Jessica Mann’s doctor said a life-threatening condition meant she needed a tubal ligation. In a move that follows a disturbing trend, the hospital said no

Weeks after learning she would give birth to her third child, Jessica Mann was faced with a difficult decision: because she was stricken by a life-threatening brain tumor, her doctor recommended she have her fallopian tubes tied at the time of her scheduled cesarean section delivery, later this month.

Mann agreed to undergo the procedure at her hospital to prevent the risk of a future pregnancy exacerbating her tumor. But the hospital, Genesys Regional Medical Center in Grand Blanc, Michigan, declined on religious grounds.

The case is part of a trend that some experts are calling a burgeoning public health crisis, as a greater proportion of patients rely on religious hospitals for medical care.

Genesys’s denial stems from a religious directive crafted by the US Conference of Catholic Bishops, which governs every Catholic-sponsored hospital in the nation.

The set of rules, called the Ethical and Religious Directives, prohibits the facilities from performing procedures like tubal ligations.

“As a Catholic healthcare system, we follow the ethical and religious directives of the church,” the hospital said in a statement to the Guardian. “Beyond that, we can’t comment on this patient’s particular case.” Ascension Health, the largest Catholic and nonprofit health system in the US, did not respond to a request for comment .

Mann’s doctor advised her that tubal ligation during the C-section would be the safest route, consistent with long-established standard of care, and prevent the need for another surgery.

“It’s not an easy thing to hear somebody tell you that,” said Mann, a social worker. “But … I talked it over with my husband and we’ve been blessed with the children that we do have. Our decision was based on the fact that we want me to be around and my kids need me around as well.”

Aware of the hospital’s rules, Mann, who is 33, requested a waiver back in May, as her doctor only has admitting privileges at Genesys.

Although Genesys had indicated it would permit exceptions for tubal ligations that were intended to cure a serious medical condition, the hospital denied Mann’s request, over the objections of her doctors. The American Civil Liberties Union of Michigan intervened last month and asked Genesys twice to reconsider. The hospital, however, remained defiant, citing its adherence to the religious directives.

On Wednesday, the ACLU filed a complaint on behalf of Mann with the Michigan department of licensing and regulatory affairs, requesting an investigation of the situation. The department has the authority to revoke the hospital’s license, or impose an administrative fine.

Catholic hospitals have some flexibility with the bishops’ directives, and doctors at Genesys previously tied the tubes of mothers after they gave birth. But the hospital’s ban on a common procedure – it’s estimated that 600,000 are performed annually – is a sign of a new trend among Catholic-affiliated institutions, said Brooke Tucker, an ACLU attorney.

“As Catholic hospitals become the sole option for more people, as they’ve merged with secular entities … they become more empowered to impose their will on the public because there’s no other recourse,” Tucker said.

As of 2011, one in 10 acute-care hospitals were either Catholic sponsored or affiliated, according to a report by the ACLU and the MergerWatch Project. Though the number of overall hospitals in the US declined over the previous decade, the report found the number of Catholic sponsored or affiliated hospitals had increased by 16%.

That added market share has introduced the beginnings of a “public health crisis”, said Elizabeth Sepper, a law professor at Washington University whose research is primarily on religion in medicine, as more religious hospitals have merged with “secular hospitals … and [are] requiring those hospitals to comply with these religious restrictions”. About one in six patients are admitted to Catholic hospitals, she said.

Over the last several years, the US conference of Catholic bishops has “cracked down” on those institutions to abide by its religious directives, Sepper said, probably prompting what took place at Genesys.

But “the legal standard for emergency care requires serious jeopardy at that moment, not what you and I might think of as an emergency”, Sepper said.

She added: “Still, tubal ligation immediately following the C-section is definitely the standard of care – anything less is effectively medical malpractice.”

Mann’s case is the latest in a spate of battles across the US over religious liberties, with individuals and organizations attempting to deny services in circumstances they say would conflict with their beliefs.

While federal law provides an exemption for hospitals who don’t want to provide abortions or sterilizations, there doesn’t appear to be any ground under federal law for a Catholic hospital to resist Michigan’s regulatory authority, Sepper said. Michigan has a so-called conscience clause for hospitals but it only applies to abortions.

The ACLU has also said federal law doesn’t apply, as Michigan statute entitles Mann to “adequate and appropriate care”, unless a physician says there is a medically appropriate reason not to perform a procedure.

In this case, said Tucker, “‘Mrs Mann was denied appropriate care and other women may have been as well.”

Now, just days from her due date, the central Michigan resident and her husband have been scrambling to get the necessary paperwork in order so she can have the procedure elsewhere.

“That’s been a struggle with insurance and getting the appropriate referrals … so that everything is all set when I do deliver,” Mann said. “At this point in my pregnancy, we should be finalizing a baby name and getting her clothes ready.”

In 2005 Mann was diagnosed with pilocytic astrocytomas, which are benign brain tumors that can cause seizures or blindness. Few options exist for remedies, Mann said.

“Basically, the treatment is to monitor it to make sure it’s not growing,” she said. “Once it starts growing, that’s when they’re going to look into options as far as another surgery.”

The condition doesn’t make giving birth any easier. When Jessica delivered her son in 2013, it was treated as a high-risk pregnancy and required a C-section. Similar to that experience, Mann must be fully anesthetized for the delivery this month – another situation that poses risks.

Mann said it’s not safe for her to deliver while partially anesthetized.

Compounding the situation is that Mann’s family identifies as Catholic, a particularly thorny issue for her.

“The fact that these people, who are not medically trained in any way, are making decisions based on their religious beliefs – that’s what’s so upsetting,” she said.