A San Francisco judge on Thursday refused to order a Catholic hospital to allow an obstetrician to use its facility to sterilize a woman just after the birth of her third child.

In denying the American Civil Liberties Union’s emergency request, superior court judge Ernest Goldsmith recognized the right of a Catholic hospital to adhere to its ethical and religious dictates.

“The religious beliefs reflected in their operation are not to be interfered with by courts,” Goldsmith said during an hour-long hearing in San Francisco. “There’s no law that says that hospitals are mandated to perform sterilizations.”

The case, brought by the ACLU, spotlights increasing tension over women’s rights to contraceptive healthcare in Catholic institutions.

Rebecca Chamorro plans to deliver her baby by cesarean section in Redding, California, at the end of the month and would like her physician to tie her tubes immediately following the birth.

But Mercy Medical Center Redding, a Catholic hospital with the only delivery room in a 70-mile radius of Chamorro’s home in the rural northern reaches of the state, cited “ethical and religious directives” and refused to allow her doctor to perform the tubal ligation. In 2009, the United States Conference of Catholic Bishops issued orders that generally prohibit sterilization in Catholic hospitals and call it “intrinsically evil”.

Goldsmith ruled that the ACLU is unlikely to win its discrimination case because the hospital’s sterilization policy applies equally to men and women. The judge also found that Chamorro could have the elective procedure in another hospital. In addition, he found insufficient evidence that the hospital allowed other tubal ligations solely for contraceptive purposes.

The ACLU challenged the use of religious directives to deny tubal ligations in a lawsuit it filed last month on behalf of Chamorro and Physicians for Reproductive Health, a nonprofit, and against the hospital and its parent, Dignity Health of San Francisco – California’s largest hospital provider. The suit alleges sex discrimination because the prohibition against sterilization disproportionately impacts women. The ACLU also contends that the hospital arbitrarily allowed some women to have the common surgical procedure while refusing it to others.

“It’s unbelievable that the hospital where my doctor has admitting privileges is denying him the ability to provide a safe, legal and common procedure, especially considering that Mercy is my only real option,” Chamorro said in an email.



Following the hearing, Elizabeth Gill, an ACLU attorney, said she disagreed with the judge’s ruling and was considering whether to appeal it. “Catholic hospitals have been aggressively expanding over the past 15 years, and as our client is experiencing, they’re the only option for care in a lot of cases,” she said.

Barry Landsberg, Dignity Health’s attorney, told the judge: “This is a request for a Catholic hospital to forsake ethical and religious directives. This is a private Catholic hospital. It’s not the public library. It can make decisions about the services it provides.”

The judge’s ruling on the emergency motion to permit Dr Samuel Van Kirk to tie Chamorro’s tubes is just the first ruling in a dispute over the rights of women to get tubal ligations following childbirth in Catholic hospitals in California.

The ultimate outcome of the lawsuit could have repercussions for women throughout the state and the nation. Dignity Health claims to be the fifth largest health system in the United States. It owns 39 hospitals, 22 of them Catholic.

“I’d have blinders on if I ignored the essence of this lawsuit,” Goldsmith said on Thursday. “It’s about church and state. It’s about exercise of religion and to what extent it can be regulated by a court.”

About 20% of American women rely on tubal ligations for contraception, making it the second most common form of birth control, according to the US Centers for Disease Control and Prevention.

A tubal ligation immediately following a C-section delivery takes two minutes, Gill said. A separate surgery requires the additional time and expense of another trip to the hospital and carries another set of medical risks.

Chamarro, 33, a pharmacist with two sons, is scheduled for a C-section on 28 January. When Van Kirk first told her that the hospital refused to allow her to have a tubal ligation, she was confused because she could not imagine that the medical center would stand in her way, she said in court papers.

But, Landsberg said, Van Kirk should have expected the denial because he agreed to be bound by the Catholic ethical and religious directives when he applied to the hospital for privileges. In a court declaration, Van Kirk estimated that Mercy denied his request to tie the tubes of women 50 times in the past eight years.

Mercy recently denied the surgery to Lynsie Brushett, who dropped out of the ACLU case after she miscarried. Van Kirk did perform a tubal ligation on Rachel Miller at Mercy in Redding following the birth of her second child in September. The hospital granted permission for Miller’s sterilization after the ACLU threatened to sue.

“I think it is totally wrong that a hospital is using religion to deny standard medical care for an entire community,” said Miller, 32, a criminal-defense attorney.

The hospital ultimately agreed to allow Miller’s tubal ligation based on her need for antibiotics to combat a fever during her first delivery, she said. But she believes her tubal ligation was no more medically necessary than Chamorro’s.

The hospital’s policy says: “Tubal ligation or other procedures that induce sterility for the purpose of contraception are not acceptable in Catholic moral teaching even when performed with the intent of avoiding further medical problems associated with a future pregnancy.”

The ACLU has also filed a complaint on behalf of Jessica Mann, who has brain tumors and was denied a postpartum tubal ligation at a Catholic hospital in Michigan.