Mercy Hospital in Durango no longer offers tubal ligations, the female sterilization procedure known as getting one’s tubes tied, at the time of cesarean sections.

The hospital stopped providing the procedure on April 15 after releasing an announcement in September saying the Centura Health-owned hospital performed “re-education” with caregivers and clinical leaders about the “Ethical and Religious Directives for Catholic Health Care Services,” the guiding ethical principles aligned with the Catholic church ministry.

Brie Todd, gynecologist at Four Corners OB/GYN, an independent clinic that provides labor and delivery services at Mercy, said in September she was informed of the planned policy shift in an Aug. 15 meeting with Patrick Sharp, former Mercy CEO, and Augustine Nellary, director of mission integration at Mercy.

She said patients are upset about the policy shift, which needlessly denies patients the simple procedure unless they carry rare ovarian or breast cancer genes, and requires patients to seek a separate surgery later if they are determined to have their tubes tied.

“It’s a complete disservice and it’s unethical to not provide the tubal ligation at the time of C-section when we’re already there,” she said. “Because it requires a second surgery.”

Having another surgery at a later time entails unnecessary health risks and costs for patients, she said. Assuming someone has the financial means to have another surgery and they can afford to take more time off work, a patient can have a sterilization procedure done at Animas Surgical Hospital. But that requires the patient to go under anesthesia for another procedure, and she may not have fully recovered from her caesarean-section.

Neither Mercy Hospital nor its parent company, Centura Health, responded to requests for comment for this story.

Nikol Chamberlin, 37, a nurse who works for Centura, had her third child about 10 weeks ago via C-section and had a tubal ligation directly afterward. She said it is “incredibly important” to have total control over one’s reproductive health and family planning choices.

Because of medical issues, she required medical intervention to deliver all her children because she is unable to deliver vaginally; if she were to labor and have sustained contractions, her uterus would rupture, she said.

Each subsequent pregnancy has increased her medical risk. Chamberlin has had three pregnancies, although her first child was born prematurely with multiple defects and died shortly after.

She said Mercy’s shift from providing tubal ligations at the time of a C-section is not driven by medical need or what is best for patients, but a move rooted in religion.

“The Catholic church is the underlying entity of Mercy. Many of our medical systems in this country are underlined by some kind of religious organization,” Chamberlin said. “But the policies and procedures that are best for the patient and best for the community should be based on what’s medically best for a patient, not what a religious organizations’ moral principles are.”

She said it is “unacceptable” that religious institutions can take away patients’ family planning options.

When it comes to medicine, many patients don’t have the luxury of choosing another hospital if one doesn't offer a certain procedure or service. She said she could have gone to Denver to have her latest child, but planning for the trip would have been an overwhelming burden.

“You just have to make sure you find a hospital that takes your insurance. Make sure you have a doctor who’s willing to deliver you and knows your history. You have to drive there and it’s an eight-hour drive. ... You have to have someone watch your kids,” she said. “You have to recover and then drive back for eight hours. So you could go to Denver if you had insurance coverage, a provider, there. You have to plan ahead. If you have to have an emergency C-section, you go into labor and you don’t know there’s no option, basically; you’re forced into having another surgery later at some point.”

Jessica Marsh, pediatrician with Pediatric Partners of the Southwest and a pediatric hospitalist at Mercy Hospital, said there is not another maternity hospital in the Durango area for people to travel to if they want to get their tubes tied after having a C-section.

“People will continue to come to Mercy to have their babies. Mothers and their families will now incur extra expenses related to travel, medical care, and childcare expenses; as well as time off work to recover from an entirely separate procedure at a different facility,” she said in an email to the Herald. “Having the tubal ligation during a C-section reduces medical cost, time out of work for mothers and their partners, lowers the risk from anesthesia and surgical complications, and results in shorter overall recovery time. This decision was not in the overall best interest of patients.”

Jessica Kaplan, an obstetrician and gynecologist at Southwest Memorial Hospital in Cortez, 47 miles west of Durango, said in an email to the Herald the hospital there offers tubal sterilization procedures, including at the time of c-section.

“We have two Ob/Gyns and a women’s health nurse practitioner. We offer comprehensive women’s healthcare including outpatient care, labor and delivery services, and surgical services. We continue to offer tubal sterilization procedures, including at the time of cesarean section,” she said.

Marsh said she is mad on behalf of women who face extra hurdles such as insurance deductibles, gas money or time off work because of Mercy’s policy decision to stop offering tubal ligations. That includes women who struggle with drug abuse or homelessness who won’t be able to make it to a separate appointment.

“This decision will prevent many women and families’ ability to prevent unintended pregnancies,” she said. “Access to contraception and family planning decreases the expense of supplemental programs like WIC (Women, Infants, and Children), Medicaid, food stamps, and allows women economic mobility for themselves and their families. This decision will increase medical costs for individuals and costs to these programs. Family planning decisions should be made within the family, not by policies from nonmedical entities.”

Chamberlin said the government needs to take legislative action to reign in hospitals like Mercy that put religious morals over patients’ best interests.

“They should not be able to implement religious policies in medicine. That’s wrong,” she said.

She said the government has legal tools it could wield to protect patients. She noted medicine is already heavily regulated.

“People need access to care. It should not be denied based on race, religion, gender identity. And that is what is happening,” Chamberlin said. “You’re being denied care because of someone else’s religious beliefs. And there is no place for that in medicine.”

U.S. Democratic Reps. Diana DeGette, Yadira Caraveo, Jason Crow, Joe Neguse and Brittany Petterson criticized Mercy Hospital for ending female sterilization in a joint news release in February.

DeGette’s office did not respond to requests for comment seeking information about what is being done or what legislative options are available to protect patients from religious institutions’ restrictive health care policies.

cburney@durangoherald.com