ACLU Asks Regulator to Investigate Tubal Ligation Denial

Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.

By Mary Anne Pazanowski

Oct. 14 — The American Civil Liberties Union of Michigan Oct. 14 asked the state's licensing and regulatory department to investigate a health-care system that it claimed refused to provide appropriate medical care to a patient.

The administrative complaint alleges that Genesys Regional Medical Center refused to grant a doctor permission to perform a tubal ligation immediately following the delivery of Jessica Mann's child. The ACLU said Mann required the procedure because she has a brain tumor that could cause complications that counsel against future pregnancies.

The complaint was filed with the state Department of Licensing and Regulatory Affairs Bureau of Community and Health Systems, Health Facilities Division.

Genesys said Mann couldn't have the procedure at its facility because it is a Catholic hospital that adheres to directives promulgated by the U.S. Conference of Catholic Bishops (USCCB). The directives ban almost all sterilizations, the ACLU said.

Genesys is a member of Ascension Health, which says on its website that it “is the largest nonprofit health system in the U.S. and the world's largest Catholic health system.” The ACLU said 10 “of the 25 largest hospital systems in the U.S. are Catholic-sponsored, and nearly one in nine hospital beds in the country is in a Catholic facility.”

Directives Challenged

The ACLU of Michigan has taken several steps to protest Catholic hospitals' adherence to the USCCB's Ethical and Religious Directives for Catholic Health Care Services, which it says are endangering women's health nationwide by precluding those hospitals from properly treating certain medical conditions.

In a press release announcing its latest action, ACLU attorney Brooke Tucker said the group was “taking the fight to the state agency that governs the hospital because it's their job to make sure women like Jessica get the care they need.”

“Religious directives have no place in hospitals, especially because they end up harming the very women they should be serving,” Tucker said.

ACLU spokeswoman Allison Steinberg told Bloomberg BNA Oct. 14 that the “ACLU of Michigan filed a similar complaint against Genesys when they first put in place their tubal policy last year.” That complaint, filed in December 2014, hasn't been resolved, she said.

The ACLU of Michigan recently filed a lawsuit against another Catholic provider, Trinity Health Corp., alleging it violated the Emergency Medical Treatment and Labor Act by failing to properly treat women during emergencies where the standard of care would require termination of a pregnancy (24 HLR 1313, 10/8/15).

In addition, an appeal is pending in another case the group filed on behalf of a woman allegedly denied appropriate medical care at a Michigan Catholic hospital. A federal district court dismissed the action in June after finding it didn't have jurisdiction over the USCCB (24 HLR 901, 7/9/15).

That lawsuit alleged that the policies adopted by the USCCB and applied in Catholic hospitals throughout the U.S. endanger women's health (22 HLR 1827, 12/19/13).

Woman Faces Health Risks

Mann's doctors recommended that she not become pregnant in the future due to the risks she faces during childbirth, including the risk of seizing during delivery, the complaint said. The tumor also prevents her from having an epidural or spinal anesthesia during a Cesarean section, meaning she would have to undergo full anesthesia and be exposed to the risks associated with the anesthesia.

To prevent future pregnancies, Mann's doctor recommended a tubal ligation be performed at the same time as the C-section. The doctor asked Genesys for permission to perform the procedure. The hospital denied the request, even though it has represented that there is a medical exception to its policy, the complaint said.

Under Michigan law, “hospital patients are ‘entitled to receive adequate and appropriate care,'” the complaint said. In addition, a patient “shall not be denied appropriate care on the basis of … sex,” according to Mich. Comp. Laws § 333.20201.

The complaint also said that Medicaid and Medicare require hospitals that participate in those programs to adhere to Conditions of Participation, including a provision stating that a patient “has the right to make informed decisions regarding his or her care.”

Here, the ACLU said, Mann's doctors agreed on the “adequate and appropriate care” for her condition. Genesys, however, “has chosen to abide by a religious policy that substantially departs from accepted medical standards.”

The system's policy, the complaint said, was contrary to the standard of care, grossly negligent and discriminatory.

Relief Requested

The ACLU of Michigan asked the department to investigate Genesys' tubal ligation ban. It pointed out that, under Mich. Comp. Laws § 333.20165, the department “may deny, limit, suspend, or revoke the license or certification or impose an administrative fine on a licensee” for negligence or failure to exercise due care or if there is evidence “of abuse regarding a patient's health, welfare, or safety or the denial of a patient's rights.”

Health-care providers like Genesys and Ascension may not “invoke their religious affiliation to excuse compliance with the generally applicable laws and regulations that apply to all hospitals, especially when doing so subjects their patients to harm,” the complaint said.

Tucker, along with Michael J. Steinberg, of the ACLU of Michigan, Detroit, represented the group.

Ascension Health didn't respond to Bloomberg BNA's request for comment.

To contact the reporter on this story: Mary Anne Pazanowski in Washington at

To contact the editor responsible for this story: Brent Bierman at

For More Information

The complaint is at


Request Health Care on Bloomberg Law