Evan Minton, who was refused gender transition surgery, adjusts his tie in Orangeville, Calif., on Aug. 30, 2019. (Jose Luis Villegas/The Sacramento Bee via AP)

Court Rules That Gender Concerns Override Religious Principles

A woman diagnosed with gender dysphoria can sue a Catholic hospital for refusing to surgically remove her uterus as part of the sex-reassignment process, despite the hospital’s religious objection to performing the operation, an appeals court in California ruled.

The ruling pits competing legal interests against each other, elevating civil rights concerns involving sexual orientation and gender identity over the right of religious institutions to adhere to their sincerely held beliefs in the provision of services.

The Court of Appeals of California ruled Sept. 17 in Minton v. Dignity Health that Dignity Health violated California’s Unruh Civil Rights Act by withholding the medical care that Evan Minton requested. The appeals court revived Minton’s lawsuit, sending it back for further consideration to San Francisco Superior Court, which previously dismissed the action.

Minton, who identifies as a man, had initiated hormone replacement therapy in 2012 and had a mastectomy in 2014, and intended to complete the hysterectomy before undergoing phalloplasty to complete the transition, Catholic News Agency reports.

Minton, who was represented by the American Civil Liberties Union, claimed in the lawsuit that Sacramento-area Mercy San Juan Medical Center, operated by Dignity Health, canceled a scheduled hysterectomy when the patient told a nurse she identified as transgendered.

“The refusal of Dignity Health to allow a doctor to perform this common procedure simply because the patient is transgender is discriminatory,” Elizabeth Gill, a senior staff attorney at the ACLU of Northern California, said when the lawsuit was filed. “This is a hospital that is open to the general public, so it’s illegal for them to turn away someone based on gender identity.”

According to the appeals court, the hospital’s refusal to perform the operation as originally scheduled caused Minton “great anxiety and grief.” Minton “experienced a startling and painful notification that the surgery would not go forward” and the cancellation itself constituted “discrimination.”

But within 72 hours of the cancellation, Dignity Health arranged for Minton to have the surgery performed at a nearby non-Catholic hospital within the network. Minton had the surgery and sued anyway.

The appeals court found that the three-day waiting period that followed the Catholic hospital’s religious objection to performing the hysterectomy violated Minton’s right under state law to receive “full and equal medical care.”

Dignity Health could safeguard the religious liberty of its Catholic hospitals only if “it can provide all persons with full and equal medical care at comparable facilities not subject to the same religious restrictions.”

Although Dignity Health “likely mitigate[ed]” Minton’s damages by performing the surgery at a different hospital, this “did not extinguish” her claim under state law, the court ruled.

Dignity Health, on the other hand, maintained throughout the legal proceeding that Mercy San Juan Medical Center was within its rights to refuse the uterus removal on religious grounds.

A 2016 letter addressed to the Centers for Medicare and Medicaid Services that was signed by the general counsel for the U.S. Conference of Catholic Bishops stated that in the bishops’ view denying surgery to remove healthy organs from an individual seeking to transition to another sex wouldn’t be discriminatory.

“A hospital does not engage in ‘discrimination’ when, for example, it performs a mastectomy or hysterectomy on a woman with breast or uterine cancer, respectively, but declines to perform such a procedure on a woman with perfectly healthy breasts or uterus who is seeking to have the appearance of a man.”

It was unclear at press time if Dignity Health intends to appeal the ruling; the health care system didn’t immediately return messages seeking comment.

But at National Review, lawyer-commentator David French urged an appeal to the Supreme Court.

An appeal should be pursued because religious freedom needs to be protected in this case, in which “a Catholic hospital was upholding basic Catholic religious doctrine,” he wrote.

“Note the burden this ruling places on Catholic institutions—they will be compelled to provide care unless they actively facilitate the provision of care elsewhere, and even the most brief delays are legally intolerable,” French wrote.

In a separate case, a Catholic charity and two foster parents are asking the Supreme Court to take up their case after a federal appeals court ruled that Philadelphia could refuse to work with the charity because it has a religious-based objection to same-sex marriage.

The case, cited as Sharonell Fulton v. City of Philadelphia, dates to March 2018, when Philadelphia officials said the opioid crisis had created an urgent need for 300 new foster care families in the city. Days later, the city blocked Catholic Social Services (CSS) and Bethany Christian Services from taking on new foster care cases, alleging the agencies had run afoul of the city’s Fair Practices Ordinance, which forbids “discrimination” on the basis of sexual orientation or gender identity.

Certain religious adoption agencies, such as CSS, choose to put children only with mother-father couples, in accordance with their Christian beliefs. But left-wing groups such as the ACLU and Lambda Legal have filed lawsuits in various states to prevent religious-based agencies such as CSS from helping children who need foster care placement.