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Mercy Hospital plans to end female sterilization procedure in 2023

Loss of treatment creates ‘unnecessary risk’ for patients, doctors say
Dr. Krista Ault, general practitioner at La Plata Family Medicine and former director of family medicine at Mercy Hospital, said she isn’t surprised Mercy plans to stop providing tubal ligation, female sterilization, in spring 2023. When Ault was considering a job at Mercy about a decade ago, she was “pleasantly surprised” to learn Mercy provided tubal ligation in the first place, she said. (Brandon Mathis/Special to the Herald)

Mercy Hospital in Durango, the only hospital with labor and delivery services within 45 miles, plans to stop performing tubal ligation, a female sterilization procedure, in spring next year because the procedure doesn’t align with Catholic values, according to a gynecologist in Durango who says she was briefed on the new policy.

Brie Todd, gynecologist at Four Corners OB/GYN, an independent clinic that provides labor and delivery services at Mercy, said the clinic received formal notification on Aug. 15 during a meeting with Patrick Sharp, CEO at Mercy, and the Rev. Augustine Nellary, director of mission integration at Mercy, that the hospital will end female sterilizations on April 15 for nearly everyone.

“We have previously been able to do a sterilization procedure at the time of a C-section for a woman who is done with child-bearing and had a medical reason not to have additional kids,” she said.

Beginning April 15, women will no longer be able to have their tubes tied as a form of birth control, for socioeconomic reasons or for medically life-threatening issues at Mercy, she said. The only exceptions will be for the few people who carry rare ovarian cancer or breast cancer genes, she said.

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

Todd said the doctors of Four Corners OB/GYN disagree with Mercy’s decision to remove the common form of contraceptive care from its services, because there are valid medical reasons to prevent pregnancy.

“Say someone has a severe heart disease or a severe kidney disease that would put her life at risk if she was pregnant again. And we would recommend she would not have future children. But that (new policy) would not (allow) us to do that surgery any further,” Todd said.

Mercy’s change in course would also force people to have two surgeries if they wanted to pursue sterilization after having a cesarean section, Todd said.

She said a tubal ligation performed at the time of a C-section takes just five minutes. The procedure involves removing a portion of the patient’s fallopian tube and results in permanent sterilization.

“That is now being taken away,” she said.

Dr. Krista Ault, a general practitioner at La Plata Family Medicine and former director of family medicine at Mercy, said some forms of contraception, such as vasectomies, have been off limits for as long as Centura Health has owned the hospital.

But during Ault’s tenure at Mercy from 2014 to 2020, practitioners were allowed to prescribe patients other forms of contraception such as IUD’s and birth control medications – as long as they didn’t outright say it was for birth control.

“Basically, when you needed to give somebody birth control you could, but it was sort of an unwritten rule that you should probably code it as ‘painful periods’ or ‘endometriosis’ or something like that where there was a medical reason besides just needing birth control,” she said.

She added, “There’s never been a woman who’s never had a painful period.”

She learned about the underhanded method of providing contraception during her on-boarding process at Mercy, she said.

Ault described herself as a “huge proponent” of women’s rights and was “pleasantly surprised” when she learned Mercy performed tubal ligation before she started working there. She wanted to be sure she could provide birth control if a patient needed it.

Impacts of denying tubal ligation at time of C-section
Mercy Hospital plans to stop providing tubal ligations, or tying a woman’s tubes to prevent unwanted pregnancies, on April 15, according to the Four Corners OB/GYN independent clinic that offers labor and delivery services in Mercy’s emergency room. (Brandon Mathis/Special to the Herald)

About 50 people underwent a tubal ligation immediately after a C-section in Mercy’s emergency room through Four Corners OB/GYN in 2021, Todd said.

If Mercy eliminates female sterilization as doctors with Four Corners OB/GYN were told it would, a mother seeking to have her tubes tied after a C-section would first need to recover from surgery (typically a six-week process), find an independent facility to handle the tubal ligation procedure, undergo another dose of anesthesia and have another surgery, she said.

Todd said the process would be laborious for a patient and would especially hurt people of lower socioeconomic status and those with restrictive insurance policies.

“We know that the best way to prevent an unintended pregnancy is to provide good contraception. This limits that,” she said.

She added that despite Mercy’s “great labor and delivery services,” asking a patient to undergo a second surgery places that woman’s health at unnecessary risk.

Ault shared similar sentiments.

“You’re taking a young, healthy woman, usually, and making them undergo anesthesia a second time when there is no earthly purpose for that,” she said. “The costs incurred with that, the medical risk incurred with that. And that’s imposing your religious beliefs on another individual.”

During the Sept. 10 Pride Festival at Buckley Park, Durango woman Katie Stewart said “even though we’ve codified abortion rights, people with uteruses still don’t have full access to their reproductive health care.”

Durango woman Katie Stewart, mother of five, said family planning should be left to families, and in particular the one who would be giving birth to a child; she said she doesn’t need religious institutions telling her how to plan her family. (Christian Burney/Durango Herald)

The mother of five, including one adoption, said having a tubal ligation saved her life after the birth of her youngest child. Nearly all of Stewart’s four pregnancies have been complicated in one way or another, she said, and she required a C-section each time she gave birth.

After giving birth for the second time in 2011, one of her doctors encouraged her to get a tubal ligation. At the time, the proposition seemed very “final” and she chose not to have the procedure.

After having one more child, she and her husband decided they were done having kids. But in 2015, Stewart took a pregnancy test that turned up positive.

That pregnancy wasn’t like most pregnancies, she said. She had hypertension, abnormally high blood pressure, and the pregnancy was taking a toll on her body.

“As my pregnancy went on, it got harder and harder for me,” she said. “Around 32 weeks, my body really started to shut down. A typical pregnancy gestation is 40 weeks. I was about eight weeks out from a full-term pregnancy.”

Her fourth child was born prematurely and spent his first week in Mercy’s newborn intensive care unit. Before her fourth and final C-section, Stewart signed off on having her tubes tied. And because Mercy is a Catholic hospital, she needed a priest to sign off on it, she said.

Stewart said she doesn’t think she would have been able to travel to another hospital for a C-section at the time of her fourth and final pregnancy. She was seeing her doctor weekly for her deteriorating health condition, she said.

“Having to travel 60 miles to get obstetric care is just mind-boggling,” she said.

It also would have been difficult to bear another surgery after recovering from the most grueling pregnancy she’d experienced.

“Reflecting on my recovery period, it was my fourth C-section, and I was in a great deal of pain for months,” she said. “I had a really hard time recovering. I was dealing with postpartum depression because I was dealing with how hard the pregnancy was. And my son was in the NICU. That’s a hard road to travel, regardless.”

She added: “Everybody should have access to life-saving health care.”

Mercy’s reported decision comes at a time when reproductive liberties face scrutiny at the federal level and in states across the country. Coloradans might feel comforted by codified rights to contraception and abortion under state law, but governments aren’t the only institutions that can grant or prevent access to sometimes life-saving procedures.

Colorado’s Reproductive Health Equity Act signed into law on April 4 protects the rights to contraception and abortion from interference by public entities, ignited by the U.S. Supreme Court’s June ruling to overturn federal protections provided by the Roe v. Wade ruling of 1973. But the new state law doesn’t affect the private and nonprofit sectors.

Todd, who was one of Stewart’s doctors during some of her pregnancies, said in an email to The Durango Herald, “Overall, the doctors at Four Corners OB/GYN have a good working relationship with Mercy Regional Medical Center. I feel we provide excellent care to our mothers and babies.”

Doctors and religious doctrine
Mercy Hospital plans to stop providing tubal ligations, or tying a woman’s tubes to prevent unwanted pregnancies, on April 15, according to the Four Corners OB/GYN independent clinic that offers labor and delivery services in Mercy’s emergency room. (Jerry McBride/Durango Herald file)

Mercy is owned by Centura Health, a Catholic nonprofit in turn owned by CommonSpirit Health, one of the largest Catholic health systems in the United States.

Todd said Mercy’s “course correction” in policy stems from the “Ethical and Religious Directives for Catholic Health Care Services,” the sixth edition of which was developed by the U.S. Conference of Catholic Bishops in 2018.

Specifically: “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”

Todd said, “I read that and I’m a little confused, because there’s that specific part of ‘a simpler treatment is not available.’”

To perform the sterilization procedure at the time of a C-section is the simpler treatment – not to have two surgeries, she said.

Todd said a woman’s reproductive choices should be her’s alone, and that someone else’s religious beliefs shouldn’t have any bearing on those choices.

cburney@durangoherald.com



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