This story was originally published by The Colorado Sun at 4:00 am MST on Jan 31, 2023.
When the only hospital in Durango with a maternity ward decided that it would no longer let women get their tubes tied, there was no public announcement.
Mercy Hospital’s website doesn’t spell it out, either.
Instead, a read-between-the-lines statement added to the Centura Health hospital’s website in September noted that Mercy is “responsible for conducting itself in a manner consistent with the ethical principles of the Catholic church ministry.” The hospital had recently completed a “reeducation” of hospital staff and board members regarding the church’s ethical and religious directives, it said, adding that “patients are fully informed of all treatment options.”
Doctors who deliver babies at Mercy said they were told that beginning April 15, they can no longer provide post-cesarean-section tubal ligations, a sterilization procedure in which the fallopian tubes are cut. Women who have decided not to have more children often have their tubes tied immediately after a C-section, when they are already under spinal anesthesia, sparing them from having to schedule a separate surgery.
The hospital already prohibited tubal ligations after vaginal births, but had been allowing them after C-sections because it had been considered an undue burden to make patients schedule a separate surgery at another hospital, doctors said.
It’s been up to obstetricians to tell their pregnant patients that they will have to go elsewhere for permanent birth control.
“Patients are furious,” said Dr. Kimberly Priebe, who delivers 90-100 babies a year and has been an obstetrician-gynecologist in Durango for 20 years. “This decision undermines our patients’ trust in Centura.”
Mercy’s prohibition of sterilization comes as health care advocates across the country are concerned about diminishing reproductive rights after the fall of Roe v. Wade, which provided a constitutional right to an abortion. Even in Colorado, a state withstatutory protection for abortion and one of the least restrictive abortion laws in the country, women are losing access to reproductive health care, particularly in rural and mountain areas where there is only one hospital in town, according to physicians and other health advocates.
Mergers that have joined Catholic health systems with secular or protestant systems have created a confusing health landscape for patients looking for abortions or sterilization, advocates say.
Mercy was founded by a congregation of Catholic nuns in 1882 and, in 2010, joined Centura Health, which is part of CommonSpirit Health, the largest Catholic health system in the country. Centura Health, formed in 1996 by the merger of Catholic Health Initiatives and Adventist Health System, has 16 hospitals in Colorado and three in Kansas. The Catholic hospitals, including Mercy, follow the Catholic directives, while the Adventist hospitals do not.
In Denver, doctors affiliated with Centura Health can steer patients who want their tubes tied after giving birth to the system’s Adventist hospitals instead of its Catholic ones. But in Durango and other towns with just one hospital, that’s not an option.
“We really are seeing a trend with hospitals, insurance companies, pharmacies, other health care entities, discriminating against people by denying basic care … all in the name of religion,” said Sophia Mayott-Guerrero, senior organizing strategist with ACLU of Colorado. The main target, she said, is reproductive access, including birth control, emergency contraception, sterilization and abortions.
“We can’t really consider access to reproductive health care in Colorado as a universally protected experience until everybody in every corner of our state can access those things,” Mayott-Guerrero said. “There’s often this perception that everybody in Colorado has access to abortion and to reproductive health care and that is just fundamentally untrue, especially in the rural parts of the state where you just don’t have additional options.”
It’s unclear why Mercy Hospital had been allowing tubal ligations after C-sections and what led to the changes revealed to doctors in August and September, though doctors believe the diocese decided to take a stricter approach. CommonSpirit Health, the Catholic owner of Mercy and other Catholic hospitals, said they had no updates to provide. The Diocese of Pueblo, which includes all of southern Colorado, referred questions to Centura Health.
Centura Health officials would not give an interview about the change at Mercy, or explain why it’s happening now, considering that Mercy has been Catholic since it was founded. The hospital system referred back to the September statement on Mercy’s website. “We do not have a new statement to issue at this time,” spokeswoman Lindsay Radford said.
The only exception is for women predisposed to cancer
At Four Corners Obstetrics and Gynecology in Durango, doctors typically ask their patients around the 28th week of pregnancy about future family planning and birth control. Many of their patients, including about 50 last year, get their tubes tied at Mercy while they are still under anesthesia from a C-section.
Priebe and her fellow doctors had been able to do this at Mercy hospital by filling out a “blessing form” that goes to a religious committee at the hospital, a process to receive permission from the church. The Catholic hospital has long prohibited tubal ligations following vaginal births, however. Vasectomies are also prohibited.
It seems the Catholic church does not want a woman dying of cancer but during pregnancy is OK?
After the latest “reeducation” of the Catholic directives, Mercy said it would allow tubal ligations post C-section for only one reason — if the woman has a genetic predisposition to ovarian or breast cancer. “This is a very small number of women, and what an arbitrary exception,” Priebe said.
“What about women with hypertension, diabetes, blood clotting disorders, uterine abnormalities, and the many other risk factors that can make pregnancy deadly? It seems the Catholic church does not want a woman dying of cancer but during pregnancy is OK?”
Priebe and the other doctors at the OB-GYN clinic are not employees of Mercy Hospital, so they can prescribe birth control, genetic counseling that could lead to an abortion decision, and discuss options to end a pregnancy. Patients who have vaginal births and want their tubes tied are sent to Animas Surgical Hospital, a physician-owned hospital in Durango that specializes in orthopedic, ophthalmological and urological surgeries.
With the new Mercy policy prohibiting tubal ligations after C-section, doctors will send those patients, too, to the local surgical hospital, though they are concerned about overwhelming the center.
And, doctors say, forcing women to schedule the procedure separate from their hospital delivery puts them at unnecessary risk, disrupts their lives with more time off work, and costs the health system more money. The Medicaid billing rate for a doctor performing a tubal ligation post C-section is a $90 add-on and takes about 10 minutes, doctors said, not including anesthesia and facility fees.
Patients who go to Animas Surgical Hospital for a standalone tubal ligation may have to pay thousands of dollars for the procedure. Federal law prohibits insurers from charging out-of-pocket costs, such as deductibles, to their covered patients for services that are classified as preventative, which includes tubal ligation, according to Colorado’s Division of Insurance. But a patient who doesn’t have insurance could have to pay the $9,900 cash-pay price, according to an Animas Surgical Hospital price list. People whose insurance doesn’t cover procedures at Animas in-network could also be hit with a big bill.
“Patients do not understand how a health care option can be refused when our hospital gets public money and purports to put patient care first,” Priebe said.
Pregnant patients in Summit County also face tough choices
Summit County is also among the communities where the only hospital is Catholic. St. Anthony Summit Medical Center in Frisco, part of Centura Health, does not provide tubal ligations.
Dr. Amy Tomlinson, an OB-GYN in Summit County, has had to explain to hundreds of patients that they cannot get their tubes tied at the hospital where they plan to give birth.
“Usually, honestly, it was a huff and a sigh and an eye roll,” she said. “Sometimes it was a jaw drop and a shake of the head. But I think women are so used to being second-class citizens in this society that I don’t think it was ever terribly surprising to people.”
Summit County women have the choice of delivering at St. Anthony and then getting their tubes tied later at another hospital, or driving more than an hour to Denver to deliver their baby so they can have the procedure at the same time. And for women who already have a C-section scar on their uterus, it’s especially dangerous to ask them to drive that far in labor, Tomlinson said.
“The Catholic position is, ‘If you don’t like it, you can go somewhere else,’” she said. “Well, it’s not like you can go across town when your hospital is the only one in a tri-county radius. We essentially become an island during snowstorms. Even if a patient wants to go elsewhere, she may not be able to get there. And then you are asking women to drive an hour or more while they are laboring. Why would we put women at risk for rupturing their uterus or for giving birth on the side of the road?”
And then you are asking women to drive an hour or more while they are laboring. Why would we put women at risk for rupturing their uterus or for giving birth on the side of the road?
And women typically want to see the same doctor who will deliver their baby for their prenatal appointments, which means Summit County patients who wanted a tubal ligation after delivery would have to get a doctor in Denver.
“That is more than two hours of travel per prenatal visit, additional transportation and child care costs, and a loss of income from lost work hours,” Tomlinson said.
Tomlinson, who is opening her own practice but in the past worked at High Country Healthcare, recalled that while removing severe scar tissue from the uterus of a patient at St. Anthony Summit, she had to ask permission from the bishop to place an IUD in the woman’s uterus in order to keep it open and prevent pain. The woman had in the past had a tubal ligation so she was already sterile, but the Catholic hospital still required her to get permission to place the birth-control method, called an intrauterine device.
And in 2010, Tomlinson gave a presentation to the St. Anthony Summit board to persuade them not to prohibit treatment of ectopic pregnancies. In the post-Roe v. Wade era, doctors across the nation have reported confusion about whether treating an ectopic pregnancy — when a fertilized egg implants in the fallopian tube instead of the uterus and can cause the tube to rupture — is considered an abortion.
In 2015, Tomlinson’s former physician group in Frisco, High Country Healthcare, became part of Centura, the same health system that operates St. Anthony Summit in the mountain town. The merger meant that Centura took on High County’s specialty and primary care physicians, as well as other medical professionals — and that those doctors could no longer provide a form of sterilization called Essure.
The device was popular at the time, though it went out of use in 2019.
Mergers result in conflicting policies, depending on hospital location
Similar to Centura Health, Colorado’s other large health system that includes Catholic hospitals has different policies at different hospitals.
Two of SCL Health’s Catholic hospitals — Saint Joseph Hospital in Denver and St. Mary’s Medical Center in Grand Junction — operate under the ethical and religious directives, meaning they do not provide sterilizations. Two of its secular hospitals — Lutheran Medical Center in Wheat Ridge and Good Samaritan Medical Center in Lafayette — also operate under the same compliance with Catholic health care, said Gregg Moss, spokesman for SCL Health, which merged with Intermountain Healthcare last year.
But Platte Valley Medical Center in Brighton does not, based on the terms of the merger.
Moss referred The Sun to an SCL Health webpage that explains the Ethical and Religious Directives for Catholic Health Care Services, which were first published in 1948 by the United States Conference of Catholic Bishops.
The hospital system’s webpage does not specifically mention birth control, tubal ligations or abortions, but says that in today’s society, Catholic hospitals are “pressured to provide medical procedures that are contrary to Catholic teaching.”
“But by refusing to provide or permit such medical procedures, Catholic health care affirms what defines it: a commitment to the sacredness and dignity of human life from conception until death,” it says.
Moss said SLC Health informs its doctors about its policies and that doctors and patients “work together to select a facility that meets their treatment goals.”
The Catholic directives allow procedures to treat cancers and other serious diseases, even if they result in sterility, Moss said. They also allow treatment of serious illnesses in pregnant women that might result in loss of the fetus.
Legislation could require hospitals to disclose what they won’t provide
Rep. Brianna Titone, an Arvada Democrat, has the issue on her radar. But she’s hoping to keep the volume of discourse on low by referring to her proposal as a transparency issue, rather than riling up debate over the hot-button matters of abortion, birth control and transgender rights.
Titone plans to introduce legislation at the state Capitol in the next few weeks that would require hospitals to disclose on their websites what services they do not provide. It’s pretty simple, and hopefully not controversial, she said. But she worries it’s not enough — forcing hospitals to disclose what they won’t do doesn’t actually solve the health care issue she’s trying to address, which is that patients are losing access to certain procedures.
“Do people even look at a website?” Titone asked. “This is a first step but I think there is more that can be done.”
“If you want to get your tubes tied after a C-section and that’s the only hospital around, at least you have the information to schedule it at a different hospital. People have a right to know what services they can and can’t get.”
Mannat Singh, executive director of the Colorado Consumer Health Initiative, condemned the decision in Durango to stop allowing tubal ligations, saying transparency isn’t her main concern.
“It is a basic human right to seek, or refuse, reproductive health care, and we will continue to work to ensure there are no barriers to seeking that care,” she said. “Expecting patients to then search for access to this care elsewhere, especially in rural areas, further endangers their health and safety and creates additional barriers to affordability.”
Clarification: This story was updated at 3:11 p.m. on Jan. 31, 2023, to provide more information about the cost of a tubal ligation at Animas Surgical Hospital. While the hospital might charge insurers between $2,700 and $10,000 to perform a standalone tubal ligation, federal law prohibits insurers from passing on out-of-pocket costs to patients. Patients whose insurance contracts with Animas Surgical Hospital should not have to pay anything. Patients who are uninsured could still be stuck with a big bill, as could some patients for whom Animas Surgical Hospital is out-of-network.