Can a Catholic Hospital Deny a Hysterectomy to a Transgender Man? California Court to Decide

It was two days before Evan Minton was scheduled to have a hysterectomy. The nurse from Mercy San Juan Medical Center near Sacramento called to go over the pre-op instructions. Minton told the nurse he’s transgender.

“I just let them know, ‘Hey, I go by he, him and his pronouns. Just wanted to give you a heads-up,’ ” Minton recalled explaining.

The next day, the hospital canceled the surgery.

“I was devastated,” said Minton. “Because it was based on who I am — and I had struggled for years and years and years to come to terms with who I am. It hit me to my core.”

Minton sued the hospital for discrimination.

Dignity Health, the hospital chain that runs Mercy and 30 other hospitals in California, said in legal documents that performing the surgery conflicts with its Catholic directives, which prohibit elective sterilizations or the removal of a “healthy uterus.”

“A Catholic hospital cannot be Catholic if it violates its ethical and religious directives,” said Barry Landsberg, an attorney with Manatt, Phelps & Phillips representing Dignity Health, during a hearing before the state Court of Appeal in San Francisco on Tuesday.

In the end, there was no harm done, the hospital's attorneys argued, because Minton got his 2016 surgery three days after his scheduled appointment at one of Dignity’s non-Catholic hospitals.

The lower court agreed, ruling in favor of the hospital.

But attorneys from the ACLU representing Minton say that decision was a mistake and appealed. They argued to the appellate justices that this case was different from a Catholic hospital's religious objections to providing abortion, for example, because the hospital routinely performs hysterectomies on women.

Sending a trans man to a different hospital for the same care is just as illegal as requiring black people to sit in a different part of a theater or to drink from a separate water fountain, they argued.

“That kind of treatment, of ‘Well, we cannot treat you here, but we’ll treat you somewhere else,’ really undermines the purpose of full and equal access,” said Elizabeth Gill, senior staff attorney with the ACLU of Northern California, which is also representing another trans man who was denied a hysterectomy at St. Joseph's Catholic hospital in Eureka.

In many rural parts of California, Gill said, the Catholic hospital is the only game in town — leaving trans people no alternatives for care.

“Although Dignity Health happens to have a non-Catholic hospital in Sacramento, it doesn't in most parts of the state,” Gill said. “And certainly as entities like Dignity Health eat up a significantly greater share of our health care market, that’s going to be increasingly true.”

Dignity Health operates in 21 states and runs 31 hospitals in California. Earlier this year, the chain joined forces with Catholic Health Initiatives, making it the fifth-largest health system in the country, according to Dignity’s website. It is one of a series of mergers and acquisitions among the state’s faith-based hospital chains in recent years.

This is why Minton’s attorneys argued over and over during the appeal hearing that the discrimination against him occurred the moment the hospital denied his surgery.

“Regardless of what happened after, that’s the problem,” Gill said.

Dignity Health's lawyers used different terms for what happened.

“This is not gender discrimination. This is religious observance,” Landsberg told the justices. “This is about tolerance and respect for religion.”

The hospital is bound by Catholic directives on care, which obliges all Catholic hospitals “to preserve the functional integrity of the human body,” according to legal documents.

Interpreting California’s civil rights law to require Mercy hospital “to perform medical procedures prohibited by Catholic doctrine would severely burden Catholic health care’s ability to express its message about human dignity,” Landsberg wrote in his brief to the appellate court, and which he reiterated during oral argument.

The case was heard by a panel of three appeals court justices: Justice Tracie Brown, Justice Alison Tucher and Presiding Justice Stuart Pollak, all of whom repeatedly challenged Landsberg’s reasoning during the hearing. They sometimes borrowed the ACLU’s arguments to frame their questions.

They pointed out that Mercy routinely performed hysterectomies on women for chronic pelvic pain or uterine fibroids, and that Minton’s doctors ordered his hysterectomy as treatment for his gender dysphoria, which his attorneys described as a serious medical condition “inextricably intertwined with Minton’s gender identity.”

Three times, Justice Pollak asked Landsberg to confirm he was arguing that the hospital’s actions did not violate the state’s civil rights law. The third time Landsberg answered no, there was no violation, Pollak dropped his chin in his hand, furrowed his brow and rubbed his jawline.

“Your honor, I can see you’re rolling your eyes at me,” Landsberg said.

Attorneys for Minton say it’s impossible to predict anything about what the justices will decide, based on their questioning. The appeals court has 90 days to issue its ruling, either upholding the opinion in favor of the hospital or sending the case back to the trial court for further fact-finding.

But Minton, who lives in Sacramento, left the hearing hopeful and optimistic.

“It made me feel great, because from my lay person’s perspective, the judges could see that [Dignity] denies care to transgender people,” Minton said. “I think it’s so wrong for a hospital system to pick and choose who they provide care to, particularly for such a vulnerable and sensitive population.”