A Hospital Denied a Woman Tubal Ligation, Even Though Pregnancy Could Kill Her

This week, the American Civil Liberties Union and the ACLU of Michigan filed a complaint with the U.S. Department of Health and Human Services’ Office for Civil Rights against Ascension Health, the largest nonprofit health system in the United States and the largest Catholic health system in the world, and its subsidiary Genesys Health System.

The basis of the ACLU complaint? Sex discrimination — as in, the fact that women are being denied access to certain kinds of care at Catholic hospitals, care that is only needed by women, such as tubal ligation, contraception, and abortion.

The complaint’s origins lie in the case of Jessica Mann, a Michigan woman whose doctor recommended she undergo a tubal ligation — the medical name for the procedure colloquially known as “having your tubes tied” — at the time of the birth of her third child, who was scheduled to be delivered via a cesarean section, because of a preexisting brain tumor that Mann had that could become life-threatening as the result of subsequent pregnancies. Tubal ligation is frequently performed at the time of a C-section delivery for women who request the procedure, as it is safest and most effective to have both surgeries performed at once and for a woman to not be subjected to two separate surgeries and the accompanying anesthesia.

However, Mann had planned to deliver at the hospital near her home — Genesys Health System in Grand Blanc, Mich., a hospital that through its affiliation with Ascension Health is governed by the religious rules developed by the United States Conference of Catholic Bishops. And under these rules, certain procedures are not only banned from being performed but also classified as “intrinsically evil.” Tubal ligation is one of the banned procedures, as it is a form of birth control, which is opposed by the Catholic Church.

“Tubal ligation is commonly performed at the time of cesarean for women who feel they have completed childbearing or have a medical reason why they don’t want to get pregnant again,” Joshua Copel, MD, a professor of gynecology and reproductive sciences at the Yale School of Medicine in New Haven, Conn., tells Yahoo Beauty. “It is considered to be highly effective — there is a very, very, very low rate of pregnancy after it occurs.”

Copel also notes that tubal ligations are commonly performed for patients seeking them at the same time as cesarean because there is less risk for a patient when they only have to undergo anesthesia and the rigor of surgery once, rather than twice.

He also adds that tubal ligations are “quick and safe” procedures generally performed outpatient via laproscopy.

“Tubal ligation is a very effective form of contraception and, for the right family, it’s the right procedure to be offered for a patient,” Copel says.

Brigitte Amiri is a senior staff attorney at the ACLU’s Reproductive Freedom Project. She explains to Yahoo Beauty that there has been a recent proliferation of Catholic hospitals in the United States, resulting in one in every six hospital beds in the U.S. being obligated to follow the religious rules outlined by the Conference of Catholic Bishops.

“A lot of times, people don’t even know a facility is Catholic, and there is no indication that a facility is bound by Catholic rules,” she says. “A secular hospital may merge with or purchase another hospital, resulting in their being bound by these ethical rules. Even hospitals with a history of having no religious affiliation may still have these ethical rules in place.”

As a result, she notes, doctors at these hospitals are prevented from providing care that conflicts with the Catholic religion, meaning that reproductive health care such as abortion (even in the case of when a woman’s life is at risk), tubal ligation, and contraception are all off the table for women seeking care at these facilities.

“In essence, Catholic hospitals turn away women seeking this kind of care and so this is sex discrimination. These are services only women need. Men do not need these services. And so treating women in this way because they need this kind of care is sex discrimination,” Amiri says.

Furthermore, Amiri explains, because of the dearth of hospital options in rural areas, the restrictions imposed on access to care by Catholic hospitals mean that rural and low-income women are often disproportionately affected by this form of discrimination.

The American College of Obstetricians and Gynecologists and the American Congress of Obstetricians and Gynecologists write in a position statement that they are “concerned that a growing number of U.S. health systems and hospitals limit the scope of reproductive health care services they provide. Because of hospital mergers and acquisitions, some communities lack any alternatives to hospitals that prohibit certain essential reproductive health services. … Prohibitions on essential care that are based on religious or other non-scientific grounds can jeopardize women’s health and safety.”

“It’s stunning to hear people say that these women can just go to another hospital,” adds Amiri. “That’s not an option for many of these women, and it’s not acceptable. Any woman should be able to go to any hospital and get the care she needs, regardless of its affiliation.”

Amiri mentions two other cases in which patients were turned away by Catholic hospitals; in one, a woman’s intrauterine device (IUD), a long-acting reversible contraceptive, became dislodged and she was at serious risk for infection, cervical and uterine lacerations, and scarring. Even after a doctor at Mercy Hospital, in Chicago, where patient Melanie Jones sought treatment for the pain and vaginal bleeding she was experiencing, confirmed that the problem was with her IUD and that it needed to be removed, that same doctor explained that he would not remove it. Jones’s insurance coverage only covered hospitals that happened to be regulated by Catholic ethics rules and thus she was left without options for where and how she could afford and receive the care she needed.

In the other case, Tamesha Means sought treatment at Mercy Health Partners in Muskegon, Mich., when her water broke at only 18 weeks of pregnancy. Because of the hospital’s Catholic affiliation, Means was turned away with only Tylenol, despite the fact that she was miscarrying and in serious pain, bleeding, and at serious risk of infection. Performing an abortion would have been an effective and appropriate treatment for Means in her current situation. But it was care she was denied.

“These are hospitals that not only are open to the public and run emergency rooms ostensibly for everyone, but they also take billions of dollars in federal funds,” says Amiri. “Any entity that receives so much federal money should abide by the federal rules that prevent sex discrimination. Taxpayer dollars are going to support religiously affiliated hospitals that turn women away.”

Amiri notes that this is the second complaint the ACLU has filed with the Office of Civil Rights against Catholic healthcare systems.

“We hope that HHS will launch an investigation and make a determination that the hospital did discriminate against Jessica Mann and the other women seeking tubal ligation at the time of delivery and seek corrective action,” Amiri concludes.

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