Doctors and administrators at a Catholic hospital in Grand Blanc, Michigan, are unnecessarily putting pregnant patients at risk by refusing to provide tubal sterilization to cesarean section patients and should be investigated by the state, according to attorneys for the American Civil Liberties Union.

The allegations are set forth in a letter sent this week to Michigan’s Department of Licensing and Regulatory Affairs. The ACLU of Michigan has received multiple complaints about a new hospital policy at Genesys Health System, according to the letter. Genesys, a Catholic hospital that adheres to the Directives for Catholic Health Care Services set out by the United States Conference of Catholic Bishops (USCCB), declared that as of November 1, 2014, its physicians would be forbidden from performing tubal ligations, the surgical sterilization process that involves severing and tying the fallopian tubes.

The USCCB opposes sterilization as a morally unacceptable means of regulating reproduction.

Tubal sterilization is the most common form of permanent birth control in the world. According to the American Congress of Obstetricians and Gynecologists (ACOG), the standard of medical care for pregnant patients who deliver via a c-section is to perform the sterilization procedure immediately following delivery. This is preferable to a patient undergoing a second, additional surgical procedure, per ACOG officials.

The ACLU claims that since Genesys’ tubal ligation ban has taken effect, patients who deliver via a c-section at Genesys and want their tubes tied are now forced to wait at least six weeks for their uterus to heal from the c-section before undergoing a second surgery, at a different location, to tie their fallopian tubes, exposing them to unnecessary risk and expense.

The ACLU’s letter details the stories of two pregnant Michigan patients, both of whom were denied tubal ligations at Genesys.

As a result of the policy change one patient, who was nine months pregnant and had planned, along with her doctor, to have her fallopian tubes tied immediately following her planned cesarean delivery, was informed 12 days before her surgery that she would be forced to have her tubes tied later in a different facility.

The only other option for Genesys patients who want or need a tubal ligation but cannot afford the expense of an additional procedure or are uneasy about the risk of an additional surgery is to seek an exception from the policy from hospital administration. But according to the ACLU, Genesys’ exemption policy is so impractical it may as well not exist.

Another patient, identified by the ACLU as “Mrs. B,” had scheduled a c-section at Genesys in November 2014 and planned to have a tubal ligation when the hospital notified her it would not honor her request. Mrs. B’s doctor only has admitting privileges at Genesys, which means Mrs. B had to choose between delivering elsewhere without her doctor, delivering at Genesys but without getting her tubes tied, or seeking an exemption from Andrew Kruse, Genesys’ vice president of mission integration. Kruse is not a doctor.

Before Mrs. B was able to contact Kruse, her water broke and she delivered her baby a week early, but without the tubal ligation her doctor was otherwise willing to perform.

The ACLU’s letter claims that as a result of Genesys’ policy change, at least two Genesys doctors have said they will now counsel c-section patients who want a tubal ligation to obtain a non-surgical form of sterilization, called Essure, rather than take the risk that accompanies a second surgical procedure.

That’s despite the fact that there is what the ACLU calls a “serious and ongoing debate” in the medical community about the effectiveness of Essure sterilization and concerns from some about its overall safety.

Essure sterilization includes placing soft, flexible inserts into the fallopian tubes. Over time, tissue forms around the inserts, and the buildup of tissue creates a barrier that prevents sperm from finding eggs, preventing conception.

Genesys’ policy reversal is not the first time Catholic hospitals in Michigan have been accused of prioritizing religious beliefs over patient health.

In 2010, a Catholic hospital in Muskegon failed to provide appropriate treatment and information to a woman named Tamesha Means over concerns treating Means’ miscarriage would be an improper facilitation of an abortion.

The hospital turned Means away three times. During Means’ third visit and after hospital staff had again instructed her to go home, she began to deliver in the waiting room. It was only then that hospital staff began to treat Means.

In December of 2013, the ACLU of Michigan and the ACLU sued the USCCB on behalf of Means.

In 2012, according to the ACLU, a Catholic hospital in Detroit failed to treat a woman who came to the hospital with vaginal bleeding and was diagnosed with an “inevitable abortion.” The patient was forced to leave the hospital in the middle of her miscarriage and seek medical treatment at another facility.

The ACLU demanded state regulators investigate Genesys’ ban on tubal ligation, which they claim violates both state and federal law.

The issue of religious directives interfering with patient health care extends beyond Michigan. Ten of the 25 largest hospital systems in the United States are Catholic-sponsored, and nearly one of nine hospital beds in the country is in a Catholic facility, according to the ACLU.