A California Court of Appeals has ruled that a religious hospital can be liable for discrimination if it refuses to provide medical services for religious reasons without immediately providing a referral to a hospital that will accommodate the patient.  

A California Court of Appeal ruled last week that a transgender male seeking a hysterectomy may sue a Catholic health system for discrimination when the system refused to provide the surgery before later providing an accommodation.

In this case, Evan Minton sought a hysterectomy to treat gender dysphoria at Mercy Hospital, a Catholic facility that is part of Dignity Health.  Mercy Hospital, bound by the Catholic Church’s health directives, refused to perform the procedure, even though it had no objection to providing hysterectomies for other reasons. After the initial denial, Dignity Health gave Minton’s doctor “emergency” admitting privileges 30 miles away at Methodist Hospital, a non-Catholic hospital which is also part of the Dignity Health network.

The trial court dismissed the case because the hospital accommodated the patient

Minton sued under the Unruh Civil Rights Act and Civil Code 51(b) which requires hospitals to provide “full and equal” access to medical procedures without regard to gender.   Dignity Health stated that Mercy Hospital’s religious directives prohibited it from performing direct sterilization services. Dignity Health said that it had granted Minton’s surgeon admitting privileges at another network hospital that could provide the surgery. Dignity Health also argued that it had free exercise and freedom of expression rights under both federal and state law.

The trial judge dismissed the claim stating that Dignity Health had quickly accommodated Minton within three days and that this did not deprive Minton of “full and equal access.”

On September 17, the Court of Appeals reversed the trial court and allowed the case to proceed to trial. The decision based on the California Supreme Court’s ruling in the case of North Coast Women’s Care Medical Group, Inv. v. Superior Court  (2008) 44 Cal. 4th 1145, which said that physicians must provide fertility services to same-sex couples despite religious objections, or find a colleague in their office who will do so.

The appeals court focused on the delay between denial and accommodation

The Appeals court focused on the delay between the initial denial of the procedure and the later accommodation at Methodist, during which time the court indicated Minton experienced discrimination.  The court said that Dignity Health did not violate Minton’s rights when they allowed the service to be performed at another hospital. Instead, they Minton’s rights when Mercy’s president told Minton’s doctor that she could never do the surgery on Minton at Mercy. Mercy did not immediately provide accommodation at the other hospital until pressured to do so. The appeals court ruled that the fact that the surgery was ultimately accommodated “did not undo the fact that the initial withholding of facilities was absolute, unqualified by an explanation that equivalent facilities would be provided at an alternative location.”

The question then remains as to what would have happened if Dignity Health were unable to accommodate the procedure at another hospital. The court of appeals applied a strict scrutiny analysis which holds that “any burden the Unruh Act places on the exercise of religion is justified by California’s compelling interest in ensuring full and equal access to medical treatment for all its residents, and that there are no less restrictive means available for the state to achieve that goal.”

The court also rejected the contention that the law’s requirement that doctors provide the same procedures on all persons without discrimination violates the free exercise or free expression rights of doctors.

The growing tension between large religious health networks and the public interest in treatment

This case is illustrative of the growing tension between large networks of religious healthcare providers and the public’s interest in receiving medical procedures of all kinds. In this case, if the hospital did not deny the surgery and immediately referred the patient to a hospital that would accommodate the plaintiff, the trial court’s dismissal would have stood. Hypothetically, if the scenario were changed,and no hospital in the network was able to provide the surgery, the court may have found that Mercy Hospital violated the law as expressed in North Coast.

Dignity Health, initially founded by the Sisters of Mercy under the name Catholic Healthcare West, has 39 acute care hospitals and 250 ancillary care sites in Arizona, California, and Nevada and is the official healthcare provider of the San Francisco Giants.

Case Name:  Minton v. Dignity Health, decided 9/17/2019