For months, Jesse Hammons prepared himself for a surgery that would help him feel more comfortable in his body.

Hammons, a 33-year-old transgender man, went through blood tests, ultrasounds and other health screenings with his doctor, finally scheduling a hysterectomy for Jan. 6 at the University of Maryland St. Joseph Medical Center.

The night before the operation, his surgeon called him to say the hysterectomy had been canceled. A hospital administrator had instructed him not to perform the procedure because it conflicted with the medical center’s Catholic beliefs, the surgeon told Hammons.

On Thursday afternoon, Hammons filed a lawsuit against St. Joseph Medical Center, claiming the hospital’s denial violated the 14th Amendment’s equal-protection clause and discrimination protections in the Affordable Care Act.

“I felt like this hospital didn’t see any worth in my life and the care that I needed,” Hammons said. “The University of Maryland St. Joseph’s should be caring for all of Maryland’s residents. We shouldn’t be denied based on who we are.”

In a statement Friday, Michael Schwartzberg, media relations director for the University of Maryland Medical System (UMMS), said the hospital “does not discriminate nor treat any patient differently on the basis of race, color, national origin, age, disability or sexual orientation.” The list in the hospital’s statement did not include gender identity.

“The health and safety of our patients is, and always will be, our highest priority,” the statement read. “UM SJMC was built on a mission of loving service and compassionate care and we sincerely regret the hurt and frustration caused by this event.”

The case follows a pattern of Catholic hospitals across the country denying care to transgender patients as Catholic medical systems have continued to expand nationwide and as the Trump administration has removed nondiscrimination protections for transgender people in health care, said Joshua Block, a staff attorney with the American Civil Liberties Union, which is representing Hammons.

It also raises questions about the separation of church and state as a growing number of Catholic hospitals merge with secular, taxpayer-supported hospitals such as UMMS, Block said.

The lawsuit also cites Bostock v. Clayton County, Ga., the landmark Supreme Court ruling last month establishing that Title VII of the Civil Rights Act of 1964, which prohibits discrimination “because of sex,” includes gay and transgender employees. Hammons’s lawsuit alleges his hysterectomy would not have been canceled if it had been approved for a diagnosis other than gender dysphoria.

“This year has been a reminder about how critical health care is to everyone and how critical it is to be able to access that health care free of discrimination,” Block said.

Hysterectomies are considered by the World Professional Association for Transgender Health to be medically necessary surgeries for transgender men diagnosed with gender dysphoria, the clinical term for emotional distress resulting from a conflict between a person’s gender identity and sex assigned at birth. Gender-affirming surgeries such as hysterectomies are routinely covered by public insurance programs, including Medicare and Maryland Medicaid. For Hammons, the surgery would help eliminate the production of estrogen in his body and drastically improve his mental health, he said.

According to the lawsuit, Gail Cunningham, the hospital’s senior vice president for medical affairs and chief medical officer, ordered the surgery canceled, telling the surgeon that Hammons’s gender dysphoria did not qualify as a sufficient medical reason to authorize the procedure.

Cunningham also told the surgeon that removing an otherwise healthy organ would violate Catholic directives to preserve the “functional integrity” of the body, according to the lawsuit.

As a Catholic hospital, St. Joseph Medical Center abides by directives outlined by the U.S. Conference of Catholic Bishops that prohibit “direct sterilization,” whether permanent or temporary. Sterilizing procedures are permitted only “when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.”

In the statement, Schwartzberg said that because of federal privacy regulations, the hospital is unable to comment on specifics of any patient’s case. However, any patient seeking care that is not available at the hospital because of the Conference of Catholic Bishops’ directives can be offered care at other UMMS hospitals, Schwartzberg said.

“As a system, UMMS is committed to addressing the healthcare needs of all Marylanders,” the statement said. “One example of this is our dedicated Transgender Health program at the University of Maryland Children’s Hospital, which helps children, adolescents and their families explore medical treatment options surrounding gender identity.”

St. Joseph Medical Center operated as a private Catholic hospital until 2012, when it was acquired by UMMS. As part of the acquisition, the medical system signed a written agreement promising to continue running the hospital as a Catholic institution abiding by directives set by the Conference of Catholic Bishops.

UMMS is a private, nonprofit organization that operates 13 hospitals and is one of the largest employers in the state. The system has received nearly $25 million in public funds in the past two years, and its board members are appointed by the Maryland governor.

Such partnerships between secular institutions and Catholic hospitals are increasingly common across the country. There are more than 660 Catholic hospitals nationwide, making the Catholic health ministry the largest group of nonprofit health-care providers in the nation, according to the Catholic Health Association of the United States.

“As Catholic hospitals continue to expand … you’re going to run into these sorts of establishment clauses more and more,” said Block, the ACLU attorney. “It’s important to make crystal clear here that if you’re going to have a hospital that is organized around religious beliefs, that hospital can’t be intertwined with the government."

Hammons, a Baltimore resident, said he had no idea the hospital had any religious affiliation that could get in the way of his surgery. His surgeon, whose name was not listed in the lawsuit, has worked with transgender men before. And because the surgeon has admitting privileges at U-Md. St. Joseph Medical Center, Hammons’s surgery was scheduled there.

After learning his surgery was canceled, Hammons said he “cried hysterically” and stayed up most of the night with his wife, Lura Groen, a Lutheran pastor in the Baltimore area. The news was devastating not only because of the pain of rejection on the basis of his gender identity, he said, but because it also meant starting over the draining process of preparing for the surgery.

He had scheduled the surgery during his winter break from classes at Community College of Baltimore County, where he is studying to be an American Sign Language interpreter and where he also works. He had to wait to reschedule the surgery until his next break from school, in mid-May. Then, the first week of May, he received a phone call from his surgeon’s office: His procedure had been postponed because of the pandemic. Putting off the surgery again brought back the anxiety and stress of being denied his surgery the first time, he said.

“At that point I just assumed it would not happen this year,” Hammons said. “Part of me felt like it might not happen ever.”

But on June 24, nearly seven months after the original date of his procedure, Hammons had the surgery. In the weeks since, he said, he has noticed a drastic change to his mental health. With his hormones balanced out, he said, he feels more focused and energized.

“I can really just see how wrong it was to be denied in the first place,” he said.

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