Just over 40 percent of all patient beds in Washington state are in Catholic hospitals, and many of them prohibit their personnel from providing a range of reproductive health services for religious reasons, according to a new report by the ACLU.

"When a pregnant woman seeks medical care at a hospital," said ACLU of Washington Executive Director Kathleen Taylor, "she should be able to trust that decisions about her treatment will be based on medicine, not religious policies."

As Cienna Madrid explained in The Stranger back in 2013, the U.S. Conference of Catholic Bishops maintain a set of "Ethical and Religious Directives" that govern Catholic hospitals—including, for example, Providence hospitals in Washington—and bar them from offering services including contraception, sterilization, and abortion.

In 46 regions around the country, according to the report, these facilities represent the "sole community hospital" in the area. The report includes a harrowing personal story from Maria (a pseudonym), a mother of two in Washington who sought care at the Catholic hospital where she worked:

Although she was aware of the hospital’s religious affiliation, her insurance coverage extended only to that hospital, and she could not afford thousands of dollars in out-of-network costs to go elsewhere. Maria’s physician explained that the pregnancy was no longer viable and that her uterus needed to be evacuated in order to stop the bleeding. But, because the Directives prohibit an abortion if the fetus still has cardiac activity, her physician advised “expectant management,” i.e., waiting to see if Maria’s body would complete the miscarriage on its own.

The hospital staff delayed performing the abortion until they were sure the fetus didn't have a hearbeat, as the religious Directives require, the ACLU report says. By that time, Maria required a blood transfusion. The transfusion led to complications in her next pregnancy, inflicting "significant emotional trauma."

The ACLU is calling on authorities to investigate Catholic hospitals for failure to provide emergency reproductive healthcare as required by federal law.

In 2013, Madrid asked local doctors at these hospitals would happen if they violated the Directives:

What happens if you're caught talking to patients about physician-assisted suicide in your private practice, or performing abortions, or, the trifecta of theoretical sins, assisting a fetal suicide on God's day of rest?

"Well, your staff privileges would certainly be revoked," the second physician tells me.

"You'd have to move out of the county," the third physician quietly says. "You couldn't get work. Every route ends at the church."