped in. Mercy Medical Center Redding (MMCR), a Catholic facility owned by national healthcare giant Dignity Health, barred Chamorro's doctor from doing the procedure. The reason? A religious-based ethical directive that deems it "intrinsically immoral" for Catholic hospital staff to partake in sterilization procedures.
Now, with her newborn baby, Chamorro sits at the center of a civil rights lawsuit against Dignity Health that raises big questions about patient autonomy and access. The lawsuit, originally filed by American Civil Liberties Union in late 2015 and updated after Chamorro gave birth, gained major support last week from the influential California Medical Association (CMA), which represents 41,000 physicians in the state. In court papers, the CMA argued that Dignity Health's religious-based rule against postpartum sterilization undermines the doctor-patient relationship, forces "substandard care" on female patients, and violates a California legal doctrine that bars corporate interference with medical decisions.
"This is an excellent example of where a doctor and his or her patient make a sound, reasonable medical decision, and they cannot carry it through because of a corporate policy," said Dr. Ruth Haskins, president-elect of the CMA, which has petitioned the court to join the lawsuit.
Plus, she added, it's illegal. "Corporations cannot make medical healthcare decisions—and that's exactly what's going on here."
In the roiling debates over women's reproductive rights, tubal ligation might seem not as big of a flashpoint for controversy as, say, the Affordable Care Act's contraception mandate. But getting your tubes tied has proven a big issue in Redding. Months before Chamorro's suit was filed last December, a patient named Rachel Miller won her own fight against Dignity Health, compelling the San Francisco-based, Catholic-affiliated nonprofit to allow her to get the procedure after the ACLU threatened to file a sex discrimination lawsuit.
According to court papers, Chamorro's frustrations began last fall when she consulted with her physician, Dr. Samuel Van Kirk, about doing the tubal ligation. It's a common procedure embraced by millions of women (there's a version for men too), which only takes a couple minutes to perform while the patient is still in the delivery room. But Van Kirk had been denied by MMCR dozens of times in the past, just like he was with Chamorro. Like many of Dignity Health's California facilities, the hospital abides by "ethical and religious directives" set down by the United States Conference of Catholic Bishops. It's a 43-page handbook of rules and guidelines which forbids abortions and assisted suicide, and allows sterilization for men and women only in cases requiring treatment of "a present and serious pathology" with no simpler options possible. Dignity Health oversees both Catholic and secular hospitals, but all of them are required to comply with these company-wide policies.
Unable to get the procedure done at MMCR, Chamorro (who declined to be interviewed) had nowhere more realistic to go. Redding, a city of nearly 90,000 located on the Sacramento River in Northern California, is home to multiple hospitals, but Mercy Medical is the only one that offers maternity services. The nearest facility that permitted the procedure and that covered Chamorro's insurance was at least 70 miles away.
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According to Elizabeth Gill, senior staff attorney at the ACLU of Northern California, it's a problem that other patients have experienced as well, as Catholic hospitals have grown into the nation's largest group of nonprofit healthcare providers, according to the Catholic Health Association of the United States. While not-for-profit health networks like Dignity Health have garnered millions of dollars in federal and state funding, Gill says that the ethical directives have effectively cut off patients from some healthcare options.
"There's a real conflict between women getting basic healthcare and these religious directives," Gill said.
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The Dignity Health lawsuit is one of the latest in the ACLU's legal campaign against Catholic hospitals. Last December the civil rights group filed suit against Michigan-based provider Trinity Health Corporation, and in 2013 it went a step further, suing the actual bishop authors of the religious directives on behalf of a woman who was denied treatment at a Catholic hospital Muskegon, Michigan while she was having a miscarriage. In Chamorro's case, which was filed in San Francisco Superior Court, she's joined as a plaintiff by an advocacy group called the Physicians for Reproductive Health.
The plaintiffs accuse Dignity Health of discriminating against Chamorro based on her gender, and also violating California medical laws that bar using non-medical criteria for approving sterilization surgeries and that restrict corporate meddling in medical decisions. After the suit was filed, Dignity Health's lawyers shot back with a strongly worded response, calling the lawsuit "an unprecedented attack on a Catholic hospital." They argued that Dignity Health has the right to religious autonomy, and that Mercy Medical Center Redding isn't running afoul of California's bar on the corporate practice of medicine "because the decision not to provide ethically prohibited medical services is the practice of religion, not medicine."
In January, days before Chamorro went into labor, a Superior Court judge ruled in Dignity Health's favor, denying Chamorro's request for a preliminary injunction ordering the hospital to do the procedure. Judge Ernest H. Goldsmith wrote that the plaintiff is "unlikely to prevail on the merits" of the case because the sterilization policy also applies to men, and that Chamorro could get the procedure done at another hospital. It's a tentative ruling that gives vindication to Lori Dangberg, vice president of the Alliance of Catholic Health Care, which represents Catholic healthcare systems and hospitals in California.
"I think it gets down to our First Amendment right to be able to provide services to the community that is aligned with our ethical and moral values," said Dangberg. "We make that known. It's not like it's some secret. Physicians understand when they have practice privileges in our hospitals what we do and do not allow."
But Haskins, of the California Medical Association, thinks that the sanctity of patient care is being compromised by the religious rule against postpartum tubal ligation. Since Chamorro wasn't able to get a postpartum tubal ligation, Haskins says this now presents limited options. There's birth control or there's an interval surgical procedure—a tubal ligation scheduled separately from childbirth, which carries higher surgical risk, leads to time away from the newborn baby, and costs a lot more.
"Not only is it not reasonable, but it's not safe, it's not healthy, and it's not medically appropriate," Haskins said of the Redding hospital's ban on the procedure. "To take somebody who's in need and send them to another hospital disrupts the doctor-patient relationship in a way that is really not OK."
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