Rachel Miller, due to have her second child in late September, agreed with her husband that this would be her last pregnancy and decided she would be sterilized by tubal ligation after giving birth. But her hospital in Redding, owned by Dignity Health in San Francisco, refused to allow her doctor to perform the procedure, saying tubal ligation violates the ethical principles of Catholic health care facilities.

Now Miller’s case could become the springboard for a legal attack on barriers to reproductive procedures — other than abortions — at Catholic hospitals in California, whose numbers are steadily increasing.

“Hospitals that are open to the general public and that receive state money shouldn’t be able to use religion to discriminate or to deny important health care,” said Elizabeth Gill, an American Civil Liberties Union attorney who represents Miller. She said the hospital receives state Medi-Cal funds as well as federal funding from both Medi-Cal and Medicare.

In an Aug. 17 letter to Mercy Medical Center in Redding, Gill said the ACLU would go to court unless the hospital reversed course and authorized the sterilization procedure. By denying “pregnancy-related care” to Miller, Gill wrote, the hospital is discriminating on the basis of sex, as defined by California law, and is also allowing “your corporate entity’s religious beliefs” to override a doctor’s medical decision, violating a state law against the corporate practice of medicine.

‘It is not our practice’

Replying to a reporter’s inquiry, the hospital said Wednesday that it “provides many women’s health services,” including childbirth and baby care. But it said that “in general, it is not our practice to provide sterilization services at Dignity Health’s Catholic facilities,” in keeping with Catholic hospitals’ Ethical and Religious Directives.

The hospital added, however, that Catholic hospitals may perform tubal ligations “on a case-by-case basis where a formal review by a committee of physicians and others permit the procedure.” And on Friday, Gill said the ACLU had learned that the hospital had contacted Miller’s physician and told him it was reconsidering its denial of the sterilization. A final decision is due Monday.

Shocked at rejection

Miller said earlier in the week that she had repeatedly called Mercy Medical Center, seeking an explanation after her doctor showed her the rejection letter he had received from the hospital in April. The hospital never responded.

“I was shocked to learn from my doctor that the hospital was telling me no and that the only basis for that was a religious doctrine,” Miller, a 32-year-old lawyer, said. “I have no problem with people practicing their religion. But because there are so many Catholic hospitals, especially in the north state where I live, it leaves women with very little choice.”

Miller had her first child by cesarean section at Mercy Medical Center 2½ years ago and plans the same procedure this time. She said the closest alternative hospital that could perform the delivery and the sterilization procedure, and accepts her insurance, is at UC Davis, more than 160 miles away. The distance from home would mean that she would be away from her first child for three to five days during her hospitalization, she said.

Tubal ligation, also known as “tying the tubes,” is a common surgical method for women to prevent future pregnancies. It is used by about 600,000 women in the United States each year, according to the American College of Obstetrics and Gynecology.

Miller’s case, if it goes to court, has a potentially broad impact because of the growth of Catholic hospitals. Dignity Health, the nation’s fifth-largest private health care system, owns 29 hospitals in California. More than half are affiliated with the Catholic Church, including St. Mary’s Medical Center in San Francisco.

More Catholic hospitals

A study released by the ACLU in 2011 found that Catholic-affiliated hospitals had increased by 16 percent nationwide over the previous decade, while the overall number of hospitals had declined. A 2012 survey by the National Health Law Program found that nearly 15 percent of all U.S. hospital beds were in Catholic institutions.

The hospitals’ Ethical and Religious Directives prohibit abortion, contraception, sterilization for both men and women — which the directives describe as “intrinsically evil” — and reproductive-assistance technology such as in vitro fertilization. The bans apply both to patients who rely on Dignity staff doctors and to those like Miller who bring in their own physicians.

Those exclusions may conflict with state and federal laws governing health care and civil rights. But religious exemptions have been gaining ground in federal courts, most notably in the U.S. Supreme Court’s Hobby Lobby ruling last year, which allowed owners of the nationwide craft-store chain to deny contraceptive coverage to female employees for religious reasons.

In a recent Catholic hospital case, the ACLU sued on behalf of a Michigan woman whose water broke midway through her pregnancy, a sign of premature labor and a possible stillbirth. Rather than telling her there was little chance the fetus could survive and that abortion was an option, she said, the hospital sent her home without treatment, relying on the church’s antiabortion directives, while she was in extreme pain, providing care only when she later miscarried. A federal judge dismissed the suit in June, saying he was unwilling to “intrude upon ecclesiastical matters.” The ACLU has appealed.

But the outcome could be different in California.

In the case of a landlady who refused to rent to an unmarried couple for religious reasons, the state Supreme Court ruled in 1996 that private businesses must comply with antidiscrimination laws, despite religious objections. And in 2004, the court said church-affiliated employers, like Catholic Charities and Catholic hospitals, were bound by a state law that entitles women to birth-control coverage in their workplace medical plans.

Procedure’s timing

California law allows Catholic hospitals to refuse to perform abortions but does not exempt them from providing other reproductive care, including sterilizations. Although sterilization is normally voluntary, major medical organizations say a tubal ligation immediately after a woman’s last intended pregnancy is such a safe and quick procedure, and so effective in preventing unwanted future pregnancies, that it should be considered “urgent” medical care.

“The immediate (post-childbirth) period ... is the ideal time to perform sterilization because of technical ease and convenience for the woman and physician,” said the American College of Obstetricians and Gynecologists in a 2012 report. “Obstetrician-gynecologists need to identify themselves as champions or patient advocates for post-partum sterilization in their respective hospitals.”

Bob Egelko is a San Francisco Chronicle staff writer. E-mail: begelko@sfchronicle.com Twitter: @egelko