Maryland Catholic hospital discriminated by denying transgender surgery

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(CNA) — A federal judge has ruled against a Catholic-founded hospital in Maryland, contending that it discriminated in refusing to perform a hysterectomy on a woman who was pursuing a purported gender transition. 

The court case concerns St. Joseph Medical Center in Towson, Maryland, part of the University of Maryland Medical System (UMMS), which had canceled a hysterectomy for 33-year-old Jesse Hammons of Baltimore, which had been scheduled for Jan. 6, 2020. Hammons identifies as a transgender man; that is, a biological woman who believes herself to be a man. The hospital said removing an otherwise healthy organ would violate Catholic ethics.

U.S. District Court Judge Deborah K. Chasanow, in her Jan. 6 ruling, also explicitly criticized Catholic ethics as formulated by the National Catholic Bioethics Center (NCBC) as discriminatory.

Joseph Meaney, president of the NCBC, warned that the ruling is part of an ongoing legal fight that could threaten the very existence of Catholic hospitals.

“The big danger is that Catholic hospitals are going to be coerced and legally attacked for not providing transgender interventions,” Meaney told CNA January 10. “Then they have to defend themselves in court. They have to stand up for their religious liberty rights and conscience rights and that, of course, is very expensive and difficult. And in the end, they might even be shut down.”

“It is very important that Catholic health care should be able to continue to practice in a way that is both ethical and moral from the Church’s perspective,” he said. “Being required to do transgender interventions would be, in effect, the destruction of Catholic health care. So it is extremely serious.” 

In her ruling, Chasanow said that UMMS and St. Joseph Medical Center had violated the Affordable Care Act’s ban on discrimination on the basis of sex. 

According to Chasanow, “the undisputed facts establish that the decision to cancel Mr. Hammons’ hysterectomy pursuant to a policy that prohibits gender-affirming care was discrimination on the basis of his sex.”

The University of Maryland St. Joseph Medical Center and the University of Maryland Medical System said in a statement to CNA that they are “carefully reviewing the decision.”

“We dispute many of the conclusions that were reached in this decision and may be in a position to comment further after additional analysis of the ruling,” they added. The medical organizations said the legal claim stemmed directly from “a surgeon mistakenly scheduling a procedure that could not be performed” at St. Joseph’s Medical Center. The health system had offered to perform the procedure at a different hospital but Hammons declined.

“Legal disagreements aside, we sincerely wish the very best for Mr. Hammons and we support his efforts to seek the highest quality health care,” the statement said.

Hammons in a statement voiced hope that UMMS can “change this harmful policy and help more transgender people access the care they need.”

UMMS has considered itself to be a private nonprofit since 1984, when the state legislature privatized it. The Maryland governor continues to appoint members of its board. The medical system argued that its privatization means it can own a Catholic hospital. However, Chasanow previously ruled that the health system has several continuing state ties that mean it is a public entity. This means that its subsidiary St. Joseph Medical Center cannot appeal to religious freedom laws such as the Religious Freedom Restoration Act, because state actors cannot cite it in their defense.

Chasanow ruled in favor of a summary judgment in the case, but damages have not yet been determined. Hammons’ legal representation included the American Civil Liberties Union.

“We’re thankful the court saw through a transparently discriminatory and harmful action by UMMS,” Joshua Block, senior staff attorney for the American Civil Liberties Union’s LGBTQ & HIV Project, said on Friday. “The government has no business operating a religious hospital, much less do they have the right to deny transgender patients care they routinely provide to cisgender patients.”

UMMS in 2012 bought St. Joseph Medical Center on the condition that it would continue to follow Catholic ethics as codified in the U.S. Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services.

Chasanow sided with the plaintiff’s claims that the hysterectomy would not have been canceled if the procedure were scheduled for a diagnosis other than gender dysphoria. Hammons has previously said the surgery would help eliminate the production of estrogen and drastically improve mental health.

Chasanow’s ruling also included debate over whether the hospital declined the surgery simply because it was sterilizing or because Catholic ethics precludes all “gender-affirming” care.

The ruling specifically cited the National Catholic Bioethics Center’s interpretation of the U.S. bishops’ ethical directives for Catholic health care. In a guidance document, the center said gender transition affirmation is unethical because it does not “conform to the true good of the human person, who is a body-soul union unalterably created male or female.”

The judge commented: “This policy, and the reasoning behind it, implicates sex stereotyping in that it prohibits treatment that facilitates patients’ physical nonconformity to their sex assigned at birth.” 

Meaney, however, defended the NCBC, which advises Catholic bishops and Catholic institutions on medical ethics.

“The National Catholic Bioethics Center stands by what we have always held to be Catholic teaching with regards to transgender interventions,” Meaney told CNA. A person’s biological sex, he said, “is determined, and good.”

Catholic and other groups challenged the Biden administration’s Department of Health and Human Services mandate of “gender-affirming” surgeries and have secured several legal injunctions, though Judge Chasanow said these did not apply in the case of St. Joseph’s Medical Center.

Meaney said there is a real worry that the Biden administration rules, if they take effect, could result in “the destruction of Catholic health care.” Forcing Catholic institutions to perform abortions or transgender interventions, which they cannot do in good conscience, would mean “they would have to shut down,” he said.